A Pilot Randomized Control Trial Demonstrating the Efficacy of the SIESTA Sleep Hygiene Intervention.

Shorter sleep duration can negatively impact children's daytime functioning and health. Latino children living near urban areas in the Mainland U.S. and Island Puerto Rico (PR) can be exposed to urban poverty and sociocultural stressors that challenge optimal sleep outcomes. Interventions to improve urban Latino children's sleep health should consider families' cultural background and environmental context to enhance acceptability and feasibility. This work describes our stepwise, multimethod approach to adapting a culturally and contextually tailored "School Intervention to Enhance Latino Students' Time Asleep (SIESTA)" for sixth- to eighth-grade Latino children residing in Greater Providence and San Juan and findings from a pilot randomized control trial (RCT) demonstrating SIESTA's efficacy. Results indicated high acceptability and greater improvement of sleep duration and behaviors in SIESTA versus control participants. The SIESTA shows potential to improve sleep outcomes in urban Latino middle schoolers. Results will inform a large-scale RCT to evaluate SIESTA's effectiveness and barriers to implementation.

Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma.

OBJECTIVE: To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma. DATA SOURCES/STUDY SETTING: National Mental Health Services Surveys conducted in 2016 and 2020. STUDY DESIGN: Repeated cross-sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk-in services, suicide prevention services, and crisis intervention team services). DATA COLLECTION/EXTRACTION METHODS: The proportion and per 100,000 population rate of facilities offering crisis services were calculated. PRINCIPAL FINDINGS: The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p = 0.06) and the magnitude of difference increased following Hurricane Maria. CONCLUSIONS: There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients.

HIV Testing in Clinical and Community Settings for an International Sample of Latino Immigrants and Nonimmigrants.

Latino/as in the U.S. and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as - both first generation immigrants and those of Latino/a descent - in the U.S. (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites.

Los latino/as representan, tanto en Estados Unidos como en España, un porcentaje desproporcionado de los casos de infección por el VIH y, a menudo son diagnosticados más tarde que sus homólogos no latino/as. Conocer los factores que influyen en la realización de la prueba del VIH en diferentes contextos resulta fundamental para la promoción de dicha prueba, lo que se considera esencial tanto para la prevención como para el tratamiento precoz. Este estudio internacional explora las diferencias en las tasas de realización de la prueba de VIH entre participantes latino/as y que fue diseñada para examinar el estado de salud mental de los imigrantes latino/as. Para ello, se han recopilado datos sobre las pruebas del VIH y sus resultados en 407 latino/as - tanto inmigrantes como de ascendencia latina-en los Estados Unidos (Boston) y España (Madrid y Barcelona). La información fue recogida en entrevistas realizadas en clínicas y agencias comunitarias. Se evaluaron los factores que predicen hacerse la prueba de VIH y de tener resultados positivos en la misma, ajustando por género, edad y el sitio de reclutamiento del paciente, y empleando para ello un modelo de regresión logística multivariado. La tasa más alta de realización de la prueba de VIH fue la de la población de Boston, seguida por Barcelona y Madrid (82%, 69%, y 59%, respectivamente, p<.0001). Según los modelos de regresión multivariada, la probabilidad de que los pacientes de Barcelona y Madrid se hicieran la prueba fue significativamente menor que la de Boston. Entre los predictores positivos para realizarse la prueba estaban un grado de escolarización superior a la secundaria, el grado de preocupación por el VIH, el uso infrecuente del condón, el informar experiencias de discriminación y el uso elevado de benzodiacepinas. Las diferencias significativas entre las tasas de realización de la prueba del VIH entre las tres ciudades sugieren la necesidad de gestionar mejores prácticas para atraer a los pacientes hacia la realización temprana de la prueba.

Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial.

