Preventing alcohol harm: Early results from a cluster randomised,controlled trial in Victoria,Australia of comprehensive harm minimisation school drug education

BackgroundIn Australia, the burden of alcohol-attributable harm falls most heavily on young people. Prevention is important, and schools have long been seen as appropriate settings for pre-emptive interventions with this high risk group. This paper evaluates the effectiveness, in relation to alcohol harm prevention, of the Drug Education in Victorian Schools (DEVS) programme, nine months after implementation. This intervention dealt with both licit and illicit drugs, employed a harm minimisation approach that incorporated interactive, skill based, teaching methods and capitalised on parental influence through home activities.MethodsA cluster randomised, controlled trial of the first ten lessons of the DEVS drug education programme was conducted with year eight students, aged 13–14 years. Twenty-one secondary schools in Victoria, Australia were randomly allocated to receive the DEVS programme (14 schools, n = 1163) or the drug education usually provided by their schools (7 schools, n = 589). Self-reported changes were measured in relation to: knowledge and attitudes, communication with parents, drug education lessons remembered, proportion of drinkers, alcohol consumption (quantity multiplied by frequency), proportion of student drinkers engaging in risky consumption, and the number of harms experienced as a result of alcohol consumption.ResultsIn comparison to the controls, there was a significantly greater increase in the intervention students’ knowledge about drugs, including alcohol (p ≤ 0.001); there was a significant change in their level of communication with parents about alcohol (p = 0.037); they recalled receiving significantly more alcohol education (p < 0.001); their alcohol consumption increased significantly less (p = 0.011); and they experienced a lesser increase in harms associated with their drinking (p ≤ 0.001). There were no significant differences between the two study groups in relation to changes in attitudes towards alcohol or in the proportion of drinkers or risky drinkers. There was, however, a notable trend of less consumption by risky drinkers in the intervention group.ConclusionsA comprehensive, harm minimisation focused school drug education programme is effective in increasing general drug knowledge, and reducing alcohol consumption and harm.     

Smoking Prevention for Students: Findings From a Three-Year Program of Integrated Harm Minimization School Drug Education

Background: This study investigated the impact of the Drug Education in Victorian Schools (DEVS) program on tobacco smoking. The program taught about licit and illicit drugs in an integrated manner over 2 years, with follow up in the third year. It focused on minimizing harm, rather than achieving abstinence, and employed participatory, critical-thinking and skill-based teaching methods. Methods: A cluster-randomized, controlled trial of the program was conducted with a student cohort during years 8 (13 years), 9 (14 years), and 10 (15 years). Twenty-one schools were randomly allocated to the DEVS program (14 schools, n = 1163), or their usual drug education program (7 schools, n = 589). One intervention school withdrew in year two. Results: There was a greater increase in the intervention students' knowledge about drugs, including tobacco, in all 3 years. Intervention students talked more with their parents about smoking at the end of the 3-year program. They recalled receiving more education on smoking in all 3 years. Their consumption of cigarettes had not increased to the same extent as controls at the end of the program. Their change in smoking harms, relative to controls, was positive in all 3 years. There was no difference between groups in the proportionate increase of smokers, or in attitudes towards smoking, at any time. Conclusions: These findings indicate that a school program that teaches about all drugs in an integrated fashion, and focuses on minimizing harm, does not increase initiation into smoking, while providing strategies for reducing consumption and harm to those who choose to smoke.     

Australian drinkers’ perceptions of alcohol-related risk by consumption status

Background: This study investigated Australian drinkers’ alcohol-related beliefs according to their alcohol risk status. The primary aims were to assess drinkers’ awareness of the association between alcohol consumption and a range of health consequences and their understanding of the degree of risk represented by their own alcohol consumption.

Method: An online survey was administered to 2168 drinkers who consume alcohol at least twice per month. Respondents reported their alcohol intake levels and their beliefs relating to the relationship between alcohol and shorter-term (proximal) risks (e.g., drink-driving) and longer-term (distal) risks (e.g., stroke and cancer).

Results: Just over half (52%) of those drinking at high or very high risk levels did not perceive their drinking to be harmful. A large majority (85%) of the sample was aware of various short-term risks of excessive alcohol consumption, but only half appeared aware of the association between alcohol consumption and more distal health conditions.

