Roberta Siliquini

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.

Smartphones and Health Promotion: A Review of the Evidence

Communication via mobile phones has become an essential tool for health professionals. The latest generation of smartphones is comparable to computers, allowing the development of new applications in health field. This paper aims to describe the use of smartphones by health professionals and patients in the field of health promotion. We conducted a bibliographic search through Pubmed. Then, research results were analyzed critically in order to select the best experiences available. All searches were carried out on November 2012 and were not limited by date. Each item from the initial search was reviewed independently by members of the project team. Initial search returned 472 items with PubMed. After the removal of duplicates, 406 items were reviewed by all the members of the project team and 21 articles were identified as specifically centered on health promotion. In the nutrition field there are applications that allow to count calories and keep a food diary or more specific platforms for people with food allergies, while about physical activity many applications suggest exercises with measurement of sports statistics. Some applications deal with lifestyles suggestions and tips. Finally, some positive experiences are reported in the prevention of falls in elderly and of sexually-transmitted diseases. Smartphones are transforming the ways of communication but the lack of monitoring of contents, the digital divide, the confidentiality of data, the exclusion of the health professional from the management of patient, are the main risks related to their use.

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.

Pregnancy e-health: a multicenter Italian cross-sectional study on internet use and decision-making among pregnant women

Background Our study aimed to estimate the prevalence of pregnancy e-health seekers in a large Italian sample; to explore the factors influencing the choices of the childbearing women regarding their lifestyles after internet consultation; and finally to investigate potential differences between primiparous and multiparous women in internet use to find information about pregnancy. Methods A multicentre survey was carried out in seven Italian cities. Data were collected through a validated questionnaire administered in waiting rooms of outpatient departments by medical doctors. Respondents were questioned about their sociodemographic status, their use of the internet to seek pregnancy information and their consequent choices to modify their lifestyles. Data were analysed using descriptive statistics and logistic regression. Results Almost all women were pregnancy e-health seekers (95%), including those who also received information from healthcare professionals. Indeed, the main reason for searching the web was the need of further knowledge on pregnancy-related topic, over and beyond other key advantages of the net such as anonymity, simplicity and rapidity. A higher likelihood of changing lifestyle after pregnancy e-health was observed among the women who searched institutional websites; declared more confidence in the information retrieved; participated into pregnancy-centred forum online; and were residents in Italy. Conclusions To reduce the likelihood for women of both finding erroneous information or misinterpreting correct ones, healthcare professionals should commit to fill the information gap and guide pregnant women in the online searches. Also, future studies are strongly needed to analyse the quality and accuracy of health information found on the web.

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.

‘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.

Electronic Cigarettes Efficacy and Safety at 12 Months: Cohort Study

Objective To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-cigarettes), directly comparing users of e-cigarettes only, smokers of tobacco cigarettes only, and smokers of both. Design Prospective cohort study. Final results are expected in 2019, but given the urgency of data to support policies on electronic smoking, we report the results of the 12-month follow-up. Data Sources Direct contact and structured questionnaires by phone or via internet. Methods Adults (30–75 years) were included if they were smokers of ≥1 tobacco cigarette/day (tobacco smokers), users of any type of e-cigarettes, inhaling ≥50 puffs weekly (e-smokers), or smokers of both tobacco and e-cigarettes (dual smokers). Carbon monoxide levels were tested in a sample of those declaring tobacco smoking abstinence. Main Outcome Measures Sustained smoking abstinence from tobacco smoking at 12 months, reduction in the number of tobacco cigarettes smoked daily. Data Synthesis We used linear and logistic regression, with region as cluster unit. Results Follow-up data were available for 236 e-smokers, 491 tobacco smokers, and 232 dual smokers (overall response rate 70.8%). All e-smokers were tobacco ex-smokers. At 12 months, 61.9% of the e-smokers were still abstinent from tobacco smoking; 20.6% of the tobacco smokers and 22.0% of the dual smokers achieved tobacco abstinence. Adjusting for potential confounders, tobacco smoking abstinence or cessation remained significantly more likely among e-smokers (adjusted OR 5.19; 95% CI: 3.35–8.02), whereas adding e-cigarettes to tobacco smoking did not enhance the likelihood of quitting tobacco and did not reduce tobacco cigarette consumption. E-smokers showed a minimal but significantly higher increase in self-rated health than other smokers. Non significant differences were found in self-reported serious adverse events (eleven overall). Conclusions Adding e-cigarettes to tobacco smoking did not facilitate smoking cessation or reduction. If e-cigarette safety will be confirmed, however, the use of e-cigarettes alone may facilitate quitters remaining so. Registration Number NCT01785537.

