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Introduction and Aims: People who use substances have a high prevalence of modifiable chronic disease health risk behaviours. Preventive care to address such risks has not traditionally been provided during substance use treatment. This study aimed to assess clinicians' attitudes towards preventive care and their association with care provision., Design and Methods: A cross-sectional study utilising computer-assisted telephone interviews was undertaken with clinicians (n = 54) of community-based substance use treatment services in one health district, Australia. Clinicians indicated their agreement with 10 attitudinal statements regarding their perceived role and self-efficacy in providing preventive care and perceptions of client interest in modifying behaviours. Logistic regression analyses examined the association between clinician attitudinal items and self-reported care provision., Results: Fifty-four clinicians (74%) agreed to participate. The most positive attitudes were preventive care being part of their role (100%), and they have the knowledge and skills to provide preventive care (100%). The least favourable attitude was clients were interested in changing their health risk behaviours (60%). Clinicians who reported that preventive care left little time to undertake acute care were more likely to assess for smoking (OR 8.06 [95% CI 1.31, 49.46]) and less likely to provide brief advice for all risks combined (OR 0.11 [95% CI 0.02, 0.63])., Discussion and Conclusions: Overall, clinicians reported positive attitudes regarding the preventive care provision for modifiable health risk behaviours in substance use treatment settings. Further research is required to investigate why, despite such positive attitudes, clinicians in substance use treatment settings do not routinely provide preventive care., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)

Background: Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption., Methods: A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach., Results: Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date., Conclusions: Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care., Trial Registration: PROSPERO-CRD42019131691., (© 2022. The Author(s).)

Introduction: This paper aimed to document alcohol use during pregnancy and determine predictors of ongoing use, including knowledge and agreement with national alcohol guideline recommendations., Methods: Pregnant women (n = 1179) attending public antenatal services in a Local Health District in NSW, Australia, were surveyed about their alcohol use before pregnancy and after pregnancy recognition, and awareness of, and agreement with, national alcohol guidelines and health-related statements. Respondent characteristics, drinking behaviour and predictors of ongoing drinking during pregnancy were assessed., Results: Most women consumed alcohol before pregnancy (79.3%) but the majority (82.0%) stopped following pregnancy recognition. Half the ongoing drinkers only drank on special occasions. Most (63.6%) women were aware of the national guidelines: 78.1% knew the recommendation that consuming no alcohol in pregnancy is safest, 4.6% thought some alcohol was safe and 17.3% were unsure. Predictors [OR (95%CI)] of ongoing drinking were older age [1.11 (1.07, 1.15)]; medium [2.42 (1.46, 4.00)] or high-risk drinking pre-pregnancy [3.93 (2.35, 6.56)]; and agreement that: avoiding alcohol in pregnancy is safest [0.05 (0.006, 0.47)]; avoiding alcohol is important for baby's health [0.14 (0.06, 0.31)] and pregnancy is a good time to change alcohol use for mother's health [0.29 (0.13, 0.63)]., Discussion and Conclusions: Results emphasise the importance of asking about special occasion drinking, the link between pre-pregnancy drinking and ongoing drinking during pregnancy, and the need to understand why women disagree with the national guideline. To ensure guidelines have their intended benefit, interventions to promote behaviour change relating to alcohol consumption during pregnancy are warranted., (© 2021 Australasian Professional Society on Alcohol and other Drugs.)

Background: Maternal behaviours in pregnancy associated with adverse pregnancy, birth and health outcomes include tobacco smoking, poor nutrition, alcohol consumption and low physical activity, collectively referred to as the SNAP risk factors. Due to the high prevalence, co-occurrence and possible interactive health effects of such health behaviours in pregnancy, antenatal interventions that support pregnant women to improve multiple SNAP behaviours have a greater potential impact on the health outcomes of women and their children than interventions addressing single behaviours. The objective of this review is to determine the effectiveness of interventions delivered as part of antenatal care that aim to improve multiple SNAP behaviours among pregnant women., Methods: Seven electronic databases will be searched for potentially eligible studies. Eligible studies will include those where pregnant women are attending antenatal care. Studies that examine the effect of an intervention that addresses multiple SNAP behaviours (≥ 2 behaviours) during pregnancy and are delivered or instigated through antenatal care in a healthcare service will be included. Systematic reviews of randomised controlled trials (RCTs), RCTs, cluster RCTs, stepped-wedge RCTs and non-randomised control trials will be eligible. Studies that include a no-intervention control, wait-list control group, standard/usual care, or another active single behavioural intervention (e.g. addressing one behaviour only) will be considered. Two independent reviewers will conduct study screening, data extraction and risk of bias assessment. Discrepancies will be resolved by consensus or a third reviewer if required. A random effects model will be used to synthesise the results. Alternative synthesis methods will be investigated in instances where a meta-analysis is not appropriate, such as summarising effect estimates, combining P values, vote counting based on direction of effect, or synthesis in narrative form., Discussion: The review will synthesise the evidence on the effect of interventions that address multiple SNAP behaviours in antenatal care and will help researchers, policy-makers and health services to develop and deliver best practice integrated models of antenatal care that have the potential to impact on both the short- and long-term health outcomes for women and their children., Systematic Review Registration: PROSPERO CRD42018095315.

