Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis aims to synthesize the efficacy of culturally sensitive prevention programs for substance use outcomes among U.S. adolescents of color (aged 11 to 18 years old) and explore whether the intervention effects vary by participant and intervention characteristics. Eight electronic databases and grey literature were searched for eligible randomized controlled trials through September 2022. Robust variance estimation in meta-regression was used to synthesize treatment effect size estimates and to conduct moderator analysis. After screening, 30 unique studies were included. The average treatment effect size across all substance use outcomes (including 221 effect sizes) was Hedges's g = -0.20, 95% CI = [-0.24, -0.16]. The synthesized effect sizes were statistically significant across types of substances (alcohol, cigarette, marijuana, illicit and other drugs, and unspecified substance use), racial/ethnic groups (Hispanic, Black, and Native American), and different follow-ups (0-12 months, >12 months). Very few studies reported substance use consequences as outcomes and the synthesized effect size was non-significant. Meta-regression findings suggest that the intervention effects may vary based on the type of substance. This meta-analysis found supportive evidence of culturally sensitive prevention programs' efficacy in preventing or reducing substance use among Black, Hispanic, and Native American adolescents. More substance use prevention efforts and evidence is needed for Asian American, Pacific Islander, and multiracial adolescents.

Getting to zero HIV/AIDS in sub-Saharan Africa: Understanding perceptions of locals using the social determinants of health framework.

This study explored a community perception of the facilitators and inhibitors of Getting to Zero (GTZ) in rural Zambia, sub-Saharan Africa. Data were collected in 2017. We use the Social Determinants of Health framework to guide organisation of key themes emerging from semistructured, focus group interviews with community members (N = 52). Data were analysed through an iterative descriptive/thematic approach which allowed for the highlighting of key themes. Emerging themes point to the significance of (a) individual, (b) sociocultural, (c) environmental and (d) economic factors, for example, treatment adherence, gender norms, food security and access to health care as important in GTZ. Implications for policy, practise and scholarship are suggested.

Testing the Nurturing Environments Framework on Youth Violence across Ethnically and Geographically Diverse Urban and Rural Samples of Adolescents.

Although research advocates for comprehensive cross sector youth violence prevention efforts, mobilizing across sectors to translate scientific recommendations into practice has proven challenging. A unifying framework may provide a foundational step towards building a shared understanding of the risk and protective factors that impact youth violence. We conducted two empirical tests of the nurturing environment framework on youth violence across ethnic and geographically diverse rural and urban adolescent samples. Results show that overall the characteristics of nurturing environments are associated with lower levels of aggression and violence. In addition, minimizing exposure to socially toxic conditions had the strongest associations with lower aggression and violence. Findings were supported across both samples, suggesting that this framework may apply in urban and rural, economically disadvantaged contexts.

Addressing Crime, Violence, and Other Determinants of Health through Community-Based Participatory Research and Implementation Science.

In this paper, we describe the assessment and planning phase of the Thrive community-based initiative to reduce violence and address other determinants of health in a community in the Southwestern United States. Using community-based participatory research (CBPR) and an implementation science framework, we engaged residents and other key stakeholders as equal partners in the assessment and planning process. The Thrive assessment and planning phase involved collaboration among researchers, residents, law enforcement, nonprofit agencies, public health, local government, and other cross-sector partners. We used implementation science in order to examine the barriers and facilitators to addressing community health and safety, to assess the nature and scope of health and safety issues, to review existing solutions, to assess the acceptability and necessary adaptations of selected interventions, and to assess feasibility and sustainability of the initiative. Through interviews, focus groups, analysis of crime incident data, geomapping, and direct observations, our findings highlighted the presence of an open-air drug market, the high-stress nature of the community, concern for the lack of opportunities for youth, the lack of trust between residents and law enforcement, and a need to address the built environment to promote safety and well-being.

Cumulative Bullying Experiences, Adolescent Behavioral and Mental Health, and Academic Achievement: An Integrative Model of Perpetration, Victimization, and Bystander Behavior.

