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09:00-10:30 Session Plenary 1: Plenary Session I

Plenary Session 1

Cluster randomised trial of Communities That Care in Australia: Translating research into prevention practice

ABSTRACT. This presentation will outline work being completed in Australia to disseminate and evaluate Communities That Care, a structured coalition planning process designed to lead to measurable improvements in child and youth health and wellbeing. 28 communities were paired based on disadvantage, urban/ nonurban location and size. One of each pair was then randomly allocated to the intervention, resulting in 14 intervention and 14 control communities. This paper will describe the Communities That Care process, efficacy and economic evaluation evidence from pilot studies and the first year findings from the randomised trial. The paper will examine the influence of the Communities That Care dissemination on Australian prevention science capacity. 

Improving the use of evidence in prevention practice - lessons learned from violence prevention in Austria

ABSTRACT. Evidence-based intervention programs have become highly important in recent years, especially in educational contexts. But transferring these programs into practice and into the wider field of public policy often fails. The presentation discusses reasons for poor transfer and describes the Austrian national strategy for violence prevention at school as an example how research can be successfully linked to policy and practice. In formulating the strategy a systematic procedure involving international experts and local stakeholders was applied. The strategy consists of six activity domains and the steps necessary for implementation. Challenges and results in implementing the national strategy are presented and lessons learned for using evidence in public policy and practice are discussed. Based on our experiences, we argue for a systematic integration of intervention and implementation research. For realizing this systematic integration, we recommend a six-step procedure (PASCIT). This procedure requires researchers to design and develop intervention programs using a field-oriented and participative approach. In particular, the perspective of policymakers has to be included as well as an analysis of which factors support or hinder evidence-based policy in contrast to opinion-based policy.

10:30-11:00Coffee Break
11:00-12:30 Session Plenary 2: Plenary Session II

Plenary Session 2

Use of Evidence-based Prevention Programmes in Communities. A Practice-based Taxonomy of Barriers and Possible Solutions

ABSTRACT. The implementation of evidence-based prevention interventions on scale to achieve population-level results is often seen as the ultimate goal of prevention science. Challenges and obstacles to reach this goal were discussed intensively in the last years, various implementation frameworks were developed, some of them were tested empirically meanwhile. Community settings were identified as promising environments for the large-scale implementation of preventive interventions. But much of the knowledge about implementation challenges, barriers and possible solutions derives from controlled study conditions, not so much from studying “naturalistic” implementation processes in the “real world”. In my talk I will present suggestions to develop a practice-based taxonomy of implementation barriers in the “real world” and consequential strategies to deal with these barriers. This taxonomy is derived from experiences during the implementation of the “Communities That Care” (CTC) model in the State of Lower Saxony in Germany. CTC is a community-change process for preventing mental, emotional and behavioural problems in youth through the implementation of effective prevention programmes and policies on scale and with fidelity. CTC activates a diverse coalition of community stakeholders to adopt science-based prevention approach to reach this goal. In Lower Saxony CTC is implemented since 2009 under natural conditions in a non-research setting. In my talk I will focus mainly on the “exploration stage” (Fixsen et al. 2014) for the programme implementation, suggestions for further research will be discussed.

Co-producing and prototyping interventions

ABSTRACT. Existing guidance on the development of complex interventions does not provide a framework for coproducing or prototyping interventions. This talk will examine the origins, intentions and application of coproduction and prototyping in design. It will present a three-stage framework that aims to increase the acceptability of an intervention with stakeholders and improve implementation before piloting. The results of the application of this framework in the development ASSIST+FRANK study, a school-based drug prevention intervention, will be presented. It will close by examining the potential benefits, limitations and barriers to applying prototyping to intervention design in prevention research.

12:30-14:00Lunch Break
12:30-14:00 Session Poster 1: Poster Session I

Poster Session 1

Polish-ukrainian scientific and methodical collaboration for supporting improvement of the prevention system and educating experts in preventing risk behaviours in the children and the youth in Ukraine

ABSTRACT. The poster will be a presentation of a polish project (name in the title) developed and realized by a team from the Kazimierz Wielki University in Bydgoszcz within the National Health Programme for years 2016-2020. The goals of the programme involve prevention and resolving of the problems associated with the use of psychoactive substances, behavioral addictions and other risk behaviours. Simultaneously, the goal is supposed to be realized through international cooperation with countries outside of the EU. Poland is interested in supporting neighbouring countries with large social issues and undeveloped prevention systems, because the close neighbourhood causes many unfavourable social phenomena that require interventions. The list of countries in need of support includes Ukraine, which aspires to become a member of the EU. In Ukraine, there is a lack of a clear social policy for prevention as well as law fundamentals and systemic solutions in regards to it. The education of the society plays a major role amongst them – it is the basic way of counteracting social issues. The foundation of the education should be the preparation of professional staff for realization of prevention tasks in practice. Ukraine lacks a consistent system for educating such professionals. This deficit is why preparing the academic staff in regards to addiction prevention based on scientific knowledge and for developing and executing a curriculum for students studying psychological and pedagogy subjects is of great imporatance. It would result in highly developed abilities of the staff directly working with the children and the youth, who are the most at risk of indulging in risk behaviours. The author will present of the concept of the project, which aim to develop by the academic staff of the Pedagogical University in Drohobycz and practitioners of prevention from Drohobych module of education for students of psychology and social work in the field of prevention of risk behaviours of children and adolescents. In addition, the first experiences and effects from the annual implementation of the 3-year project will be presented.

Online risks in adolescence: An exploratory analysis of a Parental Mediation Scale
SPEAKER: Daniel Lloret

ABSTRACT. Research findings support that parental regulation is a protective factor against adolescents' risky online behaviours. Thus, parental regulation has been studied in relation with online risks such as gambling, cyberbullying or video-games abuse. The definition of parental regulation varies among studies, but, in summary, refers to any set of strategies that parents put into practice towards the minor’s use of new technologies in order to achieve desirable and protective behavior. These strategies include information, guidance, co-use, supervision, monitoring and restrictions. Aims: To design and explore structure and psychometric properties of a scale aimed to assess parental mediation referred by minors. Method: Sample: 560 secondary education students sample (47.5% ♀; mean age: 13.34, SD = .90; range: 12-15). Instruments: Parental mediation Scale (Cabrera-Perona, Lloret, Gervilla & Anupol, 2018): Self-applied questionnaire 29 Likert-type items assessing four theoretical dimensions of parental mediation: active mediation, restrictive mediation, supervision and co-use. Other measures: Privacy and risky online behaviors Scale (Lloret & Cabrera, 2018), attitudes toward violence in educative context: (CAHV-25) (Ruiz, Llor, Puebla & Llor, 2009), cyber-victimization: Cuestionario de Cyberbullying (CCB) (Garaigordobil & Fernández-Tomé, 2011). Data Analysis: Cronbach, EFA (Exploratory Factor Analysis, maximum likelihood, varimax rotation). Results: Reliability. α Cronbach = .915. KMO = .927. Analysis revealed five factors explaining 55.98% of variance. Validity. Supervision and co-use dimensions showed significant positive correlations with cyber-victimization (p < .001). Total scores showed positive correlations with privacy (p < .001) and significant inverse correlations with attitudes toward violence (p < .05) Conclusion: The scale shows adequate psychometric properties. Our results fit with the theoretical propose and suggest five factors, splitting the factor supervision into supervision and use of parental control software.

Parenting in 2 Worlds: A Culturally Tailored Invervention Addressing Risky Sexual Behavior in Urban American Indian Adolescents
SPEAKER: Stephen Kulis

ABSTRACT. The rapidly growing majority of American Indian (AIs) adolescents who live in cities (70%) have relatively high rates of unprotected sex, multiple sex partners, inadequate HIV/STI information, and co-occurring substance use but urban AI families are severely underserved by existing prevention programs. Parenting in 2 Worlds (P2W), a culturally grounded parenting intervention for urban AIs, is designed to strengthen protective family factors against youth risky sexual behaviors and substance use, thereby promoting sexual abstinence, delay of sexual debut, and birth control use. P2W addresses key social influences on urban AI families (cultural and familial disruption, high residential mobility, socioeconomic stressors), and systematically incorporates common AI teachings and cultural values relating to parenting. This study tested the efficacy of P2W in improving parent-child communication about sexuality.

Data come from 585 parents of AI children (ages 10-17) in an RCT of P2W in three Arizona cities, representing 31 different AI tribes. Parents were randomly assigned to P2W or an informational family health curriculum, Healthy Families in 2 Worlds (HF2W) that was not culturally tailored. Both curricula had 10 workshops delivered weekly by AI community facilitators. Pretests occurred at workshop one and post-tests at workshop ten, measuring parenting skills, parent-child communication, and youth risk behaviors. We tested the efficacy of P2W through baseline adjusted regression models, employing random effects for city/site and facilitator and FIML missing data estimation, controlled for dosage, and investigated whether effects differed by parent and adolescent gender.

Most parents (77%) were female, with annual incomes under $US10,000 (56%). On average parents were 38 years old, had lived for 14 years on a reservation, and in the city for 18 years. P2W parents reported significantly larger pretest to post-test increases than HF2W parents on measures of communication with their adolescents about sexuality, safe sex, and pubertal physical changes. These desired program effects for P2W participants achieved medium size and did not differ significantly for male and female parents, but effects were stronger for parents of adolescent sons than of daughters.

Culturally grounded parenting interventions like P2W strengthen parenting practices among urban AI families that can reduce adolescent risky sexual behaviors.

Nicotine dependence and its determinants among adult smokers in Sousse, Tunisia

ABSTRACT. Background : The high nicotine dependence may contribute to failure of attempts to quit smoking

Objective : To assess the level of nicotine dependence and its determinants among adult smokers in Sousse, Tunisia

Methods : A cross-sectional survey in the city of Sousse (Tunisia) was conducted from November to December 2011. Only active smokers were included. A systematic random sampling was used to recruit the participants in cafes located in public places. In addition to sociodemographic data, levels of nicotine dependence were measured using the French version of Fagerström test. Logistic regression was used to identify independent risk factors of nicotine dependence

Results : A total of 1130 smokers were concerned in our study. Of them 892 (78.9%) were men. The mean age of the participants was 29.5 ± 12.0 years. The mean number of cigarettes smoked daily was 21.3 ± 10.5. 771 (68.5%) smokers had attempted to quit. The nicotine dependence prevalence was 89.3 % (95%CI [87.3- 91.0]). 8.7% had mild dependence (n=98), 51.9 % had moderate dependence (n=587) and 28.7% presented a severe dependence (n=324). Among smokers, levels of nicotine dependence did differ statistically with the gender (p =0.002), the age of participants (p <10-3), level of education (p =<10-3), socioeconomic level (p =<10-3), the number of cigarettes smoked per day (p <10-3), age of smoking (p <10-3), depression (p <10-3) and anxiety (p p <10-3). Independent risk factors of nicotine dependence were depression (ORa = 1.845, (95% CI:1.132- 3.007], p =0.002) and the number of cigarettes smoked per day (ORa = 1.225, (95% CI:1.182 - 1.270), p =<10-3)

Conclusion : The level of nicotine dependence was high. Intensive efforts including smoking cessation interventions and psychological components may be needed for nicotine dependent smokers.

The online activity among young people. The phenomenon of lifestreaming

ABSTRACT. The aim of the poster is to present the concept of research on the study of online activity among school youth. The aim of the research is to dignose the phenomenon of lifestreaming among school youth. The essence of the study was to get to know the tasks, developmental goals and identity needs that young people are fulfilled with the help of new technologies - mainly social networks and livestreaming applications. The research method was triangulation. The studies included two stages. The first was a survey with young people, the second were focus interviews and individual in-depth interviews with young people.

Implementation of evidence-based prevention model Communities That Care into a practice – challenges and lessons learned
SPEAKER: Martina Feric

ABSTRACT. With the initiative of NGO Step by Step and University of Zagreb Faculty of Education and Rehabilitation Sciences, during 2017 and 2018 three local communities in Croatia were introduced to the basic principles of Communities That Care (CTC) model of prevention. It is a widely accepted evidence-based model of community prevention which follows particular phases: (1) mobilization and community readiness for prevention, (2) assessment of the needs and resources, (3) definition of preventive investments priorities, (4) implementation of chosen preventive programs and (5) program and system evaluation (Hawkins, 1999; Hawkins, Catalano & Arthur, 2002). The main goal of this research project was to enable three communities in organizing effective community based prevention of behavioral problems. Selected communities were three rather similar middle sized cities whose key people were involved into an education on basic principles of community based prevention organization. During the project, the first three phases of the CTC model were implemented and included the assessment of each community readiness for prevention, application of the CTC Youth Survey (N=719 students) and need assessment just as definition of prevention priorities for each community. The results have shown that all three communities had rather low levels of readiness for prevention since their coalitions for prevention were mostly only formally established. The conducted risk and protective factors analysis has indicated crucial behavioral problems of children and youth (under age drinking, bullying) and existing strengths, (family attachment and school opportunities for prosocial involvement). According to these communities readiness for prevention level and detected problems, specific priorities for each community were defined. The challenges and lessons learned through the process of collaboration between scientists and community key people in establishing effective prevention in local community will be described.

Towards a positive change of habits. National Sobriety Program in Poland.

ABSTRACT. In the last century in Poland there have been negative changes in the use of alcoholic beverages. Average per capita consumption increased tenfold (from 1 dcm3 to 10 dcm3 per year) in last century (1918-2018). The intake in the consumer group with the most heavy drinking habits (15% of population) is very high (about 35 dcm3 per capita/per year). This situation prompted the Church and sobriety movements to convene the National Congress of Sobriety in September 2017. The National Sobriety Program is also planned with the various actions for the next 25 years. The author of the message is a co-author of this Program. In the lecture he will present the essential elements of the adopted Program on the background of already existing social activities and needs. The National Sobriety Program is a document that unites the efforts of both non-governmental organizations, the Church and the State. It is an original attempt to apply knowledge about prevention in the design of social change in the scale of a large country.

Effects of an Alcohol Prevention Program at Sporting Events: A 2-Year Follow-up Study Using Pseudopatrons

ABSTRACT. Introduction: Alcohol related problems at sporting events is of great concern around the world. In Sweden, this matter has been on the agenda for authorities and key stakeholders, demanding action to be taken. As a result, a research project was initiated in 2015 with the aim at preventing alcohol related problems by reducing intoxication levels among the spectators at sporting events. Football is the most popular sport in Sweden with the highest number of spectators, and also the highest prevalence of alcohol related problems. A multi-component program, based on STADs Responsible Beverage Service program, was therefore developed and implemented at arenas hosting games within the Swedish Premier Football League (SPFL).

Aim: To evaluate the effects of this alcohol prevention program on the security and serving staff’s frequency of denial rates towards obviously alcohol-intoxicated spectators at SPFL games.

Methods: This is a quasi-experimental control group study using the largest, and second largest city in Sweden as the intervention and control area, respectively. Baseline data was collected in 2015, and the 2-year follow-up was completed in 2017. Professional actors (i.e. pseudopatrons) were trained to act a standardized scene of obvious intoxication at the licensed premises inside the arenas as well as at the entrances to the arenas. Observers monitored all the attempts. The prevention strategies were initiated during 2016 and are still ongoing.

Results: The follow-up study demonstrate significant increases in denial rate towards obviously intoxicated spectators both at the entrances (12.9% vs. 32.8%, p=0.005) and denial of alcohol service at licensed premises inside the arena (31.8% vs. 56.8%, p<0.001).

Conclusions: The results indicate that the staff’s intervention rates towards obviously intoxicated spectators at SPFL games have increased, which can probably be explained by the implementation of the multi-component alcohol prevention program. Data collected in the control area remains to be analyzed.

Alcohol prevention at sport stadiums: Effects from a 2-year follow-up study using biological sampling to measure intoxication levels among spectators
SPEAKER: Tobias Elgan

ABSTRACT. Introduction: Alcohol intoxication and alcohol-related problems among spectators at sporting events is of great concern. Swedish authorities and key stakeholders therefore called for action to be taken. In 2015, our research group at STAD (Stockholm Prevents Alcohol and Drug Problems) initiated a novel research project with the aim to reduce intoxication levels and alcohol-related problems at large sport stadiums hosting games in the Swedish Premier Football League (SPFL). The implemented prevention strategies are based on a multi-component intervention program.

Aim: To measure the effects of an alcohol prevention program using blood alcohol concentration (BAC) levels among spectators at games in the SPSL.

Methods: A multi-component intervention program was developed and tested in a quasi-experimental control group study using a repeated cross-sectional design. Following baseline data collection in 2015 (n=3351), the intervention was implemented during 2016 and is still ongoing. Follow-up data were collected during 2016 (n=1449) and 2017 (n=2514). The setting was all arenas hosting SPFL games in the two largest cities in Sweden, Stockholm (intervention area) and Gothenburg (control area). Spectators were randomly selected at various sections inside the arenas and actual BAC-levels were measured using breath analyzers.

Results: Results from the intervention area demonstrate a statistically significant decrease (p<0.001) over time on all alcohol consumption outcomes among spectators. The mean BAC-levels among spectators decreased from 0.63 in 2015 to 0.57‰ in 2017, the proportion having a BAC-level > 0‰ decreased from 49.7 to 42.5%, and the proportion having a BAC-level of > 1.0‰ decreased from 9.7 to 5.9%.

Conclusions: Results indicate that the alcohol prevention program has had an impact on the alcohol consumption patterns among spectators at the SPFL. Next, data from the control area will be analyzed and compared to the intervention area.

To use or not to use, factors related to the non-use of cannabis in case of a real opportunity to use the drug

ABSTRACT. Aim: To study cannabis use and the factors related to cannabis non-use among students who have had the opportunity to use cannabis and to identify possible protective factors to resist. Methods: The sample consisted of 15- to 16-year-old students who participated in the European School Survey Project (ESPAD) in 2007, 2011 and 2015 in Estonia. Cannabis involvement was classified: “lifetime cannabis use” (n=1878) and “cannabis never-used while encountering at least one cannabis use opportunity” (n=1880). After adjusting for study year, gender, parents’ educational level, perceived socioeconomic status and living with both parents the odds ratios (AORs) were calculated using logistic regression. Results: The prevalence of lifetime cannabis use in Estonia was stable across three survey years, in average 26%. While the lifetime exposure to cannabis use opportunity decreased from 54% to 48%, the use of cannabis among those exposed to a cannabis use opportunity increased from 50% to 54% during the years from 2007 to 2015. Every second student who had the opportunity to use cannabis, used the drug. Considering even minimal cannabis use as a moderate or great risk, abstinence from daily smoking and not being intoxicated with alcohol were related to lower likelihood to use cannabis. Parental knowledge about where and with whom their child is spending his or her time and parent child relationship quality was related to lower odds in using cannabis. Conclusions: High exposure to a cannabis use opportunity and a high prevalence of cannabis use among those exposed to drug use, stresses the importance of developing resistance skills and techniques for children and provision of parenting practices and useful recommendations of what parents can do to prevent underage substance use.

The importance of teachers’ evaluation in an evidence-based program. The example of Universal Family Competence Program

ABSTRACT. The Family Competence Program (PCF) is the adaptation made in Spain by the GIFES-UIB Group of Strengthening Families Program (SFP). It is based on scientific evidence of multicomponent type program, it is aimed at preventing drug use and other behavioral problems in children. he complete program includes three simultaneous programs: one aimed at parents, one aimed at children and a third one aimed at the family for joint work. Universal Family Competence Program (PCF-U) are focus on families with children from 10 to 14 years old.

Evaluation of PCF-U consist in two parts: 1) evaluation of participants (pre and post test) and 2) evaluation of the process (of each session).

First part (evaluation of participants) the information are obtained by children: Kumpfer (1989) BASC-1 (Reynolds & Kamphaus, 2004) and questionnaire about tobacco, alcohol and drugs (Macià 1995); by parents: Kumpfer (1989), BASC-2 (Reynolds & Kamphaus, 2004) ; and ESFA (Barraca & Lopez-Yarto, 2017) and by teachers. Principal obstacles that have been identified compiling teachers’ information of PCF has the no previous information that they have about the family program and the possible no-link with items that include in their questionnaire with what they really could evaluated in their classroom.

The aim of this communication is focus on the evaluation of teachers. This questionnaire have three parts: 1) a brief explication about PCF-U that includes the importance and the aim of the evaluation; 2) scholar aspects (course attendance, justification of non-attendance, special education needs, parents attendance of parents to scholar meetings and number of expulsions of the student). Last part is the selection and the adaptation of BASC-3 scales (Reynolds y Kamphaus, 2004): aggressiveness, social skills, leadership, behavioral problems and isolation

Training needs among prevention professionals in Spain: The European Universal Prevention Curriculum
SPEAKER: Joan Amer

ABSTRACT. Agents involved in the fields of education, social work, and health care usually show greater interest in implementing evidence-based programs (Borntrager, Chorpita, Higa-McMillan, and Weisz, 2009; Webb, 2001). Evidence-based programs are highly developed in the United States of America, but now the trend towards these programs is coming to Europe (Axford, Elliott, and Little, 2012). In order to meet health needs and the social challenges to improving the coverage and quality of universal prevention work (Bernat, and Resnick, 2006; EMCDDA, 2017), the UPC training series was designed following the International Standards on Drug Use Prevention (UNODC, 2009; 2015), and the European Drug Prevention Quality Standards (EMCDDA, 2011).

