Longitudinal Associations between Adolescents' Character Attributes and Civic Actions.

Research suggests that character attributes may enable youth to envision and perform civic actions that benefit society, but few studies have examined the longitudinal associations between character attributes and civic actions. As a response to this gap, this study investigated how specific character attributes (purpose, future mindedness, humility, and moral courage) may be differently linked to various civic actions (community service, political activities, social activism) cross-sectionally and longitudinally. Survey data were collected from 521 adolescents (Mage = 14.44, SD = 1.92, 58.5% girls, 60.8% White). Structural equation models demonstrated that purpose and future mindedness were positively associated with all three civic actions at Time 1, but not at Time 2. Humility was not associated with any Time 1 civic actions, but was negatively associated with Time 2 political activities. Moral courage was positively associated with Time 1 social activism and Time 2 political activities. Results illuminate the short-term interplay between character attributes and civic actions and point to internal resources that may promote different forms of youth civic action.

The Five Cs of Positive Youth Development: Configurations of Thriving in Four U.S. Adolescent Samples.

Positive youth development (PYD) models are widespread, but the empirical evidence for them is primarily nomothetic (i.e., investigations of universal patterns). Contemporary developmental theory suggests that concepts and processes within PYD models should also be explored with respect to specificity. This study demonstrates how the Five Cs Model, a predominant PYD model, can be advanced using group-differential methods. Secondary data from four studies of adolescents were used to test: (1) Whether there were subgroups who varied in their patterns of scores across the Five Cs, and (2) Whether subgroups also varied in Contribution behaviors. Unexpectedly, the four data sets used could not be combined, yielding an opportunity to discuss consistencies and inconsistencies in findings across the four data sets through contextual and sample differences. Findings demonstrate how understanding specificity in theorized concepts and processes in PYD models can complement studies of universal patterns, which are both necessary to advance PYD research and practice.

Measuring Positive Development among College Students in the United States: Investigating Cross-Sectional and Longitudinal Measurement Invariance across Different Racial Groups.

Measures that are applicable to assess the positive youth development (PYD) of racially diverse college students are needed. The present study tested if a revised version of the very short form of the PYD measure (PYD-VSF) was applicable to college students from five racial groups in the U. S. (White, Black, Latinx, Asian, and other) across three measurement occasions. Participants were 5,735 college students who completed the PYD-VSF at least once across the three waves of a longitudinal study. Confirmatory factor analyses (CFA) indicated that a first-order Five Cs structure, a higher-order structure, and a bifactor structure all provided good fit to the data. Multi-group CFA across racial groups found that the first-order structure fit the data better than the higher-order and the bifactor models, and it showed configural-, factor loading-, intercept-, and residual-invariance. Longitudinal CFA models of the first-order structure supported configural-, factor loading-, intercept-, and residual-invariance. The revised PYD-VSF measure has shown the potential to assess PYD among college students of diverse racial-ethnic backgrounds.

Longitudinal Relations among Identity Distinctiveness, Continuity, and Integration among Dutch Adolescents.

Identity distinctiveness, continuity, and coherence are all components of adolescents' identity development, but their longitudinal relations have rarely been examined. Data were analyzed on these three constructs collected over three years from 349 Dutch adolescents (Mage = 14.7, SDage = 0.7, 215 [61.6%] girls and 133 [38.1%] boys). A cross-lagged panel model of the three constructs showed that stability was relatively high for distinctiveness and continuity, whereas coherence was less stable. Distinctiveness and continuity were correlated positively within time, but cross-lagged associations were mostly not significant: Only distinctiveness and coherence negatively predicted each other across waves. Results suggest that distinctiveness, continuity, and coherence may be interrelated, but may not drive the development of each other.

I Am Whatever I Say I Am: The Salient Identity Content of U.S. Adolescents.

Research about identity development has focused primarily on researcher-chosen domains or overlooked content entirely. To investigate the content that is salient to adolescents, we analyzed responses to a shortened Twenty Statements Test (ten answers to the question, "Who am I?") from 415 adolescents in the northeastern United States (Mage = 13.59 years; 63.7% girls, about 50% identified as White/European American). Inductive content analysis identified four Content codes (what the participants wrote: Personal, Social categories, Relationships, Self-evaluation) and two Structure codes (how they wrote their statements: Qualifiers and Verb Tense). Content codes appeared in eight patterns, and there were between-group differences in content and patterns. Results expand our understanding of adolescents' identity content and demonstrate its complexity.

