A facilitated discussion including contributions from Professor Nanna Mik-Meyer (Danish National Centre for Social Research, DK); Albert Kern (Ministry of Health, DE); and Dr Kathryn Oliver (University of Oxford, UK)
SPEAKER: Kathyryn Oliver
SPEAKER: Nanna Mik-Meyer
SPEAKER: Albert Kern
How can prevention systems be defined and compared across European countries?
SPEAKER: Gregor Burkhart
ABSTRACT. We performed a comparative analysis of descriptive information from EMCDDA reporting countries aiming at a typology of prevention systems. Main parameters are: how prevention is funded and planned, whether funding is conditional to quality criteria, whether the different policy sectors (health, youth, criminal justice and education) cooperate, and how much effective prevention principles are prioritised. Important moderators are regulatory policies of alcohol, tobacco and leisure industries; social capital and the harshness of drug laws; while mediators would be the coverage (provision) of interventions, and the predominance of office-based services over street based services in selective prevention. Crucial however is how prevention policies are delivered at the ground. Countries much differ regarding the training level of the workforce that delivers prevention and only the Czech Republic has addressed this to date with an accreditation system. In several countries prevention professionals repudiate manualised interventions or believe in rational human decision making (“informed choices”) and despise therefore normative interventions. Especially indicated prevention is very dependent on such professional cultures. Distinct patterns emerge in the comparison where some countries address certain aspects of a prevention system better than others do. Portugal for instance has an impressive central funding and quality control system that uses the financial and human resources for prevention in a very efficient way, but has almost no evidence-based programmes in place. Federal regions in Germany and Spain focus on delivering evidence-based manualised programmes, but sometimes lack mechanisms for roll out, quality control and financial incentives of their implementation. In some cases, education ministries hinder the access to schools. However, and especially in those countries where all factors: funds, planning, development and implementation of prevention are entirely and autonomously delegated to the local level, it is difficult to assess how much communities actually follow the sometimes existing evidence-based guidelines from national institutes.
Improving prevention system functioning on state level
SPEAKER: Frederick Groeger-Roth
ABSTRACT. Prevention science advocates for the large-scale implementation of proven effective prevention interventions to achieve positive results on population level. Implementation research aims to identify factors for successful large-scale implementation processes on different level (e.g. programme characteristics, staff competencies, community conditions etc.). The level of support for the front-line prevention stakeholders seems to play a crucial role for positive implementation results. In my talk I will describe the lessons learned in the last decade to improve the functioning of a prevention support system for community-based prevention coalitions in the State of Lower Saxony in Germany. The implementation of the “Communities That Care” – model in Lower Saxony in the last years reveals a lot about the potentials, weaknesses and challenges of prevention support systems on state level. Results from evaluation studies and quality improvement circles will be utilized to discuss some ideas for further improving of prevention support systems.
How well do prevention programmes transport across countries? Using multi-level meta-regression to test the effectiveness of imported vs. home-grown parenting programmes for child disruptive behaviour
SPEAKER: Frances Gardner
ABSTRACT. Objective Children’s disruptive behaviour problems place children at high risk for oppositional defiant disorder and conduct disorder, and carry a high burden for individuals and society. Policy makers and service providers aiming to prevent or reduce children’s disruptive behaviour problems must often choose between importing an intervention developed abroad or instead developing or using a “home-grown” (i.e., local) intervention. No comprehensive comparison of these interventions exists.
Method We performed a systematic review and multilevel meta-regression of 129 randomised trials (374 effect sizes) of transported and home-grown parenting interventions. We identified trials by searching the included trials lists of systematic reviews, found through searches in 6 databases (e.g., MEDLINE, EMBASE). Trials that had not yet been reviewed were found by searching the same databases. Primary outcome was the mean difference in effectiveness between transported and home-grown interventions to reduce disruptive child behaviour. We also compared this differential effectiveness for various intervention “brands” (e.g., Incredible Years, Triple P) and geographical regions (e.g., North America, Europe).
Results Transported and home-grown interventions did not differ in their effectiveness for reducing disruptive child behaviour (d = 0.10, NS). Results were robust across intervention brands and geographical regions. Six trials on transported interventions in Hong Kong, Iran, and Panama suggest promising results for transporting interventions to “non-western” countries, whereas one trial in Indonesia does not.
Conclusion Parenting interventions based on the same principles led to similar outcomes, whether transported or home-grown. This finding supports the selection of interventions based on their evidence base rather than on cultural specificity.
The transition from efficacy to effectiveness of prevention interventions: reflections for a more rational choice of public health interventions
SPEAKER: Alessandro Coppo
ABSTRACT. Background. The evidence based prevention is becoming increasingly important to guide the policy-makers to choose preventive interventions to offer to the people. Sometimes, however, the impact of an intervention in real conditions (effectiveness) may be less than the theoretical efficacy (efficacy) estimated on the results of published studies. The analysis of interventions aimed at changing risky lifestyles often does not take into account this aspect. Aim. To evaluate the discrepancy between efficacy and effectiveness in preventive field we used as an example some interventions for smoking cessation currently available in Italy: 1) Interventions offered by Smoking Cessation Centers, 2) "Minimal Advice" provided by family doctors. Methods. Using epidemiological data and Monte Carlo simulations, we estimated the expected effectiveness of interventions under different scenarios. We also investigated the role of some determinants of effectiveness. Results. The Smoking Cessation Centers, even if they offered the most effective intervention available do not seem able to exert a significant influence on smoking cessation rates (estimated effectiveness: 0.7%). On the contrary, the interventions based on minimal advice are anticipated to have much greater effectiveness (21%). Discussion. The only assurance of effectiveness of prevention interventions is not enough to ensure a significant impact on health. The decision to implement a large-scale preventive action should be preceded by a careful evaluation of the expected effectiveness and be followed by a post-implementation monitoring in order to estimate the real impact of the intervention.
Collective impact: setting up is hard, sustaining it is harder.
SPEAKER: Daniel Ellis
ABSTRACT. The effort involved in establishing an outcomes driven, place-based, collective impact initiative is enormous. Just one of these things is demanding, but the three together is a real challenge. To get going, you need early investment. And before you can get that, you need to have built a skilled core team which has identified the needs in your ‘place’ and therefore what outcomes the initiative intends to deliver. You need to have found the right partners prepared to adopt the collective impact values and approach in order to meet those needs, deliver those outcomes and evidence them. You need to navigate public systems and multiple commissioners.
There is no doubt that set-up is hard. But sustaining this in the long-run is even harder. Sustainability requires monitoring, learning and improvement, and this requires data. This paper describes the West London Zone’s (WLZ) approach to this.
In collaboration with the Dartington Social Research Unit (DSRU), WLZ is building a simple and engaging data system to monitor implementation of the individual and collective support provided to the cohort of young people, as well as the outcomes and trajectories of those young people. Data are collected systematically and presented via a series of innovative dashboards in a clear and visually engaging way to reduce the time burden associated with data monitoring. Data serve two primary functions: (1) learning, improvement and tailored support; and (2) monitoring of individual children’s engagement and progress to improved outcomes and accountability of partners’ provision. We will describe the set-up, data systems and flows, and provide illustrations of dynamic dashboards. We will conclude by discussing some of the successes and challenges faced creating these systems and balancing improvement with accountability functions.
