Robyn Ramsden

Drug education in victorian schools (DEVS): the study protocol for a harm reduction focused school drug education trial

BackgroundThis study seeks to extend earlier Australian school drug education research by developing and measuring the effectiveness of a comprehensive, evidence-based, harm reduction focused school drug education program for junior secondary students aged 13 to 15 years. The intervention draws on the recent literature as to the common elements in effective school curriculum. It seeks to incorporate the social influence of parents through home activities. It also emphasises the use of appropriate pedagogy in the delivery of classroom lessons.Methods/DesignA cluster randomised school drug education trial will be conducted with 1746 junior high school students in 21 Victorian secondary schools over a period of three years. Both the schools and students have actively consented to participate in the study. The education program comprises ten lessons in year eight (13-14 year olds) and eight in year nine (14-15 year olds) that address issues around the use of alcohol, tobacco, cannabis and other illicit drugs. Control students will receive the drug education normally provided in their schools. Students will be tested at baseline, at the end of each intervention year and also at the end of year ten. A self completion questionnaire will be used to collect information on knowledge, patterns and context of use, attitudes and harms experienced in relation to alcohol, tobacco, cannabis and other illicit drug use. Multi-level modelling will be the method of analysis because it can best accommodate hierarchically structured data. All analyses will be conducted on an Intent-to-Treat basis. In addition, focus groups will be conducted with teachers and students in five of the 14 intervention schools, subsequent to delivery of the year eight and nine programs. This will provide qualitative data about the effectiveness of the lessons and the relevance of the materials.DiscussionThe benefits of this drug education study derive both from the knowledge gained by trialling an optimum combination of innovative, harm reduction approaches with a large, student sample, and the resultant product. The research will provide better understanding of what benefits can be achieved by harm reduction education. It will also produce an intervention, dealing with both licit and illicit drug use that has been thoroughly evaluated in terms of its efficacy, and informed by teacher and student feedback. This makes available to schools a comprehensive drug education package with prevention characteristics and useability that are well understood.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000079842

Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs.

BackgroundExcessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.MethodsA cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.ResultsMembers of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted ‘happy hour’ promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.ConclusionsThe findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.

Influences on teachers' use of participatory learning strategies in health education classes

Objective: Participatory learning strategies are integral to the effectiveness of school-based health education programmes; however, use of such methods is not the norm in teaching. The omission of participatory learning strategies is a common form of programme breakdown leading to erosion of positive learning and behavioural outcomes. Based on a survey of 75 Australian high school health education teachers, the study’s objective is to examine teachers’ perspectives on the factors that influence their use of participatory learning strategies. Results: Whilst it is often presumed that training is the most significant factor, this study found that teachers identify understanding the educational rationale for the approach, student engagement, confidence in class control, and having positive relationships with the students, along with practicalities such as having time to adequately prepare a class, as the most significant influences on their pedagogical choices. Conclusion: The study concludes that a better understanding of the reasons why teachers make particular choices in their delivery of programmes gives valuable insight into what teachers need in order to support uptake or maintenance of such approaches. This understanding may in turn contribute to health education programmes being delivered with a higher fidelity and better outcomes for students.

Alcohol management practices in community football clubs: association with risky drinking at the club and overall hazardous alcohol consumption

INTRODUCTION AND AIMS Across the world, it has been estimated that approximately 270 million people participate in community football clubs. However, the community sports club setting is associated with high levels of risky alcohol consumption. The study examined if sporting club alcohol management practices are associated with risky consumption of alcohol by club members while at the club, and also whether such consumption is directly and indirectly associated with club member overall hazardous alcohol consumption. DESIGN AND METHODS Telephone surveys were conducted with a representative from 72 community football clubs in New South Wales, Australia, and 1428 club members. A path and mediation analysis was undertaken to determine the association between 11 club alcohol management practices and member alcohol consumption, at the club and overall hazardous consumption. RESULTS Three alcohol management practices were associated with an increased probability of risky drinking while at the club: having alcohol promotions; serving intoxicated patrons; and having bar open longer than 4 h. A mediation analyses identified that risky drinking at the club as a result of these three practices was also linked to increase risk in being an overall hazardous drinker. DISCUSSION AND CONCLUSION Modifying alcohol management practices in community football clubs has the potential to reduce both risky alcohol consumption by members in this setting and the prevalence of overall hazardous alcohol consumption. Coordinated, multi-strategic interventions are required to support community football clubs to modify their alcohol management practices and hence contribute to reducing the burden of alcohol-related harm in the community.

Alcohol Prevention and School Students: Findings from an Australian 2-Year Trial of Integrated Harm Minimization School Drug Education.

The Drug Education in Victorian Schools program provided integrated education about licit and illicit drugs, employed a harm minimization approach that incorporated participatory, critical thinking and skill-based teaching methods, and engaged parental influence through home activities. A cluster-randomized, controlled trial of the program was conducted with a student cohort during Year 8 (13 years) and Year 9 (14 years). Twenty-one secondary schools in Victoria, Australia, were randomly allocated to the Drug Education in Victorian Schools program (14 schools, n = 1,163) or their usual drug education program (7 schools, n = 589). This study reports program effects for alcohol. There was a greater increase in the intervention students’ knowledge about drugs, including alcohol; there was a greater increase in communication with parents about alcohol; they recalled receiving more alcohol education; their alcohol consumption increased less; and they experienced a lesser increase in alcohol-related harms. Among intervention group risky drinkers, consumption and harm increased less. There were no differences between study groups in attitudes toward alcohol or in the proportion of drinkers or risky drinkers. While the program did not stop students taking up drinking, it did reduce their consumption and harm.

