Maria Scatigna

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.

‘Unplugged’: A new European school programme against substance abuse

This paper presents the rationale, development and application of ‘Unplugged’, a new school programme for the prevention of substance abuse, which is based on the comprehensive social influence approach (CSI). The programme was developed, implemented and evaluated by a cross-disciplinary group of experts in the frame of a multi-centre study in seven European countries. The basic curriculum consists of 12 units, which are delivered by class teachers to a target population of 12–14 year-old students. Additional programme components were workshops for the students’ parents and debriefing sessions led by class peers. The programmes application was monitored by means of structured report forms. This process monitoring allowed for the analysis of problems in implementation, as well as of participatory aspects. ‘Unplugged’ is the first comprehensive social influence school curriculum in Europe of which the efficacy has been evaluated in a field trial, and it also constitutes an example of a theory- and evidence-based programme against youths’ substance use. This report can provide public health and school decision makers with tools to make an informed choice on these kinds of programmes and to survey their application.

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.

Cardiovascular Risk and Physical Activity: Simulated Analysis in GeneralPractice Patients Based on a Risk Score System

Abstract Aim: This cross-sectional study was aimed at evaluating the association between physical activity (PA), overweight and CV risk in a large sample of Italian general practice patients and forecast the impact of increasing PA in a general population. Methods: Regression analysis on single CV risk factors and stratification of global risk score have been carried out on 45,862 records with normal/overweight and active/inactive conditions as primary explanatory variables. Moreover a hypothetical attributable risk was calculated on the basis of expected cases. Results: HDL cholesterol resulted the risk factor most correlated with PA. Systolic blood pressure and fasting plasma glucose levels seemed to be more correlated to overweight than to PA. Active women and men would respectively have a 15% and 17% lower probability of experiencing a major cardiovascular event in the subsequent ten years than their inactive counterparts, adjusting for overweight. If inactive subjects became active at the lowest level, 818.8 cases/100,000 men and 201.5 cases/100,000 women aged 35-69 years would be protected during the same period. Conclusion: As counsellors for active lifestyle, general practitioners could contribute in reducing the absolute number of CV major events in the ‘healthy’ general population.