Testing the Impact of the Whole-Day Good Behavior Game on Aggressive Behavior: Results of a Classroom-Based Randomized Effectiveness Trial.

Three generations of developmental epidemiologically based randomized field trials of the Good Behavior Game (GBG) have been delivered to Baltimore elementary schools. With the collaboration of family and community partners, all three trials were directed at decreasing proximal targets of aggressive behavior and improving learning in first-grade classrooms with distal mental health and substance abuse outcomes. GBG is a group-contingent classroom behavior management strategy that promotes classmate/peer concern for each child's positive behavior by rewarding teams with below-criterion levels of aggressive, disruptive behavior. GBG targets early risk factors for the above distal outcomes: aggressive, disruptive behavior, family/school relationships, and school failure. Here, we report on the third-generation randomized prevention trial of the GBG (whole-day first grade program (WD)), including 12 elementary schools. WD enhanced the standard curriculum in the areas of classroom behavior management; academic instruction, particularly reading; and family-classroom partnerships. Using a within-school classroom randomized trial design, we: 1) evaluate the effectiveness of the WD program by sex and cohort and 2) measure variation in WD impact by the quality of teachers' behavior management practices. Data from 961 first graders were used in general growth mixture modeling that accounts for classroom randomization to identify distinct developmental trajectories of aggressive, disruptive behavior and GBG impact on these trajectories. In the chronic high aggression trajectory of males, ratings of aggression after WD implementation and to the end of third grade were significantly lower in the WD condition than in controls in classrooms with a higher WD dosage (Cohort 2) and especially in classrooms with higher quality of WD implementation. For females, we found a modest but significant benefit of GBG in the low trajectory class when cohorts were combined. Regarding policy implications, embedding GBG into the curricula in teacher's colleges could better support student learning and behavior. Clinical Trials Registration number: NCT00257088.

Groups of Sexual Violence Perpetration in a National Sample of Youth 13-25 Years of Age.

Little is known about how specific forms of sexual violence (SV) perpetration group together and how youth transition between these groups over time. Between 2011 and 2016, four waves of data were collected online nationally from 1129 13-25-year-olds. Six forms of SV perpetration were assessed: sexual harassment, online sexual harassment, sexual assault, coercive sex, attempted rape, and rape. We used latent class analysis to examine how different types of SV perpetration behaviors clustered together in each of the four waves. Latent transition analysis was used to examine stability and instability in group membership between the first and fourth waves assessed. Three groups were identified in each of the four waves of data collection: (1) a "non-perpetrators" group, ranging from 69 to 81% (n: 775-912) across waves, (2) a "sexual harassment" group, ranging from 17 to 29% (n: 191-327), and (3) a "multiple perpetration" group that engaged in all types of SV perpetration, ranging from 1 to 3% (n: 12-28). Most youth persisted in their behavior over time, which was true for each of the three groups (ranging between 60 and 72%). Desistence was less common, ranging from 35% of those who transitioned from sexual harassment to non-perpetration to 20% for those who transitioned from multiple perpetration to sexual harassment, and from multiple perpetration to non-perpetration. Escalation was least common, ranging from 2% who transitioned from non-perpetration to multiple perpetration to 26% who transitioned from non-perpetration to sexual harassment. Youth who perpetrate SV are heterogeneous; SV perpetration is not persistent for all youth.

Introduction to the Special Issue on "Promoting a Culture of Prevention: an International Perspective".

The primary goal of this special issue is to showcase novel, theory-driven, creative, and rigorous contributions to our understanding of the existence and development of a culture of prevention and readiness to prevent. The term "culture of prevention" is neither a set of practical guidelines nor a leading theory. Instead, it is a multidimensional term representing the general orientation and readiness of a group of people (be it a family, community, school, organization, nation, etc.) to deal with problems using a preventive, rather than a reactive, approach. The COVID-19 pandemic creates an opportunity for taking stock of the worldwide progress in creating a "culture of prevention." This special issue aims to stimulate this discourse by presenting six studies and three commentaries from international scholars focused on themes and approaches for creating a culture of prevention.

Can Machine Learning Improve Screening for Targeted Delinquency Prevention Programs?

The cost-effectiveness of targeted delinquency prevention programs for children depends on the accuracy of the screening process. Screening accuracy is often poor, resulting in wasted resources and missed opportunities to avert negative outcomes. This study examined whether screening approaches based on logistic regression or machine learning algorithms could improve accuracy relative to traditional sum-score approaches when identifying boys in the 5th grade (N = 1012) who would be repeatedly arrested for violent and serious crimes from ages 13 to 30. Screening algorithms were developed that incorporated facets of teacher-reported externalizing problems and other known risk factors (e.g., peer rejection). The predictive performance of these algorithms was evaluated and compared in holdout (i.e., test) data using the area under the receiver operating curve (AUROC) and Brier score. Both the logistic and machine learning methods yielded AUROC superior to traditional sum-score screening approaches when a broad set of risk factors for future delinquency was considered. However, this improvement was modest and was not present when using item-level information from a composite scale assessing externalizing problems. Contrary to expectations, machine learning algorithms performed no better than simple logistic models. There was a large apparent advantage of machine learning that disappeared after appropriate cross-validation, underscoring the importance of careful evaluation of these methods. Results suggest that screening using logistic regression could improve the cost-effectiveness of targeted delinquency prevention programs in some cases, but screening using machine learning would confer no marginal benefit under currently realistic conditions.

Maternal Alcohol Consumption During the Perinatal and Early Parenting Period: A Longitudinal Analysis.

OBJECTIVES: Despite potential health risks for women and children, one in five women report alcohol use during pregnancy and a significant proportion of those who quit during pregnancy return to drinking post-delivery. This study seeks to understand the longitudinal patterns of alcohol consumption before, during pregnancy and post-delivery, and the role of maternal characteristics for purposes of informing prevention design. METHODS: General growth mixture models were used to describe the average developmental patterns of maternal weekly drinking quantity at six time points, from preconception through child entering kindergarten, as well as heterogeneity in these patterns among 9100 mothers from the Early Childhood Longitudinal Study representing the 2001 US national birth cohort. RESULTS: Four distinct classes of mothers were defined by their longitudinal alcohol consumption patterns: Low Probability Drinkers (50.3 %), Escalating Risk Drinkers (12.0 %), Escalating Low Risk Drinkers (27.4 %), and Early Parenting Quitters (10.2 %). Heterogeneous covariate associations were observed. For example, mothers who gave birth after age 36 were twice as likely to be Escalating Risk Drinkers and Escalating Low Risk Drinkers (vs Low Probability Drinkers), but not more likely to be Early Parenting Quitters, when compared to mothers who gave birth between the ages of 26 and 35. CONCLUSIONS FOR PRACTICE: There is significant heterogeneity in maternal longitudinal alcohol use patterns during the perinatal period. Baseline maternal characteristics and behavior associated with these heterogeneous patterns provide valuable tools to identify potential risky drinkers during this critical time period and may be synthesized to tailor pre- and postnatal clinical counseling protocols.

Longitudinal Assessment Design and Statistical Power for Detecting an Intervention Impact.

In evaluating randomized control trials (RCTs), statistical power analyses are necessary to choose a sample size which strikes the balance between an insufficient and an excessive design, with the latter leading to misspent resources. With the growing popularity of using longitudinal data to evaluate RCTs, statistical power calculations have become more complex. Specifically, with repeated measures, the number and frequency of measurements per person additionally influence statistical power by determining the precision with which intra-individual change can be measured as well as the reliability with which inter-individual differences in change can be assessed. The application of growth mixture models has shown that the impact of universal interventions is often concentrated among a small group of individuals at the highest level of risk. General sample size calculations were consequently not sufficient to determine whether statistical power is adequate to detect the desired effect. Currently, little guidance exists to recommend a sufficient assessment design to evaluating intervention impact. To this end, Monte Carlo simulations are conducted to assess the statistical power and precision when manipulating study duration and assessment frequency. Estimates were extracted from a published evaluation of the proximal of the Good Behavior Game (GBG) on the developmental course of aggressive behavior. Results indicated that the number of time points and the frequency of assessments influence statistical power and precision. Recommendations for the assessment design of longitudinal studies are discussed.

Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States.

