Human Papillomavirus-Associated Sexual Risks Among High School Students in the U.S.: Does Sexual Orientation Play a Role?

We examined the association between sexual orientation and human papillomavirus (HPV)-related risky sexual behaviors among high school students in the U.S. We used the 2015 Youth Risk Behavior Survey, a three-stage cluster sample, nationally representative, cross-sectional study. Participants were sexually active students (Grades 9-12) in public, private, and Catholic schools in 50 states and the District of Columbia (n = 5,958). Sexual orientation dimensions were: sexual self-identity (heterosexual, gay, lesbian, bisexual, and not sure) and sex of sexual contacts. HPV-associated risky sexual risk behaviors selected a priori were early sexual debut (≤ 12 or ≥ 13 years old) and number of lifetime partners (≥ 2 or ≥ 4). Separate multiple logistic regression analyses estimated association between sexual orientation and sex of sexual contacts, and HPV-associated risky sexual behaviors. Among the 5,958 high school students, a quarter had ≥ 4, and two-thirds had ≥ 2 sexual partners. Students who self-identified as bisexual (aOR = 2.43, 99% CI 1.19-4.98) or "not sure" (aOR = 4.56, 99% CI 2.54-8.17) were more likely to have sexual debut before 13 years. Similarly, students whose sexual contacts were adolescent females who had sex with females and males were more likely to have sexual debut before they turned 13 years of age (aOR = 3.46, 99% CI 1.83-6.48), or had ≥ 4 sexual partners (aOR = 2.66, 99% CI 1.74-4.08), or had ≥ 2 sexual partners (aOR = 3.09, 99% CI 1.91-5.00). In conclusion, HPV-associated risky sexual behavior is prevalent among high school students, especially sexual minorities. Interventions tailored to this population could increase HPV vaccine uptake and prevent future HPV-associated cancers and other negative outcomes.

Families' Experiences With Family Navigation Services in the Autism Treatment Network.

BACKGROUND AND OBJECTIVES: Families of children with autism spectrum disorder (ASD) often experience challenges navigating multiple systems to access services. Family navigation (FN) is a model to provide information and support to access appropriate services. Few studies have been used to examine FN's effectiveness for families of children with ASD. This study used mixed methods to (1) characterize FN services received by a sample of families in the Autism Treatment Network; (2) examine change in parent-reported activation, family functioning, and caregiver strain; and (3) explore families' experiences with FN services. METHODS: Family characteristics and parent outcomes including parent activation, family functioning, and caregiver strain were collected from 260 parents in the Autism Treatment Network. Descriptive statistics and linear mixed models were used for aims 1 and 2. A subsample of 27 families were interviewed about their experiences with FN services to address aim 3. RESULTS: Quantitative results for aims 1 and 2 revealed variability in FN services and improvement in parent activation and caregiver strain. Qualitative results revealed variability in family experiences on the basis of FN implementation differences (ie, how families were introduced to FN, service type, intensity, and timing) and whether they perceived improved skills and access to resources. CONCLUSIONS: Findings suggest FN adaptations occur across different health care delivery systems and may result in highly variable initial outcomes and family experiences. Timing of FN services and case management receipt may contribute to this variability for families of children with ASD.

I Get By With A Little Help From My Friends: Models of Psychological Intervention in Pediatric Primary Care.

The pediatric primary care setting is ideal for addressing children's and adolescents' mental health needs. As a result of extensive training in health promotion, consultation, assessment, and treatment of psychological disorders, psychologists are uniquely positioned to support primary care pediatricians in this endeavor. This paper provides a review of models of psychology interventions in pediatric primary care including: care delivery, scope of practice, implementation and recent research. It concludes with a case example and recommendations.

A Pilot of a Brief Positive Parenting Program on Children Newly Diagnosed with Autism Spectrum Disorder.

Disruptive behaviors can be of comparable or greater concern to parents than the core symptoms of Autism Spectrum Disorder (ASD). Provision of effective interventions to address these behaviors within the first year of initial diagnosis holds great potential for improving the child's, parents', and family's functioning. We piloted a four-session, manualized, positive parenting program on 21 parents of newly diagnosed children ages 2 through 12 years using a mixed methods design. Seventy-five percent of parents completed four sessions, with 100% reporting high levels of service satisfaction. Preliminary results indicated clinically and statistically significant reductions in child maladaptive behaviors, as well as improvements in parental and family functioning. Practitioners and parents identified several potential implementation adaptations, including additional sessions to focus on ASD education and real-time parent-child interactions. Taken as a whole, these data suggest that a brief positive parenting intervention may be a feasible way to improve child, parent, and family functioning during the first year of ASD diagnosis. Findings point to the need for additional research to determine treatment efficacy and to assist with the identification of moderators and mediators of effects.

Parenting self-efficacy and empowerment among expectant mothers with substance use disorders.

