Introduction to the Special Issue: Toward a Lifespan Prevention Science - A Focus on Middle and Late Adulthood.

The interdisciplinary field of prevention science was founded on the premise of a lifespan developmental model. Prevention scientists have developed a strong set of tools and intervention technologies for understanding and potentially modifying risk and protective factors through early adulthood. However, there is a demographic imperative to apply prevention science principles to health issues in middle and late adulthood. The articles in this special issue utilize a variety of methods to investigate important scientific questions about how theories, methodologies, and interventions applied in the science of prevention can be usefully integrated into the study of health and wellness in middle and late adulthood. More specifically, contributions (1) highlight current empirical research that draws on lifespan developmental science to address the unique prevention and intervention needs in middle and late adulthood, (2) illustrate the opportunities and challenges of a lifespan approach to prevention science with special attention to middle and late adulthood, and (3) identify additional areas that prevention science can contribute to advancements in middle and late adulthood. These articles provide a glimpse into the challenges and opportunities at the intersection of prevention science and gerontology. As a field, we have much room to grow in leveraging innovative tools, approaches, and efforts to best support older adults' physical, mental, and social health, particularly for diverse and under-served populations.

Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention.

BACKGROUND: In order to achieve wide-scale impact in community settings, programs must be sustained. Theory and empirical evidence suggest that intervention characteristics, organizational context, capacity for program implementation, and processes related to implementation are associated with continued program delivery. However, few studies examine how combinations of these factors work together in different settings to influence program sustainment. METHODS: Using scales specified in the Program Sustainability Assessment Tool (PSAT), the current cross-sectional study aims to identify the necessary and sufficient conditions for the sustainment of the Strengthening Families Program for Parents and Youth 10-14 (SFP 10-14). Staff (n = 59) at SFP 10-14 implementation sites across Washington State completed an online survey reporting on their current level of SFP 10-14 sustainment. They also completed PSAT, with eight scales designed to assess conditions that consistently produce sustainment. Data were analyzed using qualitative comparative analysis. RESULTS: Environmental support was the only necessary condition for sustainment success. Four solutions sufficient to achieve sustainment were also identified. These included the combined presence of (1) environmental support, organizational capacity, and funding stability; (2) environmental support, organizational capacity, communication, and program evaluation, in the absence of strategic planning; (3) environmental support, organizational capacity, program evaluation, and partnerships, in the absence of strategic planning; and (4) environmental support, communication, partnerships, and funding stability, in the absence of program evaluation. CONCLUSIONS: Environmental support in combination with organizational capacity appeared to most consistently produce sustainment of SFP 10-14 programs in Washington State. Program providers will benefit from a focusing on enhancing those conditions to increase program sustainment.

Which aspects of coalition functioning are key at different stages of coalition development? A qualitative comparative analysis.

