ABSTRACT. Background

As a work package within an action co-financed by European Union member states, Joint Action "Reducing Alcohol Related Harm in Europe" (RARHA), we collected examples of good practice and developed an online tool kit for practitioners and policymakers in the field of alcohol prevention.

Methods

We solicited examples of good practice from prevention professionals in European Union member states, Norway and Iceland who participated in Joint Action RARHA in three areas: early interventions, public awareness campaigns and activities in school settings .

The submissions were evaluated by means of a classificatory system which qualifies interventions according to the level of underlying evidence, along an ordinal scale of four categories. The classification scheme constitutes an adaptation of an approach originally developed in the Netherlands and presently employed by the Dutch Ministry of Health.

Results and conclusion

From 32 (EU MS/EEA/EFTA) Countries, 48 cases in the three focus areas were collected and categorised in line with the methodology employed. We will present the 26 accepted interventions and describe in detail the creation of the RARHA online tool kit.

ABSTRACT. Background. In January 2016 the United Kingdom’s Chief Medical Officers released updated guidelines for lower risk levels of alcohol consumption. This study aimed to assess responses to the updated guidelines using comments made on Twitter. Methods. Tweets containing the hashtag #alcoholguidelines made during one week following the announcement of the updated guidelines were retrieved using the Twitter Archiver tool. The source, sentiment, and themes of the tweets were categorised using manual content analysis. Results. A total of 3,061 tweets was retrieved. Six sources were identified, the most prominent being members of the public and health-related organisations or individuals. Of 819 tweets rated as expressing sentiment specifically towards the guidelines, 658 expressed negative sentiment. Eleven themes were identified, three of which were broadly supportive of the guidelines, seven broadly opposed, and one neutral. The most common theme was sharing information, although many tweets using this theme were from health- or news-related accounts. The most common themes in tweets by members of the public were encouraging others to drink and disagreement. Conclusions. Findings give an insight into public responses to the new guidelines and may be useful in tailoring initial and subsequent communications of alcohol and other public health guidance.

ABSTRACT. The United Kingdom has witnessed a large shift from drinking in pubs, bars and restaurants to drinking at home- to date this phenomenon has received little attention across Europe, in particular the link if any to ask-risk drinking. An internet survey of university staff (n=458) was conducted using the AUDIT to assess at-risk drinking as a dependent variable. The independent variables included age, gender, frequency of home consumption, alcohol purchasing habits and motivations for drinking at home. There were two cut-off scores for at risk drinking firstly (Audit greater than or equal to 6 (females) and (Audit greater than or equal to 8 (males) which is consistent with much international research (Model 1) and secondly Audit greater or equal to 6 for both males and females (Model 2). This was in response to a recent change in UK guidelines suggesting that at-risk cut-offs for men and women are the same In Model 1 there were 286 hazardous drinkers (181, females 63.3%) and (105 males 36.7%). The variables that predicted at-risk drinking following a logistic regression were female (OR=5.42 95% CI 1.87-15.66), being < 39 years of age, greater frequency of consuming alcohol at home, preloading (drinking before going out), purchasing in an off licence rather than supermarket and drinking alcohol at home because it is cheaper than drinking out. For model 2 there were 328 at-risk drinkers (Female 181, 55.2%, Male 147 44.8%)and the significant predictors were age, frequency of alcohol consumed at home and not feeling comfortable drinking outside the home. These findings provide data that could be invaluable in preventing at risk drinking in adult populations

ABSTRACT. The secondary effects of an alcohol prevention program (PAS) on onset of weekly smoking and monthly cannabis use are examined among >3000 Dutch early adolescents (M age=12.64) randomized over four conditions: 1) parent intervention (PI), 2) student intervention (SI), 3) combined intervention (CI) and 4) control condition (CC). Rules about alcohol, alcohol use, and adolescents’ self-control are investigated as possible mediators. PI has a marginal aversive effect, slightly increasing the risk of beginning to smoke at T1, and increased the likelihood of beginning to use cannabis use at T1 and T2. SI delayed the onset of monthly cannabis use at T3. CI increased the risk to use cannabis at T3. No mediational processes are found. In conclusion, though this study show mixed results, negative side effects of the PI are found, particularly at earlier ages. Moreover, these results indicate the need for multi-target interventions.

