Article

Substance use prevention for adolescents: The Icelandic Model

Abstract and Figures

Data from the European School Survey Project on Alcohol and other Drugs have shown that adolescent substance use is a growing problem in western and particularly Eastern European countries. This paper describes the development, implementation and results of the Icelandic Model of Adolescent Substance Use Prevention. The Icelandic Model is a theoretically grounded, evidence-based approach to community adolescent substance use prevention that has grown out of collaboration between policy makers, behavioural scientists, field-based practitioners and community residents in Iceland. The intervention focuses on reducing known risk factors for substance use, while strengthening a broad range of parental, school and community protective factors. Annual cross-sectional surveys demonstrate the impact of the intervention on substance use among the population of 14- to 16-year-old Icelandic adolescents. The annual data from two cohorts of over 7000 adolescents (>81% response rate) show that the proportions of those who reported being drunk during the last 30 days, smoking one cigarette or more per day and having tried hashish once all declined steadily from 1997 to 2007. The proportions of adolescents who reported spending time with their parents and that their parents knew with whom they were spending their time increased substantially. Other community protective factors also showed positive changes. Although these data suggest that this adolescent substance use prevention approach successfully strengthened a broad range of parental, school and community protective factors, the evidence of its impact on reducing substance use needs to be considered in light of the correlational data on which these observations are based.
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Substance use prevention for adolescents: the
Icelandic Model
INGA DO
´RA SIGFU
´SDO
´TTIR1*, THOROLFUR THORLINDSSON2,
A
´LFGEIR LOGI KRISTJA
´NSSON1, KATHLEEN M. ROE3
and JOHN P. ALLEGRANTE1,4,5
1
Centre for Social Research and Analysis, School of Health and Education, Reykjavik University,
Reykjavik, Iceland,
2
Faculty of Social Science, University of Iceland, Institute for Public Health,
Reykjavik, Iceland,
3
Department of Health Science, San Jose State University, San Jose, CA, USA,
4
Department of Health and Behavior Studies, Teachers College, Mailman School of Public Health,
Columbia University, New York, NY, USA and
5
Department of Sociomedical Sciences, Mailman School
of Public Health, Columbia University, New York, NY, USA
*Corresponding author. E-mail: ingadora@ru.is
SUMMARY
Data from the European School Survey Project on
Alcohol and other Drugs have shown that adolescent sub-
stance use is a growing problem in western and particu-
larly Eastern European countries. This paper describes
the development, implementation and results of the
Icelandic Model of Adolescent Substance Use Prevention.
The Icelandic Model is a theoretically grounded, evi-
dence-based approach to community adolescent substance
use prevention that has grown out of collaboration
between policy makers, behavioural scientists, field-based
practitioners and community residents in Iceland. The
intervention focuses on reducing known risk factors for
substance use, while strengthening a broad range of par-
ental, school and community protective factors. Annual
cross-sectional surveys demonstrate the impact of the
intervention on substance use among the population of
14- to 16-year-old Icelandic adolescents. The annual data
from two cohorts of over 7000 adolescents (.81%
response rate) show that the proportions of those who
reported being drunk during the last 30 days, smoking
one cigarette or more per day and having tried hashish
once all declined steadily from 1997 to 2007. The pro-
portions of adolescents who reported spending time with
their parents and that their parents knew with whom they
were spending their time increased substantially. Other
community protective factors also showed positive
changes. Although these data suggest that this adolescent
substance use prevention approach successfully strength-
ened a broad range of parental, school and community
protective factors, the evidence of its impact on reducing
substance use needs to be considered in light of the corre-
lational data on which these observations are based.
Key words: adolescence; intervention; prevention; substance use
INTRODUCTION
During the 1990s and first years of the 21st
century, substance use among 15- and 16-year-old
adolescents increased in many European countries
and in the USA (Bauman and Phongsavan, 1999;
Hibell et al., 2004). In Iceland, a country with a
rather homogeneous population of just over
300 000, substance use among adolescents rose
gradually during the 1990s (Thorlindsson et al.,
1998; Hibell et al., 2004). The proportion of 10th
graders reporting that they smoked cigarettes on a
daily basis increased from 15% to 23% from 1992
to 1998; those admitting that they had ever used
Health Promotion International, Vol. 24 No. 1 #The Author (2008). Published by Oxford University Press. All rights reserved.
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hashish in their lives rose from 7% to 17% during
the same period (Thorlindsson et al., 1998).
A comparative study of 30 European
countries conducted by the European School
Survey Project on Alcohol and other Drugs
(ESPAD) showed that Icelandic adolescents,
along with their Scandinavian peers, consumed
alcohol differently than many other European
teenagers (Hibell et al., 1997). The 1995
ESPAD survey revealed that adolescents in
Iceland and other Nordic countries were more
likely to become drunk than other European
teenagers (see Figure 1). In addition, alcohol-
related accidents or injuries were more common
in Iceland than in most other places in Europe,
with 14% of Icelandic adolescents reporting
having had such an incident (see Figure 2).