Latent profile transition analyses and growth mixture models: A very non-technical guide for researchers in child and adolescent development.

Developmental scientists are often interested in subgroups of people who share commonalities in aspects of development; these subgroups often cannot be captured directly but instead must be inferred from other information. Mixture models can be used in these situations. Two specific types of mixture models, latent profile transition analyses and growth mixture models, are highly relevant to developmental science because they can identify subgroups of people who are similar in their patterns of change. This guide highlights foundational aspects of these two types of models and is intended for readers who have not previously conducted either an LPTA or a GMM, or perhaps no mixture model analyses at all. It includes four primary sections. The first focuses on understanding mixture models conceptually and applying that knowledge to identifying appropriate research questions. The second section addresses data requirements, including planning for data collection or evaluating the suitability of previously collected data, and data preparation. The third section focuses on conducting analyses, with step-by-step instructions and syntax, and the final section discusses presenting the results. I illustrate these concepts and procedures with an example data set and research questions derived from the Five Cs model of positive youth development.

How Does Racial Context Matter?: Family Preparation-for-Bias Messages and Racial Coping Reported by Black Youth.

Black families and youth likely consider specific racial discriminatory situations in preparation-for-bias messages and racial coping responses. Our study investigated coping responses embedded in youth-reported Black families' preparation-for-bias messages and youths' proactive coping responses to specific racially discriminatory situations-teachers' negative expectations, store employees' hyper-monitoring and police harassment. Gender and racial discrimination experience differences were considered along with relations between messages and coping. Our investigation was guided by the integrated-developmental, transactional/ecological, intersectionality, and Phenomenological Variant of Ecological Systems Theory theoretical frameworks. We conducted cluster analyses using data from 117 Black youth aged 13-14 to identify situation-specific family messages and youth coping responses. Families' messages and youths' responses varied in content and frequency based on the specific discriminatory situation, which suggests consideration of context.

Barriers to Goal-concordant Care for Older Patients With Acute Surgical Illness: Communication Patterns Extrinsic to Decision Aids.

OBJECTIVE: We sought to characterize patterns of communication extrinsic to a decision aid that may impede goal-concordant care. BACKGROUND: Decision aids are designed to facilitate difficult clinical decisions by providing better treatment information. However, these interventions may not be sufficient to effectively reveal patient values and promote preference-aligned decisions for seriously ill, older adults. METHODS: We conducted a secondary analysis of 31 decision-making conversations between surgeons and frail, older inpatients with acute surgical problems at a single tertiary care hospital. Conversations occurred before and after surgeons were trained to use a decision aid. We used directed qualitative content analysis to characterize patterns within 3 communication elements: disclosure of prognosis, elicitation of patient preferences, and integration of preferences into a treatment recommendation. RESULTS: First, surgeons missed an opportunity to break bad news. By focusing on the acute surgical problem and need to make a treatment decision, surgeons failed to expose the life-limiting nature of the patient's illness. Second, surgeons asked patients to express preference for a specific treatment without gaining knowledge about the patient's priorities or exploring how patients might value specific health states or disabilities. Third, many surgeons struggled to integrate patients' goals and values to make a treatment recommendation. Instead, they presented options and noted, "It's your decision." CONCLUSIONS: A decision aid alone may be insufficient to facilitate a decision that is truly shared. Attention to elements beyond provision of treatment information has the potential to improve communication and promote goal-concordant care for seriously ill older patients.

Adolescent Athletic Participation Patterns and Self-Perceived Competence: Associations With Later Participation, Depressive Symptoms, and Health.

Physical activity is important for well-being across the life span. However, links between patterns of adolescent activity, competence perceptions, and young adult outcomes are underexplored. We used data from seven waves of the 4-H Study of Positive Youth Development (N = 5,961) to assess patterns of adolescent athletic participation, whether these patterns were associated with self-perceived athletic competence and young adult physical activity, depressive symptoms, and health, and associations between changes in participation across adolescence and young adult outcomes. Competence perceptions were associated with increased participation, and more active adolescents had higher rates of adult athletic activity, with links to better health and fewer depressive symptoms. We discuss results in light of the importance of using person-centered analyses to understand active lifestyles.

