Search

There are costs and benefits to conforming and resisting gender norms, and this ratio likely changes during the transition to adulthood. In this paper, we explore the development of young men’s masculine norm resistance from adolescence through emerging adulthood. Using thematic analysis on interviews with cisgender young adult men who reported feeling at least somewhat gender atypical ( N = 30, Mage = 23, White = 74%), we found that: (a) men reported more direct and indirect gender norm resistance (GNR) as they aged, (b) as men felt less pressure to conform to gender norms, they reported more ease with expressing indirect GNR, and (c) that direct GNR generally paralleled developing an understanding of critical consciousness of broader social inequities. Our study answers the call to utilize a developmental approach to study men and masculinities, and in so doing, illuminates men’s dynamic navigation of masculine norms during the transition into adulthood.

The increased awareness of the detrimental consequences of trauma exposure has led researchers to focus their attention in identifying best practices on integrating trauma-informed approaches (TIAs) to child and family services. Yet, terms related to TIAs are often utilized without an adequate definition, and most importantly, without concrete and specific strategies to ensure that services are in fact trauma-informed. Using a multi-methods approach, this project examined important practice considerations that support successful implementation of TIA in school and community-based behavioral health settings. Key informant interviews and electronic surveys were conducted with child and family systems practitioners; interviews inquired about training, current practices, and barriers to service engagement. Data was analyzed, organized, and synthesized in accordance with core domains and specific components proposed by Hanson and Lang’s (2014) trauma-informed care framework. Findings suggest that practice of TIA differed by system and was largely driven by experiential and informal learning experiences. Practitioners also report challenges unique to each system hinder the utilization of screening and intervention best practices. Salient differences included those related to knowledge and accessibility to training, utilization of evidence-based practices, application of screening tools, and availability of resources within their systems. This brings to light the importance of considering both general and system-specific practice mechanism for the successful implementation and sustainability of TIA frameworks. We suggest system-specific strategies to help integrate trauma into services, including prioritizing capacity building efforts within each system by leveraging their natural supports and identifying systems-specific assets for both screening and intervention practices.

Community violence and its physical health consequences are well known among youth living in urban settings. However, less is known about the cumulative effect of contextual and demographic risk factors on posttraumatic stress symptoms (PTSS) among vulnerable youth. Longitudinal data (baseline, 9-month, 21-month) were analyzed to investigate trajectories of PTSS, internalizing, and externalizing symptoms among 188 youth ( Mage 12.87, 60.6% male) treated for an assault injury in an emergency department. Youth exhibited decreased mental health problems over time. Higher levels of internalizing symptoms related to decreased PTSS over time, while higher levels of PTSS predicted increased externalizing symptoms over time, thus underscoring the importance of understanding comorbidity. Gender and stressful life events were significantly associated with initial levels of symptoms and trajectories. These findings suggest the importance of understanding PTSS in the context of environments and personal factors to support appropriate treatment.

Limited work has focused on understanding mechanisms through which violence negatively impacts youth outcomes. The present study investigates how three different facets of violence exposure (witnessing violence, victimization and armed conflict) relate to Colombian youth externalizing behaviors via the indirect influence of aggressive cognitions and the moderating role of community belongingness. Data were from a sample of students ( N = 3,483) in public high schools in Colombia. Findings indicated all three facets of violence were positively associated with youth externalizing behaviors. Armed conflict and witnessing community violence positively predicted externalizing behaviors via the indirect effect of aggressive cognitions. Community belongingness moderated the association between armed conflict and witnessing on aggressive cognitions. Results highlight the need for understanding risk and protective factors from a contextual lens. The role of community belongingness as a resilience factor is discussed, as such it has implications for intervention programs targeting youth at greater risk to violence exposure.

One challenge of conducting intervention studies is ensuring that study participants are exposed to the intervention. For example, in our randomized controlled trial of Take Charge!, a mentor-implemented and research-informed violence prevention program that partners with one-on-one community-based mentoring agencies, only 50% of intervention youth with fight-related injuries were successfully matched with a mentor. We examined the differences between matched (n = 49) and unmatched (n = 49) youth with regard to demographics, time from injury to study enrollment, perceived seriousness of injury, belief that future injury can be avoided, and household chaos. Youth who were successfully matched with a mentor were more likely to perceive the injury as very serious or somewhat serious compared with unmatched youth (95.9% vs. 79.6%, p = .028). All other factors were not significantly associated with successful mentor matching. Future violence prevention interventions should consider youth perceptions as a factor that may influence the completion of desired interventions.

