School-based programmes to reduce and prevent substance use in different age groups: What works for whom? Systematic review and meta-regression analysis

Evaluation of iSTART: A Novel Substance Use Prevention Web-App Designed for Diverse College Students

There is little research assessing substance use prevention programs designed for first generation, working, and ethnic minority college students. This study assessed the effectiveness of a multi-substance web-app prevention program implemented at a Hispanic Serving Institution in southern California. Participants (N = 1066) were randomly assigned to either a control, comparison, or 5 module web-app condition. Surveys assessing substance specific knowledge, perceived health risks, normative peer use, and past 30-day alcohol, cannabis, nicotine, and illicit drug use were administered at baseline, exit, and 90-day follow-up. At exit and 90-day follow up, students assigned to the web-app had significantly greater gains in substance specific knowledge, more accurate perceptions of campus peers' substance use, and the health risks associated with substance use than comparison or control group students. Moreover, web-app students had lower incidence rates of alcohol, cannabis, nicotine, and illicit drug use at exit with effects evident at 90-day follow up for alcohol, cannabis, and illicit drug use but not nicotine use. Given young adults preference for web-based technology, our findings underscore the benefits of developing, adopting, and implementing culturally sensitive substance use prevention programming using mHealth technology among diverse college populations.

Interventions for Prevention of Tobacco Smoking in School-Aged Children and Adolescents: A Systematic Review and Meta-Analysis

Smoking is a major worldwide health concern and a leading cause of preventable diseases such as cancer and heart disease. Adolescence, marked by experimentation and risk-taking behaviors, is a critical developmental stage where tobacco smoking frequently begins. Early smoking is associated with an increased risk of health problems, reduced life expectancy, and lifetime addiction, making prevention during this stage imperative. Despite its urgency, evidence on effective non-pharmacological preventative techniques for this demographic remains limited. This systematic review and meta-analysis aimed to assess the components, efficacy, and potential negative consequences of behavior-based, non-pharmacological interventions. A systematic search of PubMed and the Cochrane Library was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria for randomized controlled trials (RCTs) published between 2014 and 2024. Eligible studies included school-aged children and evaluated smoking initiation or cessation as outcomes. Data from six RCTs involving 10,192 participants were analyzed using Review Manager (RevMan v5.4, The Cochrane Collaboration, Oxford, UK). Risk ratios (RR) with 95% confidence intervals (CI) and I² statistics were calculated to evaluate heterogeneity and intervention efficacy. Results showed that school-based educational programs significantly reduced smoking initiation rates at six months (RR = 0.38, 95% CI: 0.23-0.61, p < 0.001), though effects diminished at longer follow-up periods (12-36 months). Culturally tailored, peer-led interventions demonstrated moderate efficacy in improving attitudes toward smoking and reducing consumption. Combined interventions were the most effective overall, but variability in study design and follow-up durations limited generalizability. This research highlights the short-term effectiveness of school-based and culturally sensitive interventions in reducing adolescent tobacco use. Future research should prioritize long-term strategies that integrate digital tools, family, and community involvement to sustain behavioral changes and combat the global tobacco epidemic effectively.

Public Health Interventions Targeting the Prevention of Adolescent Vaping: A Scoping Review

OBJECTIVE

Despite a brief decline during the COVID-19 pandemic, vaping behaviors among adolescents continue to be an international public health concern because of associated health risks and harms. A thorough investigation of existing interventions preventing adolescent vaping is needed to help address this public health crisis and reduce serious and avoidable vaping-related health risks. We reviewed the literature to identify public health interventions aimed at preventing adolescent vaping and summarized their key components and outcome measures.

DESIGN

We conducted a scoping review of the literature using the Joanna Briggs Institute methodology searching in MEDLINE, CINAHL, Embase, PubMed, PsycINFO, ProQuest, and Web of Science. Two reviewers screened 589 records for relevance. Studies from any location, reported in English, and described vaping prevention interventions targeting adolescents were included. Records were excluded if they were reported in other languages, published outside the review timeframe, lacked an evaluation, focused on cessation-based interventions, or were review articles. Data extracted included intervention type, key components, and outcome measures.

RESULTS

Thirty-eight included articles were identified and categorized into three intervention categories: school-based, public education/risk communication campaigns, and public policies/government regulations. Key components of the interventions included format, duration, and topics. Formats varied from single to multi-sessions. Prominent topics covered included risks and harms associated with vaping, and the most frequently reported outcome measures used were knowledge, attitudes, and beliefs.

CONCLUSION

Our findings summarize existing public health interventions found in the literature and insights into approaches used to address the global adolescent vaping crisis.

Do school-based prevention programs impact co-occurring alcohol use and psychological distress during adolescence?

BACKGROUND

Adolescence is a critical period for preventing substance use and mental health concerns, often targeted through separate school-based programs. However, co-occurrence is common and is related to worse outcomes. This study explores prevention effects of leading school-based prevention programs on co-occurring alcohol use and psychological distress.

METHODS

Data from two Australian cluster randomized trials involving 8576 students in 97 schools were harmonized for analysis. Students received either health education (control) or one of five prevention programs (e.g. Climate Schools, PreVenture) with assessments at baseline and 6, 12, 24, and 30 or 36 months (from ages ~13-16). Multilevel multinomial regressions were used to predict the relative risk ratios (RRs) of students reporting co-occurring early alcohol use and psychological distress, alcohol use only, distress only, or neither (reference) across programs.

RESULTS

The combined Climate Schools: Alcohol and Cannabis and Climate Schools: Mental Health courses (CSC) as well as the PreVenture program reduced the risk of adolescents reporting co-occurring alcohol use and psychological distress (36 months RRCSC = 0.37; RRPreVenture = 0.22). Other evaluated programs (excluding Climate Schools: Mental Health) only appeared effective for reducing the risk of alcohol use that occurred without distress.

CONCLUSIONS

Evidence-based programs exist that reduce the risk of early alcohol use with and without co-occurring psychological distress, though preventing psychological distress alone requires further exploration. Prevention programs appear to have different effects depending on whether alcohol use and distress present on their own or together, thus suggesting the need for tailored prevention strategies.

Development of an eHealth Intervention Prototype to Prevent Health Risk Behaviors Among Hispanic Adolescents: A User-Centered Formative Study

Health risk behaviors continue to disproportionately affect Hispanic youth. Despite the existence of successful family and school-based interventions, there is a need for developing and testing individually-based preventive interventions that are easily accessed and widely disseminated. Therefore, this study aimed to develop a prototype (proof of concept) for an individual-level mobile application (app), informed by Hispanic parents and adolescents, to prevent/reduce drug use and sexual risk behaviors among Hispanic youth. An iterative user-centered approach was used to inform the development of the app prototype via focus groups with 66 participants (n = 46 adolescents, n = 20 parents). A coding team analyzed data from the focus groups and identified major themes. The coding team summarized interview data into sub-categories that yielded five intervention modules for Hispanic adolescents, three more than originally proposed (i.e., drug use and sexual risk behaviors): (1) effective communication, (2) depression, (3) sexual health, (4) drug use, and (5) mindfulness. A mobile application for health risk behaviors can be used as an additional preventive tool to decrease the existing behavioral health disparities among Hispanic youth. Incorporating a user-centered approach to inform development is important for including the needs and voices of this population.

Intersection of adverse childhood experiences, suicide and overdose prevention

Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.

[School-based cannabis prevention: Results of a cluster-randomised trial]

Acluster-randomised trial was conducted in five German federal states to evaluate the results of a school-based cannabis prevention unit. A total of 55 schools were randomly assigned to the intervention group, i.e. participation in a two-hour cannabis prevention workshop conducted by drug prevention specialists in grades 8 and 9, or to a control group with a waiting list. The knowledge, attitudes, intentions and behaviour of the young people in relation to cannabis were measured at the start of the study and six months later. 2,669 pupils(50.8% girls, average age=14.12 years) made up the sample. Effects of the intervention on the students' knowledge (adjusted regression coefficient=0.26 [0.15-0.38], p<0.001) and on the expected negative consequences of cannabis use in adolescents (adjusted regression coefficient=0.15 [0.04-0.25], p=0.006) were found. Both increased significantly more in the intervention group compared to the control group. There were no effects on other attitude-related variables, intentions or behaviour. A very short school-based workshop for grade 8 and 9 students improved their knowledge of and critical attitudes towards cannabis use, but had no effect on their future intentions and cannabis use.

