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  • Differential intervention effectiveness of a universal school-based resilience intervention in reducing adolescent substance use within student subgroups: exploratory assessment within a cluster-randomised controlled trial

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Smoking and tobacco
Research
Differential intervention effectiveness of a universal school-based resilience intervention in reducing adolescent substance use within student subgroups: exploratory assessment within a cluster-randomised controlled trial
  1. Rebecca Kate Hodder1,2,3,
  2. Megan Freund2,3,
  3. Jenny Bowman3,4,
  4. Luke Wolfenden1,2,3,
  5. Elizabeth Campbell1,3,
  6. Julia Dray1,3,4,
  7. Christophe Lecathelinais1,3,
  8. Christopher Oldmeadow5,
  9. John Attia5,
  10. John Wiggers1,2,3
  1. 1 Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
  2. 2 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  3. 3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia
  4. 4 School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
  5. 5 Clinical Research Design, IT, and Statistical Support (CReDITSS), Hunter Medical Research Institute, Wallsend, New South Wales, Australia
  1. Correspondence to Dr Rebecca Kate Hodder; rebecca.hodder{at}hnehealth.nsw.gov.au

Abstract

Objectives Interventions addressing the individual and environmental protective factors of adolescents are suggested to have potential for reducing adolescent substance use. While universally delivered school-based substance use prevention interventions are common, previous studies have suggested variable effectiveness by subgroups of students. An exploratory study was undertaken to examine the differential effectiveness of a universal school-based resilience intervention on adolescent substance use and protective factors according to their sociodemographic and previous substance use.

Design Secondary analysis of data from a cluster-randomised controlled trial.

Setting 32 Australian secondary schools.

Participants Cohort of grade 7 students (n=3155) followed up in grade 10 (aged 15–16 years; 2014; n=2105).

Intervention Three-year universal school-based intervention implemented by school staff that targeted a range of student resilience protective factors (2012–2014).

Measurements Primary outcomes included: tobacco (recent, number of cigarettes) and alcohol (recent, ‘risk’ and number of drinks) use, and secondary outcomes included: marijuana (recent) and other illicit substance (recent) use, and aggregate individual and environmental protective factor scores. Generalised and linear mixed models examined interactions between treatment and student subgroups (gender; socioeconomic disadvantage (low/high); geographic location (major city/inner regional/outer regional-remote); and previous substance use (non-user/user)) at follow-up (36 models).

Results Analysis of student follow-up data showed no differential intervention effect for any substance use or protective factor outcome for any subgroup, with the exception of one differential effect found by socioeconomic status for the outcome of mean number of cigarettes smoked by recent smokers (p=0.003). There was no evidence of an intervention effect within the low (mean difference (MD) −12.89, 95% CI −26.00 to 0.23) or high (MD 16.36, 95% CI −1.03 to 33.76) socioeconomic subgroups.

Conclusions No evidence of an intervention effect on substance use and protective factors was found according to student subgroups defined by sociodemographic characteristics or previous substance use.

Trial registration number ACTRN12611000606987.

  • differential effects of universal interventions
  • tobacco, alcohol and drug use prevention
  • adolescents
  • resilience
  • school-based drug prevention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2017-021047

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    Footnotes

    • Contributors RKH conducted the literature search, drafted the manuscript and contributed to study design, data collection, data analysis, data interpretation and coordination of the study. JW, MF, JB, LW and EC helped draft the manuscript and participated in the conception, design and coordination of the study. JD helped draft the manuscript and participated in the coordination of the study. CL, CO and JA helped draft the manuscript and conducted data analysis. All authors read and revised the manuscript critically for intellectual content and approved the final manuscript.

    • Funding The work was supported by funding from the National Health and Medical Research Council, nib Foundation, Cancer Council NSW Program Grant (PG 16-05) and Hunter New England Population Health and infrastructure support from the Hunter Medical Research Institute.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Relevant ethics committee approvals were obtained (Hunter New England Health Ref: 09/11/18/4.01; University of Newcastle Ref: H-2010–0029).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Requests for additional unpublished data should be forwarded to Rebecca.hodder@hnehealth.nsw.gov.au.