Positive Behavioral Interventions and Supports (PBIS) is a widely used multitiered prevention framework that embeds a systems approach for establishing behavioral supports for all students, across ...

Positive Behavioral Interventions and Supports (PBIS) has been shown to be a promising approach for improving a range of behavioral health and academic outcomes for youth. This study leveraged data...

This study presents findings from a 58 high-school group-randomized controlled trial testing the effectiveness of training in a multitiered system of supports for behavior (MTSS-B) framework, which was leveraged to reduce students’ risk for emotional and behavior disorders. The trial tested the impact of MTSS-B, which included (a) training in the broader MTSS-B framework that went beyond the existing Tier 1 (school-wide PBIS) training offered by the state; (b) project-provided coaching and technical assistance supports; and (c) integration and training in evidence-based behavioral or social-emotional programs at Tiers 2 and/or 3. We reported effects of MTSS-B on implementation of positive behavior supports across all three tiers using the Schoolwide Evaluation Tool (SET) and Individual Student Systems Evaluation Tool (ISSET), as well as on external observations of teachers’ use of classroom management strategies. Results indicated significant effects on multiple SET subscales and significant reductions in teachers’ use of reactive behavior management.

This mixed-methods study describes a framework for conducting cost analyses of school-based programs leveraging fidelity data and applying the ingredients method. We illustrate this approach by applying it to Positive Behavioral Interventions and Supports (PBIS), drawing on multiple sources of data from a sample of U.S. 77 schools that were trained in PBIS. We concluded that the average per school cost of PBIS was US$53,216.00 (median = US$36,698), with an average per-pupil cost of US$90.00 (median = US$58.00), which is considerably less than other school-based prevention models. The cost did, however, differ by implementation level, such that high-fidelity implementation tended to cost more than low-fidelity implementation. We provide a case illustration to elucidate some of the cost drivers of PBIS implementation. Specifically, these data highlight the variability in the amount of training and coaching by the specific evidence-based program implemented within the tiered PBIS framework. Through this case illustration, we demonstrate the utility of tracking costs of school-based program within the context of fidelity data collection. The findings also suggest the potential cost savings of PBIS, both when compared with other evidence-based interventions as well as the known costs of negative school outcomes like dropout.

Using a multilevel ecological framework, we take a qualitative approach to examining important cultural considerations that support successful implementation of trauma-informed services within the Latinx community. We conducted key informant interviews with community practitioners recruited primarily in the Phoenix, AZ metro area. Themes that emerged from interviews captured societal, community, and individual barriers to effective implementation of a culturally responsive trauma-informed approach. Specifically, multilevel barriers included socioeconomic circumstances, normalization of trauma exposure, and the transgenerational impact of trauma. Practitioners also reported approaching their work using relationship-focused and family-centered frameworks as facilitators to service engagement. We highlight the critical need for a culturally responsive trauma-informed approach that stresses the importance of context, recognizes transgenerational vulnerabilities, and promotes equity and the utilization of cultural humility in order to lessen the multilayered disparities in service accessibility experienced by minoritized communities.

The translation of evidence-based practices (EBPs) to improve students’ social, emotional, behavioral, and academic outcomes into authentic school settings has posed significant challenges for both researchers and practitioners. Among the many barriers to the adoption and use of EBPs are their associated costs. This study presents a framework for integrating the diffusion of innovation theory into an economic evaluation utilizing a societal perspective, which affords the capturing of costs of all phases from adoption through implementation of EBPs for all stakeholders. We leverage cost data from one evidence-based math intervention to serve as a model for incorporating diffusion of innovation theory into cost estimation. We exemplify how costs are distributed across personnel and organizational structures over time and across different stages of diffusion. Results suggest that the distribution of costs changes across stages of the innovation decision-making process, and lack of attention to the pre-adoption costs may partly explain challenges in EBP adoption in schools. Implications for the translation of social, emotional, behavioral, and academic interventions in schools and suggestions for future research are discussed.

