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Ponsford R, Melendez-Torres GJ, Miners A, Falconer J, Bonell C. Whole-school interventions promoting student commitment to school to prevent substance use and violence, and improve educational attainment: a systematic review. Public Health Res (Southampt) 2024; 12:1-290. [PMID: 38356404 DOI: 10.3310/dwtr3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Whole-school interventions modify the school environment to promote health. A subset of these interventions promotes student commitment to school to prevent substance (tobacco, alcohol, other drugs) use and/or violence. A previous review identified the theory of human functioning and school organisation as a comprehensive theory of such interventions, and found evidence that these interventions reduce substance use and/or violence. Objectives The objectives were to search for, appraise and synthesise evidence to address the following questions: (1) What whole-school interventions promoting student commitment to school to prevent substance use and/or violence have been evaluated, what intervention subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? (2) What factors relating to setting, population and intervention affect implementation? (3) What are the effects on student substance use, violence and educational attainment? (4) What is the cost-effectiveness of such interventions? (5) Are intervention effects mediated by student commitment to school or moderated by setting or population? Data sources A total of 56 information sources were searched (in January 2020), then an updated search of 48 of these was carried out (in May 2021). Reference lists were also searched and experts were contacted. Review methods Eligible studies were process/outcome evaluations of whole-school interventions to reduce student violence or substance use among students aged 5-18 years attending schools, via actions aligning with the theory of human functioning and school organisation: modifying teaching to increase engagement, enhancing student-staff relationships, revising school policies, encouraging volunteering or increasing parental involvement. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised qualitatively. Outcome and economic data were synthesised narratively; outcome data were meta-analysed. Results Searches retrieved 63 eligible reports on 27 studies of 22 interventions. We identified four intervention subtypes focused on student participation in school-wide decisions, improving staff-student relationships, increasing engagement in learning and involving parents. The theories of change of most intervention subtypes aligned closely with the theory of human functioning and school organisation, and informed refinement of an intervention theory of change. Theories of change for interventions increasing learning engagement did not align with this theory, aiming instead to increase school commitment primarily via social skills curricula. Factors influencing the implementation included whether or not interventions were tailorable, workable and well explained. Interventions with action groups comprising staff/students, etc. and providing local data were well implemented. Implementation was also affected by whether or not schools accepted the need for change and staff had the resources for delivery. Meta-analyses suggest small, but significant, intervention effects in preventing violence victimisation and perpetration, and substance use. There was sparse and inconsistent evidence of moderation and some evidence of mediation by student commitment to school. Two economic evaluations suggested that there is the potential for the interventions to be cost-effective. Limitations The quality of the studies was variable and the economic synthesis was limited to two studies. Conclusions Whole-school interventions aiming to promote student commitment to school share similar theories of change and factors affecting implementation. They have the potential to contribute to preventing violence and substance use among young people. Future trials should aim to optimise intervention effectiveness by better theorisation, and assess implementation and effect moderators and mediators. Study registration This study is registered as PROSPERO CRD42019154334. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/151/05) and is published in full in Public Health Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ruth Ponsford
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jane Falconer
