1. Using SALSUS Data in Alcohol and Drug Partnerships Janice Thomson East Renfrewshire ADP

2. ALCOHOL AND DRUG PARTNERSHIP Key Role Implementing national drug and alcohol strategies Planning and delivering effective local strategies Contribution to the Single Outcome Agreement National ADP Performance Framework

3. FocusNational ADP Outcome 1. HealthPeople are healthier and experience fewer risks as a result of alcohol and drug use 2. PrevalenceFewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others. 3. RecoveryIndividuals are improving their health, wellbeing and life chances by recovering from problematic drug and alcohol use. 4. CAPSMChildren and family members of people misusing alcohol and drugs are safe, well supported and have improved life chances. 5. Community Safety Communities and individuals are safe from alcohol and drug related offending and anti- social behaviour. 6. Local Environment People live in positive, health promoting local environments where alcohol and drugs are less readily available. 7. ServicesAlcohol and drug services are high quality, continually improving efficient evidence based and responsive, ensuring people move through treatment and to sustained recovery.

4. UTILISNG SALSUS DATA ALCOHOL AND DRUG PARTNERSHIP Vital Primary Source of Data on Substance Using Behaviours Informs development of ADP strategy and delivery plan Monitors progress against a number of ADP outcomes Core suite of national performance indicators

5. FocusNational ADP Outcome 2. PREVALENCEFewer adults and children are drinking or using drugs at levels or patterns that are damaging to themselves or others. % 15 year olds taking illicit drugs at least once in the last month % of 15 years reporting using illicit drugs in the last year % of 15 year olds reporting drinking on a weekly basis 6. ENVIRONMENTPeople live in positive, health promoting local environments where alcohol and drugs are less readily available. % of 15 year pupils being offered drugs.

6. UTILISNG SALSUS DATA ALCOHOL AND DRUG PARTNERSHIP Series of SALSUS Interactive Briefing Sessions planned across a range of partnerships and key stakeholders New three year ADP delivery plans in place by June 2015 Timely opportunity to reflect and review the ADP delivery plan and prevention and education framework.

7. UTILISNG SALSUS DATA ALCOHOL AND DRUG PARTNERSHIP New SALSUS reporting is welcomed Access to extended data sets Long term trend analysis Benchmarking Increased opportunity to engage with wider stakeholders

8. Thank you

9. Making the most of SALSUS in Fife Clare Campbell Health Intelligence Team Public Health Department NHS Fife

10. The Health Intelligence Team is responsible for: ensuring access to current and reliable information providing information to meet need making information widely available presenting information in a variety of ways supporting the understanding and use of information SALSUS provides us with information about young people that we cannot get from other sources In Fife:

11. We have used SALSUS or helped others to use SALSUS to: describe health behaviours, needs associated with these and changes to these over time; to help create and monitor progress towards health improvement targets and outcomes; to help inform local strategies/plans; to provide information for planning, delivering and evaluating initiatives We have made information from SALSUS available from a variety of sources and in a variety of formats Examples of how we have used SALSUS include: In Fife:

12. As indicators to support the monitoring of the progress of: Fife’s Joint Health Improvement Plan 2007-10 SALSUS 2006 Indicator: Regular smoking Indicator: Weekly drinking Indicator: Monthly drug use SALSUS 2006 Indicator: Regular smoking Indicator: Weekly drinking Indicator: Monthly drug use Chapter 5: Teenage Transitions Outcome: increasing the proportion of young people adopting a healthier lifestyle

13. ...and now indicators in: Fife’s Health and Wellbeing Plan 2011-14

14. ...focusing upon ‘supporting healthier lifestyles’: People have the personal skills, strengths, knowledge and opportunity to improve their health and wellbeing IndicatorTime periodsSource 200220062010 Percentage of young people (aged 13 and 15) who are regular smokers 14118SALSUS FHWB Plan Indicator Template:

15. SALSUS 2002, 2006, 2010 Smoking Drug Use Alcohol Consumption by age group Fife and Scotland As indicators within the KnowFife Dataset:

16. ....provide population WEMWBS scores for teenagers in Fife to compare with scores collected from participants of ‘7 Habits of Highly Effective Teenagers’ programme running in Fife To: SALSUS 2010 WEMWBS 13 & 15 year olds Fife Mean WEMWBS Score 13 year olds49.2 15 year olds49.4

