Abstract
Wide-reaching local and national public-health actions for young persons generally focus on the trio of alcohol, narcotics and tobacco (ANT), which form part of a quintet if doping and gambling are included. The World Health Organization has concluded that the use and misuse of drugs among young people are major threats to public health. Use and misuse of alcohol, narcotics and tobacco are behind a major part of unhealth, not only in the long term as aetiology for cancer, cirrhosis and cardiac diseases, but also in the short term including young people. The depressing fact is that misuse at a young age tends to continue later in life.
Use and misuse of all kinds of drugs support the reward system of the brain. An increasing tolerance is driving individuals to look for increasing quantities or to switch to more potent and more dangerous substances.
Not all individuals are equally vulnerable. However, those aged 13–18 are at greatest risk, since susceptibility is high in this cohort. In addition, use and misuse among teenagers tend to set the scene for the future.
The output and availability of all kind of drugs – ‘supplier-induced demand’ – is of major importance and is a natural focus for public-health initiatives, whether by information or by legal measures. These can focus on the individual, the family and group or on society as a whole. All measures are important, since there is a link between risk factors.
So far, for these common-sense aspects, we are on reasonably stable ground. However, how much evidence do we have of formal, preventive actions to keep young people from misuse of tobacco, alcohol, drugs and gambling? ‘Not much’ is the answer from a literature-based technology assessment by the Swedish Agency for Health Technology Assessment and Assessment of Social Services, a governmental organisation. 1
The assessment was initiated by the local authorities in Sweden to provide some guidance on the public-health efforts to keep young people on the right track. The methods used for the evaluation included thorough searches of all digitally accessible and relevant databases. In all 22,816 original papers were retrieved, and 400 were used for the assessments.
Very few if any papers provided clear support for local programmes, whether school-based or general and whether aiming at one of the substances or several. The weak point in most studies was the difficulty in long-term follow-up. The few successful programmes are holistic, taking advantage of all possible domains in society in joint efforts over an extended period of time, a communitarian perspective or straitjacket.
More generally, in the flood of input of information and influences from all kinds of media, there is limited space for programmes trying to change the lifestyle and choices for young people.
The Scandinavian Journal of Public Health invites all interested scientists to explore possible new lines in the fight against tobacco, alcohol, narcotics, doping and gambling among children and adolescents. This is an underdeveloped scientific field with major importance for the future of society. As such, the possibilities of funding from different parties in society seem bright.