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We used the narrative vignette/storytelling approach to provide a holistic illustration of prescription stimulant misuse [PSM] and diversion [PSD] initiation and maintenance among college-attending emerging adults. We conducted 32 semi-structured, theory-guided interviews with 20 students during spring and summer 2019. The participants were diverse with respect to age, race/ethnicity and gender, and had a history of PSM and/or PSD. We created four narrative vignettes using a multi-step, collaborative process that incorporated patterns of what contributed to initiation and maintenance for four identified student groups (i.e., PSM with and without a prescription and PSD with and without a prescription). Characteristics of the individual, social and broader environments influenced behavior initiation, and positive reinforcement from trial behavior contributed to maintenance. Similarities and differences were identified across the groups. Approaches for PSM and PSD prevention and intervention in college-attending emerging adults should be multifaceted and consider prescription status.

Background We interviewed college students who engage in prescription stimulant misuse and diversion to better understand perspectives on prevention and intervention strategies. Methods Trained student researchers at one southern California university completed 32 face-to-face interviews with students who had a history of misuse and/or diversion. Participants provided insights on programs, policies, and practices that have the potential to deter behavior. Data were analyzed inductively via thematic analysis. Results Students were often misinformed or unaware of existing programs, policies and practices. Additionally, some students felt their behaviors would not be detected, whereas other students felt the fear of being detected would lead them to change their behaviors. Harm reduction and treatment-based approaches to address misuse were also recommended. Conclusions Our findings emphasize the importance of better educating students about, and enforcing, existing policies. In addition, the need to better inform students of existing campus programs is warranted.

Although a growing number of studies have sought to understand what motivates the initiation of prescription stimulant misuse and diversion among college students, there has been a lack of studies focused on what motivates behavior cessation. We aimed to explore what motivates prescription stimulant misuse and diversion cessation, from the perspective of college students with a history of having initiated and then discontinued these behaviors. We conducted face-to-face interviews with students who had a history of misuse, diversion, or both, and who had intentionally, either for the short-term or long-term, ceased these behaviors. We audio-recorded, transcribed, and analyzed interviews inductively using a thematic analysis approach. Of the six themes we identified, four applied to both misuse and diversion, while two applied to diversion only. Engaging in related behavior change, seasonality of the behaviors, changes in personal needs, and negative and/or null experiences with the behaviors were themes for both misuse and diversion cessation. Themes that emerged solely for diversion cessation included: moral and legal concerns and not wanting to be perceived as a drug dealer. The information shared by students with first-hand misuse and diversion cessation experience has the potential to guide interventions designed to address prescription stimulant misuse on college campuses.

INTRODUCTION: Prescription stimulant diversion is a behavior that increases the availability and accessibility of prescription stimulants for purposes such as misuse. As such, we aimed to develop a theory-guided understanding of diversion correlates. METHODS: Data are from a probability sample of 499 undergraduate college students attending one California university. Participants completed a 100-item survey related to prescription stimulant misuse and diversion. We first calculated prevalence of diversion and associations with demographic variables. Next, to examine intrapersonal, interpersonal and environmental correlates of diversion, we estimated three separate nested logistic regression models. RESULTS: Prescription stimulant diversion was reported by approximately 10% of the sample. In the nested logistic analyses, diversion was found to be associated with intrapersonal, interpersonal and environmental variables. CONCLUSIONS: These findings highlight the importance of examining a comprehensive set of correlates to identify subgroups of students at risk for engaging in sharing and/or selling of prescription stimulants.

INTRODUCTION: The misuse use of prescription stimulants (MPS) among college students is a pressing public health concern. Past research suggests there is variation in MPS frequency by race/ethnicity. According to the Theory of Triadic Influence (Flay et al., 2009), a health behavior can increase in frequency based on experiences and characteristics of the behavior. Thus, our aim was to examine the association between experiences and characteristics of MPS with MPS frequency, by race/ethnicity. METHODS: A probability sample of students attending two California universities completed a paper-based, psychometrically validated, instrument. Students who reported engaging in MPS in their lifetime were also asked questions about frequency, cost per pill, administration routes, sources, and experience with the drug. We used regression analyses to address our research questions, and conducted analyses by racial/ethnic group (i.e., for students identifying as Asian, Latinx, and White). RESULTS: MPS frequency did not vary by race/ethnicity. The influence of characteristics of misuse on frequency varied by race/ethnicity. Additionally, frequency of experiencing the desired outcome was significantly associated with increased MPS frequency across all three racial/ethnic groups. CONCLUSIONS: Characteristics of misuse are important to consider when screening for misuse and potential dependence. Particular attention should be given to these characteristics by race/ethnicity. Implications for future research are discussed.

