There has been a general increase in substance use and associated problems among adolescents in this country in recent years. Various government and non-government organizations are being pressed to respond with effective solutions. This compendium presents evidence-based direction to effective programming for a broad range of prevention activities and should be of interest to educators, community developers, health promoters, law enforcement officers and public health nurses.
The compendium gives attention to prevention issues, principles and programs pertaining to all youth, ranging from mainstream to out-of-the-mainstream, and considers a variety of settings, from schools to street level. While some early childhood initiatives have shown strong preventive effect, they were considered beyond the scope of the investigation. Also, neither tobacco nor performance-enhancing drug use prevention programs were considered unless they reported other substance use results. Finally, policy-focused initiatives were considered only when linked to programming, but were discussed as an important underpinning to the direct service programs presented in this compendium.
Detailed discussion of current drug use patterns of Canadian youth is presented because it is crucial to base program decisions on accurate data. A number of programs that have either shown evidence of effectiveness or show promise are described in detail. To the greatest extent possible, relevant information has been collected from researchers and program sponsors, including aims, intended outcomes, prevention principles emphasized and, whenever possible, cost information. Complete contact information is included for each program.
Each of the programs presented reflects a number of prevention principles; however, it is wise to determine the extent to which programs being considered reflect the principles that are of greatest importance to you, rather than simply adopting a program.
The discussion presented in each section is relatively detailed; however, for those interested in investigating issues further, significant points are supported by cited sources to allow for follow-up.
In the appendix, a checklist is provided to guide an analysis of programs in relation to prevention principles. Also included in the appendix are various tools and resources for those interested in pursuing further research.
Substance use problem prevention:This term is used because it accommodates prevention in two contexts: (a) prevention activities designed to encourage youth not to use, and (b) activities designed to encourage users to avoid high-risk practices that could lead to serious problems or harm.
Youth: For the purposes of this compendium, the population of interest is young people in their teen years. Because psychosocial development is often delayed among high-risk youth, programming for these young people up to approximately age 24 is considered. Prevention necessarily involves a time period prior to the period of interest; consequently, later childhood (ages 7-12) issues are also part of this investigation. Youth are not a homogeneous population. At various points, the compendium accounts for distinctions between sub-populations of youth based on gender, urban-rural differences, level of risk, cultural background and stage of psychosocial development.
Universal, selective and indicated prevention: In this compendium, these terms replace the terms, primary and secondary prevention (tertiary prevention refers to treatment). The model was first described by R. Gordon in 1987 and was adapted by the US Institute of Medicine Committee on the prevention of mental disorders in 1994. It was applied to substance use issues by the National Institute on Drug Abuse in a 1997 publication, "Preventing drug use among children and adolescents: a research-based guide". The terms are more fully discussed in the Prevention principles section.
A key premise of this resource is that prevention activities need to be based on the best available information on the nature and extent of youth substance use problems. Section 2 of the compendium sets the context for later discussion on principles and programs by detailing the current patterns of youth drug use in Canada. The information presented is based on an analysis of the most recent government surveys as well as key journal articles on the epidemiology of youth substance use in Canada. This section will detail information on age of first use, age and gender differences, age of peak use and problems reported from use. The following section shows how this information can guide program development.
Section 3 presents 14 principles that represent a consensus of the project team and steering committee on the most important considerations in developing and implementing youth substance use problem prevention programming. The principles were arrived at through an extensive review of the literature and other consensus-based statements from authoritative bodies.
Whether a programmer is developing a new program, revising an existing one, or considering the purchase of a marketed program, these principles provide sound direction.
This section describes and analyzes 33 programs with a range of aims, target groups and settings that have been shown to be effective through rigorous evaluation. Among the programs presented are eight that focus on the unique needs of injection drug using (IDU) youth. Programs in this section were identified through a process which:
This section presents descriptions of 39 Canadian programs, including eight serving IDU youth. Among the programs serving IDU youth are treatment programs that are presented in this Compendium because they are engaged in the prevention of harmful effects associated with injection drug use. Programs in this section were identified through a process which:
Considerable effort went into conducting a broad investigation and adhering to a strict method; however, the following limitations were noted: