Adolescent Substance Use Behavior Change Through School Intervention Is Improved by Teacher and School Implementation Support Together, Especially for Girls.

An earlier trial of a school-based, preventative intervention, HealthWise South Africa, demonstrated some efficacy in preventing adolescent drinking and smoking in the Western Cape, South Africa. This was followed by the current implementation trial, which examined how implementation support conditions influenced adolescent drinking and smoking behavior change in the HealthWise intervention. The hybridized implementation-effectiveness trial included 34 schools (n = 2175 students) that provided student data at four waves through Grades 8 to 10. Implementation support conditions included a combination of two components (enhanced school environment and teacher consultation), resulting in four conditions: enhanced school environment, teacher consultation, both components, and standard delivery. Using configural frequency analysis, we examined how drinking and smoking behavior change differed across four configurations of intervention support longitudinally and by gender. For baseline non-smokers, results indicated sustained differences in abstention from smoking and smoking initiation between schools that received both support components and schools in the standard delivery condition. These results were primarily driven by girls. For baseline drinkers and smokers in the both components condition, changes in drinking were delayed until Grade 9 and smoking decayed by Grade 10. Results suggest that providing both school and teacher implementation support synergistically facilitates improved intervention outcomes both immediately following intervention and 2 years later across schools with diverse resource levels. Future iterations of HealthWise, and other interventions, may benefit from a multilevel implementation support strategy to improve student outcomes. More research is needed to understand how to improve HealthWise effectiveness among boys.

Leisure Boredom, Timing of Sexual Debut, and Co-Occurring Behaviors among South African Adolescents.

Sex during adolescence is normative; however, there are substantial individual differences in the timing and context of sexual debut. Leisure boredom is an underexplored correlate of sexual behavior that is associated with many adolescent health outcomes. We investigated if and how individual differences in leisure boredom may be associated with timing of sexual debut, and whether individuals engage in safe or risky behaviors at debut. Survival analysis, logistic regression, and Poisson regression were applied to eight-wave longitudinal data obtained from 3,088 South African adolescents (baseline Mage = 13.9 years) to examine associations between leisure boredom and cumulative hazard of sexual debut across adolescence, odds of co-occurring sexual behaviors, and incidence rate of co-occurring sexual risk behaviors at debut. Higher levels of leisure boredom were associated with elevated hazard cumulatively across adolescence. Higher levels of leisure boredom were also associated with lower odds of safe sex and higher odds of substance use during sex and transactional sex at sexual debut, but not casual sex or condom non-use at sexual debut. Although odds of singular risk behaviors were lower for girls than for boys, the association between leisure boredom and the number of risk behaviors at sexual debut was stronger for girls than boys. Higher trait leisure boredom was associated with elevated hazard of sexual debut, greater likelihood that risky behaviors accompanied sexual debut, and greater number of co-occurring risky behaviors at sexual debut. Results support leisure boredom as a potential target for preventing sexual risk behavior among South African adolescents.

Supporting South African High School Teachers' Implementation of a Prevention Program via Abridged Consultation: Outcomes and Moderators.

Research is lacking on consultation support for school-based evidence-based programs (EBP) intended to prevent youths' risky behaviors in schools in low-resourced settings like high schools surrounding Cape Town, South Africa. Thus, this study's objective was to examine implementation outcomes and moderators of an abridged consultation condition for supporting teachers in better implementing HealthWise, an EBP for preventing youth risky sexual and substance use behaviors. Twenty-one schools with 33 teachers receiving abridged consultation (i.e., three consultation meetings, text message reminders, lesson plans, and support kits) were compared to 26 schools with 41 teachers that did not receive any consultation. Teachers with abridged consultation self-reported delivering more HealthWise content. Moderation analyses found teachers with lower educational degrees, who received abridged consultation reported more student interest in HealthWise. When there was higher school-level risk, teachers who received abridged consultation marginally self-reported adapting HealthWise more. Findings suggest consultation support that is abridged or a lower dose than is typical can be feasible in such a low-resourced, overburdened setting while still being associated with EBP coverage, student interest, and adaptation. However, moderation findings suggest contextual factors should be considered to match teachers/schools to the implementation support that best suits them.

Parenting Practice, Leisure Experience, and Substance Use Among South African Adolescents.

