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

Black and Latinx youth are situated in a maladaptive discriminatory context in the United States; however, prosociality may be one way that youth can promote their own positive development in the face of these experiences. We examined the longitudinal associations between discrimination and prosociality among 380 Black and Latinx early adolescents (MW6age = 12.38 years, 52% female) and considered race/ethnicity and self-esteem control beliefs as potential moderators to this association. Discrimination predicted higher levels of prosociality among Black youth 6 months later, but not among Latinx youth. Discrimination also predicted higher prosociality among youth with very high self-esteem control beliefs 6 months later, but not among youth with lower levels of self-esteem control beliefs. None of these associations were significant when looking across a 1-year time frame. Our findings support the predictions of self-esteem enhancement theory and highlight the importance of considering how youth's unique racialized experiences can inform how they respond to discrimination. [ABSTRACT FROM AUTHOR]

Sexual assault is a major concern on the U.S. college campus. Engaging students as pro-social bystanders has become more common as a potentially effective mechanism for reducing the incidence of sexual assault and mitigating the harm of assaults that have already occurred. Understanding the influences of pro-social bystander behavior is imperative to developing effective programs, and the use of an evidence-based theoretical framework can help identify the differences between students who intervene and those who do not when presented with the opportunity. A sample of 815 undergraduate university students completed the Sexual Assault Bystander Behavior Questionnaire, a survey based on the theory of planned behavior (TPB) that investigates students’ perceived behavioral control to intervene, subjective norms that support intervening, attitudes toward intervening, and intent to intervene in the future. Two-tailed t tests revealed interveners reported significantly greater perceived behavioral control than non-interveners for eight of the 12 intervention behaviors, more supportive subjective norms than non-interveners for seven of the 12 intervention behaviors, more positive attitudes than non-interveners for only one of the 12 intervention behaviors, and greater intent to intervene in the future for six of the 12 intervention behaviors. Differences in the four TPB variables were not consistent for the 12 intervention behaviors. The use of a theoretical framework found to be effective in explaining—and changing—other health-related behaviors, and the inquiry into students’ opportunities to intervene to compare against their reported intervention behaviors, is new to this body of literature and contributes to the understanding of the influences of pro-social bystander behavior. [ABSTRACT FROM AUTHOR]

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

This article focuses on issues related to implementing school-based social and character development programs in the context of a large multiprogram evaluation study funded by the Institute of Education Sciences and the Centers for Disease Control and Prevention. Implementation analysis is a relatively new but important research area. The first section describes why this analysis is especially important when null results are obtained. It is also noted that not only does the intervention need to be documented but activities at the comparison site require explication. The wide range of implementation methods used at four of the seven sites in the Social and Character Development Research Program is described and difficulties in studying implementation at multiple sites are discussed. [ABSTRACT FROM AUTHOR]

Objective: To describe the nature and timing of, and population exposure to, Philip Morris USA's three explicit corporate image television advertising campaigns and explore the motivations behind each campaign. Methods : Analysis of television ratings from the largest 75 media markets in the United States, which measure the reach and frequency of population exposure to advertising; copies of all televised commercials produced by Philip Morris; and tobacco industry documents, which provide insights into the specific goals of each campaign. Findings: Household exposure to the "Working to Make a Difference: the People of Philip Morris" averaged 5.37 ads/month for 27 months from 1999-2001 ; the "Tobacco Settlement" campaign averaged 10.05 ads/month for three months in 2000; and "PMUSA" averaged 3.11 ads/month for the last six months in 2003. The percentage of advertising exposure that was purchased in news programming in order to reach opinion leaders increased over the three campaigns from 20%, 39% and 60%, respectively. These public relations campaigns were designed to counter negative images, increase brand recognition, and improve the financial viability of the company. Conclusions: Only one early media campaign focused on issues other than tobacco, whereas subsequent campaigns have been specifically concerned with tobacco issues, and more targeted to opinion leaders. The size and timing of the advertising buys appeared to be strategically crafted to maximise advertising exposure for these population subgroups during critical threats to Philip Morris's public image. [ABSTRACT FROM AUTHOR]

