Adolescent Dating Violence Prevention Program for Early Adolescents: The Me & You Randomized Controlled Trial, 2014-2015.

Objectives. To test the efficacy of Me & You, a multilevel technology-enhanced adolescent dating violence (DV) intervention, in reducing DV perpetration and victimization among ethnic-minority early adolescent youths. We assessed secondary impact for specific DV types and psychosocial outcomes.Methods. We conducted a group-randomized controlled trial of 10 middle schools from a large urban school district in Southeast Texas in 2014 to 2015. We used multilevel regression modeling; the final analytic sample comprised 709 sixth-grade students followed for 1 year.Results. Among the total sample, odds of DV perpetration were lower among intervention students than among control students (adjusted odds ratio = 0.46; 95% confidence interval = 0.28, 0.74). Odds of DV victimization were not significantly different. There were significant effects on some specific DV types.Conclusions. Me & You is effective in reducing DV perpetration and decreasing some forms of DV victimization in early middle-school ethnic-minority students.

Replication of It's Your Game Keep It Real! in Southeast Texas.

Despite the recent efforts of the Office of Adolescent Health to replicate programs with demonstrated efficacy, there are still few evidence-based HIV, sexually transmitted infection (STI), and teen pregnancy prevention programs that have been replicated in "real-world" settings. To test the effectiveness of It's Your Game…Keep It Real! (IYG), an evidence-based STI and pregnancy prevention program for middle schools, the curriculum was implemented by teachers in urban and suburban middle schools in Southeast Texas from 2012 to 2015. IYG was evaluated using a group-randomized wait-list controlled effectiveness trial design in which 20 middle schools in nine urban and suburban school districts in Southeast Texas were randomized equally, using a multi-attribute randomization protocol, to either the intervention condition (received IYG) (n = 10 schools comprising 1936 eligible seventh graders) or the comparison condition (received usual care) (n = 10 schools comprising 1825 eligible seventh graders). All students were blinded to condition prior to administering the baseline survey. The analytic sample comprised 1543 students (n = 804, intervention; n = 739, comparison) who were followed from baseline (seventh grade) to the 24-month follow-up (ninth grade). Multilevel regression analyses were conducted to assess behavioral and psychosocial outcomes at follow-up. There were no significant differences in initiation of vaginal or oral sex between study conditions at follow-up. However, at 12-month follow-up, compared with students in the comparison condition, students in the intervention condition reported increased knowledge, self-efficacy, and perceived favorable norms related to HIV/STIs, condoms, and/or abstinence; decreased intentions to have sex; and increased intentions to use birth control. Knowledge outcomes were statistically significant at 24-month follow-up. This IYG effectiveness trial did not replicate the behavioral effects of the original IYG efficacy trials. However, it adds to the growing literature on the replication of evidence-based programs, and underscores the need to better understand how variations in implementation, setting, and measurement affect the behavioral impact of such programs.Clinical trial registration clinicaltrials.gov (NCT03533192).

Prevalence and Correlates of the Perpetration of Cyber Dating Abuse among Early Adolescents.

Much is known about the prevalence and correlates of dating violence, especially the perpetration of physical dating violence, among older adolescents. However, relatively little is known about the prevalence and correlates of the perpetration of cyber dating abuse, particularly among early adolescents. In this study, using a predominantly ethnic-minority sample of sixth graders who reported ever having had a boyfriend/girlfriend (n = 424, 44.2 % female), almost 15 % reported perpetrating cyber dating abuse at least once during their lifetime. Furthermore, using a cross-sectional design, across multiple levels of the socio-ecological model, the individual-level factors of (a) norms for violence for boys against girls, (b) having a current boyfriend/girlfriend, and (c) participation in bullying perpetration were correlates of the perpetration of cyber dating abuse. Collectively, the findings suggest that dating violence interventions targeting these particular correlates in early adolescents are warranted. Future studies are needed to establish causation and to further investigate the relative importance of correlates of the perpetration of cyber dating abuse among early adolescents that have been reported among older adolescents.

