Prevention Science[JOURNAL]
Sun
200 papers
Disparities in Pediatric Firearm Injury Care: A Comparison of Chronic Illness Pathways.
Gastineau K, Murry V, Fetuga R … +3 more , Carro S, Williams R, Mehari KR
Prev Sci · 2026 Jan · PMID 41483320 · Publisher ↗
Pediatric firearm injuries represent a leading cause of morbidity and mortality in the USA, yet clinical care models for youth with firearm injuries remain fragmented and unstandardized. Unlike other serious pediatric co...
Pediatric firearm injuries represent a leading cause of morbidity and mortality in the USA, yet clinical care models for youth with firearm injuries remain fragmented and unstandardized. Unlike other serious pediatric conditions such as asthma and cancer, which benefit from established interdisciplinary care pathways, firearm injuries are often treated as isolated events without structured follow-up or coordinated support systems. This absence of standardized clinical guidelines reflects broader systemic biases in how these injuries are perceived and managed within health care. Drawing on the Injury Equity Framework and established chronic disease management models, we propose comprehensive, trauma-informed clinical guidelines for pediatric firearm injury care spanning primary, secondary, and tertiary prevention. These guidelines emphasize universal firearm safety screening integrated into routine pediatric visits, standardized protocols for acute trauma care with automatic interdisciplinary team activation, and structured longitudinal follow-up addressing medical, behavioral health, and social needs. By comparing current fragmented approaches to evidence-based care pathways used in asthma and cancer management, we identify critical gaps in continuity and comprehensiveness of firearm injury care and offer specific, actionable recommendations to close these gaps.
Youth Participatory Action Research (YPAR) in Action: a Case Study of Addressing Youth Violence and Social Inequities in New Orleans.
Lugo MA, Stevenson R, DaViera AL … +7 more , Ocasio MA, Craft T, Lewis J, Fujisaki A, Fleckman J, Theall KP, Francois S
Prev Sci · 2025 Dec · PMID 41454210 · Publisher ↗
Black youth in New Orleans experience some of the highest rates of violence in the US. Although Youth Participatory Action Research (YPAR) is recognized as an effective tool for empowering young people and fostering soci...
Black youth in New Orleans experience some of the highest rates of violence in the US. Although Youth Participatory Action Research (YPAR) is recognized as an effective tool for empowering young people and fostering social change, its application in violence prevention remains an area worthy of further application. This case study presents a YPAR-based program designed to address structural issues, including racism, discrimination, and economic disinvestment, that contribute to youth violence. The Enrichment to Empowerment (E2E) program provides a platform for youth to advocate for systemic change in their communities. This paper offers actionable insights into equity-centered approaches for violence prevention, highlighting the potential for YPAR programs as a strategy for addressing complex, community-driven issues through youth-led initiatives.
Improving Community-Based Care for Adolescents with ADHD: a Randomized Controlled Trial of Artificial Intelligence-Assisted Fidelity Supports.
Sibley MH, Bickman L, Atkins D … +9 more , Coxe S, King J, Tanana M, Martin P, Page TF, Ortiz M, Tapia J, Sparber A, Zhao X
Prev Sci · 2025 Dec · PMID 41436907 · Publisher ↗
Cognitive-behavioral treatments (CBTs) for adolescents with ADHD demonstrate promise of long-term effects on outcome. However, their implementation in routine care community clinics faces barriers that impact quantity, e...
Cognitive-behavioral treatments (CBTs) for adolescents with ADHD demonstrate promise of long-term effects on outcome. However, their implementation in routine care community clinics faces barriers that impact quantity, efficiency, and quality of delivery, as well as client outcomes. This study is a randomized controlled trial designed to evaluate the impact of an AI-assisted service delivery model on therapist implementation of Supporting Teens' Autonomy Daily (STAND), a CBT blended with Motivational Interviewing (MI) for adolescents with ADHD. Adolescents with ADHD (N = 51), who were clients at three community mental health agencies, received treatment from 23 therapists. There was randomization of adolescents and therapists to AI-assisted or standard implementation supports. In addition to standard supports (i.e., training, standard facilitation resources, technical assistance, case supervision), AI-assisted support package included digitized facilitation resources housed in a clinical dashboard (Care4), feedback on content fidelity, and AI-generated feedback on MI implementation quality. The AI-assisted group was associated with more efficient treatment delivery and lower number of appointments attended by the adolescent. There was also a significant decrement in MI quality over time in the AI-assisted group compared to the standard support group. Feedback in focus groups indicated that therapists perceived a task-oriented mindset to be associated with receipt of the AI-assisted support package, leading therapists to prioritize efficiency over relational aspects of therapy. Following the results of this trial, a future, larger RCT should examine the impact of the AI-assisted implementation model on mental health outcomes and cost savings to organizations, third party payers, and clients. Trial registration number: NCT05135065; https://www.clinicaltrials.gov ; Registered September 2021.
