Parental monitoring: association with adolescents' risk behaviors

Parent Expectations and Preparatory Activities as Adolescents with ASD Transition to Adulthood

Community stakeholders, researchers, and providers are increasingly focused on individual, family, and systemic factors that contribute to positive outcomes for adults on the autism spectrum. Parent expectations for their youth's future are associated with adult outcomes (e.g., employment, school success, independence), yet the mechanism for this effect remains unclear. This study investigated how expectations were related to parent transition-related activities in a sample of 298 parents of adolescents on the autism spectrum (48% female adolescents), stratified by parent-reported IQ (average or above, borderline, or below 70). Parent expectations for the future predicted engagement in some activities intended to enhance adult outcomes when controlling for IQ, gender, age, and household income. The results have implications for how providers discuss expectations and support families in preparing for adulthood.

The Prospective Impact of Family Functioning and Parenting Practices on Court-Involved Youth's Substance Use and Delinquent Behavior

Court-involved youth exhibit high rates of psychiatric symptoms, substance use, and delinquency, yet little is known about the contributing roles of caregiver and family factors. The current study examined whether family functioning and parental monitoring mediate the relationship between caregiver and youth psychiatric symptoms (at first court contact) and youth substance use and delinquency (two years later). Participants were 400 first-time offending court-involved youth (M_age = 14.5 years; 57.3% male; 45.6% non-Latinx White, 42.0% Latinx) and an involved caregiver (M_age = 41.0 years; 87.2% female; 53.0% non-Latinx White, 33.8% Latinx). Structural equation modeling revealed that caregiver and youth psychiatric symptoms were prospectively associated with worse family functioning, which was in turn related to higher levels of youth delinquency and greater likelihood of substance use. The results support the notion of addressing the needs of justice-involved youth and families holistically rather than treating youth as "the problem" in isolation.

Nonsuicidal Self-Injury and Suicidal Behaviors in Girls: The Case for Targeted Prevention in Preadolescence

Non-suicidal self-injury (NSSI) affects 15-20% of adolescents-disproportionately girls-and is a strong predictor of eventual suicide attempts and suicide. Many girls now initiate NSSI before age 10. These early-starters exhibit greater frequency of NSSI, use more diverse methods, and are hospitalized more often, yet there are no empirically supported prevention programs for preadolescents. Obstacles to prevention include ascertaining who is sufficiently vulnerable and specifying mechanistic intervention targets. Recent research indicates that (1) preadolescent girls with ADHD who are also maltreated are at alarming risk for NSSI and suicide attempts by adolescence, and (2) the conjoint effects of these vulnerabilities are sufficiently potent for targeted prevention. Research also indicates that existing interventions are effective in altering child- and family-level mechanisms of NSSI. These interventions alter neurobiological markers of vulnerability, which can be used as proximal efficacy signals of prevention response, without waiting for NSSI and suicide attempts to emerge.

Teen mothers' educational attainment and their children's risk for teenage childbearing

The children of teen mothers are at elevated risk for becoming teen parents themselves. The current study aimed to identify how levels of mothers' education were associated with risk of teenage childbearing for children of teen versus nonteen mothers. Through structural equation modeling, we tested whether children's environmental and personal characteristics in adolescence and subsequent sexual risk behaviors mediated the relationship between their mothers' educational attainment and their risk for teenage childbearing. With multiple-group models, we assessed whether the associations of maternal educational attainment with children's outcomes were similar for the children of teen and nonteen mothers. The sample (N = 1,817) contained linked data from female National Longitudinal Survey of Youth, 1979 (NLSY79) participants and their first-born child (son or daughter) from the NLSY79 Children and Young Adults. The mediating pathways linking higher levels of maternal education to lower risk for teenage childbearing, and magnitudes of the associations, were mostly similar for children of teen and nonteen mothers. However, nonteen mothers experienced greater associations of their high school diploma attainment (vs. no degree) with some of their children's outcomes. Also, the association of earning a high school diploma (vs. a GED) with household incomes was greater for nonteen mothers; there was no significant difference between degree types for teen mothers. Findings provide support for teen mother secondary school support programming, but point to a need for further research regarding the long-term behavioral and social outcomes associated with the high school equivalency certificate for teen mothers and their children. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The knowledge-risk-behaviour continuum among young Ugandans: what it tells us about SRH/HIV integration

Background

With a human immunodeficiency virus (HIV) prevalence of 2.1% among 15–24 year olds, opportunities for further integration of sexual and reproductive health (SRH) and HIV prevention services for young people in Uganda exist. We examine a range of factors that contribute to variance in risky sexual behaviour among young Ugandans.

Methods

A cross-sectional, nationally representative household survey was conducted between February and March 2016. The questionnaire used assessed knowledge, attitudes and practices related to SRH among young people aged 10–24 years. A composite indicator was constructed to assess risky sexual behaviour, defined as being involved in sexual relations under the influence of alcohol or drugs, engaging in sexual activities without a condom, and having multiple sexual partners in the 6 months preceding the survey. Exploratory analysis was conducted to provide descriptive statistics. Logistic regression was conducted to determine the factors associated with risky sexual behaviour. This analysis focuses on the sub-category aged 15–24 years, comprised of 2725 respondents.

Results

Knowledge levels of family planning (FP), sexually transmitted infections (STIs) and HIV across all respondents were high (above 82%). Self-reported perceived risk of STIs and pregnancy was consistently higher among 20–24 year old respondents, with 61.5% feeling at risk of STIs compared to 46.2% of 15–19 year olds. A total of 22.7% of respondents reported having been involved in risky sexual behaviour. Factors associated with risky sexual behaviour among the 15–19 years group included gender, single orphanhood, casual work, schooling status, FP knowledge and self-perceived risk of STIs/HIV. For the 20–24 year old respondents, significantly associated factors included gender, educational level, relationship to head of household, place of residence, and self-perceived risk of pregnancy.

Conclusions

Despite high general SRH/HIV knowledge and perceived risk of pregnancy and HIV, risky sexual behaviour among young Ugandans remains high. Effectiveness gaps in the integrated SRH/HIV response for young people should be addressed and targeted interventions focused on holistic prevention at individual level through information, risk awareness, and skill development should be combined with interventions targeting social structures affecting individual behaviour.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6809-y) contains supplementary material, which is available to authorized users.

