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“Sexting” (electronic transmission of sexual pictures/messages) among early adolescents is associated with early sexual activity, a marker of increased sexual risk. The current study is a secondary analysis that examined the longitudinal relationship between sexting and first-time sex among a sample of early adolescents deemed “at risk” due to behavioral or emotional problems. Adolescents participated in a longitudinal sexual risk prevention trial and completed questionnaires assessing demographics, unsupervised peer time, mental health, and participation in sexting, oral sex, and penetrative sex (vaginal/anal). Analyses included 343 early adolescents ( Mage = 12.89, 51% female, 77% racial/ethnic minority) with no history of oral or penetrative sex. Those who reported sexting at baseline were more likely to report first-time oral and/or penetrative sex by the 1-year follow-up. Exploratory analyses revealed that sexting predicted those who had engaged in both oral and penetrative sex. These findings highlight the need to address sexting in risk prevention.

OBJECTIVE This study evaluated associations among parenting stress, self-efficacy, and involvement in relation to spoken language outcomes in young children 3 years following cochlear implantation. STUDY DESIGN Cross-sectional. SETTING Six university tertiary medical centers. PATIENTS One hundred sixty-four young children with bilateral, severe-to-profound sensorineural hearing loss who had 3 years of experience with a CI; children with substantial cognitive impairments were excluded from the study. MAIN OUTCOME MEASURESS Family Stress Scale (FSS), Scale of Parental Involvement and Self-Efficacy (SPISE), Oral and Written Language Scales (OWLS). RESULTS Correlations were of moderate strength between FSS scores and SPISE scores (Parental Self-Efficacy, r = -0.45, p

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

Sleep problems are common in individuals with autism spectrum disorder (ASD). How sleep problems reflect specific ASD phenotypes is unclear. We studied whether sleep problems indexed functional impairment in a heterogeneous community sample of individuals with ASD. We analyzed 977 probands (233 females; age = 11.27 ± 4.13 years) from the Rhode Island Consortium for Autism Research and Treatment dataset, a unique public-private-academic collaboration involving all major points of service for families in Rhode Island. We found that individuals with a confirmed diagnosis of ASD were more likely to have sleep problems. However, across the whole sample and above and beyond a formal diagnosis, sleep problems were dimensionally associated with worse social impairment and poorer adaptive functioning. By using a large dataset reflective of the diversity of presentations in the community, this study underscores the importance of considering sleep problems in clinical practice to improve adaptive functioning in individuals with ASD.

Introduction Wrist actigraphy is a standard for monitoring sleep in the field; however, data quality is reduced if participants remove the device. The Actigpatch is a novel, adhesive water-resistant wearable that we have previously demonstrated as comparable to wrist actigraphy for traditional sleep-wake estimation. Here we compare assessment of nonparametric activity indexes. Methods While following fixed schedules, 39 participants simultaneously wore the Micro Motionlogger actigraph (Ambulatory Monitoring Inc., Ardley, NY) on their non-dominant wrist and the Actigpatch (Circadian Positioning Systems, Newport, RI) over the triceps of their dominant arm. Our analyses included 35 participants (21F; 32.9±13.2yrs) who contributed ≥four nights of data (range: 4-14 [mean: 10] nights). After matching devices’ tri-axial actimetry in one-minute epochs, we derived key non-parametric parameters of diurnal activity and calculated intraclass correlations to measure agreement. The non-parametric parameters include interdaily stability (IS), intradaily variability (IV), timing of the five hours of lowest activity (L5onset) and ten hours of highest activity (M10onset), and overall relative amplitude (RA). Results We observed agreement ranging from good for IS (ICC=0.77 [95%CI=0.59;0.88]; [all mean differences are patch-watch] mean difference=-0.21) to poor for IV (ICC=0.43 [0.12;0.67]; mean difference=0.29). ICC showed good agreement for M10onset (ICC=0.82 [0.67; 0.90]; mean difference=-37min) and excellent agreement for L5onset (ICC=0.91 [0.82;0.95]; mean difference=-2min). Finally, we identified good agreement when estimating the activity relative amplitude (RA ICC=0.86 [0.75; 0.93]; mean difference=0.03). An example of excellent agreement was manifested in the close estimation of L5onset (patch mean=1:04am, SD=70min; watch mean=1:06am, SD=68min). Conclusion Adding to our prior evidence that these two devices offer similar sleep-wake estimation using traditional algorithms, the present data indicate the Actigpatch offers good agreement to the Motionlogger for nonparametric analyses of IS, activity timing, and RA. Agreement was not as good for IV, with the Actigpatch showing more intradaily variability than the watch, perhaps due to the triceps placement. Because the Actigpatch is unobtrusive, water-resistant, and can be worn continuously for three weeks, it has potential benefits for studies of individuals who struggle with adherence to wearing wrist worn devices. Support (if any) R01AA025593, P20GM139743. Actigpatches provided by Circadian Positioning Systems.

Introduction Few reports have examined how pre-sleep alcohol affects performance on the next day given adequate sleep opportunity on a preferred schedule. Our goal is to identify whether alcohol intake targeting .08g% 1 hr before sleep of ~8 h will affect PVT performance on subsequent days, with the hypothesis that morning performance will be negatively affected. Methods 25 adults (13F; age range 22-57 y) completed the full study, including at-home sleep on a fixed schedule of 8-9 hr and two 3-night in-lab PSG sessions spaced ≥3 days apart. Sessions were counterbalanced for alcoholic or nonalcoholic control beverage administered in 3 drinks over 45 minutes ending 1 hr before bedtime. Alcohol was targeted to .08g%. The 10-min PVT (Ambulatory Monitoring, Inc.) was given each night (PM-Lab) 1.5 hr before drinking and in the morning after a light breakfast (AM-Lab) 50 min after waking. PVT was performed at home/work twice each day within 1.5-h windows starting 3h after waking (AM-Home) and 7.5h after waking (PM-Home). Two reaction time (RT) variables were assessed: RRT (1/RT), FRT (10% fastest RT). Linear mixed effects models were used to account for nesting of assessments within alcohol/control condition and days. Results RRTs showed slowed RT (meanRT±SE) following alcohol: AM-Lab F=7.234, p=.008, alcohol RT=246±9.6 msec, control RT=234±9.6 msec; AM-Home F=17.936, p Conclusion We found statistically significant slowing of psychomotor vigilance RT on days after pre-sleep alcohol lasting up to 3-4.5h after waking in the morning (with a trend up to 7.5-9h post waking). PVT lapses (not shown) were similarly affected by alcohol. Thus, even with sufficient sleep opportunity, RT is impaired following 3 consecutive nights of alcohol drinking. Support (if any) R01AA025593

