Dosage Explains Individual Differences in the Outcomes of a Prevention Program for Literacy Problems

Most adolescents have their first encounter with alcohol in early or middle adolescence. Parents' rule setting about alcohol has been shown to be important to delay the onset and reduce the frequency of adolescents' alcohol drinking, but less is known about the potential role of parents' beliefs about their competence in and ability to influence their adolescents' drinking habits (i.e., parental self-efficacy [PSE], Bandura (Psychological Review, 84, 191-215, 1977). In this study, we examined the direction of influence between parents' rule setting and PSE as outcomes of the program "Prevention of Alcohol use in Students" (PAS), a prevention program aiming to reduce underage drinking by targeting parents and adolescents both separately and in a combined intervention. We tested two mediation processes in which the program would (a) have a direct effect on PSE, which in turn would increase parents' rule setting or (b) have a direct effect on parents' rule setting, which in turn would increase PSE. To examine these processes, we used a sample of 2562 parent-adolescent dyads (age 12 at baseline), followed annually over 3years. The results showed that the combined intervention increased PSE via an increase in parents' rule setting. No significant effect of the intervention on rules about alcohol via PSE was found. This is the first study to test the mediation processes involving PSE and parental rule setting in an experimental context where parenting practices are being actively changed. The results suggest that giving parents concrete advice on how to deal with alcohol drinking in their adolescents and at the same time helping adolescents to develop healthy attitudes about alcohol drinking have a positive influence on parents' self-efficacy.

Objective There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. Design A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner’s (GP) appointment for high-risk persons. Screening and interventions were performed during 2005–2006. Setting A public health care centre in the town of Harjavalta, Finland. Subjects All home-dwelling 45–70-year old inhabitants without manifested CVD or diabetes. Main outcome measures All-cause and CVD mortality. Results Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants’. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. Conclusions Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis. Key Points Previously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community. Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons. Subjects not willing to participate in health surveys have the worst prognosis.

Rates of substance use disorders (SUDs) remain significantly above national targets for health promotion and disease prevention in Canada and the United States. This study investigated the 5-year SUD outcomes following a selective drug and alcohol prevention program targeting personality risk factors for adolescent substance misuse. The Co-Venture trial is a cluster randomized trial involving 31 high schools in the greater Montreal area that agreed to conduct annual health behavior surveys for 5 years on the entire 7th grade cohort of assenting students enrolled at the school in 2012 or 2013. Half of all schools were randomly assigned to be trained and assisted in the delivery of the personality-targeted PreVenture Program to all eligible 7th grade participants. The intervention consisted of a brief (two-session) group cognitive-behavioral intervention that is delivered in a personality-matched fashion to students who have elevated scores on one of four personality traits linked to early-onset substance misuse: impulsivity, sensation seeking, anxiety sensitivity, or hopelessness. Mixed-effects multilevel Bayesian models were used to estimate the effect of the intervention on the year-by-year change in probability of SUD. When baseline differences were controlled for, a time-by-intervention interaction revealed positive growth in SUD rate for the control group (b=1.380, SE=0.143, odds ratio=3.97) and reduced growth for the intervention group (b=-0.423, SE=0.173, 95% CI=-0.771, -0.084, odds ratio=0.655), indicating a 35% reduction in the annual increase in SUD rate in the intervention condition relative to the control condition. Group differences in SUD rates were reliably nonzero (95% confidence) at the fourth and fifth year of assessment. Secondary analyses revealed no significant intervention effects on growth of anxiety, depression, or total mental health difficulties over the four follow-up periods. This study showed for the first time that personality-targeted interventions might protect against longer-term development of SUD.

As obesity rates continue to rise, both effective prevention and treatment programs are urgently required. Combating obesity requires weight management programs that are accessible and scalable to large numbers of people. There is growing evidence that commercial programs, which combine behavior change techniques with the key motivators for changing habits, are effective as the first line in helping people adopt healthier dietary and activity patterns. In particular, digital programs have the potential to provide a service to large numbers of people, be widely accessible and cost effective for the individual. However, to date, digital programs have been relatively under‐utilized and under‐evaluated. There is little published evidence on the performance of programs on a large scale, outside of partnerships with primary care, where participants self‐refer and pay a nominal fee. The purpose of the following study was to examine the interrelated effect of motivation, opportunity, and ability on the behavioral outcomes of a digital commercial weight management program. To address this aim, a thematic content analysis of participants' qualitative responses to habits learned and changes adopted was conducted. Findings reveal that habits learned and changes adopted as a result of participating in the program influence not only weight loss outcomes but other health and well‐being outcomes as well.

