1
|
Ponsford R, Melendez-Torres GJ, Miners A, Falconer J, Bonell C. Whole-school interventions promoting student commitment to school to prevent substance use and violence, and improve educational attainment: a systematic review. PUBLIC HEALTH RESEARCH 2024; 12:1-290. [PMID: 38356404 DOI: 10.3310/dwtr3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Whole-school interventions modify the school environment to promote health. A subset of these interventions promotes student commitment to school to prevent substance (tobacco, alcohol, other drugs) use and/or violence. A previous review identified the theory of human functioning and school organisation as a comprehensive theory of such interventions, and found evidence that these interventions reduce substance use and/or violence. Objectives The objectives were to search for, appraise and synthesise evidence to address the following questions: (1) What whole-school interventions promoting student commitment to school to prevent substance use and/or violence have been evaluated, what intervention subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? (2) What factors relating to setting, population and intervention affect implementation? (3) What are the effects on student substance use, violence and educational attainment? (4) What is the cost-effectiveness of such interventions? (5) Are intervention effects mediated by student commitment to school or moderated by setting or population? Data sources A total of 56 information sources were searched (in January 2020), then an updated search of 48 of these was carried out (in May 2021). Reference lists were also searched and experts were contacted. Review methods Eligible studies were process/outcome evaluations of whole-school interventions to reduce student violence or substance use among students aged 5-18 years attending schools, via actions aligning with the theory of human functioning and school organisation: modifying teaching to increase engagement, enhancing student-staff relationships, revising school policies, encouraging volunteering or increasing parental involvement. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised qualitatively. Outcome and economic data were synthesised narratively; outcome data were meta-analysed. Results Searches retrieved 63 eligible reports on 27 studies of 22 interventions. We identified four intervention subtypes focused on student participation in school-wide decisions, improving staff-student relationships, increasing engagement in learning and involving parents. The theories of change of most intervention subtypes aligned closely with the theory of human functioning and school organisation, and informed refinement of an intervention theory of change. Theories of change for interventions increasing learning engagement did not align with this theory, aiming instead to increase school commitment primarily via social skills curricula. Factors influencing the implementation included whether or not interventions were tailorable, workable and well explained. Interventions with action groups comprising staff/students, etc. and providing local data were well implemented. Implementation was also affected by whether or not schools accepted the need for change and staff had the resources for delivery. Meta-analyses suggest small, but significant, intervention effects in preventing violence victimisation and perpetration, and substance use. There was sparse and inconsistent evidence of moderation and some evidence of mediation by student commitment to school. Two economic evaluations suggested that there is the potential for the interventions to be cost-effective. Limitations The quality of the studies was variable and the economic synthesis was limited to two studies. Conclusions Whole-school interventions aiming to promote student commitment to school share similar theories of change and factors affecting implementation. They have the potential to contribute to preventing violence and substance use among young people. Future trials should aim to optimise intervention effectiveness by better theorisation, and assess implementation and effect moderators and mediators. Study registration This study is registered as PROSPERO CRD42019154334. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/151/05) and is published in full in Public Health Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Ruth Ponsford
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jane Falconer
- Library & Archives Service, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
2
|
Osypuk TL, Gailey S, Schmidt NM, Garcia DA. Does poor health influence residential selection? Understanding mobility among low-income housing voucher recipients in the Moving to Opportunity Study. HOUSING POLICY DEBATE 2024; 34:508-537. [PMID: 39238599 PMCID: PMC11374104 DOI: 10.1080/10511482.2023.2301336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 09/07/2024]
Abstract
Housing mobility programs and housing choice vouchers provide low-income families with a potentially-transformative opportunity to move to low-poverty neighborhoods. However, families often face barriers to attaining upward residential mobility; poor health may be one important barrier, although few studies have examined this hypothesis. We used the experimental Moving to Opportunity (MTO) Study, constructed residential trajectories, and linked neighborhood opportunity measures to over 14,000 addresses of 3526 families across 7 years. We used latent growth curve longitudinal models to test how baseline health modified effects of MTO housing voucher treatment on neighborhood opportunity trajectories. Results show that poor baseline health adversely influenced how the voucher induced upward mobility. Voucher receipt strongly promoted residential mobility if families were healthy; moreover the low-poverty neighborhood voucher plus counseling treatment promoted higher opportunity neighborhood attainment compared to controls, regardless of the baseline health of the family. However families with health vulnerabilities did not retain the same initial neighborhood gains conferred by the housing choice voucher treatment, as families without health vulnerabilities. These results suggest that housing counseling may be one necessary element to expand neighborhood choice into higher opportunity neighborhoods for families with health challenges. Providing housing vouchers alone are insufficient to promote low-income family high opportunity moves, for families who have disabilities or special needs. The implications of these results point to scaling up housing mobility programs, to provide tailored support for low-income families to use housing choice vouchers to make high opportunity moves, which is particularly necessary for families with health challenges.
Collapse
Affiliation(s)
- Theresa L Osypuk
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, and Director of the Minnesota Population Center
| | - Samantha Gailey
- University of Minnesota, Minnesota Population Center; Assistant Professor, Michigan State University, Departments of Public Health and Forestry
| | | | - Dolores Acevedo Garcia
- Youth and Family Policy, Brandeis University, Heller School for Social Policy and Management
| |
Collapse
|
3
|
Gaete J, Inzunza C, Ramírez S, Valenzuela D, Rojas C, Araya R. The Social Competence Promotion Program among Young Adolescents (SCPP-YA) in Chile ("Mi Mejor Plan") for substance use prevention among early adolescents: study protocol for a randomized controlled trial. Trials 2022; 23:542. [PMID: 35773714 PMCID: PMC9244880 DOI: 10.1186/s13063-022-06472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use is highly prevalent among children and adolescents in Chile, and it is known how it impacts their health and social adjustment. The call for effective prevention of substance use among children adolescents has resulted in numerous school-based programs, and particularly, the Social Competence Promotion Program among Young Adolescents (SCPP-YA) has been proved to be successful for promoting social and problem-solving skills in addition to preventing substance abuse in the US population. The purpose of this study is to test the effectiveness of the Social Competence Promotion Program among Young Adolescents (SCPP-YA) in Chile ("Mi Mejor Plan"). METHODS This is a cluster randomized controlled trial, parallel-group type, where "Mi Mejor Plan" is compared to standard school preventive curricula in control schools. A total of 10 schools and 600 adolescents are expected to be recruited and randomized with 1:1 allocation. During formative work, the SCPP-YA program was culturally adapted to Chile. The effectiveness of this program will be assessed using the European Drug Addiction Prevention Trial Questionnaire (EU-Dap), measuring substance use prevalence and risk and protective factors in baseline, post-intervention, and 4 months after the end of the intervention. DISCUSSION The proposed study will be the first to test the effectiveness of the Social Competence Promotion Program among Young Adolescents (SCPP-YA) in Chile in a cluster randomized control trial and also the first study evaluating this program in Spanish-speaking Latin America. SCPP-YA has been implemented successfully in the USA. Thus, if the effects of the program are positive, wide implementation in Chile and Latin American countries is possible soon. TRIAL REGISTRATION Clinical Trials NCT04236947 . Registered on January 22, 2020.
Collapse
Affiliation(s)
- Jorge Gaete
- Research Center for Students Mental Health (ISME), Faculty of Education, Universidad de los Andes, Santiago, Chile.
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Millennium Science Initiative, Santiago, Chile.
| | - Constanza Inzunza
- Research Center for Students Mental Health (ISME), Faculty of Education, Universidad de los Andes, Santiago, Chile
| | - Saray Ramírez
- Research Center for Students Mental Health (ISME), Faculty of Education, Universidad de los Andes, Santiago, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Millennium Science Initiative, Santiago, Chile
| | - Daniela Valenzuela
- Research Center for Students Mental Health (ISME), Faculty of Education, Universidad de los Andes, Santiago, Chile
| | - Cristian Rojas
- Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Ricardo Araya
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Millennium Science Initiative, Santiago, Chile
- Department of Health Service & Population Research, King's College London, London, UK
- David Goldberg Centre, Denmark Hill, London, UK
| |
Collapse
|
4
|
Venner KL, Hernandez-Vallant A, Hirchak KA, Herron JL. A scoping review of cultural adaptations of substance use disorder treatments across Latinx communities: Guidance for future research and practice. J Subst Abuse Treat 2022; 137:108716. [PMID: 35148923 PMCID: PMC9086178 DOI: 10.1016/j.jsat.2021.108716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/26/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Much of the substance use disorder (SUD) treatment efficacy and effectiveness research is lacking consensus on which scientifically rigorous approach to employ for culturally adapting evidence-based treatments (EBTs) and evidence-based preventions (EBPs) for SUDs among Latinx communities. The aim of this paper is to provide a scoping review of the literature on cultural adaptations of SUD treatment for Latinx communities. METHODS We examined the justifications for cultural adaptations, processes of adaptations, cultural adaptations described, and efficacy and effectiveness of culturally adapted SUD interventions. The study followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Inclusion criteria consisted of whether the intervention had been culturally adapted based upon an existing EBT or EBP for SUD. Through the search of four databases, expert knowledge and reviewing the reference list of applicable articles, 30 articles met inclusion criteria, which included 14 treatment or prevention outcome articles, one single group pre-post study article, and 15 methods papers on cultural adaptations. Justifications for cultural adaptations centered on SUD health inequities among Latinx populations. RESULTS Four research groups employed adaptation models to culturally tailor evidence-based interventions and most often used elements of community-based participatory research (CBPR). Using Bernal, Bellido, & Bonilla's (1995) Ecological Validity Framework of eight dimensions, the most common cultural adaptations centered on language, context, content, and persons. Efficacy trials with Latinx populations are nascent though growing and reveal: (1) significant time effects for EBTs and most EBPs, (2) superior SUD outcomes for culturally adapted EBTs compared to standard EBTs or other comparison conditions by three research groups, (3) significant prevention intervention effects by three research groups, and (4) significant cultural or social moderators by two groups suggesting Latinx with higher cultural identity, parental familism, or baseline discrimination improve significantly more in the culturally adapted EBTs. CONCLUSION These findings suggest that the science of culturally adapting EBTs is improving in rigor with the use of models to guide the work and the conduct of clinical trials. Measurement of cultural and social variables allows for tests of moderation to understand for whom cultural adaptations are most effective. Future hybrid efficacy/effectiveness trials and implementation research should continue moving the science of cultural adaptation forward.
