ABSTRACT. Dual process models have described addiction as a combination of relatively strong bottom-up cue-related neurocognitive processes and relatively weak top-down cognitive control processes (e.g. Wiers et al., 2007). I will describe some of the tests used to assess these bottom-up processes. In line with this perspective, we found across several studies a larger impact of memory associations and approach tendencies on behavior in adolescents with relatively weak cognitive control. Dual-process models have recently come under fire (e.g. Keren & Schul, 2009), but we think they can still be useful at a descriptive psychological level, while more work should be done to illuminate the underlying neurocognitive mechanisms (Gladwin et al., 2011). Moreover, dual process models inspired new interventions aimed at changing relatively automatic processes in addiction, varieties of Cognitive Bias Modification (CBM) paradigms (see Wiers et al., 2013). I will present work on attentional re-training in alcoholism (Schoenmakers et al., 2010) and on approach-bias re-training (Wiers et al., 2011; Eberl et al., 2013), which have yielded clinically relevant results. However, results in adolescents and students with low motivation to change have been less successful (e.g. Lindgren et al., 2015). I will discuss two possible ways forward: first motivating participants for change (e.g. Motivational Interviewing), and increasing the appeal of CBM by introducing gaming elements.

Website: http://www.uva.nl/en/contact/staff/item/r.w.h.j.wiers.html?f=wiers

Publications: https://scholar.google.nl/citations?user=2vKDTuoAAAAJ&hl=nl

ABSTRACT. The European Union through its Drugs Action Plan 2013-16 requires the Council, the Horizontal Drug Group, the Member States, the Commission and the EMCDDA to "embed coordinated, best practice and quality approaches in drug demand reduction" by "Agree and commence the implementation of EU minimum quality standards, that help bridge the gap between science and practice". While in Prevention a European funded project has been carried on since 2010, in the other areas of demand reduction, namely Treatment, Social Reintegration and Harm Reduction, another European funded Project: EQUS (2011) has used the experience of Prevention to expand to the other interventions. The Greek Presidency, followed by the Italian and Latvian Presidency included the development of Quality Standards in their programs. The resulting standards have been drafted by a number of European experts and discussed at the HDG. They are based on the existing standards (a search has been conducted to include various international experiences and the Eu standards), are aspirational and give to the MS the opportunity to implement their projects and to exchange experiences through the knowledge exchange platform of the EMCDDA.

ABSTRACT. The Brazilian Ministry of Health culturally adapted one school-based drug abuse preventive programme, originally named UNPLUGGED (#TAMOJUNTO), to aid its expansion as a National Public Policy. During the dissemination process changes were made to the implementation stages.Amendment 1: the incorporation of a coach, a "multiplier", who is responsible for delivering training and providing support to the teacher every month, in a one hour session. Amendment 2: the revision of a guide for the parent’s workshop; three workshops are planned and delivered by health and school professionals. Amendment 3: the extension of training from originally just teachers to professionals - teacher, school stakeholders, health professionals and sometimes local politicians are trained concurrently. Amendment 4: the development of a logical matrix based on continuous training and documentation of the process - all in cooperation across states and federal levels.In 2014, 13088 students, spanning 86 schools, in 11 states and 7 states participated in #Tamojunto. This was achieved with a team of two supervisors, six multipliers and supported by two federal coordinators. Qualitative results showed that the the majority of local politicians ask for expansion of the program, the teachers are well engaged (less than 2% of teacher gave up during the implementation), the students are also highly engaged and are asking for extra #Tamojunto classes in the curriculum, the relations between health and education are stronger.The main challenges of this process have been in the incorporation of #Tamojunto classes within the regular school curriculum, training of healthcare and education professionals as local multipliers. Our 2015 efforts are directed at maintaining the quality of implementation during the expansion process.

ABSTRACT. Background:

People are repeatedly exposed to varying sizes of food, alcohol and tobacco products in environments such as shops, restaurants, bars and homes. This has stimulated public health policy interest in product size as a potential target for intervention to influence consumption.

Aims:

To assess the effects (and potential effect modifiers) of manipulating product sizes on selection or consumption of food, alcohol or tobacco.

Methods:

Cochrane systematic review with meta-analysis and meta-regression. Eligible studies were randomised controlled trials (between- or within-subjects) that involved comparison of at least two sizes of a portion or package of a food, alcohol or tobacco product, or an item of tableware. Outcomes were selection or consumption of the manipulated product.

Results:

We dual-screened 51,288 abstracts, from which we included 72 studies (69 food, 3 tobacco). Meta-analysis of 92 comparisons from 61 studies (6,711 participants) found a small-to-moderate effect of portion, package, or tableware size on consumption (SMD: 0.37, 95% CI: 0.29 to 0.45). A similar effect (SMD: 0.42) was found for selection. The effect size suggests that, if sustained reductions in exposure to large sizes could be achieved across the whole diet, this could reduce average daily energy consumed from food by 10%-17% among UK adults (up to 290 kcals per day).

Conclusions:

This review suggests that reducing exposure to larger sized portions, packages, and tableware can contribute to meaningful reductions in the quantities of food people select and consume. This may justify policy actions to reduce the availability and appeal of large product sizes.

ABSTRACT. Introduction: A well-functioning care of people with psychiatric problems and drug abuse presupposes collaboration between health care and the community social service. There has been a Swedish law of establishing a Collaborative Individual Plan (CIP) for such clients since 2010 but it is implemented in very small extent. Aim The aim of this study was to explore the extent of collaboration around a CIP, if the staff knew about a template for establishing a CIP, the content of the CIP templates and what the establishing of a CIP leads to. Methods: To be able to follow- up collaboration after a training course in establishing a CIP we assessed collaboration at baseline and one year after the course. There were 797 persons signing up for that course and 705 responded. The study builds on a cross-sectional design and self-reports on a web-based questionnaire. Results It was shown that the responders reported participation in between one and two CIP a month and about seven of ten worked according to a template. About two thirds knew about the template and its content. They perceived foremost positive consequences of collaboration as making it clear what needs to be performed and who is responsible. Conclusions Although respondents perceived positive consequences of collaboration and that a CIP makes the responsibilities clear they do collaborate in a very low extent.

