Katrina E. Champion

A systematic review of school‐based alcohol and other drug prevention programs facilitated by computers or the Internet

ISSUES The use of alcohol and drugs amongst young people is a serious concern and the need for effective prevention is clear. This paper identifies and describes current school-based alcohol and other drug prevention programs facilitated by computers or the Internet. APPROACH The Cochrane Library, PsycINFO and PubMed databases were searched in March 2012. Additional materials were obtained from reference lists of papers. Studies were included if they described an Internet- or computer-based prevention program for alcohol or other drugs delivered in schools. KEY FINDINGS Twelve trials of 10 programs were identified. Seven trials evaluated Internet-based programs and five delivered an intervention via CD-ROM. The interventions targeted alcohol, cannabis and tobacco. Data to calculate effect size and odds ratios were unavailable for three programs. Of the seven programs with available data, six achieved reductions in alcohol, cannabis or tobacco use at post intervention and/or follow up. Two interventions were associated with decreased intentions to use tobacco, and two significantly increased alcohol and drug-related knowledge. CONCLUSION This is the first study to review the efficacy of school-based drug and alcohol prevention programs delivered online or via computers. Findings indicate that existing computer- and Internet-based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the Internet offer a promising delivery method for school-based prevention.

The structure of adolescent psychopathology: a symptom-level analysis

BACKGROUND Most empirical studies into the covariance structure of psychopathology have been confined to adults. This work is not developmentally informed as the meaning, age-of-onset, persistence and expression of disorders differ across the lifespan. This study investigates the underlying structure of adolescent psychopathology and associations between the psychopathological dimensions and sex and personality risk profiles for substance misuse and mental health problems. METHOD This study analyzed data from 2175 adolescents aged 13.3 years. Five dimensional models were tested using confirmatory factor analysis and the external validity was examined using a multiple-indicators multiple-causes model. RESULTS A modified bifactor model, with three correlated specific factors (internalizing, externalizing, thought disorder) and one general psychopathology factor, provided the best fit to the data. Females reported higher mean levels of internalizing, and males reported higher mean levels of externalizing. No significant sex differences emerged in liability to thought disorder or general psychopathology. Liability to internalizing, externalizing, thought disorder and general psychopathology was characterized by a number of differences in personality profiles. CONCLUSIONS This study is the first to identify a bifactor model including a specific thought disorder factor. The findings highlight the utility of transdiagnostic treatment approaches and the importance of restructuring psychopathology in an empirically based manner.

Universal Internet-based prevention for alcohol and cannabis use reduces truancy, psychological distress and moral disengagement: a cluster randomised controlled trial.

AIMS A universal Internet-based preventive intervention has been shown to reduce alcohol and cannabis use. The aim of this study was to examine if this program could also reduce risk-factors associated with substance use in adolescents. METHOD A cluster randomised controlled trial was conducted in Sydney, Australia in 2007-2008 to assess the effectiveness of the Internet-based Climate Schools: Alcohol and Cannabis course. The evidence-based course, aimed at reducing alcohol and cannabis use, consists of two sets of six lessons delivered approximately six months apart. A total of 764 students (mean 13.1years) from 10 secondary schools were randomly allocated to receive the preventive intervention (n=397, five schools), or their usual health classes (n=367, five schools) over the year. Participants were assessed at baseline, immediately post, and six and twelve months following the intervention on their levels of truancy, psychological distress and moral disengagement. RESULTS Compared to the control group, students in the intervention group showed significant reductions in truancy, psychological distress and moral disengagement up to twelve months following completion of the intervention. CONCLUSIONS These intervention effects indicate that Internet-based preventive interventions designed to prevent alcohol and cannabis use can concurrently reduce risk-factors associated with substance use in adolescents. CLINICAL TRIALS REGISTRATION Australian Clinical Trials Registry ACTRN: 012607000312448.

