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Systematic Review of Mentoring to Prevent or Reduce Alcohol and Drug Use by Adolescents

      Abstract

      Background

      Use of alcohol and illicit drugs by adolescents is an important problem worldwide.

      Objective

      To undertake a systematic review of mentoring in preventing/reducing adolescents' alcohol and drug use.

      Data Sources

      We searched 8 multidisciplinary electronic databases, the gray literature, and reference lists of included studies.

      Study Eligibility Criteria, Participants, and Interventions

      Randomized controlled trials (RCTs) of mentoring in adolescents to prevent/reduce alcohol or drug use.

      Results

      Six RCTs were included in this review. Four RCTs provided evidence on mentoring and alcohol use. The 2 that could be pooled showed less alcohol use by mentored youth. Six RCTs on mentoring and drug use were identified, 2 of which provided some evidence of the effect of mentoring in reducing drug use.

      Limitations

      Only 1 RCT was at low risk of bias for randomization. None of the studies stated they concealed allocation. Of the 6 included studies, 1 was at high risk and 5 at unclear risk for attrition.

      Conclusions and Implications of Key Findings

      Four RCTs provided evidence on mentoring and alcohol use, and the 2 that could be pooled showed less use by mentored youth. The 6 RCTs that provided evidence on drug use could not be pooled. Two did provide some evidence that mentoring is associated with less drug use. Very few well-designed studies evaluate the effects of mentoring on adolescent drug and alcohol use.

