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08:00-09:30 Session Special Symposium: Special Session: Embracing ‘failure’ in prevention science

SPECIAL SESSION: Embracing ‘failure’ in prevention science: how can we promote a more open and honest response to trial results showing that interventions ‘don’t work’ or cause harm?

In fields such as aviation, learning from failure to achieve desired outcomes is an embedded process intended to optimise performance. In health and social care, by contrast, it is often not clear how learning from failure affects the commissioning of services or research; indeed, there can be a tendency to cover up or explain away such events. We see evidence of this behaviour in prevention science when trial results show no or harmful effects. Examples include not publicising findings, conducting spurious sub-group analyses or attributing the outcome post hoc to real or perceived weaknesses in trial design or execution. This is unhelpful for several reasons, not least that it contributes to research ‘waste’, undermines respect for science and potentially stifles risk-taking innovation, at best leading to incremental change. This symposium explores common policy and research responses to finding that an intervention is ineffective or harmful, such as dismissing the results, decommissioning the intervention, continuing with the ‘failed’ intervention in the absence of a better option or because it meets other criteria, and adapting the intervention and testing those adaptations. Some of these responses are illustrated through case study papers on null effect trials in subject areas such as obesity, social-emotional learning and early years support. Each case study paper describes the trial results, what happened next and, as best as can be established, why. The anchor paper suggests that the nature of each stakeholder’s response(s) is affected by, inter alia, the nature of the ‘failure’, how much they have invested in the intervention (financially, psychologically, politically and organisationally), the extent to which they accept the trial findings, the availability (or lack) or alternatives, and whether they buy into the evidence-based practice paradigm. It advances several strategies to promote a more open and honest approach towards trials of interventions that show no or harmful effects. These strategies are categorised as ‘pre-empting’, ‘preparing for’, ‘acknowledging’ and ‘responding to’ such findings. The main message from the symposium is that the real failure in prevention science is a failure to learn from and act on disappointing results.


Embracing ‘failure’ in prevention science: how can we promote a more open and honest response to trial results showing that interventions ‘don’t work’ or cause harm?
SPEAKER: Nick Axford

ABSTRACT. In fields such as aviation, learning from failure to achieve desired outcomes is an embedded process intended to optimise performance. In health and social care, by contrast, it is often not clear how learning from failure affects the commissioning of services or research; indeed, there can be a tendency to cover up or explain away such events. We see evidence of this behaviour in prevention science when trial results show no or harmful effects. Examples include not publicising findings, conducting spurious sub-group analyses or attributing the outcome post hoc to real or perceived weaknesses in trial design or execution. This is unhelpful for several reasons, not least that it contributes to research ‘waste’, undermines respect for science and potentially stifles risk-taking innovation, at best leading to incremental change. This symposium explores common policy and research responses to finding that an intervention is ineffective or harmful, such as dismissing the results, decommissioning the intervention, continuing with the ‘failed’ intervention in the absence of a better option or because it meets other criteria, and adapting the intervention and testing those adaptations. Some of these responses are illustrated through case study papers on null effect trials in subject areas such as obesity, social-emotional learning and early years support. Each case study paper describes the trial results, what happened next and, as best as can be established, why. The anchor paper suggests that the nature of each stakeholder’s response(s) is affected by, inter alia, the nature of the ‘failure’, how much they have invested in the intervention (financially, psychologically, politically and organisationally), the extent to which they accept the trial findings, the availability (or lack) or alternatives, and whether they buy into the evidence-based practice paradigm. It advances several strategies to promote a more open and honest approach towards trials of interventions that show no or harmful effects. These strategies are categorised as ‘pre-empting’, ‘preparing for’, ‘acknowledging’ and ‘responding to’ such findings. The main message from the symposium is that the real failure in prevention science is a failure to learn from and act on disappointing results.



Evaluation of a knowledge transfer scheme to improve policy making and practices in health promotion and disease prevention setting in French regions: a realist study.
SPEAKER: Linda Cambon

ABSTRACT. Evidence-based decision-making and practice are pivotal in public health and offer a way to improve health systems efficiency, credibility, and sustainability. However, barriers related to evidence properties, people, organisations and contexts do persist. To address these major knowledge transfer (KT) issues, we need to rethink how knowledge is produced and used, and examine public health services' ability to integrate research findings into decisions and operations. Our study is a comparative multiple case study that aims to assess a KT scheme in regional health agencies (ARS) and regional non-profit organizations for health education and promotion (IREPS) in four French regions. ARS and IREPS work together to implement prevention and health policies in local contexts. We use a realist evaluation. Realist evaluations examine what works, under what conditions and for whom. They are based on a middle-range (configurational) theory which describes the interactions between outcomes, mechanisms and contexts. The initial middle-range theory we built here considers that the KT scheme combines the following activities: supporting the access to and the adaptation of scientific and usable evidences; strengthening professionals' skills to analyze, adopt and use the evidences for their practices and decision-making process; facilitating the use of evidence in the organizations and processes. This KT scheme was designed for the use of five reviews of systematic reviews related to nutrition, alcohol, tobacco smoking, emotional and sexual life and psychosocial skills. The initial middle-range theory led to the design of four theories of intervention, one for each region, describing the interventions, contexts' parameters, and expected mechanisms and outcomes. This work was conducted in a preliminary 2-day workshop, gathering ARS and IREPS professionals. These theories are currently applied in the 4 regions and data are collected to identify the contexts/mechanisms/outcomes configurations of an effective KT scheme in local prevention sector. RAMESE II reporting standards for realist evaluations are used. This study will document the parameters of successful KT strategies in specific contexts of preventive health services in France, in order to determine the transferability into other contexts. For the EUSPR conference, we will present the used participative theory-based process of KT strategies mapping.

Prevention in the local communities - the clash of recommendations with reality

ABSTRACT. Introduction: Polish legal regulations impose the obligation to provide a local alcohol policy in the form of communal programs for preventing and resolving alcohol-related problems on local governments. One of the most common tasks is to carry out preventive actions addressed to children and adolescents. Systematically conducted monitoring of the activities of local governments allows to follow changes in the approach to preventive interventions (which actions are most often realized, to what extent the population is distributed, what is the level of expenditure on particular impacts), and the dissemination of recommended programs. Method: Data about activities undertaken by local communities in 2015-2017 were analyzed, special attention was given to the latest data from 2017.

Results: Over 1/3 of funds spent on local prevention and resolving alcohol-related problems are devoted to preventive activities (about PLN 180-200 million). The most funds are spent on after-school sport activities as well as camps with a preventive program. Only in the third place are preventive programs, but these are authorial programs with unproven effectiveness. Recommended programs with proven effectiveness are financed at the level of several million PLN. In case of dissemination of preventive actions, the largest number of participants is recorded in the case of authorial, non-recommended prevention programs, one-time talks and after-school sport activities (in each of these categories, 800,000 to 1 million people participated). The recommended programs are conducted among about 300,000 participants.

Conclusions: Despite the education of decision-makers dealing with local alcohol policy for many years in Poland, forms of preventive interventions of unconfirmed effectiveness are still the most widespread and most popular.

Using Monitoring and Evaluation to bridge the gap between science and practice

ABSTRACT. Connecting for Life (CfL) is Ireland’s National Strategy to Reduce Suicide 2015-2020. It is based on the best available evidence and wide-ranging consultation and engagement processes. The strategy has 69 actions under seven ambitious strategic goals; all focused on the primary and secondary prevention of suicidal behaviour, while addressing a broad range of risk and protective factors. It is a key prevention policy for many government departments including the Department of Justice, Health and Education. The HSE National Office for Suicide Prevention (NOSP) is tasked with (among other things) translating the strategy and evidence behind it into real-world effects. Monitoring and evaluation (M&E) is a new function within the NOSP, established in order to fulfil its strategic commitments, and to drive the top-down (i.e. national) and bottom-up (i.e. local) implementation of the strategy. A key evidence informed suicide prevention strategy, weaved across Connecting for Life, is ‘gatekeeper’ training. This aims to develop the attitudes, confidence, knowledge and skills in those people who are likely to come into contact with ‘at-risk’ individuals, and to help them to assess the levels of risk and manage the situation appropriately with referral when necessary. Monitoring and evaluation systems were developed to track and drive the adoption of the suite of training programmes, in the absence of a training plan, and to evidence the (short-term) outcomes. The data systems produce ‘usable actionable data’ that can help improve the quality of training and its implementation across the country. The current presentation will look at the M&E system that has been developed by the NOSP. It will also look at the challenges encountered, including resistance to data, and the establishment and maintenance of the necessary feedback loops to facilitate data-driven decision making.

The challenges of the implementation process – experiences from several European countries with the implementation of substance-use related prevention programmes from an evidence registry
SPEAKER: Klaudia Kepa

ABSTRACT. Manualised prevention programmes are often very structured and standardised interventions, which should be implemented with a limited range of variability in order to maintain the effective components of the programme. This is however difficult in the different European countries with their varying social, organisational and cultural contexts. Translation of evidence-based principles into daily practice remains a challenge for programmes that have been shown effective in one country and need to be applied in others. Manualised prevention programmes are often very structured and standardised interventions, which should be implemented with a limited range of variability in order to maintain the effective components of the programme. This is however difficult in the different European countries with their varying social, organisational and cultural contexts. Translation of evidence-based principles into daily practice remains a challenge for programmes that have been shown effective in one country and need to be applied in others. For a registry of evidence-based programmes (EBP) in a heterogeneous environment such as Europe it is therefore crucial to collect and analyse practitioners’ experiences in adjusting the programme implementations in order to overcome obstacles regarding this process in different contexts. This paper presents the main findings and lessons from the implementation experiences collected from the EMCDDA's registry of EBP, Xchange, which contains 22 EBP. The data were collected from a sample of European programme implementations included in the Xchange registry, and the answers were compared and coded. 29 implementation experiences from 8 of these programmes were available for qualitative analysis (coding, categorisation and comparison), and contain accounts of obstacles (from professionals, organisational and cultural contexts) and how they were overcome or adjusted to. Limitations are that this analysis captures predominantly those experiences that were successful and therefore were recorded in Xchange. System aspects of prevention need to be taken into account when evidence-based interventions ought to be rolled out into differing contexts. Ex- ante awareness of these factors and solution strategies from other colleagues can be helpful for practitioners in being prepared when facing realities of implementation in their contexts.

Challenges in use of evidence in development and implementation of an alcohol and drug prevention approach in sports clubs in Flanders

ABSTRACT. VAD is a Flemish government’s partner organization for the coordination and support of the subsidized prevention support system for alcohol, other drugs, psychoactive medication, gambling and gaming. VAD and regional partners strive to set up sustainable, setting tailored, multi component prevention interventions. Since 2014 VAD invests in sports clubs as a priority setting for alcohol prevention intervention. A preliminary research trial included literature review on risks and good practices in the sports setting, a needs assessment among community sports club decision makers, and focus groups with sports club stakeholders on feasibility of interventions. A three stepped approach was developed, piloted and is being implemented with train-the-trainer’s for regional sports club implementation support and Flemish level advocacy with relevant policy and decision makers. The project team with an external evaluator is also setting up a clustered effectiveness evaluation trial (rct). On the background of the development and implementation of this preventive intervention, the presentation will discuss the limits and difficulties of the use of evidence in terms of (1) the translation of theory in applicable, innovative and appropriate work forms (2) copyright/ownership of existing programs and approaches, (3) thresholds in generating own evidence, (4) the prevention policy guidelines and prevention support system as set by the subsequent governments and (5) increasing prevention system capacity by training prevention deliverers from the setting.



Location: EMCDDA 107
Estimating Causal Effects in Testing Causal Mechanisms: Problems and Solutions

ABSTRACT. Highly used in prevention research, mediation analysis is the statistical method used to investigate through which mechanisms a program changes the targeted outcome variables. Mediation analysis investigates causal mechanisms. Thus, it involves causal inference by definition. However, most current mediation analysis methods rely on assumptions that may not be satisfied for causal conclusions. If the treatment is randomized in a mediation study, causal claims can be made for the effect of the treatment on the mediator. However, randomizing the treatment will not yield accurate causal direct and indirect estimates unless certain assumptions are satisfied since the mediator status is not randomized. This study reviews the theoretical foundations of causal inference in mediation, describes methods to estimate causal direct and indirect effects, and reports the results of a large simulation study on the performance of the ordinary regression and modern causal mediation analysis methods when there are confounders of the mediator-to-outcome relation. Specifically, five methods are compared in terms of bias, to test how robust the methods are to the violation of the no unmeasured confounders assumption and confounder effect sizes. The methods explored are linear regression with adjustment, inverse propensity weighting, inverse propensity weighting with truncated weights, sequential g-estimation, and a doubly robust sequential g-estimation. Results show that failing to measure potential post-treatment confounder variables in a mediation model leads to biased estimates regardless of the analysis method used. Based on the results of the simulation study, we recommend and discuss the importance of sensitivity analysis and experimental designs that involve the manipulation of the mediator whenever it is feasible.

Embracing complexity; methodological and practical considerations for the development and evaluation of programmes which seek to create the conditions for health and reduce health inequalities.
SPEAKER: Katrina Wyatt

ABSTRACT. Poor health clusters in our most economically disadvantaged communities; there is little evidence for behavioural interventions which sustainably affect health behaviours and some programmes inadvertently widen rather than reduce health inequalities. The MRC guidance on the development and evaluation of complex interventions has been used extensively by researchers to develop behaviour change programmes but, for the most part, these are still aimed at targeting individuals or individual behaviours in isolation and the dynamic nature of the system into which it is implemented, ignored.

We will reflect on two programmes, one explicitly developed to prevent obesity in children across the socioeconomic spectrum, implemented in schools and with considerable family engagement (the Healthy Lifestyles Programme, HeLP) and one which was co-created by the police and the young people in an attempt to address high levels of antisocial youth behaviour (the TR14ers). HeLP used intervention mapping and extensive stakeholder involvement to develop an intervention which aimed to affect individual behaviours as well as the school and family environment. The programme was evaluated in a cluster randomised controlled trial involving 32 schools and 1300 children and their families and results showed no effect on objectively measured physical activity behaviours or levels of obesity. The Tr14ers have engaged over 1500 young people in dance in one of the most economically disadvantaged towns in England. The group are peer-led and have been holding weekly dance workshops for over 13 years. Using routinely collected data, outcomes attributed to participation include, reductions in truancy and antisocial youth behaviour, increases in educational attainment and reductions in asthma.

With increasing calls for a complex systems approach to inform public health evidence and practice, ways are also needed for case studies such as the TR14ers to inform programme development; understanding how they engage and sustain participation would support a move away from individual behaviours to health creating environments.

Many tools but still a challenge: assessing intervention studies in prevention and health promotion – Study appraisal with ROBINS-I in a systematic review on prevention of adiposity
SPEAKER: Antje Kula

ABSTRACT. For the assessment of intervention studies in (systematic) reviews or meta-analyses different instruments exist like the Cochrane Risk of Bias Tool. In principle, these tools focus on randomised controlled trials (RCT). RCT are considered to be the gold standard design for evaluation studies - what is not questioned here. But given the usual circumstances of intervention studies in the field of prevention or health promotion randomisation at an individual level as well as strict blinding is often not feasible. Therefore the above mentioned tools have a limited applicability in this research setting. Consequently other tools were developed, for example the Risk Of Bias In Non-randomized Studies of Interventions tool (ROBINS-I). In a systematic review on school based adiposity prevention we used the ROBINS-I assessment as a criterion for including studies in the evidence synthesis. Out of 2407 hits at the beginning we assessed 110 studies with ROBINS-I. None of the studies reached the highest rating “low potential of bias”. 48 studies were included achieving the second best rating “moderate potential of bias”. In this contribution we will give a brief summary of the instrument ROBINS-I, and will discuss its potentials and problems. The analysis of the characteristics of the included and excluded studies shows that the main limitations of the studies were insufficient consideration of confounding and/or lack of information. Nevertheless most of the studies used cluster randomisation. A further challenge was the comparability of the studies which provided a wide range of interventions as well as different follow-up periods. The results may enhance the ongoing process of developing sound study designs in the field of prevention research.

The importance of fidelity and context in realist RCTs
SPEAKER: Emily Warren

ABSTRACT. Evidence suggests that up to one third of young people in the UK are bullied by the peers. In addition to the increased risk of substance use, poor mental health, and lower academic attainment, evidence also shows that those who are either perpetrators or victims of bullying suffer greater physical and mental ill-health as adults. Intervening to change the school environment may be an effective strategy to reduce current ill-health and lessen the future burden of disease. INCLUSIVE is a theoretically informed, whole-school, multi-component intervention incorporating social and emotional learning curricula, restorative practices, and convening a student/staff action group to discuss unmet student needs, revise rules and policies, and implement locally relevant actions. It is also one of the first RCT to be evaluated using a realist ontology. An early question about whether or not an intervention improves health is determining whether or not the intervention was actually done. Fidelity of form and function will be explored to understand whether sufficient intervention activities were carried out to trigger mechanisms of action and what contextual features appear to effect this. Later analyses for this study will include developing and refining a priori hypotheses based on qualitative data and conducting moderator and mediator analyses to test the theory of change. Markham and Aveyard’s theory of human functioning and pedagogic practice, upon which INCLUSIVE is based, will then be revised and issues around the feasibility and philosophical congruence of realist RCTs will be explored.



Location: EMCDDA 012
A new revolutionary drug based on prevention: "Prevenill". The European Code Against Cancer and the Network for Prevention.

ABSTRACT. The Italian Network for Prevention supported by Center for Cancer Prevention of Piedmont and by the Oncology Network of Piedmont and Valle d'Aosta, aims at promoting the 12 recommendations of the European Code Against Cancer (ECAC). The European Code Against Cancer is an initiative of the European Commission to inform people about actions they can take for themselves or their families to reduce their risk of cancer. It has been estimated that almost half of all deaths due to cancer in Europe could be avoided if everyone followed the 12 recommendations. In formulating the recommendations, different multidisciplinary groups of experts over a two-year period, took into account the latest scientific evidence available. The Network for Prevention establishes an alliance between: public authorities, foundations, non-governmental organisations, municipalities, etc, on cancer prevention. This initiative represents a call to action and an advocacy tool to offer all partners the opportunity to support and promote prevention programs and interventions consistent with the 12 points of the European Code against Cancer. A regional media campaign it has been realized and various local initiatives were planned by the single organization in order to facilitate the dissemination of ECAC. All partners they have co-financed the project of the dissemination campaign.

Embedding health promotional organisational development in educational institutions into a communal and multi-disciplinary prevention network

ABSTRACT. Background: Funded by the German Federal Ministry of Education and Research, the project aims to promote the physical and psychological well-being and social inclusion of children between 3 and 10 years and their families in the Ortenau district by a two-track strategy: (1) prevention agents are building communal networks of stakeholders from the health, youth welfare and educational system, paying special attention to bridging system borders, (2) 18 month long organisational development processes with specially trained coaches in 30 ECEC institutions and 20 primary schools are implemented, based on an adaptive curriculum of prevention and health promotion, as educational institutions are playing a vital role when gaining access to children and their families.

Methods: A comprehensive mixed methods research design to evaluate the different outcomes is applied, including (1) qualitative interview data from community prevention agents, stakeholders, pedagogic professionals and at-risk families, (2) quantitative data on health promotion network development and communal needs assessment, and (3) a waiting-list control group design with mixed methods in ECEC institutions.

Findings: First interim analysis from the prevention network and strategy development show substantial new co-operations and the formation of multidisciplinary networks within the district. The waiting-list control group evaluation in ECEC institution show significantly higher self-reported competence levels of professionals in the pre-post-analysis (n=122) of the treatment group and also significantly higher in comparison with the waiting list control group (n=53), as well as significant pre-post-effects in the children (n=204) in the treatment group concerning self-rated self-concept and resilience and teacher-rated psychological well-being (n=221).

Discussion: The first results show positive effects of the health promotion strategy on the communal and institutional level. Especially the combination of health promotion organisational development in educational institutions backed up by a multi-professional network across system borders seems to be an effective measure to promote children’s health and has thus been transferred into regular public health care provision.

A multi-level parenting resource delivery model for families that have experienced armed conflict and displacement
SPEAKER: Wadih Maalouf

ABSTRACT. Parental support and monitoring are strong modifiable predictors of children’s psychological wellbeing in conflict and displacement settings. The provision of support to parents increases children’s resilience and promote positive developmental trajectories and long-term health. The need for a public health set of evidence-based family skills interventions is recognised in reducing engagement in risky behaviours and promote positive mental health. Accordingly and in line with the International Standards on Drug Use prevention, the United Nations Office on Drug and Crime (UNODC) recently geared its experience in piloting family skills programmes to target families living in challenged settings.  This presentation will overview the development of this multi-level parenting model that aims at availing to families (especially refugees), four key open-access interventions ranging from simple to in-depth training. The first intervention is built on collaboration with the University of Manchester and is a self-read leaflet piloted on 3000 Syrian families living in a conflict zone. The second resource is an interactive booklet and linked two hour seminar, piloted on 120 families in Nablus, Palestine. The third, developed by the UNODC, is the Strong Families programme, an open sourced, brief family skills intervention, for vulnerable populations in low resource settings consisting of 3 sessions for caregivers and their children. It was initially piloted in Afghanistan, but has now been piloted in Serbia with refugees stranded in transit. . The forth resource is a brief “Plus Parenting” programme for an existing intervention for children showing traumatic stress, Teaching Recovery Techniques (TRT+Parenting), evaluated in Turkey and piloted through a 3 arm RCT in Lebanon with Syrian refugees.

