Journal of Adolescent Health - Articles in Press

Peer Passengers: How Do They Affect Teen Crashes? - Corrected Proof

2012-01-24

Abstract: Purpose: The specific mechanisms by which peer passengers increase teen drivers' crash risk are not completely understood. We aimed to provide insight on the two primary hypothesized mechanisms, distraction and promotion of risk-taking behavior, for male and female teen drivers and further for select driver–passenger gender combinations. Methods: From the National Motor Vehicle Crash Causation Survey (2005–2007), we analyzed a nationally representative sample of 677 drivers aged 16–18 years (weighted n = 277,484) involved in serious crashes, to compare the risk of specific distraction-related and risk-taking–related precrash factors (documented via on-scene crash investigation) for teens driving with peer passengers and teens driving alone. Results: Compared with males driving alone, those with peer passengers were more likely to perform an aggressive act (risk ratio, RR [95% confidence interval] = 2.36 [1.29–4.32]) and perform an illegal maneuver (RR = 5.88 [1.81–19.10]) just before crashing; risk taking increased regardless of passenger gender. Crash-involved males with passengers were also more likely to be distracted by an exterior factor (RR = 1.70 [1.15–2.51]). Conversely, females with passengers were more often engaged in at least one interior nondriving activity (other than conversing with passengers) (RR = 3.87 [1.36–11.06]), particularly when driving with opposite-gender passengers. Female drivers, both with and without passengers, rarely drove aggressively or performed an illegal maneuver before crashing. Conclusions: Passengers may affect male teen driver crashes through both distraction and risk-promoting pathways, and female involvement primarily through internal distraction. Results of this and future studies investigating peer–driver interactions may guide development of passenger-related crash prevention efforts to complement already existing Graduated Driver Licensing passenger restrictions.

Engaging Parents in the Family Check-Up in Middle School: Longitudinal Effects on Family Conflict and Problem Behavior Through the High School Transition - Corrected Proof

Mark J. Van Ryzin, Elizabeth A. Stormshak, Thomas J. Dishion — 2012-01-17

Abstract: Purpose: Adolescence is a time of significant developmental change. During this period, levels of problem behavior that had been relatively innocuous may escalate in the company of peers, with simultaneous reductions in parental monitoring and involvement. In this article, we report the results of a randomized controlled trial of the Family Check-Up (FCU), a family-centered, school-based intervention designed to forestall the escalation of adolescent problem behavior by promoting and motivating skillful parenting through the transition to high school. Methods: In this study, 593 ethnically diverse families were randomized to be offered the FCU when their youth were in seventh and eighth grades of middle school. We used complier average causal effect analysis to examine change in family conflict, antisocial behavior, involvement with deviant peers, and alcohol use from sixth through ninth grades. Results: Analyses revealed that when compared with a matched control group, youths whose parents had engaged in the FCU demonstrated significantly lower rates of growth in family conflict (p = .052), antisocial behavior, involvement with deviant peers, and alcohol use. Discussion: Our results extend current research on the FCU and provide support for theory that links family conflict with a variety of youth problem behavior. These results and the extant research on the FCU suggest that traditional school-based service delivery models that focus on the individual child may benefit from a shift in perspective to engage parents and families.

Factors Associated With Adolescents' Propensity to Drive With Multiple Passengers and to Engage in Risky Driving Behaviors - Corrected Proof

Jessica H. Mirman, Dustin Albert, Lela S. Jacobsohn, Flaura K. Winston — 2012-01-17

Abstract: Purpose: Research shows that parenting factors and individual difference variables, such as sensation seeking (SS) and risk perceptions (RPs), are associated with increased motor vehicle crash risk for young drivers. The presence of peer passengers is also known to be associated with increased crash risk. However, as previous studies did not study these factors concurrently, less is known about the factors that are associated with driving with peer passengers and if peer passengers may mediate the effect of parenting and individual difference variables on adolescents' engagement in risky driving behavior. Methods: We examined predictors of driving with multiple passengers (DWMPs) and explored it as a potential mediator of pathways from three factors: (1) SS, (2) RPs, and (3) Parental monitoring and rule-setting to risky driving behaviors in a convenience sample of 198 adolescent drivers using a cross-sectional Web-based survey. Results: Findings indicate that both stronger RPs and perceiving parents as strong monitors and rule setters were associated with less engagement in risky driving, whereas greater SS was associated with more engagement in risky driving; RPs, monitoring, and SS were also significantly associated with DWMPs in these same directions. DWMPs partially mediated the effect of these risk factors on risky driving behavior. Conclusions: Results inform theory and policy by examining factors associated with risk taking in the context of adolescent driving. Interventions can be developed to complement graduated driver licensing laws by targeting individual difference variables and decreasing opportunities for peer passenger carriage.

Mental Distress and Subsequent Use of Psychotropic Drugs Among Adolescents—A Prospective Register Linkage Study - Corrected Proof

2012-01-10

Abstract: Purpose: To investigate the association between mental distress, other factors, and subsequent use of psychotropic drugs in adolescents aged 15–16 years. Methods: This study is based on information retrieved from the Norwegian Youth Health Surveys (2000–2003) and linked to prescription data from the Norwegian Prescription Database (2004–2009). The study population included 11,620 adolescents aged 15–16 (87% response rate) years. Self-reported mental distress (Hopkins Symptom Checklist-10 score 1.85) was recorded along with health and lifestyle habits, education plans, and family economics. Incident psychotropic drug use (outcome measure) was defined ≥1 prescriptions of one of the following psychotropic drugs: anxiolytics, hypnotics, antidepressants, or phenothiazines registered in the Norwegian Prescription Database. Results: Overall, 15.5% of the adolescents reported mental distress, 75% of them were girls. For both genders, incident psychotropic use was significantly higher among those reporting mental distresses at baseline, compared with the rest of the participants. The highest psychotropic drug use was observed among mentally distressed girls (27.7%). Mental distress was significantly associated with incident use of psychotropic drugs (odds ratio: 2.25, 95% confidence interval: 1.97–2.55). After adjustment for confounding factors and inclusion of potential mediating factors, the odds ratio attenuated to 1.59 (95% confidence interval: 1.35–1.86). Conclusions: The prevalence of mental distress among adolescents may have consequences for health promotion. Public health nurses in Norway, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the opportunity and a responsibility to identify vulnerable young people.

Resource Consumption of a Diffusion Model for Prevention Programs: The PROSPER Delivery System - Corrected Proof

2012-01-09

Abstract: Purpose: To prepare public systems to implement evidence-based prevention programs for adolescents, it is necessary to have accurate estimates of programs' resource consumption. When evidence-based programs are implemented through a specialized prevention delivery system, additional costs may be incurred during cultivation of the delivery infrastructure. Currently, there is limited research on the resource consumption of such delivery systems and programs. In this article, we describe the resource consumption of implementing the PROSPER (PROmoting School–Community–University Partnerships to Enhance Resilience) delivery system for a period of 5 years in one state, and how the financial and economic costs of its implementation affect local communities as well as the Cooperative Extension and University systems. Methods: We used a six-step framework for conducting cost analysis, using a Cost–Procedure–Process–Outcome Analysis model (Yates, Analyzing costs, procedures, processes, and outcomes in human services: An introduction, 1996; Yates, 2009). This method entails defining the delivery System; bounding cost parameters; identifying, quantifying, and valuing systemic resource Consumption, and conducting sensitivity analysis of the cost estimates. Results: Our analyses estimated both the financial and economic costs of the PROSPER delivery system. Evaluation of PROSPER illustrated how costs vary over time depending on the primacy of certain activities (e.g., team development, facilitator training, program implementation). Additionally, this work describes how the PROSPER model cultivates a complex resource infrastructure and provides preliminary evidence of systemic efficiencies. Conclusions: This work highlights the need to study the costs of diffusion across time and broadens definitions of what is essential for successful implementation. In particular, cost analyses offer innovative methodologies for analyzing the resource needs of prevention systems.

