Peer and universal drug prevention in Irish schools: food for thought.
Article Type: Letter to the editor
Subject: Teenagers (Health aspects)
Youth (Health aspects)
Drug abuse (Prevention)
Drug abuse (Research)
Health education (Usage)
Author: Van Hout, Marie Claire
Pub Date: 08/01/2011
Publication: Name: Journal of Alcohol & Drug Education Publisher: American Alcohol & Drug Information Foundation Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Psychology and mental health; Social sciences Copyright: COPYRIGHT 2011 American Alcohol & Drug Information Foundation ISSN: 0090-1482
Issue: Date: August, 2011 Source Volume: 55 Source Issue: 2
Topic: Event Code: 310 Science & research
Product: Product Code: E121930 Youth
Geographic: Geographic Scope: Ireland Geographic Code: 4EUIR Ireland
Accession Number: 268478438
Full Text: Dear Editor,

I am writing to the Journal of Alcohol and Drug Education to present results from a regional study investigating prevalence of substance use among 12 Irish secondary schools in the North Eastern region of Ireland: Counties Louth, Monaghan, Cavan and Meath. 6 of these schools received peer education, as adjunct to the universal national drug education curriculum, Social Personal and Health Education, (SPHE). The research aimed to present regional youth substance prevalence data for the Regional Drug Task Force Data Coordination unit. However, some interesting differences emerged between schools receiving peer education funded by the Drug Task Force and those schools did not. The letter also wishes to draw attention to the current lack of peer education program quality assurance and outcome evaluations in Ireland, with an increasing amount of freelance companies offering peer education (Substance Use Peer Education Responses Program (SUPER), Hands on Peer Education (HOPE), Peer Education Program (PEP), Positive Youth Education (PYE), and DAP, Cross Care) often funded by local and regional Drugs Task Forces. A systematic review of the National Documentation Centre on Drug Use databases yielded no peer education evaluations conducted to date in Ireland.

Firstly, in order to contextualise this letter for those outside of Ireland, Irish youth substance use has become increasingly diverse in relation to urban-rural dichotomies, substances chosen, earlier initiation ages, consumptive profiles, drug transitions and settings for use (Nic Gabhainn et al., 2007; National Advisory Committee on Drugs, 2008; Hibell et al., 2009). Alcohol remains the most commonly consumed substance in Ireland, with binge drinking trends amongst youth evident (Mongon et al., 2007). Youth drug prevalence trends reflect increasing lifetime, last year and last month drug taking patterns amongst all social classes and at increasingly earlier ages in Ireland (National Advisory Committee on Drugs (NACD) 2008; Alcohol and Drug Research Unit (ADRU) 2009), with 1 in 5 school going students reporting cannabis use (Nic Gabhainn et al., 2007). Treatment statistics also record increases in the 12-15 year, and 15-17 year categories for adolescent addiction treatment, with problematic alcohol, cannabis, cocaine and heroin use most common (ADRU, 2009).

The school setting remains an appropriate setting for drug preventative efforts due to its efficacy in providing a systematic approach to reaching and engaging with a large number of young people on a regular basis (Tobler, 2000; Cuijpers, 2002; Faggiano et al., 2008; Inman et al., 2011). The universal drug education curriculum (SPHE) in Ireland is focused on the general student population and is utilised as a cost effective way of targeting students at secondary level and preventing them using illicit substances. However, the findings from the recent National Drugs Strategy 2009-2016 Consultative Approach called into question the effectiveness of this curriculum that is delivered by regular teachers, with concerns centralized in the lack of specific drug awareness training and support structures, scant engagement of parents, timetabling constraints and curriculum overload affecting classroom delivery. Previous Irish research on teachers' attitudes to student substance use had also observed haphazard and lack of uniform approaches to school and teacher delivery of the drug education component in SPHE (Van Hout and Connor, 2008).

