John Noell

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.

A Construct Score Approach to the Assessment of Social Competence Rationale, Technological Considerations, and Anticipated Outcomes

This article provides a selected review of the knowledge base on social competence in children. Using the existing literature on social competence as a point of departure, a case is made that (a) a social competence construct score approach to assessing social competence is needed, (b) theoretical and empirical advances in the social competence knowledge base and in microcomputer video assessment technology make such an approach feasible, and (c) direct assessment of childrens knowledge and perceptions of key social situations, tasks, and skills can now be accomplished with far greater precision and validity than heretofore. These developments now make it possible to profile and aggregate childrens social competence across four important domain areas commonly sampled in assessing social competence (i.e., sociometric procedures, direct observations in natural settings, parent and teacher ratings, and direct assessments of childrens knowledge and perceptions of social stimuli). Social competence construct scores, developed at both global and specific levels, can be used to construct such profiles.

Incidence and prevalence of chlamydia, herpes, and viral hepatitis in a homeless adolescent population.

Background High rates of unprotected intercourse and illegal drug use have been reported among homeless adolescents. As a transient population with the potential to act as disease vectors from one location to another, incidence and prevalence of sexually transmitted infections in this population are of particular concern. Goal To assess a homeless adolescent population for incidence and prevalence of Chlamydia trachomatis, herpes simplex virus type 2, hepatitis B virus, hepatitis C virus, HIV, and psychosocial correlates of the acquisition of sexually transmitted infections. Study Design Longitudinal with assessments at baseline, 3 months, and 6 months (n = 536; 319 males and 217 females). Results Baseline prevalence of C trachomatis was 4.17% for males and 6.30% for females. Prevalence of herpes simplex virus type 2 was 5.73% for males and 12.50% for females. Hepatitis B virus and hepatitis C virus prevalences were 3.60% and 5.0%, respectively. HIV seroprevalence was 0.3%. The incidence of sexually transmitted infections was significantly higher among females than among males (16.7% versus 9.8%) and was associated with inconsistent condom use and, for females, number of partners and sex with older partners. Incident hepatitis B virus and hepatitis C virus infection rates were 3.44% and 6.61%, respectively; both were associated with injection drug use. Conclusions Among females, the incidence of herpes simplex virus type 2 (> 25%) and C trachomatis (12%) was relatively high. Inconsistent condom use was the primary factor associated with a significantly greater risk of incident sexually transmitted infections. This was especially true for females with multiple partners. Homeless adolescents also are at high risk for hepatitis B virus and hepatitis C virus infection, primarily associated with self-reported injection drug use.

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.

Interactive technology applications for behavioral counseling: issues and opportunities for health care settings.

CONTENT This article discusses the rationale for, and the potential benefits and limitations of, computer-based interactive health communication (IHC) programs for health behavior counseling. We describe common barriers to health behavior counseling in medical settings and show how IHCs can address these issues. Following an overview of current and likely near-future IHCs, the potential impact of IHCs on the patient-provider relationship is considered. Results from evaluations of IHCs are summarized and important and unique issues in evaluating IHCs are discussed. We conclude with recommendations for clinical applications, including recommendations for consumers considering purchase or adoption of IHCs and recommendations for future research.

Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents.

OBJECTIVE To examine the relationship between childhood experiences of sexual abuse, sexual coercion during adolescence, and the acquisition of sexually transmitted infections (STIs) in a population of homeless adolescents. METHOD Homeless adolescent females (N = 216) from a northwestern United States city were recruited by street outreach workers for a longitudinal study of STI epidemiology. Baseline data on childhood abuse and recent history of sexual coercion were used to predict physiologically confirmed STI acquisition over the subsequent 6 months. RESULTS About 38% of all girls reported a history of childhood sexual abuse (CSA). Girls with a history of CSA were more likely to report recent sexual coercion. In turn, sexual coercion in the last three months was significantly associated with a higher number of sexual partners (but not with a greater frequency of intercourse or with lower rates of condom use). Number of sexual partners significantly predicted the future acquisition of an STI within 6 months. CONCLUSIONS Interventions to reduce risky sexual behaviors in homeless adolescent females may need to consider the impact of CSA, particularly on the number of sexual partners during adolescence. However, it also should be noted that engagement in intercourse often results from coercion and is not voluntary in this population.

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.

Social Skills in School-Age Children and Youth: Issues and Best Practices in Assessment and Intervention.

Social skills allow individuals to develop positive relationships with others; cope successfully with the behavioral demands of specific settings; and communicate desires, needs, and preferences effectively. They also provide a foundation for competent performance in a range of academic, personal, vocational, and community contexts, Effective communication is an essential component of appropriate social behavior. This article provides definitions and conceptualizations of social skills and social competence within academic contexts. It also describes social skills assessment and intervention procedures for school-age children and youth with and without disabilities.

“Are They Still Having Sex?” STIs and Unintended Pregnancy Among Mid-Life Women

ABSTRACT Research has shown that women remain sexually active throughout mid-life and into the post-menopausal years. Recent data reveal that significant numbers of STIs (sexually transmitted infections) and unintended pregnancies occur among mid-life women. Data on STI prevalence indicate several STIs have relatively high rates among women over age 30, including HIV and HSV-2. Racial/ethnic disparities in STI prevalence between mid-life African American, Hispanic, and Caucasian women have also been noted. Data from the 1995 National Survey of Family Growth reveal 51% of pregnancies among women 40 and older are unintended. Both STIs and unintended pregnancy can result in serious health consequences for mid-life women. STIs can result in pelvic inflammatory disease and ectopic pregnancy. Unintended pregnancy can result in increased morbidity and mortality to the woman and the fetus. Mid-life women are also highly likely to go through relationship transitions (e.g., separation, divorce) and the subsequent initiation of new sexual relationships. As a result, these women are at elevated risk of STIs and unintended pregnancy. Despite these realities, there is a lack of programs addressing these two health issues among mid-life women and the unique life circumstances of women at this stage of life. The authors assert there is a compelling need for interventions to reduce STIs and unintended pregnancy in this population of women, review the literature regarding STIs and unintended pregnancy in mid-life women, identify gaps in current resources, and make recommendations for health care practice and future research.