Unplugged evaluation results - ADEPIS seminar
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An overview of the Unplugged evaluation results. ADEPIS seminar series - London - 7th July 2015.
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Unplugged evaluation results - ADEPIS seminar
- 1. Peer van der Kreeft University College Ghent, Belgium For Mentor –ADEPIS seminar “Unplugged: Life-skills for thriving youth” CAYT Centre for Analysis of Youth Services The City Centre Conference Room, Guildhal, London July 7th 2015 Effectiveness study Mediators to Effect
- 2. 2 2 Researchers meet practicioners RCT Randomized Controlled Trial 7.079 pupils 143 schools 7 EU countries °2002 29 countries °2015
- 4. 4 The study sample at baseline (n=7079) RCT °2004 CENTRE # STUDENTS MEDIAN AGE Italy Turin 1.660 14 Spain Bilbao 429 14 Italy Novara 592 14 Germany Kiel 709 13 Sweden Stockholm 1.033 13 Italy L’Aquila 732 13 Belgium Gent 858 12 Greece Thessaloniki 516 12 Austria Vienna 550 12 °Faggiano et al, Preventive Medicine 2008
- 5. 5 Effectivity 3 mths post Daily smoking 30% reduction Recent drunkenness 28% reduction Experimenting cannabis 23% reduction has a preventive effect on early onset of drug use and on the transition of experimental to frequent use. The effect is bigger for boys than for girls. www.eudap.net °Faggiano et al, Preventive Medicine 2008
- 6. 6 Daily smoking °Faggiano et al, Drug and Alcohol Dependence 2010
- 7. 7 Any drunkenness °Faggiano et al, Drug and Alcohol Dependence 2010
- 8. 8 Any cannabis °Faggiano et al, Drug and Alcohol Dependence 2010
- 9. Adiktologie Czech Rep. results - effect on longer term °Miovski et al, Prevention Science 2015
- 10. Universal prevention: for everyone? Adiktologie: Yes Effect of Unplugged is the same for pupils with different profiles (characteristics, relation to mother, school grades, ….) °Miovski et al, Prevention Science 2015
- 11. Is Unplugged also effective for pupils with low SES social economical status? Karolinska Institute Sweden further analysed data from RCT °2004: Stronger effects in underprivileged schools on frequency of drinking °Caria et al, Biomed Central 2011
- 12. Table 2. Post-test Differences in Prevalence of use (last 30 days) Low to High area SES Controls Interventions ALO smoking +6.3% +5.0% Daily smoking +4.9% +7.0% ALO drunkenness +5.1% +2.7% Regular drunkenness +2.9% +1.6% ALO cannabis +0.5% -0.9% Regular cannabis +0.3% +0.1% ALO drugs +0.2% +0.1% * ALO: At Least Once in the last 30 days Is Unplugged also effective for pupils with low SES social economical status? OED Torino University: the inequality of low to high SES drug use decreased after Unplugged °Vigna-Taglianti et al, SPR Society Prevention Research poster 2007
- 13. Gender difference °Vigna-Taglianti et al, Jounal for Epidem. Community Health 2009 OED Torino University: less effective for girls Further analysed to explain: Unplugged low on self-esteem, high on social influence developmental factors
- 14. 14 Not only effective but also safe: have lowest iatrogenic effects. Iatrogenic effects:e.g. inadequate information, wrong target group, norm narrowing, facilitating access. In the EU-DAP no iatrogenic effects were detected.
- 15. The Theoretical Model of Unplugged and the mediating factors: “Effective: great! But what is the mechanism to result? Based on an article accepted for publication in Journal of Adolescent Health 2014: Short-term mediating factors of a school-based intervention to prevent youth substance use in Europe, Giannotta F, Vigna-Taglianti FD, Galanti MR, Scatigna M, Faggiano F, and the EU-Dap Study Group.
