Cultural, social, and intrapersonal factors associated with substance use among alternative high school students.

The purpose of this study was to identify cultural, social, and intrapersonal factors associated with tobacco, alcohol, and illicit drug use among students attending dropout prevention/recovery high schools. Four mutually exclusive categories of substance use were used as outcome measures, and religiosity, educational achievement, educational aspiration, family caring, others caring, self-esteem, optimism, coping, depression, loneliness, and self-efficacy were used as predictor variables. In the final multivariate model more family caring and loneliness were inversely associated with marijuana use; young age, more family caring, less coping ability, church attendance, and low educational aspirations were significantly associated with cocaine use. This study demonstrates the importance of health education and health promotion programs for students attending alternative high schools which include prevention of initiation, as well as treatment.

Health risk behaviors of Texas students attending dropout prevention/recovery schools in 1997.

This study determined prevalence of health risk behaviors of 9th through 12th grade students attending dropout prevention/recovery alternative schools in Texas in 1997. Participants were 470 youth whose health risk behaviors were assessed using the Youth Risk Behavior Survey in an anonymous, self-administered format. Behaviors measured included frequency of weapon-carrying and fighting, suicide-related behaviors, substance use, and sexual behaviors. A substantial percentage of alternative school students reported participating in behaviors that placed them at acute or chronic health risk. Differences in the prevalence of risk behaviors were noted by gender, racial/ethnic, and age subgroups. In addition, alternative school students frequently engaged in multiple risk behaviors. These findings suggest a need for comprehensive school-based health education/intervention programs to reduce the prevalence of risk behaviors in populations of alternative school students.

Characteristics of pregnant adolescents receiving prenatal care at school-based or hospital-based clinics.

PIP: This study examines characteristics of adolescent females in prenatal care in a hospital-based teen clinic compared to a school-based teen clinic. Interviews were conducted during 1991-92 among 189 pregnant adolescents, whose mean age was 16.22 years. 48% were African American, 42% were Hispanic, and 2% were Asian or other. 75% of adolescents were single or without a spouse. 30% lived with siblings, 21% lived with their husband, 9% lived with their boyfriend, 10% lived with in-laws, 4% lived with a friend, and the rest lived with their mothers. 48% of adolescents' mothers helped with child care. 27% did not have any help. 57% were enrolled in school, 41% dropped out, and 4% graduated. 63% planned to continue their education. 75% had a parent who served as a mentor. Over 50% lived with someone who smoked cigarettes or drank alcohol. 75% had friends or relatives who smoked. Almost 25% had a sexual partner who sold drugs, and 25% had a sexual partner who had been in trouble with the law. 14% had a partner who used drugs. 62% of adolescents who had smoked before their pregnancy quit smoking. 79% of adolescents who had consumed alcohol before their pregnancy stopped consuming alcohol. Adolescents in both clinics showed no significant differences in family welfare status, initiation of prenatal care, parity, and number of living children. There were differences by clinic type for adolescent ethnic patterns of clinic use, educational status, financial and social support, and family setting. Hispanics and Whites and school dropouts were more likely to use hospital-based care. The school-based adolescents were more likely to be single; to receive support from parents, relatives, and a job; and to have higher exposure to alcohol and substance abuse. Hospital-based adolescents were more likely to live with relatives, not to have help, and to be Spanish speakers. It is recommended that services match the characteristics and needs of clients in each local setting.^ieng

A comprehensive approach to school health program needs assessments.

An assessment of health promotion needs represents a fundamental step for developing comprehensive school health programs. This project developed and tested an approach for school districts to use when conducting a district-wide needs assessment of school health programs. The approach assumes a needs assessment should be multidimensional and comprehensive. Seven priority health-related behaviors were included as well as eight components of a school health program identified by Kolbe. This paper describes each aspect of the needs assessment, discusses the importance of perspectives provided by each component, and provides recommendations for districts interested in conducting an assessment.

The effect of two types of teacher training on implementation of Smart Choices: a tobacco prevention curriculum.

