• National Institute for Health and Clinical Excellence (NICE). Interventions in schools to prevent and reduce alcohol use among children and young people. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Nov. 45 p. (Public health guidance; no. 7). [23 references]

This is the current release of the guideline.

Alcohol use

Assessment of Therapeutic Effectiveness
Counseling
Prevention

Family Practice
Internal Medicine
Pediatrics
Preventive Medicine

Advanced Practice Nurses
Allied Health Personnel
Health Care Providers
Nurses
Patients
Physician Assistants
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Public Health Departments
Social Workers
Substance Use Disorders Treatment Providers

To provide recommendations on interventions in schools to prevent and reduce alcohol use among children and young people

Children and young people in schools in the United Kingdom

Note: For the purposes of this guidance, schools include:

• State-sector, special, and independent primary and secondary schools
• City technology colleges, academies, and grammar schools
• Pupil referral units, secure training, and local authority secure units
• Further education colleges

Prevention

1. Ensuring alcohol education is a part of the curricula and is tailored for each specific group
2. Implementing the "whole school" approach
3. Offering parents information to help in developing parenting skills
4. Offering one-to-one advice and follow-up consultation where necessary
5. Referral to external services and involve parents, where appropriate
6. Maintaining and developing partnerships to support and implement alcohol education

• Changes in alcohol-related behavior, including:
  • Percentage who reported drinking alcohol (lifetime, monthly, or weekly use)
  • Amount of drinking and its frequency
  • Age at which children/young people first drank alcohol
  • Unsupervised alcohol use
• Cost-effectiveness

Searches of Electronic Databases
Searches of Unpublished Data

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Each study was described by study type and graded (++, +, -) to reflect the risk of potential bias arising from its design and execution.

Study Type

• Meta-analyses, systematic reviews of randomised clinical trials (RCTs) or RCTs (including cluster RCTs).
• Systematic reviews of, or individual controlled non-randomised trials (CNRT), case-control studies, cohort studies, controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, correlation studies.
• Non-analytical studies (for example, case report and, case series).
• Expert opinion, formal consensus.

Study Quality

++ All or most criteria have been fulfilled. Where they have not been fulfilled the conclusions are thought very unlikely to alter.

+ Some criteria fulfilled. Those criteria that have not been fulfilled or not adequately described are thought unlikely to alter the conclusions.

- Few or no criteria fulfilled. The conclusions of the study are thought likely or very likely to alter.

The main reasons for studies being assessed as (-) were:

• Limited reporting of methodological details such as methods of random assignment
• High level of participant attrition
• Lack of detail about baseline equivalence of intervention and control groups.

The interventions were also assessed for their applicability to the United Kingdom (UK) and the evidence statements were graded as follows:

A Harm-reduction approach and likely to be applicable across a broad range of settings and populations

B Harm-reduction approach and likely to be applicable across a broad range of settings and populations, assuming they are appropriately adapted

C Harm-reduction approach but applicable only to settings or populations included in the studies – broader applicability is uncertain, or approach unclear

D Clear abstinence approach or applicable only to settings or populations included in the studies

Systematic Review with Evidence Tables

Informal Consensus

At its meeting in May 2007 the Public Health Interventions Advisory Committee (PHIAC) considered the evidence of effectiveness and cost effectiveness to determine:

• Whether there was sufficient evidence (in terms of quantity, quality, and applicability) to form a judgement
• Whether, on balance, the evidence demonstrates that the intervention is effective or ineffective, or whether it is equivocal
• Where there is an effect, the typical size of effect

PHIAC developed draft recommendations through informal consensus, based on the following criteria.

• Strength (quality and quantity) of the evidence of effectiveness and its applicability to the populations/settings referred to in the scope.
• Effect size and potential impact on population health and/or reducing inequalities in health.
• Cost effectiveness (for the National Health Service [NHS] and other public sector organisations).
• Balance of risks and benefits.
• Ease of implementation and the anticipated extent of change in practice that would be required

Where possible, recommendations were linked to an evidence statement(s) (see appendix C in the original guideline document for details). Where a recommendation was inferred from the evidence, this was indicated by the reference "IDE" (inference derived from the evidence).

