Effects of a comprehensive character education program on student smoking – Findings from 4 studies Brian R. Flay, D.Phil. Professor, Public Health Oregon State University Corvallis, OR Welcome to the Positive Action Program for Academics, Character, and Prevention. Carol Gerber Allred, Ph.D. developed and taught Positive Action, as high school social studies elective in Twin Falls, Idaho from 1974 to 1977, then was asked to expand the program to the elementary school. In 1982, she founded Positive Action, Inc., and to date, the program has been used in over 10,000 schools, in every state in the U.S., as well as internationally. The number of students whose lives have been changed by the practice of positive actions is in the millions. Brian Flay, D. Phil., a Professor at Oregon State University, a world-renowned social psychologist and researcher in health promotion and prevention, has conducted a number of evaluations and is now overseeing two randomized experimental studies. The early quasi-experimental evaluations indicated numerous positive results, and Dr. Flay was intrigued. The comprehensive Positive Action program was confirming his theory, the Theory of Triadic Influence. Eventually, another kind of positive result came out of this collaboration between program developer and researcher, Brian and Carol are now husband and wife. Society for Research on Nicotine and Tobacco, Portland, OR, Feb 29 2008

Outline The Positive Action program philosophy and theory The Positive Action program components Evaluations and results Conclusions 2

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I. Overview of PA Program Positive Action (PA) is a comprehensive school-based program designed to promote student character and positive behavior, prevent an array of student problem behaviors, and improve student achievement. PA is grounded in a broad theory of self-concept that posits (a) students’ self-concepts and characters are determined by how they behave and how they feel about themselves when they do various behaviors and (b) making positive and healthy behavioral choices results in feelings of self-worth. Major features of the program include: Teacher delivered scripted PA curriculum lessons in classroom Teacher and school staff modeling/reinforcement of “PA behaviors” inside and outside of the classroom School-wide activities (e.g., PA assemblies) led by principal and PA Committee 4

Positive Action Overview The core of Positive Action is contained in an underlying philosophy. The philosophy is described in the Thoughts-Actions-Feelings Circle. Positive Action teaches the positive actions for the whole self through six units that are contained in five program components. The five completely prepared components are: K–12 curriculum, Climate Development, Counselors program, Family program, and Community program. 5

Ref. (Reference) Cognitive Behavior Therapy and Positive Psychology Basic Philosophy (Theory of Action) of the Positive Action Program & Circle You feel good about yourself when you do positive actions. Ref. (Reference) Cognitive Behavior Therapy and Positive Psychology The most profound concepts are often stated in the simplest terms:  There are two things you need to know about Positive Action.  One is the philosophy: You feel good about yourself when you do positive actions  And the other is the Thoughts-Actions-Feelings Circle, demonstrating how our thoughts lead to our actions, which creates feelings about ourselves. The circle can be either positive or negative. 6

C.F. (Reference) Depression Basic Philosophy (Theory of Action) of the Positive Action Program & Circle ...and You feel bad about yourself when you do negative actions. C.F. (Reference) Depression And you feel bad about yourself when you do negative actions.  Four-year-olds understand this. 7

II. The POSITIVE ACTION Program Components K–12 classroom curriculum over 1,200 lessons - using Teacher’s Kits (manuals and materials for each grade), classroom teachers present 15–20-minute lessons Principal’s Kits (Elementary and Secondary) a school-climate program to promote the practice and reinforcement of positive actions in the whole school population (students and staff) Counselor’s Kit used with selected individual students, small groups and families Family Kit contains prepared weekly home lessons paralleling the school program along with school parent-involvement activities Community Kit manuals and materials that align and encourage collaboration of all the environments (schools, families and community) involved in the program 8

Positive Action Focus Units (Learning Goals) In the classroom curriculum and all other materials, the Positive Action content is taught through six focus units. Unit 1: Self-Concept: What It Is, How It’s Formed, and Why It’s Important (Philosophy & Circle) Unit 2: Physical and Intellectual Positive Actions for a Healthy Body and Mind (includes motivation to learn) Unit 3: Social/Emotional Positive Actions for Managing Yourself Responsibly Unit 4: Social/Emotional Positive Actions for Getting Along with Others by Treating Them the Way You Like to Be Treated (Social-Emotional Skills & Character) Unit 5: Social/Emotional Positive Actions for Being Honest with Yourself and Others (Mental Health) Unit 6: Social/Emotional Positive Actions for Improving Yourself Continually (Setting & Achieving Goals) The purpose of the unit learning goals is to teach how our thoughts, actions, and feelings in the physical, intellectual, social, and emotional domains influence the development of character, self-concept, prevention of substance abuse and violence, development of intellectual skills and motivation to learn, creating positive relationships, academic and professional achievement, and the creation of a life worth having. 9

