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Preventing youth substance misuse: Programs that work in schools

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: Substance misuse comes with great costs for individuals and for society, including compromised mental and physical health, loss of productivity, reduced quality of life, increased justice and health care costs, and even premature disability and death. The most effective and humane way to avert these costs is to prevent substance misuse from occurring by intervening early with young people.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating school-based interventions designed to prevent adolescent substance.  Applying our inclusion criteria to the 152 studies identified from our searches, we accepted eight RCTs.

Results: Two programs — Unplugged and Project PATHS — showed success in preventing substance misuse. Unplugged provided youth with information on the effects of substances and taught them skills, including being assertive and resisting peer pressure. Project PATHS focused on positive adolescent development by teaching problem-solving and building family relationships. Both programs were delivered by teachers.

Conclusions: Compelling evidence shows that substance misuse prevention programs can be successfully delivered in schools by school staff. By investing in these programs, it is possible to avert needless suffering.

Treating substance misuse in young people

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: At any given time, an estimated 2.4% of Canadian youth use alcohol or drugs at a level that qualifies for a substance use disorder diagnosis, with alcohol and cannabis problems being the most common. Given that substance use disorders take a tremendous toll on young people and can become entrenched, effective interventions need to be provided early in life.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to treat adolescent substance use disorders.  Applying our inclusion criteria to the 104 studies identified from our searches, we accepted eight RCTs.

Results: The following seven community-based treatments showed evidence of success: Adolescent Cannabis Check-Up, Case Management, Cognitive Behavioural Therapy (CBT), Community Reinforcement, Ecologically Based Family Therapy, Motivational Interviewing and Multidimensional Family Therapy. Of these, CBT, Multidimensional Family Therapy and Motivational Interviewing had particularly strong evidence of effectiveness, with positive outcomes from multiple RCTs.

Conclusions: There are many effective interventions for treating youth substance misuse. By intervening at this early point in the lifespan, it is possible to avert far more serious problems later in life.

Preventing child maltreatment

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: All children need safety, stability and nurturing in order to flourish. Yet many children experience maltreatment, including neglect, emotional abuse, exposure to intimate partner violence, physical abuse or sexual abuse. Consequently, effective interventions to prevent maltreatment are crucial.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to prevent child maltreatment.  Applying our inclusion criteria to the 43 studies identified from our searches, we accepted three RCTs.

Results: We found strong evidence showing two programs — Child FIRST and Nurse-Family Partnership (NFP) — were successful in preventing child maltreatment. NFP, which targets key risk factors for maltreatment, including socio-economic disadvantage resulted particularly strong benefits, including reducing families’ involvement with child protective services as well as reducing child behaviour problems and improving mothers’ life circumstances. 

Conclusions: The success of NFP and Child FIRST provides evidence that child maltreatment can be prevented.

Helping children who have been maltreated

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: Child maltreatment is an avoidable form of adversity that puts children at risk for negative mental health and life course outcomes making prevention imperative. Nevertheless, when maltreatment has occurred, interventions can help reduce harm for children while also supporting parents.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for children who have been maltreated. Applying our inclusion criteria to the 68 studies identified from our searches, we accepted seven RCTs.

Results: Six interventions showed benefits. Promoting First Relationships reduced child apprehensions due to maltreatment and improved children’s behaviour and emotional responses. Child-Parent Psychotherapy increased children’s “secure attachment” to their mothers and improved their behaviour. Project Support reduced physical abuse among children exposed to intimate partner violence and improved children’s behaviour and emotional well-being. Multisystemic Therapy reduced re-abuse and out-of-home placements; it also reduced child posttraumatic stress, dissociation, and other emotional and behavioural problems. Fostering Healthy Futures reduced placement changes as well as child dissociation and emotional distress. Finally, It’s My Turn Now reduced children’s posttraumatic stress symptoms.

Conclusions: The best way to help children flourish is to support families to meet children’s basic needs, including preventing maltreatment. When children have been mistreated, practitioners should intervene before mental health symptoms develop given that emotional or behavioural problems can be prevented. Finally, children who have been maltreated and then develop emotional or behavioural symptoms need to receive effective interventions as quickly as possible.

Barriers and Facilitators to Hepatitis B Vaccination Among Sex Workers in Vancouver, Canada: Implications for Integrated HIV, STI, and Viral Hepatitis Services

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-09
Abstract: 

Objectives

Sex workers (SWs) face an increased burden of sexually transmitted and blood-borne infections, yet little is known regarding hepatitis B virus (HBV) prevention and care. This study was performed to characterize cross-sectional and prospective correlates of HBV vaccination among SWs in Vancouver.

 

Methods

Questionnaire data were drawn from a community-based cohort of SWs (2010–2017). Multivariable logistic regression was used to examine correlates of lifetime self-reported HBV vaccination. Multivariable generalized estimating equation (GEE) regression was used to assess correlates of recent vaccination.

 

Results

Among 855 participants, 68.3% reported lifetime HBV vaccination. Multivariable logistic regression showed that im/migrants (adjusted odds ratio (AOR) 0.50, 95% confidence interval (CI) 0.32–0.78) had lower odds of vaccination and that those using injection drugs (AOR 1.88, 95% CI 1.27– 2.78) and those who had undergone HIV testing (AOR 1.94, 95% CI 1.14–3.29) had higher odds of vaccination. In the multivariable GEE analysis, HIV seropositivity (AOR 1.93, 95% CI 1.26–2.97) and recent STI testing (AOR 2.95, 95% CI 1.99–4.39) correlated with recent HBV vaccination.