Modeling Pathways of Character Development across the First Three Decades of Life: An Application of Integrative Data Analysis Techniques to Understanding the Development of Hopeful Future Expectations.

There were two purposes of the present research: first, to add to scholarship about a key character virtue, hopeful future expectations; and second, to demonstrate a recent innovation in longitudinal methodology that may be especially useful in enhancing the understanding of the developmental course of hopeful future expectations and other character virtues that have been the focus of recent scholarship in youth development. Burgeoning interest in character development has led to a proliferation of short-term, longitudinal studies on character. These data sets are sometimes limited in their ability to model character development trajectories due to low power or relatively brief time spans assessed. However, the integrative data analysis approach allows researchers to pool raw data across studies in order to fit one model to an aggregated data set. The purpose of this article is to demonstrate the promises and challenges of this new tool for modeling character development. We used data from four studies evaluating youth character strengths in different settings to fit latent growth curve models of hopeful future expectations from participants aged 7 through 26 years. We describe the analytic strategy for pooling the data and modeling the growth curves. Implications for future research are discussed in regard to the advantages of integrative data analysis. Finally, we discuss issues researchers should consider when applying these techniques in their own work.

Hope in context: developmental profiles of trust, hopeful future expectations, and civic engagement across adolescence.

Hopeful expectations for the future have been shown to play an important role in the positive development of youth, including youth contributions to society. Although theory and some research suggest that familial socialization may influence future-oriented cognitions, little work has focused on the possible interrelation of parent-child relationships and the development of hope, particularly during adolescence. Accordingly, the first goal of this study was to identify developmental profiles of youth with respect to hopeful future expectations (HFE) and parental trust across adolescence. Next, we explored whether these developmental trajectories were related to youth Contribution, indexed by community leadership, service, and helping attitudes and behaviors. We used growth mixture modeling to simultaneously examine trajectories of adolescents' perceived connections with parents (indexed by parent trust) and HFE among 1,432 participants (59% female) from Waves 3 through 6 (Grades 7 through 10) of the 4-H Study of Positive Youth Development. A four-profile model provided the best fit to the data, with the following profiles: Moderate HFE/U-shaped Trust; Moderate HFE/Increasing Trust; Both Decreasing; and Both High Stable profiles. We then explored whether hope-trust profiles were related to youth Contribution in Wave 7. Contrary to hypotheses, results indicated that the profile reflecting the greatest discrepancy in HFE and trust across early to middle adolescence (i.e., Moderate Hope/U-shaped Trust) was associated with the highest mean Contribution scores. The implications of the findings for future theory and research are discussed.

Special issue introduction: Thriving across the adolescent years: a view of the issues.

Framed within a relational developmental systems model, the 4-H Study of positive youth development (PYD) explored the bases and implications of thriving across much of the second decade of life. This special issue pertains to information derived from the recently completed eight waves of the 4-H Study of PYD, and presents findings about the relations between individual and contextual variables that are involved in the thriving process. This introduction briefly reviews the historical background and the theoretical frame for the 4-H Study and describes its general methodology. We provide an overview of the articles in this special issue and discuss the ways in which the articles elucidate different facets of the thriving process. In addition, we discuss the implications of this research for future scholarship and for applications aimed at improving the life chances of diverse adolescents.

Important non-parental adults and positive youth development across mid- to late-adolescence: the moderating effect of parenting profiles.

