It's time for change: inequities and determinants of health-related quality of life among gender and sexually diverse young people in Australia.

PURPOSE: This study was guided by three research aims: firstly, to examine the longitudinal trends of health-related quality of life (HR-QoL) among gender and sexuality diverse (LGBTQA2S+) young people through adolescence (ages 14-19); secondly, to assess longitudinal associations between poor mental health and HR-QoL among LGBTQA2S+ young people through adolescence; and thirdly, to examine differences in HR-QoL among LGBTQA2S+ young people during early adolescence (ages 14 and 15) depending on select school-, peer-, and parent-level factors. METHODS: This study used three of nine available waves of data from a large population-level, probability sample-based, longitudinal cohort study, namely the K' cohort: children aged 4-5 years old at time of study enrolment followed-up biennially (~ 61% retention rate). HR-QoL weighted means and standard deviations were calculated using Child Health Utility 9D (CHU-9D) scores for LGBTQA2S+ participants at ages 14 and 15 (Wave 6), ages 16 and 17 (Wave 7), and ages 18 and 19 (Wave 8). To strategically identify policy-relevant modifiable behavioural factors suitable for prevention and early intervention, non-parametric Wilcoxon signed-rank tests tested differences in mean CHU-9D ranks at ages 14 and 15 (Wave 6) between groups (gender identity: trans vs. cis; identity-level sexuality: gay, lesbian, bisexual, or other diverse sexuality vs. heterosexual; group-level sexuality: sexually diverse vs. not sexually diverse) and selected school factors (school acceptance, belonging, freedom of expression), peer factors (peer relationship quality, trust, respect), and family factors (parental acceptance, understanding, trust), with Hedge's g correction statistics computed for effect sizes. Longitudinal associations between gender, sexuality, and poor mental health (depressive symptoms, anxiety, symptoms, self-harm thoughts/behaviour, and suicidal thoughts/behaviour) and HR-QoL were tested using mixed-effects models with random intercepts and random slopes for nested clustering (participants within postcodes). RESULTS: HR-QoL disparities disproportionately affecting LGBTQA2S+ groups relative to their cisgender, heterosexual peers, were well-established by age 14 to 15 relatively steeper reductions in HR-QoL were observed throughout adolescence among all LGBTQA2S+ groups, with HR-QoL widening the most for trans participants. Poor mental health was significantly associated with HR-QoL declines. LGBTQA2S+ participants with positive school- and parent factors related to feelings of acceptance, belonging, and freedom of self-expression, reported significantly higher HR-QoL during early adolescence. CONCLUSION: Evidence-based public health policy responses are required to address the dire HR-QoL inequities among LGBTQA2S+ young people, particularly trans young people. Prioritising the promotion of school- and family-based interventions which foster LGBTQA2S+ inclusivity, acceptance, and a sense of belonging from early adolescence through young adulthood, represents a feasible, evidence-based, and cost-effective response to address these HR-QoL disparities.

Mental ill-health and substance use among sexuality diverse adolescents: The critical role of school climate and teacher self-efficacy.

INTRODUCTION: Mental ill-health, substance use and their co-occurrence among sexuality diverse young people during earlier adolescence is relatively understudied. The preventive utility of positive school climate for sexuality diverse adolescents' mental health is also unclear, as well as the role of teachers in conferring this benefit. METHOD: Using Wave 8 'B Cohort' data from the Longitudinal Study of Australian children (N = 3127, Mage = 14.3), prevalence ratios and odds ratios were used to assess prevalence and disparities in mental ill-health and substance use, and multinomial logistic regression for co-occurring outcomes, among sexuality diverse adolescents relative to heterosexual peers. Logistic regression was used to assess associations between school climate and teacher self-efficacy with sexuality diverse adolescents' mental health. RESULTS: Mental ill-health prevalence ranged from 22% (suicidal thoughts/behaviour) to 46% (probable depressive disorders) and substance use between 66% (cigarette use) and 97% (alcohol use). Sexuality diverse participants were significantly more likely to report self-harm and high levels of emotional symptoms in co-occurrence with cigarette, alcohol and/or cannabis use. For each 1-point increase in school climate scores as measured by the Psychological Sense of School Membership scale, there was 10% reduction in sexuality diverse adolescents reporting high levels of emotional symptoms, probable depressive disorder, self-harm thoughts/behaviour and suicidal thoughts/behaviour. For each 1-point increase in lower perceived (worse) teacher self-efficacy scores as measured by four bespoke teacher self-efficacy items, odds of sexuality diverse adolescent-reported suicidal thoughts/behaviour increased by 80%. DISCUSSION: Mental ill-health, substance use and especially their co-occurrence, are highly prevalent and pose significant and inequitable health and well-being risks. Schools represent a potential site for focusing future prevention efforts and educating and training teachers on sexuality diversity is a promising pathway towards optimising these.

