Implementation Of Prevention Programs Research Articles

Reach, Adoption, and Implementation Strategies of a Telehealth Fall Prevention Program: Perspectives From Francophone Communities Across Canada.

Introduction. A fall may impact a person's physical, emotional, and psychological well-being. Fall prevention programs are being implemented to reduce these negative outcomes. However, linguistic barriers in health services may reduce access to such prevention programs. A telehealth fall prevention program was designed to increase access to such programs in French for Francophone minority communities in Canada. This capacity-building project aimed to support community partners to deliver this telehealth program and document strategies used to reach, adopt, and implement the program within various Francophone and Acadian Minority Communities. Methods. A sequential explanatory mixed methodology was used to document reach, adoption, and implementation strategies and describe the lived experiences of program facilitators and organization representatives. Reach, adoption, and implementation were documented and analyzed descriptively, while lived experiences were analyzed using content analysis following the Consortium Framework for Implementation Research. Results. Twelve organization representatives or program facilitators from eight organizations operating in four different provinces participated in the study. Three themes emerged from the qualitative data on reach and adoption: external context, internal context, and capacity building. Four themes were identified as barriers and facilitators to implementation: level of preparation and time management, interpersonal relations and telepresence, exercise facilitation and safety, and technological problem-solving. Conclusion. Using tailored reach and adoption strategies such as prioritizing provinces with higher proportions of needs and training local community program facilitators may lead to the successful implementation of a new telehealth fall prevention program. Results from this study could potentially inform other primary prevention programs or telehealth program implementation.

Decomposing difference in the kidney cancer burden measures between 1990 and 2019 based on the global burden of disease study

The kidney cancer (KC) burden measures have changed dramatically in recent years due to changes in exposure to the determinants over time. We aimed to decompose the difference in the KC burden measures between 1990 and 2019. This ecological study included data on the KC burden measures as well as socio-demographic index (SDI), behavioral, dietary, and metabolic risk factors from the global burden of disease study. Non-linear multivariate decomposition analysis was applied to decompose the difference in the burden of KC. Globally, ASIR, ASMR, and ASDR of KC increased from 2.88 to 4.37, from 1.70 to 2.16, and from 46.13 to 54.96 per 100,000 people between 1990 and 2019, respectively. The global burden of KC was more concentrated in developed countries. From 1990 to 2019, the burden of KC has increased the most in Eastern European countries. More than 70% of the difference in the KC burden measures between 1990 and 2019 was due to changes in exposure to the risk factors over time. The SDI, high body mass index (BMI), and alcohol use had the greatest contribution to the difference in the KC burden measures. Changes in characteristics over time, including SDI, high BMI, and alcohol consumption, appear to be important in the evolving landscape of KC worldwide. This finding may help policymakers design policies and implement prevention programs to control and manage KC.

Accelerating implementation of adolescent digital health prevention programs: analysis of insights from Australian stakeholders.

Chronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders' support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation. Qualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis. Nineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed. Stakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.

Association between self-efficacy and anxiety symptoms in adolescents: secondary analysis of a preventive program

Anxiety disorders are common among adolescents. To avert long-term adverse consequences, several school-based prevention programs have been created, yet few have explored the influence of emotional and social self-efficacy as a psychosocial competence on anxiety symptoms. In the context of the implementation of a school-situated anxiety prevention program named HORS-PISTE, the present study examines descriptions of anxiety symptoms associated with social anxiety, generalized anxiety, separation anxiety and panic anxiety, and two domains of self-efficacy (social and emotional), as well as an exploration of the association between these two elements, and the predictive effect of self-efficacy on anxiety symptoms. The present study included 1705 adolescents from 15 different schools in 4 different regions of Québec, Canada. Participants completed questionnaires assessing their anxiety symptoms and self-efficacy levels before and after completing the HORS-PISTE program. Our findings suggest that: emotional/social self-efficacy and anxiety symptoms differ according to certain characteristics in adolescents; self-efficacy and anxiety symptoms present a strong association in the context of the implementation of a school-based anxiety prevention program; self-efficacy has a predictive effect on anxiety symptoms; and self-efficacy presents a moderate interaction effect on anxiety symptoms change over time.

