A Sequential Explanatory Mixed Methods Study of Young Adult Tobacco and Marijuana Co-Use.

Background: The co-occurring use of tobacco and marijuana among young adults is an important behavioral phenomenon within the field of substance use. Studying tobacco and marijuana use together among young adults can provide important insight into patterns of initiation and continuation. Objectives: The primary goal of this study was to examine characteristics associated with co-use among young adults and to discover the ways experiences of co-users can help contextualize trends in co-use. Methods: This study employed a sequential explanatory mixed methods design. Quantitative analyses used 12 years of nationally representative National Health and Nutrition Examination Survey (NHANES) data (2005-2016) to assess the characteristics and experiences of young adult (21-30) co-users. Results from analyses of NHANES, prior literature, and theoretical constructs were used to develop a guide for 20 in-depth, semi-structured interviews with young adult co-users living in the state of Maryland. Interviews were analyzed using thematic analysis. Quantitative results and qualitative findings were integrated. The original NHANES analysis occurred during October and November 2017, interviews took place during December 2017 and January 2018, and all mixed methods integration was conducted in 2018. Results: Tobacco and marijuana co-users have unique characteristics and experiences compared to single product users; the experiences of co-users can offer unique insights on co-use. Meta-inferences emerged from integration. Conclusions/importance: Co-users conceptualize tobacco and marijuana differently and hold different risk perceptions for each substance. Co-users may be at risk for polytobacco product use. These findings highlight the profound influence these two substances have on young adult co-users' experiences and behaviors.

The Relationship Between Health Literacy and Health Conceptualizations:An Exploratory Study of Elementary School-Aged Children.

Analyzing children's conceptualizations of health and body and health literacy will significantly add understanding to how problematic health attitudes and behaviors may take root (Driessnack, Chung, Perkhounkova, & Hein, 2014). The knowledge gained from such an assessment can be applied towards communication contexts that aim to promote children's health literacy and their well-being. With increased health literacy, children can actively participate in decision-making regarding their own health and can understand why healthy behaviors are important to adult health (Borzekowski, 2009). The purpose of this exploratory study was to examine the understudied intersection between health literacy and health conceptualizations in children in order to elaborate on health literacy theory. Specifically, the findings contribute to health communication between children and their caregivers, and between children and health care providers. Qualitative, in depth interviews were conducted with elementary school children. The significance of the study is its contribution to health communication for children, where interventions can consider health literacy types and levels before addressing children's health outcomes. Findings show how we can understand children's conceptualizations and can address health literacy skills inside and out of the classroom in ways that resonate with children.

The Dominant Obesity Discourse Versus Children's Conceptualizations of Health: A Comparison Through Dialogue and Drawings.

The emphasis on childhood obesity reduction has been attributed to the dominant obesity discourse. However, some researchers argue that this discourse may be ineffective and even harmful for children. From a post-structuralist perspective, the dominant obesity discourse has the power to shape children's subjectivities, though subjectivities may also be influenced by personal experiences and other knowledge about bodies and health. There is limited research which explores how children's conceptualizations of health are informed by the dominant obesity discourse. To address this knowledge gap, qualitative data were collected from 8- to 11-year-old children ( n = 29) regarding their conceptualizations of health, healthy bodies, and health practices. Results suggest that children's conceptualizations reflected arguments embedded within the dominant obesity discourse, but at times, also contradicted or deviated from it. Study findings can be applied toward children's health promotion programming to offer a more holistic and inclusive perspective on health and well-being.

African American Girls' Ideal Dating Relationship Now and In the Future.

Adolescence is a particularly important and challenging time for developing long lasting romantic relationship patterns. However, limited empirical research has explored teen perceptions of ideal partner characteristics during adolescence or their significance to the quality of current and future relationships. Semi-structured in-depth interviews were conducted with 33 African American high school girls to shed light on the qualities desired in their dating relationships and relational factors that influence teen dating behaviors. Guided by the Social Ecological Framework, interviews were transcribed verbatim and entered into ATLAS.ti, for coding and analysis. Girls discussed the important influence of parents in choosing a partner and provided positive depictions of friendship and marriage with a suitable partner. More research is needed to understand how and why adolescents desire particular characteristics, how socialization shapes teen perceptions and how these preferences may be related to current and future adolescent dating choices, including violence perpetration and victimization.