At present, the UPC training series is being pilot-implemented in nine European countries (Belgium, Estonia, Germany, Italy, Poland, Czech Republic, Spain, Slovenia, and Croatia) under the name of EUPC (European Universal Prevention Curriculum). Seven semi-structured interviews were employed along with three focus groups in order to assess the training prevention needs and to know how, that being the case, training prevention needs can be addressed through evidence-based practice. The sample was 36 participants. Interviews included four academics and three government drug prevention leaders. Concerning focus groups, the first group included agents from government agencies and drug prevention NGOs. The second was composed by seven academics from disciplines such as Health Science, Psychology and Pedagogy. The third group had 11 participants doing their PhD, Master’s degree, or in their final undergraduate year.

Drug prevention agents, academics and students agreed upon the lack of recognition of the prevention agent and the need of definition of goals, skills and competences of drug prevention agents. In relation to training, a broader perspective should be incorporated, a perspective that considers the role of consumption embedded in youth cultural values and specific social settings (such as nightlife). About evidence-based practice, participants highlighted that those are not still mainstream and that taught theories should be further intertwined with recent empirical findings. Therefore, the current research acknowledges the need to forge a common curriculum [in Spain and other European countries] on drug prevention, both at the professional arena and at universities.

Substance use patterns and related problems among youths visiting youth health clinics in Sweden
SPEAKER: Pia Kvillemo

ABSTRACT. Introduction: Alcohol consumption often increases during adolescence and some youths also try other substances. An early alcohol drinking onset, binge drinking and the use of other drugs is associated with various types of negative consequences. There is a need to identify arenas where youths can be reached by alcohol and drug prevention activities.

Aim: To explore substance use patterns and related problems among youths visiting youth health clinics in Stockholm, with the goal of developing prevention strategies.

Method: An anonymous questionnaire was administrated to visitors at 11 youth health clinics in Stockholm county during autumn 2016. The questionnaire comprised questions about alcohol and drug use, risky sexual behavior (RSB), sexual abuse, and mental health. Descriptive statistics and chi-square test were used to analyze the data.

Results: 328 youths aged 15 and 27 (m = 18.8 years, 89% girls) completed the questionnaire. Based on cut-off scores of 4 for girls and 5 for boys on Audit C, 61.7% of respondents had a risky alcohol consumption (RAC). Also, 41.8% of respondents had tried another drug, primarily cannabis (77%, n = 102). Individuals who had RAC also reported significantly higher levels of RSB compared to those without RAC. Non-students reported higher levels of both RAC and RSB compared to students. One third of respondents showed signs of mental health problems (≥16 points on GHQ 12), 45.5% had experienced physical contact in a sexual way against their will, with a larger proportion of girls reporting this (49.5% girls vs. 21.9% boys, p < .01), and 15.2% had been forced to sex against their will.

Conclusion: Youths visiting youth health clinics is a vulnerable group with regard to risk behaviors and related problems. Youth health clinics thus are important arenas where youth can be reached by prevention strategies focusing on alcohol, drugs and sexual health.

Harmful effects of the alcohol and other drugs policy implementing strategies in brazil

ABSTRACT. The objective of this paper is to think over the harmful effects of the alcohol and drug policy strategies in Brazil, based on studies of legislation and literature, considering that the most affected are the vulnerable young black ones. Throughout the history of drug policy in Brazil, we can see changes in legislation, which, starting from the psychiatric reform, begin to understand the suffering caused by using alcohol and other drugs as a problem to be treated by the health system and not by the system of justice. The concepts of extended clinic, autonomy, harm reduction, were incorporated into the strategies of the policy, such as the Center for alcohol and other drug attention as well as partner services for integral care of users. However, the practice has been distancing itself from non-asylum and exclusionary intervention, contrary to what is based on scientific evidence, and is gradually approaching a reductionist understanding of the phenomenon through authoritarian, prison and manicomial practices. The analysis of the application of the current policy on alcohol and other drugs indicates that it has not produced positive effects, especially among the most vulnerable, with an increase in prisons, murders, and street people. The current policy based on the war on drugs has turned out to be a policy of war for people who use drugs, with the profile of young blacks and the most vulnerable people, with the need of enlarge discussion and understanding of the phenomenon, aiming the modification of hygienist practices, segregators and promoters of social exclusion and inequity, towards a preventive and health care policy.

Better consumer information on alcohol labels as a prevention tool

ABSTRACT. Product labels can serve a number of purposes, providing information about the product to the consumer, enticing the consumer to buy the product and informing consumers of dangers and health risks from the product.

Due to insufficient labelling, when a consumer drinks an alcoholic beverage, there is almost 100% chance that they do not know what they are drinking.

Through it advocacy efforts undetaken over last 10 years, European Alcohol Policy Alliance has set the agenda in this area in the European Union. In 2011 the European Commission exempted alcoholic beverages from obligation to list ingredients and nutritonal information. In 2017, European Commission stated that - there are no objective reasons for such an exemption.

This presentation will outline the main policy objectives and activities undertaken by Eurocare on its path to provisions for better labelling of alcoholic beverages.

Methods Eurocare has over the years unertaken a range of activities: production of publications, consumer surveys, organisation of events in the European Parliament and most recently intensified social media presence.

Conclusions The topic of alcohol labelling and how it can be utilised to inform consumers and reduce the harm caused by alcohol, is at a crucial point. Eurocare would like to present its work on the topic to inspire other participants to take on board this neglected but important topic in alcohol and food policy area.      

The FYFA project: Preventive policies in the sport settings

ABSTRACT. Young people who drink alcohol are placed at enhanced risk of immediate and longer term health and social harms. Harmful use of alcohol has been linked to more than 200 disease and injury conditions and causes a large economic and social burden in societies (WHO, 2014). Underage drinking and heavy episodic drinking of alcohol is of particular concern in Europe because of its impact on health and welfare of the population. A number of studies have linked alcohol use by young people to various problems, both short and long term. FYFA project (focus on youth, football and alcohol) aims to identify best practices in prevention of alcohol related harm in the sport setting. We hope to contribute towards reducing alcohol related harm with a special focus on underage drinking. We aim at generating good practices targeting the reduction of heavy episodic drinking among young people and developing guidelines on this matter for youth sport clubs across Europe. A multimethod design is proposed for this comprehensive project with nine main strands focusing on international, national and local levels. This project will review policies and practices relating to young people, alcohol and international sport, to gather evidence of best practices. Also, interviews with high-level stakeholders and alcohol industry representatives will be conducted. Local sport stakeholders and young people will be interviewed and communication materials will be produced on alcohol policy and early intervention. A video summarising the results on youth’s, attitudes and behaviours towards alcohol and what they would consider to be effective practices will be produced. A specific plan to facilitate communication, coordinate and monitor all the axes of this project is in place involving all partners. An evaluation plan, as well as an interim and final evaluation reports will be produced to ensure quality of the process. FYFA will promote the exchange of knowledge and good practices between and within European countries, to raise awareness of alcohol related harm amongst policy-makers and citizens. A final conference will be organised to present our evidence based guidelines.

12:30 (PsychTestChild): Bridging the Gap Between Practice and Research Evidence

ABSTRACT. Psychological tests are widely used for screening, treatment planning and evaluation research. Tests applied in Norway are often lacking information concerning their psychometric quality, including documentation of reliability, validity and Norwegian norms. is a webpage and an open-access scientific journal. The webpage systematic reviews psychometric properties of Norwegian tests and diagnostic systems assessing mental health, abilities, and other traits among children and young people. These reviews provide a rigorous assessment of psychological tests following the European Federation of Psychologists’ Associations’ (EFPA) test review model. Systematic literature searches are conducted to identify studies that report at least one of the following types of data: translation and cultural adaptation, norms, reliability, validity, and based on Scandinavian population samples. The review is conducted by two independent authors, and the article is peer-reviewed, similar to the usual evaluation of scientific papers, and finally, reviewed and approved by the editor. The goal is to evaluate the most widely used psychological tests in Norway and update published reviews with new evidence arising from recent publications on psychometric properties. So far, the systematic reviews of 56 psychological tests have been published, and more than 91 tests are registered by users for further evaluation. In addition, we hope to raise the awareness among test users of the importance of using high-quality tests during the assessment of children and young people, and that PsykTestBarn may be a source of easily accessible information about the psychometric properties of tests available in Norway. The presentation will describe the procedures applied during the review process and provide an overview concerning webpage use based on Google analytics, and the quality of the reviewed tests.

Development and validation of a Mobile App to prevent smoking relapse

ABSTRACT. Mobile Apps have become technological tools of great help to improve health-related behaviors. In fact, it can be used for health education, prevention and also as a treatment complement. One of the health-related behaviors where the development of Mobile Apps has been more important in recent years is smoking behavior. In general, existing Apps aim to increase motivation to quit smoking and to maintain abstinence once achieved. The main objective of this study is to present the development process of a Mobile App for smokers who have quit smoking through a cognitive-behavior smoking cessation intervention, in order to prevent smoking relapse since this is a very frequent phenomenon. In this study, the Mobile App development has shown that it is necessary to adapt the contents to the specific behavior targeted (smoking), to the quit smoking process and abstinence maintenance (relapse prevention), gender, type of smokers (i.e. with comorbidity), motivational level, dependence severity, possible high-risk situations that they have to manage, etc. In addition to the Mobile App development process description, we will provide the results of a pilot test that aim to validate the appropriate Mobile App performance. Thus, we will evaluate if the contents are attractive, useful, oriented to the objective that is intended, and, fundamentally, if it is an accessible and easy to use tool for preventing smoking relapse.

Prevalence rates of cyberbullying among Norwegian adolescents and support for cyberbully-victims

ABSTRACT. Bullying victimization, both traditionally and online, is causal related with poorer mental health and substance use and associated with psychosomatic health complaints and psychosocial problems. The technological development may open up for new opportunities to implement innovative measures that both promote mental health and prevent the development of mental disorders. The main purpose of this study is two folded. First, to present the prevalence rate of cyberbullying among junior high schools students in northern Norway from the “PIN-study”. Second, to present an idea about the development of a mobile application for young people who have been exposed to cyberbullying, from the protocol of the “UngRisk” project.

Methods The “PIN-study” is an epidemiological research project in Norway and part of a multinational study from the European and Asian adolescent and child mental health study called the “Adolescent health in a digital world: Associations of well-being, mental health and help-seeking with risk behaviors”. The Norwegian data was collected from junior high school students (N = 2124). Measures of being cyberbullied or being engaged in cyberbullying others was collected.

Results The prevalence of adolescents experiencing cyberbullying was 11.7% and the prevalence of adolescents being engaged in cyberbullying others was 4.3%. Boys had significantly lower odds for being cyberbullied as compared to girls (OR = .56; 95% CI: .43 – .74), but significantly higher odds for being engaged in cyberbullying others (OR = 1.65; 95% CI: 1.07 – 2.53).

Conclusion The rate of being cyberbullied is high among Norwegian adolescents and the consequences can be serious. Adolescents may find it difficult to tell their parents or other adults about their experiences of being bullied or cyberbullied. A mobile application may be a useful resource to better cope when being cyberbullied. They are easy and always accessible, and offer anonymity. The aim of the “UngRisk” project is to develop an intervention that increases cyber-coping strategies for adolescents who have been exposed to cyberbullying.

Gender, Unplugged intervention and resilience
SPEAKER: Olga Orosova

ABSTRACT. Introduction: Resilience is an important factor of successful adaptation, particularly when facing a challenging or threatening situation. Therefore, monitoring individual´s resilience and its changes in intervention programs such as Unplugged is important. The aim of this study was to explore the main effect of time and the interaction effects of gender and Unplugged intervention program on schoolchildren‘s resilience. Methods: The study was carried out as a cluster randomized controlled trial with data collection conducted immediately before (T1) and then 3 months (T2) and 18 months (T3) after the program Unplugged was implemented in Slovak primary schools. The program involved 1295 participating schoolchildren (M=11.52; 46.8% boys). The schools were randomly assigned to either experimental (EG, n=641) or control group (CG, n=654). EG was exposed to the program Unplugged. The sample was finally divided into 3 categories where the EG was further divided according the level of commitment shown by the teachers implementing the program: EG with a committed teacher, EG with an uncommitted teacher, and CG. The Adolescent Resilience Scale (Oshio et al., 2003) was used with the aim to measure the psychological features of resilient individuals at T1, T2 and T3. The analyses were conducted using a GLM Repeated Measures procedure. Results: The results of GLM repeated measure analysis indicated a significant main effect of time on resilience (F=6.58, p0.001). The results also showed significant interaction effects of gender x resilience (F=5.40, p0.001) and gender x Unplugged participation x resilience (F=3.17, p0.05). Tests of Within-subjects Contrasts indicated (i) a significant decrease in resilience from T1 to T3 (F=7.50, p0.01), (ii) a significant decrease in resilience from T1 to T3 among boys (F=5.61, p0.05), (iii) EG with a committed teacher showed a significant increase in resilience only among girls from T1 to T3 (F=3.93, p0.05). Conclusion: A persisting effect of the Unplugged intervention on resilience, i.e. 18 months after the Unplugged intervention administration, was found only among girls. The commitment of teachers implementing the program was seen to play a critical role in reaching expected level of implementation fidelity of the intervention.

Evaluation of the School and Family Prevention Program "Juego de LLaves" of the Asociación Proyecto Hombre: Results and conclusions

ABSTRACT. The National Commission for Drug Prevention of the Asociación Proyecto Hombre in Spain, together with an evaluation expert’s team of the University of Cordoba, designed the evaluation of the social and emotional impact of the school-based and family prevention program “Juego de Llaves”, under the format of an evaluative research and the CIPP evaluation model. “Juego de llaves” is an universal school based and family prevention program of the Asociación Proyecto Hombre. The Program is aimed at students in secondary education (12-16 years) and their families. Its main objective is to prevent or delay drug use and other addictive behaviors. The beneficiaries of the developed evaluation have been three: participating students, their families and the teaching staff responsible for implementing the Program. The sample is divided into 32 schools distributed in six regions, with a total of 4.195 students, 168 families and 408 teachers. 90,3% of the those schools participating were public schools. The results obtained show a high satisfaction with the methodology, the available resources and the timing of the Program. In the same way, the Program has allowed students and families feel identified with the contents worked. On the other hand, it has been found that there is a differential impact of the program in terms of gender in some of the dimensions that are addressed through it. Some improvements to introduce do allusion to review some activities that allow little participation as they are more theoretical, plus tackling the raising awareness of the teachers on their transverse task that contributes to the Program.

Using information on contextual factors for developing a tailored implementation strategy for web-based substance use prevention programs at German universities – Results of the DIOS-study

ABSTRACT. Due to the prevention law which was passed in Germany in 2015, there is an increasing interest in disseminating evidence-based preventive interventions in real-life settings, including programs for the prevention of risky substance use in the university setting. However, little is known about how to best tailor the implementation process to contextual factors and capacities of individual universities. The purpose of the study was to use information on local contextual factors to develop a tailored action plan to implement evidence-based programs for the prevention of risky substance use. Forty-three semi-structured interviews with key stakeholders at ten German universities were conducted. Interviewees were asked questions regarding perceived facilitators and barriers of students’ participation in preventive programs, needs for prevention at the individual university, as well as existing organizational structures that could support the implementation process. Interview transcripts were analysed by two independent researchers, using qualitative content analysis. While overall capacity for implementing web-based interventions across participating universities was generally low (reported elsewhere), different sets of factors facilitating or hindering implementation were identified. Regarding the first set of factors, stakeholders reported student characteristics (e.g., fear of stigmatization) and course load affecting program participation. The second set of factors was related to heterogeneity in organizational structures for supporting substance use prevention at individual universities. At some universities, a few individuals at health promotion or social work.

Factors associated with binge drinking in adolescents, through the I-Change model.

ABSTRACT. Introduction: Binge drinking (BD), can be defined as the consumption of 4/5 or more standard glasses of alcohol for women / men, respectively, in a short time1, being a great problem worldwide2. In Spain, in 2016, 31.7% of adolescents between 14 and 18 had done BD3. The I-Change Model studies the acquisition of behaviors in health, being widely used in alcohol consumption and BD4,5. Our objective is to know the factors associated with BD in adolescents, through the I-Change model.

Methodology: We conducted a Cross-sectional study, with 1247 high school students of Andalusia in 2017, through an online questionnaire. A descriptive analysis, and multilevel, at three levels of control, through the SPSS 21, was carried out.

Results: The average age was 16.32 years (SD = 1.066). 661 (53%) were girls, 545 (43.7%) were 4th of CSE, 515 (41.3%) of 1st of Baccalaureate, and 187 (15%) of Vocational Training, 767 (61.15%) were Catholics and 405 (32.5%) had no religion. 832 (66.7%) drank sometime, and 487 (39.1%) performed BD in the last 30 days. Multilevel analysis showed a significant association of BD with being older (p = 0.003), being male (p = 0.004), not having a relationship (p = 0.038), being Catholic (p = 0.008) and having more of weekly money (p = 0.009). Regarding the I-Change Model, BD was significantly associated with having a positive attitude towards alcohol (p <0.001), lower risk perception (p = 0.031), higher social model (p <0.001), higher social norm (p = 0.042), and lower self-efficacy (p <0.001).

Conclusions: BD is a public health problem in Spanish adolescents. The results highlight the importance of knowing the factors associated with BD, using the I-Change Model for the change of health generating behaviors, which should be taken into account in health promotion programs.

Family Argumentativeness and Expressiveness and Adolescent Dating Violence and Externalizing Behaviors

ABSTRACT. Background and Purpose: The influence of interparental violence on adolescent violent and other problem behaviors has been established by existing studies, however, little is known about how other aspects of family communication may have an impact. Framed by Social Learning Theory, we examine two family environment factors, argumentativeness and expressiveness, and to see 1) whether family argumentativeness and expressiveness influenced adolescent dating violence and externalizing behaviors and if there was an interaction effect; 2) whether attitude toward violence and parent-child risk communication about risk behaviors mediated these effects.

Methods: Data were collected as part of a drug and violence prevention program in Nicaragua. The sample used for this study were 1,651 adolescents (52% female) who were not exposed to the intervention at the time of the survey completion. The majority of the participants were in 7th or 8th grades with a mean age of 12.87 years (SD = 1.06). Data were analyzed in Mplus 8 using path analysis.

Results: Significant direct effects of family argumentativeness were identified for adolescent dating violence ( = .11, p < .01) and externalizing behaviors ( = .19, p < .001). Although expressiveness did not show a significant effect, interaction effects were identified for both dating violence ( = .07, p < .05) and externalizing behaviors ( = .07, p < .05). Attitude toward violence significantly mediated the effects of both family argumentativeness ( = .03, 95% CI: .02, .04) and expressiveness ( = -.03, 95% CI: -.04, -.02) on adolescent dating violence. Similarly, significant mediation effects were identified for attitude toward violence for both family argumentativeness ( = .03, 95% CI: .02, .04) and expressiveness ( = -.03, 95% CI: -.04, -.02) on externalizing behaviors.

Discussion and Conclusion: Findings highlight the importance of family communication as it relates to adolescents’ attitude toward violence, and in turn, their engagement in dating violence and externalizing behaviors. Further, findings suggest that negative modeling (argumentativeness) is a more powerful influence on violent attitudes and behaviors than positive modeling (expressiveness). Prevention efforts that promote healthy communication and especially that eliminate negative communication are suggested for this context.

Teenagers’ use of different Social Network Sites and associated behaviours: an insight from focus groups made with 11 to 16 years old French adolescents

ABSTRACT. The use of Social Networking Sites (SNS) has grown tremendously worldwide passing from 0.97 billion users in 2010 to 2.62 billion users in 2018. More than one out of two teenagers have an account on at least one SNS and are using it on a daily basis. Concerns associated to the impact of SNS use and to the content shared within these on teenager’s behaviour have been raised. Still, little is known about teenagers’ own perception of such use. Our study aimed to get an insight of adolescents’ use of SNS, their interaction with the content posted and their perception of posts associated to alcohol or tobacco. Thirty-nine French adolescents (22 boys) aged 11 to 16 years participated in the study. Ten semi-structured focus groups (7 mixed groups, 2 all-girls groups, 1 all-boys group) were conducted. Teenagers reported in majority to use Snapchat to communicate with their friends on a regular basis. On the contrary of Instagram that was also widely used, teenagers appreciated that their posts lasted less than 48h. “Likes” were given to the contacts they liked no matter the content. Few of the teenagers used twitter or Facebook. This latest was considered to be for older people or a way to fill websites identification forms faster. Teenagers reported not to see much alcohol or tobacco related post, that their contact who shared some wanted to “show off”. Whereas tobacco was clearly identified as at risk for their health, alcohol was not seen as bad for health but rather as a common practice that they could have experienced with their family or/and that they will experienced when getting in the next years or so. Participants thought to be moderately influenced by the content they were facing but not to have the power to influence other with their posts. Development of media education program should be considered to empower teenagers to face peer-to-peer digital influenced.

Testing the family resilience model: a research proposal

ABSTRACT. Introduction: The concept of family resilience has been established as the result of a new way of looking at family crises where they are seen as opportunities for families to grow and adapt. Family resilience is often seen as a process where a family that is faced with significant hardship manages to achieve good family outcomes due to certain protective factors/mechanisms. One of the most widely used models of family resilience was created by Froma Walsh. Even though many preventive interventions around the world are already based on promoting family resilience, the theoretical basis of the model needs further empirical testing. Aims: The aim of this study is to test the suggested theoretical model of family resilience by looking into the components of family resilience (family resilience factors, risks and positive outcome) in the families of Zagreb high school students and the relations between those components. Research problems also cover determining the differences in the perception of the components of family resilience (family resilience factors, risks and positive outcome) between the parents and their children. This research also aims to contribute to the development of the methodology of testing family resources. Methods: A quantitative research model will be used with a convenience sample of 300 families of Zagreb high school students. The family will be represented by a high school student and another adult family member (parent or other guardian). Their perspective will be combined into a unique family perspective using structural equation modeling. Family risk will be operationalized as the sum of disruptive life changes that affect the family. The family resilience factors examined in this research will be based on the theory of the family resilience system by Froma Walsh. Positive family outcomes will be operationalized as family life satisfaction and satisfaction with family adaptation. The research design presented here will be used for a doctoral thesis at the University of Zagreb and is presented here to discuss methodology, difficulties and opportunities. The research is part of the project Specific characteristics of families at risk: contribution to complex intervention planning that is supported by the Croatian Science Foundation.

