The Learning Collaboratory: developing and evaluating public health students' skills while promoting community health.

Introduction: Complex and continuous developments in health and healthcare require innovative changes in programs that educate public health scientists and professionals. Public health change agents need critical competencies to confront today and tomorrow's leading problems including leadership, communication, interprofessional practice, and systems thinking. The context challenges in public health education: Public Health training programs teach competencies through their applied field experience and culminating project, typically late in the program, and often implemented in isolation from peers and faculty. Objectives and skills do not always align closely with community-based program needs. Students pursuing a degree in science in public health need to deeply comprehend multi-dimensional and interconnected systemic problems and communicate with diverse stakeholders across disciplines to produce relevant community-engaged research. The University of Miami Public Health Learning Collaboratory (LC) was established to transform the learning experience of public health master's students by providing opportunities to develop necessary core skills for effective public health practice early in their training, while applying these skills to address real-world public health needs in the community. The Learning Collaboratory structure pedagogical approach and programmatic details: Spanning an average of 3 semesters, the LC promotes student involvement in collaborative and impactful capstone and thesis projects. Practice-based teaching and service learning are central approaches to teaching cross-cutting competencies of leadership, communication, problem solving, collaboration, and systems thinking in public health. Significant to the approach is the engagement of previous cohorts of senior students to teach back to junior students, further integrating concepts learned. Long term alumni feedback recognized strengths of the program, including its structure, teamwork & collaboration, critical thinking & problem solving, guidance, nurture & support, teaching back, and content & curriculum. Community partners agreed the LC prepared students to practice in the field of public health. Discussion: The LC is a promising model for master's level public health education and community application, given the opportunities it provides to strengthen and integrate students' public health skills in a supportive environment, and enhance the transferability and sustainability of student and faculty's community public health work.

eHealth Familias Unidas Mental Health: Protocol for an effectiveness-implementation hybrid Type 1 trial to scale a mental health preventive intervention for Hispanic youth in primary care settings.

This article focuses on the rationale, design and methods of an effectiveness-implementation hybrid type I randomized trial of eHealth Familias Unidas Mental Health, a family-based, online delivered intervention for Hispanic families to prevent/reduce depressive and anxious symptoms, suicide ideation/behaviors, and drug use in Hispanic youth. Utilizing a rollout design with 18 pediatric primary care clinics and 468 families, this study addresses intervention effectiveness, implementation research questions, and intervention sustainment, to begin bridging the gap between research and practice in eliminating mental health and drug use disparities among Hispanic youth. Further, we will examine whether intervention effects are partially mediated by improved family communication and reduced externalizing behaviors, including drug use, and moderated by parental depression. Finally, we will explore whether the intervention's impact on mental health and drug use, as well as sustainment of the intervention in clinics, varies by quality of implementation at clinic and clinician levels. Trail registration: ClinicalTrials.gov Identifier: NCT05426057, First posted June 21, 2022.

Sociodemographic Correlates of Affordable Community Behavioral Health Treatment Facility Availability in Florida: A Cross-Sectional Study.

Behavioral health disorders such as mental disorders (MD) and substance use disorders (SUD) are epidemics in the US; however, the availability of treatment and prevention services remains low. This study assessed neighborhood-level sociodemographic attributes to characterize the availability of behavioral health treatment facilities in Florida. The American Community Survey and SAMHSA's Behavioral Health Treatment Locator were used to identify behavioral health treatment facilities in Florida and calculate their density by census tract. Spatial lag regression models were used to assess census tract-level correlates of facility density for 390 MD treatment facilities, 518 SUD facilities, and subsets of affordable MD and SUD facilities. Behavioral health treatment facility density was negatively associated with rurality and positively associated with the proportion of non-Latino Black, Latino, insured, and college-educated populations. Stark rural-urban disparities in behavioral health treatment availability present opportunities to prioritize telehealth and mobile interventions and improve treatment utilization.

Familias Unidas Prevents Youth Internalizing Symptoms: a Baseline Target Moderated Mediation (BTMM) Study.

