1.
This webinar has been made possible with support from the
Canadian Centre on Substance Abuse
Welcome!
School and community social
influence programming for
preventing tobacco and drug
use: Evidence and
implications for public health
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2.
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3.
The Health Evidence Team
Kara DeCorby Heather Husson Robyn Traynor
Managing Director Project Manager Research Coordinator
Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca
Lori Greco Yaso Gowrinathan
Knowledge Broker Research Assistant/Coordinator

4.
What is www.healthevidence.org?
Evidence
inform
Decision Making

5.
Why use www.healthevidence.org?
1. Saves you time
2. Relevant & current evidence
3. Transparent process
4. Supports for EIDM available
5. Easy to use

6.
Canadian Centre on
Substance Abuse
Project

7.
About CCSA
• National non-profit organization; ~ 50 staff
• Vision: All Canadians should live in a healthy society,
free of alcohol and drugs-related harm
• Mission: Provide national leadership and advance
solutions to address alcohol and other drug-related
harm
• Initiate change through partnerships and knowledge
www.ccsa.ca • www.cclt.ca 7

8.
What is CCSA’s SystemAction?
• National knowledge exchange network of diverse networks
across Canada
• Facilitates exchange of research evidence to inform addictions
related prevention and treatment practices
• Public/private online space to share information and contacts
• For more information, contact
 Rod Olfert (rolfert@ccsa.ca), or
 Rebecca Jesseman (rjesseman@ccsa.ca)
8

9.
A Model for Evidence-Informed
Decision Making
Client, community,
Community
political preferences
Context
Clinician
expertise
Research Resources
evidence
Adapted with permission from National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-
Informed Decision-Making in Public Health. [fact sheet]. Retrieved from
http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf

10.
Evidence-Informed Decision Making
1. Cultivate a culture of inquiry, critical thinking
and evidence-based practice “culture”
2. Ask a clear, focused, searchable question
3. Search for the best available evidence
4. Critically appraise the relevant evidence

11.
Evidence-Informed Decision Making
5. Integrate the evidence with expertise and client
preference
6. Evaluate the outcome(s) of the change in practice or
policy
7. Engage in knowledge exchange

12.
Importance of this Review
• Canadian youth are the highest users of marijuana
world wide
• Using strong quality evidence to understand what
works in prevention for tobacco and drug use
• Examining the long-term effectiveness of social
influence programs for adolescent substance use

13.
Review
Skara, S. & Sussman, S. (2003). A review of 25 long-
term adolescent tobacco and other drug use
prevention program evaluations. Preventive Medicine
(37) 451-474.

14.
Who has heard of a PICO(T)
question before?
1. Yes
2. No

15.
Searchable Questions – Does it work
Think “PICOS”
1. Population (situation)
2. Intervention (exposure)
3. Comparison (other group)
4. Outcomes
5. Setting

16.
Summary Statement:
Skara (2003)
P adolescents 12-15, and 16-19, in the transition
period between junior high and high school
I school or community social influence programming
for the prevention of tobacco and drug use
C other intervention or usual care
O primary outcomes: long-term tobacco use, smoking
initiation; secondary outcomes: alcohol and
marijuana use
Quality Rating: 8 (strong)

17.
Social Influences Programming
• Not defined explicitly in the review itself.
• Working definition: Social influences
programming increases the awareness of the
social influences on substance-use behaviours--
family, peer, and media-- and provides
normative information and skill instruction to
resist such pressures.

18.
Overall Considerations
Relatively consistent findings for social influence programming,
mainly delivered in schools, to reduce both tobacco use rates
and other drug use (marijuana, alcohol) in adolescents 12-19,
in transition period between junior high and high school in
the long term (from 2 to 15 years).
Interventions which either offered booster sessions or
programming over longer time frames appeared to enhance
maintenance of program effects at least to end of study
The school setting offers good potential to address tobacco,
marijuana, and alcohol use reduction

19.
General Implications
Public health should promote/support/implement:
Social influence programming for adolescents 12-19, to
reduce BOTH tobacco and other drug use (marijuana,
alcohol) in the long term (at least 24 months and
beyond).
Either booster sessions or curriculum delivered over a
longer time frame, for long-term maintenance of
program effects

20.
What’s the evidence -
Outcomes reported in the review
Tobacco use (total 25 studies, 17 of which assessed outcomes via
difference in % smoking between intervention and control
groups from baseline to follow up)
Other drug use – alcohol & marijuana (9 studies providing
long-term data)

21.
What’s the evidence -
Tobacco Use
Tobacco use (total 25 studies, 17 of which assessed outcomes via
difference in % smoking between intervention and control
groups from baseline to follow up)
• 15 of 25 studies reported at least one long-term (at least 2 years) positive
effect (reductions in ever, daily, weekly, or monthly smoking)
• 11 of 17 studies that reported tobacco use from baseline to follow up found
11.4% lower smoking rates (range 9-14%) from intervention group and
control group
• Of studies specifying booster sessions or programming delivered over two-
year time frames (total 14 studies), 57% maintained long-term reductions in
use by the end of study

22.
What’s the evidence -
Alcohol & Marijuana Use
Alcohol & Marijuana Use (9 studies with long-term data)
• 8 of 9 studies reported initial or interim positive impact for follow up
periods ranging 3 months to 5 years. For 6 of these 8 projects, maintenance
effects persisted the entire duration of the project.
• Studies calculating % reduction in use rates from baseline to follow up found
a long-term reduction ranging from 6.9-11.7% for weekly alcohol use (2
studies) and 5.7% reduction for 30-day marijuana use (1 study)
• Of 7 studies specifying booster sessions, 5 of 7 studies maintained long-term
reductions in use by the end of study

23.
General Implications
Public health should promote/support/implement:
Social influence programming for adolescents 12-19, to
reduce BOTH tobacco and other drug use (marijuana,
alcohol) in the long term (at least 24 months and
beyond).
Either booster sessions or curriculum delivered over a
longer time frame, for long-term maintenance of
program effects

24.
Questions?

25.
Contact Us
info@healthevidence.org