Agreement between child self-report and parent-proxy report for functioning in pediatric chronic pain.

PURPOSE: Accurate assessment of chronic pain and functional disability in children and adolescents is imperative for guiding pain management interventions. Parents have multifaceted roles in their child's pain experience and frequently provide parent-proxy reports of pain-related functioning. However, cross-informant variance is often observed with limited understanding of contributing factors. This study aims to examine the degree of alignment between child and parent-proxy reports for Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference domain among children with chronic pain and to identify factors associated with improved child-parent agreement. METHODS: This study includes a sample of 127 youth (66.1% female) with mixed etiology chronic pain, ranging in age from 8 to 17 (M = 12.24; SD = 1.598), and their parent. Data was collected at an interdisciplinary pediatric pain clinic and online peer support groups. Measures of demographic, pain intensity, and functioning were collected. RESULTS: Means of parent-proxy reports were significantly lower than child self-reports on the PROMIS (p < 0.05). A statistically significant association between child's pain intensity (ß = 0.953, P < 0.05) and the difference between child self-reported and parent-proxy reported PROMIS functional interference scores was found. CONCLUSION: Parents underestimated pain-related functional disability relative to children's self-reports. The difference between the paired child self-report and parent-proxy report of functional disability was significantly associated with greater child self-reported pain intensity. Although parent-proxy reports in pediatric chronic pain is often used in research and practice, findings underscore the importance of incorporating child and adolescent self-report, when possible, to comprehensively capture the child's pain experience and best inform clinical interventions.

School partner perspectives on the implementation of the Your Voice Your View sexual assault prevention program for high school students.

Despite the high risk for sexual assault among adolescents, few sexual assault prevention programs designed for implementation in high schools have sustained rigorous evaluation. The present study sought to better understand the factors that influenced the implementation of Your Voice Your View (YVYV), a four-session sexual assault prevention program for 10th grade students, which includes a teacher "Lunch and Learn" training as well as a 4-week school-specific social norms poster campaign. Following program implementation, eight school partners (i.e., health teachers, guidance counselors, teachers, and principals) participated in an interview to provide feedback on the process of program implementation. The Consolidated Framework for Implementation Research was utilized to examine site-specific determinants of program implementation. Participants discussed the importance of the design quality and packaging of the program, as well as the relative advantage of offering students a violence prevention program led by an outside team, as opposed to teachers in the school. School partners highlighted the importance of intensive preplanning before implementation, clear communication between staff, the utility of engaging a specific champion to coordinate programming, and the utility of offering incentives for participation. Having resources to support implementation, a desire to address sexual violence in the school, and a positive classroom climate in which to administer the small-group sessions were seen as school-specific facilitators of program implementation. These findings can help to support the subsequent implementation of the YVYV program, as well as other sexual assault prevention programs in high schools.

Preventing sexual violence among high school students through norms correction and bystander intervention: A school-based cluster trial of Your Voice Your View.

Risk for sexual violence begins early in the lifespan; thus, interventions are needed to decrease the risk for sexual violence among high school youth. The current study evaluates the Your Voice Your View (YVYV) sexual violence prevention program using a school-based cluster trial among 26 high schools in the Northeastern United States. YVYV, includes: 1) a series of four classroom workshops designed to engage students as allies in violence prevention through bystander intervention skills training, address risks for sexual aggression, and reduce risk for victimization; 2) a Lunch and Learn teacher training workshop; and 3) a 4-week social norms poster campaign based on normative data from the school. Schools were matched based on size and demographics and randomly assigned to the intervention group or a wait-list control group. A sample of 2685 10th grade students enrolled in the research and completed assessments at baseline, 2-month and 6-month follow-up periods. The magnitude of the difference in sexual aggression did not vary by condition at either follow-up period. The magnitude of 6-month differences in experiencing unwanted sexual intercourse varied significantly by condition (IRR = 0.33 [0.14-0.76]), demonstrating a small protective effect favoring intervention schools (Cohen's f2 = 0.012). These findings highlight the promise of multicomponent interventions grounded in bystander intervention skills training, risk reduction, and social norms theory as a promising, comprehensive approach for sexual violence prevention among youth.

