Combined universal and selective prevention for adolescent alcohol use: a cluster randomized controlled trial

Area of Science:

• Adolescent health
• Public health interventions
• Substance abuse prevention

Background:

• Existing alcohol prevention models rarely combine universal and selective strategies.
• This study introduces and evaluates the first integrated approach.

Purpose of the Study:

• To assess the efficacy of a combined universal and selective alcohol prevention program.
• To compare the combined approach against standalone universal and selective methods.

Main Methods:

• Randomized controlled trial in 26 Australian schools with 2190 students (mean age 13.3 years).
• Intervention groups: universal (Climate Schools), selective (Preventure), combined (Climate Schools and Preventure; CAP), and control (health education).
• Primary outcomes: alcohol use, binge drinking, and alcohol-related harms measured over 24 months.

Main Results:

• All intervention groups (Climate, Preventure, CAP) showed significantly lower growth in likelihood to drink and binge drink compared to controls.
• The Preventure group demonstrated significantly lower growth in alcohol-related harms.
• The combined (CAP) and universal (Climate) groups showed slower drinking growth than controls, but CAP showed faster growth than Climate.

Conclusions:

• Universal, selective, and combined approaches to adolescent alcohol prevention are supported by these findings.
• A key finding is that the combined approach offered no additional benefit over universal or selective prevention alone.