Minority stressors, traumatic events, and associations with mental health and school climate among gender and sexuality diverse young people in Australia: Findings from a nationally representative cohort study.

INTRODUCTION: Population-level, nationally representative data on the prevalence of minority stressors and traumatic events, mental ill-health effects, and the preventative utility of school climate, among gender and sexuality diverse young people in Australia, is significantly lacking. In this study, we estimated the prevalence and distribution of minority stressors and traumatic events among young people by sexuality identity (gay/lesbian, bisexual, other sexuality, heterosexual), sexuality diversity (sexuality diverse, not sexuality diverse), and gender identity (transgender, cisgender) and assessed associations with mental ill-health and the moderating role of school climate factors. METHODS: Using Wave 8 (2018) follow-up data from a population-level, nationally representative longitudinal cohort study, the sample comprised 3037 young people aged 17-19 years in Australia. Prevalence ratios for minority stressors and traumatic events were calculated for gender and sexuality diverse categories using logistic regression models. Linear regression models were used to test associations between traumatic events and minority stressors, and mental ill-health. Multivariate linear regression tested school climate factors as effect modifier between minority stressors and mental ill-health among sexuality diverse young people. RESULTS: Rates of traumatic events and minority stressors were highest among bisexual and gay/lesbian young people and were significantly associated with mental ill-health among all gender and sexuality diverse young people. Highest mental ill-health effects were observed among trans young people. Among sexuality diverse young people, positive and negative feelings toward school climate were associated with decreased and increased mental ill-health, respectively. After accounting for sexuality diversity, positive overall school climate appeared protective of mental ill-health effects of sexuality-based discrimination. DISCUSSION: Minority stressors, traumatic events, and associated mental ill-health are prevalent among gender and sexuality diverse young people in Australia, especially trans, bisexual, and gay/lesbian young people. Promotion of affirmative, safe, and inclusive school climate demonstrates significant promise for the prevention and early intervention of mental ill-health among gender and sexuality diverse young people.

Selective personality-targeted prevention of suicidal ideation in young adolescents: post hoc analysis of data collected in a cluster randomised controlled trial.

OBJECTIVE: To assess the efficacy of a selective, personality-targeted intervention for reducing suicidal ideation in adolescents. DESIGN: Post hoc analysis of survey data collected in the Climate and Preventure (CAP) study, a cluster randomised controlled trial that compared strategies for reducing alcohol misuse by adolescents, 2012-2015. SETTING, PARTICIPANTS: Year 8 students at 16 New South Wales non-government schools and one Victorian non-government school. INTERVENTION: Preventure, a selective, personality-targeted intervention designed to help adolescents with personality risk factors for alcohol misuse, comprising two 90-minute sessions, one week apart. For our post hoc analysis, we combined data from the two CAP trial groups in which Preventure was offered (the Preventure and the Preventure/Climate Schools [a non-selective prevention strategy] groups) as the intervention group; and data from the two groups in which Preventure was not offered (usual health education only [control] and Climate Schools groups) as the control group. MAIN OUTCOME MEASURE: Difference between post hoc control and intervention groups in the change in proportions of students reporting suicidal ideation during the preceding six months (single item of Brief Symptom Inventory depression subscale) over three years. RESULTS: A total of 1636 students (mean age at baseline, 13.3 years; standard deviation, 0.5 years) were included in our analysis, of whom 1087 (66%) completed the suicidal ideation item in the three-year follow-up assessment. The post hoc control group included 755 students (nine schools), the intervention group 881 students (eight schools). After adjusting for nesting of students in schools and sex, reporting of suicidal ideation by students who had received Preventure had declined over three years, compared with the control group (per year: adjusted odds ratio, 0.80; 95% CI, 0.66-0.97). CONCLUSION: Personality-targeted selective prevention during early secondary school can have a lasting impact on suicidal ideation during adolescence. TRIAL REGISTRATION (CAP STUDY ONLY): Australian and New Zealand Clinical Trials Registry, ACTRN12612000026820 (prospective).

