Can Evidence-Based Prevention Programs be Sustained in Community Practice Settings? The Early Risers’ Advanced-Stage Effectiveness Trial

This study evaluated institutional sustainability of the Early Risers "Skills for Success" conduct problems prevention program. In a previous early-stage effectiveness trial Early Risers had been successfully implemented by a nonprofit community agency with guidance, supervision, technical assistance and fiscal support/oversight provided by program developers. The current advanced-stage effectiveness trial applied a randomized, control group design to determine whether this community agency could replicate earlier positive findings with a new cohort of participants, but with less direct involvement of program developers. An intent-to-intervene strategy was used to compare children randomly assigned to Early Risers or a no-intervention comparison group. Compared to results obtained in an early-stage effectiveness trial, program attendance rates were much lower and only one positive outcome was replicated. Failure to replicate program effects was not attributed to poor program implementation, because data collected pertaining to exposure, adherence and quality of delivery were acceptable, and a participation analysis showed that families who attended at higher levels did benefit. It was difficulties that the community agency experienced in engaging families in program components at recommended levels that primarily accounted for the results. Possible organizational barriers that impeded sustainability included unreliable transportation, poor collaboration between the agency and the local public school system, high staff turnover, agency downsizing, and fiduciary responsibility and accountability. It was concluded that both program developers and program providers need to be proactive in planning for sustainability.     

Results of an Independent Evaluation of Project ALERT Delivered in Schools by Cooperative Extension

Reported are results of an independent effectiveness study of the Project ALERT drug prevention program implemented in eight Pennsylvania middle schools by outside program leaders employed by Cooperative Extension. In this randomized, 2-cohort longitudinal evaluation, 1,649 seventh-grade students completed a pretest and four waves of posttests over the 2-year program and 1-year follow-up. Project ALERT's effectiveness was tested through a 3-level hierarchical linear model. Analyses failed to yield any positive effects for substance use or mediators for use in the adult or teen-assisted delivery of the curriculum. An extensive set of additional analyses detected no differential program effects by student risk level, gender, school, or level of implementation quality. Potential explanations for outcomes relative to Project ALERT's original effectiveness trial are discussed, as well as implications for future research, including the need to conduct independent effectiveness studies of previously validated programs in a variety of contexts.     

School Predictors of the Intensity of Implementation of School-Based Prevention Programs: Results from a National Study

Research has indicated that the effectiveness of school-based prevention programs is affected by the implementation quality of these programs. As the importance of implementation has become clearer, researchers have begun to examine factors that appear to be related to implementation quality. Data from a nationally representative sample of 544 schools were used to examine structural equation models representing hypothesized relationships among school and program factors and implementation intensity, controlling for exogenous community factors. Significant relationships were found between implementation intensity and several school and program factors, including local program development process, integration into school operations, organizational capacity, principal support, and standardization. Implications of these findings are discussed.     

Cigarette smoking among adolescents in Thessaloniki, Greece

OBJECTIVES: Epidemiological characteristics in tobacco smoking among adolescents were investigated in Thessaloniki, Greece. METHODS: The target sample was 1,221 students coming from 15 high schools. RESULTS: Cigarette smoking was higher among girls than boys (40.9 % vs. 34.3 %). However, the percentage of boys who were smoking more than 20 cigarettes per day was found larger than the relevant percentage of girls (81.2 % vs. 75 % of total smokers). The boys also reported an earlier initiation of tobacco use (12.7 years vs. 12.9 years in girls). Physical activity was negatively correlated with smoking, whereas drinking alcohol and low parental education were positively correlated with smoking. CONCLUSIONS: Health promotion programs should be instituted not only during adolescence, but rather before the age of 14.     

Contextual Effects in School-Based Violence Prevention Programs: A Conceptual Framework and Empirical Review

This paper reviews the theoretical and practical importance of studying contextual factors in school-based violence prevention programs and provides a framework for evaluating factors at the classroom, school, and community/district level. Sixty-two published papers describing 38 different programs were reviewed; of these 16 were identified that reported data on contextual effects or discussed possible contextual effects on the intervention. The small number of studies precludes definitive conclusions regarding contextual effects in school-based violence prevention programs, but suggests (a) some evidence for contextual effects on program outcomes, and (b) interdependence of context and implementation factors in influencing outcomes.Editors' Strategic Implications: This review suggests that contextual effects are important to school violence prevention, as context can influence outcomes directly and through interactions with implementation factors. Consequently, characteristics of the classroom, school, and community contexts should be considered by practitioners when implementing prevention programs and measured by researchers studying the processes and outcomes of these programs.     

