Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT03059433 |
| Other study ID # |
IRB#15-001190 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
April 21, 2017 |
| Est. completion date |
July 6, 2022 |
Study information
| Verified date |
September 2022 |
| Source |
University of California, Los Angeles |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial 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.
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.
