A randomized trial of Parents Who Care: effects on key outcomes at 24-month follow-up

Integrated Theory-Based Health and Development Interventions for Young People: A Global Scoping Review

BACKGROUND

Most health and developmental issues affecting young people are interrelated. However, few interventions address multiple behavioral domains simultaneously or are based on theories that encompass a holistic perspective of youth development.

AIM

The purpose of this scoping review was to identify and describe the range of theory-based, multibehavioral health interventions aimed at improving two or more of the following behavioral youth outcomes: (1) sexual and reproductive health; (2) education and employment; (3) violence; and (4) substance use.

METHODS

Interventions conducted worldwide and published in English or Spanish between January 2000 and July 2020 were identified using four databases: PubMed, PsycINFO, LILACS, and SciELO.

RESULTS

A total of 11,084 articles were identified, of which 477 were retrieved and assessed for eligibility. Twenty-three articles (evaluating 21 interventions) ultimately met the inclusion criteria. Most interventions were conducted in the United States and addressed two behavioral domains of interest, although seven interventions incorporated three domains, and one incorporated all four. Substance use was the most common domain (16 interventions) but only in the United States/Canada, followed by sexual and reproductive health (14 interventions). All produced significant improvement in at least one outcome or for at least one subgroup of youth. The most common theoretical foundations were positive youth development and social learning theory.

CONCLUSION

Integrated interventions that are theory based and evidence informed can support positive development and empower youth to make healthy decisions. Further efforts are needed to address structural and policy issues that affect young people's developmental opportunities and health outcomes.

Family, Mental Health, and Placement Outcomes of a Low-cost Preventive Intervention for Youth in Foster Care

This study assessed secondary outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years within Washington State were recruited and randomly assigned into either the Connecting program (n = 110) or a treatment-as-usual control condition (n = 110). The program included a 10-week sequence of self-directed family activities and DVDs with video clips. Survey data were collected from caregivers and youth at baseline, immediately post-intervention, and at 12 and 24 months post-intervention; placement data was collected from the child welfare department as well. Intention-to-treat analyses focused on 5 classes of secondary outcomes at 24 months post-intervention: caregiver-youth bonding, family climate, youth risk behavior attitudes, youth mental health, and placement stability. There were no intervention effects in the full sample. In subgroup analyses, among older youth (ages 16 - 17) but not younger youth (ages 13 - 15), the Connecting condition (vs. controls) yielded more frequent caregiver-reported bonding communication, bonding activities, warmth, and positive interactions, as well as less favorable youth attitudes towards early initiation of sexual behavior and substance use, and fewer youth self-injurious thoughts. Consistent with the social development model, the divergent outcomes between younger and older youth suggests Connecting's driving mechanisms involve social processes that undergo critical shifts between early and mid-adolescence. Overall, the Connecting program showed promise in older youth for long-term promotion of caregiver-youth bonding, healthy behaviors, and mental health, but did not demonstrate long-term efficacy in facilitating stable or permanent placement of youth in care.

Prevention of Illicit Drug use from the Users' Perspective

This research described the perspective of illicit drug users regarding illicit drug use prevention initiatives. The study used a convergent parallel mixed methods design, combining quantitative and qualitative methods. In the quantitative component of the study, 111 subjects from a psychosocial care centre (CAPS-AD). The qualitative data were collected through semi-structured interviews with 11 subjects who were selected from among the participants and who declared themselves to be personally affected as being or having been illicit drugs users. From the perspective of drug users, the results pointed out different prevention initiatives and the institutions that should be responsible for them. For preventive actions to be successful, they must be intersectoral and involve government, community and families.

Two-Year Risk Behavior Outcomes from Connecting, a Prevention Program for Caregivers and Youth in Foster Care

This study experimentally tested risk behavior outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years from across Washington State were recruited and randomly assigned to either the self-directed program with supplemental support (n = 110) or a treatment as usual control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Over the 10-week program, participants received motivational support contacts to prompt program completion. Survey data were collected from youth and their caregivers at baseline, directly following intervention, then again at 12 and 24 months post-intervention. Intervention effects at 24-month follow-up were found to be moderated by age. Among 16- to 17-year-old youth at follow-up, there was an intervention benefit yielding reduced use of any substance (OR = 0.71, 95% CI [0.54, 0.93], p = 0.01) and nonviolent delinquency (OR = 0.73, 95% CI [0.57, 0.94], p = 0.02). There was no intervention effect among adolescents aged 13 to 15 years for any risk behaviors. This evidence suggests that the developmental timing of a self-directed, family-focused preventive intervention for youth and their caregivers in the foster care system may influence risk behaviors that typically emerge in late adolescence. ClinicalTrials.gov Identifier: NCT03157895.

Proximal Outcomes of Connecting, an Evidence-based, Family-focused Prevention Program for Caregivers of Adolescents in Foster Care

This study experimentally tested proximal outcomes of Connecting, a low-cost, self-directed, family-based substance-use prevention program for foster families. Families (n = 220) fostering youth age 11 to 15 years were recruited and randomly assigned into the self-administered program with telephone support (n = 110) or a treatment as usual, control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Survey data were collected from youth and their caregivers at baseline and 4 months later. Results indicate 60% were 'very satisfied' with Connecting, and 85% would recommend Connecting to other caregivers. Analyses revealed foster youth in the program (n = 93) were significantly more likely than controls (n = 104) to report improved problem-solving skills (Cohen's d = .13, p = .02), involvement in making family rules (OR = 2.6, p = .02), and caregiver recognition for positive behavior (OR = 3.8, p = .03) at posttest. Improvement was observed in youth report of intervention-specific communications (B = 0.15, p = 0.07) and improved refusal skills (OR = 2.09, p = .06). No significant effects were found on bonding communication, inconsistent discipline, family conflict, monitoring, and antisocial norms about substance use and violence, nor were there significant effects from any caregiver reports on similar measures. This evidence suggests that a self-administered family-focused preventive intervention can positively influence known risk and protective factors for youth in foster care.

