Stephanie Milan

Urban Teens: Trauma, Posttraumatic Growth, and Emotional Distress among Female Adolescents.

Urban teens face many traumas, with implications for potential growth and distress. This study examined traumatic events, posttraumatic growth, and emotional distress over 18 months among urban adolescent girls (N = 328). Objectives were to (a) describe types of traumatic events, (b) determine how type and timing of events relate to profiles of posttraumatic growth, and (c) prospectively examine effects of event type and posttraumatic growth on short- and long-term emotional distress with controls for pre-event distress. Results indicate that type of event was related to profiles of posttraumatic growth, but not with subsequent emotional distress. When baseline emotional distress was controlled, posttraumatic growth was associated with subsequent reductions in short- and long-term emotional distress. Implications for future research and clinical practice with adolescents are addressed.

Social Support and Social Conflict as Predictors of Prenatal Depression

OBJECTIVE: To estimate how social support and social conflict relate to prenatal depressive symptoms and to generate a brief clinical tool to identify women at increased psychosocial risk. METHODS: This is a prospective study following 1,047 pregnant women receiving care at two university-affiliated clinics from early pregnancy through 1 year postpartum. Structured interviews were conducted in the second trimester of pregnancy. Hierarchical and logistic regressions were used to examine potential direct and interactive effects of social support and conflict on prenatal depressive symptoms measured by the Center for Epidemiologic Studies-Depression Scale. RESULTS: Thirty-three percent of the sample reported elevated levels of depressive symptoms predicted from sociodemographic factors, social support, and social conflict. Social support and conflict had independent effects on depressive symptoms although social conflict was a stronger predictor. There was a “dose–response,” with each increase in interpersonal risk factor resulting in consequent risk for probable depression based on symptom reports (Center for Epidemiologic Studies-Scale greater than or equal to 16). A composite of one social support and three conflict items were identified to be used by clinicians to identify interpersonal risk factors for depression in pregnancy. Seventy-six percent of women with a composite score of three or more high-risk responses reported depressive symptoms. CONCLUSION: Increased assessment of social support and social conflict by clinicians during pregnancy can identify women who could benefit from group or individual interventions to enhance supportive and reduce negative social interactions. LEVEL OF EVIDENCE: II

Factors influencing maltreated children's early adjustment in foster care

Internal representations of self and primary attachment figures may be one mechanism by which maltreatment affects childrens interpersonal behavior and relationships with others. Research on the continuity and influence of maltreated childrens attachment representations, however, has not included youngsters removed from abusive or neglectful home environments. This paper examines the influence of maltreated childrens maternal and self-representations on subsequent relationships with foster mothers and behavioral adjustment in foster care. Participants included 32 children, ages 9-13 years, who entered foster placement for the first time after a sustained relationship with a maltreating biological mother. Upon initially entering foster care, childrens maternal and self-representations were significantly related to each other and to severity of maltreatment history but not to other factors believed to influence the quality of parent-child relationship (e.g., maternal mental health, partner stability). In addition, these representations significantly predicted childrens subsequent views of their relationships with foster mothers. Finally, childrens behavior in their foster homes was associated with maltreatment severity, internal representations assessed at entry into foster care, and to concurrent perceptions of their new foster mothers. These findings advance our understanding of foster placements role in maltreated childrens development and provide preliminary insight into the processes associated with the formation of potentially compensatory relationships.

The context of preschool children's sleep: racial/ethnic differences in sleep locations, routines, and concerns.

