Teachers' Perceptions of the Impact of the COVID-19 Pandemic and Their Implementation of an Evidence-based HIV Prevention Program in the Bahamas.

Information on how school-based programs is implemented and sustained during crises is limited. In this study, we assessed the impact of the COVID-19 pandemic on the implementation of a HIV prevention intervention in The Bahamas. Data were collected from 139 Grade 6 teachers in 2021-2022. Teachers attended virtual training and received implementation monitoring from coordinators. On average, teachers taught 26.4 (SD = 9.2) of the 35 core activities, and 7.4 (SD = 2.4) out of 9 sessions. More than half (58.3%) of teachers completed 28 or more core activities; 69.1% covered eight or all nine sessions, which is equivalent to 80% of the HIV intervention curriculum. Almost half of the teachers (43%) reported that the pandemic negatively impacted their ability to teach the program; 72% of teachers maintained that the program remained "very important" during times of crisis. Greater self-efficacy and supports increased implementation fidelity.

Treasure (Hunt for) Your Health! Addressing Pediatric Social Determinants of Health Through Child-Friendly Community Engagement Events.

Social determinants of health (SDoH), including factors such as education level, housing, poverty, racism, and food insecurity and their impact on health outcomes have been well documented. The "Wayne Pediatrics Health and Nutrition Expo" held at Detroit's Eastern Market was an activity-based health and nutrition event addressing pediatric SDoH. Partnering with community organizations, the event had 10 stations addressing SDoH: access to a primary-care pediatrician; HIV-care and prevention; childhood literacy; clothing & winter coats; mental health and childhood development; nutrition; staying active; vaccination; and food insecurity. The free, public event featured a child-themed treasure hunt and map, music, giveaways, and live demonstrations, all in a family-friendly park atmosphere. While SDoH are considered "non-medical" factors that contribute to health and may be difficult to completely address for any individual child, our practice addressed several key SDoH at a single-day, hands-on, child-friendly community event based on the local needs of children.

Accurate, non-destructive, and high-throughput age estimation for Golden perch (Macquaria ambigua spp.) using DNA methylation.

Age structure information of animal populations is fundamental to their conservation and management. In fisheries, age is routinely obtained by counting daily or annual increments in calcified structures (e.g., otoliths) which requires lethal sampling. Recently, DNA methylation has been shown to estimate age using DNA extracted from fin tissue without the need to kill the fish. In this study we used conserved known age-associated sites from the zebrafish (Danio rerio) genome to predict the age of golden perch (Macquaria ambigua), a large-bodied native fish from eastern Australia. Individuals aged using validated otolith techniques from across the species' distribution were used to calibrate three epigenetic clocks. One clock was calibrated using daily (daily clock) and another with annual (annual clock) otolith increment counts, respectively. A third used both daily and annual increments (universal clock). We found a high correlation between the otolith and epigenetic age (Pearson correlation > 0.94) across all clocks. The median absolute error was 2.4 days in the daily clock, 184.6 days in the annual clock, and 74.5 days in the universal clock. Our study demonstrates the emerging utility of epigenetic clocks as non-lethal and high-throughput tools for obtaining age estimates to support the management of fish populations and fisheries.

Comparing standard versus enhanced implementation of an evidence-based HIV prevention program among Bahamian sixth grade students: findings from nationwide implementation trials.

