Mechanisms of Family Impact on African American Adolescents' HIV-Related Behavior

"Strap up:" Sexual socialization and safer sex practices among African American youth in foster care

Adolescent sexual health is often reflected through a problem-oriented lens. This serves to reinforce prevailing sexual scripts and cultural images of disenfranchised youth. Very little is known about the support young people in foster care, particularly youth of color, need to stay sexually healthy and safe. This article presents data on the sources and types of sexual socialization experiences that supported African American transitional age youth in foster care to protect against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Eighteen African American participants (18 to 21-years old) who reported condom use in two quantitative interviews were selected to participate in a qualitative interview. A mapping exercise and thematic analyses were used to identify the participants' sources of support and sexual socialization experiences. The study's findings indicated the youth had a combination of informal and formal sources that conveyed four types of STI/HIV prevention messages: Effective, Affective, Affinity, & Tangible. The majority of the participants (83%) received all four types of STI/HIV prevention messages from adult, partner and/or peer sources. Sources who motivated the participants the most to protect against STIs/HIV had a strong relationship with the youth and communicated openly about safer sex practices. Results of this study provide implications for future research as well as indications for practice that may be incorporated into training for child welfare practitioners, foster parents, kinship caregivers, and others who encounter youth in foster care.

Trajectory classes of cannabis use and heavy drinking among rural African American adolescents: multi-level predictors of class membership

AIMS

To inform research on the etiology and prevention of substance use among rural African American youth by (a) identifying developmental trajectory classes of cannabis use and heavy drinking across adolescence and young adulthood and (b) examining associations between trajectory class membership and multi-level assessments of risk factors.

DESIGN

A prospective study spanning 9 years with assessments of cannabis use and heavy drinking, the catecholamines epinephrine and norepinephrine, perceived stress and psychosocial risk factors.

SETTING

Rural communities in the southeastern United States.

PARTICIPANTS

African American youth (n = 518).

MEASUREMENTS

Participants were assessed for cannabis use and heavy drinking at seven assessments beginning at 16 years of age and continuing to 25 years of age. At age 19, participants provided overnight urine voids that were assayed for catecholamines, a biological marker of life stress resulting from sympathetic nervous system activation. At ages 16 and 19, participants provided information on malleable psychosocial risk factors.

FINDINGS

Latent class growth models revealed three distinct trajectory classes for cannabis use and for heavy drinking. Higher levels of circulating stress hormones and perceived stress were associated with classes reporting greater substance use over time (all Ps < 0.05). A composite of selected risk factors discriminated class membership (all Ps < 0.05). Trajectory classes characterized by rapid usage increases in early adulthood exhibited the greatest increase in deviant peer affiliations between ages 16 and 19 years.

CONCLUSIONS

Rural African American youth's cannabis use and heavy drinking across adolescence and young adulthood demonstrate distinct developmental courses; a small number of risk factors and measures of biological and perceived stress differentiate class membership prognostically. Variability over time in these measures, specifically an increase in deviant peer affiliation, may help to account for steep increases in young adulthood.

Sibling teenage pregnancy and clinic-referred girls' condom use: The protective role of maternal monitoring

Younger sisters of teenage parents have elevated rates of engaging in unprotected sex. This may result from changes in parenting behavior after a sibling becomes pregnant or impregnates a partner, and be particularly pronounced for girls seeking mental health treatment. The current study examines condom use over time in 211 African-American girls recruited from outpatient psychiatric clinics. Findings indicate that having a sibling with a teenage pregnancy history predicts less consistent condom use two years later. After accounting for earlier condom use and mental health problems, maternal monitoring moderates condom use such that for girls with a sibling with a pregnancy history, more vigilant maternal monitoring is associated with increased condom use, while for girls with no sibling pregnancy history, maternal monitoring is unrelated to adolescents' condom use two years later. Findings suggest that targeted interventions to increase maternal monitoring of high-risk teens may be beneficial for girls with a sibling history of teenage pregnancy.

