1. 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

2. TABLE OF CONTENTS
Literature 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

3. 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

4. 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

5. 2
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

6. 3
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

7. 4
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

8. 5
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

9. 6
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

10. 7
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

11. 8
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

12. 9
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).

13. 10
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).

14. 11
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

15. 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

16. 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).

17. 14
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,

18. 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)

19. 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:

20. 17
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.

21. 18
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.

22. 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.

23. 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

24. 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

25. 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.

26. 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.

27. 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.

28. 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

29. 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.

30. 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: Education
Step 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.

31. 28
Model 2
Step 1: Education
Step 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 3
Step 1: Education,
Multidimensional Scale of Perceived Social Support
Step 2: YES 2.0
Outcome variable: Civic attitudes

32. 29
References
Balch, G. I., Tworek, C., Barker, D. C., Sasso, B., Mermelstein, R. J., Giovino, G. A. (2004).
Opportunities for youth smoking cessation: Findings from a national focus group study.
Nicotine & Tobacco Research, 6, 9-17. http://dx.doi.org/10.1080/1462200310001650812
Bandura, A. (1971). Social learning theory. Stanford, CA: General Learning Corporation.
Bandura, A. (1986). Social foundations of thought and action. NJ: Englewood Cliffs.
Baric, L., & Harrison, A. (1977). Social pressure and health education: An exploratory
intervention study of health education dealing with the problem of abortion. Journal of
the Institute of Health Education. 15, 12-18. http://dx.doi.org/10.1080/03073289.1977
Benson, P. L. (1997). All kids are our kids: What communities must do to raise caring and
responsible children and adolescents. San Francisco, CA: Jossey-Bass Inc.
Bird, W. A., Martin, M. J., Tummons, J.D ., & Ball, A. L. (2013). Engaging students in
constructive youth-adult relationships: A case study of urban school-based agriculture
students and positive adult mentors. Journal of Agricultural Education, 54, 29-43.
http://dx.doi.org/10.5032/jae.2013.02029
Brennan, M. A. (2008). Conceptualizing resiliency: An interactional perspective for community
and youth development. Child Care in Practice, 14, 55-64.
http://dx.doi.org/10.1080/13575270701733732
Bruyere, E. B. (2010). Child participation and positive youth development. Child Welfare, 89,
205-220.
Campbell, A. C., Barnum, D., Ryden, V., Ishkanian, S., Stock, S., Chanoine, J. P. (2012). The
effectiveness of the implementation of Healthy Buddies, a school-based, peer-led health
promotion program in elementary schools. Canadian Journal of Diabetes, 36, 181-186.
http://dx.doi.org/10.1016/j.jcjd.2012.07.001
Catalano, R. F., Berglund, M. L., Ryan, J. A., Lonczak, H. S., & Hawkins, J. D. (2002). Positive
youth development in the United States: Research findings on evaluations of positive
youth development programs. Prevention & Treatment, 5, 98-124.
http://dx.doi.org/10.1037//1522-3736.5.1.515a
Csikszentmihalyi, M. (1990). Flow: The psychology of optimal performance. New York, NY:
HarperPerennial.
Damon, W. (2004). What is positive youth development? The Annals of the American Academic
of Political and Social Science, 591, 25-39. http://dx.doi.org/10.1177/0002716203260092