A Prospective Study of Overeating, Binge Eating, and Depressive Symptoms Among Adolescent and Young Adult Women - Corrected Proof

Hayley H. Skinner, Jess Haines, S. Bryn Austin, Alison E. Field — 2011-12-13

Abstract: Purpose: To investigate the temporal relationship between depressive symptoms and overeating and binge eating among adolescent and young adult females in the United States.Methods: We investigated incident overeating, binge eating, and depressive symptoms among 4,798 females in the Growing Up Today Study, a prospective cohort study of adolescents and young adults throughout the United States. Participants who reported at least monthly episodes of eating a very large amount of food in a short amount of time in the past year, but not experiencing a loss of control, were classified as overeaters. Those who reported a loss of control while overeating were classified as binge eaters. Depressive symptoms were assessed with the McKnight Risk Factor Survey. Participants were followed between 1999 and 2003. Generalized estimating equations were used for lagged analysis with time-varying covariates. Analyses were adjusted for age, age at menarche, body mass index, and follow-up time.Results: Females reporting depressive symptoms at baseline were two times more likely than their peers to start overeating (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.4, 2.5) and binge eating (OR = 2.3; 95% CI = 1.7, 3.0) during the follow-up. Similarly, females engaging in overeating (OR = 1.9; 95% CI = 1.1, 3.4) or binge eating (OR = 1.9; 95% CI = 1.2, 2.9) at baseline were two times more likely than their peers to develop depressive symptoms during the follow-up.Conclusions: These results indicate that it is important to consider depressive symptoms in overeating and binge eating prevention and treatment initiatives targeting adolescent and young adult females.

Suicidal Ideation and Self-Harm Behavior in a Community Sample of Preadolescent Youth: A Case-Control Study - Corrected Proof

2011-12-06

Abstract: Objective: Research has focused on understanding risk factors associated with suicidal ideation and self-harm behaviors in older youth, but less is known regarding these behaviors in preadolescents. We examined characteristics associated with suicidal ideation and self-harm behavior in youth aged 10–13 years.Design/Methods: A community sample of 387 youth was enrolled in a prospective study assessing precursors of risk behaviors. Twenty-three subjects endorsing items regarding suicidal ideation or self-harm behaviors (Achenbach's Youth Self-Report) (endorsers) were matched with 23 non-endorsers. Groups were compared on problem behaviors, impulsivity, neurocognitive function, risk behaviors, and other variables.Results: Endorsers had higher levels of impulsivity, were more likely in borderline/clinical range on 5 of 8 Youth Self-Report Syndrome scales, and reported more risk taking. Endorsers and non-endorsers were similar in neurocognitive function. More non-endorsers were on stimulants, but groups were similar in parental monitoring and parental report of behavioral/emotional issues, socioeconomic status, and marital status.Conclusion: In this study, preadolescent endorsers report significantly more problem behaviors than non-endorsers. However, parental monitoring and parent report of problems were similar between groups. Given these findings, we suggest that at-risk youth may be underrecognized at young ages.

Longitudinal Trajectories of Metabolic Control Across Adolescence: Associations With Parental Involvement, Adolescents' Psychosocial Maturity, and Health Care Utilization - Corrected Proof

2011-12-05

Abstract: Purpose: To predict trajectories of metabolic control across adolescence from parental involvement and adolescent psychosocial maturity, and to link metabolic control trajectories to health care utilization.Methods: Two hundred fifty-two adolescents (M age at study initiation = 12.5 years, SD = 1.5, range = 10–14 years) with type 1 diabetes (54.4% female, 92.8% Caucasian, length of diagnosis M = 4.7 years, SD = 3.0, range = 1–12 years) participated in a 2-year longitudinal study. Metabolic control was gathered from medical records every 3 months. Adolescents completed measures of self-reliance (functional autonomy and extreme peer orientation), self-control (self-control and externalizing behavior), and parental involvement in diabetes care (acceptance, monitoring, and frequency of help). At the end of the study, mothers reported health care utilization (diabetes-related emergency room visits and hospitalizations) over the past 6 months.Results: Latent class growth analyses indicated two distinct trajectories of metabolic control across adolescence: moderate control with slight deterioration (92% of the sample; average HbA1c = 8.18%) and poor control with rapid deterioration (8% of the sample; average HbA1c of 12.09%). Adolescents with poor and rapidly deteriorating metabolic control reported lower paternal monitoring and frequency of help with diabetes management, lower functional autonomy, and lower self-control than others. Those with poor and rapidly deteriorating metabolic control were 6.4 times more likely to report diabetes-related emergency room visits, and 9.3 times more likely to report diabetes-related hospitalizations near the end of the study.Conclusions: Parental involvement and adolescents' psychosocial maturity predict patterns of deteriorating metabolic control across adolescence and could be targeted for intervention.

Male Adolescents' Attitudes Toward Wife Beating: A Multi-Country Study in South Asia - Corrected Proof

Koustuv Dalal, Ming Shinn Lee, Mervyn Gifford — 2011-12-05

Abstract: Purpose: This study has aimed to address the gaps in knowledge about male adolescents and their attitudes toward wife beating in multi-country study in Bangladesh, India, and Nepal.Methods: The study used secondary data generated from nationally representative samples of male adolescents (aged 15–19 years) in the demographic and health surveys data in Bangladesh, India, and Nepal. These were household surveys using structured questionnaires, with 275 boys in Bangladesh, 13,078 boys in India, and 939 boys in Nepal. Chi-square tests and logistic regressions were used to assess the associations.Results: In Bangladesh, 42% of 275 respondents had justified wife beating; in India, 51% of 13,078 male adolescents had supported wife beating; and in Nepal, 28% of 939 respondents had supported wife abuse. Individual-level factors, such as rural residency, low educational attainment, low economic status, being unemployed, and having a history of family violence, were positively associated with the justification of wife abuse.Conclusions: This multi-country study indicates a general trend of male adolescents' strong supportive attitude toward wife beating, and hence may suggest that policy makers can specifically target young groups of the population for various interventions for reducing violence against women.

Core Sexual/Reproductive Health Care to Deliver to Male Adolescents: Perceptions of Clinicians Focused on Male Health - Corrected Proof

Arik V. Marcell, Jonathan M. Ellen — 2011-12-05

ABSTRACT: Purpose: Male adolescents experience adverse sexual/reproductive health (SRH) outcomes, yet few providers deliver male SRH care. Given the lack of evidence base for male SRH care, the purpose of this study was to examine perceived importance in delivering SRH care to male adolescents among clinicians focused on male health.Methods: Seventeen primary care clinicians focused on male health, representing pediatricians, family physicians, internists, and nurse practitioners, were individually queried about male adolescents' SRH needs and perceived importance to screen/assess for 13 male SRH services using a case scenario approach varying by visit type and allotted time.Results: Participants were highly consistent in identifying a scope of 10 SRH services to deliver to male adolescents during a longer annual visit and a core set of six SRH services during a shorter annual visit, including (1) counseling on sexually transmitted infection/HIV risk reduction, including testing/treatment; and assessing for (2) pubertal growth/development; (3) substance abuse/mental health; (4) nonsexually transmitted infection/HIV genital abnormalities; (5) physical/sexual abuse; and (6) male pregnancy prevention methods. Participants did not agree whether SRH care should be delivered during nonannual acute visits.Conclusions: Despite lack of data for male SRH care, clinicians focused on male health strongly agreed on male SRH care to deliver during annual visits that varied by visit type and allotted time. Study findings provide a foundation for much needed clinical guidelines for male adolescents' SRH care and have implications for education and training health professionals at all levels and the organization and delivery of male SRH services.

Beyond Age at First Sex: Patterns of Emerging Sexual Behavior in Adolescence and Young Adulthood - Corrected Proof

Abigail A. Haydon, Amy H. Herring, Mitchell J. Prinstein, Carolyn Tucker Halpern — 2011-11-17

Abstract: Purpose: Although the emergence of sexual expression during adolescence and early adulthood is nearly universal, little is known about patterns of initiation.Methods: We used latent class analysis to group 12,194 respondents from waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health) into one of five classes based on variety, timing, spacing, and sequencing of oral-genital, anal, and vaginal sex. Multinomial logistic regression models, stratified by biological sex, examined associations between sociodemographic characteristics and class membership.Results: Approximately half of respondents followed a pattern characterized predominately by initiation of vaginal sex first, average age of initiation of approximately 16 years, and spacing of >1 year between initiation of the first and second behaviors; almost one-third initiated sexual activity slightly later but reported first experiences of oral-genital and vaginal sex within the same year. Classes characterized by postponement of sexual activity, initiation of only one type of behavior, or adolescent initiation of anal sex were substantially less common. Compared with white respondents, black respondents were more likely to appear in classes characterized by initiation of vaginal sex first. Respondents from lower socioeconomic backgrounds were more likely to be in classes distinguished by early/atypical patterns of initiation.Conclusions: A small number of typical and atypical patterns capture the emergence of sexual behavior during adolescence, but these patterns reveal complex associations among different elements of emerging sexuality that should be considered in future research.

