Home > Research > Research Specific Sites > School Health and Alcohol Harm Reduction Project > About SHAHRP > Evidence Basis

Evidence Basis

The SHAHRP study aims to change young people's health behaviour through a classroom education approach. To do this effectively, the researchers have incorporated research evidence and best practice approaches from the health and education fields. The following summary of the research basis of SHAHRP will assist you in understanding the critical elements of the SHAHRP intervention and can also be used as a guide to assess the quality of other drug education resources.

Timing and Programming

Inoculation: requires that initial lessons be taught immediately prior to students initiating the behaviour of interest, in this case drinking alcohol. Lessons that provide knowledge and skills immediately prior to the behaviour can give students a solid basis as they enter into, for example, alcohol use situations. Prevalence of alcohol use data were used to define the placement of each phase of the SHAHRP intervention. The use of local prevalence data can also assist in defining the appropriate timing of the initial phase of other health related interventions.

Relevancy: requires that an additional phase of lessons be taught at a time when the students are initiating the behaviour of interest. The immediate relevancy of knowledge and skills during this phase in the students development makes it more likely that students will apply this new information and skills to their new behaviour. As with the above evidence based component, prevalence of alcohol use data were used to define the placement of phase two of SHAHRP intervention.

Transition period between primary and secondary school: practical considerations play an important part in this component (particularly so for research studies in schools). Students are likely to remain in the same school for a number of years, teachers are more specialised in the delivery of alcohol education, programs can be easily administrated and in research terms an intervention in one setting helps to assist with follow-up for survey purposes. Entry into secondary school also represents a milestone in the maturity of students, however, the prevalence of the behaviour of interest should be a stronger guide to the placement of an intervention.

In the context of developmentally appropriate school health curriculum: drug education should be taught in the context of a developmentally appropriate curriculum, have a sound curriculum basis, be placed alongside other related health issues and have the flexibility to target drug issues as they become pertinent to students. Programs conducted in isolation, or ad hoc programs, have limited scope to create change and can potentially have a negative effect on student drug use behaviour.

Booster sessions over time: in the past the research literature suggested that 30 to 40 hours of classroom lessons were required to impact on students health behaviours. More recent research suggests that booster sessions over a number of years, that develop and reinforce knowledge and skills, can also lead to behaviour change. This means that less classroom time is required to have an impact on behaviour, however, the lessons need to incorporate the following content and teaching methodology components to be effective.

Content and Teaching Methodology

Based on the experiences of young people / young people involved in the development of the intervention: it is very important that the content, scenarios and style of an intervention be based on the experiences and interest of the young people that it is trying to influence. The SHAHRP study conducted focus groups with young people and piloted the draft intervention with young people to ensure that their experiences were reflected in the classroom lessons. The involvement of young people in the development of an intervention helps to increase its relevancy as well as students interest and involvement in the program.

Provides accurate normative information: research suggests that presenting age related usage norms helps students to attain realistic understanding of usage rates among peers. Findings suggest that young people often have exaggerated notions of usage rates and presenting accurate normative information can assist in modifying behaviour if these norms are relatively low. In the first phase of SHAHRP the use of normative information was particularly useful.

Adopts a harm minimisation approach rather than being based solely on non-use goals: this issue is particularly relevant for alcohol where initiation of use occurs at a young age, where large amounts of alcohol are consumed during drinking occasions and where social rewards are gained from drinking. Risks and harms associated with the use of alcohol can be linked to the students own use or other peoples use of alcohol. A goal of harm minimisation provides both drinkers and non drinkers with strategies for reducing the chances of harm occurring, and the potential impact of harm after the event, as well as incorporating important non-use and delayed use strategies.

Programs should be skills and activity based: skills based teaching that involves students in practical activities increases students interest and learning. Teaching methods that allow students to practice behaviours that are relevant to their experience, in a low risk situation, using realistic scenarios, provide young people with important practice that they can take with them to real life situations. Programs that are interactive and provide a high level of activity in proportion to other aspects, such as lecture-style teaching, are more effective in gaining students interest and promoting student learning.

Programs should incorporate utility knowledge: past studies provide strong evidence that knowledge and attitude based programs have little effect on behaviour change. Nevertheless, the delivery of knowledge as part of a skills-training approach is an important aspect of a program. The type of knowledge provided, however, needs to be relevant to the students, needs to be applicable to their life experiences and needs to be of immediate practical use to them.

Teacher training

Teachers should be training to teach drug education: research suggests that teachers of health and drug education often lack adequate training and confidence when teaching drug education and other controversial health issues. However, teachers are best placed to know their students needs and developmental level and are best placed to incorporate drug education at an appropriate time and level for the students.

