The STAMPP logic models were developed during the application and early phases of the trial, and were based on the process evaluation of the Australian delivery of the classroom component, SHAHRP,59,107 and learning arising from the implementation of the NI adaptation of the curriculum.60 The logic model for the parental component was based on the mediation analysis of Koning et al.,117 who developed the original activities that our parental brief intervention was based upon (the Dutch PAS programme).
The logic model provided hypothesised causal pathways between intervention receipt and primary and secondary outcomes at final follow-up. The model was extended to include long-term behavioural impacts of the programmes, although assessments of these are beyond the timelines of the current project. The model provided a framework upon which the process evaluation methodology was partly based (see Chapter 2, Definitions/calculations).
provides the overall logic model of STAMPP and describes, in general terms, how the classroom and parental activities are hypothesised to lead to long-term changes in alcohol use and alcohol-related harms.
Overall schematic logic model for STAMPP
One-day training events were held in each study site before both phases of delivery of the classroom component. Training for the following academic year (from September onwards) took place in the preceding June. Training included sessions on alcohol knowledge (e.g. effects of alcohol use, prevalence rates, risk and protective factors for alcohol use), sharing experiences of the programme when delivered elsewhere and skills and lesson delivery rehearsal for each of the SHAHRP lessons.
Training involved examination of each of the SHAHRP lessons, which were entitled: ‘Myths about alcohol’; ‘Units of alcohol’; ‘Reasons why people do/don’t drink’; ‘Alcohol and the body’; ’consequences of “levels” of drinking’; ‘Blood alcohol concentration’; ‘Social and personal harms’; ‘Alcohol policy’; ‘Alcohol and the media’; ‘Advice for teenagers’; ‘A “night out”’; ‘Pressures faced by young drinkers’; and ‘Scenario-based discussion’. The six phase 1 lessons primarily encouraged knowledge development in pupils, and this was built on in phase 2, in which the lessons focused on more specific adolescent drinking behaviours, real-life scenarios or potential experiences while in an environment where alcohol is consumed. Phase 2 activities encouraged reflection, discussion and rehearsal of skills relating to alcohol-related peer pressure, similarities or differences for males and females in a drinking context, drink spiking, responsibilities towards friends, risk perception and assessing hazards related to alcohol in different environments or situations and peer advice around alcohol.
Teachers were also provided with a collection of electronic support materials to help them deliver the lessons. These included structured lesson plans and suggested techniques for information dissemination, group activities, role-plays and discussion points. Sample questions, to help facilitate discussion, and coaching points to aid in the management of the activities were included for each lesson. Teachers were also provided with videos [digital versatile disc (DVD)] that supported delivery of the lessons and student discussions. These included examples of alcohol marketing techniques and regional close circuit television footage of alcohol-related disorder in the night-time economy. Pupils were issued with separate workbooks for each phase of delivery that were designed to engage their interest. The workbooks provided information necessary for the students to perform practical activities and encouraged them to further explore each activity. In addition, the workbooks provided space for the students to record what they had learned as a way of consolidating the activity. Materials from the version of SHAHRP used in the STAMPP trial are available from the authors on request.
The classroom component of STAMPP, SHAHRP, was not based on a specific theory but on the original programme, which researchers described as an evidence-based programme based on literature review ().59 In developing STAMPP, we have drawn upon two main theories in order to understand how the programme might work: social norms theory108 and social cognitive theory.109 Briefly, social norms theory suggests that behaviour is influenced by incorrect perceptions of how other members of a social group (e.g. classmates, friendship groups) think and behave. Misperceptions between perceived and actual norms lead to an overestimation of behaviours such as alcohol use, healthy behaviours being underestimated and individuals changing their behaviour to approximate the misperceived norm. By establishing healthier or more accurate reference norms, individuals may modify their behaviour towards more healthy activities. Similarly, social cognitive theory is derived from earlier social learning theories, and suggests that alcohol use behaviour is learned through modelling, imitation and responding to the emotions of others, and that this is influenced by individual cognitions, attitudes and beliefs. It is related to social norms theory in that it considers how individual behaviour relates to that of others. The classroom component of STAMPP aims to develop relevant skills in students to help them recognise these influences on alcohol use and to develop counterstrategies to avoid harm.
Summary of the evidence-based components of the SHAHRP curriculum
The School Health and Alcohol Harm Reduction Project is an example of a resistance skills training programme and includes elements of alcohol-specific personal and social skills training.59,110–112 In accordance with the underpinning theory, it includes three main strategies: (1) teaching students to recognise high-risk situations, (2) increasing the awareness of external influences on behaviour and (3) combining self-control (i.e. the ability to control responses, to interrupt undesired behavioural tendencies and refrain from acting upon them) with refusal skills training (i.e. in order to improve self-efficacy in avoiding unhealthy behaviours but not with the consequence of social disadvantage for the young person with their peers). The knowledge delivered through SHAHRP (e.g. lessons on the effects of alcohol, description of alcohol units) does not have direct preventative effects, but is used to shape alcohol attitudes and to support situation specific decision-making. Accordingly, using the prevention taxonomy of Foxcroft,113 we classify the SHAHRP as a universal developmental programme.
Our parental intervention was based on the parental component of the Dutch PAS programme,64 which was based on research indicating that restrictive parenting practices (e.g. monitoring of children’s alcohol use, healthy attitudes towards alcohol, alcohol rule-setting) was associated with reduced prevalence of children’s alcohol use. In subsequent mediation analyses, it was shown that the PAS programme effect was mediated through children’s perceptions of parental rules, child self-efficacy and child self-control.117 There was an interaction between children’s attitudes towards alcohol and perceived parental rules on intervention outcomes, suggesting that perception of the rules set by parents shaped the attitudes of their children towards alcohol.114 Parental rule-setting on alcohol led to an increase in child self-control, which led to reduced weekly drinking at final assessment. Furthermore, parental rule-setting had direct effects on children’s alcohol use. No reciprocal sequential mediation was found (i.e. child self-control did not predict later parental rules), suggesting that the mediated relationship was robust. We hypothesise that the parental component of STAMPP works in a similar manner; parental rule-setting and monitoring reinforces the lessons received in the classroom through shaping healthier attitudes towards alcohol, and has direct effects on child drinking by reducing opportunities for use in the family home and by providing positive behavioural models around drinking.
Building on this, the second logic model () describes how the STAMPP components (separated into parent and child activities below, although there is an interaction as shown in ) are hypothesised to produce their expected effects on specific determinants of alcohol use behaviours. Some activities are delivered in phase 1 of the intervention and some in phase 2, and phase 2 activities are designed to build on skills and learning developed in phase 1. This is important, as, during the period between the two intervention phases, the natural trajectory of alcohol use means that some pupils will have initiated alcohol use, and baseline initiates may have begun to develop more regular patterns of use.
The logic model specifying the STAMPP components and expected outcomes
