The CSC intervention: A comprehensive universal internet-based intervention to prevent anxiety, depression, substance use, and related harms in Australian adolescents aged 13 to 16 years.

Intervention

Intervention code Prevention

Participating secondary schools will be randomly allocated to one of four groups. Group 1: The Control condition: One group will serve as the control group and receive their usual school drug and mental health education. The following groups will receive one of the following three study interventions: Group 2: The Climate Schools-Substance Use (CS-SU) intervention aims to reduce the use of Australia’s most commonly used licit and illicit drugs: alcohol and cannabis, and prevent related harms. Th .... Participating secondary schools will be randomly allocated to one of four groups. Group 1: The Control condition: One group will serve as the control group and receive their usual school drug and mental health education. The following groups will receive one of the following three study interventions: Group 2: The Climate Schools-Substance Use (CS-SU) intervention aims to reduce the use of Australia’s most commonly used licit and illicit drugs: alcohol and cannabis, and prevent related harms. The program consists of twelve 40-minute lessons delivered as part of the Year 8 (Year 9 in QLD) Health and Physical Education syllabus. The first six lessons will be delivered in Term 1, 2014 during consecutive Health and Physical education classes (approximately 1 lesson per week). The remaining six lessons will be delivered in Term 3, 2014 in consecutive Health and Physical education classes (approximately 1 lesson per week). The first part of each lesson is completed individually over the internet. During this part of the lesson students are engaged through cartoon story lines that impart information about the short and long term effects of alcohol and cannabis, normative alcohol and cannabis use, refusal skills, and first aid. The second part of each lesson is a group or class activity delivered by the teacher, and reinforces the information in the cartoons, while allowing interactive communication between students. Teachers are provided with a manual containing the activities, implementation guidelines, links to the education syllabus and summaries for each lesson. The first six lessons focus specifically on alcohol and are delivered approximately six months prior to the remaining six lessons which focus on cannabis. Group 3: The Climate Schools-Mental Health (CS-MH) intervention aims to reduce anxiety and depression symptoms, and to prevent the development of associated disorders later in life. The program consists of six 40-minute lessons delivered as part of the Year 9 (Year 10 in QLD) Health and Physical Education syllabus. The six lessons will be delivered in Term 1,2015 in consecutive Health and Physical education classes (approximately 1 lesson per week). The lessons are structured in the same way as the Climate Schools-Substance Use intervention. The content of the lessons focuses on identifying and effectively dealing with anxiety and depression symptoms. The six lessons are designed to be run consecutively within one school Term. Group 4: The Climate Schools Combined (CSC) Intervention will deliver both the Climate Schools-Substance Use and the Climate Schools-Mental Health interventions consecutively, as described above. The CSC intervention simultaneously targets mental health and substance use, as it is known that the two commonly co-occur and share common risk factors. For those groups receiving an intervention, teachers will be asked to complete a log book at the end of the intervention to document adherence to the intervention and record which activities they implemented in the classroom. As students are required to log in to complete the study intervention online records will indicate student completion rates. Regardless of group, teachers will be asked at the end of each year during the study period to record any other drug, alcohol or mental health education that was delivered to students participating in the trial, that was in addition to the Climate Schools courses. CSC LONG TERM FOLLOW UP 2018-2022 The CSC long-term follow up is an opportunistic extension of the landmark CSC study, whereby follow up of this cohort will extend beyond the completion of secondary school and into the critical transition period of early adulthood. The investigators will extend longitudinal follow-up for a further 5 years, inviting the participants to take part in two additional online surveys assessing demographic information, drinking and drug use habits, mental health systems, health service use and behavioural and personality inventories. Consent will also be sought to link to participants MBS and PBS data. A cost-effectiveness analysis will also examine the cost-effectiveness of the prevention program. This extended follow-up component was added after initial recruitment for Phase 1 of the CSC trial, run between 2014 – 2017.
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Comparison

Control group Active

The Climate Schools Combined (CSC) Intervention will be compared to: a) A "standard treatment" control group - Students will not receive the Climate Schools-Substance Use or Mental Health interventions. Participants will complete their standard Year 8 and Year 9 (Year 9 & 10 in QLD) Health and Physical Education classes, delivered by their usual teacher. b) The Climate Schools-Substance Use only intervention - Students will receive 12 x 40-minute lessons delivered as part of the Year 8 (Year 9 i .... The Climate Schools Combined (CSC) Intervention will be compared to: a) A "standard treatment" control group - Students will not receive the Climate Schools-Substance Use or Mental Health interventions. Participants will complete their standard Year 8 and Year 9 (Year 9 & 10 in QLD) Health and Physical Education classes, delivered by their usual teacher. b) The Climate Schools-Substance Use only intervention - Students will receive 12 x 40-minute lessons delivered as part of the Year 8 (Year 9 in QLD) Health and Physical Education syllabus. Each lesson consists of an interactive computer component and class activities from the program manual, administered by their usual teacher. c) The Climate Schools-Mental Health only intervention - Students will receive 6 x 40-minute lessons delivered as part of the Year 9 (Year 10 in QLD) Health and Physical Education syllabus. Each lesson consists of computer lessons and activities from the program manual, to be administered by their usual teacher.
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Outcomes

