An overview of the Unplugged evaluation results. ADEPIS seminar series - London - 7th July 2015.

1. Peer van der Kreeft
University College Ghent, Belgium
For Mentor –ADEPIS seminar “Unplugged: Life-skills for thriving youth”
CAYT Centre for Analysis of Youth Services
The City Centre Conference Room, Guildhal, London July 7th 2015
Effectiveness study
Mediators to Effect

2. 2
2
Researchers meet practicioners
RCT Randomized
Controlled Trial
7.079 pupils
143 schools
7 EU countries
°2002
29 countries
°2015

3. 3
Brasil
Nigeria
Pakistan
United
Kingdom

4. 4
The study sample
at baseline (n=7079) RCT °2004
CENTRE # STUDENTS MEDIAN AGE
Italy Turin 1.660 14
Spain Bilbao 429 14
Italy Novara 592 14
Germany Kiel 709 13
Sweden Stockholm 1.033 13
Italy L’Aquila 732 13
Belgium Gent 858 12
Greece Thessaloniki 516 12
Austria Vienna 550 12
°Faggiano et al, Preventive Medicine 2008

5. 5
Effectivity 3 mths post
Daily smoking 30% reduction
Recent drunkenness 28% reduction
Experimenting cannabis 23% reduction
has a preventive effect on early onset of drug use and
on the transition of experimental to frequent use. The
effect is bigger for boys than for girls.
www.eudap.net
°Faggiano et al, Preventive Medicine 2008

6. 6
Daily smoking
°Faggiano et al, Drug and Alcohol Dependence 2010

7. 7
Any drunkenness
°Faggiano et al, Drug and Alcohol Dependence 2010

8. 8
Any cannabis
°Faggiano et al, Drug and Alcohol Dependence 2010

9. Adiktologie Czech Rep. results -
effect on longer term
°Miovski et al, Prevention Science 2015

10. Universal prevention: for everyone?
Adiktologie: Yes
Effect of Unplugged is the same for pupils with
different profiles (characteristics, relation to mother, school
grades, ….)
°Miovski et al, Prevention Science 2015

11. Is Unplugged also effective for pupils
with low SES social economical status?
Karolinska Institute Sweden further
analysed data from RCT °2004:
Stronger effects in underprivileged schools on
frequency of drinking
°Caria et al, Biomed Central 2011

12. Table 2. Post-test Differences in Prevalence of
use (last 30 days) Low to High area SES
Controls Interventions
ALO smoking +6.3% +5.0%
Daily smoking +4.9% +7.0%
ALO drunkenness +5.1% +2.7%
Regular drunkenness +2.9% +1.6%
ALO cannabis +0.5% -0.9%
Regular cannabis +0.3% +0.1%
ALO drugs +0.2% +0.1%
* ALO: At Least Once in the last 30 days
Is Unplugged also effective for pupils
with low SES social economical status?
OED Torino University: the inequality of low to
high SES drug use decreased after Unplugged
°Vigna-Taglianti et al, SPR Society Prevention Research poster 2007

13. Gender difference
°Vigna-Taglianti et al, Jounal for Epidem. Community Health 2009
OED Torino University: less effective for girls
Further analysed to explain: Unplugged low on
self-esteem, high on social influence
developmental factors

14. 14
Not only effective but also safe:
have lowest iatrogenic effects.
Iatrogenic effects:e.g. inadequate
information, wrong target group,
norm narrowing, facilitating
access. In the EU-DAP no
iatrogenic effects were detected.

15. The Theoretical Model of Unplugged and the mediating
factors:
“Effective: great! But what is the
mechanism to result?
Based on an article accepted for publication in Journal of Adolescent
Health 2014: Short-term mediating factors of a school-based
intervention to prevent youth substance use in Europe, Giannotta F,
Vigna-Taglianti FD, Galanti MR, Scatigna M, Faggiano F, and the EU-Dap Study Group.

16. The theoretical model of Unplugged

17. The theoretical model of Unplugged
Unplugged
Knowledge on drugs
Risk perception
Intentions Use
Attitudes
Normative beliefs
Perceived use
Perceived acceptance
Peer’s pressure
Problem behaviour
Jessor & Jessor 1977
Social learning
Bandura 1960
Health Belief
Rosenstock 1950
Social Norms
Perkins 1986
Reasoned action-attitude
Fishbein & Ajsen 1980
Skills
Critical thinking
Creative thinking
Relationship skills
Communication skills
Assertiveness
Refusal skills
Managing emotions
Coping
Empathy
Problem solving
Decision making