Associations of childhood emotional and physical neglect with mental health and substance use in young adults.

BACKGROUND: Childhood neglect is a risk factor for subsequent mental health problems. However, research on the unique contribution of emotional and physical subtypes of neglect is lacking. Importantly, if emotional and physical neglect have different impacts on mental health, they must be examined separately to understand how to prevent and treat their effects. OBJECTIVE: This study aimed to examine associations of emotional and physical neglect with depression, anxiety, stress, alcohol and drug use in 18- to 20-year-olds. METHODS: Participants (N = 569, mean age = 18.9, 70% female) responded in an online survey to questions on childhood emotional and physical neglect, childhood abuse, symptoms of depression, anxiety and stress, and alcohol and drug use and problems. Procedures were approved by the University of Sydney Human Ethics Committee. Hierarchical linear regressions were performed, controlling for socio-demographic characteristics and other adverse childhood experiences. RESULTS: Combined neglect was associated with depression (B = 2.895, p < 0.001), anxiety (B = 1.572, p = 0.003) and stress (B = 1.781, p = 0.001). However, a second model entering emotional and physical neglect as separate exposures revealed emotional neglect was driving this association with depression (B = 2.884, p < 0.001), anxiety (B = 1.627, p = 0.001) and stress (B = 1.776, p = 0.001), and that physical neglect was not associated with any outcome. Neither emotional nor physical neglect were associated with alcohol or drug use. CONCLUSION: Emotional neglect is a risk factor for mental health problems in early adulthood. Research that combines emotional and physical neglect into a single exposure may be obscuring relationships with mental health. Mental health prevention and treatment must screen for, and address, emotional neglect.

Personality-targeted prevention for adolescent tobacco use: Three-year outcomes for a randomised trial in Australia.

This is the first study to investigate the effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of tobacco smoking over a three-year period in adolescence. A cluster randomised controlled trial was conducted to assess the effectiveness of Preventure. Schools were block randomised to either the Preventure group (n = 7 schools) or the Control group (n = 7 schools) and students were assessed at five time points (baseline, 6-, 12-, 24- and 36-months post-baseline) on measures of tobacco use, intentions to use and self-efficacy to resist peer pressure to smoke tobacco. Intervention effects were estimated using mixed models to account for the hierarchical data structure. Exploratory analyses assessed intervention effects among internalising and externalising personality traits. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820; www.anzctr.org.au). A total of 1005 adolescents (mean age: 13.4 years, SD = 0.47) attending 14 Australian schools in February 2012 were recruited to the study. Relative to students in Control schools, students in Preventure schools were less likely to report recent tobacco use (OR = 0.66 95% CI = 0.50, 0.87) and intentions to use tobacco in the future (OR = 0.77 95% CI = 0.60, 0.97) over the three-year follow-up. Students in Preventure schools with internalising personality traits had a greater increase in their likelihood to report high self-efficacy to resist peer pressure to smoke sustained three-years post program delivery (OR = 1.85 95% CI = 1.0, 3.4). Findings from this study support the use of selective personality-targeted preventive interventions in reducing tobacco smoking during adolescence.

Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment.

Importance: The proportion of mental disorders and burden causally attributable to childhood maltreatment is unknown. Objective: To determine the contribution of child maltreatment to mental health conditions in Australia, accounting for genetic and environmental confounding. Design, Setting, and Participants: This meta-analysis involved an epidemiological assessment accounting for genetic and environmental confounding between maltreatment and mental health and 3 cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, National Study of Mental Health and Well-being 2020-2022, and Australian Burden of Disease Study 2023. Causal estimates were derived on the association between childhood maltreatment and mental health conditions from a meta-analysis of quasi-experimental studies. This was combined with the prevalence of maltreatment from the ACMS to calculate the population attributable fraction (PAF). The PAF was applied to the number and burden of mental health conditions in Australia, sourced from 2 population-based, nationally representative surveys of Australians aged 16 to 85 years, to generate the number and associated burden of mental disorders attributable to child maltreatment. Exposure: Physical abuse, sexual abuse, emotional abuse, or neglect prior to age 18 years. Main Outcomes and Measures: Proportion and number of cases, years of life lost, years lived with disability, and disability-adjusted life-years of mental health conditions (anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempt) attributable to childhood maltreatment. Results: Meta-analytic estimates were generated from 34 studies and 54 646 participants and applied to prevalence estimates of childhood maltreatment generated from 8503 Australians. Childhood maltreatment accounted for a substantial proportion of mental health conditions, ranging from 21% (95% CI, 13%-28%) for depression to 41% (95% CI, 27%-54%) of suicide attempts. More than 1.8 million cases of depressive, anxiety, and substance use disorders could be prevented if childhood maltreatment was eradicated. Maltreatment accounted for 66 143 years of life lost (95% CI, 43 313-87 314), primarily through suicide, and 184 636 disability-adjusted life-years (95% CI, 109 321-252 887). Conclusions and Relevance: This study provides the first estimates of the causal contribution of child maltreatment to mental health in Australia. Results highlight the urgency of preventing child maltreatment to reduce the population prevalence and burden of mental disorders.

