Implementation effectiveness trial of a social influences smoking prevention program using schools and television

Results are reported from a quasi-experimental implementationeffectiveness trial of a television and school-based smokingprevention program. The program used the social influences approach,focusing on peer, family and media influences on adolescentsto become smokers, and providing grade 7 students (age 12–13)with the knowledge and skills to resist them. The evaluationallowed for assessments of: the value of coordinated televisionprogramming in increasing school, student and parent availabilityand acceptance of the program; the effects of program context(whether all or half of a grade cohort received the programin school) on participation and subsequent smoking behavior;and the effects of parental participation in prevention activitieson subsequent student smoking. Data on availability, acceptance,participation and implementation are reported and immediatepost-test and 1- and 2-year follow-up results. Strong effectsof television programming and context on availability, acceptanceand participation were found. Significant associations werealso found between each television viewing and parental involvementand subsequent student smoking, but a lack of overall programeffects on smoking outcomes limit their interpretation. Constraintson programming and research design suggest: (i) possible limitationsto program effects we might reasonably expect in real-worldapplications of the social influences approach and (ii) theneed for future true experimental efficacy trials to determineexactly what level of programming will be needed to achievesignificant real-world effects.     

Improving elementary school quality through the use of a social-emotional and character development program: a matched-pair, cluster-randomized, controlled trial in Hawai'i

BACKGROUND: School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school‐wide social‐emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched‐pair, cluster‐randomized, controlled design. The Positive Action Hawai'i trial included 20 racially/ethnically diverse schools and was conducted from 2002‐2003 through 2005‐2006. METHODS: School‐level archival data, collected by the Hawai'i Department of Education, were used to examine program effects at 1‐year post‐trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well‐being, involvement, and satisfaction, as well as overall school quality. Matched‐paired t‐tests were used for the primary analysis, and sensitivity analyses included permutation tests and random‐intercept growth curve models. RESULTS: Analyses comparing change from baseline to 1‐year post‐trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school‐quality indicators showed improvement in student safety and well‐being, involvement, satisfaction, quality student support, focused and sustained action, standards‐based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. CONCLUSIONS: School quality was substantially improved, providing evidence that a school‐wide social‐emotional and character education program can enhance school quality and facilitate whole‐school change.     

Fidelity of Implementation in Project Towards No Drug Abuse (TND): A Comparison of Classroom Teachers and Program Specialists

This paper presents the results of an effectiveness trial of Project Towards No Drug Abuse [TND], in which we compared program delivery by regular classroom teachers and program specialists within the same high schools. Within 18 schools that were randomly assigned to the program or control conditions, health classrooms were assigned to program delivery by teachers or (outside) specialists. Classroom sessions were observed by pairs of observers to assess three domains of implementation fidelity: adherence, classroom process, and perceived student acceptance of the program. Pre- and immediate posttest survey data were collected from 2331 students. Of the four composite indexes of implementation fidelity that were examined, only one (quality of delivery) showed a difference between specialists and teachers, with marginally higher ratings of specialists (p < .10). Both teachers and program specialists achieved effects on three of the five immediate outcome measures, including program-specific knowledge, addiction concern, and social self-control. Students' posttest ratings of the program overall and the quality of program delivery failed to reveal differences between the teacher- and specialist-led classrooms. These results suggest that motivated, trained classroom teachers can implement evidence-based prevention programs with fidelity and achieve immediate effects.     

Active Parent Consent for Health Surveys With Urban Middle School Students: Processes and Outcomes*

BACKGROUND: To achieve high participation rates and a representative sample, active parent consent procedures require a significant investment of study resources. The purpose of this article is to describe processes and outcomes of utilizing active parent consent procedures with sixth-grade students from urban, ethnically diverse, economically disadvantaged K-8 public schools involved in an evaluation of a middle school service-learning program. METHODS: As part of the evaluation of the Lead Peace-Plus service-learning program, active parent consent was obtained for participation in school-based health surveys conducted with sixth graders in 3 schools. To achieve acceptable rates of parent permission, we employed multiple procedures including regular communication with school staff, incentives for involved schools and teachers, a multipronged approach for reaching parents, and direct encouragement of students to return forms through repeated classroom visits, individual and classroom incentives. We used Fisher's exact tests to compare selected characteristics among students whose parents weren't reached, those whose parents refused, and those whose parents consented to survey participation. RESULTS: We achieved a parent response rate of 94.6% among sixth-grade students. No significant differences in student gender, race/ethnicity, school, or free/reduced lunch status were identified across parent consent status groups. Rates of absenteeism were significantly higher (p = .03) among students whose parents weren't reached compared to other groups. CONCLUSIONS: Employing a multifaceted active parent consent campaign can result in high rates of parental response with limited sampling bias among an urban, ethnically diverse and economically disadvantaged group of middle school students.     

