Dra. Giselle Amador Muñoz Costa Rica 2003

EVALUATION OF SCHOOL-BASED PREVENTION PROGRAMS Dra. Giselle Amador Muñoz Costa Rica 2003

DRUG USE IN COSTA RICA • National surveys of the years 1990, 1995 and 2000 – Surveys conducted on school-attending teenagers • Main abuse drugs are alcohol, tobacco and psychotropic tranquilizers • Illegal drugs Cannabis • Increased use of cocaine and crack • Entry drugs Tobacco and Alcohol.

PROJECT TRAZANDO EL CAMINO INITIAL DEFINITIONS 1998 • Interinstitutional cooperation IAFA, MEP, ICD • WHO/PAHO initial cooperation • Political and financial support for proper implementation • Conducted at all schools nationwide in 7th, 8th and 9th grade • Conducted by guidance teachers and counsellors once a week during the counselling hour • Involves the whole educational community

PROJECT TRAZANDO EL CAMINO IN COSTA RICA Developing life skills + Dispelling myths about drug use + Information on drugs

Definition of life skills in the Project The skills needed to have appropriate and positive behaviour enabling us to effectively deal with the demands and challenges of everyday life. WHO 1993

Life Skills considered in Trazando el Camino • Ability to make decisions • Ability to solve problems • Ability to communicate emotionally and effectively (assertiveness) • Ability to think critically and creatively • Ability to establish and maintain interpersonal relations

Life skills considered in Trazando el Camino • Ability to handle group pressure • Ability to handle own emotions • Ability to handle stress • Self-knowledge and self-esteem

First Impact Evaluation • Quasi-experimental evaluation with control group, which was impossible to get because it was conducted in all schools in the country • Consisted of a pre-test performed at the beginning of the school year and a subsequent test at the end of the school year • Questions were included on attitudes, knowledge and practices regarding use of alcohol, tobacco and other drugs • The project implementation mode was not taken into account

HIGHLIGHTS • The first opportunity to smoke, according to the pre-test evaluation, arose on average at 11.43 years old. Actual smoking took place at 11.78 years old • On average, the opportunity to drink for the first time, according to the pre-test evaluation, arose at 11.3 years old. The first intake took place at 11.57 years old. • The opportunity to smoke cannabis for the first time, according to the pre-test evaluation, on average arose at 12.41 years old. Actual smoking took place at 13.14 years old.

There are no significant differences between legal and illegal drug use prevalence among men and women. • During the period under review, the share of persons considering tobbaco use an unhealthy practice grew. • The emotional condition scale, which assesses the recent emotional status of the subject, appeared appropriate in the pre-test and there were no significant variations in the after-test. • On average, the knowledge scale grew from 78.1% to 82.5%. The same applied to the attitudes scale, which increased from 59.5% to 83.5% between the pre-test and after-test.

TRAZANDO EL CAMINO WEAKNESSESQUALITATIVE EVALUATION2002-2003 • Program carried out at 55% of schools • Only a part of the topics is covered, and the program is completed at only a few schools. • Lack of commitment on the part of authorities at central and regional leveal and in each school. • Lack of motivation on the part of some directors, counsellors and guidance teachers. • Weak training and support of guide teachers in each region

Little participation of administrative personnel, other teachers, and parents. • Some teachers regard the program as an extracurricular duty. • The time to carry out the project and inclusion in the guidance hour are inappropriate. • Failures in distribution of materials (teacher guides and student guides)

STRENGTHS • Structured program, with political support and initial PAHO guidance. • Includes an impact and process assessment. • Based on strategies proven to be effective in the US and other countries in the Americas and Europe. • Validated materials providing guidance to teachers and students. • Thematic units facilitate and provide guidance to the work of the guiding teacher and student’s participation. • Conducted nationwide at all schools.

TRAZANDO EL CAMINOQUALITATIVE EVALUATIONRECOMMENDATIONS FOR 2004 • POLICIES • Need to include clear policies on drug offer and demand reduction at the Education Ministry. • Guidelines issued by top officials for program compliance, follow-up and evaluation. • Raising awareness and motivatinh authorities in each region and school • Securing the involvement of and raising awareness on the part of fathers and mothers

TRAINING • Enhancing awareness and training of counsellors and guidance teachers. • Insisting on the need for an interactive and participation-based methodology • Experiential training for the guidance teacher and counsellor to learn life skills. • Training and motivating directors and authorities and the whole educational community.

MATERIALS • Rethinking materials in order to reduce costs and enable execution • Reducing the time allocated to each session.

SPACE AND PERSONNEL • Strengthening the guidance hour for it to be used mainly to carry out the project. • Selecting guidance teachers for them to have the features and motivation required to carry out motivation programs. • Follow-up and accompaniment to guidance teachers in charge of training.

2nd. EVALUATIONMARCH-NOV 2001 • Quasi-experimental pre-test and after-test. • 126 prompts to evaluate Life Skills • 9 questions on use of alcohol, tobacco and other drugs. • Randomly selected leading schools and control schools. • Sample of 1879 7th, 8th and 9th year students • As was the case with the first evaluation, it was not possible to have a control group

Table 1 Fields included in the evaluation instrument of the Trazando el Camino Program, Costa Rica, 2001

TABLE 3 Average scores of control and lead group students in the fields surveyed Costa Rica, 2001 (*) Diferencia estadísticamente significativa entre el pre-test y el post-test.

The fields in which significant changes occur are: • For men and women: self-esteem, stress managmeent and group pressure • Among women there is a significant increase in assertive communication • Proportionally more women achieve a higher increase

TABLE 5 Prevalence of drug consumption in life among control and lead group students estudiantes de los grupos control y líderes Costa Rica, 2001 (percentage figures) (*) Diferencia estadísticamente significativa entre el pre-test y el post-test.

RESULTS • Alcohol use increases more in control than in lead schools • Tobacco use increases in both groups • Cannabis and cocaine do not increase significantly • In slight monthly active consumption, increase statistically not significant

CUADRO 8 Active drug use and abstinence among control and lead group students, according to overall score in all fields Costa Rica, 2001 * Statistically significant difference between active and abstemious users. + Sample size insufficient for active cannabis consumption ° Used during the last thirty days °° Did not use during the last thirty days, but before that

LEARNING TO COPE BY MYSELF • Pilot project aimed at 4th, 5th and 6th grade students • Participation of 300 schools and 30,000 students in 4th grade. • Includes a qualitative and impact evaluation • Application imparts knowledge and understanding relating to the following skills: Self-knowledge and self-acceptance Decision-making Anxiety The value of the family Advertising messages Alcohol, tobacco and other drugs and the conseuqences of using them

CONCLUSIONS • Studies must be performed over several years, including a follow- up of populations exposed to the program. • A control group is needed, which leads to ethical considerations. • A connection is found between abstention and the presence of life skills, whereas active users have lower scores in those fields. • Difference between men and women in skills acquisition points to the need for programs with a gender approach. • It is essential to establish process and impact evaluations.

Dra. Giselle Amador Muñoz Costa Rica 2003