Antibiotic Knowledge, Beliefs, and Behaviors: Testing Competing Hypotheses Using an Urban Community Sample.

Antibiotic use and misuse continue to be a worldwide concern with the increasing rate of antimicrobial resistance, lack of new antibiotics in the pipeline, and rising health care costs. Despite studies that attempt to distinguish between factors associated with antibiotic use and misuse (e.g., knowledge and beliefs and provider-patient communication), few studies have tested comparative hypotheses related to antibiotic use behavior. This study 1) compares two theoretical models (health belief and patient-centered communication) to learn which best represents the pathways associated with antibiotic use; and 2) describes urban consumers' knowledge, beliefs, and behaviors regarding antibiotic use. Interviewers completed 505 intercept surveys across six clinic- and community-based sites in Southeast Michigan. Structural equation modeling was utilized to compare two competing theoretical models predicting antibiotic behavior. Findings support the assertion that a patient-provider communication model fits the data better than the null model. Descriptive statistical analysis explicated participant knowledge was mixed. While many participants knew correct general facts about antibiotics, 35% of the sample put forth that they believed that antibiotics cure colds and flu and over half (57%) endorsed the belief that antibiotics are good for treating infections caused by viruses. The implications for theory and practice are discussed including the need for clinicians to target communication strategies for the populations that they serve.

Electronic Teen Dating Violence Curves by Age.

Electronic dating violence is a form of violence perpetrated through electronics between dating partners and is associated with worse mental health, greater risk of substance use, and increased risk of in-person forms of dating violence. Though prevalent and seeming to increase in occurrence across adolescence, little is known about trajectories of electronic dating violence throughout adolescence and both risk and protective factors predicting a given trajectory. Latent growth models were used to evaluate change over time in three specific domains of electronic dating violence: harassment, coercion, and monitoring. Data are drawn from two cohorts who were surveyed annually for four years (2013-2017) from age 12 to 15 (n = 543; 48.3% female) and 15 to 18 (n = 597, 46.6% female), respectively. For all three domains of electronic dating violence, a quadratic model fit best. In general, electronic dating violence increased from early adolescence until a peak around age 16 or 17, and then leveled off. Threat-based adverse childhood experiences (i.e., exposure to physical child abuse, parental intimate partner violence, etc.) and earlier engagement in dating behaviors increased long-term risk for both age cohorts. Protective factors such as parental monitoring decreased risk but seemed to only have protective influence at developmentally-specific periods (i.e., during the developmental period of early adolescence). A better understanding of the risk and protective factors that affect the increase of electronic dating violence during adolescence is necessary to develop effective age-appropriate prevention and intervention strategies for youth.

Does sexting predict sexual behaviors among adolescents? Gender and race effects.

INTRODUCTION: Sexting has emerged as a significant public health issue. Sexting is associated with substance use and other sexual behaviors, such as oral and vaginal sex (Houck et al., 2014; Temple & Choi, 2014). Current studies on sexting are often cross-sectional, limiting the ability to determine the temporal order of sexting and sexual behaviors. Additionally, studies focus on samples of young adults (Benotsch et al., 2013). The current study extends the literature by examining sexting and sexual behaviors longitudinally among adolescents and examines race and gender differences that play a role in sexting. METHODS: The current study utilizes a prospective, 4-year longitudinal study of 1240 adolescents (aged 11-17) living in the Midwestern United States. Overall, the sample was 10% Black males, 11% Black females, 34% White Males, 31% White females, and 15% identified as Other. Analysis includes an autoregressive model with cross-lagged effects in MPlus. RESULTS: Sexting (T1) predicted oral and sexual encounters (T4) for Black males, White males, and White females but not for Black females. Oral sex and sexual encounters (T4) did not predict any sexting (T1) for all groups. Therefore, analysis establishes sexting as an antecedent to sexual behaviors for Black males, White males, and White females. Sexting and sexual behaviors did not have a significant association for Black females. CONCLUSIONS: This study identifies sexting as a precursor to sexual behaviors among adolescents. Therefore, when tailoring programs for safe sex among these populations, focusing on sexting may reduce other sexual risky behaviors.

Adolescent Risk of Dating Violence and Electronic Dating Abuse: A Latent Class Analysis.

