Universal Prevention Programs Research Articles

Effectiveness of a universal, school-based, online programme for the prevention of anxiety, depression, and substance misuse among adolescents in Australia: 72-month outcomes from a cluster-randomised controlled trial

The CSC study found that the universal delivery of a school-based, online programme for the prevention of mental health and substance use disorders among adolescents resulted in improvements in mental health and substance use outcomes at 30-month follow-up. We aimed to compare the long-term effects of four interventions-Climate Schools Combined (CSC) mental health and substance use, Climate Schools Substance Use (CSSU) alone, Climate Schools Mental Health (CSMH) alone, and standard health education-on mental health and substance use outcomes among adolescents at 72-month follow-up into early adulthood. This long-term study followed up adolescents from a multicentre, cluster-randomised trial conducted across three states in Australia (New South Wales, Queensland, and Western Australia) enrolled between Sept 1, 2013, and Feb 28, 2014, for up to 72 months after baseline assessment. Adolescents (aged 18-20 years) from the original CSC study who accepted contact at 30-month follow-up and provided informed consent at 60-month follow-up were eligible. The interventions were delivered in school classrooms through an online delivery format and used a mixture of peer cartoon storyboards and classroom activities that were focused on alcohol, cannabis, anxiety, and depression. Participants took part in two web-based assessments at 60-month and 72-month follow-up. Primary outcomes were alcohol use, cannabis use, anxiety, and depression, measured by self-reported surveys and analysed by intention to treat (ie, in all students who were eligible at baseline). This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000723785), including the extended follow-up study. Of 6386 students enrolled from 71 schools, 1556 (24·4%) were randomly assigned to education as usual, 1739 (27·2%) to CSSU, 1594 (25·0%) to CSMH, and 1497 (23·4%) to CSC. 311 (22·2%) of 1401 participants in the control group, 394 (26·4%) of 1495 in the CSSU group, 477 (37·%) of 1289 in the CSMH group, and 400 (32·5%) of 1232 in the CSC group completed follow-up at 72 months. Adolescents in the CSC group reported slower year-by-year increases in weekly alcohol use (odds ratio 0·78 [95% CI 0·66-0·92]; p=0·0028) and heavy episodic drinking (0·69 [0·58-0·81]; p<0·0001) than did the control group. However, significant baseline differences between groups for drinking outcomes, and no difference in the predicted probability of weekly or heavy episodic drinking between groups were observed at 72 months. Sensitivity analyses increased uncertainty around estimates. No significant long-term differences were observed in relation to alcohol use disorder, cannabis use, cannabis use disorder, anxiety, or depression. No adverse events were reported during the trial. We found some evidence that a universal online programme for the prevention of anxiety, depression, and substance use delivered in early adolescence is effective in reducing the use and harmful use of alcohol into early adulthood. However, confidence in these findings is reduced due to baseline differences, and we did not see a difference in the predicted probability of drinking between groups at 72-month follow-up. These findings suggest that a universal prevention programme in adolescence is not sufficient to have lasting effects on mental health and substance use disorders in the long term. In addition to baseline differences, substantial attrition warrants caution in interpretation and the latter factor highlights the need for future long-term follow-up studies to invest in strategies to increase engagement. Australian National Health and Medical Research Council.

Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care.

Improving adolescent substance use prevention and treatment is an urgent public health priority in the United States. Current intervention models do not address how adolescents with a history of caregiver substance use are at particular risk for problematic substance use. We, therefore, reviewed the evidence on adolescent substance use prevention programs integrating caregiver-focused components and propose opportunities to incorporate adaptations of existing programs into pediatric primary care to improve outcomes for at-risk adolescents exposed to caregiver substance use. There are multiple evidence-based universal prevention programs that target adolescent substance use and incorporate caregivers; however, these programs do not address the specific concerns of caregivers with substance use. Caregiver-focused programs efficaciously address family and child risk factors for adolescent substance use but are not accessible to many families and have not been longitudinally studied to assess impact on adolescent substance use. Adaptation of existing prevention programs to pediatric primary care settings may open opportunities to improve engagement of families with caregiver substance use in targeted prevention strategies. Family Screening, Brief Intervention, and Referral to Treatment (F-SBIRT) is one model that can be incorporated into pediatric primary care to contextualize evidence-based practices to address substance use in a family-focused approach. To develop F-SBIRT, further research is needed to validate caregiver-focused screening tools, determine brief intervention (BI) best practices, and adapt existing evidence-based and caregiver-focused adolescent prevention programs for use with caregivers with substance use in pediatric primary care settings.

