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Peer influence processes as mediators of effects of a middle school substance use prevention program.

ABSTRACT: BACKGROUND:Peer influence processes have been linked to escalation in substance use during the middle school years, particularly among at-risk youth. In this study, we report on an approach to prevention that attempts to counteract peer influence by interrupting the process of deviant peer clustering, in which socially marginalized youth self-aggregate and reinforce delinquent behavior, including substance use. We aimed to interrupt this process by implementing collaborative, group-based learning activities in school (i.e., cooperative learning). METHODS:In a cluster randomized trial in the Pacific Northwest (N = 1460 7th-grade students in 15 schools), we tested whether cooperative learning can reduce alcohol and tobacco use, and whether these effects are mediated by reductions in the amount of alcohol and tobacco use among one's friends. Intervention schools were provided with training in cooperative learning, and data were collected in September/October 2016 (baseline) and March 2017 (follow-up). RESULTS:Results indicated that cooperative learning significantly lowered rates of growth in alcohol (? = -0.60 [-0.36|-0.84]; p < .001) and tobacco use (? = -0.58 [-0.21|-0.94]; p = .01) between baseline and follow-up in intervention schools as compared to control schools. These effects were mediated by reductions in the prevalence of alcohol and tobacco use, respectively, among self-selected friends. CONCLUSIONS:Cooperative learning was able to significantly reduce the prevalence of both alcohol and tobacco use in friendship networks during the school year. The lower prevalence of alcohol and tobacco use among friends, in turn, reduced individual use at follow-up. This study was registered as trial NCT03119415 in ClinicalTrials.gov.

SUBMITTER: Van Ryzin MJ

PROVIDER: S-EPMC7402525 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Peer influence processes as mediators of effects of a middle school substance use prevention program.

Van Ryzin Mark J MJ Roseth Cary J CJ

Addictive behaviors 20180613

<h4>Background</h4>Peer influence processes have been linked to escalation in substance use during the middle school years, particularly among at-risk youth. In this study, we report on an approach to prevention that attempts to counteract peer influence by interrupting the process of deviant peer clustering, in which socially marginalized youth self-aggregate and reinforce delinquent behavior, including substance use. We aimed to interrupt this process by implementing collaborative, group-based ...[more]

PMID: 29921538

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Project description:Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial called Preparing to Run Effective Programs (PREP) showed that an implementation support intervention called Getting To Outcomes (GTO) improved implementation of an evidence-based substance use prevention program (CHOICE) run in community-based settings. However, more information is needed on how these interventions affect organizational barriers and facilitators of implementation. This paper aims to identify differences in implementation facilitators and barriers in sites conducting a substance use prevention program with and without GTO. PREP is a cluster-randomized controlled trial testing GTO, a two-year implementation support intervention, in Boys & Girls Clubs. The trial compares 15 Boys & Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 Boys & Girls Club sites implementing CHOICE supported by GTO (intervention group). All sites received CHOICE training. Intervention sites also received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE, and then evaluate and make quality improvements to CHOICE implementation using feedback reports summarizing their data. Following the second year of CHOICE and GTO implementation, all sites participated in semi-structured interviews to identify barriers and facilitators to CHOICE implementation using the Consolidated Framework for Implementation Research (CFIR). This paper assesses the extent to which these facilitators and barriers differed between intervention and control group. Intervention sites had significantly higher average ratings than control sites for two constructs from the CFIR process domain: planning and reflecting and evaluating. At the same time, intervention sites had significantly lower ratings on the culture and available resources constructs. Findings suggest that strong planning, evaluation, and reflection-likely improved with GTO support-can facilitate implementation even in the face of perceptions of a less desirable implementation climate. These findings highlight that implementation support, such as GTO, is likely to help low-resourced community-based organizations improve program delivery through a focus on implementation processes. TRIAL REGISTRATION: This project is registered at ClinicalTrials.gov with number NCT02135991 (URL: https://clinicaltrials.gov/show/NCT02135991). The trial was first registered May 12, 2014.

Project description:BackgroundEvidence suggests that aspects of the neighborhood environment may influence risk of problematic drug use among adolescents. Our objective was to examine mediating roles of aspects of the school and peer environments on the effect of receiving a Section 8 housing voucher and using it to move out of public housing on adolescent substance use outcomes.MethodsWe used data from the Moving to Opportunity (MTO) experiment that randomized receipt of a Section 8 housing voucher. Hypothesized mediators included school climate, safety, peer drug use, and participation in an after-school sport or club. We applied a doubly robust, semiparametric estimator to longitudinal MTO data to estimate stochastic direct and indirect effects of randomization on cigarette use, marijuana use, and problematic drug use. Stochastic direct and indirect effects differ from natural direct and indirect effects in that they do not require assuming no posttreatment confounder of the mediator-outcome relationship. Such an assumption would be at odds with any causal model that reflects an intervention affecting a mediator and outcome through adherence to treatment assignment.ResultsHaving friends who use drugs and involvement in after-school sports or clubs partially mediated the effect of housing voucher receipt on adolescent substance use (e.g., stochastic indirect effect 0.45% [95% confidence interval: 0.12%, 0.79%] for having friends who use drugs and 0.04% [95% confidence interval: -0.02%, 0.10%] for involvement in after-school sports or clubs mediating the relationship between housing voucher receipt and marijuana use among boys). However, these mediating effects were small, contributing only fractions of a percent to the effect of voucher receipt on probability of substance use. No school environment variables were mediators.ConclusionsMeasured school- and peer-environment variables played little role in mediating the effect of housing voucher receipt on subsequent adolescent substance use.

