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Prevention by social influenceProven effectiveness of universal prevention

The Drug Education Forum16 november 2009 in London

Peer van der Kreeft

Lecturer drug issues and prevention, Faculty of Social Work and Welfare Studies at the University College Ghent

Head of prevention, De Sleutel,Belgium

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Overview

1. Evidence based prevention2. EU-Dap results: effective

programme3. EU-Dap programme components4. Special attention to normative

belief 5. UNODC, Mentor and EU-Dap: int’l

dissemination

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Balance …

Interventions that large populations

easily accept

Interventions that have proven to be

effective

opinion base versus evidence base

4Action research: practicioners work together with researchers

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What works?

1. RCT Randomized Controlled Trial

2. components from meta-analyses

3. … from systematic reviews4. other research

Good practice (American Psychologists Association task force report °2005)

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Problems with evidence

• The evidence base is highly diversified and specialised

• The evidence base is always „work in progress“– Continuous need for identifying unsatisfactory practice

and for new evidence • Most evidence comes from a few countries

– Not necessarily applicable in other countries or cultures

Uchtenhagen, ICAA Edinburgh 2006

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Effectivity componentsaccording to meta-analysis Nancy Tobler 2000

• Teacher training• Information about drugs• Include normative beliefs• Focus on specific influence based skills • Interactive delivery• Involve family and community• Cultural sensitivity

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“RCT universal schoolbased prevention… The first ever European Drug Abuse

Prevention Trial EU-Dap has shown promising results. Funded by the European Commission, the project was implemented and cross-evaluated in seven countries, nine regional centres and 170 schools and involved 7 079 students (in a trial group and in a control group)….”

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Not only effective but also safe: have lowest iatrogenic effects.

Iatrogenic effects: e.g. inadequate information, wrong target group, norm narrowing, facilitate access, werther effect

In the EU-DAP Unplugged programme no iatrogenic effects were detected.

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SWEDEN/StockholmCentre for Tobacco

Prevention

SPAIN/ BilbaoEDEX

GREECE/ ThessalonikiREITOX/PYXIDA

AUSTRIA/ WienISG

GERMANY/ KielIFT-Nord

BELGIUM/ GentDe Sleutel

ITALY/ TurinPiemonte

Monitoring Centrefor Drug Abuse

EMCDDA

ITALY/ NovaraAvogadro University

CZECH REP Adiktologie

POLAND Poznan univ

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The study sample at baseline (n=7079) °2004

CENTRE # STUDENTS MEDIAN AGE

Italy Turin 1.660 14

Spain Bilbao 429 14

Italy Novara 592 14

Germany Kiel 709 13

Sweden Stockholm 1.033 13

Italy L’Aquila 732 13

Belgium Gent 858 12

Greece Thessaloniki 516 12

Austria Vienna 550 12

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The EU-Dap Cluster Randomised Controlled Trial

Effectivity of Unplugged intervention after 2nd questionnaire (3 mths post interv)

Daily smoking 30% reduction* Recent drunkenness 28% reduction

Experimenting cannabis 23% reduction

The EU-Dap class programme has a preventive effect on early onset of drug use and on the transition of experimental to frequent use. The effect is bigger for boys than for girls.

*Daily smoking, recent drunkenness, any cannabis at this age are stronger predictors

www.eudap.net

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Daily smoking Any episode of drunkenness Any use of cannabis

Changes in prevalence of past 30 days substance use between EU-Dap participants at baseline (n=7079), at the 3 months (n=6370) and at the 15 months follow-up

(n=5541)

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Daily smoking

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Any drunkenness

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Any cannabis

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Programme components

• Implementation guide• Workbook for the pupil• Cards for class• Handbook 12 lessons for the teacher • Teacher training• Three parent meetings

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Normative belief

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Normative belief workbook manual cards

Normative belief exercise21

Fill this in, fold the paper together and put it in the box I drink every week one time + 6 glasses alcohol (any alcohol) on one evening

o yes

o no I smoke every day one cigarette

o yes

o no I smoke every day one joint

o yes

o no I have every month one time unsafe sex (unprotected sex with a not-fix partner)

o yes

o no

Normative belief exercise22

How many percent do you think that in this group … binge drinks weekly (drink more than 6 glasses of alcohol on one occasion) smokes daily uses cannabis daily has unsafe sex monthly

