A Multidimensional Model of Sexual Empowerment Among Young Black Men Who have Sex with Men: A Latent Profile Analysis.

Sexual empowerment is a key strategy in HIV prevention intervention design, yet its measurement has been conceptualized as homogeneous. To date, no studies have examined whether young Black men who have sex with men (YBMSM) exhibit heterogeneity across sexual empowerment. Using baseline data from a randomized controlled trial (N = 275, HIV-negative YBMSM), we classified YBMSM into sexual empowerment profiles based on five indicators using a latent profile analysis and assessed the associations between the sexual empowerment profiles and stigma-related experiences using multinomial logistic regression. Three profiles were identified: psychologically empowered with safer sex intentions (profile 1); psychologically disempowered with safer sex intentions (profile 2); and psychologically disempowered without safer sex intentions (profile 3). YBMSM reporting fewer stigma-related experiences were more likely to be profile 1 than profile 2 and profile 3. To empower YBMSM, interventions based on sexual empowerment profile targeting the psychological/behavioral aspects of empowerment and addressing stigma are needed.

Social network isolation mediates associations between risky symptoms and substance use in the high school transition.

The current study examined whether social status and social integration, two related but distinct indicators of an adolescent's standing within a peer network, mediate the association between risky symptoms (depressive symptoms and deviant behavior) and substance use across adolescence. The sample of 6,776 adolescents participated in up to seven waves of data collection spanning 6th to 12th grades. Scores indexing social status and integration were derived from a social network analysis of six schools and subsequent psychometric modeling. Results of latent growth models showed that social integration and status mediated the relation between risky symptoms and substance use and that risky symptoms mediated the relation between social standing and substance use during the high school transition. Before this transition, pathways involving deviant behavior led to high social integration and status and in turn to substance use. After this transition, both deviant behavior and depressive symptoms led to low social integration and status and in turn greater substance use. These findings suggest that the high school transition is a risky time for substance use related to the interplay of increases in depressive symptoms and deviant behavior on the one hand and decreases in social status and integration on the other.

Codevelopment of Delinquency, Alcohol Use, and Aggression Toward Peers and Dates: Multitrajectory Patterns and Predictors.

We aimed to characterize developmental patterns of involvement in alcohol use, delinquency, and interpersonal aggression in a normative sample of adolescents by applying multitrajectory group-based modeling. Using seven waves of data from a cohort sequential study spanning the 6th to 12th grades (n = 2,825; 50% girls), we identified four distinct trajectory groups: low risk (33%), declining peer aggressors (44%), peer and dating aggressors (13%), and multidomain high risk (10%). Across all comparisons, girls were more likely than boys to be members of the peer and dating aggressor group and less likely to be members of the multidomain high-risk group. Moreover, individual (self-control, negative emotionality), family (family violence, parental monitoring), and peer (substance use norms) distinguished class membership.

A Latent Variable Approach to Measuring Social Dynamics in Adolescence.

In the study of adolescent health, it is useful to derive indices of social dynamics from sociometric data, and to use these indices as predictors of health risk behaviors. In this manuscript, we introduce a flexible latent variable model as a novel way of obtaining estimates of social integration and social status from school-based sociometric data. Such scores provide the flexibility of a regression-based approach while accounting for measurement error in sociometric indicators. We demonstrate the utility of these factor scores in testing complex hypotheses through a combination of structural equation modeling and survival models, showing that deviance mediates the relationship between social status and smoking onset hazard at the transition to high school.

Does a parsimonious measure of complex body mass index trajectories exist?

