Developing and Improving After-School Programs to Enhance Youth’s Personal Growth and Adjustment: A Special Issue of AJCP

Participating in after-school programs (ASPs) has become a common experience for children. This special issue provides a perspective on the current status of research on ASPs. This introductory article overviews the historical and current context of ASPs and then describes a developmental ecological model to guide research in this area. The model offers a framework from which to organize and synthesize the research presented in this issue. Key principles include a holistic view of development that recognizes interrelations between multiple domains of youth adjustment, attention to multiple, relevant factors within and outside of youth that affect development, examining the dynamic interplay between persons, program features, and other contexts over time, and understanding the active role of youth in affecting their own development. These principles are examined in relation to five main areas: youth characteristics, social ecologies, program features, participation, and short- and long-term outcomes. Recommendations for future research are discussed.     

Can we Build on Social Movement Theories to Develop and Improve Community‐Based Participatory Research? A Framework Synthesis Review

A long‐standing challenge in community‐based participatory research (CBPR) has been to anchor practice and evaluation in a relevant and comprehensive theoretical framework of community change. This study describes the development of a multidimensional conceptual framework that builds on social movement theories to identify key components of CBPR processes. Framework synthesis was used as a general literature search and analysis strategy. An initial conceptual framework was developed from the theoretical literature on social movement. A literature search performed to identify illustrative CBPR projects yielded 635 potentially relevant documents, from which eight projects (corresponding to 58 publications) were retained after record and full‐text screening. Framework synthesis was used to code and organize data from these projects, ultimately providing a refined framework. The final conceptual framework maps key concepts of CBPR mobilization processes, such as the pivotal role of the partnership; resources and opportunities as necessary components feeding the partnership's development; the importance of framing processes; and a tight alignment between the cause (partnership's goal), the collective action strategy, and the system changes targeted. The revised framework provides a context‐specific model to generate a new, innovative understanding of CBPR mobilization processes, drawing on existing theoretical foundations.     

Pharmacological and Behavioral Strategies for Smoking Cessation

After over two decades of intensive research, a variety of smoking cessation strategies, both behavioral and pharmacotherapeutic, have been developed and clinically validated. In this review, pharmacological products available for smoking cessation are profiled and examined for efficacy. Results of a recent comprehensive review and meta-analysis by the Agency for Health Care Policy and Research on the effects of behavior therapy on smoking cessation are also discussed. Further, meta-analyses and studies exploring the important interaction between pharmacological and behavioral therapies are considered. Applications of the growing wealth of smoking cessation strategies are discussed with respect to the needs of some special subpopulations of smokers including highly nicotine-dependent smokers and smokers with comorbid psychiatric diagnoses.     

VERB™ Summer Scorecard: Findings from a Multi-level Community-based Physical Activity Intervention for Tweens

The benefits of physical activity for adolescents are well established. Multi-level interventions may be especially effective in establishing and sustaining health-enhancing behaviors. This study explored the influences of a multi-level community intervention aimed at increasing physical activity among tweens (youth 9–13). Two Florida school districts far apart served as intervention and comparison sites in a quasi-experimental post-test design. Youth in grades 5 through 8 in the intervention community (n = 1,253) and comparison community (n = 866) completed an anonymous post-intervention survey. An intent-to-treat analysis did not show any statistically significant group differences for the physical activity outcomes examined. However, a subset analysis revealed that students who reported participating in the intervention were more likely to be physically active than youth in the comparison group, as well as youth in the intervention community who reported not participating. Participating in the intervention was significantly related to meeting recommendations for vigorous physical activity (OR = 2.08, P = 0.0259), being physically active on weekends (OR = 1.84, P = 0.0017), and reporting more days of trying a new game or sport (OR = 1.49, P = 0.046) after controlling for grade, gender, race/ethnicity, and SES. These findings support the efficacy of multi-level interventions to create effective health behavior change, especially when linkages among community, media, schools, and the home are present.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

A follow-up of a media-based,worksite smoking cessation program

Described an examination of data collected 2 years following the onset of a media-based, worksite smoking cessation intervention. Thirty-eight companies in Chicago were randomly assigned to one of two experimental conditions. In the inital 3-week phase, all participants in both conditions received self-help manuals and were instructed to watch a 20-day televised series designed to accompany the manual. In addition, participants in the group (G) condition received six sessions emphasizing quitting techniques and social support. In the second phase, which continued for 12 months, employees in G participated in monthly peer-led support groups and received incentives, while participants in the nongroup (NG) condition received no further treatment. Twenty-four months after pretest, 30% of employees in G were abstinent compared to only 19.5% in NG. This study is one of the few experimentally controlled worksite smoking cessation interventions to demonstrate significant program differences 2 years following the initial intervention. Our thanks to Lori Klett and Libby Yeager-Turner for their help in data collection. Work on the project was supported in part by National Institute on Drug Abuse grant DA-04406-01 and a grant from the Chicago Lung Association to the second author.     

Cigarette Smoking, Anxiety, and Depression

This review provides a detailed analysis of anxiety and depression as they relate to each stage of the cigarette smoking cycle: initiation, maintenance, and cessation with an emphasis on nicotine withdrawal. An analysis of the literature confirms that cigarette smoking is highly comorbid with anxiety disorders and clinical depression, and that this relationship appears to be moderated by factors such as age of the smoker, type of disorder, and level of nicotine dependence. Studies also offer evidence to suggest a relationship between smoking and both subclinical anxiety and depression. Research findings have not revealed whether common factors influence the development of anxiety, depression, and smoking, whether anxiety and depression lead to smoking, or whether the reverse is true. Nevertheless, a current understanding of the links among smoking, anxiety, and depression confirms current prevention and cessation techniques, as well as suggests new directions for research and clinical practice.     

Nature and Role of Change in Anxiety Sensitivity During NRT-Aided Cognitive-Behavioral Smoking Cessation Treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M _age = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.     

REDUCING THE ILLEGAL SALES OF CIGARETTES TO MINORS: ANALYSIS OF ALTERNATIVE ENFORCEMENT SCHEDULES

The majority of adolescent smokers are able to purchase cigarettes even though laws prohibit the sale of cigarettes to minors (Radecki & Zdunich, 1993). The present study focused on merchant licensing, civil penalties, and monitoring of merchant behavior. Several different schedules of enforcement in the city of Chicago were evaluated to determine the optimal schedules to reduce the sale of cigarettes to minors in a major metropolitan area. Schedules of 2, 4, and 6 months were effective in reducing illegal sales, from 86% to 19%, 87% to 34%, and 87% to 42%, respectively. In a control condition, illegal sales remained high (approximately 84%). Cigarette control laws that regularly enforce civil penalties for tobacco sales violations can successfully reduce minors' access to cigarettes.