Search

Most evidence-based teen pregnancy prevention programs focus on individual-level sexual health outcomes (e.g., STIs, pregnancy, teen births). To expand program and intervention approaches within teen pregnancy prevention (TPP), the Department of Health and Human Services funded two grantees, Innovative Teen Pregnancy Prevention Programs (iTP3) and Innovation Next (IN) to support and enable early innovation to advance adolescent health and prevent teen pregnancy. The pipeline to support and enable innovation in adolescent health is complex, resulting in barriers and challenges to research and evaluation of novel programs. This paper presents some of the barriers encountered by the grantees. Data for this paper was collected from key personnel and secondary data sources. Focus group participants included seven representatives (n = 7) across the two organizations. Focus group questions assessed barriers related to innovative intervention development and evaluation. Key findings include four barriers to evaluation when fostering innovative adolescent-focused pregnancy prevention interventions. These included (a) funding constraints on evaluation activities, (b) innovation readiness for rigorous testing, (c) evaluation knowledge and expertise on innovation-development teams, and (d) challenges with evaluation requirements. Novel and promising system- and technology-focused interventions with the potential to impact TPP require alternative tools and approaches for evaluation. This would allow research to focus on how systems-level change mechanisms (i.e., policy, access to care) impact sexual risk behaviors and better understand ecological and social determinants of health for the priority population. The advancement of approaches to impact adolescent health identifies the need to expand the focus of evidence-based interventions beyond the adolescent themselves and understand approaches that impact external contexts and environments related to reducing sexual and reproductive health (SRH) risk-taking. [ABSTRACT FROM AUTHOR]

The goal of the current study is to examine the degree to which measures of quality of implementation and student engagement moderate pretest–posttest changes in mediating variables that are targeted by DARE "keepin' it REAL." DARE officers (10 elementary school, five middle school) taught DARE "keepin' it REAL lessons to 1,017 elementary students (480 boys and 534 girls) and 435 middle school students (217 boys and 215 girls). We examined teachers' and students' ratings of elementary and middle schools in response to DARE officers' delivery of the program. HLM analyses revealed that students' engagement was a significant and meaningful predictor of changes in targeted mediators. Teachers' ratings of student responsiveness added little in terms of understanding these outcomes with main effects observed only for students' ability to respond to bulling and students' estimates of peer drug use. Teachers' ratings of the quality of officer implementation, on the other hand, did add to understanding students' outcomes. Effects were seen for three (peer norms about drug use, decision-making (DM) skills, intentions to avoid drug use) out of six outcome variables and suggest a stronger positive effect for elementary versus middle school students. At least for these three outcomes, understanding quality of implementation added to our ability to interpret results. Specifically, in addition to students' engagement, quality of implementation (which varied by grade) contributed to achieving positive changes in students' outcomes. [ABSTRACT FROM AUTHOR]

As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training. [ABSTRACT FROM AUTHOR]

