Prevention Research Center aims to help families and their children

"And how many adolescents do you have?" Doug Coatsworth asks, leaning back in his chair with a knowing smile. Clearly, he can tell from my expression that I am having no problem relating to the topic at hand: emotionally charged interchanges between parents and teens. Although my three kids are over 18 and "semi-launched," those tense parenting moments from the not-very-distant past are all too memorable.

Coatsworth is co-leader of family science and intervention programs and the Program on Empathy, Awareness, and Compassion in Education (PEACE) initiative at Penn State's Prevention Research Center. He is the principal investigator for a study that uses mindfulness techniques to help parents monitor their thoughts and feelings while they're interacting with their adolescent children.

"When parents get caught up in that moment — and any parent of a pre-teen or teen knows this — they can slip into familiar patterns that lead to escalating emotions and lost tempers," he says. "Mindfulness involves training your mind in ways that allow you to step back, slow down, and be really present to what is happening — to note your thoughts and emotions with a sense of dispassion. We work with parents to get them out of their heads and into their lives."

When parents and kids can talk to each other without succumbing to escalating emotions, their relationship will benefit — and that, Coatsworth and his colleagues, Mark Greenberg, Larissa Duncan and Rob Nix, believe, can reduce the risk that adolescents will get involved in dangerous activities like drinking, drugs and sex.

Coatsworth's mindfulness study is one of many projects under way through Penn State's Prevention Research Center. Established in 1997 with an endowment by alumna Edna Bennett Pierce, the center is the largest of its kind in the nation. It also is recognized as one of the best. "What sets us apart is our broad range of focuses," says acting director Ed Smith. "While we're similar to other prevention centers in that we promote effective programs and work in communities to ensure they're being done well, we incorporate a strong research component."

At one end of the center's spectrum of activity is basic child development research — how children's brains develop, how parents, peers and teachers can influence that development, and what can derail normal growth and maturation. "This part of our work doesn't involve any programs or interventions," says Smith. "It's purely about understanding — whether it's early childhood, adolescence or early adulthood. Then the other extreme is about delivery. We've applied our understanding to a program, we've tested that program and know it works, and now we want to figure out the best way to deliver it."

What happens in the middle — testing a program to find out if it works — is key to the Prevention Research Center's mission. Prevention programs are delivered on a full scale only after they've been proven effective through clinical trials and evaluation. "Whatever the objective — be it reduced substance use or reduced fighting and aggression — we keep tinkering until we think we have the right product," Smith says. "Only after we've published our findings and they've been reviewed and critically assessed do we promote our programs."

In its 15 years of existence, the Prevention Research Center has evolved along with advances in prevention science, a relatively new field that grew out of a shift in thinking about public health. The release of the 1964 Surgeon General's report that alerted the nation to the health risks of smoking was the impetus for this shift. The report suggested that, in addition to traditional public health measures — such as administering immunizations and monitoring drinking water — changing people's behavior could help them live longer and healthier lives.

"How do you push for those behavioral changes?" Smith says. "Therapy is one way, but it's costly and it's done on an individual basis. Plus you're waiting until the person develops a problem before you intervene. A growing number of professionals started seeing a common thread tying together many fields: psychology, epidemiology, psychiatry, social work. That thread is promoting well-being and preventing disorders, and this is how prevention science emerged."

With support from the National Institutes of Health and its National Institute on Drug Abuse, as well as the National Institute on Childhood Health and Human Development, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Mental Health, the Prevention Research Center continues to expand its breadth of programs and projects. Here's a sampling:

Talking to teens about drinking

"When it comes to teen drinking, there's a traditional view that parents don't have much of an impact, but here's the deal — they do," says psychologist Rob Turrisi. "Evidence shows that when parents intervene in the right ways, they can affect their teens' decisions to drink."

Turrisi developed a program for parents on how to communicate with teenagers about dangerous drinking, with a focus on college freshmen leaving home for the first time. His research shows that a number of factors are especially relevant when parents communicate with their teens: Teens need to believe their parents are giving them good advice, and they need to believe their parents are looking out for their best interest. As well, it's important for the teen to see the parent as available and accessible. "A teenager who sees his parent as being too busy and generally unavailable won't seek out that parents' advice," Turrisi says.

