Neighborhood effects on the efficacy of a program to prevent youth alcohol use

Revisão sistemática sobre o efeito do programa escolar de prevenção ao uso de drogas Keepin’ it REAL: traduzido e implementado no Brasil pelo PROERD

Resumo O Programa Educacional de Resistência às Drogas (PROERD) é o programa escolar de prevenção mais disseminado no Brasil, seu atual currículo é baseado no programa norte-americano Keepin’it REAL (kiR). Não há na literatura evidência de efetividade do PROERD na prevenção ao uso de drogas, sendo necessários estudos complementares que auxiliem a compreensão desses achados. O objetivo do presente estudo é realizar uma síntese das evidências do efeito do currículo que deu origem ao PROERD: o kiR. Através de revisão sistemática encontrou-se 17 estudos que reportaram resultados de efeito de diferentes versões do kiR no uso de drogas e/ou violência. Com exceção do estudo brasileiro, não foram encontrados estudos que avaliassem o efeito no uso de drogas da versão aplicada por policiais (DARE-kiR), a mesma implementada pelo PROERD. Foram encontradas evidências favoráveis do kiR na prevenção ao uso de drogas para o currículo do 7º ano, que contrariam os resultados de efeito nulo do PROERD. Não foram encontradas evidências internacionais do efeito do kiR no currículo do 5º ano, assim como o estudo do PROERD. Sugere-se que revisões no currículo do 7º ano do PROERD para que ele possa refletir os resultados internacionais e que o currículo do 5º ano posso ser repensado considerando as evidências negativas internacionais.

A systematic review of the effect of the school-based drug prevention program Keepin’ it REAL: translated and implemented in Brazil by PROERD

Abstract The Drug Resistance Educational Program (PROERD) is Brazil’s most widespread school-based prevention program; its current curriculum is based on the North American Keepin’ it REAL (kiR) program. There is no evidence of the effectiveness of PROERD in preventing drug use, pointing to the need for further studies to understand these findings. The aim of the study was to synthesis the evidence of the effect of the kiR curriculum (PROERD) through a systematic review. We found 17 studies that reported the effects of different versions of kiR on drug use and/or violence. Except for the Brazilian study, no studies were found that assessed the effect on drug use of the version applied by police officers (DARE-kiR), the same one implemented by PROERD. Favorable evidence of kiR in drug use prevention was found for the 7th-grade curriculum, which contradicts the PROERD’s null-effect results. No international evidence of the effect of kiR was found in the 5th-grade curriculum, in the same line as the PROERD’s study. It is suggested that PROERD’s 7th-grade curriculum should be revised to reflect international results and that the 5th-grade curriculum should be reconsidered in light of the negative international evidence.

Understanding Neighborhoods' Impact on Youth Substance Use and Mental Health Outcomes in Paterson, New Jersey: Protocol for a Community-Based Participatory Research Study

BACKGROUND

Substance use among youth is a major public health concern. Of note, substance use among youth is increasing in prevalence, and the incidence of substance use at earlier ages is rising. Given the long-term consequences of early substance use, it is important to identify factors that increase youth vulnerability to drug use, as they may be important targets for future interventions.

OBJECTIVE

This study aims to use innovative methods, such as venue-based sampling, to recruit youth who are disconnected from school and use community-based participatory research to gain a better understanding of the prevalence of substance use and important correlates among youth aged between 13 and 21 years in Paterson, New Jersey, a low-income, urban community. The study will use a convergent, mixed methods design involving multiple data collection components and the analysis of a ministrative data source, designed with the strengths of complex intervention frameworks in mind. The overall aims of the study are to identify the prevalence of substance use among youth who are engaged in school and not engaged in school; to understand important antecedents and correlates of substance use; and to use this information to inform social, environmental, and culturally appropriate interventions to address substance use and its correlates among youths in a lower-resourced urban community.

METHODS

This study will use both qualitative and quantitative methods to address important questions. Specifically, semistructured interviews using focus group and interview methodologies will be used to assess youths' lived experiences and will account for specific details that quantitative methods may not be able to attain. In addition, quantitative methods will be used to examine direct and multilevel associations between neighborhood factors and youth substance use and mental health outcomes.

