A Randomized Controlled Trial to Test the Effectiveness of an Immersive 3D Video Game for Anxiety Prevention among Adolescents.

Adolescent anxiety is debilitating, the most frequently diagnosed adolescent mental health problem, and leads to substantial long-term problems. A randomized controlled trial (n = 138) was conducted to test the effectiveness of a biofeedback video game (Dojo) for adolescents with elevated levels of anxiety. Adolescents (11-15 years old) were randomly assigned to play Dojo or a control game (Rayman 2: The Great Escape). Initial screening for anxiety was done on 1,347 adolescents in five high schools; only adolescents who scored above the "at-risk" cut-off on the Spence Children Anxiety Survey were eligible. Adolescents' anxiety levels were assessed at pre-test, post-test, and at three month follow-up to examine the extent to which playing Dojo decreased adolescents' anxiety. The present study revealed equal improvements in anxiety symptoms in both conditions at follow-up and no differences between Dojo and the closely matched control game condition. Latent growth curve models did reveal a steeper decrease of personalized anxiety symptoms (not of total anxiety symptoms) in the Dojo condition compared to the control condition. Moderation analyses did not show any differences in outcomes between boys and girls nor did age differentiate outcomes. The present results are of importance for prevention science, as this was the first full-scale randomized controlled trial testing indicated prevention effects of a video game aimed at reducing anxiety. Future research should carefully consider the choice of control condition and outcome measurements, address the potentially high impact of participants' expectations, and take critical design issues into consideration, such as individual- versus group-based intervention and contamination issues.

Depressive Symptoms: The Interaction between Rumination and Self-Reported Insomnia.

Objective. Prior research has found consistent support that rumination and insomnia are important risk factors for depressive symptoms. The aim of the present cross-sectional study is to examine the interaction between these two previously well-established risk factors (i.e., rumination and insomnia) in the explanation of depressive symptoms. Design. A total of 417 participants (277 women) with a mean age of 39 (SD = 17.59; range 18-85) completed a cross-sectional survey. Main Outcome Measures. Participants filled out the Response Rumination Scale, the Athens Insomnia Scale, and the short version of the Center for Epidemiologic Studies Depression Scale. Results. It was predicted and found that self-reported insomnia moderated the relationship between rumination and depressive symptoms. We found that particularly participants who reported higher levels of rumination as well as insomnia had the highest depressive symptoms. Conclusion. This study is the first to suggest that particularly individuals exhibiting both self-reported insomnia and higher levels of rumination also report higher levels of depressive symptoms. Health professionals screening for mental problems should be aware of this specific combination of insomnia and rumination. Explanations for this moderation effect were discussed in light of study's limitations.

Substance use outcomes in the Healthy School and Drugs program: results from a latent growth curve approach.

AIM: To assess the effectiveness of the Healthy School and Drugs (HSD) program for secondary schools on the development of substance use among Dutch early adolescents and to explore whether boys, adolescents of lower educational backgrounds, or adolescents high on personality risk traits, would benefit more from the HSD program than others. DESIGN: Randomized clustered trial with two intervention conditions (i.e., lessons and integral) among a general population of adolescents in the Netherlands. PARTICIPANTS: A total of 3784 students of 23 Dutch secondary schools. MEASUREMENTS: Structured digital questionnaires were administered pre-intervention and at 8, 20, and 32months follow-ups. The outcome measure was the rate of change in substance use across follow-ups. Differential effectiveness of the HSD program was examined for sex, educational level, and personality traits. FINDINGS: Our results show no HSD intervention effects on the development of substance use. Sex, education level, and personality characteristics of the participants did not moderate the intervention effects. CONCLUSION: The absence of effects of the Healthy School and Drugs program on the development of substance use indicates that the program should be renewed and redeveloped.

Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use: a randomized clustered trial.

