Short-term effects of a rights-based sexuality education curriculum for high-school students: a cluster-randomized trial.

BACKGROUND: An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. METHODS: A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. RESULTS: Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. CONCLUSIONS: Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. TRIAL REGISTRATION: ClinicalTrials.gov NCT02009046.

Commentary--Project Towards No Drug Abuse: an evidence-based drug abuse prevention program.

Project Towards No Drug Abuse (Project TND) is a research-based program that has been examined over seven group-randomized controlled trials. In all trials, an effect has been found on hard drug use. An effect has been found on alcohol use in four trials, and on cigarettes and marijuana in two trials. (Arguably, an effect is found on marijuana in three trials.) Program effects on violence-related behavior were established in earlier trials, though such effects were not assessed in later trials. Certainly, as in most scientific studies, there are limitations in the interpretation of the effects obtained, particularly regarding cigarette and marijuana use and violence-related behavior, and more empirical work is needed. For Project TND, however, numerous trial replications have been completed, and the effects within each trial could not have been obtained by chance alone more than 10 % of the time (two-tailed). These results suggest that Project TND is indeed evidence-based. To be evidence-based means that evidence has accumulated to suggest that the program is likely to work, at least under conditions that are comparable to those in which it has been tested.

Addressing core challenges for the next generation of type 2 translation research and systems: the translation science to population impact (TSci Impact) framework.

Evidence-based preventive interventions developed over the past two decades represent great potential for enhancing public health and well-being. Research confirming the limited extent to which these interventions have been broadly and effectively implemented, however, indicates much progress is needed to achieve population-level impact. In part, progress requires Type 2 translation research that investigates the complex processes and systems through which evidence-based interventions are adopted, implemented, and sustained on a large scale, with a strong orientation toward devising empirically-driven strategies for increasing their population impact. In this article, we address two core challenges to the advancement of T2 translation research: (1) building infrastructure and capacity to support systems-oriented scaling up of evidence-based interventions, with well-integrated practice-oriented T2 research, and (2) developing an agenda and improving research methods for advancing T2 translation science. We also summarize a heuristic "Translation Science to Population Impact (TSci Impact) Framework." It articulates key considerations in addressing the core challenges, with three components that represent: (1) four phases of translation functions to be investigated (pre-adoption, adoption, implementation, and sustainability); (2) the multiple contexts in which translation occurs, ranging from community to national levels; and (3) necessary practice and research infrastructure supports. Discussion of the framework addresses the critical roles of practitioner-scientist partnerships and networks, governmental agencies and policies at all levels, plus financing partnerships and structures, all required for both infrastructure development and advances in the science. The article concludes with two sets of recommended action steps that could provide impetus for advancing the next generation of T2 translation science and, in turn, potentially enhance the health and well-being of subsequent generations of youth and families.

One-year follow-up evaluation of the Project Towards No Drug Abuse (TND) dissemination trial.

OBJECTIVE: The aims of this trial, conducted 2004-2008, were to examine (1) the effectiveness of Project Towards No Drug Abuse (TND) at the one-year follow-up when implemented on a large scale; and (2) the relative effectiveness of two training approaches for program implementers. METHOD: A total of 65 high schools from 14 school districts across the United States were randomized to one of three conditions: regular workshop training, comprehensive implementation support, or standard care control. Physical education and health teachers delivered the program to students (n=2538). Program effectiveness was assessed with dichotomous measures of 30-day substance use at baseline and one-year follow-up. RESULTS: When the program conditions were considered in aggregate and compared to controls, the program showed a marginally significant effect in lowering marijuana use from baseline to the one-year follow-up. Significant program effects on hard drug use were achieved for baseline non-users only. There were no differences in the effects of the two program conditions. CONCLUSION: Positive outcomes may be achieved by trained teachers when they implement Project TND in real-world high school environments; however, program effects are likely to be weaker than those achieved in efficacy trials. Training workshops may be adequate to build capacity for successful program implementation.

The influence of school-based natural mentoring relationships on school attachment and subsequent adolescent risk behaviors.