Our goal was to compare and contrast the correlates of academic- and recreation-motivated misuse of prescription stimulants (MPS). Questionnaires were distributed to a probability sample of students attending two universities. We used a series of logistic regression analyses to examine intrapersonal, interpersonal, and environmental correlates of use among academic-motivated users (versus nonacademic-motivated users) and recreation-motivated users (versus nonrecreation-motivated users; N = 257 students with MPS experience). Sensations seeking, older age, academic concern, family perception of MPS, family and faculty endorsement of MPS, perceived prevalence of MPS among friends, and financial stress were unique correlates of recreation-motivated MPS. Inattention, friends’ perception of MPS, friend endorsement of MPS, perception of willingness of health care providers to write prescriptions and negative expectancies were unique correlates of academic-motivated MPS. Variables that were correlates of both motives were race/ethnicity, year in school, avoidance self-efficacy, diversion, positive MPS expectancies, MPS intention, and other substance use. These findings have important prevention and intervention implications.

To examine the prevalence, characteristics, and utility of ecological theory in explaining prescription stimulant misuse, a probability sample of 499 students from one southern California university (response rate = 94.71%) completed a 100-item paper-based survey. The illicit use of prescription stimulants (IUPS) during college was reported by approximately 21% of students, with approximately 13% of users reporting 10 or more occurrences per academic term. Characteristics of use that were examined suggest a growing trend toward recreational use. We used structural equation modeling to replicate a previously tested ecological model. The number of significant paths in this replication study (i.e., 22) was similar to the number of significant paths in the original study (i.e., 25), and 21 of the significant paths from the original study retained their significance in the replication. Results confirm prescription stimulant misuse remains prevalent, characteristics of the behavior are cause for concern, and ecological theories are a useful tool for explaining the multifaceted nature of IUPS.

Behavioral trajectories during middle childhood are predictive of consequential outcomes later in life (e.g., substance abuse, violence). Social and emotional learning (SEL) programs are designed to promote trajectories that reflect both growth in positive behaviors and inhibited development of negative behaviors. The current study used growth mixture models to examine effects of the Positive Action program (PA) on behavioral trajectories of social-emotional and character development (SECD) and misconduct using data from a cluster-randomized trial that involved 14 schools and a sample of predominately low-income, urban youth followed from 3rd through 8th grade. For SECD, findings indicated that PA was similarly effective at improving trajectories within latent classes characterized as “High/declining” and “Low/stable”. Favorable program effects were likewise evident to a comparable degree for misconduct across observed latent classes that reflected “Low/rising” and “High/rising” trajectories. These findings suggest that PA and perhaps other school-based universal SEL programs have the potential to yield comparable benefits across subgroups of youth with differing trajectories of positive and negative behaviors, making them promising strategies for achieving the intended goal of school-wide improvements in student outcomes.

This study examined whether personality characteristics, attention deficit hyperactivity disorder (ADHD) symptomology, psychological distress, and religiosity were associated with prescription stimulant avoidance self-efficacy and whether these relationships were moderated by race/ethnicity among a probability sample of 1,053 college students. We used regression analyses to examine associations between avoidance self-efficacy and the independent variables of interest, and moderation analyses to identify whether these associations were moderated by race/ethnicity. Inattention, hyperactivity, sensation seeking, and psychological distress were inversely associated with prescription stimulant avoidance self-efficacy, whereas religiosity had a direct association. Moreover, greater inattention was a risk factor for lower self-efficacy among students identifying as White but not for students identifying as Asian. Increased religiosity was a risk factor for students identifying as Latinx, whereas it was a protective factor for students identifying as White. Prevention implications are discussed.

