1. 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. 2 Positive Youth Development: The 4 C’s Connectedness (bonding)Connectedness (bonding) Competence (social, cognitive, behavioral, emotional, moral)Competence (social, cognitive, behavioral, emotional, moral) Confidence (self efficacy, self determination, belief in the future, clear & positive identity)Confidence (self efficacy, self determination, belief in the future, clear & positive identity) Character (prosocial norms, spirituality)Character (prosocial norms, spirituality) Source: Catalano et al 1998, Pittman 1993

3. 3 Note: Some of these theories cross cells, particularly the sociological theories. Some explicitly integrative theories cross many cells (e.g., Brooks, Elliott, Jessor). Theoretical Orientation: A Matrix of Theories

4. 4 BEHAVIOR Intentions/Decision E nvironment Attitudes Toward Behavior Social Normative Beliefs Intra P ersonal Self-Efficacy Social S ituation ENVIRONMENTGENETICS The Theory of Triadic Influence

5. 5 DECISIONS/INTENTIONS SOCIAL S ITUATION Values/ Evaluations Knowledge/ Expectancies BIOLOGY/ P ERSONALITY THE THEORY OF TRIADIC INFLUENCE ATTITUDES TOWARD THE BEHAVIOR Perceived Norms Information/ Opportunities Interpersonal Bonding Social Competence CULTURAL E NVIRONMENT SOCIAL NORMATIVE BELIEFS Interactions w/ Social Instit’s Others’ Beh & Atts Motivation to Comply Skills: Social+General Trial Behavior Related Behaviors Sense of Self/Control EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological Self Determination SELF-EFFICACY BEHAVIORAL CONTROL Nurture/CulturalBiological/Nature 123 789101112 131415161718 192021 22 23 g h i j k l m n o p q r C F I B E H J K Intrapersonal StreamSocial/Normative StreamCultural/Attitudinal Stream s t u v w x a b c d e f 456 A D G Distal Predisposing Influences Proximal Immediate Predictors Levels of Causation Ultimate Underlying Causes Social/ Personal Nexus Expectancies & Evaluations Affect and Cognitions Decisions Experiences Notes: 1. affective and cognitive substreams 2. feedback loops 3. Interactions between streams

6. 6 DECISIONS/INTENTIONS SOCIAL S ITUATION Values/ Evaluations Knowledge/ Expectancies BIOLOGY/ P ERSONALITY THE THEORY OF TRIADIC INFLUENCE ATTITUDES TOWARD THE BEHAVIOR Perceived Norms Information/ Opportunities Interpersonal Bonding Social Competence CULTURAL E NVIRONMENT SOCIAL NORMATIVE BELIEFS Interactions w/ Social Instit’s Others’ Beh & Atts Motivation to Comply Skills: Social+General Trial Behavior Related Behaviors Distal Influences Proximal Predictors Levels of Causation Ultimate Causes Sense of Self/Control EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological Self Determination SELF-EFFICACY BEHAVIORAL CONTROL Nurture/CulturalBiological/Nature 123 789101112 131415161718 192021 22 23 g h i j k l m n o p q r C F I B E H J K Intrapersonal StreamSocial/Normative StreamCultural/Attitudinal Stream s t u v w x a b c d e f 456 Social/ Personal Nexus Expectancies & Evaluations Affect and Cognitions Decisions Experiences A D G CHARACTER CONFIDENCE COMPETENCE CONNECTEDNESS

7. 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 S P E S P E S P E S P E S P

8. 8 Ecological Theories (Bronfrenbrenner)

9. 9 The TTI Developmental-Ecological System P SS S E P Eval Behavior SNBSelf Efficacy Att Intentions Will + Skill Exp McNB KnowValue Social Bonds Role Models Self- Control Com- petence SNB Values Environment Knowledge Environment E NVIRONMENT S ituation P erson EE Affective/Control Substreams Cognitive/Competence Substreams DEVELOPMENT & TIME Ultimate Underlying Causes Levels of Causation Distal Predisposing Influences Proximal Immediate Predictors

10. 10 All Behaviors Have Common Causes National Socio-Cultural Environment Political, Economic, Media, Religious Values, Attitudes Local Community, Families, Schools Relationships with Others Others’ Attitudes, Behaviors Social Normative Beliefs Sense 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 Achievement No Drugs Health Care Physical Healthy Behaviors Eating/Diet ADHD Conduct Disorder Mental Health Anxiety/ Depress

11. 11 % Ever had sex by lifetime risk behavior count 1991-2007 (Youth Risk Behavior Survey) Santelli, et al., J Adolescent Health, 2009

12. 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. 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

14. 14 Sense of Self/Control Social Competence Self Determination Skills: Social+General Self-Efficacy, Behavioral Control Interpersonal Bonding Others’ Behs & Atts Motivation to Comply Perceived Norms Social Normative Beliefs Information/ Opportunities Interactions w. Social Instit’s Values/ Evaluations Knowledge/ Expectancies Attitudes Toward The Behavior Decisions/Intentions Behavior Decision-making and Problem-solving skills Alternatives, Information & Consequences Values Education, Goal setting African-American History & Values Media literacy Community, Etc. Norms awareness & clarification Attachment Empathy African-American Identity & Sense of Self Self-control & Anger management Social & Self- management Skill Building Social Service Coordination Mentoring School-wide changes Parent effectiveness training Identification of African-American role models/heroes Mapping of ABAN AYA onto the TTI

15. 15 ABAN AYA: Male odds of sexual intercourse by condition

16. 16 ABAN AYA: Male condom use by condition (logit )

17. 17 Hypothetical example of differential effects by risk level (a common pattern)

18. 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. 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. 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. 21 How You Like To Be Treated Feelings Empathy How to Treat Others Conflict Resolution Communica -tion Skills Social Context/ S ituations Others’ Behavior & Approval Social Bonding/ Attachment Family School Neighborhood Peers Others’ Expectations Desire to Please Social Normative Beliefs INTENTIONS/DECISIONS BEHAVIOR Experiences from Behavior Self Concept Health & Drug Info Thinking Skills Creativity Decision-Making Problem-Solving Self Management Time, Energy, Talents, Money, Anger Social & Emotional Health Socio-Cultural E nvironment Information Environment General Values Expected Consequences Evaluation of Outcomes Mass Media Regulations Religion Economy Attitudes Toward the Behavior Intra P ersonal (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 Alternative Consequences Mapping of Positive Action content onto the TTI

22. 22 Hawaii: Lifetime Prevalence of Substance Abuse, Violent Behaviors, & Sexual Activity: 5 th grade (no significant interactions) --------------SUBSTANCE ABUSE----------SERIOUS VIOLENT BEHAVIORS--- SEX Beets et al., in press AJPH

23. 23 Snyder et al, under review

24. 24

25. 25 Counts of Positive Behaviors Endorsed (Washburn et al., in preparation)

26. 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. 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. 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