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Study flow diagram Carney 2014.
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Figure 1

Study flow diagram Carney 2014.

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Study flow diagram for updated review.
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Figure 2

Study flow diagram for updated review.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Brief intervention versus information provision, Outcome 1 Alcohol Frequency: number of alcohol days past 30 days.
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Analysis 1.1

Comparison 1 Brief intervention versus information provision, Outcome 1 Alcohol Frequency: number of alcohol days past 30 days.

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Comparison 1 Brief intervention versus information provision, Outcome 2 Alcohol Quantity: number of standard drinks in past 30 days.
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Analysis 1.2

Comparison 1 Brief intervention versus information provision, Outcome 2 Alcohol Quantity: number of standard drinks in past 30 days.

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Comparison 1 Brief intervention versus information provision, Outcome 3 Cannabis Quantity: number of joints smoked in past 30 days.
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Analysis 1.3

Comparison 1 Brief intervention versus information provision, Outcome 3 Cannabis Quantity: number of joints smoked in past 30 days.

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Comparison 1 Brief intervention versus information provision, Outcome 4 Cannabis Mean Dependence Score.
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Analysis 1.4

Comparison 1 Brief intervention versus information provision, Outcome 4 Cannabis Mean Dependence Score.

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Comparison 1 Brief intervention versus information provision, Outcome 5 Cannabis frequency: number of days smoked cannabis in past 30 days.
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Analysis 1.5

Comparison 1 Brief intervention versus information provision, Outcome 5 Cannabis frequency: number of days smoked cannabis in past 30 days.

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Comparison 1 Brief intervention versus information provision, Outcome 6 Secondary outcomes related to substance use: Mean Problem Score.
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Analysis 1.6

Comparison 1 Brief intervention versus information provision, Outcome 6 Secondary outcomes related to substance use: Mean Problem Score.

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Comparison 2 Brief intervention versus assessment only, Outcome 1 Alcohol Frequency: number of alcohol days.
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Analysis 2.1

Comparison 2 Brief intervention versus assessment only, Outcome 1 Alcohol Frequency: number of alcohol days.

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Comparison 2 Brief intervention versus assessment only, Outcome 2 Alcohol Quantity: number of standard drinks.
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Analysis 2.2

Comparison 2 Brief intervention versus assessment only, Outcome 2 Alcohol Quantity: number of standard drinks.

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Comparison 2 Brief intervention versus assessment only, Outcome 3 Alcohol Abuse: number of symptoms.
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Analysis 2.3

Comparison 2 Brief intervention versus assessment only, Outcome 3 Alcohol Abuse: number of symptoms.

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Comparison 2 Brief intervention versus assessment only, Outcome 4 Alcohol Dependence: number of symptoms.
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Analysis 2.4

Comparison 2 Brief intervention versus assessment only, Outcome 4 Alcohol Dependence: number of symptoms.

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Comparison 2 Brief intervention versus assessment only, Outcome 5 Cannabis frequency: number of cannabis use days.
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Analysis 2.5

Comparison 2 Brief intervention versus assessment only, Outcome 5 Cannabis frequency: number of cannabis use days.

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Comparison 2 Brief intervention versus assessment only, Outcome 6 Cannabis Abuse: number of symptoms.
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Analysis 2.6

Comparison 2 Brief intervention versus assessment only, Outcome 6 Cannabis Abuse: number of symptoms.

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Comparison 2 Brief intervention versus assessment only, Outcome 7 Cannabis Dependence: number of symptoms.
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Analysis 2.7

Comparison 2 Brief intervention versus assessment only, Outcome 7 Cannabis Dependence: number of symptoms.

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Comparison 2 Brief intervention versus assessment only, Outcome 8 Secondary outcomes related to substance use: Mean score on personal consequences scale.
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Analysis 2.8

Comparison 2 Brief intervention versus assessment only, Outcome 8 Secondary outcomes related to substance use: Mean score on personal consequences scale.

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Summary of findings for the main comparison. Brief intervention compared to information provision for substance‐using adolescents

Brief intervention compared to information provision for substance‐using adolescents

Patient or population: Substance‐using adolescents
Settings: High schools or further education training colleges
Intervention: Brief intervention
Comparison: Information provision

Outcomes

Illustrative comparative risks* (95% CI)

Estimate effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Information provision

Brief intervention

Alcohol frequency
Self report questionnaires
Medium‐term follow‐up: 4 to 6 months

See comment

The standardised mean alcohol frequency in the intervention groups was 0.01 standard deviations lower
(0.20 lower to 0.18 higher)

SMD ‐0.01 (‐0.20 to 0.18)

434
(2 studies)

⊕⊕⊕⊝
moderate1

Number of days of alcohol use

Alcohol quantity
Self report questionnaires

Medium‐term follow‐up: 4 to 6 months

See comment

The standardised mean alcohol quantity in the intervention groups was 0.14 standard deviations lower
(0.33 lower to 0.05 higher)

SMD ‐0.14 (‐0.33 to 0.05)

434
(2 studies)

