Preventive Interventions Addressing Underage Drinking: State of the Evidence and Steps Toward Public Health Impact

Abstract

The epidemiological features of underage drinking and evidence of its social, health, and economic consequences suggest compelling reasons for the development and dissemination of effective preventive interventions. To clarify the nature and extent of the current evidence base on preventive interventions addressing underage drinking, a review of the literature was conducted through extensive searches of the research literature on outcome evaluations, existing reviews of this body of outcome research (N ϭ 25), and summary reports of evidence on specific interventions. More than 400 interventions were identified and screened, and the evidence for 127 was reviewed. Criteria for the evaluation of evidence were established for intervention studies with alcohol-specific outcome measures for 3 developmental periods (Ͻ10, 10 -15, and 16 to Ն20 years of age). Ultimately, 12 interventions met criteria for "most promising" evidence and 29 met criteria for "mixed or emerging" evidence. Conducting this review revealed clear advances in the number of evidence-based interventions available and the quality of outcome research; however, much work remains to achieve greater public health impact through evidence-based interventions. This work should consider (1) the great need for intervention research related to understudied developmental phases, intervention domains (eg, family, school, community, and media), and populations (eg, early tweens, late teens, young adults not attending college, and nonmajority populations); (2) the critical importance of addressing key issues in research design and methods (eg, limited longitudinal studies, replication studies, and dissemination research); and (3) the need for improved consistency in application of evidence and reporting standards. Finally, we recommend the application of emerging consumer-oriented and community-participatory models for intervention development and research, designed to increase the likelihood of "real-world" public health impact through improved translation of intervention science into practice. M ANY OF THE published reports on outcomes of preventive interventions addressing underage drinking open with statements on the broad scope of the problem, based on epidemiological data and results from studies of the social, health, and economic consequences of underage drinking. It is eminently clear from such findings that the magnitude of the problem is great. In this country, lifetime prevalence rates of alcohol use among eighth-, 10th-, and 12th-graders are 41.0%, 63.2%, and 75.1%, respectively. 1 Prevalence rates for past 30-day use are substantial, at 17.1%, 33.2%, and 47.0% for the 3 grade levels. Of considerable concern are the levels of more-problematic types of use, including binge drinking and drunkenness. For example, the past 30-day rates of drunkenness among eighth-, 10th-, and 12th-graders in 2005 were 6.0%, 17.6%, and 30.2%, respectively. 1 It is noteworthy that these problematic levels of alcohol use occur worldwide. 2 There is extensive literatur...

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