The Theory of Planned Behavior and Adolescent Marijuana Use: Examining the Moderating Effects of Cigarette and E-cigarette Co-use.

Background: This study examines the moderating effects of cigarette and e-cigarette co-use on the relationship between adolescent intention to use and marijuana use using the Theory of Planned Behavior (TPB). Method: A total of 217,276 adolescents in grades 6, 8, 10, and 12 were assessed using data from a large statewide surveillance dataset of youth self-report of substance use and related risk and protective factors. Structural Equation Models consisting of latent variables representing behavioral, normative, and control beliefs were regressed on intention to use and past 30-day marijuana use. Tests of moderation of the pathways between intention and marijuana use were used to test hypotheses, and grade level, gender, and race were included as covariates. Results: The overall model fit of the TPB predicting adolescent marijuana use provided good fit to the data (χ2(127) = 58042, p < 0.01, CFI = 0.95, TLI = 0.94, RMSEA = 0.04, SRMR = 0.03). After controlling for features of the model that may serve as common liability to substance use, past 30-day cigarette use moderated the relationship between intention and marijuana use (ß = 0.46, p <.001). A stronger moderating effect was observed with past 30-day e-cigarette use (ß = 0.63, p <.001). Past 12-month nicotine vaping (ß = 0.44, p <.001) and flavor-only vaping (ß = 0.30, p <.001) strengthened the relationship between intention and marijuana use. Conclusion: Adolescent marijuana use prevention may be enhanced by targeting general inhalation behaviors and restricting access to cigarettes, e-cigarettes, and flavor-only vaping products.

Successes and lessons learned in database development for national multi-site cancer care delivery research trials: the Alliance for Clinical Trials in Oncology experience.

INTRODUCTION: Alliance for Clinical Trials in Oncology (Alliance) coordinated trials utilize Medidata Rave® (Rave) as the primary clinical data capture system. A growing number of innovative and complex cancer care delivery research (CCDR) trials are being conducted within the Alliance with the aims of studying and improving cancer-related care. Because these trials encompass patients, providers, practices, and their interactions, a defining characteristic of CCDR trials is multilevel data collection in pragmatic settings. Consequently, CCDR trials necessitated innovative strategies for database development, centralized data management, and data monitoring in the presence of these real-world multilevel relationships. Having real trial experience in working with community and academic centers, and having recently implemented five CCDR trials in Rave, we are committed to sharing our strategies and lessons learned in implementing such pragmatic trials in oncology. METHODS: Five Alliance CCDR trials are used to describe our approach to analyzing the database development needs and the novel strategies applied to overcome the unanticipated challenges we encountered. The strategies applied are organized into 3 categories: multilevel (clinic, clinic stakeholder, patient) enrollment, multilevel quantitative and qualitative data capture, including nontraditional data capture mechanisms being applied, and multilevel data monitoring. RESULTS: A notable lesson learned in each category was (1) to seek long-term solutions when developing the functionality to push patient and non-patient enrollments to their respective Rave study database that affords flexibility if new participant types are later added; (2) to be open to different data collection modalities, particularly if such modalities remove barriers to participation, recognizing that additional resources are needed to develop the infrastructure to exchange data between that modality and Rave; and (3) to facilitate multilevel data monitoring, orient site coordinators to the their trial's multiple study databases, each corresponding to a level in the hierarchy, and remind them to establish the link between patient and non-patient participants in the site-facing NCI web-based enrollment system. CONCLUSION: Although the challenges due to multilevel data collection in pragmatic settings were surmountable, our shared experience can inform and foster collaborations to collectively build on our past successes and improve on our past failures to address the gaps.

Long-term impacts of the CARE program on teachers' self-reported social and emotional competence and well-being.