[Cannabis use in teenage years: Results of the prevention radar from 2016 to 2023]

Trends des Cannabiskonsums in der Adoleszenz sollen von 2016 bis 2023 abgebildet werden. Basierend auf sieben Wellen des Präventionsradars, einer schulbasierten epidemiologischen Studie in der Sekundarstufe I, wurden die Lebenszeit- und Monatsprävalenzen des Cannabiskonsums von 12-bis 17-Jährigen für den Zeitraum von 2016 bis 2023 ermittelt. Der Auswertung lagen 54.242 Fragebögen mit Angaben zum Konsum von Cannabis zugrunde. Das Geschlechterverhältnis war ausgeglichen (50% weiblich). Das durchschnittliche Alter betrug 13,9 Jahre (SD=1,3). Von 2016 bis zum Ausbruch der COVID-19-Pandemie stieg die Lebenszeitprävalenz des Cannabiskonsums statistisch bedeutsam an, im ersten Jahr der Pandemie sank sie signifikant. Post-pandemisch hatten 12,3% (95 % KI: 11,6-13,1) der Heranwachsenden mindestens einmal in ihrem Leben Cannabis konsumiert. Dieser Wert liegt auf dem Niveau von 2016. Die Monatsprävalenz des Cannabiskonsums lag 2022/2023 bei 3,8% (95% KI: 3,4-4,3). Sowohl die Lebenszeit- als auch die Monatsprävalenz des Cannabiskonsums von Jungen liegen signifikant über den Werten der Mädchen. Angesichts der bekannten Risiken, die mit dem Cannabiskonsum im Jugendalter einhergehen können, ist es besorgniserregend, dass 2022/2023 etwa jeder achte Jugendliche bereits mit Cannabis experimentiert hatte. Konsequente verhältnis- und verhaltenspräventive Maßnahmen sind erforderlich, um den Cannabiskonsums im Teenageralter einzudämmen.

Alcohol and Cannabis Use by Adolescents with Special Educational Needs: A Systematic Review Focused on Students with Emotional and Behavioral Disorders

Aim: As most substance use prevention programs are offered at school, it is important to explore which group of students might be at increased risk. Both researchers and educators have often maintained that students with special educational needs due to emotional and behavioral disorders (SENs-EBD) are particularly vulnerable. Hence, the aim of the current systematic review was to examine the alcohol and cannabis use by students with SENs-EBD in comparison to students without SENs or other types of SENs. Methods: Adhering to the PRISMA guidelines, the review was registered on PROSPERO (CRD42023375799) and search terms were entered in Web of Science, Scopus, ERIC, and PubMed in December 2022. Publications were required to report on empirical quantitative studies (primary data) that assessed alcohol and/or cannabis use by adolescent students with SENs-EBD and a comparison group, and be published in English-language journal articles, conference papers, or book chapters from 2000 onwards. The QuADS tool was used for quality assessment. Results: Based on these criteria, six articles (sample sizes N = 61 to N = 122,180) were included for the thematic narrative synthesis. The studies revealed that the percentage of students with SENs-EBD consuming alcohol and cannabis was higher compared to students who did not have SENs or attended mainstream schools. Conclusion: The small number of heterogeneous studies, with limitations concerning the sample size, missing effect sizes, and influence of control variables, demonstrates the need for more research. The systematic review provides guidance for such future research endeavors, as well as preliminary notions for practical implications.

Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial

BACKGROUND

During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app ("Meine Zeit ohne") has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness.

OBJECTIVE

The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics.

METHODS

Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection ("congruent use": eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models.

RESULTS

The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high.

CONCLUSIONS

The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-022-06231-x.

Transitions to polysubstance use: Prospective cohort study of adolescents in Australia

BACKGROUND AND AIMS

Adolescent polysubstance use has been associated with adverse social and health outcomes. Our aim was to measure rates and transitions to polysubstance use during adolescence and identify factors associated with initiation and discontinuation of polysubstance use.

DESIGN

Prospective cohort study. Multistate Markov modelling was used to estimate rates and identify correlates of transitions between substance use states.

SETTING AND PARTICIPANTS

Adolescent-parent dyads (n = 1927; adolescents in grade 7, age ≈13 years) were recruited from Australian schools during 2010/11 (Wave 1). Adolescents were surveyed annually until 2016/17 (n = 1503; age ≈19 years; Wave 7) and parents were surveyed annually until 2014/15 (Wave 5).

MEASUREMENTS

Alcohol, tobacco, cannabis and 3,4-methylenedioxymethamphetamine (MDMA) use outcomes were collected at Waves 3-7. Potential confounders were collected at Waves 1-6 and consisted of sex, anxiety and depression symptoms and externalizing problems, parental monitoring, family conflict and cohesion, parental substance use and peer substance use. Covariates were age and family socioeconomic status.

FINDINGS

Few adolescents engaged in polysubstance use at earlier waves (Wave 3: 5%; Wave 4: 8%), but proportions increased sharply across adolescence (Waves 5-7: 17%, 24%, 36%). Rates of transitioning to polysubstance use increased with age, with few (<9%) adolescents transitioning out. More externalizing problems (odds ratio [OR] = 1.10; 99.6% confidence interval [CI] = 1.07-1.14), parental heavy episodic drinking (OR = 1.22; 99.6% CI = 1.07-1.40), parental illicit substance use (OR = 3.56; 99.6% CI = 1.43-8.86), peer alcohol use (OR = 5.68; 99.6% CI = 1.59-20.50) and peer smoking (OR = 4.18; 99.6% CI = 1.95-8.81) were associated with transitioning to polysubstance use.

CONCLUSIONS

Polysubstance use in Australia appears to be rare during early adolescence but more common in later adolescence with low rates of transitioning out. Externalizing problems and greater parental and peer substance use are risk factors for adolescent polysubstance use that may be suitable intervention targets.

Effect of a selective personality-targeted prevention program on 7-year illicit substance related outcomes: A secondary analysis of a cluster randomized controlled trial

BACKGROUND

This study evaluated the efficacy of the selective personality-targeted PreVenture program in reducing cannabis and stimulant use over a 7-year period spanning adolescence and early adulthood.

METHODS

A cluster randomized controlled trial was conducted in 14 Australian schools. Schools were randomized to PreVenture, a brief personality-targeted selective intervention, comprising two 90-minute facilitator-led sessions delivered one week apart, or a control group (health education as usual). Only students who scored highly on one of four personality traits (anxiety sensitivity, negative thinking, impulsivity, sensation seeking) were included. Students completed online self-report questionnaires between 2012 and 2019: at baseline; post-intervention; 1-, 2-, 3-, 5.5- and 7-years post-baseline. Outcomes were past 6-months cannabis use, stimulant use (MDMA, methamphetamine or amphetamine) and cannabis-related harms.

RESULTS

The sample comprised 438 adolescents (Mage=13.4 years; SD=0.47) at baseline. Retention ranged from 51% to 79% over the 7-years. Compared to controls, the PreVenture group had significantly reduced odds of annual cannabis-related harms (OR=0.78, 95% CI=0.65-0.92). However, there were no significant group differences in the growth of cannabis use (OR=0.84, 95% CI=0.69-1.02) or stimulant use (OR=1.07, 95% CI=0.91-1.25) over the 7-year period.

CONCLUSIONS

PreVenture was effective in slowing the growth of cannabis-related harms over time, however owing to missing data over the 7-year trial, replication trials may be warranted to better understand the impact of the PreVenture intervention on cannabis and stimulant use among young Australians. Alternative implementation strategies, such as delivering the intervention in later adolescence and/or providing booster sessions, may be beneficial.

[Effectiveness of a cannabis prevention program in school: results of a randomized prospective study]

BACKGROUND

In the current debate about legalized access to cannabis for adults in Germany, there is widespread agreement about the need for increased prevention among children and young people. The aim of this work is to examine the effectiveness of a school-based cannabis prevention program on knowledge, attitudes, and behavior.

METHOD

Cluster-randomized waiting list control group study with two study arms: "participation in the 'Der grüne Koffer' prevention program", a collection of methods for cannabis prevention, vs. "no participation" and two measurement time points before and four months after the intervention in four German states.

RESULTS

The mean age of the sample of 3976 adolescents from 280 school classes in grades 8 and 9 was 14.02 years (standard deviation = 0.89). The sex ratio was balanced (49.5% female). Cannabis-related knowledge increased significantly more in the intervention group compared to the control group from the first to the second measurement time point (adjusted beta = 0.25 [95% confidence interval: 0.14-0.37]). Attitudes toward cannabis use did not change significantly in either group. In the 8th grades of the intervention group, significantly fewer adolescents (2.9%) started experimenting with cannabis use for the first time during the observation period than in the control group (5.3%), whereas no group difference was detectable in the 9th grades (interaction grade level x group: odds ratio = 2.17 [1.13-4.15], p = 0.019).

DISCUSSION

The evidence of an effect of participation in the "Der grüne Koffer" prevention program on knowledge and first-time use of cannabis in the 8th grade can be considered promising against the background of previous national and international studies, which could not provide evidence of effects of school-based cannabis prevention in middle and late adolescence.

