Self-Reported Engagement in a Drug Prevention Program: Individual and Classroom Effects on Proximal and Behavioral Outcomes

Youth Assets and Alcohol, Tobacco, and Other Drug Use: The Importance of Family Structure

This research analyzed data from the Youth Asset Study (YAS), a 4-year longitudinal investigation designed to examine the prospective influence of youth assets, which are believed to influence behavior at the individual, family, and community levels, on youth risk behaviors. The purpose was to determine if specific youth assets (e.g., responsible choices, family communication, community involvement) differentially protected adolescents from alcohol, tobacco, and other drug use (ATODU) according to family structure (one-parent and two-parent households). Five waves of data were collected annually over four years from a racially/ethnically diverse sample of adolescents (N = 722, 51.5% male, baseline mean age = 14.1 years). Pearson chi-square tests for independence were used to test for significant differences in the prevalence of assets between one-parent and two-parent households. Generalized linear mixed models were used to identify prospective associations between 17 youth assets and ATODU while stratifying by family structure and controlling for sociodemographic characteristics. Compared to adolescents living in one-parent households, adolescents living in two-parent households were significantly more likely to possess six of 17 assets. Among adolescents living in one-parent households, those who possessed any one of eight youth assets were significantly less likely to use ATODU. Among adolescents living in one-parent households, those with any one of seven assets were significantly less likely to use ATODU. Family- and community-level assets had the most significant asset/ATODU associations for adolescents living in one-parent households (AORs ranged from 0.23 to 0.61). Individual-level assets had the most significant asset/ATODU associations for adolescents living in two-parent households (AORs ranged from 0.38 to 0.60). The results suggest that developing asset-based interventions tailored to the adolescents' family structure may be useful in preventing adolescents from engaging in ATODU.

Fidelity of D.A.R.E. Officers' Delivery of "keepin' it REAL" in Elementary & Middle School

The goal of the current study is to examine the degree to which measures of quality of implementation and student engagement moderate pretest-posttest changes in mediating variables that are targeted by DARE "keepin' it REAL." DARE officers (10 elementary school, five middle school) taught DARE "keepin' it REAL lessons to 1,017 elementary students (480 boys and 534 girls) and 435 middle school students (217 boys and 215 girls). We examined teachers' and students' ratings of elementary and middle schools in response to DARE officers' delivery of the program. HLM analyses revealed that students' engagement was a significant and meaningful predictor of changes in targeted mediators. Teachers' ratings of student responsiveness added little in terms of understanding these outcomes with main effects observed only for students' ability to respond to bulling and students' estimates of peer drug use. Teachers' ratings of the quality of officer implementation, on the other hand, did add to understanding students' outcomes. Effects were seen for three (peer norms about drug use, decision-making (DM) skills, intentions to avoid drug use) out of six outcome variables and suggest a stronger positive effect for elementary versus middle school students. At least for these three outcomes, understanding quality of implementation added to our ability to interpret results. Specifically, in addition to students' engagement, quality of implementation (which varied by grade) contributed to achieving positive changes in students' outcomes.

Narrative and Behavioral Engagement as Indicators for the Effectiveness of Intentionally Designed Virtual Simulations of Interpersonal Interactions

Interventions involving simulated interactions aimed at mimicking real situations must be engaging to maximize their effectiveness. This study aimed to assess how a sample of middle school girls displayed behavioral and cognitive indicators of engagement when interacting with avatars representing game characters that were controlled by a human digital puppeteer. The simulation game, DRAMA-RAMA, is a component of an intervention intended to reduce at-risk girls' sexual and other risky behaviors. We used verbal/nonverbal behaviors and surveys to assess the game players' cognitive and behavioral involvement (N = 131). Participants perceived the game scenarios and interactions as realistic and the characters as similar to people in real life. Participants' behavior indicated their involvement and interest in interacting with the game characters. Finally, participants tended to be appropriate but not effective when attempting to advise/support the characters. These findings have implications for assessing successful operationalization of communication designs in interactive virtual learning environments.

