Mental health issues are a growing concern in Estonia, while limited healthcare resources constrain the capacity of formal services to respond to increasing needs. This study explored how community facilitators interpreted the role of communities in mental health promotion, prevention, and recovery following engagement with a shared conceptual framework on community mental health. Between May 2023 and January 2024, a qualitative interpretive study was conducted through seven regional seminars involving 229 community facilitators representing all 15 Estonian counties. Discussions were structured around the World Health Organization Community Mental Health Guide and the Estonian Human Development Report: Mental Health and Well-Being. Data were collected through participatory observation and systematic note-taking and analysed using reflexive thematic analysis. Participants understood community as extending beyond geographical boundaries and being rooted in trust, belonging, shared values, and collective responsibility. Mental health was interpreted as a holistic and relational phenomenon embedded in everyday environments rather than solely as a healthcare issue. Participants emphasised the preventive value of local resources, informal support networks, community spaces, and cross-sector collaboration, while also identifying barriers including limited service availability, low awareness of existing resources, and the predominance of treatment-oriented approaches. The findings suggest that strengthening community mental health requires greater investment in prevention, stronger cross-sector collaboration, and broader recognition of community resources and non-clinical actors. The study contributes empirical evidence on how community facilitators conceptualise community as a foundation for mental health and highlights the potential of community-based approaches to complement formal mental health services.
Health education relies on matching a program to users’ needs and preferences. Using programs aligned with expert recommendations may improve outcomes. The purpose of this study was to identify and assess free, public, concussion education programs for an athlete audience and provide context for users to select a program that fits their needs. We performed a rapid scoping review following JBI Methodology and Cochrane guidelines for programs published in English during the previous five years in PubMed or SportDiscus, or in grey literature. Education specifically for post-injury care and conference abstracts were excluded. We charted primary author/organization name, program name(s), date of publication or update, delivery method(s), option to provide a certificate of completion, and program content related to expert recommendations. The search identified 1,449 unique articles and programs, and after screening at the abstract and full-text levels, identified videos (N = 6), online modules (N = 4), in-person discussion guides (N = 3), or fact sheets (N = 2) that were created by 14 organizations published between October 2013 and April 2024. Six programs provided certificates of completion. Program content varied and no programs addressed all of the expert recommendations, but clear patterns emerged. The most common recommendations included were those specifically referred to as “content of concussion education for athletes”, being honest about symptoms throughout recovery, and athletes’ role in encouraging others to report a concussion. These findings identify programs to consider when selecting educational program(s), with different delivery methods and learning objectives. Future effectiveness-implementation research is needed to expand understanding of real-world applications and outcomes.
Berlin’s techno party scene faces challenges of high alcohol and substance consumption associated with health and social issues, including intoxication and (sexual) violence. Recognising these challenges, the scene has evolved “Awareness Structures” (AS), on-site peer-led structures aiming to address patrons’ well-being during club events. This study explores currently operating AS in techno clubs in Berlin, focussing on facilitators and barriers of the effective implementation of AS as structures to prevent harm to patrons. Between September and October 2023, seven semi-structured expert interviews, including five individual interviews, one paired interview, and one focus group interview were conducted with three key stakeholder groups: techno club managers (n = 3), event collective representatives (n = 4), and Awareness Persons (AP) working within AS (n = 6). The interviews explored stakeholders’ perceptions about facilitators and barriers of currently operating AS. Data analysis followed force-field analysis combined with a qualitative content analysis method, applying a deductive-inductive strategy. The key stakeholders identified several facilitators that enhance the effective implementation of AS in techno clubs in Berlin as well as barriers that hinder its effective implementation that were categorized onto three levels: individual, operational, and organisational. Perceived facilitators included the qualified expertise of AP and additional training for other club staff, the reduced occurrence of severe incidents post-implementation, supervision for AP, and management’s commitment to prioritising patrons’ well-being. Perceived barriers included the inadequacy of training, the potential aggravation of situations with the implementation of AS, the lack of universal understanding and standards, psychological challenges faced by AP, and market forces. The findings of this study contribute to understanding the complex dynamics of currently operating AS in techno clubs in Berlin. The facilitators and barriers documented in this study suggest specific factors to be vital for the effective implementation of AS, potentially serving as setting-based harm reduction structures for patrons.
