Substance Use & Misuse, 46:1651–1663, 2011Copyright C© 2011 Informa Healthcare USA, Inc.ISSN: 1082-6084 print / 1532-2491 onlineDOI: 10.3109/10826084.2011.613441

ORIGINAL ARTICLE

Developing the Climate Schools: Alcohol and Cannabis Module: AHarm-Minimization, Universal Drug Prevention Program Facilitated bythe Internet

Nicola Clare Newton1, Laura Vogl1, Maree Teesson1 and Gavin Andrews2

1National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Sydney, New South Wales,Australia; 2Clinical Research Unit for Anxiety and Depression, University of New South Wales, Darlinghurst, Sydney,New South Wales, Australia

The Climate Schools: Alcohol and Cannabis Moduleis a universal harm-minimization school-based pre-vention program for adolescents aged 13–15 years.The core content of the program is delivered over theInternet using cartoon storylines to engage students,and teacher-driven activities reinforce the core infor-mation. The program is embedded within the schoolhealth curriculum and is easy to implement with min-imal teacher training required. The program was de-veloped in 2007 through extensive collaboration withteachers, students, and health professionals (N = 24)in Sydney, Australia and has since been evaluated (N =764). This article describes the formative research andprocess of planning that formed the development of theprogram and the evidence base underpinning the ap-proach. The study’s limitations are noted.

Keywords school-based, drug education, prevention, alcohol,cannabis, Internet, adolescence

INTRODUCTION

The importance of developing effective preventionprograms for alcohol and other drugs use is highlightedthrough the high prevalence of use (Australian Insti-tute of Health and Welfare, 2008; Office of NationalDrug Control Policy, 2008), and associated harms(Andrews, Henderson, & Hall, 2001; Australian Gov-ernment Department of Health and Ageing, 2004;Chikritzhs & Pascal, 2004; Collins & Lapsley, 2008;Hall, Degenhardt, & Lynskey, 2001; Mathers, Vos, &Stevenson, 1999). Although an array of school-basedprevention strategies for substance use exist, research

The development of the Climate Schools: Alcohol and Cannabis Module was funded by the Australian Government Department of Health andAgeing and the Alcohol Education and Rehabilitation Foundation. Climate Schools are operated on a not-for-profit basis. The authors would like toacknowledge the many schools, students, teachers, and health professionals who were involved in this research.Address correspondence to Nicola Clare Newton, National Drug and Alcohol Research Centre, University of New South Wales, 22–32 King Street,Randwick, Sydney, New South Wales 2052, Australia; E-mail: nickien@unsw.edu.au.

has failed to consistently demonstrate that universal drugprevention can be effective in reducing actual substanceuse and no single program appears to be universallyfeasible and scalable (Botvin, 2004; Faggiano et al.,2008; Soole, Mazerolle, & Rombouts, 2005; Tobler, Las-sard, Marshall, Ochshorn, & Roona, 1999; Tobler et al.,2000; White & Pitts, 1998). The two main factors whichimpede the effectiveness of school-based drug preventionprograms are a focus on abstinence-based outcomes andimplementation failure (Botvin, 2004; Botvin & Griffin,2003; Botvin, Griffin, Diaz, & Ifill-Williams, 2001;Gorman, 2003; Loxley et al., 2004; McBride, Farringdon,Midford, Meuleners, & Phillips, 2004; Midford, 2000;Munro & Midford, 2001; Newton, Vogl, Teesson, &Andrews, 2009; Vogl et al., 2009).

Typically, school-based prevention programs aimed atreducing substance use have adopted the abstinence-basedapproach (Beck, 1998). This approach conveys a strict“no-use” message regarding drug use and punishes theslightest deviation from the ideal (Munro & Midford,2001). Abstinence-based approaches have received somecriticism for providing little assistance to the many youngpeople who may have tried drugs, leaving them to developtheir own knowledge and skills to cope with drug-relatedsituations (McBride et al., 2004). Recently, we have seena shift away from the abstinence-based approach to pre-vention, toward a more pragmatic approach referred toas “informed choice” or harm–minimization (Beck, 1998;Roche, Evans, & Stanton, 1997; Weatherburn, 2008).This approach strives to not only reduce drug use, butto also minimize potential harm and problems resultingfrom the uninformed misuse of substances by fosteringinformed decision making and choices (Wodak, 2009).

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School-based programs which have used a harm-minimization approach have demonstrated promising re-sults in reducing alcohol misuse and related harms(McBride, Farringdon, Muleners, & Midford, 2006; New-ton, Vogl, et al., 2009; Vogl et al., 2009).

Like all school-based programs, including harm-minimization programs, their effectiveness is alsocompromised by implementation failure (Botvin, 2004;Ennett et al., 2003). Implementation failure occurs asa result of a number of factors including poor teachertraining, program characteristics (e.g., high level com-plexity, lack of integration into syllabus, program lengthetc), teacher characteristics, and poor program adaptation(Ennett et al., 2003). Of concern is that implementationfailure has clearly been shown to lead to poorer programoutcomes (Bosworth, 2003).

To address this problem, prevention programs need tobe designed to overcome some of the identified concernswhich lead to implementation failure. To allow foroptimal program implementation in routine practice,prevention programs need to be user-friendly, appeal toschools and teachers, be curriculum-based, commerciallyattractive, and not require extensive training or resources(Botvin & Griffin, 2003; Dusenbury & Hansen, 2004).The innovative computerized Climate Schools modelfor drug prevention was developed for this purpose(www.climateschools.com). The Climate Schools: Al-cohol Module is a computer-delivered school-basedalcohol misuse prevention program founded on a harm-minimization approach (Vogl et al., 2009). This modeloffers three major advantages over traditional school-based prevention programs. First, it requires limited stafftraining and preparation time; second, it is delivered usingcomputers and therefore facilitating consistent, easy, andflexible delivery; and finally, the intervention is placedin the context of a teenage cartoon drama to engageand maintain student interest and involvement over time(Schinke, Schwinn, Noia, & Cole, 2004). The evaluationof the Climate Schools: Alcohol Module revealed thatit was implemented with high fidelity and was found tobe effective in reducing average alcohol consumption,reducing frequency of binge drinking, reducing positiveexpectancies about alcohol, and reducing alcohol use-related harms up to 1 year following the intervention(Newton, Vogl, et al., 2009; Vogl et al., 2009). Despite thesuccess of this program, a number of further challengesexist for improving the scalability and broadening thescope of this model to school-based drug prevention. Thecurrent study aimed to develop a new Climate Schools:Alcohol Module which addressed and overcame theselimitations.