Teen Dating Violence Victimization, Perpetration, and Sexual Health Correlates Among Urban, Low-Income, Ethnic, and Racial Minority Youth.

This study explores the associations between teen dating violence (TDV) perpetration, victimization, sexual risk behaviors, and pregnancy among a sample of low-income, urban, and predominately African-American and Latino youth age 15 to 21 years ( N = 513). Findings suggest that youth who experienced TDV victimization were more likely to report inconsistent condom use in the past 12 months ( OR = 1.6) and pregnancy ( OR = 2.2) compared with nonvictimized youth. Youth who reported perpetrating dating violence were more likely to be female ( OR = 3.8) and to report multiple sex partners ( OR = 2.0), inconsistent condom use ( OR = 2.6), and prostitution in the past 12 months ( OR = 6.7). TDV perpetration and victimization were highly associated (χ2 = 127.00, p < .001); that is, 30% of the sample reported both victimization and perpetration in their previous or current romantic relationships. Findings from this study highlight the need to integrate culturally informed TDV prevention and intervention strategies into existing adolescent sexual and reproductive health education programs.

Medical Students' Beliefs About Screening for Intimate Partner Violence: A Qualitative Study.

Researchers have found that medical students who have received training on intimate partner violence (IPV) report greater comfort with screening for IPV and improved IPV interviewing skills than their counterparts. However, less is known about medical students' beliefs toward screening female patients for IPV and behavioral intention to screen. Semistructured, qualitative interviews were conducted with medical students to assess their beliefs, using the theory of planned behavior and social cognitive theory as theoretical frameworks for the interview questions. Most students felt that screening for IPV could help identify victims but could also potentially offend patients. Perceived barriers to screening included time and negative patient reactions, while perceived facilitators to screening included receiving IPV training and provision of IPV screening questionnaires while interviewing patients. Interviewees identified physicians as both supporters and nonsupporters of IPV screening. Behavioral intention scores ranged from 17 to 50 out of a possible 11 to 55. Findings from the study can help inform the IPV training needs of medical students.

The (mal) adaptive value of mid-adolescent dating relationship labels.

The aim of this study was to explore adolescent dating relationships through the prism of high school girls' narratives. We probed the contexts and meanings associated with different forms of dating to better understand the developmental significance of romantic relationships during adolescence. Cross-sectional, in-depth semi-structured interviews were conducted with 20 high school females. The analytic approach was phenomenological and grounded in the narratives rather than based on an a priori theoretical framework. Interviews were digitally recorded, transcribed verbatim by research staff and entered into ATLAS.ti 6, a qualitative data-management software package, prior to analysis. Teen relationships were found to vary along a Dis-Continuum from casual hookups to "official" boyfriend/girlfriend. There was a lack of consensus, and much ambiguity, as to the substantive meaning of different relationships. Labeling dating relationships seem to facilitate acquisition of important developmental needs such as identity, affiliation, and status, while attempting to manage cognitive dissonance and emotional disappointments. Findings underscore the confusion and complexity surrounding contemporary adolescent dating. Adolescent girls are using language and social media to assist them in meeting developmental goals. Sometimes their dating labels are adaptive, other times they are a cause of stress, or concealment of unmet needs and thwarted desires. Programs focused on positive youth development need to resonate with the realities of teens' lives and more fully acknowledge the complicated dynamics of teen dating relationships and how they are formalized, publicized and negotiated.

"If you don't have honesty in a relationship, then there is no relationship": African American girls' characterization of healthy dating relationships, a qualitative study.

