Online-delivered parenting intervention for young children with disruptive behavior problems: a noninferiority trial focused on child and parent outcomes.

BACKGROUND: This study evaluated whether an evidence-based parenting intervention, when delivered online, could effectively address disruptive behavior problems in young children and yield outcomes comparable to in-person delivery of the same intervention. METHODS: Families (n = 334) of children (3-7 years; 63% White, 22% African American, 15% other races; 63% male) with disruptive behavior problems were randomized to online-delivered intervention (ODI) or staff-delivered intervention (SDI), resulting in baseline and demographic equivalence. Primary outcome measures for child disruptive behavior (independent observation, parent report) and secondary outcome measures of parenting and family impact were assessed at baseline, postintervention, and follow-up. Conducted using intent-to-treat (ITT) as well as per-protocol (PP) methods, noninferiority analyses, which drew on an HLM framework with repeat measures across three timepoints and on REML to provide unbiased estimates of model parameters, tested whether the outcome-difference CI did not exceed the a priori noninferiority margin. RESULTS: For ITT and PP analyses, the ODI was found to be noninferior to the SDI on the primary outcome: independently observed child disruptive behavior and parent-reported child behavior problems. The pattern for secondary outcomes was more varied: (a) noninferiority for observed positive and aversive parenting; (b) noninferiority for observed quality of parent-child relationship at post but not follow-up assessment; (c) noninferiority for parent-reported inappropriate/inconsistent discipline for PP but not ITT analyses; and (d) noninferiority not confirmed for parenting daily hassles and adverse family quality of life, despite large effect sizes for the ODI (Cohen's d .75-1.07). Finally, ODI noninferiority was found for teacher-reported child disruptive behavior. CONCLUSIONS: The tested online-delivered parenting intervention demonstrated clear noninferiority with the corresponding staff-delivered parenting intervention on the primary outcome, child disruptive behavior problems, and reflected substantial though nonuniform noninferiority and meaningful effect sizes for secondary outcomes related to parenting and family. Future research will guide optimization of online interventions.

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.

An Efficacy Trial of Carescapes: Home-Based Child-Care Practices and Children's Social Outcomes.

This study reported findings from a longitudinal randomized controlled trial of Carescapes, a professional development program for home-based child-care providers in promoting children's social competence. Participants included 134 child-care providers and 310 children, ages 3-5 years, in Oregon. The Carescapes intervention group made significant improvements in observed caregiver responsiveness and monitoring, and showed decreased caregiver-reported child problem behavior and improved parent-reported peer relationships compared to the control group. Increased caregiver-reported cooperation skills were found for the intervention group at follow-up. No differences in condition were found for kindergarten teacher-reported social-behavioral, classroom, and academic skills. Moderation effects on children's behavior and peer relations were found for child age and exposure to the intervention child care.

A Longitudinal Study of E-Cigarette, Cigarette, and Marijuana Use Sequence in Youth.

Objective: There is evidence linking youth use of electronic (e-) cigarettes to subsequent cigarette and marijuana use, raising public health concerns. We examined the sequence of use of e-cigarettes, conventional cigarettes, and marijuana in a longitudinal sample of adolescents, to determine if use of e-cigarettes often preceded use of other substances. Methods: We collected self-reports from 1123 Oregon adolescents (52% female; 37% Hispanic) longitudinally from 8th to 11th grade (8 total surveys) regarding their lifetime (ever use) and current use (last 30 days) of e-cigarettes, cigarettes, and marijuana. If applicable, students also reported the delivery method of their current marijuana use. Results: Almost 10% of adolescents reported using e-cigarettes prior to use of cigarettes or marijuana, and the majority of these youth initiated use of marijuana, cigarettes, or both by 11th grade. More youth transitioned from e-cigarette use to marijuana use then from e-cigarettes to use of conventional cigarettes. Participants who were co-using e-cigarettes and marijuana in 11th grade had an increased likelihood of consuming marijuana via vaping, dabbing, and edibles, compared to those who were only using marijuana. Discussion: E-cigarettes were often the first substance used in this longitudinal sample, and more of these youth subsequently used marijuana compared to cigarettes. While research has focused on the progression from e-cigarettes to cigarettes in youth, these findings indicate that more attention should be focused on the subsequent initiation of marijuana.

Program Evaluation of Healthy Moves™: A Community-Based Trainer in Residence Professional Development Program to Support Generalist Teachers With Physical Education Instruction.