Parent and youth dopamine D4 receptor genotypes moderate multilevel contextual effects on rural African American youth's risk behavior

The present investigation extends research on Gene × Environment interactions and youth risk behavior by linking multilevel contextual factors, such as community disadvantage and protective parenting practices, to both parental and youth dopamine D4 receptor (DRD4) genotypes. We expected community disadvantage to influence youth risk behavior via a series of indirect effects involving protective parenting and youth's planful future orientation when both parents' and youth's DRD4 status was considered. Genetic moderation processes also were tested to determine whether they conformed to a diathesis-stress or a differential susceptibility model. Hypotheses were investigated with data from 361 rural African American youth and their parents assessed 3 times when youth were ages 16 to 19. Community disadvantage interacted with parental DRD4 status to predict low levels of protective parenting. Protective parenting, in turn, interacted with youth DRD4 status to forecast increases in youth's planful future orientations, a proximal influence on changes in risk behavior. The Parental DRD4 × Community Disadvantage interaction, but not youth DRD4 × Protective Parenting, conformed to a differential susceptibility model. Indirect effect analyses revealed a significant indirect path linking community disadvantage to youth risk behavior through a series of multilevel Gene × Environment interaction processes.

Pubertal timing and sexual risk behaviors among rural African American male youth: testing a model based on life history theory

Life History Theory (LHT), a branch of evolutionary biology, describes how organisms maximize their reproductive success in response to environmental conditions. This theory suggests that challenging environmental conditions will lead to early pubertal maturation, which in turn predicts heightened risky sexual behavior. Although largely confirmed among female adolescents, results with male youth are inconsistent. We tested a set of predictions based on LHT with a sample of 375 African American male youth assessed three times from age 11 to age 16. Harsh, unpredictable community environments and harsh, inconsistent, or unregulated parenting at age 11 were hypothesized to predict pubertal maturation at age 13; pubertal maturation was hypothesized to forecast risky sexual behavior, including early onset of intercourse, substance use during sexual activity, and lifetime numbers of sexual partners. Results were consistent with our hypotheses. Among African American male youth, community environments were a modest but significant predictor of pubertal timing. Among those youth with high negative emotionality, both parenting and community factors predicted pubertal timing. Pubertal timing at age 13 forecast risky sexual behavior at age 16. Results of analyses conducted to determine whether environmental effects on sexual risk behavior were mediated by pubertal timing were not significant. This suggests that, although evolutionary mechanisms may affect pubertal development via contextual influences for sensitive youth, the factors that predict sexual risk behavior depend less on pubertal maturation than LHT suggests.

Pathways from Racial Discrimination to Multiple Sexual Partners Among Male African American Adolescents

African American male adolescents' involvement with multiple sexual partners has important implications for public health as well as for their development of ideas regarding masculinity and sexuality. The purpose of this study was to test hypotheses regarding the pathways through which racial discrimination affects African American adolescents' involvement with multiple sexual partners. We hypothesized that racial discrimination would engender psychological distress, which would promote attitudes and peer affiliations conducive to multiple sexual partnerships. The study also examined the protective influence of parenting practices in buffering the influence of contextual stressors. Participants were 221 African American male youth who provided data at ages 16 and 18; their parents provided data on family socioeconomic disadvantages. Of these young men, 18.5% reported having 3 or more sexual partners during the past 3 months. Structural equation models indicated that racial discrimination contributed to sexual activity with multiple partners by inducing psychological distress, which in turn affected attitudes and peer affiliations conducive to multiple partners. The experience of protective parenting, which included racial socialization, closeness and harmony in parent-child relationships, and parental monitoring, buffered the influence of racial discrimination on psychological distress. These findings suggest targets for prevention programming and underscore the importance of efforts to reduce young men's experience with racial discrimination.

Will it help? Identifying socialization discourses that promote sexual risk and sexual health among African American youth

Because much of the existing research examining sexual communication to African American youth focuses on demographic and parental factors predicting sexual risk behaviors, less is known about factors predicting sexual health, and little is understood about the contributions of peer communications. The current study aimed to expand existing approaches by assessing which socialization discourses communicated by parents and peers contribute to sexual risk and health outcomes (sexual assertiveness, positive sexual affect, and condom self-efficacy). Participants were 631 African American undergraduates (73% female) who indicated the extent to which they had received from their parents and peers each of 28 messages representing four cultural discourses: abstinence, relational sex, sex positive, and gendered sexual roles. As expected, parents were perceived to emphasize relational sex and abstinence messages more than peers, and peers were perceived to communicate sex-positive and gendered sex role messages more than parents. Greater exposure to abstinence messages predicted lower levels of sexual experimentation, whereas exposure to sex-positive messages predicted higher levels. In addition, exposure to relational sex and sex-positive messages predicted higher levels of sexual assertiveness and positive sexual affect. Implications are discussed concerning sexual communications that could help Black youth develop healthy sexual perspectives.