The development of evidence-based interventions (EBIs) for the prevention of behavioral health problems is well supported. However, limited data exist on the sustainability of EBIs once initial support has ceased. The current study assessed, at 2 years after initial start-up support: (1) What percent of schools sustained EBI implementation? (2) To what degree did sustaining schools implement the EBI with fidelity? (3) What were the primary reasons for not sustaining the EBI? (4) What theoretical and contextual factors during initial start-up support predicted sustainment of the EBI? The study used process evaluation data from the dissemination of the Botvin LifeSkills Training (LST) middle school program in 158 school districts (including 419 schools). Fifty-one percent of districts sustained the EBI and most of these sustaining districts reported following key fidelity guidelines. Primary reasons for discontinuing centered around low teacher or administrative support and turnover. Significant predictors of sustaining LST were higher ratings of LST's complexity, benefit, and compatibility by teachers; more positive perceptions of organizational support from administrators; and smaller proportions of Black students. Results show that EBI sustainment and fidelity of implementation post-initial startup support are feasible, though likely not for all schools. Findings also suggest that cultivating support for the EBI among staff during start-up support may be helpful for sustainment and that social determinants of a school have a complex relationship with EBI sustainment. Future research should explore true causes of differences due to race/ethnicity as well as COVID-19 effects. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness of the drug and violence resistance educational program (PROERD) on short-term secondary outcomes, such as intentions to use drugs, attitudes toward drugs, school experience, and life skills (refusal, decision-making, and communication). Two cluster-randomized controlled trials were conducted in 30 public schools in the city of São Paulo (Brazil) with 4030 students (1727 fifth and 2303 seventh graders). The intervention group attended 10 PROERD classes conducted by trained police officers, whereas the control group received no intervention. PROERD is a Brazilian adaptation of the North American Drug Abuse Resistance Education (DARE) program Keepin' it REAL. Data were collected at two time points: pre-intervention and at 9-month follow-up. Two different paradigms were used in the multilevel analysis, complete case (CC), and intention-to-treat (ITT) analyses, using full information maximum likelihood (FIML). We found mixed results. Although the seventh-year curriculum seems to have positive effects on school experience (coef = 0.093; 95% CI: 0.001, −0.185), it also increases the intention to use cigarettes in the future (OR = 1.93, 95% CI: 1.109, 3.379) and the chances of accepting marijuana (OR = 1.62, 95% CI: 1.03, 2.53), and it appears to slightly reduce decision-making skills among fifth graders (coef = −0.078; 95% CI: −0.131, −0.025). Our results suggest that PROERD implementation and cultural adaptation should be reevaluated to understand why the program does not achieve the expected preventive goals and produces potential iatrogenic effects. [ABSTRACT FROM AUTHOR]

Third-variable effects, such as mediation and confounding, are core concepts in prevention science, providing the theoretical basis for investigating how risk factors affect behavior and how interventions change behavior. Another third variable, the collider, is not commonly considered but is also important for prevention science. This paper describes the importance of the collider effect as well as the similarities and differences between these three third-variable effects. The single mediator model in which the third variable (T) is a mediator of the independent variable (X) to dependent variable (Y) effect is used to demonstrate how to estimate each third-variable effect. We provide difference in coefficients and product of coefficients estimators of the effects and demonstrate how to calculate these values with real data. Suppression effects are defined for each type of third-variable effect. Future directions and implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Friendships form an important context in which adolescents initiate and establish alcohol use patterns, but not all adolescents may be equally affected by this context. Therefore, this study tests whether parenting practices (i.e., parental discipline, parental knowledge, unsupervised time with peers) and individual beliefs (i.e., alcohol descriptive norms, positive social expectations, moral approval of alcohol use) moderate friend selection and influence around alcohol use. Stochastic actor-based models were used to analyze longitudinal social network and survey data from 12,335 adolescents (aged 11 to 17, 51.3% female) who were participating in the PROSPER project. A separate model was estimated for each moderating variable. Adolescents who reported consistent parental discipline, less unsupervised time with peers, higher descriptive alcohol use norms, and less positive social expectations about alcohol use were less likely to select alcohol-using friends. Those who reported consistent parental discipline, better parental knowledge, lower descriptive alcohol use norms, and less positive social expectations were more influenced by their friends' level of alcohol use. Thus, adolescents with these characteristics whose friends frequently use alcohol are at greater risk whereas those whose friends do not use alcohol are at lower risk of using alcohol. The findings show that, although selection and influence processes are connected, they may function in different ways for different groups of adolescents. For some adolescents, it is particularly important to prevent them from selecting alcohol-using friends, because they are more susceptible to influence from such friends. These peer network dynamics might explain how proximal outcomes targeted by many prevention programs (i.e., parenting practices and individual beliefs) translate into changes in alcohol use. [ABSTRACT FROM AUTHOR]

Prevention curricula rely on audience engagement to effectively communicate their messages. However, to date, measurement of engagement has primarily focused on self-report that is often an indicator of liking or satisfaction. Emerging technologies for intervention delivery hold promise not only for additional engagement indicators but also for dissemination outside of traditional vehicles such as classroom delivery. The present study, grounded in the theory of active involvement (Greene 2013), explores the role of engagement (as measured by self-report, program analytics, and observation) with short-term substance use prevention outcomes such as self-efficacy to counter-argue and descriptive and injunctive norms. The study tracks 4-H youth (N = 310) engaged with a media literacy focused e-learning substance prevention curriculum, REAL media. Results indicate that self-reports of engagement predicted self-efficacy to counter-argue, but a program-analytic indicator of dosage predicted lower injunctive and descriptive norms, all at 3 months. The observational indicator was correlated with self-efficacy to counter-argue but not significant in the predictive models. The implications and directions for future research regarding how engagement is measured in prevention and included in studying program effects are discussed. Clinical trial: NCT03157700, May 2017. [ABSTRACT FROM AUTHOR]

