Mechanisms of Influence on Youth Substance Use for a Social-Emotional and Character Development Program: A Theory-Based Approach.

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.

Students as Prosocial Bystanders to Sexual Assault: Demographic Correlates of Intervention Norms, Intentions, and Missed Opportunities.

Sexual assault is a major public health issue. Bystander engagement programs are becoming widely used to combat sexual assault on college campuses. The purpose of this study was to examine students' intervention norms, intentions, opportunities, and behaviors as bystanders to sexual assault. Undergraduate students (N = 779) completed the Sexual Assault Bystander Behavior Questionnaire in the fall of 2014. The t tests revealed differences in students' intervention norms, intentions, opportunities, and missed opportunities based on sex, race/ethnicity, athletic participation, and fraternity/sorority membership. The findings support the use of additional measures to assess bystander behavior and to identify student subpopulations that may benefit from programs aimed at increasing prosocial intervention.

Relational victimization and peer affiliate prosocial behaviors in African American adolescents: Moderating effects of gender and antisocial behavior.

INTRODUCTION: Experiencing relational victimization (e.g., peer exclusion, untrue rumors) during adolescence can have negative social-emotional consequences, including increased antisocial behavior and substance use. The negative impact of relational victimization may be lessened by spending time with supportive, prosocial peers. METHODS: This study examined the concurrent and predictive associations between relational victimization and peer affiliates' prosocial behaviors in 244 predominately African American adolescents (ages 13-14) living in U.S. urban neighborhoods. Questionnaires were collected every six months for two years. Overt victimization was controlled for in the analysis and the moderation of gender and antisocial behaviors were tested. RESULTS: Peer affiliates' prosocial behavior was stable across the two years. Relational victimization was not associated with peers' prosocial behavior at baseline or across time. Gender did not moderate the association between relational victimization and peers' prosocial behavior. Moderating effects were found for antisocial behavior; relational victimization was positively associated with peer affiliates' prosocial behavior but only for adolescents who were low on antisocial behavior at baseline. CONCLUSIONS: For African American youth, efforts to reduce relational aggression and increase peer support in prosocial activities prior to adolescence may be useful for preventing social-emotional problems.

Control, Norms, and Attitudes: Differences Between Students Who Do and Do Not Intervene as Bystanders to Sexual Assault.

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.

School, Friends, and Substance Use: Gender Differences on the Influence of Attitudes Toward School and Close Friend Networks on Cannabis Involvement.

The school environment is extremely salient in young adolescents' lives. Adolescents who have unfavorable attitudes toward school and teachers are at elevated risk for dropping out of school and engaging in behavioral health risks. Peer network health-a summation of the positive and negative behaviors in which one's close friend group engages-may be one way by which attitudes toward school exert influence on youth substance use. Utilizing a sample of 248 primarily African-American young urban adolescents, we tested a moderated mediation model to determine if the indirect effect of attitude to school on cannabis involvement through peer network health was conditioned on gender. Attitude toward school measured at baseline was the predictor (X), peer network health measured at 6 months was the mediator (M), cannabis involvement (including use, offers to use, and refusals to use) measured at 24 months was the outcome (Y), and gender was the moderator (W). Results indicated that negative attitudes toward school were indirectly associated with increased cannabis involvement through peer network health. This relationship was not moderated by gender. Adolescents in our sample with negative attitudes toward school were more likely to receive more offers to use cannabis and to use cannabis more frequently through the perceived health behaviors of their close friends. Implications from these results point to opportunities to leverage the dynamic associations among school experiences, friends, and cannabis involvement, such as offers and use.

A longitudinal study predicting adolescent tobacco, alcohol, and cannabis use by behavioral characteristics of close friends.

Few studies have examined in detail how specific behaviors of close friends put adolescents at risk for specific types of substance use. Using a prospective, longitudinal design, we examined how well the substance use of 248 young urban adolescents was predicted by perceptions of their 3 closest friends' problematic behaviors: (1) using substances, (2) offering substances, and (3) engaging with friends in risky behavior (substance use, illegal behavior, violent behavior, or high-risk sexual behavior). Longitudinal multivariate repeated measures models were tested to predict tobacco, alcohol, and cannabis use and perceived closeness was tested as a moderator of the effects of perceptions of problematic peer behavior. Perceptions of peer substance use were significantly associated with tobacco use, and closeness moderated the influence of peer substance use and offers to use substances on tobacco use. Perceptions of problematic peer behaviors were not significantly associated with alcohol use and closeness was not significant as a moderator. Perceptions of peer substance use was significantly associated with cannabis use, and closeness moderated the influence of perceptions of peer risk behaviors, peer substance use, and offers to use substances on cannabis use. Results implicate the importance of understanding problematic peer behavior within the context of close, adolescent friendships. Adolescents with close friends who were substance users, who made offers to use substances, and who engaged in risky behaviors were more likely to use tobacco and cannabis. Perceptions of young adolescents' close friends' behaviors influenced their substance use up to 2 years later. (PsycINFO Database Record

Neighborhood disorder, peer network health, and substance use among young urban adolescents.

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.

A Mixed-Methods Approach Examining Illicit Prescription Stimulant Use: Findings From a Northern California University.

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.

Can Universal SEL Programs Benefit Universally? Effects of the Positive Action Program on Multiple Trajectories of Social-Emotional and Misconduct Behaviors.

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 (PA) program 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.

Meeting the Challenges of Longitudinal Cluster-Based Trials in Schools: Lessons From the Chicago Trial of Positive Action.

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.

Research design issues for evaluating complex multicomponent interventions in neighborhoods and communities.

Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evaluation that are key for translational research stages 3 to 5 to advance optimized adoption, implementation, and maintenance of effective and replicable multicomponent strategies. The major challenges we discuss concern (a) multiple contexts of evaluation/research, (b) complexity of packages of interventions, and (c) phases of evaluation/research questions. We suggest multiple alternative research designs that maintain rigor but accommodate these challenges and highlight the need for measurement systems. Longitudinal data collection and a standardized continuous measurement system are fundamental to the evaluation and refinement of complex multicomponent interventions. To be useful to T3-T5 translational research efforts in neighborhoods and communities, such a system would include assessments of the reach, implementation, effects on immediate outcomes, and effects of the comprehensive intervention package on more distal health outcomes.

Effects of the Positive Action Program on Indicators of Positive Youth Development Among Urban Youth.

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.

Effects of a School-Based Social-Emotional and Character Development Program on Health Behaviors: A Matched-Pair, Cluster-Randomized Controlled Trial.

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; 1170 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 SECD 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.

Commentary on the 2015 SPR Standards of Evidence.

We comment on the 2015 Society for Prevention Research standards of evidence document, summarizing major changes from the previous 2005 Standards, and point to ways in which the Standards could be further improved. We endorse important new standards, such as those on testing the causal theory and mechanisms of the intervention, improved trial reporting standards, and added attention to scale-up research and cost analyses. Despite discussion of replication in the new Standards, we are concerned about the lack of stand-alone replication standards, and the deletion of an explicit requirement for replication before an intervention is considered efficacious. Finally, we are deeply concerned about the lack of attention to the unit or level of aggregation of the intervention target. It is a major conceptual oversight. The unit targeted by an intervention (whether a cell, person, organization, community, state, nation) is a fundamental feature shaping intervention theory, research design, data collection, analyses, effect sizes, diffusion possibilities and patterns, and scale-up issues. Future Standards updates should eliminate the implicit assumption in the current text that effective preventive interventions inherently target individual persons.

The Illicit Use of Prescription Stimulants on College Campuses: A Theory-Guided Systematic Review.

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.

Teachers' Perceptions of School Organizational Climate as Predictors of Dosage and Quality of Implementation of a Social-Emotional and Character Development Program.

Organizational climate has been proposed as a factor that might influence a school's readiness to successfully implement school-wide prevention programs. The aim of this study was to evaluate the influence of teachers' perceptions of three dimensions of school organizational climate on the dosage and quality of teacher implementation of Positive Action, a social-emotional and character development (SECD) program. The dimensions measured were teachers' perceptions of (a) the school's openness to innovation, (b) the extent to which schools utilize participatory decision-making practices, and (c) the existence of supportive relationships among teachers (teacher-teacher affiliation). Data from 46 teachers in seven schools enrolled in the treatment arm of a longitudinal, cluster-randomized, controlled trial were analyzed. Teacher perceptions of a school's tendency to be innovative was associated with a greater number of lessons taught and self-reported quality of delivery, and teacher-teacher affiliation was associated with a higher use of supplementary activities. The findings suggest that perceptions of a school's organizational climate impact teachers' implementation of SECD programs and have implications for school administrators and technical assistance providers as they work to implement and sustain prevention programs in schools.

Using structural equation modeling to understand prescription stimulant misuse: a test of the Theory of Triadic Influence.

OBJECTIVE: To test a theory-driven model of health behavior to predict the illicit use of prescription stimulants (IUPS) among college students. PARTICIPANTS: A probability sample of 554 students from one university located in California (response rate=90.52%). METHODS: 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). RESULTS: 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 p<0.01 level. Additionally, 46% of the variance in IUPS frequency was explained by the tested model. CONCLUSIONS: 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.

Using social-emotional and character development to improve academic outcomes: a matched-pair, cluster-randomized controlled trial in low-income, urban schools.

BACKGROUND: School-based social-emotional and character development (SECD) programs can influence not only SECD but also academic-related outcomes. This study evaluated the impact of one SECD program, Positive Action (PA), on educational outcomes among low-income, urban youth. METHODS: The longitudinal study used a matched-pair, cluster-randomized controlled design. Student-reported disaffection with learning and academic grades, and teacher ratings of academic ability and motivation were assessed for a cohort followed from grades 3 to 8. Aggregate school records were used to assess standardized test performance (for entire school, cohort, and demographic subgroups) and absenteeism (entire school). Multilevel growth-curve analyses tested program effects. RESULTS: PA significantly improved growth in academic motivation and mitigated disaffection with learning. There was a positive impact of PA on absenteeism and marginally significant impact on math performance of all students. There were favorable program effects on reading for African American boys and cohort students transitioning between grades 7 and 8, and on math for girls and low-income students. CONCLUSIONS: A school-based SECD program was found to influence academic outcomes among students living in low-income, urban communities. Future research should examine mechanisms by which changes in SECD influence changes in academic outcomes.

Effects of Positive Action on the emotional health of urban youth: a cluster-randomized trial.

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.

Using the community readiness model as an approach to formative evaluation.

This article presents an adapted version of an established model for assessing community readiness along with an illustrative case example from the evaluation of Positive Action, a school-based social and character development intervention, implemented as part of a randomized controlled trial in Chicago Public Schools from 2004 through 2010. Community readiness is an emerging assessment approach that can be used to gauge the level of understanding, desire, and ownership that community members have regarding a community problem and/or intervention. This approach is useful in engaging the community and leveraging particular aspects of readiness that the community may exhibit in order to maximize an intervention's successful implementation. The article concludes with a discussion of ways in which a community readiness model may be useful in health promotion practice, both in schools and in other community settings.