Preliminary effectiveness of surviving the teens(®) suicide prevention and depression awareness program on adolescents' suicidality and self-efficacy in performing help-seeking behaviors

BACKGROUND: Suicide ranks as the third leading cause of death among youth aged 15‐24 years. Schools provide ideal opportunities for suicide prevention efforts. However, research is needed to identify programs that effectively impact youth suicidal ideation and behavior. This study examined the immediate and 3‐month effect of Surviving the Teens® Suicide Prevention and Depression Awareness Program on students' suicidality and perceived self‐efficacy in performing help‐seeking behaviors. METHODS: High school students in Greater Cincinnati schools were administered a 3‐page survey at pretest, immediate posttest, and 3‐month follow‐up. A total of 1030 students participated in the program, with 919 completing matched pretests and posttests (89.2%) and 416 completing matched pretests and 3‐month follow‐ups (40.4%). RESULTS: Students were significantly less likely at 3‐month follow‐up than at pretest to be currently considering suicide, to have made a suicidal plan or attempted suicide during the past 3 months, and to have stopped performing usual activities due to feeling sad and hopeless. Students' self‐efficacy and behavioral intentions toward help‐seeking behaviors increased from pretest to posttest and were maintained at 3‐month follow‐up. Students were also more likely at 3‐month follow‐up than at pretest to know an adult in school with whom they felt comfortable discussing their problems. Nine in 10 (87.3%) felt the program should be offered to all high school students. CONCLUSIONS: The findings of this study lend support for suicide prevention education in schools. The results may be useful to school professionals interested in implementing effective suicide prevention programming to their students.     

Evaluation of the Wise Guys Male Responsibility Curriculum: participant-control comparisons

BACKGROUND: Although males are often the initiators of teen sexual activity, pregnancy prevention programs generally target females. To address this deficiency, the Wise Guys Male Responsibility Curriculum was developed to be delivered to adolescent males in weekly classroom sessions. METHODS: Seventh grade participants (n = 124) in the Wise Guys program were compared to randomly selected controls (n = 106) at pretest (baseline), posttest, and 6‐month follow‐up data points. Comparisons were made on knowledge of sexual behavior and reproductive biology, knowledge of sexually transmitted disease (STD) transmission, desirable attitudes toward sex and appropriate behavior in sexual relationships; and on limited behavioral outcomes, including initiation of sexual activity, and use of condoms and contraception by sexually active adolescents. RESULTS: Wise Guys participants demonstrated greater posttest and follow‐up knowledge of sex and reproductive biology (p < .000), greater knowledge of STD transmission (p < .000), and higher rates of desirable attitudes toward sex and appropriate behavior in sexual relationships (p ≤ .013) than controls. Favorable behavioral changes were also reported among sexually active participants at follow‐up. CONCLUSIONS: The Wise Guys curriculum effectively improves adolescent males' knowledge of sexual behavior and reproductive behavior, and their knowledge of STD transmission, and instills desirable attitudes toward sex and appropriate behavior in sexual relationships. The results also indicate that the curriculum may promote greater condom use and contraception among sexually active males.     

Enhancing Educator Engagement in School Mental Health Care Through Digital Simulation Professional Development

BACKGROUND

Despite the critical role of educators as gatekeepers for school mental health services, they receive limited training to support student mental health. We report findings from a trial of an online mental health role‐play simulation for elementary school teachers on changes in attitudes and self‐reported helping behaviors for students experiencing psychological distress.

METHODS

We randomly assigned 18,896 elementary school teachers to wait‐list control or intervention conditions in which they received the 45‐ to 90‐minute online role‐play simulation. We administered a version of the validated Gatekeeper Behavior Scale at baseline and postintervention, which measures attitudinal dimensions shown to predict teacher helping behavior change. Self‐reported helping behaviors were collected at baseline and 3‐month follow‐up. Outcomes were compared between the intervention follow‐up and control group baseline measures.

