The Health4Life e-health intervention for modifying lifestyle risk behaviours of adolescents: secondary outcomes of a cluster randomised controlled trial

OBJECTIVES

To investigate the effectiveness of a school-based multiple health behaviour change e-health intervention for modifying risk factors for chronic disease (secondary outcomes).

STUDY DESIGN

Cluster randomised controlled trial.

SETTING, PARTICIPANTS

Students (at baseline [2019]: year 7, 11-14 years old) at 71 Australian public, independent, and Catholic schools.

INTERVENTION

Health4Life: an e-health school-based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app.

MAIN OUTCOME MEASURES

Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol-related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous).

RESULTS

A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow-up survey, 5698 (85.8%) two or more follow-up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57-2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64-1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72-1.38); tobacco use frequency: relative difference, 0.03 (95% CI, -0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, -0.34 (95% CI, -1.16 to 0.49) days per 30 days; device use time: relative difference, -0.07 (95% CI, -0.29 to 0.16) hours per day.

CONCLUSIONS

Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e-health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective).

Prescribed sedative and other psychotropic medication use among clients attending alcohol and other drug treatment

INTRODUCTION AND AIMS

Prescribed psychotropic medications contribute to overdose mortality among people with alcohol and other drug (AOD) disorders. We report on prescribed psychotropic medication use among AOD treatment service attendees, focusing on sedative drugs.

DESIGN AND METHODS

Prospective multi-site naturalistic outcome study in residential and outpatient AOD treatment facilities in Victoria and Western Australia. A convenience sample of 480 people (57% male; mean age 36.1) entering treatment were surveyed, of whom 313 (65%) were followed up by telephone interview after a median of 377 days. Participants' prescribed psychotropic medication use was ascertained by self-report at baseline and follow-up.

RESULTS

At baseline, 41% of participants reported prescribed sedative medication (benzodiazepine, zopiclone or zolpidem) use within the past month, including prescriptions to treat withdrawal symptoms. At follow-up, the cohort reported a reduced rate of past month prescribed sedative use (23%; P < 0.001) and this rate did not significantly differ between those who continued to use their primary drug of concern and those who were abstinent at follow-up (P = 0.08). Among those with opioids as their primary drug of concern, one-third were still being prescribed a sedative at follow-up (P > 0.99 for change from baseline). At baseline, 40% of participants were prescribed an antidepressant and 13% an antipsychotic medication, which remained similar at follow-up (45% and 13%, respectively).

DISCUSSION AND CONCLUSIONS

The high level of prescribed sedative drug use reported by people receiving AOD treatment is a serious public health concern given the increasing incidence of drug overdose deaths in Australia.

Evidence-based practice or imperfect seduction? Developing capacity to respond effectively to drug-related problems

ISSUES

The last two or three decades have seen some valuable investment in workforce development. However, significant challenges remain in developing effective practice across various systems. Despite the relevance alcohol, tobacco and other drug use have for a range of staff across diverse organisations, adoption of cross-sector and collaborative effective practice is not widespread. The most common response involves a rather singular focus on strategies that develop practitioner knowledge and skills, with much less consideration given to the complex nature of the work environment and the belief systems of people who work in these environments.

APPROACH

This paper explores the barriers to and facilitators of effective practice, extending beyond the common focus on education and training initiatives. A model of capacity building is explored as a template to inform workforce and organisational development strategies.

KEY FINDINGS

Numerous barriers, outside education and training, must be considered in order to develop and maintain effective practice across various systems of prevention and treatment. The paper culminates with recommendations on how to overcome such challenges.

IMPLICATIONS

Workforce and organisational development must extend beyond education and training initiatives. Along with a focus on organisational and system factors, we must also attend to the marginalisation of people affected by drug use and associated pejorative attitudes.

CONCLUSION

Developing effective practice in the drug field involves changing the structures, and expected outcomes of these structures, in which people work, not just encouraging a few to use new ways of working in spite of the system.

Evidence-based practice or imperfect seduction? Developing capacity to respond effectively to drug-related problems

ISSUES

The last two or three decades have seen some valuable investment in workforce development. However, significant challenges remain in developing effective practice across various systems. Despite the relevance alcohol, tobacco and other drug use have for a range of staff across diverse organisations, adoption of cross-sector and collaborative effective practice is not widespread. The most common response involves a rather singular focus on strategies that develop practitioner knowledge and skills, with much less consideration given to the complex nature of the work environment and the belief systems of people who work in these environments.

APPROACH

This paper explores the barriers to and facilitators of effective practice, extending beyond the common focus on education and training initiatives. A model of capacity building is explored as a template to inform workforce and organisational development strategies.

KEY FINDINGS

Numerous barriers, outside education and training, must be considered in order to develop and maintain effective practice across various systems of prevention and treatment. The paper culminates with recommendations on how to overcome such challenges.

IMPLICATIONS

Workforce and organisational development must extend beyond education and training initiatives. Along with a focus on organisational and system factors, we must also attend to the marginalisation of people affected by drug use and associated pejorative attitudes.

CONCLUSION

Developing effective practice in the drug field involves changing the structures, and expected outcomes of these structures, in which people work, not just encouraging a few to use new ways of working in spite of the system.

Whither the drug specialist? The work-force development needs of drug specialist staff and agencies

Drug specialist staff and agencies have been identified as having a critical role in responding to alcohol and other drug-related harm. This role must be seen in the context of the broad needs of people affected by drug use and the services that they utilize. Unfortunately, as in generic mainstream services, skill development, expertise, organizational structures and resources do not always support the demands of the drug specialist role. In order to develop the drug specialist work-force we must first review the evidence about the factors that influence effective practice. The available research indicates that a range of strategies is required and that these should not only focus on building the capacity of individuals, but also on organizations and systems. Substantial effort in capacity building is required in order to fulfil the expectations created by the title "drug specialist".

Characteristics, retention and readmissions of opioid-dependent clients treated with oral naltrexone

The aims of this study were to examine the retention rates of opioid-dependent clients treated with oral naltrexone and identify factors that influence retention in treatment of 981 opioid-dependent clients at a public out-patient clinic in Perth, Western Australia. The average retention period for all clients was 9.0 weeks. The factors associated with longer retention were being employed and referral source. Clients who were employed stayed significantly longer in treatment than unemployed clients. Clients referred from a private clinic were retained in treatment significantly longer than those referred from other sources (X = 10.3 vs. 5.9 weeks). While the majority (80.8%) had one admission to naltrexone treatment, 19.2% presented for readmission, some on three or more occasions in the study period. The median period between the end of the first episode of treatment and commencement of the second was 15.6 weeks. The median period between the end of the second episode of treatment and commencement of the third was 11.4 weeks. Those employed had a higher probability of being retained longer in treatment than those who were unemployed in subsequent treatment episodes. Clinicians should expect that initial retention in naltrexone is likely to be relatively short, and that a substantial proportion of clients will represent for further treatment.