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Discussant Comments: Positive Youth Development and Sexual Behavior

Discussant Comments: Positive Youth Development and Sexual Behavior. Brian R. Flay, D.Phil. Department of Public Health Oregon State University Annual Conference of the Society for Prevention Research, Washington, DC., May 26-29, 2009. Positive Youth Development: The 4 C’s.

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Discussant Comments: Positive Youth Development and Sexual Behavior

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  1. Discussant Comments:Positive Youth Development and Sexual Behavior Brian R. Flay, D.Phil. Department of Public Health Oregon State University Annual Conference of the Society for Prevention Research, Washington, DC., May 26-29, 2009

  2. Positive Youth Development:The 4 C’s • Connectedness (bonding) • Competence (social, cognitive, behavioral, emotional, moral) • Confidence (self efficacy, self determination, belief in the future, clear & positive identity) • Character (prosocial norms, spirituality) Source: Catalano et al 1998, Pittman 1993 2

  3. Theoretical Orientation: A Matrix of Theories Note: Some of these theories cross cells, particularly the sociological theories. Some explicitly integrative theories cross many cells (e.g., Brooks, Elliott, Jessor). 3

  4. The Theory of Triadic Influence ENVIRONMENT GENETICS IntraPersonal Environment Social Situation Attitudes Toward Behavior Self-Efficacy Social Normative Beliefs Intentions/Decision BEHAVIOR 4

  5. THE THEORY OF TRIADIC INFLUENCE CULTURAL SOCIAL BIOLOGY/ ENVIRONMENT SITUATION PERSONALITY Interactions w/ Social Instit’s ATTITUDES SOCIAL SELF-EFFICACY TOWARD THE NORMATIVE BEHAVIORAL BEHAVIOR BELIEFS CONTROL Levels of Causation Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Biological/Nature Nurture/Cultural Ultimate Underlying Causes 1 2 3 4 5 6 a f Social/ Personal Nexus c d e b Sense of Information/ Interpersonal Others’ Social Self/Control Opportunities Bonding Beh & Atts Competence Distal Predisposing Influences 7 8 9 10 11 12 g r p i q h k n Expectancies & Evaluations m l j o Self Skills: Motivation Perceived Values/ Knowledge/ Determination Social+General to Comply Norms Evaluations Expectancies 13 14 15 16 17 18 s x Affect and Cognitions u w v t Proximal Immediate Predictors 19 20 21 Decisions DECISIONS/INTENTIONS A G B H C I D E F 22 Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological Experiences K 23 Notes: 1. affective and cognitive substreams 2. feedback loops 3. Interactions between streams Related Behaviors J 5

  6. THE THEORY OF TRIADIC INFLUENCE CULTURAL SOCIAL BIOLOGY/ ENVIRONMENT SITUATION PERSONALITY Interactions w/ Social Instit’s ATTITUDES SOCIAL SELF-EFFICACY TOWARD THE NORMATIVE BEHAVIORAL BEHAVIOR BELIEFS CONTROL Levels of Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Causation Biological/Nature Nurture/Cultural Ultimate Causes 1 2 3 4 5 6 a f Social/ Personal Nexus c d e b Sense of Information/ Interpersonal Others’ Social Self/Control Opportunities Bonding Beh & Atts Competence Distal COMPETENCE CONFIDENCE CONNECTEDNESS Influences 7 8 9 10 11 12 g r p i q h k n m l j o Expectancies & Evaluations Self Skills: Motivation Perceived Values/ Knowledge/ Determination Social+General to Comply Norms Evaluations Expectancies CHARACTER 13 14 15 16 17 18 s x u w v t Affect and Cognitions Proximal 19 20 21 Predictors Decisions DECISIONS/INTENTIONS A G B H C I D E F 22 Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological K Experiences 23 Related Behaviors J 6

  7. P P P P P P P S S E S S S S E E E E E E S A Two Less and single closely less related behavior related behaviors. Eg, Eg, smoking, behaviors. Eg, smoking smoking drug abuse, and drinking sex, exercise. Closely and less related behaviors: Ultimate causes may be the same, distal predictors less so. 7

  8. Ecological Theories (Bronfrenbrenner) BROAD SOCIO-CULTURAL ENVIRONMENT SOCIAL SITUATION PERSON 8

  9. The TTI Developmental-Ecological System ENVIRONMENT Situation E E Person P P S S Values Environment Knowledge Environment P S E Value Social Bonds Role Models Know Self- Control Com- petence Cognitive/Competence Substreams Affective/Control Substreams Exp Eval Mc NB Will + Skill Att Att SNB Self Efficacy SNB Intentions Behavior DEVELOPMENT & TIME Levels of Causation Ultimate Underlying Causes Distal Predisposing Influences Proximal Immediate Predictors 9

  10. Successful and Happy Citizens All Behaviors Have Common Causes Local Community, Families, Schools National Socio-Cultural Environment Intrapersonal Biology, Personality Relationships with Others Others’ Attitudes, Behaviors Social Normative Beliefs Sense of Self, Social Skills Self-Efficacy Political, Economic, Media, Religious Values, Attitudes Conduct Disorder Physical Health Care ADHD Community Bonding Safe Sex Anxiety/ Depress Eating/Diet Law Abiding Nonviolent Mental Health Healthy Behaviors Achievement Low Risk, non-Problem Behaviors Conventional and Social Behaviors No Drugs 10

  11. % Ever had sex by lifetime risk behavior count 1991-2007 (Youth Risk Behavior Survey) Santelli, et al., J Adolescent Health, 2009 11