BACKGROUND: A single measure that distills complex body mass index (BMI) trajectories into one value could facilitate otherwise complicated analyses. This study creates and assesses the validity of such a measure: average excess BMI. METHODS: We use data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (n = 17,669). We calculate average excess BMI by integrating to find the area above a healthy BMI trajectory and below each subject-specific trajectory and divide this value by total study time. To assess validity and utility, we (1) evaluate relationships between average excess BMI from adolescence to adulthood and adult chronic conditions, (2) compare associations and fit to models using subject-specific BMI trajectory parameter estimates as predictors, and (3) compare associations to models using BMI trajectory parameter estimates as outcomes. RESULTS: Average excess BMI from adolescence to adulthood is associated with increased odds of hypertension (OR = 1.56; 95% CI: 1.47, 1.67), hyperlipidemia (OR = 1.36; 95% CI: 1.26, 1.47), and diabetes (OR = 1.57; 95% CI: 1.47, 1.67). The odds associated with average excess BMI are higher than the odds associated with the BMI intercept, linear, or quadratic slope. Correlations between observed and predicted health outcomes are slightly lower for some models using average excess BMI as the focal predictor compared to those using BMI intercept, linear, and quadratic slope. When using trajectory parameters as outcomes, some co-variates associate with the intercept, linear, and quadratic slope in contradicting directions. CONCLUSIONS: This study supports the utility of average excess BMI as an outcome. The higher an individual's average excess BMI from adolescence to adulthood, the greater their odds of chronic conditions. Future studies investigating longitudinal BMI as an outcome should consider using average excess BMI, whereas studies that conceptualize longitudinal BMI as the predictor should continue using traditional latent growth methods.

A Person-Centered Approach to the Study of Black Adolescent Religiosity, Racial Identity, and Sexual Initiation.

Decreasing the number of adolescents who have never had sexual intercourse is one way to address sexual health disparities. We used intersectionality to explore the joint effects of religiosity and racial identity on Black adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1,170), a nationally representative study of Black adolescents. Latent profile analysis and survival analysis were used to evaluate study hypotheses. Results showed four distinct profiles of religiosity and racial identity. These profiles explained 19% of the variability in sexual initiation. Additional analyses revealed sociodemographic differences in profile membership. Findings contribute to understanding ethnic heterogeneity among Black adolescents and racial identity and religiosity as sociocultural factors that influence sexual initiation; and support reconceptualizing Black adolescent religiosity.

Demographic Moderation of the Prediction of Adolescent Alcohol Involvement Trajectories.

Several school- and family-based preventive interventions target and effectively reduce adolescent alcohol misuse. However, whether demographic groups achieve equal success with these interventions is unclear. In particular, most interventions target younger adolescents, and program effectiveness tends to be measured with majority White samples; subgroup analyses are rarely reported. We analyze longitudinal data from a sample of N = 6189 adolescents (40% Black, 60% White; 50% female) in 6th through 12th grade to quantify the degree to which age, race, and gender moderate the associations between seven well-known risk and protective factors (RPFs) that serve as common intervention targets. The RPFs that we study are drawn from social learning theory, problem behavior theory, and social control theory, including individual factors (positive alcohol expectancies and deviant behavior), family context (perceived parental involvement, perceived parent alcohol use, and access to alcohol), and peer context (descriptive and injunctive norms). Multilevel growth models allow us to conduct the demographic subgroup moderation analysis. Results suggest that these well-studied RPFs explain alcohol involvement to varying degrees, but they explain substantially more variation in alcohol involvement by White adolescents compared with Black adolescents. We find differential patterns of significance and of leading predictors of alcohol involvement as a function of age, race, and gender and the interactions thereof. These results indicate that the prevention field needs to better understand the RPFs affecting minority and high school youth in order to provide a stronger basis for alcohol prevention efforts.

Child Maltreatment and Body Mass Index over Time: The Roles of Social Support and Stress Responses.