There is limited understanding of parents' role in positive youth/adolescent development through leisure in developing countries. Using a sample of 6626 8th grade students in South Africa, this study examined the interrelationships among parenting practice, adolescents' leisure experience, and substance use. Results of structural equation modeling showed that parental leisure involvement was associated with less substance use, while parental leisure over-control was associated with greater substance use. The relationship of parental leisure involvement to substance use was mediated by healthy leisure engagement. The relationship of parental leisure over-control to substance use, on the other hand, was mediated by leisure boredom and healthy leisure engagement. The model path coefficients had little variation between genders and socioeconomic groups except that parental leisure over-control had a stronger positive relationship with leisure boredom for males than females. Theoretical and practical implications were discussed.

With a little help from my friends? A longitudinal look at the role of peers versus friends on adolescent alcohol use.

INTRODUCTION: Alcohol is the most commonly used substance by South African adolescents. Social norms play a key role in alcohol use, although distinctions are not always made between descriptive and injunctive norms and peer proximity. Additionally, little research identifies factors attenuating social norms, peer proximity, and alcohol use, such as one's ability to resist peer influence. METHODS: The current study investigates the relationship between adolescent alcohol use in 9th Grade and descriptive peer and injunctive friend norms in 8th grade, the moderating role of resistance to peer influence, and sex differences. Data were from South African students (N = 3592; Mage = 14) participating in the HealthWise South Africa implementation quality trial. RESULTS: Path model results indicated injunctive friend norms, but not peer norms, influenced alcohol use. Resistance to peer influence did not moderate relationships and group comparisons found no sex differences. CONCLUSION: Findings suggest social proximity shapes influences of alcohol use. Despite a differing cultural context, findings were consistent with those from the United States, indicating social proximity is relevant cross-culturally.

Forced Sexual Experiences and Sexual Situation Self-Efficacy Among South African Youth.

Nearly 20% of South African youth experience forced or coerced sexual intercourse. Understanding the factors associated with forced sex is important for informing prevention programs aimed at reducing sexual violence and HIV and AIDS. Multilevel regression models test the association between sexual situation self-efficacy and forced sex among 2,893 South African adolescents. Findings suggest that youth are more likely to experience forced sex after periods of time when their levels of self-efficacy are lower than their average levels of self-efficacy. Furthermore, youth who are lower on their self-efficacy compared to their peers are more likely to experience forced sex. Implications for prevention research are discussed.

Trajectories of adolescent substance use development and the influence of healthy leisure: A growth mixture modeling approach.

Considerable heterogeneity exists in adolescent substance use development. To most effectively prevent use, distinct trajectories of use must be identified as well as differential associations with predictors of use, such as leisure experience. The current study used a person-centered approach to identify distinct substance use trajectories and how leisure is associated with trajectory classes. Data came from a larger efficacy trial of 2.249 South African high school students who reported substance use at any time across 8 waves. Growth mixture modeling was used to identify developmental trajectories of substance use and the influence of healthy leisure. Results identified three increasing and one stable substance use trajectory and subjective healthy leisure served to protect against use. This study is the first of its kind to focus on a sample of South African adolescents and serves to develop a richer understanding of substance use development and the role of healthy leisure.

The registration continuum in personality disorder studies: Theory, rationale, and template.

Registration is a tool to increase the rigor of personality disorder research and its ability to reduce human suffering through improving people's lives. This article details the problems that exist without registrations, which revolve around a study's outcomes' dependence on the data rather than on the theory being tested. Registrations exist on a continuum underpinned by bipolar timing and unipolar disclosure dimensions, the latter of which poses myriad points of decisions for researchers to register. The registration process provides memory aids and guideposts for researchers through the course of a study, transparently maintains public trust in the scientific enterprise, and preserves the severity of the tests used in the study. This article provides a template for personality disorder researchers to consider and examples of how researchers can use registered flexibility to plan for contingencies that might arise during a study. It also addresses challenges in evaluating registrations and implementing registration in a research workflow. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Proposing a Clinical Model for RBE Based on Proton Track-End Counts.

