In the 1960's, federally funded pre-college academic enrichment programs were created to address the education barriers experienced by underserved students. Yet, the gaps continue to persist. This study examined psychosocial factors (e.g., pro academic identity, intellectual risk taking, social support, intentions, participatory community citizenship, etc.) for improving academic outcomes and wellbeing for participants in an out-ofschool-time (OST) STEM+Medicine program. Participants' psychosocial responses were compared to a control group. Results revealed that program participants showed significant differences on key psychosocial factors compared to non-participants. Significant relationships were shown between the primary variables (i.e., intentions and participatory community citizenship scale-b) and demographic/psychosocial variables through Ordinary Least Squares (OLS) regression and path analysis models.

BACKGROUND:Primary prevention research rarely include measures for multiple risk and protective factor domains for youth alcohol, tobacco, and other drug (ATOD) use onset simultaneously within the same prospective study. The aim of this study is to test the simultaneous longitudinal relationships between risk and protective factors within these 5 domains and ATOD onset among early adolescents. METHODS:Analyses are based on waves 1 to 6 from the Young Mountaineer Health Study cohort that was conducted every ~6 months over a 3-year period between 2020 and 2023 in 20 diverse schools in West Virginia in the United States. For the present analysis, 2916 sets of student data were included from all 6 waves. Longitudinal analyses were conducted using best linear unbiased predictors for all domain exposure variables across the 6 time points using high-performance linear mixed modeling in conjunction with logistic regression. RESULTS:Risk and protective factors within the 5 exposure domains of parents/caregivers, peers, school, leisure time, and community were simultaneously related to odds of substance use onset among early adolescents. CONCLUSIONS:Our findings underscore the need for both basic and prevention research guided by systems-based approaches versus a focus on a limited set of etiological factors.

BACKGROUND:The school climate concept has been promising, but has long-standing critiques that have not been adequately addressed to date. The School as a Protective Factor approach represents one attempt to offer a new approach that builds on and extends beyond the concept of school climate while addressing previously identified limitations. CONTRIBUTIONS TO THEORY:The School as a Protective Factor approach offers a new framework for conceptualizing, measuring, and establishing protective school social and learning environments that co-promote academic achievement and student health in schools, especially student mental health and substance use/abuse prevention. This new framework includes clear definitions, explicit goals, firmly established constructs, validated measures, and an intentionally parsimonious approach that prioritizes the implementation of well-established, high-impact constructs. CONCLUSIONS AND IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The School as a Protective Factor approach presents a simple, easy-to-use means of ensuring a school social environment that meets the developmental, academic, and health needs of all children and adolescents while maximizing protection across a range of desired outcomes. Perhaps most importantly, it does so in a manner that is manageable and easily integrated into every aspect of schooling, resonates with the practical experience of school personnel, and includes brief, effective, and free measurement tools.

Introduction: Caffeine is a psychostimulant possessing arousal, motor activation, and reinforcing properties, which is consumed daily by most adolescents aged 12-19 years. Although current understanding of the implications of adolescent caffeine consumption for school behaviors remains incomplete, studies have shown that in addition to acute effects of the drug, in common with other habit-forming psychoactive substances, regular use leads to physical dependence, evidenced by recurring negative withdrawal symptoms. Methods: Employing two waves of longitudinal data, we tested the prospective association between daily caffeine use and homeroom teacher-observed self-control and problem behavior in a sample of middle-school students in 20 schools in West Virginia in the United States. Caffeine was operationalized with two dichotomized variables, daily consumption of <100 mg, and daily consumption of >100 mg, versus no daily use. Gender, mother's education, family financial status, social support by primary caregiver and adults in school, and school climate, were applied as covariates in linear mixed models. Results: Daily caffeine use of >100 mg was robustly and inversely associated with self-control and positively associated with problem behavior. Conclusions: Caffeine consumption and associated withdrawal symptoms may be an important factor in problematic school behavior among adolescents. Recent advent of highly concentrated caffeine products (e.g., caffeine "shots") commonly marketed directly at youth, should give rise to concerns including consideration about limiting caffeine consumption among children and youth.

