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Decker MJ, Gutmann-Gonzalez A, Saphir M, Nguyen NT, Zhi Q, Brindis CD. Integrated Theory-Based Health and Development Interventions for Young People: A Global Scoping Review. HEALTH EDUCATION & BEHAVIOR 2024; 51:82-93. [PMID: 36314359 PMCID: PMC10785565 DOI: 10.1177/10901981221130734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Most health and developmental issues affecting young people are interrelated. However, few interventions address multiple behavioral domains simultaneously or are based on theories that encompass a holistic perspective of youth development. AIM The purpose of this scoping review was to identify and describe the range of theory-based, multibehavioral health interventions aimed at improving two or more of the following behavioral youth outcomes: (1) sexual and reproductive health; (2) education and employment; (3) violence; and (4) substance use. METHODS Interventions conducted worldwide and published in English or Spanish between January 2000 and July 2020 were identified using four databases: PubMed, PsycINFO, LILACS, and SciELO. RESULTS A total of 11,084 articles were identified, of which 477 were retrieved and assessed for eligibility. Twenty-three articles (evaluating 21 interventions) ultimately met the inclusion criteria. Most interventions were conducted in the United States and addressed two behavioral domains of interest, although seven interventions incorporated three domains, and one incorporated all four. Substance use was the most common domain (16 interventions) but only in the United States/Canada, followed by sexual and reproductive health (14 interventions). All produced significant improvement in at least one outcome or for at least one subgroup of youth. The most common theoretical foundations were positive youth development and social learning theory. CONCLUSION Integrated interventions that are theory based and evidence informed can support positive development and empower youth to make healthy decisions. Further efforts are needed to address structural and policy issues that affect young people's developmental opportunities and health outcomes.
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Affiliation(s)
| | | | - Melissa Saphir
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Qi Zhi
- University of Hawaiʻi at Mānoa, Honolulu, HI, USA
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Cogo-Moreira H, Gusmões JD, Valente JY, Eid M, Sanchez ZM. Does #Tamojunto alter the dynamic between drug use and school violence among youth? Secondary analysis from a large cluster-randomized trial. Eur Child Adolesc Psychiatry 2023; 32:293-302. [PMID: 34417649 PMCID: PMC9971055 DOI: 10.1007/s00787-021-01863-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
The present study investigated how intervention might alter the relationship between perpetrating violence and later drug use. A cluster-randomized controlled trial design involving 72 schools (38 intervention, 34 control) and 6390 students attending grades 7 and 8 was employed in Brazil. Drug use and violence were assessed at three points. A random-intercept cross-lagged panel model examined the reciprocal association between drug use and school violence domains across the three data collection waves. For both groups, we found that the cross-lagged effect of perpetration on further drug use in adolescents was stronger than the reverse, but the interrelationship was not statistically significant between #Tamojunto and control schools. The carry-over effects of drug use and violence were also not significantly different between groups. There is a lack of evidence showing that #Tamojunto can modify the dynamics between drug use and school violence across the 21-month period. The direction of the causal effect (i.e., the more perpetration behavior, the more subsequent drug use behavior) is present, but weak in both groups. The trial registration protocol at the national Brazilian Register of Clinical Trials (REBEC) is #RBR-4mnv5g.
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Affiliation(s)
- Hugo Cogo-Moreira
- Faculty of Teacher Education and Languages, Østfold University College, 1757, Halden, Norway.
