Relations Between Interpersonal Microaggressions, Depressive Symptoms, and Pet Attachment in an LGBTQ+ Emerging Adult Sample.

Exposure to microaggressions can have detrimental impacts on the mental health of LGBTQ+ emerging adults. Positive social relationships are a well-documented protective factor that help to buffer the impact of adversity on mental health in this population. However, the role of social relationships with pets has received minimal attention in research on LGBTQ+ mental health, despite the high prevalence of pets in U.S. households. This cross-sectional study examined whether the association between interpersonal microaggressions and depressive symptoms among LGBTQ+ emerging adults varied as a function of attachment to pets across three domains: love, emotion regulation, and personal growth. We recruited 163 LGBTQ+ emerging adults (18-21 years) who lived with a cat and/or dog within the past year (98.8% sexual minority, 47.2% gender minority, 37.4% racial/ethnic minority). We found that love and emotion regulation significantly moderated the positive association between interpersonal microaggressions and depressive symptoms. Specifically, this association was only significant when love and emotion regulation were at moderate or high levels. These findings have important implications for practice with LGBTQ+ pet owners, as it suggests that high levels of pet attachment may amplify the relation between interpersonal microaggressions and depressive symptoms.

Rationale, formative research, and protocol for Calma, Conversa, y Cría: A pilot mindful parenting intervention with Latina women.

Background: Latina mothers' stress is associated with their children's health behaviors and risk for obesity; however, existing pediatric health promotion programs have not focused on maternal stress reduction. Methods: Herein we describe a study design that will examine the acceptability and feasibility of Calma, Conversa, y Cría (CCC) a 6-week mindful parenting intervention designed to reduce stress. We present the results of qualitative research with Latina mothers and experts in Latinx health and mindfulness who provided culturally-relevant feedback on existing mindful parenting strategies to inform the development of CCC. Fifty Latina mothers of children ages 3-11 years will be randomly assigned to CCC or an enhanced usual care health education intervention. Acceptability will be assessed through participant satisfaction surveys and exit interviews. Feasibility will be determined through detailed tracking of recruitment, retention, and attendance rates. A signal regarding any group differences in maternal stress, health-related parenting practices, child diet, child physical activity, and child quality of life will be explored. Discussion: The development of interventions that can reduce maternal stress and risk for obesity in Latinx children is critical to significantly reduce negative health impacts in this underserved population. Our approach includes the identification of effective cultural adaptations that should improve the feasibility and acceptability of mindful parenting strategies in Latinx families, ideally reducing maternal stress and improving parenting behaviors related to child health. If successful, CCC will be examined in a larger efficacy trial involving the measurement of objective biomarkers of children's chronic disease risk.

A longitudinal test of Mexican-origin teen mothers' cultural characteristics and children's Spanish vocabulary via mothers' Spanish language use.

OBJECTIVES: The present study examined whether teen mothers' adaptive cultural characteristics (i.e., familism values, language competency pressures, and involvement in Mexican culture and U.S. mainstream culture) when children were 3 years old (i.e., Wave 4; W4) informed mothers' Spanish language use with their children when children were 4 years old (W5) and, in turn, children's subsequent Spanish receptive vocabulary when children were 5 years old (W6). METHOD: The present study included 204 Mexican-origin children (58% male) and their mothers who entered parenthood during adolescence (M = 16.24, SD = .99 at W1). RESULTS: Five mediational processes were significant, such that mothers' higher familism values (i.e., emphasizing family support and obligations), Spanish competency pressure (i.e., stress associated with Spanish language competency), and involvement in U.S. mainstream culture at W4 were associated with mothers' lower Spanish language use with children at W5 and, in turn, children's lower levels of Spanish receptive vocabulary at W6. Mothers' greater involvement in Mexican culture and English competency pressure (i.e., stress associated with English language competency) at W4 were associated with mothers' greater Spanish language use with children at W5 and, in turn, children's greater Spanish receptive vocabulary at W6. Additionally, mothers' greater involvement in U.S. mainstream culture at W4 was directly associated with children's lower Spanish language abilities at W6. CONCLUSIONS: Findings highlight the importance of the family context in Mexican-origin children's Spanish language skills over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Changes in caregiver mental health and pediatric asthma control during COVID-19.

