Larry K Brown

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

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Publications (99)188.03 Total impact

  • [Show abstract] [Hide abstract]
    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. · 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; · 3.49 Impact Factor
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    ABSTRACT: This study examined associations among family environment, coping, and emotional and conduct problems in adolescents attending therapeutic day schools due to mental health problems.
    Journal of Adolescence 08/2014; 37(7):1133-1142. · 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
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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; · 0.75 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; · 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. · 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; · 4.47 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; · 2.81 Impact Factor
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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 01/2014; 42(1):56-65. · 0.93 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; · 2.91 Impact Factor
  • 60th Meeting of American Academy of Child and Adolescent Psychiatry; 10/2013
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    ABSTRACT: Young female offenders represent a growing number of young offenders. Studies have shown that youth in the juvenile justice system, particularly young females, report higher rates of lifetime sexual abuse than their nonoffending peers. The aim of this study was to examine gender differences in risk factors for recidivism, including a history of sexual abuse, among a juvenile court clinic sample. Findings suggest that, even after accounting for previously identified risk factors for recidivism such as prior legal involvement and conduct problems, a history of sexual abuse is the most salient predictor of recidivism for young female offenders, but not for males. The development of gender-responsive interventions to reduce juvenile recidivism and continued legal involvement into adulthood may be warranted. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Law and Human Behavior 10/2013; · 2.16 Impact Factor
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    ABSTRACT: Adolescents in therapeutic schools are at greater risk for HIV and other STIs than their peers due to earlier higher rates of sexual risk and difficulty managing strong emotions. HIV prevention programs that incorporate techniques for affect management (AM) during sexual situations may be beneficial. This paper determined the immediate impact of such an intervention, AM, compared to a standard, skills-based HIV prevention intervention and a general health promotion intervention (HP) for 377 youth, ages 13-19, in therapeutic schools in two cities. 1 month after the intervention, analyses that adjusted for the baseline scores found adolescents in AM were more likely to report condom use at last sex than those in HP (0.89 vs. 0.67, p = 0.02) and that their HIV knowledge was significantly greater. These data suggest that AM techniques might improve the impact of standard skills-based prevention programs for adolescents in therapeutic schools.
    AIDS and Behavior 08/2013; · 3.49 Impact Factor
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    ABSTRACT: Parents and families play an important role in insulating youth against high-risk sexual behavior (e.g., more partners, non-condom use) and have become an important focus of adolescent HIV prevention programs. Although adaptive parenting practices help protect youth, maladaptive practices may place them at greater risk. Parents with psychiatric disorders are more likely to display greater criticism and hostility in their communication and also display more disorganized parenting strategies with less parental monitoring. These maladaptive behaviors suggest that parental psychopathology is an important background factor to consider when implementing family based prevention programs. Examining parental psychopathology is especially relevant given recent evidence from meta-analyses of general parenting interventions that suggests parents with mental health problems may not respond as well as their peers to parent-training interventions. Strengthening Today’s Youth Life Experiences (Project STYLE) is an 11-hour family-based intervention (single day multi-family workshop and two booster sessions). It was developed and evaluated through a large scale randomized clinical trial which recruited and intervened with 721 youth in mental health treatment and their caregivers and is based on the Social-Personal Framework. The current study examines the moderating influence of parent psychopathology on the Project STYLE family based intervention targets. (e.g. parent-adolescent sexual communication, parent and adolescent HIV knowledge, parental monitoring and permissiveness). We hypothesized those parents with mental health problems would demonstrate less benefit from the family-based intervention. Study hypotheses were tested using general linear models at the 3- and 6-month assessments controlling for baseline. Tests of moderation were conducted by modeling the interaction between treatment condition (family versus control) and parental psychopathology. There were significant interactions between treatment condition and parental psychopathology for parent report of sexual communication at 3 months (t(391) = 2.04; p =.04) and 6 months (t(369) = 2.24; p =.03), and for adolescent report of parental monitoring at 3 months (t(268) = 1.93; p =.05) and 6 months (t(300) = 1.95; p =.05). In both instances, parents with psychopathology responded better to the treatment condition than those without psychopathology. There were no differences in treatment response between parents with and without psychopathology on the other outcomes. Contrary to our initial hypothesis, parents with psychiatric symptoms were either comparable to their peers without psychopathology (i.e., HIV knowledge and permissiveness) or demonstrated greater improvements (i.e., sexual communication and monitoring) following the family-based intervention. These results suggest that despite engaging in more maladaptive parenting practices, parents with mental health problems were responsive to a relatively brief but targeted intervention.
    Society for Prevention Research 21nd Annual Meeting 2015; 05/2013