Few comprehensive primary prevention approaches for youth have been evaluated for effects on multiple types of violence. Dating Matters®: Strategies to Promote Healthy Teen Relationships (Dating Matters) is a comprehensive teen dating violence (TDV) prevention model designed by the Centers for Disease Control and Prevention and evaluated using a longitudinal stratified cluster-randomized controlled trial to determine effectiveness for preventing TDV and promoting healthy relationship behaviors among middle school students. In this study, we examine the prevention effects on secondary outcomes, including victimization and perpetration of physical violence, bullying, and cyberbullying. This study examined the effectiveness of Dating Matters compared to a standard-of-care TDV prevention program in 46 middle schools in four high-risk urban communities across the USA. The analytic sample (N = 3301; 53% female; 50% Black, non-Hispanic; and 31% Hispanic) consisted of 6th-8th grade students who had an opportunity for exposure to Dating Matters in all three grades or the standard-of-care in 8th grade only. Results demonstrated that both male and female students attending schools implementing Dating Matters reported 11% less bullying perpetration and 11% less physical violence perpetration than students in comparison schools. Female Dating Matters students reported 9% less cyberbullying victimization and 10% less cyberbullying perpetration relative to the standard-of-care. When compared to an existing evidence-based intervention for TDV, Dating Matters demonstrated protective effects on physical violence, bullying, and cyberbullying for most groups of students. The Dating Matters comprehensive prevention model holds promise for reducing multiple forms of violence among middle school-aged youth. ClinicalTrials.gov Identifier: NCT01672541. [ABSTRACT FROM AUTHOR]

Recovery high schools (RHSs) provide educational programming and therapeutic support services for young people in recovery from substance use disorders (SUDs). The objectives of this study were to examine whether students with SUDs who attended RHSs report less delinquency and substance use than students with SUDs who attended non-RHSs, and how students' social problem solving styles might moderate those associations. Participants were students from a longitudinal quasi-experimental study of adolescents who enrolled in high schools after receiving treatment for SUDs. The propensity-score balanced sample included 260 adolescents (143 in RHSs, 117 in non-RHSs) enrolled in schools in Minnesota, Wisconsin, or Texas (M age = 16; 83% White; 44% female). Negative binomial regression models were used to compare delinquency and substance use outcomes for RHS and non-RHS students at 6-month and 12-month follow-ups. The results indicated that students attending RHSs after discharge from SUD treatment reported less frequent delinquent behavior while intoxicated, and fewer days of substance use relative to students attending non-RHSs. Negative problem solving styles moderated the effect of RHS attendance on substance use outcomes, with RHSs providing minimal beneficial effects for those students endorsing maladaptive problem solving styles. We conclude that RHSs offer a promising continuing care approach for adolescents in recovery from SUD problems, but may vary in their effectiveness for students with impulsive, careless, or avoidant problem solving styles. [ABSTRACT FROM AUTHOR]

The changing legal landscape of cannabis in the USA has coincided with changes in how cannabis is used, including its co-use with other substances. This study analyzed 10 years of data from a diverse cohort of youth (N = 2429; 54% Hispanic, 16% Asian, 16% white, 3% black, 10% multiracial) to examine predictors in early and late adolescence of co-use of alcohol with cannabis (AC) and tobacco with cannabis (TC) at age 21. Two forms of co-use were examined: concurrent (use of both substances in past month) and sequential (use of one substance right after the other). Analyses focused on four predictor domains: individual (e.g., resistance self-efficacy), peer (e.g., time spent around peers who use), family (e.g., sibling use), and neighborhood (i.e., perceived alcohol and drug problems in neighborhood). For each co-use combination (AC or TC), we estimated parallel process piecewise latent growth models in a structural equation modeling framework using Mplus v8. The final AC and TC co-use models included all predictor variables from the four domains. Increases in positive expectancies and time spent around peers who use AC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of AC co-use in young adulthood. Increases in sibling TC use and time spent around peers who use TC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of TC co-use in young adulthood. Overall, findings highlight the importance of addressing peer influence in prevention programming during both early and late adolescence. [ABSTRACT FROM AUTHOR]

