Prevention Science最新文献

Studies of program components (i.e., the ingredients that make up programs) have risen from obscurity to join mainstream program evaluation approaches over the last two decades. Researchers and policymakers are interested in leveraging information about the effectiveness of program components to better address the needs of programs' intended populations and reduce disparities in outcomes. Identifying which components are responsible for improving outcomes can inform evaluation design, measurement, and the state of the evidence as well as program development, adaptation, fidelity, and scale-up. This paper summarizes strategies for conducting components research, and anchors those emerging best practices in a components case study of a teen pregnancy prevention program. It offers applied guidance on ways to define and operationalize components, and best practices in measurement and analysis that have emerged from this work. This paper will help guide the prevention field toward conducting more and better research that yields consensus about which components are most important for program effectiveness.

Background: Adolescents exposed to intimate partner violence between caregivers face heightened risk of adolescent dating violence (ADV), yet few family-based prevention programs have been tailored to this group or evaluated for their impact on theorized mechanisms of change.

Methods: This single-arm pilot study examined the preliminary efficacy of eMoms and Teens for Safe Dates (eMTSD), a brief, web-based program for IPV-exposed adolescents and their mothers. Participants were 101 mother-adolescent dyads recruited via community agencies and social media. All dyads completed a baseline survey and were asked to complete six modules together over 6 weeks. Follow-up data were collected from 85 mothers and 80 adolescents. Analyses assessed pre-post changes in factors targeted by the intervention and examined cross-sectional associations between these factors and baseline ADV victimization and perpetration.

Results: Significant changes in the expected direction were found for targeted adolescent (knowledge, perceived severity, and normative beliefs) and mother (knowledge, protection motivation beliefs) cognitions. Mothers and adolescents also showed gains in conflict-resolution skills and declines in adolescent emotion dysregulation approached significance. At the family level, frequency of communication and adolescent disclosure of dating behaviors/concerns improved significantly, with trends towards improvements in cohesion and communication quality. Many of the factors that changed were also associated with baseline ADV victimization or perpetration, supporting the relevance of program targets.

Conclusions: eMTSD shows promise for improving modifiable ADV-related risk and protective factors among IPV-exposed families. A randomized trial is needed to assess impacts on ADV outcomes and inform future scale-up.

It has been demonstrated in multiple randomized trials that the PAX Good Behavior Game is an effective school-based program for reducing the severity and progression of childhood emotional and behavioral problems that are prognostic of mental disorders, personality disorders, and self-harm behavior in adolescence and early adulthood. Embedding effective programs into routine practices of frontline settings is a global priority for mental health prevention, however, little is known about what strategies effectively support program implementation in schools. The purpose of this study was to test the effect of a multicomponent implementation strategy on the adoption and efficacy of the PAX Good Behavior Game, using a cluster randomized controlled trial with a type-3 implementation-effectiveness design. The trial was conducted in 25 primary schools across New South Wales, Australia. Schools were randomly assigned to receive the PAX Good Behavior Game plus an implementation toolkit to support adoption (intervention group) or the PAX Good Behavior Game only (control group). The primary outcome was change in rate of program adoption, measured as current use or support of the PAX Good Behavior Game, first measured at 6 weeks post-registration (T0). The secondary effectiveness measure was change in students' emotional and behavioral problems, using the teacher-reported Strengths and Difficulties Questionnaire (SDQ). The first measure of the SDQ occurred at trial registration, prior to program implementation (T0). Both adoption and effectiveness were re-measured at 6 months post-registration (T1). All data were analyzed using intention-to-treat methods. Early program adoption was higher in the intervention group compared to control group (93.6% vs 45.2%: OR = 21.20, 95% CI [3.50, 128.45], z = 3.32, p < 0.001), with no differential effects at 6 months (96.8% vs 95.7%: OR = 1.21, 95% CI [0.16, 9.04], z = 0.18, p = 0.855). Emotional and behavioral problems reduced in both groups from baseline to 6 months (p < 0.001, d = - 0.25), with no differential effects observed at T1 (p = 0.474, d = - 0.08). There was a positive linear relationship between adoption and the perceived acceptability, appropriateness, and feasibility of the program for the pooled sample. It seems that providing implementation support early in the process of establishing new innovations in schools may help accelerate early adoption by increasing perceived appropriateness and acceptability, but uncertainty remains as to what support is needed to optimize implementation and effectiveness longer term. The protocol was retrospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621001125819.

