J. DRUG EDUCATION, Vol. 43(2) 121-139, 2013

EXPERIENCES OF AUSTRALIAN SCHOOL STAFF IN ADDRESSING STUDENT CANNABIS USE* PETER J. GATES, PH.D. MELISSA M. NORBERG, PH.D. PAUL DILLON, DIPTCH, MPS National Cannabis Prevention and Information Centre RAMESH MANOCHA, MBBS, B.SC., PH.D. University of Sydney, Australia

ABSTRACT

Cannabis is the most frequently used illicit drug by Australian secondary school students yet there is scant research investigating school staff responses to student cannabis use. As such, this study surveyed 1,692 school staff who attended Generation Next seminars throughout Australia. The self-complete survey identified that the majority of school staff had discussed cannabis use at least once in the past year, although teachers were less likely to report having cannabis-related discussions compared to other school staff. Staff drug education training was consistently associated with an increased prevalence of cannabis-related discussion and assistance. These findings highlight a need for drug education among school staff and particularly among teachers.

INTRODUCTION Cannabis is the most commonly used illicit drug among adolescents (UNODC, 2012). At age 12, approximately 3% of Australians have tried cannabis, and *Funded by the Australian Government Department of Health and Ageing. 121 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/DE.43.2.b http://baywood.com

122 / GATES ET AL.

approximately 29% have tried it by age 17 (White & Bariola, 2012). While few who try cannabis experience significant harm (Coffey, Lynskey, Wolfe, & Patton, 2000), early and frequent use increases the risk of harm, including reduced educational achievement (MacLeod, Oakes, Copello, Crome, Egger, Hickman, et al., 2004) and mental health concerns (Large, Sharma, Compton, Slade, & Nielssen, 2011). Delivering substance use prevention programs through school settings can help reduce cannabis uptake and therefore reduce the risk of harm (Lemstra, Bennett, Nannapaneni, Neudorf, Warren, Kershaw, et al., 2010; Norberg, Kezelman, & Lim-Howe, 2013; Porath-Waller, Beasley, & Beirness, 2010). Notably, the most recent review of cannabis prevention programs identified that universal, multi-modal programs (those that focus on general student populations and utilize a combination of delivery modalities) with booster sessions had the most promise for preventing cannabis use (Norberg et al., 2013). Although research has identified which prevention programs are most successful, scant research has explored how schools approach drug education or respond to student drug use outside of a research program. According to the national health curriculum in Australia, drug education is usually delivered during the early secondary school years to students aged 12-16 years by one or more of a range of leaders including specialist teachers, school nurses, or counselors, external specialist presenters, as well as classroom teachers. This is a concern as mounting evidence suggests that not all providers of drug education are equally effective. Systematic reviews of school-based general drug education programs (Tobler, 1992; Tobler, Roona, Ochshorn, Marshall, Streke, & Stackpole, 2000) and cannabis specific programs (Norberg et al., 2013) suggest that teachers may be the least effective at delivering drug education. Fortunately, providing teachers with training improves drug prevention (Dusenbury, Brannigan, Falco, & Lake, 2004; Dusenbury & Falco, 1995), potentially by increasing teachers ability to correctly identify at-risk students (McLaughlin, Holcomb, Jibaja-Rusth, & Webb, 1993). The present study aimed to contribute to the dearth of research by investigating any personal experience with cannabis as well as any professional cannabisrelated interactions with students as reported by Australian secondary school staff. In particular, this study aimed to differentiate the experiences of teachers from other school staff. Specifically, the four aims of the study were: 1. to develop an understanding of the staff’s personal cannabis-related experiences and their knowledge and beliefs regarding cannabis use in Australia; 2. to describe the extent to which school staff interact with students and the level of suspected and actual awareness of student cannabis use; and 3. to describe how school staff respond to student cannabis use; and 4. the final aim of the study was to explore any associations between school staff characteristics and the prevalence of suspected and known cannabis using students and the number of past-year cannabis-related discussions with students.

