Determinants of Waterpipe and Cigarette Smoking Progression among a School Based Sample of Adolescents in Irbid, Jordan: A Three-Year Longitudinal Study (2008-2011)

The prevalence of waterpipe smoking exceeds that of cigarettes among adolescents in the Middle East where waterpipe is believed as less harmful, less addictive and can be a safer alternative to cigarettes. This dissertation tested the gateway hypothesis that waterpipe can provide a bridge to initiate cigarette smoking, identified the predictors of cigarette smoking progression, and identified predictors of waterpipe smoking progression among a school-based sample of Jordanian adolescents (mean age ± SD) (12.7 ±0.61) years at baseline. Data for this research have been drawn from Irbid Longitudinal Study of smoking behavior, Jordan (2008-2011). The grouped-time survival analysis showed that waterpipe smoking was associated with a higher risk of cigarette smoking initiation compared to never smokers (P < 0.001) and this association was dose dependent (P < 0.001). Predictors of cigarette smoking progression were peer smoking and attending public schools for boys, siblings’ smoking for girls, and the urge to smoke for both genders. Predictors of waterpipe smoking progression were enrollment in public schools, frequent physical activity, and low refusal self-efficacy for boys, ever smoking cigarettes, friends’ and siblings’ waterpipe smoking for girls. Awareness of harms of waterpipe among boys and seeing warning labels on the tobacco packs by girls were protective against waterpipe smoking progression. In Conclusion, waterpipe can serve as a gateway to cigarette smoking initiation among adolescents. Waterpipe and cigarette smoking progressions among initiators were solely family-related among girls, and mainly peer-related among boys. The unique gender differences for both cigarette and waterpipe smoking among Jordanian adolescents in Irbid call for cultural and gender-specific smoking prevention interventions to prevent the progression of smoking among initiators.

Investigating positive identity development in a school-based youth development project

Adolescence is a pivotal period offering both opportunities and constraints on individual development. It is during this important time that one decides upon and commits to the values, goals, and beliefs which will form one's identity and guide one throughout the lifespan. Positive youth development programs, such as the Miami Youth Development Project's Changing Lives Program, target the formation of a positive sense of identity as a critical intervention point. Through developing a coherent and positive sense of self, adolescents take control of and responsibility for their lives and their decisions. Furthermore, a positive identity has been found to be a developmental asset and is linked to lower risk behaviors and positive outcomes including increased self-esteem, sense of purpose, and a positive view of the future. Positive youth development programs, which promote positive identity development, have been found to be more strongly tied to positive outcomes including skills, values, and competencies than have contextual opportunities. As such, it is critical to determine what leads to positive identity development. ^ The current study used structural equation modeling to evaluate three potential mediators of identity development. Findings indicated good model fit where change in identity commitment and change in identity exploration were mediated by informational identity style, personal expressiveness, and identity distress. There were also significant differences found between the control and intervention groups indicative of intervention effects. The findings of the current study suggest potential areas of intervention as well as the need for further research including longitudinal study and the use of qualitative methodology. ^

“Who’s that Faggot at the Board?”: A School-based Intervention with a Gay Student

This article describes a successful intervention conducted in a public high school in Miami, Florida, to address an incident of harassment based on a student’s sexual orientation. The implications for educators and other school personnel to intervene in such instances are considered.

Commitment language as a predictor of alcohol and marijuana use outcomes among adolescents in school -based group treatment

Despite widespread recognition of the problem of adolescent alcohol and other drug (AOD) abuse, research on its most common treatment modality, group work, is lacking. This research gap is alarming given that outcomes range from positive to potentially iatrogenic. This study sought to identify change mechanisms and/or treatment factors that are observable within group treatment sessions and that may predict AOD use outcomes. This NIH (F31 DA 020233-01A1) study evaluated 108, 10-19 year olds and the 19 school-based treatment groups to which they were previously assigned (R01 AA10246; PI: Wagner). Associations between motivational interviewing (MI) based change talk variables, group leader MI skills, and alcohol and marijuana use outcomes up to 12-months following treatment were evaluated. Treatment session audio recordings and transcripts (1R21AA015679-01; PI: Macgowan) were coded using a new discourse analysis coding scheme for measuring group member change talk (Amrhein, 2003). Therapist MI skills were similarly measured using the Motivational Interviewing Treatment Integrity instrument. Group member responses to commitment predicted group marijuana use at the 1-month follow up. Also, group leader empathy was significantly associated with group commitment for marijuana use at the middle and ending stages of treatment. Both of the above process measures were applied in a group setting for the first time. Building upon MI and social learning theory principles, group commitment and group member responses to commitment are new observable, in-session, process constructs that may predict positive and negative adolescent group treatment outcomes. These constructs, as well as the discourse analysis method and instruments used to measure them, raise many possibilities for future group work process research and practice.