Family-based preventive interventions have been found to prevent youth internalizing symptoms, yet they operate through diverse mechanisms with heterogeneous effects for different youth. To better target preventive interventions, this study examines the effects of the Familias Unidas preventive intervention on reducing internalizing symptoms with a universal sample of Hispanic youth in a real-world school setting (i.e., effectiveness trial). The study utilizes emerging methods in baseline target moderated mediation (BTMM) to determine whether the intervention reduces internalizing symptoms through its impact on three distinct mechanisms: family functioning, parent stress, and social support for parents. Data are from a randomized controlled effectiveness trial of 746 Hispanic eighth graders and their parents assessed at baseline, 6-, 18-, and 30-month post-baseline. BTMM models examined three moderated mechanisms through which the intervention might influence 30-month adolescent internalizing symptoms. The intervention decreased youth internalizing symptoms through improvements in family functioning in some models, but there was no evidence of moderation by baseline level of family functioning. There was some evidence of mediation through increasing social support for parents for those intervention parents presenting with lower baseline support. However, there was no evidence of mediation through parent stress. Post hoc analyses suggest a possible cascading of effects where improvements in support for parents strengthened parental monitoring of youth and ultimately reduced youth internalizing symptoms. Findings support the intervention's effects on internalizing symptoms in a universal, real-world setting, and the value of BTMM methods to improve the targeting of preventive interventions. ClinicalTrials.gov Identifier: NCTO1038206, First Posted: December 23, 2009.

Preventing alcohol use among Hispanic adolescents through a family-based intervention: The role of parent alcohol misuse.

Early-life alcohol use raises the risk of poor long-term alcohol and other health outcomes. U.S. Hispanics are less likely to access treatment if they develop alcohol abuse or dependence, making preventive interventions critical. Familias Unidas is a family-based intervention effective in preventing drug and sexual risk behavior among Hispanic youth. The effects of this intervention specifically on youth alcohol use have been less consistent and may be affected by parental factors. The intervention is primarily delivered to parents to ultimately reduce youth risk behaviors, applying research on protective parenting and family influences, such as parental monitoring and positive communication. This study conducted secondary data analysis of an effectiveness randomized controlled trial of the Familias Unidas intervention, examining parent moderators of intervention effects on adolescent alcohol use. A total of 746 Hispanic families with 12-16-year-old adolescents were randomized to intervention or control. Logistic regression analyses confirmed no evidence of intervention effectiveness in reducing 90-day adolescent alcohol use at 30-month follow-up. However, there was evidence that parent misuse moderated intervention effects on adolescent alcohol use. Among youth whose parents reported any episode of alcohol misuse in their lifetime, the intervention was associated with lower odds of youth alcohol use at 30 months compared to youth in the control condition. Potential reasons and intervention implications are reviewed, including how parent alcohol use experiences might raise awareness of youth risks and motivate involvement or protective behaviors. Understanding intervention moderators can help shape, target, and adapt interventions to enhance their effectiveness and reach. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Secondary Analysis to Inform the Development of Adaptive Preventive Interventions.

For the past 30 years, scholars across the fields of epidemiology, education, psychology, and numerous other fields have worked to develop interventions designed to reduce risk and enhance protection to prevent mental, emotional, and behavioral problems across the lifespan. This article presents a series of next steps that leverage this foundational science to inform the development of adaptive preventive interventions. Adaptive preventive interventions (APIs) tailor the intervention to fit the diverse, sometimes changing, needs of participants with the goal of better prevention outcomes for more individuals. Secondary analyses of data from preventive intervention trials to identify moderators, mediators, and antecedents of attrition and intervention failure can be useful for designing effective APIs. Moderators that identify intervention effect heterogeneity can be used within an API to tailor the intervention to meet the unique needs of important participant subgroups. Mediators and predictors of disengagement and attrition can be helpful tailoring variables in an API to trigger change to the intervention. Preventive intervention trials that incorporate frequent assessment of potential mediators, moderators, and antecedents of attrition during the intervention period are needed. Secondary analyses of data from preventive intervention trials provide an important foundation for next-generation APIs.

Reducing Screen-Based Sedentary Behavior Among Overweight and Obese Hispanic Adolescents Through a Family-Based Intervention.

