To better understand the human papillomavirus (HPV) vaccine series initiation among 9–17-year-old female Medicaid beneficiaries in Florida programs between June 2006 and December 2008 (n = 237,015).
Among the Florida Medicaid enrollees with itemized claims collected (non-managed care organization enrollees), we assessed the association between HPV vaccine series initiation (≥1 vaccine claim) and important demographic characteristics (age, race/ethnicity, program enrollment, area of residence, and length of enrollment).
Among 11-17-year-olds, vaccine initiation increased over time from <1% by December 2006 to nearly 19% by December 2008. By December 2008, HPV vaccine initiation increased with respect to age from 9 (1.6%) to 13 years (22.9%), remained relatively stable from ages 13 to 15 years (between 21% and 22%), and decreased among 16- (18.6%) and 17-year-olds (15.7%). Compared with girls in Pilot or Fee for Service programs, the girls in MediPass or Children's Medical Service Network programs were more likely to have initiated the vaccine series. Within three of the four programs, Hispanics were more likely than non-Hispanic white and black girls to have initiated the vaccine series.
This study expands the understanding of HPV vaccine initiation to low-income adolescents eligible for free vaccine through the Federal Vaccine for Children program. Increased understanding of reasons for the observed differences, especially by program and race/ethnicity, will aid in developing interventions to improve HPV vaccine initiation.
Human papillomavirus; Vaccines; Racial disparity; Ethnic disparity; Adolescents; Low income; Health insurance; Medicaid
To investigate patterns and correlates of sexual and reproductive health (SRH) communication among adolescent women in the United States between 2002 and 2008.
We used data from adolescent women (aged 15-19yrs) in the National Survey of Family Growth (2002 and 2006-2008, n=2,326). Multivariate analyses focused on sociodemographic characteristics and SRH communication from parental and formal sources.
Seventy-five percent had received parental communication, on abstinence (60%), contraception (56%), STIs (53%), and condoms (29%); 9% received abstinence-only communication. Formal communication (92%) included abstinence (87%) and contraceptive (71%) information; 66% received both while 21% received abstinence-only. From 2002 to 2006-2008, parental (not formal) communication increased (7%, p<0.001), including abstinence communication (4%, p=0.03). Age, sexual experience, education, mother’s education, and poverty were positively associated with SRH communication.
Receipt of parental SRH communication, especially abstinence, was increasingly common among U.S. adolescents from 2002 to 2008. Strategies to promote comprehensive communication may improve adolescents’ SRH outcomes.
adolescents; sexual and reproductive health communication; sex education; information sources; United States
Two point-of-care (POC) tests are available to detect bacterial vaginosis (BV), a common vaginal condition. This study aimed to 1) compare the accuracy of two self-performed BV tests to clinician-performed BV tests and to clinical BV; and 2) compare trust of results for self-BV testing compared to clinician-BV testing.
Participants (14–22 years old) in a study assessing self-testing for Trichomonas vaginalis were also asked to perform a self-test for BV (using a pH or sialidase test). Results were compared to clinician-tests and to clinical BV (defined by modified Amsel’s criteria). A two-item subscale from a larger acceptability scale was used to assess trust at baseline, after testing, and after discussion of results.
All 131 women performed self-BV testing correctly. Agreement between self- and clinician-tests was good (Kappa 0.5–0.7). Compared to clinical BV, self-pH was 73% sensitive and 67% specific, and self-sialidase was 40% sensitive and 90% specific. Trust in self-BV testing was lower than trust in clinician-BV testing at baseline, but increased after testing and discussion of results.
Young women can perform self-tests for BV with reasonable accuracy, which could increase testing when pelvic exams are not feasible. Trust in self-testing increased after experience and after discussion of test results. Although the pH test is over-the-counter, young women may continue to rely on clinicians for testing.
Adolescent; Vaginosis; Bacterial; Point-of-Care Systems; Patient Acceptance of Health Care; Genital Diseases; Female
The purpose of this report is to examine the effect of exposure to violence on cortisol reactivity in children with no identified serious mental health problems or reports of maltreatment. Exposure to violence was hypothesized to influence development of the stress system in this sample of youth as has been demonstrated in maltreated youth.
