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

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

Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study

Background: Adolescence represents a crucial developmental period in shaping mental health trajectories. In this study, we investigated the effect of the COVID-19 pandemic on mental health and substance use during this sensitive developmental stage. Methods: In this longitudinal, population-based study, surveys were administered to a nationwide sample of 13-18-year-olds in Iceland in October or February in 2016 and 2018, and in October, 2020 (during the COVID-19 pandemic). The surveys assessed depressive symptoms with the Symptom Checklist-90, mental wellbeing with the Short Warwick Edinburgh Mental Wellbeing Scale, and the frequency of cigarette smoking, e-cigarette use, and alcohol intoxication. Demographic data were collected, which included language spoken at home although not ethnicity data. We used mixed effects models to study the effect of gender, age, and survey year on trends in mental health outcomes. Findings: 59 701 survey responses were included; response rates ranged from 63% to 86%. An increase in depressive symptoms (β 0·57, 95% CI 0·53 to 0·60) and worsened mental wellbeing (β -0·46, 95% CI -0·49 to -0·42) were observed across all age groups during the pandemic compared with same-aged peers before COVID-19. These outcomes were significantly worse in adolescent girls compared with boys (β 4·16, 95% CI 4·05 to 4·28, and β -1·13, 95% CI -1·23 to -1·03, respectively). Cigarette smoking (OR 2·61, 95% CI 2·59 to 2·66), e-cigarette use (OR 2·61, 95% CI 2·59 to 2·64), and alcohol intoxication (OR 2·59, 95% CI 2·56 to 2·64) declined among 15-18-year-olds during COVID-19, with no similar gender differences. Interpretation: Our results suggest that COVID-19 has significantly impaired adolescent mental health. However, the decrease observed in substance use during the pandemic might be an unintended benefit of isolation, and might serve as a protective factor against future substance use disorders and dependence. Population-level prevention efforts, especially for girls, are warranted

A multi-level developmental approach towards understanding adolescent mental health and behaviour: rationale, design and methods of the LIFECOURSE study in Iceland

Purpose: Identifying and understanding modifiable risk and protective factors that can inform early detection and intervention to prevent adolescent emotional problems and harmful behaviours is among the most pressing modern-day public health challenges. This paper describes the rationale, objectives, methods, and anticipated outcomes of the LIFECOURSE study, a multi-level, bio-psychosocial prospective study designed to advance our understanding of factors that shape adolescent mental health and behaviour. Methods: Conducted by the Icelandic Centre for Social Research and Analysis at Reykjavik University, LIFECOURSE is a longitudinal population-based developmental study of Icelandic adolescents born in 2004. The study utilizes a comprehensive multi-informant assessment of individual, societal and biological factors measured across the lifespan. Data assembly and collection were conducted from 2016-2020 and utilize both retrospective and prospective data sources: (a) retrospective registry data assembled from seven national databases, (b) prospectively collected social surveys and (c) biomarker samples. Results: Of the 3914 eligible adolescents, 60.8% (n = 2378) provided informed parental consent and student assent to participate in the study, with approximately half of the participants being female (n = 1175, 49.4%) and the majority being born in the capital area (n = 1455; 61.2%). The coverage of available data from the national databases and participation in the social surveys ranged from 81.7 to 100%. Conclusions: Major gaps remain in our knowledge of how individual, societal and biological factors across the lifespan-from early life to adolescence-interact and shape the risk for emotional problems and harmful behaviours during adolescence. The LIFECOURSE study was designed to address this knowledge gap

Maternal smoking during pregnancy and scholastic achievement in childhood: evidence from the LIFECOURSE cohort study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesResearch on the impact of maternal smoking during pregnancy (MSDP) on scholastic achievement in the offspring has shown conflicting findings. The objective of this study was to assess the impact of MSDP on scholastic achievement in a birth cohort of children in 4th, 7th and 10th grades.We analysed data from the LIFECOURSE study, a cohort study of risk and protective factors in all children born in Reykjavik, Iceland, in the year 2000 (N = 1151, girls = 49.3%). Retrospective registry data for 2014-2015 were merged with prospective survey data that were collected in April 2016. Data on MSDP were assessed during regular antenatal visits at the end of the first trimester. Standardized academic achievement scores were obtained from official school transcripts. Data were analysed using OLS regressions that were entered in three hierarchical blocks.Children of mothers who smoked tobacco during the first trimester consistently revealed between 5% and 7% lower scores on standardized academic achievement in 4th, 7th and 10th grade (∼6-8 points on a normally distributed 120 point scale) than those of mothers who had not smoked tobacco during this period (P < 0.05). These findings held after controlling for several factors associated with the time of birth (e.g. birth weight, maternal age at birth, birth order, parental cohabitation and household income), as well as the year of scholastic assessment (parental cohabitation, household income and parental education).Maternal smoking during pregnancy was negatively related to scholastic achievement in the offspring during 4th, 7th and 10th grade.European Research Counci

Active and Passive Social Media Use and Symptoms of Anxiety and Depressed Mood Among Icelandic Adolescents

Adolescent use of social media platforms such as Facebook, Instagram, and Snapchat has increased dramatically over the last decade and now pervades their everyday social lives. Active and passive social media use may impact emotional health differently, but little is known about whether and to what extent either type of social media use influences emotional distress among young people. We analyzed population survey data collected from Icelandic adolescents (N = 10,563) to document the prevalence of social media use and investigate the relationship of both active and passive social media use with self-reported symptoms of anxiety and depressed mood. A hierarchical linear regression model revealed that passive social media use was related to greater symptoms of anxiety and depressed mood among adolescents and active social media use was related to decreased symptoms of anxiety and depressed mood, even after controlling for time spent on social media. When adding known risk and protective factors, self-esteem, offline peer support, poor body image, and social comparison to the model, active use was not related to emotional distress; however, passive use was still related to adolescent symptoms of anxiety and depressed mood. The effect of social media on emotional distress differed by gender as time spent on social media had a stronger relationship with emotional distress among girls. In addition, passive use was more strongly related to symptoms of depressed mood among girls. Future research should include risk and protective factors as mediators of different types of social media use and adolescent emotional distress

Vitamin D Intake and Status in 6-Year-Old Icelandic Children Followed up from Infancy.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.High serum 25-hydroxyvitamin D (25(OH)D) levels have been observed in infants in Nordic countries, likely due to vitamin D supplement use. Internationally, little is known about tracking vitamin D status from infancy to childhood. Following up 1-year-old infants in our national longitudinal cohort, our aims were to study vitamin D intake and status in healthy 6-year-old Icelandic children (n = 139) and to track vitamin D status from one year of age. At six years, the mean 25(OH)D level was 56.5 nmol/L (SD 17.9) and 64% of children were vitamin D sufficient (25(OH)D ≥ 50 nmol/L). A logistic regression model adjusted for gender and breastfeeding showed that higher total vitamin D intake (Odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.08-1.49), blood samples collected in summer (OR = 8.88, 95% CI = 1.83-43.23) or autumn (OR = 5.64, 95% CI = 1.16-27.32) compared to winter/spring, and 25(OH)D at age one (OR = 1.02, 95% CI = 1.002-1.04) were independently associated with vitamin D sufficiency at age six. The correlation between 25(OH)D at age one and six was 0.34 (p = 0.003). Our findings suggest that vitamin D status in infancy, current vitamin D intake and season are predictors of vitamin D status in early school age children. Our finding of vitamin D status tracking from infancy to childhood provides motivation for further studies on tracking and its clinical significance.Icelandic Research Fund of the Icelandic Centre for Research University of Iceland Research Fund Landspitali University Hospital Research Fun