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Several researchers have identified an increase in risk-taking behaviors by men who have sex with men (MSM) and rates of HIV infection that continue to be unacceptably high. The national diffusion and implementation of evidence-based behavioral interventions for gay men to facilitate and maintain safer sexual behaviors is an important strategy for reducing the spread of HIV. Five practical barriers during diffusion have been identified. First, some community-based organizations (CBOs) did not provide incentives for participation in behavioral interventions. Second, some interventions were conceptually complex or difficult to implement, or both. Third, some agencies lacked the capacity to implement complex interventions. Fourth, some CBOs could not bear the costs of some of the interventions. Fifth, difficulty in adapting the intervention to local conditions and populations was an immediate and persistent theme. This chapter also considers five interventions listed in the Centers for Disease Control and Prevention's Compendium that have been proven efficacious for MSM: Popular Opinion Leader, AIDS Community Demonstration Project (Community PROMISE), Mpowerment, Small Group Lecture Plus Skills Training, and Behavioral Self-Management and Assertion Skills.

The histories of the AIDS epidemic in the United States and Australia started similarly, with HIV infection concentrated among men who have sex with men (MSM). Gay communities in both countries reacted by mounting their own “grassroots” education, service, and advocacy programs, and both countries' governments reacted by funding medical and epidemiologic research. Behavioral prevention efforts followed closely thereafter. This chapter reviews the HIV/AIDS behavioral literature focusing on gay men from Australia and the United States to better understand and learn how to develop HIV behavioral interventions from the combined experience of HIV prevention researchers from the two countries. It recommends routine data collection in the following areas: attitudes, HIV testing, correlates of risk behaviors, risk reduction strategies, sexual risk behaviors, connectedness to the gay community, the range of sex practices, exposure to and use of medical and behavioral prevention services, and treatment of HIV-infected MSM.

This chapter discusses the role of theory in the development and evaluation of health behaviour interventions, focusing on sexually transmitted infection (STI). First, it outlines the rationale for using theories of behaviour change. It then describes one theoretical approach — the theory of reasoned action — and shows how the theory can be used to guide the development of an intervention. Although the discussion focuses on this particular theory, most of the comments are also applicable to other theories of behaviour change. Finally, the chapter provides a detailed discussion of a number of problems and issues that arise when using theories of behaviour change as the basis for behavioural interventions.

This chapter focuses on the role of randomized controlled trials (RCTs) of behavioural sexual health interventions in developing countries. It argues that, whenever feasible, well-conducted RCTs are the best method to evaluate the health and behavioural effects of such interventions. The appropriate use of designs such as cluster randomized trials makes it feasible to use experimental methods in the evaluation of a wide variety of sexual health interventions. The dichotomy between advocates and detractors of experimental evaluation designs has often stemmed from both groups ignoring the simple fact that both RCTs and non-RCTs can provide useful and valid information.

This chapter discusses the general points to consider when selecting outcomes for determining sexual risk reduction. It considers the attributes, limitations, measurement, and interpretation of various biological, behavioural, psychological, and other outcome measures of sexual risk reduction. The choice of outcome measures used to assess intervention effectiveness will depend on logistical as well as scientific factors. Biological outcome measures have several advantages over behavioural and cognitive measures. Biological measures are not prone to reporting bias, and thus may provide more valid data than self-reported measures. In addition, interventions that have been shown to reduce rates of sexually transmitted infections (STIs) or unintended pregnancy are likely to carry more weight with policy-makers than those that have only been shown to change sexual behaviour or cognitions.

This chapter explores a framework for the design and evaluation of complex interventions for sexual health. It includes a detailed description of the sequential phases for the development of a randomized controlled trial (RCT), using a model that, until recently, was only applied to drug evaluations. The use of such an approach to the evaluation of interventions in sexual health is discussed, with special reference to an RCT of a behavioural intervention to prevent sexually transmitted infections (STIs) among minority ethnic women from Texas, USA. The approach is also illustrated by a hypothetical intervention to involve general practice nurses in the management of chlamydia trachomatis. Finally, some of the practical difficulties encountered in following this phased approach to the development of complex intervention trials are discussed.

This chapter explores the effects that psychosocial interventions can have on cancer prognosis. The results of major studies that examined the impact of psychosocial and behavioral interventions on survival in patients with breast cancer and malignant melanoma respectively are discussed, along with the immune mechanisms that may be involved in the remarkable effects observed. The role of religion and spirituality as elements of psychosocial support in the support, treatment and prognosis of cancer patients is also considered, together with the relationship between stress, endocrine function, and cancer progression. There seems to be a convergence of evidence that factors involved in religious and spiritual belief, including meaning, purpose and hope in life, and social support, may have beneficial effects on how well and even how long people live with cancer.

