Unplugged, un programma scolastico efficace per la prevenzione dell'uso di tabacco, alcol e droghe tra gli adolescenti

[Machine translation] Abstract: eu-DAP (European Drug Addiction Prevention trial) is the first large multicenter study conducted in Europe with the aim of developing and evaluating a school program to prevent the use of tobacco, alcohol and drugs. The study was promoted by the Piedmont Epidemiological Observatory of Addiction, with the Universities of Turin and Eastern Piedmont, and funded by the European Commission in the Public Health program. It was conducted in collaboration with 6 European countries (Greece, Spain, Austria, Belgium, Germany, Sweden) and in Italy it involved 3 centers: Novara, Turin and L'Aquila. The program was conceived by a multidisciplinary group of researchers, specifically for European schools, based on scientific evidence. The program involved 141 European schools (7th, 8th, 9th grade, first higher in Italy), and more than 7000 students, during the 2004-05 school year. The program (Unplugged) is based on the comprehensive social influence approach, and is implemented in the classroom by teachers using techniques such as role play, brain storming and group discussions. It consists of 12 standardized units of 1 hour each, taught by teachers, trained in an ad hoc 3-day course and is aimed at children aged 12-14. Three units are aimed at improving knowledge on the risks of using tobacco, alcohol and drugs and the development of an attitude that is not favorable to substances; one unit is focused on the critical analysis of information on use and reducing the mis-perception of peer use (regulatory education); three units are aimed at consolidating inter-personal skills including effective communication and empathy; and finally, 4 units are aimed at developing intra-personal skills, for example problem solving and empathy; and finally, 4 units are aimed at developing intra-personal skills, such as problem solving and ability to make decisions. The effectiveness of the program was measured through a randomized and controlled trial in which 3500 students in the intervention group and 3500 students in the control group participated in three surveys: a baseline survey (November 2004), the second about 3 months after the end of the program (May 2005) and the third about a year later (May 2006). About 35% of the sample are Italian boys. At baseline, 15.5% of students said they had smoked cigarettes in the last 30 days, 6.4% had smoked daily, 3.8% had smoked cannabis, 6.7% had been drunk at least once. The effectiveness of the program in preventing or reducing substance use was analyzed with a Multi Level regression model that takes into account the design of the study with cluster sampling, and the differences in use detected at the baseline between the centers and the different arms of intervention. Following the administration of the intervention, students belonging to intervention schools showed a 30% reduction in the probability of smoking daily (OR=0.70, 95% CI 0.52-0.94), 31% of having frequent alcohol poisoning (OR=0.69, 95% CI 0.48-0.99) and 23% of using cannabis (OR=0.77, 95% CI 0.60-1.00). After follow-up at one year (15 months), the effectiveness was maintained on both sporadic (OR=0.80, 95% CI 0.67-0.97) and frequent (OR=0.62, 95% CI 0.47-0.81) drunkenness and on the use of cannabis (OR=0.74, 95% CI 0.53-1.01). In conclusion, the study shows that CSI programs are also effective in the European context, and that Unplugged is effective in reducing the use of drugs, alcohol and cigarettes in the short and medium term. Given the high prevalence of use at 14 years of age, it is recommended to apply the program as early as possible, starting from the age of 12-13.