Electronic forms of dating violence among youth are common yet little is known about how these forms of violence overlap with the commonly studied domains of physical, sexual and verbal teen dating violence. Using factor analysis and latent class analysis, this study identifies patterns of electronic, verbal, physical and sexual dating violence victimization and perpetration in 9th and 12th graders. Data are from 470 9th (n = 190; 60.5% female; mean age = 12.0 years, age range: 11.3-13.8) and 12th graders (n = 280; 63.9% female; mean age = 14.9 years, age range: 14.0-16.6) from southeastern Michigan. A 5-class solution for 9th graders and a 6-class solution for 12th graders were selected given fit and interpretability. Classes were characterized by domain(s) of violence, as opposed to perpetration or victimization. Three domains of electronic dating aggression were identified: monitoring, harassment, and coercion. Electronic dating aggression was present in the majority of classes, and overlapped substantially with other domains of violence. The highest risk class had risk of victimization and perpetration for all types of dating violence (electronic monitoring, electronic harassment, electronic coercion, verbal violence, physical violence and sexual violence). Drug use and experiencing one or more adverse childhood experiences predicted membership in a higher risk group for the older cohort, while alcohol consumption predicted higher risk for the younger cohort. The findings from this study show overlap between dating violence domains and imply that domains of electronic dating violence are important to consider in conjunction with physical, sexual and verbal domains, to address teen dating violence.

Attitudes about aggression and perpetration of Adolescent Dating Aggression: A cross-lagged panel model.

INTRODUCTION: Several cross-sectional and longitudinal studies have found associations between attitudes about aggression and aggressive behaviors. However, few studies examine all subtypes of Adolescent Dating Aggression (ADA)-physical, psychological/emotional, sexual, and stalking; occurring in person or electronically-and there is a paucity of longitudinal studies that follow adolescents over several years. METHODS: Middle school and high school students (N = 1240), in the Midwestern United States, participated in surveys one time per year for four years. Data from each year (Y1, Y2, Y3, & Y4) was used to conduct a cross-lagged panel analysis of attitudes about aggression and aggressive behaviors, among both cohorts. RESULTS: By Y4, approximately 46% of the middle school cohort and 60% of the high school cohort perpetrated some form of ADA. The cross-lagged panel analysis revealed significant cross-sectional associations in the middle school (Y1, Y2, & Y4) and high school (Y1 & Y2) cohorts. Aggressive behaviors were significantly associated with future aggressive behaviors for the middle and high school cohorts each year. Similarly, attitudes about aggression were significantly associated with attitudes in the following years for both cohorts. Among the middle school cohort, there were significant cross-lagged effects between aggressive behaviors in Y2 and attitudes about aggression in Y3, as well as aggressive behaviors in Y3 and attitudes about aggression in Y4. Among the high school cohort, a bidirectional association was found from Y2 to Y3. CONCLUSIONS: These findings suggest prevention programs should be implemented earlier, among middle school aged adolescents, and target factors beyond attitudes supporting aggression.

Stress, Coping, Resilience and Trust during the Flint Water Crisis.

In 2014, government officials in the City of Flint, Michigan switched the municipal water source from the Detroit Water System (water source: Lake Huron) to the Flint River. During this time, an estimated 102,000 Flint residents were potentially exposed to multiple chemical (e.g., lead) and biological threats (e.g., Legionella). After the switch to water sourced from the Flint River, Flint residents consistently reported concerns over water quality while also experiencing rashes, hair loss, and other health problems, including anxiety and depression. This study 1) reports on the Flint Water Crisis and its subsequent impact on residents' stress, coping, resilience and trust and 2) describes a process methodology that trained, hired and deployed Flint residents as members of a multidisciplinary research team. A random sample of 320 Flint residents underwent household-based interviews to assess their health and mental health needs. Concomitantly, household water samples were obtained and residents were connected to known resources based on interview responses relative to need. This study found that declines in health and mental health status were correlated with increased stressors (i.e., fatigue, financial concern, anxiety), coping and less resilience or the capacity to recover. Perceived trust in government officials was significantly lower after the water crisis. While the water crisis generated numerous stressors, the event also galvanized community competence to engage in solution-focused coping and other adaptive capacities. By assessing and building upon Flint residents' resilience, community resource specialists, identified and subsequently strengthened city residents' ability to survive devastating challenges.