Economic Evaluation of an Intervention to Prevent Adolescent Dating Violence (Me & You).

Me & You: Building Healthy Relationships (Me & You) is a multilevel, technology-enhanced adolescent dating violence (DV) prevention program that aimed to reduce DV among ethnic-minority, early adolescent, urban youth. A group-randomized control trial of Me & You, conducted with 10 middle schools from a large urban school district in Southeast Texas in 2014-2015, found it to be effective in reducing DV perpetration and decreasing some forms of DV victimization. Economic evaluations of DV interventions are extremely limited, despite calls for more economic analyses to be incorporated in research. We help fill this gap by evaluating the cost-effectiveness from the payer and societal perspectives of implementing the Me & You program. Using cost data collected alongside the Me & You group-randomized trial, we computed incremental cost-effectiveness ratios. Our primary outcome was "any DV perpetrated" within 12 months of the intervention. We conducted a cost-benefit analysis beyond the intervention endpoint by using literature estimates of per-victim lifetime costs of DV. We performed sensitivity analyses to assess effects of uncertain parameters. Under the base-case scenario, the cost of the Me & You curriculum compared to the standard curriculum was $103.70 per-student from the societal perspective, and the effectiveness was 34.84 perpetrations averted, implying an incremental cost per perpetration averted of $2.98, which ranged from $0.48 to $73.24 in sensitivity analysis. Thus, we find the Me & You curriculum is cost-effective and cost-saving in most scenarios. Policymakers should carefully consider school-based DV prevention programs, and cost data should be regularly collected in adolescent prevention program evaluations.

The Impact of the COVID-19 Pandemic on Adolescent Mental Health and Substance Use.

PURPOSE: The aim of this study is to determine whether COVID-19-induced financial impact, stress, loneliness, and isolation were related to perceived changes in adolescent mental health and substance use. METHODS: Data were from Baseline (2018) and Wave 3 (2020; mean age = 14.8; 50% female) of 1,188 adolescents recruited from 12 Texas public middle schools as part of a randomized controlled trial. Participants were primarily Black (23%), Latinx (41%), Asian (11%), and White (9%). We assessed mental health and substance use (Baseline and Wave 3) and pandemic-related physical interaction, loneliness, stress, family conflict, and economic situation (Wave 3). RESULTS: COVID-19-induced stress and loneliness were linked to depression (beta = 0.074, p ≤ .001; beta = 0.132, p ≤ .001) and anxiety (beta = 0.061, p = .001; beta = 0.088, p ≤ .001) among ethnically diverse adolescents. Adolescents who did not limit their physical interactions due to COVID-19 had fewer symptoms of depression (beta = -0.036, p = .03); additionally, adolescents who did not restrict their socializing were substantially more likely to report using a variety of substances (e.g., for episodic heavy drinking; odds ratio = 1.81, p = .001). Increased use of a food bank was linked to depression (beta = 0.063, p ≤ .001) and a negative change in financial situation was linked to increased alcohol use (odds ratio = 0.70, p = .04) among adolescents. DISCUSSION: After controlling for prepandemic psychopathology and race/ethnicity, COVID-19 induced isolation, loneliness, stress, and economic challenges were linked to poor mental health and substance misuse. Substantial structural, community, school, and individual level resources are needed to mitigate the impact of the COVID-19 pandemic on adolescent psychosocial health.

A Dating Violence Prevention Program for Middle School Youth: A Cluster Randomized Trial.