STUDENT CANNABIS USE IN AUSTRALIA /

123

METHODS Participants and Procedure The study sample was comprised of delegates attending a Generation Next seminar in one of seven Australian cities in 2012. These seminars are optional, professional development days designed for teachers and other professionals who work with young people. They feature didactic presentation from a range of mental health and wellbeing experts on a wide variety of topical issues relevant to this field. The seminars occur on a national circuit of seven events, each in a major city. Each seminar attracts between 400 and 1,000 delegates all of whom have selected to attend, totaling more than 4,000 delegates per year. At each seminar the delegates were provided with a survey in their conference satchel and were instructed to self-complete and turn in the study survey into provided drop-boxes for entry into a lottery to win one of five gift certificates (each $75 AUD). Of the 4,377 delegates who attended the Generation Next seminars, 2,598 (59.4%) completed the survey, and of those completing the survey, 1,692 (65.1%) were school staff and thus met the study inclusion criteria. In total, 920 surveys were self-completed by teachers (54.3%) and 772 were completed by other school staff (45.7%; 126 heads of school, 330 school counselors, 105 nurses, and 209 support staff, including chaplains, youth workers, student transitioning, and education assistants and youth support coordinators). The study sample was predominately female (n = 1,360, 81%), which reflected the Generation Next delegate population but was over representative of Australian secondary school teachers who are approximately 57% female (McKenzie, Rowley, Weldon, & Murphy, 2011). The sample had a mean age of 44 years (SD = 10.8, range 20-82 years) which was consistent with Australian teachers in secondary schools (44.5 years) (McKenzie et al., 2011). The participant occupations and other descriptive details of the participants’ school types are presented in Table 1. Measures The questions of relevance for the present study consisted of 22 questions split into four different sections. Given the lack of gold standard items investigating the variables of interest, these questions were purpose built following expert consultation between the authors. The first survey section assessed participants’ demographics (age, gender, occupation, and school details), while the second section comprised four questions regarding participants’ personal experience with cannabis. This experience referred to whether the participants had received none, a little, moderate, substantial, or a great deal of training regarding cannabis-related issues. In addition, the participants were asked if they felt cannabis should be illegal, decriminalized, or made available for medicinal purposes; whether or not they had smoked cannabis in the previous 12 months; and whether all, most, about half, a few, or none of their friends currently used cannabis.

43 81

69 46 8

35 65 22 3

86 37 1

Gender (n = 1,680) Male Female

School type (n = 1,644) Public Private Special education school

School stage (n = 1,672) Primary Secondary Middle schools Technical and further education

School location (n = 1,659) Metropolitan Rural Remote

n

69.4 29.8 0.8

28.0 52.0 17.6 2.4

56.1 37.4 6.5

34.7 65.3

%

Head of school

695 207 4

208 544 109 51

507 368 28

184 735

n

76.7 22.8 0.4

22.8 59.6 12.0 5.6

56.1 40.8 3.1

20.0 80.0

%

Teacher

233 82 3

59 145 114 7

205 110 8

36 290

n

73.3 25.8 0.9

18.2 44.6 35.1 2.1

63.5 34.1 2.5

11.0 89.0

%

Counselor

77 27 0

10 62 31 4

64 3 2

4 100

n

74.0 26.0 0.0

9.5 59.0 29.5 2.0

62.1 35.9 1.9

3.8 96.2

%

Nurses

Table 1. School Staff Gender and School Characteristics

142 61 4

40 104 48 13

142 34 16

54 153

n

68.6 29.5 1.9

19.5 50.7 23.4 6.4

74.0 17.7 8.3

26.1 73.9

%

Support staff

1233 414 12

352 920 324 76

987 595 62

321 1359

n

%

72.9 24.5 0.7

21.1 55.0 19.4 4.5

60.0 36.2 3.8

19.1 80.9

Total

124 / GATES ET AL.

