Daily Activities in European Children and Adolescents During COVID-19 School Closure: A Longitudinal Study Exploring Physical Activity, Use of Screens, and Sleep Patterns

This longitudinal study aimed to analyze the evolution of patterns of daily activities (physical activity time, screen usage time, and sleep hours) in European youth during school closure due to the COVID-19 health crisis. Participants were 624 caregivers of children and adolescents aged 3-18 from Italy, Spain, and Portugal. Evaluations were online, and four time-points were considered: retrospective measurement of daily activities before confinement (T1), and two (T2), five (T3), and eight (T4) weeks after starting the lockdown. Generally accepted international guidelines on physical activity time, screen usage time, and hours of sleep by age group were used to determine whether the pattern might increase the risk for ill health or not. To estimate the evolution of daily activities, generalized estimating equations (GEE) were used. The percentage of children who practiced less than 60 min of daily exercise increased significantly from before home confinement (47.8%) to T2 (86.4%); it slightly decreased at T3 (79.8%), and remained stable at T4 (76.1%). The percentage of children who made excessive use of screens (according to their age group) significantly increased from T1 to T2 and remained stable and high in the rest of the evaluations. The percentage of children who slept fewer or more hours than recommended for their age group remained stable between T1 and T4, although there was a significant increase at T3. In general, results found unhealthier behaviors as confinement was extended. Results are discussed in order to find strategies for promoting healthy daily activities for future pandemics.

Stressful Life Events in Children Aged 3 to 15 Years During the COVID-19 Pandemic: A Latent Class Analysis

BACKGROUND

Although several studies have reported an increase in psychological problems during the COVID-19 pandemic, the impact of stressful life events on Spanish children and adolescents using a person-oriented statistical approach and the relationships between the profiles and emotional and behavioral symptoms have not yet been examined. The present study aims to identify profiles of Spanish children and adolescents, considering life-threatening stressful events during the COVID-19 pandemic.

METHOD

Participants were 252 parents of children aged 3 to 15 years old who completed an online structured questionnaire that collected information about stressful life events related to the pandemic and its impact on their children's welfare.

RESULTS

Through Latent Class Analysis (LCA), four profiles of children and adolescents were found according to the stressful events experienced: "COVID infection, social confinement", "economic loss", "reduced social contact" and "parental stress", with no significant age or gender differences. Reduction in social contact was the most prevalent stressor. Comparisons of psychological symptoms across latent classes were analyzed.

CONCLUSIONS

The findings increase our understanding of how stressful life events during the COVID-19 situation impacted young people's psychological welfare and highlight the need to promote strategies to prevent emotional problems during a pandemic considering the identified profiles.

Effectiveness of psychological treatments for depression in childhood and adolescence: A review of reviews

Depression in childhood and adolescence is a public health problem due to its high prevalence and the impact it has in the individual development. There is clear evidence of the efficacy of Interpersonal Therapy (IPT) and Cognitive-Behavioural Therapy (CBT) in the treatment of depression in children and adolescents; however, recent reviews and meta-analyses provide new perspectives for treatment. The purpose of this work is to synthesize the bibliography available through a systematic review of systematic reviews and meta-analysis that summarizes in a comprehensive way the evidence of the last two decades on the effectiveness of psychological interventions for infant-juvenile depression. A systematic review of systematic reviews and meta-analyses was performed. A search was conducted in the Web of Science and Scopus databases. Eight records met the inclusion criteria, 2 were analysed in their entirety and from the remaining 6 the information needed for independent analysis was extracted. Seven different psychotherapies were studied: CBT and IPT were the most studied (n=7; 87.5%), followed by family therapy (n=5; 62.5%), psychodynamic therapy (n=3; 37.5%), behavioural therapy (n=3; 37.5%), computerised CBT (n=2; 25%), problem-solving therapy (n=1; 12.5%) and supportive therapy (n=1; 12.5%). IPT and CBT were shown to be effective in the treatment of adolescent depression. Half of the reviews (n=4; 50%) had a low methodological quality and the other half (n=4; 50%) were classified as critically low. In general, psychological interventions for child and adolescent depression produce significant, but modest effects. Specifically, IPT and CBT can be considered the main treatment alternatives for adolescent depression. There is insufficient data of specific psychological treatment for children diagnosed with a depressive disorder. It is suggested that research should be increased to improve the methodological quality and increase the number of studies aimed at the children population.

Spanish Validation of the Short Mood and Feelings Questionnaire (SMFQ) in Children Aged 8-12

BACKGROUND

The Short Mood and Feelings Questionnaire (SMFQ) is one of the few well-established available measures designed to assess childhood depression. The objective of the present study was to assess the psychometric properties and explore the differential item functioning (DIF) of the SMFQ in a community sample of Spanish children. Gender and age differences in SMFQ scores were also analyzed.

METHOD

The sample included 824 students aged 8-12 years (Mage = 9.64, SD = 1.2) recruited from four public and private schools in urban areas in the southeast of Spain.

RESULTS

Findings from factor analysis and Polytomous Rasch analysis supported a unidimensional interpretation of the SMFQ, thereby replicating findings across cultures and languages. The SMFQ had good reliability, and test-retest analysis indicated fair to good temporal stability. Evidence of construct validity was provided by a path diagram of the SMFQ and SDQ subscales. No age or gender differences in the SMFQ scores were observed. However, two items (3 and 11) exhibited gender-related DIF.

CONCLUSIONS

The use of SMFQ sum-scores as a continuous measure of the severity of depressive symptoms can be supported. The measure shows promise as brief, reliable, valid instrument for the assessment of depressive symptoms in Spanish children.

Examining academic self-concept as a mediator of the relationship between anxiety and depression: A longitudinal study

BACKGROUND

Self-concept plays a role as a mediator in the development and maintenance of internalizing symptoms but mechanisms through which the early presence of anxiety symptoms is associated with the subsequent development of depression is unknown. The aim of this longitudinal study was to analyze the mediating role of different areas of self-concept in the relationship between the early development of anxiety symptoms and the later appearance of depressive symptoms.

METHODS

A longitudinal study with 3 time-points was conducted, including baseline, 2 months and 12 months from the baseline assessment. A total of 217 children aged 8-12 years participated. Mediation analyses were conducted using PROCESS Macro for SPSS.

RESULTS

Academic self-concept (Time 2) mediated the relationship between Anxiety (Time 1) and Depression (Time 3) when controlling for children's sex and, age, baseline value of the mediator, anxiety (at Times 2 and 3), and depression (at Times 1 and 2). Children with self-reports of higher anxiety symptoms (Time 1) presented lower Academic self-concept (Time 2). Children who reported lower levels of Academic self-concept and Family self-concept (Time 2) were more likely to develop depressive symptoms (Time 3).