Collapse
Affiliation(s)
- Kamilla L Venner
- University of New Mexico, MSC03 2220, Albuquerque, NM 87131, United States.
| | | | - Katherine A Hirchak
- Washington State University, Elson S. Floyd College of Medicine, United States.
| | - Jalene L Herron
- University of New Mexico, MSC03 2220, Albuquerque, NM 87131, United States; University of New Mexico, Center on Alcohol, Substance Use, and Addictions, United States.
| |
Collapse
|
5
|
Essay AM, Schlechter CR, Mershon CA, Fial AV, Ellison J, Rosenkranz RR, Dzewaltowski DA. A scoping review of whole-of-community interventions on six modifiable cancer prevention risk factors in youth: A systems typology. Prev Med 2021; 153:106769. [PMID: 34416222 DOI: 10.1016/j.ypmed.2021.106769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 08/15/2021] [Indexed: 12/28/2022]
Abstract
Whole-of-community interventions delivered across entire geospatial areas show promise for improving population health for youth cancer prevention. The aims of this scoping review were to synthesize the whole-of-community intervention literature on six modifiable risk factors in youth for cancer prevention (alcohol use, diet, obesity, physical activity, sun exposure, tobacco use) and to develop and apply a typology describing the inclusion of fundamental control system functional characteristics. A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus for studies published to the end of 2019. Eligible studies included a geospatially defined whole-of-community intervention; youth 0-18 years; and at least one of the six cancer risk factor outcomes. An iterative process was undertaken to create a typology describing the functions for whole-of-community interventions guided by systems theory, and the typology was used to code the included interventions. A total of 41 interventions were included. Most interventions (43.9%) assessed multiple cancer risk factors. Few interventions provided fundamental functions necessary for community system coordination: sensor, controller, effector. Although communities are a patchwork quilt of microsystems where individuals interact in geographically bounded places nested within larger whole systems of influence, a control systems approach has not been used to frame the literature. Whole-of-community interventions can be characterized by the fundamental system functions necessary for coordinating population health improvement. Future whole-of-community intervention efforts should draw on fundamental knowledge of how systems operate and test whether adoption of the key functions is necessary for whole-of-community population health improvement.
Collapse
Affiliation(s)
- Ann M Essay
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA.
| | - Chelsey R Schlechter
- Department of Population Health Sciences, Huntsman Cancer Institute, Center for Health Outcomes and Population Equity (HOPE), University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA.
| | - Carrie A Mershon
- Department of Kinesiology, Kansas State University, Natatorium 8, 920 Denison Ave, Manhattan, KS 66506, USA.
| | - Alissa V Fial
- Raynor Memorial Libraries, Marquette University, 1355 W Wisconsin Ave, Milwaukee, WI 53233, USA.
| | - Jennie Ellison
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA
| | - Richard R Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 245 Justin Hall, 1324 Lovers Lane, Manhattan, KS 66506, USA.
| | - David A Dzewaltowski
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA.
| |
Collapse
|
6
|
Svensson R, Johnson B, Kronkvist K. A community intervention to reduce alcohol consumption and drunkenness among adolescents in Sweden: a quasi-experiment. BMC Public Health 2021; 21:764. [PMID: 33882888 PMCID: PMC8058986 DOI: 10.1186/s12889-021-10755-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background Several studies have examined the effect of community interventions on youth alcohol consumption, and the results have often been mixed. The aim of this study is to evaluate the effectiveness of a community intervention known as the Öckerö Method on adolescent alcohol consumption and perceived parental attitudes towards adolescent drinking. Method The study is based on a quasi-experimental design, using matched controls. Self-report studies were conducted among adolescents in grades 7–9 of compulsory education in four control and four intervention communities in the south of Sweden in 2016–2018. Baseline measures were collected in autumn 2016 before the intervention was implemented in the intervention communities. Outcomes were the adolescents’ alcohol consumption, past-year drunkenness, past-month drunkenness and perceived parental attitudes towards alcohol. Results Estimating Difference-in-Difference models using Linear Probability Models, we found no empirical evidence that the intervention has any effect on adolescents’ drinking habits, or on their perceptions of their parents’ attitudes towards adolescent drinking. Conclusion This is the first evaluation of this method, and we found no evidence that the intervention had any effect on the level of either young people’s alcohol consumption or their past-year or past-month drunkenness, nor on their parents’ perceived attitudes toward adolescent drinking. A further improvement would be to employ a follow-up period that is longer than the three-year period employed in this study. Trial registration ISRCTN registry: Study ID: 51635778, 31th March 2021 (Retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10755-3.
Collapse
Affiliation(s)
- Robert Svensson
- Department of Criminology, Malmö University, 205 06, Malmö, Sweden.
| | - Björn Johnson
- Department of Social Work, Malmö University, 205 06, Malmö, Sweden
| | - Karl Kronkvist
- Department of Criminology, Malmö University, 205 06, Malmö, Sweden
| |
Collapse
|
7
|
Garrett BA, Komro KA, Merlo LJ, Livingston BJ, Rentmeester S, Tobler A, Livingston MD, Kominsky TK. CONNECT: Implementation of a School-Based Alcohol Screening and Brief Intervention for Youth in the Cherokee Nation. THE JOURNAL OF SCHOOL HEALTH 2019; 89:874-882. [PMID: 31478206 DOI: 10.1111/josh.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/20/2018] [Accepted: 09/28/2018] [Indexed: 05/03/2023]
Abstract
BACKGROUND There is growing optimism regarding the use of screening and brief intervention (SBI) to identify and reduce risk behaviors during adolescence. However, understanding successful SBI implementation remains unclear. We previously reported the effects of CONNECT, a school-based SBI, on reducing the primary outcome, the rate of monthly alcohol use among primarily American Indian (AI) and White high school students in the Cherokee Nation. In this paper, we describe the design and implementation process for CONNECT. METHOD CONNECT was designed to reduce alcohol use with 2 key strategies: (1) SBI with motivational interviewing (MI), implemented by a school-based CONNECT coach, and (2) a media campaign. RESULTS Implementation results indicate that during each semester of the 2-1/2 years, between 73% and 100% of eligible students had at least one 15-minute meeting with a CONNECT coach. Postcards and posters with positive communication tips for parents were displayed in CONNECT communities. No statistically significant differences occurred between the CONNECT and control groups on the hypothesized intermediate outcomes. CONCLUSIONS We describe implementation of a universal, school-based, culturally adapted SBI that was effective in reducing alcohol use among youth living in the Cherokee Nation. Schools provide an important context for universal delivery of SBI interventions, such as CONNECT, for diverse adolescent populations, including AI youth.
Collapse
Affiliation(s)
- Brady A Garrett
- Cherokee Nation Public Health, 1296 Skill Center Circle, Tahlequah, OK, 74464
| | - Kelli A Komro
- Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida College of Medicine, PO Box 100256, Gainsville, FL, 32610-0256
| | - Bethany J Livingston
- NNLM South Central Region, Gibson D. Lewis Health Science Library, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107
| | - Shelby Rentmeester
- Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322
| | - Amy Tobler
- School of Health Sciences, Walden University, 100 Washington Avenue South, Suite 900, Minneapolis, MN, 55401
| | - Melvin D Livingston
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, EAD-709N, Fort Worth, TX, 76107
| | | |
Collapse
|
8
|
Designed Cultural Adaptation and Delivery Quality in Rural Substance Use Prevention: an Effectiveness Trial for the Keepin' it REAL Curriculum. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:1008-1018. [PMID: 30056616 DOI: 10.1007/s11121-018-0937-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined how cultural adaptation and delivery quality of the school-based intervention keepin' it REAL (kiR) influenced adolescent substance use. The goal of the study was to compare the effectiveness of the multi-cultural, urban (non-adapted) kiR intervention, a re-grounded (adapted) rural version of the kiR intervention and control condition in a new, rural setting. A total of 39 middle schools in rural communities of two states in the USA were randomly assigned to one of three conditions (i.e., control, non-adapted urban kiR, and adapted rural kiR). Data included adolescent self-reported lifetime substance use and observers' ratings of delivery quality from video recordings of lessons. Ratings of delivery quality were used to create four comparison groups (i.e., low/high delivery quality in non-adapted/urban kiR condition and low/high quality in adapted/rural kiR condition). Controlling for substance use in the 7th grade, findings compared 9th graders' (N = 2781) lifetime alcohol, cigarette, marijuana, and chewing tobacco use. Mixed model analyses revealed that rural youth receiving the culturally adapted/rural curriculum reported significantly less cigarette use than rural youth in the control condition regardless of delivery quality. In the non-adapted/urban condition, youth receiving high delivery quality delivery reported less marijuana use than those receiving low delivery quality condition. However, substance use outcomes of youth receiving high and low delivery quality in the non-adapted intervention did not differ significantly from those the control group. Findings support the effectiveness of the culturally adapted/rural keepin' it REAL curriculum for rural youth.
Collapse
|
9
|
Evaluating Neighborhood, Social, and Genetic Influences on Precursors of Alcohol Use Risk Behavior in African American Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173078. [PMID: 31450589 PMCID: PMC6747126 DOI: 10.3390/ijerph16173078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
Abstract
Background: Using a socioecological framework, we examined neighborhood and social stressors in concert with genetic risk for alcohol dependence in relation to externalizing behaviors, important precursors to alcohol-related problems. Methods: We used data from African American adolescents and their caregivers in the Gene, Environment, and Neighborhood Initiative, a subsample of the Mobile Youth and Poverty Study. Participants for the current analyses included 112 adolescents who reported ever having at least one full drink of alcohol. Empirical Bayes scores were used to estimate neighborhood-level violence and transitions. Multivariate models tested main effects and then interactions of family stressors, discrimination, and genetic risk with the neighborhood variables. Results: In the main effects model, adolescent externalizing behaviors were positively associated with greater family stressors, more racial discrimination experiences, and genetic liability, while neighborhood variables were nonsignificant. We found three significant interactions. Specifically, the joint effects of neighborhood violence and transitions and between these neighborhood variables and family stressors were significantly associated with externalizing behaviors. Conclusions: Our findings suggest genetic liability and complex interactions between neighborhood context and social stressors are important contributors that should be considered in the development of early prevention programs for adolescents who live in economically disadvantaged areas.
Collapse
|
10
|
Bagnall AM, Radley D, Jones R, Gately P, Nobles J, Van Dijk M, Blackshaw J, Montel S, Sahota P. Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC Public Health 2019; 19:8. [PMID: 30606173 PMCID: PMC6318991 DOI: 10.1186/s12889-018-6274-z] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. METHODS Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. RESULTS Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. CONCLUSIONS Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.
