Class of 2010 Abstract / OBJECTIVES: To examine the effect of a current elementary school drug education program, Too Good for Drugs, on children’s views about drugs. METHODS: This was a descriptive, prospective study using pre- and post-test methodology. Participants were given a survey prior to the initiation of a drug education program, Too Good for Drugs. One month after the completion of the drug education program the same survey was given to the participants to see if their views and overall knowledge had changed. RESULTS: The overall knowledge of the groups increased from baseline (p=0.004). Participants in the fourth-grade group had a greater difference in drug knowledge from baseline than fifth-graders (p=0.008 vs. 0.01, respectively). The fourth-grade cohort had increased healthy attitudes about alcohol (p=0.007). Both groups had healthier views on marijuana (4th p=0.007 5th p=0.03) post- intervention. CONCLUSIONS: The Too Good for Drugs curriculum is effective at improving the views about drugs among the participants. Views on alcohol and marijuana improved. Participants in the program may be better served if there were an over-the-counter and prescription drug component.

PhD / When the problem of young people using illegal drugs for recreation emerged in New South Wales in the 1960s drug education was promoted by governments and experts as a humane alternative to policing. It developed during the 1970s and 1980s as the main hope for preventing drug problems amongst young people in the future. By the 1990s drug policy experts, like their temperance forbears, had become disillusioned with drug education, turning to legislative action for the prevention of alcohol and other drug problems. However, politicians and the community still believed that education was the best solution. Education Departments, reluctant to expose schools to public controversy, met minimal requirements. This thesis examines the ideas about drugs, education and youth that influenced the construction and implementation of policies about drug education in New South Wales between 1965 and 1999. It also explores the processes that resulted in the defining of drug problems and beliefs about solutions, identifying their contribution to policy and the way in which this policy was implemented. The thesis argues that the development of drug education over the last fifty years has been marked by three main cycles of moral panic about youth drug use. It finds that each panic was triggered by the discovery of the use of a new illegal substance by a youth subculture. Panics continued, however, because of the tension between two competing notions of young people’s drug use. In the traditional dominant view ‘drug’ meant illegal drugs, young people’s recreational drug use was considered to be qualitatively different to that of adults, and illegal drugs were the most serious and concerning problem. In the newer alternative ‘public health’ view which began developing in the 1960s, illicit drug use was constructed as part of normal experimentation, alcohol, tobacco and prescribed medicines were all drugs, and those who developed problems with their use were sick, not bad. These public health principles were formulated in policy documents on many occasions. The cycles of drug panic were often an expression of anxiety about the new approach and they had the effect of reasserting the dominant view. The thesis also finds that the most significant difference between the two discourses lies in the way that alcohol is defined, either as a relatively harmless beverage or as a drug that is a major cause of harm. Public health experts have concluded that alcohol poses a much greater threat to the health and safety of young people than illegal drugs. However, parents, many politicians and members of the general community have believed for the last fifty years that alcohol is relatively safe. Successive governments have been influenced by the economic power of the alcohol industry to support the latter view. Thus the role of alcohol and its importance to the economy in Australian society is a significant hindrance in reconciling opposing views of the drug problem and developing effective drug education. The thesis concludes that well justified drug education programs have not been implemented fully because the rational approaches to drug education developed by experts have not been supported by the dominant discourse about the drug problem. Politicians have used drug education as a populist strategy to placate fear but the actual programs that have been developed attempt to inform young people and the community about the harms and benefits of all drugs. When young people take up the use of a new mood altering drug, the rational approach developed by public health experts provokes intense anxiety in the community and the idea that legal substances such as alcohol, tobacco and prescribed drugs can cause serious harm to young people is rejected in favour of an approach that emphasizes the danger of illegal drug use.