STUDENT CANNABIS USE IN AUSTRALIA /

125

The third section comprised eight Likert-type scale questions assessing participants’ contact with students, the extent of their awareness of students who use cannabis, and whether the participant informed a legal authority on becoming aware of a student’s cannabis use. Finally, the participants were asked to indicate how many occasions they had discussed cannabis with students and what form the majority of these discussions took (class lessons, conversations out of class, counseling, or other). In addition, the participants were asked to indicate what assistance they had most commonly provided to any cannabis-using students (checking either: none, educational lessons, brief intervention, reporting to a legal authority, referral to the school counselor, senior teacher, or school principal, or another form of assistance). In the fourth section the participants were asked six true or false questions chosen specifically to identify whether the participants had a working knowledge of the prevalence and acceptance of cannabis use and its health impact in Australia (each item is shown in Table 2). A cannabis knowledge test score was then computed based on the number of these items that were answered correctly (from 0 to 6) according to the 2010 National Drug Strategy Household Survey (Australian Institute of Health and Welfare, 2011). The internal consistency was measured by Cronbach’s alpha and deleted items odds ratios. These ratios, comparing whether or not a correct answer to each particular item was associated with whether the participants answered any other item correctly, are shown in Table 2. The alpa coefficient for these six items was questionable (a = 0.61), meaning that the reliability of this scale was uncertain for this sample. Data Analytic Approach The data from the study was analysed using PASW version 18 (PASW Statistics, 2009). Following descriptive analyses, the survey responses were tabled and presented by participant occupation. To address the first three study aims and determine significant differences in responses between the five participant occupations, a series of binary logistic regression analyses were conducted. In each case the dependent variable was the “yes/no” survey response which was regressed on a dummy variable representing the participants’ occupation group. Significant differences between occupations are noted in the relevant tables. To address the final aim of the study, a correlational analysis was conducted to determine whether participant characteristics were associated with response patterns. To control for the probability of false positive findings, given the number of analyses, an alpha level of a < 0.01 was considered statistically significant throughout. RESULTS Participant Characteristics The participants (n = 1,691) came from five different school-based occupations: heads of school (n = 126, 7.5%), teachers (n = 920, 54.4%), counselors (n = 330,

%

n

%

Teacher n

%

Counselor n

%

Nurses n

%

Support staff n

Total %

78

61.9

569

61.8

214

64.8

63

59.4

134

64.1

1058

62.6

105

83.3

745

81.0

265

80.3

89

84.0

170

81.3

28

22.2

176

19.1

69

20.9

19

17.9

52

24.9

344

1374

25

19.8

135

14.74 60

18.24

30

28.32,3,5

26

12.44

74

58.73,4 549

59.73,4 228

69.11,2,5

76

71.71,2,5

124

59.33,4

57

45.2

403

43.8

137

40.6

52

49.1

81

38.8

727

1051

276

43.0

62.2

16.3

20.3

81.3

*Deleted item odds ratio scores to demonstrate internal consistency, all p < 0.001.

1=significantly different from heads of school; 2=significantly different from teachers; 3=significantly different from counselors; 4=significantly different from nurses; 5=significantly different from support staff (all p < 0.01).

Correct answer (False)

Most Australians approve of the recreational use of cannabis by an adult (*deleted item odds ratio 3.0 [1.7-5.3])

Correct answer (True)

Early use of cannabis is associated with poorer educational attainment (*deleted item odds ratio 2.7 [1.8-4.1])

Correct answer (False)

More than 40% of Australians aged 14+ years have used cannabis at least once (*deleted item odds ratio 11.3 [5.5-22.9])

Correct answer (False)

Most daily cannabis users in Australia are in the 20-29 year age group (*deleted item odds ratio 1.0 [0.9-1.0])

Correct answer (True)

Cannabis users are more likely to have a mental health problem than those who do not use cannabis (*deleted item odds ratio 0.8 [0.8-0.8])

Correct answer (True)

Approximately 1 in 10 Australians under the age of 18 have smoked cannabis in the past year (*deleted item odds ratio 2.7 [1.8-4.1])

n

Head of school

Table 2. School Staff Cannabis-Related Knowledge

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19.5%), nurses (n = 104, 6.3%), and student support staff (n = 209, 12.4%). Further information regarding the participants’ school is presented in Table 1 by participant occupation. The majority of participants worked in public schools (n = 987, 58.4%), teaching secondary students (n = 920, 54.4%), in metropolitan areas (n = 1,233, 74.3%). Aim One: Describe the Participants’ Cannabis Experience, Knowledge, and Beliefs Information ascertained from the six questions regarding the participants’ cannabis-related knowledge is presented in Table 2. Notably, the participants did not commonly answer more than three out of the six knowledge questions correctly (M = 2.9, SD = 1.2, median = 3, range 0 to 6). No significant difference was found between occupation groups and the number of knowledge questions that were answered correctly. Training was seen to improve the number of correct answers (F4, 1605 = 12.98, p < 0.001), with those who reported a great deal of training answering a mean of 3.5 items correctly (SD = 0.8, median = 4, range 2 to 5), and those with no training answering a mean of 2.6 (SD = 1.2, median = 3, range 0 to 6) items correctly. Information regarding the participants’ experience with cannabis use is presented in Table 3. Aim Two: Describe Participant-Student Contact and Awareness of Student Cannabis Use Information regarding the participants’ involvement with students is presented in Table 4. Just over one-quarter of the participants (n = 472, 28.3%) reported significant contact with more than 200 students each week. Similarly, just over one-quarter of participants (n = 465, 28.0%) reported spending more than 34 hours per week with students. Less than half of the participants (n = 686; 41.5%) suspected that more than 5% of students at their school would use cannabis. When questioned on actual experiences with student cannabis use, approximately two-thirds of participants (n = 1023; 63.3%) indicated past-year awareness that at least one of their students was a cannabis user. Aim Three: Describe the Participants’ Responses to Student Cannabis Use Information regarding participant reactions to cannabis-using students and cannabis-related discussions with students is presented in Table 5. Although just under two-thirds of the sample (n = 1,023; 60.5%) knew of a student using cannabis, only 22% (n = 225) of this subsample reacted by notifying police. The sample was likely to report having had at least one recent cannabis-related discussion with their students (n = 1,041; 61.6%).