The sample consisted of 124 adolescents, ages 8 to 13 years. Data were collected at two waves of measurement, 12 months apart. Exposure to violence was operationalized as the number of different violent events each child was exposed to as a witness or victim. Cortisol reactivity was evaluated in relation to the Trier Social Stress Test for Children.
Exposure to violence occurring over the 12 months prior to the first assessment is predictive of cortisol reactivity 12 months later in males, even after controlling for age and Time 1 symptoms of psychopathology, cortisol reactivity, and lifetime exposure to violence. Lifetime exposure to violence at Time 1 is positively correlated with symptoms of Major Depressive Disorder and Generalized Anxiety Disorder in both sexes.
The unique aspect of the current findings is that typically, research studying the effects of exposure to violence is conducted with a clinical or maltreated sample. The findings show that recent exposure to violence has an effect on reactions to a laboratory stressor and has longer-term negative mental health consequences. Further study is needed to determine whether these effects are enduring or a shorter-term adaptive response to exposure to violence.
Cortisol; Stress; Violence; Adolescence
The purpose of this 12-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent well-being and behavioral outcomes, extending an earlier published account.
Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS (MLH), who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning and depression) and child/adolescent outcomes (e.g., depression, anxiety/worry, aggression, and self-concept) were assessed over 16 time-points.
Using growth curve modeling, results show a negative effect of maternal health status on child/adolescent outcomes, including child/adolescent depression, anxiety/worry, aggression, and self-concept. Interaction effects within the growth models suggest younger children are more impacted by poor maternal health than are older children/adolescents.
This is the first study to follow a cohort of children of MLH over such an extended age range, through late adolescence/early adulthood, to determine the impact of maternal health status throughout the entire developmental period.
HIV; Longitudinal Studies; Child Behavior; Child Development; Adolescent Behavior; Adolescent Development
Social capital and social attachment theories of substance use argue that positive bonds to society and the conventional values they promote deter adolescents from substance use. Using nationally representative samples of U.S. high school seniors, we hypothesized that adolescents’ community attachments, measured by social trust, social responsibility, and religiosity, would be negatively associated with lifetime and 30-day substance use.
We used repeated cross-sectional nationally representative high school senior data from 1976–2008 Monitoring the Future Study cohorts (weighted N = 64,246; 51.6% female). Participation rate ranged from 77% to 86% across years. A series of multiple linear and logistic regressions examined unique associations of adolescents’ social trust, social responsibility, and religiosity with lifetime and 30-day use of cigarettes, alcohol, marijuana, hallucinogens, cocaine, amphetamines, barbiturates, tranquilizers, and narcotics. Models controlled for gender, race, college aspirations, high school grades, parents’ education, and survey year.
Social trust, social responsibility, and religiosity showed independent negative associations with use of cigarettes, alcohol, marijuana, and six other types of drugs. After accounting for controls, community attachments related to lower lifetime and past 30-day use. Associations were consistent across measures, except social responsibility was not associated with binge drinking or lifetime illicit drugs besides marijuana.
Study strengths included the nationally representative sample, diverse substance use measures, and inclusion of controls. We extend theory by suggesting that distinct aspects of adolescents’ community attachments uniquely relate to lower substance use. Results suggest potential public health benefits of integrating promotion of community attachments with substance use prevention.
substance use; drugs; social trust; social responsibility; religiosity; values; adolescence; social capital; Monitoring the Future; prosocial development; protective factors
Cyber bullying perpetration (using communication technology to engage in bullying) is a recent phenomenon that has generated much concern. There are few prospective longitudinal studies of cyber bullying. The current paper examines the individual, peer, family and school risk factors for both cyber and traditional bullying (the latter is bullying that does not utilize technology) in adolescents.
This paper draws on a rich data set from the International Youth Development Study, a longitudinal study of students in Victoria, Australia and Washington State, United States, which began in 2002. In this paper, data from almost 700 Victorian students recruited in Grade 5 is analyzed to examine Grade 7 (aged 12-13 years) predictors of traditional and cyber bullying perpetration in Grade 9 (aged 14-15 years).
Fifteen per cent of students engaged in cyber bullying, 21% in traditional bullying and 7% in both. There are similarities and important differences in the predictors of cyber and traditional bullying. In the fully adjusted model, only prior engagement in relational aggression (a covert form of bullying such as spreading rumors about another student) predicted cyber bullying perpetration. For traditional bullying, previous relational aggression was also predictive, as was having been a victim and perpetrator of traditional bullying, family conflict, and academic failure.