This study evaluated effects of Positive Action, a school-based social-emotional and character development (SECD) intervention, on indicators of positive youth development (PYD) among a sample of low-income, ethnic minority youth attending 14 urban schools. The study used a matched-pair, cluster-randomized controlled design at the school level. A multiple-measure self-report protocol assessed four key strengths and resources for PYD: self-concept, peer affiliations, ethics, and social skills. Students (n=1170) were assessed from grades 3 to 8, the duration of the intervention, with drop-outs and late entrants included in analyses. Growth curve analyses revealed evidence of favorable program effects on each of the four types of resources. The study contributes to PYD research by providing evidence for school-based interventions in low-income, urban contexts for ethnic minority youth.

We examined party characteristics across different college drinking settings, associations between party characteristics and likelihood of drinking to intoxication, and the mediating role of perceived prevalence of intoxicated partygoers. Students (N = 6903) attending 14 public universities in California during the 2010 and 2011 fall semesters completed surveys on individual and party characteristics in six unique settings (e.g., residence hall). We used descriptive statistics to examine party characteristics by setting. We estimated multilevel logistic regression models to identify party characteristics associated with drinking to intoxication, and we used RMediation to determine significance of mediating effects. Individual and party characteristics varied by drinking context. Greater time at a party was associated with drinking to intoxication at five of six settings, while larger party size was significant only for outdoor settings. Enforcing the legal drinking age and refusing to serve intoxicated patrons were associated with lower likelihood of intoxication at Greek and off-campus parties. The presence of a keg was associated with drinking to intoxication at Greek, off-campus and outdoor parties; at bars, cover charges and drink promotions were positively associated with drinking to intoxication. In four of six settings, we found evidence of significant mediating effects through perceived prevalence of intoxicated partygoers. Findings highlight risk and protective characteristics of parties by drinking setting, and have prevention implications.

Preventing the illicit use of prescription stimulants, a particularly high-risk form of substance use, requires approaches that utilize theory-guided research. We examined this behavior within the context of a random sample of 554 undergraduate students attending a university in northern California. Approximately 17% of students self-reported engaging in this behavior during college; frequency of misuse per academic term ranged from less than once to 40 or more times. Although most misusers reported oral ingestion, a small proportion reported snorting and smoking the drug. The majority of misusers reported receiving the drug at no cost, and the primary source of the drug was friends. Misusers were motivated by both academic (e.g., to improve focus) and non-academic (e.g., to experiment) reasons. Our thematic analyses of an open-end question revealed that students abstaining from illicit use of prescription stimulants did so primarily for reasons related to health risks, ethics, and adherence regulations. Results from adjusted logistic regression analyses showed that correlates of the behavior were intrapersonal, interpersonal, and environmental in nature. We conclude that characteristics of misuse are a cause for concern, and correlates of the behavior are multifaceted. These findings, in addition to insights provided by students who choose not to engage in this behavior, suggest that a number of prevention approaches are plausible, such as a social norms campaign that simultaneously corrects exaggerated beliefs about prevalence while also illustrating why abstainers, in their own words, choose to abstain.

This study evaluated effects of Positive Action (PA), a school-based social-emotional and character development program, on self-esteem levels and processes among minority, low-income, urban youth. A matched-pair, cluster-randomized controlled trial was conducted in 14 Chicago Public Schools with outcomes assessed longitudinally for a cohort of youth followed from Grades 3 to 8. A total of 1,170 students participated in the study (53% female, 48% African American, and 27% Hispanic). Students in PA schools had more favorable change and endpoint scores on indices of self-esteem in the domains of peer and school and use of both adaptive and (to a lesser extent) maladaptive processes for developing and maintaining self-esteem. These results align with areas of emphasis within the PA program and illustrate how important areas of impact on self-esteem-related outcomes may be overlooked without differentiated assessments of both self-esteem levels and processes.