Effects of a First Grade Classroom Preventive Intervention on Parenting Behaviors 30 Years Later.
Musci RJ, Klein LM, Raghunathan RS … +4 more , Chambers-Thomas T, Ialongo NS, Voegtline KM, Johnson SB
Prev Sci · 2025 Dec · PMID 41366618 · Full text
Effective early school-based prevention programs can shift behavioral outcomes, not just across the life course, but across generations; however, few studies have sufficient follow-up to test this. Here, we assess the im...
Effective early school-based prevention programs can shift behavioral outcomes, not just across the life course, but across generations; however, few studies have sufficient follow-up to test this. Here, we assess the impact of an early preventive intervention on later parenting practices. Participants were part of a randomized trial of two elementary school prevention programs to prevent aggressive and disruptive behavior in first grade, who were followed into adulthood. Participants who became parents (52%) participated in additional data collection about parenting at ages ~ 31-34. Results generally suggest null findings between elementary school-based prevention programming and parenting in adulthood. However, females who received a classroom-based intervention had significantly higher levels of constructive parenting as compared to females in the control condition. These findings suggest that the benefits of early prevention programming may accrue across multiple generations.
Being Mindful About Overuse of Total Scores: a Comparison of Total Scores and Moderated Nonlinear Factor Analysis Scores in Assessing Mindfulness Across Race/Ethnicity, Age, and PTSD Diagnosis.
Lozano A, Saavedra LM, Bautista TG … +3 more , Sanchez M, Morgan-López AA, Amaro H
Prev Sci · 2025 Dec · PMID 41361140 · Full text
Although mindfulness-based interventions show initial positive results on a range of substance use behaviors, evaluations of mindfulness-based interventions would benefit from state-of-the-art alternative approaches to t...
Although mindfulness-based interventions show initial positive results on a range of substance use behaviors, evaluations of mindfulness-based interventions would benefit from state-of-the-art alternative approaches to the ubiquitous use of sum or total scores. Sum scores do not reflect "true" underlying mindfulness as they do not consider differences in the relative weight of each item and/or the possibility that measurement may differ across groups. The purpose of this study was to identify measurement noninvariance/differential item functioning (MNI/DIF) across racial and ethnic groups, age groups, and those with PTSD diagnoses and differences in inferences on the factors of the Five Facet Mindfulness Questionnaire between scale scores estimated using moderated nonlinear factor analysis (MNLFA) and a total score analog model (TSA). Age, PTSD diagnosis, non-Hispanic Black race/ethnicity, Hispanic race/ethnicity, and other race/ethnicity showed statistically significant MNI/DIF. In the MNLFA model, PTSD diagnosis and Hispanic race/ethnicity contributed to significant MNI/DIF on the "true" acting with awareness, describing, and observing latent factors such that Hispanic participants were higher on average on acting with awareness scores and lower on average on describing and observing scores. The TSA model failed to estimate significant differences on acting with awareness score for participants with PTSD diagnosis. Additionally, in the TSA model, there was an increase in the effect size of Hispanic participants' baseline describing and observing estimates, thus overestimating differences in respective scores for Hispanic participants. Failing to correct for MNI/DIF in mindfulness scale scores can impact inferences and effect sizes for group differences in mindfulness thus creating bias in characterizing mindfulness, particularly for Hispanic individuals and those with PTSD diagnoses.
Disrupting Racial Dehumanization As a Root Cause of Youth Violence Through Community Engaged Visual Storytelling and Narrative Change.
Smith Lee JR, Walker IA, Tillery DM … +2 more , Allette Z, Lee Z
Prev Sci · 2025 Dec · PMID 41343132 · Publisher ↗
In 2020, firearm violence became the leading cause of death for American children and teens, a critical datapoint informing the 2024 U.S. Surgeon General's advisory on firearm violence. However, firearm violence has been...