Conclusions: The relatively low levels of awareness of the alcohol–disease link and the weak relationship between perceived risk and alcohol consumption levels suggest that attempts to reduce current high levels of alcohol-related harm could include public education campaigns designed to (i) improve drinkers’ understanding of the prevalence of alcohol-related harms upon which current alcohol guidelines are based, (ii) prompt drinkers to review their intake levels in the light of the guidelines to assess their potential risk of harm, and (iii) make alcohol-related risks more salient to every-day consumption decisions.     

Early unsupervised drinking--reducing the risks. The School Health and Alcohol Harm Reduction Project

The School Health and Alcohol Harm Reduction Project (SHAHRP) aimed to reduce alcohol-related harm by enhancing students' abilities to identify and deal with high-risk drinking situations and issues. The SHAHRP study involved a quasi-experimental research design, incorporating intervention and control groups and measuring change over a 32-month period. The study occurred in metropolitan, government secondary schools (13 - 17-year-olds) in Perth, Western Australia. The 14 intervention and control schools involved in the SHAHRP study represent approximately 23% of government secondary schools in the Perth metropolitan area. The sample was selected using cluster sampling, with stratification by socio-economic area, and involved over 2,300 intervention and control students from junior secondary schools. The retention rate of the study was 75.9% over 32 months. The intervention incorporated evidence-based approaches to enhance potential for behaviour change in the target population. The intervention was a classroom-based programme, with an explicit harm minimization goal, and was conducted in two phases over a 2-year period. The results were analysed by baseline context of alcohol use to assess the impact of the programme on students with varying experience with alcohol. Knowledge and attitudes were modified simultaneously after the first phase of the intervention in all baseline context of use groups. The programme had little behavioural impact on baseline supervised drinkers; however, baseline non-drinkers and unsupervised drinkers were less likely to consume alcohol in a risky manner, compared to their corresponding control groups. In line with programme goals, early unsupervised drinkers from the intervention group were also significantly less likely to experience harm associated with their own use of alcohol compared to the corresponding control group. Unsupervised drinkers experienced 18.4% less alcohol-related harm after participating in both phases of the programme and this difference was maintained (19.4% difference) 17 months after the completion of the programme. This study indicates that a school drug education programme needs to be offered in several phases, that programme components may need to be included to cater for the differing baseline context of use groups, and that early unsupervised drinkers experience less alcohol-related harm after participating in a harm reduction programme.     

Public self-consciousness,pre-loading and drinking harms among university students

Background: Social anxiety and self-consciousness are associated with alcohol-related problems in students. The practice of pre-loading is one avenue for exploration regarding this relationship. Individuals may pre-load to reduce social anxiety and feel more confident when socializing, which could lead to the increased harms experienced. The current study aimed to explore reasons for pre-loading, and whether public and private self-consciousness and social anxiety were related to pre-loading, increased drinking, and harms. Objectives: Prospective study with four-week follow up of 325 UK students aged 18-–30 years old. Participants completed measures of private and public self-consciousness, social anxiety, alcohol consumption, alcohol-related harms, and pre-loading. Results: Financial motives and mood-related reasons, such as gaining confidence were reported as reasons for pre-loading. Pre-loading predicted hazardous alcohol consumption, but social anxiety, and public and private self-consciousness did not. However, pre-loading, public self-consciousness, and social anxiety predicted alcohol-related harms. Furthermore, public self-consciousness mediated the relationship between pre-loading and harms in a positive direction and this appeared to be more relevant in high-risk (AUDIT 8+) than low-risk drinkers. Conclusions: Students who scored higher in public self-consciousness appeared to be at greater risk of harms from pre-loading. Further research should examine this relationship with particular attention to high-risk drinkers, and explore which aspects of a night out are related to heightened self-consciousness. Interventions could incorporate measures to reduce public self-consciousness, in order to reduce the negative impacts of pre-loading.     

