Adolescent Risk Behaviors: Examining Latent Classes And Latent Transition Statuses In A Longitudinal Bahamian Sample

Adolescence is a developmental period marked by much change across physical, cognitive, psychological, and social domains leading to greater vulnerability for poor decision making. As a result, adolescence is a period of increased risk taking behaviors. Prevention of risk behaviors would benefit from early intervention prior to the onset of these risk behaviors. Unfortunately, it is difficult to identify those youth who may be most at risk. Risk-taking adolescents may choose to engage in specific risk behaviors; as well, risk factors that influence risk taking may also differ as a function of the specific domains of risk behaviors. The present study assesses youth from a longitudinal trial of two HIV intervention prevention programs following the same cohort of youth from grade six to grade 12 in the Bahamas. A person-centered approach was used to examine risk behaviors and determine whether there are certain behaviors that co-occur among different subsets of youth. Latent class analysis and latent transition analysis revealed four distinct profiles of risk behavior involvement. Latent classes of grade 12 behaviors included a low risk class, a high risk class and two moderate risk behaviors classes. The patterns of the four risk statuses identified in the latent transition analysis were similar to the latent classes. Results showed that involvement in risk behaviors at a previous time point increased the probability of remaining in either the same risk status or transitioning to another risk status compared to transitioning to the low risk status. Furthermore, it was hypothesized that contextual factors including perceived peer involvement in risk behaviors, parental monitoring, and neighborhood exposure to risk behaviors and individual level factors such as sensation seeking and values orientation would predict group membership. Results showed peer involvement in risk behaviors, neighborhood risk involvement, and gender were significant predictors of latent classes and peer involvement in risk behaviors and gender were significant predictors of latent statuses

Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention

Background Intervention effects observed in efficacy trials are rarely replicated when the interventions are broadly disseminated, underscoring the need for more information about factors influencing real-life implementation and program impact. Using data from the ongoing national implementation of an evidence-based HIV prevention program [Focus on Youth in The Caribbean (FOYC)] in The Bahamas, this study examines factors influencing teachers’ patterns of implementation, the impact of teachers’ initial implementation of FOYC, and subsequent delivery of the booster sessions on students’ outcomes. Methods Data were collected from the 80 government elementary and 34 middle schools between 2011 and 2014, involving 208 grade 6, 75 grade 7, and 58 grade 8 teachers and 4411 students initially in grade 6 and followed for 3 years. Student outcomes include HIV/AIDS knowledge, reproductive health skills, self-efficacy, and intention to use protection. Data from teachers includes implementation and modification of the curriculum, attitudes towards the prevention program, comfort level with the curriculum, and attendance at training workshops. Structural equation modeling and mixed-effect modeling analyses were applied to examine the impact of teachers’ implementation. Results Teachers’ attitudes towards and comfort with the intervention curriculum, and attendance at the curriculum training workshop had a direct effect on teachers’ patterns of implementation, which had a direct effect on student outcomes. Teachers’ attitudes had a direct positive effect on student outcomes. Teachers’ training in interactive teaching methods and longer duration as teachers were positively associated with teachers’ comfort with the curriculum. High-quality implementation in grade 6 was significantly related to student outcomes in grades 6 and 7 post-implementation. Level of implementation of the booster sessions in grades 7 and 8 were likewise significantly related to subsequent student outcomes in both grades. Conclusions High-quality initial implementation of a prevention program is significantly related to better program outcomes. Poor subsequent delivery of booster sessions can undermine the positive effects from the initial implementation while strong subsequent delivery of booster sessions can partially overcome poor initial implementation

Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting

BACKGROUND: Sustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs. OBJECTIVE: This proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time. METHODS: This study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5. RESULTS: It is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023. CONCLUSIONS: The study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14816. Xiaoming Li, Sharon Marshall, Glenda Rolle, Nikkiah Forbes, Bonita Stanton. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 21.08.2020

When Things Are Not as They Appear: Assessing the Adequacy of Cluster Randomization When Outcome Events Are Rare at Baseline

The present study randomly assigned 15 Bahamian elementary schools to one of three intervention conditions. To assess the adequacy of cluster randomization, we examined two concerns identified by the local research team: inequality of gender distribution and environmental risk among groups. Baseline significant differences in risk and protective behaviors were minimal. There were significantly more males in the intervention group. Males had higher rates of risk behavior at all assessments. Poor school performance was also higher among the intervention condition and was significantly associated with increased rates of many but not all risk behaviors. Prior to adjusting for gender and school performance, several risk behaviors appeared to be higher after intervention among intervention youth. Adjusting for gender and school performance eradicated the group differences in risk behavior rates. Results demonstrate the importance of adequate randomization where outcomes of interest are rare events at baseline or differ by gender and there is an unequal gender distribution and the importance of the local research team's knowledge of potential inequalities in environmental risk (i.e., school performance). Not considering such individual differences could impact the integrity of trial outcomes

Determinants of harsh parenting among young adult mothers with suspected histories of childhood abuse: an ecological investigation

This secondary data analysis from the National Survey on Child and Adolescent Well-Being examined the parenting behaviors of young mothers who have suspected histories of abuse as they transitioned out of the child welfare system and become parents. The sample included 164 mothers between the ages of 18-21 years. Using multiple logistic regression harsh parenting behaviors were predicted using factors for each level of the young mother\u27s ecological system. Results found that relationship with caregiver, an individual level factor, predicted severe harsh parenting, child age (microsystem) predicated mild and moderate levels of harsh parenting, and social support (exosystem) predicted moderate and severe levels of harsh parenting. Psychological risk, however, significantly predicted each level of harsh parenting. Therefore, results suggest not only providing parents with better parenting skills, but also help mend the parent-child relationship and improve mental health as it predicted each harsh parenting category including severe abuse

Additional file 3: of Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention

Mixed-effects models assessing the effects of grade 8 teacher’s delivery of booster session on student outcomes in grade 8. (DOC 52 kb