Mechanisms of Influence on Youth Substance Use for a Social-Emotional and Character Development Program: A Theory-Based Approach.

Background: The Theory of Triadic Influence (TTI) provides a comprehensive framework for understanding adolescent substance use. Objectives: We examined mechanisms by which a TTI-guided social-emotional and character development program, Positive Action (PA), influences adolescent substance use. Study data come from the PA-Chicago, longitudinal matched-pairs cluster-randomized control trial. A diverse, dynamic cohort of approximately 1,200 students from 14 low-performing schools were assessed at eight points of time, between grades 3-8, across a six-year period. Students completed scales related to substance use, self-control, deviant peer affiliation, and school attachment, adapted from the Risk Behavior Survey, Social-Emotional and Character Development Scale, Conventional Friends Scale, and People in My Life Scale. After testing the overall effect of PA on substance use, we used latent growth modeling to assess whether effects on each outcome were mediated by longitudinal changes in three composite measures aligning with the TTIs three streams. Results: Students in PA schools reported fewer experiences with drinking, getting drunk, and overall substance use. In the multiple mediator models, significant indirect effects of PA on substance use via changes in self-control were evident. Conclusions/Importance: Findings are consistent with theory and past research suggesting the influence of self-control on youth substance use. Future studies should include implementation in different settings and additional theory-based measures.Trial RegistrationThis trial is registered at ClinicalTrials.gov NCT01025674.

Relational victimization and peer affiliate prosocial behaviors in African American adolescents: Moderating effects of gender and antisocial behavior.

INTRODUCTION: Experiencing relational victimization (e.g., peer exclusion, untrue rumors) during adolescence can have negative social-emotional consequences, including increased antisocial behavior and substance use. The negative impact of relational victimization may be lessened by spending time with supportive, prosocial peers. METHODS: This study examined the concurrent and predictive associations between relational victimization and peer affiliates' prosocial behaviors in 244 predominately African American adolescents (ages 13-14) living in U.S. urban neighborhoods. Questionnaires were collected every six months for two years. Overt victimization was controlled for in the analysis and the moderation of gender and antisocial behaviors were tested. RESULTS: Peer affiliates' prosocial behavior was stable across the two years. Relational victimization was not associated with peers' prosocial behavior at baseline or across time. Gender did not moderate the association between relational victimization and peers' prosocial behavior. Moderating effects were found for antisocial behavior; relational victimization was positively associated with peer affiliates' prosocial behavior but only for adolescents who were low on antisocial behavior at baseline. CONCLUSIONS: For African American youth, efforts to reduce relational aggression and increase peer support in prosocial activities prior to adolescence may be useful for preventing social-emotional problems.

School, Friends, and Substance Use: Gender Differences on the Influence of Attitudes Toward School and Close Friend Networks on Cannabis Involvement.

The school environment is extremely salient in young adolescents' lives. Adolescents who have unfavorable attitudes toward school and teachers are at elevated risk for dropping out of school and engaging in behavioral health risks. Peer network health-a summation of the positive and negative behaviors in which one's close friend group engages-may be one way by which attitudes toward school exert influence on youth substance use. Utilizing a sample of 248 primarily African-American young urban adolescents, we tested a moderated mediation model to determine if the indirect effect of attitude to school on cannabis involvement through peer network health was conditioned on gender. Attitude toward school measured at baseline was the predictor (X), peer network health measured at 6 months was the mediator (M), cannabis involvement (including use, offers to use, and refusals to use) measured at 24 months was the outcome (Y), and gender was the moderator (W). Results indicated that negative attitudes toward school were indirectly associated with increased cannabis involvement through peer network health. This relationship was not moderated by gender. Adolescents in our sample with negative attitudes toward school were more likely to receive more offers to use cannabis and to use cannabis more frequently through the perceived health behaviors of their close friends. Implications from these results point to opportunities to leverage the dynamic associations among school experiences, friends, and cannabis involvement, such as offers and use.

Can Universal SEL Programs Benefit Universally? Effects of the Positive Action Program on Multiple Trajectories of Social-Emotional and Misconduct Behaviors.

Behavioral trajectories during middle childhood are predictive of consequential outcomes later in life (e.g., substance abuse, violence). Social and emotional learning (SEL) programs are designed to promote trajectories that reflect both growth in positive behaviors and inhibited development of negative behaviors. The current study used growth mixture models to examine effects of the Positive Action (PA) program on behavioral trajectories of social-emotional and character development (SECD) and misconduct using data from a cluster-randomized trial that involved 14 schools and a sample of predominately low-income, urban youth followed from 3rd through 8th grade. For SECD, findings indicated that PA was similarly effective at improving trajectories within latent classes characterized as "high/declining" and "low/stable". Favorable program effects were likewise evident to a comparable degree for misconduct across observed latent classes that reflected "low/rising" and "high/rising" trajectories. These findings suggest that PA and perhaps other school-based universal SEL programs have the potential to yield comparable benefits across subgroups of youth with differing trajectories of positive and negative behaviors, making them promising strategies for achieving the intended goal of school-wide improvements in student outcomes.