Dating Violence Prevention for Juvenile-Justice Involved Females: A Hybrid Trial.

OBJECTIVE: The primary objective of this hybrid I clinical trial of Date SMART (Date Skills to Manage Aggression in Relationships for Teens) was to reduce adolescent dating violence (ADV) among juvenile-justice involved females over 1 year. Secondary objectives were to determine if the intervention reduced sexual risk behavior and delinquency. Last, we evaluate system buy-in vis à vis mandated referrals to the program. METHODS: Participants were females, ages 14 to 18 (N = 240), involved in a family court in the Northeast United States. The Date SMART group intervention consisted of cognitive-behavioral skill building, and the knowledge-only comparison group consisted of psychoeducation regarding sexual health, ADV, mental health and substance use. RESULTS: Court mandates to intervention were common (41%). Among those with ADV exposure, Date SMART participants reported fewer acts of physical and/or sexual ADV (rate ratio, 0.57; 95% confidence interval [CI], 0.33-0.99) and cyber ADV (rate ratio, 0.75; 95% CI, 0.58-0.96) at follow-up, relative to control. There were significant reductions in the number of vaginal and/or anal sex acts reported by Date SMART participants relative to control (rate ratio, 0.81; 95% CI 0.74-0.89). In the overall sample, within group reductions in some ADV behaviors and delinquency were observed in both conditions. CONCLUSIONS: Date SMART was seamlessly integrated into the family court setting and received stakeholder buy-in. Although not superior to control as a primary prevention tool, Date SMART was effective in reducing physical and/or sexual ADV, and cyber ADV, as well as vaginal and/or anal sex acts, among females with ADV exposure over 1 year.

Dating Aggression among Court-Involved Adolescents: Prevalence, Offense Type, and Gender.

Adolescents involved in the juvenile justice system face a variety of risk factors that are associated with more frequent and severe experiences of aggression within romantic relationships as compared to community samples. The current study examines the nature and characteristics of adolescent dating violence (ADV) among first-time offense court-involved non-incarcerated (CINI) adolescents. A sample of 199 male and female CINI adolescents (58% male; M age = 15.05) who had a first-time, open status (e.g., truancy, curfew violation) and/or delinquent petition (e.g., assault, breaking, and entering). Overall, CINI adolescents reported prevalence rates of ADV consistent with community samples of adolescents. Females reported higher perpetration than did males in the sample of physical abuse and social networking abuse, as well as higher victimization of social networking abuse. Only one difference was found by offense type. CINI females report an increased risk for dating violence, though the cause of these gender differences is unclear. Findings also highlight that risk for ADV does not differ by offense type, suggesting that prevention efforts targeting ADV at the earliest possible intervention point, regardless of first-time offense type or severity, may be especially impactful.

Sexual Minority Status, Bullying Exposure, Emotion Regulation Difficulties, and Delinquency Among Court-Involved Adolescent Girls.

Sexual minority adolescent girls are overrepresented in the justice system. This study used the minority stress model and psychological mediation framework to investigate a pathway for this disparity among court-involved girls ages 14-18 (N = 226; mean age: 15.58; 48% sexual minority). The hypotheses were that sexual minority status would be associated with delinquency, bullying exposure would be associated with delinquency indirectly via emotion regulation difficulties, and the relationship between bullying exposure and emotion regulation difficulties would be stronger for sexual minority girls. Bullying exposure and emotion regulation difficulties were not related. Sexual minority status was related to delinquency, and emotion regulation difficulties mediated this relationship. The findings suggest interventions to build emotion regulation skills may reduce delinquency for sexual minority girls.

VOICES: An efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history.