Study Objectives The objectives of this study were to examine the relationships between sleep regularity and nonsuicidal self-injury (NSSI), including lifetime NSSI history and daily NSSI urges. Methods Undergraduate students (N = 119; 18–26 years), approximately half of whom endorsed a lifetime history of repetitive NSSI, completed a 10-day actigraphy and ecological momentary assessment (EMA) protocol. A Sleep Regularity Index was calculated for all participants using scored epoch by epoch data to capture rapid changes in sleep schedules. Participants responded to EMA prompts assessing NSSI urge severity and negative affect three times daily over the 10-day assessment period. Results Results indicate that individuals with a repetitive NSSI history were more likely to experience sleep irregularity than those without a history of NSSI. Findings also suggest that sleep irregularity was associated with more intense urges to engage in NSSI on a daily basis, even after accounting for average daily sleep duration, sleep timing, negative affect, and NSSI history. Neither sleep duration nor sleep timing was associated with NSSI history nor daily NSSI urge intensity. Conclusions Findings suggest that sleep irregularity is linked with NSSI, including NSSI history and intensity of urges to engage in NSSI. The present study not only supports the growing evidence linking sleep disturbance with the risk for self-injury but also demonstrates this relationship using actigraphy and real-time assessments of NSSI urge severity. Findings highlight the importance of delineating the nuances in sleep irregularity that are proximally associated with NSSI risk and identifying targets for intervention.

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

Objective This study examines the acceptability, feasibility, and preliminary impact of a program (HealthTRAC) combining 2 efficacious interventions (one targeting emotion regulation [TRAC] and the other a standardized behavioral weight management intervention [SBWC]) to improve weight management outcomes among a sample of adolescents with overweight and obesity. Method Adolescents with overweight or obesity (N = 38), ages 13 to 17 years, were enrolled and randomized into either the SBWC or HealthTRAC. Data were collected at baseline (before intervention), at the end of the 16-week intervention (postintervention), and 4 months after completing the intervention (4 months). Assessments included adolescent self-reports of intervention acceptability and reported emotion regulation (ER) abilities and caregiver report of adolescent ER skills. Body mass index (BMI) was used to examine the impact on adolescent weight outcomes. Analyses of covariance controlling for baseline values were used to evaluate study outcomes. Results Eighty-four percent (n = 32) of participants completed the immediate postintervention and 4-month follow-up assessments. Adolescents in both conditions reported high treatment satisfaction. Adolescents randomized to HealthTRAC demonstrated greater reductions in BMI relative to SBWC and reported greater use of emotion regulation skills. Finally, caregivers of adolescents randomized to HealthTRAC also reported greater improvements in emotion regulation abilities among their adolescents at the 4-month follow-up. Conclusion Findings suggest that the HealthTRAC intervention was acceptable, feasible to deliver, and demonstrated a positive impact on BMI and emotion regulation abilities. These data suggest that ER is related to health decision-making and is relevant to most overweight/obese adolescents seeking to lose weight.

Summary Causally interpretable meta-analysis combines information from a collection of randomized controlled trials to estimate treatment effects in a target population in which experimentation may not be possible but from which covariate information can be obtained. In such analyses, a key practical challenge is the presence of systematically missing data when some trials have collected data on one or more baseline covariates, but other trials have not, such that the covariate information is missing for all participants in the latter. In this article, we provide identification results for potential (counterfactual) outcome means and average treatment effects in the target population when covariate data are systematically missing from some of the trials in the meta-analysis. We propose three estimators for the average treatment effect in the target population, examine their asymptotic properties, and show that they have good finite-sample performance in simulation studies. We use the estimators to analyze data from two large lung cancer screening trials and target population data from the National Health and Nutrition Examination Survey (NHANES). To accommodate the complex survey design of the NHANES, we modify the methods to incorporate survey sampling weights and allow for clustering.

Poor adherence to antiretroviral therapy (ART) has significant consequences for adolescents. Conditional economic incentives (CEI) is an approach that may help address this challenge. This study evaluated the safety and preliminary efficacy of a group-based CEI program for ART adherence improvement among a sample of adolescents living in Ghana. A total of 35 adolescents (mean age: 14.7 years) on ART, though still with detectable viral load, were recruited from an HIV clinic and divided into 5 balanced groups to participate in peer-led group-based CEI activities during routine clinic visits. Four assessments were conducted across four visits at baseline and 3-, 6-, and 9-month follow-up, respectively. Main outcomes were ART adherence and viral load. Linear mixed models and thematic analysis were used for data analyses. The majority (91.4%) of the participants attended all four intervention activities. Participants reported missing an average of 1.06, 0.50, 0.91, 0.55 doses of ART in the past 7 days at baseline, 3-, 6-, and 9-month assessments, respectively. Most viral loads were ≥5,000 copies/ml at both baseline (68.6%) and 6-month assessments (54.3%). The incentive was divided between individual compensation for attending clinic and completing the assessment ($5 each, $20 in total) and a group-based compensation valued at $40 that was distributed during the 9-month assessment according to average group attendance (A≥90%, B≥75%, C≥60%, D

