Journal of prevention (2022)最新文献

Childhood exposures to adversity are common and increase risk for negative health and social outcomes throughout the life course. There is limited evidence regarding interventions to prevent or reduce the impact of adverse childhood experiences (ACEs), particularly for families with multiple adversities. Here we present the findings of mixed methods research to co-design a complex intervention to prevent adverse childhood experiences, and their impacts. Using established research methods, and the framework of the Medical Research Council (MRC) complex interventions development guidance, the work was conducted in four stages, shaped by stakeholder engagement and input at every stage. The first stage, Discover, was exploratory and employed evidence synthesis and quantitative (n = 11,564) and qualitative (n = 31) research methods to understand needs, experiences, and evidence gaps. The Define stage developed three intervention principles and identified intervention options, through a series of six co-design workshops with 41 participants and an academic research team workshop. The Develop and Deliver stages were undertaken through a Policy Lab (22 participants), and developed options for intervention design, before converging on a defined intervention that could be delivered and tested. Through this process, we developed a 'village-style' intervention, which functions at three levels: individual service users, operational, and system/strategy. Central to this are link or community health workers who would build relationships with family members, and act as a single point of contact. They should develop an understanding of family needs and the interaction of multiple complex adversities, and advocate for families, facilitating access to services. Crucially, they should use this understanding to work at and feed into operational and strategic levels to reshape services and enhance access for all families at risk of or experiencing adversity. Entry into the intervention through assessments at existing universal touch points, for example at routine perinatal or newborn appointments, should provide a prevention focus and follow the principles of proportionate universalism. Sensitive enquiry regarding financial stress may be a component of the assessment, in response to the findings of this work regarding the contexts created through the interaction of poverty and other adversities. The proposed intervention is designed to improve individual and family outcomes, and generate positive system-level changes. A feasibility study and evaluation will be required in future work, to assess the effects, costs and benefits. The processes and frameworks we developed and used may provide an adaptable template for future intervention co-design work.

Parents influence their children's social development, including their susceptibility to peer pressure. Both parenting practices and peer pressure are associated with adolescents' basic needs for autonomy and relatedness, essential for healthy development. However, the mechanisms underlying these relationships require further exploration. Grounded in Self-Determination Theory, this study addresses the following questions: (1) How do different parenting practices (parental support, psychological control, and behavioral control) affect adolescents' autonomy and relatedness? (2) Do autonomy and relatedness mediate the relationship between parenting practices and susceptibility to peer pressure? (3) Does gender moderate the association between parenting practices and susceptibility to peer pressure? Structural Equation Modelling (SEM) was used to analyse data from 2156 Dutch adolescents (Mage = 14.67, SD = 1.33; 1129 girls). Results indicate that high psychological control-a parenting practice involving guilt induction and love withdrawal-is associated with higher susceptibility to peer pressure, while high parental support is associated with reduced susceptibility. Behavioral control showed no direct effect on peer pressure. Psychological control negatively impacted autonomy and relatedness, while behavioral control and support positively affected relatedness and negatively affected autonomy. Autonomy and relatedness mediated the relationship between psychological control and susceptibility to peer pressure, and between parental support and susceptibility to peer pressure. Gender moderated the relationship between psychological control and susceptibility to peer pressure, with boys showing a stronger association. These findings highlight the importance of supportive parenting in fostering adolescents' autonomy and relatedness, ultimately reducing their susceptibility to peer pressure. They offer valuable insights for developing effective parenting programs tailored to adolescents' needs, incorporating a gender-sensitive approach.

The goal of this study was to evaluate a mediation model of two approaches to deterring the onset of alcohol, cigarette, and marijuana among middle school adolescents. Students completed surveys that included yes/no self-reports about their past 30-day and lifetime alcohol, cigarettes, and marijuana use. Surveys assessed dispositions: perceptions that drug use would interfere with desired lifestyles, perceptions about drug use prevalence and acceptability, and drug use intentions. Surveys also assessed skills: students' ability to achieve goals, make decisions, and refuse drug use offers. Classrooms were assigned by convenience to one of three conditions. In the control condition, students (N = 394) received no prescribed intervention. Core condition students (N = 101) received instruction in All Stars Core, which targeted changing students' dispositions. Students in the combined Core and Plus condition (N = 135) received instruction in both All Stars Core and in All Stars Plus, which also targeted improving students' skills. Analysis revealed that the programs achieved reductions in the onset of drug use through maintaining these students' dispositions. In contrast, control students' dispositions eroded over time, increasing their risk for drug use. The Plus intervention that targeted skills, failed to have a sufficiently large impact to allow analysis to validate skills as a statistically significant mediator of drug use outcomes. These results speak to the conclusion that, for prevention programs to succeed at deterring the onset of alcohol and drug use, interventions need to maintain or improve students' dispositions. This includes improving lifestyle incongruence, reducing perceptions that drug use is common and acceptable, and by increasing commitments to avoid drugs. Interventions that focus on building skills are less likely to achieve preventive effects.

