EVIDENCE BASED PRIMARY PREVENTION. 20 YEARS OF SUCCESSFUL WORK. J ON SIGFUSSON ICSRA I C S R A 2 0 1 6
Positive development for 18 years % 50 40 30 20 10 0 Drunk last 30 days Daily smoking 42% Cannabis once or more 32 26 26 25 23% 18 17% 16 14 14 12 12 10 12 12 9 7 9 7% 9 7 7 6 5 5% 3 3% 1998 2000 2002 2004 2006 2008 2010 2012 2015 2016
Substance use trend in several countries 15-16 year old adolescents (Alcohol use past 30 days, ESPAD 2011)
Substance use trend in several countries 15-16 year old adolescents 80 70 (Alcohol use past 30 days, ESPAD) 60 50 56 58 61 55 54 51 48 48 % 40 30 20 10 43 43 42 37 31 Iceland Finland Sweden Norway UK 38 35 17 0 1995 1999 2003 2007 2011
Substance use trend in several countries 15-16 year old adolescents (Alcohol use past 30 days, ESPAD 2011) 80 70 60 59 56 73 77 65 63 50 % 40 43 30 20 10 Iceland 37 Lithuania 31 17 0 1995 1999 2003 2007 2011
Substance Use Amongst European Youth (ESPAD, 2011) 80 70 60 50 Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis ALCOHOL USE LICHTENSTEIN 40 30 20 10 0 Iceland Malta Lichtenstein
Substance Use Amongst European Youth (ESPAD, 2011) 80 70 60 50 Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis ALCOHOL USE MALTA 40 30 20 10 0 Iceland Malta Lichtenstein
Substance Use Amongst European Youth (ESPAD, 2011) 80 70 Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis 60 50 40 ALCOHOL USE ICELAND 30 20 10 0 Iceland Malta Lichtenstein
Substance Use Amongst European Youth (ESPAD, 2011) 80 70 Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis 60 50 40 30 20 10 0 Iceland Malta Lichtenstein
What is the commitment?
The role of research 11
Why research based? Medicine Engineering Tourism Fisheries Pharmaceutical industries Children s lives, health and well-being 12
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
The twofold use of research 1. Scientific 2. Practical 14
The scientific role of research 1. In depth analysis of the data 2. 70 peer reviewed publications in journals in Europe and USA 3. Science forms the platform for practice 15
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
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
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
What did we learn? 19
Upward trend 1992-1998 30 % 25 20 15 15,1 Smoke daily Have tried hashish 20,7 22,8 17,4 10 9,6 5 7,2 0 1992 1993 1994 1995 1996 1997 1998 20
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
The main risk and protective factors Family factors Extracurricular activities, sports Peer group effect General well being 22
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
Youth in Iceland core elements: Evidence base Community approach Research policy practise: dialogue Icelandic Centre for Social Research and Analysis 24
1998 Drug-free Iceland A totally new methodology in substance use prevention Obviously, what we had been doing before, was not working. 25
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
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
60 50 40 57% Lifetime drunkenness 41% % 30 20 10 0 20% 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
60 50 40 57% Lifetime drunkenness 41% 30% less in 6 years % 30 20 10 0 20% 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
What else would we tell the policy makers? 31
100 90 80 70 60 % 50 40 30 20 10 0 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
100 90 80 70 60 Almost never Seldom Sometimes Often Almost always Strong connection between drinking alcohol and time spent with parents % 50 40 30 20 10 42,0 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
50 40 30 % Almost never Up to 3 times pr. week 4 times or more often Strong connection between smoking and participation in sports 24,9 20 10 0 9,9 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
How were the findings used? 35
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
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
Tobacco and chewing gum 38
Peanuts and Gin 39
The scientific isolation needed to be broken 40
The researchers guru approach 41
The way we work now 42
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
Knowing is not enough How do you act? 45
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 4.000.000-, yearly to Leisure Card. 46
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
What has changed? 48 48
% 50 45 40 35 30 25 20 15 10 5 23,0 Increased participation in organized leisure time activities 34,0 42,0 42,0 Increased participation in organized sports 0 2000 2006 2012 2014 Percentage of students in 9 th grade that participate in sports in a sports club four times per week or more 49
% 50 45 40 35 30 25 20 15 10 5 0 Parents and children spend more time together 23,0 33,0 46,0 50,0 1997 2006 2012 2014 Percentage of students in 9 th and 10 th grade who spend time (often/almost always) with their parents during weekdays 50
75 65 Less late outside hours 55 % 45 35 53,0 40,0 25 15 5 29,0 23,0-5 2000 2006 2012 2014 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
80 70 60 Increased parental monitoring 67,0 71,0 75,0 % 50 40 30 52,0 20 10 0 2000 2006 2012 2014 My parents know where I am in the evenings (applies very or rather well to me) 9 th and 10 th grade 52
50 42 Drunk last 30 days Daily smoking Cannabis once or more % 40 30 20 10 0 32 26 26 25 23 18 17 16 14 14 12 12 10 12 12 9 7 9 6 9 7 7 5 3 3 1998 2000 2002 2004 2006 2008 2010 2012 2015 and substance use is going down 53
% 50 45 40 35 30 25 20 15 10 5 0 42 23 17 35 19 15 Drunk last 30 days Daily smoking Hashish once or more 32 16 33 26 28 15 14 14 12 11 12 13 26 12 22 11 9 9 1998 1999 2000 2001 2002 2003 2004 2005 Substance use down by 50% in 8 years Youth in Europe started 2005 54
Youth in Europe until 2015 55
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
CONTACT US: Inga Dóra Sigfúsdóttir ingadora@ru.is Jón Sigfússon jon@rannsoknir.is Álfgeir Logi Kristjánsson - alkristjansson@hsc.wvu.edu John Allegrante jpa1@columbia.edu Thank you 57
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, 1997-2014. Addiction, 111, 645-652. 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, 662-667. 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), 23-26. Sigfusdottir, ID., Kristjansson, AL., Gudmundsdottir, ML., Allegrante, JP. (2010). A collaborative community approach to adolescent substance misuse in Iceland. International Psychiatry, 7(4), 86-88. 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, 168-171. Sigfusdottir, ID., Thorlindsson, Th., Kristjansson, AL., Roe, KM., Allegrante, JP. (2009). Substance use prevention for adolescents: The Icelandic Model. Health Promotion International, 24(1), 16-25. 58