Collapse
Affiliation(s)
- Anne-Marie Bagnall
- Centre for Health Promotion Research, School of Health & Community Studies, Leeds Beckett University, Portland 519, Leeds, LS1 3HE UK
| | - Duncan Radley
- School of Sport, Leeds Beckett University, Leeds, UK
| | - Rebecca Jones
- Centre for Health Promotion Research, School of Health & Community Studies, Leeds Beckett University, Portland 519, Leeds, LS1 3HE UK
| | - Paul Gately
- School of Sport, Leeds Beckett University, Leeds, UK
| | - James Nobles
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Margie Van Dijk
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Jamie Blackshaw
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Sam Montel
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Pinki Sahota
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds, UK
| |
Collapse
|
11
|
Stockings E, Bartlem K, Hall A, Hodder R, Gilligan C, Wiggers J, Sherker S, Wolfenden L. Whole-of-community interventions to reduce population-level harms arising from alcohol and other drug use: a systematic review and meta-analysis. Addiction 2018; 113:1984-2018. [PMID: 29806876 DOI: 10.1111/add.14277] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/08/2018] [Accepted: 05/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Whole-of-community interventions aim to reduce alcohol and other drug (AOD) use and harms by mobilizing community leaders, organizations and policy-makers to respond effectively to AOD use. The aim of this review is to estimate the effectiveness of whole-of-community interventions in reducing population-level harms arising from AOD use. DESIGN A systematic review of electronic databases CENTRAL, Embase, Medline, Medline in Process and PsycINFO was conducted from database inception to August 2017. Eligible trials had a parallel comparison group, implemented interventions in two or more community settings, and reported data on AOD use or harms. SETTING Intervention settings included schools, sporting clubs, police and law enforcement agencies, community centres, local media and retail premises. PARTICIPANTS Twenty-four trials from 63 publications were included (n = 249 125 participants). MEASUREMENTS Outcomes from AOD consumption (quantity and frequency), AOD-related crime and AOD-related accidents, injuries and hospital admissions. Data were pooled using random-effects inverse variance meta-analysis in Review Manager version 5.3. FINDINGS Risk of bias was mostly high, due to lack of random allocation, selective reporting and significant attrition. Meta-analyses indicated significant reductions in risky drinking [Alcohol Use Disorders Identification Scale (AUDIT) > 8; three trials (7 data points), relative risk (RR) = 0.78, 95% confidence interval (CI) = 0.62-0.99)], but found no impact on past-month alcohol use (five trials, RR = 0.95, 95% CI = 0.89-1.02), binge drinking (five trials, RR = 0.97, 95% CI = 0.89-1.06) or 12-month marijuana use (two trials, RR = 0.98, 95% CI = 0.86-1.11). Narrative synthesis indicated some reductions in AOD-related assault rates and arrests, but were equivocal for quantity of alcohol consumed, 12-month illicit drug use, assault or abuse, motor vehicle accidents and hospital admissions. CONCLUSIONS Interventions to reduce alcohol and other drug use and harms applied to whole communities have resulted so far in small reductions in risky alcohol consumption, but have had little impact upon past month alcohol use, binge drinking or 12-month marijuana use and the studies have been subject to high risk of bias.
Collapse
Affiliation(s)
- Emily Stockings
- National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, NSW, Australia
| | - Kate Bartlem
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Psychology, University of Newcastle, Callaghan, NSW, Australia
| | - Alix Hall
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Rebecca Hodder
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Conor Gilligan
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - John Wiggers
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| | - Shauna Sherker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Alcohol and Drug Foundation, North Melbourne, Victoria, Australia
| | - Luke Wolfenden
- Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
| |
Collapse
|
12
|
Tinner L, Caldwell D, Hickman M, MacArthur GJ, Gottfredson D, Lana Perez A, Moberg DP, Wolfe D, Campbell R. Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence. BMC Public Health 2018; 18:1180. [PMID: 30326897 PMCID: PMC6192072 DOI: 10.1186/s12889-018-6042-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multiple risk behaviour (MRB) refers to two or more risk behaviours such as smoking, drinking alcohol, poor diet and unsafe sex. Such behaviours are known to co-occur in adolescence. It is unknown whether MRB interventions are equally effective for young people of low and high socioeconomic status (SES). There is a need to examine these effects to determine whether MRB interventions have the potential to narrow or widen inequalities. METHODS Two Cochrane systematic reviews that examined interventions to reduce adolescent MRB were screened to identify universal interventions that reported SES. Study authors were contacted, and outcome data stratified by SES and intervention status were requested. Risk behaviour outcomes alcohol use, smoking, drug use, unsafe sex, overweight/obesity, sedentarism, peer violence and dating violence were examined in random effects meta-analyses and subgroup analyses conducted to explore differences between high SES and low SES adolescents. RESULTS Of 49 studies reporting universal interventions, only 16 also reported having measured SES. Of these 16 studies, four study authors provided data sufficient for subgroup analysis. There was no evidence of subgroup differences for any of the outcomes. For alcohol use, the direction of effect was the same for both the high SES group (RR 1.26, 95% CI: 0.96, 1.65, p = 0.09) and low SES group (RR 1.14, 95% CI: 0.98, 1.32, p = 0.08). The direction of effect was different for smoking behaviour in favour of the low SES group (RR 0.83, 95% CI: 0.66, 1.03, p = 0.09) versus the high SES group (RR 1.16, 95% CI: 0.82, 1.63, p = 0.39). For drug use, the direction of effect was the same for both the high SES group (RR 1.29, 95% CI: 0.97, 1.73, p = 0.08) and the low SES group (RR 1.28, 95% CI: 0.84, 1.96, p = 0.25). CONCLUSIONS The majority of studies identified did not report having measured SES. There was no evidence of subgroup difference for all outcomes analysed among the four included studies. There is a need for routine reporting of demographic information within studies so that stronger evidence of effect by SES can be demonstrated and that interventions can be evaluated for their impact on health inequalities.
Collapse
Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Deborah Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Georgina J MacArthur
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| | - Denise Gottfredson
- Department of Criminology and Criminal Justice, University of Maryland, College Park, Prince George’s, MD USA
| | - Alberto Lana Perez
- Department of Preventive Medicine and Public Health, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
| | - D Paul Moberg
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - David Wolfe
- Faculty of Education, Western University, Ontario, Canada
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canygne Hall, Bristol, BS8 2BN UK
| |
Collapse
|
13
|
Brick LAD, Nugent NR, Kahana SY, Bruce D, Tanney MR, Fernández MI, Bauermeister JA. Interaction Effects of Neighborhood Disadvantage and Individual Social Support on Frequency of Alcohol Use in Youth Living with HIV. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:276-284. [PMID: 29400400 DOI: 10.1002/ajcp.12227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Youth living with HIV (YLH) experience multiple disease-related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual- and neighborhood-level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood-specific data were compiled from the 2010 U.S. Census Bureau and matched with individual-level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non-Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross-level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed.
Collapse
Affiliation(s)
- Leslie Ann D Brick
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole R Nugent
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL, USA
| | - Mary R Tanney
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Isabel Fernández
- College of Osteopathic Medicine, Nova Southeastern University, Davis, FL, USA
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
14
|
Community Approaches for Reducing Alcohol-Related Harms: an Overview of Intervention Strategies, Efficacy, and Considerations for Future Research. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0210-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
15
|
Jones SC, Andrews K, Francis KL, Akram M. When are they old enough to drink? Outcomes of an Australian social marketing intervention targeting alcohol initiation. Drug Alcohol Rev 2018; 37 Suppl 1:S375-S383. [PMID: 29314354 DOI: 10.1111/dar.12653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS This paper reports on the evaluation of an Australian whole-of-community social marketing intervention targeting social norms, which aimed to reduce inflated perceptions of the prevalence of underage drinking and increase the age at which alcohol initiation is considered acceptable. DESIGN AND METHODS A community-wide intervention was delivered in a single community over a period of 2 years, targeting adolescents, parents and community members. Pre-and post-intervention computer-assisted telephone interview surveys were conducted in the intervention and a matched comparison (control) community. A total of 417 respondents completed both surveys (215 in the intervention community and 202 in the control community). RESULTS The intervention community saw an increase of 6 months in the average age at which it is perceived to be acceptable for young people to have a sip/taste of alcohol and 5 months in the average age at which it is perceived to be acceptable to have weak/watered down alcohol. Furthermore, there was a reduction in the perception of the prevalence of alcohol consumption by young people to a level consistent with actual underage drinking rates. In comparison, the control community saw no change in any of these variables. DISCUSSION AND CONCLUSIONS This study provides preliminary evidence that a whole-of-community social marketing intervention can change perceptions of the prevalence, and acceptability, of underage drinking. Given the central role of social norms in decisions regarding alcohol consumption, these changes have the potential to reduce parental supply and thus underage drinking.
Collapse
Affiliation(s)
- Sandra C Jones
- Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia
| | - Kelly Andrews
- Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia
| | - Kate L Francis
- Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia
| | - Muhammad Akram
- Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia
| |
Collapse
|
16
|
Abstract
BACKGROUND Alcohol is a recognized risk factor for sexually transmitted diseases acquisition, but the mechanism is unclear. Potentially, adolescents using alcohol in the 2 hours before sex (in-the-moment use) have riskier sexual partners. METHODS We used multivariable logistic regression to examine the association between in-the-moment alcohol use and partner risk characteristics reported for the most recent sex among primarily 17- to 18-year-old adolescents originally recruited from a representative sample of Chicago public elementary schools. We created 3 composite partner risk profiles: partner familiarity risk (casual and unexpected), partner context risk (age discordance and met in public), and overall risk using all measures except partner alcohol use. RESULTS Teens who reported any in-the-moment alcohol use were more likely than nondrinking teens to report casual (adjusted odds ratio [AOR], 3.2; 95% confidence interval [95% CI], 2.1-4.9), unexpected (AOR, 1.6; 95% CI, 1.0-2.5), age discordant (AOR, 3.0; 95% CI, 2.0-4.6), or met in public partners (AOR, 1.4; 95% CI, 1.0 to 2.1). For each composite measure, the number of partner risk characteristics reported increased linearly with the percent of teens drinking in the moment (Cochran-Armitage trend, P < 0.0001). Compared with zero characteristics, in-the-moment alcohol use was associated with increased odds of reporting 1 (AOR, 2.8; 95% CI, 1.7-4.5), 2 (AOR, 4.6; 95% CI, 2.7, 7.6), or 3 to 4 characteristics (AOR, 7.1; 95% CI, 3.3-15.3). CONCLUSIONS Our findings expand the link between in-the-moment alcohol use and partner risk reported in prior studies to encompass adolescents' general sexual experiences and additional partner characteristics including the highly associated composite characteristics.
