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Evaluating the Impact Of Implementing Public Bicycle Share Programs On Cycling: The International Bikeshare Impacts On Cycling and Collisions Study (IBICCS)

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-11-20
Abstract: 

Background

Despite rapid expansion of public bicycle share programs (PBSP), there are limited evaluations of the population-level impacts of these programs on cycling, leaving uncertainty as to whether these programs lead to net health gains at a population level or attract those that already cycle and are sufficiently physically active. Our objective was to determine whether the implementation of PBSPs increased population-level cycling in cities across the US and Canada.

Methods

We conducted repeat cross-sectional surveys with 23,901 residents in cities with newly implemented PBSPs (Chicago, New York), existing PBSPs (Boston, Montreal, Toronto) and no PBSPs (Detroit, Philadelphia, Vancouver) at three time points (Fall 2012, 2013, 2014). We used a triple difference in differences analysis to assess whether there were increases in cycling over time amongst those living in closer proximity (< 500 m) to bicycle share docking stations in cities with newly implemented and existing PBSPs, relative to those in cities with no PBSPs.

Results

Living in closer proximity to bicycle share predicted increases in cycling over time for those living in cities with newly implemented PBSPs at 2-year follow-up. No change was seen over time for those living in closer proximity to bicycle share in cities with existing PBSPs relative to those in cities with no PBSP.

Conclusion

These findings indicate that PBSPs are associated with increases in population-level cycling for those who live near to a docking station in the second year of program implementation.

Document type: 
Article
File(s): 

Moving Into an Urban Drug Scene among People Who Use Drugs in Vancouver, Canada: Latent Class Growth Analysis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-11-14
Abstract: 

Background

Urban drug scenes are characterized by high prevalence of illicit drug dealing and use, violence and poverty, much of which is driven by the criminalization of people who use illicit drugs (PWUD) and the associated stigma. Despite significant public health needs, little is understood about patterns of moving into urban drug scenes among PWUD. Therefore, we sought to identify trajectories of residential mobility (hereafter ‘mobility’) among PWUD into the Downtown Eastside (DTES), an urban neighbourhood with an open drug scene in Vancouver, Canada, as well as characterize distinct trajectory groups among PWUD.

 

Methods

Data were derived from three prospective cohort studies of community-recruited PWUD in Vancouver between 2005 and 2016. We used latent class growth analysis (LCGA) to identify distinct patterns of moving into the DTES among participants residing outside of DTES at baseline. Multivariable multinomial logistic regression was used to determine baseline factors associated with each trajectory group.

 

Results

In total, 906 eligible participants (30.9% females) provided 9,317 observations. The LCGA assigned four trajectories: consistently living outside of DTES (52.8%); early move into DTES (11.9%); gradual move into DTES (19.5%); and move in then out (15.8%). Younger PWUD, those of Indigenous ancestry, those who were homeless or living in a single-room occupancy hotel (SRO), and those injecting drugs daily were more likely to move in then out of DTES (all p<0.05). Living in an SRO, daily injection drug use, and recent incarceration were also positively associated with early mobility (all p<0.05).

 

Conclusions

Nearly half of the participants moved into the DTES. Younger PWUD and Indigenous peoples appeared to have particularly high mobility, as did those with markers of social-structural vulnerability and high intensity drug use. These findings indicate a need to tailor existing social and health services within the DTES and expand affordable housing options outside the DTES.

Document type: 
Article
File(s): 

Six decades of preventing and treating childhood anxiety disorders: A systematic review and meta-analysis to inform policy and practice

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

Question Anxiety disorders are the most prevalent childhood mental disorders. They also start early and persist, causing high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders?

Methods We sought randomised controlled trials (RCTs) evaluating interventions addressing anxiety problems in young people. We identified RCTs by searching CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science. Thirty-three RCTs met inclusion criteria—evaluating 8 prevention programmes, 12 psychosocial treatments and 7 pharmacological treatments. We then conducted meta-analyses by intervention type.