Logic/Theoretic Model of the Expected Effects of the Positive Action Program Program Components Immediate Outcomes Climate Development, Family Kit, Teacher/Staff Training, K–12 Instruction Curriculum, Drug Education Supplements, Community Kit, Counseling Kit * Improved relationships among school administrators, teachers, parents & community. * Improved classroom management. * Increased involvement of school with parents & community. Improved Learning Environment Expected Effects Expected Impact PA Unit Attitudes Toward Behaviors, Social Normative Beliefs, Self-Efficacy Fewer Disciplinary Problems; Reduced Substance Use; Less Violence Improved character/self-concept Learning/Study skills Self-Management Interpersonal/social skills Self-honesty, responsibility Goal setting, future orientation Improved Social and Character Development Improved School Attendance, Grades and Test Scores 10

Elementary Curriculum Kits - Grades K–6 Student activity sheets/booklets and materials for 30 students Posters Music Reinforcement stickers Hands-on activities Puppets Flannel board characters Games Others K–6 Instructor’s Manuals 140 15-minute lessons Role-playing Plays Stories Questions Poetry Games 11

Drug Education Curriculum Grade 5 and Middle School Grade 5 Drug Education Supplement Instructor’s Manual 18 15- to 20-minute lessons Stories Questions Student activity booklets and materials for 30 students Posters Music Middle School Drug Education Supplement Instructor’s Manual 30 15- to 20-minute lessons Stories Questions Student activity booklets and materials for 30 students Scripted play: “Escape from the Shadows” Games Posters Music Lessons are taught at the end of each unit of the regular PA curriculum. The kits can also stand alone. 12

Elementary Climate Kit Positive Notes Notepads Positive Action News Music – 27 songs CDs Song books Posters Video Overview Implementation Plan Scope and Sequence Booklet Principal’s manual Support Staff manual Parents’ manual Assemblies Certificates of Achievement Positive Action Balloons Positive Action Calendar Words-of-the-Week Cards Reinforcement Stickers ICU Boxes and Notes Positive Action Tokens 13

Other Program Components Counseling Program Counselor Kit Lessons for individual students or small groups Family Program Classes Home Kit Community Program Community messages and activities Civic engagement Media messages 14

III. Four studies and results I. Intensive Case Study II. Matched control study using archival data III. RCT in Hawaii elementary schools IV. RCT in Chicago Public Schools 15

Study I: Intensive case study of program implement in a small rural school First year of PA in a rural Title I school in Northern Florida. Variation in level of implementation None or Some (7 classrooms) Almost All (7 classrooms) Every Component and Lesson (11 classrooms) Students, Teachers and Parents surveyed at beginning and end of year. 16

Clear dose-response relationship between level of program implementation and student smoking in grades 4 and 5 (Χ2 = 12.6, p < .01, with no diffs. at pretest) 17

Study II: Matched control study using school-level archival data School Report Card data to find matching control schools for the PA schools Poverty (as indicated by percentage of free/reduced lunches) Mobility rates Ethnic distribution We had data on feeder patterns for each middle and high school. Data on whether or not each elementary school had actively implemented PA for 4 or more years. 55 PA schools, 29 non-PA schools Calculated % of PA graduates in each middle and high school. Archival data included reports of disciplinary actions for cigarette smoking ANCOVA adjusting for school characteristics. Flay & Allred, Prevention Science, 2003 18

ANCOVA one-tailed p = .03 19

ANCOVA one-tailed p = .04 20

Study III: Randomized Trial in Hawaii Elementary Schools Elementary schools (N = 20) on 3 Islands 5yr Effectiveness Trial Random assignment PA or Control conditions Strata matched on multiple indicators of risk PA schools received: 4yrs (2002-03 through 2005-06) Teacher training Developer, Carol Allred 3-4hrs,initial yr; booster sessions 1-2hrs Technical Support, Project Coordinator Howard Humphries Proc Mixed ANOVA analyses accounting for students clustered within schools 21

Baseline Equivalence: 2000-01 No differences are close to being statistically significant except % free/reduced lunch p = .099 22

Baseline Equivalence on Ethnic Distribution No differences are close to being statistically significant. Sample is fairly representative of all HI schools 23

Hawaii Trial: 30% reduction p = .012 for scale of combine substance use, accounting for nesting of students within schools 24