Collapse
|
17
|
For Whom Do Parenting Interventions to Prevent Adolescent Substance Use Work? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 19:570-578. [PMID: 29150747 DOI: 10.1007/s11121-017-0853-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescent substance use continues to be a significant public health problem. Parent training interventions are effective preventive strategies to reduce youth substance use. However, little is known about differences in effectiveness for youth across demographic characteristics. This review assessed the effectiveness of parent training programs at reducing adolescent substance use by participant gender, age, and race/ethnicity. Pubmed/MEDLINE, ERIC, CINAHL, and PsycINFO were searched from database origin to October 31, 2016. We included randomized controlled trials that evaluated parent training interventions; reported youth initiation or use of tobacco, alcohol, or other illicit substances; and included adolescents aged 10 to 19. Two independent reviewers extracted data. Disagreements were resolved by consensus or a third researcher. Data were synthesized using harvest plots stratified by participant demographics. A total of 1806 publications were identified and reviewed; 38 unique studies were included. Risk of bias of included studies was high. No studies targeted male teens or youth in late adolescence. Few studies targeted Asian-American, Black/African-American, or Hispanic/Latino adolescents. Overall, interventions including male and female youth and youth in early adolescence (age 10 to 14 or in 5th to 8th grade) were more beneficial than interventions including female-only or both young and older adolescents. Programs tailored to specific racial/ethnic groups, as well as programs designed for youth from multiple races/ethnic groups, were effective. Current evidence supports the benefits of offering parenting guidance to all families with adolescent children, regardless of the gender, age, or race/ethnicity of the adolescent.
Collapse
|
18
|
Hodder RK, Freund M, Bowman J, Wolfenden L, Campbell E, Dray J, Lecathelinais C, Oldmeadow C, Attia J, Wiggers J. Effectiveness of a pragmatic school-based universal resilience intervention in reducing tobacco, alcohol and illicit substance use in a population of adolescents: cluster-randomised controlled trial. BMJ Open 2017; 7:e016060. [PMID: 28821523 PMCID: PMC5629645 DOI: 10.1136/bmjopen-2017-016060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Initiation of tobacco, alcohol and illicit substance use typically occurs during adolescence, with the school setting recommended to reduce adolescent substance use. Strengthening individual (eg, problem solving) and environmental (eg, caring relationships at school) resilience protective factors of adolescents has been suggested as a strategy for reducing substance use by adolescents; however, few studies have examined this potential. A study was conducted to investigate the effectiveness of a pragmatic school-based universal 'resilience' intervention in reducing the prevalence of tobacco, alcohol and illicit substance use, and increasing the individual and environmental protective factors of students. DESIGN A cluster-randomised controlled trial. SETTING Thirty-two Australian secondary schools (20 intervention; 12 control). PARTICIPANTS Cohort of grade 7 students followed-up in grade 10 (2014; aged 15-16 years). INTERVENTION A pragmatic intervention involving school staff selection and implementation of available programmes and resources targeting individual and environmental 'resilience' protective factors for all grade 7-10 students was implemented in schools (2012-2014). School staff were provided implementation support. MEASUREMENTS An online survey collected baseline and follow-up data for primary outcomes: tobacco (ever, recent) and alcohol (ever, recent, 'risk') use, and secondary outcomes: marijuana and other illicit substance use, and individual (six-factor subscales, aggregate) and environmental (three-factor subscales, aggregate) protective factor scores. Generalised and linear mixed models examined follow-up differences between groups. RESULTS Follow-up data from 2105 students (intervention=1261; control=844; 69% of baseline cohort) were analysed. No significant differences were found between intervention and control students for any primary (ever tobacco: OR 1.25, 95% CI 0.92 to 1.68, p=0.14; recent tobacco: OR 1.39, 95% CI 0.84 to 2.31, p=0.19; recent ever alcohol: OR 1.11, 95% CI 0.83 to 1.48, p=0.46; alcohol: OR 1.13, 95% CI 0.78 to 1.62, p=0.51; 'risk' alcohol: OR 0.98, 95% CI 0.70 to 1.36, p=0.89) or secondary outcomes (marijuana: OR 1.12, 95% CI 0.74 to 1.68, p=0.57; other illicit substance: OR 1.19, 95% CI 0.67 to 2.10, p=0.54; individual protective factors: MD=0, 95% CI -0.07 to 0.06, p=0.89; environmental protective factors: MD: -0.02, 95% CI -0.09 to 0.06, p=0.65). CONCLUSIONS The universally implemented pragmatic school-based intervention was not effective in reducing the prevalence of tobacco, alcohol or illicit substance use, or in increasing the protective factors of students. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register reference: ACTRN12611000606987.
Collapse
Affiliation(s)
- Rebecca Kate Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Megan Freund
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jenny Bowman
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Julia Dray
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, IT, and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John Attia
- Clinical Research Design, IT, and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| |
Collapse
|
19
|
Livingston MD, Xu X, Komro KA. Predictors of Recall Error in Self-Report of Age at Alcohol Use Onset. J Stud Alcohol Drugs 2017; 77:811-8. [PMID: 27588540 DOI: 10.15288/jsad.2016.77.811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The present study examined factors associated with recall error in the measurement of alcohol use onset and whether there was a tendency toward earlier or later self-reported age at alcohol use onset. METHOD This study estimated the effect of predictors on the presence and direction of recall error for age at alcohol use onset. The sample (n = 1,044) was from an existing longitudinal alcohol prevention trial in urban Chicago. Estimates were derived from a series of logistic regression models comparing agreement between a retrospective and a prospective measure of age at alcohol use onset. RESULTS Eligibility for free or reduced-price lunch in 6th grade, alcohol use in 6th grade, cigarette use in 12th grade, and alcohol use in 12th grade were significantly associated with recall error of age at alcohol use onset. Self-reported substance use (alcohol and tobacco) in 12th grade was also found to predict a later self-reported age at alcohol use onset when recalled. CONCLUSIONS Those most at risk for the negative outcomes associated with early alcohol initiation are also those most likely to misreport their age at alcohol use onset.
Collapse
Affiliation(s)
- Melvin D Livingston
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M Health Science Center, College Station, Texas
| | - Kelli A Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
20
|
Komro KA, Livingston MD, Garrett BA, Boyd ML. Similarities in the Etiology of Alcohol Use Among Native American and Non-Native Young Women. J Stud Alcohol Drugs 2017; 77:782-91. [PMID: 27588537 DOI: 10.15288/jsad.2016.77.782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study examined social-and individual-level factors associated with alcohol use among young women and tested whether differences exist between Native American and non-Native young women. METHOD School-based surveys were conducted among 952 young women (ages 14-19) attending four high schools within the tribal jurisdictional service area of the Cherokee Nation in northeastern Oklahoma. Structural equation modeling using Mplus was used to assess the direct and indirect effects of social-and individual-level factors on subsequent alcohol use among Native and non-Native young women. RESULTS We found no differences in the level of risk and protective factors among Native and non-Native young women. Among Native and non-Native young women, alcohol access, parental communication, and best friends' alcohol use had statistically significant direct and/or indirect effects on alcohol use. Indirect effects were mediated through alcohol expectancies and norms. A history of alcohol problems by an adult in the household and depression were not retained as independent risk factors in either model. CONCLUSIONS We found more similarities than differences in level of and relations to alcohol use among social and individual risk and protective factors between Native American and non-Native young women from northeastern Oklahoma. The results provide support for universal prevention strategies, suggesting the importance of increasing perceptions that it is difficult to obtain alcohol and increasing parent-child communication.
Collapse
Affiliation(s)
- Kelli A Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Melvin D Livingston
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Brady A Garrett
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Cherokee Nation Behavioral Health, Tahlequah, Oklahoma
| | - Misty L Boyd
- Cherokee Nation Behavioral Health, Tahlequah, Oklahoma
| |
Collapse
|
21
|
Komro KA. 25 Years of Complex Intervention Trials: Reflections on Lived and Scientific Experiences. RESEARCH ON SOCIAL WORK PRACTICE 2017; 28:523-531. [PMID: 29962823 PMCID: PMC6022401 DOI: 10.1177/1049731517718939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
For the past 25 years, I have led multiple group-randomized trials, each focused on a specific underserved population of youth and each one evaluated health effects of complex interventions designed to prevent high-risk behaviors. I share my reflections on issues of intervention and research design, as well as how research results fostered my evolution toward addressing fundamental social determinants of health and well-being. Reflections related to intervention design emphasize the importance of careful consideration of theory of causes and theory of change, theoretical comprehensiveness versus fundamental determinants of population health, how high to reach, and health in all policies. Flowing from these intervention design issues are reflections on implications for research design, including the importance of matching the unit of intervention to the unit of assignment, the emerging field of public health law research, and consideration of design options and design elements beyond and in combination with random assignment.
Collapse
Affiliation(s)
- Kelli A. Komro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
22
|
Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis. Prev Med 2017; 100:248-268. [PMID: 28390835 DOI: 10.1016/j.ypmed.2017.04.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/02/2017] [Accepted: 04/02/2017] [Indexed: 01/03/2023]
Abstract
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.
Collapse
|
23
|
Newton NC, Champion KE, Slade T, Chapman C, Stapinski L, Koning I, Tonks Z, Teesson M. A systematic review of combined student- and parent-based programs to prevent alcohol and other drug use among adolescents. Drug Alcohol Rev 2017; 36:337-351. [PMID: 28334456 DOI: 10.1111/dar.12497] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/28/2016] [Accepted: 08/19/2016] [Indexed: 11/26/2022]
Abstract
ISSUES Alcohol and other drug use among adolescents is a serious concern, and effective prevention is critical. Research indicates that expanding school-based prevention programs to include parenting components could increase prevention outcomes. This paper aims to identify and describe existing combined student- and parent-based programs for the prevention of alcohol and other drug use to evaluate the efficacy of existing programs. APPROACH The PsycINFO, Medline, Central Register of Controlled trials and Cochrane databases were searched in April 2015 and additional articles were obtained from reference lists. Studies were included if they evaluated a combined universal intervention for students (aged 11-18 years old) and their parents designed to prevent alcohol and/or other drug use, and were delivered in a school-based setting. Risk of bias was assessed by two independent reviewers. Because of the heterogeneity of the included studies, it was not possible to conduct a meta-analysis and a qualitative description of the studies was provided. KEY FINDINGS From a total of 1654 screened papers, 22 research papers met inclusion criteria, which included 13 trials of 10 programs. Of these, nine programs demonstrated significant intervention effects in terms of delaying or reducing adolescent alcohol and/or other drug use in at least one trial. CONCLUSION This is the first review of combined student- and parent-based interventions to prevent and reduce alcohol and other drug use. Whilst existing combined student- and parent-based programs have shown promising results, key gaps in the literature have been identified and are discussed in the context of the development of future prevention programs. [Newton NC, Champion KE, Slade T, Chapman C, Stapinski L, Koning I, Tonks Z, Teesson M. A systematic review of combined student- and parent-based programs to prevent alcohol and other drug use among adolescents. Drug Alcohol Rev 2017;36:337-351].