18. Social Learning
Social Norms
Health Belief
Reasoned Action-Attitude and Planned Behaviour
Problem Behaviour
Unplugged
Knowledge on drugs
Risk perception
Intentions Use
Attitudes
Normative beliefs
Perceived use
Perceived acceptance
Peer’s pressure
Problem behaviour
Jessor & Jessor 1977
Social learning
Bandura 1960
Health Belief
Rosenstock 1950
Social Norms
Perkins 1986
Reasoned action-attitude
Fishbein & Ajsen 1980
Skills
Critical thinking
Creative thinking
Relationship skills
Communication skills
Assertiveness
Refusal skills
Managing emotions
Coping
Empathy
Problem solving
Decision making
Bandura °60
SOCIAL LEARNING THEORY
personality formed by
observing, imitation, modeling
contrary to “trial and error or
punish and reward lead to new
behavior”
Learning does not lead to
prompt behavior change, but
to cognitive change that can
activate observed behavior

19. Social Learning
Social Norms
Health Belief
Reasoned Action-Attitude and Planned Behaviour
Problem Behaviour
Unplugged
Knowledge on drugs
Risk perception
Intentions Use
Attitudes
Normative beliefs
Perceived use
Perceived acceptance
Peer’s pressure
Problem behaviour
Jessor & Jessor 1977
Social learning
Bandura 1960
Health Belief
Rosenstock 1950
Social Norms
Perkins 1986
Reasoned action-attitude
Fishbein & Ajsen 1980
Skills
Critical thinking
Creative thinking
Relationship skills
Communication skills
Assertiveness
Refusal skills
Managing emotions
Coping
Empathy
Problem solving
Decision making
Jessor and Jessor °77
PROBLEM BEHAVIOR THEORY
A problem is what is socially defined as
a concern
cf Kurt Lewin field theory: my behavior
is function of me in the environment
My risk - protection balance includes:
Psychosocial (value, expectation)
Environmental (perceived from others)
Behavior structures (alco  smoke)

20. Social Learning
Social Norms
Health Belief
Reasoned Action-Attitude and Planned Behaviour
Problem Behaviour
Unplugged
Knowledge on drugs
Risk perception
Intentions Use
Attitudes
Normative beliefs
Perceived use
Perceived acceptance
Peer’s pressure
Problem behaviour
Jessor & Jessor 1977
Social learning
Bandura 1960
Health Belief
Rosenstock 1950
Social Norms
Perkins 1986
Reasoned action-attitude
Fishbein & Ajsen 1980
Skills
Critical thinking
Creative thinking
Relationship skills
Communication skills
Assertiveness
Refusal skills
Managing emotions
Coping
Empathy
Problem solving
Decision making
Perkins °86
SOCIAL NORMS THEORY
Overestimated perception of behavior
contrary to fear based

21. Social Learning
Social Norms
Health Belief
Reasoned Action-Attitude and Planned Behaviour
Problem Behaviour
Unplugged
Knowledge on drugs
Risk perception
Intentions Use
Attitudes
Normative beliefs
Perceived use
Perceived acceptance
Peer’s pressure
Problem behaviour
Jessor & Jessor 1977
Social learning
Bandura 1960
Health Belief
Rosenstock 1950
Social Norms
Perkins 1986
Reasoned action-attitude
Fishbein & Ajsen 1980
Skills
Critical thinking
Creative thinking
Relationship skills
Communication skills
Assertiveness
Refusal skills
Managing emotions
Coping
Empathy
Problem solving
Decision making
Fishbein & Ajzen °80
THEORY OF REASONED ACTION
I think rationally from information to
awareness to intention to action (= attitude)
based on what I think that others experienced

22. Social Learning
Social Norms
Health Belief
Reasoned Action-Attitude and Planned Behaviour
Problem Behaviour
Unplugged
Knowledge on drugs
Risk perception
Intentions Use
Attitudes
Normative beliefs
Perceived use
Perceived acceptance
Peer’s pressure
Problem behaviour
Jessor & Jessor 1977
Social learning
Bandura 1960
Health Belief
Rosenstock 1950
Social Norms
Perkins 1986
Reasoned action-attitude
Fishbein & Ajsen 1980
Skills
Critical thinking
Creative thinking
Relationship skills
Communication skills
Assertiveness
Refusal skills
Managing emotions
Coping
Empathy
Problem solving
Decision making
Rosenstock °50
HEALTH BELIEF THEORY
My perceived seriousness of health problem,
benefits and self-efficacy determine my
engagement in health promotion
Perceived information risk estimation

23. Theories behind the program Example how this is present in Unplugged
Social learning theory: you learn observational,
by looking how someone else does something and
which consequences he experiences
# all: interactive small groups confront
pupils with experiences and examples of
classmates
Social norms theory: you do what you are
suppose that others do and expect from you
# 2, 4, 5, 9: information issues in the quiz
deal with correcting wrong suppositions
Health belief model: your health is determined
by your estimation of the consequences of what
you do and of the seriousness score you give
# 2: exercises about risks deal with where
you get information and how you
estimate your risks
Theory of planned behaviour: your intention is
the best predictor of your actions
#11, 12: how does your information lead
to intention
Theory of problem behaviour: what you do
becomes problematic if it is socially undesired
# 3: a lesson on alcohol distinguishes
personal, physical and social risks

24. Social Learning
Social Norms
Health Belief
Reasoned Action-Attitude and Planned Behaviour
Problem Behaviour
group and protection
Unit 4: your beliefs, norms
and information - do they
reflect reality?
Unit 5: smoking the cigarette
drug: inform yourself
Unit 6: express yourself
Unit 7: get up, stand up Unit 8: party tiger Unit 9: drugs - get informe
Unit 10: coping competencies Unit 11: problem solving and
decision making
Unit 12: goal setting
1 opening 2 group 3 alcohol
4 reality 5 smoke 6 express
7 assertive 8 contact 9 drugs
10 coping 11 problems 12 goals
Theories:
how much
present in a
lesson?