The use of evidence-based bullying prevention programs is supported to reduce experiences of all forms of bullying perpetration(cyber, traditional, and relational aggression). In addition, for traditional bullying perpetration, addressing family conflict and student academic support are also important.
Cyber bullying; bullying; adolescents; covert bullying; relational aggression; longitudinal study
Sexual health refers a state of lifespan well-being related to sexuality. Among young people, sexual health has multiple dimensions, including the positive developmental contributions of sexuality, as well as the acquisition of skills pertinent to avoiding adverse sexual outcomes such as unintended pregnancy and sexually transmitted infections (STIs). Existing efforts to understand sexual health, however, have yet to empirically operationalize a multi-dimensional model of sexual health and to evaluate its association to different sexual/prevention behaviors.
Sexual health dimensions and sexual/prevention behaviors were drawn from a larger longitudinal cohort study of sexual relationships among adolescent women (N =387, 14–17 years). Second order latent variable modeling (AMOS/19.0) evaluated the relationship between sexual health and dimensions and analyzed the effect of sexual health to sexual/prevention outcomes.
All first order latent variables were significant indicators of sexual health (β: 0.192 – 0.874, all p < .001). Greater sexual health was significantly associated with sexual abstinence, as well as with more frequent non-coital and vaginal sex, condom use at last sex, a higher proportion of condom-protected events, use of hormonal or other methods of pregnancy control and absence of STI. All models showed good fit.
Sexual health is an empirically coherent structure, in which the totality of its dimensions is significantly linked to a wide range of outcomes, including sexual abstinence, condom use and absence of STI. This means that, regardless of a young person’s experiences, sexual health is an important construct for promoting positive sexual development and for primary prevention.
Sexual health; Structural equation modeling; Sexual and prevention behavior; Adolescent women
To identify similar patterns of physical activity (PA) and sedentary behavior in 6th grade girls using cluster analysis; to determine which clusters of girls were associated with greater daily minutes of objectively-measured PA; and to examine whether girls in these clusters experienced change in PA from 6th to 8th grade.
An adventitious cohort of girls (N=957) from the Trial of Activity for Adolescent Girls (TAAG) were measured at 6th and 8th grade. Activities were identified using the 3-day physical activity recall (3DPAR) and a self-report survey and used to create clusters of 6th grade girls who had similar PA/sedentary behaviors. Accelerometry was used to assess PA in 6th and 8th grade. Data analysis consisted of FASTCLUS and mixed model repeated measures analyses in SAS.
Cluster analysis yielded 6 clusters (C1: Educational sedentary; C2: Sports and play; C3: Organized sports teams/classes/lessons in past year; C4: Active transport and chores; C5: Electronic media; C6: Sleep). Sixth-grade girls in C2 and C3 had greater average daily minutes of moderate-to-vigorous physical activity (MVPA), MET-weighted MVPA, and vigorous physical activity (VPA) compared to other clusters (p < 0.05). In 8th grade, sedentary time increased and physical activity declined among girls in all clusters (p < 0.05). Girls in C2 had the greatest decline in PA, whereas girls’ PA in C3 declined less.
Encouraging participation in organized sports teams/class/lessons in middle school girls may promote greater MVPA and VPA than other activities, and may help to better sustain PA levels over time.
Accelerometry; MVPA; Sports; Adolescents; 3DPAR
Community prevention coalitions are a common strategy to mobilize stakeholders to implement tested and effective prevention programs to promote adolescent health and well-being. This paper examines the sustainability of Communities That Care (CTC) coalitions approximately 20 months after study support for the intervention ended.
The Community Youth Development Study (CYDS) is a community-randomized trial of the CTC prevention system. Using data from 2007 and 2009 coalition leader interviews, this study reports changes in coalition activities from a period of study support for CTC (2007) to 20 months following the end of study support for CTC (2009), measured by the extent to which coalitions continued to meet specific benchmarks.
Twenty months after study support for CTC implementation ended, 11 of 12 CTC coalitions in the CYDS still existed. The 11 remaining coalitions continued to report significantly higher scores on the benchmarks of phases 2 through 5 of the CTC system than did prevention coalitions in the control communities. At the 20-month follow-up, two-thirds of the CTC coalitions reported having a paid staff person.