A relatively new area of research suggests that naturally occurring mentoring relationships may influence the development of adolescents by protecting against risk behaviors. Few studies have explored how these relationships function to reduce risk behavior among youth, especially in the school context. Based on previous research and theory, we proposed and tested a mediation model, which hypothesized that school attachment mediated the longitudinal association between school-based natural mentoring relationships and risk behaviors, including eight indicators of substance use and violence. Students (N = 3320) from 65 high schools across eight states completed a self-report questionnaire at baseline and 1-year follow-up. The sample was comprised of youth with an average age of 14.8 years and an almost equal percentage of females (53%) and males from various ethnic backgrounds. Tests for mediation were conducted in Mplus using path analysis with full information maximum likelihood procedures and models adjusted for demographic covariates and baseline level of the dependent variable. Results suggested that natural mentoring relationships had a protective indirect influence on all eight risk behaviors through its positive association on the school attachment mediator. Implications are discussed for strengthening the association between school-based natural mentoring and school attachment to prevent risk behaviors among youth.

Forbidden fruit and the prediction of cigarette smoking.

The concept of "forbidden fruit" has been popularly associated with adolescent cigarette smoking in the US. However, only a few empirical studies have been conducted to investigate how this construct operates among adolescents. We examined the concurrent and prospective relationships between two related concepts of forbidden fruit and adolescent cigarette smoking behavior and intention. We found some support for forbidden fruit attitudes as concurrent and longitudinal predictors of smoking and intention to smoke. Implications of these findings are discussed.

Impact of hurricane Rita on adolescent substance use.

Little systematic research attention has been devoted to the impact of natural disasters on adolescent substance use. The present study examined relationships among exposure to Hurricane Rita, post-traumatic stress (PTS) symptoms, and changes in adolescent substance use from 13 months pre-disaster to seven and 19 months post-disaster. Subjects were 280 high school students in southwestern Louisiana who participated in a drug abuse prevention intervention trial prior to the hurricane. Two-thirds of participants were female and 68% were white. Students completed surveys at baseline (13 months pre-hurricane) and two follow-ups (seven and 19 months post-hurricane). Results indicated a positive bivariate relationship between PTS symptoms, assessed at 7 months post-hurricane, and increases in alcohol (p < .05) and marijuana use (p < .10) from baseline to the 7 months post-hurricane follow-up. When these associations were examined collectively with other hurricane-related predictors in multivariate regression models, PTS symptoms did not predict increases in substance use. However, objective exposure to the hurricane predicted increases in marijuana use, and post-hurricane negative life events predicted increases in all three types of substance use (ps < .10). These findings suggest that increased substance use may be one of the behaviors that adolescents exhibit in reaction to exposure to hurricanes.

Effectiveness Evaluation of It's Your Game: Keep It Real, a Middle School HIV/Sexually Transmitted Infection/Pregnancy Prevention Program.

PURPOSE: This study assessed the effectiveness of the HIV/sexually transmitted infection/pregnancy prevention program, It's Your Game: Keep It Real (IYG). METHODS: IYG was implemented by classroom teachers in 24 urban middle schools from 2012 to 2015. Using a quasi-experimental design, each year we surveyed ninth-grade students in 10 high schools that were selected based on feeder patterns from project middle schools. We compared two groups of students (n = 4,562): (1) students whose middle school grade cohorts did not receive IYG ("No-IYG"), and (2) students whose middle school grade cohorts received IYG ("IYG"). Multilevel analyses examined differences between the two groups in the initiation of any type of sexual activity (oral, vaginal, or anal sex), presexual behaviors, and psychosocial mediators. RESULTS: Students in the IYG group were less likely to report initiation of sexual activity by ninth grade compared to students in the No-IYG group (odds ratio .77; 95% confidence interval .66-.90). The IYG group was significantly less likely to have engaged in presexual behaviors, including having been on a date, had a boyfriend/girlfriend, and touched or been touched on private body parts. The IYG group had better outcomes on 11 of 19 psychosocial variables, including knowledge; beliefs about abstinence, sex, friends' beliefs, norms, and behaviors; reasons for not having sex; personal limits; exposure to risky situations; self-efficacy; and quality of dating relationships. CONCLUSIONS: The results suggest that IYG, when implemented on a large scale by trained classroom teachers in urban public schools, had positive impacts on students' behaviors, beliefs, and knowledge.

Random drug testing in US public school districts.

We estimated the proportion of the nation's public school districts that have high school grades in which random drug testing is conducted. We collected data in spring 2005 from 1343 drug prevention coordinators in a nationally representative sample of school districts with schools that have high school grades; of these districts, 14% conducted random drug testing. Almost all districts randomly tested athletes, and 65% randomly tested other students engaged in extracurricular activities; 28% randomly tested all students, exceeding the current sanction of the US Supreme Court.

