143 results on '"Sylvie Naar-King"'
Search Results
2. Text Classification with Topic-based Word Embedding and Convolutional Neural Networks.
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Haotian Xu, Ming Dong 0001, Dongxiao Zhu, Alexander Kotov 0001, April Idalski Carcone, and Sylvie Naar-King
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- 2016
- Full Text
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3. Interpretable Probabilistic Latent Variable Models for Automatic Annotation of Clinical Text.
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Alexander Kotov 0001, Mehedi Hasan, April Idalski Carcone, Ming Dong 0001, Sylvie Naar-King, and Kathryn Brogan Hartlieb
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- 2015
4. African American Adolescent-Caregiver Relationships in a Weight Loss Trial
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Kai-Lin C Jen, Kathryn Brogan Hartlieb, Phillippe B. Cunningham, Deborah A. Ellis, Sylvie Naar-King, Kimberly Campbell-Voytal, and Angela J. Jacques-Tiura
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0301 basic medicine ,African american ,Persistence (psychology) ,030109 nutrition & dietetics ,media_common.quotation_subject ,Psychological intervention ,030209 endocrinology & metabolism ,Article ,Developmental psychology ,03 medical and health sciences ,0302 clinical medicine ,Weight loss ,Weight loss interventions ,Developmental and Educational Psychology ,medicine ,Behavioral interventions ,Thematic analysis ,medicine.symptom ,Life-span and Life-course Studies ,Psychology ,Autonomy ,media_common - Abstract
Successful family-based weight loss interventions for African American adolescents are rare. Parent-adolescent interactions supporting adoption of healthier nutrition and physical activity practices are not well understood. African American caregivers' and adolescents' perspectives on how they worked together to achieve weight loss need further exploration. This study describes the relationships experienced by adolescents and caregivers during the 6-month, evidence-based FIT Families weight loss trial and explores differences between families whose adolescents were successful and unsuccessful with weight loss. Exit interviews conducted with 136 adolescents (age 12–16 years; BMI percentile ≥95) and their caregivers (primarily mothers) were taped and transcribed verbatim. Content and thematic analysis was conducted to explore differences between groups stratified by weight loss. Five adolescent-caregiver relationship patterns emerged which describe dyads working together, working alone, working against each other; caregiver support and caregiver working on self. When relationship patterns were compared between groups stratified by weight loss, three themes emerged: motivation, support, and persistence. Families that achieved the greatest weight loss referred more often to working together to reach weight loss goals, attributed their success to adolescent self-motivation, with engaged caregiver support which allowed families to persist in change efforts. Family relationships involving adolescent autonomy, engaged parental support, and persistence despite challenges, clustered differently among adolescents who were successful at weight loss compared to those who were not. Interventionists trained to reinforce effective adolescent-parent interactions will advance behavioral interventions for families who have typically benefited least in prior interventions.
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- 2017
5. Brief Computer-Delivered Intervention to Increase Parental Monitoring in Families of African American Adolescents with Type 1 Diabetes: A Randomized Controlled Trial
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Bassem Dekelbab, Deborah A. Ellis, Sylvie Naar-King, Steven J. Ondersma, April Idalski Carcone, and Kathleen Moltz
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Adult ,Blood Glucose ,Male ,Parents ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Adolescent ,Motivational interviewing ,030209 endocrinology & metabolism ,Health Informatics ,Motivational Interviewing ,law.invention ,Parental supervision ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Health Information Management ,Randomized controlled trial ,Diabetes management ,law ,Intervention (counseling) ,Diabetes mellitus ,medicine ,Humans ,030212 general & internal medicine ,Parent-Child Relations ,Child ,Health Education ,Original Research ,Motivation ,Type 1 diabetes ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Black or African American ,Self Care ,Diabetes Mellitus, Type 1 ,Family medicine ,Physical therapy ,Female ,Health education ,business ,Goals ,Computer-Assisted Instruction - Abstract
African American adolescents with type 1 diabetes (T1D) are at elevated risk for poor diabetes management and metabolic control. Parental supervision and monitoring of adolescent diabetes management have been shown to promote better diabetes management among adolescents, but parents typically decrease their oversight during the transition to independent diabetes care.The purpose of the study was to conduct a randomized clinical trial to test the feasibility and efficacy of a three-session, computer-delivered motivational intervention (The 3Ms) to promote increased parental monitoring among primary caregivers of young African American adolescents with T1D. The intervention was brief and optimized for delivery during routine diabetes clinic visits.Sixty-seven adolescents with T1D aged 11-14 and their primary caregiver were randomly assigned to one of three arms: adolescent and parent motivational intervention (Arm 1), adolescent control and parent motivational intervention (Arm 2), or adolescent and parent control (Arm 3). Intervention effects were assessed 1 month after intervention completion.Parents in Arm 1 and Arm 2 had significant increases in knowledge of the importance of monitoring adolescents' diabetes care. Parents in Arm 2 also had trend to significant increases in direct observation and monitoring of adolescent diabetes care, and adolescents in Arm 2 had significant improvements in glycemic control.Findings from the present study provide preliminary support for the efficacy of a brief, computer-delivered parenting intervention for improving family management practices and adolescent health outcomes among African American adolescents with T1D and their caregivers.