An unhealthy body mass index (BMI) trajectory can exacerbate the burdens associated with child maltreatment. However, we have yet to explain why the relationship between maltreatment and BMI trajectories exists and what allows individuals to attain healthy BMI trajectories despite adversity. Guided by the Transactional Model of Stress and Coping, we evaluated (1) if peer friendship and adult mentors moderate, and (2) if impulsivity and depressive symptoms mediate, the relationship between maltreatment experiences and average excess BMI. We used data from four waves of the National Longitudinal Study of Adolescent to Adult Health (n = 17,696), following adolescents from ages 13-21 (Wave I) to 24-31 years (Wave IV). We did not find evidence of significant moderation or mediation of the maltreatment experience to average excess BMI relationship. However, models did demonstrate a relationship between peer friendship quality and average excess BMI, such that higher quality protected against higher average excess BMI (B = -0.073, s.e. = 0.02, p < 0.001). Age of maltreatment onset was also associated with average excess BMI, such that maltreatment onset in adolescence was associated with a higher average excess BMI (B = 0.275-0.284, s.e. = 0.11, p = 0.01). Although we found no evidence of moderation by social support or mediation by stress responses of the relationship between maltreatment experiences and average excess BMI, peer friendship appears to protect against higher average excess BMI from adolescence to young adulthood for all adolescents. Future public health interventions should consider how to leverage friendship in obesity prevention efforts.

Early, regular breast-milk pumping may lead to early breast-milk feeding cessation.

OBJECTIVE: To estimate the effect of early, regular breast-milk pumping on time to breast-milk feeding (BMF) and exclusive BMF cessation, for working and non-working women. DESIGN: Using the Infant Feeding Practices Survey II (IFPS II), we estimated weighted hazard ratios (HR) for the effect of regular pumping (participant defined) compared with non-regular/not pumping, reported at month 2, on both time to BMF cessation (to 12 months) and time to exclusive BMF cessation (to 6 months), using inverse probability weights to control confounding. SETTING: USA, 2005-2007. SUBJECTS: BMF (n 1624) and exclusively BMF (n 971) IFPS II participants at month 2. RESULTS: The weighted HR for time to BMF cessation was 1·62 (95 % CI 1·47, 1·78) and for time to exclusive BMF cessation was 1·14 (95 % CI 1·03, 1·25). Among non-working women, the weighted HR for time to BMF cessation was 2·05 (95 % CI 1·84, 2·28) and for time to exclusive BMF cessation was 1·10 (95 % CI 0·98, 1·22). Among working women, the weighted HR for time to BMF cessation was 0·90 (95 % CI 0·75, 1·07) and for time to exclusive BMF cessation was 1·14 (95 % CI 0·96, 1·36). CONCLUSIONS: Overall, regular pumpers were more likely to stop BMF and exclusive BMF than non-regular/non-pumpers. Non-working regular pumpers were more likely than non-regular/non-pumpers to stop BMF. There was no effect among working women. Early, regular pumpers may need specialized support to maintain BMF.

Contextual Risk Profiles and Trajectories of Adolescent Dating Violence Perpetration.

Social ecological and developmental system perspectives suggest that interactions among factors within and across multiple contexts (e.g., neighborhood, peer, family) must be considered in explaining dating violence perpetration. Yet, to date, most extant research on dating violence has focused on individual, rather than contextual predictors, and used variable-centered approaches that fail to capture the configurations of factors that may jointly explain involvement in dating violence. The current study used a person-centered approach, latent profile analysis, to identify key configurations (or profiles) of contextual risk and protective factors for dating violence perpetration across the neighborhood, school, friend and family contexts. We then examine the longitudinal associations between these contextual risk profiles, assessed during middle school, and trajectories of psychological and physical dating violence perpetration across grades 8 through 12. Five contextual risk profiles were identified: school, neighborhood, and family risk; school and family risk; school and friend risk; school and neighborhood risk; and low risk. The highest levels of psychological and physical perpetration across grades 8 through 12 were among adolescents in the profile characterized by high levels of school, neighborhood, and family risk. Results suggest that early interventions to reduce violence exposure and increase social regulation across multiple social contexts may be effective in reducing dating violence perpetration across adolescence.

Profiles of internalizing and externalizing symptoms associated with bullying victimization.

