Primary Prevention

Program Capacity to Deliver Prevention Services to Children of Adult Clients Receiving Substance Use Disorder Treatment Abstract Children whose parents have a history of substance use are at elevated risk of developing substance use disorders (SUDs) and related debilitating behaviors. Although specialty treatment programs are uniquely positioned to deliver prevention care to children of adult clients, these programs may have limited capacity to implement prevention and early intervention care services, particularly in racial and ethnic minority communities. We merged data from program surveys and client records collected in 2015 to examine the extent to which program capacity factors are associated with the odds of delivering prevention and early intervention services for children of adult clients attending outpatient SUD treatment in low-income minority communities in Los Angeles County, California. Our analytic sample consisted of 16,712 clients embedded in 82 programs. Our results show that 85% of these programs reported delivering prevention care services, while 71% of programs delivered early intervention services. Programs with organizational climates supporting change and those that served a high number of clients annually were more likely to implement both prevention and early intervention practices. Programs accepting Medicaid payments and serving clients whose primary drug was marijuana were more than three times as likely to implement prevention services. Overall, our findings suggest both program- and client-level characteristics are associated with delivering preventive care offered to children of adult clients receiving SUD treatment in communities of color. As Medicaid has become a major payor of SUD treatment services and marijuana use has been legalized in California, findings identify capacity factors to deliver public health prevention interventions in one of the nation's largest public SUD treatment systems.

Meta-Review on the Effectiveness of Classroom-Based Psychological Interventions Aimed at Improving Student Mental Health and Well-Being, and Preventing Mental Illness Abstract This meta-review summarizes existing evidence from systematic reviews and meta-analyses on the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness. Systematic reviews and meta-analyses were identified via the electronic databases PsycINFO, Web of Knowledge, Medline, Embase, and HMIC (Health Management Information Consortium). Ten systematic reviews and meta-analysis were eligible for inclusion in the final analyses. These systematic reviews and meta-analyses evaluated the effects of five types of school-based psychological interventions: Mindfulness, Social Emotional Learning, Cognitive Behavioral Therapy, Yoga, and Body-Image. Overall effectiveness reported in the included studies was significant for the most part, and ranging from small to large with respect to the effect size. The authors of all of the studies emphasized the need for additional high-quality trials to further examine the effectiveness of school-based psychological interventions aimed at improving student mental health and well-being, and preventing mental illness.

Tailgating Protective Behavioral Strategies Mediate the Effects of Positive Alcohol Outcome Expectancies on Game Day Drinking Abstract Although a growing body of evidence suggests protective behavioral strategies are associated with lower alcohol use among college students, we know little about what contributes to students' decisions to use these strategies. Alcohol outcome expectancies have been associated with alcohol use among college students, and may contribute to their decisions to use protective behavioral strategies while drinking in contexts associated with an elevated risk for heavy alcohol use. University football game tailgating is one high-risk context that has received limited empirical attention with respect to identifying risk and protective factors for use. We sought to determine whether expectancy effects on tailgating drinking may be attributable to the approach or avoidance of protective strategies in this context. We expected college students who perceive greater positive expectancies to report engaging in more protective strategies on game day, whereas we hypothesized greater negative expectancies would be associated with less use of protective strategies. College students (N = 231) reported outcome expectancies online within 7 days of tailgating and quantity of alcoholic drinks consumed while tailgating, as well as whether they used limiting consumption (i.e., counting drinks, alternating drinking water and alcohol) and harm reduction (HR; i.e., sober transportation) strategies 48 h after tailgating. Results indicated higher positive expectancies were associated with greater use of HR strategies. Positive expectancies were indirectly positively related to greater game day tailgating drinking and negatively to odds of abstaining through the use of protective strategies, and unique indirect effects were observed for HR strategies. These findings highlight important individual differences that contribute to the use of protective behaviors, and suggest that expectancy-challenge interventions may be tailored to address unsafe drinking practices and promote college student health.