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- 2017
6. Individual, social and environmental predictors of physical activity in severe to morbid obese African American adolescents
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Deborah A. Ellis, Kathryn Brogan-Hartlieb, Sylvie Naar-King, Jeffrey J. Martin, Kai-Lin Catherine Jen, and Angela J. Jacques-Tiura
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African american ,self-esteem ,lcsh:Sports ,obesity ,minority ,Family support ,Physical activity ,Aerospace Engineering ,030209 endocrinology & metabolism ,health ,Variance (accounting) ,Developmental psychology ,03 medical and health sciences ,Social support ,lcsh:GV557-1198.995 ,0302 clinical medicine ,Walkability ,030212 general & internal medicine ,adolescents ,lcsh:Sports medicine ,Psychology ,lcsh:RC1200-1245 ,Value (mathematics) ,human activities ,Clinical psychology - Abstract
The purpose of this study was to predict low, moderate, hard and very hard physical activity (PA) and walking/biking/jogging based PA. One-hundred and fifty-nine severe to morbid obese African-American adolescents participated. We predicted 8% of the variance in hard PA largely due to family support and 10% of the variance in very hard PA due to other support (e.g. counselor) and having home PA equipment. We also predicted 10% of the variance in walking/biking/jogging due to the walkability of the neighborhood. Our findings support the value of social support and environmental supports in helping obese African American adolescents increase PA.
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- 2016
7. Efficacy of Mindfulness‐Based Stress Reduction in Emerging Adults with Poorly Controlled, Type 1 Diabetes: A Pilot Randomized Controlled Trial
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April Idalski Carcone, Erica Ms Sibinga, Deborah A. Ellis, Sylvie Naar-King, Amy E. Graham, Richard B. Slatcher, and Anthony A. Hains
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Adult ,Blood Glucose ,Male ,Stress management ,medicine.medical_specialty ,Mindfulness ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Population ,Pilot Projects ,030209 endocrinology & metabolism ,Anxiety ,law.invention ,Mindfulness-based stress reduction ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Diabetes management ,law ,Internal Medicine ,medicine ,Humans ,education ,Glycemic ,education.field_of_study ,Type 1 diabetes ,Cognitive Behavioral Therapy ,Depression ,business.industry ,Psychosocial Support Systems ,medicine.disease ,030227 psychiatry ,Self-Help Groups ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Female ,business ,Stress, Psychological - Abstract
Background/objective The negative effects of stress on persons with type 1 diabetes (T1D) are well-established, but effective interventions to reduce stress among emerging adults with T1D are limited. The study objective was to conduct a pilot randomized controlled trial (RCT) to obtain preliminary data on the efficacy of mindfulness-based stress reduction (MBSR) to reduce stress and improve diabetes health outcomes in a population of high-risk, urban emerging adults with poorly controlled diabetes. Methods Forty-eight participants aged 16 to 20 years of age with T1D (mean duration = 8 years) were randomly assigned to one of three conditions: MSBR, cognitive-behavioral stress management (CBSM), or a diabetes support group. Data were collected at baseline, end of treatment, and 3 months after treatment completion. Measures of self-reported stress and depressive symptoms, diabetes management, and glycemic control were obtained. Results MBSR was found to reduce self-reported stress at end of treatment (P = 0.03, d = -0.49) and 3-month follow-up (P = 0.01, d = -0.67), but no effects on diabetes management or glycemic control were found. Diabetes support group participants had improved glycemic control at the end of treatment (P = 0.01, d = -0.62) as well as reduced depressive symptoms at 3-month follow-up (P = 0.01, d = -0.71). Conclusions Results provide preliminary support for the efficacy of MBSR to improve psychosocial adjustment in emerging adults with poorly controlled T1D but require replication in adequately powered studies. Findings also support the value of peer support in improving health outcomes in this age group.