Bullying is often ongoing during middle- and high-school. However, limited research has examined how cumulative experiences of victimization, perpetration, and bystander behavior impact adolescent behavioral and mental health and academic achievement outcomes at the end of high school. The current study used a sample of over 8000 middle- and high-school students (51% female; mean age 12.5 years) from the Rural Adaptation Project in North Carolina to investigate how cumulative experiences as a bullying victim and perpetrator over 5 years, and cumulative experiences of bystander behavior over 2 years impacted students' aggression, internalizing symptoms, academic achievement, self-esteem, and future optimism. Following multiple imputation, analysis included a Structural Equation Model with excellent model fit. Findings indicate that cumulative bullying victimization was positively associated with aggression and internalizing symptoms, and negatively associated with self-esteem and future optimism. Cumulative bullying perpetration was positively associated with aggression and negatively associated with future optimism. Cumulative negative bystander behavior was positively associated with aggression and internalizing symptoms and negatively associated with academic achievement and future optimism. Cumulative prosocial bystander behavior was positively associated with internalizing symptoms, academic achievement, self-esteem, and future optimism. This integrative model brings together bullying dynamics to provide a comprehensive picture of implications for adolescent behavioral and mental health and academic achievement.

Polysubstance Use Among Adolescents in a Low Income, Rural Community: Latent Classes for Middle- and High-School Students.

PURPOSE: Rural communities are currently being impacted by a nationwide epidemic of prescription opioid misuse. Rural adolescent substance users may be at substantial risk for later addiction to these and other drugs. METHODS: This study uses Latent Class Analysis to identify subtypes of polysubstance users among a sample of 7,074 rural adolescents. Separate models were estimated for middle- and high-school youth. Predictive validity was estimated using cumulative ordinal logistic regression of the classes on a set of youth and family characteristics. FINDINGS: We identified a 4-class solution for both middle- and high-school students marked by initiation of an increasing number of substances used at greater frequency. These classes included Substance Nonusers, Primarily Alcohol Users, Initiators-Low Frequency Users, and Initiators-Moderate-to-High Lifetime Frequency Users. About 6%-10% of youth reported using prescription drugs at least once, and in the moderate-to-high frequency class, middle-school youth were more likely to use prescription drugs and inhalants compared to high-school youth in the same class. The 4 classes were associated with race/ethnicity, and in high school with receiving free/reduced price lunch. CONCLUSION: In general, younger adolescents have lower overall use rates, but within certain classes identified by this analysis, the observed pattern suggests that younger cohorts are turning to prescription drugs and inhalants. These findings support the implementation of universal substance use prevention programs, targeted programs for youth experiencing risk factors associated with substance use, and improved rural substance abuse treatment options.

The Impact of Teen Court on Rural Adolescents: Improved Social Relationships, Psychological Functioning, and School Experiences.

Teen Court is a prevention program aimed at diverting first time juvenile offenders from the traditional juvenile justice system and reintegrating them into the community. Few studies have examined if Teen Court impacts adolescent functioning. We examined how Teen Court participation impacted psychosocial functioning, social relationships, and school experiences in a sample of 392 rural Teen Court participants relative to two comparison samples, one from the same county as Teen Court (n = 4276) and one from a neighboring county (n = 3584). We found that Teen Court has the potential to decrease internalizing symptoms, externalizing behavior, violent behavior, parent-adolescent conflict, and delinquent friends, and increase self-esteem and school satisfaction.

Risk and protective factors across multiple microsystems associated with internalizing symptoms and aggressive behavior in rural adolescents: Modeling longitudinal trajectories from the Rural Adaptation Project.

