ABSTRACT
The School Health and Alcohol Harm Reduction Project (SHAHRP) research involved the evaluation of an alcohol, harm reduction program for secondary school students. The SHAHRP intervention aimed to modify students’ alcohol related knowledge, attitudes and behaviours.
The alcohol intervention was informed by a systematic review of the school drug education area, which sought to identify components that would enhance potential for behaviour change in the target population. The systematic review was bounded by a set of criteria to ensure appropriate selection and assessment of the extensive amount of literature available on school drug education. The review included assessment of previous reviews of school drug education, and assessment of recent, effective primary studies. Of the 165 review documents uncovered, 19 met the inclusion criteria. Of the 65 recent primary studies uncovered, four met the inclusion criteria. The findings of these reviews and recent primary studies were collated with emphasis given to timing and programming issues; content and delivery issues; teacher training; dissemination, and research and evaluation issues. The findings of the systematic review, guided both the intervention and the research design of the study. This systematic literature review is available from the National drug Research Institute as an Institute monograph.
The SHAHRP intervention aimed to provide young people with sufficient practical skills to reduce the level of harm they experienced from their own and from other people's use of alcohol. This was achieved by enhancing young peoples’ abilities to identify and deal with risks and harms associated with alcohol use. The intervention was a curriculum program, with an explicit harm minimisation goal. The program was conducted in two phases over a two year period, during the students’ first and second year of secondary schooling (13 and 14 years of age). The intervention was delivered largely by teachers from Physical and Health Education Departments and emphasised interactive participation.
The SHAHRP research was a quasi experimental, longitudinal, efficacy study and was conducted in 14 metropolitan secondary schools in Perth, Western Australia. Students (n= 1111) from six of the schools received the SHAHRP program, and students (n=1232) from the eight other schools acted as a control/comparison group. Students were followed over a 32 month period, receiving two phases of intervention and participating in four periods of data collection. The retention rate over the period of the study was 75.9%.
The conceptual basis of the survey instrument used in the study, incorporated information from previous studies and student generated data. Survey measures included: alcohol related knowledge, alcohol related attitudes, overall consumption, harmful and hazardous consumption, context of alcohol use, harm associated with the students own use of alcohol, and harm associated with other people’s use of alcohol. Pre-testing of the survey instrument involved face and content validity, and internal consistency and test-retest reliability. The anonymous, self-completion surveys were completed by students under the guidance of trained research assistants who instructed students and responded to questions following a set protocol. The survey protocol involved providing a verbal summary of the study and its design to both intervention and control students and teachers.
Analysis of change involved quantitative and qualitative assessment. Quantitative assessment identified school and student level change using scales and indices developed to assess overall change in the measurement domains. Multi level modelling was used to assess change over time. Fidelity of implementation was also assessed quantitatively. Qualitative assessment involved written and verbal interviews with students and teachers. This provided insight into their views of the program, and issues associated with implementing such programs in the school setting.
The quantitative results support the alternative hypothesis that the alcohol related knowledge, attitudes and behaviours of students participating in the SHAHRP program were different to those of students who did not participate in the SHAHRP program. Over the 32 month period of the study, students who participated in the SHAHRP program had 10% greater alcohol-related knowledge, consumed 20% less alcohol, were 19.5% less likely to consume alcohol at harmful or hazardous levels, 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. These results are equivalent or greater than past school programs that have had goals of non-use and delayed use, whether they be classroom based or comprehensive/whole of school programs. Qualitative input from teachers and students, indicated that both teachers (n=61, 85 classes) and students enjoyed participating in the SHAHRP program. Intervention students were taught 80.7% of the intended intervention program as documented in the teacher manual.
With the exclusion of research and development items, the cost of implementing the SHAHRP program, over a two year period, was approximately Au$24 per student, if teachers required training in the program. If trained teachers continued to teach the SHAHRP intervention in subsequent years, then the cost of the program was reduced to Au$5.20 per student over a two year period.
The results of this study, demonstrate that a program based on research evidence, and which has a goal of harm reduction, can be successful in creating change using a classroom approach. The implications of this for future drug education programs are several. The impact of programs can be improved if research evidence is incorporated. Drug education programs may better serve students if the goal is broadened from abstinence/non-use to harm reduction. Through this change in paradigm, students, particularly those who have already started consuming alcohol, can benefit from involvement. A classroom approach is relatively easy and inexpensive to implement, compared to comprehensive/ whole of school approaches. The program can be readily implemented by school staff without the need for extensive external expertise and resource provision. These practical concerns are of critical importance as a program has to be available, workable and effective in the school setting to be of any ultimate value.
Replication of this study in other jurisdictions and with other groups of students would be a valuable addition to the school drug education field.