      Keywords

      What's New
      This updates a Cochrane Collaboration review on mentoring to prevent or reduce alcohol and drug use in adolescents. Two randomized controlled trials have been added to this updated review, while 2 other studies, previously included but not meeting current study criteria, have been deleted. Four studies assessed mentoring and alcohol; the 2 pooled found less alcohol use. Six assessed mentoring and drug use, and 2 found less use.
      The 2011 United Nations world drug report estimates that 149–271 million people 15 to 64 years of age (3.3% to 6.1% of the world's population) used an illicit drug at least once in 2009.
      • UN Office on Drugs and Crime
      World Drug Report, 2011.
      Among these are 124–203 million cannabis users (22–59 million in Africa, 41–43 million in the Americas, 31–68 million in Asia, and 29 million in Europe); 12–21 million opioid users (1–3 million in Africa, 1–2 million in the Americas, 6–12 million in Asia, and 3–3.5 million in Europe), 14–20.5 million cocaine users (1–4 million in Africa, 8–8.5 million in the Americas, up to 2 million in Asia, and 4–5 million in Europe), and 14–56 million amphetamine users.
      • UN Office on Drugs and Crime
      World Drug Report, 2011.
      As a result of incomplete information, this report did not include estimates on the use of ecstasy, hallucinogenic drugs, inhalants, or nonmedical uses of benzodiazepines or anabolic steroids, and so likely underestimates the extent of drug use worldwide. Degenhardt and Hall
      • Degenhardt L.
      • Hall W.
      Extent of illicit drug use and dependence, and their contribution to the global burden of disease.
      provide low, middle, and high estimates of the annual mortality attributable to drugs: the middle estimate for drugs is 197,000 and for alcohol 1,804,000 individuals worldwide.
      Rates of alcohol and drug use among adolescents and young adults are substantial.
      • Petrie J.
      • Bunn F.
      • Byrne G.
      Parenting programmes for preventing tobacco, alcohol or drugs misuse in children <18: a systematic review.
      The 2004–2005 European Drug Addiction Prevention trial (EU-DAP) included 6359 students 12 to 14 years of age in 6 European countries. Of these, 24% had been drunk and 8.2% had used cannabis in their lifetime; 6.7% reported at least 1 episode of drunkenness, and 3.2% had used cannabis once in the past 30 days.
      • Faggiano F.
      • Vigna-Taglianti F.D.
      • Versino E.
      • et al.
      School-based prevention for illicit drugs' use.
      • Faggiano F.
      • Vigna-Taglianti F.D.
      • Versino E.
      • et al.
      School-based prevention for illicit drugs use: a systematic review.
      • Faggiano F.
      • Vigna-Taglianti F.
      • Burkhart G.
      • et al.
      The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomized controlled trial.
      • Faggiano F.
      • Galanti M.R.
      • Bohrn K.
      • et al.
      The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial.
      • Vigna-Taglianti F.
      • Vadrucci S.
      • Faggiano F.
      • et al.
      Is universal prevention against youths' substance misuse really universal? Gender-specific effects in the EU-Dap school-based prevention trial.
      The 2001 US National Household survey reported that 60.5% of 55,561 surveyed consumed alcohol, with DSM-IV-defined rates of “tolerance” and “time spent obtaining alcohol, drinking, or getting over its effects” highest for the 18- to 23-year-olds, followed by those 12 to 17 years old. Individuals aged >50 years reported the lowest rates overall.
      • Harford T.C.
      • Grant B.F.
      • Yi H.Y.
      • et al.
      Patterns of DSM-IV alcohol abuse and dependence criteria among adolescents and adults: results from the 2001 National Household Survey on Drug Abuse.
      For DSM-IV tolerance and dependence symptoms, 7.1% of boys and 7.2% of girls aged 12 to 17 had tolerance symptoms; 1.2% of boys and girls had withdrawal symptoms; 5.4% of boys and 6.0% of girls used “much time” to acquire alcohol; and 3.2% of boys and 3.0% of girls reported episodes of hazardous use.
      • Harford T.C.
      • Grant B.F.
      • Yi H.Y.
      • et al.
      Patterns of DSM-IV alcohol abuse and dependence criteria among adolescents and adults: results from the 2001 National Household Survey on Drug Abuse.
      Cochrane systematic reviews have assessed interventions in schools, the community, families, youth clubs, colleges, emergency rooms, and young offender institutions to prevent alcohol use.
      • Faggiano F.
      • Vigna-Taglianti F.D.
      • Versino E.
      • et al.
      School-based prevention for illicit drugs' use.
      • Faggiano F.
      • Vigna-Taglianti F.D.
      • Versino E.
      • et al.
      School-based prevention for illicit drugs use: a systematic review.
      • Faggiano F.
      • Vigna-Taglianti F.
      • Burkhart G.
      • et al.
      The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomized controlled trial.
      • Faggiano F.
      • Galanti M.R.
      • Bohrn K.
      • et al.
      The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial.
      • Vigna-Taglianti F.
      • Vadrucci S.
      • Faggiano F.
      • et al.
      Is universal prevention against youths' substance misuse really universal? Gender-specific effects in the EU-Dap school-based prevention trial.
      • Foxcroft D.R.
      • Tsertsvadze A.
      Universal school-based prevention programs for alcohol misuse in young people.
      (The systematic review by Petrie et al
      • Petrie J.
      • Bunn F.
      • Byrne G.
      Parenting programmes for preventing tobacco, alcohol or drugs misuse in children <18: a systematic review.
      reported 20 studies of parenting programs, none of which focused on mentoring.) This review updates the Cochrane review of mentoring to prevent/reduce drug and alcohol use in youth.
      • Thomas R.E.
      • Lorenzetti D.
      • Spragins W.
      Mentoring adolescents to prevent drug and alcohol use.

      Methods

      Literature Search

      Eight electronic peer reviewed databases (CINAHL, the Cochrane Library, Embase, Eric, Medline, PsycINFO, Social Sciences Abstracts, Sociological Abstracts), and ClinicalTrials.gov were searched through January 2013 (Fig. 1). The reference lists of included studies were scanned to identify additional studies of relevance to this review. Search criteria for Medline are listed in Figure 2. Experts in addictions and mentoring were consulted to identify additional studies relevant to this review. No language or date restrictions were applied.

      Definition of Mentoring

      The Mentor Organization provides the simplest and most inclusive definition of youth mentoring: “A personal relationship in which a caring individual provides consistent companionship, support, and guidance aimed at developing the competence and character of a child or adolescent.”
      • Keller T.E.
      Youth mentoring: theoretical and methodological issues.
      We operationalized the Mentor Organization mentoring definition thus: children (age 6 to 12) or adolescents (age 13 to 18), mentor (peer or adult), relationship (consistent, companionship, support, and guidance), and alcohol or drug use outcome data.

