Gregor Burkhart

The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomized controlled trial

AIM To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study (EUropean Drug Addiction Prevention trial). MATERIALS AND METHODS Cluster Randomized Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and current substance use was conducted before the implementation of the program, while a post-test survey was carried out about 18 months after the pre-test. The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated by multilevel regression models. RESULTS Persisting beneficial program effects were found for episodes of drunkenness (any, POR=0.80; 0.67-0.97; frequent, POR=0.62; 0.47-0.81) and for frequent cannabis use in the past 30 days (POR=0.74; 0.53-1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition, but no difference was detected in the proportion of quitters or reducers among baseline daily smokers. CONCLUSION The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use, but not for cigarette smoking.

The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial

OBJECTIVE To evaluate the effectiveness of the school-based drug abuse prevention program developed in the EU-Dap study (EUropean Drug Abuse Prevention trial) in preventing the use of tobacco, alcohol and drugs at the post-test. METHODS Cluster Randomised Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. A pre-test survey assessing past and current substance use was conducted before the implementation of the program. The program consisted in 12-hour class-based curriculum based on a comprehensive social-influence approach. A post-test survey was carried out in all participating schools, 3 months after the end of the program. The association between program condition and change in substance use at post-test was expressed as adjusted Prevalence Odds Ratio (POR), estimated by multilevel regression model. RESULTS Program effects were found for daily cigarette smoking (POR=0.70; 0.52-0.94) and episodes of drunkenness in the past 30 days (POR=0.72; 0.58-0.90 for at least one episode, POR=0.69; 0.48-0.99 for three or more episodes), while effects on Cannabis use in the past 30 days were of marginal statistical significance (POR=0.77; 0.60-1.00). The curriculum was successful in preventing baseline non-smokers or sporadic smokers from moving onto daily smoking, but it was not effective in helping baseline daily smokers to reduce or stop smoking. CONCLUSION School curricula based on a comprehensive social-influence model may delay progression to daily smoking and episodes of drunkenness.

Methods for Synthesizing Findings on Moderation Effects Across Multiple Randomized Trials

This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

Is universal prevention against youths’ substance misuse really universal? Gender specific effects in the EU-Dap school–based prevention trial.

Background: Studies of effectiveness of school-based prevention of substance misuse have generally overlooked gender differences. The purpose of this work was to analyse gender differences in the effectiveness of a new European school-based curriculum for prevention of substance misuse among adolescents. Methods: The European Drug Abuse Prevention (EU-Dap) trial took place in seven European countries during the school year 2004–05. Schools were randomly assigned to either a control group or a 12-session standardised curriculum (“Unplugged”) based on a comprehensive social influence model. The analytical sample consisted of 6359 students (3324 boys and 3035 girls). The use of cigarettes, alcohol and illicit drugs, adolescents’ knowledge and opinions about substances, as well as social and personal skills were investigated through a self-completed anonymous questionnaire administered at enrolment and 3 months after the end of the programme. Adjusted Prevalence Odds Ratios were calculated as the measure of association between the intervention and behavioural outcomes using multilevel regression modelling. Results: At enrolment, boys were more likely than girls to have used cannabis and illicit drugs, whereas girls had a higher prevalence of cigarette smoking. At the follow-up survey, a significant association between the programme and a lower prevalence of all behavioural outcomes was found among boys, but not among girls. Age and self-esteem emerged as possible modifiers of these gender differences, but effects were not statistically significant. Conclusions: Comprehensive social influence school curricula against substance misuse in adolescence may perform differently among girls and boys, owing to developmental and personality factors.

The theoretical model of the school-based prevention programme Unplugged

Unplugged is a school-based prevention programme designed and tested in the EU-Dap trial. The programme consists of 12 units delivered by class teachers to adolescents 12–14 years old. It is a strongly interactive programme including a training of personal and social skills with a specific focus on normative beliefs. The aim of this work is to define the theoretical model of the program, the contribution of the theories to the units, and the targeted mediators. The programme integrates several theories: Social Learning, Social Norms, Health Belief, theory of Reasoned Action-Attitude, and Problem Behaviour theory. Every theory contributes to the development of the units’ contents, with specific weights. Knowledge, risk perception, attitudes towards drugs, normative beliefs, critical and creative thinking, relationship skills, communication skills, assertiveness, refusal skills, ability to manage emotions and to cope with stress, empathy, problem solving and decision making skills are the targeted mediators of the program.

Is the Strengthening Families Programme feasible in Europe

Purpose – The purpose of this paper is to provide insights into the potential of technology transfer in prevention interventions. It argues that contextual factors are more identifiable and more malleable than the cliche of “culture” as a barrier to implementation might suggest. The key question is how various contextual factors impact on programme implementation and effectiveness in the different cultures of a multifaceted continent such as Europe, and how successful programmes adapt to various contexts. Design/methodology/approach – Using a questionnaire survey, input was collected from people involved in the adaptation and implementation of the Strengthening Families Programme (SFP) in several European countries. Findings – The publications and experiences of the SFP implementers and evaluators in most of the European countries where it was introduced suggest that the programme is both feasible and effective (where outcomes are available). To achieve this, however, the implementers spent a considerable...