Preliminary findings from a systematic review of tools and instruments used to measure parent and child outcomes in evaluation studies of parent programmes for parents with children aged 0-5 years
SPEAKER: Nicole Gridley
ABSTRACT. Prevention and early intervention in the first five years of life is of significant public health importance as children with impaired social and emotional health and development are at risk of poor outcomes in later life. Research highlights the effectiveness of parenting programmes to promote child and parent well-being. Despite this, a lack of consistency in the types of outcome measures employed across different evaluation studies limits the comparability of programmes in terms of their impact on key outcomes. For example, there are a variety of tools available to assess child behaviour problems but there is uncertainty on which to choose and the rationale for the choice. Moreover, practitioners are increasingly seeking to assess impact of interventions or services on family outcomes, and there is a growing need to be able to choose the right measure, fit for purpose and context.
The purpose of the review was two-fold, and therefore a systematic dual-search strategy was applied; 1) we sought to identify the most commonly used standardised measures of parent and child social, emotional and psychological outcomes reported in randomised controlled trial evaluations of one-to-one and group-based parenting programmes designed for parents of children under the age of five; 2) we sought to identify from this list a sub-set of reliable and valid tools that could be used interchangeably by both researchers for evaluation purposes and professionals as part of ongoing monitoring processes.
This presentation will describe the rationale for conducting a systematic review of tools in parenting research. The search strategy and process for identifying appropriate tools for review will be presented, followed by an overview of our findings. The findings will focus specifically on quantitative data derived from a modified COSMIN checklist and qualitative data on acceptability obtained via focus groups with parents, researchers and health professionals.
Introducing and researching the KiVa antibullying programme in Wales
SPEAKER: Judy Hutchings
ABSTRACT. The development and evaluation of the school based KiVa antibullying programme was funded by the Finnish Government and shows excellent results in Finland, in an RCT involving 30,000 pupils and from subsequent broader roll-out and is now delivered in over 90% of all Finnish comprehensive schools. The programme includes universal actions, the core of which are class lessons, and indicated actions, specific strategies to deal with confirmed bullying incidents.
Wales has a statutory Personal Social Education (PSE) curriculum and KiVa lessons cover over 50% of this curriculum. KiVa was introduced in Wales in 2012 with Welsh Government support in a pilot trial of 17 schools. This trial targeted children aged 9 - 11 and delivered Unit 2 of KiVa. Significant reductions in reported bullying and victimisation were reported after one year of implementation and these reductions were maintained one year later. This success led to a successful bid to the BIG Lottery Innovation fund to undertake a small randomised controlled trial with Key Stage Two pupils aged 7 – 11 years in 20 Welsh primary schools. In the mean-time the Bangor Centre was accredited as a training agency for the UK and over 100 schools, including 70 in Wales, have now been trained.
This presentation reports on the outcomes from the pilot trial, the preliminary results from the RCT and broader roll out of KiVa in Wales in terms of child reported bullying and victimisation. The cost to schools of implementing KiVa is also presented. The paper describes challenges for implementers and researchers of introducing the programme to Wales and describes changes that have been made to the training and support to schools as a result of these experiences.
Using parent training in addition to standard interventions for developmentally delayed and disabled children improves behavioural problems of children, lowers parental stress and reduces family-related conflict potential
SPEAKER: Reiner Hasmann
ABSTRACT. Developmentally retarded and disabled children have a higher risk of becoming victims of violence. The Stepping Stones Parent Training (SSTP) offers for parents of affected children a behavioural intervention. It promotes social skills and encourages parents to support their child creating an inspiring learning environment and to positively influence child behaviour through consistent parenting strategies. Parents learn to have realistic expectations towards their child and to take care of their own needs. They are encouraged to accept their child’s disability and to take part in social life together. Through raising parenting competencies the parent-child relationship improves while conflict potential is reduced. Three studies investigate in different settings, how complementing medical standard treatment with SSTP positively influences dysfunctional parenting, parental stress and child behavioural problems. It is indicated to improve the child’s autonomy in everyday life and to raise parents’ self-efficacy. The effects are supposed to last beyond the end of the parenting training and high parental treatment satisfaction is expected. The data of three studies was gathered in early intervention centres (Theobald M et al, 2015 Z Psychiatr Psychol Psychother), sociopaediatric centres (Hampel OA et al, 2015 Monatsschr Kinderheilkd) and a specialized ambulance for autism-spectrum-disorders (Sprenger L et al, 2015 Kindh Entwickl). Subjects are parents with children (2 – 12 years old) treated in the respective centres during data collection. Parenting courses lasted 2 – 3 months. The pre- and post-treatment conditions were compared. Randomisation was conducted for one condition in one of the studies. Analyses and parent-interviews in these three studies showed significant improvements in child behaviour, parenting and parents’ self-efficacy, lower psychological burden for parents and improved child autonomy. Effects were stable for several months. SSTP is a useful add-on intervention treating developmentally delayed and disabled children, reducing main reasons for family-related conflicts, violence and supporting inclusion.
Preventive support options after parental divorce using the example of wir2
SPEAKER: Ralf Schäfer
ABSTRACT. About 170.000 children per year experience parental divorce in Germany. Every fifth child grows up in single parent families. In 90% of all cases the children live with their mothers. Thus and inconsistent with the demographic change, single parent families are the only family structure in Germany with tendency to rise.
Studies show the high risk of poverty associated with increased psychosocial stress and health strains among single parents and their children. Single parents face enormous challenges: Multiple burdens in everyday life, loss of social support and in some cases stressful divorces.
It is proved, that single mothers are at a higher risk of developing illnesses, compared to mothers in partnerships, for example addictive disorders, increased use of medicine, smoking, respiratory diseases, lung cancer, chronic pain, psychosomatic diseases and especially depression.
These burdens increase the risk of infantile behavior problems plus a negative educational impact and impairments to health. Long-term effects up to adult age are possible.
wir2 Bindungstraining (www.wir2-bindungstraining.de) can help to reduce these intergenerational risks. wir2 Bindungstraining is an attachment oriented parental training for single parents with children aged three to ten years.
The efficacy and sustainability of wir2 was proven within a RCT study. Therefore, it is listed in the highest category of evidence of the "Grüne Liste Prävention" and available throughout many communities of Germany.
Ten Year Follow-up of a Randomized Controlled and an Uncontrolled Trial of Triple P-Group: Outcome for Parent and Child Variables
SPEAKER: Kurt Hahlweg
ABSTRACT. Parent training is a major intervention for preventing behavior problems in childhood. The aim of the paper is to analyze the ten-year efficacy of the Triple P parent group training as a universal prevention strategy from the perspective of mothers and fathers. Method. At pre, 17 preschools were recruited for participation. Based on their respective preschool, families were either randomly assigned to a Triple P group parent training or a control group. The efficacy was analysed with a multimethod and multimodal assessment in 280 families. Furthermore, an uncontrolled trial was conducted with approximately 190 families from a low SES-background. Ergebnisse. At the follow-up’s up to 4 years later, most of the significant post-treatment changes were maintained. Mothers reported a significant reduction in dysfunctional parenting (PS), child behavior problems (CBCL), and in their psychological distress (DASS), while their relationship satisfaction (ADAS) improved. At the 10-year follow-up 249 families from the randomized controlled study were re-interviewed (retention rate 90%) as well as 110 families from the low-SES-group. Results showed stable reductions of child behavior problems at 10 year follow up, in particular Externalizing Disorders and Total CBCL scores. Furthermore, relationship quality was enhanced longitudinally, while no effects for parental stress was shown. This is the first study showing long-term effects for a brief parenting program in a universal setting.
Economic evaluation of an early childhood intervention to prevent obesity: the Primrose study
SPEAKER: Finn Rasmussen
ABSTRACT. Background Childhood obesity is a major public health concern. Given the individual and societal consequences of childhood obesity, decision-makers are in need of cost-effective prevention strategies. The aim was to assess the costs and cost-effectiveness of a novel primary prevention program targeting pre-school children attending child health centers in Sweden.
