Family-based prevention programmes for alcohol use in young people (Review) (2019)

Review question: We reviewed the evidence about the effects of family- or parent-based programmes as a way of preventing or reducing alcohol use in school-aged children.
Background: Alcohol use puts young people at increased risk for a range of short- and long-term harms and is a cause of concern for health services, policy-makers, youth workers, teachers, and parents.
Search date: The evidence was current to June 2018.
Study characteristics: We found 46 randomised controlled trials (studies where participants were randomly allocated to one of two or more intervention or control groups) that compared family-based interventions versus no intervention or an adolescent component alone. We included studies targeting general populations of parents and children (universal interventions), those targeting parents of children at increased risk of alcohol use (selective interventions), and studies targeting parents of children already using alcohol (indicated interventions). We were interested in studies following participants up to four years post intervention.
Most studies were conducted in the United States or in European countries (the Netherlands, Sweden, Poland, and Germany). One study was conducted in India. Interventions were delivered in various settings including the child's school or family home and via the Internet or print material. Interventions varied in intensity, duration, and approach, but all targeted alcohol or other drug use by promoting positive parenting approaches or enhancing parent-child relationships. The interventions focused on communication, family dynamics, rule-setting, and risk management.
The total number of participants in the included studies was 39,822, and the young people targeted ranged from 5 to 17 years of age. Participant ethnicity was mixed, with 12 studies targeting ethnic minority groups specifically.
Key results: Overall, we found no evidence for the effectiveness of family-based interventions on the prevalence, frequency, or volume of alcohol use among young people. Some analyses focusing on specific subgroups of studies (e.g. including only universal interventions, targeting ethnic minority groups) showed small intervention effects, but considering variation in results, variation between studies, and overall low quality of the evidence, we are uncertain whether these interventions have a positive effect on young people's alcohol consumption. Some studies reported positive intervention effects on secondary outcomes (parental supply of alcohol, family involvement, alcohol misuse, and alcohol dependence) but with small numbers; these studies could not be pooled, so the evidence is insufficient. No adverse effects were reported.
Quality of evidence: Overall, only very low- or low-quality evidence shows the small effects found in this review. Many of the studies did not adequately describe how families/young people/parents were allocated to the study groups, or how they concealed the group allocation from participants and personnel. We downgraded the quality of evidence due to the heterogeneity (variability) between studies and imprecision (variation) in results. These problems with study quality could result in inflated estimates of intervention effects, so we cannot rule out the possibility that slight effects observed in this review may be overstated.
The US National Institutes of Health (NIH) and the National Institutes of Alcohol Abuse and Alcoholism (NIAAA), Drug Abuse (NIDA), and Mental Health provided funding for over half (28/46) of the studies included in this review. Three studies provided no information about funding, and only 13 papers had a clear conflict of interest statement.