The first aim was to broaden the scope of the innova-tive Climate Schools alcohol model to the use of illicitdrugs and related harms. Possibly, one of the greatestchallenges in extending this platform to illicit drug useregards the acceptability of using a harm-minimization,framework given the legal issues surrounding illicit drugs.Furthermore, given the lower prevalence of use and the

greater concern regarding such drugs, it may well be thecase that some people feel that using a harm-minimizationapproach with young people is condoning the use ofdrugs, which has long been the view expressed by theproponents of the abstinence-based approach (Williams& Perry, 1998). The second aim was to foster sequentialdrug prevention by incorporating the use of boostersessions. Programs which incorporate the use of boostersessions provide young people with sequential and devel-opmentally appropriate information and have been foundto be more effective than stand-alone programs (Midford,Munro, McBride, Snow, & Ladzinski, 2002; Midford,Snow, & Lenton, 2001; Rossmanith, 2006). The final aimwas to increase the scalability of the Climate Schoolsmodel. One of the biggest challenges in school-baseddrug use prevention is to develop programs which can betaken to scale without compromising high-fidelity imple-mentation (Botvin, 2004). The Climate Schools: AlcoholModule was delivered in schools via CD-ROMS or theschool network server, making it difficult to frequentlyupdate the course material and offering no guaranteethat schools would implement the latest version. Usingthe Internet to deliver such programs can overcomethese obstacles and provide a means to continuallyupdate information with ease and ensure schools arealways using the latest version. As such, the Internetoffers a means of delivery which ensures high-fidelityimplementation.

Hence, the overall goal of the current research was todevelop a new Climate Schools Module which reinforcedthe information taught in the earlier Climate Schools: Al-cohol Module so as to transfer these skills to the use ofillicit drugs. The Climate Schools: Alcohol and CannabisModule was the first harm-minimization prevention pro-gram for illicit drugs developed to be delivered over the In-ternet. The evaluation of this program showed that the Cli-mate Schools: Alcohol and Cannabis Module, was moreeffective than drug-education-as-usual in decreasing alco-hol and cannabis use (Newton, Andrews, Teesson, & Vogl,2009; Newton, Teesson, Vogl, & Andrews, 2010). Giventhe effectiveness of this program, this paper outlines thedevelopment process used to ensure this innovative newprogram was acceptable and feasible within the schoolsystem.

There were two stages in the development of the Cli-mate Schools: Alcohol and Cannabis Module. The firststage was to ensure the intervention was based on themost current and proven health and education literature(Berkowitz & Begun, 2003; Botvin, 2004; Botvin &Griffin, 2003; Gorman, 2003; Gottfredson & Wilson,2003; Lilja, Larsson, Wilhelmsen, & Hamilton, 2003;Meyer & Cahill, 2004; Midford et al., 2002; Sussman,1991). The second stage was to collaborate with teachers,students, and health professionals in the drug use interven-tion and education fields to develop a resource which isbased on sound information and was feasible and accept-able within the classroom setting (Cahill, 2006; Midfordet al., 2002). Details of these stages are described below.

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DEVELOPING INTERNET-BASED DRUG PREVENTION 1653

STAGE 1: REVIEWING AND ADDRESSING THELITERATURE

The Climate Schools: Alcohol and Cannabis Modulewas developed to reflect effective practice in the drug-prevention literature. The main features considered in thedevelopment of the program included the interventionaims, timing, content, and delivery. Each of these is dis-cussed.

Aims of the InterventionDefining clear aims and objectives of preventive inter-ventions is important to ensure ambiguous messages arenot conveyed when implementation occurs (Dielman,1995; Moskowitz, 1989). In addition, the aims of aprogram should be culturally relevant and reflect thevalues, beliefs, and needs of the specific community athand (Anthony, 2007; Botvin & Griffin, 2003; Botvin,Schinke, Epstein, Diaz, & Botvin, 1995; Hecht & RaupKrieger, 2006; Meyer & Cahill, 2004; Midford et al.,2002). As such, the goal of the current intervention wasto develop an Internet-driven school-based preventionprogram targeting alcohol and cannabis; the two mostcommonly used drugs in Australia (Australian Institute ofHealth and Welfare, 2008). The intervention is designedto adopt a harm-minimization approach to preventionwhich falls in line with the Australian National DrugStrategy (Ministerial Council on Drug Strategy, 2006),and has been the favored approach to prevention bystudents and teachers in Australia (Midford, McBride, &Munro, 1998; Munro & Midford, 2001).

Timing of the InterventionTo achieve desired outcomes of an intervention, it is im-portant to define developmentally appropriate times to im-plement them (Berkowitz & Begun, 2003; Kellam & VanHorn, 1997; Lilja et al., 2003; McBride, 2003; Meyer &Cahill, 2004; Midford et al., 2002). Three phases duringadolescence have been identified as times when school-based drug and alcohol interventions best occur: “the in-oculations phase” (prior to initial experimentation), “theearly relevance phase” (during initial exposure), and “thelater relevance phase” (when prevalence of use is increas-ing) (McBride, 2003). The goals of an intervention differdepending on what phase is targeted. For the current in-tervention, the early relevance phase was considered themost appropriate because it reflects the time when adoles-cents begin to experiment with alcohol and cannabis andthe time when they are exposed to situations where thesedrugs may be available (Australian Institute of Health andWelfare, 2008; Gottfredson & Wilson, 2003). By interven-ing during this time, individuals are able to apply the in-formation and skills taught in the program in a meaningfulway to their own lives, and can potentially reduce the harmassociated with these drugs (Cahill, 2006; Midford et al.,2002; White & Pitts, 1998).

