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Describing an innovative approach to the evaluation of complex health interventions, this book allows reader to assess what interventions work, how and for whom. Proposing how realist evaluation methods may be incorporated within trials and systematic reviews, this approach provides useful evidence to inform policy and scientific advancement.

Abstract
We used a crisp-set Qualitative Comparative Analysis (csQCA) to analyse of how key conditions interact within police use of force incidents to contribute to Conducted Energy Devices (CED), commonly known by the brand name TASER, being drawn and red-dotted (0), or drawn, red-dotted, and fired (1). Our sample is 22 incidents (11 red-dotted, 11 red-dotted and fired) between one officer and one person subjected to force recorded in the Use of Force Monitoring Forms for CED incidents from one of the 43 police forces in England and Wales. We identify the most parsimonious causal recipes for both outcomes using five causal conditions –i.e. Intoxication, Intelligence, Prior Knowledge, Weapon Possession, and Aggression. We found three different pathways to CED being red-dotted (0) and five distinct pathways to CED being red-dotted and fired (1). Our findings show that reported intelligence and prior knowledge play central roles in shaping causal recipes, and reported aggression by the member of the public is critical to CED firing decisions.

AbstractBackgroundHealth inequities are systematic, avoidable, and unfair differences in health between populations or population subgroups. There is increased recognition of the need for systematic reviews (SRs) to address health inequities, including drawing out findings relevant to low‐ and middle‐income countries (LMICs). The aim of this study was to determine the extent to which SRs on risk factors for hearing loss reported findings associated with health inequities, and the extent to which this data was captured in the primary studies included within these SRs.MethodsWe identified SRs on risk factors for hearing loss from a report on this topic which included a systematic search for relevant SRs. SRs thus identified were inspected for data related to health inequity with reference to PROGRESS‐Plus. We compared how data were reported in SRs versus within primary studies included in the SRs, and the extent to which primary studies from LMICs were represented.ResultsWe included 17 SRs which reported findings on a variety of physiological, behavioral, demographic, and environmental risk factors for hearing loss. There were 296 unique primary studies included in the SRs, of which 251 (81.49%) were successfully retrieved. Data relating to health inequities was reported relatively infrequently in the SRs and mainly focused on gender and age. Data related to health inequities was more frequently reported in primary studies. However, several PROGRESS‐Plus criteria were only reported in a minority of primary studies. Approximately one‐third of primary studies were from LMICs.ConclusionsThere is scope to improve the reporting of data relating to health inequities in primary studies on risk factors for hearing loss. However, SR authors could do more to report health inequities than is currently undertaken, including drawing out findings relevant to LMICs where data are available.

BACKGROUND: Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political tradition, democracy and globalisation – on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review. METHODS: The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories. RESULTS: Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to ...

Objective: Positive youth development (PYD) often aims to prevent tobacco, alcohol, and drugs use and violence. We systematically reviewed PYD interventions, synthesizing process, and outcomes evidence. Synthesis of outcomes, published elsewhere, found no overall evidence of reducing substance use or violence but notable variability of fidelity. Our synthesis of process evaluations examined how implementation varied and was influenced by context. Data Source: Process evaluations of PYD aiming to reduce substance use and violence. Study Inclusion Criteria: Overall review published since 1985; written in English; focused on youth aged 11 to 18 years; focused on interventions addressing multiple positive assets; reported on theory, process, or outcomes; and concerned with reducing substance use or violence. Synthesis of process evaluations examined how implementation varies with or is influenced by context. Data Extraction: Two reviewers in parallel. Data Synthesis: Thematic synthesis. Results: We identified 12 reports. Community engagement enhanced program appeal. Collaboration with other agencies could broaden the activities offered. Calm but authoritative staff increased acceptability. Staff continuity underpinned diverse activities and durable relationships. Empowering participants were sometimes in tension with requiring them to engage in diverse activities. Conclusion: Our systematic review identified factors that might help improve the fidelity and acceptability of PYD interventions. Addressing these might enable PYD to fulfill its potential as a means of promoting health.

