Universal Prevention Programs Research Articles

A randomised controlled trial comparing the effects of directive and non-directive parenting programmes as a universal prevention programme

Purpose– The purpose of this paper is to compare the effectiveness of directive programmes led by professionals where parents were taught specific parenting knowledge and strategies (Triple P – Positive Parenting Program) and non-directive parenting programmes in the form of mutual-aid support group as a universal prevention programme.Design/methodology/approach– This study employed a randomised controlled trial design. Participants included 92 Hong Kong Chinese parents with preschool children recruited from eight kindergartens and a local church. They were randomised into Group Triple P, non-directive group and control group. They completed measures on their perception of child behaviour problems and their parental stress before and after intervention.Findings– At post-intervention, results indicated significantly greater decrease in child disruptive behaviours among participants in the Triple P group than those in the non-directive group and control group while no significant group difference was found between the latter two groups. No significant difference was found in post-intervention parental stress level among the three groups.Originality/value– This study provides empirical evidence to demonstrate the effectiveness of a directive parenting programme vs a non-directive one.

Child, Teacher and Parent Perceptions of the FRIENDS Classroom-Based Universal Anxiety Prevention Programme: A Qualitative Study.

School-based mental health prevention programmes can be effective but their adoption within schools will depend on their social acceptability. We report a qualitative evaluation summarising the views of children (115), parents (20) and school staff (47) about a universal school-based anxiety prevention programme FRIENDS. This study was conducted as part of a large scale randomised controlled trial (n = 1362) involving 40 schools in the UK providing primary education to children aged 7–11. Reported overall experience of the programme was very positive, with all three major components of the cognitive behaviour therapy programme (emotional, cognitive, and behavioural) being accepted well and understood by children. The programme was considered to be enjoyable and valuable in teaching children important skills, particularly emotional regulation and coping. Children provided examples of using the skills learned during FRIENDS to manage their emotions and solve problems. However, teachers were concerned that the programme overlapped with the current school curriculum, required additional time and almost half were unable to identify any tangible changes in the children’s behaviour. Whilst this paper provides evidence to support the social validity of the FRIENDS anxiety prevention programme, the concerns raised by teachers question the longer-term sustainability of the programme.

Effects of implicit affect on emotional coping and school adjustment: A short-term longitudinal study with a school-based universal prevention program for enhancing emotional abilities

In recent years, affect and emotions are hot research topics in the domains of psychology and brain science. Moreover, an increasing number of studies have started to investigate the effects of implicit affect on health and adjustment. The purpose of this study was to examine the effects of implicit affect on explicit emotional coping with others’ emotions and school adjustment in children.MethodsParticipants were 5th- and 6th-grade children in two public elementary schools in Japan. The final samples were fifty-six children (25 boys and 31 girls). Participants completed a battery of three questionnaires just before (T1) and after (T2) an school-based universal prevention program for enhancing emotional coping abilities with others’ emotions, which was implemented in eight classes during one month. The questionnaires were utilized for assessing implicit positive and negative affect (IPA and INA), explicit emotional coping abilities to identify, understand, and regulate others’ emotions, and the adaptive status of children at school.ResultsHierarchical regression analyses showed that higher IPA at T1 was associated with higher explicit emotional coping and motivation for learning at T2. Also, higher INA at T1 was related to better peer relationship at T2. Moreover, higher IPA and INA at T1 were concerned with higher scores of classroom climate and approval at T2.ConclusionThis study suggested that higher IPA leads to higher explicit emotional coping with others’ emotions. Also, it suggested that higher implicit affectivity (i.e., both higher IPA and INA) causes more adaptive status of children at school.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effectiveness of a school-based universal prevention program for enhancing self-confidence: Considering the extended effects associated with achievement of the direct purposes of the program