These findings show that adolescent substance
use was a problem in western and particularly
Eastern European countries, and especially in
Iceland.
Since these data were collected, Iceland has
seen a steady decline in adolescent substance
use. We believe that the decline is in
large part due to the assiduous efforts by
Icelandic authorities to both reduce risk factors
and strengthen a broad range of parental, school
and community protective factors. The
purpose of this paper is to describe the develop-
ment, implementation and results of the
Icelandic Model of Adolescent Substance Use
Prevention.
BACKGROUND AND REVIEW
OF LITERATURE
In general, affiliations with peer group, family
and the types of recreational activities available
to young people are the strongest predictors of
adolescent substance use and delinquency
(Thorlindsson et al., 1998, 2007; Kristjansson
et al., 2006). The following summarizes what is
known about potential risk factors for adolescent
substance use and informed the theoretical basis
of the intervention approach implemented in
Iceland. These risk factors were identified from a
broad range of risk factors that have been
reviewed in the available international literature;
however, the selection of risk factors we have
reviewed here is not meant to be exhaustive.
Adolescent society
There is a growing body of research that under-
scores the importance of the peer group and the
organization of adolescent leisure activities in
the formation of adolescent society and lifestyle.
Having friends that smoke, drink alcohol and
use hashish or other drugs increases the likeli-
hood of similar behaviours among adolescents
(Thorlindsson et al., 1998; Kristjansson et al.,
2006, 2008). In contrast, very few of the adoles-
cents who report having nearly no friends who
use such substances have tried drugs themselves.
These findings are consistent with an important
Fig. 1: Proportion of European 10th graders who have become drunk 10 times or more during the last 12
months, 1995. Source: Hibell et al. (1997).
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strand of research on delinquency that has been
conducted in numerous countries (Sutherland
and Cressey, 1978; Akers, 1985; Nash et al.,
2005; Palmqvist and Santavirta, 2006).
In recent years, scholars have devoted more
attention to the role of extracurricular activities
in the formation of youth lifestyle and beha-
viour. Numerous studies have revealed that par-
ticipation in supervised youth work and sports
deters adolescent substance use (Thorlindsson
and Vilhjalmsson, 1991; Thorlindsson et al.,
1998; Moore and Werch, 2005; Kristjansson
et al., 2006, 2008; Thorlindsson et al., 2007).
Some scholars have pointed out that supervised
youth work is of special importance because it
provides adolescents with an opportunity for
participation in activities where they can find
interesting things to work at while developing
valuable skills and goals toward which to strive.
Moreover, supervised youth work provides
opportunities through which adolescents can be
reached, influenced and supported in positive
ways (Bourdieu, 1993). This often occurs by
participating in mentorship programs, by place-
ment in a community program, or through
special informal relationships with an adult, a
teacher, or a sports coach (Cullen, 1994).
Family
Parental support, responsible monitoring and
the amount of time spent with children have
long been understood as social assets that
decrease the likelihood of substance use among
adolescents (Thorlindsson and Vilhjalmsson,
1991; Thorlindsson et al., 1998; Kristjansson
et al., 2006; Thorlindsson et al., 2007). Parental
support and monitoring not only directly
decrease the likelihood of substance use, they
also affect friendship choices. Thus, adolescents
who perceive that their parents provide substan-
tial support are less likely to associate with
friends who use drugs, and those who acquire
friends who use drugs are less likely to start
using drugs themselves (Warr, 1993; Thorlinds-
son and Bernburg, 2006). In addition to control
and support, the amount (as opposed to the
quality) of time spent with parents decreases
the likelihood of adolescent substance use.
Moreover, the more time adolescents spend
with their family outside of school, the less
likely they are to use drugs (Thorlindsson et al.,
1998; Kristjansson et al., 2006; Kristjansson,
2007).
Social capital
In schools where parents know the friends of
their adolescent children and develop and main-
tain relationships with the parents of their
children’s friends—a social-capital indicator
known as ‘intergenerational closure’ (Coleman,
1988)—all students benefit from such parent-
to-parent communication, whether their parents
Fig. 2: Proportion of European 10th graders who reported to have had accidents or injuries related to alcohol
use, 1995. Source: Hibell et al. (1997).
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are a part of the parental network or not
(Thorlindsson et al., 2007). Strengthening the
ties between parents and children in the local
community constitutes an important deterrent
to adolescent substance use. Moreover, to the
extent that it is through schools that parents
are most likely to meet and exercise both
direct and indirect control of their children, the
school is an important mediating structure in
building community social capital and enhan-
cing the ties and friendship of peers, the
parents of the peers and peers and their
friends’ parents. Thus, with greater levels of
community social capital, the adolescent is less
likely to begin using substances and engage in
delinquency because the strength of the com-
munity bonds contribute to preventing the
adolescent from engaging in risky behaviour
(Hirchi, 1969).