An investigation of the effects of a school-based intervention on feelings of personal expressiveness in multi-problem adolescent youth

This study was conducted to determine the effects of the Changing Lives Program intervention on troubled adolescents' feelings of personal expressiveness, believed to be one domain of positive identity development. Forty-three intervention and twenty nonintervention comparison control participants were given a battery of pre-, post-, and follow-up assessments including the Personally Expressive Questionnaire (Waterman, 1995), which was used to derive participants' feelings of personal expressiveness scores. Using Repeated Measures Analysis of Multivariate Analysis (RMANOVA), a significant four-way interaction of Time X Condition X Gender X Ethnicity was found relative to the Control, Roy's Ɵ = .166, F(2,47) = 3.899, p < .027 indicating that intervention participants' feelings of personal expressiveness did increase significantly relative to the control group. Furthermore, the results suggest differential outcomes based on ethnicity, suggesting the need for future study with respect to specificity of effects and mechanisms of identity formation in differing ethnic subgroups.

The possible selves method in evaluating youth development interventions: The use of Integrated Qualitative /Quantitative Data Analytic Strategies (IQ -DAS)

This study investigated the feasibility of using qualitative methods to provide empirical documentation of the long-term qualitative change in the life course trajectories of “at risk” youth in a school based positive youth development program (the Changing Lives Program—CLP). This work draws from life course theory for a developmental framework and from recent advances in the use of qualitative methods in general and a grounded theory approach in particular. Grounded theory provided a methodological framework for conceptualizing the use of qualitative methods for assessing qualitative life change. The study investigated the feasibility of using the Possible Selves Questionnaire-Qualitative Extension (PSQ-QE) for evaluating the impact of the program on qualitative change in participants' life trajectory relative to a non-intervention control group. Integrated Qualitative/Quantitative Data Analytic Strategies (IQ-DAS) that we have been developing a part of our program of research provided the data analytic framework for the study. ^ Change was evaluated in 85 at risk high school students in CLP high school counseling groups over three assessment periods (pre, post, and follow-up), and a non-intervention control group of 23 students over two assessment periods (pre and post). Intervention gains and maintenance and the extent to which these patterns of change were moderated by gender and ethnicity were evaluated using a mixed design Repeated Measures Multivariate Analysis of Variance (RMANOVA) in which Time (pre, post) was the within (repeated) factor and Condition, Gender, and Ethnicity the between group factors. The trends for the direction of qualitative change were positive from pre to post and maintained at the year-end follow-up. More important, the 3-way interaction for Time x Gender x Ethnicity was significant, Roy's Θ =. 205, F(2, 37) = 3.80, p <.032, indicating that the overall pattern of positive change was significantly moderated by gender and ethnicity. Thus, the findings also provided preliminary evidence for a positive impact of the youth development program on long-term change in life course trajectory, and were suggestive with respect to the issue of amenability to treatment, i.e., the identification of subgroups of individuals in a target population who are likely to be the most amenable or responsive to a treatment. ^

The utility of an Integrated Qualitative /Quantitative Data Analytic Strategy (IQ -DAS) to evaluate the impact of youth development interventions to positive qualitative change in the life course

This study reports one of the first controlled studies to examine the impact of a school based positive youth development program (Lerner, Fisher, & Weinberg, 2000) on promoting qualitative change in life course experiences as a positive intervention outcome. The study built on a recently proposed relational developmental methodological metanarrative (Overton, 1998) and advances in use of qualitative research methods (Denzin & Lincoln, 2000). The study investigated the use the Life Course Interview (Clausen, 1998) and an integrated qualitative and quantitative data analytic strategy (IQ-DAS) to provide empirical documentation of the impact the Changing Lives Program on qualitative change in positive identity in a multicultural population of troubled youth in an alternative public high school. The psychosocial life course intervention approach used in this study draws its developmental framework from both psychosocial developmental theory (Erikson, 1968) and life course theory (Elder, 1998) and its intervention strategies from the transformative pedagogy of Freire's (1983/1970). ^ Using the 22 participants in the Intervention Condition and the 10 participants in the Control Condition, RMANOVAs found significantly more positive qualitative change in personal identity for program participants relative to the non-intervention control condition. In addition, the 2X2X2X3 mixed design RMANOVA in which Time (pre, post) was the repeated factor and Condition (Intervention versus Control), Gender, and Ethnicity the between group factors, also found significant interactions for the Time by Gender and Time by Ethnicity. ^ Moreover, the directionality of the basic pattern of change was positive for participants of both genders and all three ethnic groups. The pattern of the moderation effects also indicated a marked tendency for participants in the intervention group to characterize their sense of self as more secure and less negative at the end of the their first semester in the intervention, that was stable across both genders and all three ethnicities. The basic differential pattern of an increase in the intervention condition of a positive characterization of sense of self relative to both pre test and relative to the directionality of the movement of the non-intervention controls, was stable across both genders and all three ethnic groups. ^