Cross-national research suggests cultural factors affect how parents manage and perceive their childrens sleep. In the United States, however, it is unclear whether documented racial/ethnic differences in these aspects of childrens sleep reflect culturally distinct parental values and practices or confounding sociodemographic factors. This study uses data from the Fragile Families and Child Well Being Study to examine potential racial/ethnic differences in how parents manage and perceive the sleep of their preschool children (n = 3,068), while controlling for potential sociodemographic (e.g., family structure), environmental (e.g., number of available bedrooms), and pragmatic (e.g., parental shift work) confounds. Results suggest racial/ethnic differences exist in where children sleep, how they are put to bed, and the level of concern mothers have about their childs sleep, beyond the effect of confounding factors. These differences may reflect distinct cultural values, as well as diverse goals for family and parent-child relationships. As our country becomes increasingly heterogeneous, it is important for developmental researchers and pediatric providers to understand the various ways diversity may be reflected in family life.

Psychological resources protect health : 5-year survival and immune function among HIV-infected women from four US cities

Objective:Guided by Cognitive Adaptation Theory, the aim was to determine whether psychological resources (positive affect, positive expectancy regarding health outcomes, finding meaning in challenging circumstances) protect against HIV-related mortality and decline in CD4 lymphocyte counts among women with HIV. Design:The HIV Epidemiologic Research Study, a longitudinal prospective cohort study, with semi-annual interview, physical examination and laboratory assays. Methods:A total of 773 HIV-seropositive women aged 16 to 55 years were recruited from four academic medical centers in Baltimore, Maryland; Bronx, New York; Providence, Rhode Island; and Detroit, Michigan. Semi-annually for up to 5 years, the women were interviewed, underwent physical examination, medical record abstraction, and venipuncture. Primary outcomes for these analyses included HIV-related mortality and CD4 cell count slope decline over 5 years. Results:Psychological resources were inversely associated with HIV-related mortality and time to death, beyond the effects of potential confounding variables such as clinical status (e.g., HIV viral load, symptoms, antiretroviral therapy), sociodemographic characteristics (e.g. age, race), and depression at study entry (P < 0.05). Psychological resources also were inversely associated with CD4+ cell count decline (P < 0.01), serving as a possible mechanism linking resources to mortality. Conclusions:Psychological resources may protect against HIV-related mortality and immune system decline. Findings have implications for understanding individual variability in HIV disease progression. Moreover, because psychological resources are potentially amenable to change, results can be applied to clinical interventions aimed at improving the health of women with HIV.

Prevalence, Course, and Predictors of Emotional Distress in Pregnant and Parenting Adolescents.

This study examines trajectories and correlates of emotional distress symptoms in pregnant adolescents (n = 203) and nulliparous adolescents (n = 188) from economically disadvantaged communities over an 18-month period. For both groups, the prevalence of significant emotional distress exceeded expectation based on adolescent norms; however, the severity of symptoms did not differ between the 2 groups. Results from growth curve modeling revealed a significant decline in symptoms during the study period for both groups, but pregnant adolescents experienced a different pattern of decline. Also, certain interpersonal factors (e.g., history of physical maltreatment, partner support) appeared to play a more important role in the emotional well-being of pregnant and parenting adolescents relative to nulliparous adolescents. Implications for early identification and intervention are discussed.

Prenatal and parenting stress on adolescent maternal adjustment: identifying a high-risk subgroup.

Objectives: Identifying adolescents who are at increased risk for a particularly difficult pregnancy and adjustment into parenthood is important, as the physical and psychological development of their infants rest in the well-being of these new mothers. This study aims to examine the effects of prenatal stress and parenting stress and the association with: (1) adolescent maternal adjustment; and (2) postpartum emotional distress. Methods: In a prospective longitudinal cohort study, 154 pregnant adolescents (age 14–19) from 10 public clinics were interviewed four times from the third trimester of pregnancy to 16 months postpartum. Planned comparisons of four stress groups were used to compare mean scores for measures of feelings about motherhood, infant care, parenting competency, and emotional distress. Results: Adolescent mothers who experienced high prenatal stress and high parenting stress had lower maternal adjustment (i.e., fewer positive feelings about motherhood, less infant care, and low parenting competency) and high postpartum emotional distress. Even when compared to adolescent mothers who experienced prenatal or parenting stress only, these adolescents were still at a greater disadvantage. Conclusions: Results suggest that adolescents who experience high stress during and after pregnancy are at increased risk for difficult maternal adjustment and high postpartum emotional distress. Findings support the need for health services targeting this subgroup of adolescent mothers, including both prenatal and parenting support. Early intervention to increase maternal adjustment and decrease emotional distress should remain a priority in facilitating the most optimal maternal and child health outcomes.