- Library & Archives Service, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Nguyen T, Pu C, Waits A, Tran TD, Ngo TH, Huynh QTV, Huang SL. Transforming stress program on medical students' stress mindset and coping strategies: a quasi-experimental study. BMC Med Educ 2023; 23:587. [PMID: 37596565 PMCID: PMC10439558 DOI: 10.1186/s12909-023-04559-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Stress is a significant concern in medical education, and identifying effective ways to deal with stress may help with students' mental health and professional development. This study aimed to examine the effects of the Transforming Stress Program (TSP) amongst first-year medical students on their stress mindset and coping strategies when confronted with stressors. METHODS We conducted a quasi-experimental study at the University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam. A total of 409 first-year students at the Faculty of Medicine were divided into intervention group (205 students) and control group (204 students). The 10-week TSP was delivered as an extra-curricular course. The training adopts psychoeducation based on Dialectical Behavioral Therapy with mindfulness as a fundamental practice incorporated into each component of the program. The intervention group received the training in the first semester; the control group received identical program in the second semester. Stress Mindset Measurement and Brief Coping Orientation to Problems Experienced were measured before the intervention (T0), immediately after intervention on Intervention group (T1), and six months after intervention on Intervention group (T2). RESULTS At T1, the intervention group showed 65% improvements in stress mindset scores and increases in coping strategies scores in six domains (Problem solving, Social support, Humor, Religion, Venting, and Self-distraction) and decreases in three (Avoidance, Substance use, and Self-blame). The effect sizes were significant in all outcomes (Cohen's d > 0.2). Measurements of the control group did not change significantly in the same period. At T2, effects of the TSP were found decreased in some domains (Avoidance, Substance use, and Self-blame) compared to T1, but largely remained significantly better than T0. CONCLUSIONS The TSP is a feasible and effective approach that significantly enhanced medical students' stress mindset and coping strategies. Some effects were still observable 6 months after the intervention. The relatively intensive intervention requires support of the school administration and staff.
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Affiliation(s)
- Tan Nguyen
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christy Pu
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Alexander Waits
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tuan D Tran
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | - Song-Lih Huang
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Melendez-Torres GJ, Ponsford R, Falconer J, Bonell C. Whole-school interventions promoting student commitment to school to prevent substance use and violence: a systematic review. Public Health 2023; 221:190-197. [PMID: 37480745 DOI: 10.1016/j.puhe.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/01/2023] [Accepted: 06/17/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES Whole-school interventions that promote student commitment to school are a promising modality to reduce health inequalities through school-level change; however, evidence for the effectiveness of these interventions in improving policy-relevant health outcomes, such as substance use and violence, has not been comprehensively synthesised. STUDY DESIGN This was a systematic review and meta-analysis. METHODS We searched 20 databases and a range of other sources to identify randomised trials meeting our intervention definition and reporting substance use and violence outcomes. Extracted effect estimates were meta-analysed using robust variance estimation with random effects, separating effects <1 year from baseline and effects at or more than 1 year from baseline. RESULTS We included 18 evaluations with varying risk of bias. Pooled effects suggested significant impacts on short-term (odds ratio [OR] = 0.85, 95% confidence interval [CI] 0.76, 0.96) and long-term (OR = 0.79, 95% CI 0.65, 0.98) violence perpetration, short-term (OR = 0.84, 95% CI 0.72, 0.98) and long-term (OR = 0.85, 95% CI 0.73, 0.99) violence victimisation, and short-term (OR = 0.83, 95% CI 0.70, 0.97) and long-term (OR = 0.79, 95% CI 0.62, 0.998) substance use outcomes, with effects relatively stable between short-term and long-term analyses. Stratifying substance use meta-analyses by type (e.g. smoking, alcohol) did not impact results. All meta-analyses had substantial heterogeneity. CONCLUSION Although diverse in content, interventions appear effective with respect to the review outcomes and as a form of universal prevention. Future research should consider contextual contingencies in intervention effectiveness, given considerable policy and practice interest in these interventions and the need to support schools in effective decision-making as to intervention choice.
