Randomized Trial of a Social Networks Intervention
Condition: Adolescent Behavior
Study type: Observational

Summary: 
      Advancement via Individual Determination (AVID) is a college preparatory program that
      provides a unique opportunity to determine whether schools can reduce substance use by
      re-grouping at-risk students with high-performing students, while providing additional
      academic and emotional support. Operating in 4,837 K-12th grade schools worldwide and across
      45 US states, this widely-disseminated program targets students from groups traditionally
      underrepresented in higher education who are currently performing in the academic middle
      (i.e., a 2.0-3.5 grade point average). AVID removes these students from typical classrooms
      and exposes them to a peer network in which academic performance and positive social norms
      are valued. In addition, by strengthening the student/teacher relationship, AVID expands
      students' networks of supportive adults. For low-income minority students in the academic
      middle, relatively small investments in prevention might significantly impact their academic
      and health trajectories. AVID capitalizes on a moment when social networks are in flux-the
      transition to high school-to shift these students' trajectories.

      This study is a longitudinal, randomized pilot evaluation of AVID among low-income minority
      adolescents entering high school, comparing academic performance and drug use, as well as
      other risky behaviors, over 3 years. Although social networks are hypothesized to have a
      strong influence on behavior, few studies have tried to re-wire networks to change behaviors.
      This study will provide a clearer understanding of whether schools can intentionally shape
      networks and whether these changes can reduce substance use. This study will also explore
      important mechanistic questions about whether and how AVID changes peer networks and
      relationships with teachers, whether those changes lead to improvements in academic and
      behavioral outcomes and, if so, what the relative importance of peer versus adult network
      changes are.
    

Detailed description: 
      Substance use is an increasing problem among adolescents. Despite decades of prevention work,
      most recent data suggest that, by the end of high school, a quarter of teens regularly use
      marijuana and nearly half regularly use alcohol. While adolescent marijuana use has increased
      across the country in the last decade, rates in California are higher than the national
      average. This may be partially attributable to increased social acceptance and access through
      legalized dispensaries. As the movement to legalize marijuana gains traction, similar changes
      are likely to occur throughout the country. The high prevalence of alcohol and marijuana use
      is particularly disturbing in light of evidence that even intermittent adolescent exposure
      may have long-term impacts on brain development, in addition to associations with other risky
      health behaviors and future substance abuse disorders. African American and Latino youth are
      especially at risk, making adolescent substance use prevention a potentially important
      strategy to address health disparities.

      Few effective and sustainable substance use interventions exist for high school students.
      Preventing substance use becomes more challenging as adolescents age, with fewer prevention
      programs demonstrating success for high school youth than for middle school youth. The
      challenge is to identify modifiable predictors of substance use for high-school youth and
      harness them for prevention. Furthermore, most interventions are difficult to disseminate and
      sustain due to limits on financial and human capital. AVID is already widely implemented in
      public schools. Thus, if AVID is effective in reducing substance use while also improving
      academic outcomes, the program would serve as a promising model for future interventions.

      Social networks are likely to powerfully influence adolescent substance use. There is strong
      and consistent evidence that adolescent substance use is closely tied to the behaviors and
      attitudes of individuals in their social network. Social network structure and composition
      are shaped by cultural and environmental factors. In school environments, these factors
      include policies like tracking of students based on prior achievement. Social networks then
      determine sources of support, transmission of social norms, and access and opportunity to
      engage in substance use. Although peers are powerful points of influence during adolescence,
      relationships with supportive adults can continue to protect against substance use.

      Despite great interest in social networks as potential determinants of risky behaviors,
      causal pathways linking social networks with adolescent health have yet to be fully
      categorized. Studies suggest that changes in social networks can impact substance use, but
      little is known about how to harness this relationship effectively. Answering this question
      may have applications across many social environments and health domains. Interventions that
      re-wire social networks might offer a relatively low-cost, self-sustaining, and effective
      means to prevent some of the most challenging behaviors that lead to poor health outcomes.
      School environments present a critical opportunity to impact adolescent health. Through
      near-daily exposure, school environments have the potential to shape adolescents'
      relationships, social norms, sense of identity, and educational attainment. These factors are
      likely to be mutually reinforcing and are strongly associated with substance use.

