Adolescent substance use and peer use: a multilevel analysis of cross-sectional population data

Background: Limited evidence exists concerning the importance of social contexts in adolescent substance use prevention. In addition to the important role schools play in educating young people, they are important ecological platforms for adolescent health, development and behaviors. In this light, school community contexts represent an important, but largely neglected, area of research in adolescent substance use and prevention, particularly with regard to peer influences. This study sought to add to a growing body of literature into peer contexts by testing a model of peer substance use simultaneously on individual and school community levels while taking account of several well established individual level factors. Method: We analyzed population-based data from the 2009 Youth in Iceland school survey, with 7,084 participants (response rate of 83.5%) nested within 140 schools across Iceland. Multilevel logistic regression models were used to analyze the data. Results: School-level peer smoking and drunkenness were positively related to adolescent daily smoking and lifetime drunkenness after taking account of individual level peer smoking and drunkenness. These relationships held true for all respondents, irrespective of socio-economic status and other background variables, time spent with parents, academic performance, self-assessed peer respect for smoking and alcohol use, or if they have substance-using friends or not. On the other hand, the same relationships were not found with regard to individual and peer cannabis use. Conclusions: The school-level findings in this study represent context effects that are over and above individual-level associations. This holds although we accounted for a large number of individual level variables that studies generally have not included. For the purpose of prevention, school communities should be targeted as a whole in substance use prevention programs in addition to reaching to individuals of particular concern

Stress and adolescent well-being: the need for an interdisciplinary framework

Stress and strain among adolescents have been investigated and discussed largely within three separate disciplines: mental health, where the focus has been on the negative effects of stress on emotional health; criminology, where the emphasis has been on the effects of strain on delinquency; and biology, where the focus has been to understand the effects of stress on physiology. Recently, scholars have called for increased multilevel developmental analyses of the bio-psychosocial nature of risk and protection for behaviors of individuals. This paper draws on several different but converging theoretical perspectives in an attempt to provide an overview of research relevant to stress in adolescence and puts forth a new framework that aims to provide both a common language and consilience by which future research can analyze the effects of multiple biological, social and environmental factors experienced during specific developmental periods, and cumulatively over time, on harmful behavior during adolescence. We present a framework to examine the effects of stress on diverse behavioral outcomes among adolescents, including substance use, suicidal behavior, self-inflicted harm, and delinquency

Conducting national burden of disease studies in small countries in Europe– a feasible challenge?

Background: Burden of Disease (BoD) studies use disability-adjusted life years (DALYs) as a population health metric to quantify the years of life lost due to morbidity and premature mortality for diseases, injuries and risk factors occurring in a region or a country. Small countries usually face a number of challenges to conduct epidemiological studies, such as national BoD studies, due to the lack of specific expertise and resources or absence of adequate data. Considering Europe's small countries of Cyprus, Iceland, Luxembourg, Malta and Montenegro, the aim was to assess whether the various national data sources identified are appropriate to perform national BoD studies. Main body: The five small countries have a well-established mortality registers following the ICD10 classification, which makes calculation of years of life lost (YLL) feasible. A number of health information data sources were identified in each country, which can provide prevalence data for the calculation of years lived with disability (YLD) for various conditions. These sources include disease-specific registers, hospital discharge data, primary health care data and epidemiological studies, provided by different organisations such as health directorates, institutes of public health, statistical offices and other bodies. Hence, DALYs can be estimated at a national level through the combination of the YLL and YLD information. On the other hand, small countries face unique challenges such as difficulty to ensure sample representativeness, variations in prevalence estimates especially for rarer diseases, existence of a substantial proportion of non-residents affiliated to healthcare systems and potential exclusion from some European or international initiatives. Recently established BoD networks may provide a platform for small countries to share experiences, expertise, and engage with countries and institutions that have long-standing experience with BoD assessment. Conclusion: Apart from mortality registries, adequate health data sources, notably for cancer, are potentially available at the small states to perform national BoD studies. Investing in sharing expert knowledge through engagement of researchers in BoD networks can enable the conduct of country specific BoD studies and the establishment of more accurate DALYs estimates. Such estimates can enable local policymakers to reflect on the relative burden of the different conditions that are contributing to morbidity and mortality at a country level

The Icelandic Prevention Model Evaluation Framework and Implementation Integrity and Consistency Assessment