Evaluation of the Olweus Bullying Prevention Program in US Urban Middle Schools Using a Multiple Baseline Experimental Design

We evaluated the impact of the Olweus Bullying Prevention Program (OBPP) in an 8-year study in urban middle schools that served primarily African American students living in low-income areas. Participants included 2755 students and 242 teachers. We evaluated the OBPP with a multiple-baseline experimental design where the order and intervention start time was randomly assigned for each school. We assessed the frequency of bullying behaviors and experiences including physical, relational, and verbal aggression and victimization using teacher ratings of student behavior and student-reported data, as well as cyber aggression and victimization and school climate measures using student-reported data. For teacher ratings of student behavior, we found significant main effects across all subtypes of aggression and victimization, with some variability in the timing of effects. The pattern of findings showed delayed intervention effects for boys and a weaker impact of the OBPP on 6th graders. We found main effects for student-reported cyber aggression and victimization, relational aggression, and a composite of physical, verbal, and relational victimization. Decreases in victimization emerged in the 1st or 2nd year of intervention, and reductions in aggression emerged during the 3rd year. Across all findings, once intervention effects emerged, they remained significant in subsequent intervention years. The OBPP resulted in significant decreases in student- and teacher-reported aggression and victimization. However, this intervention had limited impact on general areas of school climate including teacher support, positive peer interactions, and school safety. Overall, the findings offer important prevention and research implications.

Prevention of Illicit Drug use from the Users' Perspective

This research described the perspective of illicit drug users regarding illicit drug use prevention initiatives. The study used a convergent parallel mixed methods design, combining quantitative and qualitative methods. In the quantitative component of the study, 111 subjects from a psychosocial care centre (CAPS-AD). The qualitative data were collected through semi-structured interviews with 11 subjects who were selected from among the participants and who declared themselves to be personally affected as being or having been illicit drugs users. From the perspective of drug users, the results pointed out different prevention initiatives and the institutions that should be responsible for them. For preventive actions to be successful, they must be intersectoral and involve government, community and families.

Universal Family Drug Prevention Programs. A Systematic Review

Purpose: This study offers a response to certain recent doubts that have been cast on universal programs' preventive capacity. The main objective of this paper is to review effective universal family programs in order to carry out a cultural adaptation of SFP 10-14 for the Spanish population. Method: For this purpose, a systematic review was conducted of different databases and evidence-based practices. An analysis was made of the methodologies used in the identified programs, based on standardized criteria. A risk of bias assessment was performed. Results/Discussion: Nineteen studies were identified that report findings on the prevention of substance use, relating to 7 universal family-based prevention programs. Positive outcomes have been achieved by universal family-based substance prevention programs reported in studies with good methodological groundings. Universal prevention programs have become a key preventive tool in social contexts.

Project STRONG: an Online, Parent-Son Intervention for the Prevention of Dating Violence among Early Adolescent Boys

Despite broad calls for prevention programs to reduce adolescent dating violence (DV), there is a dearth of programs designed specifically for males. In fact, there are no programs that capitalize on the importance of parents in modeling and influencing the choices their sons make in future romantic relationships. To address these gaps, this study assessed the initial feasibility, acceptability, and efficacy of an online, parent-son intervention (STRONG) aimed at reducing DV among early adolescent males. One-hundred nineteen 7th- and 8th-grade boys were recruited, with a parent (90% mothers), from six urban middle schools in the Providence, RI area. Dyads were randomized to either STRONG or a waitlist comparison group. STRONG targets three primary constructs: relationship health knowledge, emotion regulation, and communication. Families randomized to the waitlist were nearly twice as likely at 3 months (OR = 1.92 [0.43-8.60]) and nearly 7 times as likely at 9 months (OR = 6.76 [0.66-69.59]) to endorse any form of DV perpetration (physical, sexual, verbal/emotional) when compared with STRONG families. STRONG also had positive effects on teens' attitudes toward dealing with DV, their emotional awareness, and their short-term regulation skills and was associated with increased discussion of critical relationship topics. Pilot outcomes indicate that an online DV prevention program designed to engage early adolescent boys and parents is both acceptable and engaging. Findings show promise for reducing DV behaviors and theory-driven mediators. ClinicalTrials.gov Identifier: NCT03109184.

Investigating the efficacy of a self-directed parenting intervention to reduce risky behaviors among college students: Study protocol for a multi-arm hybrid type 2 randomized control trial

BACKGROUND

Early adulthood is a critical developmental period when many youth transition from living at home to the relative autonomy of college. This transition results in increased opportunity for positive growth and identity development - and for risky substance use and sexual behaviors. Parents continue to influence young adult behavior even from a distance; however, few studies have rigorously tested parent-college student interventions.

METHODS

This multi-arm hybrid type 2 trial tests the short- and long-term efficacy of a self-directed handbook for parents of first-year college students. In the summer before college, parent-student dyads are randomly assigned to one of three conditions: control, Parent Handbook, or Parent Handbook Plus. Handbook parents receive encouragement via phone calls to read the handbook and complete activities with their student before leaving for college. Handbook Plus parents also receive booster messages targeted at risky or stressful times. Participants complete surveys of intervention-targeted knowledge, attitudes, and behaviors at baseline and four months after baseline. Students complete three additional surveys at nine, 16, and 21 months after baseline. Dyads in the intervention conditions also reported on handbook utilization, perceived usefulness, and engagement with intervention materials.

DISCUSSION

Self-directed family interventions may be a feasible strategy for involving parents of college students. This trial aimed to determine: 1) the efficacy of a self-directed handbook intervention for parents of first-year college students, including whether the addition of periodic booster messages enhanced efficacy; and 2) how variations in handbook utilization, perceived usefulness, and engagement were linked to student outcomes.

Association of Sexual Health Interventions With Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis

IMPORTANCE

Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge.

OBJECTIVE

To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes.

DATA SOURCES

For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial.

STUDY SELECTION

Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English.

DATA EXTRACTION AND SYNTHESIS

Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models.

MAIN OUTCOMES AND MEASURES

Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy.

RESULTS

Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose.

CONCLUSIONS AND RELEVANCE

The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.

Effectiveness of Facebook Groups to Boost Participation in a Parenting Intervention

Although family-based prevention programs have been shown to be effective at reducing adolescent substance use, it is often difficult and costly to recruit and retain parents in programs administered in person. The current study tested whether program engagement and parenting practices could be improved by offering parents in a self-directed family program access to a private Facebook group. Parents of middle school children (N = 103) were recruited through paid Facebook ads to a 5-week self-directed teen substance use prevention program to be completed at home together by parents and their children. Two thirds of parents (N = 72) were randomly assigned to a moderated private Facebook group that provided a forum for parents in the study to interact with each other, and one third (N = 31) were randomized to use the intervention materials without additional support. Relatively few parents participated in the Facebook group and most did not find the experience useful. However, satisfaction with the program assessed 3 months after program completion was high among all parents and most parents engaged with the materials, irrespective of Facebook group assignment. Overall, parents reported significantly lower conflict and more household rules 6 months post-intervention compared to baseline. Parenting practices did not change more among those assigned to the Facebook group than among parents who used the materials on their own. The current findings suggest that providing opportunities for parents to interact online while participating in a self-directed family intervention may not help to increase engagement or improvements in parenting practices, particularly when few parents engage with each other.

