The Ultimate Goal of Prevention and the Larger Context for Translation

Advancing Evidence-Based Public Health Policy: How Core Component Thinking Can Illuminate the Multilevel Nature of Public Health Policy

A growing body of literature uses the concept of core components to better understand small-scale programmatic interventions. Instead of interventions being viewed as unitary "black boxes," interventions are viewed as configurations of core components, which are the parts of interventions that carry their causal potential and therefore need to be reproduced with fidelity to produce the intended effect. To date, the concept of core components has not been as widely applied to public health policy interventions as it has to programmatic interventions. The purpose of this topical review is to familiarize public health practitioners and policy makers with the concept of core components as applied to public health policy interventions. Raising the profile of core component thinking can foster mindful adaptation and implementation of public health policy interventions while encouraging further research to enhance the supporting evidence base. We present 3 types of multilevel interactions in which the core components of a public health policy intervention produce effects at the population level by (1) seeking to directly affect individual behavior, (2) facilitating adoption of programmatic interventions by intermediaries, and (3) encouraging intermediaries to take action that can shape changes in upstream drivers of population health. Changing the unit of analysis from whole policies to core components can provide a basis for understanding how policies work and for facilitating novel evidence-generating strategies and rapid evidence reviews that can inform future adaptation efforts.

Co-Regulation as a Support for Older Youth in the Context of Foster Care: a Scoping Review of the Literature

Co-regulation is a relatively new theoretical framework for interventions that connects developmental science to adolescent needs and provides strategies that can be applied across contexts. It also has value in shifting the focus of interventions to the role of relationships and interactions with caring adults, as well as supportive environments. This framework may be particularly salient for older youth with foster care experience whose relationships with adults and availability of developmental supports are disrupted. To understand how co-regulation aligns with current understanding of needs and supports for this population, we conducted a scoping review that involved systematically searching four databases, coding and charting relevant information, and actively engaging expert consultants and other stakeholders. Across 46 primarily descriptive articles, co-regulation was discussed most often in relation to relationships, as expected (89% of articles). Despite theoretical and empirical evidence of the benefits of supportive environments and intentional day-to-day interactions in promoting developmental skills and competencies, these two domains of co-regulation were referenced much less (39% and 28%, respectively). Results highlight opportunities for co-regulation supports that can be provided to older youth with foster care experience by caring adults and near-aged peers in a wide range of roles. Notable limitations in the literature were identified in applying co-regulation within the context of employment and career readiness, healthy relationships, and teen parenting. Also under-researched is the role of adult self-regulation skills and co-regulation approaches for youth from diverse backgrounds, including those who identify as LGBTQ or have disabilities. Considerations for practice and future research are provided.

Why We Are Not Acting to Save Ourselves: ACT, Health, and Culture

Chronic health conditions are increasing at an alarming rate worldwide, and many could be prevented if people were to engage in specific lifestyle behaviors. Intervening on lifestyle behaviors is challenging due to the fact that the consequences associated with unhealthy behaviors are temporally distant and probabilistic, and the aversive functions of covert stimuli may interfere with people's engagement in healthy, preventative behaviors. This article explores the role of relational framing in the promotion of healthy lifestyle behaviors and summarizes research supporting the use of acceptance and commitment training (ACT) as a framework for prevention and intervention. We explore how ACT alters the context in which rigid patterns of rule following occur. ACT loosens the literal functions of stimuli so that experiential-avoidance behaviors are weakened, and healthy, values-consistent behaviors are strengthened. We propose culture-wide interventions inspired by contextual behavior science so that healthier societies can be cultivated.