This study found that the CTC coalitions maintained a relatively high level of implementation fidelity to the CTC system 20 months after the study support for the intervention ended. However, the downward trend in some of the measured benchmarks indicates that continued high-quality training and technical assistance may be important to ensure that CTC coalitions maintain a science-based approach to prevention, and continue to achieve public health impacts on adolescent health and behavior outcomes.
prevention; prevention science; Communities That Care; macro practice; community practice; evidence-based practice; social work; coalition; community research
Evaluate whether adolescent women who received economic benefits from their boyfriends were more likely never to use condoms.
Data is from a longitudinal HIV prevention intervention study with 715 African-American adolescent women in urban Atlanta surveyed at baseline, 6 months, and 12 months. The primary outcome was never using condoms in the past 14 and 60 days at 6 and 12 months. The primary predictor was having a boyfriend as primary spending money source at baseline. Analysis minimized confounding using propensity weighting to balance respondents on 81 variables.
A boyfriend was primary spending money source for 24% of respondents, who did not differ in neighborhood or family context but had lower education, more abuse history, riskier sex, and more sexually transmitted infections. After propensity score weighting, no statistically significant differences for 81 evaluated covariates remained, including age distributions. Women whose boyfriend was their primary spending money source were 50% more likely never to use condoms at 6 and 12 months and less likely to respond to the intervention at 12 months. Women whose boyfriend had been their primary spending money source but found another spending money source were more likely to start using condoms than women who continued. Women whose boyfriends owned cars were more likely never to use condoms.
Receiving spending money from a boyfriend is common among adolescent women in populations targeted by pregnancy and STI prevention interventions, and may undermine interventions’ effectiveness. Clinicians and reproductive health interventions need to address females’ economic circumstances.
Implications and Contribution
Disadvantaged teenage women who receive spending money from their boyfriends may not explicitly trade unsafe sex for money but are nonetheless more likely to have unsafe sex. Safe sex interventions and clinicians must consider economic factors that may interfere with adolescents’ practice of safe sex, particularly during an economic recession.
To examine similarities and differences in the process that parents and adolescents use to make decisions concerning participation in an asthma clinical trial. We hypothesized that a single conceptual model, tested through structural equations modeling, could explain adolescent assent and parent consent for adolescent research participation.
109 adolescents enrolled with at least one parent and received an asthma evaluation from a pediatric asthma specialist and then evaluated a hypothetical asthma research protocol. Family members independently evaluated the protocol and made research participation decisions.
Perceived risk, benefit and compensation were direct predictors of participation decisions for parents and adolescents. Adolescents perceived direct study benefit from the relationship with the physician, however parents did not. Parent decisions were most strongly associated with perceived risk, and parents associated discomfort with risk more strongly than did adolescents. Protocol procedures contributed to perceptions of benefit and discomfort for parents and adolescents.
Parent and adolescent research participation decisions are influenced by protocol variables in similar ways, although there are differences that account for disagreements within families. Findings may help investigators develop protocols that appeal to parents and adolescents and highlight issues of particular importance to address during the process of informed consent.
asthma; biomedical-research-ethics; informed-consent; adolescent-assent; research-participation-decision-making; adolescent; child; research-support
A sexually transmitted infection (STI) diagnosis may profoundly change the meaning of adolescent women’s relationships, particularly when the relationship involves a shared child. This study explored the sexual, contraceptive, and emotional characteristics of sexual partners with whom adolescent women had and did not have children in the 3 months after the first STI diagnosis.
Adolescent women (n = 387; age: 14–17 years at enrollment) were tested quarterly for STI and completed partner-specific items on emotional and sexual relationship content. We used nonparametric statistics (SPSS/18.0) to compare these characteristics between partners with whom these adolescent women did (n = 20) or did not (n = 118) share a child.
Rates of condom use at last sex, overall condom use, and condom insistence were lower with sexual partners involving shared children as compared with childless sexual partners. Relationship status, commitment to partner, and using no method of contraception were more common in parous sexual relationships as compared with nulliparous sexual relationships after an STI.
After an STI, adolescent women have different sexual risk behaviors with the fathers of their children, even after a signal event such as a recent STI diagnosis. Tailored counseling may specifically address the challenges of STI prevention with partners who have the unique status of being the “father of the baby.”