The current study examined risk and protective factors across microsystems that impact the development of internalizing symptoms and aggression over 4 years in a sample of culturally diverse, rural adolescents. We explored whether risk and protective factors across microsystems were associated with changes in rates of internalizing symptoms and aggressive behavior. Data came from the Rural Adaptation Project (RAP), a 5-year longitudinal panel study of more than 4,000 students from 26 public middle schools and 12 public high schools. Three level HLM models were estimated to predict internalizing symptoms (e.g., depression, anxiety) and aggression. Compared with other students, risk for internalizing symptoms and aggression was elevated for youth exposed to risk factors in the form of school hassles, parent-child conflict, peer rejection, and delinquent friends. Microsystem protective factors in the form of ethnic identity, religious orientation, and school satisfaction decreased risk for aggression, but were not associated with internalizing symptoms, whereas future orientation and parent support decreased risk for internalizing symptoms, but not aggression. Results indicate that risks for internalizing symptoms and aggression are similar, but that unique protective factors are related to these adolescent behavioral health outcomes. Implications and limitations were discussed. (PsycINFO Database Record

Negative Bystander Behavior in Bullying Dynamics: Assessing the Impact of Social Capital Deprivation and Anti-social Capital.

Bystanders witness bullying, but are not directly involved as a bully or victim; however, they often engage in negative bystander behavior. This study examines how social capital deprivation and anti-social capital are associated with the likelihood of engaging in negative bystander behavior in a sample (N = 5752) of racially/ethnically diverse rural youth. Data were collected using an online, youth self-report; the current study uses cross sectional data. Following multiple imputation, a binary logistic regression with robust standard errors was run. Results partially supported the hypothesis and indicated that social capital deprivation in the form of peer pressure and verbal victimization and anti-social capital in the form of delinquent friends, bullying perpetration, verbal perpetration, and physical perpetration were significantly associated with an increased likelihood of engaging in negative bystander behavior. Findings highlight the importance of establishing sources of positive social support for disenfranchised youth.

Family dynamics and aggressive behavior in Latino adolescents.

OBJECTIVES: Despite high prevalence rates and evidence that acculturation is associated with adolescent behavioral and mental health in Latino youth, little research has focused on aggressive behavior for this population. The aim of the current study was to fill this research gap by examining the influence of several aspects of family functioning, including parent-adolescent conflict, parent worry, and parent marital adjustment, on aggression among Latino adolescents. METHOD: Data come from the Latino Acculturation and Health Project (LAHP), a longitudinal investigation of acculturation in Latino families in North Carolina and Arizona. Hierarchical linear modeling was used to estimate a longitudinal rater effects model of adolescent aggression as reported by 258 Latino adolescents each paired with 1 parent for a total of 516 participants across 4 time points over a span of 18 months. RESULTS: Results indicated a general decline in aggression over the study window. In addition, parent-adolescent conflict and parent worry predicted higher adolescent aggression whereas parent marital adjustment predicted lower adolescent aggression. CONCLUSIONS: The salience of family risk factors for aggression among Latino adolescents is discussed. (PsycINFO Database Record

Measuring Adolescent Violent Behavior Across Groups: Assessing Measurement Invariance of the Violent Behavior Checklist-Modified.

Measures of violent behavior are often assumed to function identically across different groups (e.g., gender, race/ethnicity). However, failure to verify measurement invariance can lead to biased cross-group comparisons. The current study examines the measurement invariance of the Violent Behavior Checklist-Modified across genders and race/ethnicities. Using multiple group confirmatory factor analysis, configural and metric invariance are assessed in a sample of racially/ethnically diverse middle and high school students ( N = 4,128) in two rural counties. Results indicate that the Violent Behavior Checklist-Modified has partial measurement invariance across genders and race/ethnicities. Specifically, four out of six items were non-invariant across genders, while one out of six items was non-invariant across race/ethnicities. Findings suggest that the latent factor of violence may be qualitatively different across males and females. Implications are discussed.

Substance use in rural adolescents: The impact of social capital, anti-social capital, and social capital deprivation.