BACKGROUND: Sedentary behaviors, including screen-based activities, are associated with obesity, cardiovascular, and mental health risks. In the US, minority and socioeconomically disadvantaged youth engage in substantial sedentariness, requiring targeted interventions. Familias Unidas for Health and Wellness (FUHW) is a family intervention to reduce risks among Hispanic youth with overweight and obesity. Analyses examined (1) FUHW's impact on parent and adolescent screen-based sedentary behavior and (2) differential intervention effects by adolescent gender, internalizing symptoms, and body mass index. METHODS: A total of 280 overweight/obese Hispanic middle schoolers and parents were randomized to FUHW or control and assessed at baseline, 6, 12, and 24 months between 2015 and 2019. RESULTS: Linear growth models showed that exposure to FUHW was not associated with parent sedentary behavior over time (b = -0.11, P = .32) but was associated with decreases in adolescent sedentary behavior (b = -0.27, P = .03). Neither gender nor internalizing symptoms moderated intervention effects, but there were differential effects by body mass index. Compared to controls, FUHW showed significant decreases in sedentary behavior among overweight (b = -0.85, P < .01) and obese (b = -0.79, P < .01) youth but not severely obese youth. CONCLUSIONS: FUHW reduced youth screen-based sedentary behavior. Youth with severe obesity require additional intervention.

Evaluating construct equivalence of youth depression measures across multiple measures and multiple studies.

Construct equivalence of measures across studies is necessary for synthesizing results when combining data in meta-analysis or integrative data analysis. We discuss several assumptions required for construct equivalence, and review methods using individual-level data and item response theory (IRT) analysis for detecting or adjusting for violations of these assumptions. We apply IRT to data from 7 measures of depressive symptoms for 4,283 youth from 16 randomized prevention trials. Findings indicate that these data violate assumptions of conditional independence. Bifactor IRT models find that depression measures contain substantial reporter variance, and indicate that a single common factor model would be substantially biased. Separate analyses of ratings by youth find stronger evidence for construct equivalence, but factor invariance across sex and age does not hold. We conclude that data synthesis studies employing measures of youth depression should analyze results separately by reporter, explore more complex approaches to integrate these different perspectives, and explore methods that adjust for sex and age differences in item functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neighbourhood greenness and depression among older adults.

BACKGROUND: Neighbourhood greenness or vegetative presence has been associated with indicators of health and well-being, but its relationship to depression in older adults has been less studied. Understanding the role of environmental factors in depression may inform and complement traditional depression interventions, including both prevention and treatment.AimsThis study examines the relationship between neighbourhood greenness and depression diagnoses among older adults in Miami-Dade County, Florida, USA. METHOD: Analyses examined 249 405 beneficiaries enrolled in Medicare, a USA federal health insurance programme for older adults. Participants were 65 years and older, living in the same Miami location across 2 years (2010-2011). Multilevel analyses assessed the relationship between neighbourhood greenness, assessed by average block-level normalised difference vegetative index via satellite imagery, and depression diagnosis using USA Medicare claims data. Covariates were individual age, gender, race/ethnicity, number of comorbid health conditions and neighbourhood median household income. RESULTS: Over 9% of beneficiaries had a depression diagnosis. Higher levels of greenness were associated with lower odds of depression, even after adjusting for demographics and health comorbidities. When compared with individuals residing in the lowest tertile of greenness, individuals from the middle tertile (medium greenness) had 8% lower odds of depression (odds ratio 0.92; 95% CI 0.88, 0.96; P = 0.0004) and those from the high tertile (high greenness) had 16% lower odds of depression (odds ratio 0.84; 95% CI 0.79, 0.88; P < 0.0001). CONCLUSIONS: Higher levels of greenness may reduce depression odds among older adults. Increasing greenery - even to moderate levels - may enhance individual-level approaches to promoting wellness.Declaration of interestNone.

Screen-based sedentary behaviors and internalizing symptoms across time among U.S. Hispanic adolescents.

