BRIDGING THE GAP: A REVIEW OF THE SEATTLE PUBLIC SCHOOLS COMMUNITIES THAT CARE PROJECT. Susan Haws1, Koren Hanson1, Michael Arthur1, Monica Williams1, 1University of Washington, Seattle, WA United States
Given that children and adolescents spend a large portion of their time in the classroom, schools are an ideal venue for delivering youth prevention services (Kaftarian, Robinson, et al., 2004; Greenberg, 2004). Though schools are already the most common site for the implementation of tested, effective prevention programs (Pentz, 2003), schools often lack the capacity to identify appropriate programs and implement them with fidelity, much less sustain them for long enough to have a measurable impact (Spoth, Greenberg, et al., 2004). In order for prevention services to be integrated into schools and school systems, processes and structures are needed to support ongoing prevention planning and to monitor program adoption, implementation, and evaluation (Spoth, Greenberg, et al., 2004; Greenberg, 2004).
In 2002, the Seattle Public Schools used a grant awarded under the federal Safe Schools/ Healthy Students Initiative to adopt the Communities That Care® (CTC) prevention planning framework in 26 of its secondary schools. The CTC system, developed by Drs. Hawkins and Catalano (2002), was designed to mobilize communities to use youth risk and protective factor data to plan and implement tested, effective prevention programs. This project marked the first time that the CTC framework had been used by schools as a mechanism for the planning and implementation of tested, effective prevention programs. In our evaluation of the project, we sought to understand the extent to which the CTC framework was effective in facilitating the integration of prevention services into the daily operations of schools.
In this presentation we will report findings from the final round of interviews with the CTC leads at each school (n=22) regarding the evolution of the CTC teams, the factors that helped and hindered the CTC teams in their work, and the perceived impact of the CTC process on the school. Moreover, the presentation will include findings from two waves of data collection on factors which may be related to institutionalization of the CTC planning framework and/or the tested, effective programs which were put in place, including the involvement of key stakeholders in the CTC process, incorporation of CTC planning into the annual building level planning process, staff attitudes towards data, and perceptions about the CTC framework in the context of Diffusion of Innovations theory (e.g. ease of use, perceived advantage). Discussion will include accomplishments, lessons learned, and suggestions for future research on the use of the CTC framework to enhance prevention planning and sustainability in the school context.
COMMUNITY AND SCHOOL FACTORS INCREASING ADOPTION OF TESTED AND EFFECTIVE SCHOOL-BASED PREVENTION CURRICULA. Brian Smith1, Michael Arthur1, J. David Hawkins1, 1University of Washington, Seattle, WA United States
Schools are the most common site for the implementation of tested and effective prevention programs for youth in the U.S. (Pentz, 2003). Although the majority of prevention programs that schools use are either untested or have been proven ineffective (Gottfredson & Gottfredson, 2002; U.S. Department of Health and Human Services, 2001), widespread efforts to increase the use of effective school-based prevention programs are underway (U.S. Department of Education, 2002). One approach to this goal is to infuse prevention science findings into community-level prevention planning (Arthur & Blitz, 2000; Harachi et al., 2003; Hawkins et al., 2002; Hawkins, 1999; Mrazek & Haggerty, 1994). This study examined the relationship between the adoption of a science based approach to prevention planning in communities and the use of effective school-based prevention programs in the schools in those communities. The relationship between school level factors and the use of effective prevention programs was also investigated. Data for this study were collected during the 2001-2002 school year as part of the Diffusion Project, a descriptive study of the diffusion of science-based prevention practices in 41 small and medium sized towns in seven different states. Data were drawn from surveys of community leaders, principals, and teachers in the schools. Analyses utilized Hierarchical Generalized Linear Modeling (HGLM) to account for the nesting of data at the school and community level. Results showed that where community leaders reported greater adoption of prevention science based approaches, health teachers in middle and high schools were significantly more likely to report the use of tested and effective prevention curricula. Moreover, in schools where principals reported the presence of a school-based substance abuse prevention coordinator, teachers were significantly more likely to implement tested and effective prevention curricula. Finally, principals who reported higher levels of staff working exclusively in prevention, the presence of a school-based substance abuse prevention coordinator, and a greater influence of evidence-based sources of information on their choice of prevention activities were also significantly more likely to report the use of tested and effective prevention programs in their school. These findings point to the potential of community-level processes for impacting school-based prevention, highlight the role of health teachers in that relationship, and indicate that staffing focused on prevention contributes to increased use of tested and effective prevention programs.
