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The effectiveness of a school-based substance abuse prevention program: 18-Month follow-up of the EU-Dap cluster randomized controlled trial
Abstract
Aim: To evaluate the effectiveness of a school-based substance abuse prevention program developed in
the EU-Dap study (EUropean Drug Addiction Prevention trial).
Materials and methods: Cluster Randomized Controlled Trial. Seven European countries participated in the
study; 170 schools (7079 pupils 12–14 years of age) were randomly assigned to one of three experimental
conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h
curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and
current substance use was conducted before the implementation of the program, while a post-test survey
was carried out about 18 months after the pre-test. The association between program condition and
change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated
by multilevel regression models.
Results: Persisting beneficial program effects were found for episodes of drunkenness (any, POR = 0.80;
0.67–0.97; frequent, POR = 0.62; 0.47–0.81) and for frequent cannabis use in the past 30 days (POR = 0.74;
0.53–1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term
follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption
to a lower extent than those in the control condition, but no difference was detected in the proportion
of quitters or reducers among baseline daily smokers.
Conclusion: The experimental evaluation of an innovative school curriculum based on a comprehensive
social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for
cannabis use, but not for cigarette smoking.
... Aunque no mostrara una reducción general del consumo de alcohol, los no bebedores y bebedores ocasio-nales del GI progresaban hacia un consumo frecuente con menos frecuencia que en GC (Caria et al., 2011). A los 18 meses, la reducción del riesgo de episodios de embriaguez seguía persistiendo (Faggiano et al., 2010). ...
... Asimismo, se ha mostrado una reducción en el número de cigarros diarios (Faggiano et al., 2008b). Este efecto desapareció a los 18 meses (Faggiano et al., 2010), aunque la intervención era eficaz para prevenir que los no fumadores comenzaran a fumar en comparación con GC (Faggiano et al., 2008b(Faggiano et al., , 2010. ...
... Asimismo, se ha mostrado una reducción en el número de cigarros diarios (Faggiano et al., 2008b). Este efecto desapareció a los 18 meses (Faggiano et al., 2010), aunque la intervención era eficaz para prevenir que los no fumadores comenzaran a fumar en comparación con GC (Faggiano et al., 2008b(Faggiano et al., , 2010. ...
The school environment is of great relevance in the prevention of drug use in students because it is where they spend most of their time and, since education is compulsory until upper secondary school in Spain, interventions in this area can reach the majority of children up to that stage. The objective of this systematic review is to determine the level of efficacy of the school preventive programs that have been implemented in Spain. Following the PRISMA recommendations, a systematic literature search was carried out in the Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases. The search yielded 274 studies, of which 29 studies were selected. It was found that 48 drug addiction prevention programs have been implemented in Spanish school context, of which only 18 (37.5%) had an evaluation of their effectiveness following the criteria and standards of effective prevention. Conversely, the programs that were not evaluated are far from these standards in their design. It is concluded that there are two models of school prevention of drug addiction in Spain: a model that meets this description; and another model classified as "pseudo-prevention", since its design does not meet the standards of effective prevention nor has its preventive efficacy been demonstrated. El ámbito escolar adquiere una gran relevancia en la prevención del consumo de drogas en estudiantes, ya que es donde pasan una mayor parte del tiempo y, puesto que en España la enseñanza es obligatoria hasta los 16 años, las intervenciones en este ámbito pueden alcanzar a la mayoría de niños en esa etapa. El objetivo de esta revisión sistemática fue determinar qué nivel de eficacia presentan los programas preventivos escolares que se han implementado en España. Siguiendo las recomendaciones PRISMA, se llevó a cabo una búsqueda bibliográfica sistemática en las bases de datos Web of Science, PubMed/MEDLINE, Embase, Scopus y Cochrane Library. La búsqueda arrojó 274 estudios, de los cuales fueron seleccionados 29 estudios. Se ha identificado que en España se han implementado 48 programas preventivos en drogodependencias en el contexto escolar, de los cuales tan solo 18 (37,5%) cuentan con evaluación de su eficacia siguiendo los criterios y estándares de una prevención eficaz. Por el contrario, los programas que no han sido evaluados distan en su diseño de estos estándares. Se concluye que en España conviven dos modelos de prevención escolar de las drogodependencias: un modelo que responde a esta denominación; y otro modelo calificado como "pseudo-prevención", dado que su diseño no se ajusta a los estándares de la prevención eficaz ni su eficacia preventiva ha sido demostrada. Palabras clave: programas preventivos, ámbito escolar, intervención, evaluación de eficacia, revisión sistemática ■ Recibido: Mayo 2023; Aceptado: Octubre 2023. ■ Enviar correspondencia a: Víctor José Villanueva-Blasco. Universidad
... The second category encompasses interventions that teach social skills (e.g., communication skills, developing healthy relationships (Griffin et al., 2006a). Life Skills Training (Griffin et al., 2006b), Unplugged (Faggiano et al., 2010), the Climate Schools program (Newton et al., 2022; are some wellknown examples of preventive programs developed based on social theoretical models and focus on social competence in adolescents. ...
... Using the aforementioned criteria, a total of 22 [unique] interventions out of 101 eligible prevention trials (Table 1, See Fig. 4) were extracted and analyzed in terms of the type of intervention developed or applied (the specific term coined for the interventional program) as well as their content explained by their authors (Table 2). Although our initial search yielded various interventions that were successfully implemented for students, such as the Unplugged (Faggiano et al., 2010), the Illicit Project Rezapour et al. Neuroscience and Biobehavioral Reviews xxx (xxxx) 105578 Table 1 Selected substance use disorder preventive interventions (n=22) and the provided details about their components. ...
... Firstly, this review exclusively focused on school-based preventive interventions implemented on non-user students aged between 13 and 18 years in a randomized trial. Several well-known interventions, such as Unplugged (Faggiano et al., 2010), Fresh Start (Onrust et al., 2018, All Stars (Giles et al., 2010), and Illicit Project (Debenham et al., 2020), were excluded. This exclusion was because they involved parents, included an early adult population (>18 years), were delivered in pilot or feasibility studies, assessed measures other than alcohol or drug-related variables (e.g., sexual behaviors or violence), or were conducted in settings other than schools (e.g., community-based or after-school programs). ...
... The second category encompasses interventions that teach social skills (e.g., communication skills, developing healthy relationships (Griffin et al., 2006a). Life Skills Training (Griffin et al., 2006b), Unplugged (Faggiano et al., 2010), the Climate Schools program (Newton et al., 2022;2020) are some well-known examples of preventive programs developed based on social theoretical models and focus on social competence in adolescents. ...
... Using the aforementioned criteria, a total of 22 [unique] interventions out of 101 eligible prevention trials (Table 1, See Fig. 4) were extracted and analyzed in terms of the type of intervention developed or applied (the specific term coined for the interventional program) as well as their content explained by their authors (Table 2). Although our initial search yielded various interventions that were successfully implemented for students, such as the Unplugged (Faggiano et al., 2010), the Illicit Project (Debenham et al., 2020), and the Just Say Know programs Meredith et al., (2021), they couldn't be included in the review. This exclusion was due to their involvement of parents, recruitment of individuals aged >18, or evaluation of effectiveness in a pilot study rather than a randomized trial. ...
... Firstly, this review exclusively focused on school-based preventive interventions implemented on non-user students aged between 13 and 18 years in a randomized trial. Several well-known interventions, such as Unplugged (Faggiano et al., 2010), Fresh Start (Onrust et al., 2018, All Stars (Giles et al., 2010), and Illicit Project (Debenham et al., 2020), were excluded. This exclusion was because they involved parents, included an early adult population (>18 years), were delivered in pilot or feasibility studies, assessed measures other than alcohol or drug-related variables (e.g., sexual behaviors or violence), or were conducted in settings other than schools (e.g., community-based or after-school programs). ...
... Unplugged has demonstrated effectiveness, at 18-month follow-up, in reducing episodes of drunkenness (any episodes of drunkenness: Prevalence Odd Ratio (POR) = 0.80 [0.67-0.97]) and marijuana use (frequent cannabis use in the past 30 days: POR = 0.74 [0.53-1.00]) in schools from Italy, Greece, Spain, Austria, Belgium, Germany, and Sweden (Faggiano et al., 2010). Although, daily cigarette smoking was affected by the program at short-term (Faggiano et al., 2008), as it was not at 18-month follow-up (Faggiano et al., 2010). ...
... and marijuana use (frequent cannabis use in the past 30 days: POR = 0.74 [0.53-1.00]) in schools from Italy, Greece, Spain, Austria, Belgium, Germany, and Sweden (Faggiano et al., 2010). Although, daily cigarette smoking was affected by the program at short-term (Faggiano et al., 2008), as it was not at 18-month follow-up (Faggiano et al., 2010). In Czech Republic, Unplugged was effective in preventing any smoking (OR = 0.75 [0.65-0.87]) ...
... applied to understand the differences with the findings of Unplugged in Europe regarding marijuana, where prevalence is higher (Kokkevi et al., 2014), and where the program was effective in preventing its use (Faggiano et al., 2010). However, more research is needed to understand the lack of effects of the program on cigarette and other drug use -over the long term-in the different contexts where it has been implemented. ...
Objective:
To investigate the mechanisms of the #Tamojunto2.0 program that mediated the prevention of lifetime alcohol and drug use, including drug knowledge, behavioral beliefs, attitudes, decision-making skills, and refusal skills.
Methods:
A cluster-randomized controlled trial was conducted in 73 public middle schools in three Brazilian cities. The sample included 5208 students (49.4 % girls; Mage = 13.2 years). The intervention group attended twelve #Tamojunto2.0 lessons conducted by their previously trained teachers. The control group did not receive any intervention. Data were collected pre-intervention and at the 9-months follow-up. We performed multiple mediation models (for the whole sample, users, and non-users) with a post-estimation adjustment to standard errors to account for nesting. We analyzed all available mediators simultaneously according to each drug: alcohol, binge drinking, tobacco, marijuana, and inhalant lifetime use. To handle missing data, we used the "full-information maximum-likelihood" paradigm.
Results:
Outcomes in the whole sample and among non-users showed that #Tamojunto2.0 indirectly prevented lifetime alcohol use and binge drinking by increasing negative and non-positive alcohol beliefs. Only the direct effect on decreasing lifetime alcohol consumption was statistically significant. However, an indirect increase in binge drinking was observed through knowledge about alcohol, but the direct effect was not statistically significant. No effects were reported for marijuana, tobacco, or inhalants. Among users, no statistically significant effects were found for alcohol or drug use.
Conclusions:
The results suggest that the #Tamojunto2.0 program was only effective in delaying alcohol consumption via increasing negative and non-positive alcohol beliefs. It seems that mediating mechanisms vary depending on contextual characteristics, differences in socializing among adolescents, features of the educational systems, psychosocial conditions, or, fidelity issues of program implementation.
... The EU-Dap (European Drug Abuse Prevention) study was the first European trial designed to evaluate the effectiveness of a new school-based program ("Unplugged") for substance use prevention [20]. A decreased frequency of episodes of drunkenness in the past 30 days was reported by students who participated in the experimental curriculum compared with usual curricula 18 months after baseline [21]. The aim of this paper was to report on the overall program effects on alcohol use and problem drinking at the 18-month follow-up. ...
... The overall frequency of alcohol consumption, however, was not affected by participation in the curriculum. A previous report from this study showed that the program was associated with a reduced frequency of recent episodes of drunkenness [21]. Taken together, these data suggest that the preventive effects of this curriculum concerned problematic drinking rather than the frequency of consumption. ...
... The preventive effects of the EU-Dap curriculum on problem behaviors related to alcohol drinking are in line with previous reports on advanced substance use, such as drunkenness experience and marijuana use [21]. A possible explanation of why this program positively affected problem behaviors rather than frequency of alcohol consumption could be that in this age-group the variability in frequency of alcohol use is very low, because the majority of adolescents drink alcohol only on particular occasions (such as parties). ...
Purpose: School-based substance abuse prevention programs are widespread but are rarely evaluated in
Europe. We aimed to evaluate the effect of a new school-based prevention program against substance use on
the frequency of alcohol consumption and alcohol-related problem behaviors among European students.
Methods: During the school year 2004–2005, a total of 7,079 students aged 12–14 years from 143 schools in
seven European countries participated in this cluster randomized controlled trial. Schools were randomly
assigned to either control (65 schools, 3,532 students) or to a 12-session standardized program based on the
comprehensive social influence model (78 schools, 3,547 students). Alcohol use and frequency of alcoholrelated
problem behaviors were investigated through a self-completed anonymous questionnaire at baseline
and 18 months thereafter. The association between intervention and changes in alcohol-related outcomes
was expressed as odds ratio (OR), estimated by multilevel regression model.
Results: The preventive program was associated with a decreased risk of reporting alcohol-related problems
(OR�.78, 95% confidence intervals [CI]�.63–.98), although this reduction was not statistically significant in
the subgroup of 743 current drinkers at baseline. The risk for alcohol consumption was not modified by
exposure to the program (OR�.93, 95% CI�.79 –1.09). In the intervention group, nondrinkers and occasional
drinkers at baseline progressed toward frequent drinking less often than in the control group.
Conclusions: School curricula based on the comprehensive social-influence model can delay progression to
frequent drinking and reduce occurrence of alcohol-related behavioral problems in European students. These
results, albeit moderate, have potentially useful implications at the population level.
... Assessment of the frequency of current alcohol consumption included five response options, from "never" to "every day". Questions on drug use and episodes of drunkenness covered lifetime, past year and past month experiences, in line with previous studies examining changes in patterns of drug consumption in adolescents in Europe [29]. A test-retest evaluation of the repeatability of the consumption of drugs was conducted before administering these questions in the main study. ...
... Prevalence of the consumption of tobacco, alcohol and cannabis were analyzed in the past 30 days, at 6 and 12 months after intervention. In accordance with previous studies, current substance use (i.e., use in the past 30-days) is an accurate predictor of future use and subsequent escalation of the use of substances [29]. Thus, we used the following categories: (i) daily cigarette smoking; consumption of cigarettes in the last 30 days and in the last 6 months (ii) alcohol consumption in the last 30 days and in the last 6 months; (iii) any cannabis use across the life-spam. ...
... These findings are in line with those found by Faggiano et al. [29], who examined the effect of the Unplugged school program, one of the most innovative school-based programs, which includes a set of life skills such as assertiveness, decision-making and coping strategies, with the purpose of delaying the onset of substance misuse among junior high school students in seven European countries. ...
Tobacco, alcohol and cannabis use are important health problems that contribute greatly to causes of death in worldwide. Early onset of substance use increases rapidly during adolescence and it has been associated with a wide range of adverse events. Because substance use is associated with dramatic consequences, delaying the initiation of substance use among adolescents remains a major public priority. This study examined the effectiveness of a school-based intervention program based on the application of the Reasoning and Rehabilitation V2 (R&R2) program for preventing substance use among adolescents at risk of academic failure. A sample of 142 participants (aged 13–17 years old) who were studying alternative education provision in Spain were randomly allocated to two conditions (68 experimental group, 74 control group). A pre-test survey assessing past and current substance use was conducted prior the implementation of the program, while a post-test survey was conducted about 12 months after the pre-test. The results showed a significant effect of the R&R program in the reduction of cigarette smoking, episodes of drunkenness, alcohol consumption and cannabis use. However, for daily smoking and episodes of drunkenness such benefits showed a reduction over time. These findings offer additional evidence of the effectiveness of the Reasoning and Rehabilitation V2 program in Spanish adolescent students who are exposed to substance use and suggest areas of future research.
... "Unplugged" is a Social Influence universal school curriculum developed and tested in the multicentric European project "EU-Dap" (European Drug Addiction Prevention, www.eudap.net). Results of the European trial revealed short term effects of the program in reducing tobacco, cannabis and drunkenness episodes among students who participated in the experimental curriculum compared with usual curricula, and prolonged effects on drunkenness, alcohol-related problems and cannabis use (Caria et al., 2011;Faggiano et al., 2008Faggiano et al., , 2010. However, since cultural and societal influences may play a crucial role in the effectiveness of prevention programs, there is the need to replicate the evaluation of evidenced-based programs across cultural contexts (Hecht et al., 2003;Spoth et al., 2008). ...
... The choice of the class level instead of the school (the unit of randomization) was justified by two reasons: (a) the Intraclass Correlation Coefficients were larger for classes than for schools; (b) the sample size calculation was done using class ICCs. This approach was already adopted in the analysis of the original EU-Dap trial (Faggiano et al., 2008(Faggiano et al., , 2010 and should result in a more conservative estimate of the effects (Bauer et al., 2006). Since at baseline large differences in prevalence of use among zones were detected, indicators of last month's zone prevalence of tobacco, alcohol and marijuana were derived from the baseline overall database. ...