Cannabis and Harm Minimisation Drug Education: Findings from the Drug Education in Victorian Schools Study

Aims: To evaluate the effectiveness of an integrated harm minimisation focused school drug education programme in terms of reducing cannabis use and harm. Design and Methods: A cluster randomised controlled trial of the 18 lesson Drug Education in Victorian Schools (DEVS) drug education programme was undertaken with students during years eight and nine (13 and 14 years of age respectively), with follow up in year ten (15 years of age). The programme covered all drugs, employed a harm minimisation approach that used participatory, critical thinking and skills based teaching methods, and engaged parental influence through home activities. Twenty-one secondary schools in Victoria, Australia, were randomly allocated to receive the DEVS programme (14 schools) or the drug education usually provided by their schools (7 schools). In relation to cannabis, communication with parents, lessons remembered, responsible attitudes, whether used, frequency of use and associated harms were measured. Results: In comparison to controls, there was a significantly greater increase in the intervention students’ communication with parents about cannabis recall of cannabis lessons received, and responsible attitudes towards cannabis. While there were no significant differences between the two study groups in relation to the proportion of cannabis users, the increase in level of use by intervention students was significantly less and they experienced a lesser increase in associated harms. Conclusion: A harm minimisation focused school drug education programme reduced the level of cannabis use and associated harm. This supports harm minimisation education as an effective prevention strategy for school students.

Smoking prevention: what benefits are indicated by a pilot school drug education programme that focuses on minimising harm?

Background: This pilot study investigated the smoking prevention benefits of a secondary school drug education programme for all-licit and illicit drugs. The programme took a harm minimisation approach and incorporated abstinence as one of a range of prevention strategies. Method: The study population comprised a cohort of 318 Victorian junior secondary school students (intervention N = 225 in three schools, control N = 93 in one school). During Years 8 (13–14-year-olds) and 9 (14–15-year-olds), the intervention students received a 22-lesson programme derived from evidence of effective practice and aimed at minimising the harm associated with drug use. Control students received the drug education programme normally provided by their school. Results: Students who received the intervention remembered receiving more lessons about smoking and were more knowledgeable about drug use issues overall. They were no less likely to take up smoking, but those who did smoke, reported smoking fewer cigarettes and experiencing fewer harms associated with their smoking. Conclusions: This pilot study suggests that a harm minimisation approach to smoking can complement, rather than threaten, the abstinence message for adolescents. A school drug education programme with a harm reduction focus does not increase initiation into smoking and can equip smokers with the understanding and skills to make better decisions regarding use.

Rejoinder to Dennis Gorman's critique of: “Preventing alcohol harm: Early results from a cluster randomised, controlled trial in Victoria, Australia of comprehensive harm minimisation school drug education”

As researchers seeking to contribute to better alcohol and other drug prevention we appreciate the need for critical reviews of intervention programs. Gormans critique of our recent paper is therefore welcome. It does identify some weaknesses in specificity, which in hindsight could have been better addressed. It also provides an opportunity to explain why certain choices were made in terms of reporting findings (Gorman, 2015; Midford et al., 2014).

Measures to assess the performance of an Australian non-government charitable non-acute health service: A Delphi Survey of Organisational Stakeholders

Organisation performance measurement is relevant for non-profit charitable organisations as they strive for security in an increasingly competitive funding environment. This study aimed to identify the priority measures and indicators of organisational performance of an Australian non-government charitable organisation that delivers non-acute health services. Seventy-seven and 59 participants across nine stakeholder groups responded to a two-staged Delphi technique study of a case study organisation. The stage one questionnaire was developed using information garnered through a detailed review of literature. Data from the first round were aggregated and analysed for the stage two survey. The final data represented a group consensus. Quality of care was ranked the most important of six organisational performance measures. Service user satisfaction was ranked second followed by financial performance, internal processes, employee learning and growth and community engagement. Thirteen priority indicators were determined across the six measures. Consensus was reached on the priority organisational performance measures and indicators. Stakeholders of the case study organisation value evidence-based practice, technical strength of services and service user satisfaction over more commercially orientated indicators.

Alcohol prevention for school students: Results from a 1-year follow up of a cluster-randomised controlled trial of harm minimisation school drug education

Abstract Aims: The Drug Education in Victorian Schools (DEVS) programme taught about licit and illicit drugs over two years (2010–2011), with follow up in the third year (2012). It focussed on minimising harm and employed participatory, critical-thinking and skill-focussed pedagogy. This study evaluated the programme’s residual effectiveness at follow up in reducing alcohol-related risk and harm. Methods: A cluster-randomised, controlled trial was conducted with a student cohort during years eight (13–14 years old), nine (14–15 years old) and 10 (15–16 years old). Schools were randomly allocated to the DEVS programme (14 schools, n = 1163), or their usual drug education (7 schools, n = 589). Multi-level models were fitted to the data, which were analysed on an intent-to-treat basis. Statistically significant findings: Over the 3 years, there was a greater increase in intervention students’ knowledge about drugs, including alcohol. Their alcohol consumption did not increase as much as controls. Their alcohol-related harms decreased, while increasing for controls. There were fewer intervention group risky drinkers, and they reduced their consumption compared to controls. Similarly, harms decreased for intervention group risky drinkers, while increasing for controls. Conclusions: Skill-focussed, harm minimisation drug education can remain effective, subsequent to programme completion, in reducing students’ alcohol consumption and harm, even with risky drinkers.