In recent years, the Internet has received increasing recognition as an effective means of facilitating public health interventions. In particular, delivering prevention for substance use to school students via the Internet appears to be an area of great potential. The Climate Schools: Ecstasy and Emerging Drugs Module, a school-based prevention program, facilitated by the Internet, was developed to address the use of ecstasy and new and emerging drugs (Emerging Psychoactive Substances or Novel Psychoactive Substances). This four-lesson course was designed to be delivered to Australian adolescents (aged 15 to 16 years) during their standard health education classes at school, and is based on a harm-minimisation and social influence approach. The program was developed in response to the important public health challenge of new and emerging drugs as well as to address the prevention of ecstasy use among young people. To our knowledge, this will be the first school- and Internet-based prevention program specifically targeting these substances. This paper describes the process involved in developing this new Internet-based substance use prevention program.
Over the past decade, the Internet has emerged as a promising mode of delivering public health interventions. This is largely due to the dramatic increase in Internet access, with approximately one third of the world’s population now online [
The Climate Schools programs are universal school-based prevention programs delivered to adolescents via the Internet. The courses are based on a harm-minimisation approach and utilise cartoon storylines to engage students and impart information about drugs. Previous cluster randomised controlled trials (RCTs) of the Climate Schools programs for alcohol and cannabis have found the programs to be effective in reducing harmful alcohol and cannabis use and increasing alcohol- and cannabis-related knowledge [
In the past few years, there has been considerable attention among policymakers, researchers and the media on the manufacture and misuse of new and emerging drugs (NEDs), also known as Novel Psychoactive Substances, Emerging Psychoactive Substances, “synthetic drugs” and “legal highs”. These substances are specifically designed to imitate the effects of established illicit drugs, including cannabis, LSD and ecstasy [
In light of the potential for young people to misuse NEDs, several international bodies have made recommendations for addressing this new public health challenge through prevention programs. On the basis of these recommendations it appears that prevention for NEDs should occur at school during physical health and education classes, be incorporated into existing drug education programs, be innovative and make use of new technologies [
This paper proposes that prevention for NEDs can be delivered via the Internet, in conjunction with an existing universal prevention program for ecstasy, known as the Climate Schools: Ecstasy Module. Given the overlaps in the age of onset, risk factors and potential harms associated with both ecstasy and NED use [
In 2010, the Climate Schools: Ecstasy Module was developed to address and prevent the use of ecstasy and related harms among adolescents. The module was based on the successful Climate Schools framework and initial
Barrier to successful implementation | Features of Internet-based programs | Advantages |
---|---|---|
Lack of resources (teachers, time, money) | ・ Professionals not required for program delivery ・ Minimal teacher involvement in program delivery ・ No teacher training required | ・ Reduction in costs and time ・ Increased feasibility of use |
Restricted access (geographic and socioeconomic constraints) | ・ Internet is portable ・ Accessible in majority of schools ・ High development costs, but reduction in dissemination costs | ・ Less restrictive in geographically isolated and low socioeconomic areas ・ Potential for wide dissemination |
Poor implementation fidelity | ・ Content is pre-programmed ・ Delivery not dependent on the teacher | ・ Complete and consistent delivery of program content is guaranteed ・ Reduced risk for teachers to make adaptations and/or deletions |
Self-disclosure issues | ・ Increased perceptions of anonymity and privacy | ・ Potential to increase self-disclosure about substance use |
Lack of student engagement | ・ Can incorporate audio-visual elements and provide personalised feedback ・ Interactive and appealing to teenagers | ・ Increased student engagement |
development resulted in three computer-based cartoon lessons [
An important first step in developing the Climate Schools: Ecstasy and Emerging Drugs Module was to update the existing program content relating to ecstasy. Although extensive collaboration was conducted with students during original program development [
Focus Testing Method
Participants. To ascertain feedback about the relevance and acceptability of the language used in the cartoon storyline, seven students were recruited through personal networks of colleagues, friends and family to participate in focus testing. Participants ranged in age from 15 to 17 years old (Mean = 15.71 years, SD = 0.76) and more than half (57%) were female. Three students attended an Independent high school, two attended a public high school and one was a Catholic school student. The majority of participants (71%) attended co-educational high schools.