ABSTRACT. Earlier onset of self-reported drunkenness and the establishment of regular alcohol drinking in adolescence is associated with a greater risk of adult alcohol-related problems. We investigated the effectiveness of a combined skills based classroom curriculum and brief parental intervention (The Steps Towards Alcohol Misuse Prevention Programme; STAMPP), compared to alcohol education as normal (EAN), in reducing self-reported heavy episodic drinking (HED) and alcohol-related harms (ARH) in UK school children. A cluster randomised controlled trial was undertaken in 105 schools in Northern Ireland (NI) and Scotland. Schools were randomised (1:1) to STAMPP or EAN. Inclusion criteria were students attending mainstream secondary schools in NI and Scotland (academic year 2011/2012; students aged 11/12 at randomisation). The primary outcomes were: i) the prevalence of self-reported HED in the previous 30 days and ii) the number of self-reported ARHs in the previous six months, assessed at 33 months. Of the full sample (those who completed a questionnaire at either baseline or 12 months, N=12,738), 10,405 also completed the questionnaire at 33 months (81.7%).We found that fewer students in the STAMPP group reported HED compared to EAN (17% versus 26%; odds ratio=0.60, 95% CI 0.49-0.73). There was no difference in the number of self-reported ARHs (incident rate ratio = 0.92, CI 0.78-1.05). Although the classroom component was largely delivered as intended, there was very low uptake of the parental component. The results suggest that STAMPP could be an effective school-based programme to reduce the prevalence of HED in young people.

ABSTRACT. From 2010-2012 REBOUND has been developed as a European school based prevention programme at Heidelberg University Hospital with funds from DPIP and Mentor Foundation Germany. Following its first evaluation, the programme has been further optimized in 2013 and subsequently been disseminated by a newly founded organization with the purpose of building a bridge between prevention research and practice. We want to present the conclusions for programme adaption that we drew from the first evaluation, explain subsequent programme adjustments and illustrate how we built structures for effective dissemination and further evaluation. How did „best practice“, evaluation data, practical and financial considerations impact the programme? Finally we will give an in-depth description of succeeding and failing implementation endeavours by comparing two prototypical REBOUND schools in their struggle for providing evidence-based drug education. Which changes do we see in schools that have been working with REBOUND up to five years?

ABSTRACT. Introduction: The European school drug prevention program Unplugged was culturally adapted and named #Tamojunto in Brazil. This study evaluates the impact of the Program #Tamojunto for drug use prevention among adolescents in public middle schools in Brazil. Methods: A randomized controlled trial was conducted in 2014/2015 with students from 7th and 8th grades in 72 public schools in 6 Brazilian cities. At the baseline, 6610 students were evaluated and 5028 students were matched in at least one of the two waves of follow up (9 months and 21 months later). The intervention group attended 12 weekly classes of the #Tamojunto school drug prevention program, and the control group did not attend to any school prevention program during the study. Generalized Estimating Equations (GEE) were used to evaluate changes in the use of each drug, in time and between groups, focusing on past year use, recent use and first use of drugs (incidence). Results: The mean age of the adolescents was 12.5 + 0.7 and 51.3% were females. Alcohol past year use prevalence changed from 30.1% to 49.8% at the intervention group and from 29.9% to 45.8% at the control group, after 21 months. Adolescents at the intervention group was 16% more likely to have reported past year use of alcohol than students in the control group at 9 months (aOR= 1.16; 95%CI 1.02; 1.33) and at 21 months (aOR= 1.16; 95CI% 1.00; 1.35). The opposite trend was found for past year inhalants use at the 9 months follow up (aOR=0.72; 95%CI 0.57; 0.92) but not at 21 months. Incidence analysis show similar results, suggesting iatrogenic effects for alcohol initiation and protective effects for inhalants initiation. Discussion: The Brazilian version of the Unplugged program may be being misinterpreted by public school students, allowing, perhaps, the arouse of curiosity for alcohol use.

