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需要增加健康风险行为的可能性，包括攻击/暴力，抑郁，药物使用和学校脱离/失败。本研究旨在严格检验一项长期（3年）、学校随机化的普遍预防性干预（4Rs，阅读、写作、尊重和解决）对儿童从小学过渡到中学的健康风险行为的影响。具体而言，本研究将：(1)检验4Rs是否在小学至中学过渡阶段对儿童的攻击/暴力、抑郁、物质使用和学校脱离/失败产生影响；(2)探讨预防干预影响中学儿童健康危险行为的具体因果过程；(3)检验4Rs对“发育脆弱”和“生态脆弱”儿童亚群以及男孩和女孩健康风险行为的差异影响；(4)进行三组额外的探索性分析，以(a)使用动态的、连续的潜在类别建模来检查四个领域之间的共病问题，(b)探索在课堂层面上运行的4R长期影响的两个重要微观情境中介的影响，包括同伴生态和课堂气候。(c)使用倾向评分技术来测试结果的敏感性，在考虑到任何在对照学校采取干预措施后。4Rs计划是一项全校干预，将暴力预防和社会情感学习策略整合到K-5年级的语言艺术课程中，在教学冲突解决和基本学术技能之间提供教学联系。在之前的一项严格的评估中，这种干预的早期版本在改变儿童在小学期间与攻击相关的认知和信念、行为倾向和人际关系、攻击/暴力行为和学业成就的轨迹方面显示出了有希望的结果。目前的研究计划继续跟踪纽约市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。我们估计孩子们将会转到纽约市的100多所中学。本研究通过对小学阶段长期干预对儿童升学的影响进行检验，以期对健康风险行为的发生、发展过程和中介因果过程的干预理论和理解做出新的贡献。将积极向地方和国家公共卫生、刑事司法、药物使用预防和与精神健康有关的受众传播结果。公共卫生相关性：从小学到中学的过渡充满了机遇和危险，特别是对于城市学校的低收入有色人种儿童。平均而言，在小学后期和青少年早期，健康风险行为（例如暴力/攻击和犯罪、抑郁、药物使用和学业失败）的发生率增加，使儿童和青少年面临未来功能不良的更大风险。本项目利用一项基于学校的普遍暴力预防和扫盲教学计划的随机分配研究来检验(1)从童年到青春期早期几种主要健康风险行为的性质和发展路径，(2)通过小学普遍预防干预可以改变这些风险行为的程度，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.