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Chapter 4: Effective Communication of VSA Messages
Introduction
Across the literature, there is a general acknowledgement that VSA is hidden within wider concerns about substance abuse and, in many cases, attention to VSA is neglected at the expense of spreading messages about the risks associated with illegal drug misuse.
The main channels of communication of VSA messages appear to be popular media and dedicated information packs and resources developed by specialist drug agencies. A review of research relating to school drug education suggests that VSA is perhaps also somewhat overlooked in the formal drug education curriculum.
There is an absence of any contemporary widespread public awareness raising campaigns and, an initial exploration of the information outlets that are available in Scotland suggests that these are also sparse.
Given the lack of available material, especially at the local level, it is difficult to assess the effectiveness of VSA communications. Instead, this chapter provides an overview of the main resources developed for target groups affected by VSA (young people, parents and carers, professional care workers and retailers) and explores some of the reasons why VSA messages appear currently to be hidden.
Media Representations of VSA
All of the available evidence suggests that VSA has received variable levels of attention over the last 40 or so years, with a peak in the 1970s and 1980s. However, since then, it appears that the focus has declined (Blake and Butcher, 2004), and has shifted to other forms of drugs misuse. In particular, research suggests that the focus in the 1990s was on ecstasy (DoH, 2005) or 'dance scene' drugs (Hammersley, R., Khan, F., and Ditton, J., 2002) and, more recently, on heroin and cocaine use.
A comparative study carried out by Manning (2002) of media reports relating to both VSA and ecstasy deaths in 1999 (the year with the highest VSA associated deaths in the previous 10 years) showed that ecstasy received 4.6 times more press coverage than VSA. Manning concludes that:
"Although not quite invisible, the problem of VSA is certainly hugely over-shadowed by the national press fascination with ecstasy" (p.2).
As a benchmark, he cites that VSA deaths in the UK are around 4 to 5 times greater than deaths from ecstasy (Manning, 2002).
Manning (2002) reports that:
"organisations and parents particularly concerned with VSA have long suspected that journalists are more interested in ecstasy, and similar 'spectacular' drugs, rather than the mundane substances to be found in every home" (p.2).
McKeganey (unpublished) suggests that solvent abuse has:
"acquired something of the feel of 'yesterday's epidemic' to it" (McKeganey, unpublished).
This lack of reporting does, however, mask a continuation of the practice of VSA and of deaths associated with VSA. Indeed, since 1990, there have been a total of 1138 deaths associated with VSA in the UK.
A tentative analysis of media reports for the present study from 12 major popular newspapers in the UK shows that there was a peak in reporting of VSA issues and letters on the subject in 2002, with 36 articles identified for this period. Among these articles are a number relating to the deaths of a young father and a father-to-be in this year.
Similar highs can be observed for 1998 and 1999, with 31 articles identified in each year. Much of the reporting in 1999 related to the ban on sales of lighter refill gas and in 1998 reports focussed on the death of a teenage boy from inhaling deodorants and reports of the youngest VSA associated death in the UK, a 7 year old boy.
In all other years, dating back to 1996, there were less than 20 reports relating to solvent abuse in the selected newspapers.
Key Stakeholders and Target Audiences
Whilst media coverage of VSA reaches a wide readership, more formal educational and information materials have been developed in the area of VSA for specific audiences. The main materials identified from this research targeted children and young people, parents and other unpaid carers, professional care workers, the police and retailers. An overview of the resources developed for these target audiences is presented below, with many of the messages inherent in these materials being transferable to other audiences.
Young People
A number of flyers, information leaflets and advice booklets are available for young people from a variety of providers. The main documents identified from the review include:
- Safe is Sound: a video and parents' booklet for use with 11-16 year olds focussing on the dangers of abusing household and other readily available products ( http://www.re-solv.org/publications.asp)
- Chicken: a video and workbook aimed at 11-15 year olds which uses a case study of a young person's experience of VSA and the consequences for him and his family ( http://www.re-solv.org/publications.asp)
- Hazard Crew: a series of humorous cartoon style leaflets, posters and trump cards targeted at 10-14 year olds and designed by the creators of Wallace and Gromit ( http://www.re-solv.org/publications.asp)
- Polishing Your Nails: a 6 page comic strip produced by Lifeline publications. The document aims to "provide information and advice on the use of volatile substances in a care setting. It outlines the dangers associated with volatile substance use, how to deal with overdose and the problems associated with using drugs to cope with life." ( http://www.lifelinepublications.org/) The document is designed for use by young people in care with support and guidance from social services
- Tooting Gas: an 8 page comic strip produced by Lifeline publications. The documents aims to:
"make clear just how dangerous using volatile substances is and to deal with misconceptions. It also details the effects of misusing gas and solvents, including passing out, long-term damage and the high fatality rate of solvent users."