ABSTRACT. Schools and pre-schools in Sweden are urged to implement actions for health promotion and prevention of unhealthy behaviors among children. However, preventive practices in these settings often rest on “good sense, good will” approaches lacking evidence-base. Further, even when evidence-based programmes are adopted, they focus on individual behaviors and are not always implemented as intended, because of associated organizational costs. In addition, programmes have a specific focus (e.g. smoking prevention, prevention of bullying), disregarding common determinants of lifestyle and behavioral interactions. A comprehensive pre-school and school-based health promotion programme has been launched through a collaborative effort between the Stockholm County’s Health Care District and the Department of Public Health Sciences at Karolinska Institutet. The programme rests on the following pillars: 1. A continuously updated evidence-informed catalogue summarizing setting-specific interventions 2. Exclusively targeting modifications of: a. Physical environment b. Organization c. Policy and regulations d. Communication routines 3. In order to achieve modifications in multiple health-related domains: a. Substance use b. Bullying c. Nutrition and eating habits d. Physical activity e. Learning achievements f. Mental health g. Exposure to noise and to environmental allergens The catalogue is complemented with instruments for the identification of local priorities, i.e. an organization-based checklist and a student-based questionnaire. The programme is being made available through a dedicated web-site currently under pilot-testing. During the conference session, preliminary results from the pilot testing, issues of (large scale) implementation and planned evaluation studies will be presented.

ABSTRACT. The introduction of school tobacco policy (STP) could be regarded as a promising preventive strategy as some evidence suggests that the school environment can influence young people to smoke. In order to assess this hypothesis we performed a systematic review using Cochrane method. We were also interested to know whether specific components of STPs (such as smoking bans for students and/or teachers and their extent, levels of enforcement, monitoring strategies, sanctions for students or teachers found smoking, and the offer of tobacco cessation programmes) might increase their impact. We identified only one c-RCT, with high risk of bias, and 24 observational studies. The majority of studies reported that schools with highly enforced policies, smoking ban extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programs did not show a significant difference in smoking prevalence, when compared to schools adopting weaker or no policies. We discuss our results in the light of two surveys carried out after the introduction of outdoor smoking ban in Italian schools (Law n.128/2013). The majority of the observed schools did not enforced the ban and not participate to smoking prevention programs, moreover outside the schools the prevalence of smokers (school staff and students) continues to be very high. The outdoor smoking ban in Italian schools hasn’t been yet used appropriately as a strategy to prevent young people from using tobacco.

ABSTRACT. Background: Most Brazilian schools do not have a continuous project for drug use prevention, and do not conduct culturally adapted activities for that purpose. In order to strengthen drug prevention policies in schools, it is crucial to have international, evidence-based programs tested in the culture of Brazilian schools. Objective: To evaluate the impact of the Program Unplugged for alcohol and drugs use prevention among children and adolescents in public middle schools in Brazil. Methodology: A non-randomized controlled trial was conducted with 2,185 students in 16 public schools in 3 Brazilian cities. The experimental group attended 12 weekly classes under the Unplugged program for drug use prevention, and the control group did not attend to any school prevention program in the same year. Multilevel analysis stratified by age were used to evaluate changes in the consumption of each drug, in time (baseline and 4 months follow up), and between groups (control and experimental). Results: This study suggests that there is no evidence of effects of the Unplugged program in the age group of 11 to 12 years-old. However, the program seems to stimulate a decrease in recent marijuana use status (past month change from use to non-use in 85.7% of the cases in intervention and 28.6% in control, OR=17.5, p=0.039) among students from 13 to 15 years old. In addition, students at this age range who received the Unplugged program in the classroom keep drug consumption levels similar to those observed before the beginning of the program. However, students who did not participate in the program present a tendency to increase the consumption of alcohol, marijuana, and inhalants in the year of the research. Conclusions: This study adds to the evidences of the efficacy of the Unplugged program as a primary drug use prevention among Brazilian adolescents, and needs a randomized controlled trial in order to have its effectiveness in this culture verified.

ABSTRACT. Background Unplugged is a Social Influence school-based curriculum consisting of 12 units, one-hour each, delivered by trained class teachers to adolescents 12-14 years old during the school year. It was developed and tested in the European Drug Addiction Prevention trial, and it was shown to be effective in reducing cigarette smoking, episodes of drunkenness and the use of cannabis at short term. In 2010-2011, a controlled non-randomized study was conducted in Slovenia to evaluate the effectiveness of the program.

Methods 48 schools accepted to participate in the study, 26 in the intervention arm and 22 in the control one. However, 4 schools from the intervention arm dropped out, leaving a sample of 22 schools in the intervention and 22 schools in the control arm. A pre-test survey was conducted before the implementation of the program, and a post-test survey was conducted 3 months after the end of the program. All the students in the intervention and control arm were administered a self-completed and anonymous questionnaire including 42 items investigating tobacco and substance use, alcohol use and abuse, intentions, knowledge, expectations and attitudes about substances, social and personal skills, normative beliefs, family relationships, school climate. Prevalence of behaviours at post test was compared with that at pre-test in the intervention and control arms. Multilevel Analysis will be used to investigate the effectiveness of the program in preventing and reducing drug use.

Results On overall 2937 pupils of 44 schools and 155 classes participated in the baseline survey between October and November 2010. Seventy-five percent of post-test questionnaires matched with pre-test ones and were available for effectiveness analyses. Among students participating in the survey at baseline 49.3% were boys, 27.5% were 12 years old, 50.4% 13 years old, and 21.5% 14 years old. 66.6% of pupils lived with both parents, and 83.6% had siblings. On overall only 17.9% of Slovenian students declared to have smoked at least one cigarette in their life and only 2.8% smoked at least one cigarette in the last 30 days. Around 59% of pupils already drunk alcohol, and 26% drunk alcohol in the last 30 days. 15% percent of pupils had at least one episode of drunkenness in their life, whilst 4.3% had at least one episode of drunkenness in the last 30 days. Around 2% used cannabis in their life, and 0.5% in the last 30 days. Less than 1% of pupils used other illicit drugs in their life, 0.3% in the last month. Results from unadjusted analysis of the effect are very encouraging. The use of all substances appeared to be reduced by the program. However, a more appropriate multilevel adjusted analysis is ongoing.