The Icelandic Prevention Model (IPM) follows a systematic but flexible process of community capacity building, data collection, analysis, dissemination, and community-engaged decision-making to guide the data-informed selection, prioritization, and implementation of intervention strategies in preventing adolescent substance use. This paper describes two new evaluation tools intended to assess the: 1) integrity of IPM implementation, and 2) unique aspects of IPM implementation in different community contexts. These evaluation tools include a: 1) five-phase IPM Evaluation Framework for Assessing Value Across Communities, Cultures, and Outcomes (IPM-EF); and 2) 10-Step IPM Implementation Integrity and Consistency Assessment (IPM-IICA) that utilizes both quantitative (scored) and qualitative (narrative) data elements to characterize implementation integrity and consistency at both community coalition and school community levels. The IPM-EF includes five phases. Phase 1: Describe the Intervention Context; Phase 2a: Document the Extent to Which the 10 Steps of the IPM were Implemented (using the IPM-IICA scored); Phase 2b: Document the Unique Community-Specific Methods Used within the 10 Steps of the IPM to Tailor Local Intervention Delivery (using the IPM-IICA narrative); Phase 3: Measure Changes in Community Risk and Protective Factors; Phase 4: Measure the Outcomes Associated with the IPM; and Phase 5: Investigate Multiple Full Cycles Over Time.

Background: This study assessed stakeholder experience with the core processes of The Integrated Community Engagement (ICE) Collaborative, a primary prevention approach addressing adolescent substance use in rural West Virginia, after three years of county-level implementation. Objectives: Guided by the Icelandic Prevention Model (IPM), the ICE Collaborative aims to enhance cooperation between researchers, policy makers, local practitioners, and community members and facilitate a paradigm shift in youth and community substance use prevention. This shift involves moving away from strategies focused on the repeated allocation of short-term grants that fund time-limited programs to a long-term, holistic, and sustainable approach overseen by local practitioners and coalitions. Results: We conducted qualitative interviews and focus groups with 33 stakeholders during the fall of 2022. Data analyses generated six major themes: 1) It Takes a Village to Prevent Adolescent Substance Use, 2) Improving Understanding and Commitment to Prevention Through Outreach, 3) Enhancing Student Engagement and Program Accessibility, 4) Addressing the Chronic Underfunding of Prevention and Youth Development Programs, 5) Acknowledging Family Contexts and Family Member Substance Use as Risk Factors, and 6) ICE/IPM Inspiring Solution-based Conversations, Goal Setting, and Strategy Selection. Conclusions: Stakeholders reported multiple positive characteristics of ICE for their communities and applauded the long-term focus and access to local data. Several suggestions for improved strategies were also reported. Results are discussed in line with the theoretical underpinnings of the IPM and current discourse around community health promotion in rural areas.

ABSTRACTBACKGROUNDThe conceptual framework for School as a Protective Factor approach was presented in a companion article in this issue of the journal. The current article describes the validation of the School as a Protective Factor‐Brief (SPF‐Brief), a 13‐item survey measuring the 3 core constructs and 13 defining characteristics of this framework.METHODSThe SPF‐Brief was validated through 2 studies. The developmental study used a longitudinal design including 1349 participants who completed surveys over 5 semesters, while the validation study used a cross‐sectional design with 2775 participants. Both studies included middle and high school students. Factor analysis, growth model analysis, criterion‐related validation, and outcome analysis were employed.RESULTSAnalyses provided strong evidence supporting the reliability and validity of the instrument and conceptual framework. Higher SPF‐Brief scores were associated with higher math grades, English grades, and quality of life, as well as lower rates of anxiety, depression, conduct disorder, alcohol, e‐cigarette, tobacco, and cannabis use. Effect size estimates ranged from moderate to strong.CONCLUSIONSThese findings suggest the utility of the SPF‐Brief instrument and the School as a Protective Factor framework. Together, they may offer advantages to the traditional school climate approach.

Purpose: Gender diverse youth (GDY) experience higher rates of mental health concerns than their cisgender peers, but these can be ameliorated by feeling support from family, school, and community. Little is known about how youth perceptions of support vary by gender identity, especially for younger adolescents and those living in rural areas.Methods: Youth ages 12-19 years completed anonymous surveys including measures of perceived support and a two-step gender identity question. GDY (n = 206) were further categorized into binary and nonbinary gender identities. An additional 500 randomly selected cisgender youth were included for comparison. Multivariate analyses of variance with Tukey post hoc tests were employed to test GDY group differences while accounting for the interaction between scaled measures.Results: Cisgender youth had the highest perceived support across all support measures while youth who shared both binary and nonbinary aspects of their gender identity had the lowest rates of perceived support. The F tests for between-subject effects were statistically significant (p <.001) for all six support measures, and multivariate group testing was statistically significant with Wilks' l 6.38(18,1621.17) = 0.82; p <.001.Discussion: Despite research demonstrating a strong association between perceived support and improved mental health outcomes, GDY in our sample had lower rates of perceived support at the family, school, and community levels. GDY with both binary and nonbinary gender identities had the lowest levels of perceived support. Further research is needed to see if this finding is consistent in other populations and to develop targeted interventions to improve perceived support for this population.(c) 2023 Society for Adolescent Health and Medicine. All rights reserved.

