Re: Parliamentary inquiry into the potential for developing opportunities for schools to become a focus for promoting healthy community living.

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1 Mr Geoff Howard Education and Training Committee Parliament of Victoria Parliament House Spring St East Melbourne th July 2009 Re: Parliamentary inquiry into the potential for developing opportunities for schools to become a focus for promoting healthy community living. The National Drug and Alcohol Research Centre (NDARC) is pleased to provide this brief submission to the above inquiry regarding the potential for developing opportunities for schools to become a focus for promoting health community living, with a specific focus on reducing drug related harms. We have highlighted areas of NDARC research and other research which pertain to the questions and issues addressed by the inquiry. Specific health promotion programs What health promotion programs (if any) has your organisation run for schools (or a school) How successful have these programs been? How has their success been measured? CLIMATE Schools: Drug prevention programs Program information: The CLIMATE Schools drug prevention programs have been developed and evaluated by the National Drug and Alcohol Research Centre. Although previous research has shown that skills based drug prevention programs have shown promise, there is considerable evidence to suggest that the effectiveness of such programs is compromised by implementation failure and a reliance on abstinence based goals and outcomes. The CLIMATE Schools drug prevention programs have been designed to overcome such concerns i,ii,iii. The CLIMATE Schools programs which are based on a harm minimisation approach have two important components; the first component involves students completing an interactive computer based program, with the second consisting of a variety of individual, small group and class based activities. Evaluation information: Three CLIMATE Schools drug prevention programs have been evaluated utilising cluster randomised controlled trial in NSW and ACT schools. Importantly, the CLIMATE Schools drug prevention programs have been shown to be effective in changing drug use behaviour.

2 Specifically, the CLIMATE Schools: Alcohol Course iv,v was more effective than usual classes in increasing alcohol related knowledge of facts that would inform safer drinking choices and decreasing the positive social expectations which students believed alcohol may afford. For females it was effective in decreasing average alcohol consumption, alcohol related harms and the frequency of drinking to excess (> 4 standard drinks; 10g ethanol). For males the behavioural effects were not significant. The CLIMATE Schools: Alcohol and Cannabis Course vi led to significant increases in alcohol and cannabis knowledge at the end of the course and at the six and twelve month follow ups. In addition, the students who received the CLIMATE course showed a reduction in frequency of cannabis at the six month follow up, a reduction in average weekly alcohol consumption at the six and twelve month follow ups, and a reduction in frequency of drinking to excess twelve months after the intervention. Early evidence from the more recently developed CLIMATE Schools: Cannabis and Psychostimulant Course vii show that this program was effective in increasing cannabis and psychostimulant related knowledge, decreasing prodrug attitudes towards cannabis and psychostimulant use, delaying the onset and frequency of ecstasy use and decreasing the frequency of cannabis use for females. This program was also effective in decreasing young people s intention to use meth/amphetamine and ecstasy in the future. The mode of delivery offered by the CLIMATE Schools drug prevention programs has been welcomed by both students and teachers; with the latter rating this program as superior to other drug prevention approaches. Clearly the CLIMATE Schools drug prevention programs are both feasible and acceptable within the school setting and have the potential to offer an innovative new platform for the delivery of prevention education in schools. These programs have also been designed to provide a sequential and developmentally appropriate sequence of drug prevention programs for schools. National Cannabis Prevention and Information Centre Program information: The National Cannabis Information and Prevention Centre (NCPIC), which exists within the National Drug and Alcohol Research Centre, conducts education and training on the health and social effects of cannabis primarily to the alcohol and other drugs sector. In many of these trainings, high school teachers as well as school nurses are present. In October 2008, NCPIC was contacted to provide education to ACT and regional NSW High School teachers on the health and social effects of cannabis. The session went for 90 minutes and was part of an in service for teachers conducted by the ACT Department of Education. Evaluation information: A 10 item pre and post test was conducted with teachers at the beginning and the end of the training session. Baseline knowledge on cannabis prior to training ranged from 1 8 with the mean score being 5.2 (SD 1.7). At the completion of the training the range increased from 6 10 which a mean score of 8.8 (SD 1.2). On average post test scores improved by 3.6 correct answers out of 10 compared to the pre test scores. This means that on average the 'cannabis' knowledge of those who attended the training on this day improved by 36%. What health promotion programs (if any) has your organisation run for the wider community? How successful have these programs been? How has their success been measured? Alcohol Action in Rural Communities (AARC) Program information: The aim of the Alcohol Action in Rural Communities Project has been to implement and evaluate the effectiveness of using a local community approach to reduce alcohol related harm. This is an approach in which a range of intervention strategies are systematically coordinated and implemented across a whole community. The strategy recognises that alcohol related harm has multi factorial causes and requires multiple interventions to reduce harm. The community intervention involves a number of the strategies, including: Community health, emergency departments, police, general practitioners, licensed premises, local media, high schools and

