Dra. Giselle Amador MuñozDra. Giselle Amador Muñoz

Costa Rica 2003Costa Rica 2003

DRUG USE IN COSTA RICADRUG USE IN COSTA RICA

National surveys of the years 1990, 1995 National surveys of the years 1990, 1995 and 2000 – Surveys conducted on school-and 2000 – Surveys conducted on school-attending teenagersattending teenagers

Main abuse drugs are alcohol, tobacco and Main abuse drugs are alcohol, tobacco and psychotropic tranquilizerspsychotropic tranquilizers

Illegal drugs CannabisIllegal drugs Cannabis Increased use of cocaine and crackIncreased use of cocaine and crack Entry drugs Tobacco and Alcohol.Entry drugs Tobacco and Alcohol.

PROJECT TRAZANDO EL PROJECT TRAZANDO EL CAMINOCAMINO

INITIALINITIALDEFINITIONS 1998DEFINITIONS 1998

Interinstitutional cooperation Interinstitutional cooperation IAFA, MEP, ICDIAFA, MEP, ICD

WHO/PAHO initial cooperationWHO/PAHO initial cooperation Political and financial support Political and financial support

for proper implementation for proper implementation Conducted at all schools Conducted at all schools

nationwide in 7th, 8th and 9th nationwide in 7th, 8th and 9th grade grade

Conducted by guidance Conducted by guidance teachers and counsellors once teachers and counsellors once a week during the counselling a week during the counselling hourhour

Involves the whole Involves the whole educational community educational community

PROJECT TRAZANDO EL PROJECT TRAZANDO EL CAMINO IN COSTA RICACAMINO IN COSTA RICA

Developing life skillsDeveloping life skills

++Dispelling myths about drug useDispelling myths about drug use

++ Information on drugsInformation on drugs

Definition of life skills in the Definition of life skills in the ProjectProject

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

WHO 1993WHO 1993

Life Skills considered in Life Skills considered in Trazando el CaminoTrazando el Camino

Ability to make decisionsAbility to make decisions Ability to solve problemsAbility to solve problems Ability to communicate emotionally Ability to communicate emotionally

and effectively (assertiveness)and effectively (assertiveness) Ability to think critically and creativelyAbility to think critically and creatively Ability to establish and maintain Ability to establish and maintain

interpersonal relationsinterpersonal relations

Life skills considered in Life skills considered in Trazando el CaminoTrazando el Camino

Ability to handle group pressureAbility to handle group pressure Ability to handle own emotionsAbility to handle own emotions Ability to handle stressAbility to handle stress Self-knowledge and self-esteemSelf-knowledge and self-esteem

First Impact EvaluationFirst Impact Evaluation

Quasi-experimental evaluation with control Quasi-experimental evaluation with control group, which was impossible to get because it group, which was impossible to get because it was conducted in all schools in the country was conducted in all schools in the country

Consisted of a pre-test performed at the Consisted of a pre-test performed at the beginning of the school year and a beginning of the school year and a subsequent test at the end of the school yearsubsequent test at the end of the school year

Questions were included on attitudes, Questions were included on attitudes, knowledge and practices regarding use of knowledge and practices regarding use of alcohol, tobacco and other drugs alcohol, tobacco and other drugs

The project implementation mode was not The project implementation mode was not taken into account taken into account

Figure 1 Tobacco consumption history of 7th grade students

by gender March-November 1999

13,8

26,8

13,6

22,9

0 10 20 30

Men

Women

After-test

Pretest

Figure 2 Alcohol consumption history of 7th grade students

by gender March-November 1999

22,8

51,9

25,2

54,7

0 20 40 60

Men

Women

After-test

Pre-test

TABLE 1 Recent consumption and active consumption

of alcohol by gender among 7th grade students Costa Rica, Nov. 1999

VARIABLE CONSUMPT’N DURING THE LAST YEAR

CONSUMPTION DURING THE LAST MONTH

GENDER Men

Women

30.7 38.3

18.6 21.5

Table 2 Consumption ending in intoxication among 7th grade students by gender during the last year Costa Rica,

Nov. 1999

VARIABLE MEN WOMEN

Never 1 to 2 3 to 4 5 to 6

37.5 5.3 2.6 6.1

40.2 6.0 3.4 5.1

Figure 3 Cannabis consumption history of 7 th grade

students by gender March-November 1999

1,5

3,8

1,5

2,6

0 1 2 3 4

Hombres

Mujeres

After-test

Pre-test

HIGHLIGHTSHIGHLIGHTS The first opportunity to smoke, according to The first opportunity to smoke, according to

the pre-test evaluation, arose on average at the pre-test evaluation, arose on average at 11.43 years old. Actual smoking took place at 11.43 years old. Actual smoking took place at 11.78 years old11.78 years old

On average, the opportunity to drink for the On average, the opportunity to drink for the first time, according to the pre-test evaluation, first time, according to the pre-test evaluation, arose at 11.3 years old. The first intake took arose at 11.3 years old. The first intake took place at 11.57 years old.place at 11.57 years old.

