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Cummings C, Lansing AH, Hadley W, Houck CD. Intervention impact on the perceived emotion regulation repertoire of adolescents at-risk for risky sexual behaviors. Emotion 2023; 23:2105-2109. [PMID: 36595383 PMCID: PMC10314954 DOI: 10.1037/emo0001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recent calls have been made to evaluate the range, rather than the frequency of use, of strategies within adolescents' emotion regulation repertoire. It is unknown whether an emotion regulation intervention may increase adolescents' emotion regulation repertoire. To examine the direct effect of an emotion regulation intervention on adolescents' perceived emotion regulation repertoire from baseline to immediately postintervention, when controlling for baseline problems with emotional awareness and participant sex. Seventh-grade students (N = 420) participated in a 6-week emotion regulation and sexual health promotion randomized control trial. Adolescent-report measures of emotion regulation and problems with emotional awareness were collected. On average, adolescents used one additional strategy after completing the intervention; they endorsed using four (out of eight) strategies at baseline and five strategies immediately after the intervention. Emotion regulation interventions may expand adolescents' repertoire. Future research should explore whether such expansion may guide downstream effects on psychosocial functioning and prevent health risk behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Houck C, Modrowski CA, Hadley W, Barker D, Myers V, Bala K, Wickham B, Jerrod T. A Pilot Study of a Tablet-Based Emotion Regulation Intervention for Early Adolescents. J Dev Behav Pediatr 2022; 43:e505-e514. [PMID: 35943380 PMCID: PMC9560987 DOI: 10.1097/dbp.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study examined the feasibility, acceptability, and preliminary outcomes of internet-based Talking About Risk and Adolescent Choices (iTRAC), a tablet intervention designed to promote emotion regulation (ER) skills among middle schoolers as a strategy for reducing risk behaviors. METHODS Adolescents (12-14 years) were recruited from 3 urban US schools for advisory groups (n = 15), acceptability testing (n = 11), and pilot testing (n = 85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach ER strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and 1 parent completed baseline and 3-month follow-up questionnaires examining ER attitudes and behaviors; adolescents also completed behavioral tasks related to distress tolerance. RESULTS Among those randomized to iTRAC, 88% completed all modules. Moderate effect sizes ( d ≥ 0.36) were found from baseline to follow-up on adolescents' beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to ER strategies, and use of ER strategies. Parent measures of adolescent regulation showed mixed results. CONCLUSION A digital intervention to enhance ER skills for youth in early adolescence was feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents' awareness of and access to ER strategies could reduce decisions driven by transient emotions, which in turn may reduce engagement in risk behaviors and resultant negative health outcomes. This brief tablet-based intervention has the potential to be self-administered and used to increase emotional competency.
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Affiliation(s)
- Christopher Houck
- Department of Child and Adolescent Psychiatry, Bradley Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Crosby A Modrowski
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Wendy Hadley
- College of Education, University of Oregon, Eugene, OR
| | - David Barker
- Department of Child and Adolescent Psychiatry, Bradley Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | | | - Kelsey Bala
- Department of Child and Adolescent Psychiatry, Children's Research Center, Rhode Island Hospital, Providence, RI
| | - Brittany Wickham
- Department of Child and Adolescent Psychiatry, Bradley Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI
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Wright J, Sohlberg MM, McIntosh K, Seeley J, Hadley W, Blitz D, Lowham E. What is the effect of personalized cognitive strategy instruction on facilitating return-to-learn for individuals experiencing prolonged concussion symptoms? Neuropsychol Rehabil 2022:1-30. [PMID: 35543728 DOI: 10.1080/09602011.2022.2074467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the degree to which personalized cognitive strategy instruction (PCSI) assisted students with prolonged concussion symptoms (PCS) to achieve functional and academic-related goals. It was hypothesized that goal attainment on collaboratively developed functional goals and selected scores on the pre/post outcome measurements would improve following the delivery of PCSI. A non-concurrent multiple baseline design was utilized across three female participants ages 13-16. The weekly status tracking measurement of participant performance served as the primary measurement analysed to determine the existence of a functional relation between the addition of PCSI to psychoeducation and the achievement of participant outcome. Although visual analysis of the plotted status tracking data did not support the existence of a functional relation, all three participants met or exceeded functional goals on their goal attainment scales. A Tau-U analysis supported a small treatment effect. The positive response to the intervention from two of the three participants in addition to goal attainment for all three participants suggests PCSI has potential to mitigate cognitive challenges in adolescents with PCS. Implications for future research and methods to promote ecological measurement of intervention effects are discussed.
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Affiliation(s)
- Jim Wright
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
| | - McKay More Sohlberg
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
| | - Kent McIntosh
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - John Seeley
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - Wendy Hadley
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Devon Blitz
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
| | - Eli Lowham
- Department of Communication Disorders & Sciences, University of Oregon, Eugene, OR, USA
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Darling KE, Warnick J, Hadley W, Guthrie K, Jelalian E. Reactions to the U.S. Preventive Services Task Force guidelines for the management of adolescent obesity: A multi-informant qualitative approach. Clin Obes 2021; 11:e12451. [PMID: 33780999 PMCID: PMC10680043 DOI: 10.1111/cob.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/20/2021] [Accepted: 03/08/2021] [Indexed: 12/01/2022]
Abstract
The U.S. Preventive Services Task Force (USPSTF) has set forth recommendations for clinicians to screen youth (6-18 years) for obesity. Those identified should be referred to comprehensive weight management programs consisting of at least 26 contact hours and focus on multiple targets of behaviour (ie, diet, physical activity, behaviour change). However, these recommendations are primarily based upon outcomes from randomized controlled trials and the feasibility of meeting these guidelines for adolescents in a clinical setting is unknown. The present study employed a multi-informant qualitative approach with adolescents, parents, and physicians, to identify and understand multiple perspectives on the feasibility and acceptability of implementing the USPSTF guidelines. In-depth interviews with seven adolescents, seven parents, and four physicians were analysed. Generally, participants viewed the guidelines positively but identified changes that may be necessary to increase the feasibility of adolescents engaging in programs that meet these guidelines. Participants also noted the importance of flexibility within programs, indicating that it would be difficult for many adolescents to participate in a program that was not tailored to their needs and resources. Future research should focus on adapting clinical weight management programs to meet both USPSTF guidelines and the needs of adolescents and their families.