Methods The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among preschool children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period taking a societal perspective. The primary outcome of this trial is BMI at age 4. Cost data was prospectively collected alongside the trial. To account for uncertainty, bootstrapping techniques and sensitivity analyses were carried out.
Preliminary results The mean total costs of the PRIMROSE intervention was 4067 SEK per child. During preschool years direct costs mainly consist of training costs and costs for the additional time used by child health center nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents’ absence from work due to their participation in the intervention. Based the trial-based economic evaluation the incremental cost-effectiveness ratio was 1981 SEK per 0.1 BMI unit avoided.
Conclusion This health economic evaluation is among the first European economic evaluations of an early childhood obesity prevention intervention. A simulation study incorporating the life time societal impact is planned to capture all relevant costs and effect.
Main messages This economic evaluation of an early childhood obesity prevention intervention is expected to provide an estimate of the effect size needed to get lower costs per one BMI unit than by ‘usual’ primary obesity prevention at Swedish child health centers.
OPTIMISING HEALTHCARE TRANSITIONS FOR YOUNG PEOPLE
SPEAKER: Daniel Hale
ABSTRACT. Background: For young people with chronic health conditions the transition from paediatric to adult health services is fraught with difficulty. Despite policy initiatives to improve transition processes, there is little evidence of improvement. This study aims to describe transition outcomes and predictors of successful transition within a British cohort of adolescents using routinely collected hospital data.
Methods: We used data from Hospital Episodes Statistics. Our cohort included those aged 10-18 in 2004. We conducted analyses across chronic conditions as well as within asthma, cystic fibrosis, diabetes, epilepsy, and sickle cell disease. We defined successful transition as any adult service use within 6 months of the last paediatric appointment. We examined predictors of successful transition, including sociodemographics, area and pre-transition service use. Finally, we examined the association of transition success with subsequent health service use and mortality.
Results: Economically deprived young people less likely to transition successfully to adult services, as are those who transition at an early age. There were also clear area effects with London and the North-East of England performing particularly poorly. Within diabetes, poor transition predicts mortality but not post-transition service use. Within other conditions, poor transition was associated with reduced emergency contacts, inpatient service use and a reduced risk of mortality.
Conclusion: Our results suggest area and socio-economic inequalities in the provision of adequate transition. Within diabetes, there is clear evidence that poor transition increases the risk of mortality whereas across conditions, the transition to adult services occurs primarily for those with particularly severe health conditions. This confounding results in increased health risk among transitioning adolescents. Targeting policy initiatives at underserved populations could increase transition success. This may include delaying typical transition age. Within diabetes, this would decrease post-transition mortality and across conditions, may increase preventative service use within adolescents with less severe health conditions.
Physical activity and sedentary behavior in leisure time in 42-65 aged apparently healthy adults
SPEAKER: Lisa Voigt
ABSTRACT. Background: Regular physical activity (PA) and reduced sedentary time are independently and negatively associated with cardiovascular risk factors and all-cause mortality. Both aspects were examined in a sample of 42-65 aged apparently healthy adults who participated in an intervention study aimed to increase moderate and vigorous PA and to reduce sedentary time during leisure time. Methods: Among individuals who participated in a cardiovascular risk factor screening program (N=1231), 177 of 401 randomly selected apparently healthy individuals participated in the intervention study. After data cleaning 174 individuals remained for analyses (mean age of 54.4 years, SD=6.2; 35.6% men). The International Physical Activity Questionnaire and the Last 7-d Sedentary Behavior Questionnaire were completed at baseline to assess PA and sedentary behavior. Participants provided socio-demographic information. Descriptive statistics and non-parametric tests were calculated. Results: In total, leisure-time activity encompassed 15.5 MET-hours per week (Median; IQR=3.3-33.1). Participants spent 1.0 hours per week (Median; IQR=0.0-3.0) walking, were 0.5 hours per week (Median; IQR=0.0-2.0) physically active on a moderate-intensity level, and 0.0 hours per week (Median; IQR=0.0-1.5) physically active on a vigorous-intensity level. Furthermore, participants spent 2.6 hours per day (Mean; SD=1.6) watching TV and 0.9 hours per day (Mean; SD=1.4) using the computer during leisure-time (total screen time: Mean=3.5 h/day; SD=2.2). PA or screen time did not differ between sexes and regarding age. Individuals being regularly employed were less physically active (MET-h/week) in leisure time than those not (z=-3.39; p=.001) or not regularly employed (z=-3.15; p=.002). Unemployed individuals reported higher screen time than regularly employed individuals (z=-3.37; p=.001). Conclusion: Moderate and vigorous activities which are positively associated with cardio-preventive factors only account for a small amount of total leisure-time PA. Furthermore, participants reported high levels of screen time per day. The results suggest that individuals with potential to benefit from the intervention were addressed.
Does accelerometer wearing bias physical activity data? Trending in time series of physical activity measured by accelerometry as an indicator of measurement reactivity
SPEAKER: Sophie Baumann
ABSTRACT. Background: Accelerometry is thought to provide objective data on physical activity (PA). However, when a behavior is monitored, it is likely to change, even if no change may be intended. Evidence on reactive effects of accelerometry is inconclusive. The aim of this study was to investigate time trends in accelerometer-based PA as an indicator of measurement reactivity among apparently healthy adults. Methods: One hundred seventy-one participants from the general population (65% women; mean age = 55 years, range: 42–65 years) wore accelerometers during waking hours for seven days and recorded their working hours on each day wearing the accelerometer. Latent growth models were used to investigate linear and non-linear trends in three accelerometer-based PA indicators over the measurement period: sedentary behavior, light PA, and moderate-to-vigorous PA. Significant trends would imply reactive effects of accelerometry. Working hours and accelerometer wear time were included as time-varying covariates. The weekday on which the measurement started was tested as a predictor of time trends in the PA indicators. Results: Participants increased their sedentary behavior during the measurement period by 2.52 minutes per day (p = 0.02, Cohen’s d = 0.64). Light PA was reduced by 2.06 minutes per day (p = 0.04, Cohen’s d = 0.49). For moderate-to-vigorous PA, a quadratic rather than a linear time trend was found (i.e., it initially decreased and then sloped upwards). However, the differences between the first and consecutive measurement days were not significant (incidence rate ratios = 0.88–1.05, ps > 0.08). Adjusted for working hours and accelerometer wear time, the weekday on which the measurement started did not significantly affect time trends in the PA indicators. Conclusions: Accelerometry is likely to be susceptive to reactive effects which may bias PA data. The magnitude and functional form of reactivity effects may depend on the PA indicator.
Social competence and depression at the time of the great refugee crisis; European context Differences in social competence self-assesment of patientes diagnosed with depression due to the form of treatment
SPEAKER: Mirta Vranko
ABSTRACT. Depressive disorders are often associated with poor social competence and significantly disrupted social functioning that includes interpersonal relationships, frequency of interaction, a positive self-concept and social and cognitive skills (Stump et al., 2010). In the light of recent events of immigrant crisis and the many traumas and stressors faced by immigrants and refugees during their physical and psychological odyssey, they have been found to generally be at high risk for mental health problems (Keyes, 2000), especially depression and anxiety disorders, particularly post-traumatic stress disorders (Fox, Burns, Popovich, & Ilg, 2001). The aim of this paper is to observe and evaluate social competence of patients diagnosed with depression taking into account their views and perceptions of their own social competence. The study included 100 participant. A part of the sample is formed by patients who were hospitalized at University Psyhiatric Hospital Vrapče at the time of the survey. The other part of the sample involves patients who were engaged in the program of daily hospitals and social therapy program in the context of outpatient treatment. The results point out the need of strengthening social competence in different contexts similar to the needs of imigrants and refugee groups. The third phase of treatment of imigrants and refugees involves helping the refugee family maintain communication and liaison with the appropriate social services and mental health who help them in the process of adaptation and acculturation into the new host community (Guarnaccia & Lopez, 1998). Socal competence plays an important role in the process of adaptation and prevention of mental health problems, including depression, among imigrants and refugees. Taking all this into account there is a need for practicioners to design a contexually appropriate services for mental health support and strenghtening of protective factors for empowering social competence of imigrants and refugees.