The Icelandic Prevention Model (IPM) follows a systematic but flexible process of community capacity building, data collection, analysis, dissemination, and community-engaged decision-making to guide the data-informed selection, prioritization, and implementation of intervention strategies in preventing adolescent substance use. This paper describes two new evaluation tools intended to assess the: 1) integrity of IPM implementation, and 2) unique aspects of IPM implementation in different community contexts. These evaluation tools include a: 1) five-phase IPM Evaluation Framework for Assessing Value Across Communities, Cultures, and Outcomes (IPM-EF); and 2) 10-Step IPM Implementation Integrity and Consistency Assessment (IPM-IICA) that utilizes both quantitative (scored) and qualitative (narrative) data elements to characterize implementation integrity and consistency at both community coalition and school community levels. The IPM-EF includes five phases. Phase 1: Describe the Intervention Context; Phase 2a: Document the Extent to Which the 10 Steps of the IPM were Implemented (using the IPM-IICA scored); Phase 2b: Document the Unique Community-Specific Methods Used within the 10 Steps of the IPM to Tailor Local Intervention Delivery (using the IPM-IICA narrative); Phase 3: Measure Changes in Community Risk and Protective Factors; Phase 4: Measure the Outcomes Associated with the IPM; and Phase 5: Investigate Multiple Full Cycles Over Time

Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use

Adolescent substance use—the consumption of alcohol, tobacco, and other harmful drugs—remains a persistent global problem and has presented ongoing challenges for public health authorities and society. In response to the high rates of adolescent substance use during the 1990s, Iceland has pioneered in the development of the Icelandic Model for Primary Prevention of Substance Use—a theory-based approach that has demonstrated effectiveness in reducing substance use in Iceland over the past 20 years. In an effort to document our approach and inform potentially replicable practice-based processes for implementation in other country settings, we outline in a two-part series of articles the background and theory, guiding principles of the approach, and the core steps used in the successful implementation of the model. In this article, we describe the background context, theoretical orientation, and development of the approach and briefly review published evaluation findings. In addition, we present the five guiding principles that underlie the Icelandic Prevention Model’s approach to adolescent substance use prevention and discuss the accumulated evidence that supports effectiveness of the model. In a subsequent Part 2 article, we will identify and describe key processes and the 10 core steps of effective practice-based implementation of the model

A year of Covid-19 : experiences and lessons learnt by small European island states — Cyprus, Iceland and Malta

COVID-19 became a global pandemic within weeks, as every country including small states and islands experienced a surge in cases. Small islands are known to face several challenges in the quest to curb the viral spread, but with the absence of land boarders and small population size, these factors should have played to their advantage to minimize the spread. The aim of this article was to compare and contrast the COVID- 19 situation, restrictions, preparedness, management and the healthcare systems between the small population island states of Cyprus, Iceland and Malta. Methods: Data were obtained from Ministry of Health websites and COVID dashboards of the three respective Island states in Europe. Comparisons were made between the reported cases, deaths, excess deaths, years of life lost, swabbing rates, restrictive measures, vaccination roll-out and healthcare system structures. Results: Cyprus and Malta contained the COVID-19 spread better than Iceland during the first wave. However, a significantly higher viral spread and mortality rates were observed in Malta during the second waves. Similar healthcare preparedness and services, restrictions and relaxation measures were implemented across the three islands with some exceptions. Covid-19 vaccination has initiated across all Islands with Malta leading the vaccination roll-out. Conclusion: The small population size and island status proved to be an asset during the first wave of COVID-19, but different governance approaches led to a different COVID-19 outcomes, including high mortality rates during the transition phases and the subsequent waves.peer-reviewe

Cumulative risk over the early life course and its relation to academic achievement in childhood and early adolescence

Early-life risk factors, such as family disruption, maltreatment, and poverty, can negatively impact children's scholastic abilities; however, most previous studies have relied on cross-sectional designs and retrospective measurement. This study investigated the relation between cumulative risk factors during the early life course and subsequent academic achievement in a cohort of children and adolescents. Data for this study were based on registry-data material from the LIFECOURSE study of 1151 children from the 2000 birth cohort in Reykjavik, Iceland, assembled in 2014-2016. Multiple lifetime risk factors, including maternal smoking during pregnancy, parent's disability status, being born to a young mother, number of children in the household, family income, number of visits to school nurses, and reports of maltreatment, were assessed. Latent class analysis and Analysis of Covariance (ANCOVA) were used to predict academic achievement in the 4th and 7th grades. Individuals with no risk factors reported the highest average academic achievement in the 4th (M=66 points, SD=17) and 7th grades (M=67 points, SD=15). There was a significant main effect for 4th-grade risk factors and academic achievement (F [7, 1146]=12.06, p<0.001) and a similar relationship between the risk factor profile and achievement scores in 7th grade (F [7, 1146]=15.08, p<0.001). Each additional risk factor was associated with a drop in academic achievement at both grade levels. We conclude that academic achievement declines in proportion to the number of risk factors in early life

Principios Directrices y Desarrollo del Modelo Islandés para la Prevención del Uso de Sustancias en Adolescentes