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems. [ABSTRACT FROM AUTHOR]

While the long-term societal costs for youth with disruptive behavior disorders are well documented, there is a dearth of information about the comprehensive costs of implementing even the most well-regarded early intervention programs, and the costs of scaling effective interventions are even less well understood. This study estimated the costs of delivering and disseminating First Step Next (FSN), an established tier two school-based early intervention, in preschool and kindergarten settings, including the training and ongoing technical assistance that support sustained, high-quality implementation. Using the Ingredients Method, we estimated (a) the per student costs of implementation, (b) the incremental cost of offering FSN to an additional student, and (c) the cost to disseminate FSN to 40 preschool and kindergarten students, including a sensitivity analysis to examine potential areas of cost savings. The per child cost to implement the FSN intervention with 29 triads in two cohorts was $4330. The incremental cost per additional student was only $2970, highlighting efficiencies gained once intervention infrastructure had been established. The cost of disseminating the intervention to a single cohort of 40 students was $170,106, or $4253 per student. The range in sensitivity analysis was $3141-$7829 per student, with variability in personnel wages having the greatest impact on cost estimates. This research expands on existing literature by providing a more comprehensive understanding of the cost of effective disruptive behavior interventions based on real-world implementation data, using these data to estimate dissemination costs, and showing how dissemination costs are particularly sensitive to personnel wages. [ABSTRACT FROM AUTHOR]

In this article, we highlight the urgent public health need for prevention of heavy episodic drinking among underage Hispanic emerging adults in the USA. We outline the current state of binge drinking prevention programming and contrast it with the unique cultural, social, and developmental realities of this population using an ecodevelopmental framework (Szapocznik and Coatsworth 1999). Finally, we advance specific recommendations for the development and delivery of culturally tailored, multisystemic binge drinking prevention programs for underage Hispanic emerging adults. [ABSTRACT FROM AUTHOR]

Several school- and family-based preventive interventions target and effectively reduce adolescent alcohol misuse. However, whether demographic groups achieve equal success with these interventions is unclear. In particular, most interventions target younger adolescents, and program effectiveness tends to be measured with majority White samples; subgroup analyses are rarely reported. We analyze longitudinal data from a sample of N = 6189 adolescents (40% Black, 60% White; 50% female) in 6th through 12th grade to quantify the degree to which age, race, and gender moderate the associations between seven well-known risk and protective factors (RPFs) that serve as common intervention targets. The RPFs that we study are drawn from social learning theory, problem behavior theory, and social control theory, including individual factors (positive alcohol expectancies and deviant behavior), family context (perceived parental involvement, perceived parent alcohol use, and access to alcohol), and peer context (descriptive and injunctive norms). Multilevel growth models allow us to conduct the demographic subgroup moderation analysis. Results suggest that these well-studied RPFs explain alcohol involvement to varying degrees, but they explain substantially more variation in alcohol involvement by White adolescents compared with Black adolescents. We find differential patterns of significance and of leading predictors of alcohol involvement as a function of age, race, and gender and the interactions thereof. These results indicate that the prevention field needs to better understand the RPFs affecting minority and high school youth in order to provide a stronger basis for alcohol prevention efforts. [ABSTRACT FROM AUTHOR]

Assessments of youth risk and protective factors (RPFs) for substance use, delinquency, and violence have been used by communities to identify priorities and target them with prevention interventions. These same RPFs may also predict other youth problems. This study examined the strength and consistency of relationships of 41 ecological RPFs that predict antisocial behavior and substance use with sexual behavior outcomes in a sample of 2150 urban youth in 10th and 12th grade. After adjusting for controls, findings identify significant associations among the majority of community, school, family, peer, and individual risk factors, and family, peer, and individual protective factors, with sexual behavior outcomes, specifying unique associations among multiple factors with risky sex relative to both safe sex and not being sexually active. Prevention programming that targets common predictors for multiple problems may address a broad array of outcomes, including sexual health risk behaviors. [ABSTRACT FROM AUTHOR]