Middle- and high-school substance use is a pressing public health problem in the United States. Despite similar or, in some cases, elevated rates of substance use among rural youth, much of the extant research on adolescent substance use has focused on urban areas. The current study aims to uncover forms of social capital (e.g., ethnic identity), social capital deprivation (e.g., parent-child conflict), and anti-social capital (e.g., delinquent friends) that impact the use of alcohol, cigarettes, and marijuana in a sample of middle- and high-school students from the rural south. It was hypothesized that social capital factors would be associated with decreased substance use while social capital deprivation and anti-social capital factors would be associated with increased substance use. The hypotheses were tested using logistic regression models with generalized estimating equations. The findings indicated that for middle school youth, anti-social capital in the form of aggression and delinquent friends was significantly associated with an increased likelihood of using alcohol, cigarettes, and marijuana. For high school students, anti-social capital in the form of aggression and delinquent friends and social capital deprivation in the form of neighborhood crime were significantly associated with an increased likelihood of using alcohol, cigarettes, and marijuana. Violent behavior was also significantly associated with an increased likelihood of using marijuana. Females reported less substance use in both middle and high school; reports of use increased with age. Implications are discussed. Given the salience of social capital deprivation, substance use programs should emphasize the skills necessary to avoid or disengage from antisocial relationships.

Evaluating dosage effects for the positive action program: How implementation impacts internalizing symptoms, aggression, school hassles, and self-esteem.

Positive Action (PA) is a school-based intervention for elementary-, middle-, and high-school students that aims to decrease problem behaviors (e.g., violence, substance use) and increase positive behaviors (e.g., academic achievement, school engagement). PA has a long history of documented success achieving these aims, making it an Evidence Based Practice (EBP). Intervention research on EBP's has established the importance of implementation fidelity, especially with regard to program dosage; failure to properly implement an EBP can have negative consequences on targeted outcomes, especially if participants are exposed to a low dosage of the program (e.g., fewer lessons than specified). Much of the current research on PA has neglected to examine how program dosage impacts PA's effect on targeted outcomes. Using propensity score models, multiple imputation, and a 2-level hierarchical linear model, the current study fills this gap and examines how different dosages of PA as measured by years participating in PA and number of PA lessons, impacts adolescent internalizing symptoms, aggression, perceptions of school hassles, and self-esteem over a 3-year period. The current sample included middle school students in grades 6, 7, and 8 (N = 5,894). The findings indicate that students who received 3 years of the PA intervention and a high number of PA lessons had a significantly higher self-esteem score than those who received 0 years of PA or zero lessons. Participants who received 1 year of PA also reported significantly lower school hassle scores than those who received 0 years. Dosage had no statistically significant effects on aggression or internalizing score. Implications are discussed. (PsycINFO Database Record

Multi-level risk factors and developmental assets associated with aggressive behavior in disadvantaged adolescents.

The current study examined multilevel risk factors and developmental assets on longitudinal trajectories of aggressive behavior in a diverse sample of rural adolescents. Using ecological and social capital theories, we explored the impact of positive and negative proximal processes, social capital, and contextual characteristics (i.e., school and neighborhood) on adolescent aggression. Data came from the Rural Adaptation Project, which is a 5-year longitudinal panel study of more than 4,000 middle and high school students from 40 public schools in two rural, low income counties in North Carolina. A three-level HLM model (N = 4,056 at Wave 1, 4,251 at Wave 2, and 4,256 at Wave 3) was estimated to predict factors affecting the change trajectories of aggression. Results indicated that negative proximal processes in the form of parent-adolescent conflict, friend rejection, peer pressure, delinquent friends, and school hassles were significant predictors of aggression. In addition, social capital in the form of ethnic identity, religious orientation, and school satisfaction served as buffers against aggression. Negative proximal processes were more salient predictors than positive proximal processes. School and neighborhood characteristics had a minimal impact on aggression. Overall, rates of aggression did not change significantly over the 3-year study window. Findings highlight the need to intervene in order to decrease negative interactions in the peer and parent domains.

