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Home > Reducing alcohol-related harm: evaluation of a SHAHRP intervention.

Keane, Martin (2012) Reducing alcohol-related harm: evaluation of a SHAHRP intervention. Drugnet Ireland , Issue 42, Summer 2012 , p. 14.

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The intervention
McKay et al.1 recently published their findings from an evaluation of an alcohol-related harm reduction intervention targeting post-primary students aged 13–16 in the greater Belfast area. The School Health and Alcohol Harm Reduction Project (SHAHRP) aims to reduce the harms associated with teenage alcohol consumption and combines education and skills training to encourage positive behavioural change. The intervention is delivered using interactive and group-based activities, with an emphasis on discussing how alcohol-related harms might arise in specific settings, e.g. a night out, and a focus on establishing pre-planned strategies to reduce such harms.

A slightly modified version of SHAHRP, using approximately 75% of the original materials, was piloted in nine post-primary schools in the greater Belfast area. Feedback from the pilot suggested that both teachers and students found the materials helpful and easy to follow and the activities and discussion to be relevant. Based on these reports, a controlled non-randomised trial was developed to assess the effectiveness of the intervention.
The evaluation
Twenty-nine post-primary schools in the greater Belfast area took part in the study. Eight schools received SHAHRP delivered by teachers, twelve schools received SHAHRP delivered by external alcohol and drug education workers and nine schools, the control arm of the trial, received the standard curriculum on alcohol education. Both teachers and external facilitators were trained in the theory and practice of SHAHRP. In phase 1, six sessions combining 16 activities were delivered to students aged 13–14 (year 10) and in phase 2, four sessions combining 10 activities were delivered to students aged 14–15.
Data collection
Baseline data were collected in September 2005, with follow-up data collected in September 2006 after phase 1 implementation and in September 2007 after the implementation of phase 2. The final set of data was collected in March 2008, by which time no student had received any intervention for at least 11 months. Data were collected using a number of standardised instruments and all questionnaires were administered verbally. The baseline number of students (2,349) represented 34.3% of the total number of year-10 students in schools within the greater Belfast area. A total of 2,048 students remained in the cohort at the final data collection point in March 2008; this represented a 12.8% attrition rate over the 32-month period of the trial. Males made up 39.7% of the cohort at baseline and 40.2% at final follow-up.
Results
Participants receiving the SHAHRP intervention were significantly more likely to report increased levels of knowledge about alcohol and its effects, safer alcohol-related attitudes, fewer alcohol-related harms (both personal and from others) and less alcohol consumption, in contrast to participants in the control group. These effects were maintained over the 11-month period in which none of the students had received any intervention. Students receiving SHAHRP from external alcohol and drug workers reported better outcomes on improving alcohol-related knowledge and attitudes, fewer personal alcohol-related harms and less alcohol consumption, in contrast to students receiving SHAHRP from teachers.
The authors caution against interpreting the finding on alcohol-related harm to read that no student receiving the SHAHRP intervention reported an increase in harm; the correct interpretation is that the majority of students receiving this intervention did not report an increase in harm. Alcohol-related harms included consuming more alcohol than planned, being sick after consuming alcohol, experiencing hangover symptoms, inability to recall events while under the influence of alcohol, being verbally and/or physically abusive and getting into trouble with parents and/or the police.
Conclusion
The authors conclude that ‘the adapted SHAHRP intervention [trialled in Belfast] is a promising means to address one of the major health and social challenges facing young people [alcohol consumption]’ (p.118). They also acknowledge that harm reduction interventions targeting young people can be controversial; however, as in the case of students receiving SHAHRP in Belfast, such interventions do not necessarily promote or produce alcohol-friendly attitudes and/or behaviours among target groups. The students in Belfast who received the SHAHRP intervention included abstainers, novice drinkers and more experienced consumers of alcohol, yet these groups were receptive to the themes of the intervention material and activities. Such themes include staying close to trusted friends when consuming alcohol, knowing basic first-aid, organising group transport home, having mobile phones available, not making decisions while drunk, being able to identify when friends are getting drunk, being on the alert for drink spiking and mixing alcohol with other drugs and avoiding arguments and aggressive behaviour by self and others. Finally, the authors concur with similar reporting from Australia that ‘young people are capable of processing harm reduction messages which are developed and presented within the reality of their drinking experiences’ (p.118).
1.     McKay M, McBride N, Sumnall H and Cole J (2012) Reducing the harm from adolescent alcohol consumption: results from an adapted version of SHAHRP in Northern Ireland. Journal of Substance Use, 17(2): 98–121.

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