Sarah C Walker, Asia S Bishop, Juan Gudino, McKenna Parnes, Taquesha Dean, Alya A Azman, Kristin Vick, Noah Gubner
{"title":"A Non-coercive Prevention Cascade Using a Cash-Plus Model for Legally Involved Youth: a Multi-method Study of Feasibility, Acceptability, and Engagement Outcomes.","authors":"Sarah C Walker, Asia S Bishop, Juan Gudino, McKenna Parnes, Taquesha Dean, Alya A Azman, Kristin Vick, Noah Gubner","doi":"10.1007/s11121-025-01785-z","DOIUrl":"https://doi.org/10.1007/s11121-025-01785-z","url":null,"abstract":"<p><p>Youth involved in the criminal legal system (YILS) are more likely to experience significant disruptions in social determinants of health. This contributes to, and is reciprocally affected by, ongoing contact with the legal system. Using multiple methods, the current study examined the feasibility and impact of a prevention cascade model designed to universally identify and address early signals of social determinants of health needs including housing and family cohesion using a cash-plus, navigator model. The analysis included 147 youth referred to the Housing Stability for Youth in Courts (HSYNC) program from four juvenile courts in one northwestern state from 2019 through 2022. Analyses revealed youth and families receiving cash-plus were five times more likely to engage in recommended services. Engagement in services across all types of need severity (prevention and crisis) exceeded published benchmarks for other prevention and intervention engagement models. These findings suggest non-coercive services using cash-plus is a highly promising model for connecting YILS and their families to services designed to strengthen social determinants of health.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie G Craig, Katelyn Frankiewicz, Natalie R Stearns, Julie Girard-Lapointe, Allana Cortese, Natasha Vogel, Debra J Pepler
{"title":"What Do We Know About the Stop Now and Plan Program? A Systematic Review and Meta-Analysis of an Early Invention for Children and Youth with Conduct Problems.","authors":"Stephanie G Craig, Katelyn Frankiewicz, Natalie R Stearns, Julie Girard-Lapointe, Allana Cortese, Natasha Vogel, Debra J Pepler","doi":"10.1007/s11121-025-01788-w","DOIUrl":"https://doi.org/10.1007/s11121-025-01788-w","url":null,"abstract":"<p><p>Children who engage in aggressive behaviors are at heightened risk of being involved in the justice system, committing serious offenses, and becoming chronic offenders. The Stop Now And Plan (SNAP) program was designed as an early intervention to address several mechanisms underlying the development of conduct problems, including emotion regulation, prosocial behaviors, and parent-child relationships. The purpose of this study was to systematically review and synthesize current research on the SNAP program and conduct a meta-analysis. Following PRISMA guidelines, PubMed and PyscINFO were searched, and the developers of SNAP were contacted to ensure no articles were missed. Twenty-two peer-reviewed articles were ultimately included following a two-stage screening process. The meta-analysis revealed a moderate effect size change (SMD = - 0.54, 95% CI [- .42, - .65], p < .001) in externalizing problems from pre- to post-SNAP Group. The narrative review found evidence for decreases in symptoms (e.g., conduct problems, aggression, delinquency, internalizing problems) across SNAP programming. There was also preliminary evidence for changes in proposed mechanisms across the groups (e.g., emotion regulation, parent behaviors, child-parent relationship). Two randomized controlled trials (RCT) supported the efficacy of the SNAP Boys Group over another active treatment. One waitlist control found similar results for the SNAP Girls Group. There is growing evidence for SNAP, attributable to the effective clinical research partnerships established by the developers. More rigorous methods and RCTs will help solidify SNAP as a top evidence-based intervention.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deborah M Caldwell, Jennifer C Palmer, Katie E Webster, Sarah R Davies, Hugo Hughes, Joseph Rona, Rachel Churchill, Sarah E Hetrick, Nicky J Welton
