The Multisite Violence Prevention Project: Impact of a Universal School-Based Violence Prevention Program on Social-Cognitive Outcomes

This study evaluated the impact of a universal school-based violence prevention program on social-cognitive factors associated with aggression and nonviolent behavior in early adolescence. The effects of the universal intervention were evaluated within the context of a design in which two cohorts of students at 37 schools from four sites (N = 5,581) were randomized to four conditions: (a) a universal intervention that involved implementing a student curriculum and teacher training with sixth grade students and teachers; (b) a selective intervention in which a family intervention was implemented with a subset of sixth grade students exhibiting high levels of aggression and social influence; (c) a combined intervention condition; and (d) a no-intervention control condition. Short-term and long-term (i.e., 2-year post-intervention) universal intervention effects on social-cognitive factors targeted by the intervention varied as a function of students’ pre-intervention level of risk. High-risk students benefited from the intervention in terms of decreases in beliefs and attitudes supporting aggression, and increases in self-efficacy, beliefs and attitudes supporting nonviolent behavior. Effects on low-risk students were in the opposite direction. The differential pattern of intervention effects for low- and high-risk students may account for the absence of main effects in many previous evaluations of universal interventions for middle school youth. These findings have important research and policy implications for efforts to develop effective violence prevention programs. The MVPP corporate author group includes the following individuals listed by sites (sites arranged in alphabetical order) with their current affiliation noted in parentheses: Centers for Disease Control and Prevention, Atlanta GA: Thomas R. Simon, Robin M. Ikeda, Emilie Phillips Smith (Penn State University); Le’Roy E. Reese (Morehouse School of Medicine); Duke University, Durham NC: David L. Rabiner, Shari Miller-Johnson, Donna-Marie Winn (University of North Carolina – Chapel Hill), Kenneth A. Dodge, Steven R. Asher; University of Georgia, Athens GA: Arthur M. Horne, Pamela Orpinas, Roy Martin, William H. Quinn (Clemson University); University of Illinois at Chicago, Chicago IL: Patrick H. Tolan, Deborah Gorman-Smith, David B. Henry, Franklin N. Gay, Michael Schoeny, Virginia Commonwealth University, Richmond VA: Albert D. Farrell, Aleta L. Meyer (National Institute on Drug Abuse); Terri N. Sullivan, Kevin W. Allison. Correspondence concerning this article should be addressed to Albert D. Farrell, Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018. E-mail: afarrell@vcu.edu.

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Essential Elements of School-Based Smoking Prevention Programs

ABSTRACT: The current status of adolescent tobacco use in the United States is discussed in the context of the identification of those elements considered necessary for successful school-based smoking prevention programs. Also described are the conclusions of a National Cancer Institute-convened expert advisory panel charged with the task of addressing: What are the essential elements of a school-based smoking prevention program? The panel focused on nine areas in which sufficient data and experience existed to reach a preliminary conclusion or make a recommendation. The nine areas are: program impact, focus, context, and length; ideal age at intervention; need for peer and parental involvement; teacher training; and program implementation. The panel concluded U.S. school-based smoking prevention programs have had consistently positive effects, though these effects have been modest and often limited to delaying the onset of tobacco use. Though the panel felt many programs are suitable for dissemination, several research recommendations also are described.     

Short-Term Effects of a School-Based Program on Gambling Prevention in Adolescents

PurposeTo evaluate short-term effects of a school-based media education program for sixth- and seventh-grade adolescents on gambling knowledge, attitudes, and behavior.MethodsA two-wave cluster randomized control trial with two arms (intervention vs. control group) was conducted in the German Federal State of Schleswig-Holstein. The intervention group received a four-unit media education program, which contained one unit on gambling. The program was implemented by trained teachers during class time. The control group attended regular classes without any specific intervention. Survey data from 2,109 students with a mean age (SD) of 12.0 (.85) years was collected before and shortly after the intervention.ResultsThirty percent of the sample reported lifetime gambling; 6.7% were classified as current gamblers. Results of multilevel mixed-effects regression analyses revealed significant program effects in terms of an increased gambling knowledge (d = .18), decreased problematic gambling attitudes (d = .15), as well as a decrease of current gambling (d = .02) in the intervention group compared to the control group. The program had no significant influence on lifetime gambling.ConclusionsA 90-minute lesson about gambling can improve gambling knowledge and change attitudes toward gambling and gambling behavior among adolescents. Studies with a longer follow-up period are needed to test the long-term effects of such an intervention.     