Corrigendum to "The school-led Preventure study: Protocol of a cluster-randomised controlled trial of effectiveness to prevent adolescent alcohol misuse, internalising problems, and externalising problems through a personality-targeted intervention delivered by school staff", preventive medicine" [Reports 21 (2021) 101286/PMID: 33384915; PMCID: PMC7772564].

[This corrects the article DOI: 10.1016/j.pmedr.2020.101286.].

Self-compassion and avoidant coping as mediators of the relationship between childhood maltreatment and mental health and alcohol use in young adulthood.

BACKGROUND: Exposure to childhood maltreatment increases the risk of mental health and substance use problems. Understanding the mechanisms linking maltreatment to these problems is critical for prevention. OBJECTIVE: To examine whether self-compassion and avoidant coping mediate the relationship between childhood maltreatment and mental ill-health and alcohol use. PARTICIPANTS AND SETTING: Australians aged 18-20 years at baseline were recruited through social media and professional networks. METHODS: Participants (n = 568) completed an online survey, and were followed up annually for two subsequent surveys. Mediation models were conducted with the SPSS PROCESS macro. Maltreatment was the predictor; Wave 2 self-compassion and avoidant coping as mediators; Wave 3 mental health and alcohol use as outcomes. RESULTS: Childhood maltreatment predicted greater mental health symptoms (b = 0.253, 95 % CI = 0.128-0.378), and alcohol use (b = 0.057, 95 % CI = 0.008-0.107). Both self-compassion (b = 0.056, 95 % CI = 0.019-0.093) and avoidant coping (b = 0.103, 95 % CI = 0.024-0.181) mediated the relationship between maltreatment and mental health. Additionally, avoidant coping, but not self-compassion, mediated the relationship (b = 0.040, 95 % CI 0.020-0.061) with alcohol use. However, when controlling for pre-existing mental health and substance use, neither self-compassion nor avoidant coping mediated the relationship with mental health. Only avoidant coping mediated the link with alcohol use (b = 0.010, 95 % CI = 0.001-0.020). CONCLUSIONS: Findings suggests that by adulthood, self-compassion and avoidant coping may not explain future change in mental health symptoms; however, avoidant coping accounts for change in alcohol use across early adulthood. Reducing avoidant coping may prevent hazardous alcohol use across young adulthood among people exposed to childhood maltreatment.

Overnight declarative memory consolidation and non-rapid eye movement sleep electroencephalographic oscillations in older adults with obstructive sleep apnea.

STUDY OBJECTIVES: To compare overnight declarative memory consolidation and non-rapid eye movement (NREM) sleep electroencephalogram (EEG) oscillations in older adults with obstructive sleep apnea (OSA) to a control group and assess slow-wave activity (SWA) and sleep spindles as correlates of memory consolidation. METHODS: Forty-six older adults (24 without OSA and 22 with OSA) completed a word-pair associate's declarative memory task before and after polysomnography. Recall and recognition were expressed as a percentage of the morning relative to evening scores. Power spectral analysis was performed on EEG recorded at frontal (F3-M2, F4-M1) and central (C3-M2, C4-M1) sites. We calculated NREM absolute slow oscillation (0.25-1 Hz) and delta (0.5-4.5 Hz) EEG power, and slow (11-13 Hz) spindle density (number of events per minute of N2 sleep) and fast (13-16 Hz) spindle density. RESULTS: There were no significant differences in overnight recall and recognition between OSA (mean age 58.7 ± 7.1 years, apnea-hypopnea index (AHI) 41.9 ± 29.7 events/hour) and non-OSA (age 61.1 ± 10.3 years, AHI 6.6 ± 4.2 events/hour) groups. The OSA group had lower fast spindle density in the frontal region (p = 0.007). No between-group differences in SWA were observed. In the Control group, overnight recognition positively correlated with slow spindle density in frontal (rho = 0.555, p = 0.020) and central regions (rho = 0.490, p = 0.046). Overnight recall was not related to SWA or spindle measures in either group. CONCLUSIONS: Older adults with OSA had deficits in fast sleep spindles but showed preserved overnight declarative memory consolidation. It is possible that compensatory mechanisms are being recruited by OSA patients to preserve declarative memory consolidation despite the presence of sleep spindle deficits.