Universal School-Based Substance Use Prevention Using Technology-Supported Cooperative Learning

Substance use in adolescence is a significant public health issue, particularly in early-to-mid adolescence, which represents a window of risk in the etiology of substance abuse and dependence. Substance use during this development period often results from affiliation with deviant peers, who model, facilitate, and reinforce use. Existing school-based substance use prevention programs have historically aimed to build adolescent knowledge regarding the dangers of substance use and/or enhance peer refusal skills. Research finds that these programs have had some success in reducing substance use, but meta-analyses report that average effect sizes are small. In a small one-year cluster randomized trial (12 middle and high schools; N = 813 students; ClinicalTrials.gov: NCT04478240), cooperative learning (CL) was implemented with the support of specialized technology and evaluated for its ability to reduce deviant peer affiliation and, in turn, reduce substance use. CL is a structured approach to small-group learning that provides at-risk youth with the opportunity to build friendships with more prosocial youth, interrupting the process of deviant peer clustering. Multi-level modeling revealed intervention effects for deviant peer affiliation and alcohol use across the sample, while tobacco use was significantly reduced among non-White students; intervention effects for marijuana use were only marginally significant. Effects for dosage were found for all outcomes, suggesting that every lesson taught had a significant impact. We conclude that CL, delivered with the aid of specialized technology, represents a viable option for universal substance use prevention. Future research should attempt to combine this approach with evidence-based prevention curricula.

An on-line school-based substance use harm reduction programme: The Illicit Project randomized controlled trial results

AIMS

The aim of this study was to measure the effectiveness of an on-line, neuroscience-based harm reduction intervention (The Illicit Project) on substance use, harms and knowledge over a 12-month period.

DESIGN

We used a two-arm cluster-randomized controlled trial.

SETTING

The study was conducted at eight secondary schools across New South Wales, Australia.

PARTICIPANTS

A total of 950 (mean age = 15.9; standard deviation = 0.68) in grades 10-12 at participating schools in 2020 took part.

INTERVENTION AND COMPARATOR

The Illicit Project intervention group (schools = five, n = 681) received an on-line, universal substance use and harm reduction programme over three classes. The active control group (schools = three, n = 269) received school-based health education as usual.

MEASUREMENTS

Self-report questionnaires assessed primary [alcohol, nicotine, cannabis, 3,4-methylenedioxymethamphetamine (MDMA), cocaine and prescription drug misuse] and secondary outcomes (alcohol-related harms and drug literacy) at baseline and the 6- and 12-month follow-up assessment.

FINDINGS

Approximately 63% (n = 595) of the sample completed the 12-month follow-up assessment, including 58% of the intervention group (n = 396/679) and 66% of the active control group (n = 179/271). Participants in the intervention group had slower annual increases in binge drinking [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.89], nicotine use (OR = 0.80, 95% CI = 0.52-1.23), MDMA use (OR = 0.14, 95% CI = 0.02-1.00), cocaine use (OR = 0.06, 95% CI = 0.01-0.64) and prescription drug misuse (OR = 0.07, 95% CI = 0.01-0.54) compared with the active control group. There was limited evidence of an intervention effect on cannabis use and alcohol-related harm (P > 0.5). The secondary outcomes showed that the intervention group maintained higher levels of drug literacy knowledge (β = 3.71, 95% CI = 1.86-5.56) and harm reduction help-seeking skills (β = 1.55, 95% CI = 0.62-2.48) compared with the active control group.

CONCLUSION

The Illicit Project (an on-line, neuroscience-based substance use harm reduction intervention) was effective in slowing the uptake of risky substance use and improving drug literacy skills among late secondary school students in Australia, compared with school-based health education as usual.

Salient Beliefs Associated with Unsanctioned Adult Cannabis Use in an Evolving Socio-Political Environment

Background: The changing cannabis legal climate in the United States has been associated with increased prevalence of use, more favorable general attitudes, and cultural norms toward its use among young adults. The purpose of this study was to conceptualize salient beliefs governing illicit cannabis use within a state where medical use is legal and adult use remains illegal. Methods: Following an initial qualitative pilot, a prospective study (baseline and a 30-day follow-up) that utilized an electronic survey design was conducted. Students at a large US university (N = 514) completed a baseline assessment of cannabis use and Theory of Planned Behavior (TPB) constructs, and 169 completed the follow-up assessing actual behavior. Results: Roughly 60% reported illicit cannabis use. Attitude and subjective norms accounted for 57% of the variation in intention for cannabis use in the next 30 days, while intention and perceived behavioral control (PBC) explained 51% of the variation in prospective use. The majority of salient beliefs identified exhibited moderate to strong correlations with intention and behavior among the larger sample. Close friends and partners were identified as important referents, outcome expectations of relaxation, improved social functioning, and more enjoyment, as well as environmental factors, such as proximity to use, safe utilization location, and continued illegality of adult use exhibited strong associations to intention and behavior. Conclusions: The practical utility of the salient belief measures identified herein presents a useful foundation for interventions aimed at reducing illicit cannabis utilization among young adults.

Motivations for Cannabis Use in Individuals with Social Anxiety Disorder (SAD)

Social anxiety disorder (SAD) is a debilitating psychiatric condition. Consequently, it is common for those affected to resort to cannabis to cope with their symptoms. The primary objective of this study was to understand the differences between motivations for cannabis use in adults with and without SAD. We employed convergent, mixed methods to collect the data. Twenty-six individuals (age: 27.9 ± 7.3 years; 54% female) with and twenty-six (age: 27.4 ± 6.7 years; 50% female) without SAD were administered Marijuana Motives Measure (MMM). Motivations to initiate, continue, and maintain cannabis use were assessed in 12/26 participants in both groups using in-depth interviews. Cannabis weekly consumption was 3.8-fold and frequency 1.3-fold higher in the SAD group. Coping (F = 10.02; p <0.001; η2 = 0.46) and social (F = 2.81; p = 0.036; η2 = 0.19) motivations were also higher in the SAD group, after controlling for age, sex, and current CUD. The need to cope with symptoms of SAD may have been the driving force for repeated cannabis consumption. Psychoeducational programs educating children about the risk of using cannabis to cope with SAD should be implemented in vocational settings early on.

Working to Improve Youth-Police Interactions: A Pilot Evaluation of a Program for Young People

In addition to training law enforcement personnel in strategies to promote positive youth-police interactions, equipping youth with similar knowledge is critical in ensuring safe and effective youth-police encounters. The classroom-based Juvenile Justice Curriculum was designed to equip young people with knowledge about the law and their rights and to empower them to have safer interactions with police. In the current study, we conducted the first evaluation of Strategies for Youth's nationally recognized classroom-based intervention. Cross-sectional data were collected from 155 youth (M age = 15.3; 43% White, 23% Black; 61% boys) after they completed the Juvenile Justice Curriculum. Results from our study indicated young people learned new information regarding what leads to arrest and multiple ways they might consider changing their behaviors when interacting with police. Young people's negative experiences with police officers were significantly associated with reduced views that police respect them and reports that they respect police, and with increased views of police as ethnoracially biased after completing the program. Altogether, our pilot program evaluation of this program demonstrated increased awareness of what constitutes illegal behavior, program engagement, and learned strategies to improve future interactions with police. Findings highlight the importance of policy makers supporting programming like the Juvenile Justice Curriculum as one means of preventing juvenile legal system involvement. While the onus to ensure safe and effective interactions with police should not be on young people, empowering young people to understand the law and their rights may help improve the social climate surrounding community responses to police and police interactions.

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.

Systematic review of intervention functions, theoretical constructs and cultural adaptations of school-based smoking prevention interventions in low-income and middle-income countries

OBJECTIVE

To identify the approaches and strategies used for ensuring cultural appropriateness, intervention functions and theoretical constructs of the effective and ineffective school-based smoking prevention interventions that were implemented in low-income and middle-income countries (LMICs).

DATA SOURCES

Included MEDLINE, EMBASE, Global Health, PsycINFO, Web of Science and grey literature which were searched through August 2022 with no date limitations.

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCTs) with ≥6 months follow-up assessing the effect of school-based interventions on keeping pupils never-smokers in LMICs; published in English or Arabic.

DATA EXTRACTION AND SYNTHESIS

Intervention data were coded according to the Theoretical Domains Framework, intervention functions of Behaviour Change Wheel and cultural appropriateness features. Using narrative synthesis we identified which cultural-adaptation features, theoretical constructs and intervention functions were associated with effectiveness. Findings were mapped against the capability-motivation and opportunity model to formulate the conclusion. Risk of bias was assessed using the Cochrane risk of bias tool.

