PRACTICES AND INTERVENTIONS FOR PREVENTION OF ALCOHOL USE AMONG YOUNG PEOPLE IN EUROPE Presented by: Anna Markina University of Tartu

Authors: Gabriele Rocca, Alfredo Verde and Uberto Gatti University of Genoa   Anna Markina and Kristjan Kask Universty of Tartu

Our task: To identify and select programs and interventions that have been evaluated and of which the effectiveness has been proved, with the intent of enabling politicians and policy-makers to discern which interventions are effective or promising in the field of prevention.

Definitions: Intervention is a goal-directed and systematic approach toward the prevention of alcohol carried out by various providers.

Definitions: Best practices in health promotion: “those sets of processes and actions that are consistent with health promotion values, theories, evidence and understanding of the environment, that are most likely to prevent alcohol use among juveniles.” Kahan & Goodstadt (2001)

Classification of preventionprograms (Mrazek & Haggerty 1994): Universal Selective Indicated Universal - for everyone in an eligible population Selective - for those who are members of population subgroups at higher risk Indicated - for those with existing risk factors or conditions that identify them as being individually at risk.

Focusing on the contexts and actors involved: Individual; Family; School; Community; Multi-component.

Methodology Step 1: partners from 25 European countries were required to make an inventory of meso (school and community) and micro (family and individual) initiatives in the field of prevention of alcohol use among juveniles in their countries. Criteria of inclusion were: (i) the prevention programs should explicitly include the prevention of underage drinking among their aims, even if other issues are targeted (e.g. drug use or abuse, etc.) and (ii) every program/intervention should be developed in accordance with a manual, text or defined guidelines, in order to make its characteristics and implementation clearly understandable and to enable the program/intervention to be replicated. Ireland, Sweden, Denmark, Island, Norway, Finland, Austria, Germany, The Netherlands, Switzerland, Belgium, France, Spain, Italy, Cyprus, Portugal, Bosnia-Herzegovina, Poland, Russia, Lithuania, Slovenia, Hungary, Armenia, Czech Republic, Estonia. 8

Methodology Step 2: we asked national experts to propose two (or more, if available) “good” programs or interventions in their country as “best practice models” according to their competence and experience to be evaluated. Criteria of inclusion were: (i) the prevention programs should explicitly include the prevention of underage drinking among their aims, even if other issues are targeted (e.g. drug use or abuse, etc.) and (ii) every program/intervention should be developed in accordance with a manual, text or defined guidelines, in order to make its characteristics and implementation clearly understandable and to enable the program/intervention to be replicated. Ireland, Sweden, Denmark, Island, Norway, Finland, Austria, Germany, The Netherlands, Switzerland, Belgium, France, Spain, Italy, Cyprus, Portugal, Bosnia-Herzegovina, Poland, Russia, Lithuania, Slovenia, Hungary, Armenia, Czech Republic, Estonia.

Methodology Step 3: three teams of the AAA-Prevent project (Italian, Estonian and Dutch team) independently evaluated these programs selected by national experts.

Inclusion criteria for the best practices: The interventions’ focus is primary and/or secondary level prevention; The interventions have been implemented and evaluated with positive outcomes and are described in published literature; Interventions show evidence of effectiveness in eliciting desired changes;

Inclusion criteria for the best practices: The intervention addresses alcohol use prevention among children under the age of 18; The intervention addresses one or more of the following domains: individual, school, family, community, multi-component.

Clustering of countries: Central Europe: Germany, Belgium, Netherlands, Austria and Switzerland; Nordic: Ireland, Finland, Sweden, Norway, Denmark and Iceland; Mediterranean: France, Spain, Italy, Portugal and Cyprus; Eastern European: Czech Republic, Poland, Hungary, Estonia, Lithuania, Slovenia, Bosnia, Armenia and Russia.