      Study Appraisal and Synthesis Methods

      Two reviewers independently assessed each abstract and full-text study for inclusion in this review. Inclusion criteria were: 1) study design was a randomized controlled trial (RCT) or cluster randomized controlled trial (C-RCT); 2) the study reported on the results of a mentoring intervention targeted at children (age 6 to 12) or adolescents (age 13 to 18); and 3) alcohol or drug use data were reported. In addition, studies were included if they reported on any of these primary outcome measures of interest: abstinence (never uses drugs and/or alcohol); number of individuals using alcohol or drugs at least once monthly; or reductions in alcohol or drug consumption. Two reviewers independently extracted data (using the longest available follow-up) into the Cochrane Alcohol and Drugs Review Group data checklist. Risk of bias was assessed by Cochrane Handbook criteria.

      Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Ver 5.1.0. Cochrane Collaboration; 2011. Available at: http://www.cochrane-handbook.org/. Accessed June 7, 2013.

      In cases of uncertainty, we contacted authors for clarification. We excluded both studies on counseling interventions and interventions to improve parent–child relationships.
      We planned separate analyses for RCTs that compared an intervention to a control group and those that compared 2 interventions. Because studies of alcohol and drug use by children and adolescents have varying outcome measures (monthly, weekly, or daily frequency, amount drunk or drugs ingested, or an index) we planned to meta-analyze RCTs if participants, interventions, and outcome measures were sufficiently similar to make pooling appropriate, and if heterogeneity as measured by I2 was <50%. Where comparable outcome measures were not available, we planned to dichotomize baseline never-users into never/began to use, and users into declined/unchanged or increased. We planned to explore clinical heterogeneity (differences in participants, interventions, and outcomes) and methodological heterogeneity (study design, risk of bias) if there were sufficient studies. The review protocol was registered with the Cochrane Drugs and Alcohol Review Group.

      Results

      Literature Search

      A total of 2972 abstracts were screened; of these, 235 full-text articles were assessed and 6 RCTs included in the review (Fig. 3).