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- 2018
8. Multisystemische therapie voor jonge Afro-Amerikaanse astmapatiënten met verhoogd risico: een gerandomiseerde klinische trial
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Philippe Cunningham, Elizabeth Secord, Sylvie Naar-King, Deborah A. Ellis, Thomas Templin, Phebe Lam, Jean-Marie Bruzzese, and Pamela S. King
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business.industry ,Medicine ,business - Published
- 2016
9. Mediators of Treatment Effects in a Randomized Clinical Trial of Multisystemic Therapy-Health Care in Adolescents With Poorly Controlled Asthma: Disease Knowledge and Device Use Skills
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Sylvie Naar-King, Deborah A. Ellis, and Pamela King
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Male ,Family therapy ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Adolescent ,Psychological intervention ,law.invention ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Randomized controlled trial ,Behavior Therapy ,law ,030225 pediatrics ,Intervention (counseling) ,Health care ,Developmental and Educational Psychology ,Humans ,Medicine ,Anti-Asthmatic Agents ,Child ,Multisystemic therapy ,Asthma ,business.industry ,Social Support ,medicine.disease ,Combined Modality Therapy ,Home Care Services ,Black or African American ,Self Care ,Treatment Outcome ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Linear Models ,Physical therapy ,Patient Compliance ,Female ,business ,Follow-Up Studies ,Regular Articles - Abstract
Objective Determine whether Multisystemic Therapy-Health Care (MST-HC) improved asthma knowledge and controller device use skills among African-American youth with poorly controlled asthma and whether any improvements mediated changes in illness management. Methods A randomized controlled trial was conducted with 170 adolescents with moderate to severe asthma. Families were randomized to MST-HC or attention control. Data were collected at baseline and 6 and 12 months after intervention completion. Results In linear mixed models, adolescents in the MST-HC group had increases in asthma knowledge; asthma knowledge was unchanged for attention control. Controller device use skills increased for adolescents in the MST-HC group, while skills declined for attention control. Both knowledge and skills mediated the relationship between intervention condition and changes in illness management. Conclusions Tailored, home-based interventions that include knowledge and skills building components are one means by which illness management in African-American youth with poorly controlled asthma can be improved.
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- 2015
10. A Multi-Site Study of Social Cognitive Factors Related to Adherence Among Youth Living With HIV in the New Era of Antiretroviral Medication
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Bo Wang, Sylvie Naar-King, Karen MacDonell, and Veronica Dinaj-Koci
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Gerontology ,Male ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Structural equation modeling ,Medication Adherence ,03 medical and health sciences ,Social support ,Adolescent medicine ,Young Adult ,0302 clinical medicine ,030225 pediatrics ,Antiretroviral Therapy, Highly Active ,Developmental and Educational Psychology ,medicine ,Humans ,0501 psychology and cognitive sciences ,Self-efficacy ,Motivation ,business.industry ,05 social sciences ,Social Support ,Viral Load ,Self Efficacy ,Anti-Retroviral Agents ,Social Perception ,Pediatrics, Perinatology and Child Health ,Female ,business ,Viral load ,Inclusion (education) ,Social cognitive theory ,050104 developmental & child psychology ,Regular Articles - Abstract
OBJECTIVE: The goal of the current study was to determine how a set of social cognitive factors predict antiretroviral therapy (ART) medication adherence in youth living with HIV in an era of newer highly active ART medications using a conceptual model. METHODS: Behaviorally infected youth living with HIV ages 13–24 (N = 822) from 14 sites within the Adolescent Medicine Trials Unit (AMTU) were included in the study. Structural equation modeling was used to explore predictors of ART medication adherence. RESULTS: Results found that motivational readiness for ART was related to higher ART medication adherence, which was associated with lower viral load. Higher social support and higher self-efficacy had an indirect relationship with higher adherence through increased motivational readiness. Fewer psychological symptoms were associated with higher social support and higher self-efficacy. Lower substance use was directly associated with lower adherence. CONCLUSIONS: The results provide insight into factors that may be related to adherence in youth living with HIV. Findings suggest focusing on motivational readiness to increase adherence. Improving the patients’ ART self-efficacy and strengthening their social support networks during treatment can increase motivational readiness for ART treatment. Furthermore, programs maybe more effective with the inclusion of risk reduction components especially those related to substance use.
