Sarah W. Helms

Sexual Communication Between Early Adolescents and Their Dating Partners, Parents, and Best Friends

This study assessed early adolescents’ sexual communication with dating partners, parents, and best friends about six sexual health topics: condoms, birth control, sexually transmitted diseases (STDs), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), pregnancy, and abstinence/waiting. Using a school-based sample of 603 youth (ages 12 to 15; 57% female; 46% Caucasian), we examined communication differences across demographic and developmental factors, tested whether communication with parents and best friends was associated with greater communication with partners, and examined associations between communication and condom use. More than half of participants had not discussed any sexual topics with their dating partners (54%), and many had not communicated with parents (29%) or best friends (25%). On average, communication was more frequent among adolescents who were female, African American, older, and sexually active, despite some variation in subgroups across partner, parent, and friend communication. Importantly, communication with parents and friends—and the interaction between parent and friend communication—was associated with increased communication with dating partners. Further, among sexually active youth, increased sexual communication with partners was associated with more frequent condom use. Results highlight the importance of understanding the broader family and peer context surrounding adolescent sexual decision making and suggest a possible need to tailor sexual communication interventions.

High Peer Popularity Longitudinally Predicts Adolescent Health Risk Behavior, or Does It?: An Examination of Linear and Quadratic Associations

OBJECTIVE In contrast to prior work, recent theory suggests that high, not low, levels of adolescent peer popularity may be associated with health risk behavior. This study examined (a) whether popularity may be uniquely associated with cigarette use, marijuana use, and sexual risk behavior, beyond the predictive effects of aggression; (b) whether the longitudinal association between popularity and health risk behavior may be curvilinear; and (c) gender moderation. METHODS A total of 336 adolescents, initially in 10-11th grades, reported cigarette use, marijuana use, and number of sexual intercourse partners at two time points 18 months apart. Sociometric peer nominations were used to examine popularity and aggression. RESULTS Longitudinal quadratic effects and gender moderation suggest that both high and low levels of popularity predict some, but not all, health risk behaviors. CONCLUSIONS New theoretical models can be useful for understanding the complex manner in which health risk behaviors may be reinforced within the peer context.

Adolescents’ Recognition of Potential Positive and Negative Outcomes in Risky Dating Situations

Risky adolescent behavior represents a significant public health concern, with potential detrimental consequences for youth and society in general. Problem behavior theory suggests that engaging in one type of problem behavior increases the likelihood of other problem behaviors. As a result, understanding how youth perceive common dating risk situations that may place them at risk not only for dating violence but also for a variety of other problem behaviors could inform prevention programming. Using qualitative interviews with 43 urban, predominantly African American adolescents, we assessed risk perceptions via youths’ identification of potential positive and negative outcomes associated with dating situations that may place teens at risk for negative outcomes including violence and risk behaviors. Six themes each of potential positive and negative outcomes emerged, including positive themes related to interpersonal skills, relationship connections, having fun, and improving image, and negative themes related to victimization, control, jealousy, conflict, consequences, and reputation. This research has important implications for youth prevention programs, especially those focused on helping adolescents develop healthy relationships.

Problem Situations Experienced By Urban Middle School Students With High Incidence Disabilities That Impact Emotional and Behavioral Adjustment

A mixed methods approach was used to identify problem situations in peer and school contexts experienced by urban middle school students with high incidence disabilities that may impact their emotional and behavioral adjustment. A survey and semi-structured interview were conducted with a predominantly African American sample (95%) of 74 adolescents (61% boys) with high incidence disabilities (71% with learning disabilities, 15% with intellectual disabilities, and 14% with emotional or behavioral disorders). Focus groups were conducted with 35 school staff members. Based on the survey data, 14 peer and school problem situations were rated as frequently occurring and difficult to cope with. Data from the student interviews and focus groups revealed five themes of problem situations, including three in peer (i.e., peer influence, provocation, and teasing) and two in school (i.e., academic challenges and student–teacher relationships) contexts. These findings have important implications for school-based interventions focused on reducing risk for emotional and behavioral adjustment problems.

Intrinsic Religiosity Buffers the Longitudinal Effects of Peer Victimization on Adolescent Depressive Symptoms

Peer victimization is a common and potentially detrimental experience for many adolescents. However, not all youth who are exposed to peer victimization experience maladaptive outcomes, such as depression. Thus, greater attention to potential moderators of peer victimization is particularly important. The current study examined the potential moderating effect of intrinsic religiosity and religious attendance on the longitudinal association between physical and relational victimization and depressive symptoms. A diverse sample of adolescents (N = 313; Mage = 17.13 years; 54% female; 49% Caucasian, 24% African American, 19% Latino, 8% mixed race/other; 80% Christian religious affiliation) were recruited from a rural, low-income setting. Adolescents completed self-report measures of religious attendance and intrinsic religiosity, and two forms of victimization (i.e., physical and relational) were assessed using sociometric procedures in 11th grade. Depressive symptoms were measured in both 11th and 12th grade. Results suggest that relational victimization is associated prospectively with depressive symptoms only under conditions of adolescents’ low intrinsic religiosity. Findings may contribute to efforts aimed at prevention and intervention among adolescents at risk for peer victimization and depression.