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    ABSTRACT: Objective: Adolescents with mental health problems exhibit higher rates of sexual risk behaviors than their peers. Two studies examining self-regulation of emotions and behavior in early adolescence have found associations with sexual risk taking and substance use longitudinally (Hessler & Katz, 2010; Raffaelli & Crockett, 2008). This study aimed to evaluate a small, controlled study of an intervention designed to enhance early adolescents’ emotional awareness, affect management skill use, and safer sexual attitudes. Methods: Seventh graders (n=138; mean age=13.1, 38% Caucasian; 51% male) with mental health symptoms attending public schools were recruited for a 12-session, small-group, after-school HIV-prevention intervention study focused on affect regulation concepts as a strategy for reducing risk behavior. Participants completed measures on private laptop computers at baseline, followed by participation in an Affect Management (AM) intervention or a Health Promotion (HP) comparison condition. Immediately after completing the intervention, approximately two months later, participants (n=121) completed a subset of measures related to emotional competence. Results: Data were analyzed using ANCOVAs adjusting for baseline scores. Compared to participants in the Health Promotion group, adolescents who received the Affect Management intervention endorsed more awareness of their feelings (g=.38, F(1, 117)=4.70, p=.032), and more knowledge about HIV (g=.41, F(1,110)=4.97, p=.028). Moderate effect sizes were also noted on measures of affect management strategy use, g=.29, F(1, 115)=2.94, p=.089, and self-efficacy for managing emotions, g=.30, F(1, 116)=3.31, p=.072. No significant trends were noted on scales assessing identification of feelings, describing feelings, attitudes toward abstinence, or self-efficacy for HIV prevention. Conclusions: Affect regulation may represent a pathway to prevention for many adolescent risk behaviors, including substance use and sexual behavior, yet identifying strategies for developing these skills, particularly among youth with mental health symptoms, has remained a challenge. To our knowledge this is the first intervention study (although exploratory) to specifically target affect regulation skills with early teens (12-14 years old). Three of the emotion constructs assessed demonstrated trends favoring the intervention condition with modest effect sizes (.29-.38). These results, though not conclusive, provide some support for the short term impact of this intervention targeting emotional competence among at-risk youth, demonstrating that early adolescents can benefit from such instruction, which may have an impact on risky behaviors.
    Society for Prevention Research 21nd Annual Meeting 2015; 05/2013
  • Christie J. Rizzo, Larry K. Brown
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    ABSTRACT: Background: A growing body of research reveals that dating violence (DV) plays a significant role in adolescent girls’ HIV risk. DV has been associated with less condom use, younger age at first intercourse, having multiple sex partners and alcohol use prior to sexual encounters. Helping adolescent females address the common skills deficits underlying dating violence and sexual risk taking may be essential to preventing these co-occurring issues. The goal of this project is to compare a group-based, cognitive-behavioral intervention for adolescent girls with histories of physical dating violence to a knowledge-only curriculum matched for time and attention (6 two-hour weekly sessions and one booster session). Since data collection is ongoing, data presented here will focus on the preliminary effects of the study intervention on proposed mediators. The primary hypothesis is that participants in the CBT intervention will experience greater reductions in violence-promoting attitudes and depressive symptoms, as well as more frequent utilization of skills-based coping and assertive communication, relative to participants in the knowledge-only group. Methods: Adolescent girls (ages 15-17) with histories of physical dating violence were recruited from five, urban high schools. Subjects were randomized to either the CBT group (n = 29) or the knowledge-only group (n = 22). Dating violence severity and history of sexual activity were balanced across arms. Participants completed measures of skills-based coping (e.g. problem solving, cognitive restructuring, support seeking), depressive symptoms (BDI-II; Beck et al., 1996), couples violence attitudes (ACV; Foshee et al., 1998), and couples communication (CCS; Harper & Grello, 2001) at baseline (T1) and 3 months later (T2) using laptop computers. Data collection is ongoing. Results: Data were obtained, thus far, on 51 adolescent girls (M = 15.3, SD = 1.01). Due to the small sample size, effect sizes are reported. At the 3 month follow-up, teens in the knowledge-only condition were more than twice as likely to report accepting attitudes regarding couple violence (moderate effect size). Teens in the CBT-skills condition also reported greater utilization of skills-based coping and more frequent use of assertive couple communication (medium to large effect sizes). Both groups showed reductions in depressive symptoms over the three month period. Conclusion: This study provides preliminary evidence for the use of CBT-skills as a way of decreasing theoretical mediators of DV and sexual risk outcomes among a high risk group of adolescent girls already involved in physically violent dating relationships.
    Society for Prevention Research 21nd Annual Meeting 2015; 05/2013
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    ABSTRACT: Objective:Untreated psychiatric illness is detrimental to the health and well-being of HIV-infected youth. This study examines the relationships between social and demographic variables and the rates of psychiatric treatment among HIV-infected youth.Methods:Analyses are from a cross-sectional survey of 1706 HIV-infected youth (13-26 years) in care at treatment sites or affiliates of the Adolescent Medicine Trials Network for HIV/AIDS Interventions from 2010 to 2011. Among the youth who reported recent significant mental health symptoms, comparisons on demographic variables (including race, ethnicity, language spoken, level of education, sexual orientation, and household income) were made.Results:Psychiatrically symptomatic black youth were significantly less likely than symptomatic nonblack peers to receive mental health care (37.4% versus 48.6%) and psychiatric medications (19.3% versus 26.9%).Conclusion:Care providers should be alerted to the potential disparities in mental health care treatment that exist for black youth living with HIV.
    Journal of the International Association of Providers of AIDS Care. 05/2013;

Publication Stats

771 Citations
188.03 Total Impact Points

Institutions

  • 2007–2014
    • Alpert Medical School - Brown University
      • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 1991–2014
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2012
    • Providence Hospital
      Mobile, Alabama, United States
  • 2010–2012
    • Emory University
      • Department of Behavioral Sciences and Health Education
      Atlanta, GA, United States
  • 1994–2012
    • Brown University
      • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 2008–2011
    • University of Pennsylvania
      • Annenberg Public Policy Center
      Philadelphia, PA, United States
  • 2008–2010
    • Lifespan
      Providence, Rhode Island, United States