Larry K Brown

Alpert Medical School - Brown University, Providence, Rhode Island, United States

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Publications (122)267.1 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to evaluate an intervention designed to enhance early adolescents' emotion regulation skill use and to decrease risk behaviors. Adolescents 12 to 14 years old (N = 420; 53 % male) with mental health symptoms were referred for participation in either an Emotion Regulation (ER) or Health Promotion (HP) intervention consisting of 12 after-school sessions. Participants completed baseline and follow-up questionnaires on laptop computers. Using a generalized analysis of covariance controlling for baseline scores, participants in the ER intervention were less likely to be sexually active and engage in other risk behaviors, such as fighting, at the conclusion of the program. Additionally, participants in the ER intervention reported greater use of emotion regulation strategies and more favorable attitudes toward abstinence. Interventions directly targeting emotion regulation may be useful in addressing health risk behaviors of adolescents with mental health symptoms.
    Prevention Science 08/2015; DOI:10.1007/s11121-015-0597-0 · 2.63 Impact Factor

  • JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2015; DOI:10.1097/QAI.0000000000000803 · 4.56 Impact Factor

  • Journal of Family Studies 07/2015; DOI:10.1080/13229400.2015.1020984 · 0.25 Impact Factor
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    ABSTRACT: Being informed and using positive coping strategies are associated with engaging in health-promoting behaviors. We assessed whether the type of information source about HIV (personal or impersonal) and coping strategies (optimism, avoidance, or emotion-focused) are associated with HIV testing among adolescents attending therapeutic schools. Participants were 417 adolescents, ages 13-19, who attended one of 20 therapeutic day schools for emotionally/behaviorally disordered youth in two US cities (Providence, RI and Chicago, IL) and completed a baseline assessment for an HIV prevention study. Among adolescents in the study, 29 % reported having been tested for HIV. Adolescents were more likely to have been tested if they were older, female, Hispanic, identified as non-heterosexual, came from lower SES households, and had recently had unprotected sex. Additionally, youth who endorsed greater use of optimistic thinking and emotion-focused coping, and who reported having been informed about HIV by more personal sources, were also more likely to have been tested for HIV. In a multivariate analysis, having had recent unprotected sex and having more personal sources of information about HIV/AIDS were independently associated with HIV testing. Study findings suggest that, controlling for sociodemographic background, sexual risk behavior, and coping strategy, HIV testing among adolescents with emotional and behavioral problems may be increased when adolescents learn about HIV/AIDS from personal sources such as their healthcare providers, family, and friends.
    The Journal of Primary Prevention 02/2015; 36(3). DOI:10.1007/s10935-015-0383-6 · 1.54 Impact Factor
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    ABSTRACT: Abstract Juvenile offenders are a subgroup of adolescents at particular risk for HIV/STI infection. Although HIV prevalence among these youth is low (<1%) in the US, rates of other STIs, unprotected sexual activity, multiple partners, and incidents of substance use during sex are high compared with other adolescent populations. Many of these youth will enter the adult criminal justice system, which is known to have an extremely high rate of HIV infection. US constitutional mandates provide HIV/STI testing for incarcerated juveniles, but close to 80% of juvenile arrestees are never detained. Moreover, although they engage in similar HIV risk behaviors as those detained, they have limited access to available HIV/STI testing services. Thus, our study examined rates of lifetime HIV testing among a pilot sample of 60 court-involved, substance-using juveniles monitored in the community to explore rates of testing and the reasons related to lifetime testing among a high-risk, yet understudied US juvenile population.