Temporal data structure is not an identification strategy. In manuscript review and reporting, cross-sectional and longitudinal labels are sometimes used as shorthand for judging whether causal claims are appropriate. Whether a causal claim is credible depends on the effect being considered, what makes the comparison informative, what assumptions are required, and whether the analysis and supporting evidence address the main threats. We define temporal data structure as the temporal and sampling organization of measurement and distinguish it from causal identification, which concerns whether a causal estimand can be recovered under explicit assumptions. Longitudinal data can establish measurement order and show how outcomes, exposures, and other relevant factors change over time, but these advantages do not by themselves address confounding, selection, attrition, or measurement error. Conversely, cross-sectional or repeated cross-sectional data may contribute to causal inference when temporal ordering is established by design or substantive knowledge and identification arises from credible adjustment, assignment rules, thresholds, policy timing, or other design features. Using prevention examples, we show where causal leverage can come from, explain what repeated measurement adds and what it cannot establish by itself, and propose five plain-language questions for authors, reviewers, and editors. We also distinguish limitation language appropriate for associational analyses from qualified causal interpretations made under explicit assumptions. Temporal structure informs causal appraisal, but it does not determine it.
Trials of behavioural interventions aimed at preventing an Alcohol-Exposed Pregnancy (AEP) before conception report variable effectiveness. Understanding which intervention components, such as Behaviour Change Techniques (BCTs), are effective is essential when adapting for real-world implementation. This review describes the intervention models, the BCTs utilised, and the BCT combinations in effective interventions. An earlier systematic review of studies published from 1970 to 2018 was updated using the same search strategy to identify additional articles published subsequently. Searches were conducted on CINAHL, PsycINFO, Embase and PubMed to identify studies published between 2019 and 2025. Eligible study designs were randomised controlled trials (RCTs), non-randomised comparative studies, cohort studies and before-and-after studies. Studies were included if they were in English, included non-pregnant women of reproductive age or their social networks and aimed to prevent AEP. Outcomes reviewed were measures of knowledge of guidelines and attitudes towards alcohol consumption in pregnancy or when planning a pregnancy, changes in alcohol consumption and changes in behaviours to prevent unplanned pregnancies, such as effective contraception use at every sexual encounter that could lead to pregnancy. Narrative synthesis was used to describe intervention models and annotate BCTs guided by the BCT Ontology (BCTO) and alcohol-specific taxonomy. Risk of bias was assessed using the ROB 2 tool and the Modified Downs and Black Checklist. Twenty-five studies, comprising 18 studies from the previous systematic review and seven published between 2019 and 2025, were identified with 6,020 participants. Three intervention models were identified: (i) alcohol-only educational, (ii) alcohol-only screening and brief interventions (SBIs), and (iii) dual-focused (alcohol and contraception) interventions. Models included single- and multiple-session interventions, which were delivered face-to-face, remotely or digitally. Fifty-one BCTs were coded across all studies. Within the alcohol-only SBIs and dual-focused (alcohol and contraception) models, multi-session interventions generally demonstrated greater effects in intervention groups than controls and utilised more BCTs from the goal-directed and monitoring BCTO groups compared to single-session interventions. These findings deepen our understanding of why some interventions are more effective than others and suggest that tailored interactions with certain goal-directed and monitoring BCTs may enhance their effectiveness. Future research can explore greater incorporation of BCT combinations from these groups into single-session interventions and pathways to identify women who need more intense interventions for referral or support.
Prevention science has generated substantial evidence on interventions aimed at preventing substance use and other addictive behaviours. However, less attention has been paid to the conditions that hinder their design, implementation, sustainability, and equitable benefit. To propose a conceptual definition of barriers to prevention, establish criteria for identifying them, and develop a theoretical taxonomy of their main categories, incorporating a gender perspective and examining their specificity across preventive actions. Barriers to prevention should not be understood solely as operational obstacles to programme implementation, but as ecological factors, conditions, or processes that interfere with essential preventive functions and reduce the distribution of preventive protection. When barriers are structural or disproportionately affect specific groups or territories, reductions in coverage, accessibility, acceptability, continuity, equity, or preventive benefit may contribute to maintaining or amplifying prevention failure. We therefore propose a six-category taxonomy and a two dimensional identification model based on the joint presence of functional interference and observable consequences. The framework also considers how barriers may vary according to prevention form, preventive function, intervention package or strategy, mode of delivery, and setting. A more precise conceptualization of barriers to prevention may strengthen theory, improve implementation research, and support public policies that are more sensitive to equity, gender, and the regulation of risk-promoting environments.
