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...on Prevention
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www.ProjectCork.org
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Summer 2012
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Individual-focused approaches to the prevention of college student drinking.
Cronce JM; Larimer ME. Alcohol Research & Health 34(2): 210-221, 2011. (56 refs.)
Alcohol consumption is prevalent among college students and can become problematic for some. Numerous randomized controlled trials have evaluated the efficacy of individual preventive interventions in reducing alcohol use and alcohol-related problems in college student populations. Consistent with earlier reviews, the balance of the evidence from studies conducted during the past 3 years strongly supports the efficacy of brief motivational interventions combined with personalized feedback interventions (PFIs) and personalized normative feedback (PNF), as well as of stand-alone PFI/PNF interventions. Recent analyses also continue to support the efficacy of alcohol expectancy challenge interventions, although the findings are less consistent. In addition, recent analyses offer mixed support for feedback-based interventions focused solely on blood alcohol concen-tration and for multicomponent, alcohol education-focused interventions that include elements of PFI/PNF No evidence of efficacy was found for programs that only included alcohol education. Public Domain.
Strategies implemented by 20 local tobacco control agencies to promote smoke-free recreation areas, California, 2004-2007.
Satterlund TD; Cassady D; Treiber J; Lemp C. Preventing Chronic Disease 8(5): article A111, 2011. (26 refs.)
Introduction: Since 2000, local jurisdictions in California have enacted hundreds of policies and ordinances in an effort to protect their citizens from the harmful effects of secondhand smoke. We evaluated strategies used by state-funded local tobacco control programs to enact local smoke-free policies involving outdoor recreational spaces. Methods: The Tobacco Control Evaluation Center analyzed 23 final evaluation reports that discussed adopting local smoke-free policies in outdoor recreational facilities in California. These reports were submitted for the 2004 through 2007 funding period by local tobacco control organizations to the California Department of Public Health, Tobacco Control Program. We used a comparative technique whereby we coded passages and compared them by locale and case, focusing on strategies that led to the enactment of smoke-free policies. Results: Our analysis found the following 6 strategies to be the most effective: 1) having a "champion" who helps to carry an objective forward, 2) tapping into a pool of potential youth volunteers, 3) collecting and using local data as a persuasive tool, 4) educating the community in smoke-free policy efforts, 5) working strategically in the local political climate, and 6) framing the policy appropriately. Conclusion: These strategies proved effective regardless of whether policies were voluntary, administrative, or legislative. Successful policy enactment required a strong foundation of agency funding and an experienced and committed staff. These results should be relevant to other tobacco control organizations that are attempting to secure local smoke-free policy. Copyright 2011, Centers for Disease Control.
The effects of prices on alcohol use and its consequences.
Xu X; Chaloupka FJ. Alcohol Research & Health 34(2): 236-245, 2011. (102 refs.)
Over the past three decades, economists and others have devoted considerable effort to assessing the impact of alcoholic-beverage taxes and prices on alcohol consumption and its related adverse consequences. Federal and State excise taxes have increased only rarely and, when adjusted for inflation, have declined significantly over the years, as have overall prices for alcoholic beverages. Yet studies examining the effects of increases of monetary prices (e.g., through raising taxes) on alcohol consumption and a wide range of related behavioral and health problems have demonstrated that price increases for alcoholic beverages lead to reduced alcohol consumption, both in the general population and in certain high-risk populations, such as heavier drinkers or adolescents and young adults. These effects seem to be more pronounced in the long run than in the short run. Likewise, price increases can help reduce the risk for adverse consequences of alcohol consumption and abuse, including drinking and driving, alcohol-involved crimes, liver cirrhosis and other alcohol-related mortality, risky sexual behavior and its consequences, and poor school performance among youth. All of these findings indicate that increases in alcoholic-beverage taxes could be a highly effective option for reducing alcohol abuse and its consequences. Copyright 2011, National Institute on Alcohol Abuse and Alcoholism.
Participation in universal prevention programmes.
Rosenman R; Goates S; Hill L. Applied Economics 44(2): 219-228, 2012. (37 refs.)
We analyse family decisions to participate in community-based universal substance-abuse prevention programmes through the framework of expected utility theory. Family functioning, which has been shown to be a good indicator of child risk for substance abuse, provides a useful reference point for family decision making. Our results show that well-functioning families (with children at low risk for substance use) should have the lowest incentive to participate, but that high-risk families may also opt out of prevention programmes. For programmes that are most effective for high-risk youth, this could be a problem. Using data from the Strengthening Families Programme (SFP) and the Washington Healthy Youth Survey (HYS), we empirically test the implications of our model and find that at least for one measure of family functioning those families with children most likely to be at risk for substance use are opting out of the programme. Copyright 2012, Taylor & Francis.
What influences Australian women to not drink alcohol during pregnancy?
Jones SC; Telenta J. Australian Journal of Primary Health 18(1): 68-73, 2012. (28 refs.)