⊕⊕⊕⊝
moderate1

Number of standard alcohol units

Cannabis dependence
Self report questionnaires
Short‐term follow‐up: 1 to 3 months

See comment

The standardised mean cannabis dependence score in the intervention groups was 0.09 standard deviations lower

(0.27 lower to 0.09 higher)

SMD ‐0.09 (‐0.27 to 0.09)

470
(2 studies)

⊕⊕⊕⊝
moderate1

Mean dependence score

Cannabis frequency
Self report questionnaires
Short‐term follow‐up: 1 to 3 months

See comment

The mean cannabis frequency in the intervention groups was
0.07 standard deviations lower
(0.25 lower to 0.11 higher)

SMD ‐0.07 (‐0.25 to 0.11)

470
(2 studies)

⊕⊕⊕⊝
moderate1

Number of days cannabis use

Secondary outcomes related to substance use
Self report questionnaires

Short‐term follow‐up: 1 to 3 months

See comment

The mean behavioural outcomes related to substance use in the intervention groups was
‐0.01 standard deviations lower
(0.19 lower to 0.17 higher)

SMD ‐0.01 (‐0.19 to 0.17)

470
(2 studies)

⊕⊕⊕⊝
moderate1

Interactional Problems Score

*The basis for the assumed risk (e.g. the mean control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the estimate effect of the intervention (and its 95% CI). The estimate effects for certain outcomes were not estimable due to only one study assessing the specific outcome, or extremely high levels of heterogeneity making effects across studies difficult to compare.
CI: confidence interval; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Risk of bias (‐1): It was not possible to blind the participants in all of the included studies. There was also uncertainty in two of the studies about allocation concealment and blinding of outcome assessor (Walker 2011; Werch 2005).

Figuras y tablas -
Summary of findings for the main comparison. Brief intervention compared to information provision for substance‐using adolescents
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Summary of findings 2. Brief intervention compared to assessment only for substance‐using adolescents

Brief intervention compared to assessment only for substance‐using adolescents

Patient or population: Substance‐using adolescents
Settings: High schools or further education colleges
Intervention: Brief intervention
Comparison: Assessment only

Outcomes

Illustrative comparative risks* (95% CI)

Estimate effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Assessment only

Brief intervention

Alcohol frequency

Self report questionnaires
Medium‐term follow‐up: 4 to 6 months

See comment

The standardised mean alcohol frequency in the intervention groups was 0.91 standard deviations lower
(1.21 lower to 0.61 lower)

SMD ‐0.91 (‐1.21 to ‐0.61)

242
(2 studies)

⊕⊕⊝⊝
low1, 2

Number of days of alcohol use

Alcohol quantity
Self report questionnaires

Medium‐term follow‐up: 4 to 6 months

See comment

The standardised mean alcohol quantity in the intervention groups was 0.16 standard deviations lower
(0.45 lower to 0.14 higher)

SMD ‐0.16

(‐0.45 to 0.14)

179

(1 study)

⊕⊕⊝⊝
low1,2

Number of standard alcohol units

Cannabis dependence
Self report questionnaires
Medium‐term follow‐up: 4 to 6 months

See comment

The mean cannabis dependence in the intervention groups was
0.56 standard deviations lower
(0.57 lower to 0.06 higher)

SMD ‐0.26 (‐0.57 to 0.36)

190
(1 study)

⊕⊕⊝⊝
low1, 2

Mean dependence score

Cannabis frequency
Self report questionnaires
Long‐term follow‐up: 7 to 12 months

See comment

The mean cannabis frequency in the intervention groups was
0.54 standard deviations lower
(0.77 lower to 0.31 higher)

SMD ‐0.54 (‐0.77 to ‐0.31)

338
(2 studies)

⊕⊕⊝⊝
low1,2

Number of days of cannabis use

Secondary outcomes related to substance use

Self report questionnaires

Medium‐term follow‐up: 4 to 6 months

See comment

The mean mean behavioural outcomes related to substance use in the intervention groups was
0.65 standard deviations lower
(1.58 lower to 0.28 higher)

SMD ‐0.65 (‐1.58 to 0.28)

242
(2 studies)

⊕⊕⊝⊝
low1, 2

Interactional Problems Score

*The basis for the assumed risk (e.g. the mean control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the estimate effect of the intervention (and its 95% CI). The estimate effects for certain outcomes were not estimable due to only one study assessing the specific outcome, or extremely high levels of heterogeneity making effects across studies difficult to compare.
CI: confidence interval; SMD: standardised mean difference

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Risk of bias (‐1): It was not possible to blind the participants in all of the included studies. There was no allocation concealment in two of the included studies, and it was unclear whether the outcome assessor was blinded (Winters 2007b; Winters 2012). The other study was also not free of selective reporting bias (McCambridge 2004).
2Imprecision (‐1): The confidence intervals contained the null value of zero and the upper or lower confidence limit crosses an effect size of 0.5 in either direction; the sample size was also small for medium‐term follow‐up.

