The school is one of the most important contexts for carrying out health promotion programs related to the abuse of substances. Over the years, methods and intervention models have changed a great deal, both in relation to the evolution of health goals and to the role played by experts, students, parents, and teachers. We would like to offer a different perspective on health promotion at school by discussing the weaknesses and strengths of the most used methods, in order to identify the appropriate methodology, based on recent evidence research findings. We used Scopus as database for reviewing existing literature. The evolution in the methodology of health promotion programs can be synthesized through a sequence of three phases, from the 1960s to the present day

Antonio Iudici

Elena Faccio

Francesca Turco

Gianluca Castelnuovo

Matteo Mazzucato

English

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What Works for Promoting Health at School: Improving Programs against the Substance Abuse

Faccio, Elena

Iudici, Antonio

Turco, Francesca

Mazzucato, Matteo

Castelnuovo, Gianluca

Archivio istituzionale della ricerca - Università di Padova

What works for promoting health at school: Improving programs against the substance abuse

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OPINIONpublished: 12 October 2017doi: 10.3389/fpsyg.2017.01743Frontiers in Psychology | www.frontiersin.org 1 October 2017 | Volume 8 | Article 1743Edited by:Osmano Oasi,Università Cattolica del Sacro Cuore,ItalyReviewed by:Roberto Vitelli,Università degli Studi di NapoliFederico II, Italy*Correspondence:Elena Faccioelena.faccio@unipd.itSpecialty section:This article was submitted toClinical and Health Psychology,a section of the journalFrontiers in PsychologyReceived: 18 August 2017Accepted: 20 September 2017Published: 12 October 2017Citation:Faccio E, Iudici A, Turco F,Mazzucato M and Castelnuovo G(2017) What Works for PromotingHealth at School: Improving Programsagainst the Substance Abuse.Front. Psychol. 8:1743.doi: 10.3389/fpsyg.2017.01743What Works for Promoting Health atSchool: Improving Programs againstthe Substance AbuseElena Faccio 1*, Antonio Iudici 1, Francesca Turco 1, Matteo Mazzucato 1 andGianluca Castelnuovo 2, 31Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy, 2 IstitutoAuxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania, Italy, 3Department ofPsychology, Catholic University of the Sacred Heart, Milan, ItalyKeywords: health programs at school, methodology, substance abuse, Symbolic InteractionismThe school is one of the most important contexts for carrying out health promotion programsrelated to the abuse of substances. Over the years, methods and intervention models have changeda great deal, both in relation to the evolution of health goals and to the role played by experts,students, parents, and teachers. We would like to offer a different perspective on health promotionat school by discussing the weaknesses and strengths of the most used methods, in order to identifythe appropriate methodology, based on recent evidence research findings. We used Scopus asdatabase for reviewing existing literature. The evolution in the methodology of health promotionprograms can be synthesized through a sequence of three phases, from the 1960s to the present day.FIRST PHASE: HEALTH EDUCATION CENTERED ON THE FIGUREOF THE EXPERT (EARLY 1960S TO EARLY 1970S)This method of prevention has been in vogue for many years and is still popular. It was basedon the idea that an individual with medical and scientific expertise was the ideal partner for anyprevention intervention. It envisages delegating to the expert the tasks of designing, implementing,conducting, and evaluating the program. It emphasized the medical and scientific knowledge of theindividual who came from the Institute of Mental Health and Addiction into the school and wasviewed as an expert in substance abuse, but who knew very little about the students.Since s/he wasnot an educator, often the external expert found difficulties when it came to mediating his/hertechnical language with the needs of the students he was talking to. These interventions were,therefore, mainlymini-conferences for giving information (often presented as “shock information”,Toumbourou, 2007; Cimini et al., 2009), and were not adapted to the specific needs of the groupsto which they were addressed.The interventions so developed are focused on “problematic” symptoms or behaviors,considered as “causes” and predictors of drug consumption that is conceived of as an internaland almost innate tendency. This methodological choice depends on the theoretical frameworkwhich considers “addiction” as coming from people of interior fragility and which is reducible byincreasing awareness of the dangers and risks (Evans-Whipp et al., 2007). In contrast to this trend,the literature has been trying to prove how this choice of approach might be ineffective (Bangert-Drowns, 1988) for many reasons: it fully leaves out the personal student standpoints, beliefs, andmeanings about these kinds of experience (Vander Leanen, 2011); students are passive and they donot participate in the construction of the program (Orsini et al., 2012), teachers are little involvedFaccio et al. Improving Programs against Substance Abusein the intervention, and remain an unexploited resource (VanHout, 2012), and their knowledge about the classes rarelybecomes a starting point for calibrating the activities (Pettigrewet al., 2012).SECOND PHASE: HEALTH EDUCATIONCENTERED