The quality of dating relationships in adolescence can have long lasting effects on identity development, self-esteem, and interpersonal skills, and can shape values and behaviors related to future intimate relationships. The aims of this study were to: (1) investigate how African American adolescent girls characterize healthy relationships; and (2) describe the meanings of these characteristics in the context of the Centers for Disease Control and Prevention's (CDC) 12 healthy dating relationship qualities. We conducted semi-structured one-on-one in-depth interviews with 33 African American high school girls in the mid-Atlantic region. Trained staff transcribed interviews verbatim and entered the data into ATLAS.ti for coding and analysis. Participants' specified and vividly described eight healthy relationship characteristics: good communication, honesty, trust, respect, compromise, understanding, individuality, and self-confidence. Of these characteristics, three (good communication, compromise, and respect) were described in ways discordant with CDC's definitions. Findings highlight a need to better understand how girls develop values and ascribe characteristics of healthy relationships in order to reduce their risk for teen dating violence.

Exploring motivations to be active among amputees: a phenomenological approach to leisure time physical activity.

PURPOSE: People with disabilities are less active and experience increased burden of disease compared to those without disabilities. Leisure time physical activity (LTPA) participation is strongly related to improved health in all populations. Despite this, research with amputees focuses heavily on prosthetic design and function, leaving amputees an under-represented population in LTPA and motivation research. This study explored the lived experiences of motivation to engage in LTPA among amputees. METHOD: Interpretative phenomenological analysis (IPA) approach, influenced by understandings of embodiment and Self-Determination Theory (SDT), was used. Six people with lower extremity, acquired amputations created a photo-diary of their motivations to be active and participated in two in-depth interviews each. RESULTS: Study findings suggest motivations to be active among amputees are primarily influenced by personal relationships. Barriers, facilitators, and processes to be active provided insight into how LTPA participation may be affected by more than motivation. Embodiment was experienced as bodily integration of the prosthesis. CONCLUSIONS: There is evidence that the relationship between motivation and participation is not direct, but influenced by facilitators, barriers, and processes to be active. The results suggest strategies to increase activity among amputees by emphasizing LTPA with others, improving the built environment, and ensuring prosthesis fit.

Psychosocial factors associated with reports of physical dating violence victimization among U.S. adolescent males.

The present study, based upon the national 2005 Youth Risk Behavior Survey of U.S. high school students, provides the most current and representative data on physical dating violence among adolescent males (N = 6,528) The dependent variable was physical dating violence. The independent variables included four dimensions: violence, suicide, subtance use, and sexual risk behavior. Unadjusted odds ratios (OR) and 95% confidence intervals (CI) were examined followed by multivariate logistic regression analyses, which included all significant independent variables from the bivariate analyses. Adjusted OR and 95% CI were computed to assess the significance of the relationships. In terms of prevalence, 10.0% of male adolescents reported experiencing physical dating violence. Boys who reported sad/hopeless feelings (OR = 2.42), physical fighting (OR = 1.92), gun carrying (OR = 1.80), recent sexual partners (OR = 2.84), or unprotected sexual intercourse (OR = 1.81), were more likely to report physical dating violence. These findings suggest that dating violence against adolescent males is sufficiently widespread and clusters with other risk factors, and that further research and intervention efforts be directed toward better understanding and preventing both male victimization and its psychosocial sequalae.

Prevalence and psychosocial correlates of alcohol-related sexual assault among university students.

This study examined the psychosocial correlates of alcohol-related sexual assault. Undergraduate students (N = 551) were recruited to complete a web-based survey. The outcome was a composite of 2 items: "experienced an unwanted sexual advance" or "was the victim of sexual assault or date rape" as a result of another's alcohol use. The predictors were substance use, other alcohol-related interpersonal violence victimization, and alcohol-related protective behaviors. Multivariate logistic regression analyses were conducted. Females reported higher prevalence of alcohol-related sexual assault than did males (20.4% vs. 6.6%). Females who reported binge drinking (OR = 7.74) and other alcohol-related interpersonal violence (OR = 5.03) were more likely to report alcohol-related sexual assault whereas only other alcohol-related interpersonal violence was associated with alcohol-related sexual assault (OR = 43.75) among males. The findings suggest that alcohol-related sexual assault is associated with other risk factors that deserve further attention through longitudinal research and intervention efforts.

Validity and Reliability of the Healthy Families Survey: A Key Component of the Maryland Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Evaluation.

