Accuracy, Acceptability, and Burden of an Integrated Screening Approach to Facilitate the Delivery of Tailored Sexual Assault Prevention in the U.S. Air Force.

This paper examines accuracy, acceptability, and respondent burden of integrated screening to facilitate tailored sexual assault (SA) prevention program delivery in a basic military training (BMT) environment. Trainees (n = 5,951) received tailored prevention content based on self-reported sex, sexual orientation, prior SA victimization and perpetration, and past-month post-traumatic stress symptoms. Bivariate analyses examined trainee-reported screener accuracy, acceptability, and burden, including differences by tailoring-targeted subgroups (e.g. men/women). Overall accuracy and acceptability were high (>90%) despite significant subgroup variability. Screening time averaged 10.55 (SD = 1.95) minutes; individuals with prior SA took longer. Missingness increased linearly throughout the screener. Integrated screening is an accurate, acceptable way to deploy tailored SA prevention in BMT. Findings inform data-driven screening improvements and novel applications.

Examination of Veteran Fathers' Parenting and Their Adolescent Children's Substance Use in the United States.

BACKGROUND: Adolescent children of U.S. military veterans may be at increased risk for engaging in substance use; however, this has yet to be examined using nationally representative data. Parental involvement and communication are potential protective factors to target with prevention efforts, but veterans' parenting has not been studied in general, nonclinical populations. OBJECTIVES: This study presents data on parenting characteristics among fathers who are veterans of the U.S. military and the substance use behaviors of their adolescent children. METHODS: Data were analyzed from approximately 2,200 veteran fathers, 13,100 nonveteran fathers, and their children aged 12 to 17 who participated in the National Survey on Drug Use and Health from 2004 to 2013. Parenting characteristics and adolescent substance use were compared by fathers' veteran status. RESULTS: Compared with nonveteran fathers, veteran fathers were less likely to have talked with their children about the dangers of substance use, were more likely to believe that their children used substances, and were just as likely to be parentally involved. Higher percentages of adolescent children of veterans than those of nonveterans engaged in tobacco use and nonmedical use of psychotherapeutic drugs. Parental involvement and father-child communication about the dangers of substance use did not explain differences in substance use among adolescents with veteran versus nonveteran fathers. Conclusions/Importance: Adolescent children of veterans appear to be a group in particular need of substance use prevention services. Parental involvement and father-child communication may be appropriate protective factors to address in prevention efforts.

Effects of a psychosocial couple-based prevention program on adverse birth outcomes.

Although maternal stress and depression have been linked to adverse birth outcomes (ABOs), few studies have investigated preventive interventions targeting maternal mental health as a means of reducing ABOs. This randomized controlled study examines the impact of Family Foundations (FF)-a transition to parenthood program for couples focused on promoting coparenting quality, with previously documented impact on maternal stress and depression-on ABOs. We also examine whether intervention buffers birth outcomes from the negative effect of elevated salivary cortisol levels. We use intent-to-treat analyses to assess the main effects of the FF intervention on ABOs (prematurity, birth weight, pregnancy complications, Cesarean section, and days in hospital for mothers and infants) among 148 expectant mothers. We also test the interaction of cortisol with intervention condition status in predicting ABOs. FF participation was associated with reduced risk of C-section (OR .357, p < 0.05, 95 % CI 0.149, 0.862), but did not have main effects on other ABOs. FF significantly buffered (p < 0.05) the negative impact of maternal cortisol on birth weight, gestational age, and days in hospital for infants; that is, among women with relatively higher levels of prenatal cortisol, the intervention reduced ABOs. These results demonstrate that a psycho-educational program for couples reduces incidence of ABOs among higher risk women. Future work should test whether reduced maternal stress and depression mediate these intervention effects.

Can a family-focused, transition-to-parenthood program prevent parent and partner aggression among couples with young children?