The Impact of Brazilian Drug Abuse Prevention Program "Jogo Elos" in Promoting the Basis for Cultural Capital Appropriation
SPEAKER: Raquel Pedroso
ABSTRACT. Introduction: Drug-related mental disorders are the second leading cause of hospitalization in Brazilian public psychiatric institutes. The Coordination on Mental Health, Alcohol and Other Drugs Ministry of Health in Brazil in partnership with American Institutes for Research and with support of United Nations Office on Drugs and Crime, selected Good Behavior Game strategy to implement throughout national territory due to its effectiveness to decrease 2.7 times the long-term risk of substance abuse. However, significant portion of teachers who applied GBG in national territory used negative reinforcement or positive punishment contingencies, harmful conditions to emotional involvement with learning. Conceptual and structural adaptations were needed to diminish that risk.
Methods: Pre-pilot and Pilot versions of the program were experimented from 2013 to 2015 in 15 cities. To scale-up the strategy and simultaneously adapt it to national needs, the following procedures were taken: 1) analysis of program's fundamentals; 2) language review in instructional materials; 3) reinforcement contingencies analysis in accompanied classes; 4) efficacy analysis of modeling procedures to improve teaching performance; 5) structural and conceptual changes.
Results: Cross-cultural adaptations included: 1) differentiation between reinforcement and reward; 2) inclusion of praises during the game, unrelated with rule-breaking; 3) removal of public individualized feedback to rule-breaking; 4) addition of group directed feedbacks when members remain excluded of tasks; 5) addition of steps to favor children's autonomy. 83% of teachers felt comfortable/very comfortable with the strategy; 77% reported improvement on their positive perception of themselves as educators; and 90% reported that students became more cooperative. Qualitative data indicates impacts on students’ self-esteem related to their ability to learn and belong to a group.
Conclusions: Results indicate Jogo Elos effectiveness on favoring affective dispositions with school and knowledge, important path to diminish the historical disadvantage of Brazilian poorest segment of population on achieving academic success.
Latent Pattern of Health Risk Factors in Relation to Depressive Symptoms among Primary Care Patients
SPEAKER: Christian Meyer
ABSTRACT. Background The majority of the current burden of disease is attributable to unhealthy lifestyle behaviors. Epidemiological studies revealed that fulfilling multiple health risk behaviors is common. Depressive symptoms are highly prevalent as well and might be seen as a key factor impeding the adoption of a healthy lifestyle. The present paper aims to identify patterns of health risk behaviors and explore their association with depression.
Methods As part of a project conducted within the research consortium AERIAL (Grant No. FKZ01EE1406F), 2,886 consecutive patients from general medical practices and general hospitals (participation rate 88.6%) were screened for overweight/obesity, low fruit/vegetable consumption, tobacco smoking, alcohol consumption and physical inactivity. The presence of subclinical or clinical depression was assessed via the Patient Health Questionnaire depression scale (PHQ-8). Latent class analysis was performed to identify patterns of health risk behaviors. Multinomial logistic regression adjusting for age and sex was used to analyze the association of class membership with depression.
Results Best fit was found for a 3-class solution separating individuals with a healthy lifestyle (prevalence=35%), unhealthy substance abuse lifestyle (prevalence=29%), and an unhealthy overweight/inactive lifestyle (prevalence=35%). Both unhealthy lifestyle classes included low fruit and vegetable consumption. The healthy lifestyle class was less likely to report clinical or subclinical depression than the unhealthy lifestyle classes (p=.002). Clinical depression was more likely to be reported by individuals allocated to the overweight/inactive lifestyle class than the substance abuse lifestyle class (p=.03).
Discussion Depression might be considered for public health interventions addressing multiple health risk behaviors. In particular, preventive measures targeting individuals characterized by overweight and physical inactivity might benefit from including intervention content addressing depressiveness. Because our study is based on cross-sectional data, future prospective and experimental studies are necessary to further investigate causal relations of depression with health risk behaviors.
Controlling behaviours and technology-facilitated abuse perpetrated by men receiving substance use treatment in England and Brazil: prevalence and risk factors
SPEAKER: Martha Canfield
ABSTRACT. Introduction and Aims: Controlling behaviour (e.g. isolation, threats, intimidation, minimization) and sexual jealousy are highly prevalent forms of non-physical intimate partner violence (IPV) and often represents a precursor to physical and sexual violence. A wide variety of technology is now being used to abuse partners including email, text messaging, phone calls, social media, and GPS tracking. IPV perpetration is common among men receiving treatment for substance. The prevalence of controlling behaviours and technology facilitated abuse (TFA) perpetrated by men receiving treatment for substance use in England (n= 223) and Brazil (n=280) was explored. Factors associated with the perpetration of these behaviours and the association with other forms of IPV (emotional, physical, and sexual) were also explored.
Design and Methods: Secondary analysis of two cross-sectional studies was conducted. Data on participants’ socio-demographic characteristics, infidelity, IPV perpetration and victimisation, adverse childhood experiences, attitudes towards gender relations and roles, substance use, depressive symptoms, and anger expression were collected.
Results: 64% (223/143) of participants in England and 65% (280/184) in Brazil reported perpetrating controlling behaviour in their current/most recent relationship. Participants from England (33%) were more likely than those from Brazil (20%) to report perpetrating TFA (OR 1.90, 95%CI 1.27, 2.85). The odds of perpetrating TFA increased almost seven fold with the perpetration of controlling behaviour. Anger expression, infidelity, emotional IPV victimisation (England only) and experiencing a greater number of adverse childhood adversities (England and Brazil) predicted perpetrating controlling behaviour. Anger expression (England only), sexual IPV perpetration (Brazil only), and age (England and Brazil) predicted perpetrating TFA.
Discussions and Conclusions: Technological progress provides perpetrators with additional opportunities to control their partners. Addressing the characterise controlling behaviour associated with TFA could improve interventions to reduce intimate partner violence perpetration among male substance users.
Socio-economical inequalities in mortality and the contribution of life styles in the Italian Longitudinal Study.
SPEAKER: Cristiano Piccinelli
ABSTRACT. Background Social inequalities remain significant in mortality, with higher rates among the most disadvantaged people. In recent studies Behavioural Factors (BF) would appear to explain about 20-50% of inequalities in mortality.
Aims To measure social inequalities in overall mortality and assess the contribution of smoking, sedentary lifestyle, and Body Mass Index to mortality inequalities, in an Italian cohort.
Methods Cohort participants were 85,308, aged 25-74. Mortality follow-up was performed until 2012. Level of education was used as socio-economic status proxy. Mortality risks were estimated using multivariate Poisson models. The contribution of BF was estimated through the Explained Fraction (EF), comparing the model based on education, age, health status and behavioural factors with the model based on education, age and health status.
Results Mortality among low educated was 35% higher among highest educated in men and 34% in women, adjusting for age and state of health. Smoking (RR=1.59 for men and RR=1.66 for women) and sedentary lifestyle (RR=1.81 men and RR=1.46 women) were significantly associated with the risk of death in both genders, while the BMI showed contrasting effects between men and women. Among men, the BF explained 25% of the difference in mortality between the extreme classes of education, while among women their contribution was zero.
