Sexual Health Services in Schools: A Successful Community Collaborative.

School-based health centers (SBHCs) are an essential part of a comprehensive approach to address the health needs of youth. SBHCs that provide sexual health services (SHS) show promising results in improving reproductive health outcomes among youth. Despite the positive impact SBHCs can have, few school districts have SBHCs, and even fewer provide SHS. This article describes a successful 5-year project to provide SHS through SBHCs in a large county in the southeast United States. A community collaborative, including the schools, health department, community agencies and a local university, was created to address the project goals and objectives. Various steps were taken to plan for the SBHCs, including documenting community support for SHS offered through SBHCs, identifying school sites for SBHCs, and the process for offering pregnancy, STD (sexually transmitted disease), and HIV testing, treatment, and referrals. Protocols for clinic flow, testing, staffing, training, and student recruitment were developed. The staff at the SBHCs were successful in recruiting students to attend educational sessions and to receive testing and treatment. Student feedback was overwhelmingly positive. Lessons learned about the importance of the partnership's collaboration, using recommended clinic protocol, ensuring clear communication with school staff, and employing youth friendly recruitment and clinic practices are shared.

Body Dissatisfaction and Health Risk Behaviors Among Middle School Girls.

BACKGROUND: Previous studies demonstrate a relationship between body dissatisfaction and substance use and suicidal ideation among older adolescent girls and young women while less documentation exists for early adolescence. This study explored the relationship between reported weight loss attempts and substance use history and suicidal thoughts among younger female adolescents. METHODS: Participants (n = 1656) were middle school female students who participated in the 2019 Youth Behaviors Risk Survey. Participants were coded as "Trying to lose weight" and "Not trying to lose weight." Two hierarchal multiple binary logistic regressions were conducted, 1 for each of the dependent variables: (1) substance use history and (2) suicidality. RESULTS: Fifty-seven percent of the participants were trying to lose weight, 40% reported suicidal thoughts and 45% reported substance use history. Trying to lose weight was a significant predictor for both substance use (p < .01) and suicidality (p < .001). CONCLUSIONS: Body dissatisfaction and its association with risky health behaviors highlight the need for prevention education at earlier ages while reinforcing the need for availability of school counselors.

Brief integrative multiple behavior intervention effects and mediators for adolescents.

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479 students attending two public high schools participated. Participants receiving the intervention showed a significant reduction in quantity × frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, P's = .01. No effects were found on cigarette and marijuana use, exercise and sleep. Effect sizes were small with alcohol use cessation effects reaching medium size. Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors. Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors.

Are effects from a brief multiple behavior intervention for college students sustained over time?

OBJECTIVE: This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention. METHODS: A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern US. Participants were randomized to receive either a brief intervention or usual care control, with baseline, 3-month, and 12-month data collected during fall of 2007. RESULTS: A significant omnibus MANOVA interaction effect was found for health-related quality of life, p=0.01, with univariate interaction effects showing fewer days of poor spiritual health, social health, and restricted recent activity, p's<0.05, for those receiving the brief intervention. Significant group by time interaction effects were found for driving after drinking, p=0.04, and moderate exercise, p=0.04, in favor of the brief intervention. Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life. CONCLUSION: This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up.

Depression in High School: Lesbian, Gay, and Bisexual Identity as a Moderator of Sexual Assault.

BACKGROUND: Depression continues to be a public health crisis for young adults. For high school students, past research has identified trauma as a significant predictor of depression. Congruent with the theory of cumulative stress, the present study hypothesized that the effect of sexual assault on depression would be stronger among lesbian, gay, and bisexual (LGB) students than among their straight peers. METHODS: Using the Youth Risk Behavior Survey completed by students attending Duval County Public Schools in Florida (N = 3053), this study used secondary data analysis to conduct 2 regression analyses, one for boys and one for girls. RESULTS: LGB status was associated with 3-fold increase in the odds of reporting depression for both boys and girls. History of sexual assault was associated with a significant increase in reporting depression. There was also a significant interaction effect between sexual orientation and history of sexual assault among male students only (p < .05). Contrary to the hypothesis, the effect was stronger among straight boys than among LGB boys. CONCLUSION: Minority students continue to evidence greater risks for depression. Opportunities for systemic changes to address these include training teachers, banning conversion therapy, and implementing comprehensive sex education.