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Affiliation(s)
| | - R Ponsford
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - J Falconer
- Library & Archives Service, London School of Hygiene & Tropical Medicine, London, UK
| | - C Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Wolfenden L, McCrabb S, Barnes C, O'Brien KM, Ng KW, Nathan NK, Sutherland R, Hodder RK, Tzelepis F, Nolan E, Williams CM, Yoong SL. Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database Syst Rev 2022; 8:CD011677. [PMID: 36036664 PMCID: PMC9422950 DOI: 10.1002/14651858.cd011677.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions. OBJECTIVES 1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review. SELECTION CRITERIA We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines. MAIN RESULTS We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review. AUTHORS' CONCLUSIONS The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kate M O'Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Kwok W Ng
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensu, Finland
| | - Nicole K Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rebecca K Hodder
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Erin Nolan
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Musculoskeletal Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
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5
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Sánchez-Puertas R, Vaca-Gallegos S, López-Núñez C, Ruisoto P. Prevention of Alcohol Consumption Programs for Children and Youth: A Narrative and Critical Review of Recent Publications. Front Psychol 2022; 13:821867. [PMID: 35369212 PMCID: PMC8965835 DOI: 10.3389/fpsyg.2022.821867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Rafael Sánchez-Puertas
- Department of Health Sciences, Public University of Navarre, Pamplona, Spain.,Department of Psychology, Particular Technical University of Loja, Loja, Ecuador
| | - Silvia Vaca-Gallegos
- Department of Psychology, Particular Technical University of Loja, Loja, Ecuador
| | - Carla López-Núñez
- Department of Personality, Assessment and Psychological Treatments, School of Psychology, University of Seville, Seville, Spain
| | - Pablo Ruisoto
- Department of Health Sciences, Public University of Navarre, Pamplona, Spain
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Maina G, Mclean M, Mcharo S, Kennedy M, Djiometio J, King A. A scoping review of school-based indigenous substance use prevention in preteens (7-13 years). Subst Abuse Treat Prev Policy 2020; 15:74. [PMID: 32998753 PMCID: PMC7528230 DOI: 10.1186/s13011-020-00314-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Early-onset substance use is a risk factor for continued use, dependency, and poor long-term health outcomes. Indigenous youth are more likely to engage in early-onset substance use than their non-Indigenous counterparts. In Canada, culturally appropriate prevention programs are needed for Indigenous youth in elementary schools. Therefore, this scoping review aims to explore the published, international literature examining school-based substance use prevention programs for Indigenous children aged 7-13. MAIN TEXT Methods: This scoping review followed a six-step approach: 1) identifying the research questions, 2) identifying relevant studies, 3) selecting the studies, 4) charting the data, 5) collating, summarizing, and reporting the results, and 6) consulting with experts. The review was reported using guidelines from Preferred Reporting Items for Systematic reviews and Meta-Analyses extensions for Scoping Reviews (PRISMA-ScR). RESULTS Eleven articles (3 Canadian; 7 American and; 1 Australian) were included in the review. The prevention programs they studied were based on existing research or were adapted from existing interventions. The programs were tailored to each communities' culture by including Indigenous stakeholders in developing or adapting prevention programs to be culturally safe and responsive. The articles evaluated the programs' Effectiveness in changing student knowledge, attitudes, and behaviors using pre- and post-intervention surveys, randomized control trials, longitudinally designed analysis, and mixed methods. Mixed quantitative findings and qualitative findings highlighted the programs' value in building community capacity and fostering cultural revitalization. CONCLUSION This review highlights best practices for developing school-based substance use prevention programs for Indigenous youth. Findings suggest that prevention programs should be culturally responsive and provide students with the knowledge and skills to prevent and manage substance use in real-life situations. Making Indigenous beliefs, values, languages, images, and worldviews central to the prevention curriculum enhanced the Effectiveness, appropriateness, and sustainability of prevention programs. Indigenous communities are best positioned to facilitate cultural tailoring without compromising the fidelity of evidence-based prevention programs.
