Prevention Science

Since the promulgation of its Principles of Effectiveness in 1998, the Office of Safe and Drug-Free Schools of the U.S. Department of Education has promoted the use of evidence-based drug prevention programs in the nation’s schools. We report the results of a survey, conducted in 2005, of a nationally representative sample of 1,721 schools with middle school grades. Respondents comprised the staff member in the school identified as most knowledgeable about the school’s drug prevention programs. The total response rate was 78%. Respondents answered questions concerning which drug use prevention curricula they used, and, if they used more than one, which one they used the most frequently. Three federally-sponsored registries were used to specify which curricula were considered evidence-based. Findings from 2005 were then compared to earlier estimates based on a similar 1999 survey. We found that 42.6% of the nation’s schools with middle school grades were using an evidence-based curriculum, an increase of 8% from our 1999 estimate. The two most prevalent curricula in use, at 19% each, were Life Skills Training and Project ALERT. We note, however, that only 8% of Life Skills Training users and 9% of Project ALERT users reported using those curricula the most, and that only 23% of respondents overall reported that they used an evidence-based curriculum the most. More information is needed as to why over three-quarters of the nation’s schools with middle school grades continue to administer curricula that have not been identified as effective.

Observed seroincidence and prevalence rates in male-to-female (MTF) transgender individuals highlight the need for effective targeted HIV prevention strategies for this community. In order to develop an effective vaccine that can be used by transgender women, researchers must understand and address existing structural issues that present barriers to this group’s participation in HIV vaccine clinical trials. Overcoming barriers to participation is important for ensuring HIV vaccine acceptability and efficacy for the MTF transgender community. To explore barriers and facilitators to MTF transgender participation in preventive HIV vaccine clinical trials, the HIV Vaccine Trials Network conducted focus groups among transgender women in four urban areas (Atlanta, Boston, Philadelphia, and San Francisco). Barriers and facilitators to engagement of transgender women in preventive HIV vaccine clinical trials led to the following recommendations: (a) transgender cultural competency training, (b) creating trans-friendly environments, (c) true partnerships with local trans-friendly organizations and health care providers, (d) protocols that focus on transgender specific issues, and (e) data collection and tracking of transgender individuals. These results have implications for the conduct of HIV vaccine trials, as well as engagement of transgender women in research programs in general.

Globally, significant progress has been made in primary school enrollment. However, there are millions of adolescents—including orphans in sub-Saharan Africa—who still experience barriers to remaining in school. We conducted a 4-year cluster randomized controlled trial (cRCT) (N = 835) in a high HIV prevalence area in western Kenya to test whether providing orphaned adolescents with a school support intervention improves their educational outcomes. The school support intervention consisted of directly paying tuition, exam fees, and uniform costs to primary and secondary schools for those students who remained enrolled. In addition, research staff monitored intervention participants’ school attendance and helped to address barriers to staying in school. This school support intervention had significant positive impacts on educational outcomes for orphaned adolescents. Over the course of the study, school absence remained stable for intervention group participants but increased in frequency for control group participants. Intervention group participants were less likely to drop out of school compared to the control group. Furthermore, the intervention participants were more likely to make age-appropriate progression in grade, matriculate into secondary school, and achieve higher levels of education by the end of the study. The intervention also increased students’ expectations of graduating from college in the future. However, we found no significant intervention impact on primary and secondary school test scores. Results from this cRCT suggest that directly covering school-related expenses for male and female orphaned adolescents in western Kenya can improve their educational outcomes.

This paper examines strategies for interpreting and reporting estimates of intervention effects for subgroups of a study sample. The paper considers: why and how subgroup findings are important for applied research, alternative ways to define subgroups, different research questions that motivate subgroup analyses, the importance of pre-specifying subgroups before analyses are conducted, the importance of using existing theory and prior research to distinguish between subgroups for whom study findings are confirmatory (hypothesis testing) as opposed to exploratory (hypothesis generating), and the conditions under which study findings should be considered confirmatory. Each issue is illustrated by selected empirical examples.