... Since the prevalence of cigarette use in Nigeria and in our sample was very low, a large prevention effect on this substance was not expected. We rather expected, and then observed, an effect on alcohol use, that was in the Nigerian sample the most used substance, and important effects in preventing excessive alcohol use were observed at short-and mid-term follow-up in the EU-Dap trial (Faggiano et al., 2008(Faggiano et al., , 2010. In the EU-Dap trial, and in the subsequent trial conducted in Czech Republic, significant prevention effects were observed also on marijuana use (Faggiano et al., 2008;Gabrhelik et al., 2012). ...
Background
School-based programs are the most convenient interventions to tackle substance use among youth. “Unplugged” is a Social Influence universal school curriculum developed and tested in the “EU-Dap” project. In 2015, Nigeria implemented a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the effectiveness of “Unplugged” was evaluated through a cluster randomized controlled trial.
Methods
The program was adapted to the Nigerian context, assembling suggestions from monitoring forms and interviews, and performing fidelity checks on content and method. Thirty-two secondary schools were extracted from a list provided by the Federal Ministry of Education, and randomly allocated to intervention and control arms. A self-completed anonymous questionnaire was used for baseline and follow-up surveys. The analysis sample finally included 2685 pupils (mean age 14,2 years). Multilevel models were run to estimate program effects on prevalence of self-reported cigarettes, alcohol, and marijuana use. Mediation analysis was performed to identify possible mediators of program effects on alcohol use.
Results
Unplugged significantly reduced the prevalence of recent alcohol use in intervention vs control pupils. The effect on prevalence of cigarette and marijuana use was not statistically significant. The program prevented progress and encouraged regress across stages of intensity of alcohol use. Negative beliefs, risk perceptions, and class climate mediated the effect of Unplugged on alcohol use.
Conclusions
Unplugged was effective in preventing alcohol use improving beliefs, class climate and risk perceptions among Nigerian students. The implementation of the program at a larger scale in the country should be supported.
... School-based prevention programs have been implemented worldwide with the intention of reducing or delaying the onset of drug use among adolescents, with the most successful models being the ones working on the development of life skills and normative belief changes in relation to drug use (Strøm et al., 2014). To follow international prevention guidelines, the Brazilian Ministry of Health, in partnership with the United Nations Office on Drugs and Crime, decided to invest in the cross-cultural adaptation of a school program called Unplugged (Faggiano et al., 2010), which was renamed to #Tamojunto. Unplugged is a drug use prevention program for adolescents between 12 and 14 years of age, consisting of 12 classes that use interactive methods to work with social and personal skills, knowledge about drugs, and normative beliefs (Van Der Kreeft et al., 2009). ...
... The randomized controlled trial (RCT), conducted in 2014 and 2015 to evaluate the effectiveness of #Tamojunto in the Brazilian context, showed an iatrogenic result for the onset of alcohol consumption, suggesting inadequate cultural adaptations in the components about alcohol (Sanchez et al., 2018). Considering these negative results, the material was readapted so that it would once again reflect the central elements of the European Unplugged (Faggiano et al., 2010). This new version, called #Tamojunto2.0, ...
... One of the basic instruments to formulate this questionnaire was tested by the EU-DAP (European Drug Addiction Prevention Trial) and used in previous studies on the effectiveness of Unplugged (Faggiano et al., 2010). The EU-Dap collects information, knowledge, and opinions on substance use, emphasizing alcohol, tobacco, and other drug use. ...
Background: School-based prevention programs have been implemented worldwide with the intention of reducing or delaying the onset of alcohol and drug use among adolescents. However, their effects need to be evaluated, being essential to use validated and reliable questionnaires for this purpose. This study aimed to verify the semantic validity and reliability of an instrument developed to evaluate the results of a government drug prevention program for schoolchildren called #Tamojunto2.0.
Methods: This is a mixed methods study with quantitative (test-retest, confirmatory factor analysis and non-response evaluation) and qualitative analyses (focus group and field cards). The self-administered questionnaires were used for a sample of 262 eighth-grade students (elementary school II) in 11 classes of four public schools in the city of São Paulo.
Results: The level of agreement was substantial (Kappa 0.60–0.79) or almost perfect (Kappa > 0.8) for almost all questions about the use of marijuana, alcohol, cigarettes, cocaine, crack, and binge drinking. The model fit indices, for almost all secondary outcomes, indicated that the modls underlying each scale, constituted by observed and latent variables, had a good fit adjustument. The focus groups and field cards provided high-quality information that helped the researchers identify the main difficulties in applying and understanding the questions.
Conclusion: The questionnaire showed high factorial validity, reliability and understanding by adolescents. After the necessary changes, identified in this study, the questionnaire will be suitable to evaluate the results of the #Tamojunto2.0 program in a randomized controlled trial.
... The study population consisted of students attending Year 6 (around 12 years old), 7, and 8 (about 14 years old). We target adolescents aged 12-14 because this is when adolescents start experimenting with drugs (especially smoking and alcohol) and because this was the age range of students included in the original evaluation of Unplugged in Europe (30,31). ...
... The unplugged program has been tested in Europe (19,30,31) and Africa (24) with good results. Before our study was implemented, Unplugged was tested in Brazil, exploring the effectiveness of two adaptations with mixed results (25,27,29). ...
Introduction. The consumption of alcohol, tobacco, and marijuana is a public health problem that impacts the cognitive, social, and emotional development of adolescents. Prevention strategies such as the "Unplugged" program are effective in delaying the progression of daily smoking and episodes of drunkenness among adolescents. "Yo Se Lo Que Quiero" (YSLQQ) corresponds to the adaptation of this program to the Chilean context. This study assesses the acceptability and feasibility of implementing this program to the local reality.
Material and methods. This was a cluster-randomized controlled pilot study conducted on six public schools. All consented students attending 6th, 7th, and 8th grades (n = 1,180) participated in the study. The schools were randomly assigned to one of two conditions in a 1:1 ratio: 1) the "YSLQQ" intervention group (n = 526), and 2) the Control group (n = 654). The program consisted of a 12-hour class-based curriculum based on a comprehensive social-influence approach delivered by a trained facilitator. The acceptability and feasibility were assessed in the intervention group at the end of the intervention using questionnaires answered by students and facilitators. The quality and fidelity of the program were evaluated during the implementation using self-ported surveys answered by the facilitators and the assessment of video-recorded sessions rated by external observers. Finally, a pre-test and a post-test survey assessing past and current substance use and risk and protective factors were conducted before and immediately after the program's implementation.
Results. A high proportion of students (49.6%) liked the sessions. 79.2% reported that the YSLQQ helped them learn about the dangers of drugs, while 65.8% reported having more skills to avoid drug use in the future. Regarding students' satisfaction with YSLQQ, 62.9% reported being happy or very happy with the program. Facilitators reported implementing the intervention according to the manual in 73.9% of sessions. Regarding drug use, students who participated in the intervention groups reported a significant reduction in drunkenness in the last year and last 30-day prevalence and also a significant reduction in a lifetime and 30-day prevalence of cannabis use when compared with those students in the control group.
Conclusions. Our results suggest that YSLQQ has adequate acceptability and feasibility to be implemented in the Chilean context, and there were promising results in reducing drunkenness and cannabis use. Future research should confirm these results in a larger RCT study.
Trial registration: NCT04566627
... It includes 12 interactive lessons, applied by trained teachers following standardized education material (van der Kreeft et al., 2009). According to results of the original first European trial, and of replication trials conducted around the world, the program was effective in reducing tobacco, cannabis, drunkenness episodes and alcohol-related problems among students who participated in the experimental curriculum compared with usual curricula (Caria et al., 2011;Faggiano et al., 2008Faggiano et al., , 2010Gabrhelik et al., 2012;Sanchez et al., 2021;Vigna-Taglianti et al., 2021). The program is listed as effective program in systematic reviews (Catalano et al., 2012;Faggiano et al., 2014;Foxcroft & Tsertsvadze, 2011;Tremblay et al., 2020) and in the best practice portal of EMCDDA (https:// www. ...
... This could be true especially for behaviours very prevalent in the country where the experiment is conducted. For example, in the EU-Dap trial, and in subsequent replication trials, significant prevention effects were observed on the most prevalent and socially influenced risk behaviours, such as tobacco smoking (Faggiano et al., 2008;Gabrhelik et al., 2012), excessive alcohol use (Faggiano et al., 2008(Faggiano et al., , 2010, alcohol use (Vigna-Taglianti et al., 2021), and marijuana use (Faggiano et al., 2008;Gabrhelik et al., 2012). Since gambling is very prevalent among Italian adolescents (ESPAD Group, 2020; HBSC Italia, 2020), and it is socially influenced, we expect Unplugged will have a similar effect on gambling than on other highly prevalent risk behaviours. ...
Gambling risk behaviour is an emerging problem among adolescents. “Unplugged” is an effective Social Influence curriculum for preventing substance use among students. This study aims to develop and test a new component focused on gambling added to the Unplugged program. Schools of Piedmont region and Rome city were invited to participate in the study. A self-completed anonymous questionnaire including questions on socio-demographic characteristics, addictive behaviours, beliefs, attitudes and risk perceptions about gambling, normative perceptions, parental practices, school climate, refusal skills, impulsiveness, self-esteem, antisocial behaviours and sensation seeking was prepared for baseline and follow-up surveys. The protocol of the study was submitted and approved by the Novara Ethical Committee and registered in ClinicalTrials.gov (NCT05630157, Protocol ID: 080.742, 11/17/2022). Twenty-nine schools accepted to participate in the study. Sixty-three classes (1325 students) satisfied the eligibility criteria for intervention and were allocated to the intervention arm, and the other 61 (1269 students) were allocated to the control arm. Because of drop-out, absentees, refusals, and invalid questionnaires, data on 1874 students (998 in the intervention and 876 in the control arm), were available for the analysis at baseline. Data management of follow-up questionnaires is in progress. Results of the present study will be useful to clarify the effectiveness of prevention interventions in reducing gambling behaviours among adolescents. Moreover, this will be the first experience of evaluating a new component focused on a different risk behaviour, added to a curriculum previously shown as effective on other risk behaviours.
... Behavioural therapy is more generally used. In addition, even though there are early interventions developed in other countries (Aalborg et al., 2012;Alavijeh et al., 2014;Faggiano et al., 2010;Marsch and Borodovsky, 2016), international guidelines stress the importance of ensuring that interventions are culturally nuanced (UNODC et al., 2016). Studies of community-based drug rehabilitation in the Philippines suggest that a wide variety of programmes may be used, but there are few evidence-based and culturally-nuanced interventions (Hechanova et al., 2018). ...
... Aside from implementing early interventions in communities, programmes can also be implemented in schools and workplaces. Studies elsewhere have shown that preventive interventions in high schools, colleges and universities can decrease substance use among students (Faggiano et al., 2010;Strøm et al., 2014). Early interventions in workplaces have also been found to be effective (Osilla et al., 2010;Tetrick & Winslow, 2015). ...
Objective
The aim of this study was to pilot and evaluate the feasibility of an early intervention programme for low-risk drug users in the Philippines.
Design
The early intervention consists of three sessions delivered by paraprofessionals focusing on stress, wellbeing, substance use, family and drug use and communication skills. The study was conducted in two phases. In the pilot phase, a randomised controlled trial design was used. In the second phase, a larger field cohort evaluation study design was implemented.
Setting
The randomised controlled trial in the first phase was undertaken in four local government units (LGUs). The second phase took place in 13 LGUs in three island clusters in the Philippines.
Methods
In the first phase, 42 low-risk users from three urban and one rural community were randomly assigned to treatment and wait-control groups. In the second phase, 744 low-risk users undertook the programme. In both phases, the pretest and posttest measured recovery skills, life skills, quality of life, perceived family support, wellbeing and intent to use drugs.
Results
In the first phase, analysis of variance with repeated measures revealed significant differences in pretest and posttest scores in recovery skills and quality of life of participants compared to those who did not participate in the programmes. In the second phase, paired-sample t-test revealed significant improvements in terms of recovery skills, life skills, quality of life, perceived family support, wellbeing and intent to use drugs. Path analysis provided support for the programme’s theory of change. Facilitators perceived the programme to be effective and easy to implement.
Conclusions
The study suggests that an early intervention focusing on mental health and substance use delivered by paraprofessionals may be a viable means to reduce drug use and improve mental health in countries such as the Philippines that have little resources and scarce mental health professionals.
... Los datos se recopilaron en el período de febrero a marzo de 2019 a través de un cuestionario de autoinforme anónimo, aplicado por investigadores capacitados en el aula, sin la presencia del docente ni de ningún empleado de la escuela. El cuestionario se adaptó del instrumento desarrollado y probado previamente por el programa de prevención del abuso de drogas de la Unión Europea (EU-DAP) y se utilizó en estudios previos sobre la eficacia de Unplugged (18) . Se utilizó una versión traducida y adaptada al portugués de Brasil (19) , con algunas preguntas reemplazadas por ítems de dos cuestionarios ampliamente utilizados en varios estudios brasileños que evalúan a los estudiantes: un cuestionario de la Organización Mundial de la Salud (OMS), utilizado en la VI Encuesta Brasileña sobre el Uso de Drogas entre Estudiantes (20) y el cuestionario de la Encuesta Nacional de Salud de los Estudiantes, utilizada por el Ministerio de Salud de Brasil (21) . ...
... estrategias específicas para esta etapa de la vida. Se destaca que la inversión en programas de educación en salud dirigidos a la promoción de la salud de adolescentes en el entorno escolar tiene impactos en la reducción del tabaquismo, de los episodios de embriaguez y del uso de drogas, como la marihuana, como se observa en países europeos (18) . ...
Resumen Objetivo: analizar la asociación entre uso de drogas y la insatisfacción con la imagen corporal de adolescentes en tres ciudades brasileñas. Método: estudio transversal, anidado en un ensayo controlado aleatorio para evaluar el programa de prevención del uso de drogas en escuelas brasileñas #TamoJunto2.0 del Ministerio de la Salud. La muestra fue de 5.213 alumnos de 73 escuelas de tres ciudades brasileñas. El desenlace satisfacción corporal se analizó mediante la escala de Siluetas de Stunkard y las variables explicativas fueron el consumo de drogas y los datos sociodemográficos. Resultados: los adolescentes tenían entre 12 y 14 años y alrededor del 69,9% relató insatisfacción corporal, y en el último año el 35,67% consumió alcohol. La insatisfacción por sobrepeso fue mayor en las niñas (41,5%) y por bajo peso en los niños (33,1%). Los adolescentes que consumían marihuana tenían un 39% (OR=1,39) más de probabilidades de estar insatisfechos con el bajo peso y ser niña aumentó en un 24% (OR=1,24) las chances de insatisfacción por sobrepeso. Conclusión: los niveles de insatisfacción corporal merecen atención en el cuidado de enfermería hebiátrica y refuerzan la necesidad de estrategias educativas abordando la imagen corporal y el uso de drogas, relacionándola a los varios atributos subjetivos que pueden afectar la salud de los adolescentes, ya sea en la comunidad o en la escuela.
... Promoting prosocial friend selection and altering descriptive norms may therefore reduce risk of adolescent HED (Brooks-Russell et al., 2014;Hoeben et al., 2021;Patrick et al., 2014). Existing evidence-based interventions have been successful at delaying alcohol use age at onset (Hawkins et al., 1992), correcting overestimates of normative perceptions about alcohol use (Faggiano et al., 2010;Lewis & Neighbors, 2006), and promoting pro-social friend selection and interpersonal skills for addressing peer influences on alcohol use (Faggiano et al., 2010;Hawkins et al., 1992). Results support the implementation, or continued implementation, of such interventions in schools and communities similar to those sampled in the RYDS study. ...
... Promoting prosocial friend selection and altering descriptive norms may therefore reduce risk of adolescent HED (Brooks-Russell et al., 2014;Hoeben et al., 2021;Patrick et al., 2014). Existing evidence-based interventions have been successful at delaying alcohol use age at onset (Hawkins et al., 1992), correcting overestimates of normative perceptions about alcohol use (Faggiano et al., 2010;Lewis & Neighbors, 2006), and promoting pro-social friend selection and interpersonal skills for addressing peer influences on alcohol use (Faggiano et al., 2010;Hawkins et al., 1992). Results support the implementation, or continued implementation, of such interventions in schools and communities similar to those sampled in the RYDS study. ...