THE ICELANDIC MODEL
In the context of increasing substance use among
the youth in Iceland, a group of Icelandic social
scientists at the Icelandic Centre for Social
Research and Analysis (ICSRA), a non-profit
research institute in the City of Reykjavik and
now affiliated with Reykjavik University, along
with policy makers and practitioners in the field,
began collaborating in 1990s in an effort to
better understand the societal factors influencing
substance use among adolescents and potential
approaches to prevention. We developed an
evidence-based approach to adolescent substance
use prevention that involved a broad range of
relevant stake holders who worked together on
this community-based, socially embedded and
highly participatory effort.
Community-based approaches to substance
use have yielded mixed results, despite much
attention and funding over the past decade (Saxe
et al., 2006). In developing our approach, we
relied on global research findings, as well as our
own local observations about those individual
and societal factors that contribute to the likeli-
hood of adolescent substance use in Iceland.
Based on the literature, and informed by our
own work, a community-based, bottom-up
approach was designed to deter adolescent sub-
stance use. The emphasis of our approach was on
getting all relevant stake holders to the table to
build a network of support, monitoring and
opportunities for positive youth development at
the local community level. We aimed to demon-
strate that it is possible to develop theory-driven
intervention to promote and facilitate social
capital on the neighbourhood level, in order to
decrease the likelihood of adolescent substance
use by strengthening the supportive role of
parents and schools and the network of opportu-
nities around them.
The prevention model that emerged reflexively
and continuously links national-level data collec-
tion with local-level reflection and action to
increase social capital. The model builds upon
traditional planning models (iterative cycles of
evidence, reflection, action) but with character-
istics inspired by Icelandic spirit and tempera-
ment. In the first step, a coalition of social
scientists and policy makers use of national data
to identify the scope of the problem and the
broad outlines of the approach to be pursued. In
Step 2, action shifts to the local level as team
members ‘hit the road’, discussing the national
data in communities and neighbourhoods
throughout the country. By design, these local-
level discussions are inclusive, mobilizing an ever-
widening group of researchers, policy makers,
practitioners and community members, including
parents, school personnel, sports facilitators, rec-
reational and extracurricular youth workers. Step
3islocal action in multiple sites, informed by the
national data but animated by the uniquely differ-
ent spirit, talents, and imaginations of neighbour-
hoods, towns and regions. Step 4 is integrative
reflection; as local activities are reviewed by par-
ticipants, process and outcome dimensions of the
aggregate activity are explored, and then analyzed
with the new round of national data.
Several characteristics of Icelandic culture
distinguish the model from other planning
approaches. Because of its size and scope,
everything happens quickly in Iceland; indeed,
one full cycle of the iterative model can be com-
pleted in just one year. The model is based on
quick and confident action, fuelled by the
Icelandic values of independence, cooperation
and roles for everyone. Moreover, vertical and
horizontal integration of information, ideas,
activities and analysis is natural and relatively
easy. The result is a model of intervention that
has been grounded in efforts to address adoles-
cent substance abuse but could be applied to a
wide range of emergent health issues.
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METHODS
Data collection
The data used for the annual Icelandic
substance use evaluation is population-based.
The data collection is carried out in the annual
study series, Youth in Iceland. In March of each
year, we conduct population-based surveys
among 9th and 10th graders in all secondary
schools in Iceland. All aspects of data collection
are approved by an Icelandic central human
subjects review committee, require informed
consent and are supervised by the ICSRA.
Teachers at individual school sites supervise the
participation of the students in the study and
administer the survey questionnaire according
to a strict protocol from the ICSRA.
All students complete the questionnaires in
their classrooms. Students are instructed not to
write their names or social security numbers, or
any other identifying information, anywhere on
the questionnaires. They are instructed to com-
plete the entire questionnaire, but to ask for
help if they have any problems or any questions
requiring clarification. Students are asked to
place their completed questionnaire in an envel-
ope provided and seal it before returning the
questionnaire to the supervising teacher. Data
are collected from cohorts of between 3000 and
4000 14- to 16-year-old adolescent respondents,
with a typical response rate of between 81%
and 91% of the Icelandic population in these
age cohorts attending school.
Measures
The YouthinIcelandsurveys are intended to
assess the prevalence of adolescent substance
use. The study questionnaires include the same
set of questions about background factors and
substance use annually. Moreover, every 3 years,
the data collection is more comprehensive and
the questionnaires include new items about
social circumstances and potential risk factors
associated with substance use. Thus, annual
cross-sectional surveys have been used to docu-
ment trends in the social environment that have
been identified through research as potentially
important in understanding and preventing ado-
lescent substance use. The main categories,
along with background factors and rates of sub-
stance use include the following: relationship
with parents and family, friends and peer group
influences, emotional well-being and physical
health status, participation in sports and orga-
nized youth work and school attachment.
Repeated measures were used in the Icelandic
data collection process to assess substance use.