      Description of Included Studies

      We identified 6 RCTs that met our inclusion criteria, 5 from the United States and 1 from Sweden (Table 1). Aseltine et al
      • Aseltine Jr., R.H.
      • Dupre M.
      • Lamlein P.
      Mentoring as a drug prevention strategy: an evaluation of “Across Ages”.
      in a 2000 C-RCT recruited ten 6th grade classes in 10 middle schools in Springfield, Massachusetts, and randomized them to 1 of 3 groups: 1) mentoring by community adults, a community service activity (visiting frail seniors in nursing homes), and a 27-lesson school-based Positive Youth Development Curriculum (PYDC), which teaches life skills; 2) the community service activity and the PYDC; or 3) no intervention. Two cohorts of 6th graders (1997 and 1998) were each followed for 1 year.
      Table 1Description of Included Studies and Results
      Author and Study DesignStudy ParticipantsDuration and Follow-upIntervention ElementsOutcomes of InterestResults, Intervention vs Control
      Aseltine
      • Aseltine Jr., R.H.
      • Dupre M.
      • Lamlein P.
      Mentoring as a drug prevention strategy: an evaluation of “Across Ages”.
      2000 (C-RCT)
      High-risk students from ten 6th grade classrooms in 3 schools (n = 358)Total study duration 16 mo; pretest beginning of school year; posttest end of school year; follow-up 6 mo laterAcross Ages Program to reduce adolescent drug use. Mentoring Group: (1) mentoring from an elder, and adolescents help older adults (55+) maintain active roles, (2) PYDC: health and substance abuse information, community service. Curriculum Group: PYDC: health and substance abuse information, community service. Control group: no interventionProblem behavior and knowledge of/attitudes toward ATOD Use (Center for Substance Abuse Prevention National Youth Survey)Difference from pretest to follow-up: for alcohol: mentor = 1.28, curriculum = 1.33, control = 1.37; for marijuana: mentor = 1.10, curriculum = 1.18, control = 1.30, 1-tailed t tests for difference: mentor vs control = −1.87*, curriculum vs control = −1.29, control vs mentor = 0.72, mentor vs control comparison significant
      Bartle-Haring
      • Bartle-Haring S.
      • Slesnick N.
      • Collins J.
      • et al.
      The utility of mentoring homeless adolescents: a pilot study.
      2012 (RCT)
      Homeless adolescents (n = 90)Total study duration 6 mo; evaluation at completion of the 6-mo interventionSubstance use treatment and mentoring group: rapport building and goal setting, social stability, reinforcers (recreational activities and support systems); substance use treatment only group; no control groupTobacco use (tool not specified); drug and alcohol use (Form 90, NI on Alcohol Abuse and Alcoholism); problem consequences of drug use (Problem Oriented Screening Instrument)E-mail from Dr Bartle-Haring (January 15, 2012): Results noted for 28 youth at 6-mo evaluation: “Number of mentoring sessions nonsignificant in predicting the variation in the slopes for drug use, alcohol use, and tobacco use . . . age did not matter for either the intercepts or slopes”
      Bodin
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      2011 (RCT)
      Students (aged 14 y) from 28 schools—with self-reported need for additional adult contact (n = 128)Total study duration 12 mo; average follow-up at completion of intervention: intervention = 396 d, control = 400 dMentoring group: participants recruited to Swedish branch of Mentoring Foundation: health promotion and prevention of drug abuse. Mentors trained for 2 d and pairs chose own activities. Control group: Research staff phoned 6 times to ask about perceived frequency and quality of contacts with nonparental adultsTobacco use (tool not specified); annual alcohol volume (survey instrument); drug use (DUDIT-E)12-mo follow-up compared to baseline—intervention compared to control: Being drunk last month: OR 1.05, 95% CI 0.48–2.27; P = .91; no alcohol use: OR 0.90, 95% CI 0.40–2.04, P = .81); illicit drug user: OR 1.68, 95% CI 0.25–11.09, P = .59). No significant differences for intervention vs control
      Grossman
      • Grossman J.B.
      • Tierney J.P.
      Does mentoring work? An impact study of the Big Brothers Big Sisters program.
      1998, Herrera
      • Herrera C.
      • Grossman J.B.
      • Kauh T.J.
      • et al.
      Mentoring in schools: an impact study of Big Brothers Big Sisters school-based mentoring.
      2011 (RCT)
      Youth grades 4 to 9 registered with 8 Big Brother Big Sister agencies (n = 1138)Total study duration 18 mo; follow-up at 9 and 15 moIntervention group: mentoring relationship with a Big Brother or Big Sister: support to inhibit initiation of alcohol, drugs and delinquent behaviors; wait-list control group: youth pending match with a Big Brother or Big SisterInitiation of alcohol or drug use (self-report)For 934 who had not used illegal drugs at baseline: 107 (11.47%) started using drugs; change in likelihood of using illegal drugs compared to control = −45.8. For 742 who had not used alcohol at baseline: 198 (26.72%) started using alcohol; change in likelihood of using alcohol compared to control = −27.4 (no statistical analysis provided). Herrera
      • Herrera C.
      • Grossman J.B.
      • Kauh T.J.
      • et al.
      Mentoring in schools: an impact study of Big Brothers Big Sisters school-based mentoring.
      substance use at 9 mo (OR 1.19, 95% CI 0.81–1.75) (P = NS).
      Rosenblum
      • Rosenblum A.
      • Magura S.
      • Fong C.
      • et al.
      Effects of peer mentoring on HIV-affected youths' substance use risk and association with substance using friends.
      2005 (RCT)
      Youths (average 11.4 y) with an HIV/AIDS parent recruited from agencies providing services to HIV-positive individuals (n = 157)Total study duration 1 y; follow-up at completion of intervention at 1 yPeer mentoring group: trained junior peer mentors with adult supervision, plus regular services and referrals for parents/youth. Mentoring combined with education, support groups, recreational/cultural activities, and tutoring/career development. Wait-list control group: also referred to recreation groups at local agenciesUse of tobacco, alcohol, or other substances in past year (self-report)Number of peer mentoring sessions attended at 1 y correlated with a reduction in substance use (r = −0.35, P = .018). Intention-to-treat analysis of mentoring vs control at 12-mo follow-up: OR 0.64, 95% CI 0.04–9.97, Z = 0.32, P = .75) (NS)
      Taylor
      • Taylor A.S.
      • LoSciuto L.
      • Fox M.
      • et al.
      The mentoring factor: Evaluation of the across ages' intergenerational approach to drug abuse prevention.
      1999 (C-RCT)
      At-risk youth from 3 grade 6 classes (n = 562)Total study duration 3 school years. Pretest survey at beginning of program; posttest survey at end of school yearAcross Ages program to reduce adolescent drug use. Mentoring group: (1) mentoring by elder, and adolescents help older adults (55+) maintain active roles, (2) PYDC: critical thinking/problem solving, community service, parent workshops, family activities. Curriculum Group: PYDC. Control Group: No interventionFrequency of alcohol, tobacco and other drugs during previous 2 mo (self-report)Frequency of substance use: mentoring group lower compared to program group: ANOVA F(1, 315) = 3.67, P < .056. Program group higher compared to mentoring and control groups: ANOVA F(1, 315) = −3.67, P < .056
      Bodin
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      2011, Grossman
      • Grossman J.B.
      • Tierney J.P.
      Does mentoring work? An impact study of the Big Brothers Big Sisters program.
      1998, Herrera
      • Herrera C.
      • Grossman J.B.
      • Kauh T.J.
      • et al.
      Mentoring in schools: an impact study of Big Brothers Big Sisters school-based mentoring.
      2011
      Meta-analysis: We were only able to meta-analyze 2 RCTs for alcohol use