BACKGROUND: Effective implementation strategies are needed to address the challenges encountered by teachers in implementation of evidence-based HV prevention programs in schools. The current study: 1) compares implementation fidelity of Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT) intervention using enhanced implementation strategies (including biweekly monitoring/feedback and site-based mentoring) to those using more traditional approach (teacher training only); and 2) evaluates the impact of school coordinators' and mentors' performance on teachers' implementation fidelity and student outcomes. METHODS: Data from an enhanced implementation trial in 2019-2020, involving 24 government primary schools, 79 teachers, and 2252 students, were compared to data from a standard implementation trial in 2011-2012, involving 35 government primary schools, 110 teachers and 2811 students using mixed-effects modeling and structural equation modeling. FINDINGS: Teachers in the 2019-2020 trial taught more core activities (28.3 vs. 16.3, t = 10.80, P < 0.001) and sessions (7.2 vs. 4.4, t = 9.14, P < 0.001) than those participating in the 2011-2012 trial. Teachers taught > 80% of the intervention curriculum in 2019-2020 compared to 50% curriculum delivery in 2011-2012. Teachers who had a "very good" or "excellent" school coordinator in their schools taught more core activities than those who had a "satisfactory" school coordinator (30.4 vs. 29.6 vs. 22.3, F = 18.54, P < 0.001). Teachers who worked in a school which had a "very good" mentor, taught more core activities than those teachers who did not have a mentor or had only a "satisfactory" mentor (30.4 vs. 27.6; t = 2.96; p = 0.004). Teachers' confidence in implementing core activities, comfort level with the curriculum, attitudes towards sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers' implementation fidelity. The degree of implementation was significantly associated with improved student outcomes. IMPLICATIONS/CONCLUSION: An evidence-based HIV prevention intervention can achieve a high degree of implementation when delivered with enhanced implementation strategies and implementation monitoring. Future program implementers should consider the purposeful selection and training of school coordinators and mentors to support low-implementing teachers as a potentially important strategy when attempting to achieve high-quality implementation of school-based interventions.

Adaptive Management to Reduce Nest Inundation of a Critically Endangered Freshwater Turtle: Confirming the Win-win.

Inundation of Australian freshwater turtle nests has been identified as a threat to recruitment and long-term viability of species such as the critically endangered white-throated snapping turtle (Elseya albagula). Water level fluctuations within water storage infrastructure can inundate significant proportions of E. albagula nests in any year. Using an ecological risk assessment framework, operating rules for a water storage in the Burnett River (South East Queensland, Australia) were implemented to support nesting of E. albagula. Turtles were encouraged to nest at higher elevations on riverbanks by maintaining higher water levels in the impoundment during the nesting season, followed by lowering of water levels during the incubation period to minimise rates of nest inundation from riverine inflows. To verify the success of the new rules, a three-year confirmation monitoring program of nest heights and water levels was undertaken. Results of confirmation monitoring showed that 3% (2018), 11% (2019) and 0% (2020) of E. albagula nests were inundated under the new operating rules, compared to previously estimated nest inundation rates of >20% in ~24% of years of a 118-year simulation period (1890-2008) under previous storage operating rules. Emergency releases from an upstream storage in 2019 and 2020 for dam safety did not affect the success of the rule, demonstrating its resilience to natural and artificial flow regimes. This study demonstrates the importance of confirmation monitoring in verifying the efficacy of targeted changes to water management, and highlights potential application across other water storage infrastructure with threatened freshwater turtle populations requiring adaptive management.

The Effectiveness of Two Implementation Strategies for Improving Teachers' Delivery of an Evidenced-based HIV Prevention Program.

BACKGROUND: Effective implementation strategies are needed to enhance the success of evidence-based prevention programs. The current study evaluates the effects of two implementation strategies on teachers' implementation of an evidenced-based HIV intervention. METHODS: Using our 7-item pre-implementation school screening tool, we identified teachers who were at-risk for not implementing the Focus on Youth HIV-risk reduction intervention curriculum which targets grade six through grade 8 students. After completing a two-day curriculum workshop, 81 low- and moderate-performing teachers were randomly assigned to one of four experimental conditions and were asked to teach the two-month intervention curriculum. This optimization trial examines the impact of two implementation strategies: biweekly monitoring/feedbacks (BMF) and site-based assistance/mentorship (SAM). The primary outcome is implementation fidelity defined as number of core activities taught. Linear mixed-effects model was used to examine the association of the implementation strategies with implementation fidelity. RESULTS: BMF and SAM were significantly associated with teachers' implementation fidelity. Teachers who received both BFM and SAM taught the greatest numbers of core activities (15 core activities on average), followed by teachers who received either BMF (6.9 activities) or SAM (7.9 activities). Teachers who did not receive BMF or SAM taught the lowest numbers (4.1 activities). Teachers' sustained implementation of FOYC in the prior school year was related to increased implementation fidelity during the optimization trial. Teachers' confidence in implementing five core activities, attitudes toward sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers' fidelity of implementation before the optimization trial. CONCLUSION: BMF and SAM are effective in promoting teachers' implementation of youth evidence-based interventions. Researchers and future program implementers should consider teacher training, teachers' attitudes toward sex education, perceived principal support, and self-efficacy when attempting to maintain the effects of teacher-delivered interventions in schools.

Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting.

BACKGROUND: Sustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs. OBJECTIVE: This proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time. METHODS: This study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5. RESULTS: It is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023. CONCLUSIONS: The study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14816.

Age structure of the Australian lungfish (Neoceratodus forsteri).

The Australian lungfish has been studied for more than a century without any knowledge of the longevity of the species. Traditional methods for ageing fish, such as analysis of otolith (ear stone) rings is complicated in that lungfish otoliths differ from teleost fish in composition. As otolith sampling is also lethal, this is not appropriate for a protected species listed under Australian legislation. Lungfish scales were removed from 500 fish from the Brisbane, Burnett and Mary rivers. A sub-sample of scales (85) were aged using bomb radiocarbon techniques and validated using scales marked previously with oxytetracycline. Lungfish ages ranged from 2.5-77 years of age. Estimated population age structures derived using an Age Length Key revealed different recruitment patterns between river systems. There were statistically significant von Bertalanffy growth model parameters estimated for each of the three rivers based on limited sample sizes. In addition, length frequency distributions between river systems were also significantly different. Further studies will be conducted to review drivers that may explain these inter-river differences.

Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention.

BACKGROUND: Intervention effects observed in efficacy trials are rarely replicated when the interventions are broadly disseminated, underscoring the need for more information about factors influencing real-life implementation and program impact. Using data from the ongoing national implementation of an evidence-based HIV prevention program [Focus on Youth in The Caribbean (FOYC)] in The Bahamas, this study examines factors influencing teachers' patterns of implementation, the impact of teachers' initial implementation of FOYC, and subsequent delivery of the booster sessions on students' outcomes. METHODS: Data were collected from the 80 government elementary and 34 middle schools between 2011 and 2014, involving 208 grade 6, 75 grade 7, and 58 grade 8 teachers and 4411 students initially in grade 6 and followed for 3 years. Student outcomes include HIV/AIDS knowledge, reproductive health skills, self-efficacy, and intention to use protection. Data from teachers includes implementation and modification of the curriculum, attitudes towards the prevention program, comfort level with the curriculum, and attendance at training workshops. Structural equation modeling and mixed-effect modeling analyses were applied to examine the impact of teachers' implementation. RESULTS: Teachers' attitudes towards and comfort with the intervention curriculum, and attendance at the curriculum training workshop had a direct effect on teachers' patterns of implementation, which had a direct effect on student outcomes. Teachers' attitudes had a direct positive effect on student outcomes. Teachers' training in interactive teaching methods and longer duration as teachers were positively associated with teachers' comfort with the curriculum. High-quality implementation in grade 6 was significantly related to student outcomes in grades 6 and 7 post-implementation. Level of implementation of the booster sessions in grades 7 and 8 were likewise significantly related to subsequent student outcomes in both grades. CONCLUSIONS: High-quality initial implementation of a prevention program is significantly related to better program outcomes. Poor subsequent delivery of booster sessions can undermine the positive effects from the initial implementation while strong subsequent delivery of booster sessions can partially overcome poor initial implementation.

Adolescent HIV Risk Reduction in the Bahamas: Results from Two Randomized Controlled Intervention Trials Spanning Elementary School Through High School.

To address global questions regarding the timing of HIV-prevention efforts targeting youth and the possible additional benefits of parental participation, researchers from the USA and The Bahamas conducted two sequential longitudinal, randomized trials of an evidence-based intervention spanning the adolescent years. The first trial involved 1360 grade-6 students and their parents with three years of follow-up and the second 2564 grade-10 students and their parents with two years of follow-up. Through grade-12, involvement in the combined child and parent-child HIV-risk reduction interventions resulted in increased consistent condom-use, abstinence/protected sex, condom-use skills and parent-child communication about sex. Receipt of the grade-6 HIV-prevention intervention conferred lasting benefits regarding condom-use skills and self-efficacy. Youth who had not received the grade-six intervention experienced significantly greater improvement over baseline as a result of the grade-10 intervention. The HIV-risk reduction intervention delivered in either or both grade-6 and grade-10 conferred sustained benefits; receipt of both interventions appears to confer additional benefits.