Stakeholder Perceptions of Supervised Injection Facilities: A Qualitative Synthesis

ABSTRACT. Introduction: Several interventions have been developed to address the growing burden of substance use and abuse globally. One intervention that has been subject to international attention and controversy is supervised injection facilities (SIFs). Despite research showing the benefits of SIFs, research has also shown these facilities to be controversial among some stakeholders, which may prevent future scale-up. Given the quintessential role of stakeholder perception in the future of SIFs, this systematic review aimed to synthesize stakeholder perceptions of these facilities.

Methods: Nine academic databases and various search engines were searched. Additionally, experts and health departments in countries with SIFs were contacted for potential grey literature. Screening, full text review, data extraction, and quality determinations were conducted independently by both authors. All extracted perceptions were uploaded to NVivo and coded thematically.

Results: The search resulted in the inclusion of 58 articles. Stakeholder perceptions were synthesized by type of SIF (sanctioned, unsanctioned, and yet to be developed) and by stakeholder group. Ultimately, the key themes included benefits of SIFs, such as safety and a reduction in public drug use; concerns related to SIFs, such as challenges stemming from existing rules and regulations in SIFs, and their potential to increase drug use/users in the community; suggestions for SIFs, such as their location; and factors influencing their implementation, such as a lack of evidence and the need to educate the public on drug use.

Conclusion: This review identified, appraised, and synthesized existing literature on stakeholder perceptions regarding SIFs. As such, it constitutes a central resource in informing current debates on the implementation and scale-up of SIFs. Importantly, the review highlights benefits, key areas of concern, and suggestions of stakeholders, which may help facilitate a more informed discussion among policy-makers, researchers, and advocates on the development and continuation of these facilities.

Differences between youth drinking cultures in Italy and the U.S.A. What are the implications for practice?

ABSTRACT. There is a growing body of research on alcohol misuse interventions for young people and specifically college students. Most interventions, however, have been designed and implemented in the U.S.A., and the degree of applicability and required adaption in other contexts and (drinking) cultures is unclear. The U.S.A. and Italy, respectively, represent paradigmatic examples of intoxication (‘dry’) and non-intoxication drinking (‘wet’) cultures, allowing for meaningful cross-cultural comparisons. This study used a sequential explanatory mixed method design to compare the drinking cultures (i.e., schema of beliefs, practices, and values maintained by a society regarding alcohol use) of youth in Italy and the U.S.A. Quantitative and qualitative data were given equal priority and analyzed in two consecutive phases. Phase 1. Multigroup Latent Class Analysis (LCA) was used to identify subgroups of drinkers (i.e., drinking patterns) from samples of Italian (N = 424) and American (N = 323) college students (age range = 18-22). Four subgroups were found in both countries. Most participants concentrated drinking during weekends, with a notable subgroup of weekend risky drinkers. However, comparable subgroups of drinkers differed across countries in terms of the association between drinking patterns, risky drinking, and number of negative alcohol-related consequences experienced. For example, daily drinking was differentially associated with probabilities of reporting risky drinking behaviours (e.g., episodes of drunkenness) and experiencing negative consequences among American (high probabilities/consequences) and Italian youth (moderate probabilities/consequences). Phase 2. Focus group interviews with 41 Italian and 47 American youth were used to collect narratives on features of the two drinking cultures, and elaborate on the quantitative results obtained in the first phase. Preliminary results indicate there are differences in the meaning of alcohol consumption itself (e.g., whether alcohol is predominantly used to reach intoxication or has other purposes), which are influenced by alcohol availability, underlying cultural assumptions, and the policy context (i.e., drinking age). Results of this study will be discussed in light of the available research on effective alcohol misuse interventions for young people, suggesting directions for future research and implications for practice in countries where a 'wet', non-intoxication drinking culture is predominant.

Promoting Positive Choices for Aboriginal and Torres Strait Islander youth: development of an online drug prevention portal
SPEAKER: Mieke Snijder

ABSTRACT. Background Prevalence of substance-use related harms are higher in Aboriginal and Torres Strait Islander people compared to non-Indigenous people. The culturally diverse and complex context in which these harms occur accentuates the need for culturally appropriate prevention approaches, education and resources for Indigenous young people. This project aims to improve the dissemination of culturally-appropriate and evidence-based drug prevention resources through the development of an online alcohol and other drugs portal that provides an resources for Indigenous students, parents and teachers.

Methods The Positive Choices – Aboriginal and Torres Strait Islander portal was developed through in-depth consultations and focus testing with teachers, parents, students, and service providers. A scoping review of existing substance-use prevention resources was conducted to identify existing evidence-based programs using NHMRC guidelines. Fact sheets were written by researchers based on literature reviews and consultations. User testing was conducted by interviewing 12 Aboriginal and Torres Strait Islander media and communications workers around the country.

Results Consultations indicated a preference for culturally appropriate substance-use prevention materials that had a strengths-based approach, enhanced cultural knowledge, were empowering, and had a harm reduction focus. The scoping review searches identified 107 resources, of which 11 were relevant and met NHMRC evidence-base criteria. User testing feedback indicates Positive Choices is appropriate for Indigenous audiences, is easy to navigate and contains relevant and informative resources for use by school communities. Details of the focus testing with parent, teachers and students will be discussed.

Conclusions The findings of user feedback and testing indicate that the Positive Choices - Aboriginal and Torres Strait Islander portal is appropriate for Indigenous people around the country. The portal provides a much needed opportunity for teachers and parents to access evidence-based drug prevention information.

Implementation and evaluation of Positive Choices: an online initiative to address the evidence-practice gap in substance use prevention
SPEAKER: Mieke Snijder

ABSTRACT. Background Onset of substance use typically occurs during adolescence; thus preventative initiatives need to occur early on, prior to exposure. Schools are an ideal place to implement prevention strategies, with the potential for broad-ranging impact and tailoring of messages to suit students’ developmental level. In parallel, parents require guidance about how they can protect against harms associated with substance use. There is increasing evidence that the risk of substance-related harms among teenagers can be reduced substantially with the right prevention strategies. Despite this, evidence-based substance use prevention approaches are not widely implemented.

Objectives The Positive Choices project aims to address a known gap in the implementation of evidence-based substance use prevention approaches.

Method The online Positive Choices portal was developed to provide a central resource where teachers, students and their parents could easily access evidence-based drug information and prevention strategies. The portal was developed in consultation with drug and alcohol experts, as well as target users in Australia (teachers, parents and students). Research literature and drug education websites were systematically reviewed to identify resources meeting pre-specified inclusion criteria for relevance and quality. Post-launch evaluation was conducted, guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model, with school staff (n=107) and parents (n=50) post-launch to assess the success of the initiative in and determine progress towards evidence-based practice.

Results In the two years since launch, the Positive Choices portal and accompanying webinar series has been access by over 126,000 users across Australia and internationally. Evaluation feedback from teachers and parents indicated that the games, videos and factsheets were the most accessed drug prevention resources on the site. Eighty four percent of respondents said they would continue to use the portal, and 89% said they would recommend Positive Choices to a friend or colleague. There was also evidence that use of the portal changed respondents attitude and intentions to implement evidence-based prevention strategies.

Conclusion: This study represents the first implementation and evaluation of a national drug prevention initiative in Australia. Findings suggest Positive Choices has achieved broad reach, and has increased awareness and future intentions to implement evidence-based prevention strategies.

Combining evidence, photos and stories to inform development of computerised drug prevention for Australian Indigenous youth
SPEAKER: Mieke Snijder

ABSTRACT. Background: computerized substance use prevention programs have been found to be effective for non-Indigenous secondary students in Australia and internationally. The potential for sustainability, reach and implementation fidelity of computerized programs, combined with the high rates and confidence in technology use among Australian Indigenous youth, make this a promising, innovative approach in substance use prevention for Australian Indigenous secondary students.

Objective: This study aims to develop the first culturally appropriate computerized school-based substance use prevention program for Australian Indigenous youth. This presentation will discuss the innovative approaches used in the development of these resources.

Methods: Two literature reviews were undertaken to 1) identify effective elements of previous substance use prevention programs with Indigenous Populations and 2) investigate risk and protective factors of substance use for Indigenous Australians. Additionally, researchers partnered with four schools at which focus groups and interviews were conducted with teachers and parents, using an appreciative inquiry approach. Indigenous students participated in a Photovoice project where they took and shared photographs of positive social interactions in their community and their role models. Group sharing of the photographs included a creative story telling session. Students completed a brief empowerment questionnaire before and after the consultation process. User feedback sessions with teachers and students were organised to receive ongoing input in the development of the story lines.

Results: Effective elements of substance use prevention included cultural knowledge integration, substance use resistance skills and diversionary activities. Individual, relationship, community and societal risk and protective factors were identified for substance use for Indigenous Australians. Consultations indicated a need for culturally appropriate substance use prevention materials that are empowering and suitable for delivery in a mixed classroom setting. Together with an Indigenous creative agency we developed a computerized prevention program, combining illustrated story telling with classroom activities.

Implications: This study is the first to develop an interactive, computerized program for Australian Indigenous secondary students. This study show how we can integrate research evidence and participants' story into a prevention program.

Correlates of cannabis and other illicit drug use among secondary school students in Nigeria

ABSTRACT. Background: The burden of cannabis and other illicit drug use on adolescents represent a serious public health problem. The majority of studies on risk factors for substance use originate from developed coutries, while limited data are available from developing countries. The aim of the present study is to explore factors associated with cannabis and other illicit drug use among nigerian secondary school students. Methods: The survey involved 32 secondary schools and 4,078 pupils of six geo-political zones (South-South, South-West, South-East, North-Centre, North-West and North-East) and two metropolitan cities (Abuja and Lagos) between December 2015 and January 2016. Socio-demographic characteristics, parental smoking and permissiveness, friends' illicit drug use, risk perceptions and positive beliefs were investigated as correlates of ever use of cannabis and other illicit drugs through multilevel logistic regression models. Results: The prevalence of cannabis use was 7.5%, while the prevalence of other illicit drug use (e.g. amphetamines, cocaine, ecstasy, heroin, inhalants, LSD, codeine, tramadol) was 12.0%. Results of logistic regression models showed that age, living in family structure different from both parents’ families, parental smoking, parental permissiveness to smoke, friends’ cannabis and other drug use, risk perceptions and beliefs were associated with the increased probability of cannabis and other drug use in adolescence. Having more cars was only related with the probability of cannabis use but not with that of other illicit drugs use. Conclusion: Since young population is dominant in Nigeria, greater investment in adolescents’ well-being by reducing the factors that contribute to cannabis and illicit drug use should be prioritized.

Correlates of alcohol use and drunkenness among secondary school students in Nigeria

ABSTRACT. Background: Alcohol is the most used substance among adolescents in Nigeria. Studies conducted among secondary school adolescents found a worrisome prevalence of drinking. Moreover, according to WHO report on alcohol and health, Nigeria ranks second for the heavy episodic drinking among senior secondary school adolescents in Africa. While risk factors for alcohol use among adolescents are well documented in Europe and USA, they received less attention in African countries. This study aimed to investigate the factors that contribute to drinking and drunkenness episodes among secondary school adolescents across all six geopolitical zones of Nigeria. Methods: The survey involved 32 secondary schools and 4,078 pupils of six geo-political zones (South-South, South-West, South-East, North-Centre, North-West and North-East) and two metropolitan cities (Abuja and Lagos) between December 2015 and January 2016. Socio-demographic characteristics, parental alcohol use and permissiveness, friends' alcohol use, risk perceptions and positive beliefs indicator were investigated as correlates of lifetime drinking and drunkenness through multilevel logistic regression models. Results: The prevalence of lifetime drinking was 34.0%, while the prevalence of drunkenness episodes was 13.4%. Results of logistic regression models showed that male gender, living in family structure different from both parents’ families, parental and friends’ alcohol use, parental permissiveness to drink, risk perceptions and beliefs were associated with an increased probability of both drinking and getting drunk. Having more cars was only related with the probability of drinking but not with that of getting drunk. Conclusion: Since young population is dominant in Nigeria, greater investment in adolescents’ well-being by reducing the factors that contribute to drinking and drunkenness should be prioritized.

Knowledge, attitudes and behaviours on tobacco, alcohol and drugs among Nigerian secondary school students: differences by geopolitical zones

ABSTRACT. Background: Nigeria includes six geopolitical zones and one Federal Capital Territory (FCT). The zones differ from each other in many characteristics including health indicators of adult and child population. Substance use among adolescents is a public health concern. However, the available data do not allow a comparison of substance use prevalence and related factors by zone. This study aims to describe knowledge, attitudes, beliefs, risk perceptions, skills and substance use behaviors among Nigerian secondary school students, underlining differences by geopolitical zones. Methods: The population size of the zones was taken into account in extracting the schools for the study. 32 schools were invited and participated: 6 in NW, 4 in NE, 4 in NC, 2 in FCT, 8 in SW (of which 2 in Lagos), 4 in SE, 4 in SS. A self-completed anonymous questionnaire was created ad hoc for the survey. The questionnaire investigated characteristics of the social environment, tobacco, alcohol and substance use, knowledge, beliefs, and attitudes about substances, the perception of peers and friends use, personal skills and school climate. Results: 4,078 adolescents (66.4% males) participated in the survey. The mean age was 14.7 years. On average 5.1% of pupils smoked cigarettes at least once in their life, 33.6% drank alcohol, 13.1% had drunkenness episodes, 7.5% used cannabis and 11.6% other illicit drugs, with differences between zones. The highest rates of alcohol use were observed in Lagos and Southern zones, whilst cigarettes, cannabis and other drug use were higher in Northern zones. Knowledge on tobacco, alcohol, and marijuana use were quite low across all zones. Self-esteem, decision-making and refusal skills, risk perceptions and beliefs were lower in students of Northern zones. Conclusions: The prevalence of adolescent alcohol and substance use in Nigeria is not radically different from that of developed countries. Drug education and prevention activities should be planned and implemented across the country in case of alcohol, and special attention should be paid to cannabis and other illicit drugs in Northern zones. Prevention activities among adolescents can help to reduce the burden of disease related to cigarettes, alcohol, and drugs in adult ages.

Riscos & desafios: validation of an additive behaviours and dependencies preventive program among students in higher education
SPEAKER: Carla Rocha

ABSTRACT. It is evident and scientifically proven the need to invest in prevention of Psychoactive Substances use in the context of higher education, particularly among students attending the first year. The present study’s goal is to validate a comprehensive program to prevent addictions and addictive behaviours targeting this group. The Riscos & Desafios Program addresses psychoactive substance use behaviours and a wide range of specific risk and protective factors in this population. The sample consisted of 228 first year students from the University of Minho in Portugal. This study included an experimental design, with experimental and control groups, with pre, post-test and follow-up measurements. In addition to collecting sociodemographic and psychoactive substance use data, the instruments used were: AUDIT (Babor et al, 1989), Self-Control Scale (Wills et al., 2007), Sensation Seeking Scale version V (Zuckerman, 1979), Academic Experience Questionnaire (Almeida and Ferreira, 1997), Rosenberg Global Self-esteem Scale (Rosenberg, 1965) and Beck Depression Inventory (Vaz Serra & Pio Abreu, 1973). The results found validated the Riscos & Desafios Program in the extent to which it was verified in the experimental group the reduction of alcohol consumption, the reduction of risk factors and the promotion of protection factors for psychoactive substances use.

The riscos & desafios program: process evaluation

ABSTRACT. In drug use and abuse prevention scientific domain, several epidemiological studies show a high prevalence of psychoactive substance use among higher education students, especially abusive alcohol consumption. Despite the magnitude of this problem and its consequences, there is little use of effective, structured and continuous prevention strategies in Portugal. The Riscos & Desafios Program has been designed and validated in order to respond to this need. It is a co-curricular, comprehensive and multi-component competence enhancement based preventive intervention. The Program is aimed at 1st year students and is composed of a set of 8 two-hour weekly group sessions. This study presents the results of the process evaluation of the Program implementation in different contexts. The sample consisted of 301 first year students from higher education institutions in Braga and Porto. Additionally, to the process evaluation performed orally by the different actors throughout the implementation, the Riscos & Desafios Program includes six process evaluation forms used in this study. The conditions of informed consent, anonymity and confidentiality were respected. Most of the students filled the Post-Program Questionnaire in the 8th session(s) and evaluated the different dimensions - General Opinion about the Riscos & Desafios Program, Facilitators and Program Organization - in a very positive way. Likewise, most of the students rated the Program as Very Good. These data corroborate the positive face-to-face assessment provided by participants throughout the Program´s implementation. Additionally, the facilitators reported great satisfaction with the contents and activities of the program and with the high participation among the students. In sum, the process evaluation revealed clearly positive results, expressing the adequacy of the Program to the characteristics of the target group and reflecting the consistency of the theoretical-practical conceptualization formulated, as well as the methodologies and materials used. This evaluation reiterates the importance of investing on health promotion and prevention of addictive behaviors through structured programs aimed at university students who present themselves as a target population with identified needs in this area, corroborating the evaluation of efficacy of the Riscos & Desafios Program and supporting the continuity of its implementation.

Overview of the Good Behavior Game Feasibility Study and Implementation Lessons Learned in Poland

ABSTRACT. This presentation will provide an overview of the adaptation process and pilot implementation of Good Behavior Game (GBG) in two Polish cities: Warsaw and Kraków. The Good Behavior Game is an evidence-based prevention program that targets antecedents of drug and alcohol misuse in primary school classrooms. Implementation of Good Behavior Game in the United States (US) has shown correlations with reductions in drug, alcohol, and tobacco use, particularly for males who enter school with early indicators of aggressive and disruptive behavior. In Poland, we were interested in whether the results from the US research trials could be replicated in our setting and the current feasibility study is the first step towards a GBG Polish Randomized Control Trial (RCT). The presentation will begin with an overview of the recruitment of Polish GBG coaches, challenges associated with the translation of training materials, implementation supports provided by the American Institutes for Research, followed by lessons learned from the feasibility study. Finally, the presenters will discuss next steps for Good Behavior Game implementation and outcomes from the evaluation in Poland.

Prevention of Alcohol Abuse and Depression in higher education context: the Riscos & Desafios Program
SPEAKER: Carla Rocha

ABSTRACT. College students are a priority target in addictive behaviors and dependencies prevention interventions, particularly in the first year. The high prevalence of psychoactive substance use in this group and its consequences, mostly in terms of abusive alcohol consumption, associated with the fact that higher education can be a context of initiation to drug use, highlight the urgency of preventive intervention. Additionally, college students should be considered a risk group for the development of depression, particularly during the transition period of adjustment, as they are subject to various pressures. In fact, high prevalence rates of depression were found among university students in several countries. Depression constitutes a strong risk factor for drug use due to its high correlation with this behavior. Despite the magnitude of this problem and its consequences, there is little use of effective, structured and continuous prevention strategies in Portugal. The Risks & Challenges Program has been designed and validated in order to fill this gap. The present study examined the efficacy of this Program in relation to drug use and depression. The sample consisted of 228 first year students from the University of Minho, Braga, Portugal. The Riscos & Desafios Program is a co-curricular, comprehensive and multi-component competence enhancement based preventive intervention. The Program is aimed at students attending the 1st year of higher education and is composed of a set of 8 two-hour weekly sessions to be implemented in group format. In addition to collecting sociodemographic and psychoactive substance use data, the Portuguese version of Beck Depression Inventory (Vaz Serra & Pio Abreu, 1973) was used. This study included an experimental design, with experimental and control group, with pre, post-test and follow-up (6 months) measurements. The results show significant preventive effects of the Risks & Challenges Program on alcohol use (i.e., beer and spirits) and depression. Since the relation between depressive symptoms and alcohol consumption and the relation between problematic use of alcohol and risk of suicide is reported in university students (Manza, 2009; Pedrelli et al., 2011; Santana and Negreiros, 2008; SAMHSA, 2002) the results achieved with the present study are of great importance.

How important is quality of implementation for the effectiveness of the Danish alcohol prevention programme The GOOD Life?

ABSTRACT. Background: This study assessed, if the preventive effect of the school-based social norms intervention The GOOD Life was moderated by the level of exposure to, satisfaction with and comprehension of the social norms messages. Methods: In a cluster randomised controlled trial (38 schools, n=1355 pupils) the intervention and control groups of pupils completed an online survey, at baseline and at 3-months follow-up. The GOOD Life provided normative feedback through three different components (normative feedback in class, posters, web application on smartphones). At follow-up pupils in the intervention group (n=641) were asked about their satisfaction with and comprehension of the intervention. The effects were examined on three outcome measures, overestimation of peers’ drinking, binge drinking (5 or more drinks on one occasion) and alcohol-related harms using multilevel logistic regression models. Results: Increased exposure to, satisfaction with and comprehension of the social norms messages enhanced the intervention effects. For the outcome of norm perceptions higher intervention dose was associated with stronger and more significant intervention effects, while for the outcome alcohol-related harms this was only observed for higher intervention exposure and satisfaction. For binge drinking we found enhanced, but still insignificant intervention effects for those who received higher intervention dose. Conclusion: This study found that implementation factors related to both level of exposure to and pupils’ comprehension of intervention content had an impact on the effectiveness of The GOOD Life intervention. These findings suggest that implementers should take these factors into account in school-based alcohol prevention programmes.

