Development and evaluation of a transfer-oriented version of the Healthy School and Drugs program.

Schools are more and more overloaded by requests to address health and other social themes, for which they have rather limited implementation capacity. The categorical approach of school health promotion programs, with each program focusing on a specific health behavior domain, adds to the feeling of implementation overload in schools. A transfer-oriented learning approach offers a solution for such an overload since it has the potential to be effective in a range of domains, even in domains that are not explicitly taught. Transfer-oriented learning builds on similarities and associations between health behavior domains and stimulates students to apply relevant knowledge and skills to other domains than the ones in which these competencies were initially acquired. Many skills and knowledge are relevant to other domains (e.g. refusal skills share common principles across various domains and can be applied to smoking, drinking, unsafe sex, etc.). Recently, the Transferproject demonstrated the effectiveness of an experimental, transfer-oriented curriculum on several taught (smoking, safe sex) and untaught domains (alcohol, nutrition). That experimental curriculum is not eligible for large-scale implementation. That is why the present project aims at applying the knowledge gained from the Transferproject to a program that already is widely implemented and has a solid base in evidence and research.

The present project comprises the development and evaluation of a transfer-oriented version of the Healthy School and Drugs (HSD) program, a program used in 65% of Dutch secondary schools. The current version of HSD includes teaching modules about alcohol, tobacco and cannabis which are implemented sequentially in the first three years of secondary education. Although effects of the current version have been demonstrated on substance use and behavioral determinants, effects were found to erode. The present project sets out to develop a transfer-oriented version of the alcohol and tobacco e-learning modules, based on insights into the promotion of transfer from educational psychology in general and the Transferproject in particular. Subsequently, the effectiveness of the transfer-oriented modules in comparison to the current HSD modules is evaluated in a randomized trial. Effects will not only be examined with respect to the three substance use domains (alcohol, tobacco and cannabis), but also with respect to four domains which will not be addressed explicitly by the modules (i.e. fighting, bullying, leisure-time sports participation and fruit consumption). Compared to the current HSD version, the transfer-oriented HSD version is expected to (a) strengthen effects in the substance use domains (near transfer from alcohol/tobacco to alcohol/tobacco/cannabis), and to (b) produce effects in the four untaught domains (far transfer). The transfer literature and results of the Transferproject indicate that transfer effects are stronger or more likely to occur as domains are more strongly associated to the teaching domain. In addition to other reasons for selecting the four transfer domains for this study (health priority, prevalence), one reason is that the domains differ in strength of association with substance use, which enables studying the scope of transfer effects. Since fighting and bullying are more strongly associated with substance use than sports participation and fruit consumption, the strength of transfer effects in the fighting and bullying domains is expected to be higher.
The randomized trial will be conducted among pre-vocational students (vmbo), which as a group have higher prevalence rates of substance use and other health-risk and antisocial behaviors than students in higher school levels. The study will span the first three years of secondary education, with the alcohol and tobacco modules implemented sequentially in the first two years, and a long-term follow-up measurement in the third year.

General:

The transfer-oriented version of HSD, in comparison to the regular version, will have larger and more durable effects on substance use behaviors and their determinants and will have favorable effects on behavior and determinants in four untaught domains (bullying, fighting, fruit consumption and sports participation).



Specific:

At one-year follow-up, after two years of intervention, adolescents receiving the transfer-oriented version of HSD e-learning modules about alcohol and tobacco, in comparison to adolescents receiving the regular version of these modules, will:

1. Have lower prevalence of alcohol and tobacco use and have more favorable scores on determinants of these behaviors;

2. Have more favorable scores on determinants of marijuana use;

3. Have lower prevalence of bullying and more favorable scores on its determinants;

4. Have lower prevalence of fighting and more favorable scores on its determinants;

5. Have more favorable scores on determinants of fruit consumption;

6. Have more favorable scores on determinants of sports participation.

January-February 2013;

May-June 2013;

January-February 2014;

May-June 2014;

May-June 2015.

The objective of the study is to compare the effectiveness of two versions of the alcohol and tobacco modules of the Healthy School and Drugs (HSD) program: the regular version (control group) and a transfer-oriented version (experimental group).



The regular version (control group) of the modules consists of 3 e-learning sessions per module. For this study, one extra session is added per module in order to make instruction time equal between the two conditions.



The transfer-oriented version (experimental group) consists of 4 sessions: the 3 e-learning sessions of the regular version are combined with extra texts and assignments designed to promote transfer of learned knowledge and skills to other health-related behaviors. Transfer is promoted in these assignments mainly by explicitly abstracting relevant cognitive-behavioral skills which are only implicit in the regular version (e.g., ‘how to say no to something you don’t want’ as an explicit generalization of ‘how to say no to alcohol or tobacco’) and by stimulating students to apply the skills to other health-related behaviors.