Collapse
Affiliation(s)
- Nicola C Newton
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Katrina E Champion
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Tim Slade
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Cath Chapman
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Lexine Stapinski
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Ina Koning
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Zoe Tonks
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| |
Collapse
|
24
|
Ciocanel O, Power K, Eriksen A, Gillings K. Effectiveness of Positive Youth Development Interventions: A Meta-Analysis of Randomized Controlled Trials. J Youth Adolesc 2017. [PMID: 27518860 DOI: 10.1007/s10964-016-0555-6/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Positive youth development is thought to be essential to the prevention of adolescent risk behavior and the promotion of thriving. This meta-analysis examined the effects of positive youth development interventions in promoting positive outcomes and reducing risk behavior. Ten databases and grey literature were scanned using a predefined search strategy. We included studies that focused on young people aged 10-19 years, implemented a positive youth development intervention, were outside school hours, and utilized a randomized controlled design. Twenty-four studies, involving 23,258 participants, met the inclusion criteria and were included in the analysis. The impact of the interventions on outcomes including behavioral problems, sexual risk behavior, academic achievement, prosocial behavior and psychological adjustment were assessed. Positive youth development interventions had a small but significant effect on academic achievement and psychological adjustment. No significant effects were found for sexual risk behaviors, problem behavior or positive social behaviors. Intervention effects were independent of program characteristics and participant age. Low-risk young people derived more benefit from positive youth development interventions than high-risk youth. The studies examined had several methodological flaws, which weakened the ability to draw conclusions. Substantial progress has been made in the theoretical understanding of youth development in the past two decades. This progress needs to be matched in the intervention literature, through the use of high-quality evaluation research of positive youth development programs.
Collapse
Affiliation(s)
- Oana Ciocanel
- Sexual Health and Blood Borne Virus Team, Kings Cross Hospital, NHS Tayside, Clepington Road, Dundee, DD3 8EA, UK
| | - Kevin Power
- School of Natural Sciences, University of Stirling, Stirling, UK
- Area Psychological Therapies Service, NHS Tayside, 7 Dudhope Terrace, Dundee, DD3 6HG, UK
| | - Ann Eriksen
- Sexual Health and Blood Borne Virus Team, Kings Cross Hospital, NHS Tayside, Clepington Road, Dundee, DD3 8EA, UK
| | - Kirsty Gillings
- Psychology Department, Stratheden Hospital, NHS Fife, Cupar, Fife, KY15 5RR, Scotland.
| |
Collapse
|
25
|
Gordon CS, Kervin LK, Jones SC, Howard SJ. Qualitative process evaluation of an Australian alcohol media literacy study: recommendations for designing culturally responsive school-based programs. BMC Public Health 2017; 17:155. [PMID: 28153001 PMCID: PMC5288884 DOI: 10.1186/s12889-017-4031-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol media literacy programs seek to mitigate the potentially harmful effects of alcohol advertising on children’s drinking intentions and behaviours through equipping them with skills to challenge media messages. In order for such programs to be effective, the teaching and learning experiences must be tailored to their specific cultural context. Media in the Spotlight is an alcohol media literacy program aimed at 9 to 12 year old Australian children. This study evaluates the process and implementation of the program, outlining the factors that facilitated and inhibited implementation. From this evaluation, a pedagogical framework has been developed for health professionals implementing culturally responsive programs in school settings. Methods Process measures included: semi-structured interviews with teachers before and after the program was implemented (n = 11 interviews), program evaluation questionnaires completed by children (n = 166), lesson observations completed by teachers (n = 35 observations), and reflective journal entries completed by the researcher (n = 44 entries). A thematic analysis approach was used to analyse all of the data sets using NVivo. Inductive coding was used, whereby the findings were derived from the research objectives and multiple readings and interpretations of the data. Results Five key pedagogical considerations were identified that facilitated implementation. These were: connecting to the students’ life worlds to achieve cultural significance; empowering students with real-world skills to ensure relevance; ensuring programs are well structured with strong connections to the school curriculum; creating developmentally appropriate activities while providing a range of assessment opportunities; and including hands-on and interactive activities to promote student engagement. Three potential inhibitors to implementing the alcohol media literacy program in upper-elementary school classrooms were identified. These included topic sensitivities, classroom management challenges, and fitting new programs into already busy school schedules. Conclusion Overall, the program content and individual lessons were well received by the teachers and students. The lessons learned from the development, implementation and evaluation of this program can provide health professionals with key pedagogical strategies for designing culturally responsive educational programs. Culturally responsive programs are critical for ensuring interventions are effective for their specific context.
Collapse
Affiliation(s)
- Chloe S Gordon
- Early Start Research Institute, University of Wollongong, Wollongong, 2520, Australia. .,Centre for Health and Social Research, Australian Catholic University, Melbourne, 3065, Australia.
| | - Lisa K Kervin
- Early Start Research Institute, University of Wollongong, Wollongong, 2520, Australia
| | - Sandra C Jones
- Centre for Health and Social Research, Australian Catholic University, Melbourne, 3065, Australia
| | - Steven J Howard
- Early Start Research Institute, University of Wollongong, Wollongong, 2520, Australia
| |
Collapse
|
26
|
Komro KA, Livingston MD, Wagenaar AC, Kominsky TK, Pettigrew DW, Garrett BA. Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation. Am J Public Health 2017; 107:453-459. [PMID: 28103073 DOI: 10.2105/ajph.2016.303603] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a multilevel intervention designed to prevent underage alcohol use among youths living in the Cherokee Nation. METHODS We randomly assigned 6 communities to a control, Communities Mobilizing for Change on Alcohol (CMCA; a community-organizing intervention targeting alcohol access) only, CONNECT (a school-based universal screening and brief intervention) only, or a combined condition. We collected quarterly surveys 2012-2015 from students starting in 9th and 10th grades and ending in 11th and 12th grades. Response rates ranged from 83% to 90%; 46% of students were American Indian (of which 80% were Cherokee) and 46% were White only. RESULTS Students exposed to CMCA, CONNECT, and both showed a significant reduction in the probability over time of 30-day alcohol use (25%, 22%, and 12% reduction, respectively) and heavy episodic drinking (24%, 19%, and 13% reduction) compared with students in the control condition, with variation in magnitude of effects over the 2.5-year intervention period. CONCLUSIONS CMCA and CONNECT are effective interventions for reducing alcohol use among American Indian and other youths living in rural communities. Challenges remain for sustaining intervention effects.
Collapse
Affiliation(s)
- Kelli A Komro
- Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK
| | - Melvin D Livingston
- Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK
| | - Alexander C Wagenaar
- Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK
| | - Terrence K Kominsky
- Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK
| | - Dallas W Pettigrew
- Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK
| | - Brady A Garrett
- Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK
| | -
- Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK
| |
Collapse
|
27
|
Choi HJ, Miller-Day M, Shin Y, Hecht ML, Pettigrew J, Krieger JL, Lee J, Graham JW. Parent Prevention Communication Profiles and Adolescent Substance Use: A Latent Profile Analysis and Growth Curve Model. JOURNAL OF FAMILY COMMUNICATION 2017; 17:15-32. [PMID: 29056872 PMCID: PMC5650115 DOI: 10.1080/15267431.2016.1251920] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This current study identifies distinct parent prevention communication profiles and examines whether youth with different parental communication profiles have varying substance use trajectories over time. Eleven schools in two rural school districts in the Midwestern United States were selected, and 784 students were surveyed at three time points from the beginning of 7th grade to the end of 8th grade. A series of latent profile analyses were performed to identify discrete profiles/subgroups of substance-specific prevention communication (SSPC). The results revealed a 4-profile model of SSPC: Active-Open, Passive-Open, Active-Silent, and Passive-Silent. A growth curve model revealed different rates of lifetime substance use depending on the youth's SSPC profile. These findings have implications for parenting interventions and tailoring messages for parents to fit specific SSPC profiles.
Collapse
Affiliation(s)
- Hye Jeong Choi
- Department of Health Sciences, University of Missouri–Columbia
| | | | - YoungJu Shin
- Hugh Downs School of Human Communication, Arizona State University
| | | | | | | | - JeongKyu Lee
- Wee Kim Wee School of Communication & Information, Nanyang Technological University
| | - John W. Graham
- Department of Biobehavioral Health, Pennsylvania State University
| |
Collapse
|
28
|
Langford R, Bonell C, Komro K, Murphy S, Magnus D, Waters E, Gibbs L, Campbell R. The Health Promoting Schools Framework: Known Unknowns and an Agenda for Future Research. HEALTH EDUCATION & BEHAVIOR 2016; 44:463-475. [DOI: 10.1177/1090198116673800] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The World Health Organization’s Health Promoting Schools (HPS) framework is a whole-school approach to promoting health that recognizes the intrinsic relationship between health and education. Our recent Cochrane systematic review found HPS interventions produced improvements in a number of student health outcomes. Here we reflect on what this review was not able to tell us: in other words, what evidence is missing with regard to the HPS approach. Few HPS interventions engage with schools’ “core business” by examining impacts on educational outcomes. Current evidence is dominated by obesity interventions, with most studies conducted with children rather than adolescents. Evidence is lacking for outcomes such as mental or sexual health, substance use, and violence. Activities to engage families and communities are currently weak and unlikely to prompt behavioral change. The HPS approach is largely absent in low-income settings, despite its potential in meeting children’s basic health needs. Intervention theories are insufficiently complex, often ignoring upstream determinants of health. Few studies provide evidence on intervention sustainability or cost-effectiveness, nor in-depth contextual or process data. We set out an agenda for future school health promotion research, considering implications for key stakeholders, namely, national governments, research funders, academics, and schools.
