Interventions for adolescent AOD use: Publication guide

Below are some abstracts from publications from the library collection. Please contact us for more information.

Champion, K. E., Newton, N. C., Barrett, E. L., & Teesson, M. (2013). A systematic review of school‐based alcohol and other drug prevention programs facilitated by computers or the Internet. Drug and Alcohol Review, 32(2), 115-123.

Issues: The use of alcohol and drugs amongst young people is a serious concern and the need for effective prevention is clear. This paper identifies and describes current school‐based alcohol and other drug prevention programs facilitated by computers or the Internet. Approach: The Cochrane Library, PsycINFO and PubMed databases were searched in March 2012. Additional materials were obtained from reference lists of papers. Studies were included if they described an Internet‐ or computer‐based prevention program for alcohol or other drugs delivered in schools. Key Findings: Twelve trials of 10 programs were identified. Seven trials evaluated Internet‐based programs and five delivered an intervention via CD‐ROM. The interventions targeted alcohol, cannabis and tobacco. Data to calculate effect size and odds ratios were unavailable for three programs. Of the seven programs with available data, six achieved reductions in alcohol, cannabis or tobacco use at post intervention and/or follow up. Two interventions were associated with decreased intentions to use tobacco, and two significantly increased alcohol and drug‐related knowledge. Conclusion: This is the first study to review the efficacy of school‐based drug and alcohol prevention programs delivered online or via computers. Findings indicate that existing computer‐ and Internet‐based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the Internet offer a promising delivery method for school‐based prevention.

Champion, K. E., Newton, N. C., Stapinski, L. A., & Teesson, M. (2016). Effectiveness of a universal internet‐based prevention program for ecstasy and new psychoactive substances: a cluster randomized controlled trial. Addiction, 111(8), 1396-1405.

To evaluate the effectiveness of an online school‐based prevention program for ecstasy (MDMA) and new psychoactive substances (NPS). Cluster randomized controlled trial with two groups (intervention and control). Eleven secondary schools in Australia. A total of 1126 students (mean age: 14.9 years). The internet‐based Climate Schools: Ecstasy and Emerging Drugs module uses cartoon storylines to convey information about harmful drug use. It was delivered once weekly, during a 4‐week period, during health education classes. Control schools received health education as usual. Primary outcomes were self‐reported intentions to use ecstasy and NPS at 12 months. Secondary outcomes were ecstasy and NPS knowledge and life‐time use of ecstasy and NPS. Surveys were administered at baseline, post‐intervention and 6 and 12 month post‐baseline. At 12 months, the proportion of students likely to use NPS was significantly greater in the control group (1.8%) than the intervention group [0.5%; odds ratio (OR) = 10.17, 95% confidence interval (CI) = 1.31–78.91]. However, students’ intentions to use ecstasy did not differ significantly between groups (control = 2.1%, intervention = 1.6%; OR = 5.91, 95% CI = 1.01–34.73). There was a significant group difference in the change from baseline to post‐test for NPS knowledge (β = −0.42, 95% CI = −0.62 to −0.21, Cohen’s d= 0.77), with controls [mean = 2.78, standard deviation (SD = 1.48] scoring lower than intervention students (mean = 3.85, SD = 1.49). There was also evidence of a significant group difference in ecstasy knowledge at post‐test (control: mean = 9.57, SD = 3.31; intervention: mean = 11.57, SD = 3.61; β = −0.54, 95% CI = −0.97 to −0.12, P= 0.01, d= 0.73). The Climate Schools: Ecstasy and Emerging Drugs module, a universal online school‐based prevention program, appeared to reduce students’ intentions to use new psychoactive substances and increased knowledge about ecstasy and new psychoactive substances in the short term

Doumas, D. M. (2015). Web-based personalized feedback: is this an appropriate approach for reducing drinking among high school students?. Journal of Substance Abuse Treatment, 50, 76-80.

Research indicates that brief Web-based personalized feedback interventions are effective in reducing alcohol use and the negative associated consequences among college students. It is not clear, however, that this is an appropriate strategy for high school students. This study examined high school students’ perceptions of a brief Web-based personalized feedback program to assess the appropriateness of this approach for this age group. Results indicated that the majority of students found the program to be user-friendly and to have high utility. Additionally, students reporting alcohol use found the program more useful and indicated that they would be more likely to recommend the program to other students relative to non-drinkers. Findings support the appropriateness of this approach for high school students, and suggest that Web-based personalized feedback may be more positively perceived by students who have initiated drinking.

