Feasibility and acceptability of a web-based HIV/STD prevention program for adolescent girls targeting sexual communication skills.

Adolescent girls are at substantial risk of sexually transmitted diseases including HIV. To reduce these risks, we developed Health Education And Relationship Training (HEART), a web-based intervention focused on developing sexual assertiveness skills and enhancing sexual decision-making. This study assessed the feasibility and acceptability of this new program and examined if perceived acceptability varied according to participant ethnicity, sexual orientation or sexual activity status. Participants were part of a randomized controlled trial of 222 10th-grade girls (Mage = 15.26). The current analyses included those in the intervention condition (n = 107; 36% white, 27% black and 29% Hispanic). HEART took approximately 45 min to complete and was feasible to administer in a school-based setting. Participants found the program highly acceptable: 95% liked the program and learned from the program, 88% would recommend the program to a friend and 94% plan to use what they learned in the future. The primary acceptability results did not vary by the ethnicity, sexual orientation or sexual activity status of participants, suggesting broad appeal. Results indicate that this new online program is a promising method to reach and engage adolescents in sexual health education.

Overt and relational aggression in adolescents: social-psychological adjustment of aggressors and victims.

Examined the relative and combined associations among relational and overt forms of aggression and victimization and adolescents' concurrent depression symptoms, loneliness, self-esteem, and externalizing behavior. An ethnically diverse sample of 566 adolescents (55% girls) in Grades 9 to 12 participated. Results replicated prior work on relational aggression and victimization as distinct forms of peer behavior that are uniquely associated with concurrent social-psychological adjustment. Victimization was associated most closely with internalizing symptoms, and peer aggression was related to symptoms of disruptive behavior disorder. Findings also supported the hypothesis that victims of multiple forms of aggression are at greater risk for adjustment difficulties than victims of one or no form of aggression. Social support from close friends appeared to buffer the effects of victimization on adjustment.

Multimethod assessment of suicidality in adolescent psychiatric inpatients: preliminary results.

OBJECTIVE: To examine agreement among multiple assessments of adolescent suicidal ideation and suicidal behavior for adolescent psychiatric inpatients, including pencil/paper checklists; structured and unstructured interviews; and adolescent, clinician, and parent reports, and to provide suggestions for the accurate and reliable assessment of suicidality in adolescence. METHOD: Participants included 153 adolescent psychiatric inpatients (54 boys, 99 girls) between the ages of 12 and 17 years. Measurement of suicidal ideation and behavior included common assessment instruments and standard clinical practices, including the Suicidal Ideation Questionnaire, NIMH Diagnostic Interview Schedule for Children, clinician interview, and parent report (Behavior Assessment Scale for Children). RESULTS: Results revealed significantly different rates of suicidality across each instrument and poor to moderate agreement between similar measures of adolescent suicidal ideation and suicidal behavior. Agreement between measures was generally best for boys, for older adolescents, and for assessments relying on a single informant. Reporters were most likely to agree on the presence of suicidality for more severely suicidal adolescents; this finding suggests that agreement in itself may be a useful marker for adolescent suicide. CONCLUSIONS: Results of this preliminary study supported the use of multiple measurement approaches when examining adolescent suicidality, particularly those that rely on clinician judgment and adolescents' own reports. Implications for future research and for clinical practice are also discussed.

Adolescents' and their friends' health-risk behavior: factors that alter or add to peer influence.

OBJECTIVE: To examine models of risk for adolescent health-risk behavior, including family dysfunction, social acceptance, and depression as factors that may compound or mitigate the associations between adolescents' and peers' risk behavior. METHODS: Participants were 527 adolescents in grades 9-12. Adolescents reported on their substance use (cigarette and marijuana use, heavy episodic drinking), violent behavior (weapon carrying, physical fighting), suicidality (suicidal ideation and attempts), and the health-risk behavior of their friends. RESULTS: Adolescents' substance use, violence, and suicidal behavior were related to their friends' substance use, deviance, and suicidal behaviors, respectively. Friends' prosocial behavior was negatively associated with adolescent violence and substance use. Family dysfunction, social acceptance, and depression altered the magnitude of association between peers' and adolescents' risk behavior. In cumulative risk factor models, rates of adolescent health-risk behavior increased twofold with each added risk factor. CONCLUSIONS: Results supported both additive and multiplicative models of risk. Implications for intervention and primary prevention are discussed.