AIM: To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. DESIGN: Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). SETTING: General population of 11-15-year-old adolescents in the Netherlands. PARTICIPANTS: A total of 3784 students of 23 Dutch secondary schools. MEASUREMENTS: Structured digital questionnaires were administered pre-intervention and at 32 months follow-up. The primary outcome measures were new incidences of alcohol (life-time and 1-month prevalence), tobacco (life-time and 1-month prevalence) and marijuana use (life-time prevalence). FINDINGS: Main effect analyses showed no programme effects on incidences of alcohol consumption (life-time prevalence: e-learning condition: B = 0.102, P = 0.549; integral condition: B = -0.157, P = 0.351; 1-month prevalence: e-learning condition: B = 0.191, P = 0.288; integral condition: B = -0.140, P = 0.445), tobacco consumption (life-time prevalence: e-learning condition: B = 0.164, P = 0.444; integral condition: B = 0.160, P = 0.119; 1-month prevalence: e-learning condition: B = 0.088, P = 0.746; integral condition: B = 0.261, P = 0.093), or marijuana consumption (life-time prevalence: e-learning condition: B = 0.070, P = 0.732; integral condition: B = 0.186, P = 0.214). CONCLUSION: The non-significant impact of the Healthy School and Drugs programme (a Dutch school-based prevention programme for early adolescents) on incidences of alcohol, tobacco and marijuana use indicates that the programme is either ineffective or implemented inadequately.

Are there reciprocal relationships between substance use risk personality profiles and alcohol or tobacco use in early adolescence?

AIM: We examined whether reciprocal relationships were present between the SURPS personality profiles and substance use in early adolescence. METHODS: Longitudinal data of four-waves of a broader effectiveness study were used from 1068 early adolescents. RESULTS: Our cross-lagged models indicated that sensation seeking and impulsivity show strongest reciprocal associations with substance use during early adolescence. In contrast, no reciprocity was present between substance use and anxiety sensitivity and only one reciprocal relationship was present between substance use and hopelessness. CONCLUSIONS: In trying to prevent early adolescents from alcohol and tobacco use, it might be of key importance to acknowledge the mutual influence between certain personality profiles and substance use. Specifically, sensation seeking and impulsivity are relevant during early adolescence and awareness of early adolescents' vulnerability for these personality predispositions is warranted.

Do substance use risk personality dimensions predict the onset of substance use in early adolescence? A variable- and person-centered approach.

Various studies found personality to be related to substance use, but little attention is paid to the role of personality risk dimensions with regard to an early onset of alcohol, tobacco, and marijuana use. Therefore, the current study used a variable-centered approach to examine whether anxiety sensitivity, hopelessness, sensation seeking, and impulsivity predict the onset of alcohol, tobacco, and marijuana use in early adolescence. Additionally, we adopted a person-centered approach to examine whether different personality subgroups could be identified, and whether these subgroups would be predictive of substance use. For that purpose, longitudinal data of a broader effectiveness study were used from 758 early adolescents (53 % female) aged 11-14 years. Structural equation models showed that hopelessness and sensation seeking were predictive of having ever used alcohol and tobacco. Also, sensation seeking was predictive of marijuana use. Latent profile analyses on the first wave data revealed a three-profile solution for boys (i.e., resilients, internalizers, and externalizers) and a two-profile solution for girls (i.e., resilients and internalizers). In contrast to our expectation, further analyses revealed no significant differences in substance use between the different subprofiles for both boys and girls. The separate personality dimensions thus seem more relevant in predicting the onset of substance use compared to the personality profiles. However, the personality profiles might be informative in explaining more excessive substance use behaviors.

The theory of planned behavior: precursors of marijuana use in early adolescence?

