Sexting and Behavioral Health in First-time Justice-Involved Adolescents.

Objectives: We examined the prevalence of sexting, related motivations, demographics, and association with behavioral health problems among justice-involved adolescents. Hypotheses: We hypothesized positive associations between sexting and sexual risk, substance use, delinquency, and mental health problems. Methods: Participants were 307 community-supervised justice-involved adolescents with a first-time offense (Mage =14.50 years, 44.6% female) and their caregivers. Adolescents answered questions on technology use and sexting by sending, receiving, or forwarding sexually suggestive text messages and images (pictures or videos). They also completed measures of recent (past 4-month) sexual activity, unprotected sex, cigarette, alcohol, marijuana, and other drug use, and delinquency; current trauma symptoms, internalizing problems, and adaptive functioning. Results: Prevalence of sexting were 37.7% (lifetime overall; 17.0% sent texts; 17.4% sent images) and 29.5% (past-year overall; 12.8% sent texts; 13.6% sent images). Sexts were commonly sent as presents to partners, in response to sexts received, or to have fun. "Sexters" were older than "non-sexters" and more likely to identify as lesbian, gay, bisexual, or questioning. Past-year sexting was significantly associated with recent sexual activity; unprotected sex; alcohol use and days of use; marijuana and other drug use; delinquency and variety of delinquent acts; and elevated trauma symptoms and internalizing problems. Conclusions: Sexting is prevalent among adolescents with a first-time offense and co-occurs with multiple behavioral health needs. Intervention for this population may be informed by routinely assessing sexting in community settings. Familiarity with local reporting laws could help clinicians navigate the legal implications of sexting among adolescents with existing justice-system involvement.

Parent Psychological Distress: A Moderator of Behavioral Health Intervention Outcomes among Justice-Involved Adolescents.

We examined whether pre-existing parent psychological distress moderated juvenile offenders' substance use, sexual risk, and mental health outcomes in a randomized trial. Forty-seven parent-adolescent dyads received either Family-based Affect Management Intervention (FAMI) for adolescent substance use and HIV prevention or adolescent-only Health Promotion Intervention (HPI). Parents' self-reported distress at baseline significantly moderated adolescents' self-reported marijuana use and alcohol use but not other outcomes at 3 months postintervention, producing crossover interactions. FAMI outperformed HPI when parents reported high-level distress, whereas HPI outperformed FAMI when parents reported low-level distress. This finding that the relative efficacy of interventions depends on the severity of parent psychological distress could inform efforts to match substance-using, justice-involved adolescents with the intervention most likely to benefit them.

Weighty decisions: How symptom severity and weight impact perceptions of bulimia nervosa.

OBJECTIVE: The current study examined whether variations in patient weight and eating-disorder behavior frequency influenced the recognition of bulimia nervosa (BN) and the perception that it is a serious mental health concern. METHOD: Participants (N = 320) were randomly assigned to one of six conditions in which they read a vignette describing a young woman with BN. Each vignette was identical except for the variables of interest: weight status (underweight, healthy-weight, and overweight), and symptom frequency (daily or weekly binge-eating episodes and purging). RESULTS: Participants were more likely to have negative attitudes toward and blame the patient with overweight. Participants were less likely to believe that the patient with overweight was experiencing mental illness and that her problems were too serious to handle on her own. There were no significant differences by symptom frequency. DISCUSSION: Findings suggest the presence of weight stigma and that overweight might impede the recognition of eating disorders.

Latinx Youth in First Contact with the Justice System: Trauma and Associated Behavioral Health Needs.

