CLIMATE/CRUfAD* Schools: cannabis prevention programs

Published November 2009

Dr Nickie Newton, Dr Laura Vogl and Professor Maree Teesson National Drug and Alcohol Research Centre (NDARC)

*CLIMATE Schools has now been renamed CRUfAD Schools, but for the purpose of this Bulletin it will be known as CLIMATE Schools, the title used in the research project outlined.

Introduction

In most developed countries, including Australia, cannabis is the most commonly used illicit drug.1, 2 The use of cannabis is particularly high amongst adolescents and the burden of disease, social costs, and disability associated with this use is considerable.3-5 Furthermore, the detrimental effects of cannabis use are robust and include strains on forming and maintaining healthy relationships, disruption to educational and vocational paths, and hindrance to overall social development.6-8 To reduce the occurrence and cost of such problems, preventative interventions need to be initiated early before problems begin to cause disability, and vocational, educational and social harms.9 While prevention strategies exist, research has not been able to consistently demonstrate that school-based drug prevention is effective in reducing cannabis use, and no single program appears to be universally feasible and scalable.10-14 Poor program implementation has been well-recognised as a pervasive factor which has been shown to compromise the effectiveness of such programs.15

The CLIMATE Schools drug prevention programs, which are based on a harm-minimisation approach, have been designed to overcome such concerns by being specifically developed to enhance high fidelity program implementation. 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 and internet 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. They are provided in the manual to ensure that all the activities comply with the principles of evidence-based drug prevention, but also decrease the teacher s workload. 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.16-22

Two of the most recent programs which have been developed by the CLIMATE team at NDARC have focused in part on cannabis use. These are the CLIMATE Schools: Alcohol and Cannabis Module and the CLIMATE Schools: Cannabis and Psychostimulant Module. Both programs were developed with extensive input from teachers, students and health professionals to ensure the programs were based on the most current evidence around effective school-based drug education, were age appropriate and fit within the school syllabus. Tables 1 and 2 contain the lesson content of each program.

Table 1

Lesson content of the CLIMATE Schools: Alcohol and Cannabis Module Lesson

Table 2

Lesson content of the CLIMATE Schools: Psychostimulant and Cannabis Module Lesson

Both these programs have recently been evaluated utilising large cluster randomised controlled trials (RCT) and the results are presented below.

CLIMATE Schools: Alcohol and Cannabis Module

The CLIMATE Schools: Alcohol and Cannabis Module was evaluated using a cluster RCT in ten NSW schools with 764 students. Mean age at baseline was 13.08 years (SD = 0.58) and 60% were male. Five schools (n=397) were randomly allocated to the intervention condition, and five schools (n=367) were randomly allocated to the control condition. Self-report data was obtained on four separate occasions; at baseline, immediately after the course, and at six and twelve months following the intervention. 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, as well as six and twelve months following the intervention.23, 24 In addition, the intervention group showed a reduction in average weekly alcohol consumption and frequency of cannabis use at the six month follow-up, and a reduction in frequency of binge drinking at the twelve month follow-up. No differences between groups were found on alcohol expectancies, cannabis attitudes, or alcohol and cannabis harms.

Evaluation of the course

A sample of teachers (n=12) and students (n=98) from each school who completed the course were randomly chosen to evaluate the program. Both teachers and students provided positive feedback about the program and found the course to be an acceptable means of school drug education. Of the students surveyed, 93% found the cartoon delivery appropriate and enjoyable and 85% said they would use the information in their own lives. Of the teachers surveyed, 91% reported the course met the outcomes of the syllabus, 92% indicated that students liked the program, 72% endorsed the program as better than other education programs, and 75% indicated they would use the course in the future and would recommend it to others. All teachers reported implementing the program in its entirety, including all the computerised cartoon components and at least one class-based interactive activity for each lesson.

CLIMATE Schools: Psychostimulant and Cannabis Module

The CLIMATE Schools: Psychostimulant and Cannabis Module was also evaluated using a RCT in 21 NSW and ACT schools with a total of 1734 students. The mean age of students at baseline was 15.44 years (SD=0.41) and 66.2% were male. Eleven schools were allocated to the control group and ten schools to the Intervention group. The evaluation revealed that the CLIMATE Schools: Psychostimulant and Cannabis Module was effective in increasing knowledge of cannabis and psychostimulants and decreasing pro-drug attitudes.25 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. The intention to use such drugs in the future, however, was significantly subdued in the CLIMATE group. The mode of delivery was once again welcomed by both students and teachers, with the latter rating this program as superior to other drug prevention approaches and reporting that they would be likely to continue using this program in the future.