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Affiliation(s)
- Katherine E. Darling
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer Warnick
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Wendy Hadley
- Counseling and Human Services, College of Education, University of Oregon, Eugene, Oregon
| | - Kate Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Elissa Jelalian
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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Thomas JG, Goldstein CM, Bond DS, Hadley W, Tuerk PW. Web-based virtual reality to enhance behavioural skills training and weight loss in a commercial online weight management programme: The Experience Success randomized trial. Obes Sci Pract 2020; 6:587-595. [PMID: 33354337 PMCID: PMC7746971 DOI: 10.1002/osp4.451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/30/2020] [Accepted: 08/09/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Commercial online weight management programmes are popular and easily accessible but often lack training in empirically validated behaviour change strategies and produce suboptimal outcomes. This study evaluated the effects of a Web-based virtual reality (VR) programme for enhancing behavioural skills training and weight loss when offered as an adjunct to a commercial online weight management programme. METHODS N = 146 adults with overweight/obesity (body mass index [BMI] 27-40 kg/m2) were randomized to 6 months of no-cost access to the Weight Watchers (WW) online platform alone or enhanced with the Experience Success (WW + ES) programme, consisting of four Web-based VR sessions for training in behavioural weight-loss skills related to the home environment, the workplace, physical activity and social situations (i.e., a party at a friend's house). Weight was measured at the research centre at baseline, 3 and 6 months. RESULTS Both groups achieved statistically significant weight loss across the trial, with no difference in mean ± standard error (SE) weight loss between WW and WW + ES at 3 months (2.7 ± 1.1 kg vs. 4.2 ± 1.1 kg, respectively; P = .086) but greater weight loss in WW + ES at 6 months (2.6 ± 1.3 kg vs. 4.9 ± 1.3 kg, respectively; P = .042). CONCLUSIONS This study demonstrates the potential of Web-based VR skills training to enhance outcomes of commercial online weight management programmes that are widely accessible. Compared with traditional didactic methods for online skills training, VR simulation provides opportunities to learn behavioural skills via modelling and experiment with skills in real-world situations. More research is needed to identify specific behavioural mechanisms by which ES may improve outcomes.
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Affiliation(s)
- John Graham Thomas
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Carly M. Goldstein
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Dale S. Bond
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research CenterProvidenceRhode IslandUSA
| | - Wendy Hadley
- College of EducationUniversity of OregonEugeneOregonUSA
| | - Peter W. Tuerk
- Virtually Better, Inc.DecaturGeorgiaUSA
- Department of Human Services, Sheila C. Johnson Center for Clinical ServicesUniversity of VirginiaCharlottesvilleVirginiaUSA
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Darling KE, Ranzenhofer LM, Hadley W, Villalta D, Kasper V, Jelalian E. Negative childhood experiences and disordered eating in adolescents in a weight management program: The role of depressive symptoms. Eat Behav 2020; 38:101402. [PMID: 32485589 PMCID: PMC7534901 DOI: 10.1016/j.eatbeh.2020.101402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Stress negatively impacts adolescent weight status and eating behaviors. Previous research investigating this association has focused on traumatic events in childhood, but little is known about the impact of commonly experienced stressful life events and weight-related outcome. The aim of this cross-sectional study was to examine the association between negative life events and weight-related outcomes (i.e., weight status, disordered eating behaviors, insulin sensitivity) in a sample of treatment-seeking adolescents with overweight and obesity. A further aim of the study was to examine the potential mediating role of depression. METHOD Adolescents (N = 170; M age = 14.8; 62% female) presenting to an interdisciplinary weight management program completed measures related to negative life events, disordered eating patterns, and depressive symptoms prior to initiating treatment. Weight status and insulin sensitivity (using fasting glucose and fasting insulin) were objectively measured. RESULTS Stressful experiences during childhood were significantly related to weight status, F = 2.78, p < .05, and disordered eating, F = 5.51, p < .001, in regression analyses. Stressful life events were not related to insulin sensitivity. Depressive symptoms mediated the association between stressful experiences and disordered eating (b = 0.001, [CI = 0.0002, 0.0011]). Depressive symptoms did not mediate this association for weight status or insulin sensitivity. DISCUSSION Findings from the present study suggest that relatively common stressful events may be associated with development of disordered eating patterns in adolescents with overweight or obesity presenting to treatment. Providers working in weight management settings should consider assessing a range of potentially stressful life events and their potential weight-related implications.
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Affiliation(s)
- Katherine E. Darling
- Alpert Medical School of Brown University & Weight Control and Diabetes Research Center, The Miriam Hospital, United States of America,Corresponding author at: Weight Control & Diabetes Research Center, 196 Richmond Street, Providence, RI 02903, United States of America. (K.E. Darling)
| | - Lisa M. Ranzenhofer
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, United States of America
| | - Wendy Hadley
- Counseling and Human Services, College of Education, University of Oregon, United States of America
| | - Douglas Villalta
- Alpert Medical School of Brown University & Weight Control and Diabetes Research Center, The Miriam Hospital, United States of America
| | - Vania Kasper
- Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children’s Hospital, United States of America
| | - Elissa Jelalian
- Alpert Medical School of Brown University & Weight Control and Diabetes Research Center, The Miriam Hospital, United States of America
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Hadley W, Houck C, Brown LK, Spitalnick JS, Ferrer M, Barker D. Moving Beyond Role-Play: Evaluating the Use of Virtual Reality to Teach Emotion Regulation for the Prevention of Adolescent Risk Behavior Within a Randomized Pilot Trial. J Pediatr Psychol 2019; 44:425-435. [PMID: 30551157 PMCID: PMC6481385 DOI: 10.1093/jpepsy/jsy092] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of the current pilot study was to evaluate the acceptability and preliminary impact of using immersive virtual reality environments (IVREs) paired with a brief emotion regulation and risk reduction intervention (ER + IVRE) relative to this same intervention content paired with role-plays (ER + RP). METHODS Eighty-five adolescents attending middle school (grades 6th-8th; ages 12-15 years) in an urban northeast city were recruited and randomized to ER + IVRE (n = 44) or ER + RP (n = 41) and had complete data. Data examining acceptability, feasibility, sexual knowledge and attitudes, and ER were collected at baseline and 3 months after intervention completion. Analyses of covariance controlling for baseline scores were used to evaluate study outcomes. Within and between intervention effect sizes were calculated with effect sizes ≥.20 considered meaningful. RESULTS At the 3-month follow-up assessment, several within intervention condition effect sizes were found to exceed d = 0.20 across the measured sexual attitudes and ER outcomes. Between intervention analyses found that adolescents randomized to ER + IVRE attended more intervention sessions, reported less difficulty accessing ER strategies (d = 0.46), and reported higher emotional self-efficacy (d = 0.20) at the 3-month follow-up relative to adolescents randomized to the ER + RP intervention. CONCLUSIONS This study provides preliminary evidence that using virtual reality environments to enhance ER skill building in risk situations was acceptable, feasible to deliver, and positively impacted ER abilities.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University
| | - Christopher Houck
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University
| | - Larry K Brown
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University
| | | | | | - David Barker
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University
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8
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Barker DH, Hadley W, McGee H, Donenberg GR, DiClemente RJ, Brown LK. Evaluating the Role of Family Context Within a Randomized Adolescent HIV-Risk Prevention Trial. AIDS Behav 2019; 23:1195-1209. [PMID: 30701390 DOI: 10.1007/s10461-019-02400-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Project STYLE is a multi-site 3-arm RCT comparing family-based, adolescent-only, and general health promotion interventions with 721 adolescents in mental health treatment. This study reports 12-month outcomes for family context and sexual risk behaviors, and explores the role of baseline family context in modifying treatment response. Using the full sample, there were sustained benefits for parent-reported sexual communication (d = 0.28), and adolescent-reported parental monitoring (d = 0.24), with minimal differences in risk behaviors. Latent profile analysis identified four family context classes: struggling (n = 177), authoritative (n = 183), authoritarian (n = 175), and permissive (n = 181). The authoritarian and permissive classes were also distinguished by disagreement between parent and adolescent report of family context. Classes differed in terms of baseline mental health burden and baseline sexual risk behavior. Classes showed different patterns of treatment effects, with the struggling class showing consistent benefit for both family context and sexual risk. In contrast, the authoritarian class showed a mixed response for family context and increased sexual risk.