An effective technology-assisted program to prevent sleep problems among employees: findings from a multi-country workplace study

ABSTRACT. We describe a technology-assisted prevention program for sleep problems delivered in the workplace. Supported by the European Institute of Innovation and Technology (EIT, Horizon2020), the program was implemented in 2016-2017 in two sites in France and in six subsidiaries in three additional countries (China, Spain and United Kingdom) of a multinational pharmaceutical company. The program used a tablet application to measure among employees sleep duration, efficiency and quality through a 9-item questionnaire including scientifically validated scale items. During the first session of the program, 834 employees (60.1% females, n=501) completed in an isolated room the questionnaire and received, within the application, an instant personalised feedback with sleep recommendations following the Centers for Disease Control and Prevention guidelines, as well as advice to improve sleep quality and reduce sleepiness and insomnia. Immediately after the completion of the questionnaire, a health professional commented on the feedback received by each participant, customising and reinforcing the preventive messages of the program. Participants were sent by electronic mail a report of their results and attached recommendations. During the second session (follow-up) of the program, at least six months after, 291 employees (56.3% females, n=164) completed the same tablet-based questionnaire and assessed whether their sleep measures had changed or not. Using analysis of variance and adjacent logit models, we observed a significant increase of sleep duration during the week (p=0.025) and during the week-end (p=0.046). Furthermore, participants were about 2.8 times less likely to present severe sleep debt (more than 120 min), about 2.5 times less likely to report sleep problems (p<0.001) and around 1.7 times less likely to report daytime sleepiness (p=0.026) at follow-up. Women were two times more likely to suffer from sleep problems in both sessions (p=0.006). Based on the results of this program, we argue the need to introduce similar technology-assisted prevention programs in the workplace as a good “real-world” setting for prevention interventions. For this, the cost and sustainability of the program are also provided. We especially underline the benefit of combining digital and human support to foster behaviour change.

An Evaluation of the SKILLS (Support for Kids in Learning and Language Strategies) Online Programme for Teaching Assistants
SPEAKER: Anwen Jones

ABSTRACT. Increasing numbers of children are receiving additional help from school support staff to address additional learning needs. Without this, many children have poor long-term outcomes in terms of academic attainment and lifelong challenges including mental health problems and unemployment. Teaching assistants (TA’s) have wide-ranging experience but can sometimes lack skills needed to manage the social and emotional problems of some disruptive or withdrawn children. Interventions that teach parenting skills improve child outcomes. The positive behaviour management strategies taught in these programmes are also effective in improving nursery staff and teacher relationships with children, reducing negative child behaviour and improving children’s engagement. SKILLS (Support for Kids in Learning and Language Strategies) is a five week web-based programme developed for school support staff that teaches core social learning theory principles designed to strengthen TA-pupil relationships through child-led play, increase praise and develop children’s language skills. Participants were sixteen teaching assistants from six schools in North Wales, UK, who worked with children aged 4 – 7 years on a 1:1 basis. Objectives To establish whether the programme could successfully engage TAs, and to obtain feedback and suggestions for modification. Exploratory measures administered at baseline and immediately after the five week intervention examined possible changes in TA behaviour, and their sense of competence. Findings Participant responses deemed the programme beneficial to professional development, and demonstrated an overall high rate of positive feedback. Measures showed a significant increase in sense of competence and efficacy, and in the frequency of prompting language. Implications • Web-based programmes founded upon positive parenting principles can be effective in engaging TA’s to increase their use of positive behaviour strategies. • Technology can limit expense, making training more accessible to TA’s who may not always be a priority with regards to professional development. • Expanding the toolkit of TA’s can increase sense of competence.

12:30 – the automatized system of assessing prevention needs and recommending preventive activities in Polish schools
SPEAKER: Robert Porzak

ABSTRACT. The project done as requested by Polish Ministry of Education leads to prepare online platform with the diagnostic and reporting system monitoring prevention programmes done in schools. The system will contain a set of questionnaires and psychometric tests developed and adapted in the project for the diagnosis and evaluation of preventive activities. The system will recommend activities scale and type of preventive desirable for students, parents and teachers integrating school society around the prevention aims on the base of communities of practice model. The system is going to be constructed after analysis of: 1. Currently existing and desirable economic, organizational and legal-administrative conditions of prevention. 2. Preventive needs, the effectiveness of achieving preventive goals and the quality of the prevention process targeted at children and adolescents in schools of all levels. 3. Socio-cultural determinants of preventive activity, in particular the role of participants in the school community and its environment: teachers, parents, school staff, representatives of local communities. The most important variables implemented in the system are divided on the group of independent (reasons) and dependent (consequences). Variables treated as independent: 1. Symptoms of the constructive functioning of students, parents and teachers: the quality and quantity of pro-health attitudes and behaviours. 2. Students’ dispositions for self-regulation, self-confidence, coherence and hope for success. 3. Environmental model of school prevention - the relation of preventive needs to the quantity and quality of preventive activities carried out in a given school. The analysed consequences (dependent variables) include the quality and quantity of attitudes and risky behaviours of students: 1. Smoking tobacco. 2. Drinking alcohol. 3. Use of illicit psychoactive substances. 4. Use of aggression and violence, cyberbullying.

Peer influence and peer selection effects and the emergence of alcohol use and depression during adolescence: Implications for prevention
SPEAKER: Tim Slade

ABSTRACT. Background: Friends are influential in the health behaviour choices of adolescents. Adolescents whose peers drink alcohol report higher levels of alcohol consumption themselves. Yet how friendship and alcohol use behaviours co-evolve is less well understood. A separate but related body of research is emerging to show that social networks also act as powerful conduits for the spread of emotional problems such as depression. However, to date there is little research on the interplay between alcohol use and depression within the context of friendship networks. Aim: The current study examines selection and influence explanations for the spread of alcohol use and depression through Australian adolescent friendship networks. Methods: As part of a larger ongoing combined substance use, anxiety and depression prevention trial, information was collected on friendship networks from adolescents (mean age 13.1 at baseline) in 22 schools in Australia. We also collected information on perceptions of peer alcohol use, actual alcohol use, binge drinking and symptoms of depression. Stochastic actor-based modelling methods will be used to assess the strength of selection and influence processes in the evolution of alcohol use and depression over time. Results: While friendship networks have been mapped at each wave of data collection, calculation of social network indices as well as longitudinal modelling has yet to be completed. Conclusions: Uncovering the mechanisms by which the onset of drinking behaviours as well as the experience of depressive symptoms diffuse through peer networks holds great promise for understanding the etiology/causality of peer impacts on alcohol use and depression and identifying individuals strategically positioned in a network, so-called “key players”. These key players could form the basis of targeted prevention programs that capitalise on the social influence model to alter alcohol use attitudes/behaviours or emotional regulation strategies at a population level.

Using E-Health to Promote HPV Vaccination: The Women’s Stories Intervention for Planned Parenthood
SPEAKER: Rhonda Belue

ABSTRACT. HPV is a significant public health problem whose prevention and treatment, like other STDs, is confounded by issues of morality and challenges associated with treatment compliance. While effective prevention is available through a vaccine, vaccine uptake is nowhere near universal. Like many medical advances, finding and implementing strategies for taking practices to scale is a challenge further complicated by vaccine resistance within the U.S. This presentation reports on efforts, successful to date, to overcome these obstacles through a narrative, e-health intervention call Women’s Stories.

Women Stories began as a narrative intervention for college-age women delivered via videos displayed on laptops. Narratives are an ideal communication strategy for reaching resistant and/or uninformed populations, as is the case with the HPV vaccine and the technology-based delivery facilitated this process. The intervention significantly increased vaccination during a randomized clinical trial, almost doubling the uptake, resulting in recognition by the U.S. National Cancer Institute (NCI) as a “research tested intervention program”.

Even with these outcomes and this recognition, research tested interventions such as Women’s Stories are seldom ready for wide spread use because of individual and institutional barriers. Our project overcame individual barriers using technology to deliver a narrative intervention, Women’s Stories, to people seeking medical care in a clinic setting where they are more receptive to health information. Institutional barriers and the challenge of scaling up were overcome through partnering with a community-based health care system, Planned Parenthood, one of the leading providers of women’s health care. In contrast to the commonly used “build it and they will come model”, we start with the end user and integrating the intervention into existing systems. Technology played a role in accomplishing both goals. The presentation describes this innovative intervention and the challenges of integrating e-health technology for HPV vaccine promotion into the clinic setting.

Household, Moderate physical activity and the risk of breast cancer among Nigerian women.

ABSTRACT. Background Breast cancer incidence in Nigeria has risen by >120% since 2010. The mortality rate (25.9 /100 000/year) ranks highest in Africa. Studies have suggested that women who engage in household and moderate activities had lower risk of breast cancer than those who do not engage in such activities. However the roles of household and moderate physical activity (PA) in breast cancer risk have not been widely studied in Africa. With increasing access to education and improving socioeconomic status of many women in Nigeria, the household and other daily routines are expected to change. This has implications for their level of physical activity. There is a need to investigate if there is an association between household as well as moderate PA and breast cancer risk in Nigeria. Methodology The study was a multisite hospital based case-control design involving 379 histologically confirmed breast cancer cases and 403 controls. The participants aged ≥20 years were interviewed in-person between October 2016 and May 2017 using a pretested questionnaire. Cases were selected from oncology wards and controls from ophthalmology wards. Self-reported household and moderate PA were summarised as both hours per week and metabolic equivalents (MET) hours per week (met-hr/wk). Data were analysed using multivariable logistic regression, adjusting for known confounders. SPSS version 23 was used for all analyses. Findings The odd of having breast cancer(based on MET-hr/wk) was 41% less among women in the upper tertile of household PA than those in the lowest tertile (95% CI: 0.38,0.92). This was stronger among younger (OR: 0.44; 95% CI: 0.23, 0.82), premenopausal (OR: 0.40, 95% CI: 0.21, 0.75) and lean women (OR: 32; 95% CI: 0.14, 0.75).Increasing level of moderate PA was also associated with reduced breast cancer risk (P=0.04) Conclusions The study suggested that both household and moderate physical activities were inversely associated with breast cancer risk among Nigerian women. Household chores and other routine moderate activities could provide opportunities for breast cancer prevention.

The Alcohol Use Disorders Identification Test (AUDIT) in relation to severity of Alcohol Use Disorders according to the DSM 5.

ABSTRACT. Introduction: The Alcohol Use Disorders Identification Test (AUDIT) is a well-known and often used research instrument consisting of 10 items on alcohol habits. It has shown high internal and test-retest reliability, and factor analyses on general population data have shown a two-factor solution, consumption (item 1 – 3) and alcohol-related problems (Items 4-10). It has been shown that AUDIT has good criterion validity in relation to alcohol abuse and dependence according to the DSM IV. However, the introduction of DSM-5 implied a change in the diagnosis system. Instead of the diagnoses abuse and dependence the term alcohol use disorder (AUD) is employed and stratified in three levels - mild, moderate and severe. It is warranted to validate AUDIT in relation to the new diagnostic severity criteria. Method: A postal questionnaire was sent to a random sample of 1500 persons drawn from the Swedish population, half men, aged between 17 and 80 having a residence address in Sweden. The questionnaire contained AUDIT and 13 items from a DSM-5 screen. Two reminders were sent to non-responders. Statistical analyses: The percentage of risk-consumers was calculated by a simple frequency count and comparison between groups and age intervals and interaction between them were made by a two-way analysis of variance. Internal reliability was operationalized as Cronbach’s alpha and a confirmatory factor analysis tested the hypotheses of suggested factor structures among data. Additionally, an exploratory principal axis factoring evaluated the co.-variance structure among data. To evaluate the criterion validity of AUDIT against severity criteria in DSM-5 we performed a Receiver Operating Curve (ROC) analysis. All calculations were carried out with SPSS 24.0.. Clinical implications: This study provides an estimate of the prevalence of Alcohol Use Disorders (AUD) in the general Swedish population and also AUDIT cut-off levels for degrees of severity of AUD according to DSM-5 criteria. This information will be useful for future studies where AUDIT can be used to estimate the proportion and severity of AUD.

Health Literacy of 11-12 Grades Schoolchildren, their Parents and Teachers

ABSTRACT. The aim of the study: To assess health literacy level and influencing factors of 11-12 grades schoolchildren, their parents and teachers. Material and Methods. Schoolchildren, their parents and teachers were questioned using anonymous survey method. The HLS-EU-Q47 comprehensive health literacy questionnaire of 47 items, translated into Lithuanian language, has been used to assess health literacy level. The respondents were also asked about socio-demographic characteristics and other factors, which can be associated with health literacy. The statistical analysis were performed using the statistical data processing program SPSS, Microsoft Excel and WinPepi. The reliability coefficient of the survey was p<0,05. Results. The data showed that more than half of schoolchildren manifested sufficient and excellent level of health literacy. The health literacy was lower for boys than for girls, and lower for 11th graders than for 12th graders. The leading motivation for seeking health information was fear of pain. Almost all students use internet to seek online health support. Almost half of children assess their health status good. Girls more often than boys assess their health status bad. The most common health problems at school are headache and stomach ache. Approximately one third of the parents manifested a problematic or inadequate health literacy level. Smoking, less well-educated and unemployed respondents with low health literacy reported worse health status self-assessment. Limited health literacy is associated with poorer health outcomes. The results showed that a majority of the teachers belonged to the level of health literacy of „sufficient” and „excellent”. Older teachers assess their health status worse than the younger. Conclusions. More than half of schoolchildren manifested sufficient and excellent level of health literacy. Limited health literacy is associated with poorer health outcomes and worse health status self-assessment. In general, health literacy level was significantly associated with level of education and health behavior.

Micronutrient deficiency prevention and the ‘crime – counterfeit nutraceuticals’ combination in Balkan countries

ABSTRACT. The micronutrient deficiencies caused largely by a dietary deficiency of vitamins and mineral , lies upon their magnitude and their health consequences, especially in pregnant women and young children, as they affect fetal and child growth, cognitive development and resistance to infection. Overcoming micronutrient malnutrition is therefore a precondition for ensuring rapid and appropriate national development.This was the consensus reached at the FAO/WHO International Conference on Nutrition (ICN) in December 1992,where 159 countries endorsed the World Declaration on Nutrition,pledging “to make all efforts to eliminate...iodine and vitamin A deficiencies” and “to reduce substantially...other important micronutrient deficiencies, including iron.” And to do so, guidelines and strategies were published to assist countries in the design and implementation of appropriate food fortification programmes as part of a comprehensive food-based strategy for combating micronutrient deficiencies. Fortification of food can make an important contribution to the reduction of micronutrient malnutrition when and where existing food supplies and limited access fail to provide adequate levels of certain nutrients in the diet.To ensure that the target population will benefit from a food fortification programme,an appropriate food vehicle must be selected that is widely consumed throughout the year by a large portion of the population at risk of a particular deficiency. Bu instead of having new positive outputs from these strategies and guidelines, the food supply fraud, in a subcategory of Nutraceuticals, flourished in all the trades of the population with micronutrient deficiency. While most food fraud events do not have an immediate hazard, the nutraceuticals are vulnerable. The issue involves intelligent human adversaries, so the response is uniquely complex regarding mitigation and prevention

Traditional risk factors for essential hypertension: analysis of their specific combination in the EPIC Potsdam cohort

ABSTRACT. Appropriate interventions targeting specific modifiable lifestyle factors (MLFs) might have a remarkable impact on the prevention of essential hypertension. This requires a comprehensive view of population-specific data on the distribution of MLFs and their impact on hypertension risk. Objective: To determine how six MLFs (general and abdominal adiposity, alcohol consumption, smoking, low adherence to DASH diet, physical inactivity) at risk for hypertension are distributed in different combinations of occurrence and how these affect the risk. Design and Setting: Prospective study cohort, from the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)–Potsdam Study. Participants: The complete study population included 27,548 participants aged 35-65. 11,923 participants (8,107 women and 3,816 men) free from hypertension and chronic diseases were eligible for analysis. Of them 1,635 developed hypertension during a median follow-up of 10.3 years. Main Outcome and Measures: Hazard Ratios (HRs) and Population Attributable Risks (PARs%) of the six MLFs for incident hypertension had been calculated. Mutually exclusive combinations, clustering and interactions of MLFs were then investigated with details of sex-specific analyses. Results: General adiposity was the only MLF sufficient to increase per se the risk for hypertension (HR=1.86, PAR% 3.36) among participants having only 1 MLF. Among participants with risk factors > 1, the highest risk was found for the combination “general, abdominal adiposity and smoking” (HR=7.18), and highest PAR for “general adiposity and smoking” (PAR% 8.16). These combinations showed also higher prevalence than expected. Conclusions: In this German adult cohort general adiposity played a major role in enhancing the risk for essential hypertension, combined together with smoking and physical inactivity. MLFs showed remarkably tendency to occur in specific patterns rather than by chance, suggesting the advantages to promote a holistic approach through a multifactorial preventive strategy which targets more than a factor at a time.

An eHealth multiple behaviour change intervention to prevent chronic disease risk among adolescents: Development and Study Protocol of the Health4Life Initiative

ABSTRACT. Introduction: Smoking, alcohol use, poor diet, and physical inactivity are key determinants of chronic disease. More recently, screen time and unhealthy sleep have been associated with poor health. Alarmingly, these risk factors (the “Big 6”) are highly prevalent among 12-17 year-old Australians, commonly co-occur, and become entrenched by adulthood. Therefore, early and effective prevention is critical to promote current well being and reduce chronic disease risk.

Methods: This study aims to develop and evaluate an eHealth multiple behaviour change intervention to concurrently target the Big 6 among adolescents. The intervention consists of: 1) a universal, online school-based program for all students, 2) a smartphone application to track behaviours, and 3) a booster app, delivered to students who remain ‘at-risk’ as they progress throughout school. A cluster randomised controlled trial will be run in 80 schools (8000 12-13year-olds) across Australia.

Development of the Health4Life interventions, and preparation for the RCT, is in progress. Scoping activities to inform intervention development include a survey among youth to understand beliefs and knowledge about health, engagement with the Big 6, and use of smartphones. Secondary data analysis (n=853), via latent class analysis (LCA), was conducted to understand the clustering of the Big 6 among youth.

Results: The LCA indicated that the Big 6 were prevalent and clustered in 18-year olds, and associated with mental health symptoms, reinforcing the importance of intervention in early adolescence. This presentation will also report results from the online survey, and provide an overview of the interventions and RCT.

Conclusion: This will be the first trial of an eHealth multiple health behaviour intervention to concurrently target the Big 6. Addressing risk behaviours together during adolescence will not only improve the short-term physical and mental health of youth, but also carries enormous potential to enhance their capacity to lead healthy adult lives.

System of new psychoactive substances (NPS) intoxications control in Poland

ABSTRACT. The use of NPS has been a problem in Poland since 2010. Data on intoxications (deaths, non-fatal and suspicions) have been collected since the problem appeared, however, in 2013 a data collection system in today's shape was formed, which on the one hand makes it possible to compare data from all over country on the other hand, it allows you to react quickly to the sudden increase in poisoning in a given area in a short time, like in July 2015. Despite the fact that, apart from post-mortem toxicology examinations, even the biological material of acute intoxicated patients are hardly ever examined, there is the need to take into account suspected poisoning based on typical symptoms and other presumptive evidences, especially that detection of NPSs is not possible with simple tests, but only with the use of expensive and time-consuming, advanced laboratory tests. Epidemiological data on NPS intoxications from the whole country, are collected by the Chief Sanitary Inspectorate (Polish public health office) through state regional sanitary inspectorates at the regional level, who receive data from medical entities through sanitary inspectors of local level. Information on poisonings, suspicions of poisoning and deaths is collected in a two-week cycle. The collected data is transferred to the Poison Control Center in Warsaw for final verification. The data is collected via a standardized notification form, and their scope includes the following variables, especially date of medical intervention, age and gender as well as the initial of the patient, place of event, place of medical aid provided, type of assistance (out-patient, emergency care, hospitalization), the name of NPS/product. The collected data make it possible to prepare indicators (e.g. medical interventions into 100,000 inhabitants). The database gives the opportunity to present them in time series, by region, gender, age group. And learn about the trends. For example, since 2013, the percentage of intoxicated under 18 years has been steadily dropping: from 43% in 2013 to 20.5% in 2017. In 2017, there were more than 4,300 cases noticed, and since 2013, there have been almost 20,000 cases. The database is also used to prepare prevention programs.

Adherence to the Family Competence Program for Adolescents in Spain
SPEAKER: Carmen Orte

ABSTRACT. Introduction: Improving adherence of drug prevention programs is an important concern for both researchers and implementers. There are different reasons for the lack of adherence of participants to mid or long duration programs. Individual factors related with the adherence are the low socio-economic status, low educational level, scarce parental skills, depression or parental stress. Quality of implementation also impacts upon adherence. The role of facilitators is also critical. Transport access, nursery, incentives and an adapted schedule are factors associated to a larger participation. Connecting family prevention programs with schools has demonstrated its effectiveness in several programs. Overall, programs promote adherence if they are stimulating and they respond to subjective needs of participants. Here we present the adherence to 11 applications of the Family Competence Program (FCP) (Spanish version of the Strengthening Families Program 12-16), an evidence-based selective prevention program. Method: Regarding participants, 84 families ended the program (89 parents and 83 adolescents) (Experimental Group). Control group is of 23 families (23 parents and 23 adolescents). Intervention includes 11 applications of 14 sessions in five cities of Spain. About analysis, T test, Chi-square, Cochran-Mantel-Haenszel are undertaken. Results: Family retention is 85.7% in the experimental group and 92.0% in the control group. Retention of parents in the experimental group is 79.5%, and 92% in the control group. Dropout is principally a male issue (86.96% of total parental dropout). Retention is 84,7% in adolescents of the experimental group and 92% in adolescents in control group. Male adolescent dropout represents 60% of overall adolescent dropout. Main cause of dropout is work changes of participants. It is also observed a statistical significant relationship (p<0.05)(Chi Square Pearson analysis) with schools where implementations take place. Conclusions: Results demonstrate high retention. Different adherence levels occur according to type of participant (parents/adolescents) and by gender of parents (lower among fathers). High levels of adherence are associated with the organization quality of applications (schools, NGOs and social support services), with skills of facilitators (preparation and experience), and with work and social stability of participants.