Associations of Parental Monitoring and Violent Peers with Latino Youth Violence

This study aimed to examine the associations of parental monitoring and violent peers with violence among Latino youth, and whether these associations varied by acculturation. 133 adolescents were surveyed. Associations between parental monitoring, peer violence, and physical and non-physical violence were examined using bivariate and multivariable negative binomial regression. Multivariable analysis was stratified by age and acculturation. A path model examined whether peer violence mediated the relationship between parental monitoring and youth violence. Stratified analysis demonstrated that peer violence increased the risk of physical (RR = 1.24; 95% CI 1.02-1.20) and non-physical violence (RR = 1.32; 95% CI 1.08-1.62) for high-acculturated youth, whereas parental monitoring was protective for low-acculturated youth (physical RR = 0.88; 95% CI 0.78-0.99; non-physical RR = 0.80; 95% CI 0.68-0.93). In path analysis, low parental monitoring increased risk of involvement with violent peers, which was associated with increased risk of youth violence. Interventions may benefit from focusing on parental monitoring, peer violence, and tailoring by acculturation.

Parents to chronically ill adolescents have ambivalent views on confidential youth consultations - a mixed methods study

BACKGROUND

Confidential youth consultations aiming at enhancing adolescent autonomy are a cornerstone of transitional care. At the same time, parental support is essential. These conflicting considerations result in a clinical dilemma.

OBJECTIVE

The aim of this study was to examine the attitudes of parents to chronically ill adolescents regarding confidential youth consultations and to explore the underlying reasons.

METHODS

A sequential explanatory mixed methods design consisting of a cross-sectional questionnaire survey (n = 117) and three focus group interviews among parents (n = 12) to chronically ill adolescents (12-19 years) was used. Quantitative data were analyzed descriptively. Qualitative data were analyzed using King's template method.

RESULTS

The parents preferred independent youth consultations starting around the age of 14-15 years. Around 60% of the parents had one or more concerns regarding independent youth consultations. Although 64% of the parents supported conditional or full confidentiality during adolescence, 95% wanted information even though their child did not consent. In the qualitative analysis, the parents described caring for a child with chronic disease as a term of life perceiving themselves as an "octopus" with numerous roles related to daily care and treatment and at the same time with thoughts and worries regarding the future. We found four themes: 'a life with chronic disease', 'responsibility', 'protection' and 'apprenticeship'. The parents' attitudes were influenced by their roles and their perception of the adolescent's competences as well as their experience with the healthcare system.

CONCLUSIONS

Our findings suggest that parents need transitional care too.

Multisystem-Involved Youth: A Developmental Framework and Implications for Research, Policy, and Practice

Multisystem-involved youth are children and adolescents concurrently served in the child welfare, behavioral health, and/or juvenile justice systems. These youth are a high risk and vulnerable population, often due to their experience of multiple adversities and trauma, yet little is known about their multiple needs and pathways into multisystem involvement. Multisystem-involved youth present unique challenges to researchers, practitioners, and policymakers. In this article, we summarize the literature on multisystem-involved youth, including prevalence, characteristics, risk factors, and disparities for this population. We then describe a developmental cascade framework, which specifies how exposure to adverse experiences in childhood may have a "cascading" or spillover effect later in development, to depict pathways of multisystem involvement and opportunities for intervention. This framework offers a multidimensional view of involvement across service systems and illustrates the complexities of relationships between micro- and macro-level factors at various stages and domains of development. We conclude that multisystem-involved youth are an understudied population that may represent majority of youth who are already served in another service system. Many of these youth are also disproportionately from racial and ethnic minority backgrounds. Currently, for multisystem-involved youth and their families, there is a lack of standardized and integrated screening procedures to identify youth with open cases across service systems; inadequate use of available instruments to assess exposure to complex trauma; inadequate clinical and family-related evidence-based practices specifically for use with this population; and poor cross-systems collaboration and coordination that align goals and targeted outcomes across systems. We make recommendations for research, practice, and systems development to address the needs of multisystem-involved youth and their families.

The Interactive Effects of Parental Knowledge with Impulsivity and Sensation Seeking in Adolescent Substance Use

This study examined whether interactions of parental knowledge of adolescent's whereabouts with impulsivity and sensation seeking in the prediction of adolescent substance use supported the diathesis-stress or differential susceptibility model in 230 15-year old adolescents (53% girls). Interactions between impulsivity and parental knowledge supported the diathesis-stress model with high impulsivity as a vulnerability factor: when impulsivity was higher, low levels of parental knowledge were associated with higher levels of substance use. Interactions between sensation seeking and parental knowledge supported differential susceptibility with low sensation seeking as a susceptibility factor; low parental knowledge was associated with higher substance use and high parental knowledge with lower substance use when sensation seeking was lower. Our results show that impulsivity and sensation seeking should be considered independently. Results support previous research suggesting that impulsivity in adolescence may act as a vulnerability factor and suggests that low sensation seeking may be a susceptibility factor.

The association between perceived household educational support and HIV risk in young women in a rural South African community (HPTN 068): A cross sectional study

OBJECTIVE

To characterise perceived household support for female education and the associations between educational support and HIV prevalence, HSV-2 prevalence and sexual risk behaviours.

METHODS

This cross-sectional study used baseline survey data from the Swa Koteka HPTN 068 trial undertaken in Mpumalanga, South Africa. The study included 2533 young women aged 13-20, in grades 8-11 at baseline. HIV and HSV-2 status were determined at baseline. Information about patterns of sexual behaviour and household support for education was collected during the baseline survey. Linear regression and binary logistic regression were used to determine associations between household support for education and both biological and behavioural outcomes.

RESULTS

High levels of educational support were reported across all measures. HIV prevalence was 3.2% and HSV-2 prevalence was 4.7%, both increasing significantly with age. Over a quarter (26.6%) of young women reported vaginal sex, with 60% reporting condom use at last sex. The median age of sexual debut was 16 years. Household educational support was not significantly associated with HIV or HSV-2; however, the odds of having had vaginal sex were significantly lower in those who reported greater homework supervision (OR 0.82, 95%CI: 0.72-0.94), those who engaged in regular discussion of school marks with a caregiver (OR 0.82, 95%CI: 0.71-0.95) and when caregivers had greater educational goals for the young woman (OR 0.82, 95%CI: 0.71-0.96). In contrast, greater caregiver disappointment at dropout was significantly associated with reported vaginal sex (OR 1.29, 95%CI: 1.14-1.46).

CONCLUSION

Young women in rural South Africa report experiencing high levels of household educational support. This study suggests that greater household educational support is associated with lower odds of having vaginal sex and engaging in risky sexual behaviour, though not with HIV or HSV-2 prevalence.

Electronic Gaming Characteristics Associated with Class 3 Severe Obesity in Youth Who Attend the Pediatric Weight Management Programs of the COMPASS Network

BACKGROUND

The prevalence of severe obesity and electronic game use among youth has increased over time.

METHODS

We administered a survey assessing gaming and psycho-demographic characteristics to youth aged 11-17 attending five weight management programs. We conducted chi-square and logistic regression analyses to describe the association between class 3 severe obesity and gaming characteristics.

