Brian R. Flay - US grants

African American; disease /disorder prevention /control; adolescence (12-20); child (0-11); violence; substance abuse related disorder; culture; sex behavior; parents; education evaluation /planning; schools; alcoholism /alcohol abuse prevention; cooperative study; disease /disorder proneness /risk; drug abuse prevention; curriculum; health education; training; exercise; injury prevention; nutrition; low socioeconomic status; human therapy evaluation; nutrition related tag;

The overall objectives of this research are 1) to improve our understanding of the causal processes involved in becoming a user or abuser of alcohol; and 2) to improve upon methods of statistical analysis of longitudinal data in exploring causal processes. This work will be conducted on seven existing longitudinal data sets, each with four or more waves of data collected from youth between the ages of 10 and 25. The specific objectives and aims are as follows: 1. Test and replicate hypotheses regarding causal processes using the framework of an integrative theory of behavior onset and change developed by these investigators, the Theory of Triadic Influence (TTI). Specific hypotheses concern mediating influences, moderating effects (including of gender and ethnicity) and reciprocal causation mechanisms (both among predictors and regarding feedback effects of behavioral experience). 2. Extend methods of longitudinal data analysis in the following five areas: conceptualizing stages and levels of substance use, modeling of progression from stage to stage, dealing with time-varying predictors and endogeneity, handling missing data and attrition, and modeling and testing interactions in causal chains (moderated mediation). The proposed study is important because it: encompasses the high risk age range (10-25); enables replication of tests and contrasts of the most important of the existing theories; incorporates a wider range of predictor variables than any other single study; includes data from multiple ethnically and socioeconomically diverse samples; utilizes sophisticated analytical techniques to examine mediating, moderating and feedback relationships; has large enough combined sample sizes to enable split-half testing and replication for many analyses; provides opportunities to develop and test new methodology for modeling of multi- wave data; is cost-efficient because of the existence of the six data sets; and will have important implications for future prevention programs/research.

DESCRIPTION: (Applicant's Abstract) SECONDARY ANALYSIS OF SU CAUSAL PROCESSES The overall objectives of this research are 1) to improve our understanding of the causal processes involved in becoming a user or abuser of tobacco, marijuana and other drugs; and 2) to improve upon methods of statistical analysis of longitudinal data in exploring causal processes. This work will be conducted on seven existing longitudinal data sets, each with four or more waves of data collected from youth between the ages of 10 and 25. The specific objectives and aims are as follows: 1. Test and replicate hypotheses regarding causal processes using the framework of an integrative theory of behavior onset and change developed by these investigators, the Theory of Triadic Influence (TTI). Specific hypotheses concern mediating influences, moderating effects (including of gender and ethnicity) and reciprocal causation mechanisms (both among predictors and regarding feedback effects of behavioral experience). 2. Extend methods of longitudinal data analysis in the following five areas: conceptualizing stages and levels of substance use, modeling of progression from stage to stage, dealing with time-varying predictors and endogeneity handling missing data and attrition, and modeling and testing interactions in causal chains (moderated mediation). The proposed study is important because it: encompasses the high risk age range (10-25); enables replication of tests and contrasts of the most important of the existing theories; incorporates a wider range of predictor variables than any other single study; includes data from multiple ethnically and socioeconomically diverse samples; utilizes sophisticated analytical techniques to examine mediating, moderating and feedback relationships; has large enough combined sample sizes to enable complex analyses by gender and ethnicity; provides opportunities to develop and test new methodology for modeling of multi-wave data; is cost-efficient because of the existence of the six data sets; and will have important implications for future prevention programs/research.

DESCRIPTION: (Applicant's Abstract) Extension of the Aban Aya Youth Project (AAYP) will extend the development and efficacy trial of interventions to prevent the health-compromising behaviors of violence, unsafe sexual behaviors (including HIV infection), and substance use, plus associated mediating variables (knowledge, attitudes, social normative beliefs, social skills, self efficacy, intentions) among 10-17 year old African-American adolescents in disadvantaged neighborhoods of Chicago & suburbs. The project, currently funded by the Office for Research on Minority Health through NICHHD, targets grades 5-7; the proposed project will extend the interventions to grades 8-10 and data collection to grades 8-11. Intervention efficacy is experimentally tested by randomly assigning 12 schools to receive either a Social Development Curriculum (SDC), an intensive School/Community Program (S/CP), or a control condition (a Health Enhancement Curriculum [HEC]). The SDC includes information on the risks of the targeted behaviors, decision-making. social competence, resistance skills, conflict resolution, and normative beliefs, plus homework that involves parents. The curriculum is classroom-based for grades 5-8; for grades 9 & 10, we propose five all-day Saturday workshops each year. The S/CP consists of the classroom/Saturday component plus enhanced parental involvement, peer mentoring, school staff training and other organizational changes, and a Local School Health Promotion Task Force to coordinate the above activities and also to forge links with the community. All intervention components are developmentally and culturally appropriate, and the curriculum will include elements on cultural values and pride. At grades 8-10, the program will also include components to improve the transition to high school and to prevent school drop-out. The HEC focusses on different health-related behaviors (e.g., nutrition, physical activity), but is equivalent to the SDC in all other ways. Project staff will deliver the intervention components. Each year, we will also train teachers and other community-based organization staff in program delivery to ensure ongoing implementation of the program. We collect extensive process evaluation data to determine the levels of acceptance (participation and satisfaction) and expectations of the intervention components by the target audience(s) (students, parents, school personnel). We also collect extensive outcome and mediator variable data from students, parents and school personnel prior to the intervention, and at the end of grades 5-11 (grades 8-11 on this grant).

DESCRIPTION (provided by applicant): This project will 1) evaluate the efficacy of a comprehensive, multi-grade, multi-year program, the Positive Action program (PA) designed to reduce student problem behaviors (including drug use and violence), disciplinary referrals and suspensions, and academic underachievement; 2) evaluate the effects of the program on the presumed/theoretical mediator variables; and 3) assess which of these changes in mediator variables actually mediate the effects of the program on behavior and school performance. The Hawaiian school district has agreed to implement a randomized efficacy trial of the PA program. We will randomly assign schools to PA or control conditions from strata matched on multiple indicators of risk. PA schools will receive the full PA program for four years (the 2001-02 through 2004-05 school years). This includes all materials for all students (at all grades), families, teachers, and principal, plus community kits; all training for teachers and other interested staff, and continuous technical support and monitoring by a PA staff person. Data on behavior and academic achievement will be obtained from school archival records for all students for all years and, where appropriate for several years prior to the study. Students in grades 1 and 3 in the 200 1-02 school year and their parents and teachers will also be followed through the project with surveys every year. The subject population will contain equal portions of males and females, and proportionate numbers of the major ethnic groups on Oahu (Hawaiian or part Hawaiian, white, Asian, Other). Analyses will test for program effects on all hypothesized mediating variables and outcomes, and the hypothesized mediational pathways. We expect to apply for a competitive continuation to continue the study and follow the younger cohort into middle school and the older cohort into high school.

DESCRIPTION (provided by applicant): This Grand Opportunity project will create the infrastructure to begin research on comprehensive preventive interventions in the nation's highest poverty neighborhoods. Neighborhoods of concentrated poverty are major contributors to the high levels of drug abuse, antisocial behavior, depression, academic failure, and intergenerational poverty in the U.S. and thus are critical targets for public health interventions. The recent accumulation of evidence-based preventive interventions (NRC-IOM, 2009) shows that substantial reductions in the prevalence of these problems are achievable. However, such changes will not occur until we can translate existing knowledge into effective interventions in high-poverty communities. The Obama administration has called for a "Promise Neighborhood" initiative, in which 20 high-poverty neighborhoods receive help in implementing comprehensive preventive interventions. However, the scientific infrastructure to support such interventions and to conduct the research needed to evaluate them and refine them does not yet exist. Additionally, it is possible to assist more than 20 such neighborhoods. We therefore propose to create the Promise Neighborhood Consortium, which will develop the infrastructure through which the scientific community can assist America's high-poverty neighborhoods in translating existing knowledge into widespread, multiple improvements in wellbeing, including the prevention of substance abuse, antisocial behavior, risky sexual behavior, depression, and academic failure and promotion of diverse forms of pro-social behavior and academic achievement. The prevention plan will focus on promotion of nurturing environments, emphasizing impact on children, youth, and families. The Consortium will (a) build a network of neighborhood and community leaders and behavioral scientists;(b) define and begin to implement measures of wellbeing and of risk and protective factors that are fundamental to evaluating preventive intervention in neighborhoods;and (c) develop research on the impact of evidence-based policies, programs, and practices when implemented in high-poverty communities. These activities will be supported by a state-of- the-art website that networks people and organizations, obtains and displays data about neighborhoods, disseminates information about evidence-based interventions, advocates for research and intervention in high- poverty neighborhoods, and supports intervention research in these neighborhoods. Over two years, this project will (a) create a network of high-poverty neighborhoods that will be linked through systematic efforts to implement and evaluate preventive interventions;(b) implement monitoring systems in these neighborhoods;(c) develop the capacity of national, early-career, and local community prevention scientists for neighborhood development;and (d) develop experimental evaluations of intervention research in these neighborhoods to advance the efficiency and effectiveness of efforts to reduce intergenerational poverty in America. PUBLIC HEALTH RELEVANCE: We plan to create the Promise Neighborhood Consortium to develop an infrastructure through which the scientific community can develop research to evaluate interventions to help America's highest poverty neighborhoods. Using current scientific knowledge, the Consortium will help these neighborhoods identify ways to prevent substance abuse, antisocial behavior, risky sexual behavior, depression, and academic failure;to promote diverse forms of positive behavior and academic achievement;and to conduct experimental evaluations of their strategies for trying to affect these outcomes. The prevention plan will focus on promotion of nurturing environments, emphasizing impact on children, youth, and families.