Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement FREE

Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force*

Ann Intern Med. 2014;161:894-901. doi:10.7326/M14-1965

In 2008, the USPSTF recommended high-intensity behavioral counseling to prevent STIs for all sexually active adolescents and for adults who were at increased risk for STIs (B recommendation). At that time, the USPSTF also found that the evidence was insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non–sexually active adolescents and in adults who were not at increased risk for STIs (I statement). This updated recommendation reaffirms that the evidence is adequate to recommend high-intensity behavioral counseling for persons who are at increased risk (including all sexually active adolescents) and recognizes that some interventions of lesser intensity are also effective

Primary care interventions to prevent tobacco use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.


The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. (B recommendation)

Description: Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on primary care interventions to prevent tobacco use in children and adolescents.

Methods: The USPSTF reviewed the evidence on the effectiveness of primary care interventions on the rates of initiation or cessation of tobacco use in children and adolescents and on health outcomes, such as respiratory health, dental and oral health, and adult smoking. The USPSTF also reviewed the evidence on the potential harms of these interventions.

Population: This recommendation applies to school-aged children and adolescents. The USPSTF has issued a separate recommendation statement on tobacco use counseling in adults and pregnant women.

Recommendation: The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.

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The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: a systematic evidence review for the U.S. Preventive Services Task Force.

Primary Care Interventions to Prevent Tobacco Use in Children and Adolescents, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm

The U.S. Preventive Services Task Force (USPSTF) recommendations on primary care interventions to prevent tobacco use in children and adolescents.

Current Recommendation

• The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.

• Grade: B Recommendation.

Release Date: August 2013

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This article was first published in:

Patnode CD, O'Connor E, Whitlock EP, Perdue LA, Soh C, Hollis J.

Ann Intern Med. 2013 Feb 19;158(4):253-60. 

BACKGROUND: Interventions to prevent smoking uptake or encourage cessation among young persons might help prevent tobacco-related illness.

PURPOSE: To review the evidence for the efficacy and harms of primary care-relevant interventions that aim to reduce tobacco use among children and adolescents.

DATA SOURCES: Three systematic reviews that collectively covered the relevant literature; MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects through 14 September 2012; and manual searches of reference lists and gray literature.

STUDY SELECTION: Two investigators independently reviewed 2453 abstracts and 111 full-text articles. English-language trials of behavior-based or medication interventions that were relevant to primary care and reported tobacco use, health outcomes, or harms were included.

DATA EXTRACTION: One investigator abstracted data from good- and fair-quality trials into an evidence table, and a second checked these data.

DATA SYNTHESIS: 19 trials (4 good-quality and 15 fair-quality) that were designed to prevent tobacco use initiation or promote cessation (or both) and reported self-reported smoking status or harms were included. Pooled analyses from a random-effects meta-analysis suggested a 19% relative reduction (risk ratio, 0.81 [95% CI, 0.70 to 0.93]; absolute risk difference, -0.02 [CI, -0.03 to 0.00]) in smoking initiation among participants in behavior-based prevention interventions compared with control participants. Neither behavior-based nor bupropion cessation interventions improved cessation rates. Findings about the harms related to bupropion use were mixed.

LIMITATIONS: No studies reported health outcomes. Interventions and measures were heterogeneous. Most trials examined only cigarette smoking. The body of evidence was largely published 5 to 15 years ago.

CONCLUSION: Primary care-relevant interventions may prevent smoking initiation over 12 months in children and adolescents.

PMID: 23229625 [PubMed - indexed for MEDLINE]

School-based programmes for preventing smoking

Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.

Abstract

Background

Helping young people to avoid starting smoking is a widely endorsed public health goal, and schools provide a route to communicate with nearly all young people. School-based interventions have been delivered for close to 40 years.