The opportunity to smoke cannabis for the The opportunity to smoke cannabis for the first time, according to the pre-test evaluation, first time, according to the pre-test evaluation, on average arose at 12.41 years old. Actual on average arose at 12.41 years old. Actual smoking took place at 13.14 years old.smoking took place at 13.14 years old.

There are no significant differences There are no significant differences between legal and illegal drug use between legal and illegal drug use prevalence among men and women.prevalence among men and women.

During the period under review, the share During the period under review, the share of persons considering tobbaco use an of persons considering tobbaco use an unhealthy practice grew.unhealthy practice grew.

The emotional condition scale, which The emotional condition scale, which assesses the recent emotional status of assesses the recent emotional status of the subject, appeared appropriate in the the subject, appeared appropriate in the pre-test and there were no significant pre-test and there were no significant variations in the after-test.variations in the after-test.

On average, the knowledge scale grew On average, the knowledge scale grew from 78.1% to 82.5%. The same applied to from 78.1% to 82.5%. The same applied to the attitudes scale, which increased from the attitudes scale, which increased from 59.5% to 83.5% between the pre-test and 59.5% to 83.5% between the pre-test and after-test.after-test.

TRAZANDO EL CAMINO WEAKNESSESTRAZANDO EL CAMINO WEAKNESSESQUALITATIVE EVALUATIONQUALITATIVE EVALUATION

2002-20032002-2003 Program carried out at 55% of schoolsProgram carried out at 55% of schools Only a part of the topics is covered, and Only a part of the topics is covered, and

the program is completed at only a few the program is completed at only a few schools.schools.

Lack of commitment on the part of Lack of commitment on the part of authorities at central and regional leveal authorities at central and regional leveal and in each school.and in each school.

Lack of motivation on the part of some Lack of motivation on the part of some directors, counsellors and guidance directors, counsellors and guidance teachers.teachers.

Weak training and support of guide Weak training and support of guide teachers in each regionteachers in each region

Little participation of administrative Little participation of administrative personnel, other teachers, and personnel, other teachers, and parents.parents.

Some teachers regard the program as Some teachers regard the program as an extracurricular duty.an extracurricular duty.

The time to carry out the project and The time to carry out the project and inclusion in the guidance hour are inclusion in the guidance hour are inappropriate.inappropriate.

Failures in distribution of materials Failures in distribution of materials (teacher guides and student guides)(teacher guides and student guides)

STRENGTHSSTRENGTHS Structured program, with political support Structured program, with political support

and initial PAHO guidance.and initial PAHO guidance. Includes an impact and process Includes an impact and process

assessment.assessment. Based on strategies proven to be effective Based on strategies proven to be effective

in the US and other countries in the in the US and other countries in the Americas and Europe. Americas and Europe.

Validated materials providing guidance to Validated materials providing guidance to teachers and students.teachers and students.

Thematic units facilitate and provide Thematic units facilitate and provide guidance to the work of the guiding guidance to the work of the guiding teacher and student’s participation.teacher and student’s participation.

Conducted nationwide at all schoolsConducted nationwide at all schools..

TRAZANDO EL CAMINOTRAZANDO EL CAMINOQUALITATIVE EVALUATIONQUALITATIVE EVALUATION

RECOMMENDATIONS FOR 2004RECOMMENDATIONS FOR 2004

POLICIESPOLICIES Need to include clear policies on drug Need to include clear policies on drug

offer and demand reduction at the offer and demand reduction at the Education Ministry.Education Ministry.

Guidelines issued by top officials for Guidelines issued by top officials for program compliance, follow-up and program compliance, follow-up and evaluation.evaluation.

Raising awareness and motivatinh Raising awareness and motivatinh authorities in each region and schoolauthorities in each region and school

Securing the involvement of and raising Securing the involvement of and raising awareness on the part of fathers and awareness on the part of fathers and mothersmothers

TRAININGTRAINING Enhancing awareness and training of Enhancing awareness and training of

counsellors and guidance teachers.counsellors and guidance teachers. Insisting on the need for an interactive Insisting on the need for an interactive

and participation-based methodologyand participation-based methodology Experiential training for the guidance Experiential training for the guidance

teacher and counsellor to learn life teacher and counsellor to learn life skills.skills.

Training and motivating directors and Training and motivating directors and authorities and the whole educational authorities and the whole educational communitycommunity.

MATERIALSMATERIALS Rethinking materials in order to Rethinking materials in order to

reduce costs and enable executionreduce costs and enable execution Reducing the time allocated to each Reducing the time allocated to each

session.session.

SPACE AND PERSONNELSPACE AND PERSONNEL

Strengthening the guidance hour for it Strengthening the guidance hour for it to be used mainly to carry out the to be used mainly to carry out the project.project.

Selecting guidance teachers for them Selecting guidance teachers for them to have the features and motivation to have the features and motivation required to carry out motivation required to carry out motivation programs. programs.

Follow-up and accompaniment to Follow-up and accompaniment to guidance teachers in charge of guidance teachers in charge of training.training.

