1. Case Control Trials of Lions Quest Skills for Adolescence in South East Europe Research Results and Policy Implications Piloting the programme in South East Europe
Wadih MAALOUF, Expert- Programme Coordinator
Prevention Treatment and Rehabilitation Section
Drug Prevention and Health Branch
Division of Operations
UNODC
Twitter: wmaaloufun

2. Baseline - Demographics
Montenegro (N=1,572)
FYRO Macedonia (N=1,575)
Serbia (N=2,049)
INT
N (%)
CONT
p-val
`Gender
N=804
N=768
N=795
N=780
N=1,365
N=684
Males
418 (52%)
385 (50.1%)
386 (48.6%)
400 (51.3%)
668 (48.9%)
360 (52.6%)
Females
386 (48%)
383 (49.9%)
0.46
409 (51.4%)
380 (48.7%)
0.28
697 (51.1%)
324 (47.4%)
0.11
Age Years
<11
1 (0.1%)
5 (0.4%) 11
2 (0.3%)
3 (0.4%)
16 (2.1%)
11 (1.4%)
68 (5.3%)
13 (2%) 12
129 (17.2%)
158 (21.5%)
224 (28.6%)
207 (27.1%)
290 (22.6%)
105 (16.4%) 13
227 (30.2%)
253 (34.4%)
241 (30.8%)
243 (31.8%)
468 (36.5%)
294 (45.9%) 14
324 (43.1%)
260 (35.3%)
171 (21.9%)
168 (22%)
359 (28%)
199 (31%)
>14
69 (9.2%)
62 (8.4%)
0.02
129 (16.6%)
135 (17.7%)
0.77
91 (7.1%)
30 (4.7%)
<0.01
Mean age (SD)
13.4 (0.9)
13.3 (0.9)
13.3 (1.3)
13.4 (1.3)
0.40
13.1 (1.0)
13.2 (0.8)

3. Baseline - Current substance Use
Montenegro (N=1,572)
FYRO Macedonia (N=1,575)
Serbia (N=2,049)
INT
N (%)
CONT
p-val
Drinking alcohol
Never used
481 (60.1%)
487 (63.7%)
515 (64.5%)
493 (62.9%)
792 (58.2%)
425 (62.1%)
Never last 30 days
212 (26.5%)
177 (23.1%)
185 (23.2%)
182 (23.2%)
373 (27.4%)
181 (26.5%)
Users last 30 days
107 (13.4%)
101 (13.2%)
0.28
98 (12.3%)
109 (13.9%)
0.62
196 (14.4%)
78 (11.4%)
0.11
Smoking cigarettes
745 (92.7%)
718 (93.7%)
721 (91.3%)
689 (88.2%)
1,259 (92.6%)
621 (92.4%)
46 (5.7%)
36 (4.7%)
46 (5.8%)
62 (7.9%)
65 (4.8%)
30 (4.5%)
13 (1.6%)
12 (1.6%)
0.83
23 (2.9%)
30 (3.8%)
0.14
36 (2.7%)
21 (3.1%)
0.79
Smoking marijuana
788 (98.4%)
750 (98.4%)
779 (98.4%)
764 (97.8%)
1,329 (98.2%)
659 (98.1%)
7 (0.9%)
5 (0.7%)
10 (1.3%)
14 (1.8%)
10 (0.7%)
7 (1%)
6 (0.7%)
3 (0.4%)
0.69
15 (1.1%)
6 (0.9%)
0.71

