Sustainment of an Evidence-Based, Behavioral Health Curriculum in Schools.

The development of evidence-based interventions (EBIs) for the prevention of behavioral health problems is well supported. However, limited data exist on the sustainability of EBIs once initial support has ceased. The current study assessed, at 2 years after initial start-up support: (1) What percent of schools sustained EBI implementation? (2) To what degree did sustaining schools implement the EBI with fidelity? (3) What were the primary reasons for not sustaining the EBI? (4) What theoretical and contextual factors during initial start-up support predicted sustainment of the EBI? The study used process evaluation data from the dissemination of the Botvin LifeSkills Training (LST) middle school program in 158 school districts (including 419 schools). Fifty-one percent of districts sustained the EBI and most of these sustaining districts reported following key fidelity guidelines. Primary reasons for discontinuing centered around low teacher or administrative support and turnover. Significant predictors of sustaining LST were higher ratings of LST's complexity, benefit, and compatibility by teachers; more positive perceptions of organizational support from administrators; and smaller proportions of Black students. Results show that EBI sustainment and fidelity of implementation post-initial startup support are feasible, though likely not for all schools. Findings also suggest that cultivating support for the EBI among staff during start-up support may be helpful for sustainment and that social determinants of a school have a complex relationship with EBI sustainment. Future research should explore true causes of differences due to race/ethnicity as well as COVID-19 effects.

Strategic Directions in Preventive Intervention Research to Advance Health Equity.

As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.

Beyond Systems of Oppression: The Syndemic Affecting Black Youth in the US.

Adolescence is a challenging time fraught with developmental changes that influence sociocultural identity, psychosocial and biological development. Integrating a sense of ethnic identity into one's personal identity is an important task for Black youth during this developmental stage as it impacts aspirations, ideology, and interpersonal identity. Black youth are not only navigating this critical stage but doing so while traversing issues related to a syndemic of injustice rooted in anti-Black racism that permeates the very fabric of our society. This manuscript describes the syndemic of injustice framework as it relates to the ways in which anti-Black racism contributes to experiences of structural, symbolic and interpersonal violence for Black youth and how these experiences of violent oppression ultimately influence the developmental processes involved in identity formation for Black youth. Implications for social work practice are discussed.

Superwoman, Racial Identity, and Teen Dating Violence Victimization among Young Black Women.

Young Black women consistently report the highest rates of teen dating violence (TDV) in the United States. They are also navigating a world in which they are facing historical marginalization and intersectional oppression. The Superwoman stereotypic role, in which Black women showcase strength and resist vulnerability, is often adapted in reaction to this normalized existence. Yet little research has examined how these constructs are related. In addition, research suggests that a positive racial identity may function as a psychological buffer against society's negative view of Black Americans and reduce involvement in violence. The current study examined the relationship between endorsement of a Superwoman role and TDV victimization among young Black women. A total of 481 Black women, aged 18-19, completed online survey measures assessing their racial identity beliefs, endorsement of racial stereotypes, and TDV experiences. The results of the path models showed that endorsement of a Superwoman role was associated with increased TDV victimization. Results also showed that racial centrality was inversely associated with TDV; the more the young women felt that being Black was a central part of their identity, the less they reported victimization. Findings suggest a need for attention to stereotype development and racial identity in the development of healthy romantic relationships for Black youth.

Predictors of condom use among system-involved youth: The importance of Sex Ed.

Sexual health education has been proven effective in improving adolescent sexual reproductive health outcomes. System-involved youth, including those in child welfare or juvenile justice systems, experience disproportionately poor outcomes as compared to youth in the general population, especially concerning STIs and early or unplanned pregnancies. Using logistic regression, this cross-sectional study examined the odds of condom use in a sample (n = 318; 61.3% males; 79.9% African American) of system-involved youth with multiple high-risk sexual behaviors. Specifically, it examined the impact of sexual health education, attitudes and beliefs about condoms, and the moderating effect of gender. The logistic regression models showed that youth were more likely to use a condom when exposed to comprehensive sexual health education (p < .05). Beliefs about condom effectiveness increased the odds of condom use in the second model (p < .01). Gender was not found to have a moderating effect. This study examined whether receiving comprehensive sexual health education and adolescent attitudes and beliefs towards condoms were associated with non-condom use using logistic regression in a sample of system-involved youth. Results suggest that comprehensive sexual health education could improve condom use in this vulnerable population.