The utility of an integrated qualitative/quantitative data analytic strategy (IQ-DAS) to evaluate the impact of youth development interventions on positive qualitative change in the life course

This study reports one of the first controlled studies to examine the impact of a school based positive youth development program (Lerner, Fisher, & Weinberg, 2000) on promoting qualitative change in life course experiences as a positive intervention outcome. The study built on a recently proposed relational developmental methodological metanarrative (Overton, 1998) and advances in use of qualitative research methods (Denzin & Lincoln, 2000). The study investigated the use the Life Course Interview (Clausen, 1998) and an integrated qualitative and quantitative data analytic strategy (IQDAS) to provide empirical documentation of the impact the Changing Lives Program on qualitative change in positive identity in a multicultural population of troubled youth in an alternative public high school. The psychosocial life course intervention approach used in this study draws its developmental framework from both psychosocial developmental theory (Erikson, 1968) and life course theory (Elder, 1998) and its intervention strategies from the transformative pedagogy of Freire's (1983/1970). Using the 22 participants in the Intervention Condition and the 10 participants in the Control Condition, RMANOVAs found significantly more positive qualitative change in personal identity for program participants relative to the non-intervention control condition. In addition, the 2X2X2X3 mixed design RMANOVA in which Time (pre, post) was the repeated factor and Condition (Intervention versus Control), Gender, and Ethnicity the between group factors, also found significant interactions for the Time by Gender and Time by Ethnicity. Moreover, the directionality of the basic pattern of change was positive for participants of both genders and all three ethnic groups. The pattern of the moderation effects also indicated a marked tendency for participants in the intervention group to characterize their sense of self as more secure and less negative at the end of the their first semester in the intervention, that was stable across both genders and all three ethnicities. The basic differential pattern of an increase in the intervention condition of a positive characterization of sense of self relative to both pre test and relative to the directionality of the movement of the non-intervention controls, was stable across both genders and all three ethnic groups.

A study of the relationship between parental self-efficacy and indicators of school involvement exhibited by Hispanic parents of elementary school children

The purpose of this study was to examine the relationship between Hispanic parents' sense of self-efficacy at various degrees of acculturation to the United States and specific indicators of school involvement in their elementary school children's education. It assessed the effects of acculturation on the level of parental self-efficacy and their degree of school involvement. The theoretical framework guiding this investigation was Bandura's theory of self-efficacy which advocates that the amount of effort a person devotes to the accomplishment of a specific outcome is related to a person's beliefs in their capabilities regardless of actual competencies.^ The research method involved a correlational design measuring levels of parental self-efficacy, acculturation, degree of school involvement and related demographic characteristics. Multiple regression analysis was performed to determine the degree of relationships existing between the predictor variables of self-efficacy and level of acculturation, and level of school involvement. The data was subjected to a path analysis to test the validity of the causal model advanced in this study specifying a positive relationship between the constructs of acculturation, parental self-efficacy and level of school involvement.^ A total of 109 Hispanic parents of students enrolled in five elementary public schools in Dade County, Florida, were selected for participation in the study. Results revealed a significant positive correlation r =.23, p $<$.05 between level of parental self-efficacy and number of hours parents spent helping their children with homework. A statistically significant positive correlation was found between acculturation and level of self-efficacy r =.21, p $<$.05. Statistically significant positive correlations were also found between acculturation and such indicators of parental school involvement as participation in parent-teacher conferences r =.20, p $<$.05, volunteering at school, r =.22, p $<$.05, attendance at school sponsored sports activities r =.26, p $<$.01, and volunteering in field-trips r =.28, p $<$.01.^ The multiple regression analysis equation predicting level of homework assistance provided by parents and self-efficacy was statistically significant, F(2,106) = 3.59, p $<$.03. The beta weights revealed that self-efficacy contributed the most to the prediction of homework assistance by parents, B =.258, p $<$.009. In turn, the variable of acculturation was the most significant predictor of number of school based parent involvement activities, B =.281, p $<$.05 level. The path analysis confirmed the results obtained in the multiple regression analyses, establishing self-efficacy as having a direct effect on the level of homework assistance provided by parents. Conversely, the variable of acculturation had a direct effect on the number of school based parent involvement activities. ^