  12. Problem-specific Usually only one behavior or one skill Start too late Upper elementary or middle school Limited intensity and dose Often only once a week for 10–20 sessions Ecologically limited Usually only in the classroom Limited effect sizes Average effect sizes in the 0.2 range Effects not sustained Few effects beyond one year, let alone into high school Limitations of Behavior-Specific Programs 12

  13. The first test of the TTI and changing multiple behaviors at once: The African American Youth Project: “ABAN AYA” • Afro-centric programming, grades 5-8 • History, culture, Kwanza values • Name means Protection + Self Determination • Targeted drug use, violence, delinquency and unsafe sex • School-based randomized trial • 4 schools per condition – 3 arms • Social Development Curriculum (SDC) vs School + Community (SC) vs control (Health Enhancement Curriculum - HEC) • Program development informed by the TTI • Dose-response effectiveness on multiple behaviors (Archives of Pediatric & Adolescent Medicine, 04) • Multiple papers on moderation and mediators 13

  14. ABAN AYA: Male odds of sexual intercourse by condition 15

  15. ABAN AYA: Male condom use by condition (logit ) 16

  16. Hypothetical example of differential effects by risk level (a common pattern) 17

  17. Multiple Levels: Classroom curriculum Teacher training School-wide climate Family Community Multiple Domains Character education Social & emotional learning Prevention program Academic achievement Positive Action is a Comprehensive PYD Program • Multiple Outcomes: • School engagement: Attendance, Truancy • Behaviors: Violence, Substance use, Sexual behaviors • School-level indicators: Disciplinary referrals, Suspensions • Achievement: Grades, Standardized test scores 18

  18. Basic Philosophy (Theory of Action) of the Positive Action Program & Circle You feel good about yourself when you do positive actions.C.f., Cognitive Behavior Therapy and Positive Psychology You feel bad about yourself when you do negative actions. C.f. Depression 19

  19. In the classroom curriculum and in all other materials, the Positive Action content is taught school-wide through six units: • Unit 1. Self-Concept: What It Is, How It’s Formed, and Why It’s Important (the Thoughts-Actions-Feelings Circle). • Unit 2. Physical and Intellectual Positive Actions for Body & Mind • Unit 3. Social/Emotional Positive Actions for Managing Yourself Responsibly • Unit 4. Social/Emotional Positive Actions for Getting Along with Others by Treating Them the Way You Like to be Treated (Character Education and Social-Emotional Learning) • Unit 5. Social/Emotional Positive Actions for Being Honest with Yourself and Others (Mental Health) • Unit 6. Social/Emotional Positive Actions for Improving Yourself Continually 20

  20. Mapping of Positive Action content onto the TTI CLASSROOM SCHOOL FAMILY COMMUNITY Positive Action Program Components and Lessons (Exist in each Component) IntraPersonal (Individual) Social Context/ Situations Socio-Cultural Environment Genetics Biology Personality Family School Neighborhood Peers Mass Media Regulations Religion Economy Positive Role Models Feelings Empathy Self Concept Social Bonding/ Attachment Others’ Behavior & Approval General Values Information Environment Sense of Self Social Competence Health & Drug Info Values How to Treat Others Self Management Time, Energy, Talents, Money, Anger How You Like To Be Treated Self- Determination Social Skills Others’ Expectations Desire to Please Evaluation of Outcomes Expected Consequences Alternative Consequences Communica -tion Skills Conflict Resolution Social & Emotional Health Social Normative Beliefs Attitudes Toward the Behavior Self-Efficacy Thinking Skills Creativity Decision-Making Problem-Solving INTENTIONS/DECISIONS BEHAVIOR Experiences from Behavior 21

  21. Hawaii: Lifetime Prevalence of Substance Abuse, Violent Behaviors, & Sexual Activity: 5th grade (no significant interactions) SEX --------------SUBSTANCE ABUSE------- ---SERIOUS VIOLENT BEHAVIORS--- Beets et al., in press AJPH 22

  22. Snyder et al, under review 23

  23. 24

  24. Counts of Positive Behaviors Endorsed (Washburn et al., in preparation) 25

  25. Conclusions • Positive Youth Development programs can prevent multiple problem behaviors, including unsafe sex • The Positive Action progam produced multiple effects after 3 and 4 years of programming • School-level reports of misconducts, suspensions and achievement strengthen the robustness of the findings • Time trends in outcomes suggest increasing effects over time • School-wide Positive Youth Development education can be effective at: • Decreasing multiple negative behaviors, including unsafe sex • Increasing multiple positive behaviors and • School performance, including academic achievement 26

  26. Future Research – PA and PYD • Investigate whether changes in “positive developmental” mediate program effects on behavior and achievement • Investigate potential differential impacts of programs based on student gender, child risk level, etc. • Investigate more formally whether schools with different levels in the quality of implementation yield different “impacts” • Examine impact as student cohort progress into upper elementary/middle grades (grades 6-8) • Critical transitional period within emotional, behavioral, and academic domains • Need evaluations of the components of complex programs • Compare effectiveness of different PYD programs 27

  27. School-based Prevention/Promotion Studies are Large and Complex • Large randomized trials • With multiple schools per condition • Comparisons with “treatment as usual” • Measurement of implementation process and program integrity • Assessment of effects on presumed mediators • Helps test theories • Multiple measures/sources of data • Surveys of students, parents, teachers, staff, community • Teacher and parent reports of behavior • School records for behavior and achievement • Multiple, independent trials of promising programs • At both efficacy and effectiveness levels • Need cost-effectiveness analyses 28

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