33. 30
Dawes, N. P., & Larson, R. (2011). How youth get engaged: Grounded-theory research on
motivational development in organized youth programs. Developmental Psychology, 47,
259-269. http://dx.doi.org/10.1037/a0020729
DeRoche, K. K., & Laham, M. K. E. (2008). Methodological considerations for conducting
qualitative interviews with youth receiving mental health services. Forum: Qualitative
Social Research, 9, 296-308. http://dx.doi.org/10.1007/s10488-014-0570-4
Fox, J. (2008). Applied regression analysis and generalized linear models (2nd ed.). Thousand
Oaks, CA: Sage Publications.
Frantz, J. M. (2015). A peer-led approach to promoting health education in schools: The views of
peers. South African Journal of Education, 35, 1-7.
Fraser-Thomas, J. L., Côté, J., & Deakin, J. Youth sport programs: An avenue to foster positive
youth development. Physical Education and Sport Pedagogy, 10, 19-40.
http://dx.doi.org/10.1080/1740898042000334890
Furco, A., Muller, P. & Ammon, M. S. (1998) The Civic Responsibility Survey. Berkeley,
California:Service-Learning Research Center, University of California.
Gilligan, R. (2007). Adversity, resilience and the educational progress of young people in public
care. Emotional and Behavioural Difficulties, 12, 135-145.
http://dx.doi.org/10.1080/13632750701315631
Greenberger, E., & Sorensen, A. B. (1974). Toward a concept of psychosocial maturity. Journal
of Youth and Adolescence, 3, 329-358. http://dx.doi.org/10.1007/bf02214746
Grossman, J. B., & Rhodes, J. E. (2002). The test of time: Predictors and effects of duration in
youth mentoring relationships. American Journal of Community Psychology, 30, 199-
219. http://dx.doi.org/10.1037/e314762004-001
Hall, G. S. (1904). Adolescence: Its psychology and its relations to physiology, anthropology,
sociology, sex, crime, religion, and education. New York; NY: Appleton
Hamilton, S. F., Hamilton, M. A. & Pittman, K. (2004). Principles for youth development. In
S.F. Hamilton & M.A. Hamilton (Eds.), The youth development handbook: Coming of
age in American communities. Retrieved from
https://dspace.library.cornell.edu/bitstream/1813/21945/2/PrinciplesYD.pdf
Hansen, D. M., & Larson, R. (2005). The youth experience survey 2.0: Instrument revisions and
validity testing. Urbana, Illinois: University of Illinois, Urbana-Champaign.
Holt, N. (2008). Positive youth development through sport. New York, NY: Routledge.

34. 31
Institute for Digital Research and Education (IDRE). (2015). SPSS Faq. Retrieved from
http://www.ats.ucla.edu/stat/spss/faq/alpha.html
Jones, M. I., Dunn, J. G. H., Holt, N. L., Sullivan, P. J., & Bloom, G. A. (2011). Exploring the
“5Cs” of positive youth development in sport. Journal of Sport Behavior, 34, 250-267.
Kahne, J., Nagaoka, J., Brown, A., O’Brien, J., Quinn, T., & Thiede, K. (2001). Assessing after-
school programs as contexts for youth development. Youth & Society, 32, 421-446.
http://dx.doi.org/10.1177/0044118x01032004002
Lansdown, G. (2001). Promoting children’s participation in democratic decision-making.
Tuscany, SI: United Nations Children’s Fund Innocenti Research Centre.
Larson, R. W. (2000). Toward a psychology of positive youth development. American
Psychologist, 55, 170-183. http://dx.doi.org/10.1037//0003-066x.55.1.170
Larson, R., Walker, K., & Pearce, N. (2005). A comparison of youth-driven and adult-driven
youth programs: Balancing inputs from youth and adults. Journal of Community
Psychology, 33, 57-74. http://dx.doi.org/10.1002/jcop.20035
Lee, T. Y., Cheung, C. K., & Kwong, W. M. (2012). Resilience as a positive youth development
construct: A conceptual review. The Scientific World Journal, 2012, 1-9.
http://dx.doi.org/10.1100/2012/390450
Leffert, N., Benson, P. L., Scales, P. C., Sharma, A. R., Drake, D. R., & Blyth, D. A. (1998).
Developmental assets: Measurement and prediction of risk behaviors among adolescents.
Applied Developmental Science, 2, 209-230.
http://dx.doi.org/10.1207/s1532480xads0204_4
Lerner, R. M. (2004). Liberty: Thriving and civic engagement among American youth. Thousand
Oaks, CA: Sage.
Lerner, R. M. (2005). Promoting positive youth development: Theoretical and empirical bases.
Medford, MA: Institute for Applied Research in Youth Development.
Lerner, R. M., Fisher, C. B., & Weinberg, R. A. (2003). Toward a science for and of the people:
Promoting civil society through the application of developmental science. Child
Development, 71, 11-20. http://dx.doi.org/10.1111/1467-8624.00113
Lerner, R. M., Lerner, J. V., Almerigi, J. B., Theokas, C., Phelps, E., Gestsdottir, S.,…von Eye,
A. (2005). Positive youth development, participation in community youth development
programs, and community contributions of fifth-grade adolescents: Findings from the
first wave of the 4-H study of positive youth development. Journal of Early Adolescence,
25, 17-71. http://dx.doi.org/10.1177/0272431604272461