This study leveraged data from a 40-school randomized controlled trial to understand the cost of coaching to support implementation of evidence-based programs (EBPs) through a multi-tiered system of supports for behavior (MTSS-B) model. Coach activity log data were utilized to generate the annual average, per school, costs of coaching of $8198. The cost of school personnel time for coaching was estimated to be $3028. Data on coach-rated administrator buy-in, school MTSS-B engagement, and implementation infrastructure and capacity were also collected and found to be associated with coaching activities. Notably, coaches did not spend significantly different amounts of time in schools using few EBPs relative to more EBPs, indicating some inefficiency in the use of coaches’ time. These findings highlight the often-overlooked resources needed to support EBP implementation in schools.

This study aims to understand the prevalence of bullying in as well as the attributes and characteristics of injuries resulting from bullying treated in the emergency department (ED). Data come from 188 adolescents (ages 10–15) who were treated for a peer-related assault-injury in two United States urban EDs. Descriptive statistics were used to understand differences between bullied and non-bullied adolescents. A receiver operating curve (ROC) analysis was used to evaluate a possible risk index. Forty percent of adolescents identified that the incident was a result of bullying. Bullied youth reported significantly more previous bullying victimization and post-traumatic stress symptoms, but less aggression and rule breaking. A group fight, the fight involving a discordant gender, perceiving oneself as a victim, feeling that the person(s) meant to hurt them, and reporting that the fight was not resolved were significantly associated with an injury as the result of bullying. Situational characteristics such as the fight occurring in school and not arriving to the ED in an ambulance also were associated with an increased likelihood of a bullying situation. Having greater than three of these risk factors correctly identified 88% of youth who attributed the situation to bullying. Taking into account the characteristics of the assault and asking about the adolescent’s attributions of the incident can help identify patients and facilitate tailoring of appropriate intervention by social workers and other ED providers. ClinicalTrials.gov ID: NCT01770873.

Positive school climate has been consistently associated with many desirable student outcomes in both middle and high schools. However, there has been little work comparing the perceptions across these two school settings. The U.S. Department of Education conceptualized a three-factor model for school climate consisting of safety, engagement, and environment. Drawing on data from 29,720 middle and 34,950 high school students, the fit of the three-factor model was examined for measurement invariance, to explore whether the measure functioned similarly across both middle and high schools. The results indicated measurement invariance, which suggests that practitioners and researchers can confidently compare findings across middle and high schools to inform local decision making related to school-based programming. A series of multilevel analyses also explored the extent to which perceptions of school climate differed for middle and high school students; these results generally indicated that middle school students perceived the school more favorably than high school students. Implications of these findings for social workers are considered.

Background The impact of adverse childhood experiences on substance use has been well reported, however, less well documented is looking at the comparison of youth and adult substance use and their respective adverse childhood experiences. This study leveraged local data sources to support prevention efforts inside a state-level working group and examined research questions that explored the relationship between reported adverse childhood experiences and substance use for youth and adult samples at the state level. Methods This study conducted a series of logistic regression models (95% CI) between substance use outcomes with different age group populations to investigate the relationship between adverse childhood experiences and substance use for each group. Adverse childhood experiences scores and substance use were examined using two Arizona datasets: 1) Arizona Youth Survey (n = 42,009) and 2) the Behavioral Risk Factor Surveillance System (n = 5328). Results The results of youth and adult datasets were consistent: users with adverse childhood experiences scores of 4 to 6 had a positive association with more substance use. When the variables were examined, showing the entire sample of youth and adult groups compared to those subgroups with a score of zero, a score of 1 to 3, and a score of 4 to 6, the overall pattern was the same; the more frequent use of substances was directly associated to the group with higher scores. Additionally, findings support increased attention on prevention and intervention efforts with higher reports of adverse childhood experiences as well as substance use. Conclusions These findings demonstrate how local research can help prioritize prevention resources and increase the value of data-based decision-making. Policy-makers and providers can examine youth and adult data to compare priorities and assess for planning purposes. Specifically, it is possible to replicate known research findings, identify the most impacted subpopulations, and forecast the community’s future needs.