EVALUATING FEASIBILITY OF A SECONDARY STROKE PREVENTION PROGRAM

INTRODUCTION & AIMS While 80% of strokes are preventable, stroke remains the second leading cause of disability and death worldwide. Recurrent stroke has an accumulative effect that increases the level of disability and demands on healthcare. Healthy lifestyles that include regular exercise can reduce stroke risk, but stroke survivors lack guidance to modify their lifestyle after hospital discharge. Models of community care may support secondary stroke prevention with guidelines recommending physical activity and cardiovascular exercise, and referrals to support behaviour change to address modifiable risk factors. Our aim was to evaluate the implementation of a secondary stroke prevention program provided within a community rehabilitation service to see if it was feasible to deliver and acceptable for participants. METHOD We evaluated the implementation of a secondary stroke prevention program involving supervised exercise, multidisciplinary education and health coaching to address modifiable risk factors. The group-based program involved face-to-face and telehealth sessions. The primary outcomes were feasibility, examined via service information (referrals, uptake, participant demographics, costs), and participant acceptability (satisfaction and attendance). Secondary outcomes examined self-reported change in lifestyle factors, and pre-post scores on standardised clinical tests, [e.g., waist-circumference, 6-Minute-Walk (6MWT)]. RESULTS We ran seven programs in 12-months, and 37 people participated. Attendance for education sessions was 79%, and 30/37 participants completed the full program. No adverse events occurred. Participant satisfaction was high for ‘relevance’ (100%), ‘felt safe to exercise’ (96%) and ‘intend to continue’ (96%). Most participants (88%) changed (on average) 2.5 lifestyle factors (diet, exercise, smoking, alcohol). Changes in clinical outcomes seemed promising, with some being statistically significant, e.g. 6MWT (MD 59m, 95%CI 38m to 80159m, p<0.001), and waist-circumference (MD –2.1cm, 95%CI -3.9cm to -1.4cm, p<0.001). CONCLUSION The program was feasible to deliver, acceptable to participants and seemed beneficial for health. Access to similar programs may assist in secondary stroke prevention.

The clinical perspective on late-onset depression in European real-world treatment settings

The clinical phenotype of the so-called late-onset depression (LOD) affecting up to 30% of older adults and yielding heterogeneous manifestations concerning symptoms, severity and course has not been fully elucidated yet. This European, cross-sectional, non-interventional, naturalistic multicenter study systematically investigated socio-demographic and clinical correlates of early-onset depression (EOD) and LOD (age of onset ≥ 50 years) in 1410 adult in- and outpatients of both sexes receiving adequate psychopharmacotherapy. In a total of 1329 patients (94.3%) with known age of disease onset, LOD was identified in 23.2% and was associated with unemployment, an ongoing relationship, single major depressive episodes, lower current suicidal risk and higher occurrence of comorbid hypertension. In contrast, EOD was related to higher rates of comorbid migraine and additional psychotherapy. Although the applied study design does not allow to draw any causal conclusions, the present results reflect broad clinical settings and emphasize easily obtainable features which might be characteristic for EOD and LOD. A thoughtful consideration of age of onset might, hence, contribute to optimized diagnostic and therapeutic processes in terms of the globally intended precision medicine, ideally enabling early and adequate treatment allocations and implementation of respective prevention programs.

Teachers' Perceptions of the Impact of the COVID-19 Pandemic and Their Implementation of an Evidence-based HIV Prevention Program in the Bahamas.

