Prevention Science最新文献

Selective preventive interventions aim to reduce mental illness in high-risk populations, yet the reasons why some children benefit while others do not remain unclear. This study explores participants' perceptions of mechanisms contributing to change in a family-based preventive intervention for children of parents with severe mental illness. Using an exploratory sequential mixed methods approach, we conducted an abductive qualitative analysis of focus groups (eight parents, eight children) to identify narratives of mechanisms contributing to change. The qualitative findings informed a subgrouping variable for a quantitative post hoc exploratory subgroup analysis of secondary data from the VIA Family trial (N = 110). The qualitative findings indicate that child mental health problems, parents' personal unmet needs from childhood, children's relatedness to peers and family, and contextual family-focused activities contribute to change within selective prevention. Quantitative results indicated that parents motivated by a need for support at baseline exhibited meaningful improvements in the home environment upon enrollment in the experimental preventive intervention compared with families motivated to support science (mean change: 5.07, 95% CI 2.11 to 8.03). However, no significant subgroup differences were observed in changes in children's global functioning between the allocation groups. Parents' perceived need for support facilitated engagement and home improvements, while children's relatedness to peers and family contributed to their intervention experiences. These findings emphasize the importance of motivation and social connections in intervention outcomes, contributing to the growing field of precision prevention. Future research should explore these mechanisms as potential mediators or mechanisms of action for selective prevention. ClinicalTrial.gov Identifier: NCT03497663.

This study explores long-term maintenance of family income levels in families receiving parent training for disruptive child behaviors. We use data from the Danish implementation of the Incredible Years Parent training (IYPT) across 21 municipalities from 2012 to 2019. Utilizing a quasi-experimental design with matching of a subsample of 707 out of the 1229 families from the Danish IYPT sample with 690 control families drawn from the national registers, we compare annual disposable family income in intervention families with the background population and control families from 2 years before to 4 years after pretest. Our findings reveal that intervention families and control families had significantly lower annual disposable family income than the background population families across all time points. For intervention families, the financial gap from the background population families widened from USD 11,268 to USD 16,694 from the first to the last time point. Adjusted regressions comparing intervention families to control families found a small but significant financial gap, so that intervention families had USD 2189 less to their disposal per year from the first time point and USD 7596 less per year at the last time point. These results suggest that intervention families faced increasing financial strain from years before up to 4 years following the IYPT, both in relation to the general Danish population and to the matched control of socioeconomically similar families across an 8-year span. We suggest that this could reflect continued stress and disruption of work schedule due to child behavior problems. Regardless of the underlying mechanism, these findings underscore the importance of considering the long-term economic contexts of families with disruptive child behaviors. Societal strategies that address both parenting challenges and broader contextual inequalities may be needed to support healthy child development.

The Ask-Suicide Screening Questions (ASQ) is a validated tool developed to assess suicidal risk in pediatric medical settings with one item assessing historical attempts. While the psychometric properties of the ASQ are well-established, little is known about how youth respond to this question upon repeated administrations. We conducted a retrospective analysis of electronic medical record data by youth who received the ASQ from December 2019 to November 2023 at an urban academic children's hospital. Youth who disclosed a suicide attempt but denied an attempt history at a subsequent visit were identified. Multivariate regression and manual chart review were utilized to identify demographic and clinical variables related to non-disclosure of a previously disclosed attempt. Of 1861 encounters (1460 unique patients) with a disclosed historic suicide attempt, re-screening occurred in 503 future encounters. One hundred forty instances of nondisclosure occurred (127 unique patients). Encounters were classified into false positives (N = 26), encounters where nondisclosure by patients did not impact clinical response (N = 40), and encounters where nondisclosure resulted in no further suicide risk assessment (N = 74). Of this last group, 47.3% received no risk assessment at the initial visit. Compared to the initial visit, the nondisclosure visit was more likely to have a medical presenting complaint and to have negative responses on ASQ questions related to recent suicidal ideation. Denial of a historic attempt upon repeat administration of the ASQ is not uncommon among pediatric patients, and this is more likely to occur at an encounter for a medical presenting complaint.