17. To create a Fife version of: Children and Young People's Mental Health Indicators IndicatorMeasure School year/ Age FifeScotland Source/ Year Engagement with Learning School Attendance% of half day attendances in school year Primary94.695 KnowFife 2010/11 Secondary90.191 Liking of School% who like school a lot or a bit at the moment S27374 SALSUS 2010 S46563 Peer and Friend Relationships Close Friends% who have at least 3 or more close friends S28685 SALSUS 2010 S48684 Relationship with Best Friend % who find it easy to talk to their best friends about things that really bother them P7-86 HBSC 2010 S2-88 S4-92 Peer Relationship Problems % with borderline or abnormal score on the peer relationship problems scale of the SDQ S21615 SALSUS 2010 S415 SALSUS 2010 WEMWBS, Strengths and Difficulties Questionnaire, Friendship, Liking of school, Drug use, Smoking, Alcohol Consumption

18. To create an ‘infographic’ themed factsheet: SALSUS 2010 Smoking Alcohol consumption WEMWBS Friendship

19. Smoking, Alcohol consumption and Drug use: Extracted figures from Fife report and Scotland report WEMWBS, SDQ, Friendship, School: A bit more of a challenge! Downloaded SALSUS 2010 dataset from UK data archive to SPSS Used variable SPSS list and syntax to analyse data (eventually!) Produced figures for variables of interest – it was worth it! How did we do it?

20. Updating the indicators and the work described above Widening the range of SALSUS data available in KnowFife Looking in more detail at changes over time Exploring different ways of presenting SALSUS data What will we be using SALSUS 2013 for ?

21. THANK YOU clare.campbell@nhs.net KnowFife - https://knowfife.fife.gov.uk/

22. Scottish Schools Adolescent Lifestyle and Substance Use Survey Education Resource John Higgins Development Officer

23. What did we hope to achieve with the Education Resource? Support, promote and complement SALSUS Survey Greater understanding of the importance of surveys How to use and Interpret Data Challenge perceptions about Drinking, Smoking and Drug use. Promoting discussion about the issues young people face in relation to drinking, smoking, drug use? Reinforce health messages Recognise ways in which young peoples’ views can contribute to decision making at school, local and national levels.

24. What is a learning journey? Framework for suggested learning activities Template for planning Links to Curriculum for Excellence Experience and Outcomes / 3 rd Level

26. What is a learning journey? Framework for suggested learning activities Template for planning Links to CFE Experience and Outcomes / 3 rd Level Key Learning within each learning journey

28. What is a learning journey? Framework for suggested learning activities Template for planning Links to CFE Experience and Outcomes / 3 rd Level Key Learning within each learning journey Taking it further section

30. What is a learning journey? Framework for suggested learning activities Template for planning Links to CFE Experience and Outcomes / 3 rd Level Key Learning within each learning journey Taking it further section List of useful resources

32. What is a learning journey? Framework for suggested learning activities Template for planning Links to CFE Experience and Outcomes / 3 rd Level Key Learning within each learning journey Taking it further section List of useful resources Delivered within PSE but opportunities for Interdisciplinary learning.

33. Learning Journeys 1.What are surveys and why is SALSUS Important? 2.Working with Data – What does SALSUS tell us? 3.How can we respond positively to the survey? 4.What are the potential costs of drinking, smoking, or drug use and how can we use the data to influence others?

34. John Higgins Education Scotland John.Higgins@educationscotland.gsi.gov.uk Cheryl Denny ISD Cheryl.Denny@nhs.net

35. Interventions to address multiple risk behaviours in adolescents Marion Henderson & Helen Sweeting MRC/CSO Social & Public Health Sciences Unit, University of Glasgow SALSUS Launch event – Edinburgh, 11.12.14

36. Why multiple risk behaviours? Increasing evidence (mainly US studies) that many risk behaviours cluster in youth. Especially in young people from the most deprived backgrounds. Evidence that early initiation of one behaviour (e.g. smoking, drinking), is associated with later uptake of other risk-taking behaviours (e.g. sexual risk taking, binge drinking, teenage pregnancy).

