A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown.Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.     

Gender differences in perceptions of aftercare supports and services

Youth depart residential care with many continued risk factors, unique needs, and challenges as they reintegrate into the home, school, and community settings. Currently, there is limited research on needs and best practices in aftercare services and supports for youth departing from residential settings and even less is known about how these differ by gender. While preliminary studies have explored perceptions of need during reintegration and aftercare by youth and caregivers, little is known about how these may differ by gender or if perceptions change over time after experiencing the initial transition period. One way to address this knowledge gap is to identify how prepared males and females feel for reintegration in critical life domains, their beliefs about aftercare, and preferences regarding potential services or supports to aide in the reintegration at discharge. Therefore, the purpose of this study was to explore if males and females differ on preparedness for reintegration across critical life domains, beliefs about aftercare, and preferences regarding potential services or supports to aide in the reintegration at departure from a residential treatment facility (N = 132). Overall, very few differences were found between males and females at departure. Implications, limitations, and future research are discussed.     

Impact of Parenting Behaviors on Recent Alcohol Use Among African American Students

Parenting is a critical factor in substance abuse prevention. Positive parenting behaviors are identified as a protective factor for substance abuse among youth. Limited research exists that investigates the role of parenting practices on minority youth substance use. The present study seeks to examine correlates between parenting and recent alcohol use among African American youth. Specifically, to what extent do African American students report experiencing specific parenting behaviors that are measured by the National Household Survey on Drug Use and Health?, do specific parenting behaviors increase the risk of recent alcohol use among African American youth?, does the impact of parenting behaviors on recent alcohol use among African American youth differ based on sex (males and females) and age category (12–13, 14–15, and 16–17 years old) were examined in this study? Logistic regression analysis of the National Household Survey on Drug Use and Health was conducted to examine the research questions. Findings indicated that parenting behaviors was associated with recent alcohol among youth. Significant differences were found for males, females, 12–13, 14–15, and 16–17 years olds. Study findings demonstrate the importance of positive parenting behaviors in youth alcohol prevention. Program specialists may target parenting as a means of preventing and reducing youth alcohol use among African American youth.     

Motivations for self-defensive aggression in dating relationships

Previous research has suggested that the occurrence of dating violence is influenced by various motivations, including self-defense. While some data have suggested that females are more likely to use physical aggression in self-defense, assessment measures of self-defense have been limited in several notable ways, hindering efforts at fully understanding the myriad of reasons contributing to self-defensive aggression. The current study sought to examine motivations for physical aggression among male and female college students using a contextual self-report measure of self-defensive aggression designed specifically for the current study. Results showed that numerous motivations for physical aggression were endorsed by both males and females and, contrary to expectations, females were not more likely to use aggression in self-defense. Implications of these findings for future research and dating violence prevention programming are discussed.     

An institutional analysis of HIV prevention efforts by the nation's outpatient drug abuse treatment units.

Drawing from an institutional-theory perspective on innovations in organizations, this paper examines the use of human immunodeficiency virus (HIV) prevention practices by the nation's outpatient substance abuse treatment units during a critical period from 1988 to 1995. An institutional perspective argues that organizations adopt new practices not only for technical reasons, but also because external actors actively promote or model the use of particular practices. We examine the extent to which treatment units use several practices to prevent HIV infection among their clients and among drug-users not in treatment. Results from random-effects regression analyses of national survey data show that treatment units significantly increased their use of HIV prevention practices from 1988 to 1995. Further, the results show that treatment units' use of prevention practices was related to clients' risk for HIV infection, unit resources available to support these practices, and organizational support for the practices. Implications are discussed for an institutional view of organizational innovation as well as for research on HIV prevention.     

Trait anger as a mediator of difficulties with emotion regulation and female-perpetrated psychological aggression

Recent research has demonstrated the devastating impact of female-perpetrated psychological aggression in intimate relationships broadly and dating relationships specifically. With the perpetration of psychological aggression in dating relationships occurring at shockingly high rates, prevention programming for dating violence should target this form of aggression. Toward this end, it is important to understand the antecedent conditions that increase one's risk for perpetrating psychological aggression. This study sought to examine two possible risk factors for perpetrating psychological aggression among female undergraduates (N = 145), namely, emotion regulation and trait anger. Findings showed that difficulties with emotion regulation and trait anger were associated with increased psychological aggression perpetration, and trait anger mediated the link between emotion regulation and psychological aggression. Implications of these findings for prevention programming and future research are discussed.     

