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Youth at-risk for HIV are also at-risk for mental health disorders and psychiatric hospitalization. Understanding the association between engagement in HIV prevention, concurrent risk behaviors, and psychiatric hospitalization may lead to improvements in integrated prevention and mental health treatment efforts. Youth at-risk for HIV, aged 14–24 years old, predominantly Black/African American and Latinx (75%) were recruited through youth-serving clinics and community sites in Los Angeles (n = 839) and New Orleans (n = 647). We compared youth with and without histories of psychiatric hospitalization on engagement in HIV prevention, concurrent risk behaviors, and demographic characteristics. We examined predictors of hospitalization using multiple imputations for missing data. Hospitalized youth (30%) were more involved in HIV programs, but were less likely to use PrEP/PEP or condoms than non-hospitalized youth. The odds of hospitalization were higher for transgender/gender nonconforming youth relative to cisgender youth; the OR was increased after adjustment for concurrent risk behaviors. Hospitalization was associated with homelessness, trauma, incarceration, substance use, and involvement in substance abuse treatment programs. There is a continuing need to integrate the diagnosis and treatment of mental health disorders into HIV prevention programs to better address multiple challenges faced by vulnerable youth. [ABSTRACT FROM AUTHOR]

Home visiting by community health workers (CHW) improves child outcomes in efficacy trials, there is however limited evidence of impact evaluating CHW programmes when operating outside of a research project. A CHW programme, previously demonstrated efficacious in a peri-urban township, was evaluated in a deeply rural context in a non-randomised comparative cohort study. Two non-contiguous, rural areas in the Eastern Cape of South Africa of about equal size and density were identified and 1469 mother-infant pairs were recruited over 33 months. In one area, CHWs conducted perinatal home visits (intervention group). Mothers in the comparison group received standard clinic care. Maternal and child outcomes were compared between the groups at one year. Mothers in the intervention group had significantly fewer depressive symptoms than mothers in the comparison group. Children of intervention mothers attained a higher proportion of their developmental milestones, compared to children in the comparison group. There were no other significant differences between mothers and children in the two groups. It is important to establish key parameters for implementing efficacious CHW programmes, especially as the numbers of CHWs are rapidly increased and are becoming critical components of task-shifting strategies of health departments in low and middle income countries (LMIC). [ABSTRACT FROM AUTHOR]

Background: Research shows that caregiver mental health problems have direct, significant effects on child behaviour. While these risks are amplified in low-resource settings, limited evidence exists from these places, especially sub-Saharan Africa. Objective: We measured associations between caregiver mental health and child behaviour in a rural Kenyan sample, hypothesizing that higher rates of caregiver mental health would be associated with increased child behavioural problems. We also sought to provide an overview of caregiver mental health symptoms in our sample. Method: Cross-sectional data were collected from caregivers of children ages 4–5 years old enrolled in a community-based early child development programme in western Kenya. 465 caregivers were recruited and assessed at baseline, and answered questions about child behaviour, mental health symptoms (depression, anxiety, stress), and help-seeking. A multivariate linear regression model was used to assess significance of each mental health factor. Results: Caregiver anxiety (p = 0.01) and parenting stress (p < 0.001) were significantly associated with child behavioural problems. 245 caregivers (52.9%) had high levels of symptoms of depression, anxiety, or both; furthermore, 101 caregivers (21.7%) scored above the cut-off for both of these scales. A high proportion of our sample (60.6%) reported seeking some formal or informal psychosocial support services; however, less than one-third of these caregivers were symptomatic (30.9%). Conclusion: Anxiety and stress were associated with poorer child behavioural outcomes. Our sample reflected a higher prevalence of caregiving adults with mental health symptomology than previous estimates from Kenya, with few high-symptom caregivers seeking support. We discuss further implications for programming and health services delivery. [ABSTRACT FROM AUTHOR]

In the era of widespread antiretroviral therapy (ART), consequences of being HIV-exposed is unclear for children, especially in rural communities. A population sample of consecutive births (470/493) in the Eastern Cape of South Africa (SA) were recruited and reassessed at five points over the first 24 months. Maternal and child outcomes between mothers living with and without HIV were assessed using multiple linear and logistic regressions. At birth, 28% of the sample was mothers living with HIV and five additional mothers seroconverted. All mothers living with HIV reported taking ART. The rate of depressed mood and IPV was similar across serostatus. However, mothers living with HIV significantly decreased their alcohol use after learning about their pregnancy and were more likely to exclusively breastfeed when compared to mothers without HIV. Despite maternal HIV status, children had similar growth across the first 24 months of life. Future work is needed to assess if these developmental trajectories will persist. [ABSTRACT FROM AUTHOR]

Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences. [ABSTRACT FROM AUTHOR]

There is growing interest in engaging men and boys in health and development programmes targeting the intersection of HIV risk, substance abuse, and violence. Understanding the conceptualisations of masculinities or masculine identities that shape both behaviours and opportunities for intervention is central to advancing the global agenda to engage men in health and development interventions. This paper examines an intervention using soccer and job training to engage and deliver activities for HIV prevention, substance abuse, and gender-based violence in a South African township. A literature review provides theoretical, historical and social context for the intersection of gender, masculinity, soccer, violence, and sexual relationships. Qualitative data from in-depth interviews and focus groups is analysed using theoretical and contextual frames to elucidate the negotiation of shifting, contradictory, and conflicting masculine roles. Results highlight how changing risky, normative behaviours among young men is a negotiated process entailing men's relationships with women and with other men. [ABSTRACT FROM AUTHOR]

Child-mother attachment, as observed in the Strange Situation (SSP), was assessed in 61 families affected by HIV and 18 neighborhood comparison families not affected by HIV, but of similar ethnicity and socioeconomic status. Children were aged one to three years at the assessment. Secure attachment was significantly less likely among children in the HIV-affected group than among comparison group children (36% versus 67%). The most common pattern of attachment in the HIV-affected group was disorganized/ disoriented, observed in 41% of children (versus 22% of comparison children). Children from families that included a surviving grandparent with HIV showed disorganized attachments more often than children whose grandparents died (53% versus 36%). Child attachment classifications were not associated with families' participation in a family-based, cognitive-behavioral HIV intervention. These results document the inter-generational impact of young mothers' who were growing up with an HIV-infected parent. These findings suggest that families affected by HIV may benefit from interventions that address attachment issues. [ABSTRACT FROM AUTHOR]

The purpose of this research was to determine whether or not routine home visiting (by the Philani Maternal Child Health and Nutrition Project) influences the prevalence of stunted, wasted and underweight children in Cape Town peri-urban settlements. The study was a cross-sectional cohort in which weight and height measurements were collected for all children from 24 matched neighbourhoods; three years earlier 12 of these neighbourhoods were randomized to receive the home visiting intervention and 12 did not. The research took place at all households located within the 24 neighbourhoods in Khayelitsha and Mfuleni peri-urban settlements. Participants included 8715 children aged 0–6 years old (4694 intervention; 4021 control). A total of 41.3% of children were stunted, 3.1% were underweight and 1.4% were wasted. Children in the intervention group were significantly less likely to be underweight or severely underweight for age than children in the control group. While the rates of stunting were also significantly lower in intervention areas, the effect was not clinically significant, and no significant differences were found between the study arms on the prevalence of wasting. The Philani model is effective in the prevention and rehabilitation of underweight children. Philani could strengthen their intervention by focussing specifically on screening for child stunting in addition to underweight children. The results also suggests that efforts to address the long-term adverse effects of undernutrition require structural and economic transformation, in addition to socio-medical interventions. [ABSTRACT FROM AUTHOR]

Paraprofessional home visitors trained to improve multiple outcomes (HIV, alcohol, infant health and malnutrition) have been shown to benefit mothers and children over 18 months in a cluster randomised controlled trial. These longitudinal analyses examine the mechanisms which influence child outcomes at 18 months post-birth in Cape Town, South Africa. The results were evaluated using structural equation modelling, specifically examining the mediating effects of prior maternal behaviours and a home visiting intervention post-birth. Twelve matched pairs of neighbourhoods were randomised within pairs to: (1) the control condition, receiving comprehensive health care at community primary health care clinics (n = 12 neighbourhoods;n = 594 pregnant women), or (2) the Philani Intervention Program, which provided home visits by trained, paraprofessional community health workers, here called Mentor Mothers, in addition to clinic care (n = 12 neighbourhoods;n = 644 pregnant women). Recruitment of all pregnant neighbourhood women was high (98%) with 88% reassessed at 6 months and 84% at 18 months. Infants’ growth and diarrhoea episodes were examined at 18 months in response to the intervention condition, breastfeeding, alcohol use, social support and low birth weight, controlling for HIV status and previous history of risk. We found that randomisation to the intervention was associated with a significantly lower number of recent diarrhoea episodes and increased rates and duration of breastfeeding. Across both the intervention and control conditions, mothers who used alcohol during pregnancy and had low birth weight infants were significantly less likely to have infants with normal growth patterns, whereas social support was associated with better growth. HIV infection was significantly associated with poor growth and less breastfeeding. Women with more risk factors had significantly smaller social support networks. The relationships among initial and sustained maternal risk behaviours and the buffering impact of home visits and social support are demonstrated in these analyses. [ABSTRACT FROM PUBLISHER]

