Beth A. Auslander

Children's symptoms of posttraumatic stress and depression after a natural disaster: Comorbidity and risk factors.

BACKGROUND The current study examined rates of comorbidity among childrens symptoms of posttraumatic stress (PTS) and depression after a natural disaster, Hurricane Ike. We also compared children with comorbid symptoms to children without comorbid symptoms, examining recovery, severity of symptoms, and risk factors. METHOD Children (n=277; 52% girls; 38% Hispanic, 28% White, 19% Black; grades 2-4) were assessed at 8 and 15 months postdisaster. Children completed measures of PTS and depressive symptoms at both time points and measures of exposure and recovery stressors at 8 months postdisaster. RESULTS At 8 months postdisaster, 13% of children reported elevated PTS-only, 11% depression-only, and 10% comorbid symptoms of PTS and depression. At 15 months postdisaster, 7% of children reported elevated PTS-only, 11% depression-only, and 7% comorbid symptoms of PTS and depression. Children with comorbid symptoms of PTS and depression had poorer recovery, more severe symptoms, and they reported greater exposure and recovery stressors. LIMITATIONS We lacked information on childrens predisaster functioning and diagnostic interview of psychological distress symptoms. CONCLUSIONS Children with comorbid symptoms need to be identified early postdisaster. Levels of stressors should be monitored postdisaster, as highly stressed youth have difficulties recovering and may need help. Interventions should be tailored for children with comorbid symptoms of PTS and depression.

Dissonance‐based prevention of eating disorder risk factors in middle school girls: Results from two pilot trials

OBJECTIVE Although several eating disorder prevention programs reduce eating disorder risk factors and symptoms for female high school and college students, few efficacious prevention programs exist for female middle school students, despite the fact that body image and eating disturbances often emerge then. Two pilot trials evaluated a new dissonance-based eating disorder prevention program for middle school girls with body image concerns. METHOD Female middle school students with body dissatisfaction from two sites [Study 1: N = 81, M age = 12.1, standard deviation (SD) = 0.9; Study 2: N = 52, M age = 12.5, SD = 0.8] were randomized to a dissonance intervention (MS Body Project) or educational brochure control; Study 2 included a 3-month follow-up. RESULTS Intervention participants showed significant post-test reductions in only one of the six variables with both Studies 1 and 2 (i.e., pressure to be thin and negative affect, respectively), though post-test effect sizes suggested medium reductions in eating disorder risk factors and symptoms (Study 1: M d = .40; Study 2: M d = .65); reductions at 3-month follow-up in Study 2 were not evident (M d = .19). CONCLUSIONS Results suggest that this new middle school version of the Body Project is producing medium magnitude reductions in eating disorder risk factors at post-test but that effects are showing limited persistence. Continued refinement and evaluation of this intervention appears warranted to develop more effective prevention programs for this age group.

Racial/Ethnic Differences in Patterns of Sexual Behavior and STI Risk Among Sexually Experienced Adolescent Girls

STUDY OBJECTIVE Racial/ethnic differences in prevalence and patterns of oral and anal sex were analyzed among girls participating in a microbicide acceptability study. DESIGN Cross-sectional analysis SETTING Recruitment to participate in a 6-month study examining microbicide acceptability was conducted at a school-based health clinic and local colleges in Galveston, Texas and through snowball sampling. PARTICIPANTS Sexually experienced girls (n = 202) ages 14 to 21 years of age. MAIN OUTCOME MEASURES Girls reported on their demographic and sexual history at the intake interview. RESULTS AND CONCLUSIONS Their mean age was 18.2 years; 26% were white, 43% African-American, and 31% Hispanic. African-American girls were significantly less likely than whites and Hispanics to have had oral sex; no differences were found for anal sex. African-American girls were significantly older than whites and Hispanics when they initiated oral sex. African-American girls had a greater difference between ages of vaginal and oral sex initiation than whites and Hispanics. Oral sex history was associated with a 6-factor increase and anal sex history was associated with a 3-factor increase in the likelihood of a history of sexually transmitted infection. Future studies should explore these differences in greater depth in order to develop culturally specific STI prevention efforts.

School-based vaccination of young US males: Impact of health beliefs on intent and first dose acceptance

Little is known about adolescent males and their parents with respect to intent and first dose uptake of the human papillomavirus (HPV) vaccine outside of primay care settings. The purpose of this study was to evaluate potential predictors of parental intent to vaccinate (study was conducted in November 2010-December 2012) and of first dose uptake of HPV vaccine among a sample of young adolescent males, 11-15 years of age, who received care at a school-based health center (SBHC). We also examined intent as a potential mediator of the relationships between predictors (health beliefs and perceived spousal agreement) and vaccination. Slightly more than half (n=135 of 249) of parents reported an intention to vaccinate and 28% (n=69) of males received their first dose of the HPV vaccine. Two of three health beliefs were significantly associated with both intention and uptake as was perceived spousal agreement. We found intention to vaccinate was a partial mediatator between the perceived benefits of HPV vaccine and first dose acceptance. We also determined that intent was a strong mediator between both general immunization benefits and perceived spousal agreement and first dose uptake. While vaccine uptake was lower than expected, particularly considering that many barriers to vaccine initiation were eliminated because of the SBHC setting, this rate is higher than in traditional settings. After controlling for intent, only perceived benefits of the HPV vaccine remained a significant predictor of first dose acceptance.

Measurement of microbicide acceptability among U.S. adolescent girls.