Both parents and important non-parental adults have influential roles in promoting positive youth development (PYD). Little research, however, has examined the simultaneous effects of both parents and important non-parental adults for PYD. We assessed the relationships among youth-reported parenting profiles and important non-parental adult relationships in predicting the Five Cs of PYD (competence, confidence, connection, character, and caring) in four cross-sectional waves of data from the 4-H Study of PYD (Grade 9: N = 975, 61.1% female; Grade 10: N = 1,855, 63.4% female; Grade 11: N = 983, 67.9% female; Grade 12: N = 703, 69.3% female). The results indicated the existence of latent profiles of youth-reported parenting styles based on maternal warmth, parental school involvement, and parental monitoring that were consistent with previously identified profiles (authoritative, authoritarian, permissive, and uninvolved) as well as reflecting several novel profiles (highly involved, integrative, school-focused, controlling). Parenting profile membership predicted mean differences in the Five Cs at each wave, and also moderated the relationships between the presence of an important non-parental adult and the Five Cs. In general, authoritative and highly involved parenting predicted higher levels of PYD and a higher likelihood of being connected to an important non-parental adult. We discuss the implications of these findings for future research on adult influences of youth development and for programs that involve adults in attempts to promote PYD.

Profiles of problematic behaviors across adolescence: covariations with indicators of positive youth development.

Previous analyses of data from the 4-H Study of Positive Youth Development (PYD) have examined concurrent trajectories of positive development and risk/problem behaviors among adolescents, finding complex and not necessarily inverse relationships among them. In this article, we expand on prior research by employing a person-centered approach to modeling risk behaviors, assessing development from approximately 6th grade through 12th grade among 4,391 adolescents (59.9% female). Latent profiles involving the problematic behaviors of delinquency, depressive symptoms, substance use, sexual activity, disordered eating behaviors, and bullying were then assessed for concurrent relationships with the Five Cs of PYD: Competence, Confidence, Character, Caring, and Connection. We found six latent profiles, based primarily on mental health, aggression, and alcohol use, with significant differences in Confidence levels among many of the profiles, as well as some differences in the four other Cs. We discuss directions for future research and implications for application to youth policies and programs.

Balancing Act: Acute and Contextual Vestibular Sensations of Cranial Electrotherapy Stimulation Using Survey and Sensor Outcomes in a Non-Clinical Sample.

Cranial electrotherapy stimulation (CES) delivers low-intensity electrical currents to the brain to treat anxiety, depression, and pain. Though CES is considered safe and cost-effective, little is known about side effects emerging across different contexts. Our objective was to investigate how varying physical and cognitive demands impact the frequency and intensity of CES vestibular sensations in a sample of healthy young adults. We used a 2 (stimulation: sham, active) × 2 (physical demand: static sway, dynamic sit-to-stand) × 2 (cognitive demand: single-task remain silent, dual-task count backward) repeated measures design. Vestibular sensations were measured with surveys and wearable sensors capturing balance changes. Active stimulation did not influence reported vestibular sensations. Instead, high physical demand predicted more sensation reports. High cognitive demand, but not active stimulation, predicted postural sway unsteadiness. Significant effects of active stimulation on balance were observed only during the dynamic sit-to-stand transitions. In summary, CES induces vestibular sensations only for a specific outcome under certain circumstances. Our findings imply that consumers can safely maximize the benefits of CES while ensuring they are taking steps to minimize any potential side effects by considering their context and circumstances.

Embedding an Education Intervention about Shared Decision Making into an RCT: Ensuring competency and fidelity.

Objective: To describe the outcomes of training nephrology clinicians and clinical research participants, to use the Best Case/Worst Case Communication intervention, for discussions about dialysis initiation for patients with life-limiting illness, during a randomized clinical trial to ensure competency, fidelity to the intervention, and adherence to study protocols and the intervention throughout the trial. Methods: We enrolled 68 nephrologists at ten study sites and randomized them to receive training or wait-list control. We collected copies of completed graphic aids (component of the intervention), used with study-enrolled patients, to measure fidelity and adherence. Results: We trained 34 of 36 nephrologists to competence and 27 completed the entire program. We received 60 graphic aids for study-enrolled patients for a 73% return rate in the intervention arm. The intervention fidelity score for the graphic aid reflected completion of all elements throughout the study. Conclusion: We successfully taught the Best Case/Worst Case Communication intervention to clinicians as research participants within a randomized clinical trial. Innovation: Decisions about dialysis are an opportunity to discuss prognosis and uncertainty in relation to consideration of prolonged life supporting therapy. Our study reveals a strategy to evaluate adherence to a communication intervention in real time during a clinical study.

An empirical study of surrogates' preferred level of control over value-laden life support decisions in intensive care units.

