Prevention Science最新文献

The COVID-19 pandemic had disparate impacts on Black and Hispanic Americans, as observed in mortality and infection rates. The mental health impact of the pandemic is less clear, with little research exploring mental health disparities and differences by state and region. Using the Behavioral Risk Factor Surveillance System (BRFSS), state-level differences in unhealthy mental health days were examined between 2019 and 2021 for White, Black, and Hispanic respondents. Nonparametric tests assessed group differences in unhealthy mental health days, while state-level within- and between-group difference scores highlighted areas with the greatest disparities. Both White and Black respondents experienced significantly more unhealthy mental health days in 2021 than in 2019; though Hispanic respondents reported more unhealthy days in 2021 than in 2019, this finding was not statistically significant. Black respondents, but not Hispanic, reported significantly more unhealthy mental health days than White respondents in 2021. Missouri had the worst outcomes for Black respondents, with the greatest increase in unhealthy mental health days between 2019 and 2021 and the greatest difference between White and Black groups in 2021. Regionally, the Northeast had the best outcomes for Black respondents and the Midwest had the worst. These findings can help identify population groups and geographic areas most in need of disaster-preparedness efforts and policy interventions for future public health emergencies. Practitioners and state health officials can use these findings to identify potentially impactful community interventions, or to develop infrastructure for addressing community mental health.

Suicide has become the second leading cause of death among U.S. college students, exacerbated by COVID-19. A more comprehensive understanding of its risk factors can guide the development of effective prevention strategies tailored to this population. We employed a time-series cross-sectional approach and used the national survey data from the American College Health Association to examine the effects of institutional characteristics (school locale, region, size, and type) and behavioral factors (physical and social activities) on suicide risks among U.S. college students across different pandemic phases (before, early phase, and late phase). We also tested whether behavioral factors moderated the association between the pandemic period and suicide risk. After adjusting for confounders, multilevel regression results showed that (1) suicide risk increased during the pandemic, particularly in the late phase; (2) institutional characteristics, including geographic region and religious affiliation, as well as student behaviors such as physical and social activities, were significant predictors of suicide risks; and (3) behavioral factors moderated the pandemic's effect on suicide risk, as shown by the role of social activities (e.g., team sports, socializing with friends) amplifying the effect, whereas spending time with family mitigated it. Because risk rose fastest where certain social activities intensified pandemic effects, campuses should prioritize structured, lower-risk social engagement, while pairing selective strategies in high-activity settings (e.g., targeted screening, gatekeeper training) with universal measures (e.g., campus-wide suicide prevention program). Overall, this study offers evidence-informed guidance to shape campus environments that mitigate suicide risk and support student well-being, considering institutional context, behavioral factors, and public health crises.

A good understanding of the associations of COVID-19 infection and mortality with contextual factors when vaccines were not widely available is necessary for human societies to be better prepared for future outbreaks of infectious diseases. This retrospective ecological study aimed to explore the spatially varying associations of COVID-19 incidence, death, and case fatality rates with contextual socioeconomic, health, and environmental factors during the period of partial population coverage of vaccination at county level in the state of Georgia, USA. The associations of COVID-19 rates and contextual factors were analyzed using geographically weighted regression (GWR), compared with ordinary least squares regression (OLS) analysis. OLS results showed that most factors were significantly associated with COVID-19 death rate and case fatality rate, but not incidence rate. GWR results demonstrated that the associations of all three COVID-19 rates with factors varied across space: A factor might have a significant positive, significant negative, or nonsignificant association with each rate in certain counties. Most factors for poor health outcomes were significantly associated with higher risks of COVID-19 infection and mortality in more counties compared to non-significant or inverse associations. The spatially varying associations for some contextual factors were related to the socioeconomic and urbanization characteristics of counties. Some factors also affected COVID-19 infection and mortality differently. For example, persons aged 65 and older percentage was not a significant risk factor of COVID-19 infection in most counties, but it was the most spatially consistent risk factor of COVID-19 death in Georgia; fully vaccinated percentage was a more significant indicator of reducing COVID-19 infection in rural counties compared to urban and suburban areas. This study provides useful information for public health agencies and professionals to make and implement more specific and targeted local health policies.