Brand Preferences of Underage Drinkers Who Report Alcohol-Related Fights and Injuries

Background: A significant body of research has demonstrated an association between adolescent alcohol consumption and subsequent fights and injuries. To date, however, no research has identified which brands are associated with alcohol-related fights and injuries among underage drinkers. Objectives: We aimed to: (1) report the prevalence of alcohol-related fights and injuries among a national sample of underage drinkers in the U.S. and (2) describe the relationship between specific alcohol brand consumption and these alcohol-related negative consequences. Methods: We recruited 1,031 self-reported drinkers (ages 13–20 years) via an internet panel maintained by Knowledge Networks to complete an online survey. Respondents reported their past-month overall and brand-specific alcohol consumption, risky drinking behavior, and past-year alcohol-related fights and injuries. Results: Over one-quarter of the respondents (26.7%, N = 232) reported at least one alcohol-related fight or injury in the past year. Heavy episodic drinkers were over six times more likely to report one of these negative alcohol-related consequences (AOR: 6.4, 95% CI: 4.1–9.9). Respondents of black race and those from higher-income households were also significantly more likely to report that experience (AOR: 2.2, 95% CI: 1.3–3.7; AOR: 1.8, 95% CI: 1.1–3.0 and 1.1–3.2, respectively). We identified eight alcohol brands that were significantly associated with alcohol-related fights and injuries. Conclusions/Importance: Alcohol-related fights and injuries were frequently reported by adolescent respondents. Eight alcohol brands were significantly more popular among drinkers who experienced these adverse consequences. These results point to the need for further research on brand-specific correlates of underage drinking and negative health outcomes.     

The Longitudinal Prediction of Alcohol Consumption-Related Harms Among Young Adults

This study explores the longitudinal pathways by which risk and protective factors influence the development of alcohol-related harms in a representative community sample of 941 young adults (19–20 years) from Victoria, Australia, focusing on the role of concurrent risky drinking. Impulsivity at 15–16 years, alcohol-related harms at 15–16 years and 17–18 years, frequency of intoxication at 17–18 years, and antisocial behavior, friends’ drinking and living arrangements at 19–20 years were directly related to alcohol-related harms, as well as indirectly related to harms through increased risky drinking. Paternal drinking at 17–18 years was directly related to alcohol-related harms. Friends’ drinking at 19–20 years and alcohol-related harms at age 17–18 interacted with risky drinking to increase the likelihood of alcohol-related harms. Implications for intervention efforts are discussed.     

Identifying patterns of situational antecedents to heavy drinking among college students

Background: Emerging adults have the highest prevalence of heavy drinking as compared to all other age groups. Given the negative consequences associated with such drinking, additional research efforts focused on at-risk consumption are warranted. The current study sought to identify patterns of situational antecedents to drinking and to examine their associations with drinking motivations, alcohol involvement, and mental health functioning in a sample of heavy drinking college students.

Method: Participants were 549 (65.8% women) college student drinkers.

Results: Latent profile analysis identified three classes based on likelihood of heavy drinking across eight situational precipitants. The ‘High Situational Endorsement’ group reported the greatest likelihood of heavy drinking in most situations assessed. This class experienced the greatest level of alcohol-related harms as compared to the ‘Low Situational Endorsement’ and ‘Moderate Situational Endorsement’ groups. The Low Situational Endorsement class was characterized by the lowest likelihood of heavy drinking across all situational antecedents and they experienced the fewest alcohol-related harms, relative to the other classes. Class membership was related to drinking motivations with the ‘High Situational Endorsement’ class endorsing the highest coping- and conformity-motivated drinking. The ‘High Situational Endorsement’ class also reported experiencing more mental health symptoms than other groups.

Conclusions: The current study contributed to the larger drinking literature by identifying profiles that may signify a particularly risky drinking style. Findings may help guide intervention work with college heavy drinkers.     

Subgroup trends in alcohol and cannabis co-use and related harms during the rollout of recreational cannabis legalization in Washington state

