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Adolescent depression is a significant public health problem reflected in increasing rates of major depressive episodes. Depression is also a critical risk for adolescent substance use. Adolescents who have experienced a major depressive episode are approximately twice as likely to engage in heavy drinking compared to those without. Developing strategies to intervene early and reduce adolescent depressive disorders and alcohol use is warranted. We examined the relationship between adolescent depressive symptoms and alcohol use with 69 adolescents enrolled in a preventive randomized controlled pilot trial for substance use risk within a federally qualified health care setting. We also tested a mediation model to determine if a text-delivered intervention reduced alcohol use by reducing depressive symptoms. Participants were randomized to a 4-week, text-delivered stress-and-coping intervention or a waitlist control condition. Participants completed baseline assessments and monthly follow-up surveys for 3 months. Logistic regression showed that adolescents with probable depressive disorder had six times higher odds of alcohol use compared to those with sub-clinical depressive symptoms. Mediation analysis revealed that the intervention reduced alcohol use by reducing depressive symptoms for adolescents with sub-clinical depressive scores. Results support targeting proximal risk factors such as depressive symptoms among adolescents presenting for primary care with text-delivered preventive interventions in order to reduce alcohol use. Incorporating more intensive interventions for adolescents with a broad range of presenting depressive symptoms is recommended.

OBJECTIVE Studies of combat emphasize its impact upon health-related outcomes (e.g., depression). Little is known regarding the risk that combat poses to positive outcomes, such as meaning in life, and factors that mitigate this risk. We sought to investigate whether combat poses an indirect risk to life meaning and protective factors that mitigate this risk. METHOD Through an online survey at 2 time points, 153 combat-exposed veterans enrolled in college reported combat exposure, health status (posttraumatic stress disorder, depressive, somatic symptoms), meaning in life, and protective factors (social support, instructor autonomy support, coping ability, academic self-efficacy, social and community participation, and meaningful activity). We used path analysis to (a) explore whether baseline health status and life meaning mediated the relationship between combat and follow-up life meaning, and (b) test whether protective factors promoted life meaning despite combat and health status (combat-related risk). RESULTS The relationship between combat and follow-up life meaning was mediated by baseline health status and life meaning. Meaningful activity and coping ability were associated with greater life meaning independently of combat-related risk. The indirect effect of combat upon life meaning was weakened when social support, instructor autonomy support, coping ability, and academic self-efficacy were high. CONCLUSIONS Combat is associated with worse health status, in turn limiting student veterans' life meaning. This supports an expanded conception of combat-related risk, in which the effect of combat upon positive outcomes is emphasized. Findings indicate that the proposed protective factors may mitigate combat-related risk. We discuss implications for research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Leisure figures prominently in adolescent identity work. This paper tested the psychometric properties and validity of a new measure, Parental Support of Leisure Exploration (PSLE). We used three d...

The transition to parenthood can be stressful for mothers and fathers, yet education and psychosocial supports are far less available for fathers. When fathers lack information and support during this transition, they are likely to experience psychological distress, potentially influencing adjustment of mother and infant. This study examined the feasibility and acceptability of Becoming Fathers, a brief intervention for expectant and new fathers that combined education and self-care skills like mindfulness in a supportive group format. Two cohorts of men (n = 19), recruited through obstetric clinics, healthcare providers, and university listservs participated in the 5-week program. We examined the feasibility of our recruitment, assessment, and implementation protocols. Fathers indicated satisfaction on brief surveys completed after each session, and through open-ended qualitative responses collected at the end of the program. Results indicated feasibility of the protocols, and positive engagement of the fathers although recruiting this specific population remains a challenge. Qualitative responses, coded and organized into higher-order themes, indicated fathers found the intervention to be valuable, reporting the pairing of skills-based education and supportive group process created a positive learning environment. Higher-order themes emerged of community, openness/vulnerability, utility of information, and the need for more time. Mindfulness skills evoked mixed sentiments. Expectant and new fathers are not currently well supported by available programs, and there is a clear need for additional interventions focused on fathers’ experiences. Becoming Fathers, a father-focused parenting intervention targeting the transition to parenthood, has potential to meet the needs of new fathers.

Although evidence suggests many benefits of mindfulness, interpersonal forms of mindfulness are understudied. We present the conceptualization of a novel theoretical construct, mindful partnering, as interpersonal mindfulness with ones’ romantic partner; we also present initial validation of the Mindful Partnering Measure (MPM). Participants were 599 individuals from: 1) an undergraduate student sample recruited from a University subject pool (used for exploratory factor analyses, N= 335) and 2) a sample of married adults that was recruited through Mechanical Turk (used for confirmatory factor analyses, N= 264, subsets used for construct validity N= 147, and test-retest analyses N= 53). Results of the EFA and CFA supported a five-factor structure with the subscales: (1) mindful awareness, (2) nonreactivity, (3) emotional awareness, (4) acceptance/compassion, and (5) self-compassion. Tests of internal consistency, construct validity, and test-retest reliability in the sample of married adults provided evidence for reliability and validity of the total MPM to assess mindful partnering, as well as the mindful awareness and acceptance/compassion subscales. However, the other subscales did not demonstrate adequate test-retest reliability. Use of this measure in further research will allow for the study of the potential correlates and benefits of mindful partnering to further our understanding of this novel construct.