    International journal of adolescent medicine and health 01/2015; DOI:10.1515/ijamh-2014-0052
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    ABSTRACT: This study determined the prevalence and patterns of psychological symptoms in adolescents and young adults living with HIV (YLWH) in medical care and relationships between psychological symptoms, route and duration of infection, and antiretroviral treatment (ART). A clinic-based sample of 2032 YLWH (mean age 20.3 years), recruited from 20 adolescent medicine HIV clinics, completed a cross-sectional survey of health behaviors and psychological symptoms using the Brief Symptom Inventory (BSI). Overall, 17.5% of youth reported psychological symptoms greater than the normative threshold on the Global Severity Index. A wide variety of symptoms were reported. The prevalence of clinical symptoms was significantly greater in youth with behaviorally acquired HIV compared to those with perinatally acquired infection (20.6% vs. 10.8%, OR=2.06 in Multiple Logistic Regression (MLR)), and in those not taking ART that had been prescribed (29. 2% vs. 18.8%, OR=1.68 in MLR). Knowing one's HIV status for more than one year and disclosure of HIV status were not associated with fewer symptoms. A large proportion of YLWH have psychological symptoms and the prevalence is greatest among those with behaviorally acquired infection. The high rate of psychological symptoms for youth not taking ART that is prescribed is a cause for concern. Symptoms do not appear to be a transient reaction to diagnosis of HIV.
    AIDS PATIENT CARE and STDs 01/2015; 29(4). DOI:10.1089/apc.2014.0113 · 3.50 Impact Factor
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    ABSTRACT: Background: Engaging early adolescents (13-15 years) in HIV prevention is crucial given the majority of new infections occur among young people. South Africa has few family-based adolescent HIV interventions. We use an iterative process to adapt a CDC “best-evidence” family-based HIV intervention to South Africa, using data from phase 1 of an intervention acceptability and feasibility trial. Methods: The study took place in Khayelitsha, South Africa during 2013. Adaptation needs were assessed during 8 focus groups (5-9 participants per group) with Xhosa-speaking mixed gender adolescents (13-15 years) and parents or guardians (18+ years) and 19 interviews with HIV experts (ongoing, target n=30). Brown and Cape Town Universities provided ethical approvals. Focus groups and interviews were recorded, transcribed verbatim, translated from Xhosa to English, and analyzed in NVivo using a thematic analysis. Results: Findings identify cultural factors that necessitate adaptations to increase intervention acceptability. Beliefs regarding foreign origins of HIV, that anal sex or menstruation carry no risk for transmission, and traditional cures affected risk perceptions and behaviors. Parent-child communication regarding sex was taboo, with sexual communication viewed as an invitation to engage in HIV risk behavior, social sanctions for parents who discussed sex, and animosity towards children who asked about sex. Respondents identified culturally appropriate modalities to increase intervention engagement including family meetings and communal parenting. Conclusions: An existing family-based intervention will be adapted to include new content, topics, and delivery modalities for South Africa. The adapted family HIV intervention will be tested in a randomized pilot trial in 2014-2015.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: HIV-related stigma reduces HIV-prevention behaviors, testing, and optimal treatment behavior. African-Americans demonstrate greater HIV-related stigma than other races/ethnicities. Given the elevated HIV- prevalence of African-Americans, identifying effective stigma reduction strategies has implications for national testing and prevention goals among this group. This study examines the the effectiveness of a culturally-tailored media (radio and television) HIV-risk reduction intervention in reducing HIV-related stigma. Methods: A total of 1613 African-American adolescents (age 14-17) from four mid-sized cities in the Northeastern and Southeastern US participated in a randomized control trial to determine the impact of media in reducing HIV risk behavior. Two cities (one Northeastern and one Southeastern) received the media intervention. Participants completed audio computer assisted self-interviews at baseline, 3, 6 and 12 months to determine HIV-related stigma and HIV-related knowledge differences. Analysis of variance determined stigma and knowledge differences at each measurement interval. Hierarchical linear modeling (HLM) determined stigma and knowledge differences over the entire study. Results: Mean stigma scores decreased over time while knowledge increased. There were no stigma differences at baseline but there were significant differences between intervention and control cities at three months (p<0.05). These differences diminished by 6-months. HLM did not detect stigma differences. Conversely, there were no significant knowledge differences between the experimental groups at any measurement interval, but HLM indicates greater knowledge scores for the intervention group over the entire study (p<0.05). Conclusions: A coordinated media strategy to reduce HIV risk behavior demonstrated short term benefit in reducing stigma and longer-term benefit in increasing knowledge.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according to sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.