BACKGROUND: Elementary school teachers are often responsible for teaching physical education to their students, with little formal training in that instruction. This study evaluates a trainer in residence professional development program designed to improve physical education instructional attitudes and practices in elementary school generalist teachers. METHODS: Participants were 139 teachers and 3577 first to fifth grade students at 11 public elementary schools in Oregon. Program evaluation measures included pre- and postteacher surveys on teacher attitudes and practices toward teaching physical education for fidelity, postprogram lesson observations for sustainability, and teacher-reported program barriers to and facilitators of feasibility. A multivariate repeated-measures analysis of covariance test assessed changes in teacher attitudes and practices related to physical education instruction. RESULTS: There were main effects of time observed for teacher encouragement and enthusiasm and physical education teaching practices (F2,127 = 9.68, P < .001, ηp2=.132). Postprogram observations indicated sustained use of activity components and an average of 86% of physical education class time spent with students engaged in moderate to vigorous levels of physical activity. CONCLUSIONS: The trainer in residence community-based approach shows promise as an appropriate professional development strategy for generalist teachers responsible for physical education instruction. However, a longer duration, randomized control trial is needed to determine the efficacy of these programs in promoting student physical education outcomes.

Promoting Self-Regulation in Young Children: The Role of Parenting Interventions.

Self-regulation is a foundational skill in childhood and underpins various positive and negative outcomes throughout childhood, adolescence and into adulthood. Parents and the way they parent their children play a key role in the development of young children's self-regulatory capacity. However, there is limited evidence for the effectiveness of parenting interventions on child self-regulatory outcomes. This paper provides an overview of the role of parenting in the development of child self-regulation and a summary of the evidence base for parenting interventions to promote self-regulation in children under age eight, focusing on infancy, the toddler/preschooler period, and early school-age. We conclude by examining the gaps in this field of research and providing directions for future research.

Associations between marijuana use and anxious mood lability during adolescence.

OBJECTIVE: To date, research investigating the association between adolescent marijuana use and anxiety is mixed, given differences in how anxiety is measured and the age ranges studied. The research is further limited as many relevant studies have small sample sizes. This investigation examines the association between marijuana use (use in the past 30 days) and anxious mood lability (rapid fluctuation in emotional states) during early adolescence (average age 14.4, spring of 8th grade) through midadolescence (10th grade). METHODS: Participating adolescents (N = 466; 52.8% female) were from rural and suburban communities and 38% were Hispanic/Latino. Ecological Momentary Assessment (EMA) was used to measure adolescents' anxious mood in real time; the EMAs were collected within 30 days of the adolescent report of their marijuana use. RESULTS: Multilevel models with measurement waves (7 time points) nested in individuals showed that anxious mood lability was significantly higher for adolescents reporting recent marijuana use compared to those reporting no recent marijuana use. Although females were higher than males in anxious mood lability, the association between anxious mood lability and recent marijuana use did not differ by gender. Post hoc analysis showed that the associations between anxious mood lability and recent marijuana use did not differ between assessments conducted pre and post legalization of adult recreational marijuana use. CONCLUSIONS: The association between recent marijuana use and anxious mood lability for youth is important for understanding the developmental processes of cannabis use and anxious mood disorders in adolescence and young adulthood.

Friend Selection and Influence Effects for First Heavy Drinking Episode in Adolescence.

OBJECTIVE: Heavy alcohol consumption has both immediate and longer-term risks for adolescents. Using a dynamic network modeling approach, this study investigated the role of adult supervision and affiliation with heavy drinking friends in predicting the risk of a first heavy drinking episode in a community sample of adolescents. METHOD: Two cohorts of ninth grade youth (n = 1,220, 48% male) from seven communities were surveyed three times over the course of the school year (fall, winter, and spring), each time assessing their friendship networks, whether they had ever experienced a heavy drinking episode, frequency of heavy drinking over the past month, and the amount of unsupervised time spent with each of their friends over the past month. RESULTS: Participants were more likely to form friendships with classmates with similar recent heavy drinking behavior, but similarity on adult supervision of time spent with friends had no effect on friendship selection. A negative interaction was observed between these two similarity effects, implying that they were antisynergistic. Risk for a first heavy drinking episode was greater for youth with friends who had experienced such an episode already. This effect was no stronger if these friends had more such episodes in the previous 30 days but was marginally stronger if the friends reported less adult supervision. CONCLUSIONS: Heavy drinking-related friendships increase the risk of a first heavy drinking episode. Adult supervision of time spent with friends may reduce this risk. Results support interventions that target the spread of heavy drinking through adolescent social ecosystems, in addition to targeting the most at-risk individuals.