Beliefs,Attitudes, Intentions,and a Smoking-Cessation Program: A Planned Behavior Analysis of Communication Campaign Development

This study combines insights from research on communication campaigns with a social psychological theory of planned behavior and the Purdue stepped approach model of health-care delivery. This synthesis is applied in a study of beliefs, attitudes, and behavioral intentions and interests with respect to participation in a smoking-cessation program. A telephone survey based on a probability sample of 191 student smokers indicates moderate prepromotional interest in a stepped cessation program. The strongest predictor of intention to participate is attitude toward participation, followed by perceived normative expectation and control belief. Analysis of attitude-relevant beliefs indicates that program promotion must target both expectancies for healthful outcomes of program participation and evaluations of those outcomes. We also discuss the instability of student smoking, self-perceptions of smoking, and self-reports of smoking.     

Modifying the snack food consumption patterns of inner city high school students: the Great Sensations Study

The Great Sensations Program is a nutrition-education project developed for high school students. It was designed to (a) decrease students' consumption of salty snacks and (b) increase students' consumption of fresh fruit snacks. The overall programs were designed following principles of social learning: informative instruction, participatory classroom activities, personal goal setting, feedback, and reinforcement. The program was delivered in six lessons during regular health-education classes. A parental involvement program consisted of mailers and telephone calls to parents to teach them to encourage changes in student snacking habits. A schoolwide program was designed to provide out-of-class peer support for student modifications in salty snack foods. The program was evaluated in one high school using a 2 X 2 design. A second high school served as a no-treatment control. Program assessments were made at both schools before and after the classes, at the end of the school year, and the following fall the next school year following summer vacation. The schoolwide media program was effective in decreasing consumption of salty snack foods and in increasing consumption of target snack foods. However, only those students receiving classroom instruction maintained those changes until the end of the school year. No changes were maintained across summer vacation. These outcomes suggest that school programs developed using principles of social learning may be effective in facilitating important behavior changes at home and at school.     

Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs

The concepts of efficacy and effectiveness are examined from the viewpoints of the traditions and philosophies of health-care research and social program evaluation. Consideration of the status of the program being assessed, its availability to, and its acceptance by the target audience leads to the derivation of four levels of health promotion program testing: efficacy trials, under optimum conditions of program implementation and recipient participation; treatment effectiveness trials, with expected variation in target audience acceptance; implementation effectiveness trials, under varying conditions of implementation; and program evaluation of previously untested programs. These four levels of testing, together with experience in one area of health promotion research (smoking prevention), suggest eight phases of research for the development of health promotion programs: basic research, hypothesis development, pilot applied research, prototype evaluation studies, efficacy trials, treatment effectiveness trials, implementation effectiveness trials, and demonstration evaluations. Issues of design, the use of random assignment, the use of blinding procedures, and of the role of process evaluation in these different research levels, particularly efficacy and effectiveness trials, are considered in light of the terminologies and methods of health-care and social program evaluation research. Suggestions are made for improved health promotion research.     

Implementation of the Project P.A.T.H.S. in Hong Kong: observations based on the Co-Walker Scheme

The implementation quality of the Tier 1 Program (Secondary 1 Program) of the Project P.A.T.H.S. in the third year of the Full Implementation Phase was examined in this study, with classroom observations of 233 units in 157 schools. Results demonstrated that the overall level of program adherence was generally high with an average of 72.96%. A total of 13 aspects regarding program delivery were significantly correlated. Multiple regression analyses indicated that overall implementation quality was significantly predicted by student participation and involvement, classroom control, use of positive and supportive feedback, degree of achievement of the objectives, and time management. Student participation and involvement, classroom control, degree of achievement of the objectives, and time management were significant predictors of success of implementation.     