People who use substances have a high prevalence of other modifiable health risk behaviours such as tobacco smoking which contribute to an increased mortality and morbidity. Preventive care can reduce the prevalence of such behaviours and is recommended by clinical practice guidelines. This review describes the prevalence of preventive care delivery by substance use treatment healthcare providers and examines differences by treatment setting. Five databases were searched for studies published between 2005 and 2017. Eligible studies reported levels of preventive care (assessment, brief advice and/or referral/follow-up) in substance use treatment services for tobacco smoking, nutrition or physical activity. Two reviewers independently conducted article screening, data extraction and methodological quality assessment. Sixteen studies were included and all except one investigated care provision for tobacco smoking only. Four studies reported care levels as a proportion and 12 studies reported care as a score-based mean. Client-reported receipt of smoking cessation care ranged from: 79-90% for assessment; 15-79% for brief advice; 0-30% for referral/follow-up. Meta-regression analyses of 12 studies found clinician-reported preventative care for tobacco smoking was more frequently reported in studies assessing care occurring across multiple substance use treatment settings, compared to studies reporting provision in inpatient only. This review indicated that, compared to smoking cessation care, little is known about the level of preventive care for nutrition or physical activity. Overall, the delivery of smoking cessation care reported was sub-optimal. High levels of assessment relative to brief advice and low levels of referral to ongoing assistance were indicated., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Despite existing best practice care recommendations for addressing tobacco smoking, alcohol consumption and weight management in preconception and antenatal care, such recommendations are often not implemented into routine practice. Effective strategies that target known barriers to implementation are key to reducing this evidence to practice gap. The aim of this review is to synthesise the evidence on the effectiveness of implementation strategies in improving the provision of preconception and antenatal care for these modifiable risk factors., Methods: Randomised and non-randomised study designs will be eligible for inclusion if they have a parallel control group. We will include studies that either compare an implementation strategy to usual practice or compare two or more strategies. Participants may include any health service providing preconception or antenatal care to women and/or the health professionals working within such a service. The primary outcome will be any measure of the effectiveness of implementation strategies to improve preconception and/or antenatal care for tobacco smoking, alcohol consumption and/or weight management (including care to improve nutrition and/or physical activity). Secondary outcomes will include the effect of the implementation strategy on women's modifiable risk factors, estimates of absolute costs or cost-effectiveness and any reported unintentional consequences. Eligible studies will be identified via searching Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL, ProQuest Dissertations and Theses and other sources (e.g. contacting experts in the field). Study selection, data extraction and risk of bias will be assessed independently by two review authors and differences resolved by a third reviewer. If data permits, we will conduct fixed-effects or random-effects meta-analysis where appropriate. If studies do not report the same outcome or there is significant heterogeneity, results will be summarised narratively., Discussion: This review will identify which implementation strategies are effective in improving the routine provision of preconception and antenatal care for tobacco smoking, alcohol consumption and weight management. Such a review will be of interest to service providers, policy makers and implementation researchers seeking to improve women's modifiable risk factors in preconception and antenatal care settings., Systematic Review Registration: PROSPERO CRD42019131691.