Figuras y tablas -
Summary of findings 2. Brief intervention compared to assessment only for substance‐using adolescents
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Comparison 1. Brief intervention versus information provision

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Alcohol Frequency: number of alcohol days past 30 days Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Short‐term Follow up (1‐3 months)

1

269

Std. Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.29, 0.19]

1.2 Medium‐term Follow up (4‐6 months)

2

434

Std. Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.20, 0.18]

2 Alcohol Quantity: number of standard drinks in past 30 days Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Short‐term Follow up (1‐3 months)

1

269

Std. Mean Difference (IV, Random, 95% CI)

0.02 [‐0.22, 0.26]

2.2 Medium‐term Follow up (4‐6 months)

2

434

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.33, 0.05]

3 Cannabis Quantity: number of joints smoked in past 30 days Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Short‐term Follow up (1‐3 months)

1

269

Std. Mean Difference (IV, Random, 95% CI)

0.0 [‐0.24, 0.24]

3.2 Medium‐term Follow up (4‐6 months)

1

264

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.39, 0.09]

4 Cannabis Mean Dependence Score Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Short‐term Follow up (1‐3 months)

2

470

Std. Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.27, 0.09]

4.2 Medium‐term Follow up (4‐6 months)

1

264

Std. Mean Difference (IV, Random, 95% CI)

0.06 [‐0.18, 0.30]

4.3 Long‐term Follow up (7‐12 months)

1

186

Std. Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.38, 0.20]

5 Cannabis frequency: number of days smoked cannabis in past 30 days Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Short‐term Follow up (1‐3 months)

2

470

Std. Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.25, 0.11]

5.2 Medium‐term Follow up (4‐6 months)

1

264

Std. Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.30, 0.18]

5.3 Long‐term Follow up (7‐12 months)

1

186

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.31, 0.26]

6 Secondary outcomes related to substance use: Mean Problem Score Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Short‐term Follow up (1‐3 months)

2

470

Std. Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.19, 0.17]

6.2 Medium‐term Follow up (4‐6 months)

1

264

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.37, 0.11]

6.3 Long‐term Follow up (7‐12 months)

1

186

Std. Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.39, 0.19]
Figuras y tablas -
Comparison 1. Brief intervention versus information provision
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Comparison 2. Brief intervention versus assessment only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Alcohol Frequency: number of alcohol days Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Medium‐term Follow up (4‐6 months)

2

242

Std. Mean Difference (IV, Random, 95% CI)

‐0.91 [‐1.21, ‐0.61]

1.2 Long‐term Follow up (7‐12 months)

1

170

Std. Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.53, 0.14]

2 Alcohol Quantity: number of standard drinks Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Medium‐term Follow up (4‐6 months)

1

179

Std. Mean Difference (IV, Random, 95% CI)

‐0.16 [‐0.45, 0.14]

2.2 Long‐term Follow up (7‐12 months)

1

162

Std. Mean Difference (IV, Random, 95% CI)

‐0.16 [‐0.47, 0.15]

3 Alcohol Abuse: number of symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Medium‐term Follow up (4‐6 months)

1

190

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.70, ‐0.07]

3.2 Long‐term Follow up (7‐12 months)

1

170

Std. Mean Difference (IV, Random, 95% CI)

‐0.72 [‐1.07, ‐0.38]

4 Alcohol Dependence: number of symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Medium‐term Follow Up (4‐6 months)

1

190

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐0.90, ‐0.26]

4.2 Long‐term Follow up (7‐12 months)

1

170

Std. Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.47, 0.20]

5 Cannabis frequency: number of cannabis use days Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Short‐term Follow up (1‐3 months)

1

179

Std. Mean Difference (IV, Random, 95% CI)

‐0.83 [‐1.14, ‐0.53]

5.2 Medium‐term Follow up (4‐6 months)

2

242

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.50, 0.05]

5.3 Long‐term Follow up (7‐12 months)

2

338

Std. Mean Difference (IV, Random, 95% CI)

‐0.54 [‐0.77, ‐0.31]

6 Cannabis Abuse: number of symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Medium‐term Follow up (4‐6 months)

1

190

Std. Mean Difference (IV, Random, 95% CI)

‐0.34 [‐0.65, ‐0.02]

6.2 Long‐term Follow up (7‐12 months)

1

170

Std. Mean Difference (IV, Random, 95% CI)

‐0.62 [‐0.96, ‐0.28]

7 Cannabis Dependence: number of symptoms Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 Medium‐term Follow up (4‐6 months)

1

190

Std. Mean Difference (IV, Random, 95% CI)

‐0.26 [‐0.57, 0.06]

7.2 Long‐term Follow up (7‐12 months)

1

170

Std. Mean Difference (IV, Random, 95% CI)

‐0.97 [‐1.32, ‐0.62]

8 Secondary outcomes related to substance use: Mean score on personal consequences scale Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 Medium‐term Follow up (4‐6 months)

2

242

Std. Mean Difference (IV, Random, 95% CI)

‐0.65 [‐1.58, 0.28]

8.2 Long‐term Follow up (7‐12 months)

1

170

Std. Mean Difference (IV, Random, 95% CI)

‐0.78 [‐1.13, ‐0.44]
Figuras y tablas -
Comparison 2. Brief intervention versus assessment only
Ir a la tabla de la revisión