Effective classroom management practices have been associated with students' behavioral and academic outcomes, but some questions have been raised regarding the degree to which current classroom management strategies are responsive to the backgrounds of students of color in US public schools. Additionally, frameworks for culturally responsive classroom management have emerged, but little attention has been given to systematically measuring and examining these practices, particularly in conjunction with more traditional domains of classroom management. The current study used a person-centered approach with data from 103 middle-school teachers to explore how classroom management practices, including cultural responsiveness, co-occur in teacher practice, and how profiles of practices are associated with teacher and classroom characteristics and student behaviors. The latent profile analysis revealed three ordered profiles of classroom management practices (i.e., high, medium, low), suggesting that cultural responsiveness may operate as an extension of other classroom management strategies. Results also demonstrated that White students were more likely to be in classrooms with high levels of classroom management, and that students in classrooms with low levels of classroom management were more likely to demonstrate elevated levels of negative behaviors. The results suggest that a subset of teachers is in need of comprehensive professional development on a range of classroom management techniques, while all teachers could improve their practices reflecting meaningful participation and cultural responsiveness.

The objective of this study was to evaluate the cost of serving one additional youth in the Big Brothers Big Sisters of America (BBBS) program. We used a marginal cost approach which offers a significant improvement over previous methods based on average total cost estimates. The data consisted of eight years of monthly records from January 2008 to August 2015 obtained from program administrators at one BBBS site in the Mid-Atlantic. Results show that the BBBS marginal cost to serve one additional youth was $80 per mentor-month of BBBS mentoring (irrespective of program type). The cost to offer services for the average match duration of 19 months per marginal added youth was $1,503. The marginal costs per treated program participant in school-based versus community-based programs were $1,199 and $3,301, respectively. Marginal cost estimates are in the range of youth mentoring programs with significant returns on investment but are substantially higher than prior BBBS unit cost estimates reported using less robust estimation methods. This cost analysis can better inform policy makers and donors on the cost of expanding the scale of local BBBS programs as well as suggest opportunities for cost savings.

Future orientation has been established as having positive associations with health and educational outcomes for adolescents exposed to violence. However, conceptualizations of future orientation have been inconsistent. This study uses latent profile analysis to understand the interrelationships between measures of future orientation (e.g., commitment to learning, goal orientation, hope, expectancies, fatalism). Participants were 188 primarily African American male early adolescents ranging from 10 to 15 years old (60.6% male; M(age) = 12.87, SD(age) = 1.52). Adolescents in the high- and low-future orientation profiles differed on academic behaviors and aggressive behavior. A discordant profile emerged with adolescents moderate on all measures of future orientation except expectancies. Relational aspects of parenting were associated with higher likelihood of adolescents being assigned to the high- and low-future orientation profiles. These findings suggest the importance of parental warmth in promoting future orientation for adolescents in risky environments, as improving future orientation might mitigate risk for future negative academic comes or engagement in violent behavior.

Research, theory, and practice suggest an important role for parents in supporting their children when exposed to violence and helping them cope with victimization experiences. Despite this little is known about how parents respond to bullying and the factors that influence their response. Using data from 1,117 parents who reported that their middle or high schooler had been bullied in the past 30 days, this article identified different patterns of responses as well as examined the influence of perceptions of school climate, school policies and training, and school structural characteristics on their responses. A latent class analysis identified 3 different patterns of parental responses including Only Talk (72%), Contact School (23%), and Handle Themselves (5%). Parents who perceived the school to have more effective school rules were less likely to be in the class of parents who contacted the school versus the only talking class; however, school staff training was associated with a greater likelihood of parents being in the contact the school class versus the only talking class. Perceptions of equity were also related to an increased likelihood of being in the contact the school class versus the handle themselves class. These findings suggest that parents’ behaviors in response to bullying may be related to their perceptions of the school and school actions around bullying. Efforts to promote a collaborative approach to bullying between school and home should focus on communicating this expectation, potentially addressing parents’ perceptions of equitable treatment for all students. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

In Colombia, many adolescents have experienced violence related to the decades-long armed conflict in the country and have witnessed or been directly victimized by violence in their communities, often related to gang activity or drug trafficking. Exposure to violence, both political and community violence, has detrimental implications for adolescent development. This study used data from 1857 Colombian adolescents in an urban setting. We aim to understand the relations between exposure to violence and adolescent outcomes, both externalizing behaviors and developmental competence, and then to understand whether school climate (i.e., safety, connectedness, services) moderates these relations. Results demonstrate that armed conflict, community violence victimization, and witnessing community violence are positively associated with externalizing behaviors, but only armed conflict is negatively associated with developmental competence. School safety, connectedness, and services moderate the relation between community violence witnessing and externalizing behaviors. School services moderates the relation between community violence victimization and developmental competence. As students perceived more positive school climate, the effects of community violence exposure on outcomes were weakened. This study identifies potential levers for intervention regarding how schools can better support violence-affected youth through enhancements to school safety, connectedness, and services.

