Elizabeth W. Edmundson

Using Process Data To Explain Outcomes An Illustration From the Child and Adolescent Trial for Cardiovascular Health (CATCH)

The purpose of this article is to illustrate the use of process evaluation for understanding study outcomes. Data from the Child and Adolescent Trial for Cardiovascular Health (CATCH), a large school-based field trial, are used. Teacher characteristics, measures of classroom curriculum implementation, and competing influences are linked to changes in dietary knowledge, intentions, and self-efficacy of students in the intervention schools. Multiple regression analyses indicate that teacher charactenstics did not predict program implementation. Teacher characteristics and program fidelity, or the number of modifications made to the classroom curriculum during implementation, had direct and independent effects on student outcomes.

The effects of the child and adolescent trial for cardiovascular health intervention on psychosocial determinants of cardiovascular disease risk behavior among third-grade students.

Purpose. The Child and Adolescent Trial for Cardiovascular Health is a multi-site study of a school-based intervention designed to reduce or prevent the development of risk factors for cardiovascular disease. The goal was to change (or prevent) related risk behaviors and the psychosocial variables that theoretically influence those behaviors. Design. A nested design was used in which schools served as the primary unit of analysis. Twenty-four schools participated at each of four sites (Austin, San Diego, Minneapolis, and New Orleans). Each site had 10 control and 14 intervention schools. Setting and Subject. Ninety-six schools (with more than 6000 students) in the four sites were randomized to three treatment conditions: control, school-based interventions, and school-plus-family interventions. The sample included approximately equal numbers of males and females and was 67.5% white, 13.9% African-American, 13.9% Hispanic, and 4.7% other. Measures. The psychosocial determinants measured included improvements in dietary knowledge, intentions, self-efficacy, usual behavior, perceived social reinforcement for healthy food choices, and perceived reinforcement and self-efficacy for physical activity. Results. The findings indicated significant improvements in all the psychosocial determinants measured (p < .0001). The results revealed a greater impact in the school-plus-family intervention schools for two determinants, usual dietary behavior and intentions to eat heart-healthy foods. Conclusions. These findings support theory-based interventions for changing selected psychosocial determinants of cardiovascular disease risk behavior among children.

Female adolescents and onset of sexual intercourse: a theory-based review of research from 1984 to 1994.

PURPOSE To review a decade of research on the correlates of early onset of sexual intercourse among female adolescents in the United States, using Social Cognitive Theory as a framework for classification. METHODS Forty-nine studies published in peer-reviewed journals between 1984 and 1994 were reviewed and their findings coded by two independent coders. RESULTS Findings indicate that most of the studies emphasized quantitative methodologies, using cross-sectional designs and univariate statistical analyses. Many studies lacked a theoretical framework or conceptual model to guide their investigations. When evaluating empirical findings, 61% of the studies found environmental correlates and 47% found biological factors (e.g., age and pubertal development) to be significantly associated with early initiation of sexual intercourse. CONCLUSION These findings raise important questions about the quality of research on adolescent sexuality, as well as its relationship to the development of risk-reduction programs which tend to focus mainly on intrapersonal factors (such as attitudes, knowledge, and expectancies.

CATCH: classroom process evaluation in a multicenter trial.

The purpose of this paper is to describe the process evaluation model for the classroom curricula of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Project. The process evaluation plan specifically targets how much each curriculum was implemented, to what degree it was implemented as designed, and the barriers to implementation. Additionally, the rationale for each of the process evaluation measures and the instrument development process are presented. Data resulting from these measures will be essential in order to answer questions regarding the internal validity of the main outcomes of the project. Specific examples and sample results are provided from the CATCH third-grade classroom curriculum, which was implemented the first year of CATCH. A discussion also is presented of how the findings from a sample of these measures were used to gain additional insight on the salient features of the curriculum, and how those features may be related to student outcomes.

Personal and Social Motivations as Predictors of Substance Use among College Students

The Drug Use Survey was administered via a direct mail to a simple random sample of 2200 students enrolled at a large southwestern U.S. university. A purpose of the study was to determine the predictability of self-reported drug use utilizing motivations (personal and social) commonly reported by substance users. Two subscales were developed, one for each category of motivations. Reliability for each subscale as estimated by coefficient alpha was .80 and .86, respectively. A series of step-wise multiple regression analyses were computed in which individual drug use indices served as criterion variables, while the predictor variables were the personal motivations subscale (PMS) and the social motivation subscale (SMS) for each model. The results indicated that the PMS was the stronger predictor in every model with the exception of the model that predicted the alcohol use index. The SMS was the best predictor for alcohol use.

