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Systematic Review
"Family, parental, and school-based educational programs have shown a positive impact on substance misuse in children and adolescents. Social norms and other computer based interventions may be effective in reducing alcohol misuse in adults.."
The three SRs targeting an adult population included participants with high- and low riskdrinking behaviors.9-11 It was not possible to separate the results for the primary prevention population from the secondary prevention population. The length of follow-up was 6 months or less in the majority of studies, thus the durability of the effect of the intervention is unclear. None of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact.The generalizability of findings is also a potential limitation. Most of the studies were conducted in the US and thus the differences between Canada and the US in their cultural and racial composition, education and health systems should be considered when applying the findings to the Canadian context. In one SR,9 the included RCTs recruited students from university psychology classes, or limited to high-risk drinkers, thus the generalizability to the broader university or college population may be limited. Due to the length of follow-up in the D’Onise8 SR, the preschool programs studied were implemented in 1960s to 1980s and may not be generalizable to current pre-school programs. Overall there were few studies in First Nations people and all were from the US. Johnson et al.13 did not report the results of the intervention for Native Alaskan students separately from Caucasian students however in 8 of the 14 communities 90% of residents were of Native American or American Indian ancestry."
"There are numerous studies available that evaluate the effectiveness of programs to prevent substance misuse in general adult and youth populations. Three studies included First Nations People, none of which were conducted in Canada. Family or parental support programs can be effective in reducing or preventing substance misuse in adolescents. School-based programs that develop psychosocial skills have also shown positive effects on drug and alcohol misuse. The evidence to support mentoring and preschool programs for primary prevention of substance misuse are less clear. In adults, social norms interventions delivered face-to-face or via computer, or other computer based interventions, have shown some benefits in reducing alcohol use among university and college students or the general adult population. School-based programs that were culturally adapted to include Native American values and beliefs reported positive effects on some drug use outcomes among US First Nations youth. None of the studies measured death, stigma or discrimination related to substance misuse, and minimal information was available in one study on health services impact. The overall quality of the studies, however, may be considered limited. Many of these studies were underpowered and had follow-up times less than six months. Other limitations included lack of blinding, unclear allocation concealment, self-reported outcomes and attrition rates exceeding 20%. The majority of the studies were conducted in the US. Considering the importance of the population characteristics and setting to the success of psychosocial interventions, the generalizability of these studies to the Canadian context should be carefully evaluated when developing policy options."