Patient and Provider Perspectives on Communication About Body Image With Adolescents and Young Adults With Cystic Fibrosis

Objective This mixed-methods study examined perspectives of adolescents and young adults (AYAs) with cystic fibrosis (CF) and health care providers on body image communication. Methods Interviews and questionnaires were completed by 20 AYAs and 28 providers. Results Although 85% of patients reported they had never had a body image conversation with a health care provider, 74% of providers reported discussing this topic with patients. Patients and providers described body image as an important issue, which should be discussed comfortably and supportively. However, patients often preferred to discuss body image as a distinct topic, separate from physical health, whereas providers preferred integrating body image conversations within weight- and health-based discussions. Conclusions Body image is an important topic for AYAs with CF that often goes unaddressed or addressed in ways that are less preferred by patients. Providers should reduce barriers to effective communication about this important topic, particularly through increased awareness of AYA preferences.

Exploring knowledge and perceptions of palliative care to inform integration of palliative care education into cystic fibrosis care

Individuals with cystic fibrosis (CF) face the challenges of managing a chronic, progressive disease. While palliative care is a standard of care in serious illnesses, there are no guidelines for its incorporation into CF care. Patients with CF, caregivers, and CF care providers may lack knowledge about palliative care and perceive barriers to integrated care.

Preliminary Associations among Relational Victimization, Targeted Rejection, and Suicidality in Adolescents: A Prospective Study

This study examined associations between multiple types of interpersonal and noninterpersonal stressors and the subsequent occurrence of suicide ideation and attempts among female adolescents. Adolescents ages 12 to 18 years old (n = 160) at elevated risk for suicidal thoughts and behaviors were followed for 18 months, divided into two 9-month epochs for data analysis (Periods 1 and 2). Exposure to acute relational victimization, targeted rejection, nonspecified interpersonal, and noninterpersonal life stressors over the first 9-month epoch (Period 1) was assessed using semistructured interviews and an independent life stress rating team. Participants also completed phone-based semistructured interviews of suicidal thoughts and behaviors. Preliminary analyses showed significant prospective associations between acute targeted rejection and nonspecified interpersonal stress during Period 1 and suicide ideation during Period 2, as well as relational victimization and noninterpersonal stress during Period 1 and suicide attempts during Period 2. However, in logistic regression analyses that adjusted for prior suicidality and depressive symptoms, relational victimization during Period 1 (but not targeted rejection, nonspecified interpersonal or noninterpersonal events) was associated with increased odds of suicide attempt during Period 2. Therefore, acute relational victimization exposure is associated with heightened risk for suicidal behaviors in female adolescents. Future studies should examine potential mediators and moderators of this association, and these stressors should be considered for inclusion in clinical screening tools.

Reciprocal Associations between Adolescent Girls’ Chronic Interpersonal Stress and Nonsuicidal Self-Injury: A Multi-wave Prospective Investigation

PURPOSE Nonsuicidal self-injury (NSSI) is associated with increased risk of suicide attempts. Theories of NSSI assert interpersonal stress as a common risk factor for, and perhaps consequence of, NSSI. Prior research has not examined reciprocal associations between chronic interpersonal stress and NSSI. This study used a multiwave, prospective design to address this gap in a sample of adolescent girls, a group with elevated risk for both chronic interpersonal stress and NSSI. Pubertal development was examined as a moderator of the reciprocal associations. METHODS Adolescent girls (N = 220; ages 12-16, M age = 14.69 years) at heightened risk for NSSI completed a baseline assessment and follow-up assessments over 18 months, divided into two 9-month epochs (Time 1 and 2). Pubertal development was assessed via self- and parent-report. Chronic interpersonal stress was assessed using a semistructured interview at the end of each time period. NSSI was measured using a semistructured clinical interview every 3 months within both time periods to enhance accurate reporting. RESULTS Path models revealed that chronic romantic stress during Time 1, but not peer or parent-child stress, predicted NSSI during Time 2 among girls with more advanced pubertal development. Moreover, NSSI during Time 1 predicted higher levels of chronic romantic and parent-child stress during Time 2. CONCLUSIONS Results revealed a reciprocal relationship between chronic romantic stress and engagement in NSSI. Further, this association may be best understood in the context of pubertal development.

Interpersonal Stress Severity Longitudinally Predicts Adolescent Girls’ Depressive Symptoms: the Moderating Role of Subjective and HPA Axis Stress Responses

In recent decades, stress response models of adolescent depression have gained attention, but it remains unclear why only certain adolescents are vulnerable to the depressogenic effects of stress while others are not. Building on evidence that affective and physiological responses to stress moderate the impact of stress exposure on depression, the current study examined whether the interaction between severity of interpersonal stress, subjective affective reactivity, and hypothalamic-pituitary-adrenal (HPA) axis reactivity to an acute, in-vivo psychosocial stressor prospectively predicted depressive symptoms nine months later. Hypotheses were examined with a clinically-oversampled group of 182 adolescent girls (aged 12–16) to ensure an examination of the widest possible range of risk. Self-report measures of affect and salivary cortisol samples were collected before and after an in-vivo stress task to assess affective reactivity and HPA axis reactivity, respectively. Severity of interpersonal stress between baseline and nine months was assessed using a semi-structured interview and was objectively coded for severity and content theme (i.e., interpersonal vs. non-interpersonal). Results indicate that experiences of severe interpersonally-themed stress predict elevated levels of depressive symptoms longitudinally only for adolescent girls with elevated affective reactivity to stress, and suggest that these deleterious effects of stress are most exacerbated for girls with elevated physiological responses to stress. Findings suggest that it may be critical to examine both affective and physiological stress responses when assessing risk for depression in adolescents.