{"title":"Exploring the Moderating Effect of Control Group Type on Intervention Effectiveness in School-Based Anxiety and Depression Prevention: Findings from a Rapid Review and Network Meta-analysis.","authors":"Deborah M Caldwell, Jennifer C Palmer, Katie E Webster, Sarah R Davies, Hugo Hughes, Joseph Rona, Rachel Churchill, Sarah E Hetrick, Nicky J Welton","doi":"10.1007/s11121-025-01786-y","DOIUrl":"https://doi.org/10.1007/s11121-025-01786-y","url":null,"abstract":"<p><p>Many randomized controlled trials have investigated the role of school-based prevention interventions to reduce symptoms of anxiety and depression in young people. Systematic reviews have subsequently demonstrated a small, beneficial effect of these interventions when compared to a combined control group including usual care, no intervention, or waiting list controls. However, evidence from behavioral science and clinical psychology suggests control group choice may influence the relative effectiveness of non-pharmacological interventions. Here we explored whether separating this combined control group into distinct categories might influence the apparent effectiveness of preventive interventions. After updating an earlier review and network meta-analysis of preventive interventions for anxiety and depression in young people, we considered the impact of alternative control groups on estimates of effectiveness. This analysis was restricted to comparisons with cognitive-behavioral interventions only-the most common intervention used in the included studies. In targeted populations, for both anxiety and depression outcomes, the effect of a cognitive-behavioral intervention was larger when compared to waiting list controls than to usual curriculum, no intervention, or attention controls. For anxiety, the effect of no intervention was also considerably larger than waiting list control (standardized mean difference -0.37 [95% credible interval - 0.66, - 0.11], favoring no intervention). These results suggest that the beneficial effect of preventive school-based interventions previously observed in standard meta-analyses may be an artifact of combining control groups. Although exploratory, these findings indicate the impact of different control groups may vary considerably and should be taken into account when interpreting the effectiveness of interventions.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noa Leiter, Jeremy W Luk, Bethany L Stangl, Tommy Gunawan, Melanie L Schwandt, David Goldman, Nancy Diazgranados, Vijay A Ramchandani
{"title":"History of Alcohol Use Disorder and Housing Instability as Predictors of Fatigue and Mental Health Problems During the COVID-19 Pandemic.","authors":"Noa Leiter, Jeremy W Luk, Bethany L Stangl, Tommy Gunawan, Melanie L Schwandt, David Goldman, Nancy Diazgranados, Vijay A Ramchandani","doi":"10.1007/s11121-025-01784-0","DOIUrl":"https://doi.org/10.1007/s11121-025-01784-0","url":null,"abstract":"<p><p>Mental health and alcohol problems are significant public health concerns amid the COVID-19 pandemic. Housing instability and symptoms of fatigue are understudied aspects of the pandemic. This study examined history of Alcohol Use Disorder (AUD), history of COVID-19 infection, and housing instability as correlates of fatigue, anxiety, and depression symptoms. Data were drawn from 250 adults enrolled in an online survey within the NIAAA COVID-19 Pandemic Impact on Alcohol Study in between April 6 and June 2 of 2022. Participants completed self-report measures of housing stability, fatigue, and mental health symptoms. Multivariable analyses controlling for age, sex, race, ethnicity, and household income were conducted. Individuals with a history of AUD reported higher mental fatigue, anxiety symptoms, and depressive symptoms when compared to those with no history of AUD. Individuals with \"other\" housing arrangements (not renting or owning) reported higher mental fatigue, pandemic fatigue, anxiety symptoms, and depressive symptoms relative to homeowners. Individuals who worried about not having a place to live in the past 6 months reported higher physical fatigue, mental fatigue, anxiety symptoms, and depressive symptoms when compared to individuals without housing worry. History of COVID-19 infection was neither associated with mental health nor fatigue symptoms. Housing instability, as captured by housing worry and having \"other\" housing arrangements, was associated with greater fatigue and mental health problems, even after controlling for household income. Housing instability uniquely contributed to mental health symptoms, warranting further research and targeted prevention and intervention efforts.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cayson W Tiedge, Alberto Valido, Matthew Rivas-Koehl, Brian A Garcia, Luz E Robinson, Graceson Clements, Dorothy L Espelage