This study examined the implementation phase of a four-year research project to test the effectiveness of strategies to increase diffusion of Smart Choices, a school-based tobacco prevention program. The impact on curriculum implementation of two approaches to teacher training are compared. School districts were randomly assigned to a live workshop training or video training condition. The outcome of the evaluation was teachers' implementation of Smart Choices. Results show a lower proportion of video-trained teachers implemented the curriculum, but overall completeness and fidelity of implementation for those teachers who did teach the curriculum were comparable for the two groups. Video-trained teachers, however, were less likely to use brainstorming and student presentations/role plays, two of the methods prescribed by the curriculum. Implications of the results for teacher training are discussed.

Risk and protective factors for alcohol use among pregnant African-American, Hispanic, and white adolescents: the influence of peers, sexual partners, family members, and mentors.

Factors affecting the drinking patterns of 183 pregnant, African-American, Hispanic, and White adolescents were investigated, including the influence of peers, sexual partners, family members, and mentors. Among participants who drank alcohol prior to their pregnancies, 87% quit or cut back on their drinking behaviors. Those adolescents who lived in environments where their partners, peers, and relatives were drinking and using drugs were more likely to have consumed alcohol in the previous month, while adolescents who identified mentors and/or parents who provided high levels of support were less likely to have consumed alcohol. Finally, distinct patterns of both drinking and life circumstances among the African-American, Hispanic, White adolescents were revealed. The implications of these findings for future research and intervention with pregnant adolescents are discussed.

HIV education practices and training needs of middle school and high school teachers.

A statewide, cross-sectional survey was conducted among Texas secondary school teachers to determine the scope of HIV education provided and training needs. Among 269 participants, 199 (75%) taught HIV education. Investigator developed scales measured instructional emphasis, preparation adequacy, desire for future training, comfort, instructional effectiveness, social support, and instructional barriers. Alpha levels indicated high levels of internal consistency on all scales. Considerable variations were noted in instructional emphasis among 18 content areas related to HIV education. Lessons were predominantly self-developed. Most teachers were self-taught with no formal training, relied primarily on traditional teacher-centered instructional methods, felt uncomfortable and ineffective using peer leaders and role plays, wanted additional training in all subject areas, and perceived others to be supportive. Comparisons between groups indicated middle school teachers spent less instructional time on HIV education, reported more instructional barriers, less support from district personnel, a poorer fit (coordination) of HIV education with other subjects, less adequate preparation, and less responsibility and effectiveness. High school teachers were more prone to want additional training. Differences in responses to individual scale items, major instructional barriers, and recommendations for teacher training are provided.

Increasing teacher receptivity toward use of tobacco prevention education programs.

An empirical examination of teacher receptivity to and practice of tobacco prevention education provides the foundation for comprehensive staff development to increase diffusion of drug prevention education curricula. Randomly-selected first grade Texas teachers (n = 313) were asked to complete a questionnaire during the first and second years of the Smoke-Free Class of 2000 (SFC2000) project. Initially 64 percent of recipients used materials. However, two of every five first-year users did not maintain use one year later, and many who intended use never implemented. Principal components analysis of fourteen items pertaining to receptivity resulted in four scales with acceptable reliability scores: general receptivity to tobacco prevention education, personal support for teaching tobacco prevention education, personal involvement, and school involvement in tobacco prevention. Scales were predictive of initial and continued use and provide a teacher receptivity measure to guide staff development.

Correlates of coalition effectiveness: the Smoke Free Class of 2000 Program.

Fifty state and local coalitions that carry out the Smoke Free Class of 2000 program of the American Cancer Society, American Heart Association and American Lung Association were surveyed in 1990. Almost all (95%) rated themselves moderately or very active and a total of 88 900 second grade teachers were estimated to have received the materials. The availability of funds, competing priorities, lack of coordination, differences in agency service areas and personnel availability were most frequently cited as areas of concern to the coalitions. Personnel barriers and formality of coalition structure were independently related to perceived coalition effectiveness and, with the number of elementary schools, to perceived coalition activity. General recommendations, that were accepted upon completion of the assessment, included (1) formalization of agreements, mission statements, and goals and objectives, (2) attention to group formation and identification, and (3) clarification of national coalition expectations.