In 2020, firearm violence became the leading cause of death for American children and teens, a critical datapoint informing the 2024 U.S. Surgeon General's advisory on firearm violence. However, firearm violence has been a leading cause of death for Black youth-particularly, Black males-for decades, disproportionately impacting their morbidity and mortality. As the rights of Black youth to experience safety from firearm violence converge with the interests of white youth now increasingly impacted by it, it is imperative that prevention scientists critically interrogate what contributes to the national willfulness to see Black youth as perpetrators of violence deserving of punishment and a national reluctance to see Black youth as victims of violence deserving of healing and prevention? Guided by the Cycle of Dehumanization framework, we contend this pattern is symptomatic of racial dehumanization, a root cause of structural racism and violence. We argue that to successfully prevent youth firearm violence using a structural approach, we must disrupt dehumanizing narratives about Black male criminality and offer a viable solution through our visual storytelling and narrative change campaign, In All Ways Human. Using an adapted community engaged participatory action research approach and qualitative interviewing, our multimodal narrative change project captured 50 strategically disseminated (mural, billboards, kiosks, exhibits, digital galleries) portraits and stories that construct a counter-narrative with the power to prevent youth violence by transforming the ways in which Black males are seen, see one another, and see themselves. The impact and future directions of our narrative change effort are discussed.
Parental Emotional Socialization and Child Mental Health After a Military Parenting Program: A Baseline Target Moderated Mediation Model.
Cai Q, Li L, Gewirtz AH
Prev Sci · 2025 Dec · PMID 41339978 · Full text
Parental emotional socialization (PES) has been recognized as a critical mechanism in parenting programs to enhance children's well-being, especially following adversity. However, few studies have examined the potential...
Parental emotional socialization (PES) has been recognized as a critical mechanism in parenting programs to enhance children's well-being, especially following adversity. However, few studies have examined the potential moderating effect of baseline PES levels. This study aimed to examine whether supportive and unsupportive PES can mediate the intervention effects of a parenting program on child adjustment (Aim 1), and whether baseline PES can moderate the effect (Aim 2). This study utilized data from two randomized controlled trials for post-deployed military families (N = 335, Mage = 8.25, 54% girls). Families were either assigned to in-person intervention condition (n = 226) or a treatment-as-usual condition (n = 109). Baseline-targeted moderation mediation (BTMM) models were conducted for mothers and fathers separately, with child age, child sex, child minority status, family household income, and deployment length included as covariates. The parenting program had an indirect effect on child internalizing and externalizing problems 1-year post-baseline through reduced maternal unsupportive PES at post-intervention, while no indirect effect was found through supportive PES. Additionally, baseline PES moderated the impact of the ADAPT program on maternal supportive and unsupportive PES post-intervention, such that mothers who reported less supportive PES or more unsupportive PES at baseline benefited more. No intervention effect was found through fathers' PES. The findings underscore the crucial role of baseline PES in shaping behavioral parenting intervention effectiveness. The study highlights that one size does not fit all and future research and practice should consider the diverse needs and responses of families, emphasizing the delivery of personalized interventions to best meet parents' needs and maximize support.
Effects of State Paid Family Leave Policies on Preventing Household Adverse Childhood Experiences (ACEs) in Early Childhood in the United States, 2011-2019.
Perrins SP, Sheremenko G, King J … +6 more , Godoy-Garraza L, Cincotta K, Miedema S, Cremer L, D'Inverno AS, Harper CR
Prev Sci · 2025 Dec · PMID 41326895 · Full text
Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that can predict a wide range of short- and long-term negative health outcomes. More research is needed on policies that may reduce ACEs....
Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that can predict a wide range of short- and long-term negative health outcomes. More research is needed on policies that may reduce ACEs. Paid Family Leave (PFL) is a state-level policy that provides economic support for employees to care for a newborn or a recently adopted child. This study evaluated effects of PFL on reduction in household challenge ACEs. To investigate whether PFL implementation reduced the occurrence of household challenge ACEs among young children in Rhode Island and New York relative to other states without PFL implementation. This study used 2011-2019 population-based National Survey of Children's Health (NSCH) data to compare the proportion of household challenge ACEs experienced in intervention versus control states. Bayesian Additive Regression Tree (BART) and two-way fixed effects (TWFE) methods estimated post-intervention average treatment effects. United States (U.S.) Census covariates controlled for variation between states. Placebo checks bolstered the robustness of inference. Rhode Island and New York (intervention states) implemented PFL in 2014 and 2018, respectively. Control states included states that did not implement PFL as of 2019. The NSCH surveys included a 9-item ACEs questionnaire in which caregivers reported on whether their children ages 0-2 experienced various forms of abuse, and potentially traumatic household challenges (i.e., caregiver divorce, domestic violence, caregiver incarceration, caregiver mental health problems, caregiver substance use). This study focused on five household challenge ACEs and the occurrence of any household challenge ACE as primary outcomes. A treatment indicator identified intervention and control states. State-level covariates were median household income, unemployment rate, and percent uninsured. Results suggest that PFL implementation was associated with significant 4% reduction in caregiver separation and 2% reduction in caregiver incarceration ACEs in the intervention states post-PFL adoption and a significant 4% reduction in the proportion of young children experiencing any household challenge ACE relative to no PFL implementation in control states. This study adds rigorous scientific support for the public health benefits of PFL for young children and their families. Existing evidence indicates caregiver incarceration and separation may affect children's short- and long-term mental health, substance use, and school related outcomes. Support through PFL may help reduce the occurrence of household challenge ACEs and promote children's well-being.
State-level analysis of mental health disparities between White, Black, and Hispanic populations before and after COVID-19.
Duke H, Ogletree AM
Prev Sci · 2025 Dec · PMID 41324832 · Publisher ↗
The COVID-19 pandemic had disparate impacts on Black and Hispanic Americans, as observed in mortality and infection rates. The mental health impact of the pandemic is less clear, with little research exploring mental hea...
The COVID-19 pandemic had disparate impacts on Black and Hispanic Americans, as observed in mortality and infection rates. The mental health impact of the pandemic is less clear, with little research exploring mental health disparities and differences by state and region. Using the Behavioral Risk Factor Surveillance System (BRFSS), state-level differences in unhealthy mental health days were examined between 2019 and 2021 for White, Black, and Hispanic respondents. Nonparametric tests assessed group differences in unhealthy mental health days, while state-level within- and between-group difference scores highlighted areas with the greatest disparities. Both White and Black respondents experienced significantly more unhealthy mental health days in 2021 than in 2019; though Hispanic respondents reported more unhealthy days in 2021 than in 2019, this finding was not statistically significant. Black respondents, but not Hispanic, reported significantly more unhealthy mental health days than White respondents in 2021. Missouri had the worst outcomes for Black respondents, with the greatest increase in unhealthy mental health days between 2019 and 2021 and the greatest difference between White and Black groups in 2021. Regionally, the Northeast had the best outcomes for Black respondents and the Midwest had the worst. These findings can help identify population groups and geographic areas most in need of disaster-preparedness efforts and policy interventions for future public health emergencies. Practitioners and state health officials can use these findings to identify potentially impactful community interventions, or to develop infrastructure for addressing community mental health.
Three-Way Decomposition for Applied Health Equity Research: A Practical Tutorial to Understand and Address Inequalities.
Kim JH, Kim MH, Lee W
Prev Sci · 2025 Dec · PMID 41307864 · Publisher ↗
Mediation analysis is essential for understanding causal mechanisms and designing effective policy interventions. This paper explains a comprehensive framework for implementing VanderWeele's (2009) three-way decompositio...
Mediation analysis is essential for understanding causal mechanisms and designing effective policy interventions. This paper explains a comprehensive framework for implementing VanderWeele's (2009) three-way decomposition using natural effect models (NEM), focusing on its application in health equity research. While three-way decomposition helps social epidemiologists understand how social exposures influence health outcomes through differential mediator effects, its implementation through NEM has not been fully utilized. Using the R package medflex to implement NEM, we demonstrate the methodology through two case analyses: healthcare expenditure disparities between Medicaid beneficiaries and health insurance enrollees using continuous outcomes, and racial/ethnic disparities in preterm birth using binary outcomes. We provide detailed interpretations of NEM estimates in terms of three-way decomposition and discuss methodological considerations for researchers designing health policies to reduce disparities.
Interventions to Address Racism in Disciplinary Actions in K-12 Schools: A Systematic Review.
