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Rapid advancements in the healthcare system and demand for quality of care offer exciting career opportunities as well as challenges to health care providers to keep abreast with growing research knowledge. Though nursing theories provide a strong conceptual base for practice, acumen for research “uncovers scientific evidence for best practice,” and research utilization skills enable health care providers to bring fresh ideas and proven interventions to health care consumers. (Lindeke et al, 2005, p.3). It is envisaged that a well-structured PICO question can help researchers in health care to find crucial information from different databases. Hence an attempt has been made to formulate PICO questions related to drug abuse among school-aged children and search databases of Medline, Google Scholar, and CINAHL.
Substance abuse is prevalent in all age groups and it is a serious problem among adolescents. Many factors are contributing to a person’s risk for drug abuse, and a family environment that lacks attachment and ineffective parenting, association with drug-abusing peers, and easy drug availability often exposes children to delinquent behavior. Risk periods for drug abuse in a child’s life are linked with major life transitions, and studies show that the risk of transition to substance use disorders (SUD) increased with age. In this context, it is proposed to search prominent databases, such as PubMed, Google Scholar, CINAHL, etc., that provide evidence-based, peer-reviewed clinical research information.
PubMed is a service promoted by the federal government, and National Library of Medicine under the National Institute of Health, has “over 18 million citations from MEDLINE and other life science journals for biomedical articles back to 1948.” (To get started with PubMed, enter one or more search terms, (n.d)). PubMed Central is a free digital archive of biomedical and life sciences journal literature at the U.S. National Institute of Health (NIH), developed and managed by National Centre for Biotechnology (NCBI) in the National Library of Medicine. (PMC overview, 2008). “CINAHL (Cumulative Index of Nursing & Allied Health Literature) is a database of citations from 1982 to the present to articles published in nursing and allied health journals.” (How to search CINAHL, 2008).
CINAHL is considered as most useful when searching for scholarly, research, and evidence-based articles from health and behavior science journals. Defining the topic in the form of a question or statement and separating the question into specific logical components or concepts is the principal strategy to search the CINAHL database. Next stage is choosing a subject heading from medical subject heading (MeSH) and using it to describe concept of study. Appropriate terminology is crucial in locating and hitting upon citations about the selected topic
It is envisaged that a well-structured PICO question can help researchers in health care to find crucial information from different databases, such as MEDLINE/ PubMed, CINAHL, Google Scholar, etc. PICO, the short form that represents Patient or problem, Intervention of interest, Comparison, and Outcome, describes different essential parts of a structured clinical question. A good PICO question has the potential not only to help researchers to find useful information but also can guide clinical research. A PICO format is considered suitable for “testing the therapies” or other interventions and also “to explain diagnostic tests and possible causes of a problem” by a slight modification of the research question, if necessary. (Weighting the evidence: PICO questions: What are they, and why bother, 2008). (AAP).
The subject selected for research in this paper is drug abuse in school-aged children and the effectiveness of various prevention strategies. The original clinical question that motivated this research was “children and drug abuse.” The rationale for the selection of this question was increasing incidence of smoking, alcoholism, and drug addiction and associated violent incidents being reported in various articles. Youth Smoking Survey 2004-2005 conducted by Health Canada among youth in grades 5-9 indicted that the “mean age for first use of alcohol was just over 11 years”; among grade 7-9 students (age 12-14) mean age for the first use of cannabis was 12.6 years; and 12.5 percent reported substance use other than alcohol, tobacco or cannabis. (Leslie, 2008). The National Institute on Alcohol Abuse and Alcoholism estimates that “alcohol and drug abuse are associated with 100,000 deaths per year and cost society $100 billion per year.” (Mersy, 2003). Hence, an attempt has been made to format a PICO question and search database of MEDLINE/PubMed, Google Scholar, and CINAHL.
The formulation and structure of PICO question are described here. “P” identified for structuring PICO question is ‘peer pressure and drug abuse prevalence in school aged children’. The first intervention “I” may be taken as ‘parental intervention’ and the alternative or a comparative strategy “C” for prevention is ‘school health program’. The objective “O” of the intervention is ‘to prevent drug abuse in school aged children’. The PICO question may be structured as “Whether parental interventions and school health programs help prevent drug addiction among school aged children?”
The search of Google scholar using the PICO question “Whether parental interventions and school health programs help prevent drug addiction among school aged children?” retrieved 16,300 articles, of which 5,690 were recent. Among the recent articles, first article was by Kautakis and colleagues (2008) that attempts to evaluate the effectiveness of two drinking prevention programs involving 13-16-year-olds through parental intervention in Sweden. It is a quasi-experimental study of 900 pupils entering junior high school and their parents conducted in schools located in inner-city, public housing and small-town areas, in order that the program is applicable in urban and rural areas. The study population is junior high school students in grades 7-9 (ages 13-16 years) and assessment was conducted at the beginning of 7th grade. Follow-ups were conducted when the youths were in 8th and 9th grades. The study found that a strict attitude of parents against youth drinking is very effective in prevention strategies as ‘youth perceive their parents as having legitimate authority over safety issues.’ Koutakis et al (2008) conclude that “working via parents proved to be an effective way to reduce underage drinking as well as delinquency.” (Koutakis, Stattin & Kerr, 2008, p.1).
The second article relevant to the study was “School based adolescent drug prevention program,” a meta-analysis by Tobler et al (1998). An abstract of the article was available from the URL (Tobler, et al, 2000). Access to the full article was secured through institutional login or can be purchased from SpringerLink. This article was based on “a meta-analysis of 207 universal school-based drug prevention programs that compared the self-reported drug use of treatment to control or comparison youth.” The study found that primary predictors of effectiveness of the program depend on its type and size and ‘interactive programs’ that promote development of interpersonal skills showed ‘significantly greater effects than decrease with large-scale implementations.’