Early substance use is associated with long-term negative health outcomes. Emotion regulation (ER) plays an important role in reducing risk, but detecting those vulnerable because of ER deficits is challenging. Respiratory sinus arrhythmia (RSA), a biomarker of ER, may be useful for early identification of substance use risk. To examine this, we enrolled 23 adolescents (M

Endowing meta-analytic results with a causal interpretation is challenging when there are differences in the distribution of effect modifiers among the populations underlying the included trials and the target population where the results of the meta-analysis will be applied. Recent work on transportability methods has described identifiability conditions under which the collection of randomized trials in a meta-analysis can be used to draw causal inferences about the target population. When the conditions hold, the methods enable estimation of causal quantities such as the average treatment effect and conditional average treatment effect in target populations that differ from the populations underlying the trial samples. The methods also facilitate comparison of treatments not directly compared in a head-to-head trial and assessment of comparative effectiveness within subgroups of the target population. We briefly describe these methods and present a worked example using individual participant data from three HIV prevention trials among adolescents in mental health care. We describe practical challenges in defining the target population, obtaining individual participant data from included trials and a sample of the target population, and addressing systematic missing data across datasets. When fully realized, methods for causally interpretable meta-analysis can provide decision-makers valid estimates of how treatments will work in target populations of substantive interest as well as in subgroups of these populations.

As many other facets of life-biological, behavioral, psychological, cognitive, and social-undergo change during adolescence, so too does sleep. The context of sleep behavior is modified by alterations to underlying bioregulatory processes that challenge sleep's timing, regularity, and quantity. The buildup of sleep pressure during the day gets slower, opening the door for youth to stay awake later; however, the amount of sleep required does not diminish. Further, the circadian timing system delays, again providing the biological impetus for later sleep. When these changes meet societal demands for early wake, most teens cannot find a way to get enough sleep at a consistent time from night to night. Insufficient and irregular sleep provides a fragile foundation to support mental health.

Objective Molecular markers in DNA methylation at a subset of CpG sites are affected by the environment and contribute to biological (epigenetic) age. We hypothesized that shorter sleep duration and possibly irregular sleep would be associated with accelerated epigenetic aging. We examined epigenetic vs. chronological age in 12 young women selected as shorter or longer sleepers studied prospectively across the first 9 weeks of college using a daily online sleep log. Genomic DNA was isolated from two blood samples spanning the interval, and DNA methylation levels were determined and used to measure epigenetic age. Results Epigenetic vs. chronological age differences averaged 2.07 at Time 1 and 1.21 at Time 2. Sleep duration was computed as average daily total sleep time and sleep regularity was indexed using the Sleep Regularity Index. Participants with longer and more regular sleep showed reduced age difference: mean = − 2.48 [95% CI − 6.11; 1.15]; those with shorter and more irregular sleep showed an increased age difference: 3.03 [0.02; 6.03]; and those with either shorter or more irregular sleep averaged no significant change: − 0.49 [− 3.55; 2.56]. These pilot data suggest that short and irregular sleep, even in a young healthy sample, may be associated with accelerated epigenetic aging.

Composite scores offer the advantage of summarizing across multiple sexual risk behaviors to both simplify results and better capture the influence of core contextual, interpersonal, and intrapersonal dynamics that affect multiple sexual risk behaviors. There is inconsistency in how researchers utilize composite scores with minimal guidance on the advantages and disadvantages of frequently used approaches. Strengths and weaknesses of each approach are discussed in the context of assessing adolescent sexual risk behavior. A latent variable model and three commonly used composites were applied to data combined across four clinical trials (n = 1,322; 50% female). Findings suggested that the latent variable approach was limited due to minimal correlations among sexual risk behaviors, that choice of composite had minimal impact on cross-sectional results so long as there is sufficient variability in risk behavior in the sample, but composite choice could impact results from clinical trials particularly for subgroup analyses. There are unique challenges to creating composites of adolescent risk behavior, including the fluidity and infrequency of adolescent sexual relationships that result in many participants reporting no sexual behavior at any given assessment and a low correlation between the number of partners and condomless sex acts. These challenges impede application of data-driven approaches to defining sexual risk composites. Recommendations to improve consistency in reporting include: (1) reporting each type of risk behavior separately prior to forming a composite, (2) aggregating across assessments to increase the chance of observing sexual risk behaviors, and (3) continued work toward a unified definition of adolescent sexual risk behavior that can guide the development of appropriate measurement models.

OBJECTIVE: Integrative data analysis was used to combine existing data from nine trials of cognitive-behavioral therapy (CBT) for anxious youth (N = 832) and identify trajectories of symptom change and predictors of trajectories.METHOD: Youth- and parent-reported anxiety symptoms were combined using item-response theory models. Growth mixture modeling assessed for trajectories of treatment response across pre-, mid-, and posttreatment and 1-year follow-up. Pretreatment client demographic and clinical traits and treatment modality (individual- and family-based CBT) were examined as predictors of trajectory classes.RESULTS: Growth mixture modeling supported three trajectory classes based on parent-reported symptoms: steady responders, rapid responders, and delayed improvement. A 4-class model was supported for youth-reported symptoms: steady responders, rapid responders, delayed improvement, and low-symptom responders. Delayed improvement classes were predicted by higher number of diagnoses (parent and youth report). Receiving family CBT predicted membership in the delayed improvement class compared to all other classes and membership in the steady responder class compared with rapid responders (youth report). Rapid responders were predicted by older age (parent report) and higher number of diagnoses (parent report). Low-symptom responders were more likely to be male (youth report).CONCLUSIONS: Integrative data analysis identified distinct patterns of symptom change. Diagnostic complexity, age, gender, and treatment modality differentiated response classes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Project STYLE is a multi-site 3-arm RCT comparing family-based, adolescent-only, and general health promotion interventions with 721 adolescents in mental health treatment. This study reports 12-month outcomes for family context and sexual risk behaviors, and explores the role of baseline family context in modifying treatment response. Using the full sample, there were sustained benefits for parent-reported sexual communication (d = 0.28), and adolescent-reported parental monitoring (d = 0.24), with minimal differences in risk behaviors. Latent profile analysis identified four family context classes: struggling (n = 177), authoritative (n = 183), authoritarian (n = 175), and permissive (n = 181). The authoritarian and permissive classes were also distinguished by disagreement between parent and adolescent report of family context. Classes differed in terms of baseline mental health burden and baseline sexual risk behavior. Classes showed different patterns of treatment effects, with the struggling class showing consistent benefit for both family context and sexual risk. In contrast, the authoritarian class showed a mixed response for family context and increased sexual risk.