AbstractChildren and young people with care-experience (e.g. foster, kinship and residential care) report poorer mental health and wellbeing than the general population. Despite an emerging evidence-base for intervention, it is not clear if current approaches create, exacerbate or mitigate outcome inequities between different types of participants. We conducted a systematic review of international interventions targeting mental health, subjective wellbeing and suicide-related outcomes amongst care-experienced children and young people aged up to 25 years old. The review included a narrative synthesis of intervention inequities, exploring if they were more or less effective for different participant groups. Eight interventions, with 14 study reports, presented relevant data. Overall, there was no clear evidence that intervention participation could lead to inequitable impacts, being more or less effective for different groups. However, there was some tentative indication that individuals with lower exposure to maltreatment, fewer care placements, and increased baseline mental health problems, might be more responsive to intervention than other participants. There was limited evidence for wellbeing and no data availability for suicide. Future intervention evaluation should focus on assessing if there is potential to create, sustain or exacerbate inequities, and how approaches may be designed to mitigate this risk.

BACKGROUND: Whilst prevalence of youth smoking in middle and high income countries has decreased, inequality has prevailed. The introduction of legislation regulating tobacco use in public spaces varies across countries, impacting the tobacco control context. Thus reviewing our knowledge of how social networks may influence smoking differently within different contexts is required to facilitate the development of context-specific interventions. METHODS: The search, conducted on 31st May 2019, included the following smoking-related terms; schools, adolescents, peers and social networks. Inclusion and exclusion criteria were applied throughout the title and abstract screening and full text screening. Quality assessment and synthesis followed. Studies were narratively synthesised to identify changes according to legislative context. This synthesis was conducted separately for findings relating to three categories: socioeconomic status; social selection and influence; and network position. RESULTS: Thirty studies were included. Differences in the relationship between network characteristics and smoking according to socioeconomic status were measured in five out of fifteen studies in Europe. Results varied across studies, with differences in network characteristics and their association with smoking varying both between schools of a differing and those of a similar socioeconomic composition. For studies conducted both before and after the introduction of comprehensive smoking legislation, the evidence for selection processes was more consistent than influence, which varied according to reciprocity. Findings showed that isolates were more likely to smoke and in-degree and out-degree centrality were related to smoking both before and after the introduction of legislation. The relationship between popularity and smoking was contingent on school level smoking prevalence in studies conducted before the introduction of legislation, but not after. CONCLUSIONS: Overall, effects according to socioeconomic status were ...

Background: Whilst prevalence of youth smoking in middle and high income countries has decreased, inequality has prevailed. The introduction of legislation regulating tobacco use in public spaces varies across countries, impacting the tobacco control context. Thus reviewing our knowledge of how social networks may influence smoking differently within different contexts is required to facilitate the development of context-specific interventions. Methods: The search, conducted on 31st May 2019, included the following smoking-related terms; schools, adolescents, peers and social networks. Inclusion and exclusion criteria were applied throughout the title and abstract screening and full text screening. Quality assessment and synthesis followed. Studies were narratively synthesised to identify changes according to legislative context. This synthesis was conducted separately for findings relating to three categories: socioeconomic status; social selection and influence; and network position. Results: Thirty studies were included. Differences in the relationship between network characteristics and smoking according to socioeconomic status were measured in five out of fifteen studies in Europe. Results varied across studies, with differences in network characteristics and their association with smoking varying both between schools of a differing and those of a similar socioeconomic composition. For studies conducted both before and after the introduction of comprehensive smoking legislation, the evidence for selection processes was more consistent than influence, which varied according to reciprocity. Findings showed that isolates were more likely to smoke and in-degree and out-degree centrality were related to smoking both before and after the introduction of legislation. The relationship between popularity and smoking was contingent on school level smoking prevalence in studies conducted before the introduction of legislation, but not after. Conclusions: Overall, effects according to socioeconomic status were underreported in the included studies and no consistent evidence of change after the introduction of a comprehensive smoking ban was observed. Further network analyses are required using more recent data to obtain a comprehensive understanding of how network processes may influence smoking differently according to socioeconomic status, and how adaptation could be used to enhance intervention effectiveness. Systematic review registration: International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42019137358.