The need for prevention of children's exposure to family aggression is clear, yet studies have not examined effects of family based programs on both partner and parent-child aggression. This study examined moderated effects of an 8-session psychoeducational program for couples on partner psychological aggression and parent-child physical aggression when the child was 3 years old. A community sample of 169 expectant couples was randomized to intervention and control conditions. Significant program effects indicated reduced partner psychological aggression by fathers and reduced parent-child physical aggression by mothers for couples with frequent preprogram partner psychological aggression and reduced partner psychological aggression by fathers for couples with severe preprogram partner physical aggression. Efforts to prevent children's exposure to family aggression may most benefit couples exhibiting preprogram relationship risk.

The adolescent family life program: a multisite evaluation of federally funded projects serving pregnant and parenting adolescents.

OBJECTIVES: We evaluated the effectiveness of care demonstration projects supported by the Title XX Adolescent Family Life (AFL) program, which serves pregnant and parenting adolescents in an effort to mitigate the risks associated with adolescent childbearing. METHODS: This cross-site evaluation involved 12 projects and 1038 adolescents who received either enhanced services funded by the AFL program or usual care. We examined the effects of enhanced services on health, educational, and child care outcomes approximately 6 months to 2 years after intake and explored moderation of program effects by time since intake and project characteristics associated with outcomes. RESULTS: The odds of using long-acting reversible contraception (odds ratio [OR] = 1.58) and receiving regular child care (OR = 1.50) in the past month were higher in the intervention group than in the comparison group. Odds of a repeat pregnancy were lower (OR = 0.39) among intervention group adolescents than among comparison group adolescents within 12 months of intake. Several project characteristics were associated with adolescent health outcomes. CONCLUSIONS: These projects show promise in improving effective contraceptive use, increasing routine child care, and yielding short-term decreases in repeat pregnancy.

Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study.

BACKGROUND: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. OBJECTIVE: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. METHODS: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator's office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. RESULTS: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing-related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff's limited technical knowledge to perform certain technical tasks was challenging. CONCLUSIONS: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements.

A Field Test of Opportunities for Teen Dating Violence Disclosure in School-Based Relationship Education Programs.

School-based relationship education programs offer an opportunity to identify youth who are experiencing teen dating violence (TDV), support their safety, and connect them with individualized services or referrals. However, no research has tested the feasibility or accuracy of approaches to create opportunities for TDV disclosure in the context of school-based programs. The current study presents the results of a field test comparing three tools used to provide opportunities for TDV disclosure (two questionnaire-style tools and one universal education discussion guide). High school students from two federally funded healthy marriage and relationship education (HMRE) program sites (N = 648) were offered the three tools in random order over the course of the HMRE program, which lasted between 3 weeks and 3 months and took place during the school day. Onsite qualitative interviews with HMRE program staff and their local domestic violence program partners assessed how service providers saw the tools and the process of implementing them. Latent class models examined the accuracy of the tools in identifying TDV. Sensitivities of the tools were low and specificities were high; the questionnaire-style tools tended to have higher sensitivities and fewer classification errors than the universal education tool. Several three-item combinations from across the tools performed better than any intact tool, suggesting that shorter assessments may be effective, provided they include items on sexual coercion and physical violence. Qualitative findings suggested that implementation of TDV assessment and universal education in school settings is a viable strategy, provided programs are able to gain support from school staff, adapt to tight time constraints, and plan procedures for protecting student privacy and confidentiality.

Effects of media campaign messages targeting parents on adolescent sexual beliefs: a randomized controlled trial with a national sample.

Using a randomized controlled trial, this study evaluated the effects of media messages targeting parents on the sexual beliefs of 404 adolescents. The messages aimed to increase parent-child communication about waiting to initiate sexual activity. Compared with children of unexposed parents, children of parents exposed to media messages were more likely to believe that teen sexual activity is psychologically harmful. However, effects varied by parent and adolescent gender; treatment effects were only significant among adolescents whose opposite-sex parent was exposed. Parent exposure strengthened beliefs that teen sexual activity is physically harmful only among adolescents with at least 1 sexually active friend.