IMPROVING STATE-WIDE PREVENTION SERVICE DELIVERY: FINDINGS FROM THE CSAP STATE INCENTIVE GRANT CROSS-SITE EVALUATION. Carol Hagen1, Ann Landy1, Augusto Diana2, Sarah Barrett1, 1Westat, Rockville, MD United States; 2Center for Substance Abuse Prevention, Rockville, MD United States
In 1997, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Administration (SAMHSA) launched the State Incentive Grant (SIG) Program. In contrast to earlier prevention initiatives that focused on individual or community-level prevention, the SIG program focuses on state-level systems change to improve state-wide prevention service delivery and achieve reductions in substance abuse among youth. The cross-site evaluation gathered evidence on the degree to which grantees attained the SIG Program´s two main goals: (1) state-wide coordination, leveraging, and redirection of substance abuse prevention resources, and (2) development and implementation of a comprehensive state-wide prevention strategy incorporating the implementation of science-based prevention efforts. The authors will present evidence that change occurred in state-wide prevention infrastructure following the introduction of SIG awards, and further, that sub-recipients at the local level modified prevention service delivery in response to state-level policy and management changes. Service delivery changes include, but are not limited to: increase in the number of evidence-based interventions; increase in the number of individuals served; increase in the number of environmental strategies; and adaptation of programs to conform to target population characteristics. The relationship between program management changes and substance abuse-related outcomes also will be discussed. The findings have implications for federal program management, particularly related to the extent to which evidence-based programs can be taken to scale, service delivery uniformity can be improved, and accountability in program implementation can be maintained.
CONCURRENT 4, CULTURAL SENSITIVITY, Organized Symposia
SOCIAL IDENTITY, SELF-CONCEPT, AND PHYSICAL HEALTH
Chair: Ayse Uskul
SOCIAL IDENTITY, SELF-CONCEPT, AND PHYSICAL HEALTH. Ayse Uskul1, 1University of Michigan, Ann Arbor, MI United States
This symposium brings together recent research that has introduced a new foray for combining research on social identity and self with physical health-related social psychological concepts. The aim of the papers in this symposium is to answer the question of whether who we are (social identity, group belongingness) and how our selves are structured (self-concept) make a difference in our perception and experience of health. In the first paper, Oyserman will present six studies conducted with American Indian, Mexican American, African American and European American middle school and college students and reservation adults that examined the link between social identity and perception of health and engagement in certain health behaviors. Her results showed that social representations of health and health promotion function to reduce engagement in health promoting behaviors and dampen belief in the efficacy of health promotion among low SES Americans and Americans of color.
Lee, Finlayson, and Oyserman will follow-up on the ideas introduced in Oyserman´s paper and present a study with low-income female African-Americans that examined first whether group belongingness predicts engagement in health behaviors and second whether making social identity salient – being reminded that one is low SES, minority, poor – increases accessibility of risky health behaviors and decreases accessibility of health promotion behaviors. Their findings point to the importance of the level of reported group belongingness in terms of the likelihood of engagement on health promotive behaviors.
Finally, Uskul will present a study in which she examined the effects of self-concept and relevance on responses to threatening health messages that were designed to focus only on physical consequences or to focus on a combination of both physical and interpersonal consequences of engaging in a health-impairing behavior. Her results showed that higher levels of message acceptance among those who endorsed an interdependent self-construal and for whom the message was relevant, only if they were exposed to the message that focused on both the physical and interpersonal consequences. Uskul´s results suggest that messages designed to tap on individuals´ central aspects of their self may be more effective and decrease self-serving responses.
The three papers in this symposium will provide insights into and encourage discussion around why health promotion campaigns may not be as successful as one would hope in the multicultural/multiethnic world that we live in.
SOCIAL IDENTITY AND HEALTH PROMOTION. Daphna Oyserman1, 1University of Michigan, Ann Arbor, MI United States
Social class and racial-ethnic differences in health and health practices such as diet and exercise underscore the need to understand who is included and who is excluded from social representations of health and health promotion. Most notably, American Indians, African Americans, and Mexican Americans report fewer health promoting behaviors such as physical activity and maintenance of appropriate weight and have more health complications and higher morbidity than do white Americans. Discrepancies in engagement in health promotion may reflect, in part, the perception that many health messages and behaviors are `white´ and middle class, thus, at odds with low SES and minority in-group identity. Developing this notion, in the current paper I argue first that social representations of being healthy and of health promotion focus on white, middle class images and second that these representations of health may leave other Americans conflicted about the relevance and efficacy of health promotion for members of their own group resulting in lower perceived efficacy in carrying out health promotion and higher fatalism about health. I outline a process model of how social representations of health and in-group identity interact to influence perceived efficacy of health promotion for low SES and minority individuals.