    Children and Youth Services Review 11/2014; 46:177–185. DOI:10.1016/j.childyouth.2014.07.023 · 1.27 Impact Factor
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    ABSTRACT: Research on the relationship between adolescent health risk behaviors, sexual risk behaviors in particular, and perceived life satisfaction is emerging. Some researchers suggest that life satisfaction has been a neglected component of adolescent health research. African American adolescents aged 13-18 (n = 1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire via Audio Computer Assisted Self-Interview. Analyses were conducted to examine relationships between perceived difficulty in performing HIV/AIDS preventive behavior and perceived life satisfaction, while controlling for socioeconomic status. Results suggest that perceived life satisfaction is related to perceived difficulty in performing HIV/AIDS preventive behaviors, for both males and females, with variability in the magnitude of associations by gender. Further research is necessary to identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived difficulty in performing HIV/AIDS preventive behavior to develop gender-appropriate and culturally-sensitive quality of life/health promotion programs.
    AIDS and Behavior 09/2014; 19(7). DOI:10.1007/s10461-014-0900-2 · 3.49 Impact Factor
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    ABSTRACT: Objective: This study examined associations among family environment, coping, and emotional and conduct problems in adolescents attending therapeutic day schools due to mental health problems. Methods: Adolescents (N = 417; 30.2% female) ages 13-20 (M = 15.25) reported on their family environment (affective involvement and functioning), coping (emotion-focused support-seeking, cognitive restructuring, avoidant actions), and emotional and conduct problems. Results: Poorer family environment was associated with less emotion-focused support-seeking and cognitive restructuring, and more emotional and conduct problems. Emotional problems were negatively associated with cognitive restructuring, and conduct problems were negatively associated with all coping strategies. Cognitive restructuring accounted for the relationship between family environment and emotional problems. Cognitive restructuring and emotion-focused support-seeking each partially accounted for the relationship between family functioning and conduct problems, but not the relationship between family affective involvement and conduct problems. Conclusions: Findings implicate the role of coping in the relationship between family environment and adolescent mental health.
    Journal of Adolescence 08/2014; 37(7):1133-1142. DOI:10.1016/j.adolescence.2014.07.012 · 2.05 Impact Factor
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    ABSTRACT: Introduction: Unfortunately, violence and aggression characterize many teen dating relationships: up to 45% of female adolescents and 43% of male adolescents report physical dating violence (DV) victimization (O’Keefe & Treister, 1998). Adolescents often remain in violent relationships over time (O’Leary & Slep, 2003), and report similar DV experiences across partnerships (Cano et al., 1998). However, a review of the literature (Whitaker et al., 2006) suggests that there are limited primary DV prevention programs appropriate for implementation in schools. The purpose of the present study was to test the efficacy of a widely disseminated community-based DV prevention program. The study was conducted in partnership with a non-profit community agency dedicated to DV education. The agency designed a brief five-session curriculum that addresses attitudes, thoughts, and behaviors believed to be related to the development of violent relationships. This program has been taught to over 3,000 students across 10 school districts, but has not previously been the subject of research to evaluate its efficacy. Methods: The study design was a quasi-randomized control trial: half of the 10th grade classrooms were randomized to receive the five-session DV prevention program (active condition), and half were randomized to receive their usual health class curriculum (control condition). 580 10th grade students in 24 health class sections at a large public high school in New England were eligible to participate in the study, with 420 students providing data for the final sample (231 active, 169 control). Surveys were administered to all students at baseline, the end of the program, and three months after the end of the program. These surveys assessed demographics, DV attitudes and knowledge, DV victimization and perpetration, and health risk behaviors. Following completion of the research study, the control group received the DV prevention program. Results: Students who received the DV prevention program reported significant changes in terms of knowledge, attitudes and behavior in comparison with students in the control group. Students who received the DV prevention program had higher scores on the relationship violence knowledge scale 3 months after completing the program. Active group students also reported less approval of aggression after three months on measures of general and retaliatory aggression. Regarding DV attitudes, prevention program students reported less acceptance of both male and female violence perpetration than did control students after three months. Finally, a decline in average DV perpetration in the active condition between baseline and the three-month follow-up was significant at the trend level, whereas the control group mean for perpetration went up during this period. Conclusions: These findings suggest that a community-based DV prevention can promote change in attitudes and knowledge among high school students. The trend-level difference in DV perpetration is especially promising because behavior change is difficult to detect with brief, universal interventions.
