How might the ‘Youth in Iceland Model’ for preventing substance use among young people be developed and adapted for use in Dundee, Scotland?

Background
In Scotland, substance use amongst young people is a significant public health concern, with many young people reporting alcohol, tobacco and/or drug use (1,2). Prevention of youth substance use is complex. The most effective method is by restricting access to substances through regulation, pricing, taxation and laws (3,4). While evidence for school and family-based interventions is under-developed, some show promise (5–8). In Scotland, the Scottish Government supported delivery of alcohol-brief interventions into wider settings, including youth services, as part of its national Alcohol Brief Intervention programme (9). Furthermore, the new Scottish Government drug and alcohol strategy (10) prioritises the need to develop new approaches in the area of universal prevention/education for young people, advocating for development of peer-led methods.
Iceland had similar problems with high rates of substance use amongst young people during the 1990s (11) and, since implementation of a new approach, the Youth in Iceland Model (YiIM, now Planet Youth), rates of alcohol, tobacco and drug use have decreased dramatically (12). Between 1997 and 2014 rates of drunkenness decreased from 29.6% to 3.6%, and smoking from 17% to 1.6% (13). YiIM is a community-based approach aiming to prevent young people’s substance use through reducing risk factors and increasing protective factors (12). Key components are parents, organised extracurricular/recreational activities, schools, and involvement of young people (14). Schools are encouraged to strengthen supportive networks between themselves, parents, and other community organisations (14). Planet Youth has been implemented in more than 30 countries across the world.

The project
The aim of this project is to convene a co-production process involving a diverse group of individuals living and working in the City of Dundee to review and interrogate the evidence-base on the YiIM’. Young people and parents/family members will be central to the process. The group will review the scientific evidence, including that gained first hand, for its applicability to Dundee, gain an in-depth understanding of how the model could be implemented/adapted locally, and make recommendations to decision-makers in the City Council, Health Board, and Alcohol and Drug Partnership.

The project will increase in-depth awareness of a scientific approach (YiIM) to understanding/preventing substance use amongst young people. The project will advocate for full appraisal of an evidence-based approach to primary prevention in both policy and practice. A barrier to adoption of evidence in addictions policy and practice can be a failure to fully consider the importance of the local context. While certain elements of YiIM are standardised throughout the 30 participating countries, there is substantial evidence of different cities adapting/tailoring the programme to suit local conditions, such as targeting different age groups, and broadening the scope of the programme to address other issues such as young peoples’ general mental health and wellbeing. While the group process will involve critical review of the scientific evidence-base, it will also carefully consider the different distinct elements of the YiIM, and how these might add value to/detract from existing City and Scottish initiatives.

A co-production process will be used to facilitate deliberation, dialogue, and knowledge exchange (15). Key features are:

  • Establishing ground rules;
  • Joint ownership of key decisions;
  • Commitment to relationship-building;
  • Opportunities for personal growth and development;
  • Flexibility;
  • Continuous reflection;
  • Valuing and evaluating the impact of the work (adapted from INVOLVE (16)).

As well as determining the applicability of the YiIM to Dundee, a small number of the group will travel to Reykjavik to meet with city councillors, parents and young people, and the Icelandic Centre for Social Research and Analysis (ICSRA) at Reykjavik University, to ask particular questions about the YiIM in practice and particular challenges experienced at different levels of the local system. ICSRA developed the approach in collaboration with policy makers and practitioners in the 1990s and their approach reflexively and continuously links national-level data collection with local-level reflection and action to increase social capital using iterative cycles of evidence, reflection, and action. By visiting Reykjavik, and developing relationships with different stakeholders there, the Dundee group will have a more nuanced understanding to help determine how such a model could be applied/adapted to their particular local context and city. This will be brought back to the wider group and formulated into a dissemination/recommendations plan.

