Advancing Intervention and Prevention Research for Behavioral Health Problems Through Data Synthesis.

This commentary on the special issue, "Innovations and Applications of Integrative Data Analysis (IDA) and Related Data Harmonization Procedures in Prevention Science" summarizes the utility of data synthesis techniques to elucidate prevention effects in important ways, including effects on low base-rate conditions and effects across multiple small-scale studies of preventive interventions, long-term and crossover effects of preventive interventions, and addressing for whom preventive interventions work, and for how long. In addition, articles tackle methodological challenges by integrating and harmonizing data. Much progress has occurred in the past 5 years. We consider in this commentary the full collection of papers in the special issue, and their ongoing contributions of data synthesis methods for advancing research on the prevention of mental, emotional, and behavioral health problems. We organize our observations by several themes noted across the papers. We also highlight the National Institute of Mental Health's investments that align with many of the efforts summarized here to advance our understanding of prevention research.

Preventing Youth Suicide: Potential "Crossover Effects" of Existing School-Based Programs.

Notable increases in youth mental health problems combined with strains on the already stretched mental health workforce raise concerns that there will be an ensuing increase in youth suicide thoughts, behaviors, and even deaths. Schools are recognized as crucial settings for youth mental health support and suicide prevention activities, yet schools also face staff shortages and ever-increasing responsibilities for student well-being. Evidence is emerging that prevention programs originally designed to improve problem-solving skills and social-emotional functioning in youth have demonstrated downstream, "crossover effects," that is, unanticipated benefits, on youth suicidal behavior. Relatively little research on crossover effects has been conducted within school settings, despite the strong potential for commonly administered programs to have an impact on later suicide risk. We review key suicide risk factors and their proposed mechanisms of action; we also discuss factors that may protect against suicide risk. We then identify upstream prevention programs targeting the same factors and mechanisms; these programs may hold promise for downstream, crossover effects on youth suicide risk. This paper is intended to provide a framework to help researchers, practitioners, and policymakers as they consider how to prevent youth suicide using existing school-based resources. Rigorous investigation of upstream prevention programs is urgently needed to determine ideal approaches schools and communities can deploy to prevent youth suicide.

Substance use prevention research funded by the NIH.

BACKGROUND: Substance use is a leading preventable cause of death in the U.S. The National Institutes of Health (NIH) provides public funding to advance understanding on the causes of substance use disorders and apply that knowledge to improve public health through research that develops new and improved strategies to prevent substance use. The purpose of this study was to characterize substance use prevention research funded by the NIH. METHODS: Leveraging a dataset of NIH-funded prevention research, we identified grants studying substance use during 2012-2017. We coded the substances and types of prevention research studied in these grants. We generated descriptive statistics and estimated trends using weighted data representing the entire NIH substance use prevention research portfolio. RESULTS: Approximately 2.4% of all NIH research awards focused on substance use prevention during 2012-2017, with most focused on Epidemiologic Research. Alcohol and Nicotine were the top two substance categories studied. Marijuana prevention research showed a significant upward trend in funding over time (p = 0.002). Among studies of College Students and Military/Veterans, over three-quarters focused on Alcohol. Studies of Pregnant/Port-partum Women mostly focused on Nicotine. CONCLUSIONS: While substance use is a leading cause for morbidity and mortality, substance use prevention grants comprised a small portion of NIH's research portfolio during 2012-2017. These grants demonstrated breadth in the substances studied and the types of prevention research. Opportunities for further study are discussed.

Commentary on Scaling-up Evidence-based Interventions in US Public Systems to Prevent Behavioral Health Problems.

As evidence-based interventions (EBIs) to prevent mental, emotional, and behavioral health problems continue to become available, approaches for implementation in systems and settings, at scale, are needed. The article, Scaling-up Evidence-based Interventions in U.S. Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities (Fagan et al. 2019) examines five large, complex public systems (behavioral health, child welfare, education, juvenile justice, and public health) that have adopted and implemented EBIs in various ways and presents common factors that support scale-up in these systems. This commentary builds on the authors' strategic approach to offer a few additional considerations-issues of sustainability, ways of thinking about knowledge creation, and use of systems science/modeling approaches-to address scale-up in public systems. Moreover, the focus on public systems provides an opportunity to consider how the implementation and sustainment of EBIs might more directly address social determinants of health that are relevant across policy areas and public systems.

Commentary on Participation in Preventive Interventions.

In this commentary on the special issue, Preventive Parenting Interventions: Advancing Conceptualizations and Enhancing Reach, operationalization of participation, who engages in prevention interventions, and common themes from the studies are discussed. The papers in the special issue illustrate the importance of studying factors that increase participation in prevention and point out the need for additional research to understand these factors. These papers highlight the diverse conceptualizations of participation as well as a need to move toward standardization of methods to assess related constructs. Research is needed to elucidate the potential of enhanced participation and engagement in interventions to meaningfully impact intervention outcomes and ultimately improve the population-level benefit attributable to prevention efforts. Prevention scientists should attend to factors influencing participation in prevention as early in the intervention research process as possible in order to increase the likelihood that the target population will utilize evidence-based prevention interventions in real-world settings, under real-world conditions.

Family-Based Preventive Interventions: Can the Onset of Suicidal Ideation and Behavior Be Prevented?

Suicide is the second leading cause of death for youth aged 10-24. Research informed prevention efforts have the opportunity to decrease risk for suicidal ideation and behavior before it is manifested. Indeed, there is a small body of research findings demonstrating both proximal and distal effects of preventive interventions delivered in childhood and adolescence on suicidal ideation and/or behavior. These efforts build off of other secondary analyses of prevention research that has demonstrated benefits for multiple types of youth outcomes. This supplement provides "proof of concept" that family-based preventive interventions aimed at reducing a number of risk factors for suicide (e.g., substance use, externalizing, and internalizing behavior) can prevent suicidal ideation and behaviors.

Risky and protective contexts and exposure to violence in urban African American young adolescents.

Contexts of risk for and protection from exposure to violence were identified and the relation of exposure to violence to delinquent behaviors and symptoms of trauma was examined. Using the Experience Sampling Method (ESM), the immediate daily experience of risky and protective contexts was examined. One hundred sixty-seven African American 6th-, 7th-, and 8th-grade children from urban neighborhoods carried watches and booklets for 1 week. Structural equation modeling supported the hypotheses that more time in risky contexts and less time in protective contexts was related to more exposure to violence. Exposure to violence partially mediated the relation of time in protective and risky contexts to delinquent behaviors, assessed with the Juvenile Delinquency Scale and the Child Behavior Checklist, and distress levels, assessed by a posttraumatic stress disorder (PTSD) score.