While We Are Waiting

1. Risk and protection in adolescent health, mental health and behaviorJ. David Hawkins, Ph.D.SWL 579Session 2School of Social WorkUniversity of WashingtonOctober, 2009

2. While We Are Waiting • Name 3 types of prevention. • Think of an example of each type as relevant to your chosen problem area. • Be prepared to share your examples with the class.

3. O’ Connell, Boat & Warner (2009) mention two major risk factors in families. What are they? • Can you think of other family risk factors shown by research to predict increased mental, emotional or behavioral disorders in youth?

4. EPIDEMIOLOGY ETIOLOGY EFFICACY EFFECTIVENESS DISSEMINATION 2. With an emphasis on risk and protective factors, review relevant information-both from fields outside prevention and from existing preventive intervention research programs 3. Design, conduct, and analyze pilot studies and confirmatory and replication trials of the preventive intervention program 4. Design, conduct, and analyze large-scale field trials of the preventive intervention program 5. Facilitate large-scale implementation and ongoing evaluation of the preventive intervention program in the community. 1. Identify problem or disorder(s) and review information to determine its extent The preventive intervention research cycle. Preventive intervention research is represented in boxes three and four. Note that although information from many different fields in health research, represented in the first and second boxes, is necessary to the cycle depicted here, it is the review of the information, rather than the original studies, that is considered to be part of the preventive intervention research cycle. Likewise, for the fifth box, it is the facilitation by the investigator of the shift from research project to community service program with ongoing evaluation, rather than the service program itself, that is part of the preventive intervention research cycle. Although only one feedback loop is represented here, the exchange of knowledge among researchers and between researchers and community practitioners occurs throughout the cycle.

5. Research Advances in Prevention Science and Positive Youth Development • Longitudinal studies have identified factors that predict substance abuse, violence, and other problem behaviors as well as positive outcomes like success in school.

6. Concepts • Promotive factors: • factors shown to promote positive functioning/health or absence of problem regardless of risk. • Risk factors: • factors shown to increase probability of problem in longitudinal or epidemiologic studies. • Protective factors: • factors shown to decrease probability of problem behavior in presence of risk.

7. Risk Factors and Outcomes Example: Family management practices and onset of daily smoking. (Hill et al., 2005)

8. Family Management at Each Age from 11-18 • When you are away from home, do your parents know where you are and who you are with? • The rules in my family are clear. • When you misbehave do your parents take time to calmly discuss what you have done wrong? • My parents praise me for my school achievements. • My parents notice when I am doing a good job and let me know about it. • My parents put me down (reversed).

9. 86% Family management trajectories in the transition to adolescence

10. Onset of Daily Smoking by Levels of Family Management 19% 11%

12. Risk Factors Substance Abuse Delinquency Teen Pregnancy School Drop-Out Violence Depression & Anxiety Community Availability of Drugs   Availability of Firearms   Community Laws and Norms Favorable Toward Drug Use, Firearms, and Crime    Media Portrayals of Violence  Transitions and Mobility     Low Neighborhood Attachment and Community Disorganization    Extreme Economic Deprivation      Risk Factors for Adolescent Problem Behaviors Used by permission of Channing Bete Company

13. Risk Factors Substance Abuse Delinquency Teen Pregnancy School Drop-Out Violence Depression & Anxiety Family Family History of the Problem Behavior       Family Management Problems       Family Conflict       Favorable Parental Attitudes and Involvement in the Problem Behavior    Risk Factors for Adolescent Problem Behaviors Used by permission of Channing Bete Company

14. Risk Factors Substance Abuse Delinquency Teen Pregnancy School Drop-Out Violence Depression & Anxiety School Academic Failure Beginning in Late Elementary School       Lack of Commitment to School      Risk Factors for Adolescent Problem Behaviors Used by permission of Channing Bete Company

15. Risk Factors Substance Abuse Delinquency Teen Pregnancy School Drop-Out Violence Depression & Anxiety Individual/Peer Early and Persistent Antisocial Behavior       Rebelliousness    Friends Who Engage in the Problem Behavior      Favorable Attitudes Toward the Problem Behavior     Early Initiation of the Problem Behavior      Constitutional Factors     Risk Factors for Adolescent Problem Behaviors Used by permission of Channing Bete Company

16. Want to learn more about “constitutional factors”, read Chapter 5 “Perspectives from Developmental Neuroscience in O’Connell, Boat & Warner. • How can we distinguish between risk and promotive or protective factors?

17. Promotive and Protective Factors Individual Characteristics • High Intelligence • Resilient Temperament • Competencies and Skills In each social domain (family, school, peer group and neighborhood) • Prosocial Opportunities • Reinforcement for Prosocial Involvement • Social Bonding or Connectedness • Healthy Beliefs and Clear Standards for Behavior

20. Prevalence of 30 Day Marijuana UseBy Number of Risk and Protective Factors

21. Prevalence of Any Other Illicit Drug Use(Past 30 Days)By Number of Risk and Protective Factors

22. Prevalence of “Attacked to Hurt”By Risk and Protection

23. Prevalence of Academic SuccessBy Number of Risk and Protective Factors

24. Generalizations AboutRisk and Protective Factors • Risk & protective factors are found in many domains • The more risk factors present, the greater likelihood of problem behaviors, and the less likelihood of successful outcomes • Protective factors reduce effects of exposure to risk -- the greater the level of protection, the less likelihood of problem behaviors • Common risk & protective factors predict diverse behavior outcomes • Risk & protective factors show much consistency in effects across different races & cultures

25. Mediation • Example from Seattle Social Development Project. Does age of initiation of alcohol use mediate the effect of exposure to earlier risk factors in predicting alcohol misuse at age 18?