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Parent meetings

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Teacher trainingObjectives of the 3 day

training:

1. Information transfer

2. Social learning

3. Experimental learning

4. Learning to work on a positive and safe class climate

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Assets of Unplugged• Feasibility of implementation: 12 lessons,

in one semester• Balance of (1) intrapersonal,

(2) interpersonal, (3) knowledge and attitude lessons

• Correction of normative beliefs • Include non-health arguments, such as

esthetical, financial, social risk, information on cannabis marketing strategy

• Multi-cultural origin inside EU • Proven effectiveness

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Risks and challenges

• Less effective on girls – at that age • Training takes time and infrastructure• Cost of program: 200€/class• Follow up limited to 15 mths• Fading effect on smoking: booster

intervention

Unplugged disseminationItaly, Austria, Germany, Belgium, Sweden, Spain, Greece, Czech Republic, Poland plus:

• Lithuania• Romania• Russian

Federation• Croatia• Kyrgizstan• Lebanon

• Morocco• United Arab

Emirates• Egypt• Jordan• Kuwait

ICAA Estoril, October 2009

Fidelity vs. Fit

Surface Structure:

• Language and idioms• Places• Product brands• Food• Music

…

Deep Structure:

• Risk/ protective factors• Gender roles• Family and community life• Legal system• Norms and values...

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Examples adaptation issues

• encountered so far– regarding drugs– regarding gender– regarding family

• crucial Unplugged issues– social influence and interactive delivery– normative belief related to peer pressure and media

influence– drug related information in quiz cards

• include other than health risks• no emphasis on death and legal consequences• include perceived desired effects without promoting them

extra information on drugs can be added on national website

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Int’l level deliveries

Implementation of the adapted version of Unplugged in new countries with each approx 16 schools, targeting ten thousands of pupils; process-evaluate this

A randomized controlled study in participating countries with at least 3.200 pupils for outcome evaluation

A team of trainers and managers to further disseminate the programme on a national base, with the existing schools and teachers as a firm starting point

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Concrete steps national level

1. Identification of a national backup group to overview the adaptation, development, implementation and evaluation of the project.

2. Working with an operational project team to adapt Unplugged to meet the local needs and to identify trainers of teachers, in close cooperation with Mentor and EU-Dap.

3. Producing national translated and adapted programme material for training and for use in the school setting.

4. Identifying schools for implementation. 5. Teacher training followed by an agreed implementation period

for the programme in agreed conditions.6. Conducting a randomised controlled evaluation of the

effectiveness in collaboration with EU-Dap, in 1 or more countries.7. Disseminate to further schools with a view to national

implementation of the programme.

mar-09 apr-09 mag-09 giu-09 lug-09 ago-09 set-09 ott-09 nov-09 dic-09 gen-10 feb-10 mar-10 apr-10 mag-10 giu-10 lug-10 ago-101 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

UNODC MENTOR EUDAP

team BEIRUT translate & adaptTOT

MEET ING

team team TOT team team evalreport

country 1WKS&VISIT VISIT WKS

SAMP Q1 INTERVENT Q2 conference

country 2WKS&VISIT VISIT WKS

SAMP Q1 INTERVENT Q2 conference

country 3WKS&VISIT VISIT WKS

SAMP Q1 INTERVENT Q2 conference

country 4WKS&VISIT VISIT WKS

SAMP Q1 INTERVENT Q2 conference

country 5WKS&VISIT VISIT WKS

SAMP Q1 INTERVENT Q2 conference

Timeframe international level

© and €

• The EU-Dap material, in all the language versions, is intellectual copyright of OED Torino.

• This is an obligation by the EU that financed and powered the original version

• EU wants it to be public domain• No financial obligations or profits

may be liaised with the © on EU-Dap material

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Overview1. Evidence based prevention2. EU Dap results: effective programme3. EU Dap programme components4. Special attention to normative belief5. EU-Dap int’l dissemination

Thank you, peer.vanderkreeft@hogent.be

eudap.netdesleutel.be hogent.be