RESULTS

We identified 11 RCTs (n=7712 never-smokers aged 11-15); of which five arms were effective and eight (four of the effective) arms had a low risk of bias in all criteria. Methodological heterogeneity in defining, measuring, assessing and presenting outcomes prohibited quantitative data synthesis. We identified nine components that characterised interventions that were effective in preventing pupils from smoking uptake. These include deep cultural adaptation; raising awareness of various smoking consequences; improving refusal skills of smoking offers and using never-smokers as role models and peer educators.

CONCLUSION

Interventions that had used deep cultural adaptation which incorporated cultural, environmental, psychological and social factors, were more likely to be effective. Effective interventions considered improving pupils' psychological capability to remain never-smokers and reducing their social and physical opportunities and reflective and automatic motivations to smoke. Future trials should use standardised measurements of smoking to allow meta-analysis in future reviews.

Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis aims to synthesize the efficacy of culturally sensitive prevention programs for substance use outcomes among U.S. adolescents of color (aged 11 to 18 years old) and explore whether the intervention effects vary by participant and intervention characteristics. Eight electronic databases and grey literature were searched for eligible randomized controlled trials through September 2022. Robust variance estimation in meta-regression was used to synthesize treatment effect size estimates and to conduct moderator analysis. After screening, 30 unique studies were included. The average treatment effect size across all substance use outcomes (including 221 effect sizes) was Hedges's g = -0.20, 95% CI = [-0.24, -0.16]. The synthesized effect sizes were statistically significant across types of substances (alcohol, cigarette, marijuana, illicit and other drugs, and unspecified substance use), racial/ethnic groups (Hispanic, Black, and Native American), and different follow-ups (0-12 months, >12 months). Very few studies reported substance use consequences as outcomes and the synthesized effect size was non-significant. Meta-regression findings suggest that the intervention effects may vary based on the type of substance. This meta-analysis found supportive evidence of culturally sensitive prevention programs' efficacy in preventing or reducing substance use among Black, Hispanic, and Native American adolescents. More substance use prevention efforts and evidence is needed for Asian American, Pacific Islander, and multiracial adolescents.

The relationship between age at first drink and later risk behaviours during a period of youth drinking decline

AIMS

Alcohol consumption among teenagers in many high-income countries has steadily declined since the early 2000s. There has also been a steady increase in the average age at first drink, a reliable marker of later alcohol problems. This study measured whether young people who initiated drinking early were at increased risk of alcohol problems in young adulthood in recent cohorts where early initiation was comparatively rare.

DESIGN

Analysis of six waves of a repeated cross-sectional household survey (2001-16).

SETTING

Australia.

PARTICIPANTS

A total of 9576 young adults (aged 20-25 years) who had initiated drinking before the age of 20 years.

MEASUREMENTS

Respondents were classified into three groups based on their self-reported age at first drink (< 16, 16-17, 18-19 years). Outcome variables were self-reported experiences of memory loss while drinking, risky and delinquent behaviour while drinking and monthly or more frequent drinking occasions of 11 or more 10-g standard drinks.

FINDINGS

Later initiators reported lower levels of all outcomes [e.g. odds ratios (ORs) for memory loss were 0.56, 95% confidence interval (CI) = 0.50, 0.63] for those who first drank at 16 or 17 years compared with those who first drank at age 15 or younger). Significant interactions between age at first drink and survey year showed that early initiation was more strongly associated with harms (e.g. for memory loss, OR = 0.97, 95% CI = 0.94, 0.99 for 18-19 versus 15 or younger) in young adulthood for recent cohorts where early drinking was less common.

CONCLUSIONS

The decline in youth drinking may have contributed to a concentration of risk of alcohol problems among those young people who consume alcohol in early adolescence. Early initiation of drinking may be an increasingly important marker of broader risk taking as alcohol becomes less normative for teenagers.

Preventing Youth Suicide: Potential "Crossover Effects" of Existing School-Based Programs

Notable increases in youth mental health problems combined with strains on the already stretched mental health workforce raise concerns that there will be an ensuing increase in youth suicide thoughts, behaviors, and even deaths. Schools are recognized as crucial settings for youth mental health support and suicide prevention activities, yet schools also face staff shortages and ever-increasing responsibilities for student well-being. Evidence is emerging that prevention programs originally designed to improve problem-solving skills and social-emotional functioning in youth have demonstrated downstream, "crossover effects," that is, unanticipated benefits, on youth suicidal behavior. Relatively little research on crossover effects has been conducted within school settings, despite the strong potential for commonly administered programs to have an impact on later suicide risk. We review key suicide risk factors and their proposed mechanisms of action; we also discuss factors that may protect against suicide risk. We then identify upstream prevention programs targeting the same factors and mechanisms; these programs may hold promise for downstream, crossover effects on youth suicide risk. This paper is intended to provide a framework to help researchers, practitioners, and policymakers as they consider how to prevent youth suicide using existing school-based resources. Rigorous investigation of upstream prevention programs is urgently needed to determine ideal approaches schools and communities can deploy to prevent youth suicide.

Development of a Web-Based Alcohol Prevention Program Linking School-Child-Family for Intermediate Elementary Students

Family strongly influences student health behavior. However, alcohol-preventive education programs that link parents and school for intermediate-elementary school students remain scarce. Although online educational programs constitute effective interventions to intentionally improve health behaviors, traditional methods are used to implement alcohol- prevention programs for students. In this study, we aimed to (1) develop an online school-child-family alcohol-prevention program based on the theory of planned behavior and (2) examine the preliminary effects of the program on intention to consume alcohol among intermediate-elementary school students. This single-group, pre- and posttest study enrolled 46 Grade 3 students from a public elementary school in a metropolitan South Korea city and ascertained the preliminary effects of a 5-week online alcohol-prevention program by using the alcohol drinking prevention behavior scale. Attitudes, perceived behavioral control, and intention of alcohol-preventive behaviors significantly improved (p < .05) whereas subjective norms did not. The online alcohol-prevention program based on the theory of planned behavior and school-child-family linkage beneficially influenced intention, attitude, and perceived behavioral control for alcohol-prevention behavior, and the effectiveness and convenience of this program underscores its potential application as an educational intervention to improve health behaviors of intermediate-elementary school students.

Substance use prevention during adolescence: Study protocol for a large-scale cluster randomized trial of Botvin High School LifeSkills Training

BACKGROUND

Concerns about the rise in adolescent vaping and cannabis use suggest the need for effective substance use prevention programs. Botvin LifeSkills Training (LST) has a strong evidence base at the middle school level for preventing or reducing tobacco use and related problems. A high school (grades 9-10) version of the LST program was also developed and shows promising initial evidence for reducing tobacco use in a single pilot study. However, the high school version of LST has not been sufficiently tested in an experimental trial, despite being widely implemented in high schools across the U.S. This paper outlines the study protocol for a large-scale cluster randomized trial of Botvin High School LST, with objectives of documenting the design of prospective research and promoting transparency.

METHODS

A total of 60 high schools in Colorado and Ohio were randomized to the 10-session, teacher-led intervention group (n = 33 schools) or business-as-usual control group (n = 27 schools). Across two cohorts of schools, 9th-grade students complete self-report surveys at pretest, immediate posttest, 1-year follow-up, and 21-month follow-up. Primary outcomes are tobacco (nicotine) use and cannabis use. Secondary outcomes are alcohol use, illicit drug use, psychosocial behaviors (e.g., violence and mental health), and academic achievement. Intent-to-treat analyses will use multilevel modeling to estimate intervention effects across assessment points.

CONCLUSION

This independent evaluation will help to determine whether the intervention is appropriate for large-scale adoption. This trial is preregistered with the Open Science Framework (https://osf.io/dnz5q/).

Cost-effectiveness and cost-utility analyses of a web-based computer-tailored intervention for prevention of binge drinking among Spanish adolescents

BACKGROUND

Binge drinking (BD) among adolescents is a public health concern worldwide. This study assessed the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence.

METHODS

The sample was drawn from a study evaluating the Alerta Alcohol program. The population consisted of adolescents 15 to 19 years of age. Data were recorded at baseline (January to February 2016) and after 4 months (May to June 2017) and were used to estimate costs and health outcomes, as measured by the number of BD occasions and quality-adjusted life years (QALYs). Incremental cost-effectiveness and cost-utility ratios were calculated from National Health Service (NHS) and societal perspectives and for a time horizon of 4 months. A multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty.

RESULTS

The cost of reducing BD occasions by one per month was €16.63 from the NHS perspective, which from the societal perspective resulted in savings of €7986.37. From the societal perspective, the intervention resulted in an incremental cost of €71.05 per QALY gained from the NHS perspective and this was dominant, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention was dominant for girls from both the perspectives and for individuals 17 years or older from the NHS perspective.

CONCLUSIONS

Computer-tailored feedback is a cost-effective way to reduce BD and increase QALYs among adolescents. However, long-term follow-up is needed to evaluate more fully changes in both BD and health-related quality of life.

Effects of an App-Based Intervention Program to Reduce Substance Use, Gambling, and Digital Media Use in Adolescents and Young Adults: A Multicenter, Cluster-Randomized Controlled Trial in Vocational Schools in Germany

Vocational students are a risk group for problematic substance use and addictive behaviors. The study aim was to evaluate the effects of an app-based intervention on tobacco, e-cigarettes, alcohol, and cannabis use as well as gambling and digital media-related behaviors in the vocational school setting. A total of 277 classes with 4591 students (mean age 19.2 years) were consecutively recruited and randomized into an intervention (IG) or waitlist control group (CG). Students from IG classes received access to an app, which encouraged a voluntary commitment to reduce or completely abstain from the use of a specific substance, gambling, or media-related habit for 2 weeks. Substance use, gambling, and digital media use were assessed before and after the intervention in both groups with a mean of 7.7 weeks between assessments. Multi-level logistic regression models were used to test group differences. Intention-to-treat-results indicated that students from IG classes had a significantly larger improvement on a general adverse health behavior measure compared to CG (OR = 1.24, p = 0.010). This difference was mainly due to a significantly higher reduction of students' social media use in the IG (OR = 1.31, p < 0.001). Results indicate that the app "Meine Zeit ohne" is feasible for the target group and seems to have a small but measurable impact on students' health behavior.

Examining Potential Mechanisms of an Online Universal Prevention for Adolescent Alcohol Use: a Causal Mediation Analysis

Several universal school-based prevention programs, notably the Australian Climate Schools program, have proven efficacious at reducing and maintaining a lower level of harmful alcohol consumption relative to a control condition. Yet, there are limited studies investigating the potential mechanisms that account for the reduction in harmful alcohol consumption. The current study utilised modern causal mediation analysis to investigate whether several harm minimisation and social influence mediators could jointly account for the intervention effect observed in a large school-based sample. Four mediators representing knowledge, attitudes, normative perceptions, and self-efficacy to resist peer pressure were entered into a multiple casual mediation model using the potential outcomes framework. The results did not provide evidence for a joint multiple mediation model consisting of the hypothesised harm minimisation and social influence mediators. Additional research is required to further investigate the potential mechanisms underlying universal school-based prevention programs including social connectedness and cultural/environmental factors.

Updated systematic review of Australian school-based prevention programmes for alcohol and other drugs: a review protocol

INTRODUCTION

Adolescent onset substance use is associated with neurodevelopmental, social and psychological harms. Thus, alcohol and other drug prevention programmes are essential to promote health and well-being during this period. Schools are uniquely positioned to deliver such prevention programmes. The last decade has seen a large expansion of school-based alcohol and drug prevention programmes in Australia, warranting an update of the comprehensive review conducted by Teesson et al in 2012. This proposed review aims to (1) identify school-based substance use prevention programmes that have been trialled in Australia since 2011, (2) evaluate their efficacy and (3) identify intervention components associated with effectiveness. This will assist schools in identifying and adopting effective evidence-based programmes and inform future programme development, evaluation and policy.

METHODS AND ANALYSIS

Studies published from 2011 will be identified by searching the electronic databases PubMed, PsycINFO, Medline, Embase, ProQuest and Cochrane Library in addition to grey literature searches. Eligible studies will be controlled trials (including randomised controlled trials, cluster randomised controlled trials and quasi-experimental trials) of programmes measuring drug and alcohol related outcomes that are conducted in a school setting and have been trialled within Australia. Records will be independently screened for eligibility by two review authors, with disagreements being resolved by consensus or a third review author where necessary. Data extraction, risk of bias and study quality will also be completed independently by two review authors. A qualitative synthesis of all eligible studies will be presented. In addition, if there are sufficient data to combine studies, a random-effects meta-analysis will be conducted.

ETHICS AND DISSEMINATION

This research is exempt from ethics approval as no primary data are collected, with work instead being carried out on published documents. The findings of this proposed review will be disseminated in a peer-reviewed journal and at conferences.

PROSPERO REGISTRATION NUMBER

CRD42021272959.

At-School Victimization and Alcohol Use Among Minoritized U.S. Youth, 2009-2017

INTRODUCTION

Sexual minority and/or racial/ethnic minority youth may use alcohol at school as a form of minority stress-based coping. Polyvictimization is particularly prevalent among sexual minority and/or racial/ethnic minority youth and may be a useful proxy measure for minority stressors.

METHODS

Data from local administrations of the Youth Risk Behavior Survey were pooled across 42 jurisdiction years (biennially, 2009-2017) and analyzed in 2022, resulting in a sample of 118,052 U.S. youth. The prevalence of alcohol use at school was examined by sexual identity, race/ethnicity, and their intersections, stratified by sex. Multivariable logistic regression models were built to examine the disparities in alcohol use at school and the impact of school-based polyvictimization.

RESULTS

At the intersections of race/ethnicity and sexual identity, 25 of 30 sexual minority and/or racial/ethnic minority subpopulations had greater odds of alcohol use at school than their White heterosexual same-sex peers. Hispanic/Latinx not-sure males (AOR=9.15; 95% CI=5.97, 14.03) and Hispanic/Latinx lesbian females (AOR=11.24; 95% CI=6.40, 19.77) were most likely to report alcohol use at school. After adjusting for polyvictimization, the magnitude of association was attenuated for most sexual minority and/or racial/ethnic minority subpopulations; however, all but 2 significant associations remained.

CONCLUSIONS

Sexual minority and/or racial/ethnic minority youth were more likely than White heterosexual peers to use alcohol at school, with the greatest odds among multiply marginalized and polyvictimized youth. Interventions should consider addressing more than school-based victimization alone because disparities persisted, although at a lower magnitude, after accounting for polyvictimization. Future longitudinal studies are warranted to further explore the associations between multiply marginalized identities, school-based polyvictimization, and alcohol use at school.

The Intervening Role of Conversational Frequency and Valence in a School-Based Health Intervention

School-based health interventions are potentially an effective method to communicate health messages to adolescents. Unfortunately, effectiveness of such interventions is limited. Research in other contexts has shown that interpersonal communication can influence the effectiveness of health programs, but this has not been thoroughly tested for school-based health interventions. Therefore, our study investigated interpersonal communication (i.e., conversational valence and frequency) in a school-based intervention context. We used a three-wave randomized-controlled trial with 1056 students to study three aims. The first aim was to investigate the influence of a health intervention on conversational frequency and valence about drinking, snacking, and exercising. Our second aim was to investigate the influence of conversational frequency and valence on (predictors of) drinking, snacking, and exercising. Our third aim was to investigate whether the health intervention indirectly influenced the program outcomes through conversational frequency and valence. Findings showed that conversational frequency and valence were related to (predictors of) the three behaviors. Additionally, findings showed that the intervention did not influence conversational frequency and valence. Accordingly, findings showed no indirect influence of the intervention on program outcomes through conversational frequency and valence. Our findings show the potential of interpersonal communication for health behaviors and predictors; however, they also stress the importance of a health intervention to properly influence interpersonal communication. If health interventions can successfully influence interpersonal communication, intervention effectiveness can be improved.

Effect of Selective Personality-Targeted Alcohol Use Prevention on 7-Year Alcohol-Related Outcomes Among High-risk Adolescents: A Secondary Analysis of a Cluster Randomized Clinical Trial

IMPORTANCE

Alcohol consumption is one of the leading preventable causes of burden of disease worldwide. Selective prevention of alcohol use can be effective in delaying the uptake and reducing harmful use of alcohol during the school years; however, little is known about the durability of these effects across the significant transition from early adolescence into late adolescence and early adulthood.

OBJECTIVE

To examine the sustained effects of a selective personality-targeted alcohol use prevention program on alcohol outcomes among adolescents who report high levels of 1 of 4 personality traits associated with substance use.

DESIGN, SETTING, AND PARTICIPANTS

A cluster randomized clinical trial was conducted to assess the effectiveness of the selective personality-targeted PreVenture program on reducing the growth of risky alcohol use and related harms from early to late adolescence and early adulthood. Participants included grade 8 students attending 14 secondary schools across New South Wales and Victoria, Australia, in 2012 who screened as having high levels of anxiety sensitivity, negative thinking, impulsivity, and/or sensation seeking. Schools were block randomized to either the PreVenture group (7 schools) or the control group (7 schools). The primary end point of the original trial was 2 years post baseline; the present study extends the follow-up period from July 1, 2017, to December 1, 2019, 7 years post baseline. Data were analyzed from July 22, 2021, to August 2, 2022.