Examples of these measures include ‘How often
have you become drunk during the last 30 days’
and ‘How often, if ever, have you used hashish in
your lifetime.’ Examples of questions that refer to
relationships with significant others include: ‘How
easy or hard would it be to receive caring and
warmth from your parents’ and ‘How many of
our friends smoke cigarettes on a regular bases.’
Finally, participation in extracurricular activities
wasassessed,forexample,bytheresponseto
‘How often do you participate in sports outside
compulsory lessons in school’ and ‘How often do
you engage in organized school work.’
Analyses
As the data we analyzed were population-based,
descriptive statistical analyses (proportions and
measures of central tendency) were conducted
to identify and describe trends in substance use,
by year, over a 10-year period; hence, we do not
report significance tests. In addition, we gener-
ated contingency tables to examine the relation-
ship between selected risk and protective factors
and self-reported adolescent substance use.
RESULTS
Figure 3 shows surveillance data for trends in
substance use, including the proportion of
Icelandic adolescents who reported having
become drunk over the last 30 days, smoking
one cigarette or more per day and having tried
hashish once, between 1997 and 2007. It can be
seen that substance use fell substantially, and to
a large extent consecutively, throughout the
10-year period. The proportion of 10th graders
who reported becoming drunk during the last
30 days decreased from 42% in 1998 to 20% in
2007, which represents over a 50% decrease.
Also, the proportion of 10th graders who
reported smoking cigarettes daily was 23% in
1998 but fell to 10% in 2007, a 58% decrease.
Furthermore, the proportion of adolescents who
had ever used hashish in their lives decreased
from 17% in 1998 to an all-time low of 7% in
2007, representing a 60% decrease. (See
Sigfusdottir et al., 2008, for a recent report of
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trends in prevalence in substance use among
Icelandic adolescents, 1995 2006.).
Our surveillance data are consistent with the
ESPAD data that have been collected on
alcohol consumption and alcohol-related acci-
dents or injuries. Figure 4 shows that the pro-
portion of Icelandic adolescents who reported
having become drunk 10 times or more often
during the last 12 months fell from 21% in 1995
to 14% in 2003. Similarly, although in 1995, 14%
of Icelandic 10th-grade adolescents reported
having alcohol-related accidents or injuries, by
2003 only 4% reported such incidents (see
Figure 5). Moreover, when the proportion of
substance use for nine substance-use behaviours
is compared among 34 other countries
participating in ESPAD for 2003, Icelandic stu-
dents had lower than average rates of substance
use than their counterparts (see Figure 6).
Consistent with our theoretical orientation of
reducing substance use through reducing risk
factors and enhancing protective factors, there
were several interesting changes in both the risk
and protective factors for adolescent substance
use we sought to influence through our commu-
nity mobilization. In 1997, 23% of 10th graders
reported that they often or almost always spent
time with their parents during working days; this
ratio had increased to just over 31% in 2006.
Similarly, the proportion of adolescents claiming
that they had been outside after 10 p.m., four
times or more often during the last week, was
Fig. 4: Proportion of European 10th graders who report having become drunk 10 times or more during the
last 12 months, 2003. Source: Hibell et al. (2004).
Fig. 3: Percentage of self-reported substance use among Icelandic adolescents, by year, between 1997
and 2007.
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36% in 1997, but fell to 30% in 2006.
Moreover, 49% of 10th graders in 1997
reported that their parents monitored with whom
they were spending their time in the evenings
compared with almost 67% in 2006. Thus, both
time spent with parents and parental monitoring
increased substantially during the 10-year period
of our surveillance.
We also observed that 33% of 10th graders
reported in 1997 that they almost never go to
parties compared to over 43% in 2006. Similarly,
29% of youths in this age group claimed that
they almost never spent time downtown during
the evenings in 1997, in contrast to 51% in 2006.
Those reporting participation in organized sports
(with a sports club or a team) four times per week
or more often rose from 24% in 1997 to 30%
in 2006; however, a recent report by Eidsdottir
et al. (2008) notes that over half of Icelandic ado-
lescents are not achieving recommended levels of
participation and that there are differences in par-
ticipation between males and females.
Fig. 5: Proportion of European 10th graders who reported to have had accidents or injuries related to alcohol
use, 2003. Source: Hibell et al. (2004).
Fig. 6: Proportion of substance use for nine substance-use behaviours among Icelandic students compared to
the average use of students in 34 other countries participating in the European School Survey Project on
Alcohol and other Drugs (ESPAD). Source: Hibell et al. (2004).
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DISCUSSION
Substance use among Icelandic adolescents
declined dramatically from 1997 to 2007. This
decline paralleled the broad-scale implemen-
tation of the Icelandic Model of Adolescent
Substance Use Prevention during this 10-year
period, suggesting that the program may have
been instrumental in effectively reducing sub-
stance use by influencing the social circum-
stances of youth in Iceland. There are several
plausible reasons why the Icelandic Model may
have been effective in conferring protection
against substance use.