Evaluation of a Us School-Based Media Literacy Violence Prevention Curriculum on Changes in Knowledge and Critical Thinking Among Adolescents

The purpose of this study was to evaluate the effectiveness of Beyond Blame: Challenging Violence in the Media, at increasing students' knowledge about the effects of media violence and the core concepts of media literacy. During the 2007–2008 academic year, 1,693 sixth–eighth grade students from school districts around southern California participated in the study. Students were assigned to one of three treatment conditions: trained teacher, untrained teacher or control. Compared with controls, students in both intervention groups were more likely to agree that media violence may cause aggression, fear, desensitization and an appetite for more media violence at the post-test. Students in the trained group were also more likely than controls to understand the five core concepts/key questions of media literacy post-intervention.     

A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents,and Intervention and Contextual Factors in Prevention

Prevention Science - Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for...     

"Smoking Doesn''t Work:" A Smoking Prevention Project for Women Attending a Technical Institute

Women attending technical institutes often enroll in training programs for occupations with traditionally high smoking rates. In contrast, more worksites are implementing smoke-free and restricted smoking policies. "Smoking Doesn't Work," a smoking prevention project targeted at young females enrolled in a technical institute in Minnesota, used employability as the central theme in schoolwide events and classroom activities. Project intervention resulted in statistically significant increases in knowledge and awareness of smoking and employability issues. While young women enrolled in the technical institute recognized the negative image and health effects of smoking, they were less aware of the relationship between smoking status and employability. A focus on employability appears to provide a salient approach to smoking prevention with technical institute students.     

Mediation Analysis of a School-Based Drug Prevention Program: Effects of Project ALERT

This study used mediation analyses, implemented in a longitudinal structural equation modeling framework, to examine the mechanisms by which a social-influence-based school drug use prevention program (Project ALERT) achieved its effects on past month cigarette use and alcohol misuse. Participants were 4,277 South Dakotan middle-school students (2,554 treatment and 1,723 control) measured at baseline and 1 year later on past month cigarette use and alcohol misuse, as well as cigarette- and alcohol-related mediating variables targeted by the Project ALERT curriculum (i.e., resistance self-efficacy, positive and negative beliefs about use, and peer influence). Results for cigarettes showed that all hypothesized mediating variables were significant mediators of ALERTs effect on intentions to smoke and past month cigarette use, with peer influence being the strongest. Results for alcohol point to positive beliefs about the consequences of drinking as an important mediator for alcohol misuse. Taken together, the findings highlight an avenue for program improvement through increased impact on peer influence to use alcohol and drugs.     

Effect of a Smoking Ban and School-Based Prevention and Control Policies on Adolescent Smoking in Spain: A Multilevel Analysis