1 49 72

49 27 40

35 53 29 9

Proportion of friends who currently use (n = 1,656) More than a few A few None

Cannabis should be . . . (n = 1,539) Illegal Decriminalized Available for medicinal purposes

Training (n = 1,667) None A little Moderate Substantial+ 27.82,3 42.1 23.0 7.1

42.2 23.3 34.5

0.8 40.2 59.0

1.6

%

4.7

%

375 41.41,3-5 328 36.2 158 17.4 45 5.0

334 39.5 143 16.9 369 43.6

18 2.0 379 42.1 503 55.9

43

n

Teacher

2.15

%

49 144 89 45

15.01,2,5 44.0 27.2 13.8

111 37.4 68 22.9 118 39.7

8 2.5 147 45.4 169 52.2

7

n

Counselor

23 45 17 18

41 15 39

0 37 67

1

n

22.32 43.7 16.5 17.5

43.2 15.8 41.1

0.0 35.6 64.4

0.9

%

Nurses

64 77 45 19

94 29 62

14 93 99

15

n

31.22,3 37.6 22.0 9.3

50.8 15.7 33.5

6.8 45.1 48.14

7.23

%

Support staff

546 647 338 136

629 282 628

41 705 910

68

n

4.0

%

32.8 38.8 20.3 8.2

40.9 18.3 40.8

2.5 42.6 55.0

Total

1=significantly different from heads of school; 2=significantly different from teachers; 3=significantly different from counselors; 4=significantly different from nurses; 5=significantly different from support staff (all p < 0.01).

2

Smoked cannabis recently (n = 1,681) Yes

n

Head of school

Table 3. School Staff Experience with Cannabis

128 / GATES ET AL.

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Details regarding the types of cannabis-related assistance that were reported by the individual staff groups are shown in Table 6. With the exception of school counselors, the majority of participants (n = 972, 57.5%) did not report ever providing cannabis-related assistance to a student. Among those who reported taking past action to assist an individual with a cannabis-related problem (n = 814), the three most commonly reported forms of assistance taken were: referring the student to the school counselor (n = 237, 29.1%), providing a brief intervention (n = 591, 27.4%), and providing educational assistance (n = 615, 24.4%). Aim Four: Describe the Associations between School Staff Characteristics and Responses to Student Cannabis Use Results from correlation analyses conducted to explore how survey responses were associated with participant characteristics are presented in Table 7. Older participants reported a significantly lower prevalence of suspected cannabis-using students and a lower cannabis knowledge score compared to younger participants. Females reported less contact with students and were less likely to have ever assisted a cannabis-using student compared to males. Personal cannabis use was significantly associated with a lower prevalence of past cannabis-related discussion and occasions of providing cannabis-related assistance. Notably, cannabisrelated training and knowledge was significantly associated with a higher prevalence of suspected and known cannabis using students, the number of past year cannabis-related discussions, and ever assisting with a young person’s cannabisrelated concern. DISCUSSION The present study has found that a “whole school” approach, involving all school staff, may be appropriate in delivering school-based drug prevention programs as significant contact with substance-using students was not limited to the classroom teacher. Five important school occupation groups were identified in the sample: heads of school, teachers, counselors, nurses, and support staff. Moreover, there were significantly more differences than similarities found in the style of approach in assisting cannabis-using students expressed between these school-based occupations. The first aim of this study was to describe any personal experiences with cannabis by school staff and their knowledge and beliefs regarding cannabis use in Australia. Compared to the Australian population the sample was relatively less likely to support the decriminalization or medicinal availability of cannabis and more likely to report that cannabis was the greatest substance-related concern in the community. That is, less than two-thirds of the sample supported the decriminalization or medicinal availability of cannabis and one-third strongly