Importance: Immigrants are at an increased risk for co-occurring mental health and substance misuse symptoms; however, effective treatments are lacking. Objective: To evaluate the effectiveness of the Integrated Intervention for Dual Problems and Early Action (IIDEA) program compared with enhanced usual care. Design, Setting, and Participants: This effectiveness randomized clinical trial was conducted from September 2, 2014, to February 2, 2017, in 17 clinics or emergency departments and 24 community sites in Boston, Massachusetts, as well as in Madrid and Barcelona, Spain. Equal randomization (1:1) in 2-person blocks was used, assigning participants to either the IIDEA treatment group (n = 172) or the enhanced usual care control group (n = 169). Intent-to-treat analyses assessed effectiveness, and post hoc analyses examined whether results varied by symptom severity or treatment dose. Eligible participants were between 18 and 70 years of age, self-identified as Latino, screened positive for co-occurring symptoms, and were not receiving specialty behavioral health services. Interventions: Participants were randomized to a 10-session IIDEA treatment or to enhanced usual care. Main Outcomes and Measures: Primary outcomes were changes in alcohol and drug misuse and results of a urine test for drug metabolites but not for alcohol misuse. Secondary outcomes were symptoms of depression, generalized anxiety, posttraumatic stress disorder, and overall mental health. Results: In total, 341 participants were randomized to either the IIDEA treatment group (n = 172; 94 [54.7%] female, mean [SD] age, 33.5 [11.6] years) or the enhanced usual care control group (n = 169; 80 [47.3%] female, mean [SD] age, 34.3 [11.8] years). No statistically significant effects of IIDEA were found for primary drug and alcohol outcomes (ASI Lite-drug score: ß = -0.02 [SE, 0.69; P = .88; Cohen d, 0.00; 95% CI, -0.17 to 0.17]; ASI Lite-alcohol score: ß = -0.01 [SE, 1.19; P = .66; Cohen d, 0.00; 95% CI, -0.12 to 0.12]; urine drug test result: ß = -0.36 [SE, 0.43; P = .50; OR, 0.70; 95% CI, 0.30-1.61]), but statistically significant effects were observed for secondary mental health outcomes. The IIDEA treatment was effective in reducing depressive symptoms per the Public Health Questionnaire-9 score (ß = -1.14; SE, 0.47; P = .02; Cohen d, 0.20 [95% CI, 0.04-0.36]), posttraumatic stress disorder symptoms per the Posttraumatic Stress Disorder Checklist-5 score (ß = -3.23; SE, 1.59; P = .04; Cohen d, 0.25 [95% CI, 0.01-0.37]), and overall mental health symptoms per the Hopkins Symptom Checklist-20 (ß = -0.20; SE, 0.07; P = .01; Cohen d, 0.25 [95% CI, 0.08-0.42]) and composite mental health (ß = -3.70; SE, 1.75; P = .04; Cohen d, 0.19 [95% CI, 0.01-0.36]) scores at the 6-month follow-up. Exploratory analyses suggested that 6-month treatment effects occurred for patients whose drug misuse was moderate to severe at the baseline assessment. Among patients with moderate to severe substance misuse, IIDEA substantially reduced substance use per the urine test results (odds ratio, 0.25 [95% CI, 0.09-0.67]; P = .01). Treatment dose showed small to large effect sizes by outcome. Conclusions and Relevance: The IIDEA treatment did not change drug misuse but did improve secondary mental health and substance misuse outcomes for a heterogeneous population with moderate to severe symptoms; this finding provides a path for treating Latino immigrants with co-occurring mental health and substance misuse symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT02038855.

Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid.

Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities.

Evaluation of the AC-OK mental health and substance abuse screening measure in an international sample of Latino immigrants.

BACKGROUND: Early detection and intervention in primary care is integral to behavioral health. Valid, practical screening assessments are scarce, particularly for non-English speaking populations. We address this need by evaluating the psychometric properties of the Spanish version of the AC-OK Screen for Co-occurring Disorders for first and second generation immigrant Latinos in Massachusetts, USA, and Madrid and Barcelona, Spain. METHODS: 567 Latino participants were recruited in waiting areas of clinics or by referral from Primary Care, Mental Health, Substance Use, and HIV Treatment Clinics, as well as Community Agencies. We use confirmatory factor analyses to evaluate the factor structure, correlation analysis to examine concurrent and discriminant validity, and receiver operating curves (ROC) to determine the ability of the AC-OK to approximate a composite of established instruments designed to measure depression, generalized anxiety, post-traumatic stress disorder symptoms, alcohol, and drugs (including benzodiazepines) as external criteria. RESULTS: The original two factor structure was replicated in samples of Latino respondents in the US and Spain. Correlations with other measures followed the expected pattern. In both the US and Spain, ROC analyses suggested that the AC-OK scale was an adequate approximation to other specific measures of mental health (ROC=0.90) and substance abuse problems (ROC=0.83). CONCLUSIONS: The Spanish version of the AC-OK Screen has good to excellent psychometric properties in both its subscales. These findings are robust across sites, gender, and type of clinic. We recommend its use for clinical research and for routine screening at treatment centers.

