Adolescent Substance Use Behavior Change Through School Intervention Is Improved by Teacher and School Implementation Support Together, Especially for Girls.

An earlier trial of a school-based, preventative intervention, HealthWise South Africa, demonstrated some efficacy in preventing adolescent drinking and smoking in the Western Cape, South Africa. This was followed by the current implementation trial, which examined how implementation support conditions influenced adolescent drinking and smoking behavior change in the HealthWise intervention. The hybridized implementation-effectiveness trial included 34 schools (n = 2175 students) that provided student data at four waves through Grades 8 to 10. Implementation support conditions included a combination of two components (enhanced school environment and teacher consultation), resulting in four conditions: enhanced school environment, teacher consultation, both components, and standard delivery. Using configural frequency analysis, we examined how drinking and smoking behavior change differed across four configurations of intervention support longitudinally and by gender. For baseline non-smokers, results indicated sustained differences in abstention from smoking and smoking initiation between schools that received both support components and schools in the standard delivery condition. These results were primarily driven by girls. For baseline drinkers and smokers in the both components condition, changes in drinking were delayed until Grade 9 and smoking decayed by Grade 10. Results suggest that providing both school and teacher implementation support synergistically facilitates improved intervention outcomes both immediately following intervention and 2 years later across schools with diverse resource levels. Future iterations of HealthWise, and other interventions, may benefit from a multilevel implementation support strategy to improve student outcomes. More research is needed to understand how to improve HealthWise effectiveness among boys.

Leisure Boredom, Timing of Sexual Debut, and Co-Occurring Behaviors among South African Adolescents.

Sex during adolescence is normative; however, there are substantial individual differences in the timing and context of sexual debut. Leisure boredom is an underexplored correlate of sexual behavior that is associated with many adolescent health outcomes. We investigated if and how individual differences in leisure boredom may be associated with timing of sexual debut, and whether individuals engage in safe or risky behaviors at debut. Survival analysis, logistic regression, and Poisson regression were applied to eight-wave longitudinal data obtained from 3,088 South African adolescents (baseline Mage = 13.9 years) to examine associations between leisure boredom and cumulative hazard of sexual debut across adolescence, odds of co-occurring sexual behaviors, and incidence rate of co-occurring sexual risk behaviors at debut. Higher levels of leisure boredom were associated with elevated hazard cumulatively across adolescence. Higher levels of leisure boredom were also associated with lower odds of safe sex and higher odds of substance use during sex and transactional sex at sexual debut, but not casual sex or condom non-use at sexual debut. Although odds of singular risk behaviors were lower for girls than for boys, the association between leisure boredom and the number of risk behaviors at sexual debut was stronger for girls than boys. Higher trait leisure boredom was associated with elevated hazard of sexual debut, greater likelihood that risky behaviors accompanied sexual debut, and greater number of co-occurring risky behaviors at sexual debut. Results support leisure boredom as a potential target for preventing sexual risk behavior among South African adolescents.

Boys Are Victims, Too: The Influence of Perpetrators' Age and Gender in Sexual Coercion Against Boys.

Sexual coercion among adolescent boys in South Africa is an underresearched topic despite the frequency of such events. Although quantitative research has illuminated the prevalence of sexual coercion toward boys, it has provided little understanding of the context of sexual coercion for adolescent boys. Given the often severe consequences of sexual coercion, it is important to further understand these experiences to inform prevention efforts. The current study aims to provide a more nuanced understanding of the context of sexual coercion. Data come from the baseline assessment for a translational research evaluation of a school-based intervention. The current study focuses on a subset of early and middle adolescent boys who reported experiencing sexual coercion (n = 223). Analyses examine boys' reports of their perpetrators' characteristics and details about the sexual coercion encounter. Logistic regression is used to examine how coercion tactics used by the perpetrator differs depending on the perpetrator's age and gender. Eighth-grade boys were most likely to report that their perpetrator was a similar-aged female and that perpetrator's age played a particularly important role in what tactics were used. Adult perpetrators were more likely to use physical force, threaten them, harass them electronically, and drink or use drugs at the time. Results provide important insight into boys' experiences of sexual coercion that have implications for both future research and intervention efforts. Although much research is needed on the topic, intervention programs should recognize that both male and female adolescents can be victim and perpetrator.

