Prevention Science最新文献

We adapted the Family Check-Up Online (FCU-O) (1) to support families coping with pandemic-related stressors to prevent behavioral and emotional problems among middle school youth and (2) for smartphone delivery to increase access and reach during the COVID-19 pandemic. This study evaluated the direct and indirect effects of the adapted FCU-O at 4-months post-baseline. The FCU-O combines online parenting support with telephone coaching. Participants were primary caregivers of children ages 10 to 14 years. Eligibility included endorsing depression on the PHQ-2 or significant stress on a 4-item version of the Perceived Stress Scale. We randomly assigned participants to the adapted FCU-O (N = 74) or a waitlist control condition (N = 87). Participants predominantly self-identified as female (95%), 42.77 years old on average, and White (84.6%). Outcomes included caregiver reports of perceived stress and parenting, and youth conduct problems and depressive symptoms. Using a multilevel modeling approach, we tested intent-to-treat intervention effects at 4-months, with time points nested within participants. The FCU-O reduced caregiver stress and improved proactive parenting and limit setting but had no effects on youth outcomes. Effect sizes were small to moderate (Cohen's d ranged from .37 to .57). We examined indirect effects on youth outcomes at 4-months via changes in caregiver stress and parenting at 2-months. Mediation analyses suggested indirect effects on youth depressive symptoms via reductions in caregiver stress and increases in proactive parenting. Results indicate the FCU-O has potential as a public health intervention for families facing extreme stressors such as those during the COVID-19 pandemic. ClinicalTrials.gov Identifier: NCT05117099.

The COVID-19 pandemic instigated changes in almost all aspects of youth's life. While numerous studies have been implemented to understand how these changes are related to youth's development, few concerned large representative samples. This study introduces the methodology and initial results of the Quebec (Canada) Resilience Project (QRP), a representative longitudinal study. The QRP encompassed three phases: (a) 2017 census survey assessing school readiness in kindergarteners before the pandemic (n = 83,335, aged 6 years); (b) 2021 questionnaire study assessing family functioning during COVID-19-related lockdowns (n = 4524, aged 10 years); and (c) 2022 questionnaire survey assessing children's school performance and mental health post-lockdowns (n = 8217, aged 11 years). In total, 3871 children were assessed either by parents or teachers in the three phases. We explored factors associated with children school performance (maths, reading, and writing) and mental health (emotional, withdrawal, hyperactivity/impulsivity/inattention, and conduct problems symptoms). Population weights were estimated from census data to maintain the representativeness of the population. School readiness vulnerability in kindergarten and parental anxiety and depression during lockdowns were associated with both children's lower school performances and higher levels of all mental health symptoms post-lockdown. Loss in family income and parental difficulties in maintaining work-life balance during lockdowns were associated with children's lower school performance and higher levels of some mental health symptoms (emotional and hyperactivity/impulsivity/inattention) post-lockdown. The results underscore that pandemic-related disruptions were negatively associated with children's school performance, emphasizing the need for interventions in the school environment. Associations between pandemic-related disruptions and children mental health were less consistent yet emphasize the importance of parental mental health.

Black youth in New Orleans experience some of the highest rates of violence in the US. Although Youth Participatory Action Research (YPAR) is recognized as an effective tool for empowering young people and fostering social change, its application in violence prevention remains an area worthy of further application. This case study presents a YPAR-based program designed to address structural issues, including racism, discrimination, and economic disinvestment, that contribute to youth violence. The Enrichment to Empowerment (E2E) program provides a platform for youth to advocate for systemic change in their communities. This paper offers actionable insights into equity-centered approaches for violence prevention, highlighting the potential for YPAR programs as a strategy for addressing complex, community-driven issues through youth-led initiatives.

Cognitive-behavioral treatments (CBTs) for adolescents with ADHD demonstrate promise of long-term effects on outcome. However, their implementation in routine care community clinics faces barriers that impact quantity, efficiency, and quality of delivery, as well as client outcomes. This study is a randomized controlled trial designed to evaluate the impact of an AI-assisted service delivery model on therapist implementation of Supporting Teens' Autonomy Daily (STAND), a CBT blended with Motivational Interviewing (MI) for adolescents with ADHD. Adolescents with ADHD (N = 51), who were clients at three community mental health agencies, received treatment from 23 therapists. There was randomization of adolescents and therapists to AI-assisted or standard implementation supports. In addition to standard supports (i.e., training, standard facilitation resources, technical assistance, case supervision), AI-assisted support package included digitized facilitation resources housed in a clinical dashboard (Care4), feedback on content fidelity, and AI-generated feedback on MI implementation quality. The AI-assisted group was associated with more efficient treatment delivery and lower number of appointments attended by the adolescent. There was also a significant decrement in MI quality over time in the AI-assisted group compared to the standard support group. Feedback in focus groups indicated that therapists perceived a task-oriented mindset to be associated with receipt of the AI-assisted support package, leading therapists to prioritize efficiency over relational aspects of therapy. Following the results of this trial, a future, larger RCT should examine the impact of the AI-assisted implementation model on mental health outcomes and cost savings to organizations, third party payers, and clients. Trial registration number: NCT05135065; https://www.clinicaltrials.gov ; Registered September 2021.

In 2020, firearm violence became the leading cause of death for American children and teens, a critical datapoint informing the 2024 U.S. Surgeon General's advisory on firearm violence. However, firearm violence has been a leading cause of death for Black youth-particularly, Black males-for decades, disproportionately impacting their morbidity and mortality. As the rights of Black youth to experience safety from firearm violence converge with the interests of white youth now increasingly impacted by it, it is imperative that prevention scientists critically interrogate what contributes to the national willfulness to see Black youth as perpetrators of violence deserving of punishment and a national reluctance to see Black youth as victims of violence deserving of healing and prevention? Guided by the Cycle of Dehumanization framework, we contend this pattern is symptomatic of racial dehumanization, a root cause of structural racism and violence. We argue that to successfully prevent youth firearm violence using a structural approach, we must disrupt dehumanizing narratives about Black male criminality and offer a viable solution through our visual storytelling and narrative change campaign, In All Ways Human. Using an adapted community engaged participatory action research approach and qualitative interviewing, our multimodal narrative change project captured 50 strategically disseminated (mural, billboards, kiosks, exhibits, digital galleries) portraits and stories that construct a counter-narrative with the power to prevent youth violence by transforming the ways in which Black males are seen, see one another, and see themselves. The impact and future directions of our narrative change effort are discussed.

Mediation analysis is essential for understanding causal mechanisms and designing effective policy interventions. This paper explains a comprehensive framework for implementing VanderWeele's (2009) three-way decomposition using natural effect models (NEM), focusing on its application in health equity research. While three-way decomposition helps social epidemiologists understand how social exposures influence health outcomes through differential mediator effects, its implementation through NEM has not been fully utilized. Using the R package medflex to implement NEM, we demonstrate the methodology through two case analyses: healthcare expenditure disparities between Medicaid beneficiaries and health insurance enrollees using continuous outcomes, and racial/ethnic disparities in preterm birth using binary outcomes. We provide detailed interpretations of NEM estimates in terms of three-way decomposition and discuss methodological considerations for researchers designing health policies to reduce disparities.

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.