Murray L. Vincent

Aggression, Substance Use, and Suicidal Behaviors in High School Students.

OBJECTIVES We sought to analyze the frequency and correlates of suicidal behaviors in a community sample of adolescents. METHODS Information concerning suicidal thoughts and acts, aggressive behaviors, substance use and physical recklessness were collected with the 70-item self-report Youth Risk Behavior Survey from a statewide sample of 3764 South Carolina public high school students. RESULTS Seventy-five percent of students reported no suicidal behaviors, 11% reported serious suicidal thoughts, 6.4% reported specific suicidal plans, 5.9% reported attempts not requiring medical care, and 1.6% reported attempts requiring medical care. All types of suicidal behaviors occurred more frequently in females than males. Odds ratios for aggressive behaviors and cigarette use were elevated across all categories of suicide behaviors, increasing in magnitude with severity of reported suicidal behavior. Substance use was associated with some but not all categories of suicidal behaviors. The relationships were most pronounced with the use of potentially more dangerous drugs. CONCLUSIONS The results suggest that suicidal behaviors are not infrequent occurrences among adolescents and that they often coexist with other high-risk behaviors. Interventions designed to reduce suicidal behaviors should simultaneously address coexisting high-risk behaviors.

Correlates of aggressive and violent behaviors among public high school adolescents

PURPOSE This study analyzed the types and predictors of violent behaviors reported by 4,137 South Carolina adolescents, grades nine through twelve. METHODS The 70 item self-report Youth Risk Behavior Survey developed and piloted by the Centers for Disease Control and Prevention was utilized in 57 of the states public high schools. A series of logistic regression analyses were performed for each race/gender group to explore the relation of the demographic and potential risk variables to fighting and carrying weapons. RESULTS Results indicate that 38 percent of males and 11 percent of females reported carrying a weapon. Eleven percent of males and five percent of females reported fights resulting in an injury. The strongest predictors of fighting were binge drinking and sexual activity for males, any alcohol use and illegal drug use for white females, and sexual activity for black females. For carrying a weapon, the strongest predictors included alcohol use and sexual activity in all but white females, and illegal drug use among whites, but not blacks. CONCLUSION Prevention of adolescent violence calls for creative approaches in school and community settings and will require long-term intervention strategies, focused on adolescent behavior change and environmental modifications.

Adolescent risk behaviors and the potential for violence: a look at what's coming to campus.

This study analyzed the types and predictors of violent behaviors reported by students in Grades 11 and 12 in South Carolina. Results are based upon responses of 2,299 students from 57 schools, approximately 3% of the total state enrollment in those grades. The 70-item self-report Youth Risk Behavior Survey developed and piloted by the Federal Centers for Disease Control was used to collect data. The authors performed a series of logistic regression analyses to explore the relation of the demographic and potential risk variables to fighting and carrying weapons. Results from the simple logistic analyses, adjusting for race and gender, indicated that alcohol use, binge drinking, sexual activity, and use of any drugs were significantly associated (p < .05) with reported fighting. These variables and poor academic self-image were significantly associated with carrying weapons. Comprehensive multivariable models indicated that, when considered simultaneously, being black, male, sexually active, and engaging in binge drinking and drug use were significant predictors of fighting. Gender, but not race, alcohol use, drug use, or sexual activity, remained a significant predictor of carrying a weapon. Findings suggest that college risk-reduction and health-promotion programs should direct efforts at environmental modification, policy development and enforcement, as well as at personal change, including effective conflict resolution, stress management, and communication skills.

Reducing Adolescent Pregnancy Through A School- and Community-Based Intervention: Denmark, South Carolina, Revisited

A 1987 article by Vincent Clearie and Schluchter in the Journal of the American Medical Association documented declines in estimated pregnancy rates among adolescents in Denmark South Carolina site of a pregnancy prevention program. The School/Community Program for Sexual Risk Reduction Among Teens was launched in the early 1980s as an intensive school- and community-based intervention which included graduate-level sexuality education courses for school teachers; workshops for parents clergy and community leaders; programs which trained students to serve as peer counselors; and media campaigns. During the same period adolescent pregnancy rates increased in three comparison counties which did not receive program services. This reported success naturally drew widespread interest from other communities looking to accomplish the same goal. The intense interest from outside of Denmark prompted the authors to reexamine the decline in pregnancy rates in the area and investigate all plausible alternative explanations for the decrease. They found that concurrently with the operation of the Denmark program a school nurse counseled male and female students likely to initiate sexual intercourse to avoid doing so and provided students who were already sexually active with contraceptive counseling services and supplies. Activities of the nurse are therefore considered components of the overall prevention intervention in Denmark. Comparison areas were better matched and the time period covered extended to confirm that the adolescent pregnancy rate in the intervention area significantly decreased from an annual average of 77 pregnancies per 1000 women aged 14-17 during the preprogram period of 1981-82 to 37/1000 after the intervention in 1984-86. The reanalysis also however indicates that the pregnancy rate returned to 66/1000 in 1987-88 after the discontinuation of important program components and related nonprogram services. In particular adolescents younger than 16 years old required parental approval to receive contraceptive services from August 1985. Moreover a state legislator banned the provision of contraceptive services and condoms to youths at the Teen Life Center adjacent to the high school in April 1987. From then through 1988 the county health department clinic nine miles away and inaccessible by public transportation was the only family planning clinic. The school nurse resigned November 1988 while the program overall lost momentum.

Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities

CONTEXT A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy. METHODS A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. RESULTS There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community. CONCLUSIONS This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions.

Predicting adolescent risk behaviors based on an ecological framework and assets.

OBJECTIVES To examine the relationship between an aggregate risk score (smoking, drinking, and number of sex partners) and measures of youth assets in a sample of 3439 youth aged 14-18 years. METHODS Linear regression models for African American and white males and females predicted an aggregate risk score. RESULTS After adjustments, the youth asset most predictive of risk was self/peer values regarding risk behaviors. Perceived school support was also predictive. CONCLUSIONS Taking an ecological approach to the measurement of adolescent health behaviors contributes to our understanding of these risk behaviors.

Correlates of sexual abstinence among urban university students in the Philippines.

A questionnaire administered to 1295 students in introductory sociology classes at two large universities in metropolitan Manila the Philippines in 1995 confirmed the persistence of traditional values regarding premarital sex among Filipino youth. 72% of students were 18 years of age or younger. 82.9% of respondents (70.4% of males and 92.6% of females) reported they were sexually abstinent. Of those who were sexually active 52% had begun having sexual intercourse by age 16 years. 88% of respondents demonstrated adequate knowledge of AIDS and 74% were adequately informed about pregnancy risk. 52% had acceptable knowledge about contraception but only 20% were informed about condom use. The most commonly cited reasons for remaining abstinent were: wanting to wait until one is older or married religious values and concern about the risk of pregnancy or disease. Sexually abstinent students were more likely than their sexually active counterparts to attend church regularly to regard premarital sex as unacceptable and to come from low-income families. Growing exposure as a result of modernization and urbanization to messages that conflict with traditional values threatens to increase premarital sexual activity among Filipino youth unless interventions are designed to promote protective social norms and emphasize decision-making skills.

Replicating a community initiative for preventing adolescent pregnancy: from South Carolina to Kansas.

The School/Community Sexual Risk Reduction Model is a comprehensive community-wide strategy for preventing adolescent pregnancy. It was first implemented in two communities in South Carolina. This paper describes the models replication in several communities in Kansas. The School/Community Models history major program components evaluation results and the conceptual framework for the Kansas replication are described. The authors then consider the School/Community Sexual Risk Reduction Replication Initiative including the collaborators early implementation strategies for grantmaking contexts and sites technical assistance and evaluation and reinvention of the model. A discussion of the challenges and opportunities of replicating broad-scale community initiatives for preventing adolescent pregnancy concludes the paper.

Replication of a community-based multicomponent teen pregnancy prevention model: Realities and challenges

Health education curricula and the delivery of specific health services have been evaluated as to their replicability in other settings. Formal studies to evaluate replication of multicomponent community-based program models are scarce. Moreover the literature does not address the challenges in implementing complex program models and documenting replication. This article describes an initiative to transport and replicate the School/Community Sexual Risk Reduction Model created in South Carolina in three Kansas communities over a 4-year period. Objective and subjective assessments of achieving fidelity to the model core components were determined as was a description of factors that enhance or inhibit replication efforts. Assessing replication will be improved when detailed monitoring and process evaluation is in place in the development of the original program and in the replication effort. (authors)

The Program Plan Index: an evaluation tool for assessing the quality of adolescent pregnancy prevention program plans.

To assess process, impacts, and outcomes among 45 distinct county teen pregnancy prevention initiatives, several standardized data collection procedures, instruments, and protocols were developed including the Program Plan Index (PPI). The PPI was developed to determine if program plans met legislative requirements and were consistent with best practices in public health program planning and teen pregnancy prevention. Analysis of proposals from 45 counties revealed that 12 county plans were evaluated as deficient, 14 as low, 14 as acceptable, 4 as good, and 1 as excellent. Explanations for overall performance included the following: criteria used to develop the PPI based on an in-depth understanding of best practices, variations in the criteria for county request for proposals, lack of prevention expertise at the local level, and minimal time for grantees to draw down funds. Statewide efforts to improve funded community-based teen pregnancy prevention planning, implementation, and empowerment evaluation efforts are ongoing.