Collapse
Affiliation(s)
| | | | | | | | | | - Elizabeth Waters
- University of Melbourne, Carlton, Melbourne, Victoria, Australia
| | - Lisa Gibbs
- University of Melbourne, Carlton, Melbourne, Victoria, Australia
| | | |
Collapse
|
29
|
Ciocanel O, Power K, Eriksen A, Gillings K. Effectiveness of Positive Youth Development Interventions: A Meta-Analysis of Randomized Controlled Trials. J Youth Adolesc 2016; 46:483-504. [PMID: 27518860 DOI: 10.1007/s10964-016-0555-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/26/2016] [Indexed: 11/24/2022]
Abstract
Positive youth development is thought to be essential to the prevention of adolescent risk behavior and the promotion of thriving. This meta-analysis examined the effects of positive youth development interventions in promoting positive outcomes and reducing risk behavior. Ten databases and grey literature were scanned using a predefined search strategy. We included studies that focused on young people aged 10-19 years, implemented a positive youth development intervention, were outside school hours, and utilized a randomized controlled design. Twenty-four studies, involving 23,258 participants, met the inclusion criteria and were included in the analysis. The impact of the interventions on outcomes including behavioral problems, sexual risk behavior, academic achievement, prosocial behavior and psychological adjustment were assessed. Positive youth development interventions had a small but significant effect on academic achievement and psychological adjustment. No significant effects were found for sexual risk behaviors, problem behavior or positive social behaviors. Intervention effects were independent of program characteristics and participant age. Low-risk young people derived more benefit from positive youth development interventions than high-risk youth. The studies examined had several methodological flaws, which weakened the ability to draw conclusions. Substantial progress has been made in the theoretical understanding of youth development in the past two decades. This progress needs to be matched in the intervention literature, through the use of high-quality evaluation research of positive youth development programs.
Collapse
Affiliation(s)
- Oana Ciocanel
- Sexual Health and Blood Borne Virus Team, Kings Cross Hospital, NHS Tayside, Clepington Road, Dundee, DD3 8EA, UK
| | - Kevin Power
- School of Natural Sciences, University of Stirling, Stirling, UK.,Area Psychological Therapies Service, NHS Tayside, 7 Dudhope Terrace, Dundee, DD3 6HG, UK
| | - Ann Eriksen
- Sexual Health and Blood Borne Virus Team, Kings Cross Hospital, NHS Tayside, Clepington Road, Dundee, DD3 8EA, UK
| | - Kirsty Gillings
- Psychology Department, Stratheden Hospital, NHS Fife, Cupar, Fife, KY15 5RR, Scotland.
| |
Collapse
|
30
|
Allen ML, Garcia-Huidobro D, Porta C, Curran D, Patel R, Miller J, Borowsky I. Effective Parenting Interventions to Reduce Youth Substance Use: A Systematic Review. Pediatrics 2016; 138:peds.2015-4425. [PMID: 27443357 PMCID: PMC4960727 DOI: 10.1542/peds.2015-4425] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Parenting interventions may prevent adolescent substance use; however, questions remain regarding the effectiveness of interventions across substances and delivery qualities contributing to successful intervention outcomes. OBJECTIVE To describe the effectiveness of parent-focused interventions in reducing or preventing adolescent tobacco, alcohol, and illicit substance use and to identify optimal intervention targeted participants, dosage, settings, and delivery methods. DATA SOURCES PubMed, PsycINFO, ERIC, and CINAHL. STUDY SELECTION Randomized controlled trials reporting adolescent substance use outcomes, focusing on imparting parenting knowledge, skills, practices, or behaviors. DATA EXTRACTION Trained researchers extracted data from each article using a standardized, prepiloted form. Because of study heterogeneity, a qualitative technique known as harvest plots was used to summarize findings. RESULTS A total of 42 studies represented by 66 articles met inclusion criteria. Results indicate that parenting interventions are effective at preventing and decreasing adolescent tobacco, alcohol, and illicit substance use over the short and long term. The majority of effective interventions required ≤12 contact hours and were implemented through in-person sessions including parents and youth. Evidence for computer-based delivery was strong only for alcohol use prevention. Few interventions were delivered outside of school or home settings. LIMITATIONS Overall risk of bias is high. CONCLUSIONS This review suggests that relatively low-intensity group parenting interventions are effective at reducing or preventing adolescent substance use and that protection may persist for multiple years. There is a need for additional evidence in clinical and other community settings using an expanded set of delivery methods.
Collapse
Affiliation(s)
| | - Diego Garcia-Huidobro
- Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota;,School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile; and
| | - Carolyn Porta
- Department of Population Health and Systems, School of Nursing, and
| | - Dorothy Curran
- Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Roma Patel
- Departments of Family Medicine and Community Health, and
| | - Jonathan Miller
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Iris Borowsky
- Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| |
Collapse
|
31
|
A component-centered meta-analysis of family-based prevention programs for adolescent substance use. Clin Psychol Rev 2016; 45:72-80. [PMID: 27064553 DOI: 10.1016/j.cpr.2016.03.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 01/14/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
Although research has documented the positive effects of family-based prevention programs, the field lacks specific information regarding why these programs are effective. The current study summarized the effects of family-based programs on adolescent substance use using a component-based approach to meta-analysis in which we decomposed programs into a set of key topics or components that were specifically addressed by program curricula (e.g., parental monitoring/behavior management,problem solving, positive family relations, etc.). Components were coded according to the amount of time spent on program services that targeted youth, parents, and the whole family; we also coded effect sizes across studies for each substance-related outcome. Given the nested nature of the data, we used hierarchical linear modeling to link program components (Level 2) with effect sizes (Level 1). The overall effect size across programs was .31, which did not differ by type of substance. Youth-focused components designed to encourage more positive family relationships and a positive orientation toward the future emerged as key factors predicting larger than average effect sizes. Our results suggest that, within the universe of family-based prevention, where components such as parental monitoring/behavior management are almost universal, adding or expanding certain youth-focused components may be able to enhance program efficacy.
Collapse
|
32
|
Krieg AG, Kuhl DC. Race, Adolescent Binge Drinking, and the Context of Neighborhood Exposure. DEVIANT BEHAVIOR 2016; 37:615-633. [PMID: 28082754 PMCID: PMC5222539 DOI: 10.1080/01639625.2015.1060804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 05/07/2015] [Indexed: 06/06/2023]
Abstract
Drawing on theories of social structure and normative exposure, we examine how the neighborhood context of socioeconomic advantage and racial composition affects race/ethnic differences in youth binge drinking. Using data from Waves 1 and 2 of the National Longitudinal Study of Adolescent to Adult Health, logistic regressions reveal significant racial differences, with whites having higher odds of binge drinking than other groups. We also find that neighborhood advantage and racial composition have moderating effects on binge drinking; black youths' odds of binge drinking are significantly lower than whites' odds in highly advantaged neighborhoods, and Hispanics living in racially integrated neighborhoods have significantly lower odds of binge drinking than Hispanics living in white neighborhoods.
Collapse
Affiliation(s)
- Andrea G Krieg
- Bowling Green State University, Bowling Green, Ohio, USA
| | | |
Collapse
|
33
|
Cleveland HH, Wiebe RP, McGuire J, Zheng Y. Predicting High School Minority Adolescents' Drinking from Their Exposure to White Schoolmates: Differences and Similarities among Hispanic, Black, and Asian U.S. Adolescents. J Ethn Subst Abuse 2016; 14:166-86. [PMID: 25984957 DOI: 10.1080/15332640.2014.973626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
White students' drinking may constitute a risk factor for drinking among same-school minority adolescents. Our study examined data from 14,986 ethnic minority American high school students (56% female, mean age = 15.6). Models examined associations between school-level White student drinking and same-school Black, Hispanic, and Asian adolescents' drinking, as well as whether schools' proportions of White students and friendships with White schoolmates moderated these associations. Both school-level White students' drinking and minority students' friendships with White schoolmates were associated with levels of minority student drinking. But these associations were dependent upon levels of other study variables. In particular, there were higher associations between school-level risk factors and minorities' drinking when minority adolescents had high proportions of Whites among their friends.
Collapse
|
34
|
Prevention trial in the Cherokee Nation: design of a randomized community trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:291-300. [PMID: 24615546 PMCID: PMC4308639 DOI: 10.1007/s11121-014-0478-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite advances in prevention science and practice in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth, especially among vulnerable rural and Native American youth. The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavioral Health to create, implement, and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among Native American and other youth living in rural high-risk underserved communities. The intervention builds directly on results of multiple previous trials of two conceptually distinct approaches. The first is an updated version of CMCA, an established community environmental change intervention, and the second is CONNECT, our newly developed population-wide intervention based on screening, brief intervention, and referral to treatment (SBIRT) research. CMCA direct-action community organizing is used to engage local citizens to address community norms and practices related to alcohol use and commercial and social access to alcohol among adolescents. The new CONNECT intervention expands traditional SBIRT to be implemented universally within schools. Six key research design elements optimize causal inference and experimental evaluation of intervention effects, including a controlled interrupted time-series design, purposive selection of towns, random assignment to study condition, nested cohorts as well as repeated cross-sectional observations, a factorial design crossing two conceptually distinct interventions, and multiple comparison groups. The purpose of this paper is to describe the strong partnership between prevention scientists and behavioral health leaders within the Cherokee Nation, and the intervention and research design of this new community trial.
Collapse
|
35
|
Lynne-Landsman SD, Kominsky TK, Livingston MD, Wagenaar AC, Komro KA. Alcohol Sales to Youth: Data from Rural Communities Within the Cherokee Nation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:32-9. [PMID: 26228479 PMCID: PMC4697874 DOI: 10.1007/s11121-015-0579-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Access to alcohol among individuals under 21 years of age continues to be a public health concern with approximately 5000 youth deaths attributable to alcohol each year (US Department of Health and Human Services 2007). To date, there is no research on youth access to alcohol from commercial sources within rural communities with large populations of Native American families. We evaluated commercial access to alcohol by underage-appearing female confederates in 4 rural towns within the Cherokee Nation, a non-reservation tribal jurisdiction that includes a high proportion of Native Americans embedded within a predominately White population. Alcohol purchase attempts were conducted approximately every 4 weeks on 10 occasions for a total of 997 alcohol purchase attempts. In addition to purchase attempt outcome, we collected data on characteristics of the outlets and clerks. Alcohol was sold to confederates without use of age identification on 23 % of all purchase attempts. Across repeated attempts, 76 % of outlets sold alcohol to a confederate at least once. Males and younger clerks were more likely to sell alcohol to the confederates. Grocery stores and gas stations were more likely to sell alcohol to the confederate than liquor stores, but this effect was no longer significant once seller age was accounted for in a multivariable model. Three out of 4 outlets sold alcohol to young-appearing buyers at least once across repeated attempts. Results reinforce the continuing need for regular enforcement of laws against selling alcohol to minors.
