Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care

Adolescent-Parent Relationships and Communication: Consequences for Pregnancy Knowledge and Family Planning Service Awareness

PURPOSE

We explore three dimensions of parent-adolescent relationships (sexual and reproductive health (SRH) communications, connectedness, and parental monitoring) from the perspective of young adolescents as they relate to pregnancy knowledge and family planning service awareness in four diverse geographic areas ranging from low to high income settings and stratified by sex.

METHODS

Analyses utilized baseline data from four Global Early Adolescent Study sites (Shanghai, China; Kinshasa, Democratic Republic of the Congo; Denpasar and Semarang, Indonesia; and New Orleans, United States). Multiple linear regressions were conducted to assess the relationships between key characteristics of parent-adolescent relationships and pregnancy knowledge. Multiple logistic regressions were also conducted to assess relationships between key characteristics of parent-adolescent relationships and family planning service awareness.

RESULTS

Across all four sites, communication with a parent about SRH matters was significantly associated with increased pregnancy knowledge among female respondents. Further, girls in Shanghai and New Orleans and boys in Kinshasa who had ever communicated with a parent about SRH matters were significantly more likely to know where to get condoms. Finally, girls who communicated with a parent about any SRH matter were significantly more likely to know where to get other forms of contraception across all four study sites.

DISCUSSION

Findings strongly support the importance of SRH communications between young adolescents and their parents. Our findings also suggest that while parental connectedness and monitoring are beneficial they are not replacements for quality parent-adolescent communications about SRH issues that begin early in adolescence before sexual intercourse is initiated.

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.

An Exploration of the Ecological Context of Low-Income, Urban African-American Adolescent Sexual Risk

Prior health disparities research has indicated that urban, low-income African-American families and adolescents experience ecological and environmental hardships that result in higher rates of engagement in risk behaviors. Contextual factors like community violence, socioeconomic status, and family processes, as well as limited sexual health knowledge, a psychological element, also contribute to high rates of sexual risk among urban African-American adolescents. However, protective factors like parental monitoring and parent-adolescent communication about sex may decrease sexual risk among this urban teen population. Therefore, the current study sought to explore the following research questions: (1) Is parent-adolescent communication about sex associated with adolescent sexual health knowledge?, (2) Is parent-adolescent communication about sex associated with parental monitoring?, (3) Are parental monitoring and parent-adolescent communication about sex predictors of adolescent sexual risk?, (4) Are there gender differences in parent-adolescent communication about sex and parental monitoring?, and (5) Are age and gender predictors of adolescent sexual risk? A sample of approximately 1102 African-American adolescents aged 13-17 from urban Midwestern high schools were included in this study. There was no significant association found between sexual health knowledge and parent communication about sex or parental monitoring. Female adolescents reported higher levels of communication about sex than males. Findings indicated a significant negative association between parental monitoring and adolescent sexual risk, with the association being stronger for males than females. There was a significant negative association found between sexual health knowledge and adolescent sexual risk. Additionally, findings indicated a significant negative association between parental monitoring and adolescent sexual risk.

Trends in Parental Monitoring and Knowledge Over Time Between Sexual Minority and Heterosexual Girls

This study assessed whether trajectories of parental monitoring components were different for sexual minority girls (SMGs) compared to heterosexual girls. We recruited 14-19-year-old girls from two adolescent medicine clinics. We estimated growth curve models to compare how components of parental monitoring-adolescent disclosure, parental solicitation, and parental knowledge-changed over 2 years for SMGs and heterosexual girls. SMGs and heterosexual girls had similar trajectory slopes and quadratic forms of adolescent disclosure, but SMGs had consistently lower adolescent disclosure scores. Parental knowledge trajectories indicated differential intercepts and slopes for SMGs compared to heterosexual girls, suggesting potential higher risk for maladaptive behaviors. Results of this study suggest that parental monitoring may operate differently over time for SMGs compared to heterosexual girls.