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Affiliation(s)
- Geoffrey Maina
- College of Nursing, University of Saskatchewan, 210-1301 Central Avenue, Prince Albert, S5V 4W1 S.K, Canada.
| | - Maeve Mclean
- Master of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Solomon Mcharo
- College of Nursing, University of Saskatchewan, Saskatoon Campus, Saskatoon, Canada
| | - Megan Kennedy
- Librarian- Library, and Museums - Public Services 2, University of Alberta, Edmonton, Canada
| | - Joseph Djiometio
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Canada
| | - Alexandra King
- Cameco Chair in Indigenous Health, University of Saskatchewan, Saskatoon, Canada
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Heris C, Guerin N, Thomas D, Chamberlain C, Eades S, White VM. Smoking behaviours and other substance use among Indigenous and
non‐Indigenous
Australian secondary students, 2017. Drug Alcohol Rev 2020; 40:58-67. [DOI: 10.1111/dar.13130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Christina Heris
- School of Population and Global Health University of Melbourne Melbourne Australia
| | - Nicola Guerin
- Centre for Behavioural Research in Cancer Cancer Council Victoria Melbourne Australia
| | - David Thomas
- Menzies School of Health Research Darwin Australia
| | | | - Sandra Eades
- School of Population and Global Health University of Melbourne Melbourne Australia
| | - Victoria M. White
- Centre for Behavioural Research in Cancer Cancer Council Victoria Melbourne Australia
- School of Psychology Deakin University Melbourne Australia
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Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
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Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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9
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Kamper SJ, Michaleff ZA, Campbell P, Dunn KM, Yamato TP, Hodder RK, Wiggers J, Williams CM. Back pain, mental health and substance use are associated in adolescents. J Public Health (Oxf) 2019; 41:487-493. [PMID: 30204888 DOI: 10.1093/pubmed/fdy129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During adolescence, prevalence of pain and health risk factors such as smoking, alcohol use and poor mental health all rise sharply. The aim of this study was to describe the relationship between back pain and health risk factors in adolescents. METHODS Cross-sectional data from the Healthy Schools Healthy Futures study, and the Australian Child Wellbeing Project was used, mean age: 14-15 years. Children were stratified according to back pain frequency. Within each strata, the proportion of children that reported drinking alcohol or smoking or that experienced feelings of anxiety or depression was reported. Test-for-trend analyses assessed whether increasing frequency of pain was associated with health risk factors. RESULTS Data was collected from ~2500 and 3900 children. Larger proportions of children smoked or drank alcohol within each strata of increasing pain frequency. The trend with anxiety and depression was less clear, although there was a marked difference between the children that reported no pain, and pain more frequently. CONCLUSION Two large, independent samples show adolescents that experience back pain more frequently are also more likely to smoke, drink alcohol and report feelings of anxiety and depression. Pain appears to be part of the picture of general health risk in adolescents.
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Affiliation(s)
- S J Kamper
- Centre for Pain, Health and Lifestyle, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Z A Michaleff
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - P Campbell
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.,South Staffordshire and Shropshire NHS Foundation Trust, St George's Hospital, Stafford, Staffordshire, UK
| | - K M Dunn
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - T P Yamato
- Centre for Pain, Health and Lifestyle, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - R K Hodder
- Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia.,School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Australia
| | - J Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia.,School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Australia
| | - C M Williams
- Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia.,School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Australia
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10
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Dudovitz RN, Wong MD, Perez-Aguilar G, Kim G, Chung PJ. Update on How School Environments, Social Networks, and Self-Concept Impact Risky Health Behaviors. Acad Pediatr 2019; 19:133-134. [PMID: 30287394 PMCID: PMC6401257 DOI: 10.1016/j.acap.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/03/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Rebecca N Dudovitz
- Department of Pediatrics, UCLA Children's Discovery and Innovation Institute (RN Dudovitz and PJ Chung); Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung).
