Prevention Science最新文献

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.

Early identification and intervention support for children with disabilities improve their cognitive, educational, and social outcomes. Studies show that disability identification varies by child race and ethnicity, with children from historically marginalized populations being less likely to be identified during early childhood, where identification tends to happen in the community. One major factor that varies across communities is their resources, broadly defined as the environmental, social, and economic factors within a geographically defined area. While extensive evidence exists noting inequitable distribution of community resources by race and ethnicity, little research has examined whether community resources are associated with differential early disability identification rates. This study explored the association between the availability of community resources and early disability identification and whether it varied by child race or ethnicity. Leveraging 2019 statewide data collected through the Virginia Department of Education (VDOE), we combined information about 91,210 incoming kindergarteners with the Child Opportunity Index 2.0 (COI), a measure of community resources known to be associated with child development. After controlling for multiple covariates, children entering kindergarten at schools in higher-resourced communities were more likely to be identified with a disability prior to kindergarten. Although access to community resources and early disability identification rates varied by child race and/or ethnicity, the interaction effect was not significant. This study has implications for viewing community resources as potential malleable factors to address children's varying needs prior to the start of formal schooling.

Program adaptations or modifications are often necessary to suit local contexts, populations, and resources available. Despite the frequency with which program modifications are made in practice, they are rarely systematically recorded and reported comprehensively, particularly in the context of scale-up delivery led by implementers and in low- and middle-income countries. We use the FRAME framework to document the modifications of a parenting program called Parenting for Lifelong Health for Parents and Adolescents, locally known as Furaha Teens, which was delivered to over 30,000 families in Tanzania in 2020-2021. We draw on thematic analysis of 12 focus groups and 67 semi-structured interviews with program facilitators, coaches, coordinators, and managers (164 participants). Both proactive and reactive modifications were made to the program context and content. Proactive modifications included delivering the program as part of a wider package of services for families with adolescent girls, focused on HIV prevention, and adding HIV-related content. Both proactive and reactive modifications were made to make the material more acceptable to participants, such as by translating into local languages. Modifications to condense the number and frequency of sessions were reactively made by implementers to meet delivery timelines, particularly due to COVID-related closures. Study findings suggest that a range of program modifications may be required to scale programs to large cohorts as well as new contexts. To ensure successful delivery at scale, funders can support implementers in learning from the modifications and encouraging reflection on whether and how modifications affect program fidelity.

The objective of this study is to examine cross-over effects of the Raising Healthy Children universal childhood preventive intervention on adult suicide behaviors and related mental health. A nonrandomized controlled trial was conducted in elementary schools serving higher-risk areas in Seattle, Washington (during ages 6-13, grades 1-6) and followed up at ages 21-39. The panel originated in Seattle but was followed in and out of state. This study examines participants who had been in the intervention (n = 156) vs. control (n = 220) conditions in grades 1-6. The intervention provided teachers with methods of classroom management, parents with family management skills, and children with social-emotional skills training. Outcomes examined were ever suicide ideation, attempt, or completion, and DSM-IV-based criterion counts for depression, generalized anxiety disorder, PTSD, and social phobia across 6 waves, ages 21-39. At follow-up, the intervention group showed significantly lower suicide ideation and behavior, depression, generalized anxiety disorder, PTSD, and social phobia than the control group. Universal childhood preventive intervention can reduce suicide ideation and behaviors and related mental health problems in adulthood. Clinical Trials.gov ID: NCT04075019.

Mediating variables serve a primary role in devising intervention theories and applying them to practice. Prevention scientists have repeatedly called for understanding how and why an independent variable (X; e.g., intervention) is related to a dependent variable (Y; e.g., drug use). Quantitative mediation is used to describe mediating variables that intervene in the causal path from X to Y. Most methodological development for mediation analysis has focused on statistical methods and the assumptions necessary for valid application of these statistical methods. The current paper describes how qualitative methods extend into mediation research and the unique strength of qualitative mediation in identifying potential mediators and mechanisms of change not previously hypothesized. Taking examples from prevention research, we outline how qualitative mediation generates unique and complementary information about mediating mechanisms that may only be available through interviews, focus groups, observation, archival analysis, and other qualitative methodology. We briefly describe cautions when using qualitative mediation including reliance of retrospective reports, potential to influence interviewees, and selective sampling. We underline how qualitative mediation analysis is particularly well suited for exploratory studies and extracting mechanisms of action for new or adapted interventions in prevention science.

Schools' readiness appears an important factor influencing their implementation of violence prevention programs. This review was undertaken to identify, describe, and compare existing theoretical readiness models and their strengths and limitations, and to select an appropriate theoretical model to underpin the study of schools' readiness for child sexual abuse (CSA) prevention education. This, in turn, would guide development of a new instrument to assess schools' readiness for CSA prevention. Searches were conducted from September to December 2022 in ERIC, PsychINFO, PubMed, Science Direct, Sociological Abstracts, Web of Science, and Google Scholar, and handsearches were made in academic journals. We included peer-reviewed papers published in English that reported the development, testing, or use of a theoretical readiness model at an organizational level. We identified three candidate groups of theoretical models from 85 papers: the community readiness model, the multidimensional child maltreatment prevention readiness model, and organizational readiness for change theories. These models were appraised using four criteria for selecting implementation science theories and frameworks (Birken et al. 2017). We propose Weiner's (2009) organizational readiness for change as the most plausible theoretical model with both descriptive and analytical potential for assessing schools' readiness for child sexual abuse prevention education, and discuss the conceptual and empirical strengths and weaknesses of the identified models. The review has demonstrated the utility of applying criteria (Birken et al. 2017) to appraise and select theoretical readiness models in CSA prevention education and other implementation research areas.

Evidence-based program repositories have been designed to help practitioners in their decision-making. Most repositories supplement summaries of effectiveness evidence with information intended to assist with implementation of each included program (e.g., training costs). It is less common for guidance to be included to support translation of findings for a broader range of purposes, such as enhancing related programs already in place. To help address this gap within the area of youth mentoring, the National Mentoring Resource Center has appended "Insights for Mentoring Practitioners" to profiles of 47 mentoring programs included in the CrimeSolutions.gov repository of the National Institute of Justice. We qualitatively analyzed these commentaries to elucidate themes across them that can inform the development and improvement of mentoring programs. Themes included (1) ensuring alignment across program goals, design, implementation, and evaluation; (2) connecting the intervention to mentees' home, parents, and larger environment; (3) tailoring mentor engagement and support to effectively serve youth; and (4) optimizing the role of mentoring within multi-component programs. Discussion focuses on how findings inform the improvement of mentoring programs, and how content geared toward the translation of evidence to practice could enhance and improve evidence repositories.