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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