Objectives

The primary aim of this review was to determine whether school smoking interventions prevent youth from starting smoking. Our secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Tobacco Addiction Group's Specialised Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, Health Star, and Dissertation Abstracts for terms relating to school-based smoking cessation programmes. In addition, we screened the bibliographies of articles and ran individual MEDLINE searches for 133 authors who had undertaken randomised controlled trials in this area. The most recent searches were conducted in October 2012.

Selection criteria

We selected randomised controlled trials (RCTs) where students, classes, schools, or school districts were randomised to intervention arm(s) versus a control group, and followed for at least six months. Participants had to be youth (aged 5 to 18). Interventions could be any curricula used in a school setting to deter tobacco use, and outcome measures could be never smoking, frequency of smoking, number of cigarettes smoked, or smoking indices.

Data collection and analysis

Two reviewers independently assessed studies for inclusion, extracted data and assessed risk of bias. Based on the type of outcome, we placed studies into three groups for analysis: Pure Prevention cohorts (Group 1), Change in Smoking Behaviour over time (Group 2) and Point Prevalence of Smoking (Group 3).

Main results

One hundred and thirty-four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.

Pure Prevention cohorts (Group 1) included 49 studies (N = 142,447). Pooled results at follow-up at one year or less found no overall effect of intervention curricula versus control (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow-up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes.

Change in Smoking Behaviour over time (Group 2) included 15 studies (N = 45,555). At one year or less there was a small but statistically significant effect favouring controls (standardised mean difference (SMD) 0.04, 95% CI 0.02 to 0.06). For follow-up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI -0.00 to 0.02).

Twenty-five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled.

We were unable to analyse data for 49 studies (N = 152,544).

Subgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow-up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco-only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow-up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow-up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results.

Authors' conclusions

Pure Prevention cohorts showed a significant effect at longest follow-up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less. The combined social competence and social influences interventions showed a significant effect at one year and at longest follow-up. Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information-only approach were similarly ineffective.

Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions.

Behavioral interventions and counseling to prevent child abuse and neglect: a systematic review to update the u.s. Preventive services task force recommendation.

Ann Intern Med. 2013 Feb 5;158(3):179-90. doi:
10.7326/0003-4819-158-3-201302050-00590.
Selph SS, Bougatsos C, Blazina I, Nelson HD.

BACKGROUND: In 2004, the U.S. Preventive Services Task Force determined that
evidence was insufficient to recommend behavioral interventions and counseling to
prevent child abuse and neglect.
PURPOSE: To review new evidence on the effectiveness of behavioral interventions 
and counseling in health care settings for reducing child abuse and neglect and
related health outcomes, as well as adverse effects of interventions.
DATA SOURCES: MEDLINE and PsycINFO (January 2002 to June 2012), Cochrane Central 
Register of Controlled Trials and Cochrane Database of Systematic Reviews
(through the second quarter of 2012), Scopus, and reference lists.
STUDY SELECTION: English-language trials of the effectiveness of behavioral
interventions and counseling and studies of any design about adverse effects.
DATA EXTRACTION: Investigators extracted data about study populations, designs,
and outcomes and rated study quality using established criteria.
DATA SYNTHESIS: Eleven fair-quality randomized trials of interventions and no
studies of adverse effects met inclusion criteria. A trial of risk assessment and
interventions for abuse and neglect in pediatric clinics for families with
children aged 5 years or younger indicated reduced physical assault, Child
Protective Services (CPS) reports, nonadherence to medical care, and immunization
delay among screened children. Ten trials of early childhood home visitation
reported reduced CPS reports, emergency department visits, hospitalizations, and 
self-reports of abuse and improved adherence to immunizations and well-child
care, although results were inconsistent.
LIMITATION: Trials were limited by heterogeneity, low adherence, high loss to
follow-up, and lack of standardized measures.
CONCLUSION: Risk assessment and behavioral interventions in pediatric clinics
reduced abuse and neglect outcomes for young children. Early childhood home
visitation also reduced abuse and neglect, but results were inconsistent.
Additional research on interventions to prevent child abuse and neglect is
needed.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Cambios en la prevalencia del tabaquismo en los adolescentes en España

Villalbí, Joan R.; Suelves, Josep M.; García-Continente, Xavier; Saltó, Esteve; Ariza, Carles; Cabezas, Carmen

Publicado en Aten Primaria. 2012;44:36-42. - vol.44 núm 01

Resumen

Objetivo

Analizar la información sobre consumo de tabaco en adolescentes a partir de diversas encuestas escolares.