First, our approach emphasized the importance
of the family in adolescent substance use preven-
tion. This included supporting parents in prevent-
ing unattended parties in the local community,
enforcing curfews and connecting themselves with
school authorities, sports-club officials, and other
youth workers in an organized network of mutual
support. Each local school served the function of
linking these groups together. Thus, we stressed
the importance of building around the individual
by improving his or her social circumstances in
order to positively influence conduct. On the indi-
vidual level, we emphasized the role of parental
support, monitoring and time spent with parents,
and participation in organized youth activities,
such as sports or recreational and extracurricular
programs (Thorlindsson, 1989; Thorlindsson and
Vilhjalmsson, 1991). On the collective level, we
emphasized the importance of improving the local
community by linking parents together through
the school.
Second, in addition to traditional activities
such as attending meetings and participating in
the school’s parents association, new activities
were developed to engage parents. For
example, one popular activity was the parental
prowl in the neighbourhoods. Parental prowl is
a social gathering where parents in a local com-
munity walk around their neighbourhood
together during Friday and Saturday evenings.
This facilitates parents in strengthening their
local ties and getting to know one another,
while at the same time monitoring youth in
their neighbourhoods. It also contributes posi-
tively to the adolescent network and, in effect,
improves neighbourhood social capital, thus
enabling adolescents to become aware of
the supportive structure around them and the
adults to share in their mutual commitment
to their families and their community. A recent
Icelandic study has shown that parental prowl-
ing is beneficial to all youth in the local commu-
nity and not merely the children of the
participating parents (Thorlindsson et al., 2007).
Moreover, parental prowling also contributes
positively to parental engagement with the local
school and increases the likelihood of parents
attending school meetings.
Third, an important strength of our approach
is community visibility and fostering ‘commu-
nity buy-in.’ Representatives from ICSRA give
presentations and interpret each year’s survey
results in local schools and community centres.
This fostered an alliance between the ICSRA,
local schools, parental groups, local authorities
and recreational and extracurricular workers,
with the mutual goal of decreasing the likeli-
hood of adolescent substance use in the com-
munity. Thus, our approach was not a ‘project’
in the usual sense, but rather a consistent and
comprehensive ongoing partnership that sought
to reduce adolescent substance use by getting
guardianship, community attachment and infor-
mal social control on the public agenda. This
approach is similar to other community preven-
tion approaches that have utilized coalitions and
partnerships as vehicles for community action in
reducing adolescent substance use (e.g. see
Aguirre-Molina and Gorman, 1996; Arthur
et al., 2003; Greenberg et al., 2005).
Finally, the small scale of Iceland and relative
homogeneity of its population may have proven
beneficial in the nation-wide implementation
and dissemination of our approach to adolescent
substance use prevention. Moreover, Iceland’s
culture is such that the academic and intellectual
community is not isolated from the rest of the
population; on the contrary, scientific research
has often drawn immediate attention from the
public and from policy makers or interested
stake-holder groups. Mobilizing the community,
indeed the entire nation and its infrastructure,
was thus facilitated by this tradition of integrat-
ing research, policy and practice.
There are, however, several reasons why
caution needs to be exercised in attributing the
observed decline in adolescent substance use
solely to the influence of the Icelandic Model.
First, it is possible that the observed reduction in
substance use was part of a secular trend similar
to that in other countries. For example, there has
been considerable interest in the role of parental
risk factors such as parental monitoring, not only
in Iceland but throughout other Nordic countries,
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which may account for the low rates of alcohol-
related accidents in Norway.
Second, the observed decline in substance use
may have been due, in part, to ecologic factors
other than the intervention that we did not or
could not measure. These could include changes
in overall educational policies at the local level,
changes in youth unemployment and changes in
parental divorce rates, all of which may have
contributed to a secular trend in the reduction
of substance use.
Third, we do not have data on dose effect.
Such data might reveal that the communities in
which greater reductions in risk factors were
achieved also demonstrated greater reductions
in substance use. We are presently designing
studies to examine whether communities that
achieved greater reductions in risk factors and
increases in protective factors showed greater
reductions in substance use.
PRACTICAL IMPLICATIONS AND
LESSONS LEARNED
Several practical implications and lessons learned
are worth noting. First, our experience suggests
that prevention efforts need to simultaneously
activate the peer group, the school, the family and
those who organize youth activities to reduce sub-
stance use. Icelandic adolescents who used drugs
were less strongly attached to their parents and
spent less time with them. Adolescents who used
drugs were also generally more likely to have had
peers that used drugs and more likely to partici-
pate in unstructured activities without adult super-
vision. Relationships with peers and parents and
participation in organized youth work are key to
substance use prevention. Thus, in a broader
context, our findings point to the enduring
importance of social relationships, parental social
support and social control in particular and the
importance of meaning in the everyday social
world of adolescents.