BACKGROUND:Young people who experience higher levels of social support from their schools and families have been shown to be less likely to develop symptoms of negative mental health outcomes such as depression and anxiety.1-4 This raises questions concerning how young people's stress and psychological changes due to the COVID-19 pandemic as well as social support during this time have affected their overall mental health. The aim of this study was to assess the association between sources of parental- and school-level social support and youth perceptions of COVID-19-related emotional impact on mental health among early adolescent girls and boys in Appalachia.METHODS:Using linear regression, we analyzed the first and third wave of survey data from the larger parent study (Young Mountaineer Health Study) cohort, collected in 20 middle schools throughout West Virginia in the fall of 2020 and fall of 2021 (N = 1349, mean age: 11.5, response rate: 80.7%).RESULTS:Approximately half of participants reported knowing someone that had been sick with COVID-19. Those experiencing higher levels of perceived COVID-19-related emotional impact reported greater levels of depression, anxiety, and anger. Both parental and school-level social support were associated with better mental health outcomes.CONCLUSIONS:Early adolescent perceptions of COVID-19-related emotional impact were associated with depression, anxiety, and anger and moderated by social support at home and in school among 11-12-year-old youth in Appalachia.

Background Preventing nicotine use onset among children and youth is an important public health goal. One possible contributor that has received little empirical investigation is caffeine use. The goal of this study was to examine the possible contribution of caffeine to nicotine onset during early adolescence. Methods We used data from the Young Mountaineer Health Study Cohort. Survey data were collected from 1,349 (response rate: 80.7%) 6 th grade students (mean age at baseline 11.5 years) in 20 middle schools in West Virginia during the fall of 2020 and spring of 2021. We limited our analyses to students reporting never having used any form of nicotine at baseline. Logistic regression was employed in analyses. Results Approximately 8% of participants reported having used nicotine at least once between baseline and the follow-up, and 4.7% reported solely using electronic nicotine delivery systems (ENDS) and no other forms of nicotine. In multivariable analyses, we controlled for many environmental, social, and behavioral variables known to influence nicotine use such as alcohol use, peer substance use, and perceived access to nicotine. We formulated our main independent variable, caffeine consumption, as continuous deciles. Any nicotine use, as well as ENDS use only at follow-up, were modeled as dependent variables. Caffeine was significantly associated with nicotine use in both models with ORs of 1.15 (1.04–1.27) and 1.13 (1.00–1.28). Conclusions Caffeine consumption among 6 th grade non-nicotine users was associated with nicotine use at approximately 6-months follow-up.

Background: Adolescent substance use has long been a global public health issue. In this study, we explored developmental contexts that correspond with risk and protective factors associated with adolescent substance use. The developmental contexts of interest are the family domain, school domain, peer domain, and structured leisure domain. The leisure domain is of particular interest as it often corresponds with risk and protective factors different from those associated with the other domains. The purpose of this study was to assess whether the identified domains are associated with adolescent alcohol use and cannabis use.Methods: This study used previously collected adolescent health and behavior surveillance data from (N = 3,407) 7th-12th graders in a Northeastern state in the fall of 2019. The data were used to assess whether the identified domains are associated with adolescent alcohol use and cannabis use. We analyzed each outcome variable using separate multiple regression models.Results: In our model, the peer domain, specifically peer substance use behaviors and peer norms, were the strongest factors associated with substance use. Family and structured leisure offered similar levels of protection against substance use.Conclusions: Implications for utilizing the peer and leisure developmental contexts to prevent adolescent substance use and recommendations for further research and investment are discussed.