3 workplaces. The strategies used in each community are tailored to the needs of the individual community. Evaluation information: In order to evaluate the effectiveness of this strategy a randomised controlled trial is being conducted. Ten matched pairs of rural communities were identified and one community in each pair was randomly allocated to the intervention condition, and the other to the control condition. The efficacy of this community based intervention will be assessed by looking at indicators such as, alcohol related presentations to emergency departments, alcohol related incidents and crimes identified by police, alcohol related traffic accidents and prevalence of alcohol related problems in the community. The interventions will be completed by the end of 2009 and results will be available in mid Preliminary evidence from the crime data suggests a reduction in alcohol related assaults in the intervention communities is promising. Are you aware of any other especially successful health promotion programs for school or communities, from within Australia or overseas? School level programs: The School Health and Alcohol Harm Reduction Project conducted by the National Drug Research Institute is another successful health promotion project. The SHAHRP program is of particular relevance as it was conducted in Australia viii,ix. The aim of this program was to reduce the harm that young people experience as a result of their own alcohol consumption and other people s use of alcohol. The SHAHRP program consisted of a core program in Year 8 of high school (12 13 years of age) followed by an extensive booster program in the following year. SHAHRP was effective in increasing knowledge and decreasing pro drug attitudes. In terms of behavioural change, the SHAHRP program effectively decreased the amount of alcohol consumed in the past 12 months, decreased the frequency and quantity of consumption per occasion and decreased the harms students experienced as a result of their own alcohol consumption. Most behavioural effects were evident five months after each phase of the intervention phases, but once a 12 month gap had arisen since the last intervention component, the effects on alcohol consumption measures such as total consumption, frequency and quantity diminished. Significant improvements remained in the intervention group twelve months after the booster session for the number of students who reported drinking to excess and for the harms students experienced as a result of their own consumption. The results of the SHAHRP intervention clearly demonstrate that young people do have the capacity to learn, process and practice harm minimisation skills. A website link to this project:

4 Community based intervention Project Northland x,xi which was conducted in the United States, was the largest ongoing trial of a multiyear, multi component community wide program to reduce adolescent alcohol use. It was mainly conducted in rural communities and was successful in decreasing alcohol and other drug use, as well as decreasing some risk factors associated with later alcohol use. Project Northland involved many different components including business/community leaders, mass media and advertising, government leaders, peer groups, teachers, relatives, other adults, parents, siblings and best friends. This project, like other community based projects was not coordinated by school staff, but rather by an external organisation and task force. The role of schools in promoting community living. Do you believe that schools should have a role in promoting healthy living in the wider community? Why or why not? Research clearly shows that drug use is determined by a multitude of different factors. Communitywide interventions have the capacity to target the entire community, recognising the multiple determinants of drug use. Likewise, a centrally organised community wide intervention would have the capacity to provide a coherent and consistent message, which is crucial for the prevention of drug use. For example, one of the most effective strategies for preventing drug use is to change young people s misconception that underage drinking is widespread. It is a challenge to change this misconception in schools whilst media outlets are portraying quite the opposite message. A coordinated communitybased intervention would have a greater chance of being able to achieve this end. School based programs ideally need to be part of a larger community wide approach which has the capacity to impact on more distal influences in the broader social environment. Schools appear to be the ideal organisation to have a role in promoting healthy living in the wider community. To date, however, such community programs have been unable to demonstrate significant impact over and above the school based education component xii,xiii,xiv and have the disadvantage of being costly and difficult to implement xv. Given the limited number of methodologically sound evaluations of this approach, pitted against the appeal of a multifaceted approach, further investigation (coupled with continued evaluation) is a worthy pursuit. It is important, however, that the implementation of such an approach is not the sole responsibility of schools, which appears to be a system which currently reports being understaffed and overloaded. If schools are to have such a role, what models or mechanisms could they use? The lack of existing school / community wide programs represents an opportunity to formulate an innovative intervention rather than necessarily replicate existing work. Based on the community wide AARC intervention which has been conducted in rural NSW, the following principles have been found to be important: Multiple key stakeholders engaged across the community Clear and specific goals to be achieved by the strategy (e.g., reduced presentations of young people to hospital Emergency departments; reduced overnight stays for alcohol related harm; reduced numbers of drinking days; reduced numbers of high consumption days; etc) Clearly defined roles for all groups involved in the strategy.