| | - Julia D. Gusmões
- grid.411249.b0000 0001 0514 7202Department of Preventive Medicine, Universidade Federal de São Paulo, Brazil. Rua Botucatu, 740, 4° Andar, São PauloSão Paulo, SP Brazil
| | - Juliana Y. Valente
- grid.411249.b0000 0001 0514 7202Department of Preventive Medicine, Universidade Federal de São Paulo, Brazil. Rua Botucatu, 740, 4° Andar, São PauloSão Paulo, SP Brazil
| | - Michael Eid
- grid.14095.390000 0000 9116 4836Department of Education and Psychology, Methods and Evaluation Division, Freie Universität Berlin, Habelschwerdter Allee 45, Room JK 27/213, Berlin, Germany
| | - Zila M. Sanchez
- grid.411249.b0000 0001 0514 7202Department of Preventive Medicine, Universidade Federal de São Paulo, Brazil. Rua Botucatu, 740, 4° Andar, São PauloSão Paulo, SP Brazil
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Gusmoes JD, Valente JY, Cogo-Moreira H, Sanchez ZM. Predictors of School Violence Perpetration and Victimization: Effects of Drug Use and Sociodemographic Characteristics. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Valente JY, Cogo-Moreira H, Sanchez ZM. Applying a Pattern-Centered Approach to Assess the Effect of a School-Based Drug Use Prevention Program in Brazil: A Cluster Randomized Controlled Trial. JOURNAL OF PREVENTION (2022) 2022; 43:529-548. [PMID: 35590031 DOI: 10.1007/s10935-022-00681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
This study evaluated the effectiveness of a drug and violence resistance educational program (Programa Educacional de Resistência às Drogas e à Violência-PROERD) on latent substance use profiles over a 9-month follow-up period. Two PROERD curricula were evaluated through a cluster randomized controlled trials with two parts that included a total of 4030 fifth-and seventh-grade students in 30 public schools in São Paulo. The intervention groups received 10 PROERD classes delivered by trained police officers, while the control group received no intervention. The primary outcome measures were drug use (any alcohol use, binge drinking, tobacco, marijuana, and inhalants) in the past 6 months, which was assessed using a pretest and a posttest 9 months later. Latent transition analysis was employed to investigate the effect of the intervention on the probabilities associated with the transition across drug use profiles. Latent drug use profiles are underlying subgroups of individuals similar to each other regarding their pattern of polysubstance use. Two different latent drug use profiles were revealed among the fifth graders (abstainers/low users and alcohol users/binge drinkers) and three drug use profiles among the seventh graders (abstainers/low users, alcohol users/binge drinkers, and polydrug users). For both, there was no evidence of the effect of PROERD on drug transition probabilities. In conclusion, the intervention was not successful in changing transitions across adolescent drug use profiles. Thus, the failure of the intervention to affect students' substance use profiles suggests that it should be reconsidered before it is implemented further in Brazilian schools.
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Affiliation(s)
- Juliana Y Valente
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil.
| | - Hugo Cogo-Moreira
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
| | - Zila M Sanchez
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
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Racial-Based Bullying and Substance Use: a Brazilian National Cross-Sectional Survey Among Students. J Racial Ethn Health Disparities 2022; 10:1441-1454. [PMID: 35578154 PMCID: PMC9109669 DOI: 10.1007/s40615-022-01330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
Abstract
Racial discrimination has been associated with worse health status and risky health behavior. Understanding the relationship between racial-based bullying (RBB) — an overlap of bullying and interpersonal racial discrimination — and substance use can guide school-based actions to prevent bullying and substance use, but investigations rarely involve Brazilian students. We used data from the National Survey of School Health (PeNSE) 2015, which included 102,072 ninth-grade students from the capital and inland cities in the five regions of Brazil. Students self-reported their race/skin color according to the Brazilian official census. We explored racial and recent RBB differences in recent use of alcohol, tobacco, and other substances [marijuana, cocaine, crack, sniffed glue, loló/lança-perfume (ether and chloroform blend)] by comparing prevalence ratios (estimated with quasi-Poisson, crude, and adjusted models by demographic and socioeconomic characteristics) obtained from analyses of imputed data and complete case. We found that RBB prevalence increased according to racial categories associated with darker skin tones; racial differences in the prevalence of RBB were greater among girls than boys. Girls from all racial groups consistently had a higher prevalence of alcohol use than boys. RBB partially explained the recent use of alcohol and tobacco for the minority racial groups and was not associated with the use of other substances. School-based actions should explicitly incorporate anti-racist goals as strategies for substance use prevention, giving particular attention to gender issues in racial discrimination and alcohol use.