IntroductionWe have developed a group of school-based universal prevention programs for children's health and adjustment. The programs are characterized by new theories such as the somatic-marker hypothesis and enjoyable methods that utilize animated stories and games. This study adopted one of the programs for the development of self-confidence.ObjectiveThe aim was to examine the effectiveness of the program. In addition to the direct purposes of the program, children's adjustments at school and homeroom class were evaluated as extended effects.MethodsParticipants were third grade children in six public elementary schools in Japan. The final sample included 442 children (219 boys and 223 girls). The program was implemented weekly in one regular 45-minute class over 8 weeks. Participants completed a battery of three questionnaires three times, 1 month before the start of the program (T1), 1 week before the start of the program (T2), and during 1 week after the last class of the program (T3).ResultsResults showed that all of the main endpoints of the program significantly improved in the intervention condition (i.e., changes from T2 to T3), compared to the control condition (i.e., changes from T1 to T2). Moreover, children's adjustment at school and homeroom class increased in the intervention condition, compared to the control condition. However, implicit affect was unchanged.ConclusionThis study suggests that the program is effective for enhancing self-confidence, along with adjustments at school and in class. Future research that examines the sustainability of the effectiveness of the program is planned.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Effectiveness and Sustainability of a Universal School-Based Programme for Preventing Depression in Chinese Adolescents: A Follow-Up Study Using Quasi-Experimental Design

BackgroundA pilot study about the effectiveness of a universal school-based programme, “The Little Prince is Depressed”, for preventing depression in Chinese adolescents in Hong Kong was conducted and reported previously. This study used a larger sample to examine the effectiveness and sustainability of the programme.MethodsThis study used quasi-experimental design. Twelve schools enrolled in “The Little Prince is Depressed” programme either as an intervention or a control condition. The intervention schools carried out the 12-session programme in two phases: the professional-led first phase and the teacher-led second phase. All participants were required to complete a questionnaire at three time points measuring their (1) depressive, anxiety, and stress levels; (2) knowledge of mental health; (3) attitudes towards mental illness; (4) perceived social support; and (5) help-seeking behaviours.ResultsA total of 3,391 students participated in the study. The level of depressive symptoms did not reduce significantly at post-intervention; however, a delayed effect was observed at follow-up assessment for the participants of the teacher-led group in reducing anxiety and stress levels. Also, the knowledge of mental health and attitudes towards mental illness of the intervention-group participants significantly improved at post-test, and the outcomes were maintained at 4 to 5 months after the intervention in both the professional-led and the teacher-led conditions (p<.05). A preference among schoolchildren for whom to seek help from was identified.ConclusionsThe universal depression prevention programme was effective in enhancing knowledge of mental health and promoting a more positive attitude towards mental illness among adolescents in Hong Kong. In particular, the teacher-led group showed better outcomes than the professional-led group in reducing students’ anxiety and stress at follow-up period. The programme can achieve sustainability in schools if teachers are provided with adequate support.

Parenting Profiles and Adolescent Dating Relationship Abuse: Attitudes and Experiences.

Parenting behaviors such as monitoring and communications are known correlates of abusive outcomes in adolescent dating relationships. This longitudinal study draws on separate parent (58 % female; 61 % White non-Hispanic, 12 % Black non-Hispanic, 7 % other non-Hispanic, and 20 % Hispanic) and youth (ages 12-18 years; 48 % female) surveys from the nationally representative Survey of Teen Relationships and Intimate Violence. Latent class analyses were applied to investigate whether there are distinguishable parenting profiles based on six measures of parent-youth relationship and interactions, with youth's attitudes about abusive dating behavior and both perpetration and victimization examined in a follow-up survey as distal outcomes (n = 1117 parent-youth dyads). A three-class model-a "Positive Parenting" class, a "Strict/Harsh Parenting" class, and a "Disengaged/Harsh Parenting" class-was selected to best represent the data. The selected latent class model was conditioned on parents' (anger trait, relationship quality, attitudes about domestic violence) and youth's (prior victimization and perpetration) covariates, controlling for parent's gender, race/ethnicity, income, marital status, and youth's age and gender. Youth in the "Positive Parenting" class were significantly less likely 1 year later to be tolerant of violence against boyfriends under any conditions as well as less likely to perpetrate adolescent relationship abuse or to be a victim of adolescent relationship abuse. Parents' anger and relationship quality and youth's prior perpetration of adolescent relationship abuse as well as gender, age, and race/ethnicity predicted class membership, informing universal prevention program and message design, as well as indicated efforts to target communications and services for parents as well as for youth.