PhD / When the problem of young people using illegal drugs for recreation emerged in New South Wales in the 1960s drug education was promoted by governments and experts as a humane alternative to policing. It developed during the 1970s and 1980s as the main hope for preventing drug problems amongst young people in the future. By the 1990s drug policy experts, like their temperance forbears, had become disillusioned with drug education, turning to legislative action for the prevention of alcohol and other drug problems. However, politicians and the community still believed that education was the best solution. Education Departments, reluctant to expose schools to public controversy, met minimal requirements. This thesis examines the ideas about drugs, education and youth that influenced the construction and implementation of policies about drug education in New South Wales between 1965 and 1999. It also explores the processes that resulted in the defining of drug problems and beliefs about solutions, identifying their contribution to policy and the way in which this policy was implemented. The thesis argues that the development of drug education over the last fifty years has been marked by three main cycles of moral panic about youth drug use. It finds that each panic was triggered by the discovery of the use of a new illegal substance by a youth subculture. Panics continued, however, because of the tension between two competing notions of young people’s drug use. In the traditional dominant view ‘drug’ meant illegal drugs, young people’s recreational drug use was considered to be qualitatively different to that of adults, and illegal drugs were the most serious and concerning problem. In the newer alternative ‘public health’ view which began developing in the 1960s, illicit drug use was constructed as part of normal experimentation, alcohol, tobacco and prescribed medicines were all drugs, and those who developed problems with their use were sick, not bad. These public health principles were formulated in policy documents on many occasions. The cycles of drug panic were often an expression of anxiety about the new approach and they had the effect of reasserting the dominant view. The thesis also finds that the most significant difference between the two discourses lies in the way that alcohol is defined, either as a relatively harmless beverage or as a drug that is a major cause of harm. Public health experts have concluded that alcohol poses a much greater threat to the health and safety of young people than illegal drugs. However, parents, many politicians and members of the general community have believed for the last fifty years that alcohol is relatively safe. Successive governments have been influenced by the economic power of the alcohol industry to support the latter view. Thus the role of alcohol and its importance to the economy in Australian society is a significant hindrance in reconciling opposing views of the drug problem and developing effective drug education. The thesis concludes that well justified drug education programs have not been implemented fully because the rational approaches to drug education developed by experts have not been supported by the dominant discourse about the drug problem. Politicians have used drug education as a populist strategy to placate fear but the actual programs that have been developed attempt to inform young people and the community about the harms and benefits of all drugs. When young people take up the use of a new mood altering drug, the rational approach developed by public health experts provokes intense anxiety in the community and the idea that legal substances such as alcohol, tobacco and prescribed drugs can cause serious harm to young people is rejected in favour of an approach that emphasizes the danger of illegal drug use.

No description available.

Parents play a central role in their children's education and social development and therefore can be extremely influential in children's attitudes, decisions and behaviour towards drugs. Despite this, there has been limited research to date which explores the parents' perspective and their needs in the area of drug education. This thesis reports on research which surveyed 92 parents of secondary students (Years 7-10) across ten secondary schools in the Australian Capital Territory. Two follow up focus group sessions, involving fourteen parents of secondary students, were also conducted with self-nominated parents of these respondents. The issues explored in the research include parents' concerns and knowledge of young people and drug issues, and their needs for a drug education program aimed at parents. The results show that parents see their role in drug education as a central one and are concerned about drugs in relation to their children and other young people. They are largely unaware of school drug policies and school drug education programs and want to work in closer partnership with the school and community in educating their children about drug issues. Parents identified a need for accurate and up to date information as they do not have sufficient knowledge in this area. Parents also identified a need to develop skills in dealing with adolescents and drug issues. This study provides insight into a range of parents' views on drug issues and confirms that parents would like to develop both knowledge and skills in order to support young people and reinforce school drug education programs. A number of implications of the results for the involvement of parents in drug education programs are presented, including: parent needs, strategies for delivery/ implementation and motivating factors for encouraging parental participation in such programs.

Denna kvalitativa studie undersöker erfarenheter och upplevelser kring ANDT undervisning hos skolpersonal. Vidare skildrar studien svårigheter respektive möjligheter som skolpersonal upplever i samband med undervisningen. Studien genomfördes med en kvalitativ ansats utifrån en hermeneutisk forskningstradition och resultatet grundas på sex semistrukturerade intervjuer. Resultatet har tolkats utifrån Antonovsky´s salutogena synsätt och det centrala begreppet KASAM samt Björklunds tolkning av KASAM i ett skolperspektiv utifrån komponenterna begriplighet, hanterbarhet och meningsfullhet. Resultatet indikerar på att ANDT undervisning bedrivs på samtliga skolor men med varierande upplägg. Det framgår även av resultatet att lärare anser att interaktionen mellan eleverna är en betydelsefull komponent i undervisningen. En slutsats är att hade inte lärare upplevt den tidsbrist som förekommer inom deras yrke hade utveckling av ANDT undervisning haft möjlighet att bli mer omfattande. Detta genom att exempelvis skapa ett bättre samarbete mellan olika aktörer, mer involvering av föräldrar samt en mer ämnesövergripande undervisning.