Information on how school-based programs is implemented and sustained during crises is limited. In this study, we assessed the impact of the COVID-19 pandemic on the implementation of a HIV prevention intervention in The Bahamas. Data were collected from 139 Grade 6 teachers in 2021-2022. Teachers attended virtual training and received implementation monitoring from coordinators. On average, teachers taught 26.4 (SD = 9.2) of the 35 core activities, and 7.4 (SD = 2.4) out of 9 sessions. More than half (58.3%) of teachers completed 28 or more core activities; 69.1% covered eight or all nine sessions, which is equivalent to 80% of the HIV intervention curriculum. Almost half of the teachers (43%) reported that the pandemic negatively impacted their ability to teach the program; 72% of teachers maintained that the program remained "very important" during times of crisis. Greater self-efficacy and supports increased implementation fidelity.

Effectiveness of School Violence Prevention Programs in Elementary Schools in the United States: A Systematic Review

School violence remains a major concern for scholars, policymakers, and the public in the United States. Despite the implementation of various school violence prevention programs, information regarding their effectiveness in the United States is outdated and limited. This systematic review identified current elementary school programs that effectively reduce school violence in the United States and determined the types of elementary school violence prevention programs implemented, their effectiveness, and the types of tools used to enhance such programs. A qualitative methodological approach was employed, and four databases were searched. English articles published between 2012 and 2023 were selected. Furthermore, data involving elementary school education, school personnel, teachers, and children (5–12-year-old) in the United States were included in the thematic analysis. Results confirmed that the school-wide Positive Behavior Interventions and Supports program effectively decreases violence, suspensions, office referrals, and disruptive behaviors, whereas positive action effectively reduces negative violent behaviors. Social–emotional learning (SEL) implementation also reduced behavioral issues. The findings of this study are relevant for guiding teachers, school administrators, policymakers, teacher education preparation programs, and health professionals in constructing evidence-based violence prevention programs with an added SEL component for elementary schools.

Community-Identified Implementation Strategies for Promoting the Adoption of HIV Self-Testing in a Southern California American Indian community: A Rapid Qualitative Analysis.

HIV incidence increased by 18% between 2015 and 2019 among American Indians (AIs) despite declining rates in other racial/ethnic groups. Culturally-appropriate implementation of prevention programs is needed to address the intersectional conditions contributing to HIV vulnerabilities experienced by AIs. The objectives of this study were to understand factors influencing HIV testing decisions and identify implementation strategies to promote the acceptability of HIV self-testing (HIVST) in a southern California AI community. A total of 15 semi-structured interviews were completed with adult community members of a southern California AI reservation. Analysis used a rapid analytic approach that was guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and expert recommendations for implementing change (ERIC) compilation. Two team members applied a standardized summary template to elucidate implementation determinants and implementation strategies for adopting HIVST. Barriers to HIV testing identified by community members included HIV-related stigma and privacy concerns within their community. Community members expressed positive perceptions of the acceptability of HIVST, with many identifying ease of use and privacy as appealing attributes. Several implementation strategies were suggested for facilitating the adoption of HIVST, including increasing access to tests by mailing kits to community members and increasing demand for kits through media campaigns (e.g., local flyers, social media posts, and booths at tribal events). Community members also recommended discreet packaging of kits and cultural adaptation of accompanying materials (e.g., educational videos featuring community members). The qualitative input from AI community members facilitated identification of implementation strategies that may promote the acceptability and culturally-appropriateness of HIVST.

