Journal of prevention (2022)最新文献

Persons with Type 2 diabetes mellitus (T2DM, ~ 38.1 million Americans) are at risk of poor health, cardiovascular disease (CVD) and chronic kidney disease (CKD) if their disease is poorly controlled. T2DM control requires disease self-management through adequate physical activity and optimum diet. We evaluated the physical activity and diet patterns of the US T2DM population against the American Diabetes Association and clinical practice guideline norms, and their associations with health outcomes. Using a cross-sectional, observational study design, we studied the US T2DM population's physical activity and fruit/vegetable intake (independent variables), and their associations with three health outcomes, self-rated health (from the SF-36 question on experienced health status, categorized as excellent/very good/good vs. fair/poor), CVD-free status, and CKD-free status. We used pooled data from the Behavioral Risk Factor Surveillance Surveys (2015, 2017 and 2019) on adults aged 30-75 years with T2DM (defined as diabetes mellitus diagnosed after age 30). Physical activity categories were inactive, insufficiently active, sufficiently active, highly active, and fruit/vegetable intake categories, ≤ 2, 3-4, and ≥ 5 daily servings. We used hierarchical logistic regression, adjusting for demographic variables (age, sex, race), and potentially confounding factors, diabetes severity (disease duration, insulin use), chronic comorbidity, overweight/obese, smoking, alcohol overuse, having a regular healthcare provider, and having health insurance. Missing data were coded as a separate category. We conducted a subgroup analysis of those with ≥ 10 years of disease duration. Among 119,298 respondents with T2DM (52.1% female, mean age 62.1 years, 94% insured), 36.9% were physically inactive and 16.2% insufficiently active, 52.6% consumed ≤ 2 daily servings of fruit/vegetables, 57% reported excellent-good health, 24.7% had CVD, and 9.7% had CKD. Physical activity showed a dose-dependent association with self-rated health (reference group, physically inactive; adjusted OR for insufficiently active 1.77 (95%CI 1.71-1.83), sufficiently active, 2.33 (2.24-2.43), highly active, 2.63 (2.54-2.72)), as did fruit/vegetable intake [reference group ≤ 2 daily servings; OR for 3-4 servings, 1.12 (1.09-1.16), and ≥ 5 servings, 1.13 (1.08-1.17)]. Physical activity was associated with being CKD-free (ORs, 1.29 (1.22-1.37), 1.50 (1.40-1.60), 1.52 (1.44-1.60, respectively), and being CVD-free (1.31 (1.25-1.37), 1.34 (1.28-1.41, and 1.37(1.31-1.42), respectively). Fruit/vegetable intake was not associated with CVD. CKD outcome was not studied due to dietary restrictions of CKD patients. Subgroup analyses (53,925 respondents) showed similar results. Over a third of the US T2DM population and the subgroup with long-term T2DM were physically inactive, a sixth were insufficiently active, and over half had negligible fruit/vegetable intake. On the positive side, even limited physica

The European Prevention Curriculum (EUPC) is a European initiative to promote professional and quality-assured substance use prevention. In Austria, the EUPC is trialled via a three-year pilot project to explore its appropriateness and long-term feasibility. We report on the first two years of EUPC project implementation as part of a Special Issue on EUPC implementation practice and lessons learnt. As of January 2025, four national trainers had delivered a total of four trainings (three in-person, one online), reaching over 70 professionals in Austria and six from neighbouring countries. EUPC training was offered free of charge, and a three-day format appeared to work best for the basic module. Participants recommended EUPC for continuation beyond the pilot phase, citing not only its potential to promote professionalisation, quality assurance and evidence-based work but also to facilitate exchanges of perspectives, networking and a common prevention language among different professionals. Existing prevention infrastructures were used to create a suitable system for project coordination and dissemination of EUPC. The pilot is jointly undertaken by two major stakeholders representing different contexts: the national public health institute and the national association of provincial addiction prevention units. Creating a shared vision for the project and securing necessary funding was initially challenging but was achieved through relationship-building, a shared commitment to 'quality in prevention' and a focus on the potential benefits of offering EUPC. These aspects also helped to successfully navigate the balance between a flexible approach to EUPC at the European level and the practical need for a structured approach in Austria. Our insights from a formative evaluation, routine data collection and team discussions can support further development of EUPC at the European level and in other countries.