Communication style matters, too. When parents talk with their kids, it's important for them to show empathy and understanding, stay calm and relaxed, and be clear, direct, responsive, and supportive. Finally, after parents convey their expectations about drinking, they need to follow up to see if those expectations are being met, and then respond in a way that keeps communication channels open.

"Other approaches simply encourage a conversation or two, but they don't show parents how to follow up," Turrisi says. "Parents who use our program learn how to 'check in' to see if what they talked about is being translated into action and then what to do after the check-in. Our approach encourages parents to be vigilant. And if they put all this into practice, their discussions with teens will be that much more effective."

Bullies and brain activity

Watching kindergarteners watch cartoons can help scientists understand aggressive behavior. Neuroscientist Lisa Gatzke-Kopp is interested in how young children's brains are organized, and in a recent study of kindergarteners in the Harrisburg (Pa.) School District she and her colleagues compared aggressive children, who get into fights easily or bully others, to nonaggressive kids. "We wanted to find out how aggressive children experience and manage their emotions — would it be different from the methods their nonaggressive classmates use?" says Gatzke-Kopp.

The researchers collected teacher ratings of each child's behaviors, including aggression, disobedience and self-control. They also brought in a mobile research laboratory to measure the children's heart rate, skin conductance and brain activity while they were watching cartoon video clips depicting fear, sadness, happiness and anger. The goal was to see how both the aggressive and the nonaggressive children reacted to different emotions, and whether those reactions are linked to aggression.

The team found that 90 percent of the aggressive kids in the study fell into one of two categories: They were either low in verbal ability, or they were more easily aroused physiologically. "The kids with lower verbal ability have a harder time extracting what other people are feeling," Gatzke-Kopp says. "They don't have a nuanced sense of emotions — everything is either happy or sad to them — so they might not be good at seeing how their behavior is making another child feel. Because they have a hard time communicating verbally, hitting is the easier solution when they're frustrated."

The second group of kids, who were more physiologically aroused, might have trouble distinguishing between a minor annoyance and a major threat. They are more apt to act on impulse, easily losing control of their behavior.

"Kids who hit their classmates when they're frustrated or disrupt the class are at especially high risk for long-term consequences, including delinquency, violence, dropping out of school, abusing substances, and even suicide," Gatzke-Kopp says. "Research tells us that the earlier we can intervene, the better the chances of getting these children back on track. This study shows us there are different underlying causes for problem behavior, and we might need different types of treatments to change that behavior."

Yoga for kids

The words "yoga class" probably don't evoke a group of inner-city ten-year-olds practicing poses and breathing. But it's happening in Baltimore, as part of the Prevention Research Center's PEACE component. PEACE encompasses a broad range of programs that share the goal of promoting health and well-being in children, youth and families through awareness, compassion and empathy. One of those programs, led by psychologist Mark Greenberg, focuses on teaching yoga and mindfulness techniques. With partners from Johns Hopkins University and the Holistic Life Foundation — a Baltimore-based nonprofit organization that initiates human and environmental health programs — Greenberg and colleagues set up the program in four Baltimore public schools.

The idea was to try yoga as a way of helping fourth and fifth graders from low-income families deal with stress by building self-regulation skills. "Poverty is stressful, and stress can impair kids' ability to regulate their thoughts and emotions," says Greenberg. "Yoga can help."

Classes started with yoga positions, so the kids could be active, then ended with stillness and silence. Although kids weren't sure what to make of the whole thing at first, they caught on quickly. Says Greenberg, "We began to see them really having fun with the poses and then becoming relaxed and quiet — abnormally quiet!"

A pilot study shows that after completing yoga classes, kids were at lower risk for developing anxiety and depression because they were better at managing their thoughts and emotions. In particular, kids reported lower levels of emotional arousal, intrusive thought patterns, and rumination (thinking about the same thing over and over). Currently, a second, larger study is under way to expand the project and measure more factors, including improvement in overall health and well-being.

Caring for teachers

Another program that falls under the center's PEACE initiative focuses on teachers. Prevention scientist Patricia Jennings and her colleagues Christa Turksma and Richard Brown created a professional development program for teachers in collaboration with the Garrison Institute, a not-for-profit organization that explores the intersection of contemplation and engaged action in the world. CARE for Teachers (Cultivating Awareness and Resilience in Education) — shows teachers how they can use mindfulness techniques to slow things down in the midst of a hectic classroom.