Background: Text-delivered prevention programs provide unique opportunities to deliver substance use prevention interventions to at-risk populations. Methods: A pilot randomized controlled trial wa...

Adolescent female tobacco users are more likely to have a depression disorder relative to tobacco using adolescent males. Less is known about how sex interacts with depression within the context of...

This study leverages data from a pilot randomized controlled trial to investigate whether the effectiveness of a text-delivered mHealth intervention targeting adolescent depression and anxiety differs according to residential- and activity space-based measures of exposure to community-level socioeconomic disadvantage. For depression, we find that intervention efficacy is significantly stronger for youth residing in more disadvantaged neighborhoods, even after controlling for individual level socioeconomic status, as well as marginal moderating effects of activity space-based neighborhood disadvantage on treatment efficacy. We do not find evidence of treatment efficacy moderation by neighborhood disadvantage regarding anxiety. While the generalizability of our findings is restricted to this sample and for this intervention, this research serves as a motivating example and initial evidence for how mHealth intervention efficacy can vary by characteristics of the environment, in particular community-level disadvantage. Future clinical research should investigate whether the effectiveness of mHealth interventions may be enhanced by personalization based on an individual's contextual environmental exposures.

Objective: To understand whether symptoms of health conditions explain the negative association between combat exposure and student Veterans' achievement of a meaningful life. Participants: 153 combat Veterans enrolled in college between November 2013 and April 2018. Methods: Through an online survey, participants reported combat exposure, health status (symptoms of conditions such as depression), and aspects of a meaningful life (belonging, self-understanding, and doing) at two time points. Path analysis was used to explore whether baseline health status mediated the relationship between combat exposure and belonging, self-understanding, and doing at follow-up. Results: Indirect effects indicated that the negative influence of combat on student Veterans' sense of belonging, self-understanding, and doing at follow-up was mediated by poor health at baseline. Conclusions: Combat exposure may contribute to the development of health conditions, which in turn limit student Veterans' experience of three aspects of a meaningful life: a sense of belonging, self-understanding, and doing.

The current study examined unfolding relations among mothers' mindful parenting, parent-adolescent recurrent conflict, and adolescents' externalizing and internalizing problems. In a community sample of 117 families (31% black, Asian, American Indian, or Latino), parents and adolescents (52% female; average age = 12.13 years) were followed over 15 months. Parents answered questions about mindful parenting and recurrent conflict, and adolescents reported on their own externalizing and internalizing problems. Path analyses indicated that higher levels of mindful parenting were significantly related to lower levels of recurrent conflict 2-3 months later, controlling for previous levels of recurrent conflict. Moreover, lower levels of recurrent conflict were significantly related to lower levels of externalizing problems and internalizing problems 1 year later, controlling for previous levels of those problems. Subgroup analyses indicated that relations were comparable across subgroups defined by adolescent gender, race, parent marital status, and family financial strain. The effects of mindful parenting were robust even after accounting for other indicators of positive and supportive parenting, namely inductive reasoning and warmth in the parent-adolescent relationship. These findings highlight the potential of mindful parenting to improve family interactions and adolescent adjustment.

Exposure to frequent, intense, and poorly resolved interparental conflict puts adolescents at risk for problems in many domains, including internalizing and externalizing problems, and stress physiological dysfunction. Existing intervention strategies to target these adolescents focus almost solely on improving marital dynamics, for example, through relationship education or couples therapy. However, interventions that aim to enhance marital communication require high levels of parental commitment and motivation for change, and may be expensive and time-consuming. In the current paper, we argue that it is essential to also apply intervention strategies that directly promote the regulatory capabilities of adolescents to improve outcomes for youth from high-conflict homes. Mindfulness, or present-moment, nonjudgemental awareness, is associated with myriad positive outcomes in adults (e.g., lower levels of depression and anxiety, and greater emotion regulation). We propose that mindfulness interventions are an ideal intervention strategy for adolescents from high conflict homes. Mindfulness interventions may target the mechanisms whereby destructive marital interaction impacts youth, by providing distance between experiences and evaluations, training regulation of attention, and enhancing self-compassion and nonjudgement, as well as by enhancing relationships. We also provide an example of a specific intervention model designed to increase mindfulness in youth, Learning to Breathe (L2B).

