To identify the factors contained in the SHARP Tool, a multi-disciplinary research team comprising representatives from SAMHSA's Center for the Application of Prevention Technologies and former State Epidemiological Outcomes Workgroup contract engaged in a multi-phase review of the research literature. Search methods and criteria are described below.
Please note that the SHARP Tool will be expanded and updated as new lines of research are identified.
The Pilot Study
To better understand the role and importance of shared factors in behavioral health, the research team conducted a preliminary pilot review of the literature.
- The team reviewed more than 100 articles and reports, including the Institute of Medicine (IOM) report Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities,1 as well as articles, books, and websites referenced in this report.
- This review generated a preliminary list of factors which the research team organized according to the four levels of the social ecological model: individual, relationship, community, and society.
- Within each level, the team further categorized the factors by sub-level (e.g., school, income, and housing) based on social and demographic commonalities.
Review Procedures
Informed by the findings from the pilot review, the team launched a broader, more systematic review of the research literature. For this review, the team identified an expanded list of search terms for each sub-level, as well as separate search terms for substance abuse and mental health (tobacco was not included among the substances). This expanded review, limited for now to articles published between 2000 and 2014, is underway.
To identify relevant articles, the team is searching the following databases: Pubmed, FirstSearch, ProQuest (i.e., Applied Social Sciences Index and Abstracts, ERIC, PILOTS, PsycINFO, Social Services Abstracts, Sociological Abstracts, etc.), and Google Scholar.
To identify relevant articles, the team combines search terms as follows (See Table 1, below):
- Within each sub-level, the researchers pair each factor search term (Column A) with each sub-level search term (Column B) AND each substance abuse search term (Column SA), as follows:
A + B + SA (e.g., risk + school + substance abuse) - Next, the researchers pair each factor search term (Column A) with each sub-level search term (Column B) AND each mental health search term (Column MH), as follows:
A + B + MH (e.g., risk + school + mental health)
The team then reviews the citations generated by each sub-level-specific search and deletes duplicates. Table 1 provides an example of the search terms used to identify factors related to one of the identified sub-levels: school.
| A | B | SA | MH |
|---|---|---|---|
| Factor Search Terms | Sub-Level Search Terms | Substance Abuse-related Search Terms | Mental Health-related Search Terms |
| risk, risk factor, protective factor | school, children, students, elementary, middle school, high school, primary/ secondary/postsecondary education, private/public education, college or university, catchment area, school culture/norms/ environment, academic environment/setting, undergraduate, degree program, freshman, sophomore, junior, senior | substance use/abuse, illicit/illegal drug use/abuse, alcohol use/abuse, addiction, narcotics, inhalants, marijuana, opioids | mental health, mental illness/instability, PTSD, co-occurring, comorbid/comorbidity, mood/personality disorder, depression/depressive, behavioral/emotional disorder/instability, neurosis, psychopathy, psychosis, delusions, anxiety, suicide, suicidal tendencies/thoughts, MEB (mental, emotional, and behavioral disorders) |
Review Criteria
To generate a final list of articles to review, the team uses these criteria:
- The full text is available in English, and the research was conducted in an English-speaking country.
- The article looks at either substance abuse or mental health outcomes.
- The study employs a quantitative research study design that includes discussion of population sample size, response and attrition rate, and measurement of the main variables or concepts.
- The article was published in a peer-reviewed journal or was a dissertation or government-sponsored study that uses sound research design.
To determine which factors identified in these articles are shared, the team uses these criteria:
- At least one article reveals an association of the factor with both substance abuse and mental health; or
- At least one article reveals an association of the factor with substance abuse outcomes and at least one article reveals an association of the factor with mental health outcomes.
Articles meeting the second criterion are only included if the factors identified in both articles shared at least one of the following characteristics: age group, gender, race/ethnicity, or special populations (e.g., inmates, veterans). For example, if one article identifies a factor associated with substance abuse in 12- to 25-year-olds, the corresponding article must show that the same factor is associated with mental health outcomes in the same age group.
Keeping Track
For each article reviewed, the team documents the following information: type of factor (i.e., risk or protective), factor, level (i.e., individual, relationship, community, or society), sub-level, study population, outcomes/key findings (e.g., alcohol use, early initiation of marijuana use, depression, suicidal ideation), study design method used, sample size and characteristics (e.g., age, race, ethnicity, gender, special populations), and study limitations.
References
- Institute of Medicine (U.S.), O'Connell, M. E., Boat, T. F., Warner, K. E., & National Research Council (U.S.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, D.C: National Academies Press.