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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Effectiveness of school-based programs for reducing drinking and driving and riding with drinking drivers: a systematic review

RW Elder, JL Nichols, RA Shults, DA Sleet, LC Barrios, and R Compton.

Review published: 2005.

CRD summary

This review assessed school-based programmes for reducing driving after drinking (DD) and riding with drinking drivers (RDD). The authors concluded that there was sufficient evidence to recommend school-based instructional programmes for reducing RDD, but insufficient evidence for DD and peer organisational and social norming programmes. This was a well-conducted review and the conclusions are likely to be robust.

Authors' objectives

To assess the effects of school-based programmes for reducing driving after drinking (DD) and riding with drinking drivers (RDD).

Searching

MEDLINE, PsycINFO, Social SciSearch, ERIC, NTIS and TRIS were searched to December 2002 for studies published in English in peer-reviewed journals and technical or government reports; the search terms were not reported. In addition, reference lists were checked and experts were contacted.

Study selection

Study designs of evaluations included in the review

Only comparative studies that met minimum predefined study design and study execution criteria were eligible for inclusion (see Criteria On Which the Validity (or Quality) of Studies Was Assessed). The included studies followed up participants for between 1 and 84 months; in most studies the duration of follow-up was 6 months or less.

Specific interventions included in the review

Studies of school-based programmes were eligible for inclusion. The review classified interventions into three types: instructional programmes mainly conducted in the classroom; peer organisation programmes conducted in a variety of settings; and social norming programmes mainly conducted on college campuses. The included instructional programmes used didactic presentations with or without a focus on skills development and reducing risk-taking behaviour. Instructional sessions usually lasted about 1 hour and programmes consisted of 1 to 12 sessions (median 5 sessions).

Participants included in the review

Inclusion criteria for the participants were not specified. The primary studies included junior and senior high school students and university students.

Outcomes assessed in the review

Studies that assessed outcomes related to DD or RDD were eligible for inclusion. The primary review outcomes were self-reported DD, self-reported RDD, combined DD and RDD, self-reported DD intent, and crash or motor vehicle violation records.

How were decisions on the relevance of primary studies made?

The authors did not state how the studies were selected for the review, or how many reviewers performed the selection.

Assessment of study quality

The studies were categorised according to the appropriateness of the study design:

greatest (concurrent comparison group and prospective measures of exposure and outcomes);

moderate (retrospective design or multiple pre or post measurements but no concurrent comparison group); or

least (single pre and post measurements and no concurrent comparison group or exposure and outcome measured in a single group at the same point in time).

Study execution was assessed by considering the following threats to validity: descriptions of study population and interventions; sampling; measurement of exposure and outcomes; data analysis; interpretation of the results (including follow-up, bias and confounding); and other (unspecified). A total of 9 threats to validity were possible. The studies were then classified as having good (0 to 1 threats), fair (2 to 4 threats) or limited (5 or more threats) quality of execution. Only studies rated as having good or fair execution were included in the review.

Two reviewers independently assessed validity. Any disagreements were resolved through discussions with a team of experts.

Data extraction

Two reviewers independently extracted the data using a data extraction form. Any disagreements were resolved through discussions with a team of experts. For each study, effect sizes (ESs) and 95% confidence intervals (CIs) were calculated where possible; details of the methods used for studies of different designs were reported.

Methods of synthesis

How were the studies combined?

The studies were grouped according to the type of programme and outcome, and combined in a narrative. The median change in ESs (reported in standard deviation (SD) units) and the range of ESs were reported for similar studies. The evidence for each type of intervention was classified as sufficient or insufficient according to rules of evidence from the Guide to Community Preventive Services (see Other Publications of Related Interest no.1).

How were differences between studies investigated?

Differences between the studies were discussed in the text of the review.

Results of the review

Twelve studies were included.

Instructional programmes were assessed in 8 studies: 4 randomised controlled trials (RCTs) (3,115 individuals plus 87 classes), one non-randomised study (n=664), one before-and-after study with concurrent control (n=322), one time series with concurrent control (n=2,376), and one before-and-after study with no control (n=60).