Primary healthcare services are recommended to provide preventive care to address chronic disease risk behaviours. However, all care elements are infrequently provided, and there is a need to understand the impact of partial care provision on behaviour change. This study examined the association between variable levels of preventive care receipt from primary care clinicians on short-term behaviour change for four risk behaviours. A survey was undertaken with 5639 Australian community health service clients (2009-2014). Clients self-reported: engagement in risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, physical inactivity) in the month prior to and four week post their community health service appointment; receipt of preventive care during appointments (assessment, advice, referral/follow-up) for each behaviour. Univariate regression models explored the association between change in risk status and preventive care received. The odds of behaviour change for those receiving all three care elements was significant for all behaviours, compared to no care, ranging from 2.02 (alcohol consumption, 95% CI 1.16-3.49) to 4.17 (inadequate fruit and/or vegetable consumption, 95% CI 2.91-5.96). Receipt of both assessment and advice increased the odds of behaviour change, compared to no care, for all behaviours except smoking, ranging from 2.32 (physical inactivity, 95% CI 1.60-3.35) to 2.83 (alcohol consumption, 95% CI 1.84-4.33). Receipt of 'assessment only' increased the odds of behaviour change, compared to no care, for inadequate fruit and/or vegetable consumption (OR = 2.40, 95% CI 1.60-3.59) and physical inactivity (OR = 2.81, 95% CI 1.89-4.17). Results highlight the importance of primary care clinicians providing best practice preventive care to maximise client behaviour change., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Despite clinical guideline recommendations, implementation of antenatal care addressing alcohol consumption by pregnant women is limited. Implementation strategies addressing barriers to such care may be effective in increasing care provision. The aim of this study is to examine the effectiveness, cost and cost-effectiveness of a multi-strategy practice change intervention in increasing antenatal care addressing the consumption of alcohol by pregnant women., Methods: The study will be a randomised, stepped-wedge controlled trial conducted in three sectors in a health district in New South Wales, Australia. Stepped implementation of a practice change intervention will be delivered to sectors in a random order to support the introduction of a model of care for addressing alcohol consumption by pregnant women. A staged process was undertaken to develop the implementation strategies, which comprise of: leadership support, local clinical practice guidelines, electronic prompts and reminders, opinion leaders, academic detailing (audit and feedback), educational meetings and educational materials, and performance monitoring. Repeated cross-sectional outcome data will be gathered weekly across all sectors for the study duration. The primary outcome measures are the proportion of antenatal appointments at 'booking in', 27-28 weeks gestation and 35-36 weeks gestation for which women report (1) being assessed for alcohol consumption, (2) being provided with brief advice related to alcohol consumption during pregnancy, (3) receiving relevant care for addressing alcohol consumption during pregnancy, and (4) being assessed for alcohol consumption and receiving relevant care. Data on resources expended during intervention development and implementation will be collected. The proportion of women who report consuming alcohol since knowing they were pregnant will be measured as a secondary outcome., Discussion: This will be the first randomised controlled trial to evaluate the effectiveness, cost and cost-effectiveness of implementation strategies in improving antenatal care that addresses alcohol consumption by pregnant women. If positive changes in clinical practice are found, this evidence will support health service adoption of implementation strategies to support improved antenatal care for this recognised risk to the health and wellbeing of the mother and child., Trial Registrations: Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).

Objectives: To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined., Design: A pre-post trial conducted from May 2012 to May 2014., Setting: Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia., Participants: Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up., Interventions: A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity., Primary and Secondary Outcome Measures: Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up., Results: Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24% vs 54%, p<0.001), brief advice (26% vs 46%, p<0.001), and clinicians speaking about (10% vs 31%, p<0.001) and arranging a referral (1% vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22% vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care., Conclusion: This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed., Trialregistration Number: ACTRN12614000469617., Competing Interests: Competing interests: None decalred., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To examine the effect of universal, school-based, resilience-focused interventions on mental health problems in children and adolescents., Method: Eligible studies were randomized controlled trials (RCTs) of universal, school-based interventions that included strategies to strengthen a minimum of 3 internal resilience protective factors, and included an outcome measure of mental health problems in children and adolescents aged 5 to 18 years. Six databases were searched from 1995 to 2015. Results were pooled in meta-analyses by mental health outcome (anxiety symptoms, depressive symptoms, hyperactivity, conduct problems, internalizing problems, externalizing problems, and general psychological distress), for all trials (5-18 years). Subgroup analyses were conducted by age (child: 5-10 years; adolescent: 11-18 years), length of follow-up (short: post-≤12 months; long: >12 months), and gender (narrative)., Results: A total of 57 included trials were identified from 5,984 records, with 49 contributing to meta-analyses. For all trials, resilience-focused interventions were effective relative to a control in reducing 4 of 7 outcomes: depressive symptoms, internalizing problems, externalizing problems, and general psychological distress. For child trials (meta-analyses for 6 outcomes), interventions were effective for anxiety symptoms and general psychological distress. For adolescent trials (meta-analyses for 5 outcomes), interventions were effective for internalizing problems. For short-term follow-up, interventions were effective for 2 of 7 outcomes: depressive symptoms and anxiety symptoms. For long-term follow-up (meta-analyses for 5 outcomes), interventions were effective for internalizing problems., Conclusion: The findings may suggest most promise for using universal resilience-focused interventions at least for short-term reductions in depressive and anxiety symptoms for children and adolescents, particularly if a cognitive-behavioral therapy-based approach is used. The limited number of trials providing data amenable for meta-analysis for some outcomes and subgroups, the variability of interventions, study quality, and bias mean that it is not possible to draw more specific conclusions. Identifying what intervention qualities (such as number and type of protective factor) achieve the greatest positive effect per mental health problem outcome remains an important area for future research., Systematic Review Protocol and Registration: Systematic Review of Universal Resilience Interventions Targeting Child and Adolescent Mental Health in the School Setting; http://dx.doi.org/10.1186/s13643-015-0172-6; PROSPERO CRD42015025908., (Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours., Methods: A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009-May 2014). Segmented logistic regression models were developed to assess intervention effectiveness., Results: A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity., Conclusions: The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision., Trial Registration: Australian Clinical Trials Registry ACTRN12611001284954 . Registered 15 December 2011. Retrospectively registered.