Developmental implications of HIV prevention during adolescence: Examination of the long-term impact of HIV prevention interventions delivered in randomized controlled trials in grade six and in grade 10.

Dramatic changes occur in abstract reasoning, physical maturation, familial relationships and risk exposure during adolescence. It is probable that delivery of behavioral interventions addressing decision-making during the pre-adolescent period and later in adolescence would result in different impacts. We evaluated the intervention effects of an HIV prevention program (Bahamian Focus on Older Youth, BFOOY) administered to grade 10 Bahamian youth and parents to target HIV protective and risk behaviors. We also examined the effects of prior exposure to a similar intervention (Focus on Youth in the Caribbean, FOYC) four years earlier. At six months post-intervention, receipt of BFOOY by youth unexposed to FOYC increased HIV knowledge and condom-use skills. Differences based on BFOOY exposure were not present among FOYC-exposed youth, whose knowledge and condom-use skills were already higher than those of unexposed youth. Youth receiving both interventions displayed a carryover effect from FOYC, demonstrating the highest scores six months post-intervention.

Hypercoagulability in adolescent girls on oral contraceptives-global coagulation profile and estrogen receptor polymorphisms.

Oral contraceptive (OCP) induced changes on coagulation are complex with high inter-individual variability. The precise reason for differences in this variability is unknown. We hypothesized that global coagulation assays better delineate these changes and variability in hypercoagulability may be the result of differences in estrogen metabolism and thrombophilia. Fifty-two adolescents initiating OCPs were prospectively enrolled; 33 subjects completed the study. Samples were analyzed prior to and after OCPs for procoagulant and anticoagulant factor activities and thrombin generation (TG) +/-thrombomodulin. Participants were genotyped for common thrombophilia and estrogen receptor-α (ESR-α) single nucleotide polymorphisms (SNPs). SNP genotypes were compared to coagulation parameters; TG parameters and differences pre and post OCPs were examined. At baseline, a striking finding was elevated FVIII levels. FVL was absent in all and F2 G20210A was present in one participant. The ESR-α polymorphism was present in heterozygous state in 59% and homozygous state in 21% participants. There were no differences in VWF levels and FVIII: C after being on OCPs. Protein S levels decreased with OCPs. Sixty percent of participants showed evidence of hypercoagulability on TG testing on OCPs. Higher thrombin peak and endogenous thrombin potential (ETP) were seen on TG after OCPs. With thrombomodulin, ETP and thrombin peak did not decrease after OCPs, signifying 'thrombomodulin resistance'. We demonstrated that OCPs induce a state of "variable" hypercoagulability in adolescents, predominantly through the protein S pathway. Genetic and nongenetic factors may account for the variable increase in hypercoagulability. Further research is needed to understand this.

Factors influencing implementation dose and fidelity thereof and related student outcomes of an evidence-based national HIV prevention program.

