CRICOS Provider Code: 00113B

PREVENTING ICE AND OTHER DRUG ISSUES IN YOUR COMMUNITY

Professor John W.Toumbourou, PhD

Chair in Health Psychology, Deakin UniversityHonourary Research Fellow, Centre for Adolescent Health, Murdoch

Children’s Research Institute,

Chief Executive Officer, Communities That Care Ltd.,

Royal Children’s Hospital, Melbourne Australia

Professor John W. Toumbourou, PhDChair in Health Psychology, Deakin University

what are the major alcohol and

other drug problems that we

need to prevent?

Deakin University CRICOS Provider Code: 00113B

YOUTH DATA

Secondary School Surveys age 12 to 15

Use of illicit drugs other than marijuana

2009

Victoria 2.3%

2012 Victoria at average age 23 IYDSUsed stimulants (speed, amphetamines,uppers, meth, crystal, ice) last year 13.8%

Deakin University CRICOS Provider Code: 00113B

AGE 23 PAST YEAR STIMULANT USEFreq. Percent

Never 2,042 86.16

1-2 times 126 5.32

3-5 times 62 2.62

6-9 times 47 1.98

10-19 times 48 2.03

20-29 times 14 0.59

30-39 times 9 0.38

40 or more times 22 0.93

Deakin University CRICOS Provider Code: 00113B

PREDICTORS OF AGE 23 PAST YEAR STIMULANT USE

(N = 2, 176: IYDS VICTORIA 2012)

Incident Rate Ratio p

Adolescent Predictors

Female 0.92 0.01

Year 9 Alcohol Use 1.06 0.00

Year left school prior to Year 12 1.07 0.02

Age 21 Predictors

Religious Involvement 0.96 0.01

Not in an Intimate Relationship

_Intimate Relationship 0.89 0.01

_Engaged or Married 0.89 0.02

Peer Alcohol Use and Problems 1.21 0.00

Intimate Partner Alcohol Use and Problems 1.06 0.06

Night Social Settings Alcohol Availability and Observable Problems 1.05 0.02

across all communities our

shared challenge is to

encourage compliance with

the health guidelines

AOD Guidelines

Low risk alcohol

Av 2 per day or less

Not more than 4

Adolescents

No alcohol use

Pregnancy &

breastfeeding

No alcohol use

Tobacco

No use

Illicit drugs

No use

what is currently working well?

Australia’s health

SOME SUCCESSES

continuing reductions in mortality

reductions in road accidents and injuries

reductions in tobacco use

reductions in adolescent alcohol use

reductions in illicit drug use

successes in containing HIV/ AIDS

reductions in youth suicide

CHALLENGES

rising child health problems (eg., abuse)

rising young adult alcohol harms

rising youth violent offending

increasing sexual health problems

high rates of mental health problems

threats related to obesity/ diabetes

rising differentials & impacts of poverty

Australia’s health

community prevention context

individual

neighbourhood

state & nation

NEW INVESTMENTS WHO?

- Tax tobacco /alcohol *** Federal

- Liquor Licensing *** State

- Age 21

- Industry regulation

- Community Change ** Local

- Enforcing local laws/ Accords

- Redressing disadvantage - renewal

- Community mobilisation – environments

for child and youth development

Toumbourou & Loxley at al (2007)

three distinct community approaches

Disadvantaged Areas

– early years investments

Markets - Entertainment Precincts

– managing alcohol markets

– harm minimization

Healthy Development in Areas with High

Rates of Families with Children

– children and young people

– alcohol prevention

less alcohol &

other drug

harm

disadvantage

managing

markets

positive

youth

development

how do we to encourage

effective prevention in

areas with high levels of

disadvantage?

Could we reduce place-based disadvantage in our community?