Mental Health and Educational Experiences Among Black Youth: A Latent Class Analysis.

Disproportionately lower educational achievement, coupled with higher grade retention, suspensions, expulsions, and lower school bonding make educational success among Black adolescents a major public health concern. Mental health is a key developmental factor related to educational outcomes among adolescents; however, traditional models of mental health focus on absence of dysfunction as a way to conceptualize mental health. The dual-factor model of mental health incorporates indicators of both subjective wellbeing and psychopathology, supporting more recent research that both are needed to comprehensively assess mental health. This study applied the dual-factor model to measure mental health using the National Survey of American Life-Adolescent Supplement (NSAL-A), a representative cross-sectional survey. The sample included 1170 Black adolescents (52% female; mean age 15). Latent class analysis was conducted with positive indicators of subjective wellbeing (emotional, psychological, and social) as well as measures of psychopathology. Four mental health groups were identified, based on having high or low subjective wellbeing and high or low psychopathology. Accordingly, associations between mental health groups and educational outcomes were investigated. Significant associations were observed in school bonding, suspensions, and grade retention, with the positive mental health group (high subjective wellbeing, low psychopathology) experiencing more beneficial outcomes. The results support a strong association between school bonding and better mental health and have implications for a more comprehensive view of mental health in interventions targeting improved educational experiences and mental health among Black adolescents.

Intimate partner violence and pregnant and parenting adolescents in out-of-home care: reflections on a data set and implications for intervention.

AIMS AND OBJECTIVES: To present the findings from a data set reflecting intimate partner violence among adolescents who are pregnant and parenting and living in out-of-home care and to analyse these findings in order to generate potential interventions to address this significant issue. BACKGROUND: Because of their developmental stage, coupled with the stress of pregnancy and new parenthood, adolescent women who are pregnant or postpartum are often at a high risk of abuse. Violence may include physical, emotional/psychological, verbal and sexual abuse, along with birth control sabotage and pregnancy coercion. Adolescent mothers in out-of-home care such as foster care, juvenile detention facilities, kinship care or living in complex family circumstances may be at an even higher risk of intimate partner violence related to the increase in stress, conflict and tenuous situations. DESIGN: This descriptive study was designed, using baseline self-report and demographic data, to examine the relationship of pregnancy or parenting among adolescents with a fear of or reported involvement in intimate partner violence. METHODS: A total of 151 sexually active, urban, system-involved youths in out-of-home care were assessed between 2012-2015 with a survey questionnaire assessment of sexual reproductive health behaviours, areas of risk and protective factors. RESULTS: The findings indicated a significant association between ever having been pregnant and fear of intimate partner violence. CONCLUSIONS: In this population, fear of intimate partner violence was prevalent among adolescent mothers, adding to the complexity of an already difficult family situation. Due to the small sample size and the potential correlation between intimate partner violence and adolescent motherhood, future longitudinal studies with larger samples of adolescents residing in out-of-home care are needed to better understand how this relationship impacts adolescent mothers, their children and families.

Youth Violence: How Gender Matters in Aggression Among Urban Early Adolescents.

Although research suggests gender differences in both forms and functions of aggressive behavior, there has been limited research into these types among African American early adolescents. This study examined the types and patterns of aggression in girls and boys in that group. Participants were 452 predominantly African American middle school youth (50.4% girls) aged 11 to 13 ( M = 11.97) enrolled in three urban public schools. Students were invited to participate in a school-based intervention designed to prevent aggressive and deviant behaviors. Assessments occurred pre- and post-intervention. Surveys were analyzed to identify gender differences in the levels and types of aggressive behaviors, as well as differences in predictors of aggressive behaviors. Predictors were measured at baseline; aggressive behaviors at follow-up. There were significant gender differences in types of aggressive behaviors and their predictors indicating a need to develop and implement more suitable, gender-tailored prevention and treatment approaches.