Teacher stress is at an all-time high, negatively impacting the quality of education and student outcomes. In recent years, mindfulness-based interventions have been shown to promote well-being and reduce stress among healthy adults. In particular, mindfulness-based interventions enhance emotion regulation and reduce psychological distress. One such program specifically designed to address teacher stress is Cultivating Awareness and Resilience in Education (CARE). The present study examined teachers' self-reported data collected at three time points over two consecutive school years as part of a randomized controlled trial of CARE. The study involved 224 teachers in 36 elementary schools in high poverty areas of New York City. Teachers were randomly assigned within schools to receive CARE or to a waitlist control group. This study builds on previous experimental evidence of the impacts of CARE on teacher self-reported outcomes for this sample of teachers within one school year (Jennings et al., 2017). Results indicate that at the third assessment point (9.5 months after participating in the program), CARE teachers showed continued significant decreases in psychological distress, reductions in ache-related physical distress, continued significant increases in emotion regulation and some dimensions of mindfulness. Findings indicate that teachers who participated in mindfulness-based professional development through CARE reported both sustained and new benefits regarding their well-being at a follow-up assessment almost one-year post-intervention compared to teachers in the control condition. Implications for further research and policy are discussed.

Learning to BREATHE: an intervention to foster mindfulness in adolescence.

During adolescence, young people are traversing exciting and also challenging stages in their development. Mindfulness, if taught in a developmentally appropriate way, has the potential to be an asset in adolescents' lives. Developmentally appropriate approaches of mindfulness intervention during adolescence need to consider adolescents' social contexts (for example, school setting, peer group, family), their cognitive and emotional stages in development, and age-specific strength and vulnerabilities. This chapter puts mindfulness education into a developmental perspective, and presents the Learning to BREATHE program as a school-based universal intervention for adolescents. The authors describe developmental dimensions and themes of the program, and discuss common challenges of program implementation in schools. A case example of bringing the Learning to BREATHE program into the school context is provided.

Improving classroom learning environments by Cultivating Awareness and Resilience in Education (CARE): results of a randomized controlled trial.

Cultivating Awareness and Resilience in Education (CARE for Teachers) is a mindfulness-based professional development program designed to reduce stress and improve teachers' performance and classroom learning environments. A randomized controlled trial examined program efficacy and acceptability among a sample of 50 teachers randomly assigned to CARE or waitlist control condition. Participants completed a battery of self-report measures at pre- and postintervention to assess the impact of the CARE program on general well-being, efficacy, burnout/time pressure, and mindfulness. Participants in the CARE group completed an evaluation of the program after completing the intervention. ANCOVAs were computed between the CARE group and control group for each outcome, and the pretest scores served as a covariate. Participation in the CARE program resulted in significant improvements in teacher well-being, efficacy, burnout/time-related stress, and mindfulness compared with controls. Evaluation data showed that teachers viewed CARE as a feasible, acceptable, and effective method for reducing stress and improving performance. Results suggest that the CARE program has promise to support teachers working in challenging settings and consequently improve classroom environments.

Opening the "Black Box": family check-up intervention effects on self-regulation that prevents growth in problem behavior and substance use.

Family-school interventions are a well-established method for preventing and remediating behavior problems in at-risk youth, yet the mechanisms of change underlying their effectiveness are often overlooked or poorly understood. The Family Check-Up (FCU), a school-based, family-centered intervention, has been consistently associated with reductions in youth antisocial behavior, deviant peer group affiliation, and substance use. The purpose of this study was to explore proximal changes in student-level behavior that accounts for links between implementation of the FCU and changes in youth problem behavior. Data were drawn from a randomized controlled trial study of the efficacy of the FCU among 593 ethnically diverse middle school students followed longitudinally from 6th through 8th grades. Latent growth curve analyses revealed that random assignment to the FCU intervention condition was related to increased mean levels of students' self-regulation from 6th to 7th grades, which in turn reduced the risk for growth in antisocial behavior, involvement with deviant peers, and alcohol, tobacco, and marijuana use through the 8th grade. Overall, these findings highlight the robust implications of self-regulation as a proximal target for family-centered interventions.