Project STRIDE Research Articles

Formative evaluation of a STEAM and nutrition education summer program for low-income youth

In-depth formative evaluations are vital for curriculum development and program planning but are often not conducted before a program pilots. A formative evaluation of Project stRIde was conducted to gain insight from experts and identify revisions to the curriculum. Project stRIde is a science, technology, engineering, arts, and mathematics (STEAM) and nutrition-based curriculum developed for 4th and 5th grade students from low-income and diverse families. Nine experts spanning the fields of nutrition education, cultural competency, elementary education, summer programs, and STEAM outreach were recruited to participate in an expert content review (ECR) survey and virtual interviews. Seven core themes were identified: effectively promoting student engagement, increased guidance or support needed, activity too difficult for age, time, confidence in teaching lessons, cultural appropriateness, and strengths of curriculum in promoting STEAM education and innovation. Across the lessons, all reviewers agreed that the lessons were accurate, incorporated STEAM concepts, and were culturally appropriate for this population. Future major edits to the curriculum include creating supplemental videos, modifying some activities for age level, and incorporating more opportunities for participant engagement. Overall, an ECR is an effective way to examine a program’s strengths and limitations and should be included in the beginning stages of program planning.

P132 Pilot Year Evaluation of a STEAM and Nutrition Summer Program for Low-Income, Urban Youth

<h3>Background</h3> Racially and ethnically diverse and low-income youth are more likely to experience academic and health-related disparities. The newly developed Project Science and Technology Reinforced by Innovative Dietary Education (Project stRIde) is a STEAM and nutrition summer camp program supported by a USDA CYFAR grant. It is designed for elementary-aged youth with the purpose of reinforcing content learned over the school year and improving dietary behaviors. <h3>Objective</h3> To conduct a process evaluation of the Project stRIde pilot program, assess needs for future camp staff implementation, assess post-lesson knowledge, and evaluate change in self-efficacy, attitudes towards STEAM, and skin carotenoid levels. <h3>Study Design, Setting, Participants</h3> The study used a mixed methods design to collect pre/post-test data for youth and interviews with staff. The program was delivered once a week for six weeks by nutrition and 4-H professionals to low-income, racially, and ethnically diverse youth (n = 40; grades 4-7) attending two urban summer camps in Rhode Island. Participants were 71.8% Black, 28.2% White, and 32.4% identified as Hispanic or Latino. <h3>Measurable Outcome/Analysis</h3> Program process measurements, interviews with camp staff, and weekly post-lesson questions for youth were collected along with pre/post measures. T-tests assessed pre/post attitudes towards STEAM, Asking for Fruit and Vegetable Self-Efficacy (AFVSE), and skin carotenoid levels with a significance level of <i>P</i> < 0.05. <h3>Results</h3> Overall, 67.5% of youth attended 4 or more lessons. Interviews with summer camp staff indicated the program was engaging and well-structured. Staff suggested shorter videos and stand-alone activities with basic concepts and understandable directions. For most lessons, youth scored ≥70% on post-lesson questions. There were no changes in attitudes towards STEAM, AFVSE, or skin carotenoid scores. <h3>Conclusions</h3> Project stRIde had an overall promising pilot year with post-lesson questions indicating youth comprehension of the content. Modifications to curriculum content and delivery will be made in order for this program to be successful and sustainable in future years. <h3>Funding</h3> USDA

Intersectional health disparities: the relationships between sex, race/ethnicity, and sexual orientation and depressive symptoms

ABSTRACT This study uses Intersectionality-informed methods to quantitatively examine experiences of discrimination and depressive symptoms among historically marginalised populations. Using mediation models and data from Project STRIDE collected in 2005–2006, discrimination (attributed to gender and/or sexual orientation and/or race/ethnicity) was modelled as a mediator between identity and depressive symptoms among seven diverse identity-based subgroups (75% sexual minorities and 50% Black or Hispanic). Discrimination partially mediated the effect of identity on depressive symptoms for sexual minority Black women, but only when accounting for discrimination on the basis of all three marginalised identities (woman, Black, and lesbian/bisexual). Sexual minority Black and white men experienced significantly less/less frequent depressive symptoms relative to straight white men, holding constant discrimination. While quantitatively modelling intersectionality is inherently nuanced, this study may serve as a framework for carrying out future quantitative intersectionality-based studies. Ultimately, intersectionality research contributes to the potential for a healthier and more equitable society for all.