Does Adolescent Alcohol Harm Minimization Policy Exposure Reduce Adult Alcohol Problems? A Cross-National Comparison

PURPOSE

Adolescent alcohol use carries risks for problem behaviors, such as injury and school dropout, as well as increases the risk of alcohol dependence later on, making public health approaches that curb youth alcohol use a key concern. The present study uses a two-state comparison of alcohol-related policies in Victoria, Australia and Washington State, U.S. (harm minimization in Australia and zero tolerance in the U.S.) to examine whether youth alcohol use in each state is related to alcohol-related problems in young adulthood.

METHODS

Data were drawn from the International Youth Development Study (N = 1,965) that followed youth in Victoria and Washington states from age 13 years, with follow-up at ages 14 and 15 years, and then again at age 25 years. Multiple-group structural equation modeling was used to test whether early alcohol use was equally related to alcohol problems (measured by the Alcohol Use Disorder Identification Test) at age 25 years and whether the relationship was moderated by family and school environments that were tolerant of youth drinking and by gender.

RESULTS

Youth in Victoria reported greater rates of alcohol use compared with youth in Washington, as well as more permissive family and school environments. Early alcohol use was equally associated with Alcohol Use Disorder Identification Test problems at age 25 years in the two nations, and none of the moderators significantly changed the association.

CONCLUSIONS

Results suggest that harm minimization policies adopted in Victoria are less effective at reducing alcohol problems during young adulthood compared with the stricter zero-tolerance approaches adopted in Washington State.

How can adolescent aggression be reduced? A multi-level meta-analysis

Aggressive behaviour among adolescents has significant social and economic costs. Numerous attempts have been made to intervene to reduce aggression in adolescents. However, little is known about what factors enhance or diminish intervention effectiveness. The present systematic review and meta-analysis, therefore, seeks to quantify the effectiveness of interventions to reduce aggressive behaviour in adolescents and to identify when and for whom such interventions work best. Sixteen databases were searched for randomised controlled trials that assessed interventions to reduce aggression among adolescents. After screening 9795 records, 95 studies were included. A multi-level meta-analysis found a significant overall small-to-medium effect size (d = 0.28; 95% CI [0.17, 0.39]). More effective interventions were of shorter duration, were conducted in the Middle East, were targeted at adolescents with higher levels of risk, and were facilitated by intervention professionals. Potentially active ingredients were classified using the Behaviour Change Technique Taxonomy. Behavioural practice and problem solving were components of more effective interventions targeted at the general population. Overall the findings indicate that psychosocial interventions are effective in reducing adolescent aggression. Future trials need to assess the effect of individual techniques and their combination to identify the key components that can reduce aggression in adolescents.

Primary Care-Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Interventions to discourage the use of tobacco products (including electronic nicotine delivery systems or e-cigarettes) among children and adolescents may help decrease tobacco-related illness and injury.

OBJECTIVE

To update the 2013 review on primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents to inform the US Preventive Services Task Force.

DATA SOURCES

The Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE, PsyINFO, and EMBASE (September 1, 2012, to June 25, 2019), with surveillance through February 7, 2020.

STUDY SELECTION

Primary care-relevant studies; randomized clinical trials and nonrandomized controlled intervention studies of children and adolescents up to age 18 years for cessation and age 25 years for prevention. Trials comparing behavioral or pharmacological interventions with no or a minimal tobacco use intervention control group (eg, usual care, attention control, wait list) were included.

DATA EXTRACTION AND SYNTHESIS

One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality. Studies were pooled using random-effects meta-analysis.

MAIN OUTCOMES AND MEASURES

Tobacco use initiation; tobacco use cessation; health outcomes; harms.

RESULTS

Twenty-four randomized clinical trials (N = 44 521) met inclusion criteria. Behavioral interventions were associated with decreased likelihood of cigarette smoking initiation compared with control interventions at 7 to 36 months' follow-up (13 trials, n = 21 700; 7.4% vs 9.2%; relative risk [RR], 0.82 [95% CI, 0.73-0.92]). There was no statistically significant difference between behavioral interventions and controls in smoking cessation when trials were restricted to smokers (9 trials, n = 2516; 80.7% vs 84.1% continued smoking; RR, 0.97 [95% CI, 0.93-1.01]). There were no significant benefits of medication on likelihood of smoking cessation in 2 trials of bupropion at 26 weeks (n = 523; 17% [300 mg] and 6% [150 mg] vs 10% [placebo]; 24% [150 mg] vs 28% [placebo]) and 1 trial of nicotine replacement therapy at 12 months (n = 257; 8.1% vs 8.2%). One trial each (n = 2586 and n = 1645) found no beneficial intervention effect on health outcomes or on adult smoking. No trials of prevention in young adults were identified. Few trials addressed prevention or cessation of tobacco products other than cigarettes; no trials evaluated effects of interventions on e-cigarette use. There were few trials of pharmacotherapy, and they had small sample sizes.

CONCLUSIONS AND RELEVANCE

Behavioral interventions may reduce the likelihood of smoking initiation in nonsmoking children and adolescents. Research is needed to identify effective behavioral interventions for adolescents who smoke cigarettes or who use other tobacco products and to understand the effectiveness of pharmacotherapy.

Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

IMPORTANCE

Tobacco use is the leading cause of preventable death in the US. An estimated annual 480 000 deaths are attributable to tobacco use in adults, including from secondhand smoke. It is estimated that every day about 1600 youth aged 12 to 17 years smoke their first cigarette and that about 5.6 million adolescents alive today will die prematurely from a smoking-related illness. Although conventional cigarette use has gradually declined among children in the US since the late 1990s, tobacco use via electronic cigarettes (e-cigarettes) is quickly rising and is now more common among youth than cigarette smoking. e-Cigarette products usually contain nicotine, which is addictive, raising concerns about e-cigarette use and nicotine addiction in children. Exposure to nicotine during adolescence can harm the developing brain, which may affect brain function and cognition, attention, and mood; thus, minimizing nicotine exposure from any tobacco product in youth is important.

OBJECTIVE

To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of primary care interventions for tobacco use prevention and cessation in children and adolescents. The current systematic review newly included e-cigarettes as a tobacco product.

POPULATION

This recommendation applies to school-aged children and adolescents younger than 18 years.