RESULTS

Four hundred twelve youth (51% female, 26% Black, 25% Hispanic, 43% White, and 44% with class 3 severe obesity) completed the survey. There was a stepwise relationship between time spent gaming and class 3 severe obesity, with 28% of those playing 2 to <4 hours a day, 48% of those playing 4 to <6 hours a day, and 56% of those playing ≥6 hours a day having class 3 severe obesity (p = 0.002). Compared to youth without class 3 severe obesity, youth with class 3 severe obesity were more likely to have a TV in the bedroom (76% vs. 63%, p = 0.004) and play games on a console (39% vs. 27%, p = 0.03) and were less likely to report parental limit setting on type of games played (7% vs. 16%, p = 0.006). Youth who played games ≥4 hours a day were 1.94 times (95% confidence interval 1.27-3.00) more likely to have class 3 severe obesity than those who played <4 hours a day, after adjustment for demographic, behavioral, and academic variables.

CONCLUSIONS

Our study demonstrates a clear association between gaming characteristics, especially time spent gaming, and severe obesity in youth. Further research testing family-based interventions that target gaming behaviors in youth are needed.

Do maternal knowledge and paternal knowledge of children's whereabouts buffer differently against alcohol use? A longitudinal study among Finnish boys and girls

BACKGROUND

Previous research suggests that parental knowledge of the child's activities and whereabouts prevents adolescents' alcohol use. However, evidence on whether the positive effects of maternal and paternal knowledge are distinctive for boys' and girls' alcohol use is inconclusive. We examined whether perceived parental knowledge at age 13 prevents alcohol use at age 16, whether the effect of maternal and paternal knowledge was the same for both genders, and whether paternal knowledge had as strong an effect as maternal knowledge.

METHOD

Adolescents answered a school survey in 2011 (age 13) and 2014 (age 16) in Finland (N = 5742). Perceived maternal and paternal knowledge was measured separately using a Parents' Monitoring Scale. The data were analysed via moderation regression modelling using Bayesian estimation.

RESULTS

Perceived maternal and paternal knowledge at age 13 predicted boys' and girls' lower alcohol use at age 16. For those who had not used alcohol at age 13, parental knowledge protected against an increase of alcohol use at age 16. Both maternal and paternal knowledge had a shielding effect against the increase of boys' and girls' alcohol use, but maternal knowledge had a stronger shielding effect than paternal knowledge.

CONCLUSIONS

Both maternal and paternal perceived knowledge at age 13 buffers against the adverse development of alcohol use at age 16 for both genders. Underlining the importance of parent-child communication and knowledge about the child's activities should be a part of family health counselling and school health services.

Are parenting practices associated with the same child outcomes in sub-Saharan African countries as in high-income countries? A review and synthesis

Introduction

There is increasing interest in the transferability of parenting interventions from high-income countries (HICs) to low-income countries (LICs) in order to improve child development and health outcomes. This is based on the premise that associations between parenting practices and child outcomes are similar in both settings. Many parenting interventions in HICs are evidence-based, but less evidence exists on associations of parenting practices with child outcomes in LICs, in particular, sub-Saharan African (SSA) countries. This review synthesises evidence on the association of parenting practices with child outcomes in SSA in order to compare findings with those from HICs.

Methods

We searched electronic databases—Web of Science, ASSIA, Embase, IBSS and PsycINFO—to identify studies from SSA that reported quantitative associations between parenting practices and child health or psychosocial outcomes (eg, sexual and reproductive health (SRH), mental health, conduct disorders). Due to inconsistent conceptual framing of parenting across studies, we used a modified version of the international WHO classification of parenting dimensions to guide synthesis of the results.

Results

Forty-four studies met our inclusion criteria. They were conducted in 13 SSA countries and included cross-sectional and longitudinal studies, and were predominantly descriptive studies rather than intervention research. Synthesis of results showed that associations between patterns of parenting (‘positive’/‘harsh’) and child outcomes (including SRH, mental health and conduct disorders) in studies from SSA were broadly similar to those found in HICs.

Conclusions

These findings suggest that the impacts of parenting practices on child outcomes are similar across contrasting global regions and, therefore, parenting interventions from HICs might be successfully transferred to SSA, subject to appropriate adaptation. However, this review also highlights the paucity of evidence in this area and the urgent need for higher quality studies to confirm these findings to help develop effective parenting interventions in SSA.

"House Arrest" or "Developmental Arrest"? A Study of Youth Under House Arrest

Studies have examined the potential benefits and risks of alternative forms of detention, such as house arrest, for adults but, despite its growing use, little research has examined the implications of house arrest for juveniles. The current research examined the experience of 14 adolescents under house arrest. Six main themes were identified in the narratives of the participants: the experience of detention, daily schedule and utilization of time, emotions and self-reflection, relationships with peers, relation to parents and supervisor(s), and contact with professionals. Findings emphasized the potential developmental dangers of house arrest at the critical stage of adolescence. Yet, analysis also showed that the period of house arrest has the potential to be a period of positive changes, and can be used for successful rehabilitation.

The Increasing Diversity and Complexity of Family Structures for Adolescents

The structure of adolescents' families, and thus parental forms, in the United States, have become more heterogeneous and fluid over the past several decades. These changes are due to increases in never-married, single parents, divorce, cohabitation, same-sex parenting, multi-partnered fertility, and co-residence with grandparents. We document current diversity and complexity in adolescents' families as important context for rethinking future parenting theory and research. We also discuss how understandings of adolescents' families are somewhat limited by current methods used to measure characteristics of families. We recommend social network and profile-based methods as alternatives to capturing key dimensions of family structure and processes. Understanding the diversity of households and families in which adolescents are raised can improve theory and research on parenting.

Associations Between Croatian Adolescents' Use of Sexually Explicit Material and Sexual Behavior: Does Parental Monitoring Play a Role?

The use of sexually explicit material (SEM) has become a part of adolescent sexual socialization, at least in the Western world. Adolescent and young people's SEM use has been associated with risky sexual behaviors, which has recently resulted in policy debates about restricting access to SEM. Such development seems to suggest a crisis of the preventive role of parental oversight. Based on the Differential Susceptibility to Media Effects Model, this study assessed the role of parental monitoring in the context of adolescent vulnerability to SEM-associated risky or potentially adverse outcomes (sexual activity, sexual aggressiveness, and sexting). Using an online sample of Croatian 16-year-olds (N = 1265) and structural equation modeling approach, parental monitoring was found consistently and negatively related to the problematic behavioral outcomes, regardless of participants' gender. While SEM use was related to sexual experience and sexting, higher levels of parental monitoring were associated with less frequent SEM use and lower acceptance of sexual permissiveness. Despite parents' fears about losing the ability to monitor their adolescent children's lives in the Internet era, there is evidence that parental engagement remains an important protective factor.