A Mixed-Methods Approach Examining Illicit Prescription Stimulant Use: Findings From a Northern California University.

Preventing the illicit use of prescription stimulants, a particularly high-risk form of substance use, requires approaches that utilize theory-guided research. We examined this behavior within the context of a random sample of 554 undergraduate students attending a university in northern California. Approximately 17% of students self-reported engaging in this behavior during college; frequency of misuse per academic term ranged from less than once to 40 or more times. Although most misusers reported oral ingestion, a small proportion reported snorting and smoking the drug. The majority of misusers reported receiving the drug at no cost, and the primary source of the drug was friends. Misusers were motivated by both academic (e.g., to improve focus) and non-academic (e.g., to experiment) reasons. Our thematic analyses of an open-end question revealed that students abstaining from illicit use of prescription stimulants did so primarily for reasons related to health risks, ethics, and adherence regulations. Results from adjusted logistic regression analyses showed that correlates of the behavior were intrapersonal, interpersonal, and environmental in nature. We conclude that characteristics of misuse are a cause for concern, and correlates of the behavior are multifaceted. These findings, in addition to insights provided by students who choose not to engage in this behavior, suggest that a number of prevention approaches are plausible, such as a social norms campaign that simultaneously corrects exaggerated beliefs about prevalence while also illustrating why abstainers, in their own words, choose to abstain.

Effects of a School-Based Social-Emotional and Character Development Program on Health Behaviors: A Matched-Pair, Cluster-Randomized Controlled Trial.

There is considerable research that suggests that school-based social-emotional programs can foster improved mental health and reduce problem behaviors for participating youth; in contrast, much less is known about the impact of these programs on physical health, even though some of these programs also include at least limited direct attention to promoting physical health behaviors. We examined the effects of one such program, Positive Action (PA), on physical health behaviors and body mass index (BMI), and tested for mediation of program effects through a measure of social-emotional and character development (SECD). Participating schools in the matched-pair, cluster-randomized trial were 14 low-performing K-8 Chicago Public Schools. We followed a cohort of students in each school from grades 3 to 8 (eight waves of data collection; 1170 total students). Student self-reports of health behaviors served as the basis for measures of healthy eating and exercise, unhealthy eating, personal hygiene, consistent bedtime, and SECD. We collected height and weight measurements at endpoint to calculate age- and gender-adjusted BMI z-scores. Longitudinal multilevel modeling analyses revealed evidence of favorable program effects on personal hygiene [effect size (ES) = 0.48], healthy eating and exercise (ES = 0.21), and unhealthy eating (ES = -0.19); in addition, BMI z-scores were lower among students in PA schools at endpoint (ES = -0.21). Program effects were not moderated by either gender or student mobility. Longitudinal structural equation modeling demonstrated mediation through SECD for healthy eating and exercise, unhealthy eating, and personal hygiene. Findings suggest that a SECD program without a primary focus on health behavior promotion can have a modest impact on outcomes in this domain during the childhood to adolescence transition.

Commentary on the 2015 SPR Standards of Evidence.

We comment on the 2015 Society for Prevention Research standards of evidence document, summarizing major changes from the previous 2005 Standards, and point to ways in which the Standards could be further improved. We endorse important new standards, such as those on testing the causal theory and mechanisms of the intervention, improved trial reporting standards, and added attention to scale-up research and cost analyses. Despite discussion of replication in the new Standards, we are concerned about the lack of stand-alone replication standards, and the deletion of an explicit requirement for replication before an intervention is considered efficacious. Finally, we are deeply concerned about the lack of attention to the unit or level of aggregation of the intervention target. It is a major conceptual oversight. The unit targeted by an intervention (whether a cell, person, organization, community, state, nation) is a fundamental feature shaping intervention theory, research design, data collection, analyses, effect sizes, diffusion possibilities and patterns, and scale-up issues. Future Standards updates should eliminate the implicit assumption in the current text that effective preventive interventions inherently target individual persons.

Teachers' Perceptions of School Organizational Climate as Predictors of Dosage and Quality of Implementation of a Social-Emotional and Character Development Program.