EVIDENCE ASSESSMENT

The USPSTF concludes with moderate certainty that primary care-feasible behavioral interventions, including education or brief counseling, to prevent tobacco use in school-aged children and adolescents have a moderate net benefit. The USPSTF concludes that there is insufficient evidence to determine the balance of benefits and harms of primary care interventions for tobacco cessation among school-aged children and adolescents who already smoke, because of a lack of adequately powered studies on behavioral counseling interventions and a lack of studies on medications.

RECOMMENDATION

The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-feasible interventions for the cessation of tobacco use among school-aged children and adolescents. (I statement).

Spatial Analysis of the Impact of a School-Level Youth Violence Prevention Program on Violent Crime Incidents in the Community

This study investigated the effect of a school-based violence prevention program on community rates of violence for youth aged 10 to 18 in three urban communities with high rates of crime and poverty. We evaluated the impact of the Olweus Bully Prevention Program (OBPP) combined with a family intervention using a multiple baseline design in which we randomized the order and timing of intervention activities across three schools. Outcomes were police reports of violent crime incidents involving offenders aged 10 to 18 years (N = 2859 incidents) across a 6-year period. We used Bayesian hierarchical regression modeling to estimate the reduction of youth violence in the census blocks of the intervention middle school zones. Models controlled for percent female head-of-household, median household income, and percent renter-occupied housing units. Block groups within the attendance zones of schools receiving the intervention had a reduced risk of violence compared with those that did not (relative risk = 0.83, 95% credible interval = 0.71, 0.99). Our findings suggest that the school-level intervention was associated with a significant reduction in community-level youth violence. Public health professionals, program planners, and policy-makers should be aware of the potential community-wide benefit of school-level interventions.

Primary and secondary prevention strategies against illicit drug use among adults aged 18-25: a narrative review

OBJECTIVES

We reviewed the literature for preventive programs against illicit drug use that specifically target adults aged 18-25 (i.e. emerging adults).

METHODS

Narrative review of preventive programs that have a high strength of recommendation according to the US Preventive Services Task Force (USPSTF) grading system.

RESULTS

Prevention programs that met the criteria are school and college based, family-based, community based, peer-led, workplace-based, and technology-based interventions. They target the known modifiable risk factors associated with illicit drug use among adolescents and young adults.

CONCLUSION

The preventive programs we reviewed are utilizing evidence-based strategies for the prevention of illicit drug use. Further research is needed to formulate new and effective preventive strategies for the reduction of illicit drug use by emerging adults.

Assessment of Parent-Based Interventions for Adolescent Sexual Health: A Systematic Review and Meta-analysis

IMPORTANCE

Parent-based sexual health interventions have received considerable attention as one factor that can increase safer sexual behavior among youth; however, to our knowledge, the evidence linking parent-based interventions to youth sexual behaviors has not been empirically synthesized.

OBJECTIVE

To examine the association of parent-based sexual health interventions with 3 primary youth outcomes-delayed sexual activity, condom use, and parent-child sexual communication-as well as several secondary outcomes. We also explored potential moderators of intervention effectiveness.

DATA SOURCES

A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles.

STUDY SELECTION

Studies were included if they: (1) sampled adolescents (mean age, ≤18 years), (2) included parents in a key intervention component, (3) evaluated program effects with experimental/quasi-experimental designs, (4) included an adolescent-reported behavioral outcome, (5) consisted of a US-based sample, and (6) were published in English.

DATA EXTRACTION AND SYNTHESIS

Standardized mean difference (d) and 95% confidence intervals were computed from studies and meta-analyzed using random-effects models. A secondary analysis evaluated potential moderating variables.

MAIN OUTCOMES AND MEASURES

The primary outcomes were delayed sexual activity, condom use, and sexual communication.

RESULTS

Independent findings from 31 articles reporting on 12 464 adolescents (mean age = 12.3 years) were synthesized. Across studies, there was a significant association of parent-based interventions with improved condom use (d = 0.32; 95% CI, 0.13-0.51; P = .001) and parent-child sexual communication (d = 0.27; 95% CI, 0.19-0.35; P = .001). No significant differences between parent-based interventions and control programs were found for delaying sexual activity (d = -0.06; 95% CI, -0.14 to 0.02; P = .16). The associations for condom use were heterogeneous. Moderation analyses revealed larger associations for interventions that focused on younger, compared with older, adolescents; targeted black or Hispanic youth compared with mixed race/ethnicity samples; targeted parents and teens equally compared with emphasizing parents only; and included a program dose of 10 hours or more compared with a lower dose.

CONCLUSIONS AND RELEVANCE

Parent-based sexual health programs can promote safer sex behavior and cognitions in adolescents, although the findings in this analysis were generally modest. Moderation analyses indicated several areas where future programs could place additional attention to improve potential effectiveness.

Family-based prevention programmes for alcohol use in young people

BACKGROUND

Alcohol use in young people is a risk factor for a range of short- and long-term harms and is a cause of concern for health services, policy-makers, youth workers, teachers, and parents.

OBJECTIVES

To assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age).Specifically, on these outcomes, the review aimed:• to assess the effectiveness of universal family-based prevention programmes for all children up to 18 years ('universal interventions');• to assess the effectiveness of selective family-based prevention programmes for children up to 18 years at elevated risk of alcohol use or problem drinking ('selective interventions'); and• to assess the effectiveness of indicated family-based prevention programmes for children up to 18 years who are currently consuming alcohol, or who have initiated use or regular use ('indicated interventions').

SEARCH METHODS

We identified relevant evidence from the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, MEDLINE (Ovid 1966 to June 2018), Embase (1988 to June 2018), Education Resource Information Center (ERIC; EBSCOhost; 1966 to June 2018), PsycINFO (Ovid 1806 to June 2018), and Google Scholar. We also searched clinical trial registers and handsearched references of topic-related systematic reviews and the included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster RCTs (C-RCTs) involving the parents of school-aged children who were part of the general population with no known risk factors (universal interventions), were at elevated risk of alcohol use or problem drinking (selective interventions), or were already consuming alcohol (indicated interventions). Psychosocial or educational interventions involving parents with or without involvement of children were compared with no intervention, or with alternate (e.g. child only) interventions, allowing experimental isolation of parent components.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 46 studies (39,822 participants), with 27 classified as universal, 12 as selective, and seven as indicated. We performed meta-analyses according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity.Upon comparing any family intervention to no intervention/standard care, we found no intervention effect on the prevalence (standardised mean difference (SMD) 0.00, 95% confidence interval (CI) -0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low-quality evidence) or frequency (SMD -0.31, 95% CI -0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low-quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD -0.14, 95% CI -0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low-quality evidence).When comparing parent/family and adolescent interventions versus interventions with young people alone, we found no difference in alcohol use prevalence (SMD -0.39, 95% CI -0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low-quality evidence) or frequency (SMD -0.16, 95% CI -0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low-quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta-analysis.In general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported.