Social cognition and social identity approaches are integrated in a process model delineating how contexts dampen health efficacy and increase health fatalism. Six studies are described with American Indian, Mexican American, African American and European American middle school and college students and reservation adults. Results show that (1) health promotion is viewed as 'white, middle class', (2) unhealthy lifestyle is viewed as in-group, (3) focusing on one´s stigmatized social identity (e.g. race/ethnicity, SES) increases fatalism and (4) priming inclusion in larger society reduces fatalism. Three follow-up experiments show (5) priming similarities to middle class whites increases health efficacy only if social identity does not include unhealthy lifestyle behaviors. Meta-analyses across studies show that the effect sizes are moderate overall and large for studies examining the interaction of in-group identity and larger societal inclusion/exclusion.
DOES IDENTITY (GROUP BELONGINGNESS) INFLUENCE WILLINGNESS TO ENDORSE HEALTHY BEHAVIOR IN A COMMUNITY SAMPLE?. Shawna Lee1, Tracey Finlayson1, Daphna Oyserman1, 1University of Michigan, Ann Arbor, MI United States
Why are risky and protective health behaviors differentially related to social group membership? This research is a follow-up to studies showing effects of social identity (race/ethnicity/social class) on beliefs about efficacy of health promotion (Oyserman & Fryberg, 2003). We examined two predictors of health behaviors. First, we assessed whether overall level of group belongingness was a significant predictor of health behaviors. Second, we assessed whether making social identity salient – being reminded that one is low SES, minority, poor – increases accessibility of risky health behaviors and decreases accessibility of health promotion behaviors.
To make salient stigmatizing social identity membership, participants in the priming condition first had to identify their social identity by indicating their race-ethnicity, social class, and income levels. Participants were then asked questions about group belongingness, a series of questions asking participants to rate the centrality of the social identity categories they just replied to. Participants then rated involvement in promotive and risky health behaviors. In the no prime condition, participants first rated involvement in promotive and risky health behaviors, and then filled out the questions related to social identity and Group Belongingness.
We surveyed a community sample of primarily female, low-income African-Americans attending the weekly job fair at a state social service agency. ANOVA results revealed that participants with strong group belongingness had higher beliefs that ingroup members smoke cigarettes and cigars more often and were less likely to eat fruit and vegetables. This group also reported lower levels of likelihood of future flossing. Individuals who showed lower group belongingness reported worse self-rated oral health and lower levels of consumption of fresh fruits and vegetables in the past week. Results also revealed that individuals who were in the social identity prime condition and who endorsed strong group belongingness were more likely to be a smoker.
This research suggests that in a community sample of African Americans, group belongingness influences people´s endorsement of their personal engagement with health behaviors related to smoking, oral health, and diet. Group belongingness was associated with perceiving the ingroup as not engaging in healthy behaviors. Priming social identity had few significant effects, perhaps because being African American is a chronically salient identity in the American culture. An implication of this research is that changing people´s associations of health behaviors with identity factors may influence willingness to desist from negative health behaviors.
SELF-CONCEPT, RELEVANCE, AND RESPONSES TO THREATENING HEALTH MESSAGES. Ayse Uskul1, 1University of Michigan, Ann Arbor, MI United States
Past research has demonstrated that health messages are more likely to be rejected when they are highly relevant to the people who receive these messages (e.g., Liberman and Chaiken, 1992). However, studies that have reported findings on self-serving, defensive responses to threatening health messages have typically used messages emphasizing the physical consequences of health-impairing behaviours. However, it has been shown that people´s concerns can go beyond the mere physical consequences of a health problem, to include consequences regarding interpersonal domains of their lives. This was found to be especially true for those who endorse an interdependent self-concept whose selves are defined in more relational terms (Uskul & Hynie, 2004) compared to those that endorse an independent self that is defined as autonomous and self-contained.
The current paper discusses a study conducted to examine individuals´ responses to health messages that report the physical consequences of engaging in a health-impairing behaviour only and to those that combine both the physical and interpersonal consequences (e.g. being a burden on others or not being able to care for others) and whether these responses vary as a function of the type of self-concept endorsed. To that end, 199 female university students were asked to read a fabricated health message (Kunda, 1987) that reported on an alleged link between caffeine and fibrocystic disease. Participants who reported consuming either no or 1 cup of coffee a day (low relevance) or 2 or more cups of coffee a day (high relevance) were randomly assigned to read one of the two health messages. They were then given questions concerning their beliefs of the content of the message, emotions, and perceptions of risk and relevance in addition to self-construal measures. Results showed that endorsing a strong interdependent self-construal, being in the high relevance group, and being exposed to a health message that emphasized interpersonal and physical consequences of coffee consumption was associated with reduced defensiveness, in that this group showed higher levels of acceptance of detrimental interpersonal effects of coffee, stronger negative emotions, higher perceived levels of personal risk, and personal relevance. These results suggest that messages tailored to speak to the most important aspects of one´s self-concept may be more effective than those that solely report on physical consequences of health-impairing behavior.