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Affiliation(s)
- David H Barker
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Wendy Hadley
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Heather McGee
- Office of Medical Education, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Geri R Donenberg
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Lansing AH, Guthrie KM, Hadley W, Stewart A, Peters A, Houck CD. Qualitative Assessment of Emotion Regulation Strategies for Prevention of Health Risk Behaviors in Early Adolescents. J Child Fam Stud 2019; 28:765-775. [PMID: 31680761 PMCID: PMC6824428 DOI: 10.1007/s10826-018-01305-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ability to regulate emotions has been linked to a variety of adolescent health risk behaviors, including sexual risk behaviors, especially for adolescents who are experiencing mental health symptoms. However, there is limited information available on intuitive emotion regulation strategies for early adolescents with mental health symptoms to facilitate the adaptation of emotion regulation interventions for psychopathology to health risk behavior prevention. For example, interventions to prevent sexual risk behaviors in early adolescence have yet to specifically target emotion regulation. This paper describes the use of focus groups to identify emotion regulation strategies that were understood by and acceptable to early adolescents with mental health symptoms who are also more likely to engage in risky health behaviors. Qualitative data were collected through focus groups (k=5 groups) with 15 early adolescents with mental health symptoms. The most commonly generated emotion regulation strategies were leaving the situation, distraction, physical release, expressing oneself to someone, positive thinking, and considering other options. Translation of these findings for use in preventive health-risk behavior interventions (including for sexual risk) is discussed.
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Affiliation(s)
- Amy Hughes Lansing
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University & The Miriam Hospital, Providence, RI, USA
| | - Wendy Hadley
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - April Peters
- Bradley/Hasbro Children's Research Center, Providence, RI, USA
| | - Christopher D Houck
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Houck CD, Barker DH, Hadley W, Menefee M, Brown LK. Sexual Risk Outcomes of an Emotion Regulation Intervention for At-Risk Early Adolescents. Pediatrics 2018; 141:peds.2017-2525. [PMID: 29748192 PMCID: PMC6317536 DOI: 10.1542/peds.2017-2525] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE With this study, we examined the efficacy of a health intervention program that was focused on emotion regulation (ER) skills in reducing sexual risk behaviors among early adolescents with suspected mental health symptoms. METHODS Seventh grade adolescents with suspected mental health symptoms participated in a 6-week, after-school sexual risk prevention trial in which a counterbalanced, within-school design comparing an ER focused program to a time- and attention-matched comparison group was used. Adolescents completed a computer-based survey regarding their sexual behavior at 6-month intervals for 2.5 years. RESULTS Adolescents who received ER skills training exhibited a delay in the transition to vaginal sex over 30 months compared with those in the comparison condition (adjusted hazard ratio = 0.61; 95% confidence interval [0.42 to 0.89]). They also reported fewer instances of condomless sex over the follow-up period (adjusted rate ratio = 0.36; 95% confidence interval [0.14 to 0.90]). Among those who were sexually active, those in the ER condition reported fewer instances of vaginal or anal sex (adjusted rate ratio = 0.57; 95% confidence interval [0.32 to 0.99]). CONCLUSIONS An intervention used to teach ER skills for the context of health decision-making resulted in lower risk among young adolescents with suspected mental health symptoms by delaying the onset of vaginal sex as well as reducing penetrative acts without a condom. Incorporating emotion education into health education may have important health implications for this age group.