AUTHORS' CONCLUSIONS

The results of this review indicate that there are no clear benefits of family-based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed.

Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes?

Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6 months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.

Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence

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.

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

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

Parent-based interventions on adolescent alcohol use outcomes: A systematic review and meta-analysis

BACKGROUND

The effects of parent-based interventions on adolescent alcohol use are unclear, including what factors moderate intervention effects. This study examines the effects of parent-based interventions on adolescent alcohol use and whether the treatment effects vary by participants' characteristics and intervention characteristics.

METHODS

Eleven electronic databases and relevant studies' references were searched for eligible studies published before March 2017. Randomized controlled trials investigating the efficacy of any parent-based intervention for alcohol use outcomes among adolescents up to 18 years old were eligible for review. Two reviewers independently conducted screening, data extraction, and risk of bias assessment. Robust variance estimation in meta-regression was used to analyze treatment effect size estimates and to conduct moderator analysis.

RESULTS

Twenty studies were included in the meta-analysis. The average treatment effect size across all drinking outcomes, with 44 effect sizes from 20 studies, was g = -0.23 with a 95% confidence interval [-0.35, -0.10] which is statistically significant. Parent-based interventions appreared to have larger mean effect sizes on adolescent drinking intention than binge drinking. Interventions targeting both general and alcohol-specific parenting strategies had larger average effect sizes than interventions targeting alcohol-specific parenting only.

CONCLUSIONS

This meta-analysis found evidence of parent-based interventions' efficacy in preventing or reducing adolescent alcohol use.

Addressing Barriers to Recruitment and Retention in the Implementation of Parenting Programs: Lessons Learned for Effective Program Delivery in Rural and Urban Areas

Research has demonstrated the effectiveness of family-based programs for reducing adolescent risk behaviors and promoting adolescent health; however, parent engagement, specifically in terms of recruitment and retention, remains a consistent challenge. Recruitment rates for family-based prevention programs range from 3 to 35%, while, on average, 28% of caregivers drop out before program completion. Thus, engagement of parents in prevention programming is of utmost concern to ensure families and youth benefit from implementation of family-based programs. In this manuscript, two Centers for Disease Control and Prevention-funded projects share their experiences with engagement of parents in violence prevention programs. Problems related to parent engagement are reviewed, as are structural, attitudinal, and interpersonal barriers specific to recruitment and retention. Examples of successful implementation strategies identified across urban and rural sites are also analyzed and lessons learned are provided.

Using Facebook to Recruit Parents to Participate in a Family Program to Prevent Teen Drug Use

Despite strong evidence that family programs are effective in preventing adolescent substance use, recruiting parents to participate in such programs remains a persistent challenge. This study explored the feasibility of using Facebook to recruit parents of middle school students to a self-directed family program to prevent adolescent drug use. The study used paid Facebook ads aiming to recruit 100 parents in Washington and Colorado using marijuana- or parenting-focused messages. All ad-recruited parents were also invited to refer others in order to compare Facebook recruitment to web-based respondent-driven sampling. Despite offering a $15 incentive for each successfully referred participant, the majority of the screened (70.4%) and eligible (65.1%) parents were recruited through Facebook ads. Yet, eligibility and consent rates were significantly higher among referred (76.6 and 57.3%, respectively) than Facebook-recruited parents (60.0 and 36.6%, respectively). Click-through rates on Facebook were higher for marijuana-focused than parenting-focused ads (0.72 and 0.65%, respectively). The final sample (54% Facebook-recruited) consisted of 103 demographically homogeneous parents (female, educated, non-Hispanic White, and mostly from Washington). Although Facebook was an effective and efficient method to recruit parents to a study with equal to better cost-effectiveness than traditional recruitment strategies, the promise of social media to reach a diverse population was not realized. Additional approaches to Facebook recruitment are needed to reach diverse samples in real-world settings and increase public health impact of family programs.

For Whom Do Parenting Interventions to Prevent Adolescent Substance Use Work?

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.

Positive parenting predicts cortisol functioning six years later in young adults

Research which indicates that adverse experiences influence hypothalamic-pituitary-adrenal (HPA) axis functioning illustrates the social environment 'getting under the skin'. The present study extended this literature by examining whether positive social forces within the caregiving environment can also impact cortisol functioning. We conducted a prospective investigation of over 300 youth, half of whom were White and half were Black. Attachment, bonding and parental rewards for positive behaviors were observed or reported by the youth as an 8th grader. Twelve repeated measures of salivary cortisol were examined six years later when youth were young adults (mean age 20). Race differences were explored. Stronger attachment, bonding and teen-reported positive parenting were predictive of high waking cortisol and steeper diurnal slopes six years later. This effect was nonlinear and additive, such that youth whose social contexts were characterized by the strongest attachment, bonding and rewarding parental relationships had the highest waking cortisol. When effects were moderated by race, findings were such that links of positive parenting with HPA functioning were more consistent for White than Black youth. Findings suggest that positive aspects of the caregiving environment can also 'get under the skin' and these effects are additive across a range of caregiving indices. These findings dovetail with an emerging literature on the powerful role of social support for shaping the body's stress response system and are interpreted as consistent with the Adaptive Calibration Model which suggests that cortisol regulation can have adaptive significance. A video abstract of this article can be viewed at: https://youtu.be/8evHXpt_TXM.

Directions for the Advancement of Culturally Adapted Preventive Interventions: Local Adaptations, Engagement, and Sustainability

To advance the implementation and dissemination of culturally adapted interventions to diverse populations, greater attention should be devoted to three underdeveloped topics: (a) local adaptations of interventions when they are implemented in community settings, (b) participant engagement, and (c) the sustainability of adapted interventions. Several typologies have been developed for studying local adaptations, and some research indicates that such adaptations might add to intervention effectiveness. There is suggestive evidence of ethnocultural group disparities in intervention engagement and in the success of efforts to boost engagement. Theory and limited data indicate that interventions' flexibility and fit with organizational culture and resources can be achieved through cultural adaptations. Furthermore, those adaptations should be associated with sustainability, but research has yet to test that hypothesis adequately. Several recommendations are made for advancing culturally adapted interventions through additional research on local adaptations during implementation, the many facets of participant engagement, and sustainability.