El uso de sustancias por los adolescentes (i.e. el consumo de alcohol, tabaco, y otras drogas), persiste como un problema global, y se mantiene como un desafío para nuestras sociedades y autoridades de salud pública. Como respuesta a las altas tasas de uso de sustancias en adolescentes en los años ‘90, en Islandia han sido pioneros en el desarrollo del Modelo Islandés Para la Prevención Primaria del Uso de Substancias – un método basado en la teoría y evidencia científica que ha demostrado su efectividad en bajar los niveles de consumo en Islandia en los últimos 20 años. Para documentar este método e informar sobre los procesos basados-en-la-práctica que puedan ayudar en establecer este modelo en otros países, describimos esquemáticamente en esta serie de dos partes la teoría, antecedentes, principios directrices del método, y los pasos centrales en la implementación exitosa del modelo. En este artículo describimos los antecedentes y contexto necesarios, la orientación teórica, el desarrollo del método, y brevemente revisamos los hallazgos y datos publicados. Adicionalmente, presentamos los cinco principios guía en los que se basa el método del Modelo de Prevención Islandés para la prevención del uso de sustancias en adolescentes, y discutimos la evidencia acumulada que apoya la efectividad del modelo. En el siguiente artículo, parte 2, identificamos y describimos procesos clave en el modelo y los diez pasos centrales de la implementación efectiva y basada en la práctica de este modelo

Implementación del Modelo Islandés para la Prevención del Uso del Sustancias en Adolescentes

Esta es la segunda de una serie de dos partes de artículos sobre el Modelo Islandés de Prevención Primaria del Uso de Sustancias (MIP) en Health Promotion Practice. El MIP es una estrategia comunitaria colaborativa que ha demostrado notable efectividad en reducir el inicio del uso de sustancias entres jóvenes de Islandia en los últimos 20 años. Mientras el primer artículo se enfocó en el contexto de fondo, orientación teórica, evaluación y evidencia de su efectividad, y los cinco principios guías del modelo, este segundo artículo describe los 10 pasos centrales en la implementación práctica. Los pasos 1 a 3 se enfocan en cómo construir y mantener la capacidad comunitaria para la implementación del modelo. Los pasos 4 a 6 se enfocan en cómo implementar un sistema riguroso de recolección de datos, como procesarlos, la diseminación de los datos y la traducción de los hallazgos. Los pasos 7 a 9 están diseñados para enfocar la atención de la comunidad y para maximizar el compromiso comunitario en crear y mantener un medioambiente social en el cual la gente joven progresivamente se hace menos proclive a consumir sustancias, e incluye ejemplos ilustrativos de Islandia. Y el paso 10 se enfoca en la naturaleza iterativa, repetitiva y de largo plazo del MIP y describe un amplio y predecible arco de oportunidades y desafíos relacionados con la implementación. Este artículo concluye con una breve discusión sobre las potenciales variaciones en los factores comunitarios para la implementación

Adolescent well-being amid the COVID-19 pandemic: Are girls struggling more than boys?

Background: Differential effects of the coronavirus SARS-CoV-2 (COVID-19) pandemic and associated public restrictions on adolescent girls and boys are emerging but have not been elucidated. This study examined gender differences across broad indicators of adolescent well-being during the COVID-19 pandemic in Iceland, and explored potential explanations for these differences. Methods: In total, 523 youth (56.5% girls) born in Iceland in 2004 completed measures on mental health problems (depressive symptoms, anger and suicide attempts) and measures designed for this study to assess broad indicators of adolescent well-being (e.g., day-to-day life, academic performance, family and peer relationships, and mental and physical health) and behavioral changes during the COVID-19 pandemic. Mental health problems during the pandemic were compared to expected scores based on nationwide ratings of same-aged peers in 2018. Results: Although both boys and girls appeared affected, girls reported a greater negative impact across all the broad indicators of well-being and behavioral change during COVID-19 than boys, and their depressive symptoms were above and beyond the expected nationwide scores (t(1514) = 4.80, p < .001, Cohen's d = 0.315). Higher depressive symptoms were associated with increased passive social media use and decreased connecting with family members via telephone or social media among girls, and decreased sleeping and increased online gaming alone among boys. Concern about others contracting COVID-19, changes in daily and school routines, and not seeing friends in person were among the primary contributors to poor mental health identified by youth, particularly girls. Conclusions: Adolescents were broadly negatively affected by the COVID-19 pandemic and accompanying restrictions; however, this negative impact was more pronounced in girls. The findings suggest that a steady routine and remaining socially connected may help youth cope with the uncertainty and social restrictions associated with a pandemic. Moreover, healthcare providers, teachers, and other professionals should pay close attention to depressive symptoms among girls during a pandemic