BackgroundFalciparum malaria remains a major occupational illness that accounts for several deaths per year and numerous lost working days among the expatriate population, working or living in high-risk malarious areas. Compliance to preventive strategies is poor in travellers, especially business travellers, expatriates and long-term travellers.MethodsIn this cross-sectional, web-based study the adherence to and outcome of a preventive malaria programme on knowledge, attitudes and practices, including the practice of self-diagnosis and standby treatment (curative malaria kit, CMK) was evaluated in 2,350 non-immune expatriates, who had been working in highly malaria endemic areas.ResultsOne-third (N = 648) of these expatriates visited a doctor for malaria symptoms and almost half (29 of 68) of all hospitalizations were due to malaria. The mandatory malaria training for non-immunes was completed by 92% of those who visited or worked in a high risk malaria country; 70% of the respondents at risk also received the CMK. The malaria awareness training and CMK significantly increased malaria knowledge [relative risk (RR) of 1.5, 95%CI 1.2–2.1], attitudes and practices, including compliance to chemoprophylaxis [RR = 2.2, 95%CI 1.6–3.2]. Hospitalization for malaria tended to be reduced by the programme [RR = 0.4, 95%CI 0.1–1.1], albeit not significantly. Respondents who did not receive instructions on the rapid diagnostic test were two times [RR = 2.3, 95%CI 1.6–3.3] more likely to have difficulties. Those who did receive instructions adhered poorly to the timing of repeating the test. Moreover, 6% (31 of 513) of those with a negative test result were diagnosed with malaria by a local doctor. 77% (N = 393) of the respondents with a negative test result did not take curative medication. 57% (252 of 441) of the respondents who took the curative medication that was included in the kit did not have a positive self-test or clinical malaria diagnosis made by a doctor.ConclusionThis survey demonstrated that a comprehensive programme targeting malaria prevention in expatriates can be effectively implemented and that it significantly increased malaria awareness.

Bullying continues to be a major concern in schools today. Many schools have implemented some type of bullying prevention program. The Olweus Bullying Prevention Program is one of these programs. Evaluation of the Olweus Bullying Prevention Program is typically done through the administration of the Olweus Bullying Questionnaire to students and produces numerical data for its report. Results have been mixed, but often show some type of decrease in bullying activity.;This study evaluated the implementation fidelity and outcomes of the Olweus Bullying Prevention Program in three elementary schools in Virginia. These schools were recommended as having a successful Olweus Bullying Program by Goodman, Fobbs and Moffett, (2011). The evaluation was conducted using a form of theory-driven program evaluation known as the Center for Disease Control's Six-step Evaluation Framework.;Stakeholders represented by administrators, teachers and guidance counselors were interviewed with questions developed from the Four Levels of General Requirements of the Olweus Bullying Prevention Program. Available extant data from the Virginia Report on Discipline, Crime and Violence and the three interviewed schools' Olweus Bullying Questionnaire survey results were also examined to look for possible evidence to support these three schools' successful programs.

This study presents insights in safety promotion of community-based intervention programs, in preventing unintentional injury among children. We modeled and used an evaluation tool to estimate the effectiveness of a community-based injury prevention program. The intervention program consisted of a five-year multidisciplinary, multi-strategic childhood safety promotion and injury prevention protocol. The purpose of the program was to set up safety awareness in ten low-income communities in Israel. This study describes the process, impact and outcome of the intervention program and includes the difficulties faced during the evaluation process, documenting the insights gained from this pilot program. The findings suggest that evaluating the program was a positive and important undertaking. Evaluating the success of the outcome in the earlier program, however, did not confirm its effectiveness. It appears there were hindrances to the progress and implementation of the program. This study gave insights into these obstacles and how we should correct them.

Despite the general positive outcomes of the Diabetes Prevention Program (DPP), the program's reach, adherence, and effectiveness among Latinos are still suboptimal. Text-message DPP can potentially overcome barriers and improve DPP outcomes for this group. We aimed to assess the feasibility, acceptability, and preliminarily effectiveness of a culturally and linguistically adapted text-message DPP for Latinos. We enrolled 26 eligible Spanish-speaking Latino adults at risk of developing type 2 diabetes (A1c = 5.7%-6.4%, body mass index ≥25) in a 6-month culturally and linguistically adapted text-message DPP. Participants received (i) two to three daily automated text-messages about healthy eating, physical activity, problem-solving skills, lifestyle change motivation, and logistics, (ii) on-demand keyword-driven messages, and (iii) on-demand chat messages with a DPP coach. Outcomes included feasibility (e.g. adherence), acceptability (e.g. satisfaction), and preliminary effectiveness (e.g. weight loss). Twenty-four participants completed the program and follow-up assessments. Participants' mean body weight changed from 191.2 to 186.7 pounds (P = .004); 45.8% of participants lost ≥3%, and 29.2% lost ≥5% of body weight. Body mass index and waist circumference were also reduced [0.9 kg/m2 (P = .003) and 1.1 cm (P = .03), pre-post]. Self-reported physical activity frequency was increased (P = .003). No statistically significant changes in diet quality were found. Most participants were satisfied with the program and perceived it to help prevent diabetes. Our pilot study of an innovative text-message DPP for Latinos demonstrated the program was acceptable, feasible, and potentially effective. Using text-message for DPP can reduce barriers to in-person participation by increasing the program's reach without compromising fidelity and effectiveness.