Krist, L., Lotz, F., Bürger, C., Ströbele‐Benschop, N., Roll, S., Rieckmann, N., … & Müller‐Riemenschneider, F. (2016). Long‐term effectiveness of a combined student—parent and a student‐only smoking prevention intervention among 7th grade school children in Berlin, Germany. Addiction, 111(12), 2219-2229.

In Germany, the smoking prevalence among adolescents is among the highest in Europe. Our aim was to evaluate the long‐term effectiveness of a combined student–parent and a student‐only smoking prevention programme to reduce the smoking prevalence among 7th grade students in Berlin. Three‐armed cluster‐randomized controlled trial (RCT). Schools as cluster units were randomized into (i) student intervention, (ii) combined student–parent intervention or (iii) control group, with follow‐up after 12 and 24 months. High schools and integrated secondary schools in Berlin, Germany. Seventh grade students aged 11–16 years. We included 47 schools, 161 classes and 2801 students [50.1% girls, mean age ± standard deviation (SD) = 13.0 ± 0.6 years]. The primary outcome was self‐reported regular smoking (at least one cigarette per day) after 24 months (point prevalence). Further self‐reported outcomes were other smoking behaviours as well as parental rules and attitudes towards smoking. Comparisons were calculated as odds ratios (OR) with 95% confidence intervals (CI). At baseline, 2.3% of the students reported that they smoked regularly. After 24 months, 7.8% and 7.0% were regular smokers in the student–only intervention and the student–parent intervention, respectively, compared with 10.1% in the control group. The OR for being a regular smoker was 0.81 (0.34–1.92) for the student–parent intervention versus control, 0.95 (CI = 0.41–2.22) for the student‐only intervention versus control and 0.85 (0.38–1.89) for student–parent intervention versus student‐only intervention. A combined student–parent smoking prevention intervention delivered via secondary schools in Berlin, Germany did not result in a statistically significant reduction in regular smoking compared with a control group or a student‐only intervention. The student‐only intervention did not result in a significant reduction in regular smoking compared with the control group.

Lammers, J., Goossens, F., Conrod, P., Engels, R., Wiers, R. W., & Kleinjan, M. (2015). Effectiveness of a selective intervention program targeting personality risk factors for alcohol misuse among young adolescents: results of a cluster randomized controlled trial. Addiction, 110(7), 1101-1109.

The effectiveness of Preventure was tested on drinking behaviour of young adolescents in secondary education in the Netherlands. A cluster randomized controlled trial was carried out, with participants assigned randomly to a two‐session coping skills intervention or a control no‐intervention condition. Fifteen secondary schools throughout the Netherlands; seven schools in the intervention and eight schools in the control condition. A total of 699 adolescents aged 13–15 years participated, 343 allocated to the intervention and 356 to the control condition, with drinking experience and elevated scores in either negative thinking, anxiety sensitivity, impulsivity or sensation‐seeking. Preventure is a selective school‐based alcohol prevention programme targeting personality risk factors. The comparator was a no‐intervention control. The effects of the intervention on the primary outcome past‐month binge drinking, and the secondary outcomes binge drinking frequency, alcohol use, alcohol frequency and problem drinking, were examined. The primary analyses of interest were intervention main effects at 12 months post‐intervention. In addition, intervention effects on the linear development of binge drinking using a latent‐growth curve approach were examined. Binge drinking rates were not significantly different between the intervention (42.9%) and control group (49.2%) at 12 months follow‐up. Intention‐to‐treat analyses revealed no significant intervention effects on alcohol use (53.9 versus 61.5%; OR = 0.99, CI = 0.86, 1.14) and problem drinking (37.0 versus 44.7%; OR = 1.03, CI = 0.92, 1.10) at 12 months follow‐up. The post‐hoclatent‐growth analyses revealed significant effects on the development of binge drinking (β= –0.16, P= 0.05), and binge drinking frequency (β= –0.14, P= 0.05). The alcohol prevention programme, Preventure, appears to have little or no effect on overall prevalence of binge drinking in adolescents in the Netherlands but may reduce the development of binge drinking over time.

