The Impact of Student Peer Leader Participation in the “Resist Expose And Challenge [big]

Tobacco” (REACT) Program on Positive Youth Development and on the Understanding of

Health

David Lorenzo, Manager

Lindsay Garofalo, Youth Engagement Specialist

Carly Cameron, Youth Engagement Summer Student

Chronic Disease and Injury Prevention

Public Health

Niagara Region

Thorold, Ontario

TABLE OF CONTENTSLiterature Review............................................................................................................................1

1.1 Developmental Science..........................................................................................................1

1.2 The Positive Youth Development Perspective.......................................................................2

1.2.1 The 5 C’s.........................................................................................................................3

1.2.2 Civic development...........................................................................................................4

1.2.3 Resilience........................................................................................................................5

1.2.4 Youth engagement...........................................................................................................7

1.3 The Convention on the Rights of the Child.........................................................................10

1.3.1 Article 12: Participation................................................................................................11

1.3.2 Population health and children’s rights.........................................................................12

1.4 Limitations to Extant Research............................................................................................14

1.5 Rationale..............................................................................................................................15

1.6 Purpose and Hypotheses......................................................................................................16

Methodology..................................................................................................................................19

2.1 Participants...........................................................................................................................19

2.2 Quantitative Measures..........................................................................................................19

2.2.1 Demographics................................................................................................................19

2.2.2 Primary Measures..........................................................................................................20

2.2.2.1 The Youth Experiences Survey 2.0........................................................................20

2.2.2.2 Civic Responsibility Survey...................................................................................20

2.2.2.3 The Resilience Scale...............................................................................................21

2.2.2.4 Multidimensional Scale of Perceived Social Support............................................21

2.3 Qualitative Measures............................................................................................................22

2.4 Procedures............................................................................................................................23

2.5 Data Analysis Plan...............................................................................................................24

2.5.1 Screening data...............................................................................................................25

2.5.2 Missing data..................................................................................................................25

2.5.3 Check for inaccurate values..........................................................................................25

2.5.4 Calculation of subscale scores.......................................................................................25

2.5.5 Univariate outliers.........................................................................................................25

2.5.6 Screening for assumptions of data analyses..................................................................25

2.5.7 Descriptive statistics and correlations...........................................................................26

2.5.8 Hypothesis testing.........................................................................................................27

References......................................................................................................................................29

Appendix A: Quantitative Measures.............................................................................................35

Appendix B: Qualitative Measures................................................................................................44

1

Literature Review

1.1 Developmental Science

In the past, researchers have described the adolescent and youth period as a time of

immense “storm and stress” (Hall, 1904; Holt, 2008); a period commonly coined as normative

developmental disturbance (Lerner, 2005). Youth were thought to be fraught with hazards,

described as “problems that must be straightened out” (Damon, 2004). This problem-centered

vision of youth has dominated professional fields and mass media (Damon, 2004). In order to

reduce and eliminate problems identified in youth, researchers have operated by developing

interventions specifically targeting problem or risk behaviours (e.g., antisocial conduct, low

motivation and achievement, drinking, smoking, drugs); a strategy known as a deficit-reduction

approach (Fraser-Thomas, Côté, & Deakin, 2005). Recently, the effectiveness of this approach

has been under consideration. Results indicate that this method is costly, and intervention

programs have only demonstrated moderate success (Fraser-Thomas et al., 2005). Additionally,

given that the deficit reduction approach focuses on those youth possessing problem behaviors, it

appears that remaining youth (e.g., youth free of drugs, alcohol use and crime) are not being

properly prepared to engage in society (Fraser-Thomas et al., 2005).

Alongside the recent criticisms of deficit reduction programs, research has further

unveiled that positive development is not simply the absence of negative or undesirable

behaviours (Lerner, 2005). Instead, it is a unique construct of its own; “preventing the

actualization of youth risk behaviours is not the same as taking actions to promote positive youth

development” (Lerner, 2005; Lerner, Fisher, & Weinberg, 2003). Thus, researchers have called

for a paradigm shift in the youth development literature, where an “asset building paradigm” is

addressed alongside the current “deficit reduction paradigm.” The focus of this new perspective

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emphasizes the strengths present in young people while simultaneously reducing problem

behaviors (Fraser-Thomas et al., 2005). This strong push to enhance and promote positive

developmental outcomes has brought about the concept of positive youth development, within

developmental literature.

1.2 The Positive Youth Development Perspective

Positive youth development contributes to a large theoretical framework that concentrates on

the positive aspects of youth and adolescent development (Lerner, 2005). While this approach

recognizes the existence of adversities and challenges that may affect children and youth, it

resists viewing the developmental process as one full of deficits and risks to be overcome

(Damon, 2004). Instead, it emphasizes the strengths present within young people, visioning them

as fully able individuals, eager to explore, gain competence and acquire the capacity to

contribute significantly to the world (Damon, 2004; Fraser-Thomas et al., 2005; Lerner, 2005).

This outcome-based focus envisions young people as resources rather than problems, and works

to highlight youths’ potentialities rather than incapacities (Damon, 2004). This approach offers

diversity to the area of youth development as it aims to understand, educate and engage youth,

including those from the most disadvantaged backgrounds, in productive activities rather than

correcting, curing or treating them for maladaptive tendencies (Damon, 2004). By identifying

that youth possess considerable resiliency and vast potential, their assets can be maximized while

preempting any self-destructive or antisocial tendencies that might otherwise arise (Damon,

2004; Larson, 2000).

The developmental implications of this positive approach are profound. Optimal

development “enables individuals to lead a healthy, satisfying, and productive life as youth, and

later as adults, because they gain the competence to earn a living, to engage in civic activities, to

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nurture others, and to participate in social relations and cultural activities” (Hamilton, Hamilton,

& Pittman, 2004). In order to effectively measure and interpret a youths’ development (to ensure

it is “optimal”), researchers categorized positive outcomes within the positive youth development

framework; namely, they identified the behavioural and attitudinal outcomes indicative of

positive youth development (Jones, Dunn, Holt, Sullivan, & Bloom, 2011). An example of this

would be the 40 developmental assets developed by Benson and colleagues. These core assets

are believed to facilitate positive youth development and help youth interact in society in a

healthy and positive way (Benson, 1997; Leffert, Benson, Scales, Sharma, Drake & Blyth, 1998).

Research indicates the development assets play a powerful protective role throughout youth

development; the more assets youth have, the less likely they are to engage in high-risk

behaviours such as alcohol, tobacco, and drug use, and the more likely they are to thrive and be

resilient (Benson, 1997; Leffert et al., 1998). However, this framework is quite extensive and

poses difficulties when attempting to measure asset development in a clear and concise manner.