Conclusions More than 2000 pupils participated to the evaluation study in Slovenia. Preliminary unadjusted results on the effectiveness of the program are encouraging. However, final results of the adjusted model are needed.

ABSTRACT. This study aimed to test the effectiveness of a web-based intervention to prevent alcohol abuse among nightclub patrons. A probabilistic sample of patrons from 31 nightclubs in São Paulo, Brazil was invited to respond to an online screening with the AUDIT instrument. 1057 patrons met the inclusion criteria to participate in a randomized controlled trial with data collection at times 0, 3, 6 and 12 months. For data analysis, participants were classified in two AUDIT score groups: “high-risk drinking” (AUDIT>8; 44%) and “low-risk drinking” (AUDIT<8; 56%). In both risk-drinking groups, the intervention group was exposed to a single dose of a personalized normative feedback screen with information on the participant's alcohol consumption and its potential consequences, through images and texts. At the baseline, the “high-risk drinking” group presented a mean AUDIT score of 12.6±4.1 and the “low-risk drinking” group, 3.7±2.2, with no significant differences between intervention and control groups. After 12 months, no differences were found between intervention and control situation in both risk-drinking groups. However, in both situation a change in the mean AUDIT score was found: a 14% decrease among patrons at the “high-risk drinking” group (95%CI 7.4%-18.8%;p<0.001) and a 13% increase among patrons in the “low-risk drinking” group (95%CI 3.3%-24.7%;p=0.009). The results suggest that, independent of the group (intervention or control), the time effect of participating in the study may have a beneficial outcome in reducing harmful drinking among patrons at the high-risk group. However, the participation in the study was potentially iatrogenic for patrons from the low-risk group.

ABSTRACT. Alcohol misuse is a public health concern. Behaviour work which focuses on preventing and regulating maladaptive alcohol consumption suggests drinkers act rationally in choosing to consume alcohol. Many social cognition approaches view cognitive attributes as the primary mediator of behaviour. For example, much prevention work focuses on changing attitudes towards other drinkers or intentions to consume alcohol. These approaches are particularly limited when explaining maladaptive behaviours, including why individuals continue to consume alcohol despite being aware of health risks. Instead of focusing on psychological complexity, prevention researchers should consider the functional significance of the contexts where alcohol is consumed. It is possible that environmental cues and the affordability of certain contexts may determine behaviour on a non-conscious, automatic level. Taking a socioecological approach, behaviour is not viewed as something which is planned and rational, but as something which emerges from the direct and unmediated relationship between drinkers and their drinking environments. This then changes the focus of prevention from cognitive mediators or determinants of behaviour to the range of opportunities for action that these contexts afford. This presentation will consider the challenges in studying the complex social contexts in which alcohol is consumed, including related conventions and social norms which may also mediate behaviour. An overview of alcohol-related affordances and implications will be provided using examples from previous research, using methods such as non-participant observation, photo-elicitation and Q-Methodology. It will be argued that taking a function-based approach is challenging, but could be particularly valuable in explaining and preventing problematic consumption.

ABSTRACT. Background: The UK Department for Education (DfE) Social Care Innovation Programme aims to innovate and re-design social care service delivery to achieve higher quality, improved outcomes and better value for money. Within the programme, Dartington Social Research Unit (DSRU) is leading an evaluation of a promising intervention. Through volunteers in the local community, Safe Families for Children offer short-term hosting of children aged 10 or under, family befriending and the provision of resources to families in crisis.

Method: DSRU has worked with Safe Families to establish a Public Social Partnership (PSP) with local authorities (LAs) in 5 regions across England. An evaluation of Safe Families is integral to the PSP and involves a process evaluation, cost-benefit analysis and a randomised controlled trial to assess impact. For the latter, DSRU has developed a mobile device application (app). The app allows social workers to screen families for eligibility and make referrals to the local Safe Families team, and enables Safe Families’ social workers to collect data from families. DfE are funding initial delivery; however, the PSP commits the LAs to provision of further funding if the evaluation demonstrates positive impact.

Discussion: The project provides an opportunity to assess the impact communities can have on families who would typically access social care. The PSP is the first of its kind in England. The innovative approach to working with public systems not only allows Safe Families to achieve a sustainable model, but also improves the use of evidence in policy and practice.

ABSTRACT. Neuromarketing in tobacco advertising

Neuromarketing is a relatively new science, which combines the fields of neurology, psychology and economics. With the help of modern technology, it can follow the brain response of someone who is subject to advertising. Neuromarketing studies the workings and thought processes, which influence our buying decisions, habits and dependence. Tobacco addiction and marketing strategy of the tobacco industry, as well as their dominant position in our consumer society, are still considered as one of the most serious problems in today's world. Neuromarketing touches on advertising in the tobacco industry and it's influence on our subconscious mind. It also reveals interesting results of a extensive study on tobacco advertising and plain packaging. Neuromarketing reveals new questions about ethics of advertising and the effect off neuromarketing strategies on contemporary society and the subconscious of the individual.

ABSTRACT. On the occasion of the announcement of the French National Smoking Reduction Program 2014-2019, the National Institute for Health Promotion and Health Education (INPES) launched a media campaign that reminded the risks of tobacco smoking and referred smokers who wanted to quit to Tabac Info Service (TIS), a cessation service that includes a quitline and a website with a fully automated web-based program to help smokers quit. The campaign was broadcast on TV, radio and internet from September 26th to October 22nd. A cohort of 3,000 smokers aged 15 to 85 years-old were recruited from an access panel before the campaign (T0) and interviewed about their smoking patterns, their attitudes towards smoking and cessation and their intentions to quit. All respondents were re-contacted just after the campaign and 6 months after the campaign. The response rates were respectively 75% and 69%. Exposure to the campaign was assessed from self-report and probability of exposure calculated from TV viewing habits. Smoking cessation, quit attempts and variations in attitudes and intentions to quit were estimated according to the level of exposure with logistic regressions adjusted for sociodemographics and baseline outcomes. Several studies already dealt with the impact of media campaigns on smoking outcomes, mainly in Anglo-Saxon countries. To our knowledge, the present study is the first in France to use a longitudinal design in order to evaluate the impact of a media campaign against smoking. It should help broaden the results of the literature to non-Anglo-Saxon contexts and improve future media campaigns.