Organizational climate has been proposed as a factor that might influence a school's readiness to successfully implement school-wide prevention programs. The aim of this study was to evaluate the influence of teachers' perceptions of three dimensions of school organizational climate on the dosage and quality of teacher implementation of Positive Action, a social-emotional and character development (SECD) program. The dimensions measured were teachers' perceptions of (a) the school's openness to innovation, (b) the extent to which schools utilize participatory decision-making practices, and (c) the existence of supportive relationships among teachers (teacher-teacher affiliation). Data from 46 teachers in seven schools enrolled in the treatment arm of a longitudinal, cluster-randomized, controlled trial were analyzed. Teacher perceptions of a school's tendency to be innovative was associated with a greater number of lessons taught and self-reported quality of delivery, and teacher-teacher affiliation was associated with a higher use of supplementary activities. The findings suggest that perceptions of a school's organizational climate impact teachers' implementation of SECD programs and have implications for school administrators and technical assistance providers as they work to implement and sustain prevention programs in schools.

Development and psychometric properties of a theory-guided prescription stimulant misuse questionnaire for college students.

A theory-guided instrument for examining prescription stimulant misuse in the college population was developed and its psychometric properties were evaluated from 2011 to 2012 at one Pacific Northwest (United States) university. Study methods included instrument development, assessment by five health and measurement professionals, group interviews with six college students, a test-retest pilot study, and a paper-based, in-classroom, campus study using one-stage cluster sampling (N = 520 students, 20 classrooms, eligible student response rate = 96.30%). The instrument demonstrated reliability (i.e., internal consistency and stability) and validity (i.e., face, content, and predictive). Limitations and implications are discussed.

Using the community readiness model as an approach to formative evaluation.

This article presents an adapted version of an established model for assessing community readiness along with an illustrative case example from the evaluation of Positive Action, a school-based social and character development intervention, implemented as part of a randomized controlled trial in Chicago Public Schools from 2004 through 2010. Community readiness is an emerging assessment approach that can be used to gauge the level of understanding, desire, and ownership that community members have regarding a community problem and/or intervention. This approach is useful in engaging the community and leveraging particular aspects of readiness that the community may exhibit in order to maximize an intervention's successful implementation. The article concludes with a discussion of ways in which a community readiness model may be useful in health promotion practice, both in schools and in other community settings.

Person mobility in the design and analysis of cluster-randomized cohort prevention trials.

Person mobility is an inescapable fact of life for most cluster-randomized (e.g., schools, hospitals, clinic, cities, state) cohort prevention trials. Mobility rates are an important substantive consideration in estimating the effects of an intervention. In cluster-randomized trials, mobility rates are often correlated with ethnicity, poverty and other variables associated with disparity. This raises the possibility that estimated intervention effects may generalize to only the least mobile segments of a population and, thus, create a threat to external validity. Such mobility can also create threats to the internal validity of conclusions from randomized trials. Researchers must decide how to deal with persons who leave study clusters during a trial (dropouts), persons and clusters that do not comply with an assigned intervention, and persons who enter clusters during a trial (late entrants), in addition to the persons who remain for the duration of a trial (stayers). Statistical techniques alone cannot solve the key issues of internal and external validity raised by the phenomenon of person mobility. This commentary presents a systematic, Campbellian-type analysis of person mobility in cluster-randomized cohort prevention trials. It describes four approaches for dealing with dropouts, late entrants and stayers with respect to data collection, analysis and generalizability. The questions at issue are: 1) From whom should data be collected at each wave of data collection? 2) Which cases should be included in the analyses of an intervention effect? and 3) To what populations can trial results be generalized? The conclusions lead to recommendations for the design and analysis of future cluster-randomized cohort prevention trials.

Effects of a social-emotional and character development program on the trajectory of behaviors associated with social-emotional and character development: findings from three randomized trials.

The effects of a school-based social-emotional and character development program, Positive Action, on the developmental trajectory of social-emotional and character-related behaviors was evaluated using data from three school-based randomized trials in elementary schools. Results come from 1) 4 years of data from students in 20 Hawai'i schools, 2) 3 years of data from students in 14 schools in Chicago and 3) 3 years of data from students in 8 schools in a southeastern state. Random intercept, multilevel, growth-curve analyses showed that students in both control and Positive Action schools exhibited a general decline in the number of positive behaviors associated with social-emotional and character development that were endorsed. However, the Positive Action intervention significantly reduced these declines in all three trials. Taken together, these analyses 1) give insight into the normative trajectory of behaviors associated with social-emotional and character development and 2) provide evidence for the effectiveness of Positive Action in helping children maintain a relatively beneficial developmental trajectory.

Replication in prevention science.

