Implementation of a youth violence prevention programme in primary care

Adaptive interventions for alcohol misuse and violent behaviors among adolescents and emerging adults in the emergency department: Outcomes from a sequential multiple assignment randomized controlled trial

INTRODUCTION

Harnessing technology for delivery of behavioral health interventions to reduce alcohol use and aggression may reduce morbidity among youth. This paper describes the outcomes from a sequential, multiple assignment, randomized trial (SMART) testing interventions for youth (ages 14-20) in the emergency department (ED).

METHODS

Youth (n = 400) in the ED screening positive for binge drinking and aggression received the SafERteens brief intervention (BI) and were randomly assigned to boosters: Text Messages (TM) or Health Coach (HC) (1st stage; weeks 1-4). Participants completed 8 weekly surveys, with outcomes assessed at 4- and 8-months. After the 1st stage, response/non-response was determined (e.g., binge drinking or aggression). Responders were re-randomized to continued or minimized condition; non-responders were re-randomized to continued or intensified condition (2nd stage; weeks 5-8). Analyses examined outcomes from the initial randomization; and comparisons between responders and non-responders on primary (alcohol consumption, aggression), secondary (alcohol consequences, violence consequences) and exploratory (alcohol misuse, victimization, drug use, drug consequences) outcomes.

RESULTS

There were no significant differences in outcomes between 1st stage boosters or 2nd stage boosters for non-responder or responder groups. However, significant changes over time were observed across all participants, with the odds of abstaining from alcohol increased at 4 (OR 3.97, 95 % CI 2.46-6.41) and 8-months (OR 4.36, 95 % CI 2.11-9.02), while the odds of aggression (OR 0.39, 95 % CI 0.16-0.94) decreased at 8-months; significant decreases were also observed for other outcomes.

CONCLUSIONS

Findings support the promise of digital health interventions for youth with binge drinking and aggression.

Firearm possession among emergency department youth and young adults: A latent class analysis

INTRODUCTION

Firearm injuries are a leading cause of death for youth/young-adults. We utilized latent class analysis to identify distinct motivational/behavioral patterns of firearm possession in a youth/young-adult emergency department sample to inform prevention strategies.

METHODS

Cross-sectional data were obtained from surveys conducted among youth/young-adults (age = 16-29; n = 1311) seeking emergency department treatment (7/10/2017-6/25/2018). Latent class analysis was performed for individuals reporting firearm possession (n = 223) using five variables: carriage frequency, social carriage, risky firearm behaviors, ownership/carriage for protection, and recreational ownership/carriage. Descriptive statistics were examined.

RESULTS

In this sample, 17.0 % reported having firearms (age-22.7; 48.0 %-male; 49.3 %-Black; 52.5 %-public assistance). Latent class analysis identified four classes: 1-recreational possession (n = 51); 2-possession for protection with low carriage (n = 60); 3-carriage for protection with low risky firearm behaviors (n = 76); and 4-carriage for protection with high risky firearm behaviors (n = 36). Class-1 (recreational possession) had low firearm victimization, violence exposure, and community violence. This class primarily kept long-guns with secure storage patterns. Class-2 (protection with low carriage) were mostly female youth/young-adults with children and reported moderately high rates of violence exposure. Nearly 20 % stored their firearm unlocked. Class-3 and -4 endorsed firearm carriage for protection, with Class-4 also engaging in risky firearm behaviors. Both classes had high violence exposure; however, Class-4 had higher risk profiles including higher marijuana misuse, mental health symptoms, and firearm victimization.

CONCLUSIONS

Among an emergency department sample, four distinct firearm possession classes emerged with different risk levels. Understanding firearm behaviors and risk/protective factors is critical to tailoring healthcare-focused interventions to address individual needs and reduce injury risk.

Integrating Implementation Science in Interpersonal Violence Research and Practice: A Systematic Review of Barriers and Facilitators of Implementation

Despite the prevalence and harmful consequences of interpersonal violence and the growth in intervention research, applying research evidence and strategies into practice remains limited. This systematic review addresses this gap by using the Consolidated Framework of Implementation Research (CFIR) to characterize barriers and facilitators in efforts to prevent and address interpersonal violence. A systematic search of peer-reviewed literature was conducted using the following databases: PubMed, Embase, CINAHL, Cochrane, Web of Science, Scopus, and APA PsycInfo. The searches resulted in 1,319 articles for initial screening, with 31 studies included in the final synthesis. The selected studies were original research highlighting barriers and facilitators of implementing interpersonal violence interventions for adolescents and adults across various US settings, employing quantitative, qualitative, or mixed methods approaches. Excluded studies included protocols, reviews, and research that did not identify barriers or facilitators of implementing violence prevention or intervention programs. Published from 2007 to 2023, the selected studies spanned healthcare, school, community, correctional, and military settings. Using the CFIR, the review identified multilevel barriers (e.g., lack of cultural relevance, leadership commitment) and facilitators (e.g., intervention adaptability, stakeholder engagement) across five domains: outer setting (external factors), inner setting (organizational characteristics) implementation process, individual characteristics, and intervention characteristics. These findings underscore the importance of adaptable, culturally relevant strategies and comprehensive stakeholder involvement for effective implementation. The review emphasizes the need for enhanced pre-implementation planning, capacity building, and organizational support to address identified barriers. Furthermore, it highlights the necessity for further research in under-researched settings, employing evidence-based implementation strategies.

