Appendix D: gaps in the evidence

Appendix D: gaps in the evidence

PHIAC identified a number of gaps in the evidence relating to the interventions under examination, based on an assessment of the evidence, stakeholder comments and fieldwork data. These gaps are set out below.

  1. There is a lack of well-designed studies on the effectiveness and cost- effectiveness of alcohol education programmes in schools in England (most of the available evidence originates from the US). There is also a lack of research on whether effective US-based programmes can be implemented successfully in the UK. The 'Blueprint' programme is currently being evaluated, but other prevention programmes in England need to be evaluated on an ongoing basis.

  2. There have been few economic evaluations of alcohol education and few of those have considered both the costs and consequences of implementing school-based programmes.

  3. Many studies had design limitations which potentially affect their validity, in particular, in relation to:

    • the methods used to randomise participants or clusters

    • the way participant numbers were reported at baseline and the way details of attrition were reported

    • the use of non-validated surrogate outcome measures that were not relevant to English policy

    • the lack of power in the studies

    • the analyses used

    • analyses which did not take baseline imbalances into account

    • the use of self-reported data (reports could be biased as alcohol use is a sensitive issue associated with social values).

      In addition, the differential effectiveness of interventions in relation to disadvantaged and minority groups could not be determined.

  4. Few studies utilised standardised outcome measures which had been determined a priori; these should include adverse outcomes and measures of harm. Reporting of findings often lacked clarity and detail.

  5. There is a lack of data on how alcohol education programmes impact on crime, levels of violence and other consequences of alcohol use.

  6. Standardised data on the impact of alcohol use among children and young people is limited (this data should cover, for example, injuries and other health effects, violence and disorder, unintended pregnancies and school attendance). In addition, there is a lack of data on long-term drinking trends among children and young people, and on the long-term health and social impacts (into adulthood).

  7. There is a lack of qualitative studies looking at: children and young people's attitudes towards – and views on – alcohol use; the meaning and role of alcohol in their lives; and the role of the alcohol industry.

  8. There is a lack of data on the effectiveness of peer-led alcohol education for children and young people.

  9. Alcohol education programmes tend to be evaluated in isolation or as part of general substance misuse programmes. There has been little evaluation of alcohol education offered as part of general health education and life skills training.

  10. The effectiveness of using the PSHE and PSHE education framework to deliver alcohol education (as part of the National Healthy Schools Programme) needs further evaluation.

  11. There is a lack of research into the differential effectiveness of interventions for different groups of children and young people. In particular, there is a lack of research into the impact that interventions can have on those most at risk of alcohol-related harm and in relation to health inequalities.

  12. There is a lack of research on how different types of school and the demographic profile of a school affects the uptake, delivery and impact of alcohol education programmes.

  13. There is a lack of evidence on what skills and qualities are needed to deliver an effective alcohol education programme in schools.

  14. There is a lack of research on the impact of new licensing laws (for instance, all-day opening) on the way children and young people use alcohol.

The Committee made five recommendations for research. These are listed in section 5.