P68 A Formative Evaluation of a STEAM and Nutrition Education Summer Program for Low-Income Youth

<h3>Background</h3> Project Science and Technology Reinforced by Innovative Dietary Education (Project stRIde) aims to provide a science, technology, engineering, arts, mathematics (STEAM), and nutrition education curriculum to low-income, racially and ethnically diverse, incoming 5th and 6th-grade youth. A formative evaluation of Project stRIde was conducted from May-July 2020 to gain insights from expert content reviewers and identify revisions before piloting. <h3>Objective</h3> The objective of this study was to conduct an expert content review of the Project stRIde curriculum to assess the content, cultural sensitivity, feasibility, and curriculum standard adherence to inform revisions to the curriculum. <h3>Study Design, Setting, Participants</h3> Nine experts spanning the fields of nutrition education, cultural competency, elementary education, summer youth programming, and STEM outreach were recruited to participate in an expert content review survey and virtual interviews. <h3>Measurable Outcome/Analysis</h3> Experts completed a 63-item questionnaire containing open- and closed-ended questions covering the lessons. Virtual interviews included follow-up questions. Interviews were recorded, transcribed, and coded in NVivo by 2 coders. An inductive approach was used to identify themes. <h3>Results</h3> Inter-rater reliability for the 2 coders yielded an unweighted kappa value of 0.83. Seven core themes were identified: (1) effectively promoting youth engagement, (2) increased lesson guidance or support needed, (3) activity difficulty for age, (4) time, (5) confidence in teaching lessons, (6) cultural appropriateness, and (7) strengths of curriculum in promoting STEAM education and innovation. Reviewers agreed that the lessons were accurate, incorporated STEAM concepts, and were culturally appropriate for this population. All 9 experts contacted completed the survey and interview. They all agreed that they would be confident in delivering the curriculum themselves. <h3>Conclusion</h3> An expert content review by a diversified panel as part of a formative evaluation process is an effective way to develop an engaging, age-appropriate curriculum.

Minority stress and sexual minorities of colour: the mediating role of mastery

ABSTRACT The minority stress model states that routine forms of discrimination are associated with adverse health consequences. Despite this well-supported association, there is a limited body of research applying this model for sexual minorities of colour. We utilise an intersectional approach to investigate how minority stress at the intersection of sexual and racial identities impacts psychological health outcomes. In the current study, we examine how various sources of minority stress (perceived stigma, internalised homophobia, and everyday discrimination) are associated with psychological health, through an indirect effect of mastery (Study 1) in addition to authenticity (Study 2) in two independent samples of sexual minorities of colour. Study 1 (n = 262) included sexual minorities of colour from Project STRIDE, and in Study 2, participants (n = 75) were recruited across several online platforms. Mediation analyses revealed that increased minority stressors, like discrimination, were significantly associated with a decrease in psychological health, through a decline in mastery. We did not find support for authenticity as a mediator. This study has important implications for understanding the experiences and health consequences for sexual minorities of colour.

Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling.

A large body of research demonstrates disparities in psychological health attributed to sexual minority identity, racial/ethnic minority identity, and socioeconomic status (SES). Fewer studies have explicated the role of these multiple attributes on psychological health and explored the role of SES and psychosocial resources in determining outcomes. We analyzed data from Project STRIDE, a longitudinal survey involving a diverse sample of gay and bisexual adult men (n = 198). Using structural equation modeling, we tested hypothesized direct and indirect effects of race/ethnicity, SES, and three psychosocial mediational variables (collective self-efficacy, everyday discrimination, internalized homophobia) on two outcome variables—psychological and social well-being—assessed at 1-year follow-up. Our model indicated that: (1) race/ethnicity and SES were significantly associated with each other and with each psychosocial mediator; (2) higher SES was directly and indirectly associated with both measures of well-being; and (3) collective self-esteem and everyday discrimination mediated the association between SES and both measures of well-being. The model also indicated that racial/ethnic associations with psychological mediators and outcomes are evident in the context of SES, but these effects might be suppressed when the model does not consider SES. Findings highlight the critical role of SES and race/ethnicity in determining the psychological and social well-being of sexual minority men. Specification of mediating variables—collective self-efficacy, everyday discrimination, internalized homophobia—indicates potential intervention targets to improve psychological and social health in sexual minority men. Associations between race/ethnicity and SES support the need for intersectional frameworks in addressing the health of sexual minority men.