OBJECTIVE: to describe parenting self-efficacy and family empowerment among expectant mothers with substance use disorders. DESIGN: the study employed a quantitative cross-sectional design. PARTICIPANTS: participants were 71 pregnant women with substance use disorders entering a gender-specific, substance use disorder, residential treatment facility. MEASUREMENTS: measurement tools included: the demographic data form, the Parenting Sense of Competence Scale, the Addiction Severity Index, and the Family Empowerment Scale. FINDINGS: women in their third trimester reported statistically significant higher levels of both parenting self-efficacy and family empowerment than women in their first trimester. KEY CONCLUSIONS: interventions that promote parenting self-efficacy and family empowerment need to target women in their first trimester. IMPLICATIONS FOR PRACTICE: midwives with specialized training in substance abuse disorders are in a unique position to bolster expectant mothers' parenting capabilities during the addiction recovery process.

Brief, Rapid Response, Parenting Interventions Within Primary Care Settings.

Opportunities created by the Patient Protection and Affordable Care Act along with the increased prevalence of pediatric behavioral and mental health concerns provide new challenges for pediatric health care providers. To address these matters, providers need to change the manner by which they provide health care to families. A novel approach is providing brief, rapid response, evidence-based parenting interventions within the pediatric primary care setting. Family-focused parenting programs support the American Academy of Pediatrics recommendations of improving mental health via supports in pediatric primary care to maximize the social and psychological well-being of families. A considerable body of research indicates that parenting interventions reduce the severity and frequency of disruptive behavior disorders in children and provide support to parent by bolstering parental resilience and improving overall family functioning. Providing these services within the pediatric primary care setting addresses the need for fully integrated health services that are family-centered and easily accessible.

Reducing Barriers to Care in the Office-Based Health Care Setting for Children With Autism.

The purpose of this survey-design research study was to evaluate the usefulness of a researcher-developed tool designed to improve office-based health care services and to assess the barriers and resources affecting office-based health care services for children with autism spectrum disorder. Fifty-four health care providers (HCPs) and 59 parents participated in the study. HCPs reported child behaviors, communication, and fears as barriers to providing care, whereas parents reported child behavior, sensory issues, and feelings of a disconnect with the HCP as barriers. HCPs identified the parent as a key resource. Parent-identified resources included provider adaptations to the patient, including slowing down the delivery of care and environmental adaptations to the office. In addition, both HCPs and parents indicated that the researcher-developed tool would be useful in reducing barriers during the HCE. Reducing barriers and improving health care interactions during delivery of care for children with autism spectrum disorder has the potential to improve health outcomes.

Rapid-response parenting intervention in diagnostic centers as a patient-centered innovation for autism spectrum disorders.

Parents of children newly diagnosed with autism spectrum disorders are a high-need population for whom skills-based parenting interventions likely help. Diagnostic centers are compelling locations to deliver parenting interventions because families are served in an accessible location and at a time they receive overwhelming treatment recommendations. Additionally, behavioral interventions in these settings may be especially effective in helping parents feel an early sense of mastery of disruptive child behaviors and enable families grappling with this diagnosis to be proactive and build resilience. Providing parenting interventions in diagnostic centers is a promising service delivery innovation and deserves expanded piloting and testing.

The mentor-youth alliance: the role of mentoring relationships in promoting youth competence.

Mentoring programs hold great promise for fostering competency in disadvantaged youth. Although considerable theoretical work has been conducted to explain the role of mentoring relationships in promoting positive youth outcomes, very little empirical research has directly investigated this alliance. The present study developed and validated a tool to assess mentees' perceptions of their relationships with their mentors and to investigate the relationship between this alliance and youth competency. Based on pilot data from four cross-national mentoring programs (N=276), a 10-item, two-factor Mentor-Youth Alliance Scale (MYAS) was created. Subsequent confirmatory factor analyses conducted on national evaluation data from a multi-site study of mentoring programs (N=219), generated a 10-item, one-factor solution. The one-factor MYAS significantly predicted youths' scores in four competency domains: Family Bonding, Relationships with Adults, School Bonding, and Life Skills, at 8-months post-intake. Higher competency youth were more likely to be female, younger on average, and have a higher quality of relationships with their mentors than were lower competency youth. Implications for the development of the mentor-protégé relationship are discussed.

The role of sex, self-perception, and school bonding in predicting academic achievement among middle class African American early adolescents.

To date, little research has addressed within-group variables as predictors of academic achievement among middle-class African American youth. The present study helped fill this gap by investigating the role of sex, self-perceptions, and school bonding as predictors of academic success among 174 middle class early adolescent boys (n = 91) and girls residing in a large Midwestern city. Results of a path analysis indicated that gender identity fully mediated the relationship between biological sex and adolescents' perceptions of peer acceptance. Perceptions of peer acceptance were positively related to perceptions of behavior, which, in turn, were related to school bonding. School bonding was then related to academic achievement. The findings are discussed within the context of helping educators to better meet students' educational needs.