OBJECTIVE: This study evaluated caregivers' stress and depressive symptoms, and children's asthma control, before COVID-19 began and after its onset among families in the RVA Breathes program. METHODS: The RVA Breathes intervention, which took place in an urban city in the United States, includes asthma education delivered by a community health worker (CHW), a home assessment, and school nurse components. Participants included 125 children (5-11 years) with asthma and their caregivers (48% household income <$25,000) enrolled prior to the pandemic. Families were randomized to an active intervention arm (full intervention or intervention without school nurse component) or the control group. Caregivers completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Perceived Stress Scale (PSS); children and caregivers completed the Childhood Asthma Control Test (cACT). Assessments pre-COVID-19 were compared to those completed after the pandemic's onset. RESULTS: Children in both intervention groups had better cACT scores after the start of COVID-19 compared to before (t(55) = -2.131, p = .019; t(28) = -2.893, p = .004). Caregivers in the intervention groups had lower PSS scores after the start of COVID-19 compared to pre-COVID-19 (t(53) = 3.928, p < .001; t(28) = 2.568, p = .008). Furthermore, CES-D scores improved among caregivers in the full intervention (t(48) = 1.789, p = .040). Caregivers in the control condition did not report significant changes in stress or depressive symptoms. CONCLUSIONS: Findings suggest that support from interventionists, including CHWs, might have alleviated stress and depressive symptoms during COVID-19, as well as improved asthma control during the pandemic.

Processes underlying Mexican adolescents' sexual behaviors and intentions: Examining the roles of familial cultural values and parental monitoring.

OBJECTIVES: The study examined the associations between familial cultural values of familismo (familism) and respeto (respect), parental monitoring, and Mexican adolescents' sexual behaviors. METHOD: The sample consisted of 1,024 Mexican adolescents (12-18 years) from two urban schools in Puebla, Mexico. RESULTS: Findings indicated that respeto was associated with paternal and maternal monitoring, sexual responsibility, sexual intention, and sexual behavior. Further, through indirect effects, among males, respeto was associated with paternal monitoring, which was, in turn, associated with sexual intentions. CONCLUSIONS: Findings highlight the relevance of caregivers and cultural values in Mexican adolescents' sexual health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived Stress, Religiosity, and Substance Use Among African American and Latinx College Students with Asthma in the USA.

This study examined associations among perceived stress, religiosity, and substance use in African American and Latinx college students with asthma. Participants included 194 college students with asthma (18-20 years, 63.4% African American, 21.1% Latinx). Eligible students completed an online questionnaire that included measures of asthma control, perceived stress, religiosity, alcohol misuse, and last 30-day tobacco use and marijuana use. Over one-quarter (25.3%) of participants reported using tobacco and 31.9% reported using marijuana in the past 30 days. Perceived stress and religiosity were each independently associated with multiple indicators of substance use. Asthma control moderated associations between religiosity and tobacco use in the past 30 days (b = - .014, p = .002), such that the association between religiosity and tobacco use was stronger among those with better asthma control. Participant gender significantly moderated the association between perceived stress and alcohol misuse (b = - .099, p = .029); a stronger, positive association between stress and alcohol misuse was found among men. Students' perceived stress levels were associated with marijuana use in the past 30 days and high alcohol misuse. Religiosity was inversely linked to substance use. There is a need for healthcare providers to recognize and focus on substance use prevention specifically among African American and Latinx college students with asthma.

The COVID-19 pandemic: asthma control, tobacco use, and mental health among African American and Latinx college students.

OBJECTIVE: This study investigated the impact of COVID-19 on tobacco use and mental health in US African American and Latinx college students with asthma. Associations among asthma control, tobacco use, and mental health were also examined. METHODS: 105 African American and Latinx college students with asthma (18-23 years) completed two online questionnaires (June 2019-March 2020 for Time 1; August 2020-October 2020 for Time 2). Participants completed the Epidemic-Pandemic Impacts Inventory (measure of COVID-19 impact), Asthma Control Test, Generalized Anxiety Disorder scale, Patient Health Questionnaire (measure of depression), Perceived Stress Scale, and items related to tobacco use. RESULTS: Asthma control improved (t = -3.326, p = 0.001) from Time 1 to 2, and e-vapor product use decreased (χ2104 = 6.572, p = 0.010). COVID-19 impact was positively associated with students' symptoms of anxiety, depression, and perceived stress (B = 0.201, p < 0.001; B = 0.179, p < 0.001; and B = 0.199, p = 0.001, respectively) at Time 2. These results remained significant with the Benjamini-Hochberg correction. Asthma control at Time 1 was negatively associated with anxiety symptoms at Time 2 (B = -0.418, p = 0.023); however, associations with perceived stress (B = -0.514, p = 0.019) and all other tobacco product use (B = -0.233, p = 0.030) did not remain significant with the Benjamini-Hochberg correction. CONCLUSIONS: As hypothesized, a higher COVID-19 impact score was associated with students endorsing more mental health symptoms. Better control of asthma symptoms before the pandemic predicted fewer anxiety symptoms during the pandemic.