These interventions will be presented briefly together with preliminary results from their pilots. These resources offer brief, integrated support for families in humanitarian and low resource settings, enabling integrated, coherent information to be disseminated depending on local resources/needs. This aligns with international humanitarian principles and approaches to strengthening families by agencies in low resource settings worldwide.

Effectiveness of Mois sans tabac, a French national and regional campaign against smoking

ABSTRACT. Background: In October 2016, Santé publique France, the national public health agency, launched a national mass-media campaign aiming at triggering quit attempts among smokers: “Mois sans tabac”, inspired by the English ‘Stoptober’. This campaign sets smokers the objective of being smokefree for one month, in November. About 180,000 smokers registered on a dedicated website and were proposed various cessation helps (quitline, interactive mobile phone-based coaching, self-help kit). About 2,000 local events were organized to raise public awareness. Methods: The effectiveness evaluation is based on a specific analysis of the 2017 Health Barometer, a random survey representative of the population living in metropolitan France conducted between January and July 2017 on a sample of 25,319 individuals aged 18-75 years-old. Multivariate regressions will allow testing the association between exposure to the campaign and quit attempts in the last quarter of 2016. This time period enables to take into account potential postponement of smokers’ quit attempts initially scheduled in October and anticipation of other ones scheduled in December. Results: Nearly one in six daily smokers (15.9%) report making a 24-hour quit attempt in the last quarter of 2016, and 18.4% of them report that it was related to Mois Sans Tabac, which represents approximately 380,000 quit attempts related to the operation. About half of the individuals who made a quit attempt in the last quarter of 2016 used external assistance (47.7%), more among those reporting that this was linked to Mois Sans Tabac (67.1%). These initial results will be completed by an analysis based on the level of exposure to the campaign. Conclusion: First results show that the first edition of Mois sans tabac was successful in triggering quit attempts among smokers.

09:30-11:00 Session Parallel 3.4: DIET AND PHYSICAL HEALTH

Parallel Session 3.4: DIET AND PHYSICAL HEALTH

Location: Palacete 007
Effects of an intensity level video demonstration on self-reported physical activity

ABSTRACT. Background: In questionnaires, respondents tend to report more time spent in higher intensity physical activity (PA) than what is directly measured (e.g. by accelerometer). The aim of this study was to test whether a video demonstration of different PA intensities can reduce over-reporting of PA. Methods: Using a tablet PC-supported survey among inpatients on cardiology wards in 2016, participants were randomly assigned to either a “video group” or a “no video group”. Both groups answered the International Physical Activity Questionnaire-Short Form. Before that, the “video group” received a 3-minute video demonstration, whereas the “no video group” did not. The effect of the video on the reported minutes per week (min/week) of PA and moderator effects of sex, age, and school education were investigated using zero-inflated negative binomial models (vigorous and moderate PA) or negative binomial models (walking). Results: In the total sample (N = 353, mean age = 62.6 years, 65.4% male), there was no effect of the video demonstration on any PA outcome concerning whether or not any activity was reported and concerning min/week of PA. When any vigorous PA was reported, women in the “video group” reported less min/week of vigorous activity than women in the “no video group” (Incidence Rate Ratio [IRR] 0.46, 95%-Confidence Interval [95% CI] 0.25 to 0.86, p=0.02). Men in the “video group” reported more min/week of walking than men in the “no video group” (IRR 1.83, 95% CI 1.29 to 2.59, p=0.001). Age in men and school education in women were found to be significant moderators of the video effect. Discussion: The video demonstration reduced self-reported PA only in certain subgroups. Further research should identify the effects of intensity level video demonstrations on the concordance of self-reported and directly measured PA and moderating effects of video and recipients’ characteristics.

Implementing the GRADE Evidence to Decision (EtD) framework to answer a broad public health question: Challenges and solutions.

ABSTRACT. Despite major investments in both research and policy over the past 25 years, evidence-informed practice still has room for significant improvements in many areas of healthcare and prevention (Djulbegovic & Guyatt, 2017, Rutter et al., 2017). One reason is the lack of evidence concerning what works for whom in which circumstances. Another equally relevant reason is the failure to use existing evidence in practice. As evidence-informed practice requires integration of the best available knowledge into the decision-making process, the design of this process is critical for its success. To facilitate evidence-informed decision-making for clinical practice guidelines, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group has developed the EtD framework ( (Alonso-Coello et al., 2016).

In this presentation, we will report the challenges of and solutions for implementing the GRADE EtD framework to answer the question, whether or not lifestyle intervention programs for obese children/adolescents should be implemented in Lower Austria.

The main challenges were as follows: 1. To get the representatives of all relevant interest groups (funder, practitioners, children, parents, scientific experts) to agree on a manageable selection of outcomes based on which the decision should be made; 2. To match the above outcomes - partly formulated in colloquial language – with key/MeSH terms for literature search; 3. A lack of evidence for half of the criteria based on which the decision should be made; 4. The heterogeneity of outcome measures reported in the literature. Among other solutions that will be explained in the presentation, we had to adapt the GRADE system for rating the quality of the evidence.

When limited public resources are used and the health of the population is at stake, it should be an ethical imperative to inform decisions with the best available evidence. The GRADE EtD framework enables an evidence-informed practice through transparent and comprehensible recommendations based on the best available evidence. Even though its implementation requires considerable time and resources, those are usually outweighed by its benefits.

Exploring the acceptability and feasibility of using activity monitoring devices to support physical activity within an exercise referral scheme for adults with, or at risk of, a chronic health condition.
SPEAKER: Jemma Hawkins

ABSTRACT. Introduction: Whilst there is evidence for initial effectiveness of exercise referral schemes for increasing physical activity, evidence of long-term effects is limited. In Wales, a trial of the National Exercise Referral Scheme [NERS] showed small but significant impacts on physical activity at 12-month follow-up. Technologies such as wearable activity monitoring devices may enhance long-term maintenance of activity by facilitating goal setting and progress monitoring and supporting intrinsic motivation. This pilot trial explored the acceptability and feasibility of implementing accelerometry-based activity monitors within NERS.

Methods: A pilot randomised controlled trial with embedded process evaluation and economic evaluation was conducted. New NERS participants (mean age=57, 65% female) were randomised to receive either an activity monitor alongside NERS (n=88) or NERS usual practice (n=68) and completed questionnaires at baseline, 16-weeks and 52-weeks. Twenty intervention participants and 12 NERS staff members completed interviews at 4-weeks and 52-weeks.

Results: Findings suggest that participant experiences of utilising the activity monitors were mixed. Approximately half of participants reported that the devices were easy to use (49%) and met their expectations (57%). In interviews, some participants reported that the monitors helped them to become more aware of their physical activity levels and increased their motivation. Barriers to acceptability included general and device-specific wearability and technological problems, such as device malfunctioning and computer compatibility issues. Staff also reported device- and context-specific technological barriers to implementing the monitors alongside usual practice.

Conclusion: The researchers have worked closely with NERS stakeholders including the funders and national coordinating staff to ensure that the findings are used to inform future use of the activity monitors within the scheme. Whilst some findings were device-specific, there are broader lessons for future research and practice which incorporates activity monitoring devices into physical activity interventions including implications for delivery staff time and training.

Using theory of change to develop an intervention theory for designing and evaluating behavior change SDApps for healthy eating and physical exercise: THE OCAPREV PROJECT

ABSTRACT. Connected health devices and applications (SD Apps) are being portrayed as a new way for prevention, with the promise of accessibility, effectiveness and personalization. Many effectiveness evaluations (experimental designs) with a strong internal validity exist. While effectiveness does appear to vary, the mechanisms used by these devices have not yet been thoroughly investigated. Our OCAPREV research seeks to unpack this black box. Thus, we propose to describe the elaboration process of an intervention theory for healthy eating and physical activity SDApps. It includes a set of vigilance criteria to comply with when addressing possible impacts on social health inequalities. To build this theory, we drew on theory-driven approaches and in particular on the theory of change (ToC). For this, we developed a cumulative and iterative process combining scientific data from literature, and knowledge from experts (researchers and practitioners) and from patients or users. It was a 3-step process as follows: 1 - identifying the evidence base; 2 - developing theory through design intervention and creating realistic expectations, including in our case specific work on social health inequalities (SHIs); 3 - modeling process and outcome. We were thus able to produce an evidence-based theory according to the ToC model, based on scientific evidence and experts and users expertise. It sets out a causal pathway leveraging 11 key mechanisms - theoretical domains - with which 50 behavior change techniques can be used towards 3 ultimate goals (COM-B). Furthermore, the theory specifically addresses SHI criteria. This theory is an aid to SDApp design and evaluation and it allows health inequalities to be fully considered. Firstly it enables developers to adopt a more over-arching and thorough approach to supporting behavior change, and secondly it encourages comprehensive and contributive evaluations of existing SDApps. Lastly, it allows health inequalities to be fully considered.

09:30-11:00 Session Parallel 3.5: RISK AND RESILIENCE

Parallel Session 3.5: RISK AND RESILIENCE

Location: EMCDDA 106
Refining and testing measures of dating and relationship violence (DRV) among adolescents in England: Cognitive interview and baseline findings from the Project Respect DRV prevention programme

ABSTRACT. Dating and relationship violence (DRV) – intimate partner violence among adolescents – is associated with a range of negative health outcomes including HIV and other STIs, substance use and suicidality. Though recognised and researched more extensively in the US, DRV is a rapidly emerging area of public health research and practice in the UK. Existing UK prevalence estimates vary by sampling frame and method of measurement. Available evidence suggests DRV is widespread in the UK, with 22% of girls reporting physical DRV and 27% of boys and 48% of girls reporting emotional DRV. Evidence on whether DRV is patterned by socioeconomic status or ethnicity is mixed.

Two established measures of DRV in the US, the Safe Dates (SD) and short Conflict in Adolescent Dating Relationships Inventory (CADRI-s), have not been used before in the UK. As part of Project Respect, a pilot cluster RCT of a DRV prevention programme in England, we adapted and refined these measures for use with adolescents in England and then piloted the refined measures.

After adapting the measures to incorporate controlling behaviours (CADRI-s) and online behaviours (both CADRI-s and SD), we tested the adapted measures in cognitive interviews with 15 secondary school students aged 12-15 in England. The measures were refined based on these findings and then piloted in a self-complete baseline survey with 1,429 students aged 12-14 in five secondary schools taking part in Project Respect.

We will present the refinements to the SD and CADRI-s indicated by cognitive interviewing to optimise the measures for use with adolescents in England. We will present findings from the baseline survey including estimates of prevalence of DRV victimisation and perpetration among girls and boys, and we will explore associations between DRV victimisation and perpetration and other factors. We will discuss how these findings build on the nascent DRV evidence base in the UK.

Could population prevalence and socio-economic inequalities in children’s mental health problems be reduced by increasing physical activity? A policy simulation in the UK Millennium Cohort Study (MCS)

ABSTRACT. Introduction Greater moderate-to-vigorous physical activity (MVPA) is associated with lower risk of internalising child mental health problems (CMHP) such as depression and anxiety. The population impact of increasing MVPA on prevalence and inequalities in CMHP is unknown. Therefore, we simulated universal achievement of the UK government’s target of 60 minutes (m) MVPA per day in the Millennium Cohort Study (~18000 children born 2000-2).

Methods Of 6,497 children with MVPA data (accelerometer) at 7 years(y), 5,369 had data for the outcome (CMHP [parent-reported Strengths and Difficulties Questionnaire (SDQ] 11y), exposure (income quintiles, 5y) and confounders. Predicted probabilities of CMHP were estimated in logistic marginal structural models, weighted for attrition, baseline and intermediate confounding. Inequalities were risk ratios (RRs) and differences (RDs) [95%CIs]). Intervention was simulated by re-estimating predicted probabilities after modifying MVPA.

Results 49% achieved the 60m MVPA target, with greater activity levels observed at lowest income (average 65 min/ day). Intervention simulation (30m average increase for all children), led to 96% achievement of the 60m MVPA target. While not significant according to traditional thresholds, prevalence of internalising CMHP decreased after intervention from 9.3% (95% CI: 7.9, 10.7), to 9.0% (95% CI: 6.7, 11.2).

Comparing children in lowest income families to those in the highest quintile, increasing MVPA did not reduce relative risk of internalising CMHP (1.86), but may reduce absolute inequalities (RD; 5.86 [1.06, 10.65] before, and 5.65 [0.96, 10.34] after intervention). Sensitivity analyses using teacher-reported SDQ showed similar results.

Discussion Using causal methods to simulate a policy-based intervention at population level, our findings imply that universal achievement of the UK national MVPA target for children may reduce population prevalence and absolute inequalities in internalising CMHP. Caution is indicated when applying present findings to externalising CMHP comprising hyperactivity and conduct problems, whose features may characterise MVPA.

Traditional Gender Roles and Gender Convergence in Substance Use among Spanish Adolescents
SPEAKER: Stephen Kulis

ABSTRACT. Purpose: The rapidly closing gender gap in substance use observed in many societies is often attributed to declining conformity to traditional gender roles (TGRs). Socialization into TGRs has been viewed as promoting male substance use but discouraging it among females. This study investigated TGRs as predictors of narrowing gender differences in substance use among Spanish adolescents.

Methods: We collected questionnaire data from students in four public secondary schools in low income Seville neighborhoods (n=259, Mage=14.7, 51% female). Outcomes included recent and lifetime frequency of alcohol, tobacco, inhalant and marijuana use, recent binge drinking and drunkenness. A 5-item TGRs scale assessed endorsement of a polarized gender division of family labor and power (Cronbach’s alpha=.75). Controlling for age and SES, separate regression analyses by gender and gender interaction models tested whether TGRs predicted outcomes differently for males and females.

Results: Except for marijuana, where males used more frequently than females (and the difference persisted after controlling for TGRs), there were no gender differences in any of the other substance use outcomes. Conformity to TGRs predicted greater use of all four substances, but in substance-specific and gendered patterns. For females, TGRs predicted only greater overall use of alcohol and tobacco. For males, but not females, TGRs predicted more binge drinking and drunkenness, and more use of marijuana and inhalants.

Discussion and Implications: Results for males are consistent with arguments that polarized gender role expectations for men increase male adolescents’ behavioral risk-taking. For females, TGRs did not provide protection from substance use, but instead, were associated with increased use of licit substances. Results may reflect persisting TGRs in the family, conflicting gender role messages for females, and gender segregation in exposure to substance offers and opportunities. Implications for prevention include the need to design interventions that recognize shifting TGR norms, provide decision-making alternatives to those promoted by TGRs, and help youth navigate gendered behavioral expectations.

Influences of Personal Characteristics on Group-based Club Intervention Outcomes

ABSTRACT. This study (funded by National Institutes of Health, R01AA022331) of nightclub patrons and their social drinking groups, tests an intervention, Nightlife Safety Plans (NSP), designed to reduce escalation of overuse of alcohol/drugs, physical aggression, and sexual aggression during an evening at the club. NSP relies on social groups that arrive at the club together, to identify early signs of problems and to take actions to intercede called the Three O’s: Outreach, Options, and Out. Data analyzed in this presentation consists of 352 groups (961 participants) gathered over 41 nights (Friday and Saturday) at 7 different clubs. Data from online surveys, alcohol breath tests, and biological drug tests (post-test only) were gathered at entrance and exit for pre- and post-test assessments of the intervention effects. Biological measures reveal at least one club patron per group was legally intoxicated (Breath Alcohol Concentration—BAC, >.08%) in 60% of groups and at least one patron was positive for drugs in 50% of the groups. Further, at least one club patron per group experienced physical and/or sexual aggression within 40% of groups. Results indicated that experimental groups were significantly more likely to intervene with group members, using a significantly higher number of intervention strategies (i.e., the 3 O’s), to assess situations for physical aggression and sexual harassment, and to respond to friends experiencing sexual harassment. Further experimental groups used significantly more protective strategies to keep group members safe and discourage their friends from alcohol overuse and drug use. Reduced levels of alcohol use and intoxication or impairment (BAC > .05), as assessed by breath tests, were found among the groups in the experimental as compared to the control condition. In this presentation, moderating influences of personal characteristics (e.g., age, gender, sexual minority status) on outcomes are examined. Groups provide an opportunity to deliver and implement peer-focused safety strategies to enhance safety during the time spent in the club. Our focus on clubs also reaches young adults who are working (two-thirds not in college), an underserved population.

Parental Influences on Adolescent Major Depressive Symptoms and Marijuana Use
SPEAKER: William Crano

ABSTRACT. With its medicalization, legalization, and decriminalization in many U.S. states rendering marijuana more accessible, researchers and policy makers have become increasingly concerned with the its effects on adolescents. This concern is motivated by research that indicates a substantial relation between teen depression and subsequent marijuana use. The relation of parental monitoring and warmth with adolescent depression and marijuana use may reveal a previously unexamined factor that may facilitate understanding, influencing, and supporting adolescents during this critical developmental phase. Our research examines direct and indirect relations between parental influence, youth depression, and marijuana use, which may enable deeper understanding of the genesis and effects of adolescent depression, and facilitate positive adolescent development through prevention of psychotropic substance use. A path analytic approach (N = 12,115) on data from a representative U.S. sample indicated depressive symptoms had an indirect effect on the relationship between parental warmth (p < .001), monitoring (p = .01), and adolescent marijuana use. Depressive symptoms had significant indirect effects on parental warmth and marijuana use (both p < .001), and on parental monitoring and marijuana use (both p < .05). Exploring relationships grouped by respondents’ age (12-14 and 15-17 years, respectively) revealed only minor differences. Understanding the role of parental influences in marijuana use among adolescents with depressive symptoms may lead to important developments in prevention and treatment.

11:00-11:30Coffee Break
11:30-13:00 Session Plenary 3: Plenary III

Plenary 3

Chess, not chequers

ABSTRACT. The prevalence of chronic diseases is increasing, inequalities are widening, and the resources to respond are ever more constrained. There are no simple answers to any of this, but an important part of the problem may lie in the ways in which we conceptualise these challenges, grounded in traditional models of cause and effect. Reconceptualising these complex problems in ways that truly take account of their complexity allows us to generate different and more relevant kinds of evidence, construct more meaningful practical and policy responses, and evaluate those responses in more appropriate ways. This talk will explore these themes, and propose ways in which they might be achieved.

13:00-14:30Lunch Break
13:00-14:30 Session Poster 2: Poster Session II

Poster Session 2

Alcohol Availability, Use, and Harms Among Adolescents in Three Northeastern Mexican Cities

ABSTRACT. Despite efforts to restrict its access, alcohol remains readily available to youth in most countries. However, little is known about how alcohol use and related harms among youth in developing countries are related to alcohol availability. This study examined the associations between the perceived and actual availability of alcohol and alcohol use, heavy episodic drinking, and alcohol-related harms in a sample of 594 12- to 17-year-old students in central Mexico. Overall, 59% (n=350) of the students reported past-year drinking; 57% of these students reported past-30-day alcohol use, 34% reported heavy episodic drinking in the past 30 days, and 55% reported experiencing at least one alcohol-related harm in the past year. Youth who purchased alcohol at off-premise establishments were consistently more likely to engage in past-30-day alcohol use and heavy episodic drinking and to have experienced alcohol-related harms in the past year. Perceived alcohol availability was positively related to past-30-day alcohol use and harms. Drinking at on-premise establishments was also positively associated with alcohol-related harms. Preventive efforts in Mexico to reduce the availability of alcohol at both on- and off-premise establishments are imperative.

Injecting cocaine and heroin users own smartphone too: Let’s provide them with ICT tools for reduce harms associated with drug consumption!
SPEAKER: Fran Calvo

ABSTRACT. Introduction Persons who inject drugs, including individuals experiencing extreme social exclusion situations like homelessness, use information and communication technologies. Literature review concludes they can to beneficiate of eHealth, and mHealth proposals like general population.

Objective The objective of this proposal is to plan and develop the way to incorporate web or mobile tools to persons who inject drugs (PWID) of the harm reductions programs of the Mental Health and Addiction Network of Girona (Catalonia).

Method Actions until today We analysed the scientific literature during 2015 and 2017 and a systematic review about how PWID use ICT was performed.

We analysed the potentiality of the context (city of Girona) to apply ICT programs and tools. We studied how PWID and homeless used mobile phones and social network sites and if could be possible that they will use ICT resources.

We decided to design and develop the first needle exchange points finder of Europe. It’s a web-app for mobile devices. Besides being a geolocation of services the app allows PWID to comment the experience of use anonymously (like a social network site).

Develop contained some phases:

1. Usability tests. We conducted 3 usability tests with professionals and PWID during February and March of 2018. 2. Improving. We apply the upgrades resulting of the usability test. Capacitation and diffusion: We trained college students and they broadcast to PWID.

Future actions Pilot use of the web-app will starts on April and for 6 months. Qualitative and quantitative evaluation plans will be perform.

Conclusion Professionals and users refers this web-app will be useful to improve the access to injection materials and to increase the participation of PWID in the community. It’s expected that this web-app diversify the patterns of distribution of needles and improve the experience and participation of PWID.

