• By Laura Whybra
  • Posted on Monday 02nd February, 2015

“Unplugged” schools program shows promise preventing substance use, but leaves gender issues unresolved

strong>Recognizing that schools can play an important part to play in preventing harmful use of tobacco, alcohol and illegal drugs is the easy part for policy makers. Finding interventions that are both practicable and “work” is a whole lot harder – as illustrated by the trial of a substance-abuse prevention program across schools in seven European countries.The positive headline news provided by researchers from the EU-Dap study group that developed and tested the “Unplugged” intervention with 12 to 14-year olds is that it remained effective after 15 months in reducing episodes of drunkenness, alcohol-related problems and frequent cannabis use among boys compared with a control group.But the study also raises the kinds of question that prove frustrating for service planners when trying to commission and implement preventive interventions since they are unlikely to be fully answered without further research. Why, for example, did the curriculum produce positive, statistically significant effects among boys, but not girls? Why was a slow-down in the rate of increased cigarette use just after the program not sustained 15 months later? And why was the significant impact on drunkenness and other alcohol-related problems restricted to students in schools serving the more socially disadvantaged neighborhoods? Substance use is, as the EU-Dap researchers note, a hugely important contributor to ill health and premature death in developed countries. Since first-use accelerates up to the age of 15, schools are an obvious place to intervene with universal prevention strategies.Yet despite being widely adopted, the effectiveness of school-based interventions is subject to continuing scientific debate, sharpened by evidence that some programs have proved ineffective or even unintentionally harmful. Recent research reviews highlight the message that only some, not all, approaches show promise in this area.A “social influence” approachThe Unplugged curriculum was devised a decade ago, drawing on evidence from a combination of “social influence” and “social competence” approaches – addressing young people’s social and personal skills and their normative beliefs. It is delivered by trained, class teachers in 12 one-hour lessons. An interactive approach builds students’ knowledge about harmful substance use while promoting critical thinking, problem-solving skills, effective communication, empathy, and coping with emotions and stress. The trial was conducted in 2004-5 with a sample of 7,079 students in Italy, Greece, Spain, Austria, Belgium, Germany and Sweden, reduced to 6,604 immediately after the intervention and 5,541 at 15-month follow-up. Randomization took place at school level, leading to Unplugged being taught at 78 schools, while students of the same age in 65 others formed a control group. One implementation difficulty that emerged was that the time needed to complete each module of the course was an hour, but the standard length of lessons in participating schools was 50 minutes. Data showed that only 56 per cent of the Unplugged classes completed the whole curriculum, although 66 per cent took part in at least ten of the 12 units. However, fewer than 5 per cent of classrooms did not receive any units. According to the EU-Dap researchers, their study results provide “some evidence that classroom curricula based on a Comprehensive Social Influence approach can be effectively delivered in the school setting in very different European sociocultural environments, and can contribute to a delay in the onset of substance abuse.” In considering why tobacco use did not follow the same, sustained trend as drunkenness and cannabis use, the researchers suggest three possible explanations: Smoking dependence in adolescence can occur following only sporadic use of tobacco; smoking may still be normative behavior in some of the participating countries, and; the intensity of the program may not have been as great as other, more successful interventions. Gender differencesRegarding gender, they note that boys were more likely than girls to have used cannabis recently when the program started, and were slightly more likely to report episodes of being drunk. However, in the case of tobacco, it was girls who smoked rather more than boys to begin with.The researchers think convincing answers may lie in the different ages at which girls and boys acquire relevant life skills and competencies. Data suggesting that the program was more effective among the youngest girls taking part seems to support this view. Personality characteristics may also contribute to the explanation, given evidence that girls whose self-esteem scored low in tests gained the least benefit from the program. Although plausible, given established links between low self-esteem and the risk of drug use among girls, this was not an issue that Unplugged, as a “social influence” program, was capable of tackling. In relation to the stronger effects found in schools serving disadvantaged neighborhoods, the researchers suggest their students may have experienced less out-of-school family education about harmful substance use than students in more affluent areas. However, it was also possible that teachers serving deprived areas were keener to implement the training in interactive teaching that the program provided.Looked at positively, the results imply that classroom programs like Unplugged have the potential to contribute to a reduction in health inequalities – a key target of health policies across Europe. But there are many other issues that need to be investigated and resolved – not least the seeming need for gender-specific timing and content – before their potential can be fully unlocked.*********Reference: Vigna-Taglianti, F. D., Galanti, M. R., Burkhart, G., Caria, M. P., Vadrucci, S., & Faggiano, F. (2014). “Unplugged,” a European school-based program for substance use prevention among adolescents: Overview of results from the EU-Dap trial. New Directions for Youth Development,141, 67-82. doi: 10//yd.20087

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