Relationship discord and depressive symptoms in sexual minority individuals over time.

Although there is a well-established positive association between romantic relationship discord and depressive symptoms, there have been few studies assessing this association with sexual minority individuals, who are at increased risk for depression and whose relationships may be subjected to unique challenges (and strengths) given their sexual minority status. This study examined the cross-sectional and longitudinal associations between romantic relationship discord and depressive symptoms in sexual minority individuals using data from Project STRIDE, which is a longitudinal survey of 18-59 year-old residents of New York City. Data from 107 individuals in romantic relationships showed significant positive cross-sectional associations between relationship discord and depressive symptoms both at baseline and at a 1-year follow-up. Results from multiple regression analyses indicated that relationship discord at baseline was significantly and positively associated with depressive symptoms 1 year later, whereas depressive symptoms at baseline were not significantly associated with relationship discord 1 year later. The longitudinal association between relationship discord and depressive symptoms remained statistically significant adjusting for internalized heterosexism and discrimination at baseline. Findings are largely similar to those in research conducted in samples not recruited based on sexual minority status and provide an important extension of work that has shown a positive association between relationship discord and depressive symptoms for sexual minority individuals cross-sectionally. If replicated, these findings may have implications for the use of couple-based interventions for depression in sexual minority individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intersectional minority stress disparities among sexual minority adults in the USA: the role of race/ethnicity and socioeconomic status

Few studies have examined the intersection of race/ethnicity and socioeconomic status on the experience of minority stressors among sexual minority adults. We examined whether there are differences in reports of minority stressors by race/ethnicity and socioeconomic status, and whether socioeconomic status moderates the associations between race/ethnicity and minority stressors. We analysed data from Project Stride, a community-based sample of 396 self-identified lesbian, gay and bisexual adults in New York City. We conducted a hierarchical multiple regression analysis to examine the associations between race/ethnicity and socioeconomic status on minority stressors. In adjusted models, African American and Latino sexual minority adults experienced greater anticipated stigma relative to their white counterparts. Socioeconomic status significantly moderated the association of race/ethnicity and enacted stigma. For African Americans, higher socioeconomic status was associated with more enacted stigma, whereas higher socioeconomic status was associated with reduced enacted stigma among whites. Minority stress processes are likely to operate differently for sexual minority people of colour compared with white sexual minority people, and for higher-socioeconomic status versus lower-socioeconomic status sexual minority people. Future research should consider the intersectional axes of identity that contribute to enacted stigma and disparities in mental and physical health, especially for US African American sexual minority adults.

Prevalence, Diagnosis, and Treatment Rates of Mood Disorders among Opioid Users under Criminal Justice Supervision

ABSTRACTBackground: Individuals involved in the criminal justice system have disproportionately high rates of psychiatric disorders when compared to the general U.S. population. If left untreated, the likelihood of subsequent arrest increases and risk for adverse health consequences is great, particularly among opioid users. Objectives: To explore the prevalence, characteristics, and treatment of mood disorders among justice involved opioid-dependent populations. Methods: The current study enrolled 258 treatment-seeking opioid-dependent individuals under community-based criminal justice supervision (e.g., probation, parole) screened from the larger parent study, Project STRIDE, a seek/test/treat randomized control trial (RCT) examining HIV and opioid use treatment. During baseline, individuals were screened for depression using the Patient Health Questionnaire-9 (PHQ-9) and screened for bipolar disorder using the Mood Disorder Questionnaire (MDQ) tool. Results: Overall, 78 (30%) participants screened positive for moderate to severe depression and 54 (21%) screened positive for bipolar disorder. Participants self-reported mood disorders at higher rates than they screened positive for these conditions. Participants screening positive for these conditions experienced significantly greater family, legal, and medical problems on the Addiction Severity Index-Lite (ASI-Lite) than those who did not screen positive. Incidence of a lifetime suicide attempt was found to be associated with a positive screen for both mood disorders. Prescribed psychotropic treatment utilization was similar among those who screened positive for depression or bipolar disorder with approximately 38% reporting taking medication. Importance: Findings suggest universal mood disorder screening to improve comprehensive psychiatric care and treatment of opioid-dependent justice-involved individuals.