Culturally enhancing a group-based motivational interviewing substance use prevention program for Latine youth.

Background: Group Motivational Interviewing for Teens (GMIT) has been effective in reducing youth substance use in diverse communities, yet more research is needed to determine its efficacy in reducing tobacco and alternative tobacco products (ATP) use among Latine adolescents. This study modified GMIT to include a focus on ATPs (GMIT-ATP). GMIT was also linguistically translated so it could be offered in English and Spanish, culturally enhanced, and parent sessions were added (GMIT-ATP + P). Methods: The study's aims were to 1) Develop a model of how cultural context, family relationships, and adolescent tobacco-related skills/beliefs are associated with smoking and ATP use; 2) Examine the impact of the GMIT-ATP intervention on adolescent tobacco use; 3) Examine whether the GMIT-ATP + P intervention improves family/parenting factors associated with reduced adolescent tobacco use; 4) Examine whether GMIT-ATP + P is more effective than GMIT-ATP in improving adolescent tobacco use; 5) Explore whether essential components of our behavior change model mediate the impact on tobacco use, and 6) Explore whether cultural factors influence the impacts of our intervention. Latine adolescents (ages 10-16) and their parents/guardians were recruited throughout Virginia. Parents and adolescents completed three surveys: before and immediately after the program ends and at 3-months post-intervention. Families attended 3 GMIT-ATP or GMIT-ATP + P sessions. Conclusion: Findings from this study will be disseminated in Latine communities and with providers working with Latine youth and can serve as a community-based model to reduce substance and tobacco use (e.g., ATP) in these Latine communities.

Discrimination and Health Among First-Generation Hispanic/Latinx Immigrants: the Roles of Sleep and Fatigue.

INTRODUCTION: A growing literature documents the associations between discrimination and health. Emerging evidence suggests that among Hispanic/Latinx immigrants, discrimination leads to the deterioration of health outcomes over time. While sleep has been proposed as an important mediator of the relationship between discrimination and health, few studies have explicitly investigated this pathway, particularly among Hispanic/Latinx populations. OBJECTIVE: To investigate the relationships between racial/ethnic discrimination, sleep, and physical and mental health among Hispanic/Latinx immigrants in the USA. Data and Methods Using data from a parent study of first-generation Hispanic/Latinx immigrants in the southeastern USA, we conducted sequential mediation analyses using the bootstrapping method to investigate whether self-reported sleep duration, sleep quality, and fatigue mediate the relationship(s) between self-reported discrimination, as measured by the discrimination subscale of the Riverside Acculturative Stress Inventory, and self-reported physical and mental health. RESULTS: Nocturnal awakenings, fatigue, and sleep quality were statistically significant sequential mediators of the relationship between discrimination and physical health (b = -.001, SE = .001, CI [-.0027, -.0001]); fatigue alone also mediated this relationship (b = -.01, SE = .01, CI [-.0279, -.0003]). Nocturnal awakenings, fatigue, and sleep quality were also significant sequential mediators of the relationship between discrimination and mental health (b = -.001, SE = .001, CI [-.0031, -.0001]). CONCLUSION: Sleep and fatigue play an important role in linking discrimination and health among first-generation Hispanic/Latinx immigrants. The development and implementation of interventions that focus on reducing fatigue among this population could mitigate the effects of unfair treatment on health outcomes.

Adaptations to the RVA Breathes clinical trial due to the COVID-19 pandemic.