Onset Trajectories of Sexting and Other Sexual Behaviors Across High School: A Longitudinal Growth Mixture Modeling Approach.

Sexting is receiving substantial scholarly attention and is now considered commonplace in adolescence. Little is known, however, about the normative contexts and the development of adolescent sexting behavior, including the initiation of sexting in relation to other sexual behaviors. In this study, we used growth mixture modeling to identify classes of onset trajectories for sexual behaviors across high school. Participants included 429 high school students (54% female) who completed annual assessments of sexual behavior over a three-year period. We identified four distinct classes: postponement (9%) with no behaviors other than hand-holding and kissing initiated by Grade 11, gradual onset (44%) with sexting and other sexual behaviors emerging incrementally across high school, continuous onset (32%) with sexting and other sexual behaviors within the first three years of high school, early onset (15%) with initiation of sexting and all other sexual behaviors prior to or by the end of Grade 9. Boys were more likely than girls to be members of the postponement versus gradual onset class, while Black students were more likely than White students to be members of the early versus gradual onset class. Sexting behavior appears to be common in adolescence and co-emerges with genital contact behavior across varying trajectories of sexual development. These findings provide the foundation for contextualizing sexting within normative sexual development. Further, this information can inform efforts to promote sexual health.

Family cumulative risk and at-risk kindergarteners' social competence: the mediating role of parent representations of the attachment relationship.

Secure attachment relationships have been linked to social competence in at-risk children. In the current study, we examined the role of parent secure base scripts in predicting at-risk kindergarteners' social competence. Parent representations of secure attachment were hypothesized to mediate the relationship between lower family cumulative risk and children's social competence. Participants included 106 kindergarteners and their primary caregivers recruited from three urban charter schools serving low-income families as a part of a longitudinal study. Lower levels of cumulative risk predicted greater secure attachment representations in parents, and scores on the secure base script assessment predicted children's social competence. An indirect relationship between lower cumulative risk and kindergarteners' social competence via parent secure base script scores was also supported. Parent script-based representations of the attachment relationship appear to be an important link between lower levels of cumulative risk and low-income kindergarteners' social competence. Implications of these findings for future interventions are discussed.

Feminine Discrepancy Stress and Psychosocial Maladjustment Among Adolescent Girls.

Discrepancy stress, stress about being perceived to not conform to one's gender role (i.e., gender role discrepancy), has demonstrated effects on risky sexual and violent behaviors. However, evidence of these effects has been limited to men and boys, neglecting the impact gender role discrepancy and discrepancy stress may have on girls. In addition, no study to date, has assessed the mental health correlates of gender role discrepancy and discrepancy stress. In the current study, we sought to elucidate the relationship between perceived feminine discrepancy and feminine discrepancy stress and psychosocial maladjustment while controlling for trauma symptoms stemming from the potential repercussions of feminine discrepancy. Maladjustment was measured by creating a second-order latent factor derived from four first-order latent constructs: sexual behavior, substance use, mood disorder symptoms, and hopelessness. Data are drawn from a cross-sectional sample of female students in middle and high school (N = 643) who completed self-report questionnaires. Using structural equation modeling, we found girls reporting feminine discrepancy (i.e., less feminine than the average girl) were more likely to report feminine discrepancy stress and trauma symptomatology. Controlling for feminine discrepancy and trauma symptoms, the relationship between discrepancy stress and maladjustment was positive and significant. Additionally, girls reporting feminine discrepancy scored higher on trauma symptomatology, and trauma demonstrated a strong direct effect on psychosocial maladjustment. These data suggest that developing trauma focused prevention strategies that incorporate social norms around gender socialization may have an impact on multiple behavioral and mental health problems.

Masculine Discrepancy Stress and Psychosocial Maladjustment: Implications for Behavioral and Mental Health of Adolescent Boys.