Purpose Target hardening, or increasing the use of security measures, is a frequently used response to perceived safety concerns in schools. Studies are mixed as to their effectiveness on students’ perceptions of safety and little is known about their influence on other aspects of school climate, particularly for minority students. This study will examine the association between observed security measures in secondary schools and students’ perceptions of safety, equity, and support. Methods School climate surveys were completed by 54,350 students from 98 middle and high schools across the state of Maryland beginning in Spring 2014. Concurrent observations of the school physical environment, including security measures (i.e., officers and cameras), were conducted by trained outside assessors. Multilevel regression analyses examined the association between school security officers and cameras and students’ perceptions of safety, equity, and support, while controlling for school and neighborhood characteristics. Cross-level interactions explored differential effects of security measures for Black students. Results Greater use of security cameras inside the school was related to lower perceptions of safety, equity, and support. A moderate level of security camera use outside the school was related to higher student perceptions of support. Security officer presence was associated with higher perceptions of safety. For black students, cameras were associated with elevated perceptions of safety and support relative to white students. Conclusions Our findings may suggest that outside cameras and security may be perceived by students as safekeeping, whereas inside cameras may evoke feelings of being viewed as potential perpetrators who need surveillance.

While the negative impact of extensive exposure to community violence and armed conflict is known, less emphasis has been focused on outcomes supportive of resilience. It is critical to begin exploring these constructs to both promote healing from decades-long conflict and to inform targeted interventions that focus on positive youth development in contexts of adversity. This study thus utilized a person-centered approach to estimate violence exposure profiles among 3,443 Colombian youth to explore what demographic covariates and positive youth development outcomes, such as school engagement, hope, goals, social competence, future expectations, and barriers to education were associated with each violence exposure profile. Four profiles emerged: a low exposure profile, a high community violence profile, a some combined exposure profile, and a high combined exposure profile, each with various levels of community violence witnessing and victimization as well as armed conflict exposure. Demographic covariance results showed older, urban, male youth were more likely to be in the high violence exposure profiles compared to the low exposure group. Youth in the high combined exposure profile were more likely to have lower hope, educational expectations, and social competence compared to the low exposure group. Findings highlight that a person-centered approach provides a more multidimensional view of adolescent violence exposure. Demographic differences suggested the importance of tailoring violence prevention initiatives to the local context. Finally, results concerning positive youth development outcomes suggest that resiliency-oriented constructs, which can be instrumental toward youth’s postwar healing and growth, should be emphasized among populations who experience high levels of co-occurring exposure.

Objective Research has identified the United States (U.S.) as a global outlier in its firearm ownership rates, with a correspondingly higher risk of youth firearm violence compared to other countries. The relative extent of disparities in youth firearm violence within the U.S. has been less clear. Little is known about factors in the social ecology driving these disparities and whether current firearm violence prevention approaches sufficiently address them. Method Applying a health disparities framework, we synthesized epidemiological, sociological, and prevention science literatures, emphasizing structural inequalities in youth sociocultural positionality in life course developmental context. We also highlighted findings from national injury data and other studies regarding the magnitude and impacts of youth firearm violence disparities. Results The burden of firearm violence varied markedly at intersections of gender, race, place, developmental stage, and homicidal or suicidal intent. Firearm homicide among Black boys and young men (ages 15-24) was at outlier levels - many times greater than the rates of any other demographic group, developmental stage, or violence intent, particularly in urban settings. Recent research has operationalized structural racism and implicated historically racialized spaces as a root cause of this disparity. In contrast, elevated firearm suicide rates were found among Native and White boys and young men in rural settings; firearm-related cultural attitudes and gender socialization were points of consideration to explain these disparities. We highlighted research-based youth firearm violence preventive interventions, and emphasized gaps in efforts focused on structural and sociocultural factors. Conclusions More explicit attention to reducing firearm homicide among Black boys and young men and firearm suicide among Native and rural White boys and young men is urgently needed and has potential to substantially lower overall rates of firearm violence in the U.S.