We evaluated the impact of a smoking ban in schools and of school-based smoking prevention and control policies on adolescent smoking. Annual surveys carried out between 2001 and 2005 that were representative of students in the 4th year of secondary education in the Madrid region, with 203 schools and 9127 students participating. The student questionnaire gathered information about personal and family variables. The contextual factors were: the periods before (years 2001?C2002) and after the law; and through a survey of school management boards: compliance with the law, policy reflected in the school regulations, existence of complaints against smoking, and undertaking of educational activities regarding smoking. Multilevel logistic regression models were constructed with two dependent variables: current smoking and the proportion giving up smoking. Smoking declined in 2003, the first year after the law came into force (Odds ratio: 0.80; CI 95%: 0.66?C0.96), and this decline was maintained in 2005. By contrast, smoking increased in those schools that did not undertake educational programmes regarding smoking (Odds ratio: 1.34; CI 95%: 1.13?C1.59), and in those that received complaints about smoking (Odds ratio: 1.12; CI 95%: 0.96?C1.29). This association is partly due to the effect of the increase in giving up smoking. The inclusion of contextual variables into the model with the individual factors reduces the variability of smoking between schools by 32.6%. In summary, the coming into force of a law banning smoking in schools, and the implementing of educational policies for the prevention and control of smoking are related to a lower risk of adolescent smoking.     

The Linkage Approach Applied to a School-Based Smoking Prevention Program in the Netherlands

ABSTRACT: Effective diffusion strategies are necessary to enhance use of innovative health promotion programs. One strategy uses the linkage approach to innovation-development and diffusion planning. The linkage approach enhances collaboration among three systems: resource system (university-based researchers), linkage system (district health educators), and user system (teachers). This article illustrates how the linkage approach was applied in a smoking prevention research project. Identification of the linkage system and the collaborative process between the resource system and linkage system are described. Results from a process evaluation indicated the linkage approach was feasible in a school-based smoking prevention project.     

Drug Abuse Prevention Among Minority Adolescents: Posttest and One-Year Follow-Up of a School-Based Preventive Intervention

Most drug abuse prevention research has been conducted with predominantly White middle-class adolescent populations. The present study tested a school-based drug abuse preventive intervention in a sample of predominantly minority students (N = 3,621) in 29 New York City schools. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills in an effort to provide students with skills and information for resisting drug offers, to decrease motivations to use drugs, and decrease vulnerability to drug use social influences. Results indicated that those who received the program (n = 2,144) reported less smoking, drinking, drunkenness, inhalant use, and polydrug use relative to controls (n = 1,477). The program also had a direct positive effect on several cognitive, attitudinal, and personality variables believed to play a role in adolescent substance use. Mediational analyses showed that prevention effects on some drug use outcomes were mediated in part by risk-taking, behavioral intentions, and peer normative expectations regarding drug use. The findings from this study show that a drug abuse prevention program originally designed for White middle-class adolescent populations is effective in a sample of minority, economically disadvantaged, inner-city adolescents.     

Acceptability and Student Outcomes of a Violence Prevention Curriculum

Violence in schools and its prevention have become focal points for research, practice, and policy. This study investigated the effectiveness of the Second Step violence prevention curriculum on all fourth and fifth grade students (N = 455) in one small urban school district. Scores on tests measuring knowledge of the curriculum increased significantly. Significant positive changes were also found for Behavior Assessment System for Children items reflecting student use of problem solving as well as report card items indicating respectful and cooperative behavior. Qualitative data from interviews with students provided in depth information about treatment acceptability and types of behavioral changes observed. Student interviews support the conclusion that the quantitative pre-post changes were directly connected to key components of the violence prevention curriculum. Implications for future research and practice are considered. Editors’ Strategic Implications: The authors present quantitative and qualitative data to suggest that a cognitive problem solving model represents a promising practice for school violence prevention efforts with urban, elementary school children. Longitudinal, experimental research will be necessary to draw any stronger conclusions.     

Effects of a School-Based Drug Abuse Prevention Program for Adolescents on HIV Risk Behavior in Young Adulthood

Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection.     

