Papers by Rebecca Dudovitz
Health Promotion Practice, Sep 26, 2022
“Bring Change 2 Mind” (BC2M) high school clubs may destigmatize mental illness among club members... more “Bring Change 2 Mind” (BC2M) high school clubs may destigmatize mental illness among club members, but clubs’ (1) reach and impact on non-club members at the same school, (2) connection to student help-seeking attitudes, and (3) mechanisms by which they destigmatize mental illness, are unknown. This community-partnered evaluation involved pre/post surveys of predominantly Latino (72%) students at three urban public schools and focus groups and interviews with a sample of club members (n = 26/65, 40%) and all club staff (n = 7, 100%). Multivariate regressions tested relationships between variables. In 84% of the student body responded in the Fall (n = 1,040) and Spring (n = 1,031). Non-club member engagement in BC2M (reach) increased from 25% (Fall) to 44% (Spring) (p < .01). Engagement with BC2M clubs was associated with decreased stigma among members (p < .05) but not non-members (p = .19). Decreased stigma was associated with help-seeking attitudes (p < .01). Possible BC2M mechanisms identified by students and staff include the following: (1) fostering a positive campus climate, (2) normalizing mental health discussions, (3) increasing peer support and help-seeking, and (4) increasing awareness of positive coping behaviors. While BC2M clubs likely reduce stigma for members, effects did not reach non-members, challenging the potential of BC2M clubs as a schoolwide strategy to destigmatize mental health services. Future projects could investigate how to reach non-BC2M members, complement BC2M with other school climate interventions to increase impact, and measure BC2M impact alongside other outcomes relevant to schools, such as academic achievement.
JAMA Pediatrics, May 1, 2019
Journal of Child and Family Studies, Jan 21, 2019
Objectives Schools are thought to have an important impact on adolescent behaviors, but the mecha... more Objectives Schools are thought to have an important impact on adolescent behaviors, but the mechanisms are not well understood. We hypothesize that there are measurable constructs of peer-and teacher-related extrinsic motivations for adolescent behaviors and sought to develop measures of school culture that would capture these constructs. Methods We developed several survey items to assess school behavioral culture and collected self-reported data from a sample of adolescents age 14-17 attending high school in low income neighborhoods of Los Angeles. We conducted exploratory and confirmatory factor analysis to inform the creation of simple-summated multi-item scales. We also conducted a cultural consensus analysis to identify the existence of shared pattern of responses to the items among respondents within the same school. Results From 1159 adolescents, six factors were identified: social culture regarding popular (Cronbach's alpha = 0.84) and respected (alpha = 0.83) behaviors, teacher support (alpha = 0.86) and monitoring of school rules (alpha = 0.85), valued student traits (alpha = 0.67) and school order (alpha = 0.68). Cultural consensus analysis identified a shared pattern of responses to the items among respondents at 8 of the 13 schools. School academic performance, which is based on standardized test results, is strongly correlated with social culture regarding popular behaviors (Pearson's correlation coefficient r = 0.64), monitoring of school rules (r = 0.71), and school order (r = 0.83). Conclusions The exploratory and confirmatory factor analyses did not support a single, overall factor that measures school culture. However, the six identified sub-scales might be used individually to examine school influence on academic performance and health behaviors.
Journal of School Health, Nov 20, 2022
ABSTRACTBackgroundAdolescent behaviors and academic outcomes are thought to be shaped by school c... more ABSTRACTBackgroundAdolescent behaviors and academic outcomes are thought to be shaped by school climate. We sought to identify longitudinal associations between school climate measures and downstream health and academic outcomes.MethodsData from a longitudinal survey of public high school students in Los Angeles were analyzed. Eleventh‐grade health and academic outcomes (dependent variables, eg, substance use, delinquency, risky sex, bullying, standardized exams, college matriculation), were modeled as a function of 10th‐grade school climate measures (independent variables: institutional environment, student‐teacher relationships, disciplinary style), controlling for baseline outcome measures and student/parental covariates.ResultsThe 1114 student respondents (87.8% retention), were 46% male, 90% Latinx, 87% born in the United States, and 40% native English speakers. Greater school order and teacher respect for students were associated with lower odds of multiple high risk behaviors including 30‐day alcohol use (odds ratio [OR] 0.81; 95% confidence interval [CI] [0.72, 0.92] and OR 0.73; [0.62, 0.85]) and 30‐day cannabis use (OR 0.74; [0.59, 0.91] and OR 0.76; [0.63, 0.92]). Neglectful disciplinary style was associated with multiple poor health and academic outcomes while permissive disciplinary style was associated with favorable academic outcomes.Implications for School Health Policy, Practice, and EquitySchool health practitioners may prospectively leverage school environment, teacher‐student relationships, and disciplinary style to promote health and learning.ConclusionsOur findings identify specific modifiable aspects of the school environment with critical implications for life course health.
Public Health Reports, Jul 1, 2022
Objectives National data on the health of children and adolescents exposed to commercial sexual e... more Objectives National data on the health of children and adolescents exposed to commercial sexual exploitation (CSE) are lacking, during both adolescence and adulthood. Using nationally representative data, we examined the health of male and female adolescents in grades 7-12 who experienced CSE exposure and subsequent adult health outcomes and access to health care. Methods Our retrospective cohort study used data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (1994-2008) to characterize relationships between CSE exposure before or during adolescence and health during adolescence and adulthood. The analytic sample included 10 918 adult participants aged 24-34 in Wave IV. We performed bivariate analyses, stratified by sex, to quantify the relationship between CSE exposure before or during adolescence and adolescent and adult health outcomes. Results Four percent of participants reported having a CSE exposure before or during adolescence (5% of males, 3% of females). Factors associated with CSE exposure among adolescents included race/ethnicity, parental education level, previous abuse, same-sex romantic attractions, history of ever having run away from home, and substance use. During adolescence, exposure to CSE was associated with worse overall health, depressive symptoms, and suicidal thoughts for both males and females. In adulthood, adolescent CSE exposure was associated with depression among males and functional limitations among females. A higher percentage of males with CSE exposure before or during adolescence, compared with their non–CSE-exposed peers, used the emergency department as their usual source of care during adulthood. Conclusions CSE exposure before or during adolescence was associated with poor adolescent and adult health outcomes and health care access. Observed differences between males and females warrant further exploration.