RESULTS

The intervention group posttraining scores were significantly higher (p < .001) than the control group for all the preparedness, likelihood, and self‐efficacy Gatekeeper Behavior subscales. All 5 helping behaviors were significantly higher among the intervention group at follow‐up compared to the control group at baseline.

CONCLUSIONS

We found that a brief online role‐play simulation was an effective strategy for improving teacher attitudes and behaviors needed to perform a positive mental health gatekeeper role in schools.

     

Kickin’ Asthma: School‐Based Asthma Education in an Urban Community

BACKGROUND: In urban communities with high prevalence of childhood asthma, school‐based educational programs may be the most appropriate approach to deliver interventions to improve asthma morbidity and asthma‐related outcomes. The purpose of this study was to evaluate the implementation of Kickin’ Asthma, a school‐based asthma curriculum designed by health educators and local students, which teaches asthma physiology and asthma self‐management techniques to middle and high school students in Oakland, CA. METHODS: Eligible students were identified through an in‐class asthma case identification survey. Approximately 10‐15 students identified as asthmatic were recruited for each series of the Kickin’ Asthma intervention. The curriculum was delivered by an asthma nurse in a series of four 50‐minute sessions. Students completed a baseline and a 3‐month follow‐up survey that compared symptom frequency, health care utilization, activity limitations, and medication use. RESULTS: Of the 8488 students surveyed during the first 3 years of the intervention (2003‐2006), 15.4% (n = 1309) were identified as asthmatic; approximately 76% of eligible students (n = 990) from 15 middle schools and 3 high schools participated in the program. Comparison of baseline to follow‐up data indicated that students experienced significantly fewer days with activity limitations and significantly fewer nights of sleep disturbance after participation in the intervention. For health care utilization, students reported significantly less frequent emergency department visits or hospitalizations between the baseline and follow‐up surveys. CONCLUSIONS: A school‐based asthma curriculum designed specifically for urban students has been shown to reduce symptoms, activity limitations, and health care utilization for intervention participants.     

The effects of a fruit and vegetable promotion intervention on unhealthy snacks during mid‐morning school breaks: results of the Dutch Schoolgruiten Project

Background: Ample fruit and vegetable (F&V) intake has been associated with a decreased risk of chronic disease. The health‐enhancing effects of increased F&V consumption, however, would be even more apparent if the increased F&V consumption additionally led to a lower intake of unhealthy, high calorie snacks. Therefore, the present study aimed to investigate whether a primary school‐based intervention (the Dutch Schoolgruiten Project) that promoted F&V intake could additionally reduce the intake of unhealthy, high calorie snacks during school breaks. Methods: The study applied a longitudinal design with baseline and two follow‐up measurements. Children were aged 9–10 years old at baseline; 705 children were included. The main strategy was a F&V scheme that improved the availability, accessibility and exposure to F&V at school by providing one serving of fruit or vegetables twice a week at no cost. The amounts of F&V and unhealthy snacks for consumption at school were measured using a single‐item question included in a questionnaire. Multilevel autoregressive logistic regression models with a three‐level structure (school, child and time) were used to assess the effect of the intervention on both F&V and unhealthy snack consumption. Results: The children of the intervention group brought F&V from home to school at follow‐up significantly more often than the children of the control schools [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.04; 1.90] and brought fewer unhealthy snacks (OR = 0.56, 95% CI = 0.34; 0.92). Conclusion: The present study provides some evidence that the Schoolgruiten intervention effect on F&V intake also reduced unhealthy snacking during school breaks.     