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Ng ED, Chua JYX, Shorey S. The Effectiveness of Educational Interventions on Traditional Bullying and Cyberbullying Among Adolescents: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2022; 23:132-151. [PMID: 32588769 DOI: 10.1177/1524838020933867] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In consideration of the adverse societal, physical, and psychological impacts of bullying on a child's development and future, many studies have developed anti-bullying programs and educational interventions to curb bullying occurrences. Therefore, this systematic review aimed to examine the effectiveness of such educational interventions at reducing the frequencies of traditional bullying or cyberbullying and cybervictimization among adolescents. A comprehensive search was conducted using PubMed, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and ProQuest Dissertations and Theses. Only quantitative studies that reported the effects of educational interventions on reducing the frequencies of traditional bullying or cyberbullying victimization and perpetration were included. Seventeen studies (Ntotal = 35,694 adolescents, Rangechild age = 10-18 years) were finalized, and meta-analyses were conducted using a random effect model. Overall, the existing educational interventions had very small to small effect sizes on traditional bullying and cyberbullying perpetration (traditional: standardized mean differences [SMD] = -.30 and cyber: SMD = -.16) and victimization (traditional: SMD = -18 and cyber: SMD = -.13) among adolescents. Type of intervention (i.e., whole school-based or classroom-based), program duration, and presence of parental involvement did not moderate program effectiveness, but cyberbullying programs were more effective when delivered by technology-savvy content experts compared to teachers. Since existing educational interventions were marginally effective in reducing bullying frequencies, further research is needed to identify key moderators that enhance educational programs or develop alternative forms of anti-bullying interventions.
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Affiliation(s)
- Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Validation of the European Drug Addiction Prevention Trial Questionnaire (EU-Dap) for substance use screening and to assess risk and protective factors among early adolescents in Chile. PLoS One 2021; 16:e0258288. [PMID: 34634082 PMCID: PMC8504767 DOI: 10.1371/journal.pone.0258288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Substance use is highly prevalent among Chilean adolescents, and the damage it causes at the neurobiological, psychological, and social levels is known. However, there are no validated screening instruments that also assess risk and protective factors for this population in Chile, which is essential for evaluating future prevention interventions. OBJECTIVE To determine the psychometric properties of the European Drug Addiction Prevention Trial Questionnaire (EU-Dap) questionnaire. METHODS A cross-sectional study was carried out in 13 schools in the city of Santiago de Chile. The sample included 2261 adolescents ranging from 10 to 14 years old. Linguistic and cultural adaptation was assessed using focus groups with adolescents, the construct validity was evaluated using confirmatory factor analysis, and measures of its reliability were also determined. Furthermore, the associations regarding risk and protective factors with substance use were explored. RESULTS Substance use questions were well understood and seemed to adequately capture the consumption of different drugs. Regarding the subscales of risk and protective factors, the analyses showed that most subscales had good psychometric properties, and few needed some degree of improvement (e.g., some items were removed). After the changes, most final subscales had good or adequate goodness of fit adjustments and good or acceptable internal consistency. Finally, the main associated factors with the substance use outcomes were: future substance use and school bonding for tobacco use; negative beliefs about alcohol, future substance use, school bonding and refusal skills for alcohol use; and negative beliefs about marihuana, positive attitudes towards drugs, risk perception, and substance abuse index for marihuana use. Normative beliefs increased the risk for all substances use. CONCLUSIONS The current findings suggest that the EU-Dap is a valid and reliable instrument, and it may help to evaluate the effectiveness of drug use prevention interventions.
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Finch M, Featherston R, Chakraborty S, Bjørndal L, Mildon R, Albers B, Fiennes C, Taylor DJA, Schachtman R, Yang T, Shlonsky A. Interventions that address institutional child maltreatment: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1139. [PMID: 37133265 PMCID: PMC8356353 DOI: 10.1002/cl2.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Child maltreatment has serious short and long-term negative impacts for those experiencing it. Child maltreatment occurring in institutional settings has recently received substantial attention. However, evidence about the effectiveness of interventions that prevent, disclose, respond to, or treat maltreatment that has occurred in these environments is fragmented and can be difficult to access. This evidence and gap map (EGM) collates this research evidence. It was developed as a resource for stakeholders operating in the child health, welfare and protection sectors, including practitioners, organisational leaders, policy developers and researchers, wanting to access high quality evidence on interventions addressing institutional child maltreatment. Objectives The objectives of this EGM were twofold: (a) To provide a structured and accessible collection of existing evidence from finalised and ongoing overviews of systematic reviews, systematic reviews and effectiveness studies of interventions addressing institutional child maltreatment-for those who work to fund, develop, implement and evaluate interventions aimed at ensuring children's