Active parental consent for a school-based community violence screening: comparing distribution methods

BACKGROUND: Students are unable to benefit from many school programs designed to address their mental health needs if their parents do not consent to their participation. As part of an ongoing effort in a large urban school district to meet the mental health needs of students traumatized by violence exposure, this paper examines the impact of alternative approaches on parental response and consent rates for an initial screening to participate in a school mental health program. METHODS: Two alternative approaches were used to obtain consent for students to participate in a school-based intervention for students exposed to violence. For one cohort, consent forms were distributed along with school information and other school forms during a parent orientation meeting. In the other cohort, school mental health clinicians visited student homerooms to distribute consent forms and explain the program and evaluation to students. RESULTS: There were significantly higher rates of return of consent forms (89.8% vs 53.2%) and parents consenting to participate (69.6% vs 27.9%) among parents receiving consent forms at a school meeting than among parents whose forms were distributed to children in a classroom, with comparable rates of active refusals to participate (20.1% vs 25.3%). CONCLUSIONS: Overall return rates and rates of consent for screening participation were substantially higher when the consent form and accompanying materials were provided directly to parents rather than distributed in the classroom and sent home with students. These findings have implications for efforts to obtain active consent from parents for students to participate in school mental health programs.     

Implementation of the Secondary 3 Program of Project P.A.T.H.S.: observations based on the co-walker scheme

Abstract The present study was conducted to explore the implementation quality of the Secondary 3 Program of the Tier 1 Program of Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in the third year of the Full Implementation Phase. Classroom observations of 182 units in 129 schools were conducted. Results showed that the overall level of program adherence was 73.9%. Thirteen aspects concerning program delivery were significantly correlated. Multiple regression analyses revealed that overall implementation quality was significantly predicted by student participation and involvement, strategies to enhance student motivation, use of positive and supportive feedback, degree of achievement of the objectives, and lesson preparation. Success of implementation was significantly predicted by student participation and involvement, classroom control, use of positive and supportive feedback, opportunity for reflection, degree of achievement of the objectives and time management. The present findings generally suggest that the implementation quality of Project P.A.T.H.S. was high.     

Development of a school-based nutrition intervention for high school students: Gimme 5

PURPOSE: To describe a 4-year intervention targeting fruit/vegetable consumption by high school students. DESIGN: This is a cohort study involving six pairs of schools (n = 12) matched on gender, race, enrollment, and location with schools randomly assigned within pairs to intervention or control conditions. SETTING: Twelve Archdiocese of New Orleans high schools. SUBJECTS: Cohort was defined as students (n = 2339) who were ninth-graders in the 1993-94 school year who provided baseline data. INTERVENTION: Four components of the intervention are: (1) school-wide media-marketing campaign, (2) school-wide meal and snack modification, (3) classroom workshops and supplementary subject matter activities, and (4) parental involvement. MEASURES: Focus groups were conducted for target population input and program development. Process evaluation included student feedback on media-marketing intervention materials and activities reported here. Process measures also included school meal participation, student characteristics, and verification of intervention activities. RESULTS: Focus groups identified barriers to increased consumption of fruit and vegetables as lack of availability, variety, and inconsistency in taste. Student attitudes were favorable regarding a school program to improve diet and parental involvement. Low consumption of fruits/vegetables was reported. After a 2-month school-wide program introduction utilizing various media-marketing materials and activities, 93% of students were aware of the program and 96% could identify the healthy eating message. CONCLUSIONS: Program development can be guided and enriched by student input via focus groups. Media-marketing activities effectively delivered health messages and attracted students' attention. Materials and activities used were acceptable channels for increasing awareness, positive attitudes, and knowledge about fruits/vegetables.     

The “Generacion Diez” After-School Program and Latino Parent Involvement with Schools

The current study examines associations between participation in after-school programs and change in Latino parent involvement with schools. Hierarchical linear regression analyses demonstrated that parents of children who had higher after-school program attendance rates were significantly more likely to report increases in the quality of relationships with their children's teachers, frequency of parent-teacher contact, and engagement with their children's schooling over a two-year period. However, greater home educator contacts were related to decreases in quality and quantity of parent-school involvement. A primary implication is that attendance in school-based after-school programs may draw parents into children's regular-day school context. Editors' Strategic Implications The authors illustrate the promising practice of using after-school programs to promote parent involvement and to help integrate the often disparate family and school contexts for Latino children.     

Community support for adolescent parents and their children: The parent-to-parent program in Vermont

Most adolescent parents now receive good prenatal and neonatal medical care, some receive limited amounts of parenting instruction, and increasing numbers can participate in school completion programs. But few programs address the social isolation and broad developmental disruptions that often accompany adolescent parenthood. This article describes the implementation and short-term effects of one program that does strive to meet adolescents' long-term, broad support needs. The Parent-to-Parent program is a home-based program designed to enhance the ability of adolescent parents to meet their young children's and their own developmental needs. Through long-term home visiting by specially trained local volunteers, parent group meetings, and work with local human service institutions, the program strives to (1) enhance the quality of parent-child interaction; (2) enhance the parents' ability to locate and acquire services that will help them meet basic needs; (3) enhance parent and child involvement in community life; and (4) help the parents become more aware of their own options for the future, and more capable of implementing the plans they make.     