Tobacco Advertisement Liking, Vulnerability Factors, and Tobacco Use among Young Adults

ABSTRACT. Introduction: Young adulthood (ages 18-24) is a crucial period in the development of long-term tobacco use patterns. Tobacco advertising and promotion lead to the initiation and continuation of smoking among young adults. We examined whether vulnerability factors moderated the association between tobacco advertisement liking and tobacco use in the United States. Methods: Analyses were conducted among 9,109 U.S. young adults in the nationally-representative Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-14). Participants viewed 20 randomly selected sets of tobacco advertisements (five each for cigarettes, e-cigarettes, cigars, and smokeless tobacco) and indicated whether they liked each ad. The outcome variables were past 30-day cigarette, e-cigarette, cigar, and smokeless tobacco use. Covariates included tobacco advertisement liking, age, sex, race/ethnicity, sexual orientation, education, poverty level, military service, and externalizing and internalizing mental health symptoms. Results: Liking tobacco advertisements was associated with tobacco use, and this association was particularly strong among those with lower educational attainment (cigarettes, e-cigarettes, cigars), living below the poverty level (e-cigarettes, smokeless tobacco), and military service (smokeless tobacco). Conclusions: The association between tobacco advertisement liking and tobacco use was stronger among young adults with lower educational attainment, living below the poverty level, and military service. Policies that restrict advertising exposure and promote counter-marketing messages in this population could reduce their risk.

Psychometric Properties of the Spanish version of the Child Anxiety Life Interference Scale for Parents (CALIS-P)

ABSTRACT. Anxiety disorders have a negative impact on the children’s life, including emotional, social, family and educational areas. Evaluation of childhood anxiety has focused mainly on symptomatology, and measures of anxiety life interference in children are scarce. Furthermore, collecting information about interference of anxiety in the children’s and their family daily functioning through multiple informants is recommended for a better diagnostic and intervention. The Child Anxiety Life Interference Scale – parent version analyses life interference and impairment related to children's anxiety both in their own daily functioning and in their parents’ life. This study aimed to examine the psychometric properties of the Spanish version of CALIS-P in children aged 6-8 years old. Participants were 181 primary school children (45.9% girls), and data was collected through their parents, who answered a survey on their children’s emotional status. The factorial structure, reliability, convergent and divergent validity of the Spanish CALIS-P were examined. Confirmatory factor analysis supported the good fit of the original three-factor model, including “Outside Home Interference”, “At Home Interference” and “Parent Life Interference”. High internal consistency of the Spanish version of CALIS-P was found for the total score (alpha = .91) and subscales (alpha = .75 - .87). Temporal stability after 4 weeks was also satisfactory (ICC > .65). Convergent validity was proven by positively correlations among CALIS-P and measures of anxiety symptoms (SCAS-P, SDQ-P), and divergent validity was supported with negative correlations with the Prosocial behavior scale of SDQ-P. The results provide evidence of the instrument utility both in research field and in the clinical practice.

Short-term effects of a transdiagnostic prevention program in reducing emotional symptoms in a non-clinical sample of Spanish-speaking children

ABSTRACT. Emotional disorders, such as both anxiety and depression, are common comorbid conditions among Spanish children. Super Skills for Life (SSL) is an 8-session transdiagnostic prevention program focused on comorbid anxiety and depression symptoms, which effectiveness was proven in English children. This study aimed to examine the effectiveness of SSL program for reducing comorbid symptoms of anxiety and depression in a non-clinical sample of Spanish children. This study enrolled nine schools located in the province of Alicante, Spain. A total of 2,700 parents of children aged 8-12 were invited to participate by responding a screening survey. Of them, 181 participants’ parent responded and 125 children met the criteria to participate (anxiety symptoms) and responded the pretest survey. Finally, 119 children aged 8-12 years, 51 females (42.9%) received the intervention. Children completed individually measures of anxiety and depression, interference of anxiety with their lives, and other emotional and behavioral difficulties before and after the intervention. Generalized estimation equations and adjusted odds ratios were calculated in order to assess the effectiveness of the intervention. Immediately after the intervention, a significant decrease in anxiety and depression symptoms, as well as in the other analyzed outcomes, was observed. Compared to the baseline assessment, children were less likely to present symptoms of generalized anxiety, separation anxiety, depression, dysphoria, negative self-esteem, anxiety life Interference, emotional symptoms, and general difficulties (i.e., including emotional and behavioral difficulties) in the posttest. Our findings provide initial support for the effectiveness of SSL program for reducing comorbid emotional problems in the short-term in Spanish-speaking children. This study suggests the suitability of the program as a prevention strategy for non-clinical Spanish population with anxiety and depression symptoms. Long-term effects of SSL in Spanish children need to be explored.

Climate Schools Plus (CSP): Implementing & evaluating an integrated online intervention for students and parents to prevent alcohol and cannabis harms among adolescents

ABSTRACT. Early initiation of substance use significantly increases risk of developing substance dependence and mental disorders later in life and parents play a key role in preventing substance use among their adolescents. The current study aims to address this by evaluating the effectiveness of the first integrated, online substance use prevention program for students and parents – Climate Schools Plus (CSP). The CSP study builds on the success of the Climate Schools program, with the addition of a newly developed parenting component, based on a successful Dutch program [1] and informed by consultation with parents, teachers and researchers.

A cluster RCT is being conducted with Year 8 students and their parents from twelve schools between 2018-2020, in which schools are randomly alloacted to receive either the CSP program or their usual health education. Measures include substance use, parental self-efficacy, communication quality etc. and participants will also be asked to provide feedback on the intervention content (e.g., how acceptable, appropriate and enjoyable did they find the program).

This presentation will describe the results of beta-testing, conducted with over 200 parents, who reported they were not confident they could stop their child becoming drunk and would be interested in accessing an interactive, self-paced prevention program from a reputable institution. The presentation will also outline the feedback obtained from participant evaluations of the year 8 intervention, which are currently underway.

If proven to be effective, this comprehensive program could be implemented widely, as part of a national strategy to significantly reduce the burden of disease, social costs, and disability associated with early substance use in adolescents. Furthermore, the CSP program has the potential to bridge the gap between evidence-based research and parent-practices by allowing parents direct access to research output via the convenience of an online platform.

14:00-15:30 Session Parallel 1.1: SCHOOLS, MENTAL HEALTH, AND WELLBEING


Beyond individual achievements: is there a link between school social and pedagogic climate and adolescents’ mental health?

ABSTRACT. Introduction The associations of school achievement (academic grades); truancy; and other indicators of school affection and school social integration with mental health of young people are well known. However, whether a school’s overall climate and pedagogic environment influence adolescent mental health through these or other mediation mechanisms is not known. These questions are highly relevant in the European context of high labour market competition, uncertainty about school status and mission, and increasing rates of mental ill health among youths. We sought to assess this relationship in a longitudinal study of adolescents attending the last three years of the Swedish compulsory school. Methods A longitudinal study was initiated in 2013 comprising 3959 students from 101 schools in Central Sweden, with 3-year follow-up (the Kupol Study Participants were in average 13 years old at inception. Information about mental health was provided by the students themselves and by their parents through questionnaire-based annual surveys. School climate was investigated through aggregate measures provided by students exiting the last school grade and by the teaching personnel answering the PESOC, a Swedish scale developed to capture pedagogic and social dimensions of school environment. Lastly, a subsample of the cohort donated saliva samples for the analysis of DNA epigenetic changes. Results Available results from studies based on this cohort’s data will be presented and discussed. Among these: 1. Children’s and their parents’ high academic expectations and aspirations seem to predict rather good than poor mental health 2. Favourable school pedagogic environment as rated by teachers (but not as rated by students) predicts symptoms of mental ill health among students 3. Favourable school pedagogic environment is associated with lower frequency of bullying and of truancy 4. There is a cross sectional association between epigenetic changes and self-reported symptoms of depression and anxiety, as well as between negative school experiences and epigenetic changes Conclusions School climate is a multi-dimensional construct that can be linked to adolescent mental health through multiple pathways. Mental health, learning achievements and academic goals should be addressed in school- based prevention policies and program as part of a unique developmental trajectory.

Implementation of a new indicated prevention program for school children with symptoms of anxiety and depression

ABSTRACT. Introduction: Implementation of interventions into routine primary care settings is challenging. Limited resources and a lack of support from implementing organizations and program developers present challenges to transition of interventions from adoption to full sustainability. Children`s mental health service settings are often multilayered and complex. Diverse policies and governmental regulations overlay service settings in which individuals with diverse attitudes and experiences work. Research has shown that interventions including implementation support, produce better outcomes than those that do not. The aim of this study was to investigate the implementation quality of an ongoing effectiveness evaluation of the EMOTION intervention, an indicated CBT prevention program for children with symptoms of emotional problems.

Methods: Trained health care and childcare professionals from different municipal services (e.g., school health care services) delivered EMOTION in schools. The professionals (N = 68) filled out a survey before and after running groups (96 % women, mean age = 39.6, SD =9.7). The pre-group survey contained questions regarding professional background and experience, and organizational factors (e.g., leadership, work culture and autonomy). The post-group survey measured the group leaders` satisfaction, together with their intention to continue running EMOTION groups. The children (N = 274) were assessed before, midway, and after completion of the intervention groups, using the Multidimensional Anxiety Scale for Children for Children (MASC-C), and the Mood and Feelings Questionnaire, short version (SMFQ).

Results: A model of the relationship between group leader characteristics, organizational characteristics, and treatment outcomes within the intervention group, will be tested using multilevel, SEM analyses.

Discussion: The discussion will focus on how group leaders and their organizations affect the children`s outcome after completion of the intervention through the quality of delivery. Improving the implementation processes by identifying relevant factors is an important contribution to succesfull implementation of indicated preventive interventions in children`s mental health services.

How to reduce cyberbullying at schools? Construction and evaluation of new electronic aggression prevention programme aimed at adolescents

ABSTRACT. The presentation aims to introduce a new prevention program called IMPACT (Polish abbreviation from Interdisciplinary Model of Preventing Aggression and Cyberbullying) developed by a consortium composed of NGOs: the Praesterno Foundation, Empowering Children Foundation and academic institutions: the Faculty of Psychology of the Warsaw University, Warsaw University of Technology and Nofer Institute of Occupational Medicine in Lodz as part of a project co-financed by the Polish National Center for Research and Development (Social Innovations II program). The program integrates elements of pedagogical and psychological intervention as well as aspects of internet security skills. Construction of the program was preceded with psychological diagnosis of peer electronic aggression phenomenon and identification of factors that could serve as inhibitors of cyberbullying (focusing on safe-control and empathy-activation). Developed on the basis of interdisciplinary scientific research and educational experience of NGOs taking part in the project, the innovative 10-hour program includes detailed lessons plans together with auxiliary multimedia materials. From November 2017 to June 2018 pilot implementation was carried out in 30 schools from different regions of Poland. The implementation of the program in these schools was carefully monitored and evaluated, including the measurement of the preventive impact of the program. The results of this evaluation will be presented along with the conclusions for the practical implementation of the program to schools and possibilities of trans-cultural adaptation.

Time for Change - An Innovative Approach to Create a Digital Offer

ABSTRACT. Recent data (Carli et al., 2014, Wagner et al., 2017) indicate that a significant proportion of young people are temporarily experiencing an increased risk behavior regarding the consumption of alcohol, nicotine, illicit drugs and/or games of chance. At the same time, digital media play a major role in the daily lives of young people and young adults in Austria. A recent youth trend study identifies, that 96.7 % of 14- to 19-year-olds in Austria own a smartphone (Institut für Jugendkulturforschung, 2014). For this reason, it seemed obvious to create a digital offer to increase risk awareness and harm reduction for this vulnerable group. The goal for this innovative E-Mental Health project is to empower young people to develop skills to manage risks associated with the use of legal/illegal substances and/or games of chance through a low-threshold web based intervention. Therefore, the Institute for Addiction Prevention Vienna, a subsidiary of the Office of Addiction and Drug Policy of Vienna, developed digital prototypes using the "Design Thinking Approach" (Lewrick et al., 2017). In her talk, Dr. Malischnig will present the process that has been dealt. She will show which jobs are to be done to develop a project with the help of the “Design Thinking Approach”. The task starts with understanding and analyzing the real life situation of the target group and concludes with the creation of plenty of innovative ideas for digital prototypes. In her project the ideas for designs were subsequently assessed by representatives of the target group to be sure that the results effectively meet their needs. It is shown that the selected method is suitable to develop innovative health promotion, prevention, treatment or relapse prevention programs.

Initiating change in the school environment to reduce bullying and aggression: a cluster randomised controlled trial of the Learning Together (LT) intervention in English secondary schools
SPEAKER: Emily Warren

ABSTRACT. Background Bullying and aggression among young people are some of the most importnt mental health problems. The Learning Together intervention involved students in efforts to modify their school social environment using restorative approaches. We hypothesised that in intervention schools there would be lower rates of self-reported bullying, perpetration of aggression, and improved student secondary outcomes at follow-up compared with controls.

Methods Design: Cluster RCT with integral economic and process evaluations. Setting: 40 secondary schools across southeast England. Assignment: Schools were randomly allocated to implement LT over 3 years or continue with standard practice (controls). Intervention: Schools were given a) a social/emotional skills curriculum, b) staff training in restorative approaches, c) an external facilitator to convene an Action Group to revise policies and oversee delivery, and d) data on local student needs to inform decisions. Primary outcomes: Self-reported experience of bullying victimization (Gatehouse Bullying Scale; GBS) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime (ESYTC) school misbehaviour subscale) measured at 36 months. Analysis: Intention-to-treat analysis using longitudinal mixed-effects models.

Registration: ISRCTN10751359

Findings 6667 students participated in baselines (93.6%) and 5960 (83.3%) at final follow-up. No schools withdrew from the study. Primary outcome: GBS scores were significantly lower amongst intervention schools than controls at 36 months (adj mean difference [95% CI];-0.03 [-0.06, 0.00]). There was no evidence of a significant difference in ESYTC scores. Secondary outcomes: Students in intervention schools reported higher quality of life (1.44 [0.07, 2.17]) and psychological wellbeing scores (0.33 [0.00, 0.66]); lower psychological total difficulties (SDQ) score (-0.54 [-0.83, -0.25]); and lower odds of having smoked (OR [95% CI]; 0.58 [0.43, 0.80]; drunk alcohol (0.72 [0.56, 0.92); been offered/tried illicit drugs (0.51 [0.36, 0.73]); and being in contact with police in the past 12 months (0.74 [0.56, 0.97].

Interpretation LT was effective across a broad range of key public health targets for adolescents. Universal school-environment interventions are a highly promising approach to promoting health and wellbeing in adolescence.

14:00-15:30 Session Parallel 1.2: ILLICIT SUBSTANCES

Parallel Session 1.2: ILLICIT SUBSTANCES

Location: EMCDDA 107
International Standards on Drug Use Prevention, UNODC/WHO Second Updated Edition

ABSTRACT. In March 2018, UNODC and WHO launched the International Standards on Drug Use Prevention, Second Updated Edition. These Standards summarize the globally available scientific evidence, describing interventions and policies found to be effective in preventing substance use, outlining the characteristics linked to positive, no or negative outcomes. Concurrently, they offer guidance on the features of effective national drug prevention systems. The Standards aim foremost to assist decision makers worldwide to improve their national prevention systems by implementing evidence-based prevention strategies. The first edition of the Standards were developed based on a review of literature published prior to 2013. At that time, the identified good quality literature originated almost entirely from western high income countries. Furthermore, the evidence was scarce with regard many areas of prevention that have evolved since, such as online programs or programs targeting older adolescent or vulnerable populations. For the Second Updated Edition, UNODC and WHO have undertaken an update of the Standards to take stock on the advances made in prevention research by conducting a review of systematic reviews published between 2013 and 2018, also capturing the research on the emerging areas of prevention. The methodology of the review will be presented including reflections on using the ROBIS quality assessment tool and providing a summary of key findings and observations as well as identifying emerging areas for prevention, including the use of technologies, that merit further research in order for them to be considered at the level of evidence. Furthermore, the plans for disseminating the Standards using communication technologies as well as potential ways of using them as a vehicle for supporting better quality and coverage of prevention worldwide will be discussed.

Web-based self-help vs. chat-counselling vs. adherence-focused guidance for cannabis misusers

ABSTRACT. Background: In European countries, cannabis is the most commonly used illicit drug. Offering a web-based self-help tool could potentially reach users who otherwise would not seek traditional help. In a previous study, we demonstrated that chat-counselling in addition to Web-based self-help increases adherence and effectiveness, but was rarely used. Thus, the aim of the current study is to increase adherence in cannabis misusers with different Web-based treatment offers. Methods: A three-arm RCT to compare the effectiveness of (1) a web-based self-help intervention with adherence-focused guidance and social presence (arm 1); (2) a similar intervention without social presence (arm 2); and (3) a waiting list at reducing cannabis use in problematic users. The two active interventions consist of 8 modules designed to reduce cannabis use and attenuate common mental disorder symptoms based on the approaches of motivational interviewing and cognitive behavioral therapy. Data is collected at baseline, 6 weeks, and 3 months after baseline. Data analysis follows the intention-to-treat (ITT) principle and uses multiple imputation by chained equations to deal with missing values. Results: Intermediate ITT analyses demonstrate effectiveness in form of harm reduction for smoked standard joints in study arm 1 (beta=-10.41, SE=4.80, t=-2.16, p=.04, d=-.95), as well in the one without social presence (study arm 2; beta=-11.45, SE=3.60, t=-3.18, p < .01, d=-1.06) in comparison with the waiting list. These effects were higher as in the previous study with the chat-counselling offer. The intervention arm without social presence was also effective compared with the waiting list in the number of consumption days (beta=-5.75, SE=2.39, t=-2.40, p=.02, d=-.89). There was no increase in adherence regarding the number of finished modules (VB1: M=2.7, SD=2.6; VB2: M=2.3, SD=2.5; t=0.81, df=142, p=.21). Conclusions: The preliminary results could not show higher adherence as was postulated. However, the effectiveness of both interventions is very promising compared to the results of our previous chat-based counselling study but has still to be viewed with caution as we have included half of the required total sample so far. The complete study is to be expected to be published in the summer of 2019.

The effectiveness of parallel adolescent and parent interventions to reduce substance use among immigrant and refugee youth

ABSTRACT. Purpose: The purpose of this study (2012-2017) was to assess the combined effectiveness of two efficacious parallel interventions for immigrant and refugee adolescent substance use prevention: a parenting program, Families Preparing the New Generation (FPNG); and a school-based youth curriculum, keepin’ it REAL (kiR). The study followed an ecodevelopmental perspective.

Methods: To test effectiveness, the research team relied on a community partner to deliver the interventions under “real world” conditions in a large urban center in the USA with high numbers of immigrant and refugee families. Parent-adolescent dyads (N=532) from 19 middle schools were randomized into three intervention conditions: Parent-Youth (PY), Parent Only (PO) and Comntrol (C). Data were collected through four surveys: baseline (T1), 4 months (T2), 8 months (T3), and 20 months (T4). The interventions occurred between T1 and T2. Generalized estimating equations (GEE) were used to estimate the effectiveness of the interventions on the use of different substances. Multiple imputations were used to handle attrition and missing data. The final analytic sample included 508 youth.

Results: The results indicate that between T1 and T4, adolescents in the C condition had significantly higher probabilities of overall substance use, while adolescents in the PO condition had marginally lower probabilities of overall substance use between T2 and T4. Adolescents in the PY condition remained stable over time with no significant increases or decreases in substance use. At T4, adolescents in the PO condition were significantly less likely to report overall substance use compared to adolescents in the C condition. The same pattern of results were seen separately for alcohol use. There were no significant differences between the intervention groups over time in inhalant, cigarette, or marijuana use.

Discussion & implications: The parent only (PO) conditions yielded the strongest effects. This finding has important implications for prevention with this population. It highlights the importance of involving families in any prevention efforts for youth. Future research includes the replication and adaptation of the intervention in partnership with European countries with high numbers of immigrants and refugees. Additional implications for prevention and cultural adaptation science as well as translational research will be discussed.

E-health and m-health: using new technologies to respond to drug problems

ABSTRACT. In this presentation - based on a recent EMCDDA commissioned paper - we will provide a definition of e-health and m-heath tools to address substance use problems, and a taxonomy to describe such tools systematically. A number of examples of e-health tools that are currently being used in Europe for prevention and harm reduction of substance use will be presented, based on a selective literature search. It was found that most of the available research has focused on the reduction of cannabis use, alcohol moderation and smoking cessation, and to a lesser extent on reducing use of stimulants and opioids. Recent reviews and other studies on the effectiveness of e-health tools will be discussed. The presentation concludes with a number of future challenges for the wider implementation of e-health and m-health for substance use prevention in Europe.