Making Life Choices Program: A psychoeducational intervention for promoting critical cognitive and affective competencies in adolescents at-risk for problem behaviors

The long term goal of the work described is to contribute to the emerging literature of prevention science in general, and to school-based psychoeducational interventions in particular. The psychoeducational intervention reported in this study used a main effects prevention intervention model. The current study focused on promoting optimal cognitive and affective functioning. The goal of this intervention was to increase potential protective factors such as critical cognitive and communicative competencies (e.g., critical problem solving and decision making) and affective competencies (e.g., personal control and responsibility) in middle adolescents who have been identified by the school system as being at-risk for problem behaviors. The current psychoeducational intervention draws on an ongoing program of theory and research (Berman, Berman, Cass Lorente, Ferrer Wreder, Arrufat, & Kurtines 1996; Ferrer Wreder, 1996; Kurtines, Berman, Ittel, & Williamson, 1995) and extends it to include Freire's (1970) concept of transformative pedagogy in developing school-based psychoeducational programs that target troubled adolescents. The results of the quantitative and qualitative analyses indicated trends that were generally encouraging with respect to the effects of the intervention on increasing critical cognitive and affective competencies. ^

An investigation of the relationship between maltreatment and alcohol and other drug (AOD) problems in African -American and Hispanic adolescent girls

Maltreatment experienced in childhood or adolescence is a known risk factor for later problem alcohol and/or other drug (AOD) use (Bailey & McCloskey, 2005; Shin, Edwards, Heeren, 2009). A growing body of empirical work has found significant associations between adolescent girls’ AOD use and maltreatment experiences. However, questions remain as to how this relation unfolds with African-American and Hispanic adolescent girls. Guided by four relational models that have been proposed in the literature, this study examined the links between maltreatment, trauma symptoms, and alcohol and/or other drug (AOD) problems in a sample of 170 African-American and Hispanic adolescent girls who were participants in a school-based AOD use intervention. Results of this study revealed that maltreatment experiences (physical and emotional abuse) were positively related to trauma symptoms, which were positively related to AOD problem severity, alcohol abuse, alcohol dependency, drug abuse, and drug dependency. Perceived discrimination moderated this relation between sexual abuse and trauma symptoms, such that more perceived discrimination resulted in a stronger effect of sexual abuse on trauma symptoms. Ethnic identity moderated the relation between sexual abuse and AOD problem severity, such that ethnic identity demonstrated protective properties in the relation between sexual abuse and AOD problem severity. My research adds to extant knowledge on the relation between maltreatment and AOD use in adolescent girls and suggests the importance of developing interventions targeting maltreatment and AOD use concurrently.

An Investigation of the Relationship Between Maltreatment and Alcohol and Other Drug (AOD) Use Among African-American and Hispanic Adolescent Girls

Maltreatment experienced in childhood or adolescence is a known risk factor for later problem alcohol and/or other drug (AOD) use (Bailey & McCloskey, 2005; Shin, Edwards, Heeren, 2009). A growing body of empirical work has found significant associations between adolescent girls’ AOD use and maltreatment experiences. However, questions remain as to how this relation unfolds with African-American and Hispanic adolescent girls. Guided by four relational models that have been proposed in the literature, this study examined the links between maltreatment, trauma symptoms, and alcohol and/or other drug (AOD) problems in a sample of 170 African-American and Hispanic adolescent girls who were participants in a school-based AOD use intervention. Results of this study revealed that maltreatment experiences (physical and emotional abuse) were positively related to trauma symptoms, which were positively related to AOD problem severity, alcohol abuse, alcohol dependency, drug abuse, and drug dependency. Perceived discrimination moderated this relation between sexual abuse and trauma symptoms, such that more perceived discrimination resulted in a stronger effect of sexual abuse on trauma symptoms. Ethnic identity moderated the relation between sexual abuse and AOD problem severity, such that ethnic identity demonstrated protective properties in the relation between sexual abuse and AOD problem severity. My research adds to extant knowledge on the relation between maltreatment and AOD use in adolescent girls and suggests the importance of developing interventions targeting maltreatment and AOD use concurrently.