General population's knowledge and attitudes about antibiotics: a systematic review and meta-analysis

Nowadays, the development of antibiotic resistance represents one of the most important issues of the global public health. The incorrect use of antimicrobial drugs is recognized as one of the leading causes of antibiotic resistance. Therefore, a better understanding of the existing pieces of evidence pertaining knowledge and attitudes about antibiotic and antibiotic resistance in the general population worldwide is advisable.

In)accuracy of blood pressure measurement in 14 Italian hospitals

Objectives: The diagnosis and control of hypertension depend on accurate measurement of blood pressure (BP). The literature on the accuracy of BP recording by health professionals is, however, limited, and no study directly interviewed patients in the hospital setting. This multicenter cross-sectional study aimed at evaluating the compliance to current recommendations on BP measurement by health professionals directly from patients and to investigate potential predictors of higher quality in BP recording. Methods: A trained nurse interviewed a random sample of adult patients hospitalized for an ordinary admission (except in the emergency room) lasting more than one night, without mental disorder, who had their BP routinely measured by the hospital personnel less than 3 h before. The questionnaire contained 15 items on the main procedures that are common to current guidelines. Results: Fourteen public hospitals from seven regions of Italy participated, and 1334 questionnaires were collected. Nine of the recommended practices were followed in the majority (>70%) of BP recordings, whereas some others were infrequent or rare: in 98.6, 82.2 and 81.1% of the participants, respectively, the arm circumference was never recorded, BP was measured only once, and BP was never recorded in both arms. Overall, 10 or more recommended procedures were followed during 33.4% recordings. At multivariate analysis, physicians were less likely than nurses to provide a more accurate BP measurement. Conclusions: The operators compliance to some recommendations in BP measurement is unacceptably low. This survey provides detailed indications for medical directors on the procedures and settings to prioritize in educational programs, which are definitely needed.

Patterns of drug use among young men in Piedmont (Italy)

Increasing alarm is shown regarding patterns of polydrug use among young people, particularly regarding recreational drugs. Prevalence of recreational drug usage in Europe is not clearly defined, varying for ecstasy, from 0.2% (Finland, 1995) to 9.2% (UK, 1995) and suggesting a tendency to increase in the last years. The aim of this study is to present patterns of polydrug use among a sample of the general population of young males in Piedmont (Northern Italy), focusing particularly on ecstasy consumption. A cross sectional study was carried out between September and November 1998 on a continuous sample of 3274 18-year-old conscripts. A self-administered anonymous questionnaire on socio-demographic characteristics and substances use was submitted during routine tests. Results showed that the overall lifetime prevalence of drug use is 36.6%; prevalence of polydrug use is 30% and the more frequently associated drugs are LSD, cocaine, inhalants and ecstasy. One hundred and forty five (4.6%) subjects reported having taken ecstasy at least once in their life; 20 of the 145 (13.8%) suffered from negative effects and three (2%) presented to a hospital or to a physician. The risk of ever taking ecstasy is inversely related to fathers education, with a trend that is quite similar to that of heroin consumption but that is different from the trend for cannabis. In conclusion the four major results of this study are: (i) a prevalence of drug consumption similar to other European estimates, with a clear tendency to polydrug use; (ii) for ecstasy, a very high association rate with other substances; (iii) the moderately high prevalence of self-reported symptoms, and (iv) a social distribution of use similar to the one observed for heroin. This last consideration suggests that a high level of attention and further research should be addressed to the natural history of ecstasy use.