A Small-Scale Randomized Efficacy Trial of Carescapes: Enhancing Children's Social Development in Child Care Homes.

The quality of the child care environment and caregiver practices can potentially have significant, lasting impact on children's social development. This study involves the development and a small-scale efficacy trial of the Carescapes program, a video-based training program that focuses on promoting positive social development in young children attending family child care. Fifty-seven caregivers who provided child care in their homes were randomly assigned to immediate intervention or waitlist control groups. Random coefficients analyses showed significant increased use of effective behavior management practices and decreased overall children's problem behavior for the intervention group. A mediation model demonstrated that increases in effective behavior management practices were associated with decreases in problem behavior. A medium intervention effect was found for caregiver's monitoring and a small effect for use of positive attention. These effects declined 5 months following the intervention. Implications for future efficacy and effectiveness studies in family child care settings that involve strategies to facilitate maintenance are discussed.

Influence of parent-youth relationship, parental monitoring, and parent substance use on adolescent substance use onset.

The quality of parent-child relationships likely influences many decisions and behaviors made by early adolescents, including their alcohol and marijuana use. We examined how parent-youth relationship quality, parental monitoring, and parent substance use were associated with initiation of alcohol use, binge drinking, and marijuana use by 400 adolescents by the spring of 8th grade (ages 13-14), and changes in initiation through 9th grade (assessed 3 times; fall, winter, and spring). We measured both parent and adolescent report of parent-youth relationship quality and parental monitoring, expecting that both perspectives would uniquely contribute. Discrete Time Survival models showed that youth report of both a poorer parent-youth relationship and lower parental monitoring were associated with alcohol use, binge drinking, and marijuana use onset. Parent binge drinking also predicted youth alcohol onset and parent report of poor quality relationship predicted marijuana onset. Youth report of a poor relationship with parents was a stronger predictor for girls than boys on their alcohol use onset, and youth report of parental monitoring was more protective for girls than boys for both alcohol and marijuana use onset. Implications for preventing use of these substances during early and mid-adolescence are discussed. (PsycINFO Database Record

Legalization of recreational marijuana and community sales policy in Oregon: Impact on adolescent willingness and intent to use, parent use, and adolescent use.

Studies investigating the impact of medical marijuana legalization have found no significant changes in adolescent use. In one of the few studies focused on recreational marijuana, we investigated how recreational marijuana legalization and community sales policy influenced factors that likely impact youth use (youth willingness and intent to use, parent use) as well as youth use. Legalization of recreational marijuana in Oregon coincided with our study on adolescent substance use. Cohort 1 transitioned from 8th to 9th grade prior to legalization and Cohort 2 made this transition during legalization (N = 444; 53% female). Communities were allowed to opt out of sales. Multivariate linear regression models estimated the impact of legalization and community sales policy on changes in attitudes and parent use (2 time points 1 year apart). Zero-inflated Poisson growth curve models estimated the effects on initial levels and rate of change from 8th through 9th grade (4 time points). In communities opting out of sales, the prior-to-legalization cohort was less likely to increase their willingness and intent to use marijuana, and the legalization cohort was more likely to increase intent to use. For youth who used marijuana, legalization was associated with increased use, and those in communities opting out of sales had greater growth in marijuana use. Community policy appears to impact youth attitudes toward, and use of, marijuana. Results suggest that legalization of recreational marijuana did not increase marijuana use for youth who did not use marijuana but did increase use in youth who were already using. (PsycINFO Database Record

Electronic Cigarette Use by Youth: Prevalence, Correlates, and Use Trajectories From Middle to High School.

