Programs, interventions and policies for preventing tobacco, alcohol and drugs use: evidence of effectiveness

Background The use of tobacco, alcohol and other drugs is the predominant cause of the burden of disease in developed countries, including mortality excess, and wide-ranging effects on personal safety, mental health, and social well-being. The aim of this work is to identify the programs, interventions, and policies effective for preventing tobacco and drug use, and alcohol misuse. Methods Systematic reviews, reports of international agencies, and guidelines of preventive practice were searched and examined. The Cochrane Library (Issue 1/2007), the Medline database and the websites of NICE, CDC, European Union, WHO, SIGN, NIDA, and EMCDDA were also explored. All documents useful for the research question were examined and synthesised. The primary prevention interventions were classified in: 1) universal prevention, when targeted to the general population as well as to specific unselected populations (school, family, community); 2) selective prevention, when targeted to subsets of the population identified as having a higher risk of drug use than average; 3) indicated prevention, when targeted to those who have already taken drugs and are considered to be at risk of becoming addicted. Results Bans and restrictions are effective in preventing tobacco and alcohol use. School-based programs based on the comprehensive social influence approach, and family programs for selected populations appear to be effective. Mass media campaigns can be effective in reducing tobacco use, especially when associated with school-based and community programs. Knowledge-based school programs and employment skills programs are not effective. No evidence is available on the interaction among market advertising, prevention campaigns, and programs at the community levels. Conclusions The availability of data on effectiveness of interventions is far from satisfactory, particularly for interventions at a population level. However, the evidence collected so far is sufficient on which to base effective public health policies.