Susan Feigelman

Impact of perceived parental monitoring on adolescent risk behavior over 4 years

PURPOSE To determine the stability of perceived parental monitoring over time and its long-term effect on health risk behaviors among low-income, urban African-American children and adolescents. DESIGN Prospective, longitudinal follow-up (4 years). SUBJECTS A total of 383 African-American youth aged 9-15 years at baseline recruited from nine recreation centers serving three public housing communities in an Eastern city. OUTCOME MEASURES A six-item measure assessing perceived parental monitoring and an 11-item self-reported measure assessing unprotected sex, drug use, and drug trafficking were administered at baseline and at regular intervals over the subsequent 4 years. ANALYSIS Concordance was assessed by Pearson correlation coefficients at the level of scale and by kappa scores at the level of items. The association between the monitoring score and risk involvement was determined by stepwise multiple regression analysis including parental monitoring, age, gender, intervention status, and two-way interactions between parental monitoring and age, gender, intervention status as independent variables. RESULTS The perception of being monitored demonstrated consistency over time. Parental monitoring was inversely correlated with all three targeted risk behaviors cross-sectionally and prospectively. CONCLUSION These data provide evidence for an inverse relationship between perceived parental monitoring and risk involvement cross-sectionally and longitudinally. These data support the long-term effect of perceived parental monitoring on risk behaviors among urban, low-income African-American children and adolescents. Coupled with some evidence suggesting that directed interventions might be able to increase parental monitoring, this study provides a solid platform for reinforcing the importance of parental monitoring and directing intervention efforts at strengthening parental monitoring to reduce adolescent risk behaviors.

Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents

PURPOSE To examine gender and age differences among urban, low-income, African-American children and adolescents in perceived monitoring by their parents, and the association of perceived parental monitoring with family characteristics, health risk behaviors, and risk perceptions. METHODS Three cross-sectional surveys were conducted in 1992 (n = 455), 1994 (n = 355), and 1996 (n = 349). Respondents aged 9-17 years were recruited from low-income urban areas including public housing communities and associated recreation centers. Both multivariate analysis of variance and correlation analysis were performed. RESULTS Low levels of perceived parental monitoring were associated with participation in several health risk behaviors, including sexual behavior, substance/drug use, drug trafficking, school truancy, and violent behaviors. Females perceived themselves to be more monitored than did males. In general, the perceived parental monitoring tended to decrease with advancing age of the youth. CONCLUSIONS The strong inverse correlation between perceived parental monitoring and adolescent risk behavior suggests that parental monitoring initiatives may be an effective intervention tool. Longitudinal studies are needed to determine the long-term relationship between perceived parental monitoring and adolescent risk involvements.

Parental underestimates of adolescent Risk behavior : A randomized, controlled trial of a Parental monitoring intervention

OBJECTIVES To develop and evaluate an intervention (ImPACT) seeking to increase monitoring (supervision and communication) by parents and guardians of African-American youth regarding high risk and protective behaviors; and to develop an instrument to assess parental monitoring, the Parent-Adolescent Risk Behavior Concordance Scale. DESIGN/INTERVENTION This research was a randomized, controlled longitudinal study. Baseline (preintervention), and 2 and 6 months postintervention data were obtained via a talking MacIntosh computer regarding youth and parent perceptions of youth involvement in 10 risk behaviors, parental monitoring and youth-parent communication, and condom-use skills. Intervention parents and youth received the ImPACT program and a video emphasizing parental supervision and discussion, followed by a structured discussion and role-play emphasizing key points. Control parents and youth received an attention-control program on goal-setting, which also included an at-home video and discussion. PARTICIPANTS A total of 237 parents and one each of their youth (ages 12-16 years) recruited from eight public housing developments located in a city in the mid-Atlantic region. RESULTS Similarity of youth and parental reporting on the Parent-Adolescent Risk Behavior Concordance Scale was positively correlated with protective behaviors, perceived parental monitoring, and good parent-youth communication. At baseline, parents significantly underestimated their youths risk behaviors. However, 2 and 6 months postintervention, the ImPACT program increased similarity of reports by youth and their parents of youth involvement in risk and protective behaviors. In addition, at 6 months postintervention, intervention (compared to control) youths and parents also demonstrated higher levels of condom-use skills. CONCLUSION Parental monitoring interventions such as ImPACT should be given to parents in conjunction with more traditional youth-centered risk-reduction interventions.

Children in kinship care: How do they fare?

Abstract The placement of children in need of out-of-home care with relatives (i.e., kinship care) has been an increasing trend. The study summarized in this paper represents the first comprehensive assessment of the physical and mental health and educational status of children in kinship care. The anticipated high risk status of these children was supported by study findings in all areas of assessment. These findings are discussed and recommendations are offered for policy, practice and future research.

Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model

CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care–based programs have been developed, and most have not been well evaluated. OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0–5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.