%

n

%

Teacher

1 19 34 72 0.8 15.1 27.0 57.12-5

1 221 406 282 0.1 24.3 44.7 31.01,3,5

1 200 70 51

n

0.3 62.1 21.8 15.81,2

%

Counselor

0 1-10 11-20 21-30 35+ 2 21 27 31 43 1.6 16.9 21.8 25.0 34.73-5

4 64 148 377 315 0.4 7.1 16.3 41.5 34.73-5

1 47 99 118 56

0.3 14.6 30.8 36.8 17.41,2

Current number of hours spent with students per week (n = 1,660)

0 1-50 51-200 201+

Number of students in current weekly contact (n = 1,668)

n

Head of school

1 34 25 24 19

0 40 38 25

n

%

1.0 33.0 24.3 23.3 18.41,2

0.0 38.8 36.9 24.31

Nurses

Table 4. School Staff Involvement with Students

2 45 51 74 32

0 104 61 42

n

1.0 22.0 25.0 36.3 15.71,2

0.0 50.3 29.4 20.31,2

%

Support staff

10 211 350 624 465

3 584 609 472

n

Total

0.6 12.7 21.1 37.6 28.0

0.2 35.0 36.5 28.3

%

130 / GATES ET AL.

80 22 16 6

64.53 17.7 12.9 4.8 570 137 132 58

63.53,5 15.3 14.7 6.5 158 55 76 34

47 35 15 25

38.53 28.7 12.3 20.5 398 325 96 84

44.13,5 36.0 10.6 9.3 65 120 68 72

20.01,2,4,5 36.9 20.9 22.2

48.91,2 17.0 23.5 10.5

34 39 9 23

54 12 28 9

32.43 37.1 8.6 21.9

52.4 11.7 27.2 8.7

64 61 29 48

107 25 39 37

31.72,3 30.2 14.4 23.8

51.42 12.0 18.8 17.8

608 580 217 252

969 251 291 144

36.7 35.0 13.1 15.2

58.5 15.2 17.5 8.7

1=significantly different from heads of school; 2=significantly different from teachers; 3=significantly different from counselors; 4=significantly different from nurses; 5=significantly different from support staff (all p < 0.01).

0 1-5 6-10 11+

Number of known students who use cannabis (n = 1,657)

0-5% 6-10% 11-25% 26+%

Percentage of students suspected to be cannabis users (n = 1,655)

STUDENT CANNABIS USE IN AUSTRALIA / 131

%

n

%

Teacher n

%

Counselor n

%

Nurses n

%

Support staff n

%

Total

39 18 9 8

52 25 11 37

41.63 20.0 8.8 29.6

52.72,4,5 24.3 12.2 10.8

399 250 102 160

2 8 10 34 10 8 3.2 12.92 13.72,3 54.82,3,4 16.12,3 12.92,3

56 204 260 166 21 21

12.03 43.61,3,5 50.81,3,4,5 35.51,3-5 4.51,3-5 4.51

24.21,2 29.1 11.3 35.5

4 1.82,4 8 3.72,4 12 4.81,2,4,5 18 8.31,2,4,5 185 85.31,2,4,5 2 0.91,4,5

79 95 37 116

175 69.72,4 42 16.7 21 8.4 13 5.2

6 15 21 16 16 6

10.2 25.43 31.32,3 27.11,3 27.12,3 10.23

39 36.8 30 28.3 9 8.5 28 26.4

9 15 24 58 34 14

66 58 23 60

6.9 11.52 17.02,3 44.63 26.22,3 10.82,3

31.92 28.0 11.1 29.0

65 94.21,3,5 104 76.51,2,4 2 2.9 16 11.8 2 2.9 8 5.9 0 0.0 8 5.9

77 250 327 292 266 51

635 458 182 401

798 125 58 42

8.2 26.7 34.9 31.2 28.4 5.4

37.9 27.3 10.9 23.9

78.0 12.2 5.7 4.2

1=significantly different from heads of school; 2=significantly different from teachers; 3=significantly different from counselors; 4=significantly different from nurses; 5=significantly different from support staff (all p < 0.01).