Supporting South African High School Teachers' Implementation of a Prevention Program via Abridged Consultation: Outcomes and Moderators.

Research is lacking on consultation support for school-based evidence-based programs (EBP) intended to prevent youths' risky behaviors in schools in low-resourced settings like high schools surrounding Cape Town, South Africa. Thus, this study's objective was to examine implementation outcomes and moderators of an abridged consultation condition for supporting teachers in better implementing HealthWise, an EBP for preventing youth risky sexual and substance use behaviors. Twenty-one schools with 33 teachers receiving abridged consultation (i.e., three consultation meetings, text message reminders, lesson plans, and support kits) were compared to 26 schools with 41 teachers that did not receive any consultation. Teachers with abridged consultation self-reported delivering more HealthWise content. Moderation analyses found teachers with lower educational degrees, who received abridged consultation reported more student interest in HealthWise. When there was higher school-level risk, teachers who received abridged consultation marginally self-reported adapting HealthWise more. Findings suggest consultation support that is abridged or a lower dose than is typical can be feasible in such a low-resourced, overburdened setting while still being associated with EBP coverage, student interest, and adaptation. However, moderation findings suggest contextual factors should be considered to match teachers/schools to the implementation support that best suits them.

Parenting Practice, Leisure Experience, and Substance Use Among South African Adolescents.

There is limited understanding of parents' role in positive youth/adolescent development through leisure in developing countries. Using a sample of 6626 8th grade students in South Africa, this study examined the interrelationships among parenting practice, adolescents' leisure experience, and substance use. Results of structural equation modeling showed that parental leisure involvement was associated with less substance use, while parental leisure over-control was associated with greater substance use. The relationship of parental leisure involvement to substance use was mediated by healthy leisure engagement. The relationship of parental leisure over-control to substance use, on the other hand, was mediated by leisure boredom and healthy leisure engagement. The model path coefficients had little variation between genders and socioeconomic groups except that parental leisure over-control had a stronger positive relationship with leisure boredom for males than females. Theoretical and practical implications were discussed.

Profiles of Adolescent Leisure Motivation and Substance Use in the HealthWise South Africa Research Trial: A Person-Centered Approach.

Engaging in intrinsically motivated behaviors, both within and outside of the leisure context, is associated with well-being. However, individuals can be driven by multiple types of motivation simultaneously, and the impact of constellations of leisure motivation is relatively unknown. The current study uses South African adolescents in the HealthWise South Africa efficacy trial (N=2,204; M age =14.0) to identify profiles of leisure motivation, examine the association between profiles and substance use, and evaluate the impact of HealthWise on changes in motivation profiles over time. Results indicate three distinct profiles: high consistent motivation, low consistent motivation, and high intrinsic motivation. Members of the high intrinsic profile had the lowest odds of substance use. Profiles were fairly stable across all time points except for females in a high-training intervention school. Results illustrate the importance of identifying and understanding typologies of leisure motivation and health across time, which can be used to promote positive development in adolescents.

More Bored Today Than Yesterday? National Trends in Adolescent Boredom From 2008 to 2017.

PURPOSE: Boredom is an accepted part of adolescence. Developmental and contextual factors are likely to conspire to increase boredom during adolescence, which, in turn, relates to health risk behaviors. However, literature is lacking in the developmental course of boredom across adolescence as well as historical variation in boredom. The present study used multicohort nationally representative samples of U.S. secondary school students to identify historical trends and grade level differences in boredom overall and by sex. METHODS: The present study includes 8th, 10th, and 12th graders from 2008 to 2017 who completed the Monitoring the Future self-report survey (n = 106,784). Joinpoint was used to identify historical trends in boredom and linear regression to identify grade level differences. RESULTS: Boredom increased historically both across and within grades with girls generally demonstrating greater increases than boys. Across grade, boredom appears to peak in 10th grade for boys and decrease across grade for girls. CONCLUSIONS: Study findings indicate boredom has been increasing among adolescents over the past several years, with greater increases among girls. Increases may be concomitant with recent increases in mental health difficulties, suggesting that the overarching psychosocial profile of U.S. adolescents is becoming less optimal. Findings also suggest boredom peaks in 10th grade overall although when analyzing separately by sex, girls' boredom declines from 8th to 12th grade. It is clear that boredom is a worthy target for intervention both in clinical and prevention contexts.

