Heather Janisse

Maternal Resolution of Child Diagnosis: Stability and Relations With Child Attachment Across the Toddler to Preschooler Transition

In this longitudinal study, the authors investigated individual differences in how families adapt to a childs congenital disorder. Family impact, maternal grief resolution, and child attachment were assessed among 74 mothers and their toddlers with a neurological disorder or disfigurement. Fifty dyads were reevaluated 16 months later. For children with neurological compared with disfigurement diagnoses, there was a greater likelihood of negative impact on family, unresolved maternal grief, and insecure attachment at Time 1. Children classified as secure were significantly more likely to have mothers classified as resolved regarding their reactions to their childrens diagnosis. Maternal grief resolution was significantly stable (77%) over time and mediated the relation between type of diagnosis and child security. With time, negative impact of child condition on the family decreased and percentage of children classified as secure increased, suggesting that on average families improved. Results suggest that helping parents come to terms emotionally and cognitively with their childs condition may be a useful focus for intervention.

Using motivational interviewing in HIV field outreach with young african american men who have sex with men: A randomized clinical trial

OBJECTIVES We sought to determine whether field outreach with motivational interviewing, as compared with traditional field outreach, leads to increases in HIV counseling and testing and rates of return for test results among young African American men who have sex with men (MSM). METHODS In a randomized, 2-group, repeated-measures design, 96 young African American MSM completed a motivational interviewing-based field outreach session and 92 young African American MSM completed a traditional field outreach session. The percentages of participants agreeing to traditional HIV counseling and testing (an oral swab of the cheek) and returning for test results were the primary outcome measures. RESULTS More of the participants in the motivational interviewing condition than the control condition received HIV counseling and testing (49% versus 20%; chi(2)(1) = 17.94; P = .000) and returned for test results (98% versus 72%; chi(2)(1) = 10.22; P = .001). CONCLUSIONS The addition of motivational interviewing to field outreach is effective in encouraging high-risk young African American MSM to learn their HIV status. Also, peer outreach workers can be effectively trained to reduce health disparities by providing evidence-based brief counseling approaches targeting high-risk minority populations.

Physical Activity, Social Support, and Family Structure as Determinants of Mood Among European-American and African-American Women

ABSTRACT The literature indicates that mood is an important predictor of physical and psychological well-being. Mood influences a persons health perceptions, treatment compliance, and recovery. Given the importance of mood as an outcome, it is important to identify predictors of mood. The current study examined physical activity, social support, and family structure as determinants of mood among women who had recently begun a walking program. Two hundred and fifty-nine European-American and African-American women between the ages of 30 and 60 participated in the study. A significant positive relation was found between physical activity, social support, and mood, while a negative relation was found between number of children and mood. Hierarchical regression revealed that physical activity, social support of friends, marital status, and number of children were significant predictors of womens mood. Race moderated the relation between number of children and mood. This study suggests that physical activity, social support, and family may be important factors in the psychological well-being of women.

Multiple Risk Behaviors Among Youth Living with Human Immunodeficiency Virus in Five U.S. Cities

PURPOSE To describe multiple risk behaviors (substance use, sexual risk, and medication adherence) in a multi-site sample of youth living with human immunodeficiency virus (HIV) in five U.S. cites. METHODS Youth (N=352) were recruited from four Adolescent Trials Network (ATN) sites (Philadelphia, Fort Lauderdale, Baltimore, and Los Angeles) and one non-ATN site in Detroit and screened for multiple problem behaviors for an intervention study. A substance abuse problem was determined with the CRAFFT, a six-item adolescent screener. Single items were used to screen for current sexual risk and for an HIV medication adherence problem. Of the youth, 239 (68%) had at least one of the three risk behavior problems based on the screener. A total of 186 (52.8%) completed longer, in-depth questionnaires for each problem behavior. RESULTS Of the 352 youth screened, 60% had problem level substance use and 42% had a sexual risk problem. Of the 165 (47%) who were prescribed medications, 91 (55%) reported an adherence problem. A total of 112 (32%) reported no problem behavior, 123 (35%) reported 1 problem behavior, 95 (27%) reported 2 problem behaviors, and 20 (6%) reported 3 problem behaviors. Males were more likely to have a substance use problem. Younger youth living with HIV and those perinatally infected were more likely to have an adherence problem. Among the 186 (52.8%) completing longer measures, those with a substance abuse problem had higher substance use on a timeline follow-back procedure than those without. Participants who screened positive for a sexual risk problem reported more unprotected sex on an in-depth interview than those without. Those who screened positive for an adherence problem had higher viral loads than those without an adherence problem. CONCLUSIONS Results suggest high rates of problem behaviors among youth living with HIV, particularly in older youth. Younger and perinatally infected youth may require specialized adherence interventions. Associations between the screener and more in-depth assessment measures suggest potential clinical utility of screening youth for high-risk behaviors.