Barriers to and Correlates of Retention in Behavioral Health Treatment Among Latinos in 2 Different Host Countries: The United States and Spain.

CONTEXT: Latino immigrants constitute a large portion of the Spanish and US immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care. OBJECTIVES: To identify and compare perceived barriers related to behavioral health care among first- and second-generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers. DESIGN, SETTING, AND PARTICIPANTS: Data were obtained from the International Latino Research Partnership project. First- or second-generation self-identified Latino immigrants aged 18 years and more who resided more than 1 year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics. MAIN OUTCOME MEASURES: Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors. RESULTS: Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with the number of visits were concerns about the cost of services and uncertainty about where to go or who to see. CONCLUSIONS: After adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care.

Applying generalizability theory methods to assess continuity and change on the Adolescent Quality of Life-Mental Health Scale (AQOL-MHS).

PURPOSE: The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) is designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years. Initial findings support its reliability, validity and conceptual model for use of its three domains (emotional regulation, self-concept and social context). Our current study tests the usefulness of the AQOL-MHS for tracking changes in HRQOL during the course of service use. METHODS: Three waves of data were collected from 59 participants who were recruited from mental health clinics, where waves were spaced 4 months apart. Participants were receiving services at baseline assessment and were tracked for follow-up appointments regardless of treatment status. We analyze conventional reliability statistics for individual differences (e.g., Cronbach's alpha and test-retest correlations), and to estimate the reliability of change, we carried out a variance decomposition analysis. RESULTS: The psychometric analyses from Chavez et al. (Qual Life Res 23(4):1327-1335, 2014) were replicated with comparable results. A generalizability theory (GT) analysis revealed that the AQOL-MHS domains can measure change reliably. The reliability estimates varied from .65 to .78. Although there was reliable change at the individual level, on the average the AQOL-MHS means improved only slightly over time. CONCLUSIONS: The reliability of change for all three scales in the AQOL-MHS was acceptable, but consistently lower than the Cronbach's alpha values for each wave. Future work will use this approach to adapt our current measure to provide a better reliability of within-person change and thus broaden its applicability for prospective use.

Measurement properties of the Adolescent Quality of Life Mental Health Scale (AQOL-MHS).

BACKGROUND: This article presents data on the psychometric properties of a new measure, the Adolescent Quality of Life Mental Health Scale (AQOL-MHS), designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years. Participants were recruited in Puerto Rico to have one of five prevalent mental health disorders. The initial instrument development was achieved through a grounded theory approach with the use of focus groups and in-depth interviews. METHODS: We conducted two stages of exploratory factor analyses (EFA) on 60 candidate items. The first stage was to establish the number of factors to extract, and the second was to improve the model by selecting the best items. A final EFA model retained 31 items and 3 factors labeled Emotional Regulation (11 items), Self-Concept (10 items) and Social Context (10 items). RESULTS: The instrument showed good internal consistency, test-retest reliability, and construct validity. The hypotheses-driven validity tests were all supportive of the AQOL-MHS. There was evidence for convergent validity and discriminant validity, and results for known-groups' validity were overwhelmingly supportive of the ability of the instrument to identify differences between groups. CONCLUSIONS: These preliminary findings support our conceptual model and the use of the AQOL-MHS domain and overall scores. We believe that this instrument will provide clinicians additional insight into the different aspects of quality of life that are important to adolescents with mental health problems. Therefore, we consider the AQOL-MHS a vital patient-centered outcome measure for assessment strategies in the prevention and treatment of this population.

Starting from scratch: the development of the Adolescent Quality of Life-Mental Health Scale (AQOL-MHS).

This article documents the initial development of a Spanish mental health quality of life (QOL) instrument based on the adolescents' own assessment of important domains to their QOL. Using a grounded theory approach, we targeted five mental health disorders: attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, generalized anxiety disorder, and major depressive disorder. In-depth interviews (n = 40) and three focus groups (n = 20) were conducted and analyzed using qualitative methods to guide the development of items. A convenient sample of island Puerto Rican adolescents aged 12-18 was recruited from outpatient mental health clinics. Qualitative analysis revealed a total of 87 themes. They were distributed based on core QOL domains such as (1) Self, (2) Peers, (3) Family, (4) School, and (5) Environment. Items were written based on prevailing themes and using as closely as possible, words and phrases used by the adolescents to describe their views and perceptions of QOL. The goal for the AQOL-MHS is to pinpoint specific areas of health-related QOL for each psychiatric diagnostic group that will provide valuable information to assist both patients and providers set, define and evaluate adequate mental health treatment goals.