Follow-up Analysis of Adolescents Partially Vaccinated Against Human Papillomavirus - Corrected Proof

Amanda F. Dempsey, Sarah E. Schaffer, Lisa M. Cohn — 2011-11-07

Abstract: Purpose: To evaluate factors associated with human papillomavirus vaccination among a cohort of female adolescents previously identified as receiving only one or two doses of vaccine.Methods: This was a 15-month follow-up analysis of a previously identified cohort of 9–18-year-old female adolescents seen in primary clinics within a university-based health system. Vaccine receipt and associated factors were identified by review of administrative records.Results: Among the 1,714 partially vaccinated female adolescents, 53% eventually completed the vaccination series. There was a wide range of dosing intervals ranging from 31 to 840 days between first and second doses and from 85 to 666 days between second and third doses. Race and insurance type were associated with lower rates of series completion, but not with receiving second doses.Conclusions: Approximately half of the partially vaccinated girls in our cohort eventually completed the series, albeit often over a longer than recommended interval. There were important disparities in human papillomavirus vaccination.

Socioeconomic Status and Bone Mass in Spanish Adolescents. The HELENA Study - Corrected Proof

2011-11-07

ABSTRACT: Purpose: Socioeconomic status (SES) has been frequently associated with body composition, particularly fat mass and obesity. However, the SES-bone mass association is not clear. We aimed to evaluate the associations between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mineral content in Spanish adolescents.Methods: Participants were 322 adolescents (164 boys and 158 girls, 12.5–17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence study. The social background of the adolescents was self-reported using an SES questionnaire, and the bone variables were measured using dual-energy x-ray absorptiometry. Physical activity was measured using accelerometers. Calcium intake was estimated from two nonconsecutive 24 hours recalls. One-way analysis of covariance was performed to examine the relationships between SES indicators and bone mass using different sets of confounders: basic model (sex + sexual maturation), model 1 (basic model + height), model 2 (basic model + lean mass), and model 3 (basic model + calcium intake + average physical activity).Results: Adjusted results showed no association between SES indicators and whole-body or total hip bone mineral content. Additional analyses were performed in lumbar spine, pelvis, and hip subregions (femoral neck, trochanter, and intertrochanter), and no significant associations were observed at these sites either.Conclusions: Our data do not support a link between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mass in adolescents.

Predictors of Highly Active Antiretroviral Therapy Utilization for Behaviorally HIV-1–Infected Youth: Impact of Adult Versus Pediatric Clinical Care Site - Corrected Proof

2011-11-07

Abstract: Objectives: We evaluated highly active antiretroviral therapy (HAART) utilization in youth infected with HIV through risk behaviors who met treatment criteria for HAART. We assessed the impact of receiving care at an adult or pediatric HIV clinical site on initiation and discontinuation of the first HAART regimen in behaviorally infected youth (BIY).Methods: This was a retrospective analysis of treatment-naive BIY, aged 12–24 years, who enrolled in the HIV Research Network between 2002 and 2008 and who met criteria for HAART. The outcomes were time from meeting criteria to initiation of HAART and time to discontinuation of the first HAART regimen. Analyses were conducted using Cox proportional hazards regression.Results: Of 287 treatment-eligible youth, 198 (69%) received HAART; of these 198 youth, 58 (29.3%) subsequently discontinued HAART. In multivariable analyses, there was no significant difference in the time between meeting treatment criteria and initiating HAART for BIY followed at adult or pediatric HIV clinical sites. However, BIY followed at adult sites discontinued HAART sooner than BIY followed at pediatric HIV clinical sites (adjusted hazard ratio [AHR]: 3.19 [1.26–8.06]).Conclusions: Two-thirds of treatment-eligible BIY in the HIV Research Network cohort initiated HAART; however, one-third who initiated HAART discontinued it during the study period. Identifying factors associated with earlier HAART initiation and sustainability can inform interventions to enhance HAART utilization among treatment-eligible youth. The finding of earlier HAART discontinuation for youth at adult care sites deserves further study.

Youth Access, Creation, and Content of Smokeless Tobacco (“Dip”) Videos in Social Media - Corrected Proof

Andrew B. Seidenberg, Elizabeth J. Rodgers, Vaughan W. Rees, Gregory N. Connolly — 2011-11-07

Abstract: Background: Smokeless tobacco (SLT) use among white adolescent males has increased in recent years, and prevalence of SLT use among adolescent males exceeds that for smoking in several U.S. states. Recent reports have described the presence of cigarette-related content on social media Web sites popular among youth; however, little has been reported on SLT content. Methods: The YouTube video search engine was searched for the popular SLT brand Skoal, and the first 50 search results were downloaded. Video statistics data were collected for and content analysis was performed on all videos featuring smokeless use (82%). Access to SLT YouTube videos by youth was also determined by assessing whether YouTube permits youth viewing and creation of SLT videos. Results: Mean number of views for videos analyzed was 15,422, and the most watched video had 124,276 views. Descriptions of SLT flavor/smell and social references/interactions were found in 48.8% and 63.4% of videos, respectively. By contrast, references to drug (nicotine) effects (12.2%) and public health messaging (9.8%) were less common. None of the SLT videos in the sample had restrictions that would block youth viewing. In addition, evidence of self-identified youth creating SLT videos was found for 13% of unique users in the sample. Conclusions: YouTube does not restrict youth from creating or viewing “dip videos.” Proactive efforts are needed to ensure that YouTube and other online media do not become influential vehicles for tobacco promotion to youth.

Bidirectional Prospective Associations Between Physical Activity and Depressive Symptoms. The TRAILS Study - Corrected Proof

Nikolaos Stavrakakis, Peter de Jonge, Jans Ormel, A.J. Oldehinkel — 2011-11-07

Abstract: Purpose: Low levels of physical activity (PA) have been shown to be associated with depression in adults. The few studies that focused on adolescents yielded mixed and inconsistent results. Efforts to examine the direction of this relationship have been inconclusive up to now. The aims of this study were therefore to investigate (1) the direction of the inverse association between PA and depressive symptoms over time, and (2) whether these associations are specific to particular clusters of depressive symptoms in adolescents.Methods: Depressive symptoms and PA were assessed in a population sample of adolescents (N = 2,230) who were measured at three waves between age 10 and age 17. Depressive symptoms were measured by the Affective Problems scale of the Youth Self-Report and Child Behavior Checklist, whereas PA was operationalized as the amount of time spent on physical exercise. Structural equation modeling was used to examine bidirectional effects of PA and depressive symptoms over time.Results: We found significant cross-lagged paths from prior PA to later depression as well as from prior depression to later PA (beta values = −.039 to −.047). After subdividing depression into affective and somatic symptoms, the affective symptoms were reciprocally related to PA, whereas the paths between somatic symptoms and PA did not reach statistical significance.Conclusions: An inverse bidirectional association between PA and general depressive symptoms was observed. This association was restricted to affective symptoms.

Risk Perceptions After Human Papillomavirus Vaccination in HIV-Infected Adolescents and Young Adult Women - Corrected Proof

2011-11-07

Abstract: Purpose: To examine risk perceptions (perceived risk of human papillomavirus [HPV], perceived risk of other sexually transmitted infections [STIs], and need for safer sexual behaviors) and to determine factors associated with these risk perceptions after HPV vaccination.Methods: Data were collected at the baseline visit of an HPV-6, −11, −16, −18 vaccine clinical trial in 16–23-year-old HIV-infected young women (N = 99). Immediately after receiving the first vaccine dose, participants completed a confidential questionnaire that included three 5-item scales measuring perceived risk of HPV, perceived risk of other STIs, and need for safer sexual behaviors. Linear and logistic regression models were used to examine associations between baseline characteristics (demographic characteristics; cluster of differentiation antigen 4 (CD4+) count; HIV viral load; knowledge about HPV and HPV vaccines; sexual behaviors; and STI diagnosis) and each measure of risk perceptions.Results: Most participants perceived themselves to be at lower risk for HPV (mean scale score = 19.5/50), most perceived that they were not at lower risk for other STIs (mean = 31.2/50), and the vast majority reported that there was still a need for safer sexual behaviors after vaccination (mean = 43.1/50). Multivariate analyses indicated that knowledge about HPV and HPV vaccines was associated with perceived need for safer sexual behaviors (OR = 1.05, 95% CI = 1.0–1.1).Conclusions: Although almost all young women in this study believed that safer sexual behaviors were still important after HPV vaccination, a subset believed they were at less risk for STIs other than HPV. Educational interventions are needed to prevent misperceptions and promote healthy behaviors after vaccination.