PURPOSE: The aim of this study was to examine the use of electronic cigarettes (e-cigarettes) among adolescents over time, including correlates of lifetime use by eighth grade and trajectories of current use across ninth grade. METHODS: Participants (N = 1,091) from seven school districts in Oregon, United States, completed four self-report surveys on substance use, from the spring of eighth grade (M age = 14.4 years old; standard deviation = .50) through the spring of ninth grade. RESULTS: Overall, 27.7% of eighth graders had used e-cigarettes, and 16.8% were current e-cigarette users (used in the past 30 days); use did not significantly differ by gender or ethnicity. Correlates of e-cigarette lifetime use by eighth grade included lifetime and current use of marijuana, alcohol, cigarettes, and chewing tobacco. Five percent of students were "accelerators," on average using e-cigarettes 14 of the last 30 days in eighth grade, increasing to daily use (30/30 days) by the end of ninth grade. Across all substances, those in the accelerator group were more likely to have reported lifetime substance use by eighth grade and current substance use in ninth grade, compared to the "infrequent/no use" group. CONCLUSIONS: A sizeable proportion of young adolescents are using e-cigarettes, and e-cigarette use is highly correlated with use of other substances, including marijuana. Adolescents who progress to daily e-cigarette use in high school are more likely to use other substances compared to low or nonusers. E-cigarettes may be a relatively new addition to a constellation of substances being actively used by a segment of the youth population.

A longitudinal study predicting adolescent tobacco, alcohol, and cannabis use by behavioral characteristics of close friends.

Few studies have examined in detail how specific behaviors of close friends put adolescents at risk for specific types of substance use. Using a prospective, longitudinal design, we examined how well the substance use of 248 young urban adolescents was predicted by perceptions of their 3 closest friends' problematic behaviors: (1) using substances, (2) offering substances, and (3) engaging with friends in risky behavior (substance use, illegal behavior, violent behavior, or high-risk sexual behavior). Longitudinal multivariate repeated measures models were tested to predict tobacco, alcohol, and cannabis use and perceived closeness was tested as a moderator of the effects of perceptions of problematic peer behavior. Perceptions of peer substance use were significantly associated with tobacco use, and closeness moderated the influence of peer substance use and offers to use substances on tobacco use. Perceptions of problematic peer behaviors were not significantly associated with alcohol use and closeness was not significant as a moderator. Perceptions of peer substance use was significantly associated with cannabis use, and closeness moderated the influence of perceptions of peer risk behaviors, peer substance use, and offers to use substances on cannabis use. Results implicate the importance of understanding problematic peer behavior within the context of close, adolescent friendships. Adolescents with close friends who were substance users, who made offers to use substances, and who engaged in risky behaviors were more likely to use tobacco and cannabis. Perceptions of young adolescents' close friends' behaviors influenced their substance use up to 2 years later. (PsycINFO Database Record

Neighborhood disorder, peer network health, and substance use among young urban adolescents.

BACKGROUND: The current study investigated the moderating effect of peer networks on neighborhood disorder's association with substance use in a sample of primarily African American urban adolescents. METHODS: A convenience sample of 248 adolescents was recruited from urban health care settings and followed for two years, assessing psychological, social, and geographic risk and protective characteristics. A subset of 106 substance using participants were used for the analyses. A moderation model was tested to determine if the influence of neighborhood disorder (percent vacant housing, assault index, percent single parent headed households, percent home owner occupied, percent below poverty line) on substance use was moderated by peer network health (sum of peer risk and protective behaviors). RESULTS: Evidence for hypothesized peer network moderation was supported. A latent growth model found that peer network health is most strongly associated with lower baseline substance use for young adolescents residing in more disordered neighborhoods. Over the course of two years (ages approximately 14-16) this protective effect declines, and the decline is stronger for more disordered neighborhoods. CONCLUSIONS: Understanding the longitudinal moderating effects of peer networks within high-risk urban settings is important to the development and testing of contextually sensitive peer-based interventions. RESULTS: suggest that targeting the potential protective qualities of peer networks may be a promising approach for interventions seeking to reduce substance use, particularly among younger urban adolescents living in high-risk neighborhoods.

Oppositional defiant disorder toward adults and oppositional defiant disorder toward peers: initial evidence for two separate constructs.

Confirmatory factor analysis of 25 items on the Child and Adolescent Disruptive Behavior Inventory (CADBI, Version 2.3; G. L. Burns, T. K. Taylor, & J. C. Rusby, 2001) was conducted on teacher ratings of 824 kindergarten children and replicated on 534 children. Model fit was improved when correcting for 2 method effects: (a) adjacent items and (b) identical behaviors (e.g., argues with adults, argues with peers). The results show that the 25 items loaded on 3 distinct but correlated factors: Hyperactivity, Oppositional to Adults, and Oppositional to Peers. These more refined constructs from the CADBI may be useful for practitioners in identifying children who are at risk and for helping define appropriate contexts in which to intervene. The CADBI and analytic procedures also may contribute to future psychoeducational research on the development of problem behavior.