Not applicable

Overall, school-based alcohol interventions were found to be cost effective, given the fact that they may avert the high costs associated with harmful drinking (both in terms of health and other consequences). However, intensive long-term programmes may not be cost effective.

It should be noted that the economic analysis carried out to determine whether or not an intervention was cost effective was subject to very large uncertainties.

External Peer Review
Internal Peer Review

The draft guidance, including the recommendations, was released for consultation in July 2007. At its meeting in September 2007, the Programme Development Groups (PDG) considered comments from stakeholders and the results from fieldwork, and amended the guidance. The guidance was signed off by the National Institute for Clinical Excellence (NICE) Guidance Executive in October 2007.

This document constitutes the Institute's formal guidance on interventions in schools to prevent and reduce alcohol use among children and young people. It also looks at how to link these interventions with community initiatives, including those run by children's services.

The evidence statements that underpin the recommendations are listed in appendix C of the original guideline document.

School-Based Education and Advice

Recommendation 1

Who is the target population?

Children and young people in schools.

Who should take action?

Head teachers, teachers, school governors and others who work in (or with) schools including: school nurses, counsellors, healthy school leads, personal, social, and health education (PSHE) coordinators in primary schools and personal, social, health. and economic (PSHE) education coordinators in secondary schools.

What action should they take?

• Ensure alcohol education is an integral part of the national science, PSHE and PSHE education curricula, in line with Department for Children, Schools and Families (DCSF) guidance.
• Ensure alcohol education is tailored for different age groups and takes different learning needs into account (based, for example, on individual, social, and environmental factors). It should aim to encourage children not to drink, delay the age at which young people start drinking, and reduce the harm it can cause among those who do drink. Education programmes should:
  • Increase knowledge of the potential damage alcohol use can cause—physically, mentally, and socially (including the legal consequences)
  • Provide the opportunity to explore attitudes to—and perceptions of—alcohol use
  • Help develop decision-making, assertiveness, coping, and verbal/non-verbal skills
  • Help develop self-esteem
  • Increase awareness of how the media, advertisements, role models, and the views of parents, peers, and society can influence alcohol consumption
• Introduce a "whole school" approach to alcohol, in line with Department for Children, Schools and Families guidance. It should involve staff, parents, and pupils and cover everything from policy development and the school environment to the professional development of (and support for) staff.
• Where appropriate, offer parents or carers information about where they can get help to develop their parenting skills. (This includes problem-solving and communication skills, and advice on setting boundaries for their children and teaching them how to resist peer pressure.)

Recommendation 2

Who is the target population?

Children and young people in schools who are thought to be drinking harmful amounts of alcohol.

Who should take action?

Teachers, school nurses, and school counsellors.

What action should they take?

• Where appropriate, offer brief, one-to-one advice on the harmful effects of alcohol use, how to reduce the risks, and where to find sources of support. Offer a follow-up consultation or make a referral to external services, where necessary.
• Where appropriate, make a direct referral to external services (without providing one-to-one advice).
• Follow best practice on child protection, consent, and confidentiality. Where appropriate, involve parents or carers in the consultation and any referral to external services.

Partnerships

Recommendation 3

Who is the target population?

Children and young people in schools.

Who should take action?

• Head teachers, school governors, healthy school leads, and school nurses.
• Extended school services, children's services (including the Children's Trust/children and young people's strategic partnership), primary care trusts (PCTs), drug and alcohol action teams, crime disorder reduction partnerships, youth services, drug and alcohol services, the police, and organisations in the voluntary and community sectors.

What action should they take?