Gender role discrepancy (GRD), or nonconformity to socially prescribed gender roles, has been linked to a multitude of adverse mental and behavioral health outcomes. Masculine discrepancy stress (MDS), stress about being perceived not to conform to one's gender role, may explain the relationship between GRD and deleterious health outcomes. However, research on MDS has primarily been restricted to adult males. This leaves a critical gap pertaining to the potential effect of MDS on adolescent boys, who may be more malleable and susceptible to the influence and pressures of gender socialization. In the current study, data are drawn from a sample of adolescent male students (N = 592) who completed self-report questionnaires. We employed structural equation modeling to test the effects of GRD and MDS on psychosocial maladjustment measured via sexual behavior, substance use, violence, mood disorder symptoms, and hopelessness. In addition, we controlled for critical risk factors including sociodemographic characteristics, adverse childhood experiences, trauma symptoms, and neighborhood disorganization. Findings indicate significant potentiating effects of MDS on maladjustment while there were direct protective effects of GRD. These data suggest that developing prevention strategies that incorporate social norms pertaining to gender socialization may have an impact on multiple behavioral and mental health problems.

In Search of Modifiable Risk and Protective Factors for Teen Dating Violence.

The present research explores the additive and interactive effects of anger or hostility (A/H), acceptance of violence (AoV), and constructive conflict resolution strategies (CRS) on the perpetration of physical and sexual teen dating violence (TDV). Adolescents completed surveys assessing physical and sexual TDV perpetration, A/H, AoV, and positive CRS. While the findings require replication with longitudinal data, the results suggest that developing interventions to modify AoV and A/H may have the potential to prevent instances of TDV perpetration among both boys and girls. The results for CRS were mixed and necessitate further exploration. These cross-sectional data provide insight into potentially fruitful areas of exploration for the development and tailoring of prevention strategies for teens at risk for physical and sexual TDV perpetration.

The Development of Severe and Chronic Violence Among Youth: The Role of Psychopathic Traits and Reward Processing.

Psychopathic traits are a manifestation of a personality pathology that comprises a core affective-interpersonal dysfunction (callous-unemotional traits) and an impulsive-antisocial behavioral component. Of particular importance, psychopathic traits are associated with the perpetration of some of the most severe acts of violence, and they appear to indicate a subset of youth at risk for earlier onset, greater frequency, and persistence of violent offending. Although these youth represent a minority of the population, they commit a significant proportion of the violence in the general community. In our review, we highlight evidence of a unique neurobiological predisposition that underlies the core affective deficits and describe contemporary accounts for the developmental processes leading to the antisocial behavior associated with psychopathy. Current evidence suggests that, for this subset of youth, the structure and function of neural circuitry supporting emotion processing, reward learning, decision making, and the development of emotion related to empathy may be crucial to understanding why they are at risk for violence. In particular, a reward dominant pattern of neurobehavioral conditioning may explain how these youth progress to some of the most severe and persistent forms of violence. However, this pattern of conditioning may also be essential to the primary prevention of such deleterious behavior. We suspect that effective strategies to prevent such violence may ultimately be informed by understanding these affective and motivational mechanisms.

Adolescent stalking and risk of violence.

Stalking perpetration and the associated risk for violence among adolescents has generally been neglected. In the present study, 1236 youth completed surveys assessing empirically established stalking indicators, threats and aggression toward stalking victims, dating violence, and violent delinquency. Latent Profile Analysis identified 3 latent classes of boys: non-perpetrators (NP), hyper-intimate pursuit (HIP), and comprehensive stalking perpetrators (CSP) and, and 2 classes for girls: NP and HIP. Boys in the CSP class were the most violent youth on nearly all indices with boys in the HIP class demonstrating an intermediate level of violence compared to NP boys. Girls in the HIP class were more violent than NP girls on all indices. These findings suggest stalking in adolescence merits attention by violence prevention experts. In particular, juvenile stalking may signify youth at risk for multiple forms of violence perpetrated against multiple types of victims, not just the object of their infatuation.

Longitudinal Effects of Electronic Dating Violence on Depressive Symptoms and Delinquent Behaviors Across Adolescence.