A Longitudinal Evaluation of the Positive Action Program in a Low-Income, Racially Diverse, Rural County: Effects on Self-Esteem, School Hassles, Aggression, and Internalizing Symptoms.

Positive Action is a school-based program that aims to decrease problem behaviors (e.g., violence, substance use) and increase positive behaviors (e.g., school engagement, academic achievement). Although a number of studies have shown that Positive Action successfully achieves these goals, few studies have evaluated the program's effectiveness in rural schools. Given that rural youth are at an increased risk for risky behaviors (e.g., violence, substance use), this is a critical gap in the existing Positive Action research base. The current study assesses the impact of Positive Action on change rates of self-esteem, school hassles, aggression, and internalizing symptoms in a group (N = 1246, 52% female) of ethnically/racially diverse (27% White, 23% African American, 12% mixed race/other, 8% Latino, 30% as American Indian) middle school youth (age range 9-20) located in two violent, low-income rural counties in North Carolina. One county engaged in Positive Action over the 3-year study window while the other county did not. Following multiple imputation and propensity score analysis, 4 two-level hierarchical linear models were run using each of the outcome measures as dependent variables. The results indicate that the program generates statistically significant beneficial effects for youth from the intervention county on self-esteem scores and school hassles scores. Although the program generates beneficial effects for intervention youth on the change in aggression scores, the finding is not statistically significant. The finding on the change in internalizing scores shows a non-significant detrimental effect: the youth from the comparison county have lower internalizing scores than those from the intervention county. Implications are discussed.

Prosocial Bystander Behavior in Bullying Dynamics: Assessing the Impact of Social Capital.

Individuals who observe a bullying event, but are not directly involved as a bully or victim, are referred to as bystanders. Prosocial bystanders are those individuals who actively intervene in bullying dynamics to support the victim and this prosocial behavior often ends the bullying. The current study examines how social capital in the form of social support, community engagement, mental health functioning, and positive school experiences and characteristics is associated with the likelihood of engaging in prosocial bystander behavior in a large sample (N = 5752; 51.03% female) of racially/ethnically diverse rural youth. It was hypothesized that social capital would be associated with an increased likelihood of engaging in prosocial bystander behavior. Following multiple imputation, an ordered logistic regression with robust standard errors was run. The hypothesis was partially supported and results indicated that social capital in the form of friend and teacher support, ethnic identity, religious orientation, and future optimism were significantly associated with an increased likelihood of engaging in prosocial bystander behavior. Contrary to the hypothesis, a decreased rate of self-esteem was significantly associated with an increased likelihood of engaging in prosocial bystander behavior. The findings highlight the importance of positive social relationships and community engagement in increasing prosocial bystander behavior and ultimately decreasing school bullying. Implications were discussed.

The effects of positive and negative parenting practices on adolescent mental health outcomes in a multicultural sample of rural youth.

The quality of parent-child relationships has a significant impact on adolescent developmental outcomes, especially mental health. Given the lack of research on rural adolescent mental health in general and rural parent-child relationships in particular, the current longitudinal study explores how rural adolescents' (N = 2,617) perceptions of parenting practices effect their mental health (i.e., anxiety, depression, aggression, self-esteem, future optimism, and school satisfaction) over a 1 year period. Regression models showed that current parenting practices (i.e., in Year 2) were strongly associated with current adolescent mental health outcomes. Negative current parenting, manifesting in parent-adolescent conflict, was related to higher adolescent anxiety, depression, and aggression and lower self-esteem, and school satisfaction. Past parent-adolescent conflict (i.e., in Year 1) also positively predicted adolescent aggression in the present. Current positive parenting (i.e., parent support, parent-child future orientation, and parent education support) was significantly associated with less depression and higher self-esteem, future optimism, and school satisfaction. Past parent education support was also related to current adolescent future optimism. Implications for practice and limitations were discussed.

Bullied youth: the impact of bullying through lesbian, gay, and bisexual name calling.

