Jennifer Burton

Couples-Focused Behavioral Interventions for Prevention of HIV: Systematic Review of the State of Evidence

HIV is frequently transmitted in the context of partners in a committed relationship, thus couples-focused HIV prevention interventions are a potentially promising modality for reducing infection. We conducted a systematic review of studies testing whether couples-focused behavioral prevention interventions reduce HIV transmission and risk behavior. We included studies using randomized controlled trial designs, quasi-randomized controlled trials, and nonrandomized controlled studies. We searched five electronic databases and screened 7,628 records. Six studies enrolling 1,084 index couples met inclusion criteria and were included in this review. Results across studies consistently indicated that couples-focused programs reduced unprotected sexual intercourse and increased condom use compared with control groups. However, studies were heterogeneous in population, type of intervention, comparison groups, and outcomes measures, and so meta-analysis to calculate pooled effects was inappropriate. Although couples-focused approaches to HIV prevention appear initially promising, additional research is necessary to build a stronger theoretical and methodological basis for couples-focused HIV prevention, and future interventions must pay closer attention to same-sex couples, adolescents, and young people in relationships.

Randomized Prevention Trial for Early Conduct Problems: Effects on Proactive Parenting and Links to Toddler Disruptive Behavior

Despite knowledge of early pathways to conduct problems, few preventive interventions are specifically designed to modify disruptive behavior in toddlerhood. One potential prevention target is proactive and positive parenting, which is associated with reduced risk of conduct problems in preschoolers. This randomized trial with 120 low-income 2-year-old boys examined whether a brief family-centered intervention that reduces disruptive behavior (D. Shaw, T. Dishion, L. Supplee, F. Gardner, & K. Arnds, 2006) also leads to increases in proactive and positive parenting. It also explored whether change in parenting predicts change in disruptive behavior. In the intervention group, proactive and positive parenting skills increased among parents of 3-year-olds. Change in proactive and positive parenting of 2- to 3-year-old toddlers correlated with change in child disruptive behavior, although the mediation effect of positive parenting was of only borderline significance. Findings suggest that even within a brief and multifaceted preventive intervention, change in proactive parenting skills contributes modestly but significantly to change in child problem behavior.

Docosahexaenoic Acid for Reading, Cognition and Behavior in Children Aged 7–9 Years: A Randomized, Controlled Trial (The DOLAB Study)

Background Omega-3 fatty acids are dietary essentials, and the current low intakes in most modern developed countries are believed to contribute to a wide variety of physical and mental health problems. Evidence from clinical trials indicates that dietary supplementation with long-chain omega-3 may improve child behavior and learning, although most previous trials have involved children with neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) or developmental coordination disorder (DCD). Here we investigated whether such benefits might extend to the general child population. Objectives To determine the effects of dietary supplementation with the long-chain omega-3 docosahexaenoic acid (DHA) on the reading, working memory, and behavior of healthy schoolchildren. Design Parallel group, fixed-dose, randomized, double-blind, placebo-controlled trial (RCT). Setting Mainstream primary schools in Oxfordshire, UK (n = 74). Participants Healthy children aged 7–9 years initially underperforming in reading (≤33rd centile). 1376 invited, 362 met study criteria. Intervention 600 mg/day DHA (from algal oil), or taste/color matched corn/soybean oil placebo. Main Outcome Measures Age-standardized measures of reading, working memory, and parent- and teacher-rated behavior. Results ITT analyses showed no effect of DHA on reading in the full sample, but significant effects in the pre-planned subgroup of 224 children whose initial reading performance was ≤20th centile (the target population in our original study design). Parent-rated behavior problems (ADHD-type symptoms) were significantly reduced by active treatment, but little or no effects were seen for either teacher-rated behaviour or working memory. Conclusions DHA supplementation appears to offer a safe and effective way to improve reading and behavior in healthy but underperforming children from mainstream schools. Replication studies are clearly warranted, as such children are known to be at risk of low educational and occupational outcomes in later life. Trial Registration ClinicalTrials.gov NCT01066182 and Controlled-Trials.com ISRCTN99771026