Multifactorial discrimination as a fundamental cause of mental health inequities

BackgroundThe theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change. Using an intersectional framework, we evaluated multifactorial discrimination as a fundamental cause of mental health disparities.MethodsUsing baseline data from the Project STRIDE: Stress, Identity, and Mental Health study, we examined the health effects of discrimination among individuals who self-identified as lesbian, gay, or bisexual. We used logistic and linear regression to assess whether multifactorial discrimination met the four criteria designating a fundamental cause, namely that the cause: 1) influences multiple health outcomes, 2) affects multiple risk factors, 3) involves access to resources that can be leveraged to reduce consequences of disease, and 4) reproduces itself in varied contexts through changing mechanisms.ResultsMultifactorial discrimination predicted high depression scores, psychological well-being, and substance use disorder diagnosis. Discrimination was positively associated with risk factors for high depression scores: chronic strain and total number of stressful life events. Discrimination was associated with significantly lower levels of mastery and self-esteem, protective factors for depressive symptomatology. Even after controlling for risk factors, discrimination remained a significant predictor for high depression scores. Among subjects with low depression scores, multifactorial discrimination also predicted anxiety and aggregate mental health scores.ConclusionsMultifactorial discrimination should be considered a fundamental cause of mental health inequities and may be an important cause of broad health disparities among populations with intersecting social identities.

Project Stride: An Equine-Assisted Intervention to Reduce Symptoms of Social Anxiety in Young Women

Although there is evidence supporting the use of equine-assisted activities to treat mental disorders, its efficacy in reducing signs and symptoms of social anxiety in young women has not been examined. We developed and pilot tested Project Stride, a brief, six-session intervention combining equine-assisted activities and cognitive-behavioral strategies to reduce symptoms of social anxiety. A total of 12 women, 18-29 years of age, were randomly assigned to Project Stride or a no-treatment control. Participants completed the Liebowitz Social Anxiety Scale at baseline, immediate-post, and 6 weeks after treatment. Project Stride was highly acceptable and feasible. Compared to control participants, those in Project Stride had significantly greater reductions in social anxiety scores from baseline to immediate-post [decrease of 24.8 points; t (9) = 3.40, P = .008)] and from baseline to follow-up [decrease of 31.8 points; t (9) = 4.12, P = .003)]. These findings support conducting a full-scale efficacy trial of Project Stride.

Physical activity interventions and changes in perceived home and facility environments

Objective To examine changes in environmental perceptions over time and associations between changes in perceptions and physical activity among participants in two physical activity interventions. Methods Two independent trials were examined. Project STRIDE (STRIDE) ( N = 239) was conducted from 2000 to 2004 in Rhode Island. Step into Motion (SIM) ( N = 249) was conducted from 2003 to 2006 in Rhode Island and Pennsylvania. Both trials tested various delivery channels for providing individually tailored motivational materials to increase physical activity among sedentary adults. Neither intervention aimed to change perceptions of the environment. At baseline, 6, and 12 months, surveys assessed physical activity and perceived facility and home equipment availability. Results In both trials, perceived facility availability increased from baseline to 6 months. Significant increases continued from 6 to 12 months in SIM only. Increases were not significantly different by treatment group. Perceived home equipment availability also increased from baseline to 6 months in both trials and from 6 to 12 months in SIM only. In STRIDE, greater increases were observed for intervention compared to control participants. Increased facility and home equipment availability were associated with increased minutes of physical activity in both trials. Conclusions Perceived facility and home equipment availability improved during participation in two individual-level physical activity interventions.