Collapse
Affiliation(s)
- Sarah D Lynne-Landsman
- Department of Health Outcomes and Policy, College of Medicine and Institute for Child Health Policy, Gainesville, FL, USA.
| | | | - Melvin D Livingston
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Alexander C Wagenaar
- Department of Health Outcomes and Policy, College of Medicine and Institute for Child Health Policy, Gainesville, FL, USA
| | - Kelli A Komro
- Department of Health Outcomes and Policy, College of Medicine and Institute for Child Health Policy, Gainesville, FL, USA
| |
Collapse
|
36
|
Gewin AM, Hoffman B. Introducing the cultural variables in school-based substance abuse prevention. DRUGS-EDUCATION PREVENTION AND POLICY 2015. [DOI: 10.3109/09687637.2015.1071781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
37
|
Kuklinski MR, Fagan AA, Hawkins JD, Briney JS, Catalano RF. Benefit-Cost Analysis of a Randomized Evaluation of Communities That Care: Monetizing Intervention Effects on the Initiation of Delinquency and Substance Use Through Grade 12. JOURNAL OF EXPERIMENTAL CRIMINOLOGY 2015; 11:165-192. [PMID: 26213527 PMCID: PMC4512954 DOI: 10.1007/s11292-014-9226-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine whether the Communities That Care (CTC) prevention system is a cost-beneficial intervention. METHODS Data were from a longitudinal panel of 4,407 youth participating in a randomized controlled trial including 24 towns in 7 states, matched in pairs within state and randomly assigned to condition. Significant differences favoring intervention youth in sustained abstinence from delinquency, alcohol use, and tobacco use through Grade 12 were monetized and compared to economic investment in CTC. RESULTS CTC was estimated to produce $4,477 in benefits per youth (discounted 2011 dollars). It cost $556 per youth to implement CTC for 5 years. The net present benefit was $3,920. The benefit-cost ratio was $8.22 per dollar invested. The internal rate of return was 21%. Risk that investment would exceed benefits was minimal. Investment was expected to be recouped within 9 years. Sensitivity analyses in which effects were halved yielded positive cost-beneficial results. CONCLUSIONS CTC is a cost-beneficial, community-based approach to preventing initiation of delinquency, alcohol use, and tobacco use. CTC is estimated to generate economic benefits that exceed implementation costs when disseminated with fidelity in communities.
Collapse
Affiliation(s)
| | - Abigail A. Fagan
- Department of Criminology, Sociology, and Law, University of Florida
| | - J. David Hawkins
- Social Development Research Group, School of Social Work, University of Washington
| | - John S. Briney
- Social Development Research Group, School of Social Work, University of Washington
| | - Richard F. Catalano
- Social Development Research Group, School of Social Work, University of Washington
| |
Collapse
|
38
|
Gordon CS, Jones SC, Kervin L. Effectiveness of alcohol media literacy programmes: a systematic literature review. HEALTH EDUCATION RESEARCH 2015; 30:449-465. [PMID: 25840435 DOI: 10.1093/her/cyv015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 03/08/2015] [Indexed: 06/04/2023]
Abstract
Alcohol media literacy is an emerging field that aims to address the link between exposure to alcohol advertising and subsequent expectancies and behaviours for children and adolescents. The design, rigour and results of alcohol media literacy programmes vary considerably, resulting in a number of unanswered questions about effectiveness. To provide insight into some of these questions, a systematic literature review of alcohol media literacy studies was conducted. The review was guided by the following research question: What considerations are needed to develop an effective school-based alcohol media literacy programme? On the basis of a critical synthesis of 10 interventions (published in the period 1997 to May 2014), our findings provide a comprehensive understanding of the descriptive, methodological and outcome characteristics of this small body of significant research. The review provides considerations for future alcohol media literacy programmes, including the need for an interactive pedagogical approach within the naturalistic school setting, implementation fidelity and a holistic approach to programme evaluation, a means for maintaining relevance, consideration of gender differences, relevance for an international audience and use of follow-up and longitudinal data.
Collapse
Affiliation(s)
| | - Sandra C Jones
- Centre for Health Initiatives, University of Wollongong, Wollongong 2520, Australia, Centre for Health and Social Research, Australian Catholic University, Melbourne 3065, Australia and Early Start Research Institute, University of Wollongong, Wollongong 2520, Australia
| | - Lisa Kervin
- Centre for Health Initiatives, University of Wollongong, Wollongong 2520, Australia, Centre for Health and Social Research, Australian Catholic University, Melbourne 3065, Australia and Early Start Research Institute, University of Wollongong, Wollongong 2520, Australia
| |
Collapse
|
39
|
Livingston MD, Komro KA, Wagenaar AC. The effects of survey modality on adolescents' responses to alcohol use items. Alcohol Clin Exp Res 2015; 39:710-5. [PMID: 25752744 DOI: 10.1111/acer.12659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 12/19/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined differences in response to self-reported alcohol use items by survey mode, whether self-report differences were the result of modality effects or self-selection, and whether these differences varied across the treatment and control arms of a preventative intervention trial. METHODS Data from an existing alcohol prevention trial were used to estimate the effect of survey modality on adolescent's self-reported alcohol use at ages 17 to 18. Estimates were derived from regression models controlling for self-reported alcohol use during 8th grade, measured using a single survey modality, as well as time invariant selection factors. RESULTS No statistically significant survey modality effects were found. No differential effects of survey modality were observed by assigned intervention group. CONCLUSIONS We provide initial evidence that adolescent alcohol prevention trials may use multiple survey modalities when necessary to increase response rates without harming interpretation of intervention effects.
Collapse
Affiliation(s)
- Melvin D Livingston
- Department of Health Outcomes & Policy and Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida
| | | | | |
Collapse
|
40
|
Thomas RE, Baker PRA, Thomas BC, Lorenzetti DL. Family-based programmes for preventing smoking by children and adolescents. Cochrane Database Syst Rev 2015; 2015:CD004493. [PMID: 25720328 PMCID: PMC6486099 DOI: 10.1002/14651858.cd004493.pub3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is evidence that family and friends influence children's decisions to smoke. OBJECTIVES To assess the effectiveness of interventions to help families stop children starting smoking. SEARCH METHODS We searched 14 electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO, CINAHL unpublished material, and key articles' reference lists. We performed free-text internet searches and targeted searches of appropriate websites, and hand-searched key journals not available electronically. We consulted authors and experts in the field. The most recent search was 3 April 2014. There were no date or language limitations. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions with children (aged 5-12) or adolescents (aged 13-18) and families to deter tobacco use. The primary outcome was the effect of the intervention on the smoking status of children who reported no use of tobacco at baseline. Included trials had to report outcomes measured at least six months from the start of the intervention. DATA COLLECTION AND ANALYSIS We reviewed all potentially relevant citations and retrieved the full text to determine whether the study was an RCT and matched our inclusion criteria. Two authors independently extracted study data for each RCT and assessed them for risk of bias. We pooled risk ratios using a Mantel-Haenszel fixed effect model. MAIN RESULTS Twenty-seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow-up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty-three interventions were tested in the USA, two in Europe, one in Australia and one in India.The control conditions fell into two main groups: no intervention or usual care; or school-based interventions provided to all participants. These two groups of studies were considered separately.Most studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta-analysis.There was moderate quality evidence family-based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non-smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but confidence intervals were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17).Eight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta-analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n = 388).No studies identified any adverse effects of intervention. AUTHORS' CONCLUSIONS There is moderate quality evidence to suggest that family-based interventions can have a positive effect on preventing children and adolescents from starting to smoke. There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons. The evidence is therefore strongest for high intensity programmes used independently of school interventions. Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%. However, these findings should be interpreted cautiously because effect estimates could not include data from all studies. Our interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting). This is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting.
Collapse
Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1.
| | | | | | | |
Collapse
|
41
|
Langford R, Bonell C, Jones H, Pouliou T, Murphy S, Waters E, Komro K, Gibbs L, Magnus D, Campbell R. The World Health Organization's Health Promoting Schools framework: a Cochrane systematic review and meta-analysis. BMC Public Health 2015; 15:130. [PMID: 25886385 PMCID: PMC4339015 DOI: 10.1186/s12889-015-1360-y] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/06/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization's Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed. METHODS We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school's ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses. RESULTS We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates. CONCLUSION This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.
Collapse
Affiliation(s)
- Rebecca Langford
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Christopher Bonell
- Social Science Research Unit, Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK.
| | - Hayley Jones
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Theodora Pouliou
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Simon Murphy
- Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Elizabeth Waters
- Jack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3053, Melbourne, Australia.
| | - Kelli Komro
- Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 1329 SW 16th Street, Gainesville, FL, 32610-0177, USA.
| | - Lisa Gibbs
- Jack Brockhoff Child Health & Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3053, Melbourne, Australia.
| | - Daniel Magnus
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| | - Rona Campbell
- School of Social & Community Medicine, University of Bristol, 39 Whatley Rd, Bristol, BS8 2PS, UK.
| |
Collapse
|
42
|
Abstract
This paper reviews the magnitude and empirical findings of social epidemiological neighborhood effects research. An electronic keyword literature search identified 1369 empirical and methodological neighborhood effects papers published in 112 relevant journals between 1990 and 2014. Analyses of temporal trends were conducted by focus, journal type (e.g., epidemiology, public health, or social science), and specific epidemiologic journal. Select papers were then critically reviewed. Results show an ever-increasing number of papers published, notably since the year 2000, with the majority published in public health journals. The variety of health outcomes analyzed is extensive, ranging from infectious disease to obesity to criminal behavior. Papers relying on data from experimental designs are thought to yield the most credible results, but such studies are few and findings are inconsistent. Papers relying on data from observational designs and multilevel models typically show small statistically significant effects, but most fail to appreciate fundamental identification problems. Ultimately, of the 1170 empirically focused neighborhood effects papers published in the last 24 years, only a handful have clearly advanced our understanding of the phenomena. The independent impact of neighborhood contexts on health remains unclear. It is time to expand the social epidemiological imagination.
