To keep young­sters off drugs?

Mail & Guardian - - Health -

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

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