Therefore, Lerner, Fisher and Weinberg (2000) constructed the 5 C’s of positive youth

development, as a means of generating a more concise outcome based model to evaluate youths’

development.

1.2.1 The 5 C’s. With the recent emphasis being placed on the positive aspects of adolescent

development, Lerner and colleagues have categorized the mental, behavioural, and social

elements of development into a set of five ideal outcomes (Little, 1993). These five outcomes,

also known as the 5 C’s, are: competence, confidence, connection, character and caring

(compassion). Lerner et al. (2005) describes the 5 C’s of positive youth development as follows:

Competence refers to the positive view of one’s actions in social, academic, cognitive and

vocational domains. Confidence refers to an internal sense of overall positive self-worth and

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self-efficacy. Connection refers to positive bonds that are formed through interaction with

other individuals, peers, family, school and the community, where both parties contribute to

the relationship. Character refers to the respect one has for societal and cultural rules,

possession of standards for correct behaviours, a sense of right and wrong and integrity.

Caring and compassion refer to a sense of sympathy and empathy for others (p. 23).

It has been suggested that when these 5 C’s are present in a young person, there emerges a sixth

C, known as contribution (Fraser-Thomas, 2005; Lerner, 2005). In other words, if youth develop

into physically, socially, psychologically, emotionally, and intellectually healthy adults, they will

contribute or “give back” to civil society; inadvertently promoting positive development in the

next generation of youth (Fraser-Thomas, 2005). That is, a young person behaves in a way

suggestive of the 5 C’s by contributing positively to their self, family, community and ultimately,

civil society (Lerner, 2004; 2005). The contribution component of the positive youth

development framework is of particular interest to this review. It signifies the long-term, lasting

effects of positive development and provides communities and civil society with influential

leaders and advocates. For the purposes of this review, there are two notable indicators of

contribution: civic responsibility and civic attitudes.

1.2.2 Civic development. Approaching the definition of civic development from the

positive youth development perspective allows us to better understand how contribution is seen

in practice. Programs and activities that foster developmental assets instill in youth the

importance of civic-oriented responsibilities and the development of attitudes supporting these

beliefs (Sherrod, 2007). Youth learn how to give back to their community and eventually

develop the commitment, motivation and desire to do so, on their own terms (Sherrod, 2007).

Achieving optimal civic development implies that one feels accountable and responsible for

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contributing to their civic or community organizations; a feeling that extends long term into

adulthood (Sherrod, 2007). Research suggests that when youth engage in community programs

and activities, it not only prevents them from adopting problematic behaviours, but also

empowers them to become “engaged citizens” (Brennan, 2008). As a result, researchers have

recognized behavioural (civic engagement, civic responsibility) and attitudinal (civic attitudes)

components of contribution; adults that contribute to their community and civic society, and

understand the importance of civic contribution, likely possessed qualities indicative of the 5 C’s

as youth (Sherrod, 2007).

1.2.3 Resilience. Research on resilience has been a major theme in developmental

psychopathology; to better understanding why some children and adolescents possess greater

capacity to adapt despite “distressing life conditions and demanding societal conditions” (Lee,

Cheung, & Kwong, 2012). Resilience, most simply, manifests itself as the ability to respond or

perform positively in the face of adversity, to achieve despite the presence of disadvantages, or

to significantly exceed expectations under negative circumstances (Brennan, 2008; Gilligan,

2007). Several studies investigating the functional role of resilience in the stress process have

identified that high-resilient individuals are able to recover from daily stress more effectively.

Thus, resilient qualities serve to inhibit the scope, severity, and diffusion of daily stressors; a

process that extends into later adulthood as well (Benson, 1997; Brennan, 2008; Lee et al., 2012;

Ong, Bergeman, Bisconti, & Wallace, 2006). Studies have shown that individuals with a greater

capacity to adapt despite facing adversity possess a multitude of internal and external protective

factors (e.g., social support, self-esteem) (Lee et al., 2012).

Professionals in the area of resiliency have started collaborating with youth development

programs, as they represent an ideal opportunity to foster resilience in youth. Programs centered

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on positive youth development represent opportunities for youth to be immersed in a supportive

environment and experience positive engagement (Brennan, 2008; Lee et al., 2012). Thus, when

youth participate in programs or activities in their communities, they acquire key protective

factors linked to resilience; achieve mastery in social competence, problem-solving, autonomy,

and sense of purpose, as well as develop a valuable relationship with their community and those

in it (Brennan, 2008; Greenberger & Sorensen, 1974). Therefore, this model conceptualizes

resilience as an indicator of positive youth development; positive youth development is a

necessary condition for resilience, and resilience reflects the presence of positive youth

development. In other words, youth are presented with developmental tasks (e.g., problems,

adversities), to which they must adapt (Lee et al., 2012). Successful adaptation ensures positive

developmental outcomes and ensures that youth acquire the competence needed to uphold

resilience (Lee et al., 2012). Interestingly, resilience can also be a determinant of positive youth

development; a necessary forerunner (Lee et al., 2012). As a necessary forerunner, resilience

functions as a predictor where positive youth development is an outcome highly dependent on

resilient qualities (Lee et al., 2012). Thus, resilience and positive youth development represent a

bidirectional model with a fluid relationship.

Interestingly, results indicate that youth possessing adaptive capacities are more likely to

become committed leaders in their community in the future (Brennan, 2008). This further

suggests that those possessing positive developmental outcomes, in particular those associated

with resilience, will be more likely to engage in long-term community contribution (Brennan,

2008).

Youth development programs are emerging as an effective and strategic way to help

youth achieve these goals of healthy adolescent development. The idea of these programs is to

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engage youth in a way that maximizes their potential, thus fostering the aspects needed for full

and resilient development, and successful outcomes throughout the lifespan.

1.2.4 Youth engagement. Youth engagement is a tenet of the youth development

approach and represents an effective way to build upon youths’ capabilities. Evidence suggests

that youth development is triggered not just when youth join and participate in a program, but

when they become psychologically engaged in the programs’ activities (Dawes & Larson, 2011).