Teacher training should involve interactive modelling of activities: research suggests that teacher training that involves the interactive modelling of an intervention's activities increases teachers confidence and ability to teach the program. This type of training allows teachers to experience and identify classroom management and practical issues associated with the program as well as providing them with a model of good practice particularly in relation to debriefing and discussion around key issues.

Research Issues

Although less important in the context of classroom teaching, the following research considerations were adopted as part of the SHAHRP0 research study: fidelity of implementation (how well and how much of the program was taught) was measured and incorporated into analysis and understanding of change; measures of program success were based on realistic student experiences; the research was conducted over a long time period to allow for delays in behaviour change; and analysis incorporated stratification for previous use.

References for evidence based approach

  1. Australian Drug Foundation. The risk reduction approach to alcohol education. In: Reducing the Risk. An alcohol action program for schools, 1994. Australian Drug Foundation, Melbourne, Australia
  2. Australian Institute of Health and Welfare. Releases 1999, Drugs: Where are the biggest problems (Online). Available: https://www.aihw.gov.au/news-media/media-releases/1999/mar/drugs-where-are-the-biggest-problems. 1999
  3. Ballard R, Gillespie A, Irwin R. Principles for drug education in schools. An initiative of the School Development in Health Education Project. Canberra: University of Canberra, Faculty of Education, 1994
  4. Basch C, Sliepcevich E, Gold R, Duncan D, Kolbe L. Avoiding type III errors in health education program evaluation: A case study. Health Education Quarterly 1985; 12, 4: 315-331
  5. Berberian R, Gross C, Lovejoy J, Paperella S. The effectiveness of drug education programs. A critical review. Health Education Monographs 1976; 4: 377-398
  6. Blaze-Temple D, Sing K, Binns W. Drug use behaviour and attitudes from a household survey of Perth teenagers. Perth, Western Australia: National Centre for Research into the Prevention of Drug Abuse, Curtin University, 1990
  7. Botvin G, Baker E, Renick N, Filazzola A, Botvin E. A cognitive-behaviour approach to substance abuse prevention. Addictive Behaviour 1984; 9:137-147
  8. Botvin G, Schinke s, Epstein J, Diaz T. Effectiveness of culturally focused and generic skills training approaches to alcohol and drug abuse prevention among minority adolescents: two year follow-up results. Psychology of Addictive Behaviours 1995; 9, 183-194
  9. Botvin G. Substance abuse prevention research: Recent developments and future directions. Journal of School Health 1986; 56: 369-374
  10. Bremburg S. Does school health education effect the health of students? A literature review. In: Nutbeam D, Haglund B, Farley P. et al. Youth health promotion: From theory to practice in school and community. London: Forbes Publications, 1991:89-107
  11. Commonwealth Department of Health and Family Services. National Drug Strategy, Household survey. Survey Report 1995. Australian Government Publishing Service, Canberra, 1996, ISBN 0 644 36880 1
  12. Cross D. School drug education - What works? Paper presented at the launch of the School Drug Education Project. Perth, Western Australia: 4 April 1997
  13. Dielman T, Shope J, Leech S, Butchart A. Differential effectiveness of an elementary school-based alcohol misuse prevention program. Journal of School Health 1989; 59, 6: 255-263
  14. Dielman T. School-based research on the Prevention of Adolescent Alcohol Use and Misuse: Methodological issues and advances. Journal of Research in Adolescence 1994; 4, 2:271-293
  15. Dunsebury L, Falco M. Eleven components of effective drug abuse prevention curricula. Journal of School Health 1995; 65, 10: 420-424
  16. Dusenbury L, Falco M, Lake A. A review of the evaluation of 47 drug abuse prevention curricula available nationally. Journal of School Health 1997; 67(4), 127-131
  17. Evans R. Smoking in children. Developing a social psychological strategy of deterrence. Preventive Medicine 1976; 5:122-127
  18. Foxcroft D, Lister-Sharp D, Lowe G. Alcohol misuse prevention for young people: A systematic review reveals methodological concerns and lack of reliable evidence of effectiveness. Addiction 1997; 92(5), 531-537
  19. Goodstadt M. School-based drug education in North America: What is wrong? What can be done? Journal of School Health 1986; 56:278-281
  20. Green LW, Kreuter M. Health promotion planning: An educational and environmental approach. Mountain View, USA: Mayfield Publishing Company, 1991
  21. Hansen W, Graham J. Preventing alcohol, marihuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine 1991; 20, 414-430