SOCIO-ECOLOGICAL PREDICTORS OF INTERCOURSE FREQUENCY AND NUMBER OF SEXUAL PARTNERS AMONG MALE AND FEMALE AFRICAN AMERICAN ADOLESCENTS

The current study examined 14 waves of data derived from a large, community-based study of the sexual behavior of impoverished youth between 12 and 17 years of age residing in the Deep South. We used multilevel linear modeling to identify ecological predictors of intercourse frequency and number of sexual partners among gender-specific subsamples. Results indicated that predictors of adolescent sexual behavior differed by both type of sexual behavior and gender. For males, age, maternal warmth, parental knowledge, curfew, self-worth, and sense of community predicted intercourse frequency, while age, parental knowledge, curfew, self-worth, friend support, and sense of community were significantly associated with having multiple sexual partners. Among females, age, curfew, and self-worth exerted significant effects on intercourse frequency, while age, parental knowledge, curfew, and self-worth exerted significant effects on having multiple sexual partners. Implications and future directions are discussed.

Dopamine receptor gene d4 polymorphisms and early sexual onset: gender and environmental moderation in a sample of african-american youth

PURPOSE

Early sexual onset and its consequences disproportionately affect African-American youth, particularly male youth. The dopamine receptor D4 gene (DRD4) has been linked to sexual activity and other forms of appetitive behavior, particularly for male youth and in combination with environmental factors (gene × environment [G × E] effects). The differential susceptibility perspective suggests that DRD4 may exert this effect by amplifying the effects of both positive and negative environments. We hypothesized that DRD4 status would amplify the influence of both positive and negative neighborhood environments on early sexual onset among male, but not female, African-Americans.

METHODS

Hypotheses were tested with self-report, biospecimen, and census data from five prospective studies of male and female African-American youth in rural Georgia communities, N = 1,677. Early sexual onset was defined as intercourse before age 14.

RESULTS

No significant G × E findings emerged for female youth. Male youth with a DRD4 long allele were more likely than those with two DRD4 short alleles to report early sexual onset in negative community environments and not to report early onset in positive community environments.

CONCLUSIONS

Dopaminergic regulation of adolescent sexual behaviors may operate differently by gender. DRD4 operated as an environmental amplification rather than a vulnerability factor.

Avoiding adolescent pregnancy: a longitudinal analysis of African-American youth

PURPOSE

The timing and social context of pregnancy have significant implications for the well-being of African-American young people. Rarely, however, do studies focus on identifying the developmental processes associated with young people's avoidance of pregnancy until after adolescence.

METHODS

We tested hypotheses regarding the factors associated with delayed fertility (no experience of a pregnancy by age 19) among a sample of 889 African-American youth recruited at age 11 and assessed longitudinally through age 19. We hypothesized that, during preadolescence (age 11), health-promoting environmental processes would be linked to nurturant-responsive parenting, which in turn would be linked to youths' conventional future orientations and risky sexual behavior in midadolescence (age 16) and to pregnancy experience by late adolescence (age 19). Hypotheses were tested with logistic structural equation modeling.

RESULTS

Our conceptual model fit the data well. We identified a cascade process whereby protective environments were associated with nurturant-responsive parenting, which was associated with youths' conventional future orientations; conventional future orientations were associated with avoidance of sexual risk behaviors at age 16 and avoidance of pregnancy by age 19. We identified an additional direct effect between nurturant-responsive parenting and avoidance of risky sexual behavior.

CONCLUSIONS

The results suggest processes that may be targeted to facilitate delayed fertility among African-American youth.

The development of conventional sexual partner trajectories among african american male adolescents

African American male youth disproportionately report involvement with multiple sexual partners, which increases their risk for sexually transmitted infections and initiation of unplanned pregnancies. Little is known about the developmental precursors of sexual partner trajectories among African American male youth. Moreover, few studies focus on the many African American youth who evince highly conventional sexual partner trajectories, i.e., youth who have only one partner or abstain from sexual activity across time. Using four waves of data from a longitudinal study, we hypothesized that an accumulation of social and economic disadvantages in early adolescence would negatively influence youths' conventional sexual partner trajectories in late adolescence. We expected these disadvantages to affect youths' receipt of protective family processes and their reports of a set of intrapersonal processes (self-regulation, hope, and low levels of anger) linked to generally conventional behavior. Hypotheses were tested with data from 315 African American male youth from 11 to 18.5 years of age and their primary caregivers. Our results supported the hypotheses. Socioeconomic disadvantages during preadolescence predicted less involvement in conventional sexual partner trajectories from ages 16 to 18.5 years. This association was mediated by protective family processes and a set of interrelated intrapersonal protective processes. Preventive interventions designed to promote protective parenting and intrapersonal processes can be expected to promote sexual behavior trajectories characterized by abstinence or relations with very few partners.

Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

Contributions of family environment and parenting processes to sexual risk and substance use of rural African American males: a 4-year longitudinal analysis

This study sought to identify factors that forecast sexual risk and alcohol or other substance use patterns among 411 rural African American males as they transitioned from middle childhood to late adolescence. In addition, an exploration was undertaken to examine the contribution of both risk and protective factors in distinguishing rural African American males at highest risk for engaging in risky sexual behavior and elevated substance use from those with relatively low risk of engaging in these behaviors. Findings revealed that exposure to negative life events during middle childhood has prognostic significance for rural African American males' susceptibility to engaging in HIV-related risk behaviors as they transition into adolescence and young adulthood. High-risk engaging males had significantly higher means on susceptibility to risk and marginally significantly higher means on substance-using peer affiliation. High-risk rural African American males also reported lower means on involved-vigilant parent than the normative group (low-risk group). However, economic hardship, family stress, parental psychological functioning, and harsh and inconsistent parenting did not emerge as significant predictors of high- or low-risk group membership. The implication for future research and preventive interventions is discussed.

Protective Parenting, Relationship Power Equity, and Condom Use Among Rural African American Emerging Adult Women

Sexually transmitted infections disproportionately affect African Americans, particularly young women. The influence of a set of interrelated protective parenting processes-instrumental and emotional support, sexual risk communication, and encouragement of goals for employment or education-on emerging adult women was examined. Parenting was hypothesized to affect consistent condom use through its association with women's reports of power equity in their intimate relationships. Hypotheses were tested with 135 sexually active women 18 to 21 years of age living in rural southern communities. Structural equation modeling indicated that (a) parenting processes predicted women's self-reported relationship power equity and consistent condom use, and (b) relationship power equity predicted consistent condom use. Limited support emerged for a mediational role of relationship power equity in explaining the influence of parenting on consistent condom use. Parental involvement and young women's establishment of personal control in their intimate relationships are important goals for sexual risk reduction programs.

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.

Integrating condom skills into family-centered prevention: efficacy of the Strong African American Families-Teen program

PURPOSE

The Strong African American Families-Teen (SAAF-T) program, a family-centered preventive intervention that included an optional condom skills unit, was evaluated to determine whether it prevented unprotected intercourse and increased condom efficacy among rural African American adolescents. Ancillary analyses were conducted to identify factors that predicted youth attendance of the condom skills unit.

METHODS

Sixteen-year-old African American youths (N = 502) and their primary caregivers were randomly assigned to SAAF-T (n = 252) or an attention control (n = 250) intervention. SAAF-T families participated in a 5-week family skills training program that included an optional condom skills unit. All families completed in-home pretest, posttest, and long-term follow-up interviews during which adolescents reported on their sexual behavior, condom use, and condom efficacy. Because condom use was addressed only in an optional unit that required caregiver consent, we analyzed efficacy using complier average causal effect analyses.

RESULTS

Attendance in both SAAF-T and the attention control intervention averaged 4 of 5 sessions; 70% of SAAF-T youth attended the condom skills unit. Complier average causal effect models indicated that SAAF-T was efficacious in reducing unprotected intercourse and increasing condom efficacy among rural African American high school students. Exploratory analyses indicated that religious caregivers were more likely than nonreligious caregivers to have their youth attend the condom skills unit.

CONCLUSIONS

Results suggest that brief condom skills educational modules in the context of a family-centered program are feasible and reduce risk for sexually transmitted infections and unplanned pregnancies.

