The ultimate goal of our public health system is to reduce the incidence of disability and premature death. Evidence suggests that, by this standard, the USA falls behind most other developed ...countries largely as a function of disparities in health outcomes among significant portions of the US population. We present a framework for addressing these disparities that attributes them, not simply to differences in the behavioral and physical risk factors, but to social, environmental, and structural inequities such as poverty, discrimination, toxic physical setting, and the marketing of harmful products. These inequities result from de facto and instituted public policies. An analysis of the NIH research portfolio indicates a relative lack of investment in experimental evaluations of preventive interventions—especially studies targeting disadvantaged populations. Moreover, experimental research on reducing social inequities is almost entirely lacking. A line of research focusing on the drivers of inequities and their dissolution must include experimental evaluation of strategies for getting policies adopted that will reduce inequities. In conclusion, a summary is provided of the types of research that are needed and the challenges involved in conducting the experimental research that is essential for reducing inequities and disparities and, in turn, prolonging life.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In the past 10 years, mental and behavioral health has seen a proliferation of technology-based interventions in the form of online and other computer-delivered programs. This paper focuses on ...technology-based treatment and preventive interventions aimed at benefitting children and adolescents via either involving the parents and families, or only the youth. The review considered only technology-based interventions that had at least one published study with a randomized controlled trial design. Questions being addressed included: (1) What are the technology-based interventions in the mental/behavioral health area that have been systematically evaluated in published studies? (2) What are the common and unique characteristics of these interventions and their application with respect to sample characteristics, target problems, and technology characteristics (platforms, structures, elements, and communication formats)? and (3) Which intervention approaches and strategies have accrued the greatest evidence? The review identified 30 technology-based psychosocial interventions for children and families, 19 of which were parent or family-focused (32 studies) and 11 of which were youth-focused (in 13 studies). For the parent/family-focused interventions, greatest promise was found in those that addressed either youth behavioral problems or depressive/anxious symptoms, as well as more general bolstering of parenting efficacy. The youth-focused interventions showed some promise in reducing depressive/anxious symptoms. Advantages and disadvantages of the technology-based approaches were considered, and areas for future research and development were discussed.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Parental substance abuse is a serious problem affecting the well-being of children and families. The co-occurrence of parental substance abuse and problematic parenting is recognized as a major ...public health concern. This review focuses on 21 outcome studies that tested dual treatment of substance abuse and parenting. A summary of theoretical conceptualizations of the connections between substance abuse and parenting provides a backdrop for the review. Outcomes of the dual treatment studies were generally positive with respect to reduction of parental substance use and improvement of parenting. Research in this area varied in methodological rigor and needs to overcome challenges regarding design issues, sampling frame, and complexities inherent in such a high-risk population. This area of work can be strengthened by randomized controlled trials, use of mixed-methods outcome measures, consideration of parent involvement with child protective services, involvement of significant others in treatment, provision of concrete supports for treatment attendance and facilitative public policies.
•Parental substance abuse and parenting difficulties dually threaten public health.•The nature and quality of dual-treatment outcome studies are reviewed.•Multiple pathways and conceptual frameworks inform this area.•Methodological rigor varied but positive outcomes were observed.•Methodology, interventions, and public policy can and should be strengthened.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
This review examines the potential roles of parental self-efficacy (PSE) in parent and child adjustment and the role of parental cognitions in understanding behaviors and emotions within families. ...The areas in this review include parental competence and psychological functioning, as well as child behaviors, socio-emotional adjustment, school achievement, and maltreatment. There is strong evidence linking PSE to parental competence, and more modest linkage to parental psychological functioning. Some findings suggest that PSE impacts child adjustment directly but also indirectly via parenting practices and behaviors. Although the role of PSE likely varies across parents, children, and cultural–contextual factors, its influence cannot be overlooked as a possible predictor of parental competence and child functioning, or perhaps an indicator of risk. PSE may also be an appropriate target for prevention and intervention efforts. Limitations in the literature include measurement problems, variability in conceptualizations and definitions of the construct, and the lack of research exploring causality. Future research should focus on clarifying the measurement of PSE, studying potential bias in self-report of PSE, and utilizing experimental and longitudinal designs to untangle the issues of causal direction and potential transactional processes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Adverse parenting practices, including child maltreatment, interfere with children's adjustment and life outcomes. In this article, Ronald Prinz describes the Triple P—Positive Parenting Program, ...designed to improve parenting population-wide.
Prinz offers four main reasons to take a population approach. First, official records grossly underestimate the extent of problematic parenting. Second, communities need to normalize involvement in parenting support programs rather than singling out or stigmatizing parents. Third, a population approach could have many benefits, such as preventing behavioral and emotional problems in early childhood, encouraging greater school readiness, and reducing the risk of problems during adolescence. Fourth, compared to strategies that target a narrow segment of parents and children, a population approach may create a climate of positive social contagion for positive parenting.
Triple P—a multitiered system of programs with varying intensity levels, delivery formats, and specialized variants—aims to increase the number of parents who have the knowledge, skills, and confidence to raise their children well; to decrease the number of children who develop behavioral and emotional problems; and to reduce the number of children maltreated by their parents. Prinz outlines the origins and guiding principles of Triple P, describes the program model, and explains the conceptual framework for the multitiered approach to prevention. He then summarizes the evidence for this approach, emphasizing population studies that have tested the full Triple P system. He also discusses such critical issues as implementation and quality assurance, benefits versus costs, and significant obstacles to adopting a population strategy for parenting support.
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BFBNIB, IZUM, KILJ, NMLJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
Adverse parenting practices, including child maltreatment, interfere with children's adjustment and life outcomes. In this article, Ronald Prinz describes the Triple P-Positive Parenting Program, ...designed to improve parenting population-wide. Prinz offers four main reasons to take a population approach. First, official records grossly underestimate the extent of problematic parenting. Second, communities need to normalize involvement in parenting support programs rather than singling out or stigmatizing parents. Third, a population approach could have many benefits, such as preventing behavioral and emotional problems in early childhood, encouraging greater school readiness, and reducing the risk of problems during adolescence. Fourth, compared to strategies that target a narrow segment of parents and children, a population approach may create a climate of positive social contagion for positive parenting. Triple P-a multitiered system of programs with varying intensity levels, delivery formats, and specialized variants-aims to increase the number of parents who have the knowledge, skills, and confidence to raise their children well; to decrease the number of children who develop behavioral and emotional problems; and to reduce the number of children maltreated by their parents. Prinz outlines the origins and guiding principles of Triple P, describes the program model, and explains the conceptual framework for the multitiered approach to prevention. He then summarizes the evidence for this approach, emphasizing population studies that have tested the full Triple P system. He also discusses such critical issues as implementation and quality assurance, benefits versus costs, and significant obstacles to adopting a population strategy for parenting support.
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BFBNIB, IZUM, KILJ, NMLJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK
The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple ...P—Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independently derived population indicators: substantiated child maltreatment, child out-of-home placements, and child maltreatment injuries. This study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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