MacArthur, G. J., Harrison, S., Caldwell, D. M., Hickman, M., & Campbell, R. (2016). Peer‐led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years: a systematic review and meta‐analysis. Addiction, 111(3), 391-407.

Peer‐led interventions may offer a beneficial approach in preventing substance use, but their impact has not yet been quantified. We conducted a systematic review to investigate and quantify the effect of peer‐led interventions that sought to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years. Medline, EMBASE, PsycINFO, CINAHL, ERIC and the Cochrane Library were searched from inception to July2015 without language restriction. We included randomized controlled trials only. Screening and data extraction were conducted in duplicate and data from eligible studies were pooled in a random effects meta‐analysis. We identified 17 eligible studies, approximately half of which were school‐based studies targeting tobacco use among adolescents. Ten studies targeting tobacco use could be pooled, representing 13 706 young people in 220 schools. Meta‐analysis demonstrated that the odds of smoking were lower among those receiving the peer‐led intervention compared with control [odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62–0.99, P= 0.040]. There was evidence of heterogeneity (I2= 41%, χ215.17, P= 0.086). Pooling of six studies representing 1699 individuals in 66 schools demonstrated that peer‐led interventions were also associated with benefit in relation to alcohol use (OR = 0.80, 95% CI = 0.65–0.99, P= 0.036), while three studies (n= 976 students in 38 schools) suggested an association with lower odds of cannabis use (OR = 0.70, 0.50–0.97, P= 0.034). No studies were found that targeted other illicit drug use. Peer interventions may be effective in preventing tobacco, alcohol and possibly cannabis use among adolescents, although the evidence base is limited overall, and is characterized mainly by small studies of low quality.

Mahu, I. T., Doucet, C., O’Leary‐Barrett, M., & Conrod, P. J. (2015). Can cannabis use be prevented by targeting personality risk in schools? Twenty‐four‐month outcome of the adventure trial on cannabis use: a cluster‐randomized controlled trial. Addiction, 110(10), 1625-1633.

To examine the effectiveness of a personality‐targeted intervention program (Adventure trial) delivered by trained teachers to high‐risk (HR) high‐school students on reducing marijuana use and frequency of use. A cluster‐randomized controlled trial. Secondary schools in London, UK. Twenty‐one secondary schools were randomized to intervention (n= 12) or control (n= 9) conditions, encompassing a total of 1038 HR students in the ninth grade [mean (standard deviation) age = 13.7 (0.33) years]. Brief personality‐targeted interventions to students with one of four HR profiles: anxiety sensitivity, hopelessness, impulsivity and sensation‐seeking. Primary outcome: marijuana use. Secondary outcome: frequency of use. Assessed using the Reckless Behaviour Questionnaire at intervals of 6 months for 2 years. Personality risk was measured with the Substance Use Risk Profile Scale. Logistic regression analysis revealed significant intervention effects on cannabis use rates at the 6‐month follow‐up in the intent‐to‐treat sample [odds ratio (OR) = 0.67, P= 0.05, 95% confidence interval (CI) = 0.45–1.0] and significant reductions in frequency of use at 12‐ and 18‐month follow‐up (β = –0.14, P≤ 0.05, 95% CI = –0.6 to –0.01; β = –0.12, P≤ 0.05, 95% CI = –0.54 to 0.0), but this was not supported in two‐part latent growth models. Subgroup analyses (both logistic and two‐part models) reveal that the sensation‐seeking intervention delayed the onset of cannabis use among sensation seekers (OR = 0.25, β = –0.833, standard error = 0.342, P= 0.015). Personality‐targeted interventions can be delivered effectively by trained school staff to delay marijuana use onset among a subset of high‐risk teenagers: sensation‐seekers.

Newton, N. C., Champion, K. E., Slade, T., Chapman, C., Stapinski, L., Koning, I., … & Teesson, M. (2017). A systematic review of combined student‐and parent‐based programs to prevent alcohol and other drug use among adolescents. Drug and Alcohol Review, 36(3), 337-351.

