Christopher J. Mehus

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.

Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda.

In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.

Assessing the feasibility of providing a parenting intervention for war-affected families in northern Uganda.

This article reports the results of a feasibility study of an intervention, Enhancing Family Connection (EFC), conducted in Northern Uganda in 2012. Enhancing Family Connections sessions were an adaption of the Parent Management Training, Oregon model. Three interrelated areas of feasibility were assessed: (a) acceptability, (b) usability, and (c) limited efficacy. This study utilized questionnaires and semi-structured interviews completed by mothers and a focal child pre- and post-intervention. Results indicated that mothers found the intervention acceptable to their families and culture and showed promise for Enhancing Family Connections efficacy in changing parenting behaviors. This study supports continued development of this intervention.

LGBTQ Youth's Views on Gay-Straight Alliances: Building Community, Providing Gateways, and Representing Safety and Support

BACKGROUND Gay-Straight Alliances (GSAs) are school-based clubs that can contribute to a healthy school climate for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. While positive associations between health behaviors and GSAs have been documented, less is known about how youth perceive GSAs. METHODS A total of 58 LGBTQ youth (14-19 years old) mentioned GSAs during go-along interviews in 3 states/provinces in North America. These 446 comments about GSAs were thematically coded and organized using Atlas.ti software by a multidisciplinary research team. RESULTS A total of 3 themes describe youth-perceived attributes of GSAs. First, youth identified GSAs as an opportunity to be members of a community, evidenced by their sense of emotional connection, support and belonging, opportunities for leadership, and fulfillment of needs. Second, GSAs served as a gateway to resources outside of the GSA, such as supportive adults and informal social locations. Third, GSAs represented safety. CONCLUSIONS GSAs positively influence the physical, social, emotional, and academic well-being of LGBTQ young people and their allies. School administrators and staff are positioned to advocate for comprehensive GSAs. Study findings offer insights about the mechanisms by which GSAs benefit youth health and well-being.

Helping Young People Stay Afloat: A Qualitative Study of Community Resources and Supports for LGBTQ Adolescents in the United States and Canada

ABSTRACT LGBTQ youth are at increased risk of poor health outcomes. This qualitative study gathered data from LGBTQ adolescents regarding their communities and describes the resources they draw on for support. We conducted 66 go-along interviews with diverse LGBTQ adolescents (mean age = 16.6) in Minnesota, Massachusetts, and British Columbia in 2014–2015, in which interviewers accompanied participants in their communities to better understand those contexts. Their responses were systematically organized and coded for common themes, reflecting levels of the social ecological model. Participants described resources at each level, emphasizing organizational, community, and social factors such as LGBTQ youth organizations and events, media presence, and visibility of LGBTQ adults. Numerous resources were identified, and representative themes were highly consistent across locations, genders, orientations, racial/ethnic groups, and city size. Findings suggest new avenues for research with LGBTQ youth and many opportunities for communities to create and expand resources and supports for this population.

Young mentors’ relationship capacity: Parent–child connectedness, attitudes toward mentees, empathy, and perceived match quality

Because the responsibility of developing strong connections to mentees often depends on mentors themselves, examining mentor qualities and relational capacity may identify malleable factors—or potential points of intervention—to improve perceived match quality. Relational capacity has been proposed as a theoretical concept for understanding how mentors’ previous experience, characteristics, and skills relate to mentoring quality. Our conceptual model posited that parent–child relationships build young mentors’ relational capacity for successful mentoring relationships. Using data from young mentors age 15–26 participating in the Big Brothers/Big Sisters school-based mentoring program (n = 155), this study extends current knowledge by examining potential mediators of the relationship between young mentors’ perceived parent–child connectedness and perceived match quality. Attitudes toward mentees and empathy skills mediated the relationship between parent–child connectedness and perceived match quality. Findings suggest that parent–child connectedness contributes to attitudes and skills that may strengthen perceived match quality. From a positive youth development perspective, young mentors with low relational capacity may require support to ensure high-quality matches.