A case study in developmental discontinuity: PROSPER Interventions and adolescent substance use trajectories shape young adult substance use and mental health problems.

The loss of John Schulenberg reverberates across the developmental and prevention sciences. In honor of his many contributions, this paper applies his ideas of developmental continuity and discontinuity to understand the process by which PROSPER delivered universal prevention programs (delivered in Grades 6 and 7) affect young adult outcomes. Guided by these developmental models, we deconstructed adolescent substance use initiation trajectories into two discrete phases-early and late adolescence, demarcated by substance use initiation levels at the end of 9th grade. We evaluated the effects of PROSPER interventions on these phases, and in turn, the effects of adolescent substance use initiation on young adult antisocial behavior, alcohol and drug use consequences, and depression symptoms. This sample included 1,984 young adults who participated in the PROSPER intervention trial in Grade 6 (two cohorts, 2002 and 2003), followed over 8 adolescent measurement occasions (Fall and Spring of Grade 6; Spring of Grades 7-12). Young adult outcomes were averaged across three waves (collected at ages 20, 23, and 25). PROSPER interventions were associated with reduced substance use initiation in early adolescence, but not escalation during late adolescence. In turn, substance use in both early and late adolescence was uniquely associated with young adult antisocial behavior, depression symptoms, and substance use consequences. PROSPER interventions were associated with young adult antisocial behavior and problematic substance use via reduced risk for early initiation status. Findings are discussed in terms of developmental continuity and discontinuity.

Changes in Anxiety Symptoms and Their Correlates in Adolescents Participating in a School-Based Anxiety Prevention Program During the COVID-19 Pandemic

Anxiety disorders have been on the rise among adolescents over the past decade. The COVID-19 pandemic appears to have contributed to this increase, putting further pressure on often already overburdened health systems. Universal prevention programs may offer a potential solution, but few have been evaluated in the context of a pandemic. The objective of this article is to measure the impact of a universal prevention program—the HORS-PISTE program—on several anxiety-related variables in the context of a pandemic. The HORS-PISTE program consists of 10 workshops spread over the two first years of high school, secondary 1 and 2 (grade 7 and 8 equivalent). Workshops are held in a classroom setting and focus on the development of psychosocial skills. The study was conducted in Quebec with 1,202 secondary 1 and 2 students (48.7% girls, 51.3% boys) with an average age of 12.58 years ( SD = 0.75). They completed an assessment protocol before and after participating in the HORS-PISTE program in the autumn of 2020. Their answers were subjected to descriptive analysis and multivariate analysis of variance. Results indicate a significant decrease in symptoms for several of the measured variables between the two measurement times, such as those associated with panic disorder, generalized anxiety disorder, and test anxiety. The results also show a decrease in some variables related to the interference of anxiety symptoms and the cognitive and behavioral vulnerabilities targeted by the program. The discussion highlights possible explanations for the results, as well as how universal prevention programs may contribute to the prevention of anxiety during adolescence, especially in a pandemic context.

The Effectivity of a School-Based Early Intervention Targeting Psychological Complaints and Non-Suicidal Self-Injury in Adolescents.

Background: Recent research suggests a concerning trend of non-suicidal self-injury (NSSI) and suicidal behaviors emerging at younger ages (as early as age 12). Early onset of NSSI is linked to more severe outcomes. While universal school-based prevention programs have shown promise in addressing suicidal behaviors, there is limited research on their effectiveness in preventing NSSI onset among adolescents. This study aims to evaluate the efficacy of a universal prevention program in schools for NSSI and mental complaints while enhancing resilience and mental health in 11-14-year-old adolescents. Methods: In total, 329 Flemish secondary school students (55.6% female), aged 11 to 14 years, participated in a 4 h classroom universal prevention, with a focus on emotion regulation, mental health, and specific strategies to prevent NSSI and reduce stigma. For both the intervention and control group (N = 124), a pre-, post-, and one-month follow-up questionnaire was administered, containing reliable and valid measures for NSSI and suicidality, emotion regulation, help-seeking behaviors, well-being, and psychological distress. Results: The prevention program effectively reduced NSSI and psychological distress, particularly for adolescents with a history of NSSI. Conclusions: These findings support previous research on the effectiveness of school-based programs in reducing mental complaints and suggest promising outcomes for NSSI prevention.