      Baseline nondrinkers at 12-mo follow-up (Bodin 2011) and 18-mo follow-up (Grossman 1998) mentoring compared to control: OR 0.72, 95% CI 0.58–0.90, Z = 2.86, P = .004; χ2 = 0.00, I2 = 0%
      RCT = randomized controlled trial; PYDC = Positive Youth Development Curriculum; OR = odds ratio; CI = confidence interval.
      *P ≤ .5.
      Bartle-Haring et al
      • Bartle-Haring S.
      • Slesnick N.
      • Collins J.
      • et al.
      The utility of mentoring homeless adolescents: a pilot study.
      randomly assigned 90 homeless youth in a US city (of whom 29 were 14 to 18 years of age) either to substance abuse treatment plus mentoring or to substance abuse treatment for 6 months. The mentors were asked to help the youth set goals, access Medicaid, housing, and food resources, identify rewarding recreational activities and alternative support systems, and transition to alternative support systems. In a 2011 study, Bodin and Leifman
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      recruited 128 14-year-olds (who had expressed a desire for more adult contact) from 28 schools in 3 Swedish cities through the Swedish Mentor Foundation. They were expected to meet with their mentor for 2 to 4 hours every 2 weeks. Mentees chose their own activities, and the mentors received supervision from a program director or psychologist.
      Grosmann and colleagues
      • Grossman J.B.
      • Tierney J.P.
      Does mentoring work? An impact study of the Big Brothers Big Sisters program.
      • Grossman J.B.
      • Rhodes J.E.
      The test of time: predictors and effects of duration in youth mentoring relationships.
      • Herrera C.
      • Grossman J.B.
      • Kauh T.J.
      • et al.
      Mentoring in schools: an impact study of Big Brothers Big Sisters school-based mentoring.
      • Rhodes J.E.
      • Reddy R.
      • Grossman J.B.
      • et al.
      Volunteer mentoring relationships with minority youth: An analysis of same- versus cross-race matches.
      • Rhodes J.E.
      • Reddy R.
      • Grossman J.B.
      The protective influence of mentoring on adolescents' substance use: direct and indirect pathways.
      recruited all 1138 students ages 10 to 16 who approached 8 Big Brothers Big Sisters agencies from 1991 to 1993 and randomized them to either mentoring (average duration 12 months) or a wait list. The mentors were young (79% were 20 to 34 years) and well educated (87% some college, college graduate, or graduate degree), and functioned as friends, with 42% meeting weekly and another 24% meeting at least 3 times/month.
      Rosenblum et al
      • Rosenblum A.
      • Magura S.
      • Fong C.
      • et al.
      Effects of peer mentoring on HIV-affected youths' substance use risk and association with substance using friends.
      recruited 61 adolescents (average age 11.4 years) with an HIV-positive parent from community organizations and agencies that serve HIV-positive clients and randomized them to either 1) weekly meetings with older peers (supervised by an adult) with recreational activities, field trips, and in-house activities (storytelling, arts and crafts, poetry, public speaking, coping strategies to deal with peer pressure, and Internet use), or 2) no intervention other than referral to local agency recreational groups. The youths were followed for 1 year.
      Taylor et al,
      • Taylor A.S.
      • LoSciuto L.
      • Fox M.
      • et al.
      The mentoring factor: Evaluation of the across ages' intergenerational approach to drug abuse prevention.
      in a C-RCT, recruited 562 6th graders at 3 public middle schools in Philadelphia, and randomized them to either 1) being mentored during the 6th grade school year and summer by adults aged 55 years or older from the community, a community service program (visits to frail seniors in nursing homes over an 8-week period, and planting trees or cleaning up a neighborhood or planting a community garden), participating in monthly parent activities and support workshops, and the 27 lesson school-based PYDC curriculum, or 2) community service, parent workshops, and the PYDC. Three cohorts of 6th graders were followed each for a year during 1991–1994.