Progress Toward a Multisectoral Community Intervention Approach to Prevention of the Word Gap

Children learn language through the interactions they have with their parents/caregivers beginning at birth. Hart and Risley (1995) discovered an inequity in the home language input children received from parents/caregivers. Children reared in low-income families received less input (conversations, turns) from parents than did children reared in more advantaged families. Less language input was linked to a disparity in children's vocabulary learning by age 3. The long-term result of this social determinant of early language/literacy learning is a life trajectory of poor educational, economic, and health attainment for many children in families with limited resources, at vast cost to individuals, communities, and the nation. What is needed is an approach to word-gap prevention that is capable of achieving positive individual, community, and population outcomes. Translating research into practice, we developed the Bridging the Word Gap Community Action Planning Guide (BWG-CAPG) using a combined behavior-analytic, community psychology, and public health framework for this purpose (Greenwood et al., 2017). We also developed a progress-monitoring measure, the online BWG Community Check Box Evaluation System, to provide feedback on a community's actions and progress in implementing their plan. Results from an initial pilot investigation within and across three community sectors in a large urban city were promising. BWG Community Check Box results indicated a number of desired outcomes: (a) capacity development and mobilization, (b) community implementation actions, and (c) community changes in practices, programs, and policies. Implications are discussed.

Developmental Prevention of Prejudice: Conceptual Issues, Evidence-Based Designing, and Outcome Results

This article reviews conceptual and empirical issues on the developmental prevention of prejudice in childhood and adolescence. Developmental prejudice prevention is defined as interventions that intentionally change and promote intergroup attitudes and behavior by systematically recognizing theories and empirical results on the development of prejudice in young people. After presenting a general conception of designing evidence-based interventions, we will discuss the application of this model in the field of developmental prejudice prevention. This includes the legitimation, a developmental concept of change, and the derivation of intervention content and implementation. Finally, we summarized recent evaluations results by reviewing meta-analytical evidence of programs and discuss important issues of future research and practice.

Buffering negative effects of immigration on cognitive, social, and educational development: A multinational meta-analysis of child and adolescent prevention programmes

Growing up in migrant families is a well-known distal risk factor related to poorer outcomes in child and adolescent health, academic, socioemotional and behavioural development. This article reviews the effects of various prevention measures such as early education programmes, cognitive and language training or parent and teacher training on child and adolescent developmental outcomes in immigration samples. Using several comprehensive literature searches, we found 138 research reports with 141 studies and 175 comparisons on preventing negative effects of immigration. Overall, programmes yielded an effect size of d = 0.26 at post-test using the random effect model. These effects decreased over time while still differing significantly from zero. A cross-tabulation of prevention approach/programme type by different outcome domains revealed several important results such as high effects of child cognitive and language training programmes on child academic and language outcomes and relatively low effects of all programmes on child socioemotional outcomes. In addition, individualised and culturally tailored programmes seems to be more effective. However, generalised effects on more distal educational outcomes (e.g., school degrees) were generally weak. Hence, it remains questionable whether individual psychosocial and educational programmes are able to counterbalance the multifaceted risks of immigration.

Come On Up for the Rising: A Review of Biglan's Rebooting Capitalism

In Rebooting Capitalism: How We Can Forge a Society that Works for Everyone, Anthony Biglan (2020) explains that a free-market and capitalist narrative, sculpted by a coalition of the extremely wealthy, has led to a commonly held myth that the pursuit of individual wealth will improve the overall well-being of the populous. Instead, our current economic system and public policies have resulted in cultural practices that increase wealth inequality, incite racial tensions, and destroy the natural world. The book functions as a call to arms for behavior analysts to join a coalition of interdisciplinary professionals with a like-minded mission of creating a nurturing form of capitalism, grounded in behavior science, that improves the quality of life for all people.

Changing course: supporting a shift to environmental strategies in a state prevention system

Background

This study examines how the North Carolina state prevention system responded to a policy shift from individual-level prevention strategies to environmental strategies from the perspective of the organizations implementing the policy shift.

Methods

We use two data sources. First, we conducted interviews to collect qualitative data from key informants. Second, we used prevention provider agency expenditure data from the year the shift was announced and the following year.

Results

The interviews allowed us to identify effective features of policy change implementation in complex systems, such as the need for clear communication and guidance about the policy changes. Our interview and expenditure analyses also underscore variation in the level of guidance and oversight provided by implementing agencies to prevention providers.

Conclusions

Our analyses suggest that more active monitoring and oversight may have facilitated more consistent implementation of the policy shift toward greater use of environmental prevention strategies.

