Boozebusters Evaluation
2007
Introduction
This paper describes the evaluation of the Boozebusters programme in schools for 2007. A description of our main partner’s financial contribution is followed by a brief literature review, which makes reference to local and national policy and guidelines. This is then followed by details of the Boozebusters programme and includes a full analysis of the results achieved. This evaluation also includes formal outcomes from the facilitator’s evaluation sessions and then provides over all recommendations for next year’s programme.
The Boozebusters alcohol education programme was delivered to all S2 pupils in high schools across Fife during 2007. The programme initially started in West Fife four years ago but has continued to expand resulting in 18 out of the 19 High Schools welcoming the programme into their S2 curriculum, this year.
The Boozebusters programme aims to support young people to understand the social, legal and health consequences of underage drinking and to help them make informed and appropriate choice in their future lives.
Funding
The 2007 programme has been funded with the assistance of DIAGEO, NHS Fife Community Health Partnerships and Community Safety Partnership, Fife.
DIAGEO is the main funder with an award for 2007 of £10,000.
DIAGEO believes ‘that the correct response to alcohol misuse is for drinks manufacturers and retailers, governments, health authorities, health professionals and interested citizen groups to work together to find common ground and ways of promoting responsible drinking’.
DIAGEO also share with us the ‘concerns about underage drinking and binge drinking by a minority of young people’ and state that ‘young people sometimes experiment with drinking and can encounter problems if not given appropriate education and guidance. Parents and teachers, as role models, need to know the facts about alcohol and lead by example. The industry has a role to play and we have helped developed world-class awareness materials for use with young people’, Boozebusters aims to fulfill that approach by working closely with DIAGEO.
DIAGEO continue to remain committed to ‘open dialogue with public health authorities, research and academic communities and others with an interest in alcohol’s impact on health. They ‘are a signatory to the Dublin Principles, which set out the ethical basis for co-operation between the drinks industry, governments, scientific researchers and the public health community’.
We hope to continue working with them in the future.
Fife Community Safety Partnership awarded Boozebusters £6000 to support delivery of the programme but in addition also awarded us with £10000 which allowed us to develop an information card for young people. Ten thousand copies were created in total. The ‘flip 4 info’ information card was handed out to over 4000 pupils at all schools participating. All of the remaining 6000 cards have been distributed throughout Fife at various events including Blue Light Disco’s.
NHS Fife Community Health Partnerships, Improving Health teams awarded us £6000. This money was used to fund different parts of the project including creation of facilitators’ packs and briefing documents for all those involved and delivery of promotional items to schools. Additional alcohol information leaflets were also purchased and distributed to young people.
Alcohol
In general alcohol plays a very important part in Scottish society. Excessive drinking amongst young people is often associated with both short and long term health conditions but increasingly importantly with anti social behaviour, youth disorder and violent crime. Preventing these individual health and social issues requires robust and effective types of intervention.
Alcohol is an integral part of the British society and this ultimately impacts on the way young people think, behave and use alcohol during their transition to adult hood. Alcohol use by young people often mirrors the way the rest of our adult society uses alcohol. We therefore often see particular replications of adult attitudes and behaviours amongst young people. In comparison to drug use, alcohol is the commonly acceptable substance and forms part of each of our ‘normal’ learned behaviour.
To develop appropriate responses to these problems we realise that the internal ‘norms’ of youth behaviour are not easily changed or influenced by traditional methods of imparting information about the risks associated with excess alcohol consumption. If interventions are not appropriately pitched then we can become ‘hypocritical in the eyes of young people’ (The Globe Magazine, 2001). The World Health Organisation stated: “alcohol policies directed at young people should be part of a broader societal response, since drinking among young people to a large extent reflects the attitudes and practices of wider adult society”.
According to the Commission of the European Communities (2000) the main difference between the adult behaviours and youth behaviours, where alcohol use is concerned, appears to be around the young people’s ability to manage associated risks. They claim that young people do not always have ‘sufficient experience or guidance to enable them to accurately evaluate potential risks such as the risks associated with the inappropriate consumption of alcohol’ (Commission of the European Communities, 2000). Young people can therefore potentially expose themselves to a range of risks resulting in damage to their health and wellbeing such as encounters with crime and anti social behaviour to unintended sexual relationships.