INTRODUCTION: The pervasive use of technology has raised concerns about its association with adolescent mental health, including internalizing symptoms. Existing studies have not always had consistent findings. Longitudinal research with diverse subgroups is needed. METHODS: This study examines the relationship between screen-based sedentary (SBS) behaviors and internalizing symptoms among 370 Hispanic adolescents living in Miami, Florida- United States, who were followed for 2 ½ years and assessed at baseline, 6, 18 and 30 months post-baseline between the years 2010 and 2014. Approximately 48% were girls, and 44% were foreign-born, most of these youth being from Cuba. Mean age at baseline was 13.4 years, while at the last time-point it was 15.9 years. RESULTS: Findings show that girls had higher internalizing symptoms and different patterns of screen use compared to boys, including higher phone, email, and text use. SBS behaviors and internalizing symptoms cooccurred at each time-point, and their trajectories were significantly related (r = 0.45, p < .001). Cross-lagged panel analyses found that SBS behaviors were not associated with subsequent internalizing symptoms. Among girls, however, internalizing symptoms were associated with subsequent SBS behaviors during later adolescence, with internalizing symptoms at the 18-month assessment (almost 15 years old) associated with subsequent SBS behaviors at the 30-month assessment (almost 16 years old; ß = 0.20, p < .01). CONCLUSIONS: Continued research and monitoring of internalizing symptoms and screen use among adolescents is important, especially among girls. This includes assessments that capture quantity, context, and content of screen time.

Evidence-based prevention programs targeting youth mental and behavioral health in primary care: A systematic review.

The objectives of this systematic review were to: 1) identify evidence-based youth (i.e., infancy, pre-school age, school age, and adolescence) mental and behavioral health disorder preventive interventions conducted in or offered by primary care settings, and 2) describe these interventions' characteristics, efficacy, and clinical involvement. Randomized controlled trials that targeted the prevention of mental or behavioral health outcomes for youth and had a connection to primary care were included. The PRISMA guidelines were utilized for two phases: 1) searching PubMed, EMBASE, PsycInfo, CINAHL, and Cochrane databases in January 2017; and 2) searching United States Preventive Services Task Force (USPSTF) Systematic Reviews in November 2017. The two phases revealed 504 and 58 potential articles, respectively. After removal of duplicates, screening of abstracts, and full-text reviews, 19 interventions (infancy: n = 2, pre-school age: n = 3, school age: n = 6, adolescence: n = 8) were included: 1) 10 interventions described in 17 articles from the databases, and 2) 9 interventions described in 11 articles from the USPSTF reviews. The included interventions capitalized on primary care settings as a natural entry point to engage youth and families into interventions without requiring a large amount of clinic involvement. Commonalities of efficacious interventions and recommendations for future research are discussed. The authors encourage primary care providers, mental and behavioral health providers, and/or public health researchers to continue developing and testing preventive interventions, or adapting existing interventions, to be implemented in primary care.

Health Disparities in the Relationship of Neighborhood Greenness to Mental Health Outcomes in 249,405 U.S. Medicare Beneficiaries.

Prior studies suggest that exposure to the natural environment may be important for optimal mental health. The present study examines the association between block-level greenness (vegetative presence) and mental health outcomes, in a population-based sample of 249,405 U.S. Medicare beneficiaries aged ≥65 years living in Miami-Dade County, Florida, USA, whose location did not change from 2010 to 2011. Multilevel analyses examined relationships between greenness, as measured by mean Normalized Difference Vegetation Index from satellite imagery at the Census block level, and each of two mental health outcomes; Alzheimer's disease and depression, respectively, after statistically adjusting for age, gender, race/ethnicity, and neighborhood income level of the individuals. Higher block-level greenness was linked to better mental health outcomes: There was a reduced risk of Alzheimer's disease (by 18%) and depression (by 28%) for beneficiaries living in blocks that were 1 SD above the mean for greenness, as compared to blocks that were 1 SD below the mean. Planned post-hoc analyses revealed that higher levels of greenness were associated with even greater mental health benefits in low-income neighborhoods: An increase in greenness from 1 SD below to 1 SD above the mean was associated with 37% lower odds of depression in low-income neighborhoods, compared to 27% and 21% lower odds of depression in medium- and high-income neighborhoods, respectively. Greenness may be effective in promoting mental health in older adults, particularly in low-income neighborhoods, possibly as a result of the increased opportunities for physical activity, social interaction, or stress mitigation.