    Society for Prevention Research 22nd Annual Meeting 2013; 05/2014
  • Selby M Conrad · Rebecca R Swenson · Evan Hancock · Larry K Brown ·
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    ABSTRACT: Abstract Adolescents with abuse histories have been shown to be at increased risk to acquire Human Immunodeficiency Virus/Sexually Transmitted Infections (HIV/STI). Additionally, teens with lower levels of self-restraint or higher levels of distress, such as those with psychiatric concerns, have also demonstrated increased sexual risk behaviors. This study explored sex differences in sexual risk behaviors among a sample of adolescents in a therapeutic/alternative high school setting. Moderated regression analysis showed that a lower level of self-restraint was associated with sexual risk behaviors in boys but not in girls. Rather, the interaction of self-restraint and multiple types of abuse was associated with greater sex risk within girls in this sample. Results suggest that girls and boys with abuse histories and low levels of self-restraint may have different intervention needs related to sexual risk behaviors.
    Journal of Child Sexual Abuse 05/2014; 23(5). DOI:10.1080/10538712.2014.919371 · 0.75 Impact Factor
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    ABSTRACT: To assess the associations of sexual risk behavior with psychiatric impairment and individual, peer, and partner attitudes among adolescents receiving mental health treatment. Adolescents (N=893, 56% female, 67% African American) completed assessments of psychiatric impairment, rejection sensitivity, peer norms, HIV knowledge, perceived vulnerability, self-efficacy and condom use intentions. Two structural equation models were used to test the study hypotheses; one for sexually active youth and one for non-active youth. For non-active youth, psychiatric impairment influenced self-efficacy and condom use intentions via peer norms, rejection sensitivity, and perceived vulnerability. Among the sexually active youth, sexual risk was related to impairment and previous condom use. These results suggest that individual, peer, and partner factors are related to impairment and to sexual risk attitudes, but depend on previous sexual experience.
    Journal of HIV/AIDS & Social Services 04/2014; 13(2):198-213. DOI:10.1080/15381501.2013.789416
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    ABSTRACT: Juvenile offenders have disproportionately high rates of psychiatric and substance use disorders relative to their nonoffending counterparts. Less is known about the impact of psychiatric and substance use disorders on repeat juvenile justice involvement among juveniles specifically referred for forensic mental health evaluations. We describe the demographic, psychiatric, and legal history background of 404 juveniles who underwent a court clinic forensic mental health evaluation, and we examine the association between these factors and detention rates of 20 percent over a 12-month postevaluation period. After accounting for known predictors of reoffending, such as prior offense history and externalizing disorders, dual diagnosis (i.e., co-occurring psychiatric and substance use disorders) remained a salient predictor of future detention. Consistent with prior literature on juvenile offending, substance use may greatly enhance the likelihood of subsequent detention.
    The journal of the American Academy of Psychiatry and the Law 03/2014; 42(1):56-65. · 0.93 Impact Factor
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    ABSTRACT: The present study examined the link between the emotional context of sexual situations and sexual risk, specifically by examining the relationship of teens' recall of their affective states prior to sex with their sexual risk behaviors and attitudes. Adolescents (ages 13-19) attending therapeutic schools due to emotional and behavioral difficulties (n = 247) completed audio computer-assisted self-interviews regarding sexual behavior, including ratings of their emotions prior to last sexual activity. Positive emotions were most commonly endorsed (43-57 % of participants), however, significant proportions (8-23 %) also endorsed negative emotions prior to last sex. Both positive and negative emotions were significantly related to risk attitudes and behavior in regression analyses. The affective contexts of sexual experiences may be important predictors of risk in adolescence.
