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Network meta-analysis is a popular statistical technique for synthesizing evidence from studies comparing multiple interventions. Benefits of network meta-analysis, over more traditional pairwise meta-analysis approaches, include evaluating efficacy/safety of interventions within a single framework, increased precision, comparing pairs of interventions that have never been directly compared in a trial, and providing a hierarchy of interventions in terms of their effectiveness. Network meta-analysis is relatively underutilized in prevention science. This paper therefore presents a primer of network meta-analysis for prevention scientists who wish to apply this method or to critically appraise evidence from publications using the method. We introduce the key concepts and assumptions of network meta-analysis, namely, transitivity and consistency, and demonstrate their applicability to the field of prevention science. We then illustrate the method using a network meta-analysis examining the comparative effectiveness of brief alcohol interventions for preventing hazardous drinking among college students. We provide data and code for all examples. Finally, we discuss considerations that are particularly relevant in network meta-analyses in the field of prevention, such as including non-randomized evidence.

The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.

Not all participants will benefit equally from even well-established, evidence-based prevention programs. For this reason, the field of prevention science is beginning to embrace individual tailoring of interventions. The Family Check-Up was among the first prevention programs to tailor at the family level as opposed to the more prevalent focus on adapting programs for different cultures, genders, and other immutable participant characteristics. Despite tailoring, families with lower levels of stress and parental mental health issues, children with lower baseline conduct problems, and families living in an extremely deprived neighborhood benefitted less from the Family Check-Up. This study examined baseline targeted moderation (BTM) within a trial of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the Family Check-Up for primary care delivery and explicit targeting of obesogenic behaviors. Ethnically diverse, low-income families (N = 240) with children ages 5.5 to 12 years identified in pediatric primary care with elevated body mass index (BMI) were enrolled and randomized to FCU4Health or usual care. Few BTM effects were found using single-variable-as-moderator and latent-class-as-moderator analytic approaches across the primary (child BMI, body composition) and secondary outcomes (family health routines; child eating behaviors, food choices, emotional problems, problem behaviors, quality of life; caregiver BMI and body composition), as well as hypothesized mediators (child self-regulation, parenting skills). The high-risk nature of the sample and the FCU4Health being individually tailored might have mitigated finding BTM effects. This trial was prospectively registered (NCT03013309 ClinicalTrials.gov).

To combat the rampant spread of the SARS-CoV-2 virus that is responsible for the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) has provided Americans with empirically supported preventive behavioral guidelines (e.g., wearing a face mask). However, there is a need to develop behavioral strategies that can effectively increase adherence to these guidelines, especially for young adults, who report particularly poor adherence. Across several domains of prevention science, norms-based interventions have successfully motivated constructive health behavior by correcting normative misperceptions, but these strategies are only relevant when these misperceptions are widespread. We examined the accuracy of young adults’ perceptions of peers’ adherence to CDC-recommended behavioral guidelines (i.e., perceived social norms) to assess the rationale for employing norm-correcting strategies. Young adult college students (N = 539; Mage = 19.5 years) self-reported their level of adherence to a list of preventive behavioral guidelines and estimated the norms regarding the extent to which other young adults adhered to these guidelines. We measured adherence and perceived norms for each guideline in terms of adherence frequency, ranging from 0 to 100% of the time. We found that young adults, on average, underestimated the extent to which other young adults adhere to each of the recommended preventive behaviors. That is, young adults tended to think that other young adults are failing to adhere to CDC guidelines, whereas our self-reported data showed adherence frequency may be quite high. Moreover, we found positive associations between self-reported adherence and perceptions of others’ adherence—that is, those who underestimated others’ adherence also self-reported lower adherence to guidelines. Findings from this study establish proof-of-concept for the development of norms-based strategies designed to improve young adults’ adherence to preventive behavioral guidelines that are both specific to the COVID-19 pandemic and that prepare for future contagious outbreaks.

Engagement in HIV care and a high level of antiretroviral therapy (ART) adherence for people living with HIV is crucial to treatment success and can minimize the population burden of the disease. Despite this, there is a critical gap in HIV prevention science around the development of interventions for serodiscordant male couples. This paper reports on the results of a randomized controlled trial to assess the efficacy of Stronger Together, a dyadic counseling intervention aimed at increasing engagement in and optimizing HIV care among serodiscordant male couples in Atlanta, GA, Boston, MA, and Chicago, IL. Between 2014 and 2017, 159 male serodiscordant couples (total N = 318) in Atlanta, GA, Boston, MA, and Chicago, IL were enrolled and equally randomized to either the Stronger Together intervention arm (a three-session dyadic intervention involving HIV testing and adherence counseling) or a standard of care (SOC) control arm. Couples completed individual study assessments via an audio computer assisted self-interviewing (ACASI) system at baseline, 6, 12 and 18 months. Primary outcomes included being prescribed and currently taking ART, and fewer missed doses of ART in the past 30 days; because the trial was not powered to examine viral suppression, we examined this as an exploratory outcome. Longitudinal data analysis was by an intention-to-treat approach. Participants ages ranged from 18 to 69 (mean = 35.9), and are predominantly white (77.5%), and college educated (68.4% earned a college degree or higher). Participants randomized to the Stronger Together arm had a significantly greater odds of being prescribed and currently taking ART over time than those in the SOC arm (at 12 months OR 2.75, 95%CI 1.35–4.67, p-value 0.020, and at 18 months OR 2.91, 95%CI 1.61–4.88, p-value 0.013). Similarly, those in the Stronger Together arm had a significantly lower odds of missing a dose of ART in the past 30 days over time compared to those in the SOC arm (at 12 months OR 0.28, 95%CI 0.09–0.81, p-value 0.019, and at 18 months OR 0.25, 95%CI 0.07–0.82, p-value 0.023). Among male couples in serodiscordant relationships, the Stronger Together intervention resulted in significantly improved HIV treatment outcomes at both 12 and 18 months of follow-up. This trial is the first to date to demonstrate evidence of efficacy for a dyadic counseling intervention and has the potential to fill a critical gap in secondary HIV prevention interventions for serodiscordant male couples.

“Dating Matters®” is a CDC-developed comprehensive, multi-component teen dating violence (TDV) prevention model, made available to the public in 2019. A longitudinal, multi-site demonstration project found that the model significantly reduced TDV during middle school relative to an evidence-based, single-program intervention (Safe Dates; Niolon et al., 2019 ), when implemented across 46 middle schools in four high-risk urban areas with predominantly Black (55%) and Hispanic (28%) youth participants. Research on the costs of implementing TDV prevention strategies is limited, despite recognition within the field of prevention science that such data are critical to widespread dissemination. The current study adds to the available literature on the cost of dating violence prevention by estimating the budgetary impact from the payer perspective of implementing the comprehensive Dating Matters model, compared to Safe Dates, at four sites over four school years to inform prevention planning in communities. Total costs of implementing Dating Matters were relatively stable within sites over time but varied greatly between sites ( M = $175,452 per year; range = $130,149 to $227,604). The mean per-student cost of Dating Matters was $145.40 but also ranged widely ($20.66 to $324.65) across sites and years. Variation was largely driven by staffing costs and number of students served. As expected, total and per-student costs were substantially lower at all sites for the Safe Dates program ( M = $12,148; range = $2,848 to $17,840; $44.81 per student) compared to Dating Matters. This study provides an estimate from the payer perspective to demonstrate the budgetary impact of Dating Matters. These estimates can help inform implementation decisions and planning by potential funders, communities, and organizations as they seek to support and implement effective TDV prevention strategies. It also adds substantially to understanding of the additional costs associated with a move from single-program interventions to community-wide initiatives.