This study aims to investigate the mediating role of nocturnal sleep duration in the association between depressive symptoms trajectories and subsequent pain outcomes. Using data from the English Longitudinal Study of Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS), 6,874 participants were included. Latent class mixture models (LCMM) were employed to identify depressive symptoms trajectories. Logistic regression analysis was conducted to examine the association between these trajectories and pain. Three depressive symptoms trajectories were identified in both cohorts: low-stable (class 1), increase-then-decrease (class 2), and decrease-then-increase (class 3). In ELSA, classes 2 and 3 exhibited 93
Behaviour change theories have substantially advanced understanding of the mechanisms through which behaviours are initiated, maintained, and sustained. However, less attention has been directed towards the temporal conditions under which these mechanisms are able to operate consistently in everyday life. This conceptual paper explores whether differences in temporal conditions may contribute to the variability frequently observed in behaviour change interventions. The paper proposes a complementary framework centred on the concepts of tempo, interval, and behavioural consolidation. Rather than introducing an alternative behaviour change theory, the framework considers how environments differ in the temporal conditions they create for behavioural processes to unfold. It suggests that these conditions may influence the extent to which existing behaviour change mechanisms are able to operate effectively over time. The framework is illustrated through conceptual applications to food environments, learning environments, sleep, and clinical prevention, demonstrating how temporal conditions may provide an additional perspective across behavioural, cognitive, physiological, and professional domains. By making temporal conditions explicit, this perspective complements existing behaviour change models and generates new questions for prevention research and practice. Rather than asking only how behaviour changes, it encourages consideration of whether the temporal conditions required for behavioural consolidation are present in the first place.
Nearly half of all cancer diagnoses are attributable to modifiable risk factors, yet cancer prevention continues to underinvest in one of its most consequential life-course windows: early adulthood. Community college students represent a large and underserved population in this period who cluster cancer-relevant risk behaviors, including tobacco use, alcohol consumption, physical inactivity, and poor diet, while remaining largely invisible in prevention research and practice. Although community colleges enroll millions of students nationwide and disproportionately serve lower-income, racial and ethnic minority, and medically underserved populations, they are rarely treated as core prevention infrastructure. This debate paper argues that cancer prevention is missing a critical opportunity by failing to prioritize community colleges as settings for life-course intervention. We integrate epidemiologic, developmental, and prevention science evidence to advance three claims early adulthood is a uniquely malleable period for shaping trajectories of cancer risk; community colleges concentrate both modifiable risk and health inequities at population scale; and place-based prevention strategies offer a feasible pathway for intervening in under-resourced institutional environments where clinical prevention is limited. Drawing on implementation experience from the Be Well Baytown is the initiative -a community-embedded prevention program operating at Lee College is the community college, a Hispanic-Serving Institution in Baytown, Texas-we illustrate how community colleges can support multi-component, theory-driven cancer prevention efforts. We conclude that continued neglect of community colleges reflects not a lack of prevention promise but a failure of prevention prioritization. Aligning cancer prevention investment with where early-adult risk accumulates will require treating community colleges as essential components of prevention infrastructure.
Black adolescents face disproportionate behavioral health and substance use risks amplified by structural racism and discrimination, yet access to culturally grounded, family-centered preventive interventions remains exceedingly rare. Telehealth may advance prevention equity by eliminating geographic and logistical access barriers. A randomized controlled trial enrolled 170 families with Black adolescents (ages 11–12) assigned to T-SAAF—a telehealth adaptation of the evidence-based Strong African American Families program—or a no-treatment control. At 2 year follow-up, 145 families (85
Childhood obesity represents a major public health challenge, with long-term consequences for individual health and the sustainability of healthcare systems. Early childhood, particularly the 5–11 age range, is a critical period for establishing lifestyle habits related to nutrition and physical activity. Promoting healthy behaviors during this stage is therefore essential for effective primary prevention. Recent national data from the Italian surveillance system shows that excess body weight remains widespread among Italian children aged 8–9 years: approximately 19
Contemporary prevention discourse increasingly defines its mission as "empowering individuals" - building resilience, skills and assertiveness so that people can resist substance use, bullying, abuse, gambling, violence and gender-based harms. Such individual-level (i-frame) interventions can be effective, and several rest on a solid evidence base. Drawing on Chater and Loewenstein's i-frame/s-frame distinction and on classical public-health scholarship from Rose, McKinlay, Marmot and Marteau, this paper argues that the field has drifted into a near-monopoly of the i-frame and sidelined the environmental, regulatory and commercial determinants that public health itself rates as most effective. We trace the trend through six domains (substance use, bullying, child sexual abuse, youth violence, gender-based prevention and gambling) and through a telling institutional silence about it. We argue that this drift is reinforced by a market-fundamentalist "Illegitimacy Thesis" that frames any structural measure as paternalism, and by commercial and political actors with a direct interest in keeping policy on the individual side of the scale. Even high-quality developmental programmes hit a ceiling when the surrounding environment and its neurobehavioural consequences continues to push in the opposite direction. We read the two frames as complementary rather than rival; the problem we diagnose is their current imbalance, not the use of individual-level methods as such. We propose three correctives: restoring environmental language to foundational declarations, treating prevention systems as social ecologies rather than delivery pipelines for individual-level programmes, and naming and acting on the vested interests that shape the frame. The lesson of nineteenth-century cholera - fix the water, do not teach every household to boil it - is the lesson prevention has yet to fully relearn.