Parenting for the promotion of adolescent mental health: a scoping review of programmes targeting ethnoculturally diverse families

A scoping review of the literature on parenting programmes that target the promotion of adolescent mental health was conducted to examine the quality of the studies and unique content of programmes for parents from ethnoculturally diverse communities. PsycINFO and Web of Science were searched in April, 2011 (for all publications prior to that date) and again in August, 2015 (for publications from April, 2011 to August, 2015) using specific keywords and inclusion criteria. A hand search was also conducted. Overall, 107 studies met inclusion criteria for final data extraction and included evaluations of interventions targeted at substance use, early/risky sexual activity and behavioural problems. Eighteen of the 107 studies described programmes targeting parents of adolescents from diverse ethnocultural communities; the quality of these 18 studies was assessed using a marginally modified version of the Downs and Black Checklist (Downs & Black 1998). Their average quality assessment score was 16 out of 28. In addition, two key themes reflected in successful interventions emerged: strengthening parent-adolescent relationship through communication, and importance of community engagement in designing and implementing the intervention. Findings indicate gaps in service delivery to parents of adolescents from ethnoculturally diverse communities; there are a limited number of studies on programmes targeting ethnoculturally diverse parents of adolescents, and the quality of studies that do exist is overall low. Given increasing diversity, more emphasis should be placed on developing and modifying programmes to meet the needs of ethnoculturally diverse communities. More rigorous, standardised efforts should be made to evaluate programmes that do exist.

Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults

PURPOSE

To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation.

METHODS

We conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews.

RESULTS

Compared with no tobacco counseling, the model predicts that annual counseling for youth would reduce the average prevalence of smoking cigarettes during adult years by 2.0 percentage points, whereas annual counseling for adults will reduce prevalence by 3.8 percentage points. Youth counseling would prevent 42,686 smoking-attributable fatalities and increase quality-adjusted life years (QALYs) by 756,601 over the lifetime of the cohort. Adult counseling would prevent 69,901 smoking-attributable fatalities and increase QALYs by 1,044,392. Youth and adult counseling would yield net savings of $225 and $580 per person, respectively. If annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking prevalence would be 5.5 percentage points lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over their lifetimes. Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates.

CONCLUSIONS

Brief tobacco counseling provides substantial health benefits while producing cost savings. Both youth and adult intervention are high-priority uses of limited clinician time.

The Effectiveness of Family Interventions in Preventing Adolescent Illicit Drug Use: A Systematic Review and Meta-analysis of Randomized Controlled Trials

In order to quantify the effectiveness of family interventions in preventing and reducing adolescent illicit drug use, we conducted a systematic review and meta-analysis of randomized controlled trials. We searched the Cochrane Database of Systematic Reviews, Educational Research Information Centre (ERIC), MEDLINE, Embase, and PsycINFO for studies published between 1995 and 2013. Results were described separately for different outcomes (marijuana vs. other illicit drugs) and intervention types (universal, selective, and indicated prevention). Meta-analyses were performed when data were sufficient (e.g., marijuana and other illicit drug initiation in universal samples), using random effect models. Otherwise, we provided narrative reviews (e.g., regarding selective and indicated prevention). Thirty-nine papers describing 22 RCTs were eligible for inclusion. Universal family interventions targeting parent-child dyads are likely to be effective in preventing (OR 0.72; 95 % CI 0.56, 0.94) and reducing adolescent marijuana use, but not in preventing other illicit drugs (OR 0.90; 95 % CI 0.60, 1.34). Among high-risk groups, there is no clear evidence for the effectiveness of family interventions in preventing and reducing illicit drug use and drug disorders. The three small RCTs among substance-(ab)using adolescents gave some indication that programs might reduce the frequency of illicit drug use. Family interventions targeting parent-child dyads are likely to be effective in preventing and reducing adolescent marijuana use in general populations, but no evidence for other illicit drug use was found. We underline the need to strengthen the evidence base with more trials, especially among at-risk populations.

Knowledge Lability: Within-Person Changes in Parental Knowledge and Their Associations with Adolescent Problem Behavior

Higher levels of parental knowledge about youth activities have been associated with lower levels of youth risky behavior. Yet little is known about how parental knowledge fluctuates during early adolescence and how those fluctuations are associated with the development of problem behavior. We use the term lability to describe within-person fluctuations in knowledge over time with higher lability indicating greater fluctuations in knowledge from year-to-year. This longitudinal study of rural adolescents (N = 840) investigated if change in parental knowledge across four waves of data from grades 6 to 8 is characterized by lability, and if greater lability is associated with higher youth substance use, delinquency, and internalizing problems in grade 9. Our models indicated that only some of the variance in parental knowledge was accounted for by developmental trends. The remaining residual variance reflects within-person fluctuations around these trends, lability, and measurement and occasion-specific error. Even controlling for level and developmental trends in knowledge, higher knowledge lability (i.e., more fluctuation) was associated with increased risk for later alcohol and tobacco use, and for girls, higher delinquency and internalizing problems. Our findings suggest that lability in parental knowledge has unique implications for adolescent outcomes. The discussion focuses on mechanisms that may link knowledge lability to substance use. Interventions may be most effective if they teach parents to consistently and predictably decrease knowledge across early adolescence.

Long-term effectiveness of a combined student-parent and a student-only smoking prevention intervention among 7th grade school children in Berlin, Germany

BACKGROUND AND AIMS

In Germany, the smoking prevalence among adolescents is among the highest in Europe. Our aim was to evaluate the long-term effectiveness of a combined student-parent and a student-only smoking prevention programme to reduce the smoking prevalence among 7th grade students in Berlin.

DESIGN

Three-armed cluster-randomized controlled trial (RCT). Schools as cluster units were randomized into (i) student intervention, (ii) combined student-parent intervention or (iii) control group, with follow-up after 12 and 24 months.

SETTING

High schools and integrated secondary schools in Berlin, Germany.

PARTICIPANTS

Seventh grade students aged 11-16 years. We included 47 schools, 161 classes and 2801 students [50.1% girls, mean age ± standard deviation (SD) = 13.0 ± 0.6 years].

MEASUREMENTS

The primary outcome was self-reported regular smoking (at least one cigarette per day) after 24 months (point prevalence). Further self-reported outcomes were other smoking behaviours as well as parental rules and attitudes towards smoking. Comparisons were calculated as odds ratios (OR) with 95% confidence intervals (CI).