Introduction and Aims: Health risk behaviours, such as smoking, nutrition and physical inactivity, are significant contributors to chronic disease for people with substance use disorders. This study reports the prevalence of these behaviours amongst substance use treatment clients, their attitudes towards modifying such behaviours and the acceptability of receiving support to do so. Client characteristics associated with risk status and interest in modifying behaviours were examined., Design and Methods: A cross-sectional survey was undertaken with clients of 15 community substance use treatment services within in New South Wales, Australia. Data for the study were collected via computer assisted telephone interviews., Results: Of those contactable and eligible, 386 (71%) clients completed the survey. Clients reported a high prevalence of smoking (80%), insufficient fruit and/or vegetable consumption (89%) and insufficient physical activity (31%). Overall, 51-69% of clients reported considering modifying their health risk behaviours and 88-97% thought it was acceptable to be provided preventive care to address such behaviours. Younger clients were more likely to smoke (18-34 years (odds ratio [OR] = 4.6 [95% confidence interval [CI] = 1.9, 11.3]); 35-54 years (OR = 2.6 [95% CI = 1.2, 5.7])) and be interested in increasing vegetable consumption (18-34 years (OR = 4.4 [95% CI = 1.3, 14.8]); 35-54 years (OR = 8.0 [95% CI = 2.5, 25.4])) than older clients (≥55 years)., Discussion and Conclusions: There is a high prevalence of health risk behaviours amongst clients of community substance use treatment services. However, contrary to commonly cited barriers to care provision, clients are interested in modifying their risk behaviours and report that receiving preventive care to address these behaviours is acceptable. [Tremain D, Freund M, Wolfenden L, Wye P, Bowman J, Dunlop A, Gillham K, Bartlem K, McElwaine K, Gow B, Wiggers J. Modifiable health risk behaviours and attitudes towards behaviour change of clients attending community-based substance use treatment services. Drug Alcohol Rev 2017;36:369-377.]., (© 2016 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in reducing such health behaviors. This study aimed to examine clinician provision of preventive care to clients of community substance use treatment services., Methods: A cross-sectional survey was undertaken with 386 clients and 54 clinicians of community substance use treatment services in one health district in New South Wales, Australia. Client- and clinician-reported provision of three elements of care (assessment, brief advice and referral) for three health risk behaviors (tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity) was assessed, with associations with client characteristics examined., Results: Provision was highest for tobacco smoking assessment (90% client reported, 87% clinician reported) and brief advice (79% client reported, 80% clinician reported) and lowest for fruit and vegetable consumption (assessment 23%, brief advice 25%). Few clients reported being offered a referral (<10%). Assessment of physical activity and brief advice for all behaviors was higher for clients residing in rural/remote areas., Conclusion: Assessment and brief advice were provided to the majority of clients for smoking, but sub-optimally for the other behaviors. Further investigation of barriers to the provision of preventive care within substance use treatment settings is required, particularly for referral to ongoing support., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Challenges associated with the integration of physical health within alcohol and other drug (AOD) treatment services persist. The construct of recovery capital has gained currency within the sector, however, its potential in understanding the integration of physical health within AOD treatment has not been examined. This study explores the role of physical health in the process of recovery, examining the potential of 'recovery capital' frameworks to enhance integrated care., Methods: Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data was collected from clients (n = 20) and staff (n = 13) and transcribed. Data were systematically coded and analysed using the iterative categorisation method., Results: Unmanaged physical health issues compromised recovery, particularly when associated with hopelessness and pain. Improved physical health ameliorated sources of negative recovery capital such as boredom, social isolation and mental health symptoms. When addressed during treatment, physical health facilitated recovery capital resources through knowledge and skill acquisition, increased autonomy, enjoyment and immersive experience. Benefits extended to domains of 'social capital' (social connection) and 'cultural capital' (physical appearance)., Discussion and Conclusions: Physical health offers variegated pathways for building recovery capital. Findings support calls for a more assertive approach to addressing physical health when AOD treatment occurs outside of primary care settings. Future research should examine the potential of recovery capital as a heuristic for optimising care of physical health issues and health-related behaviour within AOD treatment services., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France. This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/. This is the first version of the protocol. [ABSTRACT FROM AUTHOR]

