Health Behaviour in School-aged Children (HBSC), a WHO collaborative cross-national study, has provided information about the health, well-being, social environment and health behaviour of 11-, 13and 15-year-old boys and girls for over 30 years. This latest international report from the study presents findings from the 2013/2014 survey, which collected data from almost 220 000 young people in 42 countries in Europe and North America. The data focus on social context (relations with family, peers and school), health outcomes (subjective health, injuries, obesity and mental health), health behaviours (patterns of eating, toothbrushing and physical activity) and risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying) relevant to young people’s health and well-being. New items on family and peer support, migration, cyberbullying and serious injuries are also reflected in the report.

Growing up unequal: gender and socioeconomic differences in young people's health and well-being.

Interventions for Adolescent Substance Abuse: An Overview of Systematic Reviews

Background
Drug addiction is a chronic, relapsing disease. Primary interventions should aim to reduce first use or to prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions.

Objectives
To evaluate the effectiveness of universal school-based interventions in reducing drug use compared to usual curricular activities or no intervention.

Search methods
We searched the Cochrane Drugs and Alcohol Group's Trials Register (September 2013), the Cochrane Central Register of Controlled Trials (2013, Issue 9), PubMed (1966 to September 2013), EMBASE (1988 to September 2013) and other databases. We also contacted researchers in the field and checked reference lists of articles.

Selection criteria
Randomised controlled trials (RCT) evaluating school-based interventions designed to prevent illicit drugs use.

Data collection and analysis
We used the standard methodological procedures expected by The Cochrane Collaboration.

Main results
We included 51 studies, with 127,146 participants. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA.

Social competence approach versus usual curricula or no intervention

Marijuana use at < 12 months follow-up: the results favoured the social competence intervention (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.81 to 1.01, four studies, 9456 participants, moderate quality evidence). Seven studies assessed this outcome (no data for meta-analysis): two showed a positive significant effect of intervention, three showed a non-significant effect, one found a significant effect in favour of the control group and one found a trend in favour of the control group.

Marijuana use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2678 participants, high quality evidence). Seven studies assessed this outcome (no data for meta-analysis): two showed a significant positive effect of intervention, three showed a non-significant effect, one found a significant effect in favour of the control group and one a trend in favour of the control group.

Hard drug use at < 12 months: we found no difference (RR 0.69; 95% CI 0.40 to 1.18, one study, 2090 participants, moderate quality evidence). Two studies assessed this outcome (no data for meta-analysis): one showed comparable results for the intervention and control group; one found a statistically non-significant trend in favour of the social competence approach.

Hard drug use at 12+ months: we found no difference (mean difference (MD) -0.01; 95% CI -0.06 to 0.04), one study, 1075 participants, high quality evidence). One study with no data for meta-analysis showed comparable results for the intervention and control group.

Any drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two studies, 2512 participants, moderate quality evidence). One study with 1566 participants provided continuous data showing no difference (MD 0.02; 95% CI -0.05 to 0.09, moderate quality evidence).

Social influence approach versus usual curricula or no intervention

Marijuana use at < 12 months: we found a nearly statistically significant effect in favour of the social influence approach (RR 0.88; 95% CI 0.72 to 1.07, three studies, 10,716 participants, moderate quality evidence). One study with 764 participants provided continuous data showing results that favoured the social influence intervention (MD -0.26; 95% CI -0.48 to -0.04).

Marijuana use at 12+ months: we found no difference (RR 0.95; 95% CI 0.81 to 1.13, one study, 5862 participants, moderate quality evidence). One study with 764 participants provided continuous data and showed nearly statistically significant results in favour of the social influence intervention (MD -0.22; 95% CI -0.46 to 0.02). Of the four studies not providing data for meta-analysis a statistically significant protective effect was only found by one study.

Hard drug use at 12+ months: one study not providing data for meta-analysis found a significant protective effect of the social influence approach.

Any drug use: no studies assessed this outcome.

Combined approach versus usual curricula or no intervention

Marijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies, 8701 participants, moderate quality evidence). One study with 693 participants provided continuous data and showed no difference (MD -1.90; 95% CI -5.83 to 2.03).