This study investigated mental health indicators, substance use, and their relationships, by race/ethnicity. A probability sample of 1,053 students at two California universities self-reported their frequency of substance use and rated their experience with indicators of mental health. One-way analysis of variance (ANOVA), chi-square tests, and multivariate censored regression models were estimated to examine which indicators of mental health were associated with each substance use form by race/ethnicity. Results from the one-way ANOVA and chi-square tests showed differences in substance use prevalence and mental health by race/ethnicity. For example, students who identified as White demonstrate a higher prevalence for every form of substance use in comparison to the Asian, Latino, and "All other" categories. Results from the regression showed, among Whites, inattention was associated with prescription stimulant misuse, and psychological distress was associated with marijuana use. Among Latinos, inattention was associated with cocaine and prescription stimulant use. Among Asians, psychological distress was associated with tobacco use and the misuse of prescription painkillers. Findings highlight the need to ensure subpopulations receive needed services.

To test a theory-driven model of health behavior to predict the illicit use of prescription stimulants (IUPS) among college students.A probability sample of 554 students from one university located in California (response rate=90.52%).Students completed a paper-based survey developed with guidance from the Theory of Triadic Influence. We first assessed normality of measures and checked for multicollinearity. A single structural equation model of frequency of IUPS in college was then tested using constructs from the theory's three streams of influence (i.e., intrapersonal, social situation/context, and sociocultural environment) and four levels of causation (i.e., ultimate causes, distal influences, proximal predictors, and immediate precursors).Approximately 18% of students reported engaging in IUPS during college, with frequency of use ranging from never to 40 or more times per academic term. The model tested had strong fit and the majority of paths specified within and across streams were significant at the p0.01 level. Additionally, 46% of the variance in IUPS frequency was explained by the tested model.Results suggest the utility of the TTI as an integrative model of health behavior, specifically in predicting IUPS, and provide insight on the need for multifaceted prevention and intervention efforts.

Prior research has yet to elucidate how constellations of protective factors in childhood and prevention efforts simultaneously may influence youth involvement in problem behaviors across different points in development. The current study examines how latent classes of social and emotional learning (SEL) skills, parent-child relationships, and peer influences in third grade and receipt of an ongoing SEL intervention predict substance use and violence in fifth and eighth grade. The urban, predominantly low-income, sample (N = 1,169) was nested in 14 schools that were randomly assigned to the Positive Action program or business-as-usual. Membership in a latent class reflecting protective childhood factors predicted less substance use and violence in fifth grade; however, the SEL program predicted less substance use and violence in eighth grade. Findings generally support that SEL interventions can successfully target and boost developmentally appropriate positive behaviors and can prevail over initial risk factors with enough time and exposure.

Background The illicit use of prescription stimulants (IUPS) has emerged as a high-risk behavior of the 21st century college student. As the study of IUPS is relatively new, we aimed to understand (1) characteristics of IUPS (i.e., initiation, administration routes, drug sources, motives, experiences), and (2) theory-guided intrapersonal, interpersonal, and environmental correlates associated with use. Methods Using one-stage cluster sampling, 520 students (96.3% response rate) at one Pacific Northwest University completed a paper-based, in-classroom survey on IUPS behaviors and expected correlates. Aim 1 was addressed using descriptive statistics and aim 2 was addressed via three nested logistic regression analyses guided by the Theory of Triadic Influence. Results The prevalence of ever engaging in IUPS during college was 25.6%. The majority (>50.0%) of users reported initiation during college, oral use, friends as the drug source, academic motives, and experiencing desired outcomes. Intrapersonal correlates associated with use included identifying as White, lower grade point average, diagnoses of attention deficit disorder, and lower avoidance self-efficacy. Interpersonal correlates of use included off-campus residence, varsity sports participation, IUPS perceptions by socializing agents, and greater behavioral norms. Exposure to prescription drug print media, greater prescription stimulant knowledge, and positive attitudes towards prescription stimulants were environmental correlates associated with use. In all models, IUPS intentions were strongly associated with use. Conclusions IUPS was prevalent on the campus under investigation and factors from the intrapersonal, interpersonal and environmental domains were associated with the behavior. Implications for prevention and future research are discussed.

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.