Background: Recent research suggests a concerning trend of non-suicidal self-injury (NSSI) and suicidal behaviors emerging at younger ages (as early as age 12). Early onset of NSSI is linked to more severe outcomes. While universal school-based prevention programs have shown promise in addressing suicidal behaviors, there is limited research on their effectiveness in preventing NSSI onset among adolescents. This study aims to evaluate the efficacy of a universal prevention program in schools for NSSI and mental complaints while enhancing resilience and mental health in 11–14-year-old adolescents. Methods: In total, 329 Flemish secondary school students (55.6% female), aged 11 to 14 years, participated in a 4 h classroom universal prevention, with a focus on emotion regulation, mental health, and specific strategies to prevent NSSI and reduce stigma. For both the intervention and control group (N = 124), a pre-, post-, and one-month follow-up questionnaire was administered, containing reliable and valid measures for NSSI and suicidality, emotion regulation, help-seeking behaviors, well-being, and psychological distress. Results: The prevention program effectively reduced NSSI and psychological distress, particularly for adolescents with a history of NSSI. Conclusions: These findings support previous research on the effectiveness of school-based programs in reducing mental complaints and suggest promising outcomes for NSSI prevention. [ABSTRACT FROM AUTHOR]

Background: The number of children and adolescents with inflammatory bowel disease (IBD) is increasing. Many chronically ill children and adolescents have low health literacy. Patient empowerment (PE) enables positive changes and control over one's disease through specific activities, information, and counseling. The CEDNA (IBD Needs Assessment) Survey aimed to provide the necessary data to improve PE in pediatric IBD (PIBD). Methods: Questionnaires were distributed to adolescent IBD patients and parents of children and adolescents with IBD throughout Germany. The answers were given anonymously. Based on the available data, a subgroup analysis was conducted in relation to the age of the patients and the period since diagnosis. For the parents' responses, the same age groups were analyzed for comparison with the patients' responses. Results: From October 2021 to April 2022, 2810 questionnaires were distributed and 1158 questionnaires were completed (n = 708 parents [61.1%], n = 450 patients [38.9%]). The results indicate that health literacy in children with IBD is low. Significant gaps in knowledge of important IBD topics were identified, and a comparison of responses regarding preferred methods and timing of obtaining information revealed differences between patient and parent preferences. The greatest need for knowledge on IBD topics was found in the group of 16–17-year-old patients on transition (n = 214, 31.8%) and in the group of patients diagnosed 1–2 years ago on the causes of IBD (n = 288, 17.4%). The willingness to seek advice was unexpectedly low. Conclusions: The analysis of all findings according to the patient's age structure and duration since diagnosis can be used to enable age-appropriate communication at certain stages of the disease. This tailored information should increase patients' health literacy, improve their management of the disease, and reduce the burden on their families. [ABSTRACT FROM AUTHOR]

Meeting the needs of students in schools has been challenging for many years. Consequently, some schools have responded with comprehensive, multi-tiered intervention systems (e.g., MTSS) aimed at addressing students' academic, behavioral, and social-emotional needs. However, most educators have a rudimentary understanding of these systems and the impact of trauma and traumatic experiences on students' response to interventions. Currently, there is limited research on how building level-administrators integrate trauma-informedness into these tiered systems. This conceptual article outlines the importance of administrators' perception, understanding, and implementation of using a trauma-informed lens in educational decision making, specifically regarding MTSS implementation. This article presents an overview of the literature and an approach to trauma-informed approach that administrators can utilize when making educational decisions, specifically within multi-tiered systems of intervention and student supports. [ABSTRACT FROM AUTHOR]

Single‐visit surveys of plots are often used for estimating the abundance of species of conservation concern. Less‐than‐perfect availability and detection of individuals can bias estimates if not properly accounted for. We developed field methods and a Bayesian model that accounts for availability and detection bias during single‐visit visual plot surveys. We used simulated data to test the accuracy of the method under a realistic range of generating parameters and applied the method to Florida's east coast diamondback terrapin in the Indian River Lagoon system, where they were formerly common but have declined in recent decades. Simulations demonstrated that the method produces unbiased abundance estimates under a wide range of conditions that can be expected to occur in such surveys. Using terrapins as an example we show how to include covariates and random effects to improve estimates and learn about species‐habitat relationships. Our method requires only counting individuals during short replicate surveys rather than keeping track of individual identity and is simple to implement in a variety of point count settings when individuals may be temporarily unavailable for observation. We provide examples in R and JAGS for implementing the model and to simulate and evaluate data to validate the application of the method under other study conditions. [ABSTRACT FROM AUTHOR]

