Abigail A. Fagan

Worldwide application of prevention science in adolescent health

The burden of morbidity and mortality from non-communicable disease has risen worldwide and is accelerating in low-income and middle-income countries, whereas the burden from infectious diseases has declined. Since this transition, the prevention of non-communicable disease as well as communicable disease causes of adolescent mortality has risen in importance. Problem behaviours that increase the short-term or long-term likelihood of morbidity and mortality, including alcohol, tobacco, and other drug misuse, mental health problems, unsafe sex, risky and unsafe driving, and violence are largely preventable. In the past 30 years new discoveries have led to prevention science being established as a discipline designed to mitigate these problem behaviours. Longitudinal studies have provided an understanding of risk and protective factors across the life course for many of these problem behaviours. Risks cluster across development to produce early accumulation of risk in childhood and more pervasive risk in adolescence. This understanding has led to the construction of developmentally appropriate prevention policies and programmes that have shown short-term and long-term reductions in these adolescent problem behaviours. We describe the principles of prevention science, provide examples of efficacious preventive interventions, describe challenges and potential solutions to take efficacious prevention policies and programmes to scale, and conclude with recommendations to reduce the burden of adolescent mortality and morbidity worldwide through preventive intervention.

Results of a type 2 translational research trial to prevent adolescent drug use and delinquency: a test of Communities That Care.

OBJECTIVE To test whether the Communities That Care (CTC) prevention system reduces adolescent alcohol, tobacco, and other drug use and delinquent behavior communitywide. DESIGN The Community Youth Development Study is the first randomized trial of CTC. SETTING In 2003, 24 small towns in 7 states, matched within state, were randomly assigned to control or CTC conditions. PARTICIPANTS A panel of 4407 fifth-grade students was surveyed annually through eighth grade. Intervention A coalition of community stakeholders received training and technical assistance to install the CTC prevention system. They used epidemiological data to identify elevated risk factors and depressed protective factors in the community, and chose and implemented tested programs to address their communitys specific profile from a menu of effective programs for families, schools, and youths aged 10 to 14 years. MAIN OUTCOME MEASURES Incidence and prevalence of alcohol, tobacco, and other drug use and delinquent behavior by spring of grade 8. RESULTS The incidences of alcohol, cigarette and smokeless tobacco initiation, and delinquent behavior were significantly lower in CTC than in control communities for students in grades 5 through 8. In grade 8, the prevalences of alcohol and smokeless tobacco use in the last 30 days, binge drinking in the last 2 weeks, and the number of different delinquent behaviors committed in the last year were significantly lower for students in CTC communities. CONCLUSION Using the CTC system to reduce health-risking behaviors in adolescents can significantly reduce these behaviors communitywide.

Addressing core challenges for the next generation of type 2 translation research and systems: the translation science to population impact (TSci Impact) framework.

Evidence-based preventive interventions developed over the past two decades represent great potential for enhancing public health and well-being. Research confirming the limited extent to which these interventions have been broadly and effectively implemented, however, indicates much progress is needed to achieve population-level impact. In part, progress requires Type 2 translation research that investigates the complex processes and systems through which evidence-based interventions are adopted, implemented, and sustained on a large scale, with a strong orientation toward devising empirically-driven strategies for increasing their population impact. In this article, we address two core challenges to the advancement of T2 translation research: (1) building infrastructure and capacity to support systems-oriented scaling up of evidence-based interventions, with well-integrated practice-oriented T2 research, and (2) developing an agenda and improving research methods for advancing T2 translation science. We also summarize a heuristic “Translation Science to Population Impact (TSci Impact) Framework.” It articulates key considerations in addressing the core challenges, with three components that represent: (1) four phases of translation functions to be investigated (pre-adoption, adoption, implementation, and sustainability); (2) the multiple contexts in which translation occurs, ranging from community to national levels; and (3) necessary practice and research infrastructure supports. Discussion of the framework addresses the critical roles of practitioner–scientist partnerships and networks, governmental agencies and policies at all levels, plus financing partnerships and structures, all required for both infrastructure development and advances in the science. The article concludes with two sets of recommended action steps that could provide impetus for advancing the next generation of T2 translation science and, in turn, potentially enhance the health and well-being of subsequent generations of youth and families.

The Relationship Between Adolescent Physical Abuse and Criminal Offending: Support for an Enduring and Generalized Cycle of Violence

Prospective investigations have demonstrated support for the cycle of violence theory. However, few studies have examined whether or not abuse occurring during adolescence increases the prevalence and frequency of criminal involvement, or explored the long-term consequences of such victimization. In addition, there has been little investigation of whether or not the effects of abuse vary depending on characteristics of the victim, such as sex, race/ethnicity, age, family structure or income. Using data from the National Youth Survey, this study demonstrates that adolescent physical abuse has immediate and enduring effects on the prevalence and frequency of a variety of self-reported offenses, including violent and non-violent crimes, drug use and intimate partner violence. Furthermore, the study reveals that while victimization increases the prevalence of offending for victims of varying backgrounds, the frequency of offending is moderated by family income, area of residence, and family structure. Implications for prevention are discussed.

Gender Similarities and Differences in the Association Between Risk and Protective Factors and Self-Reported Serious Delinquency

Boys consistently report higher rates of serious offending during late adolescence than do girls, yet research is mixed regarding the ways in which males and females may differentially experience risk and protection in their families, schools, peer groups, and as individuals. This article examines gender differences in 22 psychosocial risk and protective factors associated with serious delinquency. Based on self-reported information from 7,829 10th-grade students completing the Communities That Care Youth Survey, all psychosocial factors were significantly related to serious delinquency for both sexes. For 12 of the 22 factors, the strength of the association was significantly greater for males, and, for 18 factors, boys reported higher levels of risk exposure and lower levels of protection than did girls. Together, these findings suggest that boys’ greater involvement in serious delinquency is due to the combination of experiencing more risk and less protection than girls and the greater association of these predictors with serious delinquency for boys compared to girls. Implications for prevention programming are discussed.

Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity

BackgroundWidespread replication of effective prevention programs is unlikely to affect the incidence of adolescent delinquency, violent crime, and substance use until the quality of implementation of these programs by community-based organizations can be assured.MethodsThis paper presents the results of a process evaluation employing qualitative and quantitative methods to assess the extent to which 432 schools in 105 sites implemented the LifeSkills Training (LST) drug prevention program with fidelity. Regression analysis was used to examine factors influencing four dimensions of fidelity: adherence, dosage, quality of delivery, and student responsiveness.ResultsAlthough most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants (i.e., site coordinators, principals, and LST teachers), ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Across sites, 86% of program objectives and activities required in the three-year curriculum were delivered to students. Moreover, teachers were observed using all four recommended teaching practices, and 71% of instructors taught all the required LST lessons. Multivariate analyses found that highly rated LST program characteristics and better student behavior were significantly related to a greater proportion of material taught by teachers (adherence). Instructors who rated the LST program characteristics as ideal were more likely to teach all lessons (dosage). Student behavior and use of interactive teaching techniques (quality of delivery) were positively related. No variables were related to student participation (student responsiveness).ConclusionAlthough difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that organizations should consider to ensure fidelity, such as selecting programs with features that minimize complexity while maximizing flexibility. Time constraints in the classroom should be considered when choosing a program. Student behavior also influences program delivery, so schools should train teachers in the use of classroom management skills. This project involved comprehensive program monitoring and technical assistance that likely facilitated the identification and resolution of problems and contributed to the overall high quality of implementation. Schools should recognize the importance of training and technical assistance to ensure quality program delivery.

Early Risk Factors for Adolescent Antisocial Behaviour: An Australian Longitudinal Study:

Objective: This investigation utilizes data from an Australian longitudinal study to identify early risk factors for adolescent antisocial behaviour. Method: Analyses are based on data from the Mater University Study of Pregnancy, an ongoing longitudinal investigation of womens and childrens health and development involving over 8000 participants. Five types of risk factors (child characteristics, perinatal factors, maternal/familial characteristics, maternal pre- and post-natal substance use and parenting practices) were included in analyses and were based on maternal reports, child assessments and medical records. Adolescent antisocial behaviour was measured when children were 14 years old, using the delinquency subscale of the Child Behaviour Checklist. Results: Based on a series of logistic regression models, significant risk factors for adolescent antisocial behaviour included childrens prior problem behaviour (i.e. aggression and attention/restlessness problems at age 5 years) and marital instability, which doubled or tripled the odds of antisocial behaviour. Perinatal factors, maternal substance use, and parenting practices were relatively poor predictors of antisocial behaviour. Conclusions: Few studies have assessed early predictors of antisocial behaviour in Australia and the current results can be used to inform prevention programs that target risk factors likely to lead to problem outcomes for Australian youth.

Implementing effective community-based prevention programs in the community youth development study

There is mixed evidence regarding the extent to which communities can replicate science-based substance use and delinquency prevention programs with high implementation fidelity, that is, in close adherence to the theoretical rationale and specifications of the program. This article examines implementation of 16 tested and effective preventive interventions replicated during 2004—2006 by 12 communities participating in the Community Youth Development Study. Results revealed that across all programs the majority of required material, core components, and lessons were delivered; implementers were prepared, enthusiastic, and used a variety of teaching practices to convey material; and high levels of engagement by program participants were observed. The results indicate that, using a comprehensive system to proactively monitor implementation, community coalitions can ensure high-quality replication of effective prevention programs.

THE CYCLE OF VIOLENCE IN CONTEXT: EXPLORING THE MODERATING ROLES OF NEIGHBORHOOD DISADVANTAGE AND CULTURAL NORMS

Although the cycle of violence theory has received empirical support (Widom, 1989a, 1989b), in reality, not all victims of child physical abuse become involved in violence. Therefore, little is known regarding factors that may moderate the relationship between abuse and subsequent violence, particularly contextual circumstances. The current investigation used longitudinal data from 1,372 youth living in 79 neighborhoods who participated in the Project on Human Development in Chicago Neighborhoods (PHDCN), and it employed a multivariate, multilevel Rasch model to explore the degree to which neighborhood disadvantage and cultural norms attenuate or strengthen the abuse-violence relationship. The results indicate that the effect of child physical abuse on violence was weaker in more disadvantaged communities. Neighborhood cultural norms regarding tolerance for youth delinquency and fighting among family and friends did not moderate the child abuse-violence relationship, but each had a direct effect on violence, such that residence in neighborhoods more tolerant of delinquency and fighting increased the propensity for violence. These results suggest that the cycle of violence may be contextualized by neighborhood structural and cultural conditions.

The Gender Cycle of Violence: Comparing the Effects of Child Abuse and Neglect on Criminal Offending for Males and Females

Despite ample evidence of the relationship between childhood maltreatment and offending, the ways in which the cycle of violence operates remain unclear. For example, feminist researchers contend that female victims are more likely to become offenders, compared to male victims, but more research is needed to substantiate this claim. Moreover, the contradictions in research findings-with retrospective research demonstrating that most offenders have histories of abuse, and prospective work indicating that the majority of victims do not become involved in crime-highlight the importance of identifying the intermediating variables that lead from maltreatment to criminality. This review summarizes investigations related to the cycle of violence, discusses the intermediating circumstances that may affect the cycle, and identifies whether or not these processes are similar for women and men.