PRE- AND POST-NATAL METHODS FOR PREVENTING EARLY CHILDHOOD CARIES

In general, the world recognizes the lack of preventive measures against dental caries in children, as evidenced by itsprevalence and intensity with a signifi cant range of fl uctuations.The aim of the study. To describe modern approaches to the prevention of early childhood dental caries in children basedon the analysis of foreign and domestic literature.Materials and methods. The study used the bibliosemantic method and structural and logical analysis. The electronicdatabases PubMed, MEDLINE, Scopus, Web of Science and EMBASE were used to search modern scientifi c literature using the key words «early childhood caries», «macro and trace elements», «probiotics», «prenatal prevention», «postnatal prevention», «oral cavity microfl ora».Results and discussion. At this stage of caries development, the most eff ective prevention programs are those developedon the basis of methods to minimize the impact of risk factors for the development of the disease, such as microbial plaque,low resistance of dental tissues to demineralization, frequent consumption of carbohydrates. The practical implementation of comprehensive prevention programs is very diffi cult, as it should be carried out before the birth of a child and continue throughout life. Often the role of the dentist is to organize and monitor the program, while specifi c preventive measures can and should be implemented by health and education authorities, medical personnel, parents and educators. The greatest impact will be achieved through collaboration among specialists in various medical and non-medical fi elds.Conclusions. Based on the analysis of the literature, there is a great interest of the world’s leading scientists in the prevention of early childhood caries. However, the problems of developing adapted preventive measures taking into account etiologic factors remain relevant.

A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care

BackgroundMore than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations.MethodsWe systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to “Aboriginal and Torres Strait Islander peoples,” “Chronic Disease,” and “Primary Health Care”. Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches.ResultsDatabase searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery.ConclusionEnabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.

Clinical and socio-demographic profile of pneumonia in children aged 2 months to 5 years

Among the common childhood illnesses, pneumonia is a substantial cause of morbidity and mortality in children throughout the world. Approximately, 150 million episodes of childhood pneumonia are reported every year, out of which 95% are from developing countries. In addition, socioeconomic and environmental factors like overcrowding, air pollution, passive smoking, practice of bottle feeding etc., contribute to the significant rise in incidence of pneumonia during recent years. The known factors affecting mortality are malnutrition, inadequate vaccination, illiteracy and lack of exclusive breast feeding.Pneumonia is one of the most prevalent Pediatric infections, and it is a leading cause of morbidity and mortality in children all over the world. Every year, approximately 150 million cases of childhood pneumonia are reported, with 95 percent of cases coming from underdeveloped nations. Furthermore, socioeconomic and environmental variables like as overcrowding, air pollution, passive smoking, and the practice of bottle feeding, among others, have contributed to the large increase in pneumonia incidence in recent years. Malnutrition, inadequate immunization, illiteracy, and a lack of exclusive breast feeding are all documented variables that contribute to mortality.A total of 120 children in the age group of 2 months to 5 years, diagnosed with Pneumonia as per standard definition were enrolled in the study. Detailed history was taken including socio demographic factors and physical examination was done in all children. Appropriate investigations were done. : Children aged between 2 and 12 months constituted 60% of cases. The male to female ratio was 1.5:1. 27.5% children had low birth weight, 63.3% were exclusively breast fed up to 6 months of age. Severe and very severe pneumonia was seen in 90% of children between age group 2 months and 2 years, 63.6% with low birth weight, and 66.6% with partial immunization status. Significant association was found between early weaning and severity of pneumonia (45.45% vs 26.3%).Children less than 2 years are more prone for developing pneumonia. Low birth weight, partial immunization status of the children, early weaning, history of bottle feeding, lower socioeconomic status, overcrowding, malnutrition and lack of maternal literacy were shown to have an increased risk for severe and very severe pneumonia in children. As most of the above stated factors are modifiable, the implementation of various preventive and educational programs in our society has a likelihood to reduce the occurrence and severity of pneumonia in children

Perceptions of professional stakeholders on perpetration prevention programs designed to prevent sexual offending against children

There has been an increasing focus on the development of perpetration prevention programs designed to prevent the onset of sexual offending against children (online and offline). The present study involved a thematic analysis of 20 professional stakeholders in Nova Scotia who participated in a semi-structured interview that occurred prior to the development and implementation of a perpetration prevention program. Results highlighted that stakeholders saw value in a perpetration prevention program aimed at preventing the onset of sexual offending against children. Stakeholders noted that program content should address sexual-based concerns, focus on improving mental health and well-being, and consider the role of trauma. Stakeholders also emphasized the importance of creating a safe therapeutic environment. Several barriers were identified that focused on recruitment challenges, the role of fear and stigma, and the inclusion of diverse clients and facilitators. The importance of leveraging community organizations and supports was also highlighted. Implications of the findings are discussed in relation to perpetration prevention programming.

Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV

Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of HIV primary care. To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non-high-density lipoprotein (HDL) cholesterol level in a diverse population of PWH receiving antiretroviral therapy (ART). This randomized clinical trial enrolled PWH at 3 academic HIV clinics in the US from September 2019 to January 2022 and conducted follow-up for 12 months until January 2023. Included patients were 18 years or older and had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. Participants were stratified by trial site and randomized 1:1 to either the multicomponent EXTRA-CVD (A Nurse-Led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention) intervention group or the control group. Primary analyses were conducted according to the intention-to-treat principle. The EXTRA-CVD group received home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse at 4 in-person visits (baseline and 4, 8, and 12 months) and frequent telephone check-ins up to every 2 weeks as needed. The control group received general prevention education sessions from the prevention nurse at each of the 4 in-person visits. Study-measured SBP was the primary outcome, and non-HDL cholesterol level was the secondary outcome. Measurements were taken over 12 months and assessed by linear mixed models. Prespecified moderators tested were sex at birth, baseline ASCVD risk, and trial site. A total of 297 PWH were randomized to the EXTRA-CVD arm (n = 149) or control arm (n = 148). Participants had a median (IQR) age of 59.0 (53.0-65.0) years and included 234 males (78.8%). Baseline mean (SD) SBP was 135.0 (18.8) mm Hg and non-HDL cholesterol level was 139.9 (44.6) mg/dL. At 12 months, participants in the EXTRA-CVD arm had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P < .001) lower non-HDL cholesterol level compared with participants in the control arm. There was a clinically meaningful but not statistically significant difference in SBP effect in females compared with males (11.8-mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06). Results of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for PWH. ClinicalTrials.gov Identifier: NCT03643705.

The effectiveness of drug prevention programs among children in schools

The problem of discipline and moral decay nowadays in society in Malaysia is very concerning, especially among children and teenagers, as it spreads very fast and keeps being very difficult to deal with. Drug abuse is a big problem that is spreading among the world community and this will have a very bad effect especially the development of human capital. This study aimed to find out the effectiveness of Drug Prevention Programs among children at school. From this Program we want to know the level of awareness, knowledge, skills, and spirituality among children. This study has used quantitative design and is supported by qualitative data. The first phase is a case study that uses the interview with teachers and government anti-drug agency officers who are involved in the implementation of the program. For the second phase of the study, researchers have used the survey method by distributing questionnaires to the recipient subjects, who are primary school students in at-risk states who have been selected to follow the drug prevention program. The results of the survey show that all the indicators of the effectiveness of the participants, namely awareness, knowledge, skills, and spirituality, have a high percentage, with percentage values of 78.0%, 93.4%, 84.2%, and 93.4%. Overall, of the study show that the implementation of the drug prevention program in schools has achieved its objectives, in addition to paying attention to the effectiveness factors as well as the obstacles and weaknesses encountered.

Implementation of a Childcare-Based Obesity Prevention Program for Vulnerable Families During the COVID-19 Pandemic: Lessons for School Nurses.