The randomized controlled trial (RCT) has become one of the fundamental tools of medical research. In particular, evidence from RCTs is now recognized as a ‘gold standard’ for the evaluation of new health interventions. In RCTs of drugs and vaccines, the products to be compared are usually allocated randomly to individual subjects. Individual randomization may also be appropriate for some RCTs of sexual health interventions. In many cases, however, it may be more appropriate to allocate randomly entire clusters of individuals to each condition. For example, depending on the design of the intervention, trials of behavioural programmes could employ randomization of schools, villages, or entire districts. Such trials are referred to as cluster randomized trials (CRTs). This chapter begins by discussing the rationale for employing the CRT design to evaluate sexual health interventions. Such trials require special methods for their design and analysis that differ from those used in standard individually randomized trials, and these methods are briefly discussed. Finally, the chapter considers some of the limitations and disadvantages of this study design.

This chapter examines policy and practice for addressing health inequalities during adulthood. It discusses the key sources of vulnerability including lifestyle, psychosocial health and material living conditions and analyses the evidence base for what works and the relationship of what works to the policy environment. It suggests that the evidence base for interventions targeting psychosocial health and material deprivation is far more tenuous than for behavioural interventions targeting lifestyle.

This chapter examines policy and practice in addressing health inequalities in older people. It considers efforts to improve the health and well-being of older citizens through lifestyle/behavioural interventions, initiatives that target housing and living standards and initiatives designed to improve access to health and social care. It suggests that older people themselves are more concerned about their independence and quality of life rather than the availability or quality of care services.

This chapter begins with a definition of culture that is useful in exploring the issue of global mental health, followed by a delineation of approaches to clarify the interrelationship of culture and mental health. The chapter then examines current knowledge of mental disorders in low-resource contexts using approaches from anthropology (the culture-bound approach) and epidemiology (the cross-cultural or transnational approach). This is followed by discussion of both social behaviors and functionality, issues associated with mental health that are affected by the culture in which a person lives. What follows is an exploration of risk and resiliency factors, including an examination of the difficulty inherent in differentiating between culture-specific vulnerabilities and vulnerabilities associated more generally with the effects of poverty in a low-resource environment. Finally, the chapter delineates how culture and context can influence the selection and adaptation of behavioral interventions and treatments.

Organizing for effective change requires an understanding both of formal systems and of intimate human relationships. It requires that efforts be intentionally embedded within local context while remaining attuned to the human dynamics that breathe life into these very communities. Chapter 2 proposed that true educational reform requires deep and sustained systems-level change. Chapter 3 explored the impact that relationships have on the sense of connection, trust, and vulnerability necessary for the transformative process. Building on a systems-level lens and an investment in human relationships, this chapter will explore the tenets of behavioral learning theory to better understand how behavior change contributes to transformation within students and school communities. Changing behavior is difficult; it is a slow, often circuitous, journey. It requires real people, with their own personal preferences and habits, to change behaviors that they may have grown strongly accustomed to overtime. What’s more, school professionals responsible for shaping the behavior of others within the education setting often lack the foundational knowledge and skills to do so. In the process of reshaping student behavior and inspiring adult learning, educators frequently start with ambitious goals that lack a clearly articulated plan for promoting the changes necessary to achieve them. Without a roadmap, it is commonplace for educators to become convinced that efforts at change are going nowhere, to lose hope or give up along the way, and tell themselves that “we just can’t help this difficult student” or “this schoolwide initiative won’t work here.” This chapter proposes that the principles of behavioral learning theory can be applied to (1) teach students the social-emotional skills they need to become successful scholars and citizens and (2) build the capacity of adults to improve the overall culture and climate of a school campus. Guided by the tenets of behavioral learning theory we ask the following questions: How do we approach challenging behavior as an opportunity to engage with students and build new behavioral skills? How do we create proactive discipline systems with the explicit purpose of creating a sense of predictability, consistency, and equity?

