Nicola C. Newton

Effectiveness of a Selective, Personality-Targeted Prevention Program for Adolescent Alcohol Use and Misuse: A Cluster Randomized Controlled Trial

CONTEXT Selective school-based alcohol prevention programs targeting youth with personality risk factors for addiction and mental health problems have been found to reduce substance use and misuse in those with elevated personality profiles. OBJECTIVES To report 24-month outcomes of the Teacher-Delivered Personality-Targeted Interventions for Substance Misuse Trial (Adventure trial) in which school staff were trained to provide interventions to students with 1 of 4 high-risk (HR) profiles: anxiety sensitivity, hopelessness, impulsivity, and sensation seeking and to examine the indirect herd effects of this program on the broader low-risk (LR) population of students who were not selected for intervention. DESIGN Cluster randomized controlled trial. SETTING Secondary schools in London, United Kingdom. PARTICIPANTS A total of 1210 HR and 1433 LR students in the ninth grade (mean [SD] age, 13.7 [0.33] years). INTERVENTION Schools were randomized to provide brief personality-targeted interventions to HR youth or treatment as usual (statutory drug education in class). MAIN OUTCOME MEASURES Participants were assessed for drinking, binge drinking, and problem drinking before randomization and at 6-monthly intervals for 2 years. RESULTS Two-part latent growth models indicated long-term effects of the intervention on drinking rates (β = -0.320, SE = 0.145, P = .03) and binge drinking rates (β = -0.400, SE = 0.179, P = .03) and growth in binge drinking (β = -0.716, SE = 0.274, P = .009) and problem drinking (β = -0.452, SE = 0.193, P = .02) for HR youth. The HR youth were also found to benefit from the interventions during the 24-month follow-up on drinking quantity (β = -0.098, SE = 0.047, P = .04), growth in drinking quantity (β = -0.176, SE = 0.073, P = .02), and growth in binge drinking frequency (β = -0.183, SE = 0.092, P = .047). Some herd effects in LR youth were observed, specifically on drinking rates (β = -0.259, SE = 0.132, P = .049) and growth of binge drinking (β = -0.244, SE = 0.073, P = .001), during the 24-month follow-up. CONCLUSIONS Findings further support the personality-targeted approach to alcohol prevention and its effectiveness when provided by trained school staff. Particularly novel are the findings of some mild herd effects that result from this selective prevention program. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00776685.

When Hurt Will Not Heal Exploring the Capacity to Relive Social and Physical Pain

Recent discoveries suggest that socialpain is as real and intense as physical pain, and that the social-pain system may have piggybacked on the brain structure that had evolved earlier for physical pain. The present study examined an important distinction between social and physical pain: Individuals can relive and reexperience social pain more easily and more intensely than physical pain. Studies 1 and 2 showed that people reported higher levels of pain after reliving a past socially painful event than after reliving a past physically painful event. Studies 3 and 4 found, in addition, that people performed worse on cognitively demanding tasks after they relived social rather than physical pain. Implications for research on social pain and theories about social pain are discussed.

Internet-based prevention for alcohol and cannabis use: final results of the Climate Schools course

AIMS To establish the long-term efficacy of a universal internet-based alcohol and cannabis prevention programme in schools. METHODS A cluster-randomized controlled trial was conducted to assess the effectiveness of the Climate Schools: Alcohol and Cannabis Course. The evidence-based course, aimed at reducing alcohol and cannabis use, is facilitated by the internet and consists of 12 novel and curriculum consistent lessons delivered over 6 months. PARTICIPANTS A total of 764 year 8 students (13 years) from 10 Australian secondary schools were allocated randomly to the internet-based prevention programme (n = 397, five schools), or to their usual health classes (n = 367, five schools). MEASURES Participants were assessed at baseline, immediately post, and 6 and 12 months following completion of the intervention, on measures of alcohol and cannabis knowledge, attitudes, use and related harms. RESULTS This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12-month follow-up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol- and cannabis-related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools. CONCLUSIONS Internet-based prevention programs for school-age children can improve students knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.

