Objectives. This study aimed to evaluate the psychometric properties of the EPOCH Measure of Adolescent Well-Being in a large sample of Czech high school students. Sample and Settings. Data were collected from 2,967 adolescents (15 to 19 years old) as part of a broader school-based survey conducted across 13 secondary schools in the Czech Republic. Hypotheses. The authors hypothesized that the Czech version of EPOCH would replicate the original five-factor structure and demonstrate good internal consistency and construct validity. Analyses. Analyses included item-level descriptives, test-retest reliability, Mokken scaling, confirmatory factor analysis (CFA), measurement invariance across gender and age groups, and correlations with related constructs. Results. The results confirmed the five-factor model with good fit indices and demonstrated adequate internal consistency (McDonald's omega ranging from .75 to .84). Multi-group CFA supported configural, metric, and scalar invariance, with partial support for strict invariance. EPOCH subscales correlated meaningfully with external variables, in line with theoretical expectations, supporting the instrument's nomological validity. Limitations. The cross-sectional design represents a limitation, restricting conclusions about temporal stability and predictive validity. While the findings provide strong evidence that the Czech version of the EPOCH is a reliable and valid measure of adolescent well-being suitable for use in school-based research and practice, further studies are recommended to reinforce its nomological validity. Given the current selection of external validation measures-such as self-esteem, depressive symptoms, and satisfaction of basic psychological needs in physical education-future research should expand the scope of external variables to more comprehensively examine the theoretical network surrounding adolescent well-being.

We used latent transition analysis with a panel cohort of youth to examine change in cognitive skill use and its influence on self-esteem and drug use. Skills were assessed in the 7th and 9th grades, self-esteem in the 10th grade, and drug use in the 12th grade. Three status groups emerged, including both high and low cognitive skill use, and a class employing mostly self-talk reward strategies. There was moderate stability in status; however, over time, some youth transitioned between classes. The mean levels of 10th grade self-esteem were higher in youth who consistently engaged in cognitive skills or remained moderate self-reinforcers over time. Self-esteem was protective with less drug use reported among those with higher self-esteem and more consistent cognitive skill use. These findings reinforce the importance of teaching youth a wide range of cognitive skills that boost executive functioning, especially given their prospective beneficial effects on self-esteem and drug use.

Sexually transmitted infections (STIs) are most prevalent among emerging adults (ages 18–29) in the USA. Heightened risk of STIs is partly due to increased self-exploration and experimentation during this developmental period, compounded by sexual health misinformation that spreads through peer interactions and online media. Despite a well-documented impact of (false) beliefs on behavior, very little is known about sexual myths among emerging adults in the USA and the structure of these myths. In the current study, we introduce the Sexual Health Myth-Conceptions Scale (SHMCS) with two primary goals: (1) to identify common sexual health myth-conceptions (i.e., a fusion of myths and misconceptions) among US emerging adults and (2) to evaluate the scale’s psychometric properties. A sample of 1,162 US-based emerging adults were recruited through Prolific, an online crowdsourcing platform, and completed the 34-item SHMCS. Item-level characteristics, exploratory factor analysis, exploratory structural equation modeling, and bifactor analysis were used to establish factorial validity. Item response theory (IRT) was used to examine item and scale performance. Results of factor analyses reinforce three persistent factors, including multi-topic or general, pornography use, and STIs/pregnancy. Results of a 2-PL IRT model reinforce good discrimination and moderate item difficulty across the spectrum of myth-conceptions. Although the SHMCS would benefit from further psychometric refinement, it shows promise as a tool for assessing general and domain-specific sexual health myth-conceptions and for advancing understanding their roles in sexual health among emerging adults.

Cognitive development during adolescence is arguably unmatched by any other period of life. Enhanced brain maturation, increased memory capacity, and the acquisition of new cognitive skills help prepare adolescents for adult social roles. Among these skills is cognitive monitoring, or the ability to reflect on one's own thinking-traditionally referred to as "metacognition." Using cross-sectional data from the first wave of a longitudinal panel cohort, we examined three facets of cognitive monitoring: decision-making (e.g., gathering information, evaluating alternatives), self-reinforcement (e.g., praise and encouragement), and affective self-regulation (e.g., emotional control) in four age groups of Czech high school students. Multiple-group confirmatory factor analysis tested primary, higher-order, age and gender-based models. Overall, model fit was acceptable, with only trivial differences in item intercepts, factor correlations, variances, and latent factor means. Primary factor models revealed gender differences favoring girls' use of decision-making strategies and older youth employing more decision-making skills. A higher-order metacognitive factor to account for correlations among the monitoring skills was supported across both age and gender groups. Results are discussed in terms of promoting cognitive monitoring as a key 21st-century skill and advancing higher-order reflective skills as a critical learning task during adolescence.