Determinants of Parental Intentions to Vaccinate Kindergarten Children Against Seasonal Influenza in Xiamen, China Abstract Seasonal influenza epidemics occur almost every year, and children under 6 years of age constitute one of the most susceptible groups. While free vaccinations are offered to preschool children in some large cities in China, Xiamen lacks a free vaccination policy and other effective policies aimed at increasing parents' acceptance of the vaccine. Using the health belief model (HBM), we sought to: (1) investigate the determinants of parents' intentions to vaccinate their kindergarten children against seasonal influenza if the free policy were implemented, and (2) explore the possible interaction effects between "cues to action" and "perceived susceptibility" and/or "perceived severity." A total of 1350 parents with kindergarten children were selected by stratified random sampling from half the population in Xiamen, of whom 1211 responded effectively to our survey. Scobit models with testing for interactions among the key concepts of the HBM were used to investigate factors associated with parents' intentions to vaccinate their children. In total, 85.1% of 1211 parents reported that they were willing to vaccinate their children if free influenza vaccinations were offered, although only 37 children (3.1%) had received influenza vaccination in the previous year, and 261 (21.6%) had been vaccinated since birth. Parents' perceived susceptibility (AOR = 1.77), perceived benefits (AOR = 3.12), perceived barriers (AOR = 0.38) and cues to action (AOR = 3.54) in terms of childhood vaccination against influenza were significantly associated with their vaccination intentions. The only observed interaction effect was between perceived susceptibility and cues to action (AOR = 1.57), which had additive effects on strengthening parental intentions to vaccinate their children. Our findings can be used as a basis for formulating government strategies aimed at improving influenza vaccination coverage among children in kindergarten and guiding culturally informed primary prevention efforts among their parents.

Is Weight Discrimination Associated With Physical Activity Among Middle Aged and Older Adults? Abstract Older adults (> 65) are less physically active than all other adult age groups. Although experiences of weight discrimination have been inversely associated with physical activity in several studies of middle-aged and older adults, the role of weight discrimination in this relationship has not been sufficiently explicated. Using data from the Health and Retirement Study (a longitudinal panel study of U.S. adults aged 50 and older), we hypothesized that, among middle aged and older adults, weight discrimination would (a) be inversely related to respondents' reported level of physical activity; and (b) partially mediate the relationship between BMI and physical activity. Using multiple logistic regression analysis, we found an inverse relationship between weight discrimination and vigorous physical activity (OR = 0.79; 95% CI [0.66, 0.94]), as well as between weight discrimination and moderate physical activity (OR = 0.76; 95% CI [0.62, 0.92]). Weight discrimination mediated 13% of the relationship between BMI and vigorous physical activity, as well as 9% of the relationship between BMI and moderate physical activity. Weight discrimination may thus pose a barrier to regular physical activity among middle aged and older adults. Future research and interventions should identify effective ways of mitigating barriers experienced because of weight discrimination in the promotion of physical activity among these age groups, as well as how we may effectively reduce the perpetration of weight discrimination in various settings.

Replication of It's Your Game…Keep It Real! in Southeast Texas Abstract Despite the recent efforts of the Office of Adolescent Health to replicate programs with demonstrated efficacy, there are still few evidence-based HIV, sexually transmitted infection (STI), and teen pregnancy prevention programs that have been replicated in "real-world" settings. To test the effectiveness of It's Your Game…Keep It Real! (IYG), an evidence-based STI and pregnancy prevention program for middle schools, the curriculum was implemented by teachers in urban and suburban middle schools in Southeast Texas from 2012 to 2015. IYG was evaluated using a group-randomized wait-list controlled effectiveness trial design in which 20 middle schools in nine urban and suburban school districts in Southeast Texas were randomized equally, using a multi-attribute randomization protocol, to either the intervention condition (received IYG) (n = 10 schools comprising 1936 eligible seventh graders) or the comparison condition (received usual care) (n = 10 schools comprising 1825 eligible seventh graders). All students were blinded to condition prior to administering the baseline survey. The analytic sample comprised 1543 students (n = 804, intervention; n = 739, comparison) who were followed from baseline (seventh grade) to the 24-month follow-up (ninth grade). Multilevel regression analyses were conducted to assess behavioral and psychosocial outcomes at follow-up. There were no significant differences in initiation of vaginal or oral sex between study conditions at follow-up. However, at 12-month follow-up, compared with students in the comparison condition, students in the intervention condition reported increased knowledge, self-efficacy, and perceived favorable norms related to HIV/STIs, condoms, and/or abstinence; decreased intentions to have sex; and increased intentions to use birth control. Knowledge outcomes were statistically significant at 24-month follow-up. This IYG effectiveness trial did not replicate the behavioral effects of the original IYG efficacy trials. However, it adds to the growing literature on the replication of evidence-based programs, and underscores the need to better understand how variations in implementation, setting, and measurement affect the behavioral impact of such programs. Clinical trial registration clinicaltrials.gov (NCT03533192).

