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

Positive Youth Development:Positive Youth Development:The 4 C’sThe 4 C’s

• Connectedness (bonding)Connectedness (bonding)

• Competence (social, cognitive, behavioral, Competence (social, cognitive, behavioral, emotional, moral)emotional, moral)

• Confidence (self efficacy, self Confidence (self efficacy, self determination, belief in the future, clear & determination, belief in the future, clear & positive identity)positive identity)

• Character (prosocial norms, spirituality)Character (prosocial norms, spirituality)

Source: Catalano et al 1998, Pittman 1993

3

Note: Some of these theories cross cells, particularly the sociological theories. Some explicitly integrative theories cross many cells (e.g., Brooks, Elliott, Jessor).

LEVEL OF TYPES OF INFLUENCE

INFLUENCE INTRAPERSONAL SOCIAL SITUATION/ INTERPERSONAL

ENVIRONMENTAL/ ATTITUDINAL

ULTIMATE Biological theories Psychoanalytic theories Resilience (Garmazey) Personality theories Self-Control (Gottfredson & Hirschi)

Social Control (Elliott) Family Systems (Brooks) Peer Clustering (Oetting)

Class Conflict Low SES Anomie Social Disorganization Strain Theory (Merton) Radical Theories

DISTAL Personal competence Self-Esteem theories Self-Derogation (Kaplan) Personal control theories

Social attachment/ bonding Social Development (Hawkins) Differential Association Social Learning (Akers, Bandura)

(General knowledge) Cultural Identity Values theories Motivation theories

PROXIMAL Social skills Self regulation/ control Self-efficacy (Bandura)

Social Norms theories Conformity theories

Expectancy theories Attitude theories

Fishbein & Ajzen (TRA); Ajzen (TPB)

Feedback Systems Theories

Theoretical Orientation: A Matrix of Theories

4

BEHAVIOR

Intentions/Decision

Environment

Attitudes TowardBehavior

Social Normative Beliefs

IntraPersonal

Self-Efficacy

Social Situation

ENVIRONMENT

GENETICS

The Theory of Triadic Influence

5

DECISIONS/INTENTIONS

SOCIAL SITUATION

Values/Evaluations

Knowledge/Expectancies

BIOLOGY/PERSONALITY

THE THEORY OF TRIADIC INFLUENCE

ATTITUDESTOWARD THE

BEHAVIOR

PerceivedNorms

Information/Opportunities

InterpersonalBonding

SocialCompetence

CULTURALENVIRONMENT

SOCIALNORMATIVE

BELIEFS

Interactions w/Social Instit’s

Others’Beh & Atts

Motivationto Comply

Skills:Social+General

Trial Behavior

Related Behaviors

Sense ofSelf/Control

EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological

SelfDetermination

SELF-EFFICACYBEHAVIORAL

CONTROL

Nurture/CulturalBiological/Nature

1 2 3

7 8 9 10 11 12

13 14 15 16 17 18

19 20 21

22

23

g h i

jk

l m no

p q r

CF

IB E H

J

K

Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream

s

t u v w

x

a

b c d e

f4 5 6

A D G

DistalPredisposingInfluences

ProximalImmediatePredictors

Levels ofCausation

UltimateUnderlyingCauses

Social/Personal Nexus

Expectancies & Evaluations

Affect andCognitions

Decisions

Experiences

Notes: 1. affective and cognitive substreams2. feedback loops3. Interactions between streams

6

DECISIONS/INTENTIONS

SOCIAL SITUATION

Values/Evaluations

Knowledge/Expectancies

BIOLOGY/PERSONALITY

THE THEORY OF TRIADIC INFLUENCE

ATTITUDESTOWARD THE

BEHAVIOR

PerceivedNorms

Information/Opportunities

InterpersonalBonding

SocialCompetence

CULTURALENVIRONMENT

SOCIALNORMATIVE

BELIEFS

Interactions w/Social Instit’s

Others’Beh & Atts

Motivationto Comply

Skills:Social+General

Trial Behavior

Related Behaviors

DistalInfluences

ProximalPredictors

Levels ofCausation

UltimateCauses

Sense ofSelf/Control

EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological

SelfDetermination

SELF-EFFICACYBEHAVIORAL

CONTROL

Nurture/CulturalBiological/Nature

1 2 3

7 8 9 10 11 12

13 14 15 16 17 18

19 20 21

22

23

g h i

jk

l m no

p q r

CF

IB E H

J

K

Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream

s

t u v w

x

a

b c d e

f4 5 6

Social/Personal Nexus

Expectancies & Evaluations

Affect andCognitions

Decisions

Experiences

A D G

CHARACTER

CONFIDENCECOMPETENCE CONNECTEDNESS

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

SP

E

S P

ES

P

ES

P

E

SP

8

Ecological Theories (Bronfrenbrenner)