A Comprehensive Evaluation of a Universal School-Based Depression Prevention Program for Adolescents.

The present study proposes and demonstrates a comprehensive framework for evaluation of a universal school-based depression prevention program. Efficacy was evaluated by considering the impact of continuous versus categorical approaches to operationalizing outcome, the effect of the intervention on key change agent variables, and moderation of intervention effects by student symptom severity at baseline. Participants 252 adolescent boys and girls (60% male), aged 13 to 17years (M = 13.62years, SD = 0.60years) from four schools in the state of Victoria, Australia, who were allocated by school into a waitlist = control (n = 88) or a CBT-based intervention (n = 164) group. The intervention involved six 45-min weekly sessions run during wellbeing classes. While the intervention and control groups did not differ in average improvement in symptoms by post-intervention, further analyses showed that responsiveness was highly variable within the intervention, and those with elevated depressive symptoms benefitted most. The proposed change agents of self-esteem, resilience, body image satisfaction, and perceived social support did not uniquely predict change in depressive symptoms but collectively accounted for substantial variance in this change process. Collectively, this framework provided insights into aspects of the intervention that worked and highlighted areas for improvement, thus providing clear direction for future research.

Long-term effects of two childhood psychosocial interventions on adolescent delinquency, substance use, and antisocial behavior: a cluster randomized controlled trial

Examine the long-term effects of two childhood universal prevention programs on adolescent delinquency, substance use, and antisocial behavior. The cluster randomized controlled trial involved 56 schools and 1,675 children in Zurich, Switzerland. Two evidence-based interventions, namely the social-emotional skills program Promoting Alternative Thinking Strategies (PATHS) and the cognitive-behavioral parenting program Triple P, were implemented during the first two years of primary school, at ages 7 and 8 years. Outcomes were measured at ages 13 and 15 years, and included youth self-reports and teacher assessments. Multilevel models were used to account for the clustered nature of the interventions. Effects were estimated with the inclusion of baseline covariates. Across 13 outcomes related to delinquency, substance use, and antisocial behavior at ages 13 and 15 years, only two non-negligible effects were found. The first was a reduced prevalence of police contacts in the PATHS condition [effect size (ES) = −0.225). The second was a difference in competent conflict resolution skills in the combined PATHS + Triple P condition compared to the context (ES = 0.259), but in the unexpected direction: participants in the combined treatment appeared to be less competent than their control group peers. All other effects were either statistically non-significant or negligible in size (i.e., ES < |0.200|). Even “evidence-based” interventions may have few long-term effects on delinquency, substance use, and antisocial behavior. Our findings add to the small literature on the long-term effectiveness of early universal prevention in field settings.

Universal violence and child maltreatment prevention programs for parents: A systematic review

The present study aimed to review recent literature on universal violence and child maltreatment prevention programs for parents. The following databases were used: Web of Science, PsycINFO, PsycARTICLES, PubMed, LILACS, and SciELO. The keywords included the following: (Parenting Program or Parent Training or Parent Intervention) and (Maltreatment or Violence or Violence Prevention). For inclusion in this review, the programs had to be structured, working in groups of parents aiming to improve parenting practices. Twenty-three studies were included, and 16 different types of parenting programs were identified. Ninety-one percent of the studies were conducted in developed countries. All the programs focused on the prevention of violence and maltreatment by promoting positive parenting practices. Only seven studies were randomized controlled trials. All studies that evaluated parenting strategies (n=18), reported after the interventions. The programs also effectively improved child behavior in 90% of the studies that assessed this outcome. In conclusion, parenting educational programs appear to be an important strategy for the universal prevention of violence and maltreatment against children. Future studies should assess the applicability and effectiveness of parenting programs for the prevention of violence against children in developing countries. Further randomized control trials are also required.