Peer coaching: building collegial support for using innovative health programs.

To ensure students achieve intended benefits from effective health programs, it is necessary to maximize program implementation and maintenance. Peer coaching provides a post-inservice staff development approach for health educators to strengthen teacher use of new health programs during implementation trials. While peer coaching positively influences teacher behavior and student outcomes, previous coaching programs have been limited in scope, have not been theoretically derived or adequately evaluated, and have not been systematically applied to health programs. This paper addresses teacher needs during trials, reviews peer coaching program features, and proposes a model to guide future planning, evaluation, and research. In this model, critical components of the coaching program include classroom assessments, coaching team cluster meetings, and administrative support. Strategies based on Social Learning Theory and Diffusion Theory are incorporated into the peer coaching program to influence teacher perceptions of their work roles, capability to implement a program, and commitment to the new instructional program. Interrelations among components are discussed and directions for future research and practice are suggested.

Enhancing program implementation and maintenance through a multiphase approach to peer-based staff development.

School-based health education programs often are limited by failures in implementation and maintenance. While inservice training has proven beneficial, teacher training research indicates that the more complex the demands on teachers using innovative psychosocially based health education curricula, the greater the necessity for post-inservice follow-up staff development. Evidence is presented that 1) teachers respond to innovations in developmental stages, 2) a multiphase approach to staff development is necessary to assist teachers during each stage, 3) post-inservice staff development requires opportunities for teacher collaboration, 4) approaches to staff development should fit the stage of teacher development, and 5) the organizational context of staff development is critical. Peer-based approaches to post-inservice staff development are presented, with a review of strengths and limitations of each approach.

An evaluation of the effectiveness of a planned diffusion process: the Smoke-Free Class of 2000 project in Texas.

The first year of the Texas Triagency Coalition Smoke-Free Class of 2000 project (SFC2000) in Texas was evaluated using a descriptive model developed from diffusion theory. Tobacco-prevention education (TPE) materials were to be made available to all first grade teachers within the state. A random sample survey of 213 teachers indicated that 96 (44.7%) had received the materials. Adoption and implementation were high. By May of 1989, 64.2% of those teachers receiving materials had adopted and already implemented the program, and 25.3% had adopted and intended to use the materials. Almost all (96.8%) of those teachers who received the kit indicated that they would maintain the first grade program in the coming school year. Of respondents to a 1 year follow-up survey, 41.1% used it the first year only, 27.3% used it both years, 12.5% used it only in year 2 and 18.2% did not use it either year. Of those receiving the kits, 48% indicated that they had not previously taught TPE and thus were introduced to the concept of TPE through the SFC2000 kits. Receptivity was highest (over 90% agreement) for including TPE in elementary school curricula, with fewer teachers strongly agreeing with items tapping personal involvement with TPE. This evaluation of a statewide component of a national initiative reinforces the need to consider the dissemination and implementation of materials when planning large-scale interventions and evaluating their impact.

A comparison of smokeless tobacco and smoking practices of university varsity and intramural baseball players.

To examine the smokeless tobacco (ST) and smoking practices of collegiate varsity and intramural baseball players, 284 undergraduate athletes at two major Southwestern universities were surveyed using a questionnaire previously developed to measure use among this population. About one-fourth of all athletes were current ST users and 4% smokers. Over half of varsity players (53%) compared to 25.9% of intramural players used one or both forms of ST. Varsity players were about 20 times more likely to use ST as to smoke, while intramural players were about five times as likely to use ST than to smoke. On both teams, use of chewing tobacco was associated with use of snuff. Smoking was not associated with ST use in either group. Mean ages for initiation for all products was 15, and for quitting, 18. There was no evidence that one form of tobacco served as a gateway for the other among these young adult athletes. Over a fourth of all users started after age 17, suggesting that college is an appropriate locus for both ST prevention and cessation programming. Such programs for this population must address the unique characteristics of the social environment in collegiate baseball.