Brief Report: Parent's Health Literacy among High-Risk Adolescents with Insulin Dependent Diabetes

OBJECTIVE To describe the health literacy of parents of high-risk adolescents with insulin dependent diabetes and to examine the relation of parents health literacy with treatment adherence. METHODS Participants were 93 adolescents in poor metabolic control diagnosed with insulin dependent diabetes and their primary caregivers. RESULTS All parents had adequate health literacy as defined by the S-TOFHLA. Better parent reading comprehension scores were significantly related to family structure, race, and treatment regimen. Reading comprehension in turn significantly predicted adherence for adolescents on an intensive insulin regimen but not for those on conventional regimens. CONCLUSIONS Parents with low health literacy may struggle to help their children adhere to the increasingly complex diabetes regimens being used at present. Such families may benefit from more intensive diabetes education or different approaches to teaching diabetes management skills.

The effects of multisystemic therapy on family support for weight loss among obese African-American adolescents: Findings from a randomized controlled trial

Objective: To determine whether multisystemic therapy, an intensive, home- and community-based intervention, could increase family support for healthy eating and exercise in obese African-American adolescents. Relationships between changes in family support, weight status, and body fat composition at the end of the trial were also evaluated. Method: A pilot randomized clinical trial was conducted with 49 obese adolescents (body mass index ≥ 95th %ile). Participants were randomized to receive multisystemic therapy or Shapedown, a group weight loss intervention. Participants received treatment for 6 months. Data were collected at baseline and 7-month posttest (i.e., treatment termination). Changes in family support for healthy eating and exercise were assessed by self-report questionnaire. Bivariate analyses were used to assess the relationship between change in family support during the trial and youth body mass index, percent overweight, and body fat composition at follow-up. Results: Participation in multisystemic therapy was associated with significantly greater improvements in family encouragement for healthy eating and family participation in exercise and greater decreases in discouraging behavior from family members than Shapedown participation. Increases in family participation in exercise were significantly related to lower youth body mass index, percent overweight, and body fat composition at follow-up. Conclusions: Intensive, home- and community-based treatment increased family support for health behavior changes among obese minority adolescents, and these changes were directly related to weight status. Such health improvements are important for the well-being of a subset of youth who are at high risk for future health complications.

Predictors of condom use in a multisite study of high-risk youth living with HIV.

Young people between the ages of 13 to 24 are at persistent risk for HIV infection in the United States (Centers for Disease Control and Prevention [CDC], 2006). Young adulthood is a period characterized by experimentation, including engagement in risky behaviors (e.g., substance use and sexual behavior) (Moore & Parsons, 2000). Most young adults are sexually active, with the highest rates of sexual activity reported among youth of color (Park, Mulye, Adams, Brindis, & Irwin, 2006). The prevalence of sexually transmitted infections (STIs), especially chlamydia and gonorrhea, peak in young adulthood and are highest among youth of color (CDC, 2003).

Brief Report: Predictors of Optimal HIV Appointment Adherence in Minority Youth: A Prospective Study

OBJECTIVE This study investigated motivation to attend appointments, self-efficacy, self-esteem, substance use, and emotional distress as predictors of optimal HIV appointment adherence in minority youth living with HIV. METHODS Utilizing a prospective design, questionnaires were collected from 82 minority youth (mean age = 20.3) at baseline and appointment adherence was assessed over the subsequent 12-month period. Appointment adherence was dichotomized to reflect optimal (i.e., at least one appointment in each of the four quarters) versus suboptimal appointment adherence (i.e., no appointment in at least one of the four quarters). RESULTS High levels of motivation to attend appointments, high levels of self-efficacy, and low levels of alcohol use were associated with optimal HIV appointment adherence. CONCLUSIONS Interventions promoting motivation and self-efficacy, while addressing alcohol use and awareness of appointment adherence may be promising in improving optimal HIV appointment adherence in minority youth.

African American Preschool Children's Physical Activity Levels in Head Start

The purpose of this study was to describe the physical activity levels of urban inner city preschoolers while attending Head Start, the federally funded preschool program for children from low-income families. Participants were 158 African American children. Their physical activity during Head Start days was measured using programmed RT-3 accelerometers. Results revealed that the children spent the most time in sedentary and light physical activity, while their participation in moderate-to-vigorous physical activities was low. Given the sedentary class format and limited physical space for the Head Start programs observed, we suggest adding a structured physical activity component to Head Start schools to fight the overweight and obesity crisis.

Dietary Vitamin D Intake Among High-Risk Adolescents With Insulin Dependent Diabetes

Purpose The purpose of the present study was to describe the dietary intake of vitamin D in an urban, low income, predominantly African American sample of adolescents with insulin dependent diabetes. Methods Participants were 99 adolescents diagnosed with insulin dependent diabetes. Vitamin D intake was estimated from dietary recall data. Blood glucose levels were also assessed. Results The average daily vitamin D intake estimated from dietary recall data was 102 IUs (SD = 64.4) with 70% of adolescents consuming less than 50 IUs of vitamin D in their day. Level of vitamin D intake was a significant predictor of HbA1c levels in the current sample. Conclusions Results indicate a need for the assessment of vitamin D levels in this at-risk population, as supplementation may be indicated.