27. Moderation • Example from Seattle Social Development Project. Does good family management in adolescence moderate the effects of individual characteristics in predicting symptoms of alcohol dependence in adulthood?

28. SSDP Measures of BAS - behavioral activation system Carver & White, 1994: BAS associated with strong pursuit of appetitive goals, responsiveness to reward, sensation seeking, impulsiveness. • Done crazy things even if they are a little dangerous ? • Done something dangerous because someone dared you to do it? • Done what feels good, no matter what? • Gone to a wild, out-of-control party? • Upset or annoyed adults just for the fun of it? How many times have you done the following things? alpha = .80

29. SSDP Measures of BIS - behavioral inhibition system Carver & White, 1994: BIS inhibits behavior that may lead to negative or painful outcomes. Thus, BIS activation causes inhibition of movement toward goals. Fear, frustration, anxiety. • I worry a lot. • I am nervous or tense. • I am too fearful or anxious. • I am self-conscious or easily embarrassed. • I feel that I am overly anxious to please others. • I am afraid of making mistakes. alpha = .77

30. Alcohol Dependence Symptoms Age 27 Do BAS and BIS predict Alcohol Dependence Symptoms in Adulthood? BAS BIS 8th and 9th Grades (ages 14-15)

31. BAS is predictive of Alcohol Dependence Symptoms at age 27  = .11, p < .008 controlling for ethnicity, poverty and gender

32. BIS is NOT predictive of Alcohol Dependence Symptoms at age 27  = .01, ns

33. Consistent+ FamilyManagement Alcohol Dependence Symptoms Age 27 Does Consistent Good Family Management Moderate this Effect? ? ? BAS BIS

34. Does the Effect of BAS on Age 27 Alcohol Dependence Depend on Good/Poor Family Management?  = .11, p < .008

35. Family management practices moderate the effect of BAS on Age 27 Alcohol Dependence Symptoms  = .15, p < .01  = -.010, ns Interaction,  = -.28, p < .003

36. Does the Effect of BIS on Age 27 Alcohol Dependence Depend on Good/Poor Family Management?  = .01, ns

37. Family management practices do not moderate the effect of BIS on Age 27 Alcohol Dependence Symptoms  = -.02, ns  = .006, ns Interaction,  = .02, ns

38. Prosocial involvement Prosocial rewards Bonding to prosocial others Belief in the moral order External constraints:Laws, norms, family & classroom standards Substance Use, Abuse and Addiction Skills for interaction Position in the social structure: race, SES, age, gender Individual constitutional factors Antisocial opportunities Antisocial involvement Antisocial rewards Bonding to antisocial others Belief in antisocial values Example of Theory:The Social Development Model PROSOCIAL PATH Prosocial opportunities ANTISOCIAL PATH ( +, - ( - ) ( + )

39. Risk and Protection at Higher Levels of Aggregation • Communities vary significantly in levels of risk and protective factors and substance use outcomes. • Community levels of risk and protective factors are significantly correlated with levels of adolescent substance use. (Hawkins et al. 2005. Prevention Science)

40. Study of Risk/Protective Factors and Academic Achievement in Washington Schools Objective: To examine the strength of relationships between the levels of risk and protection in schools and students’ standardized test scores in those schools.

41. Washington State Data Data from the Communities that Care Youth Survey on schools' prevalence of risk and protective factors, drug use and other problem behaviors in middle and high schools from 8th and 10th graders Data from the Washington Assessment of Student Learning (WASL) on individual students’ academic test scores and demographic characteristics from 7th and 10th graders Data from 82,030 students in 423 schools and 156 school districts collected in 2002-03 were matched at the school building level

42. School Building Risk and Protective Factor Effects Fall 2002 Survey Spring 2003 WASL 10th Grade ATOD Use & Risk/Protective Factors 10th Grade WASL Scores

43. Analysis Plan Test these relationships after controlling for other possible influences: • individual students’ gender, race, and special education status, • school building free and reduced lunch eligibility, • district level size and per pupil expenditures

44. Findings In schools where students reported experiencing fewer risk factors, 10th graders were more likely to pass each of three WASL tests. Greater likelihood of passing the WASL Fewer Risk Factors

45. Findings In schools where students reported experiencing more protective factors, students were more likely to pass each of three WASL tests. More Protective Factors Greater likelihood of passing the WASL

46. Relationship Between Number of School Building Risk Factors and Probability of Meeting WASL Standard (10th-Graders)

47. Relationship Between Number of School Building Protective Factors and Probability of Meeting WASL Standard (10th-Graders)

48. Past Year Antisocial Behavior

49. Peer-Individual Overall

50. Peer-Individual Peer-Individual Estimated National Value