Teacher perspectives after implementing a human sexuality education program.

To help teachers enhance the effectiveness of their classroom instruction in human sexuality education, it is necessary to understand their attitudes and concerns about their teaching experiences. Forty-seven sixth grade teachers were surveyed one year after curriculum implementation to examine perceptions of themselves, their students, colleagues, and community. Teachers answered 70% of the knowledge items correctly and indicated slightly liberal orientations. Overall levels of teachers' views generally were positive on scales designed to measure: importance of the items studied, responsibility for student outcomes, three measures of comfort, adequacy of preparation, required changes, ease of use, social supports, and student responses. However, patterns of teacher responses within scales indicated numerous concerns related to curriculum implementation. The concerns and teacher-identified benefits and barriers to teaching the course indicate a focus for continuing education.

PIP: To help teachers enhance the effectiveness of their classroom instruction in human sexuality education, it is necessary to understand their attitudes and concerns about their teaching experiences. 47 6th grade teachers were surveyed 1 year after curriculum implementation to examine perceptions of themselves, their students, colleagues, and community, in a large urban school district in southwestern US. The teachers previously had completed 1 week of inservice training during summer 1987 and had volunteered to participate in the project. Teachers answered 70% of the knowledge items correctly and indicated slightly liberal orientations. Overall levels of teachers' views generally were positive on scales designed to measure: importance of the items studies, responsibility for student outcomes, 3 measures of comfort, adequacy of preparation, required changes, ease of use, social supports, and student responses. However, patterns of teacher responses within scales indicated numerous concerns related to curriculum implementation. While teachers placed high value across the importance, responsibility, and comfort scales, on self-esteem, interactional skills, and STDs, diminished importance was placed on birth control and student sexual behavior. Similarly, identification and use of resource materials was indicated as the area in which teachers felt least adequately prepared and felt the most change from previous teaching techniques. Access to resources also was a major cause of dissatisfaction with administrative support. However, the strong support teachers perceived from administrators at the school and district levels, their positive perceptions of student responses, and the higher-order teacher concerns for the impact of the curriculum on students are encouraging and bode well for maintenance of the curriculum. Many of the teacher attitudes identified are associated with desire to continue teaching the human sexuality education course. The concerns and teacher-identified benefits and barriers to teaching the course indicate a focus for continuing education.

Evaluation of training effects on teacher attitudes and concerns prior to implementing a human sexuality education program.

Teacher changes in knowledge, attitudes, and concerns about teaching a new human sexuality education curriculum due to inservice training were examined; 59 middle school teachers were surveyed before and after one week of training. Significant (p less than .05) increases in knowledge, perceptions of importance of teaching the curriculum, intent to teach, and level of comfort with course content suggest areas of positive learner changes. Effects were not noted for sexual orientation (liberal vs. conservative) or responsibility for student outcomes. Relationships (p less than .05) were noted between comfort, importance, responsibility, and intent to teach with expectations of how students, colleagues, administrators, parents, and community would respond, as well as perceptions of curriculum congruence with teaching style and the adequacy of preparation to teach the curriculum. Few responses were associated with teacher personal characteristics.

PIP: Teacher changes in knowledge, attitudes, and concerns about teaching a new human sexuality education curriculum due to inservice training were examined; 59 middle school teachers were surveyed before and after 1 week of training. Significant (p.05) increases in knowledge, perceptions of importance of teaching the curriculum, intent to teach, and level of comfort with course content suggest areas of positive learner changes. Effects were not noted for sexual orientation (liberal vs. conservative) or responsibility for student outcomes. Relationships (p.05) were noted between comfort, importance, responsibility, and intent to teach with expectations of how students, colleagues, administrators, parents, and community would respond, as well as perceptions of curriculum congruence with teaching style and the adequacy of preparation to teach the curriculum. Few responses were associated with teacher personal characteristics. Teachers were from a southwestern US urban school district, taught physical education, and had either volunteered or been asked to participate by a supervisor or principal. Before and after questionnaires were used to monitor changes.