safety in institutional settings; (b) to identify gaps in the available evidence on interventions addressing institutional child maltreatment-thereby helping to inform the research agendas of funders and other organisations. Search Methods A comprehensive search strategy identified relevant studies from published and grey literature, comprising: (1) 10 electronic academic databases; (2) five trial and systematic review registries; (3) nine organisational websites; (4) websites and reference lists of inquiry reports associated with seven international inquiries into child abuse and (4) the lists of included studies within systematic reviews identified by the search strategy. Members of this EGM's Subject Matter Experts group were also invited to forward relevant unpublished studies or grey literature. Selection Criteria The selection criteria were developed to identify finalised and ongoing overviews of reviews, systematic reviews and primary studies that reported on the effectiveness of interventions addressing child maltreatment (including sexual abuse, physical abuse, neglect and emotional abuse) within institutional settings. Eligible effectiveness study designs included: randomised controlled trials (RCTs), nonrandomised trials, controlled before-and-after studies and quasi-experimental studies. Reviews were eligible if they reported a systematic literature search strategy. Data Collection and Analysis All screening, data extraction, coding and critical appraisals were undertaken by two or more reviewers working independently, with discrepancies resolved via consensus or by a third reviewer. The titles and abstracts of studies identified by the search strategy were screened, and each full text of potentially relevant studies was further assessed for inclusion. Key data were extracted from all included studies and reviews. This included information about: publication details (e.g., year, author, country), inclusion/exclusion criteria (for reviews), study design, institutional setting, target population, type of maltreatment, intervention type and outcomes. Critical appraisal of included systematic reviews was achieved using the AMSTAR 2 tool, and completed RCTs were assessed using the updated Cochrane Risk of Bias 2.0 tool. Main Results Number of studies The electronic database search yielded 6318 citations, and a further 2375 records were identified from additional sources. Following deduplication and title/abstract screening, 256 studies remained for full text review. A total of 73 eligible studies (reported across 84 publications) met the inclusion criteria, including: 11 systematic reviews (plus, one update); 62 primary studies (including, three protocols for primary studies). Study characteristics The studies were conducted across 18 countries, however more than half (52%) were undertaken in the United States. Overall, most studies evaluated curriculum-based interventions delivered in educational settings, primarily aimed at the prevention of sexual abuse. Institutional setting: Most studies evaluated interventions in school or early learning environments (n = 8 systematic reviews; n = 58 primary studies). Far fewer studies examined other organisational settings. Out of home care (including foster care, residential care and orphanages), and social service organisations servicing children were minimally represented. No studies were identified where the primary setting was sports clubs, churches/religious organisations, summer/vacation camps, detention centres/juvenile justice settings, or primary/secondary health care facilities. Target population: Most interventions targeted children rather than adults (n = 7 systematic reviews; n = 47 primary studies) from the general population. Fewer studies included populations known to be at an increased risk, or those already exposed to maltreatment. Just over a third of the primary studies conducted an analysis to ascertain differences in the effect of an intervention between the genders. Intervention type: Prevention interventions were the most studied (n = 5 systematic reviews; n = 57 primary studies), with additional studies including prevention approaches alongside other intervention types. Fewer studies evaluated interventions targeting disclosure, institutional responses, or treatment interventions. Type of maltreatment: The vast majority of the studies assessed interventions solely addressing the sexual abuse of children (n = 8 systematic reviews; n = 45 primary studies). The remaining studies addressed other forms of maltreatment, including physical and emotional abuse, or neglect, either in combination or as a sole focus. Outcomes: Primary reported outcomes reflected the bias toward child targeted interventions. Outcome measures captured child wellbeing and knowledge outcomes, including measures of mental health, children's knowledge retention and/or self-protective skills. Measures of maltreatment disclosure or maltreatment occurrence/reoccurrence were less common, and all other outcome categories included in the EGM were minimally or not reported. A third of studies reported on some measure of implementation. Study quality The overall quality of the studies was low to moderate. Most systematic reviews were low-quality (n = 10), with only one high quality review (and update) identified. Most completed RCTs had some concerns relating to the risk of bias (n = 30), and the remainder were considered to be at a high risk of bias (n = 19). Authors' Conclusions This EGM has highlighted a substantial need for more high quality studies that evaluate interventions across a broader range of institutional contexts and maltreatment types. The current evidence base does not represent countries with large populations and the greatest incidence of child maltreatment. Few studies focussed on perpetrators or the organisational environment. Further evidence gaps were identified for interventions relating to disclosure, organisational responses and treatment, and few studies assessed interventions targeting perpetrators' maltreatment behaviours, recidivism or desistence. Future studies should also include measure of programme implementation.