An evaluation of an abstinence-only sex education curriculum: an 18-month follow-up

The article examines the results from an 18-month follow-up evaluation of an abstinence education curriculum series. Participants were students from 15 school districts recruited to participate in the project. The intervention was the Sex Can Wait curriculum series, consisting of upper elementary, middle school, and high school components. The 5-week curriculum was implemented by teachers who had participated in a special teacher training workshop. Both intervention and comparison students were surveyed before and after the curriculum intervention and at 18-month follow-up. Results indicated short-term effects as follows. Upper elementary intervention students indicated higher level of knowledge, more hopefulness for the future, and greater self-efficacy than did the comparison group. Middle school intervention students did not differ from comparison students. High school intervention students reported lower participation rates than the comparison group students in sexual intercourse (ever and last month), a more positive attitude toward abstinence and a greater intent to remain abstinent. Long-term (18 month) benefits were noted as follows: upper elementary intervention students had greater knowledge and were less likely than comparison students to report participation in sexual intercourse in the last month. Middle school intervention students were less likely than comparison students to report participation in sexual intercourse ever and sexual intercourse in the last month. High school intervention students evidenced greater knowledge and greater intent to remain abstinent than did comparison students. Results indicate that the program did have some positive benefits that should be considered by those interested in abstinence education programming.     

A pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills in community pre-schools in Jamaica

Background School‐based interventions involving teacher and/or child training have been shown to benefit teacher practices and to prevent conduct problems and improve children's social and emotional competence in developed countries; however, we are aware of no reports from a developing country. We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if this approach is appropriate for use with Jamaican pre‐school teachers and children. Methods Five pre‐schools in Kingston, Jamaica were randomly assigned to an intervention (3 pre‐schools with 15 classrooms) or control (2 pre‐schools with 12 classrooms) condition. Intervention involved seven whole‐day teacher workshops using the Incredible Years Teacher Training programme supplemented by 14 child lessons in each class. The project was evaluated through structured observations of four categories of teacher behaviour and four observer ratings: two rating scales of child behaviour and two rating scales of classroom atmosphere. Results Significant intervention benefits were found to teachers' behaviour with increased positive behaviour [b = 7.9; 95% confidence interval (CI): 3.5, 12.3], reduced negative behaviour (b =?3.5; 95% CI: ?6.6, ?0.2) and increases in the extent to which teachers promoted children's social and emotional skills (b = 46.4; 95% CI: 11.0, 81.7). The number of teacher commands was not significantly reduced (b =?2.71; 95% CI: ?6.01, 0.59). Significant intervention benefits were found to ratings of child behaviour with an increase in children's appropriate behaviour (b = 5.7, 95% CI: 1.0, 10.8) and in children's interest and enthusiasm (b = 7.2, 95% CI: 0.9, 13.5). Intervention also benefited classroom atmosphere with increases in opportunities provided for children to share and help each other (b = 1.3, 95% CI: 0.5, 2.1) and in teacher warmth (b = 1.3, 95% CI: 0.9, 1.8). Conclusion This is a promising approach for improving the emotional climate of Jamaican pre‐school classrooms and for improving child behaviour and participation.     

Effect of a low-cost, teacher-directed classroom intervention on elementary students' physical activity

BACKGROUND: Effective physical activity (PA) interventions are warranted for youth, and schools have been identified as logical locations for such involvement. Experts and professionals in the field promote comprehensive school PA programs, including classroom PA. The purpose of this study was to determine the effect of a low‐cost, teacher‐directed classroom‐based intervention on the school PA of elementary children. METHODS: Nine classroom teachers were provided inexpensive curricula and trained to implement and instruct PA breaks (2 × 30 minute training sessions). The teachers were encouraged to lead 1 activity break per day after the training. One hundred and six elementary students wore pedometers up to 12 days over 3 monitoring periods during the school year (baseline, follow‐up, post follow‐up) to assess the effectiveness and the sustainability of the intervention. The teachers self‐reported the frequency of activity breaks instructed. RESULTS: The teachers (n = 5) who complied with the recommended 1 activity break per day had students who accrued ～33% more mean school steps/day at follow‐up (～1100) and post follow‐up (～1350) compared to controls. Teachers (n = 4) in the intervention who did not comply with the 1 activity break per day recommendation had students accrue similar mean school steps/day as controls. CONCLUSION: Inexpensive, teacher‐directed classroom‐based PA interventions can be effective in improving children's PA levels if teachers implement 1 activity break per school day. We recommend promoting the notion of 1 activity break per day in the classroom as part of a comprehensive school PA program that includes quality physical education, recess, and before/after school programs.     

