White young adults in the United States are at elevated STD and HIV risk when they engage in high-risk behaviors. Black young adults, however, are at high risk even when their behaviors are normative. Factors other than individual risk behaviors and covariates appear to account for racial disparities, indicating the need for population-level interventions.

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Objectives Using a randomized controlled trial in rural eastern Zimbabwe, we tested whether comprehensive support to keep orphan adolescent girls in school could reduce HIV risk. Methods All orphan girls in grade 6 in 25 primary schools were invited to participate in the study in fall 2007 (n=329). Primary schools were randomized to condition. All primary schools received a universal daily feeding program; intervention participants received fees, uniforms, and a school-based helper to monitor attendance and resolve problems. We conducted annual surveys and collected additional information on school dropout, marriage, and pregnancy rates. We analyzed data using generalized estimating equations over 3 time points, controlling for school and age at baseline. Results The intervention reduced school dropout by 82% and marriage by 63% after 2 years. Compared with control participants, the intervention group reported greater school bonding, better future expectations, more equitable gender attitudes, and more concerns about the consequences of sex. Conclusions We found promising evidence that comprehensive school support may reduce HIV risk for orphan girls. Further study, including assessment of dose response, cost benefit, and HIV and herpes simplex virus 2 biomarker measurement, is warranted.

Individually randomized treatments are often administered within a group setting. As a consequence, outcomes for treated individuals may be correlated due to provider effects, common experiences within the group, and/or informal processes of socialization. In contrast, it is often reasonable to regard outcomes for control participants as independent, given that these individuals are not placed into groups. Although this kind of design is common in intervention research, the statistical models applied to evaluate the treatment effects are usually inconsistent with the resulting data structure, potentially leading to biased inferences. This article presents an alternative model that explicitly accounts for the fact that only treated participants are grouped. In addition to providing a useful test of the overall treatment effect, this approach also permits one to formally determine the extent to which treatment effects vary over treatment groups and whether there is evidence that individuals within treatment groups become similar to one another. This strategy is demonstrated with data from the Reconnecting Youth program for high school students at risk of school failure and behavioral disorders.Methods for analyzing data from randomized experiments have been widely disseminated for the case where the unit of randomization matches the unit to which treatment is administered. Approaches for analyzing data in which individuals are randomly assigned to individually administered treatments (e.g., individual therapy) are found in standard univariate and multivariate texts (e.g., Maxwell & Delaney, 2004;Neter, Kutner, Nachtsheim, & Wasserman, 1996). Approaches for analyzing data in which preexisting (intact) groups (e.g., clinics, classrooms, or neighborhoods) are randomly assigned to groupadministered treatments, as in cluster-randomized designs, are also readily available (see Murray & Blitstein, 2003;Raudenbush, 1997). These latter approaches account for lack of independence of observations within group to protect the nominal Type I error rate, either through adjustments of the test statistic and degrees of freedom (e.g., Baldwin, Murray, & Shadish, 2005) or by use of a mixed-effects (multilevel) model (e.g., Janega et al., 2004).A third type of design is also common in practice yet has received comparatively little methodological attention. Under this design, randomization to treatment is done on an individual basis; however, the treatment is administered in a group setting so that multiple Correspondence concerning this article should be addressed to Daniel J. Bauer, Department of Psychology, University of North Carolina, Chapel Hill, NC 27599-3270. dbauer@email.unc.edu. NIH Public Access Author ManuscriptMultivariate Behav Res. Author manuscript; available in PMC 2010 April 13. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript individuals receive the treatment together. The groups are not preexisting but rather are formed by the investigator solely for the purpose of treatment provis...

Teens engaging in risk behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use.

This study examines adoption and implementation of the US Department of Education's new policy, the 'Principles of Effectiveness', from a diffusion of innovations theoretical framework. In this report, we evaluate adoption in relation to Principle 3: the requirement to select research-based programs. Results from a sample of 104 school districts in 12 states indicate that many districts appear to be selecting research-based curricula, but that the quality of implementation is low. Only 19% of the responding district coordinators indicated that schools were implementing a research-based curriculum with fidelity. Common problems included lack of teacher training, lack of requisite materials, use of some but not all of the required lessons and teaching strategies, and failure to deliver lessons to age-appropriate student groups. This study represents the first attempt to assess the quality of implementation of research-based programs as required by the Principles of Effectiveness. We conclude that low levels of funding, inadequate infrastructure, decentralized decision making and lack of program guidance have contributed to the slow progress in improving school-based prevention.

Descriptive, bivariate, and logistic regression analyses were used to examine attitudes and use among 16 to 25 year olds in California and 10 other states. This study found that although some marijuana-related attitudes changed between 1995 and 1999, use did not increase. These findings suggest that recent policy changes have had little impact on marijuana-related behavior.

Society increasingly holds schools responsible for the effectiveness of health promotion activities, such as drug abuse prevention efforts funded through the federal Safe and Drug-Free Schools program. Consequently, school districts use student surveys as a method for assessing trends and evaluating effects of programs on behavior. Because cost and practical concerns often preclude consistent population-based school survey sampling, risk indicators can provide an essential tool in analyzing needs assessment and program evaluation data. In this paper, three risk measures associated with substance use were selected from among commonly used school surveys. These measures--truancy, grade point average, and recent sexual intercourse--were compared, using meta-analysis techniques, to assess the reliability of risk measures across different survey instruments, different communities, and different points in time. Truancy was judged superior, because of its strong predictive value, particularly among younger students, and because rates can be compared to school records to assess sampling validity over time.