Objective: To test psychosocial mediators of the effects of an intervention in reducing the rate of growth of violence among adolescents. Method: Five hundred and seventy-one African American adolescent males participated in this randomized trial. Multilevel modeling techniques were used to ascertain both intervention and mediated effects. Results: Intervention significantly reduced rate of growth of violence and 5 social and psychological factors in the treatment group relative to the control group. Four of these social and psychological factors were found to be complete mediators between the intervention and its preventive effects. Conclusion: Changing psychological mediating variables is central to reducing youth violence. [ABSTRACT FROM AUTHOR]

Objective: To report long-term effectiveness of the Positive Action program. Methods: Used matched-schools design and schoollevel achievement and disciplinary data to evaluate program effects on student performance and behavior in elementary schools. Results: Participation in the Positive Action program improved student behavior, school involvement, and academic achievement at all 3 levels of schools, with the results showing a clear dose-response relationship. Conclusion: Results provide clear evidence that a coherent, comprehensive, and integrated program can have enduring effects in multiple domains. [ABSTRACT FROM AUTHOR]

Abstract: This study examined the effects of smoking policy on 4,807 adolescents in 23 schools over a two-county area in California. Amounts and prevalence rates of adolescent smoking were measured with a self-report survey and a biochemical measure; school smoking policy was measured with two independent surveys of school staff. Policy effects were evaluated with multiple and logistic regression analyses controlling for school-level socioeconomic status and environmental support for teaching and administration. Of the 23 schools, 100 percent had a formal written and regularly enforced policy component restricting student smoking on school grounds, 94 percent restricted students leaving school grounds, 65 percent restricted smoking near school grounds, and 57 percent had a smoking prevention education plan. Schools with policies having all four versus < four components, high versus low emphasis on prevention, and a low versus high emphasis on cessation reported lower amounts of smoking in the last week and in the last 24 hours. Punitive consequences of policy violation bad no effect. Results were compared to school staff observations of adolescent smoking, and school archival records of student smoking violations in the last year. Results suggest that school smoking policy is associated with decreased amounts of smoking in adolescents. [ABSTRACT FROM AUTHOR]

The article presents information on the integrity of delivery of a social resistance smoking prevention curriculum known as the resistance skills training. Two components of integrity were measured. The first being the degree to which instructors followed curriculum guidelines for role plays and the second, quality of delivery. The data collection procedure included videotape sessions at two junior high schools, one in Los Angeles, California, and one in San Diego, California. The investigation represents a methodological advancement in the study of integrity of curriculum delivery, as an analogue assessment procedure was used.

Presents a study that explored the sources of drugs and weapons for a group of pre-adolescents who live in disadvantaged neighborhoods in Chicago, Illinois. Methodology; Results; Discussion.

The Midwestern Prevention Program (MPP) is an ongoing trial of a multi-component intervention--including a school-based social influence curriculum, a parent program, mass-media programming, community organization, and health policy change--designed to prevent drug and alcohol abuse among adolescents. In this article, we focus on the Indianapolis program site, and we address relationships between parental participation in the program and adolescent drug use. Components of the parent program included parent-child homework exercises linked to the curriculum, establishment of a parent program implementation committee at each school, implementation of parenting skills training by researcher-trained parent committee members, and participation in community-wide drug abuse prevention meetings. The analysis sample included 1,001 students who partidpated in the school-based social influence curriculum and completed self-report questionnaires at baseline and 18-month follow-up and whose parents completed a mailed parent survey. This sample represents 45% of the target sample of students (n = 2,213) who had data at both measurement points and whose parents were sent a survey. Results indicate that 73% of parent respondents participated in one or more of the program components. Multiple regression analyses indicated that parental participation in the program was negatively associated with adolescent use of alcohol and cigarettes at follow-up, after controlling for drug use by friends, siblings, and parents, parent--child communication variables, and demographics. Parental participation was also negatively associated with friends' and siblings' substance use at follow-up. We discuss the implications of the results for future parent prevention programming. [ABSTRACT FROM AUTHOR]

Describes a multicommunity trial for the primary prevention of adolescent drug abuse in the Kansas City metropolitan area. Mass media programming; School-based educational program for youths; Parent education and organization; Community organization; Health policy components that are introduced sequentially into communities.