Cost-effectiveness of alternative approaches for motivating activity in sedentary adults: Results of Project STRIDE

Objective. To evaluate the cost-effectiveness of non-face-to-face interventions for increasing physical activity in sedentary adults. The study took place in Providence, Rhode Island between the years 2000 and 2004. Methods. Two hundred and thirty-nine participants were randomized to Phone, Print or a contact control. Phone and Print groups were mailed regular surveys regarding their level of physical activity, motivational readiness and self-efficacy. Surveys were scanned by a computer expert system to generate feedback reports. Phone group participants received feedback by telephone. Print group participants received feedback by mail. The contact control group received mailings unrelated to physical activity. Intervention costs were assessed prospectively, from a payer perspective. Physical activity was measured using the 7-day Physical Activity Recall. Ambulatory health service use was assessed via monthly surveys. Results. The Print intervention was more economically efficient than the Phone intervention in engaging participants in a more active lifestyle. Conclusion. The Print intervention provides an efficient approach to increasing physical activity. Research is needed to determine the cost-effectiveness of the intervention in a more diverse population, within the context of the health service delivery system and over a longer period of time.

Telephone versus print delivery of an individualized motivationally tailored physical activity intervention: Project STRIDE.

Given that only 25% of Americans meet physical activity recommendations, there is a need to develop and disseminate effective, evidence-based interventions to promote physical activity. The authors tested 2 delivery channels, telephone and print, to determine whether one was more effective in promoting physical activity. The authors randomly assigned 239 healthy, sedentary adults to (a) telephone-based individualized feedback, (b) print-based individualized feedback, or (c) contact control. Both intervention arms were guided by a motivationally tailored, theoretically driven computer expert system. Physical activity as measured by the 7-day Physical Activity Recall interview. At 6 months, both telephone and print arms significantly increased in minutes of moderate intensity physical activity compared with control, with no differences between the intervention arms. At 12 months, print participants reported a significantly greater number of moderate intensity minutes than both telephone and control participants, who did not differ. Results suggest that both telephone and print enhance the adoption of physical activity among sedentary adults; however, print interventions may be particularly effective in maintaining physical activity in the longer term.

Perceived Enjoyment Moderates the Efficacy of an Individually Tailored Physical Activity Intervention

Given the decreased rate of morbidity and mortality associated with physical activity, understanding the factors that enhance the efficacy of physical activity interventions is a priority. The present study examined the moderating effect of baseline enjoyment of physical activity on the efficacy of a physical activity intervention. Participants were 238 healthy low-active adults enrolled in Project STRIDE, a randomized, controlled, clinical trial comparing individually tailored print and telephone interventions to a contact control. Results indicated a significant interaction between intervention assignment (telephone or print intervention vs. contact control) and baseline enjoyment on physical activity at 6 months, as measured by the 7-Day Physical Activity Recall (z = 2.44, p &lt; .05). These results indicate that our motivationally tailored physical activity promotion program may be more effective among individuals reporting greater enjoyment of physical activity at baseline, and suggest that attention be paid to designing programs that can be effective for participants who report lower levels of physical activity enjoyment.

Examination of print and telephone channels for physical activity promotion: Rationale, design, and baseline data from Project STRIDE

BackgroundProject STRIDE is a 4-year randomized controlled trial comparing two computer-based expert system guided intervention delivery channels (phone vs. print) for physical activity adoption and short-term maintenance among previously sedentary adults. MethodsSedentary adults (n=239) were randomized to one of the following (1) telephone-based, individualized motivationally-tailored feedback; (2) print-based, individualized motivationally-tailored feedback; (3) contact-control delayed treatment group (received intervention after 12 months as control). This paper: (1) outlines the study design, rationale, and participant sample; and (2) describes relationships between baseline variables to better understand their influence on the efficacy of the intervention. ResultsParticipants averaged 19.8±25.0 min of physical activity/week that was at least of moderate intensity, with no group differences. The average estimated VO2 at 85% of maximum heart rate was 25.6 ml/kg/min. Body fat was 34.1% for women and 23.2% for men and the BMI of the sample averaged 28.5 kg/m2. ConclusionsProject STRIDE examines non face-to-face approaches for promoting physical activity behavior. It has unique features including a direct comparison of an expert system guided intervention delivered via phone or print. Future analyses will examine the cost-effectiveness of the interventions and this will likely yield important information for policy-makers.