Delivering prevention for alcohol and cannabis using the Internet: a cluster randomised controlled trial.

OBJECTIVE To establish the efficacy of an internet based prevention program to reduce alcohol and cannabis use in adolescents. METHOD A cluster randomised controlled trial was conducted with 764 13-year olds from ten Australian secondary schools in 2007-2008. Half the schools were randomly allocated to the computerised prevention program (n=397), and half to their usual health classes (n=367). The Climate Schools: Alcohol and Cannabis prevention course is facilitated by the internet and consists of novel, evidence-based, curriculum consistent lessons aimed at reducing alcohol and cannabis use. Participants were assessed at baseline, immediately post, and at six months following the intervention. RESULTS Compared to the control group, students in the intervention group showed significant 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 related harms. CONCLUSIONS The course is acceptable, scalable and fidelity is assured. It increased knowledge regarding alcohol and cannabis, and decreased use of these drugs.

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.

Australian school-based prevention programs for alcohol and other drugs: A systematic review

ISSUES To reduce the occurrence and costs related to substance use and associated harms it is important to intervene early. Although a number of international school-based prevention programs exist, the majority show minimal effects in reducing drug use and related harms. Given the emphasis on early intervention and prevention in Australia, it is timely to review the programs currently trialled in Australian schools. This paper reports the type and efficacy of Australian school-based prevention programs for alcohol and other drugs. APPROACH Cochrane, PsychInfo and PubMed databases were searched. Additional materials were obtained from authors, websites and reference lists. Studies were selected if they described programs developed and trialled in Australia that address prevention of alcohol and other drug use in schools. KEY FINDINGS Eight trials of seven intervention programs were identified. The programs targeted alcohol, cannabis and tobacco and most were based on social learning principles. All were universal. Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use at follow up. CONCLUSION Existing school-based prevention programs have shown to be efficacious in the Australian context. However, there are only a few programs available, and these require further evaluative research. This is critical, given that substance use is such a significant public health problem. The findings challenge the commonly held view that school-based prevention programs are not effective.

CLIMATE Schools: alcohol module: cross-validation of a school-based prevention programme for alcohol misuse

Objective: The aim of the present study was to conduct a cross-validation trial of the efficacy of a computerized school-based intervention for alcohol misuse in adolescents. Method: A cluster randomized control trial was carried out. Intervention and control groups were assessed at baseline, immediately after and 6 months after the intervention. A total of 764 Year 8 students from 10 independent secondary schools in Sydney, Australia participated in the study. Half of the schools were randomly allocated to the computerized prevention programme (n=397), and half to their usual classes (n=367). The six-lesson computerized intervention was evidence and curriculum based while having a focus on harm-minimization. Knowledge, expectancies, alcohol consumption (frequency, quantity and binging), patterns of use, and harms associated with ones own use of alcohol were assessed. Results: There were significant improvements in knowledge regarding alcohol use at immediate and 6 month follow up. Average weekly alcohol consumption was reduced immediately after the intervention. No differences between groups were found on alcohol expectancies, frequency of drinking to excess and harms related to alcohol use over time. Conclusions: The present results support the Climate Management and Treatment Education (CLIMATE) Schools: alcohol module as an effective intervention in increasing alcohol knowledge and reducing alcohol use in the short term.