Introduces John P. Elder, American Academy of Health Behavior 2003 Research Laureate. Extensive work in Mexico; Consulting work in other developing countries; Work spanning tobacco use, sun exposure, diet and nutrition and physical activity; Academic and career highlights.

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. [ABSTRACT FROM AUTHOR]

Background: Youth problem behaviors remain a public health issue. Youth in low-income, urban areas are particularly at risk for engaging in aggressive, violent, and disruptive behaviors. Purpose: To evaluate the effects of a school-based social–emotional learning and health promotion program on problem behaviors and related attitudes among low-income, urban youth. Design: A matched-pair, cluster RCT. Setting/participants: Participants were drawn from 14 Chicago Public Schools over a 6-year period of program delivery with outcomes assessed for a cohort of youth followed from Grades 3 to 8. Data were collected from Fall 2004 to Spring 2010, and analyzed in Spring 2012. Intervention: The Positive Action program includes a scoped and sequenced K–12 classroom curriculum with six components: self-concept, social and emotional positive actions for managing oneself responsibly, and positive actions directed toward physical and mental health, honesty, getting along with others, and continually improving oneself. The program also includes teacher, counselor, family, and community training as well as activities directed toward schoolwide climate development. Main outcome measures: Youth reported on their normative beliefs in support of aggression and on their bullying, disruptive, and violent behaviors; parents rated youths’ bullying behaviors and conduct problems; schoolwide data on disciplinary referrals and suspensions were obtained from school records. Results: Multilevel growth-curve modeling analyses conducted on completion of the trial indicated that Positive Action mitigated increases over time in (1) youth reports of normative beliefs supporting aggressive behaviors and of engaging in disruptive behavior and bullying (girls only) and (2) parent reports of youth bullying behaviors (boys only). At study end-point, students in Positive Action schools also reported a lower rate of violence-related behavior than students in control schools. Schoolwide findings indicated positive program effects on both disciplinary referrals and suspensions. Program effect sizes ranged from −0.26 to −0.68. Conclusions: These results extend evidence of the effectiveness of the Positive Action program to low-income, minority, urban school settings, and to middle school–aged youth. Trial registration: This study is registered at ClinicalTrials.gov NCT01025674. [Copyright &y& Elsevier]

Purpose: Interventions to improve school ethos can reduce substance use but "upstream" causal pathways relating to implementation and school-level changes are uncertain. We use qualitative and quantitative data from a pilot trial to build hypotheses regarding these., Methods: The Healthy School Ethos intervention involved two schools being provided with facilitation, training, and funding to plan and implement actions (some mandatory and some locally determined) to improve school ethos over one year. The evaluation involved a pilot-trial with two intervention and two comparison schools; semi-structured interviews with facilitators, staff, and students; and baseline and follow-up surveys with students aged 11 to 12 years., Results: Student accounts linked participation in planning or delivering intervention activities with improved self-regard and relationships with staff and other students. Some activities such as re-writing school rules involved broad participation. Students in receipt of actions such as peer-mediation or motivational sessions reported benefits such as improved safety and relationships. Some student accounts linked improved self-regard and relationships with increased engagement and aspirations, and reduced substance use. At 9-month follow-up, students in intervention schools reported less hurting and teasing of others and feeling unsafe at school. Other outcomes suggested intervention benefits but were not significant., Conclusions: School-ethos interventions may reduce substance use through upstream pathways involving the aforementioned factors. Future phase-III trials should quantitatively model the extent to which these mediate intervention effects., (Copyright © 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Underage heavy episodic drinking is a major contributor to alcohol-related morbidity/mortality. Reports indicate underage binge drinking among college students is widespread and has remained stable over the past decade. This study describes individual characteristics and calendar-specific events associated with binge drinking episodes over the course of freshman college academic year (2002-2003)., Methods: Students (N=827, age 18 years), with a prior history of tobacco use, attending a large Midwest university completed weekly web-based surveys on the number of drinks consumed for each of the past 7 days over the duration of 35 consecutive weeks (avg. number of weeks reported 16.0+/-10.5)., Results: Average prevalence of binge episodes across the academic year was 17.2+/-14.4%, 23.6+/-8.3%, and 66.3+/-11.2% for weekdays, Thursdays, and weekend days, respectively. Two-level random effects logit survival models for repeated events indicated the prevalence of weekday and Thursday binge drinking was associated with specific university/community events (Local festival odds ratio [OR] 6.03, 95% confidence interval [CI] 4.34-8.36), holidays (New Year's Eve OR 18.48, CI 12.83-26.63), and academic breaks (Spring Break OR 6.45, CI 4.57-9.08). Expected associations of younger age of first heavy drinking, past 12-month drinking, and experiencing negative consequences from heavy drinking were observed., Conclusions: Although individual characteristics were related to engaging in a binge episode, binge episodes were strongly associated with time-specific calendar events. Effective interventions to prevent immediate and long-term health consequences associated with binge drinking should consider environmental and institutional policy-level controls to reduce high levels of binge drinking on college campuses connected with holidays and university/community events.