Prenatal alcohol exposure is responsible for increasing chronic disease risk in later life, including obesity and metabolic syndrome. Alcohol drinking may compromise endogenous antioxidant capacity, causing an increase in free radicals and reactive oxygen species in the newborn. Excessive reactive oxygen species could attack the cellular proteins, lipids, and nucleic acids, leading to cellular dysfunction. Moreover, oxidative stress could play a crucial role in the altered synthesis and release of neurotrophins and progressive mitochondrial modifications with uncontrolled apoptosis. This narrative review aims to underline the important role of alcohol abuse in oxidative stress events and consequent metabolic and neurocognitive impairments in children exposed to alcohol during gestational life. [ABSTRACT FROM AUTHOR]

Stable isotope analysis of fish muscle tissue has been used to quantify fish migratory behavior in many systems, and these chemical tracers are especially useful for euryhaline fishes that traverse significant salinities and gradients in baseline signatures. However, the removal of muscle tissues often requires lethal sampling. Fish scales may be removed non-lethally and offer potential alternatives to stable isotope ratios from muscle to indicate recent feeding histories. For this study, red drum Sciaenops ocellatus were collected in subtropical estuaries in the northwestern Gulf of Mexico and analyzed for stable isotope (𝛿 13 C and 𝛿 15 N) compositions of scale exteriors. Decalcification of scale samples was deemed unnecessary given the preservation of linearity and minimal offsets between paired decalcified and untreated scale samples. Stable isotope signatures of muscle tissue and scales were closely matched and indicated high degrees of residence within bays at fine spatial scales. This study also surveyed the existing body of literature comparing scale and muscle isotope values from the same individuals and found that the majority reports linear relationships with slopes close to unity, although species-specific offsets and intercepts vary. This work expands the body of literature indicating that scales are a viable non-lethal alternative for stable isotope assessments of dietary and habitat use histories for mobile fishes., (© 2023 Fisheries Society of the British Isles.)

The combined use of otolith chemistry and tissue isotopes has the potential to reveal movements, habitat associations and food web interactions at a variety of spatial and temporal scales. Here, a combination of otolith Ba:Ca life-history transects with muscle tissue δ 13 C and δ 15 N values has been used to assess habitat use and oligohaline residence in red drum Sciaenops ocellatus in subtropical estuaries in the north-western Gulf of Mexico. Tissue isotopes were distinct among capture locations, particularly between bays with differing proximities to freshwater inflow sources. Otolith edge Ba:Ca values and tissue δ 13 C values were not correlated. These results indicated that fish were neither residing in nor feeding in oligohaline waters for significant periods of time within the tissue turnover window of several months prior to capture. Nonetheless, spatial differences in tissue isotope values indicated limited mixing among bays and relatively high site fidelity during estuarine occupancy. Lifetime otolith Ba:Ca transects revealed individual variability in the magnitude of residence in oligohaline waters. Using a mean oligohaline occupancy threshold, an estimated 82% of individuals used oligohaline waters at some point in their life. Nonetheless, 66% of individuals spent <20% of their life histories in oligohaline waters, suggesting intermittent and infrequent excursions into low salinity waters. Finally, a literature survey identified 56 peer-reviewed publications using combinations of otolith chemistry and tissue stable isotope ratios with a wide range of marker pairings and study aims. The diversity of ecological questions that can be asked with the combined use of these two approaches will provide valuable insight into fish ecology., (© 2022 Fisheries Society of the British Isles.)

Background: The Australian Clinical Practice Guidelines for Pregnancy Care recommend that during the first and subsequent antenatal visits all pregnant women are weighed; advised of recommended gestational weight gain (GWG), dietary intake and physical activity; and offered referrals for additional support if needed. The extent to which these recommendations are implemented and women's acceptability of recommended care is unknown. This study examines women's reported receipt and acceptability of guideline care for GWG, and characteristics associated with receipt of such care and its acceptability. Methods: From September 2018 to February 2019 a telephone survey was undertaken with women who had recently had a baby and received antenatal care from five public maternity services within a health district in Australia. Women self-reported their demographic characteristics, and receipt and acceptability of recommended GWG care. Receipt and acceptability of such care, and their association with the characteristics of women and the maternity service they attended, were examined using descriptive statistics and multivariable logistic regression analyses. Results: Of 514 women, 13.1% (95%CI:10.3–16.5) reported that they received an assessment of weight at both their first and a subsequent antenatal visit, and less than one third (30.0%; 95%CI:26.0-33.9) received advice on their recommended GWG range, dietary intake and physical activity. Just 6.6% (95%CI:4.8–9.1) of women reported receiving all assessment and advice components of recommended antenatal care, and 9.9% (95%CI:7.6–12.8) of women reported being referred for extra support. Women who were younger (OR = 1.13;95%CI:1.05–1.21), identifying as Aboriginal and Torres Strait Islander (OR = 24.54;95%CI:4.98-120.94), had a higher pre-pregnancy BMI (OR = 1.13;95%CI:1.05–1.21), were experiencing their first pregnancy (OR = 3.36;95%CI:1.27–8.86), and lived in a least disadvantaged area (compared to mid-disadvantaged area (OR = 18.5;95%CI:2.6-130.5) and most disadvantaged area (OR = 13.1;95%CI:2.09–82.4)) were more likely to receive recommended assessment and advice. Most Aboriginal (92%) and non-Aboriginal (93%) women agreed that recommended GWG care is acceptable. Conclusion: Most women perceive antenatal care for GWG as recommended by the Clinical Practice Guidelines as acceptable, but did not receive it. When provided, such care is not delivered consistently to all women regardless of their characteristics or those of the maternity service they attend. There is a need for service-wide practice change to increase routine GWG care in pregnancy for all women. [ABSTRACT FROM AUTHOR]

