Lisa James

Predictive Validity of the Expanded Susceptibility to Smoke Index

OBJECTIVES The susceptibility to smoking index can be improved as it only identifies one third of future adult smokers. Adding curiosity to this index may increase the identification of future smokers and improve the identification of effective prevention messages. METHODS Analyses used data from the California Longitudinal Study of Smoking Transitions in Youth, for whom tobacco use behaviors, attitudes, and beliefs were assessed at 3 time points from age 12 through early adulthood. Logistic regressions were used to evaluate whether baseline curiosity about smoking was predictive of smoking during the 6-year follow-up period and whether curiosity about smoking provided evidence of incremental validity over existing measures of susceptibility to smoking. RESULTS Compared to those who were classified as definitely not curious about smoking, teens who were classified as probably not curious (OR adj = 1.90, 95% CI = 1.28-2.81) and those classified as definitely curious (OR adj = 2.38, 95% CI= 1.49-3.79) had an increase in the odds of becoming a young adult smoker. Adding curiosity to the original susceptibility to smoking index increased the sensitivity of the enhanced susceptibility index to 78.9% compared to 62.2% identified by the original susceptibility index. However, a loss of specificity meant there was no improvement in the positive predictive value. CONCLUSIONS The enhanced susceptibility index significantly improves identification of teens at risk for becoming young adult smokers. Thus, this enhanced index is preferred for identifying and testing potentially effective prevention messages.

Cyber Dating Abuse Among Teens Using School-Based Health Centers

OBJECTIVE: To estimate the prevalence of cyber dating abuse among youth aged 14 to 19 years seeking care at school-based health centers and associations with other forms of adolescent relationship abuse (ARA), sexual violence, and reproductive and sexual health indicators. METHODS: A cross-sectional survey was conducted during the 2012–2013 school year (participant n = 1008). Associations between cyber dating abuse and study outcomes were assessed via logistic regression models for clustered survey data. RESULTS: Past 3-month cyber dating abuse was reported by 41.4% of this clinic-based sample. More female than male participants reported cyber dating abuse victimization (44.6% vs 31.0%). Compared with no exposure, low- (“a few times”) and high-frequency (“once or twice a month” or more) cyber dating abuse were significantly associated with physical or sexual ARA (low: adjusted odds ratio [aOR] 2.8, 95% confidence interval [CI] 1.8–4.4; high: aOR 5.4, 95% CI 4.0–7.5) and nonpartner sexual assault (low: aOR 2.7, 95% CI 1.3–5.5; high: aOR 4.1, 95% CI 2.8–5.9). Analysis with female participants found an association between cyber dating abuse exposure and contraceptive nonuse (low: aOR 1.8, 95% CI 1.2–2.7; high: aOR 4.1, 95% CI 2.0–8.4) and reproductive coercion (low: aOR 3.0, 95% CI 1.4–6.2; high: aOR 5.7, 95% CI 2.8–11.6). CONCLUSIONS: Cyber dating abuse is common and associated with ARA and sexual assault in an adolescent clinic-based sample. The associations of cyber dating abuse with sexual behavior and pregnancy risk behaviors suggest a need to integrate ARA education and harm reduction counseling into sexual health assessments in clinical settings.

A family planning clinic-based intervention to address reproductive coercion: A cluster randomized controlled trial

OBJECTIVE We assessed the effectiveness of a provider-delivered intervention targeting reproductive coercion, an important factor in unintended pregnancy. STUDY DESIGN We randomized 25 family planning clinics (17 clusters) to deliver an education/counseling intervention or usual care. Reproductive coercion and partner violence victimization at 1 year follow-up were primary outcomes. Unintended pregnancy, recognition of sexual and reproductive coercion, self-efficacy to use and use of harm reduction behaviors to reduce victimization and contraception nonuse, and knowledge and use of partner violence resources were secondary outcomes. Analyses included all available data using an intention-to-treat approach. RESULTS Among 4009 females ages 16 to 29 years seeking care, 3687 completed a baseline survey prior to clinic visit from October 2011 to November 2012; 3017 provided data at 12-20weeks post-baseline (T2) and 2926 at 12months post-baseline (T3) (79% retention). Intervention effects were not significant for reproductive coercion [adjusted risk ratio (ARR) 1.50 (95% confidence interval 0.95-2.35)] or partner violence [ARR 1.07 (0.84-1.38)]. Intervention participants reported improved knowledge of partner violence resources [ARR 4.25 (3.29-5.50)] and self-efficacy to enact harm reduction behaviors [adjusted mean difference 0.06 (0.02-0.10)]. In time point-specific models which included moderating effects of exposure to reproductive coercion at baseline, a higher reproductive coercion score at baseline was associated with a decrease in reproductive coercion 1 year later (T3). Use and sharing of the domestic violence hotline number also increased. CONCLUSION This brief clinic intervention did not reduce partner violence victimization. The intervention enhanced two outcomes that may increase safety for women, specifically awareness of partner violence resources and self-efficacy to enact harm reduction behaviors. It also appeared to reduce reproductive coercion among women experiencing multiple forms of such abuse.

A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

BACKGROUND AND OBJECTIVES: Few evidence-based interventions address adolescent relationship abuse in clinical settings. This cluster randomized controlled trial tested the effectiveness of a brief relationship abuse education and counseling intervention in school health centers (SHCs). METHODS: In 2012–2013, 11 SHCs (10 clusters) were randomized to intervention (SHC providers received training to implement) or standard-of-care control condition. Among 1062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention). RESULTS: Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (−0.02 to 0.22); intentions to intervene = 0.03 (−0.09 to 0.15); and knowledge of resources = 0.18 (−0.06 to 0.42). Intervention participants had improved recognition of sexual coercion compared with controls (adjusted mean difference = 0.10 [0.01 to 0.18]). In exploratory analyses adjusting for intensity of intervention uptake, intervention effects were significant for increased knowledge of relationship abuse resources and self-efficacy to use harm reduction behaviors. Among participants reporting relationship abuse at baseline, intervention participants were less likely to report such abuse at follow-up (mean risk difference = −0.17 [−0.21 to −0.12]). Adolescents in intervention clinics who reported ever being in an unhealthy relationship were more likely to report disclosing this during the SHC visit (adjusted odds ratio = 2.77 [1.29 to 5.95]). CONCLUSIONS: This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.