To keep youngsters off drugs?
to feel good, rather than by using alcohol and drugs — and children from low-income families received help to take part. In Reykjavik, for instance, where more than a third of the country’s population lives, a Leisure Card gives families 35000 krona (£250) a year for each child to pay for recreational activities.
Crucially, the surveys have continued. Each year, almost every child in Iceland completes one. This means up-to-date, reliable data is always available.
Between 1997 and 2012, the percentage of children aged 15 and 16 who reported often, or almost always, spending time with their parents on weekdays doubled — from 23% to 46% — and the percentage who participated in organised sports at least four times a week increased from 24% to 42%. Meanwhile, cigarette smoking, drinking and cannabis use in this age group plummeted.
“Although this cannot be shown in the form of a causal relationship — which is a good example of why primary prevention methods are sometimes hard to sell to scientists — the trend is very clear,” notes Álfgeir Kristjánsson, who worked on the data and is now at the West Virginia University School of Public Health in the US. “Protective factors have gone up, risk factors down, and substance use has gone down — and more consistently in Iceland than in any other European country.”
Jón Sigfússon apologises for being just a few minutes late. “I was on a crisis call!” He prefers not to say precisely to where, but it was to one of the cities elsewhere in the world that has now adopted, in part, the Youth in Iceland ideas.
Youth in Europe, which Jón heads, began in 2006 after the already remarkable Icelandic data was presented at a European Cities Against Drugs meeting and, he recalls, “People asked: what are you doing?”
Participation in Youth in Europe is at a municipal level rather than being led by national governments.
In the first year, there were eight municipalities. To date, 35 have taken part, across 17 countries, varying from some areas where just a few schools take part to Tarragona in Spain — where 4 200 15-year-olds are involved. The method is always the same: Jón and his team talk to local officials and devise a questionnaire with the same core questions as those used in Iceland, plus any locally tailored extras. For example, online gambling has recently emerged as a problem in some areas, and local officials want to know if it’s linked to other risky behaviour.
Just two months after the questionnaires are returned, the team sends back an initial report with the results, plus information on how they compare with other participating regions. “We always say that, like vegetables, information has to be fresh,” says Jón. “If you bring these findings a year later, people would say, ‘Oh, this was a long time ago and maybe things have changed …’”
The team has analysed 99 000 questionnaires from places as far afield as the Faroe Islands, Malta and Romania, as well as South Korea and, very recently, Kenya and Guinea-Bissau. Broadly, the results show that, when it comes to teen substance use, the same protective and risk factors identified in Iceland apply everywhere.
There are some differences; in one country, participation in organised sport actually emerged as a risk factor. Further investigation revealed that this was because young ex-military men — keen on muscle-building drugs, drinking and smoking — were running the clubs. Here, then, was a well-defined, immediate, local problem that could be addressed.
Although Jón and his team offer advice and information on what has been found to work in Iceland, it’s up to individual communities to decide what to do in the light of their results. In some cities — such as the origin of Jón’s “crisis call” — there is an openness to the data and there is money, but he has observed that it can be much more difficult to secure and maintain funding for health prevention strategies than for treatment.
No other country has made changes on the scale seen in Iceland. When asked whether anyone has copied the laws to keep children indoors in the evening, Jón smiles. “Even Sweden laughs and calls it the child curfew!”
Across Europe, rates of teen alcohol and drug use have generally improved over the past 20 years, though nowhere as dramatically as in Iceland, and the reasons for improvements are not necessarily linked to strategies that foster teen wellbeing. In the United Kingdom, for example, the fact that teens are now spending more time at home interacting online could be one of the major reasons for the drop in alcohol consumption.
But Kaunas, in Lithuania, is one example of what can happen through active intervention. Since 2006, the city has administered the questionnaires five times, and schools, parents, healthcare organisations, churches, the police and social services have come together to try to improve children’s wellbeing and curb substance use. For instance, parents get eight or nine free parenting sessions each year. In 2015, the city started offering free sports activities on Mondays, Wednesdays and Fridays, and there are plans to introduce a free ride service for lowincome families, to help children who don’t live near facilities.
Between 2006 and 2014, the number of 15- and 16-year-olds in Kaunas who reported getting drunk in the past 30 days fell by about a quarter, and daily smoking fell by more than 30%.
At the moment, participation in Youth in Europe is haphazard, and the team in Iceland is small. Jón would like to see a centralised body with its own dedicated funding to focus on its expansion. “Even though we have been doing this for 10 years, it is not our full, main job. We would like somebody to copy this and maintain it all over Europe,” he says. “And why only Europe?”
Data from other parts of Europe — including cities such as Bucharest with major social problems and relative poverty — shows that the Icelandic model can work in very different cultures, Milkman argues.
In the US, the need for similar programmes is high: underage drinking accounts for 11% of all alcohol consumed nationwide, and excessive drinking causes more than 4300 deaths among under-21-yearolds every year. But a national programme along the lines of Youth in Iceland is unlikely to be introduced in the US.
One major obstacle is that, whereas in Iceland there is longterm commitment to the national project, community health programmes in the US are usually only funded short-term.
Short-termism also impedes effective prevention strategies in the UK, says Michael O’Toole, chief executive of Mentor, a charity that works to reduce alcohol and drug misuse in children and young people.
Here, too, there is no national coordinated alcohol and drug prevention programme. It’s generally left to local authorities or to schools, which can often mean children are simply given information about the dangers of drugs and alcohol — a strategy that, he agrees, evidence shows does not work.
O’Toole fully endorses the Icelandic focus on parents, school and the community all coming together to support children, and on parents or carers being engaged in young people’s lives.
Improving support for children could help in so many ways, he stresses. Even just with alcohol and smoking, there is plenty of data to show that the older a child is when they have their first drink or cigarette, the healthier they will be over the course of their life.
But not all the strategies would be acceptable in the UK — the child curfews being one, parental walks around neighbourhoods to identify children breaking the rules perhaps another.
And a trial run by Mentor in Brighton that involved inviting parents into schools for workshops found that it was difficult to get them engaged.
Public wariness and an unwillingness to engage will be challenges wherever the Icelandic methods are proposed, thinks Milkman, and go to the heart of the balance of responsibility between states and citizens.
“How much control do you want the government to have over what happens with your children? Is this too much of the government meddling in how people live their lives?”
In Iceland, the relationship between people and the state has allowed an effective national programme to cut the rates of teenagers smoking and drinking to excess — and, in the process, brought families closer and helped children to become healthier in all kinds of ways.
Will no other country decide these benefits are worth the costs?
A law was passed prohibiting children aged between 13 and 16 from being outside after
10pm in winter and midnight in summer
Model city: Iceland’s capital Reykjavik lured teenagers away from drugs and alcohol with an old-fashioned mix of present parenting and afterschool activities. Photo: Stoyan Nenov/Reuters