OBJECTIVE: This study established the validity and reliability of the Healthy Families Survey, a 45-item survey measuring nutrition and physical activity behaviors among children and parents enrolled in the Maryland Supplemental Nutrition Assistance Program-Education. METHODS: Analysis included 1,376 pretest surveys. A factor analysis was conducted to establish construct validity, item analyses were conducted to determine item relevance for the target population, and Cronbach α was established to assess internal reliability. RESULTS: The factor analysis extracted 9 factors, with 91% of variables loading appropriately (>+0.30 loading) onto factors. Item analyses identified 6 variables with low (<0.20) or high (>0.80) mean values at baseline. Seven of the 9 subscales had Cronbach α ≥ .60. CONCLUSIONS AND IMPLICATIONS: The Healthy Families Survey demonstrated both strong construct validity and internal reliability and can be used by Supplemental Nutrition Assistance Program-Education agencies to assess child and parent nutrition and physical activity behaviors.

Understanding Knowledge, Attitudes, and Behaviors Toward West Nile Virus Prevention: A Survey of High-Risk Adults in Maryland.

OBJECTIVE: To assess knowledge, attitudes, and behaviors toward West Nile virus (WNV) prevention among Maryland adults ≥60 years old who are at increased risk of severe WNV disease utilizing the health belief model. METHODS: Using a stratified random sample of households from zip codes with ≥2 human WNV cases, we conducted a telephone survey of 211 Maryland adults ≥60 years old between October and December 2012. RESULTS: Participants expressing worry about WNV were over thrice more likely to use insect repellent in the prior 90 days (adjusted odds ratio [aOR] = 3.46, 95% confidence interval [CI] = 1.33-8.95) and nearly thrice more likely to drain standing water around their homes than those not worried (aOR = 2.86, 95% CI = 1.25-6.52). Respondents perceiving a benefit in paying less for WNV vaccine were more likely to support mosquito control programs (aOR = 16.00, 95% CI = 1.50-170.68). CONCLUSIONS: Future interventions to promote WNV prevention among older adults should seek to enhance perceptions of vulnerability to WNV through risk communication, including media outreach and written messaging, emphasizing the benefits of personal protective behaviors. Community partnerships may aid in outreach to this population.

Affective dysregulation predicts incident nonmedical prescription analgesic use among college students.

INTRODUCTION: This study investigated the relationship between four suspected risk factors-affective dysregulation, conduct problems, depressive symptoms, and psychological distress-and incident nonmedical prescription analgesic (NPA) use among college students. METHODS: The sample was derived from 929 college students from a large, mid-Atlantic university who completed the third annual College Life Study assessment (Y3) and were NPA use naïve at baseline (Y1). A series of logistic regression analyses were conducted to evaluate the predictors of incident NPA use by Y3. Separate models were developed to evaluate the association between the suspected risk factors and (a) NPA use relative to non-use of other drugs, including nonmedical use of other drug classes, (b) NPA use relative to other drug use, and (c) other drug use relative to non-use. All models included gender, parental education level, and race/ethnicity. RESULTS: Affective dysregulation was significantly associated with becoming an incident NPA user relative to both drug users without NPA use as well as non-users, after statistically controlling for demographic characteristics and other factors. Conduct problems in early childhood were positively related to both incident NPA use and other drug use without NPA use relative to non-users, after statistically controlling for demographic characteristics and other factors. Depressive symptoms were associated with NPA incidence at the bivariate level only. CONCLUSIONS: These findings extend previous research suggesting that NPA use might be related to deficits in regulating negative emotional states, and highlight possible markers for screening and intervention to prevent NPA use.

Prevalence and psychosocial correlates of forced sexual intercourse among U.S. high school adolescents.

Although a history of forced sexual intercourse affects a relatively small number of U.S. adolescents, it is a persistent and alarming public health problem. This study examined the robustness of the risk profile of adolescents who report a history of forced sexual intercourse using the most current and representative data from the national 2005 Youth Risk Behavior Survey. Overall, 8.01% of high school adolescents reported a history of forced sexual intercourse. The lifetime prevalence for females (10.3%) was roughly twice of that for males (4.8%). Important differences in the risk profile associated with forced sexual intercourse were found by gender.

