unplugged evaluation results - adepis seminar

Peer van der KreeftUniversity College Ghent, Belgium

For Mentor –ADEPIS seminar “Unplugged: Life-skills for thriving youth”CAYT Centre for Analysis of Youth Services

The City Centre Conference Room, Guildhal, London July 7th 2015

Effectiveness studyMediators to Effect

2

2Researchers meet practicioners

RCT RandomizedControlled Trial

7.079 pupils143 schools

7 EU countries

°200229 countries

°2015

3

Brasil

Nigeria

Pakistan

United

Kingdom

4

The study sample at baseline (n=7079) RCT °2004

CENTRE # STUDENTS MEDIAN AGE

Italy Turin 1.660 14

Spain Bilbao 429 14

Italy Novara 592 14

Germany Kiel 709 13

Sweden Stockholm 1.033 13

Italy L’Aquila 732 13

Belgium Gent 858 12

Greece Thessaloniki 516 12

Austria Vienna 550 12

°Faggiano et al, Preventive Medicine 2008

5

Effectivity 3 mths post

Daily smoking 30% reductionRecent drunkenness 28% reductionExperimenting cannabis 23% reduction

has a preventive effect on early onset of drug use and

on the transition of experimental to frequent use. The

effect is bigger for boys than for girls.

www.eudap.net

°Faggiano et al, Preventive Medicine 2008

http://www.eudap.net/

6

Daily smoking

°Faggiano et al, Drug and Alcohol Dependence 2010

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Any drunkenness


8

Any cannabis


Adiktologie Czech Rep. results -effect on longer term

°Miovski et al, Prevention Science 2015

Universal prevention: for everyone?

Adiktologie: YesEffect of Unplugged is the same for pupils with

different profiles (characteristics, relation to mother, school

grades, ….)

°Miovski et al, Prevention Science 2015

Is Unplugged also effective for pupilswith low SES social economical status?

Karolinska Institute Sweden further

analysed data from RCT °2004:

Stronger effects in underprivileged schools on

frequency of drinking

°Caria et al, Biomed Central 2011

Table 2. Post-test Differences in Prevalence of use (last 30 days) Low to High area SES

Controls Interventions

ALO smoking +6.3% +5.0%

Daily smoking +4.9% +7.0%

ALO drunkenness +5.1% +2.7%

Regular drunkenness +2.9% +1.6%

ALO cannabis +0.5% -0.9%

Regular cannabis +0.3% +0.1%

ALO drugs +0.2% +0.1%

* ALO: At Least Once in the last 30 days

Is Unplugged also effective for pupils with low SES social economical status?

OED Torino University: the inequality of low to

high SES drug use decreased after Unplugged

°Vigna-Taglianti et al, SPR Society Prevention Research poster 2007

Gender difference

°Vigna-Taglianti et al, Jounal for Epidem. Community Health 2009

OED Torino University: less effective for girls

Further analysed to explain: Unplugged low on

self-esteem, high on social influence

developmental factors

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Not only effective but also safe: have lowest iatrogenic effects.

Iatrogenic effects:e.g. inadequate information, wrong target group, norm narrowing, facilitating access. In the EU-DAP no iatrogenic effects were detected.

The Theoretical Model of Unplugged and the mediating factors:

“Effective: great! But what is the

mechanism to result?

Based on an article accepted for publication in Journal of Adolescent Health 2014: Short-term mediating factors of a school-based intervention to prevent youth substance use in Europe, Giannotta F, Vigna-Taglianti FD, Galanti MR, Scatigna M, Faggiano F, and the EU-Dap Study Group.

