Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2017 Aug 18;7(8):e016060.
doi: 10.1136/bmjopen-2017-016060.

Effectiveness of a pragmatic school-based universal resilience intervention in reducing tobacco, alcohol and illicit substance use in a population of adolescents: cluster-randomised controlled trial

Rebecca Kate Hodder  1   2   3 , Megan Freund  2   3 , Jenny Bowman  2   3 , Luke Wolfenden  1   2   3 , Elizabeth Campbell  1   3 , Julia Dray  1   2   3 , Christophe Lecathelinais  1   3 , Christopher Oldmeadow  4 , John Attia  4 , John Wiggers  1   2   3
Affiliations
Randomized Controlled Trial

Effectiveness of a pragmatic school-based universal resilience intervention in reducing tobacco, alcohol and illicit substance use in a population of adolescents: cluster-randomised controlled trial

Rebecca Kate Hodder et al. BMJ Open. .

Abstract

Objectives: Initiation of tobacco, alcohol and illicit substance use typically occurs during adolescence, with the school setting recommended to reduce adolescent substance use. Strengthening individual (eg, problem solving) and environmental (eg, caring relationships at school) resilience protective factors of adolescents has been suggested as a strategy for reducing substance use by adolescents; however, few studies have examined this potential. A study was conducted to investigate the effectiveness of a pragmatic school-based universal 'resilience' intervention in reducing the prevalence of tobacco, alcohol and illicit substance use, and increasing the individual and environmental protective factors of students.

Design: A cluster-randomised controlled trial.

Setting: Thirty-two Australian secondary schools (20 intervention; 12 control).

Participants: Cohort of grade 7 students followed-up in grade 10 (2014; aged 15-16 years).

Intervention: A pragmatic intervention involving school staff selection and implementation of available programmes and resources targeting individual and environmental 'resilience' protective factors for all grade 7-10 students was implemented in schools (2012-2014). School staff were provided implementation support.

Measurements: An online survey collected baseline and follow-up data for primary outcomes: tobacco (ever, recent) and alcohol (ever, recent, 'risk') use, and secondary outcomes: marijuana and other illicit substance use, and individual (six-factor subscales, aggregate) and environmental (three-factor subscales, aggregate) protective factor scores. Generalised and linear mixed models examined follow-up differences between groups.

Results: Follow-up data from 2105 students (intervention=1261; control=844; 69% of baseline cohort) were analysed. No significant differences were found between intervention and control students for any primary (ever tobacco: OR 1.25, 95% CI 0.92 to 1.68, p=0.14; recent tobacco: OR 1.39, 95% CI 0.84 to 2.31, p=0.19; recent ever alcohol: OR 1.11, 95% CI 0.83 to 1.48, p=0.46; alcohol: OR 1.13, 95% CI 0.78 to 1.62, p=0.51; 'risk' alcohol: OR 0.98, 95% CI 0.70 to 1.36, p=0.89) or secondary outcomes (marijuana: OR 1.12, 95% CI 0.74 to 1.68, p=0.57; other illicit substance: OR 1.19, 95% CI 0.67 to 2.10, p=0.54; individual protective factors: MD=0, 95% CI -0.07 to 0.06, p=0.89; environmental protective factors: MD: -0.02, 95% CI -0.09 to 0.06, p=0.65).

Conclusions: The universally implemented pragmatic school-based intervention was not effective in reducing the prevalence of tobacco, alcohol or illicit substance use, or in increasing the protective factors of students.

Trial registration: Australia and New Zealand Clinical Trials Register reference: ACTRN12611000606987.

Keywords: adolescents; alcohol; drug/substance use; resilience; school-based intervention; substance use prevention; tobacco.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study flow diagram.
See this image and copyright information in PMC

References

    1. Rehm J, Taylor B, Room R. Global burden of disease from alcohol, illicit drugs and tobacco. Drug Alcohol Rev 2006;25:503–13. 10.1080/09595230600944453 - DOI - PubMed
    1. Mathers C, Boerma T, Ma Fat D. The global burden of disease: 2004 update. Geneva, Switzerland: World Health Organisation, 2008.
    1. Rehm J?rgen, Mathers C, Popova S, et al. . Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. The Lancet 2009;373:2223–33. - PubMed
    1. National Drug Intelligence Center. The economic impact of illicit drug use on American Society. Washington, DC, USA: Department of Justice, 2011.
    1. Centers for Disease Control and Prevention. Smoking-attributed mortality, years of potential life lost, and productivity losses - United States 2000-2004: Morbidity and Mortality Weekly Report, 2008. - PubMed

Publication types

MeSH terms