Parental emotional socialization (PES) has been recognized as a critical mechanism in parenting programs to enhance children's well-being, especially following adversity. However, few studies have examined the potential moderating effect of baseline PES levels. This study aimed to examine whether supportive and unsupportive PES can mediate the intervention effects of a parenting program on child adjustment (Aim 1), and whether baseline PES can moderate the effect (Aim 2). This study utilized data from two randomized controlled trials for post-deployed military families (N = 335, Mage = 8.25, 54% girls). Families were either assigned to in-person intervention condition (n = 226) or a treatment-as-usual condition (n = 109). Baseline-targeted moderation mediation (BTMM) models were conducted for mothers and fathers separately, with child age, child sex, child minority status, family household income, and deployment length included as covariates. The parenting program had an indirect effect on child internalizing and externalizing problems 1-year post-baseline through reduced maternal unsupportive PES at post-intervention, while no indirect effect was found through supportive PES. Additionally, baseline PES moderated the impact of the ADAPT program on maternal supportive and unsupportive PES post-intervention, such that mothers who reported less supportive PES or more unsupportive PES at baseline benefited more. No intervention effect was found through fathers' PES. The findings underscore the crucial role of baseline PES in shaping behavioral parenting intervention effectiveness. The study highlights that one size does not fit all and future research and practice should consider the diverse needs and responses of families, emphasizing the delivery of personalized interventions to best meet parents' needs and maximize support.

Image-based sexual abuse is an increasingly prevalent form of technology-facilitated harm, yet disclosure rates remain low. Understanding why youth do not disclose image-based sexual abuse is critical for developing effective prevention and intervention strategies. This paper examined the reasons youth do not disclose image-based sexual abuse incidents and identified incident- and person-level characteristics associated with different nondisclosure motives. Participants were recruited online to this US-based cross-sectional study between June 28, 2023, and April 1, 2024, using social media advertisements targeting individuals aged 18-28. A total of 6204 individuals completed the survey; 2854 (46.0%) reported experiencing image-based sexual abuse before age 18. The analytic sample included 2522 incidents reported by 1551 participants that were not disclosed. The most frequently cited reasons for nondisclosure were fear of getting in trouble with family (53.9%), embarrassment (52.9%), and the belief that they could handle the incident alone (45.2%). Reasons varied by image-based sexual abuse subtype. Longer incident duration and explicit content were related to fear of getting into trouble with their family or the police, and having multiple people responsible was related to many reasons for nondisclosure (i.e., fear of getting in trouble, fear the person would find out, embarrassment, and feeling like no one could help) ,. Female participants and sexual/gender minority youth were more likely to report barriers specific to fear and shame. Prior victimization was associated with a greater belief that no one could help and fear of getting in trouble or the person finding out. Prevention should address common fears, challenge stigma and self-blame, and ensure youth have access to trusted adults and non-punitive disclosure options. These findings support clinical efforts to reduce barriers and promote safe disclosure pathways for these survivors.

This study examines changes in the conditions for social and emotional learning (SEL) implementation in California over the 2023-2024 school year, following approximately 3.5 years of CalHOPE Student Support. Grounded in the SHIFT-SEL model, CalHOPE aims to build statewide SEL infrastructure through a nested implementation support system, with County Offices of Education (COEs) positioned as key intermediaries. Educational leaders (507 in Fall 2023 and 386 in Spring 2024) reported on their well-being, workplace climate, and SEL implementation conditions. This study builds on prior work by including county, district, and school site SEL leaders in the analysis, enabling a broader examination of change across multiple levels of the education system. Cross-sectional comparisons showed that COE leaders reported more favorable conditions than district and school leaders, particularly in the extent of the supports they provided. Longitudinal analyses revealed small but significant improvements among district/school leaders in well-being, implementation supports, leadership capacities, and SEL structures and routines, while conditions at the COE level remained favorable. These findings suggest progress in infrastructure for SEL implementation support statewide and illustrate the potential of regional intermediaries for scaling prevention practice.

Addressing socio-demographic differences that affect mental health service encounters is crucial for ethical practice and enhancing therapeutic alliances. Yet discussing personal perceptions of socio-demographic influences within a large healthcare system can be challenging due to discomfort among staff and the need for engagement at both interpersonal and organizational levels. The SITE project sought to intervene on one healthcare system's mental health providers' willingness to discuss patient background during care coordination. An internal workgroup used intervention mapping enhanced with frameworks from socio-demographic-focused literature and implementation science. Data collection included surveys, interviews, and a participatory consensus process. The results were two multi-component intervention packages designed to address interpersonal and organizational barriers, each targeting providers' willingness and psychological safety in addressing patient-specific background factors with colleagues. The interventions were adopted by the setting and then later dissolved due to administrative shifts. While the resultant interventions are unique to this setting, we demonstrate a repeatable process for adapting a well-known intervention development method (intervention mapping (IM)) informed by theory and implementation science. This process can be applied in other healthcare systems for discerning multi-level interventions appropriate to different contexts.

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.

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.

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.