ABSTRACT. Background: This study sought to gain feedback from teachers and adolescents on a novel online intervention for use in schools, designed to reduce alcohol misuse in 11-14 year-old pupils. Theoretically based on the Prototype Willingness Model, the Alcohol Smart Quiz (ASQ) aimed to change alcohol prototypes and encourage adolescents to make plans to enable them to deal with peer pressure, or unintended consequences of drinking. Methods: A qualitative, think aloud interview study was conducted. Participants (17 adolescents aged 11-14 and nine secondary school teachers) were prompted to talk out loud about what they were thinking while they worked through the intervention using LifeGuide software. Transcripts were analysed using thematic analysis. Findings: Themes relating to credibility, acceptability and feasibility were identified and related to ‘moderation’, ‘decision making’, ‘harm reduction’, and ‘alcohol and culture’. Adolescents were positive about ASQ and found the content of the intervention appealing. Teachers were welcoming of the format of the ASQ as a means of generating discussions around alcohol within the classroom. Discussion: For both groups ‘moderate’ drinking was an acceptable message to deliver within schools, alongside a focus on decision making in social situations. There is a challenge in drawing a line between moderation and drinking ‘too much’. The underlying culture of drinking, seen as an inevitable part of teenage life, has implications for harm reduction, related to the physical effects of alcohol and its portrayal on social media. The importance of gaining feedback during intervention development to enhance acceptability is discussed.

ABSTRACT. This study is the first part of a doctoral thesis and aims to examine the implementation of the school prevention program to alcohol and drug use - "Unplugged" in eight Brazilian public schools in 2013 and, based on Grounded Theory, organize recommendations of adjustments to the Brazilian context with the analysis of 144 Cartographic diaries. The adjustments are based on: (1) the challenges of the new prevention paradigm that the program proposes to implementers (health and education); (2) the factors that demobilize the implementation and immediate effects that mobilize; and (3) the institutional arrangements necessary for implementation. The diaries reported the program's effects: improvement in the teacher and student relationship and of students with each other; rescue students uninterested in participation in school; improvement in teacher practice; improved discipline in the classroom; understanding on normative beliefs on the part of students. The biggest challenges revealed were the organization of implementation that considers the hours of planning de classes and meeting with the multiplier, the inclusion of the classes in the curriculum, the management of the duration of the classes, and the low participation of the school and heath management on the organization of the implementation. The adequacy of recommendations to the Brazilian context intend to contribute to decision-making with a view to qualify continuity for sustainability of the project.

ABSTRACT. Introduction. Knowing the process of relapse in smokers is important in treatments for smoking cessation. The aim of the present study is to analyze if there are differences in the relapse curve in men and women who quit smoking after attending a psychological treatment. Methods. Sample was composed by 266 participants who were abstinent at the end of treatment (59.8%; mean age = 41.20, S. D. = 10.80; Fagerström Test for Nicotine Dependence, mean = 4.78, S. D. = 2.15). Differences according to gender were analyzed at 1, 3, 6, and 12 months follow-ups. Results. As time increases, the number of participants that relapse is higher. At 12 months, a 55.27% of the total sample relapsed (57% men and 54.1% female). No differences were found in relapse according to gender in any of the periods assessed. Conclusion. The relapse curve shows a decrease in abstinence rates over time. No differences were found in relapse according to gender at the different follow-ups. This indicates that there are not any differences between men and women in the smoking relapse process.

ABSTRACT. Parental media mediation has been grouped into three styles: Active/instructive mediation, restrictive mediation, and a third more varied category (Barkin et al., 2006; Nikken & Jansz, 2006; Valkenburg et al. 1999). None of the styles is consistently linked to a reduction of children´s media risks. There is evidence of counter-intentional effects (Livingstone & Helsper, 2008; Nathanson, 2002). So maybe talking doesn´t really help? We compared the influence of “talking vs. acting” on three different parameters of screen media usage: time, content and (dys)functional usage. We used structural equation modelling with longitudinal data of a four year time frame (χ2 = 144.63(40, N = 795), SRMR = .04, GFI = .97), explaining media usage in 6th grade by 3rd grade predictor variables (parental mediation and screen availability in children´s bedrooms) while controlling for socio-cultural capital in the families. First, there was a small correlation (φ = -.22) between parental mediation and screen availability. Second, the effect of screen availability on usage times (r = .39) was much larger (factor 2.6) than that of parental mediation (r = - .15). Third, the effect on dysfunctional usage was also somewhat larger for screen availability (r = .19) than that of parental mediation (r = - .14). Fourth, the effects on content (r = ± .16) were of equal extent. Reducing screen availability is a promising prevention strategy in the family setting facing resistance from media industry, but also from parental convenience and peer pressure among children.

ABSTRACT. Background: Physical activity may reduce cardiovascular diseases and cancer. The decline of regular physical exercise with increasing age suggests prevention activities. Methods: Following the Intervention Mapping Protocol we developed a computer-based brief intervention (CBI) aiming to reduce sedentary behavior (SB) and to increase physical activity (PA) during leisure time among adults aged 40 to 64 years. Results: The intervention is based on the Health Action Process Approach (HAPA), comprising three tailored letters based on separate assessments, delivered over six month. The first letter provides information on knowledge regarding SB and PA as well as intervenes on self-efficacy depending on the mindset of participants (non-intender, intender, actor). The second letter focuses on benefits and barriers of PA as well as the role of social support for PA. In case of actional stage, the third letter intervenes on self-efficacy again and suggests action and coping planning. Otherwise, the letter includes ipsative feedback according to the second letter. The number of text modules comprised 594, 306 and 647 for letter one to three, respectively. Currently, the CBI is tested on 177 participants randomly allocated to a control and an intervention group. Conclusions: The study may provide data on feasibility of the CBI and will be used as basis for focus groups to optimize the intervention.