Maintain and develop partnerships to:

• Support alcohol education in schools as part of the national science, PSHE, and PSHE education curricula
• Ensure school interventions on alcohol use are integrated with community activities introduced as part of the "Children and young people's plan"
• Find ways to consult with families (parents or carers, children and young people) about initiatives to reduce alcohol use and to involve them in those initiatives
• Monitor and evaluate partnership working and incorporate good practice into planning

None provided

The type and quality of supporting evidence is identified and graded for each recommendation (see Appendix C in the original guideline document).

• Prevention and reduction of alcohol use among children and young people
• Delay in age at which young people start drinking
• Reduction in harm caused by drinking

Not stated

• This guidance represents the views of the Institute and was arrived at after careful consideration of the evidence available. Those working in the National Health Service (NHS), local authorities, the wider public, voluntary and community sectors should take it into account when carrying out their professional, managerial or voluntary duties.
• Practitioners will need to use their professional judgement to determine the type of content needed for education programmes aimed at different groups. They will also need to judge whether or not a child or young person is drinking "harmful amounts of alcohol."
• The Public Health Interventions Advisory Committee (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 in Appendix D of the original guideline document.

National Institute for Health and Clinical Excellence (NICE) guidance can help:

• National Health Service (NHS) organisations meet Department of Health (DH) standards for public health as set out in the seventh domain of 'Standards for better health' (updated in 2006). Performance against these standards is assessed by the Healthcare Commission, and forms part of the annual health check score awarded to local healthcare organisations.
• Local authorities (including social care and children's services) and National Health Service organisations meet the requirements of the government's 'National standards, local action, health and social care standards and planning framework 2005–2008'.
• Provide a focus for children's trusts, health and wellbeing partnerships and other multi-sector partnerships working on health within a local strategic partnership.
• Support schools aiming for healthy school status.
• National and local organisations within the public sector meet government indicators and targets to improve health and reduce health inequalities.
• Local authorities fulfill their remit to promote the economic, social and environmental wellbeing of communities.
• Local National Health Service organisations, local authorities and other local public sector partners benefit from any identified cost savings, disinvestment opportunities or opportunities for re-directing resources.

NICE has developed tools to help organisations implement this guidance. For details, see the "Availability of Companion Documents" field.

Staying Healthy

Effectiveness

• National Institute for Health and Clinical Excellence (NICE). Interventions in schools to prevent and reduce alcohol use among children and young people. London (UK): National Institute for Health and Clinical Excellence (NICE); 2007 Nov. 45 p. (Public health guidance; no. 7). [23 references]

Not applicable: The guideline was not adapted from another source.

2007 Nov

National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]

National Institute for Health and Clinical Excellence (NICE)

NICE Project Team
Public Health Interventions Advisory Committee

NICE Project Team Members: Mike Kelly, CPHE Director; Simon Ellis, Associate Director; Dr Louise Millward, Lead Analyst; Dr Hilary Chatterton, Analyst; Dr Una Canning, Analyst; Dr Caroline Mulvihill, Analyst; Dr Bhash Naidoo, Technical Adviser (Health Economics)