An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here?

Background and Objectives: A wealth of research has identified adverse childhood experiences (ACEs; abuse, neglect, violence or disorder in the home) as a strong risk factor for substance misuse. Synthesis of the existing evidence is critical to shape policy and inform directions for future research. Existing reviews have focused on specific substances or substance use outcomes (eg, disorder), and do not include discussion of the mechanisms that operate between ACEs and substance misuse. The current umbrella review aims to synthesize reviews on the relationship between ACEs and substance misuse, review the evidence on the mechanisms linking these, identify existing gaps in our knowledge, and discuss critical directions for future research, practice, and public policy. Methods: Two electronic databases (PsycINFO and Medline) were searched for reviews published between 1998 and 2022 on the link between ACEs and substance misuse. Twenty articles met eligibility criteria and were qualitatively synthesized. Results: Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder, among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across neurobiological, endocrine, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning. Nonetheless, the literature is subject to limitations surrounding potential unmeasured cofounders and causality, as well as decontextualizing childhood adversity from broader structural issues that influence the link between ACEs and substance misuse. Research, policy, and practice that seek to holistically understand and address the relationship between ACEs and substance misuse within the broader social determinants of health is crucial.

Personality as a Possible Intervention Target to Prevent Traumatic Events in Adolescence.

Traumatic events (severe injury, violence, threatened death) are commonly experienced by children. Such events are associated with a dose-response increasing risk of subsequent substance use, mental illness, chronic disease, and premature mortality. Preventing the accumulation of traumatic events is thus an urgent public health priority. Substance use risk personality profiles (impulsivity, sensation seeking, hopelessness, and anxiety sensitivity) may be an important target for preventing trauma exposure, given associations between these personality traits and risky behaviour, substance misuse, and injuries across adolescence. The current study aimed to investigate associations between personality at age 13 and the number of traumatic events experienced by age 18. It also examined associations between traumas before age 13 and personality at age 13. Participants were the control group of a cluster-randomised controlled trial examining prevention of adolescent alcohol misuse. Baseline data were collected at ages 12-13 (2012). Participants were followed-up at ages 18-19 (2017-2018). Personality profiles of hopelessness, anxiety sensitivity, impulsivity, and sensation seeking were measured at baseline using the Substance Use Risk Profile Scale. Traumatic events and age of exposure were measured at age 18-19 using the Life Events Checklist for DSM-5. Mixed-effect regression was conducted on 287 participants in Stata 17, controlling for sex. High scores on hopelessness, impulsivity, and sensation seeking at age 13 were associated with a greater number of traumatic events by age 18. Impulsivity and sensation seeking predicted the number of new traumatic events from age 13 to 18. Prior trauma exposure was associated with high hopelessness at age 13. Adolescents exhibiting high impulsivity or sensation seeking may be at greater risk of experiencing traumatic events. Additionally, early trauma exposure may contribute to the development of a hopelessness personality trait.

Clusters of Adversity Types Among U.S. Youth: Associations With Mental Health.