      Risk of Bias

      Only the study of Bodin and Leifman
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      was at low risk of bias for random sequence generation. The other 5 studies were at unclear risk of bias because they stated only random allocation without describing a strong method. All 6 were at unclear risk for allocation concealment because they made no statement to that effect. Only the study of Taylor et al
      • Taylor A.S.
      • LoSciuto L.
      • Fox M.
      • et al.
      The mentoring factor: Evaluation of the across ages' intergenerational approach to drug abuse prevention.
      was rated at low risk of bias for attrition. The study of Rosenblum et al
      • Rosenblum A.
      • Magura S.
      • Fong C.
      • et al.
      Effects of peer mentoring on HIV-affected youths' substance use risk and association with substance using friends.
      was rated as being at high risk of bias for attrition, while the remaining 4 studies were rated as unclear as they reported no differential attrition analysis. No study described blinding (which would have been possible for outcome assessors and data analysts). All 6 studies were at low risk of bias for selective reporting and other biases (Fig. 4).

      Outcomes

      Alcohol Use

      Although 4 RCTs provided evidence about mentoring and the prevention of alcohol use,
      • Aseltine Jr., R.H.
      • Dupre M.
      • Lamlein P.
      Mentoring as a drug prevention strategy: an evaluation of “Across Ages”.
      • Bartle-Haring S.
      • Slesnick N.
      • Collins J.
      • et al.
      The utility of mentoring homeless adolescents: a pilot study.
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      • Grossman J.B.
      • Tierney J.P.
      Does mentoring work? An impact study of the Big Brothers Big Sisters program.
      • Herrera C.
      • Grossman J.B.
      • Kauh T.J.
      • et al.
      Mentoring in schools: an impact study of Big Brothers Big Sisters school-based mentoring.
      none found statistically significant differences or odds ratios that did not include the null effect line. We were able to pool only Grossman and colleagues
      • Grossman J.B.
      • Tierney J.P.
      Does mentoring work? An impact study of the Big Brothers Big Sisters program.
      • Grossman J.B.
      • Rhodes J.E.
      The test of time: predictors and effects of duration in youth mentoring relationships.
      and Bodin and Leifman
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      and computed an odds ratio of 0.72 (95% CI 0.58–0.90; z = 2.86, P = .004, χ2 = 0%, I2 = 0%).

      Drug Use

      Six RCTs provided evidence about mentoring and drug use. The results could not be pooled because of differences in outcome measures. Two RCTs reported positive results. Aseltine et al
      • Aseltine Jr., R.H.
      • Dupre M.
      • Lamlein P.
      Mentoring as a drug prevention strategy: an evaluation of “Across Ages”.
      reported results only for marijuana and found less use in the mentored than control group (P ≤ .05). Rosenblum et al
      • Rosenblum A.
      • Magura S.
      • Fong C.
      • et al.
      Effects of peer mentoring on HIV-affected youths' substance use risk and association with substance using friends.
      found that only 53% of the students randomized to peer mentoring actually attended mentoring sessions. For those who attended, mentoring was associated with less substance use (P = .018). (However, for the entire sample of 157, we computed an odds ratio of 0.64 [95% CI 0.04–9.97; z = 0.32, P = .75].) Taylor et al
      • Taylor A.S.
      • LoSciuto L.
      • Fox M.
      • et al.
      The mentoring factor: Evaluation of the across ages' intergenerational approach to drug abuse prevention.
      combined tobacco, drugs, and alcohol, and at the 3-year follow-up found that while the mentoring group had less substance use than the curriculum group (P < .056), the control group also reported less substance use than the curriculum group (P < .056).
      Four studies found no relationship of mentoring and drug use. Bodin and Leifman
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      investigated the use of 9 categories of illegal drugs within a 6-month time period and found no significant results (OR 1.68, 95% CI 0.25–11.09, P = .59). The sample of Bartle-Haring et al
      • Bartle-Haring S.
      • Slesnick N.
      • Collins J.
      • et al.
      The utility of mentoring homeless adolescents: a pilot study.
      of 14- to 18-year-olds was small (n = 28), and the study found no relationship of mentoring to drug or alcohol use. Herrera et al,
      • Herrera C.
      • Grossman J.B.
      • Kauh T.J.
      • et al.
      Mentoring in schools: an impact study of Big Brothers Big Sisters school-based mentoring.
      for the data of Grossman and Tierney,
      • Grossman J.B.
      • Tierney J.P.
      Does mentoring work? An impact study of the Big Brothers Big Sisters program.
      found no significant difference (OR 1.19, 95% CI 0.81–1.75). We computed an intention-to-treat analysis for Rosenblum et al
      • Rosenblum A.
      • Magura S.
      • Fong C.
      • et al.
      Effects of peer mentoring on HIV-affected youths' substance use risk and association with substance using friends.
      and found no effect.

