Rulison Kelly L, Feinberg Mark, Gest Scott D, Osgood D Wayne
Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina.
The Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania.
J Adolesc Health. 2015 Oct;57(4):433-40. doi: 10.1016/j.jadohealth.2015.06.007. Epub 2015 Jul 23.
We tested whether effects of the Strengthening Families Program for Youth 10-14 (SFP10-14) diffused from intervention participants to their friends. We also tested which program effects on participants accounted for diffusion.
Data are from 5,449 students (51% female; mean initial age = 12.3 years) in the PROmoting School-community-university Partnerships to Enhance Resilience community intervention trial (2001-2006) who did not participate in SFP10-14 (i.e., nonparticipants). At each of five waves, students identified up to seven friends and self-reported past month drunkenness and cigarette use, substance use attitudes, parenting practices, and unsupervised time spent with friends. We computed two measures of indirect exposure to SFP10-14: total number of SFP-attending friends at each wave and cumulative proportion of SFP-attending friends averaged across the current and all previous post-intervention waves.
Three years post-intervention, the odds of getting drunk (odds ratio = 1.4) and using cigarettes (odds ratio = 2.7) were higher among nonparticipants with zero SFP-attending friends compared with nonparticipants with three or more SFP-attending friends. Multilevel analyses also provided evidence of diffusion: nonparticipants with a higher cumulative proportion of SFP-attending friends at a given wave were less likely than their peers to use drugs at that wave. Effects from SFP10-14 primarily diffused through friendship networks by reducing the amount of unstructured socializing (unsupervised time that nonparticipants spent with friends), changing friends' substance use attitudes, and then changing nonparticipants' own substance use attitudes.
Program developers should consider and test how interventions may facilitate diffusion to extend program reach and promote program sustainability.
我们测试了针对10 - 14岁青少年的强化家庭计划（SFP10 - 14）的效果是否从干预参与者扩散到了他们的朋友。我们还测试了计划对参与者的哪些效果导致了扩散。
数据来自促进学校 - 社区 - 大学伙伴关系以增强复原力社区干预试验（2001 - 2006年）中的5449名学生（51%为女性；平均初始年龄 = 12.3岁），这些学生未参与SFP10 - 14（即非参与者）。在五个时间点的每一个，学生们最多列出七个朋友，并自我报告过去一个月的醉酒和吸烟情况、物质使用态度、养育方式以及与朋友度过的无监督时间。我们计算了两种间接接触SFP10 - 14的指标：每个时间点参加SFP的朋友总数，以及当前和所有之前干预后时间点参加SFP的朋友的累积比例平均值。
干预三年后，与有三个或更多参加SFP的朋友的非参与者相比，没有参加SFP的朋友的非参与者醉酒（优势比 = 1.4）和吸烟（优势比 = 2.7）的几率更高。多层次分析也提供了扩散的证据：在给定时间点有更高比例参加SFP的朋友的累积比例的非参与者，比他们的同龄人在该时间点使用毒品的可能性更小。SFP10 - 14的效果主要通过减少无组织社交的量（非参与者与朋友度过的无监督时间）、改变朋友的物质使用态度，然后改变非参与者自己的物质使用态度，从而在友谊网络中扩散。
项目开发者应考虑并测试干预措施如何促进扩散，以扩大项目覆盖范围并提高项目可持续性。
