Recommendation ID

What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education?

Any explanatory notes
(if applicable)

Why the committee made the recommendations

It is current practice for schools to use a whole-school approach for alcohol education (universal and targeted) and other health-related topics that have a personal, social, health and economic education (PSHE) component. This helps schools ensure that consistent messages are given about a topic, such as alcohol education, whether taught through relationships education, relationships and sex education (RSE) and health education, or PSHE and the national science curriculum. In England universal alcohol education forms part of the usual curriculum delivered through health education or PSHE.

Evidence was identified on delivering universal alcohol-specific education programmes in a mix of approaches and components (for example, in or out of the classroom, on its own or in combination with family or community). This evidence showed that the effectiveness of specific universal alcohol education programmes is no better than usual alcohol education. In England usual alcohol education is delivered through health education or PSHE, so the committee thought that alcohol education could continue to be delivered this way.

Although the published cost-effectiveness evidence was limited it indicated that universal interventions could be cost effective. The economic analysis showed the same. So the committee agreed that universal interventions could offer good value for money. However, they were mindful that cost effectiveness was closely related to the cost of the intervention. The benefits of the intervention, measured as a reduction in the number of related crime and hospital events, also had a significant impact on cost effectiveness because of their high associated costs.

The cost-effectiveness analysis showed that universal interventions are more likely to be cost effective in the older age groups that might be drinking already, than in the younger ones that might not. The committee were concerned that this might lead to a focus on interventions for older children and young people. However, they did not think the evidence justified prioritising interventions for these groups because of limitations in study design. In addition, the studies used short follow-up, compared the interventions with usual education, and used outcomes such as problematic drinking (which is less common in younger age groups and unlikely to capture other benefits of alcohol education).

One of the elements of the whole-school approach is the involvement of parents and carers. The committee acknowledged that parents or carers have an influence on their child's health behaviours. They considered that involving them in the school's approach to alcohol education is essential to improve the consistency of messages that pupils receive. Evidence was identified on universal alcohol programmes that involved parents, but it was inconclusive. The committee believed that limitations in study design, such as short follow-up, might explain this. The evidence also showed that it can be difficult to engage parents successfully (for example to attend family education activities at school). The committee agreed that more research was needed to evaluate the different ways to do this (research recommendation 6).

Evidence from qualitative studies showed that teachers may lack confidence in teaching alcohol education and don't know the best materials to use. The committee were aware of accredited materials and training resources (although not reviewed by NICE) based on their experience of current practice. These include materials from PSHE Association, Public Health England and Mentor-ADEPIS.

The committee also reiterated that it was the school's responsibility to use materials that are free from bias, and informed by evidence if possible. Also, the committee were mindful of a 2016 review noting that the delivery of education messages by the alcohol industry has no significant public health effects (see Public Health England's public health burden of alcohol: evidence review). The committee were also aware of international criteria on how to select teaching materials and support resources (see the United Nations Office on Drugs and Crime guidance on school-based education for drug abuse prevention), but NICE did not review this.

The committee discussed that schools share experiences and knowledge and adopt examples of alcohol education that have worked in other local schools. However, there was no evidence to support this practice. There was also concern that adapting examples of good practice for local needs may alter the effectiveness of interventions (for example straying too far from key content and processes).

Evidence from qualitative studies shows that many schools find it difficult to prioritise alcohol education because of the demands of a crowded curriculum. But, given that health education will be compulsory from 2020, the committee thought it important that schools find time to plan for alcohol education in the curriculum.

How the recommendations might affect practice

The recommendations will aim to reinforce current best practice because they are based on existing processes that all schools should be following and will become mandatory. However, the statutory changes may mean that schools need to make changes in how they prioritise health education as part of their overall curriculum planning.

Full details of the evidence and the committee's discussion are in evidence review A: universal interventions.

Source guidance details

Comes from guidance
Alcohol interventions in secondary and further education
Date issued
August 2019

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/08/2019