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Affiliation(s)
- Christopher D. Houck
- Bradley Hasbro Children’s Research Center and Rhode Island Hospital, Providence, Rhode Island; and,Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - David H. Barker
- Bradley Hasbro Children’s Research Center and Rhode Island Hospital, Providence, Rhode Island; and,Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Wendy Hadley
- Bradley Hasbro Children’s Research Center and Rhode Island Hospital, Providence, Rhode Island; and,Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Maya Menefee
- Bradley Hasbro Children’s Research Center and Rhode Island Hospital, Providence, Rhode Island; and
| | - Larry K. Brown
- Bradley Hasbro Children’s Research Center and Rhode Island Hospital, Providence, Rhode Island; and,Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Hadley W, Lansing A, Barker DH, Brown LK, Hunter H, Donenberg G, DiClemente RJ. The longitudinal impact of a family-based communication intervention on observational and self-reports of sexual communication. J Child Fam Stud 2018; 27:1098-1109. [PMID: 29910594 PMCID: PMC5999025 DOI: 10.1007/s10826-017-0949-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parents can play a vital role in shaping teenagers' sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent-adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent adolescent sexual communication was examined at 12-months among adolescents with mental health problems. Of the 721 parent- adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent-adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent Body-Language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 hours of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12-months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent-adolescent sexual communication among a mental health sample.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
| | - Amy Lansing
- Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - David H Barker
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
| | - Larry K Brown
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
| | - Heather Hunter
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, One Hoppin Street, Suite 204, Providence, RI 02903
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Esposito-Smythers C, Hadley W, Curby TW, Brown LK. Randomized pilot trial of a cognitive-behavioral alcohol, self-harm, and HIV prevention program for teens in mental health treatment. Behav Res Ther 2016; 89:49-56. [PMID: 27883927 DOI: 10.1016/j.brat.2016.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/18/2016] [Accepted: 11/11/2016] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
| | - Wendy Hadley
- Rhode Island Hospital & Alpert Medical School of Brown University, Bradley/Hasbro Children's Research Center, One Hoppin Street, Suite 204, Providence, RI, 02903, USA
| | - Timothy W Curby
- George Mason University, Department of Psychology, MSN 35F, Fairfax, VA, USA
| | - Larry K Brown
- Rhode Island Hospital & Alpert Medical School of Brown University, Bradley/Hasbro Children's Research Center, One Hoppin Street, Suite 204, Providence, RI, 02903, USA
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Abstract
This study aimed to evaluate an intervention designed to enhance early adolescents' emotion regulation skill use and to decrease risk behaviors. Adolescents 12 to 14 years old (N = 420; 53 % male) with mental health symptoms were referred for participation in either an Emotion Regulation (ER) or Health Promotion (HP) intervention consisting of 12 after-school sessions. Participants completed baseline and follow-up questionnaires on laptop computers. Using a generalized analysis of covariance controlling for baseline scores, participants in the ER intervention were less likely to be sexually active and engage in other risk behaviors, such as fighting, at the conclusion of the program. Additionally, participants in the ER intervention reported greater use of emotion regulation strategies and more favorable attitudes toward abstinence. Interventions directly targeting emotion regulation may be useful in addressing health risk behaviors of adolescents with mental health symptoms.
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Affiliation(s)
- Christopher D Houck
- Bradley Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Bradley/Hasbro Children's Research Center, One Hoppin Street, Suite 204, Providence, RI, 02903, USA.
| | - Wendy Hadley
- Bradley Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David Barker
- Bradley Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Larry K Brown
- Bradley Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Evan Hancock
- Bradley Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI, USA
| | - Brandon Almy
- Bradley Hasbro Children's Research Center, Rhode Island Hospital, Providence, RI, USA
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14
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Hadley W, Brown LK, Barker D, Warren J, Weddington P, Fortune T, Juzang I. Work It Out Together: Preliminary Efficacy of a Parent and Adolescent DVD and Workbook Intervention on Adolescent Sexual and Substance Use Attitudes and Parenting Behaviors. AIDS Behav 2016; 20:1961-72. [PMID: 27155880 PMCID: PMC5003055 DOI: 10.1007/s10461-016-1418-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of the current study was to test an interactive DVD and workbook specifically designed for African-American parents and adolescents (ages 13-18), based on an efficacious face-to-face intervention, to address key factors associated with risk. A total of 170 parent-adolescent dyads were enrolled and randomly assigned to receive either the "Work It Out Together" DVD or a General Health Promotion DVD (HP). Parents and adolescents completed measures of HIV knowledge, self-efficacy, and parenting behaviors. Immediately after receiving the Work It Out Together intervention, parents and adolescents demonstrated higher HIV knowledge and greater HIV prevention self-efficacy. Three months after receiving the Work It Out Together intervention, parents and adolescents reported higher levels of parental monitoring and sexually active adolescents reported higher levels of condom use self-efficacy and a lower rate of recent sex. These outcomes provide preliminary evidence that the "Work It Out Together" DVD impacted individual attitudes and protective parenting behaviors.
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Affiliation(s)
- Wendy Hadley
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center (BHCRC), Rhode Island Hospital and Brown Medical School, One Hoppin Street, Suite 204, Providence, RI, 02903, USA.
| | - L K Brown
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center (BHCRC), Rhode Island Hospital and Brown Medical School, One Hoppin Street, Suite 204, Providence, RI, 02903, USA
| | - D Barker
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center (BHCRC), Rhode Island Hospital and Brown Medical School, One Hoppin Street, Suite 204, Providence, RI, 02903, USA
| | - J Warren
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center (BHCRC), Rhode Island Hospital and Brown Medical School, One Hoppin Street, Suite 204, Providence, RI, 02903, USA
| | | | - T Fortune
- MEE Productions, Inc., Philadelphia, PA, USA
| | - I Juzang
- MEE Productions, Inc., Philadelphia, PA, USA
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15
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Houck CD, Barker DH, Hadley W, Brown LK, Lansing A, Almy B, Hancock E. The 1-year impact of an emotion regulation intervention on early adolescent health risk behaviors. Health Psychol 2016; 35:1036-45. [PMID: 27175579 DOI: 10.1037/hea0000360] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Sexual activity often begins in early adolescence, and adolescents with mental health symptoms are at greater risk for sexual activity and other health risks. This study aimed to evaluate a developmentally targeted intervention designed to enhance early adolescents' emotion regulation competencies as a strategy for reducing health risk behaviors, including sexual initiation. METHOD Adolescents 12 to 14 years old (N = 420; 53% male) with mental health symptoms participated in either an emotion regulation (ER) or health promotion (HP) intervention consisting of 12 after-school sessions. Participants completed questionnaires on laptop computers at baseline, 2-, 6-, and 12-month follow-ups. RESULTS Time to event analyses were used to compare intervention conditions on rate of initiation to vaginal sex. Results showed that participants in the ER condition were less likely to transition into vaginal sexual activity by 1-year follow-up than were those in the HP condition (adjusted hazard ratio = 0.58, 95% confidence interval [0.36, 0.94], p = .01). However, those who were sexually active did not report differences in sexual risk behaviors (e.g., condomless sex). Participants in the ER condition were significantly less likely to report violence behaviors and showed improvement on a behavioral measure of emotion identification; however, they did not differ from HP participants on self-reports of emotional competence. CONCLUSIONS Emotion regulation strategies can be used to delay sexual initiation among early adolescents with mental health symptoms and may have an important role in health education. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Amy Lansing
- Department of Psychiatry, Geisel School of Medicine
| | - Brandon Almy
- Institute of Child Development, University of Minnesota
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16
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Yurasek AM, Hadley W. Commentary: Adolescent Marijuana Use and Mental Health Amidst a Changing Legal Climate. J Pediatr Psychol 2016; 41:287-9. [PMID: 26883502 DOI: 10.1093/jpepsy/jsw005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The purpose of this commentary was to briefly summarize the literature on the relationship between adolescent marijuana use and mental health and how policy changes surrounding marijuana decriminalization and legalization might impact this relationship. METHODS A comprehensive literature search on adolescent marijuana use, mental health, and the impact of decriminalization and legalization was conducted. Findings are briefly summarized and discussed. RESULTS Although there is a great deal of ambiguity regarding the causal direction of marijuana use and mental health problems, what can safely be gleaned from this body of research is that early and frequent use of marijuana during adolescence is associated with the development of more psychiatric-related problems than occasional use or nonuse. CONCLUSIONS Until there is greater clarity in this domain, clinicians should continue to screen adolescent patients for marijuana use as well as mental health difficulties, but may need to be more thoughtful about screening among early adolescents, if in fact a shift in the age of marijuana uptake occurs amidst policy changes.