CONCLUSIONS

Feeling competent in the school environment may be considered a protective factor against the development of depression in childhood. The identification of risk factors facilitates the development and implementation of preventive programs.

Early detection of anxiety problems in childhood: Spanish validation of the brief Spence Children's Anxiety Scale for parents

The small percentage of children with anxiety problems who receive psychological treatment, and the negative psychological consequences associated with these problems highlight the need for early detection. Although assessment instruments with appropriate measurement properties exist, they tend to be extensive, making it difficult to apply them in clinical settings, schools, or primary care practices. This study aimed to adapt the Spanish brief version for parents of the Spence Children's Anxiety Scale (SCAS-P-8). For this purpose, information on 215 children between 8 and 12 years of age was reported by 163 parents. The Spanish version of the SCAS-P-8 adequately fit a one-factor structure, χ² = 44.25; df = 19; comparative fit index = .97; Tucker-Lewis index = .96; root mean square error of approximation: .07 (.04, .09); standardized root mean squared residual = .08. Evidence of internal consistency of the total SCAS-P-8 score was good (α = 0.82), and the direct correlations obtained between the SCAS-P-8 and internalizing problems showed evidence of convergent validity. Moreover, the appropriate measurement properties of the SCAS-P-8 were shown to be independent of gender. Differences in sociodemographic variables and SDQ-P between children with anxiety symptoms and those without anxiety symptoms were also discussed. Information reported by parents can help the clinician carry out an accurate diagnosis. A brief assessment scale can be easily applied in schools or primary care settings.

Validation of the Children's Separation Anxiety Scale - Parent Version (CSAS-P)

The main objective of this research was to validate the parents’ version of the Children’s Separation Anxiety Scale (CSAS-P), which assesses separation anxiety symptoms in pre-adolescence, the stage with the highest incidence of anxiety disorder due to separation. In Study 1, 1,089 parents, those children aged between 8 and 11 (M = 9.59, SD = 1.11), 51.7% girls, were selected by random cluster sampling, who completed the CSAS-P to obtain the factorial structure. Exploratory factor analysis identified four related factors: Worry, Opposition, Calm, and Distress, which explained 42.93% of the variance. In Study 2, 3,801 parents, those children aged between 8 and 11 (M = 9.50, SD = 1.10), 50.2% girls, completed the CSAS-P, and their children completed the Children’s Separation Anxiety Scale (CSAS). The four related-factor model from Study 1 was validated by confirmatory factor analysis. The CSAS-P had adequate internal consistency (α = 0.84), temporal stability (r = 0.72), and invariance across children’s age and gender and the parent who completed the scale. Age and gender differences were small: older children scored higher on Worry and younger children on Distress; the girls scored higher on all factors. Small differences were also found depending on the parent who completed the scale without finding a clear pattern. Parents scored significantly lower than the child on all four factors of the scale. The results support the reliability and validity of the CSAS-P, an instrument that complements the child’s self-report in the framework of the multi-source assessment.

Psychological Symptoms in Italian, Spanish and Portuguese Youth During the COVID-19 Health Crisis: A Longitudinal Study

Aiming to slow down the spread of the COVID-19, a lockdown was declared in the first term of 2020 in many European countries, applying different restrictions measures. Although the psychological effects of home confinement in children have been described, there is a lack of longitudinal research examining the impact of the confinement over time. The present study analyzes the evolution of the psychological wellbeing of children and adolescents from three European countries with different restrictions. Parents of 624 Italian, Spanish, and Portuguese children and adolescents aged 3 to 18 years old completed the "Impact Scale of COVID-19 and Home Confinement on Children and Adolescents" two, five, and eight weeks after the lockdown. Results show a different pattern for each country. Children from Italy, the first European country that applied a lockdown, were better adapted than Spanish and Portuguese children the first two weeks after confinement but they were more psychologically impacted by home confinement at the eight-week assessment. Portuguese children, who followed a general duty of home confinement, were the best adapted to the situation, with no significant differences over time. A significant change was found in anxiety symptoms in Spanish children, with a decrease at the last assessment. Findings suggest that long confinements and hard restrictions affect children, so prevention measures should be applied during confinements to prevent psychological problems in children.

Effects as a function of implementation fidelity of a transdiagnostic prevention program in young school-aged children

Super Skills for Life (SSL) is a transdiagnostic prevention program for school-aged children with internalizing problems. The current study aimed to examine the short- and long-term (12-month follow-up) effectiveness of SSL, depending on implementation fidelity. Participants were 123 Spanish-speaking children aged 6-8 years with internalizing symptoms and their parents. High (n = 41) and low fidelity (n = 26) groups were established and compared with a control group (CG) (n = 56). Compared to CG, the high-fidelity group (HFG) achieved better outcomes than the low-fidelity group (LFG) at short and long term, including symptoms of anxiety, depression, and internalizing problems, and also externalizing problems at long-term. The LFG improved key symptoms at short term (depression) and long term (anxiety and depression). Findings suggest that SSL is beneficial even if not delivered at maximum fidelity, although considering the influence of implementation fidelity is critical because the high-fidelity implementation yielded the greatest effects when compared to the CG. This research provides valuable data, analyzing for the first time the influence of fidelity on SSL outcomes in young school-aged children exhibiting internalizing symptoms, while there is still a lack of studies of these characteristics concerning transdiagnostic prevention programs targeting childhood anxiety and depression.

Validation of the brief version of the Spence Children's Anxiety Scale for Spanish children (SCAS-C-8)

OBJECTIVE

This study aimed to validate the self-reported brief version of the Spence Children's Anxiety Scale-Children (SCAS-C-8) in pre-adolescent Spanish children.

METHOD

Participants were 824 children aged 8-12 from a community sample. The results revealed a good fit to the one-factor structure, adequate internal consistency (α = 0.75), and evidence of test-retest reliability (α = 0.77).

RESULTS

The strong relationship between the SCAS-C-8 and emotional problems provided evidence of convergent validity. Also, the results showed factorial gender invariance.

CONCLUSION

The SCAS-C-8 is a suitable instrument for pre-adolescent Spanish children. The brevity and simplicity of this scale may facilitate early detection and help to narrow the existent gap between the presence of anxiety problems and psychological assistance-seeking.