Impact of a community-based intervention on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's physical activities.

INTRODUCTION: Latino grandparents are often involved in rearing grandchildren, but their roles in promoting children's physical activity (PA) have been largely overlooked. This study examined the impact of a community-based intervention called Nietos Activos y Saludables (Active and Healthy Grandchildren) on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's (aged 2-12 years) PA. METHOD: The Spanish language intervention, consisting of 4 weekly sessions, was delivered to 12 Latino grandparents (primarily female, aged > 60 years) in Los Angeles County from October to November 2017. Pre- and posttest surveys and postintervention focus groups assessed the intervention impact. RESULTS: Participants indicated that the intervention provided useful information. After intervention sessions, participants achieved a higher score in test on PA requirements for children. They also reported greater knowledge about children's PA, local resources for children's PA, and modifying children's behavior. Additionally, participants reported greater confidence in motivating children in PA and collaborating with parents in promoting children's PA. Results of focus groups generally confirmed the quantitative findings. DISCUSSION: Nietos Activos y Saludables intervention has the promise to increase Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's PA. Future studies should test the impact of the intervention on grandparents' behavior and grandchildren's health outcomes using a randomized controlled trial. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

With a little help from my friends? A longitudinal look at the role of peers versus friends on adolescent alcohol use.

INTRODUCTION: Alcohol is the most commonly used substance by South African adolescents. Social norms play a key role in alcohol use, although distinctions are not always made between descriptive and injunctive norms and peer proximity. Additionally, little research identifies factors attenuating social norms, peer proximity, and alcohol use, such as one's ability to resist peer influence. METHODS: The current study investigates the relationship between adolescent alcohol use in 9th Grade and descriptive peer and injunctive friend norms in 8th grade, the moderating role of resistance to peer influence, and sex differences. Data were from South African students (N = 3592; Mage = 14) participating in the HealthWise South Africa implementation quality trial. RESULTS: Path model results indicated injunctive friend norms, but not peer norms, influenced alcohol use. Resistance to peer influence did not moderate relationships and group comparisons found no sex differences. CONCLUSION: Findings suggest social proximity shapes influences of alcohol use. Despite a differing cultural context, findings were consistent with those from the United States, indicating social proximity is relevant cross-culturally.

A Qualitative Study of Latino Grandparents' Involvement in and Support for Grandchildren's Leisure Time Physical Activity.

BACKGROUND: Latino grandparents are often involved in rearing of grandchildren. However, their roles in promoting Latino children's leisure time physical activity (LTPA) have been largely overlooked by researchers. AIM: The purpose of this study is to examine Latino grandparents' involvement in and support for grandchildren's (age 2-12) LTPA as well as issues facing Latino grandparents. METHOD: Participants included 53 Latino grandparents who lived with/cared for or used to live with/care for grandchildren of 2 to 12 years old in three low-income areas of Los Angeles County. Data were collected using 4 semistructured focus groups and 26 semistructured interviews. Transcribed data were systematically and iteratively coded and analyzed. RESULTS: Latino grandparents perceived various benefits of physical activity to their grandchildren's physical and mental health, and supported grandchildren's LTPA directly and indirectly. The direct support included doing physical activity with grandchildren, taking grandchildren to places for physical activities, verbally asking grandchildren to do physical activities, and rewarding grandchildren for doing physical activities. The indirect support was made through providing suggestions to parents. Mothers usually regulated Latino grandparents' involvement in or support for grandchildren's LTPA and tended to promote a maternal lineage. Some Latino grandparents reported barriers to supporting grandchildren's LTPA, including lack of information, access to affordable and safe LTPA facilities/programs, transportation, money, and time. CONCLUSIONS: Latino grandparents are advocates for grandchildren's LTPA and support grandchildren's LTPA directly and indirectly. It may be promising to develop interventions to increase Latino grandparents' competency in supporting grandchildren's LTPA.

Predicting secondary school dropout among South African adolescents: A survival analysis approach.