An Examination of the Importance of Strain in the Cannabis Gateway Effect

Gateway theory has been the source of much debate in both the research literature and public policy. Support for gateway sequencing has been mixed, especially in research that has considered the role of criminological variables in the etiology of substance use. For example, limited prior research has observed as important in gateway sequencing the effects of severe stressors. Data from the National Longitudinal Study of Adolescent to Adult Health are utilized to test gateway theory and examine whether severe stressors affect the relationship between frequency of cannabis use and later use of other illicit drugs (OIDs). Findings suggest that while frequency of cannabis use does increase the likelihood of later use of OIDs, this relationship may be the result of the common cause of experiencing severe stress. Implications of the findings are discussed.

Is Technology-Mediated Parental Monitoring Related to Adolescent Substance Use?

BACKGROUND

Prevention researchers have identified parental monitoring leading to parental knowledge to be a protective factor against adolescent substance use. In today's digital society, parental monitoring can occur using technology-mediated communication methods, such as text messaging, email, and social networking sites.

OBJECTIVES

The current study aimed to identify patterns, or clusters, of in-person and technology-mediated monitoring behaviors, and examine differences between the patterns (clusters) in adolescent substance use.

METHODS

Cross-sectional survey data were collected from 289 parents of adolescents using Facebook and Amazon Mechanical Turk (MTurk). Cluster analyses were computed to identify patterns of in-person and technology-mediated monitoring behaviors, and chi-square analyses were computed to examine differences in substance use between the identified clusters.

RESULTS

Three monitoring clusters were identified: a moderate in-person and moderate technology-mediated monitoring cluster (moderate-moderate), a high in-person and high technology-mediated monitoring cluster (high-high), and a high in-person and low technology-mediated monitoring cluster (high-low). Higher frequency of technology-mediated parental monitoring was not associated with lower levels of substance use.

CONCLUSIONS

Results show that higher levels of technology-mediated parental monitoring may not be associated with adolescent substance use.

Using marijuana, drinking alcohol or a combination of both: the association of marijuana, alcohol and sexual risk behaviour among adolescents

Background Although the association between alcohol use and sexual risk behaviour has been well-documented, there is little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents.

METHODS

A diverse sample of sexually active adolescents (n = 616) aged 12-18 years (50.32% Hispanic; 31.17% Black) completed a survey on alcohol use, marijuana use and sexual risk behaviour during a visit to a primary care clinic.

RESULTS

Adolescents were more likely to report having had two or more sexual partners in the past 3 months if they reported using both alcohol and marijuana (OR=3.90, P<0.0001), alcohol alone (OR=2.51, P<0.0001) or marijuana alone (OR=1.89, P<0.001) compared with adolescents who reported no use during the past month. Adolescents were more likely to report having both two or more partners and condomless sex if they used both alcohol and marijuana (OR=3.19, P<0.001) or alcohol alone (OR=3.41, P<0.01) in the past month compared with adolescents who reported using marijuana alone or had no use of either.

CONCLUSIONS

Providers should screen for both alcohol and marijuana use among adolescents and discuss how use of alcohol or alcohol in conjunction with marijuana may be associated with sexual risk behaviours.

Messages About Abstinence, Delaying Sexual Debut and Sexual Decision-Making in Conversations Between Mothers and Young Adolescents

STUDY OBJECTIVE

Little is known about the information shared during family discussions about sexuality. From a public health perspective, abstinence is one of the most important sexuality topics parents can talk about with adolescents. We sought to characterize the messages mothers communicate to young adolescents regarding abstinence.

DESIGN

Content analysis of dyadic discussions that occurred between June 2011-December 2012 between mothers and their 10- to 14-year-old adolescent sons and daughters. Discussions were audio-recorded, transcribed, and a grounded theory approach to content analysis performed.

SETTING

Urban city in Western Pennsylvania.

PARTICIPANTS

Twenty-one dyads; 15 mother-daughter dyads and 6 mother-son dyads.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

None.

RESULTS

Four key themes emerged reflecting the high priority mothers placed on abstinence, delaying their adolescent's sexual debut, and nurturing sexual decision-making skills. Theme 1 focused on ensuring that adolescents understand what abstinence means. In defining abstinence, only 1 mother explained what sex is. The 3 remaining themes emphasized sexual decision-making and emphasized when it is acceptable to stop being abstinent (theme 2), why abstinence is important (theme 3), and mothers' desire to engage in ongoing discussions, particularly when an adolescent was considering becoming sexually active (theme 4). Messages did not vary according to mothers' age or according to adolescent age, gender, or race.

CONCLUSION

Mothers convey complex information about abstinence and sexual decision-making to young, non-sexually active adolescents. Message tailoring on the basis of the adolescents' age or sex was not observed.

Assessment of culture and environment in the Adolescent Brain and Cognitive Development Study: Rationale, description of measures, and early data

Neurodevelopmental maturation takes place in a social environment in addition to a neurobiological one. Characterization of social environmental factors that influence this process is therefore an essential component in developing an accurate model of adolescent brain and neurocognitive development, as well as susceptibility to change with the use of marijuana and other drugs. The creation of the Culture and Environment (CE) measurement component of the ABCD protocol was guided by this understanding. Three areas were identified by the CE Work Group as central to this process: influences relating to CE Group membership, influences created by the proximal social environment, influences stemming from social interactions. Eleven measures assess these influences, and by time of publication, will have been administered to well over 7,000 9-10 year-old children and one of their parents. Our report presents baseline data on psychometric characteristics (mean, standard deviation, range, skewness, coefficient alpha) of all measures within the battery. Effectiveness of the battery in differentiating 9-10 year olds who were classified as at higher and lower risk for marijuana use in adolescence was also evaluated. Psychometric characteristics on all measures were good to excellent; higher vs. lower risk contrasts were significant in areas where risk differentiation would be anticipated.

How Patterns of Learning About Sexual Information Among Adolescents Are Related to Sexual Behaviors

CONTEXT

Parents, peers and media are informal sources of sexual information for adolescents. Although the content of sexual information communicated by these sources is known to vary, little is known about what adolescents report actually learning from each source.

METHODS

Data from 1,990 U.S.14-17-year-olds who participated in an online survey in 2015 were used to assess learning about four topics (sex, condoms, hormonal birth control and romantic relationships) from three informal sources (parents, peers, and television and movies). Gender and race differences in learning by source and topic were assessed using t tests. Following a factor analysis, learning about all topics was grouped by source, and regression analyses were conducted to examine associations between learning from each source and three outcomes: sexual activity, condom use and hormonal birth control use. Models included interactions between information sources and race and gender.

RESULTS

White adolescents reported learning more from parents and less from media than black adolescents. Compared with males, females learned more about hormonal birth control and less about condoms from their parents, and more about relationships from peers and media. Learning from parents and from peers were positively associated with adolescents' sexual activity (unstandardized coefficients, 0.26 and 0.52, respectively). Learning from parents was positively associated with condom use (odds ratio, 1.5).