Public Health Interventions Advisory Committee (PHIAC) Members: Professor Sue Atkinson, CBE, Independent Consultant and Visiting Professor in the Department of Epidemiology and Public Health, University College London; Mr John Barker, Associate Foundation Stage Regional Adviser for the Parents as Partners in Early Learning Project, DfES National Strategies; Professor Michael Bury, Emeritus Professor of Sociology, University of London and Honorary Professor of Sociology, University of Kent; Professor Simon Capewell, Chair of Clinical Epidemiology, University of Liverpool; Professor K K Cheng, Professor of Epidemiology, University of Birmingham; Ms Joanne Cooke; Director, Trent Research and Development Support Unit (RDSU), University of Sheffield; Dr Richard Cookson, Senior Lecturer, Department of Social Policy and Social Work, University of York; Mr Philip Cutler, Forums Support Manager, Bradford Alliance on Community Care; Professor Brian Ferguson, Director of the Yorkshire and Humber Public Health Observatory; Mr Howard Gilfillan, Former Head Teacher, Branksome Comprehensive School, Darlington; Professor Ruth Hall, Regional Director, Health Protection Agency, South West; Mr Alasdair Hogarth, Head Teacher, Archbishops School, Canterbury; Ms Amanda Hoey, Director, Consumer Health Consulting Limited; Mr Andrew Hopkin, Assistant Director, Local Environment, Derby City Council; Dr Ann Hoskins, Deputy Regional Director of Public Health, NHS North West; Ms Muriel James, Secretary for the Northampton Healthy Communities Collaborative and the King Edward Road Surgery Patient Participation Group; Professor David R Jones, Professor of Medical Statistics, Department of Health Sciences, University of Leicester; Dr Matt Kearney, General Practitioner, Castlefields, Runcorn and GP Public Health Practitioner, Knowsley; Ms Valerie King, Designated Nurse for Looked After Children for Northampton PCT, Daventry and South Northants PCT and Northampton General Hospital. Public Health Skills Development Nurse, Northampton PCT; (CHAIR) Professor Catherine Law, Professor of Public Health and Epidemiology, University College London Institute of Child Health; Ms Sharon McAteer, Public Health Development Manager, Halton and St Helens PCT; Mr David McDaid, Research Fellow, Health and Social Care and Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science; Professor Klim McPherson, Visiting Professor of Public Health Epidemiology, Department of Obstetrics and Gynaecology, University of Oxford; Professor Susan Michie, Professor of Health Psychology, BPS Centre for Outcomes Research & Effectiveness, University College London; Dr Mike Owen, General Practitioner, William Budd Health Centre, Bristol; Ms Jane Putsey, Lay Representative. Chair of Trustees of the Breastfeeding Network; Dr Mike Rayner, Director of British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford; Mr Dale Robinson, Chief Environmental Health Officer, South Cambridgeshire District Council; Ms Joyce Rothschild, School Improvement Adviser, Solihull Local Authority; Dr Tracey Sach, Senior Lecturer in Health Economics, University of East Anglia; Professor Mark Sculpher, Professor of Health Economics, Centre for Economics (CHE), University of York; Dr David Sloan, Retired Director of Public Health; Dr Dagmar Zeuner, Joint Director of Public Health, Hammersmith and Fulham PCT

Expert cooptees to PHIAC: Mrs Joan Harris, School Nurse, Bath and North East Somerset PCT; Ms Sarah Smart, Development Manager, PSHE Subject Association

Expert testimony to PHIAC: Professor Ian Gilmore, President, Royal College of Physicians; Mr Andrew McNeill, Director, Institute of Alcohol Studies; Ms Rhian Stone, Independent Public Policy Consultant; Dr Linda Wright, Alcohol Health Promotion Researcher and Writer

All members of the Public Health Interventions Advisory Committee are required to make an oral declaration all potential conflicts of interest at the start of the consideration of each public health intervention appraisal. These declarations will be minuted and published on the National Institute for Health and Clinical Excellence (NICE) website.

Members are required to provide in writing an annual statement of current conflicts of interests, in accordance with the Institute's policy and procedures.

Potential members of the Public Health Programme Development Groups (PDG), and any individuals having direct input into the guidance (including expert peer reviewers), should provide a formal written declaration of personal interests. A standard form has been developed for this purpose which also includes the Institute's standard policy for declaring interests. This declaration of interest form should be completed before any decision about the involvement of an individual is taken.

Any changes to a Group member's declared conflicts of interests should also be recorded at the start of each PDG meeting. The PDG Chair should determine whether these interests are significant.

If a member of the PDG has a possible conflict of interest with only a limited part of the guidance development or recommendations, that member may continue to be involved in the overall process but should withdraw from involvement in the area of possible conflict. This action should be documented and be open to external review. If it is considered that an interest is significant in that it could impair the individual's objectivity throughout the development of public health guidance, he or she should not be invited to join the group.

This is the current release of the guideline.

None available

This summary was completed by ECRI Institute on January 29, 2008. The information was verified by the guideline developer on February 1, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.