Implications of Smokeless Tobacco Use Among Athletes.

In brief: This literature review delineates the current status of smokeless tobacco. It discusses the prevalence and terminology as well as periodontal effects, buccal mucosal and soft-tissue alterations, leukoplakia, cancer, carcinogenic components, hemodynamic alterations, and potential addiction. It is clear that physicians and dentists should discourage their patients from using smokeless tobacco. Young people particularly may be influenced by popular sports figures and celebrities who convey the erroneous impression that smokeless tobacco is harmless.

Bimodal initiation of smokeless tobacco usage: Implications for cancer education

One hundred fifty (150) randomly chosen adult male subjects (average age 37) drawn from a university general dental clinic were classified by self-report into three equal categories of fifty smokeless tobacco users, fifty cigarette smokers (non-smokeless tobacco users), and fifty non-tobacco users. According to questionnaire results, a bimodal curve was exhibited among smokeless tobacco users with the two peaks of initiation at ages 12 and 18 compared to a unimodal age of initiation for cigarette smokers at age 16. Two different cohorts of smokeless tobacco users based on age of initiation were observed with differences reported in level of education, urban versus rural origin, average length of time in using smokeless tobacco, and the type of smokeless tobacco product used. Young initiators appeared to be primarily from rural communities having a strong parental or familial influence when initiating smokeless tobacco usage, whereas older initiators appeared to be primarily from more urbanized regions with peer influences as the most significant for initiating smokeless tobacco usage. Other characteristics associated with one or the other cohort were also reported, pointing to different educational measures that may be necessary for prevention and intervention, based on the age of initiating smokeless tobacco usage, as well as place of residence.

Implications for the Alcohol/Drug Education Specialist Working with Children of Alcoholics: A Review of the Literature from 1988 to 1992

This article reviews the scientific literature on children of alcoholics (COAs) from 1988 to 1992. First the publications were divided into two classifications: practitioner-oriented and research-oriented literature. Each practitioner-oriented article was evaluated on the following criteria: program description, theoretical model, recommendations substantiated by research, behavioral indicators of COAs, suggestions for intervening, and resource lists. For each of the research-oriented articles, the variables measured, sample source, sample size, and number of COAs in the sample are listed. Additionally, those articles are evaluated for research design, instruments, and analytical techniques. Reviews of early research in this area identified severe methodological limitations across the majority of articles. However, results of this more recent review indicate that research on COAs no longer suffers from previously common methodological weaknesses and sampling biases. The research-based literature also indicated that a large number of COAs are resilient, which calls into question common assumptions about the inevitable negative effects of familial alcoholism. Alcohol/drug education specialists need to be cognizant of the more recent results on non-clinical samples of COAs in designing and implementing sensitive programs.

Personality Traits of Smokeless Tobacco Users and Nonusers: A Comparison

This study investigated the personality characteristics of male university students who were either users or nonusers of smokeless tobacco. The hypotheses attempted to determine any differences in personality characteristics between users and nonusers of smokeless tobacco, and examine differences in personality characteristics according to the amount of smokeless tobacco used. A university sample of 289 males revealed 19% (55) prevalence of smokeless tobacco users. Each subject was administered Cattells Sixteen Personality Factor Questionnaire and a demographic questionnaire. An analysis of variance revealed that smokeless tobacco users exhibited significant differences (p less than .01) in both personality characteristic A (more reserved, less outgoing socially) and personality characteristic I (self-reliant, less sentimental), and significant difference (p less than .05) in personality characteristic Q2 (more conforming, group dependent). No significant differences were noted in personality among persons who used varying amounts of smokeless tobacco.

Discerning the Epidemiology of Drug Use among a Sample of College Students.

Although estimates concerning the prevalence of various forms of substance abuse vary considerably, it is critical to note that even the more conservative estimates indicate a major public health problem. Furthermore, increased drug experimentation has been frequently associated with the college experience. Utilizing a slightly modified version of the National Institute on Drug Abuse (NIDA) Monitoring the Future Survey, the present study examined the epidemiology of self-reported drug taking behaviors (e.g., alcohol, marijuana, tranquilizers, stimulants, psychedelics, etc.) among a sample (n = 683) of students attending a major public university. Data analyses focused on the specific settings and social groupings in which drug use occurred as well as on the frequency and type(s) of drug taking behaviors. Based on the results yielded from a disjoint cluster analysis, four distinct groups of drug users were identified. These four groups then served as categories of the dependent variable in a discriminant function analysis. A general linear models procedure was employed to identify the more efficacious discriminating (i.e., independent) variables.