CONCLUSION

Adolescents' learning about sex from informal sources varies by race and gender. Future research should examine whether sexual health interventions and message development can capitalize on these differences.

When parents supply alcohol to their children: Exploring associations with drinking frequency, alcohol-related harms, and the role of parental monitoring

BACKGROUND

Youth obtain alcohol from many sources, including friends, siblings, parents and other adults. Whether parental supply, relative to other sources, is associated with experiencing a negative alcohol-related outcome is an area of considerable debate. Less well understood is whether the observed association is further contextualized by level of parental monitoring of the child.

OBJECTIVES

This study has two main objectives: 1) determine if there is a relationship between parental supply, drinking frequency, and alcohol-related harms among youth; and 2) assess whether parental monitoring moderates this relationship.

METHODS

Participants were drawn from the 2012 Student Drug Use Survey in Canada's Atlantic Provinces, an anonymous cross-sectional survey of high school students (ages 15-19 years). Adjusted regression models assessed the association between drinking frequency, experiencing alcohol-related harms, and four different sources of supply. Additional analyses stratified on levels of parental monitoring.

RESULTS

Relative to receiving alcohol from friends, parental supply was associated with lower odds of experiencing any alcohol-related harm (AOR 0.42; 95% CI 0.28-0.61) and loss of control (AOR = 0.42; 95% CI 0.29-0.62). Drinking frequency did not differ by source of supply. Associations between parental supply and harm were absent among youth reporting low levels of parental monitoring.

CONCLUSIONS

Youth who receive alcohol from parents' report fewer alcohol-related harms relative to those who obtain their alcohol from friends, despite no observed differences in drinking frequency. Understanding how parents may help to minimize experiences of alcohol-related harm among youth beyond the simple promotion of abstinence from drinking is warranted.

Human Immunodeficiency Virus Risk Factors and Beliefs Reported by Families Presenting to a Pediatric Emergency Department

OBJECTIVES

Adolescents are at greater risk for acquiring human immunodeficiency virus (HIV) due to increased risk behaviors. Parental influence is known to reduce adolescent risk behaviors. We compared HIV risk behaviors reported by adolescents to parents' perception of adolescent risky behavior engagement. We also examined participants' knowledge of HIV transmission and testing preferences.

METHODS

Participants included English-speaking adolescents and parents presenting to a pediatric emergency department. Participants were interviewed separately in private. Modeled after existing instruments, "adolescent" and "parent" questionnaires included multiple choices items, Likert-type scales, and standard yes/no and true/false options. Data were analyzed using a κ statistic and observed agreement to measure discordance between adolescent and parent responses.

RESULTS

Participants included 126 adolescents and 110 parents. Many adolescents reported ever having sex (61%), of which 32% reported always practicing safe sex. Comparative analysis revealed low agreement between adolescents' risk behaviors and parents' perception of risk behavior engagement by youth. Discordance concerning tobacco use was greatest (κ = 0.13), followed by drug use (κ = 0.19) and ever having sex (κ= 0.19), and alcohol use (κ= 0.22). There was also poor agreement regarding HIV transmission knowledge (ie, oral sex; κ = 0.16). Participants shared strong agreement regarding parental support for adolescent interest in HIV testing (95.5%).

CONCLUSIONS

Parents are mostly unaware of adolescents' broad risk behaviors. Participants' knowledge of HIV transmission is limited. Adolescents and parents shared strong agreement regarding HIV testing preferences. Multidimensional HIV prevention strategies aiming to decrease adolescent risk behaviors, increase parental involvement, and improve adolescent and parental knowledge of HIV transmission are needed.

Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective

Background

Child disruptive behavioural problems are a large and costly public health problem. The Incredible Years®(IY) parenting programme has been disseminated across the UK to prevent this problem and shown to be effective in several trials. It is vital for policy to know for which families IY is most effective, to be sure that it helps reduce, rather than widen, socioeconomic inequalities. Individual trials lack power and generalisability to examine differential effects; conventional meta-analysis lacks information about within-trial variability in effects.

Objectives

To overcome these limitations by pooling individual-level data from the IY parenting trials in Europe to examine to what extent it benefits socially disadvantaged families. Secondary objectives examine (1) additional moderators of effects on child behaviour, (2) wider health benefits and potential harms and (3) costs, cost-effectiveness and potential long-term savings.

Design

Individual participant data meta-analysis of 14 randomised trials of the IY parenting intervention.

Settings

UK (eight trials), the Netherlands, Ireland, Norway, Sweden and Portugal.

Participants

Data were from 1799 families, with children aged 2–10 years (mean 5.1 years; 63% boys).

Interventions

IY Basic parenting programme.

Main outcome measures

Primary outcome was disruptive child behaviour, determined by the Eyberg Child Behavior Inventory Intensity scale (ECBI-I). Secondary outcomes included self-reported parenting practices, parenting stress, mental health, children’s attention deficit hyperactivity disorder (ADHD) and emotional symptoms.

Results

There were no differential effects of IY on disruptive behaviour in families with different levels of social/socioeconomic disadvantage or differential effects for ethnic minority families, families with different parenting styles, or for children with comorbid ADHD or emotional problems or of different ages. Some moderators were found: intervention effects were strongest in children with more severe baseline disruptive behaviour, in boys, and in children with parents who were more depressed. Wider health benefits included reduced child ADHD symptoms, greater parental use of praise, and reduced harsh and inconsistent discipline. The intervention did not improve parental depression, stress, self-efficacy or children’s emotional problems. Economic data were available for five UK and Ireland trials (maximumn = 608). The average cost per person of the IY intervention was £2414. The probability that the IY intervention is considered cost-effective is 99% at a willingness to pay of £145 per 1-point improvement on the ECBI-I. Estimated longer-term savings over 20 years range from £1000 to £8400 per child, probably offsetting the cost of the intervention.

Limitations

Limitations include a focus on one parenting programme; the need to make assumptions in harmonising data; and the fact that data addressed equalities in the effectiveness of, not access to, the intervention.

Conclusions

There is no evidence that the benefits of the IY parenting intervention are reduced in disadvantaged or minority families; benefits are greater in the most distressed families, including parents who are depressed. Thus, the intervention is unlikely to widen socioeconomic inequalities in disruptive behaviour and may have effects in narrowing inequalities due to parent depression. It was as likely to be effective for older as for younger children. It has wider benefits for ADHD and parenting and is likely to be considered to be cost-effective. Researchers/funders should encourage data sharing to test equity and other moderator questions for other interventions; further research is needed on enhancing equality of access to interventions.

Funding

The National Institute for Health Research Public Health Research programme.