Heavy episodic drinking (HED) is a major public health concern, and youth who engage in HED are at increased risk for alcohol-related problems that continue into adulthood. Importantly, there is heterogeneity in the onset and course of adolescent HED, as youth exhibit different trajectories of initiation and progression into heavy drinking. Much of what is known about the etiology of adolescent HED and alcohol-related problems that persist into adulthood comes from studies of predominantly White, middle-class youth. Because alcohol use and related problems vary by race/ethnicity and socioeconomic status, it is unclear whether previous findings are relevant for understanding developmental antecedents and distal consequences of adolescent HED for minoritized individuals. In the current study, we utilize a developmental psychopathology perspective to fill this gap in the literature. Using a racially and economically diverse cohort followed from adolescence well into adulthood, we apply group-based trajectory modeling (GBTM) to identify patterns of involvement in HED from age 14 to 17 years. We then investigate developmental antecedents of GBTM class membership, and alcohol-related distal outcomes in adulthood (∼ age 31 years) associated with GBTM class membership. Results highlight the importance of adolescent alcohol use in predicting future alcohol use in adulthood.
... This selection has been made due to non-individual randomization in cluster-randomized trials and the inclusion of quasi-experimental studies. [35,44] L M L L L L L ALF 2 [45,46] M L L L L L L Rebound [47] M H L L L L L Unplugged [48][49][50][51] M L U L L L L L-Q [52] M L L L L L L F&S 1 [53] M L L L L L L F&S 2 [37] M H H M L L L IPSY 1 [36,[54][55][56][57][58] M L L L L L L IPSY 2 [59] M L L L L L L IPSY 3 [60] M L L L L L L L-Q Lions Quest: erwachsen werden, F&S Fit und Stark. H high, M moderate, L low, U unclear. ...
... The evaluation studies differ in particular regarding the regional location of the schools, the respective types of school, and the age and gender of the participants ( Table 5). All studies except for one evaluation of the program F&S [53] (Schools in Austria, Denmark, Germany, and Luxembourg) and the evaluation of Unplugged [48][49][50][51] (Schools in seven European countries: Austria, Belgium, Germany, Greece, Italy, Spain, and Sweden) have been implemented in Germany. Whereby the locations could not always be localized precisely. ...
In school-based addiction prevention, life skills programs (LSPs) have been established since the 1990s. The scientific evidence regarding program effectiveness is in parts unclear. This review links life skills not to behavioral outcomes but to three facets of the self: the affective evaluative, the dispositional & dynamic, and the cognitive descriptive facet of the self. This complements the evidence on behavioral outcomes. In a systematic literature search we have identified drug-specific life skills programs in German language and their evaluation studies. We have mapped the instruments used to assess effectiveness of the LSP on three facets of the self, which are site of action of intrapersonal skills. We identified six comparable life skills programs that have been evaluated at least once. In five of these programs, different facets of life skills have been assessed with a total of 38 different measurement instruments. We found that improvements in affective evaluative and dispositional & dynamic facets of the self could be stimulated by LSPs, complementing previous evidence focusing on behavioral outcomes. Conclusion: Numerous instruments have been used that are not directly comparable but can be categorized by facets of the self. As a result, it is found that life skills programs can have an impact on building attitude and the shaping of intrapersonal skills. Interpersonal competencies such as communication skills and empathy have not been measured. Furthermore, a consensus on measurement instruments for life skills should be found.
... The questionnaire was adapted from the instrument previously developed and tested by the European Drug Abuse Prevention Trial (EU-Dap) and used in previous studies assessing the effectiveness of Unplugged (18) . ...
... In Brazil, the culture related to alcohol consumption is so permissive in adolescence that, when combined with poor control in the sale of alcoholic drinks, requires investments in studies to assess these vulnerabilities. in European countries (18) . ...
Objective: analyze the association between drug use and body dissatisfaction among adolescents in three Brazilian cities. Method: cross-sectional study, using a nested randomized controlled trial to evaluate the drug use prevention program #TamoJunto2.0 of the Ministry of Health in Brazilian schools. The sample consisted of 5,213 students from 73 schools in three Brazilian cities. The outcome body satisfaction was analyzed using the Stunkard scale and the explanatory variables were drug use and sociodemographic data. Results: the adolescents were between 12 and 14 years old; about 69.9% of them reported body dissatisfaction, and 35.67% used alcohol in the previous year. Dissatisfaction due to overweight was higher among girls (41.5%) and dissatisfaction due to underweight was higher among boys (33.1%). Adolescents who used marijuana were 39% (OR=1.39) more likely to feel dissatisfied due to underweight and being a girl increased the chances of feeling dissatisfied due to overweight by 24% (OR=1.24). Conclusion: the levels of body dissatisfaction deserve attention in hebiatric nursing care and reinforce the importance of educational strategies addressing body image and drug use, relating them to the various subjective attributes that can affect the health of adolescents, whether in the community or at school.
... The fifth-grade questionnaire had approximately 80 questions, and the seventh-grade questionnaire had 50 questions, taking a maximum of 50 min for the students to complete. The instruments were based on the European Drug Addiction Prevention Trial (EU-DAP) questionnaire (Faggiano et al., 2010) and translated and adapted into Brazilian Portuguese (Galvão et al., 2021). The questionnaires have been used in previous studies to evaluate school drug prevention programs in Brazil . ...
... This code was matched across surveys using the Levenshtein algorithm, which can identify similarities between a set of characteristics (Levenshtein, 1965). This matching procedure was previously conducted in drug prevention program evaluations in Europe (Faggiano et al., 2010) and Brazil . ...
This study evaluated the effectiveness of a drug and violence resistance educational program (Programa Educacional de Resistência às Drogas e à Violência—PROERD) on latent substance use profiles over a 9-month follow-up period. Two PROERD curricula were evaluated through a cluster randomized controlled trials with two parts that included a total of 4030 fifth-and seventh-grade students in 30 public schools in São Paulo. The intervention groups received 10 PROERD classes delivered by trained police officers, while the control group received no intervention. The primary outcome measures were drug use (any alcohol use, binge drinking, tobacco, marijuana, and inhalants) in the past 6 months, which was assessed using a pretest and a posttest 9 months later. Latent transition analysis was employed to investigate the effect of the intervention on the probabilities associated with the transition across drug use profiles. Latent drug use profiles are underlying subgroups of individuals similar to each other regarding their pattern of polysubstance use. Two different latent drug use profiles were revealed among the fifth graders (abstainers/low users and alcohol users/binge drinkers) and three drug use profiles among the seventh graders (abstainers/low users, alcohol users/binge drinkers, and polydrug users). For both, there was no evidence of the effect of PROERD on drug transition probabilities. In conclusion, the intervention was not successful in changing transitions across adolescent drug use profiles. Thus, the failure of the intervention to affect students’ substance use profiles suggests that it should be reconsidered before it is implemented further in Brazilian schools.
... Gunther et al. (2006) found that peers' positive comments about smoking fostered participants' smoking habits, whereas peers' negative comments hindered them. The causal relationship between peers' negative comments about smoking and smoking abstinence has also been confirmed in several randomized controlled trials [27][28][29][30] . For example, fifty-nine junior high schools were randomly divided into experimental and control clusters. ...
... First, in the first 3 months, gamblers need to have as many peers as possible and develop a social norm of not gambling. These social norms could be effective in reducing the risks [27][28][29][30][31] . ...
Habit formation occurs in relation to peer habits and comments. This general principle was applied to gambling abstinence in the context of online self-help forums to quit gambling. Participants in this study, conducted between September 2008 and March 2020, were 161 abstinent and 928 non-abstinent gamblers who participated in online self-help chat forums to quit gambling. They received 269,317 comments during their first 3 years of forum participation. Gamblers had an increased likelihood of 3-year continuous gambling abstinence if they had many peers in the forums. However, they had a decreased likelihood of gambling abstinence if they received rejective comments from the forums. Based on these results, online social network-based interventions may be a new treatment option for gamblers.
... To shed lights on the potential impact of class characteristics on quantitative aspects of implementation of a preventive programme, we conducted a secondary analysis of the European Drug Addiction Prevention (EU-DAP) trial. 21 The curriculum evaluated in this trial achieved modest albeit prolonged effects on alcohol problematic drinking and illicit drugs use, 22,23 but was conducted in its entirety by about half of the teachers, 24 thus providing a wide range of implementation completeness and fidelity. ...
... From the questions assessing substance use, 23 we derived three binary indicators of 'any cigarette smoking', 'any cannabis use' and 'any episode of drunkenness' in the past 30 days, respectively. Further, students were asked whether they would expect to improve their grades by the end of the school year. ...
Background: Partial implementation may explain modest effectiveness of many school-based preventive
programmes against substance use. We studied whether specific characteristics of the class could predict the
level of implementation of a curriculum delivered by class teachers in schools from some European countries.
Methods: Secondary analysis of data from an evaluation trial. In seven European countries, 78 schools (173 classes)
were randomly assigned to a 12-unit, interactive, standardized programme based on the comprehensive social
influence model. Curriculum completeness, application fidelity, average unit duration and use of role-play were
monitored using structured report forms. Predictors of implementation were measured by aggregating at class
level information from the baseline student survey. Class size, gender composition, mean age, factors related to
substance use and to affection to school were analysed, with associations estimated by multilevel regression
models. Results: Implementation was not significantly predicted by mean age, proportion of students with
positive academic expectation or liking school. Proportion of boys was associated with a shorter time devoted
to each unit [� =�0.19, 95% confidence intervals (CI) �0.32 to �0.06]. Class size was inversely related to application
fidelity [Odds ratio (OR) 0.92, 95% CI 0.85 to 0.99]. Prevalence of substance use was associated with a
decreased odds of implementing all the curriculum units (OR 0.81, 95% CI 0.65 to 0.99). Students’ connectedness
to their class was associated with increased odds of teachers using role-play (OR 1.52, 95% CI 1.03 to 2.29).
Conclusions: Teachers’ implementation of preventive programmes may be affected by structural and social characteristics
of classes and therefore benefit from organizational strategies and teachers’ training in class
management techniques.
... Additionally, a systematic review of European studies [16] highlighted another program called "Unplugged" implemented in seven countries, where positive results were obtained three months after the end of the intervention and 18 months later. Among these findings, there was a decrease in the frequency of drunkenness and cannabis use compared to controls [17]. ...
... The effectiveness of this program was assessed by its authors over time; In 2010, the intervention was associated with a reduction in the prevalence of drunkenness episodes of around 38% and 26% in the use of marijuana in the last 30 days [17]. In 2011 it was shown to be associated with a decreased risk of reporting alcohol-related problems [21]. ...
Background
Substance use is among the main contributors to disease among children and adolescents in the Americas region. The call for effective prevention of substance use among adolescents has resulted in numerous school-based programs, and particularly the Unplugged program has been proved to be successful in reducing the prevalence of different substances in seven European countries. The purpose of this study is to test the effectiveness of the Unplugged program in Chile (“Yo Sé Lo Que Quiero”).
Methods
This is a cluster randomized controlled trial, parallel-group type, where “Yo Sé Lo Que Quiero” is compared to standard school preventive curricula in control schools. A total of 70 schools and 8400 adolescents are expected to be randomized with 1:1 allocation. During formative work, the Unplugged program was culturally adapted to Chile, and the instrument to assess the primary and secondary outcomes was validated. The effectiveness of this program will be assessed using the European Drug Addiction Prevention Trial Questionnaire (EU-Dap), measuring substance use prevalence and risk and protective factors in baseline, post-intervention, and four months after the end of the intervention.
Discussion
The proposed study will be the first to test the effectiveness of a school-based substance use prevention program in Chile in a cluster randomized control trial and the first study evaluating the Unplugged program in Spanish-speaking Latin America. A model for disseminating the Unplugged program inside Europe already exists and has been implemented successfully in several countries. Thus, if the effects of the program are positive, wide implementation in Chile and Latin American countries is possible soon.
Trial registration
ClinicalTrials.govNCT04236999. Registered on January 17, 2020.
... Studying drug prevalence among secondary school students in metropolis like Douala, Cameroon is of paramount importance due to its potential impact on the students' well-being and academic performance. Research has shown that the living environment of young people is contaminated with various psychoactive substances, emphasizing the need to understand the prevalence and factors associated with substance abuse among adolescents [8]. Another study conducted in Cameroon among medical and nursing students in Cameroon show that they are likely to experience mental health problems due to the stressful nature of their studies, highlighting the importance of addressing substance abuse among students [9]. ...
The escalating prevalence of psychoactive substance use (Pa SU) presents a significant concern in the African context, particularly among schooling adolescents, leading to potential physical and mental health complications, making substance use a giant monster for every developing society. To address this, the study focused on determining the prevalence and understanding the factors associated with psychoactive substance (Pa SU) among secondary school students in the Douala III and Douala IV districts. A cross-sectional study was conducted from January to March 2023, engaging students in secondary schools in the Douala III and Douala IV districts. Utilizing a self-administered questionnaire, comprehensive data on student sociodemographic, parental social information, and patterns of psychoactive substance use were collected. Statistical analyses, performed using SPSS, explored associated factors, with statistical significance set at p < 0.05. Enrolling 1054 students, the study reflected a male-to-female sex ratio of 3:2, with an average age of 15.29 ± 1.9 years (range: 12 to 20 years). Psychoactive substance life tune use (Pa SU) experimentation prevalence reached 91.0%, while current consumption was noted at 42.8%, exhibiting a male predominance. Alcohol emerged as the most frequently consumed substance, succeeded by caffeine and nicotine. Cannabis stood as the sole illicit substance, with tramadol being the only psychotropic medication used without medical guidance. Male gender (AOR = 1.58; CI: 1.07–2.34; p = 0.022), age > 16 years (AOR = 2.94; CI: 2.02–4.27; p < 0.001), the presence of a family member using psychoactive substances at home (AOR = 3.80; CI: 2.61–5.53; p < 0.001), and the presence of a friend using psychoactive substances in the surroundings (AOR = 32.92; CI: 22.02–49.20; p < 0.001) were independently identified as risk factors associated with current PaSU among students. This study provides valuable insights into the prevalence and associated factors of psychoactive substance use among secondary school students in Douala, Cameroon. The results underscore the urgent need for targeted interventions and parental awareness programs to mitigate the impact of psychoactive substance use on adolescents.
... Rights reserved. Caria et al. (2011), Faggiano et al. (2007, 2010 ¿Vivir el momento? Of the 30 programs indexed in best practice portals without efficacy evaluations (81.08%), 28 are classified as low quality, very low quality, or without evidence. ...
The objective was to identify the quality level of school-based drug prevention programs in Spain and their indexing in portals of best practices. The systematic review of program evaluation studies is through Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane Library. Next, a search was carried out in best practice portals (Portal of Good Practices in Reducing the Demand for Drugs and Other Addictions; Evidence-based Prevention; Xchange). Forty-eight programs were identified, but only 18 evaluated their efficacy, 13 being classified as moderate to high quality. Of the total, 37 are indexed in best practice portals, but only seven have efficacy evaluations. Of the rest, 28 are classified as low, very low quality, or no evidence. Eleven programs with efficacy evaluations which were not indexed in these portals were identified. Only four out of 10 evaluated programs have been indexed. In Spain, an evidence-based prevention model coexists with a pseudo-preventive model. Only one in four programs has scientific support that justifies its choice and sustainability as best practice. Among the evaluated programs, the ones that can be recommended for use due to their strong evidence are Project EX and Unplugged, with another 11 being recommended with additional studies. On the other hand, ITACA and En Plenas Facultades have the least evidence of efficacy, although they should be considered in a better position than the 30 programs which have not been evaluated. It is necessary to continue promoting a culture of evaluation of prevention interventions.
... The instrument was based on the European Drug Addiction Prevention Trial questionnaire (EU-Dap 2004; EU-DAP Study Group 2016), which was used in previous evaluation studies of Unplugged program (the original version of #Tamojunto program, designed and implemented in Europe) (Faggiano et al. 2010;Giannotta et al. 2014). The questionnaire had modules on sociodemographic data; variables for the calculation of socioeconomic status; month, year, and lifetime use of alcohol, tobacco, marijuana, inhalants, cocaine, amphetamines, benzodiazepines, and crack, and binge drinking (consumption of 5 or more doses of alcoholic beverages on a single occasion); scales for measuring mediating variables: intention to use drugs, school environment, attitudes about drugs, behavioral beliefs, knowledge about drugs (alcohol, tobacco, and marijuana), refusal skills (alcohol, tobacco, and marijuana), and decision-making skills; bullying; problems arising from alcohol use; parenting styles; and drug use in the family and best friend. ...