OBJECTIVES: We conducted a cluster randomized controlled trial to test the a priori hypothesis that students attending an intervention middle school would be less likely to report physical adolescent relationship abuse (ARA) 1 year later compared with students attending a control school. Secondary objectives were to determine if the intervention reduced substance misuse, bullying, and fighting. METHODS: Twenty-four Texas public middle schools were matched by the size of student enrollment, number of economically disadvantaged students, and race and ethnicity of the student body and randomly assigned to the intervention (n = 12; 1237 participants) or the control (n = 12; 1531participants) group. The intervention, Fourth R, is a classroom-based curriculum delivered by existing teachers and consists of 21 lessons on injury prevention, substance use, and growth and development. RESULTS: Participants (50% female) self-reported ethnicity as Hispanic or Latinx (35%), Black or African American (24%), Asian American (17%), White (8%), and multiethnicity or other (16%). Among those who have dated, students in the intervention schools were less likely to report perpetrating physical ARA (intervention = 14.9% versus control = 18.3%) relative to students in the control schools (adjusted odds ratio, 0.66; 95% confidence interval, 0.43-1.00; P = .05). In the overall sample, no significant differences emerged between control and intervention groups with respect to substance misuse, fighting, and bullying. CONCLUSIONS: The middle school version of Fourth R is effective in reducing physical ARA perpetration over at least 1 year. The intervention did not have an effect on bullying perpetration, physical fighting with peers, and substance misuse. Long-term assessment, especially follow-up that covers the transition to high school, is needed to examine the program benefit on key outcomes.

Socio-Ecological Factors Associated With Students' Perceived Impact of an Evidence-Based Sexual Health Education Curriculum.

BACKGROUND: Although schools often implement evidence-based sexual health education programs to address sexual and reproductive health disparities, multiple factors may influence program effectiveness. METHODS: Using student-reported perceived impact measures as a proxy for program effectiveness, we employed a socio-ecological approach to examine student, teacher, school, and district factors associated with greater perceived impact of It's Your Game (IYG), an evidence-based middle school sexual health education program. The student sample was 58.7% female, 51.8% Hispanic, mean age 13.2 years, from 73 middle schools. We assessed students' (N = 4531) perceived impact of IYG on healthy decision-making (α = 0.75) and sexual communication (α = 0.71); satisfaction with IYG activities and teacher; and demographics. We assessed teachers' (N = 56) self-efficacy to teach IYG, perceived administrative support, implementation barriers, and demographics. School and district data were abstracted from state records. We used multilevel logistic regression to estimate associations between independent variables and student-reported perceived impact. RESULTS: In final multivariate models, students' demographics (sex, ß = 0.06, SE = 0.015), satisfaction with IYG (ß = 0.21, SE = 0.012), and their IYG teacher (ß = 0.18, SE = 0.013) (all p = .000) were significantly associated with perceived impact on healthy decision-making. Similar findings resulted for sexual communication. No other variables were significantly associated with perceived impact. CONCLUSIONS: Helping schools select age-appropriate, culturally relevant programs, and facilitate supportive learning environments may enhance the perceived impact of sexual health education programs.

Efficacy of It's Your Game-Tech: A Computer-Based Sexual Health Education Program for Middle School Youth.

PURPOSE: Few computer-based HIV, sexually transmitted infection (STI), and pregnancy prevention programs are available, and even fewer target early adolescents. In this study, we tested the efficacy of It's Your Game (IYG)-Tech, a completely computer-based, middle school sexual health education program. The primary hypothesis was that students who received IYG-Tech would significantly delay sexual initiation by ninth grade. METHODS: We evaluated IYG-Tech using a randomized, two-arm nested design among 19 schools in a large, urban school district in southeast Texas (20 schools were originally randomized). The target population was English-speaking eighth-grade students who were followed into the ninth grade. The final analytic sample included 1,374 students. Multilevel logistic regression models were used to test for differences in sexual initiation between intervention and control students, while adjusting for age, gender, ethnicity, time between measures, and family structure. RESULTS: There was no significant difference in the delay of sexual activity or in any other sexual behavior between intervention and control students. However, there were significant positive between-group differences for psychosocial variables related to STI and condom knowledge, attitudes about abstinence, condom use self-efficacy, and perceived norms about sex. Post hoc analyses conducted among intervention students revealed some significant associations: "full exposure" (completion of all 13 lessons) and "mid-exposure" (5-8 lessons) students were less likely than "low exposure" (1-4 lessons) students to initiate sex. CONCLUSIONS: Collectively, our findings indicate that IYG-Tech impacts some determinants of sexual behavior, and that additional efficacy evaluation with full intervention exposure may be warranted.

