Climate Schools: Universal computer-based programs to prevent alcohol and other drug use in adolescence

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Author: Laura Vogl, Nicola Newton, Maree Teesson, Wendy Swift, Aspasia Karageorge, Catherine Deans, Rebecca McKetin, Bronwyn Steadman, Jennifer Jones, Paul Dillon, Alys Havard, Gavin Andrews

Resource Type: Technical Reports

NDARC Technical Report No. 321

EXECUTIVE SUMMARY

Background
Early initiation to drug use is associated with a range of negative consequences including substance use disorders, co-morbid mental health problems, juvenile offending, impaired educational performance and early school drop-out, resulting in negative impacts on both current functioning and future life options [1-3]. Preventing drug use and misuse in young Australians is essential and the school setting is the ideal location for delivering such prevention programs [4]. Although school-based prevention programs do exist, the efficacy of such programs is contentious [5-8]. Given that school-based drug prevention is the primary means by which drug prevention education is delivered to adolescents, it is essential to focus on increasing program efficacy. Previous research has shown that two factors compromise the efficacy of the school-based prevention programs: (1) the focus on abstinence-based outcomes [5] and (2) implementation failure [9]. Hence, the aim of the current research was to develop an innovative new platform for the delivery of drug prevention education which would potentially overcome such concerns. This new platform of delivery is known as CLIMATE Schools.

CLIMATE Schools
The CLIMATE Schools drug prevention programs are designed to overcome the factors which have been identified as compromising program efficacy by being based on a harm-minimisation approach and being developed in such a way as to enhance high fidelity program implementation. Specifically, there is a growing body of evidence suggesting that harm-minimisation programs for drug use could potentially be more effective than abstinence-based programs as they provide greater scope for preventive information and skills, whilst catering for all young people irrespective of levels of use [10-12]. In terms of improving implementation, the CLIMATE Schools programs have also been developed in collaboration with teachers, students and relevant health and legal professionals to ensure they address different issues which have been identified to compromise implementation (e.g., program complexity, teacher workload, teacher training and program adaptation). Specifically, each of the CLIMATE schools drug prevention programs is a curriculum-based program consisting of six lessons, each with two components; a 15-20 minute computer-based component and an array of prepared classroom activities for teachers and pupils. The computer component involves students navigating their way through a cartoon-based teenage drama. Each lesson deliberately forms part of an ongoing teenage drama to encourage teachers to present all lessons and avoid the temptation to omit any one of them. The computer delivery guarantees that the complete content is consistently delivered to each student overcoming the majority of the obstacles to effective program implementation. The classroom activities are included to allow students to interact with the content in relation to their own lives. These activities include role plays, small group discussions, decision making and problem solving activities and skill rehearsal, all of which have been identified as being central to program efficacy [13-19].

CLIMATE Schools: Alcohol Module
The first program developed to test this innovative new model for prevention addressed alcohol misuse and related harms in adolescents. This program, titled CLIMATE Schools: Alcohol Module, was evaluated [11] utilising a randomised controlled trial (RCT) in 16 New South Wales (NSW) and Australian Capital Territory (ACT) schools. This evaluation revealed that the CLIMATE Schools: Alcohol Module was effective in increasing alcohol-related knowledge of facts that would inform safer drinking choices, and in decreasing the positive social expectations which students believed alcohol may afford. For females, the program was effective in decreasing average alcohol consumption, alcohol-related harms and the frequency of drinking to excess (> 4 standard drinks; 10g ethanol). For males, the behavioural effects were not significant. The CLIMATE Schools: Alcohol Module has also been evaluated with a different sample of Australian students [20]. The RCT used in the cross-validation trial comprised 10 schools from NSW. The results demonstrated the CLIMATE Schools: Alcohol Module to be effective in increasing alcohol related knowledge up to six month following the intervention, and reducing average consumption of alcohol immediately after the intervention. The results of this module were promising and provided the impetus to assess if this innovative new platform of delivery for school-based drug prevention could be extended to other drugs of concern in adolescence.

Cannabis and psychostimulants became the next area of focus since these are two of the three most commonly used illicit drugs among Australian youth [21]. To address both drug/drug classes, two separate modules needed to be developed, as for prevention to be effective it must be relevant and developmentally appropriate. Cannabis and psychostimulants have very different median ages of initiation and hence for these programs to be relevant and developmentally appropriate they need to be delivered at different ages. To prevent uptake and minimise drug-related harm, the cannabis intervention was developed to be implemented in Year 8 of high school (ages 12-14), as by 13 years of age, 10% of the population have tried cannabis. The psychostimulant program was developed for Year 10 of high school (14-16 years of age), when the prevalence of methamphetamine/amphetamine (meth/amphetamine) and ecstasy use just starts to increase. The programs, however, were also developed to provide a booster session for previously addressed drugs since the research evidence suggests that including booster sessions can enhance program efficacy. Hence, two new modules were developed and evaluated: the CLIMATE Schools: Alcohol and Cannabis Module and, the CLIMATE Schools: Psychostimulant and Cannabis Module.

CLIMATE Schools: Alcohol and cannabis module
The CLIMATE Schools: Alcohol and Cannabis Module was evaluated using a cluster RCT in 10 NSW schools. The evaluation revealed that in comparison with usual drug education programs, students in the intervention group showed significantly greater improvements in alcohol and cannabis knowledge at the end of the course and the six month follow-up. In addition, the intervention group showed a reduction in average weekly alcohol consumption and frequency of cannabis use at the six month follow-up. No differences between groups were found on alcohol expectancies, cannabis attitudes, or alcohol and cannabis harms.

CLIMATE Schools: Psychostimulant and cannabis module
The CLIMATE Schools: Psychostimulant and Cannabis Module was also evaluated using an RCT in 21 NSW and ACT schools. This evaluation revealed that the CLIMATE Schools: Psychostimulant and Cannabis Module was effective in increasing knowledge of cannabis and psychostimulants and decreasing pro-drug attitudes. In the short-term the module was effective in subduing the uptake of ecstasy and decreasing the frequency of use. Females who received the CLIMATE Schools: Psychostimulant and Cannabis Module also used cannabis significantly less frequently than students who received drug education as usual. There were no changes in meth/amphetamine use or harms resulting from cannabis or psychostimulant use in general. The low prevalence of use is the most likely reason for why the CLIMATE intervention did not impact on drug-related harms. Finally, the CLIMATE intervention was effective in decreasing students’ intention to use meth/amphetamine and ecstasy in the future.

Conclusions
The findings from the evaluation of all three CLIMATE Schools drug prevention programs provides evidence that school-based drug prevention programs based on a harm-minimisation approach and delivered by computer can offer an innovative new platform for the delivery of prevention education for both licit and illicit drugs in schools. The mode of delivery was certainly welcomed by both students and teachers, with the latter rating these programs to be superior to other drug prevention approaches and reporting that they would be likely to continue using these programs in the future. The CLIMATE drug prevention programs now offer a suite of sequential and developmentally appropriate interventions catering for both licit and illicit drug use. What remains to be done is to trial the complete suite and assess if this enhances programmatic effects.

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