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

2. 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

3. 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

4. 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

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

6. 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
Criminal Acts
707 Other Offences

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

8. Substance use …
44% highschool children regularly or occasionally consume alcohol
51-64 % 2nd grade students engage in ” Binge drinking” – ESPAD 2007
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

9. 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

10. Based on

11. Based on

12. Possible solutions 1
Based on

13. 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 !

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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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

22. 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

23. 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

24. 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

25. Evaluation...

26. Evaluation...

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

28. 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

30. 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