Racial and Ethnic Representation in Preventive Intervention Research: a Methodological Study.

Individuals who are Asian or Asian American, Black or African American, Native American or American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and Hispanic or Latino (i.e., presently considered racial ethnic minoritized groups in the USA) lacked equal access to resources for mitigating risk during COVID-19, which highlighted public health disparities and exacerbated inequities rooted in structural racism that have contributed to many injustices, such as failing public school systems and unsafe neighborhoods. Minoritized groups are also vulnerable to climate change wherein the most severe harms disproportionately fall upon underserved communities. While systemic changes are needed to address these pervasive syndemic conditions, immediate efforts involve examining strategies to promote equitable health and well-being-which served as the impetus for this study. We conducted a descriptive analysis on the prevalence of culturally tailored interventions and reporting of sample characteristics among 885 programs with evaluations published from 2010 to 2021 and recorded in the Blueprints for Healthy Youth Development registry. Inferential analyses also examined (1) reporting time trends and (2) the relationship between study quality (i.e., strong methods, beneficial effects) and culturally tailored programs and racial ethnic enrollment. Two percent of programs were developed for Black or African American youth, and 4% targeted Hispanic or Latino populations. For the 77% of studies that reported race, most enrollees were White (35%) followed by Black or African American (28%), and 31% collapsed across race or categorized race with ethnicity. In the 64% of studies that reported ethnicity, 32% of enrollees were Hispanic or Latino. Reporting has not improved, and there was no relationship between high-quality studies and programs developed for racial ethnic youth, or samples with high proportions of racial ethnic enrollees. Research gaps on racial ethnic groups call for clear reporting and better representation to reduce disparities and improve the utility of interventions.

Common Methodological Problems in Randomized Controlled Trials of Preventive Interventions.

Randomized controlled trials (RCTs) are often considered the gold standard in evaluating whether intervention results are in line with causal claims of beneficial effects. However, given that poor design and incorrect analysis may lead to biased outcomes, simply employing an RCT is not enough to say an intervention "works." This paper applies a subset of the Society for Prevention Research (SPR) Standards of Evidence for Efficacy, Effectiveness, and Scale-up Research, with a focus on internal validity (making causal inferences) to determine the degree to which RCTs of preventive interventions are well-designed and analyzed, and whether authors provide a clear description of the methods used to report their study findings. We conducted a descriptive analysis of 851 RCTs published from 2010 to 2020 and reviewed by the Blueprints for Healthy Youth Development web-based registry of scientifically proven and scalable interventions. We used Blueprints' evaluation criteria that correspond to a subset of SPR's standards of evidence. Only 22% of the sample satisfied important criteria for minimizing biases that threaten internal validity. Overall, we identified an average of 1-2 methodological weaknesses per RCT. The most frequent sources of bias were problems related to baseline non-equivalence (i.e., differences between conditions at randomization) or differential attrition (i.e., differences between completers versus attritors or differences between study conditions that may compromise the randomization). Additionally, over half the sample (51%) had missing or incomplete tests to rule out these potential sources of bias. Most preventive intervention RCTs need improvement in rigor to permit causal inference claims that an intervention is effective. Researchers also must improve reporting of methods and results to fully assess methodological quality. These advancements will increase the usefulness of preventive interventions by ensuring the credibility and usability of RCT findings.

Frequency and Risk of Marijuana Use among Substance-Using Health Care Patients in Colorado with and without Access to State Legalized Medical Marijuana.

With increasing use of state legalized medical marijuana across the country, health care providers need accurate information on patterns of marijuana and other substance use for patients with access to medical marijuana. This study compared frequency and severity of marijuana use, and use of other substances, for patients with and without state legal access to medical marijuana. Data were collected from 2,030 patients who screened positive for marijuana use when seeking health care services in a large, urban safety-net medical center. Patients were screened as part of a federally funded screening, brief intervention, and referral to treatment (SBIRT) initiative. Patients were asked at screening whether they had a state-issued medical marijuana card and about risky use of tobacco, alcohol, and other illicit substances. A total of 17.4% of marijuana users had a medical marijuana card. Patients with cards had higher frequency of marijuana use and were more likely to screen at moderate than low or high risk from marijuana use. Patients with cards also had lower use of other substances than patients without cards. Findings can inform health care providers of both the specific risks of frequent, long-term use and the more limited risks of other substance use faced by legal medical marijuana users.