RVA Breathes, a community program to improve asthma management and care coordination among children living in a low-income, urban area, is being evaluated in a randomized clinical trial. In March 2020, RVA Breathes was converted to a remote program due to the COVID-19 pandemic; this report provides an update on the modifications made to the RVA Breathes trial. Additionally, given that families in the program have been disproportionally impacted by both COVID-19 and significant social unrest at both the local and national level, strategies used to enroll and engage families in the trial who bore disproportionately high burdens during this time period are outlined. Remote sessions (telephone or video) for families enrolled in the program prior to the onset of COVID-19 began in April 2020; enrollment of new families began remotely in July 2020 using adapted consent procedures. Baseline, intervention, and follow-up sessions were delivered either via the telephone or video depending upon family preference. Strategies were implemented to engage caregivers and children in completing measures over the telephone or video versus in person. Tangible intervention materials and participant payments were dropped off at family homes using contactless procedures. Our team was able to adapt and safely continue a large, community-based clinical trial, despite the increased health risks and social isolation mandates from the pandemic, by transitioning to a remote format. Challenges remain in determining whether RVA Breathes as a remote program has had the same impact on child asthma as the face-to-face interventions that comprised its original format.

Ethnic discrimination and weight outcomes among Latinx emerging adults: Examinations of an individual-level mediator and cultural moderators.

OBJECTIVES: Latinxs have the highest prevalence of obesity in the United States, which can further contribute to the pervasive disparities in morbidity and mortality. Although the experience of discrimination is associated with obesity in racial/ethnic minorities, mediators and moderators of this association, specifically among Latinx emerging adults, have been understudied. The present study investigated an individual-level mediator (eating disorder symptoms) and cultural moderators (familismo support, ethnic identity affirmation) of the association between perceived discrimination and body mass index (BMI) among Latinx emerging adults. METHOD: Secondary analysis was conducted using cross-sectional data obtained from 198 Latinx emerging adults (70% female, Mage = 20.59, SDage = 1.78). RESULTS: Participants who reported greater, as opposed to fewer, experiences of ethnic discrimination were likely to report more eating disorder symptoms, which in turn was associated with increased BMI. There was no evidence supporting familismo support or ethnic identity affirmation as moderators, suggesting that even those with high levels of familismo or ethnic identity were susceptible to the negative consequences of the experience of ethnic discrimination. CONCLUSIONS: Addressing health-compromising eating behaviors and attitudes among Latinx emerging adults might be one effective means to addressing the negative consequences of discrimination on weight-related outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Considerations to Youth's Psychopathology and Mental Healthcare Disparities Research through the Intersections of Dominant and Non-dominant Identities.

This article presents a commentary on the interactive associations of demographic factors on youth's psychopathology and mental health service utilization. Intersectionality allows for a more comprehensive understanding of how intersecting non-dominant identities play a role in health outcomes and mental health treatment use. However, these studies can consider conceptualizing intersectionality beyond the methods/statistics, as well as attend to the broader context around what the scientific data is informing. Further, it is imperative that researchers conducting this type of work consider multiple possible interpretations and acknowledge the researcher(s) positionality. Research implications that incorporate intersecting non-dominant demographic identities and its role with other broader systems of position, privilege, and power are therefore discussed. In doing so, these implications may further contribute to the discussion of youth's mental health- and mental healthcare-disparities.

A community-based asthma program: Study design and methods of RVA Breathes.

Disparities in pediatric asthma morbidity and healthcare utilization exist on the basis of race, ethnicity, environment, and income; interventions are needed to address these inequities. The following protocol describes an evidence-based intervention, RVA Breathes, designed to coordinate pediatric asthma care across family, home, community, and medical sectors. Community stakeholder feedback was utilized to refine the intervention specifically for the Richmond, Virginia community. The aims of this study are to assess the effect of RVA Breathes on asthma-related healthcare utilization, as well as secondary outcomes of asthma control, asthma symptoms, and quality of life. We will enroll 300 elementary school children from the Richmond City Public School system. Participants will be between the ages of 5-11, have a diagnosis of asthma, and have had an asthma exacerbation (as indicated by an asthma-related ED visit, hospitalization, unscheduled PCP visit, or use of systemic steroids) in the last two years. Participants will be randomized to one of three groups: asthma education + home environment remediation + school intervention, asthma education + home environment remediation, or a comparator condition. Data will be collected across one baseline research visit, four intervention sessions, and four follow-up research visits over the course of 18 months. A General Linear Mixed Model (GLMM) will be used to test primary aims. We expect the findings will provide support for coordination of asthma care across sectors. Further, we hope RVA Breathes will serve as a model of community-based pediatric asthma care.

