Renee E. Sieving

The effects of race/ethnicity, income, and family structure on adolescent risk behaviors.

OBJECTIVES The study examined the unique and combined contributions of race/ethnicity, income, and family structure to adolescent cigarette smoking, alcohol use, involvement with violence, suicidal thoughts or attempts, and sexual intercourse. METHODS Analyses were based on the National Longitudinal Study of Adolescent Health. A nationally representative sample of 7th to 12th graders participated in in-home interviews, as did a resident parent for 85.6% of the adolescent subjects. The final sample included 10,803 White, Black, and Hispanic 7th to 12th graders. RESULTS White adolescents were more likely to smoke cigarettes, drink alcohol, and attempt suicide in the younger years than were Black and Hispanic youths. Black youths were more likely to have had sexual intercourse; both Black and Hispanic youths were more likely than White teens to engage in violence. Controlling for gender, race/ethnicity, income, and family structure together explained no more than 10% of the variance in each of the 5 risk behaviors among younger adolescents and no more than 7% among older youths. CONCLUSIONS Findings suggest that when taken together, race/ethnicity, income, and family structure provide only limited understanding of adolescent risk behaviors.

Social Connections, Trajectories of Hopelessness, and Serious Violence in Impoverished Urban Youth.

Youth living in impoverished urban neighborhoods are at risk for becoming hopeless about their future and engaging in violent behaviors. The current study seeks to examine the longitudinal relationship between social connections, hopelessness trajectories, and subsequent violent behavior across adolescence. Our sample included 723 (49% female) African American youth living in impoverished urban neighborhoods who participated in the Mobile Youth Survey from 1998 through 2006. Using general growth mixture modeling, we found two hopelessness trajectory classes for both boys and girls during middle adolescence: a consistently low hopelessness class and an increasingly hopeless class with quadratic change. In all classes, youth who reported stronger early adolescent connections to their mothers were less hopeless at age 13. The probability of later adolescent violence with a weapon was higher for boys and was associated with the increasingly hopeless class for both boys and girls. Implications for new avenues of research and design of hope-based prevention interventions will be discussed.

Family and Racial Factors Associated With Suicide and Emotional Distress Among Latino Students

BACKGROUND Latino youth experience disproportionate rates of mental health problems including suicide and depression. Better understanding of underlying risk and protective factors on the part of school-based health professionals, teachers, and health care providers in their lives is warranted. The aims of this secondary analysis of 2004 Minnesota Student Survey data were to (1) describe the mental health status of a statewide sample of Latino 9th- and 12th-grade students; (2) explore relationships of family protective factors (communication, caring, and connection) with suicidal ideation, suicidal attempts, and emotional distress; and (3) highlight similarities and differences in family protective factors among subgroups of Latino students. METHODS Parallel analyses were completed for Latino-only and Latino-mixed students. Bivariate logistic regression models were used to examine associations between each family variable and each study outcome. RESULTS Nearly 1 in 5 Latino high school students have had suicidal thoughts in the past year; past year suicide attempts ranged from 6% to 18.5% across grade and gender subgroups. Most concerning are ninth-grade Latino girls, a group in which 30-40% reported suicidal thoughts and 14-19% reported attempting suicide in the past year. CONCLUSIONS An important study finding is the high rate of suicidal ideation, suicide attempts, and emotional distress among students who self-identified as being of mixed ethnicity. Study findings can be used to inform mental health promotion initiatives and culturally tailor interventions with Latino students.

Reliability of self-reported contraceptive use and sexual behaviors among adolescent girls.

This study examines two issues relevant to adolescents’ self‐reported sexual and contraceptive use behaviors: reliability of partner‐referent reports versus 3‐ and 6‐month reports, and test‐retest reliability of reports completed over a 2‐week period. Data are from 196 13‐ to 18‐year‐old girls recruited into this study while they sought reproductive care from health clinics in a metropolitan area. All participants reported having had sexual intercourse during the past 6 months. Twice over a 2‐week interval, participants completed the same paper‐and‐pencil surveys. The survey presented questions about sexual behavior and contraceptive use using 3 sequential frames of reference: within the past 6 months, within the past 3 months, and by specific sexual partners in the past 6 months. Findings demonstrate that adolescent girls can reliably report sexual behavior and contraceptive use over a 6‐month interval. Study findings have implications for future research utilizing adolescents’ self‐reported sexual and contraceptive use behaviors.

Parents' beliefs about condoms and oral contraceptives: are they medically accurate?

