(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)
A Data Review reported in Issue 9, 2016 of Substance Use & Abuse describes a latent class analysis (where patterns of behaviours are grouped) for adolescent alcohol & drug use across Europe. "Data from 25 European countries were used to identify patterns of adolescent (12–16 years, 50.6% female) substance use (N = 33,566). Results: Latent class analysis revealed four substance use classes: nonusers (68%), low-alcohol users (recent use of beer, wine, and alcopops; 16.1%), alcohol users (recent use of alcohol and lifetime use of marijuana; 11.2%), and polysubstance users (recent use of alcohol, marijuana, and other illicit drugs; 4.7%). Results support a general pattern of adolescent substance use across all countries; however, the prevalence rates of use patterns vary for each country. Conclusions/importance: The present research provides insight into substance use patterns across Europe by using a large international adolescent sample, multidimensional indicators and a variety of substances. Substance use patterns are helpful when targeting policy and prevention strategies." Read More>>
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)
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Adolescent substance use following participation in a universal drug prevention program is reported in an article in Issue #3, 2015 of Substance Abuse. "The study examined whether adolescents receiving a universal, school based, drug prevention program in Grade 7 varied, by student profile, in substance use behaviors post program implementation. Profiles were a function of recall of program receipt and substance use at baseline." Students who had no baseline substance use and had program recall were significantly less likely to use substances. For other students, including those who had no recall of the program but were not using at the start of the program and those who were using before participating in the program, the universal program had no impact. Read more>> (An item from the ISHN Member information service)
Several articles in Issue #8-9, 2015 of Substance Use & Misuse are part of a special Issue describing progress (and not) in substance abuse. The title of the issue says it well "Fifty Years Later: Ongoing Flaws and Unfinished Business". The articles include some great insights into the debates, many ongoing, within this filed. They include a discussion of the politics in dropping the term "addiction" and turning to problematic or misuse; the failure to address discrimination as a cause of substance abuse; the clever marketing that underlies "evidence-based practices" and how the concept of "gateway drug" needs to be retired. Another article likes drug use by young people in Hong Kong to the profound economic and social changes that have occurred there in the past five decades. One not to be missed is an article discussing how negative (focus on risk and problems) and positive (focus on assets and youth development) models in adolescent substance abuse prevention are found wanting. The over reliance on RCT studies as the "gold standard" in knowledge development is also debated. Another article describes the ongoing challenges associated with implementation and maintenance of effective programs. Other deal with context, the challenges of integrated programming, evidence-based vs local programs, and community-school cooperation. n brief, the special issues captures much of the recent history and challenges in substance abuse prevention but it also offers insight into prevention and promotion more generally. Read More>> (An item from the ISHN Member information service)
(An item from the ISHN Member information service) Two news stories identified this week help to explain the potential confusion and debates about e-cigarettes. On August 18th, the US government (National Institutes of Health) released a report noting that e-cigarette use by teens would likely lead to smoking tobacco. On August 19th, the Health Department in England released a research review stating that e-cigarettes were 95% less harmful than tobacco. Both of these studies are likely accurate. What is confusing is the government intentions in both cases and what fact-based health messages are intended by the release of each study. Read more>>
(An item from the ISHN Member information service) A blog post from Live Science suggests that a better understanding is needed of the practical or real life reasons why teens use marijuana is required. Based on a study done in the USA, the author suggests that boredom, experimentation and pleasure (to get high) are among the strongest reasons for use. Mixing marijuana with other drugs to increase the effect was another. The study then examined which reasons were associated with the use of other drugs, exploring the often discussed notion that marijuana is a gateway to other drugs. Experimentation was not tied to other drug use but boredom was. Read more>>
(From the ISHN Member information service) The WHO fact sheet describing the response of health ministries to prevent and control NCDs indicates the collective, global intentions and strategies. The ideas and actions not mentioned on the page and in the action plan are as important as the ones that are highlighted. WHO summarizes the actions needed as follows:
