Prevention Science最新文献

The Good Behavior Game (GBG) is a team-based classroom management intervention developed to mitigate disruptive behaviors and promote prosocial behaviors of school-aged children. While the short-term benefits of the GBG are well documented in meta-analyses and systematic reviews, it is less clear for what long-term outcomes the GBG may reduce risk. The goal of this systematic review was to synthesize findings across papers that evaluated the long-term effects of the GBG. A total of 22 papers from 5 original studies examining the influence of the GBG on a myriad of distal outcomes across the lifespan were identified by our search and met inclusion criteria for this review. Distal outcomes were assigned confidence in evidence indicators (i.e., strong, moderate, mixed, no evidence) and we specified for what developmental period and participant subgroup GBG treatment effects were found. Results revealed that there is strong evidence the GBG decreases the risk of tobacco use in late adolescence. There is also moderate evidence that the GBG prevents the progression of disruptive/aggressive behaviors from developing into more severe forms of externalizing behavior (e.g., antisocial/criminal behavior) among persistently aggressive children. When paired with a curriculum enhancement, the GBG is more likely to bolster math/reading achievement, thereby increasing the likelihood of college attendance especially for women. Additional outcomes showed moderate evidence (e.g., illicit substance use, prosocial behaviors, suicidal behaviors) whereas other outcomes showed mixed to no evidence (e.g., social acceptance, alcohol use). Given only a handful of these outcomes have been tested by independent researchers across developmental periods, more replication studies are needed to fully appreciate the GBG's long-term impact on less studied outcomes.

The novelty of the college transition places older adolescents and emerging adults at increased risk for engaging in substance misuse. Preventive interventions such as First Years Away from Home, a self-directed handbook intervention, can teach caregivers effective strategies for preparing their student for this transition. Responsiveness (i.e., participants' engagement and interest in an intervention), is one implementation dimension that can impact participant outcomes and can be improved by selecting appropriate implementation strategies (i.e., methods that aim to improve implementation outcomes; IS). Using a person-centered analytic approach, this study examines classes of responsiveness to First Years Away from Home among caregivers of first-year college students with data from 543 dyads randomly assigned to two intervention conditions (Handbook, Handbook +) who were exposed to two ISs in the randomized controlled trial. Handbook and Handbook + caregivers had access to a Transition Support Specialist (IS #1) the summer prior to students moving to campus, and Handbook + caregivers received booster messages (IS #2) to remind them of the handbook content throughout the students' first year in college. A multiple group latent class analysis was conducted to identify classes of responsiveness and determine whether the classes differ by Handbook condition. Responsiveness classes were then used to predict any past 30-day student alcohol, cannabis, or simultaneous alcohol and cannabis use during their first semester. We identified four distinct classes of responsiveness among caregiver-student dyads (Non-Responders, Discontinued Average Responders, Average Responders, High Responders). Moreover, class membership varied across Handbook conditions and Average Responders reported any drinking significantly less than Non-Responders in the Handbook + condition. Implications for implementation of self-directed interventions and addressing varying ways participants respond to interventions are discussed. ClinicalTrials.gov Identifier: NCT03227809.

Individuals who identify as transgender/gender diverse face an increased risk of discrimination, particularly in health care settings. This discrimination has been associated with higher odds of substance use coping and attempting suicide. However, risk and protective factors that can moderate this relationship remain under-evaluated. The present study examines the role of LGBTQ-friendly state policy climates in preventing discrimination-based outcomes of substance use coping and attempting suicide in the transgender/gender diverse community. Data from the 2008-2009 National Transgender Discrimination Survey were merged with state policy climate scores. Policy climate scores were derived from the tracking of legislation through the Movement Advancement Project. Participants were asked about using substances to cope, prior suicide attempts, and three types of discrimination at mental health clinics (denied equal treatment, verbal harassment/disrespect, physical assault). Being denied equal treatment or service and being verbally harassed or disrespected were both associated with increased odds of using substances to cope and attempting suicide. Residing in a more LGBTQ-friendly policy climate moderated the relationship between being denied equal treatment and a prior suicide attempt as well as the relationship between verbal harassment and both suicide attempt and use of substances to cope. Findings underscore the potential of LGBTQ-friendly policy climates to serve as a protective factor against discrimination faced by the transgender/gender diverse community. A greater understanding of the role of policies in the relationship between discrimination and adverse outcomes can help form policy-based prevention in an effort to improve the lives of individuals in the transgender/gender diverse community.

Converging evidence underscores the influence of structural racism on the emergence of externalizing behaviors among Black youth. Recent studies suggest that family-centered prevention may attenuate some of the effects of structural racism on youth mental health. Hypotheses were tested regarding the potential of the Strong African American Families (SAAF) preventive intervention (ClinicalTrials.gov Identifier: NCT03590132) to (a) attenuate the influence of structural racism on low self-regulation, (b) attenuate the influence of low self-regulation on externalizing behaviors, and (c) disrupt the pathway from structural racism to externalizing behaviors via low self-regulation. Hypotheses were tested with data from 472 Black youth (mean age = 11.61 at pre-test) and their caregivers participating in a randomized prevention trial. Structural racism was indexed according to a cumulative risk model based on census-level indicators of Black-White disparities in labor force participation, housing, educational attainment, poverty, and a measure of racial segregation. Consistent with hypotheses, we found that SAAF buffered the influence of structural racism risk on low self-regulation. A significant buffering effect was not detected on the path from low self-regulation to externalizing behaviors. Conditional indirect effect analysis suggested that attending SAAF disrupted the pathway linking structural racism to externalizing behaviors via low self-regulation. Study findings underscore the potential benefits of widespread dissemination of family-centered prevention targeting evidence-based protective processes designed for Black youth. Clinical Trial: Registered at Clinicaltrials.gov, NCT03590132, July 5, 2018.