FINDINGS

At baseline, 2.3% of the students reported that they smoked regularly. After 24 months, 7.8% and 7.0% were regular smokers in the student-only intervention and the student-parent intervention, respectively, compared with 10.1% in the control group. The OR for being a regular smoker was 0.81 (0.34-1.92) for the student-parent intervention versus control, 0.95 (CI = 0.41-2.22) for the student-only intervention versus control and 0.85 (0.38-1.89) for student-parent intervention versus student-only intervention.

CONCLUSION

A combined student-parent smoking prevention intervention delivered via secondary schools in Berlin, Germany did not result in a statistically significant reduction in regular smoking compared with a control group or a student-only intervention. The student-only intervention did not result in a significant reduction in regular smoking compared with the control group.

Feasibility of Connecting, a Substance-Abuse Prevention Program for Foster Teens and their Caregivers

OBJECTIVE

To test the feasibility, usability, and proximal outcomes of Connecting, an adaptation of a low-cost, self-directed, family-based substance use prevention program, Staying Connected with Your Teen, with foster families in a randomized, waitlist control pilot study.

METHOD

Families (n = 60) fostering teens between 11 and 15 years of age were recruited into the study and randomly assigned into the self-administered program with telephone support from a family consultant (n = 32) or a waitlist control condition (n = 28).

RESULTS

Overall satisfaction with the program was high, with 100% of parents reporting they would recommend the program to other caregivers and reporting being "very satisfied" or "satisfied with the program. Program completion was good, with 62% of families completing all 91 specified tasks. Analyses of proximal outcomes revealed increased communication about sex and substance use (posttest1 OR = 1.97, and 2.03, respectively). Teens in the intervention vs. the waitlist condition reported lower family conflict (OR=.48), and more family rules related to monitoring (OR = 4.02) and media use (OR = 3.24). Caregivers in the waitlist group reported significant increases in the teen's positive involvements (partial eta sq = 17% increase) after receiving the intervention.

CONCLUSIONS

Overall, program participation appeared to lead to stronger family management, better communication between teens and caregivers around monitoring and media use, teen participation in setting family rules, and decreased teen attitudes favorable to antisocial behavior. This small pilot study shows promising results for this adapted program.

Implementation Measurement for Evidence-Based Violence Prevention Programs in Communities

Increasing attention to the evaluation, dissemination, and implementation of evidence-based programs (EBPs) has led to significant advancements in the science of community-based violence prevention. One of the prevailing challenges in moving from science to community involves implementing EBPs and strategies with quality. The CDC-funded National Centers of Excellence in Youth Violence Prevention (YVPCs) partner with communities to implement a comprehensive community-based strategy to prevent violence and to evaluate that strategy for impact on community-wide rates of violence. As part of their implementation approach, YVPCs document implementation of and fidelity to the components of the comprehensive youth violence prevention strategy. We describe the strategies and methods used by the six YVPCs to assess implementation and to use implementation data to inform program improvement efforts. The information presented describes the approach and measurement strategies employed by each center and for each program implemented in the partner communities. YVPCs employ both established and innovative strategies for measurement and tracking of implementation across a broad range of programs, practices, and strategies. The work of the YVPCs highlights the need to use data to understand the relationship between implementation of EBPs and youth violence outcomes.

Effective Parenting Interventions to Reduce Youth Substance Use: A Systematic Review

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.

Family-Based Interventions in Preventing Children and Adolescents from Using Tobacco: A Systematic Review and Meta-Analysis

BACKGROUND

Tobacco is the main preventable cause of death and disease worldwide. Adolescent smoking is increasing in many countries with poorer countries following the earlier experiences of affluent countries. Preventing adolescents from starting smoking is crucial to decreasing tobacco-related illness.

OBJECTIVE

To assess effectiveness of family-based interventions alone and combined with school-based interventions to prevent children and adolescents from initiating tobacco use.

DATA SOURCES

Fourteen bibliographic databases and the Internet, journals hand-searched, and experts consulted.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

Randomized controlled trials (RCTs) with children or adolescents and families, interventions to prevent starting tobacco use, and follow-up ≥6 months.

STUDY APPRAISAL/SYNTHESIS METHODS

Abstracts/titles independently assessed and data independently entered by 2 authors. Risk of bias was assessed with the Cochrane Risk-of-Bias tool.

RESULTS

Twenty-seven RCTs were included. Nine trials of never-smokers compared with a control provided data for meta-analysis. Family intervention trials had significantly fewer students who started smoking. Meta-analysis of 2 RCTs of combined family and school interventions compared with school only, showed additional significant benefit. The common feature of effective high-intensity interventions was encouraging authoritative parenting.

LIMITATIONS

Only 14 RCTs provided data for meta-analysis (approximately a third of participants). Of the 13 RCTs that did not provide data for meta-analysis 8 compared a family intervention with no intervention and 1 reported significant effects, and 5 compared a family combined with school intervention with a school intervention only and none reported additional significant effects.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

There is moderate-quality evidence that family-based interventions prevent children and adolescents from starting to smoke.

Evidence-Based Prevention for Adolescent Substance Use

Due to the significant consequences of adolescent substance use behaviors, researchers have increasingly focused on prevention approaches. The field of prevention science is based on the identification of predictors of problem behaviors, and the development and testing of prevention programs that seek to change these predictors. As the field of prevention science moves forward, there are many opportunities for growth, including the integration of prevention programs into service systems and primary care, an expansion of program adaptations to fit the needs of local populations, and a greater emphasis on the development of programs targeted at young adult populations.

A component-centered meta-analysis of family-based prevention programs for adolescent substance use

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.

Reciprocal relations between coalition functioning and the provision of implementation support

Community coalitions have been promoted as a strategy to help overcome challenges to the dissemination and implementation of evidence-based prevention programs. This paper explores the characteristics of coalitions that enable the provision of implementation support for prevention programs in general and for the implementation of evidence-based prevention programs with fidelity. Longitudinal cross-lagged panel models were used to study 74 Communities That Care (CTC) coalitions in Pennsylvania. These analyses provide evidence of a unidirectional influence of coalition functioning on the provision of implementation support. Coalition member knowledge of the CTC model best predicted the coalition's provision of support for evidence-based program implementation with fidelity. Implications for developing and testing innovative methods for delivering training and technical assistance to enhance coalition member knowledge are discussed.