Depressive symptoms and delinquent behaviors that emerge during adolescence pose both short- and long-term negative outcomes. Though there is growing evidence that exposure to teen dating violence is also associated with a greater likelihood of depressive symptoms and delinquent behaviors such as engaging in peer violence and substance use, less is known about the effects of specific forms of electronic dating violence (i.e., electronic harassment, electronic coercion, and electronic monitoring) across adolescence on depressive symptoms and delinquent behaviors. Data were drawn from a 4-year prospective longitudinal study of two cohorts of youth followed from age 12 to 15 (n = 526, 52% female) and age 15 to 18 (n = 592, 53% female). Two mixed-effects models (stratified by cohort) were employed to evaluate depressive symptoms and delinquent behavior outcomes by exposure to electronic harassment, electronic coercion, and electronic monitoring, while accounting for verbal dating violence, physical dating violence, sexual dating violence, exposure to threat-based adverse childhood experiences, exposure to deprivation-based adverse childhood experiences, and gender across all four waves of data collection. Higher exposure to electronic sexual coercion was predictive of increased depression (ß = .015, p = .018). Increased exposure to electronic sexual coercion (ß = .007, p = .004) and electronic monitoring (ß = .008, p = .045) were both predictive of more delinquency across adolescence. By delineating the effects of in-person verbal, physical, and sexual dating violence with unique electronic domains, we found unique additional risk from domains of electronic dating violence, which was particularly pronounced for youth who reported electronic sexual coercion. Electronic sexual coercion heightens the risk of depressive symptoms and delinquent behaviors in males and females beyond the risk presented by in-person forms of dating violence and should be accounted for in prevention and intervention programs. Future research should explore the effect of perceived normativity on the prevalence of electronic harassment and subsequent influence on outcomes.

The relation of violence exposure and ethnicity to intelligence and verbal-performance discrepancies in incarcerated male adolescents.

Incarcerated populations have an estimated incidence of intellectual disabilities (IDs) far higher than national norms, ranging as high as 10%. In the present study, the relation between ID and violence exposure in 115 incarcerated adolescents was examined. Interpersonal violence exposure (IPV-E) predicted an average decrease in full scale IQ of 4.5 points, explaining approximately 5% of the difference in IQ. Child maltreatment increased the odds of having a verbal disability by three folds and explained 17% of the variance in verbal disability. Hierarchical regression was used to examine the relative contribution of ethnicity, poverty, and violence exposure to intellectual functioning. The literature on racial bias in incarceration and the implications for the present study are discussed.

The Effects of Adverse Childhood Experiences on Internalizing and Externalizing Behaviors among Black Children and Youth.

There is limited research on the short-term effects of ACEs on Black children and youth. Black children and youth are disproportionately exposed to abuse, neglect, and other victimizations (Drake et al. 2009; Wade et al. Journal of Family Issues, 17(3), 283-316, 2014). Investigating ACEs will provide a broader understanding of childhood trauma on developmental processes. The current study investigates how ACES impacts psychological distress, substance use, and delinquency among Black children and youth. Hypotheses were tested using a subsample of longitudinal data from 265 participants who were recruited from six school districts in Southeast Michigan. ACEs at T1 significantly predicted depressive symptoms at T2 (ß = .19, p < .05), which in turn predicted substance use (ß = .20, p < .05), and delinquency (ß = .19, p < .05). Psychological distress also mediated the associations between ACEs and substance use, and delinquency. To engage youth in prevention/interventions and practice, it is important to understand the contexts in which they develop i.e. having knowledge on the specific type of victimization instances that Black youth may experience more than their peers as well as the social factors. Therefore, taking a trauma-informed approach that will acknowledge the adverse childhood experiences that youth went through and to understand how these experiences shape their development through adolescence may be efficacious.

Adapting an evidence-based positive youth development intervention to prevent sexual and teen dating violence.

Adapting evidence-based interventions (EBIs) guided by implementation science frameworks is a promising way to accelerate the translation of effective violence prevention in schools. School-based interventions offer an opportunity to reduce the risk of multiple forms of violence, including sexual violence (SV) and teen dating violence (TDV). EBIs in schools reach large populations of adolescents, including those underserved in other settings. Although specific SV/TDV prevention programs exist, evaluations indicate limited effectiveness over time. We adapted systematically the Youth Empowerment Solutions (YES) violence-prevention EBI using key adaptation steps described in implementation science frameworks to expand the scope of YES to integrate an SV/TDV focus and meet the needs of local youth. In the formative project year, the team adapted YES to integrate SV/TDV content informed by key steps outlined in frameworks including ADAPT-ITT, research-tested intervention programs, and map of the adaptation process. These steps include: (a) assess school and student needs, (b) identify, select an EBI, (c) consult with experts with knowledge in the new topic area (SV/TDV), (d) collaborate with community partners and stakeholders, (e) identify areas for adaptation while maintaining fidelity to core elements, (f) train staff, (g) pilot test adapted materials, (h) implement, and (i) evaluate. We developed the YES for Healthy Relationships (YES-HR), a school-based prevention program that retained core elements of YES, including content related to mastery, adult resources, leadership skills, and community engagement, while integrating SV/TDV-specific content (e.g., consent). Implementation science adaptation frameworks are useful in guiding the systematic adaptation of existing EBIs to meet the needs of youth.

