Elsevier

Preventive Medicine

Volume 113, August 2018, Pages 132-139
Preventive Medicine

Social marketing and community mobilisation to reduce underage alcohol consumption in Australia: A cluster randomised community trial

https://doi.org/10.1016/j.ypmed.2018.02.032Get rights and content

Highlights

  • An RCT of 28 communities, targeting adolescent alcohol consumption in Australia.

  • A multilevel intervention targeting adolescent's alcohol consumption, based on theory and evidence.

  • A decline in consumption was observed, but was not significantly different between 28 communities.

  • Subgroup analysis identified differences for primary and secondary measures.

Abstract

Background and aims

In many countries adolescent alcohol use is a major health problem. To supplement national policies, it is important to trial community interventions as a potential strategy to prevent adolescent alcohol use.

Methods

This study evaluated a multicomponent community intervention that included community mobilisation, social marketing, and the monitoring of alcohol sales to minors. Evaluation was a clustered randomised trial design with 14 intervention and 14 control communities. Prior to randomisation, communities were matched on socioeconomic status and location. Intervention communities were not blinded.

Participants

3545 Year 8 students (M = 12 years) were surveyed at baseline from 75 schools; 3377 students were surveyed post intervention in 2013 from 54 schools.

Outcomes

It was hypothesised that the primary outcome, individual alcohol consumption in last 30 days, after the intervention would be 15% lower in intervention communities. Secondary outcomes were consumption in the past year and intention not to drink before age 18.

Results

The intervention communities showed larger relative reductions compared to the controls in last 30-day consumption and past year (10%), but not significantly different. A significantly lower proportion of participants in the intervention community (63%), compared to the controls (71%), reported intending to drink before 18 years old. Subgroup analysis identified regional and state differences for some secondary measures.

Conclusions

Intervention assignment was associated with lower adolescent intention to drink before the age of 18. However, more intensive and longer-term intervention may be required to measure significant differences in behaviour change.

Trial registration: ACTRN12612000384853.

Protocol: Rowland B, Toumbourou JW, Osborn A, et al. BMJ Open 2013;3:e002423. doi:10.1136/bmjopen-2012-002423

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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