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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