Alcohol Use and Sexual Risk Behaviors among Adolescents with Psychiatric Disorders: A Systematic Review and Meta-Analysis

Adolescents with psychiatric disorders appear to be at increased risk for acquiring HIV and other sexually transmitted infections; however, little is known about the prevalence of behavioral risk factors in this population. This meta-analysis aimed to assess the prevalence of alcohol use and sexual risk behaviors among adolescents with psychiatric disorders. Electronic database searches identified studies sampling adolescents diagnosed with psychiatric disorders and assessing both alcohol and sexual risk behaviors. Fourteen studies sampling 3,029 adolescents with psychiatric disorders were included. The majority of adolescents with psychiatric disorders report alcohol use and sexual risk behaviors. Risk reduction interventions targeting these two behaviors are needed.

Evaluation of respondent-driven sampling in a study of urban young men who have sex with men

Evidence suggests that respondent-driven sampling (RDS) is an efficient approach to sampling among varied populations of adult men who have sex with men (MSM) both in the USA and abroad, although no studies have yet evaluated its performance among younger MSM, a population with a steep rise in HIV infection in recent years. Young MSM (YMSM) may differ in terms of their connectedness to other YMSM (e.g., due to evolving sexual identity, internalization of sexual minority stigma, and lack of disclosure to others) and mobility (e.g., due to parental monitoring) which may inhibit the sampling process. The aims of this study were to evaluate the efficiency and effectiveness of RDS-based sampling among young urban MSM and to identify factors associated with recruitment success. We hypothesized that demographic, social, behavioral, and network factors, including racial/ethnic minority status, homelessness (i.e., as an indicator of socioeconomic marginalization), HIV-positive status, substance use problems, gay community connectedness, and network size would be positively related to recruitment productivity, while sexual minority stigmatization, environmental barriers (e.g., parental monitoring), and meeting sex partners on the internet (i.e., virtual venue) would be negatively related to recruitment productivity. Between December 2009 and February 2013, we used RDS to recruit a sample of 450 YMSM, ages 16-20. Findings suggest that the use of RDS for sampling among YMSM is challenging and may not be feasible based on the slow pace of recruitment and low recruitment productivity. A large number of seeds (38 % of the sample, n = 172) had to be added to the sample to maintain a reasonable pace of recruitment, which makes use of the sample for RDS-based population estimates questionable. In addition, the prevalence of short recruitment chains and segmentation in patterns of recruitment by race/ethnicity further hamper the network recruitment process. Thus, RDS was not particularly efficient in terms of the rate of recruitment or effective in generating a representative sample. Hypotheses regarding factors associated with recruitment success were supported for network size and internalized stigma (but not other factors), suggesting that participants with larger network sizes or high levels of internalized stigma may have more and less success recruiting others, respectively.

Efficacy of an HIV/STI sexual risk-reduction intervention for African American adolescent girls in juvenile detention centers: a randomized controlled trial

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.

Associations Between Psychiatric Impairment and Sexual Risk Behavior Among Teens in Mental Health Treatment

AIMS

To assess the associations of sexual risk behavior with psychiatric impairment and individual, peer, and partner attitudes among adolescents receiving mental health treatment.

METHODS

Adolescents (N=893, 56% female, 67% African American) completed assessments of psychiatric impairment, rejection sensitivity, peer norms, HIV knowledge, perceived vulnerability, self-efficacy and condom use intentions. Two structural equation models were used to test the study hypotheses; one for sexually active youth and one for non-active youth.

RESULTS

For non-active youth, psychiatric impairment influenced self-efficacy and condom use intentions via peer norms, rejection sensitivity, and perceived vulnerability. Among the sexually active youth, sexual risk was related to impairment and previous condom use.

DISCUSSION

These results suggest that individual, peer, and partner factors are related to impairment and to sexual risk attitudes, but depend on previous sexual experience.