Risk and Protective Factors

Shaping Child and Adolescent

Development

Parents

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

School

Peers

Community

Risk and Protective Factors

Shaping Child and Adolescent

Development

Parents

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

School

Peers

Community

Snowball: Risk Accumulates through Early Developmental

Challenges without Protection

Snowstorm: Extended Exposure to Norms and Models that Support

Problem Behavior without Protection

Toumbourou and Catalano, 2005

Risk Factors

Sub

stan

ce U

se

De

linq

ue

ncy

Tee

n

Pre

gnan

cy

Sch

oo

l Dro

p-

Ou

t

Vio

len

ce

CommunityAvailability of drugs

Community laws and norms favourable to drug use

Transitions and mobility

FamilyFamily history of the problem behaviour

Family conflict

Favourable parent attitudes and involvement in the problem

behaviour

SchoolAcademic failure

Lack of commitment to school

Individual/PeerFavourable attitudes toward problem behaviour

Early initiation of problem behaviour

Elevated risk factors for recent substance use

0

10

20

30

40

50

60

70

80

0-1 2-3 4-6 7-9 >=10

Risk factors

%

alcohol

cigarettes

marijuana

other drugs

Elevated risk factors for mental health and social problems

0

10

20

30

40

0-1 2-3 4-6 7-9 >=10

Risk factors

%

Early sexual activity

Depressive symptoms

Deliberate self-harm

At risk of homelessness

Number of Risk Factors and Probability of

Meeting Achievement Test Standard (10th Grade Students)

Arthur et al., 2006

Communities vary in child-reports of risk exposure

John A. Pollard , P h.D. Developmental Research and Pr ograms

No s tudents

in t his a re a .

In su f fic ie nt n um b e r of

st u de n ts in th is ar e a.

Neighborhood #2

Neighborhood #1 Neighborhood #3

John A Pollard, PhD, Developmental Research and Programs

A range of interventions have now been subjected to randomised

trials and have economic-benefit estimates

http://www.wsipp.wa.gov

Aos et al, 2011

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Evidence-based solutions to

intergenerational disadvantage

($ benefit / $ spent: Aos et al, 2011)

Alcohol, tobacco & drug

use interventions ($7)Parents

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Evidence-based solutions to

intergenerational disadvantage

($ benefit / $ spent: Aos et al, 2011)

Family home visiting for

at risk parents ($3+)Parents

Parents

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Evidence-based solutions to

intergenerational disadvantage

($ benefit / $ spent: Aos et al, 2011)

Parent education / family intervention

($3 - $10)

School

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Evidence-based solutions to

intergenerational disadvantage

($ benefit / $ spent: Aos et al, 2011)

Early childhood

education ($3+)

Tutoring ($4 - $12)

School reorganisation ($2)

Good behaviour game ($97)

Socio-emotional curricula ($13)

Peers

Community

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Evidence-based solutions to

intergenerational disadvantage

($ benefit / $ spent: Aos et al, 2011)

Mentoring ($5+)

Community

Employment

Training / Job

Assistance

($35)

how do we encourage

effective prevention in

entertainment precincts

and alcohol markets?

Community Action

Community partnerships are formed

Police, health, venues, local government

Integrated training and planning

Monitoring systems better record alcohol violations

Venues and hotspots are identified in violation data

Evidence-based venue and situational intervention

Wallin , E. Lindewald, B. Andréasson, S. (2004) Institutionalization of a Community Action Program Targeting Licensed Premises in Stockholm, Sweden. Evaluation Review, 28(5), 396-419.