RESULTS

A previous analysis from a substance use initiative in Paterson, New Jersey found that youth who use substances such as marijuana and alcohol are more likely to have higher rates of depression and anxiety. On the basis of the research questions, this study will examine the association between neighborhood characteristics, substance use, and mental health symptoms among youth in Paterson by using quantitative and qualitative methods and will use these findings to inform the adaptation of a community- and evidence-based substance use prevention intervention for these youths.

CONCLUSIONS

The findings of this study will provide an important contribution to understanding the role of socioecological factors in predicting substance use and mental health outcomes among youth in a lower-resourced, urban community. Furthermore, these findings will serve as evidence for the development of a culturally informed, community-based prevention program to address substance use disparities for youth, including those who are truant in Paterson, New Jersey.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/29427.

"Bullets Have no Names": A Qualitative Exploration of Community Trauma Among Black and Latinx Youth

Repeated exposure to violent crime and drug use among youth of color can have negative health and behavioral outcomes. Using a community trauma theoretical framework, this qualitative study examines the lived experiences of Black and Latinx youth living in an under-resourced community with high levels of violent crime. Data were collected through eleven focus groups comprising of (N = 59) youth. Common themes arose including daily occurrences of witnessing gun violence, feelings of hopelessness, and lack of opportunities among youth. Implications highlight the importance of youth serving community-based organizations to nurture resilience and community healing within trauma-exposed neighborhoods.

Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people

BACKGROUND

Engagement in multiple risk behaviours can have adverse consequences for health during childhood, during adolescence, and later in life, yet little is known about the impact of different types of interventions that target multiple risk behaviours in children and young people, or the differential impact of universal versus targeted approaches. Findings from systematic reviews have been mixed, and effects of these interventions have not been quantitatively estimated.

OBJECTIVES

To examine the effects of interventions implemented up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people.

SEARCH METHODS

We searched 11 databases (Australian Education Index; British Education Index; Campbell Library; Cumulative Index to Nursing and Allied Health Literature (CINAHL); Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; Embase; Education Resource Information Center (ERIC); International Bibliography of the Social Sciences; MEDLINE; PsycINFO; and Sociological Abstracts) on three occasions (2012, 2015, and 14 November 2016)). We conducted handsearches of reference lists, contacted experts in the field, conducted citation searches, and searched websites of relevant organisations.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster RCTs, which aimed to address at least two risk behaviours. Participants were children and young people up to 18 years of age and/or parents, guardians, or carers, as long as the intervention aimed to address involvement in multiple risk behaviours among children and young people up to 18 years of age. However, studies could include outcome data on children > 18 years of age at the time of follow-up. Specifically,we included studies with outcomes collected from those eight to 25 years of age. Further, we included only studies with a combined intervention and follow-up period of six months or longer. We excluded interventions aimed at individuals with clinically diagnosed disorders along with clinical interventions. We categorised interventions according to whether they were conducted at the individual level; the family level; or the school level.

DATA COLLECTION AND ANALYSIS

We identified a total of 34,680 titles, screened 27,691 articles and assessed 424 full-text articles for eligibility. Two or more review authors independently assessed studies for inclusion in the review, extracted data, and assessed risk of bias.We pooled data in meta-analyses using a random-effects (DerSimonian and Laird) model in RevMan 5.3. For each outcome, we included subgroups related to study type (individual, family, or school level, and universal or targeted approach) and examined effectiveness at up to 12 months' follow-up and over the longer term (> 12 months). We assessed the quality and certainty of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