Another relevant article dealing with school-level prevention activities, located while searching Google scholar, was by Noam & Herman (2002). This article titled “Where education and mental health meet: Developmental prevention and early intervention in schools” hypothesizes that traditional strategies are insufficient to address the increasing needs of ever-growing number of troubled children entering U.S Schools (Where education and mental health meet, 2002). Noam and Herman introduce a “school-based prevention and intervention method for young adolescents called Responsive Advocacy for Life and Learning in Youth (RALLY).The program developed to suit classroom intervention and after-school settings is projected to provide non-stigmatizing support to students. This three-tiered prevention model integrates children, teachers, and families in high-risk environments through developmental specialists. Full text of this article is also not available for free access.
Search in MedlinePlus using the same PICO question “Whether parental interventions and school health programs help prevent drug addiction among school-aged children?” retrieved only one article. This article can be accessed from URL (The Health & Retirement Study: Growing Older in America, 2009).
It was on health and retirement study published by National Institute on Aging. A review of the article revealed that it has little relevance to the PICO question formatted for researching drug addition among school-aged children.
Since the search has not produced expected results an attempt has been made to search PubMed Central using the same PICO question. Two articles have been retrieved from PubMed Central, of which one article was relevant to the research topic. The article by Johnson et al (2007) delves into youth use of harmful legal products such as misuse of prescription drugs and over-the-counter drugs. They propose an innovative, comprehensive, community-based prevention intervention. Based on research evidence that indicates increased use of inhalants among 8th graders, Johnson and colleagues present a conceptual framework to link ‘casual connections among significant variables in the use of harmful legal products.’ They have conceptualized five important variables, such as community readiness, rules and regulations, anti-drug norms, social influence, and cultural identity as important tools in reducing youth use of harmful legal products. From these key variables three evidence-based prevention intervention components have been combined to form a comprehensive community prevention intervention. These three interventions involve community mobilization, environmental strategies, and school-based prevention education. It is hypothesized that “if the availability of harmful products is reduced and youths’ cognitive behavioral skills are increased then youth use of these products will decrease.” (Johnson et al, 2007). As there are very few returns to the initial PICO question, another search of PubMed with a modified question was attempted. Search of PubMed database using the words “peer parent-school intervention/preventing school-age drug addiction” retrieved 5 articles, of which 2 articles were guidelines for school health programs. The study by Shortt et al (2007) is found to be more appropriate for research. The study examines the influence of family factors relative to school, peer and individual influences on the development of adolescent alcohol use during the first year of secondary school. It also explores feasibility of preventing adolescent alcohol use by modifying family factors. A total of 2315 randomly selected grade seven students from 24 schools in Melbourne, Australia was involved in the study. The study found that “prevalence of lifetime alcohol use in year 7 was 33% and rose to 47% in year 8,” and considerable alcohol use was detected in early secondary school. (Family, school, peer and individual influences on early adolescent alcohol use: first-year impact of the Resilient Families program, 2007)
Another study located in PubMed was on “Contribution of parental and social influences to cannabis use in a non-clinical sample of adolescents” by Chabrol et al (2008). This study enquires the relative contributions of peers and parental influences and adolescents’ own beliefs about use of cannabis. There were 559 high-school and secondary school students and a questionnaire survey was conducted in this study. The 29 item questionnaire was scored on a 7-point Likert scale. The results showed that 22% of girls and 28% of boys used cannabis during the last six months, and 49% of fathers and 39% of mothers of these cannabis users have or had the habit of using cannabis. The study results indicated that “less the number of peers opposed to cannabis use and lower the negative expectations, the higher the risk for initiation of use.” (Chabrol, et al, 2008).
It is found that slight changes in search questions produce a varied responses. Hence, formulating research questions is crucial in locating specific and subject-oriented articles from different web sources. Majorities of studies reviewed have shown that parental intervention, school health programs, and community-based interventions are important for preventing drug abuse among school-aged children.
Reference
- Family, school, peer and individual influences on early adolescent alcohol use: first-year impact of the Resilient Families program. (2007). NCBI. Web.
- How to search CINAHL: What is CINAHL. (2008). M Library University of Michigan.
- Johnson, knowlton., et al. (2007). A community prevention intervention to reduce youth from inhaling and ingesting harmful legal products: Prevention education. Pubmed Central Journal List. Web.
- Koutakis, N., Stattin, H., & Kerr, M. ( 2008). Reducing youth alcohol drinking through a parent-targeted intervention: the Örebro prevention program. Addiction, 103: 1629-1637.
- Koutakis, Nikolaus., Stattin, Håkan., & Kerr, Margaret.(2008). Reducing youth alcohol drinking through a parent-targeted intervention: the Örebro Prevention Program: Abstract. Addiction.
- Leslie, Karen. (2008). Public health: Youth substance use and abuse: Challenges and strategies for identification and intervention. CMAJ. Web.
- Lindeke, Linda., et al. (2005). Advanced practice nursing: core concepts for professional role development: Overview of advanced practice nursing. Springer Publishing Company. 3. Web.
- Mersy, David J. (2003). Recognition of alcohol and substance abuse. American Family Physician.
- PMC overview. (2008). Pubmed Central. Web.
- The Health & Retirement Study: Growing Older in America. (2009). National Institute of Aging.
- Tobler, Nancy S., et al. (2000). The Journal of Primary Prevention. Springer Link.
- To get started with PubMed, enter one or more search terms. (n.d). NCBI.
- Weighting the evidence: PICO questions: What are they, and why bother. (2008). AAP Grand Rounds.
- Where education and mental health meet: Developmental prevention and early intervention in schools. (2002). Cambridge journals. Web.
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