Health Risk Behavior in Late Childhood: Impact of Longitudinal Randomized Trial

描述(由申请人提供)：从小学到中学的过渡增加了健康危险行为的可能性，包括攻击/暴力、抑郁、药物使用和学校脱离/失败。这项研究建议严格测试一项名为4Rs(阅读、写作、尊重和解决)的长期(3年)、学校随机的普遍预防干预对儿童从小学到中学过渡期间健康危险行为的影响。具体地说，本研究将：(1)检验4Rs在从小学到中学的过渡过程中是否会导致儿童的攻击/暴力、抑郁、药物使用和学校脱离/失败的变化；(2)考察预防性干预影响儿童初中健康危险行为的具体因果过程；(3)检验4Rs对儿童健康危险行为的不同影响，包括“发展脆弱”和“生态脆弱”儿童以及女孩和男孩；和(4)进行另外三组探索性分析，以(A)使用动态的、连续的潜在班级模型来检查四个领域之间的共病问题，(B)探索4R在课堂层面上运行的长期影响的两个重要的微语境中介因素的影响，包括同伴生态和课堂气氛，以及(C)使用倾向评分技术来测试结果的敏感性，在考虑到控制学校的任何干预之后。4Rs计划是一项全校干预计划，将预防暴力以及社会和情感学习策略纳入K-5年级的语言艺术课程，在教学冲突解决和基本学术技能之间提供教学联系。在之前的严格评估中，这种干预的早期版本在改变儿童与攻击相关的认知和信念、行为倾向和人际关系、攻击性/暴力行为以及小学期间的学业成就方面取得了有希望的结果。目前的研究建议继续跟踪纽约市18所小学的800多名儿童(其中9所被随机分配接受4R)，从小学结束到中学最后一年。我们估计，这些孩子将转到纽约市100多所中学就读。本研究通过检验小学阶段实施的长期干预对儿童随后向中学过渡的影响，希望对健康危险行为几个关键领域的干预理论和对儿童健康危险行为发生、发展过程和因果过程的理解做出新的贡献。结果将主动传播给地方和国家公共卫生、刑事司法、预防药物使用和与心理健康有关的受众。与公共卫生相关：从小学到中学的过渡既充满了机会，也充满了危险，特别是对城市学校的低收入有色人种儿童来说。平均而言，在小学后期和青春期早期，健康危险行为(如暴力/攻击和犯罪、抑郁、使用药物和学习失败)的比率增加，使儿童和青年面临未来功能不佳的更大风险。本项目利用一个普遍的学校暴力预防和扫盲指导计划的随机分配研究来检查(1)从童年到青春期早期几种主要健康危险行为的性质和发展路径，(2)这些危险行为在多大程度上可以通过小学普遍的预防性干预来改变，以及(3)干预产生影响的重要过程。

DESCRIPTION (provided by applicant): The transition from elementary to middle school entails increased likelihood of health risk behaviors including aggression/violence, depression, substance use, and school disengagement/failure. This study proposes to rigorously test the effects of a long-term (3-year), school-randomized universal preventive intervention called 4Rs (Reading, Writing, Respect and Resolution) on children's health risk behaviors as they make the transition from elementary to middle school. Specifically, the proposed study will: (1) test whether 4Rs produces changes in children's aggression/violence, depression, substance use, and school disengagement/failure over the transition from elementary to middle school; (2) examine the specific causal processes by which the preventive intervention affects children's health risk behaviors in middle school; (3) test differential effects of 4Rs on children's health risk behaviors for subgroups of "developmentally vulnerable" and "ecologically vulnerable" children as well as for girls and boys; and (4) conduct three additional exploratory sets of analyses to (a) examine issues of comorbidity among the four domains using dynamic, continuous latent class modeling, (b) explore the impact of two important micro-context mediators of 4R's long-term impact operationalized at the classroom-level including the peer ecology and classroom climate, and (c) use propensity score techniques to test the sensitivity of the results after accounting for any take-up of the intervention in the control schools. The 4Rs Program is a whole-school intervention that integrates violence prevention and social and emotional learning strategies into the language arts curriculum for grades K-5, providing a pedagogical link between teaching conflict resolution and fundamental academic skills. In a prior rigorous evaluation, an earlier version of this intervention demonstrated promising results in altering children's trajectories of aggression- related cognitions and beliefs, behavioral dispositions and interpersonal relationships, aggressive/violent behavior, and academic achievement over the course of elementary school. The current study proposes to continue to follow over 800 children in 18 New York City elementary schools (9 of which were randomly assigned to receive 4Rs) from the end of elementary school through the final year of middle school. We estimate that the children will move to over 100 middle schools throughout New York City. By testing the effects of a long-term intervention delivered in elementary school on children's subsequent transition to middle school, this study hopes to make new contributions to intervention theory and understanding of the onset, developmental course, and mediating causal process in several key domains of health risk behaviors. Results will be proactively disseminated to local and national public health, criminal justice, substance use prevention and mental health-related audiences. PUBLIC HEALTH RELEVANCE: The transition from elementary to middle school is fraught with both opportunity and danger, especially for low-income children of color in urban schools. On average, rates of health risk behaviors (e.g., violence/aggression and delinquency, depression, substance use, and academic failure) increase during the late elementary and early adolescent years putting children and youth at greater risk for poor future functioning. This project capitalizes on a random assignment study of a universal school-based violence prevention and literacy instruction program to examine (1) the nature and developmental path of several primary health risk behaviors from childhood through early adolescence, (2) the degree to which these risk behaviors are modifiable by a universal preventive intervention in elementary school, and (3) the important process by which the intervention has its impact.