Prevention Science最新文献

Children's mental health disorders are rising, underscoring the need to implement behavioral parent training (BPT) programs. However, wide variability in BPT effectiveness often reflects inconsistencies in implementation fidelity. This study examines test-retest reliability of the GenerationPMTO model's Fidelity of Implementation Rating System (FIMP) over a 17-year period. Seven coders provided ratings of 34 video segments from families participating in the Marriage and Parenting in Stepfamilies (MAPS) intervention, coded at two time points (2004, 2021) using first and third iterations of the FIMP manual. Variance decomposition analyses determined how much variability in scores was attributable to the interventionist, the observational coder, the session, and the year the data were coded. Test-retest intraclass correlation coefficients (ICCs) examined reliability across FIMP domains (knowledge, structure, teaching, process, and overall). Therapist differences accounted for the largest variance (38.1%), followed by coders (14.1%) and session (10.7%). Year did not significantly contribute, indicating that FIMP revisions have not undermined earlier fidelity metrics. Reliability analyses showed acceptable-to-excellent ICCs (range = 0.73-0.92), supporting the comparability of historical and current ratings. These findings indicate that GenerationPMTO's FIMP refinements maintain core fidelity metrics. By demonstrating stable fidelity data over time, the study bolsters confidence in both historical results and current coding practices. These outcomes reinforce the utility of long-standing training materials and support the use of stable fidelity tools in ongoing implementation and training contexts. Such synergy between fidelity measurement and adaptation fosters sustained program effectiveness across service contexts, allowing providers to align newer fidelity protocols with established best practices.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that can predict a wide range of short- and long-term negative health outcomes. More research is needed on policies that may reduce ACEs. Paid Family Leave (PFL) is a state-level policy that provides economic support for employees to care for a newborn or a recently adopted child. This study evaluated effects of PFL on reduction in household challenge ACEs. To investigate whether PFL implementation reduced the occurrence of household challenge ACEs among young children in Rhode Island and New York relative to other states without PFL implementation. This study used 2011-2019 population-based National Survey of Children's Health (NSCH) data to compare the proportion of household challenge ACEs experienced in intervention versus control states. Bayesian Additive Regression Tree (BART) and two-way fixed effects (TWFE) methods estimated post-intervention average treatment effects. United States (U.S.) Census covariates controlled for variation between states. Placebo checks bolstered the robustness of inference. Rhode Island and New York (intervention states) implemented PFL in 2014 and 2018, respectively. Control states included states that did not implement PFL as of 2019. The NSCH surveys included a 9-item ACEs questionnaire in which caregivers reported on whether their children ages 0-2 experienced various forms of abuse, and potentially traumatic household challenges (i.e., caregiver divorce, domestic violence, caregiver incarceration, caregiver mental health problems, caregiver substance use). This study focused on five household challenge ACEs and the occurrence of any household challenge ACE as primary outcomes. A treatment indicator identified intervention and control states. State-level covariates were median household income, unemployment rate, and percent uninsured.  Results suggest that PFL implementation was associated with significant 4% reduction in caregiver separation and 2% reduction in caregiver incarceration ACEs in the intervention states post-PFL adoption and a significant 4% reduction in the proportion of young children experiencing any household challenge ACE relative to no PFL implementation in control states. This study adds rigorous scientific support for the public health benefits of PFL for young children and their families. Existing evidence indicates caregiver incarceration and separation may affect children's short- and long-term mental health, substance use, and school related outcomes. Support through PFL may help reduce the occurrence of household challenge ACEs and promote children's well-being.

Effective early school-based prevention programs can shift behavioral outcomes, not just across the life course, but across generations; however, few studies have sufficient follow-up to test this. Here, we assess the impact of an early preventive intervention on later parenting practices. Participants were part of a randomized trial of two elementary school prevention programs to prevent aggressive and disruptive behavior in first grade, who were followed into adulthood. Participants who became parents (52%) participated in additional data collection about parenting at ages ~ 31-34. Results generally suggest null findings between elementary school-based prevention programming and parenting in adulthood. However, females who received a classroom-based intervention had significantly higher levels of constructive parenting as compared to females in the control condition. These findings suggest that the benefits of early prevention programming may accrue across multiple generations.