Pathways to delinquency and substance use among African American youth: Does future orientation mediate the effects of peer norms and parental monitoring?

The following study assessed whether future orientation mediated the effects of peer norms and parental monitoring on delinquency and substance use among 549 African American adolescents. Structural equation modeling computed direct and indirect (meditational) relationships between parental monitoring and peer norms through future orientation. Parental monitoring significantly correlated with lower delinquency through future orientation (B = -.05, standard deviation = .01, p < .01). Future orientation mediated more than quarter (27.70%) of the total effect of parental monitoring on delinquency. Overall findings underscore the importance of strengthening resilience factors for African American youth, especially those who live in low-income communities.

Constructing tailored parental monitoring strategy profiles to predict adolescent disclosure and risk involvement

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Many parents use multiple monitoring strategies in different combinations over time to monitor their adolescents.

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Adolescents of parents who use multiple strategies reported greater risk involvement.

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Parents who solicited information only from adolescents had greater knowledge and adolescent disclosure.

Gender Differences in Relations among Perceived Family Characteristics and Risky Health Behaviors in Urban Adolescents

BACKGROUND

Research regarding the role of gender in relations between family characteristics and health risk behaviors has been limited.

PURPOSE

This study aims to investigate gender differences in associations between family processes and risk-taking in adolescents.

METHODS

Adolescents (N = 249; mean age = 14.5 years) starting their first year at an urban high school in the northeastern USA completed self-report measures that assessed family characteristics (i.e., parental monitoring, family social support, family conflict) and health behaviors (i.e., tobacco use, alcohol use, marijuana use, sex initiation) as part of a prospective, community-based study. Multivariate logistic regression models were used to investigate gender differences in associations between the family characteristics and health behaviors.

RESULTS

Among males, higher levels of perceived parental monitoring were associated with lower odds of using tobacco and having ever engaged in sex. Among females, higher levels of perceived parental monitoring were associated with lower odds of marijuana use, alcohol use, and having ever engaged in sex. However, in contrast to males, among females (a) higher levels of perceived family social support were associated with lower odds of alcohol use and having ever engaged in sex and (b) higher levels of perceived family conflict were associated with higher odds of marijuana use and having ever engaged in sex.

CONCLUSION

Family processes were more strongly related to health behaviors among adolescent females than adolescent males. Interventions that increase parental monitoring and family social support as well as decrease family conflict may help to protect against adolescent risk taking, especially for females.

Social Media and Sexual Behavior Among Adolescents: Is there a link?

BACKGROUND

Adolescent sexual risk taking and its consequences remain a global public health concern. Empirical evidence on the impact that social media has on sexual health behaviors among youth is sparse.

OBJECTIVE

The study aimed to examine the relationship between social media and the change in sexual risk over time and whether parental monitoring moderates this relationship.

METHODS

This study comprised a sample of 555 Latino youth aged 13-19 years from Maryland, United States completing baseline and follow-up surveys. Mixed-effects linear regression was used to examine the relationship between social media and the change in sexual risk over time and whether parental monitoring moderated the relationship.

RESULTS

Sexual risk behaviors significantly increased between baseline (T1) and follow up (T2) (mean=0.432 vs mean=0.734, P<.001). Youth sending more than 100 text messages per day had significantly higher sexual risk scores (beta=1.008, P<.001) but significantly larger declines in sexual risk scores for higher levels of parental monitoring (beta=-.237, P=.009).

CONCLUSIONS

Although adolescents exchange SMS at high rates, parental monitoring remains vital to parent-child relationships and can moderate SMS frequency and sexual risk behaviors, despite parental influence diminishing and peer pressure and social influences increasing during adolescence.

Childhood Adversities and Substance Misuse Among the Incarcerated: Implications for Treatment and Practice in Correctional Settings

BACKGROUND

Incarcerated populations have high rates of childhood adversities and substance use problems. Moreover, childhood adversities are well-documented predictors of substance misuse.

OBJECTIVE

To investigate the impact of childhood sexual and physical abuse, caregiver abuse of drugs or alcohol, and time spent in foster care on several substance misuse outcomes.

METHODS

Data comes from a sample of 16,043 incarcerated men and women in the United States Survey of Inmates in State and Federal Facilities. Bivariate analyses revealed differences by sex in childhood adversities and socioeconomic characteristics. Logistic regression analyses assessed the data for a link between childhood adversities and substance misuse after adjusting for other variables. Analyses were stratified by sex to show differences in predictors of substance misuse between men and women.

RESULTS

Childhood adversities increased the risk of many substance misuse outcomes. The prevalence of physical abuse, sexual abuse, foster care, and caretaker abuse of drugs or alcohol were greatest for inmates who reported injecting and sharing drugs. Growing up with a caregiver that used drugs or alcohol was a consistent predictor of increased risk of substance misuse for men and women. However, childhood sexual abuse increased risk for only women.

CONCLUSIONS

Inmates who experience physical abuse, sexual abuse, foster care involvement and caretakers who use drugs and alcohol are at an increased risk of substance misuse, injecting drug use and syringe sharing. Implications suggest correctional HIV prevention and substance misuse programs must address unresolved trauma and important gender differences.

Preventing the Onset of Child Sexual Abuse by Targeting Young Adolescents With Universal Prevention Programming

Child sexual abuse (CSA) is a serious public health problem that increases risk for physical and mental health problems across the life course. Young adolescents are responsible for a substantial portion of CSA offending, yet to our knowledge, no validated prevention programs that target CSA perpetration by youth exist. Most existing efforts to address CSA rely on reactive criminal justice policies or programs that teach children to protect themselves; neither approach is well validated. Given the high rates of desistance from sexual offending following a youth's first CSA-related adjudication, it seems plausible that many youth could be prevented from engaging in their first offense. The goal of this article is to examine how school-based universal prevention programs might be used to prevent CSA perpetrated by adolescents. We review the literature on risk and protective factors for CSA perpetration and identify several promising factors to target in an intervention. We also summarize the literature on programs that have been effective at preventing adolescent dating violence and other serious problem behaviors. Finally, we describe a new CSA prevention program under development and early evaluation and make recommendations for program design characteristics, including unambiguous messaging, parental involvement, multisession dosage, skills practice, and bystander considerations.

Race Differences in Patterns of Risky Behavior and Associated Risk Factors in Adolescence

Using data from the National Longitudinal Study of Adolescent Health (Add Health), this study expands on previous research by (a) examining differences across race in patterns or "subgroups" of adolescents based on nine self-reported behaviors (e.g., delinquency, substance use, risky sexual practices) and (b) comparing the risk factors (e.g., peer association, parenting, neighborhood cohesion), both within and across the race-specific subgroups, related to membership into the identified latent classes. The data used in this study include respondents aged 13 to 17 who participated in Waves 1 and 2 of the Add Health in-home interview. Latent class analysis (LCA) identified key differences in the number and characteristics of the latent classes across the racial subgroups. In addition, both similarities and differences in the risk factors for membership into the latent classes were identified across and within the race-specific subgroups. Implications for understanding risky behavior in adolescence, as well as directions for future research, are discussed.