BACKGROUND: Teachers' implementation of evidence-based prevention programs in schools is inconsistent. Using data gathered from the national implementation among grade six students in The Bahamas of an evidence-based HIV intervention [Focus on Youth in the Caribbean (FOYC)], this study examines differences in the degree of implementation ("dose") and adherence to the core activities ("fidelity of implementation") by teachers according to theoretically and historically relevant teachers' characteristics, attitudes, and experiences pre-intervention and post-intervention. The relationship of implementation dose and implementation fidelity is assessed according to student outcomes. METHODS: Beginning in 2008, the Bahamian Ministry of Education (MOE) included FOYC in the grade six curriculum nationwide. Consistent with standard practice, teachers were offered MOE training workshops in FOYC prior to delivery. The MOE conducted an anonymous curricular assessment among the grade six students at the beginning and end of the school year. Teachers agreeing to participate in the research component were asked to complete a pre-implementation and post-implementation assessment of attitudes and prior experiences. RESULTS: Teachers taught 15.6 out of 30 core activities, 24 out of the 46 total activities, and 4.6 out of 8 sessions on average. Three teachers' implementation groups were identified: 1) High Implementation Group (31.7% of the teachers), characterized by high levels of implementation dose and fidelity of implementation; 2) Moderate Implementation Group (52.8%), showing moderate levels of implementation dose but high levels of fidelity of implementation; and 3) Low Implementation Group (15.6%), with low levels of implementation dose and fidelity of implementation. Low Implementation Group teachers compared to teachers in the two higher performing groups had less training in interactive teaching, limited prior exposure to the FOYC curriculum, incomplete attendance at FOYC training workshops, and low levels of comfort in teaching FOYC lessons. Students taught by teachers in the Low Implementation Group demonstrated poorer outcomes relevant to the four student outcomes (HIV/AIDS knowledge, preventive reproductive health skills, self-efficacy, and intention to use protection if they were to have sex). CONCLUSIONS: Both implementation dose and implementation fidelity are related to student outcomes. Teachers at risk for limited implementation can be identified pre-intervention, thus opening the possibility for focused pre-intervention training.

Adolescent Sexual Health Education: Parents Benefit Too!

The inclusion of parents in adolescent-targeted interventions is intended to benefit the adolescent. Limited research has explored whether parents participating in these programs also benefit directly. We examined the impact of Caribbean Informed Parents and Children Together, the parenting portion of an adolescent-targeted HIV prevention intervention, on parent-reported measures. Bahamian parent-youth dyads (N = 1,833) participating in the randomized control trial were assigned to receive one of four conditions. Parents were assessed longitudinally at baseline and 6 and 12 months later. Through 12 months follow-up, parents exposed to Caribbean Informed Parents and Children Together showed higher knowledge of condom use skills, perceptions of improved condom use competence on the part of their youth, and perceived improved parent-child communication about sex-related information. Although youth were the targeted beneficiary, parents also benefited directly from the sexual risk reduction parenting program. Parents demonstrated improved perceptions and knowledge that would enable them to more effectively guide their child and also protect themselves from sexual risk.

Recruitment strategies and the retention of obese urban racial/ethnic minority adolescents in clinical trials: the FIT families project, Michigan, 2010-2014.

INTRODUCTION: The successful recruitment and retention of participants is integral to the translation of research findings. We examined the recruitment and retention rates of racial/ethnic minority adolescents at a center involved in the National Institutes of Health Obesity Research for Behavioral Intervention Trials (ORBIT) initiative by the 3 recruitment strategies used: clinic, informatics, and community. METHODS: During the 9-month study, 186 family dyads, each composed of an obese African American adolescent and a caregiver, enrolled in a 6-month weight-loss intervention, a sequential multiple assignment randomized trial. We compared recruitment and retention rates by recruitment strategy and examined whether recruitment strategy was related to dyad baseline characteristics. RESULTS: Of the 186 enrolled families, 110 (59.1%) were recruited through clinics, 53 (28.5%) through informatics, and 23 (12.4%) through community. Of those recruited through community, 40.4% enrolled in the study, compared with 32.7% through clinics and 8.2% through informatics. Active refusal rate was 3%. Of the 1,036 families identified for the study, 402 passively refused to participate: 290 (45.1%) identified through informatics, 17 (29.8%) through community, and 95 (28.3%) through clinics. Recruitment strategy was not related to the age of the adolescent, adolescent comorbidities, body mass index of the adolescent or caregiver, income or education of the caregiver, or retention rates at 3 months, 7 months, or 9 months. Study retention rate was 87.8%. CONCLUSION: Using multiple recruitment strategies is beneficial when working with racial/ethnic minority adolescents, and each strategy can yield good retention. Research affiliated with health care systems would benefit from the continued specification, refinement, and dissemination of these strategies.

Assessing the effects of a complementary parent intervention and prior exposure to a preadolescent program of HIV risk reduction for mid-adolescents.