Although mindfulness-based interventions show initial positive results on a range of substance use behaviors, evaluations of mindfulness-based interventions would benefit from state-of-the-art alternative approaches to the ubiquitous use of sum or total scores. Sum scores do not reflect "true" underlying mindfulness as they do not consider differences in the relative weight of each item and/or the possibility that measurement may differ across groups. The purpose of this study was to identify measurement noninvariance/differential item functioning (MNI/DIF) across racial and ethnic groups, age groups, and those with PTSD diagnoses and differences in inferences on the factors of the Five Facet Mindfulness Questionnaire between scale scores estimated using moderated nonlinear factor analysis (MNLFA) and a total score analog model (TSA). Age, PTSD diagnosis, non-Hispanic Black race/ethnicity, Hispanic race/ethnicity, and other race/ethnicity showed statistically significant MNI/DIF. In the MNLFA model, PTSD diagnosis and Hispanic race/ethnicity contributed to significant MNI/DIF on the "true" acting with awareness, describing, and observing latent factors such that Hispanic participants were higher on average on acting with awareness scores and lower on average on describing and observing scores. The TSA model failed to estimate significant differences on acting with awareness score for participants with PTSD diagnosis. Additionally, in the TSA model, there was an increase in the effect size of Hispanic participants' baseline describing and observing estimates, thus overestimating differences in respective scores for Hispanic participants. Failing to correct for MNI/DIF in mindfulness scale scores can impact inferences and effect sizes for group differences in mindfulness thus creating bias in characterizing mindfulness, particularly for Hispanic individuals and those with PTSD diagnoses.

Students of color are disciplined for behavioral infractions at higher rates than white students in K-12 schools in the USA. The consequences of racism in K-12 schools include mental health problems, school dropout, and disproportionate disciplinary practices, leading to the school-to-prison pipeline. Many school personnel implement interventions to address student behavior rather than racism and other implicit biases. Furthermore, culturally relevant practices are imperative to address the root causes of racial disparities in student discipline. For these reasons, a systematic and comprehensive review of the published literature on school-based interventions in the USA (including public and private K-12 schools) was conducted to identify interventions to remedy racial disparities in school discipline, as well as the research designs used to test their efficacy. The final sample includes 48 studies that directly or indirectly attempt to address the race discipline gap. There were only three studies that reduced race disparities in school discipline with a culturally relevant intervention. Future researchers may consider the importance of the school's cultural context and intervention audience when developing and testing efforts to reduce racial disproportionality.

Asian American and Pacific Islanders (AAPI) youth report a high prevalence rate of youth violence. Logic models that guide violence prevention programming are often not culturally specific and may not address the unique structural/social drivers of youth violence in minoritized communities. Monsoon has received Rape Prevention and Education (RPE) funding from the Iowa Department of Health and Human Services (Iowa HHS) since 2007 through a competitive application process. The specific aim of Monsoon's Youth Sexual Violence Prevention Program (YVPP) is to "prevent gender-based violence by educating and empowering peers through outreach and workshops." In response to growing awareness at Iowa HHS about the limitations of the State RPE programmatic logic model in addressing AAPI-specific context for youth violence, Monsoon received additional RPE funds to establish the first culturally specific RPE logic model in Iowa. This initiative aims to fill a gap in culturally relevant evaluation resources. This paper describes the academic-community partnership initiated in 2023 that guided the participatory development of the culturally specific logic model and evaluation plan, for youth violence prevention in AAPI communities. Monsoon partnered with staff and faculty from the Center for Disease Control and Prevention (CDC)-funded Prevention Research Center for Rural Health (PRC-RH) in this work. PRC-RH faculty and staff reviewed documents and interviewed Monsoon leaders and youth staff. An AAPI-specific youth staff logic model and evaluation research questions were developed using a community-based research approach. Based on these, a mixed-methods evaluation plan was outlined. This case study highlights the critical importance of community-engaged research and practice to develop culturally specific logic models and evaluation designs for youth sexual violence prevention in the AAPI community.