The current study examined age-varying patterns of cannabis use, cannabis-specific risk factors, and their associations across young adulthood. We used repeated cross-sectional data from young adults (N = 15,251; M_age = 22.02 years, SD_age = 2.22; 68% female) who enrolled in the annual, statewide Washington Young Adult Health Survey between 2015 and 2022. Logistic time-varying effect models showed that cannabis use increased from ages 18-22 and remained relatively stable through age 26. Most cannabis-specific risk factors increased gradually across young adulthood, although perceptions of cannabis use acceptability (injunctive norms) increased substantially through age 23 followed by decreases. Ease of obtaining cannabis, perceptions about others' use (descriptive norms), and low perceived physical harm were generally associated with any past-month cannabis use with stronger associations around age 18. Injunctive norms and low perceived psychological harm were consistently associated with past-month use across young adulthood. Ease of obtaining cannabis, injunctive norms, descriptive norms, and low psychological harm were associated with frequent cannabis use across young adulthood with associations strongest prior to age 21. Low perceived physical harm was associated with frequent use across young adulthood with associations getting somewhat stronger across ages. Findings underscore the importance of focusing on cannabis-specific risk factors in preventive intervention efforts over the course of young adulthood, including focus on young adults in their mid- 20 s in the context of legalized cannabis.

We used coincidence analysis to explore whether various forms of gender-affirming care (GAC) in the presence or absence of medical mistrust facilitate HIV pre-exposure prophylaxis (PrEP) use and adherence. Using secondary data collected between 2014 and 2024 from the RADAR Cohort Study, we performed two crisp-set coincidence analyses with 86 trans feminine young adults for PrEP use and 24 trans feminine young adults for PrEP adherence. Our final model for PrEP use explained over 90% of participants who had used PrEP in the past 6 months with 60% consistency. This model identified receipt of hormone replacement therapy (HRT) OR being on parental insurance as predictors of PrEP use. We identified two final models for PrEP adherence, which explained 50% of participants with 83% consistency: (1) past receipt of puberty blockers OR high suspicion of medical providers in the absence of parental insurance; (2) current or past receipt of HRT in the absence of barriers to GAC and the absence of parental insurance. Our study highlights the significant role of GAC in facilitating PrEP use and adherence among trans feminine individuals. Specifically, HRT and the absence of parental insurance emerged as key predictors, underscoring the need for integrated and accessible GAC to enhance PrEP uptake and adherence in this population.

School-based mindfulness programs (SBMPs) have shown a range of academic, emotional, and behavioral outcomes. However, heterogeneity in curricular content obscures accurate interpretation of results. To unpack the "black box" of SBMPs and better contextualize intervention outcomes, this investigation examined the practices, skills, and knowledge conveyed in twelve curricula. Required curricular elements (CEs) from the written curricula were coded for mindfulness practices and skills, and lessons were coded for mindfulness knowledge conveyed. Curricula had a different composition of components depending on theoretical foundation and program length. All curricula included intrapersonal (i.e., individual) practices, most often engaging somatic awareness. Interpersonal (i.e., relational) practices were identified in eight curricula and were infrequent, except in two programs that focused on kindness/compassion. All curricula cultivated intrapersonal skills of focused attention, emotion awareness, and emotion regulation at varying levels. Programs derived from MBSR cultivated the highest proportion of skills focused on awareness of mental states. Longer programs had a significantly higher proportion of CEs focused on interpersonal skills compared to shorter programs. Longer programs also had a higher proportion of lessons concentrated on focused attention and on empathy/perspective taking. Knowledge conveyed in lessons did not always correspond to the practices and skills coded, indicating students may be learning about topics even if they are not actively practicing or engaged in skill cultivation. This study offers clarity regarding the curricular content of SBMPs, making it possible to investigate links between active ingredients and program outcomes, refine theories of change, and better prepare teachers facilitating SBMPs.

Community advisory boards bridge the gap between researchers and community members to yield the most informed and successful implementation of prevention services. Youth community advisory boards demonstrate the same research-community member benefit but forming them presents unique challenges that often limit their use. In this article, we present lessons learned from a participatory research study in which we engage young people with problematic sexual behaviors (PSB) in an anonymous community advisory board and interviews. After completing a survey, 16 interview participants and five advisory board members aged 14-21 with PSB were interviewed about the research process, providing insights into survey clarity and participant experiences. Data were analyzed using content analysis to identify key themes. Seven themes emerged from qualitative data analyses. Young people with PSB strongly support research on PSB and they are willing to discuss about sensitive and stigmatized topics. They are not harmed by engaging in these discussions and are capable of providing consent for their participation. Ensuring confidentiality is vital to creating a safe and ethical research environment. Creative communication methods are valuable for building trust and facilitating engagement, while establishing clear boundaries between researchers and participants is essential to maintaining professionalism and respect throughout. Limitations include small sample size, lack of early advisory board involvement, and constraints about participant verification and demographic data. This study highlights not only how to involve a vulnerable, at-risk community of young people in community-based participatory research on a highly stigmatized topic, but also the many benefits of this approach.