Indoor Tanning Device Use Among Male High School Students in the United States - Corrected Proof

Justin Miyamoto, Zahava Berkowitz, Sherry Everett Jones, Mona Saraiya — 2011-10-31

Abstract: Purpose: Indoor tanning is a risk factor for developing melanoma. Although in 2009, 6.7% of male high school students reported using an indoor tanning device, compared with 25.4% of female students (Eaton DK, Kann L, Kinchen S, et al, MMWR Surveill Summ 2010;59:1–142), it is also less well characterized in male than in female adolescents.Methods: The associations between appearance-related and other health-related behaviors with indoor tanning device use were examined among male high school students in the United States, using the 2009 National Youth Risk Behavior Survey.Results: Adjusted analysis of cross-sectional data showed that indoor tanning device use was positively associated with ever having taken steroids without a doctor's prescription, unhealthy weight control practices, binge drinking, eating fruits and vegetables five or more times per day, playing on at least one sports team, and attempted suicide.Conclusions: Understanding the relationship between indoor tanning device use and appearance-related and other health-related behaviors is useful in designing risk reduction interventions for skin cancer prevention.

The Impact of a Comprehensive Microfinance Intervention on Depression Levels of AIDS-Orphaned Children in Uganda - Corrected Proof

Fred M. Ssewamala, Torsten B. Neilands, Jane Waldfogel, Leyla Ismayilova — 2011-10-31

Abstract: Purpose: By adversely affecting family functioning and stability, poverty constitutes an important risk factor for children's poor mental health functioning. This study examines the impact of a comprehensive microfinance intervention, designed to reduce the risk of poverty, on depression among AIDS-orphaned youth.Methods: Children from 15 comparable primary schools in Rakai District of Uganda, one of those hardest hit by HIV/AIDS in the country, were randomly assigned to control (n = 148) or treatment (n = 138) conditions. Children in the treatment condition received a comprehensive microfinance intervention comprising matched savings accounts, financial management workshops, and mentorship. This was in addition to traditional services provided for all school-going orphaned adolescents (counseling and school supplies). Data were collected at wave 1 (baseline), wave 2 (10 months after intervention), and wave 3 (20 months after intervention). We used multilevel growth models to examine the trajectory of depression in treatment and control conditions, measured using Children's Depression Inventory (Kovacs).Results: Children in the treatment group exhibited a significant decrease in depression, whereas their control group counterparts showed no change in depression.Conclusions: The findings indicate that over and above traditional psychosocial approaches used to address mental health functioning among orphaned children in sub-Saharan Africa, incorporating poverty alleviation-focused approaches, such as this comprehensive microfinance intervention, has the potential to improve psychosocial functioning of these children.

A Family Intervention to Reduce Sexual Risk Behavior, Substance Use, and Delinquency Among Newly Homeless Youth - Corrected Proof

2011-10-31

Abstract: Purpose: We evaluate the efficacy of a short family intervention in reducing sexual risk behavior, drug use, and delinquent behaviors among homeless youth.Methods: A randomized controlled trial of 151 families with a homeless adolescent aged 12 to 17 years. Between March 2006 and June 2009, adolescents were recruited from diverse sites in Southern California and were assessed at recruitment (baseline), and at 3, 6, and 12 months later. Families were randomly assigned to an intervention condition with five weekly home-based intervention sessions or a control condition (standard care). Main outcome measures reflect self-reported sexual risk behavior, substance use, and delinquent behaviors over the past 90 days.Results: Sexual risk behavior (e.g., mean number of partners; p < .001), alcohol use (p = .003), hard drug use (p < .001), and delinquent behaviors (p = .001) decreased significantly more during 12 months in the intervention condition compared with the control condition. Marijuana use, however, significantly increased in the intervention condition compared with the control condition (p < .001).Conclusions: An intervention to reengage families of homeless youth has significant benefits in reducing risk over 12 months.

Testing Three Explanations of the Emergence of Weapon Carrying in Peer Context: The Roles of Aggression, Victimization, and the Social Network - Corrected Proof

2011-10-31

ABSTRACT: Purpose: To examine the relative contribution of weapon carrying of peers, aggression, and victimization to weapon carrying of male and female adolescents over time.Methods: Data were derived from a population-based sample of male (N = 224) and female (N = 244) adolescents followed from grade 10 (M age = 15.5) to grade 11 (M age = 16.5). Peer networks were derived from best friend nominations. Self-reports were used to assess weapon carrying. Aggression and victimization were assessed using both self- and peer-reports. Use of dynamic social network modeling (SIENA) allowed prediction of weapon carrying in grade 11 as a function of weapon carrying of befriended peers, aggression, and victimization in grade 10, while selection processes and structural network effects (reciprocity and transitivity) were controlled for.Results: Peer influence processes accounted for changes in weapon carrying over time. Self-reported victimization decreased weapon carrying 1 year later. Peer-reported victimization increased the likelihood of weapon carrying, particularly for highly aggressive adolescents. Boys were more likely to carry weapons than girls, but the processes associated with weapon carrying did not differ for boys and girls.Conclusions: These findings revealed that, in this population-based sample, weapon carrying of best friends, as well as aggression, contributed to the proliferation of weapons in friendship networks, suggesting processes of peer contagion as well as individual vulnerability to weapon carrying.

The Consequences of Juvenile Detention Reform for Mental Health and Sexually Transmitted Infection Screening Among Detained Youth - Corrected Proof

2011-10-31

Abstract: Purpose: To understand how diversion of low-risk youth from juvenile detention affected screening practices for detained youth.Methods: In a 22-month cross-sectional study of 2,532 detainees (age, 13–18 years), mental health and sexually transmitted infection (STI) screening data were compared before and after the beginning of diversion efforts through implementation of a Risk Assessment Instrument (RAI).Results: Detention diversion resulted in a 30% census reduction. In a logistic regression, younger age (odds ratio [OR] = 1.10 for a 1-year increase; confidence interval [CI]: 1.03, 1.17), Hispanic versus white race/ethnicity (OR = .53; CI: .35, .82), and less severe crime (OR = .90 per 1 point; CI: .89, .91) predicted reduced likelihood of detention. Mental health and STI screening increased significantly after implementation of the RAI. Additionally, the rate of positive STI tests increased among detained males (9% pre-RAI to 14% after implementation of the RAI, p = .01). However, implementation of the RAI did not result in a significant increase in the number of positive mental health screens.Conclusions: Universal mental health and STI screening are increasingly common public health practices in detention centers. The results of this study indicate that juvenile justice diversion programming affects public health screening rates among detained youth in our population. Future study of the possible unintended consequences of criminal justice initiatives on public health outcomes is recommended.

Local Tobacco Policy and Tobacco Outlet Density: Associations With Youth Smoking - Corrected Proof

Sharon Lipperman-Kreda, Joel W. Grube, Karen B. Friend — 2011-10-31

Abstract: Purpose: This study investigates the associations between local tobacco policy, tobacco outlet density, and youth smoking. A primary focus is on whether local tobacco policy moderates the relation between outlet density and youth smoking.Methods: In all, 1,491 youth (51.9% male, mean age = 14.7 years, standard deviation = 1.05) in 50 midsized California cities were surveyed through a computer-assisted telephone interview. Measures of local clean air policy and youth access policy were created based on a review of tobacco policies in these cities. Outlet density was calculated as the number of retail tobacco outlets per 10,000 persons, and city characteristics were obtained from 2000 U.S. Census data.Results: Using multilevel regression analyses and controlling for city characteristics, tobacco outlet density was positively associated with youth smoking. No significant main effects were found for the two tobacco policy types on any of the smoking outcomes after controlling for interactions and covariates. However, statistically significant interactions were found between local clean air policy and tobacco outlet density for ever smoked and past 12-month cigarette smoking. Comparisons of simple slopes indicated that the positive associations between tobacco outlet density and youth smoking behaviors were stronger at the lowest level of local clean air policy compared with the moderate and high levels.Conclusions: Our results suggest that tobacco outlet density is related to youth smoking. In addition, local clean air policy may act as a moderator of relationship between tobacco outlet density and youth smoking, such that density is less important at moderate and high levels of this tobacco policy.

