Health promotion and drug prevention within the public health system Public Health Institute of Primorsko-goranska county Krešimirova 52A, 51 000 Rijeka Health promotion and drug prevention within the public health system …evidence based approach Darko Roviš, prof.

Public Health Institute Actively working in health promotion since 1905 Departments: Social medicine Health ecology Epidemiology Microbiology School and university medicine Drug prevention and outpatient treatment

Department for Drug prevention and outpatient treatment Office for Drug prevention Office for Outpatient treatment Health promotion and drug prevention programs: Universal Selective Indicative Outpatient treatment: Drug free approach Maintainence Detox program Specific drug treatment: Psychotherapy in penal system Family support groups Community involvement Drug prevention committees Healthy cities University programs

Office for Drug prevention Fiorello la guardie 23, Rijeka Team of Two psychologists, defectologist, and teacher Formed in 2005. Health promotion and drug prevention: Life Skills Taining Ready- Steady-Healthy Youth Counselling Bulletin – Rizik

Drug abuse and addiction - Major and still rising problem for Croatia - Drug rate of 250 /100 000 population - EU countries 200-800 / 100 000 population Total number of addict Opiate addict New addict New opiate addict

Drug abuse and adiction in Rijeka county TREATED DRUG ADDICT 1995. year– 17 addict 1996. year– 115 addict 2001. year– 649 addict 2004. year– 460 addict 2006. year– 634 addict 2007. year– 666 addict 1 148 Criminal Acts 707 Other Offences

Why do we talk of addicts when we are discussing children ?

Substance use … 44% highschool children regularly or occasionally consume alcohol 51-64 % 2nd grade students engage in ” Binge drinking” – ESPAD 2007 2002. - 50 interventions of ER service Drinking 10 times or often (last 30 day) 1st and 2nd grade students 1/3 tried marihuana more than once 25-40 % smokes often Majority thinks it is “normal” to drink and smoke

Starting from early age… First time hard liker? Research on 8th grade PGZ bullying, gambling Up to 20 % of children low self-esteem ½ exposed to social violence 12-25% peer rejection ½ go out where other are smoking, drinking drug using Fammily and school communication poor Prevention in lower elementary school grades

Based on

Based on

Possible solutions 1 Based on

How to direct our efforts to produce wanted effect How to direct our efforts to produce wanted effect ? Less mental & behavioural problems and drug abuse in communities and the population !

Evidence based evidence-based research-based science-based blueprint programs model programs promising programs effective programs

Science based programs Based on evidence, Tested in practice Methodologically clear design Significant reduction of negative outcomes and related risks Based on theory Detail evaluated

Evidence based aproach in Rijeka High quality implementation of best evidence based model programs. Careful pilot program design following the principles of effectiveness Quasi experimental evaluation design

Principles of effectiveness Comprehensiveness Variety of teaching methods Sufficient lasting Theory based Building positive, strong and stabile relationships Time Following developmental psychopathology Social-cultural appropriateness Evaluation Education

Developing a prevention model on a community level Package of multiple interventions that target Children in different age groups Children, families, social network, community Risk and protective factors Common and disorder-specific factors Use of variety of intervention methods Building evidence-based interventions

Support group in Penal system Narodni Zdravstveni List Prevention programs at PHI Youth Counseling Life Skills Training Ready Steady Health Bulletin RIzik Family self help group Support group in Penal system Health youth Narodni Zdravstveni List Educating Educators Junior in the house

LIFE SKILLS TRAINING 2005/06 - 31 school - 1657 students 2006/07 - 150 assistants 3168 students 2007/08 - 39š school 165 assistants 3427 students 2008/09 44 school 180 assistants over 3500 students Series of workshops for 6th and 7th grade Pilot program for 3rd and 4th garde

Life Skills Training (Dr.Gilbert J. Botvin) Universal prevention level (smoking, alcohol, drugs, violence) Evidence based Experience in implementation and evaluation (SAD, EU, Australia) Based on theory (Risk reduction model) Aim: reduce the increase in substance use in adolescents Risk factors Early first contact with cigarettes, alcohol, drugs Lack of self-control Poor assertiveness Protective factors High Sef-esteem Good social and communication skills Good decision making skills Good problem solving skills assertivness Coping with stress and anxiety, Goal setting Resistance to peer pressure

Self image and self esteem Workshops Self image and self esteem Decision making Smoking Alcohol Marihuana Media Anxious emotions Facing anger Communication skills Social skills Asertivness Conflict resolution

Activities in 2007/08 MATERIALS Prepared and printed materials for 6th and 7th grade Student manual for 6th grade Teacher manual for 6th grade Student manual for 7th grade Teacher manual for 7th grade Student questioners Evaluation forms for teachers

Activities in 2007/08 EVALUATION AND SUPEVISION EDUCATION Pre-test Post-test Evaluation forms filled after each workshop Supervision workshop in February 2008 EDUCATION 2 X two day education for teachers and school coordinators October 2008 February 2009

Evaluation...

Evaluation...

Evaluation... Reduction higher than 50 % Evidence that program WORKS Corresponds to results form USA,EU Troubles for the firs generation

Life Skills Training 4 Rijeka school + 1 County school … for 3rd and 4th grade (8-9 years) 4 Rijeka school + 1 County school Total: 300 učenika Piloting for two years 8 workshops held 1 x month Sef-esteem Decision making Smoking Media advertisement Coping with stress Communication skills Social skills Assertivens

Ready Steady Healthy Themes Pilot program u 2007/08 based on risk reduction model 5 workshops with 8th graders (14 years) Evaluation questionery Scholl staff + parents engagement Deliver the program to school services Themes Adolescence Coping skills Drugs –one way street Peer pressure Health lifestyles