Background: Coalitions are increasingly utilized to promote positive community health outcomes. Typically, coalitions produce more desirable outcomes when coalition functioning is strong and the coalition model is implemented with fidelity. Although theory indicates that coalitions proceed through predictable stages of development, minimal research explicitly examines functioning and fidelity at these different stages. Method: Within a larger evaluation of Washington State Community Prevention and Wellness Initiative, this cross-sectional study employs qualitative comparative analysis to illuminate the coalition functioning conditions necessary and sufficient to produce high model fidelity at different stages of development in 43 substance misuse prevention coalitions in one state. Results: In the formation stage, only the presence of high levels of coalition leadership was sufficient to produce high model fidelity. In the maintenance stage, three combinations of conditions were sufficient: (1) sustainability planning if, and only if, accompanied by the absence of coalition participation costs, (2) coordinator leadership, and (3) a combination of coalition leadership and team cohesion. In the institutionalization stage, two solutions were sufficient: (1) coalition leadership if, and only if, accompanied by the absence of sustainability planning, and (2) sustainability planning if, and only if, accompanied by the absence of coordinator leadership. Conclusions: This study illustrates several tangible steps technical assistance providers may take to increase the likelihood of achieving model fidelity. In the formation stage, skillful and inclusive coalition leadership is important. In the maintenance stage, technical assistance should focus on reducing participant-perceived costs; increasing sustainability planning; enhancing coordinator-specific leadership; and developing team cohesion and coalition leadership. For coalitions in the institutionalization stage, coalition leadership and sustainability planning may be prime targets for technical assistance.Plain Language Summary: Community coalition approaches to addressing social problems are common and have some evidence of producing positive community outcomes. Research shows that coalitions produce more desirable outcomes when coalition functioning is strong and the coalition model is implemented as it was designed. Although theory suggests that coalitions proceed through predictable stages of development, few studies look at which supports are most needed, at each stage, to improve coalition functioning and implementation. This study aims to help answer that question by determining which aspects of coalition functioning, in which combinations, are key to strong, well-functioning coalitions at different developmental stages in a sample of prevention coalitions in Washington State focused on youth substance misuse. The results suggest that having a strong coalition leadership team is key for all coalitions, regardless of development stage. For coalitions earlier in their formation, this was especially true. For coalitions further into their development, the combination of strong coordinator leadership and strong team cohesion was particularly important. Finally, for the most well-established coalitions, if sustainability planning was weak, strong coalition team leadership was key; but if coordinator leadership was weak, strong sustainability planning was critical to offset the lack of strong leadership. The results can be used to inform the types of technical assistance provided to support coalitions at different developmental stages.

Investigating the efficacy of a self-directed parenting intervention to reduce risky behaviors among college students: Study protocol for a multi-arm hybrid type 2 randomized control trial.

BACKGROUND: Early adulthood is a critical developmental period when many youth transition from living at home to the relative autonomy of college. This transition results in increased opportunity for positive growth and identity development - and for risky substance use and sexual behaviors. Parents continue to influence young adult behavior even from a distance; however, few studies have rigorously tested parent-college student interventions. METHODS: This multi-arm hybrid type 2 trial tests the short- and long-term efficacy of a self-directed handbook for parents of first-year college students. In the summer before college, parent-student dyads are randomly assigned to one of three conditions: control, Parent Handbook, or Parent Handbook Plus. Handbook parents receive encouragement via phone calls to read the handbook and complete activities with their student before leaving for college. Handbook Plus parents also receive booster messages targeted at risky or stressful times. Participants complete surveys of intervention-targeted knowledge, attitudes, and behaviors at baseline and four months after baseline. Students complete three additional surveys at nine, 16, and 21 months after baseline. Dyads in the intervention conditions also reported on handbook utilization, perceived usefulness, and engagement with intervention materials. DISCUSSION: Self-directed family interventions may be a feasible strategy for involving parents of college students. This trial aimed to determine: 1) the efficacy of a self-directed handbook intervention for parents of first-year college students, including whether the addition of periodic booster messages enhanced efficacy; and 2) how variations in handbook utilization, perceived usefulness, and engagement were linked to student outcomes.

Investigating the Relationship between University Students' Psychological Flexibility and College Self-Efficacy.

For many, college is a period of transition, marked with acute stress, threats to success, and decreases in self-efficacy. For certain groups of students, the risk of these poor outcomes is elevated. In this study, 348 students from a large residential university in the western United States were surveyed to understand the role of psychological flexibility and inflexibility on self-efficacy and the potential moderating impact of year in college and underrepresented racial minority (URM) status. Results indicated that students who are psychologically flexible reported greater college self-efficacy, whereas students who are psychologically inflexible reported lower college self-efficacy. The impact of psychological inflexibility on self-efficacy was moderated by URM status and year in school; psychological inflexibility had a stronger impact on URM students' self-efficacy than non-minority students, and psychological inflexibility had a greater effect on college students starting college as opposed to students who had been enrolled for multiple years.

Qualitative Comparative Analysis: A Mixed-Method Tool for Complex Implementation Questions.