Pregnant and parent adolescents; STI; Sexual relationships; Sexual and contraceptive behavior
Compare the levels of risk and protective factors and the predictive influence of these factors on alcohol, tobacco and cannabis use over a 12-month follow-up period in Washington State in the United States and Victoria, Australia.
Longitudinal school-based survey of students drawn as a 2-stage cluster sample recruited through schools, and administered in 2002 and 2003 in both states. The study uses state-wide representative samples of students in Grades 7 and 9 (N = 3876) in Washington State and Victoria.
Washington State students relative to Victorian students had higher rates of cannabis use but lower rates of alcohol and tobacco use at time 1. Levels of risk and protective factors showed few but important differences that contribute to the explanation of differences in substance use; Washington State students relative to Victorian students reported higher religiosity (Odds ratio [OR] 0.96 vs. 0.79) and availability of handguns (OR 1.23 vs. 1.18), but less favorable peer, community and parent attitudes to substance use. The associations with substance use at follow-up are generally comparable, but in many instances were weaker in Washington State.
Levels of risk and protective factors and their associations with substance use at follow-up were mostly similar in the two states. Further high quality longitudinal studies to establish invariance in the relations between risk and protective factors and substance use in adolescence across diverse countries are warranted.
adolescence; substance use; cross-national comparison; longitudinal study; risk factors; protective factors
To describe women’s condom use patterns over time and assess predictors of dual method use 12 months after initiating hormonal contraceptives.
We conducted a prospective cohort study among women aged 15–24 years initiating oral contraceptive pills, patch, ring, or depot medroxyprogesterone and attending public family planning clinics. Participants completed questionnaires at baseline and 3, 6, and 12 months after enrollment. We used multivariable logistic regression to assess baseline factors associated with dual method use at 12 months among 1,194 women who were sexually active in the past 30 days.
At baseline, 36% were condom users, and only 5% were dual method users. After initiation of a hormonal method, condom use decreased to 27% and remained relatively unchanged thereafter. Dual method use increased to a peak of 20% at 3 months but decreased over time. Women who were condom users at baseline had nearly twice the odds of being a dual method user at 12 months compared with nonusers (adjusted odds ratio [AOR] = 2.01, 95% CI: 1.28–3.14). Women who believed their main partner thought condoms were “very important,” regardless of perceived sexually transmitted infection risk or participant’s own views of condoms, had higher odds of dual method use (AOR = 2.89, 95% CI: 1.47–5.71).
These results highlight a potential missed opportunity for family planning providers. Providers focus on helping women initiate hormonal methods, however, they may improve outcomes by giving greater attention to method continuation and contingency planning in the event of method discontinuation and to the role of the partner in family planning.
Dual method; Contraception; Adolescent; Young adult; Condoms; Sexually transmitted diseases; Depot medroxyprogesterone acetate; Oral contraceptives; Contraceptive patch; Vaginal ring
The purpose of this study is to identify population subgroups of adolescents who are homogenous with respect to sociodemographic factors and potentially modifiable risk and protective factors related to overweight status in a nationally representative sample of adolescents ages 12–17. Methods: The data used for this study are from the Centers for Disease Control and National Center for Health Statistics' National Survey of Children's Health, 2003 (NSCH). Classification and Regression Trees (CART) were used to identify population segments of adolescents based on risk and protective factors for obesity.
In the final CART model, 12 variables remained, including: poverty level, race, gender, participation in sports, number of family meals, family educational attainment, child physical activity, participation in free lunch programs, neighborhood safety and connectedness, TV viewing time, and child age in years. Poverty level was determined to be the most variable related to weight status in this sample of adolescents. Adolescents living in households below approximately the 300% poverty level were subject to a different constellation of predictors than adolescents living in homes above the 300% poverty level.
Our results demonstrate how risk and protective factors related to obesity emerge differently among sociodemographic subgroups and the relative importance of these risk and protective factors in relation to adolescent overweight status. Interventions that work for one population subgroup may not work for another.
We examine sexual violence and reproductive health outcomes among sexually experienced youth in Port-au-Prince, Haiti, using the Priorities for Local AIDS Control methodology to identify participants in locations where sexual partnerships are formed. Sexual violence is common and is significantly associated with condom use, pregnancy experience and recent STI symptoms.