There is a strong social norm against consuming alcohol during pregnancy. However, many women do not realise they are pregnant until the sixth week and are not provided with information about the risks of consuming alcohol until they visit a health professional in the second trimester. We conducted semi-structured interviews with 12 midwives and 12 pregnant women from two regions in NSW in 2008-09 to explore attitudes towards alcohol consumption during pregnancy, and the factors that may encourage or inhibit women from following the recommendation to abstain from drinking while pregnant. Both groups noted the social issues around pregnant women consuming alcohol due to perceived social norms and the challenges in not revealing early pregnancy status at social events. Copyright 2012, Csiro Publishing.
Drug education in Victorian schools (DEVS): The study protocol for a harm reduction focused school drug education trial.
Midford R; Cahill H; Foxcroft D; Lester L; Venning L; Ramsden R et al. BMC Public Health 12: article 112, 2012. (44 refs.)
Background: This study seeks to extend earlier Australian school drug education research by developing and measuring the effectiveness of a comprehensive, evidence-based, harm reduction focused school drug education program for junior secondary students aged 13 to 15 years. The intervention draws on the recent literature as to the common elements in effective school curriculum. It seeks to incorporate the social influence of parents through home activities. It also emphasises the use of appropriate pedagogy in the delivery of classroom lessons. Methods/Design: A cluster randomised school drug education trial will be conducted with 1746 junior high school students in 21 Victorian secondary schools over a period of three years. Both the schools and students have actively consented to participate in the study. The education program comprises ten lessons in year eight (13-14 year olds) and eight in year nine (14-15 year olds) that address issues around the use of alcohol, tobacco, cannabis and other illicit drugs. Control students will receive the drug education normally provided in their schools. Students will be tested at baseline, at the end of each intervention year and also at the end of year ten. A self completion questionnaire will be used to collect information on knowledge, patterns and context of use, attitudes and harms experienced in relation to alcohol, tobacco, cannabis and other illicit drug use. Multi-level modelling will be the method of analysis because it can best accommodate hierarchically structured data. All analyses will be conducted on an Intent-to-Treat basis. In addition, focus groups will be conducted with teachers and students in five of the 14 intervention schools, subsequent to delivery of the year eight and nine programs. This will provide qualitative data about the effectiveness of the lessons and the relevance of the materials. Discussion: The benefits of this drug education study derive both from the knowledge gained by trialling an optimum combination of innovative, harm reduction approaches with a large, student sample, and the resultant product. The research will provide better understanding of what benefits can be achieved by harm reduction education. It will also produce an intervention, dealing with both licit and illicit drug use that has been thoroughly evaluated in terms of its efficacy, and informed by teacher and student feedback. This makes available to schools a comprehensive drug education package with prevention characteristics and useability that are well understood. Copyright 2012, BioMed Central.
Alcohol prevention: What can be expected of a harm reduction focused school drug education programme?
Midford R; Cahill H; Ramsden R; Davenport G; Venning L; Lester L et al. Drugs: Education, Prevention and Policy 19(2): 102-110, 2012. (40 refs.)
Aim: This pilot study investigated what alcohol prevention benefits could be achieved by a harm reduction focused school drug education intervention that addressed all drug use, both licit and illicit. Method: The study population comprised a cohort of 225 students in three intervention secondary schools and 93 students in a matched control school in Victoria, Australia. A classroom drug education programme, derived from evidence of effective practice and designed to reduce alcohol and other drug harm, was provided to the intervention students during years eight (13-14 year olds) and nine (14-15 year olds) by teachers trained in its delivery. The control students received the drug education programme normally provided by their school. Findings: The students, who received the intervention, were more knowledgeable about drug use issues, communicated more with their parents about alcohol, drank less, got drunk less, and experienced fewer alcohol related harms. They also remembered receiving more alcohol lessons. They were, however, no less likely to have tried alcohol. Conclusions: The findings are consistent with other studies that have demonstrated school alcohol education that focuses on harm reduction can be effective in reducing consumption, risk and harm. In this study, this was achieved even though the students were not persuaded against taking up drinking, and the intervention did not focus solely on alcohol. These findings have implications for both the goals and coverage of future school drug education programmes. Copyright 2012, Informa Healthcare.
Healthy Lungs: Cancer education for middle school teachers using a "train and equip" method.
Burns ER. Journal of Cancer Education 27(1): 179-185, 2012. (24 refs.)
Prevention of the initiation of tobacco use, which is associated with increased risk of developing cancer of the lung, the oral cavity, larynx, and emphysema, should target middle school-age children because that is where experimentation with tobacco use usually begins. Millions of children attending school do not receive proper education regarding the biological science of the human respiratory system coupled with the impact that tobacco use has at the cell, tissue, and organ levels of biological organization because their teachers are ill-prepared and ill-equipped to teach this normal and cancer-related content. The University of Arkansas for Medical Sciences has a statewide outreach program that provides middle school teachers training in a "Healthy Lungs" curriculum that covers the normal functional anatomy of the respiratory system as a basis for adding the effect of tobacco use and its associated cancers and emphysema. This training also provides each participant a resource kit of supplies, materials, and items of equipment. A long-term implementation survey identified a high degree of transference of content and use of the resource kit items into new classroom learning activities for the trainee's students for both the normal functional anatomy of the human respiratory system and associated general and cell/tissue/organ-specific cancer biology. Copyright 2012, Springer.