Second, our data point to the importance of
timing the implementation of prevention efforts
at the critical developmental moment. Our
experience suggests that substance use prevention
efforts need to be started early, at around the age
of 12 or 13, when intervention has the best poss-
ible chance of interrupting experimentation and
stemming use. Thus, reaching young people early
in their school years, as well as the parents of
younger adolescents, is critical to success.
Finally, it is important to bear in mind that the
Icelandic approach is a long-term strategy.
Indeed, a key lesson from our experience is that
it is possible to work effectively with both known
and emergent community-level risk and protec-
tive factors for a particular behaviour without
attempting to prove a direct causal relationship.
A well-constructed theoretical framework that
links community-level mobilization to individual
behaviour, coupled with an institutionalized
capacity for consistent and sensitive population-
based data collection, can yield a rich, dynamic
and nuanced picture of inter-related trends at the
individual, family, community and societal levels.
Integrated community frameworks such as the
Developmental Assets Model (Benson et al.,
2004; Mannes et al., 2005) and the Spectrum of
Prevention (Cohen and Swift, 1999) can provide
guidance for such intergenerational, intersectoral
and essentially dynamic interventions.
CONCLUSION
Preventing adolescent substance use remains a
challenge for both European and North-
American societies. The Icelandic Model of
Adolescent Substance Use Prevention focuses on
both risk reduction and the enhancement of pro-
tective factors at various levels of prevention.
Although this study utilized correlational data and
was not designed to establish a causal effect, we
observed a significant reduction in the proportion
of substance use among Icelandic adolescents over
a decade during which the Icelandic Model was
implemented. We believe our data demonstrate
that it is possible to define and implement well-
organized steps in promoting adolescent emotion-
al well-being by capitalizing on opportunities at
several community levels to reduce substance use
nationally. The Icelandic Model is a promising
example of such an approach.
ACKNOWLEDGMENTS
We gratefully acknowledge the support of the
Office of the President of the Republic of
Iceland. We also thank the anonymous reviewer
whose comments and suggestions enabled us to
strengthen a revision of this manuscript. A
version of this paper was presented at the
annual meeting of the 14th European Cities
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Against Drugs (ECAD) Mayors’ Conference,
Istanbul, Turkey, 10 May 2007.
FUNDING
Actavis; Icelandic Alcohol and Drug Prevention
Committee; Icelandic Red Cross; City of
Reykjavik; and Sports and Recreational Commit-
tee of Reykjavik to I.D.S; Iceland-US Education
Commission, Fulbright Program, to J.P.A.
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The Icelandic model 25
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... In recent years there has been increasing attention given to Iceland and the country's approach to prevention. Iceland had problems with adolescent substance use during the 1990s, with rates higher than many countries [19,20]. In 1998, 42% of [14][15][16] year olds reported being drunk in the last month, 23% being daily smokers, and 17% had ever used cannabis [20]. ...
... Iceland had problems with adolescent substance use during the 1990s, with rates higher than many countries [19,20]. In 1998, 42% of [14][15][16] year olds reported being drunk in the last month, 23% being daily smokers, and 17% had ever used cannabis [20]. Since implementation of a new approach, the Icelandic Model (IM), rates of alcohol, tobacco and drug use have decreased dramatically [20], with drunkenness rates reducing to 20%, smoking to 10% and cannabis use to 7% in 2007. ...
... In 1998, 42% of [14][15][16] year olds reported being drunk in the last month, 23% being daily smokers, and 17% had ever used cannabis [20]. Since implementation of a new approach, the Icelandic Model (IM), rates of alcohol, tobacco and drug use have decreased dramatically [20], with drunkenness rates reducing to 20%, smoking to 10% and cannabis use to 7% in 2007. The rates of use have continued to reduce over the years, with even lower rates of substance use now reported [21]. ...
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Background Substance use among young people is a significant public health concern, particularly in Scotland. Primary prevention activities are essential in delaying young people’s substance use and reducing the harms associated with use. However, such prevention activities are generally lacking. The Icelandic Model (IM) has received increasing attention and has been associated with improvements in substance use in Iceland since the 1990s. There is interest in implementing the IM in Scotland but concerns regarding transferability. This research study aimed to address a gap in the evidence base by providing insight into stakeholders’ views of the IM in Dundee and more widely in Scotland. Methods Qualitative data were collected via semi-structured telephone interviews with 16 stakeholders. Data were analysed using Framework Analysis in NVivo, informed by the Consolidated Framework for Implementation Research. Results Participants were keen for more prevention activities to be delivered in Scotland and were generally supportive of the IM, given the high rates of substance use and related harm. A range of positive factors were identified, including the evidence base, the multi-component nature of the IM, and availability of current services that could be embedded into delivery. Several barriers were noted, relating to funding, the franchise model, support and buy-in and cultural differences. Conclusions Our findings provide insight into the views of a range of stakeholders regarding the potential implementation of the IM in Scotland, and perceived barriers and facilitators. There is a desire for primary prevention activities in Scotland, driven by concerns about high rates of substance use and related harms, and a general lack of effective and evidence based prevention activities across the country. Several key barriers would need to be addressed in order for implementation to be successful, and participants were clear that initial piloting is required. Future research and evaluation is required to examine its potential and the outcomes of the approach in Scotland.