Emulating real-life situations with a play task to observe parenting skills and child behaviors.

Play tasks that use standardized procedures and materials are a practical way to assess parenting skills, child behaviors, and the ways in which parents and children interact. We describe a systematic process for developing the parent-child play task (PCPT) to assess mother-child interactions for a randomized controlled trial of a video-based parenting program. Participants were 307 mothers and their 3- to 6-year-old children who presented oppositional and disruptive behavior challenges. The validity of the PCPT was investigated by testing (a) the extent to which the tasks elicited the specific parent and child behaviors of interest, (b) the consistency of individuals' behavior across the play tasks, and (c) the concurrent associations of the PCPT-observed child behaviors and mother reports of child behavior. The different tasks elicited the mother and child behaviors that they were designed to elicit. Behavior consistency across tasks for individual mothers and children was fair to good, with the exception of 2 task-specific behaviors. Mother's guidance (provision of instructions to foster a skill) during the teaching task and children's interruptions while mother was busy during the questionnaire task were highly task specific. Modest associations were found between observed children's noncompliance and inappropriate behaviors and mother-reported conduct problems and oppositional behaviors. Implications for clinical and research assessments are discussed.

Psychosocial correlates of physical and sedentary activities of early adolescent youth.

This study examines physical and sedentary activities of early adolescent boys and girls using Ecological Momentary Assessment (EMA), a method that can link mood and behaviors in specific social situations. Twenty-seven assessments were collected across 7 days from 82 participating adolescents, three times in seventh grade and one time in eighth grade. Assessments were completed during nonschool hours when youth had "free time." Gender differences, longitudinal trends, and associations of physical activities (PA) and small screen recreation (SSR) with moods and peer presence are examined. Boys were engaged in PA more than girls. Patterns of PA differed by gender; boys significantly decreased PA from seventh to eighth grade, whereas girls had increased PA only during the spring. PA was associated with happier mood and was more likely to occur in the presence of peers. SSR significantly increased from seventh grade to eighth grade for both boys and girls. SSR occurred more when youth were alone and was not associated with mood. Neither PA nor SSR was more likely to occur during weekdays or weekends. Implications for intervention efforts to increase PA in youth are discussed.

Antisocial Behavior Trajectories and Social Victimization Within and Between School Years in Early Adolescence.

Antisocial behavior typically increases during early adolescence, but the possibility of seasonal variation has not been examined. In this study, trajectories of antisocial behavior were estimated for early adolescent boys and girls. Data were obtained from a 3-year longitudinal study of 11 middle schools in the western U.S. (n = 5,742), with assessments completed four times per academic year. Antisocial behavior increased steadily throughout 6th grade, but beginning in 7th grade for boys and 8th grade for girls, it declined during the school year. Significant increases between grades 6-7 and 7-8 were found for both genders. Trajectories varied by contextual and individual-level social victimization and gender. Implications for theoretical development and future studies are discussed.

Concurrent and predictive associations between early adolescent perceptions of peer affiliates and mood states collected in real time via ecological momentary assessment methodology.

This study uses ecological momentary assessment (EMA) to simultaneously capture youths' perceptions of peer affiliates and social contexts to determine their association with youths' current and future mood states. A sample of 82 seventh grade students (36 at risk for developing or escalating rule breaking and substance use and 46 randomly selected) from 4 schools participated. Using EMA methodology, we had students report their peer affiliations, perceptions of peer affiliates, moods, activities, location, and behaviors during their free time. Data from 3 assessment waves were collected; each wave consisted of 27 randomly prompted assessments during a week. Youths spent a large portion of their free time watching television, on the computer, or playing video games. Being "out and about" increased over the school year, whereas adult supervision decreased, showing an increase in potentially risky situations. Happiness was associated with affiliating with peers who were perceived to be popular. Negative moods were associated with affiliating with peers by whom they were teased or treated meanly. Multilevel models found that both levels and lability of negative moods (i.e., sadness, anxiety) were predicted by risk status and affiliation with peers who tease them. Compared with boys, girls who affiliated more with peers who teased them and were classified as at risk had more extreme negative moods and negative mood lability. EMA methodology has demonstrated the ways in which salient intrapersonal and peer processes are associated over time, which can inform efforts to prevent the development and escalation of behavior problems, substance use, and mood disorders in adolescence.