Evaluation of a Three-Year Urban Elementary School Tobacco Prevention Program

ABSTRACT: The longitudinal study compared effects of varying amounts of tobacco instruction (one, two, and three years) on the knowledge, attitudes, and behavioral intentions of urban elementary students. A three-year, fourth-through-sixth grade tobacco prevention curriculum was developed based on the Centers for Disease Control and Prevention's Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. The curriculum comprised five, 45-minute lessons per year. The same trained instructor taught the curriculum all three years. Six intervention schools were taught the curriculum, and two control schools were not. A 49-item questionnaire was used to assess tobacco knowledge, attitudes, and behavioral intentions. The experimental group's posttest knowledge and attitude scores were significantly higher than the control group's posttest scores. No significant differences occurred in posttest behavioral intention scores between the control and intervention groups.     

Long-term process evaluation of a school-based programme for overweight prevention

Background The epidemic increase in childhood overweight demands effective and also feasible prevention programmes. A school‐based environmental and educational intervention focusing on the promotion of water consumption was found to be effective for overweight prevention in children. Process evaluation and long‐term surveillance are necessary to evaluate the feasibility and sustainability of the intervention programme in a school setting. Methods Process evaluation was conducted during the intervention period (one school year) and a 19‐month follow‐up after the intervention trial on the prevention of overweight in 17 elementary schools. Data were collected through measuring the water flow of water fountains installed in schools, and questionnaires and interviews were administered to teachers and headmasters of intervention schools. Main outcomes were implementation of the intervention components, behavioural modification of the children concerning water consumption, and teacher and headmaster attitudes towards the intervention. Results Eleven out of 17 intervention schools maintained the water fountains until 19‐month follow‐up. The mean water flow of the fountains decreased initially, but remained stable after the during the follow‐up period. The implementation rate of the educational units by teachers varied between the units from 13% to 84%. Teachers graded the overall concept of the intervention as good, continuously during the intervention and follow‐up period. The majority of teachers organized the water supply of the fountains on the class level during the intervention period but not during the follow‐up. Conclusions The long‐term process evaluation showed that the combined educational and environmental intervention has potential for sustained modifications in the beverage consumption habits of children. It also identified barriers and promoting factors of a sustainable and feasible implementation of the preventive programme in a school setting.     

Two-year follow-up of the 'Families for Health' programme for the treatment of childhood obesity

Background The high prevalence of obesity in children in the UK warrants continuing public health attention. ‘Families for Health’ is a family‐based group programme for the treatment of childhood obesity. Significant improvements in body mass index (BMI) z‐score (?0.21, 95% CI: ?0.35 to ?0.07, P= 0.007) and other health outcomes were seen in children at a 9‐month follow‐up. Aim To undertake a 2‐year follow‐up of families who attended ‘Families for Health’ in Coventry, to assess long‐term outcomes and costs. Methods ‘Families for Health’ is a 12‐week programme with parallel groups for parents and children, addressing parenting skills, healthy lifestyles and emotional well‐being. The intervention was delivered at a leisure centre in Coventry, England, with 27 overweight or obese children aged 7–13 years (18 girls, 9 boys) and their parents, from 21 families. A ‘before‐and‐after’ evaluation was completed with 19 (70%) children followed up at 2 years. The primary outcome was change in BMI z‐score from baseline; secondary outcomes were children's quality of life, parent–child relationships, eating/activity habits and parents' mental health. Costs to deliver the intervention and to families were recorded. Results Mean change in BMI z‐score from baseline was ?0.23 (95% CI: ?0.42 to ?0.03, P= 0.027) at the 2‐year follow‐up and eight (42%) children had a clinically significant reduction in BMI z‐score. Significant improvements were seen in children's quality of life and eating habits in the home, while there were sustained reductions in unhealthy foods and sedentary behaviour. Fruit and vegetable consumption and parent's mental health were not significantly different at 2 years. Costs of the programme were £517 per family (£402 per child), equivalent to £2543 per unit reduction in BMI z‐score. Conclusions Improvements in BMI z‐score and certain other outcomes associated with the ‘Families for Health’ programme were sustained at the 2‐year follow‐up. ‘Families for Health’ is a promising new childhood obesity intervention, and a randomized controlled trial is now indicated.     