    AIDS and Behavior 02/2014; 18(8). DOI:10.1007/s10461-014-0716-0 · 3.49 Impact Factor
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    ABSTRACT: The purpose of this study was to test an integrated cognitive behavioral and contingency management (CBT/CM) intervention for young people living with HIV (YPLH) with an alcohol and/or cannabis use disorder in an open pilot trial. Seventeen participants (ages 18–24) were recruited from three HIV community clinics. Assessments were completed at pre-and post-treatment as well as 3 month follow-up. Eighty percent of participants were retained in the study. Results suggest that the CBT/CM intervention was acceptable, feasible, and could be delivered with fidelity. Further, participants reported significant reductions in alcohol use, withdrawal symptoms, dependence symptoms and related problems, as well as co-occurring depressive symptoms and delinquent behavior across assessment periods. A trend was evident for reductions in marijuana use and related problems. Overall, these preliminary results suggest that a substance abuse CBT/CM intervention tailored to YPLH is acceptable, feasible, and holds promise for symptomatic improvement. Further testing of this type of protocol is warranted.
    Journal of Substance Abuse Treatment 02/2014; 46(2):244–250. DOI:10.1016/j.jsat.2013.07.008 · 3.14 Impact Factor
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    ABSTRACT: Objectives: This study aimed to examine the prevalence of sexting behaviors (sexually explicit messages and/or pictures) among an at-risk sample of early adolescents as well as the associations between sexting behaviors and sexual behaviors, risk-related cognitions, and emotional regulation skills. It also aimed to determine whether differences in risk were associated with text-based versus photo-based sexts. Methods: Seventh-grade adolescents participating in a sexual risk prevention trial for at-risk early adolescents completed a computer-based survey at baseline regarding sexting behavior (having sent sexually explicit messages and/or pictures), sexual activities, intentions to have sex, perceived approval of sexual activity, and emotional regulation skills. Results: Twenty-two percent of the sample reported having sexted in the past 6 months; sexual messages were endorsed by 17% (n = 71), sexual messages and photos by 5% (n = 21). Pictures were endorsed significantly more often by females (χ(2)[2] = 7.33, P = .03) and Latinos (χ(2)[2] = 7.27, P = .03). Sexting of any kind was associated with higher rates of engaging in a variety of sexual behaviors, and sending photos was associated with higher rates of sexual activity than sending text messages only. This was true for a range of behaviors from touching genitals over clothes (odds ratio [OR] = 1.98, P = .03) to oral sex (OR = 2.66, P < .01) to vaginal sex (OR = 2.23, P < .01). Conclusions: Sexting behavior (both photo and text messages) was not uncommon among middle school youth and co-occurred with sexual behavior. These data suggest that phone behaviors, even flirtatious messages, may be an indicator of risk. Clinicians, parents, and health programs should discuss sexting with early adolescents.
    PEDIATRICS 01/2014; 133(2). DOI:10.1542/peds.2013-1157 · 5.47 Impact Factor
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    ABSTRACT: Objective: The study examined the efficacy of family-based and adolescent-only HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment. Methods: A randomized controlled trial (RCT) with 721 adolescents (ages 13-18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention. Results: Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (p<.01) and self-efficacy (p<.05). The family-based intervention, compared with the other interventions, produced significant improvements in parent-teen sexual communication (p<.01), parental monitoring (p<.01), and parental permissiveness (p=.05). Conclusions: This RCT found that the HIV prevention interventions reduced sexual risk behavior over three months in a large, diverse sample of youths in mental health treatment and that the family-based intervention improved parental monitoring and communication with teens about sex. These interventions show promise.
    Psychiatric services (Washington, D.C.) 01/2014; 65(3). DOI:10.1176/ · 2.41 Impact Factor
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    ABSTRACT: A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. 42 adolescents (55% male), with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues.
    Journal of Pediatric Psychology 12/2013; 39(3). DOI:10.1093/jpepsy/jst092 · 2.91 Impact Factor

Publication Stats

2k Citations
267.10 Total Impact Points


  • 2000-2015
    • Alpert Medical School - Brown University
      • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 1988-2015
    • Brown University
      • • Department of Psychiatry and Human Behavior
      • • Department of Pediatrics
      Providence, Rhode Island, United States
  • 1989-2014
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2012
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 2011-2012
    • Providence Hospital
      Mobile, Alabama, United States
  • 2010
    • Lifespan
      Providence, Rhode Island, United States
  • 2009
    • University of Pennsylvania
      • Annenberg Public Policy Center
      Philadelphia, PA, United States

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