EVIDENCE BASED PRIMARY PREVENTION. 20 YEARS OF SUCCESSFUL WORK. I C S R A

Transcription

1 EVIDENCE BASED PRIMARY PREVENTION. 20 YEARS OF SUCCESSFUL WORK. J ON SIGFUSSON ICSRA I C S R A

2 Positive development for 18 years % Drunk last 30 days Daily smoking 42% Cannabis once or more % 18 17% % % 3 3%

3 Substance use trend in several countries year old adolescents (Alcohol use past 30 days, ESPAD 2011)

4 Substance use trend in several countries year old adolescents (Alcohol use past 30 days, ESPAD) % Iceland Finland Sweden Norway UK

5 Substance use trend in several countries year old adolescents (Alcohol use past 30 days, ESPAD 2011) % Iceland 37 Lithuania

6 Substance Use Amongst European Youth (ESPAD, 2011) Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis ALCOHOL USE LICHTENSTEIN Iceland Malta Lichtenstein

7 Substance Use Amongst European Youth (ESPAD, 2011) Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis ALCOHOL USE MALTA Iceland Malta Lichtenstein

8 Substance Use Amongst European Youth (ESPAD, 2011) Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis ALCOHOL USE ICELAND Iceland Malta Lichtenstein

9 Substance Use Amongst European Youth (ESPAD, 2011) Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis Iceland Malta Lichtenstein

10 What is the commitment?

11 The role of research 11

12 Why research based? Medicine Engineering Tourism Fisheries Pharmaceutical industries Children s lives, health and well-being 12

13 Indicators Health status indicators, anxiety, depressive symptoms, physical health status, lifestyle and leisure time activities, local community networks, negative life events and strain, parents and family, peer group economic and psychological issues, studies and school, substance use, values and attitudes, violence and delinquency, and more 13

14 The twofold use of research 1. Scientific 2. Practical 14

15 The scientific role of research 1. In depth analysis of the data peer reviewed publications in journals in Europe and USA 3. Science forms the platform for practice 15

16 The practical role of research Data collections on substance use regularly Practical information immediately to the municipalities Local information INTO all levels of prevention work is a KEY issue 16

17 Importance of frequent measuring Every school, every parent, every prevention worker can see the current situation in their close community and can act accordingly. Not 2-3 years later but almost immediately 17

18 Children's rights Children have the right to have a say about what they want, what they do and how they feel We have the obligation to make good use of what they tell us, react and constantly try to make their lives better. 18

19 What did we learn? 19

20 Upward trend % ,1 Smoke daily Have tried hashish 20,7 22,8 17,4 10 9,6 5 7,

21 The year is 1998 At this point of time research had already showed us that certain circumstances and behaviour in the lives of adolescents were strongly connected with use We tried to establish the risk and protective factors 21

22 The main risk and protective factors Family factors Extracurricular activities, sports Peer group effect General well being 22

23 And analysing deeper Family factors Organized activities vs. unorganized Extracurricular activities, sports Inside and outside of school, at home, bullying e.t.c. General well being Time spent with parents Support Monitoring Control Peer group effect Positive and negative effects. How we as parents approach the peer group Staying outside late Hanging out in malls 23

24 Youth in Iceland core elements: Evidence base Community approach Research policy practise: dialogue Icelandic Centre for Social Research and Analysis 24

25 1998 Drug-free Iceland A totally new methodology in substance use prevention Obviously, what we had been doing before, was not working. 25

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27 Aim of Drug-free Iceland To change the actual behaviour of youth and not only their attitudes Change the life-style environment of our children so that they would be in lesser risk of substance use 27

28 Our focus is primary prevention Primary prevention, preventing the development of substance use before it starts Secondary prevention, that refers to measures that detect substance use Tertiary prevention efforts that focus on people already abusing substances 28

29 % Lifetime drunkenness 41% % % 10% 13 year 14 year 15 year 13 year 14 year 15 year Childen born 1985 Children born 1991 Substance use follows cohorts Sigfusdottir et al., 2011, Global Health Promotion 29

30 % Lifetime drunkenness 41% 30% less in 6 years % % 10% 50% less than six years before 13 year 14 year 15 year 13 year 14 year 15 year Children born 1985 Children born 1991 Substance use follows cohorts Sigfusdottir et al., 2011, Global Health Promotion 30

31 What else would we tell the policy makers? 31

32 % None or few A few Many Almost all 68,2 49,3 23,3 4,6 Boys who have become drunk past 30 days Percentage of students in 9 th and 10 th grade who have become drunk in the last 30 days depending on if their friends become drunk one pr. month 32

33 Almost never Seldom Sometimes Often Almost always Strong connection between drinking alcohol and time spent with parents % ,0 27,8 17,6 12,0 10,4 0 Girls who have become drunk last 30 days Percentage of girls in 9 th and 10 th grade who have become drunk in the last 30 days depending on how much time they spend with parents 33