| | - Mitchell D Wong
- Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung); Department of Internal Medicine, General Internal Medicine and Health Services Research (MD Wong)
| | | | - Grace Kim
- Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung)
| | - Paul J Chung
- Department of Pediatrics, UCLA Children's Discovery and Innovation Institute (RN Dudovitz and PJ Chung); Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung); Department of Health Policy and Management, Fielding School of Public Health (PJ Chung), University of California, Los Angeles; RAND Corporation (PJ Chung), Santa Monica, Calif
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11
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Nowak M, Papiernik M, Mikulska A, Czarkowska-Paczek B. Smoking, alcohol consumption, and illicit substances use among adolescents in Poland. Subst Abuse Treat Prev Policy 2018; 13:42. [PMID: 30497492 PMCID: PMC6267883 DOI: 10.1186/s13011-018-0179-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/09/2018] [Indexed: 12/28/2022]
Abstract
Background The use of alcohol, tobacco, and illicit substances typically first occurs in adolescence. The purpose of this study was to examine alcohol, cigarette, and illicit substance use among adolescents in Poland, including the age of initiation, frequency of use, methods of access, location of use, and parental knowledge and attitude. Methods An author-derived questionnaire was used to cross-sectionally survey 541 participants aged 13–17 years old. Due to the fact that some answers were lacking, the number of questionnaires analysed was 538 in case of smoking and illicit substances use, and 535 in case of alcohol drinking. Results The use of alcohol, cigarette, and illicit substance among the investigated group was 36.1, 37.6, and 10.8% respectively. The average age of initiation was 13–14 years old. Parents were aware of alcohol, cigarette, and illicit substance use 49.5, 35.8 and 22.4% of the time, respectively, and the rate of acceptance was 5.7 and 6.7% for alcohol and cigarettes. More than 28% of participants smoked in school, and 32.7% accessed illicit substances in the school’s neighborhood. Conclusions The rate of alcohol, cigarette, and illicit substance use in Poland is high and increasing, despite globally designed preventative actions. Parents’ awareness of children’s alcohol, cigarette, or illicit substance use is low, and schools hardly fulfil their educational and protective role. Preventative actions are necessary, and local challenges should be considered.
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Affiliation(s)
- Maria Nowak
- Department of Clinical Nursing, Medical University of Warsaw, E. Ciolka Street 27, 01-445, Warsaw, Poland
| | - Malgorzata Papiernik
- Department of Clinical Nursing, Medical University of Warsaw, E. Ciolka Street 27, 01-445, Warsaw, Poland
| | - Alicja Mikulska
- Department of Clinical Nursing, Medical University of Warsaw, E. Ciolka Street 27, 01-445, Warsaw, Poland
| | - Bozena Czarkowska-Paczek
- Department of Clinical Nursing, Medical University of Warsaw, E. Ciolka Street 27, 01-445, Warsaw, Poland.
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12
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Hodder RK, Freund M, Bowman J, Wolfenden L, Campbell E, Dray J, Lecathelinais C, Oldmeadow C, Attia J, Wiggers J. Differential intervention effectiveness of a universal school-based resilience intervention in reducing adolescent substance use within student subgroups: exploratory assessment within a cluster-randomised controlled trial. BMJ Open 2018; 8:e021047. [PMID: 30158221 PMCID: PMC6119444 DOI: 10.1136/bmjopen-2017-021047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/08/2018] [Accepted: 07/06/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Interventions addressing the individual and environmental protective factors of adolescents are suggested to have potential for reducing adolescent substance use. While universally delivered school-based substance use prevention interventions are common, previous studies have suggested variable effectiveness by subgroups of students. An exploratory study was undertaken to examine the differential effectiveness of a universal school-based resilience intervention on adolescent substance use and protective factors according to their sociodemographic and previous substance use. DESIGN Secondary analysis of data from a cluster-randomised controlled trial. SETTING 32 Australian secondary schools. PARTICIPANTS Cohort of grade 7 students (n=3155) followed up in grade 10 (aged 15-16 years; 2014; n=2105). INTERVENTION Three-year universal school-based intervention implemented by school staff that targeted a range of student resilience protective factors (2012-2014). MEASUREMENTS Primary outcomes included: tobacco (recent, number of cigarettes) and alcohol (recent, 'risk' and number of drinks) use, and secondary outcomes included: marijuana (recent) and other illicit substance (recent) use, and aggregate individual and environmental protective factor scores. Generalised and linear mixed models examined interactions between treatment and student subgroups (gender; socioeconomic disadvantage (low/high); geographic location (major city/inner regional/outer regional-remote); and previous substance use (non-user/user)) at follow-up (36 models). RESULTS Analysis of student follow-up data showed no differential intervention effect for any substance use or protective factor outcome for any subgroup, with the exception of one differential effect found by socioeconomic status for the outcome of mean number of cigarettes smoked by recent smokers (p=0.003). There was no evidence of an intervention effect within the low (mean difference (MD) -12.89, 95% CI -26.00 to 0.23) or high (MD 16.36, 95% CI -1.03 to 33.76) socioeconomic subgroups. CONCLUSIONS No evidence of an intervention effect on substance use and protective factors was found according to student subgroups defined by sociodemographic characteristics or previous substance use. TRIAL REGISTRATION NUMBER ACTRN12611000606987.