The translation and scale-up of evidence-based programs require new methods to guide implementation decisions across varying contexts. As programs are translated to real-world settings, variability is introduced. Some program components may have minor roles to play in producing positive outcomes, and some may have major roles, but only if adapted to meet different contextual demands. While some sources of variability are likely to improve program outcomes, we currently lack methods that allow us to determine the critical components or combinations of components that serve as causal pathways to a desired outcome and then to advise practitioners accordingly. In this paper, we introduce a promising tool for this purpose and illustrate its use in a translational research context. Qualitative Comparative Analysis (QCA) is often used to examine causality in situations that have complex, multiply-determined outcomes. The basic premise of QCA is that different sets of causal conditions, or causal pathways, may lead to a single outcome (the principle of equifinality). We applied QCA to a selection of the highest- and lowest-performing programs from a multi-year two-state dissemination of The Strengthening Families Program for Parents and Adolescents 10-14 to determine which components or combinations of components at the implementation, program delivery, and participant levels produced desired participant outcomes. In particular, we examined which components were necessary (i.e., in the absence of these factors, the outcome didnot occur), and which were sufficient (i.e., in the presence of these factors, the outcome always occurred). Results demonstrated that certain conditions were necessary for program success. In addition, given those necessary conditions, there were two sets of conditions sufficient to produce success, regardless of the presence or absence of any of the others. QCA, not previously used in prevention science research, helps to illuminate causal pathways, leading to concrete, evidence-based implementation decisions that facilitate generalization and scale-up.

Strategies for Effective Eating Development-SEEDS: Design of an Obesity Prevention Program to Promote Healthy Food Preferences and Eating Self-Regulation in Children From Low-Income Families.

OBJECTIVE: To develop a scientifically based childhood obesity prevention program supporting child eating self-regulation and taste preferences. This article describes the research methods for the Strategies for Effective Eating Development program. A logic model is provided that depicts a visual presentation of the activities that will be used to guide the development of the prevention program. DESIGN: Randomized, controlled prevention program, pretest, posttest, 6 months, and 12 months. SETTING: Two sites: Houston, TX and Pasco, WA. Each trial will last 7 weeks with 8-10 mother-child dyads in each arm (prevention and control). PARTICIPANTS: Recruitment at Head Start districts (Texas; n = 160) and Inspire Child Development Center including Early Childhood Education and Head Start (Washington; n = 160). Sixteen trials with 16-20 parent-child dyads per trial will provide adequate power to detect moderate effects. INTERVENTION: Multicomponent family-based prevention program incorporating a dialogue approach to adult learning and self-determination theory. MAIN OUTCOME MEASURES: Child assessments will include observed taste preferences, caloric compensation, and eating in the absence of hunger. Parent assessments will include parent-reported feeding, feeding emotions, acculturation, child eating behaviors, child food preferences, and child dietary intake. Heights and weights will be measured for parent and child. ANALYSIS: A multilevel growth modeling analysis will be employed to consider the nested nature of the data: time points (level 1) within families (level 2) within trials (level 3).

Moving Beyond Drinking to Have a Good Time: a Person-Centered Approach to Identifying Reason Typologies in Legal-Aged College Student Drinkers.

Alcohol use, reasons for use, and consequences of use continue to be a major concern in college student populations. This is especially true for students of legal drinking age who may experience different reasons for and greater negative consequences of alcohol use than students under 21 years old. Although multiple studies have used person-centered approaches to understand motivations for and ultimately prevent alcohol use, few have identified multiple typologies of reasons for alcohol use. The current study used latent class analysis to identify homogeneous subtypes of reasons for alcohol use and how classification was associated with alcohol-related consequences in college students aged 21 years old and older (N = 2300) from the 2013 Indiana College Substance Use Survey. Four profiles of reasons for alcohol use emerged across males and females: social drinkers, feel good drinkers, relaxed escaping drinkers, and emotion coping drinkers. Although the likelihood of consequences differed across gender, the emotion coping drinkers were more likely to experience all negative consequences, suggesting that it was a high-risk class. In general, this pattern of risk continued with the feel good drinkers and female relaxed escaping drinkers. These results can help optimize college substance use prevention and intervention efforts to (1) identify and understand characteristics of high- and low-risk student drinkers and (2) tailor the content of interventions to those specific profiles resulting in more effective approaches to reducing alcohol use.

