Elsevier

Preventive Medicine

Volume 57, Issue 4, October 2013, Pages 278-296
Preventive Medicine

Review
Population-level interventions to reduce alcohol-related harm: An overview of systematic reviews

https://doi.org/10.1016/j.ypmed.2013.06.019Get rights and content

Highlights

  • A systematic overview of population-level alcohol interventions is presented.

  • Evidence for effective interventions was found in nine out of ten policy sectors.

  • Consistent evidence to support regulatory and statutory enforcement interventions

  • Interventions targeting specific population groups are less consistently supported.

  • Detailed context assessment and reporting are particularly important in this field.

Abstract

Objective

To analyse available review-level evidence on the effectiveness of population-level interventions in non-clinical settings to reduce alcohol consumption or related health or social harm.

Method

Health, social policy and specialist review databases between 2002 and 2012 were searched for systematic reviews of the effectiveness of population-level alcohol interventions on consumption or alcohol-related health or social outcomes. Data were extracted on review research aim, inclusion criteria, outcome indicators, results, conclusions and limitations. Reviews were quality-assessed using AMSTAR criteria. A narrative synthesis was conducted overall and by policy area.

Results

Fifty-two reviews were included from ten policy areas. There is good evidence for policies and interventions to limit alcohol sale availability, to reduce drink-driving, to increase alcohol price or taxation. There is mixed evidence for family- and community-level interventions, school-based interventions, and interventions in the alcohol server setting and the mass media. There is weak evidence for workplace interventions and for interventions targeting illicit alcohol sales. There is evidence of the ineffectiveness of interventions in higher education settings.

Conclusion

There is a pattern of support from the evidence base for regulatory or statutory enforcement interventions over local non-regulatory approaches targeting specific population groups.

Introduction

Alcohol is the world's third largest disease risk factor causing 2.5 million deaths annually worldwide (World Health Organization, 2011). It results in substantial societal costs through healthcare costs, crime and productivity losses (Anderson et al., 2009). Implementing effective population-level interventions to reduce the negative consequences of alcohol consumption is therefore a major public health priority (Beaglehole et al., 2011). The drivers and consequences of alcohol consumption span a range of biological, behavioural, social and economic dimensions. Addressing the complex causal pathways of alcohol-related harm therefore requires interventions targeting multiple points along this pathway. Numerous primary studies and systematic reviews have assessed the effectiveness of alcohol interventions. However, making valid judgements on the strength of the overall evidence base remains a challenge due to the diversity of proposed intervention mechanisms and the heterogeneity of outcome measures used. Understanding this evidence base is critical given the propensity for alcohol industry bodies to cite a weak evidence base when challenging policy implementation (Babor and Robaina, 2012).

This overview of systematic reviews, a methodology recognised by the Cochrane Collaboration (Becker and Oxman, 2011), provides a comprehensive, up-to-date analysis for policymakers and researchers of review-level evidence on population-level interventions to reduce alcohol consumption or its adverse health effects.

Section snippets

Methods

Medline, Embase, Cochrane, Social Policy and Practice, DARE1

Results

Fifty-two primary reviews were included, of which nine conducted meta-analyses. Twelve reviews were rated high quality, 29 medium and 11 low. No reviews reported funding by alcohol industry organisations; however, review funding was inconsistently reported. The reviews were categorised according to ten broadly-defined policy areas as shown in Table 1. Reviews covering two policy areas were categorised according to their main focus, with findings outside this category discussed within the other

Discussion

This paper presents an overview of the current evidence base for population-level interventions to reduce alcohol consumption and related harm which will be relevant for researchers and policymakers. Our findings are consistent with other major national (for example NICE, 2010) and international (notably Babor et al., 2010) reviews of the topic. This systematic overview updates and adds to this literature by focussing only on evidence directly concerning population-level intervention

Conclusion

This systematic overview provides a broad but rigorous summary of current research evidence for both generalist public health professionals and policymakers in health and non-health sectors. There is review-level evidence supporting population-level alcohol interventions in all policy sectors identified, with the notable exception of higher education settings. There is more consistent support for the effectiveness of interventions targeting alcohol consumption or harm if they involve regulatory

Conflict of interest statement

This work was supported by the National Institute for Health Research (NIHR)’s School for Public Health Research (SPHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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