Major components of mindfulness, such as the development of empathy and compassion and the sharing of experience between people, necessitate a consideration of interpersonal relationships. The purpose of this paper is to review the literature on interpersonal mindfulness to-date and present a new way to conceptualize and measure mindfulness as it is cultivated and developed in interpersonal relationships. We reviewed empirical literature on mindfulness in relationships and current conceptualizations and measures of mindfulness. Specifically, we focused attention on mindfulness in parenting and how cultivation of mindfulness impacts the parent–child interactions. Empirical investigations of mindfulness have largely centered on the intrapersonal and have rarely involved both intra- and interpersonal components of human experience. Further, although mindfulness is thought to involve the moment-to-moment awareness of human experience as it unfolds over time, empirical studies rarely measure mindfulness as a dynamic construct. We suggest that dynamic systems theory can provide a useful framework in understanding how mindfulness both organizes and is organized by interpersonal interactions. We discuss several ways in which dynamic systems theory can inform the conceptualization of mindfulness as a process that takes place both within and between individuals. Finally, we present examples of how fine-grained and time-varying methods rooted in dynamic systems theory and currently utilized in human development research can be applied to understanding how mindfulness is manifested within close interpersonal relationships.

Patients in the medical intensive care unit (MICU) face life-threatening conditions leading to physical and psychological stress, and decreased occupational engagement. Mind-body interventions include techniques based on connecting the mind, body, brain, and behavior to positively influence health. The purpose of this study was to explore the use of mind-body interventions as a tool for use by occupational therapists (OT) to improve health and occupational performance. This was an exploratory case study completed with the patient, "Ann" in a MICU. Ann was a 57-year-old female who was admitted to the MICU for abdominal pain and later diagnosed with septic shock. Two mind-body sessions were completed with Ann and her responses were assessed via multiple variables, including: respiratory rate; blood pressure; heart rate; oxygen saturation; and anxiety. Ann stayed within normal ranges for all variables. This study demonstrates it was feasible to elicit mind-body interventions in this setting, with this patient.

Emerging fathers experience a variety of stressors, including identity and role transitions, changes in their relationships, and challenges in developing caregiving skills. Increasing expectations for father involvement in childcare are emphasizing the importance of the father role, but social supports for new fathers remain scarce. Nineteen expectant and new fathers participated in a pilot 5-week group intervention aimed at improving stress coping and involvement attitudes using a combination of mindfulness practices and skill-building for parenting and partner communication. We administered surveys pre- and postintervention to assess efficacy in the areas of stress, depressive symptoms, father involvement attitudes, and mindfulness. Within-participant differences were compared across participants as well as examining individual reliable change. Results indicated initial reductions in stress and depressive symptoms and increases in the mindfulness constructs of nonjudgment and nonreactivity. No significant changes were found in father involvement attitudes. Perinatal intervention specific to fathers holds promise as an underexplored avenue for supporting families across the transition to parenthood.

All states have youth sports concussion laws that have helped shape school concussion policy. However, state laws do not specify how schools distribute policy. The present study examined parent, youth, and school personnel’s knowledge of school concussion policy in Colorado and ease of access to policy via school website. Youth ( n = 1,987), parents ( n = 520), and school personnel ( n = 130) completed an online survey about knowledge of their schools’ concussion policy. Less than half of parents (48.9%) and students (43.0%) knew their school had a policy. School personnel were aware of the policy (96%). Among youth, rates of knowledge differed across gender, school level, and sport participation. Forty-nine percent of school district websites contained information on concussion. There are gaps in knowledge of concussion policy for youth and their parents. Teachers, administrators, coaches, and school nurses, who are educated on policy, could help facilitate communication. School websites are not being fully utilized to disseminate concussion policy.

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.

Using cannabis to reduce psychological and physical distress, referred to as self-medication, is a significant risk factor for cannabis use disorder. To better understand this high-risk behavior, a sample of 290 young adults (ages 18–25; 45.6% female) were recruited from two U.S. universities in January and February of 2020 to complete a survey about their cannabis use and self-medication. Results: seventy-six percent endorsed using cannabis to reduce problems such as anxiety, sleep, depression, pain, loneliness, social discomfort, and concentration. When predicting reasons for self-medication with cannabis, logistic regression models showed that lower CUDIT-R scores, experiencing withdrawal, living in a state where cannabis was illegal, and being female were all associated with higher rates of self-medication. Withdrawal symptoms were tested to predict self-medication with cannabis, and only insomnia and loss of appetite were significant predictors. To further explore why young adults self-medicate, each of the original predictors were regressed on seven specified reasons for self-medication. Young adults experiencing withdrawal were more likely to self-medicate for pain. Participants living where cannabis is legal were less likely to self-medicate for anxiety and depression. Living where cannabis is illegal also significantly predicted self-medicating for social discomfort—though the overall model predicting social discomfort was statistically non-significant. Finally, female participants were more likely to self-medicate for anxiety. These results suggest widespread self-medication among young adults with likely CUD and underscore the complexity of their cannabis use. The findings have implications for understanding why young adults use cannabis in relation to psychological and physical distress and for accurately treating young adults with cannabis use disorder.