This study identified profiles of internalizing (anxiety and depression) and externalizing (delinquency and violence against peers) symptoms among bullying victims and examined associations between bullying victimization characteristics and profile membership. The sample consisted of 1196 bullying victims in grades 8-10 (Mage = 14.4, SD = 1.01) who participated in The Context Study in three North Carolina counties in Fall 2003. Five profiles were identified using latent profile analysis: an asymptomatic profile and four profiles capturing combinations of internalizing and externalizing symptoms. Associations between bullying characteristics and membership in symptom profiles were tested using multinomial logistic regression. More frequent victimization increased odds of membership in the two high internalizing profiles compared to the asymptomatic profile. Across all multinomial logistic regression models, when the high internalizing, high externalizing profile was the reference category, adolescents who received any type of bullying (direct, indirect, or dual) were more likely to be in this category than any others.

Bidirectional Relationships between Alcohol-Specific Parental Socialization Behaviors and Adolescent Alcohol Misuse.

BACKGROUND: Although numerous studies have examined parental influence on adolescent alcohol misuse, few have examined how adolescents impact parental behavior or the reciprocal nature of parent-adolescent behavior relative to alcohol misuse. OBJECTIVES: This study assessed bidirectional relationships between adolescent alcohol misuse and three alcohol-specific parenting behaviors (substance-specific monitoring, permissive communication messages about alcohol, and cautionary communication messages about alcohol). METHODS: Data were from 1,645 parent-adolescent dyads drawn from a longitudinal study spanning grades 6-10. A multivariate latent curve model with structured residuals was used to test study hypotheses. RESULTS: One marginally significant result emerged (increased alcohol misuse leads to greater substance-specific monitoring) after accounting for underlying developmental processes. CONCLUSIONS: Though practical implications are limited based on the results of the study, further directions for research regarding study design and measurement are provided to more fully examine dynamic processes between parents and adolescents relative to alcohol use.

Depressive Symptomology as a Moderator of Friend Selection and Influence on Substance Use Involvement: Estimates from Grades 6 to 12 in Six Longitudinal School-Based Social Networks.

Although the contributions of friend selection and friend influence to adolescent homophily on substance use behaviors has been of enduring research interest, moderators of these processes have received relatively little research attention. Identification of factors that dampen or amplify selection and influence on substance use behaviors is important for informing prevention efforts. Whereas prior research has examined adolescent drinking, smoking, and marijuana use, the current study examined whether friend selection and friend influence operated on substance use involvement, an indicator of problematic use, and whether depressive symptomology moderated these processes. In addition, it examined whether these relationships varied from grade 6 to 12. The study used a cohort-sequential design in which three cohorts of youth (first surveyed in grades, 6, 7, and 8) in six school-based longitudinal social networks were surveyed up to seven times, yielding N = 6817 adolescents (49% female). Stochastic actor-oriented models were applied to test hypothesized relationships in the six networks, then results were synthesized in a meta-analysis. Depressive symptoms did not moderate selection or influence on substance use involvement at any grade level, but indirectly contributed to diffusion of substance use involvement through school networks via patterns of network ties. Research is needed on contextual factors, particularly in schools, that might account for when, if at all, depressive symptoms condition friend selection and influence on substance use.

Consequences of Involvement in Distinct Patterns of Adolescent Peer and Dating Violence.

Typological theoretical perspectives suggest that the consequences of involvement in peer and dating violence may depend on the particular pattern of violent behaviors that youth experience and/or engage in. Yet few studies have examined whether distinct patterns of dating and peer violence involvement differentially predict developmental outcomes. Using two waves of data, the current study examined the prospective associations between distinct patterns of peer and dating aggression and victimization, identified using latent class analysis, and a range of potential developmental outcomes in a general population sample of adolescents in the 8th to 10th grades (n = 3068; 46% female, 58% White, 31% Black, 11% other race/ethnicity). The findings suggest that, compared to youth involved in other patterns of violence, youth involved in peer and dating violence as aggressors and victims are at greatest risk for negative sequelae, although results differed considerably for girls and boys and on the outcome variable and comparison groups being examined.