Selection effects and prevention program outcomes.

A primary goal of the paper is to provide an example of an evaluation design and analytic method that can be used to strengthen causal inference in nonexperimental prevention research. We used this method in a nonexperimental multisite study to evaluate short-term outcomes of a preventive intervention, and we accounted for effects of two types of selection bias: self-selection into the program and differential dropout. To provide context for our analytic approach, we present an overview of the counterfactual model (also known as Rubin's causal model or the potential outcomes model) and several methods derived from that model, including propensity score matching, the Heckman two-step approach, and full information maximum likelihood based on a bivariate probit model and its trivariate generalization. We provide an example using evaluation data from a community-based family intervention and a nonexperimental control group constructed from the Washington State biennial Healthy Youth Survey (HYS) risk behavior data (HYS n = 68,846; intervention n = 1,502). We identified significant effects of participant, program, and community attributes in self-selection into the program and program completion. Identification of specific selection effects is useful for developing recruitment and retention strategies, and failure to identify selection may lead to inaccurate estimation of outcomes and their public health impact. Counterfactual models allow us to evaluate interventions in uncontrolled settings and still maintain some confidence in the internal validity of our inferences; their application holds great promise for the field of prevention science as we scale up to community dissemination of preventive interventions.

Component analysis of adherence in a family intervention.

PURPOSE: Most studies of adherence use a single global measure to examine the relation of adherence to outcomes. These studies inform us about effects of overall implementation but not about importance of specific program elements. Previous research on the Strengthening Families Program 10-14 has shown that outcomes were unrelated to global adherence. The purpose of the present study was to determine whether adherence to specific components of SFP was related to outcomes, even though global adherence was not. DESIGN/METHODOLOGY/APPROACH: The authors micro-coded data from an observational study of 11 instances of SFP (N = 47 facilitators, 151 participants) into specific process and content components. Using multilevel analysis, they examined the relation of each component to program outcomes, accounting for individual- and program-level variables. FINDINGS: Most associations of adherence with outcome were negligible for European-Americans but significant for minority participants. RESEARCH LIMITATIONS/IMPLICATIONS: Global assessments of implementation are insufficient for complex, multi-component prevention programs and may obscure relations of implementation to outcomes. Additionally, program components may function differently based on participant characteristics. PRACTICAL IMPLICATIONS: Facilitators would benefit from understanding the function of individual program components, particularly when programs are delivered to diverse audiences. Program developers should provide detailed logic models of program theory to guide facilitators' decisions about adaptation. ORIGINALITY/VALUE: This is one of only a few studies to examine the relation of adherence to specific intervention components to outcomes in a real-world setting. Results show the utility of component analysis and the importance of considering individual characteristics for implementation assessment.

Motivating effort: a theoretical synthesis of the self-sufficiency and two-market theories.

We conducted two experimental studies to examine the effect of introducing social and monetary incentives on participants' (1) effort and (2) willingness to participate in a study. We found that extra credit invoked both communal sharing (CS, social reward) and market pricing (MP, monetary reward) schemas, thus leading to higher willingness to participate and greater effort in an experiment compared to an equivalent cash reward. Consistent with the potential combinational nature of different labour markets proposed by the relational theory, our results suggest that the labour market framework of monetary versus social incentive is not mutually exhaustive of all types of incentive, and the combinational effect created by introducing both labour markets may be the best motivator.

A Comparison of Participant and Practitioner Beliefs About Evaluation.

The move to build capacity for internal evaluation is a common organizational theme in social service delivery, and in many settings, the evaluator is also the practitioner who delivers the service. The goal of the present study was to extend our limited knowledge of practitioner evaluation. Specifically, the authors examined practitioner concerns about administering pretest and posttest evaluations within the context of a multisite 7-week family strengthening program and compared those concerns with self-reported attitudes of the parents who completed evaluations. The authors found that program participants (n = 105) were significantly less likely to find the evaluation process intrusive, and more likely to hold positive beliefs about the evaluation process, than practitioners (n = 140) expected. Results of the study may address a potential barrier to effective practitioner evaluation-the belief that having to administer evaluations interferes with establishing a good relationship with program participants.