Conclusions In both sexes the differences in mortality for education are significant. Smoking, sedentary lifestyle and BMI reduce by 25% the differences in mortality between extreme classes of instruction in men. No reduction was observed in women. The reason of this difference is the social gradient in smoking, that is the opposite between men and women. The persistence of a differential in mortality may be due to other proximal factors not considered, such as dietary habits and exposure to environmental factors, but also to a direct effect of the socioeconomic status on mortality.
Lessons learned from practical examples of prevention in the UK public sector
SPEAKER: Miguel Garcia-Sanchez
ABSTRACT. This paper synthesises findings from three separate research projects, which assessed the impact of policy programmes implemented by public sector organisations between 2013 and 2016 in the UK. Outcomes The projects assessed prevention outcomes cross all age groups, including: • Academic attainment of under-18s from deprived backgrounds • Emotional wellbeing of families experiencing stressful circumstances, such as bereavements • Mental health of adults exposed to domestic violence • Levels of independence of socially isolated elderly people • Health status of elderly people who receive support at their homes Methods The projects were assessed by the same team of researchers using a wider range of evaluative techniques, including: • Pre-and-post tests • Statistical counterfactuals • Qualitative interviews The team used established questionnaires like EQ-5D, Warwick-Edinburgh mental health and wellbeing questionnaire, Adult Social Care Survey, and Health Survey for England. Applications By October 2016, the research will have been used by decision makers in a number of English local authorities to make operational and investment decisions. At the presentation, we will explain how the research has been used in practice. Relevance This paper is relevant to the objectives of the conference because it provides evidence of the effectiveness of programmes that intend to bring the health of a number of target groups in line with that of the rest of the population. This is particularly the case in relation to our statistical counterfactuals. Implications This paper will have meaningful implications for prevention research. Far from a purely academic exercise, the paper will highlight how research conclusions are used by decision makers. We will place the emphasis on the challenges around putting prevention into practice, for example, the extent to which the principle of ‘prevention, rather than cure’ is practical when short-term resources are limited.
Feasibility of a Proportionate Universal approach to the delivery of a family-based substance misuse prevention intervention: recruitment, group composition and implementation fidelity
SPEAKER: Jeremy Segrott
ABSTRACT. Background: Universal interventions have been criticised for having low reach among those most in need of support. Targeted approaches also face difficulties in identifying such groups, and may create barriers to engagement through stigmatisation. Proportionate Universalism (PU) addresses these limitations by integrating universal and targeted approaches (Marmot Review, 2010). Few studies have examined the implementation of PU, including the feasibility of combining universalism and targeting. Aims: This study evaluated the Proportionate Universal approach adopted by the Strengthening Families Programme 10-14 – a universal prevention intervention, in Wales, UK. Groups of participants comprised a mix of families who would find participation in a group intervention challenging and families who would not be challenged (target split=30:70%). This aimed to optimise implementation fidelity by managing challenge levels, and create group dynamics supporting hypothesized behaviour change. The study assessed: recruitment and reach across families with/without challenges; fidelity to the group composition model; and relationships between group composition and intervention implementation. Methods: Routine data were used to describe recruitment/retention and group composition. Questionnaires completed by parents/carers and children provided data on family characteristics. Intervention fidelity was assessed through facilitator/observer scores, and researcher observation. Interviews with recruitment/programme staff explored implementation of the group composition model. Results: Recruitment (n=715 families) succeeded in reaching families with heightened support needs. Most programmes achieved group compositions in which the majority of participants were families without challenges, which was the 70:30 model’s aim. Intervention fidelity and family attendance were high. Staff valued PU because it helped manage group dynamics, provide support to participants with higher levels of need, and enable delivery of activities as intended. Conclusion: Proportionate Universalism may improve the reach of universal interventions, and enable provision of support to participants with differing levels of need whilst maintaining intervention fidelity and avoiding some of the iatrogenic effects of targeted programmes.
Developing evidence-based prevention system for local communities in Slovenia
SPEAKER: Matej Košir
ABSTRACT. Institute Utrip conducted an analysis of situation in Slovenia in the field of prevention in 2011. One of the main conclusions was that there is a huge lack of evidence-based interventions at local level and also that there is an unstable and inadequate infrastructure for quality prevention work in almost all local communities in the country. Despite of rather long tradition of so-called “local action groups” approach (since the beginning of 1990s), there is a very small number of such local counselling bodies still active in reality. Furthermore, in most cases the work of those bodies is not based on evidence-based principles and minimum quality standards at all. The project which was initiated by rather small local community in northern part of Slovenia (Radlje ob Dravi) intends to develop a sustainable local prevention system and the major focus in pilot phase has been to increase knowledge and skills on quality prevention of local key stakeholders (e.g. local authorities, school staff, health and social services, youth workers, police etc.) and bring some evidence-based prevention interventions to their local community. The main catalysts of this progress are local authorities and youth centre. The project which started in 2013 uses the Communities That Care (CTC) programme as a model approach, but a bit adapted to national and local context. There have been several improvements of local situation in the field of prevention since the start of the project. Some results will be presented at the conference and several challenges for the future will be discussed with other attendees.
Training and education in preventive science and interventions: pilot implementation of UPC into the complex model of academic master study program in Addiction Science in Prague
SPEAKER: Michal Miovsky
ABSTRACT. The undergraduate bachelor’s study programme in addictology (Addiction Science) in the Czech Republic was opened in 2005. The academic addictology programme consists of full undergraduate education at the bachelor’s and master’s degree levels and, more recently, a doctoral (Ph.D.) degree. Prevention theory and practice is separate part/component of this study program and graduates are trained and prepared for real preventive work and using different preventive interventions in real practice. The Prague creative team has decided to implement Universal prevention curriculum (UPC) unto the master program and create completely new model of university master program for international students in English. It is a pilot implementation of UPC curriculum into the university context covers evaluation study conducted in collaboration with the International consortium of universities providing addiction programs (ICUDDR) established in Honolulu (USA) in March 2016 and University of South Florida. Author will reflect the process of developing an original Prague comprehensive program in addiction science and explain the context and procedure of UPC pilot implementation and creating new master study program integrated UPC curriculum.
Translating into Practice the EDPQS Trainer's Guide: an Experience with University of Genoa (IT), Faculty of Psychology Students
SPEAKER: Rachele Donini
ABSTRACT. The European Drug Prevention Quality Standards (EDPQS) were published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in 2011. They can help the prevention community as they: • Define what quality means in relation to drug prevention • Offer a vision of what prevention should aspire to • Formulate basic- and expert-level expectations toward prevention activities • Translate good practice recommendations into specific quality statements In October 2015 were launched a number of practical tools and materials, descending from the EDPQS, which aim to support practitioners, policy-makers and other members of the prevention community to achieve quality in their activities. EDPQS Toolkit 3, the EDPQS trainer’s guide, is one of the tools mentioned above and is designed to help trainers and professional educators to deliver training on quality and quality standards in drug prevention, including suggestions for interactive workshops with practitioners, decision-makers and University students, supported by presentation slides, participant handouts and more. An experience with 60 students of University of Genoa, that were trained following the EDPQS trainer’s guide will be proposed and discussed in its translation. The aims of the training were to test the tool, to train the new generations and to enhance students’ awareness, including in the psychological and cultural background classes and teachings about prevention and health promotion, which are still considered a subject not specific to the psychological profession. The difficulties of adapting to a specific context, the strengths of the EDPQS toolkit 3 and some of the training impacts will be presented , taking into account both the quantitative and qualitative results based also on the pre and post seminar quiz and the satisfaction forms, compiled by the students. The presentation wants to show the trainer’s guide translation process into practice and to offer some suggestions to enhance the tool.