A Cross-Cultural Study on Attachment and Adjustment Difficulties in Adolescence: The Mediating Role of Self-Control in Italy, Spain, China, and Poland

From a socio-ecological perspective, individuals are influenced by the interplay of individual, relational, and societal factors operating as a broader system. Thereby, to support youth adjustment during the critical adolescence period, the interplay between these factors should be investigated. This study aimed to investigate cross-cultural differences in adolescents' maternal and paternal attachment, adolescents' adjustment difficulties and self-control, and in their association. N = 1000 adolescents (mean (M) age = 16.94, SD = 0.48; 45.90% males) from China, Italy, Spain, and Poland participated by completing self-report measures. Results showed cross-country similarities and differences among the considered variables and their associative pattern. Moreover, conditional process analysis evaluating the association between maternal vs. paternal attachment and adjustment difficulties, mediated by self-control, and moderated by country, was performed. Maternal attachment directly, and indirectly through greater self-control, influenced adjustment difficulties in all four countries. This association was stronger among Spaniards. Paternal attachment influenced directly, and indirectly through self-control, on adolescents' adjustment difficulties only in Italy, Spain, and Poland, and was stronger among Polish adolescents. For Chinese adolescents, paternal attachment solely associated with adjustment difficulties when mediated by self-control. Thus, results highlighted both similarities and differences across countries in the interplay between maternal vs. paternal attachment and self-control on adolescents' adjustment difficulties. Implications are discussed.

Gestión emocional parental y sintomatología infantil durante la pandemia del covid-19

La pandemia por coronavirus ha provocado una situación de alerta sanitaria inesperada que ha resultado muy estresante tanto para niños como para adultos. Sin embargo, escasos estudios han explorado en qué medida la gestión emocional de las familias durante el confinamiento ha podido influir en la salud mental de los menores. Por ello, el objetivo del presente estudio fue analizar si el nivel de estrés de los padres, su satisfacción con la crianza y sus estrategias de regulación emocional estaban relacionadas con la sintomatología de sus hijos. La muestra de este estudio se compuso de 219 padres de niños españoles con edades comprendidas entre 3 y 18 años (M = 8,30; DT = 4,35). Los participantes completaron un formulario online para medir su satisfacción con la crianza (KPS), su estrés percibido (EEP-10) y sus estrategias de regulación emocional (ERQ) durante el confinamiento por la pandemia. Los resultados indicaron que existía una relación significativa entre las dificultades psicológicas de los niños y el estrés de sus padres, siendo el estrés parental un predictor de mayor sintomatología infantil. Asimismo, el estrés parental estuvo asociado con el menor uso de la reevaluación cognitiva y mayor uso de la supresión expresiva como estrategias de regulación emocional. El uso de la supresión expresiva como estrategia de regulación emocional estuvo relacionado con mayor sintomatología en los niños. Por otra parte, la mayor satisfacción parental con la crianza se asoció a un menor estrés parental y sintomatología en los niños. En conclusión, los hallazgos del estudio sugieren que el estrés de los padres debido a la situación del COVID-19 tuvo repercusiones negativas en el estado emocional de sus hijos. Por tanto, es necesario aportar recursos a las familias para facilitar el afrontamiento de estas situaciones estresantes y favorecer un mayor bienestar familiar.

Psychological Treatments for Depression in Adolescents: More Than Three Decades Later

Depression is a common and impairing disorder which is a serious public health problem. For some individuals, depression has a chronic course and is recurrent, particularly when its onset is during adolescence. The purpose of the current paper was to review the clinical trials conducted between 1980 and 2020 in adolescents with a primary diagnosis of a depressive disorder, excluding indicated prevention trials for depressive symptomatology. Cognitive behavioral therapy (CBT) is the pre-eminent treatment and is well established from an evidence-based treatment perspective. The body of research on the remaining treatments is smaller and the status of these treatments is varied: interpersonal therapy (IPT) is well established; family therapy (FT) is possibly effective; and short-term psychoanalytic therapy (PT) is experimental treatment. Implementation of the two treatments that work well-CBT and IPT-has more support when provided individually as compared to in groups. Research on depression treatments has been expanding through using transdiagnostic and modular protocols, implementation through information and communication technologies, and indicated prevention programs. Despite significant progress, however, questions remain regarding the rate of non-response to treatment, the fading of specific treatment effects over time, and the contribution of parental involvement in therapy.

Spanish version of Super Skills for Life in individual modality: Improvement of children's emotional well-being from a transdiagnostic approach

OBJECTIVE(S)

This study analyzed the short-term effects of the Super Skills for Life (SSL) program in its individual format from the parents' perspective.

METHODS

Parents of 70 Spanish children aged 8-11 years (M = 9.31; SD = 1.16) completed assessment instruments about their children's emotional state at the baseline and postintervention.

RESULTS

Analyses revealed significantly lower scores in depression (The Mood and Feelings Questionnaire), anxiety, and specific disorders (The Spence Children's Anxiety Scale) (i.e., panic attack/agoraphobia, separation anxiety, social phobia, and generalized anxiety). Significant improvements were also found in anxiety life interference at home (The Child Anxiety Life Interference Scale), total difficulties, internalized and externalized problems, emotional symptoms, peer problems, and hyperactivity/inattention (The Strengths and Difficulties Questionnaire) at posttest. SSL was effective in reducing psychopathological symptoms similarly in both girls and boys.

CONCLUSIONS

These promising results provide preliminary support for the usefulness of the SSL program in individual format for the indicated prevention of children's emotional problems. This study provides a valuable resource for research and clinical practice.

The Nighttime Fears Scale: Development and psychometric evidence of a standardized self-report scale to assess nighttime fears in children

Nighttime fears are highly prevalent in children and are linked to children's distress and internalizing problems, especially childhood anxiety. Although its assessment may be critical, there is a lack of available standardized self-reports. This study aimed to describe the development and psychometric evaluation of the Nighttime Fears Scale (NFS), a new standardized self-report for assessing nighttime fears in school-aged children. The construction of the scale was based on prior relevant research and involvement of researchers and clinicians, experts in childhood anxiety, and fears. A total of 794 Spanish-speaking children (51.1 % girls) aged 8-12 years completed the NFS along with measures of anxiety, sleep problems, internalizing and externalizing problems, and positive behaviors. Exploratory and confirmatory factor analyses supported a four-factor structure of the NFS, consisting of 21 items measuring a range of potentially fear-provoking stimuli at nighttime. Strong internal consistency (alphas ranging from .87 to .94), adequate test-retest reliability, and evidence of convergent, divergent and incremental validity was found. This study provides initial support for the use of the NFS by clinicians and researchers, suggesting that it is a promising tool for a rapid and easily-administered assessment to identify the presence and intensity levels of a set of common children's nighttime fears.

