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This study examines the cost effectiveness of two interventions for disruptive behavior problems: First Step Next (FSN), a school-based intervention, and a multicomponent intervention that combined FSN with a home-based intervention, homeBase (hB). Analyses were based on findings from a large-scale comparative efficacy trial in the United States (Frey et al., 2022). Intervention costs were estimated using an activities-based ingredients method (Levin & McEwan, 2001). For each disruptive behavior examined (attention-deficit/hyperactivity disorder [ADHD], conduct disorder [CD], and comorbid ADHD and CD), we defined intervention response as movement from the clinical range into the borderline or normative range or from the borderline range into the normative range at post-intervention. Comparative cost-effectiveness analyses involved calculating incremental cost-effectiveness ratios (ICERs), which showed that the combined intervention was always more cost effective. Improvement in comorbid ADHD and CD was the costliest to achieve, followed by CD, and then ADHD. Sensitivity analyses showed that FSN + hB had a high probability of being cost effective across a range of estimates, indicating stakeholder willingness to pay to reduce disruptive behavior problems. This study expands the literature by estimating the costs of implementing a school-based intervention alone or alongside a home-based intervention with elementary students and comparing their cost effectiveness.

Embedded pragmatic clinical trials (ePCTs) and quality improvement (QI) activities often occur simultaneously within healthcare systems (HCSs). Embedded PCTs within HCSs are conducted to test interventions and provide evidence that may impact public health, health system operations, and quality of care. They are larger and more broadly generalizable than QI initiatives, and may generate what is considered high-quality evidence for potential use in care and clinical practice guidelines. QI initiatives often co-occur with ePCTs and address the same high-impact health questions, and this co-occurrence may dilute or confound the ability to detect change as a result of the ePCT intervention. During the design, pilot, and conduct phases of the large-scale NIH Collaboratory Demonstration ePCTs, many QI initiatives occurred at the same time within the HCSs. Although the challenges varied across the projects, some common, generalizable strategies and solutions emerged, and we share these as case studies. KEY LESSONS: Study teams often need to monitor, adapt, and respond to QI during design and the course of the trial. Routine collaboration between ePCT researchers and health systems stakeholders throughout the trial can help ensure research and QI are optimally aligned to support high-quality patient-centered care.

Rural adolescents are at risk for firearm-related injury and death. In response, professional organizations have called for communication between adolescents, parents, and providers about firearms. A shared understanding of firearms between providers and families can facilitate effectiveness of health interventions. However, few studies engage adolescents in identifying their perception of common firearm terminology. The current study aimed to understand how adolescents in rural communities defined firearm-related terms including firearm, carrying, and handling, and differences in terms based on prior firearm training. Data were from a mixed methods community-based participatory study of 93 adolescents from rural Washington state. Thematic qualitative coding identified themes for firearm (gun, weapon, projectile, and tool), carrying (on you/your person, transportation, and holding), and handling (actively using, safe use, and holding) and differences between those with prior firearms training. Findings provide insight into perceptions of firearm-related terms for adolescents, an often-neglected voice, and inform rural policy and prevention efforts. [ABSTRACT FROM AUTHOR]

Purpose : Few cost-effectiveness studies have been conducted on social-emotional interventions for students in preschool settings. The current study is a cost-effectiveness analysis of the First Step Next (FSN) intervention for preschool students. Method : Our approach involved a secondary analysis of a randomized control trial that utilized the ingredients method to estimate costs (Levin & McEwan, 2001). In addition, effect sizes were used to generate incremental cost-effectiveness ratios representing the cost of improving student outcomes by one standard deviation (1 SD). Results : FSN was more cost-effective for improving behavior in the school setting than in the home setting, with an average cost per 1 SD improvement of $3,833 and $6,329, respectively. Additionally, the intervention had greater cost-effectiveness for social skill-related outcomes than problem behavior-related outcomes among preschool students. Discussion : This study advances our understanding of the costs and outcomes of practices designed to improve the school success of our youngest learners. [ABSTRACT FROM AUTHOR]

Background and aims: For young adults, the disruptions brought by the COVID‐19 pandemic to work, social relationships and health‐care probably impacted normative life stage transitions. Disaster research shows that negative effects of these events can persist for years after the acute crisis ends. Pandemic‐related disruptions may have been especially consequential for young adults with a history of substance use disorder (SUD). The current work aimed to measure the broad impact of the COVID‐19 pandemic on young adults with and without a history of SUD. Design, setting and participants: Data were from a longitudinal panel of n = 4407 young adults across the United States surveyed repeatedly from 2014 to 2019 (aged 19–26 years, pre‐pandemic) and again in 2021 (aged 28 years, mid‐pandemic). Measurements: We fitted multi‐level models to understand the association between SUD history and pandemic outcomes, controlling for potential confounders (socio‐demographic and health measures). Outcomes included overall life disruption; mental health, social and economic impacts; substance use; and physical health. Findings Young adults with a history of SUD reported greater life disruption (standardized β = 0.13–0.15, Ps < 0.015) and negative mental health impacts (standardized β = 0.12–0.14, Ps < 0.012), experienced approximately 20% more work‐related stressors (relative risks = 1.18–1.22, Ps < 0.002) and 50% more home‐related stressors (relative risks = 1.40–1.51, Ps < 0.001), and had two to three times the odds of increased substance use during the pandemic (odds ratios = 2.07–3.23, Ps < 0.001). Findings generally did not differ between those with a recent SUD diagnosis and those in recovery from SUD before the pandemic began. Conclusions: United States young adults with a history of substance use disorder (SUD) reported more life disruption and greater negative physical and mental health, social and economic impacts during the COVID mid‐pandemic period than young adults with no history of SUD. [ABSTRACT FROM AUTHOR]

Purpose: Alcohol use and handgun carrying are more prevalent among youth in rural than urban areas and their association may be stronger among rural adolescents. Alcohol use may be modifiable with implications for reducing handgun carrying and firearm‐related harm. We examined the association between lagged alcohol use and subsequent handgun carrying in rural areas and examined variation in the association by developmental stages, hypothesizing that it would be stronger among adolescents than youth adults. Methods: We used a longitudinal sample of 2,002 adolescents from ages 12 to 26 growing up in 12 rural communities in 7 states with surveys collected from 2004 to 2019. We estimated the association of lagged past‐month alcohol use on handgun carrying in the subsequent 12 months using population‐average generalized estimating equations with logistic regression on multiply imputed data. Findings: During adolescence (ages 12‐18), those who drank heavily had 1.43 times the odds (95% CI = [1.01, 2.03]) of subsequent handgun carrying compared to those who did not drink alcohol, and those who consumed alcohol but did not drink heavily had 1.30 times the odds of subsequent handgun carrying compared to those who did not drink (95% CI = [0.98, 1.71]). During young adulthood (ages 19‐26), associations of alcohol use (OR = 1.28; 95% CI = [0.94, 1.63]) and heavy drinking (OR = 1.38; 95% CI = [1.08, 1.68]) were similar to adolescence. Conclusions: Alcohol use and subsequent handgun carrying were positively associated during adolescence and young adulthood among individuals who grew up in rural areas, similar to findings in urban areas. Reducing alcohol use may be an important strategy to prevent handgun carrying and firearm‐related harm among young people in rural areas. [ABSTRACT FROM AUTHOR]