INTRODUCTION: Childhood adversities are risk factors for subsequent mental health problems. Research commonly focuses on adverse childhood experiences, despite evidence that other exposures, such as neighborhood violence or peer victimization, co-occur with adverse childhood experiences and are associated with similar mental health outcomes. This study explored the clustering of these exposures and examined the associations with mental health. METHODS: Data were a nationally representative sample of U.S. children aged 10-17 years (N=1,959), collected in 2013-2014. Latent class analysis was conducted on 22 types of childhood adversity. Regression models examined associations with mental health and substance use. These secondary analyses were conducted in 2021. RESULTS: A total of 5 classes were identified: Low all (59% of the sample), Abuse (29%), High multiple adversities (5%), Peer adversity (4%), and Neighborhood violence (4%). All classes had poorer mental health and a higher prevalence of substance use than Low all, with particularly harmful levels in High multiple adversities. Neighborhood violence was not significantly different from High multiple adversities on mental health symptoms and showed a greater proportion of past-year substance use than all other classes except High multiple adversities. Peer adversity and Abuse classes did not differ significantly in any outcomes. CONCLUSIONS: Findings highlight the particularly deleterious impact of neighborhood violence and highly co-occurring adversity types on mental health and substance use. It is important to extend our conceptualization of adverse childhood experiences to include peer adversity and neighborhood violence and shift from a siloed approach to examining all these exposures.

Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study.

BACKGROUND: To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website's usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period. OBJECTIVE: Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention. METHODS: Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants' feedback about Positive Choices. RESULTS: A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8% to 14% among school staff and from 15% to 22% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants' suggestions for improvement informed a recent website update. CONCLUSIONS: The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities.

Effect of Selective Personality-Targeted Alcohol Use Prevention on 7-Year Alcohol-Related Outcomes Among High-risk Adolescents: A Secondary Analysis of a Cluster Randomized Clinical Trial.

Importance: Alcohol consumption is one of the leading preventable causes of burden of disease worldwide. Selective prevention of alcohol use can be effective in delaying the uptake and reducing harmful use of alcohol during the school years; however, little is known about the durability of these effects across the significant transition from early adolescence into late adolescence and early adulthood. Objective: To examine the sustained effects of a selective personality-targeted alcohol use prevention program on alcohol outcomes among adolescents who report high levels of 1 of 4 personality traits associated with substance use. Design, Setting, and Participants: A cluster randomized clinical trial was conducted to assess the effectiveness of the selective personality-targeted PreVenture program on reducing the growth of risky alcohol use and related harms from early to late adolescence and early adulthood. Participants included grade 8 students attending 14 secondary schools across New South Wales and Victoria, Australia, in 2012 who screened as having high levels of anxiety sensitivity, negative thinking, impulsivity, and/or sensation seeking. Schools were block randomized to either the PreVenture group (7 schools) or the control group (7 schools). The primary end point of the original trial was 2 years post baseline; the present study extends the follow-up period from July 1, 2017, to December 1, 2019, 7 years post baseline. Data were analyzed from July 22, 2021, to August 2, 2022. Interventions: The PreVenture program is a 2-session, personality-targeted intervention designed to upskill adolescents to better cope with their emotions and behaviors. Main Outcomes and Measures: Self-reported monthly binge drinking, alcohol-related harms, and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test-Concise consumption screener. Results: Of 438 participants (249 male [56.8%]; mean [SD] age, 13.4 [0.5] years) from 14 schools, 377 (86.2%) provided follow-up data on at least 2 occasions, and among those eligible, 216 (54.0%) participated in the long-term follow-up. Compared with the control condition, the PreVenture intervention was associated with reduced odds of any alcohol-related harm (odds ratio [OR], 0.81 [95% CI, 0.70-0.94]) and a greater mean reduction in the frequency of alcohol-related harms (ß = -0.22 [95% CI, -0.44 to -0.003]) at the 7.0-year follow-up. There were no differences in the odds of monthly binge drinking (OR, 0.80 [95% CI, 0.56-1.13]) or hazardous alcohol use (OR, 0.87 [95% CI, 0.59-1.27]) at the 7.0-year follow-up. Exploratory analyses at the 5.5-year follow-up showed that compared with the control condition, the PreVenture intervention was also associated with reduced odds of monthly binge drinking (OR, 0.87, [95% CI, 0.77-0.99]) and hazardous alcohol use (OR, 0.91 [95% CI, 0.84-0.99]), but this was not sustained. Conclusions and Relevance: This study demonstrated that a brief selective personality-targeted alcohol use prevention intervention delivered in the middle school years can have sustained effects into early adulthood. Trial Registration: anzctr.org.au Identifier: ACTRN12612000026820.

Targets for intervention to prevent substance use in young people exposed to childhood adversity: A systematic review.