Adolescents pursue life goals through daily activities that pave the way toward a future or ideal self. Very little is known, however, regarding what youth consider to be important activities in support of their life goals. In the present study, we examined four psychometric methods of weighting and rank ordering activities associated with six life goals (Fitness, Helpful, Smart, Talented, Creative, and Social). Cross-sectional data were obtained from an online survey of 2,001 youth ages 13 to 15 who picked a life goal and then rated whether 21 activities align with their life goal. Eleven of the activities for each goal were selected by ChatGPT and mixed with 10 filler activities (drawn from the remaining life goals). Four weighting methods including an ipsative distribution-based approach, confirmatory factor analysis, item response theory, and multidimensional scaling were used to rank order activities. The distribution method produced upper quartiles based on standard deviation width. Select activities were relatively concordant for six life goals using the four methods, underscoring the uniformity and convergence of these different approaches. All four methods provided evidence of the uniformity of the select 11 activities. Findings are discussed in terms of the composition of adolescent life goals, their rank-order consistency across different weighting schemes, and their conceptual importance as we learn more about what youth consider relevant activities as they pursue their life goals.

Numerous studies have now documented that athletes of different competition levels vary in their motivational styles. Some are internally motivated and train to be better based on intrinsic values, whereas others are controlled by external pressures that drive performance. A third style does not make causal attributions regarding their performance and are amotivated. In the current study, we used latent profile analysis to examine unique typologies of sports motivation in 456 Czech university students comprised of both recreational and more elite athletes participating in various sports and attending a sport education program. Four qualitatively distinct profiles were distinguished varying in the composition of intrinsic, extrinsic, and amotivation. The four profiles differed in their mean levels of social physique anxiety, global self-esteem, and physical self-worth, three markers of how a person feels about themselves in terms of normative standards. Multiple group comparisons based on gender, individual versus team sports, and level of competition reinforced relative consistency in profile composition. Results are discussed in terms of how people can blend different motivational styles, what this portends for self-beliefs, and whether there is relative consistency across meaningful groups.

Background:Insurance companies frequently require prior authorization (PA) for medication prescriptions to ensure quality control and safety. The added layer of scrutiny can contribute to provider dissatisfaction and has been associated with adverse patient outcomes. Health care providers have changed prescribing behaviors to avoid PA. Understanding factors contributing to this phenomenon can facilitate systemic change and better patient care. Objective:The objectives of this study are to identify unique unobserved subgroups of prescribers with similar PA-related behaviors using a finite mixture modeling approach; characterize subgroup membership by important covariates; and examine the influence of subgroup membership on 3 relevant prescribing outcomes. Methods:A cross-sectional, web-based, nationwide survey of 1173 prescribers was oversampled for psychiatry in support of developing a software-as-a-solution to facilitate PA. Latent class analysis included 12 indicators assessing the degree of PA involvement, provider-insurance communication, and the methods of obtaining or avoiding PA. Covariates included age, gender, race, provider role, specialty, number of prescribers, and patient load. Three clinical decision outcomes included prescribing medication other than initially preferred due to PA delays, avoiding newer medications due to anticipated need for PA, and modifying a diagnosis to obtain PA. Results:In total, 1147 prescribers responded with 1144 usable surveys (age, median 50.003 [range 25.00, 72.00] years; 569 (49.74%) females; 67.13% White; 44.84% psychiatrists). In total, 4 unique classes were obtained based on 12 indicators assessing PA-related activities. Classes included a high PA denial class (291 [25.15%]), a Low Volume PA (178 [15.93%]), a class denoted by Problematic Communication Issues with insurers (227 [19.96%]), and a Low Volume PA Class with Problematic Experiences (446 [38.97%]). Only 3 of the 7 covariates (age, specialty type, and patient load) provided additional means to characterize class membership. The observation that certain demographics (race and gender) and provider characteristics (specialty) may not be informative has policy implications and can inform means to improve provider-insurer communication. The largest class reporting problematic PA experiences had significantly higher mean levels for changing their prescribing and diagnostic behaviors than the remaining classes. Conclusions:Providers are not homogeneous regarding their experience with PA and insurance companies. It is, therefore, important to recognize subtle behavioral differences and find ways to accommodate the PA process to their unique needs. This will facilitate the appropriate implementation of PA by insurance companies. Providers can then avoid the need to alter medications, change diagnoses, or resist prescribing newer, effective medications that may require lengthy clinical documentation.