The long-term regular use of tobacco and hazardous alcohol use are responsible for significant mortality and morbidity as well as social and economic harm in Australia each year. There is necessary the more cost-efficient primary prevention strategies are equally, if not more important. Youth have been identified as an important primary prevention target group in public health initiatives designed to reduce drug-related harm. Strengthening parents' capacity to reduce children's risk of alcohol, tobacco and other drug-related harm is also recognised as an important strategy. The first chapter of this thesis introduces this public health issue, provides a summary of the present state of play regarding parent-training intervention research, and presents the research hypotheses. A comprehensive review of the epidemiological, empirical, and theoretical literature pertaining to this research is presented in Chapter 2. Recreational alcohol, tobacco and other drug (ATOD) use results in some 23 000 deaths (representing around 18% of all deaths) and the premature loss of some 160 000 person-years of life each year in Australia. The social consequences have been estimated to cost the Australian community almost $19 billion annually. The prevalence of young people in these data is also cause for concern. In Western Australia (WA), nearly one third of the alcohol-related deaths in the period 1993-1995 occurred in people aged less than 25 years. In 1995 in WA, alcohol use was responsible for almost two thirds of all drug-related deaths in those aged 15-34 years. Furthermore, road crashes accounted for almost half (45%) of the deaths among those aged under 25 years in WA and alcohol was a leading factor in these crashes. There is agreement that the use of ATODs is a learned behaviour and therefore broadbased psychosocial theories offer the most promising explanation for its onset. / Recent research addressing adolescent ATOD-use initiation has focused on the concepts of adolescent vulnerability and resilience. This Social Development Model identifies several social factors that are posited to predict or be protective of ATOD use (and other hazardous behaviours) during childhood and adolescence. While parents are not the only social influence on children, they provide the primary social learning environment for children and as such, can play an important role in whether or not their children initiate ATOD use. Four major groups of parenting risk and protective factors are evident from the literature. These include parental modelling of ATOD use, the normative standards parents set regarding ATOD use, their parenting style and family management techniques, and the nature of parent-child communication. The provision of skills training consistent with the concepts of 'authoritative parenting' is supported in the literature as a means to reduce the likelihood of children engaging in hazardous behaviours. Such training is promoted as being an effective and enduring strategy for reducing youth behaviours, such as regular use of tobacco and hazardous use of alcohol and/or other drugs, that have the potential to cause substantial health, social, and financial harm. Few ATOD programs focussing on parenting skills (particularly parent-child communication) were found to have been subjected to rigorous efficacy or effectiveness studies. Of those subjected to empirical investigation, most were constrained by methodological shortcomings and/or difficulties in recruiting and maintaining substantial parent participation. / Seeking ways to recruit and engage a high percentage of Australian parents in such a program is an important area for investigation because, while they may be difficult to reach, parents have persuasive and powerful influences on children's health behaviour. Potential predictors of parental participation were identified in the literature and a consultation process with parents was undertaken to determine their needs and preferences as well as strategies to recruit and engage a greater proportion of parents. The methodology of this research therefore comprised a small Exploratory Study followed by a larger efficacy trial. The Exploratory Study involved consultation with eight small groups of parents regarding the design and content of an ATOD educational intervention. The methodology of this consultation is presented in detail in Chapter 3. A questionnaire and structured group discussions of parents' responses were used to collect quantitative and qualitative data regarding their opinions and preferences regarding the frequency, intensity, time and type of an ATOD-related educational intervention. The results of the consultation with parents and a concurrent discussion of how each finding relates to previous research are presented in Chapter 4. Of the 213 parents/guardians invited, 110 responded, of which 72 indicated they would attend one of the discussion groups. While the attendance at the discussion groups was very low (response rate of 24% n=51), the total number of parents consulted exceeded or was equivalent to similar formative research. / Parents reported they worry about the potential harm associated with ATOD use by children and probably underestimate their own children's vulnerability and ATOD-use experiences. They wanted to be involved in the planning phases of parent-oriented ATOD-related educational interventions. Parents also identified numerous barriers for their participation in educational programs. They identified flexibility and convenience regarding intervention delivery as being essential and preferred interventions to be home-based. The parents reported that any intervention directed at parents should be supported by parents, non-judgemental, simple, time-efficient, easy to use, fun, colourful