Objective: Crevalle Jack Caranx hippos are important coastal predators and support an increasingly popular catch‐and‐release sport fishery. However, population declines have recently been perceived by stakeholders in parts of the species' range. Here, we aimed to provide distribution and harvest trends for Crevalle Jack in the northwestern Gulf of Mexico. Methods: Long‐term fishery‐independent and fishery‐dependent data were collected by the Texas Parks and Wildlife Department from 1983 to 2021. Bag seine, bay trawl, and gill‐net samples were collected in conjunction with angler creel surveys. Crevalle Jack that were observed in fishery‐independent sampling were used to assess patterns in both juvenile and adult relative abundance, distribution, and seasonality. In addition, boosted regression tree models were used to highlight important predictors of Crevalle Jack presence. Crevalle Jack harvest observed during angler surveys was used to describe the fishery, including differences in inshore and offshore catch patterns. Relative abundance of both juveniles and adults was variable across years but displayed no trend throughout the time series. Result: Crevalle Jack of all sizes were found within inshore waters, with subadults and large adults particularly reliant on estuarine systems. Recruitment peaked in early summer, with juveniles occupying all major estuaries along the coast. Shifts in recruitment were evident in bag seines, as the mean date of catch trended almost 2 weeks earlier over the study period. The Crevalle Jack fishery was spread across inshore and offshore waters, with significantly larger fish harvested offshore during summer. The majority of anglers who harvested Crevalle Jack stated that they were specifically targeting other species, thus supporting the notion that the targeted fishery is mainly catch and release. Conclusion: As Crevalle Jack declines have been noted elsewhere in the species' range, these results could help to inform future management decisions in Texas. Impact statementCrevalle Jack are an important sport fish in the eastern Gulf of Mexico. However, anglers have noted population declines in parts of their range. Here, we examined seasonality, distribution, and recruitment of Crevalle Jack in Texas. Results indicate that populations are stable and provide important insights into Crevalle Jack ecology. While the fishery is largely catch and release, the reliance of large Crevalle Jacks on estuaries and nearshore waters could see them increase in popularity as an accessible sport fish. These findings will be important to inform future management decisions. [ABSTRACT FROM AUTHOR]

Development of Florida's marine Fisheries-Independent Monitoring (FIM) program began in 1985, and it initiated long-term monitoring in Tampa Bay in 1989 with the purpose of providing timely fishery-independent data and analyses to fishery managers for the conservation and protection of the species that support Florida's fisheries. Over time, the program expanded sampling in other Florida estuaries. Data from this monitoring program are integral to the assessment and management of numerous state and federally managed fishes, so long-term consistency is of paramount importance, but sampling design modifications have been necessary over time. This review presents three case studies in which the estuarine component of the FIM program was changed to address emerging data needs in management of Florida's fishery resources, while maintaining standardization and consistency with long-term surveys statewide. In the first case study, survey changes increased the amount of data on juvenile common snook, Centropomus undecimalis, on the Gulf of Mexico and Atlantic coasts and improved indices of abundance, survival estimates, and age-length keys for state management purposes. In the second case study, the FIM program improved estimates of abundance of juvenile reef fishes by initiating a complementary survey that expanded FIM sampling to new regions of the Florida Gulf coast and targeted a unique habitat (polyhaline seagrass beds along estuarine shoal habitats) not previously sampled in the standard longterm survey. In the third case study, the FIM program addressed a data limitation for regional management of spotted seatrout, Cynoscion nebulosus, by initiating seasonal sampling in western Florida. In each case study, the standard long-term survey design was modified to include sampling of new and unique areas and habitats, providing valuable data on estuarine fish assemblages that support analyses at the broader, ecosystem level. Survey amendments were designed to maintain standardization and consistency, all with limited additional funding. The success of these survey modifications was the result of several key factors: mission-focused programmatic goals, geographically dispersed laboratories, standardized protocols, ongoing critical analysis of the data, grant award success, and high-level data management. Although each case study originated with a survey expansion, all were followed by survey reductions or streamlining, so expansion and reduction scenarios are presented in this review. Regardless of these modifications, the mission of the FIM program remains the same: to provide timely data and analysis for the use of fishery managers, including state and federal partners. [ABSTRACT FROM AUTHOR]