Background and Objective: Topical microbicides will only be effective if they are acceptable to potential users. The purpose of this study is to develop a scale to evaluate characteristics and aspects of topical microbicides that are important to adolescent girls. Study Design: Girls (n = 207) completed a questionnaire on perceptions of microbicide-like products. Results: A principal components factor analysis with a varimax rotation produced a 6-factor solution. The mean factor scores suggested that girls saw the products positively. Age was positively correlated with “comparison to condoms” and “comfort while using” factor scores and inversely correlated with “negative impact on interpersonal relationships” factor score. Sexually transmitted infection (STI) history was related to higher scores on the “health benefits” and “pleasure” factors. Age, race/ethnicity, and STI history were not related to the other factor scores. Conclusion: The current scale shows promise in assessment of microbicide acceptability, and in general, girls expressed positive views about microbicides.

School-based HPV immunization of young adolescents: Effects of two brief health interventions

Adolescent immunization rates for human papillomavirus (HPV) are low and interventions within school-based health centers (SBHCs) may increase HPV uptake and series completion. We examined the effect of a parent health message intervention on HPV vaccination intent, first dose uptake and series completion among adolescents who received care at SBHCs. Via computer-assisted telephone interviews (CATI), 445 parents of young adolescents were randomly assigned to 2 two-level interventions using a 2 × 2 design (rhetorical question (RQ) or no-RQ and one-sided or two-sided message). The RQ intervention involved asking the parent a question they were likely to endorse (e.g., “Do you want to protect your daughter from cervical cancer?”) with the expectation that they would then behave in a manner consistent with their endorsement (i.e., agree to vaccinate). For the one-sided message, parents were given information that emphasized the safety and effectiveness of HPV vaccine, whereas the two-sided message acknowledged that some parents might have concerns about the vaccine, followed by reassurance regarding the safety and effectiveness. At CATI conclusion, parents indicated intentions to have their adolescents vaccinated. Parents who endorsed any intent were sent a consent form to return and all adolescents with signed returned consents were vaccinated at SBHCs. Medical records were reviewed for uptake/completion. Parents were 87% female; adolescents were 66% male and racially/ethnically diverse. 42.5% of parents indicated some intention to immunize, 51.4% were unsure, and 6.1% were not interested. 34% (n = 151) of adolescents received their first dose with series completion rates of 67% (n = 101). The RQ component of the intervention increased intention to vaccinate (RR = 1.45; 95%CI 1.16,1.81), but not first dose uptake or series completion. The 1-sided and 2-sided messages had no effect. This brief, RQ health intervention enhanced intent, but did not impact vaccination rates, likely due to the time delay between the intervention and consent form receipt.

Gender-specific predictors of genital herpes vaccine acceptance in a college population.

Vaccines represent one promising method for reducing the sexually transmitted disease (STD) epidemic. This study evaluated whether influences on the decision to accept a genital herpes vaccine differed by gender. In all, 518 college students completed a questionnaire on sexual history, health beliefs, and acceptance of a potential genital herpes vaccine. Each predictor variable plus a gender interaction term were analysed in separate logistic regression models. Follow-up analyses were performed by gender for outcomes that displayed significant interactions. Results indicated that a prior history of an STD and increased perception of risk for acquiring genital herpes were significant predictors of vaccine acceptance for men, while younger age and concerns about vaccine safety were significant predictors for women. Endorsement of a vaccine strategy targeting sexually experienced people was an influential factor for both genders, but was a much stronger one for women. Results suggest that gender-specific strategies may be crucial to genital herpes vaccine acceptance.

Adolescent intimate heterosexual relationships: measurement issues.

During adolescence, individuals develop increased ability to have emotionally and physically intimate relationships. The type of intimate relationship will make a difference as to whether the adolescent engages in protective behaviors or avoids risky behaviors. However, in reviewing the literature on the association of relationship type and sexual risk and protective behaviors, four methodological challenges were noted. These challenges limit our understanding of the impact of relationship type. These four challenges are: (a) inconsistent definitional frameworks; (b) lack of adolescent voices; (c) lack of consideration of gender; and (d) poor differentiation between individual and relationship risk. These issues direct the course of future work in this area and are necessary to advance the field of adolescent sexual health, particularly with regard to the development and testing of appropriate interventions designed to reduce untoward outcomes of adolescent sexuality.

HPV vaccine uptake in a school-located vaccination program

ABSTRACT Previous research has implied that while parents may be willing to have their adolescents receive some recommended vaccines via school-located vaccination program (SLVP), they were less likely to agree to the HPV vaccine being administered via SLVP. During an SLVP in a large urban area, 86% of those participating in the program received an HPV vaccine.

Adolescents' and young women's use of a microbicide surrogate product when receiving oral sex.

STUDY OBJECTIVE Genital herpes, which can be spread through oral sex, is an important target for microbicides. We examined episode-specific predictors of young womens receptive oral sex and of microbicide surrogate use. DESIGN Longitudinal study. SETTING Participants were recruited to participate in a microbicide acceptability study from adolescent clinics and local colleges and through snowballing. PARTICIPANTS Young women (ages 14 to 21 y) who reported sexual contact on at least 1 weekly phone interview (n = 181) were included from the larger sample of 208 young women. MAIN OUTCOME MEASURES On weekly diary phone interviews, participants reported whether or not their last sexual contact included receptive oral sex and whether or not their last sexual contact included use of a microbicide surrogate. RESULTS AND CONCLUSIONS Participants reported a total of 1042 episodes of sexual contact of which 311 included receptive oral sex and 354 included microbicide surrogate use. Being older, having sex for the first time with a partner, and having given oral sex were associated with having received oral sex during a sexual episode. Being older, being African American, and having discussed the microbicide surrogate with their partner were associated with having used the microbicide surrogate use during a sexual episode. These results indicate that oral sex should be considered in the design of clinical trials. Future studies need to evaluate ways to promote consistent microbicide use in the context of receiving oral sex as well as those factors (eg, taste, pleasure) which may serve as a barrier.