Alcohol misuse is more prevalent, frequent, and severe among young adults who use cannabis. Treatment of dual alcohol and cannabis users may have mixed results, with some studies reporting that alcohol misuse increases when cannabis use decreases (substance substitution), while others report that alcohol misuse decreases along with decreasing cannabis use (treatment spillover), and others report no association. Additionally, little research tests whether gender differences are found in treatment of dual alcohol and cannabis users, which may be expected given previous alcohol-focused treatments showing larger effects for females. In the current study, we present a secondary analysis of a randomized clinical trial testing a text message-delivered cannabis use disorder (CUD) treatment (peer network counseling text or “PNC-txt”). The trial included 101 young adults ages 18–25 who met criteria for CUD. We tested whether alcohol use and binge drinking frequency (4+/5+ drinks for women/men) decreased in response to the PNC-txt treatment, which has previously shown effectiveness in reducing cannabis use days. Latent growth models tested PNC-txt effects on the monthly rate of change in alcohol use and binge drinking across three months. In the full sample, we found no evidence of significant treatment effects on alcohol use (d = −0.07) or binge drinking (d = −0.10). Moderation analyses, however, indicated the PNC-txt effect on both alcohol use and binge drinking differed significantly by gender. PNC-txt led to significantly larger decreases in alcohol use (d = −0.53) and binge drinking days (d = −0.43) across the three months for females, whereas the study saw opposite (but nonsignificant) effects for males (d = 0.30 and 0.16 for alcohol use and binge drinking, respectively). We found no evidence that reductions in alcohol use and binge drinking were associated with cannabis use decreases, arguing against direct substitution or spillover effects. These results provide evidence that treatments focused on cannabis use may have secondary beneficial effects for young-adult alcohol misuse, although such effects may be limited to women.

Background Maternal self-care, behaviors facilitating healthy eating, physical activity (PA), and stress management, are targets for child obesity prevention efforts and there is a need for optimized interventions to enhance these efforts. Plan, Do, Study, Act (PDSA) Cycling, a quality improvement process using rapid cycle testing to develop and refine interventions within healthcare settings, is less often used in maternal health and nutrition studies. Objective PDSA Cycles were applied during the development of the Healthy EnviROnments (HEROs) Self-care intervention to refine and verify intervention components including content, delivery methods, and digital strategies. Study Design, Setting, Participants HEROs Self-care was designed for low-income mothers of preschoolers in rural Colorado to improve healthy eating, PA, and stress management. Three sequential PDSA cycles were conducted via group or individual interviews with: 1) an expert panel (n = 8), 2) a convenience sample (n = 5), and 3) target audience (n = 6). Outcomes, Measures and Analysis Three cycles of group and/or individual interviews provided insights into intervention components: Cycle 1 provided input on program content: flow, activities, and materials; Cycle 2 provided feedback on delivery methods: in-person and videoconferencing meeting strategies, duration, and use of electronic binders; and Cycle 3 gathered information about the feasibility of digital strategies: website, iPad, and an activity tracker. Interviews were transcribed, data were compiled from group discussion notes, and data from each cycle was analyzed for emergent themes around intervention components. Results In Cycle 1, areas for refinement included the addition of mindfulness activities, revision of handouts for literacy level, and additional time for group discussion. Cycle 2 verified that content was acceptable to the target audience and delivery methods functioned in rural areas. Cycle 3 verified that digital strategies were feasible. Conclusion PDSA cycles allow for the optimization of intervention components prior to full-scale implementation, potentially saving resources and resulting in more efficacious interventions.

Attendance and participant engagement are two consistent predictors of the efficacy of preventive interventions. Although both are typically measured and analyzed as static factors, evidence indicates patterns of attendance and participant engagement change over the course of intervention. Understanding parent characteristics that predict engagement may inform strategies to maximize parents' involvement thereby increasing intervention uptake and improving effects. This study examined whether parents' baseline characteristics predicted their engagement in a family-based intervention. The study was conducted with 515 caregivers participating in a randomized comparative trial testing the efficacy of The Mindfulness-Enhanced Strengthening Families Program 10-14 (MSFP 10-14) and The Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14). Facilitator ratings were used to measure parent engagement. Results indicated generally high levels of initial engagement with small, but a significant linear increase across the intervention. Parental education level and involvement with their youth predicted engagement in the first session, while parents' marital/relationship status, avoidance of conflict with their youth, involvement with their youth, and perceived parent-youth relationship quality at baseline predicted change in engagement. Results highlight engagement as a dynamic construct that changes over time and indicates potential variables that may help identify parents that may need support engaging in this intervention.