35. 32
Lindsey, B. J. (1997). Peer education: A viewpoint and critique. Journal of American College
Health, 45, 187-189. http://dx.doi.org/10.1080/07448481.1997.9936882
Little, R. R. (1993). What’s working for today’s youth: The issues, the programs, and the
learnings. Institute for Children, Youth, and Families Fellows’ Colloquium. Michigan,
US: Michigan State University.
Mabry, J. B. (1998). Pedagogical variations in service-learning and student outcomes: How time,
contact, and reflection matter. Michigan Journal of Community Service Learning, 5, 32-
47.
Marmot, M. (2011). Social determinants of health – what doctors can do. London, UK: British
Medical Association
McGuire, W. J. (1964). Some contemporary approaches. Advances in Experimental Social
Psychology, 1, 191-229. http://dx.doi.org/10.1016/s0065-2601(08)60052-0
Mellanby, A. R., Rees, J. B., & Tripp, J. H. (2000). Peer-led and adult-led school health
education: A critical review of available comparative research. Health Education
Research, 15, 533-545. http://dx.doi.org/10.1093/her/15.5.533
Mikkonen, J., & Raphael, D. (2010). Social determinants of health: The Canadian facts.
Toronto, ON: York University School of Health Policy and Management.
Mincemoyer, C. C., & Perkins, D. F. (2005). Measuring the impact of youth development
programs: A national on-line youth life skills evaluation system. The Forum for Family
and Consumer Issues, 10.
Minister of Supply and Services Canada (MSSC). (1991). Convention on the rights of the child
(Cat. Publication No. S2-210/1991E). Gatineau, QC: Department of Canadian Heritage
Printing Office.
Mitchell, R. C. (2003). Canadian health care and child rights – What are the links? Canadian
Journal of Public Health/Revue Canadienne de Santé Publique, 94, 414-416.
Mitchell, R. C. (2011). Human rights and health promotion: A Canada fit for children?
International Journal of Child, Youth and Family Studies, 2, 510-526.
Ong, A. D., Bergeman, C. S., Bisconti, T. L., & Wallace, K. A. (2006). Psychological resilience,
positive emotions, and successful adaptation to stress in later life. Journal of Personality
and Social Psychology, 91, 730-749. http://dx.doi.org/10.1037/0022-3514.91.4.730
Raphael, D. (2009). Social determinants of health: Canadian perspectives (2nd ed.). Toronto,
ON: Canadian Scholars’ Press Inc.

36. 33
Shernoff, D. J., & Vandell, D. L. (2007). Engagement in after-school program activities: Quality
of experience from the perspective of participants. Journal of Youth and Adolescence, 36,
891-903. http://dx.doi.org/10.1007/s10964-007-9183-5
Sherrod, L. (2007). Civic engagement as an expression of positive youth development.
Approaches to Positive Youth Development, 1, 59-74.
http://dx.doi.org/10.4135/9781446213803.n3
Stattin, H., Kerr, M., Mahoney, J., Persson, A., & Magnusson, D. (2005). Explaining why a
leisure context is bad for some girls and not for others. Mahwah, NJ : Lawrence Erlbaum
Tremblay, P. F. Assumption in multiple regression. Retrieved from
http://publish.uwo.ca/~ptrembla/resources/Assumptions-Multiple-Regression.pdf
United Nations Committee on the Rights of the Child (UNCRC). (2009). General comment no.
12: The right of the child to be heard. Retrieved from
http://www.refworld.org/docid/4ae562c52.html
United Nations International Children's Emergency Fund (UNICEF). (2014). The convention on
the rights of the child. Retrieved from http://www.unicef.org/rightsite/
van Daalen-Smith, C. (2007). A right to health: Children’s health and health care through a child
rights lens. In K. Covell & R. B. Howe (Ed.), A question of commitment: Children’s
rights in Canada (pp. 73-97). Waterloo, ON: Wilfrid Laurier University Press.
Vandell, D. L., Shernoff, D. J., Pierce, K. M., Bolt, D. M., Dadisman, K., & Brown, B. B.
(2005). Activities, engagement, and emotion in after-school programs (and elsewhere).
New Directions for Youth Development, 105, 121-129. http://dx.doi.org/10.1002/yd.111
Vandergrift, K., & Bennett, S. (2012). Children’s rights: A framework for health promotion.
Healthcare Quarterly, 15, 14-17. http://dx.doi.org/10.12927/hcq.2013.22947
Wagnild, G. M. (2009). A review of the Resilience Scale. Journal of Nursing Measurement, 17,
105-113. http://dx.doi.org/10.1891/1061-3749.17.2.105
Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the
Resilience Scale. Journal of Nursing Management, 1, 165-178
Walker, K., & Larson, R. (2006). Adult-driven youth programs: An oxymoron? The Prevention
Researcher, 13, 17-20.
Wong, N. T., Zimmerman, M. A., & Parker, E. A. (2010). A typology of youth participation and
empowerment for child and adolescent health promotion. American Journal of
Community Psychology, 46, 100-114. http://dx.doi.org/10.1007/s10464-010-9330-0