Scott BA, Stilwell SM, Pearson ZV … +3 more , Zimmerman MA, Hsieh HF, Heinze J
Prev Sci · 2025 Nov · PMID 41273609 · Full text
Students of color are disciplined for behavioral infractions at higher rates than white students in K-12 schools in the USA. The consequences of racism in K-12 schools include mental health problems, school dropout, and...
Students of color are disciplined for behavioral infractions at higher rates than white students in K-12 schools in the USA. The consequences of racism in K-12 schools include mental health problems, school dropout, and disproportionate disciplinary practices, leading to the school-to-prison pipeline. Many school personnel implement interventions to address student behavior rather than racism and other implicit biases. Furthermore, culturally relevant practices are imperative to address the root causes of racial disparities in student discipline. For these reasons, a systematic and comprehensive review of the published literature on school-based interventions in the USA (including public and private K-12 schools) was conducted to identify interventions to remedy racial disparities in school discipline, as well as the research designs used to test their efficacy. The final sample includes 48 studies that directly or indirectly attempt to address the race discipline gap. There were only three studies that reduced race disparities in school discipline with a culturally relevant intervention. Future researchers may consider the importance of the school's cultural context and intervention audience when developing and testing efforts to reduce racial disproportionality.
Suicide Risks Among U.S. College Students: a Time-Series Cross-Sectional Study Examining Institutional Characteristics and Behavioral Factors.
Deng L, Lee C, Lee S … +2 more , Ding Y, Newman G
Prev Sci · 2025 Dec · PMID 41266904 · Full text
Suicide has become the second leading cause of death among U.S. college students, exacerbated by COVID-19. A more comprehensive understanding of its risk factors can guide the development of effective prevention strategi...
Suicide has become the second leading cause of death among U.S. college students, exacerbated by COVID-19. A more comprehensive understanding of its risk factors can guide the development of effective prevention strategies tailored to this population. We employed a time-series cross-sectional approach and used the national survey data from the American College Health Association to examine the effects of institutional characteristics (school locale, region, size, and type) and behavioral factors (physical and social activities) on suicide risks among U.S. college students across different pandemic phases (before, early phase, and late phase). We also tested whether behavioral factors moderated the association between the pandemic period and suicide risk. After adjusting for confounders, multilevel regression results showed that (1) suicide risk increased during the pandemic, particularly in the late phase; (2) institutional characteristics, including geographic region and religious affiliation, as well as student behaviors such as physical and social activities, were significant predictors of suicide risks; and (3) behavioral factors moderated the pandemic's effect on suicide risk, as shown by the role of social activities (e.g., team sports, socializing with friends) amplifying the effect, whereas spending time with family mitigated it. Because risk rose fastest where certain social activities intensified pandemic effects, campuses should prioritize structured, lower-risk social engagement, while pairing selective strategies in high-activity settings (e.g., targeted screening, gatekeeper training) with universal measures (e.g., campus-wide suicide prevention program). Overall, this study offers evidence-informed guidance to shape campus environments that mitigate suicide risk and support student well-being, considering institutional context, behavioral factors, and public health crises.
Adapting a Youth Sexual Violence Prevention Logic Model and Evaluation to Asian American and Pacific Islander Youth in Iowa: a Case Study.
Yusef M, Bailly K, Lu B … +5 more , Haines H, Sursely A, Goedken ML, Beltran R, Afifi RA
Prev Sci · 2025 Nov · PMID 41261313 · Publisher ↗
Asian American and Pacific Islanders (AAPI) youth report a high prevalence rate of youth violence. Logic models that guide violence prevention programming are often not culturally specific and may not address the unique...
Asian American and Pacific Islanders (AAPI) youth report a high prevalence rate of youth violence. Logic models that guide violence prevention programming are often not culturally specific and may not address the unique structural/social drivers of youth violence in minoritized communities. Monsoon has received Rape Prevention and Education (RPE) funding from the Iowa Department of Health and Human Services (Iowa HHS) since 2007 through a competitive application process. The specific aim of Monsoon's Youth Sexual Violence Prevention Program (YVPP) is to "prevent gender-based violence by educating and empowering peers through outreach and workshops." In response to growing awareness at Iowa HHS about the limitations of the State RPE programmatic logic model in addressing AAPI-specific context for youth violence, Monsoon received additional RPE funds to establish the first culturally specific RPE logic model in Iowa. This initiative aims to fill a gap in culturally relevant evaluation resources. This paper describes the academic-community partnership initiated in 2023 that guided the participatory development of the culturally specific logic model and evaluation plan, for youth violence prevention in AAPI communities. Monsoon partnered with staff and faculty from the Center for Disease Control and Prevention (CDC)-funded Prevention Research Center for Rural Health (PRC-RH) in this work. PRC-RH faculty and staff reviewed documents and interviewed Monsoon leaders and youth staff. An AAPI-specific youth staff logic model and evaluation research questions were developed using a community-based research approach. Based on these, a mixed-methods evaluation plan was outlined. This case study highlights the critical importance of community-engaged research and practice to develop culturally specific logic models and evaluation designs for youth sexual violence prevention in the AAPI community.