Despite significant progress in prevention science over the past 30 years in developing evidence-based interventions and policies, there has not been equal success in attracting support from policymakers and gaining acceptance by communities. In recognition of this gap, the editors of Prevention Science put out a call to scientists to help clarify and define the concept of a "culture of prevention." Such a culture would influence the creation of an infrastructure for implementing and sustaining the most effective strategies informed by research. The journal call stated a culture of prevention was a "general orientation or readiness of a group of people… to address problems by using a preventive, rather than a reactive approach." This commentary examines the concept demonstrated in the array of papers presented here in which the "culture of prevention" is applied in different contexts-occupational safety and health, substance use, school, governmental, community, around problem behaviors, and violence. It is important to note that the papers represent perspectives and experiences from several countries, including some cross-national experiences providing an international framework. While a final definition awaits further research, the commentary summarizes important elements that might constitute that evolving definition and pave the way for the implementation of more effective prevention programming.

Sexual violence (SV), homophobic name-calling, and bullying commonly occur in school settings. As such, comprehensive school-based violence prevention strategies are needed. Recent calls in prevention science argue that investigations of preventive interventions must move beyond simply testing if programs work; rather, they must also examine how interventions work. The purpose of this study was to explore the differential uptake of salient change mechanisms of a school-based primary prevention program, Sources of Strength (Sources) in rural schools, and examine contextual factors that may influence implementation outcomes in rural contexts. As a supplement to a randomized controlled trial of Sources in 20 high schools in Colorado, the present project utilized a rigorous qualitative design to conduct staff focus groups and student interviews within four schools (two intervention and two waitlist schools) that participated in the RCT. Results suggest variability in uptake of Sources key processes (expansion of networks to build connections, school-wide activities, and staff support) in intervention schools. While these were indicated as non-formalized processes in waitlist schools, there was also variability in these reports. Furthermore, results revealed specific contextual factors including cultural norms, degree of rurality, and school-level buy-in/investment that impacted implementation outcomes for intervention and waitlist schools (e.g., pre-implementation readiness). Implications are discussed around alignment of a school's policies, procedures, and values with the preventative intervention in effort to support strong implementation.

There can be a tendency for investigators to disregard or explain away null or negative results in prevention science trials. Examples include not publicizing findings, conducting spurious subgroup analyses, or attributing the outcome post hoc to real or perceived weaknesses in trial design or intervention implementation. This is unhelpful for several reasons, not least that it skews the evidence base, contributes to research “waste”, undermines respect for science, and stifles creativity in intervention development. In this paper, we identify possible policy and practice responses when interventions have null (ineffective) or negative (harmful) results, and argue that these are influenced by: theinterventionitself (e.g., stage of gestation, perceived importance);trial design,conduct,and results(e.g., pattern of null/negative effects, internal and external validity);context(e.g., wider evidence base, state of policy); andindividual perspectives and interests(e.g., stake in the intervention). We advance several strategies to promote more informative null or negative effect trials and enable learning from such results, focusing on changes to culture, process, intervention design, trial design, and environment.

In this thought leader commentary, the author makes observations about the findings and recommendations noted in this special issue. The broad scope of these reports from bullying; mental, emotional, and behavioral health; English language and dual language learners; optimal development; the promise of adolescence; optimal health; and shaping summertime experiences enhances our perspective on the important developmental time of childhood, adolescence, and young adulthood. Two broad perspectives—positive youth development and distinctive risky behaviors—are highlighted among other important themes. The author observes that the Board on Children, Youth, and Families of the National Academies of Sciences, Engineering, and Medicine could add value in synthesizing the implications of these studies for federal, state, and local agencies; communities; and the youth population itself, identifying both commonalities and research gaps across these reports. Such a synthesis could provide a roadmap including common and unique predictors, evidence-based interventions to address these predictors, and perspectives on integrative and complementary aspects of community, state, and federal systems. Advocacy is needed to take evidence summarized in these reports to scale. In this context, evidence-based practices from promotion to treatment backed by new implementation research in scale-up are likely to return immense benefits to society.

The project ‘Quality of leisure time as a protective factor for the development of behavioural problems' aims to investigate the influence of structured leisure time on mitigating adolescents' involvement in risk behaviours. Leisure can be a powerful context for positive youth development, but it can also be a context for youth engagement in risk behaviours. Therefore, the research question is: How does participation in structured leisure time activities influence risk sexual behaviour from the perspective of Croatian high school students? The sample consists of a total population of high school students from one county in Croatia (2,977 students, from 9 high schools). The age of the participants ranged from 14 to 20 years (51% female). The following questionnaires were used: (1) Adolescent Leisure Time Questionnaire; (2) Youth Experience Survey; (3) Risk Sexual Behaviour of Adolescents Questionnaire. Preliminary data show that 57% of adolescents currently participate in structured leisure activities. Before the pandemic COVID 19, 23% of adolescents participated in structured leisure activities twice a week, while during the pandemic COVID 19, only 15% did. Moreover, 35% of adolescents did not participate in structured leisure activities during the pandemic because they were anxious. Regarding risk sexual behaviours, 29% of adolescents had sexual intercourse, and of those 16% reported having experienced it before the age of 14. Unprotected sexual intercourse in the past 6 months under the influence of alcohol was reported by 15%, and under the influence of cannabis by 6% of adolescents. In presenting this work, the influence of structured leisure time activities on adolescents' risk sexual behaviour will be emphasized. The broader perspective and understanding of adolescents' leisure time and how it influences adolescent's behaviour and/or developmental outcomes is important for planning evidence-based strategies and interventions in the field of prevention science. Key messages The findings of this study can be an important resource for evidence-based intervention planning aimed at promoting positive youth development/prevention of youth risk behaviours. It is important to focus on creating opportunities in the community for quality leisure time use and educating key stakeholders about the importance of investing in quality leisure for youth.

We review the current literature on preventing challenging behaviors in people with neurodevelopmental disabilities. The goal of the review is to identify existing best practices shown to prevent or reduce challenging behaviors. We then review emerging areas of innovation that may help contribute to a more robust approach to prevent the development of these behaviors. Preventative interventions that include family-based protective factors, communication skills, social competence, and/or functional skills show evidence of reducing or preventing challenging behaviors. Research on the emergence of challenging behaviors from stereotypy suggests an additional avenue for prevention, as does the diagnosis and treatment of health conditions that can contribute to challenging behaviors. There is also a growing literature suggesting that biological factors such as behavioral phenotypes and gene variants associated with aggression may be viable avenues for prevention research. This paper shows that the prevention of challenging behaviors is a tangible possibility and raises areas for future research to more robustly develop a prevention science focused on pre-empting the development of challenging behaviors in people with neurodevelopmental disabilities.

The Mapping Advances in Prevention Science IV (MAPS-IV) Translation Research Task Force report provides an important enumeration of challenges and potential opportunities for improving extent of implementation of evidenced based interventions. The aspiration is for scientifically based prevention to be implemented widely enough to show population level shifts in incidence and prevalence. The MAPS-IV Task Force report by Fagan and colleagues (2019) provides a thoughtful and informative report that notes important exemplars towards that goal as well as key challenges and suggests strategies for greater impact across five publicly funded systems affecting human development. Comments are offered that center around the value of embedding prevention science within often larger and more sustained social and political forces as well as embracing scaling up within the complex funding streams in which prevention will be sustainable at scale. These include increasing attention to practical considerations that can affect how prevention is viewed, appreciated, and likely utilized as well as the ongoing challenge of how to relate evidenced based programs with the more prevalent and often preferred approaches of those deciding what is funded and what is actually implemented. This valuable contribution to Society for Prevention Research and prevention science is characterized as an important step toward strategies that might plausibly move prevention from primarily demonstration efforts to sustainable public health strategies integrated into the major systems of influence on human development.