Bullying is a common experience for many school-aged youth, but the majority of bullying research and intervention does not address the content of bullying behavior, particularly teasing. Understanding the various forms of bullying as well as the language used in bullying is important given that bullying can have persistent consequences, particularly for victims who are bullied through biased-based bullying, such as being called gay, lesbian, or queer. This study examines bullying experiences in a racially and ethnically diverse sample of 3,379 rural elementary-, middle-, and high-school youth. We use latent class analysis to establish clusters of bullying behaviors, including forms of biased-based bullying. The resulting classes are examined to ascertain if and how bullying by biased-based labeling is clustered with other forms of bullying behavior. This analysis identifies 3 classes of youth: youth who experience no bullying victimization, youth who experience social and emotional bullying, and youth who experience all forms of social and physical bullying, including being bullied by being called gay, lesbian, or queer. Youth in Classes 2 and 3 labeled their experiences as bullying. Results indicate that youth bullied by being called gay, lesbian, or queer are at a high risk of experiencing all forms of bullying behavior, highlighting the importance of increased support for this vulnerable group.

Familial influences on internalizing symptomatology in Latino adolescents: an ecological analysis of parent mental health and acculturation dynamics.

The aim of this study was to examine if family system dynamics (e.g., parent mental health, marriage quality, conflict, and cohesion) that have often been overlooked when studying Latino families play a more important role in predicting adolescent internalizing symptoms than acculturation processes. Data comes from the Latino Acculturation and Health Project, a longitudinal investigation of acculturation in Latino families in North Carolina and Arizona (Smokowski & Bacallao, 2006, 2010). Researchers conducted in-depth, community-based interviews with 258 Latino adolescents and 258 of their parents in metropolitan, small-town, and rural areas. Interviews were conducted at four time points at intervals of approximately 6 months. Parent and adolescent ratings of the adolescent's internalizing symptoms were used as the dependent variable in a longitudinal hierarchical linear model with a rater effects structure. Results showed that parent-adolescent conflict and parent mental health (fear/avoidance of social situations and humiliation sensitivity) were significant predictors of adolescent internalizing symptoms. Acculturation scales were not significant predictors; however, internalizing symptoms decreased with time spent in the United States. Females and adolescents from lower socioeconomic status families reported more internalizing symptoms, while participants who had been in the United States longer reported fewer internalizing symptoms. Implications were discussed.

Multilevel risk factors and developmental assets for internalizing symptoms and self-esteem in disadvantaged adolescents: modeling longitudinal trajectories from the Rural Adaptation Project.

The current study filled significant gaps in our knowledge of developmental psychopathology by examining the influence of multilevel risk factors and developmental assets on longitudinal trajectories of internalizing symptoms and self-esteem in an exceptionally culturally diverse sample of rural adolescents. Integrating ecological and social capital theories, we explored if positive microsystem transactions are associated with self-esteem while negative microsystem transactions increase the chances of internalizing problems. Data came from the Rural Adaptation Project, a 5-year longitudinal panel study of more than 4,000 middle school students from 28 public schools in two rural, disadvantaged counties in North Carolina. Three-level hierarchical linear modeling models were estimated to predict internalizing symptoms (e.g., depression, anxiety) and self-esteem. Relative to other students, risk for internalizing problems and low self-esteem was elevated for aggressive adolescents, students who were hassled or bullied at school, and those who were rejected by peers or in conflict with their parents. Internalizing problems were also more common among adolescents from socioeconomically disadvantaged families and neighborhoods, among those in schools with more suspensions, in students who reported being pressured by peers, and in youth who required more teacher support. It is likely that these experiences left adolescents disengaged from developing social capital from ecological microsystems (e.g., family, school, peers). On the positive side, support from parents and friends and optimism about the future were key assets associated with lower internalizing symptoms and higher self-esteem. Self-esteem was also positively related to religious orientation, school satisfaction, and future optimism. These variables show active engagement with ecological microsystems. The implications and limitations were discussed.