BACKGROUND: Girls have unique developmental pathways to substance use and justice system involvement, warranting gender-responsive intervention. We tested the efficacy of VOICES (a 12-session, weekly trauma-informed, gender-responsive substance use intervention) in reducing substance use and HIV/STI risk behaviors among justice- and school-referred girls. METHODS: Participants were 113 girls (Mage = 15.7 years, SD = 1.4; 12 % White, 19 % Black, 15 % multi-racial; 42 % Latinx) with a history of substance use referred from juvenile justice (29 %) and school systems (71 %). Study assessments were completed at baseline, 3-, 6- and 9-months follow-up. Primary outcomes included substance use and HIV/STI risk behaviors; secondary outcomes included psychiatric symptoms (including posttraumatic stress) and delinquent acts. We hypothesized that girls randomized to the VOICES (n = 51) versus GirlHealth (attention control; n = 62) condition would report reduced alcohol, cannabis and other substance use, HIV/STI risk behaviors, psychiatric symptoms, and delinquent acts. RESULTS: Girls randomized to VOICES reported significantly less cannabis use over 9-month follow-up relative to the control condition (time by intervention, p < .01), but there were no between group differences over time in HIV/STI risk behavior. Girls in both conditions reported fewer psychiatric symptoms and delinquent acts over time. CONCLUSIONS: Data support the use of a trauma-informed, gender-responsive intervention to reduce cannabis use among girls with a substance use history and legal involvement; reducing cannabis use in this population has implications for preventing future justice involvement and improving public health outcomes for girls and young women, who are at disproportionate health and legal risk relative to their male counterparts.

A Review of Parent- and Family-based Prevention Efforts for Adolescent Dating Violence.

Prevention efforts for adolescent dating violence (ADV) have largely focused on adolescent-based interventions with little emphasis on parent- and family-based interventions, despite the integral role parents serve in adolescent relationship development. This literature review provides an overview of the existing parent- and family-based intervention efforts for ADV. This review highlights that some programs are geared toward a universal audience, whereas others are more targeted towards populations believed to be at greater risk for ADV. Some programs primarily target parents, whereas others integrate parent-based components into primarily adolescent-focused or comprehensive programs. Aspects to consider when selecting a program are discussed, as well as future directions. Suggested future directions involve broadening existing parent- and family-based programming for ADV to include a focus on secondary and tertiary prevention, gender differences, and gender and sexual minorities. This review also highlights the need for existing programs to expand their evaluation of behavioral outcomes and comparison of programs to one another.

The Influence of Peer Support for Violence and Peer Acceptance of Rape Myths on Multiple Forms of Interpersonal Violence Among Youth.

Significant work has highlighted the associations among physical dating violence, bullying perpetrated in person, and cyberbullying. Yet these experiences are most often examined in isolation. The present study adds to the literature by testing the hypothesis that peer factors (e.g., perceived peer support for sexual violence and perceived peer endorsement of rape myths) display associations with three forms of aggression (physical dating violence perpetration, perpetration of bullying in-person, and cyberbullying perpetration). A sample of 2,830 10th-grade youth, recruited across 27 high schools in the northeast region of the United States, completed self-report surveys assessing peer context and the perpetration of violence. To examine the potential shared risk of peer approval for sexual violence and peer endorsement of rape myths and multiple forms of violence, a multivariate extension to multilevel models (MLMs) was used. Findings suggested that as hypothesized both peer support for sexual violence and perceptions of peer endorsement of rape myths each made a significant contribution in association with dating aggression perpetration, in person bullying, as well as cyberbullying. Findings offer insight into the development of aggression in adolescence and highlight the necessity of unified research examining multiple domains together. Discussion also underscores the potential benefits of targeting peer context and perceptions of peer norms through cross-cutting prevention programming for adolescents.

Depressive Symptoms Moderate Dating Violence Prevention Outcomes Among Adolescent Girls.

Purpose: Few dating violence prevention programs assess how variations in initial violence risk affects responsiveness. This study examines the efficacy of Date SMART, a dating violence and sexual risk prevention program designed to target high-risk adolescent girls, in preventing dating violence in the context of varying initial levels of depressive symptoms. Method: A diverse sample of N = 109 female adolescents with a history of physical dating violence participated in a randomized controlled trial of the Date SMART program and a knowledge only (KO) comparison. Results: Using baseline depression level as a primary risk factor, a series of multilevel models revealed significant main effects of baseline depression such that higher baseline depression was associated with greater physical dating violence perpetration and victimization. Results also showed a three-way interaction for assessment point, depressive symptoms, and condition for physical dating violence perpetration. Specifically, those with higher baseline depression in Date SMART showed significantly less physical dating violence perpetration at follow-ups compared with those with higher baseline depression in the KO group. This difference in violence reduction between conditions was not observed for those with lower baseline depression. Discussion: Date SMART appears to effectively reduce physical dating violence perpetration in those with higher levels of initial risk. Current findings support that adolescents with different risk profiles respond differently to violence prevention programs.