Validation and Adaptation of the Brief Self-Control Scale With Spanish Adolescents: Factorial Structure and Evidences of Reliability, Validity, and Factor Invariance Across Gender and Age

During adolescence, the difficulty to control impulses is especially notable. The Brief Self-Control Scale has been used in different countries for years to study associations between self-control and other variables. However, its factor structure is not completely clear, and it is necessary to have a scale with psychometric assurances that evaluates self-control in adolescents. The aim of this study was to examine the factorial structure of the Brief Self-Control Scale and to provide evidences of reliability, validity, and factor invariance across gender and age in a sample of Spanish adolescents. Participants were 693 adolescents from Southeastern Spain, aged 13 to 18 years. Data supported an excellent fit to a two-dimensional model and evidences of reliability, validity and factor invariance across gender and age were obtained. This study provides new data on the two-dimensionality of self-control. The need of this tool becomes increasingly relevant to the susceptibility of new emerging addictions, such as mobile phones or internet.

Subtyping of Strengths and Difficulties in a Spanish Children Sample: A Latent Class Analysis

BACKGROUND

Externalizing and internalizing problems are frequent during childhood and are often comorbid. The current study aimed to explore subtypes of strengths and difficulties among Spanish children.

METHODS

The Spanish version of the Strengths and Difficulties Questionnaire was administered to 325 children (47.1% girls), aged 7-12 years (M = 9.64; SD = 1.34). Latent Class Analysis (LCA) was carried out to identify risk profiles in children according to their symptoms. ANOVA and multinomial logistic regression were performed to explore associations between latent classes and SDQ subscales, gender, age and number of siblings.

RESULTS

Five latent classes were found: "high difficulties" (34.2%), "internalizing" (5.2%), "externalizing" (26.5%), "hyperactive" (14.5%), and "well-adjusted" (19.7%). Children belonging to "High difficulties" group showed the highest scores for emotional symptoms, conduct problems, and hyperactivity/inattention. The most prevalent pure profiles were the "externalizing" and "hyperactivity" group, which represent children with elevated behavioral problems, restlessness and distraction. Children in the "internalizing" class showed the highest risk of peer problems.

CONCLUSIONS

These results support the diversity in the patterns of psychological strengths and difficulties and highlight the importance of early detection and intervention, especially in children's behavioral problems, in order to avoid vulnerability to comorbidity and more severe symptoms in the future.

Rumination, Catastrophizing, and Other-Blame: The Cognitive-Emotional Regulation Strategies Involved in Anxiety-Related Life Interference in Anxious Children

Childhood anxiety problems have a great impact on the daily functioning of children and their families. The first objective of this study was to compare whether the use of cognitive-emotional regulation strategies differs in children with and without anxious symptomatology. A second objective was to analyze the possible mediating role of regulation strategies in the relationship between the presence of anxious symptomatology and its subsequent interference in children's lives. In total, 315 children (53.7% boys) between 8 and 12 years old participated. Mann-Whitney-Wilcoxon U-test was used to analyze differences in the use of cognitive-emotional regulation strategies between children with and without anxious symptomatology. In order to identify the cognitive-emotional regulation strategies which mediate the relation between anxiety and the consequent interference in children's lives, mediation analyses were carried out. As expected, children with anxious symptomatology used more maladaptive regulatory strategies than those without such symptomatology. Multiple mediation models in parallel showed that catastrophizing, rumination, and other-blame mediated the relationship between anxiety problems and their consequent interference. The identification of functional or dysfunctional patterns of cognitive-emotion regulation may favor the inclusion of new components in the evidence-based interventions currently available, in an attempt to increase rates of remission of anxiety.

Anxiety and Depressive Symptoms in Children and Adolescents during COVID-19 Pandemic: A Transcultural Approach

BACKGROUND

Despite being necessary to delay the spread of COVID-19, home confinement could have affected the emotional well-being of children and adolescents. Knowing which variables are involved in anxiety and depressive symptoms could help to prevent young people's psychological problems related to lockdown as early as possible. This cross-sectional study aims to examine anxiety and depressive symptomatology in Italian, Spanish, and Portuguese children and adolescents in order to determine which variables are related to poorer well-being during the pandemic.

METHOD

The parents of 515 children, aged 3-18 years old, completed an online survey. Children's anxiety symptoms were assessed using the Spence Children's Anxiety Scale-Parent Version, and depressive symptoms were measured with the Short Mood and Feelings Questionnaire-Parent Version.

RESULTS

We found differences in anxiety and depression between countries, with higher anxiety scores in Spanish children, and higher depression scores in Spanish and Italian children compared to the Portuguese. Anxiety and depressive symptoms were more likely in children whose parents reported higher levels of stress.

CONCLUSIONS

These findings are discussed in the light of detecting and supporting affected children as early as possible.

Anxiety and Depressive Symptoms in Children and Adolescents during COVID-19 Pandemic: A Transcultural Approach

BACKGROUND

Despite being necessary to delay the spread of COVID-19, home confinement could have affected the emotional well-being of children and adolescents. Knowing which variables are involved in anxiety and depressive symptoms could help to prevent young people's psychological problems related to lockdown as early as possible. This cross-sectional study aims to examine anxiety and depressive symptomatology in Italian, Spanish, and Portuguese children and adolescents in order to determine which variables are related to poorer well-being during the pandemic.

METHOD

The parents of 515 children, aged 3-18 years old, completed an online survey. Children's anxiety symptoms were assessed using the Spence Children's Anxiety Scale-Parent Version, and depressive symptoms were measured with the Short Mood and Feelings Questionnaire-Parent Version.

RESULTS

We found differences in anxiety and depression between countries, with higher anxiety scores in Spanish children, and higher depression scores in Spanish and Italian children compared to the Portuguese. Anxiety and depressive symptoms were more likely in children whose parents reported higher levels of stress.

CONCLUSIONS

These findings are discussed in the light of detecting and supporting affected children as early as possible.

Internalizing and externalizing symptoms in Spanish children aged 6-8: Results of a latent profile analysis

BACKGROUND

Internalizing and externalizing problems are widely addressed in research. However, most studies use variable-centred approaches and ignore the possible co-occurrence of both types of symptoms. This study aimed to identify homogeneous groups of children with similar psychological difficulties and strengths, using latent profile analysis as a person-centred approach.

METHODS

The parents of 107 Spanish children aged 6 to 8 years completed the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The results revealed the existence of four latent groups. The children who belonged to the high difficulties group showed the most severe symptoms in emotional problems, peer problems and hyperactivity. The children classified in the externalizing group showed high levels of hyperactivity, behavioral problems, and emotional problems. On another hand, the internalizing profile grouped children with emotional and peer problems. Finally, the well-adjusted group showed an adequate psychological adjustment in all evaluated variables. High difficulties were associated with lower educational attainment of their parents.