INTERVENTIONS

The PreVenture program is a 2-session, personality-targeted intervention designed to upskill adolescents to better cope with their emotions and behaviors.

MAIN OUTCOMES AND MEASURES

Self-reported monthly binge drinking, alcohol-related harms, and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test-Concise consumption screener.

RESULTS

Of 438 participants (249 male [56.8%]; mean [SD] age, 13.4 [0.5] years) from 14 schools, 377 (86.2%) provided follow-up data on at least 2 occasions, and among those eligible, 216 (54.0%) participated in the long-term follow-up. Compared with the control condition, the PreVenture intervention was associated with reduced odds of any alcohol-related harm (odds ratio [OR], 0.81 [95% CI, 0.70-0.94]) and a greater mean reduction in the frequency of alcohol-related harms (β = -0.22 [95% CI, -0.44 to -0.003]) at the 7.0-year follow-up. There were no differences in the odds of monthly binge drinking (OR, 0.80 [95% CI, 0.56-1.13]) or hazardous alcohol use (OR, 0.87 [95% CI, 0.59-1.27]) at the 7.0-year follow-up. Exploratory analyses at the 5.5-year follow-up showed that compared with the control condition, the PreVenture intervention was also associated with reduced odds of monthly binge drinking (OR, 0.87, [95% CI, 0.77-0.99]) and hazardous alcohol use (OR, 0.91 [95% CI, 0.84-0.99]), but this was not sustained.

CONCLUSIONS AND RELEVANCE

This study demonstrated that a brief selective personality-targeted alcohol use prevention intervention delivered in the middle school years can have sustained effects into early adulthood.

TRIAL REGISTRATION

anzctr.org.au Identifier: ACTRN12612000026820.

Assessment of Psychosocial Programs to Prevent Sexual Violence During Adolescence: A Systematic Review and Meta-analysis

IMPORTANCE

Sexual violence is a public health problem that affects adolescents globally. To our knowledge, no meta-analysis of prevention programs for adolescent sexual violence has been conducted.

OBJECTIVE

To perform a systematic review and meta-analysis of randomized clinical trials evaluating the efficacy of psychosocial programs for preventing sexual violence during adolescence.

DATA SOURCES

Peer-reviewed articles published in English were searched in PsycINFO, ERIC, PsycArticles, PubMed, and Web of Science databases through December 2021.

STUDY SELECTION

Studies were included if they were randomized clinical trials assessing the efficacy of a psychosocial prevention program targeting sexual violence and delivered to adolescents aged 10 to 19 years.

DATA EXTRACTION AND SYNTHESIS

Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify studies. The quality of individual studies was assessed with the Revised Cochrane Collaboration Risk of Bias tool. A random-effects model was used to pool odds ratios (ORs). Exploratory subgroup and metaregression analyses were performed to evaluate the associations between moderators and effect sizes.

MAIN OUTCOMES AND MEASURES

Primary outcomes were perpetration of sexual violence, experience of sexual violence, and a composite measure of any perpetration or experience of sexual violence.

RESULTS

Data were analyzed from 20 trials involving 37 294 adolescents. Compared with control conditions, prevention programs were associated with a significant reduction in the perpetration (OR, 0.83; 95% CI, 0.73-0.95; P = .005) and experience (OR, 0.87; 95% CI, 0.78-0.98; P = .02) of sexual violence, as well as a 13% significant reduction of any sexual violence (OR, 0.87; 95% CI, 0.78-0.97; P = .009). Exploratory analyses of the combination of program setting and participant age indicated that programs that were delivered in school settings and targeted at adolescents aged 15 to 19 years yielded significantly larger effect sizes (Cochran Q = 4.8; P = .03) compared with programs that were either delivered outside of a school setting or targeted younger adolescents. Quality assessment of trials revealed concerns of risk of bias across several included studies.

CONCLUSIONS AND RELEVANCE

In this meta-analysis, evidence suggested that prevention programs were associated with reducing adolescent sexual violence, especially when implemented at school with older adolescents. However, there is need for additional high-quality research. Prevention of adolescent sexual violence remains understudied compared with other similarly important public health prevention targets.

Youth-Reported School Connection and Experiences of a Middle School-Based Screening, Brief Intervention, and Referral to Treatment Initiative: Preliminary Results From a Program Evaluation

PURPOSE

This study aimed (1) to evaluate the feasibility of a school-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) program that expands on traditional SBIRT to support the mental health and well-being of middle school students and (2) to assess its effects on students' connection with adults at school.

METHODS

Focus group discussions were conducted with 26 students in grades 6-8 to understand student perspectives about an innovative school-based SBIRT program. A subset of middle school students from the SBIRT program who received a brief intervention (BI) after screening (n = 116) were asked to rate their experience meeting with the interventionist in terms of feeling comfortable, feeling listened to, and talking about their goals. Additionally, these students' ratings of connection to adults at school was compared from the time of screening (baseline) to following BI using two-sided paired t-tests.

RESULTS

Students who participated in focus groups expressed favorable opinions about universal screening and this school-based SBIRT model and noted that relationship building with adults at school was an important factor for open communication and motivating behavior change for students. Nearly all students who completed the post-BI survey rated their experiences with interventionists during BI as "Excellent," "Very Good," or "Good" in all categories (98%). Students' reported mean school connection scores significantly higher after participation in school-based SBIRT than at baseline (5.9/8 vs. 7.0/8, p < .001).

DISCUSSION

Middle school students were satisfied with the school-based SBIRT model and participation in the program resulted in increased student connection with adults at school. These findings improve our understanding of the experience of SBIRT intervention with middle school students and on school connection in particular.

Moving school-based CSA prevention education online: Advantages and challenges of the "new normal"

One of the many outcomes of the COVID-19 pandemic was a shift in the delivery of elementary (primary) education. Schools transitioned swiftly to e-learning and prioritized education that was already or could be easily adapted to virtual formats. Given the paucity of online content available, it is not likely that child sexual abuse (CSA) prevention education was prioritized. Given that CSA prevention education has demonstrated success in increasing knowledge, protective behaviors, and disclosures, and the potential long-term need for e-learning options, there is a demand for an exploration of how CSA prevention can be implemented using e-learning strategies. In the current discussion, we explore how school-based CSA prevention education could be implemented in a "new normal" context of e-learning. We first present the existing e-learning content for CSA prevention education. We then describe how best practices for prevention education can be applied to e-learning. Finally, we present considerations for the use of e-learning specifically for CSA prevention education. In short, implementing CSA prevention programs through e-learning offers many affordances for program accessibility and reach, flexibility in implementation and opportunities for greater exposure to content, and a wide range of ways to demonstrate effective skills and engage children in cycles of practice and feedback. E-learning, may also, however, limit important conversations between children and trained instructors that lead to disclosures. The extant literature leaves us unsure as to whether implementing CSA prevention programs through e-learning will result in better or worse outcomes for children. However, given the increasing demand for e-learning options, and the promise of some new e-learning programs, further research on the effectiveness of e-learning CSA prevention programs is warranted.

Components Related to Long-Term Effects in the Intra- and Interpersonal Domains: A Meta-Analysis of Universal School-Based Interventions

The aims of the present meta-analysis were to (1) examine long-term effects of universal secondary school-based interventions on a broad range of competencies and problems and (2) analyze which intervention components were related to stronger or weaker intervention effects at follow-up. Fifty-four studies of controlled evaluations (283 effect sizes) reporting on 52 unique interventions were included. Long-term intervention effects were significant but small; effect sizes ranged from .08 to .23 in the intrapersonal domain (i.e., subjective psychological functioning) and from .10 to .19 in the interpersonal domain (i.e., social functioning). Intervention components were generally related to effects on specific outcomes. Some components (e.g., group discussions) were even related to both stronger and weaker effects depending on the assessed outcome. Moreover, components associated with long-term effects differed from those associated with short-term effects. Our findings underscore the importance of carefully selecting components to foster long-term development on specific outcomes.

PROSPERO registration number: CRD42019137981.

The association between public health engagement in school-based substance use prevention programs and student alcohol, cannabis, e-cigarette and cigarette use

OBJECTIVE

This study examined the associations between public health engagement (PHE) in school-based substance use prevention programs and student substance use. For the purposes of this study, PHE refers to any form of collaboration between the local government public health agency and the school to promote the physical and mental health of students.

METHODS

Data for this study were collected from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour (COMPASS) study during the 2018/2019 data collection year. Multilevel logistic regression was used to analyze the associations between PHE and student substance use.

