Welcome & Introduction

School-based and School-Linked Substance Abuse Prevention in Low Resource Countries:
Summary Statements & Response Form for a Delphi-type Discussion

These statements are intended to summarize what we know and need to know about school-based and school-linked substance abuse prevention (SAP) in low resource countries (LRC’s). These draft statements have been taken from a review of readily available collections of research, reports and resources as part of a larger project on preventing non-communicable diseases in low resource countries being undertaken by the International School Health Network (ISHN) with support from Plan International-UK. This document has been prepared to assist in the discussion in a webinar and follow up web meetings as part of a series on LRC’s offered by the members of the FRESH Partnership.

Readers interested in responding to these statements can simply complete this survey. Contact Doug McCall (dmccall@internationalschoolhealth.org) to be invited to the web meetings and related email discussions.

Note: These draft statements have been extracted from a longer and more complete version which contains the findings of a review of readily available collections of research, reports and resources. That document has a table with three columns. The left-hand column presents an extensive framework that applies to all contexts and all aspects of substance abuse prevention. The middle column reports on the review of items located with explicit references to or content on low resource countries. The third column contains these draft statements. The numbering in this extracted list of statements follow the findings of the review, which are often combined in a concluding statement. Consequently, the numbering below does not follow a continuous set of numbers.

PLEASE review that longer version before or as you complete this form. Just mark an “x” where you agree or disagree. Please add additional statements based on the review or your own work. Or suggest the deletion or amendment of any statement contained in this draft.

Note: Many sections of the outline used to collate the findings of the review are left blank because no specific LRC references on that item were located in this review. However, this does not signify that these sections and items do not apply to the LRC context. It simply signifies that few published research article, reports or resources have been published explicitly about LRC’s on that point.

If readers are interested in the sources used for the left- hand column on all SAP knowledge, they can peruse a very extensive Bibliography/Toolbox on school SAP research, reports and resources maintained by the International School Health Network.

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* 1. (Item 1.1 in review) Given the circumstances in low resource countries, substance abuse prevention policies, programs and practices should be positioned firmly within community and social development strategies that include greater access to schooling

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* 2. (Item 1.2 in review)  The school in LRC’s is often the hub of community life and can be the base for family focused programs and outreach. Resilient and close-knit families are a strength within LRC’s and should be a priority for school-linked SAP.

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* 3. (Item 2.1 in review) With few resources and social services, it is difficult for schools to respond supportively to disruptive students, especially when access and participation in schools is fragile. Innovative and sustainable strategies to engage community elders, faith-based organizations, large companies and community-based resources need to be developed, tested and disseminated. 

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* 4. (Item 3.1 in review) The knowledge derived from new research employing systems science and organizational development theories need to be combined with what we know about community development and social/economic development in LRC’s. Although the size of government systems will be less, the complexities will be similar and require the applications of the emerging tools and concepts from systems-based approaches. 

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* 5. (Item 5.1 in review) The relatively low rates of alcohol and tobacco consumption in LRC’s may be misleading because of the use of locally produced alternatives to commercial products.

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* 6. (Item 8.1 in review) There may be generational differences between young people and adults, with rapidly increasing substance use by youth in LRC’s. This may occur when the economic resources rise to a certain level and consumption is aggressively encouraged by tobacco and alcohol companies.

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* 7. (Item 8.2 in review) We need to have more regular, reliable survey and administrative data to monitor use of substances by young people in LRC’s.

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* 8. (Item 11.1 in review) Since most substances and addictive behaviours pose specific risks that need to be addressed in school prevention programs and since most of the published research is dominated by substances consumed in HRC’s, we need better exchanges of knowledge and practices among LRC’s about these risks.

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* 9. (Item 15.1 in review) The advertising and other forms of marketing of tobacco, alcohol and other products may be the most urgent risk/threat to substance abuse among young people in LRC’s.

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* 10. (Item 19.1 in review) The substances used by young people in LRC’s include tobacco and alcohol but also other home-grown products, plants, inhalants, paint thinner and other substances. There will be specific, practical knowledge about these substances that will need to be included in any LRC programs.

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* 11. (item 20.1 in review) As in many other contexts, the approaches and programs in LRC’s would benefit from the explicit use of behaviour theories to guide policy and program development. Freire’s theory of Participatory education appears to be very relevant if a community/social development approach is to frame the school-related efforts.

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* 12. (Item 22.1 in review) Applied research is urgently needed in the LRC context to test and better understand the more effective combinations of policies, programs and practices that can be sustained to prevent substance abuse

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* 13. (Item 23.1 in review) Longitudinal or post-hoc studies of the funding topic-focused programs and priorities of large donor organizations and government programs need to be undertaken to determine if these project-driven approaches are sustainable over the medium and long-term. Financing schemes that require a portion of the funding to be devoted to maintaining infrastructure such as coordinators, an overall health education curriculum/program and a minimum level of school-linked or school-based services could be part of this investigation.  

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* 14. (Item 24.1 in review) Feasible and effective models of multi-intervention programs to prevent substance abuse and other behavioural problems as well as promote positive youth development need to be created, tested and disseminated. LRC applications on other issues such as water/sanitation/hygiene have been developed, so this type of combination of interventions addressing a cluster of behavioural issues should be considered. 