Mind-body interventions involve practices that intentionally combine mental and physical fitness, showing promise for improving psychological and cognitive health in older adults. Limited research exists on adherence to these interventions and the demographic and psychosocial factors that may predict variability in compliance. In the current study, we identified key correlates-demographic, psychosocial, and cognitive-of adherence to two mind-body interventions. Baseline and intervention data were analyzed together from a randomized controlled trial of older adults who participated in two four-week mind-body interventions and completed practice logs (n = 60). Adherence was defined as the average weekly self-reported minutes of homework practice during the intervention. Baseline correlates included education, sex assigned at birth, working memory score, emotion dysregulation, positive and negative affect, trait mindfulness, and depression. Partial least squares regression was used to identify latent components. A significant one-component solution from the final model explained 23.08% of the variance in practice minutes. Greater adherence was associated with mild depressive symptoms, difficulties with emotion regulation, and lower working memory scores. These findings suggest that participants with mild emotional and cognitive difficulties may be more likely to adhere to mind-body interventions. These results emphasize the target population likely to engage in mind-body interventions and may be valuable for designing tailored interventions and developing strategies to maximize adherence. This study was registered on ClinicalTrials.gov (#NCT03432754) on February 14, 2018.

We examined the associations of impulsivity, sensation-seeking, and peer electronic nicotine delivery systems (ENDS) use on longitudinal changes in ENDS use frequency across ages 19-29 years old. Data were drawn from a larger multi-wave study of college students in Texas. Participants were 1227 initially 19-25-year-old young adults who currently used ENDS at least once across six waves (baseline: fall 2015, final wave: spring 2019). At baseline, participants were 21.3 years old on average, 43.6% male, 35.5% non-Hispanic White, 32.5% Hispanic/Latino, 16.2% Asian, 6.7% Black, and 9.1% another racial/ethnic identity. Growth curve modeling with an accelerated longitudinal design was used to test direct and interactive associations of age, impulsivity, sensation-seeking, and peer ENDS use on ENDS use frequency across young adulthood, 19-29 years old. Findings indicated that the trajectory of ENDS use frequency increased with increasing age. Impulsivity, but not sensation-seeking, was associated with an increase in ENDS use frequency across increasing age. Impulsivity and sensation-seeking significantly interacted with peer ENDS use: those high in impulsivity or sensation-seeking used ENDS less frequently as they aged when they had fewer peers who use ENDS, and those high in sensation-seeking used ENDS more frequently when they had more peers who use ENDS. Peers play an important role for young adults with impulsivity and/or sensation-seeking-having few peers who use ENDS was protective of escalations in ENDS use, and having more peers who use ENDS increases the risk for escalations in ENDS use for those high in sensation-seeking only.

This study evaluates El Camino, a goal-setting sexual health promotion program developed for Latino youth. A cluster randomized controlled trial was conducted in grades 9-12 in 68 classrooms (n = 746 students) across 11 schools in Maryland with large populations of Latino students. A total of 208 students were lost to follow-up, leaving 538 students for an intention-to-treat analysis (El Camino, 34 clusters, n = 289; control, 34 clusters, n = 249). At baseline, most participants (72.1%) reported never having had vaginal sex and no sex in the last 3 months (84.4%). This study did not detect any significant intervention impacts on sexual behavior outcomes but found impacts on several proximal sexual health outcomes. At post-test, approximately 1-2 weeks after curriculum completion, scores were significantly higher among El Camino participants compared to control participants on measures of contraception knowledge (β = 0.5 (cluster robust SE 0.1)), condom knowledge (0.4 (0.1)), consent knowledge (0.3 (0.1)), and awareness of birth control methods (0.9 (0.1)), as well as confidence to discuss sex with a partner (0.3 (0.1)). A total of 84.7% of El Camino participants reported positive attitudes toward condom use compared to 67.1% of control participants (OR = 2.7, 95% CI [1.8, 4.0]); 83.1% reported intending to use condoms if sexually active compared to 72.6% of control participants (1.9, [1.2, 2.9]); 80.9% reported knowing where to get birth control compared to 48.9% of control participants (4.4, [2.8, 7.0]), and 83.3% reported being confident to state and ask for consent compared to 70.5% of control participants (2.1, [1.2, 3.7]). This study also found that intervention impacts varied by student gender and program implementation factors. Overall, El Camino appears to be effective in improving sexual health knowledge, self-efficacy, and intentions among Latino youth.Trial registration: Clinicaltrials.gov NCT06485284. Date 7-3 - 24.