RESULTS

Data from 84 schools and 42,149 students were included; 70% of schools had PHE in substance use prevention programs. PHE in substance use prevention appears to have had no significant impact on student substance use in our models. When PHE was divided into five methods of engagement, it was found that when public health solved problems jointly with schools, the odds of a student using alcohol or cannabis significantly increased. When schools were split into low- and high-use schools for each substance measured, some methods of PHE significantly decreased the odds of cannabis and cigarette use in high-use schools and significantly increased the odds of alcohol and cannabis use in low-use schools.

CONCLUSION

This study highlights the need to develop better partnerships and collaborations between public health and schools, and the importance of ensuring that school-based substance use prevention programs are evidence-based and tailored to the specific needs of schools and students.

Trends in Teaching Sexual and Reproductive Health Skills in US Secondary Schools in 35 States, 2008 to 2018

BACKGROUND

Little is known about trends in implementing skills-based instruction in US schools, specifically for sexual and reproductive health (SRH). We examined state-level trends in the percentage of US secondary schools teaching SRH skills in a required course in grades 6 to 8 and 9 to 12.

METHODS

Representative data from 35 states participating across 6 cycles of School Health Profiles (2008-2018) was analyzed. The prevalence of teaching four SRH skills was assessed through lead health education teacher self-administered questionnaires. Logistic regression models examined linear trends in the percentages of schools teaching SRH skills in grades 6 to 8 and 9 to 12. Trends were calculated for states with weighted data (response rates ≥70%) for at least 3 cycles, including 2018.

RESULTS

During 2008 to 2018, the median percentage of schools addressing each SRH skill ranged from 63.5% to 69.7% (grades 6-8) and 88.2% to 92.0% (grades 9-12). Linear decreases in SRH skills instruction were more common for grades 6 to 8 than grades 9 to 12; linear increases were comparable for both groups. Most states demonstrated no change in the percentage of schools teaching SRH skills in grades 6 to 8 and 9 to 12.

CONCLUSIONS

Limited changes and decreases in SRH skills instruction in US secondary schools suggest efforts to strengthen SRH education are needed.

Using a multi-module web-app to prevent substance use among students at a Hispanic Serving Institution: development and evaluation design

BACKGROUND

Despite effective strategies to prevent substance use and substance use disorders among college students, challenges remain. As young adults' preference for and comfortability with web-based technology continues to increase, leveraging innovative approaches to rapidly evolving mHealth technology is critical for the success of lowering the risk for substance use and related consequences in college populations, and especially those at Hispanic Serving Institutions. Therefore, the present study describes the rationale, development, and design of iSTART, a novel web-app to prevent substance use among students.

METHODS

The web-app was developed following the intervention mapping protocol, and in collaboration with numerous stakeholders, including a community-based partner specializing in substance abuse prevention and treatment. A 30-day multi-module web-app intervention was developed based on key theoretical constructs, behavior change strategies, and practical module components: attitudes (knowledge), perceived susceptibility (risk perceptions), subjective norms (normative re-education), and self-efficacy (refusal skills). This intervention will be evaluated via a time series design using a sample of 600 students randomly assigned to either the intervention, comparison, or control condition at a public institution in southern California.

DISCUSSION

The iSTART web-app is an innovative and sustainable program ideal for college campuses with diverse student populations. If this prevention web-app is successful, it will significantly contribute to the evidence of effective substance use interventions in the college setting, and identify the benefits of mHealth programs to prevent future substance use.

TRIAL REGISTRATION

NCT05362357 retrospectively registered on May 4, 2022 on clinicaltrials.gov .

Individual and Contextual Characteristics Associated With Alcohol Use Among Brazilian Adolescents

Objective: To analyze the association between individual and contextual characteristics with alcohol indicators of experimentation, use in the last 30 days and drunkenness in Brazilian adolescents.

Methods: Cross-sectional study based on data from 100,914 student attending 9^th grade from the 2015 National School Health Survey. Multilevel logistic regression models were performed for the outcomes: alcohol experimentation; use in the last 30 days and drunkenness; and exposures, adjusted for adolescents’ sociodemographic characteristics.

Results: Girls were more likely to experiment alcohol (OR = 1.09; 95% CI = 1.05–1.12), use it in the last 30 days (OR = 1.09; 95% CI = 1.00–1.13) and less prone to drunkenness (OR = 0.90; 95% CI = 0.87–0.93). A higher proportion of public-school students reported drinking. There was a positive association of substance use by parents, peers and the adolescents themselves with the outcomes. Having a policy of banning alcohol consumption at school was associated with a greater chance of alcohol experimentation in public schools.

Conclusion: Exposure to legal and illegal substances by friends, family members and a prohibitive school environment favored the outcomes.

Effectiveness of an app-based intervention to reduce substance use, gambling, and digital media use in vocational school students: study protocol for a randomized controlled trial

BACKGROUND

Substance-related and addictive disorders are among the most common mental disorders in adolescence and young adulthood. Vocational school students are a risk group for problematic substance use and addictive behavior. However, the availability of evidence-based prevention concepts and programs is underdeveloped in the vocational school setting.

METHODS/DESIGN

A two-arm cluster randomized waitlist-controlled trial will be conducted to evaluate the effectiveness of an app-based intervention to decrease substance use, gambling, and digital media use in vocational school students in Germany. Vocational students will participate in an app-based intervention that is designed to support voluntary commitment to abstain from or reduce substance or digital media use over a period of 2 weeks. The "education-as-usual" control arm will have access to the intervention after data collection is completed. One of the primary outcome measures will be the use of alcohol, nicotine, and digital media 30 days after the intervention. Several secondary outcome measures will also be included, such as cannabis consumption, gambling, symptoms of stress, physical activity, mindfulness, well-being, impulsivity and sensation seeking, and readiness to change. A total of 4500 vocational students from 225 classes will be recruited and randomized across three German federal states.

DISCUSSION

This study protocol describes the design of an RCT testing the effectiveness of an app-based intervention to reduce addictive behaviors in vocational school students. It is expected that this approach will be feasible for and effective in the vocational school setting and that the study provides comprehensive information on the key factors involved in temporary abstaining or reducing substance or digital media use.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00023788 . Registered on 20 January 2021.

Prevention of Alcohol Consumption Programs for Children and Youth: A Narrative and Critical Review of Recent Publications

Background

Youth substance use is a public health problem globally, where alcohol is one of the drugs most consumed by children, and youth prevention is the best intervention for drug abuse.

Objective

Review the latest evidence of alcohol use prevention programs in empirical research, oriented to all fields of action among children and youth.

Methods

A narrative and critical review was carried out within international databases (PsychInfo, Pubmed, Web of Science, and Scopus) in August 2021 and was limited to empirical studies that appeared in the last five years (2017-2021). A flow diagram was used according to the PRISMA statements. Empirical research articles in English with RCTs and quasi-experimental design that included alcohol, children, and young people up to 19 years of age (universal, selective, or indicated programs) were included. The authors examined the results and conceptual frameworks of the Prevention programs by fields of action.

Results

Twenty-two articles were found from four fields of action: school (16), family (2), community (2), and web-based (2), representing 16 alcohol prevention programs. School-based alcohol prevention programs are clinically relevant [Theory of Planned Behavior, Refuse, Remove, Reasons, Preventure, The GOOD Life, Mantente REAL, Motivational Interviewing (BIMI), Primavera, Fresh Start, Bridges/Puentes], they are effective in increasing attitudes and intentions toward alcohol prevention behavior, while decreasing social norms and acceptance of alcohol, reducing intoxication, and increasing perceptions with regards to the negative consequences of drinking.

Discussion

This narrative and critical review provides an updated synthesis of the evidence for prevention programs in the school, family, community, and web-based fields of action, where a more significant number of programs exist that are applied within schools and for which would have greater clinical relevance. However, the prevention programs utilized in the other fields of action require further investigation.

Effectiveness of a neuroscience-based, harm reduction program for older adolescents: A cluster randomised controlled trial of the Illicit Project

The prevention of risky adolescent substance use is critical. Limited age-appropriate, school-based programs target adolescents aged 16-19 years, despite this representing the age of initiation and escalation of substance use. The Illicit Project is a neuroscience-based, harm reduction program targeting late adolescents, designed to address this gap. The current study aims to evaluate the program's effectiveness in reducing risky substance use and related harms among late adolescents. A cluster randomised controlled trial was conducted involving 950 students (Mage = 15.9 years SD = 0.68; 60% Female) from eight secondary schools in Australia. Five schools received The Illicit Project program, and three schools were randomised into the active control group (health education as usual). All students completed a self-report survey at baseline and 6-months post-baseline and intervention students completed a program evaluation survey. Outcomes include alcohol and substance use, alcohol related harms and drug literacy levels (knowledge and skills). At 6-months post baseline, individuals in the intervention group were less likely to engage in weekly binge drinking (OR = 0.56), high monthly alcohol consumption (OR = 0.56), early onset cannabis use (OR = 0.35), risky single occasion cannabis use (OR = 0.48), MDMA use (OR = 0.16) or nicotine product use (OR = 0.59) compared to the control group. Students in the intervention group were less likely to have experience alcohol related harms (OR = 0.57) and more likely to have higher drug literacy scores (β = 2.44) at follow-up. These preliminary results support the effectiveness of The Illicit Project. Further follow-up is required to determine the durability of the results over time.

