School-based interventions effective in preventing multiple risk behaviours

School-based interventions effective in preventing multiple risk behaviours

Brian McAvoy
Clinical question

How effective are individual, family and school-based interventions for the primary or secondary prevention of multiple risk behaviours among young people (up to 18 years)?

Bottom line

School‐based programmes provided universally without consideration of individual risk were likely to be effective in preventing tobacco use, alcohol use and physical inactivity (moderate‐quality evidence) and might also be beneficial in relation to illicit drug use (low‐quality evidence). Evidence was less certain for the effects of such multiple-risk-behaviour interventions for cannabis use, sexual-risk behaviours and unhealthy diet. Individual and family‐level interventions seemed to have little or no benefit in relation to the outcomes considered. Included studies had a combined intervention and follow-up period of ≥6 months.


Most studies were conducted in the US. Seven studies reported adverse effects, which involved evidence suggestive of increased involvement in a risk behaviour among participants receiving the intervention compared with participants given control interventions.


Health-risk behaviours, such as smoking and drug use, can group together during the teenage years, and engagement in these multiple-risk behaviours can lead to health problems such as injury and substance abuse during childhood and adolescence, as well as non‐communicable diseases later in life. Currently, we do not know which interventions are effective in preventing or decreasing these risky behaviours among children and young people.

Cochrane Systematic Review

MacArthur et al. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Reviews, 2019, Issue 10. Art. No.: CD009922.DOI: 10.1002/14651858. CD009922.pub2. This review contains 70 studies involving mostly high-income countries.