Background: In western countries, the prevalence of behavioral risk factors for poor health is known to vary across social groups, the most economically disadvantaged population groups showing also the most unfavourable profile of risks. Whether primary prevention of behavioral risk factors is likely to amplify or to reduce this inequality is not known. Methods: In order to answer this question, we analysed the data from the EU-DAP study, a multicentric community trial evaluating a european school program aiming to deter adolescents from using tobacco, alcohol and illicit drugs. The study was designed as a four arms controlled randomized experiment, with blocks corresponding to social stratification of the schools catchment areas. The social strata were defined as high, intermediate and low, depending on a series of indicators developed at the center level. Overall, 143 schools and about 7000 students in seven countries participated in the experiment. The intervention group carried out an innovative program based on a comprehensive social influence model. The control group followed the usual health curriculum taught in the school. Results: In the short term, the program was effective in delaying all kinds of substance use, especially at the more advanced stages of the behavior. When the data were analysed separately by social groups, the efficacy was found to vary depending both on type of substance and on stage of the behavior. For instance, concerning cigarette smoking the efficacy was higher in social stratum 2 (intermediate) and 3 (low) then in social stratum 1 if any smoking in the past 30 days was considered, while it was higher in the most advantaged stratum (adj. OR=0.57, CI=0.30-1.07) and in the intermediate stratum (OR=0.56, CI 0.34-0.93) than in low social stratus for daily cigarette smoking. The social profile patterns of other substance use was less straightforward. Conclusions: Different factors linked to social circumstances mediate the efficacy of primary prevention on initial and advanced stages of substance use, at least regarding smoking behavior.
Do effective drug prevention programs also reduce social inequality in risks? Learning from the eu-dap trial
VIGNA-TAGLIANTI, Federica;
2007-01-01
Abstract
Background: In western countries, the prevalence of behavioral risk factors for poor health is known to vary across social groups, the most economically disadvantaged population groups showing also the most unfavourable profile of risks. Whether primary prevention of behavioral risk factors is likely to amplify or to reduce this inequality is not known. Methods: In order to answer this question, we analysed the data from the EU-DAP study, a multicentric community trial evaluating a european school program aiming to deter adolescents from using tobacco, alcohol and illicit drugs. The study was designed as a four arms controlled randomized experiment, with blocks corresponding to social stratification of the schools catchment areas. The social strata were defined as high, intermediate and low, depending on a series of indicators developed at the center level. Overall, 143 schools and about 7000 students in seven countries participated in the experiment. The intervention group carried out an innovative program based on a comprehensive social influence model. The control group followed the usual health curriculum taught in the school. Results: In the short term, the program was effective in delaying all kinds of substance use, especially at the more advanced stages of the behavior. When the data were analysed separately by social groups, the efficacy was found to vary depending both on type of substance and on stage of the behavior. For instance, concerning cigarette smoking the efficacy was higher in social stratum 2 (intermediate) and 3 (low) then in social stratum 1 if any smoking in the past 30 days was considered, while it was higher in the most advantaged stratum (adj. OR=0.57, CI=0.30-1.07) and in the intermediate stratum (OR=0.56, CI 0.34-0.93) than in low social stratus for daily cigarette smoking. The social profile patterns of other substance use was less straightforward. Conclusions: Different factors linked to social circumstances mediate the efficacy of primary prevention on initial and advanced stages of substance use, at least regarding smoking behavior.
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