Developing and validating a new scale to measure the acceptability of health apps among adolescents.

BACKGROUND: The acceptability of health interventions is centrally important to achieving their desired health outcomes. The construct of acceptability of mobile health interventions among adolescents is neither well-defined nor consistently operationalized. OBJECTIVES: Building on the theoretical framework of acceptability, these two studies developed and assessed the reliability and validity of a new scale to measure the acceptability of mobile health applications ("apps") among adolescents. METHODS: We followed a structured scale development process including exploratory factor analyses (EFAs), confirmatory factor analyses (CFAs), and employed structural equation modeling (SEM) to assess the relationship between the scale and app usage. Adolescent participants used the Fooducate healthy eating app and completed the acceptability scale at baseline and one-week follow-up. RESULTS: EFA (n = 182) determined that the acceptability of health apps was a multidimensional construct with six latent factors: affective attitude, burden, ethicality, intervention coherence, perceived effectiveness, and self-efficacy. CFA (n = 161) from the second sample affirmed the six-factor structure and the unidimensional structures for each of the six subscales. However, CFA did not confirm the higher-order latent factor model suggesting that the six subscales reflect unique aspects of acceptability. SEM indicated that two of the subscales-ethicality and self-efficacy-were predictive of health app usage at one-week follow-up. CONCLUSIONS: These results highlight the importance of ethicality and self-efficacy for health app acceptability. Future research testing and adapting this new acceptability scale will enhance measurement tools in the fields of mobile health and adolescent health.

Intervening for sustainable change: Tailoring strategies to align with values and principles of communities.

This paper presents a rationale for tailoring implementation strategies within a values-driven implementation approach. Values-driven implementation seeks to organize implementers around clarifying statements of their shared values in ways that harmonize implementation dynamics related to individual and group mental models, relationships among implementers, and the implementation climate. The proposed approach to tailoring strategies is informed by systems theory and emphasizes the need to focus on both tangible events and behaviors, as well deeper patterns, structures, relationships, and mental models, in order to increase the likelihood of sustaining implementation efforts and improving outcomes for people and communities. We offer for consideration three specific sets of context determinants that are under-represented in the implementation literature and that emerge as especially relevant within a systems approach to identifying and successfully tailoring implementation strategies in the implementation setting including relationships, mental models, and implementation climate.

Investigating the Complex Relationship Between Intimate Partner Violence Victimization and Perpetration Among System-Involved Women in Heterosexual Relationships: An Exploratory Analysis.

Research indicates women who perpetrate intimate partner violence (IPV) experience both more frequent and more severe IPV victimization. However, the IPV field needs additional research to understand the complex relationship between various forms of IPV victimization (e.g., psychological, physical, sexual) and IPV perpetration by women. In particular, the field needs a better understanding of the unique interplay of various forms of IPV victimization and perpetration among female system-involved survivors (i.e., female survivors involved with child protective services and/or the court system and mandated to services). Such understanding would aid extant efforts to ensure that mandated services address the experiences and meet the needs of these system-involved women. To address this knowledge gap, we conducted an exploratory, secondary data analysis using cross-sectional baseline data collected as part of a larger evaluation study of a psychoeducational therapeutic IPV and parenting program for system-involved IPV survivors mandated to services (N = 73). Results from multiple regression analyses revealed that both psychological and physical IPV victimization were uniquely associated with the perpetration of psychological and physical abuse by system-involved female IPV survivors. Furthermore, our examination of the interaction between physical and psychological victimization and its impact on perpetration revealed that higher levels of both physical and psychological IPV victimization were associated with significantly higher levels of psychological perpetration (p < .01) and increased likelihood of physical perpetration (p < .05). Results are discussed in the context of service provision within systems, agencies, and programs targeting system-involved women mandated to services for IPV.

Effect of a Trauma-Awareness Course on Teachers' Perceptions of Conflict With Preschool-Aged Children From Low-Income Urban Households: A Cluster Randomized Clinical Trial.

