Andria B. Eisman

Adolescent Resilience: Promotive Factors That Inform Prevention

Resilience theory provides a framework for studying and understanding how some youths overcome risk exposure and guides the development of interventions for prevention using a strengths-based approach. In this article, we describe basic concepts of the theory, such as promotive factors, and distinguish assets and resources that help youths overcome the negative effects of risk exposure. We also present three models of resilience theory-compensatory, protective, and challenge-and review empirical research on three promotive factors-ethnic identity, social support, and prosocial involvement-that include individual, family, and community levels of analysis and have modifiable qualities for informing interventions. Finally, we present examples of how research findings from the three promotive factors can be translated into interventions to enhance youth development.

Depressive symptoms, social support, and violence exposure among urban youth: a longitudinal study of resilience

Depression is a serious mental health concern among adolescents. Violence exposure is a potent risk factor for depression. Social support may help reduce depression risk, even when adolescents are exposed to violence. Using a compensatory model of resilience, we investigate the influence of violence exposure and social support on depression over time in a sample of urban youth during the high school years (N = 824, 52% female, mean age Year 1 = 14.9). We used growth curve modeling to examine depressive symptoms across adolescence and its association with violence exposure and social support, accounting for important sociodemographic characteristics (sex, socioeconomic status, and race/ethnicity). Depressive symptoms on average increase from Year 1 to 2 of high school and then are stable or decline from Years 2 to 4. Violence observation and conflict in the family were each associated with increased depressive symptoms during the high school years. Mother support was associated with decreased depressive symptoms over time. Our results support a compensatory model of resilience. Promoting positive parent-child communication among urban youth living in disadvantaged contexts may help reduce the probability that exposure to violence will result in depressive symptoms.

Youth Empowerment Solutions: Evaluation of an After-School Program to Engage Middle School Students in Community Change:

We report on an effectiveness evaluation of the Youth Empowerment Solutions (YES) program. YES applies empowerment theory to an after-school program for middle school students. YES is an active learning curriculum designed to help youth gain confidence in themselves, think critically about their community, and work with adults to create positive community change. We employed a modified randomized control group design to test the hypothesis that the curriculum would enhance youth empowerment, increase positive developmental outcomes, and decrease problem behaviors. Our sample included 367 youth from 13 urban and suburban middle schools. Controlling for demographic characteristics and pretest outcome measures, we found that youth who received more components of the curriculum reported more psychological empowerment and prosocial outcomes and less antisocial outcomes than youth who received fewer of the intervention components. The results support both empowerment theory and program effectiveness.

Trajectories of organized activity participation among urban adolescents: Associations with young adult outcomes

Organized activity participation provides opportunities for adolescents to develop assets that may support favorable outcomes in young adulthood. Activity participation may be especially beneficial for marginalized youth as they are likely to face stressors that increase risk of negative outcomes. We used growth mixture modeling (GMM) to identify activity participation trajectories among African American adolescents in an urban, disadvantaged community (Wave 1: mean age=14.86 years, SD=0.64; 49% male, N=681). We also investigated if young adult outcomes differed by trajectory subgroups. Our results suggested a three-class model best fit the data: low, decreasing (74%), moderate, consistent (21%) and moderate, increasing participation subgroups (5%). Adolescents in the increasing subgroup reported higher life satisfaction and lower substance use in young adulthood compared to the decreasing subgroup. Youth who increase participation in activities over time may experience greater opportunities for building assets related to positive development that support health and well-being into young adulthood.

Exposure to violence during adolescence as a predictor of perceived stress trajectories in emerging adulthood

Early exposure to violence during adolescence is related to negative psycho-social outcomes later in life. In the present study, we examined the influence of cumulative exposure to violence during adolescence and trajectories of perceived stress in emerging adulthood in a sample of at-risk urban youth (N = 850; 80.1% African American; 50% female). Growth curve modeling indicated an overall decrease in reported stress as individuals aged. Baseline levels of violence exposure (Mage = 14.9) were associated with higher perceived stress levels in emerging adulthood (Mage = 20.1), but also slightly more negative perceived stress slopes from adolescence into emerging adulthood (Mage = 15.9-22.1). Individuals reporting increased violence exposure over time during adolescence also reported higher perceived stress levels in emerging adulthood (Mage = 20.1). Associations held after controlling for demographics and baseline functioning variables. The results suggest that violence exposure may disrupt normative adaptation to daily stressors in emerging adulthood.

Effects of a brief ED-based alcohol and violence intervention on depressive symptoms

OBJECTIVE Depressive symptoms frequently co-exist in adolescents with alcohol use and peer violence. This papers purpose was to examine the secondary effects of a brief alcohol-and-violence-focused ED intervention on depressive symptoms. METHOD Adolescents (ages 14-18) presenting to an ED for any reason, reporting past year alcohol use and aggression, were enrolled in a randomized control trial (control, therapist-delivered brief intervention [TBI], or computer-delivered brief intervention [CBI]). Depressive symptoms were measured at baseline, 3, 6, and 12months using a modified 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Poisson regression was used (adjusting for baseline age, gender, and depressive symptoms) to compare depressive symptoms at follow-up. RESULTS Among 659 participants, higher baseline depressive symptoms, female gender, and age≥16 were associated with higher depressive symptoms over time. At 3months, CBI and TBI groups had significantly lower CESD-10 scores than the control group; at 6months, intervention and control groups did not differ; at 12months, only CBI had a significantly lower CESD-10 score than control. CONCLUSIONS A single-session brief ED-based intervention focused on alcohol use and violence also reduces depressive symptoms among at-risk youth. Findings also point to the potential efficacy of using technology in future depression interventions.