Is Environment Really A Function

IcongratulateDavidFoxcroftforthisfinepaper“Canpreven-tionclassification beimprovedby consideringthe functionofprevention?” In essence, it proposes, in addition to the classi-fication into universal, selective, and indicated (“forms”),another axis, where environmental, developmental,and infor-mational approaches are introduced as “functions.” In thissystem,environmentalpreventionwouldnolongerbeafourthcategory complementing universal, selective, and indicatedprevention, but another functional dimension, pervadingtransversally the three forms of prevention. When Davidpresented his model at the Second Annual Meeting of theEuropeanSocietyforPreventionResearch,Iwaspuzzled,andsincethen,havecontinued pondering whetherthisproposalisreallypreferableto themodel wehavebeenpromotingwithinthe EU.AnumberofDavid’s critical comments on the existingmodel present me with problems as follows:1. David makes a point that in the current model, environ-mental prevention would overlap with universal preven-tion, and even with selective and indicated prevention,because it can have differential effects or may addresscertain groups only, such as minors. Taken to its logicalconclusion—the argument that measures lack universali-ty—then only mass media campaigns are universal, be-cause all other approaches commonly labeled“universal”target sub-populations, like young people, working peo-ple,andsoon.Ihadalwaysunderstoodfromtheliteraturethat the defining characteristic of “universal” is that thevulnerability of the target population is not assesseddifferentially.Besides,themodelwehavebeenusinguntilnow was not meant to consist of clear-cut side-by-sidecategories,butratherofspheres-within-spheres,similartoBronfenbrenner’s 1979 model of macro-, meso-, and mi-crospheres of influence. Environmental prevention, here,isanoutersphere,whichtargetsphysical,social,econom-ic, and virtual environments. In contrast to the other threeforms, it does not target people directly (i.e., in directinteraction). Nevertheless, all four approaches obviouslyaim at behavioral change of individuals. Therefore, I donot see it as conceptually confusing that the outer sphere,in the form of family norms and socialization—as exam-ples of environmental prevention—has effects on an in-dividual child.Most of uswould agree that all preventionstrategiesaim atultimatelychangingindividual behavior;the environmental ones by changing context, the otherthree by persuasion according to differing vulnerabilitiesand needs. That environmental strategies can be carriedoutwithincommunitystrategiesdoesalsonotconstituteaviolation of the category system: all four forms (or“spheres”) ofpreventioncan becarriedout inall classicalsettingsforprevention.Lastly,evenifgun-controllawsorage limits might affect only or mostly those most at risk,they are still applied to society and the population as awhole,unlikeindicated approaches, whichtarget selectedindividuals only.2. David seems to interpret environmental prevention asrestricted to regulation alone. However, non-coercive en-vironmentalinfluencesonbehaviorcanalsobeclassedasenvironmental prevention, even if sometimes the borderswith health promotion may be ill-defined. Examples arepositive school or learning climate and the spatial andlogistical arrangement of nightlife events. None of theseimply changing behavior by persuasion.3. I would not subscribe to the view that universal ap-proaches “are generally more impactful on better off,lower risk population groups. ” Rather, it seems—when

Bridging the science-practice gap in drug demand reduction: A European perspective

The growing demand for accountability of interventions in public health is having an impact on the drug demand reduction field. Clear ‘evidence-based’ practices now receive greater priority when decisions are taken about the quality of services and the planning and allocation of funds. This article aims to explore the benefits and limitations of the term ‘evidence-based practices’ when applied to public health, and in particular the drug demand reduction field. Parallel to a top-down approach, where academic research recommends empirically supported interventions, a bottom-up approach, where professionals in the field generate practice-based evidence themselves, is promoted as well. Complementary to evidence-based practices, there is a need to cultivate practice-based evidence or evaluation of practices at field level, as the latter constitute an important pillar of our knowledge base of what works in the drugs field. This article presents findings based on a descriptive analysis of more than 400 evaluated drug demand reduction interventions implemented at field level, in more than 17 EU Member States, carried out by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). These findings underline the need to foster and support an analysis of ‘what works’ under real-life conditions.

Resource tool for using evidence-based prevention and evaluation in practice

We report about internet-based resource tools that compile the available evidence and knowledge base for designing and evaluating theory-based prevention interventions. Their relevance is discussed with a view to a recently noticeable climate of uncertainty about the effectiveness of prevention work.

Selective Prevention: Addressing Vulnerability to Problem Drug Use in Europe.

Following the 2003 publication of the European Union (EU) Council Recommendations and the 2005–2008 and 2009–2012 EU Drugs Action Plans, increasing attention has been given in EU member states’ drug policies to populations that are vulnerable to problem drug use (PDU). Monitoring data reported to the EMCDDA by designated agencies from 30 countries highlight that vulnerable populations tied to institutions (e.g. young drug law offenders, pupils with academic problems, youth in care institutions) receive more attention in policy and intervention provision than vulnerable groups that are hard to reach (e.g. immigrants and homeless youth). The context of vulnerability to PDU in the EU is discussed, including the inadequacy in many member states of alternatives to imprisonment for underage drug law offenders, the difficulty of addressing the needs of ethnic and migrant groups and opportunities for prevention in culturally disadvantaged neighbourhoods.