Internet-based prevention for alcohol and other drugs: An overview of the universal Climate Schools prevention programs

ABSTRACT. Objective: Substance use is one of the leading causes of burden of disease among young people, and effective prevention is critical. The Climate Schools courses are online, universal school-based programs designed to prevent alcohol and other drug use and related harms among adolescents. Developed in consultation with students, teachers and health professionals, the courses utilise cartoon storylines, quizzes and group activities, within an online delivery framework, to engage students. The aim of this presentation is to provide an overview of the effectiveness of the Climate Schools courses and to discuss future directions for dissemination and ongoing development.

Methods: To date, four Climate Schools modules have been developed and evaluated: 1) Alcohol module; 2) Alcohol & Cannabis module; 3) Cannabis & Psychostimulants module; and the 4) Ecstasy & Emerging Drugs module. Approximately 14,000 students from 157 schools in Australia have participated in six randomised controlled trials (RCTs) of these Climate Schools courses. In each RCT, schools were randomly allocated to an intervention (Climate Schools) or control group (health education as usual). Students completed self-report surveys across multiple time points assessing alcohol and other drug use, harms, and knowledge. Multi-level models were conducted to analyse group differences over time, taking into account the clustered nature of the data.

Results: Results from the RCTs have shown the Climate Schools courses to be effective in increasing knowledge about alcohol and other drugs (Cohen’s d=.56 to .77), decreasing alcohol use (d= up to .42), binge drinking (d= up to .56), cannabis use (d=.19) and reducing alcohol-related harms (d=.20). Moreover, all of the Climate Schools modules were well-received by students and teachers, with teachers rating the programs as having high educational quality, and more favorable than other drug and alcohol education programs.

Conclusions: Climate Schools provides schools with evidence-based prevention resources that can be readily accessed online. Future directions include continuing to take the intervention to scale, and evaluating the effectiveness of an integrated online program for students and parents, known as the Climate Schools: Student & Parent intervention.

14:00-15:30 Session Parallel 1.3: ALCOHOL

Parallel Session 1.3: ALCOHOL

Location: EMCDDA 012
Implementation and qualification of preventive programs and production of evidence: an integrating approach of systemic variables and epidemiological data

ABSTRACT. Evidence-based prevention programs have been implemented and evaluated in different contexts and cultures resulting in improvements in quality of health interventions. At the same time, results and evidences are often interpreted in isolation, with little consideration of social, cultural, and context realities as well as cultural and systemic phenomena. There is even a opposition between the understanding of social and systemic problems and punctual actions and measures focused on the effect on individuals. This study relates data and experience in Brazilian health and education system and aims to understand such detachment and to point out relations between qualification of an intervention, evaluations and epidemiology but also observe the system of relations that receive interventions.

In Brazil prevention technology has been implemented on a large scale since 2013 with 3 school and community-based programs (Brazilian versions of Unplugged, GBG, and Strengthening Families), as public policy through the Ministry of Health and Justice, including studies as the first RCT on the #Tamojunto (Unplugged version) program, among others various analyses and researches.

Based on these experiences, can be evidenced relationships between health and education network management data with epidemiological - what therefore can contribute to public policies as well as qualification of prevention practices. One example is that data from RCTs indicates that one of the prevention programs had mixed results with increased alcohol experimentation, (use in the year and use in life) and protection on use of inhalants and also protection for receiving bullying. On the other hand, teachers, students, practitioners and policy makers and other researchers observed strong adhesion to the program, although demand and dissemination limited by the training capacity of the federal government.

The intersection of this information with other social variables is what makes the political decision very complex. Preventive actions may play a role in replacing highly iatrogenic or combat practices (with no theory bases or efficiency studies) so it is necessary to have this broad vision to reconcile management decisions with improvement of programs beyond to consider serious social crises, associated with crime, urban violence as relevant phenomena and that impact prevention practices.

Regulating alcohol marketing as a preventive measure for alcohol-related harm: Towards a suitable model for Belgium

ABSTRACT. Background - Exposure to alcohol marketing can lead to earlier alcohol drinking initiation and increased alcohol consumption. Although restricting alcohol marketing is identified as one of the most cost-effective measures to prevent alcohol-related harm, Belgium still has limited regulation on alcohol marketing. The aim of this policy-oriented study is to find a regulatory model that protects public health and fits within the Belgian context.

Methods - We studied six regulatory models in Finland, France, Norway, Poland, The Netherlands, and the United Kingdom, by means of document analysis and explorative expert interviews. Furthermore, we conducted semi-structured interviews with Belgian stakeholders (n=20) to understand their perception of a suitable regulation model for Belgium. The sample consists of private actors, policymakers, researchers and (public) health actors.

Results - In the studied countries, rules concerning alcohol marketing are incorporated in statutory and non-statutory bodies. The models range from including comprehensive general bans to flexible voluntary codes. Most stakeholders disagree that strict state-regulation fits the Belgian context. It is questioned whether a restrictive model is appropriate and feasible in a context where alcohol production and consumption is socially, culturally and economically embedded in society. In addition, some actors challenge the effectiveness of stricter regulation if it is not part of a more comprehensive alcohol policy.

Discussion - From a public health perspective, a restrictive alcohol marketing approach is recommended. Countries with perceived ‘alcohol cultures’ (e.g. France) illustrate that strict regulation models are feasible. However, the lack of support among stakeholders increases the likelihood of future relaxation of the regulations and a decrease in effectiveness. The current study recommends a model that stipulates the allowed marketing communications instead of the prohibited practices. This offers the possibility to allow certain types of alcohol marketing, with a limited risk of undesirable substitution effects. Lastly, a restrictive alcohol marketing approach will be most effective in preventing alcohol-related harm within the framework of a comprehensive multi-domain alcohol policy.

Closing the gap between research and intervention implementation: a welcome challenge
SPEAKER: Ina Koning

ABSTRACT. As recognized by the conference organizers, the use of research findings in intervention development and implementation remains a challenge. In the current study, we face this challenge by involving several stakeholders in the development of an intervention targeting alcohol use in a small municipality in the Netherlands. Moreover, the development of the intervention activities has a strong scientific foundation. A needs assessment has been conducted, making use of qualitative as well as quantitative data collection methods, longitudinal data will be collected and a comparable control group is used. However, in practice a cultural change is needed, people can’t wait to undertake action, or show high resistance. Also, policy makers are much in favor of the so-called 'Iceland model', an integral intervention program targeting substance use. Yet, we opt for the evidence to provide input for intervention development. The design of the study, results of the needs assessment as well as the ways that were and will be undertaken to close the gap between research and intervention implementation will be discussed.

Effectiveness of a selective prevention program targeting personality risk factors for alcohol misuse among young adolescents: Results of a cluster randomized controlled trial and implications for implementation

ABSTRACT. Aim: Preventure is a selective school-based alcohol prevention program targeting personality risk traits. To explore whether specific groups of adolescents (i.e., scoring high on personality risk traits, having a lower education level, or being male) benefit more from the Preventure intervention with regard to curbing their drinking behaviour. Design: A clustered randomized controlled trial, with participants randomly assigned to a 2-session coping skills intervention or a control no-intervention condition. 699 adolescents aged 13–15; 343 allocated to the intervention and 356 to the control condition; with drinking experience and elevated scores in either negative thinking, anxiety sensitivity, impulsivity or sensation seeking. Measurements: Differential effectiveness of the Preventure program was examined for the personality traits group, education level and gender on past-month binge drinking (main outcome), binge frequency, alcohol use, alcohol frequency and problem drinking, at 12 months post-intervention. Findings: On the one hand, logistic regression analyses revealed no significant effects on the primary outcome binge drinking, and the secondary outcome measures alcohol use, problem drinking, alcohol and binge drinking frequency at 12 months post-intervention. On the other hand, latent-growth analysis revealed that the intervention overall resulted in significantly less growth in binge drinking and binge drinking frequency over 12 months’ time. Subgroup analyses revealed that the intervention was primarily effective among the personality traits of anxiety sensitivity and sensation seeking, and among young adolescents with a lower level of education. Within these groups, intervention effects were found for binge drinking and alcohol use at 12 months post-intervention. Conclusions: The alcohol selective prevention program Preventure appears to have effect on the prevalence of binge drinking and alcohol use among specific groups in young adolescents in the Netherlands, particularly personality traits and lower educated adolescents. Implementation: Based on these results the intervention has been further developed for other school types, e.g. demonstration schools and special needs education. These type of schools have a vulnerable population of students, including students with psychiatric disorders, problem behaviours, and mild intellectual disabilities. An implementation pilot is carried out at these schools. The results of this pilot will be available at the time of the conference.

The impact of alcohol health warning labels on drinking behaviours: an international survey
SPEAKER: Emma Davies

ABSTRACT. Background: Alcohol is responsible for a large share of death and disability around the world. Legislation is the most effective way to reduce consumption, but providing information to drinkers is also important to raise awareness of health impacts. The European Union has recently called for some information, such as the strength of drinks and calorie content, to be mandatory on alcohol labels, and research has started to explore the effects of including health information. However, there is still a lack of evidence for the effectiveness alcohol labelling, as well as about the most appropriate messages to deliver. Methods: The Global Drug Survey (GDS) is a large anonymous cross-sectional web survey. This study included data from 77,974 respondents who reported alcohol consumption in the last month (64.2% male) during November and December 2017 (GDS2018). Seven health messages relating to liver disease, cancer, heart disease, calories, violence, taking two days off, and myths about benefits of drinking were presented. Respondents were asked if the information was new to them, if they believed it, if it was personally relevant, and if it would change their drinking. Results: The message that cancer was associated with alcohol use was the least well known, and this label had the potential to encourage almost 40% of drinkers to think about drinking less. The label suggesting there were few health benefits associated with alcohol was believed by the smallest proportion (62%) of respondents. The message about violence was rated as the most personally relevant label (40%). Discussion: These findings support the call for mandatory health warning labels on alcohol. Although information may not be sufficient by itself for behaviour change, health warning labels could play a role as part of a broader package of measures to reduce alcohol related harms. More work is needed to explore the optimal type of messages and images that will have the most impact on behaviour. Further research should also address factors that influence whether drinkers see health messages as personally relevant to them, as this may be a barrier to effectiveness.

14:00-15:30 Session Parallel 1.4: INNOVATIONS IN PREVENTION


Location: Palacete 007
Hot spot analysis of crime in Krakow (Poland)
SPEAKER: Ewa Radomska

ABSTRACT. Researchers associated with geography of crime or environmental criminology have for years proven that crime is a spatially heterogeneous phenomenon. Each place can create a separate microenvironment differing in the social and economic status of people residing and staying there, the level of formal and informal social control, the degree of social cohesion and the architectonic system. Certain characteristics of public space may correlate with greater or lesser susceptibility of a place to problems related to the crime of a given type or public disorder. The presentation will focus on the use of crime map technology and Geographical Information Systems (GIS) in the local crime prevention policy. We will present the results of the exploratory analysis of Krakow's hot spots, i.e. places where an above-average accumulation of crimes is not accidental. It is indicated that even half of all criminal events committed in a given area can be concentrated in hot spots and many problems with crime could be solved more efficiently if we focused on them.

Gamification of physical activity as a method of addressing health and social inequalities – Findings from 18 UK interventions.

ABSTRACT. Background: People who are physically active have a 20-30% reduced risk of premature death, however a recent review concluded insufficient evidence for current population physical activity (PA) interventions, citing scalability as a major contributory factor. Beat the Street aims to address this key implementation issue by turning a town/city into a game where players register their walking and cycling journeys by tapping a smartcard on RFID readers called ‘Beat Boxes’ placed on lampposts around the town or city. Players monitor their progress via a website where they can see their own and their team’s progress, and the overall city/town target.

Methods: During registration, participants completed a questionnaire which included a validated physical activity (PA) measure. Follow up surveys were distributed at the end of the game and up to 8 months later. Pre-intervention/post-intervention comparisons were completed based on survey responses and in-depth analysis was completed based on data from each player’s activity by tapping their smartcard on beat boxes.

Results: In 2016, 18 community-wide interventions were delivered throughout the UK. In total, 300,053 people played the game, 64,512 players registered online and 6,767 players completed a follow-up survey immediately following the game period. Across all interventions delivered in 2016, 62% of participants were living in the highest 4 deciles of multiple deprivation and 10% had a long-term medical condition. Pre-test/post-test analyses revealed a 9% increase in the proportion of people meeting the World Health Organisation PA guidelines and a 5% decrease in the proportion of people reporting being inactive (p <.05).

Conclusions: The findings from 18 Beat the Street interventions delivered across the UK in 2016 suggests gamification is a promising approach to changing population levels of PA. The demographic characteristics of participants implies gamification may be particularly effective for reaching typically ‘hard-to-reach’ groups such as those living with a long-term medical condition and those living in areas of high deprivation.

Preliminary results from the effectiveness study of the preventive EMOTION intervention and use of technology to improve uptake of the intervention in the services.

ABSTRACT. ABSTRACT BODY: Introduction: Anxiety and depression are common disorders in childhood. Having elevated levels of internalizing symptoms may also reduce functioning and increase the risk of later development of anxiety or depression. The new transdiagnostic preventive intervention (EMOTION) targeting symptoms of anxiety and depression in school aged children was evaluated. First prelimenary results are presented. Then, planned use of innovative methods and technology to meet the pressures of practice, improve uptake and ensure continued quality improvement are discussed.

METHODS: A cluster randomized controlled study with school children (N = 873) aged 8 – 12 years was conducted in multiple schools (N = 36) in Norway to evaluate the preventive EMOTION intervention. With informed consent, N = 1686 children were screened using the Multidimensional Anxiety Scale for Children (MASC-C) and the Mood and Feelings Questionnaire, short version (SMFQ). Children scoring 1 SD or more above an expected population mean on the measures of anxiety and depression were invited to participate in the study. Parents of these children also reported on measures of anxiety and depression.

RESULTS: The preliminary results from the effectiveness evaluation of the preventive intervention, indicating reduced levels of anxious and depressive symptoms, will be presented. Plans to meet the pressures of practice and to ensure uptake of the intervention in the youth services using partial internet-based delivery and use of virtual reality technology as promising innovations will be discussed.

CONCLUSION: The new preventive transdiagnostic EMOTION intervention reduced symptom levels of anxiety and depression. To meet the pressures in the services, improve uptake and ensure continued quality improvement of the new promising preventive intervention, use of innovative approaches will be discussed.

Efficacy and conditions of efficacy of a smoking cessation e-'Tabac Info Service': ee-TIS trial, a combined approach for evaluation
SPEAKER: Linda Cambon

ABSTRACT. An e-'Tabac Info Service' (e-TIS) has been designed to provide intensive support to smokers who are wishing to quit. It is based on effectiveness criteria of online programs, various theoretical models, psychosocial and behavioural change theories and tobacco specialists' expertise. E-TIS helps smokers to progress through different stages (contemplation, intention, action) providing tailored activities, self-reporting exercises, tips, social or psychological support, reassurance and motivational text messages. These contacts are adapted to individuals and progress levels. E-TIS evaluation started in 2017 and still runs. Its aim is to i) assess e-TIS efficacy and ii) describe e-TIS efficacy conditions through the Medical Research Council recommendations for the process evaluation of complex interventions. The study is a two-arm pragmatic randomised controlled trial including a process evaluation with 3000 participants randomised to the intervention or control arm (current practices). The main judgment criterion is the point prevalence abstinence (PPA) of 7 days at 6 months. The efficacy is blind analysed by comparison at 3, 6, 12 months of the primary and secondary endpoints in both arms (e.g. PPA and continuous abstinence). To assess the processes, we will clarify the intervention components (BCTs used in e-TIS) and the environmental components to which the subjects have been exposed. We will also look into how e-TIS has been used (frequency and duration of use, activities performed). To do so, we will characterize the intervention theory by attributing one or several BCTs to each contact (e.g. messages, activities, questionnaires). This will be carried out by a multidisciplinary committee as follows: (1) two groups of researchers will attribute BCTs to contacts, (2) both groups will compare their results and draw a consensus and (3) researchers will present their results to the committee which will draw in turn a consensus. Then we will describe the pathway of users in the intervention arm and analyze the influence of users characteristics, processes, context and exposure to BCTs on the outcome. For the EUSPR conference, the evaluation protocol, preliminary results on e-TIS efficacy and conditions of efficacy will be presented. This study helps to design comprehensive and contributive evaluations of existing apps.

Using innovative, interactive, virtual reality gaming technology to reduce risky sexual behavior in early adolescents: The challenges of testing and implementing innovative, cutting edge prevention technology
SPEAKER: Michael Hecht

ABSTRACT. An interdisciplinary research team from nursing, communication, public health, performance, and gaming technology disciplines successfully developed, implemented and evaluated the Mighty Girls curriculum to reduce risky sexual behaviors among early adolescent Latinas. While overall US teen pregnancy has declined, it remains high among US Hispanics/Latinos and in any case, exacts significant personal and social costs whenever it occurs. The team developed a curriculum, Mighty Girls, that combines face-to-face interactive lessons with a highly interactive, single player, virtual reality computer game (DRAMA-RAMA). The lessons teach about the consequences of choices, and sexual pressure resistance skills. The game reinforces lesson content and builds resistance skills by creating a live simulation of everyday early adolescent social encounters involving peer pressure. Results for a randomized group efficacy trial indicate that the Mighty Girls program significantly effects resistance self-efficacy and heavy petting behavior 3 months post intervention relative to baseline levels. The project, however, was not without implementation challenges involving the use of innovative, cutting edge, internet based technology in low income schools. The presentation will describe: (1) the technology that underlies this virtual reality computer game, and the advantages of using simulated peer interactions over traditional role play; (2) how this computer game was created, including the evidence that was used to guide and inform this process; (3) evaluation findings; (4) the challenges of interdisciplinary disciplinary work, (4) challenges faced in implementing this curriculum; (5) costs associated with the current technological approach and (6) potential alternative technologies. We will conclude by discussing how technology-based interventions such as Mighty Girls can be taken to scale, including how Hecht’s company, REAL Prevention, has accomplished this with other technology-based interventions.

14:00-15:30 Session Parallel 1.5: EARLY CAREER SESSION I

Parallel Session 1.5: EARLY CAREER SESSION 1

Location: EMCDDA 106
Preconception health behaviours of reproductive aged women
SPEAKER: Adina Lang

ABSTRACT. Introduction: Missed opportunities exists to optimise women’s health before (preconception) and between (interconception) pregnancies. This represents a timely window to address reproductive intentions, wellbeing and behaviours in accordance with guidelines to reduce maternal and child health risks. This study aimed to assess pregnancy intention, preconception health (PCH) behaviours and information preferences of pregnant women.

Methods: A cross-sectional survey, incorporating a validated pregnancy intention measure, of pregnant women aged 18-44 years attending a public maternity service in Melbourne, Australia (August 2017-March 2018).

Results: Two-hundred-and-seventeen women (30±4.9 years) completed the study questionnaire. Planned pregnancies were reported by 70% of women, while 28% were ambivalent and 2% were unplanned. Overall, most women took vitamin supplementation with folic-acid (multivitamins 43.8%, folic-acid alone 12.4% or folic-acid with iodine 8.8%) and 49% accessed information on a PCH topics from a health professional. On multivariable analysis for sociodemographic factors, supplementation with folic-acid was independently associated with age (>25 years; OR 3.4, 95%CI 1.1-10.4 p=0.032) and planned pregnancy (OR 22.2, 95%CI 8.4-59.0 p<0.001). Accessing information from a health professional was independently associated with planned pregnancy (OR 3.4, 95%CI 1.8-6.7 p<0.001), and having a planned pregnancy was independently associated with being married/defacto (OR 5.6 95%CI 1.8-18.1 p=0.004). Women’s preferred sources of preconception information were health professionals (70%), internet (62%) family/friends (33%), mobile apps (27%), books/magazines/leaflets (18%) and social media (11%).

Conclusion: A high proportion of women in this study planned for pregnancy. Encouragingly, there was good uptake of supplementation with folic-acid, a marker of appropriate PCH behaviour. However, under half of women accessed a health professional for preconception information and opportunities exists for improved engagement. A system-wide shift is needed integrating PCH promotion within the healthcare continuum, including awareness-raising and multi-strategic collaborative efforts by health practitioners, researchers and policy-makers to improve PCH.

Problem solving skills in kindergarten children – preliminary results of the WALLY testings within the KOAKIK-project
SPEAKER: Antje Kula

ABSTRACT. Problem solving competences are listed as one of the ten life skills defined by the World Health Organisation. The promotion of life skills is quite often a part in or the aim of interventions in the field of prevention and health promotion. The joint KOAKIK (Cognitive activation in inclusive childcare institutions) project, funded by the Lower Saxonian Ministry for Science and Culture, aims at strengthening the abstract and personal learning competences of kindergarten children by training the educational staff in cognitively activating methods (Sustained Shared Thinking and Scaffolding). Effects will be evaluated in a controlled longitudinal study design using a mixed methods approach. 26 childcare institutions take part (intervention group n=16, control group n=10). Qualitative and quantitative data will be collected at staff as well as child level at two measurement points in time. Considering the problem of indirect assessment of the children’s skills by interviewing parents or educational staff, we choose the WALLY test as an instrument for evaluation. The children’s problem solving skills in the context of social challenges are assessed directly. Baseline measurements provide datasets of more than 300 children. In our contribution, we will give a brief summary of the WALLY test and the results of the preliminary analysis of the baseline measurements as well as discuss its potentials and problems. The conclusions may enhance the ongoing process of developing sound study designs in the field of prevention research.