" To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them. An important way to reduce NCDs is to focus on lessening the risk factors associated with these diseases. Low-cost solutions exist to reduce the common modifiable risk factors (mainly tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol) and map the epidemic of NCDs and their risk factors. Other ways to reduce NCDs are high impact essential NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment. Evidence shows that such interventions are excellent economic investments because. The greatest impact can be achieved by creating healthy public policies that promote NCD prevention and control and reorienting health systems. Lower-income countries generally have lower capacity for prevention and control. Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions". Our initial comments: (1) The WHO is clearly medical, focused on health services rather than health promotion. (2) The absence of disease is the goal rather than overall health. (3) Other sectors are expected to be partners but a settings-based approach, essential to these partnerships, is neglected and forgotten. Read more>> (From the ISHN Member information service) The release of the WHO status report/global action plan this week represents the efforts of health ministries to address a cluster of physical health diseases. The key facts are not new: "(1) NCD's kill 38 million people each year. (2) Almost 3/4 of deaths (28 million) occur in low- and middle-income countries.(3) Sixteen million deaths occur before the age of 70; 82% of these "premature" deaths occur in low/middle-income countries. (4) Cardiovascular diseases account for most deaths, (17.5 million), followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million). These 4 groups of diseases account for 82% of all NCD deaths. Tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol increase the risk of NCDs. Tobacco accounts for around 6 million deaths every year and is projected to increase to 8 million by 2030. About 3.2 million deaths annually can be attributed to insufficient physical activity. More than half of the 3.3 million annual deaths from harmful drinking are from NCDs In 2010, 1.7 million annual deaths from cardiovascular causes have been attributed to excess salt/s. To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them.odium intake.More than 190 countries agreed in 2011 to reduce the avoidable NCD burden in a Global action plan. This plan aims to reduce the number of premature deaths from NCDs by 25% by 2025. In 2015, countries will begin to set national targets and measure progress on the 2010 baselines. The UN General Assembly will convene a third high-level meeting on NCDs in 2018 to take stock of national progress. Read more>>
(From the ISHN Member information service) An article in the January 2015 issue of Substance Use, Misuse examines the correlation between study sport involvement and the use of drugs and alcohol. The authors report "The empirical research examining the impact of sports participation on alcohol and other drug use has produced mixed results. Part of this problem may be the result of how different types of sports participation create different experiences that shape certain types of behaviors that either facilitate or deter substance use. Objectives. We examined the association between different types of competitive sports participation and substance use among a nationally representative sample of adolescents. Methods: Two recent cross-sections from the Monitoring the Future were merged to capture a large subsection of adolescents who participate in either high-contact sports (football, wrestling, hockey, and lacrosse), semicontact sports (baseball, basketball, field hockey, and soccer), and noncontact sports (cross-country, gymnastics, swimming, tennis, track, and volleyball). Results: Multivariate analyses revealed that adolescents who participated in high-contact sports had higher odds of using substances during the past 30 days and initiating substance use at early ages. Further, adolescents who participated in noncontact sports had lower odds to indicate smoking cigarettes and marijuana during the past 30 days. Read more>>
(From Drug & Alcohol Findings UK) A cogent analysis of the limitations of school-based drug education is discussed in a blog post from this multi-partner knowledge exchange organization in the UK. The article suggests that school-based instruction is, almost by definition, constrained by the social forces surrounding and enshrined in schools. When adults, whose normative beliefs and practices encourage alcohol use, try to impose a delay in access to this popular pastime in the adult world on adolescents, the results are predictably limited. The article suggests a possible divorce of the "educational" aspects (empowering youth to make decisions) from the preventive aspects. Or, at least, the article suggests, that the goals of drug education should be modified to more limited objectives (harm reduction) or different objectives more compatible with schooling (character building, preventing school dropouts etc). Here is a brief except:
"School-based drug education was and for many remains the great hope for preventing unhealthy or illegal substance use. Across almost an entire age group it offers a way to divert the development of these forms of substance use before they or their precursors have taken root. Though promise is clear, the fulfilment is less so. Most disappointing for Europe and for the UK were results from the seven-nation EU-Dap European drug education trial and the English Blueprint trial. The former was the largest European drug education trial ever conducted and tested a sophisticated US-style social influence programme, yet the results were patchy – generally positive but modest and usually not statistically significant benefits relative to control schools. The multi-million pound Blueprint trial was the largest in Britain and featured advanced interactive teaching methods reinforced by parental