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Evidence Base for Drug Prevention Service Gaps in Rural Areas Professor Mark Bellis Dr Harry Sumnall Yuko M c Grath Karen Hughes Centre for Public Health.

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Presentation on theme: "Evidence Base for Drug Prevention Service Gaps in Rural Areas Professor Mark Bellis Dr Harry Sumnall Yuko M c Grath Karen Hughes Centre for Public Health."— Presentation transcript:

1 Evidence Base for Drug Prevention Service Gaps in Rural Areas Professor Mark Bellis Dr Harry Sumnall Yuko M c Grath Karen Hughes Centre for Public Health

2 Brief Overview Drug Use in England and Wales –Recreational –Problematic Some Rural Issues in Drug Use Rural Issues in Drug Prevention Evidence Base to date from the HDA Collaborating Centre for Drug Prevention Centre for Public Health

3 Prevalence of Drug Use in the Last Year among the General Population Estimated number of users (16-59) Thousands 3,357613486642 63 45 Centre for Public Health British Crime Survey 2003 Over 1 in 4 (16-24) used drugs in last year Around 50% of population ever used illegal drugs

4 Source: ESPAD survey of 15-16 year olds(1999) Levels of lifetime use of any illegal drugs: UK vs Europe (36% vs 16%) School use of Drugs Comparison between UK and Europe Centre for Public Health

5 BCS 2000; Deehan and Saville 2004; O’Hagan 2000 Lifetime Drug Use among Young People General Population, Club Goers and Techno-Club Goers Centre for Public Health

6 Frischer et al, 2004, Hickman et al, 2004 Estimated Prevalence of Problematic Drug Use Problematic drug use –0.6% Total population –0.9% 15-64 Year olds Injecting drug use –0.2% Total population –0.3% for 15- 64 Year olds Locality Estimates (Injecting, 15-44 Year olds) –Brighton2.0% –Liverpool1.5% –London 1.2% Centre for Public Health

7 Rates/100,000 Numbers Centre for Public Health Estimated rates and numbers of Problematic Drug Use per 100,000 population for English DATs (2001) Frischer et al 2004 Estimates are generally based on urban studies and relatively little is known about levels in rural communities

8 Drug Prevention is a mechanism for reducing Inequalities and Social Exclusion The effects it has on these issues should help prioritise action

9 Bundles of Rural Disadvantage Employment –Access –Quality –Vulnerability –Low incomes Environment –Housing unaffordable Transport –Poor –Expensive Definition of Rurality unclear ~ 28% of UK population Standards generally –Better health –Higher educational qualifications –Incomes higher Deprivation –1 in 4 living in low income –Dispersed Centre for Public Health

10 Characteristics of Rural Drug Use National Surveys too small to measure local variation Research data: –Use follows National trends –Cannabis and amphetamine available and cheaper –Access to magic (psilocybin) mushrooms and veterinary drugs (e.g. ketamine) Increasing Nationally –Varies between villages and proximity to urban centres –Dance Drugs availability depends upon cultural participation Increased with mobility and youth culture Centre for Public Health

11 McVeigh et al, 2003 Mean year of First Use of Crack NW National Drug Treatment Monitoring System Centre for Public Health

12 Drugs Use by Drug Treatment Clients by PCT NW National Drug Treatment Monitoring System Centre for Public Health McVeigh et al, 2003

13 Have a Party in the Country “Imagine being shacked up in a remote setting, with all your mates, a thumping sound system and a stash of stimulants. The worst that can happen is that you tread in a freshly-laid cow pat”

14 Tourism and Festivals Glastonbury –Three days –140,000 people (official only) –Reported drug offences – 85 –2C-i –65 (largest seizure) –4,000 tickets for locals BBC 15 th August 2004 –Thousands at illegal parties –Neighbours Complain Exposure to Drug Culture –Festivals –Tourism –Holiday Work

15 "I was on E for 2 weeks. On the way back I couldn't find words for things I saw or type on my phone." Dutch Person returning from Spain (IREFREA) Centre for Public Health Frequency of Ecstasy Use in UK and Ibiza (1999 & 2002 Users only)

16 Hughes et al, 2004; Hennink et al 1999 Seasonal staff in Holiday Resorts Drug use among British Casual workers in Bars and Clubs in Ibiza Seasonal workers Abroad see increased drug and sexual activity Seasonal workers in UK holiday centres see significant increases in sexual activity whilst at holiday centre Initiation into Drug Use Centre for Public Health

