Introduction
Customer orientation | Focus on the needs, wants and attitudes of the targeted persons towards the intervention. |
Insight | Examine why people behave the way they do. |
Segmentation | Dividing a heterogeneous target group into more homogeneous segments, based on motives, values, behaviours, attitudes, knowledge and opinions, is called audience segmentation [26‐28]. Developing an intervention based on these motives/values for a certain segment increases the chance that the audience will adopt the targeted public health intervention [26, 29]. |
Behavioural goals | Clear and attainable behavioural goals must be set for the audience in a chosen segment. |
Exchange | Incentives for the targeted behaviour must be increased and barriers must be removed. |
Competition | Competition, which is all the forces that compete with the time/interest of the target group, must be clear. Competitive factors for drinking less alcohol include, for example, the social norms and peer pressure. |
Methods mix | It is important to mix interventions, because a mix will be more successful than one single intervention [22]. |
Theory based |
Methods
Inclusion criteria | Operationalization |
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Effects of an alcohol prevention intervention | – An included study evaluates the effect of an alcohol prevention intervention. |
– The invention is about any kind of alcohol prevention, aimed at increasing desired and healthy alcohol behaviour or at decreasing undesired and unhealthy alcohol behaviour. For example the prevention of the (high-risk) use of alcohol, the prevention of harm caused by alcohol (for example drinking and driving), or changing perceptions about the effect of drinking alcohol. | |
– There are no age limits to the target group of the intervention. | |
Intervention developed according to the principles of social marketing | – Social marketing consists of eight criteria (as outlined in Table 1). An intervention was developed according to one or more social marketing criteria. |
– In the abstract and/or in the full text of the included study, social marketing, or one or more social marketing criteria, were explicitly mentioned. |
Authors, and intervention name | Target group intervention | Description social marketing intervention | Social marketing criteria applied |
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Incerto, et. al., 2011 [32], “Fourth Year Fifth” event. | Fourth-year college students, in Virginia, U.S. | Intended to prevent participating in the “Fourth Year Fifth” event. Consisted of 12 interventions. Further, 9 examples were given to behave protectively. | Customer orientation, insight, behavioural goals, exchange, methods mix. |
Glassman, et. al., 2010 [33], “Less is more”. | College students aged 18–24 years, in South-East, U.S. | Intended to decrease high-risk drinking, and drinking and driving, and to change the perception that alcohol use increases sexual opportunities. Messages were disseminated from 2004 to 2008. | Customer orientation, insight, exchange, competition, methods mix. |
Slater, et. al., 2006 [34], “Be under your own influence”. | Sixth graders from middle-high school and seventh graders from junior-high school, in North-East, South-East, Mid-West, and West, U.S. Mean age 12.2 years. | Intended to emphasize the inconsistency of marijuana, alcohol and tobacco use with one’s aspirations, and to reframe substance use as an activity that impaired, rather than enhanced personal autonomy. Materials were distributed during first and second year. | Customer orientation, insight, behavioural goals, exchange, competition, methods mix. |
Rothshild, et. al., 2006 [35], “Road Crew”. | Men aged 21-34 years in 8 rural communities, U.S. | Intended to create ride programs for people who drank too much alcohol, to decrease alcohol-related crashes by 5%. The intervention did not attempt to change the level of consumption of alcohol. | Customer orientation, insight, segmentation, behavioural goals, exchange, methods mix. |
Gomberg, et. al., 2001 [37], “Just the facts”. | Freshmen at the University of Mississippi, U.S. | Intended to change the perceptions of student drinking norms and alcohol consumption, and to decrease high- risk drinking. Implemented in fall 1995 and in spring 1996. | Insight, segmentation, methods mix partly, theory based. |
“Thanks for being a sober driver” focuses on rewarding the behaviour of sober drivers. Impaired drivers were charged. Consisted of a mix between education (media campaign) and enforcement (roadside spot-checks by police). Lasted 1 year. | |||
Caverson, et. al., 1990 [36], “Thanks for being a sober driver”. | Inhabitants aged 16+ years of the regional municipality of Sudbury, Ontario (Canada). | Insight, segmentation, exchange, methods mix. |
Authors, intervention name, and aim of study | Study design and analysis | Target group study | Outcome variables and results | Risk/possible bias |
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Incerto, et. al., 2011 [32], “Fourth Year Fifth”event, determine effectiveness of social norms marketing campaign to prevent participating in the “Fourth Year Fifth” event 1. | Observational cross-sectional. Web-based survey to random sample. Wilcoxon Signed-Rank tests. Descriptive statistics. | n = 536/1,000, response rate = 53.6%. | Participation in the “Fourth Year Fifth” event: 19.6% participated. Application of protective behaviours: 86.3% diluted alcohol; 80.6% had sufficient sleep; 78.6% ate large breakfast. Relation participation and exposure to campaign elements : χ2 = 34.81, d.f. = 6, p ≤ 0.001. | No control group. No pretest. Different response prompts to questions: no comparison possible. Short-term effect only. |