Findings For prevention, the cognitive-behavioural therapy (CBT) programme Coping and Promoting Strength stood out for reducing anxiety diagnoses. For psychosocial treatment, 9 CBT interventions also reduced diagnoses: Cool Kids; Cool Little Kids Plus Social Skills; Coping Cat; Coping Koala; One-Session Treatment; Parent Education Program; Skills for Academic and Social Success; Strongest Families and Timid to Tiger. Successful CBT interventions were used with children ranging from pre-schoolers to teens in homes, communities/schools and clinics. For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events. Meta-analyses indicated strongest effects for CBT (Log OR=0.95; 95% CI, 0.69 to 1.21) and SSRI treatments (1.57; 1.09 to 2.06).

Conclusions CBT is effective for preventing and treating childhood anxiety—across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases.

Fifty years of preventing and treating childhood behaviour disorders: A systematic review to inform policy and practice

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018
Abstract: 

Question Oppositional defiant and conduct disorders (ODD and CD) start early and persist, incurring high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders?

Study selection and analysis We sought randomised controlled trials (RCTs) evaluating interventions addressing the prevention or treatment of behaviour problems in individuals aged 18 years or younger. Our criteria were tailored to identify higher-quality RCTs that were also relevant to policy and practice. We searched the CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science databases, updating our initial searches in May 2017. Thirty- seven RCTs met inclusion criteria—evaluating 15 prevention programmes, 8 psychosocial treatments and 5 medications. We then conducted narrative synthesis.

Findings For prevention, 3 notable programmes reduced behavioural diagnoses: Classroom-Centered Intervention; Good Behavior Game; and Fast Track. Five other programmes reduced serious behaviour symptoms such as criminal activity. Prevention benefits were long term, up to 35 years. For psychosocial treatment, Incredible Years reduced behavioural diagnoses. Three other interventions reduced criminal activity. Psychosocial treatment benefits lasted from 1 to 8 years. While 4 medications reduced post-test symptoms, all caused important adverse events.

Conclusions Considerable RCT evidence favours prevention.

Clinical implications Effective prevention programmes should therefore be made widely available. Effective psychosocial treatments should also be provided for all children with ODD/CD. But medications should be a last resort given associated adverse events and given only short-term evidence of benefits. Policymakers and practitioners can help children and populations by acting on these findings.

Building children’s resilience

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2008
Abstract: 

Background: Parenting has a profound impact on children’s well-being. Positive parent-child relationships can promote children’s brain development, academic functioning, social competence, mental health and self-esteem. Responsive caregiving also buffers children from the negative impacts of adversity and stress. Given this, we set out to identify interventions that can promote positive parenting.    

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of parenting interventions for high-risk families. Applying our inclusion criteria, we accepted four RCTs.

Results: All four programs produced some beneficial outcomes. Familias Unidas reduced child behaviour problems and increased parent involvement. Family Check-Up similarly increased maternal involvement. Nurse Home Visitation improved children’s language development and executive functioning among particularly high-risk families. SAFEChildren improved parental involvement in children’s education as well as children’s reading skills.  

Conclusions: Programs that encourage warm and consistent parenting can improve the lives of children and families, especially among those facing significant adversities.  

Addressing bullying behaviour in children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2008
Abstract: 

Background: When bullying occurs, children pay a significant price. Those who are bullied are at risk for impaired social developmental, mental and physical illnesses and school absenteeism. Children who bully others frequently suffer from high rates of mental disorder and from learning problems. To help avoid these detrimental outcomes, interventions that can prevent bullying are greatly needed.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of anti-bullying interventions. Applying our inclusion criteria, we accepted eight RCTs evaluating seven programs.

Results: Four programs were successful in reducing bullying: Brief Strategic Family Therapy, Integrative Family Therapy, Bullies and Dolls, and Steps to Respect. The first two programs were targeted to children who were engaging in bullying  and were delivered to families in clinics. In addition to reducing bullying, they also reduced children’s anger and engagement in risky behaviours. The latter two interventions were universal preventative interventions delivered within schools.

Conclusions: These results find that adults can intervene to help end bullying by ensuring that effective interventions are employed so children’s environments are free from the fear and intimidation that bullying creates. 