Understanding the interplay between genetic factors and family environmental processes (e.g. interparental relationship quality, positive vs negative parenting practices) and children’s mental health (e.g. anxiety, depression, conduct problems, ADHD) in the contexts of adoption and foster care research and practice is critical for effective prevention and intervention programme development. While evidence highlights the importance of family relationship processes (e.g. interparental relationship quality, parent‒child relationship quality) for the mental health and well-being of children in adoption and foster care, there is relatively limited evidence of effective interventions specifically for these families. Additionally, family-based interventions not specific to the context of adoption and foster care typically show small to medium effects, and even where interventions are efficacious, not all children benefit. One explanation for why interventions may not work well for some is that responses to an intervention may be influenced by an individual’s genetic make-up. Alternatively, the targets of family relationship level interventions (e.g. parenting processes) may not always affect the specific environment ‘trigger’ deemed salient to specific child/adolescent outcomes. This article summarises how genetically informed research designs can help disentangle genetic from environmental processes underlying psychopathology outcomes for children, and how this evidence can provide improved insights into the development of more effective preventive intervention targets for adoptive and foster families. We discuss current difficulties in translating behavioural genetics research to prevention science and provide recommendations to bridge the gap between behavioural genetics research and prevention science, with lessons for adoption and foster care research and practice.

Tom Dishion, a pioneer in prevention science, was one of the first to recognize the importance of adapting interventions to the needs of individual families. Building towards this goal, we suggest that prevention trials be used to assess baseline target moderated mediation (BTMM), where preventive intervention effects are mediated through change in specific targets, and the resulting effect varies across baseline levels of the target. Four forms of BTMM found in recent trials are discussed including compensatory, rich-get-richer, crossover, and differential iatrogenic effects. A strategy for evaluating meaningful preventive effects is presented based on preventive thresholds for diagnostic conditions, midpoint targets and proximal risk or protective mechanisms. Methods are described for using the results from BTMM analyses of these thresholds to estimate indices of intervention risk reduction or increase as they vary over baseline target levels, and potential cut points are presented for identifying subgroups that would benefit from program adaptation because of weak or potentially iatrogenic program effects. Simulated data are used to illustrate curves for the four forms of BTMM effects and how implications for adaptation change when untreated control group outcomes also vary over baseline target levels.

This article reviews the evidence regarding behavioral science approaches to the prevention of substance use disorders. Prevention science grew out of research on family and school-based interventions that were designed to treat common behavioral problems of children and adolescents. That research showed that the amelioration of problems such as aggressive behavior could prevent the development of later problems including substance use, depression, and academic failure. We begin by reviewing evidence regarding the risk factors that contribute to the development of substance use disorders, as well as the protective factors that can reduce their likelihood. We then describe a variety of family, school, and community prevention programs that have been shown to prevent youthful use and abuse of substances. We conclude by describing the progress that has been made in getting these programs widely and effectively implemented, and the challenges we face in getting to the point where most communities are achieving considerable success in prevent substance use and the other common and costly behavioral and psychological problems of children and adolescents.

Objective: A substantial barrier to translating prevention science into practice is the potential for low implementation fidelity when evidence-based interventions are delivered in real-wor...

As our knowledge of HIV evolved over the decades, so have the approaches taken to prevent its transmission. Public health scholars and practitioners have engaged in four key strategies for HIV prevention: behavioral-, technological-, biomedical-, and structural/community-level interventions. We reviewed recent literature in these areas to provide an overview of current advances in HIV prevention science in the United States. Building on classical approaches, current HIV prevention models leverage intimate partners, families, social media, emerging technologies, medication therapy, and policy modifications to effect change. Although much progress has been made, additional work is needed to achieve the national goal of ending the HIV epidemic by 2030. Nurses are in a prime position to advance HIV prevention science in partnership with transdisciplinary experts from other fields (e.g., psychology, informatics, and social work). Future considerations for nursing science include leveraging transdisciplinary collaborations and consider social and structural challenges for individual-level interventions.

Background Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a dearth of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel web-based methodology leveraging the field of human-centered design to generate multiple ARA intervention concepts with SGMY. Objective This paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness of using web-based human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. Methods We are conducting a longitudinal, web-based human-centered design study with 45-60 SGMY (aged between 14 and 18 years) recruited via social media from across the United States. Using MURAL (a collaborative, visual web-based workspace) and Zoom (a videoconferencing platform), the SGMY will participate in four group-based sessions (1.5 hours each). In session 1, the SGMY will use rose-thorn-bud to individually document their ideas about healthy and unhealthy relationship characteristics and then use affinity clustering as a group to categorize their self-reported ideas based on similarities and differences. In session 2, the SGMY will use rose-thorn-bud to individually critique a universal evidence-based intervention to reduce ARA and affinity clustering to aggregate their ideas as a group. In session 3, the SGMY will use a creative matrix to generate intervention ideas for reducing ARA among them and force-rank the intervention ideas based on their potential ease of implementation and potential impact using an importance-difficulty matrix. In session 4, the SGMY will generate and refine intervention concepts (from session 3 ideations) to reduce ARA using round robin (for rapid iteration) and concept poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, the SGMY will complete validated measures about the feasibility, acceptability, and appropriateness of the web-based human-centered design methods (a priori benchmarks for success: means >3.75 on each 5-point scale). Results This study was funded in February 2020. Data collection began in August 2020 and will be completed by April 2021. Conclusions Through rigorous testing of the feasibility of our web-based human-centered design methodology, our study may help demonstrate the use of human-centered design methods to engage harder-to-reach stakeholders and actively involve them in the co-creation of relevant interventions. Successful completion of this project also has the potential to catalyze intervention research to address ARA inequities for SGMY. Finally, our approach may be transferable to other populations and health topics, thereby advancing prevention science and health equity. International Registered Report Identifier (IRRID) DERR1-10.2196/26554

Technology is intertwined in our lives. We can be characters preparing to slay dragons in video games or seek help from approachable virtual service representatives to make medical appointments. In this special issue focused on prevention science in the field of research on intellectual and developmental disabilities (IDDs), readers might be surprised to find an article addressing the use of avatars and agents. These virtual characters provide a friendly interface to represent a computer program. The application of avatars and agents in preventative intervention for children and youth with IDDs is in an early stage of development. However, this technology has the potential to innovate the field. Computerized agents can project human-like emotions. These qualities provide unique behavioral and motivational reinforcement for engagement in agent-administered computer programs. Equally important, agents hold the promise of reducing disparities in access to prevention efforts, as they can be delivered (virtually) anywhere. Accordingly, preventative interventions could reach children with IDDs in rural populations or children with low-incidence IDDs who would not commonly have access to a specifically targeted program. In this review, we first define avatars and agents in more detail and provide a brief history of their evolution for context. We then synthesize the extant research that informs our understanding of how children with IDDs respond and engage with agent-based computer programs. We conclude our review with an appraisal of the methodological approaches used and recommendations for future research efforts.

Background: There is a critical gap in HIV prevention science around the development of interventions that help male couples form and adhere to safer sexual agreements. This paper reports the results of a randomized controlled trial (RCT) to assess the efficacy of Nexus , a telehealth delivered intervention that combines Couples’ HIV Counseling and Testing (CHTC) with home-based HIV-testing, examining the impact of the intervention on the couples’ formation and adherence to safer sexual agreements. Methods: Between 2016 and 2018, 424 male couples were recruited online from across the U.S and equally randomized to the intervention arm (a telehealth delivered CHTC session with two home HIV-testing kits) or a control arm (two home HIV-testing kits), with study assessments at baseline, 3 and 6 months. Outcomes included the formation and adherence to safer sexual agreements, dyadic discordance in reporting sexual agreements, breakage of sexual agreements, and perceptions of the benefit of PrEP. Findings: Couples randomized to the intervention arm had significantly greater odds of reporting a safer sexual agreement (3 months OR 1.87, 95%CI 1.21-2.90, p-value 0.005, and 6 months OR 1.84, p-value 0.007), lower odds of reporting discordant sexual agreements at 6 months (OR 0.62, p-value 0.048), and a significantly lower odds of reporting breaking their sexual agreement (3 months OR 0.51, p-value 0.035, and 6 months OR 0.23, p-value 0.000). By 6 months, couples in the intervention arm were less likely to say PrEP was beneficial to one (RRR 0.33, P=0.000) or both of them (RRR 0.29, P=0.000) than being beneficial to neither of the partners. Interpretation: The high levels of acceptability and efficacy of the intervention demonstrate strong potential for the scale-up of this efficacious intervention that leverages existing interventions (CHTC) and delivers them through a low-cost telehealth platform to create significant behavioral change among male couples. Trial Registration: The study was registered on ClinicalTrials.gov (NCT02335138) Funding: The study was supported by National Institutes of Health (Grant No. R01HD078131). Declaration of Interest: The authors declare no competing interests. Ethical Approval: Ethical approval was obtained from the University of Michigan (HUM00102906) Institutional Review Board.

