1Champion KE, et al. BMJ Open 2018;8:e020433. doi:10.1136/bmjopen-2017-020433
Open access
Cluster randomised controlled trial of an online intervention to prevent ecstasy and new psychoactive substance use among adolescents: final results and implications for implementation
Katrina E Champion, Nicola Clare Newton, Lexine Stapinski, Maree Teesson
To cite: Champion KE, Newton NC, Stapinski L, et al. Cluster randomised controlled trial of an online intervention to prevent ecstasy and new psychoactive substance use among adolescents: final results and implications for implementation. BMJ Open 2018;8:e020433. doi:10.1136/bmjopen-2017-020433
► Prepublication history and additional material for this paper are available online. To view these files, please visit the journal online (http:// dx. doi. org/ 10. 1136/ bmjopen- 2017- 020433).
Received 2 November 2017Revised 20 August 2018Accepted 10 October 2018
NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
Correspondence toDr Katrina E Champion; k. champion@ unsw. edu. au
Research
© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
AbstrACt Objectives To evaluate the effectiveness of the online Climate Schools: Ecstasy and Emerging Drugs module over 2 years, and examine the impact of intervention dose on outcomes.Design Cluster randomised controlled trial.setting Secondary schools in Australia.Participants 1126 students (aged 14.9 years) from 11 schools.Intervention Five schools were randomly allocated to the four-lesson internet-based Climate Schools: Ecstasy and Emerging Drugs module. This universal intervention uses cartoon storylines to deliver harm-minimisation information about ecstasy and new psychoactive substances (NPS). It was delivered during health education classes over 4 weeks. Six schools were randomised to the control group (health education as usual). Participants were not blinded to intervention allocation.Outcomes measures Students completed self-report surveys at baseline, post-test, 6, 12 and 24 months post-baseline. Intentions to use ecstasy and NPS (including synthetic cannabis and synthetic stimulants), knowledge about ecstasy and NPS and lifetime use of ecstasy and NPS were assessed. This paper reports the results at 24 months post-baseline.Analysis Mixed effects regressions were conducted to analyse intervention effects from baseline to 24 months. Post ho
c analyses using Inverse Probability of Treatment Weighting compared controls with students who: i) completed all four lessons (‘full dose’) and ii) partially completed the intervention (≤three lessons, ‘incomplete dose’).results Primary analyses found that controls were significantly more likely to intend on using synthetic cannabis compared with intervention group students (OR=3.56, p=0.01). Results from the weighted analyses indicated that controls reported significantly lower knowledge about ecstasy (p=0.001) and NPS (p=0.04) compared with the full-dose group. No significant differences were observed between the incomplete dose and control groups.Conclusions The online intervention was effective in modifying students’ intentions to use synthetic cannabis up to 24 months; however, this study highlights the importance of delivering prevention programmes in full to maximise student outcomes.
trial registration number ACTRN12613000708752.
Ecstasy use among young Australians is relatively low, with 3.2% of adolescents aged 14–19 years reporting past year use in 2016.1 However, for those adolescents who do use ecstasy, the potential for harm is considerable, with adverse effects ranging from confusion and dehydration to impaired brain functioning and mental health prob-lems.2 3 In addition to concerns about estab-lished illicit drugs such as ecstasy, there are new and emerging issues in the global land-scape of drug use that also need to be consid-ered. One such challenge is the growth in the number and availability of new psychoactive substances (NPS) and the severity of conse-quences associated with their use.4
NPS are substances that are specifically designed to imitate the effects of established illicit drugs and to circumvent existing drug laws. Although NPS are typically sold online or in ‘headshops’ as legal alternatives to
strengths and limitations of this study
► A key strength of this study is its robust and longi-tudinal design. A cluster randomised controlled trial was conducted in 11 Australian schools (n=1126 students) over a 2-year period.
► Sophisticated statistical analyses were employed. Multilevel regressions were estimated to analyse differential group change in outcomes from baseline to the 24-month follow-up.
► This study used novel online intervention comple-tion data to examine the effect of dosage on student outcomes.
► Attrition at the 24-month follow-up was higher than anticipated, despite comprehensive efforts to assess students who were absent from school on the day of a survey.