The influence of socioenvironmental risk factors on risk-taking behaviors among Bahamian adolescents: a structural equation modeling analysis.

Background: Adolescents' risk-taking behaviors can have profound impacts on their future health. Few studies have established a relationship between multiple social environmental factors and adolescent risk behaviors. We used structural equation modeling to examine the role of parental monitoring and environmental risks on adolescents' behavioral intentions and risk behaviors. Methods: Data were collected through the baseline survey of a national implementation project among 2205 Grade 6 students in 24 government schools in The Bahamas in 2019. Structural equation modeling examined relations among parental monitoring, environmental risk factors, behavioral intentions, and risk behaviors. Results: Students had engaged in various delinquent, substance use, and sexual risks. In the structural equation model, parental monitoring demonstrated direct negative (protective) effects on behavioral intentions and risk behaviors, whereas environmental risk factors had a direct positive effect on adolescent behavioral intentions and risk behaviors. The model had an R2 value of 0.57 for adolescent risk behaviors. Conclusion: Parental monitoring and environmental risk factors had strong influences on risk-taking behaviors of early adolescents. Future adolescent health behavior interventions should consider offering additional prevention resources to early adolescents who are exposed to multiple environmental risk factors.

Fostering Engagement in Health Behavior Change: Iterative Development of an Interactive Narrative Environment to Enhance Adolescent Preventive Health Services.

PURPOSE: Accidents and unintentional injuries account for the greatest number of adolescent deaths, often involving use of alcohol and other substances. This article describes the iterative design and development of Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE), a narrative-centered behavior change environment for adolescents focused on reducing alcohol use. INSPIRE is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded intervention for health behavior change by leveraging 3D game engine and interactive narrative technologies. METHODS: Adolescents were engaged in all aspects of the iterative, multiyear development process of INSPIRE through over 20 focus groups and iterative pilot testing involving more than 145 adolescents. Qualitative findings from focus groups are reported, as well as quantitative findings from small-scale pilot sessions investigating adolescent engagement with a prototype version of INSPIRE using a combination of questionnaire and interaction trace log data. RESULTS: Adolescents reported that they found INSPIRE to be engaging, believable, and relevant to their lives. The majority of participants indicated that the narrative's protagonist character was like them (84%) and that the narrative featured virtual characters that they could relate to (79%). In the interactive narrative, the goals most frequently chosen by adolescents were "stay in control" (60%) and "do not get in trouble" (55%). CONCLUSIONS: With a strong theoretical framework (social-cognitive behavior change theory) and technology advances (narrative-centered learning environments), the field is well positioned to design health behavior change systems that can realize significant impacts on behavior change for adolescent preventive health.

Blurring the boundaries between synthesis and evaluation. A customized realist evaluative synthesis into adolescent risk behavior prevention.

Realist methodologies have been increasingly advocated for the investigation of complex social issues. Public health programs, such as those designed to prevent adolescent risk behavior, are typically considered complex. In conducting a realist review of the empirical literature relating to such programs, we encountered several challenges, including (a) an overabundance of empirical evidence, (b) a problematic level of heterogeneity within and between methodological approaches, (c) discrepancies between theoretical underpinnings and program operationalization, (d) homogeneity of program outcomes, with very little variation in program effectiveness, and (d) a paucity of description relating to content and process. To overcome these challenges, we developed a customized approach to realist evidence synthesis, drawing on the VICTORE (Volition, Implementation, Contexts, Time, Outcomes, Rivalry, and Emergence) complexity checklist and incorporating stakeholder engagement as primary data to achieve greater depth of understanding relating to contextual and mechanistic factors, and the complex interactions between them. Here we discuss the benefits of this adapted methodology alongside an overview of the research through which the methodology was developed. A key finding from this research was that combining the complexity checklist with primary data from stakeholder engagement enabled us to systematically interrogate the data across data sources, uncovering and evidencing mechanisms which may otherwise have remained hidden, giving greater ontological depth to our research findings. This paper builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research. HIGHLIGHTS: Published reporting standards for realist review provide a set of guiding principles for conducting realist research. However, these are not recommended to be used in a prescriptive sense, and customization of the methodology to account for potential idiosyncrasies within a specific evidence base is accepted. A small number of papers within the existing literature have used each of the two key adaptions discussed within this study, though reasons for doing so have not been considered in any great depth. Furthermore, combining both of these adaptions to take an evaluative approach to realist synthesis is novel to this work and lends greater ontological depth to the research findings than may otherwise have been achieved. This study builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research.

Constructing tailored parental monitoring strategy profiles to predict adolescent disclosure and risk involvement.