Health behavior insights: the transtheoretical/stages of change model: Carlo C. DiClemente, PhD.

Showcased in this article is an interview with Carlo C. DiClemente, PhD, an internationally renowned health behavior researcher and codeveloper of the Transtheoretical or Stages of Change Model. In this verbatim interview transcript, later edited by the authors and interviewee, Dr. DiClemente, he provides practical information and frank commentary on the steps to follow and pitfalls to avoid in developing, implementing, evaluating, and disseminating efficacious programs for affecting the health and well-being of individuals and populations. A concluding section summarizes key lessons learned from the professional experiences of Dr. DiClemente and discusses implications for advancing health behavior intervention practice and research.

Efficacy of a brief image-based multiple-behavior intervention for college students.

BACKGROUND: Epidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors. PURPOSE: The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students. METHODS: A total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up. RESULTS: Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261) = 2.73, p = 0.01, marijuana-use behaviors, F(4, 278) = 3.18, p = 0.01, and health-related quality of life, F(5, 277) = 2.80, p = 0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281) = 9.49, p = 0.00, than those in the standard care control. CONCLUSIONS: A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.

Brief multiple behavior health interventions for older adolescents.

PURPOSE: This study examined whether brief intervention strategies founded on the Behavior-Image Model and addressing positive images of college and career success could be potentially efficacious in impacting multiple health habits of high-risk adolescents transitioning into adulthood. DESIGN: Participants were stratified by grade level and drug use and individually randomized to one of the three Plan for Success interventions, with baseline and 1 month postintervention data collections. SETTING: A large, relatively diverse suburban school in northeast Florida. SUBJECTS: A total of 375 11th and 12th grade students participated during the spring semester 2006. INTERVENTION: Three interventions studied included: (1) Goal Survey, (2) Goal Survey plus Contract, or (3) Goal Survey plus Consult. MEASURES: Outcome measures included multiple health risk, health promotion, and personal development behaviors, as well as image and belief measures. ANALYSIS: Repeated-measures MANOVAs and ANOVAs were used to examine intervention effects. RESULTS: MANOVAs were significant for alcohol use, F(4,328) = 6.33, p = .001; marijuana use, F(4,317) = 3.72, p = .01; exercise, F(3,299 = 4.28, p = .01; college preparation, F(2,327) = 6.26, p = .001; and career preparation, F(2,329) = 6.17, p = .001, with most behaviors improving over time, whereas group-by-time interaction effects were found for nutrition habits, F(6,652) = 2.60, p = .02; and career preparation, F(4,658) = 3.26, p = .01, favoring the consultation. CONCLUSION: Brief interventions founded on the Behavior-Image Model may have potential to improve selected health and personal development habits among older adolescents.

Brief Image-based Health Behavior Messages for Adolescents and Their Parents.

This study tested the efficacy of brief image-based print mediated parent/caregiver and adolescent messages integrating physical activity with alcohol use avoidance. A total of 684 high school students were randomly assigned to either the parent postcard or adolescent flyer arm, with baseline and four-month post-intervention data collections. A significant repeated measures interaction (group × time) was found (F(4,344)=2.48, p=.04), with univariate tests showing less alcohol use frequency and problems (p's<.05) among adolescents exposed to parent materials. Repeated measures factorial MANOVAs for group × time × prior current drug use were significant, with drug using adolescents receiving parent print messages showing less alcohol initiation and frequency, and marijuana initiation and frequency (p's<.05). Very brief print materials sent to parents/caregivers may hold some promise for influencing substance use among adolescents, particularly those already using drugs.

A brief experimental alcohol beverage-tailored program for adolescents.