Mental ill-health is a leading contributor to adolescent disease burden, with females and socioeconomically disadvantaged youth facing higher rates of mental disorders. Adolescence is a key period for the development of lifestyle risk factors for mental disorder, which are increasingly being recognized as important and novel population-level preventive intervention targets. We used decision trees to examine combinations of sociodemographic factors and the "big six" lifestyle behaviours (poor sleep, physical inactivity, sedentary screen time, poor diet, alcohol use and smoking) prospectively associated with worse anxiety, depression and psychological distress scores. We examined survey data from 3978 Australian adolescents (mean age 14.6 at baseline) who participated in the Health4Life study in 2021 and 2022. CART decision trees were run to rank the relative importance of each risk factor and to identify combinations of risk factors that characterize groups with highest anxiety (PROMIS-AP), depression (PHQ-8A) and psychological distress (K6) scores 1 year later. Gender was the primary differentiator of risk, with cisgender females and gender diverse adolescents having consistently worse mental ill-health scores than cisgender males. Inadequate sleep and excessive sedentary recreational screen time were consistently the top lifestyle factors and often emerged in combination to characterize higher risk groups. These findings offer new insights into relative importance of various lifestyle risk factors in adolescent mental health and highlight both the increased risk from engaging in combinations of unhealthy lifestyle behaviours and the need for targeted prevention and early intervention initiatives to reduce the gender gap in adolescent mental health.

The purpose of this study was to estimate the costs of starting up diverse interventions for preventing opioid misuse in young people aged 15 to 30. Interventions were to be delivered in the context of research trials funded under the National Institutes of Health HEAL (Helping to End Addiction Long-term®) Prevention Initiative. Start-up activities were conducted in systems and settings across the United States from 2019 to 2023. Start-up costs were estimated using activity-based costing from a provider perspective and common methods and data collection procedures across projects (n = 8). Descriptive statistics were used to understand the magnitude of and variability in start-up costs, cost drivers, and staff time. Factors explaining variability were identified from project activity descriptions. Start-up activities cost $37,541 on average, and $33,492 at the median (2020 USD). Labor drove costs (89% on average). Training, project management, and partner engagement accounted for 78% of start-up costs on average. There was considerable variability in total and activity costs. Start-up activities provide an essential foundation for successful intervention delivery and sustainability, yet the resources needed and associated costs for this phase of intervention implementation do not receive much attention. We found that interventions faced unique start-up challenges and leverage points, resulting in differences in total cost and activity cost burden. ClinicalTrials.gov Identifier: NCT01088542, NCT04901312, NCT04678960, NCT04617938, NCT04550715, and NCT04135703.

Preventive parenting programs effectively promote positive parenting behaviors and prevent negative child behavioral health outcomes, but engagement is often low. Self-directed eHealth interventions are increasingly available as an option that offers flexibility and increased access for parents. Yet, reports of and operationalizations of engagement within self-directed programs vary and correlates of eHealth engagement are not well understood. Thus, this study systematically reviewed reports to identify common operationalizations of engagement in self-directed preventive eHealth parenting programs, predictors of engagement, and associations between engagement and child behavioral health outcomes. Of 835 records screened, 31 unique studies had caregivers that participated in a self-directed eHealth preventive parenting programs that defined engagement or program adherence. Most studies reported the number of modules completed as a measure of parent engagement. About one-third of programs also reported frequency of parent program access. There was great variability in variables examined as correlates of eHealth program engagement, limiting the ability to draw consistent patterns of predictors of engagement. Evidence linking engagement to youth mental and behavioral health outcomes was similarly limited. Although module or session completion was the most common metric, studies varied in how engagement was further defined and applied. This heterogeneity poses challenges for comparing engagement rates across studies, but individual studies provide emerging evidence of potential ways to increase engagement within self-directed programs (e.g., phone coaching, ordering of content). Overall, this review underscores the need for further research as eHealth interventions continue to be offered to parents.

Depression and substance use are often comorbid, but less is known about these associations in non-clinical community samples. Moreover, existing research is primarily cross-sectional or focuses on long-term trajectories of depressive symptoms and substance use. The present study examines within-person associations to estimate the extent to which monthly fluctuations in depressive symptoms relate to alcohol and cannabis use. A community sample of 778 young adults (M_age = 21.1 at baseline, 56% female) completed up to 33 monthly surveys (82.7% total response rate) scattered across a 6-year period (2015-2021). Zero-truncated regression was used to stratify associations with any use and amount of use on months that alcohol and cannabis were reported, respectively. Pertaining to alcohol use, depressive symptoms predicted lower odds of drinking alcohol on a given month; however, if young adults did drink, then depressive symptoms predicted heavier drinking (i.e., more drinks per week). For cannabis, depressive symptoms predicted both greater odds of using cannabis and heavier use in that month (i.e., greater hours high per week). Associations between depressive symptoms and alcohol/cannabis quantity indices were mediated by coping motives. Findings highlight the risks of elevated depressive symptoms for young adults, in terms of alcohol and cannabis use.