Primary prevention interventions represent a promising strategy for addressing rising rates of substance use among adolescents, yet substantial heterogeneity exists in intervention formats, content, goals, outcomes measured, and effectiveness. This scoping review aimed to document primary prevention initiatives targeting adolescent substance use. A systematic search of APA PsycINFO, ERIC, Medline, CINAHL, and SocINDEX was conducted for articles published 2020 onward. Eligible studies examined primary prevention interventions targeting substance use related outcomes among adolescents aged 10-19, were published in English, and were conducted in the United States, Canada, or Australia. Studies focused on treatment or diagnosed substance use disorders were excluded. Two independent reviewers screened articles, and data were charted using a standardized form. The search identified 24,617 records, of which 71 studies met inclusion criteria. Studies varied widely in sample size, design, and intervention characteristics and were conducted primarily in the United States, with additional studies from Australia and followed by Canada. Most interventions were school-based, followed by digital, media-based, community-based, and policy-level approaches, with fewer hospital- and parent-based programs. Interventions most commonly targeted general substance use or e-cigarette use. Many interventions demonstrated improvements in knowledge, attitudes, risk perception, and refusal skills, while effects on substance use behaviours were mixed and varied by intervention type and substance. School-based interventions were prominent and show promise for improving knowledge and attitudes, but evidence for sustained behavioural change is limited. Future research should emphasize long-term outcomes and further evaluate emerging digital and policy-level strategies.
There is a clear imperative to prevent youth crime and violence owing to the significant social and economic costs for individuals involved and wider society. A considerable evidence base for 'what works' in this space exists but gaps remain. To address these, it is necessary to evaluate intervention effectiveness. The aim of this article is to explore challenges and potential solutions regarding outcome measurement in such evaluations. To do this we draw on the literature and our experience as evaluators. We argue that outcome selection should be informed by a robust theory of change, and that normally this will mean focusing on non-crime/violence outcomes. We identify challenges with self-report measures of youth crime and violence, and consequent effects on participants' engagement in the intervention and the quantity and quality of data they provide. We also discuss ways of using administrative data on crime and violence in evaluations and the practical, scientific and ethical issues these raise. While the challenges identified can partially be addressed, we conclude that currently evaluations of preventive interventions should mostly focus on intermediate outcomes with a known causal link to crime and violence. The longer-term impact on crime and violence can be tracked using administrative data accessed via an archive. We appreciate policymaker and funder pressure to quantify short-term intervention impact on crime and violence but contend that it is important not to force the issue. Meanwhile, it is essential to test the feasibility and acceptability of alternative approaches to measuring crime and violence in evaluations and to share the learning.
Childhood experiences of economic disadvantage have harmful and long-lasting effects on child health. Early intervention can reduce some harms but it is unclear whether addressing economic disadvantage alongside psychosocial support yields additional benefits. This systematic scoping review aimed to identify evaluated programmes that integrate parenting support (PS) and financial well-being support (FWbS) for parents of children aged 0–19. The objectives were to describe programmes, relevant components, evaluation designs and impact on outcomes, and to consider if any programmes merit replication and testing in a UK context. Outcome or implementation evaluations of integrated PS and FWbS programmes published in English were included (no publication date or geographical limitations). A database search was supplemented by a programme registry search and consultation with parenting experts. Papers were screened independently by two reviewers. Data were extracted for: publication and study characteristics; programme description; evaluation method; measures used; and impact on outcomes (narrative description by study). Each data extraction record was checked by a second reviewer. Searches yielded 2988 (databases) and 346 (registries) articles and 20 programmes (expert consultation). After full text screening, 11 articles covering 11 programmes were included. All were targeted rather than universal. The majority principally offered PS with minimal FWbS (mostly money management). Theoretical justifications for integration of PS and FWbS were limited. Nine studies measured financial, parent health/well-being, parenting or child health/development outcomes; only two measured all four. Four studies measured implementation outcomes. Within-study impact on outcomes was mixed. Integrated PS*FWbS programmes are scarce and heterogeneous in design, content and evaluation. None should be replicated in the UK but components could be adopted and adapted in work to develop and evaluate theory-informed integrated PS*FWbS programmes.