37. SPHSU (2011) data – clustering of smoking and drinking in Scottish S2, S3 & S4 pupils

38. Ever smoking Ever alcohol without parental knowledge S2 Neither 62% Smoke 1% 8%8% Drink 29%

39. SPHSU (2011) data – clustering of smoking and drinking in Scottish S2, S3 & S4 pupils Ever smoking Ever alcohol without parental knowledge S2 Neither 62% Smoke 1% 8%8% Drink 29% S3 Neither 43% Smoke 2% 14% Drink 42%

40. SPHSU (2011) data – clustering of smoking and drinking in Scottish S2, S3 & S4 pupils Ever smoking Ever alcohol without parental knowledge S2 Neither 62% Smoke 1% 8%8% Drink 29% S3 Neither 43% Smoke 2% 14% Drink 42% S4 Neither 28% Smoke 2% 19% Drink 50%

41. SPHSU (2011) data – clustering of smoking and drinking in Scottish S2, S3 & S4 pupils Ever smoking Ever alcohol without parental knowledge S2 Neither 62% Smoke 1% 8%8% Drink 29% S3 Neither 43% Smoke 2% 14% Drink 42% S4 Neither 28% Smoke 2% 19% Drink 50% Which means that almost all smokers are also secret drinkers = CLUSTERING.

42. SPHSU (2011) data – clustering of smoking and drinking by deprivation Ever smoking Ever alcohol without parental knowledge Least deprived Neither 50% Smoke 3% 17% Drink 29% Mid Neither 44% Smoke 4% 28% Drink 25% Most deprived Neither 34% Smoke 4% 38% Drink 24%

43. SPHSU (2011) data – clustering of smoking and drinking by deprivation Ever smoking Ever alcohol without parental knowledge Least deprived Neither 50% Smoke 3% 17% Drink 29% Mid Neither 44% Smoke 4% 28% Drink 25% Most deprived Neither 34% Smoke 4% 38% Drink 24% Which means clustering is more likely in the most deprived pupils.

44. SALSUS 2013 - clustering

47. So … 19% regularly used one or more substance

48. SALSUS 2013 - clustering So … 19% regularly used one or more substance And … 8% regularly used two or more substances

49. SALSUS 2013 - clustering So … 19% regularly used one or more substance And … 8% regularly used two or more substances Which means that of those who DID regularly use substances, around 40% used two or more.

50. SPHSU (2003) data – odds of 3+ sexual partners in late adolescence according to current substance use MalesFemales Smokers2.64.3 Heavy drinkers3.43.6 Ever drugs2.76.7

51. SPHSU (2003) data – odds of 3+ sexual partners in late adolescence according to current substance use MalesFemales Smokers2.64.3 Heavy drinkers3.43.6 Ever drugs2.76.7

52. SPHSU (2003) data – odds of 3+ sexual partners in late adolescence according to current substance use MalesFemales Smokers2.64.3 Heavy drinkers3.43.6 Ever drugs2.76.7

53. SPHSU (2003) data – odds of 3+ sexual partners in late adolescence according to current substance use MalesFemales Smokers2.64.3 Heavy drinkers3.43.6 Ever drugs2.76.7 Which means a clear link between adolescent substance use and sexual risk behaviours

54. Risky sexual behaviour Average daily school attendance Perceived parent disapproval of adolescent sex More parental-adolescent activities Low parental aspirations Low school attendance/truancy Overlap in risk and protective factors for risky sexual behaviour and substance use

55. Smoking, drinking and cannabis use Risky sexual behaviour Parental presence Household access to substances Self-esteem Average daily school attendance Perceived parent disapproval of adolescent sex More parental-adolescent activities Community norms pro drug use Perceived high availability of drugs Family history of substance use Favourable attitudes towards antisocial behaviour Sensation seeking Low parental aspirations Low school attendance/truancy

56. Overlap in risk and protective factors for risky sexual behaviour and substance use Smoking, drinking and cannabis use School connectedness Family-parent connectedness Academic achievement Risky sexual behaviour Parental presence Household access to substances Self-esteem Appears older than most Average daily school attendance Perceived parent disapproval of adolescent sex More parental-adolescent activities Community norms pro drug use Perceived high availability of drugs Family history of substance use Favourable attitudes towards antisocial behaviour Family history of problem behaviour Availability of drugs Sensation seeking Low income & poor housing Experience of authority care Low parental aspirations Low school attendance/truancy Antisocial behaviour

