Bristol Medical School, Population Health Sciences, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
BMC Public Health. 2022 Jun 3;22(1):1111. doi: 10.1186/s12889-022-13072-5.
Engagement in multiple substance use risk behaviours such as tobacco smoking, alcohol and drug use during adolescence can result in adverse health and social outcomes. The impact of interventions that address multiple substance use risk behaviours, and the differential impact of universal versus targeted approaches, is unclear given findings from systematic reviews have been mixed. Our objective was to assess effects of interventions targeting multiple substance use behaviours in adolescents.
Eight databases were searched to October 2019. Individual and cluster randomised controlled trials were included if they addressed two or more substance use behaviours in individuals aged 8-25 years. Data were pooled in random-effects meta-analyses, reported by intervention and setting. Quality of evidence was assessed using GRADE. Heterogeneity was assessed using between-study variance, τ2 and Ι, and the p-value of between-study heterogeneity statistic Q. Sensitivity analyses were undertaken using the highest and lowest intra-cluster correlation coefficient (ICC).
Of 66 included studies, most were universal (n=52) and school-based (n=41). We found moderate quality evidence that universal school-based interventions are likely to have little or no short-term benefit (up to 12 months) in relation to alcohol use (OR 0.94, 95% CI: 0.84, 1.04), tobacco use (OR 0.98, 95% CI: 0.83, 1.15), cannabis use (OR 1.06, 95% CI: 0.86, 1.31) and other illicit drug use (OR 1.09, 95% CI: 0.85, 1.39). For targeted school-level interventions, there was low quality evidence of no or a small short-term benefit: alcohol use (OR 0.90, 95% CI: 0.74-1.09), tobacco use (OR 0.86, 95% CI: 0.66, 1.11), cannabis use (OR 0.84, 95% CI: 0.66-1.07) and other illicit drug use (OR 0.79, 95% CI 0.62-1.02). There were too few family-level (n=4), individual-level (n=2) and combination level (n=5) studies to draw confident conclusions. Sensitivity analyses of ICC did not change results.
There is low to moderate quality evidence that universal and targeted school-level interventions have no or a small beneficial effect for preventing substance use multiple risk behaviours in adolescents. Higher quality trials and study reporting would allow better evidence syntheses, which is needed given small benefit of universal interventions can have high public health benefit.
Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD011374. DOI: 10.1002/14651858.CD011374.
青少年时期同时参与多种物质使用风险行为，如吸烟、饮酒和吸毒，可能会导致不良的健康和社会后果。针对多种物质使用风险行为的干预措施的影响，以及普遍性方法与针对性方法的差异影响，由于系统评价的结果存在差异，目前仍不清楚。我们的目的是评估针对青少年多种物质使用行为的干预措施的效果。
我们对截至 2019 年 10 月的 8 个数据库进行了搜索。如果个体干预措施针对 8-25 岁个体的两种或多种物质使用行为，则纳入个体和群组随机对照试验。使用随机效应荟萃分析对数据进行汇总，并根据干预措施和环境进行报告。使用 GRADE 评估证据质量。使用研究间方差、τ2 和 I2 以及研究间异质性统计量 Q 的 p 值来评估异质性。使用最高和最低群组内相关系数（ICC）进行敏感性分析。
在 66 项纳入的研究中，大多数为普遍性（n=52）和基于学校的（n=41）。我们发现，有中等质量证据表明，普遍性的基于学校的干预措施在短期内（最多 12 个月）可能对减少青少年的酒精使用（OR 0.94，95%CI：0.84，1.04）、烟草使用（OR 0.98，95%CI：0.83，1.15）、大麻使用（OR 1.06，95%CI：0.86，1.31）和其他非法药物使用（OR 1.09，95%CI：0.85，1.39）没有或仅有很小的益处。对于有针对性的学校层面干预措施，有低质量证据表明，在短期内没有或仅有较小的益处：酒精使用（OR 0.90，95%CI：0.74-1.09）、烟草使用（OR 0.86，95%CI：0.66，1.11）、大麻使用（OR 0.84，95%CI：0.66-1.07）和其他非法药物使用（OR 0.79，95%CI 0.62-1.02）。家庭层面（n=4）、个体层面（n=2）和组合层面（n=5）的研究太少，无法得出明确的结论。ICC 的敏感性分析并未改变结果。
有低到中等质量的证据表明，普遍性和有针对性的学校层面的干预措施对预防青少年多种物质使用风险行为没有或仅有很小的益处。更高质量的试验和研究报告将允许更好的证据综合，鉴于普遍性干预措施的小益处可能具有很高的公共卫生益处，因此这是必要的。
Cochrane 系统评价数据库 2014 年第 11 期。ART. No.: CD011374. DOI: 10.1002/14651858.CD011374.
