Childhood and adolescence are critical periods for preventing behavioral problems, and intervening during these stages can produce lifelong benefits. If basic needs remain unaddressed, however, behavioral problems can escalate to include violence. Schools may expel students in severe cases, further ostracizing them and often setting them on a course of continued aggression. We evaluated a school-based intervention, Pathways to Potential (P2P), designed to address students’ basic needs. By addressing social determinants of behavioral problems, we hypothesized that P2P also would be associated with fewer violence-related expulsions. This study used targeted minimum loss-based estimation to estimate average treatment effects (ATE) of P2P on rates of expelling students in Michigan K-12 schools from 2013–14 through 2016–17. Outcomes included expulsions for (1) overall violence, (2) weapons, and (3) firearms. Treated schools received P2P from 2013–14 through 2016–17 (n = 98). Comparison schools were untreated but in districts where some schools received P2P (n = 346). Mean pre-treatment rates for overall violence-related, weapon-related, and firearm-related expulsions were 0.85 (SD = 2.32), 0.30 (SD = 1.07), and 0.04 (SD = 0.33) per 1,000 student-years, with no differences between treatment and comparison schools. Analyses did not find that P2P was associated with changes in expulsion rates for overall violence (ATE: − 0.01 [ − 0.10, 0.08]), but it was associated with decreases for weapons (ATE: − 0.06 [ − 0.10, − 0.02]), including firearms (ATE: − 0.03 [ − 0.06, − 0.01]). Findings were robust to sensitivity checks. School-based interventions that address fundamental causes of health and well-being may offer a promising strategy for preventing severe aggression at a critical stage in children’s lives.
Gambling chasing has traditionally been defined as continued gambling after losses in an effort to recover money, although recent evidence suggests that it may also include broader persistence following salient outcomes, including wins. However, most research has focused on adults, and evidence in adolescence remains limited. The present study examined gambling severity, craving, delay discounting, and alcohol use as factors associated with gambling continuation and persistence in 258 Italian adolescents aged 16–19 years who completed a computerized chasing task and were randomly assigned to a control or loss condition. After an initial 30-trial block, participants were informed whether they had preserved or lost their money, according to the experimental condition, and could then choose to terminate play or continue for up to 30 additional trials. Experimentally induced losses did not significantly affect either continuation or persistence. Continuation was independently associated with GACS Anticipation, GACS Desire, and steeper delay discounting, whereas persistence was independently associated with GACS Desire, steeper delay discounting, and alcohol use. Gambling severity was associated with persistence at the bivariate level but did not contribute uniquely in multivariate analyses, although significant indirect associations emerged through GACS Desire, delay discounting, and alcohol use. Overall, these findings support a multidimensional view in which motivational, temporal decision-making, and disinhibitory processes are associated with adolescent gambling beyond overall severity or loss exposure. While causal pathways and intervention effects cannot be established, the findings identify candidate processes for future prevention research.
Patient groups with known vulnerabilities to poor health outcomes may be less likely to receive or benefit from evidence-based practices (EBPs). Implementation science—the study of methods and strategies to promote EBP adoption into routine clinical practice—can both mitigate and exacerbate health inequities. Despite increasing recognition of health equity’s importance to implementation science, implementation strategies do not typically integrate health equity. We aimed to pilot and evaluate a health equity adaptation to Evidence-Based Quality Improvement (EBQI), a multi-faceted implementation strategy bundle. The health equity adaptation provided specific steps to incorporate health equity into practice facilitation and quality improvement (QI) training, including a health equity didactic session provided to frontline primary care clinical champions. Our mixed methods evaluation included a clinical champion survey to assess acceptability of the health equity training and clinical champion and practice facilitator interviews to assess feasibility and acceptability of embedding health equity within the implementation strategy. We calculated survey response means and used rapid qualitative analysis to analyze interviews. Survey responses indicated neutral to high acceptability of the health equity didactics. In interviews, clinicians and facilitators reported that equity-infused practice facilitation was valuable and effective in supporting equity considerations in implementation. Facilitators felt comfortable incorporating the adaptation into future EBQI facilitation. Champions noted the equity adaptation influenced how they provided care to their patients. Our evaluation also revealed areas for improvement, and challenges inherent in implementation and health equity work. Future work can refine the health equity adaptation for other implementation projects that use EBQI.
Suicide is a preventable cause of death that requires targeted interventions tailored to at-risk populations. This study conducts an ecological spatial analysis with two main objectives: (1) To analyze the spatial pattern of suicide mortality in Spain at the municipal level; and (2) to evaluate the association between suicide deaths and occupation (with a focus on the distribution across professional sectors) as well as the municipality’s GDP per capita. Moran’s I index and Local Indicators of Spatial Association were used to identify spatial clustering. Due to the high correlation coefficient among the different occupational sectors, the variables describing each municipality’s occupational structure were derived using Principal Component Analysis. For the association analysis, we applied bivariate spatial association techniques and, subsequently, we calculated relative risk models adjusting for all independent variables. The spatial analysis revealed clusters of both high and low incidence in the country. Suicide deaths showed a negative relationship with employed male population (RR = 0.96; 97.5
Implementation fidelity is essential for preventive interventions to produce their intended effects, yet it is often difficult to achieve in real-world settings. Achieving fidelity depends in part on how well facilitators are trained; however, opportunities to practice program delivery skills are often limited by time, cost and staff turnover. Generative artificial intelligence offers a promising approach to simulating participant interactions for training purposes; however, evidence regarding the feasibility and performance of such simulations remains limited. In this formative feasibility study, we developed and iteratively refined a text-based generative AI chatbot designed to simulate adolescent participants in a brief motivational interviewing-based substance use prevention program. We evaluated the chatbot’s feasibility, acceptability, and perceived utility for facilitator practice. Five program-certified facilitators each completed two text-based simulated sessions with the chatbot, resulting in a total of 374 distinct messages. Chatbot responses were rated independently by three trained coders on coherence, realism, and contextual appropriateness, and semi-structured interviews were conducted with facilitators following each session to assess their experiences interacting with the chatbot. Coder ratings indicated high mean message-quality scores across sessions, suggesting that the chatbot consistently generated coherent and context-appropriate adolescent-like responses. Qualitative findings suggested that facilitators perceived the chatbot as realistic, engaging, and useful for practicing motivational interviewing skills, particularly for navigating adolescent ambivalence and resistance. Facilitators also reported reduced performance anxiety relative to traditional role-play, while noting limitations related to the absence of nonverbal cues. These findings suggest that a text-based generative AI chatbot simulating adolescent participants could be a useful tool to enhance facilitator training in motivational interviewing-based prevention programs. Future research should examine whether such tools improve training effectiveness, facilitator skill acquisition, and implementation fidelity.