Negative Substance Use Consequences Associated With Noncondom Use Among Male, but Not Female, Alternative High School Students.

BACKGROUND: Alternative (or continuation) high schools are institutions designed for students at risk for not graduating due to behavioral, educational, or medical problems. The present study explored the relationship between negative substance use consequences (eg, having trouble at school or work) and noncondom use in this at-risk population and whether these associations varied by sex. METHODS: Participants (N = 1101; 62.9% Hispanic; Mage = 16.85) were sampled from 24 alternative high schools in California, and data were analyzed using cross-sectional multivariate logistic regression models. RESULTS: We observed a relationship between the number of negative substance use consequences and probability of noncondom use at the last sexual encounter for boys (p < .001) but not girls (p > .05). There were significant associations between specific social consequences (missing school/work) and dependence symptoms (selling personal items to get alcohol or drugs) with noncondom use for boys only. There was a similar association between substance use frequency and noncondom use for boys. CONCLUSIONS: These findings suggest that substance use consequences may be a useful and advantageous indicator of risky sexual behaviors such as noncondom use for boys, but not girls, in alternative high school settings. Future research and intervention programming recommendations are discussed.

Type II translation: transporting prevention interventions from research to real-world settings.

This article summarizes research on Type II translation of prevention interventions aimed at enhancing the adoption of effective programs and practices in communities. The primary goal of Type II translation is to institutionalize evidence-based programs, products, and services. First, the authors describe theoretical frameworks that are useful to guide Type II translation research. Second, research on prevention program implementation, including fidelity of implementation and factors that are associated with successful program implementation, is summarized. The authors describe interventions designed to enhance the dissemination of preventive interventions in community and public health settings. Third, they describe strategies used by prevention program developers who have taken programs to scale. Fourth, they present a case example of Project Towards No Drug Abuse (TND), an empirically validated high school-based substance abuse prevention program. They describe ongoing research on the dissemination of Project TND. Finally, they provide suggestions for future Type II translation research.

Translation in the health professions: converting science into action.

The systematic translation of evidence-based research findings, tools, and information into practice is critical to improving the quality of our nation's health. However, despite several decades of advances in developing medical knowledge based on high-quality empirical evidence, widespread implementation of these findings into practice in diverse applied settings has not been achieved. This article reviews definitions and conceptual models that describe the translation of research from basic discovery to real-world applications, summarizes the various issues involved in the process of translation, discusses multiple barriers, and provides recommendations to surmount these hurdles. Areas of further research in this arena are suggested. Finally, the article concludes that translational research is an important area to continue to pursue requiring long-term collaborative commitment among researchers and practitioners.

Predisposing, enabling and need-for-care predictors of adolescents' intention to use sexual health services.

BACKGROUND: The study aimed to understand the influence of predisposing, enabling and need-for-care factors on adolescents' intention to use sexual health services, using Andersen's Behavioural Model of Health Service Utilisation to organise and test these factors. METHODS: A sample of predominantly Hispanic teens (n=600) in Los Angeles, California completed a self-report survey about their sexual health knowledge, beliefs, intentions, and behaviours. Hierarchical regression modelling was used to examine the incremental influences on adolescents' intention to use sexual health services of: 1) predisposing sociodemographic factors; 2) predisposing knowledge and beliefs about sexual health; 3) enabling factors regarding perceived access to sexual health services; and 4) a need-for-care factor (sexual experience). RESULTS: Adolescents reported high intentions to use sexual health services (3.25 on a 4-point scale), yet only 42% reported knowing where to access services. Sexual health knowledge and beliefs significantly predicted adolescents' intention to use services beyond the effect of sociodemographics (P<0.001). Enabling factors indicating awareness of and importance attributed to accessibility significantly predicted intention to use services incremental to predisposing factors (P<0.001). However, need for care - that is, sexual experience - was not statistically associated with intention to use services (P=0.402). CONCLUSIONS: Sexual health interventions are needed to provide sexual health information, promote positive beliefs about health care, and ensure adolescents' awareness of and access to sexual health services.

Stressful Life Events and Predictors of Post-traumatic Growth among High-Risk Early Emerging Adults.