LIMITATIONS

Data were reported from a single source of information, father or mother. Also, the socio-demographic variables that were related to each one of the four profiles only considered the age and educational level of the main informant.

CONCLUSIONS

These data suggest that co-occurrence of symptoms is very high in young Spanish children. It is essential to carry out clinical assessments that include both types of symptoms. Considering externalization and internalization as independent and exclusive phenomena can compromise the effectiveness of psychological treatments and preventive programs.

Sexually Unexperienced Adolescents Benefit the Most From a Sexual Education Program for Adolescents: A Longitudinal Cluster Randomized Controlled Study

Using a longitudinal cluster-randomized controlled design, we examined whether the effects of Competencies for Adolescents with a Healthy Sexuality (COMPAS), an evidence-based sexual health promotion intervention, differ by adolescents' sexual experience. Participants were 699 students aged 14-16, 45.9% were sexually experienced, and assessed in the baseline, posttest, and 12- and 24-month follow-ups. All were recruited from 10 schools that were randomly assigned to the COMPAS program and waiting-list groups (WLG). Using an intent-to-treat analyses, longitudinal changes in psychosocial and behavioral outcomes were explored using generalized estimating equations. Compared to the WLG, COMPAS had a positive impact on six of the seven psychological and behavioral outcomes. Non-sexually experienced reported more favorable HIV-related attitudes, higher condom use intention, lower number of sexual partners, and higher condom use than those sexually experienced. Findings support the importance of implementing sex education actions before adolescents get involved in their first intimate relationships in order to achieve greater impact.

Immediate Psychological Effects of the COVID-19 Quarantine in Youth From Italy and Spain

The COVID-19 quarantine has affected more than 860 million children and adolescents worldwide, but to date, no study has been developed within Western countries to examine the psychological impact on their lives. The present study aims to examine for the first time the emotional impact of the quarantine on children and adolescents from Italy and Spain, two of the countries most affected by COVID-19. Participants were 1,143 parents of Italian and Spanish children aged 3 to 18 years who completed a survey providing information about how the quarantine affects their children and themselves, compared to before the home confinement. Results show that 85.7% of the parents perceived changes in their children's emotional state and behaviors during the quarantine. The most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). Spanish parents reported more symptoms than Italians. As expected, children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine. Furthermore, when family coexistence during quarantine became more difficult, the situation was more serious, and the level of stress was higher, parents tended to report more emotional problems in their children. The quarantine impacts considerably on Italian and Spanish youth, reinforcing the need to detect children with problems as early as possible to improve their psychological well-being.

How Super Skills for Life may help children to cope with the COVID-19: Psychological impact and coping styles after the program

As this is the first time that a pandemic has occurred in our recent history, preventive interventions for children´s emotional problems during confinement were not planned. A main goal of Super Skills for Life Program (SSL) is to provide children with skills to build emotional resilience and coping strategies for daily and difficult life situations, so examining how the program may help children to face the COVID-19 situation could be appropriate. The aim of this research was to compare parents’ perception of immediate psychological reactions to confinement and coping styles in children who received the SSL program before home confinement (n = 48) with an equivalent sample of children who did not attend the program (n = 48). Another objective was to study the relationship between children’s immediate psychological reactions to confinement and their coping styles. Parents (n = 96) completed an online survey providing information on sociodemographic variables, children’s immediate psychological reactions (anxiety/activation, mood, sleep, behavioral alterations, eating and cognitive alterations), and children’s coping styles (task-oriented, emotion-oriented, and avoidance-oriented strategies). Results indicated that the control group presented more symptoms of anxiety (p ≤ .001), worse mood (p ≤ .001), more sleep problems (p ≤ .01), and more cognitive alterations (p ≤ .01) during home confinement than children who received the program. Children in the control group were also more likely to use emotion-oriented strategies (p = .001), which were associated with presenting more psychological alterations. Although the SSL program was not created specifically for coping with the COVID-19 situation, it seems to provide children with skills to cope with this unexpected event.

Spanish Validation of the Adolescent Self-Consciousness Questionnaire

Self-consciousness development takes place mainly in adolescence because the brain undergoes certain structural changes that facilitate abstract thinking and metacognition, thus favoring the development of identity. Despite the importance of self-consciousness for mental health, there are no specific measurement instruments for Spanish adolescents. The objective of this study was to explore the dimensions of self-consciousness among Spanish adolescents aged between 13 and 18 years and validate the Chinese Adolescent Self-Consciousness Questionnaire (ASC) in this population. A second-order confirmatory factor analysis (CFA) was conducted in accordance with previous validations of the ASC, using R Studio and the Lavaan package, to test its adequacy in a Spanish sample. Internal consistency and temporal stability were also tested, and evidence of validity was found. The results showed a good fit to the model eliminating four items with poor fit indices, CFI = .90, TLI = .89, RMSEA = .078, 95% CI [.076, .080]. Higher self-consciousness was associated with greater self-esteem and lower depressive symptomatology. No significant gender differences were found. This study provides a valid measure to evaluate self-consciousness in Spanish adolescents. The relationship established between self-consciousness and anxiety and depression requires further study as self-consciousness is involved in the development and maintenance of adolescent psychopathology.

Effects of Super Skills for Life on the social skills of anxious children through video analysis

BACKGROUND

Super Skills for Life (SSL) is an innovative transdiagnostic cognitive-behavioral prevention program that has demonstrated positive results targeting children's internalizing problems. SSL has a strong component aimed at enhancing social competence, including strategies such as video-feedback with cognitive preparation. This study examined for the first time the immediate impact of SSL on improving social skills in young children with anxiety symptoms, as well as mediating factors predicting SSL anxiety outcomes.

METHOD

Participants were 67 Spanish-speaking children aged 6-8 years old. Children were video-recorded and assessed behaviorally through a 2 minute speech task, before and after the 8-session program.

RESULTS

The results revealed significant positive behavioral changes related to children' social skills in several domains. Depression acted as a mediator of change in pre- to post-intervention generalized anxiety scores.

CONCLUSIONS

This study provides initial support for the usefulness of SSL to immediately improve social skills in young children with anxiety symptoms.

One-Year follow-up effects of a cognitive behavior therapy-based transdiagnostic program for emotional problems in young children: A school-based cluster-randomized controlled trial

BACKGROUND

The present study examined the long-term efficacy of a transdiagnostic prevention program, Super Skills for Life (SSL), among young children with emotional problems. SSL is based on the principles of cognitive behavioral therapy, behavioral activation, and social skills training.