Coping Power Adapted as Universal Prevention Program: Mid Term Effects on Children’s Behavioral Difficulties and Academic Grades

Aggressive behaviors in schools have the potential to cause serious harm to students’ emotional and social well-being and to limit their ability to achieve their full academic potential. Prevention programs developed to reduce children’s aggressive behaviors in school settings can provide interventions at a universal or targeted level. The main aim of our randomized control study was to examine the efficacy of Coping Power, adapted as a universal prevention program, in reducing children’s behavioral problems and improving school grades. Nine classes participated (184 students, mean age 91 months) from two elementary state schools in Tuscany, Italy. Study findings showed a significant reduction in behavioral problems and an improvement in school grades for the intervention classes relative to the control classes. This study suggests the Coping Power program can be delivered in school settings at both universal and targeted prevention levels, and that in this multi-tiered prevention model, teachers, educators and school psychologists can learn a set of intervention skills which can be delivered with flexibility, thus reducing some of the complexity and costs of schools using multiple interventions.     

Integrating life skills into a theory-based drug-use prevention program: effectiveness among junior high students in Taiwan

BACKGROUND: Drug use has been noted among students in Taiwan during the past decade and schools have a role in preventing or delaying students' drug use. We developed and evaluated a school‐based, drug‐use prevention program integrating the theory of planned behavior (TPB) and life skills for junior high school students. METHODS: We recruited 441 seventh graders from randomly selected schools: N = 143 experimental groups, N = 142 conventional groups, and N = 156 control groups. The experimental group received ten 45‐minute sessions of theory‐based interventions. The conventional group got traditional didactic teaching and drug refusal skills. The control group received no intervention. RESULTS: Compared to the control group, experimental group students showed greater improvement in attitude, subjective norm, perceived behavioral control, life skills, and intention not to use drugs. Compared to the conventional group, the experimental group had significantly higher posttest scores for 4 of the 5 outcomes, including life skills (96.53 vs. 90.92, p < .001), attitude (27.43 vs. 24.40, p = .012), subjective norm (29.51 vs. 28.06, p = .002), and perceived behavioral control (18.59 vs. 16.81, p < .001). The conventional group scored significantly higher in behavioral intention than did the control group. CONCLUSION: Study results demonstrated the effectiveness of a drug‐use prevention program integrating the TPB and life skills.     

Efficacy of the Incredible Years Programme as an early intervention for children with conduct problems and ADHD: long-term follow-up

Background This study examined the long‐term efficacy of the Incredible Years (IY) BASIC Parenting Programme delivered as a preventive intervention with parents of pre‐school children who display signs of attention deficit hyperactivity disorder (ADHD) and conduct problems. Families were followed up after the completion of a controlled trial with 11 Sure Start areas in North and Mid‐Wales and North West England. Methods Participants in the study were 50 pre‐school children whose parents had received the intervention. Child ADHD symptoms were assessed at baseline, at follow‐up one (6 months after baseline); at follow‐up two (12 months after baseline); and at follow‐up three (18 months after baseline). Families in the original waiting‐list control group were not assessed after follow‐up one as they had subsequently received the same intervention. Results The significant post‐intervention improvements in child ADHD symptoms evident at follow‐up one were maintained over time, as demonstrated by statistical and clinical stability of measures. No significant differences were found for ADHD symptoms across each follow‐up, indicating that the gains made post intervention were maintained for at least 12 months, with 57% of the sample maintaining scores below the clinical cut‐off on the Conners. Eighty‐six, 58, and 30 per cent respectively had maintained at least a modest, large, or very large improvement in ADHD symptoms at follow‐up three. Conclusions Findings from this study suggest that the IY psychosocial treatment programme is a valuable intervention in the longer term for many pre‐school children displaying early signs of ADHD.     