A pilot study of what African American maternal caregivers and their adolescent daughters talk about when asked to discuss tobacco together

Parents play a critical role in shaping their children's substance use behaviors, yet few studies have examined the messages that caregivers give their adolescents about tobacco. In this study, we identify tobacco-related messages discussed by African American maternal caregivers and their adolescent daughters. Twenty-five African American maternal caregivers and their adolescent daughters participated in a video-taped discussion about tobacco. Discussions were transcribed and coded thematically. Seven themes emerged, which were grouped into tobacco-messages and communication strategies. Messages included health risks, non-health-related reasons to stop smoking, reasons people smoke, and tobacco products and marijuana. Strategies caregivers used to communicate their tobacco-related messages included sharing personal or their families' experience with smoking, using humor, and role-playing. Finally, embedded within all of the themes, participants expressed their disapproval of tobacco use, whether it was directed at their own use, their adolescents' use, a family members' use, or peers' use. African American maternal caregivers and their daughters openly talk about a variety of tobacco-related topics, and caregivers are open to sharing their own and their families' experience with substance use. Findings also suggest that having caregivers and their adolescents participate in discussions tasks could be potentially beneficial in facilitating discussions and could identify areas in which caregivers could use help in discussing sensitive topics.

Programs to Strengthen Parent-Adolescent Communication About Reproductive Health: A Systematic Review

CONTEXT

When caring for an adolescent client, providers of contraceptive services must consider whether and how to encourage parent/guardian-child communication about the adolescent's reproductive health. The objective of this systematic review was to summarize the evidence on the effectiveness of programs designed to increase parent-child communication about reproductive health. The review was used to inform national recommendations on quality family planning services. Data analysis occurred from mid-2011 through 2012.

EVIDENCE ACQUISITION

Several electronic bibliographic databases were used to identify relevant articles, including PubMed, CINAHL, PsycINFO, and Popline, published from January 1985 through February 2011.

EVIDENCE SYNTHESIS

Sixteen articles met the inclusion criteria: all studies examined the impact on at least one medium- or short-term outcome, and two studies assessed the impact on teen pregnancy. One study examined the impact of a program conducted in a clinic setting; the remainder examined the impact of programs in community settings. All studies showed a positive impact on at least one short-term outcome, and 12 of 16 studies showed an increase in parent-child communication about reproductive health. Four of seven studies found an impact on sexual risk behavior.

CONCLUSIONS

Most programs increased parent-child communication, and several resulted in reduced sexual risk behavior of adolescents. This suggests that delivering a clinic-based program that effectively helps parents/guardians talk to their adolescent child(ren) about reproductive health, or referring parents/guardians to an evidence-based program in the community, may be beneficial. However, further rigorous research on delivery of these programs in clinical settings is needed.

The process of adapting a universal dating abuse prevention program to adolescents exposed to domestic violence

Adolescents exposed to domestic violence are at increased risk of dating abuse, yet no evaluated dating abuse prevention programs have been designed specifically for this high-risk population. This article describes the process of adapting Families for Safe Dates (FSD), an evidenced-based universal dating abuse prevention program, to this high-risk population, including conducting 12 focus groups and 107 interviews with the target audience. FSD includes six booklets of dating abuse prevention information, and activities for parents and adolescents to do together at home. We adapted FSD for mothers who were victims of domestic violence, but who no longer lived with the abuser, to do with their adolescents who had been exposed to the violence. Through the adaptation process, we learned that families liked the program structure and valued being offered the program and that some of our initial assumptions about this population were incorrect. We identified practices and beliefs of mother victims and attributes of these adolescents that might increase their risk of dating abuse that we had not previously considered. In addition, we learned that some of the content of the original program generated negative family interactions for some. The findings demonstrate the utility of using a careful process to adapt evidence-based interventions (EBIs) to cultural sub-groups, particularly the importance of obtaining feedback on the program from the target audience. Others can follow this process to adapt EBIs to groups other than the ones for which the original EBI was designed.

Exploring heavy drinking patterns among black and white young adults

ABSTRACT.

OBJECTIVE

This investigation examined patterns of heavy drinking among Black and White young adults from a person-centered perspective and linked family and individual factors in adolescence to young adult drinking patterns.

METHOD

The analysis focuses on 331 10th-grade students (168 Whites, 163 Blacks; 51% males) who were followed into young adulthood (ages 20 and 22). Cluster analyses using heavy episodic drinking, drunkenness, and alcohol problems in young adulthood resulted in groups of drinkers with different patterns. Groups were examined across and within race. Associations between young adult drinking groups and adolescent family and individual factors were tested.

RESULTS

Groups followed well-established race differences, with Whites clustering into frequent drinking groups more than Blacks, and Blacks clustering into non-heavy drinking groups more than Whites. Further, Black heavy drinkers reported fewer alcohol problems than White counterparts. Parental monitoring, consistent discipline, ethnic identity, and delinquency were associated with adult heavy episodic drinking groups for both races. Monitoring and delinquency, along with parental norms, were associated with drunkenness groups for both races. However, race differences were observed for drunkenness clusters such that attachment was predictive for White clusters, and parental guidelines and discipline were predictive for Black clusters.

CONCLUSIONS

Large race differences in heavy drinking at young adulthood were confirmed. Family dynamics in 10th grade were identified as important for the development of different drinking patterns in the early 20s, when many individuals have left home, which suggests a key target for substance use prevention programs. (J. Stud. Alcohol Drugs, 75, 839-849, 2014).

The effectiveness of telephone counselling in the treatment of illicit drug and alcohol use concerns

INTRODUCTION

Technology-assisted substance use interventions such as 'high-tech' internet-based treatments are thought to be effective; however, the relatively 'low-tech' use of telephone counselling does not yet have an established evidence base. This paper reviews the literature including articles with information on the use of telephone counselling for the treatment of illicit drug or alcohol use.

METHODS

A systematic literature search using a set of telephone counselling and substance-related terms was conducted across four electronic databases. English studies prior to June 2014 that involved the use of telephone counselling with the treatment of illicit drug or alcohol use as a primary or secondary outcome were included. Review papers, opinion pieces, letters or editorials, case studies, published abstracts, and posters were excluded. In all, 94 publications were included in the review.

RESULTS AND DISCUSSION

The literature was supportive of telephone counselling for the treatment of alcohol use in the short term; however, literature regarding illicit drug use was particularly scarce. The generalisability of findings was limited by evident methodological issues in the included studies.

Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence

BACKGROUND

US adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health.

MATERIALS AND METHODS

This review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants - sexual activity, number of sexual partners, condom use, and other contraceptive use - among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent-youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use.

RESULTS

Our review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent-youth relationship programs and clinic-based program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use).

CONCLUSION

Future efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use.