Longitudinal Outcomes of an Alcohol Abuse Prevention Program for Urban Adolescents

PurposeThis randomized clinical trial examined longitudinal outcomes from an alcohol abuse prevention program aimed at urban youths.MethodsStudy participants were an ethnically and racially heterogeneous sample of early adolescents, recruited from community-based agencies in greater New York City and its environs. Once they assented to study participation and gained parental permission, youths were divided into three arms: youth intervention delivered by CD-ROM (CD), the same youth intervention plus parent intervention (CD_P), and control. Once all youths completed baseline measures, those in CD and CD_P arms received a computerized 10-session alcohol abuse prevention program. Parents of youths in the CD_P arm received supplemental materials to support and strengthen their children's learning. All youths completed postintervention and annual follow-up measures, and CD- and CD_P-arm participants received annual booster intervention sessions.ResultsSeven years following postintervention testing and relative to control-arm youths, youths in CD and CD_P arms reported less alcohol use, cigarette use, binge drinking, and peer pressure to drink; fewer drinking friends; greater refusal of alcohol use opportunities; and lower intentions to drink. No differences were observed between CD and CD_P arms.ConclusionsStudy findings lend support to the potential of computerized, skills-based prevention programs to help urban youth reduce their risks for underage drinking.     

Effects of a Saliva Pipeline Procedure on Adolescent Self-Reported Smoking Behavior and Youth Smoking Prevention Outcomes

Background. Two strategies to resolve the problem of under- or overreporting of tobaccouse among adolescents have been utilized: (a) objective measures for validating self-reports and (b) procedures for improving validity of self-reports, such as the pipeline procedure. The objectives of this article are to investigate the hypothesis that reporting biases may be related to intervention status and to examine what effect such biases would have on interpretation of treatment effects. Method. A two-by-two factorial design was used, with the first factor a pipeline manipulation consisting of pipeline versus control condition, and the second factor treatment status, consisting of treatment versus reference schools. Within each of the schools, half of the 9th-grade classrooms were randomly assigned to a pipeline condition and half served as controls. Analysis was conducted with school as the unit of analysis. Results. The main effect for pipeline condition and the significant interaction between treatment and pipeline conditions were not significant. However, the pipeline manipulation did have an effect on the difference detected between treatment and reference schools; 4.3% difference between treatment and reference schools in the control condition versus 9.9% difference in the pipeline condition, both in the direction of a treatment effect. Using saliva thiocyanate as an objective measure of smoking status suggested differential false negative reporting where students in the reference community falsely claimed to be nonsmokers more frequently than in the treatment community (10.04% versus 5.96%). Conclusions. The reporting bias assessed by the pipeline procedure alone appears to have masked treatment outcome effects. Adjusting the smoking-dependent variable for false negatives seems to have increased the treatment outcome effects even further. This result is contrary to the expectation that the treatment community would experience greater demand pressures to underreport their smoking behavior. Further investigation to address response biases in intervention studies is warranted.     

Outcomes of a Latino Community-Based Intervention for the Prevention of Diabetes: The Lawrence Latino Diabetes Prevention Project