We aimed to analyze the association between latent classes of drug use of the ‘closest psychosocial network’ (CPN) (i.e. parents, siblings, and best friend) of adolescents, and adolescents’ lifetime drug use practices (tobacco, alcohol, and binge drinking). A prospective cohort study, nested in a randomized controlled trial, was performed among public school students in six Brazilian cities (N = 3,148; 51.4% girls; Mage=12.6 years), for 21 months. Latent class analyses and multilevel mixed-effect logistic regressions were performed. Regressions were clustered at the school and individual levels and adjusted for sex, age, socioeconomic status, and relatives with whom the adolescents lived. The three-class model was the best solution for the three drug use practices, ranging from minimum to high exposure of drug use influence. Those adolescents with high exposure were more likely to use tobacco and practice binge drinking. In the alcohol model, a gradient of association was observed as the exposure increased. CPN’s drug use may predict substance use in adolescents. It was observed that if the mother’s drug use is similar to that of the father, it may predict higher drug use in the other CPN characters. Our results support the idea that preventive actions in adolescence should be comprehensive, i.e. including components targeting the family (e.g. parenting and communication skills) and peers (e.g. refusal skills and perception of use). Mainly, integrating family-based components in the curriculum of school-based prevention programs is recommended.
... The questionnaire used was based on the European Drug Addiction Prevention Trial Questionnaire (Faggiano et al., 2010) validated in Portuguese (Galvão et al., 2021). ...
The scientific literature firmly states that bullying can affect adolescent mental health, however, it lacks longitudinal studies on potential psychological risk factors of bullying involvement, especially in less developed countries. This longitudinal study with 1,739 7th-grade students of 30 Brazilian schools aimed to analyze how psychiatric symptomatology can predict bullying patterns among adolescents. We conducted a latent class analysis to identify patterns of bullying victimization and perpetration. Multinomial logistic regressions were conducted to assess if baseline psychiatric symptoms affected bullying latent classes at nine-month follow-up. Analyses considered the complex multilevel data structure and were adjusted for sociodemographic variables. We found three bullying latent classes: minimal involvement, victims, and bully-victims. Internalizing psychiatric symptomatology predicted the probability of belonging to the “victims” class. Externalizing symptoms increased the future probability of belonging to the “bully-victims” class. These findings are independent of sociodemografic variables, such as age, socioeconomic status, and sex. Conduct problems were a risk factor for all bullying latent classes. Therefore, bullying prevention actions should target children and early adolescents with internalizing and externalizing symptoms.
... The instrument used was designed based on the EU-DAP (European Drug Addiction Prevention Trial) ( Faggiano et al., 2010 ), which was translated and adapted into Brazilian Portuguese ( Prado et al., 2016 ). "Open bar " attendance during the past year was the outcome variable. ...
Background:
"Open bar" parties are events where a flat fee is paid for unlimited alcohol consumption. At these events, alcohol intoxication is frequent amongst attendees. This study explored the prevalence of "open bar" attendance amongst Brazilian youth and the factors associated with this practice.
Methods:
Data was collected at the baseline of randomized controlled trial amongst 5,213 8th grade students in three Brazilian cities. Weighted logistic regression was performed.
Results:
Mean age was of 13.23 years (SE 0.01) and 17.1% of the students have reported attending "open bar" events in the past year. Attendees were wealthier, had higher odds to engage in binge drinking, to use marijuana, to be exposed to alcohol advertising, and to report more alcohol problems and clinical psychiatric symptoms when compared with non-attendees.
Conclusions:
The ban on selling alcohol to minors has not been properly enforced. Legislation to restrict alcohol promotions and advertising in Brazil needs to be implemented and effectively monitored.
... This instrument has been employed in previous studies to evaluate schoolbased drug prevention programs in Brazil [41,42]. It was designed based on the European Drug Addiction Prevention Trial (EU-DAP) questionnaire [43], translated and adapted into Brazilian Portuguese. We added a few questions from the World Health Organization (WHO) questionnaire, used in the VI Brazilian Survey on Drug Use among Students [44], and the National Survey of School Health (PENSE) questionnaire, from the Ministry of Health [45]. ...
Background
Based on the US DARE-kiR, a version of the Keepin’ it REAL program, the Drug and Violence Resistance Educational Program (PROERD) is the most widely implemented Brazilian prevention program. It originates from the translation of the DARE-kiR, a version of the Keepin’ it REAL program. Previous results suggest its inefficiency in preventing drug use among Brazilian adolescents. Since kiR fidelity can impact program outcomes, this mixed-methods study evaluates the PROERD implementation fidelity and its effects on preventing drug use among adolescents.
Methods
Data from two cluster randomized controlled trials (cRCTs) with 4,030 students from 30 public schools in São Paulo (1,727 fifth graders and 2,303 seventh graders), assessed at two-time points, were analyzed quantitatively. After implementing each lesson during the cRCT, 19 PROERD instructors answered fidelity forms. The effect of PROERD fidelity on alcohol, cigarettes, marijuana, inhalant, and cocaine use (the last two only among seventh graders) in the six months prior to follow-up assessment was analyzed by logistic regressions for fifth grade and mixed effect models for seventh graders. For qualitative analysis, semi-structured interviews were conducted with PROERD instructors and investigated by thematic analysis.
Results
Quantitative analysis showed that PROERD implementation fidelity had no impact on drug use among fifth and seventh graders. Conversely, the qualitative analysis revealed important aspects that may influence implementation fidelity and consequently program effectiveness, such as adaptations made by instructors, school infrastructure, among others, besides program application.
Conclusion
PROERD requires cultural adaptation to improve its implementation in Brazilian public schools.
... In this 1 h/week in-school intervention over 12 weeks (with an 18-month followup), students learn about different substances and search for the associated toxic properties and physiological alterations. This study resulted in a reduction of about 38% for alcohol use and 26% for cannabis use (Faggiano et al., 2010). Moreover, other reviews covering 29 and 51 US-based studies, respectively (Faggiano et al., 2005(Faggiano et al., , 2014 indicate that school-based programs produce a Number Needed to Treat (NNT) ratio of 33 for marijuana use (i.e., one out of every 33 students will be positively influenced by the intervention and will choose not to smoke marijuana), which is considered successful compared to similar studies. ...
En los últimos años se ha visto un creciente interés por el conocimiento relacionado con el cerebro y las neurociencias. Esto ha llevado a que se genere una importante cantidad de investigaciones y que el contexto propicie el surgimiento de creencias erróneas.
Estudios realizados en varios países convergen en el hallazgo de que el conocimiento sobre neurociencias en todos los campos de conocimiento es pobre y en algunos estudios en Europa y América del Sur, incluso se observó que un mayor interés en neurociencia predice (paradójicamente) una mayor creencia en neuromitos, combinada con una incapacidad para juzgar información como real o pseudocientífica.
La brecha entre la neurociencia cognitiva y el aprendizaje sigue siendo muy amplia . Y una de las consecuencias de esta distancia es la propagación de mitos que en muchos casos cuentan con algún sustento científico pero que son resultado de una malinterpretación o descontextualización de los resultados de investigaciones.
Especialmente en el ámbito de la educación, la necesidad de incorporar recursos que permitan renovar la visión del aprendizaje ha favorecido el desarrollo de estas creencias erróneas, que se convierten en dogma y generan confusión sobre los aquellos aspectos que tienen una base científica y aquellos que deben ser refutados.
... It has been developed, implemented and tested in seven European Union countries [13]. Its effectiveness in preventing or reducing daily tobacco use, heavy alcohol use, recent cannabis use [14], as well as binge drinking and tobacco and alcohol use [15,16], has made Unplugged an effective program for dealing with substance use in adolescents. ...
The “Intervention Program based on Self” (IPSELF) project was created to address the gap between the acquisition of life skills during prevention programs and their application with a session for developing one’s self-concept included in the European program “Unplugged”. The present study evaluated its effectiveness. A total of 157 middle school students (94 girls, 63 boys, MAGE = 12.89, SD = 0.45) from three schools in France participated in this study. The participants attended one of two programs (Unplugged/IPSELF). The effectiveness of the IPSELF add-on session was measured with the Self-Concept Clarity Scale, and the differences between the two programs was measured with the prototype willingness model. Adolescents in IPSELF rated the typical nonsmoker and cannabis nonsmoker more favorably, and the typical drinker less favorably. They felt more different from the typical smoker and drinker after participation in IPSELF. More alcohol experimenters were observed in Unplugged. The knowledge gained in IPSELF appeared to help adolescents more than that gained in Unplugged to change their smoking behavior. Furthermore, IPSELF had a more beneficial effect for girls, who felt that they had gained more control over their alcohol and cannabis use than boys, whereas Unplugged had a more positive effect on boys, who gained better control over their consumption. Moreover, the girls felt that they had gained more knowledge about the substances discussed in IPSELF than in Unplugged. We therefore recommend the use of IPSELF especially with female audiences.
... The curriculumwhich comprises 12 Unplugged sessions-is based on the theory of cognitive social influence and promotes intrapersonal skills (critical thinking versus normative beliefs) and interpersonal skills (assertiveness and skills of how to resist peer pressure), while also providing information on the different substances, in such a way as to promote good decision-making. The evaluation study showed a significant reduction in alcohol and marijuana use that persisted up to 15 months after the end of the intervention [22,23]. This type of intervention has also allowed students to develop a better bond and a greater sense of belonging to their school [24]. ...
Background
Substance use is highly prevalent among children and adolescents in Chile, and it is known how it impacts their health and social adjustment. The call for effective prevention of substance use among children adolescents has resulted in numerous school-based programs, and particularly, the Social Competence Promotion Program among Young Adolescents (SCPP-YA) has been proved to be successful for promoting social and problem-solving skills in addition to preventing substance abuse in the US population. The purpose of this study is to test the effectiveness of the Social Competence Promotion Program among Young Adolescents (SCPP-YA) in Chile (“Mi Mejor Plan”).
Methods
This is a cluster randomized controlled trial, parallel-group type, where “Mi Mejor Plan” is compared to standard school preventive curricula in control schools. A total of 10 schools and 600 adolescents are expected to be recruited and randomized with 1:1 allocation. During formative work, the SCPP-YA program was culturally adapted to Chile. The effectiveness of this program will be assessed using the European Drug Addiction Prevention Trial Questionnaire (EU-Dap), measuring substance use prevalence and risk and protective factors in baseline, post-intervention, and 4 months after the end of the intervention.
Discussion
The proposed study will be the first to test the effectiveness of the Social Competence Promotion Program among Young Adolescents (SCPP-YA) in Chile in a cluster randomized control trial and also the first study evaluating this program in Spanish-speaking Latin America. SCPP-YA has been implemented successfully in the USA. Thus, if the effects of the program are positive, wide implementation in Chile and Latin American countries is possible soon.
Trial registration
Clinical Trials NCT04236947. Registered on January 22, 2020.
... In this 1 h/week in-school intervention over 12 weeks (with an 18-month followup), students learn about different substances and search for the associated toxic properties and physiological alterations. This study resulted in a reduction of about 38% for alcohol use and 26% for cannabis use (Faggiano et al., 2010). Moreover, other reviews covering 29 and 51 US-based studies, respectively (Faggiano et al., 2005(Faggiano et al., , 2014 indicate that school-based programs produce a Number Needed to Treat (NNT) ratio of 33 for marijuana use (i.e., one out of every 33 students will be positively influenced by the intervention and will choose not to smoke marijuana), which is considered successful compared to similar studies. ...
One of the effects of the current COVID-19 pandemic is that low-income countries were pushed further into extreme poverty, exacerbating social inequalities and increasing susceptibility to drug use/abuse in people of all ages. The risks of drug abuse may not be fully understood by all members of society, partly because of the taboo nature of the subject, and partly because of the considerable gap between scientific production/understanding and communication of such knowledge to the public at large. Drug use is a major challenge to social development and a leading cause of school dropout rates worldwide. Some public policies adopted in several countries in recent decades failed to prevent drug use, especially because they focused on imposing combative or coercive measures, investing little or nothing in education and prevention. Here we highlight the role of neuroscience education as a valid approach in drug use education and prevention. We propose building a bridge between schools and scientists by promoting information, student engagement and honest dialogue, and show evidence that public policy regulators should be persuaded to support such science-based education programs in their efforts to effect important positive changes in society.
... Sus contenidos se centran en: habilidades para la vida, información sobre drogas y cuestionamiento de la percepción normativa (28) . Los resultados de su evaluación indican que los no bebedores y los bebedores ocasionales, al inicio progresaron hacia el consumo frecuente de alcohol con menos frecuencia que en el grupo de comparación (29) además, se encontraron efectos beneficiosos persistentes del programa para episodios de embriaguez (30) . ...
Objective:
Alcohol: Conciencia con ciencia is an educational-community universal prevention project for 12-year-old students (1st of ESO) which consists of three sessions and it is being implemented every school year since 2012. The objective was to evaluate its effect on alcohol consumption, attitudes and knowledge in the subsequent courses (2nd and 3rd of ESO), in order to know its durability.
Methods:
It is a cross-sectional observational study in different phases (applied in October and April), quasi-experimental with a comparison group. In the 2017/2018 academic year, all 2nd (n=2,892) and 3rd of ESO (n=2,601) students completed a questionnaire based on knowledge, opinions and consumption patterns in selected educational centers (18 centers in 13 municipalities). Statistical analysis: chi-square tests of contingency and difference of differences.
Results:
The number of students who started drinking is less in the intervention group during the subsequent school year, with differences between groups (31.5% vs. 36.6% in October, and 35.9% vs. 43.4% in April) (October p=0.037, April p=0.006) and difference in negative differences in favour of the intervention (-2.6%), more pronounced in girls (-8.1%). Although the study includes alcohol, the greatest perception of risk extends to tobacco and cannabis. The effect on knowledge maintained the following year, being the differences statistically significant. The group pressure recognized by those who suffer it was significantly higher during 2nd of ESO in the comparison group (October p=0.002, April p=0.015), being its durability longer in girls.
Conclusions:
The intervention stops the beginning of consumption, drunkenness and every-week consumption the hole next school year (2nd ESO) after intervention, but in 3rd of ESO the effect of the intervention disappears, being therefore necessary to reinforce it with the implementation of the project Drogas: ALTACAN in 2nd of ESO.
... Unplugged is a school-based prevention programme designed by a group of European experts and tested in the EU-Dap (European Drug Addiction Prevention) trial (10). The programme was effective in reducing drunkenness episodes, cigarette and cannabis use among adolescents (11,12). ...
Unplugged is a school-based prevention programme designed and tested in the EU-Dap trial.
The programme consists of 12 units delivered by class teachers to adolescents 12–14 years old. It is a
strongly interactive programme including a training of personal and social skills with a specific focus on
normative beliefs. The aim of this work is to define the theoretical model of the program, the contribution
of the theories to the units, and the targeted mediators. The programme integrates several theories: Social
Learning, Social Norms, Health Belief, theory of Reasoned Action-Attitude, and Problem Behaviour
theory. Every theory contributes to the development of the units’ contents, with specific weights. Knowledge,
risk perception, attitudes towards drugs, normative beliefs, critical and creative thinking, relationship
skills, communication skills, assertiveness, refusal skills, ability to manage emotions and to cope with
stress, empathy, problem solving and decision making skills are the targeted mediators of the program.
(Global Health Promotion, 2016; 23(4): 49–58)
... We assume an ICC of 0.015. As there was no ICC available for NSSI, this assumption is based on data from two studies of binge drinking behavior in adolescents [65,66]. Comparability between NSSI and binge drinking can be expected, as both represent maladaptive strategies for coping with one's own feelings or for dealing with personal stress. ...
Background
Non-suicidal self-injury (NSSI) has become a substantial public health problem. NSSI is a high-risk marker for the development and persistence of mental health problems, shows high rates of morbidity and mortality, and causes substantial health care costs. Thus, there is an urgent need for action to develop universal prevention programs for NSSI before adolescents begin to show this dangerous behavior. Currently, however, universal prevention programs are lacking.
Methods
The main objective of the present study is to evaluate a newly developed universal prevention program (“DUDE – Du und deine Emotionen / You and your emotions”), based on a skills-based approach in schools, in 3200 young adolescents (age 11–14 years). The effectiveness of DUDE will be investigated in a cluster-randomized controlled trial (RCT) in schools ( N = 16). All groups will receive a minimal intervention called “Stress-free through the school day” as a mental health literacy program to prevent burnout in school. The treatment group ( N = 1600; 8 schools) will additionally undergo the universal prevention program DUDE and will be divided into treatment group 1 (DUDE conducted by trained clinical psychologists; N = 800; 4 schools) and treatment group 2 (DUDE conducted by trained teachers; N = 800; 4 schools). The active control group ( N = 1600; 8 schools) will only receive the mental health literacy prevention. Besides baseline assessment (T0), measurements will occur at the end of the treatment (T1) and at 6- (T2) and 12-month (T3) follow-up evaluations. The main outcome is the occurrence of NSSI within the last 6 months assessed by a short version of the Deliberate Self-Harm Inventory (DSHI-9) at the 1-year follow-up (primary endpoint; T3). Secondary outcomes are emotion regulation, suicidality, health-related quality of life, self-esteem, and comorbid psychopathology and willingness to change.