Media exposure, internalization of the thin ideal, and body dissatisfaction: comparing Asian American and European American college females.

Internalization of the thin ideal mediates the media exposure-body dissatisfaction relation in young adult European American females. There is little related research on Asian Americans. We used structural equations modeling to test: (1) whether media exposure was associated with body dissatisfaction in Asian American young adult females, (2) internalization of the thin ideal mediated any such association, and (3) whether the mediational model provided equivalent fit for European American and Asian American samples. Participants were 287 college females (154 Asian Americans, 133 European Americans). Internalization of the thin ideal explained the media exposure-body dissatisfaction association equally well for both groups. Results suggest that Asian Americans may be employing unhealthy weight control behaviors, and may be prone to developing eating disorders, at rates similar to European American young adult females. Clinicians need to screen carefully for body dissatisfaction, unhealthy weight control behaviors, and eating disorders in Asian American females.

Measuring bias in self-reported data.

Response bias shows up in many fields of behavioural and healthcare research where self-reported data are used. We demonstrate how to use stochastic frontier estimation (SFE) to identify response bias and its covariates. In our application to a family intervention, we examine the effects of participant demographics on response bias before and after participation; gender and race/ethnicity are related to magnitude of bias and to changes in bias across time, and bias is lower at post-test than at pre-test. We discuss how SFE may be used to address the problem of 'response shift bias' - that is, a shift in metric from before to after an intervention which is caused by the intervention itself and may lead to underestimates of programme effects.

Trophic structure and mercury distribution in a Gulf of St. Lawrence (Canada) food web using stable isotope analysis.

Even at low concentrations in the environment, mercury has the potential to biomagnify in food chains and reaches levels of concern in apex predators. The aim of this study was to relate the transfer of total mercury (THg) and methylmercury (MeHg) in a Gulf of St. Lawrence food web to the trophic structure, from primary consumers to seabirds, using stable nitrogen (δ(15)N) and carbon (δ(13)C) isotope analysis and physical environmental parameters. The energy reaching upper trophic level species was principally derived from pelagic primary production, with particulate organic matter (POM) at the base of the food chain. We developed a biomagnification factor (BMF) taking into account the various prey items consumed by a given predator using stable isotope mixing models. This BMF provides a more realistic estimation than when using a single prey. Lipid content, body weight, trophic level and benthic connection explained 77.4 and 80.7% of the variation in THg and MeHg concentrations, respectively in this food web. When other values were held constant, relationships with lipid and benthic connection were negative whereas relationships with trophic level and body weight were positive. Total Hg and MeHg biomagnified in this food web with biomagnification power values (slope of the relationship with δ(15)N) of 0.170 and 0.235, respectively on wet weight and 0.134 and 0.201, respectively on dry weight. Values of biomagnification power were greater for pelagic and benthopelagic species compared to benthic species whereas the opposite trend was observed for levels at the base of the food chain. This suggests that Hg would be readily bioavailable to organisms at the base of the benthic food chain, but trophic transfer would be more efficient in each trophic level of pelagic and benthopelagic food chains.

Individual and peer group normative beliefs about relational aggression.

Studies show that children who use relational aggression process social information in unique ways; however, findings have been inconsistent and limited by methodological weaknesses. This short-term longitudinal study examined developmental changes in 245 (49% female; ages 8-13) 3rd through 8th graders' normative beliefs about relational aggression and tested the hypothesis that individual and classroom-level norms predict relational aggression 1 year later. Results showed that the transition to middle school was marked by increased approval of relational aggression, and individual norms predicted future relational aggression. Importantly, a contextual model showed that students in peer groups highly supportive of relational aggression became increasingly aggressive. Findings extend social information processing theories of relational aggression to focus on the role of peer group cognitions.

Detecting selection effects in community implementations of family-based substance abuse prevention programs.