Hawaii program effects on absenteeism 25

Hawaii dose-response relationship 26

Study IV: Randomized Trial of PA in Chicago Public Schools Elementary Schools (N = 14) 3 yr Effectiveness Trial Random Assignment PA or Control Conditions Strata matched on multiple indicators of risk PA Schools Received: 3 yrs (2003-04 through 2006-07) Teacher Training Developer: Dr. Carol Allred 3-4 hrs training, initial yr; booster sessions 2 hrs, subsequent yrs Technical Support: Chicago Project Coordinator, Vanessa Brechling Data Collection Local (UIC) Multi-site (US Dept of Education) 27

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p = .023 for scale of combined substance use, accounting for clustering of students within schools 30

and significant for suspensions (p = .037) using one-tailed tests. Effects on School-Level reports of misconducts and suspensions (Chicago) In ANCOVA models predicting year 4 differences from year 1 levels and condition, differences at year 4 are marginally significant for misconducts (p = .054) and significant for suspensions (p = .037) using one-tailed tests. 31

IV. Conclusions Implementing school-wide character education programs to address a wide range of outcomes is challenging Limited resources of urban school systems NCLB Evaluation of school-based character/social development programs is complicated by control schools implementing similar programs under “business as usual” conditions Clear dose-response relationships were evident in quasi-experimental evaluations In RCTs program effects on smoking at 5th grade were obtained after 3 or 4 years of programming School-level reports of misconducts and suspensions strengthen the robustness of the findings Time trends in outcomes and long-term follow-up studies suggest increasing effects over time School-wide social and character development education can be effective at: decreasing multiple negative behaviors, including smoking Implementation challenge in context of NCLB NCLB influences teachers to focus time on students’ standardized test score performance rather than on teaching PA as means to enhance student ability to improve test scores. Evaluation challenges Lack of True Counterfactuals – control schools had school-based prevention programs as well 32

Why does Positive Action have such strong effects in multiple domains? Links all behaviors/actions to feelings, thoughts and values Increases awareness of social influences and correction of normative beliefs Emphasizes universal values and principles, and is appropriate for all ethnic and SES groups Is consistent with multiple theories of education, learning and behavior development and change Works on the multiple social ecologies in which youth live and develop School, home, community 33

Future Research Investigate potential differential impacts of PA based on student gender, child risk level, etc. Investigate whether schools with different levels in the quality of implementation yield different “impacts” Examine impact of PA as student cohort progresses into upper elementary grades (grades 6-8) Critical transitional period within emotional, behavioral, and academic domains 34

Future Work/Needs – The bigger picture Larger scale trials ICCs for attitudes (.03-.1) and behavior (.01-.05) are generally smaller than for achievement (.15-.2) Still need Ns of 20 or more per condition rather than 7-10 Improved measures of integrity and dosage delivered and received Teacher, student and observer reports Contractual reporting systems? Longer term follow-ups Effects take several years to even start emerging Prior work suggests important long-term effects are possible Methods of analysis to accommodate differential implementation Propensity scoring, CACE, instrumental variable 35

Acknowledgments Studies I and II were unfunded, conducted by the author at the University of Illinois at Chicago (UIC). Study III was funded by grant #R01-DA13474 from NIH/NIDA to Brian Flay, initially at UIC then at Oregon State University (OSU). The findings reported from Study IV are based on research conducted as part of the Social and Character Development (SACD) research program funded by the Institute of Education Sciences (IES), U.S. Department of Education through Grant # R215S020218 to UIC (2003-2005) and OSU (2005-2008). The SACD Consortium consists of representatives from IES, the Centers for Disease Control and Prevention (CDC), and the national evaluation contractor, Mathematica Policy Research, Inc. (MPR), and each grantee site participating in the evaluation. The content of this presentation does not necessarily reflect the views or policies of the SACD Consortium members including IES, CDC, and MPR, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Correspondence concerning this presentation should be addressed to Brian R. Flay, D.Phil., Principle Investigator, Department of Public Health, 254 Waldo Hall, Oregon State University, Corvallis, OR 97330, brian.flay@oregonstate.edu. 36

SACD disclaimer statement: The Social and Character Development (SACD) research program funded by the Institute of Education Sciences (IES), U.S. Department of Education includes a national evaluation study conducted by Mathematica Policy Research (MPR), and complementary research studies conducted by each grantee. The findings reported here are based on the complementary research activities carried out by Brian Flay, Oregon State University, and David L. DuBois, University of Illinois at Chicago, under the SACD program. These findings may differ from the results reported for the SACD national evaluation study. The findings presented in this conference presentation are based on a smaller sample size of children, classrooms, and teachers, utilized a different set of outcome measures, and sought to answer complementary research questions. The content of this presentation does not necessarily reflect the views or policies of the SACD Consortium including IES, CDC, and MPR, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Department of Education. 37

Have a Positive Action Day! 38