Internalizing symptoms (i.e., anxiety, depressive symptoms, suicidality) are alarmingly
common among adolescents. In 2019, nearly 37% of high school students reported feeling
anxious, sad, or hopeless, representing an increase from 2017 (i.e., 31%), and nearly 19%
seriously considered suicide, an increase from 2017 (17%). The coronavirus pandemic has
exacerbated this problem, with research finding that social isolation resulting from the
pandemic was linked to higher levels of stress, fear, loneliness, anxiety, depression,
and suicide ideation among adolescents. Importantly, ethnic/racial disparities have been
documented in internalizing symptoms, with more negative outcomes for Latinas and Black
males. Current universal school-based approaches to prevention have reported uneven or
limited effects, or no effects at all. Questions have also been raised regarding cost and
accessibility. Despite the uneven track record of universal school-based (Tier 1)
approaches, which has led some to recommend an emphasis on targeted (Tier 2) approaches,
Tier 1 programs possess several advantages. First, given the demographic heterogeneity in
risk factors, as well as disparate access to high-quality, culturally-sensitive health
care, schools remain attractive as Tier 1 programs can ensure equitable access to primary
prevention services. Second, universal programs avoid the difficulty of identifying
adolescents at risk, and third, Tier 1 programs minimize the risk of stigmatizing
adolescents who seek out or are referred to services. In this project, submitted to the
Transformative Research Award initiative, the investigators will use cooperative learning
(CL) as a universal (Tier 1) school-based prevention program to target malleable
peer-based risk factors and subsequently evaluate how change in these mechanisms can
reduce adolescent internalizing symptoms. CL targets various forms of maladaptive peer
relations that create stress and comprise a significant risk factor for internalizing
symptoms in adolescence; CL also promotes peer protective factors that can reduce the
likelihood of internalizing symptoms (e.g., peer acceptance). CL has also been found to
promote more cross-race interaction and interracial attraction, greater cross-ethnic
academic support, and more frequent cross-ethnic friendships. To support teachers in
implementing CL, the investigators will use a Web-based software platform that provides
an accessible, high-fidelity mechanism to deliver CL lessons. The investigators will not
only test for intervention effects, but will also evaluate the relative strength of
specific, theoretically-derived change mechanisms, and uncover key issues/barriers
related to implementation that will allow the investigators to dynamically adjust our
implementation approach to achieve maximum impact during subsequent scale-up. This
project is designed to establish feasibility with teachers and schools and counter
potential threats to implementation fidelity while also creating a roadmap to enhanced
scalability and sustained implementation. Significant results from this project could
inspire broad uptake of this approach in educational contexts, potentially addressing a
significant public health need during a time of crisis due to the coronavirus pandemic.