PURPOSE: This study examined profiles of adverse childhood experiences (ACEs) and mental and substance use disorders (MSUDs), and associations between distinct profiles of ACEs and MSUDs. METHODS: Participants were adults (N = 34, 652) involved in the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analysis was used to examine both profiles of ten ACEs and ten past year MSUDs. Dual latent class analysis regression was used to examine associations between profiles of ACEs and MSUDs. Given gender differences in ACEs and MSUDs, analyses were conducted separately for females and males. RESULTS: Four profiles of ACEs and three profiles of MSUDs were selected for both genders. The four profiles of ACEs were characterized by the following probabilities: high multiple ACEs, high parental substance abuse, high childhood physical abuse, and low ACEs. The three profiles of MSUDs were characterized by the following probabilities: high multiple MSUDs for females and low MSUDs except alcohol use disorders for males, moderate-to-high major depressive episode, and low MSUDs. When compared to the low ACEs and MSUDs profiles, members in the higher ACEs profiles had 3.71-89.75 times greater odds of also being members in the higher MSUDs profiles. However, more than one-third of members in the high multiple ACEs profiles were also in the low MSUDs profiles. CONCLUSIONS: Study findings suggest four profiles of the ACEs widely studied as part of the Adverse Childhood Experiences study and risk and resilience for recent MSUDs among men and women nationally affected by ACEs.

Maternal patterns of postpartum alcohol consumption by age: a longitudinal analysis of adult urban mothers.

The purpose of this study is to investigate a) longitudinal patterns of maternal postpartum alcohol use as well as its variation by maternal age at child birth and b) within maternal age groups, the association between other maternal characteristics and alcohol use patterns for the purposes of informed prevention design. Study sample consists of 3397 mothers from the Fragile Families and Child Wellbeing Study representing medium and large US urban areas. Maternal drinking and binge drinking were measured at child age 1, 3, and 5 years. We conducted separate longitudinal latent class analysis within each of the three pre-determined maternal age groups (ages 20-25, n = 1717; ages 26-35, n = 1367; ages 36+, n = 313). Results revealed different class structures for maternal age groups. While two classes (NB [non-binge]-drinkers and LL [low-level]-drinkers) were identified for mothers in each age group, a third class (binge drinkers) was separately distinguished for the two older age groups. Whereas binge drinking rates appear to remain stable over the 5 years postdelivery for mothers who gave birth in their early twenties, mothers ages 26 and older increasingly engaged in binge drinking over time, surpassing the binge drinking behavior of younger mothers. Depression significantly increases the odds of being a NB-drinker for the 20-25 age group and that of being a binge drinker for the 36+ age group, whereas smoking during pregnancy is associated with subsequent binge drinking only for mothers ages 20-25. Findings highlight the importance of distinguishing risk factors by maternal age groups for drinking while parenting a young child, to inform the design of intervention strategies tailored to mothers of particular ages.

Mental disorders associated with subpopulations of women affected by violence and abuse.

Violence against women is a major public health problem associated with mental disorders. Few studies have examined the heterogeneity of interpersonal violence and abuse (IVA) among women and associated mental health problems. Latent class analysis was used to identify subpopulations of women with similar lifetime histories of IVA victimization and to examine 10 associated past-year mental disorders. Participants were 19,816 adult women who participated in Wave 2 of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC). The 3-class model was best supported by the data. Class 1 (6.7%) had a high probability of witnessing domestic violence as a child. Class 2 (21.8%) had a low probability of all events except lifetime sexual assault. Class 3 (71.5%) had a low probability for all events. Mental disorders were more common among members of Classes 1 and 2 than Class 3. For example, members in Class 1 were approximately 8 and 9 times more likely than members in Class 3 to have had posttraumatic stress disorder or a drug use disorder, respectively, during the past year. Of the 10 mental disorders, 5 were more common among members of Class 1 than of Class 2. Findings suggest the mental health consequences of IVA among women are extensive and interventions should be tailored for distinct subpopulations affected by IVA.

Youth aggressive/disruptive behavior trajectories and subsequent gambling among urban male youth.