CONCURRENT 5, ETIOLOGY, Organized Symposia
CLUB DRUGS, RISKY SEX AND YOUNG ADULTS: AN EMERGING OPPORTUNITY FOR PREVENTION RESEARCH
Chair: Susan Martin
CLUB DRUGS, RISKY SEX AND YOUNG ADULTS: AN EMERGING OPPORTUNITY FOR PREVENTION RESEARCH. Susan Martin1, Jeffrey Arnett2, 1National Institute on Drug Abuse, Rockville, MD United States; 2University Park, MD United States
Despite ample prevention intervention research on early adolescence and middle -school age youth, both epidemiological and preventive intervention studies focused on emerging adults is very sparse. This is unfortunate since the period between 18 and 25 years of age, recently labeled “emerging adulthood” (Arnett 2000), has been identified as a unique developmental stage and the one during which drug use and abuse as well as sexual risk-taking peak. This session is designed to explore findings from studies that focus on particularly high-risk groups of emerging adults--- urban youth that use club drugs and/or attend dance parties at electronic music dance events (EMDEs that formerly were termed “raves”) and private parties. Based on observation and in-depth interviews, the presenters will: (a) examine the associations of Ecstasy or MDMA with the use of various drugs (and poly-drug use patterns) and risky sexual behavior; (b) explore the environmental factors and event characteristics that are associated with these risky behaviors; and (c) identify individual and environmental prevention strategies to reduce club drug use and sexual risk-taking among emerging adults.
PREVENTING CLUB DRUG USE AMONG RAVE ATTENDEES. George Yacoubian1, 1Pacific Institute for Research and Evaluation, Calverton, MD United States
The “rave” phenomenon has been a major element in the resurgence of psychedelic drug use in Western society. Raves are characterized by large numbers of youth dancing for long periods of time and by the use of “club drugs,” such as 3, 4-methylenedioxymethamphetamine (MDMA or “ecstasy”). While a small body of research has explored the use of ecstasy and other club drugs (EOCD) among club rave attendees in the United States, 2 major limitations remain. First, no studies have investigated the relationship between EOCD use and high-risk sexual behavior, a known risk factor for HIV transmission, among members of this population. Second, the extent to which club owners and rave promoters would be receptive to a community-level, EOCD- and high-risk sexual behavior-related preventive intervention is unknown. To address these critical gaps in the prevention arena, we, first, explore the association between EOCD use and high-risk sexual behaviors among club rave attendees along the Baltimore-Washington corridor, and second, assess the feasibility of a community-based preventive intervention within these settings. Implications for the relationship between social setting and the use of club drugs among young adults and the implications for future prevention interventions within these settings are discussed.
EXAMINING CLUB ENVIRONMENTS FOR FACTORS AFFECTING DRUG USE AND OTHER RISKY BEHAVIORS AMONG EMERGING ADULTS. Brenda Miller1, Debby Furr-Holden2, Roland Moore1, Bob Voas2, 1Pacific Institute for Research and Evaluation, Berkeley, CA United States; 2Pacific Institute for Research and Evaluation, Calverton, MD United States
Emerging adults (aged 18-25) are frequent attendees of electronic music dance events (EMDEs) and these events are associated with high levels of drug use (Miller et al., in press; Arria et al., 2002; Yacoubian et al., 2003). Several risky behaviors associated with drug use identified in these settings include drug overdosing, alcohol intoxication, sexual behaviors, aggression, and driving while under the influence of alcohol or drugs. Characteristics of the venues (the physical location or setting) that host EMDEs and the characteristics of the events themselves may increase or decrease drug use on premises, associated risky behaviors, and undesirable outcomes. This presentation will provide information on an observational study of East and West Coast club settings (currently being conducted for 100 events) where emerging adults frequent EMDEs. Observations include measures of: (1) drug and alcohol use on premises and related problems (e.g., intoxication/overdose); (2) venue characteristics (e.g., capacity, physical conditions, and posted policies or practices); (3) event characteristics (e.g., security, special theme night); and (4) risky behaviors (e.g., aggression, visible sexualized behaviors). Based on these observations, we present a typology of events and venues that will guide us in developing appropriate environmental and individualized prevention programs for at-risk young adults in these settings.