•Many parents use multiple monitoring strategies in different combinations over time to monitor their adolescents.•Adolescents of parents who use multiple strategies reported greater risk involvement.•Parents who solicited information only from adolescents had greater knowledge and adolescent disclosure.

Differences in polysubstance use among youth in the child welfare system: toward a better understanding of the highest-risk teens.

The current study extended limited prior work on polysubstance use among youth in the child welfare system (CWS) by addressing their potentially greater risk of engaging in polysubstance use, the causes of interpersonal variation in use, and changes in use over time, particularly at later points of involvement in the CWS. Using longitudinal data from the National Survey of Child and Adolescent Well-Being (n=1,178), a series of time-invariant and time-varying demographic and contextual factors were explored to assess their role both overall and at unique points of involvement in the CWS. A series of unconditional and conditional curve-of-factor models were estimated and results indicated that time-invariant characteristics of ethnicity and gender were not related to polysubstance use. Time-variant characteristics of age and placement were associated with polysubstance use and highlighted the dynamic nature of age as a risk factor. Out-of-home placement was protective against later substance use for youth who had been removed from contexts with their original caretaker where there were higher levels of reported violence. Our results suggest that in the child welfare population, the modeling of multiple substances rather than a single substance in isolation is more informative because it yields information on the confluence of behaviors that tend to occur and evolve together.

Prevalence of and risk factors for substance use among perinatally human immunodeficiency virus-infected and perinatally exposed but uninfected youth.

PURPOSE: This study examined risk factors associated with recent substance use (SU) among perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and perinatally exposed, uninfected (PHEU) youth and compared SU lifetime prevalence with the general population of United States (U.S.) adolescents. METHODS: We conducted cross-sectional and longitudinal analyses of 511 PHIV+ and PHEU youth (mean age at study entry, 13.2 years; 51% female; 69% PHIV+; and 72% African-American) enrolled in a U.S. multisite prospective cohort study between 2007 and 2009. Substance use data were collected by audio computer-assisted self-interview. Youth Risk Behavior Surveillance System and Monitoring the Future data were used to compare SU lifetime prevalence with U.S. samples. RESULTS: Perinatal HIV infection was not a statistically significant risk factor for alcohol or marijuana use. Risk factors for alcohol use among PHIV+ youth included higher severity of emotional and conduct problems and alcohol and marijuana use in the home by the caregiver or others. Risk factors for marijuana use among PHIV+ youth included marijuana use in the home, higher severity of conduct problems, and stressful life events. Similar SU risk factors among PHEU youth included SU in the home and higher severity of conduct and emotional problems. Overall lifetime prevalence of SU by age was similar to that in national surveys. CONCLUSIONS: Although SU lifetime prevalence and risk factors for PHIV+ and PHEU adolescents were similar to national norms, the negative consequences are potentially greater for PHIV+ youth. Prevention efforts should begin before SU initiation and address the family and social environment and youth mental health status.

Parental Monitoring and Risky Behavior in Bahamian Youth.

Adolescent involvement in risk behaviors is a concern that crosses geographical and cultural boundaries. Research has identified a number of factors which influence child behavior outcomes. This study explored the role of perceived neighborhood problems, parent-child relationships and parental monitoring, as they relate to engagement in risk behaviors among a sample of 497 Bahamian early adolescents. Contrary to the hypothesized direction, results of the latent growth model showed an increase in perceived parental monitoring over the four year period. Consistent with our hypotheses, adolescents who reported greater monitoring reported less involvement in sexual activity, less involvement in physical fights and less alcohol consumption. Positive interactions between parent and child also significantly predicted the initial status and rate of change of parental monitoring.

Risky Behavior in Affluent Youth: Examining the Co-occurrence and Consequences of Multiple Problem Behaviors.

Children of affluent parents are often excluded in psychological research as they are considered to be at "low risk"; however, research is beginning to suggest that this previously under-studied population may be at risk for developing multiple problem behaviors, including substance use and externalizing problems. The current study aimed to extend the application of Problem Behavior Theory (PBT) to a sample of affluent adolescents by examining the extent to which these behaviors co-occurred and were associated with negative outcomes. Data were collected from 1,147 high school students living in an affluent community via anonymous questionnaires regarding their engagement in various problem behaviors. PBT was supported in this sample, and youth who engaged in multiple problem behaviors reported experiencing more negative outcomes than youth who did not engage in these behaviors. The findings of this study support the generalizability of PBT and also highlight the importance of continuing to study affluent youth in addition to traditionally high-risk populations.