OBJECTIVE: The objective of this study was to develop and test a brief, experimental alcohol preventive intervention matched to the use of specific alcohol beverages among adolescents. METHOD: A total of 232 high school students who drank within the last year participated in this study. Participants were randomly assigned to either the experimental intervention or a minimal intervention control. Four-month postintervention data are reported. RESULTS: Overall multivariate analyses of covariance (MANCOVAs) were significant (p's < .05) on risk factors (influenceability, perceived severity, perceived susceptibility and perceived peer prevalence) for three of six beverages (beer, wine and distilled spirits), with a fourth, malt liquor, approaching significance (p = .06). These tests showed intervention adolescents experiencing less risk for alcohol use than control adolescents. In addition, whereas the overall MANCOVA for malt liquor use was not significant, univariate analyses were significant for 30-day frequency (F = 5.69, 1/195 df, p = .01) and 30-day quantity of malt liquor use (F = 4.03, 1/195 df, p = .04) with intervention adolescents showing less consumption than control adolescents. A post hoc analysis examining differential intervention effects using preintervention drug use as a factor (i.e., 30-day cigarette or marijuana use) showed a significant overall factorial MANCOVA interaction (F = 6.90, 4/189 df, p = .000), with drug-using intervention adolescents consuming cigarettes and marijuana less frequently than drug-using control adolescents at postintervention. CONCLUSIONS: The findings of this study suggest the brief, beverage-tailored intervention reduced certain risk factors mediating individual alcohol beverage use and consumption of malt liquor (4 months after intervention) and may have reduced the frequency of cigarette and marijuana use among those already using drugs.

New evidence: data documenting parental support for earlier sexuality education.

BACKGROUND: Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. METHODS: As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). RESULTS: Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. CONCLUSIONS: Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education.

Sexual behaviors of middle school students: 2009 Youth Risk Behavior Survey results from 16 locations.

BACKGROUND: The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS: In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey-Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t-tests were calculated for these 5 items by gender, age, and race for each location. RESULTS: Data show that 5-20% of sixth graders and 14-42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION: Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.

Pilot of a computer-based brief multiple-health behavior intervention for college students.

OBJECTIVE: Given the documented multiple health risks college students engage in, and the dearth of effective programs addressing them, the authors developed a computer-based brief multiple-health behavior intervention. This study reports immediate outcomes and feasibility of a pilot of this program. PARTICIPANTS: Two hundred students attending a midsized university participated. METHODS: Participants were randomly assigned to the intervention or control program, both delivered via computer. Immediate feedback was collected with the computer program. RESULTS: Results indicate that the intervention had an early positive impact on alcohol and cigarette use intentions, as well as related constructs underlying the Behavior-Image Model specific to each of the 3 substances measured. Based on the implementation process, the program proved to be feasible to use and acceptable to the population. CONCLUSION: Results support the potential efficacy of the intervention to positively impact behavioral intentions and linkages between health promoting and damaging behaviors among college students.

Brief multiple behavior interventions in a college student health care clinic.

PURPOSE: This study examined the effects of brief image-based interventions, including a multiple behavior health contract, a one-on-one tailored consultation, and a combined consultation plus contract intervention, for impacting multiple health behaviors of students in a university health clinic. METHODS: A total of 155 college students attending a major southern university were recruited to participate in a study evaluating a health promotion program titled Project Fitness during the fall 2005 and spring 2006. Participants were randomly assigned to one of three treatments as they presented at the clinic: 1) a multiple behavior health contract, 2) a one-on-one tailored consultation, or 3) a combined consultation plus contract intervention. Baseline and 1-month post-intervention data were collected using computer-assisted questionnaires in a quiet office within the student health clinic. RESULTS: Omnibus repeated-measures analyses of variance were significant for drinking driving behaviors, F(2,136) = 4.43, p = .01, exercise behaviors, F(5,140) = 6.12, p = .00, nutrition habits, F(3,143) = 5.37, p = .00, sleep habits, F(2,144) = 5.03, p = .01, and health quality of life, F(5,140) = 3.09, p = .01, with improvements on each behavior across time. Analysis of group-by-time interaction effects showed an increase in the use of techniques to manage stress, F(2,144) = 5.48, p = .01, and the number of health behavior goals set in the last 30 days, F(2,143) = 5.35, p = .01, but only among adolescents receiving the consultation, or consultation plus contract. Effect sizes were consistently larger across health behaviors, and medium in size, when both consult and contract were used together. CONCLUSIONS: Brief interventions using a positive goal image of fitness, and addressing a number of health habits using a contract and consultation strategy alone, or in combination, have the potential to influence positive changes in multiple health behaviors of college students attending a university primary health care clinic.