In terms of youth peer education as adjunct approach to national drug education curricula, evidence based findings are mixed (Sumnall et al., 2006). The reported benefits of peer led approaches include the acquisition of new knowledge and skills, improved organizational skills and heightened self esteem, but these outcomes may be constrained by peers' personal experiences of drugs, clashes with teachers, and compromized peer group trust (Hartley-Brewer, 2002; Strange et al., 2002, Audrey, 2006). Research indicates that the success of the peer led program hinges on the similarity between the peer educator and the recipient, the content and amount of sessions and follow-up or booster sessions, levels of student interaction, and whether teachers are present during peer led delivery of material (Shiner, 1999; Cuijpers, 2002; McDonald, 2004).

The peer education program in this research commenced on a regional basis in 2003 and was regulated by the Irish National Quality Standards in Substance Use Education. The program aimed to equip students in first and fifth years with factual information about the risks attached to alcohol, cigarette and drug use. Six randomly selected schools in the total sample (n = 12) agreed to take part in the peer education program. Two students from first and fifth year classes in the six schools participating in peer education volunteered to train and act as a Peer Educator and were provided with a resource pack containing factual information on alcohol, cigarettes, drugs, examples of games to engage fellow students, and questionnaires to assist in group facilitation. The content was delivered offsite by two staff from the peer education company, in order for all Peer Educators to meet and engage together in a neutral and nonschool environment. Following completion of Peer Educator training, the students returned to their respective schools, met with their teachers, and delivered peer education in their respective classes of between 25 and 35 students. This was timetabled in the form of two sessions per month, including introduction, tobacco, alcohol and other drugs, with a conclusion in the form of a presentation/evaluation session. Fieldwork for the regional survey took place in 2010 (1). The total sample consisted of 429 students who were present on the chosen day of survey administration. Study samples consisted of first year (59% male, 41% female) and fifth year classes (56% male, 44% female). The survey questions targeted alcohol, cigarette, and drug use, substance initiation, frequencies of use, and perceptions of alcohol, cigarette and drug availability. 51% of first year and 54% of fifth year students received peer education.

Firstly, in terms of general alcohol, cigarette, and illicit drug prevalence, 57.05% of first year students (55% male, 58.6% female) had tried alcohol compared to 62.05% of fifth year students (59% male, 66.6% female). Indeed, the majority of Irish school children have consumed alcohol with the likelihood of lifetime prevalence of alcohol in Irish school going children increasing with each year of age, to almost all 17 year olds reporting ever having consumed alcohol (Nic Gabhainn et al., 2007; Hibell et al., 2009). According to the National Health Behaviours for School Children (HBSC) short report on Alcohol in 2008, Irish girls initiate into drinking later than boys, but by age 14/15 girls report similar trends in lifetime prevalence and drunkenness (Gavin et al., 2008). In this research there was a significant gender difference with fifth year females significantly more likely to report alcohol use (p [less than or equal to] .001). The findings are also somewhat worrying when considering the percentage of first year self reported lifetime use of alcohol. In terms of cigarette use, 12.1% of first year students (14.8% males, 7% females) had tried cigarettes compared to 39.4% of fifth year studentds (40.5% males, 38% females). National research shows that Irish young persons' self-reported cigarette use increases with age with few gender differences evident (Molcho et al., 2007). Smoking rates in Ireland recorded by the HSBC were greater among older children, with almost a quarter of boys and a third of girls aged 15-17 years reporting lifetime prevalence (Gavin et al., 2006). However, the HBSC report also indicated that current smoking levels decreased since 2002, and a reduction in smoking rates among children aged 15-17 years was evident (Gavin et al., 2006; Nic Gabhainn et al., 2008). In this research, statistically significant differences in self-reported age at first use of alcohol (12.37/13.87years) and cigarettes (12.50/13.37years) were found with first year students initiating at younger ages than fifth (p [less than or equal to] .001). Lastly, these findings also underscore earlier drug initiation rates identified in the HBSC findings with 3.4% of first year students (4.2% males, 2.3% females) self-reporting illicit drug use with mean initiation at 13.5 years compared to 16.4% of fifth year students (16% males, 17.2% females) with mean initiation at 14.2 years. In terms of drug consumptive choices, cannabis was reported as most commonly tried followed by ecstasy and cocaine with some students reporting headshop (2) product use as first time drug of choice. Availability to alcohol and cigarettes was reportedly most common in familial settings with drug availability highest in schools. The relative ease of access pertaining to illicit substance availability, and in particular cannabis in the Irish context, remains central to youth substance initiation and use during childhood and adolescent years.