Elos Program Transfer to States and Municipalities: Technology Development on Child Prevention Inspired on Good Behavior Game
SPEAKER: Flora Lorenzo

ABSTRACT. Due to low dissemination of effective Brazilian practices in prevention of harmful drug use, since 2013 the Mental Health Department of the Ministry of Health develops Elos Program for municipalities and states. It was based on Good Behavior Game from a partnership with the American Institutes for Research and United Nations Office on Drugs and Crime. Scale it up as a public policy requires Policy Transfer to local Health and Education networks with strategies that ensure autonomous implementation and adherence to GBG core elements which subsidies its effectiveness in reducing 2.7 times the risk of harmful use of substances. Procedures involved (a) content development for coaches training and guide; (b) provision of training for 121 coaches from health and educational services from eight cities in four federal states, 53 of which were Pedagogical Coordinators with high responsibilities within schools; (c) complements of teacher's training, including: organization of Implementation Guide in 18 steps, additional activities about core elements and social determinants of health; (d) provision of training and support for 236 teachers; and (e) designing a Family Component to extend protection factors to other contexts. Elos technology transfer design reached 6.236 students from 1st to 5th grades from 59 schools in 2016-2017. Concerning educators perception, 80% of respondents to monitoring system indicated that children became more cooperative, 64% described a decrease in physical and verbal aggression and 88% reported improvements in classroom management. Also most of educators (68%) evaluated local coaches support as crucial for the program success. Professionals perceptions are aligned with what is considered nurturing features in educational institutions, which are important protection factors during child development. It is necessary to improve, however, the use of fidelity tools by local professionals and the use of monitoring systems, essential strategies to guarantee program's quality in a national range scale.

Normative beliefs of teachers and health professionals implementing prevention programs

ABSTRACT. Introduction Normative beliefs have been studied in different contexts, especially in peer influence, school environment, drawing parallels with behaviors such as substance use, violence, and bullying among other response patterns. This study intends to observe moderation of normative beliefs in professionals of a prevention program and investigate possible impacts on preventive interventions. Method Data were collected on perception of prevention professionals (teachers and health professionals) of #Tamojunto, adapted version of Unplugged in Brasil, through individual estimate, and later groups average regarding the prevalence of substance use patterns of one-time use in life, one-time use in last month, and 6 or more times use in last month, of alcohol, tobacco, marijuana and inhalants by adolescents from sixth grade to middle school, and later compared with national epidemiological data on substance use (Cebrid, 2010). Results Data indicate a large difference between professional's beliefs about substance use in relation to national research. The prevalence in Cebrid research was lower than the perception of professionals in all patterns of use, ranging from 59 times smaller (in the case of frequent use of Marijuana) to a relatively close percentage in alcohol use pattern (difference of only 10% or 1.18 times higher than the research indicator). Conclusion It was verified approximation in responses of groups and individuals, and great difference with research data (more evident in Marijuana, Inhalants and Tobacco). Questions and subsequent research may investigate determinants involved in such pattern. Normative beliefs can be a determinant variable of the quality of prevention, and even a complementary form to observe, monitor and evaluate in smaller scale than large tests with students. In any case, it is interesting to observe beliefs in different contexts and investigate their relationship with different substance patterns and quality of prevention interventions.

Indicated prevention within the diversion scheme in Hungary: using evaluation results for developing regulatory document to improve practice of prevention-education service (PES)


The prevention-education service (PES) is an indicated prevention within the diversion scheme provided for offenders using drugs without signs of addiction. As an alternative to prison it is a mandatory programme for people caught by the police.

The main objectives are to: prevent regular drug use and development of addiction, decrease time/frequency of usage, promote healthy lifestyle, develop life skills and self-reflection. Further objectives can be modification of attitudes, improvement of quality of life, achieving abstinence. The ultimate aim is the abolition of criminal proceedings.

PES and its clientele

PES is implemented as a 24-hour mandatory programme carried out within 6-12 months. Clients belong to a wide age range (13y-66y), have various drug use patterns and socio-economic backgrounds, and very low motivation. This extreme variety makes the individual needs assessment crucial at start.

Evaluation research

An evaluation study was carried out among 16 PES service providers with the biggest clientele. The quantitative element aimed at describing the services/programmes delivered, the clients’ characteristics and – with a pre-test-post-test design – operationalising the general and service specific objectives of the programmes to measure changes at client level which might be contributed to the PES programme. The qualitative element aimed at checking if the service providers followed the recommendations of the so far existing (outdated) professional regulatory document. 2,5-3 hours semi-structured interviews with representatives of the service providers were conducted.

Based on the research findings the regulatory document was updated. Recommendations were formulated related to all aspects of the service. As the main obstacle to achieve considerable results with the clients – according to professionals - is the mandatory nature of PES, specific methods/techniques were suggested. A great emphasis was put on the development of a plan at client level to provide personalised interventions. As evaluation is mostly missing from the practice as well as regular supervision is not in place these were also highly recommended. The final draft of the regulatory document was consulted with practitioners from the field to assess the importance, relevance and feasibility of the recommendations as these criteria proved to be significant during the development of EDPQS

Alternative to prison for young offenders using drugs – Evaluation of the immediate impact of indicated drug prevention interventions in Hungary as part of the diversion scheme


The diversion scheme in Hungary is established for drug users who were caught by the police because of consuming or possessing small amounts of controlled substances. It offers a pathway into harm reduction, treatment and prevention as an alternative to prison for the benefit of the offenders and the society. The engagement is mandatory for the offender to avoid prison. One form of diversion scheme is provided in the format of indicated prevention as a prevention-education service (PES) for those who do not show signs of addiction.


The objectives of the research were: to describe the content of PES in a structured way according to internationally accepted criteria (EMCDDA, EDDRA); to describe the profile of the of PES clients (socio-demographic characteristics, drug using patterns); to examine if services met the criteria in the PES regulatory document; to evaluate the effectiveness of the services according to their general and specific objectives; and to check the satisfaction of the clients with the intervention they participated in.


The evaluation followed a ’pre-test post-test single group’ design. A face-to-face self-administered questionnaire was used. The items described the individual characteristics of the clients and operationalised the general and specific objectives of the interventions of 16 PES service providers with the biggest clientele based on client turnover data of previous years. The pre-test was administered upon entering (706 individuals) whilst the post-test upon completing the intervention (420 individuals). During the analysis changes in drug use and certain psychological variables according to general and specific objectives of the interventions, clients’ satisfaction and fitting with the recommendations of the regulatory documents were explored.


During the presentation the description of the interventions, client characteristics and regression models built on individual and program characteristics explaining the changes in drug use and mediating variables will be shown.

Qualitative analysis regarding the implementation Elos and #Tamojunto prevention programs in northeastern cities of Brazil, 2016: Challenges and perspectives of improvement and re-revaluation

ABSTRACT. Background: In 2013, two programs on drug use prevention were adapted and implemented in Brazil, as follows: #Tamojunto (originally “Unplugged”) and ELOS (“Good Behaviour Game”). This study aims to discuss programs’ implementation aspects according to teachers and multipliers´ from two Brazilian northeastern states (Ceará and Rio Grande do Norte), in 2016. Methods: 12 schools were selected (6 for each program). Teachers and program multipliers from these schools attended focus groups and answered in-depth interviews. Data collection was accomplished in October-December, 2017. The interviews were recorded via digital audio and transcripted for content analysis. Results: One focus group; 11 in-depth interviews focusing teachers and 8 multipliers from ELOS were carried out, whereas respecting #Tamojunto 7 interviews with teachers and 8 with multipliers were done. Most teachers in charge of ELOS considered the formative and the monitoring meetings satisfactory. Some multipliers considered the formative satisfactory, but the monitoring meetings insufficient. In the context of #Tamojunto, both teachers and multipliers liked the formative activities and considered the monitoring meetings satisfactory. In the both programs, the interviewees highlighted difficulties in their agendas, besides insufficient number of the monitoring meetings. The interviewees said that ELOS minimum standards do not match the original protocol. The implementation period fell short of the recommended timetable, whereas for #Tamojunto there were problems regarding the discontinuation/interruption of the regular 12 classes. Conclusions: Lack of compliance with the standard procedures of both programs has been frequently observed. Changes were made in order to improve programs, due to the interviewees’ perception that they were not working, but provisional adaptations tend to be unartfully done. One should highlight the serious caveats of public education in contemporary Brazil. Teachers are overburdened, poorly trained and paid, and work under unfavorable conditions.

Substance use and dependence among Brazilian adolescents: Findings from a National Survey, 2015

ABSTRACT. Background: In Brazil, most studies on substance use have assessed clinical samples or findings from local ethnographic studies from major drug scenes located in the industrialized southeastern metropolitan areas (e.g. São Paulo, Rio). This study summarizes sociodemographic characteristics of youth aged 12-17 years old, who have been contacted and interviewed by a probability survey, all over the country. Methods: The III Brazilian Household Survey on Substance Use is a nationwide representative survey that interviewed 16,273 individuals selected by a multi-stage probability sampling in 2015. Individuals self-reported their HIV status and answered about 12-month substance use and DSM-IV dependency criteria for alcohol, benzodiazepines, amphetamines, opioids, inhalants, ketamine, LSD, ecstasy, cannabis, powder and crack cocaine and Fägerstrom test for nicotine dependence. The prevalences and corresponding 95% confidence intervals (CIs) were estimated considering the complex sample design and weight calibration. The results summarize descriptive statistics of this segment of the national sample. Results: After weighting and post-stratification findings refer to a population of 20,276,385 adolescents aged 12-17y. Alcohol use was reported by 22.2% (95%CI:19.0-25.5) and 8.8% (95%CI:6.1-11.5) in the last 12m and 30d, respectively. Approximately 120,000 adolescents (0.6%[95%CI:0.2-1.1]) were classified as alcohol dependent. Tobacco smoking was reported by 3.8% (95%CI:2.2-5.4) and 2.4% (95%CI:1.2-3.5), in the last 12m and 30d, respectively. Approximately 61,000 (0.3%[95%CI:0.0-0.7]) were classified as tobacco dependent. Cannabis was reported to be smoked by 2.2% (95%CI:0.9-3.5) and 1.3% (95%IC:0.2-2.4) in the last 12m and 30d, respectively. Around 12,000 adolescents were classified as cannabis dependent. For illicit substances other than cannabis, prevalences were 0.7% (95%IC:0.1-1.3) and 0.2% (95%IC:0.0-0.6), in the last 12m and 30d, respectively. Conclusions: Prevalence of use was higher for licit substances (e.g. alcohol and tobacco), reinforcing the need to reinforce prevention of such substances, which use is widespread and that seem to be function as gatekeeper substances in this segment.

Assessing the relationship between smoking and abdominal obesity in a National Survey of Adolescents in Brazil

ABSTRACT. Abdominal obesity is even a stronger risk factor than overall obesity for noncommunicable chronic diseases. We examined the association between smoking and abdominal obesity among adolescents. Analyses were based on 38,813 subjects aged 15-17 years from the Study of Cardiovascular Risks in Adolescents (ERICA), a Brazilian school-based national survey. Abdominal obesity was defined considering waist circumference (WC) percentiles. Statistical analyses, stratified by sex, considered the sample complex design. Poisson regression with robust variance was used to estimate smoker-to-nonsmoker abdominal obesity prevalence ratio (PR), adjusting by sociodemographic and lifestyle variables. Higher prevalence of abdominal obesity was observed among adolescents who consumed >1 cigarettes/day, comparing to nonsmokers: considering WC >80th percentile, adjusted-PR for boys was 1.27 [95%CI:1.05,1.52] and, for girls, 1.09 [95%CI:1.00,1.19]; using the 90th percentile, adjusted-PR were 2.24 [95%CI:1.70,2.94] and 1.27 [95%CI:1.12,1.46], respectively for male and female adolescents. Our findings suggest a positive association between cigarette consumption and the prevalence of abdominal obesity, for both boys and girls. Although other studies had found this association in adults, our study contributes to this discussion by assessing it in adolescents using a nationwide representative sample of medium and large municipalities.

Cognitive testing of survey items on social norms relating to sexual behaviour and dating and relationship violence with young adolescents in England

ABSTRACT. Background Increasingly, interventions to improve adolescent sexual and reproductive health and prevent dating and relationship violence (DRV) are incorporating social norms approaches. These strategies aim to shift perceptions of what behaviours are typical and acceptable in a ‘reference group’ of important others. Despite the proliferation of norms-based interventions, studies of such programmes rarely attempt to measure changes in social norms and there is little consensus on how to do so. Such measures would require that participants could distinguish between their personal attitudes and the views of others and could report on the latter. As part of our research piloting two school-based interventions that aim to shift norms concerning sexual behaviour, gender and DRV, we adapted and cognitively tested measures of personal attitudes and descriptive and injunctive norms relating to these phenomena with adolescents in England.

Methods We conducted cognitive interviews with 25 young people aged 12-15 in England. We assessed the extent to which the intended meaning of each item was clear to participants (understandability) and the extent to which participants were able to respond to the questions (answerability).

Results While participants found it easier to answer questions about their own views compared to those of others, our data suggest respondents were able to distinguish between these two phenomena. For norms items, answerability was improved where participants could draw on concrete experiences of social norms being publicly displayed, including through social sanctioning. Where norms were less publicly manifest, this detracted from the answerability of our questions.

Discussion Our data suggest it is possible to develop social norms measures about sexual behaviour, gender and DRV that are both understandable and answerable for 12-15 year-olds in England, but careful consideration is needed to establish the value of including measures of social norms that are not publicly manifest among this age group.

Gender differences regarding behavior/patterns crack use: Crack National research findings, Brazil, 2012

ABSTRACT. Background: Men and women usually presented marked differences on drug use patterns as well as on drug use-related risk behaviors. Identification and understanding such differences may contribute to public policies tailored to each population group needs, taking in consideration gender perspectives (among others). This study aims to identify differences among men and women, regarding their pattern of use and their behaviors related to crack cocaine use, recruited from open drug scenes, all over Brazil.

Methods: In 2012, a National Survey on Crack Cocaine interviewed 7,381 regular (after PAHO’s CODAR criteria) crack/cocaine consumers, aged 18+y. Crack users answered a questionnaire and were rapidly tested for HCV and HIV. The prevalence and corresponding 95% confidence intervals (CI) were estimated considering the complex sample design. Bivariate analyses, stratified by sex, defining contingency tables and their respective statistics.

Results: Men reported more frequently to have used crack in consequences of ‘curiosity/desire’ than women (84% [95%CI:80.5-86.9] vs. 16% [95%CI:13.1-19.5] respectively; p=0.00). The average time of crack use (in months) was significantly higher for men than women (81.23 [95%CI:79.30-83.17] and 71.70 [95%CI:68.67-74.73], respectively). However, women reported to do more intense use (in terms of the number of stones per period of time [a binge “session”]) than men (21.31 [95%CI:18.87-32.02] and 13.25 [95%CI:11.56-14.94], respectively). Among men, a much higher proportion of polydrug use was found than in women (80% [95%CI:76.7-82.9] vs. 20% [95%CI:17.1-23.3], respectively; p-value=0.000). Men shared devices for crack use more often than women (76.9% [95%CI:73.1-80.3] vs. 23.1% [95%CI:19.7-26.9], respectively; p=0.014), despite the fact they have accessed harm reduction programs more frequently (56.3% [95%CI:33.0-77.1] and 43.7% [95%CI: 22.9-67.0]), respectively; p=0.028).

Conclusion: Some important differences have been clearly identified and need to be taken into consideration in the design and implementation of more sensitive, properly tailored prevention and harm reduction initiatives.

Education professionals’ awareness and attitudes to evidence-based practices for social and emotional skills in early childhood

ABSTRACT. Poor social and emotional skills in early childhood can be a sign of poor mental health and well-being. Schools play a pivotal role in the prevention of poor mental health in children through the implementation of evidenced-based practices (EBPs) for social and emotional learning. Despite the documented benefits of EBPs for good social and emotional development, it appears that teachers do not use them systematically. An analysis of the theoretical frameworks for intervention implementation suggests that successful EBP-adoption is related to professionals’ knowledge and awareness of the innovation to be implemented and their attitude about it. The literature suggests that cultivating a culture of learning and research-informed practice in the sector of education could boost teachers’ uptake of EBP by increasing awareness and developing positive attitudes towards the use of research-informed practices. Therefore, it is proposed that a better understanding of the teacher factors that influence the adoption of EBP, and of the potential of research-informed educational practice to enhance EBP implementation, could help understand the challenges in universal and systematic uptake of EBP for early childhood social and emotional development.

The effectiveness of the "Unplugged" program in Nigeria: adaptation, Training of Trainers and implementation

ABSTRACT. In 2015, the United Nations Office on Drugs and Crime (UNODC) with the collaboration of the Federal Ministry of Education (FME), the National Drug Law Enforcement Agency (NDLEA) and the National Agency for Food and Drug Administration (NAFDA), implemented in Nigeria a large-scale project funded by the European Union (EU) to promote healthy lifestyles in schools, families and communities. Within the project, the implementation and evaluation of the school-based prevention program “Unplugged” were planned. The Unplugged 12 session school based drug abuse prevention program has been evaluated in 7 European countries 2005-2008 with positive results. It was subject to further implementation and study in many other countries in and outside the EU since then. the Nigeria project the challenge of a robust study design was accompanied by many challenges to implementation factors. Before the control and intervention groups were randomized, the project team went through a preliminary implementation phase, in order to assemble input for adaptation of the program materials. Adaptations were submitted to a control on fidelity to critical elements of the intervention. The teacher is the deliverer of Unplugged, therefore trained in a three day workshop. International Master Trainers guided Nigerian trainers through a three phase TOT process, resulting in 7 local trainers certified by the EU-Dap Faculty to deliver training to teachers and one master trainer to further train other trainers. This process that in the study phase delivered input to adaptation of the training scenario. The UNODC Nigeria team established this pre-trial phase, study phase and further implementation phase with EU-Dap consultants within the EU-sponsored large scale project. From 2015 until today relevant stakeholders were involved with the focus on sustainability and upscale. The Ministry of Education was obviously a prominent stakeholder, but others were also addressed in order to guarantee quality dissemination and funding. A first good example of local financing and dissemination was experienced in the North-West State of Kebbi, February 2018. Conclusions: throughout the study phase and anticipating on effectiveness results, crucial issues for implementation are to be established.

Gender differences in results of a UNODC-LCIF multisite Case Control Trial of the Lions Quest Skills for Adolescence in South East Europe
SPEAKER: Wadih Maalouf

ABSTRACT. UNODC has an ongoing global initiative promoting evidence based prevention programmes in line with the UNODC and WHO International Standards on Drug Use Prevention (focusing on low/middle income countries). The UNODC collaboration with Lions Clubs International Foundation (LCIF) availed the opportunity to pilot Lions Quest Skills for Adolescence (LQSFA) as part of this initiative. LQSFA is a programme targeting elementary school age students and built on a Social and Emotional Learning approach. The abbreviated (40 session) version of LQSFA was used during pilot in close coordination and partnership with the Ministries of Education of concerned countries. Following translation and adaptation of LQSFA, a total of 5,041 elementary school students (2,954 cases and 2,087 controls) from 85 schools in Serbia, Montenegro and FYRO Macedonia participated in the pilot. The programme was implemented through 231 teachers trained on its content. An analysis of the change of the indicators (delta change) between t0 and t1 was undertaken in cases and controls, by country. Currently almost 3,000 additional students from Bosnia Herzegovina, Albania and Guatemala are in the process of participating in clincal trials in their respective countries. The average age of the students where programme was already implemented was 13.3 years (47% to 50% of the sample- depending on the country- were girls). The programme showed a significant effect on current use of substances (alcohol, cigarettes and marijuana) as well as intention to use substances (alcohol, cigarettes and marijuana) in the next 3 months among ever users. This impact was noted despite challenges in implementation (only a few of these schools managed to undertake all 40 sessions of LQSFA in one academic year). This paper will discuss gender differences in the results noted on the main two indicators (current substance use and intention to use in the next 3 months among users). It will also shed light on the differences in refusal skills, perception of harm and normative belief of the use of these substances among peers by gender. The challenges and lessons learned during operations will also be presented.

Examining international digital solutions for career development and support

ABSTRACT. This session will explore the ways digital solutions are being employed internationally to enhance the field of substance use and prevention including online training, webinars, online networking and the promotion of research in digital spaces.

The strengthened presence of digital health interventions and prolific use of social media in the substance use field is drawing professionals to work more frequently in online spaces. This can present many opportunities for interconnected approaches, shared learning and professionalisation opportunities.

Working within a global remit, the International Society of Substance Use Professionals (ISSUP) seeks to connect those working in the field with key research, training opportunities and serve as a digital focal point for information about substance use prevention and treatment.

Within the session we will explore the ways in which technology can support the field of substance use prevention and treatment as a unique and multidisciplinary field, drawing on examples of the work of ISSUP and other international agencies in:

• developing online networks of substance use professionals; • sharing knowledge online; • providing online support to face-to-face training; • giving physical initiatives an online presence • and online training

By highlighting opportunities to strengthen the field through online working and the development of digital resources or training tools we hope to inspire anyone who is unsure about how they can kickstart their professional digital journey.