"Being a teacher is challenging," Jennings says. "Teachers are under a lot of pressure to fulfill curriculum and testing requirements. They have to deal with their stress in a classroom in front of 20 or 30 kids, and they are not supposed to get angry. It's like having your brake and accelerator going at the same time, and it wears you out. In my own teaching days I remember being all too aware of how stress interfered with my ability to be present and teach in a way that allowed minds to open."

Combining mindfulness practices and emotional skills training, CARE has been demonstrated to work. A two-year pilot project shows that the program helps reduce various kinds of stress.

"I was particularly excited to see that teachers reported a sense of reduced time urgency," Jennings says. "We hear all the time that teachers feel they don't have enough time to get things done. But after participating in our pilot project, teachers told us — and they were actually amazed by this — that they felt a sort of psychological space. I think what happens when you're under time pressure is that you spend so much time thinking about what you have to do that you're not doing it. By deliberately slowing down, teachers perceived they had more time and were accomplishing more."

Fighting boredom

"I'm bored." It's a common refrain among kids, and apparently it's not just an American thing. Prevention scientist Ed Smith and his wife, Linda Caldwell, professor of recreation, park, and tourism management, are conducting a long-term study in South Africa, using school-based prevention techniques to reduce substance abuse and sexual risk among eighth and ninth graders. The study focuses on getting kids to make smart choices when it comes to their free time.

"South Africa has the highest rate of HIV/AIDS in the world and we're working with very high-risk, low-income populations," Smith says. "We think it's critical to reach teens with the message that they do have choices. When we started talking to these kids it became clear that teen boredom is a universal phenomenon. That sense of 'whatever' resonated so well with the South African kids."

Through role play and other activities, teachers delivering the program help kids recognize risky situations and come up with alternative things to do that are exciting but don't get them into trouble. "These kids don't have the option of learning how to scuba dive or skateboard," Smith says. "But we want them to realize they do have options. We've heard some kids say, 'Well, I never thought about hiking up Table Mountain.'"

Smith and Caldwell are in the 11th year of their study. They work with two South African universities to run the program in 48 high schools in former apartheid-era townships. Clinical trials show the program works as a school curriculum — teens that were followed through 11th grade reported less risky behavior. The next step is to adapt the program so that teachers can deliver it even more efficiently, and researchers are tweaking delivery variables such as training and support. Some teachers are simply handed the program, others get an afternoon training, and still others get a two-day, in-depth training. Similarly, some teachers receive support via text message or personal visit, while others are on their own. This research design, developed in conjunction with Linda Collins (Methodology Center) and John Graham (Biobehavioral Health), employs cutting edge methods to solve real-life problems.

"It's complicated because we end up with this huge matrix of who is getting what," Smith says. "But our purpose is relatively simple: We want to take this program, which we now know is effective, and maximize its efficiency and cost/benefit ratio. Is the enhanced training and support worth the cost? Will we see more changes in kids' behavior as a result? We'll find out.

"And I'll be honest with you — this is the best thing I've done in my life. You can't do anything bigger or more impactful than this. We're having an effect on kids' health, and that's exciting."

Douglas Coatsworth, is professor of human development and family studies, jdc15@psu.edu. Edward A. Smith, is interim director of the Prevention Research Center, eas8@psu.edu. Robert Turrisi, is professor of biobehavioral health, rjt13@psu.edu. Lisa Gatzke-Kopp, is assistant professor of human development, lmk18@psu.edu. Mark Greenberg, is Edna Peterson Bennett Endowed Chair in Prevention Research and Professor of Human Development and Psychology, mxg47@psu.edu. Patricia Jennings, is Research Assistant Professor, Prevention Research Center for the Promotion of Human Development, paj16@psu.edu. The Prevention Research Center is based in Penn State's College of Health and Human Development and encompasses program areas that include Family Science and Intervention, Emerging Adulthood, School-based Prevention Research, and the Program on Empathy, Awareness, and Compassion in Education (PEACE). For more information, visit http://www.prevention.psu.edu/