5 Consistent with these findings, community wide school based interventions which have been successfully implemented to date are generally coordinated by external organisations and tasks forces. How could health, education and other organisations work together more effectively to coordinate health promotion activities between communities and schools? A possible means by which health, education and other organisations could work together could be to set up a task force, rather than leave it to be the responsibility of the school alone. The members of the task force could be representatives from the different social environments which have been shown to impact on adolescent drug use and other health related behaviours. Specifically, Williams et al xvi provide an illustration of the different social environments which impact on adolescent drug use. They include: Business/community leaders, Mass media and advertising, government leaders, peer groups, teachers, relatives, other adults, parents, siblings and peers. Alternatively, the mechanisms that could dictate which groups ought to be involved, and how, could depend on what is trying to be achieved. Ideally, the interventions and strategies could be tailored to the individual communities and their specific needs. For example, if the aim is to decrease alcohol related crime, it may be important to include police representation on the task force, as well as community groups to ensure alternative activities for young people are also available. Thank you for the opportunity to provide information for this inquiry. Should you require any further information, please do not hesitate to contact us in the future. Yours sincerely, Laura Vogl, PhD Research Fellow National Drug and Alcohol Research Centre University of New South Wales E: T: +61 (2) F: +61 (2) References i Vogl, L., Teesson, M and Dillon, P., Climate Schools: Alcohol Module. 2004, National Drug and Alcohol Research Centre, UNSW: Sydney.

6 ii Newton, N., Vogl, L., Teesson, M., Dillon, P., Martin, G., Swift, W., et al., Climate Schools: Alcohol and Cannabis Module. 2007, National Drug and Alcohol Research Centre, UNSW: Sydney. iii Vogl, L., Deans, C., Teesson, M., Vogl, G., Mason, E., Newton, N.C et al., Climate Schools: Psychostimulant and Cannabis Module. 2008, National Drug and Alcohol Research Centre, UNSW: Sydney. iv Vogl, L., Teesson, M., Andrews, G., Bird,K., Steadman, B and Dillon, P., A computerized harm minimization prevention program for alcohol misuse and related harms: randomized controlled trial. Addiction, : p v Newton, N.C., Vogl, L., Teesson, M., and Andrews, G., CLIMATE Schools: alcohol module: cross validation of a school-based prevention programme for alcohol misuse. Australian and New Zealand Journal of Psychiatry, (3): p vi Newton, N.C., Andrews, G., Teesson, M., and Vogl, L., Delivering prevention for alcohol and cannabis using the internet: A cluster randomised controlled trial. Preventive Medicine, : p vii Vogl, L., Newton, N., Teesson, M., Karageorge, A., Deans, C., Swift W., et al., Climate Schools: Drug Prevention Programs, in Report prepared for the Australian Government Department of Health and Ageing. 2009, National Drug and Alcohol Research Centre. viii McBride, N., et al., Harm minimization in school drug education: Final results of the School Health and Alcohol Harm Reduction Project (SHAHRP). Addiction, (3): p ix McBride, N., et al., Early results from a school alcohol harm minimization study: The School Health and Alcohol Harm Reduction Project. Addiction, (7): p x Williams, C. and C. Perry, Lessons from Project Northland: Preventing alcohol problems during adolescence. Alcohol Health and Research World, (2): p xi Williams, C., et al., Project Northland: Comprehensive alcohol use prevention for young adolescents, their parents, schools, peers and communities. Journal of Studies on Alcohol, Suppl. 13: p xii Flay, B.R., Approaches to substance use prevention utilizing school curriculum plus environment change. Addictive Behaviors, (6): p

7 xiii Tobler, N.S., et al., School-based adolescent drug prevention programs: 1998 metaanalysis. Journal of Primary Prevention, (4): p xiv Wood, E., et al., A systematic review of school-based studies involving alcohol and the community. Australian and New Zealand Journal of Public Health, (6): p xv McBride, N., School drug education: A developing field, and one element in a community approach to drugs and young people: A response to the commentaries. Addiction, (3): p McBride, N., et al., Harm minimization in school drug education: Final results of the School Health and Alcohol Harm Reduction Project (SHAHRP). Addiction, (3): p Flay, B.R., Approaches to substance use prevention utilizing school curriculum plus environment change. Addictive Behaviors, (6): p xvi Williams, C. and C. Perry, Lessons from Project Northland: Preventing alcohol problems during adolescence. Alcohol Health and Research World, (2): p

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