Adolescent nicotine use continues to be a significant public health problem. We examined the relationship between the age of youth reporting current smoking and concurrent risk and protective factors in a large state-wide sample. We analyzed current smoking, depressive symptoms, and socio-demographic factors among 4027 adolescents aged 12–17 years by using multivariate logistic regression (see 2005 California Health Interview Survey (CHIS) Public Use File). Consistent with previous work, Latinos, girls, those whose family incomes were below the poverty level, and those with fair-poor health were more likely to display depressive symptoms. Males, whites, older teens, and those in fair-poor health were more likely to be current smokers. In a multivariate analysis predicting depressive symptoms, the interaction between age and current smoking was highly significant (WaldX2 = 15.8,p < 0.01). At ages 12–14 years, the probability of depressive symptoms was estimated to be four times greater among adolescents who currently smoked compared to those who were not current smokers. The likelihood of depressive symptoms associated with current smoking decreases with age and becomes nonsignificant by 17 years. Interventions to reduce smoking may be most useful among youth before 12 years of age and must be targeted at multiple risks (e.g., smoking and depression). [ABSTRACT FROM PUBLISHER]

This study compares HIV-affected families' and their non-HIV-affected neighbors' behavioral health outcomes and family conflict. To compare two groups from the same neighborhoods at four points over 18 months, mothers living with HIV (MLH) (N = 167) and their school-age children (age 6–20) were recruited from clinical care settings in Los Angeles, CA, and neighborhood control mothers (NCM) without HIV (N = 204) were recruited from modal neighborhoods. In addition, children living at home who were 12 years and older were recruited. We assessed parenting behaviors, family conflict, mental health, sexual behavior, substance use, and HIV-related health behaviors over time. MLH perceived greater economic insecurity at baseline, less employment, and involvement in romantic relationships. MLH reported more emotional distress and substance use than NCM. MLH, however, reported lowered HIV transmission risk. The random regressions indicated that MLH exhibited higher levels of risk and became significantly less depressed and less anxious over time than their non-HIV-affected neighbors. MLH also reported less initial family violence and conflict reasoning than NCM; violence decreased and conflict increased over time for MLH relative to NCM. Children of MLH decreased their marijuana use but hard drug users of MLH increased their risk, over time, compared to children of NCM. Moreover, children of MLH reported more internalizing behaviors than children of NCM. Even when compared to other families living in the same economically disadvantaged communities, MLH and their children continue to face challenges surrounding family conflict and key behavioral health outcomes, especially with respect to substance use and mental health outcomes. These families, however, show much resilience, and MLH report lowered levels of HIV transmission risk, their children report no greater levels of HIV transmission risk, and levels of family violence were lower than reported by families in the same neighborhoods. [ABSTRACT FROM PUBLISHER]

Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between human immunodeficiency virus (HIV)-related risk factors and resiliency (survival skills) of homeless adolescents over a two-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates. [ABSTRACT FROM PUBLISHER]

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Using cluster analysis techniques, we identified two distinct clusters of newly homeless adolescents in Los Angeles (n = 261): those who are protected and doing relatively well while out of home with more protective than risk factors, and those who are risky with more risk than protective factors. The objective of this study was to examine the trajectories of human immunodeficiency virus (HIV) risk behaviors and exiting homelessness among protected newly homeless adolescents, compared to those who are classified as risky. HIV risk behavior included unprotected sex, having multiple sex partners and hard drug use. Logistic regression mixed-effects models were used to evaluate the trajectories of HIV risk behaviors and exiting homelessness over time. The adolescents in the protected group reported significantly less unprotected sex ( p = 0.0156), being abstinent or monogamous ( p < 0.0001) and less hard drug use ( p < 0.0001) compared to the adolescents in the risky group. In addition, the protected group reported more “exiting homelessness”, compared to the risky group ( p = 0.0007). However, the differences in the level of unprotected sex between the protected and risky groups decreased over time. Our findings confirm the notion that newly homeless adolescents are indeed heterogeneous. Given that the risk behavior profiles of protected group merges to the risky group over time, our findings underscore the need to mount tailored interventions to be designed for the protected group early in the process. [ABSTRACT FROM AUTHOR]

The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups. [ABSTRACT FROM AUTHOR]