A complete lesson Part of a lesson Part of, or a complete lesson Informal conversation Counseling Other (not specified)

43.83,5 27.4 11.2 17.6

415 84.21,3,5 47 9.5 18 3.7 13 2.6

The majority of these discussions were . . . (n = 936)

0 1-2 3-4 5+

Number of discussions (n = 1,676)

0 1-2 3-5 6+

Occasions where legal authorities were informed regarding student use (of those who were aware of at least one student who used (n = 1,023)

n

Head of school

Table 5. School Staff Reactions to, and Discussion Regarding, Student Cannabis Use

132 / GATES ET AL.

4 4

Referred to the school principal

Other assistance (DOA referrals)

n 446 105 49 7 151 15 30 12

% 41.32,3 2.82-4 21.12,3 2.8 22.93 1.8 3.7 3.7

1.53-5

3.7

1.8

18.53

0.9

6.01,3-5

12.91,3

54.71,3-5

%

Teacher %

35

4

0

22

3

101

12.51,2

1.4

0.0*

7.91,2

1.1

36.11,2,4,5

57 20.41,2,5

58 20.71,2,4,5

n

Counselor

7

2

0

13

1

13

19

37

n

7.62

2.2

0.0*

14.1

1.1

14.12,3

20.71,5

40.22,3

%

Nurses

20

6

0

26

0

37

15

76

n

11.22

3.4

0.0*

14.5

0.0*

20.72,3

8.43,4

42.52,3

%

Support staff

78

46

17

237

14

223

199

662

n

%

5.3

3.1

1.2

16.1

0.9

15.1

13.5

44.9

Total

1=significantly different from heads of school; 2=significantly different from teachers; 3=significantly different from counselors; 4=significantly different from nurses; 5=significantly different from support staff (all p < 0.01). *=Comparative analyses could not be conducted due to missing data.

2

25

Referred to a senior teacher

Referred to the school counselor

3

23

Brief interventions

Reported to a legal authority

3

45

No assistance

Educational lessons

n

Role taken (n = 1,476)

Head of school

Table 6. Main Form of Cannabis-Related Assistance by School Staff

STUDENT CANNABIS USE IN AUSTRALIA / 133

–0.078**

–0.002

0.024

–0.042

–0.020

0.160***



*p < 0.05; **p < 0.01; ***p < 0.001. Note: Due to the number of analyses, p < 0.01 was considered statistically significant.



— —









Cannabis knowledge score

0.393***

0.170***

— — —









Level of cannabis training

0.497*** 0.191***

0.458***

— —









Frequency of cannabis discussions

0.496*** 0.148*** 0.382***

0.619***











Prevalence of known users

0.333***

0.086**

0.464***







Prevalence of suspected users

–0.001

0.622***

–0.011

–0.040

–0.129***







Level of weekly student contact —

–0.072**

–0.082**

–0.137**

0.072**





Past year cannabis use

0.251***

–0.71**

–0.011

–0.004

–0.051

–0.006

0.027

–0.141***

0.039



Sex

–0.015

–0.83**

–0.063*

–0.027

0.006

–0.78**

0.098***

0.30

Age

–0.004

Sex

Level of cannabis training

Prevalence Prevalence Level of weekly student of suspected of known Past year users users contact cannabis use

Frequency of cannabis discussions

Cannabis Ever assisted knowledge a cannabisusing student score

Table 7. Correlation between Participant Characteristics and Training, Knowledge, and Experience with Cannabis-Using Students

134 / GATES ET AL.

