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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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    The webinar will begin shortly, please remain on the line.
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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
What is www.healthevidence.org?



                     Evidence
                          inform



             Decision Making
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
Canadian Centre on
Substance Abuse
Project
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
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
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
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
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
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
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.
Who has heard of a PICO(T)
    question before?

         1. Yes
         2. No
Searchable Questions – Does it work
                    Think “PICOS”


 1. Population (situation)
 2. Intervention (exposure)
 3. Comparison (other group)
 4. Outcomes
 5. Setting
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)
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.
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
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
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)
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
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
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
Questions?
Contact Us
info@healthevidence.org

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School and community social influence programming for preventing tobacco and drug use: Evidence and implications for Public Health

  • 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 You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  • 2. Participant Side Panel in WebEx Housekeeping Use Q&A to post comments/questions during the webinar •‘Send’ questions to All (not privately to ‘Host’) Connection issues •Recommend using a wired Internet connection (vs. wireless), to help Q&A prevent connection challenges  WebEx 24/7 help line: 1-866-229-3239
  • 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
  • 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