小学校高学年児童および中学生における反応スタイルの調整効果とストレス生成効果

Relationships between response styles, stressors, and depressive symptoms were investigated in a cross section of adolescents from 4th to 9th grades. A model including stress-diathesis and stress-generation was developed to examine whether response styles moderated the effects of stressors on depressive symptoms, and whether response styles were linked to an increased likelihood of stressors. Results indicated that rumination and distraction functioned as moderators in adolescents that are high ruminators, or in adolescents that are low distractors exhibiting a stronger association between stressors and depression. Furthermore, all response styles were associated with the stressor level, such that rumination and distraction were related to increased levels of stressors, whereas problem-solving was related to decreased levels of stressors. It is suggested that a universal depression prevention programs for adolescents should focus on attenuating rumination and enhancing problem-solving skills.

Alcohol expectancies and drinking behaviors among college students with disordered eating

ABSTRACTObjective: The authors investigated binge drinking, alcohol expectancies, and risky and protective drinking behaviors in relation to disordered eating behaviors in male and female college students. Participants: The full sample consisted of 7,720 undergraduate students, 18 to 22 years of age. Drinking behaviors were analyzed in 4,592 recent drinkers. Methods: Participants anonymously completed a survey as part of a universal alcohol abuse prevention program between September 2007 and April 2008. Results: Co-occurring disordered eating behaviors and binge drinking characterized 17.1% of males and 19.0% of females. Rates of binge drinking were higher in those with disordered eating behaviors. Students with disordered eating behaviors also had more positive and negative alcohol expectancies and engaged in more risky and fewer protective drinking behaviors than their counterparts. Conclusions: Students with disordered eating behaviors have outcome expectancies and behavior patterns associated with problematic drinking. These findings may enhance prevention and intervention programs.

Examining reward-seeking, negative self-beliefs and over-general autobiographical memory as mechanisms of change in classroom prevention programs for adolescent depression

BackgroundEffective methods to prevent adolescent depressive symptoms could reduce suffering and burden across the lifespan. However, psychological interventions delivered to adolescents show efficacy only in symptomatic or high-risk youth. Targeting causal risk factors and assessing mechanistic change can help devise efficacious universal or classroom based prevention programs. MethodsA non-randomized longitudinal design was used to compare three classroom-based prevention programs for adolescent depression (Behavioral Activation with Reward Processing, “Thinking about Reward in Young People” (TRY); Cognitive Behavioral Therapy (CBT) and Mindfulness Based Cognitive Therapy (MBCT)), and determine cognitive mechanisms of change in these programs. Cognitive mechanisms examined were reward-seeking, negative self-beliefs (assessed with behavioral tasks) and over-general autobiographical memory. 256 healthy adolescents aged 13–14 participated with 236 (92%) and 227 (89%) completing the pre- and post-assessments. ResultsTRY was the only intervention associated with a reduction in depressive symptoms at follow-up. Reward-seeking increased following TRY. In the other programs there were non-significant changes in cognitive mechanisms, with more reflective negative self-beliefs in CBT and fewer over-general autobiographical memories in MBCT In the TRY program, which focused on increasing sensitivity to rewarding activities, reward seeking increased and this was associated with decreased depressive symptoms. LimitationsDue to the infeasibility of a cluster randomized controlled trial, a non-randomized design was used. ConclusionsIncreased reward-seeking was associated with decreased depressive symptoms and may be a mechanism of depressive symptom change in the intervention with a focus on enhancing sensitivity and awareness of reward. This study provides preliminary evidence to suggest that incorporating activities to enhance reward sensitivity may be fruitful in randomized controlled trials of universal prevention programs for depression.

