gms | German Medical Science

Hazardous alcohol consumption of children, adolescents and young adults has been increasing for several years in Germany. Alcohol prevention programs are intended to stop this development. For the review of the efficacy of these programs the German Institute for Medical Documentation and Information (DIMDI) has commissioned a health technology assessment (HTA) which has given an international overview of the efficacy of alcohol prevention measures. German alcohol prevention measures are insufficiently included in scientific electronic data bases. This report has therefore the aim to find out the efficacy of German alcohol prevention programs and the federal structures of funding bodies.

The HTA-report “Prevention of alcohol misuse among children, youths and young adults” (DIMDI, Band 112, 2011) has shown that internationally only a few prevention measures lead to a sustainable reduction of the amount and/or frequency of alcohol consumption. For Germany a deficit regarding the efficacy evaluation of alcohol preventive measures has been stated. Additionally the need of the development of specific and target group oriented preventive measure has been pointed out.

Who are the funding bodies of alcohol prevention programs for children, adolescents and young adults in Germany?

How are the alcohol preventive measures financed in Germany?

Which alcohol preventive projects are evaluated in Germany?

Which alcohol preventive measures are effective in Germany (efficacy evaluation)?

The funding bodies of alcohol prevention programs have been identified by an internet research. To gather the current alcohol prevention programs a written survey has been conducted among 17 federal institutions, 69 state institutions, 165 municipalities and five health insurances. A specific questionnaire has been developed for the survey which collected key information of the single preventive project, including the question whether an efficacy evaluation is in the planning or has been already conducted and which outcome parameter have been used.

One federal agency, 15 state institutions, 77 municipalities and two health insurances participated in the survey. These 95 institutions documented 208 alcohol prevention projects. The target groups of the preventive measures range from kindergarten children to 27-year old adults. The objectives of the preventive measures are comprehensive and cover the promotion of health and life competence skills, addiction and violence prevention, knowledge transfer, reduction of psychic stress, empowerment of capacity to act and willingness to change, responsible consumption behavior, attitude change, retardation of alcohol consumption age, reduction of excessive alcohol consumption. Only for eleven projects (5,3 %) the efficacy has been evaluated. Only four projects show efficacy (1,9 %), only two projects are methodologically satisfying.

It is evident that corresponding to the federal structure of Germany preventive measures are initiated and performed at the federal, the state and the municipal level. Currently 36 million Euro are spent annually for alcohol prevention measures for children, adolescents and young adults in Germany.

Federal institutions, state institutions and municipalities cooperate only in a limited way. As central actor the Federal Centre for Health Education (BZgA) is involved in numerous projects. Two of these are the internet platforms Dot.sys and PrevNet which are however not up-to-date, not comprehensive and currently not suitable for scientific analysis.

The term evaluation is used in a broad sense by the prevention projects, but in most cases a process evaluation has been done. The quality of the eleven documented efficacy evaluations is not very high due to several limitations (e. g. number of cases, sampling, study design, outcome parameters, statistical tests, follow-ups). Only two projects, “Klasse2000” and “Aktion Glasklar” can be regarded as evidence based. The prevention project “HaLT” which has been implemented in 147 municipalities, is actually not evidence based.

The efficiency of the millions of Euro which are spent for alcohol prevention measures is not evaluated, neither the cost-benefit- nor the cost-effectiveness-relation. This is completely in contradiction to the health economical and political demand that prevention should be (cost)-effective.

Basically, this report confirms the conclusion of the HTA-report “Prevention of alcohol misuse among children, youths and young adults” that non-evaluated alcohol prevention projects are conducted to the greatest possible extent in Germany. What is needed in Germany is a general new direction and transformation of research and of the implementation of alcohol preventive measures for children, adolescents and young adults. Before preventive measures are realized area-wide, it is mandatory to verify their efficacy by parameters like significant reduction of alcohol consumption, risk drinking or binge drinking. Only in this way the financial means and resources are allocated meaningful and effective.

Keywords: alcohol misuse; alcohol prevention; alcoholism; children; drinking; EBM; effectiveness; efficacy; efficiency; evaluation; evidence based medicine; Germany; Health Technology Assessment; HTA; intervention; intoxication; peer review; prevention; preventive project; program evaluation; youth