Objective The purpose of the current pilot study was to evaluate the acceptability and preliminary impact of using immersive virtual reality environments (IVREs) paired with a brief emotion regulation and risk reduction intervention (ER + IVRE) relative to this same intervention content paired with role-plays (ER + RP). Methods Eighty-five adolescents attending middle school (grades 6th-8th; ages 12-15 years) in an urban northeast city were recruited and randomized to ER + IVRE (n = 44) or ER + RP (n = 41) and had complete data. Data examining acceptability, feasibility, sexual knowledge and attitudes, and ER were collected at baseline and 3 months after intervention completion. Analyses of covariance controlling for baseline scores were used to evaluate study outcomes. Within and between intervention effect sizes were calculated with effect sizes ≥.20 considered meaningful. Results At the 3-month follow-up assessment, several within intervention condition effect sizes were found to exceed d = 0.20 across the measured sexual attitudes and ER outcomes. Between intervention analyses found that adolescents randomized to ER + IVRE attended more intervention sessions, reported less difficulty accessing ER strategies (d = 0.46), and reported higher emotional self-efficacy (d = 0.20) at the 3-month follow-up relative to adolescents randomized to the ER + RP intervention. Conclusions This study provides preliminary evidence that using virtual reality environments to enhance ER skill building in risk situations was acceptable, feasible to deliver, and positively impacted ER abilities.

Objective Cystic fibrosis (CF) is the most common indication for pediatric lung transplantation and the third most common for adults. The selection of candidates and timing of transplant is challenging and whether there is a survival benefit of this procedure for pediatric patients is controversial. Use of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a well-validated, disease-specific quality of life measure may improve pretransplant referral decision-making. Methods This multicenter study evaluated whether specific domains on the CFQ-R (i.e., Physical Functioning, Respiratory Symptoms), assessed pretransplant, predicted survival 4-year post-transplant (n = 25). A two-step Cox regression, with physical predictors entered in step one (i.e., age, CF-related Diabetes, FEV1% predicted) and the Physical Functioning and Respiratory Symptoms CFQ-R scales entered in step two, was used to assess whether the CFQ-R explained additional and unique variance. Receiver Operating Characteristic (ROC) curves were used to assess the sensitivity and specificity of optimal cut-points of significant CFQ-R domains. Results The Respiratory Symptoms scale predicted survival 4-year post-transplant (Exp(B) = 0.38, 95% CI = 0.14–1.01; area under the curve = 0.87) and once it was added to the model, no other individual predictors were significant. The incremental improvement beyond the physical parameters approached but did not reach statistical significance (χ2 Δ = 5.79, p = .06). Conclusions This study suggested that including patient-reported outcomes could aid pretransplant referral decision-making. The Respiratory Symptoms scale in particular may serve as a useful tool to help determine when to refer and evaluate an individual for transplant.

This brief report examines the evidence for moderators of psychosocial treatment for youth with obsessive-compulsive disorder (OCD). Understanding treatment moderators can help clinicians select the most appropriate intervention for a particular patient and consequently increase the likelihood of initial response. A systematic search of the literature was conducted to identify randomized trials and meta-analyses reporting on moderators of psychosocial treatment for pediatric OCD. All studies included a comparison of cognitive-behavioral therapy (CBT) to active or control conditions. Few studies have evaluated moderators of psychosocial treatment for youth with OCD, and among those studies, few variables have demonstrated a differential effect on treatment response. Moderator analyses require large samples to garner the statistical power necessary to adequately evaluate differential responding in subgroups, and unfortunately, most reports of moderators in this review are post-hoc investigations of datasets from trials with relatively small sample sizes. Given the overwhelming number of CBT treatment variants and potential moderators, it would be impossible to conduct all the necessary head-to-head trials with sufficient sample sizes to develop helpful clinical guidelines. The best option for advancing the moderator literature is to utilize advanced statistical approaches for pooling existing data sets. Recommendations for leveraging emerging techniques in individual participant data meta-analysis (IPD-MA) are briefly discussed.

Background The International Depression Epidemiological Study (TIDES) found elevated rates of screen positivity for depression and anxiety among individuals with cystic fibrosis (CF). Depression is associated with worse adherence and health-related quality of life in CF. We investigated the relationship with mortality. Methods Subjects were untransplanted participants in TIDES 12+ years of age receiving care at one of 45 collaborating US CF care centers who completed the Hospital Anxiety and Depression Scale and/or Center for Epidemiologic Studies Depression Scale during a stable visit between 2006 and 2010. Clinical characteristics and mortality data were obtained from the CF Foundation Patient Registry. The association of a positive screen with 5-year survival was evaluated using Cox Proportional Hazards modeling. Results Of 1005 eligible patients, 25% screened positive for depression and 34% screened positive for anxiety. Patients who screened positive for depression were more likely to be older, have a residual function mutation, public insurance, and more pulmonary exacerbations in the screening year. There were 96 deaths. The unadjusted 5-year Hazard Ratio (HR) for death among those with depression was 2.0; 95% CI (1.3, 3.0)]. When adjusted for predetermined potential confounders the HR for the entire population was 1.4; 95% CI (0.9, 2.2). The adjusted HR was higher in adults [1.6; 95% CI (1.0, 2.4)] and those screening in the severe range [2.0; 95% CI (1.2, 3.4)]. Anxiety was not associated with mortality. Conclusions A positive depression screen is associated with increased mortality among adults with CF. Research into the etiology of this relationship is needed.

