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Positive Action (PA)
Intervention for prevention of substance use, violence, and sexual activity among elementary schoolchildren.
Positive Action (PA) is designed to prevent alcohol and other substance use, violent behaviors, and sexual activity among elementary school students on Hawaiian Islands. It is based in positive youth development and social-emotional and character development theory which is strength-based and focuses on positive aspects of child behavior. PA consists of a classroom-based curriculum, a kit to encourage school-wide climate changes, and family and community involvement components. This was a matched-pair, cluster randomized, controlled study to test PA efficacy. Students received the intervention for 4 to 5 years (1st through 5th grades) and were assessed in 5th grade.
Outcomes
PA reduced negative outcomes. The effect possibly was mediated by changes in academic behaviors.
Youth who participated in PA self-reported that they were significantly less likely to engage in substance use, including both any consumption of alcohol and drinking to intoxication, violent behavior, and sexual activity, compared to youth in the control group. There was a dose-response; students exposed to the program for at least 3 years had significantly lower rates of negative behaviors. However, teacher reports did not consistently confirm behaviors reported by students, and there was no evidence that this change would be stable over time. There was evidence that reductions in negative outcomes were mediated by increases in positive academic behaviors.
Costs
Mid-range costs primarily associated with training and intensity of intervention.
Assuming access to school infrastructure, start-up costs include intensive training of teachers, administrators, and support staff, as well as the PA kit. Ongoing costs include regular re-training across years of the intervention plus booster sessions and mini-conferences. Intervention delivery was intensive and required considerable teacher and school staff time; however, this seems to have been folded into teachers’ regular requirements.
Cultural Engagment
None Reported.
There was no cultural adaptation and no mention of input from community stakeholders.
Participants
Child; Native; Female, Male
Setting
School
Delivery
Multi-level, Face-to-Face
Students attending Hawaiian elementary schools.
The study recruited 1st and 2nd grade students and followed them through 5th grade. Analysis included 5th graders who provided parental consent and student assent (n = 1,714). Participants self-identified as follows: primarily Hawaiian or part Hawaiian (26.1%), multiple ethnic backgrounds (22.6%), American Indian (1.7%), other Pacific Islander (4.7%), Female (50%). Teachers delivered the curriculum in 140 lessons (each 15 to 20 minutes) over several years.
Staffing Needs
Certified Professional, Educator
Elementary school staff including classroom teachers.
Classroom teachers, with support from school administrators and support staff (e.g., counselors), delivered the intervention.
Research Design
Randomized controlled experimental design
Developmental stage of research
Strong research design, but needs further testing among Indigenous youth as well as improved follow-up.
The evidence supporting the use of PA in enhancing positive behaviors and reducing negative behaviors, such as substance use, violent behavior, and sexual activity, is promising. The present study makes use of a control group and a large sample. However, follow-up would be required to evaluate both effectiveness and stability of effects over time. A larger body of evidence assessing PA for Indigenous youth would be helpful.
Potential
Positive Action shows promise in reducing alcohol use and negative behaviors among elementary schoolchildren.
The results of this large-scale, randomized experiment suggest PA successfully reduced the prevalence of negative behaviors among young children attending public schools in Hawaii. The relatively large effects demonstrate the effectiveness of this school-based program, but the single assessment limits the ability to predict stability of effects. There are no specific cultural adaptations or modules that lend themselves to adaptation, which limits transportability.
References
Beets MW, Flay BR, Vuchinich S, et al. Use of a social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii. Am J Public Health. 2009;99(8):1438-1445. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707473. https://doi.org/10.2105/ajph.2008.142919.
Snyder FJ, Acock AC, Vuchinich S, Beets MW, Washburn IJ, Flay BR. Preventing negative behaviors among elementary-school students through enhancing students' social-emotional and character development. Am J Health Promot. 2013;28(1):50-58. https://pubmed.ncbi.nlm.nih.gov/23470183. https://doi.org/10.4278/ajhp.120419-quan-207.2.
Snyder FJ. Socio-emotional and character development: A theoretical orientation. J Character Educ. 2014;10(2):107-127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605220.
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