In other words, when the individual is motivated to a degree that their attention is absorbed in the

tasks and challenges of the activity, when they are fully invested, and when they have a valued

choice in the situations in which they are involved, they reap the greatest developmental benefits

(Dawes & Larson, 2011). This is also known as a state of “flow;” complete absorption in an

activity that is intrinsically interesting with no psychic energy left for distractions

(Csikszentmihalyi, 1990; Shernoff & Vandell, 2007). This concept has been embraced by

practitioners working in contexts where fostering positive experiences is especially important

(e.g., teachers in schools) (Csikszentmihalyi, 1990). However, it has recently had a growing

impact in school-based youth development programs. If student’s can be fully engaged in

school-based extracurricular activities, that challenge them to an appropriate degree, that they

enjoy and are passionate about, the most optimal capacity and development can be achieved. In

fact, Larson (2000) stated that voluntary, structured activities such as those seen in school-based

after-school programs, combine the focused, discipline aspects of work with enjoyable aspects of

leisure; uniquely benefiting positive youth development (Shernoff & Vandell, 2007). For

example, in a study examining activities, engagement, and emotion in after-school programs,

researchers found that when youth were engaged in their programs, they experienced more

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intrinsic motivation, put forth more concerted effect and felt less apathetic (Vandell, Shernoff,

Pierce, Bolt, Dadismna, & Brown, 2005).

Throughout the growth and development of programs that facilitate youth engagement,

research has discovered that youth can be engaged not only as a member of the program, but also

as a leader (e.g., counselor, instructor etc.). In this model, both the youth leading the program, as

well as the youth the program targets (e.g., youth involved in risky behaviours), are both able to

benefit developmentally. This has been most notable in programs surrounding sensitive topics,

such as “risky” behaviours (e.g., Drug Abuse Resistance Education developed as a substance

abuse prevention program). Research has noted that this type of sensitive health information is

more easily shared between people of a similar age; youth are not always perceptive when these

messages are delivered from adults or authority figures (Mellanby, Rees, & Tripp, 2000; Wong

et al., 2010). For example, in a qualitative study examining opportunities for youth smoking

cessation, participants stated that their current cessation programs led by adults were

“unnecessary and ineffective,” even making some students want to smoke more (Balch, Tworek,

Barker, Sasso, Mermelstein, & Giovino, 2004). Students stated they would be more interested in

cessation programs if they were staffed by other adolescents, because it would increase its

“appeal and credibility” (Balch et al., 2004). It appears that to ensure a health promotion project

is effective and well-received among young adults; their peers may represent the best venue for

delivering health messages. The use of peer-led health promotion strategies aligns with the social

influences theoretical model, framed under the theories of social learning (Bandura, 1971, 1986),

social inoculation (McGuire, 1964) and social norms (Baric & Harrison, 1977; Frantz, 2015).

These theories propose that “friends seek advice from friends and are also influenced by the

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expectations, attitudes and behaviours of the groups to which they belong (Lindsey, 1997;

Mellanby et al., 2000).

Peer-led education has been widely used in schools to address issues such as, but not limited

to, sexual health promotion and education, smoking prevention, alcohol education, oral health

and healthy eating (Campbell, Barnum, Ryden, Ishkanian, Stock, Chanoine, 2012; Mellanby et

al., 2000). One example would be a school-based, peer-led health promotion program known as

“Healthy Buddies” (Campbell et al., 2012). This program empowers elementary-school children

to live healthier lives, using older students as the vessel for these positive messages (Campbell et

al., 2012). Older students receive healthy living lessons to teach their younger “buddies,”

encouraging positive attitudes and behaviours related to physical activity, nutrition and body

image (Campbell et al., 2012). In an evaluation of this program, results found that both older and

younger buddies showed greater increases in healthy living knowledge, when compared to

students receiving information from adult teachers (Campbell et al., 2012). A recent meta-

analysis identified 13 experimental studies comparing peer-led and adult-led health education

programs in various schools (Mellanby et al., 2000). Results indicated that peer-led programs

were more effective in altering the knowledge, attitudes and health-related behaviours of their

peer targets, in comparison to adult-led programs (Mellanby et al., 2000).

Lastly, there is extensive literature supporting the effectiveness of peer-led health education

as a double-sided approach to health promotion; target youth are motivated to engage in healthier

behaviours based on information from their fellow peers, and “peer leaders” are given the

opportunity to become “engaged” in a challenging role possessing meaningful responsibilities

(Campbell et al., 2012; Mellanby et al., 2000).

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From a program development standpoint, it is interesting to reflect on various frameworks

that have driven successful programs in the past. For the purposes of this review, the Convention

on the Rights of the Child will be examined as a relevant framework for developing youth-led

health promotion programs.

1.3 The Convention on the Rights of the Child

The Convention on the Rights of the Child (CRC) is the most rapidly and widely ratified

international human rights treaty in history (United Nations International Children’s Emergency

Fund [UNICEF], 2014). This agreement spells out the range of rights to which children

everywhere are entitled (UNICEF, 2014). It outlines basic standards for children’s well-being

throughout different stages of their development, and since its inception in 1989; it is the first

universal, legally binding code of child rights (UNICEF, 2014). The Convention states that

children, those under the age of 18, need special care and protection regardless of gender, origin,

religion or possible disabilities (UNICEF, 2014). The treaty highlights that as indicated in the

Declaration of the Rights of the Child, “the child, by reason of his physical and mental

immaturity, needs special safeguards and care, including appropriate legal protection, before as

well as after birth” (Minister of Supply and Services Canada [MSSC], 1991). The Convention

has dramatically changed the way children are viewed and treated: as human beings with a

distinct set of rights, as opposed to passive objects of care and charity (UNICEF, 2014). By

affording children the necessary protection and assistance, we can ensure their full and

harmonious development physically, spiritually, morally and socially (MSSC, 1991). Although

the Convention has 54 articles in all, it is guided by four fundamental principles: (a) non-

discrimination, (b) the best interests of the child, (c) survival, developmental and protection and

of particular interest to this review, (d) participation (MSSC, 1991; UNICEF, 2014).

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1.3.1 Article 12: Participation. This fundamental principle of the CRC states that

children are entitled to participate in the decisions that affect them, given they possess opinions

that should be accounted for (Lansdown, 2001; MSSC, 1991; UNICEF, 2014):

1. State Parties shall assure to the child who is capable of forming his or her own

views the right to express those views freely in all matters affecting the child, the

views of the child being given due weight in accordance with the age and maturity

of the child.

2. For this purpose, the child shall in particular be provided the opportunity to be

heard in any judicial and administrative proceedings affecting the child, either

directly, or through a representative or an appropriate body, in a manner

consistent with the procedural rules of national law (MSSC, 1991, p. 6).

By providing children with the right to voice their opinion, particularly with respect to decisions

that affect them, adults are acknowledging respect for the views of the children (UNICEF, 2014).