ABSTRACT. 16% of European population aged 15 has used cannabis during the last year, a third of them reported problematic use, two or more points in CAST (ESPAD). The “Pasa la vida” (PLV) program is a selective prevention intervention for 15-18 years old cannabis users. It uses an audio-visual support to encourage reflection about cannabis consequences from a non-directive approach. PLV is implemented in five sessions where beneficiaries debate about the use of cannabis as an amusement resource, its value as a social facilitator and its usefulness as coping style when difficulties arise. The aim of this study is to assess the efficacy of PLV. 3097 secondary students from Portugal, Spain, Italy, and Romania aged 15-18 years old were assigned to control (1321) and experimental group (2586). A pre-post intragroup design was carried out. The interval between measurements was 7-9 weeks. The evaluated variables were: Intention to Use Cannabis, Attitude towards Use, Self-Efficacy to Avoid Using, Risk Perception, and Use during the last 30 and seven days. In experimental group all measures significantly decreased but with a small size effect. No differences were found in the control group in Intention, Self-Efficacy, and Risk-Perception. Conclusions: A non-directive approach is a good strategy to reach late-adolescent cannabis users. Adolescents' beliefs are well settled down and resistant to change. Changing habits and attitudes in frequent cannabis users may require a longer intervention. CAPPYC Project. Funded by European Commission. General Directorate of Justice. Funding program JUST/2013/Action Grants.

ABSTRACT. Background – Little is known about the components which make behavioural prevention interventions successful in tackling alcohol abuse and illicit drug use. Identification of the most effective components may contribute to making behavioural prevention interventions more effective and efficient. Aim – To test the feasibility of a method to evaluate components of behavioural prevention interventions by assessing the effects of 2 promising units of the Unplugged curriculum (UC) on predefined mediators. Methods/Design – A randomized controlled trial involving 1,040 students aged 13-14 years old was performed in Novara, Italy, in the framework of the EU funded ALICE RAP project (www.alicerap.eu). Two schools were randomly selected and allocated to intervention and control group. A brief school-based intervention comprising two individual components selected from the UC was delivered by previously trained teachers. Students in the control group received the usual school curriculum. A self-report questionnaire was administered before and after the intervention. Results: Regression analyses adjusted for age, sex, and socioeconomic status revealed no evidence of a difference with regard to the mediators assessed. However, the greater levels of baseline negative mediators in the control group disappeared after the intervention, and this can be interpreted as an effect of the intervention in the expected direction. Discussion – Whether an intervention of two units (out of twelve) of the UC is able to affect the mediating mechanisms which contribute to the program effect on addictive behaviour, is a hypothesis that remains to be studied. The component evaluation used in this study model could serve to create a repository of effective components that can be offered to prevention researchers and professionals.

ABSTRACT. Data on Czech children suggest a high prevalence of substance use leading to exposure to serious long-term health problems. We conducted a randomized, controlled, 3-arm, prospective, school-based prevention trial to study the effectiveness of the two independent prevention interventions (Unplugged and nPrevention) in comparison to a single prevention intervention (Unplugged) and no intervention at all. There were five waves of data collection conducted from September 2013 to December 2015, collected in 71 schools, with total of 11,361 valid questionnaires collected. The number of respondents decreased from 2,547 in the first wave to 2,082 in the fifth wave. The Unplugged intervention was implemented in the 6th grade during the 2013/2014 school year, the n-Prevention intervention consisting of four lessons (including two supportive animated videos for children about neurology and neurobiology of addiction, further modified the intervention lessons) was delivered in the 7th grade. Other prevention activities were monitored. The effectiveness of primary prevention activities was assessed using the method of Generalized Estimating Equations (GEE). Effective, as compared with the (no intervention) control group, after the fourth follow-up (30 months after baseline) appear only the combination of interventions nPrevention and Unplugged. We found no statistically significant effectiveness in the Unplugged intervention group only in any of the monitored prevalence indicators, on the contrary, it appears that belonging to this study group increases the chance of drunkenness in the past 30 days (OR = 1.42, p <0.05). Preliminary results also indicate a slightly higher effectiveness in boys than in girls for combination of the interventions nPrevention and Unplugged. Implication for further dissemination and research will be discussed.