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- 2018
11. Naturalistically observed conflict and youth asthma symptoms
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Valerie A. Simon, Sylvie Naar-King, Richard B. Slatcher, Daniel J. Saleh, Erin T. Tobin, Elizabeth Secord, Heidi S. Kane, Wayne Pierantoni, and Pavadee Poowuttikul
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Male ,Biopsychosocial model ,Adolescent ,media_common.quotation_subject ,Context (language use) ,Lymphocyte proliferation ,Anger ,Article ,Developmental psychology ,Conflict, Psychological ,Interpersonal relationship ,Surveys and Questionnaires ,Humans ,Interpersonal Relations ,Generalizability theory ,Child ,Everyday life ,Applied Psychology ,media_common ,Mental health ,Asthma ,Psychiatry and Mental health ,Caregivers ,Female ,Family Relations ,Self Report ,Psychology - Abstract
Multiple factors in family environment have been known to exacerbate childhood asthma morbidity, such as psychological stress (Marin, Chen, Munch, & Miller, 2009), marital conflict (Northey, Griffin, & Krainz, 1998), parental stress (Shalowitz, Berry, Quinn, & Wolf, 2001), and family conflict (Anda et al., 2006). Additional family characteristics, such as poor caregiver or youth mental health (Ortega, Goodwin, McQuaid, & Canino, 2004; Wood et al., 2007), family disorganization (Kaugars, Klinnert, & Bender, 2004), and minority ethnicity (Bauman et al., 2002) all are contributing components through which the family environment and stress can negatively impact the asthma symptom profile. Research also has demonstrated that increased exposure to stress in adolescents with asthma is associated with greater eosinophil counts, increased lymphocyte proliferation, and increased production of pro-inflammatory cytokines, which may contribute to increased asthma symptom expression (Chen et al., 2006; Kang et al., 1997). Given the accumulating evidence for a biopsychosocial model of asthma, it is important for researchers to identify aspects of relationships that can contribute to the exacerbation and persistence of asthma symptoms. Furthermore, the research to date has largely focused on the extent to which very general family characteristics, such as family-related stress, impact asthma morbidity during youth using parent and youth accounts of the family environment. No investigations to our knowledge have examined the direct effect of daily conflict in everyday life on youth health. Frequent conflict in the home has been theorized to create vulnerabilities in youth by disrupting biological and psychological processes through interactions with genetic and environmental factors (Repetti, Taylor, & Seeman, 2002). Family conflict has been associated with a variety of poor health outcomes, including lower weight attainment in infancy (Stein, Woolley, Cooper, & Fairburn, 1994), slower growth in childhood (Montgomery, Bartley, & Wilkinson, 1997), and greater psychological distress during adolescence (Gunnlaugsson , Kristjansson, Einarsdottir, & Sigfusdottir, 2011). Research also has demonstrated that youth growing up in environments with increased conflict and anger have amplified emotional responses to stressors and more often use maladaptive coping strategies, which negatively impact physical health (Cummings, Zahn-Waxler, & Radke-Yarrow, 1981; Repetti, Robles, & Reynolds, 2011; Valiente, Fabes, Eisenberg, & Spinrad, 2004). Surprisingly, very little is known about the direct impact of conflict at home on serious physical health problems, such as asthma during childhood and adolescence. Moreover, there has been a recent call for research focusing on the adversities youth face on a routine basis, such as family conflict, to clarify links between stress during development and chronic illness (Miller, Chen, & Parker, 2011). Family conflict is a construct that typically is measured via brief questionnaire reports or laboratory interactions. However, questionnaire reports of family conflict include potential sources of bias, aspects of social desirability, and shared method variance (Campbell & Fiske, 1959; Mehl, Robbins, & Deters, 2012). Additionally, assessing family conflict from short