Appendix C: the evidence

This appendix sets out the relevant evidence statements taken from the review (see appendix B for the key to study types and quality assessments) and links them to the relevant recommendations. The evidence statements are presented here without references – these can be found in the full review (see appendix E for details). It also sets out a brief summary of findings from the economic appraisal.

The combined review and economic appraisal are available on the NICE website. Where a recommendation is not taken directly from the evidence statements, but is inferred from the evidence, this is indicated by IDE (inference derived from the evidence).

Recommendation 1: evidence statements 1, 2, 3c, 5.

Recommendation 2: evidence statements 4a, 5.

Recommendation 3: IDE.

Evidence statements

Evidence statement 1

There is evidence from a high-quality systematic review (++) that three programmes: Strengthening Families, Botvin's life skills training (LST) and a culturally focused curriculum for Native American students, can produce long-term reductions (greater than 3 years) in alcohol use.

Evidence statement 2

There is evidence from two classroom-based, teacher-led programmes that targeted children between the ages of 12 and 13 years, to suggest that interventions using the life skills approach (three RCTs [+]) or focusing on harm reduction through skills-based activities (School Health and Alcohol Harm Reduction Project [SHAHRP]) (one CNRT [+]) can produce medium- to long-term reductions in alcohol use and, in particular, risky drinking behaviours such as drunkenness and binge drinking. However, the applicability and transferability of these programmes requires further study.

Evidence statement 3c

There is evidence (one RCT [+]) to suggest that a culturally-tailored skills training intervention for Native American students may have long-term effects on alcohol use. However, given the cultural specificity of this programme, it has limited applicability to UK practice and policy.

Evidence statement 4a

There is evidence to suggest that brief intervention programmes that involve nurse-led consultations regarding a young person's alcohol use, such as the STARS for Families programme (two RCTs [++], seven RCTs [+]), that target children aged 12–13, can produce short-, but not medium-term reductions in heavy drinking. However, these types of programme may have limited applicability as they are based on an abstinence approach.

Evidence statement 5

There is evidence to suggest that programmes that begin early in childhood, combine a school-based curriculum intervention with parent education, such as the Seattle Social Development Project (SSDP) (one CNRT [+]) and Linking the Interests of Families and Teachers (LIFT) (one RCT [-]), which target a range of problem behaviours including alcohol use, can have long-term effects on heavy and patterned drinking behaviours. In addition, the Healthy School and Drugs Project (one CNRT [+]), which targeted secondary school students, had short-term effects on alcohol use. However, longer-term effects of the programme have not been examined.

Cost-effectiveness evidence

Overall, school-based alcohol interventions were found to be cost effective, given the fact that they may avert the high costs associated with harmful drinking (both in terms of health and other consequences). However, intensive long-term programmes may not be cost effective.

It should be noted that the economic analysis carried out to determine whether or not an intervention was cost effective was subject to very large uncertainties.

Fieldwork findings

Fieldwork aimed to test the relevance, usefulness and feasibility of implementing the recommendations and the findings were considered by PHIAC in developing the final recommendations. For details, go to the fieldwork section in appendix B and online.

Fieldwork participants were generally positive about the recommendations and their potential to help prevent or reduce alcohol use among children and young people. The recommendations were seen to reinforce aspects of the National Healthy Schools Standard and the Science and PSHE and PSHE education curricula, particularly in relation to Key Stages 3 and 4.

Participants felt that the 'harm reduction' approach adopted was a more realistic option than abstention, although they were clear that young people who decide not to use alcohol should also be respected.

The promotion of community partnerships was acknowledged as critical in ensuring a consistent, comprehensive response to alcohol use across education settings and the community.

The majority of participants said the recommendations were relevant to their roles. They also said that although the interventions being promoted did not offer a new approach, this good practice has not been implemented universally. Wider and more systematic implementation would be achieved if:

  • there was a strong network of support staff (such as school nurses)

  • schools developed links with local youth substance misuse services

  • teachers and support staff were appropriately trained and skilled

  • the recommendations were promoted as 'standards' rather than guidance

  • the recommendations were implemented as part of wider local or national alcohol strategies

Many participants reported that they would use NICE guidance to help plan new initiatives as it provided information that was not currently included in DCSF or Qualifications and Curriculum Authority (QCA) guidance.