Research has shown that sequential and developmen-tally appropriate messages, such as booster or follow-

up sessions following the initial program are critical tomaintain positive effects of programs over time (Botvin& Griffin, 2003; Tobler et al., 2000; White & Pitts,1998). Follow-up sessions cater for changing develop-mental needs of individuals and changes in contexts ofdrug use (Shope, Copeland, Marcoux, & Kamp, 1996). Asa result, the current program was designed as the secondstage to the already established and efficacious ClimateSchools: Alcohol Module (Newton, Vogl, et al., 2009;Vogl et al., 2009), thereby acting as the next sequentialstep in drug education among this age group.

Context of the InterventionSchool provides an ideal location to implement druguse prevention programs, as it is at school where youngpeople spend a large part of their waking lives (Ennettet al., 2003; Jones, Sumnall, Burrell, McVeigh, & Bellis,2006). Placing drug-education programs within theschool environment and embedding it within a broaderhealth and personal development curriculum provides thebenefit of continuing interventions as students grow andchange (Meyer & Cahill, 2004; Midford et al., 2002).Through developing programs within such a context, thecontent of the program is designed to reflect curriculumguidelines making it easier for teachers to deliver themwithout spending more time than they would otherwise(Dusenbury & Falco, 1997). In light of the above research,the Climate School: Alcohol and Cannabis Module wasdesigned to fit within standard health curriculum. In NewSouth Wales, Australia, this is known as the PersonalHealth and Psychical Education (PDHPE) curriculum.The program was designed to address the outcomes forStage 4 of the curriculum, which caters for Years 7 and8 of high school, when students are 12–14 years of age,reflecting the time when most students are experiencinginitial exposure to alcohol and cannabis (AustralianInstitute of Health and Welfare, 2008).

Length of the Intervention. Evidence surroundingthe length of effective school-based drug education variesgreatly. What does appear consistent is that programeffectiveness increases as the number of sessions in aprogram increase (Rossmanith, 2006; Soole et al., 2005;Tobler et al., 2000; White & Pitts, 1998). Lengthy andintensive drug use-prevention programs can, however,pose the disadvantage of failing to be implemented intheir entirety due to time restrictions within the schoolenvironment where the focus is more on academic andeducational achievement rather than long-term behaviorchange (Ringwalt et al., 2003). In a review of the lit-erature, Hawks, Scott and McBride (2002) recommendteaching a greater number of sessions in the initialprogram (namely 4–10), and fewer sessions (namelythree to eight) in the follow-up program. To fit withinthese limits and to meet requirements and length of theAustralian PDHPE syllabus, it was proposed that theClimate Schools: Alcohol and Cannabis Module includesix lessons.

Content of the Intervention. There are many dif-ferent approaches that can be adopted when developing

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school-based prevention programs. The approach shownto be most effective in decreasing both alcohol andcannabis use is the social influence approach to preven-tion (Gorman, 2003; Tobler et al., 1999, 2000). Thisapproach incorporates three components, including infor-mation, normative content, and resistance-skills training.These components vary depending on whether a programhas a harm-minimization or abstinence-based goal(Cahill, 2006; McBride, 2003) and are outlined below.

The first component of the social influence approachwhich needs to be addressed is the “information” taughtin a program. The information must be developmentallyappropriate and be based on outcomes immediatelyrelevant to the students (Berkowitz & Begun, 2003;Dusenbury & Falco, 1997; Kellam & Van Horn, 1997;Lilja et al., 2003). The information must also be accurateand credible and discuss both positive and negative effectsof drug use (Cahill, 2006; Roberts et al., 2001). Theideal message of harm-minimization, is that harms canbe avoided if people avoid drugs completely (Martlett,1996). In Australian society today, abstinence is anunrealistic expectation and, as such, it is imperative thatprevention programs convey messages regarding thesocial, psychological, physical, and legal consequencesof drug use (McBride, 2003; Meyer & Cahill, 2004).

Unlike cannabis, alcohol is a legal drug in Australiaand alcohol consumption is somewhat socially acceptedas a normal part of growing up (Australian Institute ofHealth and Welfare, 2005). For this group, it is impor-tant that guidelines are provided in prevention programsto help them minimize harms related to consuming alco-hol. Published guidelines called “The Australian AlcoholGuidelines” have been developed by the Australian Na-tional Health and Medical Research Council (2001), andprovide recommendations for levels of alcohol consump-tion considered to reduce the probability of alcohol use-related short- and long-term harms. Although these guide-lines are directed at adults, they do recommend that peopleunder the age of 18 should not consume alcohol beyondthe low-risk levels set.1

The second component of the social influence approachto be addressed when developing prevention programsis “normative education.” This refers back to relating toyoung people in ways that are developmentally and imme-diately appropriate (Berkowitz & Begun, 2003). The aimof the normative component is to advocate safer choicesby teaching young people that most people their age do notuse alcohol and drugs, and the small proportion who dochoose to use, do so mainly in ways that are not high risk(Australian Institute of Health and Welfare, 2008; Cahill,2006). Research has shown that by presenting an individ-ual with accurate information regarding his/her peers’ useof alcohol and drugs, he/she is less likely to use alcoholand drugs (Hansen & Graham, 1991).

1 At the time of developing this program, “The Australian AlcoholGuidelines” were under review. New guidelines have recently been re-leased by the Australian National Health and Medical Research Council(March 6, 2009).

The final component of the social influence approachto be addressed is “resistance-skills training.” Undera harm-minimization approach, this involves teachingstudents the skills they need to resist drugs as well asthe additional skills they need to minimize related harms(McBride, 2003). To do this, students must first learn toidentify sources of pressure to use drugs, such as media,society, family, and peers (Dusenbury & Falco, 1997;Midford et al., 2002). Following this, students mustlearn the appropriate skills to resist such pressures orminimize the harms in such situations, while maintainingfriendships and social standing (Cahill, 2006). In light ofthe above literature, the content for the Climate Schools:Alcohol and Cannabis Module was developed and isoutlined in Table 1.