Programs for Preventing Depression in Adolescence: Who Benefits and Who Does Not? An Introduction to the Supplemental Issue.

We introduce this supplemental issue of Prevention Science, which brings together a set of papers from leading investigators who have conducted trials testing whether intervention programs prevent adolescent depression. Using data from these trials, these papers explore a series of factors that might account for variation in intervention benefit, employing several novel methods for assessing effect heterogeneity. These studies follow two general paradigms: three papers report findings from single randomized preventive intervention trials, while the remaining papers develop and apply new methods for combining data from multiple studies to evaluate effect heterogeneity more broadly. Colleagues from NIMH and SAMHSA also provide commentaries on these studies. They conclude that synthesis of findings from multiple trials holds great promise for advancing the field, and progress will be accelerated if collaborative data sharing becomes the norm rather than the exception.

Two-Year Impact of Prevention Programs on Adolescent Depression: an Integrative Data Analysis Approach.

This paper presents the first findings of an integrative data analysis of individual-level data from 19 adolescent depression prevention trials (n = 5210) involving nine distinct interventions across 2 years post-randomization. In separate papers, several interventions have been found to decrease the risk of depressive disorders or elevated depressive/internalizing symptoms among youth. One type of intervention specifically targets youth without a depressive disorder who are at risk due to elevated depressive symptoms and/or having a parent with a depressive disorder. A second type of intervention targets two broad domains: prevention of problem behaviors, which we define as drug use/abuse, sexual risk behaviors, conduct disorder, or other externalizing problems, and general mental health. Most of these latter interventions improve parenting or family factors. We examined the shared and unique effects of these interventions by level of baseline youth depressive symptoms, sociodemographic characteristics of the youth (age, sex, parent education, and family income), type of intervention, and mode of intervention delivery to the youth, parent(s), or both. We harmonized eight different measures of depression utilized across these trials and used growth models to evaluate intervention impact over 2 years. We found a significant overall effect of these interventions on reducing depressive symptoms over 2 years and a stronger impact among those interventions that targeted depression specifically rather than problem behaviors or general mental health, especially when baseline symptoms were high. Implications for improving population-level impact are discussed.

Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response.

Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms for some youth. This paper examines variation in intervention response for internalizing symptoms using individual-level data pooled across four distinct Familias Unidas trials: (1) 266 eighth grade students recruited from the general school population; (2) 160 ninth grade students from the general school population; (3) 213 adolescents with conduct, aggression, and/or attention problems; and (4) 242 adolescents with a delinquency history. Causal inference growth mixture modeling suggests a three-class model. The two largest classes represent youth with low (60 %) and medium (27 %) internalizing symptoms at baseline, and both intervention and control participants show reductions in internalizing symptoms. The third class (13 %) represents youth with high levels of baseline internalizing symptoms who remain at steady levels of internalizing symptoms when exposed to the intervention, but who experience an increase in symptoms under the control condition. Female gender, low baseline levels of parent-adolescent communication, and older age were associated with membership in the high-risk class. These synthesis analyses involving a large sample of youth with varying initial risk levels represent a further step toward strengthening our knowledge of preventive intervention response and improving preventive interventions.

Predictors of Participation in an eHealth, Family-Based Preventive Intervention for Hispanic Youth.

The Familias Unidas intervention is an efficacious family-based preventive intervention for reducing substance use and other health risks among Hispanic youth. A current randomized controlled trial (RCT) is examining this intervention's efficacy when delivered via the Internet (eHealth). eHealth interventions can overcome logistical barriers to participation, yet there is limited information about the feasibility of these interventions, especially among ethnic minorities. This paper examines participation and predictors of participation in the eHealth Familias Unidas intervention in a sample of 113 Hispanic families whose adolescent had behavioral problems. Analyses examined multidimensional ways of characterizing participation, including the following: (1) total intervention participation, (2) initial engagement (participating in at least one of the first three intervention sessions), (3) completing the pre-recorded, eHealth parent group sessions, and (4) participating in the live, facilitator-led, eHealth family sessions. Participation in this eHealth intervention was comparable to, and in most cases higher than, previous, face-to-face Familias Unidas interventions. High levels of baseline family stress were associated with lower initial engagement and lower family session participation. Greater parental Hispanicism was associated with more participation in eHealth parent group sessions and across the total intervention. Higher levels of baseline effective parenting, in other words less intervention need, were significantly associated with lower levels of total intervention participation and lower levels of family session participation. Implications for preventive interventions delivered via Internet are discussed.