... One of the most highly utilized components of the prevention program was the "parental prowl," in which parents joined together to walk around their neighborhood and monitor youth during Friday and Saturday evenings. Though the lack of a community monitoring approach is not necessarily risky, the "parental prowl" enhanced neighborhood social capital and contributed to a substantial decline in adolescent substance use following the implementation of the Icelandic Prevention Model (Sigfúsdóttir et al., 2009). Such findings also bolster Vanyukov and colleagues' (2016) argument that resistance factors may have stronger translational impact than risk factors, given their potentially broader application and direct relationship with healthy outcomes. ...
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Genetic factors contribute to the intergenerational transmission of alcohol misuse, but not all individuals at high genetic risk develop problems. The present study examined adolescent relationships with parents, peers, and romantic partners as predictors of realized resistance, defined as high biological risk for disorder combined with a healthy outcome, to alcohol initiation, heavy episodic drinking, and alcohol use disorder (AUD). Data were from the Collaborative Study on the Genetics of Alcoholism ( N = 1,858; 49.9% female; mean age at baseline = 13.91 years). Genetic risk, indexed using family history density and polygenic risk scores for alcohol problems and AUD, was used to define alcohol resistance. Adolescent predictors included parent-child relationship quality, parental monitoring, peer drinking, romantic partner drinking, and social competence. There was little support for the hypothesis that social relationship factors would promote alcohol resistance, with the exception that higher father-child relationship quality was associated with higher resistance to alcohol initiation ( $$\hat \beta $$ = −0.19, 95% CI = −0.35, −0.03). Unexpectedly, social competence was associated with lower resistance to heavy episodic drinking ( $$\hat \beta $$ = 0.10, 95% CI = 0.01, 0.20). This pattern of largely null effects underscores how little is known about resistance processes among those at high genetic risk for AUD.
... 25 ICSRA researchers assert that the positive impact of these community-level interventions stems from youths' increased opportunity to develop life skills and form healthy, supportive relationships with adults, which builds social capital within the community. 26 Iceland has witnessed substantial reductions in youth substance use over the past few decades as a result of this model, which has since been adopted in other jurisdictions internationally. 27 In the Canadian context, many of the population level, built environment-focused public health interventions to date have focused on increasing individuals' physical activity. ...
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Objectives There has been relatively little exploration to date of potential protective effects within school neighbourhoods, such as those conferred by facilities that seek to promote health with respect to substance use and related harms. This study examined how the density of sports and recreation facilities in the school neighbourhood is associated with the likelihood of binge drinking, e-cigarette use, cigarette smoking and cannabis use among Canadian secondary school students. Design Longitudinal data from the COMPASS study on Canadian youth health behaviours from 2015/2016 to 2017/2018 was linked with school neighbourhood data capturing the number of sports and recreation facilities within a 1500 m radius of schools. Setting Secondary schools and school neighbourhoods in Alberta, British Columbia, Ontario and Quebec who participated in the COMPASS study. Participants 16 471 youth who participated in the COMPASS study over three school years (2015/2016–2017/2018). Primary and secondary outcome measures Binge drinking, e-cigarette use, cigarette use, cannabis use. Results Logistic regression models using generalised estimating equations identified that greater density of sports and recreation facilities within the school neighbourhood was significantly associated with lower likelihood of binge drinking and e-cigarette use but was not associated with cigarette smoking or cannabis use. Conclusions This research can help to support evidence-informed school community-based efforts to prevent substance-related harms among youth.
... When adolescents especially do not want parents and peers to know about their cigarette use, the Open access presence of parents and peers can deter adolescents from smoking at sports clubs. 6 Even though adolescents do not associate sports clubs with youth smoking, smoking by adults is perceived as more normal. This might relate to the view that sports clubs should protect children and adolescents against smoking, but have no 'patronising' role towards adult members. ...
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Objectives The aim of this study is to explore the beliefs, attitudes and social norms of Dutch adolescents with regard to smoking and sports. In addition, we examine whether there are differences between adolescents at sports clubs with versus without an outdoor smoke-free policy (SFP). Design Qualitative design in the form of focus group interviews. Setting Focus group interviews (n=27) were conducted at 16 sports clubs in the Netherlands. Soccer, tennis, field hockey and korfball clubs were included. Focus group discussions were transcribed verbatim and analysed thematically using MAXQDA. Participants 180 adolescents aged 13–18 years old were included in the study. All participants signed an informed consent form. For participants younger than 16 years, parental consent was required. Results With respect to smoking in relation to sports, participants had mostly negative beliefs (ie, smoking has a negative effect on health and sports performance), attitudes (ie, sports and smoking are activities that do not fit together; at sports clubs smoking is not appropriate), and social norms (ie, it is not normal to smoke at sports clubs). The same beliefs, attitudes and social norms were expressed by participants at both sports clubs with and without an outdoor SFP. However, argumentation against smoking was more detailed and more consistent among participants at sports clubs with an outdoor SFP. Conclusion Adolescents have negative beliefs, attitudes and social norms with regard to smoking in relationship to sports. Outdoor SFP at sports clubs might reinforce these negative associations. These findings point to the potential importance of sports in the prevention of adolescent smoking.