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Affiliation(s)
- Meghan Finch
- National Centre for Implementation ScienceNewcastle UniversityWallsendNew South WalesAustralia
| | - Rebecca Featherston
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health SciencesMonash UniversityCaulfieldVictoriaAustralia
| | | | - Ludvig Bjørndal
- Centre for Evidence and ImplementationMelbourneVictoriaAustralia
| | - Robyn Mildon
- Centre for Evidence and ImplementationMelbourneVictoriaAustralia
| | - Bianca Albers
- Centre for Evidence and ImplementationMelbourneVictoriaAustralia
| | | | | | | | - Taoran Yang
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health SciencesMonash UniversityCaulfieldVictoriaAustralia
| | - Aron Shlonsky
- Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health SciencesMonash UniversityCaulfieldVictoriaAustralia
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Mari JJ, Gadelha A, Kieling C, Ferri CP, Kapczinski F, Nardi AE, Almeida-Filho N, Sanchez ZM, Salum GA. Translating science into policy: mental health challenges during the COVID-19 pandemic. ACTA ACUST UNITED AC 2021; 43:638-649. [PMID: 33710250 PMCID: PMC8639016 DOI: 10.1590/1516-4446-2020-1577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.
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Affiliation(s)
- Jair J Mari
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Christian Kieling
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Departamento de Psiquiatria e Medicina Legal, UFRGS, Porto Alegre, RS, Brazil
| | - Cleusa P Ferri
- Departamento de Psiquiatria e Psicologia Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Flavio Kapczinski
- Departamento de Psiquiatria, UFRGS, Porto Alegre, RS, Brazil.,McMaster University, Hamilton, Canada
| | - Antonio E Nardi
- Instituto de Psiquiatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Academia Nacional de Medicina, Rio de Janeiro, RJ, Brazil.,Academia Brasileira de Ciências, Rio de Janeiro, RJ, Brazil
| | - Naomar Almeida-Filho
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, SP, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Giovanni A Salum
- Seção de Afeto Negativo e Processos Sociais, Departamento de Psiquiatria e Medicina Legal, HCPA, UFRGS, Porto Alegre, RS, Brazil
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Fraguas D, Díaz-Caneja CM, Ayora M, Durán-Cutilla M, Abregú-Crespo R, Ezquiaga-Bravo I, Martín-Babarro J, Arango C. Assessment of School Anti-Bullying Interventions: A Meta-analysis of Randomized Clinical Trials. JAMA Pediatr 2021; 175:44-55. [PMID: 33136156 PMCID: PMC7607493 DOI: 10.1001/jamapediatrics.2020.3541] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Bullying is a prevalent and modifiable risk factor for mental health disorders. Although previous studies have supported the effectiveness of anti-bullying programs; their population impact and the association of specific moderators with outcomes are still unclear. OBJECTIVE To assess the effectiveness of school anti-bullying interventions, their population impact, and the association between moderator variables and outcomes. DATA SOURCES A search of Ovid MEDLINE, ERIC, and PsycInfo databases was conducted using 3 sets of search terms to identify randomized clinical trials (RCTs) assessing anti-bullying interventions published from database inception through February 2020. A manual search of reference lists of articles included in previous systematic reviews and meta-analyses was also performed. STUDY SELECTION The initial literature search yielded 34 798 studies. Included in the study were articles that (1) assessed bullying at school; (2) assessed the effectiveness of an anti-bullying program; (3) had an RCT design; (4) reported results; and (5) were published in English. Of 16 707 studies identified, 371 met the criteria for review of full-text articles; 77 RCTs were identified that reported data allowing calculation of effect sizes (ESs). Of these, 69 independent trials were included in the final meta-analysis database. DATA EXTRACTION AND SYNTHESIS Random-effects and meta-regression models were used to derive Cohen d values with pooled 95% CIs as estimates of ES and to test associations between moderator variables and ES estimates. Population impact number (PIN), defined as the number of children in the total population for whom 1 event may be prevented by an intervention, was used as an estimate of the population impact of universal interventions targeting all students, regardless of individual risk. MAIN OUTCOMES AND MEASURES The main outcomes are the effectiveness (measured by ES) and the population impact (measured by the PIN) of anti-bullying interventions on the following 8 variable categories: overall bullying, bullying perpetration, bullying exposure, cyberbullying, attitudes that discourage bullying, attitudes that encourage bullying, mental health problems (eg, anxiety and depression), and school climate as well as the assessment of potential assocations between trial or intervention characteristics and outcomes. RESULTS This study included 77 samples from 69 RCTs (111 659 participants [56 511 in the intervention group and 55 148 in the control group]). The weighted mean (range) age of participants in the intervention group was 11.1 (4-17) years and 10.8 (4-17) years in the control group. The weighted mean (range) proportion of female participants in the intervention group was 49.9% (0%-100%) and 50.5% (0%-100%) in the control group. Anti-bullying interventions were efficacious in reducing bullying (ES, -0.150; 95% CI, -0.191 to -0.109) and improving mental health problems (ES, -0.205; 95% CI, -0.277 to -0.133) at study end point, with PINs for universal interventions that target the total student population of 147 (95% CI, 113-213) and 107 (95% CI, 73-173), respectively. Duration of intervention was not statistically significantly associated with intervention effectiveness (mean [range] duration of interventions, 29.4 [1 to 144] weeks). The effectiveness of anti-bullying programs did not diminish over time during follow-up (mean [range] follow-up, 30.9 [2-104] weeks). CONCLUSIONS AND RELEVANCE Despite the small ESs and some regional differences in effectiveness, the population impact of school anti-bullying interventions appeared to be substantial. Better designed trials that assess optimal intervention timing and duration are warranted.