Underlying Processes in the Norwegian Universal Preventive Program for Social Anxiety

Underlying Processes in the Norwegian Universal Preventive Program for Social Anxiety

Underlying processes in the Norwegian Universal Preventive Program for social anxiety

Objective: Social Anxiety Disorder (SAD) is among the most common, widespread, and incapacitating psychiatric disorders, also among children and adolescents. Although efficient treatments have been reported, few children and adolescents receive adequate treatment. A universal prevention program has been shown to be efficacious both among those with syndromal and subsyndromal social anxiety. However, few universal prevention investigations undergo testing of mechanistic hypotheses or how an intervention works across levels of social anxiety. This study aims to test and report the processes underlying the effectiveness of an RCT prevention program to reduce social anxiety in a population-based sample of preadolescents. Method: A parallel multiple mediator model was used to examine the mediation of outcomes from the Norwegian Universal Prevention Program for Social Anxiety (NUPP-SA) by five intermediary variables that well approximate established DSM-5 social anxiety disorder diagnostic criteria. The sample consisted of 1748 pupils between 11 years - 14 years (SD = 1.1) of age assessed twice during a one-year period. Results: The NUPP-SA works differently for the total sample compared to those with social anxiety disorder symptoms. Among the former, the NUPP-SA intervention works via public performance, avoidance, physical/cognitive, and assertiveness factors. For the latter, the NUPP-SA works via the public performance factor. The intervention did not work for either group via the social encounter factor. Conclusion: Universal prevention programs are essential for reducing the impacts of chronic disorders at the individual, institutional, and societal levels. The results from this study support the notion that many children with various levels of social anxiety can be impacted with a Universal prevention intervention program specifically aimed at reducing public performance anxiety.

Addressing help-seeking, stigma and risk factors for suicidality in secondary schools: short-term and mid-term effects of the HEYLiFE suicide prevention program in a randomized controlled trial

BackgroundSuicidal ideation and suicide attempts present a serious public health concern among adolescents and young adults. School-based suicide prevention programs are a key tool for addressing this problem. However, more research is necessary to assess their effectiveness, acceptability, and safety. In response, the HEYLiFE suicide prevention program was developed to enhance help-seeking, reduce stigma towards suicidal peers and diminish risk factors for suicidality. This article presents the evaluation findings of the HEYLiFE program in German secondary schools.MethodsWe conducted a randomized-controlled trial measuring short-term pre-post within-group effects in the intervention group only and mid-term effects at 6-months-follow-up compared to a waitlist-control group. Schools were assigned randomly to the intervention or control group (no blinding). We recruited students ≥12 years of age. Primary outcomes were knowledge about suicidality, attitudes towards suicidality, stigma towards a suicidal peer, help-seeking intentions and behaviours, risk factors for suicidality. The data was analysed with linear mixed models and generalized linear mixed models.ResultsA total of N = 745 students participated (n = 353 intervention group, n = 392 control group). We observed favourable short-term effects on knowledge, attitudes towards suicidality and fear towards a suicidal peer. Unexpectedly, the program also led to an increase in desire for social distance and a decrease in prosocial emotions towards a suicidal peer. The mid-term effects of the program were exclusively favourable, resulting in enhanced attitudes towards help-seeking while protecting from a sharper rise in risk-factors for suicidality and from an increase in social distance. The program had more favourable effects on females and on students aged >13 years. The program was well-received by the students, and no serious adverse events were reported.ConclusionsThese findings demonstrate the effectiveness of the HEYLiFE universal suicide prevention program in addressing variables associated with suicidal ideation and suicide attempts among adolescents on the mid-term. The short-term negative effects on stigma and more negative effects on males should be addressed in the future. Future evaluation studies should examine its effects on suicidality and its effectiveness within populations at high risk.Trial registrationThe study was preregistered in the German Clinical Trials Register (registration number: DRKS00017045; registration date: 02/04/2019).

Adapting a selective parent-focused child sexual abuse prevention curriculum for a universal audience: A pilot study.