Collapse
|
43
|
Komro KA, Livingston MD, Kominsky TK, Livingston BJ, Garrett BA, Molina MM, Boyd ML. Fifteen-minute comprehensive alcohol risk survey: reliability and validity across American Indian and White adolescents. J Stud Alcohol Drugs 2015; 76:133-42. [PMID: 25486402 PMCID: PMC4263775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/05/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE American Indians (AIs) suffer from significant alcohol-related health disparities, and increased risk begins early. This study examined the reliability and validity of measures to be used in a preventive intervention trial. Reliability and validity across racial/ethnic subgroups are crucial to evaluate intervention effectiveness and promote culturally appropriate evidence-based practice. METHOD To assess reliability and validity, we used three baseline surveys of high school students participating in a preventive intervention trial within the jurisdictional service area of the Cherokee Nation in northeastern Oklahoma. The 15-minute alcohol risk survey included 16 multi-item scales and one composite score measuring key proximal, primary, and moderating variables. Forty-four percent of the students indicated that they were AI (of whom 82% were Cherokee), including 23% who reported being AI only (n = 435) and 18% both AI and White (n = 352). Forty-seven percent reported being White only (n = 901). RESULTS Scales were adequately reliable for the full sample and across race/ethnicity defined by AI, AI/White, and White subgroups. Among the full sample, all scales had acceptable internal consistency, with minor variation across race/ethnicity. All scales had extensive to exemplary test-retest reliability and showed minimal variation across race/ethnicity. The eight proximal and two primary outcome scales were each significantly associated with the frequency of alcohol use during the past month in both the cross-sectional and the longitudinal models, providing support for both criterion validity and predictive validity. For most scales, interpretation of the strength of association and statistical significance did not differ between the racial/ethnic subgroups. CONCLUSIONS The results support the reliability and validity of scales of a brief questionnaire measuring risk and protective factors for alcohol use among AI adolescents, primarily members of the Cherokee Nation.
Collapse
Affiliation(s)
- Kelli A Komro
- Institute for Child Health Policy, University of Florida, Gainesville, Florida
| | - Melvin D Livingston
- Institute for Child Health Policy, University of Florida, Gainesville, Florida
| | | | | | | | | | - Misty L Boyd
- Cherokee Nation Behavioral Health, Tahlequah, Oklahoma
| |
Collapse
|
44
|
Jones SC. Using social marketing to create communities for our children and adolescents that do not model and encourage drinking. Health Place 2014; 30:260-9. [DOI: 10.1016/j.healthplace.2014.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/30/2014] [Accepted: 10/10/2014] [Indexed: 12/18/2022]
|
45
|
The differential impact of a classroom-based, alcohol harm reduction intervention, on adolescents with different alcohol use experiences: A multi-level growth modelling analysis. J Adolesc 2014; 37:1057-67. [DOI: 10.1016/j.adolescence.2014.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/06/2014] [Accepted: 07/27/2014] [Indexed: 11/17/2022]
|
46
|
Cairns G, Purves R, McKell J. Combining school and family alcohol education: a systematic review of the evidence. HEALTH EDUCATION 2014. [DOI: 10.1108/he-12-2013-0066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to map and identify evidence for effective components of combined school and family alcohol education interventions. The paper describes current practice, evaluative evidence of its effects, and highlights specific elements of school and family linked education associated with effective prevention or reduction of alcohol misuse by young people aged 11-18 years.
Design/methodology/approach
– This paper takes the form of a systematic review.
Findings
– The review found evidence of small positive effects for interventions delivered over short and longer term duration and low and higher levels of direct contact with students and families. Family-based elements that correlated with positive effects were targeting information and skills development, family communications, and stricter parental attitudes to alcohol misuse. School-based components which involved life skills and social norms approaches were associated with reductions in risky behaviours. Weaker evidence indicated that peer-led programmes, external delivery agents and linkages of school-based components to community-level change may strengthen combined school and family intervention programmes.
Research limitations/implications
– The heterogeneity of the studies precluded the option to perform meta-analysis.
Practical implications
– There is a need for more focused use of planning and evaluation tools, and especially more explicit articulation of behaviours and/or behavioural determinants targeted; the methods that will be employed and the conceptual basis for the programme design could contribute to deeper understanding amongst the intervention community of how and why impact is or is not achieved.
Social implications
– Few studies provide information on the concepts, assumptions or change objectives that shape programme design. The potential benefits of combining school and family education interventions warrants further exploration.
Originality/value
– The authors believe this is the first review to systematically examine objectives, design and impact of combined school and family alcohol education interventions.
Collapse
|
47
|
van Goethem A, van Hoof A, Orobio de Castro B, Van Aken M, Hart D. The role of reflection in the effects of community service on adolescent development: a meta-analysis. Child Dev 2014; 85:2114-30. [PMID: 25056762 DOI: 10.1111/cdev.12274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This meta-analysis assessed the effect of community service on adolescent development and the moderation of this effect by reflection, community service, and adolescent characteristics to explicate the mechanisms underlying community service effects. Random effects analyses, based on 49 studies (24,477 participants, 12-20 years old), revealed that community service had positive effects on academic, personal, social, and civic outcomes. Moderation analyses indicated that reflection was essential; the effect for studies that include reflection was substantial (mean ES = .41) while community service in the absence of reflection yielded negligible benefits (mean ES = .05). Effects increased when studies include more frequent reflection and community service, reflection on academic content, and older adolescents. These findings have implications for understanding and improving community service.
Collapse
|
48
|
Lima-Serrano M, Lima-Rodríguez JS. Impact of school-based health promotion interventions aimed at different behavioral domains: a systematic review. GACETA SANITARIA 2014; 28:411-7. [PMID: 24923204 DOI: 10.1016/j.gaceta.2014.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/01/2014] [Accepted: 05/07/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Given that lifestyleshave similar determinants and that school-based interventions are usually targeted at all the risks that affect adolescents, the objective of this systematic review was to summarize the characteristics and effects of school-based interventions acting on different behavioral domains of adolescent health promotion. METHODS The review process was conducted by two independent reviewers who searched PubMed, Scopus, PsycINFO, and ERIC databases for experimental or observational studies with at least two measures of results published from 2007 to 2011, given that the research information available doubles every 5 years. Methodological quality was assessed with a standardized tool. RESULTS Information was extracted from 35 studies aiming to prevent risk behaviors and promote healthy nutrition, physical activity, and mental and holistic health. Activities were based on theoretical models and were classified into interactive lessons, peer mediation, environmental changes, parents' and community activities, and tailored messages by computer-assisted training or other resources, usually including multiple components. In some cases, we identified some moderate to large, short- and long-term effects on behavioral and intermediate variable. CONCLUSIONS This exhaustive review found that well-implemented interventions can promote adolescent health. These findings are consistent with recent reviews. Implications for practice, public health, and research are discussed.
Collapse
Affiliation(s)
- Marta Lima-Serrano
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, España
| | - Joaquín S Lima-Rodríguez
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, España.
| |
Collapse
|
49
|
Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014; 2014:CD008958. [PMID: 24737131 PMCID: PMC11214127 DOI: 10.1002/14651858.cd008958.pub2] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
Collapse
Affiliation(s)
- Rebecca Langford
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Christopher P Bonell
- Institute of Education, University of LondonSocial Science Research Unit18 Woburn SquareLondonLondonUKWC1H 0NR
| | - Hayley E Jones
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Theodora Pouliou
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Simon M Murphy
- Cardiff UniversityCardiff School of Social Sciences1‐3 Museum PlaceCardiffSouth GlamorganUKCF10 3BD
| | - Elizabeth Waters
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Kelli A Komro
- University of FloridaHealth Outcomes and Policy and Institute for Child Health PolicyPO Box 100177GainesvilleFloridaUSA32610‐0177
| | - Lisa F Gibbs
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Daniel Magnus
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Rona Campbell
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | | |
Collapse
|
50
|
Shakeshaft A, Doran C, Petrie D, Breen C, Havard A, Abudeen A, Harwood E, Clifford A, D'Este C, Gilmour S, Sanson-Fisher R. The effectiveness of community action in reducing risky alcohol consumption and harm: a cluster randomised controlled trial. PLoS Med 2014; 11:e1001617. [PMID: 24618831 PMCID: PMC3949675 DOI: 10.1371/journal.pmed.1001617] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/30/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The World Health Organization, governments, and communities agree that community action is likely to reduce risky alcohol consumption and harm. Despite this agreement, there is little rigorous evidence that community action is effective: of the six randomised trials of community action published to date, all were US-based and focused on young people (rather than the whole community), and their outcomes were limited to self-report or alcohol purchase attempts. The objective of this study was to conduct the first non-US randomised controlled trial (RCT) of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and harms measured using both self-report and routinely collected data. METHODS AND FINDINGS We conducted a cluster RCT comprising 20 communities in Australia that had populations of 5,000-20,000, were at least 100 km from an urban centre (population ≥ 100,000), and were not involved in another community alcohol project. Communities were pair-matched, and one member of each pair was randomly allocated to the experimental group. Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement; general practitioner training in alcohol screening and brief intervention (SBI); feedback to key stakeholders; media campaign; workplace policies/practices training; school-based intervention; general practitioner feedback on their prescribing of alcohol medications; community pharmacy-based SBI; web-based SBI; Aboriginal Community Controlled Health Services support for SBI; Good Sports program for sports clubs; identifying and targeting high-risk weekends; and hospital emergency department-based SBI. Primary outcomes based on routinely collected data were alcohol-related crime, traffic crashes, and hospital inpatient admissions. Routinely collected data for the entire study period (2001-2009) were obtained in 2010. Secondary outcomes based on pre- and post-intervention surveys (n = 2,977 and 2,255, respectively) were the following: long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. At the 5% level of statistical significance, there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption (1.90 fewer standard drinks per week, 95% CI = -3.37 to -0.43, p = 0.01) and less alcohol-related verbal abuse (odds ratio = 0.58, 95% CI = 0.35 to 0.96, p = 0.04) post-intervention, the low survey response rates (40% and 24% for the pre- and post-intervention surveys, respectively) require conservative interpretation. The main limitations of this study are as follows: (1) that the study may have been under-powered to detect differences in routinely collected data outcomes as statistically significant, and (2) the low survey response rates. CONCLUSIONS This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12607000123448.
Collapse
Affiliation(s)
- Anthony Shakeshaft
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Christopher Doran
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Dennis Petrie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Alys Havard
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Ansari Abudeen
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Elissa Harwood
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
| | - Anton Clifford
- National Drug and Alcohol Research Centre, Faculty of Medicine, UNSW (University of New South Wales), Sydney, New South Wales, Australia
- Institute for Urban Indigenous Health, Bowen Hills, Queensland, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Stuart Gilmour
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|