  22. Hansen W, Johnson C, Flay B. et al. Affective and social influence approaches to the prevention of multiple substance abuse among seventh grade students: Results for Project SMART. Preventive Medicine 1988; 17: 135-154
  23. Hawthorne G. The social impact of Life Education: estimating drug use prevalence among Victorian primary school students and the state level effects of the Life Education program. Addiction, 1996; 91, 8:1151-1159
  24. Holder H, Howard J. Community prevention trials for alcohol problems. Methodological issues. Westport United States of America: Praeger Publishers, 1992
  25. Holman D. The value of intervention research in health promotion. Presented at the Western Australian Health Promotion Foundation 'Enriching and improving health promotion research' seminar. Perth, Western Australia: 16th October 1996
  26. Jacobson M, Vermont City Drops DARE program. UPDATE[Online]. Available E-mail: update@adca.org.au [1999, May 26]
  27. James R, Fisher J. A review of school-based drug education in Australia 1978-1990. Perth, Western Australia: National Centre for Research into the Prevention of Drug Abuse, Curtin University; 1991
  28. Jessor R. Keynote address. In: Papers from the State of the Art in Adolescent Drug Abuse Prevention. Sydney: Sydney Health Education Unit, Sydney Institute of Education, 1987: 9-17
  29. Johnson C, Pentz M, Weber M, et al. Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents. Journal of Consulting and clinical Psychology 1990; 58, 447-457
  30. Johnston L, O'Malley P, Bachman J. Drug use among American high school seniors, college students and young adults, 1997-1990. Washington DC: DHHS Publication No. ADM 91-1813, United States Government Printing Office, 1991
  31. Kelder S, Perry C, Klepp K, Lytle L. Longitudinal tracking of adolescent smoking, physical activity and food choice behaviour. American Journal of Public Health 1994; 84, 7:1121-1126
  32. Kinder B, Pape N, Walfish S. Drug and alcohol education. A review of outcome studies. International Journal of Addictions 1980; 15:1035-1054
  33. McBride N, Midford R. The National Initiatives in Drug Education Project: Western Australia evaluation report. Perth, Western Australia: National Centre for Research into the Prevention of Drug Abuse, Curtin University, 1996
  34. McGraw S, Stone E, Osganian S, et al. Design of process evaluation within the child and adolescent trial for cardiovascular health (CATCH). Health Education Quarterly (supplement 2) 1994; S5-S26
  35. McLeod J. Rethinking Drinking: You're in Control. An alcohol education program for secondary students. Reflections on the development, implementation and strengths of the program. Melbourne, Victoria: Youth Research Centre, Faculty of Education, University of Melbourne, 1997
  36. Midford R, McBride N. National Initiatives in Drug Education evaluation report. Perth, Western Australia: National Centre for Research into the Prevention of Drug Abuse, Curtin University, 1997
  37. Milburn K.. A critical review of peer education with young people with special reference to sexual health. Health Education Research; 1995, 10:407-420
  38. Murray D, Perry C. The prevention of adolescent drug abuse. Implications of etiological, developmental, behavioural and environmental models. Rockville, Maryland: National Institute on Drug Abuse, Monograph Series 56, 1985
  39. Perry C, Williams C, Veblen-Mortenson S, et al. Project Northland: Outcomes of a community wide alcohol use prevention program during early adolescence. American Journal of Public Health 1996; 86, 7: 956-965
  40. Saunders B, Baily S. Alcohol and young people: minimising the harm. Drug and Alcohol Review 1993; 12: 81-90
  41. Shope J, Copeland L, Marcoux B, Kamp M. effectiveness of a school-based substance abuse prevention program. Journal of Drug Education 1996; 26, 323-337
  42. Staulcup H, Kenward K, Frigo D. A review of federal primary alcoholism prevention projects. Journal of Studies on Alcohol 1979; 40:943-968
  43. Stevens M, Freeman d, Mott L, Youells F. Three-year results of prevention programs on marijuana use: the New Hampshire study. Journal of Drug Education 1996; 26, 257-273
  44. Ward J, Hunter G, and Power R. Peer education as a means of drug prevention and education among young people: An evaluation. Health Education Journal; 1997, 56,3:251-263
  45. White D, Pitts M. Educating young people about drugs: a systematic review. Addiction 1998; 93(10), 1475-1487
  46. Wilks J. Adolescent attitudes towards alcohol. Drug Education Journal of Australia 1991;5, 3: 239-244
  47. Young M. Review of research and studies related to health education practice (1961-1966). School health education. Health Education Monograph 1968: 28:1-97
  48. Youth Research Centre. Rethinking Drinking You're in Control. Resource materials, 1995