Outcome: Use and harmful use of alcohol and cannabis. Students will be asked to rate the frequency and quantity of their alcohol consumption in standard drinks, frequency of drinking to excess (defined as having more than five standard drinks on a single occasion), and age of first alcohol consumption. These questions are were originally adapted from the School Health and Alcohol Harm Reduction Project (SHAHRP) ‘Patterns of Alcohol’ index and trials of the Preventure program, an .... Outcome: Use and harmful use of alcohol and cannabis. Students will be asked to rate the frequency and quantity of their alcohol consumption in standard drinks, frequency of drinking to excess (defined as having more than five standard drinks on a single occasion), and age of first alcohol consumption. These questions are were originally adapted from the School Health and Alcohol Harm Reduction Project (SHAHRP) ‘Patterns of Alcohol’ index and trials of the Preventure program, and reflect those used in previous CLIMATE Schools trials. Cannabis and other drug use will be measured by questions based on the National Drug Strategy Household Survey (NDHS), 2010, and the Australian Secondary Students Alcohol and Drug Survey (ASSAD), 2011. This allows for comparison between use in the current sample and a large scale representative group of Australians. Long-term follow-up: Alcohol and cannabis use: Drinking frequency and binge drinking will be assessed using an adapted version of the Patterns of Alcohol Index. A shortened version of the Patterns of Cannabis Use instrument, will be used to measure use and frequency of cannabis use.
Timepoint: Assessed at baseline and at 6, 12, 18, 24 and 30 months after study commencement. Long-term follow-up: Primary outcomes will be assessed long-term via the administration of two additional follow-up surveys spanning 5 and 7 years post-intervention.
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Outcome: Overall anxiety/depression levels . The ‘Kessler 6 plus’ scale (K6+) will be used to assess psychological distress in the past month. Depression symptoms will be measured using the ‘Patient Health Questionnaire 8’ (PHQ8), while anxiety symptoms will be measured by the ‘Generalised Anxiety Disorder 7-item scale’ (GAD-7). The 3-item ‘Mini Social Phobia Inventory’ (mini-SPIN) will assess social anxiety symptoms. The ‘Strengths and Difficulties Questionnaire’ (SDQ) will be .... Outcome: Overall anxiety/depression levels . The ‘Kessler 6 plus’ scale (K6+) will be used to assess psychological distress in the past month. Depression symptoms will be measured using the ‘Patient Health Questionnaire 8’ (PHQ8), while anxiety symptoms will be measured by the ‘Generalised Anxiety Disorder 7-item scale’ (GAD-7). The 3-item ‘Mini Social Phobia Inventory’ (mini-SPIN) will assess social anxiety symptoms. The ‘Strengths and Difficulties Questionnaire’ (SDQ) will be used to assess both positive and negative attributes of the students. Long-term follow-up: Primary outcome 2: Symptoms of anxiety & depression: The K6+, PHQ-9 and GAD-7 will be used to assess overall anxiety/depression levels.
Timepoint: Assessed at baseline and at 6, 12, 18, 24 and 30 months after study commencement. Long-term follow-up: Primary outcomes will be assessed long-term via the administration of two additional follow-up surveys spanning 5 and 7 years post intervention.
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Outcome: Anxiety, depression and substance use knowledge. Alcohol related knowledge will be assessed using a questionnaire originally adapted from the SHAHRP 16-item ‘Knowledge of Alcohol’ index, and as used in previous trials using the CLIMATE Schools programs. Participants’ knowledge about cannabis will be assessed by 16 items from the ‘Knowledge about Cannabis’ scale used in previous CLIMATE Schools trials. Participants’ knowledge about coping with anxiety and depression wil .... Outcome: Anxiety, depression and substance use knowledge. Alcohol related knowledge will be assessed using a questionnaire originally adapted from the SHAHRP 16-item ‘Knowledge of Alcohol’ index, and as used in previous trials using the CLIMATE Schools programs. Participants’ knowledge about cannabis will be assessed by 16 items from the ‘Knowledge about Cannabis’ scale used in previous CLIMATE Schools trials. Participants’ knowledge about coping with anxiety and depression will be assessed from 7 questions that cover appraisal, reality focused and emotion focused coping.
Timepoint: Assessed at baseline and at 6, 12, 18, 24 and 30 months after study commencement.
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