Combining Photovoice and Focus Groups: Engaging Latina Teens in Community Assessment

BACKGROUND Latino adolescents, especially girls, experience higher obesity rates and are more likely to be physically unfit than non-Latino white peers. Out-of-school programs to increase physical activity and fitness in older Latino teens are critical, but sustained engagement is challenging. PURPOSE This study combined a community-based participatory research methodology, Photovoice, with focus groups to engage Latina teens and their parents in identifying barriers to physical activity and initiating policy change actions to address them. The study investigates the effectiveness of applying Photovoice as both an evaluation tool and a leadership/advocacy intervention in a community-based obesity prevention program. DESIGN Focus group data were collected between July 2009 and October 2010 and analyzed between November 2010 and July 2011. Five focus groups were held with adults (n = 41: 95% Latino) and four with teens (n = 36: 81% Latino, 10% non-Hispanic white, 9% African-American). SETTING/PARTICIPANTS All participants (19 teens, six adults) were Latino. Spanish-speaking staff of a community-based agency, program staff, high school guidance counselors, and a job development agency recruited participants. Teens aged 14-19 years enrolled in New Britain CT, high schools, and their parents were eligible. MAIN OUTCOME MEASURES Data from Photovoice workshops (three with teens, two with parent-teen dyads) were collected and concurrently analyzed between July 2009 and August 2011. RESULTS Teens criticized school-based physical exercise programs in favor of out-of-school exercise and career advice. Parental restrictions and work, transportation, and safety issues were cited as barriers to afterschool physical activity programs. CONCLUSIONS Photovoice can empower teens and parents to address exercise barriers by promoting advocacy that leads to policy change (e.g., an out-of-school physical education option).

Avoidance, Anxiety, and Sex: The Influence of Romantic Attachment on HIV-Risk among Pregnant Women

Most unprotected sex occurs in close relationships. However, few studies examine relational factors and sexual risk among high-risk populations. Romantic Attachment Theory states that individuals have cognitive working models for relationships that influence expectations, affect, and behavior. We investigated the influence of attachment avoidance and anxiety on sexual beliefs (e.g., condom use beliefs, self-efficacy), behavior (e.g., condom use, multiple partners, unprotected sex with risky partners), and sexually transmitted infections (STIs) among 755 high-risk, young pregnant women (ages 14–25) recruited from urban prenatal clinics. Attachment anxiety predicted sexual beliefs, condom use, and unprotected sex with risky partners controlling for demographic variables. Sexual beliefs did not mediate the relationship between attachment orientation and sexual behavior. Current relationship with the father of the baby did mediate the effect of attachment anxiety on multiple partners and STIs. Results indicate the importance of including general relational factors, such as attachment, in HIV prevention.

Sexual Risk Following a Sexually Transmitted Disease Diagnosis: The More Things Change the More They Stay the Same

The purpose of this study is to assess changes in sexual risk behaviors, attitudes toward using condoms, and perceived susceptibility to future STDs for adolescent females who recently were diagnosed with an incident STD compared to those who were not diagnosed with an incident STD. Adolescent females (N=308) were assessed at two time points, 6 months apart. Ninety-two participants were diagnosed with an STD, and 216 were not diagnosed with an STD in between the two time points. Results indicated that adolescents did not significantly change their behaviors, attitudes, or perceptions following the diagnosis of an incident STD compared to those who were not diagnosed with an incident STD. This suggests that an STD diagnosis alone is not sufficient to motivate adolescent females to reduce their sexual risk behavior and change their sexual risk attitudes and perceptions.