Led by Content Researcher, Kira Weir from the International Society of Substance Use Professionals (ISSUP) and supported by Jeff Lee, Senior Consultant for ISSUP.

Kira brings more than five years of experience in the field of substance use and digital communication.

Jeff has worked in the education and training field for health drug demand reduction for many years as a resource developer, trainer and project manager and “practitioner”. He has worked nationally and internationally as a consultant to governments and international agencies as well as with his work with Mentor International and ISSUP.

Alerta Alcohol: Long-term Effects of a Web-based computer tailored intervention to prevent alcohol drinking among Andalusian adolescents.

ABSTRACT. Background: ALERTA ALCOHOL, a web-based computer tailored intervention, was developed to prevent binge-drinking in Spanish adolescents that provide personalized health messages which could be more likely to attract attention of adolescents. Objective: to evaluate the effectiveness of ALERTA ALCOHOL. Method: Cluster randomized controlled trial (RCT), with 8 schools experimental and 7 control schools. The participants (1247) were students aged 16-18 years belonging to the public-school system of Andalusia. 612 students (349 EC, 263 CC) participated at four-month-follow-up (dissertation rate 50.92%) and 226 (104 EC, 122 CC) at 18-months-follow-up. After eliminating those that not completed the questionnaire or not did the first evaluation, only 152 were recovered of the final evaluation (50 EC, 102 CC). The dependent variables were lifetime consumption, weekly consumption, excessive drinking and intention to reduce alcohol and binge drinking. When possible multilevel linear or binomial regression, in other case, conventional multivariate analysis were carried out. Results 661 (53%) were girls, with an average age of 16 years, of which 461 (55.4%) had drunk, and 283 (58.1%) binge-drunk in the last 30 days. Instead 9 males (56.3%) had excessive drinking. At four-months-follow-up, there was an un-adjusted effect of the program (p<0,05), binge-drinking was reduced only significantly in EC (reduced 7.7%; p=.015) vs CC (reduced 4.4%; p=.221). There was a significant adjusted effect of the intervention on excessive drinking (p=.040), being the OR=0,11 comparing EC vs CC. Finally, there was an interactive adjusted effect with religion on alcohol reduction intention. The program was significantly more effective on Catholic but significantly less effective on Muslim participants (p=.026); and an adjusted effect on binge-drinking reduction intention (p=.042). These effects disappeared at 18-months follow-up. Conclusions: It is shows an effect of Alerta Alcohol on intention to reduce alcohol and binge drinking and to reduce excessive drinking and a marginally effect to reduce binge-drinking at short-term but this effects are not maintained at long-term. In futures studies, we should design strategies to avoid the high rate of desertion. In spite of this, Alerta Alcohol could be useful and could be considered as a good practice to reduce alcohol and binge-drinking in Spanish adolescents.

The effectiveness of the "Unplugged" program in Nigeria: study design and results

ABSTRACT. Background. In 2015, the United Nations Office on Drugs and Crime (UNODC) with the collaboration of the Federal Ministry of Education (FME), the National Drug Law Enforcement Agency (NDLEA) and the National Agency for Food and Drug Administration (NAFDA), implemented in Nigeria a large-scale project funded by the European Union (EU) to promote healthy lifestyles in schools, families and communities. Within the project, the implementation and evaluation of the school-based prevention program “Unplugged” were planned. Methods. The Federal Ministry of Education provided a list of 60 federal schools available for the project. Sample size calculations estimated about 4000 pupils were needed for the evaluation study. Considering 45 pupils per class, and 3 classes participating in each school, 32 schools were randomly extracted from the FME list. The extraction was performed at the central level, in OED Institute in Torino, Italy, taking into account the population size of the zones: 6 schools were extracted 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 surveys. To preserve confidentiality, the questionnaires were labelled with a 9-digit individual code self-generated by the student. 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. Unplugged was effective in reducing the prevalence of sporadic, regular and daily alcohol use, and of marijuana use among younger pupils, improving negative beliefs on cigarettes and alcohol, reducing the erroneous perception of peers’ prevalence of cigarettes and alcohol use, with a stronger effect among younger pupils, and improving class climate. Conclusions. Unplugged reached in Nigeria good results in preventing alcohol and marijuana use, and improving class climate and normative beliefs, similarly to what observed in the European original effectiveness study. Therefore, the implementation of Unplugged at a larger scale in the country can be supported, with the attention of focusing on younger adolescents.

Developing your digital skillset in the field of substance use and prevention.

ABSTRACT. Technology has allowed us to become more connected and share information more readily. It has also led to increased competition for funding opportunities, job vacancies and research. This generates greater need for those embarking on a professional career to network effectively and ensure that they are well informed about the latest developments in their field.

Our globally digital world is dynamic and requires the skills to think critically about information found online, adapt to incoming changes and respond with an agile approach.

This session will discuss key tools to utilise in keeping up to date with developments in the substance use field, getting connected to other professionals and searching for key research and funding opportunities. The Content and Research team from the International Society of Substance Use Professionals (ISSUP) will discuss the ways they work to keep the Knowledge Share section of the ISSUP website up to date while working virtually. The newly developed Networks feature of the ISSUP website will also be discussed amongst other examples of ways in which new technology can assist career development and networking opportunities.

The tools discussed during the session all allow the early career prevention specialist to enhance their professional standing, knowledge and network opportunities. There will also be the opportunity to feedback on what digital tools would further enhance the needs of the group.

The workshop will be led by Kira Weir who has more than five years experience of working in digital communication and online promotion focusing on the field of health and wellbeing

Validation of scales to evaluate motivations to cannabis use among adolescents between 15 and 18 years old.

ABSTRACT. Objective: To test the reliability and validity of the scale based on the Model I Change which evaluates the motivations to consume cannabis in Spanish adolescents: Attitude, Social Influence and Self-efficacy.

Methods: A questionnaire was designed and validated by Delphi groups, which evaluates the motivations of cannabis use in adolescents. The validation of the content to the questionnaire will be carried out through the calculation of the mean, standard deviation, median and percentage of high valuations (4-5), and the calculation of the content assessment index. We performed a pilot study with 236 adolescents between 15 to 18 years old from Sevilla and Cádiz, previously their parents give the informed consent. The internal consistency was measured (Cronbach's Alpha> 0.70) and the construct validity by exploratory factor analysis. Sampling adequacy was assessed by testing Kaiser-Meyer-Olkin tests (KMO> 0.50) and the Bartlett's Sphericity test, with significant values. It was evaluated that: items had a Pearson's r> 0.30 on first factor during the extraction and> 0.40 in the matrix of rotated components; The first factor will explain a minimum of 20% of the variance; and that the total variance explained was> 50%. The Varimax rotation was used. The analysis was performed with SPSS 21.0 statistical software.

Results: The factorial analysis showed data in favor of the multidimensionality of scales, assuming certain limitations. Cronbach’ Alpha values are between 0,7 and 0,962 were obtained for all. Before the rotations, the first factor explained> 26% of the variance and the total variance explained was always> 58%. After the rotation, the factorial loads of the items were> 0.40 for their membership factor.

Conclusions: We present an instrument with indications of reliability and validity that could be used to determine the motivations that lead adolescents to consume cannabis for subsequent intervention on them.

Drug Prevention for Adolescents in Violent Urban Settings: Implementation and Evaluation of Keepin’ it REAL in a Mexican Border City

ABSTRACT. Cities provide a unique educational, cultural, and economic context for adolescents to develop socially and psychologically. However, cities may also have a negative impact on their mental health and well-being, particularly when they are exposed to settings with high levels of drug-trafficking related violence, substance abuse, and pervasive poverty. The purpose of this study is to examine and discuss barriers and facilitators to the implementation of Keepin’ it REAL, an efficacious school-based drug prevention program, in a Mexican mid-size city bordering the United States and experiencing high levels of drug-trafficking and drug related violence. The analysis combines data from a pretest survey (n=1,418) and focus groups conducted with both teachers and middle-school students in the city of Nogales, Mexico between 2017 and 2018. In this study 91.6%, 67.4% and 59.6% of students have witnessed, have been victimized and have participated in a violent events, respectively, at home, school or neighborhood. Qualitative data indicate a high acceptance of the program among teachers and students and positive impacts on individual assertiveness and preventive behaviors despite of a local culture of normalized drug-related violence and substance use. The presentation provides recommendations for drug prevention interventions in violent urban settings that build on individual, family, and community strengths to promote the mental health and well-being of children. Findings from this study can be applied to other Mexico-USA border cities as well as to other countries with similar transborder issues.

The health economic consequences related to the use of anabolic androgenic steroids (AAS) in Sweden

ABSTRACT. BACKGROUND: In line with the objectives of the Swedish national public health policy, a national drug strategy was developed – A Comprehensive Strategy for Alcohol, Narcotics, Doping and Tobacco (ANDT) – with the overarching goal to have a society free from narcotics and doping, reduced medical and social harm from alcohol, and reduced tobacco use. In the last decades, the use of anabolic androgenic steroids (AAS) has become a public health concern, where reports estimate that about 1% of all men have tried AAS. This study aims to estimate: a) the health and economic consequences related to the use of AAS in Sweden, and b) the cost-effectiveness of interventions for the prevention of AAS use. This work is a part of a series of projects commissioned by the Public Health Agency of Sweden as part of their ANDT strategy. METHODS: A scoping review was performed to find evidence on the epidemiology and consequences related to AAS use. Meetings were held with experts to identify the most relevant and well researched consequences associated with AAS use, from a public sector and a broader perspective. This information was used to develop a population-based cohort Markov model to estimate the costs and outcomes resulting from the delivery of an intervention for the prevention of AAS use compared to a “do-nothing scenario”. The model targeted a cohort of males aged 18-35 who attend gyms in Sweden, and followed them until the age of 65. RESULTS: Despite the relatively low prevalence of AAS use, there is a large amount of research on related consequences. The consequences most commonly referred to in the literature are hypertension, hypercholesterolemia, hypogonadism, depression, anxiety and criminally, all which entail a large financial burden to the society. Preliminary findings show that a generic hypothetical preventive intervention could reduce the negative outcomes and costs related to the use of AAS. CONCLUSIONS: A generic preventive intervention targeting the use of AAS among young male adults in Sweden could benefit the society by improving health outcomes and reducing costs. This study is the first examining the longer-term costs and outcomes related to AAS use.

Facilitators and barriers identified during the implementation of 100% Pure Hard Training – a preventive method aimed to reduce the prevalence of anabolic-androgenic-steroids and growth hormones among gym-goers.

ABSTRACT. Introduction/Background: Doping has previously been perceived as an issue solely related to elite sports; however, it has become more common among recreational sportspeople. Doping among this group primarily concerns performance-enhancing supplements such as anabolic-androgenic-steroids (AAS) and growth hormones. The side effects of AAS are severe and may cause both physical and mental health issues e.g. cardiomegaly, liver diseases as well as anxiety and/or aggressive behaviour. The method 100% Pure Hard Training (PHT) was developed by STAD (Stockholm Prevents Alcohol and Drug Problems) as gym owners and staff raised concern about the prevalence of AAS among non-elite gym-goers. The key components of 100% PHT are community mobilization, policy work, training of gym staff, certification, follow-ups, and media advocacy. Today, about 600 gyms across Sweden are working with 100% PHT. Each gym is part of a local network, which is managed by a coordinator; the coordinators are in turn managed by STAD on a national level.

Aim: To identify facilitators and barriers related to the implementation of 100% PHT in order to improve the national dissemination of the method.

Method: A semi-structured questionnaire was distributed in 2017 to 68 coordinators spread across 20 counties in Sweden. The survey was sent out by email with four follow-up reminders, resulting in 39 respondents.

Results: A number of facilitating factors were identified, such as an interest and perceived need of doping prevention, a high level of engagement and cooperation between stakeholders, and the method 100% PHT being straightforward and easy to understand. Many coordinators described time constraints and lack of resources as the main barriers.

Conclusion: In line with similar preventive methods, main facilitating factors related to the implementation of this nation-wide anti-doping method were persistence and continuous support from the project management on a national level and from the coordinators on a local level. Lack of resources was identified as a main barrier, whereas community mobilization a crucial factor for success.

My life, My choice. Universal school- based prevention programme for students with mild intellectual disability.
SPEAKER: Anna Borucka

ABSTRACT. The poster will present: the main assumptions, goals, content and main results of formative evaluation of the programme for pupils aged 13-16 with intellectual disability. The main goals of the programme are: • To increase students knowledge of risk related with using psychoactive substances and new psychoactive substances. • To develop of the students communication social skills. • To improve parent’s skills of providing emotional support to their children. This programme is the first proposal of universal prevention which is dedicated to implement in Polish schools for students with special educational needs. The programme is conducted by teachers in the form of 8-hours lessons for students, workshops for parents and concluding meeting (group game) for students. The main results of formative evaluation of the programme are promising and confirmed the positive effects concerning strengthening of protective factors and increasing of the knowledge about the risk of using psychoactive substances. The programme was prepared and tested by Foundation ”Poza Schematami” in the frame of agreement with the National Bureau for Drug Prevention and financed from the Gambling Problem Solving Found.

Multi-level, Multi-component community-based behavior change interventions: basics and challenges (Example of promoting physical activity)

ABSTRACT. Individual-level approaches to lifestyle behavior change at the population level have been unsuccessful. Thus, there is an increasing interest in integrated programs that intervene in multiple community settings at the same time and involve policy and system changes. The purpose of this work is to highlight and explain the most common challenges faced by a multi-level, multi-component approach to community-based intervention for healthy living.

The five challenges areas are : • Building collaboration and partnerships • Creating intensity and effectiveness of intervention activities. • Creating consistency between activities and across levels. • Synchronizing program activities across institutional settings and levels. • Designing the intervention programs to be sustainable post intervention.

Role of Police in environmental prevention: pilot assessment of the effect of increased law enforcement in Czech republic

ABSTRACT. Czech Police and its Czech National Drug Headquarters (NDH) are actors in Czech crime and drugs control system that is also viewed as preventive. Preventive action of Police is, according to its own statements, twofold. First, Czech Police and NDH support and run specific prevention programs, for example in primary schools. Second, the enforcement of law is supposed to have an influence on environment that should limit the availability of illegal drugs and influence the societal values regarding the use of illegal drugs. Consequently, this should have a preventive effect on use of illegal drugs. However, the effect of law enforcement on environment is not known.

Our aim is to introduce a pilot assessment of the effect of increased law enforcement between 2005 and 2015 (police arrests related to cannabis) on societal values (social acceptability of cannabis use, punitive attitudes) and availability of cannabis. The number of arrests related to cannabis rose gradually from 682 persons in 2005 to 1449 persons in 2015. The statistics of NDH are used to measure annual increase in cannabis related police arrests (2005-2016). The data from surveys conducted by The Public Opinion Research Centre of Czech Academy of science are used to measure societal values related to cannabis. Furthermore, the data from the surveys conducted by The Czech National Monitoring Centre for Drugs and Addiction (National Focal Point) are used to measure perceived availability of cannabis. To analyse the effect of increased law enforcement efforts, time series are observed between 2005 and 2016. Preliminary results suggest that despite the law enforcement efforts societal values were developing towards higher acceptability of cannabis. Considering the availability of drugs, the results seem inconclusive. These results are discussed with regard to other significant events: change of legislation, medialisation of increased law enforcement and specific heavy medialised cases (the operation against „growshops“).

Is your weekly budget linked to your alcohol consumption?

ABSTRACT. Previous studies have assessed the possible association between socioeconomic position and alcohol use. In adolescents, their own financial resources play a more important role in their drinking behaviour, rather than their parents’ income. For example, higher adolescent weekly income (≥€50) was associated with regular alcohol use and consumption of larger amounts. In young adults, also personal and household income was positively correlated with alcohol use frequency and quantity. The aim of this study is to determine if sociodemographic characteristics and weekly budget are associated with alcohol use in young people. 307 participants (56% men, M age=21.6 years, SD=3.08, range=14-35 years) who were drinking in the streets (botellón) of Palma de Majorca were interviewed. They completed a survey about sociodemographic data, weekly budget, and drinking frequency. Breath Alcohol Concentration (BrAC) was assessed with a breathalyser. Participants had a median weekly budget of €50. The weekly budget was categorised as low (LWB) (<€49) or high (HWB) (≥€50). 64.3% of the sample had a high weekly budget. We found statistically significant differences in these two groups by gender (χ2(1, N=300)=9.842, p=.002; 72% HWB in men, whereas 54.5% HWB in women) and age (Mann-Whitney U test: Z = -6.381; p<0.001; Mdn=22 years in HWB, Mdn=20 years in LWB). Men with higher weekly budget present higher BrAC (Mann-Whitney U test: Z=-2.170; p=.030; Mdn=0.23 mg/L in HWB, Mdn=0.12 mg/L in LWB) and AUDIT score (Mann-Whitney U test: Z=-2.3; p=.021; Mdn=9 in HWB, Mdn=7 in LWB) and more drunk episodes (Mann-Whitney U test: Z=-1.973; p=.048; Mdn=3 in HWB, Mdn=2 in LWB). On the other hand, women with higher weekly budget present higher BrAC (Mann-Whitney U test: Z=-1.98; p=.048; Mdn=0.12 mg/L in HWB, Mdn=0.07 mg/L in LWB), more alcoholic drinks consumed (Mann-Whitney U test: Z=-2.231; p=.026; Mdn=2 in HWB, Mdn=2 in LWB) and more drunk episodes in the last month (Mann-Whitney U test: Z=-2.478; p=.013; Mdn=2.5in HWB, Mdn=2 in LWB). High weekly budget is strongly associated with higher alcohol consumption. Health and prevention programmes should also focus on money management.

Brazilian adolescents transfer for their lives what they learn in the Strengthening Families Program? A short-term descriptive analysis.

ABSTRACT. The Strengthening Families Program (SFP 10-14) has been implemented in Brazil since 2013 as a family-based social technology for drug abuse prevention. This study aims to understand to what extent adolescents apply the content learned in the program to their lives. In-depth interviews were applied at the end of the intervention to 24 adolescents aged 10 to 14 years (15 females, 9 males). The data was analyzed through thematic analysis and calculation of the frequency of reports. Most of the participants (N = 20) reported applying skills learned in the intervention to their everyday lives. Use of life skills, including peer pressure resistance (7 reports), problem solving (3), and critical thinking (1) were identified. It was found that there was a transfer of the daily use of family protective processes related to control: compliance with rules and limits (6), respect for authorities (6) and increased responsibility (4). Adolescents reported transferring protective processes related to emotion in their family interactions, including improvement in communication (6), conflict management (5), family problem solving (4), family closeness (4), perception of affection (2) and emotional regulation (1). The findings also showed improvement in the perspective of future time (8). Fewer reports have been identified regarding improved school engagement (3). On the other hand, a small number of youth reported not being able to apply the learning (3) or an absence of change (1). It is concluded that such findings are compatible with the expected results in the short and medium term, such as improvement in the quality of the family relationship and life skills. More detailed analysis on low school effectiveness is recommended, as well as evaluation of the impacts of the program in the medium and long term.

Norms, refusal skills and alcohol drinking among early adolescents
SPEAKER: Anna Janovska

ABSTRACT. Introduction: In early adolescence, alcohol drinking can be initiated and escalate, often as a result of significant advances in one’s psychological and social development. This study explored how alcohol drinking is related to self-esteem, self-control, refusal skills and personal, injunctive and descriptive norms. Methods: Data from a representative sample of 572 elementary school pupils (gender: 50.1% male; age: M=13.49 years, SD=0.59 years) were collected within a project aimed at universal school-based prevention (APVV-15-0662, APVV-0253-11, KEGA 016UPJŠ-4/2017). The respondents completed the Self-Control Scale (α=0.573), the Self-Esteem Scale (α=0.712), the Refusal Skills Scale (α=0.899) and they were asked about their personal, injunctive and descriptive norms of alcohol drinking. Binary logistic regression was used to explain their self-reported alcohol consumption, dependent variable was dichotomized (they have never drunk alcohol or have drunk only once; they have drunk alcohol multiple times). Findings: Alcohol drinking of adolescents was found to be positively associated to personal norms (p=0.001, OR=0.458), social injunctive norms (parents: p=0.012, OR=0.540; personal: p=0.025, OR=0.650) and refusal skills (p=0.003, OR=0.896) as well as positively linked to descriptive norms concerning drinking of their peers (p=0.001, OR=2.122). The associations between alcohol drinking and self-esteem, self-control and social injunctive norms concerning friends were not statistically significant. Our data support the existence of gender differences (p=0.041, OR=2.120), i.e. boys tended to drink more often than girls. Conclusion: The study confirmed the importance of prevention programmes that influence the formation of norms concerning alcohol drinking and develop adolescents’ refusal skills.