- 16. The theoretical model of Unplugged
- 17. The theoretical model of Unplugged Unplugged Knowledge on drugs Risk perception Intentions Use Attitudes Normative beliefs Perceived use Perceived acceptance Peer’s pressure Problem behaviour Jessor & Jessor 1977 Social learning Bandura 1960 Health Belief Rosenstock 1950 Social Norms Perkins 1986 Reasoned action-attitude Fishbein & Ajsen 1980 Skills Critical thinking Creative thinking Relationship skills Communication skills Assertiveness Refusal skills Managing emotions Coping Empathy Problem solving Decision making
- 18. Social Learning Social Norms Health Belief Reasoned Action-Attitude and Planned Behaviour Problem Behaviour Unplugged Knowledge on drugs Risk perception Intentions Use Attitudes Normative beliefs Perceived use Perceived acceptance Peer’s pressure Problem behaviour Jessor & Jessor 1977 Social learning Bandura 1960 Health Belief Rosenstock 1950 Social Norms Perkins 1986 Reasoned action-attitude Fishbein & Ajsen 1980 Skills Critical thinking Creative thinking Relationship skills Communication skills Assertiveness Refusal skills Managing emotions Coping Empathy Problem solving Decision making Bandura °60 SOCIAL LEARNING THEORY personality formed by observing, imitation, modeling contrary to “trial and error or punish and reward lead to new behavior” Learning does not lead to prompt behavior change, but to cognitive change that can activate observed behavior
- 19. Social Learning Social Norms Health Belief Reasoned Action-Attitude and Planned Behaviour Problem Behaviour Unplugged Knowledge on drugs Risk perception Intentions Use Attitudes Normative beliefs Perceived use Perceived acceptance Peer’s pressure Problem behaviour Jessor & Jessor 1977 Social learning Bandura 1960 Health Belief Rosenstock 1950 Social Norms Perkins 1986 Reasoned action-attitude Fishbein & Ajsen 1980 Skills Critical thinking Creative thinking Relationship skills Communication skills Assertiveness Refusal skills Managing emotions Coping Empathy Problem solving Decision making Jessor and Jessor °77 PROBLEM BEHAVIOR THEORY A problem is what is socially defined as a concern cf Kurt Lewin field theory: my behavior is function of me in the environment My risk - protection balance includes: Psychosocial (value, expectation) Environmental (perceived from others) Behavior structures (alco smoke)
- 20. Social Learning Social Norms Health Belief Reasoned Action-Attitude and Planned Behaviour Problem Behaviour Unplugged Knowledge on drugs Risk perception Intentions Use Attitudes Normative beliefs Perceived use Perceived acceptance Peer’s pressure Problem behaviour Jessor & Jessor 1977 Social learning Bandura 1960 Health Belief Rosenstock 1950 Social Norms Perkins 1986 Reasoned action-attitude Fishbein & Ajsen 1980 Skills Critical thinking Creative thinking Relationship skills Communication skills Assertiveness Refusal skills Managing emotions Coping Empathy Problem solving Decision making Perkins °86 SOCIAL NORMS THEORY Overestimated perception of behavior contrary to fear based
- 21. Social Learning Social Norms Health Belief Reasoned Action-Attitude and Planned Behaviour Problem Behaviour Unplugged Knowledge on drugs Risk perception Intentions Use Attitudes Normative beliefs Perceived use Perceived acceptance Peer’s pressure Problem behaviour Jessor & Jessor 1977 Social learning Bandura 1960 Health Belief Rosenstock 1950 Social Norms Perkins 1986 Reasoned action-attitude Fishbein & Ajsen 1980 Skills Critical thinking Creative thinking Relationship skills Communication skills Assertiveness Refusal skills Managing emotions Coping Empathy Problem solving Decision making Fishbein & Ajzen °80 THEORY OF REASONED ACTION I think rationally from information to awareness to intention to action (= attitude) based on what I think that others experienced
- 22. Social Learning Social Norms Health Belief Reasoned Action-Attitude and Planned Behaviour Problem Behaviour Unplugged Knowledge on drugs Risk perception Intentions Use Attitudes Normative beliefs Perceived use Perceived acceptance Peer’s pressure Problem behaviour Jessor & Jessor 1977 Social learning Bandura 1960 Health Belief Rosenstock 1950 Social Norms Perkins 1986 Reasoned action-attitude Fishbein & Ajsen 1980 Skills Critical thinking Creative thinking Relationship skills Communication skills Assertiveness Refusal skills Managing emotions Coping Empathy Problem solving Decision making Rosenstock °50 HEALTH BELIEF THEORY My perceived seriousness of health problem, benefits and self-efficacy determine my engagement in health promotion Perceived information risk estimation
- 23. Theories behind the program Example how this is present in Unplugged Social learning theory: you learn observational, by looking how someone else does something and which consequences he experiences # all: interactive small groups confront pupils with experiences and examples of classmates Social norms theory: you do what you are suppose that others do and expect from you # 2, 4, 5, 9: information issues in the quiz deal with correcting wrong suppositions Health belief model: your health is determined by your estimation of the consequences of what you do and of the seriousness score you give # 2: exercises about risks deal with where you get information and how you estimate your risks Theory of planned behaviour: your intention is the best predictor of your actions #11, 12: how does your information lead to intention Theory of problem behaviour: what you do becomes problematic if it is socially undesired # 3: a lesson on alcohol distinguishes personal, physical and social risks
- 24. Social Learning Social Norms Health Belief Reasoned Action-Attitude and Planned Behaviour Problem Behaviour group and protection Unit 4: your beliefs, norms and information - do they reflect reality? Unit 5: smoking the cigarette drug: inform yourself Unit 6: express yourself Unit 7: get up, stand up Unit 8: party tiger Unit 9: drugs - get informe Unit 10: coping competencies Unit 11: problem solving and decision making Unit 12: goal setting 1 opening 2 group 3 alcohol 4 reality 5 smoke 6 express 7 assertive 8 contact 9 drugs 10 coping 11 problems 12 goals Theories: how much present in a lesson?