Background. Since 2005, most US states have expanded civilian rights to use deadly force in self-defense outside the home. In most cases, legislation has included removing the duty to retreat anywhere one may legally be, commonly known as stand-your-ground laws. The extent to which these laws affect public health and safety is widely debated in public and policy discourse. Objectives. To synthesize the available evidence on the impacts and social inequities associated with changing civilian rights to use deadly force in self-defense on violence, injury, crime, and firearm-related outcomes. Search Methods. We searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Sociological Abstracts, National Criminal Justice Reference Service Abstracts, Education Resources Information Center, International Bibliography of the Social Sciences, ProQuest Dissertations and Theses, Google Scholar, National Bureau of Economic Research working papers, and SocArXiv; harvested references of included studies; and consulted with experts to identify studies until April 2020. Selection Criteria. Eligible studies quantitatively estimated the association between laws that expanded or restricted the right to use deadly force in self-defense and population or subgroup outcomes among civilians with a comparator. Data Collection and Analysis. Two reviewers extracted study data using a common form. We assessed study quality using the Risk of Bias in Nonrandomized Studies of Interventions tools adapted for (controlled) before–after studies. To account for data dependencies, we conducted graphical syntheses (forest plots and harvest plots) to summarize the evidence on impacts and inequities associated with changing self-defense laws. Main Results. We identified 25 studies that estimated population-level impacts of laws expanding civilian rights to use deadly force in self-defense, all of which focused on stand-your-ground or other expansions to self-defense laws in the United States. Studies were scored as having serious or critical risk of ...

BACKGROUND: Adolescent HIV and pregnancy rates in Southern Africa are amongst the highest in the world. Despite decades of sexual and reproductive health (SRH) programming targeting adolescents, recent trends suggest there is a continued need for interventions targeting condom use for this age group. METHODS: This review synthesises evidence from qualitative studies that describe the determinants of condom use among adolescents in Southern Africa. We conducted systematic searches in four databases. Data were extracted, appraised for quality and analysed using a 'best-fit' framework synthesis approach. RESULTS: We coded deductively findings from 23 original studies using an a priori framework and subsequently conducted thematic analysis. Synthesised findings produced six key themes relating to: 1) pervasive unequal gender norms and restrictive masculinities favouring male sexual decision-making and stigmatising condom use in committed relationships; 2) other social norms reflecting negative constructions of adolescent sexuality and non-traditional family planning; 3) economic and political barriers including poverty and a lack of policy support for condom use; 4) service-level barriers including a lack of youth-friendly SRH services and comprehensive sex education in schools; 5) interpersonal barriers and facilitators including unequal power dynamics in sexual partnerships, peer influences and encouraging condoning condom use, and inadequate communication about SRH from parents/caregivers; and 6) negative attitudes and beliefs about condoms and condom use among adolescents. A conceptual model was generated to describe determinants of condom use, illustrating individual-, interpersonal- and structural-level barriers and facilitating factors. CONCLUSION: SRH programming targeting barriers and facilitators of condom use at multiple levels is recommended in Southern Africa. We present a multilevel integrated model of barriers and facilitators to guide adolescent SRH decision-making, programme planning and evaluation. ...

AbstractIntroductionAs adolescents transition from childhood to adulthood, they experience major physical, social and psychological changes, and are at heightened risk for developing mental health conditions and engaging in health‐related risk behaviours. For adolescents living with HIV (ALHIV), these risks may be even more pronounced. Research shows that this population may face additional mental health challenges related to the biological impact of the disease and its treatment, the psychosocial burdens of living with HIV and HIV‐related social and environmental stressors.DiscussionPsychosocial interventions delivered to adolescents can promote positive mental health, prevent mental health problems and strengthen young people's capacity to navigate challenges and protect themselves from risk. It is likely that these interventions can also benefit at‐risk populations, such as ALHIV, yet there is little research on this. There is an urgent need for more research evaluating the effects of interventions designed to improve the mental health of ALHIV. We highlight four priorities moving forward. These include: generating more evidence about preventive mental health interventions for ALHIV; including mental health outcomes in research on psychosocial interventions for ALHIV; conducting intervention research that is sensitive to differences among ALHIV populations and involving adolescents in intervention design and testing.ConclusionsMore robust research on promotive and preventive mental health interventions is needed for ALHIV. Programmes should be informed by adolescent priorities and preferences and responsive to the specific needs of these groups.