Implementing and Delivering the InterventionSuccessful implementation of prevention programs re-quires that all essential components are delivered correctlyand consistently (Botvin, 2004; Ennett et al., 2003). Com-puters have the benefit of providing a medium which notonly allows for consistency in delivery, but also over-comes the issue of teachers not delivering programs con-secutively and in their entirety (Bosworth, 2003). Utiliz-ing the Internet guarantees the use of up-to-date programs,which are readily modifiable by producers and most im-portantly can be taken to scale without compromising pro-gram fidelity. Programs delivered by computers and theInternet have the advantage over lengthier programs bydecreasing the time required for students to learn mate-rial (Barber, 1990; Bosworth, 2003), and offer an interac-tive delivery technique which is an essential component ofthe social influence approach to prevention (Dusenbury &Falco, 1997; Meyer & Cahill, 2004).

Importantly, computer-based programs do not requireextensive teacher training, thereby overcoming the issueof teachers feeling unfamiliar or uncomfortable with newtechniques which so often impacts on effective implemen-tation (Dusenbury & Falco, 1997). Furthermore, comput-ers are able to incorporate cartoons to create meaning-ful contexts and simulate real life situations to deliverthe core content of a program (Schinke et al., 2004). Re-search has found cartoons to be an effective medium forconveying information to teenagers because students arekept interested and enthusiastic, and are able to relate toreal life scenarios which they may encounter themselves(Ingrand, Verneau, Silvain, & Beauchant, 2004; Rule &Auge, 2005). As such, the Climate Schools: Alcohol andCannabis Module uses cartoon storylines to deliver thecore content of the program. The development of the sto-rylines for the cartoon-based lessons is outlined below.

STAGE 2: CREATING THE PROGRAM SCRIPTS ANDMANUAL

Writing of Initial ScriptsThe initial cartoon scripts comprised of six lessons cov-ering the core content described in Table 1. The scripts

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TABLE 1. Lesson content of the Climate Schools: Alcohol and Cannabis Module

Lesson Content

1 • Alcohol, the law and underage drinking• Standard drinks• Australian Guidelines for low-risk drinking limits• Identifying the number of standard drinks in alcoholic beverages• Prevalence and patterns of alcohol use among 14–15-year olds• Acute harms/consequences associated with alcohol use

2 • Alcohol, the law and underage drinking• Identifying reasons why teenagers choose to drink or not to• Alcohol-free activities• Acute and chronic harms/consequences of drinking alcohol• Identifying the potential for risk and harm in common teenage drinking scenarios• Exploring ways to prevent alcohol-related harm in common teenage drinking scenarios, e.g., tips to keep people who were

drinking too much alcohol safe, and ways to minimize alcohol consumption• Drug refusal skills

3 • Australian Guidelines for low-risk drinking limits• Acute and chronic harms/consequences of drinking alcohol• What is cannabis?• Prevalence and patterns of cannabis use among 14–16 year olds• Identifying reasons why teens choose to or choose not to use cannabis• Acute harms/consequences of using cannabis on health and well-being• Varying effects of cannabis from person to person

4 • Cannabis and the law• Economic consequences of using cannabis• Acute and chronic harms/consequences of using cannabis on health and well-being• Varying effects of cannabis from person to person• Recognizing problems associated with cannabis use• Teaching and responding to risk and harm in common teenage scenarios• Tips to keep people who are using cannabis safe

5 • Acute and chronic harms/consequences of cannabis on health and well-being• Relationship between cannabis use and mental illness• Identifying reasons why people choose to or choose not to use cannabis• Recognizing problems associated with cannabis use• Seeking help

6 • Dealing and coping with challenging situations• Effects of other people’s drug use• Recognizing and responding to risk and harms of cannabis• Tips to help friends reduce or cease using cannabis• Alternatives to using cannabis• Identifying when to seek help• Identifying where to seek help, e.g., resources and support agencies for teenagers using cannabis (both at school and in the

community)

provided students with information and skills through thecontext of a teenage drama where a number of youngpeople experiment with alcohol and cannabis. The scriptswere written in a way that would appeal to young peo-ple initially using feedback and suggestions received fromthe development of the original Climate Schools: AlcoholModule.

Review of Scripts by Specialists in Drug and AlcoholFieldsThe involvement of teachers and students is essential inthe development of school-based drug prevention pro-grams (Cahill, 2006; Dusenbury & Falco, 1995; Midfordet al., 2002; Tobler et al., 2000; Tobler & Stratton, 1997).Keeping in line with this, a number of health professionals

in the drug and alcohol research and clinical fields wereapproached to review the information and content of theinitial scripts. A total of nine specialists with knowledgein prevention and treatment of substance-use disordersagreed to review the scripts. Seven were recruited from theNational Drug and Alcohol Research Centre (NDARC),one from the Clinical Research Unit for Anxiety and De-pression (CRUfAD) at St Vincent’s Hospital, and onefrom the Children and Adolescents Mental Health Unitat Northern Sydney Central Coast Area Health Service.All health professionals who reviewed the initial scriptsagreed that the vast majority of the content was accurateand correct in accordance with the most current research.Any information that was queried was checked with theliterature and changed accordingly. Minor changes to the

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language in terms of words used to describe alcohol andcannabis use were changed to ensure it reflected that ofyoung people today.

COLLABORATION WITH STUDENTS

Recruitment & ParticipationTo ensure the scripts were acceptable and age-appropriate,five teenagers (60% male) aged between 13 and 16 yearswere recruited through staff members at NDARC. Threeparticipants attended Catholic schools and two attendedIndependent schools. Written informed consent was ob-tained from each student prior to completing the question-naire.

MeasuresThe questionnaire was a mixed quantitative–qualitativescale that covered student demographics, comments, andrecommendations concerning the content and language ofthe lessons, acceptability and realism of the stories, anddelivery of the program. Response options were on a five-point Likert scale ranging from “Strongly Disagree” to“Strongly Agree.” They were then asked to write downany suggested changes to the stories and to give an overallrating of the program on a five-point Likert scale rangingfrom “Excellent” to “Terrible.”

ProcedureTwo lessons of the initial scripts along with the question-naire were sent to the students once they agreed to partici-pate. Students were asked to read the scripts and write anyfeedback or suggestions for improvement on the scripts asthey read. It was explained to students that the scripts hadbeen developed for young people in Year 8 (12–14 yearsof age), and it was their role to assess whether they thoughtthe scripts correctly reflected the language and scenariosof people of that age. Once they had read the scripts, stu-dents were asked to complete the questionnaire and returnit with the scripts in a reply paid envelope. Upon com-pletion of the questionnaire, students were sent a movievoucher as compensation for their time.