Sexual violence; condom use; pregnancy; STI symptoms; Haiti
This manuscript presents an overview of the developmental outcomes of children adopted from institutional care. I describe how institutional care is a risk factor for typical human development and describe the areas of development, both behavioral and neurobiological, that are most vulnerable to this risk. Also described is variation in outcome and resilience, where some children thrive despite exposure to adverse rearing conditions. I conclude with an emphasis on heterogeneity in outcome, describing how the risk associated with institutional care is not a deterministic factor, but rather an influential one.
There is significant current interest in the degree to which prenatal exposures, including maternal psychological factors, influence child outcomes. Studies that detect an association between prenatal maternal psychological distress and child developmental outcomes are subject to a number of interpretative challenges in the inference of causality. Some of these are common to many types of prenatal exposures that must necessarily rely on observational designs. Such challenges include the correlation between prenatal and postnatal exposures and the potential role of other sources of shared influence, such as genetic factors. Others are more specific to this area of research. These include: confounding between maternal report of child outcomes and the maternal psychological attributes under study; difficulties in distinguishing maternal stress from more ubiquitous aspects of maternal personality; and the lack of association between cortisol and measures of maternal psychological stress. This article considers these methodological issues and offers an additional methodology focused on fetal neurobehavior for discerning potential mechanisms that may mediate associations between maternal psychological functioning and the developing fetal nervous system.
Pregnancy; fetus; prenatal stress; fetal development; fetal behavior; programming
To explore how youth contextualize substance use problems and recovery, in general and for themselves, in relation to the commonly accepted chronicity framework.
Fourteen focus groups were conducted with 118 youth in substance abuse treatment settings (aged 12-24; 78.3% male; 66.1% Latino) located throughout diverse areas of Los Angeles County. Transcribed qualitative focus group data were analyzed for major substance use and recovery themes.
Most (80%) youth do not accept a chronicity framework that conceptualizes substance use problems as recurring and constituting a life-long illness. Most (65%) view substance use problems as a function of poor behavioral choices or a developmental/social lifestyle phase. Youth perceptions of recovery tend to parallel this view, as most define recovery to mean having an improved or changed lifestyle that is achieved through making better behavioral choices (67%) and exerting personal control over one's behavior (57%) through willpower, confidence, or discipline. Other recovery themes identified by youth were substance use related (47%), wellness or well-being related (43%) and therapeutic or treatment related (14%).
Findings highlight the importance of considering youth perceptions about substance use chronicity and recovery in making improvements and promoting new developments in clinical and recovery support approaches to better meet the needs of youth with substance use problems. Findings are discussed under a theoretical context of behavior change to provide insights for the treatment and recovery communities.
Treatment-involved Youth; Substance Use; Chronicity and Recovery
Friendship networks are an important source of peer influence. However, existing network studies vary in terms of how they operationalize friendship and friend’s influence on adolescent substance use. This study uses social network analysis to characterize three types of friendship relations: (1) mutual or reciprocated, (2) directional, and (3) intimate friends. We then examine the relative effects of each friendship type on adolescent drinking and smoking behavior.
Using a saturated sample from the Add Health data, a nationally representative sample of high-school adolescents (N=2,533 nested in 12 schools), we computed the level of exposure to drinking and smoking of friends using a network exposure model, and their association with individual drinking and smoking using fixed effect models.
Results indicated that the influence from (1) is stronger on adolescent substance use than (2), especially for smoking. Regarding the directionality of (2), adolescents are equally influenced by both nominating and nominated friends on their drinking and smoking behavior. Results for (3) indicated that the influence from “best friends” was weaker than the one from non-“best friends,” which indicates that the order of friend nomination may not matter as much as nomination reciprocation.
This study demonstrates that considering different features of friendship relationships is important in evaluating friends’ influence on adolescent substance use. Related policy implications are discussed.
social network analysis; friends’ influence; adolescent drinking alcohol; smoking cigarette; friendship network
This study investigates measures of family conflict, family management, and family involvement at ages 10–12, 13–14, and 15–18 as predictors of adult depression, anxiety, and substance use disorder symptoms classes at age 27. The objective was to assess the relative influence on adult outcomes of each family predictor measured similarly at different points in adolescent development.