Victimization profiles in girls involved in the juvenile justice system: A latent class analysis.

BACKGROUND: Previous research has demonstrated that youth involved in the juvenile justice system endorse diverse patterns of victimization. However, previous research investigating victimization profiles among youth involved in the juvenile justice system has primarily consisted of boys. OBJECTIVE: This study investigated victimization profiles and correlates of victimization exposure, including posttraumatic stress symptoms and risk behaviors, in a sample of girls involved in the juvenile justice system. PARTICIPANTS AND SETTING: Participants were 245 girls involved in the juvenile justice system (Mage = 15.57, SD = 1.13) participating in a dating violence prevention program. The sample was racially diverse, and 48 % self-identified as Hispanic/Latina. METHOD: Prior to participating in the intervention, participants completed self-report measures of adversity and victimization exposure, posttraumatic stress symptoms, and risk behaviors. RESULTS: Results of latent class analysis identified three distinct victimization profiles. The first class (n = 106) was characterized by low levels of victimization. The second class (n = 98) experienced predominantly emotional victimization (i.e., emotional dominant). The third class (n = 41) was characterized by exposure to polyvictimization (i.e., polyvictimization predominant). Girls categorized into the polyvictimization dominant class evidenced the greatest levels of posttraumatic stress symptoms, substance use, suicidal behaviors, and sexual risk behaviors. CONCLUSIONS: Girls involved in the juvenile justice system report distinct patterns of victimization, which are differentially associated with posttraumatic stress symptoms and risk behaviors. The present study underscores the importance of implementing trauma-informed assessment and intervention practices within juvenile justice systems.

Project STRONG: an Online, Parent-Son Intervention for the Prevention of Dating Violence among Early Adolescent Boys.

Despite broad calls for prevention programs to reduce adolescent dating violence (DV), there is a dearth of programs designed specifically for males. In fact, there are no programs that capitalize on the importance of parents in modeling and influencing the choices their sons make in future romantic relationships. To address these gaps, this study assessed the initial feasibility, acceptability, and efficacy of an online, parent-son intervention (STRONG) aimed at reducing DV among early adolescent males. One-hundred nineteen 7th- and 8th-grade boys were recruited, with a parent (90% mothers), from six urban middle schools in the Providence, RI area. Dyads were randomized to either STRONG or a waitlist comparison group. STRONG targets three primary constructs: relationship health knowledge, emotion regulation, and communication. Families randomized to the waitlist were nearly twice as likely at 3 months (OR = 1.92 [0.43-8.60]) and nearly 7 times as likely at 9 months (OR = 6.76 [0.66-69.59]) to endorse any form of DV perpetration (physical, sexual, verbal/emotional) when compared with STRONG families. STRONG also had positive effects on teens' attitudes toward dealing with DV, their emotional awareness, and their short-term regulation skills and was associated with increased discussion of critical relationship topics. Pilot outcomes indicate that an online DV prevention program designed to engage early adolescent boys and parents is both acceptable and engaging. Findings show promise for reducing DV behaviors and theory-driven mediators. ClinicalTrials.gov Identifier: NCT03109184.

Perpetration of Electronic Intrusiveness Among Adolescent Females: Associations With In-Person Dating Violence.

Electronic intrusiveness is a form of cyber dating abuse that includes monitoring a partners' location, whom a partner is talking to, and other private information via technology and social networking sites. The aim of this study was to further explore the prevalence of electronic intrusiveness, as well as to assess how electronic intrusiveness relates to in-person dating violence while controlling for known risk factors for in-person dating violence, namely, depression, emotion regulation, and acceptance of couple violence. Data for this study were drawn from the baseline assessment of a larger clinical trial. A sample of high-risk adolescent females between the ages of 14 and 17 with a lifetime history of prior dating violence victimization or perpetration was used. Participants completed self-report measures for all study variables. Findings demonstrate that perpetration of electronic intrusiveness within the past 3 months is common among a sample of high-risk adolescent females, with rates across various modes of technology ranging from 30% to 57%. Results also revealed electronic intrusiveness is associated with in-person dating violence perpetration after accounting for known risk factors. This study highlights the need to increase awareness of electronic intrusiveness and to better incorporate electronic intrusiveness into theoretical and empirical models of dating violence.