Sustainable improvements in health and well-being depend not only on the dissemination of effective interventions, but also on communities having the capacity and power to shape the conditions that influence their lives. In this article, we discuss how a systematic “domains” approach can be used to operationalize empowerment-oriented interventions that view communities as active agents of change. This approach strengthens communities’ capacity to take ownership of their health and to co-produce changes based on their needs. We also explain how prevention researchers and practitioners can benefit from key dimensions of capacity building, participation, and social justice. These dimensions can help address the social determinants of health and enable disadvantaged and vulnerable communities to resist dominant, top-down structures through collective organization and action, thereby fostering stronger and healthier communities. Prevention scientists who incorporate empowerment-oriented processes into the communities with which they work are well positioned to support collaborative efforts that promote empowerment, equity, and healthier communities. This approach can enhance the relevance, sustainability, and equity of prevention initiatives.
While workplace health promotion has traditionally emphasized risk reduction, knowledge about the extent to which interventions incorporate health-promoting resources such as Sense of Coherence, Participation, Goal-Setting, Variability, and Empowerment is fragmented. This scoping review examined how these salutogenic principles are operationalized in behavioral workplace health promotion programs focused on primary prevention. A systematic search across five databases identified 128 intervention studies published between 2014 and 2024. Each program was assessed using a Salutogenesis-Score (0–5) reflecting the number of salutogenic principles integrated into its design and delivery. Overall, the incorporation of salutogenic principles was moderate. Empowerment, Variability, and Sense of Coherence were most frequently represented, whereas Participation and Goal-Setting appeared considerably less often. For instance, tailored interventions that included individualized counseling or self-management tools achieved high scores, with multi-component programs showing the strongest overall alignment. Although many programs contain elements that support health-promoting behavior, their potential to fully activate salutogenic mechanisms remains underused. Strengthening participatory approaches and personalized goal-setting may enhance employee agency, adaptability, and long-term engagement, thereby fostering more sustainable and empowering workplace health promotion.
Cochrane reviews provide high-quality evidence syntheses. To guide the production and dissemination of new Cochrane reviews, an evidence map based on the characteristics of existing reviews is necessary. This study is a scoping review that aimed to create an evidence map of Cochrane reviews on nutrition and physical activity (PA) in healthy and at-risk populations, describe stakeholder involvement in review production and assess the dissemination of these reviews. This scoping review follows a registered protocol and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA ScR) guideline. Eligible studies were Cochrane reviews on nutrition and PA for healthy and at-risk populations that were identified in the Cochrane Database of Systematic Reviews through to 22 January 2026 and selected independently by two researchers from 2043 search hits. Extracted data included bibliographic, population, and intervention or concept characteristics, information on stakeholder involvement in review production and open-access Altmetric data on the online and scientific attention towards Cochrane reviews. Data were processed into meaningful categories and synthesised using descriptive statistics. The included Cochrane reviews (n = 260) were published between 1999 and 2026. Review focus was on nutrition (n = 193, 74
Prevention programs are often delivered before unhealthy risk behaviors emerge, yet their effectiveness is frequently judged by impacts on those distal behaviors. This creates a need for stronger evidence on proximal outcomes that predict later adolescent risk behaviors. We analyzed longitudinal survey data from approximately 1,100 youth in grades 9-12 who had received a relationship education program in 27 schools across seven U.S. states. The sample was 60% White, 23% Hispanic, and 49% girls. Outcome-specific regression models estimated associations between 30 posttest proximal outcomes and nine later sexual behavior and substance use outcomes over six months. Because analyses were exploratory, findings were interpreted with attention to effect-size magnitude, directional consistency, and theoretical coherence. Twenty-two proximal outcomes had statistically significant associations with one or more later behavioral outcomes. Sexual behavior associations were generally coherent and moderate in magnitude, whereas substance use associations were more often smaller, isolated, or theoretically inconsistent. Risky social media behavior emerged as the clearest cross-domain risk factor. Self-efficacy to use relationship skills and self-awareness about personal strengths and weaknesses showed the clearest protective patterns for sexual behavior outcomes. Intentions to have sex also showed directionally consistent negative associations across domains, although this pattern was contrary to prior expectations and was interpreted cautiously. These findings strengthen the evidence base on longitudinal predictors of adolescent risk behaviors and identify proximal outcomes that may be useful when direct assessment of later behavioral outcomes is infeasible or uninformative.
This study evaluated the efficacy of the Claudia Carraro universal prevention program in reducing eating disorder (ED) specific and non-specific risk factors in adolescents. A cluster randomized controlled trial was conducted in Italian secondary schools (N = 1205; mean age = 15.2 ± 0.8 years; 65