Not only does this ratify the rights to which children are entitled, but it also has ample

implications from a youth development perspective. The United Nations Committee on the

Rights of the Child [UNCRC] asserts that participation is a mechanism for promoting the full

development of the personality; a concept known as positive youth development in the human

development literature (Bruyere, 2010; UNCRC, 2009). As children mature, they develop

capacities to participate in more complex and meaningful relationships, experiences and

opportunities and acquire a sense of “empowerment…ownership and control of their own

endeavors and destinies” (Bruyere, 2010; World Health Organization [WHO], 1986). The more

children participate in these, the less likely they are to participate in risk behaviours and the more

likely they are to develop into a thriving individual; when one considers things beyond their own

12

self-interest and supports the promotion of equity, democracy, social justice and personal

freedom (Bruyere, 2010). Enforcement of the articles promotes a child’s evolving capacities,

growth of functionally valued competencies and empowers children to assert their right to

participate; thus, article 12 has the ability to enhance positive youth development participation.

On the other hand, exercising one’s right to participate facilitates a plethora of developmental

assets as well (e.g., leadership, teamwork, sense of self). In this sense, the CRC and positive

youth development are closely intertwined and should be considered as such in youth

developmental literature.

1.3.2 Population health and children’s rights. Health and well-being have recently

emerged as a globally accepted “human rights” principle (Mitchell, 2011). The “determinants of

population health” are considered an overarching framework driving Canada’s national health

care system. These determinants represent the primary factors that shape the health of Canadians

(Mikkonen & Raphael, 2010). More specifically, our health is shaped by how income and wealth

is distributed, whether or not we are employed, and if so, the working conditions we experience

(Mikkonen & Raphael, 2010). Our well-being is determined by the health and social services we

receive and our ability to obtain quality education, food and housing, among other factors

(Mikkonen & Raphael, 2010). Evidence suggests that the quality of the social determinants of

health experienced by Canadians helps explain known health inequalities (Mikkonen & Raphael,

2010). In terms of health among Canadian children, it appears there is a clear link between

current population health policy, and children’s rights. Those advocating for children’s rights

believe that ongoing health care reform debates in Canada should also include those who stand to

inherit the results; young people under the age of eighteen (Mitchell, 2011). By seeking

representation from populations of young Canadians, we give them the opportunity to exercise

13

their rights, enhance their knowledge of health care and voice an opinion that may otherwise go

unheard (Mitchell, 2011). Population health policies are closely linked with goals of the treaty,

and may represent a more comprehensive, holistic way for health policy-makers and service

providers to limit inequities in population health. For example, the WHO has declared a need for

global health, defined by the achievement of a level of health that would “enable all of the

world’s people to lead a socially and economically productive life” (WHO, 2015). The strategy

to achieve this health-for-all principle is aimed at “reducing differences in current health status

and ensuring equal opportunities and resources to enable all people to achieve their fullest health

potential”; a blatant effort to reduce health inequities, improve population health and recognize

the rights of every individual.

From the CRC perspective, Article 24, which recognizes that every child has a right to

the “highest attainable standard of health and to facilities for the treatment of illness,” may

provide a useful balance for the overemphasis on clinical medicine in Canada’s health system

(Vandergrift & Bennett, 2012). The article defines “health” across a wide scope; from nutrition

and clean water to environmental pollution, the prevention of accidents and access to health

knowledge (Vandergrift & Bennett, 2012). With regard to population health, authors in the field

of children’s rights have acknowledged that respecting one’s rights “enables health, quality of

life and well-being” by default (van Daalen-Smith, 2007). If we can acknowledge and actively

practice human right obligations, we can hope to improve the health and well-being of our

population (Raphael, 2009). This conceptualization of health from a CRC perspective distinctly

parallels the philosophy of current health promotion; one based on the premise that health is

“created in the context of everyday – where people live, love, work and play” (WHO, 1986).

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Thus, the Convention not only provides an integrated framework to promote children’s health

but also represents a social movement linking health and human rights (Raphael, 2009).

Lastly, work targeting children has been shown to bear fruit throughout the lifespan

(Marmot, 2011). Studies have noted that health improvements within this population can be

acquired in a very short time period with little to no expense (Marmot, 2011). In fact, when

children are cuddled, talked to regularly and read to daily, they thrive emotionally and improve

their intellectual capacity; a simple method to ensure the health and subsequently, the rights of

every child are being recognized (Marmot, 2011). Thus, by implementing interventions and

programs for youth to grow, develop and reach their potential, we can facilitate long-term health

improvements.

1.4 Limitations to Extant Research

Developmental research has established the benefits associated with the positive youth

developmental model; one that emphasizes the provision of opportunities and supports that can

help youth gain the abilities and knowledge they will need as they mature (Kahne, Nagaoka,

Brown, O’Brien, Quinn, & Thiede, 2001). The model projects that these outcomes are facilitated

when youth participate in structured activities that provide opportunities to develop personal and

social assets (Kahne et al., 2001; Mincemoyer & Perkins, 2005). Within these programs and

activities, youth are often asked to take on challenging roles, meaningful responsibilities and

make civic contributions. Youth and staff professionals are thought to develop relationships that

facilitate personal support and monitoring – important protective factor for positive youth

development (Kahne et al, 2001). However, despite the theoretical research supporting this

developmental trajectory, very few programs are formally evaluated to determine if they are in

fact fostering the outcomes they are targeting (Catalano, Berglund, Ryan, Lonczak, & Hawkins,

15

2002; Mincemoyer & Perkins, 2005). This gap in evaluation appears to be most notable when

examining youth contribution, a critical aspect of the positive youth development approach.

Further, one of the few studies that did in fact evaluate contribution, did so using measurement

tools that were not adequately reliable (α = 0.37; a reliability coefficient of 0.70 or higher is

considered "acceptable”; Institute for Digital Research and Education [IDRE], 2015). Thus, these

results must be considered with a critical eye (Lerner et al., 2005).

In summary, not only does the positive youth development literature lack in the

evaluation of community contribution, but those that have evaluated contribution did so with

questionable resources. Thus, there is a need for a reliable, research-based evaluation to

determine the impact of positive youth development programs on contribution components such

as civic development, civic responsibilities and civic attitudes. This gap in the literature will be

acknowledged in the present study.

1.5 Rationale

Research states that when youth are fully engaged in extracurricular activities that

challenge them to an appropriate degree and those they enjoy and are passionate about, the most

optimal capacity and development can be achieved (Shernoff & Vandell, 2007). Further,

research states that the CRC is linked closely with population health; providing children with the

ability to know and practice their rights should be linked to a healthier population (e.g., when

children have the ability to act on their rights, they are not discriminated against, they get to

actively participate in their health and increase their knowledge of health, thus reducing

inequalities in determinants of health). However, these theories are often untested within a

practical setting. Therefore, this study aims to fill an important gap in the literature by

conducting an impact evaluation of the “Resist Expose And Challenge [big] Tobacco” (REACT)

16

Program; a peer-led, rights-based health promotion program within the Public Health department

at the Niagara Region. By conducting a valid and reliable evaluation, we can generate useful,

impactful data that can be shared with community decision makers, legislators, parents and

stakeholders. Results will identify the long term impact of youth engagement and may inform the

generation of similar programs across public health units (Mincemoyer & Perkins, 2005).