Psychosocial factors associated with reports of physical dating violence among U.S. adolescent females.

The present study, based upon the national 2005 Youth Risk Behavior Survey of U.S. high school students, provides the most current and representative data on dating violence among adolescent females (N = 7,179). The dependent variable was physical dating violence. The independent variables included four dimensions: violence, suicide, substance use, and sexual risk behavior. Unadjusted odds ratios (OR) and 95% confidence intervals (CI), were examined followed by multivariate logistic regression analyses, which included all significant independent variables from the bivariate analyses. Adjusted OR and 95% CI were computed to assess the significance of the relationships. In terms of prevalence, 10.3% of female adolescents reported experiencing physical dating violence. Black girls (OR = 1.47) and girls who reported sad/hopeless feelings (OR = 1.42) considered suicide (OR = 1.55), engaged in physical fighting (OR = 2.17), had recent sexual partners (OR = 2.10), or had unprotected sexual intercourse (OR = 1.70) were more likely to report physical dating violence. These findings suggest dating violence against adolescent females is widespread and associated with a host of other risk factors that deserve further attention through longitudinal research and intervention efforts.

Psychosocial correlates of dating violence victimization among Latino youth.

To examine the association between physical dating violence victimization and risk and protective factors, an anonymous, cross-sectional, self-reported survey was administered to Latino youth (n=446) residing in suburban Washington, DC. Multivariate logistic regression models were constructed, and adjusted OR and 95% CI were examined. Approximately 9% of Latino adolescents reported physical dating violence victimization. Overall, youth who reported carrying a gun, involvement in physical fights and suicidal thoughts were at greater odds of reporting dating violence. Among females, fighting was the sole risk behavior associated with dating violence. Girls who reported a stronger sense of self were less likely to report dating violence. Among males, gun carrying, but not physical fighting, and having considered suicide were associated with dating violence. Spending time each week with a mentor was also positively associated with male dating violence victimization. Dating violence appeared to cluster with other risk behavior engagement. Important gender differences in associated risk and protective behaviors were identified and should be incorporated into primary and secondary prevention activities.

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.

Truth and consequences: ethics, confidentiality, and disclosure in adolescent longitudinal prevention research.

PURPOSE: To examine data from a natural experiment resulting from a change made in the confidentiality agreement midway through a randomized, longitudinal, controlled trial to prevent or delay adolescent alcohol use. The investigators explored the impact of the change on adolescents' rates of participation and affirmative responses to a question on suicidal thoughts. METHODS: Adolescents 12-17 years old were administered a question on suicidal thoughts as part of a confidential exit interview after a general health examination with their primary care provider. After administration to 263 adolescents, the exit interview was made conditionally confidential with the remaining 181 adolescents. The revised consent form and protocol stipulated that researchers would reveal to appropriate professionals and parents any adolescent indicating suicidal thoughts. Prevalence estimates for the suicidal thoughts question and study participation rates were computed for conditions both before and after the change. RESULTS: Fewer adolescents responded affirmatively to the suicidal thoughts question when they were recruited using the revised (1%) than the original (8%) consent form and protocol (p=.001). The revised confidentiality agreement did not affect participation rates. CONCLUSIONS: Adolescents who assent to participate in research studies may be less likely to disclose personal information regarding suicidal thoughts if they know that their disclosure may result in a break in confidentiality. Specific guidelines are needed for conditional and unconditional confidentiality agreements to study mental health in adolescent longitudinal prevention research.

Multiple sexual-partner behavior among sexually active US adolescent girls.

OBJECTIVE: To examine the relationship of multiple sexual-partners to other risk behaviors among adolescent girls. METHODS: Ninth- through 12th-grade sexually active girls (N=3288) who completed the 1999 national Youth Risk Behavior Survey were participants. Multivariate logistic regression was used to examine all significant independent relationships. RESULTS: Having one recent sexual-partner was associated with lack of condom use and being in 12th grade whereas having 2 or more partners was associated with fighting, cigarette use, binge drinking, and African American ethnicity. CONCLUSIONS: A small but important subset of adolescent girls report having recent multiple sexual-partners. These girls are more likely to report other problem-prone health behaviors.