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Intervention Summary

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Climate Schools: Alcohol and Cannabis Course

The Climate Schools: Alcohol and Cannabis Course is a school-based program for 13- and 14-year-olds that aims to prevent and reduce alcohol and cannabis use as well as related harms. Designed to be implemented within the school health curriculum, Climate Schools is based on a social influence approach to prevention and uses cartoon storylines to engage and maintain student interest and involvement.

The intervention is implemented in twelve 40-minute lessons. The first six lessons, delivered in the first half of the school year, are based on the Climate Schools: Alcohol module and focus specifically on alcohol use. The remaining six lessons, delivered approximately 6 months later, are based on the Climate Schools: Alcohol and Cannabis module; these lessons reinforce the alcohol information and also address cannabis use. The six lessons in each module are typically delivered weekly. Each lesson consists of two parts: an Internet-based activity and a teacher-led activity. During the first half of each lesson, students individually log onto the Climate Schools Web site using confidential login information and follow an episode of a cartoon-based drama about teenagers who experience real-life situations involving alcohol and cannabis. These stories impart information about the short- and long-term effects of using alcohol and cannabis, normative alcohol and cannabis use, refusal skills, and first aid. Each episode ends with a short quiz to assess student knowledge of the facts conveyed. The second half of each lesson is a teacher-led group or class activity that reinforces the information in the cartoons and allows interactive communication between students. No training is required for teachers to implement the intervention.

The original version of the intervention, developed in Australia, was used in the study reviewed by NREPP to assess Quality of Research. The version of the intervention available for use in the United States, which was modified from the original version to reflect U.S. laws, standard drink measurements, and colloquialisms and other terms, was reviewed to assess Readiness for Dissemination.

Descriptive Information

Areas of Interest Substance abuse prevention
Outcomes Review Date: August 2012
1: Alcohol-related knowledge
2: Cannabis-related knowledge
3: Alcohol use
4: Binge drinking frequency
5: Cannabis use frequency
Outcome Categories Alcohol
Drugs
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Non-U.S. population
Settings School
Geographic Locations Urban
Implementation History The intervention was developed in Australia in 2006 and was later modified for use in the United Kingdom and United States. The intervention has been delivered to approximately 4,000 students in Australia and the United Kingdom in both public and private schools. Evaluations have been conducted in Australia (2006-2009) and the United Kingdom (2010-2011).
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: August 2012

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

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(6), 579-584.  Pub Med icon

Newton, N. C., Teesson, M., Vogl, L. E., & Andrews, G. (2009). Internet-based prevention for alcohol and cannabis use: Final results of the Climate Schools Course. Addiction, 105(4), 749-759.  Pub Med icon

Supplementary Materials

Newton, N. C. (2009). The development and evaluation of a school-based prevention program for alcohol and cannabis use delivered via the Internet (Unpublished doctoral thesis, University of New South Wales, Sydney, Australia).

Vogl, L., Newton, N., Teesson, M., Swift, W., Karageorge, A., Deans, C., et al. (2010). Climate Schools: Drug prevention programs. Sydney, Australia: National Drug and Alcohol Research Centre, University of New South Wales.