COVID-19 brought significant changes to the role of school nurses, necessitating the development of remote health education programs. However, there is a lack of evidence and pedagogical lessons for digitally transforming education for socially vulnerable children. This qualitative study analyzes the health educational needs and barriers faced by children and service providers in a childcare-based obesity prevention program during the pandemic in South Korea. Through a thematic content analysis, four core themes emerged: (a) heightened concerns about obesity and the pandemic's impact on facilities, (b) unexpected positive outcomes of the program, (c) digital readiness gaps, and (d) insufficient program satisfaction (better than nothing). When designing a digital-based health education program for vulnerable children, assessing individual readiness and facility suitability is crucial. Additionally, school nurses should incorporate hybrid pedagogy, integrating technology-mediated activities. By leveraging technology effectively and considering individual and environmental factors, educators can provide comprehensive and accessible health education.

Longitudinal associations between adult-supervised drinking during adolescence and alcohol misuse from ages 25–31 years: A comparison of Australia and the United States

Prior studies suggest that adult supervised drinking in adolescence predicts greater adolescent alcohol misuse. Long-term follow up data examining how adult supervised drinking during adolescence relates to alcohol misuse in adulthood are lacking. Longitudinal data from the International Youth Development Study tested associations between adult supervised drinking during adolescence (ages 13–16; 2002–2004) and adult alcohol misuse (ages 25–31; 2014, 2018, 2020). Cross-nationally matched samples were compared in Washington State, USA (n = 961) and Victoria, Australia (n = 1,957; total N = 2,918, 55 % female, 83 % White), where adult-supervised adolescent alcohol use was more common. Multilevel analyses adjusted for state, sex, adolescent drinking, parent education, family management, family history of substance use problems, and parent alcohol-related norms. Adult supervised drinking in adolescence (at dinner or parties, on holidays) predicted more adult alcohol misuse (mean Alcohol Use Disorders Identification Test score; b[SE] 0.07[0.03]; p = 0.004) and higher rates of alcohol-impaired driving (Odds Ratio [OR] 1.501, p = 0.034) and riding with an alcohol-impaired driver (OR 1.669, p = 0.005), but not the use of strategies to moderate alcohol intake (e.g., counting drinks). Better family management (monitoring, clear rules) in adolescence predicted less adult alcohol misuse. Associations were similar in the two states. Reducing the frequency of adult supervised drinking and improving family management practices in adolescence may help to decrease alcohol misuse well into adulthood. Findings support the widespread implementation of substance use prevention and family management training programs.

Ethnic Disparities in Betel Nut Use

Abstract: Adolescent substance use has been extensively studied in Western countries. However, knowledge of substance use, particularly betel nut use, among adolescents in the Pacific Islands, remains limited. The present study examined ethnic differences in betel nut use and intention to use, and factors explaining such ethnic differences, in Guam, a US-Affiliated Pacific Islands in the Western Pacific. Participants were 674 ethnically diverse students (49% female; Mage = 12.7, SD = 0.89) from eight local public middle schools. Self-report questionnaires were used to assess study variables. The results indicated that although the majority of participants did not use betel nut, there were significant differences in rates of betel nut use and intentions to use between ethnic groups. Compared with adolescents from other ethnic groups represented in the study, adolescents from the Freely Associated States (FAS) of Micronesia, or non-CHamoru Micronesians were more likely to use betel nut in the past 30 days and in their lifetime and to expect to use betel nut in the near future. These ethnic differences were partially mediated by proposed factors such as observation or familiarity with and access to betel nut and approval by parents, peers, and the community. In other words, FAS ethnicity was a significant predictor of higher levels of familiarity with betel nut; FAS ethnicity also predicted lower levels of difficulty in accessing betel nut and perceived disapproval of betel nut use from parents, peers, and the community. These, in turn, predicted more betel nut use and intention as reported by FAS adolescents. These findings can be used to inform the design and implementation of intervention and prevention programs to reduce ethnic disparities among at-risk youth vulnerable to betel nut use in the Pacific.