Diseño

Se extraen de diversos estudios los datos relativos a prevalencia de fumadores diarios al final de la escuela secundaria obligatoria por sexo, analizando tendencias.

Emplazamiento

Se revisan los 5 estudios representativos de adolescentes en España: Encuesta Estatal sobre Uso de Drogas en Estudiantes de Secundaria (ESTUDES); Estudio de Comportamientos de los Escolares Relacionados con la Salud (ECERS-HBSC); Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles dirigido a población Juvenil (SIVFRENT-J); estudio de Factores de Riesgo en Estudiantes de Secundaria (FRESC); Estudio de Monitorización de las Conductas de Salud de los Adolescentes (EMCSAT).

Resultados

La prevalencia de fumadores diarios varía entre estudios, en varones entre 8,5 y 13,3% y en chicas entre 12,7 y 16,4%. Aunque se aprecian oscilaciones en algunos estudios, la tendencia entre 1993 y 2008 es de descenso. Con los datos más recientes se puede estimar un declive anual ponderado de la prevalencia de tabaquismo en la adolescencia del 6,47% anual para los varones y 6,96% para las chicas.

Conclusiones

Hay un patrón de descenso de la prevalencia de fumadores diarios adolescentes en España a partir de los diversos estudios existentes, que ofrecen datos consistentes, aunque hay que mantener la vigilancia debido a la existencia de oscilaciones. Esto concuerda con la información derivada de las ventas y de encuestas en población adulta. En cualquier caso, sería deseable que el ritmo de cambio fuera más acentuado y constante.

Palabras clave Encuestas. Adolescentes. Prevalencia. Tabaco. Valoración.

Introducción

Introducción En los últimos años se han producido avances en las políticas de control del tabaquismo en España. De forma concomitante, se ha documentado una disminución de la prevalencia en la población general, en buena parte asociada a una mayor densidad de abandonos precoces entre los fumadores¹. Al avanzar en el control del tabaquismo, es razonable que disminuya también su incidencia entre los menores, contribuyendo así al declive de la epidemia. Este proceso no está bien estudiado en España, y periódicamente trascienden a los medios de comunicación y en medios profesionales visiones contradictorias sobre la situación. El objetivo de este trabajo es analizar la evolución del tabaquismo en la población adolescente a partir de las fuentes de información existentes con carácter representativo poblacional, datos válidos y series largas para valorar los procesos de cambio en curso. Su hipótesis es que los progresos en las políticas de prevención y los cambios seculares se están traduciendo en un menor consumo de tabaco entre adolescentes. Material y métodos Se analizan los datos relativos al tabaco en la adolescencia en 5 encuestas escolares de ámbito poblacional y de aplicación sistemática y mantenida a lo largo del tiempo existentes en España, que publican datos desagregados para adolescentes, concentrando el análisis en la franja de edades de escolarización obligatoria para garantizar su representatividad²: Encuesta Estatal sobre Uso de Drogas en Estudiantes de Secundaria (ESTUDES); Estudio de Comportamientos de los Escolares Relacionados con la Salud (ECERS-HBSC); Sistema de Vigilancia de Factores de Riesgo Asociados a Enfermedades No Transmisibles dirigido a...

Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008.