Introduction College students often experience irregular sleep timing, short sleep duration, and weight gain. Using data from a large, prospective study on sleep in first-year college students, we examined whether students’ sleep regularity index (SRI; Phillips et al., 2017) was associated with body mass index (BMI) and BMI change (∆BMI) during the first nine weeks of their college semester. Methods Analyses included data from 583 students (mean age = 18.7± 0.5 years; 59% Female; 48% non-White) who had their height and weight assessed at the start of classes (T1) and end (T2) of nine weeks. ∆BMI was calculated as the difference between T2 and T1, with a positive value indicating an increase in BMI. Throughout the semester, participants completed on-line daily sleep diaries that included bedtime, wake-time, sleep onset latency, and wake after sleep onset for the previous major sleep episode and daytime naps. Based on this data, total sleep time (TST) was calculated as time spent asleep between bedtime and wake-time, and SRI was calculated by comparing participants’ sleep/wake states across adjacent 24-hour periods. Average SRI reflects participants’ sleep regularity (0 (random) to 100 (perfect regularity)) across the study. Data were analyzed with hierarchical linear regressions that controlled for sex and average TST. Results Average SRI was 74.1±8.7 (range 25.7–91.6). Average BMI at T1 was 22.0±3.5; 6% of participants were underweight (BMI less than 18.5), 6% overweight (≥25 and Conclusion We found that lower sleep-wake regularity associated with greater baseline BMI but less BMI increase during the initial transition to college. Given that the majority of our participants were normal weight young adults, our findings may indicate that sleep regularity associates with healthy growth in this population. Support (if any) R01MH079179, T32MH019927(P.W.)

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent-adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent adolescent sexual communication was examined at 12-months among adolescents with mental health problems. Of the 721 parent- adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent-adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent Body-Language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 hours of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12-months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent-adolescent sexual communication among a mental health sample.

Objective This study is a secondary analysis of outcomes examining risk behavior in the context of the naturalistic occurrence of parental monitoring and participation in an emotion regulation intervention over a 12-month period. Method Early adolescents with mental health symptoms (N=420), ages 12-14 years, were recruited and randomized into either an Emotional Regulation (ER) or Health Promotion (HP) condition. Assessments included adolescent self-report of unsupervised time, substance use and sexual behavior at baseline, 6-months, and one year post-intervention. Analytic groups were formed by intervention condition (ER or HP) and baseline reports of unsupervised time (≤1× per week or >1× per week of unsupervised time with opposite sex peers) resulting in a total of four groups. Logistic regression and time-to-event analyses were used to test differences in substance use and delay of sexual initiation between the groups. Results Participation in the ER intervention in the presence of low unsupervised time was superior in reducing both substance use and sexual initiation than either factor alone; and either factor alone was more effective than the absence of both. Conclusion Findings suggest that interventions targeting health risk behaviors, including substance use and sexual risk behavior, among early adolescents with mental health symptoms may be more effective when targeting both internal (e.g., emotional regulation) and external (e.g., unsupervised time spent with peers) protective factors. Limiting unsupervised time spent with peers through parental monitoring may serve to scaffold and reinforce early adolescent acquisition of effective emotion regulation which can be employed during emotionally arousing risk situations.

Olfactory sensitivity has traditionally been viewed as a trait that varies according to individual differences but is not expected to change with one’s momentary state. Recent research has begun to challenge this position and time of day has been shown to alter detection levels. Links between obesity and the timing of food intake further raise the issue of whether odor detection may vary as a function of circadian processes. To investigate this question, 37 (21 male) adolescents (M age = 13.7 years) took part in a 28-h forced desynchrony (FD) protocol with 17.5 h awake and 10.5 h of sleep, for 7 FD cycles. Odor threshold was measured using Sniffin’ Sticks 6 times for each FD cycle (total threshold tests = 42). Circadian phase was determined by intrinsic period derived from dim light melatonin onsets. Odor threshold showed a significant effect of circadian phase, with lowest threshold occurring on average slightly after the onset of melatonin production, or about 1.5○ (approximately 21:08 h). Considerable individual variability was observed, however, peak olfactory acuity never occurred between 80.5○ and 197.5○ (~02:22–10:10 h). These data are the first to show that odor threshold is differentially and consistently influenced by circadian timing, and is not a stable trait. Potential biological relevance for connections between circadian phase and olfactory sensitivity are discussed.

Depressive mood in youth has been associated with distinct sleep dimensions, such as timing, duration and quality. To identify discrete sleep phenotypes, we applied person-centred analysis (latent class mixture models) based on self-reported sleep patterns and quality, and examined associations between phenotypes and mood in high-school seniors. Students (n = 1451; mean age = 18.4 +/- 0.3 years; 648 M) completed a survey near the end of high-school. Indicators used for classification included school night bed-and rise-times, differences between non-school night and school night bed- and rise-times, sleep-onset latency, number of awakenings, naps, and sleep quality and disturbance. Mood was measured using the total score on the Center for Epidemiologic Studies-Depression Scale. One-way ANOVA tested differences between phenotype for mood. Fit indexes were split between 3-, 4-and -phenotype solutions. For all solutions, between phenotype differences were shown for all indicators: bedtime showed the largest difference; thus, classes were labelled from earliest to latest bedtime as 'A' (n = 751), 'B' (n = 428) and 'C' (n = 272) in the 3-class solution. Class B showed the lowest sleep disturbances and remained stable, whereas classes C and A each split in the 4-and -class solutions, respectively. Associations with mood were consistent, albeit small, with class B showing the lowest scores. Person-centred analysis identified sleep phenotypes that differed in mood, such that those with the fewest depressive symptoms had moderate sleep timing, shorter sleep-onset latencies and fewer arousals. Sleep characteristics in these groups may add to our understanding of how sleep and depressed mood associate in teens. Refereed/Peer-reviewed

The current study examines emotion regulation as a novel dynamic factor of juvenile arrest as it compares with known static and dynamic risk factors. Participants included seventh graders at five urban public schools ( N = 420, Mage = 13, 53% male). The predictive relationship between adolescent self-, parent-, and teacher-report of baseline adolescent emotional competence and arrest at 30-month follow-up was assessed. Stepwise logistic regression analyses revealed that teacher report of emotion regulation strategies, minority status, and lifetime marijuana use were significant predictors of arrest. Findings indicate teacher report of emotion regulation competence in early adolescence may be an important consideration for prevention program development.