OBJECTIVES: We (1) evaluated the impact of an evidence-based HIV prevention program with and without a parent component among mid-adolescents living in the Caribbean and (2) determined the effect of prior receipt of a related intervention during preadolescence on intervention response. METHODS: A randomized, controlled 4-cell trial of a 10-session, theory-based HIV prevention intervention involving 2564 Bahamian grade-10 youths (some of whom had received a comparable intervention in grade 6) was conducted (2008-2011). Randomization occurred at the level of the classroom with follow-up at 6, 12, and 18 months after intervention. The 3 experimental conditions all included the youths' curriculum and either a youth-parent intervention emphasizing adolescent-parent communication, a parent-only goal-setting intervention, or no parent intervention. RESULTS: An intervention delivered to mid-adolescents in combination with a parent-adolescent sexual-risk communication intervention increased HIV/AIDS knowledge, condom-use skills, and self-efficacy and had a marginal effect on consistent condom use. Regardless of prior exposure to a similar intervention as preadolescents, youths benefited from receipt of the intervention. CONCLUSIONS: Preadolescents and mid-adolescents in HIV-affected countries should receive HIV prevention interventions that include parental participation.

Adolescent age at time of receipt of one or more sexual risk reduction interventions.

PURPOSE: Age of the target audience at time of intervention is thought to be a critical variable influencing the effectiveness of adolescent sexual risk reduction interventions. Despite this postulated importance, to date, studies have not been designed to enable a direct comparison of outcomes according to age at the time of intervention delivery. METHODS: We examined outcomes of 598 youth who were sequentially involved in two randomized controlled trials of sexual risk prevention interventions, the first one delivered in grade 6 (Focus on Youth in the Caribbean [FOYC]) and the second one in grade 10 (Bahamian Focus on Older Youth [BFOOY]). Four groups were examined, including those who received (1) both treatment conditions, FOYC and BFOOY; (2) FOYC in grade 6 and the control condition in grade 10; (3) the control condition in grade 6 and BFOOY in grade 10; and (4) both control conditions. Intentions, perceptions, condom-use skills, and HIV-related knowledge were assessed over 60 months. RESULTS: Data showed that those who received both interventions had the greatest increase in condom-use skills. Youth who received FOYC in grade 6 had greater scores in knowledge and intention. CONCLUSION: These results suggest that youth receive the most protection with early and repeated exposure to interventions. These findings suggest that educators should consider implementing HIV prevention and risk reduction programs as a fixed component of education curriculum beginning in the preadolescent years and if possible also during the adolescent years.

The impact of youth, family, peer and neighborhood risk factors on developmental trajectories of risk involvement from early through middle adolescence.

Few studies have analyzed the development course beginning in pre-/early adolescence of overall engagement in health-risk behaviors and associated social risk factors that place individuals in different health-risk trajectories through mid-adolescence. The current longitudinal study identified 1276 adolescents in grade six and followed them for three years to investigate their developmental trajectories of risk behaviors and to examine the association of personal and social risk factors with each trajectory. Group-based trajectory modeling was applied to identify distinctive trajectory patterns of risk behaviors. Multivariate multinomial logistic regression analyses were performed to examine the effects of the personal and social risk factors on adolescents' trajectories. Three gender-specific behavioral trajectories were identified for males (55.3% low-risk, 37.6% moderate-risk, increasing, and 7.1% high-risk, increasing) and females (41.4% no-risk, 53.4% low-risk, increasing and 5.2% moderate to high-risk, increasing). Sensation-seeking, family, peer, and neighborhood factors at baseline predicted following the moderate-risk, increasing trajectory and the high-risk, increasing trajectory in males; these risk factors predicted following the moderate to high-risk, increasing trajectory in females. The presence of all three social risk factors (high-risk neighborhood, high-risk peers and low parental monitoring) had a dramatic impact on increased probability of being in a high-risk trajectory group. These findings highlight the developmental significance of early personal and social risk factors on subsequent risk behaviors in early to middle adolescence. Future adolescent health behavior promotion interventions might consider offering additional prevention resources to pre- and early adolescent youth who are exposed to multiple contextual risk factors (even in the absence of risk behaviors) or youth who are early-starters of delinquency and substance use behaviors in early adolescence.