Adapting Mpowerment to a Rural Area

As HIV/AIDS continues to disproportionately impact men who have sex with men (MSM) (CDC, 2010a), effective and timely prevention strategies for this population must be developed. Specifically, evidence-based interventions that can be easily adapted and have proven effectiveness are needed. Hence, the purpose of the current study was to assess the impact of the Mpowerment Project (Hayes, Rebchook, & Kegeles, 2003), a community level HIV prevention program originally designed for young urban gay men, when adapted for rural gay men. The Mpowerment Project is recognized as evidence- based intervention by the CDC (CDC, 2009b). The current study is an extension of this research, assessing Mpowerment model fidelity and the behavioral and attitudinal changes that occurred among participants. Data were collected from participants in a rural area of southeast Idaho from 2002-2004. Data were collected prior to M-Group participation and at a three months follow-up. The 66 individuals completing the M-Group pre and posttest assessment also attended a minimum of three study events and a maximum of 226 events. Results revealed no significant changes in attitudinal variables and all but one behavioral variable among Rural Mpowerment (R-MP) participants. The one significant behavior change was an increase in reported safer sex discussion among friends, indicating a possible change in the social norm regarding safer sex. Results also indicate that program fidelity was maintained and the Mpowerment Project is adaptable to rural areas. However, there was no indication of attitudinal changes in participants of this study. There were no changes in behavioral variables aside from discussion about safer sex with friends increasing. The lack of evidence-based interventions for rural gay men highlights the need for further research on the community impact of the Mpowerment Project on rural participants.

Evaluating heavy episodic drinking effects on educational attainment

Adolescence and emerging adulthood are transition points that offer both opportunities and constraints on individual development. The purpose of this study is threefold: First, to examine two models (i.e., young adolescents in grades 7 and 8 and older adolescents in grade 12) of heavy episodic drinking and examine how heavy episodic drinking affects subsequent educational attainment. By utilizing two different developmental transitions, i.e., middle school to high school and high school to college, it may be possible to better understand the temporal effects of alcohol use and subsequent educational attainment. The second purpose of this study is to examine how alcohol use at Time 1 may lead to the problems in the adolescent's immediate context due to alcohol (i.e., problems with parents, peers, romantic relationships, problems at school) and to examine if these problems affect educational attainment over and above alcohol use alone. The third purpose of this study is to examine the potential gender differences in these models. The study uses data from the National Longitudinal Study of Adolescent Health, which is a large scale, nationally representative school based sample of 20,745 adolescents who were interviewed in grades 7 to 12. Two longitudinal mediational models were evaluated utilizing structural equation modeling. Binge drinking and number of days drunk were used as indicators for a latent variable of heavy episodic drinking (i.e., LHED). In the 7th and 8th grade model, direct effects of LHED were found to predict educational attainment at grade 12. Additionally, in the 7th and 8th grade sample, a mediated relationship was found whereby educational attainment was predicted by problems with parents. Problems with parents were predicted by number of days drunk in the past year. In the 12th grade sample, there were no direct effects or indirect effects of alcohol on educational attainment. This study highlights the need for using a longitudinal framework when examining heavy episodic drinking's effects on educational attainment. ^

Adapting Mpowerment to a rural area

As HIV/AIDS continues to disproportionately impact men who have sex with men (MSM) (CDC, 2010a), effective and timely prevention strategies for this population must be developed. Specifically, evidence-based interventions that can be easily adapted and have proven effectiveness are needed. Hence, the purpose of the current study was to assess the impact of the Mpowerment Project (Hayes, Rebchook, & Kegeles, 2003), a community level HIV prevention program originally designed for young urban gay men, when adapted for rural gay men. The Mpowerment Project is recognized as evidence- based intervention by the CDC (CDC, 2009b). The current study is an extension of this research, assessing Mpowerment model fidelity and the behavioral and attitudinal changes that occurred among participants. Data were collected from participants in a rural area of southeast Idaho from 2002-2004. Data were collected prior to M-Group participation and at a three months follow-up. The 66 individuals completing the M-Group pre and posttest assessment also attended a minimum of three study events and a maximum of 226 events. Results revealed no significant changes in attitudinal variables and all but one behavioral variable among Rural Mpowerment (R-MP) participants. The one significant behavior change was an increase in reported safer sex discussion among friends, indicating a possible change in the social norm regarding safer sex. Results also indicate that program fidelity was maintained and the Mpowerment Project is adaptable to rural areas. However, there was no indication of attitudinal changes in participants of this study. There were no changes in behavioral variables aside from discussion about safer sex with friends increasing. The lack of evidence-based interventions for rural gay men highlights the need for further research on the community impact of the Mpowerment Project on rural participants.