Policy responses to multiple risk behaviours in adolescents.
Hale DR; Viner RM. Journal of Public Health 34(1): 111-119, 2012. (65 refs.)
Adolescence has long been considered a period of increased risk behaviour. This supposition has been supported by a wealth of empirical evidence and recently, health risk behaviours have been identified as a key mechanism for the general deterioration of adolescent health relative to other age groups. Research regarding adolescent risk behaviour suggests that there are often strong links between individual risk behaviours. The mechanisms for these associations have been attributed to common risk and protective factors, as well as gateway effects stemming from increased accessibility to additional risk behaviours. This has important implications for policy interventions designed to reduce risk behaviours in adolescence. Not only does a multiple risk behaviour approach increase the effectiveness of individual risk behaviour policy, but it is also conducive to a more cohesive, coherent and efficient approach to adolescent risk in general. Several examples of cohesive policy responses to multiple risk behaviours have emerged, but generally, policy remains segregated into individual risk domains. With increasing evidence for the effectiveness of integrated approaches, multiple risk behaviours require consideration to design and implement effective and efficient policy responses. Copyright 2012, Oxford University Press.
Evaluating the impact of a substance use intervention program on the peer status and influence of adolescent peer leaders.
Sheppard CS; Golonka M; Costanzo PR. Prevention Science 13(1): 75-85, 2012. (30 refs.)
The current study involved an examination of the impact of a peer-led substance use intervention program on the peer leaders beyond the substance use-related goals of the intervention. Specifically, unintended consequences of an adult-sanctioned intervention on the targeted peer leader change agents were investigated, including whether their participation affected their peer status, social influence, or self perceptions. Twenty-two 7th grade peer-identified intervention leaders were compared to 22 control leaders (who did not experience the intervention) and 146 cohort peers. Three groups of measures were employed: sociometric and behavioral nominations, social cognitive mapping, and leadership self-perceptions. Results indicated that unintended consequences appear to be a legitimate concern for females. Female intervention leaders declined in perceived popularity and liked most nominations over time, whereas males increased in total leader nominations. Explanations for these results are discussed and further directions suggested. Copyright 2012, Springer.
What public health strategies are needed to reduce smoking initiation?
Pierce JP; White VM; Emery SL. Tobacco Control 21(2): 258-264, 2012. (80 refs.)
Smoking initiation is a key behaviour that determines the future health consequences of smoking in a society. There is a marked difference in smoking patterns around the world, driven by initiation rates. While a number of high-income countries have seen smoking prevalence decline markedly from peak, many low-income and middle-income countries appear to still be on an upward trend. Unlike cessation where changes are limited by nicotine dependence, rates of smoking initiation can change rapidly over a short time span. Interventions that can be effective in achieving this include increases in the price of tobacco products, mass media anti-smoking advertising, smoke-free policies, smoking curricula in schools, restrictions on marketing opportunities for the tobacco industry as well as social norms that lead to restrictions on adolescents' ability to purchase cigarettes. Comprehensive tobacco control programmes that aim to denormalise smoking behaviour in the community contain all of these interventions. Rapid reductions in smoking initiation in adolescents have been documented in two case studies of comprehensive tobacco control programmes in California and Australia. Consistent and inescapable messages from multiple sources appear to be key to success. However, the California experience indicates that the rapid decline in adolescent smoking will not continue if tobacco control expenditures and the relative price of cigarettes are reduced. These case studies provide strong additional evidence of the importance of countries implementing the provisions of the Framework Treaty on Tobacco Control. Copyright 2012, BMJ Publishing.
Actions speak louder than words: An experiment on the impact of peers discouraging young adult smoking.
Harakeh Z; Vollebergh WAM. European Addiction Research 17(6): 316-320, 2011. (20 refs.)
This study investigates whether antismoking peer pressure and/or nonsmoking peers are protective factors and decrease young adults' likelihood to smoke. An experiment was conducted among 59 daily-smoking young adults aged 16-24 years. The experiment consisted of four conditions. During the session, the confederate and participant sat in a camper van and had to do a 30-min joint music task. The participants' smoking behavior was observed during this task. The results of Poisson log-linear analysis, controlling for participants' carbon monoxide level and gender, showed that young adults smoked fewer cigarettes in the presence of a nonsmoking model pressuring the young adult not to smoke compared to a heavy-smoking model not using any pressure. At the same time, the results of Fisher's exact test indicated that the total number of cigarettes smoked did not differ significantly for nonsmoking peers verbally pressuring the young adult not to smoke compared to nonsmoking peers not verbally pressuring the young adult. Our findings indicate that the protective effect of peer influence merely lies in that the peer does not smoke. Therefore, antismoking programs and policy should focus specifically on reducing exposure to smoking peers. Copyright 2011, Karger.
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