Project description:ImportanceAdolescent relationship abuse (ARA) and sexual violence (SV) reported among adolescents point to the need for prevention among middle school-age youths.ObjectiveTo test an athletic coach-delivered relationship abuse and sexual violence prevention program among middle school male athletes.Design, setting, and participantsAn unblinded cluster randomized clinical trial from spring 2015 to fall 2017 at 41 middle schools (38 clusters). The study included 973 male middle school athletes (ages 11-14 years; grades 6-8; participation rate 50%) followed up for 1 year (retention 86%).InterventionsCoaching Boys Into Men (CBIM) is a prevention program that trains athletic coaches to talk to male athletes about (1) respectful relationship behaviors, (2) promoting more gender-equitable attitudes, and (3) positive bystander intervention when harmful behaviors among peers are witnessed.Main outcomes and measuresThe primary outcome was change in positive bystander behaviors (ie, intervening in peers' disrespectful or harmful behaviors); secondary outcomes were changes in recognition of what constitutes abusive behavior, intentions to intervene, gender-equitable attitudes, and reduction in recent ARA/SV perpetration (at end of sports season and 1-year follow up).ResultsOf the 973 participants, 530 were white (54.5%), 282 were black (29.0%), 14 were Hispanic (1.4%), and the remainder were multiracial, other race/ethnicity, or not reported. Positive bystander behaviors increased at end of sports season and at 1-year follow-up (relative risk, 1.51; 95% CI, 1.06-2.16 and 1.53; 95% CI, 1.10-2.12, respectively) as did recognition of abuse (mean risk difference, 0.14; 95% CI, 0.01-0.27 and 0.14; 95% CI, 0.00-0.28, respectively). At 1-year follow-up, among those who ever dated, athletes on teams receiving CBIM had lower odds of reporting recent ARA/SV perpetration (odds ratio, 0.24; 95% CI, 0.09-0.65). Gender attitudes and intentions to intervene did not differ between study arms. In exploratory intensity-adjusted and per protocol analyses, athletes on teams receiving CBIM were more likely to report positive bystander behaviors and to endorse equitable gender attitudes and less likely to report ARA and sexual harassment perpetration 1 year later.Conclusions and relevanceAn athletic coach-delivered program for middle school male athletes is an effective strategy for reducing relationship abuse among younger adolescents.Trial registrationClinicalTrials.gov Identifier: NCT02331238.

Project description:Objective:To evaluate the effect of a school-based tobacco program in preventing initiation of tobacco use among adolescents in Saudi Arabia. Methods:We used a quasi-experimental controlled design. Four intervention and four control schools were selected from the regional education registry. A baseline questionnaire was administered to all grade 7 students before implementing the tobacco prevention program, Dentists Fighting Nicotine Dependence (DFND). The intervention group (n =379) received the DFND program whereas the control group (n = 255) received the regular tobacco program administered by the Department of Education. The program was delivered by trained health educators over 5?weeks. Pre- and post-test surveys (immediate and 2-year post-intervention) were collected. Study outcomes were current tobacco use, tobacco knowledge, attitude towards not using tobacco, and perceived behavioral control (PBC) of tobacco use. Covariates included sex, parent education, academic performance, absenteeism, student allowance, and religiosity. Data were analyzed using a two-level hierarchical mixed models. Results:In the immediate post-test, 597 participants (intervention, n = 366; control, n = 231) were surveyed. There was no difference in tobacco use between intervention and control schools, however, the intervention group had significantly higher mean scores for knowledge (? = 1.27, SE = 0.27, P?<?.01) and attitude toward not using tobacco (? = 5.17, SE = 2.48, P?<?.05) after adjusting for covariates. At 2-year post-intervention, 463 participants (intervention, n = 289; control, n = 173) were surveyed. There were no differences in tobacco use, knowledge, attitude or PBC between intervention and control groups. Conclusions:Our program did not impact tobacco use. In the short-term, the program significantly improved knowledge and attitude towards not using tobacco. These effects decayed 2 years post-intervention without additional programming. Increasing the effectiveness of DFND may be achieved by expanding curriculum content and practice time throughout the school years and by targeting high-risk adolescents within the program.

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Peer influence processes as mediators of effects of a middle school substance use prevention program.

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Peer influence processes as mediators of effects of a middle school substance use prevention program.

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