Life events, genetic susceptibility, and smoking among adolescents.

Although stressful life events during adolescence are associated with the adoption of unhealthy behaviors such as smoking, both social circumstances and physical traits can moderate the relationship. This study builds on the stress paradigm and gene-environment approach to social behavior by examining how a polymorphism in the serotonin transporter gene 5-HTTLPR moderates the effect of life events on adolescent smoking. Tests of interaction hypotheses use data from the Family Transitions Project, a longitudinal study of 7th graders followed for 5years. A sibling-pair design with separate models for the gender composition of pairs (brothers, sisters, or brother/sister) controls for unmeasured family background. The results show that negative life events are significantly and positively associated with smoking. Among brother pairs but not other pairs, the results provide evidence of gene-environment interaction by showing that life events more strongly influence smoking behavior for those with more copies of the 5-HTTLPR S allele.

Unpacking the 'information barrier': comparing perspectives on information as a barrier to climate change adaptation in the interior mountain West.

Inadequate information has been repeatedly identified as a barrier to climate change adaptation planning and implementation. However less is known about how information functions as a barrier, and to what degree it prevents adaptation compared to other perceived barriers. In addition, the role of institutional context in mediating the demand for information in the context of adaptation has been less well studied. This paper helps to clarify the role that information plays in adaptation planning for two sectors of public employees working at similar scales, in similar locations, with similar challenges. We conducted surveys and semi-structured interviews to investigate the demand for information in support of adaptation implementation and planning from US federal public lands managers and municipal officials in the US interior West. We found that federal managers and municipal officials both consulted information frequently for decision making, and while both groups indicated that lack of information at relevant scales was a barrier to adaptation planning, this was seen as a much stronger barrier for federal managers than for communities. Uncertainty of information was raised as an issue, but results were mixed on whether or not this acted as a strong barrier. While peer-reviewed publications were seen as the "best available science," and correlated with adaptation planning, they were not accessed directly as frequently as other sources of information, including colleagues, the internet and reports. The strong connection between communities and adjacent federal lands may provide an opportunity for networking that could facilitate the flow of information relevant for adaptation.

Life course transitions in early adulthood and SES disparities in tobacco use.

A huge literature has documented adult socioeconomic disparities in smoking but says less about how these disparities emerge over the life course. Building on findings that smoking among adolescents differs only modestly by parental SES, we utilize a life course perspective on social differentiation to help explain the widening disparities in smoking in young adulthood. Our theory suggests that achieved socioeconomic status and the nature and timing of adult role transitions affect age-based trajectories of smoking and widen disparities in adult smoking. The analyses use data from the National Longitudinal Study of Adolescent Health, which follows a representative national sample over four waves from ages 11-17 in 1994/1995 to 26-34 in 2007/2008. The results show divergent age trajectories in smoking by parental education and that achieved socioeconomic status and life course roles in young adulthood account in good part for differences in the age trajectories. The findings demonstrate the value of the life course perspective in understanding processes of increasing stratification in health behavior and health during the transition to adulthood.

Cohort change and the diffusion of environmental concern: A cross-national analysis.