Outcomes

Outcome 1: Alcohol-related knowledge
Description of Measures Alcohol-related knowledge was assessed using the 16-item alcohol knowledge questionnaire, an instrument adapted in part from the School Health and Alcohol Harm Reduction Project (SHAHRP) Knowledge of Alcohol index. Nine items were taken directly from the index or were used with minor changes (e.g., "Most Year 8 students are regular drinkers" was used instead of "Most Year 9 students are regular drinkers"). An additional 7 items were created to test knowledge of material conveyed in the Climate Schools lessons (e.g., "Drinking black coffee helps the sobering up process," "Most 14 year olds do not drink alcohol to get drunk"). For each item, students were asked to indicate "true," "false," or "don't know." Scores ranged from 0 to 16, with higher scores representing greater alcohol-related knowledge. Students completed the instrument online in a classroom setting.
Key Findings Ten Australian secondary schools were randomly assigned to one of two groups: one providing the intervention to year 8 students (13-year-olds) and one providing these students with the school's usual health class. In all but one control group school, the health class included drug education. Participants were assessed at pretest, posttest (immediately after completion of the intervention), and 6 and 12 months after completion of the intervention. Increases in scores on the alcohol knowledge questionnaire were greater for the intervention group than the control group from pre- to posttest (increase of 2.41 vs. 0.54; p < .01), pretest to 6-month follow-up (increase of 2.37 vs. 0.74; p < .01), and pretest to 12-month follow-up (increase of 2.13 vs. 0.70; p < .01).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 2: Cannabis-related knowledge
Description of Measures Cannabis-related knowledge was assessed using the 16-item cannabis knowledge questionnaire, an instrument adapted from the Cannabis Quiz. Two items were taken directly from the Cannabis Quiz, and 14 were created using information included within the multiple-choice items in the quiz. For each item (e.g., "It is possible to detect cannabis in urine and blood between 1-5 days after use," "Cannabis use improves people's memory and learning"), students were asked to indicate "true," "false," or "don't know." Scores ranged from 0 to 16, with higher scores indicating greater cannabis-related knowledge. Students completed the instrument online in a classroom setting.
Key Findings Ten Australian secondary schools were randomly assigned to one of two groups: one providing the intervention to year 8 students (13-year-olds) and one providing these students with the school's usual health class. In all but one control group school, the health class included drug education. Participants were assessed at pretest, posttest (immediately after completion of the intervention), and 6 and 12 months after completion of the intervention. Increases in scores on the cannabis knowledge questionnaire were greater for the intervention group than the control group from pre- to posttest (increase of 2.88 vs. 0.54; p < .01), pretest to 6-month follow-up (increase of 1.83 vs. 0.33; p < .01), and pretest to 12-month follow-up (increase of 1.95 vs. 0.30; p < .01).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)
Outcome 3: Alcohol use
Description of Measures Alcohol use was assessed using 3 items from the alcohol use questionnaire, an instrument adapted from the SHAHRP Patterns of Alcohol index (the items were changed to ask about the past 3 months rather than the past 12 months). The items were, "Have you had any alcohol in the past 3 months?" (answered on a yes/no scale), "In the past 3 months, how often did you have an alcoholic drink of any kind?" (answered on an 8-point scale from "everyday" to "less often"), and "In the past 3 months, on an average day when you drank alcohol, how many standard drinks did you have?" (answered on an 8-point scale from "less than 1" to "13 or more"). A composite score for average weekly alcohol use over the past 3 months was computed; for drinkers, the response to the second item (number of drinking days/week) was multiplied by the response to the third item (number of drinks/drinking day). Students completed the instrument online in a classroom setting.
Key Findings Ten Australian secondary schools were randomly assigned to one of two groups: one providing the intervention to year 8 students (13-year-olds) and one providing these students with the school's usual health class. In all but one control group school, the health class included drug education. Participants were assessed at pretest, posttest (immediately after completion of the intervention), and 6 and 12 months after completion of the intervention. From pre- to posttest, no significant differences were found between the two groups on average number of drinks per week. However, the average number of drinks per week decreased for the intervention group and increased for the control group from pretest to 6-month follow-up (decrease of 0.88 drinks vs. increase of 2.67 drinks; p < .02) and from pretest to 12-month follow-up (decrease of 0.63 drinks vs. increase of 5.30 drinks; p < .02).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 4: Binge drinking frequency
Description of Measures Binge drinking frequency was assessed using an item from the alcohol use questionnaire, an instrument adapted from the SHAHRP Patterns of Alcohol index. The item, which measures the frequency of drinking to excess (defined as consuming more than four standard drinks for females and more than six standard drinks for males on a single occasion), was changed to ask about the past 3 months rather than the past 12 months, and response options were replaced with a free-response format. Female participants were asked, "In the last 3 months, how many times have you had more than 4 standard drinks on any one occasion?" Male participants were asked, "In the last 3 months, how many times have you had more than 6 standard drinks on any one occasion?" Students completed the instrument online in a classroom setting.
Key Findings Ten Australian secondary schools were randomly assigned to one of two groups: one providing the intervention to year 8 students (13-year-olds) and one providing these students with the school's usual health class. In all but one control group school, the health class included drug education. Participants were assessed at pretest, posttest (immediately after completion of the intervention), and 6 and 12 months after completion of the intervention. From pre- to posttest and from pretest to 6-month follow-up, no significant differences were found between the two groups on the number of binge drinking occasions in the past 3 months. However, compared with the intervention group, the control group had a significantly greater increase in the number of binge drinking occasions from pretest to 12-month follow-up (increase of 0.05 vs. 0.85 occasions; p < .02).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 5: Cannabis use frequency
Description of Measures Cannabis use frequency was assessed using 2 items taken from a questionnaire within Australia's 2007 National Drug Strategy Household Survey (NDSHS): "Have you used cannabis in the last 3 months?" (answered on a yes/no scale) and "In the last 3 months how often did you use cannabis?" (answered on a 6-point scale ranging from "more than once a day" to "about once a month"). Students completed the instrument online in a classroom setting.
Key Findings Ten Australian secondary schools were randomly assigned to one of two groups: one providing the intervention to year 8 students (13-year-olds) and one providing these students with the school's usual health class. In all but one control group school, the health class included drug education. Participants were assessed at pretest, posttest (immediately after completion of the intervention), and 6 and 12 months after completion of the intervention. From pre- to posttest, no significant differences were found between the two groups on cannabis use frequency in the past 3 months. However, the frequency of cannabis use decreased for the intervention group and increased for the control group from pretest to 6-month follow-up (decrease of 0.06 times/week vs. increase of 0.20 times/week; p < .02). This difference between groups was no longer significant at 12-month follow-up.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 60% Male
40% Female
100% Non-U.S. population