Parent training for feeding problems in children with autism spectrum disorder: A review of the literature

A scoping review of the literature was conducted to identify published studies in which parents of children with Autism spectrum disorder (ASD) were trained to implement interventions designed to improve their child’s feeding and mealtime behaviors. Twenty-six studies were included in the review. Of these, 23 used single subject designs, and 3 used group designs. All reported improvements in target behaviors (usually acceptance of novel foods or reduction in disruptive mealtime behavior). However, only 3 described a procedure for incorporating parent input into the intervention plan; 7 directly measured parents’ fidelity in implementing intervention procedures; and 7 assessed social validity or parent satisfaction. Thus, there is a need for more systematic involvement of parents in treatment for feeding in children with ASD and more comprehensive outcome assessment.     

Drug use prevention programs, gender, and ethnicity: evaluation of three seventh-grade Project SMART cohorts

One-year follow-up data from three seventh-grade cohorts of Project SMART were examined to assess the effects of two social psychology-based programs within each of six subgroups: males, females, Asians, blacks, Hispanics, and whites. The three cohorts (total N = 5,070) were those receiving curriculum or serving as controls as seventh-graders in 1982-1983, 1983-1984, and 1984-1985 school years. The outcome measures used were composite indices based on lifetime and recent use items for cigarettes, alcohol, and marijuana. The major analysis was ANCOVA on classroom means for the composite indices at post-test, using pretest classroom means for the indices as a covariate. The results showed clear prevention effects for females but not for males. Overall prevention effects were strongest for cigarette smoking, but were also evident for alcohol. Significant sex by program interactions, showing differential program effects for males and females, were found for cigarettes and marijuana, but not for alcohol. There was a nonsignificant trend suggesting that the programs were most effective for Asians and least effective for whites.     

Sociocultural determinants of physical activity among children.

BACKGROUND: This study explores underresearched sociocultural predictors of children's physical activity and fitness, with particular attention paid to the influence of ethnicity independent from potential confounders such as social class. METHODS: Utilizing a 1997/1998 cross-sectional sample of 107 children (ranging in age from 6.5 to 13 years, mean = 10 years) participating in a longitudinal study of childhood obesity in Birmingham, Alabama, predictors of television viewing, vigorous exercise, habitual physical activity, exercise in school P.E. classes, sports team participation, and maximal aerobic capacity were identified, utilizing multiple regression analyses. RESULTS: The results indicated few ethnic differences in childhood physical activity once characteristics such as social class and single vs dual parent family background were controlled for. Specific multivariate findings included higher levels of television viewing and vigorous exercise among children from single parent homes; lower habitual physical activity among girls; less P.E. exercise among African Americans and children from single parent homes; higher sports team participation among older yet physically immature children; and higher physical fitness among boys, Caucasians, physically mature children, and children from single parent homes. CONCLUSIONS: This study illustrates the multidimensional nature of childhood physical activity and the influence of sociocultural factors on children's activity patterns.     

Cues to Parent Involvement in Drug Prevention and School Activities

ABSTRACT: This exploratory study used focus group methods to identify strategies that promote parent involvement with young children in an alcohol, tobacco, and other drug (ATOD) prevention program. The Health Belief Model (HBM) guided the interview process and data analysis. Five focus groups were conducted with low-income parents and school personnel from two urban elementary schools in Lexington, Kentucky. Cues to Action was the most frequent HBM construct expressed by both parents and school personnel in regard to ATOD prevention programs and general school activities. Enthusiasm for school activities expressed by children to their parents was identified as the core cue to parent involvement. Transportation, child care, and incentives were the basic requirements for parent involvement. Positive attitudes of school personnel, a combination of communication strategies, and multiple channels for involvement were major cues to parent involvement. Recommendations for involving parents in ATOD prevention and general school activities are suggested.     

Self-perceptions of competence and social support in Korean children

This study assesses the effects of social support from parents, teachers, and peers on various dimensions of children's self-perception. The Korean versions of the Self-Perception Profile and Social Support Scale were administered to 189 Korean elementary school children in grades three through six. Children's perceived scholastic competence can best be explained by teachers' unique contribution and joint effects of parents with peers and teachers. Teacher support is a strong contributing factor to children's perceived physical appearance and athletic competence, while peer support is important for children's perception of social acceptance and behavioral conduct.