Patterns and correlates of new psychoactive substance use in a sample of Australian high school students

INTRODUCTION AND AIMS In recent years there has been growing concern about new psychoactive substances (NPS) designed to mimic the effects of established illicit drugs. This paper explores the patterns and correlates of NPS use in a sample of Australian students. DESIGN AND METHODS A cross-sectional survey was conducted in Australia in 2014. Data were collected from 1126 students (mean age: 14.9 years) from 11 secondary schools. Students completed a self-report questionnaire assessing NPS use and knowledge, beliefs and intentions to use these substances. NPS users were compared with non-users and illicit drug users, who had not used NPS, in terms of gender, binge drinking, tobacco use, psychological distress and self-efficacy to resist peer pressure. RESULTS Of the 1126 students, 3% reported having ever tried NPS, 2.4% had used synthetic cannabis and 0.4% had used a synthetic stimulant. Analyses revealed that NPS users were more likely to have had an episode of binge drinking in the past 6 months, tried tobacco and had higher levels of psychological distress and lower perceived self-efficacy to resist peer pressure than non-users, but did not significantly differ from users of other illicit drugs. DISCUSSION AND CONCLUSIONS NPS use appears to be uncommon among Australian school students. Although adolescents that do use these substances did not differ from students that had used traditional illicit drugs, both appear to be higher-risk groups of students than non-users. Our findings suggest that universal education about NPS be incorporated into existing drug prevention programmes, and that targeted NPS prevention may also be warranted among high-risk adolescents. [Champion KE, Teesson M, Newton NC. Patterns and correlates of new psychoactive substance use in a sample of Australian high school students. Drug Alcohol Rev 2016;35:338-344].

The validity of the Substance Use Risk Profile Scale (SURPS) among Australian adolescents.

AIMS This study investigated the validity of a brief personality screening measure for substance use in adolescents, the Substance Use Risk Profile Scale (SURPS), among Australian adolescents. DESIGN AND PARTICIPANTS A total of 527 adolescents (mean age: 13.38years, SD=0.43) from seven Australian schools were assessed at two time points 24months apart. The concurrent and predictive validity of the SURPS was determined using a series of linear and logistic regressions, and was compared to the results in a United Kingdom (UK) sample. SURPS subscale scores for the Australian population were also reported and compared to those in the UK. FINDINGS Overall, the SURPS subscale scores for Australian adolescents were similar to those for adolescents from the UK. Tests of concurrent and predictive validity in the Australian sample demonstrated that the all four personality profiles - Hopelessness (H), Anxiety Sensitivity (AS), Impulsivity (IMP), and Sensation Seeking (SS) - were related to measures of substance use and other behavioural and emotional characteristics. In addition, all the predicted specific prospective relationships between the personality profiles and particular substance use and other behavioural problems were confirmed except that H was not associated with illicit drug use. Overall, the results were similar between the Australian and UK samples. CONCLUSIONS The SURPS is a valid and useful measure for identifying Australian adolescents at high-risk for substance use and other emotional and behavioural problems. Implications for prevention are discussed.

Combined universal and selective prevention for adolescent alcohol use: a cluster randomized controlled trial

BACKGROUND No existing models of alcohol prevention concurrently adopt universal and selective approaches. This study aims to evaluate the first combined universal and selective approach to alcohol prevention. METHOD A total of 26 Australian schools with 2190 students (mean age: 13.3 years) were randomized to receive: universal prevention (Climate Schools); selective prevention (Preventure); combined prevention (Climate Schools and Preventure; CAP); or health education as usual (control). Primary outcomes were alcohol use, binge drinking and alcohol-related harms at 6, 12 and 24 months. RESULTS Climate, Preventure and CAP students demonstrated significantly lower growth in their likelihood to drink and binge drink, relative to controls over 24 months. Preventure students displayed significantly lower growth in their likelihood to experience alcohol harms, relative to controls. While adolescents in both the CAP and Climate groups demonstrated slower growth in drinking compared with adolescents in the control group over the 2-year study period, CAP adolescents demonstrated faster growth in drinking compared with Climate adolescents. CONCLUSIONS Findings support universal, selective and combined approaches to alcohol prevention. Particularly novel are the findings of no advantage of the combined approach over universal or selective prevention alone.

Prevention of alcohol and other drug use and related harm in the digital age: what does the evidence tell us?