Testing an Online Program to Foster Need Crafting During the COVID-19 Pandemic

The COVID-19 pandemic represents a threat not only to individuals' physical health but also to their mental health. Self-Determination Theory assumes that the satisfaction of basic psychological needs for autonomy, relatedness and competence promotes psychological well-being during destabilizing times. Yet, the pandemic seriously hampered individuals' opportunities to satisfy their needs. The current study provides a preliminary test of the effectiveness of a 7-session online program, LifeCraft, that promotes individuals' proactive attempts to uplift their need-based experiences (i.e., need crafting). Next to the effects on individuals' need crafting skills, we examined program-effects on adults' need-based experiences and mental health and we explored the role of participants' program engagement. An experimental study among 725 Belgian adults [M age = 51.67 (range = 26 - 85); 68.55% female] was conducted, with an experimental condition of 252 and a control condition of 473 participants. At the level of the entire sample, there was limited evidence for the effectiveness of the program. There were only small immediate program-effects on need crafting and well-being. After taking into account the role of program engagement, findings showed that the program was more beneficial for participants who actively participated, with these participants reporting immediate and stable increases in need crafting, need satisfaction and well-being and decreases in need frustration. Further, changes in need crafting fully mediated changes in need-based experiences and well-being. To conclude, the findings provide initial evidence for the effectiveness of LifeCraft during the COVID-19 pandemic, with active participation being a prerequisite for the program to be effective.

Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups

Background

Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination.

Objective

The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls.

Methods

This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests.

Results

Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities.

Conclusions

This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency.

The Role of Engagement in Effective, Digital Prevention Interventions: the Function of Engagement in the REAL Media Substance Use Prevention Curriculum

Prevention curricula rely on audience engagement to effectively communicate their messages. However, to date, measurement of engagement has primarily focused on self-report that is often an indicator of liking or satisfaction. Emerging technologies for intervention delivery hold promise not only for additional engagement indicators but also for dissemination outside of traditional vehicles such as classroom delivery. The present study, grounded in the theory of active involvement (Greene 2013), explores the role of engagement (as measured by self-report, program analytics, and observation) with short-term substance use prevention outcomes such as self-efficacy to counter-argue and descriptive and injunctive norms. The study tracks 4-H youth (N = 310) engaged with a media literacy focused e-learning substance prevention curriculum, REAL media. Results indicate that self-reports of engagement predicted self-efficacy to counter-argue, but a program-analytic indicator of dosage predicted lower injunctive and descriptive norms, all at 3 months. The observational indicator was correlated with self-efficacy to counter-argue but not significant in the predictive models. The implications and directions for future research regarding how engagement is measured in prevention and included in studying program effects are discussed. Clinical trial: NCT03157700, May 2017.

Evaluation of Undergraduate Students' Responsiveness to a 4-Week University-Based Animal-Assisted Stress Prevention Program

An increase in the prevalence of stress among college students is compromising their mental health and academic success. One approach to stress prevention that has seen a surge in implementation is the use of university-based Animal Visitation Programs (AVPs). Despite their popularity and promising causal findings, program evaluations on students' responsiveness (e.g., enjoyment, attendance, perceptions on usefulness and behavioral change) have yet to be conducted. Using a mixed methods approach, this study reports results of a program evaluation embedded in a randomized controlled trial examining the efficacy of incorporating various levels (0%, 50% or 100%) of Human Animal Interaction (HAI) into a four-week long university-based stress prevention program resulting in three conditions: (1) Evidence-based Academic Stress Management content only (0% HAI), (2) Human Animal Interaction with therapy dogs only (100% HAI) and (3) equal combinations of Academic Stress Management and HAI (50% HAI). Responsiveness (e.g., enjoyment, usefulness, recommendation and behavioral change) was assessed quantitatively and qualitatively using self-reported survey data collected immediately following the program and again six weeks later. The results suggest that combining evidence-based content presentations with HAI was associated with higher levels of enjoyment, perceived usefulness, and likelihood of recommendation compared to presenting content presentation or HAI alone, although doing so did not result in differences in perceived behavioral change by condition. Themes of students' perceptions on the role of HAI in shaping program enjoyment, usefulness, recommendations and behavioral change were described.