Image-Based Sexual Abuse: Characteristics Linked to Different Reasons Why Youth Decide Not to Disclose.
Mitchell KJ, Jones LM, Gewirtz-Meydan A … +2 more , O'Brien J, Colburn D
Prev Sci · 2025 Dec · PMID 41239180 · Full text
Image-based sexual abuse is an increasingly prevalent form of technology-facilitated harm, yet disclosure rates remain low. Understanding why youth do not disclose image-based sexual abuse is critical for developing effe...
Image-based sexual abuse is an increasingly prevalent form of technology-facilitated harm, yet disclosure rates remain low. Understanding why youth do not disclose image-based sexual abuse is critical for developing effective prevention and intervention strategies. This paper examined the reasons youth do not disclose image-based sexual abuse incidents and identified incident- and person-level characteristics associated with different nondisclosure motives. Participants were recruited online to this US-based cross-sectional study between June 28, 2023, and April 1, 2024, using social media advertisements targeting individuals aged 18-28. A total of 6204 individuals completed the survey; 2854 (46.0%) reported experiencing image-based sexual abuse before age 18. The analytic sample included 2522 incidents reported by 1551 participants that were not disclosed. The most frequently cited reasons for nondisclosure were fear of getting in trouble with family (53.9%), embarrassment (52.9%), and the belief that they could handle the incident alone (45.2%). Reasons varied by image-based sexual abuse subtype. Longer incident duration and explicit content were related to fear of getting into trouble with their family or the police, and having multiple people responsible was related to many reasons for nondisclosure (i.e., fear of getting in trouble, fear the person would find out, embarrassment, and feeling like no one could help) ,. Female participants and sexual/gender minority youth were more likely to report barriers specific to fear and shame. Prior victimization was associated with a greater belief that no one could help and fear of getting in trouble or the person finding out. Prevention should address common fears, challenge stigma and self-blame, and ensure youth have access to trusted adults and non-punitive disclosure options. These findings support clinical efforts to reduce barriers and promote safe disclosure pathways for these survivors.
Adapting Intervention Mapping to Improve Patient-Centeredness of Mental Health Services.
Domlyn AM, Dedert E, Wilson SM
Prev Sci · 2025 Dec · PMID 41219544 · Publisher ↗
Addressing socio-demographic differences that affect mental health service encounters is crucial for ethical practice and enhancing therapeutic alliances. Yet discussing personal perceptions of socio-demographic influenc...
Addressing socio-demographic differences that affect mental health service encounters is crucial for ethical practice and enhancing therapeutic alliances. Yet discussing personal perceptions of socio-demographic influences within a large healthcare system can be challenging due to discomfort among staff and the need for engagement at both interpersonal and organizational levels. The SITE project sought to intervene on one healthcare system's mental health providers' willingness to discuss patient background during care coordination. An internal workgroup used intervention mapping enhanced with frameworks from socio-demographic-focused literature and implementation science. Data collection included surveys, interviews, and a participatory consensus process. The results were two multi-component intervention packages designed to address interpersonal and organizational barriers, each targeting providers' willingness and psychological safety in addressing patient-specific background factors with colleagues. The interventions were adopted by the setting and then later dissolved due to administrative shifts. While the resultant interventions are unique to this setting, we demonstrate a repeatable process for adapting a well-known intervention development method (intervention mapping (IM)) informed by theory and implementation science. This process can be applied in other healthcare systems for discerning multi-level interventions appropriate to different contexts.
Modifications of a Parenting Program in the Context of Scaling-Up and Scaling-Out: Documenting Furaha Teens in Tanzania Using FRAME.
