Focus of the intervention
School-based programmes to reduce drinking and driving deliver knowledge about the effects of drink-driving, as well as teaching participants refusal skills.
Often interactive in their approach, these programmes can be delivered as part of wider substance abuse packages or in isolation. As well as school-organised programmes, this review also evaluates peer-organised programmes, which focus on encouraging fellow students to refrain from drink-driving.
It also looks at social norming programmes, which are based on university campuses and aim to reduce alcohol use by providing more accurate information regarding alcohol consumption.
This narrative is primarily based on one systematic review covering 13 studies, with additional information on economic costs from Review two (59 studies).
Effect – how effective is it?
There is some evidence that the intervention has reduced crime, but overall the intervention has not had a statistically significant effect on crime.
The overall results of Review one are based on the findings from 13 primary evaluations, although those regarding the primary outcome of reducing drink-driving were based on only 5.
Other non-crime outcomes measured in the primary studies included riding with drinking drivers. All outcomes were based on self-reporting by programme participants. Overall there was no significant impact on criminal justice related outcomes, however, there was sufficient evidence to suggest that these programmes are effective in reducing self-reported riding with drinking drivers.
How strong is the evidence?
Although the review was systematic, some forms of bias that could influence the study conclusions remain. The overall evidence is taken from Review one covering 13 studies.
The statistical analysis conducted in the review was based upon a low number of studies (five primary studies for drink-driving), and while there was some evidence for beneficial effects of peer-organised and social norming campaigns, these were based on only two primary studies each. One study reported on outcomes related to crashes, showing a small decrease amongst programme participants during the first year, however, this effect disappeared in subsequent years.
Mechanism – how does it work?
Review one suggests that these initiatives may reduce drink driving by:
a) increasing participants’ knowledge of the consequences of, and alternatives to, drinking and driving
b) developing participants’ refusal skills
c) changing perceived social norms about drinking and driving.
These may then lead to a change in attitude and intentions, as well as impact upon the susceptibility to peer, media and other societal influences. Ultimately this should lead to a decrease in drink driving and the crashes, injuries and deaths associated with these behaviours.
Moderators – in which contexts does it work best?
There were mixed results for subgroups of behaviours, with the impact of the program upon high-risk (heavier drinkers) and low-risk (lighter drinkers) behaviours being inconclusive and inconsistent. Two studies of school-based programmes showed a higher impact on drink-driving for those drivers who drank more frequently, while another comparable study showed the opposite.
The small number of studies which tested peer-organised programs in schools compared to school-organised instructional programmes meant a comparison was not possible, but it would seem that peer-organised programmes confer a wide range of social benefits upon participants beyond just drink-driving outcomes.
Implementation – what can be said about implementing this initiative?
Review one suggests that there is evidence that in order for programmes to be more successful, an interactive delivery approach is necessary.
Programmes varied in their content and delivery method – three studies had primarily lecture-based presentations, while the other six studies, which were school-organised instructional programmes, involved much more interactivity. The more interactive programmes focused on skills development such as refusal. Programme sessions generally lasted one hour, and programme length varied from 1 to 12 sessions, with a median of 5 sessions.
The content of programmes was varied, including short films, graphic images of road crash victims, role-playing activities and presentations by emergency personnel. Risk reduction skills and dealing with peer pressure were learning components in some studies, as was raising awareness of drink driving laws and social norms around alcohol. With the small number of available studies it is not possible to ascertain whether any particular type of content is more effective than another.
All of the studies in the review were conducted in the US, with students in high school grades 8 to 12 the focus of programmes.
Economic considerations – how much might it cost?
There was no information on the cost of programmes within Review one. Review two (based on 59 studies) gives basic information about cost per participant per year of school-based interventions in three different geographical regions: The Americas (USD $0.29); Europe (USD $0.34); and Western Pacific including China (USD $0.53). There was no cost benefit analysis within Review two.
The wide variety in the content, delivery and length of school-based programmes made direct comparison of results difficult. Further research is needed to determine the optimal configuration of content, delivery method and exposure needed, especially with different subpopulations.
There were inconsistent results regarding follow-up periods – some programmes suggested a decrease in effectiveness over time, while others suggested an increase.
It is suggested that school-based programmes may not be effective if implemented below a certain threshold of exposure, which was not specified in the review. Programme length varied from 1 to 12 sessions, with a median of 5 sessions.
To maximise the effectiveness of school-based programmes, they may need to be part of a larger community effort.
Peer-organised programmes may provide wider benefits to members including personal growth, social support and a sense of citizenship in the community.
There is some evidence that the intervention has reduced drink-driving, but overall the intervention has not had a statistically significant effect on crime. Student-focused programmes are varied in their content, delivery and intensity, and appear to work better when delivered with an interactive approach. They do show evidence of being effective for reducing self-reported riding with drink drivers.
Elder, R. W., Nichols, J. L., Shults, R. A., Sleet, D. A., Barrios, L. C. and Compton, R. (2005) ‘Effectiveness of School-Based Programs for Reducing Drinking and Driving and Riding with Drinking Drivers’, American Journal of Preventative Medicine, Vol. 28, No. 5s, 288 – 304
Anderson, P., Chisholm, D. and Fuhr, D. C. (2009) ‘Alcohol and Global Health 2: Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol’, Lancet, Vol. 373, 2234 – 2246
Summary prepared by
This narrative was prepared by UCL Jill Dando Institute and was co-funded by the College of Policing and the Economic and Social Research Council (ESRC). ESRC Grant title: 'University Consortium for Evidence-Based Crime Reduction'. Grant Ref: ES/L007223/1.