Rosemary Geddes

Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review.

AIMS To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. METHODS A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. CONCLUSIONS There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.

Rehabilitation experiences after obstetric fistula repair: systematic review of qualitative studies

To synthesise evidence on womens experiences surrounding rehabilitation and reintegration after obstetric fistula repair in sub‐Saharan Africa and explore recommendations from women and health service providers.

A rapid review of key strategies to improve the cognitive and social development of children in Scotland

OBJECTIVES Inequalities in health and educational outcomes in Scotland show a strong and persistent socioeconomic status gradient. Our aims were to provide policy-makers with a synthesis of international research evidence that assesses the effectiveness of early childhood interventions aimed at equitably promoting cognitive and social development and suggest potential areas for action in Scotland. METHODS A rapid review was conducted of review level studies of early childhood interventions with outcome measures relating to child cognitive-language or social-emotional development, subsequent academic and life achievement. Websites were searched and interviews were conducted to identify relevant interventions, policies and programmes delivered in Scotland. RESULTS : Early childhood intervention programmes can reduce disadvantage due to social and environmental factors. Scottish health policy demonstrates a clear commitment to early childhood development but much work remains in terms of detail of policy implementation, identification of high risk children and families, and early childhood monitoring systems. CONCLUSIONS Programmes should provide a universal seamless continuum of care and support from pregnancy through to school entry with the intensity of support graded according to need. The current information systems in Scotland would be inadequate for monitoring the effects of early childhood interventions especially in relation to cognitive-language and social-emotional development.

Experiences of knowledge brokering for evidence-informed public health policy and practice: three years of the Scottish Collaboration for Public Health Research and Policy

Background Despite interest in knowledge translation and exchange (KTE) in public health, few reports provide an account of knowledge brokerage organisations such as the Scottish Collaboration for Public Health Research and Policy (SCPHRP). SCPHRPs role is to identify public health interventions that equitably address major health priorities, foster collaboration between public health stakeholders, and build capacity for collaborative intervention research.

A cross-sectional pilot study of the Scottish early development instrument: a tool for addressing inequality

BackgroundEarly childhood is recognised as a key developmental phase with implications for social, academic, health and wellbeing outcomes in later childhood and indeed throughout the adult lifespan. Community level data on inequalities in early child development are therefore required to establish the impact of government early years’ policies and programmes on children’s strengths and vulnerabilities at local and national level. This would allow local leaders to target tailored interventions according to community needs to improve children’s readiness for the transition to school. The challenge is collecting valid data on sufficient samples of children entering school to derive robust inferences about each local birth cohort’s developmental status. This information needs to be presented in a way that allows community stakeholders to understand the results, expediting the improvement of preschool programming to improve future cohorts’ development in the early years. The aim of the study was to carry out a pilot to test the feasibility and ease of use in Scotland of the 104-item teacher-administered Early Development Instrument, an internationally validated measure of children’s global development at school entry developed in Canada.MethodsPhase 1 was piloted in an education district with 14 Primary 1 teachers assessing a cohort of 154 children, following which the instrument was adapted for the Scottish context (Scottish Early Development Instrument: SEDI). Phase 2 was then carried out using the SEDI. Data were analysed from a larger sample of 1090 participants, comprising all Primary 1 children within this school district, evaluated by 68 teachers.ResultsThe SEDI displayed adequate psychometric and discriminatory properties and is appropriate for use across Scotland without any further modifications. Children in the lowest socioeconomic status quintiles were 2–3 times more likely than children in the most affluent quintile to score low in at least one developmental domain. Even in the most affluent quintile though, 17% of children were ‘developmentally vulnerable’, suggesting that those in need cannot be identified by socioeconomic status alone.ConclusionsThe SEDI offers a feasible means of providing communities with a holistic overview of school readiness for targeting early years’ interventions.

SP3-68 A systematic review of interventions to prevent or reduce substance use and sexual risk behaviour in young people

Background Interventions aimed at preventing risky behaviour in adolescence and young adulthood have largely focused on single risk behaviours and a limited number of underlying predictors. Interventions that take a broader approach to reducing risk behaviour may more effectively and efficiently reduce multiple risk behaviours. Methods We performed a systematic review to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Results From 1129 articles, 18 experimental studies met our inclusion criteria, which were heterogeneous in nature and design. Study results were mixed, with programmes generally impacting on some outcome measures, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. There was some evidence that intervening in the early- to mid childhood school years has a high impact on later risk behaviour. Conclusions We found few studies that demonstrated a consistent, significant and sustained impact on risk behaviours. However, there is some evidence that programmes can have a long-term impact on multiple risk behaviours, with the most promising interventions addressing multiple domains of risk and protective factors. Complex interventions therefore need to be developed in the context of effective cross-sector engagement and collaboration. Furthermore, the current focus on investing in pre-school “early years” programmes should be extended to include the early- to mid-childhood school years.