Shenderovich Y, Martin M, Lachman JM … +3 more , Mgunga S, Ndyetabura E, Wamoyi J
Prev Sci · 2025 Nov · PMID 41165964 · Full text
Program adaptations or modifications are often necessary to suit local contexts, populations, and resources available. Despite the frequency with which program modifications are made in practice, they are rarely systemat...
Program adaptations or modifications are often necessary to suit local contexts, populations, and resources available. Despite the frequency with which program modifications are made in practice, they are rarely systematically recorded and reported comprehensively, particularly in the context of scale-up delivery led by implementers and in low- and middle-income countries. We use the FRAME framework to document the modifications of a parenting program called Parenting for Lifelong Health for Parents and Adolescents, locally known as Furaha Teens, which was delivered to over 30,000 families in Tanzania in 2020-2021. We draw on thematic analysis of 12 focus groups and 67 semi-structured interviews with program facilitators, coaches, coordinators, and managers (164 participants). Both proactive and reactive modifications were made to the program context and content. Proactive modifications included delivering the program as part of a wider package of services for families with adolescent girls, focused on HIV prevention, and adding HIV-related content. Both proactive and reactive modifications were made to make the material more acceptable to participants, such as by translating into local languages. Modifications to condense the number and frequency of sessions were reactively made by implementers to meet delivery timelines, particularly due to COVID-related closures. Study findings suggest that a range of program modifications may be required to scale programs to large cohorts as well as new contexts. To ensure successful delivery at scale, funders can support implementers in learning from the modifications and encouraging reflection on whether and how modifications affect program fidelity.
Beyond Clicks: A Systematic Review of How Engagement is Defined, Predicted, and Linked to Child Outcomes in Self-directed eHealth Preventive Parenting Programs.
Kuckertz MJ, Kim JJ, Nandiwada-Hofer VM … +5 more , Basha SAJ, Kasim A, Karpel L, Georgeson AR, Gonzales NA
Prev Sci · 2025 Nov · PMID 41144144 · Full text
Preventive parenting programs effectively promote positive parenting behaviors and prevent negative child behavioral health outcomes, but engagement is often low. Self-directed eHealth interventions are increasingly avai...
Preventive parenting programs effectively promote positive parenting behaviors and prevent negative child behavioral health outcomes, but engagement is often low. Self-directed eHealth interventions are increasingly available as an option that offers flexibility and increased access for parents. Yet, reports of and operationalizations of engagement within self-directed programs vary and correlates of eHealth engagement are not well understood. Thus, this study systematically reviewed reports to identify common operationalizations of engagement in self-directed preventive eHealth parenting programs, predictors of engagement, and associations between engagement and child behavioral health outcomes. Of 835 records screened, 31 unique studies had caregivers that participated in a self-directed eHealth preventive parenting programs that defined engagement or program adherence. Most studies reported the number of modules completed as a measure of parent engagement. About one-third of programs also reported frequency of parent program access. There was great variability in variables examined as correlates of eHealth program engagement, limiting the ability to draw consistent patterns of predictors of engagement. Evidence linking engagement to youth mental and behavioral health outcomes was similarly limited. Although module or session completion was the most common metric, studies varied in how engagement was further defined and applied. This heterogeneity poses challenges for comparing engagement rates across studies, but individual studies provide emerging evidence of potential ways to increase engagement within self-directed programs (e.g., phone coaching, ordering of content). Overall, this review underscores the need for further research as eHealth interventions continue to be offered to parents.
Development and Validation of an Electronic Health Record-Derived Prediction Model for Preventing COVID-19 Hospitalization and Death.
Coley RY, Hays R, Pardee RE … +10 more , Fuller S, Rogers K, Allen CL, Arterburn DE, Frazier RK, Kent DJ, Mun S, Mwatha T, Thottingal P, Westbrook EO
Prev Sci · 2025 Oct · PMID 41111097 · Publisher ↗
Hospitalization and death following COVID-19 infection continue to pose a major public health concern and place strain on health system resources. Outpatient antiviral medication can reduce the risk of COVID-19 hospitali...