- 25. 1opening 2 group 3 risks 4 reality 5 smoke 6 express 7 assertive 9 drugs 8 contact 10 coping 11 problem 12 goals Lessons linked to mediators
- 26. Mediators measured to prove which ones lead to effect Positive attitude towards drugs Negative attitude Positive beliefs Negative beliefs Knowledge Perception of number of user friends Refusal skills Perception of positive class climate
- 27. Effectiveness on mediators Path a Path bMediator β (S.E.) p value β (S.E.) p valu Youth cigarettes use in the past 30 days Positive attitudes towards drugs -.041 (.020) .038 .075 (.014) .000 Negative attitudes towards drugs - n.s. .025 (.011) .022 Positive beliefs tobacco -.044 (.021) .034 - n.s. Negative beliefs tobacco -.029 (.017) .086 - n.s. Knowledge about tobacco .049 (.021) .022 - n.s. Refusal skills tobacco -.030 (.015) .040 .280 (.016) .000 Perception of number of smokers friends -.051 (.020) .010 .071 (.009) .000 Perception of positive class climate -.047 (.021) .022 - n.s. Youth’s ever being drunk Positive attitudes towards drugs -.040 (.019) .036 .126 (.017) .000 Negative attitudes towards drugs - n.s. .027 (.015) .078 Positive beliefs alcohol -.038 (.018) .040 .037 (.012) .002 Negative beliefs alcohol - n.s. .069 (.014) .000 Knowledge about alcohol .153 (.017) .000 - n.s. Refusal skills alcohol -.032 (.018) .072 .151 (.016) .000 Perception of number of drunk friends - n.s. .067 (.010) .000 Perception of positive class climate -.047 (.021) .022 .022 (.010) .034 Youth’s ever use of cannabis Positive attitudes towards drugs -.041 (.021) .044 .121 (.016) .000 Negative attitudes towards drugs - n.s. .042 (.012) .000 Positive beliefs cannabis -.050 (.019) .006 - n.s. Negative beliefs cannabis - n.s. .044 (.012) .000 Knowledge about cannabis .137 (.022) .000 - n.s. Refusal skills cannabis -.033 (.019) .074 .180 (.016) .000 Perception of number of users friends -.042 (.020) .034 .048 (.008) .000 Perception of positive class climate -.048 (.021) .022 - n.s.
- 28. Gregor Burkhart - EMCDDA / OEDT - 28 Mediators in EU-DAP (www.eudap.net) Cannabis (LTP) OR .77 Regular drunkenness OR .69 Daily smoking OR .7 Normative Beliefs ↓ Refusal skills↑Positive attitude to illicit drugs ↓
- 29. Mediators with a proven lead to effect: Positive attitude towards drugs Perception of number of user friends Refusal skills Other mediators in Unplugged measured: Negative attitude towards drugs Positive beliefs Negative beliefs Knowledge Perception of positive class climate
- 30. 30 another way to look at the results 40 One case You deliver Unplugged to... To avoid... 35 31 82 98 60 Thinking in HEALTH ECONOMY terms…
- 31. 31 Small comparison 128 One case blood pressure fatality You deliver special medication to... To avoid... Thinking in HEALTH ECONOMY terms…
- 32. 32 One case breast cancer fatality You deliver mammographic screening for 10 years to... To avoid... Sackett DL, Haynes RB: Summarizing the effects of therapy: A new table and some more terms. Evidence-Based Medicine1997;2:103-104 Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD001877. DOI: 10.1002/14651858.CD001877.pub2 Small comparison
- 33. 33 40 One case You deliver Unplugged to... To avoid... 35 31 82 98 60 Thinking in HEALTH ECONOMY terms…
- 35. So… if implementing Unplugged or similar programmes • Take care of process evaluation • Monitor your intervention on regional/school/class level • Connect to the EU-Dap network for further analyses • Keep updated of the published studies’ results
- 36. Thank you EU-Dap study group www.eudap.net peer.vanderkreeft@hogent.be