There is variability in home visiting program impacts on the outcomes achieved by high risk families. An understanding of how effects vary among families is important for refining service targeting and content. The current study assessed whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting impacts on maternal psychosocial functioning. In this multisite RCT of home visiting in a population-based, ethnically-diverse sample of families at risk for maltreatment of their newborns (n = 643), families were randomly assigned to home visited (HV) and control groups. HV families were to receive intensive services by trained paraprofessionals from birth-3 years. Outcome data were collected when children were 1, 2, and 3 years old and 7, 8, and 9 years old. Overall, short- and long-term outcomes for HV and control mothers did not differ significantly. Demographic attributes, a general measure of overall maternal risk, and partner violence did not moderate program impact on psychosocial functioning outcomes. Maternal relationship security did moderate program impact. Mothers who scored high on relationship anxiety but not on relationship avoidance showed the greatest benefits, particularly at the long-term follow-up. Mothers scoring high for both relationship anxiety and avoidance experienced some adverse consequences of home visiting. Further research is needed to determine mediating pathways and to inform and test ways to improve the targeting of home visiting and the tailoring of home visit service models to extend positive home visiting impacts to targeted families not benefiting from current models.

The dynamic wait-listed design (DWLD) and regression point displacement design (RPDD) address several challenges in evaluating group-based interventions when there is a limited number of groups. Both DWLD and RPDD utilize efficiencies that increase statistical power and can enhance balance between community needs and research priorities. The DWLD blocks on more time units than traditional wait-listed designs, thereby increasing the proportion of a study period during which intervention and control conditions can be compared, and can also improve logistics of implementing intervention across multiple sites and strengthen fidelity. We discuss DWLDs in the larger context of roll-out randomized designs and compare it with its cousin the Stepped Wedge design. The RPDD uses archival data on the population of settings from which intervention unit(s) are selected to create expected posttest scores for units receiving intervention, to which actual posttest scores are compared. High pretest–posttest correlations give the RPDD statistical power for assessing intervention impact even when one or a few settings receive intervention. RPDD works best when archival data are available over a number of years prior to and following intervention. If intervention units were not randomly selected, propensity scores can be used to control for non-random selection factors. Examples are provided of the DWLD and RPDD used to evaluate, respectively, suicide prevention training (QPR) in 32 schools and a violence prevention program (CeaseFire) in two Chicago police districts over a 10-year period. How DWLD and RPDD address common threats to internal and external validity, as well as their limitations, are discussed.

A hierarchical linear model was used to estimate the individual and school level effects for marijuana use among a national sample of 12th-grade students. School effects were small in comparison to individual level effects, accounting for 2.9% of the variance in marijuana use. At the individual level, perceived harm, perceived availability, and their interaction were significant predictors, each of which varied randomly across schools. Among two school-level predictors, the normative environment for perceived harm was not significant, but normative perceived availability predicted level of marijuana use. The effect of perceived availability on marijuana use was stronger in larger, compared to smaller communities. Results are discussed in light of the use of random regression methods for identifying school-specific patterns of risk and protection for prevention planning.

Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent–Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (MChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.

Despite widespread concern about the frequent failure of trained prevention staff to continue to use evidence-based programs following periods of intensive training, little research has addressed the characteristics and experiences of counselors that might predict their sustained use of a program. The current study follows a sample of school counselors who were trained to use an indicated preventive intervention, the Coping Power program, in an earlier dissemination study, and determines their levels of continued use of the program’s child and parent components in the 2 years following the counselors’ intensive training in the program. Counselor characteristics and experiences were also examined as predictors of their sustained use of the program components. The Coping Power program addresses children’s emotional regulation, social cognitive processes, and increases in positive interpersonal behaviors with at-risk children who have been screened to have moderate to high levels of aggressive behavior. The results indicated that counselors’ perceptions of interpersonal support from teachers within their schools, their perceptions of the effectiveness of the program, and their expectations for using the program were all predictive of program use over the following 2 years. In addition, certain counselor personality characteristics (i.e., conscientiousness) and the level of actual teacher-rated behavior change experienced by the children they worked with during training were predictors of counselors’ use of the program during the second year after training. These results indicate the central importance of teacher support and of child progress during training in the prediction of counselors’ sustained use of a prevention program.