Post on 12-Jan-2016
description
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:Positive Youth Development:The 4 C’sThe 4 C’s
• Connectedness (bonding)Connectedness (bonding)
• Competence (social, cognitive, behavioral, Competence (social, cognitive, behavioral, emotional, moral)emotional, moral)
• Confidence (self efficacy, self Confidence (self efficacy, self determination, belief in the future, clear & determination, belief in the future, clear & positive identity)positive identity)
• Character (prosocial norms, spirituality)Character (prosocial norms, spirituality)
Source: Catalano et al 1998, Pittman 1993
3
Note: Some of these theories cross cells, particularly the sociological theories. Some explicitly integrative theories cross many cells (e.g., Brooks, Elliott, Jessor).
LEVEL OF TYPES OF INFLUENCE
INFLUENCE INTRAPERSONAL SOCIAL SITUATION/ INTERPERSONAL
ENVIRONMENTAL/ ATTITUDINAL
ULTIMATE Biological theories Psychoanalytic theories Resilience (Garmazey) Personality theories Self-Control (Gottfredson & Hirschi)
Social Control (Elliott) Family Systems (Brooks) Peer Clustering (Oetting)
Class Conflict Low SES Anomie Social Disorganization Strain Theory (Merton) Radical Theories
DISTAL Personal competence Self-Esteem theories Self-Derogation (Kaplan) Personal control theories
Social attachment/ bonding Social Development (Hawkins) Differential Association Social Learning (Akers, Bandura)
(General knowledge) Cultural Identity Values theories Motivation theories
PROXIMAL Social skills Self regulation/ control Self-efficacy (Bandura)
Social Norms theories Conformity theories
Expectancy theories Attitude theories
Fishbein & Ajzen (TRA); Ajzen (TPB)
Feedback Systems Theories
Theoretical Orientation: A Matrix of Theories
4
BEHAVIOR
Intentions/Decision
Environment
Attitudes TowardBehavior
Social Normative Beliefs
IntraPersonal
Self-Efficacy
Social Situation
ENVIRONMENT
GENETICS
The Theory of Triadic Influence
5
DECISIONS/INTENTIONS
SOCIAL SITUATION
Values/Evaluations
Knowledge/Expectancies
BIOLOGY/PERSONALITY
THE THEORY OF TRIADIC INFLUENCE
ATTITUDESTOWARD THE
BEHAVIOR
PerceivedNorms
Information/Opportunities
InterpersonalBonding
SocialCompetence
CULTURALENVIRONMENT
SOCIALNORMATIVE
BELIEFS
Interactions w/Social Instit’s
Others’Beh & Atts
Motivationto Comply
Skills:Social+General
Trial Behavior
Related Behaviors
Sense ofSelf/Control
EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological
SelfDetermination
SELF-EFFICACYBEHAVIORAL
CONTROL
Nurture/CulturalBiological/Nature
1 2 3
7 8 9 10 11 12
13 14 15 16 17 18
19 20 21
22
23
g h i
jk
l m no
p q r
CF
IB E H
J
K
Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream
s
t u v w
x
a
b c d e
f4 5 6
A D G
DistalPredisposingInfluences
ProximalImmediatePredictors
Levels ofCausation
UltimateUnderlyingCauses
Social/Personal Nexus
Expectancies & Evaluations
Affect andCognitions
Decisions
Experiences
Notes: 1. affective and cognitive substreams2. feedback loops3. Interactions between streams
6
DECISIONS/INTENTIONS
SOCIAL SITUATION
Values/Evaluations
Knowledge/Expectancies
BIOLOGY/PERSONALITY
THE THEORY OF TRIADIC INFLUENCE
ATTITUDESTOWARD THE
BEHAVIOR
PerceivedNorms
Information/Opportunities
InterpersonalBonding
SocialCompetence
CULTURALENVIRONMENT
SOCIALNORMATIVE
BELIEFS
Interactions w/Social Instit’s
Others’Beh & Atts
Motivationto Comply
Skills:Social+General
Trial Behavior
Related Behaviors
DistalInfluences
ProximalPredictors
Levels ofCausation
UltimateCauses
Sense ofSelf/Control
EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological
SelfDetermination
SELF-EFFICACYBEHAVIORAL
CONTROL
Nurture/CulturalBiological/Nature
1 2 3
7 8 9 10 11 12
13 14 15 16 17 18
19 20 21
22
23
g h i
jk
l m no
p q r
CF
IB E H
J
K
Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream
s
t u v w
x
a
b c d e
f4 5 6
Social/Personal Nexus
Expectancies & Evaluations
Affect andCognitions
Decisions
Experiences
A D G
CHARACTER
CONFIDENCECOMPETENCE CONNECTEDNESS
7
A
single
behavior
Eg,
smoking
Two
closely
related
behaviors.
Eg, smoking
and drinking
Less and
less related
behaviors.
Eg, smoking,
drug abuse,
sex, exercise.
Closely and less related behaviors: Ultimate causes may be the same, distal predictors less so.
