(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>>

(From Prevention Plus Wellness) Helping children, adolescents and young adults understand how health risk behaviors and health enhancing behaviors influence each other is critical to them making effective decisions for enhancing their whole health. In particular, youth need to know how substance abuse and health promoting habits affect each other to either enhance or interfere with their physical and mental health, perceived self-image, and achieving important life goals. In the past, health behaviors were viewed as being largely independent of each other. We now know that it is more common for youth to experience a number of co-existing unhealthy behaviors rather than a single behavior problem. These co-occurring behaviors influence each other both directly, as well as indirectly through common underlying risk and protective factors such as self-image and self-regulation skills. Effective prevention programs should therefore help young people identify how multiple areas of their lives interconnect to influence their future health, well-being and happiness. Below we provide some tips for teachers and parents on how to communicate with youth to help them make the connection between substance abuse and healthy behaviors. Read more>>

(An item from the ISHN Member information service) Family dinners have recently been highlighted as a way of promoting health of children and adolescents as well as preventing different health problems. However, an article in Issue #3, 2013 of the Journal of Health & Social Behavior reports that an analysis of the 1997 US National Longitudinal Study of Youth (n = 5,419) suggests that dinners have little effect on substance use and may actually cause an increase. The authors report that "The results indicate that family dinners are not generally associated with alcohol or cigarette use or with drug use initiation. However, a continuous measure of family dinners is modestly associated with marijuana frequency, thus suggesting a potential causal impact. These results show that family dinners may help prevent one form of substance use in the short term but do not generally affect substance use initiation or alcohol and cigarette use." Read more>>

(An item from the ISHN Member information service) The research about the importance of the transition in adolescent development has been confirmed again in two longitudinal studies reported in Issue #3, Journal of Adolescence. One article reports on a British study that concludes that "Depressive symptoms, school liking and conduct problems predicted lower attainment across time having controlled for the temporal stability in psychological functioning and attainment. School concerns predicted lower attainment for boys only, and the effects of depressive symptoms on later attainment were significantly stronger for boys compared to girls. School liking – and school concerns for boys – remained significant predictors of attainment when controlling for conduct problems." The Australian study correlated cannabis use with depression at all ages during the transition into adulthood. Read More>>

(An item from the ISHN Member information service) An article in the May 2013 issue of MBC Public Health may suggest that school health promotion efforts be more focused on students in vocational courses and alternative schools. This study aimed at investigating hazardous drinking, tobacco smoking and physical inactivity as well as their associations and demographic predictors in vocational school students.Out of 57 contacted vocational schools in Switzerland, a total of 24 schools participated in a survey assessing gender, age, immigrant background, educational attainment and vocational field as well as the their smoking, drinking and other behaviours. The authors report that "Of the surveyed students, 79.4% showed at least one risk factor, 43.6% showed two or more and 9.6% showed all three health risk factors. Hazardous drinking was more prevalent in male, physical inactivity was more prevalent in female vocational school students. The proportion of students with low physical activity and tobacco smoking increased with increasing age. While the combination of hazardous drinking and tobacco smoking was higher in males, the other risk factor combinations were observed particularly among females. Read more>>

(An item from ISHN Member information service) An updated systematic review of school-based smoking prevention programs paradoxically shows a long-term effect of those programs but only certain types had a short term effect within one year. The authors report that " We identified 49 randomised controlled trials (over 140,000 school children) of interventions aiming to prevent children who had never smoked from becoming smokers. At longer than one year, there was a significant effect of the interventions in preventing young people from starting smoking. Programmes that used a social competence approach and those that combined a social competence with a social influence approach were found to be more effective than other programmes. However, at one year or less there was no overall effect, except for programmes which taught young people to be socially competent and to resist social influences. A smaller group of trials reported on the smoking status of all people in the class, whether or not they smoked at the start of the study. In these trials with follow-up of one year or less there was an overall small but significant effect favouring the controls. This continued after a year; for trials with follow-up longer than one year, those in the intervention groups smoked more than those in the control groups.When trials at low risk of bias from randomisation, or from losing participants, were examined separately, the conclusions remained the same. Programmes led by adults may be more effective than those led by young people. There is no evidence that delivering extra sessions makes the intervention more effective. Read more>>

(An item from ISHN Member information service) Working across multiple systems to prevent a problem or promote health is not easy, even with collaboration mandated from above. An article in Issue #1, 2013 of Critical Public Health describes some of those challenges in an analysis of alcohol abuse prevention partnerships in England. The authors report that: "Tackling alcohol-related harms crosses agency and professional boundaries, requiring collaboration between health, criminal justice, education and social welfare institutions. It is a key component of most multi-component programmes in the United States, Australia and Europe. The findings are based on a mix of open discussion interviews with key informants and on semi-structured telephone interviews with 90 professionals with roles in local alcohol partnerships. Interviewees reported the challenges of working within a complex network of interlinked partnerships, often within hierarchies under an umbrella partnership, some of them having a formal duty of partnership. The new alcohol strategy has emerged at a time of extensive reorganisation within health, social care and criminal justice structures. Further development of a partnership model for policy implementation would benefit from consideration of the incompatibility arising from required collaboration and from tensions between institutional and professional cultures. A clearer analysis of which aspects of partnership working provide ‘added value’ is needed. Read more>