 

Conclusions

Im/migrant SWs from HBV-endemic settings appear to face gaps in HBV prevention. Evidence-based interventions addressing gaps in voluntary HBV prevention and care are needed, including community-based and culturally safe services. Injection drug use and HIV testing were linked to enhanced vaccination, suggesting that harm reduction and HIV programmes may facilitate linkage to HBV prevention.

Document type: 
Article
File(s): 

Helping youth with bipolar disorder

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019
Abstract: 

Background: Although bipolar disorder is rare in young people, effective treatments are critical for those experiencing it.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for youth with bipolar disorder. Applying our inclusion criteria to the 50 studies identified from our searches, we accepted 12 RCTs.

Results: Among the five medications assessed, aripiprazole and lithium stood out. Aripiprazole significantly reduced disorder severity and manic symptoms while improving overall functioning. Lithium also reduced manic symptoms while improving overall functioning. Still, both had significant side effects. Among the three psychosocial interventions assessed — Multifamily Psychoeducational Psychotherapy, Child and Family-Focused Cognitive-Behavioural Therapy, and Family-Focused Therapy — all showed benefit. In contrast, the dietary supplement flax oil was not effective.

Conclusions: Most young people with bipolar disorder will need medication to manage this condition. Aripiprazole and lithium should be considered first, given their effectiveness and their regulatory approval. The three effective psychosocial treatments should also be considered as an adjunct to medication. 

Helping youth who self-harm

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019
Abstract: 

Background: Approximately one in five young people will engage in self-harm at some point during adolescence.  Many of these youth would benefit from treatment to learn better ways of coping.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for youth who self-harm. Applying our inclusion criteria to the 49 studies identified from our searches, we accepted seven RCTs evaluating five interventions.

Results: All psychosocial interventions were delivered to youth engaging in self-harm.  Among them, four RCTs evaluated treatments that aimed to comprehensively address self-harm and were delivered as stand-alone interventions. The other three RCTs assessed treatments aimed to address self-harm by supplementing standard clinical care.  Of the stand-alone treatments, Dialectical Behaviour Therapy (DBT) and Mentalization-Based Treatment both proved effective. DBT stood out for significantly reducing self-harm, suicide attempts and suicidal ideation according to two RCTs, conducted in Norway and the United States.  One supplementary treatment, Resourceful Adolescent Parent Program, also succeeded. This program, provided to parents, was effective in reducing youth self-harm and suicide attempts.

Conclusions: By the time a young person or their family seeks help for self-harm, feelings of distress may be daunting. Consequently, it is essential that effective treatments are provided immediately. 

Gender Differences in Mental Disorders, Substance Use, and Service Use among Indigenous Canadians Experiencing Homelessness and Mental Illness

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-28
Abstract: 

Background

Indigenous people are over represented among homeless populations worldwide and the prevalence of Indigenous homelessness appears to be increasing in Canadian cities. Violence against Indigenous women in Canada has been widely publicized but has not informed the planning of housing interventions. Despite historical policies leading to disenfranchisement of Indigenous rights in gender-specific ways, little is known about contemporary differences in need between homeless Indigenous men and women. This study investigated mental health, substance use and service use among Indigenous people who met criteria for homelessness and mental illness, and hypothesized that, compared to men, women would have significantly higher rates of trauma, suicidality, substance dependence, and experiences of violence.

Methods

This study was conducted using baseline (pre-randomization) data from a multi-site trial. Inclusion in the current analyses was restricted to participants who self-reported Indigenous ethnicity, and combined eligible participants from Vancouver, BC and Winnipeg, MB. Logistic regression analyses were used to model the independent associations between gender and outcome variables.

Results

In multivariable regression models among Indigenous participants (n = 439), female gender was predictive of meeting criteria for PTSD, multiple mental disorders, current high suicidality and current substance dependence. Female gender was also significantly associated with reported physical (AOR: 1.52, 95% CI = 1.10–2.23) and sexual (AOR: 6.31, 95% CI = 2.78–14.31) violence.

Conclusions

Our analyses of Indigenous men and women who are homeless illustrate the distinct legacy of colonization on the experiences of Indigenous women. Our findings are consistent with the widely documented violence against Indigenous women in Canada. Housing policies and services are urgently needed that take Indigenous historical contexts, trauma and gender into account.

Document type: 
Article
File(s): 

The British Columbia Healthy Connections Project: Findings on Socioeconomic Disadvantage in Early Pregnancy

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-22
Abstract: 

Background

Maternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems — particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada.

 Methods

Participants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons.

 Results

Most participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use (p-value ≤0.05).

 Conclusions

This cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities — at higher rates than other Canadians. Furthermore, despite Canada’s public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children.

 Trial registration

Registered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060. Active not recruiting.

Document type: 
Article
File(s): 

The Relationship between Gender, Parenthood and Practice Intentions among Family Medicine Residents: Cross-Sectional Analysis of National Canadian Survey Data

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-15
Abstract: 

Background: Family medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents.

Methods: We conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics.

Results: Almost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do.

Conclusions: Both parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide comprehensive care soon after entering practice.

Background: Family medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents.

Methods: We conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics.

Results: Almost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do.

Conclusions: Both parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide comprehensive care soon after entering practice.

 

Document type: 
Article
File(s):