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Table 1 Screening tool, sample, study design, setting, intervention type, health outcomes measured, and findings of the included studies

From: Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review

Study

Screening tool

Sample/study design, setting

Intervention and outcomes measured

Findings

QRSa

Chen et al. (2011) [45]

Face-to-face (trained researchers with computer-assisted personal interviewing technology), private room within clinical setting, eligibility screen

Domains screened:

• substance use

• sexual risk

• medication adherence

N = 142, 16–24 years, primary care clinic for HIV positive young people, 5 sites, 45 % female, HIV positive with at least 2 of 3 HIV risk behaviours, RCT

4 × 60 minute motivational interviewing (MI) sessions focused on 2 most problematic behaviours by mental health clinicians

Outcomes measured:

• no condom use behaviour

• risk of no condom use behaviour

Improvement:

• no condom use for participants categorised as at increased sexual risk (adjusted B = .364, p < .01) and those categorised as not at risk (adjusted B = .325, p < .01)

• low sexual risk (63 % vs. 32 %, p < .01) and likelihood to be in delayed high sexual risk group (16 % v 50 %, p < .01)

35.5

Mason et al. (2011) [46]

Face-to-face (trained interviewer), clinic waiting room, eligibility screen

Domains screened:

• substance use (incl. drink driving)

• mental health

N = 28, 14–18 years, general primary care, 1 site, 100 % female, African American with at least 1 substance use risk, pilot RCT.

1 × 20 min MI session with a social network component by trained interviewers (not clinical staff)

Outcomes measured:

• substance use

• trouble due to alcohol

• substance use before sex

• social network quality

• offers to use marijuana

• social stress

• readiness to start counselling

Improvement:

• substance use before sex (F(1) = 4.870, p = .038, η2 = 0.18)

• social stress (F(1) = −0.187,p = .047, η2 = 0.16),

• trouble due to alcohol use (F(1) = 4.301, p = .049, η2 = 0.15)

• offers to use marijuana (F(1) = 4.222, p = .047, η2 = 0.14)

No change:

• substance use

• social network quality

• readiness to start counselling

22

Olson et al. (2008) [52]

Digital (PDA) self-administrated, waiting room, intervention screen

Domains screened:

• diet

• exercise

• screen time

• substance use

11–20 years, general primary care, two cross-sectional sample recruited pre and post intervention within 5 sites and completed baseline and 6 month follow up survey. Usual care group prior to intervention: N = 148, 47 % female

Participants recruited 1 year after intervention introduced in practices: N = 136, 50 % female

1 × brief MI session by trained clinician within consultation.

Outcomes measured:

• exercise

• fruits and vegetables

• milk intake

• sweetened beverages

• screen time

Improvement:

• exercise scores between intervention (0.581) and control (−0.220, p = .006)

• milk intake between intervention (0.190) and usual care (−0.313, p = .012)b

No change:

• fruit and vegetables

• sweetened beverages

• screen time

23.5

Ozer et al. (2011) [51]

Pen/paper, self-administrated, waiting room, intervention screen

Domains screened:

• seat belt and helmet use

• substance use

• sexual behaviour

14 years, paediatric clinic Longitudinal study (N = 904) compared with several cross-sectional surveys (safety N = 579, sexual behaviour N = 1306, substance use N = 1410)

2 × clinical encounters: 1. provider intervention following ‘5 A’ framework for behavioural counselling; 2. health educator intervention 15–30 min informed by social cognitive theory

Outcomes measured:

• seat belt use

• helmet use

• tobacco use

• alcohol use

• drug use

• sexual behaviour

Improvement:

• helmet use (OR = 2.0, 95 %, CI = 1.1,3.7, p ≤ .05).

No change:

• smoking

• alcohol

• drug use

• sexual behaviour

28

Patrick et al. (2006) [44]

Computer, self-administrated, immediately before intervention in the clinical office, intervention screen

Domains screened:

• diet

• exercise

N = 819, 11–15 years, general primary care, 6 sites, stratified by gender (53 % female), RCT with sun exposure protection as control group. Participants booked in for a well care visit

A 12-month intervention consisting of a computer-assisted stage of readiness-based goal setting followed by brief health care provider counselling, a printed manual and 12 months of monthly mail and telephone counselling, parent intervention to help encourage change in diet and physical activity

Outcomes measured:

• calories from fat

• fruit and vegetable servings

• sedentary behaviour

• minutes per week exercise

• days per week exercise

Improvement:

• sedentary behaviours per week for girls (% change was −12 % for intervention and 4.8 % for control group, p = .001) and boys (% change was −24 % for intervention and 2.4 % for control group, p = .001)

• physical active days per week for boys (relative risk,1.47, 95 % CI: 1.19,1.75) compared to the control group

No change:

• calories from fat

• fruit/vegetables

• minutes of physical activity per week

34

Sanci et al. (2015) [48]

Practitioner (in consultation)- or self-administrated (waiting room), pen/paper, intervention screen

Domains screened:

• diet

• exercise

• substance use

• mental health

• violence and safety (incl. drink driving)

N = 901, 14–25 years, general primary care, 40 sites, 76 % female, pragmatic clustered RCT stratified by postcode advantage score and billing type

Intervention: Clinician training (9 h) in health risk screening, motivational interviewing, youth friendly practice; 2 × clinic visits. Comparison: Didactic educational seminar in youth and health risk screening

Outcomes measured:

• tobacco use

• alcohol use

• illicit drug use

• risk of STI

• risk of unplanned pregnancy

• road safety

• emotional distress

Improvement:

• illicit drug use at 3 months (RD −6.0, CI:-11,−1.2; OR 0.52, CI: 0.28, 0.96)

• risk for STI at 3 months (RD −5.4, CI: −11, 0.2; OR 0.66, CI: 0.46,0.96)

• unplanned pregnancy at 12 months (RD −4.4; CI: −8.7, −0.1; OR 0.40, CI: 0.20,0.80)

No change:

• tobacco use

• alcohol use

• road safety

• emotional distress

40

Stevens et al. (2002) [50]

Self-administrated pen/paper, subject home, intervention screen (in both intervention arms)

Domains screened:

• substance use

• seat belt and helmet use

• gun access and use

N = 3525c, paediatric clinic, 12 sites, 46 % female, 5th and 6th grade adolescents and parents, clustered RCT with two active arms

1 of 2 interventions: 1. home interventions (parent discussed risk with child and developed plan) plus practice intervention included MI. 2. site visits, newsletters, telephone calls; printed material

Outcomes measured:

• alcohol use

• tobacco use

• seatbelt use

• helmet use

• gun storage

No change:

• tobacco use

• seatbelt use

• gun storage

Negative effect:

• Increased alcohol use at 24 and 36 months; OR = 1.27, 95 % CI: 1.03, 1.55, p = .02 and OR: 1.30, 95 % CI: 1.07, 1.57, p = .01, respectively

29.5

Walker et al. (2002) [47]

Face-to-face (nurse), unspecified location, intervention screen

Domains screened:

• mental health

• physical health

• substance use

• diet

• exercise

• sexual health knowledge

• health damaging behaviours

N = 1516, 14–16 years, general primary care, 8 sites, 51 % female, clustered RCT

1 × 20 min consultation with nurse to discuss health concerns & develop plans for healthier lifestyles based on self-efficacy and behaviour change

Outcomes measured:

• diet

• exercise

• tobacco use

• alcohol use

No Change:

• smoking

• alcohol use

• exercise

• diet

26.5

Werch et al. (2007) [49]

Computer, self-administrate, immediately before intervention in quiet clinic office, intervention screen (in all 3 intervention arms)

Domains screened:

• exercise

• diet

• sleep

• stress management

• substance use

N = 155c, student health care, 1 site, 66 % female, 3 arms randomised trial

1 of 3 interventions from trained research staff: 1. multiple behaviour health contract based on Behavior-Image Model; 2. 1 × 25 min tailored consultation with fitness specialist; or 3. a combined consultation plus contract intervention

Outcomes measured:

• alcohol use

• tobacco use

• marijuana use

• drink driving

• exercise

• diet

• sleep

• quality of life

• self-control

• stress management

Improvement:

• drink driving behaviours in all groups (F(2136) = 4.43, p = .01)

• exercise behaviours in all groups, (F(5140) = 6.12, p < .001)

• nutrition habits in all groups, (F(3143) = 5.37, p < .001)

• sleep habits in all groups (F(2144) = 5.03, p = .01), and health quality of life, (F(5140) = 3.09, p = .01)

• Stress management F(2144) = 5.48, p = .01, and the number of health behaviour goals set in the last 30 days, F(2143) = 5.35, p = .01, but only among adolescents receiving the consultation, or consultation plus contract

No change:

• alcohol use

• tobacco use

• marijuana use

• quality of life

• self-control

25.5

  1. aAverage score on the Quality Rating Scale between the two raters
  2. bt-tests conducted on average change in health behaviours, however no statistical detail provided
  3. cAge range not provided