Eating Habits and Total and Abdominal Fat in Spanish Adolescents: Influence of Physical Activity. The AVENA Study - Corrected Proof

2011-10-31

Abstract: Objective: To evaluate the association between specific dietary habits and body fatness in Spanish adolescents, and to analyze the role of leisure-time physical activity (LTPA) in this association.Methods: In this cross-sectional study, 1,978 adolescents (1,017 girls) aged 13.0–18.5 years from the AVENA (Alimentación y Valoración del Estado Nutricional en Adolescentes) study were included. Particular dietary habits (breakfast, mid-morning snack, lunch, afternoon snack, dinner, and nighttime snack, as well as time spent eating, number of meals, consumption of soft drinks, and ready-to-eat foods) and LTPA were self-reported and analyzed as dichotomic variables (yes/no). The sum of six skinfold thicknesses and waist circumference (WC) values were the main body fatness variables.Result: Skinfolds and WC values were lower in adolescents who reported consumption of mid-morning snack, afternoon snack, more than four meals per day, and an adequate speed of eating, independently of participation in LTPA. Moreover, a beneficial influence of breakfast consumption on skinfolds and WC values was observed in those adolescent boys who did not participate in LTPA (p for interactions = .044 and .040, respectively).Conclusions: In Spanish adolescents, certain healthy dietary habits (i.e., mid-morning snack, afternoon snack, > 4 meals per day, adequate eating speed) are associated with lower body fatness, independently of engaging in LTPA. In addition, among boys with non-LTPA, those who skipped breakfast showed the highest body fatness values, indicating a beneficial influence of daily breakfast on body fat in this particular group.

The Influence of Socioeconomic Status on Cannabis Use Among French Adolescents - Corrected Proof

2011-10-19

ABSTRACT: Purpose: To investigate the influence of the family socioeconomic status (F-SES) on various intensities and frequencies of cannabis use in late adolescence.Design/Settings/Participants: Data were obtained from a cross-sectional survey conducted in 2008, which was representative of French youth aged 17(n = 39,542). Outcomes were overall use (abstinence, lifetime use, 1–9, and 10+ uses in the past year) for all adolescents, and frequent use for those who smoked cannabis at least 10 times in the past year (≤9, 10–19, 20+ uses in the past month). Additionally, cannabis use disorders and heavy use (having smoked at least 4 joints last time) were studied among previous-year users. F-SES was the highest occupational category of both parents (in 7 categories, from managers/professionals [used as the reference category] to inactive/unemployed). Multinomial logistic regressions were computed controlling for gender; other substances use; parental separation; parental use of alcohol, tobacco, and cannabis; housing, being out of school, and sociability.Findings: For overall use, we found a strong positive social gradient: the lower the F-SES or the higher the frequency of use, the lower the odds ratio (OR) (from .85 to .52 for 10+ uses in the past year among farmers). For frequent use, we found a strong negative gradient: the lower the F-SES category, the higher the OR (from 1.02 to 2.05 among inactive/unemployed), and likewise for cannabis use disorder and heavy use (OR = 1.85 and 2.03 among inactive/unemployed).Conclusions: Adolescents from affluent families are more prone to experimentation with cannabis and to use it at low levels but present lower levels of frequent, heavy, or problematic use than those from other SES categories. Mechanisms that hinder transition to intensive use should be investigated.

Knowledge of Medication Abortion Among Adolescent Medicine Providers - Corrected Proof

Mandy S. Coles, Kevin K. Makino, Rachael Phelps — 2011-10-14

Abstract: Purpose: Adolescents are at high risk for unintended pregnancy and abortion. The purpose of this study was to understand whether providers caring for adolescents have the knowledge to counsel accurately on medication abortion, a suitable option for many teenagers seeking to terminate a pregnancy.Methods: Using an online questionnaire, a survey related to medication abortion was administered to U.S. providers in the Society for Adolescent Health and Medicine. We conducted χ2 analyses to evaluate the knowledge of medication abortion by reported adolescent medicine fellowship training, and to compare responses to specific knowledge questions by medication abortion counseling. Furthermore, we examined the relationship between providers' self-assessed and actual knowledge using ANOVA.Results: We surveyed 797 providers, with a 54% response rate. Almost 25% of respondents incorrectly believed that medication abortion was not very safe, 40% misidentified that it was < 95% effective, and 32% did not select the correct maximum recommended gestational age (7–9 weeks). Providers had difficulty identifying that serious complications of medication abortion are rare. Those who counseled on medication abortion had more accurate information in all knowledge categories, except for expected outcomes. Medication abortion knowledge did not differ by adolescent medicine fellowship completion. Only 32% of respondents had very good knowledge, and self-assessed knowledge minimally predicted actual knowledge (r2 = .08).Conclusions: Knowledge regarding medication abortion safety, effectiveness, expected outcomes, and complications is suboptimal even among adolescent medicine fellowship trained physicians, and self-assessment poorly predicts actual knowledge. To ensure pregnant teenagers receive accurate counseling on all options, adolescent medicine providers need better education on medication abortion.

First Sexual Intercourse and Subsequent Regret in Three Developing Countries - Corrected Proof

2011-10-12

Abstract: Purpose: Adolescents who engage in sex can be affected by a range of negative physical and psychological consequences. We intend to analyze the reasons behind first sex, regret, and the association between reasons and regret.Methods: A questionnaire was implemented to 8,495 high schools students aged 14–18 years residing in the Philippines, El Salvador, and Peru. Sexually active participants responded whether several circumstances were reasons involved in their first sexual relationship. They also responded whether they regretted having already had sexual relationships.Results: More than one-third of respondents reported at least one external pressure leading to first sex, and about one-half reported at least one reason implying getting carried away by sexual arousal.More females affirmed they regret having already had sex. Logistic regression shows that reasons for first sex associated with regret were partner insistence, “uncontrolled situations,” and seeing sexual images. These reasons were associated with regret even when love was also reported as related to first sex.Conclusions: Adolescent sexual experience is often motivated by pressure (such as external pressure [because most friends already had sex or because of partner insistence]) and circumstances (such as getting carried away by sexual arousal [through an “uncontrolled situation” or viewing sexual images]) that lower the control over their decisions concerning sex, rather than by mature decisions, and this may result in later regret. Adolescents should be helped by parents, educators, and policy makers to be aware of these characteristics of sexual behavior of adolescents and empowered to make assertive and informed decisions concerning their sexuality.

Sexual Risk Avoidance and Sexual Risk Reduction Interventions for Middle School Youth: A Randomized Controlled Trial - Corrected Proof

2011-10-10

Abstract: Purpose: To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation.Methods: Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.Results: Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54–.77), among females (AOR: .43, 95% CI: .31–.60), and among African Americans (AOR: .38, 95% CI: .18–.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47–.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33–.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36–.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19–.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52–.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01–2.82). Both programs positively affected psychosocial outcomes.Conclusions: The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.

Psychometric Properties of the Revised Parental Monitoring of Diabetes Care Questionnaire in Adolescents With Type 1 Diabetes - Corrected Proof

2011-10-10

Abstract: Purpose: We evaluated the psychometric properties of a revised version of the Parental Monitoring of Diabetes Care questionnaire (PMDC-R) designed to evaluate parental supervision and monitoring of adolescent diabetes care behaviors. The revised measure was intended to capture a broad range of ways used by parents to gather information about youth adherence to diabetes care.Methods: Two hundred sixty-seven caregivers of 12–18-year-old adolescents with type 1 diabetes completed the PMDC-R. Measures of parental knowledge of youth illness management, illness management behavior, and metabolic control were also obtained.Results: The PMDC-R demonstrated good internal consistency (alpha coefficient = .91) and test–retest reliability (r = .79, p < .001). Supporting the instrument's construct validity, a bifactor model with one primary factor and three secondary factors had an acceptable fit to the data (comparative fit index = .92, root mean square error of approximation = .06). Concurrent validity was also supported. In structural equation models, parental monitoring, as assessed by the PMDC-R, had a significant direct effect on parental knowledge of adolescent diabetes management and, through knowledge, an indirect effect on adolescent diabetes management and metabolic control.Conclusions: The PMDC-R displayed strong psychometric properties and represents an important next step in refining the measurement of parental monitoring for youth with chronic illnesses.

Contraceptive Paths of Adolescent Women Undergoing an Abortion in France - Corrected Proof

Caroline Moreau, James Trussell, Nathalie Bajos — 2011-10-10

Abstract: Purpose: Although more than 30,000 teenagers had an induced abortion in France in 2007 (14.3% of all abortions), little is known about their abortion experience. We explore young women's decisions related to their abortion and the patterns of abortion care among teenagers in France, and draw particular attention to the contraceptive circumstances surrounding the abortion.Methods: The data are drawn from the French National Survey of Abortion Patients conducted in 2007, comprising 1,525 women aged 13–19 years.Results: A majority of French teens (82%) reported their pregnancy was unplanned and took on the responsibility of having an abortion: 45% made the decision alone, 46% shared the decision with their family or partner, and 9% reported the decision was made on their family's or partner's request alone. Sixty-nine percent of teenagers were eligible for both medical and surgical abortions, but only 43% thought they were given a choice of methods. Two-thirds of pregnancies were caused by contraceptive misuse or failure, mostly due to condom slippage or breakage (26%) or inconsistent pill use (20%). In 68% of cases, teenagers were prescribed a more effective method than the one they were using before, although only 11% received a prescription for a long-acting method. One in five teenagers reported not receiving a prescription for contraception.Conclusions: Our results reveal varying degrees of young women's autonomy in the decisions regarding their abortion. Although most teens switch to more effective methods of contraception after an abortion, only a minority receives a prescription for a long-acting method.