Patterns of Retention in a Preventive Intervention with Ethnic Minority Families

  This study examined socio-demographic, child, and family-level correlates of retention patterns among parent participants of Familias Unidas/SEPI (Coatsworth, Pantin, & Szapocznik, 2002), a randomized, controlled trial of a family-focused preventive intervention. The current study's aim was to identify variables that could be used to classify ethnic minority (African American and Hispanic) caregivers (N = 143) into their known patterns of retention across 30 sessions of the intervention. Person-centered analyses identified three broad attendance pattern groups: (a) non-attenders; (b) variable-attenders; (c) consistent-high-attenders. Subgroups of the variable-attender group included: (a) dropouts; (b) variable-low-attenders; (c) variable-high-attenders. Four socio-demographic indicators were significant discriminators of the broad retention patterns. Three family-level factors were significant discriminators of the variable-attender subgroups. Additional significant mean/rate differences among retention pattern groups on correlates are reported. Implications for how retention is examined in preventive interventions and for developing intervention strategies for improving retention rates are discussed. Editors Strategic Implications: The authors address factors related to clients’ engagement and retention from multiple ecological levels. Lessons from this low income, low education, minority sample may prove useful to program developers who want to build in supports and incentives prior to program implementation.

Promoting Positive Adolescent Development for At-Risk Students with a Student Assistance Program

This study evaluated the psycho-educational small-group component of the CASPAR Youth Services Student Assistance Program with a randomized-controlled trial. Two cohorts of at-risk sixth graders from six schools in two communities were randomly assigned to intervention or control conditions and tested one and a half years later at the end of the seventh grade. A generalized estimating equations model yielded a significant intervention effect on all three composite outcome variables. The results support the effectiveness of prevention strategies aimed at promoting positive youth development and a social influence process for adolescents that creates trusting relationships as the foundation for helping youth improve key skills, exert greater control over their lives, and make informed decisions about substances. EDITOR'S STRATEGIC IMPLICATIONS: School administrators should be aware of this promising approach (pending replication) of using student assistance counselors to promote children's intrinsic motivation and potential for positive decision making.     

Bullying and subjective health among adolescents at schools in Latvia and Lithuania

OBJECTIVES: To investigate the prevalence of bullying among adolescents in Latvia and Lithuania and to study its association with self-rated health, health complaints, and life satisfaction. METHODS: A total of 3417 students in Latvia and 5626 in Lithuania were surveyed using the Health Behaviour Study among School-aged Children 2001/2002 (HBSC) questionnaire and research protocol. RESULTS: Being a victim, bully, or bully/victim was reported by 30.1% adolescents in Latvia and 52.3% in Lithuania with the highest proportion reporting being a victim. Bullying was associated with poor subjective health and low life satisfaction. CONCLUSIONS: The factors explaining the difference of bullying prevalence between both countries should be studied to develop effective anti-bullying interventions relevant to local conditions.     

Counteracting obesity: developing a policy framework to guide action

Summary Objectives:  The purpose of this paper is to stimulate further debate regarding possible courses of policy action aimed at preventing obesity. Gostin’s framework for classifying antiobesity legal interventions is tested and extended to incorporate non-legislative policy initiatives to include a comprehensive array of policy actions available to deal with obesity. Methods:  A web search of the literature has been conducted. Initiatives from USA, Canada and the European Union were discussed in terms of their objectives and fit with the framework. Results:  Gostin’s framework was found to be a useful tool in organizing all the initiatives (legislative and non-legislative). However, sometimes a broader definition of the category was needed. As well, in some categories, few initiatives were implemented to date and several new categories have to be added to the framework to classify all the existing initiatives. Conclusions:  The theoretical developed framework will assist new initiatives assess possible courses of action as well as countries or organizations that have already implemented some measures identify what else can be done to effectively fight overweight and obesity.     

The Role of Behavior Observation in Measurement Systems for Randomized Prevention Trials

The role of behavior observation in theory-driven prevention intervention trials is examined. A model is presented to guide choice of strategies for the measurement of five core elements in theoretically informed, randomized prevention trials: (1) training intervention agents, (2) delivery of key intervention conditions by intervention agents, (3) responses of clients to intervention conditions, (4) short-term risk reduction in targeted client behaviors, and (5) long-term change in client adjustment. It is argued that the social processes typically thought to mediate interventionist training (Element 1) and the efficacy of psychosocial interventions (Elements 2 and 3) may be powerfully captured by behavior observation. It is also argued that behavior observation has advantages in the measurement of short-term change (Element 4) engendered by intervention, including sensitivity to behavior change and blinding to intervention status.     