and community-wide components. Its government funders expected the results to “trigger a fundamental assessment of the place of drug education” in UK drug policy. If it did, it would be to confirm that drug education in secondary schools makes little contribution to the prevention of problems related to drinking and illegal drug use, though the evidence in respect of smoking is stronger. By the end of the follow-up period, on none of the most relevant measures was there was any sign that Blueprint had retarded growth in substance use any more effectively than usual lessons in the non-Blueprint schools. What might lie behind such disappointments can be divided in to at least two possibly interrelated domains: contradictions in principle, shortfalls in practice. Among the first is the contradiction between the objectives of education and those of prevention: the former seeks to empower children to think for themselves and open up new horizons, the latter to channel thoughts, attitudes and actions in ways intended by programme developers and teachers. Then there are potential contradictions within prevention programmes themselves. Some aim to limit young people’s autonomy in their choice of friends and substances by extending autonomy in decision-making, to encourage conformity to non-drug use values by discouraging conformity to other young people, to develop team work and social solidarity without accepting that youngsters may express this by going along with their peers as well as deciding not to". Read more>> (From Drug & Alcohol Findings) The featured review brought together the findings of three reviews conducted for the Cochrane collaboration, each concerned with the effectiveness of ‘universal’ programmes aiming to prevent the development of drinking or drink-related problems in young people aged 18 or younger. As opposed to programmes for high-risk groups, universal programmes target large groups such as an entire age range, whether or not they are known to be specially prone to substance use or problems.The reviewed evidence supports the effectiveness of some but not all universal programmes for alcohol misuse prevention among young people. Given the variability in the results, particular attention should be paid to the content of programmes and the context in which they are delivered, including the setting, key personnel and target age. A programme may for example be effective where adolescent alcohol drinking is rare, but ineffective where it is the norm and reflects powerful social and cultural pressures to drink. Specifically in the school setting, some studies found no effects of preventive programmes, others statistically significant effects. Most commonly observed positive effects were for drunkenness and binge drinking, and it seems that certain generic psychosocial and developmental prevention programmes can be effective and could be considered as policy and practice options.
Main findings School-based programmes Of the 53 trials, 41 were conducted in North America. Relative to a standard curriculum, six of the 11 trials of alcohol-specific interventions found some statistically significant reductions in drinking. Another 39 studies tested more generic programmes. Of these, 14 found some statistically significant reductions in drink-related outcomes relative to a standard curriculum. Some apparently positive results may have been due to inadequate adjustment for ‘clustering’ effects (eg, of children in a class and of classes in schools), and in some studies results were confined to certain subgroups and/or some measures of drinking but not others. Most commonly, significant effects related to drunkenness and binge drinking. Impacts tended to last longer after generic than after alcohol-specific or other programmes. Overall, the evidence is more convincing for certain generic rather than alcohol-specific programmes. Among generic programmes, those based on psychosocial or developmental approaches (life skills in Life Skills Training; social skills and norms in Unplugged; behaviour norms and peer affiliation in the Good Behaviour Game) were most likely to report statistically significant effects over several years when compared to standard school curricula or other types of interventions. Family-based programmes All but one of the 12 trials were conducted in North America. Nine recorded statistically significant reductions in drinking, in some cases over longer as well as shorter term follow-ups. One study recorded apparently negative effects which may have arisen by chance or due to methodological issues. In another, though ineffective on its own, the family-based intervention was effective when combined with a school-based intervention. There is some evidence for the short to medium-term success of gender-specific interventions for daughters, typically involving their mothers. Some trials found impacts only among children already using substances at the start of the trial. Multi-component programmes All but three of the 20 trials were conducted in the USA. Relative to comparison conditions, 12 trials reported statistically significant reductions in drinking lasting up to three years among children allocated to multi-component programmes. Six of the 20 trials found no statistically significant differences, and in another significant reductions were confined to children already drinking at the start of the trial. It was unclear whether in general adding further prevention components to an existing programme improved outcomes; reports on four trials indicated some possible benefits, but another three trials found no such indications. Read More>> |
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