Condoms, Culture, and Conviction: The Effect of Acculturation and Religiosity on Latina Condom Use during First Sex with New Partners

Latinas in the United States are less likely than their non-Hispanic peers to use condoms. Previous research has identified acculturation and religiosity as two key determinants of Latina condom use, but results are inconsistent, impairing the translation of findings to practice. The current study examines these constructs together and addresses methodological concerns noted in the literature. Structural equation modeling performed on a nationally representative sample of Latinas indicated that intrinsic religiosity increased condom use whereas acculturation decreased condom use. Extrinsic religiosity indirectly increased condom use via intrinsic religiosity. Implications for practice and policy are discussed.

Testing three pathways to substance use and delinquency among low-income African American adolescents

OBJECTIVE

Mounting literature suggests that parental monitoring, risky peer norms, and future orientation correlate with illicit drug use and delinquency. However, few studies have investigated these constructs simultaneously in a single statistical model with low income African American youth. This study examined parental monitoring, peer norms and future orientation as primary pathways to drug use and delinquent behaviors in a large sample of African American urban adolescents.

METHODS

A path model tested direct paths from peer norms, parental monitoring, and future orientation to drug use and delinquency outcomes after adjusting for potential confounders such as age, socioeconomic, and sexual orientation in a sample of 541 African American youth.

RESULTS

Greater scores on measures of risky peer norms were associated with heightened risk of delinquency with an effect size that was twice in magnitude compared to the protective effects of future orientation. Regarding substance use, greater perceived risky peer norms correlated with the increased likelihood of substance use with a standardized effect size 3.33 times in magnitude compared to the protective effects of parental monitoring.

CONCLUSIONS

Findings from this study suggest that interventions targeting risky peer norms among adolescent African American youth may correlate with a greater impact on reductions in substance use and delinquency than exclusively targeting parental monitoring or future orientation.

Sleep patterns and problems among early adolescents: Associations with alcohol use

INTRODUCTION

Sleep and sleep-related problems are associated with alcohol use and related problems among adults. However, existing research on associations between sleep and alcohol use among early adolescents is minimal, and potential individual and family factors that may affect this association remain largely unexplored. We examined potential associations between frequency of alcohol use and initial insomnia, subjective daytime sleepiness, sleep irregularity, and disturbed sleep among a low-income, ethnic minority sample of early adolescents; we also considered whether psychopathology symptoms and/or parental monitoring accounted for any associations found.

METHODS

127 youth who participated in the Camden Youth Development Study (64 male; mean age=13.2; 71% Hispanic, 32% African-American) were assessed using self-report measures of sleep, alcohol use, psychopathology symptoms (depressive and conduct disorder), and parental monitoring; in addition, teacher reports of attention-deficit hyperactivity disorder were used.

RESULTS

Initial insomnia and daytime sleepiness (but not sleep irregularity or disturbed sleep) were associated with frequency of alcohol use. The association between initial insomnia and alcohol use remained significant when each form of psychopathology and parental monitoring were adjusted for.

CONCLUSIONS

Among early adolescents, frequency of alcohol use is associated with initial insomnia, even once symptoms of psychopathology and family environment (parental monitoring) are adjusted for. Longitudinal research investigating the direction of this effect and other possible mediators and moderators would be useful in developing preventative and treatment interventions.

Environmental and temperamental correlates of alcohol user patterns in grade 7 students

Aims

We examined the effects of temperamental dispositions, friends using alcohol and parental monitoring on grade 7 students' alcohol use patterns.

Design

The analyses were drawn from a cross-sectional survey of 3710 grade 7 students (mean age =12.53) that participated in a large Norwegian school-based intervention study. Alcohol user patterns were measured through combining self-reported lifetime alcohol experience, heavy episodic drinking and any alcohol involvement in the previous 30 days. Behavioural inhibition/activation sensitivity (BIS/BAS), parental monitoring and the number of friends using alcohol were measured through the adolescents' self-report.

Results

As many as 68.8% of boys and 83.3% of girls were non-users of alcohol, whereas 9.1% of boys and 3.9% of girls reported use of alcohol last month. Heavy episodic drinking last month was reported by 3.1% of the boys and by 0.8 % of the girls. A multinomial regression analysis revealed strong associations between the number of friends using alcohol and alcohol user patterns, moderate inverse associations between parental monitoring and alcohol user patterns, and a weak association between BIS/BAS components and alcohol user patterns.

Conclusion

The results demonstrate the importance of socio-environmental factors in a period in which alcohol use is predictive of later negative outcomes.

Parental supply of alcohol and alcohol consumption in adolescence: prospective cohort study

BACKGROUND

Parents are a major supplier of alcohol to adolescents, yet there is limited research examining the impact of this on adolescent alcohol use. This study investigates associations between parental supply of alcohol, supply from other sources, and adolescent drinking, adjusting for child, parent, family and peer variables.

METHOD

A cohort of 1927 adolescents was surveyed annually from 2010 to 2014. Measures include: consumption of whole drinks; binge drinking (>4 standard drinks on any occasion); parental supply of alcohol; supply from other sources; child, parent, family and peer covariates.

RESULTS

After adjustment, adolescents supplied alcohol by parents had higher odds of drinking whole beverages [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.33-2.45] than those not supplied by parents. However, parental supply was not associated with bingeing, and those supplied alcohol by parents typically consumed fewer drinks per occasion (incidence rate ratio 0.86, 95% CI 0.77-0.96) than adolescents supplied only from other sources. Adolescents obtaining alcohol from non-parental sources had increased odds of drinking whole beverages (OR 2.53, 95% CI 1.86-3.45) and bingeing (OR 3.51, 95% CI 2.53-4.87).

CONCLUSIONS

Parental supply of alcohol to adolescents was associated with increased risk of drinking, but not bingeing. These parentally-supplied children also consumed fewer drinks on a typical drinking occasion. Adolescents supplied alcohol from non-parental sources had greater odds of drinking and bingeing. Further follow-up is necessary to determine whether these patterns continue, and to examine alcohol-related harm trajectories. Parents should be advised that supply of alcohol may increase children's drinking.