Discussion
DUDE is tailored to diminish the incidence of NSSI and to prevent its possible long-term consequences (e.g., suicidality) in adolescents. It is easy to access in the school environment. Furthermore, DUDE is a comprehensive approach to improve mental health via improved emotion regulation.
Trial registration
German Clinical Trials Register (DRKS) DRKS00018945. Registered on 01 April 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018945
... For instance, programs such as "Life Skills Training", "Project Towards No Drug Abuse (TND)", and "All Stars" can delay or prevent adolescent tobacco, alcohol, and cannabis use [15,16]. In particular, one of the most known preventive programs is the Unplugged program, which has been shown to be effective in seven European countries [17][18][19] and highlighted as one of the best preventive programs in the world in recent systematic reviews [16,20]. ...
Background:
Substance use is highly prevalent among Chilean adolescents, and the damage it causes at the neurobiological, psychological, and social levels is known. However, there are no validated screening instruments that also assess risk and protective factors for this population in Chile, which is essential for evaluating future prevention interventions.
Objective:
To determine the psychometric properties of the European Drug Addiction Prevention Trial Questionnaire (EU-Dap) questionnaire.
Methods:
A cross-sectional study was carried out in 13 schools in the city of Santiago de Chile. The sample included 2261 adolescents ranging from 10 to 14 years old. Linguistic and cultural adaptation was assessed using focus groups with adolescents, the construct validity was evaluated using confirmatory factor analysis, and measures of its reliability were also determined. Furthermore, the associations regarding risk and protective factors with substance use were explored.
Results:
Substance use questions were well understood and seemed to adequately capture the consumption of different drugs. Regarding the subscales of risk and protective factors, the analyses showed that most subscales had good psychometric properties, and few needed some degree of improvement (e.g., some items were removed). After the changes, most final subscales had good or adequate goodness of fit adjustments and good or acceptable internal consistency. Finally, the main associated factors with the substance use outcomes were: future substance use and school bonding for tobacco use; negative beliefs about alcohol, future substance use, school bonding and refusal skills for alcohol use; and negative beliefs about marihuana, positive attitudes towards drugs, risk perception, and substance abuse index for marihuana use. Normative beliefs increased the risk for all substances use.
Conclusions:
The current findings suggest that the EU-Dap is a valid and reliable instrument, and it may help to evaluate the effectiveness of drug use prevention interventions.
... The questionnaire used for data collection has been used in previous studies to evaluate school drug prevention programs in Brazil. Further, it was designed based on the European Drug Addiction Prevention Trial questionnaire ( Faggiano et al., 2010 ), and translated and adapted into Brazilian Portuguese ( Cainelli de Oliveira Prado et al., 2016 ). We also added a few questions from the World Health Organization questionnaire, used in the VI Brazilian Survey of Drug Use Among Students ( Carlini et al., 2010 ), and the Brazilian National Survey of School Health (PENSE) questionnaire, which is used by the Brazilian Ministry of Health ( IBGE, 2016 ). ...
Background
The Drug and Violence Resistance Educational Program (PROERD) is widely disseminated and implemented as a public policy in Brazil. PROERD's current curricula are the translation of the North American program DARE-Keepin'it REAL, based on the theories of socio-emotional learning and resistance training. The present study aims to evaluate the effectiveness of PROERD in the prevention of drug use.
Method
Two PROERD curricula were analyzed through two cluster randomized controlled trials conducted with 4030 students (1727 5th graders and 2303 7th graders) in 30 public schools in São Paulo. The intervention group received ten PROERD classes delivered by trained police officers, and the control group received no intervention. Data collection was performed using self-administered questionnaires on smartphones at two points in time (baseline pre-intervention and nine months follow-up). The outcomes evaluated were initiation and recent drug use. Two different paradigms were used in a multilevel analysis: an analysis of complete cases (CC) and an intention to treat missing data through full information maximum likelihood and selection model.
Results
We found no evidence of the effectiveness of PROERD as an intervention for the prevention of drug use. For the conditional transition analysis, we found that 7th graders in the PROERD group who were already binge drinking at baseline had a significantly higher chance of maintaining this consumption pattern when compared to the control group.
Conclusion
The lack of preventive effects found here suggests that a process evaluation may address concrete implementation and cultural adaptation issues.
Introduction
Universal school-based social-emotional learning (SEL) programs target several social-emotional skills assuming a relationship between the skills and psychosocial health outcomes. However, greater insight into the relationship is required to clarify the skills that are most crucial to address. It will support the development and refinement of SEL programs. This study investigated (1) the relationship among the social-emotional skills, (2) the association between the skills and psychosocial health variables, and (3) the mediating effect of the skills on psychosocial variables.
Methods
Using self-report questionnaires (N = 796) completed by adolescent students (aged 14–18) in preparatory vocational tracks in Dutch secondary education, associations were identified between five SEL skills and two psychosocial health variables, emotional-behavioral difficulties, and prosocial behavior.
Results
There was a high degree of overlap between the five skills (self-awareness, social awareness, self-management, relationship skills, and responsible decision-making). The skills were univariately associated with emotional-behavioral difficulties and prosocial behavior. In the multivariate model, self-management most strongly correlated with emotional-behavioral difficulties and mediated the relationship between self-awareness and emotional-behavioral difficulties. Social awareness showed the highest correlation with prosocial behavior and mediated the relationship between prosocial behavior and three other skills: self-awareness, relationship skills, and responsible decision-making.
Discussion
Self-management and social awareness seem to be the central skills to promote the psychosocial health outcomes of students in preparatory vocational secondary education tracks. These two skills mediate the relationship between other social-emotional skills, emotional-behavioral difficulties, and prosocial behavior.
A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full, encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment. New transformative transdiagnostic approaches suggest changes spanning conventional categories. They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms. These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole. Therefore, they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment. Multiplicity of stressors has been considered mostly during and following catastrophes, without considering the resulting mixed clinical picture and life event concomitant stressors. We herewith suggest a new category within the conventional classification systems: The Complex Stress Reaction Syndrome, for a condition of multiplicity of stressors, which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era, in the general population. We argue that this condition may be relevant to daily, regular life, across the lifespan, and beyond conditions of catastrophes. We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder, more costly to health systems and the suffering individuals. Means for derived prevention and treatment are discussed.
How temperament is in relation to school readiness
Process evaluation can improve the quality of program implementation and the achievement of program outcomes. This paper aims to describe the fidelity of implementation of the school-based prevention program 'Unplugged' in Nigeria, i.e., the degree to which the intervention was delivered as intended, and the satisfaction of teachers and students. The program aims to prevent tobacco, alcohol, and substance use and consists of 12 standardized units, one-hour each, delivered by class teachers. Sixteen schools implemented the program. Eleven schools, 33 classes, 27 teachers, 993 students provided process evaluation data. Eighty-two percent of classes implemented the entire program, with lower rates of activities implementation at the beginning and at the end of the program. Each unit took on average 55 minutes. More than 90% of teachers perceived high students' interest for units 1, 4, 5, 8, and 9, high interactivity for units 1, 2, 8, and 9, and declared high comfort in implementing most units. About 80% of teachers reported an improvement in knowledge, teaching skills, and relationships with students due to the program. More than 75% of students declared the program changed their way of seeing themselves, was helpful to answer questions about themselves, and improved their relationships with mates and teachers. About 95% of students reported an increase in knowledge of the consequences of substance use. Students declared Unplugged educative, informative, helpful, impacting on change, interesting and suggested the program should be spread to other schools.
Purpose:
The Brazilian version of the prevention program Unplugged, #Tamojunto, has had a positive effect on bullying prevention. However, the curriculum has recently been revised, owing to its negative effects on alcohol outcomes. This study evaluated the effect of the new version, #Tamojunto2.0, on bullying. For adolescents exposed to the school-based program #Tamojunto2.0, we investigated (1) whether the prevalence of bullying victimization and perpetration was reduced, (2) whether this reduction was moderated by gender, and (3) whether the program's effect on bullying was mediated by adolescents' alcohol use.
Methods:
A cluster randomized controlled trial was conducted using 5,208 eighth-grade students from 73 Brazilian public schools. Baseline data were collected before program implementation, and follow-up data were collected nine months later. We used a multilevel mixed-effects model to examine the effect of #Tamojunto2.0 on bullying, and a moderation model to test the moderating effect of gender on program outcomes. A mediation analysis was performed to determine lifetime alcohol use as a mediator of the intervention effect on bullying.
Results:
We found that the positive effect of #Tamojunto2.0 on bullying victimization (β = -0.019, 95% confidence interval = -0.035; -0.002) and perpetration (β = -0.027, 95% confidence interval = -0.051; -0.004) was mediated by a decrease in alcohol use, but not moderated by gender.
Discussion:
#Tamojunto2.0 program can be indirectly effective in the prevention of bullying by decreasing adolescents' alcohol use. Moreover, alcohol and drug use prevention programs might also affect bullying outcomes through mediation, and we suggest that future studies consider this.
Background
There are insufficient accurate data on the prevalence of substance use among children in Iran. WHO is conducting a survey to study the prevalence of substance use among children in Iran. This manuscript describes the method that was used for developing the tools for the aforementioned survey.
Methods
A literature review was done on the risk factors, existing scales, and special considerations in conducting a substance use survey on children. The identified risk factors were then prioritized, and standard scales were selected for each. Based on the priority and the cultural and psychosocial properties of each age group, the methods of the survey were defined. Then, a qualitative assessment on content validity was done, and the tool was piloted among 90 participants.
Results
The tool contained 104 items for the 9- to 12-year-olds age group, and 168 items for each of the 12- to 15-year-olds and 15- to 18-year-olds age groups, respectively. The results of the Cronbach’s Alpha analysis showed a coefficient of 0.754 for the 9- to 12-year-olds age group, 0.735 for 12- to 15-year-olds, and 0.889 for the 15- to 18-year-olds.
Conclusion
The developed tool considered socio-cultural acceptability, cognitive, and ethical standards and showed high reliability and validity.
Background:
Externalizing problems are commonly associated with alcohol outcomes in adolescence. Nevertheless, findings regarding internalizing problems are mixed, and fewer longitudinal studies have considered the both problems concomitantly and the role of gender. We examined the role of externalizing and internalizing problems in predicting adolescent alcohol-related harm and binge drinking, taking into account the gender differences. We also evaluated if externalizing problems could moderate the association between internalizing problems and alcohol outcomes.
Method:
We used longitudinal data from 2368 8th grade students across 37 public schools in three Brazilian cities. Linear and logistic regressions were performed to analyze the association between alcohol outcomes and the independent variables (externalization and internalization scores, and sociodemographic variables) according to gender. We also tested the same model with an interaction term between externalizing*internalizing.
Results:
Our results suggest that externalizing problems predict adolescents' binge drinking in both genders; it also may predict adolescents' alcohol-related harms, but only in boys. Internalizing problems seem to be a gender-specific risk factor for binge drinking among girls. All findings are independent of comorbid problems and sociodemographic variables.
Limitation:
The findings should be considered taking into account the short follow-up period from risk factors to the outcomes.
Conclusion:
Our results highlight the contribution of internalizing and externalizing problems to the development of alcohol-related harm and binge drinking in early adolescence and the need for interventions to prevent early behavioral problems that consider the role played by gender.
The drug use prevention program #Tamojunto2.0, a Brazilian version of the European Unplugged, showed effectiveness in preventing the alcohol use onset at short term. However, we aimed to evaluate the program effects on its secondary outcomes, such as drug knowledge, behavioral beliefs, attitudes, decision-making skills, and refusal skills. A cluster-randomized controlled trial (registration: RBR-8cnkwq) was conducted in 73 public middle schools in three Brazilian cities (N = 5,208 students; 49.4% girls; Mage= 13.2 years). The intervention group attended twelve #Tamojunto2.0 lessons conducted by their own teachers previously trained. The control group received no intervention. Data were collected pre-intervention (February/March 2019) and at nine-month follow-up (November/December 2019). We used multiple imputation to handle missing data and performed multilevel mixed-effect regression models, adjusted for sex, age, socioeconomic status, and city. The #Tamojunto2.0 program seems to have increased drug knowledge (Coef.= 0.26, 95%CI = 0.17–0.36), and negative and non-positive alcohol beliefs (Coef.= 0.24, 95%CI= 0.05–0.42), according to its logical framework. Nevertheless, it was found no evidence regarding the program’s effect on marijuana beliefs, attitudes, decision-making skills, and refusal skills. These findings could explain the effectiveness of the program in preventing the onset of alcohol consumption in adolescent participants. More research is needed to observe the long-term effects of the program on primary and secondary outcomes.
Background and aims:
Family history of substance use disorder (SUD) affects a child's risk of the disorder through both genetic and shared environmental factors. We aimed to estimate the association between parental or older sibling SUD history with the risk of adolescent SUD diagnosis.
Design, setting and participants:
We conducted a population-based cohort study using administrative healthcare databases in the Province of Manitoba, Canada, which has a universal and publicly-funded healthcare system. We included all children born from 1984 to 2000 who have linkages to both parents and were followed until age 18 years. We used generalized estimating equation models to produce unadjusted and adjusted relative risk (RR) estimates of adolescent SUD risk. Study cohort included 134,389 children and 31,307 full sibling pairs; 51.3% were male and 35.4% first born.
Measurements:
The exposure was SUD diagnosis in a mother or father in either hospitalization or outpatient physician visit records before children's age of 13 years. The secondary exposure was an adolescent SUD diagnosis in an older full sibling. The outcome was SUD diagnosis during adolescence (13 and 18 years of age) identified in either hospitalization or physician visit records. Children demographics and characteristics associated with SUD diagnosis were included in the models.
Findings:
Of the 134,389 children, 9.5% had a mother with a history of SUD, 11.3% had a father and 1.3% had an older sibling with a history of SUD diagnosis; 2,566 (1.9%) had an adolescent SUD diagnosis. An increased risk of adolescent SUD was observed with SUD history in mothers (adjusted RR (aRR) 2.50; 95% confidence interval [CI] 2.26, 2.79), fathers (aRR 2.15; 95% CI 1.95, 2.37), both parents (aRR 3.74; 95% CI 3.24, 4.31) and older sibling (aRR 3.85; 95% CI 2.53, 5.87).
Conclusions:
A family history of substance use disorder in parents or older siblings appears to be associated with increased SUD risk in adolescents.
What approaches and methods can be employed that will effectively reduce the risk of antisocial behaviour and of other criminal offending in schools? We report an evidence review involving a search of eight electronic databases from 2010 to 2020. This produced 6331 unique items and a final set of 49 review articles and 116 research studies. Only a small amount of evidence supported direct placement of police personnel in schools risked opening a “school-to-prison pipeline”. It is possible to reduce levels of several types of problems amongst school students, of kinds that are associated with participation in delinquency and adult crime including reduction of bullying, other forms of conflict and aggression, dating and relational violence and risk of involvement in alcohol and drug abuse. School-wide interventions that emphasize social norms emerged more positively than selectively targeted interventions. Disciplinary responses to violations worked best in a positive and supportive school climate rather than responses that emphasized security or punishment. Police services can advise and engage in multi-agency initiatives through liaison roles, highlighting potential links between problems exhibited in schools and the appearance of more serious delinquent activity.
O livro A Experiência Brasileira de Prevenção Escolar e Comunitária do Uso de Álcool e Outras Drogas: Registro Histórico de Adaptação, Implementação e Avaliação entre os Anos de 2013 a 2018 apresenta um conjunto de ações inovadoras de prevenção escolar e comunitária de problemas decorrentes do uso de álcool e outras drogas. Tratou-se de uma iniciativa da Coordenação de Saúde Mental, Álcool e Outras Drogas, do Ministério da Saúde, em parceria com o Escritório das Nações Unidas sobre Drogas e Crimes (UNODC), que foi, em seguida, implementada, intersetorialmente, com a participação da Secretaria Nacional de Políticas sobre Droga, do Ministério da Justiça e da Fundação Oswaldo Cruz. Essas ações se deram no âmbito do “Plano de Ação e Enfrentamento ao Crack”, do qual derivou o “Programa Crack: é Possível Vencer”, com três eixos norteadores: segurança, cuidado e prevenção.