Sleep in Mexican-American adolescents: social ecological and well-being correlates.

A burgeoning body of research documents links between sleep and adjustment in adolescence, but little is known about the role of the social ecology in promoting healthful sleeping habits. This study was aimed at identifying the socio-cultural correlates of adolescents' sleep, including average nighttime sleep duration, average daytime napping, and night-to-night variability in sleep duration and assessing the links between these dimensions of sleep and adjustment in Mexican-American youth. Participants were 469 Mexican-American adolescents (50.5% female) and their mothers and fathers. Data on family socio-cultural characteristics and youth adjustment were collected in home interviews with youth, mothers, and fathers, and, during 7 evening telephone interviews, adolescents reported on nighttime sleep and daytime napping for the prior 24-h period. Night-to night variability and napping were more strongly linked to youth depressive symptoms and risky behavior than was average nighttime sleep, whereas nighttime sleep predicted lower body mass index. Lower parental acculturation and fathers' familism values predicted more healthful sleep, and higher levels of family income, parental education and neighborhood crime predicted less healthful sleep. In addition to illuminating the significance of socio-cultural influences on youths' sleep, this study contributes to the literature by documenting the multidimensionality of sleep patterns and their links with adjustment in an understudied population.

Preventing Intimate Partner Violence Among Teen Mothers: A Pilot Study.

Despite high rates of intimate partner violence (IPV) among teens who are pregnant or parenting, the field is lacking evidence-based prevention programs designed for this population. The purpose of this study was to comprehensively adapt the evidence-based Safe Dates IPV prevention program and conduct a pilot study of the adapted program with female teens who were pregnant or parenting. We completed formative research including a literature review, focus groups, and pre-testing of adapted content to inform the revised curriculum. We then conducted a randomized controlled trial with 32 teens (average age = 17) to compare the adapted program to the original program on implementation characteristics and outcomes, including IPV perpetration and victimization. Directions of effect favored the adapted program over the original program for 18 out of 21 implementation outcomes for which models could be estimated and for 11 of 12 participant outcomes. The strongest effects, all favoring the adapted program, were found for observer-reported adherence to the curriculum, participant ratings of the relevance of characters and scenarios, participant knowledge of ways to get help for abuse, and attitudes toward IPV. These findings demonstrate the feasibility and acceptability of the adapted program for this target population and suggest that the program may be efficacious when evaluated in a larger study.

Measurement and correlates of intimate partner violence among expectant first-time parents.

Research on the implications of varying measurement strategies for estimating levels and correlates of intimate partner violence (IPV) has been limited. This study explored measurement and correlates of IPV using a community sample of 168 couples who were expecting their first child. In line with prior research, couple agreement regarding the presence of violence was low, and maximum reported estimates revealed substantial IPV perpetrated by both expectant mothers and fathers. Different types of IPV scores predicted unique variance in mental health problems and couple relationship distress among both the whole sample and the subsamples who perpetrated any violence. Discussion focuses on the methodological and substantive implications of these findings for the study of IPV during the transition to parenthood.

Enhancing coparenting, parenting, and child self-regulation: effects of family foundations 1 year after birth.

This study investigated whether a psycho-educational program with modest dosage (eight sessions), delivered in a universal framework through childbirth education programs and targeting the coparenting relationship would have a positive impact on observed family interaction and child behavior at 6-month follow-up (child age 1 year). One hundred sixty-nine couples, randomized to intervention and control conditions, participated in videotaped family observation tasks at pretest (during pregnancy) and at child age 1 year (2003-2007). Coparenting, parenting, couple relationship, and child self-regulatory behaviors were coded by teams of raters. Intent-to-treat analyses of program effects controlled for age, education, and social desirability. Evidence of significant (p < 0.05) program effects at follow-up emerged in all four domains. Effect sizes ranged from 0.28 to 1.01. Targeting the coparenting relationship at the transition to parenthood represents an effective, non-stigmatizing means of promoting parenting quality and child adjustment.