Family environment and rates of mental health and behavioral problems in HIV-negative adolescents and their parents living with HIV (PWH) were compared to adolescents and parents from non HIV-affected families living in similar inner-city neighborhoods. Adolescents and their parents were interviewed and a case-control sample was constructed. Data on sixty-two matched pairs of adolescents of PWH and those of neighborhood parents and forty-six matched pairs of PWH and HIV-negative parents were examined. Compared to neighborhood controls, adolescents of PWH experienced greater life stressors and family conflict and reported lower self-esteem. PWH reported greater emotional distress and substance use. However, there were no significant differences in emotional distress or externalized problem behaviors between the two adolescent groups. Clinical implications are discussed. [ABSTRACT FROM AUTHOR]

ZIP models were used to detect reductions in drug abuse among young people living with HIV (YPLH) over 15 months when most young people abstain from use. YPLH (n = 171) aged 16 to 29 years were randomly assigned to an 18 session intervention or a delayed-intervention condition. The ZIP models showed significant reductions in abuse of multiple substances over time in the non-delayed intervention. Previous analyses did not find significant reductions. Intervention efficacy often cannot be detected if there are highly skewed distributions of outcomes, such as drug abuse. ZIP modeling offers an opportunity to more reliably detect behavioral changes. [ABSTRACT FROM AUTHOR]

The reliability of self-reports of sexual acts and sexually transmitted disease symptoms was compared among 199 food market workers in an eastern coastal city in China using audio computer-assisted self-interviewing (ACASI) and computer-assisted personal interview (CAPI). Two assessments (ACASI and CAPI) were evaluated with each participant; 100 participants were interviewed with ACASI first, followed by CAPI, and 99 participants were interviewed by CAPI first, followed by ACASI. McNemar tests showed that participants were significantly more likely to report that they had engaged in lifetime sexual intercourse when using a CAPI interview than an ACASI interview. There was no significant difference between CAPI and ACASI in reports of the number of lifetime sexual partners and two measures of sexually transmitted disease. Participants with less education were more likely to give inconsistent responses than participants with more education and older participants were more likely to have discrepancies in their sexual behavior responses than younger participants. ACASI is not necessarily a better mode of data collection than CAPI for sensitive behavioral measures among urban market workers in China. [ABSTRACT FROM AUTHOR]

This study explores discrepancies in perceiving family conflict between HIV-infected parents and their adolescent children aged 12 to 22. A representative sample of 382 adolescent children and their HIV+ parents were recruited and assessed over 4 years. Relationships between discrepancies in perception and family demographics and the impact of discrepancies on adolescent adjustment are examined. A significant gap in perceiving family conflict was reported between parents and young adolescents aged 12. A higher level of discrepancy was associated with poor economic status, lower parental education, parental hard drug use, and negative parental coping style. Behavioral intervention programs for adolescents must consider both parents' and adolescents' psychosocial status and behavioral indicators as well as their impact on perceptions of family conflict. [ABSTRACT FROM AUTHOR]

Most research has focused on the individual characteristics of homeless young people, yet contextual factors such as service delivery are crucial to understanding this population's pathways in and out of home or stable accommodations. The limited research that has examined service delivery has documented the importance of providing appropriate services. To understand the pathways that enable young people to exit homelessness and become safely housed, we discuss the need for better descriptive and evaluation information that accurately reflects the perspectives of service providers and clients. [ABSTRACT FROM AUTHOR]

This study assessed whether coping styles had an influence on physical health outcomes either concurrently or longitudinally in a sample of HIV-positive youth. Coping styles were characterized as positive, passive, depressive withdrawal, and escapist. A cross-sectional latent variable analysis ( N = 279) assessed associations among environmental stress, self-esteem, social support, coping styles, AIDS symptoms, and CD4 count. A more restricted longitudinal analysis ( N = 174) tested associations among earlier environmental stress, self-esteem, coping styles, and AIDS symptoms at follow-up. CD4 count was not associated with coping styles in the cross-sectional analysis. Concurrent AIDS symptoms were significantly predicted by depressive withdrawal and environmental stress. A passive coping style modestly predicted more AIDS symptoms longitudinally. Correlates of perceived health and well-being of persons with HIV/AIDS are important to investigate in addition to more objective measures such as CD4 count that may not be amenable to change through coping style interventions alone. [ABSTRACT FROM AUTHOR]