9

The TTI Developmental-Ecological System

P PS S

S

E

P

Eval

Behavior

SNB SelfEfficacy

Att Att

Intentions

Will + Skill ExpMc NB

KnowValue SocialBonds

RoleModels

Self-Control

Com-petence

SNB

ValuesEnvironment

KnowledgeEnvironment

ENVIRONMENT

Situation

PersonE E

Affective/Control Substream

s

Cog

nitiv

e/C

ompe

tenc

e S

ubst

ream

s

DEVELOPMENT & TIME

UltimateUnderlyingCauses

Levels ofCausation

DistalPredisposingInfluences

ProximalImmediatePredictors

10

All Behaviors Have Common CausesNationalSocio-

Cultural Environment

Political, Economic,Media, Religious

Values, Attitudes

Local Community,Families, SchoolsRelationships with Others

Others’ Attitudes, Behaviors

Social Normative BeliefsSense 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

AchievementNo Drugs

Health

Care

Physical

Healthy Behavior

s

Eating/Diet

ADHD

Conduct Disorder

Mental Health

Anxiety/Depress

11

% Ever had sex by lifetime risk behavior count 1991-2007 (Youth Risk Behavior Survey)

Santelli, et al., J Adolescent Health, 2009

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

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

15

ABAN AYA: Male odds of sexual intercourse by condition

0

0.5

1

1.5

2

6 7 8

Grade

Cha

nge

in lo

g od

ds o

f sex

ual i

nter

cour

se

HEC SDC S/C

16

ABAN AYA: Male condom use by condition (logit )

0.0

0.5

1.0

1.5

2.0

6 7 8

Grade

Chan

ge in

logi

t of c

ondo

mus

e

HEC SDC S/C

17

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

0

1

2

3

4

5

6

T1 T2 T3 T4 T5

Time of measurement

Lev

el o

f b

ehav

ior

Hi Risk Program

Hi Risk Control

Med Risk Program

Med Risk Control

Lo Risk Program

Lo Risk Control

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

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

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

How You

Like To Be

Treated

Feelings Empathy

How to Treat

Others

Conflict Resolution

Communica -tion Skills

Social Context/

Situations

Others’ Behavior

& Approval

Social Bonding/ Attachment

Family School Neighborhood Peers

Others’ Expectations

Desire to Please

Social Normative

Beliefs

INTENTIONS/DECISIONS

BEHAVIORExperiences from

Behavior

Self Concep

t

Health & Drug Info

Thinking Skills Creativity Decision-Making Problem-Solving

Self Managemen

t

Time, Energy, Talents, Money, AngerSocial &

Emotional Health

Socio-Cultural

Environment

Information Environment

General Values

Expected

Consequences

Evaluation of Outcomes

Mass Media Regulations Religion

Economy

Attitudes Toward the

Behavior

IntraPersonal (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

AlternativeConsequences

Mapping of Positive Action content onto the TTI

22

Hawaii: Lifetime Prevalence of Substance Abuse, Violent Behaviors, & Sexual Activity: 5th grade (no significant interactions)

0

5

10

15

20

25

TobaccoUsage

Alcohol Been Drunk Any IllicitDrug Use

Been High onDrugs

Carried aknife or razorto use to hurt

someone

Threatened tocut or stabsomeone

Cut orstabbed

someone onpurpose tohurt them

Carried a gun Shot atsomeone

Voluntary sexwith someone

of theopposite sex

Lif

etim

e P

reva

len

ce (

%)

Control Positive Action

Substance Abuse Violent Behaviors Sexual Activity

--------------SUBSTANCE ABUSE------- ---SERIOUS VIOLENT BEHAVIORS--- SEX

Beets et al., in press AJPH

23

Effects of PA on Student Absenteeism Hawaii Randomized Trial (4 yrs of PA)

(Multiple baseline - 1997-2001)

8.5

9

9.5

10

10.5

11

11.5

12

12.5

1997 1998 1999 2000 2001 2002 2003 2004 2005* 2006* 2007*

Year (* indicates significant differences between conditions)

Avera

ge D

ays A

bsen

t

CONTROL Means

PA Means

STATE Standard

Snyder et al, under review

24

Effect of PA on SAT (Stanford 9) Reading ScoresHawaii Randomized Trial 2000-2006 (4 yrs of PA)

(No testing in 2001 due to a teacher strike)

69

70

71

72

73

74

75

76

77

78

79

2000 2002 2003 2004 2005 2006* 2007*

Year (* indicate where conditions significantly different)

% S

co

rin

g A

vera

ge o

r B

ett

er

CONTROL Means

PA Means

STATE

25

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

30

40

50

60

70

80

Posi

tive B

eh

avi

ors

0 1 2 3 4Year

PA Group Control Group

Hawai'iEstimated Change in Positive Behavior

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

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

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