Impulsivity and sensation seeking have been linked to hazardous drinking, increased sexual risk behaviors, and lower treatment adherence among persons living with HIV (PLH). The dopamine active transporter1 (DAT1 or SLC6A3) gene has been linked to impulsivity and sensation seeking in several populations but has not been investigated among populations of PLH. This study used data from 201 PLH who report a recent history of heavy episodic drinking. Results indicate that DAT1*10R vs DAT1*9R genotype was related to higher propensity for risk taking (standardized difference score (d) = 0.30 [95% CI: 0.02;0.59]), more hazardous drinking (d = 0.35 [0.05;0.64]), and more condomless sex (rate ratio (RR)= 2.35[1.94; 2.85]), but were counter-intuitively associated with fewer sexual partners (RR = 0.65[0.43;0.91]) and possibly better treatment adherence (d = 0.32 [−0.01;0.65]). Results are consistent with the suggested associations between DAT1 and risk-taking behavior. The counter-intuitive finding for partner selection and treatment adherence may be evidence of additional factors that place PLH at risk for engaging in hazardous drinking as well as relationship difficulties and problems with treatment adherence (e.g., depressive symptoms, avoidant coping, trauma history). Caution is required when using a single gene variant as a marker of complex behaviors and these findings need to be replicated using larger samples and additional variants.

Introduction Individuals with autism spectrum disorder (ASD) often experience sleep problems. A reliance on case-control studies rather than dimensional samples limit our ability to understand how sleep problems distinguish diagnosis and severity of ASD. To address this need, we present preliminary findings from a large community sample of individuals with heterogeneous autism phenotypes. Methods All participants (≤ 21 years) were selected from the Rhode Island Consortium for Autism Research and Treatment (RI-CART) (final n= 977; 233F; 11.27±4.13 years), a public-private-academic registry of families in Rhode Island affected by ASD-like symptoms. Participants completed the Autism Diagnostic Observation Schedule, 2nd Edition to confirm the presence of diagnosable ASD. Each caretaker also completed dimensional measures of functional impairment: Social Responsiveness Scale, 2nd edition and the Vineland Adaptive Behavior Scale (2nd/3rd editions). Caretakers were asked whether the participant suffered current/past sleep problems: yes/no. All analyses are adjusted for age, sex, race, ethnicity, caregiver education, and scale-version (e.g., 2nd/3rd ed., where applicable). Results Endorsement of sleep problems distinguished ASD diagnosis: a confirmed diagnosis of ASD was associated with greater prevalence of sleep problems compared to ASD diagnosis (OR: 1.58; 95% CI: 1.05,2.38; p = .028). Across the sample, endorsement of sleep problems was associated with impairments in adaptive behavior (b = -4.73; 95% CI: -7.47,-2.00045; p = .001) and social responsiveness (b = 6.72; 95% CI: 3.27,10.16; p < .001). Conclusion These data from a heterogenous community sample provide evidence for a link of sleep to the phenomenology of ASD. While the search for better diagnostic indicators of ASD continues, we recommend that clinicians consider a brief assessment of sleep behaviors of patients with such neurodevelopmental conditions as autism. Support Simons Foundation Autism Research Initiative, Hassenfeld Child Health Innovation Institute at Brown University. K01MH109854 (JMS), NIGMS Advance CTR (JMS). KNAW Ter Meulen Grant (MEKV).

Objective Latino STYLE is a family-centered, HIV-focused intervention (HIV) emphasizing cultural factors and parent-adolescent communication. We hypothesized that, compared with a general health promotion (HP) intervention, the HIV arm would improve caregiver and adolescent HIV knowledge, attitudes, parental monitoring, sexual communication, and family relationships after a 3-month postintervention period. This article reports on the short-term findings of the longer trial. Methods A single-site, two-arm, parallel, family-based, randomized, controlled trial was conducted; eligible participants were Latino adolescents aged 14–17 and their primary caregiver. The study was conducted at the University of South Florida with 227 adolescent-caregiver dyads allocated to the HIV (n = 117) or HP (n = 110) intervention after completing a baseline assessment. Interim measures at 3-month follow-up included demographics, HIV knowledge, self-efficacy, parental monitoring, sexual communication, family relationships, and adolescent sexual behavior. Results Adolescents in the HIV group reported small effects in parental permissiveness and the HP group reported small effects for family support. Caregivers in both groups reported decreases in all outcomes. Incidence of past 90-day sexual intercourse decreased in both treatment arms. Among those who were sexually active over the past 90 days, the number of sex acts decreased from baseline, particularly in the HIV group. The percentage of condom-protected sex acts increased in the HIV group and decreased in the HP group, but did not reach statistical significance. Conclusions The HIV Latino STYLE intervention was not efficacious in improving hypothesized outcomes over a 3-month period. However, exploratory analyses revealed moderate effects for decreases in adolescent sexual risk behavior, particularly in the HIV group.