BACKGROUND AND AIMS: Childhood adversity is a strong, and concerningly prevalent, risk factor for the later development of substance misuse. Yet despite substantial accumulating evidence for causal mechanisms, there has been little attempt to synthesize the strength of the evidence. Importantly, these mechanisms may be amenable to intervention, providing targets for substance use prevention among those exposed to childhood adversity. The present review aimed to systematically identify mediating and moderating mechanisms operating between childhood adversity and substance use. METHODS: A systematic review was conducted. Electronic databases (PubMed, MEDLINE, PsycINFO, Web of Science and CINAHL) were searched from 1998 to 2020 for modifiable mediators and moderators of the relationship between childhood adversity and substance use in people aged 10-24. Data was qualitatively synthesised, using a socio-ecological perspective to group mediators/moderators into individual, interpersonal, community, and public policy/cultural levels of behaviour. RESULTS: After screening against eligibility criteria, 50 studies were included in the current review. The mediators at the individual level of behaviour showing the largest and most consistent effect sizes included externalising behaviour, anger, coping motives for substance use, and post-traumatic stress symptoms. Among individual-level moderators, religiosity, future orientation and depressive symptoms all attenuated the relationship between childhood adversity and substance use. At the interpersonal level, peer relationships and mother-child relationships mediated the effect of adversity on substance use. Moderators included family cohesion and relationship quality. Community factors were less commonly studied, though school mobility and educational achievement mediated 14% and 28% of the total effect of childhood adversity on substance use respectively. No mediators or moderators were identified for public policy/culture. CONCLUSIONS: A substantial proportion of the relationship between childhood adversity and substance use in youth is mediated through individual, interpersonal and community factors. Coupled with the knowledge that existing, evidence-based programs effectively address many of the identified mediators and moderators, this review advances knowledge on optimal targets to prevent substance misuse among those exposed to childhood adversity.

The school-led Preventure study: Protocol of a cluster-randomised controlled trial of effectiveness to prevent adolescent alcohol misuse, internalising problems, and externalising problems through a personality-targeted intervention delivered by school staff.

Mental disorders and problematic alcohol use are common, co-occurring and cause significant harm to individuals and society. It is critical to intervene early to prevent chronic and debilitating trajectories. Existing prevention programs among adolescents are limited in effectiveness and implementation. This Australian-first study will examine the effectiveness and feasibility of a personality-targeted program called Preventure, in preventing the onset or escalation of alcohol use, internalising problems and externalising problems among young Australians, when delivered by school staff. A cluster randomised controlled trial (RCT) of effectiveness will be conducted from 2020 to 2022 with 12 schools in Sydney, Australia, with students aged 13 years at baseline. Schools will be randomly allocated to the Preventure intervention or a control condition who will receive their usual Health Education curriculum. Schools allocated to the intervention will deliver Preventure to students scoring one standard deviation above the population mean on one of four personality traits. Preventure consists of two 90-minute group sessions that incorporate cognitive-behavioural therapy and motivational interviewing to promote coping skills. Students will be invited to complete surveys at baseline, 6- and 12-months following the intervention. Primary outcomes include student alcohol use, internalising problems, and externalising problems. Implementation fidelity, feasibility and acceptability will also be examined through surveys with school staff and students. Ethical approval has been obtained from the University of Sydney Human Research Ethics Committee, and the State Education Research Applications Process for research in public schools in NSW. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000790943).

Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review.

Importance: Childhood adversity (CA) is a powerful determinant of long-term physical and mental health that is associated with elevated risk for chronic disease and psychopathology. However, the degree to which CA contributes to mortality as a preventable driver of ill-health and death is unknown. Objective: To estimate the contribution of CA to health behaviors, including smoking and sedentary behavior, as well as the annual mortality attributable to CA in the US through influences on leading causes of death (eg, cardiovascular disease). Evidence Review: For this systematic review, the PsycINFO and MEDLINE databases were searched on November 15, 2019. The databases were searched for publications from inception (1806 for PsycINFO, 1946 for MEDLINE) to November 15, 2019. Meta-analyses of the associations between CA and morbidity outcomes were included. The population attributable fraction (PAF) was calculated from these associations along with the estimated US prevalence of CA. The PAF was then applied to the number of annual deaths associated with each cause of death to estimate the number of deaths that are attributable to CA. Additionally, the PAF was applied to the incidence of health behaviors to derive the number of cases attributable to CA. Exposure to 1 or more experiences of adversity before the age of 18 years was analyzed, including abuse, neglect, family violence, and economic adversity. Findings: A total of 19 meta-analyses with 20 654 832 participants were reviewed. Childhood adversity accounted for approximately 439 072 deaths annually in the US, or 15% of the total US mortality in 2019 (2 854 838 deaths), through associations with leading causes of death (including heart disease, cancer, and suicide). In addition, CA was associated with millions of cases of unhealthy behaviors and disease markers, including more than 22 million cases of sexually transmitted infections, 21 million cases of illicit drug use, 19 million cases of elevated inflammation, and more than 10 million cases each of smoking and physical inactivity. The greatest proportion of outcomes attributable to CA were for suicide attempts and sexually transmitted infections, for which adversity accounted for up to 38% and 33%, respectively. Conclusions and Relevance: The results of this systematic review suggest that CA is a leading contributor to morbidity and mortality in the US and may be considered a preventable determinant of mortality. The prevention of CA and the intervention on pathways that link these experiences to elevated disease risk should be considered a critical public health priority.

