More than one quarter of Australian teenagers put themselves at risk of short-term alcohol-related harm at least once a month and 17% use an illicit drug at least once a year. As such, the need for prevention is clear. Although an array of school-based prevention programs exist, the majority show minimal effects in reducing drug use and related harms, and some have even report iatrogenic effects. Given that school–based drug prevention is the primary means by which drug education is delivered, it is essential to focus on increasing program efficacy. Ideally, preventive interventions should aim to delay onset in both adolescents with low-risk profiles who may be influenced to take up substances due to peer influence and social conformity, and adolescents with high-risk profiles whose underlying vulnerability to psychopathology can lead to substance misuse. Yet, there appear to be no models of well implemented programs that do this. The current proposal addresses this gap by developing and evaluating a comprehensive approach to preventing substance use and related harms in adolescents by combining effective ‘universal’ and ‘targeted’ school-based prevention programs. The proposed model, known as the CAP (Climate and Preventure) intervention, builds on our unique success in this area through developing the effective universal Climate, and targeted Preventure programs.
To modify the targeted Preventure program for use in Australia and to evaluate the effects of the combining this program with the effective ‘universal’ Climate program (the CAP intervention) in preventing substance use and related harms in Australian adolescents.
Stage 1: Modifying the targeted Preventure program for Australia
The first stage in the research will be to modify the Preventure program for Australia. To do this, we will conduct focus groups with students, and interviews with teachers and health professionals to ensure the content and scenarios of Preventure are relevant to Australia, and to ensure the program is age and context appropriate and fits within the Australian school curriculum.
Stage 2: Evaluation of the ‘CAP intervention’
Following the modification of Preventure which will be combined with Climate to make up the CAP intervention, we seek to demonstrate the effectiveness of the intervention by running a cluster RCT in schools in Australia. Schools will be randomly allocated to one of four groups; (1) the ‘Control’ condition (CO), (2) the ‘Climate only’ condition (CL), (3) the ‘Preventure only’ condition (PR), or (4) the ‘Climate and Preventure’ condition (CAP). All students will be assessed via an online self-report questionnaire at baseline, immediately-post, and 6, 12, 18 and 24 months after the intervention on their levels of drug knowledge, drug use, related harms, intentions to use drugs and mental health.
The CAP study project manager and research assistant were hired in 2011 and the two research psychologists were hired in early 2012. In 2011 ethics approval was obtained from UNSW along with support from both the Catholic Education Office Sydney and the NSW Department of Education and Communities. This was the first time NDARC has obtained approval to invite NSW public schools to take part in research. As a result, over 3000 Year 8 students (aged 13-14 yrs) from 27 schools in NSW and Victoria (18 private and 9 public schools) were recruited to take part in the CAP study.
The comprehensive CAP intervention was successfully implemented in participating schools in 2012. The universal internet-based Climate Schools program was delivered to approximately 1200 students by teachers. Feedback from teachers and students confirm the ease of implementation and acceptability of the program, as evidenced by their very positive evaluations. In addition, our research psychologists delivered a total of 162 90-minute group sessions of the ‘targeted’ Preventure program to over 350 ‘high-risk’ students. These students provided very positive feedback, with 89% reporting they found the skills they learnt were very helpful in their lives. In this same year, members of the CAP team successfully disseminated study findings in the form of six peer reviewed publications, two reports and thirteen national and international conference presentations.
Currently the post-treatment follow up surveys are being collated, and further follow up surveys will be collected in 2013, 2014 and 2015.
Peer reviewed publications:
Newton NC, Teesson M, Barrett EL, Slade T, Conrod PJ (2012). The CAP study, evaluation of integrated universal and selective prevention strategies for youth alcohol misuse: Study protocol of a cluster randomized controlled trial. BMC Psychiatry, accepted 17th August, 2012, DOI: 10.1186/1471-244X-12-118
Kelly E, Barrett EL, Newton N, Champion KE, Rosenfeld J, Teesson M, Slade T, Conrod P. Adolescent bullying and personality type: Risk factors for substance use. Conference of the Australasian Professional Society on Alcohol and Other Drugs.Melbourne (Nov 2012).
Champion, K., Newton, N.C., Barrett, E. L., & Teesson, M. (2012). A systematic review of school-based alcohol and other drug prevention programs facilitated by computers or the internet. Poster presented at the National Drug and Alcohol Research Centre Annual Symposium, Sydney, Australia, August 28th 2012.
If the program can reduce the target risk factors by levels equal or greater than that of the stand-alone programs, then it will be a most significant contribution to promoting and maintaining the good health of the community in Australia and reducing the burden of disease, social costs, and disability associated with substance abuse.