Adolescent peer crowd affiliation: linkages with health-risk behaviors and close friendships.

OBJECTIVE: To examine adolescents' peer crowd affiliation and its linkages with health-risk behaviors, their friends' health-risk behaviors, the presence of close friends in the same peer crowd, and adolescents' social acceptance. METHODS: We interviewed 250 high school students and identified six categories: popular, jocks, brains, burnouts, nonconformists, or average/other. Adolescents also reported on their health-risk behaviors (including use of cigarettes, alcohol, marijuana and other drugs; risky sexual behaviors; and other risk-taking behaviors), the health-risk behaviors of their friends, the peer crowd affiliation of their closest friends, and their perceived social acceptance. RESULTS: Burnouts and nonconformists had the highest levels of health-risk behaviors across the areas assessed, the greatest proportions of close friends who engaged in similar behaviors, and relatively low social acceptance from peers. Brains and their friends engaged in extremely low levels of health-risk behaviors. Jocks and populars also showed evidence of selected areas of health risk; these teens also were more socially accepted than others. In general, adolescents' closest friends were highly nested within the same peer crowds. CONCLUSIONS: The findings further our understanding of adolescent behaviors that put them at risk for serious adult onset conditions associated with high rates of morbidity and mortality. We discuss the implications of the findings for developing health promotion efforts for adolescents.

Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity.

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.

Patterns of children's coping with life stress: implications for clinicians.

In a study of children's patterns of coping with daily stressors, boys and girls 9-17 years old were asked to complete a coping checklist in response to one of four types of stressors--school, parents/family, siblings, or peer/interpersonal. Patterns of coping-strategy use were found to be similar across the various stressors, with wishful thinking, problem-solving, and emotional regulation being among those most frequently used. Older adolescents, compared to younger children, tended to use a broader range of coping strategies, regardless of stressor. Implications for clinical practice are discussed.

Links between mothers' and children's social competence and associations with maternal adjustment.

Extended previous research on family factors related to children's social competence by examining links between 3 domains of maternal social competence (social skills, social frames, network size) and 3 domains of children's social competence (social skills, peer-rated social preference, and network size) in a sample of 78 mothers and their kindergarten children (42 girls, 36 boys). The mediational role of maternal social competence in the association between mothers' depression and interpersonal sensitivity symptoms and children's social competence was also tested. Results supported associations between all 3 domains of mothers' and children's social competence, with maternal social skills the most frequent predictor of children's social competence. Gender differences suggested that maternal social competence was more strongly related to sons' peer acceptance and daughters' social skills. A mediational model received preliminary support for girls, with maternal psychological symptoms related to girls' social competence via maternal social skills. Implications include the need for continued study of maternal social competence as a family factor related to children's peer functioning and the development of family-based interventions for young children experiencing peer problems.

Symptoms of posttraumatic stress in children after Hurricane Andrew: a prospective study.

The authors examined symptoms of posttraumatic stress in 3rd-5th grade children during the school year after Hurricane Andrew. From a conceptual model of the effects of traumatic events, 442 children were evaluated 3, 7, and 10 months postdisaster with respect to (a) their exposure to traumatic events during and after the disaster, (b) their preexisting demographic characteristics, (c) the occurrence of major life stressors, (d) the availability of social support, and (e) the type of coping strategies used to cope with disaster-related distress. Although symptoms of posttraumatic stress disorder (PTSD) declined over time, a substantial level of symptomatology was observed up to 10 months after the disease. All 5 factors in the conceptual model were predictive of children's PTSD symptoms 7 and 10 months postdisaster. Findings are discussed in terms of the potential utility of the model for organizing thinking about factors that predict the emergence and persistence of PTSD symptoms in children.

Prediction of posttraumatic stress symptoms in children after hurricane Andrew.

The authors used an integrative conceptual model to examine the emergence of posttraumatic stress disorder (PTSD) symptoms in 568 elementary school-age children 3 months after Hurricane Andrew. The model included 4 primary factors: Exposure to Traumatic Events, Child Characteristics, Access to Social Support, and Children's Coping. Overall, 62% of the variance in children's self-reported PTSD symptoms was accounted for by the 4 primary factors, and each factor improved overall prediction of symptoms when entered in the analyses in the order specified by the conceptual model. The findings suggest that the conceptual model may be helpful to organize research and intervention efforts in the wake of natural disasters.