An application of the theory of planned behaviour to help-seeking in adults with currently untreated mental health problems -- a longitudinal study

ABSTRACT. Background. A considerable proportion of people with mental health problems does not seek professional help. Therefore, we examined socio-psychological precursors of help-seeking via the theory of planned behaviour (TPB) in a sample of adults with currently untreated mental health problems. Methods. We assessed components of the TPB, help-seeking intentions and behaviour in a longitudinal sample of 188 participants from the general population (Mage=50.34; SD=16.19; 70.7% female). Components of the TPB (attitudes, subjective norms, and perceived behavioural control), help-seeking intentions and covariates were assessed at baseline. Help-seeking from mental health professionals was assessed at 3- and 6-month follow-ups. The TPB was examined via path models controlling for covariates. Results. Attitudes (β=0.24), and subjective norms (β=0.26) predicted intentions (R2=27%), which in turn predicted help-seeking (β=0.34; R2=23%). Perceived behavioural control was associated with help-seeking intentions and behaviour in bivariate regression models, but did not reach significance in the path models. Limitations. Our study was conducted in Germany, thus our findings are rooted in the German healthcare system, which differs from other countries’ healthcare systems. Conclusions. The TPB is a tenable model for explaining help-seeking for mental health problems. However, the role of perceived behavioural control is less clear, as only its component self-efficacy showed the anticipated positive trends towards help-seeking. Therefore, particularly fostering positive attitudes towards professional treatment and activating social support seems pivotal, e.g. for general practitioners, who often represent the first point of contact for people with mental health problems in the general population. Funding. This study was supported by the German Research Foundation (DFG) [grant numbers SCHO 1337/4-1, SCHM 2683/4-1].

Don‘t offend to peer: Raising problem awareness and building treatment motivation in users of child sexual abuse images

ABSTRACT. Reaching people with pedophilic or hebephilic inclinations as early as possible is an important factor of the prevention of child sexual abuse (CSA) and the use of child sexual abuse images (CSAI). CSAI are readily available on file-sharing networks, even to users without advanced technological skills – providing images displaying the whole spectrum of CSA including very severe sexual offences against children. Law enforcement has not been able to stop the exchange of CSAI in these networks during the last 15 years and users in most countries do not fear prosecution. Despite the high relevance of closed communities exchanging CSAI, most content gradually diffuses into openly available file sharing networks. "Don’t offend to peer" (DOTP) is a research project, that analyses and infiltrates established, searchable peer-to-peer file sharing networks with therapy messages masked as CSAI as part of a comprehensive internet-driven approach, which aims at raising problem awareness in users of CSAI and inform them about therapeutic options. The objective of the promoted therapeutic approach lies in working on the ability to control sexual impulses and sexual behaviour directed at children. The presentation will give insights into the first results of DOTP and outline innovative internet-driven ways of targeting stigmatized populations, which carry health relevant risk factors.

Effects of video-feedback and cognitive preparation for improving social performance and anxiety symptoms through Super Skills for Life program

ABSTRACT. Several cognitive-behavioral programs focused on the treatment of social anxiety have been developed in the last decade. However, the effects of the components video-feedback and cognitive preparation have not been widely studied interventions targeted to children. Super Skills for Life (SSL) is a cognitive-behavioral program that integrates behavioral activation, social skills training, video-feedback and cognitive preparation. This program has proven to be effective in reducing emotional problems and anxious symptoms in Spanish children. Nevertheless, few results have specifically evaluated the effectiveness of SSL program on social performance, despite its relationship to social anxiety and other anxiety disorders. The current study aims to analyze the effect of SSL program on social performance in a sample of 57 children aged 8 to 12 years old, who presented emotional symptomatology. Children answered self-reports about anxiety symptoms before and immediately after intervention. Children’s social performance was assessed through an activity in which they had to talk for 2 minutes while they were being recorded. These activities were conducted in the first and last session of the program. Post-intervention results showed lower level of anxiety and an improvement of social and communication skills compared to the baseline. SSL program had a different impact on social performance between boys and girls. In general, the impact of SSL program was higher in boys, but more appropriate social performance was observed in girls. These results suggest that the SSL program, through video-feedback with cognitive preparation, contributes to the reduction of anxiety and to the improvement of social performance in children. Findings of the current study indicate that SSL program may prevent and treat anxiety symptoms (including social anxiety) through the improvement of social competence. Future studies should explore the mechanisms that underlie the effectiveness of the SSL program, including social competence, to reduce social anxiety and other anxiety problems in children.

15:30-16:00Coffee Break
16:00-18:00 Session Parallel 2.1: Special Session: The Prevention Workforce: An Emerging New Identity

Parallel Session 2.1 - The Prevention Workforce: An Emerging New Identity

One of the greatest challenges facing the prevention field is in the establishment of a professional workforce. For decades prevention professionals struggled to define themselves as being members of a legitimate, well-defined field and not step-children of other disciplines. With the creation of the U.S. and E.U. Societies for Prevention Research, the publication of the International Standards on Drug Use Prevention (United Nations Office on Drugs and Crime) and of the European Drug Prevention Quality Standards (European Monitoring Centre for Drugs and Drug Addiction), and, most recently the development of the Universal Prevention Curriculum (Applied Prevention Science International) and in association with the International Consortium of Universities for Drug Demand Reduction, the prevention field, specifically the substance use prevention field, is well-poised to be established as a bone fide profession. Several challenges lie ahead—integrating prevention science into practice, the invisible nature of prevention diffused over many settings, and, the inconsistency of service delivery that leads to erratic funding over time and no structured career paths for prevention professionals. The panel will first address the professional needs of four levels of prevention professionals defining special attributes of each. These include the policy maker at all government levels; the program planner/decision maker at the local level; the prevention worker implementing prevention interventions/policies; and the newcomer either trained already in some discipline such as education, social work, public health who is new to prevention and the student who is in college or university who could have a focus/major in prevention science and its application. Important to these presentations is a discussion of what are next steps in creating prevention workforce and its new identity.

Location: EMCDDA 107
The Prevention Workforce-An Emerging New Identity
SPEAKER: Zili Sloboda

ABSTRACT. One of the greatest challenges facing the prevention field is in the establishment of a professional workforce. For decades prevention professionals struggled to define themselves as being members of a legitimate, well-defined field and not step-children of other disciplines. With the creation of the U.S. and E.U. Societies for Prevention Research, the publication of the International Standards on Drug Use Prevention (United Nations Office on Drugs and Crime) and of the European Drug Prevention Quality Standards (European Monitoring Centre for Drugs and Drug Addiction), and, most recently the development of the Universal Prevention Curriculum (Applied Prevention Science International) and in association with the International Consortium of Universities for Drug Demand Reduction, the prevention field, specifically the substance use prevention field, is well-poised to be established as a bone fide profession. Several challenges lie ahead—integrating prevention science into practice, the invisible nature of prevention diffused over many settings, and, the inconsistency of service delivery that leads to erratic funding over time and no structured career paths for prevention professionals. The panel will first address the professional needs of four levels of prevention professionals defining special attributes of each. These include the policy maker at all government levels; the program planner/decision maker at the local level; the prevention worker implementing prevention interventions/policies; and the newcomer either trained already in some discipline such as education, social work, public health who is new to prevention and the student who is in college or university who could have a focus/major in prevention science and its application. Important to these presentations is a discussion of what are next steps in creating prevention workforce and its new identity.

16:00-18:00 Session Parallel 2.2: Special Session: EPPIC: Exchanging Prevention practices on Polydrug use among youth In Criminal justice systems

Parallel Session 2.2 - EPPIC: Exchanging Prevention Practices on Polydrug Use among Youth in Criminal Justice Systems

EPPIC (Exchanging Prevention Practices on Polydrug Use among Youth in Criminal Justice Systems) is a three year European project funded by the Third EU Health Programme 2014-2020 (Chafea). It focuses on prevention and addressing all types of illicit drug use among young people (15-24) who are in touch with the criminal justice system. The project involves partners in six European countries (Austria, Denmark, Germany, Italy, Poland and UK).  A range of qualitative approaches have been used to identify innovative prevention approaches and projects; to collect new information: on the drug using trajectories of young people in the criminal justice system and on their perceptions and experiences of interventions; and to examine the views of service providers on prevention approaches for this target group.  The papers in this special session will examine some of the preliminary findings from the project focusing on the following themes: coercion and the criminal justice system; drug using and offending careers; diversity and prevention initiatives; best practice and quality standards for those in touch with the CJS; the relationship between legislation and prevention and the development of holistic approaches and interventions.

Location: EMCDDA 012
Drug Treatment for Young People in a Coercive Context: A Paradoxical Choice

ABSTRACT. Polydrug use is common among young people in touch with the criminal justice system. However, the consumption of alcohol, tobacco and illegal drugs is not a single problem of health or criminality, but the complex interaction of multiple problems of mental health and social deprivation. Substance use is often a means of coping with extensive difficulties, such as domestic violence and parental drug addiction. Moreover, health problems are often connected with economic deprivation: poor schooling, poor housing and being unable to get into the job market, which again increases the risk of entering criminal networks. Therefore, most jurisdictions in Europe take developmental and socio-economic circumstances of young people into account and offer drug treatment both in the course of imprisonment and as a procedural alternative to imprisonment. Juveniles in particular are granted specific medical and psychological therapy together with provisional suspension of their sentences. In this paper we will discuss coercive elements in the process of treatment. The formal “offer” by the prosecution or the judge to take treatment is often experienced as an obligation in the eyes of an offender. However, we may argue that all therapeutic drug treatment includes elements of coercion to some extent. This may have severe consequences for the relationship between a therapist and the client. We will examine the practical conditions and discuss the consequences of this “paradoxical choice” in three settings considered in the EPPIC project: drug therapy in prisons, in residential facilities, and in out-patient psycho-therapy. In each situation therapy has a different meaning and different treatment methods are applied. How does therapy in a coercive context react to socio-economic deprivation and mental health problems of young people who came in touch with the criminal justice system? How do therapists cope with the challenges in this particular enforcement context?

The role of critical moments in young drug-using offenders’ careers
SPEAKER: Sara Rolando

ABSTRACT. Youth drug consumption and involvement in criminal activities are major concerns in contemporary western societies. Many studies have been conducted in order to shed light on the relationship between use of psychoactive substances and crime; however this kind of research presents a number of limitations. First, the majority of studies is about heavy heroin users and is influenced by the ‘official view’ that tends to problematize drug use. Second, too often the drug use is decontextualized from the broader social context. Third, there are limits coming from the epistemological assumption which assumes that interviewees possess ‘reasoned reasons’ for what they do and, therefore, that their practices are objectifiable (Allen 2007). Trying to avoid these risks, the present study focuses on the concept of “critical moments” (Thomson et al. 2002), applying an analytical approach appropriate to uncovering the role of social structures and processes on individual biographies. Indeed the approach entails comparison between different narratives in order to understand how young people react to similar circumstances based on their social and cultural resources. Furthermore, the concept of critical moments bridges the gap between what young people tell and what actually happens to them, and between the interviewer’s and the interviewee’s points of view. Data are drawn from 40 interviews with Italian current or past young users (age 15-25) who are in touch with the Criminal Justice System. The research is part of the EPPIC project (

Challenges to providing culturally sensitive substance misuse interventions for Black, Asian and Ethnic Minority (BAME) groups within the youth justice system in the UK.
SPEAKER: Helen Gleeson

ABSTRACT. In the UK, young people accessing substance misuse services via the Youth Justice System (YJS) usually do so as part of an out of court (caution) disposal where they are offered intervention as an alternative to custody. The Race Equality Act (2010) states that public services must be offered to all people regardless of their race or ethnicity. However, there are disparities in the treatment and outcomes of young people across all levels of the YJS (Lammy, 2017). Both the Drugs Strategy (2017) and the Serious Violence Strategy (2018) make explicit the links between violent crime and drugs, reinforcing the narrative of young black males as dangerous and violent. Preventing or reducing drug use is itself often framed as a means of protecting society and ‘vulnerable’ youth. If the accepted narrative of non-white substance using youth is that of the dangerous gang member it is unlikely that interventions to reduce the individual harm of substance misuse, or the exploitation of young people within gang culture (for example in the issue of County Lines), will be tackled with empathy or with genuine reference to needs of this population. Practitioners working across the bounds of YJS and substance misuse are alert to the different needs of their diverse service users but at present can only offer ‘flexible’ interventions to individuals without sufficient training or awareness of the impact of cultural nuances that would promote positive outcomes for different ethnic groups. This presentation will assess the various frames/narratives applied to young BAME people in the YJS in England and Wales who present with substance misuse needs and the ways that these narratives are acknowledged and responded to within services from a practitioner perspective. Data are drawn from 15 individual interviews with professionals from across England and one focus group with six professionals as part of the EPPIC project. (This presentation is linked to other EPPIC project presentations from partner countries)

Quality Standards for Interventions Aiming at Drug Use among Young People in Touch with Criminal Justice Systems in Different European Countries: an Overview
SPEAKER: Niels Graf

ABSTRACT. There is a rising interest in documenting and ensuring the evidence base of interventions in drug demand reduction. As a consequence, several quality standards have been developed on global, European and national levels to ensure appropriate implementation and delivery of interventions and to maximize their impact. Yet, quality standards explicitly designed for interventions aiming at drug use among young people in touch with criminal justice systems (CJSs) do not exist. However, drug use among young people in touch with CJSs typically results from an interaction of multiple problems (e.g. social and economic deprivation) so that interventions have to address several challenges at the same time in order to be effective. Moreover, interventions often cross policy and practice domains (e.g. health, criminal justice, social welfare). This also raises challenges regarding the nature, content and relevance of quality standards for interventions targeting young drug users in the CJSs.

Against this background we consider whether there are crucial elements in existing quality standards applicable to interventions aiming at our target group. To this end, we firstly conduct a content analysis of existing quality standards to identify elements and principles that are potentially relevant to interventions for drug using young people in touch with CJSs. Secondly, drawing on qualitative interviews with professionals in six European countries (Austria, Denmark, Germany, Italy, Poland and UK) we analyze practitioners’ perceptions of the usefulness of quality standards for their daily work and of the barriers to implementing quality standards. Based on this analysis, we raise questions regarding what kind of quality standards, ‘good practice’ guidelines or practical toolkits might be most relevant and appropriate for the development, maintenance and evaluation of interventions for young drug users in the CJS.

Abstract submitted for the EPPIC panel

Does drug legislation contribute to or limit prospects for adequate prevention?

ABSTRACT. National drug laws have to respect international drug conventions, binding globally what limits the degree of freedom to shape legislative frameworks and policies at the country level. In all partner countries, use of prohibited substances is not penalised. Their possession, however, is punishable in all of them, including potential deprivation of liberty. At the same time, many studies show that experiments with drug use or recreational drug use are part of the lives of many young people. Polydrug use or the use of multiple substances either concurrently or simultaneously is reported to be increasing among young people in Europe. Against this context, drug policies and drug interventions have to face the challenge of how to balance prohibitive laws with the normalisation of drugs in youth cultures. As the Candis evaluation carried out in Poland and interviews conducted in the frame of the EPPIC study show, many young people participating in interventions are willing to accept interventions focused on harm reduction, including limited use of drugs, rather than total abstinence. On the other hand, law enforcement agents and some therapists consider even limited use as an offence and promote interventions aimed at a drug free life. Moreover, parents and representatives of educational and social assistance institutions may not accept interventions whose aims include safer or limited drug use. In addition to existing policies and data from interviews with both therapists and young people, the trajectories of drug use will be analysed to see how legal responses or restrictive social reactions may impact on the lives of young people and how national specificities of national legislations modify this impact.

Same concept, different practices? Enactments of a ’holistic approach’ in two welfare institutions accommodating young adults with offending behavior and drug use experiences in Denmark.

ABSTRACT. A ‘holistic approach’ (Da.: ’helhedsorienteret indsats’) has become a buzz word in welfare policy and in how welfare institutions approach citizens in need of help in Denmark. In this paper we discuss how a ‘holistic approach’ is enacted in two different welfare institutions that accommodate young adults with offending behavior and experiences of illegal drug use. The first intervention is offered in remand prison, the latter in the community. A ‘holistic approach’ is a fuzzy concept, but overall it implies: 1) that all relevant aspects are taken into account when a service is offered to a citizen in need of help, and 2) some level of inter-professional practices and/or co-ordination between different welfare institutions (Lau et al., 2017). In other words, to focus not only on e.g. handling problematic drug use in drug treatment, but also on the broader well-being and everyday life circumstances (housing, job/education, economy, social network, etc.), and to involve other welfare services to help the citizen. Drawing on interviews with 8 professionals, evaluation reports and other written material we analyze and compare how a ‘holistic approach’ is enacted in the two welfare services. We draw on research literature that discusses how policies are implemented in practice and argue that a phenomenon like a ‘holistic approach’ is continuously in the making and exists only in its enactments in social and institutional practices (Bjerge et al. 2013). We argue that the way a ‘holistic approach’ is enacted depends on the institutional set-up, economic possibilities, policy frameworks, professionals’ backgrounds, etc. Our two interventions differ especially on these parameters and hence make an interesting case for analyzing enactments of a ‘holistic approach’. The results indicate how implementation of a concept like a ‘holistic approach’ can be used in interventions accommodating young people, but also in welfare institutions more generally.

(This abstract is part of EPPIC and the proposed special session on this EU funded research project)

16:00-18:00 Session Parallel 2.3: Special Session: How to study and apply effective components

Parallel Session 2.3 - How to study and apply effective components


Evidence based prevention and treatment programs do not always show the expected effectiveness in ‘real world’ situations. This might be explained by an inadequate fit between program techniques and the service context. To improve this fit we are moving beyond the traditional program protocols and examine effective components. With the current evaluation approach it is impossible to establish whether a program protocol is the most effective approach. By examining to which extent components are associated with effectiveness (or ineffectiveness) current programs can be improved by including effective components or excluding ineffective components. Additionally, new programs can be developed based on effective components. Hence, a modular approach is used as a new technique to adjust or design interventions. This will improve the effectiveness of programs and minimize possible negative effects of the program.

In this symposium, first Dr. Melendez-Torres will present what types of components there are and which methods can be used for elicitation. Then, Mertens will present results of her meta-analysis concerning which components appear to be effective or ineffective components in secondary school based prevention programs. Third, Dr. Kjøbli will elaborate on how the effectiveness of components can be rigorously evaluated and how to use this knowledge to improve interventions or assemble them as a package. The next presenter, Dr. Skeen will discuss how to develop an intervention based on common components and test this program’s effectiveness. She will relate this information to her current WHO project. Lastly, Prof. Weisz will act as a discussant to give his insights concerning the research field of effective components and future directions for research in this field.

Location: Palacete 007
What exactly is a component and where do we find them? Methods and typologies for component identification

ABSTRACT. (This abstract is linked with the abstracts of Mertens MSc., Dr. Kjøbli, and Dr. Skeen in the symposium: How to study and apply effective components, discussant Prof. Weisz.)

The description and elaboration of intervention components is important to understand the ‘active ingredients’ of complex interventions, with possibilities for the development of more efficient and effective interventions and the identification of underlying principles of change both within and across intervention types and the conditions they seek to address. In this presentation, we will offer a working taxonomy of methods and types of components in complex interventions, with examples. We propose that there are three major types of components: activities and actions, which relate to tasks or behaviours undertaken as part of the intervention (e.g. behavioural activation); features, which relate to intervention characteristics but cannot be described as activities (e.g. targeting to risk or population groups); and mechanisms, which relate to change processes interventions seek to deploy. We also propose that there are three key methods for elicitation and elaboration of components: theory-led approaches, which rely on a set of ‘theoretically anticipated’ components (e.g. the use of limit-setting in parenting interventions, as anticipated by social learning theory); views-led approaches, which draw on the perspectives of stakeholders to identify components; and inductively-led approaches, which rely on intervention descriptions to identify a component scheme without necessary regard to theoretical similarities.

What (not) to do? Meta-analysis of effective components of secondary school based prevention programs

ABSTRACT. (This abstract is linked with the abstracts of Dr. Melendez-Torres, Dr. Kjøbli, and Dr. Skeen in the symposium: How to study and apply effective components, discussant Prof. Weisz.)

Many school based prevention programs target students’ socio-emotional adjustment (i.e., intrapersonal skills including regulation of behavior, thoughts, emotions and attitudes about the self) and social safety (i.e., interpersonal skills including development of positive relationships with others, attitudes about the school and social topics). However, knowledge about the effectiveness and components of these interventions is lacking. Therefore we aim to 1) examine the general effectiveness of these interventions, 2) identify common components and 3) analyze which components are most strongly associated with effectiveness of the interventions. PubMed, PsycInfo, ERIC, and CENTRAL were systematically searched for controlled studies of secondary school based prevention programs targeting students’ socio-emotional adjustment and/or social safety. The search resulted in 7870 unique records of which 104 are included and currently coded. Preliminary results showed that school based interventions have an overall small positive effect on improving students’ socio-emotional adjustment (d = .15, p < .001) and social safety (d = .21, p < .001). Common components in these programs are similar (i.e., insight building, social skills training, emotion regulation, discussion, role play, didactic instruction, having a manual, based on a theory, school staff involvement). No effective components for improving students’ socio-emotional adjustment have been identified yet. An effective component for improving students’ social safety appears to be the component homework. Ineffective components for improving students’ socio-emotional adjustment seem to be relaxation, self-control, and use of worksheets. For improving students’ social safety no ineffective components have been identified yet. More interventions will be included to provide more robust results. Identification of effective or ineffective components for improving students’ socio-emotional adjustment and social safety will clarify which components seem important for these behaviors. As a consequence, existing interventions could be improved or new interventions developed. Additionally, it enables schools to critically select interventions that target specific behaviors.