Adverse and other unintended consequences of setting-based interventions to prevent illicit drug use: A systematic review of reviews

This article explores adverse and unintended consequences (AUCs) of setting-based public health interventions to prevent illicit drug use, including the mechanisms leading to these AUCs. Additionally, the reporting of AUCs in systematic reviews was assessed. Therefore, we conducted a systematic review of reviews and searched four big databases were searched. We included systematic reviews concerned with setting-based interventions to prevent illicit drug use. We used AMSTAR 2 to rate the overall confidence of the results presented in the reviews. Data on study characteristics, types and mechanisms of AUCs were extracted. An a priori categorisation of consequences drew on the WHO-INTEGRATE framework, and the categorisation of mechanisms on the Behaviour Change Wheel. For reviews reporting AUCs, the same information was also retrieved from relevant primary studies. Findings were synthesised narratively and in tables. Finally, we included 72 reviews, of which 18 reported on AUCs. From these, 11 primary studies were identified. Most of the reviews and primary studies were conducted in educational settings. The most prevalent AUCs reported in systematic reviews and primary studies were paradoxical health effects (i.e. increase of drug use). Potential mechanisms discussed primarily focussed on the change though social norms and practices. Changes of knowledge and perception were also mentioned. Concluding, the identified reviews and primary studies paid insufficient attention to AUCs of public health interventions to prevent illicit drug use. Where reported, it was mostly as an afterthought and narrowly framed as health related. No mentions of potential broader social consequences were found.

Use of Tobacco Products, Alcohol, and Other Substances Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021

The COVID-19 pandemic has been associated with established risk factors for adolescent substance use, including social isolation, boredom, grief, trauma, and stress. However, little is known about adolescent substance use patterns during the pandemic. CDC analyzed data from the Adolescent Behaviors and Experiences Survey, an online survey of a probability-based, nationally representative sample of public- and private-school students in grades 9–12 (N = 7,705), to examine the prevalence of current use of tobacco products, alcohol, and other substances among U.S. high school students. Prevalence was examined by demographic characteristics and instructional models of the students’ schools (in-person, virtual, or hybrid). During January–June 2021, 31.6% of high school students reported current use of any tobacco product, alcohol, or marijuana or current misuse of prescription opioids. Current alcohol use (19.5%), electronic vapor product (EVP) use (15.4%), and marijuana use (12.8%) were more prevalent than prescription opioid misuse (4.3%), current cigarette smoking (3.3%), cigar smoking (2.3%), and smokeless tobacco use (1.9%). Approximately one third of students who used EVPs did so daily, and 22.4% of students who drank alcohol did so ≥6 times per month. Approximately one in three students who ever used alcohol or other drugs reported using these substances more during the pandemic. The prevalence of substance use was typically higher among non-Hispanic American Indian or Alaska Native students, older students, and gay, lesbian, or bisexual students than among students of other racial or ethnic groups, younger students, and heterosexual students. The prevalence of alcohol use also was higher among non-Hispanic White students than those of other racial or ethnic groups. Students only attending school virtually had a lower prevalence of using most of the substances examined than did students attending schools with in-person or hybrid models. These findings characterizing youth substance use during the pandemic can help inform public health interventions and messaging to address these health risks during and after the COVID-19 pandemic.

Use of Tobacco Products, Alcohol, and Other Substances Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021

The COVID-19 pandemic has been associated with established risk factors for adolescent substance use, including social isolation, boredom, grief, trauma, and stress. However, little is known about adolescent substance use patterns during the pandemic. CDC analyzed data from the Adolescent Behaviors and Experiences Survey, an online survey of a probability-based, nationally representative sample of public- and private-school students in grades 9-12 (N = 7,705), to examine the prevalence of current use of tobacco products, alcohol, and other substances among U.S. high school students. Prevalence was examined by demographic characteristics and instructional models of the students' schools (in-person, virtual, or hybrid). During January-June 2021, 31.6% of high school students reported current use of any tobacco product, alcohol, or marijuana or current misuse of prescription opioids. Current alcohol use (19.5%), electronic vapor product (EVP) use (15.4%), and marijuana use (12.8%) were more prevalent than prescription opioid misuse (4.3%), current cigarette smoking (3.3%), cigar smoking (2.3%), and smokeless tobacco use (1.9%). Approximately one third of students who used EVPs did so daily, and 22.4% of students who drank alcohol did so ≥6 times per month. Approximately one in three students who ever used alcohol or other drugs reported using these substances more during the pandemic. The prevalence of substance use was typically higher among non-Hispanic American Indian or Alaska Native students, older students, and gay, lesbian, or bisexual students than among students of other racial or ethnic groups, younger students, and heterosexual students. The prevalence of alcohol use also was higher among non-Hispanic White students than those of other racial or ethnic groups. Students only attending school virtually had a lower prevalence of using most of the substances examined than did students attending schools with in-person or hybrid models. These findings characterizing youth substance use during the pandemic can help inform public health interventions and messaging to address these health risks during and after the COVID-19 pandemic.

The 7-Year Effectiveness of School-Based Alcohol Use Prevention From Adolescence to Early Adulthood: A Randomized Controlled Trial of Universal, Selective, and Combined Interventions

OBJECTIVE

Alcohol use is a leading cause of burden of disease among young people. Prevention strategies can be effective in the short-term; however little is known about their longer-term effectiveness. The aim of this study was to examine the sustainability of universal, selective, and combined alcohol use prevention across the critical transition period from adolescence into early adulthood.

METHOD

In 2012, a total of 2190 students (mean age, 13.3 years) from 26 Australian high schools participated in a cluster randomized controlled trial and were followed up for 3 years post baseline. Schools were randomly assigned to deliver the following: (1) universal Web-based prevention for all students (Climate Schools); (2) selective prevention for high-risk students (Preventure); (3) combined universal and selective prevention (Climate Schools and Preventure [CAP]); or (4) health education as usual (control). This study extends the follow-up period to 7-years post baseline. Primary outcomes were self-reported frequency of alcohol consumption and binge drinking, alcohol-related harms, and hazardous alcohol use, at the 7-year follow-up.

RESULTS

At 7-year follow-up, students in all 3 intervention groups reported reduced odds of alcohol-related harms compared to the control group (odds ratios [ORs] = 0.13-0.33), and the Climate (OR = 0.04) and Preventure (OR = 0.17) groups reported lower odds of hazardous alcohol use. The Preventure group also reported lower odds of weekly alcohol use compared to the control group (OR = 0.17), and the Climate group reported lower odds of binge drinking (OR = 0.12), holding mean baseline levels constant.

CONCLUSION

This study demonstrated that both universal and selective preventive interventions delivered in schools can have long-lasting effects and reduce risky drinking and related harms into adulthood. No added benefit was observed by delivering the combined interventions.

CLINICAL TRIAL REGISTRATION INFORMATION

The CAP Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use and Related Harms in Australian Adolescents; https://www.anzctr.org.au/; ACTRN12612000026820.

Efficacy of the Virtual Reality Intervention VR FestLab on Alcohol Refusal Self-Efficacy: A Cluster-Randomized Controlled Trial

It is currently unknown whether a virtual social environment can support young people in building their skills to overcome peer pressure when offered alcohol. This study evaluated the efficacy of the newly developed virtual reality simulation game VR FestLab on the refusal self-efficacy regarding social pressures to drink of Danish male and female students aged 15-18. VR FestLab features a party setting where adolescents can "steer" their own party experience. Eleven schools were included in a cluster-randomized controlled trial and allocated to either the intervention (n = 181) or the active control group (n = 191). Students in intervention schools played VR FestLab, while those in the control group played the VR game Oculus Quest-First Steps. The primary outcome measure was the social pressure subscale of the drinking refusal self-efficacy scale (DRSEQ-RA). The intervention effects were measured immediately after the intervention/control session (T1) and after a 6-week follow-up (T2). Data were examined using linear mixed regression models. Our study did not demonstrate a significant effect of drinking refusal self-efficacy at T1. For all secondary outcomes, we observed no substantial differences between the intervention and control groups. This study provides new insights into the feasibility and effectiveness of an innovative virtual reality alcohol prevention tool. VR FestLab can be an innovative and promising contribution to complement existing school-based alcohol prevention, but more research is needed to improve its effectiveness.