Individually tailored interventions can address the myriad multi-level determinants of chronic health conditions. Limited measurement modalities to quantify tailoring disallow examining "active ingredient" effects on outcomes and implementation fidelity. The objective of this study is to develop and validate the Observational Assessment Tool for Tailoring (OATT) for behavioral prevention interventions. We developed the OATT and coded n = 172 videorecorded sessions from two trials of the Family Check-Up® 4 Health (FCU4Health), an individually tailored prevention and management program for behavioral health and obesogenic behaviors with English and Spanish-speaking participants. The sample was culturally diverse (> 65% Hispanic/Latino). Confirmatory factor analysis (CFA) tested the two-factor model. McDonald's Omega estimated internal consistency. Discriminant and predictive validity tests were conducted with FCU4Health fidelity, engagement, and health behavior outcomes, informed by the Implementation Cascade Model. CFA confirmed a two-factor structure for both trials (i.e., RMSEA ≤ 0.06, CFI and TLI of ≥ 0.95, SRMR < 0.08 chi-square p ≥ 0.05). Reliability and inter-rater reliability were good (ICC > 0.77) for both trials and English and Spanish videos. The OATT was not correlated (p > 0.05) with discriminant validity variables. Path analysis for predictive validity indicated that fidelity to the Individualized Treatment Planning factor directly predicts improvements in participant engagement (B = 0.16, p = 0.01, 95% CI [0.03-0.29]), which directly predicts improvements in parent health behaviors 12 months post-baseline (B = 0.18, p = 0.01, 95% CI [0.02-0.34]). The development of the OATT is a critical step to measure and guide tailored intervention development, implementation, and evaluation. Future studies are needed to replicate predictive validity findings and test the OATT factor structure with larger samples and different prevention initiatives.

A quarter of 11-year-old children in the USA have tried alcohol, typically provided by parents. Parents are the primary source of alcohol socialization for preteens, yet many are unaware of their influence and lack tools to discourage early-onset alcohol involvement (EOAI). We piloted BIPAS Alcohol, an mHealth intervention grounded in social cognitive theory, to prevent alcohol socialization. In this two-arm randomized waitlist control trial, 132 parents were randomized to receive BIPAS Alcohol immediately or after a 3-month delay. Self-reported outcomes were assessed at baseline and at 3 months. We analyzed intent-to-treat (ITT) effects using generalized linear models. We also tested moderation of intervention exposure by parental alcohol use frequency. BIPAS Alcohol improved parents' alcohol prevention beliefs, attitudes, and behaviors, including parenting self-efficacy, permissive beliefs, communication with other caregivers, alcohol socialization, and allowing sips. In moderation analyses, parent alcohol use frequency was associated with weaker effects on alcohol access and stronger effects on allowance of sipping. Moderation analyses suggested stronger effects on permissive beliefs and allowance of sips and weaker effects on alcohol access among parents who drank more frequently. BIPAS Alcohol is a promising preventive intervention for delaying EOAI. Its long-term effectiveness should be confirmed using a larger, more diverse sample.

Youth mentoring programs are an increasingly popular intervention and prevention strategy to promote positive youth development and to address a range of youth needs. Past research shows positive, albeit moderate, effects of mentoring across multiple domains, but there is evidence that suggests heterogeneity in treatment outcomes. Several studies have examined the role of risk factors in mentoring outcomes, but less is known about the role of protective factors. This study examines the extent to which ecological factors outside of the mentoring relationship, specifically, youth risk factors and existing social support, play a role in the effectiveness of mentoring in promoting adaptive coping outcomes, as measured by academic achievement, self-efficacy, and expectations. Using a person-centered approach, we examined (1) whether there were distinct profiles of youth participating in mentoring using mentee risk factors and existing social support as indicators; (2) associations between profiles and youth race/ethnicity and gender; and (3) whether profiles differed in post-program adaptive coping outcomes. Two classes of youth were identified. One class reported higher risk factor presence and higher social support and was more likely to be youth of color. The second class reported lower risk factor presence and lower social support. Classes did not differ in their adaptive coping outcomes. The implications of these findings for mentoring programs and further research are discussed.