BackgroundThere is a great need for effective primary prevention intervention strategies to reduce and delay onset of adolescent substance use. The Icelandic Prevention Model (IPM) showed great success in Iceland over the past twenty plus years, however, evidence for the transferability of model is still somewhat limited. Using data collected in Tarragona during regional efforts to begin adoption of the IPM in Catalonia, this study tested the transferability and stability of the core risk and protective factor assumptions of the IPM overtime and examined trends of lifetime smoking, e-cigarette-use, alcohol-use, intoxication, and cannabis-use within the same time period.MethodsThis study includes responses from 15- to 16-years-olds from two region-wide samples taken in 2015 and 2019 in Tarragona (N = 2,867). Survey questions assessed frequency of lifetime: smoking, e-cigarette-use, alcohol-use, intoxication, and cannabis-use, and the core model assumptions. Demographic data were also collected. Logistic regression models of main effects with and without time interaction were used to test assumptions and their stability across time. Chi-square tests and Wilcoxon–Mann–Whitney U tests were used to compare prevalence of substance use and mean scores of primary prevention variables respectively.ResultsLifetime: smoking (−7%, p < 0.001) and cannabis-use (−4%, p < 0.001) decreased, and e-cigarette-use increased (+33%, p < 0.001) in Tarragona. Lifetime intoxication (−7%, p < 0.001) decreased in a single zone exclusively. Most core model assumptions held in their hypothesised direction across time. The strongest positive association was observed between time spent with parents during weekends and reduced odds of lifetime smoking (OR: 0.62, 95%CI: 0.57–0.67) and the strongest negative association was observed between being outside after midnight and increased odds of lifetime intoxication (OR: 1.41, 95%CI: 1.32–1.51). Mean scores of primary prevention variables also changed disproportionately in Tarragona.ConclusionThis study confirms that the core IPM assumptions are similar in Tarragona as in Iceland and other contexts previously examined. They also indicate that prevalence of lifetime smoking, intoxication, and cannabis-use decreased disproportionately in Tarragona between 2015 and 2019 during the first phase of regional adoption of the model. Thus, targeting model assumptions represents a viable primary prevention strategy for communities that hope to reduce smoking, alcohol-use, intoxication, and cannabis-use among adolescents.

This study discusses a survey that explores youth gender identity in the Appalachian region.

Alcohol use impairs psychosocial and neurocognitive development and increases youth vulnerability to academic failure, substance use disorder and other mental health problems. Early adolescent alcohol use onset is of particular concern, forecasting substance abuse in later adolescence and adulthood. Evidence to date suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to early onset of alcohol use. The objective of the Young Mountaineer Health Study (YMHS) is to investigate the influence of contextual and health behavior variables on early onset of alcohol use among middle school-aged youth in resource-poor Appalachian rural communities. This is a program of prospective cohort studies of ~2,200 middle school youth from a range of twenty rural, small town, and small city (< 30k) public schools in West Virginia. Students participate in 6 waves of data collection (2 per year), over the course of middle school (6th- 8th grades, fall and spring). Based on an organizational arrangement which includes a team of local data collection leaders, supervising contact agents in schools, and an “honest broker” system to de-identify data linked via school IDs, we have been able to collect novel forms of data (self-report, teacher-report, census linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. To date, three waves of student survey data, two waves of teacher data, and a selection of archival school records have been collected. Student survey Wave 1: N = 1,349 (response rate = 80.7%), Wave 2: N = 1,649 (response rate = 87.0%), and Wave 3: N = 1,909 (response rate = 83.1%). The COVID-19 pandemic had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system has proven vitally important in mitigating a potentially far greater negative impact of the pandemic on our data collection processes. The YMHS will employ a large dataset to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Further, the program will test hypotheses regarding contextual factors (e.g., parenting practices, neighborhood collective efficacy) that protect youth from community disadvantage, and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. So far, data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic. Data quality checking, preliminary analyses, and manuscript preparations are currently under way. N/A

Preventing or delaying the onset of alcohol use among children and youth is an important public health goal. One possible factor in alcohol use onset among early adolescents is caffeine. The aim of this study was to assess the possible contribution of caffeine to the onset of alcohol use during early adolescence. We used data from the Young Mountaineer Health Study Cohort. Survey data were collected from 1349 (response rate: 80.7%) 6th grade students (mean age at baseline 11.5 years) in 20 middle schools in West Virginia during the fall of 2020, and again approximately 6 months later in spring of 2021. We limited our analyses to students reporting never having used any form of alcohol at baseline. Logistic regression was employed in multivariable analyses and both Odds Ratios and Relative Risks reported. At follow-up, almost 14% of participants reported having consumed alcohol at least once and 57% used caffeine of 100 mg + daily. In multivariable analyses we controlled for social and behavioral variables known to impact tobacco use. Caffeine use was operationalized as a three-level factor: no use, <100 mg per day, and 100 + mg per day, with the latter being the approximate equivalent of the minimum of a typical cup of coffee or can of energy drink. Caffeine use of 100 mg + per day was significantly related to alcohol use at 6-months follow-up (OR: 1.79, RR: 1.56, p = .037). We conclude that caffeine consumption among 11-12-year-old adolescents may be a factor in early onset of alcohol use.