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agreed that cannabis was the greatest substance-related concern compared to approximately 70% and 4.1% of Australians, respectively (Australian Institute of Health and Welfare, 2011). In addition, the participants reported relatively low rates of recent personal cannabis use when compared to the Australian population (4.0% compared to 10.1%) (Australian Institute of Health and Welfare, 2011). In contrast, however, the participants were more likely to approve of the regular cannabis use by an adult compared to the population (14.4% compared to 8.3%). The participants also reported an elevated number of friends who smoked cannabis compared to data collected from health professionals. That is, 45% of the current sample reported having friends who use cannabis, while only 26% of GPs and 41% of nurses attending Healthed seminars reported having cannabis-using friends (Norberg, Gates, Dillon, Kavanagh, Manocha, & Copeland, 2012). Regarding the participants’ cannabis-related professional training, only one in four participants reported at least a “moderate” level of previous training (28.5%). Notably, teachers were significantly less likely to report any training compared to all other school staff occupations. Further, it was uncommon for the sample to answer at least 50% of the knowledge questions correctly (mean 2.9, SD = 1.2), with no significant difference between participant occupations. The second aim of this study was to describe the participants’ interaction with students and their level of suspected and actual awareness of student cannabis use. With the exception of school counselors, more than half of all school occupation groups reported being in significant contact with more than 50 students on a weekly basis (37.6% of counselors). In addition, with the exception of school nurses, more than half of all groups reported spending more than 20 hours per week with students (41.7% of nurses), although teachers were significantly more likely to report greater than 30 hours of contact compared to other school staff (75.6% of teachers). Notably, teachers and heads of school were the least likely members of school staff to report being aware of a student who used cannabis (55.9% and 61.5%, respectively) and also were significantly more likely to report the lowest suspected prevalence of student cannabis use (that is, 63.5% and 64.5% reported that 0-5% of students used cannabis). The third aim of this study was to describe school staff response to student cannabis use. Approximately two-thirds of staff reported having at least one occasion of a cannabis-related conversation or of assisting a cannabis-using student, while approximately one in seven staff had notified a legal authority about a student’s use (62.1%, 61.0%, 13.7%, respectfully). Interestingly, teachers and heads of school were the least likely to have ever discussed cannabis use with a student or assisted a cannabis using student compared to counselors, support staff, and nurses (56.2% or 45.3% and 58.4% or 58.7% compared to 75.8% or 79.3%, 68.1% or 57.5%, 63.2% or 59.8%, respectively). However, heads of school were more likely than counselors, support staff, nurses, and teachers to have reported a student’s cannabis use to a legal authority (47.3% compared

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to 30.3%, 23.5%, 5.8%, and 15.8%). These data suggest that, while all school staff would be inclined to operate by codes of conduct that emphasize confidentiality, it is clear that students were less likely to confide in heads of school. This may be because this group was most likely to report their cannabis use to a legal authority, or alternatively, because this group reported the least amount of student contact. There was evidence to suggest that the school staff were responding to student cannabis use in a way that was appropriate to their occupation. That is, teachers most commonly reported discussing cannabis use as part of or a complete school lesson (50.8%), and most commonly provided a referral to the school counselor to assist cannabis-using students. A large study of 528 high school teachers supported this finding, reporting that the majority of participants (62%) would make such a referral if confronted with a student who needed cannabis-related assistance (Kantor, Caudill, & Ungerleider, 1992). As expected, counselors most commonly discussed cannabis use as part of a counseling session (85.3%) and provided brief interventions (36.1%) to at-risk students. In contrast, nurses showed greater variation in how they approached cannabis-related discussions, although most commonly approached cannabis-related discussions as an educational lesson (31.3%) and also provided educational lessons to cannabis-using students (20.7%). Support staff most commonly discussed cannabis use as part of an informal discussion (a discussion outside of the classroom; 44.6%) and provided brief interventions (20.7%) to at-risk students. Finally, heads of school most commonly reported having informal cannabis-related discussions (54.8%), and provided referrals to the school counselor (22.9%) or a brief intervention (21.1%) to cannabis-using students. Notably, of those who reported providing some form of cannabis-related assistance, over half of this subsample (61.9%) reported providing the assistance that they believed was expected of them. Thus, it seems that response to a student’s cannabis use was in accordance with their professional role. The final aim of the study was to determine how participant characteristics such as age, gender, cannabis-related training and knowledge, and personal cannabis use were associated with the prevalence of suspected and known cannabis-using students as well as the prevalence of cannabis-related discussions with students. Importantly, the level of reported cannabis-related training was consistently associated with the frequency to which all school staff reported awareness of student cannabis use, had taken previous action to assist a cannabisusing student, and the number of correct responses to the cannabis knowledge questions. These associations are consistent with a significant research body regarding the positive impacts of training school staff (Pettigrew, Miller-Day, Shin, Hecht, Krieger, & Graham, 2012, for example). In contrast, personal cannabis use was associated with a decreased frequency of engaging in cannabisrelated discussions or assistance and the level of contact with students did not show any significant associations in this regard.