Lessons from the use of vignettes in the study of mental health service disparities.

OBJECTIVE: To examine the development, feasibility, and use of a vignette approach as an important tool in health services disparities research. DATA SOURCE: Interviews with vignette developers and qualitative data from a novel mental health services disparities study that used vignettes in two samples: (1) predominantly low-income parents of children attending mental health specialty care who were Latino or non-Latino White and (2) Latino and non-Latino mental health clinicians who treat children in their practice. STUDY DESIGN: We conduct a content analysis of qualitative data from patients and providers in the Ethnic Differences Study to explore the feasibility of vignette methodology in health services disparities research, and we identify lessons learned that may guide future vignette development. PRINCIPAL FINDINGS: Vignettes provide a valuable approach that is acceptable to participants, elicits important insight on participant experience and services, and sheds light on factors that can help optimize study design for exploring health disparities questions. CONCLUSIONS: Researchers, clinicians, and others should consider a set of factors that help determine when a vignette approach is warranted in research, training, or for other uses, including how best to address identified weaknesses.

Short-term persistence of DSM-IV ADHD diagnoses: influence of context, age, and gender.

OBJECTIVE: Little is known about the effect of social context and gender on persistence of attention-deficit/hyperactivity disorder (ADHD) in children of early and middle school years. The study compared persistence of DSM-IV ADHD and ADHD not otherwise specified (NOS) over 2 years in two groups of Puerto Rican children. METHOD: A three-wave study obtained data on Puerto Rican children 5 through 13 years of age at baseline. Samples were drawn in the South Bronx in New York (n = 1,138) and two metropolitan areas in Puerto Rico (n = 1,353). The Diagnostic Interview Schedule for Children Version IV was used to diagnose ADHD and ADHD-NOS. RESULTS: ADHD or ADHD-NOS diagnosis at wave 1 strongly predicted disorder at waves 2 and 3. ADHD had a significantly stronger predictive effect than ADHD-NOS consistently across site and gender. There was a significant interaction with baseline age. For those younger at baseline, the strength of the prediction of ADHD-NOS was relatively weak; for older children, the presence of ADHD-NOS at baseline predicted risk of subsequent ADHD or ADHD-NOS. CONCLUSIONS: Persistence of ADHD in children of similar ethnicity does not manifest differently across context and gender. Results suggest that age-specific symptom criteria and modification of age-of-onset criteria should be considered for the diagnosis.

Ethnic differences in perceived impairment and need for care.

Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on severity (mild vs. serious), nature of the problem (internalizing vs. externalizing), as well as gender and ethnicity (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos.

ADHD and gender: are risks and sequela of ADHD the same for boys and girls?

BACKGROUND: Research comparing treatment-referred boys and girls with attention-deficit/hyperactivity disorder (ADHD) has yielded equivocal results. Contradictory findings may be associated with differential referral practices or unexplored interactions of gender with ADHD subtypes. METHOD: We examined possible gender differences in ADHD and its subtypes among children aged 4 to 17 in a representative community sample (N = 1896) in Puerto Rico. Caretakers provided information through the Diagnostic Interview Schedule for Children (version IV) and a battery of impairment, family relations, child problems, comorbidity and treatment measures. RESULTS: ADHD was 2.3 times more common in boys than girls, but with one exception there was little evidence that the patterns of associations of ADHD with correlates were different for boys and girls. The exception was school suspension, which was more common among ADHD boys than girls. Additional gender interactions were found when ADHD subtypes were considered. Among those with combined type (n = 50), boys were more likely to be comorbid with mood disorders than girls. For those with the inattentive type (n = 47), girls were more likely to be comorbid with anxiety disorders than boys. CONCLUSIONS: Our findings lend cross-cultural generalizability to recent reports that gender does not interact with correlates for ADHD overall, but that it may play a role in subtypes.

ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents.

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.

Association between psychiatric disorders and smoking stages within a representative clinic sample of Puerto Rican adolescents.