Journal of School HealthVolume 92, Issue 10 p. 939-940 EDITORIAL Forgotten Student Needs: Providing Access to Play, Rest, Friendship, and Fun Through Recess Michael J. Mann PhD, Corresponding Author Michael J. Mann PhD Editor, Journal of School Health, Associate Professor mmann@ashaweb.org mikemann@boisestate.edu orcid.org/0000-0002-3421-4184 Boise State University, Boise, ID, USAAddress correspondence to: Michael J. Mann, Editor, Journal of School Health, Associate Professor, (mmann@ashaweb.org and mikemann@boisestate.edu), Boise State University, Boise, ID.Search for more papers by this author Michael J. Mann PhD, Corresponding Author Michael J. Mann PhD Editor, Journal of School Health, Associate Professor mmann@ashaweb.org mikemann@boisestate.edu orcid.org/0000-0002-3421-4184 Boise State University, Boise, ID, USAAddress correspondence to: Michael J. Mann, Editor, Journal of School Health, Associate Professor, (mmann@ashaweb.org and mikemann@boisestate.edu), Boise State University, Boise, ID.Search for more papers by this author First published: 07 September 2022 https://doi.org/10.1111/josh.13238Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume92, Issue10October 2022Pages 939-940 RelatedInformation

BackgroundA clinically-certified gene expression profile improved survival in a cohort of stage I-IIA NSCLC patients by identifying those likely to benefit from adjuvant intervention. EGFR mutation status has not provided this type of predictive risk discrimination in stage IA NSCLC, and overtreatment of low-risk stage IB patients may have limited the overall benefit seen recently in the adjuvant application of a third-generation TKI. We compared EGFR mutation data to molecular risk stratification in a prospective, early-stage cohort.Materials and MethodsTwo hundred fifty eligible stage I-IIA non–squamous NSCLC patients underwent prospective molecular risk stratification by the 14-gene prognostic assay. Platinum doublet adjuvant chemotherapy (AC) was recommended for molecular high-risk (MHR). Differences in freedom from recurrence (FFR) and disease-free survival (DFS) were evaluated.ResultsAt 29 months, prospective molecular testing yielded an estimated FFR of 94.6% and 72.4% in low-risk and untreated MHR patients, respectively, and 97.0% among MHR patients receiving AC (P < .001). In contrast, there was no association between EGFR status and recurrence, while molecular risk predicted survival and response to AC within both the EGFR mutation(+) and mutation(-) populations. Sixty-seven percent of EGFR(+) and 49% of EGFR(-) patients were molecular low-risk.ConclusionThis prospective study demonstrates the utility of the 14-gene assay independent of EGFR mutation. Basing adjuvant intervention in early-stage NSCLC on EGFR status alone may undertreat up to 51% of EGFR(-) patients likely to benefit from adjuvant intervention, and overtreat as many as 67% of EGFR(+) patients more likely to be free of residual disease.

There is growing recognition that home visitation programs serving at-risk families may be an appropriate mechanism for detecting and reducing intimate partner violence (IPV). More research is needed about how home visitors assess and respond to IPV, especially in rural and underserved areas with unique social and geographic challenges. This study describes the qualitative, needs assessment phase of a larger mixed-methods evaluation of IPV assessment, referral processes, and safety planning with clients within a statewide home visitation program. Three focus groups were conducted with home visitors (n = 16) in West Virginia's Home Visitation Program in May 2015. Home visitors represented four separate home visitation models and provided services across 12 of West Virginia's 55 counties. Guiding questions focused on home visitors' current protocol, experiences, barriers, and facilitators to (a) screening and assessment for IPV, (b) making referrals after disclosures of IPV, and (c) developing safety plans with IPV-exposed clients. Barriers identified by home visitors included the nature of assessment tools, issues with service availability and access in rural areas, and lack of education and training surrounding safety planning. Facilitators included building relationships and trust with clients, providing anticipatory guidance when making referrals, and tailoring safety plans to clients' unique situations. Participants also expressed a critical need to develop procedures for assuring home visitor safety when supporting IPV-exposed clients. These qualitative data highlight issues surrounding the management of IPV in home visitation and have the potential to inform future enhancements to programs that are specifically tailored to the needs of rural, disadvantaged communities.