      Discussion

      We pooled 2 of the 4 studies for which there were alcohol outcomes, finding significantly less alcohol use in the mentored groups.
      • Bodin M.
      • Leifman H.
      A randomized effectiveness trial of an adult-to-youth mentoring program in Sweden.
      • Herrera C.
      • Grossman J.B.
      • Kauh T.J.
      • et al.
      Mentoring in schools: an impact study of Big Brothers Big Sisters school-based mentoring.
      We were unable to pool the 6 RCTs that provided evidence on mentoring and drug use. Of these, only 2 found any support for mentoring. A 2009 review of mentoring in adolescence identified 6 literature reviews, 16 program evaluations, and 5 meta-analyses.
      • Rhodes J.E.
      • Lowe S.R.
      Mentoring in adolescence.
      This review concluded that most mentoring studies are not rigorously evaluated, do not test which are the core elements of mentoring, and do not assess how mentoring could meet the needs of mentees with different genders, social situations, and cultures.
      • Rhodes J.E.
      • Lowe S.R.
      Mentoring in adolescence.
      A review of 53 randomized interventions with US African American children and adolescents identified 10 studies that were conducted according to manuals and 29 studies that were evaluated.
      • Bandy T.
      • Moore K.A.
      What Works for African American Children and Adolescents: Lessons From Experimental Evaluations of Programs and Interventions.
      Of the 6 that focused on substance use, 2 were family based and 4 school based. None used a mentoring intervention. This review concluded that programs that have strong family acceptance, create community partnerships, are of high intensity, and meet consistently and frequently are more successful.
      The next step in evaluating the effects of mentoring on alcohol and drug use in adolescents would be to conduct RCTs that are at low risk of methodological bias (ie, at low risk of bias in the randomization process, concealment of allocation, blinding where feasible, and low attrition) and adequately powered. The Big Brothers/Big Sisters International Web site (http://www.bbbsi.org) notes mentorship programs in 12 countries. Establishing and evaluating a standardized drug and alcohol mentoring intervention with valid and reliable outcome measures could be accomplished through this organization. Alternatively, interventions could be coordinated through the sites of the National Longitudinal Study of Adolescent Health, a large, nationally representative sample of middle and high schools in the United States.
      • Whitney S.D.
      • Hendricker E.N.
      • Offutt C.A.
      Moderating factors of natural mentoring relationships, problem behaviors, and emotional well-being.

      Conclusions and Implications of Key Findings

      Four RCTs provided evidence on mentoring and alcohol use; the 2 studies that could be pooled showed less alcohol use by mentored youth. Although the 6 RCTs that provided evidence on drug use could not be pooled, 2 provided some evidence that mentoring is associated with less drug use. Very few well-designed studies have evaluated the effects of mentoring on adolescent drug and alcohol use.

      Acknowledgments

      A new literature search was undertaken through January 27, 2013, and the original review updated and rewritten: Thomas RE, Lorenzetti D, Spragins W. Mentoring adolescents to prevent drug and alcohol use. Cochrane Database of Systematic Reviews 2011;(11):CD007381. Funded in part by a grant from the Canadian Tobacco Control Research Initiative .

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