In Bosnia and Herzegovina, prevention efforts have traditionally relied on methods not informed by scientific evidence, limiting their effectiveness. This practitioner narrative explores the implementation of the European Prevention Curriculum (EUPC) in Bosnia and Herzegovina as part of a Special Issue on EUPC implementation practice and lessons learnt, examining the first outcomes of the training on decision, opinion, and policy makers (DOPs) and its role in fostering the adoption of evidence-based prevention strategies. Since 2022, ten EUPC training courses have been conducted in nine cities, engaging 178 key stakeholders from various sectors. The training aims to enhance participants' knowledge of science-based prevention principles and equip them with tools for informed decision-making in policy development and program implementation. To assess the outcome of EUPC training, we analyzed changes in policy discussions, strategic planning, and funding allocation for prevention programs. Key indicators include the proposal for the first national Prevention Strategy and the revision of public funding criteria to prioritize evidence-based initiatives. These findings demonstrate the training's role in shaping a more structured and effective prevention landscape. By systematically strengthening the capacity of key stakeholders, EUPC training serves as a catalyst for embedding science-based prevention within national frameworks. This paper highlights its potential to drive a paradigm shift toward sustainable, evidence-informed public health policies.

This paper outlines the adaptation and implementation of the European Prevention Curriculum (EUPC) in Brazil, launched in 2022 to enhance the skills of professionals in substance use prevention. The EUPC-Brazil project follows a decentralized model with significant collaboration from regional and local stakeholders, as well as international partners, such as the European Union Drugs Agency (EUDA). The curriculum was adapted through feedback from local professionals and policymakers, ensuring its relevance to national needs while maintaining European best practices. Initial pilot trainings have shown positive results, with participants reporting increased competence in applying evidence-based practices. Challenges such as resource limitations and regional disparities in access to training are being addressed through ongoing adaptation and the creation of virtual communities for continued peer learning. The findings provide key insights for other countries looking to implement the EUPC, emphasizing the importance of local adaptation, stakeholder engagement, and long-term sustainability.

The European Prevention Curriculum (EUPC) was introduced in Greece through the European Commission co-funded project, ASAP training. In this project, a comprehensive training on EUPC for decision-, opinion- and policy-makers was developed with basic and advanced modules. The first EUPC trainings in Greece began in 2019. Since then, both the basic and the advanced modules of the EUPC have been offered by four accredited trainers. Between 2019 and mid-2024, EUPC training engaged 89 professionals. Trainings are conducted based on the Trainer's Guide developed under ASAP, with updates incorporated when available by the EUDA, ensuring alignment with the latest evidence in the science of prevention. While maintaining fidelity to Trainer's Guide, minor adaptations, such as extending the duration, have been introduced to better suit stakeholders involved so far, encouraging reflection on current practices and enhancing engagement. EUPC has contributed to the establishment of a common language in prevention, updating professionals with current evidence-based practices, and fostering critical reflection on existing practices. Despite challenges such as resistance to change and the need for structured evaluations of EUPC trainings, the curriculum has empowered professionals by reinforcing the importance of rigorous, systematic approaches in designing and implementing prevention strategies and interventions. Future plans aim to expand EUPC's reach into the education sector and address broader risk behaviours, while expanding its reach to regional and local levels as well as ensuring its sustainability. These initiatives underscore EUPC's pivotal role in shaping a cohesive prevention framework that benefits both local communities and national policy objectives.

The Flemish community in Belgium has been actively involved in the European Prevention Curriculum (EUPC) since its adaptation of the UPC (Universal Prevention Curriculum) to the European context, followed by participation in the ASAP-training project (Building effective drug prevention results across Europe, based on prevention systems analysis and widespread professional training). This practitioner narrative explores the implementation of the EUPC in the Flemish community in Belgium as part of a Special Issue on EUPC implementation practice and lessons learnt. The implementation of the EUPC in the Flemish community has demonstrated positive effects on the broader substance use prevention landscape, highlighting the importance of high-quality prevention initiatives. Despite these successes, challenges persist, particularly within a prevention support system constrained by limited resources. Key obstacle is getting and maintaining the engagement of decision-makers, opinion leaders, and policymakers, which were central to the EUPC's original focus. In response to this challenge, the Flemish community is gradually developing supplementary materials. These efforts continue to be guided by EUPC-related content, aiming to enhance the region's capacity for effective substance use prevention.