ON THE FIGURE OF THETEACHER WITH AD HOC TRAINING (1970STO 1980S)Many schools soon realized that a work highly focused on theexpertise of the external expert, based on “spot” intervention,was not able to touch the real student needs, as the continuityof the relationship is the main educational tool. The effectivenessof preventive intervention cannot ignore the daily life of therelationship and the relationship between educator and student.Consequently, a strong movement was born that was devoted tothe culture of the direct promotion of health within the systemitself. This has led to the development of a “health promotingschool” through new teaching methodologies and innovativelearning processes, including so-called life skills and cooperativelearning. These methodologies can only be brought by teacherswho have received ad hoc training, and are strongly motivatedto use their teaching role to coordinate an effective strategy thatallows for the redistribution of tasks and functions: students areeducating students and the role of the expert is often replacedby testimony, or by someone who, having a history of substanceconsumption, can conjure up emotions, offer advice and dissuadestudents from risk behaviors and dangerous situations (Pellai,2006; Iudici, 2015; Cipolletta et al., 2017).THIRD PHASE: HEALTH EDUCATIONFOCUSED ON STUDENTS’ SKILLS, ORMODELS RELATED TO THE PRACTICE OFPEER EDUCATION (FROM THE 1990S TOTHE PRESENT DAY)Peer education is a methodology that, at different levels, involvesteenagers as the main actors in the strategic and operationalchoices with regard to prevention projects (Vygotskij, 1980;Gardner, 1993). There are multiple applications of thismethodology: from the pure model, where peer educators andtheme are chosen by adults, to the mixed model where the themeof work is chosen by adults while its realization is in the hands ofadolescents; to the empowered peer education, where adolescentsexercise decision-making power in the same way as adults.This methodology focuses on the social skills of the youngeducators. It eliminates the traditional contribution of the“teacher,” leaving almost a blank paper to the peers. In doing so,the effectiveness of the project is closely linked to the charismaand popularity of the peer educators. The contribution of the peereducators is also more enigmatic, based on their relationship tosubstances and their particular point of view.HOW SHOULD THE DISSEMINATION OFEFFECTIVE PROGRAMMES BECONDUCTED?Cuijpers (2002) conducted a systematic literature reviewexamining the current scientific knowledge with regard to thecharacteristics of effective drug prevention programs. The mostimportant evidence-based quality criteria identified in theseresearches relate to interactive delivery methods, the role of peerleaders, the development of life skills, and the emphasis on socialnorms, commitment not to use, and intentions not to use. Theincrease in effectiveness is therefore linked to the ability of theprogram to enter into the adolescents’ way of thinking, into theirbeliefs, and to strengthen resistance to social pressures. Moreextensive community intervention and also the involvement ofteachers, parents, and the entire community has been proven tobe the best method to strengthen the effects.A NEW METHODOLOGICAL PROPOSALFOR INTERVENTIONSince the methodology chosen for conducting an intervention islinked to precise theoretical assumptions and is strictly boundto the aims of the intervention program, it is important toascertain the strength of each of the considered methodologies,on the basis of a scientific approach. Referring to the theoreticalmodel of Symbolic Interactionism (Mead, 1934; Blumer, 1962)the process of producing meanings does not dwell within theheads of individuals; rather, it is the effect of the discoursefulnegotiation of meanings and the exchange of points of view(Faccio, 2011; Faccio et al., 2014, 2016, 2017). From this firsttheoretical assumption, some important implications arise for thework at school:(1) The effectivness of the intervention does not depend onthe discussion of specific contents about the substance use,rather, it depends on sharing points of view about whatstudents consider to be meaningful as a form of addiction.(2) Central to project planning should be the person (the studentand his network of relationships) in terms of the globality ofhis expressive and communicative potential, regardless of thepresence or absence of symptoms, pathology, or risk factors(Iudici and Verdecchia, 2015).(3) In general terms, we might hypothesize that the proposalthat expert should negotiate with the school leader and theprofessors responsible for health projects—in line with ourtheoretical model—should involve a shift in conceptualizingthe theme of addiction, from the Change in Behavior to theDevelopment of Skills, and from Identification of the Causesof Consumption, to the research of Intentions (Iudici, 2015).The goal is therefore not to demonize the substance use or toscare the students, rather than to think together with themabout the search for identity and personal fulfillment needsthat can be entrusted improperly by using substances.The structure of each meeting must be characterized by anextremely flexible methodology, since the effectiveness of theFrontiers in Psychology | www.frontiersin.org 2 October 2017 | Volume 8 | Article 1743Faccio et al. Improving Programs against Substance Abuseprogram depends on how the person is living and what s/heis thinking, and not on the aims defined at the