ABSTRACT. The “great challenge live and move” (GCLM) is a project implemented since 2013 in order to promote physical activity (PA) in 7-11 years old French school-aged children and their parents. Drawing upon the theory of planned behavior (TPB; Ajzen, 1991), this study aim to test the impact of the GCLM on (1) TPB key constructs (e.g., attitude) and PA practice of children and (2) TPB key constructs of parents as well as their involvement in shared family PA. The primary hypothesis is that the GCLM will increase the proportion of children meeting the current international recommendation of 60 minutes of daily PA. A controlled design is used with 10 schools in the intervention group and 6 schools in the control group. A total of 1120 children (Mean age = 8.94) and 347 parents (Mean age = 40.98) took part in this study. Intervention was one month and a half long and included components targeting both TPB constructs and actual PA practice (e.g., playful PA games). Intervention was implemented by both in-the-field education (e.g., school teachers) and public politics stakeholders (e.g., community of communes). Children answered a questionnaire measuring TPB constructs toward PA and weekly PA practice. Parents also answered a questionnaire measuring TPB constructs toward shared family PA and their involvement in shared family PA. Analyses (e.g., repeated-measures ANOVAs) will be performed to examine potential differences in the evolution of variables between intervention and control group for both children and parents. Results will be available at this time.

ABSTRACT. Physical activity guidelines encourage the daily accumulation of lifestyle activities, such as stair climbing, since the 2000s. However, physical inactivity is steadily rising in Western countries. This study aimed to evaluate whether stair-promoting signed intervention, located near or at the stairs, could change individual stair-use behavior, and whether specific content messages could have stronger impact. We achieved our objective by following randomly chosen commuters of three Parisian metro stations, characterized by an escalator and an adjacent stairway of less than 24 steps, over 9 weeks. We enable to follow them by daily filming individual's stair/escalator decisions in each station. We found that individual stair use increased significantly during the intervention period, and remained significantly higher than at pre-intervention period even after removal the motivational signs when the message content making salient how easy it is to move is implemented.

ABSTRACT. Studies of the Strengthening Families Program (SFP10-14) universal substance-misuse prevention intervention in the United States have produced evidence of effectiveness but say little about implementation processes. This paper presents findings from the mixed-methods process evaluation of a trial of SFP in Wales (Project SFP10-14UK) during 2010-2012, inves

Structured observation; reports from SFP facilitators; and routine monitoring data assessed the extent to which SFP10-14UK was implemented as intended. Semi-structured interviews with implementers elicited their perceptions of SFP and implementation processes. Qualitative data were coded using a thematic framework. Quantitative and qualitative data were used together to examine reasons for variation in fidelity across research sites. Results were interpreted using the four constructs of the General Theory of Implementation.

Fifty-six programmes were delivered across 7 research sites to 218 families with children aged 10-14 (60% of 361 in the intervention group). National training and positive attitudes of local staff achieved high coverage rates; targets for staffing; and provision of free travel, refreshments and child care. Staffing standards were easier to attain when staff were employed by the same organisation. Targets for group size and composition were met less frequently due to challenges in participant recruitment. Reduced capacity in public-sector organisations during an economic recession (2010-2012) aggravated difficulties in recruiting staff and participant families.

While coverage rates and staffing reached high standards of fidelity, requirements for group size and composition were less often met. Mixed methods provided insights into staff and participant recruitment; and the utility of General Implementation Theory in a pragmatic study of a complex intervention was demonstrated.

ABSTRACT. In this presentation we share preliminary results from a pilot of online professional development for the Good Behavior Game.

The Good Behavior Game is an evidence-based prevention program that targets antecedents of drug and alcohol abuse in primary school classrooms. Implementation of the Good Behavior Game has shown correlations with a reduction in drug, alcohol, and tobacco use, particularly for males who enter school with early indicators of aggressive and disruptive behavior.

Because effective implementation of the Good Behavior Game has traditionally required on-site training and coaching, many communities face barriers of both program costs and access to trainers and coaches. Online learning provides a potential solution to these accessibility challenges if it can be implemented with similar quality and fidelity to on-site training and coaching.

Our presentation focuses on a small-scale pilot study designed to explore key implementation factors necessary for successful online implementation of the Good Behavior Game training and support model. As part of this pilot process, we converted our in-person professional development into online course modules that combined elements of both facilitated and self-paced learning. We will share lessons learned from this development process, including key considerations that emerged as essential to the acceptability, feasibility, and relevance on the online training modules. Next we will explore teacher characteristics and patterns of online learning and practice that contributed to fidelity of implementation. Finally, we will discuss potential implications for the field and directions for further research.

ABSTRACT. Objective: The objective was to evaluate a manualized and theory-driven primary prevention intervention program, which applied motivational interviewing (MI) with the aim to prevent childhood obesity. The program was embedded in Swedish child health services and started when eligible children were 9-10 months of age.

Methods: Child health care centres (CHC) were randomized and included 1369 families. Families belonging to intervention CHCs took part in nine sessions focusing on the promotion of healthy food and physical activity habits with a nurse trained in MI. Families belonging to the control CHCs received regular care. Primary outcomes were children’s body mass index (BMI) and waist circumference (WC) at four years of age. Secondary outcomes were children’s and mother’s food and physical activity habits and mother’s BMI and WC. Effect measures were means (β) and risk ratios (RR) from linear and Poisson regression estimated with generalized estimating equations.

Results: There were no statistically significant differences in children’s BMI (β=-0.11 [95% CI: -0.31; 0.08]), WC (β= -0.48 [95% CI:-0.99; 0.04]) and prevalence of overweight (RR=0.95 [95% CI: 0.69; 1.32]). No significant intervention effect was observed regarding mothers’ anthropometric data and mother’s and children’s physical activity habits. There was a higher consumption frequency of vegetables, fruits and fish and a lower consumption of sugared drinks, French fries and discretionary calories in the intervention group than in the control group.

Conclusion: While there were no significant group differences in children’s and mother’s anthropometric data and physical activity habits, there was suggestive evidence of healthier food habits.

ABSTRACT. Dental caries is the most common chronic disease of childhood, and the most common reason children are admitted to hospital in Western countries. Dental treatment is 5-10% of the global health costs in industrialised countries. Data from the WHO Oral Health Database indicates that the global unweighted mean number of decayed, missing or filled teeth (DMFT) per 12 year old in 2004 was 2.3 worldwide. There are significant disparities among countries (www.fdiworldental.org/data-hub). In Bosnia & Herzegovina, the DMFT among 12 years old children is 4.2, and 4.8 in Croatia, to be compared with 1.1 in Italy or 1.6 in Greece. There is a progressive increase in the incidence of caries if sugar intakes are high. In addition to preventive measures including availability of fluoride in drinking water or toothpaste, structural measures are required as recommended by the 2015 WHO Guideline on Sugars intake for adults and children. In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake. The food industry has demonstrated its capacity to adapt product composition through reformulation and the dental profession advocate for a rapid enforcement of the WHO recommendations to reduce the burden of dental diseases and chronic diseases. The example of the agreement signed between the Swiss health authorities and the food industry to voluntary reduce over the next four years sugar content in yoghurts and breakfast cereals will be discussed.