Why do Group-based Behavioural Parent Training Programs Increase Parents’ Well-being? Understanding Mediating Mechanisms
SPEAKER: Metin Özdemir
ABSTRACT. Background Group-based behavioural parent training programs, such as Incredible Years and Comet, primarily focus on helping parents develop behavior management skills to reduce problems behaviors in children. Their effectiveness in reducing children’s conduct problems is well documented. Several studies also have shown that parents who participate in these programs reduce in depressive symptoms and stress. This (unintended) positive outcome of such programs has not been explained. The current study tested three potential mediating pathways (i.e., increased parenting efficacy, reduced problem behaviors in children, and increased social support) that may explain why behavioural parent training programs may improve parents’ mental-health by reducing depressive symptoms and stress.
Method The mediation hypotheses were tested using data from an RCT study that evaluated the effectiveness of Incredible Years and Comet programs in actual service settings. The data included 423 parents who were randomized into either one of the treatment conditions or a waitlist control group. The mediation models were fitted using latent change models.
Results The results of the mediation analyses showed that both increased parenting efficacy and reduced child problems mediated the link between participation in group-based parent training programs and improved well-being in parents. The mediation effects held for both parents of boys and girls.
Conclusion The findings suggest that evidence-based behavioural parent-training programs not only has the potential to reduce child problem behaviors but also improve parents’ mental-health. This secondary outcome set additional ground for dissemination of effective parent-training program programs.
Understanding moderator effects in prevention by using individual participant data (IPD) meta-analysis: Equity effects of parenting interventions across Europe
SPEAKER: Frances Gardner
ABSTRACT. Parenting interventions are a key strategy for preventing youth disruptive behaviour problems. Although beneficial main effects are well-documented, the extent of subgroup effects is unclear. Moderator analyses are important for targeting interventions, and establishing whether they have unwanted effects on social disparities. Unfortunately, most randomised trials lack power for moderator analyses. Systematic reviews produce conflicting findings, and by relying solely on aggregate trial-level moderators (eg sample mean SES), fail to utilise rich within-trial variability in participant characteristics. For understanding if programs are likely to widen or narrow social inequalities in child disruptive behaviour, which is highly patterned by social class, well-powered moderator analyses are needed.
Thus we pooled individual participant data (IPD), behavioural and economic, from a near-complete set of 14 randomised trials across 6 European countries (n=1800; ages 2-12) of one parenting intervention, Incredible Years. Trials were conducted independently of the programme developer. Where measures differed, we harmonised predictor /outcome data across trials, using norm deviation scores. We examined family and child moderators of intervention effects on disruptive behaviour. Analyses used random effects modelling to separate individual- from trial-level variation, and multiple imputation for missing data.
The pooled intervention effect on disruptive behaviour was d=.50. Moderator analyses found disadvantaged, and ethnic minority families benefit as much from the intervention as families without those characteristics. Having more severe levels of disruptive behaviour, or parental depression, increased effectiveness and cost-effectiveness of the intervention.
This study is the first to synthesise data from multiple independent trials of a parenting intervention, and suggests that the intervention, if scaled up, would not only have average benefits across a population, but would also have no detrimental effects on social disparities in child disruptive behaviour. The study illustrates benefits of IPD meta-analysis for enhancing power and transparency, and understanding moderators and equity effects in prevention science.
Cultural adaptation of the Unplugged evidence based intervention in a variety of countrie
SPEAKER: Peer van der Kreeft
ABSTRACT. Unplugged is a school based drug prevention intervention of twelve sessions, designed and tested by the EU-Dap Drug Abuse Prevention Trial group, based on a CSI Comprehensive Social Influence model. It has been made available open source on the eudap.net website and the EU-Dap Faculty project °2011 established a cascade trainer of trainers network for further dissemination after publication of results. EU-Dap Faculty was also mandated to support new dissemination centers in the adaptation of materials. While the original study group encompassed 7 EU-countries, as of today number of implementing countries is more than tripled and includes regions in Asia, the Middle East and Africa. The adaptation of the printed materials and of the teacher training are documented in project reports*. In the presented study the team of University College Ghent (Belgium) categorized documented adaptations in superficial and deep issues. We established a database for further analysis and as a utensil for current implementers to improve their Unplugged versions. This presentation will reveal some interesting topics of the adaptation process in conjunction with UNODC in Brazil, the Region of Middle East and North Africa, Pakistan and Nigeria. Also the adaptation process in an IKEA Social Initiative together with Mentor for Lithuania, Russia, Romania, Croatia and Kyrgyzstan will be covered. Further we will disclose the systematic overview of concrete adaptation issues and throw a light on their background or narrative. We will open discussion on the degree of fidelity to the proven effective intervention and on the use of the findings of this study for other adaptation processes. *Van der Kreeft, P., Jongbloet, J., & Van Havere, T. (2014). Factors affecting implementation: cultural adaptation and training. In Z. Sloboda, & H. Petras (editors), Defining prevention science. (blz. 315-334). New York: Springer.
Ecodevelopmental Predictors of Distinctive Profiles of Alcohol and Drug Use by Urban American Indian Youth
SPEAKER: Stephen Kulis
ABSTRACT. The majority of American Indians (AI) now live in cities, but research is lacking on the social determinants of their unique vulnerability to and resilience against substance use. This presentation describes how distinctive substance use patterns of urban AI youth are related to multi-level ecodevelopmental influences. Data come from 2,407 urban AI youth in the 2012 Arizona Youth Survey, a state-wide survey of 8th, 10th, and 12th grade students. Eight dichotomized last 30-day substance use measures (alcohol, binge drinking, tobacco, inhalants, marijuana, other illicit drugs, prescription misuse, OTC misuse) were employed in an Mplus latent class analysis (LCA) that also tested for mean differences on measures of positive and negative influences of families, peers, schools and neighborhoods. The LCA supported a 4-class solution: (1) non-users of all substances (69%); (2) users of tobacco and marijuana but not alcohol (4%); (3) “gateway” users (alcohol, cigarettes, marijuana, usually at least two in combination) (17%); and (4) polysubstance users who combined “gateway” and other illicit drug use (6%). There were significant mean differences across the classes on 21 ecodevelopmental measures (all except peer approval of prosocial behavior). The general pattern was that the non-user class reported the highest scores on positive influences (e.g. positive family communication, peer prosocial behavior, positive teacher interactions, neighborhood attachment) and lowest scores on negative influences (e.g., adult substance abuse in family, involvement with antisocial peers, neighborhood drug availability), while polysubstance users scored lowest on positive and highest on negative influences. The latent class using substances other than alcohol is distinctive in this population; compared to other urban AI substance using youth, they reported less exposure to negative ecodevelopmental influences. Knowledge of how to strengthen positive family, peer and school influences on urban AI youth and prevent, counter, or buffer key negative influences can inform family and school interventions.