1.6 Purpose and Hypotheses

The purpose of this project is two-fold. Firstly, we are conducting a thorough evaluation of the

developmental outcomes associated with being a peer leader in the REACT program, from a

quantitative perspective. Secondly, we are interested in how young people’s understanding of

health has been impacted by their participation in the Niagara Region’s REACT program, from a

qualitative perspective. REACT is a program within Public Health that employs high school-

aged activists to plan and implement initiatives throughout the Niagara Region, with the

intention of advocating for healthy lifestyles. This group of high school students works as “peer

leaders” to educate their peers on: tobacco, mental health, healthy eating and physical activity,

sexual health and substance misuse. Firstly, this study aims to assess whether being a peer leader

in the program did in fact contribute to positive youth development outcomes. More specifically,

if being a peer leader in the REACT program is associated with positive youth experiences, and

whether it predicts feelings of civic responsibility, positive civic attitudes and greater resilience.

The second objective is to determine if the REACT experience allows youth to practice and

exercise their unique set of rights, and if this has influenced their understanding of health. Both

of these investigations will be examined in current and previous peer leaders (including those

that were peer leaders at the program’s inception up until youth currently acting as a peer leader).

The specific hypotheses that will be investigated are:

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A. Participation as a peer leader in the REACT program will be associated with

positive identity experiences (identity exploration and identity reflection).

B. Participation as a peer leader in the REACT program will be associated with

positive initiative experiences (goal setting, effort, problem solving and time

management).

C. Participation as a peer leader in the REACT program will be associated with

positive basic skills (emotional regulation, cognitive skills and physical

skills).

D. Participation as a peer leader in the REACT program will be associated with

positive interpersonal relationships (diverse peer relationships and prosocial

norms).

E. Participation as a peer leader in the REACT program will be associated with

positive team work and social skills (group process skills, feedback,

leadership and responsibility).

F. Participation as a peer leader in the REACT program will be associated with

positive adult networks and social capital (integration with family, linkages to

community and linkages to work and college).

G. Participation as a peer leader in the REACT program will be associated with

few negative experiences (stress, negative peer influences, social exclusion,

and negative group dynamics).

H. A positive REACT experience will predict one’s civic responsibility over and

above one’s level of education.

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I. A positive REACT experience will predict one’s civic attitudes over and

above one’s level of education.

J. A positive REACT experience will predict one’s resilience over and above

one’s level of education and perceived social support.

19

Methodology

2.1 Participants

Participants will consist of current and previous REACT peer leaders. This consists of

both males and females aged 16-28. Students vary in ethnicity, socio-economic status and their

student/employment status. Given recruitment will include past and present peer leaders, it is

difficult to predict exact demographic characteristics; they may be in post-secondary school,

working in a full-time job, married, single etc. However, this study is examining the long term

impact of the REACT program; therefore it is appropriate to collect data from all peer leaders

regardless of their demographic characteristics. Further, the objectives are to determine whether

being a peer leader in the REACT program predicts positive development outcomes and a greater

understanding of health, regardless of when they participated (the peer leader role is the focus of

this evaluation, not age of the participants).

2.2 Quantitative Measures

The following excerpt refers to methodology for the quantitative component. All

participants will be asked to complete a series of questionnaires to assess the outcomes of

interest. Copies of all questionnaires can be found in Appendix A.

2.2.1 Demographics. Participants will be asked to self-report their date of birth, sex, the

years they worked as a peer leader for the REACT program, the racial or ethnic group to which

they most identify, the highest level of education completed, their current employment/student

status, and field of employment where applicable.

20

2.2.2 Primary Measures. The primary measures will assess one’s experience in REACT,

how responsible one feels to contribute to their civic society, one’s attitudes towards civic

contribution and resilience.

2.2.2.1 The Youth Experiences Survey 2.0 (YES; Hansen & Larson, 2005). The Youth

Experience Survey 2.0 (YES 2.0) was developed to survey high-school aged adolescents about

their developmental experiences in an extracurricular activity or community-based program. The

YES includes 18 scales that assess self-reported experiences in the activity or program within six

conceptual domains of development: Identity Work, Initiative, Basic Skills, Teamwork and

Social Skills, Interpersonal Relationships, and Adult Networks. Five scales dealing with negative

experiences that may interfere with development are also assessed. For each of the 66 items,

participants indicate the degree to which they agree with the statement, using a 4-point Likert

scale ranging from 1 (yes, definitely) to 4 (not at all). For example: “Learned to focus my

attention.” Items will be reverse scored where required, such that higher scores indicate a more

positive REACT youth experience. A mean score will be calculated for each subscale.

Cronbach’s alpha indicates adequate internal consistency reliability for the overall scale (α =

0.87).

2.2.2.2 Civic Responsibility Survey (Furco, Muller, & Ammon, 1998). This survey

measures youths’ community awareness, knowledge, and investment in helping to improve their

community. For each of the 24 items, participants indicate the degree to which they agree with

the statement, using a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly

agree). For example: “I try to find time or a way to make a positive difference in the

community.” Items are scored such that higher scores indicate feeling greater responsibility to

contribute to one’s civic society. The mean of the 24 items will be calculated to represent the

21

participants overall civic responsibility. Cronbach’s alpha indicates adequate internal consistency

reliability for the overall scale (α = 0.87).

2.2.2.3 The Resilience Scale (Wagnild & Young, 1993). Resilience is the ability to cope

with various life stressors. This scale measures resilience in different domains of young people’s

lives. For each of the 14 items, participants indicate the degree to which they agree with the

statement, using a 7-point Likert scale ranging from 1 (disagree) to 5 (agree). For example: “My

belief in myself gets me through hard times.” Items are scored such that higher scores indicate

greater resilience. The mean of the 14 items will be calculated to represent the participants

overall resilience. Cronbach’s alpha indicates adequate internal consistency reliability for the

overall scale (α = 0.91; Wagnild, 2009).

2.2.2.4 Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem,

Zimet, & Farley, 1988). The Multidimensional Scale of Perceived Social Support (MSPSS) is a

uni-dimensional tool that measures how one perceives their social support system, and from what

sources an individual receives this support from (i.e., family, friends, and significant other). For

each of the 12 items, participants indicate the degree to which they agree with the statement,

using a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree).