Este livro versa sobre o terceiro eixo, prevenção, que foi operacionalizado por meio da adoção de três programas internacionais baseados em evidência para implementação em escolas e serviços de proteção social básica: Unplugged, que se tornou #Tamojunto; GoodBehavior Game, que foi adaptado e tornou-se Jogo Elos; e StrengtheningFamilies, nomeado, inicialmente, de Programa Fortalecendo Famílias e, posteriormente, de Programa Famílias Fortes. Enquanto os dois primeiros foram implementados no contexto escolar, o último destinava-se a famílias usuárias dos serviços de proteção social básica. O texto busca retratar as aprendizagens acumuladas, relativas à adaptação, implementação, avaliação e fortalecimento dos três programas preventivos referidos. Esperamos que as lições aprendidas e os processos que as geraram, descritos neste livro, possam manter viva a memória desses anos de intenso trabalho, seja nos espaços de formulação de políticas públicas, gestão, implementação, ensino ou pesquisa.
This study aimed to evaluate the effectiveness of the drug and violence resistance educational program (PROERD) on short-term secondary outcomes, such as intentions to use drugs, attitudes toward drugs, school experience, and life skills (refusal, decision-making, and communication). Two cluster-randomized controlled trials were conducted in 30 public schools in the city of São Paulo (Brazil) with 4030 students (1727 fifth and 2303 seventh graders). The intervention group attended 10 PROERD classes conducted by trained police officers, whereas the control group received no intervention. PROERD is a Brazilian adaptation of the North American Drug Abuse Resistance Education (DARE) program Keepin’ it REAL. Data were collected at two time points: pre-intervention and at 9-month follow-up. Two different paradigms were used in the multilevel analysis, complete case (CC), and intention-to-treat (ITT) analyses, using full information maximum likelihood (FIML). We found mixed results. Although the seventh-year curriculum seems to have positive effects on school experience (coef = 0.093; 95% CI: 0.001, −0.185), it also increases the intention to use cigarettes in the future (OR = 1.93, 95% CI: 1.109, 3.379) and the chances of accepting marijuana (OR = 1.62, 95% CI: 1.03, 2.53), and it appears to slightly reduce decision-making skills among fifth graders (coef = −0.078; 95% CI: −0.131, −0.025). Our results suggest that PROERD implementation and cultural adaptation should be reevaluated to understand why the program does not achieve the expected preventive goals and produces potential iatrogenic effects.
Strengthening life skills is a popular approach for prevention and health promotion in schools. It aims to empower students to deal effectively with the demands of everyday life by improving self-regulation, making informed decisions, and building supportive social relationships. By addressing various health-related topics such as friendship, sexuality, violence, or substance use, life skills education has the potential not only to teach students how to act responsively regarding their health and well-being, but also to build a comprehensive understanding of the biological, psychological, and social factors influencing their individual development. However, little is known about whether the contents of life skills programs differ depending on student age, either in terms of the set of skills promoted or the influencing factors on health that are the focus. This systematic review addressed this gap by analyzing evaluated school-based life skills programs regarding age-specific targeted life skills, underlying theoretical frameworks, and effectiveness. The analysis, following the PRISMA guidelines, was based on longitudinal evaluation studies published between 2007 and 2020, which were retrieved from six electronic databases, and referred to eighteen programs. Results showed that programs were mostly implemented in adolescence and that the targeted life skills shifted from a more behavioral-affective focus in childhood to a broader set of life skills targeted in adolescence which emphasized social and sociocultural influencing factors on health. Little evidence was available on the effectiveness of the programs on life skills development. Ultimately, life skills education promotes health-related self-regulation, especially in adolescence. However, further research is needed to clarify how to achieve sustainable effects in the development of life skills, both in childhood and adolescence.
Purpose:
This meta-analysis aimed to analyze the effects of smoking prevention programs for young adolescents at early smoking stages to identify the appropriate characteristics of prevention programs for this population.
Methods:
Searches of health-related databases and Google Scholar were conducted, and 23 randomized studies were included in the analysis. The main outcome variable was smoking behavior. The analysis was conducted using Comprehensive Meta-Analysis software (version 3.0).
Results:
Smoking prevention programs significantly reduced smoking behaviors (OR=0.85, 95% CI=0.77-0.93). School-based programs (OR=0.79, 95% CI=0.75-0.83), programs by trained teachers or educators (OR=0.77, 95% CI=0.71-0.83), high-intensity programs (OR=0.82, 95% CI=0.75-0.91), and programs in an in-school setting (OR=0.82, 95% CI=0.74-0.90) had the most significant effect on reducing smoking behavior.
Conclusion:
For young adolescents, smoking prevention programs are most effective when they are school-based or highintensity programs, and when conducted by teachers or educators with proper training. Further studies are required since there was insufficient research to explore the effect of web-based programs or family-centered programs on adolescent smokers.
This paper presents the rationale, development and application of ‘Unplugged’, a new
school programme for the prevention of substance abuse, which is based on the
comprehensive social influence approach (CSI). The programme was developed,
implemented and evaluated by a cross-disciplinary group of experts in the frame of
a multi-centre study in seven European countries. The basic curriculum consists of
12 units, which are delivered by class teachers to a target population of 12–14 year-old
students. Additional programme components were workshops for the students’ parents
and debriefing sessions led by class peers. The programme’s application was monitored
by means of structured report forms. This process monitoring allowed for the analysis
of problems in implementation, as well as of participatory aspects.
‘Unplugged’ is the first comprehensive social influence school curriculum in Europe of
which the efficacy has been evaluated in a field trial, and it also constitutes an example of
a theory- and evidence-based programme against youths’ substance use. This report can provide public health and school decision makers with tools to make an informed choice
on these kinds of programmes and to survey their application.
Using a new technique for tracing the sequence of use over time, this study examined the pattern of drug involvement among 4,145 West Coast adolescents over the 4-year span from Grades 7-10. During the period covered, the mid- to late 1980s, we found no evidence that cocaine has become a gateway drug. However, the data provided some support for treating cocaine initiation as a separate stage that precedes the onset of hard drugs other than pills. The analysis also showed that increased involvement with legal drugs constitutes an important step in the transition to hard drug use for most adolescents. Weekly alcohol use followed marijuana use and preceded use of all other illicit drugs for Hispanic, White, and Black youth. However, it followed use of hard drugs for Asians. Weekly smoking formed a distinct stage between initial use of pills and other hard drugs for non-Hispanic Whites. The results underscore the importance of prevention efforts aimed at curbing the transition to regular use of alcohol and cigarettes, as well as their initial use.
Drug addiction is a long-term problem caused by an uncontrollable compulsion to seek drugs. People may use drugs to seek an effect, to feel accepted by their peers or as a way of dealing with life's problems. Even after undertaking detoxification to reach a drug-free state, many return to opioid use. This makes it important to reduce the number of people first using drugs and to prevent transition from experimental use to addiction. For young people, peers, family and social context are strongly implicated in early drug use. Schools offer the most systematic and efficient way of reaching them. School programs can be designed to provide knowledge about the effects of drugs on the body and psychological effects, as a way of building negative attitudes toward drugs; to build individual self-esteem and self-awareness, working on psychological factors that may place people at risk of use; to teach refusal and social life skills; and to encourage alternative activities to drug use, which instil control abilities. The review authors found 32 controlled studies, of which 29 were randomised, comparing school-based programs aimed at prevention of substance use with the usual curriculum. The 46,539 students involved were mainly in sixth or seventh grade. Programs that focused on knowledge improved drug knowledge to some degree, in six randomised trials. Social skills programs were more widely used (25 randomised trials) and effectively increased drug knowledge, decision-making skills, self-esteem, resistance to peer pressure, and drug use including of marijuana (RR 0.8) and hard drugs (heroin) (RR 0.5). The programs were mainly interactive and involved external educators in 20 randomised trials. Effects of the interventions on assertiveness, attitudes towards drugs, and intention to use drugs were not clearly different in any of the trials. Most trials were conducted in the USA and, as a nation's social context and drug policies have a significant influence on the effectiveness of the programs, these results may not be relevant to other countries. Measures of change were often made immediately after the intervention with very little long-term follow up or investigation of peer influence, social context, and involvement of parents.
To evaluate the long-term effectiveness of recent behavioural interventions in the prevention of cigarette use among children and youth and to compare the effectiveness of different school-based, community-based and multisectorial intervention strategies.
A structured search of databases and a manual search of reference lists was conducted. Randomised controlled trials published in English or German between August 2001 and August 2006 targeting youths up to 18 years of age were assessed independently by two researchers according to predefined inclusion criteria and with regard to methodological quality. Data abstraction was performed and crosschecked by two researchers. Where appropriate, pooled effect estimates were calculated and tested in sensitivity analyses.
Of 3555 articles, 35 studies met the inclusion criteria. The follow-up duration ranged from 12 months to 120 months. Although the overall effectiveness of prevention programs showed considerable heterogeneity, the majority of studies reported some positive long-term effects for behavioural smoking prevention programs. There was evidence that community-based and multisectorial interventions were effective in reducing smoking rates; in contrast, the evidence for school-based programs alone was inconclusive. Regardless of the type of intervention, the reductions observed in smoking rates were only modest.
The present work identified moderate evidence for the effectiveness of behavioural interventions to prevent smoking. Although evidence for the effectiveness of school-based interventions was inconclusive, evidence for the effectiveness of community-based and multisectorial interventions was somewhat stronger. Future research should investigate the effectiveness of specific intervention components and the cost-effectiveness of interventions analysed in methodologically high-quality studies.
Using a new technique for tracing the sequence of use over time, this study examined the pattern of drug involvement among 4,145 West Coast adolescents over the 4-year span from Grades 7-10. During the period covered, the mid- to late 1980s, we found no evidence that cocaine has become a gateway drug. However, the data provided some support for treating cocaine initiation as a separate stage that precedes the onset of hard drugs other than pills. The analysis also showed that increased involvement with legal drugs constitutes an important step in the transition to hard drug use for most adolescents. Weekly alcohol use followed marijuana use and preceded use of all other illicit drugs for Hispanic, White, and Black youth. However, it followed use of hard drugs for Asians. Weekly smoking formed a distinct stage between initial use of pills and other hard drugs for non-Hispanic Whites. The results underscore the importance of prevention efforts aimed at curbing the transition to regular use of alcohol and cigarettes, as well as their initial use.
Results from a longitudinal experiment to curb drug use during junior high indicate that education programs based on a social-influence
model can prevent or reduce young adolescents' use of cigarettes and marijuana. This multi-site experiment involved the entire
seventh-grade cohort of 30 junior high schools drawn from eight urban, suburban, and rural communities in California and Oregon.
Implemented between 1984 and 1986, the curriculum's impact was assessed at 3-, 12-, and 15-month follow-ups. The program,
which had positive results for both low- and high-risk students, was equally successful in schools with high and low minority
enrollment. However, the program did not help previously confirmed smokers and its effects on adolescent drinking were short-lived.
To evaluate the long-term efficacy of a school-based approach to drug abuse prevention.
Randomized trial involving 56 public schools that received the prevention program with annual provider training workshops and ongoing consultation, the prevention program with videotaped training and no consultation, or "treatment as usual" (ie, controls). Follow-up data were collected 6 years after baseline using school, telephone, and mailed surveys.
A total of 3597 predominantly white, 12th-grade students who represented 60.41% of the initial seventh-grade sample.
Consisted of 15 classes in seventh grade, 10 booster sessions in eighth grade, and five booster sessions in ninth grade, and taught general "life skills" and skills for resisting social influences to use drugs.
Six tobacco, alcohol, and marijuana use self-report scales were recorded to create nine dichotomous drug use outcome variables and eight polydrug use variables.
Significant reductions in both drug and polydrug use were found for the two groups that received the prevention program relative to controls. The strongest effects were produced for individuals who received a reasonably complete version of the intervention--there were up to 44% fewer drug users and 66% fewer polydrug (tobacco, alcohol, and marijuana) users.
Drug abuse prevention programs conducted during junior high school can produce meaningful and durable reductions in tobacco, alcohol, and marijuana use if they (1) teach a combination of social resistance skills and general life skills, (2) are properly implemented, and (3) include at least 2 years of booster sessions.
In autumn 1995 The Norwegian Cancer Society in cooperation with The Research Center for Health Promotion, University of Bergen started a study of school-based interventions aiming at preventing smoking among pupils in Norwegian secondary schools. The study comprised a nationwide sample of 4441 students at 99 schools (195 classes). This panel of students is followed through annual data collections till they graduate in spring 1997. Written consensus from students and parents was obtained from 95%. Schools were systematically allocated to one of four groups: Group A, control; Group B, intervention, containing classroom program, involvement of parents and teacher courses; Group C, like B, but without teacher courses; Group D, like B, but without parental involvement. Baseline data were collected by questionnaires administered in class in November 1994 and the first follow-up survey was carried out in May 1995. At follow-up the proportion of smokers had increased by 8.3 percentage points in Group A (control) and by 1.9 percentage points in Group B (most extensive intervention). As expected, the recruitment of smokers was higher in Groups C and D than in the ideal intervention, but lower than in the control group. Effects of the most extensive program among subgroups of students were examined by comparing Groups A and B. Students are categorized as high risk or low risk based on scores on scales measuring sensation seeking, physical maturity, antisocial behavior and parental smoking. The effect of the program on recruitment of smokers seems to have been at least as strong or even stronger among 'high-risk' students than among other students.
To examine the effectiveness of a drug abuse prevention program in reducing the initiation and escalation of smoking in a sample of predominantly minority junior high school girls.
The 15-session prevention program teaches social resistance skills within the context of a broader intervention designed to promote general personal and social competence skills, and is implemented in the seventh grade. Smoking rates in girls from 29 New York City public schools who received the program (n = 1,278) were compared to smoking rates in a control group of girls (n = 931) who did not.
Those who participated in the program were less likely to initiate smoking relative to controls, due in part to significant program effects on smoking intentions, smoking knowledge, perceived peer and adult smoking norms, drug refusal skills, and risk taking. Experimental smokers in the intervention group were less likely to escalate to monthly smoking relative to controls, due in part to significant program effects on smoking intentions.
A school-based drug abuse prevention approach previously found to be effective among white youth significantly reduced smoking initiation and escalation among urban minority girls.
This study examined the plausibility of the gateway hypothesis to account for drug involvement in a sample of middle school students participating in a drug abuse, prevention trial. Analyses focused on a single prevention approach to exemplify intervention effects on drug progression. Improvements to social competence reduced multiple drug use at 1- and 2-year follow-ups. Specific program effects disrupted drug progression by decreasing alcohol and cigarette use over 1 year and reducing cigarette use over a 2-year period. Controlling for previous drug use, alcohol was integrally involved in the progression to multiple drug use. Subgroup analyses based on distinctions of pretest use/nonuse of alcohol and cigarettes provided partial support for the gateway hypothesis. However, evidence also supported alternate pathways including cigarette use as a starting point for later alcohol and multiple drug use. Findings underscore the utility of targeting more than one gateway substance to prevent escalation of drug involvement and reinforce the importance of social competence enhancement as an effective deterrent to early-stage drug use.
This study evaluated the substance initiation effects of an intervention combining family and school-based competency-training intervention components. Thirty-six rural schools were randomly assigned to 1 of 3 conditions: (a) the classroom-based Life Skills Training (LST) and the Strengthening Families Program: For Parents and Children 10-14, (b) LST only, or (c) a control condition. Outcomes were examined 1 year after the intervention posttest, using a substance initiation index (SII) measuring lifetime use of alcohol, cigarettes, and marijuana and by rates of each individual substance. Planned intervention-control contrasts showed significant effects for both the combined and LST-only interventions on the SII and on marijuana initiation. Relative reduction rates for alcohol initiation were 30.0% for the combined intervention and 4.1% for LST only.
Many studies that have evaluated educational and psychosocial prevention programmes were considered and appraised in this systematic review. A number of programmes showed evidence of ineffectiveness. Those that reported longer-term evaluations (over three years follow-up) were examined in more detail and several promising studies were re-analysed to provide a better indication of the potential impact of the prevention programme. On the basis of this re-analysis, the Strengthening Families Programme (SFP) in particular but also culturally focused skills training appear to offer promise. However, all of the studies included in the review showed some methodological weaknesses and it is therefore necessary to replicate these studies with more robust design and analysis, and across different settings.
We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities.
Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline.
The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use.
School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.
We review recent developments in the design and analysis of group-randomized trials (GRTs). Regarding design, we summarize developments in estimates of intraclass correlation, power analysis, matched designs, designs involving one group per condition, and designs in which individuals are randomized to receive treatments in groups. Regarding analysis, we summarize developments in marginal and conditional models, the sandwich estimator, model-based estimators, binary data, survival analysis, randomization tests, survey methods, latent variable methods and nonlinear mixed models, time series methods, global tests for multiple endpoints, mediation effects, missing data, trial reporting, and software.