Integrating Tobacco Prevention Skills into an Evidence-Based Intervention for Adolescents with ADHD: Results from a Pilot Efficacy Randomized Controlled Trial.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for tobacco use, but tobacco use prevention strategies are not regularly incorporated into evidence-based ADHD interventions. We conducted a pilot randomized-controlled trial to determine the feasibility of integrating tobacco use prevention skills into a behavioral treatment for ADHD and to provide preliminary efficacy data comparing a combined (ADHD + tobacco) intervention (N = 40) to an ADHD only intervention (N = 23) on tobacco risk outcomes. Sixty-three adolescents (72% male; 13-17 years) with ADHD and their caregivers were randomly assigned to condition and families were masked to condition. Parent and adolescent ratings were collected at baseline, immediate post-intervention, and at 3- and 9-month follow-up assessments. The combined intervention was (1) implemented with high fidelity (94%), (2) well received by parents and adolescents as evidenced by high levels of treatment attendance (82%) and satisfaction with the intervention, and (3) associated with parent- and adolescent-reported reductions in tobacco use risk. Relative to the ADHD intervention, the combined intervention buffered against increases in tobacco risk, including reduced intentions to smoke and maladaptive social normative beliefs, and increased parental control, family cohesion, and family communication about substance use. Effect sizes at post-treatment were in the small to moderate range. Overall, this study provides preliminary support for a parent-adolescent behavioral treatment supplemented with family-based tobacco prevention strategies. This approach targets families already in treatment for ADHD, reducing barriers that occur when families attend multi-session prevention programs in addition to ADHD treatment.

School Nurses' Perspectives on Components of Asthma Programs to Address Pediatric Disparities.

OBJECTIVE: To use a community engaged, collaborative approach with school nurses working within an urban community, to develop recommendations for future school-based interventions targeting pediatric asthma disparities. METHODS: Open-ended survey data were collected from 33 nurses (77% of nurses in the school district) during a face-to-face monthly health services meeting. Questions asked nurses to estimate the proportion of students with asthma with the necessary forms and medications at school and to describe perceived barriers to having such forms and medications, and potential initiatives that could be implemented. A 30-min asthma education class was also piloted with school nurses, who then rated its acceptability and feasibility. Open-ended survey data were analyzed using thematic analysis. RESULTS: Nurses estimated that 12% of students with asthma had an asthma action plan, 19% had a medication release form, and 15% had medications at school (i.e. inhalers). Four themes emerged regarding barriers to asthma management in schools and strategies for promoting asthma management in schools: coordination of care, asthma education, access to care, and medication adherence. Nurses noted the need for education focused specifically on teaching inhaler technique, and better communication between schools, providers, and families. CONCLUSIONS: School nurses provided valuable information regarding specific barriers, as well as approaches to addressing these barriers in a future intervention. Findings suggest that a school-based intervention needs to address coordination among schools, parents, and medical providers, and will be optimally effective if it also addresses structural barriers.

Engaging with the Richmond Community to Reduce Pediatric Asthma Disparities: Findings from a Community-engaged Needs Assessment.

Childhood asthma disparities persist, with children living in low-income areas experiencing worse morbidity. We partnered with a community-academic research team and stakeholders to conduct a needs assessment to understand barriers and supports to asthma treatment. We convened a community advisory board, comprised of parents of children with asthma, youth with asthma, and members of key community organizations. Two focus groups with parents of children with asthma and four focus groups with youth with asthma were conducted, and a survey was administered to 100 parents. A visual mapping process was used to gather qualitative data about barriers, strategies, and outcomes, and allowed advisory board members to interpret focus group and survey data within the lived experiences of families. Focus group themes included parent stress/anxiety, concerns about school nurses, and lack of trust in providers. Findings from focus groups and surveys suggested that emergency department visits were not perceived negatively by families, although health providers and researchers generally view them as such. Public health implications include systemic changes that allow the healthcare system to address families' acute needs and worry. A community program focused on education and coordination among families, schools, and medical homes might improve asthma outcomes at the population level.

The relation between body image perceptions, parental messages, and depressive symptoms among Latinx college students.