A general causal model to guide alcohol, tobacco, and illicit drug prevention: assessing the research evidence

The problems associated with the use of alcohol, tobacco, and other drugs (ATOD) extract a significant health, social, and economic toll on American society. While the field of substance abuse prevention has made great strides during the past decade, two major challenges remain. First, the field has been disorganized and fragmented with respect to its research and prevention practices; that is, there are often separate ATOD prevention "specialists." Second, both the prevention researchers who test the efficacy of specific prevention strategies and the practitioners who implement prevention efforts often lack an overall perspective to guide strategy selection. To address these limitations, we present an ATOD causal model that seeks to identify those variables (Domains) that are theoretically salient and empirically connected across alcohol, tobacco, and illicit drugs. For the researcher, the model demonstrates important commonalities, as well as gaps, in the literature. For the practitioner, the model is a means to recognize both the complexity of the community system that produces ATOD problems and the multiple intervention points that are possible within this system. Researchers and practitioners are thus challenged to work synergistically to find effective and cost-effective approaches to change or reduce ATOD use and associated problems.     

College student binge drinking and the "prevention paradox": implications for prevention and harm reduction

Considerable attention has been paid to heavy episodic or "binge" drinking among college youth in the United States. Despite widespread use, the binge measure is perceived by some as a low intervention threshold. We use data from the Harvard School of Public Health College Alcohol Study (n = 49,163) to describe patterns of consumption and harms along a continuum including the binge measure to demonstrate the validity of the binge threshold and prevention paradox in college. While the heaviest drinkers are at greatest risk for harm, they are relatively few and generate proportionately small amounts of all drinking-harms. The risk of harms is not zero among lower level drinkers in college. Because they are numerous, they account for the majority of harms. This paradoxical pattern suggests we moderate consumption among the majority using environmental approaches, the efficacy of which are described using case study data from a national prevention demonstration. Implications for prevention policy, programming, and media advocacy are discussed.     

Adolescent substance use and family-based risk and protective factors: a literature review

Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory, social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed.     

The influence of perceptions of practice characteristics: An examination of agricultural best management practice adoption in two Indiana watersheds

Agricultural best management practices (BMPs), or conservation practices, can help reduce nonpoint source pollution from agricultural lands, as well as provide valuable wildlife habitat. There is a large literature exploring factors that lead to a producer’s voluntary adoption of BMPs, but there have been inconsistent findings. Generally, this literature has not examined specific attributes of BMPs that may affect acceptability to farmers and ultimately adoption. To address these limitations, a qualitative analysis of in-depth interviews with farmers was conducted to determine which characteristics make four common BMPs more or less acceptable to agricultural producers. Interviews were conducted with forty-five producers in two watersheds in Indiana, USA. The producers were asked about their use of these conservation practices and the reasons behind their decisions. This study outlines the perceived characteristics of each conservation practice that are most important in either facilitating or impeding adoption of those practices. Results indicate that perceived high levels of relative advantage (e.g., reduced inputs, time-savings, and on-farm and environmental benefits), compatibility (with farm system and needs of producer), and observability (observing practice’s advantages) are most important in increasing adoption of conservation practices. Low levels of perceived relative advantage and incompatibility of practices were found to be most important in non-adoption of conservation practices. Perceived risk and complexity associated with specific practices were only found to limit adoption for a few practices, though it was an important barrier for conservation tillage. In order to increase adoption, conservation promoters should focus on raising awareness of the on-farm and financial benefits, the environmental benefits, and compatibility of conservation practices with current farm operations.     

Perceived personal immunity: Beliefs about susceptibility to AIDS

Subjects aged 18–25 were surveyed regarding their beliefs about susceptibility to getting AIDS. Males generally viewed their probability of contracting AIDS under conditions of risky sexual behavior to be significantly lower than did females. Subjects’ risk status was classified based on their recent self‐reported condom use and the number of different partners with whom they had sexual intercourse during the past year. High‐risk males perceived themselves to be at significantly lower risk than others who engaged in the same practices. High‐risk females perceived themselves to be at equal risk to others who engaged in unprotected sex with numerous partners. Condom use was significantly related to subjects’ socioeconomic status. These findings indicate that information about factors that augment risk for contracting HIV may, in and of itself, be insufficient to foster adequate preventive behaviors among many sexually active individuals.     

