evidence based primary prevention the icelandic …...2013 icsra reykjavik university evidence based...

2013 ICSRA │ Reykjavik University

Evidence based primary preventionThe Icelandic Model

Gothenburg │Förebygg.nu

November 2013

Jón Sigfússon©ICSRA / Reykjavik University


42

35

3233

2628

26

2225

18 19

14

97

5

23

1916

15 14 1412

11 12 1010

75

3

1715

12 11 12 13

9 9 97

66

32

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013

%

What if these were corporate results?


Substance use decrease amongst 15-16 year old adolescents

42

3532

33

26 2826

2225

18 19

149

7

5

23

1916

15 14 14 12 11 12 1010

7

3

1715

12 11 12 13

9 9 97 6 6

3 30

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013

%

Drunk last 30 days

Daily smoking

Hashish once or more


How has this been achieved?

• Research as a basis for policy and actions on the local and national level

• An evidence based bottom up approach – not top down

• Prevention work has been focused on risk and protective factors in the lives of youth

• Managed to keep a constant dialogue betweenall those who are responsible for preventionin the close community of the children


Structure of presentation

1. The role of research in prevention work

2. Background of the prevention model

3. Methodology, characteristics and emphasis

4. Actions in regard to primary prevention


The role of research


ICSRA background

• A governmental Youth Research Institution

from 1992 focusing on education and upbringing

of youth

• ICSRA established 1998 with a broad focus on all

aspects of youth research

• Lead Youth Research Institution since 1998


ICSRA specialization

• 10 to 13 year old in Primary school:

• 2000-2013 – Bi-annually (Prognostic factors)

• 14 to 16 year old in Primary school:

• 1992-2013 – Annually (Status and development)

• 16 to 20 year old in High school/Junior college:

• 1992-2013 – Every third year

• Dropout students


Indicators

Health status indicators, anxiety, depressive

symptoms, physical health status, lifestyle and

leisure time activities, local community networks,

negative life events and strain, parents and family,

peer group economic and psychological issues,

studies and school, substance use, values and

attitudes, violence and delinquency, and more…


The twofold use of research

1. Scientific

2. Practical


The scientific role of research

1. In depth analysis of the data

2. 50 peer reviewed papers past 5 years

3. Publications in journals in Europe and USA

4. Science forms the platform for practice


Collaborators

• Karolinska Institutet, Sweden

• Kings College, London

• University of Ireland, Galway

• Reykjavik University

• University of California, Irvine

• Columbia University, NY

• University of Iceland

• Penn State University


The practical role of research

1. Population data collection on substance use

every year (no samples, always population).

2. Practical descriptive reports within 2-3 months of

each data collection to the municipalities

3. School reports to the schools

4. Local information INTO all levels of prevention

work is a key issue


Importance of frequent measuring

• Every school, every parent, every

prevention worker can see the current

situation in their close community and

can act accordingly.

• Not 2-3 years later but almost

immediately


Childrens rights

• Children have the right to have a say about

what they want, what they do and how they

feel.

• We have the obligation to make good use of

what they tell us, react and constantly try to

make their lives better.

• People agree on this today


Prevention approachBackground


In the year 1992

• Governmental decision to start collecting

data from 15-16 year old students.

• Aim: To see if and how information collected

could benefit policymaking and decisions for

actions in youth matters in general.

• Several data collections until 1998


Upward trend 1992 – 1998

15,1

20,722,8

7,2

9,6

17,4

0

5

10

15

20

25

30

1992 1993 1994 1995 1996 1997 1998

%

Smoke daily Have tried hashish


1998

• At this point of time research already showed

us that certain circumstances and behavior in

the lives of adolescents was strongly

connected with use.

• We tried to establish the risk and

protective factors.


The four main risk and protective factors

Familyfactors

Peer group effect

General well being

Extracurricular

activities, sports


And analyzing deeper

Familyfactors

Peer group

General well being

Extracurricular

activities

Time spent with parentsSupportMonitoringControl

Organized activitiesvs.

unorganized

Inside and outside of school, at home, bullying e.t.c.

Positive and negative effects.How we as parents approach the peer groupStaying outside late


1998 Drug-free Iceland

• Based on these findings a research based action

plan was initiated by the government with the

aim to try out a totally new methodology in

substance use prevention.

• Obviously, what had been done before, was not

working.


Organizations promoting drug free areas in 2013

• Common phrases in declarations/mission statements:

• Fight against drugs, Attack or Combat drugs

• Intensify police measures, Offensive actions against

drugs, School action plans against drugs

• … and a lot of handshakes and resolutions …

• Very little on evidence-based work, role of parents,

addressing risk factors in the close community and

informal social control


Aim of Drug free Iceland

• To change the actual behavior of youth and

not only their attitudes

• Change the life-style environment of our

children so that they would be in lesser risk of

substance use


The methodology


Our focus is primary prevention

•Primary prevention, preventing the development of

substance use before it starts

•Secondary prevention, that refers to measures that

detect substance use

•Tertiary prevention efforts that focus on people

already abusing substances


Substance use follows cohortsSigfusdottir et al. 2011, Global Health Promotion

20

41

57

10

25

41

8

22

32

4

12

21

614 16

1 6

11

0

10

20

30

40

50

60

13 14 15 13 14 15

Cohort 1984 Cohort 1991

%

Lifetime drunkenness


Substance use follows cohortsSigfusdottir et al. 2011, Global Health Promotion

20

40

57

10

25

41

0

10

20

30

40

50

60

13 14 15 13 14 15

Cohort 1984 Cohort 1991

%

Lifetime drunkenness


What else could we tell the policymakers?


Percentage of girls in 9th and 10th grade who have become drunkin the last 30 days depending on how much time they spend with parents

42,0

27,8

17,612,0 10,4

0

10

20

30

40

50

60

70

80

90

100

Girls who have become drunk last 30 days

%

Almost never Seldom Sometimes Often Almost always


Percentage of students in 9th and 10th grade who have become drunk in the last 30 days depending on if their friends become drunk once pr. month.

4,6

23,3

49,3

68,2

0

10

20

30

40

50

60

70

80

90

100

Boys who have become drunk past 30 days

%

None or few A few Many Almost all


Percentage of students in 9th and 10th grade who smoke daily depending on if they practice sports

12,5

24,9

10,4 9,9

4,0 3,5

0

10

20

30

40

50

Boys who smoke daily Girls who smoke daily

%

Almost never Up to 3 times pr. week 4 times or more often


Main actionsBased on the research findings


Local actions – examples:

• Research as a basis in policymaking and actions

• Strengthen parent organizations and cooperation

• Support extra – curricular activities / sports

• Support active NGOs´

• Support Young people at risk inside schools

• Form co-operative work groups against drugs

• Anti smoking/drinking campains

• Strengthen social capital


National actions – examples:

• Legal age of adulthood raised from 16 to 18 years

• Age limits to buy tobacco and alcohol (18 and 20)

• Strict regulations for sellers of tobacco

• A total advertising ban of tobacco and alcohol

• Restricted access to buying alcohol and tobacco

• Total visibility ban of tobacco and alcohol

• Rules on outside hours for adolecents


Visibility ban of tobacco


Outside hours reminder


Rules on outside hours

• Why? Risk factor to “hang out” late with peers

• Addressed to parents to encourage sleep of children

• Stickers on every refrigerator

• Under 12 year old 20:00 from 1st of May to 1st of

September (summer) and until 22 in winter.

• 13 to 16 year old until midnight in summer and

22:00 in winter.


The scientific isolation needed to be broken


The researchers “guru“ approach


We needed to focus on close community

• How could an average figure on alcohol use in

Sweden help prevention workers in Gothenburg?

• “Average” is the biggest liar!

• Population research / yearly

• Reports to 80% of municipalities

• School reports to 70% of schools

• Local information within 2-3 months of data

collection each year


Every school can see where students stand. Local figures for smoking in 33 gymnasiums (16-19)

2,3

5,2 5,8 6

,6 7,9 8,5 8,8

8,9 9,1

9,2 1

0,6

11

,9

12

,0

12

,5

12

,5

12

,6

12

,8

12

,8

13

,2

14

,3

14

,9

15

,5

15

,6

16

,9

17

,1 18

,6

19

,8

20

,9

21

,0 23

,1 25

,5 27

,0

31

,4

0

10

20

30

40

50

Sch

oo

l

Av

era

ge

Sch

oo

l

%


Local information fuels dialogue

• Dialogue between key stakeholders

• Politicians, municipalities and local authorities

• Parental groups and family planners

• School authorities and school workers

• Health educators, health and social services

• Leisure time workers, prevention workers

• Sports and youth institutions


The way we work now


Knowing is not enough.

How do you act?


One practical example


The Reykjavik City Leisure Card

The Leisure Card initiative is to guarantee that all

children up to the age of 18 have the opportunity to

engage in leisure activities outside school.

The City of Reykjavik allocates approximately

EUR 3.000.000-, yearly to the Leisure Card

Influencing parents first and foremost


Twofold goal

1. Humanitarian goal

• Less substance use

2. Financial goal

• Return on investment is multiple


And what is achieved?


Percentage of students in 9th grade that participate insports in a sports club four times per week or more

23,0

34,0

42,0

0

5

10

15

20

25

30

35

40

45

50

2000 2006 2012

%

Increased organizedsports participation


Percentage of students in 9th and 10th grade who spend time (often/almost always) with their parents

during weekdays

23,0

33,0

46,0

0

5

10

15

20

25

30

35

40

45

50

1997 2006 2012

%

Time spent with parents


Proportion of students in 9th and 10th grade who have been out after 10 pm (3 times or more) in the

past week

53,0

40,0

29,0

-5

5

15

25

35

45

55

65

75

2000 2006 2012

%

Less late outside hours


My parents know where I am in the evenings (applies very or rather well to me) 9th and 10th

grade

52,0

67,071,0

0

10

20

30

40

50

60

70

80

2000 2006 2012

%

Increased parental monitoring


And substance use is going down

42

35

3233

2628

26

2225

18 19

149

7

5

23

1916

15 14 1412

11 12 1010

7

3

1715

12 11 12 13

9 9 97

66

3 3 20

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013

%

Drunk last 30 days

Daily smoking

Hashish once or more


What about evaluation?


Kristjansson et al. 2010, Preventive Medicine


To conclude


ADPY


Youth in Europe starts 2005

42

3532

33

2628

26

2223

1916

15 14 1412 11

1715

12 11 12 13

9 9

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004 2005

%

Drunk last 30 days Daily smoking Hashish once or more

Substance use down by 50% in 8 years

15 – 16 year old who have become drunk past 30 days in some European cities 2013

5,4

8,69,8 10,3

12,2

15,3 16,1 16,8

19,2 19,7

24,2 24,2

28,0

0

5

10

15

20

25

30

35

40

45

50

%

15 – 16 year old who have become drunk past 30 days in Reykjavik 2013 and 1998

5,4

8,69,8 10,3

12,2

15,3 16,1 16,819,2 19,7

23,024,2

28,0

42,0

0

5

10

15

20

25

30

35

40

45

50

RVK 2013 RVK 1998

%


What is the commitment?

Thank youGothenburg│November 2013

2013 ICSRA │Reykjavik University

evidence based primary prevention the icelandic …...2013 icsra reykjavik university evidence based...

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