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Affiliation(s)
- Ali M Yurasek
- School of Public Health, Center for Alcohol and Addiction Studies, Brown University,
| | - Wendy Hadley
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital, and The Alpert Medical School of Brown University
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17
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Thomas JG, Spitalnick JS, Hadley W, Bond DS, Wing RR. Development of and feedback on a fully automated virtual reality system for online training in weight management skills. J Diabetes Sci Technol 2015; 9:145-8. [PMID: 25367014 PMCID: PMC4495525 DOI: 10.1177/1932296814557326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Virtual reality (VR) technology can provide a safe environment for observing, learning, and practicing use of behavioral weight management skills, which could be particularly useful in enhancing minimal contact online weight management programs. The Experience Success (ES) project developed a system for creating and deploying VR scenarios for online weight management skills training. Virtual environments populated with virtual actors allow users to experiment with implementing behavioral skills via a PC-based point and click interface. A culturally sensitive virtual coach guides the experience, including planning for real-world skill use. Thirty-seven overweight/obese women provided feedback on a test scenario focused on social eating situations. They reported that the scenario gave them greater skills, confidence, and commitment for controlling eating in social situations.
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Affiliation(s)
- J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI, USA
| | | | - Wendy Hadley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA Bradley/Hasbro Children's Research Center/Rhode Island Hospital, Providence, RI, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI, USA
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18
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Creech SK, Hadley W, Borsari B. The Impact of Military Deployment and Reintegration on Children and Parenting: A Systematic Review. ACTA ACUST UNITED AC 2014; 45:452-464. [PMID: 25844014 DOI: 10.1037/a0035055] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom; OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their children. This systematic review examines findings from 3 areas of relevant research: the impact of deployment separation on parenting, and children's emotional, behavioral, and health outcomes; the impact of parental mental health symptoms during and after reintegration; and current treatment approaches in veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent may be related to increased emotional and behavioral difficulties for children, including higher rates of health-care visits for psychological problems during deployment. Second, symptoms of PTSD and depression may be related to increased symptomatology in children and problems with parenting during and well after reintegration. Third, although several treatments have been developed to address the needs of military families, most are untested or in the early stages of implementation and evaluation. This body of research suggests several promising avenues for future research.
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Affiliation(s)
- Suzannah K Creech
- Providence VA Medical Center, Providence, Rhode Island and Brown University
| | - Wendy Hadley
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island and Brown University
| | - Brian Borsari
- Providence VA Medical Center, Providence Rhode Island and Brown University
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19
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Joppa MC, Rizzo CJ, Brown LK, Hadley W, Dattadeen JA, Donenberg G, DiClemente R. Internalizing Symptoms and Safe Sex Intentions among Adolescents in Mental Health Treatment: Personal Factors as Mediators. Child Youth Serv Rev 2014; 46:177-185. [PMID: 25284921 PMCID: PMC4180408 DOI: 10.1016/j.childyouth.2014.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.
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Affiliation(s)
- Meredith C. Joppa
- Department of Psychology, Rowan University. 201 Mullica Hill Road, Glassboro, NJ 08028
| | - Christie J. Rizzo
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Larry K. Brown
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Wendy Hadley
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Jodi-Ann Dattadeen
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Geri Donenberg
- Department of Psychiatry, University of Illinois at Chicago. Institute for Juvenile Research, Chicago, IL
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20
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Jelalian E, Hadley W, Sato A, Kuhl E, Rancourt D, Oster D, Lloyd-Richardson E. Adolescent weight control: an intervention targeting parent communication and modeling compared with minimal parental involvement. J Pediatr Psychol 2014; 40:203-13. [PMID: 25294840 DOI: 10.1093/jpepsy/jsu082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Adolescent weight control interventions demonstrate variable findings, with inconsistent data regarding the appropriate role for parents. The current study examined the efficacy of a standard adolescent behavioral weight control (BWC) intervention that also targeted parent-adolescent communication and parental modeling of healthy behaviors (Standard Behavioral Treatment + Enhanced Parenting; SBT + EP) compared with a standard BWC intervention (SBT). METHODS 49 obese adolescents (M age = 15.10; SD = 1.33; 76% female; 67.3% non-Hispanic White) and a caregiver were randomly assigned to SBT or SBT + EP. Adolescent and caregiver weight and height, parental modeling, and weight-related communication were obtained at baseline and end of the 16-week intervention. RESULTS Significant decreases in adolescent weight and increases in parental self-monitoring were observed across both conditions. Analyses of covariance revealed a trend for greater reduction in weight and negative maternal commentary among SBT condition participants. CONCLUSIONS Contrary to hypotheses, targeting parent-adolescent communication and parental modeling did not lead to better outcomes in adolescent weight control.