BackgroundThe US state of Washington legalized recreational cannabis in 2012; how this impacted the co-use of cannabis and alcohol in the population overall and among key subgroups has not been examined. The aim of this study is to investigate changes in patterns of alcohol- and cannabis use and alcohol-related harms during the rollout of retail recreational cannabis stores.MethodsData come from six cross-sectional samples recruited between January 2014-October 2016 via Random Digit Dial procedures (N = 5492). Survey-weighted multivariable regression adjusting for gender, age, race/ethnicity, education, employment, marital status, cannabis use, and survey year were used for statistical analyses.ResultsIn the sample overall, no significant changes were observed in any alcohol use measures between 2014–2016, while the prevalence of cannabis use significantly (P < 0.05) increased from 25.0% to 31.7%, the prevalence of alcohol-related harms at home significantly decreased from 2.1% to 1.0%, and the prevalence of alcohol-related financial harms decreased from 1.5% to 0.8%. Both women and men significantly increased any cannabis use, while women also experienced significantly fewer alcohol-related harms at home and financial harms over time, and increases in the prevalence of cannabis users/non-drinkers. Those 18–29 years old significantly reduced the number of drinking days and overall volume in the past 30 days, and those 30–49 years old significantly decreased alcohol-related harms at home and financial harms. Those 50+ years old significantly increased any cannabis use and simultaneous use of cannabis and alcohol. Non-cannabis users slightly decreased average number of drinks/day, and cannabis users significantly decreased alcohol-related financial harms.ConclusionsBetween 2014–2016, the years during and immediately following the introduction of legal recreational cannabis stores in Washington state, there were no significant changes in cannabis and alcohol co-use or overall alcohol consumption. The only significant changes in the sample overall were an increase in any cannabis use and decreases in alcohol-related harms at home and alcohol-related financial harms.     

Alcohol prevention: What can be expected of a harm reduction focused school drug education programme?

Aim: This pilot study investigated what alcohol prevention benefits could be achieved by a harm reduction focused school drug education intervention that addressed all drug use, both licit and illicit.

Method: The study population comprised a cohort of 225 students in three intervention secondary schools and 93 students in a matched control school in Victoria, Australia. A classroom drug education programme, derived from evidence of effective practice and designed to reduce alcohol and other drug harm, was provided to the intervention students during years eight (13–14 year olds) and nine (14–15 year olds) by teachers trained in its delivery. The control students received the drug education programme normally provided by their school.

Findings: The students, who received the intervention, were more knowledgeable about drug use issues, communicated more with their parents about alcohol, drank less, got drunk less, and experienced fewer alcohol related harms. They also remembered receiving more alcohol lessons. They were, however, no less likely to have tried alcohol.

Conclusions: The findings are consistent with other studies that have demonstrated school alcohol education that focuses on harm reduction can be effective in reducing consumption, risk and harm. In this study, this was achieved even though the students were not persuaded against taking up drinking, and the intervention did not focus solely on alcohol. These findings have implications for both the goals and coverage of future school drug education programmes.     

The longitudinal prediction of alcohol consumption-related harms among young adults

This study explores the longitudinal pathways by which risk and protective factors influence the development of alcohol-related harms in a representative community sample of 941 young adults (19-20?years) from Victoria, Australia, focusing on the role of concurrent risky drinking. Impulsivity at 15-16?years, alcohol-related harms at 15-16?years and 17-18?years, frequency of intoxication at 17-18?years, and antisocial behavior, friends' drinking and living arrangements at 19-20?years were directly related to alcohol-related harms, as well as indirectly related to harms through increased risky drinking. Paternal drinking at 17-18?years was directly related to alcohol-related harms. Friends' drinking at 19-20?years and alcohol-related harms at age 17-18 interacted with risky drinking to increase the likelihood of alcohol-related harms. Implications for intervention efforts are discussed.     

Adolescents’ anticipated social outcomes for drinking alcohol and being drunk

The aim of this study was to investigate the social outcomes adolescents anticipate from three social figures (mother, father and peers) for two alcohol-related behaviours (drinking alcohol and being drunk) and how these anticipated social outcomes relate to adolescents’ engagement in underage drinking and experience of alcohol-related harm. The sample was comprised of 651 (329 female) adolescents (age range: 12–16 years; 81% White). Results revealed that the anticipation of less social censure, from mother and peers, for drinking alcohol, related to greater engagement in underage drinking. Further, when underage drinkers were examined separately, lower levels of censure anticipated from mothers and peers for being drunk were associated with higher levels of alcohol-related harm. These findings highlight the importance of not considering social outcomes as a monolithic process. Instead, the results underscore the complexity of adolescents’ social environment and the need for research and interventions to examine this context in terms of the different social figures that influence adolescents and the different alcohol-related behaviours adolescents may engage in. Further, it highlights the notable influence of mothers and peers on adolescents' drinking self-regulation, and their potential roles in intervention programs aimed at reducing underage drinking and its associated harms.     