Rowland, B., Toumbourou, J.W., Osborn, A.,

Smith, R., Hall, J., Kremer, P., Kelly, A.,

Williams, J., Leslie, E. (2013) A clustered

randomised trial examining the effect of social

marketing and community mobilisation on the

age of uptake and levels of alcohol

consumption by Australian adolescents: Study

protocol. BMJ Open. vol. 3, no. 1, pp. 1-8.

e002423. doi:10.1136/bmjopen-2012-002423

Deakin University CRICOS Provider Code: 00113B

ALCOHOL SUPPLY MONITORING

• Monitored sales of alcohol to underage youth through take away alcohol sales outlets (bottle shops)

• Confederates were young adults but were rated as under age 18 by an independent panel

• Attempt to purchase alcohol with AUD$15 without having age ID

Deakin University CRICOS Provider Code: 00113B

ALCOHOL SUPPLY MONITORING (CONT)

• Randomised trial where 28 communities were paired across Australia in three states – Vic, WA, Qld. Half (14 were randomised to intervention)

• 310 stores were the subject of repeat visits in 2012 and 2013

• Intervention involved feedback to the 14 intervention communities

• 150 Store owners and staff in the 14 intervention communities received letters after the 2012 visits detailing the intervention and reporting on the sales practices of their staff

what percentage of the

retailers sold alcohol to

minors prior to the

intervention?

Deakin University CRICOS Provider Code: 00113B

Deakin University CRICOS Provider Code: 00113B

ALCOHOL SALES TO MINORS

0

10

20

30

40

50

60

70

80

2012

2013

Overall Control Intervention

Per

cen

tag

e

Deakin University CRICOS Provider Code: 00113B

ALCOHOL SALES TO MINORS (CONT)

• Intervention retailers showed a 37% reduction in sales (Adjusted odds ratios=0.63, 95% CI 0.40 - 1.00, p=0.049) after controlling for baseline sales

• An unexpected effect whereby staff in the store alone were less likely to sell to minors

how do we to encourage

effective prevention in

our communities with

high rates of families and

children?

Most of our current investments do

not have evidence for beneficial outcomes

– many are neutral some are harmful

• Sports clubs (not in Good Sports)

• Ineffective alcohol, drug and health education (beer goggles)

• School suspension/ Expulsion

• Special classes for problem kids

• Peer education

• Boot camps

• Incarceration

there are a range of effective solutions that

we could implement

• Increasing alcohol price

• Supply reduction

• Healthy child and youth development

• Addressing pathways to disadvantage

JASON CLARKE

what types of community

alcohol and other drug issues do

you face in your region?

Communities that Care Ltd

to improve community prevention service delivery and increase prosocial norms to

encourage the healthy development of children and young people

Communities that Care

Bunbury

Ballarat

Mornington

PS

Myrtleford

Robina, Redcliffe,

Woodbridge

KalgoorlieMandurah

Hobson’s Bay,

Knox, Stonnington,

Bendigo,

Baw Baw Shire,

Cardinia,

East GippslandGeelong,

Warrnambool

Yarra

Communities That Care

a consulting and training system that assists communities to identify and implement

effective prevention strategies while monitoring their local effectiveness

Communities that Care

• Communities That Care is an effective method for encouraging community investment in cost-effective prevention

• Effectively reduces population rates of child & adolescent problems and encourages positive development

• Promotes care and trust to achieve bridging social capital that can address the causes of disadvantage

Scientific literature recommends Communities that Care

• Greenberg MT, Feinberg ME, et al 2005 ‘… A comprehensive study of communities that care in Pennsylvania’ in T Stockwell, P Gruenewald, JW Toumbourou & W Loxley (eds) Preventing harmful substance use: …, London: Wiley.

• Hawkins JD, Brown EC, et al. 2008 ‘Early effects of Communities That Care ….’, Journal of Adolescent Health, 43:1, pp. 15–22.

• Hawkins JD, Oesterle S, et al 2009 ‘Results of a type 2 translational research trial …’. Archives of Pediatric and Adolescent Medicine, 163:9, pp.789–98.

• Kuklinski MR., Briney JS, et al 2012 ‘Cost-benefit analysis of Communities That Care: Outcomes at eighth grade’, Prevention Science. 13, pp. 150–161.