( http://www.lifelinepublications.org/) The target audience is adults and young people engaged in the recreational use of drugs and its use is advised with support for under 16s.
- Take a Sniff: a comic style leaflet giving factual information and advice about solvent abuse, designed for younger children ( http://www.hopeuk.org/)
- Solvents - Stuff on Series: a 16 page booklet covering solvents, including:
"what the drug is, brief history of use, effects, dangers, the law, top 10 safety tips, what the young characters think of the drug and where to find more and get help if needed." ( http://www.hit.org.uk/publications/ )
At the time of writing, a pilot of a dedicated solvent awareness pack is being implemented in North East Fife. The pack was developed by the Drug and Alcohol Project Levenmouth ( DAPL) in conjunction with the Drug Education Liaison Training Agency ( DELTA) and Fife Constabulary, and was initially targeted at Primary 7 students. It included a leaflet which was written by young people, a booklet including a story detailing the risks of buzzing solvents and gases, weighing up the risks, a true false quiz, information on how to get out of sticky situations and contact numbers of people who could help. This was trialled in 9 primary schools, as well as a number of community based projects (including the Girls Brigade, Boys Brigade and other youth organisations) and received favourable feedback from participants. The pack was modified following a request from one school to be used with Primary 4-7 pupils and additional interactive tasks, a poster, a DVD and tutor resource were added to enhance the pack and make it more flexible and appeal to a wider audience. Initially, 10 schools will receive this revised pack and DAPL are due to provide a report evaluating the effectiveness of the resource later this year.
Despite the development of such resources, and the ready availability of the leaflets and other resources listed above, there is evidence to suggest that young people may not consider VSA to be high risk behaviour.
Findings from the 2000 Scottish Crime Survey Young Persons' Survey show that 45% of 12-15 years olds surveyed felt that trying glue or solvents once or twice was a 'great risk'. A sizeable proportion (27%) of respondents said that they thought there was only moderate risk associated with this behaviour.
When asked to consider regular use of glue or solvents, the proportion of young people who said that this held great risks increased to 71% with 15% saying that it was moderately risky.
Data from the 2003 State of the Nation Survey also showed that, of the 972 people aged 17-25 who were surveyed, 58% said that they thought trying glue or solvents once or twice was a great risk with a further 19% saying that it was only moderately risky. Again, 73% of respondents felt that more regular use was high risk and an additional 15% thought it was moderately risky.
In England, a 1996 Health Education Authority National Drugs Campaign Survey of 11-16 years olds reported that awareness of glue sniffing risks was high (80% of respondents were aware of the dangers), however, only around 50% of respondents demonstrated awareness of the intoxication potential of aerosols, butane gases and correction fluids.
This data, among others, suggests that there may be a need for greater awareness raising and education in this field. It is also not clear from the research evidence the extent to which the information materials listed above have been evaluated, although such work may be hidden in the grey literature.
Importantly, recent research published by the Department of Health ( MORI, 2006) suggests that, for some young people, discovery of VSA (and future experimentation) occurs via school or youth groups where awareness raising sessions that are designed to deter young people actually encourage experimentation. There is a need, perhaps, for more research to be undertaken to explore this association.
Parents and Carers
The main guidance documents for parents that are widely cited in the literature include:
Information is also available to parents focussing on identifying symptoms of VSA and advice on seeking professional help via the 2003 Know the Score publication - Volatile Substance Abuse. The main messages contained in the leaflet (which are reported elsewhere in other similar leaflets) are:
- communicating with children non-aggressively and reassuring them of parental care and support
- making sure that young people know the dangers associated with VSA
- encourage participation in alternative behaviours to alleviate boredom often associated with VSA, and ensure that their peers are also distracted from VSA so as to prevent recreational use in groups.
As with young people, there is a lack of research in Scotland that specifically engages with parents to discuss attitudes towards VSA and the potential risks presented to their children. In Northern Ireland, a survey carried out for the Health Promotion Agency (2002) showed that parents tended to think that their child would not be 'foolish' enough to try solvent abuse and they were, instead, more concerned with other drug experimentation. Few had discussed VSA with their children and most found discussions about drug misuse a challenge.
Care Professionals
The most frequently cited resource for carers of solvent abusers is the 2000 publication by Richard Ives and the Health Education Board for Scotland ( HEBS) - Volatile Substance Abuse: Guidance for Professionals. Despite now being more than 5 years old, this is still cited in number of scholarly and informal reports on VSA and provides guidance on the effects of VSA, how to respond to VSA, the roles of professionals and sources of further information and support.