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Alcohol-related knowledge 3.0 3.0 2.5 3.0 2.5 3.0 2.8
2: Cannabis-related knowledge 3.5 3.0 2.5 3.0 2.5 3.0 2.9
3: Alcohol use 3.0 3.0 2.5 3.0 2.5 3.0 2.8
4: Binge drinking frequency 2.5 3.0 2.5 3.0 2.5 3.0 2.8
5: Cannabis use frequency 3.5 3.5 2.5 3.0 2.5 3.0 3.0

Study Strengths

The measures used in the study generally have good reliability and validity and are based on instruments that have been widely used by independent researchers. The fidelity of the Internet-delivered portion of the intervention was good, and students generally completed the online activities. Attrition was low, and there is no evidence of differential attrition across the intervention and control groups. The statistical analyses used were appropriate and sophisticated and included Bonferroni adjustments for multiple comparisons.

Study Weaknesses

The measure used for binge drinking has marginal reliability based on reported Cronbach's alpha coefficients. Teachers varied widely in regard to which activities, and how many activities, they completed with their class. In addition, there were differences between the study groups at baseline: Intervention group schools contained a greater proportion of females than control group schools, and students in the intervention group had higher alcohol-related knowledge, cannabis-related knowledge, average consumption of alcohol, and frequency of binge drinking.

Readiness for Dissemination
Review Date: August 2012

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Program Web site, http://www.climateschools.com

Other dissemination materials:

  • Climate Schools: Alcohol and Cannabis Module Student Quiz
  • Climate Schools: Alcohol and Cannabis Module Teacher Evaluation
  • Climate Schools: Alcohol and Cannabis Module Teacher Log Book
  • Climate Schools: Alcohol Module Student Quiz
  • Climate Schools Student Evaluation

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.1 2.7 2.5 2.8

Dissemination Strengths

The course is accessible online and includes downloadable lesson summaries and activity guides. An implementation guide provides helpful instructions for setting up and delivering the course. Forced sequential navigation through each online lesson ensures consistency in implementation. Implementers may contact the developers directly by email for technical assistance. Quizzes are available at the end of each online lesson to ensure that students are learning the material. Teacher and student evaluations help measure perception of program quality; these evaluations are to be returned to the developers for use in improving program delivery and quality.

Dissemination Weaknesses

It is unlikely that teenagers will carry the standard drink chart with them as suggested by characters in the story. Materials do not clearly indicate the appropriate participants for the intervention in terms of culture, race, or ethnicity. No resources are available to build teacher expertise in overall program implementation (e.g., guides on teaching strategies, managing student discussions, and responding to common challenges; methods for sharing best practices with other implementers). Apart from student quizzes, no outcome monitoring tools or evaluation guidance is available.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Online course, including login information for teachers and students, and all quizzes Free Yes
Implementation guide, teacher and student evaluation forms, and teacher log book Free Yes
Email technical assistance Free No

Additional Information

Teachers must register on the program Web site before students can access the program.

Contact Information

To learn more about implementation or research, contact:
Nicola Newton, Ph.D.
+ 61 2 9385 0333
nickien@unsw.edu.au

Maree Teesson, Ph.D.
+ 61 2 9385 0333
m.teesson@unsw.edu.au

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

Web Site(s):