Appropriate interventions for young people may therefore have to focus more on reducing risks and developing young people’s skills to ensure they are aware of the dangers resulting from excessive under age drinking. Or, school programmes in future need to be able to promote community initiatives in order to have more sustained effect.
Fife
In Fife, we have seen an increase in alcohol consumption. For example, according to local hospital admissions data, presentations to Accident and Emergency (A&E) and deaths due to excessive drinking, have increased for both male and females in all age groups (NHS Fife, Information Services, 2006). Specific details of alcohol use amongst young people are documented in the Scottish Adolescent Lifestyle Substance Use Survey (SALSUS). However, in addition, there were around 35,000 general acute inpatient emergency admissions with an alcohol-related diagnosis in 2005/6 (Source: Alcohol Statistics Scotland, 2007. Further, the number of attendances to A&E due to alcohol misuse was estimated to be 11% of all A&E attendances in an audit carried out by NHS QIS in 2006 (note: the majority of those attending A&E were not admitted). While no figure for the total number of A&E attendances is available, scaling up from the NHS QIS audit suggests the number of alcohol-related attendances could be in the region of 100,000.
The total number of presentations to primary and secondary care due to excessive use of alcohol is not known.
The SALSUS 2007 report holds information on a range of health behaviours specific to young people. The information contained in the report offers details of young people in Fife. In relation to alcohol it states that 49% of the pupils who have ever had a drink reported that they had consumed five or more drinks on the same occasion on four or more times in the last 30 days. Fifteen percent (15%) of young people had consumed five or more drinks on the same occasion on four or more times in the last 30 days. In 2002, 55% of 13 year olds in Fife who had had an alcoholic drink had been really drunk as had 79% of 15 year olds drinkers. Compared with 2006, there has been no significant change in the proportion of either age group that have been drunk. These are local figures to Fife. However; this is similar to the national Scottish picture of underage drinking.
Young people’s access to alcohol, in Fife, is found in various opportunistic ways. These include asking another person including strangers, older teenagers and relatives to buy alcohol for them. Another common method for purchasing alcohol is buying it from a local shop directly or by ordering take away and delivered food which includes an alcohol purchase.
In Fife, Friday and Saturday nights appear to be the most popular days for youth drinking (SALSUS Survey 2007). But the most popular place to drink was “at home”. However amongst the older teenage age group (15 year olds and above) nearly 45% of them report drinking outdoors compared to 36% in 2004.
Alcohol Education in Fife
Alcohol education takes place in various settings across Fife. In schools it is delivered as part of the personal and social education element of the schools curriculum. In the community various alcohol projects are developed with young people in youth work settings and as part of youth work activities.
There are also various community initiatives aimed at reducing underage drinking and tackling risk taking behaviours relative to underage drinking are offered in Fife. Some of these include youth enforcement activities where a test purchasing scheme aims to reduce the purchase and sales of alcohol to young people and youth diversion activities and youth achievement and educational projects.
Different Fife based voluntary and statutory agencies deliver drugs and alcohol education to primary and secondary aged school children, such as Fife Constabulary and Drug and Education Liaison Training Agency (DELTA). This is complemented by ‘Boozebusters’ educational programme targeting 12-13 year olds. The programme aims to promote healthy lifestyle choices and reduce the potential risks to young people’s health and wellbeing. In doing so it also addresses youth disorder and anti social behaviour; and promotes social responsibility and active citizenship. The programme in schools is tied into local and national plans and strategies, educational objectives as well as NHS public health guidelines.
Strategies, plans and key documents
Relevant Fife strategies and documents depict set targets which aim to reduce levels of underage drinking. Fife Drug and Alcohol Action Team (DAAT) within their corporate Action plan 2007-2008, have listed national and local indicators aimed at measuring against the national target. These are stated as; reduced frequency of and level of drinking from 20% of 12-15 year olds to 18% between 1995 and 2006, and to 16% by 2010.