ResultsInformation obtained from the questionnaires and writ-ten feedback on the scripts were combined to summa-rize students’ responses to the development of the ClimateSchools: Alcohol and Cannabis Module.

Content of the Lessons. The majority of studentsagreed that the content in the scripts is age-appropriate.However, participants were undecided about whether ornot Year 8 students would be challenged by the lessonsand whether they would be able to completely compre-hend and understand the information.

Characters in the Lessons. Although students pro-vided mixed responses about the likability of the charac-ters in the scripts, all the written feedback was positive,such as “The characters seem quite realistic and I proba-bly wouldn’t change them.”

Relating to the Storyline. The majority of participantsindicated they were happy with the storylines and did notrecommend changing them. They reported that studentsin their age group would be able to relate to them well.The only comments relating to the appropriateness of thestoryline concerned the amount of drug use and numberof parties in the scripts, such as “Students should be ableto relate but the story was a bit too bang, bang, bang.”

Language Acceptability. In terms of language, partic-ipants commented on changing specific words and phrasesand overall making the scripts sound more “cool,” and less“full-on” when referring to drug use and terminology.

Delivery and Navigation of Program. Students wereundecided about whether or not they would have troublenavigating the program, but when asked if the programcould be changed to make delivery more efficient, the onlyresponses were “no” and “no, I don’t think so.”

Summary of Collaboration with Students. The over-all rating of the program by Year 8 students was pos-itive with no participant rating the program negatively.The majority (80%) rated the program as “good,” andthe remainder (20%) rated the program as “average.”Students’ main concerns related to the age appropriate-ness of the scripts. Specifically, they thought the drug useand terminology was too intense at times and should beabridged. They were also concerned about how well peo-ple their age would be able to understand the informationand thought some of the concepts may be too difficult tocomprehend. Finally, participants were concerned aboutthe number of parties and events throughout the scripts,stating that the behavior was not a very realistic reflectionof their age group and therefore should be reduced.

FOCUS GROUPS WITH TEACHERS

RecruitmentLetters outlining the aims of the developmental phase ofthe study were sent to Heads of PDHPE departments atschools where NDARC had previously established col-laborative links. The letter provided information on whatwould be required of the teachers if they agreed to par-ticipate. They were advised that interviews could be con-ducted individually or in groups at their school and thateach teacher involved would be reimbursed $50 for theirtime.

ParticipantsTen teachers from three schools in Sydney agreed to be in-volved in the development process of the Climate Schools:Alcohol and Cannabis Module. Teachers ranged in agefrom 21 to 47 years (mean = 32.1 years of age) and 60%were female. Two teachers were recruited from Catholicschools, two from Catholic/independent schools, and sixfrom government schools. The majority (70%) taughtin single-sex schools and 30% taught in co-educationalschools. Teaching experience ranged from 1 to 24 yearswith the average teaching experience being 8.9 years.

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DEVELOPING INTERNET-BASED DRUG PREVENTION 1657

TABLE 2. Percentage of teachers who indicated that the program adequately addressed the following components

Component Lesson 1 Lesson 2 Lesson 3 Lesson 4 Lesson 5 Lesson 6

Acceptability for students to relate to the story 90% 90% 80% 90% 90% 100%Educational content 90% 100% 100% 100% 90% 80%Learning: Understanding and remembering concepts 90% 90% 80% 90% 90% 90%Length of lessons to adequately cover concepts 90% 80% 100% 90% 90% 90%Language acceptability for students 90% 90% 90% 90% 90% 90%Language and story acceptability for teachers and schools 90% 100% 90% 90% 90% 90%

MeasuresThe questionnaire covered teacher demographics, curricu-lum requirements, acceptability and relevance of programcharacteristics, effectiveness of the program, attitudes to-ward a harm-minimization approach, and implementationand delivery of the program.

Demographics. Teachers were asked to indicate theirage, gender, teaching experience, school type, and schoolcomposition.

Curriculum Requirements. Teachers were asked torate on a five-point Likert scale how well they thought theprogram fitted with the Year 7–10 PDHPE curriculum forYear 8 students, with one indicating “extremely well” andfive indicating “not at all well.” Teachers were also askedto suggest any alterations to make the program better fitthe curriculum.

Program Characteristics. For each lesson, teacherswere asked to indicate “yes” or “no” as to whetheror not the scripts appropriately addressed the follow-ing domains; “student’s perceived ability to relate to thestoryline,” “educational content,” “learning and under-standing,” “length of the lessons,” and “acceptability ofthe language” for the students and teachers. They werealso asked to write down any additional comments con-cerning these domains for each lesson.

Harm-Minimization, Approach. Teachers were askedto indicate on a five-point Likert scale how effective theythought the program would be in getting students to mini-mize their use of alcohol and cannabis and adopt strategiesto reduce related harms. On the scale, one represented “ex-tremely well” and five represented “not at all well.” Teach-ers were also asked to indicate on a five-point Likert scalehow acceptable they felt a harm-minimization, approachto prevention was, with one indicating “extremely accept-able” and five indicating “not at all acceptable.” Finally,they were asked to provide further comments and suggestalternative approaches if they wished.

Implementation. Teachers were asked to indicate“yes,” “no,” or “undecided” as to whether or not they couldforesee any problems with the implementation of the pro-gram and to suggest alternatives to overcome any foresee-able obstacles.

Practicality. Teachers were asked to indicate “yes,”“no,” or “undecided” as to the practicality of the programand if they believed teachers would need further trainingto implement the program. Finally, teachers were askedto indicate on the availability of computer and technology

resources at their school and to comment on any issuesthat may impede program delivery.

Summary of Teacher Focus GroupsTo summarize the results from the teacher focus groups,responses were grouped into the main features involved indeveloping school-based preventive interventions. Theseare the aims, timing, content, and delivery of the program.