Effectiveness of a Universal, Interdependent Group Contingency Program on Children's Academic Achievement: A Countywide Evaluation

The Good Behavior Game (GBG) is a universal prevention program designed to increase academic engagement and to decrease disruptive behavior in elementary school-age children. Teachers and other school personnel use interdependent group contingencies to improve students’ behavior in the classroom. Previous research indicates the GBG is efficacious in reducing behavior problems; however, little research has examined its effects on academic achievement in real-world settings. In this study, the authors evaluated the PAX GBG, a commercially available version of the GBG, as it is typically administered in elementary schools. The authors examined standardized reading and mathematics scores across one academic year for 949 students enrolled in the GBG or comparison classrooms. Results showed significant but small effects of the GBG on reading and mathematics. Results were greatest for boys, children with lower achievement scores at baseline, and students from more economically disadvantaged school districts. School personnel may find the PAX GBG useful in improving children's behavior and academic skills.

A Quasi-Randomized Trial of a School-Wide Universal Prevention Program: Results and Lessons Learned

Prevention in School (PS) is a comprehensive program which aims to improve the learning climate and reduce problem behavior in elementary schools. Core components are teaching of school rules, praise and rewards to support prosocial behavior, and a forum involving parents. This trial investigated the effects of PS on its intended outcomes, and includes 23 schools, 3,207 students, and 188 teachers. Multilevel regression analyses indicated no program effects two years after the start of the program. Problems with program components, implementation and study limitations may have contributed to the null findings. The lessons learned may be used to guide program revisions, and are important to consider in future attempts to implement and evaluate similar school interventions in a Swedish context.

Preventing alcohol use with a universal school-based intervention: results from an effectiveness study.

BackgroundThe effectiveness of the universal school-based alcohol prevention program “Unge & Rus” [Youth & Alcohol] was tested by an independent research group. The program aims to prevent alcohol use and to change adolescents’ alcohol-related attitudes. The main outcome measure was frequency of monthly alcohol use, favorable alcohol attitudes, perceived behavioral control (PBC), positive alcohol expectancy and alcohol-related knowledge.MethodsJunior high school students (N = 2,020) with a mean age of 13.5 years participated in this longitudinal pre, post and one-year follow-up study with a quasi-experimental design, involving an intervention group and a comparison group recruited from 41 junior high schools in Norway. Multilevel analysis was used to account for the repeated observations (level 1) nested within students (level 2) who in turn were clustered within school classes (level 3).ResultsResults showed an increased level of alcohol-related knowledge in the intervention group (p < .005) as compared to the comparison group at one-year follow-up. However, no significant difference in change was found between the intervention group and the comparison group in frequency of monthly alcohol use, alcohol-related attitudes, PBC or alcohol expectancy at one-year follow-up.ConclusionsThis study offers adequate data on the effectiveness of a school-based alcohol prevention program widely implemented in Norway. Under its current method of implementation, use of the program cannot be supported over the use of standard alcohol curriculum within schools.

A qualitative analysis of factors influencing middle school students' use of skills taught by a violence prevention curriculum

This study examined factors that influenced the use of skills taught in a school-based universal violence prevention program. Interviews were conducted with 91 students from two urban schools (83% were African American and 12% multiracial) and 50 students from a nearby county school (52% were White, 32% African American, and 12% multiracial). About half the sample (54%) was male. All had been in sixth grade classrooms where the Second Step (Committee for Children, 1997b) violence prevention curriculum had been implemented earlier in the school year or in the preceding school year. Qualitative analysis of interview transcripts suggested that participants' use of intervention skills was influenced by their beliefs and values, perceived relevance and effectiveness of the skill, issues related to enacting the behavior, and contextual factors. These findings highlight the need for a more intensive and comprehensive effort to address barriers and supports that influence the relevance and impact of school-based violence prevention programs.