Education is one of the strongest predictors of health worldwide. In South Africa, school dropout is a crisis where by Grade 12, only 52% of the age appropriate population remain enrolled. Survival analysis was used to identify the risk of dropping out of secondary school for male and female adolescents and examine the influence of substance use and leisure experience predictors while controlling for demographic and known predictors using secondary, longitudinal data. Results indicated being male, not living with one's mother, smoking cigarettes in the past month, and lower levels of leisure-related intrinsic motivation significantly predicted dropout. Results support comprehensive prevention programmes that target risk behaviour and leisure.

Perceived Parental Control, Restructuring Ability, and Leisure Motivation: A Cross-Cultural Comparison.

Leisure is viewed worldwide as an important developmental context for adolescents. As leisure research and programs are shared across nations, it is crucial to examine the cultural equivalence of leisure-related constructs and how they are related. Grounded in self-determination theory, this study explored the influence of perceived parental control and leisure restructuring ability on leisure motivation (amotivation and autonomous motivation) using samples of eighth grade adolescents in the United States and South Africa. Results of multiple-group structural equation modeling showed that the measurement model of the constructs was equivalent across the two samples, but the determinants of leisure motivation differed between the two samples. The findings provide implications for future cross-cultural research in leisure and offer insights on design and adaptation of leisure-based intervention and education programs in different cultural contexts.

Urban Adolescents' Physical Activity Experience, Physical Activity Levels, and Use of Screen-Based Media during Leisure Time: A Structural Model.

There is limited understanding of the relationship between physical activity and use of screen-based media, two important behaviors associated with adolescents' health outcomes. To understand this relationship, researchers may need to consider not only physical activity level but also physical activity experience (i.e., affective experience obtained from doing physical activity). Using a sample predominantly consisting of African and Latino American urban adolescents, this study examined the interrelationships between physical activity experience, physical activity level, and use of screen-based media during leisure time. Data collected using self-report, paper and pencil surveys was analyzed using structural equation modeling. Results showed that physical activity experience was positively associated with physical activity level and had a direct negative relationship with use of non-active video games for males and a direct negative relationship with use of computer/Internet for both genders, after controlling for physical activity level. Physical activity level did not have a direct relationship with use of non-active video games or computer/Internet. However, physical activity level had a direct negative association with use of TV/movies. This study suggests that physical activity experience may play an important role in promoting physical activity and thwarting use of screen-based media among adolescents.

Trajectories of adolescent substance use development and the influence of healthy leisure: A growth mixture modeling approach.

Considerable heterogeneity exists in adolescent substance use development. To most effectively prevent use, distinct trajectories of use must be identified as well as differential associations with predictors of use, such as leisure experience. The current study used a person-centered approach to identify distinct substance use trajectories and how leisure is associated with trajectory classes. Data came from a larger efficacy trial of 2.249 South African high school students who reported substance use at any time across 8 waves. Growth mixture modeling was used to identify developmental trajectories of substance use and the influence of healthy leisure. Results identified three increasing and one stable substance use trajectory and subjective healthy leisure served to protect against use. This study is the first of its kind to focus on a sample of South African adolescents and serves to develop a richer understanding of substance use development and the role of healthy leisure.

Longitudinal Patterns of Active Leisure among South African Youth: Gender Differences and Associations with Health Risk Behaviours.

This study identified adolescents' patterns of active leisure participation over two years and five waves of data and how those patterns were related to substance use and sexual activity. Participants included 3581 primarily Colored (mixed race) South African adolescents. Latent class analysis was utilized to determine patterns of active leisure patterns and multinomial logistic regression was used to examine the relationships between the patterns and substance use and sexual activity. Four patterns were identified: Non-Participants; Early Participants; Late Participants; and Consistent Participants. Most males were Consistent Participants, whereas most females were Non-participants. Female Consistent Participants had the lowest odds of tobacco use, marijuana use, and sexual activity by the tenth grade relative to the other patterns, whereas Early Participants had the highest odds. In contrast, male Consistent Participants were at moderate risk of engaging in health risk behaviors relative to the other patterns. These findings suggest the need for a cautious approach to developing active leisure-based interventions, taking into account the contextual factors that may influence participation and health risk behaviors.

Boredom Prone or Nothing to Do? Distinguishing Between State and Trait Leisure Boredom and its Association with Substance Use in South African Adolescents.