Dissemination
A 40-minute documentary film; briefing documents for policy makers and communities; comic strip style postcards and posters; a commentary/short report academic journal article will be produced throughout the process. As part of the project we will also host an event for a wide range of stakeholders, including to those working in policy, academia and practice, and the public. The recommendations will also be disseminated via Drugs Research Network Scotland, Scottish Alcohol Research Network and the Scottish Government’s Alcohol and Drug Partnerships mailing list to inform academic and practice communities about the work. The involvement of schools and teachers will also be essential. All project outputs will be available on the Society for the Study of Addiction website.
For more information about the project, please contact:
Dr Hannah Carver
Hannah.carver@stir.ac.uk

Project team: Dr Tessa Parkes (University of Stirling), Dr Hannah Carver (University of Stirling), Pat Tyrie (Dundee Drugs Commission).
Working group: Dave Barrie (Addaction); Millie Strachan (Dundee and Angus College); Simon Little (Dundee ADP); Jamie Kelly (Leisure and Culture Dundee); Laura Henderson (NHS Tayside); Lee Caldwell (Addaction).
Funded by: Society for the Study of Addiction

References
1. Currie C, Zanotti C, Morgan A, Currie D, de Looze M, Roberts C, et al. Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) Study: International report from the 2009/2010 survey [Internet]. World Health Organisation [cited 2019 Feb 12]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf
2. Black C, Setterfield L, Murray L. Scottish schools adolescent lifestyle and substance use survey (SALSUS) drug use report (2015) [Internet]. Scottish Government [cited 2019 Feb 12]. Available from: https://www.gov.scot/publications/scottish-schools-adolescent-lifestyle-substance-use-survey-salsus-drug-use/
3. Jackson C, Haw S, Frank J. Adolescent and young adult health in Scotland [Internet]. Scottish Collaboration for Public Health Research and Policy [cited 2019 Feb 12]. Available from: http://www.scphrp.ac.uk/adolescent-and-young-adult-health-in-scotland/
4. Toumbourou JW, Stockwell T, Neighbors C, Marlatt GA, Sturge J, Rehm J. Interventions to reduce harm associated with adolescent substance use. Lancet. 2007;369(9570):1391–401.
5. Faggiano F, Minozzi S, Versino E, Buscemi D. Universal school-based prevention for illicit drug use. Cochrane Database Syst Rev [Internet]. 2014 [cited 2019 Feb 12]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003020.pub3/epdf/full
6. Thomas R, McLellan J, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev [Internet]. 2013 [cited 2019 Feb 12]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001293.pub3/epdf/full
7. Foxcroft DR, Tsertsvadze A. Universal family-based prevention programs for alcohol misuse in young people. Cochrane Database Syst Rev [Internet]. 2011 [cited 2019 Feb 12]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009308/epdf/full
8. Gates S, McCambridge J, Smith L, Foxcroft D. Interventions for prevention of drug use by young people delivered in non-school settings. Cochrane Database Syst Rev [Internet]. 2006 [cited 2019 Feb 12]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005030.pub2/epdf/abstract
9. Stead M, Parkes T, Nicoll A, Wilson S, Burgess C, Eadie D, et al. Delivery of alcohol
4
brief interventions in community-based youth work settings: Exploring feasibility and acceptability in a qualitative study. BMC Public Health. 2017;17(1):357.
10. Scottish Government. Rights, Respect and Recovery [Internet]. Scottish Government [cited 2019 Feb 12]. Available from: https://www2.gov.scot/Resource/0054/00543437.pdf
11. Sigfúsdóttir ID, Kristjansson AL, Gudmundsdottir ML, Allegrante JP. A collaborative community approach to adolescent substance misuse in Iceland. Int Psychiatry. 2010;7(4):86–8.
12. Sigfúsdóttir ID, Thorlindsson T, Kristjánsson ÁL, Roe KM, Allegrante JP. Substance use prevention for adolescents: The Icelandic Model. Health Promot Int. 2009;24(1):16–25.
13. Kristjansson AL, Sigfusdottir ID, Thorlindsson T, Mann MJ, Sigfusson J, Allegrante JP. Population trends in smoking, alcohol use and primary prevention variables among adolescents in Iceland, 1997-2014. Addiction. 2016;111(4):645–52.
14. Sigfusdottir ID, Kristjansson AL, Gudmundsdottir ML, Allegrante JP. Substance use prevention through school and community-based health promotion: a transdisciplinary approach from Iceland. Glob Health Promot. 2011;18(3):23–6.
15. Bovaird T, Loeffler E. We’re all in this together: User and community co-production of public outcomes [Internet]. University of Birmingham [cited 2019 Feb 12]. Available from: https://www.birmingham.ac.uk/Documents/college-social-sciences/government-society/inlogov/discussion-papers/inlogov-co-production-chapter.pdf
16. INVOLVE. Guidance on co-producing a research project [Internet]. INVOLVE [cited 2019 Feb 12]. Available from: http://www.invo.org.uk/wp-content/uploads/2018/03/Copro_Guidance_Mar18.pdf