Purpose This project investigated internal consistency and test–retest reliability of the frequently used Pubertal Development Scale (PDS) and compared parent and child reports with clinician-rated Tanner staging. Methods Using a repository of data collected from 1995 to 2016, 252 participants (aged 7.8–17.7 years) provided self- and parent-reported PDS and received Tanner staging by a certified health care professional within 30 days. Internal consistency and test–retest reliability statistics were evaluated for 56 children across two assessments occurring within 6 months. Comparisons with Tanner staging involved examining concurrent validity and calibration analysis using data from 233 child and 252 parental ratings. Results Self- and parent-reported PDS demonstrated good internal consistency, with Cronbach's alpha .91–.96; high test–retest reliability was confirmed with intraclass correlation coefficient .81–.92. The association of Tanner stage with self- and parent-reported PDS was moderate to high; Kendall's Tau ranged from .67 to .76, and intraclass correlation coefficient ranged from .73 to 83. The absolute agreement of Tanner stage with self- and parent-reported PDS was low; Cohen's Kappa ranged from .20 to .37. However, combining pubertal scores into three stages of development (pre/early-, mid-, and late/post-pubertal) improved interrater agreement across measures (κ = .65, 95% confidence interval = .57–.73). Conclusions The present study shows that the PDS is reliable and generally tracks with Tanner staging (for both self and parent report). Low absolute agreement indicates that PDS categories do not map directly to specific Tanner stages, partly because a premature adrenarche is often misinterpreted by parents and pediatricians alike. However, three broad categories showed better agreement and are generally adequate for most applications in child and adolescent research.

Holding support groups with the same cohort of adolescents during clinic visits promises to increase engagement in care. Participants (N = 35 patients, aged 12-18, 50% female, from an adolescent HIV clinic in Kumasi, Ghana, were divided into 5 teams. Clinic visits were coordinated for members of each team. Team members participated in group discussions and activities while waiting to meet with their medical team. Teams met quarterly for 1 year. Participants reported benefits from talking with peers about the challenges of managing HIV. Clinic attendance improved from the preceding year (54% versus 84%). There were reductions in perceived internal stigma, perceived external stigma, worries about unintended disclosure from taking antiretroviral therapy (ART), and reduced ART concerns. The program demonstrated the feasibility, safety, and acceptability of facilitating increased interaction among adolescents living with HIV during clinic visits. Improvements in clinic attendance, perceived stigma, and concern about medications suggest that the intervention is a promising candidate for additional study.

Introduction Among adolescents, sleep health has been associated with emotional and mood regulation, cognitive functioning, and behavior. Few studies, however, have examined the Sleep Regularity Index (SRI, Phillips et. al, 2017) and its associations with mental health and well-being in this age group. For this study, we examined whether SRI in 15-16-year-old adolescents would predict internalizing and externalizing symptoms as measured by Youth Self-Report (YSR) scores two years later. We hypothesized that a higher baseline sleep regularity would predict lower internalizing and externalizing YSR scores at the 2-year follow-up. Methods The sample included 32 adolescents (14 male) ages 15-16yr (mean = 15.6) at baseline and 2 years later (mean age = 17.7). Actigraphy data and YSR scores were collected at baseline, and YSR was examined at follow-up. Participant’s SRIs were calculated using 24-hour actigraphy data scored for sleep and wake. YSR T-scores of 60 or above indicate borderline clinical internalizing (n = 2) and externalizing (n = 4) symptoms at follow-up. We used linear regression modeling to determine whether baseline SRI predicted YSR scores 2 years later. Covariates included sleep start time, sleep duration, sex, and baseline YSR scores. Results At baseline, average SRI and YSR scores were not significantly correlated (internalizing: r = 0.10; externalizing: r = 0.24, p’s > 0.1). SRI score at baseline (mean = 80.5 ± 7.4) significantly predicted YSR internalizing scores (mean = 42 ± 9) at the 2-year follow up (t(26) = 2.57, p = 0.016) but not externalizing scores (mean = 44.8 ± 10.3, t(26) = .78, p = 0.44). Conclusion We observed that sleep regularity was associated with internalizing symptoms two years later; however, the association was not in the expected direction: higher SRI was correlated with increased YSR internalizing scores at the 2-year follow-up. As most participants were in a healthy range for YSR scores at both assessments, a possible explanation for this finding is that those with higher SRIs have greater self-awareness in assessing their internal feelings. Future work will examine SRI values and YSR in this sample across 6 assessments acquired at 6-month intervals. Support (if any) AA13252 (NIH)

Objective Sexual activity often begins in early adolescence, and adolescents with mental health symptoms are at greater risk for sexual activity and other health risks. This study aimed to evaluate a developmentally targeted intervention designed to enhance early adolescents' emotion regulation competencies as a strategy for reducing health risk behaviors, including sexual initiation. Method Adolescents 12 to 14 years old (N = 420; 53% male) with mental health symptoms participated in either an emotion regulation (ER) or health promotion (HP) intervention consisting of 12 after-school sessions. Participants completed questionnaires on laptop computers at baseline, 2-, 6-, and 12-month follow-ups. Results Time to event analyses were used to compare intervention conditions on rate of initiation to vaginal sex. Results showed that participants in the ER condition were less likely to transition into vaginal sexual activity by 1-year follow-up than were those in the HP condition (adjusted hazard ratio = 0.58, 95% confidence interval [0.36, 0.94], p = .01). However, those who were sexually active did not report differences in sexual risk behaviors (e.g., condomless sex). Participants in the ER condition were significantly less likely to report violence behaviors and showed improvement on a behavioral measure of emotion identification; however, they did not differ from HP participants on self-reports of emotional competence. Conclusions Emotion regulation strategies can be used to delay sexual initiation among early adolescents with mental health symptoms and may have an important role in health education. (PsycINFO Database Record