Reducing adolescent substance use is important in South Africa, a developing nation with increasing adolescent substance use, lack of leisure/recreation opportunities, and high rates of adolescent discretionary time. Previous research suggests leisure boredom and adolescent substance use co-occur in this setting. Using longitudinal data from 2,580 SA adolescents as they progressed from the 8th to 11th grade, the current study disentangles the associations of trait and state leisure boredom with substance use, and examines how ability to restructure boring situations moderates those associations. On average, individuals with higher trait boredom used more substances, and on occasions when state boredom was high, the prototypical adolescent used more substances. Although restructuring did not moderate these associations, greater ability was associated with lower substance use independent of leisure boredom. Findings illustrated the importance of considering how trait and state aspects of leisure may contribute to adolescents' risk behavior and addressed through preventive intervention.

The Dynamic Association between Healthy Leisure and Substance Use in South African Adolescents: A State and Trait Perspective.

South Africa has an increasing adolescent substance use problem, lack of leisure opportunities and resources, and high adolescent discretionary time. How aspects of leisure relate to adolescent substance use is not well understood. Little research has been conducted on the leisure behaviors and experiences of South African adolescents, if and how those behaviors are associated with substance use, and ecological influences on those associations. By applying multi-level models to longitudinal data obtained from youth living in high-risk contexts, this research examines the association between state and trait healthy leisure and adolescent substance use and how perceived parental over-control moderates those associations. Results indicate healthy leisure protects against substance use at state and trait levels, provides empirical support that risk behavior can be addressed through leisure-based interventions, and emphasizes the importance of both short- and long-term processes when considering the context-dependent nature of adolescents' leisure experiences.

Was Bob Seger Right? Relation Between Boredom in Leisure and [Risky] Sex.

This article examines the association between boredom in leisure and risky sexual behaviors among South African youth (N = 1695) using longitudinal data. We hypothesized that youth who were higher on boredom in leisure at the end of ninth grade would be more likely to report engaging in risky sexual behaviors at the beginning of tenth grade. Chi-square results indicate youth, especially male youth who experience high levels of leisure boredom in ninth grade, are more likely to engage in risky sexual behaviors in tenth grade. These findings have implications for prevention programs that aim to delay sexual initiation, reduce sexual risk behaviors, and decrease the transmission of HIV and AIDS. The findings support the need for additional research on how the reduction of leisure boredom may be a potential target for reducing sexual risk among youth.

Linking Life Skills and Norms With Adolescent Substance Use and Delinquency in South Africa.

We examined factors targeted in two popular prevention approaches with adolescent drug use and delinquency in South Africa. We hypothesized adolescent life skills to be inversely related, and perceived norms to be directly related to later drug use and delinquency. Multiple regression and a relative weights approach were conducted for each outcome using a sample of 714 South African adolescents ages 15 to 19 years (M = 15.8 years, 57% female). Perceived norms predicted gateway drug use. Conflict resolution skills (inversely) and perceived peer acceptability (directly) predicted harder drug use and delinquency. The "culture of violence" within some South African schools may make conflict resolution skills more salient for preventing harder drug use and delinquency.

Translational Research in South Africa: Evaluating Implementation Quality Using a Factorial Design.

BACKGROUND: HealthWise South Africa: Life Skills for Adolescents (HW) is an evidence-based substance use and sexual risk prevention program that emphasizes the positive use of leisure time. Since 2000, this program has evolved from pilot testing through an efficacy trial involving over 7,000 youth in the Cape Town area. Beginning in 2011, through 2015, we are undertaking a new study that expands HW to all schools in the Metro South Education District. OBJECTIVE: This paper describes a research study designed in partnership with our South African collaborators that examines three factors hypothesized to affect the quality and fidelity of HW implementation: enhanced teacher training; teacher support, structure and supervision; and enhanced school environment. METHODS: Teachers and students from 56 schools in the Cape Town area will participate in this study. Teacher observations are the primary means of collecting data on factors affecting implementation quality. These factors address the practical concerns of teachers and schools related to likelihood of use and cost-effectiveness, and are hypothesized to be "active ingredients" related to high-quality program implementation in real-world settings. An innovative factorial experimental design was chosen to enable estimation of the individual effect of each of the three factors. RESULTS: Because this paper describes the conceptualization of our study, results are not yet available. CONCLUSIONS: The results of this study may have both substantive and methodological implications for advancing Type 2 translational research.