PURPOSE: In proton therapy, the clinical application of linear energy transfer (LET) optimization remains contentious, in part because of challenges associated with the definition and calculation of LET and its exact relationship with relative biological effectiveness (RBE) because of large variation in experimental in vitro data. This has raised interest in other metrics with favorable properties for biological optimization, such as the number of proton track ends in a voxel. In this work, we propose a novel model for clinical calculations of RBE, based on proton track end counts. METHODS AND MATERIALS: We developed an effective dose concept to translate between the total proton track-end count per unit mass in a voxel and a proton RBE value. Dose, track end, and dose-averaged LET (LETd) distributions were simulated using Monte Carlo models for a series of water phantoms, in vitro radiobiological studies, and patient treatment plans. We evaluated the correlation between track ends and regions of elevated biological effectiveness in comparison to LETd-based models of RBE. RESULTS: Track ends were found to correlate with biological effects in in vitro experiments with an accuracy comparable to LETd. In patient simulations, our track end model identified the same biological hotspots as predicted by LETd-based radiobiological models of proton RBE. CONCLUSIONS: These results suggest that, for clinical optimization and evaluation, an RBE model based on proton track end counts may match LETd-based models in terms of information provided while also offering superior statistical properties.

Introducing the at-risk average causal effect with application to HealthWise South Africa.

Researchers often hypothesize that a causal variable, whether randomly assigned or not, has an effect on an outcome behavior and that this effect may vary across levels of initial risk of engaging in the outcome behavior. In this paper, we propose a method for quantifying initial risk status. We then illustrate the use of this risk-status variable as a moderator of the causal effect of leisure boredom, a non-randomized continuous variable, on cigarette smoking initiation. The data come from the HealthWise South Africa study. We define the causal effects using marginal structural models and estimate the causal effects using inverse propensity weights. Indeed, we found leisure boredom had a differential causal effect on smoking initiation across different risk statuses. The proposed method may be useful for prevention scientists evaluating causal effects that may vary across levels of initial risk.

Impact of HealthWise South Africa on polydrug use and high-risk sexual behavior.

This study was designed to evaluate the efficacy of the HealthWise South Africa HIV and substance abuse prevention program at impacting adolescents' polydrug use and sexual risk behaviors. HealthWise is a school-based intervention designed to promote social-emotional skills, increase knowledge and refusal skills relevant to substance use and sexual behaviors, and encourage healthy free time activities. Four intervention schools in one township near Cape Town, South Africa were matched to five comparison schools (N = 4040). The sample included equal numbers of male and female participants (Mean age = 14.0). Multiple regression was used to assess the impact of HealthWise on the outcomes of interest. Findings suggest that among virgins at baseline (beginning of eighth grade) who had sex by Wave 5 (beginning of 10th grade), HealthWise youth were less likely than comparison youth to engage in two or more risk behaviors at last sex. Additionally, HealthWise was effective at slowing the onset of frequent polydrug use among non-users at baseline and slowing the increase in this outcome among all participants. Program effects were not found for lifetime sexual activity, condomless sex refusal and past-month polydrug use. These findings suggest that HealthWise is a promising approach to HIV and substance abuse prevention.

Effects of HealthWise South Africa on condom use self-efficacy.

The present study examines the impact of the HealthWise South Africa prevention intervention on condom use self-efficacy. Students from the Cape Town area were assessed at the beginning and end of each school year, beginning in the 8th grade and ending in the 11th. The intervention was delivered in 12 lessons during the 8th grade and 6 lessons during the 9th grade. Using three-level multiphase mixed-effects models, we found that HealthWise had a statistically significant positive effect on condom use self-efficacy, although effects differed for boys and girls. HealthWise had an effect during the first phase of the intervention (8th grade) for girls and during the second phase (9th grade) for boys. We speculate that the gender differences occur because the 8th grade lessons of the intervention taught skills such as discussion, decision making, and negotiation, which may be more salient to girls, and a 9th grade lesson explicitly focused on condom use within the context of sexual relationships, which may have been more salient to boys.

The assessment of physical risk taking: Preliminary construct validation of a new behavioral measure.