Long-term Associations Between Substance Use-Related Media Exposure, Descriptive Norms, and Alcohol Use from Adolescence to Young Adulthood

Adolescents and young adults in the United States are constantly exposed to substance-related media and advertising content. The current study seeks to explore, developmentally, how exposure to substance-related media content influences both normative beliefs about peer alcohol use and individual alcohol use. Youth (N = 4'840; 50.6% female) were followed for ten years from age 12 to 22. Auto-regressive latent trajectory with structured residual (ALT-SR) models were used to explore within-person reciprocal associations between substance-related media content, descriptive norms, and alcohol use. Results indicated that' across adolescence and young adulthood, exposure to substance-related media content was associated with increased alcohol use via perceived alcohol norms. The pathway from media exposure to alcohol use was mediated by increased perceived norms for adolescents only. With screen time increasing over the last decade, it is important to invest resources into real-time interventions that address substance-related social media content as it relates to misperceived norms and to begin these interventions in early adolescence.

A Typology of Interactional Patterns Between Youth and Their Stepfathers: Associations with Family Relationship Quality and Youth Well-Being

Stepfamilies are an increasingly common family form, many of which are headed by a resident mother and stepfather. Stepfather-child relationships exert notable influence on stepfamily stability and individual well-being. Although various stepfather roles have been observed, more research is warranted by which stepfather-child interactions are explored holistically and across a variety of life domains (e.g., recreational, personal, academic, and disciplinary). Thus, the primary purpose of the current study is to explore varying interactional patterns between youth and their stepfathers. A latent class analysis is conducted using a representative sample of 1,183 youth (53% female; mean age = 15.64 years, SD = 1.70 years; 62% non-Hispanic White) residing in mother-stepfather families from Wave I of the National Longitudinal Study of Adolescent to Adult Health. Latent-class enumeration processes support a four-class solution, with latent classes representing inactive, academically oriented, casually connected, and versatile and involved patterns of youth-stepparent interaction. Notable differences and similarities are evident across patterns with respect to family relationship quality, youth well-being, and socio-demographic characteristics. Differences are most stark between the inactive and versatile and involved patterns. Ultimately, the results showcase notable variation in youth-stepparent interactional patterns, and one size does not necessarily fit all stepfamilies. Family practitioners should be mindful of variation in youth-stepparent interactional patterns and assist stepfamilies in seeking out stepparent-child dynamics that are most compatible with the needs and dynamics of the larger family system.

Innovation and Integrity: Desiderata and Future Directions for Prevention and Intervention Science

This article summarizes essential implications of the papers within this special issue and discusses directions for future prevention and intervention research on conceptual issues, methodological and transfer-related challenges and opportunities. We identify a need to move from programs to principles in intervention research and encourage the implementation of research on potential mechanisms underlying intervention effectiveness. In addition, current methodological issues in intervention research are highlighted, including advancements in methodology and statistical procedures, extended outcome assessments, replication studies, and a thorough examination of potential biases. We further discuss transfer-related issues, for example the need for more research on the flexibility and adaptability of programs and intervention approaches as well as more general problems in knowledge translation reasoning the need for enhanced communication between practitioners, policy makers, and researchers. Finally, we briefly touch on the need to discuss the relation between single intervention programs, the mental health system, and changes of contextual conditions at the macro level.

Innovation and Integrity in Intervention Research: Conceptual Issues, Methodology, and Knowledge Translation

In this article, we introduce the special issue entitled Innovation and Integrity in Intervention Science. Its focus is on essential problems and prospects for intervention research examining two related topics, i.e., methodological issues and research integrity, and challenges in the transfer of research knowledge into practice and policy. The main aims are to identify how to advance methodology in order to improve research quality, examine scientific integrity in the field of intervention science, and discuss future steps to enhance the transfer of knowledge about evidence-based intervention principles into sustained practice, routine activities, and policy decisions. Themes of the special issue are twofold. The first includes questions about research methodology in intervention science, both in terms of research design and methods, as well as data analyses and the reporting of findings. Second, the issue tackles questions surrounding the types of knowledge translation frameworks that might be beneficial to mobilize the transfer of research-based knowledge into practice and public policies. The issue argues that innovations in methodology and thoughtful approaches to knowledge translation can enable transparency, quality, and sustainability of intervention research.