Testing the social interaction learning model's applicability to adolescent substance misuse in an Australian context

ABSTRACT Background: Parents and peers both influence the development of adolescent substance misuse, and the Social Interaction Learning (SIL) model provides a theoretical explanation of the paths through which this occurs. Objective: The SIL model has primarily been tested with conduct outcomes and in US samples. This study adds to the literature by testing the SIL model with four substance use outcomes in a sample of Australian youth. Method: We used structural equation modeling to test the fit of the SIL model to a longitudinal sample (n = 907) of students recruited in grade 5 in Victoria, Australia participating in the International Youth Development Study, who were resurveyed in grades 6 and 10. Results: The model fit was good (χ2(95) = 248.52, p < .001; RMSEA = .04 [90% CI: .036 – .049]; CFI = .94; SRMR = .04). Path estimates from parenting to antisocial behavior and from antisocial behavior to antisocial peers were significant. In turn, having antisocial peers was significantly related to alcohol use, binge drinking, tobacco use, and marijuana use. From parenting, only the direct path to marijuana use was significant, but indirect effects were significant. Conclusions: The SIL model illustrates that parenting plays an early role in the formation of adolescent peer relations that influence substance misuse and identifies etiological pathways that can guide the targets of prevention. The SIL pathways appear robust to the Australian social and policy context.

Longitudinal, reciprocal relationships between family management and antisocial peer associations

INTRODUCTION Poor family management and antisocial peer associations are related risk factors for negative outcomes such as adolescent substance misuse and conduct disorders. The relationship between family management and antisocial peer associations is complex. The purpose of this study was to test the reciprocal relationships between youth-reports of poor family management and antisocial peer associations over multiple time-points. METHODS We used four data points (5th-11th grade) from the Australian arm of the longitudinal International Youth Development Study (IYDS) to test a random-intercepts cross-lagged path model (N = 922). RESULTS The model fit the data well with path estimates showing that poor family management predicted greater antisocial peer associations at the next wave but not the reverse. A second model included a third autoregressive path to control for youths own antisocial behavior; the direction of the relationships between poor family management and antisocial peer associations did not change. CONCLUSIONS These results indicate that across adolescence poor family management predicts greater antisocial peer association, which provides evidence that family-focused interventions are an important prevention strategy even in adolescence.

Identifying the roles of fathers in post-war northern Uganda: Groundwork for a parenting intervention

ABSTRACT Parents are the most proximal influence in children’s lives and parenting practices can moderate the relationship between risk-laden contexts and child outcomes. The present study is part of a broader project supporting Acholi parents in northern Uganda and adds to growing literature on the impact of fathers in children’s lives and fatherhood. Critical ethnography guided individual interviews with 19 fathers, three focus groups, informal conversations with community members and field observations to learn about Acholi fathering roles. Findings show that fathers have three primary ideal roles, to: provide for their children, educate their children, and provide a stable and peaceful home. These roles are all future oriented and occur within broader relational and social contexts including family relationships, recovery from war, and a changing but hierarchical society. The extent to which these roles are fully realised varied based on these contextual factors and individual differences. Findings provide directions for future research with fathers and support our research team’s inclusion of fathers in future parent education programmes.

Living as an LGBTQ Adolescent and a Parent’s Child: Overlapping or Separate Experiences:

It is well known that parental and community-based support are each related to healthy development in lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, but little research has explored the ways these contexts interact and overlap. Through go-along interviews (a method in which participants guide the interviewer around the community) with 66 youth in British Columbia, Massachusetts, and Minnesota, adolescents (aged 14-19 years) reported varying extent of overlap between their LGBTQ experiences and their parent–youth experiences; parents and youth each contributed to the extent of overlap. Youth who reported high overlap reported little need for resources outside their families but found resources easy to access if wanted. Youth who reported little overlap found it difficult to access resources. Findings suggest that in both research and practice, considering the extent to which youth feel they can express their authentic identity in multiple contexts may be more useful than simply evaluating parental acceptance or access to resources.