Effectiveness of strategies to reduce risky alcohol consumption among youth living in rural or remote areas: a systematic review
Authors: Cibich Mikaela , Hines Sonia , Carey Timothy A. 
Published: June 2023

Objective:
This review aimed to evaluate the effectiveness of strategies to reduce risky alcohol consumption among youth living in rural and remote areas.

Introduction:
Youth living in rural and remote areas are more likely to drink alcohol and experience alcohol-related harm than youth living in urban locations. This is the first review assessing the effectiveness of strategies to reduce young people’s risky alcohol consumption in rural and remote areas.

Inclusion criteria:
We considered papers that included youth (aged 12 to 24 years; also referred to in this review as “young people”) who were identified as living in rural or remote locations. Any intervention or strategy designed to reduce or prevent alcohol consumption among this population was included. The primary outcome was frequency of short-term risky alcohol consumption as measured by self-reported incidents of drinking 5 or more standard drinks in 1 session.

Methods:
We conducted this systematic review in accordance with the JBI methodology for systematic reviews of effectiveness. We searched for published and unpublished English-language studies and gray literature from 1999 to December 2021. Two authors screened titles and abstracts before full-text screening and data extraction. Two authors reviewed the extracted data to identify studies that reported duplicate data (eg, due to progressive publication of longitudinal data sets) and, where multiple studies reported the same data set, the study with the measure most proximal to the primary outcome measure and/or with the longest follow-up was selected. Two authors then critically appraised the studies. There were no interventions that assessed their impact on the primary outcome in more than 1 study; in turn, the feasibility and utility of statistical pooling and the Summary of Findings were limited. Instead, results and certainty of evidence is provided in narrative format.

Results:
Twenty-nine articles1-29 reporting 16 studies were included in the review: 10 RCTs1,4,7,8,11,13,17,20,26,27; 4 quasi-experimental studies2,9,12,16; and 2 cohort studies10,28. All studies except 110 were conducted in the USA. Only 3 studies1,2,4 measured the primary outcome of short-term risky alcohol consumption and included a comparison group. A meta-analysis of 21,2 of these studies showed that interventions that included motivational interviewing had a small and non-significant effect on short-term risky alcohol consumption amongst Indigenous youth in the United States. Meta-analyses of the effect of a variety of interventions on secondary outcomes demonstrated that intervention was not more effective than control for reducing past month drunkenness and were less effective than control for reducing past month alcohol use. The heterogeneity of effects was evident within these meta-analyses as well as studies unable to be meta-analyzed.

Conclusion:
Based on this review, no interventions can be broadly recommended for reducing short-term risky alcohol consumption among youth in rural and remote areas. Further research to increase the robustness of available evidence in relation to the effectiveness of strategies to reduce short-term risky alcohol consumption among youth in rural and remote areas is urgently required.

Systematic Review Registration:
PROSPERO CRD42020167834