{"title":"Understanding Suicidal Thoughts and Behaviors Among LGBTQ + Youth: Differential Associations Between Bullying and Substance Use.","authors":"Cayson W Tiedge, Alberto Valido, Matthew Rivas-Koehl, Brian A Garcia, Luz E Robinson, Graceson Clements, Dorothy L Espelage","doi":"10.1007/s11121-025-01783-1","DOIUrl":"https://doi.org/10.1007/s11121-025-01783-1","url":null,"abstract":"<p><p>Rates of suicidal thoughts and behaviors (STB, i.e., suicidal thoughts, plans, and attempts), substance use, and bullying victimization are higher among lesbian, gay, bisexual, transgender, and/or queer (LGBTQ +) youth compared to their heterosexual peers. However, research examining the interactive and potentially compounding associations of concurrent bullying and substance use (alcohol, cannabis, hallucinogens, and opioids) with STB is sparse, especially among LGBTQ + youth. Thus, the current study aims to understand how these substances moderate the association between bullying victimization and STB by utilizing data (N = 96,482) from the combined 2003-2019 Youth Risk Behavior Survey (YRBS). Using a cross-sectional design and hierarchical logistic regression, we found that, on average, LGBTQ + youth who were bullied were more likely to report planning to attempt suicide (O.R. = 2.71, p < .01). Similarly, youth who reported using opioids/prescription drugs (O.R. = 4.60, p < .05) or hallucinogens (O.R. = 8.89, p < .01) were more likely to attempt suicide. No significant associations between alcohol use and STB were found. Lastly, cannabis emerged as a significant moderator of the associations between bullying victimization and suicidal ideation and plans, such that adolescents who were bullied and used cannabis were less likely to report suicidal ideation and planning compared to those who were bullied but did not use cannabis. These findings highlight that different substances are distinctively associated with STB among LGBTQ + youth, providing a better understanding of how individuals who are being bullied may cope and to develop prevention programs to combat suicidal thoughts, planning, and attempts.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andria B Eisman, Christine Koffkey, Suzanne Brown, Christina Holmes, Barry Schmidt, Eric Swihart, Tracy Robinson, Bo Kim
{"title":"Using After Action Review to Identify Rapid Response Implementation Strategies for Emerging Drugs Among Youth.","authors":"Andria B Eisman, Christine Koffkey, Suzanne Brown, Christina Holmes, Barry Schmidt, Eric Swihart, Tracy Robinson, Bo Kim","doi":"10.1007/s11121-025-01787-x","DOIUrl":"https://doi.org/10.1007/s11121-025-01787-x","url":null,"abstract":"<p><p>Drug use trends change rapidly among youth, leaving educators and researchers struggling to respond promptly. Widely adopted universal evidence-based interventions (EBIs), such as the Michigan Model for Health™ (MMH), and their delivery systems offer an opportunity to reach large youth populations and reduce the onset and escalation of emerging drug use trends. Tier 1 EBIs do not always reflect the most current needs of the context and population. Implementation strategies are needed to optimize EBIs and system responsiveness to emerging drugs. This study employs after action review (AAR) to examine past responses to emerging drugs and design implementation strategies for rapid responses. AAR centers on four key questions: (1) What was expected to happen? (2) What happened? (3) What went well? and (4) What can be improved? We collected qualitative data from 35 participants, including state education partners, school administrators, counselors, teachers, prevention specialists, and the state's health coordinator network. We used rapid qualitative and iterative inductive-deductive thematic analytic approaches. Data analysis revealed three central tenets for rapid responses: collaboration, readiness, and planning. We then identified implementation strategy core functions aligned with the central tenets and strategy form options (e.g., build/leverage a coalition) for each function to accommodate school-level heterogeneity. We created a systematic process to develop and deploy an implementation blueprint for building prevention infrastructure to enhance rapid responses for emerging drugs leveraging an existing intervention (MMH) and delivery system. AAR is a promising approach to identifying gaps and best practices in school-based responses to urgent drug crises. Our results indicate that while the core implementation strategy functions are constant, health coordinators benefit from strategy options tailored to their context. Trial registration: NCT05806840, https://classic.clinicaltrials.gov/ct2/show/NCT05806840 .</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Golfo Tzilos Wernette, Kristina Countryman, Dongru Chen, Okeoma Mmeje, Ananda Sen, Quyen M Ngo, Caron Zlotnick