CONTEXT • Behavioral lifestyle interventions to lower body mass index (BMI; kg/m(2)) are the standard approach for preventing adolescent-onset type 2 diabetes (T2D). Unfortunately, existing programs have had limited long-term success of lessening insulin resistance, the key physiological risk indicator for T2D. Underlying psychosocial factors, particularly depressive symptoms, have been related to insulin resistance, independent of BMI or body fat. Preliminary evidence indicates that mindfulness-based programs show promise for intervening with depression and T2D; yet, this approach is novel and data in adolescents are scarce. OBJECTIVE • The objectives of this study were (1) to evaluate the benefits, and potential underlying mechanisms, of a mindfulness-based intervention in adolescents at-risk for T2D with depressive symptoms and (2) to consider clinical implementation with this specific, psychologically, and medically at-risk adolescent population. DESIGN AND SETTING • The research team conducted a case study report. The setting was an outpatient therapy clinic and research laboratory at a university. PARTICIPANT • The participant was a 16-y-old female with elevated depressive symptoms, obesity, and insulin resistance, and a family history of T2D. INTERVENTION AND OUTCOMES • The intervention was a 6-wk mindfulness-based group program. The key outcomes were patterns of change in trait mindfulness, depression, and insulin resistance in the course of a 1-y follow-up. Secondary outcomes were patterns of change in reported-overeating patterns and cortisol awakening response. RESULTS • Compared with her scores at baseline, the participant displayed a pattern of increased trait mindfulness, decreased depressive symptoms, and lessening of insulin resistance immediately following the group program and at 1 y. BMI and body fat were stable. There was a remission in reported-overeating and a pattern of declining cortisol awakening response 1 y later. Participant feedback on the intervention was generally positive but also provided potential modifications to strengthen acceptability and effectiveness. CONCLUSIONS • The current case results suggest that teaching mindfulness skills to adolescent girls at risk for T2D with depressive symptoms may offer distinctive advantages for treating depression and T2D risk. Clinical implications for increasing the success of implementing mindfulness-based programs in this population include a focus on promotion of social connectedness within the group, implementation of strategies to increase adherence to home practice activities, and the use of facilitation techniques to promote concrete understanding of abstract mindfulness concepts. Future, adequately powered clinical trial data are required to test therapeutic mechanisms and recommended adaptations.

OBJECTIVES: Mindful parenting and parenting cognitions likely have important linkages to each other and to parent-child communication, but these linkages have not been tested. In this article, we test the bidirectional linkages between mindful parenting and parenting cognitions (sense of competence, parent-centered attributions) and the underlying mediational processes that link them to parent-child communication (parental solicitation and youth disclosure). METHODS: Longitudinal, autoregressive cross-lagged models were run within a longitudinal sample of rural and suburban early adolescents and their mothers (n = 421; mean adolescent age = 12.14, 46% male, 73% white). RESULTS: Significant bidirectional linkages were found between mindful parenting and parenting cognitions across Time 1 and Time 2. Greater mindful parenting at Time 1 was associated with more positive parenting cognitions (e.g., greater perceptions of parental competence and fewer negative parent-centered attributions or self-blame) at Time 2. More positive parenting cognitions at Time 1 were also associated with greater levels of mindful parenting at Time 2. Mindful parenting at Time 2 mediated the association between parenting cognitions (both parent-centered attributions and sense of competence) at Time 1 and parental solicitation at Time 3. CONCLUSIONS: Mindful parenting and parenting cognitions influence each other over time. Parenting cognitions can affect parental solicitation via increases in mindful parenting. The discussion focuses on potential underlying processes.

The primary goal of this chapter is to provide a brief overview of family-based prevention science. We adopt a developmental perspective, highlighting aspects of basic, family, and applied developmental sciences from birth through adolescence. We illustrate distinct family and parenting practices at different developmental stages and focus our attention on family processes associated with substance use and interventions designed to alter them. Our aims are to (1) review aspects of family functioning and parenting practices that serve as risk or protective processes for healthy youth development and as targets for family-based preventive interventions, (2) review evidence supporting the efficacy of family-based prevention programs for reducing substance use, (3) briefly illustrate exemplary family-based interventions, and (4) highlight some key challenges to effective implementation or testing of these programs and provide some directions for future research.

While urban greenspace is increasingly recognized as important to mental health, its role in substance use is understudied. This exploratory study investigates the interaction of greenspace with peer network health, sex, and executive function (EF) in models of substance use among a sample of disadvantaged, urban youth. Adolescents and their parents were recruited from a hospital in the mid-Atlantic region of the U.S. Residential greenspace at the streetscape level was derived from analysis of Google Street View imagery. Logistic regression models were used to test the moderating effect of greenspace on the association between peer network health and substance use, as well as additional moderating effects of sex and EF. The significant negative association of peer network health with substance use occurred only among youth residing in high greenspace environments, a moderating effect which was stronger among youth with high EF deficit. The moderating effect of greenspace did not differ between girls and boys. Greenspace may play an important role in moderating peer influences on substance use among disadvantaged, urban adolescents, and such moderation may differ according to an individual’s level of EF. This research provides evidence of differences in environmental susceptibility regarding contextual mechanisms of substance use among youth, and it informs the development of targeted substance use interventions that leverage social and environmental influences on adolescent substance use.