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

Objective: This paper examines overall and gender- and racial/ethnic-specific relationships between exposure to state-sponsored anti-tobacco televised advertising and smoking-related outcomes among US middle and high school students using five years of cross-sectional nationally representative data., Design: Nationally representative 8th, 10th, and 12th grade student sample data for 1999-2003 were merged with commercial ratings data on mean potential audience exposure to network and cable television anti-tobacco advertising across the 74 largest US designated market areas, resulting in a final sample size for analysis of 122,340. Associations between state-sponsored anti-tobacco televised advertising exposure and youth smoking-related beliefs and behaviours were modelled while controlling for relevant individual and environmental factors as well as other televised tobacco-related advertising., Results: Higher potential for exposure to state anti-tobacco advertising within the previous four months was generally associated with decreasing odds of current smoking across groups. In addition, such exposure was related, to varying degrees, with decreased perceptions that most/all friends smoked, stronger five-year intentions not to smoke, and increased perceived harm of smoking. These relationships appeared possibly to be weaker for Asian students., Conclusions: The results from these analyses indicate that state anti-tobacco advertising significantly relates to beneficial outcomes -- especially regarding current smoking behaviour -- among US youth as a whole.

The purpose of this investigation was to determine if the Aban Aya Youth Project, a culturally grounded intervention, produced differences in changes over time in core intervening variables (i.e., communal value orientation, empathy, violence avoidance efficacy beliefs) and whether these variables mediated intervention effects on the development of youth violent behavior. Fifth grade cohorts at 12 schools were randomly assigned to one of two intervention conditions or an attention placebo control condition and followed longitudinally through eighth grade. A total of 668 students (49% male) participated in the study. Mediation analyses suggested that both program conditions (as compared to the control condition) led to steeper increases over time in empathy which, in turn were related to reductions in the likelihood of violent behavior over time. No other significant program effects were detected, although changes over time in violence avoidance efficacy were associated with reduced likelihood of violent behavior. Findings are discussed in terms of theory development, program development and points of refinement of the Aban Aya Youth Project and implications for future research.

Objectives: We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics., Methods: We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified., Results: We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was 2000 dollars. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment., Conclusions: There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.