ABSTRACT. Young adults engage in high risk behaviors (e.g., heavy alcohol use, drug use, physical/sexual aggression, and driving drunk/riding with a drunk driver) in clubs. We developed a group-based intervention to use the influence of the peer group to keep group members safe for the evening and to reduce harms. Based on group members’ responses to a short screener, an algorithm calculates in real time the type of risks (e.g., sexual aggression) that group members are most likely to experience that night at the club. Using a random control trial, the experimental condition consists of engaging group members in a brief, interactive app tailored to their specific risks for that evening. This intervention app provides specific skills: 1) Recognizing early indicators of emerging problems; (2) Reaching out to the vulnerable group member; (3) Identifying acceptable options to avoid risky behavior; (4) Deciding upon conditions under which the entire group would leave the club. Groups assigned to the control condition reviewed a program on fire safety. Upon exiting the club, patrons provide self-report data on physical and sexual aggression experiences and intentions to drive intoxicated or ride with an intoxicated driver. Biological markers of alcohol and drug use are attained to assess the levels of use. Group members’ data are linked and data are nested within club and evening. This presentation will focus on the first 200 groups that were randomized into the experimental or control condition with data on the levels of high risk behaviors and actions taken during the evening. For groups in the experimental condition, process data are presented including the group plans to intervene if needed, the types of options that were identified, and the agreed plan for exiting. Discussion includes next steps for sustainability and how social media may provide an important technique for delivery.

ABSTRACT. Objectives: The ever-increasing demands of life, coupled with internal and external pressure to succeed, require functional stress coping and enhancement strategies. Pharmacological neuroenhancement (PNE) refers to the non-medical use of prescription and recreational drugs for the purpose of cognitive or mood enhancement to improve performance at work or while studying. The ongoing bioethical debate on PNE is often legitimated by the assumption that neuroenhancement will widely spread. This assumption was questioned as the enhancing effects of the substances used differ between and even within individuals. Furthermore, the debate focused mainly on illicit substance use of healthy individuals while individuals with mental disorders who might enhance themselves as well were excluded. Methods: Data from three self-conducted Swiss studies on pharmacological neuroenhancement (N=10,084, N=6,275, and N=64) will be presented and contextualized within the current European literature. Moreover, two different forms of self-medication will be discussed that require different prevention strategies. Key factors for preventing problematic PNE will be identified based on the research findings. Results: Cognitive enhancement most likely relates to students using drugs for better grades. Nevertheless, mood enhancement was more common than cognitive enhancement in the general population. Moreover, current medical treatment of a mental disorder was the strongest predictor of both enhancement forms. Additional self-medication of mental disorders bears further health risks and calls for adjusted environmental prevention approaches. Discussion: Taking into consideration the complexity of substance use for PNE, problematic use patterns, vulnerable groups and effective prevention strategies have been identified. The importance of the prevention of substance use for PNE in school, workplace, family, and recreational settings will be discussed with a special focus on the transition from adolescence to adulthood.