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Affiliation(s)
- Rebecca Kate Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Megan Freund
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jenny Bowman
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Julia Dray
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, IT, and Statistical Support (CReDITSS), Hunter Medical Research Institute, Wallsend, New South Wales, Australia
| | - John Attia
- Clinical Research Design, IT, and Statistical Support (CReDITSS), Hunter Medical Research Institute, Wallsend, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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13
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Hodder RK, Campbell E, Gilligan C, Lee H, Lecathelinais C, Green S, MacDonald M, Wiggers J. Association between Australian adolescent alcohol use and alcohol use risk and protective factors in 2011 and 2014. Drug Alcohol Rev 2017; 37 Suppl 1:S22-S33. [PMID: 29266434 DOI: 10.1111/dar.12623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND AIMS Changes in risk and protective factors of adolescent alcohol use may be contributing to the recent decline in Australian adolescents alcohol use. The study aimed to determine the: (i) prevalence of alcohol use, risk and protective factors in 2011 and 2014; and (ii) association between alcohol use and risk and protective factors in 2011 and 2014. DESIGN AND METHODS A repeat cross-sectional study was conducted. Grade 9-10 (aged 15-17 years) students from 32 Australian secondary schools were sampled in 2011 and 2014. A self-report survey collected data regarding alcohol use (ever, recent, 'binge drinking'), risk factors (e.g. alcohol use/permissive attitude to alcohol by friends/siblings/parents) and protective factors (e.g. self-efficacy; school/home/community support; peer caring relationships). Descriptive statistics were used to determine differences in alcohol use, risk and protective factors between 2011 and 2014. Adjusted multivariable logistic regression analyses examined associations between alcohol use, risk and protective factors separately in 2011 and 2014 (six models). RESULTS Fewer adolescents reported alcohol use in 2014 compared with 2011 (ever: 56.6% vs. 67.9%, recent: 17.3% vs. 21.2%, 'binge drinking': 20.0% vs. 23.5%; 2011: n = 4366; 2014: n = 5199). Significant differences between 2014 and 2011 were found for some risk (five lower; one higher) and protective factors (four lower). Risk factors that were significantly lower in 2014 compared to 2011 were amongst variables with the strongest associations with alcohol use. DISCUSSION AND CONCLUSIONS The strength of associations with alcohol use, and decrease in the prevalence of certain risk factors in 2014 compared to 2011, suggests such factors may be contributing to the decline in adolescent alcohol use.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre Health Behaviour, The University of Newcastle, Newcastle, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre Health Behaviour, The University of Newcastle, Newcastle, Australia
| | - Conor Gilligan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre Health Behaviour, The University of Newcastle, Newcastle, Australia
| | - Hopin Lee
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre Health Behaviour, The University of Newcastle, Newcastle, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre Health Behaviour, The University of Newcastle, Newcastle, Australia
| | - Sue Green
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Meghan MacDonald
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre Health Behaviour, The University of Newcastle, Newcastle, Australia
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