Young Mothers' and Fathers' Perceptions of Relationship Violence: A Focus Group Study.

Teens and young adults who are pregnant or parenting are important targets for efforts to prevent intimate partner violence (IPV). To intervene appropriately and effectively, we need to fully understand the unique issues and contexts for IPV in this population. This focus group study examined young parents' ( N = 28) perceptions of their relationships, stressors and sources of conflict, forms of IPV, and help-seeking behaviors. We examined data using template, content, thematic, and framework analyses. Findings about relationships and violence between young parents provide valuable insights for future intervention programs designed to prevent or address IPV among teen parents.

Moderation of the association between parent and adolescent cigarette smoking by selected sociodemographic variables.

This study examines variation in the associations between cigarette smoking by mother or father and adolescent cigarette smoking by selected sociodemographic characteristics. The study data are from nationally representative samples of adolescents aged 12 to 17 living with their mothers (n=4734) and/or fathers (n=3176). Mother cigarette smoking was more strongly associated with cigarette smoking by daughters than sons. The association between father cigarette smoking and adolescent cigarette smoking did not vary by adolescent gender. The association between mother or father cigarette smoking and adolescent cigarette smoking did not vary by parent's education, family structure, or adolescent age or race/ethnicity.

Establishing family foundations: intervention effects on coparenting, parent/infant well-being, and parent-child relations.

This study investigated the ability of a theoretically driven, psychosocial prevention program implemented through childbirth education programs to enhance the coparental relationship, parental mental health, the parent-child relationship, and infant emotional and physiological regulation. A sample of 169 heterosexual, adult couples who were expecting their 1st child was randomized to intervention and control conditions. The intervention families participated in Family Foundations, a series of 8 classes, delivered before and after birth, that was designed as a universal prevention program (i.e., it was applicable to all couples, not just those at high risk). Intent-to-treat analyses indicated significant program effects on coparental support, maternal depression and anxiety, distress in the parent-child relationship, and several indicators of infant regulation. Intervention effects were not moderated by income, but greater positive impact of the program was found for lower educated parents and for families with a father who reported higher levels of insecure attachment in close relationships. These findings support the view that coparenting is a potentially malleable intervention target that may influence family relationships as well as parent and child well-being.

Effects of a Workplace Intervention on Parent-Child Relationships.

This study tested whether effects of a workplace intervention, aimed at promoting employees' schedule control and supervisor support for personal and family life, had implications for parent-adolescent relationships; we also tested whether parent-child relationships differed as a function of how many intervention program sessions participants attended. Data came from a group randomized trial of a workplace intervention, delivered in the information technology division of a Fortune 500 company. Analyses focused on 125 parent-adolescent dyads that completed baseline and 12-month follow-up home interviews. Results revealed no main effects of the intervention, but children of employees who attended 75% or more program sessions reported more time with their parent and more parent education involvement compared to adolescents whose parents attended less than 75% of sessions, and they tended to report more time with parent and more parental solicitation of information about their experiences compared to adolescents whose parents were randomly assigned to the usual practice condition.

A Multi-Domain Self-Report Measure of Coparenting.

OBJECTIVE: This study reports the psychometric properties of a multi-domain measure of the coparenting relationship in dual-parent families. METHOD: 152 couples participating in a transition to parenthood study completed the Coparenting Relationship Scale and additional measures during home visits at child age 6 months, 1 year, and 3 years. RESULTS: Psychometric and construct validity assessments indicated the measure performed satisfactorily. The 35-item measure demonstrated good reliability and strong stability. Subscales measuring theoretically and empirically important aspects of coparenting (coparenting agreement, coparenting closeness, exposure of child to conflict, coparenting support, coparenting undermining, endorsement of partner's parenting, and division of labor) demonstrated good reliability as well. A 14-item brief overall measure showed very strong associations with the overall measure. Relations of the full scale with a measure of social desirability were weak, and the full scale was positively associated with positive dimensions of the dyadic couple relationship (love, sex/romance, couple efficacy) and inversely associated with negative dimensions (conflict, ineffective arguing)-as expected. CONCLUSIONS: This initial examination of the Coparenting Relationship Scale suggests that it possesses good psychometric properties (reliability, stability, construct validity, and inter-rater agreement), can be flexibly administered in short and long forms, and is positioned to promote further conceptual and methodological progress in the study of coparenting.