There are a number of important preventable risk factors that have been associated with the prevalence and incidence of various types of cancers. These risk factors include sedentary lifestyle, poor diet, obesity, sun exposure, and tobacco use (Friedenreich & Orenstein, 2002; Healthy People 2010, 1998; Pappo, 2003; Slattery, Schumacher, West, Robison, & French, 1990). These risk factors are modifiable, and early prevention in childhood may reduce the likelihood of developing cancers such as melanoma and lung, colon, breast, prostate, and endometrial cancers (IARC Working Group, 2002). For example, according to the International Agency for Research on Cancer, between one fourth and one third of cancer cases may be attributed to the combined effects of obesity and physical inactivity (IARC Working Group, 2002), thus promoting both weight control and physical activity in youths may be beneficial for preventing cancer. Therefore, the identification of multiple risk factors that may be linked to cancer prevention that could be incorporated into prevention programs may be an effective approach for cancer prevention in youth. A social ecological model is presented in this chapter as a framework for understanding multilevel strategies for promoting healthy lifestyles to prevent cancer in youths (Bronfenbrenner, 1979, 1992; Wilson & Evans, 2003). According to the ecological model, health behavior is affected by intrapersonal, social, cultural, and physical environmental variables. A social ecological framework (McLeroy, Bibeau, Steckler, & Glanz, 1988) conceptualizes health behavior (e.g., physical activity) as affected by multiple levels of influence. Based on this social ecological model, five levels of influence are specified: (a) individual influences (e.g., biological and psychosocial); (b) interpersonal influences (e.g., family, peers); (c) institutional factors (e.g., school, work sites); (d) community factors (e.g., relationship among organizations, institutions, and social networks); and (e) public policy (e.g., laws and policies at the local, state, national, and international levels). In this model, health behaviors such as physical activity, nutrition, sun exposure, and tobacco use are conceptualized as a function of the interaction of individual, family, and peer influences and school, community, mass media, and public policy influences.

In high school Tim remained below grade level, had low self-esteem, made poor choices in friends, and rebelled against authority. He was also diagnosed with personality disorder and oppositional defiant disorder, in addition to attention deficit disorder (ADD), depression, and post-traumatic disorder (PTSD). He reluctantly took his prescribed drugs and turned to marijuana to self-medicate. This chapter narrates Tim's struggles all throughout high school: his failed extra-curricula endeavors, his marijuana possession, along with several suspensions and detentions due to bad behavior. By the end of the school year, a scheduled Planning and Placement Team (PPT) meeting called for Tim's manifestation determination, functional behavioral analysis, and behavioral intervention plan review. Tim's parents finally decided to transfer him to boarding school.

This chapter makes practical suggestions for managing moral psychology for ethical goals. It does so by looking at interventions aimed at 1) altering human psychology and 2) restricting the impact of morally objectionable psychological biases. The chapter provides justification for intervening to change people’s attitudes toward animals, within the context of debates over the permissibility of “nudges.” Empirical research on reducing bias between groups of human beings is discussed in order to inform proposals for changing attitudes to animals. Classic moral goals in animal ethics are also discussed, with an eye toward how these goals could be assisted by having a better understanding of moral psychology.

Neuropsychological assessment has a long history in the United States military and has played an essential role in ensuring the mental health and operational readiness of service members since World War I (Kennedy, Boake, & Moore, 2010). Over the years, mental health clinicians in the military have developed paper-and-pencil assessment instruments, which have evolved in terms of psychometric rigor and clinical utility, but not in terms of technological sophisti­cation. Since the advent of modern digital computing technology, considerable research has been devoted to the development of computer-automated neuropsychological assessment applications (Kane & Kay, 1992; Reeves, Winter, Bleiberg, & Kane, 2007), a trend that is likely to continue in the future. While many comparatively antiquated paper-and-pencil-based test instruments are still routinely used, it is arguably only a matter of time until they are supplanted by more technologically advanced alternatives. It is important to note, however, that questions have been raised about the ecological validity of many commonly used traditional neuropsychological tests, whether paper-and-pencil-based or computerized (Alderman, Burgess, Knight, & Henman, 2003; Burgess et al., 2006; Chaytor & Schmitter- Edgecombe, 2003; Chaytor, Schmitter-Edgecombe, & Burr, 2006; Parsons, 2016a; Sbordone, 2008). In the context of neuropsychological testing, ecological validity generally refers to the extent to which test performance corresponds to real-world performance in everyday life (Sbordone, 1996). In order to develop neuropsychological test instruments with greater ecological validity, investigators have increasingly turned to virtual reality (VR) technologies as a means to assess real-world performance via true-to-life simulated environments (Campbell et al., 2009; Negut, Matu, Sava, & Davis, 2016; Parsons, 2015a, 2015b, 2016a). Bilder (2011) described three historical and theoretical formulations of neuropsychology. First, clinical neuropsychologists focused on lesion localization and relied on interpretation without extensive normative data. Next, clinical neuropsychologists were affected by technological advances in neuroimaging and as a result focused on characterizing cognitive strengths and weaknesses rather than on differential diagnosis.

This chapter examines how a school inside a juvenile justice facility can be transformed in meaningful ways by sharing the story of the Maya Angelou Academy in Washington, D.C. In November 2006, Vincent Shiraldi, the head of Washington's juvenile justice agency, asked the authors to create a program that will educate incarcerated youth, facilitate their positive reintegration into the community, and support their personal success. This chapter describes the philosophy and program components at the Maya Angelou Academy, including the core academic curriculum, career training, positive behavioral intervention model, and individualized transition planning. It also discusses credit accumulation, reading and math gains, and documented changes in the way students perceive school as a place they can succeed, along with the challenges inherent in creating high-quality educational options in a juvenile correctional setting.