4. Delta change current use of substances– within group
* <0.05; ** <0.01

5. Baseline – Intention to use next 3 months in current users
Montenegro (N=1,572)
FYRO Macedonia (N=1,575)
Serbia (N=2,049)
INT
N (%)
CONT
p-val
Intention to drink alcohol No
682 (84.7%)
670 (87.7%)
680 (85.6%)
666 (85%)
1,171 (86.5%)
575 (84.9%)
Yes
123 (15.3%)
94 (12.3%)
0.09
114 (14.4%)
118 (15%)
0.7
183 (13.5%)
102 (15.1%)
0.34
Intention to smoke cigarettes 
778 (96.9%)
745 (97.4%)
764 (96.3%)
764 (97.3%)
1,294 (95.8%)
657 (96.3%)
25 (3.1%)
20 (2.6%)
0.55
29 (3.7%)
21 (2.7%)
0.27
57 (4.2%)
25 (3.7%)
Intention to smoke marijuana 
785 (97.8%)
751 (98.4%)
785 (99.2%)
769 (98.8%)
1,315 (97.3%)
666 (98.2%)
18 (2.2%)
12 (1.6%)
0.33
6 (0.8%)
9 (1.2%)
0.42
37 (2.7%)
12 (1.8%)
0.18

6. Delta change Intention to use substances among current users– within group
* <0.05; ** <0.01

7. ANOVA analysis post-intervention outcome
Montenegro
FYRO Macedonia
Serbia
 Substance use in the last 30 days* 
Study group
N at t1
t1 %
p value at t1 
p value at t1
Alcohol
INT
101/738
13.7
130/736
17.7
209/1,188
17.8
CONT
121/732
16.5
0.13
151/730
20.7
0.14
216/1,060
20.4
0.09
Cigarettes
25/740
3.4
18/736
2.4
55/1,187
4.6
34/731
0.21
40/728
5.5
<0.01
56/1,048
5.3
0.44
Marijuana
12/736
1.6
5/736
0.7
37/1,183
3.1
33/731
4.5
14/727
1.9
0.03
26/1,044
2.5
0.37
Substance use – intention to use in the coming 3 months ** 
111/739 15
141/734
19.2
234/1,188
19.7
130/731
0.15
154/729
21.1
0.36
238/1,056
22.5
0.10
32/738
4.3
13/736
1.8
74/1,178
6.3
42/729
5.8
36/727
4.9
88/1,054
8.3
0.06
14/736
13/733
47/1,173 4
28/726
3.9
0.02
16/727
2.2
0.56
38/1,050
3.6
0.63

8. Transferability documenting positive effect (bottom-up success)!
Impact on substance use initiation and intentions to use substances among users . Very encouraging.
Relatively short follow up period.
Replication across countries with similar cultures encouraging (despite first attempt in countries were scientific culture is not prominent).

9. Exploring effect on normative belief (estimates of friends and 7th graders use), perception of harm and refusal skills as well as gender differences (as much as possible).
Process lead to no full implementation. Practicality of implementing in 1 academic year, need to stretch to 2
Difference of modality of implementation of the study in Serbia. Yet results still encouraging.

10. High affinity and motivation in countries due to absence of such programmes (despite original hesitation of MoE).
Encourage government to dig in deeper in the data to look for sub-group analyses (moderators/interactions).
Run further studies on scale up and process refinement.
Expansion plans ongoing to benefit Albania and Bosnia-Herzegovina and Guatemala (2 year implementation)

12. EUSPR 2015, 2016, 2017 / SPR

13. Reviewer 2:
The researchers are to be congratulated on their work on this substantial research project across three countries. This is exactly the sort of study that should be informing policy and practice and should be included in high level Cochrane systematic reviews of the effectiveness of school based alcohol prevention efforts.  I particularly liked that the manuscript clearly describes the skills based orientation of the prevention curriculum, and notes that this is consistent with best evidence and practice identified in the latest international guidance from high level and well regarded organizations.  

14. Colleagues Matthew Kiefer Milos Stojanovic, Bojan Milosavljevic
Giovanna Campello, Hanna Heikkila
Ziad Khatib
Marianne Jannsson fredriksson
Ministries of Education (Serbia, FYRO Macedonia, Montenegro)
Teachers

15. Wadih MAALOUF EMAIL: wadih.maalouf@unodc.org Twitter: wmaaloufun
Case Control Trials of Lions Quest Skills for Adolescence in South East Europe Research Results and Policy Implications Piloting the programme in South East Europe
Wadih MAALOUF
Twitter: wmaaloufun