The economics of children’s mental health

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Background: There is an increasing push towards policy-makers approving interventions for childhood mental disorders based on clinical effectiveness and cost considerations. To this end, high-quality economic evaluations of these interventions are starting to accumulate. Consequently, we set out to review the available data to help determine which prevention programs constitute the wisest use of limited public funds.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of mental disorder prevention programs that also had an economic evaluation. Applying our inclusion criteria, we accepted four RCTs.

Results: Coping With Stress resulted in significantly more depression-free days for participants with an average incremental cost-effectiveness ratio of id="mce_marker"0 per depression-free day.  Fast Track significantly lowered the incidence of conduct disorder but only among the high-risk children. However, the cost per averted case of conduct disorder was still more than $752,000 for this group of children. Nurse Home Visitation resulted in significantly fewer serious behavioural problems many years after the program ended, including fewer criminal convictions. It also resulted in a net saving among the highest risk families by reducing other service use. Finally, Perry Preschool similarly resulted in less criminal activity as well as higher educational achievement and employment earning years after the program ended. It also produced a net savings.

Conclusions: Prevention programs can not only avert needless suffering for children and families, they can also produce cost-savings for society. 

Understanding and treating psychosis in young people

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Background: Medications are a key treatment for young people with psychosis. In fact, up to 80% of individuals will experience a remission of psychotic symptoms within their first year of treatment with antipsychotic medication. Given the array of antipsychotics available, we set to determine which of these medications provide the best outcomes for youth considering both effectiveness and side effect profiles.  

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of interventions for psychosis. Applying our inclusion criteria, we accepted seven RCTs evaluating 6 medications.

Results: The medications clozapine, haloperidol, olanzapine and risperidone proved successful in treating psychosis in young people. However, due to clozapine’s side effect profile, it is typically reserved for youth who have not responded to at least two other antipsychotics. When price is a consideration, older antipsychotic have the benefit of costing less while having similar effectiveness to newer medications. 

Conclusions: With careful management, antipsychotic medications can dramatically improve functioning and reduce suffering for youth with psychosis.

Preventing suicide in children and youth

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Background: Suicide is a leading cause of death among young people. Interventions to reduce youth suicide include both primary prevention programs as well as targeted treatments. We set out to evaluate the effectiveness of both types of interventions.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of interventions designed to prevent or treat suicidal thoughts or attempts among young people. Applying our inclusion criteria, we accepted four RCTs.

Results: The one primary prevention program, Signs of Suicide (SOS), resulted in significantly fewer suicide attempts among high school students. One treatment program, Multisystemic Therapy (MST), was also effective in reducing suicide attempts. 

Conclusions: There is solid evidence that suicide rates among young people can be significantly reduced with effective prevention programs like SOS. MST may be particularly effective for high-risk youth. 

Addressing parental depression

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2010
Abstract: 

Background: When parents suffer from depression, children can be substantially impacted. These offspring can have an increased risks for social problems, cognitive delays and mental disorders. Consequently, we set out to determine if addressing parental depression can improve children’s outcomes.

Methods: We used systematic review methods to identify randomized controlled trial (RCT) evaluations of interventions aimed at supporting children of depressed parents. Applying our inclusion criteria, we accepted six RCTs.

Results: While the six interventions were highly diverse, ranging a home visiting program for mothers of infants to a group cognitive-behavioural therapy (CBT) family intervention, most interventions involved both parents and children. Among interventions for young children and their mothers, Clinician Home Visiting improved many aspects of the mother-child relationship, including maternal sensitivity and infant responsiveness. Psychodynamic Therapy and Non-Directive Counselling also both reduced behaviour problems in very young children. Among the interventions for school-age children and their parents, a group CBT family intervention and a group cognitive therapy (CT) program for youth both reduced depressive symptoms. The former also reduced parental depression symptoms and child anxiety symptoms while the latter reduced youth suicidality and improved youth’s overall functioning.  

Conclusions: There are a range of options for helping families when a parent experiences depression. For mothers of young children, it is helpful to focus on parenting skills and healthier ways of viewing themselves as parents. For older children and families, CBT and BT interventions can support children’s mental wellbeing.