Importance: Adverse childhood experiences are common and are associated with changes in early development and learning, but training early childhood educators in trauma-informed approaches to care has not been evaluated with randomized clinical trials. Objective: To determine whether a 6-session (12-week) professional development course, "Enhancing Trauma Awareness," improved the quality of teachers' relationships with the children in their classrooms. Design, Setting, and Participants: This cluster randomized clinical trial conducted from September 2017 to May 2018 allocated classrooms by a computer-generated random sequence to intervention (attend Enhancing Trauma Awareness course) and control (no course) groups. Outcomes were reported by participants via survey and analyzed by group allocation. Classrooms under the auspice of the School District of Philadelphia, Pennsylvania, serving 3- and 4-year-old children living in low-income households were invited to participate. Lead and/or assistant teachers from 63 of 348 eligible classrooms (18.1%) agreed to participate, and none were excluded. Of 96 enrolled teachers, 93 (96.9%) were assessed at follow-up (61 of 63 classrooms [96.8%]). Exposures: In September 2017, 32 classrooms (48 teachers) were assigned to receive a professional development course that taught about the effects of trauma using a group-based relational process, and 31 classrooms (48 teachers) received no intervention. Teachers completed online surveys immediately before and after the course. Exploratory focus groups with intervention teachers (n = 15) were conducted 5 months after the course ended. Main Outcomes and Measures: The primary outcome was teacher-children relationship quality, with a hypothesized decrease in teacher-children conflict scores. Secondary outcomes included relational capacities (eg, empathy, emotion regulation, and dispositional mindfulness). Focus group themes described teachers' experience of the course. Results: Of 96 teachers enrolled, 93 (96.9%) were women, and 58 (60.4%) were 40 years and older. Follow-up surveys were completed by 46 teachers (95.8%) in the control group and 47 (97.9%) in the intervention group, of whom 38 (79.2%) attended 4 or more course sessions. Adjusting for baseline values, mean (SE) conflict scores after the course were not significantly different between course participants (15.8 [0.6]) and controls (15.0 [0.6]) (effect size = 0.16; 95% CI, -0.19 to 0.52). There were no significant between-group differences in secondary outcomes. However, in focus groups, the teachers reported improvements in teacher-children relationship quality and several related relational capacities. Conclusions and Relevance: A course to enhance trauma awareness among preschool teachers did not reduce teacher-children conflict scores, yet qualitative assessments suggested the potential for improved teacher-children relationship quality. Trial Registration: ClinicalTrials.gov identifier: NCT03303482.

Preliminary Efficacy of Family Implemented TEACCH for Toddlers: Effects on Parents and Their Toddlers with Autism Spectrum Disorder.

This study examined the effects of an intervention to support parents and promote skill development in newly diagnosed toddlers with ASD. Participants included 50 children with ASD under 3 and their parents who were randomly assigned to participate in a 6-month intervention, Family Implemented TEACCH for Toddlers (FITT) or 6 months of community services as usual. FITT included 90-min in-home sessions (n = 20) and parent group sessions (n = 4). Results revealed significant treatment effects on parent stress and well-being, with families in the FITT group showing decreased stress and improved well-being over time. While no treatment effects were found for global child measures, there were significant treatment effects on social communication skills.

The Impact of Individual Differences on a Bilingual Vocabulary Approach for Latino Preschoolers.

Purpose: The purpose of this study was twofold: First, we replicated in a new sample our previous findings that a culturally and linguistically responsive (CLR) bilingual approach for English vocabulary instruction for preschool Latino dual language learners was effective. Subsequently, we investigated whether the positive effect of CLR instruction varies as a function of individual child characteristics, including baseline vocabulary levels and gender. Method: Using a randomized pretest-posttest follow-up group design, we first replicated our previous study (N = 42) with a new sample by randomly assigning 35 Spanish-speaking Latino preschoolers to a CLR bilingual group or an English-only group. The preschoolers received small-group evidence-informed shared readings targeting 30 English words 3 times a week for 5 weeks in their preschools. Vocabulary outcomes were measured using both standardized and researcher-developed measures. We subsequently conducted further studies with the combined sample size of 77 children to examine the variability in intervention effects related to child gender and baseline vocabulary levels. Results: The direct replication study confirmed findings of our earlier work suggesting that the CLR bilingual approach promoted greater gains in L1 and L2 vocabulary than in an English-only approach. The extension studies revealed that the effect of the CLR bilingual vocabulary approach on English and Spanish vocabulary outcomes was not impacted by gender or vocabulary status at baseline. Conclusion: This study provides additional evidence of the benefits of strategically combining L1 and L2 for vocabulary instruction over an English-only approach. Our findings also suggest that preschool Latino dual language learners can benefit from a bilingual vocabulary instructional approach regardless of gender or baseline vocabulary levels in L1.