This study explores value change across cohorts for a multinational population sample. Employing a diffusion-of-innovations approach, we combine competing theories predicting the relationship between socio-economic status (SES) and environmentalism: post-materialism and affluence theories, and global environmentalism theory. The diffusion argument suggests that high-SES groups first adopt pro-environmental views, but as time passes by, environmentalism diffuses to lower-SES groups. We test the diffusion argument using a sample of 18 countries for two waves (years 1993 and 2000) from the International Social Survey Project (ISSP). Cross-classified multilevel modeling allows us to identify a non-linear interaction between cohort and education, our core measure of SES, in predicting environmental concern, while controlling for age and period. We find support for the diffusion argument and demonstrate that the positive effect of education on environmental concern first increases among older cohorts, then starts to level off until a bend-point is reached for individuals born around 1940 and becomes progressively weaker for younger cohorts.

Does reading keep you thin? Leisure activities, cultural tastes, and body weight in comparative perspective.

While sedentary leisure-time activities such as reading, going to movies, attending cultural events, going to sporting events, watching TV, listening to music, and socialising with friends would seem to contribute to excess weight, a perspective focusing on socioeconomic status (SES) differences in cultural tastes suggests the opposite, that some sedentary activities are associated with lower rather than higher body weight. This study aims to test theories of cultural distinction by examining relationships between leisure-time activities and body weight. Using 2007 data on 17 nations from the International Social Survey Program (ISSP), the analysis estimates relationships between the body mass index and varied leisure-time activities while controlling for SES, physical activities, and sociodemographic variables. Net of controls for SES and physical activities, participation time in cultural activities is associated with lower rather than higher body weight, particularly in high-income nations. The results suggest that both cultural activities and body weight reflect forms of distinction that separate SES-based lifestyles.

Trends in the genetic influences on smoking.

Using twin pairs from the National Survey of Midlife Development in the United States, we estimate that 35 percent of the variance in regular smoking is due to additive genetic influences. When we disaggregate the sample by birth cohort we witness strong genetic influences on smoking for those born in the 1920s, 1930s, and 1950s, but negligible influences for those born in the 1940s and 1960s. We show that the timing of the first Surgeon General's Report coincides with an increase in the genetic influences on regular smoking, but subsequent legislation prohibiting smoking in public places has significantly reduced these influences. These results are in line with existing gene-environment interaction theory, and we argue that variation in genetic influences across cohorts makes it difficult and potentially misleading to estimate genetic effects on health behaviors from data obtained from a single point in time.

Education inequality in mortality: The age and gender specific mediating effects of cigarette smoking.

A debate within the mortality literature centers around the impact of health behaviors on the prospects of disadvantaged groups. Meanwhile, a growing body of work illustrates the social processes that shape changes in smoking levels by socioeconomic status (SES), especially educational attainment. These literatures are merged by examining the mediating effects of cigarette smoking on education gaps in U.S. adult mortality by age and gender. Findings reveal that cigarette smoking is an important mediator of the education-mortality gap for all males and for younger females. In particular, education-mortality gaps for young men narrow considerably when cigarette smoking is accounted for, while older women experienced no reduction in the education-mortality gap with controls for smoking. These results are consistent with diffusion arguments that describe SES differences in smoking adoption by age and gender and provide strong evidence that smoking is an important differentiator of mortality risks by education.

Making Evidence-Based Interventions Relevant for Users: A Comparison of Requirements for Dissemination Readiness Across Program Registries.

This study compares prevention program registries in current use on their level of support for users seeking to implement evidence-based programs. Despite the importance of registries as intermediaries between researchers and the public, and although previous studies have examined how registries define their standards for methodological soundness and evidence of efficacy, little research has focused on the degree to which registries consider programs' dissemination readiness. The result is that registry users are uncertain whether listed programs and their necessary support materials are even available for implementation. This study evaluates 11 publicly and privately funded prevention registries that review the evidence base of programs seeking to improve child health and prosocial outcomes on the degree to which they use dissemination readiness as an evidentiary criterion for rating programs, and the extent and type of information they provide about dissemination readiness to support real-world implementation. The results show wide variability, with few having standards about dissemination readiness or making evidence-based information about interventions easily accessible to users. Findings indicate the need for registries to (1) do more to assess dissemination readiness before including programs on their website and (2) offer more complete information on dissemination readiness and implementation support to users.

