Modeling Ecological Risk, Health Promotion, and Prevention Program Effects for Rural Adolescents

Objective: Universal prevention programs such as Positive Action (PA) mitigate risk factors and enhance promotive factors, often leading to improved adolescent functioning and school climate. The current study used 5 waves of data to assess the impact of PA on adolescent mental health and perceptions of school climate 1 year after completion of the program in a sample of low-income, rural youth. Method: Following multiple imputation and propensity score analysis, we ran 4 (2-level) hierarchal linear models to examine program effects. Results: PA program participants reported significant increases in self-esteem and significant decreases in school hassles relative to youths who did not participate in PA. Participation in PA did not have a significant impact on internalizing symptoms or aggression. Risk factors across the adolescents’ ecology had a strong negative impact on the outcomes, and some promotive factors modestly bolstered adolescent functioning. Conclusions: Findings highlight the influence that risk factors—especially negative interpersonal conflicts—have on adolescent outcomes and indicate that, although PA can help improve adolescents’ perceptions of themselves and their school climate, the program might need to be tailored for use in low-income, rural areas.