Background Maternal self-care, or behaviors facilitating healthy eating, physical activity (PA), and stress management practices, may play an important role in child weight status. Few childhood obesity interventions, however, consider maternal self-care and health practices. Objective To understand existing beliefs, practices, and supports or barriers related to self-care in mothers of preschoolers in rural communities via in-depth interviews, and develop and refine a theory-based self-care intervention using Intervention Mapping (IM). Study Design, Setting, Participants A semi-structured interview guide was developed using Social Cognitive Theory constructs and pilot tested to establish content and face validity. Telephone interviews with mothers (n = 19) recruited from preschool centers in rural Colorado were conducted by a trained researcher. Measurable Outcome/Analysis Interviews were recorded, transcribed verbatim, coded, and analyzed using an iterative approach. IM steps were then followed: formulation of change objectives, material creation, and implementation/evaluation plan development. Results Three interview themes emerged: self-care practices; facilitators and barriers; and resources. Mothers had varying definitions of self-care and contexts in which self-care strategies were used. The majority of participants described self-care practices as important for helping them be a better mom, but reported infrequent practices of self-care. Barriers such as time, access to healthy food options or facilities for PA, and exhaustion made incorporation difficult in daily life. This input guided IM for the development of a self-care program which includes 2 workshops, 4 remote health coaching sessions, and a companion website. Topics addressed include what defines self-care, how to incorporate self-care behaviors into a busy life, and how self-care can benefit families. Conclusions Understanding mothers’ existing self-care practices and beliefs provided insights to inform and guide the development and refinement of a self-care intervention using IM. A maternal self-care intervention offers a unique approach to childhood obesity prevention efforts.

Importance: Occupational therapists can foster student veterans’ resilience, but targets for intervention must be developed. Objective: To explain factors influencing student veterans’ successful adaptation to past combat exposure, we hypothesized that participants with high life meaning would have greater levels of protective factors and lower levels of health conditions than those with low life meaning. Design: Longitudinal panel study with two measurements. Participants were classified by level of combat exposure (high–low) and life meaning (high–low) at follow-up, yielding four possible classifications (e.g., resilient group: high combat exposure, high life meaning). Linear mixed models were fit to obtain adjusted means of protective factors and health conditions for each classification; independent-samples t tests were used to examine differences between classifications. Setting: Community. Participants: Convenience sample of 153 combat-exposed student veterans. Outcomes and Measures: Psychometrically sound measures of combat exposure, life meaning, protective factors (social and instructor autonomy support, coping ability, academic self-efficacy, social–community participation, and meaningful activity), and health conditions (posttraumatic stress [PTSD], depression, somatic symptoms). Results: Groups with high life meaning at follow-up in response to both levels of combat exposure reported greater meaningful activity and coping ability and fewer depressive symptoms. Participants with high life meaning in response to low combat exposure had greater social support and fewer somatic symptoms; participants with high life meaning in response to high combat exposure had lower PTSD. Conclusions and Relevance: Occupational therapists may foster student veterans’ resilience by promoting meaningful activity, social support, and coping ability while managing symptoms of health conditions. What This Article Adds: To the best of our knowledge, this study is the first to offer empirical support for potential targets of occupational therapy intervention that address student veterans’ successful adaptation to combat exposure. Findings suggest that researchers should develop and test interventions that facilitate successful engagement in meaningful and shared activities and that occupational therapists should work within multidisciplinary teams to bolster coping ability and manage symptoms of combat-related health conditions.

Background Disclosure of concussion is vital for proper diagnosis and treatment. Youth have many stakeholders to whom they may disclose concussion, including parents, peers, coaches, and school personnel. We examined whom high school and middle school youth report concussion and the level of concussion education of the recipients of the disclosure. Methods Data were analyzed from 2362 students, 680 parents, and 150 school personnel who completed an online survey about concussion reporting, education, and training. Results Youth were most likely to disclose concussions to parents, particularly mothers, and their peer group. Middle school youth reported to teachers and school nurses at higher rates than high school youth. High school youth were more likely to disclose concussion to coaches and athletic trainers than middle school youth. While mothers were the most likely recipient of youths’ reporting, they were least likely to have received concussion education. Conclusions Recipients of youth concussion disclosure differs by school level. Parents are the most common recipients of disclosure. The role of school personnel and coaches changes as youth enter high school. Youth primarily report concussions to parents, yet parents receive the least amount of concussion training. These findings highlight the need for targeted concussion training for stakeholder groups as their role in disclosure may differ by school age.