Parents are encouraged to be the primary sex educators for their children; however little is known about the accuracy of parents views about condoms and oral contraceptives. Telephone surveys using validated measures provided data on beliefs about the effectiveness safety and usability of condoms and the pill among 1069 parents of 13-17-year-olds in Minnesota and Wisconsin in 2002. Pearson chi-square tests and multivariate logistic regression models were used to compare beliefs according to sex age race religion education income and political orientation. Substantial proportions of parents underestimated the effectiveness of condoms for preventing pregnancy and sexually transmitted diseases (STDs). Only 47% believed that condoms are very effective for STD prevention and 40% for pregnancy prevention. Fifty-two percent thought that pill use prevents pregnancy almost all the time; 39% thought that the pill is very safe. Approximately one-quarter of parents thought that most teenagers are capable of using condoms correctly; almost four in 10 thought that most teenagers can use the pill correctly. Fathers tended to have more accurate views about condoms than mothers did; mothers views of the pill were generally more accurate than fathers. Whites were more likely than nonwhites to hold accurate beliefs about the pills safety and effectiveness; conservatives were less likely than liberals to hold accurate views about the effectiveness of condoms. Campaigns encouraging parents to talk with their teenagers about sexuality should provide parents with medically accurate information on the effectiveness safety and usability of condoms and the pill. (authors)

am I qualified? How do I know? a Qualitative Study of Sexuality educators' Training experiences

Abstract Background: National Health Education Standards in the U. S. focus on key concepts and skills around health issues, including sexuality. However, little is known about the extent to which classroom teachers are trained to deliver sexuality education. Purpose: The purpose is to explore pre-service training experiences and needs of sexuality educators in Minnesota. Methods: Seven focus groups were conducted with a diverse sample of 41 sexuality educators, and qualitative analysis was used to detect themes across groups. Results: Results indicate a wide variety of pre-service teaching experience, ranging from no instruction to extensive training. Teachers had numerous suggestions for ways their training could have better prepared them to teach sexuality education, such as ways of working with culturally diverse students. Teachers described many ways in which they were unprepared in their first year of teaching sexuality education. Discussion: Training programs to prepare sexuality educators are not adequately preparing teachers for their multifaceted role. Findings point to the need to train sexuality educators differently than teachers for other subjects. Translation to Health Education Practice: Findings indicate that pre-service training programs should greatly expand their offerings, tighten requirements and hone methodologies in sexuality education to meet the needs of todays teachers and students.

Prime Time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors.

PURPOSE Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic service who are at high risk for pregnancy. This article examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention. METHODS This study was a randomized controlled trial with 253 girls aged 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention used a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months after enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time. RESULTS At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception, and dual contraceptive methods with their most recent partner as compared with the control group. The intervention group also reported greater stress management skills with trends toward higher levels of prosocial connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use. CONCLUSION Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth.

A clinic-based, youth development approach to teen pregnancy prevention

OBJECTIVE To provide a description of Prime Time, an intervention to reduce pregnancy risk behaviors among high-risk adolescent girls. METHODS Prime Time, a clinic-based, multicomponent youth development intervention aims to reduce sexual risk behaviors, violence involvement, and school disconnection. RESULTS We highlight key considerations in conceptualization, design, and methods for a Prime Time randomized trial. CONCLUSIONS Prime Time comes at a time of great interest in restructuring adolescent health services. This study represents an important effort to expand preventive and youth development services among young people most vulnerable to early pregnancy, for whom services must go beyond traditional problem-oriented approaches.

Prime Time: Sexual Health Outcomes at 24 Months for a Clinic-Linked Intervention to Prevent Pregnancy Risk Behaviors

IMPORTANCE Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. OBJECTIVE To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention. DESIGN Randomized controlled trial. SETTING Community and school-based primary care clinics. PARTICIPANTS Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey. INTERVENTION Offered during an 18-month period, Prime Time includes case management and youth leadership programs. MAIN OUTCOME MEASURES Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months. RESULTS At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners. CONCLUSIONS AND RELEVANCE This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.

A Clinic-Based Youth Development Program to Reduce Sexual Risk Behaviors Among Adolescent Girls: Prime Time Pilot Study

Multifaceted, sustained efforts are needed to reduce early pregnancy and sexually transmitted diseases among high-risk adolescents. An important area for research is testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have rigorously evaluated a dual approach of building protective factors while addressing risk. This article presents findings from a pilot study of Prime Time, a clinic-based youth development intervention to reduce sexual risk behaviors among girls at risk for early pregnancy. Girls aged 13 to 17 years meeting specified risk criteria were assigned to Prime Time treatment groups. The Prime Time intervention included a combination of case management services and peer leadership groups. Participants completed self-report surveys at baseline, 12 and 18 months following enrollment. At 12 months, the intervention group reported significantly fewer sexual partners than the control group. At 18 months, the intervention group reported significantly more consistent condom use with trends toward more consistent hormonal and dual method use. Dose-response analyses suggested that relatively high levels of exposure to a youth development intervention were needed to change contraceptive use behaviors among adolescents at risk for early pregnancy. Given promising findings, further testing of the Prime Time intervention is warranted.