Exploratory spatial analysis: Understanding the geography of risks for trafficking and preventive efforts through the implementation of kNOw MORE!—: an educational program in middle and high schools in San Diego, California

Human trafficking (HT) violates human rights and brings long-lasting consequences for victims. This study aimed to geographically and statistically analyze (1) the implementation of a youth educational prevention program, kNOw MORE! (kM!) located in San Diego County (SD); (2) clusters of student participants who desired to talk further about trafficking after participating in kM!; (3) clusters of SD regions that included protective factors based on mental and social services for survivors of HT and similar populations; and (4) the low and high risk clusters for trafficking within SD. kM! is a preventive program that seeks to increase knowledge and self-efficacy to prevent trafficking. kM! is designed to increase knowledge and self-efficacy among middle and high school students to prevent HT. Databases used included the U.S. Census, the California Longitudinal Pupil Achievement Data System, kM!’s (2016–2020), among others. Results indicate that kM! was implemented throughout the six regions of SD. These presentations reached a total of N = 11,586 participants. Analysis of ZIP codes highlighted the South and East regions as representing the highest cluster for kM!’s presentations. Central, North Inland, and South Regions of SD are among the ones with highest percentiles of HT vulnerability scores. Regarding protective factors, the Central Region of San Diego contains the highest clustering of mental health and social services. These findings can assist diverse stakeholders and leaders to geographically strategize their anti-trafficking efforts. However, complete and uniform open databases at multiple levels are required to best inform the associations between geographical spaces and HT vulnerability.

Implementation of a Primary Prevention Program for Posttraumatic Stress Disorder in a Cohort of Professional Soldiers (PREPAR): Protocol for a Randomized Controlled Trial.

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can manifest after a traumatic event where the individual perceives a threat to his or her life or that of others. Its estimated prevalence in the European population is 0.7% to 1.9%. According to the "dose-response" model, individuals who are most exposed to traumatic events are most at risk of developing PTSD. Hence, it is unsurprising that studies have observed a higher prevalence among the military population, ranging from 10% to 18%, or even up to 45%. This project's overall goal is to evaluate the primary prevention actions that can strengthen the resilience of at-risk professionals, notably military personnel, in the short term, with the medium- to long-term aim of preventing the occurrence of PTSD and improving the patient's prognosis. This study's objectives are (1) to design a primary prevention program for PTSD, tailored to the studied military population and compatible with operational constraints; and (2) to implement and validate the Primary Prevention of Posttraumatic Stress Disorder in Military Professionals (PREPARE) program in the short term with operational personnel belonging to the French Mountain Infantry Brigade. This is a single-center, prospective, randomized, parallel-group controlled cohort study. The cohort is divided into 2 groups: the nonintervention group receives no training, and the intervention group follows a dedicated prevention program (structured into 8 workshops and 2 debriefing and practice reinforcement workshops). Each participant is evaluated 4 times (at inclusion, +4 months, +6 months, and +12 months). During each visit, participants complete several psychosocial questionnaires (which take 15-80 minutes to complete). Samples (a 30-mL blood sample and three 5-mL saliva samples) are collected on 3 occasions: at inclusion, +4 months, and +12 months. Emotional reactivity (electrocardiogram and electrodermal activity) is measured before, during, and after the classic and the emotional Stroop task. The project is currently ongoing, and results are expected to be published by the end of 2024. The study adopts an integrative approach to the processes that play a role in the risk of developing PTSD. Our biopsychosocial perspective makes it possible to target levers related to factors specific to the individual and socio-professional factors. The following dimensions are addressed: (1) biophysiology (by studying markers of the neurobiological stress response, wear and tear, and vulnerability phenomena and reinforcing the flexibility of the autonomic nervous system), (2) psychology (by facilitating and measuring the development of flexible coping strategies to deal with stress and evaluating the moderating role of the individual's sense of duty in the development of PTSD), and (3) social (by facilitating community strategies aimed at reducing stigmatization and supporting the use of care by professionals in difficulty, in the institutional context). ClinicalTrials.gov NCT05094531; https://clinicaltrials.gov/study/NCT05094531. DERR1-10.2196/47175.