The Role of Mother–Child Joint Play in the Early Development of Children's Conduct Problems: A Longitudinal Observational Study

This observational study examined the relationship between mother–child spontaneous joint play and the development of conduct problems in preschoolers, using a short-term longitudinal design. The sample consisted of 60 children showing a range of levels of conduct problems, recruited at their third birthday through community health services in low SES areas. Spontaneous joint play and other mother–child activities were coded from naturalistic, unstructured observations in the home. Amount of time spent in joint play at age 3 predicted individual improvement in conduct problems at age 4, and importantly, this association was independent of initial level of child conduct problems and hyperactivity, social class, maternal depression, and frequency of negative mother–child interactions. The amount of time the child spent unoccupied and not interacting with mother independently predicted worsening conduct scores over time. However, time spent in other activities, including joint conversation and solitary play did not predict change in conduct scores over time. The results suggest that positive and proactive parenting processes such as joint play may make a unique contribution to the very early development of conduct problems, independent of other risk factors. There was no evidence that this association was mediated by child factors such as hyperactivity and poor attention skills.

Preventive Home Visits for Mortality, Morbidity, and Institutionalization in Older Adults: A Systematic Review and Meta-Analysis

Background Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services. Methods and Findings Data Sources: Ten databases including CENTRAL and Medline searched through December 2012. Study Selection: Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. Data Extraction and Synthesis: Two authors independently extracted data. Outcomes were pooled using random effects. Main Outcomes and Measures: Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness. Results Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [−0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = −0.06 [−0.11 to −0.01]) and physical functioning (SMD = −0.10 [−0.17 to −0.03]) respectively, but these may not be clinically important. Conclusions Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.

Low Blood Long Chain Omega-3 Fatty Acids in UK Children Are Associated with Poor Cognitive Performance and Behavior: A Cross-Sectional Analysis from the DOLAB Study

Background Omega-3 long-chain polyunsaturated fatty acids (LC-PUFA), especially DHA (docosahexaenonic acid) are essential for brain development and physical health. Low blood Omega-3 LC-PUFA have been reported in children with ADHD and related behavior/learning difficulties, as have benefits from dietary supplementation. Little is known, however, about blood fatty acid status in the general child population. We therefore investigated this in relation to age-standardized measures of behavior and cognition in a representative sample of children from mainstream schools. Participants 493 schoolchildren aged 7–9 years from mainstream Oxfordshire schools, selected for below average reading performance in national assessments at age seven. Method Whole blood fatty acids were obtained via fingerstick samples. Reading and working memory were assessed using the British Ability Scales (II). Behaviour (ADHD-type symptoms) was rated using the revised Conners’ rating scales (long parent and teacher versions). Associations were examined and adjusted for relevant demographic variables. Results DHA and eicosapentaenoic acid (EPA), accounted for only 1.9% and 0.55% respectively of total blood fatty acids, with DHA showing more individual variation. Controlling for sex and socio-economic status, lower DHA concentrations were associated with poorer reading ability (std. OLS coeff. = 0.09, p = <.042) and working memory performance (0.14, p = <.001). Lower DHA was also associated with higher levels of parent rated oppositional behavior and emotional lability (−0.175, p = <.0001 and −0.178, p = <.0001). Conclusions In these healthy UK children with below average reading ability, concentrations of DHA and other Omega-3 LC-PUFA were low relative to adult cardiovascular health recommendations, and directly related to measures of cognition and behavior. These findings require confirmation, but suggest that the benefits from dietary supplementation with Omega-3 LC-PUFA found for ADHD, Dyspraxia, Dyslexia, and related conditions might extend to the general school population.

Men who have sex with transgender women: challenges to category-based HIV prevention.