Stressful life events (SLEs) may elicit positive psychosocial change among youth, referred to as Post-traumatic Growth (PTG). We assessed types of SLEs experienced, degree to which participants reported PTG, and variables predicting PTG across 24 months among a sample of high risk, ethnically diverse early emerging adults. Participants were recruited from alternative high schools (n = 564; mean age=16.8; 65% Hispanic). Multi-level regression models were constructed to examine the impact of environmental (SLE quantity, severity) and personal factors (hedonic ability, perceived stress, developmental stage, future time orientation) on a composite score of PTG. The majority of participants reported positive changes resulted from their most life-altering SLE of the past two years. Predictors of PTG included fewer SLEs, less general stress, having a future time perspective, and greater identification with the developmental stage of Emerging Adulthood. Findings suggest intervention targets to foster positive adaptation among early emerging adults who experience frequent SLEs.

Prevalence and co-occurrence of addictive behaviors among former alternative high school youth: A longitudinal follow-up study.

BACKGROUND AND AIMS: Recent work has studied addictions using a matrix measure, which taps multiple addictions through single responses for each type. This is the first longitudinal study using a matrix measure. METHODS: We investigated the use of this approach among former alternative high school youth (average age = 19.8 years at baseline; longitudinal n = 538) at risk for addictions. Lifetime and last 30-day prevalence of one or more of 11 addictions reviewed in other work was the primary focus (i.e., cigarettes, alcohol, hard drugs, shopping, gambling, Internet, love, sex, eating, work, and exercise). These were examined at two time-points one year apart. Latent class and latent transition analyses (LCA and LTA) were conducted in Mplus. RESULTS: Prevalence rates were stable across the two time-points. As in the cross-sectional baseline analysis, the 2-class model (addiction class, non-addiction class) fit the data better at follow-up than models with more classes. Item-response or conditional probabilities for each addiction type did not differ between time-points. As a result, the LTA model utilized constrained the conditional probabilities to be equal across the two time-points. In the addiction class, larger conditional probabilities (i.e., 0.40-0.49) were found for love, sex, exercise, and work addictions; medium conditional probabilities (i.e., 0.17-0.27) were found for cigarette, alcohol, other drugs, eating, Internet and shopping addiction; and a small conditional probability (0.06) was found for gambling. DISCUSSION AND CONCLUSIONS: Persons in an addiction class tend to remain in this addiction class over a one-year period.

A Rights-Based Sexuality Education Curriculum for Adolescents: 1-Year Outcomes From a Cluster-Randomized Trial.

PURPOSE: The purpose of this study was to evaluate the impact of a rights-based sexuality education curriculum on adolescents' sexual health behaviors and psychosocial outcomes 1 year after participation. METHODS: Within 10 urban high schools, ninth-grade classrooms were randomized to receive a rights-based curriculum or a basic sex education (control) curriculum. The intervention was delivered across two school years (2011-2012, 2012-2013). Surveys were completed by 1,447 students at pretest and 1-year follow-up. Multilevel analyses examined curriculum effects on behavioral and psychosocial outcomes, including four primary outcomes: pregnancy risk, sexually transmitted infection risk, multiple sexual partners, and use of sexual health services. RESULTS: Students receiving the rights-based curriculum had higher scores than control curriculum students on six of nine psychosocial outcomes, including sexual health knowledge, attitudes about relationship rights, partner communication, protection self-efficacy, access to health information, and awareness of sexual health services. These students also were more likely to report use of sexual health services (odds ratio, 1.37; 95% confidence interval, 1.05-1.78) and more likely to be carrying a condom (odds ratio, 1.97; 95% confidence interval, 1.39-2.80) relative to those receiving the control curriculum. No effects were found for other sexual health behaviors, possibly because of low prevalence of sexual activity in the sample. CONCLUSIONS: The curriculum had significant, positive effects on psychosocial and some behavioral outcomes 1 year later, but it might not be sufficient to change future sexual behaviors among younger adolescents, most of whom are not yet sexually active. Booster education sessions might be required throughout adolescence as youth initiate sexual relationships.

Coping mediates the effects of depressive symptoms on sleep problems.

OBJECTIVES: To explore the relationships of perceived stress and depressive symptoms to sleep problems, testing for mediation by adaptive and maladaptive coping strategies. METHODS: Alternative high school students (N = 1676) completed self-report surveys. Cross-sectional data were analyzed via Preacher and Hayes' procedures for multiple mediation. RESULTS: The positive relationship between depressive symptoms and sleep problems was mediated partially by anger coping (positively related to sleep problems). The positive relationship between perceived stress and sleep problems was not mediated by coping strategies. CONCLUSIONS: Findings provide information on psychological factors that may lead to poor sleep outcomes, and are useful for developing health promotion interventions to impact lifelong health behaviors.

