How to prevent alcohol and illicit drug use among students in affluent areas: a qualitative study on motivation and attitudes towards prevention

Background The use of alcohol and illicit drugs during adolescence can lead to serious short- and long-term health related consequences. Despite a global trend of decreased substance use, in particular alcohol, among adolescents, evidence suggests excessive use of substances by young people in socioeconomically affluent areas. To prevent substance use-related harm, we need in-depth knowledge about the reasons for substance use in this group and how they perceive various prevention interventions. The aim of the current study was to explore motives for using or abstaining from using substances among students in affluent areas as well as their attitudes to, and suggestions for, substance use prevention. Methods Twenty high school students (age 15–19 years) in a Swedish affluent municipality were recruited through purposive sampling to take part in semi-structured interviews. Qualitative content analysis of transcribed interviews was performed. Results The most prominent motive for substance use appears to be a desire to feel a part of the social milieu and to have high social status within the peer group. Motives for abstaining included academic ambitions, activities requiring sobriety and parental influence. Students reported universal information-based prevention to be irrelevant and hesitation to use selective prevention interventions due to fear of being reported to authorities. Suggested universal prevention concerned reliable information from credible sources, stricter substance control measures for those providing substances, parental involvement, and social leisure activities without substance use. Suggested selective prevention included guaranteed confidentiality and non-judging encounters when seeking help. Conclusions Future research on substance use prevention targeting students in affluent areas should take into account the social milieu and with advantage pay attention to students’ suggestions on credible prevention information, stricter control measures for substance providers, parental involvement, substance-free leisure, and confidential ways to seek help with a non-judging approach from adults.

Acceptability And Feasibility of a Gamified Digital Eating Disorder Selective Prevention Program (AcceptME) Based On Acceptance And Commitment Therapy (ACT)

Background: Digital prevention programs for a variety of psychological conditions, including eating disorders (EDs) are increasing. Yet, none to date have leveraged gamification and vicarious learning components grounded in empirically-supported therapeutic approaches to engage young people at risk for developing EDs in behavior change. The current paper describes the development and preliminary acceptability and feasibility testing of AcceptME, a novel self-directed, gamified digital ED selective prevention program based on Acceptance and Commitment Therapy (ACT). AcceptME helps women and girls identified at risk for an ED relate differently to their thoughts and feelings, such that these experiences do not have undue influence over their behavior and actions can instead be guided by personal values. Methods: Users learned skills of psychological flexibility by helping a third-person avatar (a main character in a storyline) navigate situations that elicit distressing thoughts/feelings, and via interactive exercises, practiced applying these skills to their own experiences. Young women and girls in the Republic of Cyprus with high weight concern scores (N=58, Mage=15.27, SD=2.25) completed six 30-minute digital sessions and reported on session and intervention acceptability.Results: Attrition was 35.42%. The majority of participants were either “Very” (40%) or “Mostly” (57%) Satisfied with the program. Fifty-two percent reported that the program “Helped a lot,” and 48% said it “Helped a bit.” Conclusion: Digital technology and gamification have advantages for engagement and delivery. The current study suggests a promising direction for early ED interventions to reach at risk youth and preliminary data to guide development.

Online interventions for reducing anxiety, depression, and stress among adolescents: A systematic review and meta-analysis (Preprint)

BACKGROUND As the coronavirus 2019 disease pandemic has emerged as a threat to mental health, demand is increasing for online interventions that can replace face-to-face programs to prevent mental health problems. Adolescents not only have willingness to use an online mental health intervention, but also have generally positive perceptions of online intervention. However, there is still no general agreement regarding the effects of online interventions on adolescent mental health. OBJECTIVE This study aimed to evaluate the effectiveness of online interventions for reducing anxiety, depression, and stress among adolescents through a systematic review and meta-analysis. METHODS A systematic search of studies was performed using PubMed, EMBASE, and Cochrane Library CENTRAL. The Cochrane Collaboration’s tool was used for assessing risk of bias in randomized controlled trials (RCT). We performed meta-analyses to synthesize effect sizes of the included studies, which were calculated as standardized mean differences (SMD) with 95% confidence intervals (CI). RESULTS A total of 19 studies met the inclusion criteria, and 16 studies that reported sufficient numerical data were used for quantitative data synthesis. Regarding prevention level in the included interventions, universal prevention for general adolescents and selective prevention for vulnerable adolescents were conducted by 12 and seven studies, respectively. Among the interventions in this review, cognitive behavior therapy (CBT) and family-based interventions were most often used. In the result of a meta-analysis, online interventions have shown beneficial effect on reducing depression (SMD, -0.096; 95% CI. -0.175 to -0.017). Subgroup meta-analyses by preventive level found a significant effect of universal prevention on reducing depression (SMD, -0.102; 95% CI, -0.197 to -0.008) but no statistically significant effect of selective prevention on reducing depression (SMD, -0.082; 95% CI, -0.224 to 0.061). The effects of online interventions in reducing anxiety (SMD, -0.107; 95% CI, -0.231 to 0.018) and stress (SMD, -0.071; 95% CI, -0.157 to 0.016) among adolescents were not statistically significant in meta-analyses. CONCLUSIONS The findings of meta-analyses showed that online interventions significantly reduced depression among adolescents, and especially that universal prevention interventions significantly reduced depression. However, there is limited evidence for the effectiveness of online interventions for reducing anxiety and stress among adolescents. We suggest further RCTs regarding effectiveness of online intervention for adolescent anxiety and stress.