Parents are an obvious, but underutilized player in the prevention of child sexual abuse (CSA). A handful of universal parent-focused prevention programs have emerged, however, the evidence for these programs is mixed and the programs suffer ubiquitously from barriers to implementation (e.g., poor engagement, low participation) thereby limiting public health impact. To combat these barriers and improve evidence, researchers previously developed and tested a selective parent-focused CSA prevention program. While promising, the selective approach still leaves a gap in the prevention landscape-parents from the universal audience. However, there appear to be no standardized methods to inform this type of adaptation-interventions designed as universal or selective have primarily been delivered as such. This study sought to adapt the selective curriculum for a universal audience and examined the acceptability and feasibility of the program for evaluation in a future trial. Using mixed methods, N = 31 parents (i.e., primary caregiver for a child under 13) completed pre- and post-workshop surveys followed by a brief individual interview conducted via Zoom. Interviews, coded using content analysis methods, focused on three themes: parents as agents of prevention (e.g., prior action, confidence), curriculum (e.g., content, design), and engagement (e.g., future marketing and promotion). Overall participants' mean score on CSA-related awareness and intention to use protective behavioral strategies increased. The participants found the curriculum highly acceptable noting strengths in the content and design. All told, the results of this pilot study suggest the acceptability and feasibility of examining the efficacy of the universal parent-focused curriculum in a larger trial. Procedural challenges, such as bots in recruitment, identify areas of caution in design of the larger trial and a roadmap for others seeking to adapt selective programs for universal audiences.

Implementation of the Good Behavior Game in Polish Elementary Schools Under COVID-19 Restrictions

Objectives of the research: The main aim of the research was to verify the quality of the implementation of the “Good Behavior Game” (GBG) program in Polish schools and to determine its effects on students and teachers during the COVID-19 pandemic.&#x0D; Research methods: The methodology of the research was based on qualitative and quantitative data analysis. The data was retrieved from teachers’ and coaches’ assessments and the results of playing the GBG in 19 elementary schools in Krakow, Poland during four months of the COVID-19 pandemic.&#x0D; A short description of the context of the issue: The Good Behavior Game is an American universal prevention program that can limit the risky behavior of adolescents and young adults and can help children starting their education to play the role of a student. For teachers, it is additionally an effective tool for classroom management. It is based on four basic pillars: class rules, teamwork, positive reinforcement, and observing students’ behavior.&#x0D; Research findings: The results show the obstacles and difficulties involved in implementing the GBG under COVID-19 restrictions. The findings show how the actions of teachers and coaches translated into an observable reduction in pupils’ disruptive behavior.&#x0D; Conclusions and/or recommendations: The analysis revealed a gradual increase in the quality of program implementation in all areas of evaluation. In terms of the program’s effect on the pupils, the findings showed that over time they gradually successfully internalized the rules and were behaving in line with expectations. Using the GBG in the context of online education caused by the restrictions of the COVID-19 pandemic posed a challenge to teachers: they had to change teaching methods, prepare new educational resources, and modify GBG procedures. The context of the pandemic can also be seen as an added value in the education process. Better digital competences and an innovative attitude toward the education process were observed among both teachers and students.

Leave no one behind: Rethinking policy and practice at the national level to prevent mental disorders

The global burden of mental disorders is increasing, in line with the shift from communicable to chronic non-communicable diseases. Mental disorders affect the functioning of individuals, resulting not only in enormous emotional suffering and diminished quality of life, but also in stigma and discrimination. This burden extends to the community and society, with far-reaching economic and social consequences. Even under optimal conditions, treatment alone will never be sufficient to reduce the global burden of mental disorders, so a shift in focus from treatment to prevention of mental disorders should be promoted at the central level in the form of legislation, policy formulation and resource allocation. Universal and selective prevention programs should be prioritized nationally, as they aim to change the risk profile of the entire population and specifically target populations at risk for mental disorders, respectively. In this article, we review the key risk factors for mental disorders and the measures that can be taken at the national level to prevent them, taking into due consideration that prevention efforts can vary based on the audience they are addressing, level of intensity they are providing, and the life phase they target. By adopting a human rights perspective and placing the social determinants of health at the center of our narrative, we maintain that improving mental health cannot be achieved by strengthening health services alone. Coordination across government departments is needed to implement multi-level public health interventions across a wide range of settings, programs, and policies. Focusing on children's mental health and addressing poverty, gender inequality and social discrimination should be absolute priorities for national mental health policies and plans.