and interactive. Parents recommended that practical communication skills (such as how to talk with children, how to raise the topic and what topics to talk about) be addressed in the intervention. Parents also recommended a range and combination of strategies to promote and maintain parent involvement, such as rewarding children of parents who participate. The second part of this research involved merging the exploratory data with information from previous similar research to develop a drug-related educational intervention for parents. A parent-directed ATOD educational intervention, designed to assist parents to talk with their Year 6 children about smoking cigarettes and drinking alcohol, was developed and implemented. Its feasibility and impact on parent-child drug-related communication were evaluated in a randomised comparison trial. The methods utilised in this trial are detailed in Chapter 5. Seven data collection instruments were developed and standardised data collection procedures were established. Demographic, process and impact data were collected. Schools were randomly selected and randomly assigned to one of three study conditions. / Parents were recruited from schools. Intervention-group 1 was given a choice of learn-at-home drug education materials and Intervention-group 2 received learn-at-home drug education materials but were not given a choice. The Comparison-group parents were not exposed to the intervention. Completeness of the dissemination and implementation of the intervention were assessed, as were dose-response effects. Validity analyses of the parent-directed intervention indicated that the theoretical domains were adequately covered and the messages intended for parents were unambiguous. The student and parent questionnaires were also found to be valid and reliable. Data were obtained from 69.1% (n=830) and 24.5% (n=294) of the study sample (n=1201) at the first and second follow-ups respectively. Sample parents were successfully identified at both follow-ups and parent-child communication data were accurately matched (Chapter 6). At the first follow-up parents in Intervention-group 1 were more likely than parents in the Comparison Group, to have ever talked with their Year 6 child about smoking cigarettes; talked more recently; reported high parent-child engagement during such communication; and to have talked about more of the four specified tobacco-related topics in the two weeks prior to data collection. In addition, there were positive dose-response relationships for these dependent variables. While there were no significant differences between study conditions (Intervention- group 2 versus Comparison Group was marginally significant) regarding the duration of the last parent-child discussion about smoking cigarettes, there were positive dose-response effects. / Likewise, compared to Comparison-group parents, those in Intervention-groups 1 and 2 were more likely to have ever talked with their Year 6 child about drinking alcohol at the first follow-up, to Comparison-group parents, those in Intervention-group 1 were also more likely to have talked with their Year 6 children more recently about drinking alcohol. Parents in both of the Intervention Groups were more likely than parents in the Comparison Group, to have reported: talking about drinking alcohol for a longer duration; having higher parent-child engagement during such communication; and talking about more of the three nominated alcohol-related topics. Additionally, there were positive dose-response relationships for the alcohol-related dependent variables. Furthermore, while dose-response effects were evident between the high and/or middle intervention-dose categories and the low-dose category, there were no differences between the middle and high categories for any of the dependent tobacco- or alcohol-related dependent variables. No statistically significant differences were found between the responses of parents who were offered a choice of intervention materials (Intervention-group 1) and those who were not (Intervention-group 2). The overall agreement between parents and their children to equivalent parent-child communication variables, at both baseline and first follow-up was low. Furthermore, the range of parent-child agreement between the items varied considerably. At the first follow-up, however, there appeared to be slightly increased levels of agreement between Intervention-group parents and their children, than there was between Comparison-group parents and their children. / At the second follow-up the proportion of parents who had talked about none of the specified tobacco-related topics was low but there were no significant differences between the study conditions. There were, however, significant differences in the intended direction between study conditions with regard to how many of the specified alcohol-related topics parents reported discussing with their children. The likelihood of Type III error appeared to be minimal and indicators of parent and intervention itself and The findings of this study, discussed in Chapter 7, support the conclusion that parents of 10-11 year-old children are receptive to participating in a home-based drug-related educational intervention. The learn-at-home drug-related educational intervention implemented in this study appeared to have a significant impact on their drug-related communication with their Year 6 children. This study also identified strategies to enhance the recruitment and retention of participants in parent-training interventions, which are challenges inherent in parent-based intervention research. Despite identified limitations, this intervention appears to be a promising approach in the primary prevention of ATOD-related problems in Australia.