Black young people are at high risk for firearm homicide in the USA. A promising intervention for mitigating firearm-related injuries and deaths is mentoring provided by individuals with specific lived experiences with firearm violence and trauma (e.g., credible messengers, violence interrupters) in community violence intervention (CVI) programs. The purpose of this study was to identify the factors through which mentoring interventions in CVI programs could cultivate protective factors (e.g., social support) that prevent interpersonal firearm violence. Semi-structured interviews were conducted with 20 mentors and program administrators in CVI programs in Washington State to examine their insights on the components of mentoring interventions that could work towards preventing firearm violence. A framework was developed through the use of a constructivist grounded theory methodology to capture the components within mentoring interventions in CVI programs aiming to prevent firearm violence among marginalized young people in communities disproportionately impacted by community firearm violence. Implications for both mentoring and CVI research are outlined in the manuscript.

Adolescents with conduct disorder (CD) often exhibit deficits in emotion recognition, strained parent and peer relationships, and elevated social stress. This randomized controlled trial tested Impact VR, a brief, immersive socioemotional intervention, with the aim of building protective factors and improving socioemotional functioning among youth with CD. A total of 110 adolescents with CD (M_age = 13.79; 58% male) were randomized to either the Impact VR intervention or an active control. Outcomes were assessed at baseline, post-intervention, and 3-month follow-up, including emotion recognition accuracy (ER40 total and subscales: fear, sadness, anger, happy, neutral), self-reported peer relationships, parent relationships, and social stress. Mixed-effects models controlled for baseline scores. Impact VR produced significant improvements in ER40 total accuracy (d = 0.74, p < .001), with specific gains for fear (d = 0.54, p < .001), sadness (d = 0.75, p < .001), and anger (d = 0.50, p = .014). No group differences emerged for happy (p = .126) or neutral (p = .050). Impact VR participants also reported stronger peer relationships (d = 0.58, p = .002) and parental relationships (d = 0.54, p < .001), and reductions in social stress at the 3-month follow-up (d = 0.53, p < .001). Findings demonstrate that even brief, scalable interventions delivered through immersive virtual experiences can yield meaningful improvements in socioemotional functioning for adolescents with CD. Impact VR represents a promising, engaging, and developmentally sensitive addition to the prevention science toolbox.

Artificial intelligence and machine learning (AI/ML) in prevention science may improve or perpetuate health inequities. Community engagement is one proposed strategy thought to empirically mitigate bias in AI/ML tools. We outline how to incorporate community engagement at every stage of the model development and implementation. Borrowing from a framework for phases of prevention research, we describe the value and application of engaging communities to help shape more rigorous and relevant applications of AI/ML for prevention science. We provide concrete examples from real-world applications, including efforts in suicide prevention with Indigenous communities, on chronic disease prevention for Hispanic and Latino populations, and a community-driven effort to leverage AI/ML to improve allocation of resources focused on social determinants of health for Native Hawaiians. This work aims to provide applied examples of how community-engagement has been incorporated into AI/ML development and implementation, with the goal of encouraging those in the prevention science field to consider the voices of the community as the use of such tools grows. Engaging with the community around AI/ML is critical to ensure these tools reach populations in need and advance health equity for all.

This systematic review synthesizes empirical research on organizational strategies that support the sustainability and scale-up of community-based interventions designed to promote youth psychological well-being. While research has established the effectiveness of youth mental health interventions in community contexts, less is understood about the processes that ensure their long-term sustainability and scale-up. A search across seven databases yielded 27 eligible empirical studies (2003-2025) including peer-reviewed and grey literature. The Synthesis without Meta-analysis (SWiM) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) standards provided a framework for conducting and documenting the review. Evaluations of methodological quality were carried out using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Consolidated Standards of Reporting Trials (CONSORT), and the Critical Appraisal Skills Programme (CASP). Two dominant strategies for intervention retention and effectiveness were identified: training and technical assistance (12 studies, 44%) and capacity building with implementation support (12 studies, 44%). The main barriers to sustainability and scale-up were reported as staffing as well as other resource limitations (financial, human, and technical), while facilitators included strong communication and leadership, sufficient funding and partnerships, and access to training and technology. Eleven studies (41%) sustained interventions beyond the initial funding period, with key factors including intervention fidelity, agency incentives, organizational support, therapist retention, and stakeholder engagement. The findings highlight the potential benefits of embedding sustainability and scale-up strategies in the pre-implementation phase, anticipating foreseeable barriers, and considering intervention fidelity, workforce stability, and organizational readiness as important precursors to sustainability and scale-up.