The theoretical model of the school-based prevention programme Unplugged

Unplugged is a school-based prevention programme designed and tested in the EU-Dap trial. The programme consists of 12 units delivered by class teachers to adolescents 12-14 years old. It is a strongly interactive programme including a training of personal and social skills with a specific focus on normative beliefs. The aim of this work is to define the theoretical model of the program, the contribution of the theories to the units, and the targeted mediators. The programme integrates several theories: Social Learning, Social Norms, Health Belief, theory of Reasoned Action-Attitude, and Problem Behaviour theory. Every theory contributes to the development of the units' contents, with specific weights. Knowledge, risk perception, attitudes towards drugs, normative beliefs, critical and creative thinking, relationship skills, communication skills, assertiveness, refusal skills, ability to manage emotions and to cope with stress, empathy, problem solving and decision making skills are the targeted mediators of the program

The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial

OBJECTIVE: To evaluate the effectiveness of the school-based drug abuse prevention program developed in the EU-Dap study (EUropean Drug Abuse Prevention trial) in preventing the use of tobacco, alcohol and drugs at the post-test. METHODS: Cluster Randomised Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. A pre-test survey assessing past and current substance use was conducted before the implementation of the program. The program consisted in 12-hour class-based curriculum based on a comprehensive social-influence approach. A post-test survey was carried out in all participating schools, 3 months after the end of the program. The association between program condition and change in substance use at post-test was expressed as adjusted Prevalence Odds Ratio (POR), estimated by multilevel regression model. RESULTS: Program effects were found for daily cigarette smoking (POR=0.70; 0.52-0.94) and episodes of drunkenness in the past 30 days (POR=0.72; 0.58-0.90 for at least one episode, POR=0.69; 0.48-0.99 for three or more episodes), while effects on Cannabis use in the past 30 days were of marginal statistical significance (POR=0.77; 0.60-1.00). The curriculum was successful in preventing baseline non-smokers or sporadic smokers from moving onto daily smoking, but it was not effective in helping baseline daily smokers to reduce or stop smoking. CONCLUSION: School curricula based on a comprehensive social-influence model may delay progression to daily smoking and episodes of drunkenness

The effectiveness of a school-based substance abuse prevention program: 18-Month follow-up of the EU-Dap cluster randomized controlled trial

AIM: To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study (EUropean Drug Addiction Prevention trial). MATERIALS AND METHODS: Cluster Randomized Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and current substance use was conducted before the implementation of the program, while a post-test survey was carried out about 18 months after the pre-test. The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated by multilevel regression models. RESULTS: Persisting beneficial program effects were found for episodes of drunkenness (any, POR=0.80; 0.67-0.97; frequent, POR=0.62; 0.47-0.81) and for frequent cannabis use in the past 30 days (POR=0.74; 0.53-1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition, but no difference was detected in the proportion of quitters or reducers among baseline daily smokers. CONCLUSION: The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use, but not for cigarette smoking

Do the socioeconomic context and the European geographical area modify parental influences on smoking experimentation among adolescents?

Adolescent smoking is a major public health problem. While the socioeconomic status (SES) of the neighbourhood and that of the family are known to play a role in smoking onset and progression, it is not clear whether it modifies the association between parental influences and adolescent behaviour. The purpose of this study is to investigate family correlates of adolescent smoking experimentation and to explore the modifying role of socioeconomic context and European geographical area in a sample of European adolescents. This is a secondary analysis of the baseline survey of the European Drug Addiction Prevention (EU-Dap) trial which took place in seven European countries and involved 7079 students. School SES was used as indicator of socioeconomic context. European countries were aggregated in two geographical areas: North-Central and South. The associations between parental, family factors, and adolescents smoking experimentation were analysed through multilevel mixed-effect logistic regression models, stratified by school SES and European geographical area. Parental smoking, permissiveness towards tobacco, family conflicts, problematic relationships, low connectedness, and low parental control were significantly associated with adolescent smoking experimentation. Paternal smoking was a stronger correlate of adolescent smoking in low SES schools, while maternal smoking in high SES schools. Parental permissiveness was a stronger correlate in low SES schools. Family conflicts and low parental control were correlates only in low SES schools. The associations did not substantially differ between European geographical areas, with the exception of parental smoking that was a stronger correlate in the North, and parental control that was a correlate only in the South of Europe. To reduce inequalities in tobacco-related outcomes, prevention efforts in low socioeconomic contexts appear to be a public health priority. Parental smoking, permissiveness, family relationships, and connectedness should be addressed in preventive programs