Substance Use & Misuse, May 9, 2023
Progress in Community Health Partnerships, 2011
• To improve insecticide-treated net use for the prevention of malaria by involving the community... more • To improve insecticide-treated net use for the prevention of malaria by involving the community in the creation and implementation of an intervention.
Journal of Adolescent Health, Mar 1, 2023
Academic Pediatrics, 2023
Annals of global health, Mar 12, 2015
Social Science & Medicine, Mar 1, 2021
Objectives:School racial/ethnic segregation in U.S. schoolsDifferences in school racial/ethnic co... more Objectives:School racial/ethnic segregation in U.S. schoolsDifferences in school racial/ethnic composition may increase health disparities by concentrating educational opportunities that confer long-term health benefits in schools serving predominantly wwhite students. For racial minority students, high concentrations of white students may increase exposure to racismis also associated with psychologicstress, which may ultimately reduceing the long-term health benefits from educational opportunities. Meanwhile associations of racial/ethnic academic tacking within schools and health have been mixed. We sought to test whether: 1) differences in racial/ ethnic composition between schools and, 2) racial/ethnic distribution of students in academic tracks within schools are associated with long-term health benefits or risks for white, Black and Latinx students.Methods:We analyzed the National Longitudinal Study of Adolescent to Adult Health (12,438 participants, collected 1994–2008), to test whether the school-level segregation (percent of non-Latinx white students at participants’ school during adolescence) was associated with adult health outcomes at ages 18–26 & 24–32, controlling for contextual factorscomparing Black, Latinx, and white students, and controlling for contextualf factors. A secondary analysis explored whether racial/ethnic cohorting across levels of English courses was associated with each health outcome.Results:Attending a school with a higher percent of white students was associated with higher adult depression scores, substance abuse, and worse self-rated health for black Black students; lower depression scores, better self-rated health, and alcohol abuse for white students; and no health differences for Latinx students. Greater within school racial/ethnic cohorting across English courses was associated with increased odds of alcohol abuse for white students; decreased odds of alcohol abuse for Black and Latinx students; and decreased odds of drug abuse for Black students.Conclusion:Among Bblack youth, attending a school with a higher percentage of white students is associated with worse behavioral health in adulthood. Understanding the potential impacts of school racial/ethnic composition on health is critical to designing policies that maximize access to opportunity and health.Education policies should comprehensively address school quality and racism to maximize adult health.
PLOS ONE
The success of personal non-pharmaceutical interventions as a public health strategy requires a h... more The success of personal non-pharmaceutical interventions as a public health strategy requires a high level of compliance from individuals in private social settings. Strategies to increase compliance in these hard-to-reach settings depend upon a comprehensive understanding of the patterns and predictors of protective social behavior. Social cognitive models of protective behavior emphasize the contribution of individual-level factors while social-ecological models emphasize the contribution of environmental factors. This study draws on 28 waves of survey data from the Understanding Coronavirus in America survey to measure patterns of adherence to two protective social behaviors–private social-distancing behavior and private masking behavior–during the COVID-19 pandemic and to assess the role individual and environmental factors play in predicting adherence. Results show that patterns of adherence fall into three categories marked by high, moderate, and low levels of adherence, with ...
Journal of Adolescent Health
Journal of Adolescent Health
Pediatrics
BACKGROUND AND OBJECTIVES Academic tracking is a widespread practice, separating students by prio... more BACKGROUND AND OBJECTIVES Academic tracking is a widespread practice, separating students by prior academic performance. Clustering lower performing students together may unintentionally reinforce risky peer social networks, school disengagement, and risky behaviors. If so, mixing lower performing with high performing youth (“untracking”) may be protective, leading to better adolescent health. METHODS Advancement via Individual Determination (AVID), a nationally-disseminated college preparatory program, supports placing middle-performing students in rigorous college-preparatory classes alongside high-performing peers. We conducted the first randomized, controlled trial of AVID in the United States, randomizing 270 students within 5 large public high schools to receive AVID (AVID group) versus usual school programming (control group). Participants completed surveys at the transition to high school (end of eighth grade/ beginning of ninth grade) and the end of ninth grade. Intent-to-t...
Pediatrics
Adolescence is a critical transition period that sets the stage for adulthood and future health o... more Adolescence is a critical transition period that sets the stage for adulthood and future health outcomes. Marked by key developmental milestones in brain maturation, increasing independence from parents, and greater connections to peers, adolescence is also a time of heightened risk for behavioral health problems, including substance use, violence, delinquency, and mental health issues. High school completion is a significant life course event and a powerful social determinant of health and health disparities. Jessor’s Theory of Problem Behavior suggests that adolescent health behaviors and mental health problems are closely tied to poor educational outcomes and peer network formation in a reinforcing feedback loop, or vicious cycle, often leading to school failure, school disengagement, and drop-out. Schools are a novel platform through which vicious cycles can be disrupted and replaced with virtuous ones, simultaneously improving education and health. This article describes the po...
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Papers by Rebecca Dudovitz