Differences in psychosocial risk variables for HIV as a function of sexual experience

The aim of this study was to analyze the differences in psychosocial risk variables for HIV as a function of sexual experience in an adolescent population. The study sample consisted of 846 adolescents of both sexes aged between 14 and 19 years. Participants responded to several questionnaires that assessed four psychosocial variables related to risk sexual behavior for HIV infection: 1) perception of peer group norms, 2) condom use self-efficacy, 3) attitudes towards condom use and 4) parental communication about sexuality, STIs, HIV and pregnancy. Participants in both groups with sexual experience (with and without penetration) reported better communication with their mothers on sexuality and scored higher in positive attitudes towards condom use than those in the group without sexual experience. The sexual experience with penetration group perceived more negative peer group norms related to safe sexual behavior than the group without sexual experience; the group without sexual experience had a higher perception of condom use self-efficacy than the sexual experience with penetration group.

Sexual experience among emotionally and behaviorally disordered students in therapeutic day schools: an ecological examination of adolescent risk

OBJECTIVE

This study examined gender differences in family, peer, partner, and mental health characteristics related to sexual experience among emotionally and behaviorally disordered students in therapeutic day schools, a population at elevated risk for negative sexual health outcomes.

METHODS

A total of 417 13- to 20-year-old adolescents reported on their family functioning, peer and partner relationship characteristics, mental health problems, and self-reported sexual behavior.

RESULTS

For boys and girls, peer influence and conduct problems predicted sexual experience, and family dysfunction was related to negative peer influence. Greater rejection sensitivity was related to less sexual experience for boys and girls. The final path model revealed indirect effects of family dysfunction on boys' but not girls' sexual experiences.

CONCLUSIONS

Findings underscore the utility of an ecological approach to understand social and personal mechanisms that increase risk and mitigate negative outcomes among emotionally and behaviorally disordered boys and girls in therapeutic day schools.

Do psychiatric disorders moderate the relationship between psychological distress and sexual risk-taking behaviors in young men who have sex with men? A longitudinal perspective

Young men who have sex with men (YMSM) account for two-thirds of new HIV infections in young people in the United States. Identifying between-person and within-person correlates of sexual risk-taking provides critical information for developing behavioral prevention efforts for this group. Possible predictors of sexual-risk behavior in YMSM include major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and variation in psychological distress over time. To date, research has been equivocal with regard to the relationship between psychiatric disorders, psychological distress, and sexual risk behaviors. Participants included 119 16-20-year-old YMSM. Ethnicity/race of the participants included: black/African-American (46.2%), white (19.3%), Latino/Hispanic (12.6%), multiracial (11.8%), Asian/Pacific Islander (2.5%), and other (5.9%). Sexual risk outcomes included total number of male partners and unprotected anal sex acts across four waves of data collection (24 months). The study found that the between-person correlates, including ethnicity and age, predicted total male partners. Between-person correlates, including ethnicity, MDD, and a moderating effect of PTSD on psychological distress emerged as determinants of unprotected anal sex acts.

Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth

BACKGROUND

Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%-45% of individuals within this age group, making these phenomena major public health concerns. Lesbian, gay, bisexual, and transgender (LGBT) youth particularly are at risk for engaging in these behaviors. Nevertheless, relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population.

PURPOSE

This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth.

METHODS

A community sample of 246 LGBT youth (aged 16-20 years) was followed prospectively over five time points at regular 6-month intervals. Participants completed a baseline structured interview assessing suicide attempt history and questionnaires measuring gender nonconformity, impulsivity, and sensation-seeking. At follow-up assessments, participants completed a structured interview assessing self-harm and questionnaires for suicidal ideation, hopelessness, social support, and LGBT victimization. Data were collected from 2007 to 2011, and HLM analyses were conducted in 2011.

RESULTS

A history of attempted suicide (p=0.05); impulsivity (p=0.01); and prospective LGBT victimization (p=0.03) and low social support (p=0.02) were associated with increased risk for suicidal ideation. Suicide attempt history (p<0.01); sensation-seeking (p=0.04); female gender (p<0.01); childhood gender nonconformity (p<0.01); and prospective hopelessness (p<0.01) and victimization (p<0.01) were associated with greater self-harm.

CONCLUSIONS

General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population.

Sexual risk among African American girls: psychopathology and mother-daughter relationships

OBJECTIVE

To examine the associations among mental health problems, maternal monitoring and permissiveness, mother-daughter communication and attachment, and sexual behaviors among African American girls receiving outpatient psychiatric care. Youths with mental health problems report higher rates of HIV-risk behavior than do their peers, and African American girls have higher rates of sexually transmitted infections than do girls of all other racial groups.