Introduction:The Perceived Locus of Causality (PLOC) scale is widely used to assess motivation in physical education (PE), but no validated Czech version has been available. This study aimed to translate, adapt, and validate the revised PLOC (PLOC-R) in Czech high school students. Methods:A total of 2,967 students (mean age = 16.62, SD = 1.18) completed the Czech-adapted PLOC-R along with measures of psychological need satisfaction and PE engagement. Confirmatory factor analysis (CFA) tested its five-factor structure, while exploratory analyses identified problematic items. Results:The initial model showed moderate fit, but removing three items resulted in better factorial validity of the scale (CFI = 0.94, RMSEA = 0.06). Internal consistency was acceptable (ω = 0.78-0.90), except for external regulation (ω = 0.58). The scale demonstrated strict measurement invariance across gender and grade, and correlations with external variables supported its validity. Discussion:This study provides the first validated Czech PLOC-R, enabling reliable assessment of PE motivation and facilitating cross-cultural comparisons.

In this commentary, I revisit some of the core issues raised in both the first and second special issues on "Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers." I first outline the concerns that I think are of paramount importance and then very briefly dissect each one from the perspective of a prevention scientist. I add commentary where I think the field can benefit and strengthen to advance the "science" of implementation support. At the same time, I also raise several points that I think will contribute to a better understanding of "how" TTA works, for "whom" and under what conditions. This portion of the commentary attends to the different training and learning modalities used for TTA, the argument that capacity building should be the objective, decluttering the constructs of motivation and readiness, and whether we can ever validly assess a public health impact from TTA. I offer suggestions to address each concern and hope that the field can benefit from this discussion as we usher in a new era.

We introduce the second of two special issues that examine the science and practice of implementation support with takeaways for training and technical centers (TTACs). Major goals of both issues were to provide: rationale, concepts, and tools for evaluating training and technical assistance (TTA); an evidence-base for TTACs; and greater understanding of what is required to close the research-practice gap. To achieve these ambitious goals, we encouraged submissions from a broad array of individuals and groups involved in TTA. The seven articles in this second issue were written by a diverse mix of individuals affiliated with TTACs, federal agencies, research-oriented think tanks, and implementation scientists whose focus is on advancing the TTA literature. We felt that the collective wisdom garnered from their experiences would complement the first issue (June 2024) and collectively forge ahead and provide a vision of what is to come. We also thought it would be useful to provide perspectives on what it looks like when readers could examine both issues as a whole. Therefore, we included five commentaries-from the two editors and esteemed colleagues-who help provide a holistic perspective on the present and future of the science and practice of implementation support.

students could readily access class materials (e.g., handouts, tests, and supplementary lesson materials) and upload homework assignments.In addition to their academic instructional role, schools are also a primary source of distributing various supplemental prevention and intervention services that affect the health and well-being of children [15].In many cases, these programs were considerably curtailed if not completely reduced.Beginning in March 2020 when stay-at-home orders were initiated nationwide, the implementation of drug prevention programs like D.A.R.E.'s keepin' it REAL were cut back as police officers that teach this program had limited access to schools.This provided a rare opportunity to document and examines the impact of COVID-19 on officers' delivery of the program.Such a focus falls in line with other efforts to examine the effects of the pandemic disruption on educational practices and the detrimental effects of a national lockdown on student academic performance [16,17] and mental health [18][19][20]. Concerns about the Disruption of In-class InstructionThere is a general consensus that school closure would have some adverse effect on students, particularly those who have specific definable needs.This might include students who are economically

Our study addresses the limited availability of well-validated scales for assessing general sexual knowledge among college populations. To fill this gap, we examined the psychometric properties of a 41-item sexual knowledge scale derived from the Sexual Knowledge and Attitudes Test - Adolescents (SKAT-A) in a sample of young adults aged 18-25 (N = 1,291). We employed classical test theory (CTT) procedures, followed by item response theory (IRT) and computerized adaptive testing (CAT), to refine the SKAT-A knowledge scale. Both CTT and IRT analyses identified six items for removal due to poor discrimination and difficulty parameters. A confirmatory factor analysis supported a well-defined unidimensional latent trait of sexual knowledge. The results of CAT simulations using dynamic item administration demonstrated the scale's measurement precision, with moderate test reliability and relatively low standard errors. On average, there was a 54.3% reduction in the number of items administered without compromising scale reliability. This study concludes that the SKAT-A efficiently assesses a unidimensional trait of sexual knowledge in college-attending young adults. It highlights that only a subset of items from the full test bank is necessary to achieve this, providing a practical and reliable tool for assessing sexual knowledge in this population.