It's Your Game-Tech: Toward Sexual Health in the Digital Age.

Adolescent sexually transmitted infection (STI) and birth rates indicate a need for effective middle school HIV/STI, and pregnancy prevention curricula to delay, or mitigate consequences of, early sexual activity. Individual and organizational barriers to adoption, implementation, and maintenance, however, can hamper dissemination of evidence-based sexual health curricula, adversely impacting fidelity and reach. Internet-based approaches may help mitigate these barriers. This paper describes the development and feasibility testing of It's Your Game (IYG)-Tech, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing effective sexual health curriculum-It's Your Game… Keep it Real (IYG). IYG-Tech development adaptation steps were to: 1) Select a suitable effective program and gather the original program materials; 2) Develop "proof of concept" lessons and test usability and impact; 3) Develop the program design document describing the core content, scope, and methods and strategies; and 4) produce the new program. Lab- and school-based tests with middle school students demonstrated high ratings on usability parameters and immediate impact on selected psychosocial factors related to sexual behavior-perceptions of friends' beliefs, reasons for not having sex, condom use self-efficacy, abstinence intentions, negotiating with others to protect personal rules, and improved knowledge about what constitutes healthy relationships (all p < .05). Youth rated IYG-Tech is favorably compared to other learning channels (>76.2% agreement) and rated the lessons as helpful in making healthy choices, selecting personal rules, detecting challenges to those rules, and protecting personal rules through negotiation and refusal skills (89.5% - 100%). Further efficacy testing is indicated for IYG-Tech as a potential strategy to deliver effective HIV/STI, and pregnancy prevention to middle school youth.

Behavioral and psychosocial effects of two middle school sexual health education programs at tenth-grade follow-up.

PURPOSE: An earlier randomized controlled trial found that two middle school sexual education programs-a risk avoidance (RA) program and a risk reduction (RR) program-delayed initiation of sexual intercourse (oral, vaginal, or anal sex) and reduced other sexual risk behaviors in ninth grade. We examined whether these effects extended into 10th grade. METHODS: Fifteen middle schools were randomly assigned to RA, RR, or control conditions. Follow-up surveys were conducted with participating students in 10th grade (n = 1,187; 29.2% attrition). RESULTS: Participants were 60% female, 50% Hispanic, and 39% black; seventh grade mean age was 12.6 years. In 10th grade, compared with the control condition, both programs significantly delayed anal sex initiation in the total sample (RA: adjusted odds ratio [AOR], .64, 95% confidence interval [CI], .42-.99; RR: AOR, .65, 95% CI, .50-.84) and among Hispanics (RA: AOR, .53, 95% CI, .31-.91; RR: AOR, .82, 95% CI, .74-.93). Risk avoidance students were less likely to report unprotected vaginal sex, either by using a condom or by abstaining from sex (AOR: .61, 95% CI, .45-.85); RR students were less likely to report recent unprotected anal sex (AOR: .34, 95% CI, .20-.56). Both programs sustained positive impact on some psychosocial outcomes. CONCLUSIONS: Although both programs delayed anal sex initiation into 10th grade, effects on the delayed initiation of oral and vaginal sex were not sustained. Additional high school sexual education may help to further delay sexual initiation and reduce other sexual risk behaviors in later high school years.

Feasibility of providing sexually transmitted infection testing and treatment in off-campus, nonclinic settings for adolescents enrolled in a school-based research project.