Just One Click: A Content Analysis of Advertisements on Teen Web Sites - Corrected Proof

Amy Slater, Marika Tiggemann, Kimberley Hawkins, Douglas Werchon — 2011-10-10

Abstract: Purpose: The current study provides a comprehensive analysis of the content of advertisements on Web sites targeted at adolescents, with a particular focus on the female beauty ideal.Methods: Advertisements (N = 631) from 14 Web sites popular with adolescents were analyzed with respect to product advertised, characteristics of people presented, and emphasis on appearance and the thin beauty ideal.Results: Although a wide variety of products were featured, advertisements for cosmetics and beauty products were the most frequent. Further, many of the products advertised (e.g., dating services, weight loss products, gambling games) might be considered inappropriate for the intended audience (i.e., teenagers) of the Web site. People who were a part of advertisements were generally female, young, thin, and attractive. Advertisements for games, weight loss products, and cosmetic and beauty products strongly focused on appearance and laid emphasis on the thin ideal.Conclusions: Like advertisements in mainstream media, advertising on the Internet perpetuates the stereotypical ideal of feminine beauty. Adolescents using the Internet are likely to be exposed to numerous advertisements that reinforce the importance of beauty and thinness, which could have a detrimental impact on how they feel about their bodies.

The Impact of Role Models on Health Outcomes for Lesbian, Gay, Bisexual, and Transgender Youth - Corrected Proof

Jason D.P. Bird, Lisa Kuhns, Robert Garofalo — 2011-10-10

Abstract: Purpose: There is little research on the impact of role models on health outcomes for lesbian, gay, bisexual, and transgender (LGBT) youth. This exploratory study describes the presence and availability of LGBT-affirming role models, and examines the relationship between the accessibility of role models and health outcomes among a community-based sample of LGBT youth.Methods: A convenience sample of 496 ethnically diverse, 16–24-year-old LGBT youth was recruited to complete a computer-assisted interview, using standardized instruments validated with adolescents. The prevalence and characteristics of role models were described. Differences in subgroup distribution were assessed using Pearson χ2 test (p < .05). Differences in health outcomes for those with and without role models and the nature of those role models were determined using analysis of covariance models, with post hoc Bonferroni tests to probe significant global findings.Results: Sixty percent of the participants reported having a role model, with younger participants significantly more likely to report having a role model. A majority of the participants reported having inaccessible role models, especially among younger participants. The presence and accessibility of a role model did not have a significant relationship to binge drinking, drug use, or sexually transmitted infection diagnoses; however, participants with inaccessible role models showed increased psychological distress versus those with accessible or no role models.Conclusions: Inaccessible role models may not be sufficient for protecting youth from negative outcomes, and formal mechanisms for connecting LGBT youth with caring adults who can serve as role models, such as mentoring programs, are critical.

HIV Risk and Perceptions of Masculinity Among Young Black Men Who Have Sex With Men - Corrected Proof

2011-10-03

Abstract: Purpose: Young black men who have sex with men (YBMSM) are known to have the highest rates of HIV infection in the United States. Although reported rates of unprotected anal intercourse are similar to the rates of men who have sex with men of other racial/ethnic backgrounds, YBMSM aged 15–22 years are five times more likely to be HIV-infected than the comparably aged white men who have sex with men. We explored contextual social-environmental factors that may influence how YBMSM assess risk, choose partners, and make decisions about condom use.Methods: We analyzed semi-structured interviews with 35 YBMSM (age: 18–24 years) in New York City, Upstate New York, and Atlanta. We used structured analytic coding based on a theoretical scheme that emerged from the data.Results: Perception of masculinity was the primary contextual factor influencing partner selection, risk assessment, and decision-making with regard to condom usage. Four primary themes emerged: (1) greater preference for partners perceived as masculine; (2) discomfort with allowing men perceived as feminine to be the insertive partner in anal intercourse; (3) a power dynamic such that partners perceived as more masculine made condom-use decisions within the dyad; and (4) use of potential partners' perceived masculinity to assess HIV risk.Conclusions: Perceived masculinity may play a significant role in HIV risk for YBMSM and may be an important concept to consider in prevention strategies directed toward this population.

Characteristics of African American Adolescent Females Who Perceive Their Current Boyfriends Have Concurrent Sexual Partners - Corrected Proof

2011-09-23

Abstract: Purpose: Perceived partner concurrency, reporting that a current sexual partner has other sexual partners, may pose sexual health risks to adolescents. We examined the contextual characteristics of African American female adolescents who reported their current boyfriend was having concurrent sexual relationships.Methods: Participants were African American adolescent females (N = 511; mean age = 17.6) recruited from sexual health clinics. Before participating in an STD/HIV prevention trial, the participants completed audio computer-assisted self-interviews with measures of perceived partner concurrency and individual- (e.g., depression, substance use), interpersonal- (e.g., social support, interpersonal stress), and community-level factors (i.e., neighborhood quality).Results: Twenty-seven percent of participants reported their belief that their current boyfriend had concurrent sexual partners during their relationship. In a logistic regression analysis, participants endorsing perceived partner concurrency reported less relational power (adjusted odds ratio [AOR] = .94, 95% confidence interval [CI] = .89–.98, p < .01), decreased relationship commitment (AOR = .88, 95% CI = .80–.96, p < .01), elevated perceived interpersonal stress (AOR = 1.02, 95% CI = 1.003–1.04, p < .05), and previous STD diagnoses (AOR = 2.07, 95% CI = 1.31–3.28, p < .01; overall model: χ2 = 67.25; p < .001).Conclusions: Results suggest that the efficacy of sexual risk reduction interventions may be improved by emphasizing the increased HIV/STD risks associated with having a boyfriend with concurrent sex partners. In addition, interventions may benefit from incorporating stress management training and addressing key relationship dynamics, particularly among adolescents with a history of STDs.

Impact of Victimization on Risk of Suicide Among Lesbian, Gay, and Bisexual High School Students in San Francisco - Corrected Proof

John P. Shields, Kelly Whitaker, Jill Glassman, Heather M. Franks, Kelli Howard — 2011-09-23

Abstract: Purpose: This study investigated the association between sexual orientation, victimization, and suicide risk-related outcomes among youth attending public high schools in San Francisco.Methods: Data from the 2009 Youth Risk Behavior Survey were analyzed using bivariate and logistic regression methods for complex samples to examine the relationship between sexual orientation, victimization, and three suicide risk-related outcomes (sadness/depression, suicide planning, and attempting suicide) while controlling for demographics and substance use.Results: Lesbian, gay, or bisexual (LGB) youth reported significantly higher rates of substance use, victimization, and suicide risk-related outcomes than heterosexual youth. However, in the controlled regression models, victimization was a significant predictor of sadness/depression and suicide attempts, regardless of sexual orientation. There was a significant interaction effect between sexual orientation and victimization on suicide planning, with heterosexual youth more affected than LGB youth.Conclusions: Results underscore the deleterious effect of victimization on suicide risk-related outcomes, regardless of sexual orientation. As LGB youth continue to report higher rates of victimization, effective violence prevention approaches must focus on reducing violence among youth, specifically LGB youth. Additional research should focus on identification of other factors that may help further explain elevated suicide risk among LGB youth.

Patterns of Disclosure Among Youth Who Are HIV-Positive: A Multisite Study - Corrected Proof

2011-09-05

Abstract: Purpose: Disclosure of serostatus is critical in preventing the transmission of HIV among youth. The purpose of this exploratory study was to describe serostatus disclosure in a multisite study of youth living with HIV.Methods: This study investigated serostatus disclosure and its relationship to unprotected sex among 146 youth participating in a multisite study of young people living with HIV who were sexually active within the past 3 months.Results: Forty percent of participants reported a sexual relationship with a partner to whom they did had not disclosed their serostatus. Participants with multiple sexual partners were less likely to disclose their serostatus than those with one partner. Disclosure was more frequent when the serostatus of the sexual partner was known. Disclosure was not associated with unprotected sex.Conclusions: Prevention initiatives should focus on both disclosure and condom use in this high-risk population, particularly for youth with multiple sexual partners.