Objective: Despite a growing emphasis on holistic student wellness in higher education, sexual well-being often remains neglected as part of wellness. We conducted a website content review to assess the broad utilization of wellness models and the specific integration of sexual well-being into wellness programs. Methods and results: Targeting 51 flagship and top 50 private institutions, we found that 82.35% of flagships and 64.00% of top private institutions mentioned some form of the wellness model. However, integration of the wellness model into on-campus or local resources varied considerably across institutions. Importantly, only two institutions (both private) addressed sexuality as its own unique dimension of wellness. Conclusion: The current study underscores the need for wellness programs to include a focus on sexual well-being. Skills and knowledge that college students learn through wellness programs can help them make better health decisions and improve their quality of life while in college and beyond.

Physical activity in the form of “active breaks” can be combined with academic instruction in primary school. However, few studies have examined the feasibility of conducting active breaks in secondary school. To address this gap, we conducted focus groups (FGs) regarding the implementation of an active breaks (ABs) protocol with 20 teachers and 10 secondary school students. Barriers/facilitators toward the implementation of ABs were classified using grounded theory inductive methods framed by the socio-ecological model. Individual-level factors were instrumental for both teachers and students. Teachers highlighted personal fears and concerns regarding using ABs, while students reported fears related to peer behaviour during the activity. Both teachers and students agreed that ABs can improve cognitive skills and time-on-task behaviour. Teachers articulated concerns related to student behaviour during ABs including possible social exclusion and injury. Students felt that ABs might affect classroom management and interfere with maintaining students’ academic focus. Teachers underscored that ABs required social support from the administration and colleagues. Students felt that ABs could support teachers’ instructional focus and provide them with an energy respite. Collectively, the FGs suggested that environmental limitations could hinder the implementation of ABs. Involving teacher and student feedback during the codesign phase can rationally inform the design of school-based ABs.

This exploratory cross-sectional study, guided by primary socialization theory, examined relations between four primary socialization agents of sexual learning (i.e., mothers, fathers, friends/peers, and online media) and sexual attitudes, sexual knowledge, and risky sexual behavior. Latent-variable structural equation models were tested using self-report data obtained from 515 emerging adults who had spent at least 6 months attending in-person college classes. Results showed that learning about sex from mothers was associated with more conservative sexual attitudes and lower risky sexual behavior. Sexual learning from friends/peers was linked to liberal sexual attitudes and greater sexual knowledge. Learning from online media was associated with increased sexual knowledge. To account for a shift in sexual learning patterns from before to after entry to college, we created algebraic difference scores for each source of sexual information. Greater reliance on sexual learning from friends/peers in the past 6 months of college relative to before college was associated with liberal sexual attitudes and greater sexual knowledge. Additional analyses revealed different effects of learning about sex from mothers more during college than before college between those living on campus vs. commuters living at home. The discussion emphasizes the different role that each of the primary socialization agents plays for emerging adults’ sexual development, including the protective role of mothers against risky sexual behavior, the impact of friends and peers on sexual attitudes and knowledge, and the shifting dynamics of socialization processes during college.

ObjectivesPractice-to-recommendations gaps exist in croup management and have not been critically investigated. This study examined the therapeutic management of croup among a national sample of Italian pediatric providers.MethodsA survey was administered online to a sample of primary care and hospital-based pediatricians. Demographic data, perception regarding disease severity, treatment and knowledge of croup, choices of croup treatment medications, and knowledge of and adherence to treatment recommendations were compared between hospital and primary care pediatricians. Oral corticosteroids alone, oral corticosteroids with or without nebulized epinephrine and nebulized epinephrine plus oral or inhaled corticosteroids were considered the correct management in mild, moderate and severe croup, respectively. The determinants for correct management were examined using multivariate logistic regression analysis.ResultsSix hundred forty-nine pediatricians answered at least 50% of the survey questions and were included in the analysis. Providers reported extensive use of inhaled corticosteroids for mild and moderate croup. Recommended treatment for mild, moderate and severe croup was administered in 46/647 (7.1%), 181/645 (28.0%) and 263/643 (40.9%) participants, respectively. Provider's age and knowledge of Westley Croup Score were significant predictors for correct management of mild croup. Being a hospital pediatrician and perception of croup as a clinically relevant condition were significant for moderate croup.ConclusionsSignificant differences exist between recommended guidelines and clinical practice in croup management. This study suggests wide variability in both the treatment of croup and clinical decision making strategies among hospital and primary care pediatricians. Addressing this issue could lead to noteworthy clinical and economic benefits.

