National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia.
Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.
Addiction. 2018 Nov;113(11):1984-2018. doi: 10.1111/add.14277. Epub 2018 Jul 5.
Whole-of-community interventions aim to reduce alcohol and other drug (AOD) use and harms by mobilizing community leaders, organizations and policy-makers to respond effectively to AOD use. The aim of this review is to estimate the effectiveness of whole-of-community interventions in reducing population-level harms arising from AOD use.
A systematic review of electronic databases CENTRAL, Embase, Medline, Medline in Process and PsycINFO was conducted from database inception to August 2017. Eligible trials had a parallel comparison group, implemented interventions in two or more community settings, and reported data on AOD use or harms.
Intervention settings included schools, sporting clubs, police and law enforcement agencies, community centres, local media and retail premises.
Twenty-four trials from 63 publications were included (n = 249 125 participants).
Outcomes from AOD consumption (quantity and frequency), AOD-related crime and AOD-related accidents, injuries and hospital admissions. Data were pooled using random-effects inverse variance meta-analysis in Review Manager version 5.3.
Risk of bias was mostly high, due to lack of random allocation, selective reporting and significant attrition. Meta-analyses indicated significant reductions in risky drinking [Alcohol Use Disorders Identification Scale (AUDIT) > 8; three trials (7 data points), relative risk (RR) = 0.78, 95% confidence interval (CI) = 0.62-0.99)], but found no impact on past-month alcohol use (five trials, RR = 0.95, 95% CI = 0.89-1.02), binge drinking (five trials, RR = 0.97, 95% CI = 0.89-1.06) or 12-month marijuana use (two trials, RR = 0.98, 95% CI = 0.86-1.11). Narrative synthesis indicated some reductions in AOD-related assault rates and arrests, but were equivocal for quantity of alcohol consumed, 12-month illicit drug use, assault or abuse, motor vehicle accidents and hospital admissions.
Interventions to reduce alcohol and other drug use and harms applied to whole communities have resulted so far in small reductions in risky alcohol consumption, but have had little impact upon past month alcohol use, binge drinking or 12-month marijuana use and the studies have been subject to high risk of bias.
全社区干预旨在通过动员社区领导、组织和决策者来有效应对药物使用问题，从而减少酒精和其他药物（AOD）的使用和危害。本研究旨在评估全社区干预在减少因 AOD 使用而产生的人群伤害方面的有效性。
对电子数据库 CENTRAL、Embase、Medline、Medline in Process 和 PsycINFO 进行了系统检索，检索时间从数据库建立到 2017 年 8 月。合格的试验具有平行比较组，在两个或更多社区环境中实施干预，并报告了关于 AOD 使用或危害的数据。
干预环境包括学校、体育俱乐部、警察和执法机构、社区中心、当地媒体和零售场所。
从 63 篇文献中纳入了 24 项试验（n=249125 名参与者）。
从 AOD 消费（数量和频率）、与 AOD 相关的犯罪以及与 AOD 相关的事故、伤害和住院治疗的角度评估结果。使用 Review Manager 版本 5.3 中的随机效应逆方差荟萃分析汇总数据。
由于缺乏随机分配、选择性报告和大量失访，偏倚风险大多较高。荟萃分析表明，在危险饮酒方面有显著减少（酒精使用障碍识别测试量表（AUDIT）>8；三项试验（7 个数据点），相对风险（RR）=0.78，95%置信区间（CI）=0.62-0.99），但在过去一个月的酒精使用方面没有影响（五项试验，RR=0.95，95%CI=0.89-1.02）， binge drinking（五项试验，RR=0.97，95%CI=0.89-1.06）或 12 个月的大麻使用（两项试验，RR=0.98，95%CI=0.86-1.11）。叙述性综合表明，在与 AOD 相关的攻击率和逮捕率方面有所降低，但在酒精消耗数量、12 个月非法药物使用、攻击或滥用、机动车事故和住院治疗方面的影响结果并不确定。
迄今为止，针对整个社区实施的减少酒精和其他药物使用和危害的干预措施已导致危险饮酒量略有减少，但对过去一个月的酒精使用、 binge drinking 或 12 个月的大麻使用没有影响，并且这些研究存在很高的偏倚风险。