Longitudinal Effects of Parents’ Behaviors on Adolescent Children’s Binge Drinking and Later Arrests in Young Adulthood: A Secondary Analysis
SPEAKER: William Crano
ABSTRACT. This research was designed to assess the effects of parental actions on their children’s binge drinking and later criminally antisocial behaviors in adulthood. For adult males, binge drinking typically is defined as imbibing 5 or more alcohol beverages in a 2-hour period; for women, the definition involves 4 or more drinks in that time. For youth, the limits probably are lower, but as yet are ill defined. A longitudinal weighted path analytic model (N = 9421 parent-child pairs, spanning 12-14 years) across four measurement waves indicated that low levels of parental monitoring and warmth, alcohol use, and expectations regarding their 9-14 year-old children’s alcohol usage predicted these children’s binge drinking one year later. These variables, along with adolescent binge drinking, predicted binging in young adulthood 5 to 6 years later. Binge drinking in both adolescence and young adulthood predicted these young adults’ likelihood of incarceration 5 to 7 years later. These results indicate the strong and enduring effects of parental behaviors on their children’s alcohol use and related consequences, and counsel development of prevention campaigns designed to help parents adopt strategies involving strict rules regarding their children’s alcohol use, and the importance of a warm and supportive family environment.
Taking an evidence-based programme to scale: insights from thinking about KiVa in Wales
SPEAKER: Nick Axford
ABSTRACT. It rare for evidence-based programmes be taken to scale. Initial funding is often allocated for efficacy evaluations only. One repercussion of this is that little attention is given to scale issues until after a programme has been tested and found effective. By then, it may be too late: decisions about what to fund have been taken, and too often the EBP fizzles out.
An RCT in Wales of the KiVa bullying prevention programme afforded the opportunity to consider from early on three issues deemed pertinent to any effort to scale an EBP: (i) the need and demand for the programme (and approach generally), and how to build demand; (ii) how well the programme aligns with the local social, policy, cultural and educational context; and (iii) how the implementation of the programme at scale can best be enabled given the context (i.e. the most suitable support structure for implementation, including training, technical assistance and financing).
Focus groups were held with key stakeholders in the implementation of school-based bullying interventions in Wales, namely policy makers and anti-bullying advocates (including representatives from Welsh Government, local education authorities, anti-bullying NGOs, teacher unions), teachers and other educators (working in KiVa schools), and parents (also from KiVa schools). These were supplemented by data from structured interviews with 41 staff in KiVa schools.
Four themes emerged from focus groups: (i) “We need consistency, but…”; (ii) An ideal world; (iii)” Do we even want an anti-bullying programme?”; and (iv) Modifying content is what good teachers do. Messages from the interviews focused on: improving integration within schools; tailoring the materials; adjusting aspects of the training; re-thinking costs; and encouraging wider uptake.
In addition to describing the method briefly and the research findings, the presentation will consider implications for the scaling of EBPs within schools and potentially other settings.
Do computer- and theory-based brief alcohol interventions among unemployed persons with at-risk alcohol use decrease unemployment after 15 months?
SPEAKER: Katja Haberecht
ABSTRACT. Objectives: Brief alcohol interventions (BAI) can reduce at-risk alcohol use. However, little is known about positive effects on other aspects of life. This study aimed to investigate 15-month effects of two computer- and theory-based BAIs on unemployment among initially unemployed persons with at-risk alcohol use. Methods: As part of the randomized controlled “Trial on proactive alcohol interventions among job-seekers, TOPAS”, 1,243 18- to 64 years old job-seekers with at-risk alcohol use were systematically recruited at three job agencies, and randomized to (i) a stage tailored intervention based on the trans-theoretical model of intentional behavior change (ST), (ii) a non-stage tailored intervention based on the theory of planned behavior (NST) and (iii) assessment only (AO). After baseline and after the 3-month assessment, both intervention groups received individualized computer generated feedback letters and self-help manuals. All study groups were followed up 6 and 15 months after baseline. This study included only those 586 participants initially unemployed. To test the effects of ST and NST on employment status 15 months after baseline, latent growth models with study group as a predictor were calculated. Socio-demographic and socio-economic variables as well as self-rated health, at-risk alcohol use and motivation to change were included as covariates. Results: In all three groups unemployment significantly decreased over 15 months (ST: OR = 0.06; 95%-CI: 0.01-0.27; NST: OR = 0.04; 95%-CI: 0.01-0.18; AO: OR = 0.05; 95%-CI: 0.01-0.21). No intervention effects were found on unemployment. Age, school education, self-rated health, alcohol consumption and motivation to change significantly affected the development of unemployment over time. Conclusions: After 15 months, no BAI effect on unemployment was found. BAIs resulting in reduced at-risk drinking and in improved health might be helpful in improving chances to be re-employed. This however could be a longsome process needing longer follow-ups to be detected.
Do in-person and computer-based brief alcohol interventions reduce alcohol use among general hospital inpatients after 2 years? Results from the randomized controlled trial PECO
SPEAKER: Jennis Freyer-Adam
ABSTRACT. Background: Little is known about the efficacy of in-person and computer-based alcohol interventions beyond the first year after intervention. The aim was to investigate the comparative 2-year efficacy among general hospital inpatients with at-risk alcohol use. Methods: As part of the randomized controlled trial „Testing delivery channels of individualized motivationally tailored alcohol interventions among general hospital inpatients: in-person versus computer-based, PECO” 18-64 year old general hospital inpatients were systematically screened for at-risk alcohol use. Nine-hundred-sixty-one of those who screened positive for at-risk alcohol use and negative for more severe alcohol problems were randomized by timeframe to: a) in-person counseling (PE), b) computer-generated individualized feedback letters (CO) and c) assessment only (AO). Both interventions were designed to include three contacts: on the ward, and 1 and 3 months later. At months 6, 12, 18 and 24 computer-assisted telephone interviews were conducted assessing self-reported gram alcohol per week, at-risk alcohol use and highest blood alcohol concentration. Latent growth modeling was used. Trial Registration: www.ClinicalTrials.gov: NCT01291693. Results: At month 24, CO resulted in a greater reduction of self-reported gram alcohol per week than AO (incidence rate ratio, IRR=0.74, p<0.05); CO and PE differences did not reach statistical significance (IRR=1.23, p<0.09). PE resulted in reduced at-risk alcohol use at month 6 compared to AO (odds ratio=0.50, 95% confidence interval 0.25-0.98, p<0.05). Conclusions: CO resulted in reduced self-reported alcohol use after two years. PE resulted in an impressive reduction of at-risk alcohol use in the short-term only. Theory-based computer-delivered interventions are an effective and staff-releasing alternative to in-person interventions. Future studies should investigate whether computer-based and in-person interventions have differential long-term effects on health and quality of life. Funding: German Cancer Aid (108376, 109737, 110676, 110543, 111346).
Dissemination and sustainable implementation of web-based interventions for the prevention of harmful substance use among German university students – Preliminary results of the DIOS-project
SPEAKER: Claudia R. Dr. Pischke
ABSTRACT. In the past 2½ years, the German Federal Ministry of Health funded the development, implementation, and scientific evaluation of multiple web-based interventions for the prevention and/or reduction of harmful substance use in German university students. Two controlled intervention studies demonstrated the effectiveness of these web-based interventions (i.e., ISPI, eCHECKUP TO GO- German version) in reducing alcohol and cannabis use in this population. Both interventions are, in part, based on the ‘social norms’ approach, highlighting perceived discrepancies between personal and peer substance use, and providing feedback based on actual consumption rates assessed in student populations at respective universities. Following the intervention studies in the initial funding period, the aims of the current DIOS-project are 1.) to develop a strategy with university stakeholders for broadly disseminating the previously tested interventions, 2.) to assess the current status of web- and non-web-based substance use prevention programs at 10 selected universities, and 3.) to implement ISPI and eCHECKUP TO GO – German version at these universities. To develop a dissemination strategy, two workshops will be held jointly with university stakeholders in Northern as well as Southern Germany. To assess the current implementation status of preventive programs, telephone interviews will be conducted with four key stakeholders at each of the participating universities. In addition, readiness for implementing web-based interventions at each university will be assessed. To implement ISPI and eCHECKUP TO GO – German version at the selected universities, a toolbox, including intervention materials, will be created. Furthermore, based on the interview results, university stakeholders will be given recommendations which intervention to implement at their university. They will also be coached during the implementation process and the implementation will be monitored employing a process evaluation. Preliminary findings regarding the dissemination strategy and university readiness to implement web-based interventions will be presented.