Male breast cancer

Male breast cancer (MBC) is a rare disease. However, as global populace ages, there is a trend to MBC increasing. Although aetiology is still unclear, constitutional, environmental, hormonal (abnormalities in estrogen/androgen balance) and genetic (positive family history, Klinefelter syndrome, mutations in BRCA1 and specially BRCA2) risk factors are already known. Clinic manifestation is painless hard and fixed nodule in the subareolar region in 75% of cases, with nipple commitment earlier than in women. Breast cancer has similar prognostic factors in males and females, among which axillary adenopathy (present in 40–55% cases) is the most important one. Although mammography, ultrasonography and scintigraphy can be useful tools in diagnosis; clinical assessment, along with a confirmatory biopsy, remains the main step in the evaluation of men with breast lesions. Infiltrating ductal carcinoma is the most frequent histological type. The established standard of care is modified radical mastectomy followed by tamoxifen for endocrine-responsive positive disease, although other options are being explored. While similarities between breast cancer in males and females exist, it is not appropriate to extrapolate data from female disease to the treatment of male. There is a need for specific multi-institutional trials to better understanding of clinicopathologic features and establishment of optimal therapy for this disease.     

Parents' knowledge,attitudes and practices about preventing child sexual abuse: a literature review

Increased concern about high rates of child sexual abuse has led to the demand for more prevention programmes, particularly those aimed at parents. Research on how parents manage and reduce the risk of child sexual abuse can help plan programmes. This literature review explores published research on the knowledge, attitudes and practices of parents on the risk and prevention of child sexual abuse and identifies gaps and needs for further research. The majority of studies reviewed originated in North America and Asia, were quantitative, surveyed mainly mothers and were more than ten years old. Recommendations are made for more current and country specific research, further research to gain a deeper understanding of how parents manage the risk of child sexual abuse, more comprehensive research covering a range of knowledge, attitude and practice variables, and greater inclusion of fathers in research. Copyright © 2009 John Wiley & Sons, Ltd.     

Young Parents’ Relationship Characteristics,Shared Sexual Behaviors,Perception of Partner Risks,and Dyadic Influences

Rising rates of heterosexually transmitted HIV among youth and young adults, particularly from ethnic minorities, create an urgent need to understand risk factors and perceptions of risk within the context of couple relationships. This study examined reports of young mothers and fathers (predominantly Latino) about background characteristics, relationship quality and length, HIV-related risk factors, and perceptions of partners’ behaviors and personal history. Higher concordance was found for relationship characteristics and partners' personal history (e.g., incarceration) than on shared sexual behaviors. Most males and females stated that they were monogamous; however, those whose partners reported concurrency were unaware of this. Many were unaware of their partners’ HIV testing status. Relationship quality was higher when females accurately perceived their partners' self-reported HIV-related risk behaviors. Length of the relationship did not influence concordance. Findings support the need for HIV prevention programs to promote open discussion about condom use and HIV testing within sexual partnerships.     

Coital debut: the role of religiosity and sex attitudes in the Add Health Survey

Recent reviews suggest that religiosity is associated with the delay of adolescent coital debut (Rostosky, Wilcox, Wright, Randall, in press; Wilcox, Rostosky, Randall, Wright, 2001). Few studies, however, have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15-21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls - but not boys - who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect. Finally, a significant interaction between race and religiosity indicated that African American adolescent males who had either signed a virginity pledge or were more religious were significantly more likely to debut than both White non-Hispanic males and African American males who were less religious and/or who had not signed a pledge. The implications of these results for adolescent pregnancy prevention programming are discussed.     

Physical training as a substance abuse prevention intervention for youth

Program evaluation data from school and community applications of a physical fitness drug prevention program is presented. A train-the-trainer methodology was applied to install the program in twenty-two settings within the state of Illinois. The physical training program consisted of exercise and educational modules delivered over a twelve-week time period that focused on learning values and life skills through exercise. Complete pre-post data were obtained on 329 participating youth at six school and community based sites. Significant increases were demonstrated in physical activity and physical fitness (cardiovascular endurance, strength, and flexibility). Youth self-report data indicated significant decreases in risk factors such as low self-concept, poor school attendance, anxiety, depression, and number of friends who use alcohol and drugs. There were significant reductions in the percentage of youth who used cigarettes, smokeless tobacco, and alcohol. It was concluded that a strong relationship was demonstrated for increased fitness leading to lowered risk factors and usage patterns. Likewise, the train-the-trainer model was shown to be an effective installation approach to expand fitness programming within prevention settings.     

Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation

Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.     

Measuring risk and protective factors for substance use,delinquency, and other adolescent problem behaviors. The Communities That Care Youth Survey

Risk and protective factors predictive of adolescent problem behaviors such as substance abuse and delinquency are promising targets for preventive intervention. Community planners should assess and target risk and protective factors when designing prevention programs. This study describes the development, reliability, and validity of a self-report survey instrument for adolescents ages 11 to 18 that measures an array of risk and protective factors across multiple ecological domains as well as adolescent problem behaviors. The instrument can be used to assess the epidemiology of risk and protection in youth populations and to prioritize specific risk and protective factors in specific populations as targets for preventive intervention.