Does integrated academic and health education prevent substance use? Systematic review and meta-analyses.
2018
Background:
Prevention of substance (alcohol, tobacco, illegal/legal drug) use in adolescents
is a public health priority. As the scope for school
‐
based health education is constrained in school
timetables, interventions integrating academic and health education have gained traction in the
UK and elsewhere, though evidence for their effectiveness remains unclear. We sought to syn-
thesize the effectiveness of interventions integrating academic and health education for the pre-
vention of substance use.
Methods:
We searched 19 databases between November and December 2015, among other
methods. We included randomized trials of interventions integrating academic and health educa-
tion targeting school students aged 4
–
18 and reporting substance use outcomes. We excluded
interventions for specific health
‐
related subpopulations (e.g., children with behavioural difficul-
ties). Data were extracted independently in duplicate. Outcomes were synthesized by school
key stage (KS) using multilevel meta
‐
analyses, for substance use, overall and by type.
Results:
We identified 7 trials reporting substance use. Interventions reduced substance use
generally in years 7
–
9 (KS3) based on 5 evaluations (
d
=
−
0.09, 95% CI [
−
0.17,
−
0.01],
I
2
= 35%), as well as in years 10
–
11 (KS4) based on 3 evaluations (
−
0.06, [
−
0.09,
−
0.02];
I
2
= 0%). Interventions were broadly effective for reducing specific alcohol, tobacco, and drug
use in both KS groups.
Conclusions:
Evidence quality was highly variable. Findings for years 3
–
6 and 12
–
13 could
not be meta
‐
analysed, and we could not assess publication bias. Interventions appear to have a
small but significant effect reducing substance use. Specific methods of integrating academic
and health education remain poorly understood.
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