The Role of Religious Socialization and Religiosity in African American and Caribbean Black Adolescents' Sexual Initiation.

This study determined the nature of the associations between religious socialization, religiosity, and adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1170), a nationally representative study of black adolescents. Factor analysis, structural equation modeling, and logistic regression were used to evaluate hypotheses. Results indicated that as black adolescents received more messages about religious beliefs and practices, their religiosity was greater and, in turn, they were less likely to report sexual initiation; findings varied by ethnicity, gender, and age. Findings contribute to understanding religious socialization and its association with sexual initiation.

Variability in self-rated health trajectories from adolescence to young adulthood by demographic factors.

Self-rated health (SRH) is a robust measure of general health status and an indicator of where and when to target disease prevention efforts-especially in adolescent populations when clinical endpoints are rare. This study's purpose was to model SRH trajectories from ages 13 to 31 and identify whether and when differences between demographic groups emerge. We employed a conditional latent growth model of SRH in December 2016 using a nationally representative sample of 11,512 adolescents from the National Longitudinal Study of Adolescent to Adult Health data collected in 1994-2008. The average SRH trajectory is curvilinear: SRH increases until age 21 and then decreases. This trajectory contains significant between-individual variability in the intercept and linear slope. Males and self-identified non-Hispanic Blacks had higher SRH at age 13 but experienced steeper linear declines than their demographic counterparts. Individuals who grew up in households without two parents and whose parents did not graduate college had consistently lower SRH compared to those living in households with two parents and whose parents graduated college. Self-rated health is not stable over the span of early adolescence to young adulthood; demographic factors account for differences in individual variability around the starting point and overtime changes in SRH. Because these differences are apparent as early as age 13years, prevention efforts targeting demographic-based disparities should occur early in life.

Structural and functional network characteristics and facility delivery among women in rural Ghana.

BACKGROUND: Health facility births contribute to the prevention of maternal deaths. Although theoretical and empirical evidence suggest that social network characteristics influence facility delivery, examination of this relationship in sub-Saharan Africa is limited. We determined whether network structural and functional characteristics were associated with, or had an interactive effect on health facility delivery in rural Ghana. METHODS: Data on mothers (n = 783) aged 15-49 years came from a Maternal and Newborn Health Referral (MNHR) project in Ghana, and included egocentric network data on women's social network characteristics. Using multivariate logistic regression we examined the relationship between facility delivery and women's network structure and functions, as well as the interaction between network characteristics and facility delivery. RESULTS: Higher levels of instrumental support (e.g. help with daily chores or seeking health care [OR: 1.60, CI: 1.10-2.34]) and informational support (OR: 1.66, CI: 1.08-2.54) were significantly associated with higher odds of facility delivery. Social norms, such as knowing more women who had received pregnancy-related care in a facility, were significantly associated with higher odds of facility delivery (OR: 2.20, CI: 1.21-4.00). The number of network members that respondents lived nearby moderated the positive relationship between informational support and facility delivery. Additionally, informational support moderated the positive relationship between facility delivery and the number of women the respondents knew who had utilized a facility for pregnancy-related care. CONCLUSIONS: Social support from network members was critical to facilitating health facility delivery, and support was further enhanced by women's network structure and norms favoring facility delivery. Maternal health interventions to increase facility delivery uptake should target women's social networks.

Patterns of Dating Violence Victimization and Perpetration among Latino Youth.