Replication research is essential for the advancement of any scientific field. In this paper, we argue that prevention science will be better positioned to help improve public health if (a) more replications are conducted; (b) those replications are systematic, thoughtful, and conducted with full knowledge of the trials that have preceded them; and (c) state-of-the art techniques are used to summarize the body of evidence on the effects of the interventions. Under real-world demands it is often not feasible to wait for multiple replications to accumulate before making decisions about intervention adoption. To help individuals and agencies make better decisions about intervention utility, we outline strategies that can be used to help understand the likely direction, size, and range of intervention effects as suggested by the current knowledge base. We also suggest structural changes that could increase the amount and quality of replication research, such as the provision of incentives and a more vigorous pursuit of prospective research registers. Finally, we discuss methods for integrating replications into the roll-out of a program and suggest that strong partnerships with local decision makers are a key component of success in replication research. Our hope is that this paper can highlight the importance of replication and stimulate more discussion of the important elements of the replication process. We are confident that, armed with more and better replications and state-of-the-art review methods, prevention science will be in a better position to positively impact public health.

Students as Prosocial Bystanders to Sexual Assault: Demographic Correlates of Intervention Norms, Intentions, and Missed Opportunities.

Sexual assault is a major public health issue. Bystander engagement programs are becoming widely used to combat sexual assault on college campuses. The purpose of this study was to examine students' intervention norms, intentions, opportunities, and behaviors as bystanders to sexual assault. Undergraduate students (N = 779) completed the Sexual Assault Bystander Behavior Questionnaire in the fall of 2014. The t tests revealed differences in students' intervention norms, intentions, opportunities, and missed opportunities based on sex, race/ethnicity, athletic participation, and fraternity/sorority membership. The findings support the use of additional measures to assess bystander behavior and to identify student subpopulations that may benefit from programs aimed at increasing prosocial intervention.

Use of a social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii.

OBJECTIVES: We assessed the effectiveness of a 5-year trial of a comprehensive school-based program designed to prevent substance use, violent behaviors, and sexual activity among elementary-school students. METHODS: We used a matched-pair, cluster-randomized, controlled design, with 10 intervention schools and 10 control schools. Fifth-graders (N = 1714) self-reported on lifetime substance use, violence, and voluntary sexual activity. Teachers of participant students reported on student (N = 1225) substance use and violence. RESULTS: Two-level random-effects count models (with students nested within schools) indicated that student-reported substance use (rate ratio [RR] = 0.41; 90% confidence interval [CI] = 0.25, 0.66) and violence (RR = 0.42; 90% CI = 0.24, 0.73) were significantly lower for students attending intervention schools. A 2-level random-effects binary model indicated that sexual activity was lower (odds ratio = 0.24; 90% CI = 0.08, 0.66) for intervention students. Teacher reports substantiated the effects seen for student-reported data. Dose-response analyses indicated that students exposed to the program for at least 3 years had significantly lower rates of all negative behaviors. CONCLUSIONS: Risk-related behaviors were substantially reduced for students who participated in the program, providing evidence that a comprehensive school-based program can have a strong beneficial effect on student behavior.

Sustaining a school-based prevention program: results from the Aban Aya Sustainability Project.

Sustaining effective school-based prevention programs is critical to improving youth and population-based health. This article reports on results from the Aban Aya Sustainability Project, an effort to sustain a school-based prevention program that was tested via a randomized trial and targeted violence, drug use, and risky sex-related behaviors among a cohort of 5th-grade African American children followed through 10th grade. Sustainability project health educators trained parent educators to deliver the Aban Aya prevention curriculum in five schools, and project researchers studied the resultant curricular implementation and relations between the research and school-based teams. Study results showed uneven implementation across the five schools that we largely attributed to parent educator preparation and parent educator-health educator relations. These and related results are discussed to answer the study's primary research question: How viable was the sustainability project's parent-centered approach to sustaining a school-based prevention program?

Evaluating mediation in longitudinal multivariate data: mediation effects for the Aban Aya Youth Project drug prevention program.

This study illustrates a method to evaluate mediational mechanisms in a longitudinal prevention trial, the Aban Aya Youth Project (AAYP). In previous studies, interventions of AAYP were found to be effective in reducing the growth of violence, substance use and unsafe sex among African American adolescents. In this article, we hypothesized that the effects of the interventions in reducing the growth of substance use behavior were achieved through their effects in changing intermediate processes such as behavioral intentions, attitudes toward the behavior, estimates of peers' behaviors, best friends' behaviors, and peer group pressure. In evaluating these mediational mechanisms, difficulties arise because the growth trajectories of the substance use outcome variable and some of the mediating variables were curvilinear. In addition, all of the multivariate mediational measures had planned missing data so that a score from the multiple items for a mediator could not be formed easily. In this article, we introduce a latent growth modeling (LGM) approach; namely, a two-domain LGM mediation model, in which the growth curves of the outcome and the mediator are simultaneously modeled and the mediation effects are evaluated. Results showed that the AAYP intervention effects on adolescent drug use were mediated by normative beliefs of prevalence estimates, friends' drug use behavior, perceived friends' encouragement to use, and attitudes toward the behavior.