Application of the actor-partner interdependence model in parent-adolescent emotion regulation and depression.

BACKGROUND: The family environment is an important context for the development and maintenance of depressive symptoms within families. In this study, we evaluated whether parent and adolescent self-reports of emotion regulation constructs are linked with their own (actor effects) and each other's (partner effects) depressive symptoms. METHODS: Participants were 123 adolescent-parent dyads, recruited from adolescent inpatient and partial hospitalization programs, who completed self-report assessments of emotion dysregulation and depression. RESULTS: Using the Actor-Partner Interdependence Model (APIM), results revealed expected actor effects for emotion regulation strategies, but not impulsiveness. A significant partner effect for parents' impulsiveness and adolescents' depressive symptoms was observed, demonstrating the interdependent nature of these characteristics in the sample. Interpretation of APIM model coefficients indicated that greater parent impulsiveness was associated with less adolescent depression symptom severity. LIMITATIONS: Limitations include a small sample of primarily Caucasian adolescents who were receiving intensive psychiatric services making generalizability more challenging. The sample also consisted of largely mothers which is important to consider given there are known gender differences in rates of depression and sensitivity to interpersonal processes. CONCLUSIONS: Overall, findings shed light on the nature of these characteristics within the families of depressed adolescents and the role of emotion regulation in the parent-child relationship. Implications of this work and future studies are discussed.

Individual and Relationship Characteristics of Adolescent Girls With Histories of Physical Dating Violence.

The objective of this article is to examine the individual and relational characteristics of adolescent girls with a history of physical DV, as well as to utilize partner-specific, temporal data to explore links between these factors and recent or ongoing DV experiences. Participants were 109 high school girls (ages 14-17) identified as having a history of DV through a school-based screening procedure. Details regarding the timing of DV and links with specific dating partners were gathered using Timeline Followback (TLFB) interview methodology. At study entry, 30% endorsed clinical levels of depression symptoms and 89% reported delinquent behaviors. Forty-four percent reported vaginal intercourse in their lifetime and of those, 35% reported not using a condom at last sex. During the 90 days prior to study entry, 69% of youth reported having a romantic relationship and 58% of those youth reported physical/sexual violence. Data revealed that more physical/sexual violence was associated with longer relationship length, Wald χ2(2) = 1,142.63, p < .001. Furthermore, depressive symptoms, not delinquency, contributed significantly to recent DV experiences, even when relationship length was controlled. Our findings suggest that prevention programs for this population should teach participants how to quickly recognize unhealthy relationship characteristics, as violence severity increases with relationship length. Programs for adolescent girls should also address depressive symptoms, which are linked to DV severity when other risks are taken into account. Finally, the TLFB calendar method appears useful for gathering the temporal and partner-specific data needed to understand the complexity of dating relationships and violence experiences in this population.

In the eye of the swiper: a preliminary analysis of the relationship between dating app use and dimensions of body image.

BACKGROUND: Dating apps are largely visual platforms and based on evaluations of the attractiveness of users. Thus, engaging with this type of social media may be associated with body image concerns. OBJECTIVE: This study aimed to explore the relationship between dating app use and body image. METHODS: College students (n = 170, 50% females) reported on dating app use, as well as body shame, surveillance, body satisfaction, media ideal internalization, and controllability beliefs related to weight/shape. RESULTS: Among males, frequent checking of dating apps was positively correlated with body shame and negatively with beliefs regarding weight/shape controllability. Media internalization was negatively correlated with experiencing negative feelings when using dating apps, and positively with positive feelings. Few associations emerged among females. CONCLUSION: Dating app use seems most tightly associated with body image concerns among males. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Let's Get Digital: Understanding Adolescent Romantic Relationships Using Naturalistic Assessments of Digital Communication.