2nd. EVALUATION2nd. EVALUATIONMARCH-NOV 2001MARCH-NOV 2001

Quasi-experimental pre-test and after-test.Quasi-experimental pre-test and after-test. 126 prompts to evaluate Life Skills126 prompts to evaluate Life Skills 9 questions on use of alcohol, tobacco and 9 questions on use of alcohol, tobacco and

other drugs.other drugs. Randomly selected leading schools and Randomly selected leading schools and

control schools.control schools. Sample of 1879 7th, 8th and 9th year Sample of 1879 7th, 8th and 9th year

studentsstudents As was the case with the first evaluation, it As was the case with the first evaluation, it

was not possible to have a control groupwas not possible to have a control group

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

FIELD MEANING NUMBER OF QUESTIONS

RELIABILITY

Decision-making Measures the youth’s ability to make decisions by himself or herself

11 74.4

Interpersonal relations

Measures the youth’s ability to interact socially.

6 47.8

Assertive communication

Measures ability to communicate and transmit messages effectively

12 40.7

Perception of threats Measures the way youths perceive their social settingl

8 42.5

Self-esteem Measures the opinion youths have about themselves.

6 17.6

Group pressure Measures the influence peer groups exert on teenages, which may or may not interfere in decisions

7 31.3

TABLE 3Average scores of control and lead group students in the fields

surveyedCosta Rica, 2001

FIELDS pre-test After-test pre- test After- test

CONTROL CONTROL LEAD LEAD

Decision-making 4.02 3.94 (*) 3.99 4.01

Interpersonal relations. 3.62 3.61 3.56 3.66 (*)

Assertive communication 3.47 3.66 (*) 3.41 3.65 (*)

Self-esteem 3.69 4.13 (*) 3.65 4.10 (*)

Stress management 2.83 3.79 (*) 2.90 3.80 (*)

Group pressure 2.52 4.19 (*) 2.53 4.21 (*)

(*) Diferencia estadísticamente significativa entre el pre-test y el post-test.

The fields in which significant The fields in which significant changes occur are:changes occur are:

For men and women: self-esteem, stress For men and women: self-esteem, stress managmeent and group pressuremanagmeent and group pressure

Among women there is a significant Among women there is a significant increase in assertive communicationincrease in assertive communication

Proportionally more women achieve a Proportionally more women achieve a higher increasehigher increase

TABLE 5Prevalence of drug consumption in life among control and

lead group students estudiantes de los grupos control y líderesCosta Rica, 2001(percentage figures)

DRUGS pre-test After-test pre- test after test

CONTROL CONTROL LEAD LEAD

Alcohol 37.4 45.0* 33.5 41.1*

Tobacco 11.8 21.0* 13.0 23.0*

Cannabis 1.0 1.9 1.0 2.5

Cocaine 0.3 0.6 0.4 0.5

(*) Diferencia estadísticamente significativa entre el pre-test y el post-test.

RESULTSRESULTS

o Alcohol use increases more in control Alcohol use increases more in control than in lead schoolsthan in lead schools

o Tobacco use increases in both groupsTobacco use increases in both groupso Cannabis and cocaine do not Cannabis and cocaine do not

increase significantlyincrease significantlyo In slight monthly active consumption, In slight monthly active consumption,

increase statistically not significantincrease statistically not significant

CUADRO 8Active drug use and abstinence among control and lead group students,

according to overall score in all fieldsCosta Rica, 2001

CONSUMPTION TYPE CONTROL LEAD

after-test after-test

AlcoholActive YES°Active NO°°Abstemious

3.863.903.89

3.903.883.93

TobaccoActive YESActive NO

Abstemious

3.75*3.853.91

3.76*3.863.94

CannabisActive YES (+)

Active NOAbstemious

3.443.993.90

3.743.913.91

* 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 LEARNING TO COPE BY MYSELFMYSELF

Pilot project aimed at 4th, 5th and 6th grade students Pilot project aimed at 4th, 5th and 6th grade students Participation of 300 schools and 30,000 students in 4th Participation of 300 schools and 30,000 students in 4th grade. grade. Includes a qualitative and impact evaluationIncludes a qualitative and impact evaluationApplication imparts knowledge and understanding Application imparts knowledge and understanding relating to the following skills: relating to the following skills: Self-knowledge and self-acceptanceSelf-knowledge and self-acceptanceDecision-makingDecision-makingAnxietyAnxietyThe value of the familyThe value of the familyAdvertising messagesAdvertising messagesAlcohol, tobacco and other drugs and the conseuqences Alcohol, tobacco and other drugs and the conseuqences of using themof using them

CONCLUSIONSCONCLUSIONS Studies must be performed over several Studies must be performed over several

years, including a follow- up of populations years, including a follow- up of populations exposed to the program.exposed to the program.

A control group is needed, which leads to A control group is needed, which leads to ethical considerations.ethical considerations.

A connection is found between abstention and A connection is found between abstention and the presence of life skills, whereas active the presence of life skills, whereas active users have lower scores in those fields.users have lower scores in those fields.

Difference between men and women in skills Difference between men and women in skills acquisition points to the need for programs acquisition points to the need for programs with a gender approach.with a gender approach.

It is essential to establish process and impact It is essential to establish process and impact evaluations.evaluations.