Insufficient individual outdoor activity is common among older adults, yet research on the association between individual outdoor activity frequency and all-cause mortality among older adults remains limited. Therefore, we aimed to explore the association between individual outdoor activity frequency and all-cause mortality among older Chinese adults. We conducted a prospective cohort study using data from 8117 participants aged 65 years or above from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Accelerated failure time (AFT) models were used to assess the longitudinal association between individual outdoor activity frequency and all-cause mortality by using time ratios (TRs) and 95% confidence intervals (CIs). Subgroup analyses of the association were conducted by age, sex and residence. In addition, sensitivity analyses were performed to assess the robustness of main results. During a median follow-up period of 5.11 years, a total of 3893 (47.96%) participants died. Compared with participants who never engaged in individual outdoor activity, those who engaged rarely or sometimes (TR: 1.24, 95% CI: 1.10-1.40) and those who engaged regularly or almost every day (TR: 1.59, 95% CI: 1.48-1.70) had a statistically significant longer survival time in the fully adjusted model. Subgroup analyses showed consistent associations in nearly all strata. Sensitivity analyses confirmed the robustness of main results. Frequent participation in individual outdoor activity was significantly associated with longer survival time among older Chinese adults. Our findings support encouraging older adults to engage in regular individual outdoor activity for longevity benefits.

Substance use and high-risk sexual behaviors remain pressing public health challenges among U.S. adolescents, with tobacco, alcohol, and marijuana being the most used substances. While previous research has shown an association between substance use and risky sexual behavior, there is limited data on how these associations vary based on demographic modifiers such as race, sex, and sexual identity among sexually active adolescents. This study explores the association between current substance use (cigarettes, e-cigarettes, alcohol, and marijuana) and high-risk sexual behaviors (having multiple sexual partners and lack of condom use), examining how these associations vary by race, sex, and sexual identity. The 2023 Youth Risk Behavior Survey (YRBS) data was analyzed for 5420 adolescents attending U.S. public and private high schools. Multiple Logistic regression was used to examine associations, and interaction effects for race, sex, and sexual identity were introduced to the model to determine variations in associations. Overall adjusted analyses revealed current use of cigarette, e-cigarette, and alcohol was associated with higher likelihood of having multiple (2 or more) sexual partners in the past 3 months. Additionally, current marijuana use was associated with a higher likelihood of not using a condom during last sexual intercourse. A statistically significant interaction was observed only for the association between current marijuana use and condomless sex during last sexual intercourse (p = 0.010). Stratified analyses indicated that this association varied by sexual identity and was stronger among heterosexual students compared to Lesbian, Gay, Bisexual, Queer, and other (LGBQ+) students. Results confirm the link between substance use and high-risk sexual behavior among youth, reinforcing our need for increased programming around substance use prevention and sexual health education. Heterosexual youth may be at increased risk for high-risk sexual behavior associated with their marijuana use, calling for tailored interventions that target the unique needs of this demographic subgroup.

The burden that multimorbidity places on people, families, and society as a whole has made it a global public health concern. While physical activity (PA) is supported by the World Health Organization (WHO) as a crucial approach for avoiding chronic diseases, there is minimal data to support its link with multimorbidity, especially among populations of middle-aged and elderly in China. Derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, a cross-sectional data was employed in this study. To analyze the linear connection between multimorbidity and PA, Restricted Cubic Spline (RCS) and Binary logistic regression were applied. The heterogeneity of this association across other groups was investigated using subgroup and interaction analysis. Three sensitivity analyses validated the results' robustness. Among 19,453 participants, 25.24% of middle-aged and older individuals actively engaged in moderate vigorous PA, 58.40% often participated in vigorous PA, and the prevalence of multimorbidity was 40.18%. After adjusting for all confounding factors, compared with low-intensity PA, moderate vigorous PA (OR = 0.889, 95% CI: 0.810-0.976) and vigorous PA (OR = 0.731, 95% CI: 0.673-0.794) demonstrated a significantly attenuated risk of multimorbidity. Multimorbidity and PA did not significantly correlate linearly, according to the RCS result. Age, residence, social activities and drinking were found to have substantial modifying effects on the relationship between PA and multimorbidity, according to the subgroup and interaction analyses. The outcomes of this research underline the the association between physical activity and a reduced risk of multimorbidity. This suggests that under the premise of ensuring safety, higher levels of physical activity among middle-aged and older adults may be linked to later onset of chronic disease.