Association between Socio-Ecological Risk Factor Clustering and Mental, Emotional, and Behavioral Problems in Hispanic Adolescents.

Compared to non-Hispanic whites, Hispanic adolescents in the U.S. report higher rates of several mental, emotional, and behavioral (MEB) problems such as substance use, sexual risk behaviors, and internalizing and externalizing problems. There is evidence of common pathways in the development of MEB problems with certain subgroups of Hispanic adolescents being at greater risk. In the present article, we report analysis of baseline data for 959 Hispanic adolescents who participated in one of two randomized controlled trials evaluating a family-based preventive intervention. Utilizing latent class analysis, we identified subgroups of Hispanic adolescents based on socio-ecological risk and protective factors (e.g., parent-adolescent communication, parental involvement in school). Three distinct socio-ecological risk subgroups (high, medium, and low risk) were identified and exhibited significant differences from each other across a majority of socio-ecological risk and protective factors. Adolescents in higher socio-ecological risk subgroups reported greater MEB problems across all outcomes. Individual comparisons revealed significant differences between the low socio-ecological risk group and both the medium and high socio-ecological risk group in lifetime alcohol use, smoking, and sex, as well as internalizing and externalizing problems. Implications for intervention include focusing on specific risk subgroups and targeting shared risk and protective factors rather than specific MEB outcomes.

eHealth Familias Unidas: Pilot Study of an Internet Adaptation of an Evidence-Based Family Intervention to Reduce Drug Use and Sexual Risk Behaviors Among Hispanic Adolescents.

This paper describes the Internet adaptation of an evidenced-based intervention for Hispanic families, eHealth Familias Unidas, and explores whether an Internet-based format is feasible and acceptable to Hispanic families. Core intervention components from the evidence-based intervention, Familias Unidas, were transposed into a video format and edited for content. Additionally, interactive exercises and a soap opera series were incorporated to reinforce intervention content and optimize participant engagement and retention. To understand the feasibility and acceptability of eHealth Familias Unidas, we conducted a pilot study and examined findings from: (1) session completion rates for both e-parent group sessions and family sessions (n = 23 families); and (2) qualitative data collected from Hispanic parents (n = 29) that received the eHealth intervention. Engagement and attendance in the intervention showed that 83% of families engaged in the intervention and that there was an overall session completion rate of 78%. Qualitative interviews were conducted mid and post intervention with a combined total of 29 participants. A general inductive approach was used to derive themes from the collected data. Overall, parents expressed positive feedback in regards to the intervention and stated that there were multiple lessons learned from participating in eHealth Familias Unidas. Findings indicate that an Internet-based family intervention is not only feasible and acceptable for Hispanic families, but also offers a viable option to ameliorate barriers to participation and implementation of preventive interventions.

Clinic Personnel, Facilitator, and Parent Perspectives of eHealth Familias Unidas in Primary Care.

INTRODUCTION: The purpose of this qualitative study was to understand the feasibility and acceptability of implementing eHealth Familias Unidas, an Internet-based, family-based, preventive intervention for Hispanic adolescents, in primary care. METHODS: Semistructured individual interviews with clinic personnel and facilitators (i.e., physicians, nurse practitioners, administrators, and mental health workers; n = 9) and one focus group with parents (n = 6) were audiorecorded, transcribed verbatim, and analyzed using a general inductive approach. RESULTS: Nine major themes emerged, including recommendations to minimize disruption to clinic flow, improve collaboration and training of clinic personnel and the research team, promote the clinic as a trusted setting for improving children's behavioral health, and highlight the flexibility and convenience of the eHealth format. DISCUSSION: This study provides feasibility and acceptability findings, along with important considerations for researchers and primary care personnel interested in collaborating to implement an eHealth preventive intervention in pediatric primary care.