Mentoring relationships are characterized by a sustained, high quality, and skill-building relationship between a protege and mentor (Handbook of Youth Mentoring, Los Angeles, SAGE, 2014). Within prevention science, youth mentoring programs emphasize creating a specific context that benefits a young person. Program-sponsored relationships between youth and adults allow for creating a mentor-mentee partnership, but do not require the establishment of a strong bond in order to deliver prevention-focused activities and experiences (Handbook of Youth Mentoring, Los Angeles, SAGE, 2014). Motivational Interviewing (MI) is a counseling style used widely to promote health behavior change and in prevention interventions. As part of an upstream approach to HIV prevention, we combined mentoring and MI by training peer mentors to use MI skills in their interactions as part of a large RCT of a mobile life skills intervention for adolescent men who have sex with men (AMSM). Our training model developed for training peer mentors in MI skills resulted in peers reaching and exceeding established MI fidelity thresholds (e.g., mean percentage of complex reflections = 80%, mean reflection to question ratio = 2.2:1). We offer reflections on lessons learned and future directions for those researchers and practitioners who may benefit from adapting this blended approach for mentoring AMSM.

Because families are the primary food socialization agent for children, they are a key target for nutrition interventions promoting healthy eating development. Although researchers and clinicians have developed and tested successful family nutrition interventions, few have gained widespread dissemination. Prevention and implementation science disciplines can inform the design, testing, and dissemination of feeding interventions to advance the goals of widespread adoption and population health impact. We review concepts and frameworks from prevention science and dissemination and implementation (D&I) research that are useful to consider in designing, implementing, and evaluating feeding interventions. Risk and protective factor frameworks, types of translation processes, and implementation dimensions are explained. Specifically, we address how research–practice partnerships can reduce time to dissemination, how designing for modularity can allow for contextual adaptation, how articulating core components can strengthen fidelity and guide adaptation, and how establishing technical assistance infrastructure supports these processes. Finally, we review strategies for building capacity in D&I research and practice for nutrition professionals. In sum, the research and knowledge bases from prevention and implementation sciences offer guidance on designing and delivering family interventions in ways that maximize the potential for their broad dissemination, reducing time to translation and optimizing interventions for real-world settings.

Statement of purpose One challenge of conducting intervention studies is ensuring that study participants complete the intervention. For instance, in our randomized controlled trial of Take Charge!, an emergency department-based, mentor-implemented and research-informed violence prevention program that partners with one-on-one community-based mentoring agencies, only 50% of intervention youth were successfully matched with a mentor. Understanding differences between those who complete the intervention and those who do not can further inform the implementation of future studies. Methods/approach Between June 2014-June 2016, we recruited 188 assault-injured youth aged 10–15 years from two urban pediatric emergency departments (Baltimore, MD; Philadelphia, PA). Participants were randomized to receive an intervention that included referral to Big Brothers Big Sisters for pairing with a mentor (n=98) or a comparison group that received usual care (n=90). Of the intervention group, 49 (50.0%) youth were successfully matched with a mentor. Using descriptive statistics, t-tests and chi-square analysis, we compared matched and unmatched youth with regard to demographics, time from injury to study enrollment, perceived seriousness of injury, willingness to change, risk behaviors, and a measure of household chaos. Results Youth who were successfully matched with a mentor were more likely to perceive the injury as very serious or somewhat serious compared with unmatched youth (95.9% vs. 79.6%, p=0.028). All other factors were not significantly associated with successful mentor matching. Conclusions Youth perception of seriousness of injury was associated with successful mentor matching in our study population. This may be related to the youth’s motivating factors for prevention of future injury. Significance and contributions to injury and violence prevention science Ensuring that study participants complete an intervention can be challenging. Future violence prevention interventions should consider youth perceptions of injury severity or life threat as part of the motivation to complete desired interventions.

Statement of Purpose To investigate variability in observed concussion incidence between NCAA colleges participating in a multisite prospective study of concussion, and to quantify the effect of selected school-level factors on concussion risk. Methods/Approach Data on sport-related concussion (SRC) were provided by the CARE Consortium, a multisite study of 30 collegiate institutions. School-level factors included NCAA Division (DI, DII, DIII) and school type (military or civilian) and a 3-level Sport Risk Index (Low, Medium, High). Random intercepts G-side log-binomial regression was used to model between- and within-school variability in concussion risk in NCAA athletes. Three concussion outcomes were modeled: all SRCs, competition SRCs only, and practice SRCs only. Results School-Level Risk Factors: In fully adjusted models with all SRCs as the outcome, Sport Risk Index was the strongest predictor (risk ratio (RR) of 6.0; 95%CI: 4.4, 8.1, for the High vs. Low categories of the Index). Concussion risk was higher in Division I schools than in Division 2 (RR=1.6, 95%CI: 0.6, 4.2) and Division 3 schools (RR=1.8, 95%CI: 0.9, 3.6) schools. Military academies had an elevated risk of SRC (RR=1.5; 95%CI: 0.7, 3.3; analysis limited to NCAA athletes). School-Level Variability: Most of the variability in SRC risk was at the level of the athlete, not at the school. For all three outcomes, the within-school (athlete-level) variance was over five times the between-school variance. Adjusting for our three school-level risk factors (Division, Mil/Civ, and Sport Risk Index) removed 40% of the variation between schools for competition SRC, and 25% for overall SRCs and practice SRCs. Conclusions Sport-level factors predict concussion risk, and a substantial portion of variability in concussion risk between schools is readily explainable. Significance and Contributions to Injury and Violence Prevention Science Understanding school-level determinants and variability in concussion risk may identify opportunities for interventions to reduce SRC incidence.

Statement of Purpose This study aimed to identify factors associated with perception of minimized life expectancy in assault-injured youth, a population at-risk for future assault-related injuries. Methods/Approach Assault-injured youth (n=188; ages 10–15 years; 61% male; 96% black) were recruited from two urban pediatric emergency departments (Baltimore, MD, Philadelphia, PA) to participate in a mentoring intervention to prevent violence. At enrollment, youth were asked ‘Do you think you will live to 35?’; youth responding ‘yes’ (optimistic life expectancy) were compared to youth responding ‘maybe’ (uncertain life expectancy) using descriptive statistics, t-tests and chi-square analysis. Results Although there were no differences between the groups in age, gender or socioeconomic status, youth with an uncertain life expectancy (31.4%, n=59) were more likely to have a family member injured by violence (61.0% vs. 43.4%, p=0.028) or in a gang (42.1% vs. 19.2%, p=0.002) and less likely to take steps to avoid a fight (57.6% vs. 76.7%, p=0.01) or think about consequences before acting (70.7% vs. 87.6%, p=0.007). These youth were also more likely to believe that revenge is a good thing (47.4% vs. 29.0%, p=0.019), and think about suicide (42.9% vs. 7.9%, p Conclusions One third of assault-injured early adolescents expressed uncertainty of living until age 35. Several risk factors and behaviors were identified as being associated with possible risk of premature death. Significance and Contributions To Injury And Violence Prevention Science Perception of risk of premature death is present in a sizable proportion of assault-injured youth. Future work should investigate the impact that an uncertain life expectancy has on future behaviors and response to violence prevention interventions.

