Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
School of Medicine and Public Health, The University of Newcastle, Callaghan Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, The University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
Prev Med. 2017 Jul;100:248-268. doi: 10.1016/j.ypmed.2017.04.003. Epub 2017 Apr 6.
Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau=0.0, I=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.
普遍的基于学校的干预措施，旨在解决青少年的“韧性”问题，可能是减少青少年物质使用的一种手段。然而，先前的系统评价并未考察这种干预方法的有效性。本系统评价旨在：1）评估基于学校的普遍“韧性”干预措施是否能有效降低青少年吸烟、饮酒或使用非法物质的流行率；2）按干预特征亚组描述这种有效性。合格的研究是在 1994 年至 2015 年期间进行的同行评审报告，包括年龄在 5-18 岁的参与者，报告了青少年吸烟、饮酒或使用非法物质的情况，并实施了普遍的基于学校的“韧性”干预措施（即解决个人（如自尊）和环境（如学校联系）韧性保护因素的措施）。使用 meta 分析综合二项结果的试验效果，并报告效应大小作为优势比。进行了亚组（按干预类型、预防方法、环境、干预持续时间、随访时间）和敏感性分析（排除高偏倚风险的研究）。从 16619 条记录中确定了 19 项合格的研究（烟草：n=15；酒精：n=17；非法物质：n=11）。对于非法物质使用的二项测量，发现总体干预效果（n=10；OR：0.78，95%CI：0.6-0.93，p=0.007，Tau=0.0，I=0%），但对烟草和酒精使用没有效果。当排除被评估为高偏倚风险的研究时，得到了类似的结果。在多个干预特征亚组中，对于非法物质使用，总体干预效果明显，但对于烟草和酒精使用则不然。这些结果支持实施针对“韧性”保护因素的普遍的基于学校的干预措施，以减少青少年非法物质使用，但表明需要采取其他方法来解决烟草和酒精使用问题。PROSPERO 注册号：CRD42014004906。