AIM:People may differ in their vaccine-related beliefs (i.e. efficacy, safety, purpose), with a host of factors influencing these differences. This can produce homogeneous groups of individuals who share certain beliefs, attitudes and opinions not only towards vaccines but science and medicine in general. This study aims to characterise distinct subgroups and identify ideal targets for tailored public health interventions to reinforce favourable vaccine beliefs.METHODS:Latent class analysis was used to derive unique profiles using the 2019 Gallup survey of 140 countries. We modelled a composite of vaccine beliefs and regressed this on class membership and relevant covariates.RESULTS:Patterns of item endorsement indicated a well-fitting five-class model, with classes distinguished based on whether individuals sought personal knowledge about science, medicine and health; trusted science and scientists; and reported confidence in the health care system. The lowest levels of vaccine beliefs were reported by a class lacking trust and confidence and the highest levels were reported by a class endorsing trust, confidence and desiring medical and scientific knowledge. Country-level income was moderately related to class membership, and vaccine beliefs were higher in lower-income countries.CONCLUSIONS:Findings suggest that public health campaigns can focus on improving trust in science and medical providers. Efforts to improve vaccination rates can only be achieved when individuals trust science, view the work of scientists as beneficial and hold favourable views towards health care providers. Individuals will then accrue the necessary wisdom to make good health care decisions that affect not only themselves but also their fellow citizens.

OBJECTIVES:Prior authorization (PA) aims to promote the safe and effective use of medications and to control costs. However, PA-related administrative tasks can contribute to burden on health care providers. This study examines how such tasks affect treatment decisions.STUDY DESIGN:Cross-sectional, online survey.METHODS:We conducted an online survey of US medical providers in 2020 based on a convenience sample of 100,000 providers. Multivariate path analysis was used to examine associations among provider practice characteristics, step therapy and other health plan requirements, perceived burdens of PA, communication issues with insurers, and prescribing behaviors (prescribing a different medication than planned, avoiding prescribing of newer medications even if evidence-based guideline recommendations are met, and modifying a diagnosis). Weighted analyses were conducted to assess nonresponse bias.RESULTS:A total of 1173 respondents (1.2% response rate) provided 1147 usable surveys. Step therapy requirements had the largest effect on clinical decision-making. Other significant effects on clinical decision-making included perceived PA likelihood, communication issues, and health plan requirements (eg, clinical documentation). Weighted analyses showed that the study conclusions were unlikely to have been biased by nonresponse.CONCLUSIONS:Respondents report that they may alter clinical decisions to avoid PA requirements and related burdens, even in cases in which use of the PA medication was clinically appropriate. Processes that reduce the administrative burden of PA through improved communication and transparency as well as standardized documentation may help ensure that PA more seamlessly achieves its goals of safe and effective use of medications.

The acquisition of healthy dietary and exercise habits during childhood is essential for maintaining these behaviors during adulthood. In early childhood, parents have a profound influence on a child's lifestyle pursuits, serving as both role models and decision-makers. The present study examines family factors as potential contributors to healthy lifestyle habits and their child's overall diet quality among a sample of primary school children. A secondary aim is to evaluate several aspects of diet quality using the Mediterranean adaptation of the Diet Quality Index-International (DQI-I). This cross-sectional study involved 106 children enrolled in a primary school located in Imola, Italy. Data were collected from October to December 2019 using an interactive tool used to assess parent characteristics, children's lifestyle, food frequency (ZOOM-8 questionnaire), and actigraph accelerometers to capture children's physical activity and sedentary behavior. Adherence to the Mediterranean Diet (expressed by KIDMED Index) was positively associated with fathers' educational level, parental sport participation, and the parent's overall nutritional knowledge. Higher mothers' educational level was inversely associated with children's leisure screen time. Parents' nutritional knowledge was positively related to children's average daily minutes of organized sport activities. The better score for DQI-I was for consumption adequacy, followed by variety and moderation. The lowest score was for overall balance. The present study reinforces the importance of family factors in young children's lifestyle choices, particularly their dietary, leisure time, and exercise habits.