OBJECTIVE: We examined the prevalence of smoking behaviors and their association with specific psychiatric disorders in a representative sample of youth from behavioral health clinics in Puerto Rico. METHOD: A complex sampling design was used to select the sample, and analyses were conducted to account for the unequal selection probability, stratification, and clustering. All analyses were weighted back to the clinical population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0. RESULTS: More than one third of the sample reported experience with cigarette smoking, and approximately one quarter reported smoking at least once per week (23.4%). As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. These were the only disorders that remained significantly associated with nicotine dependence after controlling for comorbidity. CONCLUSIONS: Our findings confirm the need for screening of smoking behavior and nicotine dependence in treatment settings and the integration of psychiatric/substance use treatments with smoking cessation.

Persistence of mental health service use among Latino children: a clinical and community study.

This study examined predictors of treatment persistence (receiving mental health services at two time points one year apart) among children in Puerto Rico who had previously sought care for mental health concerns. Children and their primary caregivers completed interviews one year apart. Treatment persistence was lower among children recruited from community sampling (n = 137) than those children recruited from public and private clinics (N = 381). Persistence was associated with psychological measures of need and co-morbidity only in the clinical sample, while in both samples persistence was associated with measures of family burden and school functioning. In multivariate analyses, persistence was associated in both the clinical and community samples with a measure of school functioning but not with diagnosis, impairment, or parental concerns about the child's behavior.

Prevalence and factors associated to sexual behavior in Puerto Rican adolescents.

Sexual relations with intercourse (ASR-I) and high prevalence of teen pregnancies (19.2%, in 2002) among adolescents in Puerto Rico constitute a serious biopsychosocial problem. Studying the consequences and correlates of ASR-I in community and mental health samples of adolescents is important in designing and implementing sexual health programs. Randomized representative cross-sectional samples of male and female adolescents from 11-18 years old (N = 994 from the general community, N = 550 receiving mental health services) who had engaged in ASR-I were the subjects of this study. Demographic, family, and sexual data and the DISC-IV were collected from individual interviews. Logistic regression models, bivariate odds ratios, Chi-squares, and t tests were used in the statistical analysis. The mental health sample showed higher rates of ASR-I, lifetime reports of pregnancy and lower age of ASR-I onset for females. No gender difference in the prevalence of ASR-I was observed in both samples. Older adolescents from the community sample meeting psychiatric diagnosis criteria, and with lower parental monitoring, were more likely to engage in ASR-I, whereas in the mental health sample, adolescents with lower parental monitoring and parental involvement reported significantly more ASR-I. Prevalence of ASR-I and Risky Sexual Behavior (RSB) were almost identical. Adolescents with mental health disorders initiate and engage in ASR-I earlier and more frequently regardless of gender. Older adolescents are more likely to engage in ASR-I and parent-child relationships emerged as a highly relevant predictor of adolescent sexual behavior. The high correspondence between ASR-I and RSB has important clinical implications.

Psychometric properties of the Spanish version of two mental health outcome measures: World Health Organization Disability Assessment Schedule II and Lehman's Quality Of Life Interview.

This study presents data on the cultural adaptation to Latino populations of two outcome measures that respond to the need for developing comprehensive instruments for outcome assessments in minority populations. We examined the psychometric properties of outcome measures designed to assess impairment in functioning, and quality of life. Impairment in functioning was measured with the Disability Assessment Schedule II (WHO-DASII) developed by the World Health Organization (1997) and quality of life was measured with A. F. Lehman's (A. F. Lehman, 1983; A. F. Lehman, 1988) shortened Quality of Life Interview (QOLI). Spanish speaking consumers (N = 198) from Fresno (CA), San Antonio (TX) and San Juan (PR) participated in this study. They were recruited from both mental health outpatient clinics and primary care rural clinics. The WHO-DASII showed good to excellent internal consistency in all sites (alpha = .72 to .97) except for one subscale (Self-Care alpha = .47). Test-retest reliability estimates were mostly moderate to substantial (.57 to .83), again with one exception, the Self-Care subscale (.46). For the QOLI internal consistency ranged from .34 to .98 and test-retest reliability ranged from .40 to .86 across all sites. An initial validation strategy using both known-groups and concurrent validity produced promising evidence of the construct validity of both measures. The Spanish versions of the WHO-DASII and the QOLI lend support to the translation and adaptation process to which these instruments were subjected.