Racial convergence in cigarette use from adolescence to the mid-thirties.

Cigarette smoking by whites and African Americans shows puzzling age differences: An African American advantage during the teen years no longer appears in mid-adulthood. This study uses two data sets to examine whether the life-course change is real--and not due to misleading comparisons across different cohorts--and then whether the racial convergence is consistent with resource or stress arguments emphasizing, respectively, cessation among whites or late initiation among African Americans. First, multilevel growth models using data from the National Youth Survey-a prospective, longitudinal study of a randomly selected national sample of teens followed from ages 12 to 18 in 1977 to ages 26 to 34 in 1992--reveal that the racial convergence in smoking prevalence over the life course among this cohort is due primarily to greater white cessation. Second, consecutive cross-sectional samples of the National Health Survey replicate the broad patterns found in the NYS and show that convergence in smoking trajectories by race has strengthened over time. Together the results most favor a resource explanation of the different life-course patterns of smoking among whites and African Americans.

Changes in Youth Smoking, 1976-2002: A Time-Series Analysis.

During the past several decades, smoking prevalence among youth has fluctuated in puzzling and unexpected ways. To help understand these changes, this study tests seven explanations: (a) compositional changes, (b) sample selection, (c) adult smoking, (d) social strain, (e) cigarette prices, (f) tobacco advertising, and (g) other drug use. Figures on smoking prevalence come from the Monitoring the Future (MTF) Surveys from 1976-2002, whereas figures on aggregate determinants for the same time period come from government publications. Graphs of the time-series trends to determine temporal correspondence and time-series regression models to test for statistical influence reveal two variables that have expected effects. Increases in cigarette prices reduce smoking, particularly in the most recent years, and higher marijuana initiation (or use) is associated with greater smoking during most of the time period. However, much of the change in youth smoking, particularly the most recent rise and fall, remains unexplained.

Life Course Changes in Smoking by Gender and Education: A Cohort Comparison Across France and the United States.

Widening of educational disparities and a narrowing female advantage in mortality stem in good part from disparities in smoking. The changes in smoking and mortality disparities across cohorts and countries have been explained by an epidemic model of cigarette use but are also related to life course changes. To better describe and understand changing disparities over the life course, we compare age patterns of smoking in three cohorts and two nations (France and the United States) using smoking history measures from the 2010 French Health Barometer (N = 20,940) and the 2010 U.S. National Health Interview Survey Sample Adult File (N = 20,444). The results demonstrate statistically significant widening of gender and educational differences from adolescence to early and middle adulthood, thus accentuating the disparities already emerging during adolescence. In addition, the widening disparities over the life course have been changing across cohorts: Age differences in educational disparities have grown in recent cohorts (especially in France), while age differences in gender disparities have narrowed. The findings highlight the multiple sources of inequality in smoking and health in high-income nations.

The impact of employee assistance services on workplace outcomes: Results of a prospective, quasi-experimental study.

Employee Assistance Programs (EAPs) are widely used to help employees experiencing personal or work-related difficulties that impact work productivity. However, rigorous research on the effectiveness of programs to improve work-related outcomes is lacking. The current study represents a major advance in EAP research by using a prospective, quasi-experimental design with a large and diverse employee base. Using propensity scores calculated from demographic, social, work-related, and psychological variables collected on baseline surveys, we matched 156 employees receiving EAP to 188 non-EAP employees. Follow-up surveys were collected from 2 to 12 months post-baseline (M = 6.0). At follow-up, EAP employees had significantly greater reductions in absenteeism (b = -.596, p = .001) and presenteeism (b = -.217, p = .038), but not workplace distress (b = -.079, p = .448), than did non-EAP employees. Tests of moderation of baseline alcohol use, depression, anxiety, and productivity indicate that for the most part, the program works equally well for all groups. However, EAP did more to reduce absenteeism for those who began with lower severity of depression and anxiety at baseline. Results provide the scientific rigor needed to demonstrate EAP impact on improved work outcomes. In the first study of its kind, findings confirm the value of EAPs to help employees address personal and work-related concerns that are affecting job performance. (PsycINFO Database Record

Global Patterns and Determinants of Sex Differences in Smoking.