Thesis Statement The thesis argument is that theory can be developed about the implementation, maintenance and dissemination of school health education based on a school development approach. Such theory development can assist teachers to design programs appropriate to the needs of their classrooms, schools and communities. Thesis Setting The implementation and maintenance of school health education programs has not usually been the focus of research and as a consequence is rarely reported in the literature. The research in this thesis draws upon many disciplines and fields but in order to answer the thesis questions methodological processes were required that were consistent with current school situations. The earlier School Development in Health Education (SDHE) program's work in research, development and dissemination provided the setting for the thesis. Methodology of the Research The methodology of the research study involved a case study approach using both multiple and single case studies. Data have been drawn from SDHE schools in South Australia undertaking health, sexuality and drug education. The methodology adopted for the studies in this thesis is a case study design incorporating an iterative theory-study-theory sequence in which an initial theory statement derived from the literature guides the development of a multiple case study which, in effect, 'tests' the theory in a qualitative way. The finding of the case study then informs development and elaboration of the theory statement in its second version. This is then used to test the next multiple case study which leads to further development of the theory in its third version. The third iteration of the theory is tested in a single case study that leads to the fourth and final version of the theory. Data analysis was aided by the use of the Q.S.R. NUD.IST computer package that helped to manage and explore the thesis ideas about the data. In establishing these syntheses the chain of evidence in the data sets was maintained. The analysis also allowed the thesis findings to be used to test theories about the data that answered the thesis questions. Thesis Findings The findings of the thesis are contained in the final version of the theory. The theory is structured around program drivers, phases, types and processes that together produce implementation, maintenance and dissemination. This final theory statement is the basis for drawing the thesis conclusions. Thesis Conclusions It was concluded that patterns of factors that enhance and inhibit the implementation, maintenance and dissemination of school health education programs could be placed in a theoretical framework that can guide practice in school health education. To be successful school health education programs have to include three critical elements: leadership, action research and funding. Leaders or program drivers need to be identified and resourced; they may be principals or designated teaching staff with access to decision making, policy processes and resource allocation in schools. Teachers need to engage in a reflective action research process to develop, modify and sustain their curriculum development work. Programs require adequate funding resources for teachers' professional development, including action research, and the purchase of human and material resources. Schools planning to introduce programs may learn from the experience of others but they must themselves engage in the critical and essential program features identified in the final version of the theory. Implications The thesis conclusions imply the need to use more efficient ways of bringing schools' and teachers' hidden competence to the fore to support school health education program through varied patterns of professional development, technical support and curriculum development and implementation, and through funding of enhanced professional practice for health literacy. A major implication for the health sector is that many health workers need to learn collaborative skills since there is a tendency to take control and attempt to direct what teachers should do rather than work with and support them. An implication for programs in complex social environments is the need for careful planning in collaboration with other stakeholders. The critical elements developed in this thesis also apply - leadership, action research and funding. Evaluation can adopt a case study approach as a more suitable method for examining what happens in programs than an overly simplistic approach of assessing goals and objectives which ignores the differences in program implementation for different sites with the necessary localisation. Further Research Further research suggested by the thesis findings are in the areas of school health education in the changing administrative and management environment today, and of the use of various types of case study research in tandem to answer comprehensive and complex program performance questions.

Drug use and misuse among young people in Australia has caused concern throughout the community and has prompted nationwide action to address the problem. One component of intervention strategies with young people is drug education. Drug education in Australia represents an international philosophy of prevention and takes a harm minimisation approach to intervention. One strategy that has had international success in the area of drug education with young people, and that has been used effectively in health education in Australia since the 1970s, is peer education. Peer drug education involves young people conducting drug education sessions with their peers. An example of peer drug education in Australia is the Teenagers Teaching Teenagers' (Triple T) program, conducted in the Australian Capital Territory (ACT). Evaluations and descriptions of peer drug education programs tend to focus more on outcomes pertaining to program recipients and fail to explore in detail the specific experience of peer leaders. Existing research on the experience of peer leadership does not explore in detail the personal experience of leaders, that being the effect of peer leadership training and duties on leaders' personal perceptions of drugs, their behaviour with drugs and their own feelings and skills. This thesis explores the personal experience of a group of peer leaders who participated in the Triple T program in 1994. It considers their perceptions of the program at the time of training and then goes on to explore the impact of this experience on their formulation of ideas about drugs to the present day. The thesis is a qualitative project which utilises in-depth interviewing and focus groups to gather data and then presents a thematic analysis of participant response. The thesis asks two research questions, 1. What do young men and women involved in the Triple T program take from the experience of peer leadership training and duties? 2. In what way does the Triple T' experience appear to contribute to the development of drug related ideas of these young people in the two years following involvement in the program? The findings suggest that the participants gained information, skills and personal development from the training and generally found it to be a positive experience. However, participants distanced themselves personally from a substantial amount of the training content and did not personally reflect on the training content to any great extent at the time of training. Training processes and some aspects of leadership duties more personally affected them, although again there was personal distancing from this part of the program. In exploring the findings there was difficulty determining the influence of the training experience due to participant reluctance to attribute influence to any one source on the formulation of ideas. Instead, participants describe a complex interaction of influences on the formulation of ideas about drugs and a process which involves maintaining control, upholding the notion of informed choice and incorporating ideas about drugs into the formation of an adult identity. Influences on these ideas include the training, actual experiences with drugs and observations of others. The thesis exploration suggests that being involved in peer drug education does impact on peer leaders but this experience was not personalised to any great degree at the time of training. However, in the following two years, participants called on the training information as well as other influences as they formed their ideas about drugs. The thesis raises some issues of how to maximise leaders' personal connection to the peer drug education process, if this is in fact a desired outcome of peer education. It also suggests the need for further research into the experience of peer leaders who seem to have remained the least considered party in the peer education movement.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 5 uppsatser.