The strong African American families-teen trial: rationale, design, engagement processes, and family-specific effects

This study addresses two limitations in the literature on family-centered intervention programs for adolescents: ruling out nonspecific factors that may explain program effects and engaging parents into prevention programs. The Rural African American Families Health project is a randomized, attention-controlled trial evaluating the efficacy of the Strong African American Families-Teen (SAAF-T) program, a family-centered risk-reduction intervention for rural African American adolescents. Rural African American families (n = 502) with a 10th-grade student were assigned randomly to receive SAAF-T or a similarly structured, family-centered program that focused on health and nutrition. Families participated in audio computer-assisted self-interviews at baseline and 6-month follow-up. Program implementation procedures yielded a design with equivalent doses, five sessions of family-centered intervention programming for families in each condition. Of eligible families screened for participation, 76% attended four or five sessions of the program. Consistent with our primary hypotheses, SAAF-T youth, compared to attention-control youth, demonstrated higher levels of protective family management skills, a finding that cannot be attributed to nonspecific factors such as aggregating families in a structured, interactive setting.

Perceived discrimination and longitudinal increases in adolescent substance use: gender differences and mediational pathways

OBJECTIVES

This study was designed to test hypotheses about the prospective association of adolescents' perceptions of discrimination with increases in substance use and the processes that mediate this association.

METHODS

African American youths residing in rural Georgia (n = 573; mean age = 16.0 years) provided longitudinal data on their experiences with discrimination, substance use, school engagement, and affiliations with substance-using peers.

RESULTS

For male youths, perceived discrimination was significantly related to increases in substance use, and, as hypothesized, this association was mediated by the contributions of perceived discrimination to decreases in school engagement and increases in affiliations with substance-using peers. Analyses also indicated that discrimination influences substance use rather than vice versa.

CONCLUSIONS

Results are consistent with the hypothesis that high levels of discrimination are linked to increases in substance use for African American male adolescents.

From racial discrimination to risky sex: prospective relations involving peers and parents

This study investigated how early experience with racial discrimination affected the subsequent risky sexual behaviors of a diverse sample of African American youths (N = 745). The analyses focused on 3 risk-promoting factors thought to mediate the hypothesized discrimination → risky sex relation: negative affect, affiliation with deviant peers, and favorable attitudes toward risky sex. In addition, attentive parenting was examined as a protective factor. Analyses using structural equation modeling revealed that youths who perceived more racial discrimination at age 10 or 11 were engaging in more sexual risk taking at age 18 or 19. This relation was mediated by the hypothesized risk-promoting factors via pathways that were consistent with our conceptual model. Results also indicated a prospective reciprocal relation between parenting and children's deviant affiliations: deviant peer affiliations at age 10 or 11 predicted more attentive parenting behaviors by the parents; this response from the parents, in turn, predicted relatively fewer deviant affiliations when the youths were 15 or 16. Study findings are discussed in terms of their relevance to the disproportionately high rates of sexually transmitted infections among African Americans.

Natural mentoring processes deter externalizing problems among rural African American emerging adults: a prospective analysis

A 3-wave model linking natural mentoring relationships to externalizing behavior was tested with 345 rural African American emerging adults in their final year of high school. Structural equation models were executed linking multi-informant reports of mentor-emerging adult relationship quality with youths' externalizing behavior 18 months later. Consistent with our primary hypotheses, emerging adults whose relationships with their natural mentors were characterized by instrumental and emotional support and affectively positive interactions reported lower levels of anger, rule-breaking behavior, and aggression. These effects emerged independent of the influences of family support and youth gender. Two intrapersonal processes, a future orientation and self-regulation, emerged as mediators of the influence of natural mentoring relationships. The influence of natural mentors was most pronounced for emerging adults experiencing high levels of life stress.

Risk and protective factors for unprotected intercourse among rural African American young adults

OBJECTIVES

Despite increasing risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), few data are available concerning the factors associated with risky sexual behavior among African American young adults who do not attend college. Additionally, the possibility that different risk mechanisms affect men and women remains understudied. This article reports on the risk and protective factors associated with unprotected intercourse and gender differences in these factors' influence among this group. Predictors were derived from ecological and self-regulatory theories of risk behavior.

METHODS

African Americans aged 18-21 years were recruited via respondent-driven sampling (RDS) from seven contiguous rural counties. Risk and protective factors for unprotected intercourse were analyzed for 214 of 292 participants who reported sexual intercourse during the past three months.

RESULTS

Among sexually active participants, 62.6% used condoms inconsistently. The influence of leaving the parental home, perceived discrimination, risk-taking peers, family relationships, risk-taking propensity, and binge drinking on unprotected intercourse were moderated by gender. Positive attitudes toward condom use were associated with less unprotected intercourse controlling for the influence of risk variables for both men and women.

CONCLUSIONS

Men and women have unique STI prevention needs. Additional research addressing these needs is necessary, particularly for rural African American men.