This study examines the prevalence of trauma exposure and its association with psychiatric symptoms, substance use, and sexual activity among First-Time Offending, Court-Involved Non-Incarcerated (FTO-CINI) Latinx youth. Latinx youth (N = 181), ages 12-18, were recruited from a family court in the Northeastern region of the United States as part of a longitudinal cohort study of 423 FTO-CINI youth. Baseline data on trauma exposure and symptoms, psychiatric symptoms, substance use (alcohol/marijuana), and sexual activity among the Latinx sample were analyzed by age, gender, and offense type (status versus delinquent). Almost three-quarters of Latinx FTO-CINI youth reported lifetime trauma exposure. Almost half of Latinx youth reported lifetime marijuana use, 30% reported lifetime alcohol use, and 33% reported lifetime sexual activity. Females reported higher rates of internalizing symptoms and greater affect dysregulation. Trauma-exposed youth were more likely than their non-exposed peers to have reported more externalizing symptoms; trauma-exposed females compared to trauma-exposed males reported more severe internalizing symptoms. Latinx FTO-CINI females may have different behavioral health needs than their male counterparts. Court-based screening and assessment practices should attend to the specific behavioral needs of this unique, underserved population.

Assessing the Feasibility of Peer Coach Training for Disruptive Middle School Youth: A Mixed Methods Pilot Study.

In U.S. schools, disruptive behavior is by far the primary reason for disciplinary referrals, including suspensions and expulsions. School-based interventions targeting disruptive behavior usually position struggling youth as treatment recipients and neglect the psychosocial benefits of helping others. In this mixed methods pilot study, we evaluate the preliminary feasibility and acceptability of Peer Coach Training (PCT), a novel, school-based intervention for youth referred for disruptive behavior that deemphasizes the youth's existing problems and focuses instead on training youth to help their peers. We used quantitative and qualitative methods to evaluate the feasibility and acceptability of PCT on two cohorts of disruptive youth (N = 9) in an urban middle school in Southern California. Youth and teachers completed assessments at baseline, post-treatment, and three-month follow-up. At posttreatment and follow-up, youth reported significant reductions in externalizing problems, as well as reductions in conduct problems, attention problems, and aggressive behavior; in contrast, teacher ratings yielded null findings. Qualitative interviews revealed that youth and teachers observed positive changes in peer interactions, self-confidence, and classroom participation efforts. Youth satisfaction data indicated that youth enjoyed participating in PCT and would highly recommend it to their friends. Results from this pilot evaluation suggest that training youth to help their peers is an appealing, feasible, and promising strategy for reducing disruptive behavior, however, controlled trials are needed to provide evidence for treatment efficacy.

Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study.

BACKGROUND: Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking. OBJECTIVE: This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth's behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability. METHODS: CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability. RESULTS: Overall, 28 individuals participated in focus groups and interviews-8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive. CONCLUSIONS: Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but lack of clear guidelines about privacy, confidentiality, and information sharing poses ethical conundrums. Future hybrid-type research designs that explore the efficacy of the intervention while also studying ethical, system, and policy-level factors associated with using digital health interventions to improve CINI youth outcomes is a key next step.

Preferred descriptions for loss of control while eating and weight among patients with binge eating disorder.

Patients with binge eating disorder (BED) typically also have excess weight, making them vulnerable to stigmatizing attitudes about mental illness and obesity. Further, one of the diagnostic features of BED is experiencing a loss of control during binge eating episodes. It is possible that patients feel negatively judged when clinicians assess for loss of control as it may activate stereotypes of patients with obesity lacking willpower. We developed a questionnaire to assess preferences for common loss of control descriptions and gathered data on preferences for weight-related terms among 46 patients with BED. Analyses revealed the majority of common descriptors for loss of control eating were viewed neutrally, with loss of control being the most preferred term. Descriptions suggesting patients were addicted to food or did not consider stopping eating once they started binge eating were viewed negatively. The following weight descriptions were viewed negatively: heaviness, large size, obesity, excess fat, and fatness. Terms such as BMI, and unhealthy body weight or BMI were viewed more favorably and weight was the most preferred term. These findings provide empirical support for healthcare providers' use of terms to use and terms to avoid when talking to patients with BED about eating and weight.