Secondly, when comparing schools with peer education and schools without, self-reported alcohol use (69.5%) was significantly higher [p [less than or equal to] .01] among first year students who participated in peer education compared with students who did not participate (44.6%) and also when controlling for gender. First year students who participated in peer education were just as likely to report ever using cigarettes (8.6%) or illegal drugs (2.9%) as were first year pupils who did not participate in peer education (15.7%/4%). In terms of fifth year pupils, no statistically significant differences in self-reported alcohol use were present between groups that received peer education and those that did not (60%/64%). However, fifth year pupils who received peer education reported significantly lower rates of ever using cigarettes (31.1%, p [less than or equal to] .05) and illicit drug use (10.9%, p [less than or equal to] .05), compared to pupils who did not participate in peer education (47.8%/22%). The results also indicated that peer educated fifth year pupils who self-reported alcohol use, were significantly less likely to self-report illegal drug use, compared to pupils who did not self-report alcohol use (p [less than or equal to] .001).

One may speculate that the peer education program may have contributed to heightened social normalcy of alcohol consumption among first year students and deterred cigarette and drug experimentation at later stages. However, we have no clear picture of baseline trends prior to participation, and at most these findings indicate increasingly younger ages of initiation to alcohol, cigarettes and illicit drugs. Peer normalcy in substance consumptive and risk reduction patterns are present in contemporary Irish youth cultures (Keene, 2011). Similarly, the Blueprint Evaluation Team (2009) in their evaluation report on multicomponent drug education in the United Kingdom, underscores how alcohol is considered more acceptable among first and sixth year students than smoking or taking drugs. Research emphasizes the need for incorporation of social influence considerations into future prevention interventions, universal or otherwise (Caria et al., 2011). At the very least, this research highlights the need for improved scripting, design and outcome evaluation of peer education tactics within the universal drug education curriculum. Tobler (2000) in his meta-analysis underscored the need for considerable training and support for implementing high-quality interactive programing for teachers. Research by Fitzpatrick (2003) had investigated the potential inclusion of peer education into the curriculum in Ireland and observed reluctance on teacher's part to utilize this approach. Indeed, the presence of teachers during Peer Educator delivery may have stifled or stimulated the results in some way (Sumnall et al., 2006). Therefore, the fit between student groups and Peer Educators must be carefully considered within a cultural, gender, and life-stage approach. A strong focus on both substance-specific and timely universal and peer education objectives remains vital in targeting substance related knowledge, attitudinal and behavioral (i.e., delay of onset of initiation, reduction in prevalence markers, etc.) changes in students.

ACKNOWLEDGEMENT

The research was funded by the North Eastern Regional Drug Task Force (NERDTF), Ireland. The opinions expressed in this article are of the researcher and are not necessarily those of the North Eastern Regional Drugs Task Force.

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Fitzpatrick, Marie (2003) Use of peer education in the social, personal and health education programme in a second level school. MSc thesis, Royal College of Surgeons in Ireland. Unpublished.

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(1) Ethical approval for the survey was gained in 2007 at Waterford Institute of Technology, Ireland. Informed and parental consent was obtained from all participating schools. The research was conducted in accordance to standards set by the NACD's Guidelines on Good Research Practice: Research Ethics (2002) and Children First National Guidelines for the Protection and Welfare of Children (2004).

(2) A head shop is a retail outlet which specialises in drug paraphernalia related to consumption of cannabis, other recreational drugs, and New Age herbs, as well as counterculture art, magazines, music, clothing and home decor. On the 3rd of June 2010, the Irish government published the General Scheme of the Criminal Justice (Psychoactive Substances) Bill which stated that under the proposed Scheme, the sale or supply of substances (formerly known as legal highs) that for human consumption are not specifically proscribed under the Misuse of Drugs Acts but which have psychoactive effects will be a criminal offence.

Dr. Marie Claire Van Hour Lecturer

Department of Health, Sport and Exercise Science School of Health Sciences

Waterford Institute of Technology Waterford

Ireland

Tel: 00353872375979

Email: mcvh@eircom.net
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