A methodological explanation of Decision Tree and Random Forest techniques to predict alcohol use

ABSTRACT. Data Mining is the process of discovering “interesting, unexpected or valuable structures in large databases” and add new ways of analysing data and representing results. While the main body of the analysis in the field of substance use has been done with classical statistical techniques, few studies use Data Mining tools. The aim of this study is to present the advantages of two Data Mining techniques to predict alcohol use: Decision Trees and Random Forests. 307 participants (organized into 62 natural groups of friends) who were drinking in the streets of Palma de Majorca were interviewed (44% women) (median age=21 years, range=21). We assessed Breath Alcohol Concentration (BrAC) to have an objective measure of alcohol concentration (mg/L) and the Alcohol Use Disorders Identification Test (AUDIT). Participants also reported their drunkenness’ perception (10-point Likert scale) and socio-demographic information. We run classical models, Decision Trees (DT) and Random Forests (RF). DT create sequential partitions of a dataset that maximise the differences of a response variable. DT show in a graphical way how the analysed variables interact to predict BrAC. RF displays the most important variables in the prediction of alcohol use. Through this example, models’ performance is analyzed, explained and compared with classical models. Data mining techniques are useful techniques to study alcohol use risk and protective factors. The advantages and disadvantages in contrast to classical techniques are discussed.

Inter-individual differences in autonomy and autonomy support in relation to alcohol use among university students
SPEAKER: Jozef Benka

ABSTRACT. Introduction: Autonomy and support of autonomous self-regulation have been shown to be important determinants of well-being and health-related behaviors prospectively and across different domains (Ng et al, 2012). Moreover, understanding the persistence of healthy behaviors is a key issue of every successful preventive activity. This study uses the concept of Self-determination theory and focuses on intrapersonal and environmental factors of autonomous self-regulation and explores their associations with alcohol use among university students. Methods: The data used in the analysis consisted of 697 university students (Mean age = 21.28; SD = 1.93; 60% women) studying in Slovakia. Autonomy was measured at two conceptual levels. Firstly, it was assessed at the level of inter-individual differences by the Index of Autonomous Functioning consisting of three subscales: Authorship/self-congruence, Interest-taking and Susceptibility to control (Weinstein et al. 2012). With regard to autonomy support from the environment, three types of autonomy support were addressed: Promotion of autonomous thought (Silk et al. 2003), Promotion of autonomous decision-making (Grolnick et al. 1997) and Physical separation scale addressing the pressures and controlling/manipulative behaviors. The Alcohol Use Disorders Identification Test was used to address alcohol use (Barbor et al. 2001; Maisto et al. 2000). A linear regression was used as the main statistical method. Results: The results of the linear regression analysis showed that after controlling for age and gender alcohol use was negatively associated with the Authorship/self-congruence (β=-0.174; p≤0.001) on the level of inter-individual differences and with physical separation (β=-0.135; p≤0.001) on the level of autonomy support from the environment. Other measured aspects of autonomy did not produce significant results. Discussion: Although the interpretation of the results cannot overcome the limits of the correlational design, the findings of this study show that both levels of autonomy were in its important aspects associated with alcohol use. On the level of interpersonal differences, it was the tendency to integrate one´s experiences and on the level of the environment, it was the processes undermining individual´s autonomy. The interplay of these factors and their interaction can further increase the understanding of the role of autonomy in the context of prevention science.

Positive development of adolescents
SPEAKER: Miranda Novak

ABSTRACT. During the year 2017, Croatian Laboratory for Prevention Research has conducted a project Positive Development of City of Zagreb’s Youth – state of the art. Purpose of the project was to explore the positive development and risk behaviour of adolescents. In addition to the insights into the risk behaviour of young people, a picture of strengths and challenges at the individual level and at the level of environments in which young people live was gained (family, school, community). Constructs also included internalized problems, the family and individual resilience of students, social-emotional competences, school attachment as well as mindfulness. The aim of this paper is to present the conducted research as an example of science to practice efforts.

The research intended to obtain quality epidemiological data on adolescents that could serve as a foundation for preventive interventions planning. A representative sample of the survey included 4821 students from 24 secondary schools in Zagreb, Croatian capital. Age of the participants was 14 to 19 (48.2% female and 43.7% were male). Data from 4821 students in the Zagreb City area indicates a high prevalence of alcohol consumption (21.8% of the participants use alcohol once or twice a week) while cannabis is used once or twice a week by 6.1% of the participants. Peer violence is also present, as many as 37% of the survey respondents report that they have witnessed their peers being abused in last 4 weeks, and 17% of them have been exposed to peer violence themselves. 27,2% of participants reports they have been hopeless during last two weeks, 9,4% have made a plan how to commit suicide while 4,4% of participants have reported suicidal attempt. School attachment of children is quite low while their perception of family protective factors is quite high. 12,2% of participants report upon serious depressive symptoms, 22,2% report upon severe anxiety symptoms and 7,5% report upon severe stress symptoms.

The purpose of the paper is to present the starting point for continuous monitoring of the needs of adolescents in Croatia, aiming national monitoring and data that could serve as a starting point for youth intervention planning.

Sales of tobacco cigarettes to pseudo-under age mystery shoppers

ABSTRACT. Introduction: Preventing the onset and reducing the number of adolescents who smoke and develop an addiction is a great public health concern. To reduce availability of tobacco the purchase age limit is 18 years in many countries, including Sweden. According to the tobacco law in Sweden, sales clerks have to ensure that the customer is of age by performing ID checks. Aim: To study the prevalence of sales clerks’ denial rates of tobacco sales to underaged. Method: Nine mystery shoppers (females and males) attempted to purchase cigarettes without providing an ID. The mystery shoppers were 18, but had a younger appearance as judged by an expert panel. During each attempt the adolescents were working in pairs, one acting as the shopper and the other as the observer. 320 tobacco sales outlets were randomly selected from 12 municipalities in Stockholm County and 287 purchases attempts were conducted. Types of outlets were grocery stores, gas stations, convenience stores and kiosks. Results: In 25% of the purchase attempts cigarettes were sold although no valid ID was provided by the mystery shopper. Female shoppers were significantly more successful in the purchases than male shoppers. In 10% of the attempts, the sales clerk sold cigarettes after requesting, but not receiving, an ID. Age-limit signs were observed in 90% of the outlets. A successful purchase attempt was significantly associated with the lack of age-limit signs. Conclusion: Our results indicate that under-age adolescents who want to buy cigarettes could find an outlet that sells to them rather easily. The poor adherence to the tobacco law, might fail to protect adolescents from smoking cigarettes. Hence, there is a need for implementing strategies to prevent sales of tobacco to underaged.

Quantifying the effect of screen advertising on dietary intake in children
SPEAKER: Simon Russell

ABSTRACT. Food and drink marketing is a large global industry and evidence indicates disproportionate marketing of products high in sugar, fat and salt. While use of media is changing, especially among young people, children in England remain exposed to high volumes of advertising, particularly of unhealthy food and drinks. There has not been a review to date which considers experimental and ‘real world’ studies or that separately analyses the impact of TV and advergame advertising in terms of caloric intake in children. A rapid systematic review of the quantitative effect of screen advertising on children’s dietary intake and obesity was undertaken with the main aim of estimating the effect size in experimental and non-experimental (real world) settings. In April 2018, systematic searches were undertaken of scientific and economics databases; search results were imported into EPPI-Reviewer 4 software to facilitate the review and apply a machine learning approach to screening. A total of 40 papers met the inclusion criteria, 25 with measured outcomes (experimental) and 15 with non-measured outcomes (non-experimental) for dietary intake. Meta-analyses were conducted for studies with measured outcomes where food advert exposure could be compared to non-food advert exposure. Food advertising was found to increase dietary intake among children (age range 2-14, mean 8.8 years) in experimental conditions for both TV and advergame advertising by 61 and 53 kcals respectively; an effect by BMI group was also found. Findings from non-experimental studies found exposure to TV food advertising to be positively associated with and predictive of dietary consumption in children. This review shows that short-term exposure to unhealthy food advertising on TV and advergames increases immediate calorie consumption, and that food advertising on TV is predictive of greater dietary intake among children. The findings of this research are likely to have notable implications for prevention policy and practice.

The cultural adaptation process of the efficacious prevention keepin’it REAL program in Spain

ABSTRACT. Keepin’it REAL (Mantente REAL) is an efficacious prevention program developed and evaluated through several RCTs in the USA, Mexico, Guatemala and Uruguay. A pilot study of the intervention in in Seville-Spain in 2016 identified the need for a cultural adaptation of the curriculum for Spanish secondary school students. The proposed oral presentation will provide a summary of the cultural adaptation process conducted in 2017-2018 in response to the findings of the Seville’s Mantente REAL pilot study (N=259 high school students). The finding highlighted the need to integrate the lived experiences of Spanish youth. The qualitative analysis of transcripts of the students’ focus groups provided the basis for the adaptation process. One of the main themes that emerged from the focus groups was the need to incorporate unique Spanish risk and protective factors: 1) risky situations and contexts, 2) adolescents’ perceptions of risks and 3) family and peers as protective and risk factors. Students, teachers, administrators and parents of two high schools of Seville actively participated in all phases of the adaptation process. Including a comprehensive editing of the teacher and student manuals and the production of five new educational videos. The purpose of this presentation is also to reflect on the adaptation of the videos as a prevention process in itself: the students who have participated in the process have reflected among peers, have become aware of exposure to risks, have learned to use the strategies on which they have worked. In partnership with the ASU team, Seville researchers preserved the core elements of the original intervention. The experience of creating Mantente REAL-Seville contributes to adaptation and prevention science by improving the cultural fit of an efficacious intervention in a different social and cultural context. Such level of local involvement supports its applicability and sustainability. Future research will test the efficacy of the new adapted version through an RCT in Andalusia and Galicia.

Moderators of Treatment Effects in a Parenting Intervention Study in South Africa

ABSTRACT. Parenting interventions are a promising approach to improve parenting, and to prevent and reduce child maltreatment. This study was nested within a cluster-randomised trial of Sinovuyo Teen parenting programme in the Eastern Cape Province, South Africa. The programme was developed in collaboration between researchers, UNICEF, the World Health Organisation, local NGOs, and the South African government.

Previous research has found mixed results on whether the most disadvantaged families benefit as much from parenting interventions as families with more resources, and very few studies examine this question in low- and middle-income countries. This paper aims to examine whether different families were able to benefit to a similar extent from Sinovuyo Teen in regard to parenting skills and child maltreatment by caregivers in high-risk families with adolescents aged 10-18.

Caregiver and adolescent reports from baseline, post-test, and follow-up at 5-9 months after the intervention were analysed using intention-to-treat longitudinal multilevel analyses (N=552 families). We tested seven moderation effects for each of the primary outcomes.

Overall, the intervention group showed significant improvements on a number of outcomes. In total, thirteen moderator effects were statistically significant, but none remained significant after correcting for multiple comparisons testing. Hence, our study suggests that parenting interventions in low- and middle-income countries can be similarly effective for the most disadvantaged families.

Core components of measurement feedback systems

ABSTRACT. Over the last decade, there has been a growing interest in the use of measurement feedback systems (MFS) in intervention research and practice. This has led to the development of several different systems, as well as studies on these systems to determine their effect. Many of the MFS have obvious similarities, but there is also a great deal of variation, including, the type of data collected and how it is presented to the therapist, degree of implementation support, etc.

We plan to assess the evidence for the different components that make up the variations in MFS – i.e. identify “core components”. Generally, the first step in identifying core components is to find all MFS effect studies that have been conducted. Second, one needs to break the reported systems into meaningful components, and finally, one can evaluate the evidence for the identified components. However, Lyon et al. (2016) has recently compiled a comprehensive list of the capabilities and characteristics of available MFSs and the frequency of these components’ usage. Because Lyon et al. (2016) have recently addressed these first two steps, we will therefore be able to forego these primary steps and start with step three: considering the identified component evidence.

Building on the work by Lyon et al (2016), we intend to review the effects different MFS components have on clinical outcomes, therapeutic alliance, and client satisfaction. For this purpose, we will replicate the search from this review to update it to include studies over the past two years. Furthermore, we will group all studies together to investigate which components correlate with positive effects.

An overview of core components of MFS can both be a good tool for developers and clinical administrators, and function as an indicator for future research.

Unplugged - Drug Addiction Prevention School Based Program in Jordan

ABSTRACT. Background: UNPLUGGED is a school-based drug prevention program for adolescents between 12 and 14 years of age and is based on the cognitive social influence model. The innovative aspects of UNPLUGGED is that it has been developed in a cooperation of seven EU-countries known as the EU-Dap project and evaluated for effectiveness during an earlier phase. Mentor Arabia implemented the program in Jordan schools.

Method: Nationwide trainings were conducted in Jordan with 50 participants representing various stakeholders and constituting the national team, and 60 teachers reaching 8,200 students in 2016. In 2018, 260 teachers were trained reaching 52,000 students. Attitudes of youth targeted by were compared to a control group, taking into consideration various demographic variables.

Results: Results attested that Jordanian students who followed the unplugged program demonstrated strong prevention attitudes compared to the control. The program is now adopted by the Jordanian Ministry of Education.

Conclusions: The program confirmed patterns in the relationship between life-skills based prevention programs and anti-drug attitudes; showing that life-skills acquisition at a young age is directly related to prevention behaviors.

Main Messages: - Schools are appropriate settings for alcohol, illicit drugs and tobacco use prevention. - School staff can target youths at a young age before their beliefs about smoking have been established. - School general curricula in itself can be used as part of a preventive approach, for instance a positive school climate is a protective factor against drug abuse.

Social determinants of binge drinking of Spanish adolescents according to gender

ABSTRACT. Background and objective The National Plan on Drugs defines binge drinking as the consumption of 5 or more alcoholic beverages in a single occasion of consumption, in an approximate interval of 2 hours. Historically, alcohol consumption has been associated with the male gender, however, in recent years there has been a rebound in the use of this substance by women, especially in adolescents. Despite this, there are still stigmatizations regarding gender. Objective: to analyze the socioeconomic factors related to Binge Drinking according to gender.

Methods The study sample is part of a two-arm Cluster Randomized Controlled Trial (CRCT) with an experimental (EC) and a waiting-list control condition (CC) randomized at the school level, using a web-based computer-tailored program to prevent binge drinking (BD) in adolescence, known as ALERTA ALCOHOL. Analysis were a carried out in Andalusian adolescents between 15 and 19 years of age. Panel data were required for the multivariate regression.

Results The total sample consisted of 1247 subjects in the pre-intervention period and 612 adolescents in the follow-up period. In girls, the age, weekly pocket money, being cannabis user, a major number of cigarettes per week and friendly pressure to do binge drinking resulted to be risk factors of BD. On the other hand, in boys, the age, father´s schooling years, being smoker, family and friendly pressure to do BD, were risk factors to BD. In relation to protective factors, in both boys and girls, family functionality and having partner were statistically significant.

Conclusion There are not many differences according to gender. It seems clear that being smoker is related to being binge drinker, such as the increase of age. However, it seems that the family environment affects more boys than girls. Although in girls, it is important to highlight that these with higher weekly pocket money the consumption of alcohol is higher too. This finding could be taken into account in developing preventing strategies that should have genders perspective. However, strategies to prevent binge drinking should include the family regardless the gender.

A pilot study of a Mindfulness and Compassion Program for Portuguese Adolescents: adaptation and efficacy study.

ABSTRACT. 1 out of 5 adolescents will experience a significant psychological problem while studying (Stuart, 2006), and also most mental health problems manifest themselves in adolescence being treated only later (Kelly, Jorm, & Wright, 2007). Adolescence is an ideal time to acquire knowledge and skills that leak into adult life, that make important to develop health promotion programs and increase mental health. Hence, would be important to test a mindfulness-compassion intervention, because will meet one of the priority areas for the promotion of healthy lifestyles identified by the National Mental Health Plan-DGS and National School Health Program. Although there have been no self-compassion programs designed to fit emotional and development needs, interests and challenges of adolescents. In this sense, the program that will be tested in this study was adapted from the adult Mindful Self- Compassion created and endorsed by Neff and Germer The purpose of this research is to test feasibility, acceptability and effectiveness of mindfulness self-compassion program for Portuguese adolescents. Additionally, identify relevant psychosocial outcomes associated with the intervention with adolescents The design is a pre-/post-pilot intervention study, repeated measures, with a mixed-methodology embedded design-qualitative and quantitative data and measures. It is planned to involve 40 participants (ages 12/13 to 17) from high schools of the region center oft he country) in the implementation of the program) The instruments will be administered at baseline and post-intervention and will include program and outcomes evaluation (such as, anxiety, depression; stress; mindfulness and compassion adolescents scales; Social connectedness; psychological inflexibility…). Will be conducted descriptive statistics; paired t-tests will conduct to examine change in outcome measures before and after the intervention; hierarchical regressions to examine whatever changes in mindfulness and self-compassion predicted changes in psychological outcomes It is expected based on review literature that: program would be feasible, acceptable and effective for Portuguese adolescents; a positive perception of the intervention relating to the participants' roles; also indicated that mindfulness, self-compassion, perceived stress, and life satisfaction improved from pre- intervention to post-intervention for adolescents that assigned to the program; Mindfulness and self-compassion would independently predict changes in psychosocial outcomes measures

Pathways to the continuity or discontinuity of the Strengthening Families Program in Brazil: the perspective of the group leaders

ABSTRACT. The sustainability of preventive programs in health policy is one of the main challenges for health research and management. In 2013, the Ministry of Health initiated a family-based drug abuse prevention program, the Strengthening Families Program (SFP 10-14), which has been implemented in Brazil for economically vulnerable families. However, after a large-scale implementation effort for several Brazilian states, a slowdown in the execution of SFP 10-14 has been observed in the current year. In this scenario, it becomes relevant to understand the pathways that can favor the continuity or discontinuity of this program as a drug policy preventive tool. This study aims to understand the barriers and facilitators for the sustainability of this program in Brazil. 153 group leaders, who are responsible for offering sessions for adolescents, caregivers and families, answered a questionnaire with open questions regarding reasons for the continuity or the interruption of the program in Brazil. Content analysis revealed nine barriers to sustainability: organizational capacity (75 reports), political support (26), adaptation of the program (25), family adherence (21), strategic planning (8), partnerships (2), communication (1), stability of funds (1) and evaluation of the program (1). In turn, the facilitators identified were organizational capacity (58 reports), public health impact (49), partnerships (26), political support (11), strategic planning (3), program adaptation (2) and communication (1). In conclusion, these findings indicate that routes to success in the sustainability of SFP 10-14 in Brazil could be constructed with investments in organizational capacity, political support, program adaptation, recruitment and adherence of families and partnerships. On the other hand, neglect of these factors could undermine its maintenance. Positive impacts of the program could be utilized as inducers of action for advocacy.

Efficacy of the STM program in prevention of drug use in adolescents

ABSTRACT. This study investigated the effectiveness of a universal drug prevention program, the STM program, for the consumption of drugs (alcohol, tobacco and cannabis) in adolescents. The STM is a multimodal program with components of social influence and life skills, using an interactive methodology. It is a controlled, quasi-experimental, non-random, longitudinal study with two measurement times. Participants were 893 high school students. Results show that the STM program is effective to reduce the frequency of alcohol and cannabis use, and moderate the increase of tobacco use and binge drinking, in the last 30 days. There is a differential effectiveness depending on the drug.

“SOS Namoro”: a systematic and theory-based development of a web-based tailored intervention to prevent dating violence among Brazilian youth.

ABSTRACT. Dating violence has an alarming prevalence among Brazilian adolescents. School-based preventive programs have been implemented, but remain to be isolated initiatives with low reach. Health education strategies based on innovative technologies with a high potential of diffusion are urgent. This study aimed to develop a computer-tailored intervention to prevent victimization and perpetration of dating violence among Brazilian youth. The intervention, called SOS Namoro, is based on the I-Change Model and Attachment Theory and is a universal preventive program targeted to adolescents with a current partner. According to the I-Change Model, it is expected that the users will increase their knowledge of dating violence and quality of relationships; decrease attitudes of violence tolerance; criticize social norms that endorse sexist practices; identify sources of social support; distinguish positive from negative romantic relationships models; and improve self-efficacy to implement protection plans in the face of violence. According to the Attachment Theory, it is assumed that the intervention will favor responsiveness and management of conflict skills. The design included a needs assessment; a definition of objectives of change; development of the library of messages; elaboration of a questionnaire for tailoring feedbacks according to the relevant variables; integration of the content in the software Tailor Builder; pre-testing; and usability and efficacy evaluation planning. As a result, an intervention composing of four online sessions was developed. Session 1 gives a tailored orientation on attachment style and risk perception of violence. Session 2 addresses knowledge on conflict management, intimate relationships models and an action plan to improve everyday interactions. Session 3 covers social norms, self-efficacy and an action plan to cope with conflicts. Session 4 discusses attitudes, social support and an action plan to protect from violence. Improvements on the interface and tailoring refinement was done after pre-testing to improve attractiveness and decrease risk of iatrogenic effects. The intervention usability and efficacy should be investigated in further studies.