OBJECTIVES: This study examines the role of parental messages about body image in relation to body image dissatisfaction (BID) and depressive symptoms among Latinx college students. We assessed negative and positive messages about body image from mothers and fathers to examine the indirect effect of BID in explaining links from parental communication to depressive symptoms. METHOD: The sample included 198 Latinx college students in the southeastern United States (age range 18-25, 70% female). We used four mediation models, whereby parental comments were modeled to affect depressive symptoms through BID. RESULTS: Results indicated that although there was no direct effect between parental messages and depressive symptoms, both negative maternal and paternal comments had indirect effects on depressive symptoms via BID. CONCLUSIONS: Parental messages about body image have significant implications for understanding the etiology of BID and concomitant depressive symptoms among Latinx college students. The findings highlight the important role of parental communication in Latinx student health and the need for future studies to better understand Latinx college students' interpretations of their parents' positive and negative comments. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Relationship Between Body Image Perceptions and Condom Use Outcomes in a Sample of South African Emerging Adults.

HIV continues to be a health priority in South Africa. Consistent condom use helps prevent HIV, yet less than half of South African emerging adults use condoms consistently. Cultural beliefs about illnesses (e.g., being thin is perceived to be a sign of HIV infection) suggest that body image perceptions may play a role in emerging adults' condom use outcomes. We explored the relationships between body image perceptions (i.e., body dissatisfaction, body consciousness) and condom use outcomes (e.g., attitudes, negotiation efficacy, past use) in a sample of South African emerging adults. Participants (n = 379) recruited from university residences completed an anonymous survey. Participants' mean age was 21.79 years, 54.6% were female, 96.1% identified as Black African, and 73.5% reported primarily speaking IsiZulu. For women, the relationship between body dissatisfaction and condom negotiation efficacy was mediated by body consciousness and condom use attitudes after controlling for BMI, relationship status, and mental health symptoms. Further, the relationship between body dissatisfaction and past condom use was mediated by body consciousness. These results were not significant for men. Findings from this study suggest that integrating messages about body image perceptions into HIV prevention efforts targeting South African emerging adult women may be warranted.

Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes.

OBJECTIVE: Adolescents with type 1 diabetes (T1D) frequently experience deterioration in glycemic control. Providers have unique opportunities to address diabetes self-management, yet little is known about the most effective way to communicate with adolescents. This investigation used a motivational interviewing (MI) framework to characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined relations between adolescent patient-provider communication and (a) T1D self-management and (b) glycemic control (hemoglobin A1c [HbA1c]). METHODS: Medical encounters between pediatric endocrine providers and 55 adolescents with T1D (49% female; M age = 14.8 years; M baseline HbA1c = 8.6%) were audio recorded and coded using standardized rating instruments. Patients and parents completed measures assessing T1D care behaviors and self-efficacy. Assessments were completed at routine endocrinology visits (baseline) and 1 and 3-month post-baseline; HbA1c was obtained from medical records at baseline and 3-month. RESULTS: Hierarchical multiple regressions showed that greater provider use of MI non-adherent behaviors (eg, confronting, persuading) was associated with (a) poorer 3-month HbA1c, P < 0.001; (b) worse 1-month adolescent diabetes adherence P < 0.001, and (c) lower diabetes self-efficacy at 1-month (P < 0.001) follow-up. Lower patient self-efficacy for diabetes self-management mediated the relation between provider use of MI non-adherent language and lower diabetes adherence (P = 0.020). CONCLUSION: Providers' use of persuasion and confrontation regarding risks of non-adherence was associated with poorer glycemic control and adherence. Communication training for providers that targets reductions in MI-inconsistent language may have the potential to improve diabetes self-care in this vulnerable population.

Addressing Barriers to Recruitment and Retention in the Implementation of Parenting Programs: Lessons Learned for Effective Program Delivery in Rural and Urban Areas.

Research has demonstrated the effectiveness of family-based programs for reducing adolescent risk behaviors and promoting adolescent health; however, parent engagement, specifically in terms of recruitment and retention, remains a consistent challenge. Recruitment rates for family-based prevention programs range from 3 to 35%, while, on average, 28% of caregivers drop out before program completion. Thus, engagement of parents in prevention programming is of utmost concern to ensure families and youth benefit from implementation of family-based programs. In this manuscript, two Centers for Disease Control and Prevention-funded projects share their experiences with engagement of parents in violence prevention programs. Problems related to parent engagement are reviewed, as are structural, attitudinal, and interpersonal barriers specific to recruitment and retention. Examples of successful implementation strategies identified across urban and rural sites are also analyzed and lessons learned are provided.