Establishing healthy eating (HE) behaviors in childhood is essential for chronic disease prevention. Children's eating behaviors are shaped by social norms of their families, schools, and peer groups, yet the relative influence of these normative sources remains unclear. This study examined the associations between competing dietary norms and children's dietary behaviors. Data were based on the follow-up of a school-based intervention study, with 196 third- and fourth-grade students from eight schools in rural Northern Taiwan. Participants were recruited at the beginning of the fall semester and followed up at 2nd and 4th month after baseline. Children reported their HE behaviors in the last 7 days. Dietary social norms were reported, included: observing adults' HE behaviors at home, perceived expectations of HE from home adults and school teachers, and peer HE norms measured by the class-level average HE behaviors. Observing adults' HE behaviors at home was significantly associated with children's daily milk consumption (OR = 1.57, [95% CI: 1.12-2.19]). Exposed to 10% of children in class adopting a HE behavior during follow-up, a child was more likely to develop FV 5-a-day (OR = 1.21 [1.08-1.36]), not drinking sugar-sweetened beverages (OR = 1.26 [1.14-1.39]), and daily water consumption at school (OR = 1.11 [1.002-1.22]). Children's dietary behaviors were more strongly influenced by observed adult behaviors at home and peer norms than by perceived adults' expectations. Preventive nutrition efforts should prioritize healthy role modeling and supportive peer environments to promote sustained change.

China has one of the world's largest obese populations combined with the largest scale of mobile internet penetration, but there is limited evidence on the relationship between mobile internet use (MIU) and body mass index (BMI) among obese Chinese adults. We aimed to explore the effect of MIU on BMI in obese Chinese adults and the heterogeneity of this effect at different quartiles. Data were derived from two waves of the China Family Panel Studies (CFPS) spanning 2020 to 2022. The final analytic sample comprised 15098 observations, focusing on adults defined as obese. We employed logistic random effects models to examine the general association between MIU and obesity risk, followed by linear random effects models to quantify the specific impact of MIU duration on BMI within the obese population. Furthermore, quantile regression and subgroup analyses were utilized to investigate the heterogeneity of these effects across different BMI distributions and age cohorts. Firstly, after controlling for covariates and individual-level random effects, MIU was positively correlated with obesity (OR=1.054, 95%CI: 1.003-1.108, p<0.05), and further positively influenced BMI among obese adults (B=0.032, p<0.05). Secondly, the coefficient of MIU's impact on BMI among obese adults increased progressively and remained significant as the quantile rose from lower to higher levels (at or above the 30th percentile). Lastly, when age groups were used as the basis for division, the effect of MIU on BMI among obese adults was only significant among young adults (B=0.041, p<0.05). We confirmed that a longer duration of MIU may lead to an increase in BMI among obese Chinese adults, and this relationship exhibits heterogeneity across different quantiles and age groups.

Self-harm is the most significant risk factor for death by suicide. The aim of this study is to present trends and characteristics of hospital-presenting intentional self-harm and events of undetermined intent in Croatia from 2017 to 2023, with a focus on sex and age differences, in order to identify the at-risk groups towards whom prevention activities should be directed. Data were collected from the National Public Health Information System, and hospitalization rates were analyzed by sex, age, and year of hospitalization. The average hospitalization rate for intentional self-harm was 27.46 per 100,000, while the overall rate (including events of undetermined intent) was 44.47 per 100,000. Trends over the years indicate a general increase in hospitalization rates from 2017 to 2023, with the exception of 2020, when a temporary (statistically non-significant) decline was recorded. The highest rate in the observed period was reached in 2022. Furthermore, significant sex differences were observed. The hospitalization rate for intentional self-harm was statistically significantly higher among females (24% lower in males). However, when events of undetermined intent were included, the hospitalization rate became statistically significantly higher among males (7% higher compared to females). The highest hospitalization rates were recorded among females aged 15-19 years, peaking in 2022 (195.76 per 100,000). It is necessary to strengthen the system of monitoring and diagnostics and to develop targeted, gender-sensitive preventive interventions in order to reduce the risk of self-harm and the associated risk of suicide mortality.

Child sexual abuse (CSA) remains a significant public health concern with lasting impacts on victims' mental, emotional, and social well-being. In recent decades, school-based prevention programs have been implemented globally to increase children's knowledge, attitudes, and protective behaviors. Although previous meta-analyses have reported overall program effectiveness, there is limited synthesis regarding the influence of variables such as session count and intervention style. This study aims to provide an updated meta-analysis focused on the effectiveness of school-based CSA prevention programs, with particular attention to the knowledge, attitudes, and behaviors of participants. A systematic search of six databases (Web of Science, Scopus, PsycINFO, MEDLINE, ERIC, and YÖKTEZ) was conducted to identify studies published between 2012 and 2022. Inclusion criteria encompassed randomized and quasi-experimental studies involving school-aged children (5-18 years) and evaluating school-based CSA prevention interventions. Following PRISMA guidelines, 26 studies (N = 13,669) were included. Effect sizes were calculated using Hedges' g under both fixed and random effects models, and moderator analyses were conducted based on intervention style, grade level, and session count. The overall effect size for knowledge outcomes was 0.796 (random effects model), while the effect size for attitude and behavior outcomes was 0.759. Moderator analyses revealed that intervention length and participant educational level significantly influenced knowledge outcomes (p < 0.05), whereas modern intervention styles had a greater effect on attitudes and behaviors (p = 0.036). School-based CSA prevention programs are effective in improving children's knowledge and fostering protective attitudes and behaviors. Programs with multiple sessions and those targeting younger students demonstrate greater efficacy. Findings underscore the need for standardizing program components and assessing long-term impacts to enhance program sustainability and generalizability.