Procedure. Students that agreed to participate were asked to visit a website setup specifically for the purpose of focusing testing and to view the three cartoon lessons of the Climate Schools: Ecstasy Module. Participants were sent a brief self-report questionnaire to complete, which covered demographic information and asked students to provide their open-ended feedback about the wording and language used in each of the three lessons. Students were asked to return their completed questionnaire via email or post, and were reimbursed a $20 iTunes voucher in appreciation of their time. All aspects of this research were approved by the University of New South Wales Human Research Ethics Committee (UNSW HREC09189).
Focus Testing Results
Qualitative comments provided by students indicated that on the whole, students enjoyed the program and thought it was an informative resource. Students gave a number of suggestions for slight changes to the language used in the cartoon lessons for example replacing the term “gang” with “group” and “turn tables” with “mixer and speakers”. Based on these results, minor revisions were made to the cartoon script in an attempt to reflect the language used by teenagers today. Given the importance of normative education in the social influence approach [
The second stage in the development of the Climate Schools: Ecstasy and Emerging Drugs Module involved incorporating new content about NEDs into the existing cartoon storyline and teacher and student resources.
Developing the lesson content and writing the cartoon script. The first step in creating the additional lesson content about NEDs for the Climate Schools: Ecstasy and Emerging Drugs Module was to determine what content should be addressed. Due to the rapid growth in the availability of NEDs and the varying content and quality of these drugs it is difficult to provide clear prevention messages about particular brands and types of NEDs [
Focus testing method. Once the key messages had been devised, the next step involved writing the cartoon script to incorporate the new NED-related content into the existing storyline. Following this, focus testing was conducted to obtain feedback from health professionals and young people about the content and language used in the new lesson. Health professionals in the field of drug and alcohol research (n = 6) were provided with the script and asked to review it for accuracy, acceptability and relevance. Students (n = 7) were also sent the new script and asked to comment on whether they thought people their age would understand and enjoy the lesson content. Students were asked to write down their feedback about the language and wording used in the new script and return it via email or post. Students were sent a $20 iTunes voucher to thank them for their time. All aspects of this research were approved by the UNSW HREC (09189).
Focus testing results. Feedback received from the students was mostly positive, with only minor changes proposed to the script (examples of specific comments are provided in
and slight changes to the wording and language used were also put forward.
An issue that was raised by both students and health professionals was the terminology used in the cartoon script to refer to NEDs. For example, in relation to the term “New and Emerging Drugs”, one researcher ques-
Message | Aim |
---|---|
Legal does not mean safe. | To correct the misperception that because NEDs are sometimes marketed as being legal, that they are safe to use. |
NEDs are not necessarily legal. | To inform students that even though NEDs are sometimes marketed as “legal highs” they are often quickly banned under new legalisation and their legal status can change rapidly. |
Taking NEDs is a gamble. | To educate students that there is not enough research on these substances to know what they contain and what effects they might have, especially in the long term. |
Most young people in Australia do not use NEDs | Use international prevalence data on NED use and internet monitoring data from Australia to correct overestimates of NED use among peers. |
tioned “would anyone actually say that?” and one student commented “the word emerging drugs sounds off. Maybe use it like once or twice then the other time use legal highs”. Although the term “legal highs” may be the more easily understood and preferred by young people, its use is problematic. According to Corazza, Demetrovics [
Creating the final teacher manual
Consistent with the existing Climate Schools courses, the final teacher manual included three components for each lesson: a teacher summary, a student summary and optional class activities. Guidelines for implementing the Climate Schools: Ecstasy and Emerging Drugs Module and an overview of how the program links to the NSW PDHPE syllabus were also included in the manual.
