Health promotion and drug prevention within the public health system …evidence based approach...
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Transcript of Health promotion and drug prevention within the public health system …evidence based approach...
Health promotion Health promotion and drug prevention and drug prevention
within thewithin the public health systempublic health system
…evidence based approach
Darko Roviš, prof.
Public Health Institute of Primorsko-goranska county
Krešimirova 52A, 51 000 Rijeka
Public Health InstitutePublic Health Institute
Actively working in health promotion since 1905
Departments: Social medicine Health ecology Epidemiology Microbiology School and university medicine Drug prevention and outpatient treatment
Office for Drug Office for Drug prevention prevention
Department for Drug prevention and outpatient treatment
Office for Office for Outpatient Outpatient treatmenttreatment
Health promotion and Health promotion and drug prevention drug prevention programsprograms::
• Universal Universal • SelectiveSelective• Indicative Indicative
Specific drug treatmentSpecific drug treatment::
• PPsychotherapysychotherapy in p in penal systemenal system• Family support groupsFamily support groups
Outpatient treatment:Outpatient treatment:
• DDrug free approachrug free approach• MMaintainence aintainence • DDetox programetox program
Community involvementCommunity involvement
• Drug prevention committeesDrug prevention committees• HealthHealthyy cities cities • University programsUniversity programs
Office for Drug Office for Drug prevention prevention
Fiorello la guardie 23, RijekaFiorello la guardie 23, Rijeka
Team of Two psychologists, defectologist, and teacher Formed in 2005.
Health promotion and drug prevention:
Life Skills Taining Ready- Steady-Healthy Youth Counselling Bulletin – Rizik
- M- Major and still rising problem for Croatiajor and still rising problem for Croatiaa- D- Drug rate of rug rate of 250 /100 000 250 /100 000 populationpopulation- - EU countries EU countries 200-800 / 100 000 200-800 / 100 000 population population
Total number of addict
Opiate addict
New addict
New opiate addict
Drug abuse and
addiction
Drug abuse and adiction Drug abuse and adiction in Rijeka countyin Rijeka county
TREATED DRUG ADDICT
1995. year– 17 addict
1996. year– 115 addict
2001. year– 649 addict
2004. year– 460 addict
2006. year– 634 addict
2007. year– 666 addict
1 148 Criminal Acts 707 Other Offences
Why do we talk of addicts when we are discussing children ?
44% highschool children regularly or occasionally consume alcohol 51-64 % 2nd grade students engage in ” Binge drinking” – ESPAD 2007 2002. - 50 interventions of ER service
SubstanceSubstance use use ……
1/3 tried marihuana more than once
25-40 %
smokes often
Majority thinks it is “normal” to drink and smoke
Drinking 10 times or often (last 30 day)
1st and 2nd grade students
First time hard liker?
• bullying, gambling
• Up to 20 % of children low self-esteem
• ½ exposed to social violence
• 12-25% peer rejection
• ½ go out where other are smoking, drinking drug using
• Fammily and school communication poor
Research on 8th grade PGZ
Starting from early age…
Based on
Based on
Possible solutions
1
Based on
How to direct our efforts to produce wanted effect ?
Less mental & behaviouralproblems and drug abuse in communities and thepopulation !
Evidence basedEvidence based
evidence-basedresearch-basedscience-basedblueprint programsmodel programspromising programseffective programs
Science based programsScience based programs
Based on evidence, Tested in practiceMethodologically clear designSignificant reduction of negative outcomes and
related risks
Based on theoryDetail evaluated
Evidence based aproach in Evidence based aproach in RijekaRijeka
High quality implementation of best evidence based model programs.
Careful pilot program design following the principles of effectiveness
Quasi experimental evaluation design
ComprehensivenessVariety of teaching methodsSufficient lastingTheory basedBuilding positive, strong and stabile
relationshipsTimeFollowing developmental psychopathology Social-cultural appropriatenessEvaluationEducation
Principles of effectivenessPrinciples of effectiveness
Developing a prevention model on a community level
Package of multiple interventions that target Children in different age groups Children, families, social network, community Risk and protective factors Common and disorder-specific factors
Use of variety of intervention methods
Building evidence-based interventions
Prevention programs at PHI
Youth Counseling
Life Skills Training
Ready SteadyHealth
BulletinRIzik
Family self help group
Support group in
Penal system
Health youth
Narodni Zdravstveni List
Educating Educators
Junior in the house
LIFE SKILLS TRAINING
Series of workshopsfor 6th and 7th grade
Pilot program for 3rd and 4th garde
2005/06- 31 school- 1657 students 2006/07 - 38 school- 150 assistants- 3168 students
2007/08 - 39š school-165 assistants -3427 students
2008/09- 44 school-180 assistants- over 3500 students
Life Skills Training• Universal prevention level (smoking, alcohol, drugs, violence)• Evidence based• Experience in implementation and evaluation (SAD, EU, Australia)
• Based on theory (Risk reduction model)• Aim: reduce the increase in substance use in adolescents
Protective factorsProtective factors
• High Sef-esteem • Good social and communication skills• Good decision making skills• Good problem solving skills • assertivness • Coping with stress and anxiety,• Goal setting • Resistance to peer pressure
Risk factorsRisk factors
• Early first contact with cigarettes, alcohol, drugs
• Lack of self-control• Poor assertiveness
(Dr.Gilbert J. Botvin)
Workshops
Self image and self esteem Decision making
Smoking Alcohol
MarihuanaMedia
Anxious emotionsFacing anger
Communication skills Social skills Asertivness
Conflict resolution
Activitiesin 2007/08
MATERIALS
Prepared and printed materials for 6th and 7th grade
– Student manual for 6th grade– Teacher manual for 6th grade
– Student manual for 7th grade– Teacher manual for 7th grade
– Student questioners– Evaluation forms for teachers
EVALUATION AND SUPEVISION• Pre-test• Re-test• Post-test
• Evaluation forms filled after each workshop
• Supervision workshop in February 2008
EDUCATION• 2 X two day education for teachers and
school coordinators – October 2008– February 2009
Activities in 2007/08
Evaluation...
Evaluation...
Evaluation...
Reduction higher than 50 % Evidence that program WORKS Corresponds to results form USA,EU Troubles for the firs generation
Life Skills Training
• 4 Rijeka school + 1 County school• Total: 300 učenika• Piloting for two years
• 8 workshops held 1 x month
• Sef-esteem• Decision making• Smoking • Media advertisement
• Coping with stress• Communication skills• Social skills • Assertivens
… for 3rd and 4th grade (8-9 years)
Ready
• Pilot program u 2007/08 based on risk reduction model• 5 workshops with 8th graders (14 years)• Evaluation questionery• Scholl staff + parents engagement• Deliver the program to school services
ThemesAdolescenceCoping skills
Drugs –one way streetPeer pressure
Health lifestyles
SteadyHealthy