ABSTRACT. Uruguay is the first country to decriminalize marijuana and involve the national government in marijuana cultivation (certifying growers), distribution (through pharmacies) and adult user registration. Critics argue that decriminalization will normalize drug use for children, erode norms discouraging drug use, undermine social cohesion, and lead to greater marijuana use among adolescents. While it is too soon to know the full impact of decriminalization, national statistics show increasing adolescent marijuana use, particularly in the capital, Montevideo. Piloting and adapting a culturally-grounded substance use prevention program in Uruguay provides an opportunity to better understand how to prevent adolescent marijuana use in a global context where marijuana is increasingly decriminalized/legalized. We pilot tested a linguistically adapted version of the U.S.-based keepin’ it REAL (kiR) substance use prevention program in two Montevideo middle schools. Randomized into a treatment, kiR, (N=58) and control (N=96) condition, students (mean age = 12.4) completed a pre-test prior to implementation and post-test immediately after. Changes in last 30-day amounts and frequency of marijuana were examined with paired t-tests, baseline adjusted regression models with full information maximum likelihood adjustments for attrition, and Cohen’s d effect sizes. The control group reported significant increases in amount and frequency of marijuana use from pretest to post-test while these measures declined among students receiving kiR. Differences between the control and intervention schools were statistically significant, and achieved medium effect sizes (d=.31, .32). The results indicate that kiR can be an effective tool in teaching drug resistance strategies and reducing marijuana use among adolescents in a country where marijuana use is decriminalized. Although results cannot be generalized due to the small sample and particular characteristics of the schools and neighborhood, they provide sufficient evidence to continue exploring the impact of decriminalization, marijuana use, and the impact that evidence-based prevention programs like kiR can make.

ABSTRACT. Tobacco smoking is high in France; its burden is colossal, especially compared to many of its European neighbors. Widely advertised as tobacco replacement products, e-cigarettes recently gained much popularity in France. Yet, they cause many controversies, mostly related to tobacco smoking: “can they be considered as effective smoking cessation tools?”, “do they undermine tobacco denormalization?”, “are they a gateway to smoking, especially in young non-smokers?”.

To cope with a situation combining a tremendous threat (smoking) with a new and potentially effective help (vaping), it is necessary to monitor closely their use. Cross sectional datasets do not allow for causal inference, however, they are helpful in highlighting patterns of consumption, health related behaviors and factors associated with them. In that sense, general population representative surveys such as the 2014 Health Barometer (financed by Santé publique France, the national public health agency) and the 2015 Cancer Barometer (financed by the French national cancer institute- INCa), bring out results which take part in the overall discussion.

These two studies based on random sampling included respectively 15,635 and 3,931 individuals and are representative of the French population aged 15-75yo. They allow estimating smoking and vaping rates as well as dual use and characteristics related to those behaviors. Both daily smoking and daily vaping rates remained stable between 2014 and 2015 (at respectively 28.8% and 3.0%). However, current vaping rate decreased (from 5.9% to 4.0%), resulting in an increase of the proportion of daily users among vapers. Moreover, the proportion of former tobacco smokers among vapers is 26% in 2015 (vs 15% in 2014), significantly increasing in a one year period. Those findings will be compared with recent trends observed in other European countries.

ABSTRACT. Prejudice and other forms of negative intergroup attitudes cause serious social problems in many societies throughout the world. Their consequences may include social exclusion and segregation and as well as racism, political extremism and hate crimes. The presentation reports results of an extended research program conducted of our research team within the last 10 years. Core of this research is an extensive evaluation study on the PARTS prevention program, a multimodal intervention to prevent prejudice and promote tolerance in elementary school children. It combines three intervention components: Intercultural learning, extended contact stories, and exercises to promote related cognitive and social-cognitive skills (e.g., multiple classification skills, perspective-taking, social-problem solving). The study has a randomized treatment-control-group design with five measurement points (pre, post, three follow-ups up to five years later) and was implemented at 15 elementary schools in the State of Thuringia, Germany (Total n = 560). The results revealed significant short-term improvements favouring the program group on proximal outcome measures (e.g., prejudice toward a target outgroup, intercultural knowledge), while effects on distal outcomes (e.g., interpersonal tolerance, social distance to a non-target outgroup) were weak. However, as there were significant long-term effects one or even five years later on some prejudice and tolerance measures, small but stable preventive effects of the PARTS programs could be confirmed. Differential results showed that the quality of implementation was one of the most predictable factors for program effectiveness. Overall, these and the meta-analytic evidences clearly speak for a developmental perspective for preventing negative intergroup attitudes.