Determinants of university students physical exercise: a study from Lebanon

BACKGROUND: Studies to assess the patterns of physical exercise among University students in Lebanon are lacking. The current study looks at the prevalence of physical exercise among university students in Beirut and predictors of performing physical exercise. METHODS: In a cross-sectional study, a proportionate random sample of university students selected from five major universities were asked to complete a self-administered questionnaire related to physical exercise, demographic, scholastic, and health risk behavioral characteristics. Physical exercise was divided into: "No" (<0.5 h) and "Yes" (>0.5 h) per week. Chisquare tests and binary regression were conducted to determine the predictors of performing physical exercise. RESULTS: Of 2,013 students, only 26.4 % engaged in physical exercise. Predictors of performing physical exercise for males, were adoption of exercise as the method of weight control, while for females, they were living abroad, drinking excessive alcohol, and adopting exercise for weight control. CONCLUSION: The prevalence of physical exercise among Lebanese university students is low. Weight control remains the most important predictor of physical activity in males and females.     

Effects of Rape on Men: A Descriptive Analysis

Previous studies of the effects of rape on men have focused mainly on clinical populations. This study extended current research by investigating the effects of rape on a non-clinical sample of men recruited from the general population by media advertising. A total of 40 male rape victims were asked to provide details of their assaults, levels of psychological disturbance, long-term effects, and reporting issues. Results revealed that most assaults had been carried out using physical or violent force, in a variety of different circumstances. All of the victims reported some form of psychological disturbance as a result of being raped. Long-term effects included anxiety, depression, increased feelings of anger and vulnerability, loss of self-image, emotional distancing, self-blame, and self-harming behaviors. Findings are discussed in relation to previous research in the area and perceptions of rape.     

Cultural Adaptations to a Family Life Skills Program: Implementation in Rural Appalachia

Numerous parent education programs have been developed to provide parents with the skills and support necessary to effectively improve their parenting abilities. The Strengthening Families Program (SFP) employs a "family skills training" approach for parents and their children (ages 6 to 10). This study focuses on the implementation and outcomes of a culturally adapted SFP in southwestern Virginia, an area known for its Appalachian culture. Two groups were compared (those that received an adapted curricula and those that did not) on retention rates, parental outcomes, child outcomes, and program satisfaction. Retention rates were significantly improved for those participants in the adapted curricula group; however, parent and child outcomes were not affected. Statistically significant improvements for parents were found in effective discipline practices, family cohesion, family conflict, confidence in parenting, and punishment practices; and for both groups of children in increased child social skills and closeness to mothers between pre- and post-test times.     

Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania

Objectives:  The incidence of cervical cancer in Eastern Europe has been on the rise, in contrast to the reduction in incidence in most countries of Western Europe. The objectives of the paper are to delineate the inequalities in cervical cancer screening in Romania and Bulgaria and identify explanations for these inequalities. Methods:  Representative samples of women – 1 099 in Bulgaria and 1 053 in Romania, were interviewed through a structured questionnaire. Results:  We found multiple dimensions of inequalities in cervical cancer prevalence and prevention, including disparities in comparison to other countries, disparities due to socioeconomic status, education, residency and ethnicity, as well as differential barriers faced by women in access to screening and in relationships with providers. We identified mediators of the effects of socio-economic status on screening history. Conclusions:  The study concludes that the effect of SES on screening is mediated mainly by the structural barriers in accessing the healthcare system, as well as women’s perceptions of the multiple costs of the smear. These conclusions are relevant to the development of national screening programs and health promotion in the two countries. Submitted: 19 March 2008; revised: 29 January 2009; accepted: 19 February 2009     

Epidemiology of eczema among Lebanese adolescents

OBJECTIVE: The study aims to determine the prevalence of eczema among Lebanese adolescents and identify demographic, nutritional and environmental characteristics associated with eczema. METHODS: A cross-sectional study conducted on a convenient sample of 3 153 students (13-14 years) selected from five different provinces in Lebanon. Significant unadjusted demographic, nutritional and environmental variables were considered in a stepwise regression model. RESULTS: Ever having an itchy rash that lasted for a period more than six months was reported by 788 (25.0%) adolescents, while 404 (12.8%) reported ever having eczema. Females and passive smokers were at 1.5 increased risk of having eczema than their counterparts. Exercising regularly, living near a busy area, and frequent eating of eggs were positively associated with eczema. Finally, adolescents who suffered from allergic diseases, asthma (Odds ratio (OR): 1.64, 95% CI: 1.16-2.32), rhinitis (OR: 1.35, 95% CI: 1.07-1.70) and hay fever (OR: 2.77; 95% CI: 2.12-3.62) also reported having had eczema. CONCLUSION: Environmental factors were found to play an important role in the prevalence of eczema among adolescents.     