17 Casual Workers are ideally placed to influence holidaymakers Health messages should target Casual Workers Centre for Public Health Ecstasy use - Casual Workers vs. Holidaymakers

18 Drug Prevention “Speak to someone you trust, who knows about drugs, whenever you feel you need to speak to them” Centre for Public Health

19 Rural Goldfish Bowl Access to Services –High Visibility –Low Confidentiality –Low Confidence – High Self Reliance Community Involvement –Everyone Knows Distant Services –Difficult to Access Deprivation Dispersed Generation Gap Bubble –Schools –Media –Community

20 Rural Drug Use – Added Impact Urban schools –Higher deprivation, lower achievement but –Not reflected in life-time drug use Rural heroin users –Higher injecting Health Service –Non Specialist – Limited Options (Stimulants) –Staff recruitment poor but wide skills required –Isolated Services and Workers (Progress) –Variation in Services (Syringe Exchange) (Forsyth & Barnard, 1999) Centre for Public Health

21 Major Review

22 (Category 1 White & Pitts, 1998) Evidence Base for School Based Prevention School based drugs education accounts for 0.14% of the variance in drug use –i.e. 3.7% of young people who would use drugs delay onset or never use Methodologically strongest –alcohol, tobacco and cannabis Targeting hard to reach – Poorly evaluated – Need peer recruitment and outreach (Rural Issue) Centre for Public Health

23 Best Evidence for Drug Prevention Interactive Teaching Techniques –Facilitators- training/support from programme developers Rural – initial support difficult Positive effects Short Lived –Decline with time without booster sessions Rural - continued support stretched Multiple Joined up components for health education –Involve schools, communities, health initiatives, media, and take into account cultural sensitivities Rural - may be better as community often better integrated? Parish councils, local business involvement, District councils, Countryside Agency Generational Bubble and Communications Issues Health Development Agency - Canning et al., 2004 Centre for Public Health


25 Countryside Agency, 2003 BT exchanges ADSL enabled, August 2004 Internet Access Availability of affordable rural broadband (2003): –Urban population: 95% –Rural villages: 7% –Remote rural areas: 1% Regular personal internet use: –Urban areas: 47% –Rural areas: 45% –Deprivation Gradient Television Coverage

26 Qualities of Best Programmes Young People’s Perspective –Including the most marginalized - Dispersed –Ways back when off track – Special Support Planned, focused and persistent –Early intervention, intensive, sustained –Long term management difficult Understanding risk and protective factors –Why start, What stops some, How some exit –Poor Local Research Use data and local knowledge –Target action and monitor their success –University Support Coomber et al., in press Centre for Public Health

27 Quarterly Report April to September 2004 rapid summary report on effective drug prevention evidence Yuko M c Grath  Dr Harry Sumnall Professor Mark Bellis Contact NCCDP, Centre for Public Health, Liverpool JMU, 8 Marybone, Liverpool, L3 2AP 0151 231 5818 Technical Updates Generic Communications

28 Collaborating Centre for Drug Prevention Information Service –Provides answers to questions on drug prevention evidence base –Frequently Asked Questions System –National 2005 Effective Action Briefing –Evidence into Action –May 2005

29 Summary Missing –Scale and Nature of Rural Drug Use Very Large and Dispersed Could glean some picture from National Data –Likely to be changing rapidly Internet, Parties, Tourism May even lead in some recreational areas Problematic –Tendency to follow urban but little use made –NDTMS routinely examine this Goldfish Bowl –Kept out – Generic National messages? –Isolated within Drug Users Service Access & Confidentiality Movement to distant services difficult Centre for Public Health

30 Summary Prevention Issues –School Services Specialist Support – Training, Availability and Sustainability Generation Difference – Better understood –Other Prevention Stimulant services poor even in urban areas Syringe Exchange needed and cost effective Long Term Management an issue with individuals multi-tasking Rural Possibilities –Good Community Development –Link Media, School, Police, Council, Parish, DAAT –Peer-led and social/familial work effective and suited to rural setting –Mobile Services and Support needs examining Centre for Public Health

31 National Collaborating Centre for Drug Prevention Centre for Public Health Marybone 8, Liverpool JMU, Liverpool L3 2AP UK Professor Mark Bellis

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