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Affiliation(s)
- David Fraguas
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Covadonga M. Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Miriam Ayora
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Manuel Durán-Cutilla
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Renzo Abregú-Crespo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iciar Ezquiaga-Bravo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain,Department of Psychiatry, Hospital del Mar, Institut de Neuropsiquiatria i Addiccions, Barcelona, Catalonia, Spain
| | - Javier Martín-Babarro
- Department of Developmental Psychology and Education, Universidad Complutense, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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11
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Becker P, Razzouk D. Direct healthcare costs and their relationships with age at start of drug use and current pattern of use: a cross-sectional study. SAO PAULO MED J 2021; 139:18-29. [PMID: 33656124 PMCID: PMC9632499 DOI: 10.1590/1516-3180.2020.0115.r1.21102020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is well known that early start of drug use can lead users to psychosocial problems in adulthood, but its relationship with users' direct healthcare costs has not been well established. OBJECTIVES To estimate the direct healthcare costs of drug dependency treated at a community mental health service, and to ascertain whether early start of drug use and current drug use pattern may exert influences on these costs. DESIGN AND SETTING Retrospective cross-sectional study conducted at a community mental health service in a municipality in the state of São Paulo, Brazil. METHODS The relationships between direct healthcare costs from the perspective of the public healthcare system, age at start of drug use and drug use pattern were investigated in a sample of 105 individuals. A gamma-distribution generalized linear model was used to identify the cost drivers of direct costs. RESULTS The mean monthly direct healthcare costs per capita for early-start drug users in 2020 were 1,181.31 Brazilian reais (BRL) (274.72 United State dollars (USD) according to purchasing power parity (PPP)) and 1,355.78 BRL (315.29 USD PPP) for late-start users. Early start of drug use predicted greater severity of cannabis use and use of multiple drugs. The highest direct costs were due to drug dependence combined with alcohol abuse, and due to late start of drug use. CONCLUSIONS Preventive measures should be prioritized in public policies, in terms of strengthening protective factors before an early start of drug use.
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Affiliation(s)
- Paula Becker
- PhD. Occupational Therapist, Department of Psychiatry, Centro de Economia em Saúde Mental (CESM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Denise Razzouk
- MSc, PhD. Psychiatrist and Affiliated Professor, Department of Psychiatry, Centro de Economia em Saúde Mental (CESM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
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12
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Valente JY, Cogo-Moreira H, Sanchez ZM. Evaluating the effects of parenting styles dimensions on adolescent drug use: secondary analysis of #Tamojunto randomized controlled trial. Eur Child Adolesc Psychiatry 2020; 29:979-987. [PMID: 31563980 DOI: 10.1007/s00787-019-01410-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/20/2019] [Indexed: 12/31/2022]
Abstract
The present study examined parenting style dimensions (demandingness and responsiveness) as predictors of adolescent drug use and also evaluated whether parenting styles dimensions moderate the effects of the implemented prevention program. 6.391 students in the 7th and 8th grades at 72 Brazilian public schools participated in a three-wave randomized controlled trial to evaluate a school drug-use prevention program. We used structural equation modeling to test if baseline parenting style dimensions (demandingness and responsiveness) would predict the use of drugs (alcohol, binge drinking, cannabis, inhalants, and tobacco) after 21 months. Additionally, we evaluated an interaction version of the above-described model to test if the effect of the prevention program would be moderated by either or both parenting style dimensions. Higher levels of parent demandingness predicted lower chances of adolescent drug use (e.g., Cigarette use OR 0.76, 95% CI 0.64-0.89); responsiveness on the five outcomes showed p value superior to 0.01. The effect of the #Tamojunto intervention is unlikely to be conditioned to either parenting style dimensions on the assessed outcomes.Clinical trial registration Brazilian Register of Clinical Trials (REBEC): #RBR-4mnv5g ( https://www.ensaiosclinicos.gov.br/rg/?q=tamojunto ).