On the influence of a raffle upon responses to an urban transportation survey in New York City

Objectives:  Determine whether raffling off prizes to increase participation in surveys triggers multiple responses from the same participants. Methods:  All staff, instructors, and students of Queens College, New York, were invited to a 5 minute online survey about commuting in winter 2007. Entry in the raffle to win one of two iPODs was not conditional upon survey completion. Results:  Participation was 18.7 %, and 3913 eligible responses. Of the 183 (4.7 %) participants with two answers, responses were consistent, with weighted kappas ranging between 0.48 and 1.00, and Pearson r’s between 0.81 and 1.0. Kappa’s were lower for opinion than for factual questions. The duplicate responses came from people with characteristics similar to the full sample. Commute modes included car (46 %), bus but no subway (28 %), and bus and subway (21 %). The median commute time was 90 minutes round-trip, and was greater than 120 minutes for 1/4 of the respondents. Conclusion:  Participation was low despite the raffle. The small percentage of duplicate answers, maybe prompted by the reminding emails, had a negligible impact on the results.     

Mediators and Moderators of Parental Involvement on Substance Use: A National Study of Adolescents

Current social developmental theories of drug use often incorporate mediation processes, but it is generally unknown whether these mediation processes generalize across ethnicity and gender. In the present study, we developed a mediation model of substance use based on current theory and research and then tested the extent to which the model was moderated by gender and ethnicity (African American, European American, and Hispanic American), separately for 8th and 10th graders. The respondents were adolescents from the 1994, 1995, and 1996 cohorts of the Monitoring the Future (MTF) project, which conducts yearly in-school surveys with nationally representative samples. Multi-group, structural equation modeling (SEM) results indicated much similarity across gender and ethnicity for school success and time spent with friends as partial mediators of risk taking and parental involvement on drug use (controlling for parental education). However, there were some differences in the magnitude of indirect effects of parental involvement and risk taking on substance use for 8th-grade African American girls. Discussion focuses on the potential success of prevention efforts across different ethnicities and gender that target parent-child relationship improvement and risk taking, and considers possible culture- and gender-specific issues.     

Nonkin Natural Mentors in the Lives of Older Youths in Foster Care

This study explored the nonkin natural mentoring relationships among older youths in foster care. Three hundred thirty-nine youths nearing their exit from one state’s alternative care system were interviewed. Those that reported the presence of a natural mentor, 62% (n=211), were subsequently asked about how they met their mentor, how long they have known their mentor, how frequently they have contact with their mentor, and the quality of the relationship. Seventy percent of the youth with mentors reported having known their mentors for over 1 year. Youth reported high levels of contact and relationship quality. Ethnic group membership, gender, where youth were living, and clinical characteristics were associated with individual mentoring characteristics. Child and adult service delivery systems might benefit from considering ways to support the continuation of these relationships during the transition period.     

Social network effect on self-rated health in type 2 diabetic patients – results from a longitudinal population-based study

OBJECTIVES: The aim is to analyse the association between social network and self-rated health in a longitudinal design for persons with type 2 diabetes, comparing them with persons without diabetes. METHODS: The analyses are based on data from the population-based 'KORA-A study' conducted in the region of Augsburg (Germany), with data from 1990/1995 (t (0)) and 1998 (t (1)), including 164 persons with type 2 diabetes and 207 persons without diabetes. The social network was assessed by the Berkman/Syme index. RESULTS: For the type 2 diabetes group, the multivariate analyses show that a high score of social network at t (0) is associated with good self-rated health at t (1), even if self-rated health at t (0) is included in the model (OR 2.69; 95 % CI: 1.21-5.98). For the non-diabetes group, no such association was found. CONCLUSIONS: The results point towards a 'buffer effect' of the social network, indicating that the positive effect on health can be seen mostly among those who are exposed to a high level of burden, in this case exposed to a chronic disease such as type 2 diabetes.