METHODS

One-hundred and twenty-three Spanish-speaking children, aged 6 to 8 years, and their parents participated in the study. They were recruited from ten schools. Schools were randomly allocated to either the intervention (IG) or waiting-list control (WLC) groups. The children's parent completed a set of questionnaires to measure their child's anxiety and depressive symptoms, general difficulties and positive attributes, and psychosocial impairment. Parent's assessment at baseline and at a 12-month follow-up was assessed using an intent-to-treat approach.

RESULTS

The IG, compared to WLC group, showed significant baseline-to-follow-up reductions in anxiety and depressive symptoms, as well as in behavioral difficulties and psychosocial impairment in various life domains.

LIMITATIONS

The small sample size and the reliance on parental reports were the major limitations of this study.

CONCLUSIONS

This study provides initial evidence of the long-term effects of SSL, suggesting that it is a promising indicated preventive intervention for young children with emotional problems.

Immediate Psychological Effects of the COVID-19 Quarantine in Youth From Italy and Spain

The COVID-19 quarantine has affected more than 860 million children and adolescents worldwide, but to date, no study has been developed within Western countries to examine the psychological impact on their lives. The present study aims to examine for the first time the emotional impact of the quarantine on children and adolescents from Italy and Spain, two of the countries most affected by COVID-19. Participants were 1,143 parents of Italian and Spanish children aged 3 to 18 years who completed a survey providing information about how the quarantine affects their children and themselves, compared to before the home confinement. Results show that 85.7% of the parents perceived changes in their children's emotional state and behaviors during the quarantine. The most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%). Spanish parents reported more symptoms than Italians. As expected, children of both countries used monitors more frequently, spent less time doing physical activity, and slept more hours during the quarantine. Furthermore, when family coexistence during quarantine became more difficult, the situation was more serious, and the level of stress was higher, parents tended to report more emotional problems in their children. The quarantine impacts considerably on Italian and Spanish youth, reinforcing the need to detect children with problems as early as possible to improve their psychological well-being.

Spanish Validation of the Child Anxiety Life Interference Scale (CALIS-C): Psychometric Properties, Factorial Structure and Factorial Invariance Across Gender

The Child Anxiety Life Interference Scale (CALIS-C) is a measure created to specifically identify life interference and impairment related to children's anxiety disorders in areas of daily functioning. Despite being a widely used scale, a Spanish version of the CALIS-C is not available. The purpose of this study was to adapt and validate the CALIS-C for Spanish-speaking children. We examined the CALIS-C factorial structure, factorial invariance across gender, and psychometric properties in a community sample of 336 (46.7% girls) Spanish-speaking children aged 8-12 years. Confirmatory factor analysis provided support for the original two-factor model. Excellent internal consistency coefficients were found for the total scale (0.88) and the subscales (0.85 and 0.82). 8-week test-retest reliability was moderate (IC = 0.51). Evidence of convergent and divergent validity was found, and factorial invariance across gender was reached. The current study provides initial support for the use of the CALIS-C with Spanish-speaking children by clinicians and researchers.

Super Skills for Life: Eficacia de un programa transdiagnóstico de prevención indicada para los problemas emocionales infantiles

El programa Super Skills for Life es un protocolo de intervención cognitivo-conductual basado en el enfoque transdiagnóstico. Está dirigido a niños de 6 a 12 años con síntomas de ansiedad y/o depresión y consta de 8 sesiones de intervención. Además de los componentes que habitualmente han mostrado su eficacia para la reducción de los problemas emocionales, incluye estrategias como la activación conductual, el entrenamiento en habilidades sociales y el video-feedback con preparación cognitiva previa, que suponen un beneficio añadido. Aunque fue inicialmente creado como un programa de prevención indicada para niños anglosajones, ha sido traducido y adaptado para ser administrado a población infantil española. Los estudios de eficacia que se han llevado a cabo con niños españoles ponen de manifiesto que el programa es capaz de reducir la sintomatología emocional a corto y largo plazo, y que reduce otros síntomas presentes, como problemas de atención e hiperactividad, problemas de conducta o problemas en las relaciones sociales. El programa se encuentra en fase de evaluación para probar su eficacia en otros formatos de aplicación y con otras poblaciones mostrando hasta el momento resultados prometedores

Spanish validation of the Delaying Gratification Inventory in adolescents

BACKGROUND

Individual differences in the capacity to delay gratification explain considerable variability in adult life outcomes related to health, psychological well-being, and social relationships. Although individual differences in delay of gratification begin to emerge in adolescence, few studies have tried to evaluate this construct in adolescents, especially in Spanish. The goal of this study was to validate the Delaying Gratification Inventory and to analyse its psychometric properties in Spanish adolescents.

METHOD

Using a sample of 695 adolescents (M = 15.18, SD = 1.22) between 13 and 18 years old, the factor structure, internal consistency and reliability were tested.

RESULTS

The analyses showed an adequate fit to the original model (χ ² (550) = 1671.59, CFI = .92, TLI = .92, RMSEA = .063, 95% CI [.063, .071]), and appropriate internal consistency (α = .80). The ability to delay gratification was directly and moderately associated with self-control and self-consciousness, and inversely and moderately related with depression and psychological difficulties.

CONCLUSION

This study provides new data on a tool for assessing the ability to delay reward in Spanish adolescents, a key regulatory ability to prevent unhealthy high-risk behaviours that are associated with serious health, psychological, and social problems.

Effectiveness of the program Super Skills For Life in reducing symptoms of anxiety and depression in young Spanish children

BACKGROUND

Super Skills for Life (SSL) is a transdiagnostic prevention program designed for children with anxiety and depressive symptoms based on cognitive-behavioral therapy. This study is a trial of the efficacy of the SSL program to reduce anxiety and depression symptoms in a representative sample of Spanish children aged 6 to 8.

METHOD

This cluster randomized controlled trial involved 123 Spanish-speaking children recruited from 10 schools. Schools were the unit of randomization, and were randomly assigned to one of two experimental conditions: intervention group (SSL) and waiting list control (WLC) group. Assessments were conducted before and after the 8-week intervention.

RESULTS

Generalized estimating equations showed that, compared with WLC, the intervention significantly reduced emotional symptoms of anxiety and depression. Significant improvements were also found in specific symptoms of anxiety disorders, and in the interference of anxiety in the child´s life.

CONCLUSIONS

The findings of this study provide initial support for the immediate effects of SSL, suggesting that it is a valuable resource for the early reduction of anxiety and depressive symptoms in young Spanish-speaking children.

