Title: The effects of Positive Youth Development interventions on substance use violence and inequalities: systematic review of theories of change processes and outcomes
Funder: Department of Health (England)

Abstract: UK young people have among the worst health in Europe with marked inequalities across the social scale. Health risk behaviours increase during adolescence and lead to high rates of later chronic disease and other problems and substantial economic costs. There are increasing calls for adolescent health interventions to address multiple rather than single risk behaviours because such behaviours cluster together and because such interventions are potentially more feasible and efficient. Positive Youth Development (PYD) is one such intervention. We define PYD interventions as involving voluntary education provided by youth workers targeting young people age 11-18 and going beyond merely the prevention of problem behaviour to address generalised positive development in terms of: vocational academic social or cognitive skills; self-confidence; positive identities attitudes and aspirations; and/or relationships with adults or peers. Our definition excludes PYD delivered in school time and interventions that primarily target families. There is major investment in PYD signalled by the UK government’s Positive for Youth report and the most recent public health white paper. However the evidence base for public health benefits is unclear. We will conduct a systematic review addressing: (RQ1) What theories of change inform PYD interventions delivered to young people aged 11-18 addressing substance use and violence?; (RQ2) What characteristics of participants and contexts are identified as barriers and facilitators of implementation and receipt in process evaluations of PYD?; (RQ3) What is the effectiveness and cost-effectiveness of PYD when compared to usual or no treatment in reducing substance use (smoking alcohol drugs) and violence (perpetration and victimization)?; and (RQ4) What characteristics of participants and contexts appear to moderate/are necessary and sufficient for PYD effectiveness? We will include theoretical literature and empirical process and outcome/economic evaluations. We will search for these via multiple strategies. Two reviewers will undertake screening data extraction and quality assessment using pre-existing tools seeking a third opinion where necessary. Our review and thematic synthesis of theories of change (RQ1) will enable us to create a taxonomy of PYD interventions and theory of change of how these are implemented and aim to achieve their effects in different contexts and subgroups. Our review and thematic synthesis of process evaluations (RQ2) will enable us to refine this theory of change to incorporate hypotheses about potential barriers and facilitators of implementation and receipt relating to characteristics of participants and contexts. Our review of outcome and economic evaluations (RQ3) will enable us to estimate the effectiveness and cost-effectiveness of PYD. Our use of meta-regression and qualitative comparative analysis will allow us to develop hypotheses about what factors relating to participants and contexts moderate / are necessary and sufficient for intervention effects (RQ4). Our review will provide policy-makers with evidence about whether for whom and in what settings PYD is effective in reducing youth substance use and violence. (Full references in detailed project description.)


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE