National Center for Education in Maternal and Child Health
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April 26, 2002
1. Monograph Contributes to Growing Body of Research on How to Foster Positive School Climate
2. New Report Released on Evaluation of Abstinence Education Programs
4. Article Describes Theory-Based Development and Testing of an Adolescent Tobacco Program
5. Study Seeks to Improve Adolescents' Adherence to Community Treatment After a Suicide Attempt
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1. MONOGRAPH CONTRIBUTES TO GROWING BODY OF RESEARCH ON HOW TO FOSTER POSITIVE SCHOOL CLIMATE
Improving the Odds: The Untapped Power of Schools to Improve the Health of Teens presents findings from two related studies that look at what fosters school connectedness (i.e., students' feeling that they are part of their school and that they are cared for at school). The authors note that school connectedness has been associated with a lower prevalence of many unhealthy behaviors among adolescents. Based on data from the National Longitudinal Study of Adolescent Health (Add Health), the findings reported in this monograph demonstrate that a few school attributes -- classroom management; school size; and integration of friendship groups across lines of race, gender, and social status -- help explain why students in some schools feel a greater sense of school connectedness than do those in others. The publication includes strategies that school administrators, parents, and teachers can adopt to foster adolescents' sense of school connectedness.
This report was prepared by the Center for Adolescent Health and Development at the University of Minnesota with assistance from the Robert Wood Johnson Foundation (RWJF). It is the third in a series of monographs funded by RWJF presenting new research findings from Add Health that have immediate applicability. This report and the other monographs in the series are available at http:www.allaboutkids.umn.edu.
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2. NEW REPORT RELEASED ON EVALUATION OF ABSTINENCE EDUCATION PROGRAMS
The Evaluation of Abstinence Education Programs Funded Under Title V Section 510: Interim Report, prepared by Mathematica Policy Research, Inc., presents interim findings from an independent, federally funded evaluation of the abstinence education programs authorized under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) and defined under Title V, Section 510 (b)(2)(A-H) of the Social Security Act. The report draws most heavily on 4 years of implementation experiences in a selected group of abstinence education programs funded under Section 510. It includes background information on the evaluation of abstinence education programs, as well as information on early implementation experiences of abstinence education programs and the foundation for assessing the impact of abstinence education programs. Later reports from the evaluation will present estimates of the short- and longer-term effects of the programs, as well as studies on special topic areas. The report is available at http://www.mathematica-mpr.com/PDFs/evalabstinence.pdf.
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3. ANALYSIS FOCUSES ON UNDERSTANDING THE LINK BETWEEN COMMUNITY CHANGE AND POPULATION-LEVEL HEALTH OUTCOMES
"[Our] findings suggest a possible link between improvement in the population-level health outcome of birth rate and the amount, intensity, and exposure to community change," state the authors of an article published in the April 2002 issue of Health Education and Behavior. Focusing on data from one site in a multi-site comprehensive school/community initiative for adolescent pregnancy prevention in Kansas, this article compared measures of community change to changes in birth rate among girls ages 14 to 17 years in two Wichita, KS, target areas for the time periods of preintervention (1991-1993) and intervention (1994-1998).
The authors found that
* The majority of the community changes (59%) were implemented in Target Area A, with 11% implemented in Target Area B;
* Target Area A implemented community changes for all the identified risk factors related to adolescent pregnancy as well as community changes related to behavior change strategies and program components, while Target Area B implemented several but not all of these;
* Community changes implemented in Target Area A involved all the identified sectors (including business, health, schools/education, religious, social services/youth, government/law, community, media, and family), while the changes implemented in Target Area B focused on the schools/education sector only;
* Youth and community leaders were the targets of changes within both target areas; however, the changes implemented in Target Area A also reached parents, families, and the general community; and
* The birth rates decreased in Target Area A and increased in Target Area B.
"Positive changes in birth rates were found in the area with the greatest number of community changes and with the most varied distributions of community change across program component, risk factor, behavior change strategy, and sector," conclude the authors. They suggest that "this approach offers community initiatives a way to develop empirical legitimacy for their efforts by showing a beginning link between the environmental change they facilitate (an intermediate outcome) and improvement in (more distant) population-level health outcomes." They also suggest that this analysis may provide funders, community leaders, and support organizations with a better understanding of what is necessary and sufficient for the work of public health improvement.
Paine-Andrews A, Fisher JL, Patton JB. 2002. Analyzing the contribution of community change to population health outcomes in an adolescent pregnancy prevention initiative. Health Education and Behavior 29(2):183-193.
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4. ARTICLE DESCRIBES THEORY-BASED DEVELOPMENT AND TESTING OF AN ADOLESCENT TOBACCO PROGRAM
"In a continuing evolutionary process, intervention programs need to step beyond the theoretical and challenge unforeseen issues in 'real world' implementation," state the authors of an article published in the March/April 2002 issue of the American Journal of Health Behavior. This article discusses the Adolescent Tobacco Use Awareness and Cessation Program (ATCP) trial designed to develop, evaluate, and disseminate effective tobacco cessation programming for adolescents in conjunction with Texas legislation making tobacco use by adolescents illegal. A major focus of the article is on describing the multiple iterative steps necessary in creating and testing adolescent smoking-cessation programs.
In searching the literature and conducting focus groups in the 2 years they spent preparing to launch the program, researchers found that (1) the majority of adolescent smokers felt they most needed help learning to cope with uncomfortable situations without turning to tobacco, (2) 80% of adolescent smokers were either in the precontemplation or the contemplation stage of quitting smoking (i.e., not yet in the action stage), and were less prepared than adults to quit smoking, and (3) adolescents in the early stages of cessation tended to prematurely move into the action stage, and this was associated with high relapse rates.
The program was geared toward adolescents at the precontemplation or contemplation stages. It consisted of four 2-hour sessions conducted over 2 weeks, with breaks between the sessions to allow the adolescents to use what they learned and to reflect. At the end of each of the first three sessions, the adolescents were asked to pledge to engage in some type of tobacco-use reduction that they would be willing to perform over the next few days. By emphasizing a manageable behavior change, the chances of success were enhanced.
During the trial, a total of approximately 146 classes were conducted at 27 sites, and 1,601 adolescents were served. Data on tobacco-use behaviors and cognitive/affective variables were collected before and after participation in the ATCP. The authors found that by the end of the program
* Daily use had dropped by nearly 10%;
* The number of adolescents who believed they would use tobacco again dropped;
* The intended age of stopping smoking dropped from nearly 21 years of age to under 20;
* Tobacco knowledge increased; and
* Self-efficacy related to cessation dropped significantly, but adolescents were more likely to believe that they now had the skills to quit smoking when they decided to do so.
The authors conclude that "such a program is well worth exploring as a public health intervention."
Smith DW, Colwell B, Zhang JJ, et al. 2002. American Journal of Health Behavior 26(2):137-144.
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5. STUDY SEEKS TO IMPROVE ADOLESCENTS' ADHERENCE TO COMMUNITY TREATMENT AFTER A SUICIDE ATTEMPT
This intervention, "which is designed to primarily affect family and individual barriers to participation in treatment, may be useful, but only if there are enough resources devoted to ensuring adequate access to services," state the authors of an article published in the April 2002 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Lack of adherence to treatment is a significant problem in psychotherapy research and has been shown to be particularly problematic with adolescents who attempt suicide. The purpose of this study was to determine whether adolescents who participated in a problem-solving intervention would attend more outpatient psychotherapy sessions than a comparison group of adolescents who received standard disposition planning.
Sixty-three adolescents ages 12 to 18 who had initiated a suicide attempt and were receiving medical care in either the emergency department or the pediatrics ward of a children's hospital in the Northeast were randomly assigned to a standard disposition planning group or an experimental compliance enhancement group. The 1-hour compliance enhancement intervention took place in the hospital after one of three postdoctoral fellows in psychology had conducted standard disposition planning. Three months after the suicide attempt, a research assistant conducted a structured telephone follow-up interview with parents and adolescents in each group. The research assistant also made a separate contact with treatment providers. All evaluable adolescents in each group were compared on baseline and follow-up measures.
Results are as follows:
* A direct comparison of the groups did not reveal a statistically significant difference between the compliance enhancement and standard disposition groups on the number of outpatient psychotherapy sessions attended; and
* A separate analysis to control for differences between groups that were noted at baseline (hopelessness) and at follow-up (service barriers) revealed a statistically significant difference; the compliance enhancement group attended significantly more outpatient psychotherapy sessions than the standard disposition group.
The authors note that "the compliance enhancement intervention in this study was effective in increasing treatment adherence compared with standard disposition planning only when the barriers to service in the community were controlled." The findings reported here underscore just how critical it is to eliminate service barriers (e.g., waiting lists and problems with insurance coverage) for adolescents who have attempted suicide and are seeking treatment.
Spirito A, Boergers J, Donaldson D, et al. 2002. An intervention trial to improve adherence to community treatment by adolescents after a suicide attempt. Journal of the American Academy of Child and Adolescent Psychiatry 41(4):435-442.
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MCH Alert © 2002 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by MCH Library Services at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02 MC 0001-01) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
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EDITORS: Jolene Bertness, Tracy Lopez
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