{"title":"A Whole New World: Overcoming Methodological Challenges in the Post-Pandemic Recruitment of Pregnant Women at Risk of STIs.","authors":"Golfo Tzilos Wernette, Kristina Countryman, Dongru Chen, Okeoma Mmeje, Ananda Sen, Quyen M Ngo, Caron Zlotnick","doi":"10.1007/s11121-025-01775-1","DOIUrl":"https://doi.org/10.1007/s11121-025-01775-1","url":null,"abstract":"<p><p>The impact of the COVID-19 pandemic on recruitment has been significant, including the recruitment of pregnant individuals with behavioral health risk factors. The objective of this manuscript is to highlight our response to the methodological challenges created by the pandemic and how we leveraged technology to adapt and expand our recruitment procedures for the Health Check-up for Expectant Moms, a technology-delivered behavioral skills intervention aimed at empowering and motivating pregnant women engaging in substance use and sexual health risks (e.g., condomless sex, multiple partners) to reduce their likelihood of STIs and substance use during pregnancy. After the onset of the pandemic, we transitioned from in-person recruitment to remote clinic recruitment (e.g., by phone, text messaging, and e-mail) as well as social media campaigns via Facebook® and Instagram® with a confidential web-based screening questionnaire for our study targeting pregnant women in 27 counties of Michigan. For remote recruitment, we contacted 6238 women; 1360 completed the study screening questionnaire (mean age = 31.5; SD = 4.6), 90 were eligible, and 73 were enrolled (6% eligibility). For social media recruitment, we had 2512 completing the pre-screening questionnaire. Of these, 501 (mean age = 31.9; SD = 4.6) went on to complete the full study screening questionnaire, 25 women were eligible, and 20 were enrolled (5%). Our 5% eligibility rate from our social media campaign is on par with our remote and in-clinic recruitment methods yet took far less time (15 weeks vs. 150 weeks vs. 48 weeks, respectively). Despite study recruitment challenges related to the pandemic, remote recruitment-particularly social media-was found to be a successful approach, may have a broader reach, and a cost-effective alternative to active recruitment.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transfer Learning Prediction of Early Exposures and Genetic Risk Score on Adult Obesity in Two Minority Cohorts.","authors":"Wenying Chen, Yuxin Liu, Shuo Zhang, Zhou Jiang, Ting Wang, Shuiping Huang, Ping Zeng","doi":"10.1007/s11121-025-01781-3","DOIUrl":"https://doi.org/10.1007/s11121-025-01781-3","url":null,"abstract":"<p><p>Due to ethnic heterogeneity in genetic architecture, genetic risk score (GRS) constructed within the European population generally possesses poor portability in underrepresented non-European populations, but substantial genetic similarity exists across diverse ancestral groups. We here explore the prediction performance of early exposures and GRS on body mass index (BMI) through leveraging genetic similarity knowledge acquired from Europeans into non-Europeans. We present a linear mixed prediction model for BMI in three distinct UK Biobank cohorts under the transfer learning framework, where we consider Asians (n = 7487) and Africans (n = 7533) as target samples and Europeans (n = 280,575) as informative auxiliary samples. Besides environmental and behavior exposures, we incorporate multiple BMI-related variants, by which the GRS is constructed via transfer machine learning techniques informed by genetic similarity shared across target and auxiliary samples. The use of GRS gained more predictive odds for BMI than the model with traditional risk factors alone in the Asian and African cohorts, leading to an approximately 3.6% and 0.7% accuracy improvement in each target population. After borrowing genetic similarity from Europeans via transfer learning, the R<sup>2</sup> increased to 0.270 for Asians and 0.302 for Africans, enhanced by 21.1% and 7.5%, respectively, compared to the early exposure-only models. We also provided evidence for the well-known conclusion that GRS constructed in the European population behaved poorly in non-Europeans. Prediction accuracy is greatly elevated in racial minority or underrepresented populations via the transfer learning method by leveraging shared genetic similarity from informative auxiliary populations.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah M Chilenski, Meg Small, Jochebed G Gayles, Brittany Rhoades Cooper, Louis D Brown
