Promoting the bilateral relations and analyzing the Icelandic model for prevention

Contract № BG 01-002/12.06.2015

Supported by the Fund for Bilateral Relations at National Level for Bulgaria under the EEA FM and NFM 2009-2014

www.eeagrants.org

ConferenceAnalyzing the Icelandic model for prevention addictions

among children and adolescents and promoting the bilateral relations

02.02.2016

Grand Hotel Bulgaria

Promoting the bilateral relations and analyzing the Icelandic model for prevention

Contract № BG 01-002/12.06.2015

Supported by the Fund for Bilateral Relations at National Level for Bulgaria under the EEA FM and NFM 2009-2014

www.eeagrants.org

“Evidence Based Primary Prevention –The Icelandic Model”

Jón Sigfússon

02.02.2016Grand Hotel Bulgaria

42

32

26 26 25

1814

75

23

16 1412 12 10

73 3

17

12 129 9 7

9 6

0

10

20

30

40

50

1998 2000 2002 2004 2006 2008 2010 2012 2015

%

Drunk last 30 days Daily smokingCannabis once or more

Substance use decrease amongst 15-16 year old adolescents

Substance Use Amongst European Youth (ESPAD, 2011)

Iceland Malta Lichtenstein0

10

20

30

40

50

60

70

80

Cigarette use past 30 days Alcohol use past 30 days Lifetime use of cannabis

Structure of presentation1. The role of research in prevention work2. Background of the prevention model3. Methodology, characteristics and emphasis4. Actions in regard to primary prevention

The role of research

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Prevention work must be evidence based!

If we do not than we are steering blind!

ICSRA specialization• Research in three age groups:

• 10 to 13 year old in primary school• 14 to 16 year old in primary school• 16 to 20 year old in high school / junior college

ICSRA database 1992 - 2015 Twenty two data collections amongst 15-16 year old pupils since 1992

IndicatorsHealth 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 research1. In depth analysis of the data2. 50 peer reviewed papers past 5 years3. Publications in journals in Europe and USA4. Science forms the platform for practice

The practical role of research1. Data collections on substance use every year2. Practical descriptive reports within 2-3 months of each data

collection to the municipalities3. School reports to the schools4. Local information INTO all levels of prevention work is a KEY issue

Importance of frequent measuringEvery 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

Children's rights1. Children have the right to have a say about what they want, what

they do and how they feel2. We have the obligation to make good use of what they tell us,

react and constantly try to make their lives better.

Prevention approach background

Upward trend 1992 - 1998

15,1

20,722,8

7,29,6

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 had already showed us that certain circumstances and behaviour in the lives of adolescents were strongly connected with use

We tried to establish the risk and protective factors

The main risk and protective factors

Familyfactors

Peer group effect

General well being

Extracurricularactivities, sports

And analysing deeper

Familyfactors

Peer group effect

General well being

Extracurricularactivities, sports

Time spent with parents SupportMonitoringControl

Positive and negative effects.How we as parents approach the peer groupStaying outside lateHanging out in malls

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

Organized activitiesvs.

unorganized

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

Aim of Drug-free Iceland• To change the actual behaviour 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

1 611

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 would we tell the policy makers?

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Percentage of girls in 9th and 10th grade who have become drunk in 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 one 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 actions: Based on research findings

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Examples of local actions1. Research as a basis in policy making and actions

2. Strengthen parent organizations and co-operation

3. Support extracurricular activities / sports

4. Support active NGOs’

5. Support young people at risk inside schools

6. Form co-operative work groups against drugs

7. Anti smoking / drinking campaigns

8. Strengthen social capital

Examples of national actions1. Legal age of adulthood raised from 16 to 18 years2. Age limits to buy tobacco and alcohol (18 and 20)3. Strict regulations for sellers of tobacco4. A total advertising ban of tobacco and alcohol5. Restricted access to buying alcohol and tobacco6. Total visibility ban of tobacco and alcohol7. Rules on outside hours for adolescents

Tobacco and chewing gum

Peanuts and Gin

The scientific isolation needed to be broken

The researchers “guru” approach

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We needed to focus on close community• How could an average figure on alcohol use in Sofia help prevention workers in Varna?• “Average” doesn´t tell all the story.• Local information within 2-3 months of data collection each year.

Every school can see where students standLocal figures for smoking in 33 gymnasiums (16-19 years old)

2,3 5,

25,

8 6,6 7,

9 8,5 8,8

8,9

9,1

9,2 10

,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

,917

,1 18,6 19

,8 20,9

21,0 23

,1 25,5 27

,031

,4

0

10

20

30

40

50

Scho

ol

Ave

rage

Scho

ol

%

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

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And what is achieved?

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Percentage of students in 9th grade that participate in sports 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 participation in organized sports

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

05101520253035404550

1997 2006 2012

%

Time spent with parents

Percentage 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

%

I ncreased parental monitoring

…and substance use is going down

42

32

26 26 25

1814

7

5

23

16 1412 12 10

73 3

17

12 129 9

7

96

0

10

20

30

40

50

1998 2000 2002 2004 2006 2008 2010 2012 2015

%

Drunk last 30 days Daily smoking Cannabis once or more

Youth in Europe until 2015

Thank you

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