Ever increasing demands for accountability, together with the proliferation of lists of evidence-based prevention programs and policies, led the Society for Prevention Research to charge a committee with establishing standards for identifying effective prevention programs and policies. Recognizing that interventions that are effective and ready for dissemination are a subset of effective programs and policies, and that effective programs and policies are a subset of efficacious interventions, SPR's Standards Committee developed overlapping sets of standards. We designed these Standards to assist practitioners, policy makers, and administrators to determine which interventions are efficacious, which are effective, and which are ready for dissemination. Under these Standards, an efficacious intervention will have been tested in at least two rigorous trials that (1) involved defined samples from defined populations, (2) used psychometrically sound measures and data collection procedures; (3) analyzed their data with rigorous statistical approaches; (4) showed consistent positive effects (without serious iatrogenic effects); and (5) reported at least one significant long-term follow-up. An effective intervention under these Standards will not only meet all standards for efficacious interventions, but also will have (1) manuals, appropriate training, and technical support available to allow third parties to adopt and implement the intervention; (2) been evaluated under real-world conditions in studies that included sound measurement of the level of implementation and engagement of the target audience (in both the intervention and control conditions); (3) indicated the practical importance of intervention outcome effects; and (4) clearly demonstrated to whom intervention findings can be generalized. An intervention recognized as ready for broad dissemination under these Standards will not only meet all standards for efficacious and effective interventions, but will also provide (1) evidence of the ability to "go to scale"; (2) clear cost information; and (3) monitoring and evaluation tools so that adopting agencies can monitor or evaluate how well the intervention works in their settings. Finally, the Standards Committee identified possible standards desirable for current and future areas of prevention science as the field develops. If successful, these Standards will inform efforts in the field to find prevention programs and policies that are of proven efficacy, effectiveness, or readiness for adoption and will guide prevention scientists as they seek to discover, research, and bring to the field new prevention programs and policies.

Aims: To demonstrate that intentions predict long-term future levels of smoking, irrespective of level of past smoking experience. A growing body of research suggests that intentions about future smoking might play an important role in addition to the influence of past smoking experience on the likelihood of smoking in future., Design: Using logistic regression analyses, we assessed the relationship between baseline smoking experience and a firm intention 'not to be smoking cigarettes 5 years from now' with four outcome measures of smoking at follow-up: 30-day smoking at a 3/4- and 5/6-year follow-up and current established smoking (self-described regular smokers or former smokers who had smoked in the past 30 days) at a 3/4- and 5/6-year follow-up., Participants: US nationally representative samples of 12th graders who responded to the Monitoring the Future (MTF) survey from the years 1976 to 1993, inclusive. For these panels, we linked stage of smoking and intentions at 12th grade to follow-up measures of smoking collected at 3/4 years after baseline and 5/6 years after baseline., Findings: Analysis of 3/4-year follow-up data (weighted n = 4544) and 5/6-year follow-up data (weighted n = 3885) for both definitions of smoking outcome indicated that there was a dose-response relationship between levels of baseline smoking experience and the likelihood of future smoking. In addition, independent of baseline smoking experience, there was a statistically significant protective effect for a firm intention not to smoke in five year's time on future smoking behavior., Conclusions: The findings suggest that evaluative studies of tobacco control policies and programs might usefully employ smoking uptake categories that incorporate smoking intentions as early indicators of outcome.

The prevention of youth problem behaviors is increasingly guided by science. Sound epidemiological research is coming to guide preventive efforts. Valid methods of monitoring the incidence and prevalence of youth problems increasingly shape preventive practice. The identification of empirically supported prevention interventions is becoming more sophisticated, and numerous scientific organizations have begun to engage in dissemination activities. These trends will be accelerated by increased media advocacy for the use of scientific methods and findings, the development of a registry of preventive trials, achievement of consensus about the standards for identifying disseminable interventions, and increased research on the factors that influence the effective implementation of science-based practices.

Objective: To explore relationships among problem and positive youth behaviors, commonalities among their predictors, and implications for prevention., Methods: Review etiology and prevention literatures., Results: Risky/unhealthy/antisocial behaviors, poor mental health, and poor academic achievement are highly prevalent and pose critical dilemmas for parents and educators. All behaviors are highly correlated with, and predict, each other; have many of the same risk and protective factors; and strongly influence success and happiness in life. Some examples of comprehensive programs with positive results in multiple domains are provided., Conclusion: We need to prevent problem behaviors and promote positive behaviors with comprehensive, coherent, and integrated approaches.