Carol W. Metzler

Development of Adolescent Problem Behavior

The developmental model of adolescent antisocial behavior advanced by Patterson and colleagues (e.g., Patterson, Reid, & Dishion, 1992) appears to generalize the development of a diverse set of problem behaviors. Structural equation modeling methods were applied to 18-month longitudinal data from 523 adolescents. The problem behavior construct included substance use, antisocial behavior, academic failure, and risky sexual behavior. Families with high levels of conflict were less likely to have high levels of parent–child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. Poor parental monitoring and associations with deviant peers were strong predictors of engagement in problem behavior. These constructs accounted for 46% of the variance in problem behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this developmental process.

The Validation of a Construct of High-Risk Sexual Behavior in Heterosexual Adolescents.

The potential spread of HIV infection into the adolescent population underscores the need for valid measures of high-risk sexual behavior in adolescents. This article reports on the development and construct validation of two measures of high-risk sexual behavior for heterosexual adolescents. Based on evidence that diverse problem behaviors are interrelated in adolescents, it was hypothesized that specific risky sexual behaviors, such as nonuse of condoms and multiple partners, would be interrelated, and that the cluster of high-risk sexual behaviors would be correlated with measures of other adolescent problem behaviors. The interrelationships among specific sexual behaviors were consistent across three independent samples, and the composite sexual behavior measures were correlated with measures of other problem behaviors. The results provide support for the validity of a construct of high-risk sexual behavior and point to the need for interventions that target diverse risky sexual behaviors.

A randomized controlled trial of a behavioral intervention to reduce high-risk sexual behavior among adolescents in STD clinics

A five-session behavioral intervention to reduce risky sexual behavior was evaluated in a randomized controlled trial, in which 339 adolescents, ages 15 to 19 years, were recruited in public sexually transmitted disease clinics and randomly assigned to receive the intervention or usual care. The intervention targeted (a) decision-making about safer sex goals, (b) social skills for achieving safer sex, and (c) acceptance of negative thoughts and feelings. Compared to the control group at 6-months follow-up, treatment participants reported fewer sexual partners, fewer nonmonogamous partners, and fewer sexual contacts with strangers in the past 3 months, and less use of marijuana before or during sex. Treated adolescents also performed better on a taped situations test of skill in handling difficult sexual situations. Strongest intervention effects were for male and nonminority youth. Further research is needed to develop interventions with strong, durable effects across gender and ethnic groups that can be delivered cost-effectively within existing service systems.

Relationships between Peer Harassment and Adolescent Problem Behaviors.

Concurrent and predictive relationships between peer harassment and problem behavior were examined for middle and high school students as well as gender differences in these relationships. Students recruited in fifth through seventh grades (n = 223) and their parents provided quarterly questionnaire data and were followed up into high school. As hypothesized, experiencing frequent peer harassment in middle school was associated with greater problem behavior concurrently and prospectively into high school. Students experiencing frequent harassment exhibited more aggressive and antisocial behavior and were more likely to associate with deviant peers and use cigarettes during middle school than those experiencing some or no harassment. In regression analyses, frequent verbal harassment predicted antisocial behavior, alcohol use, and deviant peer association in high school, and frequent physical harassment predicted later antisocial behavior, aggression, deviant peer association, and multiple problem behavior. Gender interactions were found for prediction of later aggressive and antisocial behavior.

Does sexual coercion play a role in the high-risk sexual behavior of adolescent and young adult women?

Sexual coercion and its relationship to high-risk sexual behavior were examined in five samples of young women. Sample 1 (N=22) consisted of sexually active adolescents aged 15 to 19. Samples 2 (N=206) and 3 (N=70) were recruited from among patients at three sexually transmitted disease clinics. Sample 4 (N=51) consisted of young homeless women living on the street in a large city. Sample 5 (N=51) was recruited from among young women on a college campus. Across all samples, 44.4% of women indicated that they had been forced into some form of sexual activity against their will. Self-reports of sexually coercive experiences were consistently related to risky sexual behavior. It appears that many young women are coerced into engaging in high-risk sexual behavior. This implies the need for greater attention to male coercive sexual behavior and womens skills for coping with such behavior.