It is important to consider racialized experiences and proximal indicators of academic success for Black youth when understanding the achievement gap. Acknowledging that racial discrimination is detrimental for the academic success of Black youth, this study extended previous research by examining the influence of racial discrimination stress. Using hierarchical regression analysis and a moderated moderation model, this study examined racial discrimination stress and school belonging as predictors of academic attitudes and beliefs among 344 Black youth (M age = 15.6). Additionally, we examined the interactive effects of school belonging as a buffer for racial discrimination stress, with particular focus on majority White schools. Analyses revealed that school belonging was linked with academic competence, academic efficacy, and academic skepticism. Furthermore, school belonging buffered the impact of racial discrimination stress on academic efficacy among Black youth in majority White schools. These findings highlight the co-occurrence of risk and protective factors among Black youth and demonstrate the additive influence of school racial composition on academic attitudes and beliefs. The practical and theoretical implications of these findings demonstrate the crucial role of school context in understanding risk and protective factors for the academic attitudes and beliefs of Black youth.

Objective: While cigarette smoking in the United States has declined, the age range of smoking initiation has risen to include young adults. This study investigated the relationship of Theory of Planned Behavior constructs (TPB; attitudes, subjective norms, and perceived behavioral control [PBC]) to nonsmoking intention among college students. Participants: Participants were 619 students at a Southeastern US university (69.8% female, 70.8% ≤ age 21, and 73.5% white). Methods: Students were recruited by email in March 2013 to participate in an online TPB-based questionnaire. Results: Future-oriented attitudes and PBC predicted higher nonsmoking intention; subjective norms did not. Moderator analyses indicated injunctive norms were more influential for occasional smokers and PBC was less influential. Conclusions: Findings suggest TPB is useful in predicting nonsmoking intention, but differentially for nonsmokers and occasional smokers. Future work should consider the health-related utility of future-oriented attitudes toward nonhealth domains and the differing beliefs of occasional smokers.

Students often have differing perceptions of their school's climate. Although these subjective perceptions can be meaningful outcome predictors, discrepancies create challenges for those seeking to globally characterize or intervene to improve the climate of a school. Trained, independent observers can provide insights on perceptible and ostensibly malleable aspects of the school; however, the extent to which these observations help us to understand differences in students' report of school climate has not been examined. To study this, we assessed convergence and divergence between independent observers' assessments and students' perceptions of school climate at the classroom and school levels. Data come from the Maryland Safe and Supportive Schools Initiative (MDS3), which included 20,647 students and observations of 303 teachers in 50 high schools. Students responded to survey items regarding safety, engagement, and environment; independent observers assessed teachers' classroom practices and the school physical environment. A three-level model partitioned variance to the individual, classroom, and school levels. The variance in students' climate perceptions was primarily between students, with most classroom and school intraclass correlation coefficients (ICCs) ranging from 0.01 to 0.08, though one was as high as 0.20; however, observations explained large percentages of between-school variation in climate (58%-91%). Findings suggest the potential utility of outside observations for explaining school-level variation in school climate to inform decision-making and future research.

Objective This study presents results from an educational training to increase adolescent dating violence (ADV) screening among primary care clinicians and provides adolescents' perceptions regarding discussing ADV with their clinicians. Methods A national dating violence advocacy group provided a training in ADV to 16 clinicians serving an urban health clinic. Knowledge, self-efficacy, and expectations were examined before training, after training, and at a 6-month follow-up. Forty-five adolescent patients of the clinicians were also surveyed. Results Analysis shows significant increases in clinician knowledge, self-efficacy, outcome expectancies, and outcome expectations after training and at the 6-month follow-up. About half of adolescents reported that they would disclose if they were in an abusive relationship and believed that their providers could help them. Discussion This training successfully improved clinician self-efficacy, outcome expectancies, knowledge, and behavioral capability regarding ADV. Additional research is needed to determine whether the training leads to improved ADV screening and intervention.