Poly drug use in adolescents represents a significant public health issue, heightening risk for abuse, dependency, and a variety of short- and long-term psychological, psychosocial, and health consequences. However, past studies have typically examined just one or two substances in isolation and there is a lack of research that has comprehensively examined possible predictors of poly drug use in adolescents. To inform the development of comprehensive prevention programs that can simultaneously target multiple substances, the present study sought to identify psychological, environmental, and demographic factors that are most strongly associated with alcohol, tobacco, and cannabis poly drug use. Adolescents aged 15 to 17 years (n = 1661; 50.9% male) completed a survey on their use of alcohol, tobacco, and cannabis over the last 30 days. Various psychological, environmental, and demographic factors were also assessed. Weighted multiple-level logistic regression was conducted to assess the factors associated with poly drug use. In total, 20.3% of respondents had used at least one substance, 6.7% reported using two substances, and 3.3% reported using all three substances. The most common combined pattern of use was alcohol and tobacco, followed by alcohol and cannabis. Several factors emerged as significant, with conduct problems, depression, and the school environment accounting for the most variance. Specific psychological and environmental factors appear to be particularly important domains to target in adolescent substance use prevention programs. Early identification of adolescent depression and conduct problems and the development of programs that address these symptoms in youth may be effective approaches to delaying or preventing poly drug use in this population. [ABSTRACT FROM AUTHOR]

This randomized trial tested a strategy originally developed for school settings, the Pax Good Behavior Game (PAX GBG), in the new context of afterschool programs. We examined this approach in afterschool since 70% of all juvenile crime occurs between the hours of 3–6 pm, making afterschool an important setting for prevention and promotion. Dual-career and working families need monitoring and supervision for their children in quality settings that are safe and appropriately structured. While substantial work has identified important features of afterschool programs, increasing attention is being given to how to foster quality. PAX GBG, with its focus on shared norms, cooperative teams, contingent activity rewards, and liberal praise, could potentially enhance not only appropriate structure and supportive relationships, but also youth self-regulation, co-regulation, and socio-emotional development. This study examined the PAX GBG among 76 afterschool programs, serving 811 youth ages 5–12, who were diverse in race-ethnicity, socio-economic status, and geographic locale. Demographically matched pairs of afterschool programs were randomized to PAX GBG or treatment-as-usual. Independent observers conducted ratings of implementation fidelity and program quality across time; along with surveys of children’s problem and prosocial behavior. Interaction effects were found using hierarchical linear models such that experimental programs evidencing higher implementation fidelity demonstrated better program quality than controls, (i.e., less harshness, increased appropriate structure, support, and engagement), as well as reduced child-reported hyperactivity and intent-to-treat effects on prosocial behavior. This study demonstrates that best practices fostered by PAX GBG and implemented with fidelity in afterschool result in higher quality contexts for positive youth development. [ABSTRACT FROM AUTHOR]

While there is growing awareness for the need to examine the etiology of problem behaviors across cultural, racial, socioeconomic, and gender groups, much research tends to assume that constructs are equivalent and that the measures developed within one group equally assess constructs across groups. The meaning of constructs, however, may differ across groups or, if similar in meaning, measures developed for a given construct in one particular group may not be assessing the same construct or may not be assessing the construct in the same manner in other groups. The aims of this paper were to demonstrate a process of testing several forms of equivalence including conceptual, functional, item, and scalar using different methods. Data were from the Cross-Cultural Families Project, a study examining factors that promote the healthy development and adjustment of children among immigrant Cambodian and Vietnamese families. The process described in this paper can be implemented in other prevention studies interested in diverse groups. Demonstrating equivalence of constructs and measures prior to group comparisons is necessary in order to lend support of our interpretation of issues such as ethnic group differences and similarities. [ABSTRACT FROM AUTHOR]