Increasing the Prevalence of Successful Children: The Case for Community Intervention Research

This paper makes a case for research on community interventions on child rearing. Sufficient evidence has accumulated about the development of children’s problem behavior to justify evaluating efforts to reduce the prevalence of these problems in whole communities. The contextual risk factors for diverse child behavior problems are well understood, and interventions to ameliorate individual risk factors have been developed and evaluated. Because interventions with individual children have proven to be efficacious, it is now appropriate to direct energy toward reducing the prevalence of children with behavior problems. At the same time, existing interventions have limitations. Community interventions may be needed to modify the larger social context for families. This paper enumerates possible components of a community intervention to improve child-rearing outcomes. Existing evidence indicates that communities would benefit from making parent training and family support programs available to parents. Validated methods of identifying and remediating academic and behavioral problems in schools are available, but influencing schools to adopt them remains a problem. Community organizing could mobilize communities to allocate the resources necessary to support such parenting and schooling programs as well as encourage their adoption. Media campaigns could foster community support and directly influence parenting practices. Efforts to modify peer influences to use illicit substances have received empirical support; similar efforts may be relevant to preventing other problems. The development of a science of community interventions on child rearing is hampered by overreliance on randomized control trials. For this reason, two examples of time-series experimental evaluations of community intervention components are described here.

Primary Health Care: Potential Home for Family-Focused Preventive Interventions

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings.

Social media and gamification: engaging vulnerable parents in an online evidence-based parenting program

The aim of this study was to examine the feasibility (accessibility, engagement and impact) of adding social media and gaming features (e.g., social sharing with anonymity, badges to incentivize skills practice, an accredited facilitator for support) and access via smartphones to an evidenced-based parenting program, Triple P Online. The highly vulnerable population included 155 disadvantaged, high-risk parents (e.g., 76% had a family annual income of less than

Multiple Levels and Modalities of Measurement in a Population-Based Approach to Improving Parenting

15,000; 41% had been incarcerated; 38% were in drug/alcohol treatment; and 24% had had a child removed due to maltreatment). The ethnic groups most commonly identified were African American (24%) and Hispanic (66%). Respondents were primarily mothers (86%) from five community programs in Los Angeles. The study used a single group repeated measures design (pre, post, 6-month follow-up). Data collected included standardized self-report measures, post-intervention focus groups and interviews, website usage reports, and Google Analytics. Significant multivariate ANOVA time effects were found, demonstrating reductions in child behavioral problems, reduced lax/permissive and over-reactive parenting, and decreased parental stress. No effects were found for parental confidence, attributions, or depression and anxiety (which were in the normal range at baseline). Positive effects were maintained or improved at 6-month follow-up. The participants engaged in the online community and valued its flexibility, anonymity, and shared learning. This foundational implementation trial provides support for future rigorous evaluation of social media and gaming features as a medium for increasing parental engagement in evidence-based parenting programs online--a public health approach to protect and improve the development of vulnerable children.

Social and behavioral factors associated with high-risk sexual behavior among adolescents

The goal of a public health approach to improving parenting is to increase the prevalence of effective parenting practices in a population. Achieving this goal requires that a large proportion of the population be reached with a spectrum of effective parenting supports, widely accessible in the community, and delivered in a variety of formats, through a variety of settings, and at different levels of intensity. Similarly, measuring the effectiveness of such a public health approach to improving parenting requires a spectrum of measurement tools at multiple levels so that child and family outcomes can be assessed at multiple levels of intervention. The levels of measurement include: (1) micro-focused observational measures, (2) easy-to-administer parent survey measures, (3) population-level prevalence indicators, and (4) program implementation measures. This chapter discusses these four levels of measurement, providing examples of each and exploring the contribution that each makes to a public health strategy.