For example: “My family is willing to help me make decisions.” Items are scored such that

higher scores indicate greater perceptions of social support. A mean score will be calculated for

each subscale. Cronbach’s alpha indicates adequate internal consistency reliability for the overall

scale (α = 0.88).

Theorists have suggested that people who have a functional support system are less

vulnerable to external stressors; thus, social support acts as a protective factor in the resilience

22

framework (Lee et al., 2012). Given that we are interested in how being a peer leader in REACT

exclusively contributed to participants resilience, we will be using the MSPSS to control for the

social support one receives outside of REACT. By doing this we can isolate the effect that

REACT had on resilience. In other words, we are looking to discover whether the REACT youth

experience contributed to variance in resilience over and above social support.

2.3 Qualitative Measures

A qualitative, thematic analysis of documentary and focus group interview data will be

conducted through the lenses of the UN Convention on the Rights of the Child and the social

determinants of population health (Mitchell, 2003 & 2011). Drawing on Mitchell (2011) and

DeRoche and Layman (2008) in particular, the following represents the main research question

for this aspect of the evaluation: “How has young people’s understanding of health been

impacted by their participation in the Niagara Region’s REACT program?” Focus group

questions will explore how providing young people with the opportunity to exercise their rights

may have impacted their understanding of health and potentially their determinants of health.

Through the implementation of programs such as REACT, youth are learning about healthy

behaviours and practices, while practicing leadership and dedication; thus, we are interested if

REACT has helped contribute to life-long wellness through education, social support, healthy

development, personal health practices and coping skills; all social determinants of population

health. Theoretically, by applying a rights-based approach to health promotion programs,

inequalities in determinants of population health specific to youth should be reduced. Focus

group questions will explore this contention. The focus group interview guide can be found in

Appendix B.

23

2.4 Procedures

After obtaining ethics clearance from Niagara Region’s Research Ethics Board, past and

present peer leaders were recruited to participate in a study designed to evaluate the REACT peer

leader position. Peer leaders were recruited by word of mouth, email and social media. Current

peer leaders organized a “reunion” picnic, which took place August 15th. The purpose of this

event was to bring past and present peer leaders together to connect and discuss their

experiences. In preparation for the picnic, current peer leaders created a “Facebook” group where

they informed and invited other peer leaders to the event. The investigators used this group as a

vessel to alert participants about the evaluation study as well. In addition, researchers compiled a

list of past and present peer leaders and the emails that are on the Region file for them. Based on

research supporting effective recruitment strategies, investigators sent out a Facebook and email

alert on July 20, informing all peer leaders about the upcoming evaluation and the opportunity

for them to get involved in research that will assist the program. The link to the evaluation

survey was released on July 30. Again, based on research examining effective recruitment and

reminder strategies, a reminder email/Facebook post was released once a week, on a different

day each week, to capitalize on differing work or school schedules. The student investigator

attended the reunion picnic on August 15 to distribute hard copies of the survey and encouraged

individuals to complete the evaluation for a chance to win a $50 gift card. A quiet, discrete area

was set aside for individuals to complete the package at the event. Peer leaders we had

connections to through email or Facebook were encouraged to “spread the word” about the

evaluation study in order to reach any participants whose contact information could not be

located.

24

In terms of the qualitative component, peer leaders who expressed interested in

participating in the focus group interview were contacted by email to confirm their participation

(6-8 were recruited for peer leader focus groups). Focus group testing took place at the Niagara

Region headquarters in a private and confidential meeting room on Thursday August 13. Dr.

Richard Mitchell, an associate professor in the Child and Youth Studies Department at Brock

University (http://www.brocku.ca/social-sciences/departments-and-centres/child-and-youth-

studies/faculty-contacts/richard-mitchell; richard.mitchell@brocku.ca), facilitated this focus

group interview. A students from Brock University involved in research on campus, was also

present during the interview period for video recording and transcribing purposes. Past and

present youth engagement specialists (6-8) will also be contacted in the near future regarding key

informant interviews. Consent concerning both of the evaluation components was acquired

before administering measurement tools. Those completing the online survey tool or focus group

interview were provided with detailed instructions regarding the purpose of the study, potential

benefits and risks, confidentiality and anonymity, one’s rights as a voluntary participant and the

use of implied consent in this study; participants were made aware that by actively participating,

they were agreeing to the terms of the study and were thus, implying their official consent to

participate with no signature required. Peer leaders interested in completing either evaluation

component who were under the age of 18 were provided with a parental consent form to be

completed and signed by their parent or guardian before access to either research component

was granted.

2.5 Data Analysis Plan

All data will be analyzed using SPSS 20.0. Data will first be screened for entry errors and

checked to ensure the assumptions for the appropriate statistical tests are met.

25

2.5.1 Screening data. Before analyzing the data, it will be screened for missing and

inaccurate values by examining the frequencies of responses.

2.5.2 Missing data. Missing data will be screened visually. For cases where data for an

entire questionnaire is missing, the participant’s data will not be used for any analyses involving

that questionnaire. Where specific items are missing, visual inspection will determine the quality

and pattern of missing items. This can confirm if missing data is random in nature. If less than

5% of the data is missing and there is no consistent pattern, an appropriate subgroup mean will

be used as a substitute for missing items.

2.5.3 Check for inaccurate values. A frequency count will be conducted to ensure all

values on the questionnaire items are plausible. If an implausible response is detected, the

original questionnaire data will be revisited and the correct value substituted for the value

originally inputted.

2.5.4 Calculation of subscale scores. Items will be reverse scored where appropriate

before running any analyses. Mean scores for each scale/subscale will be calculated where

appropriate (YES 2.0, The Civic Responsibility Scale, Civic Attitudes Scale, The Resilience

Scale).

2.5.5 Univariate outliers. Outliers are extreme values that may distort the results of a

statistical analysis. Potential outliers can be identified by z-scores greater than ± 3.29 (p < 0.001,

two-tailed test), therefore, z-scores will be calculated to screen for potential univariate outliers.

Cases flagged as potential outliers will be examined and if appropriate, researchers will reduce

their influence or delete the outliers completely before further data screening.

2.5.6 Screening for assumptions of data analyses. All data will be screened to ensure it

meets the assumptions of the main data analysis, hierarchical multiple regression. These

26

assumptions include linear relationship, multivariate normality, little to no multicollinearity, no

auto-correlation, and homoscedasticity (Fox, 2008; Tremblay, 2013).