Objectives. We tested the effectiveness of a community-based, literacy-sensitive, and culturally tailored lifestyle intervention on weight loss and diabetes risk reduction among low-income, Spanish-speaking Latinos at increased diabetes risk.Methods. Three hundred twelve participants from Lawrence, Massachusetts, were randomly assigned to lifestyle intervention care (IC) or usual care (UC) between 2004 and 2007. The intervention was implemented by trained Spanish-speaking individuals from the community. Each participant was followed for 1 year.Results. The participants’ mean age was 52 years; 59% had less than a high school education. The 1-year retention rate was 94%. Compared with the UC group, the IC group had a modest but significant weight reduction (−2.5 vs 0.63 lb; P = .04) and a clinically meaningful reduction in hemoglobin A1c (−0.10% vs −0.04%; P = .009). Likewise, insulin resistance improved significantly in the IC compared with the UC group. The IC group also had greater reductions in percentage of calories from total and saturated fat.Conclusions. We developed an inexpensive, culturally sensitive diabetes prevention program that resulted in weight loss, improved HbA1c, and improved insulin resistance in a high-risk Latino population.Type 2 diabetes is a serious disorder with many complications and is characterized by insulin resistance and relative insulin deficiency. The prevalence of diabetes in Latino Americans is 1.5 times that in non-Latino Whites.1 Between 1988 to 1994 and 2005 to 2006, the prevalence of diabetes increased from 9.6% to 12.6% in the adult Latino population.2,3 Prediabetes, as defined by impaired glucose tolerance or impaired fasting blood glucose, is often present 5 or more years before the development of type 2 diabetes.4 Several randomized clinical trials have shown that it is possible to prevent or delay the progression of the prediabetic state to clinical type 2 diabetes.5–7The Diabetes Prevention Program (DPP) demonstrated that a lifestyle intervention incorporating dietary modification and increased physical activity produced an average weight loss of 5.6 kilograms at 1 year and by 4 years reduced the incidence of diabetes by 58% versus usual care.7 However, the intervention was intensive and costly, beginning with a 16-session curriculum that was delivered individually over 24 weeks and continuing with a number of follow-up individual and group sessions. The total intervention cost over the first year was $1399 per participant. The participants, although representing diverse American subpopulations, were generally well-educated, literate in English, and of average socioeconomic status.The effectiveness of the DPP lifestyle intervention delivered in a lower cost, lower intensity format to high-risk populations is not known. We hypothesized that a community-based, culturally tailored, literacy-sensitive lifestyle intervention delivered in a primarily group-based format would facilitate weight loss and reduce the risk of type 2 diabetes among low-income Latinos at elevated risk of developing diabetes.     

Effects of a School-Based Drug Prevention Program on Sexual Risk Behavior Among Adolescents in Brazilian Schools

Archives of Sexual Behavior - Sexual risk behaviors are closely related to the use of alcohol, tobacco, and other illicit drugs as well as teen dating violence. School-based drug prevention...     

When Intraclass Correlation Coefficients Go Awry: A Case Study From a School-Based Smoking Prevention Study in South Africa

Objectives. We conducted a group randomized trial of 2 South African school-based smoking prevention programs and examined possible sources and implications of why our actual intraclass correlation coefficients (ICCs) were significantly higher than the ICC of 0.02 used to compute initial sample size requirements.Methods. Thirty-six South African high schools were randomly assigned to 1 of 3 experimental groups. On 3 occasions, students completed questionnaires on tobacco and drug use attitudes and behaviors. We used mixed-effects models to partition individual and school-level variance components, with and without covariate adjustment.Results. For 30-day smoking, unadjusted ICCs ranged from 0.12 to 0.17 across the 3 time points. For lifetime smoking, ICCs ranged from 0.18 to 0.22; for other drug use variables, 0.02 to 0.10; and for psychosocial variables, 0.09 to 0.23. Covariate adjustment substantially reduced most ICCs.Conclusions. The unadjusted ICCs we observed for smoking behaviors were considerably higher than those previously reported. This effectively reduced our sample size by a factor of 17. Future studies that anticipate significant cluster-level racial homogeneity may consider using higher-value ICCs in sample-size calculations to ensure adequate statistical power.It is common when one is conducting public health interventions to randomize and then intervene with intact social groups, such as schools, churches, or worksites, rather than individuals. Appropriate analysis of such group- or cluster-randomized trials must account for the statistical similarity of participants within these larger units.^1,2 Individuals within clusters may enter the study with greater similarity than individuals randomly selected from the general population and they may also respond to an intervention in a dependent manner. Failure to account for either source of similarity violates the basic premise of participant nonindependence assumed in traditional statistical approaches and can result in inflated type I error.^1,2 Such within-group similarity is typically captured by the intraclass correlation coefficient (ICC).The following metaphor may help conceptualize how an ICC can affect sample size. A zero ICC occurs when 2 completely unrelated individuals are randomly selected from the general population. In this case, each person contributes a full independent observation. If, however, siblings from the same household were selected, because of their shared environment and genetics, depending on the degree of similarity, this would result in slightly less than 2 independent observations. If nonidentical twins were selected, they would contribute an even lower degree of independent observation; identical twins, even less. In the extreme case, if Siamese twins were recruited, they would begin to approach the contribution of a single individual. In most cluster-randomized studies, the degree of nonindependence within a group is low, but its impact on overall statistical power can still be great because of the variance inflation formulae used to adjust for the ICC.If the ICC is known before conducting a trial, sample size requirements can be adjusted upward to account for the reduction in true sample size and statistical power, decreasing the chances of type II error. As noted by Murray et al.,³ however, it is often difficult to obtain a reliable ICC estimate that is entirely applicable to one''s proposed study. Archival ICC estimates are often derived from samples, measures, contexts, or study designs that differ from the one proposed, limiting their utility. Whereas overestimation of the ICC can lead to an overpowered study and, therefore, inefficient use of resources, underestimation of the ICC can lead to an underpowered study (i.e., type II error).We recently conducted a group randomized trial of 2 school-based smoking prevention programs designed for South African youths from 2004 to 2008. In computing our a priori sample-size requirements, we used ICC estimates drawn from published school-based smoking prevention studies, all of which were conducted in the United States. Prior ICCs were predominantly in the range of 0.02 to 0.04,⁴ and our sample size was computed accordingly. However, when the study was completed and we examined the actual ICC it turned out to be significantly higher than we had anticipated. As a result, many of our outcomes that would have been statistically significant with the ICC that was originally projected turned out to be null. We felt it would be useful to publish and explain these ICCs to assist other investigators.     