We describe challenges in the 6-year longitudinal cluster randomized controlled trial (CRCT) of Positive Action (PA), a social–emotional and character development (SECD) program, conducted in 14 low-income, urban Chicago Public Schools. Challenges pertained to logistics of study planning (school recruitment, retention of schools during the trial, consent rates, assessment of student outcomes, and confidentiality), study design (randomization of a small number of schools), fidelity (implementation of PA and control condition activities), and evaluation (restricted range of outcomes, measurement invariance, statistical power, student mobility, and moderators of program effects). Strategies used to address the challenges within each of these areas are discussed. Incorporation of lessons learned from this study may help to improve future evaluations of longitudinal CRCTs, especially those that involve evaluation of school-based interventions for minority populations and urban areas.

•Illicit use of prescription stimulants (IUPS) is prevalent among college students.•Associations were found between race, gender, and IUPS characteristics.•Being Asian or Latino increased the odds of smoking stimulants.•Being Female increased the odds of using stimulants to lose weight.•Many of the associations remained after controlling for known correlates of IUPS.

This study evaluated effects of Positive Action, a school-based social-emotional and character development (SECD) intervention, on indicators of positive youth development (PYD) among a sample of low-income, ethnic minority youth attending 14 urban schools. The study used a matched-pair, cluster-randomized controlled design at the school level. A multiple-measure self-report protocol assessed four key strengths and resources for PYD: self-concept, peer affiliations, ethics, and social skills. Students (n=1170) were assessed from grades 3 to 8, the duration of the intervention, with drop-outs and late entrants included in analyses. Growth curve analyses revealed evidence of favorable program effects on each of the four types of resources. The study contributes to PYD research by providing evidence for school-based interventions in low-income, urban contexts for ethnic minority youth.

There is considerable research that suggests that school-based social-emotional programs can foster improved mental health and reduce problem behaviors for participating youth; in contrast, much less is known about the impact of these programs on physical health, even though some of these programs also include at least limited direct attention to promoting physical health behaviors. We examined the effects of one such program, Positive Action (PA), on physical health behaviors and body mass index (BMI), and tested for mediation of program effects through a measure of social-emotional and character development (SECD). Participating schools in the matched-pair, cluster-randomized trial were 14 low-performing K-8 Chicago Public Schools. We followed a cohort of students in each school from grades 3 to 8 (eight waves of data collection; 1,170 total students). Student self-reports of health behaviors served as the basis for measures of healthy eating and exercise, unhealthy eating, personal hygiene, consistent bedtime, and SECD. We collected height and weight measurements at endpoint to calculate age- and gender-adjusted BMI z-scores. Longitudinal multilevel modeling analyses revealed evidence of favorable program effects on personal hygiene (effect size [ES] = 0.48), healthy eating and exercise (ES = 0.21), and unhealthy eating (ES = −0.19); in addition, BMI z-scores were lower among students in PA schools at endpoint (ES = −0.21). Program effects were not moderated by either gender or student mobility. Longitudinal structural equation modeling demonstrated mediation through SECD for healthy eating and exercise, unhealthy eating, and personal hygiene. Findings suggest that a social-emotional and character development program without a primary focus on health behavior promotion can have a modest impact on outcomes in this domain during the childhood to adolescence transition.

The illicit use of prescription stimulants (IUPS) is a substance use behavior that remains prevalent on college campuses. As theory can guide research and practice, we provide a systematic review of the college-based IUPS epidemiological literature guided by one ecological framework, the theory of triadic influence (TTI). We aim to assess prevalence, elucidate the behavior’s multietiological nature, and discuss prevention implications. Peer-reviewed studies were located through key phrase searches (prescription stimulant misuse and college, “prescription stimulant misuse” and “college,” illicit use of prescription stimulants in college, and nonmedical prescription stimulant use in college students) in electronic databases (PubMed, PubMed Central, and EBSCO Host) for the period 2000 to 2013. Studies meeting inclusion criteria had their references reviewed for additional eligible literature. Statistically significant correlates of IUPS in the 62 retrieved studies were organized using the three streams of influence and four levels of causation specified in the TTI. Results show that the prevalence of IUPS varies across campuses. Additionally, findings suggest the behavior is multifaceted, as correlates were observed within each stream of influence and level of causation specified by the TTI. We conclude that IUPS is prevalent in, but varies across, colleges and is influenced by intrapersonal and broader social and societal factors. We discuss implications for prevention and directions for future research.