The theoretical model of Unplugged

The theoretical model of Unplugged

Unplugged

Knowledge on drugsRisk perception

Intentions Use

Attitudes

Normative beliefsPerceived use

Perceived acceptancePeer’s pressure

Problem behaviourJessor & Jessor 1977

Social learningBandura 1960

Health BeliefRosenstock 1950

Social NormsPerkins 1986

Reasoned action-attitudeFishbein & Ajsen 1980

SkillsCritical thinking

Creative thinkingRelationship skills

Communication skillsAssertivenessRefusal skills

Managing emotionsCoping

EmpathyProblem solvingDecision making

Social Learning

Social Norms

Health Belief

Reasoned Action-Attitude and Planned Behaviour

Problem Behaviour

Unplugged


Intentions Use

Attitudes













Bandura °60

SOCIAL LEARNING THEORY

personality formed by

observing, imitation, modeling

contrary to “trial and error orpunish and reward lead to new

behavior”

Learning does not lead to

prompt behavior change, but

to cognitive change that can

activate observed behavior

Social Learning

Social Norms

Health Belief


Problem Behaviour

Unplugged


Intentions Use

Attitudes













Jessor and Jessor °77

PROBLEM BEHAVIOR THEORY

A problem is what is socially defined as

a concern

cf Kurt Lewin field theory: my behavioris function of me in the environment

My risk - protection balance includes:

Psychosocial (value, expectation)

Environmental (perceived from others)

Behavior structures (alco smoke)

Social Learning

Social Norms

Health Belief


Problem Behaviour

Unplugged


Intentions Use

Attitudes













Perkins °86

SOCIAL NORMS THEORY

Overestimated perception of behavior

contrary to fear based

Social Learning

Social Norms

Health Belief


Problem Behaviour

Unplugged


Intentions Use

Attitudes













Fishbein & Ajzen °80

THEORY OF REASONED ACTION

I think rationally from information to

awareness to intention to action (= attitude)

based on what I think that others experienced

Social Learning

Social Norms

Health Belief


Problem Behaviour

Unplugged


Intentions Use

Attitudes













Rosenstock °50

HEALTH BELIEF THEORY

My perceived seriousness of health problem,

benefits and self-efficacy determine my

engagement in health promotion

Perceived informationrisk estimation

Theories behind the program Example how this is present in Unplugged

Social learning theory: you learn observational,

by looking how someone else does something and

which consequences he experiences

# all: interactive small groups confront

pupils with experiences and examples of

classmates

Social norms theory: you do what you are

suppose that others do and expect from you

# 2, 4, 5, 9: information issues in the quiz

deal with correcting wrong suppositions

Health belief model: your health is determined

by your estimation of the consequences of what

you do and of the seriousness score you give

# 2: exercises about risks deal with where

you get information and how you

estimate your risks

Theory of planned behaviour: your intention is

the best predictor of your actions

#11, 12: how does your information lead

to intention

Theory of problem behaviour: what you do

becomes problematic if it is socially undesired

# 3: a lesson on alcohol distinguishes

personal, physical and social risks

Social Learning

Social Norms

Health Belief


Problem Behaviour

Unit 1: opening Unplugged Unit 2: to be or not to be in a group

Unit 3: choices - alcohol, risk and protection

Unit 4: your beliefs, norms and information - do they

reflect reality?

Unit 5: smoking the cigarette drug: inform yourself

Unit 6: express yourself

Unit 7: get up, stand up Unit 8: party tiger Unit 9: drugs - get informed

Unit 10: coping competencies Unit 11: problem solving and decision making

Unit 12: goal setting

1 opening 2 group 3 alcohol

4 reality 5 smoke 6 express

7 assertive 8 contact 9 drugs

10 coping 11 problems 12 goals

Theories: how much

present in a lesson?

1opening

2 group

3 risks

4 reality

5 smoke

6 express

7 assertive

9 drugs

8 contact

10 coping

11 problem

12 goals

Lessons linked to mediators

Mediators measured to prove which ones lead to effect

Positive attitude towards drugs

Negative attitude

Positive beliefs

Negative beliefs

Knowledge

Perception of number of user friends

Refusal skills

Perception of positive class climate

Effectiveness on mediatorsPath a Path b Path a*b Mediator

β (S.E.) p value β (S.E.) p value β (S.E.) p value

Youth cigarettes use in the past 30 days

Positive attitudes towards drugs -.041 (.020) .038 .075 (.014) .000 -.003 (.002) .070

Negative attitudes towards drugs - n.s. .025 (.011) .022 - n.s.