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Affiliation(s)
- Elissa Jelalian
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Wendy Hadley
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Amy Sato
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Elizabeth Kuhl
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Diana Rancourt
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Danielle Oster
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Elizabeth Lloyd-Richardson
- Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Bradley Hasbro Children's Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Department of Psychology, Kent State University, Department of Psychology, University of Massachusetts at Dartmouth, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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Hadley W, McCullough MB, Rancourt D, Barker D, Jelalian E. Shaking up the system: the role of change in maternal-adolescent communication quality and adolescent weight loss. J Pediatr Psychol 2014; 40:121-31. [PMID: 25214645 DOI: 10.1093/jpepsy/jsu073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The association between directly observed mother-adolescent weight-related communication quality and adolescent percent overweight within the context of an adolescent weight control study was examined. METHODS As part of a larger study examining the impact of a behavioral weight control intervention that included attention to parent-adolescent communication (Standard Behavioral Treatment + Enhanced Parenting, SBT + EP) compared with an efficacious Standard Behavioral Treatment (SBT), 38 mother-adolescent dyads participated in a weight-related videotaped discussion. Discussions were taped and collected pre- and postintervention. RESULTS No significant differences emerged in the quality of mother-adolescent communication between SBT (n = 19) and SBT + EP (n = 19) participants, nor was baseline mother-adolescent communication quality associated with adolescents' weight loss in either condition. However, a decline in communication quality was associated with better outcomes for adolescents participating in the SBT group. CONCLUSIONS This study provides preliminary evidence that a change in mother-adolescent communication is associated with successful weight loss among adolescents.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - Mary Beth McCullough
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - Diana Rancourt
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - David Barker
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
| | - Elissa Jelalian
- Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University Bradley/Hasbro Children's Research Center, Rhode Island Hospital and The Warren Alpert Medical School of Brown University
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22
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Hadley W, Barker DH, Lescano CM, Stewart AJ, Affleck K, Donenberg G, DiClemente R, Brown LK. Associations Between Psychiatric Impairment and Sexual Risk Behavior Among Teens in Mental Health Treatment. J HIV AIDS Soc Serv 2014; 13:198-213. [PMID: 26023302 PMCID: PMC4443474 DOI: 10.1080/15381501.2013.789416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | - David H. Barker
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Angela J. Stewart
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | - Katelyn Affleck
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | - Larry K. Brown
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
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Brown LK, Hadley W, Donenberg GR, DiClemente RJ, Lescano C, Lang DM, Crosby R, Barker D, Oster D. Project STYLE: a multisite RCT for HIV prevention among youths in mental health treatment. Psychiatr Serv 2014; 65:338-44. [PMID: 24382603 PMCID: PMC9215702 DOI: 10.1176/appi.ps.201300095] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the efficacy of family-based and adolescent-only HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment. METHODS A randomized controlled trial (RCT) with 721 adolescents (ages 13-18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention. RESULTS Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (p<.01) and self-efficacy (p<.05). The family-based intervention, compared with the other interventions, produced significant improvements in parent-teen sexual communication (p<.01), parental monitoring (p<.01), and parental permissiveness (p=.05). CONCLUSIONS This RCT found that the HIV prevention interventions reduced sexual risk behavior over three months in a large, diverse sample of youths in mental health treatment and that the family-based intervention improved parental monitoring and communication with teens about sex. These interventions show promise.
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Hadley W, Houck CD, Barker DH, Garcia AM, Spitalnick JS, Curtis V, Roye S, Brown LK. Eliciting affect via immersive virtual reality: a tool for adolescent risk reduction. J Pediatr Psychol 2013; 39:358-68. [PMID: 24365699 DOI: 10.1093/jpepsy/jst092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. METHODS 42 adolescents (55% male) with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. RESULTS The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. CONCLUSIONS This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues.
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Affiliation(s)
- Wendy Hadley
- PhD, Bradley/Hasbro Children's Research Center, One Hoppin Street, Suite 204, Providence, RI 02903, USA.
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Hadley W, Stewart A, Hunter HL, Affleck K, Donenberg G, DiClemente R, Brown LK. Reliability and Validity of the Dyadic Observed Communication Scale (DOCS). J Child Fam Stud 2013; 22:279-287. [PMID: 23645977 PMCID: PMC3639442 DOI: 10.1007/s10826-012-9577-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | - Angela Stewart
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | - Heather L. Hunter
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | - Katelyn Affleck
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | | | | | - Larry K. Brown
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
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Seth P, Lang DL, Diclemente RJ, Braxton ND, Crosby RA, Brown LK, Hadley W, Donenberg GR. Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment. Sex Health 2012; 9:240-6. [PMID: 22697141 DOI: 10.1071/sh10098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 07/19/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. METHODS Three hundred and seventy nine sexually active adolescents, aged 13-18 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. RESULTS After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR)=3.2, P=0.0001), obtain their HIV test results (AOR=2.9, P=0.03), refuse sex out of fear for STI acquisition (AOR=1.7, P=0.04), or avoid a situation that might lead to sex (AOR=2.4, P=0.001), and were less likely to have a casual sex partner (AOR=0.40, P=0.002). Additionally, females were more likely to report inconsistent condom use (AOR=2.60, P=0.001) and have a STI (AOR=9.1, P=0.0001) than their male counterparts. CONCLUSIONS Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.
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Affiliation(s)
- Puja Seth
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA 30322, USA.
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27
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Affiliation(s)
- Christopher D Houck
- Bradley/Hasbro Children's Research Center, One Hoppin Street, Suite 204, Providence, RI 02903, USA.
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Tolou-Shams M, Hadley W, Conrad SM, Brown LK. The Role of Family Affect in Juvenile Drug Court Offenders' Substance Use and HIV Risk. J Child Fam Stud 2012; 21:449-456. [PMID: 22661883 PMCID: PMC3361893 DOI: 10.1007/s10826-011-9498-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Family-based interventions targeting parenting factors, such as parental monitoring and parent-child communication, have been successful in reducing adolescent offenders' substance use and delinquency. This pilot, exploratory study focuses on family and parenting factors that may be relevant in reducing juvenile offenders' substance use and sexual risk taking behavior, and in particular examines the role of family emotional involvement and responsiveness in young offenders' risk-taking behaviors. Participants included 53 juvenile drug court offenders and their parents. Results indicate that poor parent-child communication is associated with marijuana use and unprotected sexual activity for young offenders; however, family affective responsiveness is also a significant unique predictor of unprotected sexual activity for these youth. Findings suggest that interventions focused on improving parent-child communication may reduce both marijuana use and risky sexual behavior among court-involved youth, but a specific intervention focused on improving parents and young offenders' ability to connect with and respond to one another emotionally may provide a novel means of reducing unprotected sexual risk behaviors.