The European Prevention Curriculum (EUPC) was introduced in Georgia to ensure the quality of the National Drug Prevention Strategy implementation. This paper provides a practitioner's narrative of the experiences and lessons learned during the implementation of EUPC in Georgia, as part of a Special Issue on EUPC implementation experiences. The narrative is grounded in the authors' direct involvement in the implementation of the EUPC, including the translation and cultural adaptation of the curriculum, the capacity building of national trainers, and the delivery and evaluation of EUPC training to 146 local stakeholders. Drawing on implementation experiences, training participant feedback, and implementers' observations, the account highlights key lessons learned. The translation and cultural adaptations of the EUPC manual along with the development of national training capacity laid a strong foundation for piloting the first EUPC training for decision-makers, opinion leaders and policymakers (DOPs) in Georgia. As a result of the training, participants demonstrated an increased understanding of evidence-based prevention principles. However, challenges emerged, including the culture-specific pace of content comprehension and the participants' limited prior exposure to evidence-based prevention. Key lessons include the necessity to tailor training complexity to the needs of different target groups while putting in place the mechanisms assuring fidelity, quality and the necessity of creating a sustainable infrastructure for EUPC implementation.

This practitioner narrative provides a comprehensive overview of the implementation of the European Prevention Curriculum (EUPC) in Cyprus, contributing to the Special Issue on EUPC implementation practices and lessons learned. The Cyprus National Addictions Authority (NAAC) is the main coordinating body responsible for licit and illicit substances, as well as gambling disorders, as defined by national legislation. As the national reference point and coordination centre for the EUPC, NAAC has played a key role in introducing and establishing EUPC training in Cyprus. By the end of 2024, five training sessions had taken place with the participation of 68 Decision-Opinion-and Policy-Makers (DOPs) from various sectors, including governmental and non-governmental organizations, law enforcement, and education. These training sessions have been facilitated by four national trainers, with the goal of conducting two training cycles per year to ensure broad participation. The integration of the EUPC into the licensing and funding processes of prevention programs has streamlined associated procedures, providing a structured rationale and evidence-based knowledge to relevant stakeholders. Since the introduction of the EUPC, trainers have noticed a gradual shift in the perception of evidence-based prevention among NAAC and stakeholders in the field of addictions. However, embedding EUPC principles into national practices is an ongoing process that requires sustained efforts. Change does not occur overnight, and the full impact of the EUPC at the national level will only become evident over time. Looking ahead, NAAC is committed to advocating for the continued delivery of EUPC training for prevention DOPs. Data on process evaluation is being collected, with plans to analyze evaluation data in the future and assess the effectiveness of these training sessions.

This practitioner narrative aims to describe the implementation of the European Prevention Curriculum (EUPC) in Latvia, highlighting the structure, key achievements, challenges, and lessons learnt to inform future implementation efforts. Until 2025, Latvia has translated the EUPC handbook into the national language, ensured EUPC basic trainings since 2021 and the academic course since 2023, and, with the support of the European Drugs Agency (EUDA, formerly known as the European Monitoring Centre for Drugs and Drug Addiction, EMCDDA), trained five national EUPC trainers. Currently, the EUPC training is offered at most twice a year-once for national decision-makers, opinion leaders, and policymakers (DOPs) and once for university students. Key barriers to the large-scale implementation of the EUPC include limited funding, the additional workload associated with delivering EUPC trainings for national trainers, the absence of a national implementation framework, and the lack of official recognition of EUPC certification. Nevertheless, an analysis of participants' pre-test and post-test responses demonstrates an increase in self-reported knowledge related to EUPC content. Furthermore, elements of the EUPC have been integrated into various methodological and educational materials on substance use prevention in Latvia.

Prevention science has made significant strides in establishing evidence-based interventions and quality standards for drug prevention. However, widespread dissemination and implementation remains limited. This article explores how in the European context reference points such as the European Drug Prevention Quality Standards (EDPQS), the Universal Prevention Curriculum (UPC) and the United Nations Office on Drugs and Crime (UNODC) International Standards on drug use prevention created the roots to promote evidence-based prevention. This article briefly reports the outputs of the ASAP-Training project and how it can be considered as a milestone in the European dissemination of the EUPC, thanks to the idea of linking the training of the prevention professional workforce to the analysis of countries' prevention systems. Key outputs include the development of national prevention profiles, training curricula, and an online platform to support sustainability together with a new-born network of European trainers that now counts more than a hundred members. The paper ends with the presentation of the Italian institutional process that brought the EUPC into the framework of the national prevention plan, assuring its sustainability and wider dissemination in all Italian regions. The collaboration with the European Union Drugs Agency (EUDA) ensures ongoing access and dissemination of training resources, ultimately aiming to enhance the quality and impact of drug prevention efforts in Europe.