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The Strengthening Families Program 10-14 (SFP10-14) is a manualized preventive intervention that studies in the USA has shown longer-term impacts on the development of substance use behaviours in young people. Outside the USA, a recent Swedish adaptation found no effects, but this adaptation omitted key components. In this paper we report results from three other European trials (Wales, Germany, Poland) of SFP10-14 where adaptations were more consistent with the original US program.
Methods
Randomised controlled trials were undertaken in Wales (N= 715, two-year follow-up); Germany (N=302, 18-month follow-up); and Poland (N=583, two-year follow-up). All trials were ISCRTN registered with published protocols. Primary outcomes across the trials were youth substance use measures. Secondary outcomes included family and parenting measures. Multilevel ITT analyses were undertaken and reported using CONSORT guidance.
Results
Follow-up rates were 81% in Wales, 83% in Germany and 57% in Poland. Results on comparable primary outcomes were, Wales: OR=1.12 95% CI=0.72-1.73 (drinking), OR=1.45 95% CI=0.83-2.52 (drunkenness); Germany: OR=0.95 95% CI=0.54-1.78 (drinking); Poland: OR=0.90, 95% CI=0.73-3.86 (drinking), OR=1.30, 95% CI 0.28-5.46 (drunkenness). Analysis of secondary outcomes showed a more complex picture, with possible impact on family and parenting measures in Germany and Wales but not Poland.
Conclusions
Over a 18-month to two-year follow-up period, randomized trials of three separate adaptations of the US SFP10-14 showed no evidence of intervention effect on primary outcome measures of alcohol use or excessive drinking in ITT analyses. The original USA trials of SFP10-14 showed significant impacts on alcohol outcomes only after four-years of follow-up, though incidence of alcohol use and excessive use is at a later age in the USA than in Europe, raising questions of applicability of the intervention to different cultural and epidemiological contexts. Impacts on secondary outcomes in the European trials showed a complex pattern, with some intermediate effects in some settings.