Statement of Purpose California coastal cliffs are known for scenic views, natural beauty inviting the public to explore, but are also known for environmental risks. An increase of falls from cliffs with severe outcomes, combined with risky behaviors, was identified. A review describing cliff-related falls from two geographically different coastal regions was done. Methods/Approach All trauma admissions 2010–2018 from two trauma centers (TC) was reviewed for unintentional falls at coastal cliffs. Study sites have coastline catchments with distinct differences. North TC (NTC): higher cliffs with trails towering over the beach; South TC (STC): lower shoreline cliffs. All injury event data available were reviewed from both sites, including prehospital and media. Medical record and registry data collected include demographics, diagnoses, procedures, outcomes. Results 159 trauma patients treated at sites were identified. Males comprised 67%, mean age 31.5 years. 48% occurred between 2014–2016. NTC had more events (54% vs 41%), younger patients (29 vs 34 years) and more complex injuries. Mean length of stay was similar (8 vs 7 days) but differences in gender, age and injuries were evident between sites. Activities prior to injury included hiking, hang gliding and intentional jumping into ocean. 47% with positive alcohol. Fall distance ranged 10–300 feet. 75% discharged home, 4 hospital deaths, 10 at scene. Conclusions Coastline cliffs continue to change with erosion and development. Communities continue to fight to preserve natural beauty while ensuring public safety. Incidence increase corresponded with documented surge of social media for gathering and intentional cliff jumping but has since subsided slightly. Visitors, unfamiliar with the environment were common, as well as alcohol use combined with poor judgment; potentially fatal combinations. Significance and Contributions to Injury and Violence Prevention Science There exists common behaviors, severity and outcomes demonstrating opportunities to develop education and prevention interventions, and still enjoy that sunset.

Statement of Purpose Opioid overdose represents an urgent public health problem in the United States, with Michigan ranking among the states hardest hit by the dramatic escalation over the past 15 years. A key barrier to addressing this problem is the lack of timely surveillance data, with data in many jurisdictions lagging by up to 18 months. In response to this need, the University of Michigan Injury Prevention Center partnered with the Michigan High Intensity Drug Trafficking Areas (HIDTA) to develop a near real-time opioid overdose surveillance system. Methods/Approach The System for Opioid Overdose Surveillance (SOS) collects and automatically cleans data daily from emergency medicine services (EMS) encounters where naloxone was administered, and from Medical Examiner (ME) records where overdoses are suspected (confirmation via toxicology reports are obtained 4 to 12 weeks later). Current coverage is 100% of the state through EMS, and MEs in counties totaling 75% of the state population. County-level summaries generated by SOS are viewable on a public web site. Authorized public health and public safety stakeholders have access to a dashboard that allows customizable demographic and spatio-temporal data summaries in near real-time. This dashboard was designed in part through an iterative process with stakeholders in two Michigan counties. Results Qualitative work completed with community stakeholders in two Michigan counties suggests SOS can be used to improve planning, implementation, and responses to opioid overdoses. Conclusions Timely opioid overdose surveillance in Michigan can have broad implications for both public health and public safety, allowing for focused interventions and resource allocation in communities with the highest rates of opioid overdose. Significance and Contributions to Injury and Violence Prevention Science SOS’s multidisciplinary model can be replicated across the nation to inform data-driven opioid overdose prevention and response efforts with the ultimate goal of reducing overdose injuries and fatalities.

Statement of Purpose Trauma recidivists are patients who present to an emergency room or trauma center on more than one occasion for different incidents of traumatic injury. Although a major public health issue, there has not yet been a systemic review of the literature that synthesizes our understanding of correlates of trauma recidivism. The purpose of this presentation is to report on the findings of a systematic review of the trauma recidivism literature. This oral presentation focuses on the methodological findings and recommendations that resulted from the review. Methods/Approach 13 data bases were searched from inception to 2017 for studies that explicitly compared hospital-based trauma recidivists to non-recidivists. The search was conducted using PRISMA guidelines for systematic reviews. Results Screening resulted in the selection of 29 studies that met the inclusion criteria. Conclusions The literature review generated findings that could inform the quality of research among victims of violent injury. Methodological considerations to consider include, a) identifying a common ‘recidivism window’ that allows detection of patients who are at risk for recidivism, b) disaggregate patients by epochs informed by the human development literature, and c) improving on mixed method methodologies. Significance and Contributions to Injury and Violence Prevention Science Social science concepts and methodology coupled with medical/victim research can help provide a deeper understanding of the meanings and processes that shape both health research and the behaviors of patients that lead to subsequent re-injury. Insights from this research and the collaborations that stem from it can guide the design of health care delivery practices and interventions that acknowledge and adapt to social, cultural, and economic barriers; harness social mechanisms to increase their effectiveness; or even attempt to manipulate social and cultural determinants of health directly.

Statement of Purpose Male youth residing in low-resource neighborhoods experience high rates of violence. Prior research in marginalized communities suggests that a singular adult presence may not universally confer protection amidst high levels of community violence. This study aimed to describe adolescent-adult support network structure and quality and analyze associations between network properties and violence exposure among male youth in low-resource neighborhoods. Methods/Approach 45 male youths, ages 13–21, completed social network surveys as part of a community-based violence prevention study in Pittsburgh, PA to define family-, school-, and community-based adult supports and past 30-day violence exposure (operationalized as any/none). Logistic regression examined associations between 1) perceived strength of overall emotional and instrumental support, 2) strength of social support type, 3) network size, and violence exposure. Wilcoxon rank-sum tests examined associations between network density and violence exposure. Results Mean participant age was 17.6 years (SD=1.5); 77.8% were African American. In the past 30 days, 84% reported witnessing violence, 60% perpetrating violence, and 69% being victimized. Increased immediate and extended family support were associated with significantly higher odds of witnessing violence (OR: 4.91, 95%CI: 1.25–19.63; OR: 3.99, 95%CI: 1.23–13.01, respectively). Mean number of adult supports was 4.8 (range:1–14). Increased number of adult supports was associated with higher odds of witnessing violence (OR: 2.17, 95%CI: 1.01–4.66). Network density (Median=0.50) was significantly inversely associated with witnessing violence (z=2.32, p=0.02). Conclusion Findings highlight complex associations between adolescent-adult support network structure, relationship quality, and violence. Associations between family support and witnessing violence may reflect families providing increased support to help youth navigate community violence. Inverse associations between network density and violence exposure suggest that network connectivity may act as a protective factor against witnessing violence. Significance/Contribution to Injury and Violence Prevention Science Results can guide interventions to leverage adult support networks and protect youth from violence.

Statement of Purpose To evaluate how place (i.e. urban and rural) impacts stressors for law enforcement officers (LEOs) during traumatic calls for service. Methods/Approach LEOs were recruited for six focus groups across one urban and one rural police department from April to November 2019. A semi-structured format was used to gain insight into how officers respond to consecutive high-stress calls for service, including the mechanistic effects of decompression techniques and mental health care utilization. Transcripts were thematically analyzed in an iterative deductive and inductive coding scheme to identify anticipated and emergent findings. Results A total of 22 LEOs participated, with mean ages of urban and rural officers of 37.9 and 40.8, respectively. Several similarities between urban and rural LEOs emerged related to consecutive stress: 1) Lack of officers to meet high volume of calls; 2) Stringent and fluid management; 3) Environmental stressors leading to a cyclical nature of calls. Rural officers reported unique stress due to: 1) Distance to calls 2) Lack of partners; 3) Lengthy backup response times; 4) Limited or no access to mental health care. Urban officers uniquely reported: 1) Large volume of civilian-police interactions; and 2) Negative perceptions from media and the public. Conclusions While all LEOs experience consecutive stress, the nature of the stress differs by rural vs. urban employment location. Additional research and interventions for these two, unique populations are needed to combat consecutive stress and reduce LEO injuries. Significance and Contributions to Injury and Violence Prevention Science Consecutive and continuous exposure to high-stress calls may influence police officers’ immediate risk for morbidity and mortality and inhibit their decision-making ability. Past literature has only focused on single police departments making it difficult to evaluate how context, like urban and rural environments, influence LEO stress.