In addition to the updates made to the ecstasy-related content presented in the lesson summaries, new information on NEDs was incorporated. This content was devised from the latest available information and literature on NEDs and resulted in the addition of a fourth lesson summary. Once the lesson summaries were finalised, the next step was to review and design the accompanying class activities for each lesson, including both reviewing and updating the existing activities relating to ecstasy, and designing new activities about NEDs.
A number of factors informed the development of the optional class activities for the Climate Schools: Ecstasy and Emerging Drugs Module. First, teacher evaluation data from previous trials of the Climate Schools: Alcohol and Cannabis Module [
Student | Feedback |
---|---|
Student A | “The added info about synthetic drugs is new to most teens and adds a bit more variation to the repetitive drug talks we get on all well know drugs like weed, E, LSD etc.” |
Student B | “I think this would be understood by your target audience” “Alcohol” should be changed to “grog” |
Student C | Change “No, not at all mate” to “No way!” |
Theme | Examples |
---|---|
Teacher resources and student activities need to be online and interactive | “Would be nice to see the teacher resources go online and become more interactive” “More online activities and interactive online activities |
Greater interactivity between students and the program | “More interactivity built into the student material” “More interactive activities for after the cartoon. So for when some of the faster readers finish, they can automatically complete the online activities” |
Enhanced learning for students | “Activities more focused on decision-making and on developing skills, rather than just getting information” “Additional activities need to allow for higher order thinking” |
that teachers prefer activities that encourage student engagement and learning and offer a greater level of interactivity. This is consistent with drug education literature which supports the use of interactive teaching methods in the delivery of drug prevention. For example, according to the International Standards for Drug Use Prevention [
One means of increasing the level of interactivity between the Climate Schools program and the student was to include a “Stop and Think” component in each of the four online cartoon lessons. These components consist of a series of questions at important points in the storyline, in which students are required to think critically about certain situations the characters are in and the possible consequences of the character’s behaviour.The activities were also informed by existing drug and alcohol and other educational resources, the Stage 5 NSW PDHPE syllabus outcomes, principles for school drug education [
Taking this all into account, four activities per lesson were created to accompany the cartoon lessons of the Climate Schools: Ecstasy and Emerging Drugs Module. The aim of the activities was to reinforce the content presented in the online cartoons and cover a range of skills, including goal setting, peer pressure resistance, effective and assertive communication and decision-making. To give teachers flexibility, some activities were made available as individual online tasks, such as worksheets, mind maps and crosswords. A selection of group activities, such as role-plays and class discussions, were also developed which aim to encourage discussion and interaction among teacher and students.Once the activities were finalised, the manual was sent to graphic designers to be made into visually attractive booklets to appeal to teachers and students. All program content, including the four cartoon lessons and corresponding activities, was then programmed and uploaded online to the study website (www.csistudy.org.au).
The current paper describes the development of the Climate Schools: Ecstasy and Emerging Drugs Module, a four-lesson Internet-based prevention program developed specifically to address and prevent the use of NEDs and ecstasy among adolescents. The strength of the program lies in the fact that it will be among the first Internet-based intervention designed to specifically target ecstasy and NED use among adolescents. In addition, it is an important
response to recommendations made by major international bodies about the need to address the growing public health challenge of NEDs. Although the program was developed in consultation with students and health professionals working in the field, a limitation of the current study is the small number of participants who vetted the cartoon scripts and provided feedback. Nonetheless, the results obtained from the focus testing was critical in informing the intervention and ensuring that it was acceptable, relevant and appealing to Year 10 students.
Following development, the next step in evidence-based prevention is to evaluate interventions for efficacy. To achieve this, a cluster RCT is currently being conducted among over 1100 Australian secondary school students from 11 schools to evaluate the Climate Schools: Ecstasy and Emerging Drugs Module. If deemed effective, the module will provide schools with an interactive prevention program for ecstasy and NEDs that can be easily disseminated among schools and readily implemented by teachers via the Internet.
This study is funded by the National Health and Medical Research Council (NHMRC) and the Australian Government Department of Health. The authors would like to acknowledge all the students, teachers and health professionals involved in the development process.
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.