The Unique and Interactive Effects of Parent and School Bonds on Adolescent Delinquency.

Parent and school bonds are protective against delinquency. This study used longitudinal data and multilevel Poisson regression models (MLM) to examine unique and interactive associations of parent and school bonds on youth delinquency in a sample of rural adolescents (n = 945; 84% White). We investigated whether youth sex or transitioning to a new middle school moderated the linkages between parent and school bonds and later delinquency. Results indicated reduced delinquency was associated with positive parent and school relationships. Parent and school bonds interacted such that linkages between parent bonding and youth delinquency were stronger when youth also had high school bonding - suggesting an additive effect. However, interactive effects were only found when youth remained in the same school and became nonsignificant if they transitioned to a new school. Findings support prior evidence that parent and school bonds - and their interaction - play a unique role in reducing delinquency.

A culturally and linguistically responsive vocabulary approach for young Latino dual language learners.

PURPOSE: This study examined the role of the language of vocabulary instruction in promoting English vocabulary in preschool Latino dual language learners (DLLs). The authors compared the effectiveness of delivering a single evidence-informed vocabulary approach using English as the language of vocabulary instruction (English culturally responsive [ECR]) versus using a bilingual modality that strategically combined Spanish and English (culturally and linguistically responsive [CLR]). METHOD: Forty-two DLL Spanish-speaking preschoolers were randomly assigned to the ECR group (n=22) or CLR group (n=20). Thirty English words were presented during small-group shared readings in their preschools 3 times a week for 5 weeks. Multilevel models were used to examine group differences in postinstruction scores on 2 Spanish and 2 English vocabulary assessments at instruction end and follow-up. RESULTS: Children receiving instruction in the CLR bilingual modality had significantly higher posttest scores (than those receiving the ECR English-only instruction) on Spanish and English vocabulary assessments at instruction end and on the Spanish vocabulary assessment at follow-up, even after controlling for preinstruction scores. CONCLUSIONS: The results provide additional evidence of the benefits of strategically combining the first and second language to promote English and Spanish vocabulary development in this population. Future directions for research and clinical applications are discussed.

Adult outcomes as a function of an early childhood educational program: an Abecedarian Project follow-up.

Adult (age 30) educational, economic, and social-emotional adjustment outcomes were investigated for participants in the Abecedarian Project, a randomized controlled trial of early childhood education for children from low-income families. Of the original 111 infants enrolled (98% African American), 101 took part in the age 30 follow-up. Primary indicators of educational level, economic status, and social adjustment were examined as a function of early childhood treatment. Treated individuals attained significantly more years of education, but income-to-needs ratios and criminal involvement did not vary significantly as a function of early treatment. A number of other indicators were described for each domain. Overall, the findings provide strong evidence for educational benefits, mixed evidence for economic benefits, and little evidence for treatment-related social adjustment outcomes. Implications for public policy are discussed.

Early educational intervention, early cumulative risk, and the early home environment as predictors of young adult outcomes within a high-risk sample.

The extent to which early educational intervention, early cumulative risk, and the early home environment were associated with young adult outcomes was investigated in a sample of 139 young adults (age 21) from high-risk families enrolled in randomized trials of early intervention. Positive effects of treatment were found for education attainment, attending college, and skilled employment; negative effects of risk were found for education attainment, graduating high school, being employed, and avoiding teen parenthood. The home mediated the effects of risk for graduating high school, but not being employed for teen parenthood. Evidence for moderated mediation was found for educational attainment; the home mediated the association between risk and educational attainment for the control group, but not the treated group.