Why Children Comply: A Multilevel Meta-Analysis of Parenting Behaviors that Prevent Children’s Non-Compliance
SPEAKER: Patty Leijten
ABSTRACT. Why do children do what parents ask them to do? Understanding why children comply, or not, is essential for understanding how conduct problems develop and for optimizing prevention strategies to reduce conduct problems. Current strategies for reducing conduct problems are moderately effective at best (Weisz & Kazdin, 2010) and fail to benefit a quarter to a third of the participating families (Shelleby & Shaw, 2012). We classified relevant theoretical work into three perspectives: reciprocity theory posits that children comply to repay parent’s investments, reinforcement theory posits that children comply to approach rewards and avoid punishments, and, as a variant of the latter perspective, social deprivation theory posits that children comply to approach acceptance and avoid exclusion. We performed a multilevel meta-analysis of the effects of experimentally manipulated discrete parenting behaviors that tap into each of the perspectives to prevent children's non-compliance. We identified studies by systematically searching databases and through contacting experts. Twenty studies (78 effect sizes) on five discrete parenting behaviors were included: parent-child play (reciprocity), praise and verbal reprimands (reinforcement), and time-out and ignore (social deprivation). We included two types of outcomes: observed child compliance and parent-reported disruptive child behavior. There was no support for the reciprocity hypothesis—parent-child play did not affect child compliance, and there was no support for the reinforcement hypothesis—praise and verbal reprimand did not affect child compliance. Only the social deprivation hypothesis was supported: providing time-out for noncompliance and withholding attention from the child after non-compliance led to improved child compliance. All findings were robust across observed and parent-reported outcomes. Our findings suggest that one main motivation for why children comply may be to avoid social exclusion from their parents.
Finding a simple formula - a human face as an effective, automatic factor inhibiting cyberbullying
SPEAKER: Magdalena Kozubal
ABSTRACT. Multiple studies picture bullying as a group process in which peer bystanders play an important role (on-line and off-line alike). Body of evidence clearly show the relation between empathy and lower rates of bullying and cyberbullying also in the context of cyberbystanders. In most of antibullying programs empathy is activated by the exposure of a complex material presenting a victim‘s predicament. The study dealt with the issue to what extent the empathic stimuli – can be reduced remaining effective in limiting reinforcing bullying behaviour of a cyberbystander. Numerous studies confirm the exceptional significance of the human face as an universal social stimulus. Mere exposure of a face with the expression of sadness or pain activates mirrored neurons responsible for activating empathy. Experimental research was carried out on junior high-school students aged 14-17 n = 292 exploring if a human face will suffice in limiting online violence peer reinforcement. Empathy activation was varied on the level of the stimulus complexity exposing: a face with the expression of sadness (1), a film presenting a cyberbullying victim in a specific social context in regard to a cyberbullying victim (2), and control conditions (3). Cyberbystander reinforcing bullying behaviour, i.e. forwarding or deleting a message ridiculing a peer, was the dependent variable. The results revealed that not only a complex stimulus, such as the physical and psychological characteristic of a victim, but also a mere exposure of a face activate empathy and significantly limit reinforcing bullying behaviour of a cyberbystander.
Engaging fathers in parenting programs: Insights for new interventions
SPEAKER: Diego Garcia-Huidobro
ABSTRACT. Introduction: Parenting programs are one of the most effective strategies to prevent multiple risky outcomes during adolescence, including substance use, sexually transmitted infections, and teen pregnancies. Parenting programs that engage two parents when available have reported better outcomes. However, these programs are mostly attended by mothers. Using mixed methods, this study evaluated delivery preferences of fathers and other non-attenders in a parenting program targeting immigrant Latino families with adolescents (Padres Informados. Jovenes Preparados, PIJP). Methods: A convergent parallel study, including a simultaneous individual interview and survey, was used with 1) fathers who could have enrolled in PIJP but did not, 2) mothers with low attendance at PIJP, and 3) Latino parents with adolescents without exposure to PIJP. Results: 36 participants (18 fathers and 18 mothers) enrolled in this study. Qualitative findings grouped in: 1) general preferences (want to have fun, choose topics, and highlight family benefit), 2) delivery preferences (want group component including sessions with mothers and fathers separated, as well as an individual option in case unable to attend a meeting with online videos and follow-up phone calls or home visits), 3) recruitment strategies (pre-intervention engagement home visit), and 4) participation strategies (incentives that promote family connection such as movie tickets for the whole family). Quantitative findings identified preferences regarding scheduling, and verified qualitative findings. Conclusions/Translation to Practice: Interventions including father and non-attender preferences are more likely to engage a higher number of fathers and other participants, and make family-based parenting programs even better strategies to reduce adolescent health-risk behaviors.
Drug prevention quality standards - science fiction or …?
SPEAKER: Sanela Talić
ABSTRACT. Prevention science is rather young field but there have already been significant developments in the theory, research and practice. This is particularly true for the US. In Europe, the situation is slightly different. Findings within the project Science for Prevention Academic Network (SPAN) confirm often-mentioned requirement for education of prevention workers and the desired establishment of the education system, which will offer quality education and training for these workers. In any case, despite the short existence of prevention as a science, we have some quality tools (such as the European Drug Prevention Quality Standards) and programmes that are result of diligent and very professional work of researchers and practitioners. Unfortunately, in practice, they are not used or are used in very small extent. The aim of presentation is to give the audience the insight into the main idea, methods and theories of my doctoral dissertation, which will be focused on existing quality standards (EDPQS, UNODC and others). Plan is to determine the readiness of existing prevention system in Slovenia for standards and to seek opportunities for their introduction into practice and so lay a solid foundation for a more stable prevention system.
Perceived barriers to condom use among adolescents from Spain: Implications for condom use
SPEAKER: Alexandra Morales
ABSTRACT. Consistent and correct use of condom sex is a highly effective method for preventing sexual transmission infections and unplanned pregnancies. The current literature is not consistent in identifying what are the most relevant barriers in adolescents; and few studies have evaluated so fat the relationship between barriers to condom use and condom use in adolescents from Spain. The objectives of the study were threefold: (1) to analyze perceived barriers to condom use in Spanish adolescents; (2) to examine whether there are gender differences in perceived barriers, and (3) to analyze the relationship between barriers to condom use and self-reported condom use. The sample consisted of 629 Spanish adolescents between 13 and 18 years (M=15.17, SD=0.04); 51.5% were males. The most prevalent barriers for not using condoms were the following: the fact that people may think that they wear a condom because they seek sex (40.9%), the fear of that condoms get broken (37.9%), and fear of that condoms can be found by their parents (37.4%). There were gender differences in 10 of the 19 analyzed barriers. Compared to females, males were more likely to report decreased pleasure and discomfort in wearing a condom as condom use barriers; both were associated with lower condom use. Compared to males, females were more likely to report barriers such as that their parents could find the condoms, shame to wear them and do not know how to put condoms correctly; however, these barriers were not related to condom use. In females, the perception of rejection of condom use by the sexual partner was associated with less use of condoms during sex. It is important to design campaigns and interventions aimed at overcoming these barriers, taking into account gender differences, with the principal goal of increasing consistent condom use among adolescents.
Health system dynamics
SPEAKER: Peter Hovmand
Complex systems approaches to prevention
SPEAKER: Harry Rutter