METHOD

A sample of 12- to 16-year-old African American girls (N = 266, mean age = 14.46 years) and their female caregivers (73% biological mothers) completed computerized assessments of girls' mental health symptoms, maternal monitoring and permissiveness, and mother-daughter communication and attachment. Girls indicated their sexual risk behaviors (vaginal/anal sex, consistent condom use, number of partners).

RESULTS

African American girls who reported clinically significant externalizing problems, more permissive parenting, less open mother-daughter sexual communication, and more frequent mother-daughter communication were more likely to report having had vaginal and/or anal sex. Sexually active girls with greater maternal attachment were less likely to report inconsistent condom use.

CONCLUSIONS

Findings revealed important risk and protective factors for African American girls in psychiatric care. HIV-prevention programs may be strengthened by improving mother-daughter relationships and communication and by reducing girls' mental health problems.

Clinical depression and condom use attitudes and beliefs among African American adolescent females

Depression, HIV, and other sexually transmitted diseases (STDs) are growing concerns among African American adolescent females. Theoretical models contribute to identification of mediators of condom use; however, minimal research has addressed the explicit relationship between clinical depression and condom use in African American adolescent females. The authors report results from quantitative surveys with clinically depressed (n = 64) and nondepressed (n = 64) African American adolescent females in two large metropolitan cities in the eastern United States. Theoretical mediators of condom use in the study sample-attitudes, subjective norms, perceived behavioral control, and intentions-were investigated. Significant differences existed between the groups in condom use frequency (U = 356.5, p = .037); however, there were no statistically significant differences in condom use attitudes and beliefs. Although clinically depressed and nondepressed African American adolescent females may hold similar attitudes and beliefs about condom use, differences in condom use frequency may be a psychopathologic occurrence.

Sensation seeking moderates the effects of alcohol and drug use prior to sex on sexual risk in young men who have sex with men

Men who have sex with men (MSM) account for more than half of all new HIV/AIDS diagnoses in the United States each year, and young MSM (ages 13-24) have the highest increases in new infections. Identifying which young MSM engage in sexual risk-taking in which contexts is critical in developing effective behavioral intervention strategies for this population. While studies have consistently found positive associations between the use of certain drugs and sexual risk, research on alcohol use as a predictor of risk has been less consistent. Participants included 114 young MSM from a longitudinal study of LGBT youth (ages 16-20 at baseline). Participants reported number of unprotected sex acts with up to nine partners across three waves of data collection spanning a reporting window of 18 months, for a total of 406 sexual partners. Sensation seeking was evaluated as a moderator of the effects of both alcohol and drug use prior to sex on sexual risk. Higher levels of sensation seeking were found to significantly increase the positive associations between frequency of unprotected sex and frequency of both alcohol use and drug use with partners. Follow-up analysis found that average rates of alcohol use moderated the association between alcohol use prior to sex and sexual risk, such that decreases in average alcohol use increased the positive association between these variables. Results suggest that while drug use with partners increased sexual risk for all young MSM, the effects of alcohol use prior to sex were limited in low sensation-seeking young MSM as well as those who are high alcohol consumers on average. Implications for future research and behavioral interventions are discussed.

Involving vulnerable populations of youth in HIV prevention clinical research

Adolescents continue to be at high risk for HIV infection, with young men who have sex with men and youth with drug abuse and/or mental health problems at particularly high risk. Multiple factors may interact to confer risk for these youth. Engaging vulnerable youth in HIV prevention research can present unique challenges in the areas of enrollment, retention, and trial adherence. Examples of successful engagement with vulnerable youth offer encouraging evidence for the feasibility of including these youth in clinical trials. Ethical challenges must be taken into consideration before embarking on biomedical HIV prevention studies with vulnerable youth, especially in the global context. Given the many individual and contextual factors that contribute to their high-risk status, it is essential that vulnerable youth populations be included in HIV prevention clinical research studies.