Positive beliefs tobacco -.044 (.021) .034 - n.s. - n.s.

Negative beliefs tobacco -.029 (.017) .086 - n.s. - n.s.

Knowledge about tobacco .049 (.021) .022 - n.s. - n.s.

Refusal skills tobacco -.030 (.015) .040 .280 (.016) .000 -.008 (.004) .040

Perception of number of smokers friends -.051 (.020) .010 .071 (.009) .000 -.004 (.002) .016

Perception of positive class climate -.047 (.021) .022 - n.s. - n.s.

Youth’s ever being drunk



Positive beliefs alcohol -.038 (.018) .040 .037 (.012) .002 -.001 (.001) .096

Negative beliefs alcohol - n.s. .069 (.014) .000 - n.s.

Knowledge about alcohol .153 (.017) .000 - n.s. - n.s.

Refusal skills alcohol -.032 (.018) .072 .151 (.016) .000 -.005 (.003) .078

Perception of number of drunk friends - n.s. .067 (.010) .000 - n.s.

Perception of positive class climate -.047 (.021) .022 .022 (.010) .034 - n.s.

Youth’s ever use of cannabis



Positive beliefs cannabis -.050 (.019) .006 - n.s. - n.s.

Negative beliefs cannabis - n.s. .044 (.012) .000 - n.s.

Knowledge about cannabis .137 (.022) .000 - n.s. - n.s.

Refusal skills cannabis -.033 (.019) .074 .180 (.016) .000 -.006 (.003) .078

Perception of number of users friends -.042 (.020) .034 .048 (.008) .000 -.002 (.001) .048

Perception of positive class climate -.048 (.021) .022 - n.s. - n.s.

Gregor Burkhart - EMCDDA / OEDT -28

Mediators in EU-DAP (www.eudap.net)

Cannabis (LTP) OR .77

Regular drunkenness OR .69

Daily smokingOR .7

Normative Beliefs ↓ Refusal skills↑ Positive attitude to illicit drugs ↓

Mediators with a proven lead to effect:

Positive attitude towards drugs

Perception of number of user friends

Refusal skills

Other mediators in Unplugged measured:

Negative attitude towards drugs

Positive beliefs

Negative beliefs

Knowledge

Perception of positive class climate

30

another way to look at the results

40

One case

You deliver Unplugged to... To avoid...

35

31

82

9860

Thinking in HEALTH ECONOMY terms…

31

Small comparison

128 One caseblood pressure fatality

You deliver special medication to... To avoid...


32

One casebreast cancer fatality

You deliver mammographic screening for 10 years to... To avoid...

Sackett DL, Haynes RB: Summarizing the effects of therapy:

A new table and some more terms. Evidence-Based

Medicine1997;2:103-104

Gøtzsche PC, Nielsen M. Screening for breast cancer with

mammography. Cochrane Database of Systematic Reviews

2006, Issue 4. Art. No.: CD001877. DOI:

10.1002/14651858.CD001877.pub2

2000

Small comparison

33

40

One case

You deliver Unplugged to... To avoid...

35

31

82

9860


Evidence based prevention

So… if implementing Unplugged or similar programmes

• Take care of process evaluation

• Monitor your intervention on regional/school/class level

• Connect to the EU-Dap network forfurther analyses

• Keep updated of the published studies’ results

Thank you

EU-Dap study group

www.eudap.net

[email protected]

unplugged evaluation results - adepis seminar

Education

drunkenness faggiano

cannabis faggiano et

effect of unplugged

daily smoking faggiano

alo drunkenness

alo cannabis

high ses drug use

preventive effect