Other widely cited guidance documents include:
In Scotland, Scottish Drugs Forum also offer training seminars for professionals and a free online VSA training resource for health professionals is also offered by the charity Re-Solv.
Guidance documents and training packages specifically appear to target social work services staff as the main stakeholders in VSA.
In general, however, the evidence suggests that VSA is no longer prioritised by some social care professionals working in the field due to demands being placed on resources from other forms of substance misuse.
Work by Jagger (1997), which involved surveys of social workers responses to glue sniffing, showed that some workers simply perceived the practice to be 'normal' adolescent behaviour, whilst others categorised it as being pathological and, therefore, outwith their remit, instead requiring psychiatric expertise.
Research by Staffordshire University Institute of Social Work and Applied Social Studies (Boylan et al., 2001) suggests that social work services typically demonstrate greatest concern about cannabis among young people in social care (Boylan et al., 2001). This prioritising of other drugs over solvents comes from a perceived lower prevalence of VSA among children by care professionals and a generally low level of awareness of the hidden nature and other risks associated with VSA among professionals. Boylan et al. conclude that there is a clear need for better training regarding VSA among this group.
Research recently commissioned by the Scottish Executive, and being carried out by Re-Solv, the national charity dedicated to the prevention of solvent and volatile substance abuse, aims to address the low prioritisation and perceived marginality of VSA in the lives of young people in contact with social work departments. This project, which aims to develop a resource targeted at professionals working in Scottish social work domains, will seek to address the information needs that exist among this group at the strategic, managerial and operational levels. The work is being carried out to build on and complement existing good practice guidance and play a role in teaching professionals about effective interventions which can reduce death and other ill-effects of VSA.
Police
Although there is little evidence that relates directly to VSA training and awareness among the police, discussions with stakeholders suggests that this is necessary. Davidson and Walkinshaw (1997) also report low levels of awareness among the police of the inherent risks associated with VSA.
One of the main reasons for this is a perceived lack of awareness among the police of appropriate responses to interactions with solvent abusers. Anecdotal evidence suggests that police response to discovering solvent abusers in action is to attempt arrest for anti-social behaviour or public disorder offences and this may, in some cases involve chasing and pursuing the user. This poses significant risks to the health of solvent abusers since over-excitement of the heart in someone who has inhaled solvents, glues or aerosols can cause death. As Adgey, Johnston and McMehan explain:
"volatile substance abuse sensitises the heart to circulating catecholamines, such that sudden alarm or exercise (for example fright or running) may precipitate sudden death" (p.219).
A police briefing sheet was developed by Re-Solv and is available to police forces throughout the UK. It specifically offers advice on not chasing or pursuing solvent sniffers, however, the extent of circulation of this document is not clear.
The argument for ensuring effective training of police officers in relation to VSA is strengthened by the observation that the most common external provider of school drug education is the police (Lowden and Powney, 2000) accounting for 71% of secondary schools included in their survey and 68% of primary schools.
Historically, the police have also been shown to be the main referral agency of young people to the Children's Reporter (Jagger, 1996; HEBS & Ives, 1999).
Retailers
The main guidance documents available to retailers are:
- A loaded gun: a video for retailers aimed at raising awareness of their legal responsibilities in relation to sales of solvents ( http://www.re-solv.org/publications.asp)
- Retail Awareness Kit: produced by Re-Solv and the Health Education Authority, this pack also provides details on retailers' legal responsibilities regarding sales of volatile substances ( http://www.re-solv.org/publications.asp).
Again, survey evidence from the Northern Ireland Health Promotion Agency survey (2002) showed that retailers did not perceive or understand the risks of VSA, and were not always aware of relevant laws affecting sales.
Drug Education
In addition to the various resources developed for the above target groups, a review of existing drug education research was carried out to explore the extent to which VSA is specifically addressed in the formal curriculum.
The literature around drug education is vast, and a review of this material was too great for the current research programme. Previous research (Stead and Angus, 2004), commissioned by the Scottish Executive Education Department ( SEED), does, however, provide an overview of the main lessons that can be gleaned from the drug education literature.
Research from the National Children's Bureau ( NCB) (Blake and Butcher, 2004, p.2) also asserts that the most effective teaching and learning occurs when:
- there is a safe learning environment
- pupils are involved in planning and take responsibility for their learning; the education involves elements of knowledge, skills and values and explores emotion
- active learning methods are used (including brainstorming, pair and small group discussions, case studies, simulation and role play)
- learning about diversity and difference is integral
- adults (especially those with previous personal experience) act as facilitators
- activities are differentiated to allow pupils to achieve their own level
- assessment forms part of the process
- the education is linked to other sources of confidential information and support such as peers, school counsellors and community drug service.