Purpose of review Alcohol and other drug use are major contributors to the global burden of disease. Prevention is critical and evidence is beginning to support the use of online mediums to prevent alcohol and other drug use and harms among adolescents. This study aims to expand the evidence base by conducting a systematic review of recent universal prevention programs delivered by computers and the Internet. Recent findings A total of 12 papers reporting outcomes from trials of nine universal online prevention programs were identified. Of the identified interventions, five targeted multiple substances, two focused solely on alcohol, one targeted only cannabis and one primarily addressed smoking. The majority of programs were delivered at school; however one was implemented in a primary care setting. Six programs demonstrated significant, but modest, effects for alcohol and/or other drug use outcomes. Summary Evidence to support the efficacy of computer and Internet-based prevention programs for alcohol and other drug use and related harms among adolescents is rapidly emerging, demonstrating that online prevention is an area of increasing promise. Further replication work, longer-term trials and attempts to increase the impact are required.

A cross-validation trial of an Internet-based prevention program for alcohol and cannabis: Preliminary results from a cluster randomised controlled trial

Objective: Replication is an important step in evaluating evidence-based preventive interventions and is crucial for establishing the generalizability and wider impact of a program. Despite this, few replications have occurred in the prevention science field. This study aims to fill this gap by conducting a cross-validation trial of the Climate Schools: Alcohol and Cannabis course, an Internet-based prevention program, among a new cohort of Australian students. Method: A cluster randomized controlled trial was conducted among 1103 students (Mage: 13.25 years) from 13 schools in Australia in 2012. Six schools received the Climate Schools course and 7 schools were randomized to a control group (health education as usual). All students completed a self-report survey at baseline and immediately post-intervention. Mixed-effects regressions were conducted for all outcome variables. Outcomes assessed included alcohol and cannabis use, knowledge and intentions to use these substances. Results: Compared to the control group, immediately post-intervention the intervention group reported significantly greater alcohol (d = 0.67) and cannabis knowledge (d = 0.72), were less likely to have consumed any alcohol (even a sip or taste) in the past 6 months (odds ratio = 0.69) and were less likely to intend on using alcohol in the future (odds ratio = 0.62). However, there were no effects for binge drinking, cannabis use or intentions to use cannabis. Conclusion: These preliminary results provide some support for the Internet-based Climate Schools: Alcohol and Cannabis course as a feasible way of delivering alcohol and cannabis prevention. Intervention effects for alcohol and cannabis knowledge were consistent with results from the original trial; however, analyses of longer-term follow-up data are needed to provide a clearer indication of the efficacy of the intervention, particularly in relation to behavioral changes.

A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice

Background The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response. Objective This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community. Methods Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit’s acceptability, relevance, and appeal. Results Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were “to get information for myself” (185/451, 41.0%) and “to find out how to help a friend or a family member” (136/451, 30.2%). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection, improving the ease of navigation, and balancing a “low prevalence of use, yet high impact” message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93% (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07% (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website. Conclusions The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities.

Climate schools plus: an online, combined student and parent, universal drug prevention program.

Early initiation of substance use significantly increases ones risk of developing substance use dependence and mental disorders later in life. To interrupt this trajectory, effective prevention during the adolescent period is critical. Parents play a key role in preventing substance use and related harms among adolescents and parenting interventions have been identified as critical components of effective prevention programs. Despite this, there is currently no substance use prevention program targeting both students and parents that adopts online delivery to overcome barriers to implementation and sustainability. The Climate Schools Plus (CSP) program was developed to meet this need. CSP is an online substance use prevention program for students and parents, based on the effective Climate Schools prevention program for students. This paper describes the development of the parent component of CSP including a literature review and results of a large scoping survey of parents of Australian high school students (n = 242). This paper also includes results of beta-testing of the developed program with relevant experts (n = 10), and parents of Australian high school students (n = 15). The CSP parent component consists of 1) a webinar which introduces shared rule ranking, 2) online modules and 3) summaries of student lessons. The parent program targets evidence-based modifiable factors associated with a delay in the onset of adolescent substance use and/or lower levels of adolescent substance use in the future; namely, rule-setting, monitoring, and modelling. To date, this is the first combined parent-student substance use prevention program to adopt an online delivery method.