ABSTRACT. Using the HEPCOM platform, communities can interact with European best practice tools and experiences to be successful in preventing obesity locally. 20 Partners coordinate the European project HEPCOM (promoting Healthy Eating and Physical activity in local COMmunities) to improve local interventions implemented aiming to raise awareness on nutritional status as a key contributor to citizens’ health protection. A pilot phase has being developed in 15 countries to upscale European projects and practices by a web learning platform that makes available evidence-based tools. Three local communities were selected in each country. Local needs were overviewed, mapping good practices in 32 European projects to identify criticalities in the 45 local pilots (Gap analysis). This cluster is testing a web platform that includes practical tools to be used in planning, implementing and evaluating local interventions. In Italy, three Local Health Units (LHUs) developed pilot experiences in collaboration with schools: Central Naples 1 - Mothers who promote health by peer education; Southern Naples 3 - Growing up happily: Pact for healthy snack break; Rome B - Promoting health by nutritional surveillance system “OKKio alla Salute, 2014”. Once data on the 45 pilots are gathered by 90 questionnaires, the platform will be finalized in late 2015. In Europe and in Italy, many young people are overweight and behave unhealthily (wrong eating habits, low physical activity, sedentariness). A correct weight status makes individuals live healthily, reducing the risk of diseases and unsustainable pressure on public health systems. Empowering local communities can help to prevent youth obesity.

ABSTRACT. Background: The existing evidence base for the impact of affective imagery on health behaviour is most plentiful in relation to graphic picture warnings and smoking, with few experimental studies focused on food products.

Aims: To examine the impact of presenting images of food products paired with images of positive and negative health consequences of their consumption, on food choice and attitudes.

Methods: Participants (N=711) were randomly allocated in a 2 x 3 factorial design (food type x affective valence) to one of six conditioning procedures that paired images of either energy-dense snack foods or fruit, with: (a) images of negative health outcomes, (b) images of positive health outcomes, or (c) a no image control. The primary outcome was food choice assessed post-intervention with a behavioural choice task. Secondary outcomes were implicit attitudes (assessed pre- and post-intervention) and explicit attitudes (assessed post-intervention).

Results: Presenting images of negative health outcomes led to more healthy food choices relative to control and positive image conditions, irrespective of whether they were paired with images of energy-dense snack foods or fruit. This relationship was partially mediated by changes in implicit and explicit attitudes. Images of positive health outcomes did not alter food choices.

Conclusions: This study replicates and extends previous research showing that presenting images of negative health consequences increases healthy food choices. Because effects were elicited by manipulating affective valence irrespective of paired food type, these results appear more consistent with an explanation based on priming than on evaluative conditioning.

ABSTRACT. Clinical commissioning groups (CCGs) now control around two-thirds of the NHS budget,influencing healthcare provider priorities and playing a key role in implementing the NHS plan. However,significant failures in healthcare have highlighted a dissonance between expressed values of leaders and everyday routine practices. This research explores the leadership behaviour of commissioners and the role it plays in determining quality and safety in healthcare. The research took a two phase approach: phase 1 used focused video ethnography to observe commissioners in a mock board room setting; phase 2 employed a quantative questionnaire to determine the leadership behaviours that subordinates would expect their commissioners to adopt. The findings of this research identified that the leadership style most prevalent within the commissioners was transactional in nature. The questionnaire to subordinates of commissioners identified that transformational leadership had the best outcome on staff performance if this was linked to positive leadership style. In addition, commissioners appear to lack consistency when analysing risks effectively and holding providers to account, citing issues such as ‘professional drift’ and concerns over further scrutiny, as validation for this approach. This confusion of leadership behaviours,allied with poor analyse of risk leaves commissioners prone to repeating previous healthcare failures.

ABSTRACT. There are different ways of trying to respond to the potential harmful effects of drug use. Obtaining a greater understanding of the meanings of, and motivation for consumption of drugs is an important part of this, particularly in order to understand why people continue to use drugs after initial experimentation or where there may be a high probability of harm. By exploring the concept of identity in non-dependent drug users and how this affects their substance related decision-making, it may be possible to broaden understandings of use and develop more relevant and responsive interventions and messages of prevention. The roots of identity theory are found in the work of George Herbert Mead (1934) whose work has been simplified into the formula, ‘society shapes self shapes social behaviour’. With this theory, the main outcomes of interest are the effects of identification on an individual's sense of self and attitudes towards others, and the actions that are motivated by these socially derived understandings. Bourdieu’s (1984) theoretical framework discussed cultural, economic and social capital, recognising how individuals play an active role within the process of identity formation through acting and performing identity within particular social settings in the pursuit of power, status and particular associations. By reviewing the literature and applying these concepts to drug use, this paper explores how theories of identity can help explain why people use illegal substances, in particular, assessing the role of health in the construction of drug user identities and how users negotiate problems and risks associated with drug-identity related behaviour.

ABSTRACT. Since 2010, a team of scientist at the Faculty of Education and Rehabilitation Sciences, University of Zagreb continuously conduct a national project called “Youth Gambling in Croatia”. Research results show that youth gambling is widespread risk behaviour among Croatian adolescents - 82% of high-school students gambled at least once in their lifetime, around 20% regularly bet on sport events, while 12.9% of young people developed adverse psychosocial consequences related to gambling (Ricijas et al., 2011; Dodig, 2013). This presentation is a result of new pilot-research within project activities called “Parents’ perception of youth gambling”. Study was conducted in May/June 2015 with high-school students and their parents in a town of Ivanic Grad, while the final study will be conducted in fall 2015. Both subgroups of participants were given a parallel form of questionnaire aimed at exploring gambling activities, knowledge about gambling, attitudes towards gambling and industry etc. The aim of this paper is to explore parents’ knowledge about their children’s gambling, as well as symptom of adverse psychosocial consequences, while comparing them to children’s self-report. Due to increased availability and accessibility of games of chance in Croatia, together with alarming results of conducted studies, project team developed and piloted youth gambling prevention program “Who really wins?”. This 9 week program is primarily indented for adolescents, but also includes one 2 hour lecture for parents. Results of this study will serve as a base-line for further research, but also as indicators for developing more efficient preventive interventions aimed at families as a whole.