This study examines the association between aggressive/disruptive behavior development in two distinct developmental periods-childhood (i.e., Grades 1-3) and early adolescence (i.e., Grades 6-10)-and subsequent gambling behavior in late adolescence up to age 20. The sample consists of 310 urban males of predominately minority and low socioeconomic status followed from first grade to late adolescence. Separate general growth mixture models were estimated to explore the heterogeneity in aggressive/disruptive behavior development in the aforementioned two periods. Three distinct behavior trajectories were identified for each period: a chronic high, a moderate increasing, and a low increasing class for childhood, and a chronic high, a moderate increasing, followed by decreasing and a low stable class for early adolescence. There was no association between childhood behavior trajectories and gambling involvement. Males with a moderate behavior trajectory in adolescence where two times more likely to gamble compared to those in the low stable class (OR = 1.89, 95% CI = 1.11, 3.24). Those with chronic high trajectories during either childhood or early adolescence (OR = 2.60, 95% CI = 1.06, 6.38; OR = 3.19, 95% CI = 1.18, 8.64, respectively) were more likely to be at-risk/problem gamblers than those in the low class. Aggressive/disruptive behavior development in childhood and early adolescence is associated with gambling and gambling problems in late adolescence among urban male youth. Preventing childhood and youth aggressive/disruptive behavior may be effective to prevent youth problem gambling.

The evaluation of two first-grade preventive interventions on childhood aggression and adolescent marijuana use: a latent transition longitudinal mixture model.

Aggressive, disruptive behavior during early childhood has been linked to a number of later negative outcomes, one of them being adolescent marijuana use. This study evaluates the impact of two first-grade universal interventions (classroom-centered and family-school partnership) on the development of aggression in early childhood (grades 1-3) and marijuana use in adolescence (grades 8-12) via a latent transition longitudinal mixture model. For males, despite the significant proximal impact of the classroom-centered intervention on trajectory class membership of early childhood aggression, as well as the significant association between aggression trajectory class membership and marijuana use longitudinal latent class membership, the predicted probabilities of being in the high frequency marijuana use class did not differ significantly by intervention status, though in the expected direction. Associations for females are limited to the proximal impact of the classroom-centered intervention on trajectory class membership of aggression. This study extends the prior work of Petras et al. (Prev Sci 12:300-313, 2011) by considering that aggressive, disruptive behavior during early childhood is linked not only to adolescent aggressive, disruptive behavior (i.e., homotypic continuity) but also to adolescent marijuana use (i.e., heterotypic continuity) and by considering that an early intervention may influence later non-targeted behaviors through these heterotypic developmental pathways. Implications for developmental theories and substance abuse prevention are discussed.

The use of multiple versus single assessment time points to improve screening accuracy in identifying children at risk for later serious antisocial behavior.

Guided by Kraemer et al.'s (Psychological Methods, 3:257-271, 1999) framework for measuring the potency of risk factors, we sought to improve on the classification accuracy reported in Petras et al. (Journal of the American Academy of Child and Adolescent Psychiatry 43:88-96, 2004a) and Petras et al. (Journal of the American Academy of Child and Adolescent Psychiatry 44:790-797, 2005) by using multiple as opposed to single point in time assessments of early aggressive and disruptive behavior in the classification of youth who would likely benefit from targeted preventive interventions. Different from Petras et al. (2004a, 2005), the outcome used in this study included serious antisocial behavior in young adulthood as well as in adolescence. Among males, the use of multiple time points did not yield greater classification accuracy than the highest single time points, that is, third and fifth grades. For females, although fifth grade represented the best single time point in terms of classification accuracy, no significant association was found between earlier time points and the later outcome, rendering a test of the multiple time points hypothesis moot. The findings presented in this study have strong implications for the design of targeted intervention for violence prevention, indicating that the screening quality based on aggression ratings during the elementary years is rather modest, particularly for females.

The developmental impact of two first grade preventive interventions on aggressive/disruptive behavior in childhood and adolescence: an application of latent transition growth mixture modeling.

