The proposed research will examine long-term effects of an innovative partnership-based intervention delivery model called PROSPER (PROmoting School/community-university Partnerships to Enhance Resilience). Primary effects examined will be reductions in emerging adult substance misuse, antisocial behaviors, and sexual risk behaviors for AIDS and other STIs, along with improvements in healthy adult functioning, among project participants who received evidence-based interventions during middle school. This proposed work extends a randomized control study of the PROSPER model, involving two sequential cohorts of youth and families from an understudied rural population. A total of 28 rural school districts in IA and PA, ranging in size from approximately 1,300 to 5,200 students, were selected and randomly assigned to either the PROSPER partnership condition or to a usual programming control condition. Local teams in the PROSPER partnership sites selected and implemented family-focused and school-based evidence-based interventions (EBIs) for middle school students. The evaluation of intervention outcomes began with approximately 12,000 students (90% of those eligible) in the two cohorts who participated in a 6th grade pretest assessment; follow-up assessments with the students in these cohorts were conducted each spring, through the 12th grade. Following 12th grade, 2,000 randomly selected students from that sample were recruited for continued follow-up assessments. The proposed study will extend those follow-ups to ages 22 and 24.
Aims of the proposed study are to: (1) evaluate long-term substance misuse behaviors, anti-social behaviors and sexual risk behavior outcomes of the PROSPER partnership-supported middle-school EBIs; and (2) evaluate mediators and moderators of long-term EBI effects, informed by an extension of the outcome model specified in the original study. Positive results from the first two grant periods have established PROSPER effectiveness, with evidence of: effective functioning of community teams; strong participation in EBIs; long-term, high quality EBI implementation; sustainability of teams and EBIs; and economic analyses indicating PROSPER efficiency. Most importantly, results show strong EBI outcomes through middle and high school, with positive effects on: young adolescent competencies (e.g., peer refusal skills); parenting effectiveness and family functioning; reduced adolescent conduct problems; and reduced misuse of a wide range of substances through the end of high school. These results suggest a unique opportunity for demonstrating early preventive intervention impacts on healthy adult functioning; the prospect of establishing such impacts would constitute a compelling case for national diffusion of the PROSPER model. Literature reviews failed to reveal another study with a comparably large rural sample that allows assessment of intervention effects on general health, reduced problem behaviors, reduced sexual risk behaviors for AIDS/STIs, and other benefits for participants as they transition into adulthood.
The proposed study examines how an innovative system for delivering evidence-based preventive interventions designed for general populations can have substantial public health impact. It extends earlier outcome research that already has demonstrated: (1) the viability and sustainability of the system; (2) practically-significant relative reduction rates for a number of problem behaviors through adolescence, including prescription drug misuse; (3) stronger effects among higher-risk participants in some cases; and (4) evidence of economic efficiencies. Further potential public health and economic benefits will be evaluated by studying long-term effects of interventions at the emerging adult stage, including effects on sexual risk behaviors for AIDS and other STIs; a highly important aspect of this study is its focus on understudied rural middle school students and their families.
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