Conclusions

The innovative design of the CLIMATE Schools drug prevention program has been found to be effective in increasing cannabis-related knowledge, and decreasing the cannabis use up to twelve months following the interventions. In addition, the contemporary and novel design and delivery of the courses has been found to be acceptable to students and teachers as a means of delivering drug education. As such, the novel internet-based course, which adopts a specific harm-minimisation goal, provides a promising framework for the provision of school-based prevention programs in the future.

Further information on the CLIMATE Schools drug prevention programs can be found at www.climateschools.tv. Correspondence to: Dr. Nickie Newton ([email protected]) or
Dr. Laura Vogl ([email protected]).

The development and evaluation of the CLIMATE Schools programs have been funded by the Australian Government Department of Health and Ageing, the Australian Research Council, the Alcohol Education and Rehabilitation Foundation and the National Health and Medical Research Council.

References

  1. Australian Institute of Health and Welfare. (2008). National Drug Strategy Household Survey: First results. Canberra: AIHW.
  2. Office of National Drug Control Policy. (2008). Marijuana: The greatest cause of illegal drug abuse. Washington, DC.
  3. Mathers, C., Vos, T. & Stevenson, C. (1999). The burden of disease and injury in Australia. Canberra: Australian Institute of Health and Welfare.
  4. Andrews, G., Henderson, S. & Hall, W. (2001). Prevalence, comorbidity, disability and service utilisation: Overview of the Australian National Mental Health Survey. British Journal of Psychiatry 178,145-153.
  5. Collins, D.J. & Lapsley, H.M. (2008). The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Canberra: Commonwealth of Australia.
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  7. Chikritzhs, T. & Pascal, R. (2004). Under-age drinking among 14-17 year olds and related harms in Australia. Canberra: Australian Government Department of Health and Ageing.
  8. Australian Government Department of Health and Ageing. (2004). Responding to the mental health needs of young people in Australia: Discussion paper, principles and strategies. Canberra: National Mental Health Strategy.
  9. Spooner, C. & Hall, W. (2002). Public policy and the prevention of substance-use disorders. Current Opinion in Psychiatry 15, 235-239.
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  13. Tobler, N.S., Lassard, T., Marshall, D., Ochshorn, P., & Roona, M. (1999). Effectiveness of school-based drug prevention programs for marijuana use. School Psychology International 20, 105-137.
  14. Faggiano, F., Vigna-Taglianti, F.D., Versino, E., Zambon, A., Borraccino, A., & Lemma, P. (2008). School-based prevention for illicit drugs use: A systematic review. Preventive Medicine 46, 385-396.
  15. Ennett, S.T., Ringwalt, C.L., Thorne, J., Rohrbach, L.A., Vincus, A., Simons-Rudolph, A., et al.(2003). A comparison of current practice in school based substance use programs with meta-analysis findings. Prevention Science 4, 1-14.
  16. Botvin, G. & Griffin, K. (2003). Drug abuse prevention curricula in schools. In Z. Sloboda & W.J. Bukoski (eds.). Handbook of drug abuse prevention: Theory, science and practice. New York: Kluwer Academic/Plenum Publishers.
  17. Meyer, L. & Cahill, H. (2004). Principles for school drug education. Canberra: Australian Government Department of Education Science and Training.
  18. Cuijpers, P. (2002). Effective ingredients of school-based drug prevention programs: A systematic review. Addictive Behaviors 27, 1009-1023.
  19. Cahill, H. (2006). Devising classroom drug education programs. In R. Midford & G. Munro (eds.). Drug education in schools: Searching for the silver bullet. Melbourne: IP Communications.
  20. Midford, R., Munro, G., McBride, N., Snow, P., & Ladzinski, U. (2002). Principles that underpin effective school-based drug education. Journal of Drug Education 32, 363-386.
  21. Tobler, N.S., Roona, M.R., Ochshorn, P., Marshall, D.G., Streke, A.V., & Stackpole, K.M. (2000). School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary Prevention 20, 275-336.
  22. Tobler, N.S. & Stratton, H.H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of the research. The Journal of Primary Prevention 18, 71-128.
  23. Newton, N.C., Andrews, G., Teesson, M., & Vogl, L.E. (2009). Delivering prevention for alcohol and cannabis using the internet: A cluster randomised controlled trial. Preventive Medicine 48, 579-584.
  24. Newton, N.C., Teesson, M., Vogl, L., & Andrews, G. (2009). Internet-based prevention for alcohol and cannabis use: Final results of the Climate Schools Alcohol and Cannabis Course. Addiction, Accepted 21st October 2009.
  25. Vogl, L., Newton, N., Teesson, M., Swift, W., Karageorge, A., Deans, C., et al. (2009). Climate Schools: Drug Prevention Programs. Sydney: National Drug and Alcohol Research Centre, UNSW.

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