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* 15. (Item 27.1 in review) Future studies, situation assessments and program evaluations related to substance abuse prevention need to also examine the status of the core components of a comprehensive approach to school health and development. These include a core curriculum, over-arching policy, designated services and minimum standards for a safe and healthy school environment.

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* 16. (Item 28.1 in review) The linkages between over-arching government policies restricting access and advertising of substances and school education and awareness programs for students, staff and parents need to be strengthened. No smoking bans (including school staff), alcohol free community events using school facilities, education to improve media literacy among students, parent information meetings, refusing offers of sponsorship or free educational materials from corporations selling substances and other actions are all possible in LRC’s. As well, schools can use the images and messages from warnings on packages and public services ads in the classroom and within the school to reinforce their impact. Further, a communities and cities in LRC’s develop, municipalities and governments can ensure that vendors/points of sale are not located near schools.

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* 17. (Item 29.1 in review) A fact-finding investigation on the status of health, personal-social development education in low resource and other countries is urgently required. We need to know the official status (required or recommended) core curricula, cross-curricular frameworks, co-curricular activities and non-formal learning opportunities. We need to know the actual hours of instruction/learning that students can be expected to receive.

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* 18. (Item 38.1 in review) Like other contexts and on other health and social issues, teacher education and development in substance abuse prevention in LRC’s has been piece-meal, project-driven and sporadic. 

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* 19. (Item 41.1 in review) There are some examples of SAP instructional programs developed in high resource countries that have been adapted to LRC’s and have been evaluated or are seen by participants as being effective.

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* 20. (Item 45.1 in review) More examples of school-based and school-linked health and addiction services in LRC’s need to be identified, shared and assessed for insights into practice-based improvements.

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* 21. (Item 47.1 in review) Practice-based standards for SAP-related health, addiction and other services that have been adapted to the LRC context need to be developed through direct consultation with LRC’s.

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* 22. (Item 48.1 in review) Further investigation into the use of brief interventions and motivational interviewing in the LRC context is warranted.

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* 23. (Item 49.1 in review) Further investigation into the use of mobile technologies to screen, inform and support adolescents in LRC’s should be considered. These programs should be linked to schools in a manner similar to other school-based and school-linked services.

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* 24. (Item 51.1 in review) The status and effectiveness of drug searches and testing in LRC’s should be investigated. School discipline policies should be updated based on these investigations.

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* 25. (Item 54.1 in review) Closely-knit and resilient families are often a strength in low resource countries, so it makes practical, evidence-based and experience-tested good sense to ensure that parenting programs are included in multiple intervention programs on substance abuse prevention and other issues.

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* 26. (Item 55.1 in review) Given the scarcity of resources, SA prevention programs in LRC’s should be framed within broader social, economic and community strategies, including access to and attainment in schools. 

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* 27. (Item 56.1 in review) Mass media and community awareness programs should be better coordinated with school-based programming in areas such as life skills education, school activities, parent information days and special events.

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* 28. (Item 59.1 in review) Scaling up single interventions, multi-intervention programs on SAP or multi-component approaches that will include SAP require much more “real-world” planning that examines feasibility, fit within the organizations expected to provide ongoing support and much more of a systems approach. A systems approach, although wider in scope, permits and encourages participants at all levels in all systems to identify small incremental system-quality improvements approach rather than to maintain an expensive (time and money) or artificially rigorous program. For LRC’s, this systems approach may be more realistic and feasible

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* 29. (Item 62.1 in review) We need to know if and how often the FRESH and similar assessments of school policies/programs and student substance-related behaviours have been used in countries. Further, we need to know more about how the use of these indicators and self-assessment tools have been used to improve policy and practice in LRC’s.  

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* 30. (Item 62.2 in review) These indicators could be updated and adapted for LRC’s by including questions relating to the use of other substances as well as asking questions about student perceptions of school climate, their relationships with teachers and parents, their normative beliefs about substance use in their communities etc.

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* 31. (Item 66.1 in review) Developing and maintaining a sustainable school health and development infrastructure to deliver prevention programming on issues such as substance abuse prevention is likely the greatest challenge facing low resource countries. Applied research to identify more LRC examples and targeted knowledge exchange activities are needed. 

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* 32. (Item 68.1 in review) We need to know more about ecological, systems-based approaches and strategies in low resource countries. This investigation needs to be led by people who work in LRC’s with the support and attention of donor organizations, experts, UN agencies and global NGO’s. 

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* 33. (Item 70.1 in review) We need to identify, examine and disseminate many specific steps and modifications to the ways that the health, social and development sectors use to work within education systems in LRC’s.

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* 34. (Item 71.1 in review) Consideration should be given to establishing an ongoing series of knowledge exchange activities focused on school-based and school-linked substance abuse prevention. Directions and suggestions identified in the discussion of this review could help to develop a deeper knowledge of SAP in low resource countries. These activities should strive to link the existing centres and networks interested in schools through the effective use of web-based technologies.

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* 35. (Item 72.1 in review) Several studies analyzing the trans-national data from the GSHS and GYTS have demonstrated the value of trend analysis regarding SAP in LRC’s. We need to know how researchers and officials can be encouraged and supported to create and maintain knowledge exchange and development networks similar to that which exists for the HBSC.

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