Additional strategies, plans and supporting documents include;
· Curriculum for Excellence 2007
· Health Promoting Schools Accreditation Scheme 2004
· Health Promotion and Nutrition (Scotland) Act 2008
· Framework for Nursing in Schools 2006
· The Plan for Action on Alcohol (update) 2007
· Fife Community Safety Strategy 2007-2010
· Fife Constabulary Policing Plan 2007-2008
· NHS Fife, Dunfermline and West Fife, Kirkcaldy and Levenmouth, Glenrothes and North East Fife Community Health Partnerships Improving health team action plans
· Children’s Services Plan 2007
· Joint Health Improvement Plan 2007-2010
NICE Guideline
National Institute for Clinical Excellence (NICE) Guidelines are offered to NHS Fife as guidance for developing appropriate interventions ensuring most effective methods are utilised, however NHS Fife public health prevention work is supported by the public health guidance by Scottish Intercollegiate Guidelines Network (SIGN). In the absence of an appropriate SIGN guideline relevant to our educational health education work we refer to NICE guidelines.
NICE public health guidelines number 7 (2007), offers formal guidance on educational interventions relevant to reducing alcohol use amongst children and young people.
There are no specific guidelines on recommended safe levels of alcohol consumption for young people so we are offered by NICE appropriate approaches which encourage children not to drink, delay the age at which young people start drinking and aim to reduce potential risks and how it may cause amongst those who do drink.
NICE guideline 7 (2007) identified gaps in existing evidence around interventions for young people. Validity of the research methodology used in much of the studies reviewed for the purpose of this NICE guideline has been questioned by NICE. NICE have suggested that many alcohol education programmes appear to be researched in conjunction with other substance misuse programmes however little research has been conducted as part of a wider public health and skill development programme. Our aim is to enhance further understanding of this approach were alcohol education is coupled with life skills and general health information from a public health perspective. A lack of evidence of the effectiveness of such programmes in school exists. NICE 2007 claim there is a lack of data on how alcohol education programmes coincide with other types of behaviour associated with excess alcohol consumption such as violence or anti social behaviour.
Boozebusters
Boozebusters delivers educational messages to young people aged between 12-13 year olds in their second year at high school. In 2007 we expanded the project to include all High schools and some off campus units for children with additional support needs.
The programme for schools consists of pupil watching a drama presentation followed by workshops and then rounded up by a finale to the whole session. The play is performed by a mix of professional actors and actresses as well as current drama students attending the Adam Smith College in Kirkcaldy.
Following the drama all pupils attend a workshop led by a couple of facilitators from either one of the agencies participating in the programme, this could mean a children and young people’s nurse working alongside a Police officer and a drugs worker from the Voluntary sector.
A finale to the play is offered at the end of the session when the pupils then receive an evaluation form and some free promotional items. The pupils also receive an information card with a list of services and addresses which they can access at other times, such as drugs agencies and statutory service details. The card also promotes the school nursing service, youth diversion activities and personal safety messages.
Results
The following graphs detail the Fife high schools S2 pupil’s results. Individual results for each school are available if requested. Eighteen secondary schools took part in the Boozebusters programme. A total of 3111 questionnaires were completed by pupils.
The following graph depicts the amount of returned questionnaires by schools.
Table 1: Returns by schooln / %
Dunfermline & West Fife Community Health Partnership
Dunfermline High School / 303 / 10%
Woodmill High School / 117 / 4%
Inverkeithing High School / 239 / 8%
St Columba's High School / 154 / 5%
Beath High School / 209 / 7%
Lochgelly High School / 33 / 1%
Kirkcaldy & Levenmouth Community Health Partnership
Balwearie High School / 248 / 8%
Buckhaven High School / 170 / 5%
Kirkcaldy High School / 214 / 7%
Kirkland High School / 99 / 3%
St Andrews High School / 131 / 4%
Viewforth High School / 59 / 2%
Glenrothes & North East Fife Community Health Partnership
Auchmuty High School / 159 / 5%
Bell Baxter High School / 212 / 7%
Glenrothes High School / 136 / 4%
Glenwood High School / 191 / 6%
Madras College / 292 / 9%
Waid Academy / 145 / 5%
Total / 3111 / 100%
Table 2: Gender
n / %
Male / 1510 / 49%
Female / 1584 / 51%
Missing data / 17 / 1%
Total / 3111 / 100%