Translating Prevention Research for Evidence-Based Policymaking: Results from the Research-to-Policy Collaboration Pilot

The importance of basing public policy on sound scientific evidence is increasingly being recognized, yet many barriers continue to slow the translation of prevention research into legislative action. This work reports on the feasibility of a model for overcoming these barriers-known as the Research-to-Policy Collaboration (RPC). The RPC employs strategic legislative needs assessments and a rapid response researcher network to accelerate the translation of research findings into usable knowledge for policymakers. Evaluation findings revealed that this model can successfully mobilize prevention scientists, engage legislative offices, connect policymakers and experts in prevention, and elicit congressional requests for evidence on effective prevention strategies. On average, the RPC model costs $3510 to implement per legislative office. The RPC can elicit requests for evidence at an average cost of $444 per request. The implications of this work, opportunities for optimizing project elements, and plans for future work are discussed. Ultimately, this project signals that the use of scientific knowledge of prevention in policymaking can be greatly augmented through strategic investment in translational efforts.

Prevention of eating disorders: 2018 in review

This article reviews the 10 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2018. Two models frame this analysis. This first is the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment (recovery). The second parses the phases of prevention into rationale, theory, and methodology → clarification of risk factors, including very high risk, shading into warning signs → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. Collectively, the articles illustrate how complex and demanding the field of prevention is, with respect to, for example, phases of program development, the multidimensional ecology of interventions, and methodological requirements for demonstrating that a program deserves to be designated "evidence-based." A subset of the articles also illustrates how far the increasingly broad and dynamic field of prevention has advanced. Examples include models of eating disorder development in high-risk populations such as people with type 1 diabetes; prevention programming for young children; and after-school preventive interventions that combine dissonance-based lessons with empowering participation in community advocacy and activism.

Standards of Evidence for Conducting and Reporting Economic Evaluations in Prevention Science

Over a decade ago, the Society for Prevention Research endorsed the first standards of evidence for research in preventive interventions. The growing recognition of the need to use limited resources to make sound investments in prevention led the Board of Directors to charge a new task force to set standards for research in analysis of the economic impact of preventive interventions. This article reports the findings of this group's deliberations, proposes standards for economic analyses, and identifies opportunities for future prevention science. Through examples, policymakers' need and use of economic analysis are described. Standards are proposed for framing economic analysis, estimating costs of prevention programs, estimating benefits of prevention programs, implementing summary metrics, handling uncertainty in estimates, and reporting findings. Topics for research in economic analysis are identified. The SPR Board of Directors endorses the "Standards of Evidence for Conducting and Reporting Economic Evaluations in Prevention Science."

Family Economic Security Policies and Child and Family Health

In this review, we examine the effects of family economic security policies (i.e., minimum wage, earned income tax credit, unemployment insurance, Temporary Assistance to Needy Families) on child and family health outcomes, summarize policy generosity across states in the USA, and discuss directions and possibilities for future research. This manuscript is an update to a review article that was published in 2014. Millions of Americans are affected by family economic security policies each year, many of whom are the most vulnerable in society. There is increasing evidence that these policies impact health outcomes and behaviors of adults and children. Further, research indicates that, overall, policies which are more restrictive are associated with poorer health behaviors and outcomes; however, the strength of the evidence differs across each of the four policies. There is significant diversity in state-level policies, and it is plausible that these policy variations are contributing to health disparities across and within states. Despite increasing evidence of the relationship between economic policies and health, there continues to be limited attention to this issue. State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child well-being. The mounting evidence will help to guide future research and policy making for evolving toward a more nurturing society for family and child health and well-being.