... This is precisely the proposition of the IPM. As a process-structure to strengthen and maintain collaborative partnerships and inform evidence-based decision making, the IPM assumes that long-term impact will only be achieved with a systematic collaboration between researchers, policy makers, and practitioners (Kristjansson et al., 2020a;Sigfusdottir et al., 2009Sigfusdottir et al., , 2020. ...
... Based on the findings of this study, we consider that the practice of PA should be considered from the socio-ecological model [77], contributing to a holistic view of the interaction of intrapersonal, interpersonal, institutional, community, and public policy factors. The practice of PA should be integrated into a multibehavioral health promotion model, rather than addressing these behaviors in isolation [78]. Several systematic reviews and studies [79,80] point in this direction, having demonstrated greater efficacy and impact at the preventive level. ...
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The practice of physical activity (PA) is a healthy habit that offers health benefits. In contrast, the lack thereof may be associated with an increase in diseases, even at an early age. The objective of this study was to analyze the association between unhealthy behaviors, such as tobacco consumption and problematic internet use, and the practice of PA in adolescents. Protective factors (physical activity and sport) and risk factors (leading a sedentary life, tobacco use, and problematic internet use) were evaluated. Other variables such as sex, the intensity of physical activity, and being a member of a sports federation were also evaluated. The sample consisted of a total of 1222 Spanish adolescents. Univariate descriptive analysis and multiple linear regression were used, and confirmatory factor analyses and structural models were also estimated. The results confirm a significant positive association between physical activity, intensity, and being a member of a sports federation, as well as between cigarette consumption and internet use. It is advisable to implement public policies that promote the practice of sports as a direct investment in health, preventing the consumption of tobacco and other habits that are harmful to the health of adolescents.
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Background: Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries. Methods: The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. Results: A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted. Conclusions: There remains a need for innovative, evidence-based approaches to improve TAY mental health care.
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Aims Europe’s Beating Cancer Plan set a goal of creating a Tobacco-Free Generation in Europe by 2040. Prevention is important for achieving this goal. We compare the Nordic countries’ preventive tobacco policies, discuss the possible determinants for similarities and differences in policy implementation, and provide strategies for strengthening tobacco prevention. Methods We used the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to identify the key policies for this narrative review. We focused on Articles 6, 8, 9, 11, 13 and 16 of the WHO FCTC, and assessed the status of the required (core) and recommended (advanced) policies and their application to novel tobacco and nicotine products. Information on the implementation of strategies, acts and regulations were searched from global and national tobacco control databases, websites and scientific articles via PubMed and MEDLINE. Results The WHO FCTC and European regulations have ensured that the core policies are mostly in place, but also contributed to the shared deficiencies that are seen especially in the regulations on smokeless tobacco and novel products. Strong national tobacco control actors have facilitated countries to implement some advanced policies – even as the first countries in the world: point-of-sale display bans (Iceland), outdoor smoking bans (Sweden), flavour bans on electronic cigarettes (Finland), plain packaging (Norway), and plain packaging on electronic cigarettes (Denmark). Conclusions Collaboration and participation in reinforcing the European regulations, resources for national networking between tobacco control actors, and national regulations to provide protection from the tobacco industry’s interference are needed to strengthen comprehensive implementation of tobacco policies in the Nordic countries.
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Criminologists have long recognized the importance of family and peers in the etiology of delinquency, but these two influences are commonly analyzed in isolation. However, if peers are treated as potential instigators of delinquency (following differential association theory) and parents as potential barriers to delinquency (following control theory), a crucial question emerges: Is parental influence capable of counteracting the influence of delinquent peers? Analysis of data from the National Youth Survey reveals that the amount of time spent with family is indeed capable of reducing and even eliminating peer influence. By contrast, attachment to parents (the affective relation between parents and offspring) apparently has no such effect. Instead, it appears to affect delinquency indirectly by inhibiting the initial formation of delinquent friendships.
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Although “social support” is present as a theme in many criminological writings, it has not been identified explicitly as a concept capable of organizing theory and research in criminology. Drawing on existing criminological and related writings, this address derives a series of propositions that form the foundation, in a preliminary way, for the “social support paradigm” of the study of crime and control. The overriding contention is that whether social support is delivered through government social programs, communities, social networks, families, interpersonal relations, or agents of the criminal justice system, it reduces criminal involvement. Further, I contend that insofar as the social support paradigm proves to be “Good Criminology”—establishing that nonsupportive policies and conditions are criminogenic—it can provide grounds for creating a more supportive, “Good Society.”