ABSTRACT. Background: The European “Action plan to reduce the harmful use of alcohol 2012-2020” identifies media communications as an important factor affecting youth. References to alcohol and tobacco are indeed common in the content of entertainment programming popular with youth, especially television series.

Objective: This research aims to provide an accurate and thorough assessment of how alcohol and tobacco are portrayed in prime-time television series in France.

Methods: We systematically coded and analyzed visual and auditory references to substances in the 14 TV series most popular with French youth during the 2013 television season (based on Mediametrie ratings). To enable cultural comparisons, half of the series was French and the other imported (primarily US). We focus on how often verbal discussions, visual depictions and actual consumption behavior occur, which character is associated with drinking / smoking, and document the associations with and consequences of drinking or smoking. Procedures and rules of content analysis were followed carefully, with coding conducted by two trained coders, and 25% of the total sample of 180 episodes double-coded. Reliability was assessed via interclass coefficients.

Results: All the data are coded and the analyses are in progress. The findings will be ready for sharing by the time of the symposium. The results of the content analysis will be used to describe generally the extent and nature of alcohol & tobacco portrayals in TV programs. Initial results reveal a wide presence of substance messages: 87.22% of TV series include alcohol messages, 47.78% tobacco and 47.22% show both.

ABSTRACT. A research project in rural Cambodia in partnership with local VCHW’s demonstrates the capacity of this valuable workforce to identify and solve public health issues in their communities. Through the use of Photovoice VCHW’s were able to show that their concerns were about structural and environmental public health issues that focused on prevention and the wider social determinants of health. However without governmental support for services such as rubbish collection, access to toilets and safe water, long standing problems related to poor hygiene, malnutrition and flood related diseases will continue to be a problem. A follow up participatory workshop enabled the volunteers to categorise and prioritise the issues that matter most to the people in the villages they represent. A realistic action plan to address the issues was developed and included community cooperation, advocacy techniques and education. The VCHWs know the problems and have admirable skills and knowledge of public health. They are driven in their role and are ready to help their communities but without support in the right areas, their ability to improve health is limited. VCHWs could be powerful change agents when affiliated with health systems able to adequately support their work and respond to their insights. The research here shows the capacity for this educated and skilled workforce to identify public health issues and to make plans to improve health in their communities. However while the driving force for health improvements is dictated by external bodies, the issues that matter to the people are being ignored.

ABSTRACT. Introduction: The Strengthening Families Programme 10–14 is a family-based alcohol, drugs and tobacco prevention programme, which has achieved promising results in US trials. This trial evaluated a UK adaptation (SFP 10-14UK) which implemented a proportionate universalism approach, aiming to recruit groups in which 30% were families who may experience/present challenges in a group setting, with the remaining 70% of families drawn from the general population.

Design: Cluster randomised controlled effectiveness trial with embedded process and economic evaluations. Families were randomised to one of two treatment groups - usual care with full access to existing services (control group), or usual care plus SFP 10–14UK (intervention group).

Setting: Multi-agency partnerships delivering SFP 10-14UK in seven areas of Wales, UK.

Participants: 715 families were recruited to the trial (Intervention: 361, Control: 354), comprising 918 parents and carers (I:461, C:457) and 931 young people (I: 477, C:454) who consented to participate in data collection.

Measurements: The trial had two primary outcomes collected at 24-month follow-up - the number of occasions that young people report having drunk alcohol in the last 30 days, and drunkenness during the last 30 days, both dichotomised as ‘never’ and ‘1-2 times or more’. Secondary outcomes included other measures of young people’s substance use and health and wellbeing.

Results: 81% of recruited young people provided 24-month follow up data. Implementation fidelity was strong. From primary analysis adjusted for covariates, the odds-ratios (intervention vs. control) were, for drinking alcohol: 1.12 (95% Confidence Interval: 0.72-1.73); for drunkenness: 1.45 (95% CI: 0.83-2.52). Subgroup analyses indicated interactions between family status (challenges vs. general population) and intervention group.

Conclusions: The intervention was not found to be effective among all families. Subgroup analyses suggested improved outcomes among families with challenges, but worse outcomes among families from the general population.

ABSTRACT. Background: Early initiation and heavy substance use in childhood and adolescence is a widespread phenomenon in many parts of Europe including Germany with negative consequences for youth development. Early family based prevention such as the Strengthening Families Programme for Parents and Youth 10-14 (SFP 10-14) can reduce youth-specific risk factors and have shown promising substance use related and behavioral outcomes in several U.S. trials. Objective: To evaluate the feasibility and effectiveness of the German SFP 10-14 adaptation in a multi-centre randomized controlled trial with the expectation to replicate previous U.S.-trial results. Methods: We compared the German SFP 10-14 version comprising of 7 sessions and 4 booster sessions to a minimal 2-hour parenting intervention. The study involved N=288 adolescents and their parents and was conducted in socially disadvantaged neighbourhoods in 4 large metropolitan areas across Germany. Primary outcomes of interest were substance use initiation (alcohol, tobacco, cannabis) and parent-reported behavioural problems and were assessed at baseline, after the programme and after 6- and 18-months. Substance use self-reports were validated with urine samples. Programme effects were analyzed using baseline adjusted logistic regressions and linear mixed models. Results: We found reduced incidence rates for tobacco use and fewer parent-reported behavioral problems among adolescents in the SFP 10-14 group after 18-months but no significant programme effects on alcohol and cannabis. Discussion: The present study is among the first to evaluate family based substance use prevention in Germany. However, as in other European SFP 10-14 adaptations we found modest programme effects with regard to substance use outcomes which do not match the effects reported for previous evaluations in the U.S. We discuss the results with regard to contextual and methodological issues including the need for longer follow-up assessments.