Post-traumatic growth, stressful life events, and relationships with substance use behaviors among alternative high school students: a prospective study.

A highly stressful life event (SLE) can elicit positive psychosocial growth, referred to as post-traumatic growth (PTG) among youth. We examined PTG and the number of SLEs for their influence on substance use behaviours among a sample of older, diverse alternative high school students participating in a drug prevention programme (n=564; mean age=16.8; 49% female; 65% Hispanic). Surveys assessed PTG, SLEs and substance use behaviours at the two-year follow-up. Multilevel regression models were run to examine the effect of PTG and the number of SLEs on frequency of substance use at the two-year follow-up, controlling for baseline substance use, sociodemographic variables, peer substance use, attrition propensity and treatment group. Greater PTG scores were associated with lower frequencies of alcohol use, getting drunk on alcohol, binge drinking, marijuana use and less substance abuse at the two-year follow-up, but not associated with cigarette or hard drug use. Also, PTG did not moderate the relationship between cumulative number of SLEs and substance use behaviours, rather PTG appears to be protective against negative effects of a single, life-altering SLE. Fostering PTG from a particularly poignant SLE may be useful for prevention programmes targeting alcohol, marijuana and substance abuse behaviours among high-risk youth.

Youths' exposure to environmental tobacco smoke (ETS): associations with health beliefs and social pressure.

Youths' exposure to environmental tobacco smoke (ETS) is a significant public health problem in the United States. This study examined the associations between health beliefs, social pressure, and exposure to ETS among high school youth. Data were collected in 65 schools in 18 California counties during the 1996-1997 school year as part of the Independent Evaluation of the California Tobacco Control, Prevention, and Education Program. The total sample (N = 6902) represents 10th grade California youth attending public schools. The multiple group analysis approach of structural equation modeling (SEM) was employed to test the associations of five constructs of the health belief model (HBM) and one construct of perceived social pressure with ETS exposure among nonsmokers and smokers. Results demonstrated that high perceived susceptibility to disease was significantly associated with lower levels of ETS exposure for both nonsmokers (beta = -0.11, P < .01) and smokers (beta = -0.20, P < .01). High social pressure to smoke was significantly associated with higher exposure to ETS for both nonsmokers (beta = 0.30, P < .01) and smokers (beta = 0.41, P < .01). Perceived barriers predicted lower exposure to ETS for nonsmokers (beta = -0.09, P < .01) but higher exposure for smokers (beta = 0.11, P < .01). Cues to action and self-efficacy were not significantly associated with ETS exposure among nonsmokers or smokers. These findings underscore the need to increase the awareness of harms associated with second hand smoke and alter social pressure, to minimize exposure to ETS.

Prevalence and co-occurrence of addictive behaviors among former alternative high school youth.

BACKGROUND AND AIMS: Recent work has studied multiple addictions using a matrix measure, which taps multiple addictions through single responses for each type. METHODS: The present study investigated use of a matrix measure approach among former alternative high school youth (average age = 19.8 years) at risk for addictions. Lifetime and last 30-day prevalence of one or more of 11 addictions reviewed in other work (Sussman, Lisha & Griffiths, 2011) was the primary focus (i.e., cigarettes, alcohol, other/hard drugs, eating, gambling, Internet, shopping, love, sex, exercise, and work). Also, the co-occurrence of two or more of these 11 addictive behaviors was investigated. Finally, the latent class structure of these addictions, and their associations with other measures, was examined. RESULTS: We found that ever and last 30-day prevalence of one or more of these addictions was 79.2% and 61.5%, respectively. Ever and last 30-day co-occurrence of two or more of these addictions was 61.5% and 37.7%, respectively. Latent Class Analysis suggested two groups: a generally Non-addicted Group (67.2% of the sample) and a "Work Hard, Play Hard"-addicted Group that was particularly invested in addiction to love, sex, exercise, the Internet, and work. Supplementary analyses suggested that the single-response type self-reports may be measuring the addictions they intend to measure. DISCUSSION AND CONCLUSIONS: We suggest implications of these results for future studies and the development of prevention and treatment programs, though much more validation research is needed on the use of this type of measure.