Social marketing and community mobilisation to reduce underage alcohol consumption in Australia: A cluster randomised community trial
Introduction
Adolescent alcohol consumption is linked to an array of problems, including road accidents, injuries, risky sexual behaviour, antisocial behaviour, academic failure poor mental health and impacts on brain development (NHMRC, 2009). Given evidence of these problems, guidelines in Australia recommend that young people should not drink alcohol before the age of 18 years, which is also the legal age for purchasing alcohol in Australia.
Social marketing campaigns have been used effectively to promote reductions in unhealthy behaviours such as alcohol consumption (McVey and Stapleton, 2000). Brief communications, grounded in behaviour theory (Gollwitzer and Brandstätter, 1997) are often featured in health education materials. Parents also play a major role in ensuring children avoid alcohol during the adolescent years (Chan et al., 2015; Kelly et al., 2016). Alcohol sales enforcement programs, such as underage sales monitoring (using secret shoppers) and feedback, have also been used to reduce sales of alcohol to minors (Flewelling et al., 2013; Moore et al., 2012).
In Australia in 2009, adolescent consumption peaked, when 82% of adolescents (12–17 years) reported consuming at least a full serve of alcohol in their lifetime. The current national data (2014) indicates that this has declined to 68% (White and Williams, 2016). These data also indicate that 25% reported consuming alcohol in the last month. Approximately 40% report being supplied alcohol by a parent (AIHW, 2014). The present study used a clustered randomised control trial to evaluate a multicomponent community-wide alcohol intervention, designed to reduce adolescent alcohol consumption with year 8 adolescents (approximately 12 years of age).
Based on a related USA trial (see Rowland et al., 2013), the primary hypothesis was that intervention communities would have a 15% lower proportion of adolescents that recently consumed alcohol, compared to controls. Secondary hypotheses were that adolescents in intervention communities would show that 15% fewer would report consuming alcohol in the last year, and being supplied alcohol by their parents, compared with controls. It was also hypothesised that there would be significantly more participants in the control group intending to consume alcohol before the age of 18, compared to controls.
Section snippets
Trial registration protocol
The trial was registered with the Australian New Zealand Clinical Trial Registry: ACTRN12612000384853. A protocol for the trial has been published (see Rowland et al., 2013).
Design
The intervention used a repeat cross-sectional, parallel group cluster randomised controlled trial design (see Fig. 1), with communities randomised to either control or intervention.
Setting
The intervention occurred within Statistical Local Areas (SLA: An Australian Standard Geographic Classification structure consisting of
Baseline
At baseline, there were more males in the intervention (54%) group, compared with the control (51%) (χ2(1) = 3.81; N = 3512; p = .051). Similarly, the age of respondents was significantly higher in the intervention group (M = 12.4; SD = 0.71), compared with the control (M = 12.0; SD = 0.59) (t (3508) = −17.3; p = .000). At baseline, the difference in consumption levels in the last 30 days was also significantly different between the intervention (29%) and control (24%) groups (χ2(1) = 10.96; N
Discussion
This is the first Australian community trial designed to reduce adolescent alcohol consumption at a population level. The primary hypothesis that adolescents in the intervention communities would report a 15% lower consumption of alcohol in the last 30 days was not supported, with the observed fall 10%. The secondary hypotheses that adolescents in the intervention communities would show 15% lower consumption in the last year was not supported as the observed fall was 10% and there was no
Conflict of interest statement
The authors declare that they have no conflict of interest. Coauthor John Toumbourou is a voluntary Director and the Chief Executive Officer, and Bosco Rowland Deputy CEO of the not-for-profit company Communities That Care Ltd that disseminates the Communities That Care youth survey in Australia.
Acknowledgements
Funding was provided by Australian Research Council Linkage Grant (grant #LP100200755), the National Health and Medical Research Council (NHMRC APP1087781), the Murdoch Childrens Research Institute, Communities That Care Ltd, 14 local community partners, Centre for Youth Substance Abuse Research (CYSAR) at the University of Queensland, VicRoads Victorian Community Road Safety Partnership Program and the Victorian Transport Accident Commission Community Road Safety Grants Program.
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