The mediating role of adolescent self-efficacy in the relationship between parental practices and adolescent alcohol use.

This study investigated the mediating role of adolescent self-efficacy in the relationship between parental practices and adolescent alcohol use. Resistance self-efficacy was a perfect mediator in the relationship between parental monitoring and lower alcohol use. Resistance self-efficacy may determine the effect of parental monitoring on deterring alcohol use in adolescents.

Sport and physical activity participation and substance use among adolescents.

PURPOSE: To examine the association between participation in specific school-sponsored sports and out-of-school sports/physical activities and substance use. METHODS: Subjects consisted of 891 8th grade youth from three schools. Baseline data were collected using the Youth Alcohol & Drug Survey (2000) and following standardized protocols. Logistic regressions were conducted to identify associations between the independent variables of school-sponsored sports, and out-of-school sports/physical activities, and each of the four substance use dependent variables, while controlling for race. Additionally, logistic regressions were run separately for males and females to examine gender differences. RESULTS: Participation in any one of seven specific sports/physical activities was associated with increased substance use for one or both genders, whereas participation in any one of four other specific sports/physical activities was associated with decreased use for one or both genders. Those sports associated with increased use differed for males and females, as did those associated with decreased use. Females in school-sponsored dance/cheerleading/gymnastics were at decreased risk of alcohol use, whereas those in out-of-school dance/cheerleading/gymnastics, skateboarding or surfing were at increased risk for using at least one substance. Males in out-of-school swimming were at decreased risk of heavy alcohol use, whereas those in school-sponsored football, swimming, wrestling or out-of-school tennis were at increased risk for using at least one substance. CONCLUSIONS: Educators cannot assume all sports/physical activities have a positive relationship with youth substance use. School-sponsored, male-dominated sports appeared to be associated with an increased substance use risk for males, whereas out-of-school, mixed-gender sports appeared to be for females.

A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents.

The primary purpose of this study was to test the efficacy of a brief, multi-health behavior intervention integrating physical activity and alcohol use prevention messages for high school-aged adolescents. A total of 604 participants, 335 9th and 269 11th grade students from a suburban high school in northeast Florida participated in this study. A randomized control trial was conducted with participants randomly assigned within grade levels to receive either a brief consultation and prescription with a mailed reinforcing follow-up flyer (Project SPORT) or a minimal intervention control consisting of a wellness brochure provided in school and a pamphlet about teen health and fitness mailed to the home. Differences between intervention groups were evaluated with a series of MANCOVA tests. Project SPORT participants demonstrated significant positive effects at 3-months postintervention for alcohol consumption, alcohol initiation behaviors, alcohol use risk and protective factors, drug use behaviors, and exercise habits, and at 12-months for alcohol use risk and protective factors, cigarette use, and cigarette initiation (p's < 0.05). A post hoc analysis examining interactions between past 30-day use of marijuana and/or cigarettes by treatment group indicates significant positive effects for drug using adolescents who received Project SPORT on alcohol consumption, drug use behaviors, and drug use initiation at 3-months, and for drug use behaviors and exercise habits at 12-months (p's < 0.05). A brief, 12-min one-on-one consultation integrating alcohol avoidance messages within those promoting fitness and other positive health behaviors holds promise for influencing adolescent alcohol and cigarette use and other health behaviors at posttreatment and 1 year later. Long-term sustained effects for cigarette and marijuana use, and both vigorous and moderate physical activity, were found among adolescents using marijuana and/or cigarettes prior to intervention.