Background The study examined whether adolescents receiving a universal, school based, drug prevention program in Grade 7 varied, by student profile, in substance use behaviors post program implementation. Profiles were a function of recall of program receipt and substance use at baseline. Methods A secondary analysis was conducted on data from the Adolescent Substance Abuse Prevention Study, a large, geographically diverse, longitudinal school-based cluster-randomized controlled trial of the Take Charge of Your Life drug prevention program. Profiles were created using self-reported substance use (preintervention) and program recall (postintervention) at Grade 7. First, characteristics of each of the 4 profiles of treatment students who varied by program recall and baseline substance use were explored. Then, multilevel logistic regression analyses were used to examine differences in the odds of substance use (alcohol, tobacco, and marijuana) among student profiles at the 6 additional study waves (Time 2 [Grade 7] through Time 7 [Grade 11]). Results Pearson's chi-square tests showed sample characteristics varied by student profile. Multilevel logistic regression results were consistent across all examined substance use behaviors at all time points. Namely, as compared with students who had no baseline substance use and had program recall (No Use, Recall), each of the remaining 3 profiles (No Use, No Recall; Use, Recall; Use, No Recall) were more likely to engage in substance use. Post hoc analyses showed that for the 2 subprofiles of baseline substance users, there were only 2 observed, and inconsistent, differences in the odds of subsequent substance use by recall status. Conclusions Findings suggest that for students who were not baseline substance users, program recall significantly decreased the likelihood of subsequent substance use. For students who were baseline substance users, program recall did not generally influence subsequent substance use. Implications for school-based drug prevention programs are discussed.

Mitigating and preventing substance use among adolescents requires approaches that address the multitude of factors that influence this behavior. Such approaches must be tested, not only for evidence of empirical effectiveness, but also to determine the mechanisms by which they are successful. The aims of the present study were twofold: 1) To determine the effectiveness of a school-based social-emotional and character development (SECD) program, Positive Action (PA), in reducing substance use (SU) among a sample of U.S. youth living in a low-income, urban environment, and 2) to test one mechanism by which the program achieves its success. We used longitudinal mediation analysis to test the hypotheses that: 1) students attending PA intervention schools engage in significantly less SU than students attending control schools, 2) students attending PA intervention schools show significantly better change in SECD than students attending control schools, and 3) the effect of the PA intervention on SU is mediated by the change in SECD. Analyses revealed program effects on both SECD and SU, a relationship between SECD and SU, and the effects of PA on SU were completely mediated by changes in SECD. Future research directions and implications for school-based social-emotional and character development efforts and substance use prevention are addressed.

A theory-guided instrument for examining prescription stimulant misuse in the college population was developed and its psychometric properties were evaluated from 2011 to 2012 at one Pacific Northwest (United States) university. Study methods included instrument development, assessment by five health and measurement professionals, group interviews with six college students, a test-retest pilot study, and a paper-based, in-classroom, campus study using one-stage cluster sampling (N = 520 students, 20 classrooms, eligible student response rate = 96.30%). The instrument demonstrated reliability (i.e., internal consistency and stability) and validity (i.e., face, content, and predictive). Limitations and implications are discussed.

Purpose We examined the effects of Positive Action (PA), a school-based social-emotional learning and health promotion program, on the emotional health of predominately low-income and ethnic minority urban youth. Methods The study was a matched-pair, cluster-randomized controlled trial involving 14 Chicago public schools. Outcomes were assessed over a 6-year period of program implementation for a cohort of youth in each school, followed from grades 3 to 8. Youth reported on their emotional health (positive affect, life satisfaction, depression, anxiety) and social-emotional and character development. Growth-curve and structural-equation modeling analyses assessed overall program effects on the emotional health outcomes as well as mediation of these effects via the program's impact on youths' social-emotional and character development. Results Students in PA schools, compared with those in control schools, had more favorable change over the course of the study in positive affect (standardized mean difference effect size [ES] = .17) and life satisfaction (ES = .13) as well as significantly lower depression (ES = −.14) and anxiety (ES = −.26) at study end point. Program effects for positive affect, depression, and anxiety were mediated by more favorable change over time in social-emotional and character development for students in PA schools. Conclusions Results suggest that universal, school-based programs can benefit the emotional health of youth in low-income, urban settings. The modest magnitude of effects over an extended period of program implementation, however, reflects the challenges of both mounting interventions and offsetting formidable risks for mental health problems in such environments.

