27 May 2013
My first day in San Francisco was spent doing all things international. I attended my first meeting of the Advisory Group for the Society for Prevention Research’s International Task Force, learning about what the Task Force is doing to help facilitate and promote international collaboration. I also attended the International Networking Forum (organised by the Task Force). It’s a great idea, connecting prevention researchers from different countries and making us all feel welcome. This meeting included an overview of the Task Force’s priorities for the coming year:
- Contributing to the development of a prevention hub, including a registry of prevention researchers around the world;
- Working on defining what we mean by prevention science, in different countries and areas of research;
- Drawing together online content which summarise effective interventions and strategies;
- Developing the structures and strategies of the efforts to build international collaboration through and beyond the International Task Force.
Highlights for me were the discussions we had about the challenges of international collaboration, potential sources of help (such as the International Association of Addiction Journals online mentorship scheme), the work of the UN ODC, and the plans for the future development of the European Society for Prevention Research.
Finally, it was time for the international poster session, at which I presented the work I’m doing with DECIPHer on an exploratory trial of the Kids, Adults Together Programme.
KAT is an alcohol misuse prevention programme, and the poster focused mainly on recruitment rates into the trial, and the numbers of parents which attended a school-based family evening which forms part of the programme. This was a good opportunity to talk to research and practice colleagues from around the world about our research and the work of DECIPHer more generally, and promote knowledge exchange.
The first official day of the conference got off to a fantastic start, with some excellent plenary papers on the crucial role of the social and environmental determinants of health. Leonard Syme argued that social class is often controlled for in studies, but rarely studied, and that we have to move away from a narrow focus on individual behaviours and risk factors. Sandro Galea described the need to avoid allowing the ‘urgent’ to crowd out the ‘important’. He suggested that while focus on the ‘riveting distraction’ of individual behaviour interventions, rather than looking at social determinants, we will always have social gradients of health.
Then came a parallel session on engaging high risk youth and their families in preventive interventions. The papers in this session and the summary at the end highlighted the importance of understanding what we mean by engagement, and how best to promote it.
Another excellent session followed, on the transportability and adaptation of parenting interventions. Frances Gardner from Oxford University presented the results of a systematic review examining the effectiveness of interventions transported from their original countries of development to new places. The take-home message was that the four interventions discussed were at least as effective in the new country, and sometimes more so, with stronger effects in non-Western countries. Helen Baker Henningham described the adaptation of The Incredible Years for Jamaican schools, and highlighted the importance of understanding the environments in which teachers worked when implementing an intervention.
In the last parallel session of the day, Jonathan Pettigrew gave a paper on the relationship between implementation quality and the outcomes in a trial of Keepin It Real, a school-based substance misuse prevention intervention. His results indicated that the quality of intervention delivery mattered as much (if not more so) than the extent to which all programme activities were delivered.
I think the best thing about this conference is the willingness of people to talk to others – to share knowledge and ask questions. So what have I learnt so far? It’s striking just how much research at the conference has been about parenting and family relationships, and it brings home for me the real impact of processes such as parental communication on young people’s health and wellbeing. Secondly, sometimes our research findings can surprise us and raise questions as well as answers. Why for instance, should programmes which are adapted for new countries be more effective than in their original country of development? Thirdly, studying implementation is crucial – it tells us so much about how our interventions work and the contexts within which they operate.
Thursday 29 May 2013
My highlight from day two of the conference was excellent parallel session on school health, where Chris Bonell gave a paper on the results of a systematic review of school effects on pupils’ health. One key finding was that ‘valued added’ had better health outcomes, as well as higher attainment and lower truancy levels than might be expected. He suggested that this might be because these ‘authoritative’ schools provide support and control which engage pupils in school-based identities.
Yoland Anyon discussed the differing levels of school-based service utilisation among different ethnic groups. One conclusion was that students from Asian backgrounds had lower levels of service use, perhaps because staff were less likely to pick up the more internalising behaviours found to be more prevalent in these students. This seemed to match some of the findings I identified whilst recently reviewing the literature on school-based mental health services. Jamie Dowdy presented the third paper in the session, which examined differing levels of engagement with extra-curricular activities in school.
Over lunch, I led a ‘brown bag’ discussion group on developing and evaluating complex interventions. A key issue that we discussed concerned the challenges around selecting which prevention interventions to adopt, when many share overlapping content. Should we be thinking about sharing and replicating programmes, or the principles that form their basis?
Who says academic life can’t be glamorous?
I started off in a session looking at how interventions aimed at preventing substance misuse in adolescents can have longer-term impacts on the health and wellbeing of young adults. The presentations by Richard Spoth, Mark Eddy and Marie-Hélène Verénneau examined three different interventions – Strengthening Families Programme 10-14, LIFT and Family Check-up. Given the challenges of retaining participants in trials, the follow-up data presented was impressive.
Friday morning’s plenary had three quite different presentations. Megan Gunnar discussed how early adversity in childhood can affect neurological and physiological development, but nurturing and attachment can act as a buffer. Irwin Sandler examined the effects of the NBP parenting intervention, which had positive effects only on parenting and externalising behaviours at six months, but many more effects at long-term follow-up, and better impacts for high risk families. Next came what was, in my opinion, one of the best talks of the conference, Carl Castro’s overview of the US army’s attempts to improve the psychological health of soldiers returning from deployment.
My first afternoon session comprised four short papers on different aspects of the development and evaluation of Familias Unidas, a parenting intervention for Latino families in the US. One of the key messages from this session was that interventions which attempt to change one behaviour or outcome have the potential to influence others unintentionally. In this case, there appeared to be some increase in physical activity among youth from families with low parental involvement at baseline.
I chaired the final session of the conference, which contained three papers concerned with different aspects of alcohol consumption. The first, by Kerry Lippy, examined how policies around alcohol consumption or social norms/social disorganisation have the potential to reduce alcohol-related sexual violence. The second, by Kate Karriker-Jaffee, was concerned with how neighbourhoods’ socio-economic characteristics might affect negative consequences of drinking, and the role of economic distress, affluence, and drinking norms. Finally, Eileen Pitpitan reported the findings of a survey of clients of female sex workers in Mexico, which examined whether place of sex moderated the association between alcohol consumption and condom use.
I got a lot out of the four days of the conference. Overall, I’d say the following were, for me, the key messages:
- International collaboration (or at least dissemination or knowledge exchange) has a key role to play in enhancing our understanding of what works, where, and how it works.
- We need to embrace the complexity of prevention interventions. They can have a range of intended (and sometimes unintended) outcomes, and these may differ between different groups. Additionally, what works in one place doesn’t necessarily work in another place, but sometimes it can do.
- Finally, we sometimes need to move beyond trying to change one behaviour or a narrow aspect of health/wellbeing and embrace connections and systems. At the very least we need to understand how something like parenting, school attachment, or physical activity, sits within a broader network of causal pathways.
I hope to go back next year; it was worth the journey and the jetlag to come away with new ideas and connections. Now the challenge is to try and harness them in my own work.