Predictors of Onset for Non-suicidal Self-injury Within a School-Based Sample of Adolescents

This paper reports on a prospective study exploring risk factors specifically related to the onset of non-suicidal self-injury (NSSI) during adolescence. We examined cumulative incidence and predictors of onset of NSSI over 1 year among 1,973 school-based adolescents (13–19 years old; M?=?14.9, SD?=?0.96) from five states in Australia. Data showed cumulative incidence of 3.8 % (95 % CI [3.0–4.7 %]) over 1 year. Multiple socio-demographic and psychosocial factors were assessed using sequential logistic regression models. Onset of NSSI was associated with being female (OR?=?3.47, 95 % CI [1.48–8.18]), being born outside of Australia (OR?=?3.05, 95 % CI [1.10–8.47]), not identifying as religious or spiritual (OR?=?1.80, 95 % CI [1.04–3.10]), increased psychological distress (OR?=?1.12, 95 % CI [1.08–1.16]), poor social support from family (OR?=?0.89, 95 % CI [0.83–0.95]), poor self-esteem (OR?=?0.90, 95 % CI [0.83–0.98]), and poor problem-solving coping (OR?=?0.90, 95 % CI [0.82–0.99]). These findings may assist to better identify young people more likely to start self-injuring and also highlight issues to provide a focus for prevention initiatives.     

The Hutchinson Smoking Prevention Project trial: design and baseline characteristics

INTRODUCTION: This paper describes the experimental design and baseline characteristics of the Hutchinson Smoking Prevention Project (HSPP), a 15-year trial to determine to what extent a grade 3-12 school-based tobacco use prevention intervention can deter tobacco use throughout and beyond high school. DESIGN: Trial design features include use of the school district as the unit of randomization, inclusion of the school district's entire enrollment of 3rd graders, long-term follow-up of the entire original cohort, and sample size and evaluation methods that account for the group-randomization and intraclass correlation of endpoints within school districts. The theory-based intervention is teacher-led and includes grade 3-10 curriculum units, teacher training, grade 9-12 tobacco use cessation materials, and high school staff newsletters. RESULTS: Baseline data were collected on the trial cohort of 8388 children and their parents and on the 40 collaborating school districts and communities. A comparison of the distribution of baseline variables between experimental conditions shows good balance. CONCLUSIONS. The HSPP trial's experimental design will provide a rigorous test of the intervention. The balance in baseline variables between the experimental and control conditions will help provide assurance that the trial's intervention effectiveness results, scheduled for publication in 2000, will be unbiased.