A Meta-analysis of universal mental health prevention programs for higher education students.

This meta-analysis investigated the effectiveness of universal mental health prevention programs for higher education students on a range of adjustment outcomes. A systematic literature search identified 103 controlled published and unpublished interventions involving college, graduate, or professional students. As hypothesized, skill-training programs that included a supervised practice component were significantly more effective overall (mean effect size = 0.45, confidence interval (CI) = 0.39 to 0.52) compared to skill-training programs without supervised practice (0.11, CI = -0.01 to 0.22) and psychoeducational (information-only) programs (0.13, CI = 0.06 to 0.21). When comparisons on specific outcomes were possible, skill-training programs including supervised practice were significantly more effective than the other two groups of programs in reducing symptoms of depression, anxiety, stress, and general psychological distress, and in improving social-emotional skills, self-perceptions, and academic behaviors and performance. The magnitude of effects achieved in several outcome areas is comparable to or higher than that reported in other reviews of universal programs, suggesting that skill-training programs for higher education students that incorporate supervised practice now join the ranks of other effective preventive mental health interventions. This review offers several recommendations to improve the experimental rigor of future research.

Gender differences in suicide prevention responses: implications for adolescents based on an illustrative review of the literature.

Background: There are well-documented gender differences in adolescent suicidal behavior; death by suicide is more common in males, while nonfatal suicide attempts are more common among females. Over the past three decades, researchers have documented the effectiveness of a myriad of suicide prevention initiatives. However, there has been insufficient attention to which types of suicide prevention interventions are effective in changing attitudes and behaviors for young males and females. In this review of the literature, we consider common examples of primarily universal suicide prevention programs from three implementation settings: school-based, community-based, and healthcare-based. Our purpose is to delineate how the potential gender bias in such strategies may translate into youth suicide prevention efforts. Methods: Research in which gender was found to moderate program success was retrieved through online databases. Results: The results that feature programming effects for both males and females are provocative, suggesting that when gender differences are evident, in almost all cases, females seem to be more likely than males to benefit from existing prevention programming. Conclusions: We conclude by considering recommendations that may benefit males more directly. Implications for adolescent suicide prevention in particular are discussed. Personalization of suicide intervention is presented as a promising solution to reduce suicide rates.

The longitudinal effect of the Aprender a Convivir (learning to live together) programme in childhood: the development of social competence / Efecto longitudinal del programa Aprender a Convivir en la infancia: desarrollo de la competencia social

In the context of a changing society, strategies are required to eradicate the phenomenon of antisocial behaviour. The Aprender a Convivir universal prevention programme tries to provide such a response. This study attempts to test the effectiveness of the programme through a quasi-experimental long-term study carried out over three years in some nursery schools. Of the students who participated in this study (N = 784), those from the experimental group showed significant increases in social competence compared to the control group, and behavioural problems decreased, albeit not in any significant way. To draw conclusions about the effectiveness of the programme, further improvements are proposed to the design of the study.

Prevenção Universal de Ansiedade na Infância e Adolescência: Uma Revisão Sistemática

Anxiety disorders are the most prevalent among children and adolescents of school age, affecting 4-25% of this population. Universal prevention programs can strengthen protective factors and minimize risk factors, decreasing the demand for treatment for this disorder in the future. The purpose of this article was to systematically review studies based on evidence of universal prevention programs for anxiety in childhood and adolescence produced between 1985 and 2012. The search was performed by two independent researchers, at Bireme and PsycINFO, with the following keywords in combination “prevention”, “anxiety”, “universal”, “childhood” and “adolescence”, and its english equivalents. We found 197 studies and 12 met the inclusion criteria.The review shows, on the one hand, considerable progress in the international production of scientific knowledge about these interventions, but on the other, shows an important gap in national polls, as evidenced the lack of Brazilian studies on the theme. Keywords: anxiety; universal prevention; childhood; adolescence; systematic review.