1. Health promotion and drug prevention within the public health system …evidence based approach Darko Roviš, prof. Public Health Institute of Primorsko-goranska county Krešimirova 52A, 51 000 Rijeka

2. Public Health Institute Actively working in health promotion since 1905 Departments: Social medicine Health ecology Epidemiology Microbiology School and university medicine Drug prevention and outpatient treatment

3. Office for Drug prevention Department for Drug prevention and outpatient treatment Office for Outpatient treatment Health promotion and drug prevention programs: Universal Universal Selective Selective Indicative Indicative Specific drug treatment: Psychotherapy in penal system Psychotherapy in penal system Family support groups Family support groups Outpatient treatment: Drug free approach Drug free approach Maintainence Maintainence Detox program Detox program Community involvement Drug prevention committees Drug prevention committees Healthy cities Healthy cities University programs University programs

4. Office for Drug prevention Fiorello la guardie 23, Rijeka Team of Two psychologists, defectologist, and teacher Formed in 2005. Health promotion and drug prevention: Life Skills Taining Ready- Steady-Healthy Youth Counselling Bulletin – Rizik

5. - Major and still rising problem for Croatia - Drug rate of 250 /100 000 population - EU countries 200-800 / 100 000 population Total number of addict Opiate addict New addict New opiate addict Drug abuse and addiction

6. Drug abuse and adiction in Rijeka county TREATED DRUG ADDICT 1995. year– 17 addict 1996. year– 115 addict 2001. year – 649 addict 2004. year – 460 addict 2006. year – 634 addict 2007. year – 666 addict 1 148 Criminal Acts 707 Other Offences

7. Why do we talk of addicts when we are discussing children ?

8. 44% highschool children regularly or occasionally consume alcohol 51-64 % 2 nd grade students engage in ” Binge drinking” – ESPAD 2007  2002. - 50 interventions of ER service Substance use …  1/3 tried marihuana more than once  25-40 % smokes often  Majority thinks it is “normal” to drink and smoke Drinking 10 times or often ( last 30 day) 1 st and 2 nd grade students

9. Prevention in lower elementary school grades First time hard liker? bullying, gambling Up to 20 % of children low self-esteem ½ exposed to social violence 12-25% peer rejection ½ go out where other are smoking, drinking drug using Fammily and school communication poor Research on 8 th grade PGZ Starting from early age…

10. Based on

12. Possible solutions 1 Based on

13. How to direct our efforts to produce wanted effect ? Less mental & behavioural problems and drug abuse in communities and the population !

14. Evidence based evidence-based research-based science-based blueprint programs model programs promising programs effective programs

15. Science based programs Based on evidence, Tested in practice Methodologically clear design Significant reduction of negative outcomes and related risks Based on theory Detail evaluated

16. Evidence based aproach in Rijeka High quality implementation of best evidence based model programs. Careful pilot program design following the principles of effectiveness Quasi experimental evaluation design

17. Comprehensiveness Variety of teaching methods Sufficient lasting Theory based Building positive, strong and stabile relationships Time Following developmental psychopathology Social-cultural appropriateness Evaluation Education Principles of effectiveness

18. Developing a prevention model on a community level Package of multiple interventions that target  Children in different age groups  Children, families, social network, community  Risk and protective factors  Common and disorder-specific factors Use of variety of intervention methods Building evidence-based interventions

19. Prevention programs at PHI Youth Counseling Life Skills Training Ready Steady Health Bulletin RIzik Family self help group Support group in Penal system Health youth Narodni Zdravstveni List Educating Educators Junior in the house

20. LIFE SKILLS TRAINING Series of workshops for 6 th and 7 th grade Pilot program for 3 rd and 4 th garde 2005/06 - 31 school - 1657 students 2006/07 - 38 school - 150 assistants - 3168 students 2007/08 - 39š school -165 assistants -3427 students 2008/09 - 44 school -180 assistants - over 3500 students

21. Life Skills Training Universal prevention level (smoking, alcohol, drugs, violence) Evidence based Experience in implementation and evaluation (SAD, EU, Australia) Based on theory (Risk reduction model) Aim: reduce the increase in substance use in adolescents Protective factors High Sef-esteem Good social and communication skills Good decision making skills Good problem solving skills assertivness Coping with stress and anxiety, Goal setting Resistance to peer pressure Risk factors Early first contact with cigarettes, alcohol, drugs Lack of self-control Poor assertiveness (Dr.Gilbert J. Botvin)

22. Workshops Self image and self esteem Decision making Smoking Alcohol Marihuana Media Anxious emotions Facing anger Communication skills Social skills Asertivness Conflict resolution

23. Activities in 2007/08 MATERIALS Prepared and printed materials for 6 th and 7 th grade – Student manual for 6 th grade – Teacher manual for 6 th grade – Student manual for 7 th grade – Teacher manual for 7 th grade – Student questioners – Evaluation forms for teachers

24. EVALUATION AND SUPEVISION Pre-test Re-test Post-test Evaluation forms filled after each workshop Supervision workshop in February 2008 EDUCATION 2 X two day education for teachers and school coordinators – October 2008 – February 2009 Activities in 2007/08

25. Evaluation...

27.  Reduction higher than 50 %  Evidence that program WORKS  Corresponds to results form USA,EU  Troubles for the firs generation

28. Life Skills Training 4 Rijeka school + 1 County school Total: 300 učenika Piloting for two years 8 workshops held 1 x month Sef-esteem Decision making Smoking Media advertisement Coping with stress Communication skills Social skills Assertivens … for 3 rd and 4 th grade (8-9 years)

30. Ready Pilot program u 2007/08 based on risk reduction model 5 workshops with 8 th graders (14 years) Evaluation questionery Scholl staff + parents engagement Deliver the program to school services Themes Adolescence Coping skills Drugs –one way street Peer pressure Health lifestyles Steady Healthy