Evaluation of programs: 1 Theoretical background 1 (meets the criteria) 0 (does not meet the criteria) 2 Implementation 3 Outcome 1 Theoretical background 1 (meets the criteria) = Intervention is based on strong theoretical background and references to the theory are mentioned in the program’s description. 0 (does not meet the criteria) = Intervention is based on weak theoretical background and there are no references to the theory or theoretical background is not scientifically published. 2 Implementation 1 (meets the criteria) = It is evaluated how the program has been implemented. The evaluation process is well described and published locally or in scientific journals or the evaluation is ongoing at the time () or the program has been evaluated in other country. 0 (does not meet the criteria) = The program’s implementation has not being evaluated. 3 Outcome 1 (meets the criteria) = It is demonstrated how the program’s effectiveness has been evaluated. The evaluation process is well described and published locally or in scientific journals or the evaluation is ongoing at the time () or the program has been evaluated in other country . 0 (does not meet the criteria) = The program’s effectiveness has not being evaluated.

Overall score 0..3 3 (meets our criteria) 2 (moderately meets our criteria) 1 (minimally meets our criteria) 0 (does not meet the criteria) 3 (meets our criteria) = Prevention is based on a good theoretical ground, implementation and outcome are both evaluated with the results in the positive direction and the results are published in national or international scientific journals. 2 (moderately meets our criteria) = Prevention is based on a good theoretical ground, only implementation is evaluated with the results in the positive direction and the results are published in national or international scientific journals or the implementation and outcome is evaluated in some other country or the implementation and outcome evaluation is in process. 1 (minimally meets our criteria) = Prevention is based on a strong theoretical background, implementation and outcome are not evaluated or published in local or international scientific journals; or the implementation and outcome are evaluated but reverse / no effects have been found; or theoretical background is weak, but implementation or outcomes are evaluated or published. These programs are not being published in the database. 0 (does not meet the criteria)

391 programs among 24 European countries were evaluated

Risk factor/s targeted* Individual level Program Risk factor/s targeted* Overall score Country Skoll (Self-control training) Individual, peers 3 Germany Supra-f Switzerland

Risk factor/s targeted* Family level Program Risk factor/s targeted* Overall score Country Strengthening Families Program (SFP) Individual, family, peers 2 Ireland Slovenia Triple P family 3 The Netherlands Örebro preventionsprogram (ÖPP) Family Norway Sweden Dedalo Spain

Risk factor/s targeted* School level Program Risk factor/s targeted* Overall score Country  Unplugged Individual, family, peers 3 Belgium, Italy, Lithuania, Slovenia To prevent is to live Individual, peers, school 2 Spain Drug-Reason-Impact Czech R. Life Skills and Knowledge Individual, school, peers Hungary PDD-FM Individual, peers, school, family Poland Kurzintervention Individual, peers Swizerland I am OK when I say NO WAY Denmark PAS Individual, family, school The Netherlands Social Skills Training Estonia

Risk factor/s targeted* Community level Program Risk factor/s targeted* Overall score Country Prague 6 District Individual, peers, school, family 3 Czech R. HaLT Individual, family, peers, neighbourhood Germany Don’t start too early Individual, family, peers 2 Belgium Local Alcohol Policy (PAKKA) Peers, neighbourhood Finland Responsible alcohol handling Norway STADs Responsible Beverage Service Sweden

Risk factor/s targeted* Multi-component Program Risk factor/s targeted* Overall score Country PES´P Andar (Feet for Walking) Individual, peers 2 Portugal Searching for Family Treasure Individual, family ODLOT Individual, family, peers, neighbourhood Poland Drug Policy at School Individual, school, peers 3 Belgium A cool world individual ADSUME and EI Finland Snowball Lithuania

Conclusions The main aims the prevention are the delay of onset, consumption decrease and harm reduction. Prevention in school level is considered most frequently effective compared to other domains. It is therefore important to define school as an educative alcohol-free environment.

Conclusions Interaction between families (parents) and the youth seems to be a successful approach. Community organization can play an important role in alcohol prevention. It is recommended that local communities should be more actively integrated in the alcohol prevention.

Conclusions There is a lack of evidence in evaluation, so there is a need for increasing scientific research in the area of alcohol prevention methods. Limitation of funding for developing new alcohol prevention programs. Importance of networking in application of the programs.

Thank you for your attention! http://www.aaaprevent.eu/strategies