Glassman, et. al., 2010 [33], “Less is more”, determine effectiveness of the social marketing campaign “Less is more”. | Observational longitudinal. Standardized quantitative survey with random sample. Data collection was done six times, from fall 2004 until spring 2008. Descriptive statistics. | n = 473/2,400 in fall 2004, 19.7% | Impact on high-risk drinking: significant decrease from 56.5% to 37.8%. Impact on drinking and driving: significant decrease from 37.5% to 20.6%. Impact on the perception that alcohol use increases sexual opportunities: significant decrease from 64.0% to 50.7%. | No control group. Low response rates. Other prevention efforts may have caused the effect. Short-term effect only. |
n = 1,006/4,000 in fall 2005, 25% | ||||
n = 785/4,000 in fall 2006, 19.6% | ||||
n = 835/4,000 in spring 2007, 20.9% | ||||
n = 745/4,000 in fall 2007, 18.6% | ||||
n = 546/4,000 in spring 2008, 13.7%. | ||||
Slater, et. al., 2006 [34], “Be under your own influence”, determine effectiveness of an in-school media campaign “Be under your own influence” reinforced by community-based media efforts, on the reduction of increase of substance uptake. For this review study, only results of “Be under your own influence” are discussed. | Experimental longitudinal. Randomised community crossed design: 8 communities received social marketing in-school media intervention and 8 communities did not. Four waves of data collection, during two years. Generalised linear mixed models (four-level random-intercept model). | n = 4,216 Response rates: 68.6% provided data at 4 measurements, 16.8% at 3, 10.9% at 2, and 3.7% at 1. | Alcohol use: odds ratio (OR) = 0.40, p ≤ 0.01. Effect on rate of change in alcohol use: OR = 0.82, p > 0.05. Recognition of campaign messages: Time 2, OR = 4.70, p ≤ 0.01; time 3, OR = 6.80, p ≤ 0.01; time 4, OR = 10.13, p ≤ 0.01. | Short-term effect only. Other prevention efforts may have caused the effect. |
Rothshild, et. al., 2006 [35], “Road Crew”, determine effectiveness of social marketing intervention “Road Crew”. | Experimental longitudinal. Treatment for 1 year, with pre- and post-test. Three treatment communities and five control communities. Generalized linear models. | n = 710 and n = 693 at pre-test in treatment and control groups. n = 573 and n = 371 at post-test in treatment and control groups. | Count of all rides taken in treatment communities: 10,097 rides taken by 21-34-year-olds. Self-report of drinking and driving behaviour: less likely to drive themselves or ride with someone else (OR = 0.40, p ≤ 0.05); no significant changes in alcohol-impaired driving (χ2 = 0.82, p > 0.05); decrease in reported number of alcohol-impaired driving (χ2 = 4.85, p ≤ 0.05). | Observing changes in the number of actual crashes was not possible. Possible differences between communities of treatment and control groups. Self-reported data of bar patrons possibly underestimated. |
Gomberg, et. al., 2001 [37], “Just the facts”, analyse the results of the “Just the Facts” (JTF) campaign. | Observational longitudinal. Survey with random sample. Three times of data collection (1 pretest and 2 posttests, just after the two campaign phases). Two-sample independent t tests. Chi-square analyses. Linear regression analyses. Logistic regression analyses. | n = 785 for pretest, n = 698 for first posttest n = 583 for second posttest. | Recognition of campaign logo: 6.2% at pretest, 55.4% at first posttest, 78.5% at second posttest. Alcohol use: decrease of mean number of drinks from 15.80 at pretest to 12.61 at second posttest; decrease in mean number of days from 2.96 at pretest to 2.65 at second posttest. High risk drinking: decrease for male students from 65.6% at pretest to 58.4% at posttest and for female students from 40.5% at pretest to 34.7% at second posttest. Perceived drinking norms: significant increases in correctly answered questions about the drinking norms. | Shortcomings in research design. No control group. Decreasing response rates for three surveys. Not asked to recall campaign messages, only logo and advertisements. Measurement for high-risk drinking is not comparable. |
Caverson, et. al., 1990 [36], “Thanks for being a sober driver”, determine how the “Thanks for being a sober driver” intervention was received by the community. | Observational cross-sectional. Field experiment of 1 year. Telephone interview, conducted several months after end of pilot. Other measures: number of cars stopped, number of offences and number of folders handed out at spot-checks. Further, interviews with key informants from police department and senior officers. Descriptive statistics. | n = 445/667, response rate = 67%. | Awareness of intervention: 76%. Knowledge of slogan: 13%. Stopped by the police: 79% not been drinking prior to driving. Reaction to this and other equivalent interventions: 93% good idea to reward sober drivers. | No control group. Short-term effect only. Other drinking-driving countermeasure programs were run simultaneously: not clear whether results can be attributed to “Thanks for being a sober driver”. |