Toward Creating Synergy Among Policy, Procedures, and Implementation of Evidence-Based Models in Child Welfare Systems: Two Case Examples

Over the past four to five decades, multiple randomized controlled trials have verified that preventive interventions targeting key parenting skills can have far-reaching effects on improving a diverse array of child outcomes. Further, these studies have shown that parenting skills can be taught, and they are malleable. Given these advances, prevention scientists are in a position to make solid empirically based recommendations to public child service systems on using parent-mediated interventions to optimize positive outcomes for the children and families that they serve. Child welfare systems serve some of this country's most vulnerable children and families, yet they have been slow (compared to juvenile justice and mental health systems) to adopt empirically based interventions. This paper describes two child-welfare-initiated, policy-based case studies that have sought to scale-up research-based parenting skills into the routine services that caseworkers deliver to the families that they serve. In both case studies, the child welfare system leaders worked with evaluators and model developers to tailor policy, administrative, and fiscal system practices to institutionalize and sustain evidence-based practices into usual foster care services. Descriptions of the implementations, intervention models, and preliminary results are described.

Social Interface Model: Theorizing Ecological Post-Delivery Processes for Intervention Effects

Successful prevention programs depend on a complex interplay among aspects of the intervention, the participant, the specific intervention setting, and the broader set of contexts with which a participant interacts. There is a need to theorize what happens as participants bring intervention ideas and behaviors into other life-contexts, and theory has not yet specified how social interactions about interventions may influence outcomes. To address this gap, we use an ecological perspective to develop the social interface model. This paper presents the key components of the model and its potential to aid the design and implementation of prevention interventions. The model is predicated on the idea that intervention message effectiveness depends not only on message aspects but also on the participants' adoption and adaptation of the message vis-à-vis their social ecology. The model depicts processes by which intervention messages are received and enacted by participants through social processes occurring within and between relevant microsystems. Mesosystem interfaces (negligible interface, transference, co-dependence, and interdependence) can facilitate or detract from intervention effects. The social interface model advances prevention science by theorizing that practitioners can create better quality interventions by planning for what occurs after interventions are delivered.

Snacking Quality Is Associated with Secondary School Academic Achievement and the Intention to Enroll in Higher Education: A Cross-Sectional Study in Adolescents from Santiago, Chile

Although numerous studies have approached the effects of exposure to a Western diet (WD) on academic outcomes, very few have focused on foods consumed during snack times. We explored whether there is a link between nutritious snacking habits and academic achievement in high school (HS) students from Santiago, Chile. We conducted a cross-sectional study with 678 adolescents. The nutritional quality of snacks consumed by 16-year-old was assessed using a validated food frequency questionnaire. The academic outcomes measured were HS grade point average (GPA), the likelihood of HS completion, and the likelihood of taking college entrance exams. A multivariate analysis was performed to determine the independent associations of nutritious snacking with having completed HS and having taken college entrance exams. An analysis of covariance (ANCOVA) estimated the differences in GPA by the quality of snacks. Compared to students with healthy in-home snacking behaviors, adolescents having unhealthy in-home snacks had significantly lower GPAs (M difference: -40.1 points, 95% confidence interval (CI): -59.2, -16.9, d = 0.41), significantly lower odds of HS completion (adjusted odds ratio (aOR): 0.47; 95% CI: 0.25-0.88), and significantly lower odds of taking college entrance exams (aOR: 0.53; 95% CI: 0.31-0.88). Unhealthy at-school snacking showed similar associations with the outcome variables. Poor nutritional quality snacking at school and at home was associated with poor secondary school academic achievement and the intention to enroll in higher education.

A Framework for Valuing Investments in a Nurturing Society: Opportunities for Prevention Research

Investing in strategies that aim to build a more nurturing society offers tremendous opportunities for the field of prevention science. Yet, scientists struggle to consistently take their research beyond effectiveness evaluations and actually value the impact of preventive strategies. Ultimately, it is clear that convincing policymakers to make meaningful investments in children and youth will require estimates of the fiscal impact of such strategies across public service systems. The framework offered here values such investments. First, we review current public spending on children and families. Then, we describe how to quantify and monetize the impact of preventive interventions. This includes a new measurement strategy for assessing multisystem service utilization and a price list for key service provision from public education, social services, criminal justice, health care and tax systems.