Measuring the Implementation of Youth Empowerment Solutions.

Scholars have increasingly emphasized the importance of using evidence-based programs to promote health and prevent disease. While theoretically and empirically based programs may be effective in carefully controlled conditions, many fail to achieve desired outcomes when implemented in real-world settings. Ensuring high-quality implementation of health promotion programs is critically important as variation in implementation is closely associated with program effectiveness. The purpose of this article is to present methods used to document and assess the implementation of the Youth Empowerment Solutions (YES) program. We collected process evaluation data on 25 YES groups from 12 schools over a period of 4 years. The evaluation assessed four key aspects of delivery: fidelity, dose delivered, dose received, and program quality. We found wide variations in delivery for some measures, while others were more consistent across groups. These indicators of program delivery provided a strong basis for evaluating program implementation, taking actions to improve it, and ultimately, deepening understanding of program effectiveness. The study suggests a model for using multiple methods to collect and analyze data about aspects of program delivery to guide future implementations.

Organized Activity Participation and Relational Aggression: The Role of Positive Youth Development

Relational aggression among early adolescents is a pervasive problem that negatively influences the health and well-being of youth. Strength-based approaches such as positive youth development (PYD) are a promising way to reduce risk of detrimental outcomes such as relational aggression. Participation in organized activities is a key way that youth build assets related to PYD. Yet, few researchers have examined empirically assets related to PYD as a mechanism by which organized activity participation may help reduce risk of relational aggression. In this study, we used structural equation modeling to investigate if assets associated with PYD mediate the relationship between organized activity participation and relational aggression using survey data from a diverse, school-based sample of early adolescents (N = 196; mean age = 12.39 years; SD = 0.52; 60% female; 45% African American, 27% White, 21% multiracial, and 7% other, 71% economically disadvantaged). We tested 2 competing models, 1 with decomposed PYD factors and 1 with an integrated PYD factor. Our results suggest that PYD better fit as an integrated versus decomposed construct, providing support for the notion that youth benefit most from assets related to PYD when they operate collectively. Our results also provide support for PYD-related factors as a mechanism by which participation may reduce risk of relational aggression. Limitations of this study, and implications for prevention are discussed.

Emergency Department Alcohol Intervention: Effects on Dating Violence and Depression

A technology-assisted ED BI with effects in reducing underage drinking also shows promise for reducing secondary outcomes such as mental health symptoms and dating violence. OBJECTIVES: With this study, we examined secondary outcomes of an emergency department (ED)–based brief intervention (BI) on dating violence perpetration and victimization and depression symptoms over 3, 6, and 12 months. METHODS: ED patients (14–20 years) were screened for risk drinking. Patients who received positive screen results were randomly assigned to a computer BI (n = 277), therapist BI (n = 278), or control condition (n = 281). After the 3-month assessment, participants were randomly assigned to receive the post-ED BI or control condition. BIs were used to address alcohol consumption and consequences (eg, dating violence and depression symptoms) by using motivational interviewing. RESULTS: A total of 836 patients were enrolled in the randomized controlled trial of 4389 patients screened and 1054 who reported risky drinking. Regression models were used to examine longitudinal effects of the alcohol BI on dating violence perpetration, dating violence victimization, and depression symptoms. The therapist BI resulted in a significant reduction of dating violence perpetration up to 12 months (incidence rate ratio [IRR] = 0.53; 95% confidence interval [CI]: 0.37–0.77) and depression symptoms up to 3 months (IRR = 0.85; 95% CI: 0.72–1.00) after the intervention. Computer BI resulted in a reduction of dating violence perpetration (IRR = 0.52; 95% CI: 0.35–0.76) and depression symptoms (IRR = 0.78; 95% CI: 0.66–0.94) 6 months postintervention. Post-ED BIs were associated with lower perpetration at 12 months and lower victimization at 6 and 12 months, irrespective of BI intervention randomization at baseline; however, they did not affect depression symptoms. CONCLUSIONS: A single-session ED BI revealed previously to show promise in reducing underage drinking also demonstrates promise in preventing dating violence perpetration and depression symptoms. These technology-enhanced BIs could be particularly helpful given the potential for more efficient resource usage and ease of future implementation.

More Than Just Keeping Busy: The Protective Effects of Organized Activity Participation on Violence and Substance Use Among Urban Youth

Violence and substance use disproportionately affect African American youth in urban, disadvantaged communities. Expanding positive peer and adult connections is a mechanism by which organized activity participation may reduce risk of negative outcomes. We assessed if organized activity participation decreases the likelihood of later negative outcomes through expanding positive social connections using a parallel mediation model (Wave 1: N = 681; 50% female; Mage = 14.86 years; SD = 0.65). We found indirect effects from participation to cigarette use (b = −0.04, 95% CI: −0.07, −0.01) and violent behavior (b = −0.04; 95% CI: −0.07, −0.01) through positive peer connections. We did not find indirect effects through positive adult connections. This may be because of the notable influence of peers on negative outcomes during adolescence. Organized activities can help youth expand positive peer connections, which, in turn, reduces risk of later negative outcomes. Implications for prevention are discussed.