Effectiveness of an e-Health Quasi-Randomized Controlled Universal Prevention Program for Eating Disorders in Spanish Adolescents

Eating disorders (EDs) and sub-threshold conditions are prevalent in the adolescent population. Unfortunately, most preventive interventions have been targeted at emerging adults and the effectiveness of online prevention programs has yet to be determined in adolescents. This study sought to examine the short-term effectiveness of a universal e-Health psychoeducational prevention program for EDs compared to a control (non-intervention) group in Spanish adolescents. Using a quasi-randomized trial design, a total of 161 [% girls: 45.96; Mage(SD) = 12.43 (0.43)] adolescents from 5 participating schools were allocated to two intervention arms: (1) psychoeducational intervention (n = 79) and (2) wait-list control (n = 82). The intervention was delivered over 3 months through 3 modules that were accessible 24/7 and 3 school sessions guided by the students´ tutors focusing on nutrition, promoting a healthy lifestyle, mitigating body concerns, and social pressures. Participants completed an online assessment battery including the Eating Attitudes Test (EAT-26) and measures of self-esteem, family disruption, compliance with the Mediterranean diet, and lifestyle. Correlational analysis showed small to moderate relationships between self-esteem and family function (rho = 0.413, p = 0.001), BMI (body mass index) and the EAT-26 dieting subscale (rho = 0.417, p = 0.001), physical activity and the bulimia subscale (rho = − 0.237, p = 0.003), and self-esteem and the dieting subscale (rho = − 0.223, p = 0.004). At the post-intervention assessment, the intervention group showed a statistically significant reduction in ED risk (EAT-26) (d = − 0.323, p = 0.040) and the oral control subscale (d = 0.327, p = 0.038). The e-health intervention including tutor-led digital components was effective for reducing ED risk in children. Results must be interpreted with caution due to the low statistical power and the limited sample size. Large scale randomized controlled trials with longer follow-ups will be needed to bolster the evidence.

Implementation of a Universal Preventive Program for Anxiety and Depression in First-Year Post-Secondary Students

Objective: To examine the effects of the universal level of a multilevel prevention program on knowledge development in first year college students. Participants: 1,422 college students from 71 class-groups and 25 teachers from four colleges. Methods: Measures of mental health knowledge and college transition were completed as the first and last activities of the intervention, as 172 Diane Marcotte et al. well as two weeks after its implementation. Students also completed screening measures for current levels of depressive and anxious symptoms. Results: Results showed an improvement in students' knowledge following participation in the intervention, this improvement was maintained two weeks later. Except for level of facilitator’ experience, no personal, academic, or family variables appeared to influence student learning. Lower academic performance and time spent studying for females, and being older for males, were significant characteristics of students who screened positive for current distress. Conclusions: The results of current study support the beneficial effects of a universal prevention intervention in college students.

Preventing Depressive Symptoms in Chinese Adolescents: A Pilot Cluster Randomized Controlled Trial

Purpose: Depressive symptoms are prevalent among Chinese adolescents. However, there is a lack of effective prevention programs to reduce depressive symptoms. Methods: A pilot cluster randomized controlled trial was implemented in a sample of senior secondary school adolescents. Participants in the intervention group ( N = 148) received a 6-week universal prevention course, whereas the control group ( N = 131) received a routine course focusing on career development. Results: The linear mixed models showed that the group × time interaction was significant for depressive symptoms measured by DASS-21 ( F(2, 550) = 5.72, p = .003) and marginally significant for that measured by SMFQ ( F(2, 549) = 2.41, p = .09). Likewise, the level of anxiety and stress were significantly reduced after the program, but not maintained in the follow-up. Conclusions: This pilot study showed that a universal prevention program is promising in reducing adolescent depressive symptoms.

Four Steps To My Future (4STMF): acceptability, feasibility and exploratory outcomes of a universal school-based mental health and well-being programme, delivered to young adolescents in South Africa.