Factors Associated with Parents' Belief in the Appropriateness of Providing Alcohol to their Child

Background: Parental provision of alcohol to their underage child has been associated with risky adolescent drinking. While parents' belief in the appropriateness of providing their child with alcohol may influence their provision behaviors, research into the factors associated with this belief is lacking. Objectives: This study sought to identify the factors associated with parents' belief in the appropriateness of providing alcohol to their underage child. Methods: Western Australian parents of 12–17 year olds (n = 443) completed an online survey assessing their drinking habits, alcohol provision behaviors, alcohol-related beliefs and attitudes, their child's alcohol consumption, and demographics. Results: Nearly half (44%) the parents surveyed reported providing their underage child with alcohol. Parents of older children and parents who (i) did not believe in the harms and recommendations associated with alcohol use in youth, (ii) agreed with youth-related drinking myths, and (iii) reported more occasions of alcohol consumption by their child were more likely to believe that it was appropriate to provide alcohol to their underage child. Those who believed providing alcohol to their underage child was appropriate were in turn more likely to provide alcohol. Conclusions: Interventions aiming to reduce parental provision of alcohol to children should focus on changing parents' beliefs that this is an appropriate harm minimization behavior. Belief change may be facilitated by the implementation of public education campaigns that increase parents' belief in the alcohol-related harms associated with youth drinking and debunk youth-related drinking myths.     

The nature and correlates of young women's peer-directed protective behavioral strategies

Objective

Recently, a number of studies have identified self-employed Protective Behavioral Strategies (PBS) as effective in decreasing the level of alcohol-related harm among young people. However, much of the published research has ignored important gender differences, such as women's increased tendency to rely on PBS that are social in nature. To further the understanding of women's PBS, the current study sought to investigate the nature and correlates of the strategies young women employ to keep their friends safe when drinking (i.e., peer-directed PBS).

Method

A scale measuring peer-directed PBS was developed and administered in conjunction with existing measures of alcohol consumption, personal PBS, and peer attachment. Participants consisted of 422 women aged 18–30 years, recruited among psychology students and the general public.

Results

Exploratory factor analysis revealed two clusters of peer-directed PBS; those that were aimed at reducing intoxication among one's friends and those that were designed to minimize alcohol-related harms. Further analysis found a positive relationship between women's tendency to implement personal and peer-directed PBS and that risky drinkers were less likely to engage in personal or peer-directed PBS (either type).

Conclusion

Findings indicate that personal and peer-directed PBS are related behaviors that are less frequently adopted by risky drinkers.     

Exploring Risky Drinking and Knowledge of Safe Drinking Guidelines in Older Adults

Background: Risky drinking criteria in older adults lack consistency across the literature. The variable definitions of risk have contributed in part, to widely differing prevalence estimates for risky drinking, ranging from 1% to 15%. Objectives: (1) To identify the prevalence of different types of risky drinking by applying several different criteria, (2) To investigate whether older adults have knowledge of the National Health and Medical Research Council recommended guidelines for safe drinking. Methods: The study population consisted of community dwelling past-year drinkers (n = 292) aged ≥60 years. Participants completed a postal survey on alcohol consumption using the AUDIT-C. Results: Applying multiple risky drinking criteria indicated that 6.6% to 31.7% of women and 21.6% to 44.8% of men were risky drinkers. Men were more likely than women to have inaccurate knowledge of the NHMRC guidelines, and nearly 59.2% of men who exceeded 14 drinks per week reported either not knowing the recommended limits or reported limits that exceeded the guidelines. Conclusions/Importance: A substantial number of older men drank at risky levels and overestimated safe drinking limits. Greater education on the vulnerability to alcohol-related harm together with greater screening practice by health professionals and service providers is recommended. Findings illustrate how different risky drinking criteria vary in their average AUDIT-C scores, with the NHMRC criteria showing greater average scores compared to other criteria. Results also imply that cutoff scores of ≥4 for women and ≥6 for men are consistent with a range of risky drinking criteria in older adults.     