This study examined racial and ethnic differences in the outcomes of a universal evidence-based program targeted to children and adolescents. Using data collected in 2015 and 2016 from the Alcohol: True Stories Hosted by Matt Damon program (N = 925), the study found the outcome of perceptions on risk of harm from alcohol use significantly different between the group of White respondents and the group of non-White respondents, and between the group of Hispanic respondents and the group of non-Hispanic respondents. Program effectiveness was found only among White and non-Hispanic respondents, widening the already existing gap between these populations.

We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse-centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6months in 2016. The HEAR program was effective in identifying at-risk nurses. The purpose of this paper is to report the 3-year sustainability and outcomes of this nurse suicide prevention program. Descriptive statistics are provided of program outcomes over the course of 3years. Over the 3years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous suicide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred seventy-six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment. The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well-received, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10years and now supports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions.

Healthcare reform in Kazakhstan has created a basis for shift from disease centered approach to person and prevention centered healthcare. In order to embrace that agenda, Kazakh National Medical University has developed and implemented project-based course in General practitioners (GP) training program at the internship level. The objective of the program is to acquire skills on work in multidisciplinary teams for health promotion and research. We used project-based learning pedagogical framework for the course. 6 ECTS course was integrated into curriculum of internship in the track of GP training, at the 7th year, for 1 semester. During the course participants were introduced to the theoretical concepts of health promotion and disease prevention program planning, created and implemented their own project. At the end of the course students were required to do a poster presentation. Main outcomes of educational program were that students will (1) gain understanding of health promotion and disease prevention concepts, (2) would be able to implement research skills, (3) and work in integrated multidisciplinary team. To measure results, we disseminated self-administered online based questionnaire for students after the last class (n = 122). Questionnaire consisted of 4 domains: self-development and team work, teaching, context and clinical practice. There were 17 domains that students assessed with 5-point Likert scale, where 1- strongly disagree, 2- disagree, 3- agree to some extent, 4 - agree, 5 - strongly agree. Questionnaire also included 1 open - ended question for overall comments on the course and demographic questions. The response rate was 68,8% (n = 84), overall satisfaction rate was 77.6% (3.88 out of 5), rate on team work and practical work was 86% (4.3) and 83.6% (4.18). Comments of students showed that there is still not enough understanding on integrated person-centered primary healthcare approach and lack of integrated team work at clinical sites. Key messages Education of future general practitioners should include training on teamwork in integrated teams and health promotion. Project based learning helps training multi-disciplinary team work skills not only within students but also in teams at involved sites.

Hospital-acquired pressure ulcers (HAPUs) affect patients during hospitalisation, putting patients at risk for further complications. HAPU is one of the hospital quality indicators that require quality initiatives or programmes to minimise its occurrence and consequences. The aim of this study was to assess the effectiveness of a developed quality improvement programme in preventing HAPUs. This is a retrospective comparative study, which tracked the outcomes of pressure ulcer prevention programme (PUPP) for 5 years from 2014 to 2018. Data from 50 441 patients were collected from different units in a tertiary hospital in the eastern region of Saudi Arabia. The programme focused on building a wound care team; providing education to hospital staff, patients, and their families; and continuous data monitoring, in addition to follow-up visits after discharge. Implementation of the programme was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The PUPP was effective in reducing the percentage of pressure ulcer cases. The programme can be extended and implemented in other hospitals.

BackgroundUnintentional injuries are identified as a major health concern among adolescents. The one factor that can contribute significantly to their increased rates of injury is their risk taking behaviour. Evidence...

This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program. One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self-preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable. Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in low-risk schools, neither provider type achieved outcomes superior to the control condition in those schools. Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools.

Diet Quality Outcomes of a Cooperative Extension Diabetes Prevention Program