The impact of age and type of intervention on youth violent behaviors.

This study compared the impact of the Aban Aya Youth Project (AAYP; Archives of Pediatric and Adolescent Medicine 158: 377-384, 2004) social development classroom curriculum (SDC), school/family/community (SC) intervention curriculum, and a health enhancement curriculum (HEC) attention placebo control on changes over time in violent behaviors among participating youth. Grade 5 pretest and grades 5-8 posttest data were used to investigate the possibility of differential intervention effects, especially the extent to which the SDC and SC interventions were differentially efficacious across age. Unlike most previous investigations of AAYP intervention effects, this study included youth who joined the study after baseline data collection in the outcome analyses. Findings indicated that, regardless of age level, the SDC limited the growth of violence of participating students when compared to students in the control condition. In the SC, however, reduction in the growth of violence emerged only among older participants. Importantly, this included joiners who received less exposure to the intervention. Findings for the SDC are consistent with recent meta-analyses of school based programs, whereas SC findings suggest that violence prevention curricula alone are not sufficient for highly mobile students and that interventions for such populations need to engage multiple social ecological systems. Editors' Strategic Implications: The authors present promising violence prevention findings, and they also provide important answers to dosage and developmental timing questions with their analyses of these longitudinal data.

Trajectories of smoking among freshmen college students with prior smoking history and risk for future smoking: data from the University Project Tobacco Etiology Research Network (UpTERN) study.

AIMS: Little is known about smoking during the transition to college. The current study examined trajectories of smoking among college freshmen, how trajectories predicted later smoking and the social context of smoking. DESIGN: Weekly assessments of daily smoking were collected via the web during the first year of college for a large cohort with a previous history of smoking. PARTICIPANTS AND SETTING: A total of 193 college freshmen from a large public university with a previous history of smoking who smoked frequently enough to be included in trajectory analysis. MEASUREMENTS: Measures included weekly reports of daily smoking, family smoking, perceived peer attitudes and smoking, social norms and social smoking environment. FINDINGS: Seven trajectories were identified: one of low-level sporadic smoking, one of low-level smoking with a small increase during the year, two classes with a substantial decrease during the year, two classes with relatively small decreases and one class with a substantial increase in smoking. Trajectories of smoking in the freshman year predicted levels of sophomore year smoking, and some social context variables tended to change as smoking increased or decreased for a given trajectory class. CONCLUSIONS: The transition into college is marked by changes in smoking, with smoking escalating for some students and continuing into the sophomore year. Shifts in social context that support smoking were associated with trajectories of smoking. Despite the focus of developmental models on smoking in early adolescence, the transition into college warrants further investigation as a dynamic period for smoking.

"Congratulations, you have been randomized into the control group!(?)": issues to consider when recruiting schools for matched-pair randomized control trials of prevention programs.

BACKGROUND: Recruiting schools into a matched-pair randomized control trial (MP-RCT) to evaluate the efficacy of a school-level prevention program presents challenges for researchers. We considered which of 2 procedures would be most effective for recruiting schools into the study and assigning them to conditions. In 1 procedure (recruit and match/randomize), we would recruit schools and match them prior to randomization, and in the other (match/randomize and recruitment), we would match schools and randomize them prior to recruitment. METHOD: We considered how each procedure impacted the randomization process and our ability to recruit schools into the study. After implementing the selected procedure, the equivalence of both treatment and control group schools and the participating and nonparticipating schools on school demographic variables was evaluated. RESULTS: We decided on the recruit and match/randomize procedure because we thought it would provide the opportunity to build rapport with the schools and prepare them for the randomization process, thereby increasing the likelihood that they would accept their randomly assigned conditions. Neither the treatment and control group schools nor the participating and nonparticipating schools exhibited statistically significant differences from each other on any of the school demographic variables. CONCLUSIONS: Recruitment of schools prior to matching and randomization in an MP-RCT may facilitate the recruitment of schools and thus enhance both the statistical power and the representativeness of study findings. Future research would benefit from the consideration of a broader range of variables (eg, readiness to implement a comprehensive prevention program) both in matching schools and in evaluating their representativeness to nonparticipating schools.