25. 1opening
2 group
3 risks
4 reality
5 smoke
6 express
7 assertive
9 drugs
8 contact
10 coping
11 problem
12 goals
Lessons linked to mediators

26. Mediators measured to prove which ones lead to effect
Positive attitude towards drugs
Negative attitude
Positive beliefs
Negative beliefs
Knowledge
Perception of number of user friends
Refusal skills
Perception of positive class climate

27. Effectiveness on mediators
Path a Path bMediator
β (S.E.) p value β (S.E.) p valu
Youth cigarettes use in the past 30 days
Positive attitudes towards drugs -.041 (.020) .038 .075 (.014) .000
Negative attitudes towards drugs - n.s. .025 (.011) .022
Positive beliefs tobacco -.044 (.021) .034 - n.s.
Negative beliefs tobacco -.029 (.017) .086 - n.s.
Knowledge about tobacco .049 (.021) .022 - n.s.
Refusal skills tobacco -.030 (.015) .040 .280 (.016) .000
Perception of number of smokers friends -.051 (.020) .010 .071 (.009) .000
Perception of positive class climate -.047 (.021) .022 - n.s.
Youth’s ever being drunk
Positive attitudes towards drugs -.040 (.019) .036 .126 (.017) .000
Negative attitudes towards drugs - n.s. .027 (.015) .078
Positive beliefs alcohol -.038 (.018) .040 .037 (.012) .002
Negative beliefs alcohol - n.s. .069 (.014) .000
Knowledge about alcohol .153 (.017) .000 - n.s.
Refusal skills alcohol -.032 (.018) .072 .151 (.016) .000
Perception of number of drunk friends - n.s. .067 (.010) .000
Perception of positive class climate -.047 (.021) .022 .022 (.010) .034
Youth’s ever use of cannabis
Positive attitudes towards drugs -.041 (.021) .044 .121 (.016) .000
Negative attitudes towards drugs - n.s. .042 (.012) .000
Positive beliefs cannabis -.050 (.019) .006 - n.s.
Negative beliefs cannabis - n.s. .044 (.012) .000
Knowledge about cannabis .137 (.022) .000 - n.s.
Refusal skills cannabis -.033 (.019) .074 .180 (.016) .000
Perception of number of users friends -.042 (.020) .034 .048 (.008) .000
Perception of positive class climate -.048 (.021) .022 - n.s.

28. Gregor Burkhart - EMCDDA / OEDT -
28
Mediators in EU-DAP (www.eudap.net)
Cannabis (LTP) OR
.77
Regular drunkenness
OR .69
Daily smoking
OR .7
Normative Beliefs ↓ Refusal skills↑Positive attitude
to illicit drugs ↓

29. Mediators with a proven lead to effect:
Positive attitude towards drugs
Perception of number of user friends
Refusal skills
Other mediators in Unplugged measured:
Negative attitude towards drugs
Positive beliefs
Negative beliefs
Knowledge
Perception of positive class climate

30. 30
another way to look at the results
40
One case
You deliver Unplugged to... To avoid...
35
31
82
98
60
Thinking in HEALTH ECONOMY terms…

31. 31
Small comparison
128 One case
blood pressure fatality
You deliver special
medication to... To avoid...
Thinking in HEALTH ECONOMY terms…

32. 32
One case
breast cancer fatality
You deliver mammographic
screening for 10 years to... To avoid...
Sackett DL, Haynes RB: Summarizing the effects of therapy:
A new table and some more terms. Evidence-Based
Medicine1997;2:103-104
Gøtzsche PC, Nielsen M. Screening for breast cancer with
mammography. Cochrane Database of Systematic Reviews
2006, Issue 4. Art. No.: CD001877. DOI:
10.1002/14651858.CD001877.pub2
Small comparison

33. 33
40
One case
You deliver Unplugged to... To avoid...
35
31
82
98
60
Thinking in HEALTH ECONOMY terms…

34. Evidence based prevention

35. So… if implementing Unplugged or
similar programmes
• Take care of process evaluation
• Monitor your intervention on
regional/school/class level
• Connect to the EU-Dap network for
further analyses
• Keep updated of the published studies’ results

36. Thank you
EU-Dap study group
www.eudap.net
peer.vanderkreeft@hogent.be