The worldwide spread of tobacco use in recent decades raises questions about the relative prevalence of smoking among men and women. Does the degree of gender equality in nations promote equality in cigarette use? Does rising use of cigarettes by women stem from the stage of cigarette diffusion and earlier increases among men? Or have changes in economic factors and smoking policy affected the sexes differently? This study uses aggregate data for 106 nations, measures of smoking prevalence circa 2000, and lagged measures of gender equality, cigarette diffusion, and tobacco access to address these questions and evaluate the underlying theories. With the logged ratio of female to male prevalence as the dependent variable, regression results reveal that gender equality has inconsistent effects on women's smoking relative to men, cigarette diffusion has more consistent and moderately strong effects, and economic factors have weak effects. Global patterns of adoption of cigarettes by women appear most closely associated with the early adoption by men and then movement through a regular pattern of cigarette diffusion.

COHORT CHANGES IN THE SOCIAL DISTRIBUTION OF TOLERANT SEXUAL ATTITUDES.

Though many studies have described societal-wide changes in tolerance for sexual behaviors outside marriage, few have examined how the social distribution of tolerant attitudes has changed. A diffusion-of-innovations approach predicts nonlinear change in the distribution: high SES groups adopt the attitudes first, which produces a positive relationship, but diffusion to other SES groups subsequently weakens the association with SES. I test this argument using the General Social Survey from 1973 to 2014 to compare the SES determinants of attitudes toward premarital sex, extramarital sex, same-gender sex, and teenage sex across 86 cohorts born from around 1900 to 1985. Multilevel age, period, and cohort models support diffusion arguments concerning tolerance of premarital sex by demonstrating that the effects of indicators of SES first strengthen and then weaken across cohorts. Little support emerges for diffusion arguments concerning tolerance of extramarital sex and teenage sex, and preliminary but suggestive support emerges concerning tolerance of same-gender sex.

Impact of Employee Assistance Services on Depression, Anxiety, and Risky Alcohol Use: A Quasi-Experimental Study.

OBJECTIVE: To test the impact of Employee Assistance Programs (EAPs) on reducing employee depression, anxiety, and risky alcohol use, and whether improvements in clinical symptoms lead to improved work outcomes. METHODS: The study used a prospective, quasi-experimental design with propensity score matching. Participants (n = 344) came from 20 areas of state government. EAP (n = 156) and non-EAP (n = 188) employees were matched on baseline demographic, psychosocial, and work-related characteristics that differentiate EAP from non-EAP users. Follow-up surveys were collected 2 to 12 months later (M = 6.0). RESULTS: EAP significantly reduced symptoms of depression and anxiety, but not at-risk alcohol use. EAP reductions in depression and anxiety mediated EAP-based reductions in absenteeism and presenteeism. CONCLUSIONS: EAPs provide easy-to-access work-based services that are effective at improving employee mental health.

Diffusion, cohort change, and social patterns of smoking().

In noting that common explanations of smoking cannot account for both its current inverse relationship with SES and the shift over time toward greater concentration among low SES groups, this paper presents an explanation based on diffusion and status distinctions. The explanation predicts that, as cigarette diffusion proceeds and fashions change, the social determinants of smoking will shift across cohorts, such that initially positive relationships between pre-adult components of socioeconomic status and smoking in early cohorts become negative in later cohorts. Tests using historical, cohort-linked aggregate data on cigarette diffusion, and individual-level data from the General Social Surveys covering the years from 1978 to 1994 and cohorts from 1889 to 1976 largely support the predictions. In comparing older to newer cohorts, the results show correspondence between the stage of cigarette diffusion and the direction and strength of the relationships of education, parental status, urban residence, and gender with cigarette smoking.