AimsTable 2 shows the percentage of teachers who indi-cated that the program was adequately addressed witheach component measured. The overall rating of the pro-gram by PDHPE teachers was extremely positive with noteacher rating the program negatively. Teachers were veryaccepting of the harm-minimization approach to preven-tion and believed it would be an effective way to reduceharms and risks involved with alcohol and cannabis use.That is, teachers found a harm-minimization approach tobe also acceptable for the prevention of illicit drug useamong young people. This is consistent with the litera-ture which states that the adoption of a harm-minimizationgoal, as opposed to an abstinence goal, is the favored andrecommended approach to prevention in Australia (Mid-ford et al., 1998; Ministerial Council on Drug Strategy,2006; Munro & Midford, 2001).

TimingThe Climate Schools: Alcohol and Cannabis Module wasdeigned to be implemented within Stage 4 of the PDHPEcurriculum for NSW. This stage caters for Years 7 and 8 ofhigh school when students are 12–14 years of age. Whenasked to comment on the relevance of the program to thePDHPE syllabus, the vast majority of teachers thought thecontent of the program fitted extremely well to Stage 4 ofthe syllabus. The only concern raised related to the agegroup being targeted. Some teachers stated they wouldprefer to see the program implemented in Stage 5 of thesyllabus rather than Stage 4.

This was considered; however, after further discussionwith health and education professionals, it was decidedStage 4 of the PDHPE syllabus was the correct stageto implement the program as the overall aim was to in-tervene with students’ knowledge and attitudes prior toharmful exposure of these drugs. Stage 4 coincides withthe time when adolescents are first starting to experi-ment with alcohol and cannabis and are exposed to sit-uations where these drugs may be available (Australian

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TABLE 3. Concerns and changes regarding timing (context and length) of the program

Concerns with original script Changes made to scripts

Age appropriateness of scripts: Some of the scenarios relating tosex and driving were thought to be more suitable for older agegroup (Stage 5 of the PDHPE syllabus)

⇒ The harder drug use and sexual references were omitted to makethe scripts more relevant for a younger audience and fit withinStage 4 of the PDHPE syllabus

Teachers and students felt the language and use of strong wordswas too intense and overwhelming at times

⇒ Complicated language was replaced with simplified language,and colloquial words used by young people

Students felt the language was not “cool” enough for Year 8students

⇒ The language was changed to reflect that of young people andstudents’ own words were inserted into the scripts wherepossible

Learning reinforcement: Teachers felt that reinforcement of thecore content would be useful

⇒ Questions were added at the end of each lesson to reinforce theinformation taught in the cartoons and previous lessons weresummarized at the beginning of new lessons

Institute of Health and Welfare, 2008; Gottfredson & Wil-son, 2003). Further, Stage 4 corresponds with the “earlyrelevance phase” of prevention which has been identifiedas having the greatest impact and meaning on drug useand behavior (Hawks et al., 2002; McBride, 2003).

In terms of the length of lessons, the vast majority ofteachers thought the lessons were long enough to ade-quately cover the concepts being taught. There were a cou-ple of suggestions including making some of the more dif-ficult lessons longer and possibly covering them over twolessons to give students more time to process the informa-tion. The intensity of information flow has been attenuated(see Tables 3 and 4).

ContentThe majority of teachers thought students would be ableto relate to the stories and events through the scripts. Theonly concern was that some of the scenarios would bemore suited to older adolescents, e.g., those covering sexand driving, as some students were too young to relateto these. As effective drug education program relies onteaching developmentally appropriate information whichis immediately relevant to students, these scenarios have

been revised to better relate to a younger age group (seeTables 3 and 4) (Berkowitz & Begun, 2003; Dusenbury& Falco, 1997; Kellam & Van Horn, 1997; Lilja et al.,2003).

The vast majority of teachers thought the language inthe scripts was suitable and comprehensible for Year 8students and they were not concerned about teachers orschools having a problem with the language used in thescripts. Some teachers did, however, feel that showing pic-tures of cannabis use would be deemed unacceptable bytheir school. They were concerned that explicit images ofdrug use may be perceived as encouraging the acceptabil-ity of use. As cannabis is an illegal drug in Australia, thisconcern was addressed by removing any explicit imageof cannabis (see Tables 3 and 4). Most teachers believedthe educational content of the program was adequate andwould be understood by Year 8 students. There were mi-nor concerns relating to some of the terminology and fac-tual information which some teachers felt could be toodifficult for students to thoroughly understand. Teacherswere also concerned that too much information was beingtaught in too much depth. This issue has been addressedand revised (see Tables 3 and 4).

TABLE 4. Concerns and changes regarding content of the program

Concerns with original script Changes made to scripts

Students felt there were too many events and parties throughoutthe scripts and stated this was not realistic of their age group

⇒ The number of parties and events throughout the scripts werereduced, and more of the scenes were set in school to increaserelevance to the target group

Teachers felt more emphasis on the negative effects of drug usewas needed to target males, e.g., fatality and impacts on sportrather than on relationships

⇒ The scripts were changed to reflect more negative and intenseconsequences of drugs in hopes of impacting on male’sbehavior

Drug use and explicit images of cannabis and bongs were viewedas unacceptable to schools

⇒ Scripts were changed to infer drug use rather than explicitlyshow it

Teachers felt there needed to be more emphasis on the long-termeffects of drug use and how it can be common to have manyattempts at quitting before successful

⇒ Scripts were changed to explore the issue of dependence morethoroughly and on how difficult it can be to stop using drugs

Students and teachers felt scenarios should have girls drinking“breezers” or “alco-pops” rather than beers

⇒ Changes were made to the party scenes so that girls weredrinking alco-pops (the most common alcoholic drink amongthat age group)

Teachers and students felt there was too much complicated andfactual information used when referring to alcohol andcannabis terminology and use

⇒ Technical information was cut down where possible so as not tooverload the students

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DEVELOPING INTERNET-BASED DRUG PREVENTION 1659

Implementation and DeliveryThe majority of teachers enjoyed the interactive and noveldelivery of the program and agreed that students wouldfind this a stimulating and exciting way to learn. Someteachers raised concern about using the Internet to imple-ment the program and stated that the availability of com-puters at their school was limited. Teachers suggested thatit may be easier if students could view the cartoons as awhole class on a projector, or as a DVD.