Effects of a school-based nutrition program diffused throughout a large urban community on attitudes, beliefs, and behaviors related to fruit and vegetable consumption

BACKGROUND: Obesity among US children has increased in recent years. Although increased fruit and vegetable consumption has not been directly linked to obesity prevalence, it has been posited that more fruits and vegetables (FV) could reduce the consumption of high‐fat, energy‐dense foods and may protect against childhood illnesses including asthma and other respiratory diseases. The purpose of this current research was to assess the impact of a large public school district's hybrid approach to nutrition education programming on attitudes, beliefs, and behaviors related to fruit and vegetable consumption. METHODS: A total of 12 elementary schools from the Los Angeles Unified School District (9 intervention schools, 3 control schools) were randomly selected to participate in a “hybrid” school‐based nutrition education program. Data were collected at baseline (beginning of school year) and postintervention data (end of school year 9 months later). Linear mixed models were developed to assess the impact of the intervention. RESULTS: The intervention resulted in a significant change in teacher influence on students' attitudes toward FV (p < .05) and students' attitudes toward vegetables (p < .01), even after adjusting for gender, grade, and race/ethnicity. Although not statistically significant, there was a slight increase in fruit and vegetable consumption from pretest to posttest for both the intervention and control schools. CONCLUSION: The hybrid model reflects a more accurate representation of school‐based interventions. More research is needed to identify the specific components of this model that are most successful in impacting fruit and vegetable consumption among US children.     

Limited effects of a 2-year school-based physical activity intervention on body composition and cardiorespiratory fitness in 7-year-old children

The aim of this study was to assess the effects of a 2-year cluster-randomized physical activity and dietary intervention program among 7-year-old (at baseline) elementary school participants on body composition and objectively measured cardiorespiratory fitness. Three pairs of schools were selected and matched, then randomly selected as either an intervention (n = 151) or control school (n = 170). None of the effect sizes of body composition were statistically significant. Children in the intervention group increased their fitness by an average of 0.37 z score units more than the controls (95% CI:-0.27 to 1.01, P = 0.18), representing an improvement of 0.286 W/kg. Boys had higher fitness (mean(diff) = 0.35 z scores, 95% CI: 0.13-0.58, P = 0.001) than girls, independent of study group, fitness z score at baseline and body mass index. Post hoc analysis showed that the intervention school with the highest fitness z score change was significantly different from two of the lowest control schools (mean(diff) = 0.83 z scores, 95% CI: 0.44-1.21, P < 0.0001 and mean(diff) = 0.70 z scores, 95% CI: 0.29-1.10, P = 0.01), but it was also significantly different from the lowest intervention school (mean(diff) = 0.59 z scores, 95% CI: 0.19-0.99, P = 0.05). The results of this intervention are inconclusive as regards to the effects on fitness, but the intervention did not have any statistically significant effect on body composition.     

近视防控视频科普干预对重庆市小学生的效果评价

目的 评价近视防控视频科普对重庆市小学生知信行的效果,为近视防控科普策略制定提供参考。方法 采用方便随机抽样,选取重庆市主城区的小学,选取25 117名小学生进行横断面基线调查;通过在公交车、轻轨和社区电梯轿厢持续投放一个月近视防控科普视频,宣传儿童青少年正确用眼行为,干预后选取15 891名小学生进行网络问卷效果评价。结果 基线调查收集有效问卷25 117份,效果评估收集有效问卷15 891份。小学生总体近视率为35.9％。干预后学生对影响视力的行为、有效防控近视的措施知晓率（66.8％、56.3％）均高于干预前（63.4％、50.4％）;干预前后非常赞同“儿童需要定期进行视力检查”这一观点的人数最多,分别占80.5％和82.6％;对于预防近视行为措施,如每天户外运动达到2 h的人数高于干预前（χ2 = 136.611, P＜0.001）,每天睡眠时间超过10 h的人数高于干预前（χ2 = 35.170, P＜0.001）。结论 近视防控视频科普总体取得了积极的效果。小学生近视防控知识整体提高,对于近视防控的态度更加积极,行为方面还存在较大的改善空间。     