ABSTRACT. A National Needs Assessment of Roma in Ireland was conducted in 2015 which highlighted the poor health status of Roma which mirrors the international experience of Roma.

Peer researchers were involved in every stage of the study which included 106 household (600 individuals)and used mixed methods including a survey of Roma households; in-depth interviews and focus groups with Roma, service providers and policy makers; and case studies with Roma.

The social determinants of health that contribute to or detract from the health of individuals and communities include: income; housing; education; transportation; access to services; physical environment; socioeconomic status/position; discrimination; social and environmental stressors. This paper presents the findings of the study along with recommendations as to what can be put in place to prevent ill health among the Roma community.

ABSTRACT. Various intervention programs are available that show positive effects on substance use or other targets of prevention, but there exist as well studies where there is only a very small or even no effect. In extension of addressing the question “what works”, the interest of prevention scientists and policy makers is now often accompanied by “what works for whom”. Sub-group analysis can help in detecting differential response to an intervention in case of an effective intervention. If there is no significant effect on the overall study population, sub-group analysis is often used to evaluate whether the tested program is effective for specific subgroups within the study population. The presentation illustrates some statistical approaches to evaluate the intervention effect in a subset of the participants in a trial, in particular hierarchical (or multi-level) linear models for longitudinal designs and approaches based on identifying latent classes, e.g. growth mixture models, where the individuals are attributed to (previously unknown) trajectory classes which are characterized by different courses over time. In a second part, several risks and limitations of this strategy will be discussed. Biostatisticians have especially criticized that exploratory analyses testing many subgroup differences increase the risk of false-positive results and may produce spurious findings. Therefore, guidelines have been developed for analyses in pharmacological trials as well as recommendations for interpreting and reporting estimates of intervention effects for subgroups of a study sample that may also be applicable and useful in the field of prevention research.

ABSTRACT. The majority of evidence-based programmes (EBPs) have been developed in the USA. A significant number of them have now been tested in Europe using experimental and quasi-experimental methods. In addition, recent years have seen the emergence in Europe of a number of ‘home-grown’ EBPs.

This research sought to identify key prevention and early intervention programmes for children and families that have been tested in randomised controlled trials or quasi-experimental design studies in Europe. The context was the Communities that Care (CtC) community change process for reducing youth violence, alcohol and tobacco use and delinquency, and the need to inform CtC sites in Europe about effective programmes.

The research involved searching the literature and selected international and national intervention databases. Programmes were reviewed against standards of evidence to determine the quality of the interventions, the strength of the evaluations and the consistency and strength of their impact in Europe. Preliminary scrutiny of system (or dissemination) readiness was undertaken. The extent to which interventions were tested and found effective in two or more European countries was also examined. 

The presentation will provide a descriptive analysis of the interventions that were identified, including the outcomes they focus on, the risk and protective factors they target, the age group they address and the level of intervention. Programmes are categorised according to the strength of evidence for their impact in a European context and their predicted transportability.

Challenges in doing the work will also be considered, along with implications of the analysis for the transportability of programmes across contexts and for the development and evaluation of interventions in Europe.

ABSTRACT. A large proportion of children and young people entering care in the UK are aged 10-15 years. Research reveals that this group are likely to experience poor outcomes and highlights the need for innovative support for adolescents and their families to prevent family breakdown and reduce the risk of entry to state care.

A number of evidence-based therapeutic interventions designed to improve outcomes for this population have been developed and tested in the US, including Functional Family Therapy, Multi-systemic Therapy and Multidimensional Treatment Foster Care. Typically the set-up of these complex interventions require significant up-front investment, which can be prohibitive for those seeking to offer them.