table prior tothe meeting (Blumer, 1962; Iudici et al., 2015a,b). Flexibilityshould not come from randomness or the absence of definedgoals, but rather from an initial project hypothesis, built onthe basis of a careful analysis of demand and of the realgroup needs. Functional goals have to be redefined therefore, toprogressively activated processes. As an example, we might plana differentiation in the length of the program based on the needsof the classes: for classes that during the first meeting seem tobe little involved with respect to the theme, there could be fewmeetings (3 or 4) aimed at discussing prejudices and stereotypesabout reasons for substance use, while for classes most involved,the meetings could be more numerous and specific (up to 8–10).The interactivity of the program (one of the golden points toguarantee effectiveness) can derive not only from peer education,but also from the attitude used by the adults during the meetings.The expertise of the health professional who interacts withthe class cannot be exhausted in terms of his/her knowledgeof the use of substances, but should refer to the expert’spsychological competence in reading the class-group dynamicand in involving the adolescents in an active role (Faccio et al.,2013; Iudici, 2015). Peers may not be competent in decidingthe objects of the program on the basis of the specificity of theclass-group (which is another gold-standard, following Pellai,2006). In our view, it would be important the reintroductionof the experts, considering as experts not only psychologistsand toxicologists, but also former substance users (perhapsin the co-presence with a professional), who have followed aspecific training to acquire competence in managing the group’sdynamics.In addition, the collaboration and participation of teachers isreally important, since their role is often underestimated (Iudici,2015). Their way of intervention may vary depending on theproject activation phase: before the start, they can address thetheme of substance use in their subject matter, they can also meetthe experts during an early exchange for the co-construction ofthe project, since they know the class better than anyone else.Finally, after the project, they are in a position to show studentsthe implications of what was discussed with the experts, recallingcontent, and ideas (Tupper, 2008).By summing up, all actors of the school system could beinvolved, according to their role; also parents might participatein a beginning meeting, for presenting them the program and forlistening for their requests about the parental role in dealing withthe theme of addiction, and than in a final meeting, for givingthem a feedback about the project, perhaps managed by thestudents themselves co-ordinated by the expert. The effectivenessassessment process must necessarily take place within a programof qualitative methodology (interviews or focus groups) and itmust be differentiated on the basis of the role of the participant,of the class-driven path, and the specific goals negotiated with thereferents and the students themselves but which should cover theobjectives set out above in points 1, 2, and 3.CONCLUSIONSThrough this new contribution it becomes possible to changethe traditional way to construct an intervention. The classand the students become the main focus of the activities,with their personal abilities being promoted as part of acollaborative perspective. In order to impact on their wayof thinking and “to speak their language” it is necessarythat the project be co-constructed by students and theircaregivers, in a negotiating relationship with the teachers andoperators.The addictional presence of ex-consumers of substances withspecific relational formation, could promote a progressive changein their belief system about this phenomenon, overcomingprejudice and stereotypes about drug users.AUTHOR CONTRIBUTIONSAll five authors (EF, AI, FT, MM, and GC) contributed to thedrafting phases of the article listed below: 1. Critical Reviewof Literature, 2. Discussion of proposed ideas, 3. Schedule theRationale for Opinion, 4. Re-reading the text and editing, 5. Finalapproval to the version to be published.REFERENCESBangert-Drowns, R. L. (1988). The effects of school-based substance abuseeducation - a meta-analysis. J. Drug Educ. 18, 243–264.Blumer, H. (1962). “Society as symbolic interaction,” inHuman Behavior and SocialProcesses, ed A. M. 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Torino: Bollati Boringhieri.Conflict of Interest Statement: The authors declare that the research wasconducted in the absence of any commercial or financial relationships that couldbe construed as a potential conflict of interest.The handling Editor declared a shared affiliation, though no other collaboration,with one of the authors, GC.Copyright © 2017 Faccio, Iudici, Turco, Mazzucato and Castelnuovo. This is anopen-access article distributed under the terms of the Creative Commons AttributionLicense (CC BY). The use, distribution or reproduction in other forums is permitted,provided the original author(s) or licensor are credited and that the originalpublication in this journal is cited, in accordance with accepted academic practice.No use, distribution or reproduction is permitted which does not comply with theseterms.Frontiers in Psychology | www.frontiersin.org 4 October 2017 | Volume 8 | Article 1743

What works for promoting health at school: Improving programs against the substance abuse

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