Statement of Purpose This study analyzes changes in sociodemographic and clinical characteristics of violently injured patients to guide injury prevention strategies. Methods/Approach Trauma registry data from 2005 to 2018 was analyzed to identify trends among victims of community violence. This hospital is the only level I trauma center in a large, urban area, treating 99% of all violently injured patients in the city. Results Since 2005, the median age of violently injured patients increased 9 years from 26 to 35. During this same timeframe, there was an 8.2% increase in violent injury among the White population, a 6.3% increase among the Latinx population, and a 4.9% decrease among the Black population. The rate of severe injury per 100,000 decreased from 118 to 86 in the White population and 325 to 212 in the Black population but increased from 267 to 305 in the Latinx population. There was an 18.5% decrease in penetrating injuries and 18.5% increase in blunt injuries. The mean length of hospital stay following violent injuries increased by 4.1 days. Conclusions The age of violently injured patients is increasing, and the demographic makeup of violently injured patients is shifting to include a greater proportion of White and Latinx individuals. During the study period, the proportion of Black residents in the city decreased by 28%, but the observed decrease in violent injury in this population was much lower. Additionally, the percentage of Latinx residents in the city increased by 8% during this time, but violent injury increased disproportionately. Significance and Contributions to Injury and Violence Prevention Science As older populations may have different risk factors, understanding these trends is essential to ensure violence prevention programs provide appropriate interventions and can adapt to effectively target the older population. Prolonged hospital stays may extend the opportunities for interventions to be offered.

Statement of Purpose Place-based interventions affect social and physical environmental conditions in neighborhoods and are policy-relevant opportunities for violence prevention that can also promote population health equity. This presentation discusses study design challenges and novel data integration methods relevant to such interventions. Methods/Approach We examine the impact of vacant land and abandoned building remediation on crime and violence, including family violence, through observational and quasi-experimental research and discuss methodology for an ongoing cluster randomized trial aimed at reducing blighted properties in a southern U.S. city known for elevated rates of violence and neighborhood inequities. Results Strong spatial correlations between the rate of vacant land and both violent crime and domestic violence call rates, as well as in the rates of child abuse and neglect, were evident. Cluster analysis of data on potential vacant land and abandoned houses was used to detect and select approximately 200 geographic clusters with a high density of vacant properties. Clusters were block randomized into five intervention arms based on the two cluster types, those with only vacant land and those with both vacant land and abandoned homes. Challenges were found in terms of assignment of properties within a reasonable timeline that satisfied research goals and municipal realities. Data integration software is a promising tool for examination and monitoring of trends in vacant land and resultant health and social outcomes. Conclusion Testing the efficacy of such straightforward, inexpensive, and scalable methods is challenging but can be addressed through innovative methods and adaptive trial designs. Significance and Contributions to Injury and Violence Prevention Science This presentation will discuss development of and preliminary results from a neighborhood-level cluster randomized trial that advances the science of violence prevention, as well as potential measurement tools to understand place-based disparities that can also be used to monitor progress toward neighborhood equity.

Statement of Purpose Underground gun markets create opportunities for individuals who are prohibited from gun ownership to gain access to them. Understanding how these individuals obtain guns, as well as their unsuccessful attempts to get guns, is key to developing interventions that effectively restrict the supply of guns in an underground market. Methods/Approach We recruited 195 men outside of parole and probation centers in Baltimore City. We conducted surveys with these criminal justice system-involved men about their experiences in the underground gun market. The survey data was gathered using an audio-assisted computer survey instrument. The survey was composed of questions about ability to acquire firearms, why they were desired, and selling/trading behaviors. Results 30% of respondents (n=58) reported having experience in the underground gun market. More than half of these individuals were unsuccessful in their most recent attempt to obtain a firearm due to cost- or source-related barriers. Over 80% of individuals who did not already have access to a gun but wanted one (31/38) reported wanting to acquire one for safety or protection. Most respondents who had access to firearms had handguns (90%). Individuals reported selling or trading a gun (n=35) for money (69%), drugs (46%), or other guns (23%), or accepting guns as payment for drugs. Conclusions Although an underground market can facilitate access to firearms, barriers exist that can prevent acquisition by high risk individuals. Significance and Contributions to Injury and Violence Prevention Science This is the first study to understand the availability of and access to guns in Baltimore’ underground gun market. Efforts should focus on strategies that increase accountability and restrict the supply of guns in an underground market or those that provide alternatives to gun carrying to feel safe.

Researchers, scientists, and practitioners continue to advance behavioral community approaches for addressing community health and development issues. Applied behavior analysis (ABA) offers an important perspective for examining socially important problems and goals across a range of issues. Throughout an evolutionary process of selection, behavioral community scientists continue to focus on the dimensions of ABA (e.g., applied, behavioral, analytic, conceptually systematic, generalizable, effective, technological, or reproducible). The importance of integrating a behavior-analytic perspective to support behavioral community approaches has been promoted in other disciplines, including community psychology, public health, and prevention science. This chapter examines the history and current efforts to advance behavioral community approaches, interventions, and technologies that support community health and development. Efforts facilitated by the Center for Community Health and Development with the Department of Applied Behavior Science at the University of Kansas are featured to demonstrate an evolution and scaling of behavioral community research and application. Additional resources, frameworks, and tools that have guided the implementation of behavioral community research and practice in community health and development are presented. Through the chapter, the influence of behavioral community science and research within ABA and other disciplines is examined to better understand the importance of an integrated behavioral community approach.

Two streams of theory and practice on gender equity have begun to elide. The first is work conducted to change social norms, particularly using theory that emerged from studies in social psychology. The second is work done on gender norms, emerging historically from feminist scholars working to counter gender inequality. As these two streams of work intersect, conceptual clarity is needed to understand differences and similarities between these two traditions. Increased clarity will improve efforts to address harmful norms and practices. In this article, we review similarities and differences between social and gender norms, reviewing the history of the concepts and identifying key tension points of contrast. We identified six areas of comparison that might be helpful for practitioners working for the promotion of global health as they make sense of social and gender norms. We then offer a definition of gender norms for practitioners and researchers working at the intersection between these two theories. Our definition draws from the two different streams of thought of how norms influence people's actions, acknowledging the double nature of gender norms: beliefs nested in people's minds and embedded in institutions that profoundly affect health‐related behaviours and shape differential access to health services.

In this interdisciplinary article, we provided an evidence-based discussion on the role of the supportive built environment on cancer prevention. We also extended the theoretical thinking on the built environment-cancer links by raising possible equality challenges. Following the recent call in population-level interventions in cancer prevention, our aim is to encourage readers to think about the important potentials and limitations that are raised from the point of view of the supportive built environments in relation to cancer prevention. We focus on the key links between the built environment and cancer prevention strategies (primary, secondary, and tertiary) and discuss ways in which the built environment may reflect and contribute to inequalities in cancer.