Effect of a Grade 6 HIV Risk Reduction Intervention Four Years Later Among Students Who Were and Were Not Enrolled in the Study Trial - Corrected Proof

2011-09-05

Abstract: Purpose: To assess the long-term impact of HIV-prevention interventions delivered to youth before sexual initiation and the effects of interventions delivered in nonstudy settings.Methods: A five-group comparison of HIV knowledge, and condom-use skills, self-efficacy, intentions, and practice among 1,997 grade 10 students attending one of the eight government high schools in Nassau, The Bahamas. Group 1 received an HIV-prevention intervention, Focus on Youth in the Caribbean (FOYC), in grade 6 as part of a randomized trial; group 2 received FOYC as part of the regular school curriculum but outside of the trial; group 3 received the control condition as part of the trial; group 4 received the control condition as part of the school curriculum but outside of the trial; and individuals in group 5 (naive controls) were not enrolled in a school receiving FOYC or the control conditon and did not participate in the trial.Results: FOYC youth compared with the control youth and naive controls had higher HIV knowledge, condom-use skills, and self-efficacy 4 years later. By subgroups, group 1 demonstrated higher HIV/AIDS knowledge than all groups except group 2, higher condom skills than all groups, and higher condom self-efficacy than Naive Controls. Youth in group 2 demonstrated higher HIV knowledge than youth in groups 3–5. Behavioral effects were not found.Conclusions: FOYC delivered to grade 6 students continued to have protective effects 4 years later. Positive effects are present among youth who received FOYC as part of the school curriculum but were not enrolled in the trial.

Is Depression Contagious? A Test of Alternative Peer Socialization Mechanisms of Depressive Symptoms in Adolescent Peer Networks - Corrected Proof

2011-09-05

ABSTRACT: Purpose: This study examined the role of two different types of peer socialization (convergence, contagion) in adolescents' depression, adjusting for the effects of peer selection and deselection.Methods: The sample used in this study comprised 949 Finnish adolescents (56% females; mean age: 16 years at the outset) attending classrooms in eight secondary schools. Participants identified three school peers and reported depressive symptoms twice, 1 year apart. Sociometric and behavioral data were analyzed using dynamic social network analysis.Results: Adolescents initiated relationships with peers who reported similar levels of depression before initiation of the relationship, and dissolved relationships with peers who became dissimilar in depression from time 1 (T1) to time 2 (T2). The average score of peers' depressive symptoms at T1 predicted changes in adolescent depression at T2 (convergence), but adolescents with peers who reported relatively higher initial levels of depression did not report an increase in depression (contagion).Conclusions: Over time, adolescents' depressive symptoms increasingly converged toward the average levels of their peers, but this convergence was not primarily because of contagion effects. The findings suggest that socialization processes can lead to both increases and decreases in adolescent depression, depending on peers' average level of depression.

Substance Use, Sexual Intercourse, and Condom Nonuse Among Depressed Adolescents and Young Adults - Corrected Proof

2011-09-05

Abstract: Purpose: To examine daily- and event-level associations of substance use with occurrence of sex and condom nonuse among depressed youth.Methods: Depressed, sexually active outpatients aged 15–22 years reported alcohol use, marijuana use, and sex on a personal digital assistant for 2 weeks. If they reported sex, participants indicated partner type and condom use. Data were analyzed for participants who reported both substance use and sex events (N = 39) using generalized estimating equations. Daily-level models compared the likelihood of sex and of condom nonuse between days on which participants did or did not use substances. Event-level models examined the likelihood of sex in the 2, 6, and 12 hours after substance use and the likelihood of condom nonuse if substances were used in the preceding 2, 6, and 12 hours.Results: Participants reported 307 sex events (180 unprotected) and 391 substance use events on 572 days. Substance use was associated with increased odds of sex on the same day, but not after adjusting for weekend. Depressed youth were less likely to have sex within 2 hours after substance use and more likely to have sex within 12 hours after marijuana use. There was no main effect of substance use on condom nonuse; however, there was a significant interaction such that on weekdays, condom nonuse was less likely when substances were used within 6 hours before sex.Conclusions: The findings from this small, predominantly female sample suggest that contextual factors, not intoxication, influence associations of substance use with sexual behavior in depressed youth.

Attentional Bias and Disinhibition Toward Gaming Cues Are Related to Problem Gaming in Male Adolescents - Corrected Proof

2011-09-05

Abstract: Purpose: The aim of this study was to examine whether behavioral tendencies commonly related to addictive behaviors are also related to problematic computer and video game playing in adolescents. The study of attentional bias and response inhibition, characteristic for addictive disorders, is relevant to the ongoing discussion on whether problematic gaming should be classified as an addictive disorder.Methods: We tested the relation between self-reported levels of problem gaming and two behavioral domains: attentional bias and response inhibition. Ninety-two male adolescents performed two attentional bias tasks (addiction-Stroop, dot-probe) and a behavioral inhibition task (go/no-go). Self-reported problem gaming was measured by the game addiction scale, based on the Diagnostic and Statistical Manual of Mental Disorders-fourth edition criteria for pathological gambling and time spent on computer and/or video games.Results: Male adolescents with higher levels of self-reported problem gaming displayed signs of error-related attentional bias to game cues. Higher levels of problem gaming were also related to more errors on response inhibition, but only when game cues were presented.Conclusions: These findings are in line with the findings of attentional bias reported in clinically recognized addictive disorders, such as substance dependence and pathological gambling, and contribute to the discussion on the proposed concept of “Addiction and Related Disorders” (which may include non–substance-related addictive behaviors) in the Diagnostic and Statistical Manual of Mental Disorders-fourth edition.

Family Support as a Mediator of Change in Sexual Risk-Taking Attitudes Among Orphaned Adolescents in Rural Uganda - Corrected Proof

Leyla Ismayilova, Fred M. Ssewamala, Leyla Karimli — 2011-08-29

Abstract: Purpose: Prior studies demonstrated the effect of family-based economic empowerment intervention Suubi on reducing attitudes approving sexual risk-taking behavior among orphaned adolescents in Uganda. To understand mechanisms of change, the article examines the effect of Suubi intervention on family support variables and their role in mediating the change in adolescents' attitudes toward sexual risk-taking.Methods: The Suubi study used a cluster-randomized experimental design with three waves, and included 283 orphaned adolescents from 15 primary schools in Rakai, Uganda. First, using mixed-effects models, the study tested for the effect of intervention on family support variables. Second, using mediation analysis, the study examined whether the change in sexual risk-taking attitudes was mediated by the change in family support.Results: Compared with adolescents from the control group, at wave 2, adolescents in the treatment group reported higher levels of perceived support from caregivers, were more willing to talk to caregivers about their problems, and felt more comfortable talking about sexual risk behaviors with their caregivers. Mediation analysis demonstrated that the improvement in perceived support from caregivers at wave 2 accounted for 16.8% of the reduction in adolescents' attitudes toward sexual risk-taking behavior at wave 3 (z = −2.21, p < .05).Conclusions: A family-based economic empowerment intervention Suubi may have the potential to increase family support to orphaned adolescents. Interventions aimed at strengthening existing social networks and improving connectedness with surviving family members may be critical in preventing sexual risk-taking behavior among orphaned adolescents in Uganda, which is characterized by low resources.

Patterns and Correlates of Parental and Formal Sexual and Reproductive Health Communication for Adolescent Women in the United States, 2002–2008 - Corrected Proof

Kelli Stidham-Hall, Caroline Moreau, James Trussell — 2011-08-18

Abstract: Purpose: To investigate patterns and correlates of sexual and reproductive health (SRH) communication among adolescent women in the United States between 2002 and 2008.Methods: We used data with regard to adolescent women (aged 15–19 years) from the National Survey of Family Growth (between 2002 and 2006–2008, n = 2,326). Multivariate analyses focused on sociodemographic characteristics and SRH communication from parental and formal sources.Results: Seventy-five percent of adolescent women had received parental communication on abstinence (60%), contraception (56%), sexually transmitted infections (53%), and condoms (29%); 9% received abstinence-only communication. Formal communication (92%) included abstinence (87%) and contraceptive (71%) information; 66% received both, whereas 21% received abstinence-only. Between 2002 and 2006–2008, parental (not formal) communication increased (7%, p < .001), including the abstinence communication (4%, p = .03). Age, sexual experience, education, mother's education, and poverty were positively associated with SRH communication.Conclusions: Between 2002 and 2008, receipt of parental SRH communication, especially abstinence, was increasingly common among United States adolescents. Strategies to promote comprehensive communication may improve adolescents' SRH outcomes.