Portuguese Version of the HIV-Related Attitudes Scale (HIV-AS) for Adolescents

Abstract. The HIV-related Attitudes Scale (HIV-AS) is a brief, valid, and reliable instrument, widely used in Spain. Because of the high risk of HIV in adolescents in Portugal and the scarcity of multidimensional measures to assess attitudes toward HIV-related aspects, reliable and valid instruments are essential for understanding sexual risk behaviors in this population. The aim of this study was to adapt and validate the Spanish version of the HIV-AS into Portuguese. Factor structure, internal consistency, temporal stability, and measurement equivalence with the Spanish version were examined. Analyses were conducted based on a sample of 1,618 adolescents aged 15–18 years (Portugal N = 624, and Spain N = 994). This study confirmed the four-factor structure of HIV-AS, including attitudes toward obstacles to safe sex, HIV testing, condom use, and people living with HIV/AIDS. Reliability was excellent (α = .82) and temporal stability was moderate ( r = .51). Results provided good initial support for the invariance at a strict level for Portuguese and Spanish samples. The Portuguese version of the HIV-AS is a valid and reliable tool for assessing relevant dimensions of attitudes toward HIV-related aspects in adolescents. Future research is needed to consolidate these findings and to generalize them to other populations and countries.

Validation of the short version of the Cognitive Emotion Regulation Questionnaire for Spanish children

This study aimed to validate a short version of the Cognitive Emotion Regulation Questionnaire for Spanish kids (CERQ-Sk) based on the 18-item version available for adults. A sample of 654 children aged 7-12 years completed the CERQ-Sk and tests for depression and anxiety measures. Confirmatory factor analysis supported the 18-item version and the original nine-factor structure, which includes self-blame, acceptance, rumination, positive refocusing, refocus on planning, positive reappraisal, putting into perspective, catastrophizing, and other-blame (comparative fit index = .99, Tucker-Lewis index = .98, root mean square error of approximation = .02). Internal consistency was adequate (ordinal α = .80), and the eight-week stability of this version was moderate (intraclass correlation = .69). Criterion validity was supported by correlations among self-blame, rumination, and catastrophizing (positive) and among positive reappraisal and depression and anxiety symptoms (negative). Results suggest that the short version of the CERQ-Sk is a valid and reliable instrument for assessing these cognitive emotion regulation strategies during the middle childhood developmental period. Clinicians and researchers will benefit from this briefer acceptable version when time is not available for the 36-item version. This study offers preliminary results for the first short version of the CERQ for children.

Role of smoking intention in tobacco use reduction: A mediation analysis of an effective classroom-based prevention/cessation intervention for adolescents

INTRODUCTION

Although some school-based tobacco cessation and prevention programs have been proven to be effective, there remains a lack of understanding of how these programs succeed.

METHODS

This longitudinal study aimed to test smoking intention as a mediator of Project EX's intervention efficacy to reduce tobacco use. Using a computerized random number generator, six high schools located in the Mediterranean coast were randomly selected to participate in the program condition (Spanish version of Project EX) or the waiting-list control group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 685 adolescents aged 14-20 years (mean age: 14.87; SD = 0.92; 47.4% were females) were evaluated using self-administered tests of tobacco, and smoking intention. A biomarker of smoke inhalation, a measurement of exhaled carbon monoxide (ECM), was used. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows.

RESULTS

Project EX had a significant effect on smoking intention. Indirect effects indicated that Project EX reduced the ECM level, and number of cigarettes used.

CONCLUSIONS

This is the first Spanish study that explored intention as a mediator of the long-term efficacy of Project EX to reduce tobacco use in adolescents. Results suggested that interventions that reduce consumption intention at short-term are more likely to be successful in decreasing tobacco use in the long-term.

Spanish validation of the Spence Preschool Anxiety Scale

BACKGROUND

The Preschool Anxiety Scale (PAS) is a 28-item measure designed to assess anxiety symptoms in preschoolers aged 31 to 83 months.

METHODS

The present study aims to extend the literature by examining the psychometric properties and factorial structure of the PAS in a Spanish community sample of 274 preschoolers aged 3 to 7 years.

RESULTS

Factor analysis confirmed the five-factor original model after removing eight items, suggesting a shorter 20-item version for the Spanish preschoolers. The scale demonstrated to have good internal consistency (Cronbach's α = 0.84). Moderate but significant correlations with a measure of health-related quality of life supported the convergent validity of the PAS.

CONCLUSIONS

The Spanish version of the PAS demonstrated to have good psychometric properties, providing these results initial support to its use for assessing a broad range of anxiety symptoms in Spanish-speaking preschoolers.

Spanish adaptation and psychometric properties of the child version of the Cognitive Emotion Regulation Questionnaire

Background

The Cognitive Emotion Regulation Questionnaire for children (CERQ-k) is a useful clinical and research tool to identify cognitive patterns of emotion regulation that predict the presence of emotional symptomatology. This study aimed to validate the Spanish version of the CERQ-k (the CERQ-Sk) using a sample of children from Spain, which is not available.

Methods

The sample consisted of 582 children (48.6% girls) aged between 7 and 12 years (M_age = 9.49; SD = 1.2) recruited from Alicante, Spain. Cognitive emotion regulation strategies, anxiety and depressive symptomatology were self-reported evaluated. Factor structure, internal consistency, temporal stability with the Spanish version for children were examined. Convergent validity was evaluated using Spearman correlations to examine the relationships between the CERQ-k and measures of anxiety (trait anxiety subscale of STAI-C) and depression (CDI).

Results

The Spanish version of CERQ-Sk had the same nine factors proposed in the original version. Ordinal alpha of the total scale was excellent (.88), and moderate indexes were found for each subscale (.56 to .75). The 8-week test-retest coefficient was adequate for the total scale (ICC = .74) and moderate for the subscales (.54 to .70). Evidence of convergent validity was provided through correlations with the CDI (depression) and trait anxiety subscale of the STAI-C (anxiety). Cognitive strategies such as Rumination, self-blame, catastrophizing, and other-blame were significantly and positively related to depressive and anxiety symptoms. Moreover, positive refocusing and planning seemed to act as strategies that have a positive effect on the prevention of depression in children.

Conclusions

Results suggest that the CERQ-Sk is a reliable and valid tool that can be useful for researchers and clinicians to identify maladaptive cognitive emotion regulation patterns that may increase the risk of emotional problems, and orient treatment and prevention of mental health problems in children from Spanish-speaking countries.

Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016

BACKGROUND

Numerous studies have evaluated the efficacy of interventions to reduce risk for sexually transmitted infections in adolescents in recent years, but their global effects remain unknown since 2008, the last date of a comprehensive review of prior studies.

AIMS

This study aims at evaluating the efficacy of interventions to promote sexual health, reduce STIs and unplanned pregnancies targeted to adolescents available after 2008; and analyzing the moderators of their global efficacy.

METHODS

We searched electronic databases and manual searches of some journals focused on STIs in May 2016. The studies evaluated the efficacy of interventions to reduce sexual risk in adolescents (age range: 11-19) anywhere in the world. Effect size of the relevant outcomes for sexual risk was calculated for every study. Analyses incorporated random-effect assumptions for each outcome. The homogeneity in the results was examined with the I2 statistic and its associated 95% confident interval.

RESULTS

Data from 63 studies (59,795 participants) were analyzed for behavioral and non-behavioral outcomes. In the short term, interventions had a positive impact in sexual health-related knowledge (Hedges'g = 1.01), attitudes (g = 0.29), self-efficacy toward condom use (g = 0.22), intention to refuse sex (g = 0.56), condom use intention (g = 0.46), and condom use (g = 0.38). In the medium term, positive effects observed at the short-term were maintained, although effect size significantly decreased in all variables. In the long term, interventions improved condom use (g = 0.47). Moderators of the efficacy are discussed.

CONCLUSIONS

Sexual health promotion interventions are effective to promote sexual health through increasing condom use. Effects on non-behavioral variables tend to decrease over time, while condom use increased in the long-term. Interventions should focus on the long-term efficacy, especially in behavioral and biological measures.

Problem video game playing is related to emotional distress in adolescents

Problem use of video games is an increasing risk behaviour. High exposure of adolescents to video games has been linked to a variety of disorders, but the relationship between problem video game playing and emotional welfare is unknown. The aim of the study is to analyse problem video game playing in a sample of adolescents and to determine whether there are differences between online and offline players, in addition to examining its relationship with anxiety and depressive symptomatology. A sample of adolescents (N = 380) completed self-reports measuring video game use and symptoms of anxiety and depression. We found that 7.4% of females and 30% of males can be considered as playing at problem levels. Online players were almost 12 times more likely to play at high frequency than offline players (χ2 (1, 267) = 72.72, p < .001, OR = 11.63, 95% CI [6.31, 21.43]). Males play more frequently, and play more online (χ2 (1, 267) = 50.85, p < .001, OR = 6.74, 95% CI [3.90, 11.64]), with a clear relationship between problem video game playing and anxiety (r = .24; p < .001). In females, there is a relationship between problem video game playing and depression (r = .19; p < .05). Our findings contribute to a better understanding of the psychological variables involved in problem video game playing. The implementation of strategies is suggested in order to prevent pathological gaming and associated problems.

Mediation of an efficacious HIV risk reduction intervention for adolescents: A cluster-randomised controlled trial

The 'Cuidate' programme for adolescents in Spain has proven to be effective for promoting healthy sexuality (N = 626), but the mechanisms underlying its effects are unknown. This study aimed to identify mediators of the intervention's effects compared to a control group. Participants were students from five areas of Spain, who completed baseline, immediate-posttest, 12-month and 24-month follow-up assessments. Mediation analyses revealed that 'Cuidate' positively affected consistent condom use indirectly through knowledge in serial with the intention to use condoms. The findings underscore the importance of targeting knowledge on HIV and sexually transmitted infections to promote condom use intention and consistent condom use.

Two-year Effects of a Classroom-based Smoking Prevention and Cessation Intervention Program

BACKGROUND

Project EX is a classroom-based smoking prevention and cessation intervention program that has been well evaluated and designed for assessing the prevention and cessation effects among adolescents in Spain. However, its long-term efficacy is still unknown. This study deals with the outcomes of a 2-year follow-up evaluation of Project EX.

METHODS

The intervention was tested using a clustered randomized controlled trial involving 1,546 Spanish students from 3 program schools and 3 control schools. At the end of the 2-year follow-up period, 722 subjects had completed the questionnaires (266 in the control condition and 456 in the program condition) administered to them.

RESULTS

Compared to the control condition, the program condition revealed a greater reduction in nicotine dependence (p = 0.04), smoking intention (p = 0.02), and in the number of cigarettes smoked during the previous month (p = 0.03). The CO monitor repeated assessments revealed a significant decrease of ppm levels in the program group (p < 0.001). Intent-to-treat quit rates were 14.28 and 0%, respectively, for the program and control conditions.

CONCLUSIONS

This study provides evidence about the long-term effectiveness of the Project EX classroom-based program for smoking prevention and cessation among adolescents in Spain.

Meta-analysis of the effectiveness of school substance abuse prevention programs in Spain

BACKGROUND

There has been an increase in adolescent substance use that has led to the development and implementation of prevention programs. New evidence is needed in order to improve them and optimize the resources. The aim of this paper is to use a meta-analysis to analyze the effectiveness of school drug prevention programs in Spain.

METHOD

Twenty-one studies that evaluated drug abuse prevention programs in schools, were published between 2002 and 2013, and that met the selection criteria were identified.

RESULTS

Preventive program effectiveness was low ( d = 0.16), although it was higher at the follow-up ( d = 0.30). The programs were most effective in changing attitudes ( d = 0.44) towards drugs. The models of health education ( d = 0.48) and social learning ( d = 0.20) were also very effective, especially in combination with oral, written, and audiovisual support material ( d = 0.21) and the implementation of joint programs by health education professionals and faculty members ( d = 0.25).

CONCLUSIONS

Is possible to determine the need for more rigorous evaluations of interventions to establish useful programs.

Implementation fidelity for promoting the effectiveness of an adolescent sexual health program

The goal of the present study was to examine COMPAS program (Competencies for adolescents with a healthy sexuality) outcomes based on implementation fidelity: dose, adherence, and acceptance. Participants were 716 adolescents aged 14-16 years (46.5% boys). Two fidelity groups were established: high (n=83) and low (n=312), with the remaining sample serving as a non-program control group (n=321). Knowledge about sexually transmitted infections (STIs), attitudes towards HIV, intention to use condoms, and sexual behavior were evaluated. Results indicated that adolescents receiving the intervention displayed improved STI knowledge (p<0.001) and improved attitudes toward HIV (p<0.05) as compared to the control group. Between the two intervention groups, a high-fidelity group intended to engage more in safe sex behaviors (p=0.05) and displayed greater STI knowledge (p=0.05) as compared to the low-fidelity group. The present study revealed improved efficiency when applying prevention programs with implementation fidelity.