E
S P
E
S P
E
SP
E
S P
ES
P
ES
P
E
SP
8
Ecological Theories (Bronfrenbrenner)
9
The TTI Developmental-Ecological System
P PS S
S
E
P
Eval
Behavior
SNB SelfEfficacy
Att Att
Intentions
Will + Skill ExpMc NB
KnowValue SocialBonds
RoleModels
Self-Control
Com-petence
SNB
ValuesEnvironment
KnowledgeEnvironment
ENVIRONMENT
Situation
PersonE E
Affective/Control Substream
s
Cog
nitiv
e/C
ompe
tenc
e S
ubst
ream
s
DEVELOPMENT & TIME
UltimateUnderlyingCauses
Levels ofCausation
DistalPredisposingInfluences
ProximalImmediatePredictors
10
All Behaviors Have Common CausesNationalSocio-
Cultural Environment
Political, Economic,Media, Religious
Values, Attitudes
Local Community,Families, SchoolsRelationships with Others
Others’ Attitudes, Behaviors
Social Normative BeliefsSense of Self,Social Skills
Self-Efficacy
Intrapersonal Biology,
Personality
Low Risk, non-
Problem Behaviors
Nonviolent
Safe Sex
Successful and Happy Citizens
Conventional and Social
Behaviors
Community Bonding
Law Abiding
AchievementNo Drugs
Health
Care
Physical
Healthy Behavior
s
Eating/Diet
ADHD
Conduct Disorder
Mental Health
Anxiety/Depress
11
% Ever had sex by lifetime risk behavior count 1991-2007 (Youth Risk Behavior Survey)
Santelli, et al., J Adolescent Health, 2009
12
Limitations of Behavior-Specific Programs
•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
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
15
ABAN AYA: Male odds of sexual intercourse by condition
0
0.5
1
1.5
2
6 7 8
Grade
Cha
nge
in lo
g od
ds o
f sex
ual i
nter
cour
se
HEC SDC S/C
16
ABAN AYA: Male condom use by condition (logit )
0.0
0.5
1.0
1.5
2.0
6 7 8
Grade
Chan
ge in
logi
t of c
ondo
mus
e
HEC SDC S/C
17
Hypothetical example of differential effects by risk level (a common pattern)
0
1
2
3
4
5
6
T1 T2 T3 T4 T5
Time of measurement
Lev
el o
f b
ehav
ior
Hi Risk Program
Hi Risk Control
Med Risk Program
Med Risk Control
Lo Risk Program
Lo Risk Control
18
Positive Action is a Comprehensive PYD Program
• Multiple Levels:– Classroom curriculum– Teacher training– School-wide climate– Family– Community
• Multiple Domains– Character education– Social & emotional
learning– Prevention program– Academic achievement
• Multiple Outcomes:– School engagement: Attendance, Truancy– Behaviors: Violence, Substance use, Sexual behaviors– School-level indicators: Disciplinary referrals, Suspensions – Achievement: Grades, Standardized test scores
19
You feel good about yourself when you do
positive actions.C.f., Cognitive Behavior Therapy
and Positive Psychology
Basic Philosophy (Theory of Action) of the Positive Action Program & Circle
You feel bad about yourself when you do negative
actions.C.f. Depression
20
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
21
How You
Like To Be
Treated
Feelings Empathy
How to Treat
Others
Conflict Resolution
Communica -tion Skills
Social Context/
Situations
Others’ Behavior
& Approval
Social Bonding/ Attachment
Family School Neighborhood Peers
Others’ Expectations
Desire to Please
Social Normative
Beliefs
INTENTIONS/DECISIONS
BEHAVIORExperiences from
Behavior
Self Concep
t
Health & Drug Info
Thinking Skills Creativity Decision-Making Problem-Solving
Self Managemen
t
Time, Energy, Talents, Money, AngerSocial &
Emotional Health
Socio-Cultural
Environment
Information Environment
General Values
Expected
Consequences
Evaluation of Outcomes
Mass Media Regulations Religion
Economy
Attitudes Toward the
Behavior
IntraPersonal (Individual)
Social Competence
Sense of Self
Social
Skills
Self- Determination
Self-Efficacy
Genetics Biology
Personality
CLASSROOM SCHOOL FAMILY COMMUNITY
Positive Action Program Components and Lessons (Exist in each Component)
Positive Role Models
Values
AlternativeConsequences
Mapping of Positive Action content onto the TTI
22
Hawaii: Lifetime Prevalence of Substance Abuse, Violent Behaviors, & Sexual Activity: 5th grade (no significant interactions)
0
5
10
15
20
25
TobaccoUsage
Alcohol Been Drunk Any IllicitDrug Use
Been High onDrugs
Carried aknife or razorto use to hurt
someone
Threatened tocut or stabsomeone
Cut orstabbed
someone onpurpose tohurt them
Carried a gun Shot atsomeone
Voluntary sexwith someone
of theopposite sex
Lif
etim
e P
reva
len
ce (
%)
Control Positive Action
Substance Abuse Violent Behaviors Sexual Activity
--------------SUBSTANCE ABUSE------- ---SERIOUS VIOLENT BEHAVIORS--- SEX
Beets et al., in press AJPH
23
Effects of PA on Student Absenteeism Hawaii Randomized Trial (4 yrs of PA)
(Multiple baseline - 1997-2001)
8.5
9
9.5
10
10.5
11
11.5
12
12.5
1997 1998 1999 2000 2001 2002 2003 2004 2005* 2006* 2007*
Year (* indicates significant differences between conditions)
Avera
ge D
ays A
bsen
t
CONTROL Means
PA Means
STATE Standard
Snyder et al, under review
24
Effect of PA on SAT (Stanford 9) Reading ScoresHawaii Randomized Trial 2000-2006 (4 yrs of PA)
(No testing in 2001 due to a teacher strike)
69
70
71
72
73
74
75
76
77
78
79
2000 2002 2003 2004 2005 2006* 2007*
Year (* indicate where conditions significantly different)
% S
co
rin
g A
vera
ge o
r B
ett
er
CONTROL Means
PA Means
STATE
25
Counts of Positive Behaviors Endorsed (Washburn et al., in preparation)
30
40
50
60
70
80
Posi
tive B
eh
avi
ors
0 1 2 3 4Year
PA Group Control Group
Hawai'iEstimated Change in Positive Behavior
26
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
27
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
28
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