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Affiliation(s)
- Marina Tolou-Shams
- Bradley Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, One Hoppin Street, Coro West, Suite 204, Providence, RI 02903, USA
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Stewart AJ, Theodore-Oklota C, Hadley W, Brown LK, Donenberg G, DiClemente R. Mania symptoms and HIV-risk behavior among adolescents in mental health treatment. J Clin Child Adolesc Psychol 2012; 41:803-10. [PMID: 22540428 DOI: 10.1080/15374416.2012.675569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, M age = 14.9 years) who received mental health treatment completed private, computer-based assessments of psychiatric disorders and of sexual and substance use behaviors and provided urine to screen for sexually transmitted infections (STI). Eighty-seven percent met criteria for a psychiatric disorder, and among these youth 21% were considered ESM+. Compared to those with other psychiatric disorders, ESM+ were more likely to be sexually active (61.6% vs. 53.6%), have multiple sexual partners (58.6% vs. 37.5%), have unprotected sex (38.4% vs. 28.0%), exchange sex for money (4.7% vs. 1.2%), and test positive for an STI (14.0% vs. 6.3%). Among ESM+ youth, sexual risk behaviors were primarily associated with individual factors (e.g., self-efficacy, impulsivity, and substance use) and varied depending on the type of sexual behavior (e.g., onset of sex, number of partners, and condom use). Adolescents with ESM should be regularly screened for sexual risk behaviors and receive HIV prevention skills. Efforts to increase self-efficacy for safer sex, reduce impulsivity, and decrease substance use may be effective targets for sexual risk reduction among adolescents with ESM.
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Hadley W, Hunter HL, Tolou-Shams M, Lescano C, Thompson A, Donenberg G, DiClemente R, Brown LK. Monitoring challenges: a closer look at parental monitoring, maternal psychopathology, and adolescent sexual risk. J Fam Psychol 2011; 25:319-23. [PMID: 21417519 PMCID: PMC3466599 DOI: 10.1037/a0023109] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital, One Hoppin Street, Suite 204, Providence, RI 02903, USA.
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Brown LK, Hadley W, Stewart A, Lescano C, Whiteley L, Donenberg G, DiClemente R. Psychiatric disorders and sexual risk among adolescents in mental health treatment. J Consult Clin Psychol 2010; 78:590-7. [PMID: 20658815 DOI: 10.1037/a0019632] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. METHOD Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). RESULTS Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. CONCLUSIONS The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment.
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Affiliation(s)
- Larry K Brown
- Bradley/Hasbro Children's Research Center, One Hoppin Street, Providence, RI 02903, USA.
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Grossman C, Hadley W, Brown LK, Houck CD, Peters A, Tolou-Shams M. Adolescent sexual risk: factors predicting condom use across the stages of change. AIDS Behav 2008; 12:913-22. [PMID: 18427971 DOI: 10.1007/s10461-008-9396-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 04/01/2008] [Indexed: 11/30/2022]
Abstract
This study examined factors associated with high-risk adolescents' movement toward or away from adopting consistent condom use behavior using the Transtheoretical Model Stages of Change. Participants drawn from the inactive comparison condition of a randomized HIV prevention trial (Project SHIELD) responded to items assessing pros and cons of condom use, peer norms, condom communication, and perceived invulnerability to HIV. Participants were categorized based on their condom use behavior using the Transtheoretical Model. Multiple logistic regressions found that progression to consistent condom use was predicted by continuing to perceive more advantages to condom use, reporting greater condom use communication with partners, and less perceived invulnerability to HIV. Movement away from adopting consistent condom use was predicted by a decrease in perceived advantages to condom use, increased perceived condom disadvantages, and fewer condom discussions. Future interventions may be tailored to enhance these factors that were found to change over time.
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Affiliation(s)
- Cynthia Grossman
- National Institute of Mental Health, 6001 Executive Blvd., Bethesda, MD 20892, USA.
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Abstract
The objective of this study was to examine the relationship between a history of suicide attempt and a range of current sexual risk behaviors in a large sample of sexually high-risk adolescents. Baseline data from 1,245 sexually active 15 to 21 year olds were collected as part of a multi-site, randomized trial of a brief HIV prevention program. Measures were collected using audio computer assisted self-interviews. Accounting for demographic, contextual, and substance use variables, a lifetime history of suicide attempt significantly added to multivariate regression models predicting sexual risk. Inconsistent condom users were almost twice as likely to have attempted suicide, and adolescents with an STI diagnosis were approximately twice as likely to have a history of suicide attempt. A history of suicidal behavior can be identified by clinicians and appears to be an important marker for sexual risk, which may represent an expression of emotional distress or a passive form of self-injury for suicidal adolescents.
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Affiliation(s)
- Christopher D Houck
- Bradley/Hasbro Children's Research Center and Brown Medical School, Providence, RI 02903, USA.
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Ey S, Hadley W, Allen DN, Palmer S, Klosky J, Deptula D, Thomas J, Cohen R. A new measure of children's optimism and pessimism: the youth life orientation test. J Child Psychol Psychiatry 2005; 46:548-58. [PMID: 15845134 DOI: 10.1111/j.1469-7610.2004.00372.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Optimism and pessimism are positive and negative expectations linked with well-being in adults. Research on the importance of optimism and pessimism in children is limited by the lack of a developmentally appropriate measure of children's expectations. METHOD Based upon the Life Orientation Test-Revised (Scheier, Carver, & Bridges, 1994), the Youth Life Orientation Test (YLOT) is a sixteen-item self-report measure of children's optimism and pessimism. RESULTS Reliability and validity of the YLOT was found with 204 3rd-6th graders. Optimism also predicted fewer child-reported depressive symptoms and parent-reported behavior problems assessed three months later. Pessimism predicted more child-reported anxiety symptoms and parent-reported social and academic deficits.
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Affiliation(s)
- Sydney Ey
- Pacific University, Portland, OR 97205-2732, USA.
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Tyc VL, Hadley W, Allen D, Varnell S, Ey S, Rai SN, Lensing S. Predictors of smoking intentions and smoking status among nonsmoking and smoking adolescents. Addict Behav 2004; 29:1143-7. [PMID: 15236815 DOI: 10.1016/j.addbeh.2004.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine predictors of smoking intentions among current adolescent nonsmokers and smokers as well as risk factors associated with smoking status. METHODS Adolescents (N=237), ages 12 through 18 years, were asked to complete a questionnaire that assessed smoking behavior and variables thought to be related to smoking. Cognitive-motivational variables including perceived vulnerability and optimism, not previously examined in adolescent smoking studies, were also included. RESULTS Parental smoking, higher perceived instrumental value, higher risk taking/rebelliousness, higher perceived vulnerability, and older age increased the odds of an adolescent being a smoker. Greater intentions to smoke among nonsmokers was best predicted by peer influences, less knowledge, and higher perceived instrumental value. Smokers with lower intentions to quit perceived greater instrumental value of smoking. CONCLUSIONS There are important distinctions between the factors that prompt intentions to smoke and to quit smoking. Smoking prevention/cessation programs will need to address specific factors that distinguish adolescents at varying stages of risk.