To calculate valid estimates of the costs and benefits of substance abuse prevention programs, selection effects must be identified and corrected. A supplemental comparison sample is typically used for this purpose, but in community-based program implementations, such a sample is often not available. We present an evaluation design and analytic approach that can be used in program evaluations of real-world implementations to identify selection effects, which in turn can help inform recruitment strategies, pinpoint possible selection influences on measured program outcomes, and refine estimates of program costs and benefits. We illustrate our approach with data from a multisite implementation of a popular substance abuse prevention program. Our results indicate that the program's participants differed significantly from the population at large.

Implementation quality of a family-focused preventive intervention in a community-based dissemination.

The aims of this study were to determine (1) the degree to which an evidence-based intervention (EBI) delivered outside the context of a research trial remained faithful to the content and design of the programme as intended and as reported in experimental trials of the same programme, and (2) whether implementation quality affected programme outcomes. We report results of an observational study of 11 sites involved in the statewide dissemination of a popular family-focused prevention programme, the Strengthening Families Programme for Parents and Youth 10-14. We found numerous differences between the community-based implementations we observed and researcher-driven implementations of the same programme, but variability in programme delivery and adherence to content were unrelated to programme outcomes. We conclude that short-term outcomes of well-designed EBIs delivered by well-trained facilitators may be robust to minor changes in delivery and content. However, the effects of implementation quality on longer-term outcomes are unknown.

At what age do children start taking daily asthma medicines on their own?

OBJECTIVE: Use of daily controller medications is a critical task in management of persistent asthma. Study aims were to examine (1) the association between child age and extent of daily controller-medication responsibility in a sample aged 4 to 19 years, (2) parent, child, and disease predictors of child daily controller-medication responsibility and overall daily controller-medication adherence, and (3) the association between child daily controller-medication responsibility and overall daily controller-medication adherence. METHODS: We conducted a cross-sectional telephone survey of 351 parents of children who were prescribed daily controller medication. Children's mean age was 10.4 years; 61.5% were male, and 88.1% were white. Parents provided all data, including an estimate of the percentage of child and parent daily controller-medication responsibility. Daily controller-medication adherence was measured as parents' report of percentage of daily doses taken per doses prescribed in a typical week. We used multivariate linear regression to determine associations between parent race/ethnicity, education, income, number of dependents, child age, gender, years since diagnosis, parent perception of symptom severity and control, and dependent variables (child daily controller-medication responsibility and daily controller-medication adherence). We also examined associations between child daily controller-medication responsibility and daily controller-medication adherence. RESULTS: Child daily controller-medication responsibility increased with age. By age 7, children had assumed, on average, almost 20% of daily controller-medication responsibility; by age 11, approximately 50%; by age 15, 75%; and by age 19, 100%. In multivariate models, child age and male gender remained significantly associated with child daily controller-medication responsibility, and child's age and parents' race/ethnicity remained significantly associated with daily controller-medication adherence. CONCLUSIONS: Clinicians may need to screen for child daily controller-medication management and include even young children when educating families on the use of asthma medications and other key asthma-management tasks.

"Just three more bites": an observational analysis of parents' socialization of children's eating at mealtime.

The objective of this study was to describe comprehensively the structure and process of the childhood mealtime environment. A socioeconomically diverse sample of 142 families of kindergarteners (52% females) was observed at dinnertime using a focused-narrative observational system. Eighty-five percent of parents tried to get children to eat more, 83% of children ate more than they might otherwise have, with 38% eating moderately to substantially more. Boys were prompted to eat as often as girls and children were prompted to eat as many times in single- as in two-parent households. Children were very rarely restricted in their mealtime intake. High-SES parents used reasoning, praise, and food rewards significantly more often than low-SES families. Mothers used different strategies than fathers: fathers used pressure tactics with boys and mothers praised girls for eating. Future research should examine the meanings children ascribe to their parents' communications about food intake and how perceived parental messages influence the development of long-term dietary patterns. Interpreted alongside the evidence for children's energy self-regulation and the risk of disruption of these innate processes, it may be that parents are inadvertently socializing their children to eat past their internal hunger/satiety cues. These data reinforce current recommendations that parents should provide nutritious foods and children, not parents, should decide what and how much of these foods they eat.