Examined predictors of suicidality (ideation and attempts) among 348 adolescent runways (197 boys; 56% African American; M age =16) using sex-specific models that tested the impact of the three domains of the Social Action Model: individual characteristics, interpersonal influences, and life events. Twenty-five percent of the girls and 14% of the boys had attempted suicide at least once. Male suicidality was mainly predicted by individual characteristics: identifying as gay, emotional distress, fewer conduct problems, and avoidant reasons for drug use. The interpersonal influence of suicidal friends also predicted suicidality. Variables from all three domains influenced girls: individual characteristics o flower age, lower self-esteem, and emotional distress; interpersonal influence of suicidal friends; and life events of having lived on the streets and assaults. Findings suggest some sex-specific interventions, but decreasing emotional distress and lessening the influence of suicidal friends may be useful for both boys and girls. [ABSTRACT FROM AUTHOR]

Although social skills training (SST) programs have been shown to improve children's long-term developmental outcomes, school personnel are not typically able to implement such programs. This article outlines the institutional and organizational supports, trainer selection criteria, and the training needed for school counselors to successfully implement and sustain a SST program for children. Social skills programs will only become routine in the classroom if the school setting provides administrative support for skills training, and structures to encourage implementation of SST programs (especially substantial and ongoing training based in the classroom setting). In addition to organizational level considerations, SST trainers need to be socially competent, be able to manage children in small groups, be familiar with the theoretical model underlying the SST program, have the opportunity to practice delivering the program, and have positive attitudes toward delivering the program. The procedures for selecting, training, monitoring, and evaluating school counselors who are SST trainers are described. [ABSTRACT FROM AUTHOR]

Presents a continuum of care model for HIV-positive adolescents in San Francisco, California. Development of a comprehensive HIV service delivery program; Provision of residential care facility to disabled patients; Need for prolonged assistance for patients with comorbid disorders.

The article examines the sexual and substance use behaviors among gay and bisexual adolescent males in New York City. Many youths included in this study, reported more sexual partners and encounters than the national norm, and those with the largest number of male partners were likely to barter sex for money or drugs. Further, the youths initiated sexual activity at an early age with male and female partners, compared to national norms. Moreover, the specific sexual acts practiced placed these youths at high risk for contracting or transmitting HIV. It is opined that receptive anal sex is one of the riskiest sexual behaviors for contracting HIV and common among this cohort. Although anal sex was common with male partners, only 6% of youths reported engaging in anal sex with female partners. These findings indicate that HIV prevention programs for homosexual and bisexual male youths are critical and must address sex with females, inconsistent condom use, and sexual practices while under the influence of drugs and alcohol.

Lifetime sexual behaviors were examined among 206 male and female runaway adolescents aged 11-18 in New York City who were predominantly Black or Hispanic. Most youths experienced oral, anal or vaginal sex with opposite-sex partners (84%), began to engage in these heterosexual activities at a relatively young age (M = 12.9 years), and used condoms inconsistently or not at all (56%). Among sexually active youths, males initiated heterosexual activity at a significantly earlier age than females, reported more opposite-sex partners, and had a higher prevalence rate of trading sex for money or drugs. These findings indicate specific areas for targeting AIDS prevention programs for runaway youths. [ABSTRACT FROM AUTHOR]

Focuses on the ethical issues involved in conducting research on adolescents. Principles governing the ethical responsibilities of researchers in studying adolescents; Importance of parental and youth consent in conducting research with youths; Strategies in conducting research on adolescents.

A common problem faced by professionals involved in implementing and researching intervention programs is identifying where they can turn for consultation and support in addressing the complex challenges of their work. The professional literature often does not address the specific problems they must address and does not offer personal support. Further, it is unclear what type of professional development is appropriate for meeting the somewhat unique needs of those at a senior level. This article discusses the development, formation, evolution, and ongoing work of a group of researchers and professors from universities around the country who have been collaborating since 1987. They formed a consortium of professional peers to share expertise, conduct joint projects, encourage reflective practice, provide moral support, and enhance one another's professional growth and development. Through the mutual efforts, support, and consultative assistance provided, members have been able to creatively enhance and improve their individual approaches to school intervention and also expand their influence on the field at large. [ABSTRACT FROM AUTHOR]

Innovative preventive interventions are increasingly delivered in small group settings to children in school who are at risk for a variety of negative outcomes. In addition to reducing children's risk, these interventions present the possibility of enhancing students' awareness and understanding of cross-ethnic peers. To be effective with children from diverse ethnic backgrounds, these programs must examine their underlying assumptions regarding the definitions of social competence and methods of behavior change, tailor the program for each ethnic group served, and examine the impact of the interventions across different domains of the children's life. [ABSTRACT FROM PUBLISHER]