2.5.7 Descriptive statistics and correlations. Means and standard deviations for all

variables will be calculated. This will provide additional information regarding the

characteristics of the peer leaders tested. Bivariate correlations will calculated between all

variables to determine the strength and direction of the relationship between variables. Further,

to test the hypothesis that being a peer leader in the REACT program is associated with positive

youth experiences, the following bivariate correlations will be performed:

A. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with positive identity experiences (identity exploration and identity reflection),

a bivariate correlation will be conducted.

B. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with positive identity experiences (identity exploration and identity reflection),

a bivariate correlation will be conducted.

C. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with positive initiative experiences (goal setting, effort, problem solving and

time management), a bivariate correlation will be conducted.

D. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with positive basic skills (emotional regulation, cognitive skills and physical

skills), a bivariate correlation will be conducted.

E. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with positive interpersonal relationships (diverse peer relationships and

prosocial norms), a bivariate correlation will be conducted.

27

F. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with positive team work and social skills (group process skills, feedback,

leadership and responsibility), a bivariate correlation will be conducted.

G. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with positive adult networks and social capital (integration with family,

linkages to community and linkages to work and college), a bivariate correlation will be

conducted.

H. To test the hypothesis that participation as a peer leader in the REACT program will be

associated with few negative experiences (stress, negative peer influences, social

exclusion, and negative group dynamics), a bivariate correlation will be conducted.

2.5.8 Hypothesis testing. In order to determine the degree of variance that the REACT

experience has on outcome variables (i.e., civic responsibility, civic attitudes, resilience), several

hierarchical multiple regressions will be conducted:

I. To test the hypothesis that a positive REACT experience will contribute significant

variance in civic responsibility over and above one’s level of education, a hierarchical

multiple regression will be conducted. Level of education will be entered in the first step

and REACT youth experience will be entered in the second step.

Model 1 Step 1: EducationStep 2: YES 2.0 Outcome variable: Civic responsibility

J. To test the hypothesis that a positive REACT experience will contribute to significant

variance in civic attitudes over and above one’s level of education, a hierarchical multiple

regression will be conducted. Level of education will be entered in the first step and

REACT youth experience will be entered in the second step.

28

Model 2Step 1: EducationStep 2: YES 2.0 Outcome variable: Civic attitudes

K. To test the hypothesis that a positive REACT experience will contribute to significant

variance in resilience over and above one’s level of education and perceived social

support, a hierarchical multiple regression will be conducted. Level of education and

perceived social support will be entered in the first step and REACT youth experience

will be entered in the second step.

Model 3Step 1: Education,

Multidimensional Scale of Perceived Social Support Step 2: YES 2.0 Outcome variable: Civic attitudes

29

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Appendix A: Quantitative Measures

Demographic Questionnaire

Date of birth (YYYY/MM/DD): (__ __ __ __/__ __/__ __) Sex (circle): Male Female

1. Please check all years that you worked as a peer leader for the REACT program:

2005/2006

2006/2007

2007/2008

2008/2009

2009/2010

2010/2011

2011/2012

2012/2013

2013/2014

2014/2015

2. Highest level of education you have completed:

Grade 9

Grade 10

Grade 11

Grade 12

Some university

Some college

Bachelor’s Degree

College Diploma

Some post-graduate

Master’s Degree

PhD, law or medical degree

Other

o If other, please explain:

36

3. Are you currently a student?

Yes No

4. Are you currently:

Employed (full-time)

Employed (part-time)

Self-employed

Unemployed

5. What field best represents your current or most recent employment?

Agriculture, forestry, fishing and hunting

Mining, quarrying, and oil and gas extraction

Utilities

Construction

Manufacturing

Wholesale trade

Retail trade

Transportation and warehousing

Information and cultural industries

Finance and insurance

Real estate and rental and leasing

Professional, scientific and technical services

Management of companies and enterprises

Administrative and support, waste management and remediation services

Educational services

Health care and social assistance

Arts, entertainment and recreation

Accommodation and food services

Other services )except public administration)

Public administration

37

YES 2.0

Instructions: Based on your current or recent involvement please rate whether you have had the following experiences in REACT.

Your experiences in REACT:

1 = Yes, definitely

2 = Quite a bit

3 = A little

4 = Not at all

1 (Not at all)

2 (A little) 3 (Quite a bit)

4 (Yes, definitely)

1. Tried doing new things2. Tried a new way of acting around people3. I do things here I don’t get to do anywhere

else4. Started thinking more about my future

because of this activity5. This activity got me thinking about who I

am6. This activity has been a positive turning

point in my life7. I felt left out8. I set goals for myself in this activity9. Learned to find ways to achieve my goals10. Learned to consider possible obstacles

when making plans11. I put all my energy into this activity12. Youth in this activity got me into drinking

alcohol or using drugs13. Learned to push myself14. Learned to focus my attention15. There were cliques in this activity16. Observed how others solved problems and

learned from them17. Learned about developing plans for solving

a problem18. Used my imagination to solve a problem19. Learned about organizing time and not

procrastinating (not putting things off)20. I was ridiculed by peers for something I did

in this activity

38

1 (Not at all)

2 (A little) 3 (Quite a bit)

4 (Yes, definitely)

21. Learned about setting priorities22. Practiced self-discipline23. Learned about controlling my temper24. Became better at dealing with fear and

anxiety25. I did something in this activity that was

morally wrong26. Became better at handling stress27. Learned that my emotions affect how I

perform

In this activity I have improved:28. Academic skills (reading, writing, math,

etc.)29. Skills for finding information30. Computer/internet skills31. Artistic/creative skills32. Communication skills33. Athletic or physical skills

Your Experiences in REACT:34. Made friends with someone of the opposite

gender35. Learned I had a lot in common with people

from different backgrounds36. Other youth in this activity made

inappropriate sexual comments, jokes, or gestures

37. Got to know someone from a different ethnic group

38. Made friends with someone from a different social class (someone richer or poorer)

39. Learned about helping others40. I was able to change my school or

community for the better41. Was discriminated against because of my

gender, race, ethnicity, disability, or sexual orientation

42. Learned to stand up for something I believed was morally right

39

1 (Not at all)

2 (A little) 3 (Quite a bit)

4 (Yes, definitely)

43. We discussed morals and values44. Learned that working together requires

some compromising45. Became better at sharing responsibility46. Learned to be patient with other group

members47. This activity has stressed me out48. Learned how my emotions and attitude

affect others in the group49. Learned that it is not necessary to like

people in order to work with them50. I became better at giving feedback51. I get stuck doing more than my fair share52. I became better at taking feedback53. Learned about the challenges of being a

leader54. Others in this activity counted on me55. This activity interfered with doing things

with family56. Had an opportunity to be in charge of a

group of peers57. Felt like I didn’t belong in this activity58. This activity improved my relationship

with my parents/guardians59. I had good conversations with my

parents/guardians because of this activity60. Got to know people in the community61. Came to feel more supported by the

community62. Felt pressured by peers to do something I

didn’t want to do63. This activity opened up job or career

opportunities for me64. This activity helped prepare me for college65. Demands were so great that I didn’t get

homework done66. This activity increased my desire to stay in

school

40

The Civic Responsibility Survey

Think about your daily life NOW – OUTSIDE of REACT. With that in mind, please indicate how strongly you disagree or agree with each statement. Circle the number that best describes your response.