Issues .Alcohol and other drug use among adolescents is a serious concern, and effective prevention is critical. Research indicates that expanding school‐based prevention programs to include parenting components could increase prevention outcomes. This paper aims to identify and describe existing combined student‐ and parent‐based programs for the prevention of alcohol and other drug use to evaluate the efficacy of existing programs. Approach. The PsycINFO, Medline, Central Register of Controlled trials and Cochrane databases were searched in April 2015 and additional articles were obtained from reference lists. Studies were included if they evaluated a combined universal intervention for students (aged 11–18 years old) and their parents designed to prevent alcohol and/or other drug use, and were delivered in a school‐based setting. Risk of bias was assessed by two independent reviewers. Because of the heterogeneity of the included studies, it was not possible to conduct a meta‐analysis and a qualitative description of the studies was provided. Key Findings. From a total of 1654 screened papers, 22 research papers met inclusion criteria, which included 13 trials of 10 programs. Of these, nine programs demonstrated significant intervention effects in terms of delaying or reducing adolescent alcohol and/or other drug use in at least one trial. Conclusion. This is the first review of combined student‐ and parent‐based interventions to prevent and reduce alcohol and other drug use. Whilst existing combined student‐ and parent‐based programs have shown promising results, key gaps in the literature have been identified and are discussed in the context of the development of future prevention programs.

Quek, L. H., White, A., Low, C., Brown, J., Dalton, N., Dow, D., & Connor, J. P. (2012). Good choices, great future: an applied theatre prevention program to reduce alcohol‐related risky behaviours during Schoolies. Drug and Alcohol Review, 31(7), 897-902.

Introduction and Aims. The contextual and temporal factors of post‐school celebratory events (‘Schoolies’) place young people at elevated risk of excessive drinking compared with other social occasions. This study investigates the impact of an applied theatre prevention program ‘Choices’ in reducing the risk of drinking and other risk behaviours during Schoolies celebrations. Design and Methods. Choices was delivered in the last term of Year 12 across 28 North Queensland schools. A total of 352 school leavers (43.1% male, mean age = 17.14 years) completed a questionnaire at Whitsunday Schoolies, Queensland, Australia on 23–24 November 2010. Nearly 49% of respondents had attended Choices. The survey included measures of alcohol use, illicit drug use and associated problems during Schoolies and a month prior to Schoolies. Results. After controlling for gender and pre‐Schoolies drinking, school leavers who attended Choices were significantly less likely to report illicit drug use (OR = 0.51, P < 0.05) and problem behaviours (OR = 0.40, P < 0.01) than those who did not attend Choices. There was, however, no intervention effect in risky drinking (i.e. drank on 5 or more days, typical amount five or more standard drink and binge drank on 3 or more days) at Schoolies (OR = 0.92, P = 0.80). Discussion and Conclusions. Delivery of a youth‐specific applied theatre prevention program employing a harm minimisation framework may be effective in reducing high‐risk behaviours associated with alcohol consumption at celebratory events, even if young people expect to engage in excessive alcohol consumption.

Stapinski, L. A., Reda, B., Newton, N. C., Lawler, S., Rodriguez, D., Chapman, C., & Teesson, M. (2018). Development and evaluation of ‘Pure Rush’: An online serious game for drug education. Drug and Alcohol Review, 37, S420-S428.

Learning is most effective when it is active, enjoyable and incorporates feedback. Past research demonstrates that serious games are prime candidates to utilise these principles, however the potential benefits of this approach for delivering drug education are yet to be examined in Australia, a country where drug education in schools is mandatory. The serious game ‘Pure Rush’ was developed across three stages. First, formative consultation was conducted with 115 students (67% male, aged 15–17 years), followed by feasibility and acceptability testing of a prototype of the game (n= 25, 68% male). In the final stage, 281 students (62% female, aged 13–16 years) were randomly allocated to receive a lesson involving Pure Rush or an active control lesson. The lessons were compared in terms of learning outcomes, lesson engagement and future intentions to use illicit drugs. Students enjoyed playing Pure Rush, found the game age‐appropriate and the information useful to them. Both the Pure Rush and the active control were associated with significant knowledge increase from pre to post‐test. Among females, multi‐level mixed‐effects regression showed knowledge gain was greater in the Pure Rush condition compared to control (β= 2.36, 95% confidence interval 0.36–4.38). There was no evidence of between condition differences in lesson engagement or future intentions to use illicit drugs. Pure Rush is an innovative online drug education game that is well received by students and feasible to implement in schools

Stewart, D. G., Felleman, B. I., & Arger, C. A. (2015). Effectiveness of motivational incentives for adolescent marijuana users in a school-based intervention. Journal of Substance Abuse Treatment, 58, 43-50.