Theory and research suggest that there may be significant heterogeneity in the development, manifestation, and consequences of adolescent dating violence that is not yet well understood. The current study contributed to our understanding of this heterogeneity by identifying distinct patterns of involvement in psychological, physical, and sexual dating violence victimization and perpetration in a sample of Latino youth (n = 201; M = 13.87 years; 42% male), a group that is understudied, growing, and at high risk for involvement in dating violence. Among both boys and girls, latent class analyses identified a three-class solution wherein the largest class demonstrated a low probability of involvement in dating violence across all indices ("uninvolved"; 56% of boys, 64% of girls) and the smallest class demonstrated high probability of involvement in all forms of dating violence except for sexual perpetration among girls and physical perpetration among boys ("multiform aggressive victims"; 10% of boys, 11% of girls). A third class of "psychologically aggressive victims" was identified for which there was a high probability of engaging and experiencing psychological dating violence, but low likelihood of involvement in physical or sexual dating violence (34% of boys, 24% of girls). Cultural (parent acculturation, acculturation conflict), family (conflict and cohesion) and individual (normative beliefs, conflict resolution skills, self-control) risk and protective factors were associated with class membership. Membership in the multiform vs. the uninvolved class was concurrently associated with emotional distress among girls and predicted emotional distress longitudinally among boys. The results contribute to understanding heterogeneity in patterns of involvement in dating violence among Latino youth that may reflect distinct etiological processes.

Reducing Children's Susceptibility to Alcohol Use: Effects of a Home-Based Parenting Program.

This 4-year efficacy trial tested whether a home-based, self-administered parenting program could have a long-term effect on children's cognitive susceptibility to alcohol use, and it tested hypothesized moderators and mediators of any such program effect. Using a two-group randomized controlled design, 1076 children (540 treatment; 536 control; mean age of 9.2 years at baseline) completed telephone interviews prior to randomization and follow-up interviews 12, 24, 36, and 48 months post-baseline. Mothers of children randomized to treatment received a 5-month-long parenting program during year 1, followed by two 1-month-long boosters in years 2 and 3. Exposure to the program was significantly inversely associated with susceptibility to alcohol use 48 months post-baseline (b = -0.03, p = .04), with no variation in program effects by parental alcohol use or mother's race/ethnicity or education, suggesting broad public health relevance of the parenting program. Path analyses of simple indirect effects through each hypothesized mediator showed that program exposure positively influenced parental communication to counter pro-drinking influences in the family and media domains and parental rule setting 36 months post-baseline; these variables, in turn, predicted reduced susceptibility to alcohol use 48 months post-baseline. Parallel (multiple) mediation analysis showed that the program had a significant indirect effect on susceptibility through parental rule setting. Together, the findings indicate that internalization of protective alcohol-related expectancies and intentions is possible among children whose mothers provide early exposure to alcohol-specific socialization. Additional research is needed to link alcohol-specific socialization during childhood with adolescent drinking outcomes.

The Effects of the Moms and Teens for Safe Dates Program on Dating Abuse: a Conditional Process Analysis.

Moms and Teens for Safe Dates (MTSD) is a dating abuse (DA) prevention program for teens exposed to domestic violence. In a randomized controlled trial (RCT), MTSD prevented certain types of DA victimization (psychological and physical) and perpetration (psychological and cyber) among teens with higher, but not lower, exposure to domestic violence. We built on these findings by using moderated mediation analysis to examine whether level of teen exposure to domestic violence conditioned the indirect effects of MTSD on these types of DA through targeted mediators. MTSD consisted of six mailed activity booklets. Mothers who had been former victims of domestic violence delivered the program to their teens. Mother and teen pairs were recruited into the RCT through community advertising and completed baseline and 6-month follow-up interviews (N = 277 pairs). As expected, MTSD had significant favorable effects for teens with higher but not lower exposure to domestic violence on several mediators that guided program content, including teen conflict management skills and mother-perceived severity of DA, self-efficacy for enacting DA prevention efforts, and comfort in communicating with her teen. MTSD had significant main effects on other mediators including teen feeling of family closeness and cohesion and mother-perceived susceptibility of her teen to DA. As expected, all significant indirect effects of MTSD on DA outcomes through mediators were for teens with higher exposure to domestic violence. Findings have implications for developing DA victimization and perpetration prevention programs for teens with high exposure to domestic violence.