One of the main strengths and advantages of the Cli-mate Schools: Alcohol and Cannabis Module is that itis delivered via the Internet, thereby overcoming the ob-stacles to school-based drug education regarding imple-mentation. The core content of the program is designedto be delivered through a cartoon story over the Inter-net which has the benefit of not only requiring minimumteacher training but it also maintains students interest andassures implementation fidelity (Bosworth, 2003; Ingrandet al., 2004; Schinke et al., 2004). Furthermore, the Inter-net guarantees consistent and complete delivery and en-sures that the most up-to-date program is delivered at anyone time. It allows for programs to be delivered to scaleswithout compromising program fidelity. Internet deliveryovercomes the risk of teachers adapting or changing pro-grams to meet the needs of their classes (Bosworth, 2003).Adaptation can be extremely detrimental to a program asnot only can it inadvertently remove the essential compo-nents of a program, but also it may add components whichcan detract from the efficacy of the program (Ennett et al.,2003; Ringwalt et al., 2003). As such, the delivery of thecore content by a teacher using a projector or DVD wasnot seen as a feasible option for implementing this pro-gram and this would allow for greater risk of compromisedpoor implementation.

REVISING THE SCRIPTS

From the feedback provided by professionals in the drugand alcohol field, as well as PDHPE teachers and youngpeople, many changes were made to the initial scripts.These changes can be grouped into two of the mainfeatures involved in developing school-based prevention:timing and content. A summary of these changes are pre-sented in (see Tables 3 and 4).

CREATING THE PROGRAM MANUAL AND STUDENTACTIVITIES

Once changes were made to the scripts, they were sent tothe graphic designers to illustrate. Following this, the nextstep was to develop the program manual to accompany thecomputer-driven cartoons. The aim was to develop a man-ual which would facilitate high-quality implementationof the program and consistent delivery among teachers.Factors taken into account when developing the manualreflected the literature of common obstacles to effectiveimplementation of programs including catering for a lackof teacher training and time to prepare activities (Ennettet al., 2003; Ringwalt et al., 2003). By providing teach-

ers with brief information sheets containing up-to-date in-formation as well as predesigned activities, the prepara-tion time required is minimal. Further, to appeal to bothschools and educators, the manual was made to look com-mercially attractive and easy to navigate. The informationcontent of the manual was devised from the most currentliterature on the prevalence of alcohol and cannabis use,patterns of use, and associated harms and consequencesof use. A number of existing prevention programs werereviewed and ideas provided for student activities whichwere included in the manual.

For each lesson, the manual included three compo-nents: (1) teacher summaries with current facts and statis-tics about alcohol misuse and cannabis use, (2) studentlesson summaries for students to stick in their note booksor to act as extra information, and (3) a range of relevantlesson activities to reinforce the core information coveredin the cartoons. A program outline which includes linksto the PDHPE syllabus was also provided to teachers foreach lesson.

EVALUATION OF CLIMATE SCHOOLS: ALCOHOLAND CANNABIS MODULE

To establish the efficacy, a cluster randomized controlledtrial (RCT) has been conducted with 10 schools (n = 764)in Sydney, Australia. Results from the trial have been pub-lished and demonstrate the course to be effective in in-creasing alcohol and cannabis knowledge, and decreasingthe use of these drugs up to 12 months following the in-tervention (Newton, Andrews, et al., 2009; Newton, et al.,2010). All teachers involved in the trial reported imple-menting the program in its entirety, thereby providing evi-dence that the collaborative program development and useof the Internet was able to produce a program that wasreadily implemented with high fidelity.

DISCUSSION

The aim of the current paper was to describe the forma-tive research and process of planning that formed the de-velopment of the Climate Schools: Alcohol and CannabisModule. The program was developed to address the needfor sequential and developmentally appropriate drug useprevention, building on the earlier Climate Schools: Al-cohol Module. The new Climate Schools: Alcohol andCannabis Module was developed to target the most com-monly used licit and illicit drugs used by young peoplein Australia (Australian Institute of Health and Welfare,2008). The Climate Schools: Alcohol and Cannabis Mod-ule was designed as an evidence-based prevention pro-gram which would overcome the obstacles to the imple-mentation of drug use prevention programs, improve thescalability of drug use prevention programs, and extendthe harm-minimization framework to the prevention of il-licit drugs in school (Botvin & Griffin, 2003; Tobler et al.,2000; White & Pitts, 1998). As such, the module incor-porates a social influence approach to prevention, adopts

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1660 N. C. NEWTON ET AL.

a harm-minimization goal which is accepted by teachersand students, and is consistent with the Australian Na-tional Drug Strategy (Ministerial Council on Drug Strat-egy, 2006), and is delivered over the Internet ensuringhigh-fidelity implementation.

The program was developed in collaboration withteachers, students, and specialists in the drug user treat-ment and prevention field to ensure its integrity and ease ofimplementation into school settings (Cahill, 2006; Dusen-bury & Falco, 1997; Ennett et al., 2003; McBride, 2003;Meyer & Cahill, 2004; Midford et al., 2002). The corecontent of the program was designed to be delivered overthe Internet, thereby having the advantage of an interac-tive delivery technique which requires minimal teachertraining (Barber, 1990; Bosworth, 2003). A limitation ofthe current study involves the small number of youthwho vetted the cartoon scripts and provided feedback.Although only five students were interviewed, the ini-tial scripts were based on feedback and suggestions fromyouth who were involved in developing the original Cli-mate Schools: Alcohol Module. This feedback helped towrite the scripts in a way that appealed to young peo-ple using scenarios experienced by people in this agegroup.

Overall, the Climate Schools: Alcohol and CannabisCourse program represents a novel and innovative ap-proach to drug prevention that is acceptable, easy to im-plement, fits within the school syllabus, and is scalableto meet the needs of all schools in Australia. This studyprovides support for the use of Internet-based universalinterventions, which require minimal teacher training, inpreventing substance use among adolescents.

Declaration of Interest

The authors report no conflicts of interest. The authorsalone are responsible for the content and writing of thearticle.