Data are from the Seattle Social Development Project, a theory-driven longitudinal study that began in 1985 with 808 fifth-grade students from 18 Seattle public elementary schools. A Latent Class Analysis of adult outcomes was followed by bivariate and multivariate models for each family predictor. Of the original 808 participants, 747 participants (92% of the original sample) had available data at age 27 on the mental health and substance use latent class indicators. Missing data were handled using full-information maximum likelihood estimation.
Four latent classes were derived: a “low disorder” symptoms class, a “licit substance use disorder symptoms” class, a “mental health disorder symptoms” class, and a “comorbid” class. Multivariate results show that family conflict is the strongest and most consistent predictor of the adult mental health and substance use classes. Family management, but not family involvement, was also predictive of the adult outcome classes.
It is important to lessen family conflict and improve family management to prevent later mental health and substance use problems in adulthood.
Family conflict; family management; family involvement; mental health; substance use; comorbidity; adolescence; adulthood
The Strong African American Families–Teen (SAAF–T) program, a family-centered preventive intervention that included an optional condom skills unit, was evaluated to determine whether it prevented unprotected intercourse and increased condom efficacy among rural African American adolescents. Ancillary analyses were conducted to identify factors that predicted youth attendance of the condom skills unit.
African American 16-year-olds (N = 502) and their primary caregivers were randomly assigned to SAAF–T (n = 252) or an attention control (n = 250) intervention. SAAF–T families participated in a 5-week family skills training program that included an optional condom skills unit. All families completed in-home pretest, posttest, and long-term follow-up interviews during which adolescents reported on their sexual behavior, condom use, and condom efficacy. Because condom use was addressed only in an optional unit that required caregiver consent, we analyzed efficacy using Complier Average Causal Effect (CACE) analyses.
Attendance in both SAAF–T and the attention control intervention averaged 4 of 5 sessions; 70% of SAAF–T youth attended the condom skills unit. CACE models indicated that SAAF–T was efficacious in reducing unprotected intercourse and increasing condom efficacy among rural African American high school students. Exploratory analyses indicated that religious caregivers were more likely than nonreligious caregivers to have their youth attend the condom skills unit.
Results suggest that brief condom skills educational modules in the context of a family-centered program are feasible and reduce risk for sexually transmitted infections and unplanned pregnancies.
adolescents; African-American; primary prevention; condom skills; condom efficacy; sexual behaviors
To identify significant factors that distinguish African American girls who have high STI prevention knowledge from those lacking such knowledge.
We recruited a sample of 715 African American girls from 3 public health clinics in downtown Atlanta. Using A-CASI technology we assessed for age, self-mastery, employment status, attendance at sex education classes, socioeconomic status and STI prevention knowledge.
High numbers of girls did not know that birth control pills did not protect women against the AIDS virus; that females are more susceptible to contracting STIs; and that condoms needed to be used continuously while having penile-vaginal penetration. Logistic regression findings indicated that being younger, having greater self-mastery, and being employed significantly predicted high STI knowledge.
Health educators may especially target African American girls who are younger, unemployed and experiencing low self-mastery for more tailored STI heath education.
STI prevention knowledge; African American girls; Gender and power
The timing of pubertal maturation has been associated with cigarette use, but the exact mechanisms by which maturation influences cigarette use are unclear. One hypothesis posited to explain this association is the early maturation hypothesis, that boys and girls who mature earlier than their peers have developed physically before their social resources have fully developed, leaving them ill-equipped to deal with challenges that may arise when entering physical maturity. This prospective study examines the relations between pubertal timing, social competence, and cigarette use in a sample of 1013 boys and girls, followed from 5th through 12th grade.
Latent growth modeling (LGM) was utilized to predict cigarette use across high school years (grades 9–12) from pubertal timing assessed in 5th grade (for girls) and 6th grade (for boys) as mediated by social competence across grades 6 to 8.
Earlier pubertal maturation predicted cigarette use in 9th grade and increased cigarette use across high school. Earlier maturation also predicted lower social competence in 6th grade. For girls, social competence partially mediated the relation between pubertal timing and cigarette use.
The data supported the early maturation hypothesis for both boys and girls, as earlier maturers were more likely to smoke in 9th grade and had lower social competence in 6th grade. However, social competence partially mediated cigarette use for girls only. The mechanisms by which negative outcomes are associated with pubertal maturation appear to differ by gender.
gender differences; pubertal timing; substance use; adolescence; social competence