{"title":"Collaborative Working Relationships Between Community Prevention Coalitions and Their Technical Assistance Providers: A Mixed Methods Approach for the Development of an Innovative Implementation Measure.","authors":"Sarah M Chilenski, Meg Small, Jochebed G Gayles, Brittany Rhoades Cooper, Louis D Brown","doi":"10.1007/s11121-025-01777-z","DOIUrl":"https://doi.org/10.1007/s11121-025-01777-z","url":null,"abstract":"<p><p>Prior research suggests that technical assistance which includes one-on-one, individualized support, guidance, and assistance is necessary to promote high-quality implementation of evidence-based interventions. However, this area lacks measures. This paper uses a mixed methods and community-engaged approach to develop and then evaluate a standardized measure of the collaborative working relationship between technical assistance providers and coalitions/coalition leaders. For measure development, researchers interviewed eight coalition leaders and eight coalition technical assistance providers about their experience providing or receiving technical assistance, using a human-centered design approach. A heat-mapping technique used with the interview data identified 11 themes related to the provision of high-quality technical assistance. Researchers then created survey items through an iterative process. After multiple rounds of revision and feedback with coalition leaders and coalition and technical assistance researchers, the reliability of seven of the constructs was piloted with 52 coalition leaders. The seven constructs included the following: competence and autonomy support, responsiveness, authentic and meaningful participation, co-creation, trust and rapport, compliance, and negative interactions. Researchers used Cronbach's Alphas and correlational analyses to further refine the scales. Empirical results mapped well onto prior theoretical work and suggested that the collaborative working relationship is a multi-dimensional construct. This research moves prevention research methods and measurement development into a more community-engaged, stakeholder-involved approach.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James Allen, Lisa Wexler, Charlene Aqpik Apok, Jessica Black, James Ay'aqulluk Chaliak, Katie Cueva, Carol Hollingsworth, Diane McEachern, Evon Taa'ąįį Peter, Jessica Saniguq Ullrich, Andrew Grogan-Kaylor, KyungSook Lee, Carlotta Ching Ting Fok, Matthew Berman, Suzanne Rataj, Stacy Rasmus
{"title":"Indigenous Community-Level Protective Factors in the Prevention of Suicide: Enlarging a Definition of Cultural Continuity in Rural Alaska Native Communities.","authors":"James Allen, Lisa Wexler, Charlene Aqpik Apok, Jessica Black, James Ay'aqulluk Chaliak, Katie Cueva, Carol Hollingsworth, Diane McEachern, Evon Taa'ąįį Peter, Jessica Saniguq Ullrich, Andrew Grogan-Kaylor, KyungSook Lee, Carlotta Ching Ting Fok, Matthew Berman, Suzanne Rataj, Stacy Rasmus","doi":"10.1007/s11121-025-01782-2","DOIUrl":"https://doi.org/10.1007/s11121-025-01782-2","url":null,"abstract":"<p><p>Suicide research has focused primarily on risk factors at the individual level, overlooking the potential for community-level factors that confer protection from suicide. This study builds on the concept of cultural continuity from the Indigenous suicide prevention literature. It seeks to understand the collective influences shaping individual experiences across time and frames resilience as a culturally situated process that helps individuals to navigate challenges and facilitate positive health behaviors. A collaborative Alaska Native (AN) partnership designed the Protective Community Scale (PCS) to identify mutable community-level protective factors in rural AN communities hypothesized to reduce suicide among youth, who represent the highest risk demographic in this at-risk population. Study objectives were to (a) test the measurement structure of community-level protection from suicide, (b) select best functioning items to define this structure, and (c) test the association of community protection with community-level suicide deaths and attempts. In 65 rural AN communities, 3-5 residents (n = 251) were peer-nominated for their knowledge of local resources and completed the PCS in structured interviews. Findings show community members can reliably assess the theoretically rich, multidimensional community-level protective factor structure of cultural continuity with sufficient precision to establish its inverse association with community-level suicide. Community-level protection emerges as a promising approach for universal suicide prevention in Indigenous contexts that can guide multi-level strategies that expand beyond individual-level, tertiary prevention to focus on the continuity of cultural processes as resources to build protection. These findings point the field toward consideration of cultural continuity and community protection as key factors for Indigenous suicide prevention.</p>","PeriodicalId":48268,"journal":{"name":"Prevention Science","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}