Do Help-Seeking Intentions During Early Adolescence Vary for Adolescents Experiencing Different Levels of Depressive Symptoms? - Corrected Proof

2011-08-18

Abstract: Purpose: To investigate whether help-seeking intentions for depressive symptoms vary for adolescents experiencing low, mild-to-moderate, and high levels of depressive symptoms.Methods: A total of 5,362 participants aged 12–14 years had completed the baseline assessment for a randomized controlled trial evaluating the effectiveness of a universal intervention designed to reduce depressive symptoms among high school students. The participants reported their help-seeking intentions in response to a vignette describing an individual experiencing depressive symptoms consistent with a diagnosis of a minor depressive disorder. Standard measures were used to assess participants' level of depressive symptoms and perceived level of social support.Results: Logistic regression models examined relationships between help-seeking intentions and levels of depression, after adjustment for demographic characteristics and perceived support. As compared with those with low levels of depressive symptoms, adolescents with high levels of symptoms reported less intention to seek help from friends (odds ratio [OR] = .42) or family members (OR = .29). They were also four times more likely to report that they would not seek help from anybody (OR = 4.55). A similar pattern was evident during comparisons of help-seeking intentions reported by adolescents with mild-to-moderate levels of depressive symptoms versus those with low levels of symptoms.Conclusions: Targeted and universal interventions need to encourage peers and family members to actively engage with young adolescents experiencing depressive symptoms rather than waiting for them to initiate help-seeking. This is particularly important for adolescents experiencing higher levels of depressive symptoms who may not initiate help-seeking themselves.

Body Mass Index at Age 25 and All-Cause Mortality in Whites and African Americans: The Atherosclerosis Risk in Communities Study - Corrected Proof

June Stevens, Kimberly P. Truesdale, Chin-Hua Wang, Jianwen Cai, Eva Erber — 2011-08-16

Abstract: Purpose: Approximately 20% of young adults in the United States are obese, and most of them gain weight between young and middle adulthood. Few studies have examined the association between elevated body mass index (BMI) in early adulthood and mortality or have examined that such effects are independent of changes in weight. To our knowledge, no such study has been conducted in African-American samples.Methods: We used data from 13,941 African-American and white adults who self-reported their weight at the age of 25, and had weight and height measured when they were 45–64 years of age (1987–1989). Date of death was ascertained between 1987 and 2005. Hazard ratios and hazard differences for the effects of BMI at age 25 on all-cause mortality were determined using Cox proportional hazard and additive hazard models, respectively.Results: In the combined ethnic–gender groups, the hazard ratio associated with a 5 kg/m2 increase in BMI at age 25 was 1.28 (95% confidence interval [CI]: 1.22–1.35), and the hazard difference was 2.75 (2.01–3.50) deaths/1,000 person-years. Associations were observed in all four ethnic–gender groups. Models including weight change from age 25 to age in 1987–1989 resulted in null estimates for BMI in African-American men, whereas associations were maintained or only mildly attenuated in other ethnic–gender groups.Conclusions: Excess weight during young adulthood should be avoided because it contributes to increases in death rates that may be independent of changes in weight experienced in later life. Further study is needed to better understand these associations in African-American men.

Benefits of Universal Intervention Effects on a Youth Protective Shield 10 Years After Baseline - Corrected Proof

Richard L. Spoth, Linda S. Trudeau, Max Guyll, Chungyeol Shin — 2011-08-16

Abstract: Purpose: An earlier randomized controlled study found that a universal, family-focused preventive intervention produced protective shield effects—reduced adolescent exposures to illicit substance opportunities—among adolescents in grade 12. This study examined a follow-up assessment of the sample during young adulthood.Methods: A randomized controlled trial evaluated the Iowa Strengthening Families Program that was implemented in 22 rural schools (N = 446 families) when the participants were in grade six. Measures included adolescent exposure to illicit substance use and young adult lifetime substance use (age 21; N = 331). Growth curve modeling examined indirect intervention effects through growth factors of adolescent exposure.Results: Findings from this study confirm protective shield effects that mediate long-term reduction of illicit substance use (β = −.14, p = .02, Relative Reduction Rate = 28.2%).Conclusions: The benefits of decreasing exposure to substance use during adolescence through universal interventions were supported, with positive effects extending into young adulthood.

Diminishing Gender Differences in Condom Use Among a National Sample of Young Israeli Men and Women Between 1993 and 2005 - Corrected Proof

2011-07-11

Abstract: Background: Studies related to condom use among young adults consistently point to substantial gender disparities, although the use has generally increased. This study examined trends in condom use between 1993 and 2005 among 13,988 Israelis aged 18–25 years and the associated sociodemographic factors.Methods: An HIV/AIDS Knowledge, Attitudes, and Practice survey was self-administered to dischargees from Israel's compulsory military service. Multivariate logistic regression models were used to assess trends in condom use and the association over time of sociodemographic factors and sexual behaviors with consistent condom use.Results: During the 13-year period, consistent condom use increased among men (from 35% to 58%) and women (from 17% to 54%), almost eliminating the gender difference. Among both genders, consistent condom use was associated with being single, being older at the time of sexual debut, and being religious, and was inversely associated with age and education; however, gender differences were found in the strength of the associations over time.Conclusions: The excess risk of exposure of young women to lack of condom use has minimized, an unusual situation on international comparison, although population risk for HIV and sexually transmitted infections exists in Israel. Further understanding of factors influencing the decreasing gender differences is required to reorient and tailor HIV/AIDS interventions to most effectively reach young adults of both sexes.

Trends in Sunscreen Use Among U.S. High School Students: 1999–2009 - Corrected Proof

Sherry Everett Jones, Mona Saraiya, Justin Miyamoto, Zahava Berkowitz — 2011-06-29

Abstract: Purpose: To examine trends in sunscreen use during 1999–2009 among U.S. high school students.Methods: Data from the 1999–2009 national Youth Risk Behavior Surveys were analyzed. The surveys used a three-stage cluster sample design to produce nationally representative samples of students in grades 9–12 attending public and private schools. Student participation in the survey was anonymous and voluntary. Participants completed a self-administered questionnaire during a regular class period. The overall response rates ranged from 63% to 72%.Results: During 1999–2009, the percentage of white students who never or rarely wore sunscreen when outside on a sunny day for >1 hour increased (from 57.5% to 69.4%), as did the percentage among Hispanic students (from 71.6% to 77.9%). This increase was most pronounced among white female students. The percentage of white and Hispanic students who most of the time or always wore sunscreen decreased during this same period. Rates of sunscreen use did not change among black students.Conclusions: Because of declines in sunscreen use, professionals in clinical, school, and community settings should emphasize the important role sunscreen may play in preventing skin cancer.

Retaliatory Attitudes and Violent Behaviors Among Assault-Injured Youth - Corrected Proof

2011-06-13

Abstract: Objectives: To examine the effect of retaliatory attitudes on subsequent violent behavior and fight-related injuries among youth who presented to the emergency department with assault injuries.Design: Assault-injured youth were interviewed at baseline, 6 months, and 18 months to assess fighting behavior, retaliatory attitudes, weapon carrying, and injury history as part of a larger randomized control trial.Setting: Two emergency departments in urban areas were selected for the study.Participants: A total of 129 adolescents aged 10–15 years were included in the study.Outcome measures: Fighting behavior, assault injury, weapon carrying, and aggressive behavior.Results: Higher retaliatory attitudes at baseline were associated with more aggression and a higher frequency of fighting over time.Conclusions: Retaliatory attitudes may fuel cycles of violence among youth. Medical professionals in acute care settings have an opportunity to identify youths at risk of future assault injury by assessing retaliation, providing anticipatory guidance, and referring to intervention programs.

WITHDRAWN: Alcohol Expectancies Among Adolescent Non-Drinkers: They May Not Be Drinking Now, But They Are “Thinkin Bout It” - Corrected Proof

Byron L. Zamboanga, Lindsay S. Ham, Kathryne Van Tyne, Nnamdi Pole — 2010-05-10

This article has been withdrawn at the request of the authors and/or editor. The Publisher apologizes for any inconveniences this may cause.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy

WITHDRAWN: Awareness of the Implications of Tattoo Removal among 4,277 Italian Secondary School Adolescents - Corrected Proof

2010-03-04

The Publisher regrets that this article is an accidental duplication of an article that has already been published, doi:10.1186/1471-2458-10-73. The duplicate article has therefore been withdrawn.