High Variability in Implementation of Selective-Prevention Services for Cardiometabolic Diseases in Five European Primary Care Settings

(1) Background: Cardiometabolic diseases are the most common cause of death worldwide. As part of a collaborative European study, this paper aims to explore the implementation of primary care selective-prevention services in five European countries. We assessed the implementation process of the selective-prevention services, participants’ cardiometabolic profile and risk and participants’ evaluation of the services, in terms of feasibility and impact in promoting a healthy lifestyle. (2) Methods: Eligible participants were primary care patients, 40–65 years of age, without any diagnosis of cardiometabolic disease. Two hundred patients were invited to participate per country. The extent to which participants adopted and completed the implementation of selective-prevention services was recorded. Patient demographics, lifestyle-related cardiometabolic risk factors and opinions on the implementation’s feasibility were also collected. (3) Results: Acceptance rates varied from 19.5% (n = 39/200) in Sweden to 100% (n = 200/200) in the Czech Republic. Risk assessment completion rates ranged from 65.4% (n = 70/107) in Greece to 100% (n = 39/39) in Sweden. On a ten-point scale, the median (25–75% quartile) of participant-reported implementation feasibility ranged from 7.4 (6.9–7.8) in Greece to 9.2 (8.2–9.9) in Sweden. Willingness to change lifestyle exceeded 80% in all countries. (4) Conclusions: A substantial variation in the implementation of selective-prevention receptiveness and patient risk profile was observed among countries. Our findings suggest that the design and implementation of behavior change cardiometabolic programmes in each country should be informed by the local context and provide some background evidence towards this direction, which can be even more relevant during the current pandemic period.

Feasibility and success rates of response enhancing strategies in a stepwise prevention program for cardiometabolic diseases in primary care

Background Prevention programs for cardiometabolic diseases (CMD), including cardiovascular disease, diabetes mellitus and chronic kidney disease are feasible, but evidence for the cost-effectiveness of selective CMD prevention programs is lacking. Response rates have an important role in effectiveness, but methods to increase response rates have received insufficient attention. The aim of the current study is to determine the feasibility and the success rate of a variety of response enhancing strategies to increase the participation in a selective prevention program for CMD. Methods The INTEGRATE study is a Dutch randomised controlled trial to assess the effectiveness and cost-effectiveness of a stepwise program for CMD prevention. During the INTEGRATE study we developed ten different response enhancing strategies targeted at different stages of non-response and different patient populations and evaluated these in 29 general practices. Results A face-to-face reminder by the GP increased the response significantly. Digital reminders targeted at patients with an increased CMD risk showed a positive trend towards participation. Sending invitations and reminders by e-mail generated similar response rates, but at lower costs and time investment than the standard way of dissemination. Translated materials, information gatherings at the practice, self-management toolkits, reminders by telephone, information letters, local media attention and SMS text reminders did not increase the response to our program. Conclusions Inviting or reminding patients by e-mail or during GPs consultation may enhance response rates in a selective prevention program for CMD. Different response-enhancing strategies have different patient target populations and implementation issues, therefore practice characteristics need to be taken into account when implementing such strategies. Trial registration Dutch trial Register number NTR4277. Registered 26 November 2013.

Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians

IntroductionLifestyle risk behaviours, including alcohol use, smoking, poor diet, physical inactivity, poor sleep (duration and/or quality) and sedentary recreational screen time (‘the Big 6’), are strong determinants of chronic disease. These behaviours often emerge during adolescence and co-occur. School-based interventions have the potential to address risk factors prior to the onset of disease, yet few eHealth school-based interventions target multiple behaviours concurrently. This paper describes the protocol of the Health4Life Initiative, an eHealth school-based intervention that concurrently addresses the Big 6 risk behaviours among secondary school students.Methods and analysisA multisite cluster randomised controlled trial will be conducted among year 7 students (11–13 years old) from 72 Australian schools. Stratified block randomisation will be used to assign schools to either the Health4Life intervention or an active control (health education as usual). Health4Life consists of (1) six web-based cartoon modules and accompanying activities delivered during health education (once per week for 6 weeks), and a smartphone application (universal prevention), and (2) additional app content, for students engaging in two or more risk behaviours when they are in years 8 and 9 (selective prevention). Students will complete online self-report questionnaires at baseline, post intervention, and 12, 24 and 36 months after baseline. Primary outcomes are consumption of sugar-sweetened beverages, moderate-to-vigorous physical activity, sleep duration, sedentary recreational screen time and uptake of alcohol and tobacco use.Ethics and disseminationThis study has been approved by the University of Sydney (2018/882), NSW Department of Education (SERAP no. 2019006), University of Queensland (2019000037), Curtin University (HRE2019-0083) and relevant Catholic school committees. Results will be presented to schools and findings disseminated via peer-reviewed journals and scientific conferences. This will be the first evaluation of an eHealth intervention, spanning both universal and selective prevention, to simultaneously target six key lifestyle risk factors among adolescents.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000431123), 18 March 2019.