Background Health plans are increasingly implementing quality improvement strategies aimed at meeting adolescent clinical quality measures, yet clinics often struggle to meet these measures. This qualitative study was conducted to explore how efforts to meet the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) performance measure for adolescent well-care visits were perceived by a multidisciplinary group of stakeholders. Methods The research team conducted 26 in-depth, semistructured interviews with participants from three stakeholder groups: clinic staff with direct patient contact, health care institutional leaders, and representatives of a payer organization. Interviews were about 45 minutes in duration, audio-recorded, and professionally transcribed. Framework analysis was used to identify and organize emergent themes, and Atlas.ti was used to facilitate data management and analysis. Results Stakeholder groups diverged in their opinions regarding strategies for achieving adolescent quality measures. Stakeholders with no direct patient interaction touted transactional quality improvement strategies that directly incentivized patients and families. In contrast, clinic staff with direct patient contact believed that incentive-based efforts undermined patient-provider relationships and the clinics' focus on wellness. Conclusion A considerable disconnect exists between stakeholders with and without patient contact with regard to approaches to the delivery of well care and quality improvement strategies for meeting the adolescent well-care visit performance measure. Efforts to reconcile discordant perspectives and promote a mutual understanding between payers, institutional leaders, and clinic staff could inform the development of creative initiatives that are sustainable and effective at achieving adolescent and family engagement, as well as clinical performance benchmarks.

Research has demonstrated that school and neighborhood microsystems have important implications for adolescent development, but less attention is given to the school–neighborhood mesosystem (i.e., how these contexts intersect through moderational and mediational mechanisms.) Understanding the school–neighborhood mesosystem is important conceptually, methodologically, and for public policy. This article provides a narrative review of literature that examines the effects of the school–neighborhood mesosystem on adolescent development. The review focuses on adolescents’ proximal processes and phenomenological experiences in their schools and neighborhoods, as opposed to structural characteristics of these environments. This article situates the literature reviewed within a theoretical framework adapted from prior frameworks developed to describe the family–neighborhood mesosystem. Specifically, the framework outlines four moderational mechanisms and one mediational model through which school and neighborhood contexts may intersect. Within each mechanism, a narrative review of existing scholarship is presented, and hypothetical scenarios are offered when prior research is limited. This structure highlights the utility of the theoretical framework, by allowing for greater meaning making and synthesis across existing studies, identifying gaps in the current literature, and presenting directions for future research regarding the school–neighborhood mesosystem. The implications of the school–neighborhood mesosystem for both researchers and policy makers are discussed.

School climate is an important construct for guiding violence prevention efforts in U.S. schools, but there has been less consideration of this concept in its neighboring country Mexico, which has a higher prevalence of violence. The U.S. Department of Education outlined a three-domain conceptualization of school climate (i.e., safe and supportive schools model) that includes engagement, safety, and the school environment. To examine the applicability of this school climate model in Mexico, the present study tested its measurement invariance across middle school students in the United States ( n = 15,099) and Mexico ( n = 2,211). Findings supported full invariance for engagement and modified-safety scales indicating that factor loadings and intercepts contributed almost equally to factor means, and scale scores were comparable across groups. Partial invariance was found for the environment scales. Results of a multigroup confirmatory factor analysis (MGCFA) consisting of all 13 school climate scales indicated significantly positive associations among all scales in the U.S. sample and among most scales in the Mexico sample. Implications of these findings are discussed.

African American young adults are at high risk for dual use of cigarettes and cigars. Limited work has explored and characterized the reasons for use in this population and their relative importance for initiation and current smoking of these products.Reasons for cigarette and cigar use were systematically explored and categorized using a mixed methods participatory approach called concept mapping. A series of in-person group sessions were held with 30 African American young adult (ages 18-29) current smokers of both cigarettes and cigars in Prince George's County, MD and Washington, DC. Participants brainstormed, sorted, rated, and interpreted their reasons for initiation and past 30-day use of cigarettes and cigars. A cluster map was generated using multi-dimensional scaling, and t-tests were used to explore differences in ratings by background characteristics.Participants generated 64 reasons for smoking cigarettes and cigars, and categorized these reasons into six groups: emotions, urges, access, product characteristics, lifestyle, and outside pressure. Emotions and urges were the most important motivations for initiation and current smoking of both products. Product characteristics were significantly more important for cigar initiation and smoking than for cigarettes, and outside pressure was more important for current smoking of cigars than cigarettes. Ratings differed by gender, socioeconomic status, and smoking characteristics.Cigarette and cigar smoking have several overlapping motivations, but key differences were also found, most notably for product characteristics. The FDA's regulation of cigars and cigarettes should focus on addressing key characteristics appealing to young adults to curb dual use.