Effectiveness of an email-based intervention helping parents to enhance alcohol-related parenting skills and reduce their children’s alcohol consumption – A randomised controlled trial

Aims: Developing and evaluating an email-based intervention (EBI) to enhance alcohol-related parenting skills and reduce alcohol consumption among adolescents. Methods: Over four weeks, participating parents received a weekly email containing scientific findings, practical advice and exercises in relation to such topics as alcohol-related rule-setting and communication. Using a randomised controlled trial (ID: DRKS00007763), data from 467 parents and 173 adolescents were collected via self-report online questionnaires and analysed by means of repeated measures analysis of variance. Findings: Controlling for baseline, parents in the intervention group (IG) scored higher for being informed (parents of girls: F?=?19.023, p?=?0.000; parents of boys: F?=?30.294, p?=?0.000) and for self-efficacy (parents of girls: F?=?6.122, p?=?0.014; parents of boys: F?=?10.195, p?=?0.002) at follow-up and, in the case of boys, were more successful in maintaining strict rules on alcohol consumption (F?=?13.704, p?=?0.000) than parents in the control group (CG) (girls: F?=?1.627; p?=?0.204). Boys whose parents were in the IG reported less heavy episodic drinking at follow-up (F?=?4.192, p?=?0.043), controlled for baseline, than those with parents in the CG (girls: F?=?0.567; p?=?0.454). Conclusions: The EBI has positive effects on alcohol-related parenting and may reduce heavy episodic drinking among boys. Since it is delivered via email, the programme has considerable potential to reach many parents at low cost.     

Depressive Symptoms and Drinking Outcomes: The Mediating Role of Drinking Motives and Protective Behavioral Strategies Among College Students

Background: College students with depressive symptoms tend to engage in more hazardous drinking and experience more alcohol-related consequences to cope with their symptoms. Given the perceived tension reducing effects of alcohol among these students, it is important to explore how protective factors, such as protective behavioral strategies, account for the relationships among depressive symptoms, drinking motives, and alcohol-related outcomes. Objective: To examine the mediating role of drinking motives and protective behavioral strategies on the associations that depressive symptoms have with typical weekly alcohol consumption, hazardous drinking, and alcohol-related negative consequences in a sample of college student drinkers. Methods: Traditional age college students (n = 566, 73% women; 58% White, non-Hispanic) completed measures of depression, drinking motives, protective behavioral strategies, weekly alcohol use, hazardous drinking, and alcohol-related negative consequences. Results: Coping with depression motives and controlled consumption PBS explained the association between depression and weekly alcohol consumption and hazardous drinking whereas coping with depression motives and serious harm reduction PBS explained the depression-negative consequences relationship. Conformity motives and serious harm reduction PBS explained the association between depression and hazardous drinking and alcohol-related negative consequences. Conclusions: Findings suggest that students with more depressive symptoms would benefit from clinical interventions tailored to address negative reinforcement drinking motives and, by extension, increase student utilization of PBS related to minimizing harm. Clinical and research implications are provided.     

Examining fast and slow effects for alcohol and negative emotion in problem and social drinkers

Attentional bias (AB) for alcohol-related stimuli has been consistently demonstrated in social and problem drinkers. The aims of this study were to: investigate whether AB for alcohol-related stimuli could be described as a slow effect as well as a fast effect; how these effects relate to drinking behaviour; and the influence of the experimental procedure on priming effects. Two experiments were designed. In experiment 1, problem drinkers in treatment at a community alcohol service (N?=?62) and a group of social drinking controls (N?=?60) were assessed using the modified Stroop task with alcohol, negative emotion and neutral words. Drinking patterns were also recorded on the Khavari Alcohol Test. In experiment 2, social drinking controls (N?=?40) completed the same procedure but were blinded to the study’s aims. In experiment 1, both groups demonstrated slower response times to alcohol-related than neutral stimuli in both fast and slow processes. Difference scores for alcohol compared to neutral words in the slow process were positively correlated with increases in drinking levels for both groups. In experiment 2, AB to alcohol-related stimuli disappeared when participants were unprimed. The findings highlight the importance of investigating the role of fast and slow processes in continued and problem drinking, alongside priming effects from the experimental procedure.