We included in the review a total of 70 eligible studies, of which a substantial proportion were universal school-based studies (n = 28; 40%). Most studies were conducted in the USA (n = 55; 79%). On average, studies aimed to prevent four of the primary behaviours. Behaviours that were most frequently addressed included alcohol use (n = 55), drug use (n = 53), and/or antisocial behaviour (n = 53), followed by tobacco use (n = 42). No studies aimed to prevent self-harm or gambling alongside other behaviours.Evidence suggests that for multiple risk behaviours, universal school-based interventions were beneficial in relation to tobacco use (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.60 to 0.97; n = 9 studies; 15,354 participants) and alcohol use (OR 0.72, 95% CI 0.56 to 0.92; n = 8 studies; 8751 participants; both moderate-quality evidence) compared to a comparator, and that such interventions may be effective in preventing illicit drug use (OR 0.74, 95% CI 0.55 to 1.00; n = 5 studies; 11,058 participants; low-quality evidence) and engagement in any antisocial behaviour (OR 0.81, 95% CI 0.66 to 0.98; n = 13 studies; 20,756 participants; very low-quality evidence) at up to 12 months' follow-up, although there was evidence of moderate to substantial heterogeneity (I² = 49% to 69%). Moderate-quality evidence also showed that multiple risk behaviour universal school-based interventions improved the odds of physical activity (OR 1.32, 95% CI 1.16 to 1.50; I² = 0%; n = 4 studies; 6441 participants). We considered observed effects to be of public health importance when applied at the population level. Evidence was less certain for the effects of such multiple risk behaviour interventions for cannabis use (OR 0.79, 95% CI 0.62 to 1.01; P = 0.06; n = 5 studies; 4140 participants; I² = 0%; moderate-quality evidence), sexual risk behaviours (OR 0.83, 95% CI 0.61 to 1.12; P = 0.22; n = 6 studies; 12,633 participants; I² = 77%; low-quality evidence), and unhealthy diet (OR 0.82, 95% CI 0.64 to 1.06; P = 0.13; n = 3 studies; 6441 participants; I² = 49%; moderate-quality evidence). It is important to note that some evidence supported the positive effects of universal school-level interventions on three or more risk behaviours.For most outcomes of individual- and family-level targeted and universal interventions, moderate- or low-quality evidence suggests little or no effect, although caution is warranted in interpretation because few of these studies were available for comparison (n ≤ 4 studies for each outcome).Seven studies reported adverse effects, which involved evidence suggestive of increased involvement in a risk behaviour among participants receiving the intervention compared to participants given control interventions.We judged the quality of evidence to be moderate or low for most outcomes, primarily owing to concerns around selection, performance, and detection bias and heterogeneity between studies.

AUTHORS' CONCLUSIONS

Available evidence is strongest for universal school-based interventions that target multiple- risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family- or individual-level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high-quality multiple- risk behaviour intervention studies to further strengthen the evidence base in this field.

Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis

Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau²=0.0, I²=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.

Culturally Grounded Prevention for Minority Youth Populations: A Systematic Review of the Literature

Contemporary prevention science has focused on the application of cultural adaptations of evidence-based prevention programs for minority youth populations. Far less is known about culturally grounded methods that are intended to organically develop prevention programs within specific populations and communities. This article systematically reviews recent literature on culturally grounded interventions used to prevent health disparities in ethnic minority youth populations. In this review, we assessed 31 peer-reviewed articles published in 2003 or later that fit inclusionary criteria pertaining to the development and evaluation of culturally grounded prevention programs. The evaluated studies indicated different approaches toward cultural grounding, as well as specific populations, geographic regions, and health issues that have been targeted. Specifically, the findings indicated that most of the studies focused on the development and evaluation of culturally grounded HIV/STI and substance abuse prevention programs for Mexican-American, African American, and American Indian/Alaska Native youth residing in the South or Southwestern US. These studies largely relied on community-based participatory or qualitative research methods to develop programs from the "ground up." This review has implications for the development of future culturally grounded and culturally adapted prevention programs targeting underserved minority youth populations and geographic regions. Specifically, it identifies populations and regions where culturally grounded prevention efforts are underdeveloped or non-existent, providing some scientific direction for the future development of these types of programs.

Mental health and psychosocial support in humanitarian settings: linking practice and research

This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007-10); funding by analysis of the financial tracking service and the creditor reporting system (2007-09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] -0·38, 95% CI -0·55 to -0·20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (-0·36, -0·83 to 0·10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD -0·24, -0·40 to -0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.

The influence of socioeconomic environment on the effectiveness of alcohol prevention among European students: a cluster randomized controlled trial

Background

Although social environments may influence alcohol-related behaviours in youth, the relationship between neighbourhood socioeconomic context and effectiveness of school-based prevention against underage drinking has been insufficiently investigated. We study whether the social environment affects the impact of a new school-based prevention programme on alcohol use among European students.

Methods

During the school year 2004-2005, 7079 students 12-14 years of age from 143 schools in nine European centres participated in this cluster randomised controlled trial. Schools were randomly assigned to either control or a 12-session standardised curriculum based on the comprehensive social influence model. Randomisation was blocked within socioeconomic levels of the school environment. Alcohol use and alcohol-related problem behaviours were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. Data were analysed using multilevel models, separately by socioeconomic level.