AUSTRALIAN LITERATURE REVIEWS:

• Mental health promotion (VicHealth review, 2006)

• Drug prevention (Commonwealth Prevention Monograph, 2004)

• Crime prevention (Pathways to prevention, Commonwealth Attorney Generals, 1999)

Large natural

experiment examining

roll-out across

Pennsylvania

Large community

randomized trial

across USA

Communities

0

10

20

30

40

50

60

70

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Year 7 - Alcohol Use Ever %

Victoria

Year

0

10

20

30

40

50

60

70

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Year 7 - Alcohol Use Ever %

Communities That Care MPS

Victoria

Year

0

1

2

3

4

5

6

7

8

9

10

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Year 7 - Cannabis Use Ever %

Communities That Care MPS

Victoria

Year

Year

0

5

10

15

20

25

30

35

40

45

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Year 7 - Tobacco Use Ever %

Victoria

Communities That Care MPS

Year

0

5

10

15

20

25

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Year 7 - Ever Had Sex %

Victoria

Communities That Care MPS

Any Antisocial behaviour based on reporting one or more of the following four behaviours over the past year:

• Carried a weapon • Sold illegal drugs • Stole or tried to steal a motor vehicle

such as a car or motorcycle • Attacked someone with the idea of

seriously hurting them

0

5

10

15

20

25

30

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Year 7 - Any antisocial behaviour (past year) %

Victoria

Communities That Care MPS

Creating

Communities

That Care

Get Started

Get Organised

Develop a ProfileCreate a Plan

Implement and

Evaluate

Communities That Care helps establish local prevention coalition

• Mornington Peninsula Shire Communities That Care Board

• Youth, Local government, Schools, Community health, Police, Rotary, Churches, Citizens etc.

Communities that Care

Phases 1 and 2

Communities That Care helps coalitions on a plan to target prevention

Communities that Care

Phases 3 and 4

Mornington Peninsula Shire Communities That Care Plan (2002 -2007) targeted:

• Reduction in alcohol and drugs and risky sex

• By reducing family, school risk factors and by increasing community protective factors

The CTC Youth Survey:• supplements available data by providing valid youth reports

on risk and protective factors in the key social environments that affect development

• measures behavioural outcomes: substance use antisocial behaviour school failure mental health physical activity & nutrition behaviours

• can be used with students from grade 5 – year 12

Obtaining Local Data

Characteristics of:• Community• Family• School• Peer/Individual

Known to predict youth problem behaviours

Mornington Peninsula Shire Comparison of Risk

Factors for Year 9: Communities That Care

2002-2007

0

5

10

15

20

25

30

35

Low C

omm

Atta

ch

Com

m D

isor

g

Per

s Tra

ns &

Mob

Com

m la

ws/

norm

s

Per

Ava

il Dru

gs

Poo

r Fam

Man

age

Family

conf

lict

Fam H

ist A

nti Soc

Par

Att Fav

Dru

gs

Par

Att Fav

Anti Soc

Sch

ool fa

ilure

Low com

sch

ool

Rebe

lliou

snes

s

Fav a

tt ant

i-soc

beh

Fav a

tt to

dru

g us

e

Per

c ris

ks d

rug use

Inte

r ant

i-soc

ial p

eers

Friends

' use

of d

rugs

Sen

satio

n se

eking

Rew

ant

i-soc

inv

Pe

rce

nt

Year 9, 2002

Year 9, 2007

Communities That Care

Phase 4 Communities That Care: Guide to Australian Prevention Strategies

http://www.rch.org.au/ctc/publications_resources/Publications_and_Resoruces_CTC/

Systematic review > Menu of prevention programs

Evidence based

Indexed to risk and protective factors

Focus of programs divided into 3 sections

Prevention Strategies Guide

Communities That Care

Phase 5

Communities That Care surveys help to monitor changes across

time

Contact

Deb WagnerCommunity Relations Officer, Communities That CarePH: (03) 9345 6901deborah.wagner@mcri.edu.au

CTC Website: http://communitiesthatcare.com.au/