Developing Prevention Through Sport Settings: a multi-site trial of a sport-based life skills program for the prevention of drugs, crime and violence amongst youth
SPEAKER: Wadih Maalouf

ABSTRACT. Line Up Live Up! is a 10-session open-source and evidence-informed intervention that responds to a need for evidence on the impact of sport on substance abuse or on mediating factors among children, as identified in the UNODC WHO International Standards on Drug Use Prevention. Line Up Live Up is a universal prevention program for 13-18 years old youth in marginalized and low-resource communities with mixed levels of risk for crime-, violence- or drug-related behavior.    Each of the 10 sessions includes sport activities and debriefing sessions aimed at strengthening life skills in order to achieve changes in attitudes and behavior to prevent crime, violence and drug use. It is evidence informed as it is: a) constructed on the basis of the International Standards on Drug Use Prevention as well as the Standards on Crime Prevention; b) inspired by the evidence of the UNP:UGGED school intervention and adapted to fit a school-based or out-of-school sport context; and c) enriched with inputs from consulted experts in the field of crime, violence and drug use prevention.   This presentation will give an overview of the piloting of Line Up Live Up that has been carried out so far in South Africa, Brazil and Kyrgyzstan through the delivery of training of trainers for sports coaches, teachers and others working with youth in sport setting, and through training roll out to youth. In addition, an overview will be provided of the data collected through process evaluation and of the tools developed to measure impact of the training programme. 

Comparative Regression Discontinuity: A Demonstration of its Performance with Small Samples

ABSTRACT. Regression discontinuity design (RDD) assign individuals to conditions using a cutoff score on a continuous assignment variable (e.g., poverty level for receiving a health care program). Individuals on one side of the cutoff score receives the treatment, and individuals on the other side usually receives no treatment - the control condition. It is considered to produce closest results to randomized controlled trials since the selection mechanism is known. However, the limitations of basic RDD are considerable: (1) in expectation, its results are unbiased only at the treatment cutoff and not for the entire study population; (2) it is less efficient than the randomized trial and so requires more cases for the same statistical power; and (3) it requires correctly specifying the functional form that relates the assignment and outcome variables. One way to overcome these limitations is to add a no-treatment functional form to the basic RDD and including it in the outcome analysis as a comparison function rather than as a covariate to increase power. Doing this creates a comparative regression discontinuity design (CRD). Recent studies comparing randomized trials, RDD, and CRD causal estimates have found that CRD reduces imprecision compared to RDD and also produces valid causal estimates at the treatment cutoff and also along all the rest of the assignment variable. The present study seeks to replicate these results, but with considerably smaller sample sizes. A within-study-comparison study where the treatment effect estimates coming from a synthetic RDD and CRD is compared to the estimates coming from a randomized controlled trial is conducted. The power difference between RDD and CRD is replicated, but not the bias results either at the treatment cutoff or away from it. To conclude, we highly recommend the use of CRD instead of RDD in prevention research. Yet, researchers should be cautious about using CRD without large samples.

A Health Behaviour Change Model applied to Technology use: Implementation into a Prevention Service for French Elderly People.
SPEAKER: Sacha Parada

ABSTRACT. The aim of our work is to apply research findings in health, motivation and technology use into the development of a technological prevention service toward elderly (above 50 years old). Yealth is a French start-up aiming at preventing Frailty (physical vulnerability) among seniors by assessing their weight, muscular health, day to day physical activity and energy, and developing personalized coaching programs to help them maintain and improve their health. Participants (1000 seniors expected by the end of the year) are equipped with an actimeter, a scale impedancemeter, and a dedicated tablet aggregating the data. The tablet is presenting data, informative messages, coaching programs, and self-reported measures (e.g. motivation; perceived utility) to the user.

The need for prevention is real (longer independent living for the population and cost saving for institutions), and frailty an acute health issue. But even if the service developed is adapted to answer this problematic, several pre-requisite from the users are needed for it to be effective: motivation (to adopt right behaviours) acceptance (of the technology) and observance on the long term (several years). Moreover we know that more than 70% of new health apps users’ dropout after 2 weeks (Endeavour Partners study, 2014). Hence to make sure that the service is used to its maximum potential, we propose to elaborate a model encompassing and bridging known theories of health, motivation and technological acceptance to guide the development of the service and its functionalities.

The base structure of the model originates from the Behavior Change Wheel (Michie, 2011) and the Transtheorical Model of Health Behaviour Change (Prochaska & Velicer, 1997). We used those general models to build two axis: sources of behaviour (Motivation, Capacity, Opportunity); and stages of change (Contemplation, Determination, Action and Maintenance). On those 2 axis we integrated existing motivational models (e.g. Health Belief Model, Self-determination theory) and well-tested interventional tools (e.g. planning, regulatory feedbacks) to characterize the motivational application of each new functionality. We then used technology acceptance literature recommendations to further precise the design of each functionality.

In the future we will assess the efficacy of the service based on this model’s factors.

Factors associated with alcohol use and other risky behaviours among Polish high-risk youth. A pilot study
SPEAKER: Jakub Gren

ABSTRACT. Introduction: Polish youth who have various problems are referred to special educational centres (for youth with antisocial behaviors and school problems, called Youth Corretional Centres “MOWs” and for youth with mental and school problems, called Youth Sociotherapy Centres “MOSes”). The prevalence of alcohol use and other risky behaviours are much more higher in these centers compared to youth attending ordinary schools. Therefore, those students have significantly higher risk of developing problems related to alcohol use and other risky/problem behaviours. This study aims to increase knowledge about psychosocial and behavioral risk and protective factors associated with alcohol use and other risky behaviours among Polish high-risk youth. The presented research will be continued in a much larger sample of students from special educational centers in Poland.

Method: The pilot study sample included 390 students (71% men) aged 12-20 years from 8 MOWs (52% of the sample) and 5 MOSes. All these centers were from Warsaw or Masovian district. The self-administered anonymous questionnaire have been completed in classrooms.

Results: Results showed that among students attending special educational centers risk factors predominated. Alcohol and other drug use (cigarettes, cannabis, NPSes and other), drunkenness, alcohol-related problems and problematic behaviours were significantly correlated with negative social influence (peer's approval of risky behavior, perceived substance use among friends and non-familial adults) and individual factors (subjective norms favorable for substance use and sensation seeking). The only protective factor was parental monitoring which was negatively correlated with problematic behaviors. Surprisingly, peer’s support was positively correlated with alcohol and other drug use, drunkenness and alcohol-related problems among students from MOSes and parental support was positively correlated with alcohol use, drug use, drunkenness and problematic behaviours among students from MOWs, which may indicate the specifics of these educational settings.

Conclusion: The results described in this paper indicate that special interventions are needed to prevent and reduce escalation of alcohol use and other risky and problem behaviours among youth attending these special centers.

Translating evidence into practice. The challenge of preparing comprehensive systematic reviews and communicating evidence in a simple and useful way: Experiences from the Norwegian open access journal Ungsinn
SPEAKER: Helene Eng

ABSTRACT. Background There is a general agreement that clinical practice and preventive efforts should be evidence-based. This requires that practitioners and decision makers have easy access to information about available interventions and their effectiveness.

Aim To present the rating system used by Ungsinn to evaluate interventions, and describe how the findings are communicated online through articles, newsletters and Facebook. Also, to evaluate the use of Ungsinn by Google Analytics.

Method Ungsinn ( is a Norwegian scientific open access journal that publishes systematic reviews about the evidence of psychosocial interventions for children and young people. Through the articles we aim to produce systematic and comprehensive reviews where aspects such as the description and theory of the intervention are described in addition to ratings of the effectiveness and implementation quality. In order to facilitate the knowledge transfer process, the results from the review is summarized in terms of one of six levels of evidence, from 0 = “ineffective intervention” to 5 = “strong evidence of effectiveness”. In addition, the findings are presented in online newsletters and on facebook.

Results To date, 43 interventions have been reviewed and classified. The number of page views has increased from 15000 in 2009 to 66.000 in 2017. Gradually, the practice field has started to use the website, and it is being cited in national reports and guidelines.

Discussion Even if we now have an overview of the evidence, some of the most used interventions in Norway, are still without any evidence of their effectiveness. In this presentation, we will discuss potential mechanisms influencing the choice of interventions by the services, and how Ungsinn may be used to further inspire the use of evidence-based interventions.

Improving teacher behavior management and peer relationship quality: Effects of the Flemish adaptation of the Good Behavior Game

ABSTRACT. The Good Behavior Game (GBG) is a universal, group-based intervention intended for elementary school classrooms. In line with learning and social learning theories, it aims to prevent disruptive behavior through improving teachers’ behavior management and relationships among peers. Whereas many studies have shown positive GBG-effects on students’ behavior, studies on the presumed working mechanisms are scarce. This study investigated whether the Flemish adaptation of the GBG improves teachers’ behavioral management and peer relationship quality. In a quasi-experimental study among 728 students from Grade 4 to 6 and 106 teachers in ten Flemish elementary schools (M age = 10.26 years, 51,2% boys), teacher, student an peer reports were administered at the beginning and at the end of the school year. In the intervention condition (five schools), the GBG was implemented during that school year, while the control condition (the other five schools) received education as usual. Multilevel regression analyses (level 1: student, level 2: class) showed stronger improvements in self- and student-reported teacher behavioral management in the GBG classrooms. The GBG effect on peer relationship quality was dependent on the students’ initial level of problem behavior. In the control classrooms, peer relationship quality decreased for children with high initial problem behavior, while it remained constant in de intervention group. These findings add to the scarce direct evidence that the GBG improves teacher behavior management. Second, they suggest that the GBG can buffer negative effects of problem behavior on children’s peer relations, and thus protect children at risk even without providing them with targeted or individualized interventions. Finally, this study adds to the growing evidence for the effectiveness of adapting evidence-based school interventions to the local educational context in which they are implemented.

Strategies for the integration and promotion of scientific evidence in the applied field of prevention

ABSTRACT. School-based preventive strategies that have been evaluated have tried effective in improving aspects of adolescent health, such as nutritional aspects, sexual health and the prevention of substance abuse. Systematic reviews and meta-analyzes indicate that models, components and strategies do better. However, the transfer of this evidence to the design of preventive programs, as well as the monitoring of its implementation and subsequent evaluation, continue to be areas that require improvements in systematization and effective applicability.

Based on the general principles of effective prevention, quality criteria and good practices established in the European context, a basic tool is proposed for process management of the different assignment that must be planned within the framework of a program to ensure its quality. The STM model of management of preventive programs is oriented to the integration and promotion of scientific evidence in a transversal way in the different phases of the planning process of a project, establishing for each one of them the contents and assignment that must be incorporated, as well as the derivative products after their completion.

Likewise, the STM model, developed from the proposal of European standards of quality in drug prevention elaborated by the European Monitoring Center for Drugs and Drug Addiction (2011), empower prevention technicians and program managers to carry out a check of these quality standards in those processes to which it is linked. Consequently, the STM model can be a strategy to consider in program accreditation policies.

Different profiles of family dynamics in a program for the selective prevention of substance use in adolescents
SPEAKER: María Valero

ABSTRACT. Introduction. Family dynamics are a key factor in family-based prevention programmes, especially in vulnerable population. Effective interventions to prevent drug use in adolescents often work to change family dynamics. There are many types of vulnerable families and the programmes do not always equally respond to the needs of all the participants.

The objective of this study is to identify and explain the different profiles of family dynamics of the participants who took part in The Family Competence Programme (PCF) 12-16. This paper focuses on the benefits obtained by the participating families and pays attention to the heterogeneity of these benefits.

Methodology. A pre-test post-test quasi-experimental design with control group was implemented. This study was conducted in the Balearic Islands between 2015 and 2016. During this period N=69 families took part in the PCF. K-means cluster analysis was used to identify family dynamics’ profiles.

Results. The scales used to discriminate the clusters were resilience, parent-child relationships, family cohesion and family organization. 56 families (81,16%) obtained good scores with high and mid-to-high scores in the aforementioned scales. Only 13 (18,84%) of the participant families presented a low profile of family dynamics. Overall, the main results showed four types of family dynamics: competent (18 families), poor organization (29 families), poor communication (9 families) and improvable skills (13 families).

Conclusion. The results highlight the existence of different subgroups with specific profiles in family dynamics at the end of programme. The families that participated obtained differential improvements in their family dynamics, which portrays their different needs. This fact allows us to open new avenues of investigation about the effectiveness and implications in the application of the programme or the design of the booster sessions.

From complex needs to complex intervention – example of FamResPlan research project

ABSTRACT. The overall objective of the research project Specific characteristics of families at risk: contribution to complex interventions planning (FamResPlan) is to identify characteristics of specific groups of families at risk - their risk factors, readiness for change and intervention, and the life satisfaction of family members. As a set of new, under-studied processes placed in the context of the family resilience concept, project findings could be of importance for complex interventions planning. The comprehensive FamResPlan study of families at risk is being conducted at the moment and the sample will consist of 200 families with various complex needs for intervention and support that have at least one member with serious behavioral problems. The aim of this presentation that has been fully supported by Croatian Science Foundation under the project IP-2014-09-9515, is to discuss the findings regarding the complex needs of families with at least one adult member diagnosed with an addiction disorder. In the presented study, complex needs are assessed by self-report from addiction clinic patients as well as by self-report from one of their family members. In addition, complex needs for intervention are assessed by a mental health professional from the addiction clinic. It is expected that the previously mentioned complex constructs will provide a deeper insight into the complex processes regarding intervention needs of families at risk. These insights can be used as a good foundation for developing complex interventions for this specific target group – families with one member diagnosed with an addiction disorder. As well, the results from this study should provide basic information for the development of research informed preventive interventions related to the concept of family resilience. The research data are still being collected at the time of writing this abstract, which is why the results will be presented at the conference.

Gambling among Adolescents: preliminar evaluation of a School-Based prevention program.

ABSTRACT. Introduction: 3.5% of people that gambled last year in Spain could fulfill at-risk gambling criteria. An early onset in youth has been associated with greater severity in adulthood. In this sense, recent studies show 4.9% of Spanish adolescents is at-risk criteria and 1.2% at problematic gambling (Lloret, Cabrera, Segura-Heras et al., 2016). In addition, the continuity rate of gambling, after one year, exceeds in 75% of adolescents of those that gambled one year before. Predictors usually proposed in school prevention are: Intention to gamble, Risk-Perception about gambling, Awareness about probability-Reduction of Cognitive Bias about winning, and Attitude toward gambling advertising. Aims: To assess the efficacy of a universal prevention program for problematic gambling in adolescents (3 sessions). Method: quasi-experimental PRE-POST test design with control group. Sample: 330 secondary education students (40.6% ♂; mean age: 15.70, SD = .67; range: 15-17) were randomized assigned to either an experimental intervention or a control condition. Results: Results of ANCOVA on POST-test suggested a significant difference between experimental and control groups in Intention to gamble (F (1,327) = 4.583, p < .05), Risk-Perception about gambling (F (1,327) = 11.589, p <= .001), Awareness about probability-Reduction of Cognitive Bias (F (1,327) = 24.454, p < .001), and Attitude toward gambling advertising (F (1,327) = 4.523, p < .05). Conclusion: Results of preliminary analysis encourage to continue the program in larger samples. Further longitudinal studies are needed to confirm our suggestions.

Empowering parent organizations to prevent substance use in Spain and Portugal- Aims, methods and primary outcomes of the EPOPS-project
SPEAKER: Daniel Lloret

ABSTRACT. Programs addressing multiple levels, such as the social or the physical environment are expected to be more effective for substance use prevention than single-level programs. To date, family and community interventions have been less developed than school-based programs. FERYA (Familias en red y activas – Active Family Network) is a community-focused program that takes advantage of parent organizations’ strength to boost intervention activities targeted at substance use at the local level. The program is based on the Social Development Model (Catalano and Hawkins, 1996), the Bronfenbrenner (1981) Human Development Ecology Model, and the empowerment development approach of organizations (Peterson and Zimmerman, 2004). The objective of this contribution is to present the EPOPS Project (Empowering Parents’ Organizations to Prevent Substance use) which aims to adapt and evaluate a pilot implementation of the FERYA program in two European countries: Spain and Portugal. The program is designed to train parents to be proactive agents for prevention and to achieve impact on three levels: family, community, and social-political. Therefore, via the training of parents and leaders of parent organizations, the project aims to achieve: 1) a research-based program and protocol for the prevention of substance abuse in children, as well as a training program for the implementers, 2) an evaluation model to examine the empowerment of parents organizations, and 3) tools for the assessment of the community engagement and readiness to change in communities.

Effectiveness of the school based prevention program Rock and Water in improving students’ social safety: Communication as indirect effect?

ABSTRACT. Rock and Water (R&W) is a widespread, but still poorly evaluated, school based prevention program that aims to improve students’ social safety. R&W applies a psychophysical approach, i.e., play and exercises are used to increase the strength of students, to teach them to make (physical) contact with others and to explore, respect and set own and other’s boundaries. A recurrent theme throughout the intervention is verbal and non-verbal communication. Communication is proposed to increase students’ feelings of social safety. Therefore, we will examine 1) the effectiveness of R&W in improving students’ social safety (i.e., perceived social security in the classroom, aggression, and bullying and victimization) and 2) communication as possible indirect effect of R&W on social safety. Six secondary prevocational schools are assigned to the R&W condition (N = 253) or control condition (Care as usual (CAU); i.e., current school policy to enhance students’ social safety; N = 378). Seventh Grade students participated in the study. Social safety is measured with questionnaires. Communication is assessed through video-observations in a random subsample of 65 dyads using an adapted version of the Peer Interaction Task. Same-sex dyads of classmates planned an activity together, as warm-up, and subsequently discussed three vignettes concerning daily school situations. Each of these four segments lasted 5 minutes. Interactions were coded for verbal and non-verbal communication. Deviant (e.g., “I would hit him”) and prosocial (e.g., “I would borrow him a pen”) communication were coded. Social safety and communication were measured prior and after R&W. Preliminary results of the total sample showed that R&W is more effective than CAU in decreasing conflicts in the class, in improving perceived social security in the classroom and in decreasing victimization. When analyzing part of the subsample that participated in the observation task (n dyads R&W = 7, n dyads CAU = 17) an indirect effect was found which indicated that R&W decreases victimization through increases in the reinforcement of prosocial utterances . These preliminary results indicate that R&W seems to be effective in improving students’ social safety. Additionally, it seems important that prevention programs aimed at bullying should focus on prosocial communication.

Preventing weight gain could be a strategy to achieve and maintain smoking abstinence?

ABSTRACT. Introduction Weight gain after smoking cessation is considered a barrier to achieve and maintain abstinence. Previous studies have found that this could be especially relevant in the case of women. This study aims to examine: (1) whether BMI (Body Mass Index) increase during and after quit smoking separately for men and women; and (2) whether BMI increase predicts smoking status at 3 months follow-up separately for men and women.

Method The study was conducted in male and female participating in a cognitive-behavioral smoking cessation intervention (63.1% female; mean age = 45.49, SD = 11.00). Smoking status biochemically verified through carbon monoxide in expired air (CO < 10), and weights were assessed at baseline, at the end of treatment and at 3 months follow-up. Baseline and end of treatment assessments were completed on 176 participants, of which 126 completed the 3-months follow-up.

Results Data showed that women who quit smoking increased significantly their BMI at the end of treatment (p= .009), and at 3 months follow up (p= .025), comparing with those who remained smoking. No differences in BMI were observed for abstinent men at the end of treatment neither at 3 months follow-up, comparing with those who smoked. Regarding regression analysis, only in the case of women, BMI increase was predictive of being smoker at 3 months follow-up (OR = 1.64, p =.029).

Conclusion The results of this study showed that BMI increase during and after smoking cessation was only significant in the case of women. Additionally, it was found that this BMI increment predicted significantly smoking status at 3 months-follow-up only in women. Therefore, preventing BMI increase could be a strategy to facilitate smoking abstinence in women, and it should be addressed during but also after smoking cessation interventions.

A Mobile Application to Improve Eating Behavior by Training Users to Eat Intuitively

ABSTRACT. Problem: Mobile applications focusing on healthy eating are increasingly being used to improve users’ health. The result, if not the goal, is that target groups are utilizing apps that promote healthier eating behavior, an important step in preventing metabolic disease. Despite this boon in nutrition oriented mobile applications, most are made by entrepreneurs who are not using health promotion theory in their platforms. However, several applications aimed at improving eating behavior through intuitive eating have been created by health promotion experts. Intuitive eating is a mindful method of eating aimed at preventing excesses of hunger and fullness that can result in weight cycling. This paper reviews one such intervention that has been created by a practitioner-researcher in health promotion.

Innovation: This intuitive eating app was created using evidence-based strategies to effect change, including: cues to action, interactivity, and reinforcement of learned behavior. Feedback is further individualized for each user based on how they ate to mimic face-to-face intervention. Three times-a-week users get a text cuing them to enter in how hungry and how full they got at each meal on the previous day. If they have splurged or starved, they will get feedback on the effect this behavior has on their bodies. For example, feedback for a user who skips a meal is: “Your Paleo DNA interprets this as ‘danger’, telling your body to hold on to fat, this leads to high levels of hunger hormones that slow your thyroid and reduce energy expenditure”. Users get tips on how to eat a healthier amount by listening to the homeostatic cues of hunger and fullness. User testing revealed positive impact on identifying these homeostatic cues and providing users with permission to eat enough to be full and not get too hungry.

Implications for Research: Mobile applications are an underutilized method for improving metabolic health. Yet, they hold promise for both the research of health promotion interventions on users’ health and the dissemination of these innovations. Mobile applications can assess real time users’ health behavior. They are also serving a market that is actively seeking a health-oriented intervention.

Implementation of the project ‘A window to the world of cultural diversity’ aimed at developing intercultural competences.