Results

At baseline, adolescents in schools of low socioeconomic level were more likely to report problem drinking than other students. Participation in the programme was associated in this group with a decreased odds of reporting episodes of drunkenness (OR = 0.60, 95% CI = 0.44-0.83), intention to get drunk (OR = 0.60, 95% CI = 0.45-0.79), and marginally alcohol-related problem behaviours (OR = 0.70, 95% CI = 0.46-1.06). No significant programme's effects emerged for students in schools of medium or high socioeconomic level. Effects on frequency of alcohol consumption were also stronger among students in disadvantaged schools, although the estimates did not attain statistical significance in any subgroup.

Conclusions

It is plausible that comprehensive social influence programmes have a more favourable effect on problematic drinking among students in underprivileged social environments.

Trial registration

ISRCTN: ISRCTN18092805

Parental monitoring and changes in substance use among Latino/a and non-Latino/a preadolescents in the Southwest

Prior research shows parental monitoring is associated with less substance use, but these studies have some limitations. Many examine older adolescents from White, Euro-American heritage, and cross-sectional studies are unable to test if parental monitoring decreases substance use over time. We address these limitations with longitudinal data of 2,034 primarily Latino preadolescents in Phoenix, Arizona, USA in 2004-2005. We use multilevel regression with multiple imputation of missing data. We find parental monitoring has beneficial, longitudinal effects on youth's substance use and related intentions, norms, and attitudes. Effects are invariant to gender or Latino ethnicity, except in the case of marijuana.

Influences of School Latino Composition and Linguistic Acculturation on a Prevention Program for Youth

This study examined how ethnic composition and linguistic acculturation within schools affected the efficacy of a youth substance use prevention model program. Data come from a randomized trial of the keepin' it REAL program, using a predominantly Mexican American sample of middle school students in Phoenix, Arizona. Schools were randomly assigned to a control group or to one of three culturally tailored intervention versions. We hypothesized that school ethnic and linguistic acculturation composition (percent Latino, percent non-English speaking at home) and individual level of linguistic acculturation jointly would moderate the efficacy of the prevention program, as indicated by students' alcohol, marijuana, and cigarette use. Using multilevel linear modeling and multiple imputation techniques to manage clustered data and attrition, results showed that desired program effects varied by the linguistic acculturation level of the school, the program version, and individual acculturation level. The Latino intervention version was more efficacious in schools with larger percentages of non-English speaking families, but only among less linguistically acculturated Latino students. There were no significant school level program effects connected to the percentage of Latino students at school, the other versions of the program, or among more linguistically acculturated students.

Acculturation Gaps and Problem Behaviors among U.S. Southwestern Mexican Youth

This article presents the findings of a study examining acculturation differences between adolescents and their mothers within Mexican immigrant families in the border region of the Southwest U.S. The main hypotheses of the study was that youth in mother-child dyads with mismatched acculturation strategies would report higher levels of externalizing problem behaviors than other adolescents, and that this relationship would be mediated by family conflict, acculturation conflict, family cohesion, and sense of familism. The participants formed 142 dyads (N=284) of Mexican heritage mothers and their adolescent children. Regression analysis indicated that a gap or mismatch in acculturation strategies was associated with more externalizing youth problem behaviors. Compared to the dyads where both mother and child were bicultural, only youth with more acculturated mothers demonstrated increased rates of externalizing problem behaviors. Family conflict and acculturation conflict mediated the relationship between acculturation gaps and externalizing behaviors. Implications for family-centered interventions as well as future research and policy implications are discussed.

Social epidemiology and complex system dynamic modelling as applied to health behaviour and drug use research

A social epidemiologic perspective considers factors at multiple levels of influence (e.g., social networks, neighbourhoods, states) that may individually or jointly affect health and health behaviour. This provides a useful lens through which to understand the production of health behaviours in general, and drug use in particular. However, the analytic models that are commonly applied in population health sciences limit the inference we are able to draw about the determination of health behaviour by factors, likely interrelated, across levels of influence. Complex system dynamic modelling techniques may be useful in enabling the adoption of a social epidemiologic approach in health behaviour and drug use research. We provide an example of a model that aims to incorporate factors at multiple levels of influence in understanding drug dependence. We conclude with suggestions about future directions in the field and how such models may serve as virtual laboratories for policy experiments aimed at improving health behaviour.