A growing body of research indicates that school-based social-emotional and character development (SECD) and SECD-like programs (eg, social-emotional learning, positive youth development) can influence health behaviors and academic achievement among low-income minority youth, a population disproportionately affected by disparities in health1 and education. 2 In their meta-analysis examining the impact of school-based mental health and behavioral programs set in low-income, urban schools, Farahmand et al3 reported a mean effect size (generally Hedges g) on academic outcomes of 0.24. Durlak et al4 reported a mean effect size (generally Hedges g) on academic outcomes of 0.27 in their meta-analysis on school-based social-emotional learning (SEL) programs. With respect to health-related outcomes, the Durlak meta-analysis4 also showed SEL programs decreased conduct problems (effect size = 0.22) and emotional distress (effect size = 0.24), and improved positive social behaviors (effect size = 0.24). Whereas these findings are encouraging, there is a need to accumulate further evidence regarding the capacity of SECD programs to promote academic outcomes, especially when implemented in low-income, urban schools. Accordingly, the primary purpose of this study was to examine the impact of one comprehensive, school-wide SECD program, Positive Action, on academic outcomes using a longitudinal cluster-randomized controlled design in low-income, urban schools. Positive Action5 is grounded in theories of self-concept, 6–8 is consistent with social-ecological theories of health behaviors such as the Theory of Triadic Influence (TTI), 9, 10 and proposes positive feelings, thoughts, and actions result in fewer negative behaviors and enhanced motivation to learn. The core curriculum is taught through 6 units: self-concept, positive actions for mind and body, positive social-emotional actions focusing on getting along with others, and managing, being honest with, and continually improving oneself. The sequenced classroom curriculum consists of over 140 15–20 minute, age-appropriate lessons per grade taught 4 days per week for grades K-6, and 70 20 minute lessons taught 2 days per week for grades 7 and 8. The PA program also includes teacher, counselor, family, and community training, and school-wide climate development; the school-climate kit, which was used by every school in the trial of PA under study, focuses on using curriculum lessons and school activities to promote further positive actions amongst students, the school, families, and the community. More information about PA is available at http://www.positiveaction.net. Prior research has demonstrated that the PA program impacts a range of risk and resilience factors linked to academic outcomes, as well as academic outcomes themselves. 6 In an analysis of 3 longitudinal randomized controlled trials (RCT) of PA involving students aged 6 to 11 years, PA partially mitigated the decrease in number of positive behaviors endorsed by youth across time. 11 In a matched-pair RCT of PA involving 20 schools in Hawai’i, PA was shown to create whole-school contextual change and improve school quality. 12 Students in schools receiving PA were also less likely to engage in substance use, violent behaviors, or sexual activity,13 and PA schools had significantly higher school-level academic achievement and less absenteeism.14 Limitations in prior PA research should be addressed. For example, the academic impact of PA during the middle-school years has not yet been examined. Doing so is critical, as the adolescent years represent a key developmental period with new academic and social demands. Also, the need exists to collect academic-related data from students and teachers so that precursors of academic achievement (eg, engagement with learning) that cannot be measured by school-level archival records alone can be assessed. Lastly, the need exists for experimental designs of PA in low-income, urban settings. The present study addresses these limitations by: (1) following a cohort of students during the elementary- and middle-school years; (2) including student self-reports and teacher ratings of students; and (3) being set in a low-income, urban setting. The purpose was to test the hypothesis that academic performance across time would be better among schools and students receiving PA, than those not receiving PA.