Using the theory of planned behavior to predict aggression and weapons carrying in urban African American early adolescent youth.

Aggressive and weapons carrying behaviors are indicative of youth violence. The theory of planned behavior is used in the current analysis to improve our understanding of violence-related behaviors. We examine the influence of perceived behavioral control (self-control and decision making) as a part of the overall framework for understanding the risk and protective factors for aggressive behaviors and weapons carrying. As the baseline assessment of an intervention trial, survey data were collected on 452 sixth-grade students (50% girls; 96.6% African American; mean age 12.0 years) from urban middle schools. A total of 18.4% carried a weapon in the prior 12 months, with boys more likely to carry a weapon than girls (22.5% vs. 14.2%, p = .02). Of the youth, 78.4% reported aggressive behaviors with no significant differences found between girls (81.3%) and boys (75.5%). In logistic regression models, having peers who engage in problem behaviors was found to be a significant risk factor. Youth with peers who engaged in numerous problem behaviors were five times more likely to be aggressive than those who reported little or no peer problem behaviors. Teens who reported that their parents opposed aggression (odds ratio [OR] = 0.76; confidence interval [CI] = 0.66, 0.88) and who used self-control strategies (OR = 0.59; CI = 0.39, 0.87) were found to report less aggressive behaviors. For weapons carrying, being a girl (OR = 0.56; CI = 0.32, 0.97) and self-control (OR = 0.52; CI = 0.29, 0.92) were protective factors. This study demonstrated that the theory of planned behavior may provide a useful framework for the development of violence prevention programs. Practitioners should consider integrating strategies for developing healthy relationships and improving self-control.

Preventing rapid repeat pregnancy and promoting positive parenting among young mothers in foster care.

Young mothers in foster care face considerable challenges above and beyond that of their non-foster care peers. Child welfare workers have few resources to guide them in the selection of evidence-informed programs, models, and strategies that address the unique risk factors and needs of youth in foster care who are at risk for rapid repeat pregnancy and inadequate parenting practices. Workers need knowledge of the evidence about which programs are most likely to improve key health and well-being outcomes. The article assesses the evidence-based programs identified and yields a list that reflects the best evidence for efficacy and effectiveness.

Barriers and Facilitators to School-Based Parent Involvement for Parents of Urban Public Middle School Students.

Using semistructured interviews, we explored barriers and facilitators to school-based parent involvement (SBPI) in a sample of predominately African American parents (N = 44) whose children attended urban public middle schools. Barriers to SBPI (e.g., perceptions of hostile parent-teacher interactions and aggressive, disrespectful students in the school) were more commonly reported than facilitators (e.g., child invitations for involvement). Findings suggest that parents' motivations for engaging in SBPI may be undermined by a variety of barriers, resulting in low participation. Implications and tailored strategies for enhancing SBPI in this population are presented.

Engaging Urban Parents of Early Adolescents in Parenting Interventions: Home Visits vs. Group Sessions.

Interventions targeting parents of young children have shown effectiveness, but research is lacking about best practices for engaging parents of early adolescents. Low levels of enrollment and attendance in parenting interventions present major problems for researchers and clinicians. Effective and efficient ways to engage and collaborate with parents to strengthen parenting practices and to promote healthy development of early adolescents are needed. This exploratory mixed methods study examined the feasibility of three methods of engaging parents in positive parenting activities. Participants were parents of youth ages 11-13 enrolled in three urban, public middle schools in neighborhoods characterized by high rates of community violence. Families (N = 144) were randomized into one of three interventions: six home sessions, two home sessions followed by four group sessions, or six group sessions. The majority of parents were single, non-Hispanic, African American mothers. Urban parents of middle school students were more likely to participate in home visits than in group sessions; offering a combination did not increase participation in the group sessions. As only 34% of those who consented participated in the intervention, qualitative data were examined to explain the reasons for non-participation.