School Health and Alcohol Harm Reduction Project
An Evidence-based Program to Reduce Alcohol Related Harm in Young People
What is the SHAHRP program?
The School Health and Alcohol Harm Reduction Project is a world first research study assessing the behavioural impact of classroom-based alcohol harm reduction on students' alcohol consumption and harm in alcohol use situations (Scientific Publications). The study was conducted over a 32-month period, with earlier data collection at 8 and 20 months after the completion of each phase of the program (Research Design). Each assessment measured knowledge about alcohol, attitudes towards alcohol, total consumption, risky patterns of consumption, context of alcohol use, alcohol-related harms/risks associated with the student's own alcohol use, and alcohol-related harm/risks associated with other people's alcohol use.
The evidence-based, classroom program was conducted in two phases over a two year period. The initial phase was implemented during the first year of secondary school (13 years old) when most students had not yet started to experiment with alcohol (inoculation). It consisted of 17 skill-based activities conducted over 8-10 lessons. Phase 2, which was conducted the following year (when many young people had started to experiment with alcohol), consisted of 12 activities delivered over 5-7 weeks.
The SHAHRP results indicated an immediate effect in reducing the harm that young people experienced from their own drinking, and the harm they experienced from other people's drinking. Over the period of the study (from baseline to final follow-up 32 months later), students who participated in SHAHRP consumed 20% less alcohol, were 19.5% less likely to drink to harmful or hazardous levels, had 10% greater alcohol related knowledge, experienced 33% less harm associated with their own use of alcohol and 10% less harm associated with other people's use of alcohol than did the control group (who received regular alcohol education).
During the first and second phases of the program, intervention students consumed 31.4% and 31.7% less alcohol. Differences in alcohol use were converging 17 months after the end of the program. Intervention students were 25.7%, 33.8% and then 4.2% less likely to drink to risky levels from first follow-up onwards. This shows that direct classroom programs are critically important to creating alcohol use change. However, the impact on harm reduction was maintained. The intervention reduced harm that young people experienced as a result of their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards.
The SHAHRP study was replicated in Northern Ireland with the results reinforcing the behavioural findings of the Australian SHAHRP study. Replication of SHAHRP in another jurisdiction, under a separate research group, provides stronger scientific evidence of the impact of SHAHRP on alcohol behaviours.
What is the SHAHRP classroom program?
SHAHRP is a classroom based program aimed at reducing alcohol-related harm and risky consumption. SHAHRP is designed to be implemented at a time when local prevalence data indicates that young people are starting to experiment with alcohol.
Before developing and pre-testing the program, project staff conducted extensive formative work, including talking about alcohol issues with young people, to ensure that activities were based on reality and relevant to young people (Publications: 4, 11, 15). The program is evidenced-based and incorporates findings from a systematic literature review of school drug education research (Publications: 7, 9), incorporates the experience of young people, and has been well tested in schools with students and teachers.
The SHAHRP activities incorporate various strategies for interaction including delivery of utility information; skill rehearsal; individual and small group decision making; and discussions based on scenarios suggested by students, with an emphasis on identifying alcohol-related harm and strategies to reduce harm. Interactive involvement is emphasised, with two-thirds of activities being primarily interactive and another 15% requiring some interaction between students. Interactive involvement of students provides important practice in reducing harm associated with alcohol use and is a critical aspect of lessons using an evidence-based approach.
The SHAHRP program components include:
Teacher training is conducted before each phase of SHAHRP. During Phase 1, teachers are provided with two days of training that gives an overview of the study behaviour outcomes, evidence-based components, and interactive modelling of each Phase 1 activity. Phase 2 training is conducted over two days for teachers new to the project. These teachers are briefed on the research aspects of the project and Phase 1 intervention activities during the first day of training. On day two, all teachers participate in interactive modelling of Phase 2 activities. Trainers who are experienced in interactive techniques are recommended as SHAHRP teacher trainers.
The teacher manual provides specific written guidance for teachers. The manual includes detailed and structured lesson plans for eight 60-minute lessons in the first phase and five 50-minute lessons in the second phase. Each lesson plan includes sample questions to help facilitate discussion and processing of activities and to focus on activity intention, coaching points to aid in the management of the activities, and background information about alcohol-related issues. Additional coaching points included in the teacher manual are based on feedback from teachers who have previously taught the program.
Student workbooks are available for each phase to stimulate and engage student's interest, provide information, encourage students to further explore issues and to record what they have learned as a way of consolidating practical activities. Qualitative results from the SHAHRP study show that students and teachers thought the books were appealing and great to use as reinforcement to the interactive activities.
A Trigger Visual is used in Phase 2 of SHAHRP. The DVD features scenarios that young people may experience in alcohol use situations to prompt discussion about how to minimise the harms associated with alcohol use.
The SHAHRP teacher manual and student workbooks are available free from the SHAHRP website.
The process of engaging students has been given particular emphasis during program development. To ensure that the SHAHRP intervention was sensitive to the concerns of the students it sought to influence, SHAHRP researchers conducted focus groups with 80 Western Australian teenagers. Students were allocated to the focus groups based on gender. The focus groups aimed to identify young people's alcohol use experiences, alcohol related harms of particular concern to young people, harm reduction strategies adopted by young people, and educational approaches likely to be effective with young people.
The students were generally keen to express their opinions about alcohol and issues associated with its use and were consistent in the issues they identified as of concern to them (Publications: 4, 11, 15).
Piloting intervention program
Pre-testing of the alcohol program played an important role in refining the alcohol curriculum materials to incorporate teacher and student responses, while maintaining the integrity of evidence-based components. Three Western Australian secondary schools were recruited to pilot the alcohol intervention. The program was implemented in six year eight classes (12-13 year olds) involving about 200 students and six teachers. Before implementation, pilot teachers attended a two-day training workshop based on interactive modelling of intervention activities. Pilot teachers provided written and verbal evaluation of this workshop.
Process evaluation and monitoring procedures were also piloted during this initial formative stage of the study. Pilot teachers were asked to complete a process evaluation form for each activity immediately after conducting the lesson. The process evaluation forms required comment on level of completion, student response, teacher response and suggestions to retain or modify each activity. Forms were provided to the researcher immediately after completion of each lesson. This information provided an ongoing list of suggested modifications and impressions that were used to revise the intervention before the main study.
An evaluation workshop was conducted at the conclusion of the pilot to further refine the teaching program. The workshop was attended by the pilot teachers, the primary writers of the program, and the SHAHRP research team. A triangulation of measures was adopted to assess the program including teacher and student monitoring. Each activity in the program was discussed and assessed by the pilot teachers, according to content, methods, relevance to age, timing and training. The process evaluation forms, which required comment on level of activity completion, student response, teacher response and suggestions to retain or modify for each activity, were reviewed. Each teacher also provided written student comments regarding what the students liked and disliked about the program and recommendations for improvements.
These recommendations were incorporated into the SHAHRP teaching program. One of the most valuable aspects of the pilot process was 'putting the materials to test in the real world' of the classroom, thereby gaining insight into the potential effectiveness of the harm reduction program that incorporated evidence.