34 % Almost never Up to 3 times pr. week 4 times or more often Strong connection between smoking and participation in sports 24, ,9 Girls who smoke daily 3,5 Percentage of students in 9 th and 10 th grade who smoke daily depending on if they practice sports 34

35 How were the findings used? 35

36 Examples of local actions 1. Research as a basis in policy making and actions 2. Strengthen parent organizations and co-operation 3. Support extracurricular activities / sports 4. Support active NGOs 5. Support young people at risk inside schools 6. Form co-operative work groups against drugs 7. Anti smoking / drinking campaigns 36

37 Examples of national actions 1. Age limits to buy tobacco and alcohol (18 and 20) 2. Advertising ban of tobacco and alcohol 3. Restricted access to alcohol and tobacco 4. Rules on outside hours for adolescents 5. Visibility ban of tobacco and alcohol 37

38 Tobacco and chewing gum 38

39 Peanuts and Gin 39

40 The scientific isolation needed to be broken 40

41 The researchers guru approach 41

42 The way we work now 42

43 Focus on close community How could an average figure on alcohol use in your country help prevention workers in your municipality? Average doesn t tell all the story! 43

44 44

45 Knowing is not enough How do you act? 45

46 The Reykjavík City Leisure Card The Leisure Card initiative is to guarantee that all children up to the age of 18 have the opportunity to engage in leisure activities outside school. The city of Reykjavik allocates approximately EUR , yearly to Leisure Card. 46

47 What else is gained? Less health problems Less crime / imprisonments Less social benefits cost Less unemployment Less rehabilitation cost Less broken families etc., etc. 47

48 What has changed? 48 48

49 % ,0 Increased participation in organized leisure time activities 34,0 42,0 42,0 Increased participation in organized sports Percentage of students in 9 th grade that participate in sports in a sports club four times per week or more 49

50 % Parents and children spend more time together 23,0 33,0 46,0 50, Percentage of students in 9 th and 10 th grade who spend time (often/almost always) with their parents during weekdays 50

51 75 65 Less late outside hours 55 % ,0 40, ,0 23, Percentage of students in 9 th and 10 th grade who have been out after 10 pm (3 times or more) in the past week 51

52 Increased parental monitoring 67,0 71,0 75,0 % , My parents know where I am in the evenings (applies very or rather well to me) 9 th and 10 th grade 52

53 50 42 Drunk last 30 days Daily smoking Cannabis once or more % and substance use is going down 53

54 % Drunk last 30 days Daily smoking Hashish once or more Substance use down by 50% in 8 years Youth in Europe started

55 Youth in Europe until

56 The To-Do list 1. Map the situation in the local conditions 2. From the data find the local risk and protective factors 3. Address these factors through local community work 4. Form local networks from all institutions of the municipality 5. Give immediate, practical information out quickly 6. Measure regularly and frequently 56

57 CONTACT US: Inga Dóra Sigfúsdóttir Jón Sigfússon Álfgeir Logi Kristjánsson - alkristjansson@hsc.wvu.edu John Allegrante jpa1@columbia.edu Thank you 57

58 Icelandic Model publications Kristjansson, AL., Sigfusdottir, ID., Thorlindsson, T., Mann, MJ., Sigfusson, J., Allegrante, JP. (2016). Population trends in smoking, alcohol use, and primary prevention variables among adolescents in Iceland, Addiction, 111, Kristjansson, A.L., Sigfusdottir, I.D., Allegrante, J.P. (2013). Adolescent substance use and peer use: A multilevel analysis of cross-sectional population data. Substance Abuse Treatment, Prevention, and Policy, 8:27. Kristjansson AL, Sigfusson J, Sigfusdottir ID, Allegrante, JP (2013). Data collection procedures for school-based surveys among adolescents: the Youth in Europe Study. Journal of School Health, 83, Sigfusdottir, ID., Kristjansson, AL., Gudmundsdottir, ML., Allegrante, JP. (2011). Substance use prevention through school and communitybased health promotion: A transdisciplinary approach from Iceland. Global Health Promotion, 18(3), Sigfusdottir, ID., Kristjansson, AL., Gudmundsdottir, ML., Allegrante, JP. (2010). A collaborative community approach to adolescent substance misuse in Iceland. International Psychiatry, 7(4), Kristjansson, AL., James, JE., Allegrante,JP., Sigfusdottir, ID., Helgason, AR. (2010). Adolescent substance use, parental monitoring, and leisure time activities: 12-year outcomes of primary prevention in Iceland. Preventive Medicine, 51, Sigfusdottir, ID., Thorlindsson, Th., Kristjansson, AL., Roe, KM., Allegrante, JP. (2009). Substance use prevention for adolescents: The Icelandic Model. Health Promotion International, 24(1),