Maternal Depressive Symptoms and At-Risk Young Children's Internalizing Problems: The Moderating Role of Mothers' Positivity.

Maternal depressive symptoms predict negative child behaviors, including internalizing problems. However, protective factors, such as positive emotionality and positive parenting behaviors, may play an important a role in attenuating associations between maternal depressive symptoms and child behavior problems. This manuscript presents two studies that examined buffers of links between maternal depressive symptoms and child internalizing problems. Each study examined samples of primarily African American families with young children in an impoverished large city in the Midwestern United States. Families were recruited from kindergarten classes and Women, Infants, and Children (WIC) centers. In both studies, indicators of mothers' positivity, as measured by text based analysis of positive emotion word use or behavioral observation of positive parenting behaviors, attenuated links between maternal depressive symptoms and child internalizing problems. The results suggest that risk for internalizing problems within the context of maternal depressive symptoms is reduced when parents experience and express more positive emotions and behaviors.

Behavioral and Mental Health Correlates of Youth Stalking Victimization: A Latent Class Approach.

INTRODUCTION: Although recognized as a public health problem, little attention has been paid to the problem of stalking among youth. Latent profile analysis was used to identify latent groups of adolescent stalking victims and their behavioral and mental health correlates. METHODS: A cross-sectional sample of 1,236 youths were randomly selected from 13 schools stratified by community risk level (i.e., low, moderate, and high risk) and gender. Students completed surveys assessing behavioral indicators of stalking victimization, as well as substance use, sexual behavior, dating violence, and psychiatric symptoms. Data were collected in 2013 and data analyses were performed in 2015. RESULTS: Analysis indicated the presence of a non-victim class, a minimal exposure class, and a victim class for boys and girls alike. Approximately 14% of girls and 13% of boys were in the stalking victim class. Adolescents in the victim class reported more symptoms of post-traumatic stress, mood disorder, and hopelessness, as well as more instances of alcohol use, binge drinking, and physical dating violence victimization. Girls in the victim class also reported engaging in sexting behaviors and oral sex with significantly more partners than their non-victim peers. CONCLUSIONS: These findings provide valuable knowledge of the prevalence and pertinent health correlates of stalking victimization in adolescence. The data suggest a substantial proportion of adolescents are victims of stalking and are likewise at risk for a number of deleterious health outcomes. As such, this population merits further attention by prevention researchers and practitioners.

Masculine discrepancy stress, teen dating violence, and sexual violence perpetration among adolescent boys.

PURPOSE: Addressing gender norms is integral to understanding and ultimately preventing violence in both adolescent and adult intimate relationships. Males are affected by gender role expectations which require them to demonstrate attributes of strength, toughness, and dominance. Discrepancy stress is a form of gender role stress that occurs when boys and men fail to live up to the traditional gender norms set by society. Failure to live up to these gender role expectations may precipitate this experience of psychological distress in some males which, in turn, may increase the risk to engage in physically and sexually violent behaviors as a means of demonstrating masculinity. METHODS: Five-hundred eighty-nine adolescent males from schools in Wayne County, Michigan completed a survey assessing self-perceptions of gender role discrepancy, the experience of discrepancy stress, and history of physical and sexual dating violence. RESULTS: Logistic regression analyses indicated boys who endorsed gender role discrepancy and associated discrepancy stress were generally at greater risk to engage in acts of sexual violence but not necessarily physical violence. CONCLUSIONS: Boys who experience stress about being perceived as "sub-masculine" may be more likely to engage in sexual violence as a means of demonstrating their masculinity to self and/or others and thwarting potential "threats" to their masculinity by dating partners. Efforts to prevent sexual violence perpetration among male adolescents should perhaps consider the influence of gender socialization in this population and include efforts to reduce distress about masculine socialization in primary prevention strategies.