Strongly disagree

Disagree Slightly disagree

Slightly agree

Agree Strongly agree

1. I have a strong and personal attachment to a particular community.

1 2 3 4 5 6

2. I often discuss and think about how political, social, local or national issues affect the community.

1 2 3 4 5 6

3. I participate in political or social causes in order to improve the community.

1 2 3 4 5 6

4. It is my responsibility to help improve the community.

1 2 3 4 5 6

5. I benefit emotionally from contributing to the community, even if it is hard and challenging work.

1 2 3 4 5 6

6. I am aware of the important needs in the community.

1 2 3 4 5 6

7. I feel a personal obligation to contribute in some way to the community.

1 2 3 4 5 6

8. I am aware of what can be done to meet the important needs in the community.

1 2 3 4 5 6

9. Providing service to the community is something I prefer to let others do.

1 2 3 4 5 6

10. I have a lot of personal contact with people in the community.

1 2 3 4 5 6

11. Helping other people is something that I am personally responsible for.

1 2 3 4 5 6

12. I feel I have the power to make a difference in the community.

1 2 3 4 5 6

41

Strongly disagree

Disagree Slightly disagree

Slightly agree

Agree Strongly agree

13. I often try to act on solutions that address political, social, local or national problems in the community.

1 2 3 4 5 6

14. It is easy for me to put aside my self-interest in favor of a greater good.

1 2 3 4 5 6

15. I participate in activities that help to improve the community, even if I am new to them.

1 2 3 4 5 6

16. I try to encourage others to participate in the community.

1 2 3 4 5 6

17. Becoming involved in political or social issues is a good way to improve the community.

1 2 3 4 5 6

18. I believe that I can make a difference in the community.

1 2 3 4 5 6

19. I believe that I can have enough influence to impact community decisions.

1 2 3 4 5 6

20. I am or plan to become actively involved in issues that positively affect the community.

1 2 3 4 5 6

21. Being concerned about state and local issues is an important responsibility for everybody.

1 2 3 4 5 6

22. Being actively involved in community issues is everyone’s responsibility, including mine.

1 2 3 4 5 6

23. I try to find time or a way to make a positive difference in the community.

1 2 3 4 5 6

24. I understand how political and social policies or issues affect members in the community.

1 2 3 4 5 6

42

The Resilience Scale

Think about your daily life NOW – OUTSIDE of REACT. With that in mind, please circle the answer that shows how much you agree or disagree with each statement below.

Strongly disagree

Disagree Slightly disagree

Neither agree nor disagree

Slightly agree

Agree Strongly agree

1. I usually manage one way or another. 1 2 3 4 5 6 72. I feel proud that I have accomplished

things in life.1 2 3 4 5 6 7

3. I usually take things in my stride. 1 2 3 4 5 6 74. I am friends with myself. 1 2 3 4 5 6 75. I feel that I can handle many things at a

time.1 2 3 4 5 6 7

6. I am determined. 1 2 3 4 5 6 77. I can get through difficult times because

I’ve experienced difficulty before.1 2 3 4 5 6 7

8. I have self-discipline. 1 2 3 4 5 6 79. I keep interested in things. 1 2 3 4 5 6 710. I can usually find something to laugh

about.1 2 3 4 5 6 7

11. My belief in myself gets me through hard times.

1 2 3 4 5 6 7

12. In an emergency, I’m somebody people generally can rely on.

1 2 3 4 5 6 7

13. My life has meaning. 1 2 3 4 5 6 714. When I am in a difficult situation, I can

usually find my way out of it.1 2 3 4 5 6 7

43

Multidimensional Scale of Perceived Social Support

Think about your daily life NOW – OUTSIDE of REACT. We are interested in how you feel about the following statements. Read each statement carefully. Indicate how you feel about each statement.

Very Strongly Disagree

Strongly Disagree

Mildly Disagree

Neutral Mildly Agree

Strongly Agree

Very Strongly

Agree1. There is a special person who is around

when I am in need.1 2 3 4 5 6 7

2. There is a special person with whom I can share my joys and sorrows.

1 2 3 4 5 6 7

3. My family really tries to help me. 1 2 3 4 5 6 74. I get the emotional help and support I

need from my family.1 2 3 4 5 6 7

5. I have a special person who is a real source of comfort to me.

1 2 3 4 5 6 7

6. My friends really try to help me. 1 2 3 4 5 6 77. I can count on my friends when things

go wrong.1 2 3 4 5 6 7

8. I can talk about my problems with my family.

1 2 3 4 5 6 7

9. I have friends with whom I can share my joys and sorrows.

1 2 3 4 5 6 7

10. There is a special person in my life who cares about my feelings.

1 2 3 4 5 6 7

11. My family is willing to help me make decisions.

1 2 3 4 5 6 7

12. I can talk about my problems with my friends.

1 2 3 4 5 6 7

44

Appendix B: Qualitative Measures

Focus Group Questions

How has young people’s understanding of health been impacted by their participation in the

Niagara Region’s REACT program?

1. Under Article 24 of the UN Convention on the Rights of the Child, all young people are

guaranteed the highest standard of health. Can you describe any areas of your own or the

community’s health that became important to you, your friends or families during your

time in REACT?

2. Once again referring to the UN Convention, Article 12 discusses young people’s right to

participate in society and to express their views freely in all matters. In terms of your

time in REACT how was this right to participate freely and to express your views

respected by those in authority?

3. How have your own ideas and your individual participation impacted the REACT

program or the Health Region in general?

4. From your perspective, were there any voices or groups of young people who were not

present during your time in REACT? Please explain.

5. Please recall one of your most memorable events during your time with REACT.

6. What were some of the most important aspects of belonging to REACT for you on a

personal level?

7. Could you describe your experiences with adult mentors during your time with REACT,

either from the Niagara Health Region or elsewhere?

8. Were there any aspects of the REACT program that you would like to see changed or

done differently?

9. Do you care to add any final reflections or comments about your time in REACT?