Clustering of Six Key Risk Behaviors for Chronic Disease among Adolescent Females.

Chronic diseases are the leading cause of disability and mortality globally. In Australia, females are at heightened risk. This research explored the prevalence, patterns, and correlates of six key risk behaviors (physical inactivity, poor diet, recreational screen time, inadequate sleep, alcohol use, and smoking) among adolescent females and whether knowledge of health guidelines was associated with adherence. Adolescent females completed an anonymous online questionnaire (N = 687; Mage = 13.82). Logistic regression assessed the association between knowledge and adherence. A Latent Class Analysis (LCA) and three-step procedure identified risk behavior clusters and their correlates. Despite positive health self-ratings (77% good/very good), most participants reported insufficient moderate-to-vigorous physical activity (MVPA; 89%), vegetable intake (89%), and excessive screen time (63%). Knowledge of guidelines was associated with adherence for MVPA, vegetable intake, sleep, and alcohol abstinence. Three classes emerged: "moderate risk" (76%), "relatively active, healthy eaters" (19%), and "excessive screen users" (5%). These risk-behavior clusters were associated with perceived value of academic achievement and physical wellbeing. Adolescent females commonly perceive they are in good health, despite engaging in unhealthy behaviors. Public health interventions should utilize effective behavior change strategies, adopt a multiple health behavior change approach (MHBC), and be tailored to specific risk profiles and values among females.

Identifying Targets for Substance Use Prevention in Young People Exposed to Childhood Adversity: Protocol for a Systematic Review.

BACKGROUND: Adverse childhood experiences are prevalent robust risk factors for the development of substance use problems. However, less is known about the causal mechanisms that explain these relationships. While directly preventing adverse childhood experiences is ideal, it is not always possible. In such cases, the mechanisms themselves may be amenable to intervention, allowing for the effective prevention of problematic substance use among children exposed to adversity. Identifying such mechanisms is therefore a critical step for efforts aiming to reduce the high individual and societal burdens associated with substance use globally. OBJECTIVE: This study aims to systematically identify and synthesize evidence on the modifiable mediators and moderators of the relationship between adverse childhood experiences and substance use outcomes in young people (age 10-24 years). METHODS: A systematic review will be conducted using PubMed, MEDLINE, PsycINFO, Web of Science, and CINAHL databases to determine the modifiable mediators and moderators of the relationship between adverse childhood experiences and substance use in young people. Data from the review will be qualitatively synthesized, unless we identify a sufficient number of studies (at least five) that examine the same type of adversity (eg, physical or sexual abuse) and the same mediator/moderator, in which case a quantitative synthesis (meta-analysis) will be conducted. If a quantitative synthesis is warranted, standardized effect estimates of the indirect (mediated) effect between adverse childhood experiences and substance use outcomes will be combined using a random-effects meta-analysis. Mediators/moderators will be grouped according to a socioecological perspective, using the four levels of individual, interpersonal, community, and public policy/culture. RESULTS: Electronic searches were completed in August 2019. A total of 4004 studies were included for screening after removing duplicates. After evaluating titles and abstracts against eligibility criteria, a further 3590 studies were excluded, leaving 415 studies for full-text screening. The results of the review are expected to be available by December 2020. CONCLUSIONS: The mechanisms linking adverse childhood experiences and substance use outcomes in young people are vital targets for substance use prevention efforts. This review will provide evidence to inform the development of prevention strategies in order to interrupt the negative life trajectory that can begin with childhood adversity. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020148773; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020148773. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/22368.