Marijuana use at 12+ months: the results favoured combined intervention (RR 0.83; 95% CI 0.69 to 0.99, six studies, 26,910 participants, moderate quality evidence). One study with 690 participants provided continuous data and showed no difference (MD -0.80; 95% CI -4.39 to 2.79). Two studies not providing data for meta-analysis did not find a significant effect.

Hard drug use at < 12 months: one study with 693 participants provided both dichotomous and continuous data and showed conflicting results: no difference for dichotomous outcomes (RR 0.85; 95% CI 0.63 to 1.14), but results in favour of the combined intervention for the continuous outcome (MD -3.10; 95% CI -5.90 to -0.30). The quality of evidence was high.

Hard drug use at 12+ months: we found no difference (RR 0.86; 95% CI 0.39 to 1.90, two studies, 1066 participants, high quality evidence). One study with 690 participants provided continuous data and showed no difference (MD 0.30; 95% CI -1.36 to 1.96). Two studies not providing data for meta-analysis showed a significant effect of treatment.

Any drug use at < 12 months: the results favoured combined intervention (RR 0.76; 95% CI 0.64 to 0.89, one study, 6362 participants).

Only one study assessed the effect of a knowledge-focused intervention on drug use and found no effect. The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to synthesise.

Authors' conclusions
School programmes based on a combination of social competence and social influence approaches showed, on average, small but consistent protective effects in preventing drug use, even if some outcomes did not show statistical significance. Some programmes based on the social competence approach also showed protective effects for some outcomes.

Since the effects of school-based programmes are small, they should form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.

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Universal school‐based prevention for illicit drug use

This review presents findings from an overview of meta-analyses of the effects of prevention and promotion programs to prevent mental health, substance use, and conduct problems. The review of 48 meta-analyses found small but significant changes that reduce depression, anxiety, antisocial behavior, and substance use. Furthermore, the results were sustained over time. Meta-analyses often found that the effects were heterogeneous. A conceptual model is proposed to guide the study of moderators of program effects in future meta-analyses, and methodological issues in synthesizing findings across preventive interventions are discussed.

Overview of Meta-Analyses of the Prevention of Mental Health, Substance Use, and Conduct Problems*

Internet and computer based interventions for cannabis use: A meta-analysis

This investigation used meta-analytic techniques to evaluate the effectiveness of school-based prevention programming in reducing cannabis use among youth aged 12 to 19. It summarized the results from 15 studies published in peer-reviewed journals since 1999 and identified features that influenced program effectiveness. The results from the set of 15 studies indicated that these school-based programs had a positive impact on reducing students' cannabis use (d = 0.58, CI: 0.55, 0.62) compared to control conditions. Findings revealed that programs incorporating elements of several prevention models were significantly more effective than were those based on only a social influence model. Programs that were longer in duration (≥15 sessions) and facilitated by individuals other than teachers in an interactive manner also yielded stronger effects. The results also suggested that programs targeting high school students were more effective than were those aimed at middle-school students. Implications for school-based prevention programming are discussed.

A Meta-Analytic Review of School-Based Prevention for Cannabis Use

A roadside survey of alcohol and drug use among drivers in British Columbia

The objective of this paper is to illustrate the accuracy with which police officers trained as Drug Recognition Experts (DREs) can identify the category of drug(s) ingested by persons suspected of being impaired as the result of drug use. The study examined 1,349 drug evaluations completed by DREs in Canada to determine the extent to which DRE opinions about the category of drug(s) used matched the results of toxicological analysis of fluid samples. The paper presents measures of sensitivity, specificity, the false alarm rate, and miss rate for all drug categories combined as well as for the most commonly found substances. The data demonstrate that the drug evaluations conducted by DREs in Canada are accurate.

Erin E. Beasley

Papers

A Meta-Analytic Review of School-Based Prevention for Cannabis Use

A roadside survey of alcohol and drug use among drivers in British Columbia

The Accuracy of Evaluations by Drug Recognition Experts in Canada

Toward a More Parsimonious Approach to Drug Recognition Expert Evaluations

An evaluation of immediate roadside prohibitions for drinking drivers in British Columbia: findings from roadside surveys.