The notion of peer education is, in particular, supported by the national voluntary health promotion agency Fast Forward in Scotland who provide evidence and guidance for effective delivery of drug education between young people who, they suggest, are:
"more likely to listen and respond to information given by their peers than to a 'lecture' delivered by adults." (Fast Forward, undated).
Blake and Butcher (2004) also note that children and young people respond well to education deliverd by people who have first hand experience of a specific topic or issue. This is supported by unpublished work carried out in Wellingborough Prison in England, wherin a team of ex-prisoners were involved in providing drug education in schools, remand homes and other youth organisations warning of the dangers of VSA.
There is evidence to show that formal drug education is retained by students. The 2004 SALSUS survey report states that:
"The majority (78%) of pupils in both age groups recalled having lessons on drugs in general in the last twelve months. Around half of all pupils recalled lessons on specific drugs (heroin, crack or cocaine, solvents or glue or ecstasy)." ( CAHRU, 2005, p.xiv)
The ability to recall educational content has not, however, necessarily been demonstrated to result in decreased drug experimentation. Indeed, earlier research exploring the impact of school-based drug education in Scotland found no effects of drug education on drug-related behaviour or drug-related attitudes (Coggans, Shewan, Henderson and Davies, 1991). Instead, there was evidence only that drug education raised the levels of young people's drug related knowledge (ibid).
Again, as with the lack of readily accessible evidence relating to young people's feedback on information education/information sources, there is a notable lack of research that specifically explores young people's perceptions of the effectiveness of drug education.
Further, tentative observations by the National Children's Bureau (2004) also suggest that children and young people are doubtful of messages delivered to them about the extreme dangers of drug misuse, especially when they witness others using the drugs and suffering no obvious short term consequences. In particular, scare tactics about death associated with trying drugs are seen as non-credible by young people.
Further research commissioned by SEED, and due to be published later this year, does go some way to redressing this imbalance and reports on qualitative research undertaken with Scottish school children regarding the effectiveness of drug education in schools. Early reported findings support the notion of interactive learning styles and the use of external visitors as a means of achieving effective drug education.
Finally, for the most part, drug education literature focuses on illegal drugs, alcohol and tobacco and there is less evidence that focuses specifically on VSA. A report by the National Children's Bureau ( NCB), (Blake and Butcher, 2004) designed to provide guidance on teaching and learning about VSA in schools asserts that:
"it is important that issues to do with teaching and learning about VSA are explicitly addressed" (p.3).
They also assert that VSA education must begin at primary school age, a message that is supported by other campaigners in the field, especially in light of occurrences of VSA deaths among under 10s in the last decade. That said, however, evidence also exists in the drug education literature that teaching young people about drug misuse at too young an age can be dangerous since younger children can be more suggestible. Given the ready availability of abuseable products for VSA, this precaution may be especially relevant here.
The Department for Education and Skills in England published Drugs: Guidance for Schools (2004) in which they assert that effective VSA teaching and learning occurs when it is incorporated into wider education programme but also receives dedicated time to explore the peculiarities of VSA compared to other forms of drug misuse.
Awareness Raising Campaigns
Internationally, there has been a dearth of public awareness raising campaigns that have tried to communicate messages regarding the dangers of VSA.
In the UK, a Department of Health (DoH) television advertising campaign, launched in the 1990s and specifically aimed at VSA, was hailed a success following subsequent decreases in recorded deaths among young people across the UK (DoH, 1993). The direct relationship between this campaign and the levels of VSA practice are, however, questionable since the decrease was also noted in UK jurisdictions where the advertisements had not been broadcast.
The National Youth Anti-Drug Media Campaign that was launched in the US in 1998 received bad press for failing to impact on drug misuse among young people and, in fact, it was argued by some that the campaign may have resulted in some young people being more inclined to try drugs as a result (Drug and Alcohol Findings, 2005).
Local Communications
Two dedicated information outlets exist in Scotland. In 2003, the Scottish Executive published the Know the Score document - Volatile Substance Abuse, aimed at a broad readership. The Scottish Drugs Forum also publish a quarterly newsletter - VS Focus - which focuses exclusively on VSA. This has been running since 1998 with regular issues dating up to May 2005 but is only available to members of the forum.
Information regarding the circulation, use and effectiveness of the 2 measures is not available.
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