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Affiliation(s)
- Juliana Y Valente
- Department of Preventive Medicine, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zila M Sanchez
- Department of Preventive Medicine, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, Brazil.
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13
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Castillo-Eito L, Armitage CJ, Norman P, Day MR, Dogru OC, Rowe R. How can adolescent aggression be reduced? A multi-level meta-analysis. Clin Psychol Rev 2020; 78:101853. [PMID: 32402919 DOI: 10.1016/j.cpr.2020.101853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 02/27/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022]
Abstract
Aggressive behaviour among adolescents has significant social and economic costs. Numerous attempts have been made to intervene to reduce aggression in adolescents. However, little is known about what factors enhance or diminish intervention effectiveness. The present systematic review and meta-analysis, therefore, seeks to quantify the effectiveness of interventions to reduce aggressive behaviour in adolescents and to identify when and for whom such interventions work best. Sixteen databases were searched for randomised controlled trials that assessed interventions to reduce aggression among adolescents. After screening 9795 records, 95 studies were included. A multi-level meta-analysis found a significant overall small-to-medium effect size (d = 0.28; 95% CI [0.17, 0.39]). More effective interventions were of shorter duration, were conducted in the Middle East, were targeted at adolescents with higher levels of risk, and were facilitated by intervention professionals. Potentially active ingredients were classified using the Behaviour Change Technique Taxonomy. Behavioural practice and problem solving were components of more effective interventions targeted at the general population. Overall the findings indicate that psychosocial interventions are effective in reducing adolescent aggression. Future trials need to assess the effect of individual techniques and their combination to identify the key components that can reduce aggression in adolescents.
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Affiliation(s)
- Laura Castillo-Eito
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, M13 9PL, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Marianne R Day
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Onur C Dogru
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
| | - Richard Rowe
- Department of Psychology, The University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
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14
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Valente JY, Cogo-Moreira H, Sanchez ZM. Decision-making skills as a mediator of the #Tamojunto school-based prevention program: Indirect effects for drug use and school violence of a cluster-randomized trial. Drug Alcohol Depend 2020; 206:107718. [PMID: 31761477 DOI: 10.1016/j.drugalcdep.2019.107718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/28/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate a formal mediation analysis effect of the #Tamojunto program on adolescents' drug use and violent behavior in schools through decision-making skills using a potential outcomes approach. METHODS An in-cluster randomized controlled trial was conducted in 2014-2015 with 6691 7th- and 8th-grade students in 72 public schools in 6 Brazilian cities to evaluate the effects of the European drug prevention program Unplugged, called #Tamojunto in Brazil. Baseline data were collected prior to program implementation, and follow-up data were collected 9 and 21 months later. Mediation analysis using a potential outcomes approach, in which counterfactuals are modeled if positivity is met, was used to evaluate the indirect effects of the program #Tamojunto on the third-wave of drug use (alcohol, tobacco, marijuana, inhalants, and binge drinking) and school violence (bullying or physical, verbal and sexual aggression) assessment through decision-making skills. RESULTS When controlling for all covariates, the Total Natural Indirect Effect (TNIE) was significant only for past-year drug use (TNIE = 0.003, 95%CI = 0.001; 0.007). In the adjusted models, 37.5% of the effect of the intervention on drug use was mediated by decision-making skills. CONCLUSIONS The #Tamojunto program increased drug use through decreasing decision-making skills. The findings demonstrate that this program changes decision-making skills but in the opposite direction proposed by the theoretical model of the program, suggesting that modifications are needed to produce the intended effect of the program.
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Affiliation(s)
- Juliana Y Valente
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Psychology and Education, Freie Universität Berlin, Berlin, Germany
| | - Zila M Sanchez
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil.
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