We encourage investigators who conduct GRTs to become familiar with these developments and to collaborate with methodologists who can strengthen the design and analysis of their trials.
This study examines the effects of 2 brief family-focused interventions on the trajectories of substance initiation over a period of 6 years following a baseline assessment. The 2 interventions, designed for general-population families of adolescents, were the 7-session Iowa Strengthening Families Program (ISFP) (Molgaard & Spoth, 2001) and the 5-session Preparing for the Drug Free Years Program (PDFY) (Catalano, Kosterman, Haggerty, Hawkins, & Spoth, 1999). Thirty-three rural public schools were randomly assigned to the ISFP, the PDFY, or a minimal-contact control condition. The authors evaluated the curvilinear growth observed in school-level measures of initiation using a logistic growth curve analysis. Alcohol and tobacco composite use indices--as well as lifetime use of alcohol, cigarettes, and marijuana--and lifetime drunkenness, were examined. Significant intervention-control differences were observed, indicating favorable delays in initiation in the intervention groups.
Longitudinal studies almost always have some individuals with missing outcomes. Inappropriate handling of the missing data in the analysis can result in misleading conclusions. Here we review a wide range of methods to handle missing outcomes in single and repeated measures data and discuss which methods are most appropriate.
Using data from a randomized controlled trial to compare two interventions for increasing physical activity, we compare complete-case analysis; ad hoc imputation techniques such as last observation carried forward and worst-case; model-based imputation; longitudinal models with random effects; and recently proposed joint models for repeated measures data and non-ignorable dropout.
Estimated intervention effects from ad hoc imputation methods vary widely. Standard multiple imputation and longitudinal modelling agree closely, as they should. Modifying the modelling method to allow for non-ignorable dropout had little effect on estimated intervention effects, but imputing using a common imputation model in both groups gave more conservative results.
Results from ad hoc imputation methods should be avoided in favour of methods with more plausible assumptions although they may be computationally more complex. Although standard multiple imputation methods and longitudinal modelling methods are equivalent for estimating the treatment effect, the two approaches suggest different ways of relaxing the assumptions, and the choice between them depends on contextual knowledge.
This article summarizes the theoretical basis for targeted prevention programs as they apply to different high-risk groups. We explain the advantages and disadvantages of different definitions of risk and discuss strategies for preventing drug use related problems in high-risk youth. Productive prevention programs for many at-risk groups share similar components, including those that address motivation, skills, and decision making. We present key aspects of these three components and link them to theories in clinical psychology, social psychology, sociology, and chemical dependence treatment. Among a total of 29 promising targeted prevention programs, we describe examples of empirically evaluated, intensive interventions that have made a positive impact on the attitudes and behavior of multiple problem youth. Incorporating the perspectives of multiple disciplines appears essential for progress in drug abuse and other problem behavior prevention.
To validate self reports of cigarette and smokeless tobacco (snus) use in a prospective cohort of adolescents.
A cross sectional analysis of a cohort sub-sample.
County of Stockholm, Sweden.
520 adolescents in the final grade of junior high school (mean age 15.0 years).
Concordance between self reported tobacco use and saliva cotinine concentration.
Using a cut point of 5 ng/ml saliva cotinine to discriminate active tobacco use, there was a 98% concordance between self reported non-use in the past month and cotinine concentration. The sensitivity of the questionnaire compared to the saliva cotinine test, used as the gold standard, was 90% and the specificity 93%. One hundred and fifteen out of 520 subjects (22%) reported monthly tobacco use. Among these, 67% (46/69) of the exclusive cigarette smokers, 82% (23/28) of exclusive snus users, and 94% (15/16) of mixed users (cigarettes + snus) had cotinine concentrations above 5 ng/ml. Among subjects reporting daily use 96% (64/67) had saliva cotinine concentrations above the cut point. Exclusive current cigarette users were more likely to be classified discordantly by questionnaire and cotinine test compared to snus users (odds ratio 3.2, 95% confidence interval 1.2 to 8.6).
This study confirms the reliability of adolescents' self reported tobacco use. In a context of low exposure to environmental tobacco smoke a cut off for saliva cotinine of 5 ng/ml reliably discriminated tobacco users from non-users. Irregular use of tobacco in this age group probably explains the discrepancy between self reported use and cotinine concentrations.
Drug addiction is a chronic, relapsing disease. Primary interventions should be aimed to reduce first use, or prevent the transition from experimental use to addiction. School is the appropriate setting for preventive interventions.
To evaluate the effectiveness of school-based interventions in improving knowledge, developing skills, promoting change, and preventing or reducing drug use versus usual curricular activities or a different school-based intervention .
MEDLINE , EMBASE, ERIC, PSYCHINFO, Cochrane Library, ACP Journal Club, Cochrane Drug and Alcohol Group Register, updated to February 2004, were searched. Bibliography of papers was checked and personal contacts were made to identify other relevant studies.
RCTs, CCTs or Controlled Prospective Studies (CPS) evaluating school-based interventions designed to prevent substance use.
Data were selected and extracted independently by two reviewers. Quality was assessed with the CDAG checklist. Interventions were classified as skills, affective, knowledge-focused and other characteristics were also studied (teaching, follow-up implementation, context activation).
32 studies (29 RCTs and 3 CPSs) were included. 28 were conducted in the USA; most were focused on 6th-7th grade students, and based on post-test assessment. RCTs: (1) Knowledge vs usual curricula: Knowledge focused programs improve drug knowledge (SMD=0.91; 95% CI: 0.42, 1.39).(2) Skills vs usual curricula: Skills based interventions increase drug knowledge (WMD=2.60; 95% CI: 1.17-4.03), decision making skills (SMD=0.78; CI95%: 0.46-1.09), self-esteem (SMD=0.22; CI95%: 0.03-0.40), peer pressure resistance (RR=2.05; CI95%: 1.24-3.42), drug use (RR=0.81; CI95%: 0.64, 1.02), marijuana use (RR=0.82; CI95%: 0.73, 0.92) and hard drug use (RR=0.45; CI95%: 0.24-0.85). (3) Skills vs knowledge: No differences are evident.(4) Skills vs affective: Skills-based interventions are only better than affective ones in self-efficacy (WMD=1.90; CI95%: 0.25, 3.55). (5) Affective vs usual curricula: Affective interventions improve drug knowledge (SMD=1.88; CI95%: 1.27, 2.50) and decision making skills (SMD=1.35; CI95%: 0.79, 1.9). (6) Affective vs knowledge: Affective interventions improve drug knowledge (SMD=0.60; CI95%: 0.18,1.03), and decision making skills (SMD=1.22; CI95%: 0.33, 2.12). Results from CPSs: No statistically significant results emerge from CPSs.
Skills based programs appear to be effective in deterring early-stage drug use. The replication of results with well designed, long term randomised trials, and the evaluation of single components of intervention (peer, parents, booster sessions) are the priorities for research. All new studies should control for cluster effect.
The authors propose new procedures for evaluating direct, indirect, and total effects in multilevel models when all relevant variables are measured at Level 1 and all effects are random. Formulas are provided for the mean and variance of the indirect and total effects and for the sampling variances of the average indirect and total effects. Simulations show that the estimates are unbiased under most conditions. Confidence intervals based on a normal approximation or a simulated sampling distribution perform well when the random effects are normally distributed but less so when they are nonnormally distributed. These methods are further developed to address hypotheses of moderated mediation in the multilevel context. An example demonstrates the feasibility and usefulness of the proposed methods.
The empirical evidence of effectiveness of many school-based programs against substance abuse is rather weak. The EU-Dap study is a multicenter cluster randomized community trial (CRCT) designed to evaluate such a program. This paper presents study design and baseline characteristics of the study population.
170 schools from 9 centers from seven countries (Austria, Belgium, Germany, Greece, Italy, Spain, Sweden), stratified according to average social status in the catchment area, were randomized to either three variants of the active intervention (basic curriculum, basic with peer involvement, and basic with parent involvement) or to a control group. The program under evaluation is based on a comprehensive social influence approach, and was delivered during the scholar year 2004-2005 to a population of 12- to 14-year-old students attending junior high school. An anonymous questionnaire administered before and after the intervention was used to track behavioral and attitudinal changes.
All in all, we included in the study 143 schools and 7079 students, of which 3547 in the intervention groups and 3532 in the control group. At baseline, 34.9% of students had smoked cigarettes, 24.7% had been drunk, and 8.9% had used cannabis at least once in life.
EU-Dap is the first European multicenter randomized study to evaluate the effectiveness of a school program targeting tobacco, alcohol and drug use. The baseline assessment showed high prevalence and wide geographical variations of substance use.
There is a west-east mortality gradient in Europe, more pronounced in men. The objective of this article was to quantify the contribution of alcohol use to the gap in premature adult mortality between three old (France, Sweden and United Kingdom) and four new (Czech Republic, Hungary, Lithuania and Poland) European Union (EU) member states for the year 2002. Russia was added as an external comparator.
Exposure data were taken from surveys and per capita consumption records from the World Health Organization (WHO) Global Alcohol Database. Mortality data were taken from the WHO databank. The risk relationships were taken from published meta-analyses and from the WHO Comparative Risk Assessment project. Alcohol exposure and relative risk information was combined to derive alcohol-attributable fractions for relevant causes of premature mortality.
Alcohol consumption was responsible for 14.6% of all premature adult mortality in the eight countries, 17.3% in men and 8.0% in women. This proportion was clearly higher in the new EU member states and Russia compared with the comparison countries from the old EU. For men, Russia with 29.0 alcohol-attributable premature deaths per 10,000 population had a more than 10-fold higher rate compared with Sweden (2.7 deaths/10,000). For women, the ratio between Hungary (5.0 alcohol-attributable deaths/10,000) and Russia (4.7 deaths/10,000) compared with Sweden (0.5 deaths/10,000) was almost as high, but the rates were much lower. The Czech Republic and Poland showed proportionally less alcohol-attributable premature mortality than the other new EU member states or Russia for both genders, which, however, was still higher than in any of the old EU member states.
Alcohol is a strong contributor to the health gap between western and central and eastern Europe, with both average volume of consumption and patterns of drinking contributing to burden of disease and injury. Alcohol also contributes substantially to male-female differences in mortality and life expectancy. However, there are feasible and cost-effective measures to reduce alcohol-related burden that should be implemented in central and eastern Europe.
Substance use is responsible for a large burden of disease in Canada, however updated data are needed for health care planning and policy development. This study replicates and makes improvements on 1992 estimates of substance-attributable morbidity and mortality for the year 2002. There are two objectives, the main one being to compare the substance-attributable morbidity and mortality in 1992 with 2002 using the same methods of calculation, and the second, to compare the two different methods of estimating the substance-attributable mortality and morbidity in 2002.
Estimates of substance-attributable burden were made by combining relative risk data with exposure prevalence data and disease-related mortality and morbidity information from national databases. First, identical relative risk estimates for 1992 were used with the 2002 data in order to draw direct comparisons. In a second analysis, updated relative risk and attributable disease information (post-1992) was used to better estimate the mortality and morbidity for Canada in 2002.
Overall, from 1992 to 2002, there were relative increases in substance-attributable mortality estimates for alcohol and illegal drugs, where the latter relatively increased more; and a relative decrease in tobacco-attributable mortality. In terms of absolute numbers in combined risk factors, deaths and hospital days for those under 70 years of age decreased mainly due to tobacco. Comparisons of the two methods showed that the updated method resulted in more conservative numbers than previous calculations.
There is an unacceptably high burden of substance-attributable disease in Canada in the early 2000s. Exposure changes and epidemiological shifts in population and diseases over the last 10 years have affected where the burden lies, but it is still vital to incorporate policy-based initiatives that have proven to be effective in reducing substance-attributable burden in practice.
To evaluate the effectiveness of the school-based drug abuse prevention program developed in the EU-Dap study (EUropean Drug Abuse Prevention trial) in preventing the use of tobacco, alcohol and drugs at the post-test.
Cluster Randomised Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. A pre-test survey assessing past and current substance use was conducted before the implementation of the program. The program consisted in 12-hour class-based curriculum based on a comprehensive social-influence approach. A post-test survey was carried out in all participating schools, 3 months after the end of the program. The association between program condition and change in substance use at post-test was expressed as adjusted Prevalence Odds Ratio (POR), estimated by multilevel regression model.
Program effects were found for daily cigarette smoking (POR=0.70; 0.52-0.94) and episodes of drunkenness in the past 30 days (POR=0.72; 0.58-0.90 for at least one episode, POR=0.69; 0.48-0.99 for three or more episodes), while effects on Cannabis use in the past 30 days were of marginal statistical significance (POR=0.77; 0.60-1.00). The curriculum was successful in preventing baseline non-smokers or sporadic smokers from moving onto daily smoking, but it was not effective in helping baseline daily smokers to reduce or stop smoking.
School curricula based on a comprehensive social-influence model may delay progression to daily smoking and episodes of drunkenness.
Objective:
To evaluate the long-term efficacy of a school-based approach to drug abuse prevention.
Design:
Randomized trial involving 56 public schools that received the prevention program with annual provider training workshops and ongoing consultation, the prevention program with videotaped training and no consultation, or "treatment as usual" (ie, controls). Follow-up data were collected 6 years after baseline using school, telephone, and mailed surveys.
Participants:
A total of 3597 predominantly white, 12th-grade students who represented 60.41% of the initial seventh-grade sample.
Intervention:
Consisted of 15 classes in seventh grade, 10 booster sessions in eighth grade, and five booster sessions in ninth grade, and taught general "life skills" and skills for resisting social influences to use drugs.
Measures:
Six tobacco, alcohol, and marijuana use self-report scales were recorded to create nine dichotomous drug use outcome variables and eight polydrug use variables.
Results:
Significant reductions in both drug and polydrug use were found for the two groups that received the prevention program relative to controls. The strongest effects were produced for individuals who received a reasonably complete version of the intervention--there were up to 44% fewer drug users and 66% fewer polydrug (tobacco, alcohol, and marijuana) users.
Conclusions:
Drug abuse prevention programs conducted during junior high school can produce meaningful and durable reductions in tobacco, alcohol, and marijuana use if they (1) teach a combination of social resistance skills and general life skills, (2) are properly implemented, and (3) include at least 2 years of booster sessions.
Because smoking as an identifiable risk factor for several diseases, has not declined in adults and may be increasing in teen-agers and children, a social-psychological strategy to deter smoking in children is currently being implemented in the Houston (Texas) Independent School District. The study, developed by a group at the University of Houston Psychology Department, involves various sociological and psychological devices, such as modeling, identification, and attribution in conjunction with persuasive communication techniques—affect, specificity, and feedback.A pretest, post-test design is employed in a longitudinal study. An independent variable package, used in the pilot study involving seventh graders, includes four different videotapes presented to the subjects on four consecutive days. The role-played sequences in the tapes reflect how pressures by peers, parents, and media can precipitate smoking in children. The tape presentation is followed by focused discussion about coping with these pressures. The dependent variable package, in addition to various attitudinal and reported smoking behavior responses, employs a novel nicotine-in-saliva measure for more objective determination of whether or not a student is smoking. The long term longitudinal study will involve fifth- through 12th-graders. It is hoped that preventing children from starting to smoke will prove to be more effective than attempting to deal with already addicted smokers.
This study presents one-year follow-up data from an evaluation study testing the effectiveness of a cognitive-behavioral substance abuse prevention approach which emphasizes the teaching of social resistance skills within the larger context of an intervention designed to enhance general social and personal competence. The follow-up study involved 998 eighth graders from 10 suburban New York junior high schools. Two schools were assigned to each of the following conditions (a) peer-led intervention, (b) peer-led intervention with booster sessions, (c) teacher-led intervention, (d) teacher-led intervention with booster sessions, and (e) control. The original intervention was implemented in the seventh grade; the booster intervention was implemented during the eighth grade. Results indicate that this type of prevention strategy, when implemented by peer leaders in the seventh grade and when additional booster sessions are provided during the eighth grade, can reduce tobacco, alcohol, and marijuana use. Similar effects are evident for females when the prevention program is implemented with fidelity by classroom teachers. Moreover, the prevention program is also capable of producing a significant impact on several hypothesized mediating variables.