ABSTRACT. The idea of the project ‘A window to the world of cultural diversity’ started from seeing the need for workshops for children, activities dedicated to problem of peer ethnic violence. The proposal including the outline of the new program ‘Open your eyes’ succeeded in the public financial contest. The main goal of the program was to provide children with positive experiences during contact with the elements of other cultures (Ukraine, Japan, Kenya, Indie) presented both using new technologies and material objects (gifts from foreign friends). The crucial aspect of activities with children was modelling mindful, careful, kind presence with other person as a form of being in contact with others, including children from different cultures. The clue of program was teaching the respectful attitude towards every human being, also different from these, who are well known. A variety of activities was chosen to achieve these goals, e.g. drama, storytelling (with new special texts), painting, dancing, singing. The project was implemented in Warsaw (Poland) in a few primary schools and preschools. Over one thousand children (4 – 9 year-old) participated in the program during two years of its realization. Each class/group of children was conducted by two leaders during two- or three-hour-long workshops. The project enjoyed great success in the reference of direct participants: children were really engaged, teachers from next schools wanted their children to participate. The need of continuation and extension of the project (learning respect towards the human being as a human being) was noticed.

14:30-16:00 Session Parallel 4.1: THE EUPC

Parallel Session 4.1: THE EUPC

UPC Universal Prevention Curriculum adapted for European professionals training: EUPC

ABSTRACT. While science has delivered the evidence of effectiveness, prevention providers often use unproven, obsolete and ineffective prevention strategies. Evidence suggests that prevention strategies success depends less on effective interventions availability but to a greater extent on the people who implement them, their attitudes, skills and level of training. Responding to this challenge, the Universal Prevention Curriculum (UPC) was developed by the US-based organization APSI with renowned researchers in the US, based on UNODC’s International Standards on Drug Use Prevention and the European Drug Prevention Quality Standards. The overall Leitmotiv ‘apply evidence-based prevention’ is a robust response to the scarce use of registries on both sides of the Atlantic. UPC has been adapted by research- and service based centers in 9 European countries in collaboration with APSI, EMCDDA, UNODC and ISSUP*. The process has been documented, subdivided into “surface” and “deep” adaptations, resulting in three shortened versions, the “EUPC” that will be disseminated by EMCDDA. The analysis of this adaptation process provides a basis for further USA-Europe and other international discussions regarding training curricula and intervention materials. The development of UPC highlights the importance of training of “decision-, opinion- and policymakers”(DOP), since they are the gatekeepers for the roll-out of EB prevention interventions and practice. Through focus groups and on-line surveys, the EUPC group assessed the training needs of European prevention professionals. Based on these assessments three training modules based on UPC were developed: a five day module; a 24-hour academic module and an online module. These were piloted in the Spring 2018 in 9 countries and languages: Belgium, Croatia, Czech Republic, Estonia, Germany, Italy, Poland, Slovenia and Spain. The conclusions on the adaptation process analysis and the first results of the pilot trainings will be presented and discussed. The project ends in 2018, however, prominent European institutions have already planned to disseminate the EUPC over the coming years. The EU-USA cooperation in this project is groundbreaking and can inspire many scientists and practitioners to work together to improve how EB prevention interventions are delivered in the future.

* APSI Applied Prev Science Int’l ISSUP Int’l Society of Subst Use Professionals

European Decision Makers' Feedback to a Short Training Curriculum on Prevention Science

ABSTRACT. An ongoing project funded by the European Commission in 2017 aims to adapt the Universal Prevention Curriculum(UPC) accredited by the U.S. Department of State, to the european context. It is based on UNODC’s International Standards on Drug Use Prevention and the EDPQS, European Drug Prevention Quality Standards. The Universal Prevention Curriculum (UPC) has been be pilot-implemented in 9 EU member states during the months from March to June 2018. The project partners bring together findings from a mapping and analysis study of prevention training in Europe with expert opinions as a resource for adaptation of the UPC. With local translations and smaller country-specific adaptations 11 institutes in the 9 member states established a pilot-training for mixed groups of stakeholders involving civil society, public authorities as well as NGO’s, prevention practitioners and coordinators, the academic world and policymakers. The training is designed in three distinct modules based on again a thorough study phase including focus groups and online surveys. The pilot-trainings are delivered in a short module, an extended academic module, and an online module with an e-learning basis. The pilot-training findings about the short module will be presented and discussed. A detailed presentation of feedback coming from at least 100 decision makers from over 6 european countries will be given in order to underline how and if research evidence and prevention science main topics are used in decision making processes. The training goal is to offer a better understanding of prevention science in order to help decision makers to choose interventions and allocate resources on what shows to work, reducing ineffective or iatrogenic drug prevention interventions The findings from different training versions will feed the adaptation process and are likely to address the specificities of the european context in order to build a curriculum that can satisfy the training needs of the european targets. Affinities and differences among european and american prevention cultures and policies will be highlighted and some initial ideas about the european adaptation of the UPC will be offered.

Specialized Training Course in Prevention of Addictions: the EUPC online in Portuguese

ABSTRACT. Preventive approaches are being more and more demanding for the professionals working in the field. Prevention based on prevention science requires new skills and innovative ways of professional development that must be integrated by prevention experts. The Universal Prevention Curriculum (UPC) answers to this need of a prevention work based in scientific knowledge and evidence. The European adaptation of the Universal Prevention Curriculum (EUPC) provides guidelines to work with particular contexts and vulnerable groups. Universidade Aberta (UAb) is the only public distance education university in Portugal and is member of the International Consortium of Universities for Drug Demand Reduction (ICUDDR) as an ‘education provider’. Within this scope and based on the EUPC, UAb has developed the Specialized Training Course in Prevention of Addictions which is an answer to the needs of professionals working in prevention in Portuguese speaking countries. This training delivery model achieves good geographical coverage, particularly in remote areas, far from traditional universities and therefore might be particularly useful for 1) Training on the job, for professionals already working in this or related fields, and 2) Large territorial countries, particularly in the Portuguese speaking world. The teaching and learning activities of the programme proceed asynchronously using UAb’s e-learning platform and other digital environments and tools typical from web 2.0 and 3.0. The programme design is based on the principles and guidelines established in the Virtual Pedagogical Model® specifically created for online teaching and learning at UAb. This model has the following four principles: i) Student-centred learning; ii) Education based on the flexibility of access to learning; iii) Education based on diversified interaction; iv) Education that promotes digital inclusion. In this model the student is integrated in a learning community within which pedagogical thinking is developed, as a result of the participation and collaboration in the joint construction of learning. In this presentation we explain and critically discuss the Specialized Training Course in Prevention of Addictions. Namely the pedagogical design, resources, technology and tools, interaction and collaboration, e-activities and contents.

The Universal Prevention Curricula (UPC) implementation into the Prague Model of Addiction Studies: process evaluation study

ABSTRACT. The team on Charles University (1st Faculty of Medicine) has developed own complex curriculum of Addiction Studies between 2003 and 2012 and established BC, MA and PHD university degree program based on this curricula. This model (called Prague Model) has been continually evaluated and searched and combined three different historical traditions in prevention, treatment and public health. Graduates from this program are licensed by State Authority and Addictology is regulated profession in the Czech Republic. They recognisable as a health care professionals and can provide prevention and treatment directly in the field and can be contracted by Health Insurance Companies. In 2016 has creative team decided to implement Universal Prevention Curricula (UPC) developed by team of prof. Zili Sloboda. In collaboration with INL/Colombo plan and ICUDDR was prepared an original evaluation study. The study is based on process evaluation of implementation process conducted within 2017-2018 (1st Phase). Methods: field records, observation methods, official documents, curricula documents, syllabuses, content analysis, thematic analysis. First Phase of the study was terminated by successful official accreditation of new curricula combining an original Prague Model and UPC. For evaluation we used a structural perspective and went through the implementation process step by step with full respect to both models. The second Phase of implementation and evaluation will start in September 2018 with opening new academic year when we will test the new complex curricula on first students.

An overview on the UPC-Adapt (Universal Prevention Curriculum) training piloting process of the short standardized European UPC-curriculum: strengths and points for improvement in the Belgian context.
SPEAKER: Annemie Coone

ABSTRACT. This session overviews the UPC-Adapt piloting of the short EUPC-curriculum (five days of training) in Belgium. This training module is targeting prevention policy-, decision- and opinion makers. The motivation for this UPC-Adapt project is that prevention providers often use unproven and ineffective prevention strategies and should have a qualitative level of training. One of the objectives of the UPC-Adapt project is to train prevention professionals with a standardized curriculum, based on findings from a mapping and analysis study. The mapping exercise gives information on how the EUPC fills existing gaps and fits into the generic training system. The UPC was developed by APSI and is based on UNODC’s ‘International Standards’ and the EDPQS. The design of the five day EUPC training was developed together with five other UPC-Adapt partners and based on the results of local focus groups. The short training module was divided into a 2 day elementary training and a 3 day advanced training. At the beginning and end of each training day, the trainees had to fill in a pre- and post-test (learning outcomes questionnaire) in order to compare their knowledge and skills at the beginning and at the end of the training. In addition, they filled in an open questionnaire that checked out their preferences and disapprovals in content and exercises. They were also able to express their feedback verbally. This session starts with a short overview on the training content, the recruitment of the participants and the context in which the training sessions occurred. It gives an overview on the strengths and weaknesses of the five days EUPC training based on the pre- and post-tests, open questionnaires and the feedback of the involved trainers. It gives a good idea on the different interests of prevention policy-, decision- and opinion makers and the needs they express to be trained in. The session winds up with some recommendations for the future of the EUPC.

14:30-16:00 Session Parallel 4.2: ENABLING CHANGE IN PREVENTION


Location: EMCDDA 107
The Future of Blueprints and Other Prevention Registries
SPEAKER: Karl Hill

ABSTRACT. This presentation directly addresses the conference theme of “Prevention Technologies – improving the use of evidence in prevention practice” and describes the Blueprints database of evidence-based programs (EBPs) and its potential application in prevention efforts in European countries. There is a growing demand for evidence-based programs to promote healthy youth development, but this growth has been accompanied by confusion related to varying definitions of evidence-based and mixed messages regarding which programs can claim this designation. The registries that identify evidence-based programs, while intended to help users sift through the findings and claims regarding programs, have often led to more confusion with their differing standards and program ratings. The advantages of using evidence-based programs and the importance of adopting a high standard of evidence, especially when taking programs to scale, are presented. One evidence-based registry is highlighted, Blueprints for Healthy Youth Development hosted at the University of Colorado Boulder. Blueprints' standards for recommending a program are widely recognized as the most rigorous in use, with an internal review team and expert advisory board examining methodological grounding, clearly defined goals, and reliably positive results to determine which programs meet a high standard of proven efficacy. The presentation presents the process by which a program reaches the Blueprints database, and provides examples of programs approved by Blueprints and implemented in Europe. The presentation concludes with a review of the major challenges facing registries of effective prevention programs, practices and policies and proposed strategies for addressing these challenges and enhancing the utility and efficacy of the Blueprints Registry.

How to inform policy- and decision-makers about evidence-based prevention
SPEAKER: Matej Košir

ABSTRACT. Advocacy skills are essential for the prevention scientists, researchers and practitioners to potentially influence policy- and decision-making processes for better prevention policies and practice. Those skills are important especially in those prevention areas where so-called “unhealthy” industries are influential and/or (at least) want to be important stakeholders in the field (such as alcohol, tobacco and pharmaceutical industry). They are also important to advocate for evidence-based prevention policies (e.g. alcohol, tobacco or illicit drug policy) and practice, which should be fully in line with minimum quality standards in prevention. Recognizing this need, Institute Utrip developed a series of advocacy trainings, especially for scientists, researchers and practitioners in the field of prevention. Some basic information and challenges regarding the needs for training (in purpose to increase knowledge and skills) will be presented and discussed by the authors. Outcomes of such trainings should include an increased competence for advocacy as forging stronger relationships with policy- and decision-makers and other key stakeholders in the field, advocating for the use of research to inform policy- and decision-makers about evidence-based policies and practice, providing expert testimony, writing position papers, press releases and social media posts, and committing to ongoing advocacy. Scientists, researchers and practitioners need to become more relevant to policy- and decision-makers if we want to achieve better results in prevention science and practice in Europe.

Supporting evaluation in prevention in Ibero-American countries. The Bank of Instruments of Evaluation in drug demand reduction: a COPOLAD (EU-CELAC Cooperation Programme on Drugs Policies) initiative
SPEAKER: Daniel Lloret

ABSTRACT. In the prevention scene, evaluation only reaches to a minority of the interventions. The availability of assessment tools is not always easy, and it could partly explain this lack of methodology. COPOLAD (European Cooperation Programme EU-CELAC on Drugs Policies- 2016 to 2020) is a partnership cooperation programme between the European Union, Latin America and the Caribbean ( EU-CELAC) countries aiming at improving the coherence, balance and impact of drugs policies, through the exchange of mutual experiences. A main goal for COPOLAD is boosting an evidence-based culture for prevention practice in the CELAC countries. In coherence, the objective of this work is to build up a Bank of Instruments of Evaluation (BIE) of risk-factors. Methods: The first phase involves preparing a list of instruments validated in Ibero-American countries. The inclusion criteria were that originals or adaptations must have been published in a peer-reviewed journal, or in scientific report/catalogue or in a scientific outreach book. We classified them into three categories: Individual, Family and School. Likewise, we have compiled in a fourth category the instruments to assess the severity of consumption. In the second and third phases we analysed each instrument, and in parallel, we prepared a detailed data sheet of each one. Results: 70 instruments were identified and 214 papers reviewed. Original were mainly from Spain (33.33%), Portugal (7,24%), Mexico (1,45%), and other countries (57,97%). We identified 110 cultural adaptations: Spain (29,09%), Brasil (26,36 %), Portugal (18,18%), México (10,91 %), Peru (4,55%), Colombia (3,64%), Chile (3,64%), Argentina (2,73%), Costa Rica (0,91%). Conclusions: BIE is an effective tool to engage prevention-agents and decision-makers in a more efficient methodology. Therefore, it can be used in the prevention of drug abuse, as well as to help to do a diagnosis and/or to evaluate psychosocial interventions. BIE as well fulfils the COPOLAD core objectives aiming to facilitate the implementation of evidence –based policies.

Institutional racism and prevention of use of alcohol and other drugs: a bioethical reflection

ABSTRACT. Brazil's slavery past has had effects on the organizational model of society, by ranking social groups based on their color, culture or ethnic origin. The social construction of the black person in post-abolition Brazil as a threat to society is directly related to the racism that blacks are subjected to when seeking a health service. Being a black person and a user of drugs, especially illegal ones, in Brazil, means that the healthcare processes and procedures assigned to them are often discriminatory and negligent, making it a public health issue concerning a bioethical reflection. The objective of this study is to analyze from a bioethical perspective, how institutional racism affects people's physical and mental health, and can reverberate on their relationship with drugs. As a method, it were carried out reviews and reflections of bibliographic and documentary studies on institutional racism, drug policies, accessibility and responsiveness of the health system, risk and harm reduction and bioethics. Among the findings, it was identified that drug policy has an adverse effect on black people, with ineffective preventive actions, disqualification of their mental suffering, non-responsiveness of the health service, poor quality of health care, increased incarceration and genocide of this population group, demanding a comprehension that the racial aspect goes through health interventions for blacks. It was also possible to identify that preventive actions do not recognize racism in their actions as a social determinant for drug use and abuse. It is imperative to interrupt a policy based on the war on drugs, which turns out to be a war against people who use drugs, characterizing young black people and the most vulnerable ones as the typical profile. It is urgent to expand the discussion and understanding of the phenomenon in order to change practices that are hygienist, segregating, non-preventive and that promote social exclusion and inequity.

Confronting the Challenges and Requirements in the Provision of Online Resources for Evidence-based practice
SPEAKER: Richard Lynas

ABSTRACT. There is much debate that the creation and advancement of the internet is the greatest technological development of the century. Its growth has left many non-profits with no choice but to move with the times, follow-suit with others in the sector and move significant elements of their work online. A major step has been the use of the internet for substance abuse awareness and prevention. This means of communication has raised a question of how many current online resources are evidence-based and if they meet the requirements for those working in this field.

During 2017 Mentor UK’s Alcohol and Drug Education and Prevention Information Service (ADEPIS) held a series of events for those involved in prevention work. During group sessions, there were discussions about existing online resources that support evidence-based practice and the challenges of translating this information into practice. Qualitative findings outlined the online and technological resources of greatest value to prevention workers and highlighted ways that appropriate quality resources could be of most support.

Results show that current online material does not always meet the needs of prevention workers and that many online resources are culture-specific. This review outlines findings from the discussions and explores how best online resources can be developed to meet current needs.

The Alcohol and Drug Education and Prevention Information Service (ADEPIS) was established in 2013 by the prevention charity Mentor UK to share information and resources with schools and practitioners working in drug and alcohol prevention. In 2017, ADEPIS was recognised by UNESCO, UNODC and WHO as a “prime example” of best practice in alcohol and drug education. ADEPIS is funded by Public Health England and the Home Office.

14:30-16:00 Session Parallel 4.3: CRITICAL DISCUSSIONS IN PREVENTION


Location: EMCDDA 012
How do we convince policy makers that prevention matters? Challenges in presenting the economic case for drug prevention
SPEAKER: Harry Sumnall

ABSTRACT. Drug prevention activities typically receive low priority in policy and practice responses to substance use. Whilst the economic case for investment in drug treatment is strong, for drug misuse prevention to be prioritised by funders, evidence is needed to show that interventions are both effective and cost-effective. Systematic reviews have found that most drug prevention approaches are ineffective, have small effect sizes, and are not effective in the long-term. Whilst some intervention approaches have been shown to be effective, few of these have been subject to economic evaluation outside of the USA.

We modelled the cost-effectiveness of seven interventions to prevent drug use in vulnerable populations, and which was used to support the development of national guidelines (UK). The models compared the costs (to the health and crime sectors) and health benefits (in quality-adjusted life years (QALYs)) of each intervention and its comparator. The reduction in drug use for each intervention partly offset the costs of the intervention, but with high intervention costs and low QALY gains, none of the interventions were estimated to be cost-effective in the base case. Sensitivity analysis found that some of the interventions could be cost-effective if they could be delivered at a lower cost, or if the effect could be sustained for more than two years.

Advances in prevention science have allowed for the development of theoretically-informed and evidence-based substance use interventions. However, there is currently little evidence to show that these are cost-effective, and it is therefore difficult to present a case for investment in prevention, especially in financially constrained health and social care systems. This talk will explore the need to account for sets of outcome measures in drug prevention research that incorporate the broader social costs of substance use,and discuss ways in which prevention researchers can work to develop interventions that address multiple vulnerabilities in affected groups, and which better reflect current working practices in Europe. This approach could support the development of more cost-effective interventions and help make the case for prevention.

Re-imagining early intervention
SPEAKER: Nick Axford

ABSTRACT. Early intervention is now a well-established enterprise in children’s services, demonstrated, for example, by the proliferation of standards of evidence, evidence-based programmes (EBPs) and online databases of EBPs. However, it has recently come under sustained attack, partly from critics who object fundamentally (mainly on ideological and scientific grounds) but also from those who are essentially supportive but think it could do much better. Meanwhile, trends in science, policy and wider society are either resulting in changes in the field already or should prompt a rethink. Examples include a greater emphasis on individual preferences, a deeper appreciation of complexity and the rapid expansion of digital technology. This paper describes current shifts in early intervention, exploring their origins and the opportunities and challenges they present. The shifts fall broadly into two categories, albeit with links between them: (1) how we intervene (the nature of early intervention); and (2) how we test (the evaluation of early intervention). The first category includes: from designing interventions in the laboratory to co-producing them with users in situ; from discrete interventions to whole system approaches; from fidelity to design to personalisation; from structured programmes to improvisation with common elements; and from contact time and ‘real’ to any time and virtual. The second category includes: from regular randomised controlled trials to mixed methods trials; from ‘what works’ to what works for whom, when, where, why and at what cost; and from slow linear testing to rapid cycle testing. We argue that, collectively, these changes are moving the early intervention field in four directions: a broadening (in focus and reach); a relaxing (more flexible and dynamic, less rigid and static); a deepening (more nuanced and sophisticated); and a mixing up (more iterative, less linear). While these developments are positive insofar as they represent concrete responses to observed problems, they also present challenges. For instance, new approaches to designing and testing interventions are in their infancy, meaning that time is needed to develop the necessary expertise and skills, and in some areas there is a danger of executing U-turns when what is needed is a recalibration.