OBJECTIVE: To provide an updated review of the efficacy of behavioral interventions to reduce sexual risk of human immunodeficiency virus (HIV) among adolescents.
DESIGN: We searched electronic databases, leading public health journals, and the document depository held by the Synthesis of HIV/AIDS Risk Reduction Project. Studies that fulfilled the selection criteria and were available as of December 31, 2008, were included.
SETTING: Studies that investigated any behavioral intervention advocating sexual risk reduction for HIV prevention, sampled adolescents (age range, 11-19 years), measured a behavioral outcome relevant to sexual risk, and provided sufficient information to calculate effect sizes.
PARTICIPANTS: Data from 98 interventions (51,240 participants) were derived from 67 studies, dividing for qualitatively different interventions and gender when reports permitted it.
MAIN OUTCOME MEASURES: Condom use, sexual frequency, condom use skills, interpersonal communication skills, condom acquisition, and incident sexually transmitted infections (STIs).
RESULTS: Relative to controls, interventions succeeded at reducing incident STIs, increasing condom use, reducing or delaying penetrative sex, and increasing skills to negotiate safer sex and to acquire prophylactic protection. Initial risk reduction varied depending on sample and intervention characteristics but did not decay over time.
CONCLUSIONS: Comprehensive behavioral interventions reduce risky sexual behavior and prevent transmission of STIs. Interventions are most successful to the extent that they deliver intensive content.

Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.

Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB.
Cochrane Database Syst Rev. 2010 Mar 17;3:CD004015
BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions. OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers. SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained. MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective. AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.

Counseling to Promote Breastfeeding

Esta es una actualización de las recomendaciones del año 2003 para promover la lactancia materna.

La U.S. Preventive Services Task Force recomienda las intervenciones de atención primaria, durante el embarazo y tras el nacimiento, para fomentar y apoyar la lactancia materna. Grado: recomendacion B .
Después de evaluar más de 25 ensayos aleatorios de intervenciones sobre la lactancia materna, el grupo de la Task Force llegó a la conclusión de que las intervenciones coordinadas durante el embarazo, nacimiento e infancia pueden aumentar el inicio, la duración y la exclusividad de la lactancia materna. Las intervenciones que incluyen componentes de atención prenatal y postnatal son las más eficaces en la prolongación del amamantamiento.
La lactancia materna tiene importantes beneficios para la salud de los bebés y sus madres: los bebés que son amamantados tienen menos infecciones y erupciones cutáneas alérgicas y tienen menos probabilidades de tener síndrome de muerte súbita infantil. Una vez finalizada la lactancia, tienen también menos probabilidades de desarrollar asma, diabetes, obesidad y leucemia infantil. Las mujeres que amamantan tienen menos riesgo de diabetes tipo 2, cáncer de mama, y cáncer de ovario que las mujeres que nunca amamantaron. Las recomendaciones han sido publicadas en el número de octubre de "Annals of Internal Medicine" y, junto a algunos materiales para uso clínico, están disponibles en el sitio Web de AHRQ en http://www.ahrq.gov/clinic/prevenix.htm

Behavioral counseling to prevent sexually transmitted infections: U.S. PreventiveServices Task Force recommendation statement.

U.S. Preventive Services Task Force.
Collaborators: Calonge N, Petitti DB, DeWitt TG, Dietrich AJ, Gordis L, GregoryKD, Harris R, Isham G, Leipzig R, LeFevre ML, Loveland-Cherry C, Marion LN, MoyerVA, Ockene JK, Sawaya GF, Yawn BP.

Ann Intern Med. 2008 Oct 7;149(7):491-6, W95.

DESCRIPTION: New U.S. Preventive Services Task Force (USPSTF) recommendations about behavioral counseling of adolescents and adults to prevent sexuallytransmitted infections (STIs).
METHODS: The USPSTF reviewed the evidence on the benefits and harms of counseling. The review included studies evaluating behavioral counseling interventions conducted in primary settings, those judged feasible in primary care, and those to which patients might be referred from primary care.
RECOMMENDATIONS: The USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation) Current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs. (I statement).