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Affiliation(s)
- Vida L Tyc
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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Abstract
BACKGROUND It is important to understand the factors that motivate survivors of childhood cancer to engage in healthy behaviors. This is because of their susceptibility to adverse late effects from their malignancy and its treatment. We specifically examined sociodemographic and health perception variables as predictors of health-protective behaviors in pediatric cancer survivors. PROCEDURE Forty-six patients, ages 10--18 years, who were previously treated for cancer and were 1--4 years off-therapy, were assessed using a battery of testing instruments. RESULTS Preadolescent and adolescent cancer survivors reported moderately frequent practice of a variety of health-protective behaviors. The prevalence of risky health behaviors, as indicated by alcohol and tobacco use, was low. Regression analyses indicated that the practice of health-protective behaviors was best predicted by patient's age and socioeconomic status (SES); younger adolescents and patients from higher SES more frequently engaged in healthy behaviors. Health perception variables were not significantly related to health-protective behaviors. This was true despite findings that survivors perceived themselves to be vulnerable to health problems, identified a need to protect their health, and perceived their health outcomes to be largely determined by their own behaviors. CONCLUSIONS Sociodemographic factors should be kept in mind when designing interventions to promote continuing good health for young cancer survivors. Also to be included is the assessment of specific health risks secondary to the cancer therapies given. Risk counseling that recognizes and builds on these variables will be most effective in helping this patient population observe sound health habits.
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Affiliation(s)
- V L Tyc
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
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Abstract
OBJECTIVE To examine the relationship between knowledge of tobacco-related health risks, perceptions of vulnerability to these health risks, and future intentions to use tobacco in a sample of adolescent survivors of cancer. METHODS Written self-report questionnaires were administered to 46 survivors, 10-18 years of age (61% males, 93.5% Caucasian). RESULTS Overall, survivors were generally knowledgeable about tobacco-related health risks, perceived themselves to be vulnerable to these health risks, and reported low future intentions to use tobacco. Regression analyses indicated that demographic factors, treatment-related variables, knowledge, and perceived vulnerability explained 28% of the variance in intentions scores, F:(6, 39) = 2.52, p <.05. Age and knowledge were significant predictors, indicating that older adolescent survivors and those with lower knowledge scores reported greater intentions to use tobacco. CONCLUSIONS Young survivors will benefit from risk counseling interventions that educate them about their susceptibility to specific tobacco-related health risks secondary to their cancer treatment. Intensive tobacco prevention programs that target older adolescents should be developed.
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Affiliation(s)
- V L Tyc
- Division of Behavioral Medicine, St. Jude Children's Research Hospital, Memphi, Tennessee 38105-2794, USA.
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Abstract
This study examined gender and racial differences in adolescents' risk perceptions of major diseases and motor vehicle injury and whether these perceptions agree with national mortality rates and parental health history. Adolescent (N = 135; 55% African-American) boys and girls reported on their chances compared to other adolescents of developing specific diseases or experiencing a motor vehicle injury and their knowledge of parental health history. Logistic regression models revealed that girls' risk perceptions were similar to boys' ratings even though females are at less risk than males per national figures. Caucasian adolescents inaccurately perceived that they were at significantly greater risk than African-American peers for motor vehicle injury, stroke, cancer, and heart attack. Adolescents' knowledge of a father's diabetes was predictive of greater perceived vulnerability to diabetes.
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Affiliation(s)
- S Ey
- Department of Psychology, University of Memphis, Tennessee 38152, USA
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Hadley W, Koeslag JH, Lochner JD. Ethanol ingestion and the development of post-exercise ketosis in non-alcoholic human subjects. Q J Exp Physiol 1988; 73:79-85. [PMID: 3279448 DOI: 10.1113/expphysiol.1988.sp003125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Alcoholic ketosis occurs in alcoholics, who have been shown also to be more predisposed than normal to post-exercise ketosis (Chalmers, Sulaiman & Johnson, 1977). We therefore studied post-exercise ketosis in ten normal people who drank 1.6 mol ethanol at 18.00-21.00 h, and then did a 12 km walk at 07.00 h the next morning. (The timing of the alcohol ingestion was prompted by the finding that alcoholic ketosis usually develops after the blood ethanol concentrations have fallen to zero.) Ten subjects who had not drunk alcohol for 60 h, acted as controls. All subjects were observed till 16.00 h. The blood 3-hydroxybutyrate level rose from 0.034 +/- 0.006 to 0.336 +/- 0.073 mmol/l (P less than 0.001) during the 9 h observation period in the controls, and from 0.038 +/- 0.009 to 0.352 +/- 0.127 mmol/l (P less than 0.001) in the test subjects. The differences between the two groups are not significant. Plasma free fatty acid concentrations, and insulin/glucagon ratios of the two exercise groups did not differ significantly from each other, or from those of a sedentary group (n = 16). Acute ethanol ingestion (1.6 mol/person) therefore does not predispose normal, non-alcoholic subjects to ketosis, even when ketogenesis is further stimulated by exercise.
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Affiliation(s)
- W Hadley
- Sport Science Centre, University of Cape Town Medical School, Observatory, South Africa
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Abstract
Twenty-eight cases of alpha cell tumors of the pancreatic islets have been reported. The clinical features include typical skin rash (termed migratory necrolytic erythema) and stomatitis with anemia, abnormal glucose tolerance, and weight loss. The time course of the disease is variable but the clinical syndrome may be present for up to 15 years (median five years) before discovery of the tumor. In 3 patients, cure was achieved by surgical resection, and in 17 patients in whom metastatic sites were evaluable, 16 involved the liver. Six patients have received chemotherapy: 4 with streptozotocin (STZ); 1 with dimethyl triazeno imidazole carboxamide (DTIC); and 2 with 5-fluorouracil. All 4 patients receiving STZ responded to therapy with objective regression of the tumor and in 3 the dermatitis syndrome receded as well. The selectivity of the STZ for beta cells observed in animals is contrasted with the specific antitumor activity of STZ for alpha as well as beta and delta cell tumors in man.
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