(An item from ISHN Member information service) An article in the December 2012 Issue of the Journal of Youth & Adolescence reports that different forms of religiosity will positively affect youth behaviours in regards to substance use, violence and delinquency. The researchers report that " Results revealed a five class solution. Classes were identified as religiously disengaged (10.76 %), religiously infrequent (23.59 %), privately religious (6.55 %), religious regulars (40.85 %), and religiously devoted (18.25 %). Membership in the religiously devoted class was associated with the decreased likelihood of participation in a variety of substance use behaviors as well as decreases in the likelihood of fighting and theft. To a lesser extent, membership in the religious regulars class was also associated with the decreased likelihood of substance use and fighting. However, membership in the religiously infrequent and privately religious classes was only associated with the decreased likelihood of marijuana use. Findings suggest that private religiosity alone does not serve to buffer youth effectively against involvement in problem behavior, but rather that it is the combination of intrinsic and extrinsic adolescent religiosity factors that is associated with participation in fewer problem behaviors." Read more. 

(An item from ISHN Member information service) An article in the December 2012 Issue of the Archives of Pediatrics & Adolescent Medicine analyzes the influences of the mother of your child`s friends, an expansion of the peer influence discussion in substance abuse prevention. The authors conclude that `If an adolescent had a friend whose mother was authoritative, that adolescent was 40% less likely to drink to the point of drunkenness, 38% less likely to binge drink, 39% less likely to smoke cigarettes, and 43% less likely to use marijuana than an adolescent whose friend's mother was neglectful. The study controlled for the parenting style of the adolescent's own mother, school-level fixed effects, and demographics. Read more.

(An item from ISHN Member information service) An article in Issue #6, 2012 of Education & Urban Society adds to our ongoing discussion about school connectedness and substance use. The authors note that "Research has found strong linkages between adolescent substance use and attitudes toward school. Few studies of this relationship, however, consider the different dimensions of students’ school attitudes, separating perceptions of the importance of school from the quality of students’ affective experiences therein". Using a sample of 301 urban adolescents, evenly divided into substance users and nonusers, this study examines the relationships between these two dimensions of school attitudes and substance use. Findings highlight a subset of adolescent substance users who see school as the most important place in which they routinely spend time and who differ significantly from other users, but not from nonusers, in their expressed satisfaction with school. Results also call attention to the ubiquity of urban adolescents’ dissatisfaction with their teachers, showing such dissatisfaction as unrelated to their rates of substance use. In other words, this study may mean that most students don't really care about their teachers, but this does not lead to substance use. It may be more important that students see school as an important step towards their future, so life goals may be more important than the typically vague definitions of school connectedness. Read more. 

(An item from ISHN Member information service) The strong evidence showing that a trusted adult figure in the lives of young people is vitally important has been confiremed, even for young homeless youth attending high school. An article in Issue #5, 2012 of Child & Youth Care Forum describes the factors associated with substance abuse among homeless youth who are continuing to attend high school. The researchers note that " Greater substance use was associated with gang membership, partner abuse and truancy. Lower levels of substance use were associated with higher levels of adult support. Additionally, adult support acted as both a mediator and moderator between the hypothesized risk factors and substance use". Read more.

(An item from ISHN Member information service) With the recent approval in a Washington State, USA vote on decriminalization of marijuana, an article in Issue #6, 2012 of the International Journal of Drug Policy caught our attention. The authors suggest that the value of the average, annual consumption of marijuana in British Columbia, which is next door to Washington State, is $407 million. Read more. 

(An item from ISHN Member information service) An article in the November 2012 issue of the Journal of Youth & Adolescence suggests that protective fathers (parents) who closely monitor their daughters relationships with boys will likely result in delayed and less use of alcohol. The authors report that: "for girls, higher levels of parental monitoring lead to fewer other-sex friendships, which then lead to lower levels of subsequent alcohol use. For drug use, the findings provided support for a direct relationship between early adolescent parental monitoring and late adolescent drug use for both boys and girls. Thus, parents seem to have a protective effect on their daughters’ later use of alcohol by limiting inclusion of male friends in their networks. Read more. 

(An item from ISHN Member information service)  A large scale study of the co-occurrence of substance use disorders and mental health disorders in Australia found that patients with a substance abuse problem were likely to have a MH problem but this correlation was not true in reverse. There was a total of 10,211,596 (4,671,243 males (45.75 per cent) and 5,540,353 females (54.25 per cent)) admissions. Over the six years, between 9.4 per cent and 12.6 per cent of the patients with MHDs were diagnosed as having SUDs. Of the patients diagnosed with SUDs, between 42.5 per cent and 57.4 per cent also had a diagnosis of MHDs. Overall, the comorbidity for both MHDs and SUDs was between 8.4 per cent and 11.3 per cent. The odds ratio for either SUDs or MHDs compared to the general population was between 13.0 to 20.8.The authors suggest that "the findings imply that different efforts towards the prevention, care and management of comorbidity may be warranted." This would likely be true even more for school-based and school-linked programs where the two conditions are much less likely to have reached a clinical stage and where convergence is also less likely. This underlines the case for not merging MH and SAP strategies related to schools while still seeking synergies wherever possible. Read More..  PS A similar analysis of US data from the National Survey on Drug Use and Health found that 10.8% had MH problems, 5.1% had SA problems and only 2.1% has co-ocurring problems