Risk taking is a complex heterogeneous construct that has proven difficult to assess, especially when using behavioral tasks. We present an exploratory investigation of new measure-the Assessment of Physical Risk Taking (APRT). APRT produces a variety of different outcome scores and is designed as a comprehensive assessment of the probability of success and failure, and magnitude of reward and punishment of different types of simulated physically risky behaviors. Effects observed on the simulated behaviors are hypothesized to reflect similar effects on real world physical risks. Participants (N = 224) completed APRT in a laboratory setting, half of whom had a 1.5 s delay interposed between button presses. Exploratory analyses utilizing generalized estimating equations examined the main effects and two-way interactions among five within-subject factors, as well as two-way interactions between the within-subject factors and Delay across four APRT outcome scores. Results indicated that Injury Magnitude and Injury Probability exerted stronger effects than any of the other independent variables. Participants also completed several self-report measures of risk taking and associated constructs (e.g., sensation seeking), which were correlated with APRT scores to assess the preliminary convergent and divergent validity of the new measure. After correcting for multiple comparisons, APRT scores correlated with self-reported risk taking in thrilling, physically dangerous activities specifically, but only for those who did not have a delay between APRT responses. This promising exploratory investigation highlights the need for future studies comparing APRT to other behavioral risk taking tasks, examining the robustness of the observed APRT effects, and investigating how APRT may predict real-world physical risk taking.

Boys Are Victims, Too: The Influence of Perpetrators' Age and Gender in Sexual Coercion Against Boys.

Sexual coercion among adolescent boys in South Africa is an underresearched topic despite the frequency of such events. Although quantitative research has illuminated the prevalence of sexual coercion toward boys, it has provided little understanding of the context of sexual coercion for adolescent boys. Given the often severe consequences of sexual coercion, it is important to further understand these experiences to inform prevention efforts. The current study aims to provide a more nuanced understanding of the context of sexual coercion. Data come from the baseline assessment for a translational research evaluation of a school-based intervention. The current study focuses on a subset of early and middle adolescent boys who reported experiencing sexual coercion (n = 223). Analyses examine boys' reports of their perpetrators' characteristics and details about the sexual coercion encounter. Logistic regression is used to examine how coercion tactics used by the perpetrator differs depending on the perpetrator's age and gender. Eighth-grade boys were most likely to report that their perpetrator was a similar-aged female and that perpetrator's age played a particularly important role in what tactics were used. Adult perpetrators were more likely to use physical force, threaten them, harass them electronically, and drink or use drugs at the time. Results provide important insight into boys' experiences of sexual coercion that have implications for both future research and intervention efforts. Although much research is needed on the topic, intervention programs should recognize that both male and female adolescents can be victim and perpetrator.

A Monte Carlo study of different LET definitions and calculation parameters for proton beam therapy.

The strongin vitroevidence that proton Relative Biological Effectiveness (RBE) varies with Linear Energy Transfer (LET) has led to an interest in applying LET within treatment planning. However, there is a lack of consensus on LET definition, Monte Carlo (MC) parameters or clinical methodology. This work aims to investigate how common variations of LET definition may affect potential clinical applications. MC simulations (GATE/GEANT4) were used to calculate absorbed dose and different types of LET for a simple Spread Out Bragg Peak (SOBP) and for four clinical PBT plans covering a range of tumour sites. Variations in the following LET calculation methods were considered: (i) averaging (dose-averaged LET (LETd) & track-averaged LET); (ii) scoring (LETdto water, to medium and to mass density); (iii) particle inclusion (LETdto all protons, to primary protons and to particles); (iv) MC settings (hit type and Maximum Step Size (MSS)). LET distributions were compared using: qualitative comparison, LET Volume Histograms (LVHs), single value criteria (maximum and mean values) and optimised LET-weighted dose models. Substantial differences were found between LET values in averaging, scoring and particle type. These differences depended on the methodology, but for one patient a difference of ∼100% was observed between the maximum LETdfor all particles and maximum LETdfor all protons within the brainstem in the high isodose region (4 keVµm-1and 8 keVµm-1respectively). An RBE model using LETdincluding heavier ions was found to predict substantially different LET-weighted dose compared to those using other LET definitions. In conclusion, the selection of LET definition may affect the results of clinical metrics considered in treatment planning and the results of an RBE model. The authors' advocate for the scoring of dose-averaged LET to water for primary and secondary protons using a random hit type and automated MSS.