57. Review of adolescent and young adult health in Scotland Jackson C, Frank J, Haw S; 2010. Available at: www.scphrp.ac.uk www.scphrp.ac.uk Focused on tobacco, illicit drug and alcohol use and risky sexual behaviour Aimed to provide a synthesis of what works to prevent multiple risk behaviour, for policy-makers, practitioners and academics Peer reviewed article: Jackson CA, Henderson M, Frank J, Haw S. An overview of prevention of multiple risk behaviour in adolescence and young adulthood. Journal of Public Health 2012;34:i31-i40

58. 1 st review method Literature search to identify (post 2000) reviews of intervention studies on multiple risk behaviour outcomes, including substance use and sexual risk behaviour.  Identified no such reviews

59. 2 nd review method Searched published and grey literature for reviews (or reviews of reviews) focused on single risk behaviours. Aim = to identify effective intervention approaches across risk behaviours.

60. Risk behaviour Intervention typeAlcoholSmokingIllicit drug use Sexual behaviour Pricing-- Overview of current evidence for effectiveness of interventions across risk behaviours Good evidence for effectivenessMixed evidence for effectiveness Limited data (largely due to lack of studies) *includes community interventions (which generally included school elements etc)

61. Risk behaviour Intervention typeAlcoholSmokingIllicit drug use Sexual behaviour Pricing-- Controlling availability-- Overview of current evidence for effectiveness of interventions across risk behaviours Good evidence for effectivenessMixed evidence for effectiveness Limited data (largely due to lack of studies) *includes community interventions (which generally included school elements etc)

62. Risk behaviour Intervention typeAlcoholSmokingIllicit drug use Sexual behaviour Pricing-- Controlling availability-- Mass media/advertising Overview of current evidence for effectiveness of interventions across risk behaviours Good evidence for effectivenessMixed evidence for effectiveness Limited data (largely due to lack of studies) *includes community interventions (which generally included school elements etc)

63. Risk behaviour Intervention typeAlcoholSmokingIllicit drug use Sexual behaviour Pricing-- Controlling availability-- Mass media/advertising School-based intervention Overview of current evidence for effectiveness of interventions across risk behaviours Good evidence for effectivenessMixed evidence for effectiveness Limited data (largely due to lack of studies) *includes community interventions (which generally included school elements etc)

64. Risk behaviour Intervention typeAlcoholSmokingIllicit drug use Sexual behaviour Pricing-- Controlling availability-- Mass media/advertising School-based intervention Parenting/family-based programmes Multi-domain intervention * Overview of current evidence for effectiveness of interventions across risk behaviours Good evidence for effectivenessMixed evidence for effectiveness Limited data (largely due to lack of studies) *includes community interventions (which generally included school elements etc)

65. 3 rd review method Performed a primary systematic review of experimental evaluations of interventions where both substance use and sexual risk behaviour outcomes were reported. Found: Types of intervention very mixed (programme, setting, populations). Results generally mixed (some behaviours not others; one gender or the other; short-term results).

66. Significant effects found in... 4 of 9 studies reporting on smoking 2 of 11 studies reporting on alcohol 3 of 10 studies reporting on illicit drug use 5 of 13 studies reporting on sexual risk behaviour 3 studies had a significant +ve effect on at least one substance use outcome and one sexual risk behaviour outcome

67. Example of a promising intervention approach Seattle Social Development Project Primary schools. Aimed to promote family and school connectedness/bonding. Included school (teacher training), individual (social and emotional skills) and parenting components. At age 18: reduced heavy drinking, reduced lifetime sexual activity and history of multiple partners At age 21: increased condom use at last intercourse (among single people); reduced pregnancy and childbirth among women; reduced the prevalence of having multiple partners.

68. Conclusions of review Most effective or promising interventions for multiple risk behaviour: target underlying risk and protective factors of risk behaviours; target more than one domain of risk and protective factors (individual, school, family, community); promote family- and/or school-connectedness; intervene early (pre-adolescence) and continue through adolescence. Any cross-domain approach will require effective cross-sector engagement and collaboration, particularly between the education and health sectors. Social context very important – e.g. availability and pricing of substances; cultural attitudes and social norms; marketing & media; access to attractive leisure and social facilities.