Peer organisation programmes were assessed in 2 studies: one time series with concurrent control (4 schools) and one post intervention only study with concurrent control (n=17,187).

Social norming was assessed in 2 studies: one RCT (n=160) and one before-and-after study with no control (n at least 1,786).

In terms of study quality, the attrition rates ranged from zero for short-term follow-up to nearly two thirds.

Instructional programmes (8 studies).

The results for DD were mixed. The median change in self-reported DD (5 studies) was -0.10 SD (range: -0.22 to 0.04). Three of the 4 studies assessing RDD found a statistically significant benefit of the intervention. The median change in self-reported RDD (4 studies) was -0.18 SD (range: -0.72 to -0.10). The only study assessing moving violations and crashes found no significant difference between the intervention and control; the relative risk from 1 to 6 years ranged from 0.92 to 1.14.

Peer organisation programmes (2 studies).

One quasi-experimental time series with a concurrent control group found no significant difference for combined DD and RDD between a Students Against Destructive Decisions (SADD) programme and a control group. Although rated as "greatest" design quality, the programme was not fully implemented. The other study, classified as "least suitable" for design quality and with low power to detect an effect found non-statistically significant improvements in outcomes in SADD schools.

Social norming programmes (2 studies).

One before-and-after survey with breath alcohol tests (n=1,786) found that a campus-wide campaign appeared to reduce alcohol consumption. The other study found that groups exposed to a peer theatre intervention reported a statistically significant increased use of a designated driver and decreased DD compared with unexposed controls.

Authors' conclusions

There was sufficient evidence to recommend school-based instructional programmes for reducing RDD, but insufficient evidence about the effects of programmes in reducing DD and about the effectiveness of peer organisational and social norming programmes.

CRD commentary

The review addressed a clear question that was defined in terms of the intervention, outcomes and study design. Several relevant sources were searched, but no attempts were made to locate unpublished studies, thus raising the possibility of publication bias. The restriction to studies published in English might have resulted in the loss of some relevant data. Methods were used to minimise errors and bias in the assessment of validity and extraction of data, but it was unclear whether similar steps were taken in the study selection process. Validity was assessed, but only studies meeting the minimum quality criteria were included and the results of the validity assessment were discussed. Adequate details of each included study were given. In view of the differences among studies, a narrative synthesis was appropriate. Overall, this was a well-conducted review and the conclusions are likely to be robust.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that there is a need to improve the effectiveness of school-based programmes to reduce DD and RDD; to develop a firm basis to guide the development of programmes; and to assess the effects of programme content, method of delivery, perceived status of person delivering the programme, and the characteristics of the recipients. They stated that studies should be designed to assess alcohol-related traffic violations and crashes, should provide sufficient data to allow cost-effectiveness analysis, should assess objective as well as subjective outcomes, and should take likely high drop-out rates over time into consideration. Potential harms in some sub-populations also need to be considered.

Bibliographic details

Elder R W, Nichols J L, Shults R A, Sleet D A, Barrios L C, Compton R. Effectiveness of school-based programs for reducing drinking and driving and riding with drinking drivers: a systematic review. American Journal of Preventive Medicine 2005; 28(5 Supplement): 288-304. [PubMed: 15894162]

Other publications of related interest

1. Briss PA, Zaza S, Pappaioanou M, Fielding J, Wright-De Aguero L, Truman BJ, et al. Developing an evidence-based Guide to Community Preventive Services - methods. Am J Prev Med 2000;18(1 Suppl):35-43. 2. Ditter SM, Elder RW, Shults RA, Sleet DA, Compton R, Nichols JL. Effectiveness of designated driver programs for reducing alcohol-impaired driving: a systematic review. Am J Prev Med 2005;28(5 Suppl):280-7.

Indexing Status

Subject indexing assigned by NLM

MeSH

Accidents, Traffic /prevention & control; Adolescent; Alcohol Drinking /prevention & control; Automobile Driving /education /psychology; Child; Health Behavior; Health Education; Health Knowledge, Attitudes, Practice; Healthy People Programs; Humans; Program Evaluation; School Health Services; Students /psychology

AccessionNumber

12005000231

Database entry date

30/06/2006

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 15894162

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