RATIONALE: Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood. OBJECTIVES: To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions. METHODS: This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection. MEASUREMENTS AND MAIN RESULTS: The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P < 0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation. CONCLUSIONS: Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions.

An item response theory analysis of two frequently used measures of identity development.

Identity development-exploring options and making commitments-is an important process related to human functioning across the lifespan. An accurate understanding of identity development processes requires precise measures, but commonly used questionnaires have not been subject to intensive psychometric analyses. We investigated the psychometric properties of two such measures, the Utrecht Management of Identity Commitments Scale and the Dimensions of Identity Development Scale. Previous analyses have treated the response scales as interval rather than ordinal, which may not be reasonable given the measures' Likert-type response scales. Accordingly, we evaluated their measurement precision by conducting multidimensional item response theory analyses of data from six studies of secondary and postsecondary students in The Netherlands and the United States (total N = 4,844; 36.00% boys/men, 63.07% girls/women; 0.02% nonbinary or missing gender data; 62.39% completed the measure in Dutch, 37.61% in English; 52.66% postsecondary school; 47.34% secondary school; racial, ethnic, and nationality information varied across studies). Graded response models showed that a limited range of the latent attributes was precisely measured, and the quality of items varied considerably. The measures functioned mostly similarly between gender groups, but there was substantial differential item functioning based on school level and language of the measure. We originally sought to create shortened versions, but the shortened versions provided no improvement over the low quality of the longer versions. Our analyses suggest that reflection on what these identity processes entail is needed, to develop new items that address different manifestations of the attributes under consideration. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bridging Undergraduate and Graduate Medical Education: A Resident-as-Educator Curriculum Embedded in an Internship Preparation Course.

BACKGROUND: Many graduate medical education programs have implemented curricula to develop trainees into the next generation of medical teachers; however, coordination of in-person teaching curricula is challenging due to full trainee schedules. METHODS: To address limited in-person time, we developed a largely asynchronous resident-as-educator curriculum. Our elective curricular activities are embedded within the fourth-year internship preparation course at the University of Wisconsin School of Medicine and Public Health and include trainees from internal medicine, family medicine, and pediatrics. RESULTS: Trainee self-assessment of teaching skills improved after our curriculum, and students evaluated resident sessions favorably. DISCUSSION: Trainees can be effective teachers in an internship preparation course after a brief, asynchronous teaching curriculum. To disseminate our curriculum, we designed a resident-as-educator curriculum website.

Opportunities to Improve Shared Decision Making in Dialysis Decisions for Older Adults with Life-Limiting Kidney Disease: A Pilot Study.

Background: Lack of awareness about the life-limiting nature of renal failure is a significant barrier to palliative care for older adults with end-stage renal disease. Objective: To train nephrologists to use the best case/worst case (BC/WC) communication tool to improve shared decision making about dialysis initiation for older patients with limited life expectancy. Design: This is a pre-/postinterventional pilot study. Setting/Subjects: There were 16 nephrologists and 30 patients of age 70 years and older with estimated glomerular filtration rate (eGFR) <20 mL/min per 1.73 m2 in outpatient nephrology clinics, in Madison, WI. Measurements: Performance of tool elements, content of communication about dialysis, shared decision making, acceptability of the intervention, decisions to pursue dialysis, and palliative care referrals were measured. Results: Fifteen of 16 nephrologists achieved competence performing the BC/WC tool with standardized patients, executing at least 14 of 19 items. Nine nephrologists met with 30 patients who consented to audio record their clinic visit. Before training, clinic visits focused on laboratory results and preparation for dialysis. After training, nephrologists noted that declining kidney function was "bad news," presented dialysis and "no dialysis" as treatment options, and elicited patient preferences. Observer-measured shared decision-making (OPTION 5) scores improved from a median of 20/100 (interquartile range [IQR] 15-35) before training to 58/100 (IQR 55-65). Patients whose nephrologist used the BC/WC tool were less likely to make a decision to initiate dialysis and were more likely to be referred to palliative care. Conclusions: Nephrologists can learn to use the BC/WC tool with older patients to improve shared decision making about dialysis, which may increase access to palliative care.