Preventing Adolescent Substance Use: A Content Analysis of Peer Processes Targeted Within Universal School-Based Programs Abstract Universal school-based substance use prevention programs are widely disseminated and often include a focus on peer relationships. Network theory and social network analysis (SNA) have emerged as useful theoretical and methodological frameworks for examining the role of peer relationships in prevention and intervention research. We used content analysis to systematically code the peer processes targeted by three universal school based prevention programs. We found that programs focused on peer socialization more than peer selection, and programs focused about evenly on descriptive and injunctive norms. Programs varied in their focus on positive and negative peer processes and behaviors, but most references to peer processes focused on positive processes and negative behaviors. The focus on peer processes at the dyadic, subgroup, and network levels varied across the three programs, with the heaviest focus on network level processes. When peer processes were targeted, it was rare that lessons focused on peer processes for an extended (> 50%) amount of the lesson content. However, when peer processes were a focus, discussion and reflection were commonly encouraged. These patterns are considered in the context of non-intervention research on adolescent peer relations, which highlights the importance of peer selection and dyad-level processes, and the existence of positive peer processes that promote adolescent development. In doing so, we provide a framework that can be used to (1) examine the extent to which a particular program focuses on the different peer processes, and (2) inform systematic experimental studies of the extent to which particular peer processes are malleable in response to intervention efforts.

Linking Sleep to Externalizing Behavioral Difficulties: A Longitudinal Psychometric Survey in a Cohort of Italian School-Age Children Abstract We examined the longitudinal relationship between sleep problems and behavioral problems at primary school in Italian children. We recruited a school-based sample of 227 children (age range 6–10 years) in schools located in Pisa (Italy). Parents completed the Sleep Disturbance Scale for Children (SDSC), and teachers completed the Strengths and Difficulties Questionnaire (SDQ) to evaluate children's behavioral difficulties. We used a two-step robust regression approach to identify which aspects of sleep problems might affect children's behavior at school. After removing socio-demographic effects, results indicated an association between an increase in sleep problems and the worsening of inattentive and hyperactive behavioral problems at school 1 year later. This association was particularly robust in children whose sleep problems had gotten worse over the year. We found no associations between child sleep problems and conduct problems in school settings. Schools may be a suitable arena in which to identify and prevent the development of severe externalizing behaviors through screening procedures and intervention for children's sleep problems.

CARING: The Impact of a Parent–Child, Play-Based Intervention to Promote Latino Head Start Children's Social–Emotional Development Abstract CARING is a preventive, play-based, parent–child intervention designed to promote preschoolers' social–emotional development by strengthening their bonds with their parents. We describe the qualitative impact of the CARING Preschool program on Latino preschool children and their parents. One hundred and eleven Latino families participated in a larger study of the efficacy of the CARING preschool program. Of these families, 40 participated in this qualitative study. We invited families to participate in a focus group after completing the intervention. We used an inductive approach based on grounded theory to identify thematic categories. Parents reported substantial changes in themselves, their children and the quality of their relationships with their children as a result of their participation in CARING. Parents also reported an increased understanding of their children's needs, their ability to use at home the skills learned during the intervention, and improved parent–child communication. In addition, parents reported the social skills and self-regulation abilities of their children improved. These findings highlight the promise of preventive, low-cost interventions for families facing socioeconomic and psychosocial adversity, and their potential role in strengthening parent–child relationships. Results highlight cultural parenting practices and implications for intervention with Latino families.

Framework for Supporting Adolescent Peer Leaders: A Pilot Using Text Messaging in a School-Based Substance Use Prevention Program Abstract Training peer leaders (PLs) as implementation agents is a state-of-the-art approach in prevention, but the field lacks frameworks for providing support. Text messaging, a powerful tool for direct intervention, may be useful in this regard. We introduce a conceptual framework for engaging, retaining, and educating adolescent PLs and conduct a pilot test of this framework using text messages for delivery to middle school PLs in a new, peer-led substance use prevention program. Fifty eighth-graders were recruited as PLs. We used a newly-developed framework to create text messages to strengthen peer leaders': (a) mission, agency, and team identity; (b) connection to adult mentors; (c) content knowledge and application to their own lives; and (d) preparation for prevention activities. Thirty-four texts were sent to PLs over 4 months. PL replies and participation were recorded to track engagement. Forty-one PLs (71%) received texts and completed baseline and post-program surveys. Parents and school staff completed post-program questionnaires. Eighty-five percent of PLs responded to at least one text message. Response rates for specific messages varied from 22 to 56%. Students were most likely to reply to texts about preparation for their own prevention activities in the school. Ninety-five percent of PLs said they read messages even when they did not reply. Eighty-three percent of PLs said the messages helped them accomplish their mission. PLs reported that they wanted to receive messages in the future. PL attendance had very little variability in two of the three schools, but replies to texts were associated with better attendance in one school. Our study provides a framework for supporting adolescent peer leaders in a network intervention. Automated text messaging supporting middle school PLs was feasible, engaging, and well-received. Texting activity was associated with participation in school-based activities. Future priorities include systematically varying text support to determine its true effect on implementation and on involvement by less engaged PLs.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com