This introduction examines major issues and challenges as presented in this special issue of Prevention Science, “Challenges to the Dissemination and Implementation of Evidence Based Prevention Interventions for Diverse Populations.” We describe the Fidelity-Adaptation Dilemma that became the origin of dynamic tensions in prevention science. It generated controversies and debates and new perspectives on the dissemination and implementation of evidence-based interventions (EBIs) within diverse populations. The five articles in this special issue address many of these challenges. These dynamic tensions have culminated in a reframing of this dilemma, that now argues that fidelity and adaptation are both equally important imperatives. These five articles also examine the abiding challenges of engagement and sustainability. Also, two commentaries from expert research investigators reflect on these five articles and their contributions to prevention science. The current introduction describes this “second generation” of EBI’s as they may contribute towards a reduction of the health disparities and inequities that disproportionately affect sectors of the major ethnocultural populations in the U.S. We also present a systems analysis of approaches and challenges in the dissemination and implementation of EBI’s within the contemporary integrative care environment. Finally, we mention an initiative for, “building a science of intervention adaptation,” that proposes systematic research and the creation of an archive of scientific data on the benefits and problems of intervention adaptation. Collectively these new directions can integrate scientific rigor and sensitivity to cultural factors, for enhancing the effectiveness and reach of this second generation of evidence-based interventions with diverse ethnocultural populations.

Mayor advancements have been achieved in research on the cultural adaptation of prevention and treatment interventions that are conducted with diverse ethnocultural groups. This commentary addresses conceptual, ethical, contextual, and methodological issues related to cultural adaptations. The articles in this special issue represent a major contribution to the study of cultural adaptations in prevention science. We frame our analysis of fidelity to core intervention components using a conceptual approach that examines (a) the propositional model (theory of change), (b) the procedural model (theory of action, methods), and (c) the philosophical assumptions that undergird these models. Regarding ethics, we caution against imposing the norms, values, and world views of the Western dominant society onto vulnerable populations such as ethnocultural groups. Given that the assumption of universality in behavioral science has been questioned, and as randomized clinical trials (RCTs) seldom examine the ecological validity of evidence-based interventions and treatments (EBI/T), imposing such interventions onto ethnocultural groups is problematic since these interventions contain values, norms, beliefs, and worldviews that may be contrary to those held by many ethnocultural groups. Regarding methods, several innovative designs are discussed that serve as alternatives to the RCT and represent an important contribution to prevention science. Also, we discuss guidelines for conducting cultural adaptations. Finally, the articles in this special issue make a major contribution to the growing field of cultural adaptation of preventive interventions with ethnocultural groups and majority-world populations.

Over the past 30 years, prevention science in the adolescent health field has moved from interventions focused on preventing single problem behaviors to efforts employing a dual approach, addressing risk factors that predict problems while simultaneously nurturing protective factors and promoting positive development. Through an examination of previous research and empirical case examples with vulnerable youth, this article considers the hypothesis that adolescents' sense of connectedness to caring adults acts as a protective factor against a range of risk behaviors. Multivariate analyses with existing data examined indicators of youth-adult connectedness among two groups at high risk for poor health outcomes: (1) mentor-youth relationship quality in an urban, ethnically diverse sample of students in a school-based mentoring program (2014 survey, N=239); and (2) parent-youth connectedness in a statewide sample of high school students who reported homelessness in the past year (2013 survey, N=3,627). For youth in the mentoring program, a high-quality youth-mentor relationship was significantly associated with positive social, academic, and health-related behaviors. Among students who experienced homelessness, all measures of parent connectedness were significantly associated with lower sexual risk levels. Collectively, findings from these analyses and previously published studies by this research group provide evidence that strong, positive relationships with parents and other caring adults protect adolescents from a range of poor health-related outcomes and promote positive development. Youth-adult connectedness appears to be foundational for adolescent health and well-being. Program, practice, and policy decisions should consider what strengthens or hinders caring, connected youth-adult relationships.

The global substance use problem is a serious public health concern that affects not only health, safety and well-being of communities, but also social and economic development. It particularly affects children, young people and their families. All Member States should set substance use prevention measures and programmes as a priority in order to promote health and reduce social harm. During the past few decades there has been a significant advance in prevention science that has led to the development of international prevention standards and globally accepted evidence-based interventions. This review looks into the key requirements, components and strategic interventions needed for a public health approach to prevention of substance use and disorders, and its health and social consequences. It aims at supporting Member States and civil society to identify the key elements that support countries and local communities to increase the number of substance use protective approaches in relation to risk factors across all relevant domains.الوقاية من تعاطي مواد الإدمان: التدخل المستند إلى الأدلة.ماريا رينستروم، ماريكا فيري، أحمد منديل.تمثّل المشكلة العالمية لتعاطي المخدرات شاغلاً خطراً للصحة العامة لا يقتر أثرها عى الصحة والسامة ورفاهية المجتمعات فقط، بل يمتد ليشمل التنمية الاجتماعية والاقتصادية كذلك. وتؤثر هذه المشكلة عى الأطفال والشباب وأسرهم عى وجه الخصوص. فينبغي لجميع الدول الأعضاء وضع تدابر وبرامج للوقاية من تعاطي مواد الإدمان عى سبيل الأولوية بغية تعزيز الصحة والحد من المخاطر الاجتماعية. وخال العقود القليلة الماضية، تحقق تقدّم كبر في علوم الوقاية أدى إلى وضع معاير دولية للوقاية وتصميم تدخات مستندة إلى النتائج تحظى بالقبول عى المستوى العالمي. ويتضمّن هذا العرض المتطلبات والمكونات والتدخات الاسراتيجية الرئيسية اللازمة لاعتاد نهج للصحة العامة إزاء الوقاية من تعاطي المخدرات واضطراباتها وتبعاتها الصحية والاجتماعية. ويهدف إلى توفر الدعم للدول الأعضاء والمجتمع المدني لتحديد العناصر الرئيسية التي تساعد البلدان والمجتمعات المحلية عى زيادة عناصر الحماية من تعاطي المخدرات فيا يتعلق بعوامل الخطر في جميع المجالات ذات الصلة.Prévention de l’utilisation de substances psychoactives : interventions reposant sur des bases factuelles.Le problème mondial posé par l’usage de la drogue constitue une préoccupation de santé publique sérieuse qui a non seulement des répercussions sur la santé, la sécurité et le bien-être des communautés, mais aussi sur le développement économique et social. Il affecte particulièrement les enfants, les jeunes et leurs familles. Tous les États Membres devraient accorder la priorité aux mesures et programmes de prévention de l’usage des substances psychoactives afin de promouvoir la santé et de diminuer l’impact social. Au cours des dernières décennies, on a observé une avancée notable dans le domaine des sciences de la prévention, qui a conduit à l’élaboration de normes de prévention internationales et à la mise en place d’interventions reposant sur des bases factuelles reconnues à l’échelle mondiale. La présente analyse a passé en revue les exigences, composantes et interventions stratégiques principales requises dans le cadre une approche de santé publique de prévention de l’utilisation des substances psychoactives et des troubles associés, ainsi que ses conséquences sanitaires et sociales. Elle vise à soutenir les États Membres et la société civile dans l’identification des éléments clés permettant d’aider les pays et les communautés locales à augmenter le nombre d’approches de protection contre l’utilisation de substances psychoactives en rapport avec les facteurs de risque dans tous les domaines pertinents.

Item does not contain fulltext While the availability of mental health promotion and prevention programs worldwide is growing, there is divergence in their level of effectiveness that has led to increasing interest in the development of 'effect management' strategies. Mental health promotion and prevention science and practice has a relatively young history in Croatia, but major investments towards its development have been made over the last decade. This paper reports on a research project that took place within the Istrian Region. The long-term goal of the initiative is to establish quality assurance indicators for mental health promotion and prevention interventions. The current study involved adapting the Dutch Preffi 2.0 instrument for use in Croatia. The content of the Preffi reflects the literature regarding research-based effect predictors. An instrument allows users to assess whether programs have been designed and implemented in ways that maximize their ability to be effective. The Preffi scores can be used for improving a program and the quality with which it is implemented. The first aim of the study is to determine if independent researchers can use the Preffi reliably as a quality assessment instrument. The second aim is to use the Preffi to describe the quality of one cohort of mental health promotion and prevention programs. The study represents the first steps toward developing a strategy for quality assurance that strengthens community capacity for effective service delivery and that could inform other countries whose mental health promotion and prevention efforts are in early stages of development. 11 p.