Purpose: This study examined whether adolescents receiving Motivational Interviewing (MI) intervention have different outcomes compared to those receiving Motivational Incentives (Motivational Interviewing combined with Contingency Management; MI + CM). Method: A total of 136 adolescents (from a parent study of 220 adolescents) with problematic substance use were recruited from 8 high schools in Washington State, where they completed either 8-weeks of MI or MI + CM. Frequency of marijuana use was assessed at baseline, at the end-of-treatment, and at 16-week follow-up. Results: A balanced and matched sample was created using propensity scores, then analyzed using Hierarchical Linear Modeling (HLM). Multilevel regression analyses revealed that adolescents who received MI + CM exhibited a greater reduction in use across time (p < .05). Reductions at the end-of-treatment were greater for the MI + CM condition (Cohen’s d = − .82) compared to MI alone (Cohen’s d = − .33), but did not differ at 16-week follow-up. Adolescents receiving MI + CM showed significantly fewer negative consequences of marijuana use at the end-of-treatment (t1, 124 = 2.26, p < .05), higher use of coping strategies (t1, 124 = 3.01, p < .01), and increased likelihood to attend additional treatment for substance use (χ2 1, 124 = 4.12 p < .05), though hypothesized improvements in motivation and school attendance were not found. Use of coping strategies at the end-of-treatment had a significant indirect effect on the relationship between the intervention condition and marijuana use at the end-of-treatment (F3, 121 = 10.20, R2 = .20, p < .01). Conclusion: These results suggest that the inclusion of contingencies into adolescent marijuana treatment decreases the end-of-treatment frequency of marijuana use and related consequences while increasing the use of coping strategies and the pursuit of additional treatment.

Stewart, D. G., Siebert, E. C., Arlt, V. K., Moise-Campbell, C., & Lehinger, E. (2016). READY or not: findings from a school-based MI intervention for adolescent substance use. Journal of Substance Abuse Treatment, 71, 23-29.

We aimed to examine the impact of a school-based Motivational Interviewing (MI) intervention, Project READY, on reducing adolescent substance use. We randomly assigned students (N = 244) to receive the intervention immediately (READY First) or to be in a waitlist control group (WLC). Those in WLC received the intervention once those in READY First had completed the intervention. Our hypotheses were: (1) adolescents in READY First would make greater initial reductions in their alcohol and marijuana use compared to adolescents assigned to WLC, (2) adolescents in READY First would make greater initial reductions in their alcohol and marijuana-related consequences compared to adolescents assigned to WLC, and (3) upon completing treatment, adolescents assigned to WLC would yield substance-related outcomes comparable to their peers in the READY First group. We found that those in READY First made greater initial decreases in their marijuana use and substance-related consequences upon completing treatment than participants in WLC, during the first phase of the study. Once both groups had completed the active intervention, those in the WLC had comparable marijuana use to those in READY First. At enrollment, daily marijuana users were equally represented in both groups. Post-treatment, significantly fewer participants reported daily marijuana use in the READY First group, prior to treatment initiation for WLC. Comparable reductions were observed once WLC began treatment. Those in WLC were observed to make reductions in their alcohol use at the same rate as those in READY First, prior to treatment initiation. Participants were not observed to make differential reductions in alcohol use based on group assignment. The findings from this study support the effectiveness of school-based MI interventions for adolescent marijuana use and provide evidence that MI is a critical and effective component within such interventions.

Teesson, M., Newton, N. C., & Barrett, E. L. (2012). Australian school‐based prevention programs for alcohol and other drugs: A systematic review. Drug and Alcohol Review, 31(6), 731-736.