The effectiveness of a 10-session social psychological approach to the prevention of cigarette smoking was tested on 8th, 9th, and 10th graders (N = 281) in suburban New York. The program was designed to address both the social and psychological factors promoting the onset of smoking by attempting to: (a) increase students' ability to cope with direct pressures to smoke, (b) decrease their susceptibility to indirect pro-smoking social influences, and (c) improve their ability to cope with anxiety. The program was conducted by allied health professionals and utilized group discussion, modeling, and behavior rehearsal. Results indicate significant differences between the experimental and control groups in terms of the proportion of new “experimental smokers” (P < 0.01). Furthermore, there were significantly greater pretest—post-test changes for the experimental group on several of the knowledge and psychological measures, suggesting that the decrease in the onset of smoking behavior among the experimental subjects did occur for the hypothesized reasons.
This study reports the level of participation of parents in a parent-targeted school-based drug prevention program, the differences between students whose parents participate and those who don't, and the implications for involving parents in future drug prevention programs. Among 1761 eligible seventh grade families, 1263 students (72%) and 1142 parents (65%) completed surveys assessing the quality of parent-child relationships as well as tobacco and alcohol use. Ten percent of eligible families attended at least one of the evening sessions. Compared to students whose parents completed the survey, students whose parents did not complete a survey were more likely to report they used tobacco, had more friends who used substances, were monitored less by their parents, had more risk-taking behaviors, had lower grade-point averages, and their parents had higher rates of tobacco and alcohol use. Parents who attended evening sessions had the lowest rates of tobacco use and reported spending the most time with their children. Parent-targeted drug preventions programs may stigmatize attending parents and may be unlikely to attract the highest risk families.
The prevalence of last year use of alcohol, cigarettes, marijuana and cocaine in the U.S. population and conditional prevalence of a proxy measure of last year dependence among last year users of each drug class were assessed as a function of age, gender and ethnicity. Analyses were based on three aggregated waves (1991, 1992 and 1993) of the nationally representative samples of the general population aged > or = 12 interviewed in the National Household Surveys on Drug Abuse (n = 87915). An approximation of DSM-IV drug-specific last year dependence for each drug class was derived from self-reported symptoms of dependence, data on frequency and quantity of use and drug-related problems reported for the last year. Descriptive and multivariate analyses were conducted. The inclusion of cigarettes among the drugs, the large number of cases and the wide age range of respondents (> or = 12) enable us to make drug, age, gender and ethnic comparisons not otherwise possible in any other data set. The proxy measure of dependence, however, has limitations. The five major findings are that: (1) nicotine is the most addictive of the four drugs we examined; (2) among female last year users of alcohol and marijuana, adolescents are significantly more at risk for dependence than any other age group of women; (3) conditional prevalences of last year dependence on alcohol, marijuana and cocaine are higher among adolescent females than adolescent males but significantly different only for cocaine; (4) among adults, the rates of dependence are higher among males than among females for alcohol and marijuana, but lower for nicotine; and (5) among last year users, whites are more likely than any other ethnic group to be dependent on nicotine and blacks to be dependent on cocaine.
Data from 27,616 current and former drinkers interviewed in the 1992 National Longitudinal Alcohol Epidemiologic Survey were used to examine the relationship between age at first use of alcohol and the prevalence of lifetime alcohol abuse and alcohol dependence, among all U.S. adults 18 years of age and over and within subgroups defined by sex and race. The rates of lifetime dependence declined from more than 40% among individuals who started drinking at ages 14 or younger to roughly 10% among those who started drinking at ages 20 and older. The rates of lifetime abuse declined from just over 11% among those who initiated use of alcohol at ages 16 or younger to approximately 4% among those whose onset of use was at ages 20 or older. After using multivariate logistic regression models to adjust for potential confounders, the odds of dependence decreased by 14% with each increasing year of age at onset of use, and the odds of abuse decreased by 8%. These findings are discussed with respect to their implications for prevention policies and the need to integrate epidemiological and intervention research.
The number needed to treat (NNT) is a useful way of reporting the results of randomised controlled trials.1 In a trial comparing a new treatment with a standard one, the number needed to treat is the estimated number of patients who need to be treated with the new treatment rather than the standard treatment for one additional patient to benefit. It can be obtained for any trial that has reported a binary outcome.
### Summary points
The number needed to treat is a useful way of reporting results of randomised clinical trials
When the difference between the two treatments is not statistically significant, the confidence interval for the number needed to treat is difficult to describe
Sensible confidence intervals can always be constructed for the number needed to treat
Confidence intervals should be quoted whenever a number needed to treat value is given
Trials with binary end points yield a proportion of patients in each group with the outcome of interest. When the outcome event is an adverse one, the difference between the proportions with the outcome in the new treatment (pN) and standard treatment (pS) groups is called the absolute risk reduction (ARR=pN−pS). The number needed to treat is simply the reciprocal of the absolute risk difference, or 1/ARR (or 100/ARR if percentages are used rather than proportions). A large treatment effect, in the absolute scale, leads to a small number needed to treat. A treatment that will lead to one saved life for every 10 patients treated is clearly better than a competing treatment that saves one life for every 50 treated. Note that when there is no treatment effect the absolute risk reduction is zero and the number needed to treat is infinite. As we will see below, this causes problems.
As with other …
The purpose of this study was to examine the relationship between early onset drug use and the development of lifetime DSM-IV drug abuse and dependence using a representative sample of the U.S. population. Prevalences of lifetime drug abuse and dependence were estimated for each year of age of onset of drug use from ages 13 and younger to 21 and older for the overall sample of drug users by race and gender. Linear logistic analyses were conducted to assess the relationship between age of drug use onset and lifetime drug use disorders controlling for important covariates. The major finding of this study was that early onset drug use is a significant predictor of the subsequent development of drug abuse over the life course. Early onset drug use was also a significant predictor of the subsequent development of lifetime alcohol dependence among males, females, and nonblacks, but not among blacks. After adjusting for important model covariates, the likelihood of lifetime drug abuse and dependence among the total sample of lifetime drug users was reduced by 4% and 5% with each year drug use onset was delayed. Implications of these findings are discussed in terms of the importance of collecting national data on drug use, abuse and dependence and the need for further research and its integration with prevention efforts.
This study aimed to describe the natural course of DSM-III-R alcohol disorders as a function of age at first alcohol use and to investigate the influence of early use as a risk factor for progression to the development of alcohol disorders, exclusive of the effect of confounding influences.
Data were obtained from a community sample (N=5,856) of lifetime drinkers participating in the 1990-1991 Mental Health Supplement of the Ontario Health Survey.
Survival analyses revealed a rapid progression to alcohol-related harm among those who reported having their first drink at ages 11-14. After 10 years, 13.5% of the subjects who began to drink at ages 11 and 12 met the criteria for a diagnosis of alcohol abuse, and 15.9% had a diagnosis of dependence. Rates for subjects who began to drink at ages 13 and 14 were 13.7% and 9.0%, respectively. In contrast, rates for those who started drinking at ages 19 and older were 2.0% and 1.0%. Unexpectedly, a delay in progression to harm was observed for the youngest drinkers (ages 10 and under). Hazard regression analyses revealed a nonlinear effect of age at first alcohol use, marked by an elevated risk of developing disorders among subjects first using alcohol at ages 11-14.
First use of alcohol at ages 11-14 greatly heightens the risk of progression to the development of alcohol disorders and therefore is a reasonable target for intervention strategies that seek to delay first use as a means of averting problems later in life.
No long-term impact has yet been observed with the use of the social-influences approach to school-based smoking prevention for youth. However, whether this lack of impact is due to methodologic problems with the studies or to the failure of the interventions is unclear. The Hutchinson Smoking Prevention Project (HSPP), conducted from September 1984 through August 1999, aimed to attain the most rigorous randomized trial possible to determine the long-term impact of a theory-based, social-influences, grade 3-12 intervention on smoking prevalence among youth.
Forty Washington school districts were randomly assigned to the intervention or to the control condition. Study participants were children enrolled in two consecutive 3rd grades in the 40 districts (n = 8388); they were followed to 2 years after high school. The trial achieved high implementation fidelity and 94% follow-up. Data were analyzed with the use of group-permutation methods, and all statistical tests were two-sided.
No significant difference in prevalence of daily smoking was found between students in the control and experimental districts, either at grade 12 (difference [Delta] = 0.2%, 95% confidence interval [CI] = -4.6% to 4.4%, and P =.91 for girls; Delta = 0.3%, 95% CI = -5.0% to 5.5%, and P =.89 for boys) or at 2 years after high school (Delta = -1.4%, 95% CI = -5.0% to 1.6%, and P =.38 for girls; Delta = 2.6%, 95% CI = -2.5% to 7.7%, and P =.30 for boys). Moreover, no intervention impact was observed for other smoking outcomes, such as extent of current smoking or cumulative amount smoked, or in subgroups that differ in a priori specified variables, such as family risk for smoking.
The rigor of the HSPP trial suggests high credence for the intervention impact results. Consistent with previous trials, there is no evidence from this trial that a school-based social-influences approach is effective in the long-term deterrence of smoking among youth.
This study examined correlates of program initiation and completion in a family-directed program that involved families of adolescents throughout the United States. Correlates varied by whether program initiation, program completion, or the number of activities completed was the indicator of participation. In final regression models, participation was relatively likely by non-Hispanic whites when compared with persons of race/ethnicity other than white, black, and Hispanic; by families with a female adolescent as the program recipient; by families with mothers who had many years of education; and by families with both parents living in the household. There was more participation if parents thought their child would smoke in the future and if the parent thought the adolescent did not smoke currently. Participation was higher if the adolescent felt strongly attached to the parent and if parents did not smoke. The findings are considered in the context of similar programs and future research on family-directed programs to prevent adolescent tobacco and alcohol use.
Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at high risk for substance use initiation.
The effectiveness of a universal drug abuse preventive intervention was examined among youth from 29 inner-city middle schools participating in a randomized, controlled prevention trial. A subsample of youth (21% of full sample) was identified as being at high risk for substance use initiation based on exposure to substance-using peers and poor academic performance in school. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills.
Findings indicated that youth at high risk who received the program (n = 426) reported less smoking, drinking, inhalant use, and polydrug use at the one-year follow-up assessment compared to youth at high risk in the control condition that did not receive the intervention (n = 332). Results indicate that a universal drug abuse prevention program is effective for minority, economically disadvantaged, inner-city youth who are at higher than average risk for substance use initiation.
Findings suggest that universal prevention programs can be effective for a range of youth along a continuum of risk.
To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students.
Group randomised controlled trial.
26 Dutch schools that provided junior secondary education.
1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years.
Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition.
Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis.
In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant.
In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.
Smoking is a risk factor for several diseases and has been increasing in many developing countries. Our aim was to estimate global and regional mortality in 2000 caused by smoking, including an analysis of uncertainty.
Following the methods of Peto and colleagues, we used lung-cancer mortality as an indirect marker for accumulated smoking risk. Never-smoker lung-cancer mortality was estimated based on the household use of coal with poor ventilation. Relative risks were taken from the American Cancer Society Cancer Prevention Study, phase II, and the retrospective proportional mortality analysis of Liu and colleagues in China. Relative risks were corrected for confounding and extrapolation to other regions.
We estimated that in 2000, 4.83 (uncertainty range 3.94-5.93) million premature deaths in the world were attributable to smoking; 2.41 (1.80-3.15) million in developing countries and 2.43 (2.13-2.78) million in industrialised countries. 3.84 million of these deaths were in men. The leading causes of death from smoking were cardiovascular diseases (1.69 million deaths), chronic obstructive pulmonary disease (0.97 million deaths), and lung cancer (0.85 million deaths).
Smoking was an important cause of global mortality in 2000. In view of the expected demographic and epidemiological transitions and current smoking patterns in the developing world, the health loss due to smoking will grow even larger unless effective interventions and policies that reduce smoking among men and prevent increases among women in developing countries are implemented.
Although many sociodemographic and psychosocial factors have been identified as related to adolescent smoking, few studies have examined the role of nicotine-dependence (ND) symptoms. The objective was to study the association between ND symptoms and smoking status among adolescents in the early stages of the smoking onset process.
The McGill University Study on the Natural History of Nicotine Dependence is an ongoing 6-year prospective investigation of the natural history of ND among 1267 grade 7 students in ten Montreal high schools. The baseline response was 55.4%. Subjects for this cross-sectional analysis of baseline data, collected in 1999, included 241 past 3-month smokers (mean age [SD]=13.0+/-0.7 years at baseline). ND symptoms were measured in five indicators, including a measure based on the criteria for tobacco dependence in the International Classification of Diseases-10th Revision (ICD-10), the Hooked on Nicotine Checklist, and three symptom clusters (withdrawal, self-medication, and ND/cravings symptoms). The association between ND symptom indicators and each of sporadic, monthly, weekly, and daily smoking relative to less frequent smoking was investigated in multiple logistic regression analysis.
Despite low cigarette exposure, 16.6% (95% confidence interval [CI], 11.9%-21.3%) of past 3-month smokers were tobacco dependent. The proportion increased from 0%, 3.1% (95% CI, 0.0%-9.2%), and 4.6% (95% CI, 0.2%-9.0%) among triers, sporadic smokers, and monthly smokers, respectively, to 19.4% (95% CI, 5.5%-33.3%) and 65.9% (95% CI, 51.9%-79.9%) among weekly and daily smokers, respectively. ND/cravings consistently distinguished each smoking category from less frequent smokers; the odds ratios (95% CI) for ND/cravings symptoms were 1.16 (0.99-1.35) in sporadic smokers; 1.17 (1.06-1.29) in monthly smokers; 1.34 (1.19-1.50) in weekly smokers; and 1.39 (1.22-1.59) in daily smokers.
These data challenge current smoking onset models, which suggest that ND develops only after several years of heavy or daily smoking. ND symptoms are associated, at least cross-sectionally, with increased smoking in adolescents. To increase the likelihood of being effective, tobacco-control programs for children and adolescents will need to take early ND symptoms into account.
The Life Skills Training (LST) program is the most prominent school-based smoking prevention program in terms of its consistency in being named on lists of best practices. This study assessed whether the results pertaining to cigarette smoking reported in evaluations of the LST program are measurement dependent.
Seventeen reports published between 1980 and 2003 that included at least one outcome measure pertaining to cigarette smoking were identified. Data pertaining to the cigarette smoking measures used in the analysis and whether the results showed a statistically significant difference between experimental and control groups at follow-up were extracted from the reports.
Fourteen different outcome measures were used across 17 reports. Only three pairs of reports presented the same set of outcomes. Recent reports showed the most consistent set of findings in support of the LST program, but there was little consistency in the outcome measures used in these analyses.
The use of so many smoking outcomes in the LST program evaluations raises concern as to whether the positive program effects reported are measurement dependent.
To investigate longitudinally for both genders the relation between the age of onset of drinking and several indicators of alcohol use.
In the Finnish Jyväskylä Longitudinal Study of Personality and Social Development, data have been collected by interviews, inventories, and questionnaires. Data on alcohol consumption was gathered at ages 14, 20, 27, 36 and 42 years; behavioural data at age 8.
A total of 155 women and 176 men; 90.4% of the original sample consisting of 12 complete school classes in 1968.
The age of onset of drinking was determined based on participants' responses that were closest to the actual age of onset of drinking. Four indicators of the adult use of alcohol were used: frequency of drinking, binge drinking, Cut-down, Annoyed, Guilt, Eye-opener (CAGE) and Malmö modified Michigan Alcoholism Screening Test (Mm-MAST). Socio-emotional behaviour at age 8 was assessed using teacher ratings and peer nominations.
Early onset of drinking was related to the four indicators of the use of alcohol in adulthood both in men and women. The level of adult alcohol use and alcohol problems was significantly higher in men. The risk for heavy drinking was highest in men and women if drinking was started at less than age 16 years. Socio-emotional behaviour and school success at age 8 did not predict the age of onset of drinking.
Delaying the initiation of drinking from early adolescence to late adolescence is an important goal for prevention efforts. No clear risk group for early initiators of drinking could be identified on the basis of preceding behaviour among 8-year-olds.
To study the feasibility of an anonymous coding procedure linking longitudinal information in a multi-center trial of substance abuse prevention among adolescents.
A school-based survey with re-test procedure was conducted among 485 students (mean age 13.8 years) from three countries at four study centers in order to study accuracy and repeatability of a self-generated anonymous code.
Errors affected 18% of codes and 3% of all digits required for the code generation, with highest figures for two of the seven generation items. Sixty-one percent of the codes generated at the test were repeated identically at the re-test. Seventy-six percent of the codes could be linked excluding the 2 digits with the highest error rate in code generation, while 92% were linked using the best combination of the remaining seven or six digits. There was substantial variation between the centers in the results.
Self-generation of anonymous codes is a feasible, but not a very efficient procedure to link longitudinal data among adolescents. Easy derivation and iterative matching procedures are crucial for achieving high efficiency of this type of anonymous linkage.