Hospitalization and death following COVID-19 infection continue to pose a major public health concern and place strain on health system resources. Outpatient antiviral medication can reduce the risk of COVID-19 hospitalization and death for those at risk of poor outcomes, but identifying high-risk populations who may benefit most from treatment is challenging. The objective of this study was to develop and validate a prediction model for the composite outcome of hospitalization or death in the 14 days following COVID-19 infection. Our sample included 67,530 COVID-19 infections documented in outpatient care and occurring between April 1, 2020, and November 1, 2022, for 64,529 Kaiser Permanente Washington patients who did not receive outpatient antiviral treatment; 1378 (2.0%) of these infections resulted in hospitalization or death. Our prediction model, estimated using logistic regression with LASSO variable selection and ridge penalization, included 19 risk factors and showed high performance, including an area under the curve of 0.825 (95% confidence interval 0.813-0.836). Among the 10% of infections with the highest risk predictions, the true positive rate was 48% (46-51%) and the positive predictive value was 9.9% (9.2-10.6%). Supplemental analyses confirmed strong model performance across racial and ethnic subgroups and over time. We also present our process for selecting a risk threshold above which to recommend antiviral treatment and discuss considerations for prospective clinical implementation. This project demonstrates that machine learning tools can be used by health systems to deliver timely, targeted secondary prevention to reduce the risk of serious illness or death.
Addressing Suicide and Mental Health Through Universal Childhood Intervention: Results from The Seattle Social Development Project.
Hill KG, Steeger CM, Epstein M … +2 more , Bailey JA, Hawkins JD
Prev Sci · 2025 Nov · PMID 41108509 · Full text
The objective of this study is to examine cross-over effects of the Raising Healthy Children universal childhood preventive intervention on adult suicide behaviors and related mental health. A nonrandomized controlled tr...
The objective of this study is to examine cross-over effects of the Raising Healthy Children universal childhood preventive intervention on adult suicide behaviors and related mental health. A nonrandomized controlled trial was conducted in elementary schools serving higher-risk areas in Seattle, Washington (during ages 6-13, grades 1-6) and followed up at ages 21-39. The panel originated in Seattle but was followed in and out of state. This study examines participants who had been in the intervention (n = 156) vs. control (n = 220) conditions in grades 1-6. The intervention provided teachers with methods of classroom management, parents with family management skills, and children with social-emotional skills training. Outcomes examined were ever suicide ideation, attempt, or completion, and DSM-IV-based criterion counts for depression, generalized anxiety disorder, PTSD, and social phobia across 6 waves, ages 21-39. At follow-up, the intervention group showed significantly lower suicide ideation and behavior, depression, generalized anxiety disorder, PTSD, and social phobia than the control group. Universal childhood preventive intervention can reduce suicide ideation and behaviors and related mental health problems in adulthood. Clinical Trials.gov ID: NCT04075019.
Investing in Interventions to Prevent Opioid Use Disorder in Adolescents and Young Adults: Start-up Costs from NIDA's HEAL Prevention Initiative.
Kuklinski MR, Gibbons BJ, Bowser DM … +14 more , McCollister KE, Smart R, Dunlap LJ, Shenkar E, Bonar EE, Boomer T, Campbell M, Fiellin LE, Hutton DW, Rao V, Saldana L, Su K, Walton MA, Yilmazer T
Prev Sci · 2025 Nov · PMID 41085955 · Full text
The purpose of this study was to estimate the costs of starting up diverse interventions for preventing opioid misuse in young people aged 15 to 30. Interventions were to be delivered in the context of research trials fu...
The purpose of this study was to estimate the costs of starting up diverse interventions for preventing opioid misuse in young people aged 15 to 30. Interventions were to be delivered in the context of research trials funded under the National Institutes of Health HEAL (Helping to End Addiction Long-term®) Prevention Initiative. Start-up activities were conducted in systems and settings across the United States from 2019 to 2023. Start-up costs were estimated using activity-based costing from a provider perspective and common methods and data collection procedures across projects (n = 8). Descriptive statistics were used to understand the magnitude of and variability in start-up costs, cost drivers, and staff time. Factors explaining variability were identified from project activity descriptions. Start-up activities cost $37,541 on average, and $33,492 at the median (2020 USD). Labor drove costs (89% on average). Training, project management, and partner engagement accounted for 78% of start-up costs on average. There was considerable variability in total and activity costs. Start-up activities provide an essential foundation for successful intervention delivery and sustainability, yet the resources needed and associated costs for this phase of intervention implementation do not receive much attention. We found that interventions faced unique start-up challenges and leverage points, resulting in differences in total cost and activity cost burden. ClinicalTrials.gov Identifier: NCT01088542, NCT04901312, NCT04678960, NCT04617938, NCT04550715, and NCT04135703.
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