© 2019 Hogrefe Publishing, Across many domains of health and welfare, there have been remarkable advances in prevention where public-health models have had a significant impact. Psychology has much to offer in building on these successes and we describe some excellent examples, but in general, it has not been fully engaged with prevention science and implementation. We set out some of the key challenges and opportunities for psychology and prevention science in contemporary practice, recognizing that often the rhetoric from governments to support prevention interventions do not match up to making the necessary resources available. We argue that psychology must prioritize this area of practice as there is evidence that the gains of recent decades may be under threat without concerted efforts.

One of Tom Dishion's most significant contributions to prevention science was the development of affordable, ecologically valid interventions, such as the Family Check-Up, that screen for child and family risk factors broadly, but concentrate family-specific interventions on those with greatest potential for population impact. In the spirit of this approach, investigators examined effects of a brief, universal postnatal home visiting program on child emergency medical care and billing costs from birth to age 24 months. Family Connects is a community-wide public health intervention that combines identification and alignment of community services and resources with brief, postpartum nurse home visits designed to assess risk, provide supportive guidance, and connect families with identified risk to community resources. Over 18 months, families of all 4,777 resident Durham County, North Carolina, births were randomly assigned based on even or odd birth date to receive a postnatal nurse home visiting intervention or services as usual (control). Independently, 549 of these families were randomly selected and participated in an impact evaluation study. Families, blind to study goals, provided written consent to access hospital administrative records. Results indicate that children randomly assigned to Family Connects had significantly less total emergency medical care (by 37%) through age 24 months, with results observed across almost all subgroups. Examination of billing records indicate a $3.17 decrease in total billing costs for each $1 in program costs. Overall, results suggest that community-wide postpartum support program can significantly reduce population rates of child emergency medical care through age 24 months while being cost-beneficial to communities.

Prevention science as an interdisciplinary specialty is addressed in this introduction to the special section of the journal. The six papers that comprise the special section are briefly summarised, especially noting the global regions that are represented, that is, Europe, Middle East, New Zealand and South America. Attention to the importance of differential adaptations of prevention interventions developed in one region, country or locale but implemented in another is emphasised. The Guest Editors reflect on the importance of developing cross-national collaborations to further the advance of prevention science globally.

Prevention science research has focused on early childhood and early school years, on the logic that addressing individual and contextual risk factors as early as possible would prevent the compounding of risk downstream. Methodological and technological advances have opened the door to an expanded exploration of risk, health promotion, and intervention in emerging adulthood and throughout the lifespan, but prevention science remains dominated by research on early childhood and adolescence. Articles in this special issue of Prevention Science showcase the use of new technologies to access young adult populations and to develop and deliver interventions as well as strategies to help account for developmental and cultural contexts in designing interventions. The issue represents an important step forward in applying the preventive research cycle to emerging adulthood, and it provides an opportunity to expand our horizons by building theories of development that are not tied solely to age progression.

The current field of prevention science boasts an increasing armamentarium of effective preventive interventions, reflecting the growing promise of the field. However, we have yet to achieve significant scale with the most efficacious interventions, limiting the potential impact of prevention on population and public health. Further, there is considerable evidence that the goals of scale and quality often seem to work in opposition; implementation quality and fidelity suffer as preventive interventions increase in scale, potentially diminishing returns. As prevention science continues to mature, the growing arena of implementation science has accelerated the pace at which these challenges are being addressed. We believe the field has entered an important new era, reflected by the growing number and sophistication of systems, tools, and processes aimed at increasing scalability without sacrificing high-quality implementation. Many researchers and research teams are working in isolation to address this important challenge. It is our hope that the pace of advancement can be increased by promoting a broader discussion across many researchers, practitioners, and policy makers. This special issue of the Journal of Primary Prevention, focusing on measurement and monitoring systems and frameworks for assessing implementation and adaptation of prevention programs, offers some empirical examples that demonstrate the growth and development of prevention and implementation science and practice, as these fields move us closer to scalable systems and practices in applied contexts. The collection of articles in this special issue reflect the diversity of contexts in which these challenges are being addressed and the important underlying questions that must be answered as preventive interventions seek scale with quality.

Optimising the implementation and roll-out of evidence-based programs to prevent risky health behaviours such as the use of psychoactive substances (herein referred to as substance use) depends greatly on existing prevention systems that are in place to support and sustain them over time. The field of substance-use prevention is at a pivotal point. The evolution of prevention science has demonstrated that interventions grounded in theories of human behaviour and learning are effective in not only achieving their short-term objectives such as changes in normative beliefs and intentions to use substances but also having a significant effect on substance-use outcomes and in some cases on other associated behaviours. Prevention science is concerned with how programmes or interventions can be developed, implemented, assessed and improved in terms of content and effectiveness; their internal validity, i.e. design, logic model and structure; their timing within the human life cycle; and their adequacy, relevance and feasibility for the target communities. These interventions are designed to impact human behaviour directly using manualised interventions that target individuals and groups through improving micro-level environments such as the relationship between parents and children or school teachers and students to increase prosocial attitudes and behaviours among youth, and through creating macro-level environments so as to provide social controls over harmful behaviours such as increasing taxes and thus prices of cigarettes or enforcing laws that limit access to tobacco or alcohol products such as altering where these products can be sold or imposing age restrictions on purchase and consumption.

Prevention science is inherently pragmatic. While many mechanisms may contribute to risk for substance use and abuse, we are most concerned with those that are malleable through practical means. Basic research is most often focused on whether some mechanism increases risk or protection, with little attention to whether and how that mechanism can be changed. Applied research emphasizes pragmatic malleability, testing theories of how to change such mechanisms, as a basis for designing effective prevention programs. In this chapter we introduce two applied research designs that hold promise for developing and testing pragmatic malleability relevant for the prevention of substance use and abuse: microtrials and idiographic designs. Microtrials are brief experiments testing whether focused environmental manipulations can alter specific risk or protective mechanisms. We discuss how microtrials can be expanded to test whether interventions alter these mechanisms more strongly for some people than others and evaluate their strengths and limitations for substance abuse research. Idiographic designs use intensive repeated assessments to track continuity and change in key risk or protective mechanisms. They can be integrated with experimental designs to test intervention impact on risk and protective mechanisms as well as substance-use outcomes. We discuss several useful variants and review recent advances in statistical methods for handling the complex datasets they produce. We conclude with a discussion of how microtrials and idiographic methods can be used to enhance current substance-abuse prevention programs and support the development of more effective next-generation prevention trials.

Substance misuse is a global phenomenon representing a major public health issue worldwide. Though the exact nature and patterning of the problem vary across countries there are striking similarities providing opportunities for thinking about substance misuse internationally. Similar risk and protective factors are seen in contrasting national contexts such as parenting practices and family relationships. Similarly, the short- and long-term health effects of substance misuse by young people manifest themselves across contrasting cultural and socio-economic settings. Whilst the development and effectiveness of prevention efforts vary widely, many countries have introduced prevention initiatives aimed at young people that address known risk and protective factors. School- and family-based interventions are common in many parts of the world for instance. At their best such efforts comprise well-theorised interventions with clear mechanisms of action operating within broader prevention systems which support intervention development, evaluation and long-term implementation. But there is considerable variation in the development of prevention systems, particularly when comparing high- and low/middle-income nations. Two key aspects of the development of international research and collaboration within the field of prevention science are discussed: first why international embrace of prevention science is important and the ways in which it contributes to the development of the field; and second some of the major challenges to building international research including the varying capacity of prevention systems, the complexities of working across geographical and cultural borders, the questions raised when interventions are transported to new settings and the appropriateness of undertaking cultural adaptations. The chapter describes some of the current strategies and initiatives which seek to address these challenges to build an international prevention science.