The review explores:
• the impact of alcohol education/life-skills programmes in developing school-age children’s: knowledge of, and attitudes towards, alcohol; skills (including confidence, assertiveness, resistance skills; decision-making, and ability to stay safe and healthy); and behaviours (particularly related to consumption patterns, including frequency of drinking and episodes of drunkenness)
• which alcohol education/life-skills programmes offer greatest value for money
• the processes that facilitate or inhibit the implementation, sustainability and impact of alcohol education/life-skills programmes.

The review builds on a variety of previous literature reviews, which present a mixed picture of the effectiveness of alcohol education initiatives for school-aged pupils. For full details of these reviews, see Section 2 of the report.

Review findings:
Which programmes have greatest impact on children and young people?
• Previous literature reviews of alcohol education and life-skills programmes present a mixed picture of their effectiveness for school-aged pupils.
• There are difficulties in judging impact due to:
− the challenge of generalising about effective programme ingredients
− issues related to programme fidelity. If fidelity has not been investigated through a thorough process evaluation, it is difficult to ascertain whether outcomes are a result of the effectiveness (or otherwise) of the programme, or of the way in which it has been implemented.
• This review found substantial evidence relating to the positive effects of school-based alcohol education and life-skills programmes on pupils’ alcohol related-knowledge.
• Few of the sources specifically measured the impacts on pupils’ attitudes. Those that did, have variable and inconclusive findings.
• There is little evidence of the effectiveness of alcohol education and life-skills programmes in improving pupils’ alcohol-related decision-making skills.
• There is a degree of evidence of the effectiveness of alcohol education and life-skills programmes in reducing the frequency of alcohol consumption and episodes of drunkenness among school-aged children. There are, however, limitations to several of the research studies cited.

Which programmes are most cost effective?
• Very few studies have investigated the cost benefits of universal school-based alcohol education programmes.
• There is some limited analysis of the costs incurred in running individual programmes, but no evidence as to how these compare to those of alternative programmes.
• World Health Organisation research suggests that school-based alcohol education is not cost effective in reducing alcohol-related harm in any European region. In contrast, alcohol pricing and taxation policy are cost-effective throughout Europe.
• However, some authors hypothesise that with just a very small effect size in reduced alcohol consumption rates among young people as a result of alcohol education programmes, the cost benefits to society could be substantial.
• There is evidence of one targeted residential programme in the USA (ChalleNGe), and of one specialist drug and alcohol service in the UK that have provided substantial cost benefits to individuals and society. These are not universal alcohol education programmes however.

What factors facilitate or inhibit the success of programmes?
• Programmes are not always transferrable from one situation or context to another. There needs to be caution when transferring lessons from effective programmes.
• Effective alcohol education curricula achieve a good balance between: accurate and consistent information giving and knowledge building; skills development; and sensitivity to factors influencing student attitudes and behaviours.
• Effective teaching and learning approaches include those that are interactive rather than didactic. Passive teaching approaches are associated with less favourable results.
• Course delivery by external professionals such as health workers and counsellors can sometimes lead to more positive outcomes than teacher-led delivery, and specialist school staff achieve more positive results than non-specialist teachers.
• There is tentative, but inconclusive, evidence that effective programmes focus on prevention rather than sanction, and on harm-reduction rather than abstinence.
The optimum age for effective exposure is unclear, but seems to be somewhere between the ages of 12 and 14. There is evidence that a series of short-duration interventions delivered through childhood, with booster sessions into adolescence, is an effective approach. Whatever age programmes are introduced, the cognitive expectations and teaching and learning approaches must be age appropriate.
• Parents and families act as critical protective agents for young people. Where families have been included in interventions, results are usually positive.
• In some instances, parental support is lacking. In such instances, schools have an increasingly important role to play in fulfilling a protective role.

Finally, we present the key findings of our review in relation to the degree of evidence of impact for different pupil outcomes, using the following terms: substantial evidence of impact; degree of evidence of impact; only a little evidence of impact. Where we are able to, we comment on apparent facilitators or inhibitors of impact.