Cultural Contributors to Smoking Susceptibility Outcomes Among Latino Youth: The Padres Informados/Jovenes Preparados Participatory Trial

Padres Informados/Jovenes Preparados is a community-based participatory, family-focused tobacco prevention intervention for immigrant Latino families of adolescents. We conducted a participatory randomized controlled trial including 352 Latino families. Parents and youth in the intervention condition engaged in eight family skill building sessions. Participants completed baseline and 6-month postintervention surveys assessing smoking susceptibility and contextual factors. While the intervention did not affect smoking susceptibility overall, it resulted in lower smoking susceptibility among youth in families with less adherence to traditional Latino cultural values. This family cultural orientation is a key consideration for tobacco prevention interventions focused on Latino youth.

Exploring Parental Influence on the Progression of Alcohol Use in Mexican-Heritage Youth: a Latent Transition Analysis

Mexican-heritage youth are members of the fastest growing minority group and are at particular risk for substance use including alcohol consumption. Youth face numerous risk factors including positive descriptions of substance use on media and peer offers that are potentially ameliorated by parental anti-substance use socialization efforts. Guided by primary socialization theory and the theory of planned behavior, the present study posited eight research questions to identify discrete subgroups/patterns of Mexican-heritage youth alcohol use behavior and parental influence on youth outcomes. Longitudinal survey data (n = 1147) from youth in 29 public schools located in Phoenix, Arizona, were collected over 3 years. Latent class and transition analyses identified four discrete subgroups characterized by response patterns of alcohol use behaviors and perceptions in Mexican-heritage youth: (1) non-drinker, (2) potential drinker, (3) experimenter, and (4) regular drinker. Targeted parent-child communication about alcohol and parental monitoring were found to be significant predictors for youth alcohol use. Research implications and future directions are suggested.

Associations Between Maternal Support and Physical Activity Among 5th Grade Students

BACKGROUND

A large body of research has established an association between parental support for children's physical activity (PA) and children's PA. However, there has been little attention to the relative influences of parent and child perceptions of that parental support.

PURPOSE

To examine agreement among parent and child perceptions of parent support for PA and whether these perceptions are associated with objectively-measured moderate-to-vigorous physical activity (MVPA) among those children.

METHODS

Cross-sectional associations between PA of children measured via accelerometers and child-reported and mother-reported perceptions of parental support for children's PA were assessed via mixed-model regression analyses in a cohort of 693 5th graders. Results Children's perceptions of parental support for PA were consistent with those of their mothers. Nonetheless, in models that included both children's and mothers' perceptions of parental support for PA, mothers' perceptions, but not children's perceptions, were significantly associated with children's PA. Associations were consistent for Total MVPA, After School MVPA, and Evening MVPA, with stronger associations among males than among females.

CONCLUSION

Maternal support may influence children's PA. Studies which consider only children's accounts of parental support may overlook important mechanisms.

Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland

INTRODUCTION

HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions.

METHODS AND FINDINGS

This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14-3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09-3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00-5.00; P<0.001), and ever cohabited (AOR, 2.39; CI, 1.66-3.43; P = 0.00). The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319).

CONCLUSIONS

Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function.

Randomized pilot trial of a cognitive-behavioral alcohol, self-harm, and HIV prevention program for teens in mental health treatment

Adolescents with mental health conditions represent a high-risk group for substance use, deliberate self-harm (DSH), and risky sexual behavior. Mental health treatment does not uniformly decrease these risks. Effective prevention efforts are needed to offset the developmental trajectory from mental health problems to these behaviors. This study tested an adjunctive cognitive-behavioral family-based alcohol, DSH, and HIV prevention program (ASH-P) for adolescents in mental healthcare. A two group randomized design was used to compare ASH-P to an assessment only control (AO-C). Participants included 81 adolescents and a parent. Assessments were completed at pre-intervention as well as 1, 6, and 12-months post-enrollment, and included measures of family-based mechanisms and high-risk behaviors. ASH-P relative to AO-C was associated with greater improvements in most family process variables (perceptions of communication and parental disapproval of alcohol use and sexual behavior) as well as less DSH and greater refusal of sex to avoid a sexually transmitted infection. It also had a moderate (but non-significant) effect on odds of binge drinking. No differences were found in suicidal ideation, alcohol use, or sexual intercourse. ASH-P showed initial promise in preventing multiple high-risk behaviors. Further testing of prevention protocols that target multiple high-risk behaviors in clinical samples is warranted.

The Longitudinal Impact of Perceptions of Parental Monitoring on Adolescent Initiation of Sexual Activity

PURPOSE

The association between parental monitoring and adolescent behavior is well established. Past research suggests that parents monitor adolescent activities through parental control, solicitation of information, and youth disclosure, which increase parents' knowledge of youth activity leading to decreased risk behavior. However, there is mixed evidence of the impact of these efforts on sexual behavior. We examined these strategies from the adolescent perspective and assessed their impact on the initiation of sexual activity across the transition from middle school to high school.

METHODS

Analyses include 533 primarily Latino adolescents, who had not yet had sex in eighth grade and were surveyed yearly through 10th grade.

RESULTS

Adolescents who in eighth grade reported greater parental knowledge and more family rules about dating were less likely to initiate sex between eighth and 10th grade. Exchange of information, through parental solicitation and youth disclosure, and parental control, through rules about friends and dating, as well as maternal relationship satisfaction were significant predictors of parental knowledge. There were no gender differences in the impact of dating rules and parental knowledge on sexual initiation, but the paths to acquiring knowledge did differ by gender.

CONCLUSIONS

Results suggest that parental monitoring at earlier ages has an impact on sexual initiation. Effective monitoring is an active process within a family that includes setting boundaries and exchanging information. Interventions that encourage family rules, provide strategies for improving parental solicitation of information, and increase youth disclosure by enhancing the maternal-child relationship may be more likely to impact sexual initiation.

Educational intervention for parents of adolescents with chronic illness: a pre-post test pilot study

OBJECTIVE

This pilot experimental study tested the feasibility and intended effect of an educational intervention for parents to help them assist their adolescent child with chronic illness (CI) in becoming autonomous.

METHODS

A two-phase pre-post pilot intervention study targeting parents of adolescents with CI was conducted. Parents were allocated to group 1 and 2 and received the four-module intervention consecutively. Intended effect was measured through online questionnaires for parents and adolescents before, at 2 months after, and at 4-6 months after the intervention. Feasibility was assessed through an evaluation questionnaire for parents.

RESULTS

The most useful considered modules concerned the future of the adolescent and parents and social life. The most valued aspect was to exchange with other parents going through similar problems and receiving a new outlook on their relationship with their child. For parents, improvement trends appeared for shared management, parent protection, and self-efficacy, and worsening trends appeared for coping skills, parental perception of child vulnerability, and parental stress. For adolescents, improvement trends appeared for self-efficacy and parental bonding and worsening trends appeared for shared management and coping skills.

CONCLUSION

Parents could benefit from peer-to-peer support and education as they support the needed autonomy development of their child. Future studies should test an online platform for parents to find peer support at all times and places.