We examine the impact of two universal preventive interventions in first grade on the growth of aggressive/disruptive behavior in grades 1-3 and 6-12 through the application of a latent transition growth mixture model (LT-GMM). Both the classroom-centered and family-centered interventions were designed to reduce the risk for later conduct problems by enhancing the child behavior management practices of teachers and parents, respectively. We first modeled growth trajectories in each of the two time periods with separate GMMs. We then associated latent trajectory classes of aggressive/disruptive behavior across the two time periods using a transition model for the corresponding latent class variables. Subsequently, we tested whether the interventions had direct effects on trajectory class membership in grades 1-3 and 6-12. For males, both the classroom-centered and family-centered interventions had significant direct effects on trajectory class membership in grades 6-12, whereas only the classroom-centered intervention had a significant effect on class membership in grades 1-3. Significant direct effects for females were confined to grades 1-3 for the classroom-centered intervention. Further analyses revealed that both the classroom-centered and family-centered intervention males were significantly more likely than control males to transition from the high trajectory class in grades 1-3 to a low class in grades 6-12. Effects for females in classroom-centered interventions went in the hypothesized direction but did not reach significance.

Parent psychopathology and youth internalizing symptoms in an urban community: a latent growth model analysis.

The present study examined the developmental trajectories of youth depression and anxiety symptoms from 6th through 12th grade in a low-income, urban sample (N = 141; mean age = 11.75 years; 88.7% African American). The study also tested the independent contribution of parent mood disorders, anxiety disorders, and substance use disorders assessed in early childhood to initial levels and rate of change in depression and anxiety symptoms from 6th through 12th grade. Possible gender differences in symptom course and strength of parent psychopathology predictors were examined using multiple-group analysis. Results indicated that depression symptoms declined over time for males, whereas depression symptoms initially declined, but then increased for females. In contrast, male and female adolescents each showed a decline in anxiety symptoms throughout adolescence. Findings also indicated that parent mood disorders were the only predictor of youth depression and anxiety symptoms for male and female adolescents in 6th grade. Parent anxiety disorders uniquely predicted the rate of change in depression symptoms among male adolescents. These results underscore the importance of targeting parents with mood and anxiety disorders in urban families in order to reduce the risk for internalizing difficulties in their adolescent youth.

Predicting negative life outcomes from early aggressive-disruptive behavior trajectories: gender differences in maladaptation across life domains.

Transactional theories of development suggest that displaying high levels of antisocial behavior early in life and persistently over time causes disruption in multiple life domains, which in turn places individuals at risk for negative life outcomes. We used longitudinal data from 1,137 primarily African American urban youth (49.1% female) to determine whether different trajectories of aggressive and disruptive behavior problems were associated with a range of negative life outcomes in young adulthood. General growth mixture modeling was used to classify the youths' patterns of aggressive-disruptive behavior across elementary school. These trajectories were then used to predict early sexual activity, early pregnancy, school dropout, unemployment, and drug abuse in young adulthood. The trajectories predicted the number but not type of negative life outcomes experienced. Girls with the chronic high aggression-disruption (CHAD) pattern experienced more negative outcomes than girls with consistently moderate levels, who were at greater risk than nonaggressive-nondisruptive girls. Boys with CHAD and boys with an increasing pattern had equal levels of risk for experiencing negative outcomes. The findings are consistent with transactional models of development and have implications for preventive interventions.

Early childhood behavior trajectories and the likelihood of experiencing a traumatic event and PTSD by young adulthood.

This study modeled children's trajectories of teacher rated aggressive-disruptive behavior problems assessed at six time points between the ages of 6 and 11 and explored the likelihood of being exposed to DSM-IV qualifying traumatic events and posttraumatic stress disorder (PTSD) in 837 urban first graders (71% African American) followed-up for 15 years. Childhood trajectories of chronic high or increasing aggressive-disruptive behavior distinguished males more likely to be exposed to an assaultive violence event as compared to males with a constant course of low behavior problems (OR(chronic high) = 2.8, 95% CI = 1.3, 6.1 and OR(increasing) = 4.5, 95% CI = 2.3, 9.1, respectively). Among females, exposure to traumatic events and vulnerability to PTSD did not vary by behavioral trajectory. The findings illustrate that repeated assessments of disruptive classroom behavior during early school years identifies more fully males at increased risk for PTSD-level traumatic events, than a single measure at school entry does.

The Gender Minority Stress and Resilience Measure: Psychometric Validity of an Adolescent Extension.