Although transgender women are acknowledged as a priority population for HIV prevention, there is little knowledge on men who have sex with transgender women (MSTGWs). MSTGWs challenge conventional sexual orientation categories in public health and HIV prevention research, and warrant increased attention from the public health community. This paper used qualitative techniques to analyze how MSTGWs describe their sexual orientation identities, and to explore the correspondence between men’s identities and sexual behaviors with transgender women. We conducted in-depth semi-structured individual interviews with 46 MSTGWs in San Francisco. We observed a diversity in the ways participants identified and explained their sexual orientation, and found no consistent patterns between how men described their sexual orientation identity versus their sexual behavior and attraction to transgender women. Findings from this qualitative study question the utility of category-based approaches to HIV prevention with MSTGWs and offer insights into developing HIV interventions for these men.

Fatty acids and sleep in UK children: subjective and pilot objective sleep results from the DOLAB study – a randomized controlled trial

Sleep problems in children are associated with poor health, behavioural and cognitive problems, as are deficiencies of long‐chain omega‐3 fatty acids such as docosahexaenoic acid. Theory and some evidence support a role for these fatty acids in sleep regulation, but this issue has received little formal investigation. We examined associations between blood fatty acid concentrations (from fingerstick blood samples) and subjective sleep (using an age‐standardized parent questionnaire) in a large epidemiological sample of healthy children aged 7–9 years (n = 395) from mainstream UK schools. In a randomized controlled trial, we then explored whether 16‐week supplementation (600 mg day−1) with algal docosahexaenoic acid versus placebo might improve sleep in a subset of those children (n = 362) who were underperforming in reading. In a randomly selected subsample (n = 43), sleep was also assessed objectively via actigraphy. In 40% of the epidemiological sample, Child Sleep Habits Questionnaire scores indicated clinical‐level sleep problems. Furthermore, poorer total sleep disturbance scores were associated weakly but significantly with lower blood docosahexaenoic acid (std coeff. −0.105*) and a lower docosahexaenoic acid : arachidonic acid ratio (std coeff. −0.119**). The treatment trial showed no significant effects on subjective sleep measures. However, in the small actigraphy subsample, docosahexaenoic acid supplementation led on average to seven fewer wake episodes and 58 min more sleep per night. Cautiously, we conclude that higher blood levels of docosahexaenoic acid may relate to better child sleep, as rated by parents. Exploratory pilot objective evidence from actigraphy suggests that docosahexaenoic acid supplementation may improve childrens sleep, but further investigations are needed.

Maternal attributions and observed maternal behaviour : Are they linked?

Mothers of children with behaviour problems have more negative attributions about their children than other mothers; they also report reacting differently to their childrens misbehaviour. The present study explored whether maternal attributions were associated with actual maternal behaviour observed in the home. Fifty-seven mothers and their 3-year-old children were observed in the home carrying out a range of everyday tasks and behaviour was coded using Gardners observational coding scheme. Mothers were interviewed about their attributions, using an adaptation of Walkers PAQ and level of behaviour problems was measured using the Child Behaviour Check List (CBCL). Mothers who thought the causes of the childs misbehaviour were more internal to the child had more conflict with their child, used more negative strategies and were more likely to use reactive strategies only, even when controlling for level of behaviour problem in the child. Mothers who thought the causes of the childs misbehaviour were more stable were more likely to use reactive strategies only and mothers who thought the causes of the childs misbehaviour were more global used fewer positive strategies. This study is part of the growing body of literature that suggests observed maternal behaviour is associated with maternal attributions.

Dependence and independence: Perceptions and management of risk in respect of children aged 12-16 in families with working parents

The contributions that adult men and women make to households in terms of paid and unpaid work have undergone substantial change, particularly in respect of womens responsibility for income generation, and have been seen as part of the processes of individualization. Recent contributions to the literature have suggested that children are now acquiring independence earlier as part of those same processes. The paper uses qualitative methods to explore the way in which parents in two-parent families, where both are employed, perceive the risks attached to childrens exercise of greater independence, how they seek to ‘manage’ those risks and how far the perceptions of parents accord with those of children. We find parents’ perceptions of risk to be strong, but to have little to do with working patterns. In addition, they are often at odds with the actual behaviour of the child. Risks are managed by negotiation, in which children played an active part. We are also able to make some preliminary comments on the difficulties of interpreting scale measures in relation to interview evidence.