ABSTRACT. In France, the issue of youth smoking remains a major challenge for public health. If the peer influence can encourage tobacco use, we observe that the peer education has therefore a beneficial potential to change smoking behavior of adolescents. Moreover, it was demonstrated that Theory of Planned Behaviour (TPB) has yielded the best prediction of intentions and behavior in several health domains. However, TPB is usually confined to measure the processes by which interventions change behavior, rather than to develop these interventions. In P2P program, voluntary students in professional high schools conceived and performed their own intervention, based on the TPB (with help of trained educators), to reduce their schoolmates smoking.

One of our objectives was to test if a TPB-based intervention would lead to change TPB determinants (beliefs about attitudes, social norms and behavioral control) and consequently on intentions to smoke and on tobacco behaviors. A RCT design was used with 7 schools in the intervention group and 8 in the control one. Socio-demographic, tobacco status, COtester as an objective measure and elements of the TPB (using indirect measures) were assessed with self-questionnaire before (T0) and five months later (T1), after the intervention.

At T0, among 1568 respondents (Mage=16,7, girl=35%), 30% smoked daily, 11% occasionally and 57% are non-smokers. At T1 (N=1325), they were respectively 31%, 13% and 56%. We will analyse changes in TPB outcomes between T0 and T1 using structural equation modelling to compare intervention and control groups, and the impact of those changes on smoking behaviors.

ABSTRACT. Attitudes of youth considering substance initiation can be highly ambivalent. Illicit substances’ positive draws - excitement, popularity, rebellion – conflict with fears of harm and detection. Owing to these countervailing beliefs, the balance between initiation and abstinence may be easily tipped. Invalidating the pro-substance elements of attitudes, or resistant reactions to preventive communications without impinging on the attitude’s anti-drug cognitions may foster stronger pro-drug attitudes and lessen reactance, especially among the most ambivalent. To investigate this possibility, 119 (of 657) middle-school students expressing the strongest negative attitudes toward anti-marijuana persuasive communications were randomly assigned to a no-treatment control condition, or to one of three different message conditions designed to invalidate the bases of their evaluations. As hypothesized, participants responding negatively to the anti-marijuana communications were significantly more ambivalent toward marijuana than those who responded positively (p < .01). In a tailored intervention, the most successful of three treatments that were tested invalidated participants’ most negative reactions. A follow-on mediation analysis revealed a significant link of the treatment variable with ambivalence, which was significantly associated with attitudes toward marijuana (both p < .01). Further, a Sobel test revealed full mediation (z = 2.26, p < .02). Controlling for ambivalence rendered variations among the tailored treatments non-significant. Similar, though somewhat weaker results (p < .05) were found on a measure of usage intentions. The results attest to the critical nature of attitudinal ambivalence in preventive persuasion, and suggest a dual-communication invalidating strategy may prove a useful addition to the preventionist’s arsenal.

ABSTRACT. Background – Little is known about the components which compose effective prevention interventions tackling alcohol abuse and illicit drug use. Identification of the most effective components may contribute to making behavioral prevention interventions more effective and efficient. Goals – To evaluate the effects of 4 individual school-based intervention components on promising mediators for prevention of alcohol abuse and illicit drug use in adolescence. Methods/Design – 4 randomized controlled trials will be performed in 4 centers participating in the Alice Rap project (www.alicerap.eu). 1.040 students aged 13-14 will be enrolled (260 students per center evenly distributed across intervention and control group). In each center, 6 schools will be randomly selected and allocated to either of the two study groups. 4 brief school-based interventions composed by two individual components selected from three effective interventions will be delivered by previously trained teachers (one intervention per center). Students in the control group will receive the usual school curriculum. A self-report questionnaire will be administered before and after the intervention in both study groups. The following mediators will be assessed: student beliefs about peer substance use and social acceptability of peer substance use, attitudes towards substance use, refusal skills, and self-control. Discussion – This study will provide evidence regarding the effectiveness of individual school-based intervention components in influencing mediators that are hypothesized to be associated to the prevention of alcohol abuse and illicit drug use among adolescents.

ABSTRACT. There is increasing scepticism in parts of Europe about the suitability and value of evidence-based programmes (EBPs) for improving child outcomes. Common reasons include: the disappointing impact of some interventions, especially flagship programmes imported to Europe from the US; the difficulty often of implementing EBPs with fidelity; and the failure thus far to take any programmes to scale. Counter-arguments include evidence showing that some programmes do work, indeed some work well in multiple contexts (they transport well), and the view that we are still learning how to implement programmes well (the problem is not with EBPs per se).

At the same time, there is life beyond EBPs: they are not a panacea. Alternative approaches include: common elements (often called ‘kernels’); common logic models (‘meta-theory’); using meta-analyses to inform the reform of existing provision; and redesigning EBPs (‘second generation’). Other emerging approaches to using evidence to improve child outcomes include: evidence-based innovation; system reform; changing the ecosystem; and relational social policy.

This paper describes and reviews the arguments and counter-arguments on the usefulness of EBPs, and outlines and critiques the alternative and emerging approaches. It suggests what the future might look like for EBPs.

ABSTRACT. Crime Prevention through Environmental Design (CPTED) is and approach to prevent crimes as well as incivilities/anti-social behaviour and fear of crime/feelings of insecurity through a multi-agency process to plan, design and manage/maintain a particular physical and social environment or area like a city, town, village, neighbourhood, or set of buildings. The roots of CPTED are very diverse and different. CPTED theory goes back to the social ecological approach of the Chicago school of Sociology. Other roots can be found in architecture and urban design, - planning and – management but also social psychology and situational approaches to prevent crime have been influential in CPTED. The theory is well founded but extremely divers and in that respect a bit messy.

CPTED in practice is even more eclectic since it hardly ever looks the same but – using a few general principles like territoriality, surveillance, accessibility, activity support, target hardening , image & maintenance,– always adapts itself to the local situation. It is an organic social-physical approach of prevention. Only very few measures can be fixed as rock hard requirements. As soon as more sophisticated social situational approaches are needed – like in a neighbourhood or community - the approach is an adaptive and organic one. However the CPTED approach is often very structuralized when a specific standardised process is followed. Next to several very successful schemes there are even standards for implementing CPTED.

The CPTED approach is always time-place specific. The neighbourhood level – as a geographical social-physical entity – can be a pillar structuring the approach. CPTED might be an example for the approaches in Health Promotion and Disease Prevention through Environmental Design.