Dealing with Zeros: Adolescent Drug Use, Perceived Disapproval, and Perceived Harm.

Because studies examining youth drug use often have data with a high proportion of zeros, they often do not meet the assumptions for univariate or linear regression analyses that are typically used. We demonstrate the use of zero-inflated negative binomial regression models to address excessive zeros in drug use frequency on perceptions of disapproval and perceived harm among middle and high school students (N = 522). We found that perceptions of parent disapproval were a better predictor of marijuana use (p = .01) than peer disapproval. Perceived harm was related to marijuana use (p = .04). Researchers should consider using zero-inflated negative binomial regression models when examining youth drug use.

Differences in Health Education Competencies Among Obesity Prevention and Nutrition Education Professionals.

The study purpose was to examine perceived health education competencies among those responsible for planning, implementing, and evaluating health education programs. A total of 172 obesity prevention and nutrition education professionals in the United States completed a survey measuring their perceived competency to plan, implement, and evaluate nutrition education/obesity prevention education programs based on the National Commission for Health Education Credentialing health education competencies and their endorsement of various health education approaches. Using a series of multiple hierarchical regression models, we found that those trained in health education had greater perceived competency in assessing needs (B = 1.19, t = 2.11, p = .03), planning health education programs (B = 1.63, t = 2.96, p = .004), implementing health education programs (B = 1.00, t = 2.22, p = .03), evaluating health education programs (B = 4.85, t = 3.54, p = .001), and managing health education programs (B = 1.70, t = 2.21, p = .03) than those trained in nutrition or dietetics. Additionally, those trained in health education were more likely to endorse the use of a skill-based approach to obesity prevention (B = 0.25, t = 2.53, p = .01) and less likely to endorse teaching facts and information (B = 0.24, t = 1.99, p = .05) than those trained in nutrition or dietetics. These results have implications for improving the effectiveness of health education and promotion programs and the professional preparation of health educators and dietitians alike.

A clustered randomized controlled trial to determine impacts of the Harvest of the Month program.

The study purpose was to examine the impact of the Harvest of the Month (HOTM) program on fruit and vegetable (FV) consumption, FV preferences, other eating behaviors, physical activity and other variables related to healthy eating. A clustered randomized controlled trial was employed in 28 elementary schools. After parental consent was obtained, students in grades 4-6 were randomly assigned to treatment and control conditions (Intervention= 127, Control= 148). Students in the intervention group participated in HOTM, a widely used school-based nutrition promotion and obesity prevention program. Control group schools continued their usual practice. Participants completed baseline and follow-up surveys measuring fruit and vegetable (FV) consumption, FV preferences, other eating behaviors, physical activity, FV knowledge and self-efficacy to eat, prepare and ask for FV. No impacts of HOTM were found for FV consumption or other nutritional behaviors, physical activity, FV knowledge, or self-efficacy. A positive impact of the program was only found for FV preferences. This study suggests that the HOTM program did not affect eating behaviors or physical activity behaviors. The evidence base regarding school-based nutrition education programs including HOTM could be strengthened by the use of more rigorous impact evaluations to examine their effectiveness prior to wide-spread use.

A Clustered Randomized Controlled Trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program.

OBJECTIVES: To determine the impact of Positive Prevention PLUS, a school-based adolescent pregnancy prevention program on delaying sexual intercourse, birth control use, and pregnancy. METHODS: I randomly assigned a diverse sample of ninth grade students in 21 suburban public high schools in California into treatment (n = 2483) and control (n = 1784) groups that participated in a clustered randomized controlled trial. Between October 2013 and May 2014, participants completed baseline and 6-month follow-up surveys regarding sexual behavior and pregnancy. Participants in the treatment group were offered Positive Prevention PLUS, an 11-lesson adolescent pregnancy prevention program. RESULTS: The program had statistically significant impacts on delaying sexual intercourse and increasing the use of birth control. However, I detected no program effect on pregnancy rates at 6-month follow-up. CONCLUSIONS: The Positive Prevention PLUS program demonstrated positive impacts on adolescent sexual behavior. This suggests that programs that focus on having students practice risk reduction skills may delay sexual activity and increase birth control use.

Beyond teacher training: the critical role of professional development in maintaining curriculum fidelity.

PURPOSE: To examine how teacher characteristics affected program fidelity in an impact evaluation study of the Positive Prevention PLUS program, and to propose a comprehensive teacher training and professional development structure to increase program fidelity. METHODS: Curriculum fidelity logs, lesson observations, and teacher surveys were used to measure teacher characteristics and implementation fidelity including adherence, adaptation, and lesson quality. RESULTS: Compared with non-health credentialed teachers, credential health education teachers had greater comfort and self-efficacy regarding sex-related instruction. Teacher self-efficacy and comfort were significant predictors of adherence. CONCLUSIONS: Implementation fidelity may be linked to teacher characteristics that can be enhanced during curriculum training. A 2-day teacher training may not adequately address teacher facilitation skills or the maintenance of institutional supports for implementing a program with fidelity and quality. A new model of comprehensive teacher training and support is offered. This new training infrastructure is intended to contribute to the school district's institutionalization of higher-quality comprehensive sexual health education and increase program fidelity.

My student body: effects of an internet-based prevention program to decrease obesity among college students.

OBJECTIVE: To determine the impact of My Student Body (MSB)-Nutrition, an Internet-based obesity prevention program for college students. PARTICIPANTS: Three hundred and twenty ethnically diverse undergraduate students were randomly assigned to 1 of 3 conditions: MSB-Nutrition program, an on-campus weight management course, and a comparison group. METHODS: Students completed baseline and follow-up surveys regarding their nutrition and physical activity behaviors, self-efficacy, stress, attitudes, and body weight. RESULTS: Compared with the on-campus course and a comparison group, the MSB-Nutrition program increased fruit and vegetable consumption, reduced stress, and increased fruit and vegetable self-efficacy but had no significant effect on students' exercise self-efficacy, exercise behavior, or weight loss. CONCLUSIONS: The MSB-Nutrition program was effective in changing students' nutrition behaviors but had no effect on physical activity behaviors or weight loss. Suggestions for improving Internet-based interventions aimed at decreasing obesity rates among college students are offered.

The effectiveness of a multimedia program to prevent fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) continues to be the leading preventable cause of mental retardation in the United States. Because abstaining from alcohol prior to and throughout pregnancy is the only way to prevent FAS, some prevention programs try to target women before they become pregnant. The Fetal Alcohol Spectrum Teaching and Research Awareness Campaign (FASTRAC) is a multimedia, peer-delivered educational presentation designed to reduce the incidence of FAS. Results from an ethnically diverse sample of high school students indicate that the program increased participants' knowledge regarding FAS but had no significant effect on participants' attitudes, beliefs about the dangers of FAS or intention to use alcohol during pregnancy. The FASTRAC program failed partly because of its didactic approach and the lack of health education principles that have been shown to be effective in changing other substance use behaviors. Suggestions for improving FAS prevention education programs are offered.