A pilot demonstration of comprehensive mental health services in inner-city public schools

BACKGROUND: National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner‐city neighborhoods. METHODS: The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow‐up data were assessed in multiple domains among students and teachers. RESULTS: After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. CONCLUSION: If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services.     

A randomised controlled trial of the effects of mindfulness practice on medical student stress levels

Medical Education 2011: 45 : 381–388 Objective This study aimed to determine whether the practice of mindfulness reduces the level of stress experienced by senior medical students. Methods We carried out a multicentre, single‐blinded, randomised controlled trial with intention‐to‐treat analysis in three clinical schools attached to the University of Tasmania, Hobart, Tasmania. Participants included 66 medical students in their final 2 years of study in 2009. Participants were block‐randomised to either an intervention or a usual care control group. The intervention used an audio CD of guided mindfulness practice designed and produced for this trial. Participants were advised to use the intervention daily over the 8 weeks of the trial. All participants completed two self‐report questionnaires, at baseline and at 8 weeks, respectively. The intervention group also completed a questionnaire at 16 weeks to provide follow‐up data. The primary outcome measure was the difference over time in scores on the Perceived Stress Scale (PSS). The secondary outcome measure referred to differences over time in scores on the subscales of the Depression, Anxiety and Stress Scale (DASS). Results Mean baseline scores on the PSS and the stress component of the DASS were 15.7 (maximal score of 40) and 13.2 (maximal score of 42), respectively, both of which exceed scores in age‐matched normative control data. Using multivariable analysis, participants in the intervention group demonstrated significant reductions in scores on the PSS (? 3.44, 95% confidence interval [CI] ? 6.20 to ? 0.68; p < 0.05) and the anxiety component of the DASS (? 2.82, 95% CI ? 4.99 to ? 0.64; p < 0.05). A borderline significant effect was demonstrated on the stress component of the DASS (? 3.69, 95% CI ? 7.38 to 0.01; p = 0.05). Follow‐up at 8 weeks post‐trial revealed that the effect was maintained. Conclusions Mindfulness practice reduced stress and anxiety in senior medical students. Stress is prevalent in medical students and can have adverse effects on both student health and patients. A simple, self‐administered, evidence‐based intervention now exists to manage stress in this at‐risk population and should be widely utilised.     

Adolescent attitudes toward influenza vaccination and vaccine uptake in a school-based influenza vaccination intervention: a mediation analysis

BACKGROUND: School‐based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school‐based influenza vaccination intervention and vaccine uptake. METHODS: Participants were recruited from 2 counties participating in a school‐based influenza vaccination intervention trial in rural Georgia (N = 337). Data were collected from surveys distributed to adolescents at pre‐ and post‐intervention time points and from documents indicating vaccine uptake. Guided by the Health Belief Model and the Integrated Behavioral Model, surveys assessed demographic, behavioral, and psychosocial variables. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow‐up mediated the relationship between study condition and influenza vaccine uptake. RESULTS: Controlling for background variables, step 1 of the mediation analysis revealed a significant relationship between study condition and vaccine uptake (odds ratio = 1.77, p = .038). Step 2 of the mediation analysis revealed a significant relationship between study condition and changes in psychosocial variables from baseline to follow‐up. Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between study condition and receipt of an influenza vaccination by intention to receive an influenza vaccination. CONCLUSION: Findings suggest that the success of our school‐based influenza vaccination intervention in increasing vaccine uptake was mediated by adolescents' intention to receive an influenza vaccination. Future influenza vaccination efforts geared toward rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine.