ReviewPopulation-level interventions to reduce alcohol-related harm: An overview of systematic reviews
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.
References (69)
- et al.
Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol
Lancet
(2009) - et al.
Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment
Prev. Med.
(2009) - et al.
Priority actions for the non-communicable disease crisis
Lancet
(2011) - et al.
A systematic review of the influence on alcohol use of community level availability and marketing of alcohol
Health Place
(2012) - et al.
The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms
Am. J. Prev. Med.
(2009) - et al.
Effectiveness of designated driver programs for reducing alcohol-impaired driving: a systematic review
Am. J. Prev. Med.
(2005) - et al.
Can preschool improve child health outcomes? A systematic review
Soc. Sci. Med.
(2010) - et al.
Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes: a systematic review
Am. J. Prev. Med.
(2004) - et al.
Effectiveness of school-based programs for reducing drinking and driving and riding with drinking drivers: a systematic review
Am. J. Prev. Med.
(2005) - et al.
The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms
Am. J. Prev. Med.
(2010)