Background: Mental health concerns prevent positive well-being and are key challenges for Australian children and young people. Arts organisations play a role in enhancing the positive mental health of children and young people. This paper describes the involvement of young people and their parents in the development of a resource for arts organisations' intentional support of social and emotional well-being. Methods: Six focus groups were conducted with 19 young people who participate in dance, drama, and circus programs, and 17 of their parents. Questions explored how the arts currently, and potentially, support their social and emotional well-being. Results: Three overarching themes: Connecting with Others; Being Myself; and Teaching Methods, plus 14 sub-themes were identified. Conclusion: A framework of well-being factors and pedagogies was developed to guide the creation of a resource to help support the social and emotional well-being of young people participating in arts programs. [ABSTRACT FROM AUTHOR]

Background: The incidence/prevalence of pediatric inflammatory bowel disease (IBD) is increasing. IBD places a significant burden on young patients during important developmental stages and affects their families. Children and adolescents with IBD require increased support from health care services. However, little is known about the additional support needed and how to provide it. Therefore, a large survey was conducted with a focus on patient empowerment. Methods: For the anonymous survey, called CEDNA, a patient questionnaire for adolescents with IBD and a questionnaire for parents of children and adolescents with IBD were made available throughout Germany (distributed n = 2810). Questions covered various aspects of coping with the disease, utilization of care, use and need of information and communication services, and how information should be provided. Results: From October 2021 to April 2022, 1158 (n = 708 parents (61.1%), n = 450 patients (38.9%)) questionnaires were completed. The results show a deficit in pediatric IBD care and revealed a large gap in knowledge about core IBD topics (e.g., 74.8% of patients feel poorly informed about transition, 62.4% know little about patient organizations and self-help groups, and 54.7% have little information about preventive health measures), indicating a low level of health literacy among affected children and adolescents. Conclusion: Pediatric IBD poses significant challenges for patients, their families, and healthcare teams. By empowering patients and families, and providing targeted information and communication tailored to the age of the child or adolescent and the needs of the parents, care can be improved and better adapted to the needs of patients. Actions would include providing quality information online through scientific societies and patient organizations and facilitating self-management in adolescents. [ABSTRACT FROM AUTHOR]

Schools are increasingly concerned with the promotion of student wellbeing, and relatively little is known about school libraries as wellbeing supportive spaces in contemporary schools. This article draws on qualitative interview data from students and library managers to explore how students make use of the school library, and how this relates to the library as a safe space. It finds that school libraries can be highly valued for their capacity to foster belonging and sanctuary and allow exposure to books and opportunities for reading. Students also appreciated how libraries provided a space for relaxing and recharging, supporting lively and social activities as well as quietude. There was recognition of the role of supportive library staff, who created inviting and supportive environments with careful selection of furnishings and decorations. [ABSTRACT FROM AUTHOR]

Background: Students are a priority population in mental health research. This study aimed to explore the risk factors of anxiety and depression symptoms among college students in Chongqing, a megacity under the impact of COVID-19, and to provide a basis for determining the priorities of public health policies and implementing effective educational health care interventions. Methods: In this cross-sectional study conducted in Chongqing, China, the data came from web-based stratified random sampling. Anxiety and depression symptoms were measured by the Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Studies Depression Scale (CES-D), respectively, and risk factors were analyzed by logistic regression. Results: Data were obtained from 915 college students (34.75% were male, and 65.25% were female) with age (20.29 ± 1.51) in Chongqing, China. The prevalence rates of anxiety and depression were 19.78% and 22.62%, respectively. Logistic regression analysis revealed that the risk factors of anxiety symptoms were associated with junior years, sleep time of less than 6 h a day, influence on career planning, and depression symptoms. Comprehensive, science and engineering, and medicine disciplines, having siblings, poorer mastery of study, and anxiety symptoms were risk factors for developing depression symptoms. Conclusions: During the pandemic, college students experienced varying degrees of anxiety and depression. Our research findings highlight the necessity of universities and relevant departments providing precise mental health education for college students under major public health emergencies. [ABSTRACT FROM AUTHOR]