      AVID, a widely used educational intervention, offers an important opportunity to test whether
      schools can re-wire social networks to improve adolescent health. AVID removes
      middle-performing students from a typical school environment, where social pressure often
      reinforces low academic achievement and problem behaviors, and places them alongside
      high-performing students in a college-preparatory environment where positive social norms are
      valued. AVID capitalizes on a natural transition point, when social networks are in flux, by
      targeting students at the beginning of 9th grade. Perhaps not coincidentally, 9th grade is
      also an enormously vulnerable period-36% of high school drop-outs do so in 9th grade, and
      only 15% of 9th graders who are held back will ever graduate. Finally, the program emphasizes
      the student/teacher relationship, training teachers to serve as mentors and student
      advocates, providing both academic and emotional support to cultivate a family-like
      atmosphere. Through the proposed randomized controlled pilot evaluation of AVID,
      investigators can measure whether the program successfully changes social networks, and test
      whether changes in social networks motivate changes in substance use. Understanding whether
      AVID's return on investment extends to health outcomes is vitally important given the limited
      resources available to support multiple competing K-12 education initiatives.

      The Los Angeles Unified School District (LAUSD) implemented AVID to provide academic and
      social support to students from groups traditionally under-represented in higher education
      (e.g., students of color, first generation to attend college). AVID is an international
      non-profit institution originally established in 1980 by a San Diego high school teacher.
      AVID's goal is to prepare vulnerable students functioning in the academic middle for success
      at a 4-year university. Students in each school must actively apply to the program to
      demonstrate both eligibility and interest. AVID's eligibility criteria include having a grade
      point average of 2.0-3.5 and returning a contract signed by the student and a parent
      indicating that the student chooses to participate in the program, has a desire to go to
      college, and agrees to enroll in rigorous academic courses. Identification of eligible
      candidates for AVID occurs during the second half of 8th grade, prior to high school entry,
      and is led by the AVID coordinator. At nearly every AVID high school, the number of students
      who qualify for AVID far outweighs the program's capacity-there are, on average, 40 AVID
      slots per school, which results in AVID serving only 12% of the student body. In LAUSD, the
      demographics of AVID students match those of the district-low-income, and African American or
      Latino. For example, in 2014, 86% of LAUSD's AVID students were Latino, 6% were African
      American, and 89% qualified for free or reduced lunch.

      LAUSD's AVID program has agreed to allow investigators to recruit study participants from the
      pool of students who meet the AVID eligibility requirements as well as a group of high
      performing (middle school grade point average (GPA) >3.5) students who are not AVID eligible.
      Near the end of 8th grade, LAUSD will randomize all AVID eligible applicants through a
      lottery into either AVID or a waitlist group. Prior to the random assignments being revealed,
      investigators will ask all students randomized into AVID and an equal number of students
      randomized into the waitlist group to return a signed parental consent form for study
      participation and to complete a survey. Students will be recruited and surveyed prior to
      revealing their assignment to avoid any response biases caused by happiness or disappointment
      at the lottery result. Decisions to participate in the study will have no impact on the
      lottery itself. Investigators will survey all study participants at the end of 8th grade, 9th
      grade, 10th grade, and 11th grade.
    

Intervention name(s): AVID Intervention
Intervention type(s): Other
Intervention description(s): Advancement via Individual Determination (AVID) is a college preparatory program that participating high schools have available to students.
Other intervention name(s): AVID
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Participants must be eighth grade students who are entering a Los Angeles Unified School
        District high school that is having a lottery for admission into their AVID program.
      
Keywords: Substance use; adolescent; health; social network