Social Factors and
Prevention Interventions
Head: K. Graham
While it is important to provide care and treatment for mental health
and addiction problems, it is also important to identify ways to prevent
problems before they develop, prevent minor problems from escalating into
major ones, and minimize harm and injury that occur as a result of mental
health problems and alcohol and other drug use.
The purpose of research in the Social Factors and Prevention Interventions
Section is to identify environmental (e.g., social, physical, cultural)
and individual factors (e.g., personality, predisposition, risks and protective)
that contribute to mental health and substance use problems; and to use
this knowledge to develop and evaluate research-driven interventions to
prevent problems.
At present, work in the section focuses on a number of key areas: alcohol-related
aggression, school-based and workplace-based prevention programs, early
intervention programs with at-risk youth and factors associated with the
prevention and treatment of problem gambling.
The following are highlights of some new initiatives.
Reducing Aggression
and Injury in Bars
Drinking in licensed premises is often associated with aggressive behaviour
and injury. For example, in a 1999 general population telephone survey
of Ontario adults aged 18 to 60, 30 per cent of those who reported being
involved in an incident of physical aggression during the previous 12
months said that their most recent incident occurred in or near a licensed
premise. Moreover, as reported in the news, incidents of bar staff or
patrons being injured or killed have occurred recently in a number of
communities in Ontario.
The Safer Bars program was developed by research, consulting and training
staff at CAMH and by working with bar owners, managers and staff from
across Ontario, police, legal experts, public health professionals, community
colleges and community groups.
Investigators from the Centre are leading an international project funded
by the US National Institute on Alcohol Abuse and Alcoholism to evaluate
the impact of the Safer Bars program on reducing aggression and injury
related to drinking in licensed premises. This three-year project, which
began in July, 2000, involves research observations conducted in numerous
licensed premises in Toronto, implementation of the Safer Bars program
in a randomly selected sample of premises, and observations at two time
periods following the program. These observations will measure the rate
of physical aggression as well as changes in environmental and other factors
associated with risk of aggression and injury.
Strengthening Families:
Family-Based Prevention for Children of Alcoholics
Children whose parents have alcohol or drug problems are at high risk
for a number of problems. In partnership with the University of Buffalo
and funded by the US National Institute on Alcohol Abuse and Alcoholism,
CAMH investigators are evaluating the Strengthening Families program.
The primary objective of the program is to prevent the onset and progression
of alcohol and other drug use problems among children whose parents have
alcohol problems.
This five-year project will involve approximately 720 families in which
at least one parent was previously in treatment for an alcohol problem.
From these families, at least one child between the ages of nine and 12
will be randomly assigned to either the experimental or control condition.
Information on children's alcohol outcomes and other drug-related outcomes
(including poor mental health, violence and delinquency) will be obtained
by means of two survey instruments (one for parents and one for children)
administered at pre-test (just prior to program implementation), at post-test
(immediately following the program), and at six, 12 and 18-month follow-up.
The child questionnaire will also gather detailed information on risk
and protective factors for alcohol and other drug use specific to children
whose parents have alcohol problems.
Fairness and the Human
Spirit at Work
The Centre for Addiction and Mental Health has been a leading partner
with Health Canada over the last 15 years in a research, development and
evaluation program devoted to the promotion of mental health and prevention
of problem substance use in the workplace. Currently, we are engaged in
projects that focus on the role of interpersonal fairness in the employment
relationship and how this affects mental health.
Fairness has been isolated as a powerful influence on mental health and
as a key mediator of how stress affects health in general. Funding for
these projects comes from Health Canada and from workplace partners such
as B.C. Hydro, Weyerhaeuser Canada Ltd. and Human Resources Development
Canada. However, hundreds of Canadian workplaces are involved centrally
and peripherally in executing these projects, which involve conducting
basic and applied research. CAMH is the virtual hub of a network that
involves these workplace partners together with the National Quality Institute,
the Canadian Business and Labour Centre, the Conference Board of Canada
and a consortium of largely university-based Centres for Health Promotion.
Developing and Evaluating
a Curriculum Aimed at Preventing Problem Gambling
Over the past few years, there has been a dramatic increase in the availability
of gambling opportunities. With this increased availability of gambling
has come an increase in gambling and problem gambling. Youth appear to
be particularly vulnerable to problem gambling. For example, a 1999 school
survey of students in grades 7, 9, 11 and 13 (OAC) found that 4.5 per
cent of the students scored in the pathological range for gambling problems,
according to the SOGS-RA (a common screening tool used to identify problem
gambling among youth). Problem gambling is a complex disorder involving
emotional (depression and poor coping skills) and physiological predispositions
(e.g., ADHD), but the core of the disorder is a process in which the person
learns that gambling is a fantastic escape (from stress), an exhilarating
rush and a easy way to make money (in the short term).
Investigators from the Centre have received funding from the Ontario
Problem Gambling Research Centre to develop and evaluate a prevention
curriculum. The project will develop material aimed at preventing problem
gambling in adolescents by addressing two of the main sources of vulnerability:
a lack of knowledge about the nature of random events (e.g., the erroneous
belief that you can beat the odds); and the inability to cope with stress
experienced in one's life. The curriculum includes eight lesson plans
as well as an interactive CD ROM. The evaluation of this one-year project
involves classes being randomly selected to receive the curriculum.
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