STUDY OBJECTIVES: To examine whether differences exist in self-reported sleep patterns and self-reported alcohol use for first-semester college students who do or do not report drinking during the last 6 mo of high school. METHODS: Participants were 878 first-year college students. Students completed a survey in late May/early June about alcohol use and consequences, during the last 6 mo of high school; they later completed a daily record of sleep behavior and alcohol use across the first 9 w of the first semester of college. High school drinking status (past 6 mo) was classified as positive (HS-6mo+) or negative (HS-6mo-) based on any indication of drinking on the May/June survey. Collegiate drinking was determined from first-semester daily diary alcohol reports as nondrinkers (0 reported drinks), drinkers (one or fewer heavy episodic drinking episodes (HED)), and drinkers reporting more than one HED episode. Sleep patterns were compared for nondrinkers, drinkers, and HED with no high school drinking history (HS-6mo-/HED). In addition, a separate analysis compared sleep patterns for college HED with (HS-6mo+/HED) and without (HS-6mo-/HED) high school self-reported alcohol use. RESULTS: Increased alcohol consumption in the first semester of college was associated with later bedtimes and rise times. We found no association of high school alcohol use and sleep in those with collegiate HED. CONCLUSIONS: Later sleep timing in those with greater alcohol use, supports a connection between sleep patterns and alcohol use. Such an early appearance of this connection may herald the development of alcohol use disorder in some individuals.Copyright © 2016 Associated Professional Sleep Societies, LLC. All rights reserved. Language: en

Introduction Sleep quantity and quality influence attentional bias, and attentional bias for food cues has been associated with body weight. Whether the endogenous circadian cycle and/or time from awakening to bedtime contribute to attentional bias for food and differences in weight remain unclear. Using a 28-h forced desynchrony (FD) design, we hypothesized that adolescents with overweight (OW) and obesity (O) would have more attentional bias for food cues later in the wake episode and at a later circadian phase compared to adolescents with a healthy weight (HW). Methods 50 (28 male) adolescents (12-15yr) completed 7 FD cycles. Participants completed an attentional bias task that included three food word categories (savory, sweet, fruits/vegetables) and one non-food word category (school supplies). The task was completed at 6 fixed times each cycle: Task 1 was 1.3h after scheduled awaking, Task 2 was 2h after Task 1, and Tasks 3–6 followed at 3-h intervals. Weight categorization used body mass index (BMI) percentiles (CDC): HW (>5th and Results We found no significant differences between weight groups in attentional bias for any of the food categories (p’s >.05). We also saw no significant time awake effects or circadian influence on attentional bias, nor did time awake or circadian phase moderate the associations between weight category and attentional bias (p’s >.05). Conclusion Weight groups did not impact food-related attentional bias across the wake episode or circadian phase. Future directions will explore whether attentional bias for food types predicts food choice and food consumption in this study. Support DK101046

OBJECTIVE: With this study, we examined the efficacy of a health intervention program that was focused on emotion regulation (ER) skills in reducing sexual risk behaviors among early adolescents with suspected mental health symptoms. METHODS: Seventh grade adolescents with suspected mental health symptoms participated in a 6-week, after-school sexual risk prevention trial in which a counterbalanced, within-school design comparing an ER focused program to a time- and attention-matched comparison group was used. Adolescents completed a computer-based survey regarding their sexual behavior at 6-month intervals for 2.5 years. RESULTS: Adolescents who received ER skills training exhibited a delay in the transition to vaginal sex over 30 months compared with those in the comparison condition (adjusted hazard ratio = 0.61; 95% confidence interval [0.42 to 0.89]). They also reported fewer instances of condomless sex over the follow-up period (adjusted rate ratio = 0.36; 95% confidence interval [0.14 to 0.90]). Among those who were sexually active, those in the ER condition reported fewer instances of vaginal or anal sex (adjusted rate ratio = 0.57; 95% confidence interval [0.32 to 0.99]). CONCLUSIONS: An intervention used to teach ER skills for the context of health decision-making resulted in lower risk among young adolescents with suspected mental health symptoms by delaying the onset of vaginal sex as well as reducing penetrative acts without a condom. Incorporating emotion education into health education may have important health implications for this age group.

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

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 twelve 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.

Objective The purpose of this study was to examine the moderating influence of parental monitoring (e.g., unsupervised time with opposite sex peers) and adolescent emotional competence on sexual behaviors, among a sample of at-risk early adolescents. Methods This study included 376 seventh-grade adolescents (age, 12-14 years) with behavioral or emotional difficulties. Questionnaires were completed on private laptop computers and assessed adolescent Emotional Competence (including Regulation and Negativity/Lability), Unsupervised Time, and a range of Sexual Behaviors. Generalized linear models were used to evaluate the independent and combined influence of Emotional Competency and Unsupervised Time on adolescent report of Sexual Behaviors. Analyses were stratified by gender to account for the notable gender differences in the targeted moderators and outcome variables. Results Findings indicated that more unsupervised time was a risk factor for all youth but was influenced by an adolescent's ability to regulate their emotions. Specifically, for males and females, poorer Emotion Regulation was associated with having engaged in a greater variety of Sexual Behaviors. However, lower Negativity/Lability and >1× per week Unsupervised Time were associated with a higher number of sexual behaviors among females only. Conclusions Based on the findings of this study, a lack of parental supervision seems to be particularly problematic for both male and female adolescents with poor emotion regulation abilities. It may be important to impact both emotion regulation abilities and increase parental knowledge and skills associated with effective monitoring to reduce risk-taking for these youth.

Previous research suggests parents with mental health concerns are more likely to engage in maladaptive parenting practices and are less likely to benefit from parenting interventions. The current study examined the moderating influence of parent mental health problems on response to a family HIV prevention program delivered to youth in mental health treatment and their caregivers. The family intervention targeted parent-adolescent communication and parental monitoring. Study hypotheses were tested using general linear models at three- and six-month follow-ups. Tests of moderation were conducted by modeling the interaction between treatment condition (family versus control) and parental psychopathology controlling for other relevant psychosocial factors (i.e., single parenthood, income, and education). Parents with elevated psychiatric symptoms demonstrated greater improvements in sexual communication (three and six months) and parental monitoring (three months) following the family-based intervention. Th...