Translating research into practice: a cross-sectional study using the Early Development Instrument to assess early years interventions in local level public health practice

Abstract Background Evidence that early years interventions can reduce inequalities has led to Scottish Government policy recommending that local areas implement initiatives to improve early child development. How best to measure the effects of these interventions is, however, unclear. We conducted a pilot study of the first UK use of the teacher-administered Early Development Instrument (EDI), an internationally validated measure of global child development now used at school entry in all children in Australia and most of Canada. Methods The study, conducted in the primary school setting in 2011–12, was cross-sectional in design and used qualitative and quantitative methods. During phase 1 the EDI was adapted for the Scottish context. 14 teachers assessed 154 pupils, using the instrument. Focus groups and semi-structured questionnaires were used to gather feedback from teacher participants on the instrument and the process. Phase 2 collected and analysed data from 1090 pupil participants, comprising 98% of eligible school-entrants in East Lothian local authority, assessed by 68 teachers. The 104-item EDI questionnaire has five domains of child development: physical, social, emotional, language and cognitive, and communication and general knowledge. Data were analysed with SPSS (version 17.0). The psychometric properties of the EDI were assessed with Cronbachs α. Mean scores in the domains were linked to levels of deprivation and results were mapped using Geographic Information System. Phase 3 monitored subsequent dissemination and use of EDI results. The study was approved by the School of Psychological Sciences and Health Ethics Committee of the University of Strathclyde, Glasgow, UK; the Education Authority of the relevant school district; and the Chief Scientist Office of the Scottish Government. In line with EDI data collection in other countries, opt-out consent was used for parents of pupils. All teachers provided written, informed consent. Findings Children in the most deprived quintile were 2·8 times more likely than the most affluent to be developmentally vulnerable in one or more domains; however, substantial developmental vulnerability was found across all five quintiles, not only in the most deprived. The EDI was found to be user friendly and acceptable to teachers, demonstrating high levels of internal reliability. Dissemination of results created a forum for multidisciplinary discussion and raised awareness about the importance of early child development, domains of development, and how inequalities can be tackled, leading to new initiatives based on EDI data. Interpretation The EDI is a robust instrument able to highlight developmental differences in children between socioeconomic groups and small-scale geographical areas. Its simplicity and usability lend themselves easily to community-wide implementation. Funding Medical Research Council and Chief Scientist Office of the Scottish Government.

PP52 Obesity Prevention in Scotland: A Policy Analysis using the Angelo Framework

Background The Scottish Government’s ‘Route-Map towards Healthy Weight’ published in 2010, aspired towards a comprehensive cross-government approach to tackling the rising prevalence of obesity, with commitments to addressing the fundamental societal drivers of the epidemic. The subsequent ‘Route-Map Action Plan’ set out 62 policies targeted at nutrition, physical activity or both, at all stages of the life course. We categorised each policy using the ANGELO Framework (Analysis Grid for Environments Linked to Obesity), to assess the appropriateness and likely impact of the balance of measures being proposed. ANGELO uses four broad ‘domains’: Physical, Economic, Legislative and Socio-cultural, as well as two ‘scales’ of intervention: ‘Macro’ for the national, regional or sectorial level and ‘Micro’ for the local neighbourhood/community/institutional level. Methods Two assessors (JM & RJ), used the guidance outlined by the originators of ANGELO to independently allocate a category for each intervention according to its domain (Physical, Economic, Legislative or Socio-cultural), scale (Macro or micro); and predominant ‘focus’ (activity versus nutrition). A third assessor (RG) then examined those policies where there were differences in allocation and a consensus on each was agreed by discussion. The resulting distribution of policies by scale and domain was compared with the current consensus of international research evidence around which combinations of measures are likely to have the greatest impact at a population level. Results Across the four environmental domains, the distribution of the 62 separate policy initiatives was skewed towards behavioural (Socio-cultural) measures (37.1%) and the Physical environment (33.1%) (i.e. surroundings), with less emphasis on Legislative measures (21.8%) or Economic interventions (6.4%). The distribution of both intervention scale and focus was more evenly spread with just over half of all policies (51.8%) targeted at the Macro-level scale and just under half (46.7%) having a nutrition focus. Conclusion Policy interventions (planned or underway), to tackle obesity which are supported by the Scottish Government, span across all four domains of the obesogenic environment as described by the ANGELO framework. The predominance of Socio-cultural/(i.e. behavioural) orientated interventions over Legislative and particularly Economic (or fiscal) measures (such as a sugared beverage tax), is common for most Governments, although the balance of evidence suggests that targeting the latter domains would be more effective. There is a need therefore to strive for a more balanced approach across all spheres of Government influence, with economic interventions representing the area where actions should particularly be increased.

Interventions to Prevent Substance Use and Risky Sexual Behaviour in Young People

AIMS To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. METHODS A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. CONCLUSIONS There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.

Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review: Interventions for multiple risk behaviour

AIMS To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. METHODS A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. CONCLUSIONS There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach.