School and community social influence programming for preventing tobacco and drug use: Evidence and implications for Public Health

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Canadian Centre on Substance Abuse

School and community social influence programming for preventing tobacco and drug

use: Evidence and implications for public health

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Q&A

Participant Side Panel in WebEx

The Health Evidence Team

Maureen Dobbins Scientific Director Tel: 905 525-9140 ext 22481 E-mail: [email protected]

Kara DeCorby Managing Director

Lori Greco Knowledge Broker

Robyn Traynor Research Coordinator

Heather Husson Project Manager

Yaso Gowrinathan Research Assistant/Coordinator

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Decision Making

inform

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Canadian Centre on Substance Abuse Project

About CCSA

• National non-profit organization; ~ 50 staff

• Vision: All Canadians should live in a healthy society, free of alcohol and drugs-related harm

• Mission: Provide national leadership and advance solutions to address alcohol and other drug-related harm

• Initiate change through partnerships and knowledge

www.ccsa.ca • www.cclt.ca 7

• National knowledge exchange network of diverse networks across Canada

• Facilitates exchange of research evidence to inform addictions

related prevention and treatment practices • Public/private online space to share information and contacts

• For more information, contact

Rod Olfert ([email protected]), or Rebecca Jesseman ([email protected])

What is CCSA’s SystemAction?

8

Clinician expertise

Research evidence

Community Context

Resources

Client, community, political preferences

A Model for Evidence-Informed Decision Making

Adapted with permission from National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf

1. Cultivate a culture of inquiry, critical thinking and evidence-based practice “culture”

2. Ask a clear, focused, searchable question 3. Search for the best available evidence

4. Critically appraise the relevant evidence

Evidence-Informed Decision Making

5. Integrate the evidence with expertise and client preference 6. Evaluate the outcome(s) of the change in practice or policy 7. Engage in knowledge exchange

Evidence-Informed Decision Making

Importance of this Review

• Canadian youth are the highest users of marijuana world wide

• Using strong quality evidence to understand what works in prevention for tobacco and drug use

• Examining the long-term effectiveness of social influence programs for adolescent substance use

Review

Skara, S. & Sussman, S. (2003). A review of 25 long-term adolescent tobacco and other drug use prevention program evaluations. Preventive Medicine (37) 451-474.

Who has heard of a PICO(T)

question before?

1. Yes

2. No

Searchable Questions – Does it work Think “PICOS”

1. Population (situation)

2. Intervention (exposure)

3. Comparison (other group)

4. Outcomes

5. Setting

Summary Statement: Skara (2003)

P adolescents 12-15, and 16-19, in the transition period between junior high and high school

I school or community social influence programming for the prevention of tobacco and drug use

C other intervention or usual care O primary outcomes: long-term tobacco use, smoking

initiation; secondary outcomes: alcohol and marijuana use

Quality Rating: 8 (strong)

Social Influences Programming

• Not defined explicitly in the review itself.

• Working definition: Social influences programming increases the awareness of the social influences on substance-use behaviours--family, peer, and media-- and provides normative information and skill instruction to resist such pressures.

Overall Considerations

Relatively consistent findings for social influence programming, mainly delivered in schools, to reduce both tobacco use rates and other drug use (marijuana, alcohol) in adolescents 12-19, in transition period between junior high and high school in the long term (from 2 to 15 years).

Interventions which either offered booster sessions or

programming over longer time frames appeared to enhance maintenance of program effects at least to end of study

The school setting offers good potential to address tobacco,

marijuana, and alcohol use reduction

General Implications

Public health should promote/support/implement:

Social influence programming for adolescents 12-19, to reduce BOTH tobacco and other drug use (marijuana, alcohol) in the long term (at least 24 months and beyond).

Either booster sessions or curriculum delivered over a longer time frame, for long-term maintenance of program effects

What’s the evidence - Outcomes reported in the review

Tobacco use (total 25 studies, 17 of which assessed outcomes via difference in % smoking between intervention and control groups from baseline to follow up)

Other drug use – alcohol & marijuana (9 studies providing long-term data)

What’s the evidence - Tobacco Use

Tobacco use (total 25 studies, 17 of which assessed outcomes via difference in % smoking between intervention and control groups from baseline to follow up)

•15 of 25 studies reported at least one long-term (at least 2 years) positive effect (reductions in ever, daily, weekly, or monthly smoking)

•11 of 17 studies that reported tobacco use from baseline to follow up found 11.4% lower smoking rates (range 9-14%) from intervention group and control group

•Of studies specifying booster sessions or programming delivered over two-year time frames (total 14 studies), 57% maintained long-term reductions in use by the end of study

What’s the evidence - Alcohol & Marijuana Use

Alcohol & Marijuana Use (9 studies with long-term data) •8 of 9 studies reported initial or interim positive impact for follow up

periods ranging 3 months to 5 years. For 6 of these 8 projects, maintenance effects persisted the entire duration of the project.

• Studies calculating % reduction in use rates from baseline to follow up found a long-term reduction ranging from 6.9-11.7% for weekly alcohol use (2 studies) and 5.7% reduction for 30-day marijuana use (1 study)

•Of 7 studies specifying booster sessions, 5 of 7 studies maintained long-term reductions in use by the end of study

General Implications

Public health should promote/support/implement: Social influence programming for adolescents 12-19, to

reduce BOTH tobacco and other drug use (marijuana, alcohol) in the long term (at least 24 months and beyond).

Either booster sessions or curriculum delivered over a

longer time frame, for long-term maintenance of program effects

Questions?

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