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LIMITATIONS First, this study was not exhaustive. That is, it did not include questions regarding any detail of student cannabis use (perceived or actual) nor was it within the scope of the survey to expand upon the participants’ responses to student cannabis use. Second, the external validity of the results were limited in that survey responses were participant self-report, the survey questions were purpose selected and thus without established psychometric properties, and females were overrepresented in the sample. Third, the scale developed to demonstrate school staff cannabis-related knowledge had questionable internal consistency but was included for descriptive purposes in this initial investigation. Finally, the significance of cannabis-related staff training may have reflected aspects not associated with training per se, but aspects of those who were motivated to seek such training such as an interest in student cannabis use. IMPLICATIONS AND CONCLUSIONS The current study identified three main findings. First, all school staff occupation groups were in significant contact with students and most commonly reported having at least one cannabis-related discussion with students. Second, there was great variation in responses to student cannabis use by those in different school-based occupations, with teachers reporting the least experience with student cannabis use. Third, although each occupation group most commonly responded to cannabis use appropriately to their role, there was consistent evidence supporting a common need for drug education training by each occupation group. In addition, personal cannabis use by school staff (particularly by female staff) warrants attention as this behavior was associated with reduced interaction between school staff and students regarding cannabis use. The present study supports previous work which has identified the importance of a school-wide approach. This approach should not be confused with a wholeschool approach which refers to a change in school curriculum to all student years (Flay, 2000), but an approach that considers not just teachers as leaders, but that also incorporates other facilitators including non-school staff. As with the whole-school approach, the effectiveness of a school-wide approach is yet to be consistently confirmed (Flay, 2000) although several reviews support using multiple facilitator types (Norberg et al., 2013; Tobler, 1992; Tobler et al., 2000). Notably, each staff member played a significant role in participating in cannabis-related discussions and in responding to cannabis-using students. These roles varied between occupation groups but by and large complimented each other. That is, cannabis-related discussions were delivered formally in classroom settings by teachers and nurses and informally by heads of school and support staff (outside of the classroom). Upon identifying cannabis-using students the typical response was to provide referral to school counselors who, in turn,

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provided counseling and conducted a brief intervention. Although this was the most common pathway, there was significant variation in school staff responses to student cannabis use in discussing cannabis use with students. All school staff report contact with cannabis use although a significant and positive correlation between drug education training and such contact was found. The question now is how to improve the dissemination and effectiveness (including cost-effectiveness) of such training to all school staff. As a first step, this study found that teaching staff were in greater need of further drug education training, followed by support staff, heads of school nurses, and finally school counselors. Developing an understanding of how each of these occupation groups can best respond to student drug use will lead to a whole-school approach that can effectively improve student welfare.

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McLaughlin, R., Holcomb, J., Jibaja-Rusth, M., & Webb, J. (1993). Teacher ratings of student risk for substance use as a function of specialized training. Journal of Drug Education, 23(1), 83-95. Norberg, M. M., Gates, P., Dillon, P., Kavanagh, D. J., Manocha, R., & Copeland, J. (2012). Screening and managing cannabis use: Comparing GP’s and nurses’ knowledge, beliefs, and behavior. Substance Abuse Treatment, Prevention, and Policy, 7(31), 1-10. Norberg, M. M., Kezelman, S., & Lim-Howe, N. (2013). Primary prevention of cannabis use: A systematic review of randomized controlled trials. PLoS ONE, 8(1), e53187. PASW Statistics. (2009). Release 18.0. Chicago, IL: SPSS, Inc. Pettigrew, J., Miller-Day, M., Shin, Y., Hecht, M. L., Krieger, J. L., & Graham, J. W. (2013). Describing teacher-student interactions: A qualitative assessment of teacher implementation of the 7th grade keepin’ it REAL substance use intervention. American Journal of Community Psychology, 51(1-2), 43-56. doi: 10.1007/s1046410012-19539-10461 Porath-Waller, A. J., Beasley, E., & Beirness, D. J. (2010). A meta-analytic review of school-based prevention for cannabis use. Health Education and Behavior, 37, 709-723. Tobler, N. S. (1992). Drug prevention programs can work: Research findings. Journal of Addictive Diseases, 11(3), 1-28. Tobler, N. S., Roona, M. R., Ochshorn, P., Marshall, D. G., Streke, A. V., & Stackpole, K. M. (2000). School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary Prevention, 20(4), 275-336. UNODC. (2012). World drug report 2011. United Nations Publication: Sales No. E.11.XI.10. White, V., & Bariola, E. (2012). Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2011. Victoria. Australia: Drug Strategy Branch, Australian Government Department of Health and Ageing.

Direct reprint requests to: Dr. Peter J. Gates National Cannabis Prevention and Information Centre (NCPIC) P.O. Box 684 Randwick, NSW 2031 Australia e-mail: [email protected]

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Experiences of Australian school staff in addressing student cannabis use.

Cannabis is the most frequently used illicit drug by Australian secondary school students yet there is scant research investigating school staff respo...
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