RESUME

Developper les ecoles Climat: L’alcool et le module decannabis: Une reduction des mefaits, programmeuniversel de prevention des drogues facilitee parl’Internet

Les ecoles Climat: L’alcool et le module de cannabis estun systeme universel de reduction des prejudices pro-gramme scolaire de prevention pour les adolescents agesde 13–15 ans. Le contenu de base du programme estlivre sur Internet en utilisant storylines bande dessineed’engager les eleves, l’enseignant et les activites axeesrenforcer l’information de base. Le programme est integredans le programme de sante scolaire et est facile a mettreen œuvre la formation des enseignants minimale requise.Le programme a ete elabore en 2007 grace a une collab-oration approfondie avec les enseignants, les etudiants etles professionnels de la sante (N = 24) a Sydney, en Aus-

tralie et a depuis ete evalues (N = 764). Cet article decrit larecherche formative et processus de planification qui ontforme l’elaboration du programme et la base de preuvesqui sous-tend la demarche.

RESUMEN

El desarrollo de la Climatico Escuelas: El alcohol y elmodulo de cannabis: una reduccion al mınimo deldano, el programa de prevencion universal demedicamentos facilitados por la Internet.

El clima Escuelas: El alcohol y el cannabis es un modulouniversal de minimizacion de danos programa de pre-vencion escolar para adolescentes de 13–15 anos. El con-tenido basico del programa es emitido a traves de In-ternet utilizando historias de dibujos animados para in-volucrar a los estudiantes, y la actividades impulsadaspor el profesor reforzar la informacion basica. El pro-grama esta integrado dentro del programa de salud esco-lar y es facil de implementar con la formacion del profe-sorado mınimo requerido. El programa fue desarrolladoen 2007 a traves de una amplia colaboracion con los pro-fesores, estudiantes y profesionales de la salud (N = 24)en Sydney, Australia y desde entonces ha sido evaluada(N = 764). Este artıculo describe la investigacion forma-tiva y el proceso de planificacion que se formo el desar-rollo del programa y la base de pruebas que sustentan elenfoque.

THE AUTHORSDr. Nicola Newton hasbeen working since 2006at the National Drug andAlcohol Research Centre atthe University of New SouthWales in Sydney, Australia.In 2009, she completed herPh.D. degree and was awarded apostdoctoral research fellowship.Her postdoctorate work involvescombining effective universaland indicated approachesto drug prevention aiming

to maximize prevention outcomes for both low- and high-riskstudents. This work is being carried out as a collaborative researchproject between NDARC and the Kings College London, whereNicola is currently based. Nicola’s research focuses primarilyon developing and evaluating innovative programs to minimizealcohol and drug use in adolescents. She was worked extensivelyon the CLIMATE Schools series for drug prevention which areuniversal Internet-based programs delivered in high school.She is currently adapting and piloting the CLIMATE Schoolsprograms for use in the UK. Prior to embarking on her Ph.D.,Nicola worked as a Research Officer at the Clinical ResearchUnit for Anxiety and Depression at St Vincent’s Hospital.Her research interests include adolescent mental health, and

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DEVELOPING INTERNET-BASED DRUG PREVENTION 1661

Internet-based prevention and early intervention for substanceuse.

Dr. Laura Vogl is a ResearchFellow at the National Drugand Alcohol Research Centre(NDARC) at the University ofNew South Wales. In her workat NDARC, Laura has developedand evaluated a numberof effective computerizedschool-based programs for theprevention of alcohol misuse,cannabis, and psychostimulantuse. Laura has a particularinterest in the differential

effectiveness of prevention programs for males and females. Sheis also particularly interested on the impact of parental supplyon the progression of adolescent alcohol use, and is a ChiefInvestigator on an Australian Research Council Discovery grantinvestigating this issue. Laura is a Chief Investigator on a projectexamining the differential gender effects on the uptake of ecstasyuse in adolescents and adulthood. Laura has extensive experienceas a Clinical Psychologist in the area of general adolescent andadult mental health. Her research interests include the preventionof mental health problems and adolescent mental health issues.

Prof. Maree Teesson graduatedwith a Ph.D. degree from theSchool of Psychiatry, Universityof New South Wales in 1996under Prof. Gavin Andrews. Shewas the Director of Research inthe innovative Inner City MentalHealth Services, Sydney beforetaking the role of Lecturer atNDARC in 1997. She wasDeputy Director of the Centrefrom 2002 to 2008. NDARC hasover 100 academic, research,

and administrative staff and an international reputation for drugand alcohol research. In 2008, she was awarded a prestigiousNHMRC Senior Research Fellowship. During the past 11 years,she has made a major contribution to Australia’s health andmedical research effort in the field of mental health and drug andalcohol. In particular, she is known nationally and internationallyfor her research on the comorbidity between mental disorders anddrug and alcohol disorders. She has also been a key contributorin developing new approaches to the measurement and treatmentof drug and alcohol problems and the evaluation of health servicedelivery. She has a strong track record of winning competitivescientific grant funding and has published more than 150 papers,reports, and books. In addition to her position as Acting Directorof NDARC, she holds an honorary appointment with the HealthServices Research Group, Institute of Psychiatry, London. Shemaintains a strong link with treatment services and is a foundingmember (since 1990) of the Mental Health Services Conference,Inc, the largest mental health services conference in Australia.

Professor Gavin Andrewsis Director of the ClinicalResearch Unit for Anxietyand Depression at St Vincent’sHospital, University of NewSouth Wales. During hiscareer, he has made significantcontribution to the preventionand treatment of mental healthproblems in Australia. He wasthe pioneer for computer-basedmental health treatment andprevention in Australia, proving

the success of such approaches in over 10 large clinical trials (seewww.crufad.org).

GLOSSARY

Harm minimization: Policies designed to reduce the harm-ful consequences associated with recreational drug useand other high-risk activities.

School-based prevention: Programs that are carried out inany grade of school, kindergarten through 12th grade,and run by staff members or school-designated personsor organizations.

Substance misuse: Illegal or illicit drug taking that leadsa person to experience social, psychological, physical,or legal problems related to intoxication or regular ex-cessive consumption and/or dependence.

Universal drug prevention: Preventive interventions de-livered to a whole population regardless of their levelof risk to prevent the onset of a substance-related prob-lem by preventing initiation of use.

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