BACKGROUND: This study examined the acceptability and feasibility of using a biological outcome measure to evaluate a school-based sexuality education program. Confidential field-delivered sexually transmitted infection (STI) testing by nonmedical field staff and STI treatment by medically trained field staff was assessed in off-campus and off-clinic settings for adolescents enrolled in the trial. METHODS: After parental and adolescent consent were obtained, a convenient time and location was identified to collect urine to test for chlamydia (Chlamydia trachomatis, CT), gonorrhea (Neisseria gonorrheae, NG), and trichomonas (Trichomonas vaginalis, TV) infection and to treat students with positive results. RESULTS: A total of 391 of 1742 students had permission to participate (22%); 353 (90%) provided urine samples; 28 (8%) had positive test results: CT(18), NG(5), and TV(8). Testing and treatment occurred at home for 92% and 59% of students, respectively; on weekdays (for 69% and 96%, respectively) and between noon and 8 pm (for 76% and 88%, respectively). All students who tested positive were treated. Several lessons and strategies that may improve the likelihood that students will participate in field-delivered STI testing and treatment emerged. CONCLUSION: STI testing and treatment are feasible for students enrolled in a school-based sexuality education program. However, obtaining parental consent may be challenging.

Prevalence and patterns of sexting among ethnic minority urban high school students.

Although sexting among U.S. youth has received much popular media attention, there are only limited data on its prevalence among ethnic minority youth. This study, therefore, specifically examined the prevalence and patterns of sexting (sending and/or receiving a nude or semi-nude picture/video or a sexual text-only message) among a sample of black and Hispanic youth. Data from 1,034 tenth graders from a large, urban school district in southeast Texas were used to calculate the prevalence of sexting by gender-race/ethnicity. Overlap among sexting behaviors was also examined. Electronic surveys were administered via an audio-computer-assisted self-interview on laptop computers. Prevalence estimates were obtained, and chi-square analyses were conducted to compare the distribution of sexting behaviors by gender-race/ethnicity subgroups. More than 20% of students reported sending either a nude or semi-nude picture/video or a sexual text-only message (jointly referred to as a "sext"), and more than 30% reported receiving a sext. Sexts were also frequently shared with unintended recipients. Black males and females reported similar prevalence estimates for sexting behaviors. However, they were more likely than Hispanic males to participate in some sexting behaviors. Hispanic females reported the lowest estimates for sexting behaviors for all gender-race/ethnicity subgroups. Many youth who sent or received a nude or semi-nude picture/video were also likely to have sent or received sexual text-only messages. The results of this study indicate that sexting is prevalent among ethnic minority youth. However, more research is needed to understand the specific context and circumstances around which sexting occurs in this population.

Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial.

PURPOSE: To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation. METHODS: Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes. RESULTS: Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54-.77), among females (AOR: .43, 95% CI: .31-.60), and among African Americans (AOR: .38, 95% CI: .18-.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47-.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33-.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36-.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19-.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52-.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01-2.82). Both programs positively affected psychosocial outcomes. CONCLUSIONS: The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.

Preclinical students: who are surgeons?

BACKGROUND: The purpose of the present study was to determine how preclinical medical students formulate their career choice and to determine the origin of negative perceptions regarding surgery as a career. MATERIALS AND METHODS: A qualitative study was performed with second-year medical students voluntarily participating in focus group study. Students with and without an interest in surgery attended. Topics discussed included factors influencing career choice, priorities, perceptions, exposure, and interactions with surgeons. Three investigators conducted independent content analysis. RESULTS: Career choices for students interested in surgery originated primarily from premedical school experiences/interactions with surgeons. In contrast, students not interested in surgery made career choices during medical school and choices were shaped primarily by second-year preceptors. The main priority for students interested in surgery was personal happiness that was perceived as being significantly dependent upon career satisfaction. Students not interested in surgery tended to separate happiness derived from career versus family. Negative perceptions toward surgery were developed and reinforced by media, preceptors, and classmates. All students had minimal exposure to surgeons during preclinical years and generally agreed that increased involvement with surgeons would be beneficial, particularly through preclinical preceptorships. CONCLUSIONS: Career choices of preclinical students interested in surgery were made prior to entering medical school, suggesting that outreach programs to high schools and colleges may beneficial. Negative perceptions about surgery develop through a variety of sources, including fellow classmates, preceptors, and the media. Surgeons need to take responsibility for these perceptions.