Adaptation of the ASSIST peer-led smoking intervention to deliver information from the Talk to FRANK drug education website (ASSIST+FRANK): A pilot cluster-randomised controlled trial

James White, Jemma Hawkins, Kim Madden, Aimee Grant, Vanessa Er, Lianna Angel, Timothy Pickles, Mark Kelson, Adam Fletcher, Simon Murphy, Luke Midgley, Gemma Eccles, Gemma Cox, William Hollingworth, Rona Campbell, Matt Hickman, Chris Bonell, Laurence Moore

Research output: Contribution to journalConference or Meeting Abstractpeer-review


Background Illicit drug use increases the risk of poor physical and mental health. Few effective school-based drug prevention interventions are available. We adapted an effective school-based peer-led smoking prevention intervention (ASSIST) to deliver information from the UK national drug education website, FRANK Methods We conducted a four-arm pilot cluster-randomised control trial of 1567 students aged 12-13 years in 12 schools in Wales. Three schools each (mean number students per year 131) were randomly allocated to: ASSIST+FRANK, FRANK friends, ASSIST, or usual practice which may or may not include drug eduation. ASSIST+FRANK is a peer-led smoking prevention intervention in UK Year 8 (ASSIST) followed by a drug prevention adjunct in Year 9 (+FRANK). FRANK friends is a stand-alone peer-led drug prevention intervention in Year 9. ASSIST involves 2 days off-site training, plus four follow-up sessions. +FRANK involves 1 day off-site training plus 3 followups. FRANK friends involves 2 days off-site training and four follow-ups. Influential students were trained to disseminate information on the risks of drug use and minimising harms. Primary outcome was the acceptability of the +FRANK and FRANK friends, which was assessed through interviews with students, staff, parents, and intervention staff (n=66), structured observations of delivery (195), exploratory effectiveness analysis (multilevel logistic models), and estimated costs. Secondary outcome was the lifetime use of any illicit drugs at 18 months. Intention-to-treat analyses were conducted unmasked to the intervention allocation. This trial was approved by Cardiff University School of Social Sciences Research Ethics Committee (SREC/1103; ISRCTN 14415936). Findings All 12 schools were recruited, randomised, and retained (ASSIST+FRANK 419 students, FRANK friends 440, ASSIST 347, usual practice 361). At the 18 month follow-up the student retention rate was 93% (1460/1567). +FRANK and FRANK friends were acceptable to students, teachers, and parents, and delivered as intended, but FRANK friends was preferred over +FRANK. Some staff felt pressured to meet all the learning objectives for +FRANK in 1 day training versus 2 days in FRANK friends. There could also have been a lack of novelty for +FRANK peer supporters since they had previously experienced the ASSIST intervention. The odds of lifetime drug use at 18 months was marginally lower in both the +FRANK arm and the FRANK friends arm than in the usual practice arm (38 [12·4%] of 307 vs 34 [13·4%] of 254 [odds ratio 0·96, 95% CI 0·58-1·59] and 30 [9·3%] vs 34 [13·4%] [0·70, 0·39-1·24], respectively). The estimated cost per school was £1942 for +FRANK and £3041 for FRANK friends. All progression criteria were met. Interpretation Although both interventions were acceptable to students, teachers, and parents, FRANK friends was preferred over +FRANK. There is, therefore, sufficient evidence to warrant a full-scale cluster-randomised controlled trial of FRANK friends.
Original languageEnglish
Pages (from-to)1
Number of pages1
Issue numberSPEC.ISS 1
Publication statusPublished - 1 Nov 2017
Externally publishedYes


  • illicit drug
  • child
  • conference abstract
  • controlled study
  • exploratory research
  • follow up
  • friend
  • human
  • interview
  • learning
  • major clinical study
  • outcome assessment
  • randomized controlled trial
  • research ethics
  • school child
  • smoking prevention
  • sociology
  • student retention
  • teacher
  • Wales


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