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

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

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

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

Parental underestimates of adolescent risk behavior: a randomized, controlled trial of a parental monitoring intervention.

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

Parental influence on adolescent sexual behavior in high-poverty settings.

BACKGROUND: African American adolescents living in high-poverty urban settings are at increased risk for early sexual initiation and sexually transmitted diseases. OBJECTIVE: To determine whether parental strategies to monitor their children's social behavior and to communicate with them about sexual risks help to reduce the initiation of risky sexual behavior and prevent the resulting adverse health outcomes. METHODS: To assess the viability of these strategies, we surveyed a stratified cross-section of African American children aged 9 to 17 years (N = 355) living in urban public housing. Talking computers were used to increase the confidentiality and comparability of the interviews across the wide age range. RESULTS: Children who reported high levels of parental monitoring were less likely to report initiating sex in pre-adolescence (aged < or = 10 years) and reported lower rates of sexual initiation as they aged. Children who reported receiving both greater monitoring and communication concerning sexual risks were also less likely to have engaged in anal sex. Communication was also positively related to the initiation of condom use and consistent condom use. The protective correlates of these parenting strategies were independent of the type of guardian (mother vs other family member). CONCLUSION: Interventions with parents and other guardians to increase monitoring and communication about sexual risks seem to be promising health-promotion strategies for adolescents in high-risk settings.

Similarities in sexual activity and condom use among friends within groups before and after a risk-reduction intervention.

PIP: Adolescent risk behavior is determined, in large part, by the perceived or actual social behavior of one's close friends. Thus, an intervention delivered to youth along with his or her friends could be a powerful vehicle for proactive behavior change. This possibility was assessed in 382 low-income African-American adolescent friends 9-15 years of age who were recruited from public housing developments for a longitudinal HIV risk-reduction program. These young people formed 76 friendship groups. The intervention, based on protection motivation theory, was delivered through weekly meetings of 38 of the friendship groups; the remaining 38 groups met weekly, but there were no social-cognitive interventions. Both groups received general education on HIV/AIDS and free condoms. In the intervention group, the percentage of groups in which all sexually active members used condoms increased from 33% at baseline to 69% after 6 months, 50% at 12 months (an expectable decline, indicating the need for a "booster" intervention), and 72% at 18 months. Among control friendship groups, however, homogeneous condom use within a group remained relatively stable: 17% at baseline, 18% at 6 months, 38% at 12 months, and 29% at 18 months. The intervention's impact was strongest among groups of youth with a low baseline prevalence of risk behaviors. These findings confirm the potential of use of group process as a vehicle for behavior change among adolescents.^ieng

Similarity of risk and protective behaviors among African-American pre- and early adolescent members of naturally occurring friendship groups.

To determine whether self-reported risk and protective behaviors, expectations, and attitudes are more similar among African-American early adolescents within a community-based friendship group than across groups, a cross-sectional study was conducted among 382 African-American youth 9 through 15 years of age forming 76 community-based groups of 3 through 10 same-gender friends. Each member of the friendship group reported his/her own past involvement in nine risk behaviors (sexual intercourse, substance abuse, drug-trafficking, and other delinquent activities) and two protective behaviors (high academic performance and regular church attendance) and their expectations and feelings regarding several of these behaviors. Intraclass correlation coefficients were calculated overall and by gender and age. Members were generally more similar within friendship groups than across groups with regard to several risk behaviors and expectations including sexual intercourse and drug-trafficking. Particularly striking was the similarity among members of "junior" friendship groups (e.g., median age of youth < 11 years) of both risk and protective behaviors and expectations. The finding of enhanced similarity of risk behaviors and expectations among members within groups suggests that intervention delivery through community-based friendship groups may be a useful approach for risk prevention efforts targeting pre-adolescent African-American youth living in low-income settings.

Longitudinal stability and predictability of sexual perceptions, intentions, and behaviors among early adolescent African-Americans.

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

PIP: A longitudinal study conducted among low-income African-American early adolescents identified the salience of intentions and perceptions regarding sexual intercourse to subsequent behavior. The 119 boys and girls 9-15 years of age were recruited from public housing project recreation centers in Baltimore, Maryland, in 1993. Each youth completed the Youth Health Risk Behavioral Inventory; the instrument was re-administered 6 months later. At baseline, 71 respondents (60%) were virgins; 6 (9%) became sexually active during the 6-month study period. 27 (56%) of the 48 subjects who were sexually experienced at baseline engaged in intercourse during the ensuing 6 months. Overall, the predictiveness of intention to have sex in the next 6 months and actual behavior was very strong, especially among younger youth; nearly half of young people who thought it likely they would have sex did so, while only one-fifth of those who were uncertain and one-seventh of those who considered it unlikely had sex. Condom intention, on the other hand, was not predictive of subsequent use. Youth who engaged in sexual intercourse during the study period had more perceived peer support and internal rewards for sexual activity and perceived the sequelae of intercourse as less severe than their abstinent counterparts. Overall, these findings suggest that social cognitive behavioral models that incorporate intentions and perceptions should form the theoretical basis for interventions aimed at young adolescents.

Sources of health care and health needs among children in kinship care.

OBJECTIVES: To determine the characteristics of children in kinship care and their caregivers who have access to health care (a single source of health care or a single provider), and to determine the relation between indicators of access and health needs. DESIGN: Cross-sectional. SETTING: A large eastern city. SUBJECTS: Two hundred ten children selected from households with children in kinship care in April 1989. METHODS: Data were obtained from medical records, access and demographic questionnaires, and a medical and psychologic evaluation. RESULTS: A single facility for health care was reported by 93% of the sample; two thirds of those identified one health care provider. One source of care or one provider was associated with variables such as young age at placement and medical assistance insurance. Children who did not have a single source of care were more likely to have unmet health needs (87% vs 61%, P < .05), especially unmet mental health needs (60% vs 31%, P < .05). CONCLUSIONS: Children in kinship care had good access to health care, but the level of unmet health needs was high. Children who did not have a single source of health care were more likely to have unmet health needs, especially unmet mental health needs. These findings have implications for future health care planning for children in out-of-home care.

Recent and intended drug trafficking among male and female urban African-American early adolescents.

OBJECTIVE: To investigate associations between recent and intended involvement in drug trafficking and perceptions of the social environment among high-risk urban African-American youths. METHODS: A multicomponent risk assessment survey was conducted among a convenience sample of 351 African-American youths 9 through 15 years of age residing in low-income communities. Both univariate analysis and logistic regression were performed to examine the association of youths' perceived social environment with recent and intended involvement in drug trafficking. RESULTS: Drug selling or delivering in the previous 6 months was reported by 6% of the youths; 12% expected to engage in these activities in the next 6 months. There was a strong association between drug trafficking and other high-risk behaviors, including drug use. Among both genders, perceptions that neighbors, friends, or family members were involved in drug trafficking were correlated with recent or intended drug trafficking. For boys, personal economic needs had a strong association with drug trafficking. For girls, personal feelings were more important correlates of intended involvement. CONCLUSIONS: Efforts aimed at both drug-trafficking prevention and intervention need to be community-based and multifaceted. Programs should address the youths' perceived social environments and consider gender differences regarding correlates of drug-trafficking involvement.