There is a large evidence base supporting the efficacy of mindfulness interventions in adulthood, and growing support for the efficacy of these interventions in adolescence. Historically mindfulness interventions have been delivered in person and in groups, with recommendations for home practice being a critical part of the intervention. However, compliance with these practice recommendations in adolescence is very poor. Past studies indicate that using mobile technology to promote skill transfer to real life can be an effective strategy, particularly when used as a supplement to an in-person intervention strategy. To date, however, mobile technology has largely been used to create stand-alone mindfulness interventions. The goals of the current paper are to discuss the potential opportunities and challenges with a mobile-technology-enhanced mindfulness intervention, and to present the rationale that such an approach is not only theoretical and empirically sound but also a critical next step to increase the efficacy and developmental appropriateness of mindfulness interventions for adolescents. This discussion is grounded in a specific example of a mindfulness intervention supplemented by a momentary intervention we are developing.

OBJECTIVE Providing a medical definition of concussion improves reliability of self-reported history of concussion in adult former athletes. We examine whether providing a medical definition of concussion to youth athletes increases the number of concussions reported, and whether reporting differs by age, sex, or sport type. DESIGN Cross-sectional survey. SETTING Concussion specialty clinic. PARTICIPANTS Convenience sample of youth athletes (n = 301; mean age = 15.1 ± 1.6 years) presenting for evaluation of sports-related concussion. INDEPENDENT VARIABLES Number of concussions reported before and after presentation of the medical definition of concussion ("vignette"). OUTCOME MEASURES Number of concussions reported after vignette. Paired-sample t test examined for main effect of the vignette on reporting behavior. One-way between-subjects analysis of variance with pairwise comparisons assessed for group differences. RESULTS Thirty percent of youth athletes reported an increase in number of concussions after vignette overall (P < 0.000). There was no significant difference in reporting behavior by age, sex, or sport type. CONCLUSIONS Providing the medical definition of concussion, a simple and brief intervention, gives youth athletes context to understand when a concussion has occurred. This results in an increase in the number of concussions reported when gathering a self-reported history. Reporting behavior after a vignette does not differ across sex, sport type, or age of the athlete.

OBJECTIVE: There is growing interest in mindful parenting and how this form of intentional, compassionate interactions with youth are associated with developmental outcomes. We investigated how mindful parenting changes over time, either naturally or in response to interventions, and how that change is associated with other proximal developmental changes. METHOD: We used data from a longitudinal, randomized-controlled study design (N = 432 families) to investigate the associations between changes in mindful parenting and 3 outcomes: positive parenting, parent–youth relationship quality, and youth aggression. Differences across 3 intervention conditions and between mothers and fathers were tested. RESULTS: Across conditions, changes in mindful parenting were strongly associated with changes in all 3 outcomes for both fathers and mothers. Changes in mindful parenting showed considerable variability within and across conditions. For fathers, differences in mindful parenting change were driven primarily by changes in the core mindful parenting dimension of emotional awareness. Mothers showed comparable changes in mindful parenting across conditions. CONCLUSIONS: Findings illustrate how changes in mindful parenting are associated with proximal changes that could lead to reduced youth behavior problems (e.g., aggression or substance use) and provide additional evidence for the contribution that mindfulness activities can make to standard parent training.

Research on mindful parenting, an extension of mindfulness to the interpersonal domain of parent-child relationships, has been limited by its reliance on self-report assessment. The current study is the first to examine whether observational indices of parent-youth interactions differentiate between high and low levels of self-reported mindful parenting. The Iowa Family Interaction Rating Scales (IFIRS) were used to code interactions between mothers and their 7th grade youth. Mothers drawn from the top and bottom quartiles (n = 375) of a larger distribution of self-reported interpersonal mindfulness in parenting (N = 804) represented clearly defined high and low mindful parenting groups. Discriminant function analysis (DFA) was used to analyze how well six composite IFIRS observational rating variables (e.g., parental warmth, consistent discipline) discriminated between high and low self-reports of mindful parenting. DFA results were cross-validated, with statistically significant canonical correlations found for both subsamples (p < .05). Subsequent independent samples t-tests revealed that group means were significantly different on all six IFIRS composite ratings. Confirmation of the relations between self-report mindful parenting and the observational ratings was also provided through hierarchical regression analyses conducted with a continuous predictor of mindful parenting using the full sample. Thus, the present study provides preliminary evidence for a link between self-reported mindful parenting and observed interactions between parents and youth.

Teaching mindfulness to parents as well as adolescents through a family-centered intervention approach can have a positive impact on the parent-youth relationship. In mindful parenting, caretakers are aware of their own feelings and emotions, and interact with their adolescents in a mindful way by demonstrating emotional awareness, attentive listening, nonjudgment, self-regulation, and compassion. This chapter discusses the need for family-centered mindfulness approaches in adolescence. It introduces the Mindfulness-enhanced Strengthening Families Program, describes specific program activities and their theoretical rationale, and presents initial empirical evidence from pilot studies of the intervention.