Mental health disorders affect many children in South Africa, where vulnerability is high, and treatment is limited. We sought to determine the feasibility and acceptability of a universally delivered classroom-based programme for the promotion of mental health in young adolescents. We pilot tested an 8 session, cognitive-behavioural therapy-based programme, 4 Steps To My Future (4STMF) in two schools. Participants were grade 5 learners (n = 222; Meanage = 10.62 (Standard deviation = 0.69)). 4STMF was delivered in class time by trained psychology postgraduates. Feasibility (rates of parental opt-out, child assent, assessment completion at baseline and follow-up, programme completion, session attendance and programme fidelity), acceptability (teacher feedback and focus groups with learners), as well as demographic data and data on a battery of a psychological measures were collected at baseline, postintervention and at one-month follow-up. Most eligible learners at both schools agreed to participate (85% - school 1; 91% - school 2) with more than 80% completing postintervention measures. Learner session attendance and programme fidelity were high. Teachers rated facilitators highly on confidence, preparedness, enthusiasm and classroom management and observed children to be enjoying the programme. Focus group data suggest that learners liked the programme, could recall the content and had shared some of the content with their family. An exploratory analysis of outcomes showed significant pre-post differences on self-esteem at school 1 and on emotion regulation at school 1 and school 2, maintained at follow-up. This pilot study has shown that 4STMF can acceptably and feasibly be delivered, at classroom level, as a universal school-based prevention programme to young adolescent learners in South African primary schools. The programme could fit in with school context, could be delivered by nonspecialists, showed significant improvements on self-esteem and emotion regulation and was liked by the learners.

Independent pragmatic replication of the Dove Confident Me body image program in an Australian Girls Independent Secondary School

Following calls for the independent replication of universal body image programs under diverse conditions, this research aimed to investigate whether the universal co-educational prevention program developed for audiences in the United Kingdom (Dove Confident Me, DCM), was an acceptable and effective intervention when delivered by teachers to adolescent girls attending a single-sex Australian school. Comprising two studies, Study 1, evaluated DCM among Grade 8 students (N = 198) at a single-sex private school, and compared the results with students (N = 208) s from a matched comparison group. No improvements were observed on outcome measures between the comparison and intervention girls over the three time points. Study 2 involved minor modifications to the aesthetics and content of the program, as well as the logistics of delivery. Delivered by teachers to Grade 8 students (N = 242 intervention and N = 354 comparison), there were significant improvements in acceptability of the modified DCM program, yet no interaction effects observed on outcome measures. While the program did no harm, it is possible that there are adjustments to the methods utilized and content of programs that are trialed in efforts to prevent body image concerns and eating disorders in the school setting.

Adult characteristics, skills, and approaches that facilitate supportive relationships with youth: A qualitative investigation of Sources of Strength

IntroductionSources of Strength is a universal prevention program for youth that provides tools and educational opportunities to promote wellness and reduce risk. A major aim of Sources is to build youth-adult relationships to support youth in times of distress. However, no study to date has investigated how adults effectively build relationships with youth despite this being critical to successful implementation of Sources. The present study explores both student and staff perspectives of what characteristics, skills, and approaches encourage the development of supportive student-adult relationships to inform efforts for successful intervention implementation. MethodsThis qualitative supplement to a Randomized Controlled Trial (RCT) of Sources, recruited 23 students in grades 9 to 12 for individual interviews and 11 staff members for focus groups from 2 high schools implementing the intervention. Semi-structured interview guides were used, and emergent themes were identified through process and pattern coding. ResultsKey facilitators of supportive and effective adult-youth relationships included perceptions of adults as approachable, caring, encouraging, and understanding. Successful adult advisors used humor and were perceived as invested and engaged in the lives of youth. Maintaining accountability for youth, balanced with intervention and provision of resources additionally emerged as a critical factor supporting positive relationships with youth. Sources itself emerged as a catalyst for the growth of these positive and supportive youth-adult relationships. ConclusionsTrusted adults are instrumental as both operators within prevention programs targeting young people and as facilitators in adult-youth relationships through leveraging key skills and approaches. These findings can inform quality implementation of interventions, like Sources, that embed adult-youth connections as a central feature of the program model.