Evaluating an App-Based Intervention for Preventing Firearm Violence and Substance Use in Young Black Boys and Men: Usability Evaluation Study

BACKGROUND

Young Black male individuals are 24 times more likely to be impacted by firearm injuries and homicides but encounter significant barriers to care and service disengagement, even in program-rich cities across the United States, leaving them worryingly underserved. Existing community-based interventions focus on secondary and tertiary prevention after firearm violence has occurred and are typically deployed in emergency settings. To address these service and uptake issues, we developed BrotherlyACT-a nurse-led, culturally tailored, multicomponent app-to reduce the risk and effects of firearm injuries and homicides and to improve access to precrisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. Grounded in Acceptance and Commitment Therapy, the app provides life skills coaching, safety planning, artificial intelligence-powered talk therapy, and zip code-based service connections directly to young Black male individuals at risk for violence and substance use.

OBJECTIVE

The primary aim of this study is to evaluate the usability, engagement, and satisfaction of BrotherlyACT among target young Black male users and mobile health (mHealth) experts, using a combination of formative usability testing (UT) and heuristic evaluation (HE).

METHODS

Using a convergent mixed methods approach, we evaluated the BrotherlyACT app using HE by 8 mHealth specialists and conducted UT with 23 participants, comprising 15 young Black male users (aged 15-24 years), alongside 4 adult internal team testers and 4 high school students who were part of our youth advisory board. UT included the System Usability Scale and thematic analysis of think-aloud interviews and cognitive walkthroughs. HE involved mHealth experts applying the Nielsen severity rating scale (score 0-3, with 3 indicating a major issue). All testing was conducted via REDCap (Research Electronic Data Capture) and Zoom or in person.

RESULTS

Qualitative usability issues were categorized into 8 thematic groups, revealing only minor usability concerns. The app achieved an average System Usability Scale score of 79, equivalent to an A-minus grade and placing it in the 85th percentile, indicating near-excellent usability. Similarly, the HE by testers identified minor and cosmetic usability issues, with a median severity score of 1 across various heuristics (on a scale of 0-3), indicating minimal impact on user experience. Overall, minor adjustments were recommended to enhance navigation, customization, and guidance for app users, while the app's visual and functional design was generally well received.

CONCLUSIONS

BrotherlyACT was considered highly usable and acceptable. Testers in the UT stage gave the app a positive overall rating and emphasized that several key improvements were made. Findings from our UT prompted revisions to the app prototype. Moving forward, a pilot study with a pretest-posttest design will evaluate the app's efficacy in community health and emergency care settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/43842.

Adaptive interventions for alcohol misuse and violent behaviors among adolescents and emerging adults in the emergency department: A sequential multiple assignment randomized controlled trial protocol

Alcohol use and violent behaviors among youth are associated with morbidity and mortality. An emergency department (ED) visit provides an opportunity to initiate prevention efforts. Despite promising findings from our single session SafERteens brief intervention (BI), impact is limited by modest effect sizes, with data lacking on optimal boosters to enhance effects. This paper describes the protocol for a sequential, multiple assignment, randomized trial (SMART). Adolescents and emerging adults (ages 14-20) in the ED screening positive for alcohol use and violent behaviors (physical aggression) were randomly assigned to: 1) SafERteens BI + Text Messaging (TM), or 2) SafERteens BI + remote Health Coach (HC). Participants completed weekly surveys over 8 weeks after the ED visit to tailor intervention content and measure mechanisms of change. At one-month, intervention response/non-response is determined (e.g., binge drinking or violent behaviors). Responders are re-randomized to continued intervention condition (e.g., maintenance) or minimized condition (e.g., stepped down). Non-responders are re-randomized to continued condition (e.g., maintenance), or intensified condition (e.g., stepped up). Outcomes were measured at 4 and 8 months, including primary outcomes of alcohol consumption and violence, with secondary outcomes of alcohol consequences and violence consequences. Although the original goal was to enroll 700 participants, COVID-19 impacts on research diminished recruitment in this trial (enrolled n = 400). Nonetheless, the proposed SMART is highly innovative by blending real-time assessment methodologies with adaptive intervention delivery among teens with comorbid alcohol misuse and violent behaviors. Findings will inform the content and timing booster interventions to alter risk behavior trajectories. Trial Registration:ClinicalTrials.govNCT03344666. University of Michigan # HUM00109156.