Suicidality, internalizing problems and externalizing problems among adolescent bullies, victims and bully-victims

OBJECTIVE The aim of this study is to compare suicidality, internalizing problems and externalizing problems among adolescent victims, bullies and bully-victims. METHOD This study examined bullying involvement among a subset of the baseline sample of the Climate and Preventure study, a trial of a comprehensive substance use prevention intervention for adolescents in 2012. The sample included 1588 Year 7-9 students in New South Wales and Victoria, Australia. RESULTS Victims, bullies and bully-victims had more problems than uninvolved students. Students with internalizing problems were more likely to be a victim than a bully. Some externalizing problems (alcohol and tobacco use) were associated with increased odds of being a bully, but not others (cannabis use and conduct/hyperactivity symptoms). Suicidal ideation, internalizing problems and some externalizing problems increased the odds of being a bully-victim compared to being a bully or a victim. CONCLUSION Early intervention for adolescents frequently involved in bullying may reduce the onset of substance use and other mental disorders. It would be advisable for bullying interventions to include a focus on substance use and mental health problems. A reduction in these chronic and detrimental problems among adolescents could potentially lead to a concomitant reduction in bullying involvement.

Prevalence, correlates and comorbidity of DSM-IV Cannabis Use and Cannabis Use Disorders in Australia

Objective: To report nationally representative findings on the prevalence, correlates, psychiatric comorbidity and treatment of DSM-IV Cannabis Use and Cannabis Use Disorders in Australia. Method: The 2007 National Survey of Mental Health and Wellbeing was a nationally representative household survey of 8841 Australians (16–85 years) that assessed symptoms of the most prevalent DSM-IV mental disorders. Results: Prevalence of lifetime and 12-month cannabis use was 18% and 6%; prevalence of lifetime and 12-month cannabis use disorder was 6% and 1%. The conditional prevalence (proportion of ever users who met criteria for a disorder) of lifetime and 12-month cannabis use disorder was 32.2% and 14.3%. Current cannabis use disorders were more common in males (OR 2.0) and younger users (OR 4.6). Strong associations were observed between current cannabis use disorders and alcohol use disorders (OR 3.6) and current affective disorders (OR 3.0). Only 36.2% of those with current cannabis use disorders sought any treatment. Conclusions: The prevalence of cannabis use disorders in the Australian population is comparable with that in the USA. Current cannabis use disorders are highly concentrated in young Australians who have high levels of comorbidity. The low rates of treatment seeking warrant attention in treatment and prevention strategies.

The CAP study, evaluation of integrated universal and selective prevention strategies for youth alcohol misuse: study protocol of a cluster randomized controlled trial.

BackgroundAlcohol misuse amongst young people is a serious concern. The need for effective prevention is clear, yet there appear to be few evidenced-based programs that prevent alcohol misuse and none that target both high and low-risk youth. The CAP study addresses this gap by evaluating the efficacy of an integrated approach to alcohol misuse prevention, which combines the effective universal internet-based Climate Schools program with the effective selective personality-targeted Preventure program. This article describes the development and protocol of the CAP study which aims to prevent alcohol misuse and related harms in Australian adolescents.Methods/DesignA cluster randomized controlled trial (RCT) is being conducted with Year 8 students aged 13 to 14-years-old from 27 secondary schools in New South Wales and Victoria, Australia. Blocked randomisation was used to assign schools to one of four groups; Climate Schools only, Preventure only, CAP (Climate Schools and Preventure), or Control (alcohol, drug and health education as usual). The primary outcomes of the trial will be the uptake and harmful use of alcohol and alcohol related harms. Secondary outcomes will include alcohol and cannabis related knowledge, cannabis related harms, intentions to use, and mental health symptomatology. All participants will complete assessments on five occasions; baseline; immediately post intervention, and at 12, 24 and 36 months post baseline.DiscussionThis study protocol presents the design and current implementation of a cluster RCT to evaluate the efficacy of the CAP study; an integrated universal and selective approach to prevent alcohol use and related harms among adolescents. Compared to students who receive the stand-alone universal Climate Schools program or alcohol and drug education as usual (Controls), we expect the students who receive the CAP intervention to have significantly less uptake of alcohol use, a reduction in average alcohol consumption, a reduction in frequency of binge drinking, and a reduction in alcohol related harms.Trial registrationThis trial is registered with the Australian and New Zealand Clinical Trials registry, ACTRN12612000026820.