BACKGROUND: Precursors of marijuana use in early adolescence are largely unknown because studies generally focus on marijuana use among older adolescents or adults. METHODS: In this study, we examined precursors of marijuana use in a sample of 1023 Dutch early adolescents (aged 11-14 at Time 1) who were never-marijuana user at baseline, by applying a 3-wave longitudinal design. The theory of planned behavior (TPB) was used as a theoretical framework and posits that marijuana-specific cognitions (i.e., positive and negative expectancies, evaluative attitude, social approval, and self-efficacy) are antecedents of marijuana use and that this relationship is mediated by the intention to start using marijuana. RESULTS: In accordance with these premises, our results indicated that evaluative attitude, social approval, and self-efficacy at Time 1 are related to marijuana use at Time 3 (20 months follow-up) via the intention to start using marijuana at Time 2 (8 months follow-up). More specifically, the structural equation models showed that more positive marijuana attitudes, more approval from the social environment, and lower self-efficacy were related to marijuana use initiation through a stronger intention to start using marijuana. CONCLUSION: This outcome is important for prevention efforts in that our results underline the importance of weakening adolescents' positive attitudes toward marijuana, decrease social approval of marijuana use, and stimulating the development of early adolescents' refusal skills with respect to marijuana use.

Effectiveness of the universal prevention program 'Healthy School and Drugs': study protocol of a randomized clustered trial.

BACKGROUND: Substance use is highly prevalent among Dutch adolescents. The Healthy School and Drugs program is a nationally implemented school-based prevention program aimed at reducing early and excessive substance use among adolescents. Although the program's effectiveness was tested in a quasi-experimental design before, many program changes were made afterwards. The present study, therefore, aims to test the effects of this widely used, renewed universal prevention program. METHODS/DESIGN: A randomized clustered trial will be conducted among 3,784 adolescents of 23 secondary schools in The Netherlands. The trial has three conditions; two intervention conditions (i.e., e-learning and integral) and a control condition. The e-learning condition consists of three digital learning modules (i.e., about alcohol, tobacco, and marijuana) that are sequentially offered over the course of three school years (i.e., grade 1, grade 2, and grade 3). The integral condition consists of parental participation in a parental meeting on substance use, regulation of substance use, and monitoring and counseling of students' substance use at school, over and above the three digital modules. The control condition is characterized as business as usual. Participating schools were randomly assigned to either an intervention or control condition.Participants filled out a digital questionnaire at baseline and will fill out the same questionnaire three more times at follow-up measurements (8, 20, and 32 months after baseline). Outcome variables included in the questionnaire are the percentage of binge drinking (more than five drinks per occasion), the average weekly number of drinks, and the percentage of adolescents who ever drunk a glass of alcohol and the percentage of adolescents who ever smoked a cigarette or a joint respectively for tobacco and marijuana. DISCUSSION: This study protocol describes the design of a randomized clustered trial that evaluates the effectiveness of a school-based prevention program. We expect that significantly fewer adolescents will engage in early or excessive substance use behaviors in the intervention conditions compared to the control condition as a direct result of the intervention. We expect that the integral condition will yield most positive results, compared with the e-learning condition and control condition. TRIAL REGISTRATION: The protocol for this study is registered with the Nederlands Trial Register NTR1516.

Substance use risk profiles and associations with early substance use in adolescence.

We examined whether anxiety sensitivity, hopelessness, sensation seeking, and impulsivity (i.e., revised version of the Substance Use Risk Profile Scale) would be related to the lifetime prevalence and age of onset of alcohol, tobacco, and cannabis use, and to polydrug use in early adolescence. Baseline data of a broader effectiveness study were used from 3,783 early adolescents aged 11-15 years. Structural equation models showed that hopelessness and sensation seeking were indicative of ever-used alcohol, tobacco or cannabis and for the use of more than one substance. Furthermore, individuals with higher levels of hopelessness had a higher chance of starting to use alcohol or cannabis at an earlier age, but highly anxiety sensitive individuals were less likely to start using alcohol use at a younger age. Conclusively, early adolescents who report higher levels of hopelessness and sensation seeking seem to be at higher risk for an early onset of substance use and poly substance use.