Adolescent romantic relationships involve complex patterns of interaction. Innovative technological advances offer opportunities to capture features and dynamics of these relationships that traditional research methods have not addressed. With the explosion of digital communication platforms (e.g., mobile texting, direct messaging, social media applications), researchers can now observe and understand adolescent relationships in vivo, offering for the first time a naturalistic lens into adolescent worlds. Recognizing this scientific opportunity, in this article, we 1) discuss the potential theoretical and methodological benefits of collecting and coding digital communication data to understand adolescent romantic relationships, 2) suggest ways to use these data to develop innovative prevention tools, and 3) address potential challenges in collecting digital communication data from adolescents.

The Association Between Exposure to Violent Pornography and Teen Dating Violence in Grade 10 High School Students.

Exposure to pornography in general has been linked with adolescent dating violence and sexual aggression, but less is known about exposure to violent pornography specifically. The current study examined the association of violent pornography exposure with different forms of teen dating violence (TDV) using baseline survey data from a sample of Grade 10 high school students who reported being in a dating relationship in the past year (n = 1694). Gender-stratified logistic regression models generated odds ratios adjusted for demographics, substance use, history of suspension/expulsion, gender equitable attitudes, and tolerance of rape myths to identify significant associations between violent pornography exposure and self-reported physical, sexual, and threatening TDV perpetration and victimization. Violent pornography exposure was associated with all types of TDV, though patterns differed by gender. Boys exposed to violent pornography were 2-3 times more likely to report sexual TDV perpetration and victimization and physical TDV victimization, while girls exposed to violent pornography were over 1.5 times more likely to be perpetrate threatening TDV compared to their non-exposed counterparts. Comprehensive prevention strategies for TDV may consider the potential risks associated with exposure to violent pornography, particularly for boys, and provide an alternative source of education about healthy sexual behavior and relationships.

Project Date SMART: a Dating Violence (DV) and Sexual Risk Prevention Program for Adolescent Girls with Prior DV Exposure.

This study assessed the initial feasibility, acceptability, and efficacy of an intervention aimed at reducing dating violence and sexual risk behavior in a sample of adolescent girls (ages 14-17) with prior exposure to physical dating violence (DV). One hundred and nine girls were randomly assigned to Date SMART (Skills to Manage Aggression in Relationships for Teens) or a Knowledge-only (KO) comparison group. Both intervention arms consisted of six, weekly 2-h sessions and one "booster" session 6 weeks later. Based on principles of cognitive behavioral therapy, the Date SMART intervention was designed to target common underlying skills deficits linked to both DV and sexual risk behavior in adolescent females: depression, self-regulation deficits, and interpersonal skills deficits. Assessments were administered at four time points (baseline, 3, 6, and 9 months). The Date SMART group was effective as reducing sexual DV involvement across the 9-month follow-up period. Both groups evidenced clinically meaningful reductions in physical, emotional, and digital DV involvement, total time in dating relationships, as well as reductions in depression. Findings indicate that delivering a DV and sexual risk prevention intervention to DV-affected adolescent girls is feasible and well-received. Furthermore, a skills-based approach that addresses the co-occurrence of DV and sexual risk behavior may be particularly useful for promoting reductions of sexual DV among high-risk adolescent girls. A future, large-scale trial with an inactive comparison condition is needed to evaluate the efficacy of Date SMART further. TRIAL REGISTRATION: Clinical Trials, NCT01326195, and http://www.clinicaltrials.gov.

Recidivism among First-Time Offending Truant Youth with Mental Health Symptoms.

Little is known about which first-time offending truant youth re-offend, especially in comparison to youth with first-time delinquent offenses. The purpose of this study was to compare rates and risk factors for recidivism between youth with first-time truancy offenses and delinquent offenses. All youth included in this study were referred for forensic mental health evaluation due to mental health concerns. Findings revealed that rates of 12-month recidivism were comparable and both groups were more likely to commit a future delinquent offense than a truancy or status offense. Risk for recidivism among truant youth was higher for those with an externalizing disorder and those who witnessed domestic violence. Within truant recidivists, being male and having a history of substance use increased likelihood of future delinquency. Study findings suggest that universal screening for truant youth upon court contact is justified and may be useful for selecting targeted recidivism prevention and intervention efforts. This may be particularly important for truant youth with mental health concerns, as indicated by the sample used in this study.