OBJECTIVE: Minority stress contributes to several physical and psychological problems in sexual and gender minorities but is largely understudied in transgender/gender-nonconforming (TGNC) individuals, particularly TGNC adolescents. The availability of psychometrically sound measures of adolescent minority stress can help improve assessment and treatment planning in this area. This original research study examined whether an existing measure of TGNC-related minority stress and resilience among adults could retain construct and psychometric validity when administered to TGNC adolescents. METHODS: Respondents were 258 TGNC adolescents, aged 12 -17.99 years (M=15.1, SD=1.4), majority white/European American (70.2%) and assigned female at birth (71.7%) seeking care in an interdisciplinary gender-health clinic within a pediatric academic medical center in the Midwestern United States. Respondents completed a battery of clinical measures as standard of care, including the Gender Minority Stress and Resilience Measure, measures of anxiety and depression symptoms, and parental support. RESULTS: Findings indicated that minor adaptation of the existing adult measure resulted in high internal consistency and construct validity across 9 subscales assessing domains of minority stress and resilience in this sample of TGNC adolescents. CONCLUSIONS: This study provides evidence of the factor structure, reliability and validity of an adolescent extension of the Gender Minority Stress and Resilience measure (GMSR-A). These findings demonstrate the clinical utility of the GMSR-A, a tool that can help increase understanding of minority stress and resilience phenomena experienced by TGNC adolescents.

Developmental epidemiological courses leading to antisocial personality disorder and violent and criminal behavior: effects by young adulthood of a universal preventive intervention in first- and second-grade classrooms.

BACKGROUND: Antisocial personality disorder (ASPD), violent and criminal behavior, and drug abuse disorders share the common antecedent of early aggressive, disruptive behavior. In the 1985-1986 school year teachers implemented the Good Behavior Game (GBG), a classroom behavior management strategy targeting aggressive, disruptive behavior and socializing children to the student role. From first through seventh grade the developmental trajectories of 2311 students from 19 Baltimore City Public Schools were examined. We report the GBG impact on these trajectories and ASPD and violent and criminal behavior by age 19-21. METHODS: In five urban, poor to lower middle class predominately African-American areas, three to four schools were matched and within each set randomly assigned to one of three conditions: (1) GBG, (2) a reading achievement program, or (3) the standard program. Classrooms and teachers were randomly assigned to intervention or control. Measures at 19-21 included self reports and juvenile court and adult incarceration records. GBG impact was assessed via General Growth Mixture Modeling based on repeated measures of aggressive, disruptive behavior. RESULTS: Three trajectories of aggressive, disruptive behavior were identified. By young adulthood, GBG significantly reduced the rates of ASPD and violent and criminal behavior among males in the persistent high aggressive, disruptive trajectory. REPLICATION: A replication was implemented with the following cohort of first-grade children using the same teachers, but with diminished mentoring and monitoring. Beneficial impact was found among persistent high males through seventh grade. By young adulthood GBG effects on ASPD and violent and criminal behavior were non-significant, but generally in the hypothesized direction.

Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes.

BACKGROUND: The Good Behavior Game (GBG), a method of classroom behavior management used by teachers, was tested in first- and second-grade classrooms in 19 Baltimore City Public Schools beginning in the 1985-1986 school year. The intervention was directed at the classroom as a whole to socialize children to the student role and reduce aggressive, disruptive behaviors, confirmed antecedents of later substance abuse and dependence disorders, smoking, and antisocial personality disorder. This article reports on impact to ages 19-21. METHODS: In five poor to lower-middle class, mainly African American urban areas, three or four schools were matched and within each set randomly assigned to one of three conditions: (1) GBG, (2) a curriculum-and-instruction program directed at reading achievement, or (3) the standard program. Balanced assignment of children to classrooms was made, and then, within intervention schools, classrooms and teachers were randomly assigned to intervention or control. RESULTS: By young adulthood significant impact was found among males, particularly those in first grade who were more aggressive, disruptive, in reduced drug and alcohol abuse/dependence disorders, regular smoking, and antisocial personality disorder. These results underline the value of a first-grade universal prevention intervention. REPLICATION: A replication was implemented with the next cohort of first-grade children with the same teachers during the following school year, but with diminished mentoring and monitoring of teachers. The results showed significant GBG impact for males on drug abuse/dependence disorders with some variation. For other outcomes the effects were generally smaller but in the predicted direction.