This presentation will explore findings emerging from a UK evaluation study of the implementation of a suite of US-developed interventions for adolescents on the edge care. These interventions were implemented in a project funded through the Department for Education’s 'Children’s Social Care Innovation Programme' and involved an innovative pooling of resources and partnership between multiple local authorities and a third sector organisation.

The study explored key stakeholders’ perspectives on the barriers and facilitators of setting up and delivering the interventions during the initial implementation phase of the project. Data was collected via online questionnaires and qualitative interviews conducted at two timepoints: (i) at an early stage during which time the project was transitioning from set-up to initial implementation and (ii) 10 months later during ongoing implementation and at a time when discussions around ongoing sustainability were being held.

We will share lessons learned, including key considerations that emerged as salient to the acceptability, feasibility, and sustainability of the project that will be useful for local authorities, third sector organisations and funders considering similar approaches in the future.

ABSTRACT. Introduction: Programmes commonly applied in social disciplines, such as multi-systemic therapy for juvenile crime prevention, are most frequently complex. These programmes are better characterised as events in social systems and operate by psychosocial and behavioural processes, targeting multiple outcomes and interacting with local contexts. In this light, researchers argue that systematic reviews of complex prevention programmes should assemble evidence of different types to explore variation in effects across different populations, contexts and implementation. This approach will contribute to better understanding of the most effective and sustainable prevention programmes, and therefore improve the use of evidence in policy and practice. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is the most widely adopted system worldwide for synthesisng and rating the quality of evidence. This paper outlines the specific challenges of applying GRADE to complex prevention programmes, and describes an ongoing project to extend GRADE for these programmes and interventions. Methods: We retrieved forty systematic reviews from the Cochrane Database of Systematic Reviews, and we analysed their application of GRADE and the quality of evidence ratings. We then contacted the review authors to explore the challenges they encountered when applying GRADE to complex interventions. Results: Specific challenges were identified in applying GRADE to complex interventions, namely assessments of heterogeneity, indirectness, performance bias and use of non-randomised studies in complex interventions. Authors perceived these challenges to contribute to frequent downgrading of the “best evidence possible” for these interventions. Meanwhile, GRADE was found to lack an analytic approach to integrate “parallel” evidence on programme implementation and context. Conclusions: An extension to the GRADE approach is needed to address identified challenges and enhance its value for evidence syntheses of complex interventions. We invite interested researchers to participate in this project and help us achieve the best-informed consensus on this guidance.

ABSTRACT. High levels of anxiety and depression are common psychological symptoms among children and adolescents that often affect them negatively in multiple life domains, and are possible precursors of disorders. Despite high prevalence rates, relatively few children with emotional problems are referred for treatment, indicating the need for preventive approaches. Aim Evaluation of a new indicated preventive program in schools: Coping Kids, to reduce high levels of anxiety and depressive symptoms among children aged 8 to 10 years. The program is based on empirically supported treatments, The Coping Cat program and the ACTION program, and developed in collaboration with the program owners. Method This is a clustered randomized controlled trial. The unit of allocation is 30 schools which are assigned to one of two conditions; The group cognitive behavioral intervention Coping Kids or Treatment as usual (TAU). Assessments will be undertaken at base-line, post treatment, using self-reports questionnaires for the children (n = 559), and reports on children by parents and teachers. The participants will be reassessed 12 months after the intervention. The primary outcome will be changes in depressive symptoms as measured by MFQ and anxiety symptoms by MASC. Secondary outcomes will be changes in self-esteem, Life Quality, school and daily functioning. Ethnicity and gender will be studied as moderating factors. Results Preliminary results concerning the recruitment process (CONSORT) and characteristics of the participants will be presented. Conclusion In conclusion, the transdiagnostic indicative intervention can be conducted with high fidelity in a school setting. We reach school children with high levels of anxiety and depressive symptoms. Effective early intervention with these children will have important public health implications.