Predicting engagement in a transition to parenthood program for couples.

Fostering participant engagement is a challenging but essential component of effective prevention programs. To better understand which factors influence engagement, this study examines several predictors of couple engagement in Family Foundations (FF), a preventive intervention for first-time parents shown to enhance parent mental health, couple relations, parenting quality, and child adjustment through age 3 years. FF consists of a series of classes delivered through childbirth education departments at local hospitals. Baseline data on socio-demographics, parent mental health, and couple relationship quality were examined as predictors of participants' level of engagement in FF (n = 89 couples, 178 individuals). Sociodemographic variables such as parent gender, socioeconomic status, and age predicted program engagement to a limited extent. However, findings indicated that marital status was the best predictor of engagement. Discussion focuses on how findings can inform the development of practices that promote engagement, such as the use of targeted outreach efforts for individuals most at risk of disengagement.

The use of reconsent in a national evaluation of adolescent reproductive health programs.

PURPOSE: Reconsent involves asking research participants to reaffirm their consent for study participation when there have been significant changes in the study's procedures, risks, or benefits. We described the reconsent process, identified the reconsent rate, and examined the comparability of youths enrolled via consent and reconsent in a national evaluation of adolescent reproductive health programs. METHODS: Evaluation participants from five abstinence education projects (N = 2,176) and nine projects serving pregnant or parenting adolescents (N = 878) provided either parent or youth consent or reconsent to participate in the national evaluation. Participants completed surveys that included demographic characteristics; sexual intentions, norms and behaviors; and pregnancy history. Multivariate logistic regression was used to examine associations between consent status, demographic characteristics, and risk indicators. RESULTS: The reconsent rates in the abstinence education and pregnant or parenting samples were 45% and 58%, respectively. Participant's age was positively associated with reconsent. Hispanic adolescents (and, for abstinence education, other racial/ethnic minorities) were underrepresented among youth with reconsent. Among abstinence education study participants, risk indicators were not associated with consent status. Among pregnant or parenting teens, those who had experienced repeat pregnancy were less likely than those who had experienced only one pregnancy to have been enrolled via reconsent. CONCLUSIONS: Reconsent can bolster sample size but may introduce bias by missing some racial/ethnic and age-groups. Among high-risk adolescents, reconsent may also yield a sample that differs from consented samples on risk characteristics, necessitating statistical adjustments when analyzing data.

Effects of family foundations on parents and children: 3.5 years after baseline.

This study investigated the ability of a psychosocial prevention program implemented through childbirth education programs to enhance the coparental and couple relationship, parental mental health, the parent-child relationship, and child outcomes. A sample of 169 heterosexual, adult couples expecting their first child was randomized to intervention and control conditions. The intervention families participated in Family Foundations, a series of eight classes delivered before and after birth, which was designed as a universal prevention program (i.e., applicable to all couples, not just those at high risk). Intent-to-treat analyses utilizing data collected from child age 6 months through 3 years indicated significant program effects on parental stress and self-efficacy, coparenting, harsh parenting, and children's emotional adjustment among all families, and maternal depression among cohabiting couples. Among families of boys, program effects were found for child behavior problems and couple relationship quality. These results indicate that a universal prevention approach at the transition to parenthood focused on enhancing family relationships can have a significant and substantial positive impact on parent and child well-being.