I-PREGNO – prevention of unhealthy weight gain and psychosocial stress in families during pregnancy and postpartum using an mHealth enhanced intervention: a study protocol of two cluster randomized controlled trials

BackgroundThe transition to parenthood represents a critical life period with psychosocial, and behavioral changes and challenges for parents. This often increases stress and leads to unhealthy weight gain in families, especially in psychosocially burdened families. Although universal and selective prevention programs are offered to families, specific support often fails to reach psychosocially burdened families. Digital technologies are a chance to overcome this problem by enabling a low-threshold access for parents in need. However, there is currently a lack of smartphone-based interventions that are tailored to the needs of psychosocially burdened families.AimsThe research project I-PREGNO aims to develop and evaluate a self-guided, smartphone-based intervention in combination with face-to-face counseling delivered by healthcare professionals for the prevention of unhealthy weight gain and psychosocial problems. The intervention is specifically tailored to the needs of psychosocially burdened families during the pregnancy and postpartum period.MethodsIn two cluster randomized controlled trials in Germany and Austria (N = 400) psychosocially burdened families will be recruited and randomized to i) treatment as usual (TAU), or ii) I-PREGNO intervention (self-guided I-PREGNO app with counseling sessions) and TAU. We expect higher acceptance and better outcomes on parental weight gain and psychosocial stress in the intervention group.DiscussionThe intervention offers a low cost and low-threshold intervention and considers the life situation of psychosocially burdened families who are a neglected group in traditional prevention programs. After positive evaluation, the intervention may easily be implemented in existing perinatal care structures in European countries such as Germany and Austria.Trial registrationBoth trials were registered prospectively at the German Clinical Trials Register (Germany: DRKS00029673; Austria: DRKS00029934) in July and August 2022.

Universal School-Based Social and Emotional Learning (SEL) for Diverse Student Subgroups: Implications for Enhancing Equity Through SEL.

School-based, universal social and emotional learning (SEL) has been widely practiced and promoted as a promising approach to prevent youth mental, emotional, and behavioral problems. Although prior research has accumulated robust evidence of the average effects of universal SEL, it remains unclear whether it works similarly or differentially across diverse sociocultural subgroups of students. Investigating subgroup effects has implications for understanding the impact of universal SEL on possible subgroup disparities in student social-emotional competence (SEC). This study examined whether the effects of a universal SEL program on student SEC development differed across diverse student subgroups classified by gender, race, ethnicity, socioeconomic status, disability status, and English learner status. Data came from student SEC progress monitoring collected during a 1-year quasi-experimental study of a universal SEL program (N = 1592; Grades K-2). The results of multigroup latent growth modeling suggest that (a) the intervention effects were slightly larger for Black students, compared to White or other racial-ethnic subgroups, and (b) the effects were not different across other examined subgroups. This study also found that in the comparison condition, the SEC disparities between Black and White students tended to widen throughout the year, whereas in the intervention condition, Black students showed a similar rate of growth as their White peers. Findings suggest that universal SEL may be similarly beneficial across many diverse student subgroups, while it may yield larger benefits among some racially marginalized subgroups, preventing racial disparities from further widening. Yet the benefits of SEL may not be sufficient to reduce existing subgroup disparities. These findings suggest a need for more studies to examine differential effects of universal preventive programs by diverse subgroups to better inform practices that enhance equity in youth outcomes.

OurFutures Mental Health: Protocol for a randomised controlled trial of a school-based, universal mental ill-health prevention program

Mental disorders have significant impact on the health and well-being of young people in Australia and worldwide. Intervention during adolescence is critical for reducing immediate harm and preventing the development of chronic mental disorders. This paper describes the protocol for a randomised controlled trial designed to evaluate the effectiveness of an updated version of the OurFutures Mental Health program in promoting mental health knowledge and preventing symptoms of depression and anxiety.A two-arm cluster randomised controlled trial will be conducted from 2023 to 2024 with 1400 Year 8 students (aged 13-14years) from 14 secondary schools in Australia. Schools will be randomised to the OurFutures Mental Health intervention (n = 7), or an active control condition who will receive their usual health education curriculum (n = 7). OurFutures Mental Health is a six-lesson, online cartoon-based intervention. The intervention draws on cognitive-behavioural principles and incorporates psychoeducation, self-management, and interpersonal skill acquisition. Students will complete self-report surveys at baseline, post-intervention, and 3- and 9-months post-baseline. Primary outcomes are mental health knowledge and anxiety and depressive symptoms. Subgroup analyses will examine anxiety and depression symptoms for students reporting elevated levels of these symptoms at baseline. The primary timepoint is 3-months post-baseline. Ethical approval has been granted by the University of Sydney Human Research Ethics Committee and the study is currently under review at the State Education Research Application Process for research in government schools, and Catholic Education Dioceses in NSW. This trial is prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622001582741).