Issues. To reduce the occurrence and costs related to substance use and associated harms it is important to intervene early. Although a number of international school‐based prevention programs exist, the majority show minimal effects in reducing drug use and related harms. Given the emphasis on early intervention and prevention in Australia, it is timely to review the programs currently trialled in Australian schools. This paper reports the type and efficacy of Australian school‐based prevention programs for alcohol and other drugs. Approach. Cochrane, PsychInfo and PubMed databases were searched. Additional materials were obtained from authors, websites and reference lists. Studies were selected if they described programs developed and trialled in Australia that address prevention of alcohol and other drug use in schools. Key Findings. Eight trials of seven intervention programs were identified. The programs targeted alcohol, cannabis and tobacco and most were based on social learning principles. All were universal. Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use at follow up. Conclusion. Existing school‐based prevention programs have shown to be efficacious in the Australian context. However, there are only a few programs available, and these require further evaluative research. This is critical, given that substance use is such a significant public health problem. The findings challenge the commonly held view that school‐based prevention programs are not effective

Turhan, A., Onrust, S. A., ten Klooster, P. M., & Pieterse, M. E. (2017). A school‐based programme for tobacco and alcohol prevention in special education: effectiveness of the modified ‘healthy school and drugs’ intervention and moderation by school subtype. Addiction, 112(3), 533-543.

To test the effectiveness of the Healthy School and Drugs (HSD) programme on tobacco and alcohol use in Dutch secondary special education (SE) schools, and whether this depends upon subtypes of SE schools and the level of implementation. In a quasi‐experimental design with baseline and post‐treatment follow‐up, 363 students were allocated arbitrarily or depending on teacher motivation to either intervention condition (n= 205) or usual curriculum (n= 158). Thirteen secondary SE schools spread throughout the Netherlands. Participants were recruited during the autumn of 2013 from three school subtypes: SE for adolescents with intellectual/physical disabilities (SEI; n= 13), behavioural/emotional difficulties (SEB; n= 136) and learning disabilities/developmental disorders (SEL; n= 214). Self‐reported life‐time smoking prevalence and life‐time drinking frequency as outcomes, and school subtype (SEL/SEB) and implementation fidelity (high/low) as moderators. No significant differences were found at follow‐up in life‐time smoking [odds ratio (OR) = 1.52; 95% confidence interval (CI) = 0.74–3.12] and drinking frequency (d= 0.01; 95% CI = −0.16 to 0.18). Interaction analyses revealed adverse effects in SEB students for alcohol use (d= 0.43; 95% CI = 0.16–0.69). Effect on tobacco refusal self‐efficacy was moderated positively by implementation fidelity (d= 0.35; 95% CI = 0.07–0.63). The Healthy School and Drugs programme adapted for secondary special education in the Netherlands lacked clear evidence for effects on all outcomes. This pilot study suggests further that, within special education, substance use interventions may need to be targeted at school subtypes, as these may have harmful effects among students with behavioural difficulties. Finally, limited evidence was found that programme effectiveness may depend upon implementation fidelity.

Winters, K. C., Fahnhorst, T., Botzet, A., Lee, S., & Lalone, B. (2012). Brief intervention for drug-abusing adolescents in a school setting: Outcomes and mediating factors. Journal of Substance Abuse Treatment, 42(3), 279-288.

This randomized controlled trial evaluated the use of two brief intervention conditions for adolescents (aged 12–18 years) who have been identified in a school setting as abusing alcohol and other drugs. Adolescents and their parents (N= 315) were randomly assigned to receive either a two-session adolescent-only (BI-A), two-session adolescent and additional parent session (BI-AP), or assessment-only control condition (CON). Interventions were manually guided and delivered in a school setting by trained counselors. Adolescents and parents were assessed at intake and at 6 months following the completion of the intervention. Analyses of relative (change from intake to 6 months) and absolute (status at 6 months) outcome variables indicated that for the most part, adolescents in the BI-A and BI-AP conditions showed significantly more reductions in drug use behaviors compared with the CON group. In addition, youth receiving the BI-AP condition showed significantly better outcomes compared with the BI-A group on several variables. Problem-solving skills and use of additional counseling services mediated outcome. The value of a school-based brief intervention for students is discussed.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s