The efficacy of preventive interventions is related to both the delivery of content and the uptake of that content. Although much research has focused on the quality of delivery, few studies have examined the factors that influence uptake. This study examines how and why participants' engagement-conceptualized as a dynamic process wherein participants interact with each other, the interventionists, and the intervention curriculum-changes over time. We apply growth curve models to repeated measures of engagement obtained from 252 families during a 7-week intervention trial. In the models, we examine (a) whether and how engagement changes over time, and the extent of between-person differences in change; and (b) how those changes and differences are related to chronic and session-specific aspects of family tension, while also controlling for differences across parent sex and 2 versions of the Strengthening Families Program: For Parents and Youth Ages 10-14 (SFP 10-14). Results show that, on average, engagement increased over time, linearly with some deceleration, with substantial differences in both level and rates of change. Higher in-session chronic family tension was related to lower initial levels of engagement but not rates of change. Sessions when families displayed more session-specific tension were characterized by different levels of engagement for parents, depending on their level of chronic tension. Overall, our results highlight the importance of considering engagement as a dynamic construct that changes over time in complex ways. Further understanding of the many factors that influence engagement can promote both better delivery and better uptake of intervention curriculum.

Although the majority of evidence-based programs are designed for group delivery, group process and its role in participant outcomes have received little empirical attention. Data were collected from 20 groups of participants (94 early adolescents, 120 parents) enrolled in an efficacy trial of a mindfulness-based adaptation of the Strengthening Families Program (MSFP). Following each weekly session, participants reported on their relations to group members. Social network analysis and methods sensitive to intraindividual variability were integrated to examine weekly covariation between group process and participant progress, and to predict post-intervention outcomes from levels and changes in group process. Results demonstrate hypothesized links between network indices of group process and intervention outcomes and highlight the value of this unique analytic approach to studying intervention group process.

A core mission of developmental psychopathology is studying the interplay between normal and abnormal developmental processes. Working from this perspective, we review research on associations between competence and psychopathology as divided among three major areas: (1) functional impairment in the context of formal mental disorder classification systems as a parallel to the negative extreme of competence; (2) cascade models that test longitudinal cross-domain links between constructs with statistical controls for continuity and potential common-cause variables; and (3) preventive interventions aimed at promoting competent adaptation. Each of these areas shows compelling examples of the dynamic interplay between competence in age-salient developmental tasks and either broad dimensions of psychopathology or discrete mental disorders. We begin with a historical and theoretical discussion of the nature of competence and psychopathology and conclude with an overview of this broad domain and suggestions for future work. Throughout the chapter, we emphasize the interdependence of theory and statistical methodology. Keywords: psychopathology; competence; impairment; mediation; cascade models; prevention; structural equation modeling

In the adolescent research literature, acculturation processes have been linked to the development of serious behavior problems in Hispanic adolescents, but not enough is known about how that process takes place. This article reports an investigation that sought to shed light on empirically plausible mechanisms by which family processes (i.e., familism and parenting practices) may operate as mediators of acculturation-related factors on adolescent problem behaviors among 167 Hispanic sixth- or seventh-grade early adolescents. SEM analyses identified an empirically plausible mediated pathway through which parenting practices may operate as a mediator of the effects of acculturation-related variables on adolescent problem behaviors. Second, although the role of familism as a mediator was not supported, the results did provide support for familism having indirect effects on behavior problems also through parenting practices. The findings are discussed in the context of existing research and clinical developments in the treatment of Hispanic adolescents and families.

This study, using data from two samples of rural adolescents, examined how identity experiences in a self-defining activity and perception of access to opportunities were related to four dimensions of adolescent future orientation and whether the relationship between identity experiences in a self-defining activity buffered the effects of limited opportunities on future orientation. Adolescents' identity experiences in a self-defining activity emerged as having a significant, positive association with most dimensions of future orientation in both samples and were found to be the strongest predictors of future orientation in Sample 1. In the more racially diverse Sample 2, perception of limited opportunities was the strongest and most consistent predictor of future orientation. In Sample 1, results also indicated that the strength of the negative relationship between limited opportunity and optimism is attenuated for adolescents reporting high levels of personal expressiveness compared to adolescents with ...

Parents play a fundamental role in shaping children’s development, including their dietary and physical activity behaviors. Yet family-centered interventions are rarely used in obesity prevention research. Less than half of childhood obesity prevention programs include parents, and those that do include parents or a family component seldom focus on sustainable change at the level of the family. The general absence of a family-centered approach may be explained by persistent challenges in engaging parents and families and the absence of an intervention framework explicitly designed to foster family-centered programs. The Family-centered Action Model of Intervention Layout and Implementation, or FAMILI, was developed to address these needs. FAMILI draws on theories of family development to frame research and intervention design, uses a mixed-methods approach to conduct ecologically valid research, and positions family members as active participants in the development, implementation, and evaluation of family-centered obesity prevention programs. FAMILI is intended to facilitate the development of culturally responsive and sustainable prevention programs with the potential to improve outcomes. Although childhood obesity was used to illustrate the application of FAMILI, this model can be used to address a range of child health problems.