37. 34
World Health Organization (WHO). (1986). Ottawa Charter for Health Promotion. Ottawa, ON:
Canadian Public Health Association.
World Health Organization (WHO). (2015). Global health declarations. Retrieved from
http://www.who.int/trade/glossary/story039/en/
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale
of perceived social support. Journal of Personality Assessment, 52, 30-41.

38. 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:

39. 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

40. 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 things
2. Tried a new way of acting around people
3. I do things here I don’t get to do anywhere
else
4. Started thinking more about my future
because of this activity
5. This activity got me thinking about who I
am
6. This activity has been a positive turning
point in my life
7. I felt left out
8. I set goals for myself in this activity
9. Learned to find ways to achieve my goals
10. Learned to consider possible obstacles
when making plans
11. I put all my energy into this activity
12. Youth in this activity got me into drinking
alcohol or using drugs
13. Learned to push myself
14. Learned to focus my attention
15. There were cliques in this activity
16. Observed how others solved problems and
learned from them
17. Learned about developing plans for solving
a problem
18. Used my imagination to solve a problem
19. Learned about organizing time and not
procrastinating (not putting things off)
20. I was ridiculed by peers for something I did
in this activity

41. 38
1 (Not at
all)
2 (A little) 3 (Quite a
bit)
4 (Yes,
definitely)
21. Learned about setting priorities
22. Practiced self-discipline
23. Learned about controlling my temper
24. Became better at dealing with fear and
anxiety
25. I did something in this activity that was
morally wrong
26. Became better at handling stress
27. 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 information
30. Computer/internet skills
31. Artistic/creative skills
32. Communication skills
33. Athletic or physical skills
Your Experiences in REACT:
34. Made friends with someone of the opposite
gender
35. Learned I had a lot in common with people
from different backgrounds
36. 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 others
40. I was able to change my school or
community for the better
41. 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

42. 39
1 (Not at
all)
2 (A little) 3 (Quite a
bit)
4 (Yes,
definitely)
43. We discussed morals and values
44. Learned that working together requires
some compromising
45. Became better at sharing responsibility
46. Learned to be patient with other group
members
47. This activity has stressed me out
48. Learned how my emotions and attitude
affect others in the group
49. Learned that it is not necessary to like
people in order to work with them
50. I became better at giving feedback
51. I get stuck doing more than my fair share
52. I became better at taking feedback
53. Learned about the challenges of being a
leader
54. Others in this activity counted on me
55. This activity interfered with doing things
with family
56. Had an opportunity to be in charge of a
group of peers
57. Felt like I didn’t belong in this activity
58. This activity improved my relationship
with my parents/guardians
59. I had good conversations with my
parents/guardians because of this activity
60. Got to know people in the community
61. Came to feel more supported by the
community
62. Felt pressured by peers to do something I
didn’t want to do
63. This activity opened up job or career
opportunities for me
64. This activity helped prepare me for college
65. Demands were so great that I didn’t get
homework done
66. This activity increased my desire to stay in
school

43. 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

44. 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

45. 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 7
2. 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 7
4. I am friends with myself. 1 2 3 4 5 6 7
5. 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 7
7. 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 7
9. I keep interested in things. 1 2 3 4 5 6 7
10. 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 7
14. When I am in a difficult situation, I can
usually find my way out of it.
1 2 3 4 5 6 7

46. 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
Agree
1. 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 7
4. 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 7
7. 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

47. 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?