Cost-Effectiveness Analysis of Parenting Interventions for the Prevention of Persistent Externalizing Behaviors: a Long Term Approach

ABSTRACT. BACKGROUND: Externalizing behavior disorders are common among children and place a high disease and financial burden on individuals and society. Parenting programs are commonly used to prevent such disorders, but little is known about their potential longer-term health and economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions: Comet, Connect, the Incredible Years (IY), Cope, and bibliotherapy, compared to a waitlist control, for the prevention of persistent externalizing behavior disorders in children. METHODS: A decision analytic Markov model was developed to estimate the cost-effectiveness of the interventions achieved by a reduction in the persistence of attention-deficit/hyperactivity disorder (ADHD), Conduct disorder (CD) and comorbid ADHD/CD. Epidemiological and effectiveness data were sourced from a previous RCT. We assumed intervention effects at post-test and at a two year follow-up and null effect thereafter. A limited societal perspective was adopted, including costs accruing to the healthcare and education sectors. Intervention costs were based on intervention descriptions. Disability-adjusted life years (DALYs) were used to estimate health benefits. The study sample consisted of 961 children aged 5-12 years who were followed through to the age of 18 years. Multivariate probabilistic and univariate sensitivity analyses were conducted to test model assumptions. RESULTS: Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,470 (IY) with cost offsets between US$ 537 (Connect) and US$ 1,888 (IY). All parenting interventions were cost-effective at a threshold of US$ 50,000 per DALY averted and showed negative incremental cost-effectiveness ratios. Two of the interventions, Cope and bibliotherapy were 100% likely to be cost-saving. CONCLUSIONS: Parenting interventions are cost-effective in the longer run at preventing persistent externalizing behavior disorders, when modeling children up to the age of 18. Cope and bibliotherapy show cost-savings and robust results in terms of value-for-money.

Forward-thinking prevention: The role of online assessment in future evidence-based practice. An ADEPIS case study

ABSTRACT. The Alcohol and Drug Education and Prevention Information Service (ADEPIS) is a project set up and managed by Mentor UK in response to the lack of a centralised support for evidence-based drug education and prevention, following Government’s decentralisation and localism efforts. Aimed at promoting evidence-based drug education and prevention resources for teachers and practitioners working in schools and other educational settings (both formal and informal), it has attempted to develop more interactive and effective ways to build capacity and promote implementation of best practice. In November 2017 ADEPIS launched two online self-assessment tools / quality mark frameworks to support schools and practitioners in: a) quality assessing their practice, b) increasing their understanding of evidence-based approaches and c) addressing current gaps and improving service delivery through the implementation of structured monitoring and evaluation and learning frameworks and training. The quality mark tools were developed on the basis of the European Drug Prevention Quality Standards. We want to focus on assessing the potential of services like ADEPIS internationally, and the provision of increasingly online-based assessment and training tools in supporting the workforce and promote the implementation of evidence-based practice, at a time of budget cuts and increasing public health priorities. We will do this by assessing the following points through interactive discussions with attendees, in order to encourage mutual learning and innovation: - current challenges faced by the sector, such as financial constraints; - current challenges faced by ADEPIS and Mentor, such as limited reach with schools given recent privatisation and increase of independent academies; - effectiveness of an online-based self-assessment tool on the basis of case studies’ analysis; - pioneering and increasingly effective ways of communicating evidence-based drug prevention with a variety of audiences to ensure understanding and buy in, subsequently encouraging more innovative fundraising strategies to support local implementation.

Monitoring change in local prevention systems: an Australian example
SPEAKER: Liza Hopkins

ABSTRACT. Australia, like most of the rest of the world, is facing an epidemic of chronic disease, yet much of this burden of chronic disease is preventable. There is a growing body of evidence to suggest that efforts aiming to transform health in communities often fall short in achieving what was intended. More research is needed to understand and intervene in the complex systems within which local prevention efforts are delivered. This paper reports on the Prevention Tracker project, an ambitious research project designed to describe, guide and monitor systems change efforts in chronic disease prevention across four diverse Australian communities. Working with local partners, the project utilises a range of systems inquiry tools to help understand each unique local prevention system. We work with local stakeholders to define a key systemic problem which is impacting the effectiveness of local prevention efforts and develop monitoring tools to help communities identify and measure systems change. Using the locally defined systemic problem, we work within existing prevention efforts to re-orient action and establish systems action learning teams to monitor the impact of system level change. System action learning teams within the communities offer an opportunity to reflect on practice, consider the local causes and drivers of both effort and barriers in prevention, and address existing resources towards coordinated and impactful efforts. We use the relevant data about efforts to effect systems change to develop monitoring tools to help the teams in each community capture relevant local data. Using this system-oriented approach, Prevention Tracker has been able to offer communities a set of system level tools to help them identify what is locally relevant in chronic disease prevention and to guide and monitor actions to implement systems change.



Location: Palacete 007
Challenges on prevention policy transfer in contexts with high levels of inequality
SPEAKER: Flora Lorenzo

ABSTRACT. Contexts with high levels of inequality produce intergenerational poverty cycles, school failure and inequal accesss to job opportunities. These conditions operate towards the permanence of the vulnerabilities associated with income disparity. Thus, the barriers imposed by the multidimensional poverty to socially vulnerable individuals must be included as of prevention targets instead of being considered non essential variables. Since 2013, a prevention culture has been established in Brazil as a result of the initiative of the Mental Health Department of the Ministry of Health to transfer prevention programmes to States and Municipal government settings. However, conflicting evidences were collected between qualitative and quantitative methods and between monitoring and research procedures. This led to fragilities on evidence-based prevention political agenda in course. Two interlinked hypothesis were made on the possible cause of divergences: (I) the lack of repeated measures along prevention programs on prevailing procedures of quantitative data collection; and (II) the lack of focus on the critical role of institutional practices on strengthening or inhibiting personal abilities through environmental consequences. Methods to achieve and measure complex interlocking behavioral contingencies and their social aggregate product are still neither familiar in prevention field nor in public policies. This scenario brings little information on the functional relations between dependent variables (protective behaviors) and independent variables (programs procedures) nor on its tendencies. To policy making this leads to little or even mistaken insights on critical and successful aspects of prevention strategies in progress. The national barriers to prevention might be overcome by strengthening the monitoring and research procedures by including (a) institutional determinants on protective and risk factors and (b) repeated measurements on procedures and target variables. Behavioral technology on cultural practices are suggested as important contributions to plan and measure changes on institutional practices and their social impact in transgenerational cycles of vulnerabilities.

‘Safe Kraków Programme’ – a dialogue of theory and practice

ABSTRACT. This paper aims to present best practices stemming from the process of preparation of the county crime prevention, citizen safety and public order programme ‘Safe Kraków’ (Poland). The team comprised of prevention professionals (local authorities, city officers, police, NGOs, schools, teachers, security experts) and researchers (lawyers, sociologists, sociologists of law, mediators, police scientists, criminologists, security scientists) ensured cross-disciplinary work from the early stages of programme preparation. The unique merge of safety actors representing diverse backgrounds and covering vast range of expertise created inspiring environment for shaping crime prevention programme and helped to build interinstitutional partnership. Previous nation-wide research on crime prevention programmes, crime mapping, cyclical survey on citizens’ feeling of safety created fundaments for evidence-based approach. Clear organisational structure, diverse forms of financing, responsiveness, evaluation embedded in the programme as well as scrupulous data collection anticipating the process of creating ‘Safe Kraków’ programme, innovative tools (crime mapping) and cumulated knowledge of team members were crucial for the success. Programme focuses on innovative activities which avoid duplicating duties assigned to certain city units and increasing horizontal cooperation among them. Accompanying political process of formal programme adaption and implementing it into city-wide development strategy for 2030 will be also discussed.

Is the future of prevention virtual? Examining the efficacy of a virtual human intervention to translate cancer screening guidelines

ABSTRACT. An ongoing question in prevention science is how to translate evidence in a manner that promotes behavioral change among the intended audience (Krieger & Gallois, 2017). This task is particularly challenging when the scientific evidence changes over time (Neil et al., 2017). Shifting behavioral recommendations can cause confusion and skepticism among the public. Colorectal cancer (CRC) is an example of a domain where advances in the science of prevention are not consistently translated in a manner that promotes behavioral change. While many national CRC screening guidelines recommend home stool tests such as Fecal Immunochemical Testing (e.g., Australia, Canada, United Kingdom), colonoscopy continues to be perceived as the gold standard for screening in the United States. As a result, many Americans are out of guidelines for CRC screening due to the barriers associated with colonoscopy.

Despite the need to improve CRC prevention, developing clinic-based interventions to promote home stool testing in the United States is challenging for several reasons. One is that patients may be unwilling or unable to attend to messages about screening. Another is that providers may not have the time in the clinic to recommend screening. Finally, providers may not possess characteristics known to engender trust among patients. The goal of the current study is to examine the efficacy of an intervention utilizing virtual human providers that may be suited for overcoming these challenges.

We conducted an online 3 (modality) x 2 (demographic matching) randomized message design experiment with a control group (N = 600) to examine the efficacy of using virtual humans to deliver CRC prevention messages. Modality manipulated the format of the intervention (text-based, distal virtual human, proximal virtual human). Demographic matching was manipulated by assigning participants a virtual human that either matched or mismatched their race and gender. The results have implications for the effective use of virtual human technology in a range of prevention contexts, including integration of virtual interventions into patient health portals.

Funding: This study was funded by the University of Florida Research Opportunity Seed Fund.

Injecting some science into the art of service design
SPEAKER: Tim Hobbs

ABSTRACT. Prevention scientists typically take a structured and empirically grounded approach to designing or refining services. This may include: conducting or drawing on epidemiological studies of need; considering the literature on the aetiology of the problems to be addressed; developing logic models that consider mediating and moderating mechanisms; and reviewing the evidence of ‘what works’. However, it is becoming increasingly common for evidence-based services designed within this paradigm to struggle to replicate their effects over time or in new contexts. There are various possible reasons for this, but one arguably concerns the means by which such interventions are developed.

Meanwhile, user-centred design approaches, developed initially from the field of product design, and now digital UX/UI approaches, are increasingly being adopted in service design and offered as a response to the limitations of the science-based approach to service design described above. Indeed, a whole new language and technology of user-centred service design (or design thinking) has emerged over the last decade. Prototypes are developed rapidly, with a strong emphasis on user needs and co-design, iteration and designing for actual implementation context(s).

In this paper we argue that both approaches to service design have their strengths and limitations. Crudely speaking, science-based approaches create services that probably stand a greater chance of improving outcomes – if only they could engage users and be sufficiently adaptive to scale in different and rapidly changing contexts. User-centred design approaches, by contrast, create services or systems that people like – if only they were underpinned by some evidence so that they had a greater chance of improving outcomes or not reinventing the wheel (for better or worse).

To explore these arguments we draw on some of our recent work at the Dartington Service Design Lab – including service design and adaptation with the national homelessness charity in the UK, Crisis, and our work to adapt the Family Nurse Partnership home visiting programme for young mothers in England. In both cases we describe the method of intervention adaptation and testing and analyse their strengths and limitations in relation to the science-based and user-centred service design methods respectively.

The effect of the Empowering Hospital model on healthy behaviours

ABSTRACT. Empowering Hospital ( is a project funded by the European Commission aimed at engaging chronic patients, their relatives and hospital staff in health promoting activities inside and outside the hospital. A randomized controlled trial realized in two hospitals (in Italy and in Spain) was designed to study the effect of an intervention based on risk profilation, counselling and access to health promoting opportunities. Control group was exposed to a brief advice. At baseline 977 subjects were recruited and followed for 6 months. Beneficial program effects were found for alcohol abuse (RR: 1.85, 95% CI 1.06-3.23) and for physical inactivity (RR: 1.95, 95% CI 1.35-2.82). Improvement in smoking cessation and fruit and vegetables consumption were also registered, but without any difference between intervention and control groups. The experimental evaluation of the Emp-H model demonstrated how a sustainable intervention delivered in the hospital setting can be effective in modifying risky behaviours in different target populations. Lessons learned from the project were collected in a handbook for healthcare professionals.



Location: EMCDDA 106
“Our sin was to evaluate our interventions and we have been punished for that”: the complexity of trying to associate prevention science and public policy and the use of (non)evidence
SPEAKER: Samia Abreu

ABSTRACT. There is a permanent debate in academic circles about how to influence public policy decision-making. Diverse models of the relation between science and “real word” were proposed and evaluated. Even whether it is not a main topic, the issues around this relation always appear in some matter. But what are the risks of this approximation? What happens when the research findings appoint divergences from expected results? The Brazilian Ministry of Health (MoH) has imported, culturally adapted and implemented three evidence-based programmes (Good Behavior Game, Unplugged and Strengthening Families Programme 10-14) with the intention to disseminate the Brazilian versions of the programmes nationally as public policy. The implementation reached 11.480 children, 42.686 adolescents and 1.018 families in Brazil during 4 years of implementation (Jan-2013- Dec-2016). Seeking evidence-based practice, MoH established innovative partnerships with three Brazilian universities that conducted interventions assessments indicating initial protective impact of the GBG and null and iatrogenic results for Unplugged in a RCT. The data from a quasi-experimental evaluation of SFP are still under analyses. Facing this challenge, four powers-actors were pressing in different, even contrary, directions: (1) the municipal and state implementers and decision-makers continue the implementation despite the results, (2) the researchers indicate the need of adjustments in the programmes, (3) the political leaders change their attitude towards the results according to the macro scenario: overlooking them in order to continue dissemination, or using them to justify the decision to interrupt the implementation of the programmes and (4) the technical experts in prevention advocating for the continuity of the process of transformation of programmes into public policy conditioned by investment in further adaptations and fidelity monitoring improvements. All these four powers-actors remain struggling to influence the decisions and they have been under or over-estimating the strength of the evidence in defense of their political interest.

Opportunity for successful knowledge translation in Lithuania

ABSTRACT. Local and international organizations have highlighted that health policy, prioritization and financing solutions in Lithuania are not based on evidence and research. There is a need to introduce evidence-based management tools and promoting use of evidence for decision-making and policy implementation. Lithuania as a member of the WHO Evidence-Informed Policy Network (EVIPNet) has agreed to create national measures for evidence-informed policy making. Ministry of Health and Institute of Hygiene aim to adapt the WHO EVIPNet methodology, create knowledge translation (KT) processes and establish knowledge translation platform (KTP) in Lithuania. To identify potential KTP participants, mechanisms of KT health sector public management institutions’ survey was carried out. Results showed a need for a KTP to join all health sector public management institutions, experts, academia and other stakeholders. Survey also showed that all institutions have different fields of work, manage various data and differ in capacities. In 2018 KTP of 13 institutions as equal members was established. Each member has a representative in the coordinating KTP board, which participates in priority setting, problem identification and policy dialogues. KTP members proposed priorities of which 3 were selected for pilot Evidence Briefs for Policy (EBP) based on priority setting criteria. Working groups of specialists, experts and other stakeholders will be formed to address the priorities selected. Pilot EBPs will be prepared using local data, best available evidence and experts’ knowledge. Each of the EBP will address one concrete problem; propose options as well as option implementation considerations. Prepared EBP will be presented and discussed during policy dialogues with stakeholders (experts, decision-makers, politicians, scientists, groups affected by the problem or possible solution, etc.). This presents an opportunity to initiate evidence-informed policy making processes, promote the use of the best available evidence, national dialogues and increase cooperation and inclusion.

Contextual barriers and facilitators in Strengthening Families Program implementation process in Brazil

ABSTRACT. Understanding external factors impacting preventive interventions allows refining them, fostering their effectiveness and their sustainability. Programa Famílias Fortes (PFF), a Brazilian adaptation from the Strengthening Families Program 10-14 UK, aims to boost national alcohol and drug abuse prevention policies and has been implemented to reduce risk behaviors for adolescent health by strengthening family ties. Delivery of PFF is preceded by pre-implementation tasks in a set of chained stages, considered the program’s action theory: federal-municipal government negotiations; local coalitions; services mobilization; staff training; PFF dissemination to target families, and meeting organization. This study analyzes the contextual and procedural factors considered as barriers and facilitators in each pre-implementation and implementation stage. A qualitative study was carried out through 16 interviews and 2 focus groups with professionals responsible for PFF management, supervision, and implementation. Content analysis was based on PFF’s action theory and the Context and Implementation of Complex Interventions (CICI) framework. The most recurrent barriers indicated by the managers were: working conditions of implementing agents (13.7%), municipal management weaknesses (13.2%), poor infrastructure (9.4%), inadequate use of methodologies in staff trainings (7.3%), poor adherence of managers and professionals to the Program (5.6%), and lack of financial resources (5.6%). Conversely, the following context aspects were facilitators: adequate intersectorial coalitions (10.7%), stakeholder engagement (8.9%), management agents’ awareness (7.5%), effective municipal management (6.5%), and efficient family approach strategies (6.5%). When compared to CICI theory-based instrument, these results show substantial repercussions on: the political context (31.7%), implementation agents (26.3%), and implementation strategies (25%). A less significant influence is observed regarding geographical context (6.5%), sociocultural context (5.1%), socioeconomic context (3.1%), and implementation process (2.2%). Interviewee accounts indicate that PFF requires pre-existing and functioning intersectoral coalitions, effective management structure, distribution of power, and proper financial expenditure. These results help to understand the challenges of importing family-based prevention programs from high-income countries to low-and-middle-income countries, like Brazil. The study concludes that improving PFF requires advocacy for a culture of prevention, particularly in areas of high vulnerability, for they often prioritize urgency rather than prevention.

Effects of the Incredible Years (IY) Teacher Classroom Management (TCM) program in universal and disadvantage settings; change in children’s problem behavior and social skills

ABSTRACT. Background The negative consequences of poor psychosocial functioning and disruptive behaviours in early childhood, are well documented, including peer rejection, school failure, mental health problems and criminality (Emond, Ormel, Veenstra, & Oldehinkel, 2007; Ford et al., 2012; Odgers et al., 2008). Children facing economic disadvantage are at a higher risk for a poor behavioral and emotional development (Raver et al., 2009). Prevention and early intervention practices, such as the IY-TCM program, have been proven effective in addressing these challenges, particularly when they are focused on early years of life (Webster-Stratton & Bywater, 2015). Understanding whether IY-TCM program, given as a targeted intervention towards children facing economic disadvantage, or given as a universal preventive intervention in regular settings, changed children problem behavior and social skills, were the aims in this investigation. Method Participants were children in 65 preschools in the Coimbra district in Portugal where the percentage of children receiving free lunch was used as a proxy indicator of economic need, and children in 92 Norwegian universal kindergartens settings. For the Portuguese cohort, an experimental randomized controlled between-group design was used, and 1030 children (3-6 years) were recruited. For the Norwegian cohort, a quasi-experimental pre-post design was used, and 1049 children (3-6 year) were recruited. Results Results for economically disadvantaged children, positive effects in problem behavior (t = 4.3, d = .10), and social skills (t = 5.3, d = .21) were found from pre- to post-intervention, when comparing the intervention with the control group. Results for children in universal kindergarten settings in Norway, preventive effects in problem behavior (t = 3.2, d = .14), and social competence (t = 4.6, d = .21) were documented in favor of the intervention group. Conclusion The findings give support to promising effects of the IY-TCM program implemented both in universal and disadvantage settings on children’s problem behaviours and social readiness. Furthermore, these findings may have significant social implications that can inform policymakers with regard to an effective way of reducing child risk factors and the consequent gaps observed between children coming from different economic backgrounds (Fossum, Handegård, & Drugli, 2017; Seabra-Santos et al.).

Influential factors on the implementation process of the Strengthening Families Program in Brazil: a group leader´s perspective

ABSTRACT. The Strengthening Families Program (SFP 10-14 UK) was implemented in Brazil from 2013 to 2017 as part of the broadest national initiative of evidence-based public policy for drug abuse prevention. Factors related to external and internal contexts, program delivery facilitators, and intervention characteristics may interfere with the implementation process and favor or undermine effectiveness. This study assessed satisfaction with the implementation process, based on the perspective of group leaders with previous experience in delivering SFP 10-14 UK to families in the Northeast of Brazil (N=153). The participants answered a 16 item Likert scale (0=low satisfaction; 10 = high satisfaction) focused on the delivery system, the support system, the compatibility between the goals of the intervention and service, program characteristics, and professional adherence, as well as a 13 item Likert scale (1=completely disagree; 7=completely agree) addressing training and professional self-efficacy. The findings were analyzed with descriptive statistics and showed elevated satisfaction with professional involvement. This consisted of engagement (M=9.18, SD=0.91) and self-evaluated performance (M=9.05, SD=0.82), followed by the support system, which included supervision (M=8.73, SD=1.85) and training (M=8.72, SD=1.41). The participants considered the training efficacious to improve their knowledge on protective processes to drug abuse and enhanced their self-efficacy in leading preventive groups. Likewise, the participants indicated high satisfaction with the convergence among the SFP 10-14’s and public services’ aims (M=8.83; SD=1.28) and program characteristics, the comprising manual (M=9.06; SD=1.42), complementary material (M=9.23; SD=1.21), and procedures for families (M=8.89, SD=1.19), parents (M=8.77; SD=1.42) and adolescents (M=8.95; SD=0.96). In contrast, lower levels of satisfaction were observed regarding the delivery system, this is mainly due to transport for participants (M=7.28; SD=3.47), incentives for families (M=7.44; SD=3.14) caretakers for children (M=8.11; SD=2.59) and public service infrastructure (M=8.47; SD=1.54). Implications of these findings to solve difficulties in the delivery system and to inform the development of a scale-up implementation manual for public policies professionals are discussed. Further studies should investigate the predictive role of the implementation factors on the effectiveness of SFP 10-14 in Brazil.

16:00-16:30Coffee Break
16:30-18:00 Session Plenary 4: Plenary IV

Plenary 4

Presidents' Prize Plenary Talk given by Dr Kirsten Mehlig

EUSPR 2018 Conference Prize Winners

2018 Presidents' Award: Children’s propensity to consume sugar and fat predicts regular alcohol consumption in adolescence