“Talking” computers: A reliable and private method to conduct interviews on sensitive topics with children

To obtain valid results, interviews on sex‐related topics not only require confidentiality but also privacy. However, the typical solutions to this problem, self‐administered questionnaires or telephone interviews, may not be appropriate for pre‐ and early adolescents who may require face‐to‐face (FTF) interviews. In this research, we tested the hypothesis that interviews delivered by talking computers would elicit more reports of sexual experience and positive feelings toward sex than FTF interviews with children. To test the hypothesis, we compared the results of both interview methods administered to separate samples of 300 and 96 Black children ages 9 to 15 living in public housing. The results supported the hypothesis. In addition, a subsample of the children (n = 31) who had completed both interviews reported more favorable feelings toward sex in the computer interview. Computer interviews were reliable and did not produce higher levels of missing responses than FTF interviews. The results suggest t...

Behavior problems of children in kinship care.

ABSTRACT. An increasing number of children needing out-of-home care are being placed with relatives. Despite this pervasive policy, there has been scant research on children in this arrangement called kinship care. The objectives of this study were (1) to assess the behavior of children in kinship care and (2) to identify predictors of their behavior. The caregivers of 346 children in kinship care completed the Child Behavior Checklist (CBCL). Background information was obtained from caregivers and caseworkers. Forty-two percent of boys and 28% of girls had overall CBCL scores in the clinical range, compared with an expected 10% in the general population. Logistic regressions revealed several variables significantly associated with behavior problems including: reason for placement, gender, race, caregivers perception of the child, caregivers educational level, number of contacts between caregiver and caseworker, long-term plan, and childs age. The frequent behavior problems among these high-risk children in kinship care suggest they all deserve mental health evaluations; at a minimum, periodic screening is indicated. J Dev Behav Pediatr 14:386–393, 1993. Index terms: kinship care, foster care, behavior.

Longitudinal Stability and Predictability of Sexual Perceptions, Intentions, and Behaviors Among Early Adolescent African-Americans

PURPOSE To assess the stability and predictability of perceptions, intentions, and behaviors regarding intended sexual intercourse and condom use. METHODS One hundred and nineteen African-American youth aged 9-15 years living in urban public housing provided information at baseline and 6 months later using a theory-based and culturally- and developmentally-tailored instrument assessing perceptions, intentions, and sexual behaviors. RESULTS Over the 6-month study interval, individual behaviors, intentions, and perceptions demonstrated considerable stability. Intentions regarding sexual intercourse in the next half-year were predictive of subsequent coitus among the entire cohort and among the subset who were virgins at baseline. Youth who thought it likely that they would be sexually-active in the next 6 months were at significantly elevated risk of doing so, compared to youth who were uncertain or thought coitus unlikely. However, intentions regarding future coitus among the subset of youth who were sexually-experienced at baseline were not predictive of future coital behavior. CONCLUSIONS These data suggest that social cognitive behavioral models that incorporate intentions and perceptions are appropriate as the theoretical basis for interventions targeting these young adolescents.

The relationship among violence victimization, witnessing violence, and youth distress.

PURPOSE To explore whether violence victimization and witness experiences of predominantly African-American, low-income, urban adolescents were associated with distress and whether psychosocial factors contributed to symptomatology. METHODS Data for this study were obtained from a cross-sectional survey of 349 youth between the ages of 9 and 15 years who resided in any of 10 low-income public housing communities in an East Coast city. Survey instruments assessed exposure to violence, distress symptomatology, youth psychosocial functioning, and family dynamics. Data were analyzed by computing Pearson correlation coefficients and a series of multiple linear regression models. RESULTS Witnessing violence was related to youth reports of intrusive thoughts and feelings, difficulties with concentration, and vigilant or avoidant behavior. Violence victimization was correlated with feelings of despondency about having either a happy or long life, as well as feelings of being unloved, uncared for, and afraid. Younger youth, boys, and active problem solvers were more likely to report intrusive thoughts. Problematic family communication was related to intrusive thoughts, distraction, feeling a lack of belonging, and expressions of emotional numbing. CONCLUSIONS The act of witnessing violence may be associated with a set of distinct symptoms. Youth who witness violence also need to be identified so they may be aided in dealing with their distress. Family communication, particularly problematic family communication, and problem solving also contribute to symptomatology.

Screening for Depression in an Urban Pediatric Primary Care Clinic

OBJECTIVES. The goals were to estimate the prevalence of parental depressive symptoms among parents at a pediatric primary care clinic and to evaluate the stability, sensitivity, specificity, and positive and negative predictive values of a very brief screen for parental depression. METHODS. A total of 216 mothers (because 96% of caregivers were mothers, we use this term) bringing in children <6 years of age for child health supervision completed a parent screening questionnaire in a primary care clinic. The parent screening questionnaire, a brief screen for psychosocial problems developed for the study, includes 2 questions on depressive symptoms. Mothers then completed the computerized study protocol within 2 months. This included the parent screening questionnaire as well as the Beck Depression Inventory II. Different combinations of the depression questions were evaluated against Beck Depression Inventory II clinical cutoff values. RESULTS. Twelve percent of the mothers met the Beck Depression Inventory II clinical cutoff value for at least moderate depressive symptoms. There was moderate stability of the screening questions. When a positive response to either or both of the 2 questions was considered, the sensitivity was 74%, the specificity was 80%, the positive predictive value was 36%, and the negative predictive value was 95%. CONCLUSIONS. Maternal depressive symptoms are prevalent. A very brief screen can identify reasonably those who could benefit from additional evaluation and possible treatment. This should benefit mothers, families, and children.