Influencing Adolescent Leisure Motivation: Intervention Effects of HealthWise South Africa.

This study investigates changes in self-reported motivation for leisure due to participation in HealthWise, a high school curriculum aimed at decreasing risk behavior and promoting health behavior. Participants were 2,193 mixed race adolescents (M = 14 years old) from 9 schools (4 intervention, 5 control) near Cape Town, South Africa. Students in the HealthWise school with the greatest involvement in teacher training and implementation fidelity reported increased intrinsic and identified motivation and decreased introjected motivation and amotivation compared to students in control schools. These results point to the potential for intervention programming to influence leisure motivation among adolescents in South Africa and represent a first step toward identifying leisure motivation as a mediator of program effects.

Transitions to substance use and sexual intercourse among South african high school students.

This study examined longitudinal patterns of initiating substance use and sexual intercourse among a sample of 1,143 high school students from a low-income township in Cape Town, South Africa. Longitudinal data on lifetime incidence of sexual intercourse and alcohol and marijuana use were collected semiannually from 2004 to 2006. Latent transition analysis (LTA) was used to test competing models of transitions to these behaviors. Participants were more likely to move from no risk behavior to substance use, rather than from no risk behavior to sexual intercourse. At all time points, the proportion of youth who had engaged in sexual intercourse but not substance use was very small. The study's limitations and directions for future research are discussed.

Forms, Importance, and Ineffability of Factor Interactions to Define Personality Disorders.

The emergent interpersonal syndrome (EIS) approach conceptualizes personality disorders as the interaction among their constituent traits to predict important criterion variables. We detail the difficulties we have experienced finding such interactive predictors in our empirical work on psychopathy, even when using uncorrelated traits that maximize power. Rather than explaining a large absolute proportion of variance in interpersonal outcomes, EIS interactions might explain small amounts of variance relative to the main effects of each trait. Indeed, these interactions may necessitate samples of almost 1,000 observations for 80% power and a false positive rate of .05. EIS models must describe which specific traits' interactions constitute a particular EIS, as effect sizes appear to diminish as higher-order trait interactions are analyzed. Considering whether EIS interactions are ordinal with non-crossing slopes or disordinal with crossing slopes, or entail nonlinear threshold or saturation effects may help researchers design studies, sampling strategies, and analyses to model their expected effects efficiently.

The registration continuum in clinical science: A guide toward transparent practices.

Clinical scientists can use a continuum of registration efforts that vary in their disclosure and timing relative to data collection and analysis. Broadly speaking, registration benefits investigators by offering stronger, more powerful tests of theory with particular methods in tandem with better control of long-run false positive error rates. Registration helps clinical researchers in thinking through tensions between bandwidth and fidelity that surround recruiting participants, defining clinical phenotypes, handling comorbidity, treating missing data, and analyzing rich and complex data. In particular, registration helps record and justify the reasons behind specific study design decisions, though it also provides the opportunity to register entire decision trees with specific endpoints. Creating ever more faithful registrations and standard operating procedures may offer alternative methods of judging a clinical investigator's scientific skill and eminence because study registration increases the transparency of clinical researchers' work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

In Silico Models of DNA Damage and Repair in Proton Treatment Planning: A Proof of Concept.

There is strong in vitro cell survival evidence that the relative biological effectiveness (RBE) of protons is variable, with dependence on factors such as linear energy transfer (LET) and dose. This is coupled with the growing in vivo evidence, from post-treatment image change analysis, of a variable RBE. Despite this, a constant RBE of 1.1 is still applied as a standard in proton therapy. However, there is a building clinical interest in incorporating a variable RBE. Recently, correlations summarising Monte Carlo-based mechanistic models of DNA damage and repair with absorbed dose and LET have been published as the Manchester mechanistic (MM) model. These correlations offer an alternative path to variable RBE compared to the more standard phenomenological models. In this proof of concept work, these correlations have been extended to acquire RBE-weighted dose distributions and calculated, along with other RBE models, on a treatment plan. The phenomenological and mechanistic models for RBE have been shown to produce comparable results with some differences in magnitude and relative distribution. The mechanistic model found a large RBE for misrepair, which phenomenological models are unable to do. The potential of the MM model to predict multiple endpoints presents a clear advantage over phenomenological models.