Poor mental health affects millions of parents and caregivers each year. In the absence of intervention, the duration and magnitude of mental health symptoms can have an adverse impact on parent and caregiver well-being, parenting practices, and subsequent children's development. Although home visiting is hypothesized to impact parent mental health, most studies do not demonstrate sustained benefits over time. Family Connects (FC) is a short-term, universal postnatal nurse home-visiting program designed to support children and families. Evaluations of FC demonstrate 6-month impacts on parent mental health, but longer-term (5-years post intervention) benefits have not been investigated, nor the potential mechanisms of the sustained effect. Every resident birthing family in Durham, NC, over an 18-month period (total n = 4777) was randomly assigned by birth date to FC or control condition. Implementation was strong, allowing an intent-to-treat evaluation of the model on maternal mental health. At infant age 60 months, a random, representative sample of parents (FC n = 201; control n = 200) was interviewed by condition-blind researchers with two screening instruments, the Center for Epidemiological Studies Depression Scale (CES-D) and the Mental Health Continuum scale (MHC - SF). Regression analyses with relevant covariates tested hypothesized (one-tailed) effects on these self-report scales. Parents randomly assigned to FC were significantly (p < .02) less likely to receive a depression score in the clinical range, reported a lower number of depressive symptoms (p < .04), and received better scores for social well-being (p < .04). Quality of the home environment (p < 0.10) was a significant mediator of intervention impact on later parent mental health.

Adolescents living with HIV (ALHIV) have low adherence to antiretroviral therapy (ART). Poverty and mental health challenges remain major drivers of this poor ART adherence. We explored the mediators of the impact of an economic empowerment intervention on ART adherence among ALHIV and assessed the moderating effects of depression. We randomized 39 clinics (702 participants) into the control or intervention groups. Participants were aged 10-16, living with HIV and taking ART. The intervention comprising matched savings account, financial literacy training, and microenterprise workshops. We fitted a sequential structural equation model to examine how the three mediators-HIV stigma, barriers to medical care, and healthcare transition readiness-influenced ART adherence at year seven. Depression was included as a moderator. At baseline, the mean age was 12 years, and only 73.0% achieved good adherence (≥ 90%). The intervention directly improved ART adherence, β = 0.060 (95% CI: 0.038, 0.081), p < 0.001. Also, there was a significant indirect effect of the intervention on ART adherence, mediated through barriers to medical care, β =  - 0.036 (95% CI: - 0.041, - 0.032), p < 0.001, and HIV stigma, β =  - 0.011 (- 0.016, - 0.007), p < 0.001. Depression reduced the effect of the intervention on ART adherence β =  - 0.114 (- 0.123, - 0.104), p < 0.001. Our results showed that providing ALHIV with financial resources improved their ART adherence; however, this was affected by depression. Therefore, programs aimed at improving outcomes in ALHIV should consider incorporating interventions that address mental health challenges in addition to poverty.

Alcohol prevention research for college students has resulted in numerous efficacious approaches, but the timeline from development to implementation is long. The College Alcohol Intervention Matrix (CollegeAIM) is a dissemination and implementation tool developed in 2015 and updated in 2019 to aid in the selection of evidence-based alcohol prevention strategies for higher education settings. The present study is the first to examine the use and perceptions of the CollegeAIM tool. Student affairs professionals (N=142) across 23 campuses in a statewide prevention coalition participated in a survey examining CollegeAIM with a focus on implementation outcomes and areas for actionable change. Campuses also provided their prevention strategic plans. Survey data were analyzed via calculation of descriptive statistics. Strategic plans were analyzed via content analysis techniques. Approximately one-third (38%) of participants had heard of the CollegeAIM, but many reported the tool felt unfamiliar and were largely unaware if their departments used the tool to select strategies (16% reported personal use). Over half considered CollegeAIM to be feasible, appropriate, and acceptable for selecting strategies, and CollegeAIM was largely considered to be comprehensive, helpful, and user-friendly. Content analysis of strategic plans revealed that independent of CollegeAIM use, many strategies listed in CollegeAIM were planned for implementation, including many supported by weak evidence. Within one statewide prevention coalition, the CollegeAIM is well-received though is not as widely used by higher education professionals as it could be and has potential for increased uptake with additional dissemination efforts. Recommendations for CollegeAIM use and training are provided.

People with physical disabilities experience higher rates of secondary health conditions and often have difficulty accessing healthcare and other resources to manage these conditions compared to the general population. Centers for Independent Living (CIL), community-based, non-profit, non-residential centers, are uniquely poised to facilitate the health promotion of individuals with disabilities. This project aimed to develop and provide an 8-week structured and individualized program for CIL staff to facilitate the management of secondary health conditions through setting and pursuing SMART goals with adult consumers with physical disabilities. Researchers developed and pilot-tested the Health Access for Independent Living (HAIL) program in consultation with CILs and designed it to fit within the existing CIL service delivery system. The HAIL program was developed and piloted sequentially with two cohorts of 12 CIL staff members and 23 consumers with physical disabilities in Kansas and Pennsylvania communities. The HAIL program helped 82.3% of participants achieve their health goals at their expected level and led to fewer perceived barriers to managing their health. The HAIL program provided a structured program for CIL staff to assist adult consumers with physical disabilities in managing their health and fit well into the CIL service delivery system.

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.