Improving outcomes for vulnerable children: Identifying the core components of intervention
SPEAKER: John Kjøbli

ABSTRACT. (This abstract is linked with the abstracts of Dr. Melendez-Torres, Mertens MSc., and Dr. Skeen in the symposium: How to study and apply effective components, discussant Prof. Weisz.)

Introduction: The growth of evidence-based treatment (EBT) has resulted in several efficacious and effective interventions for child psychopathology. However, systematic reviews show that the effect sizes of EBTs range from small to moderate, and they have not increased during the last decades. Many EBTs only address one problem area or diagnosis, even though compelling evidence shows that comorbidity is the rule, not the exception. Children with comorbid diagnoses do not necessarily respond well to single-problem EBTs (e.g., parent management training for conduct problems). One solution to this problem is to address the underlying processes of psychopathology (e.g., emotion regulation) and flexibly tailor intervention to the individual needs of each child. To this end, we have initiated efforts to a) apply a methodology to synthesize evidence about core components, b) to develop and test parsimonious and implementable interventions.

Methods: First, the presentation will discuss strategies on how to systematically identify, map, and assess potentially effective core components. A systematic method of identifying core components, based on a broad approach, will be presented where core component mapping is conducted separately from an evidence assessment, and where the evidence for each component is presented in an unbiased manner. Second, the presentation will offer some suggestions on how components can be rigorously evaluated (e.g., time series designs, microtrials and factorial trials), and how treatments can be optimized for widespread implementation.

Results: First, preliminary findings of a systematic identification of core components will be provided. Second, examples will be given for how and when core components can be tested and optimized with different designs, before they are assembled as a package.

Conclusions: A core component approach has the potential to improve outcomes for vulnerable children. The use of systematic methods and rigorous designs may increase the effectiveness of intervention.

Developing an intervention package to promote positive mental health, and prevent mental disorders and risk behaviours
SPEAKER: Sarah Skeen

ABSTRACT. (This abstract is linked with the abstracts of Dr. Melendez-Torres, Mertens MSc., and Dr. Kjøbli in the symposium: How to study and apply effective components, discussant Prof. Weisz.)

There are a number of physical, cognitive, social, emotional and sexual changes that occur during adolescence, which make it a period requiring special attention in global health and development efforts. Risk factors for poor outcomes during adolescence overlap, and identifying common content and delivery features of proven interventions for use across multiple outcomes, may improve cost effectiveness, intervention reach and sustainability.

We undertook a global systematic review and programme components analysis to inform the development of an evidence-based psychological intervention to address these outcomes. We identified 192 face-to-face, digital and combined interventions taking place in 35 countries to promote mental health, and/or prevent depression and anxiety, and risk behaviours during adolescence. Our analysis revealed several practice components that predicted effect sizes in one or more outcomes, seven of which predicted larger effect sizes. We also found that different instructional and intervention delivery-related components were also predictive of smaller or larger effect sizes. In this presentation, we will describe the results, and specifically show how they are being used to design and develop a multi-faceted programme that will be adapted and tested in a number of countries of varying levels of resources.

16:00-18:00 Session Parallel 2.4: PARENTS AND FAMILIES

Parallel Session 2.4: PARENTS AND FAMILIES

Rapid Cycle Testing of the Family Nurse Partnership: learning and next steps
SPEAKER: Deon Simpson

ABSTRACT. The Family Nurse Partnership (FNP) is a structured, evidence-based home visiting programme for young mothers. It was developed in the US but has now been taken to scale in England over the last 10 years. Following changes in public health commissioning arrangements, funding cuts and disappointing results from a rigorous randomised controlled trial of FNP, the FNP National Unit has worked with the Dartington Service Design Lab to co-design and implement changes in 10 sites to respond to these challenges.

Adaptations were co-designed with local commissioners, providers, practitioners, clients, FNP National Unit staff and researchers. Clinical adaptations focus on specific outcomes of local priority, notably maternal mental health, smoking cessation, breastfeeding, attachment and child neglect. System adaptations focus on improving programme outcomes and efficiency, including changing eligibility criteria to focus on more vulnerable clients and increasing the personalisation of FNP. The latter involves changing programme duration and the content and frequency of home visits to better meet client needs, and is driven by a new assessment tool.

These changes are being developed and evaluated by means of rapid cycle adaptation and testing. This involves using mixed methods data collection, small-scale delivery and minimally sufficient data to facilitate rapid analysis, feedback, iterative refinement and further testing until an acceptable solution is found. It draws on the emerging discipline of improvement science but also methods of intervention development and formative evaluation. Over the past year there have been monthly ‘small’ cycles and four ‘large’ cycles of testing and adaptation. Ten further sites have been recruited for a second phase of development.

Through this ambitious but pragmatic approach we are learning how to effect change to a well-evidenced programme in a way that responds to changing contexts and local and service user needs. We will share some of the key learning about the merits and challenges of the rapid cycle adaptation and testing approach, and how we plan to further adapt both intervention and testing method over the coming years.

Successes and Barriers to Effective Implementation in Two Self-Directed Family Interventions: What Happens, and What Matters?
SPEAKER: Laura Hill

ABSTRACT. We often lack tools to determine the external validity of evidence-based prevention programs as they are implemented in the real world. Factors at multiple levels (population, policy, organization, providers) determine implementation exposure. For evidence based parenting programs, exposure to the program is a major obstacle in real world contexts. The goal of this presentation is to examine implementation successes and barriers from two different self-directed family-based preventive interventions. The presentation addresses an important question in prevention science: What are some of the biggest implementation challenges in prevention, and how do we address these. The first study, "Connecting: Implementation Successes and Barriers of a Prevention-Based Program with Foster Families," presents implementation data from a self-directed workbook plus DVD program with foster families. We found that 82% of families engaged in some program content, yet, the level of program completion was less than we had hoped, closer to 50%. The authors will describe how these data compare to non-foster program implementation, and they will discuss implications for implementation differences and similarities in targeted versus universal programs and self-directed versus in-person programs. The second study, "First Years Away from Home: Utilization, Engagement, and Usefulness, in a Self-Directed Handbook Program for Parents of Students Transitioning to College," is also a self-directed program. We found that 85% of parents reported they read the handbook and/or completed at least some of the activities. 62% competed at least three quarters and 47% completed all 22 activities. The authors will discuss participation rates (reading the handbook) versus dosage (the degree to which parents actively engaged with and used the material); they will also compare parent perceptions of handbook utility with their young adult children's perceptions. In order to optimize the relevance of prevention, we need to understand what works, for whom, and under what conditions. Implementation barriers and successes that are similar across modalities or stages of research, as some were across these programs, provide useful information about scaling up evidence-based parenting programs effectively and efficiently.

“A community story: Sharing knowledge experiences in a prevention program”

ABSTRACT. It is usual that non-profit entities shape the community framework and promote social changes usually related with citizens´ life, wellness, health and development. Families associations have an essential role in child education. Being change agents and public institutions speakers, they can have a determinant impact in the local life, not only because the alliances with community agents they can stablish, but because they also can take an active part in public governmental programs related to health, prevention, personal and social development, safety and law regulations.

Prebenfamilia is a community prevention project created by public governmental bodies and family associations in Alava (Basque Country, Spain). It has created a network that includes also remarkable universities (specific prevention research teams) and IREFREA (European institute of prevention studies, Spain). The initiative started in 2015, and pretends to place family needs at the heart of the community. Alava is the largest territory in Basque country. Its population is mainly concentrated at the heart of its main city, Vitoria-Gasteiz (244,000 people) being the rest (80,000 people) distributed in small local villages (2,000-18,000 people), some of them located in the countryside and mountains, in some cases a bit isolated, with a limited offer of basic local resources. That is why social network among boundaries can be an opportunity to decrease isolation, sharing experiences, services and resources. It is an innovative practice with no precedents at the region.

Being conducted by a small team of people, the project incorporates action research methodology a process of inquiry, conducted by those taking the action; here, the main aim of the practitioner is to improve and refine his/her actions. Results after three years of implementation offer hopeful perspectives: prevention materials designed, 5 community workshops and reports produced, a written manifesto and a massive event hold, concerning prevention families and leisure.

Exploring Parental Feeding Styles as Contributors to Childhood Obesity: An Integrated Research-Practice Approach to Reaching Parents in Real-World Settings
SPEAKER: Louise Parker

ABSTRACT. Research evidence suggests that most children have an inborn ability to self-regulate their eating by paying attention to internal cues of hunger and fullness. However, it has also been documented that parents influence children’s self-regulation through their style of feeding behavior. On one hand, when parents exert too much external control in feeding, children may learn to ignore their internal cues. However, when they offer too little structure or control in feeding, children may engage in unchecked consumption of high calorie foods or develop patterns of mindless eating. One strategy for impacting the rising tide of childhood obesity is to promote responsive feeding practices among parents. If parents learn to avoid common feeding practices shown to be detrimental (e.g., using food as a reward or punishment), problematic child eating behaviors that lead to obesity may be reduced. A team of researchers and community-based practitioners developed and tested a family intervention to reach low income parents whose children were at high risk of obesity. Instruction in seven parent sessions was driven by a series of videos that focused on recognizing internal cues of hunger and fullness, promoting exploration of new foods, portion sizes, and appropriate structuring of both the home and external eating environment. The program was conducted at two sites in the U.S., one large metropolitan area and one smaller community. Assessments were conducted at pre-, post-, 6 months and 12 month follow ups for 254 Latino families (134 prevention, 120 control) between 2104-2016. Preliminary results indicated significant effects on increasing parent responsiveness to children’s internal cues, reduction in using food as a reward, and reduction of using pressure to force their children to eat. Parents also significantly increased the involvement of their child in helping prepare food and in using several food exploration strategies linked to healthy eating. In order to facilitate broader dissemination, the videos were later adapted to add feeding content to an existing nutrition education curriculum utilized in 40 U.S. states. A randomized control trial is currently evaluating the effectiveness of delivering this content to low income parents in both face to face and online formats.

Supporting children exposed to domestic violence through parent leadership coaching
SPEAKER: Vashti Berry

ABSTRACT. Aim: This study evaluated the feasibility, acceptability and potential impact of a strengths-based, parent-focused intervention designed to support women and children exposed to domestic violence and abuse (DVA).

Background: DVA is a highly prevalent social problem costing the English public purse £5.5bn/year. Since victims and children exposed to DVA will be at risk for social, emotional and behavioural difficulties even after they have left the violent context, secondary prevention is argued to be as important as primary intervention to both prevent recurrent victimisation and aid recovery and resilience. Research has demonstrated that parent mental health and the quality of parenting can mitigate the effects on children, and that advocacy and parenting support are good candidates for intervention.

Methodology: The Family Vision (FV) parent leadership programme is an innovative life and leadership coaching intervention designed specifically for lone parents who have experienced violent intimate relationships. The aim is to empower parents to advocate on behalf of their family and to help parents set the tone of their family culture and develop a strong sense of identity as the leader of their family. In so doing, the programme aims to improve women's empowerment and well-being, family functioning as well as children's health and development. The manualised programme was piloted in a Children’s Centre and primary school in Devon, where staff were trained to co-deliver the 11-week intervention alongside the developer. Outcome data from participating parents were collected before and after the intervention using standardized measures, and interviews and focus groups with parents and staff were conducted to understand the acceptability and feasibility of the intervention.

Findings: Twenty-four parents were offered places on the programme; 17 completed it. Measures completed by parents pre- and post-intervention demonstrated improvement across all outcome domains: parent well-being, parent empowerment and self-efficacy, quality of the parent-child relationship, and child psychosocial functioning. Qualitative data from interviews supported these findings, and provided useful insight into the mechanisms of impact.

Conclusions: These findings provide promising quantitative and qualitative data showing high levels of recruitment, retention, acceptability and feasibility of the programme. A pilot trial is in development.

16:00-18:00 Session Parallel 2.5: EARLY CAREER SESSION II

Parallel Session 2.5: EARLY CAREER SESSION 2

Location: EMCDDA 106
Presence of European and non-European migrants in services across the drug treatment spectrum in Belgium and Portugal: Implications for prevention and treatment initiatives

ABSTRACT. Introduction: Increased population diversity – resultant of new and ‘old’ migration flows, brings new challenges to drug prevention and treatment. However, little is known about the presence of migrants and ethnic minorities in drug treatment in the European Union. Contrary to census-based drug treatment registration in USA, Canada and Australia, European treatment demand indicator (TDI) protocols (1&2) only allowed for registering current nationality of service users. We analysed the presence of non-European and European migrants in treatment (as related to presence in the general population) in Belgium (a high-proportion-of-foreign-citizens country) and Portugal (low migration ratio) between 2015 and 2017.

Methods: We analysed and compared aggregated datasets obtained from national focal points. Data was aggregated at the levels of region, type of treatment (outpatient substitution treatment, crisis and day services, therapeutic communities) and types of substance used (alcohol and illicit substances). We qualitatively explore results by means of previous research outcomes (services user and provider perspectives) in the Belgian setting and qualitative interviews with Lisbon-based SUT stakeholders in the Portuguese setting.

Results: Overrepresentation in substitution treatment and underrepresentation in therapeutic communities of European and non-European migrants is apparent in Belgium and Portugal. We report significant differences between national contexts, treatment settings, regions, types of used substances, European and non-Europeans migrants and frame these results qualitatively. Although registration of nationality does not allow for in-depth analysis of treatment success, it does allow identifying important tendencies in terms of treatment and registration practices.

Discussion: Recommendations for treatment and prevention relate to a need for targeted psycho-education, structural access to treatment for varying migrant groups and knowledge transfer between outpatient, inpatient and prevention services. However, there remains a general lack of monitoring instruments and consequent analyses of migrants and ethnic minorities in drug treatment across Europe. The third TDI protocol (2013) omitted the nationality variable whereas most treatment facilities do still register non-European and European nationalities. Future research should focus on registration tools (e.g. language of mother, intersecting characteristics) supplemented with qualitative approaches for studying presence, successful service provision, service user reach, drop-out, satisfaction, treatment engagement and retention to inform prevention and treatment.

A qualitative exploration of the intersection between social influence and cultural norms in relation to the development of alcohol consumption practices during adolescence

ABSTRACT. Background Despite downward trends in alcohol consumption among young people in the UK, a substantial proportion drink and by the age of 16, at least one third of young people report weekly drinking. Evidence regarding effects of school-based preventive interventions is mixed and there remains a need for qualitative research to inform intervention development. We sought to explore young people’s perspectives around influences on alcohol use behaviour during mid-adolescence.

Methods Forty-two young people (n=21 males, n=21 females) were recruited from schools (n=30, aged 14-15 years) and youth groups (n=12, aged 14-18 years) in the West of England. In schools, participants were randomly selected from year 10 (aged 14-15) with snowball sampling used to maximise diversity of alcohol use. Additional participants were recruited from youth groups via youth workers. Data were collected via semi-structured one-to-one (n=25) and paired (n=4) interviews and one focus group. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo 10.

Results Alcohol use was perceived as a normalised social practice in the wider population and was associated with being cool, mature and popular, while enabling escape from reality and boosting confidence and enjoyment. Positive expectancies alongside opportunity contributed to motivating initiation, but social influences were paramount for most, with participants describing a need to fit in with friends to avoid social exclusion. Such influences positioned drinking and intoxication at parties as a normative social practice, further providing opportunities for social learning and subtle incentives to drink. Social media weaved into young people’s lives the display of positive alcohol-associated depictions of social status, enjoyment and maturity. The intersection of influences, norms and incentives generated a pressurised environment, characterised by conformity being experienced as an obligation to drink, and a sense of unease around abstinence which could elicit stigmatising insults.

Conclusions Social influences and norms contribute to development of a pressurised environment around alcohol consumption during mid-adolescence, driving the escalation of alcohol use as a normative social practice. Our findings highlight the need to acknowledge social influence and the drivers of cultural norms and practices when developing new interventions to prevent harmful alcohol use during adolescence.

Is long-term exposure to neighbourhood-level deprivation associated with experiences of intimate partner violence among women in early adulthood? Findings from a UK birth-cohort study

ABSTRACT. Background: Intimate partner violence (IPV) is the most common violence perpetrated against women. Designing effective prevention requires understanding the causes of IPV, best evidenced by studies that measure exposures and outcomes prospectively over time. However, a recent systematic review found no prospective-longitudinal study from outside the USA that had investigated the association between any community- or structural-level factor and IPV against women. We therefore aimed to investigate the relationship between long-term exposure to neighbourhood-level deprivation and IPV against women in a UK-based cohort.

Method: Data were from 2,126 women enrolled in the Avon Longitudinal Study of Parents and Children who completed an online assessment at Age 21 on their experiences of physical, psychological, or sexual IPV after Age 18. Participants' mothers reported on family-level socioeconomic characteristics at ten time points from baseline (gestation) until children were Age 18, including income and residential instability. Neighbourhood-level deprivation was measured at each time point using the Indices of Multiple Deprivation, which indicate overall deprivation at the Lower Layer Super Output Area (LSOA) level. We used marginal structural models to analyse the association between neighbourhood-level deprivation and IPV over time, which accounted for time-varying confounding by the socioeconomic indicators and sample attrition.

Results: 25.22% of women reported experiencing any IPV between Ages 18–21. At baseline, 15% of participants lived in the most deprived quintile of neighbourhoods and 26% in the least. Across several model specifications, long-term exposure to more versus less deprived neighbourhoods was associated with increased IPV experiences in early adulthood.

Conclusions: To our knowledge, this is the first study to prospectively investigate the association between long-term exposure to neighbourhood deprivation and IPV against women. Our findings suggest that cross-contextual testing of this association, and the mechanisms that underlie it, should be part of the IPV prevention agenda.

Young adults’ alcohol-related experiences and their role in the friends group
SPEAKER: Joella Anupol

ABSTRACT. Qualitative studies focused on alcohol use and friendship practices describe that the youth associate drinking with socializing activities. Also, in the group, there is always a friend who is the “carer and protector” (CAP) who takes the responsibility of looking after others within the context of drinking. On the other hand, research on adolescents’ alcohol use has studied the role of the group leader’s substance use, since their behaviour is mirrored by their peers. Alcohol use (AUDIT: Alcohol Use Disorders Identification Test), drinking motives (DMQ-28: Drinking Motives Questionnaire-Revised), health status (GHQ-28: General Health Questionnaire-28), anxiety (STAI: State-Trait Anxiety Inventory), leadership and personality (NEO-FFI: Neuroticism Extraversion Openness Five-Factor Inventory) were assessed. 24 friendship group discussions were conducted, with a total of 83 participants (67.5% women; M age=21.78; SD=2.897). The topics discussed were: a) alcohol use in adolescents and young people; b) first alcoholic drink consumed; c) first drunk episode; d) alcohol use in public spaces. At the end of the focus group, the participants as a group were asked to solve a hypothetical alcohol-related story. Those who presented risky alcohol use (≥8 AUDIT score) had higher scores in the following drinking motives: enhancement (Mann-Whitney U test: Z=-2.444; p=.015); coping-anxiety (Mann-Whitney U test: Z=-2.334; p=.02) and coping-depression (Mann-Whitney U test: Z=-2.169; p=.03). The person designated as CAP by the group presents lower scores in coping-anxiety motives (Mann-Whitney U test: Z=-2.085; p=.037). On the other hand, leaders’ extraversion score is the only statistically significant difference found with non-leaders (Mann-Whitney U test: Z=-2.477; p=.013). AUDIT score is positively correlated with authoritarian leadership (rs(81)=.235; p=.032), participative leadership (rs(81)=.235; p=.032), social motives (rs(81)=.242; p=.027), enhancement motives (rs(81)=.409; p<.001), coping-anxiety motives (rs(81)=.285; p=.009), coping-depression motives (rs(81)=.294; p=.007) and openness to experience (rs(81)=.305; p=.005). Few individual factors explain higher alcohol consumption. Since drinking is a social activity, friendship dynamics should be included in alcohol use prevention.

Active breaks program at school : Development, set up and feasability
SPEAKER: Roux Lydie

ABSTRACT. The Decimus Lunius Luvenalis’ “Mens sana in corpore sano” is finding a second wind with the growing interest in physical activity (PA) effects on health and cognition. PA is known as health factor. Children are recommended to practice at least 60 minutes of moderate to vigorous PA a day to benefit from PA for health. However, in in Europe, children don’t reach the recommendations. Also, we have to underline that PA and sedentary behaviors are not diametrically opposed: a single person can be physically active and being sedentary (e.g., staying sitting at the desk for more than one hour) and so, being at risk. Fostering PA and struggling sedentary behaviors is a public health priority. More and more papers are interested in the PA-cognition link. PA can foster executive functioning (high level cognitive processes that permit to adapt ourselves to environment constraints) after a single bout of exercise and can foster their development through a regular practice. A little is known about which PA dimensions are to take into account or what is the minimal dose that foster executive functions. However, aerobic exercise and cognitively engaging PA appear to foster PA. As children present less effective executive functioning than children from passed generations and as these functions are linked to success in life, health and future well-being, it is crucial to foster their development in our children. The aim of our study is to design, carry out and conduct a process analysis of an in class PA program that would be able to counteract in class sedentary behavior habits and foster children executive functioning. In order to achieve this aim, we developed and set up a 12 weeks school based program of in class active breaks. 3 classes of French CE2 participate to the study. In this presentation, we will table how we built our program from scientific framework and how we adapted it pedagogically. Then, the process analysis will permit to discuss the program in term of feasibility and interest. As the study is still in process, we are not able to give you results in this abstract.

19:30-23:00 Conference Social Dinner

Conference Social Dinner