laboratory interactions can raise questions regarding generalizability of these interactions, as research has long documented variations in parental behaviors due to changes in the context in which they are measured (Belsky, 1980). Research suggests that data should be collected from multiple informants (e.g., from both parents and children) due to contextual elements and situational determinants that may influence an individual's perceptions (Achenbach, McConaughy, & Howell, 1987; Kerr, Lunkenheimer, & Olson, 2007). Collecting questionnaire data from multiple informants can sometimes pose a challenge in family research. Alternatively, naturalistic observation can provide reasonably objective and detailed accounts of daily interactions in the home. The Electronically Activated Recorder (EAR; Mehl, Pennebaker, Crow, Dabbs, & Price, 2001) is a relatively new naturalistic observation method used to capture participant behaviors and interactions as they occur in daily life. The EAR unobtrusively takes brief recordings of ambient sounds and interactions as they occur in a participant's environment. By taking an observational approach, the EAR helps to address the potential issues of bias, shared method variance, and generalizability that can sometimes hinder questionnaire and laboratory measures of conflict. Previous studies of families have documented the usefulness of the EAR in assessing everyday behaviors in the home. For example, parental negative emotionality (Slatcher & Trentacosta, 2012) and parental depressive symptoms (Slatcher & Trentacosta, 2011) have been linked with increased problem behaviors in young children. Increased observed-conflict in the home of young children (aged 3-5) was associated with an altered diurnal cortisol profile, including flatter (less “healthy”) cortisol slopes and lowered waking cortisol levels, whereas maternal questionnaire reports of daily parent-child conflict were unrelated to cortisol patterns (Slatcher & Robles, 2012). To our knowledge, no studies to date have addressed how naturalistically-observed everyday family interactions are associated with youth asthma symptoms. This study addresses that gap by using the EAR to assess the links between observed conflict in the home and the health of youth with asthma.
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- 2015
12. Effects of Socio-Demographic Factors on Parental Monitoring, and Regimen Adherence Among Adolescents with Type 1 Diabetes: A Moderation Analysis
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April Idalski Carcone, Bassem Dekelbab, Liying Zhang, Sylvie Naar-King, Kathleen Moltz, and Deborah A. Ellis
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Parental monitoring ,Type 1 diabetes ,business.industry ,Multilevel model ,Psychological intervention ,030209 endocrinology & metabolism ,medicine.disease ,Moderation ,Article ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,Clinical research ,Diabetes mellitus ,Developmental and Educational Psychology ,medicine ,030212 general & internal medicine ,Life-span and Life-course Studies ,business ,Clinical psychology - Abstract
Parental monitoring of adolescent diabetes care is an important predictor of adolescent regimen adherence. To date, no studies have investigated whether socio-demographic factors are associated with low levels of parental monitoring or differences in parental monitoring styles, and their moderating effects in families of adolescents with type 1 diabetes. The purpose of this cross-sectional study was to determine whether youth and family socio-demographic factors moderated the relationship between monitoring and youth regimen adherence (i.e., mean frequency of blood glucose testing [BGT]). Data were collected from 267 adolescents with type 1 diabetes and their parents. Hierarchical multiple regression analyses were employed. Socio-demographic factors accounted for 17.1% of the variance in adherence. After parental monitoring scales were entered, R2 in all eight equations increased and R2 change score in six of eight equations were significant. All models were significant after the interaction terms were entered. In the adolescent report models, parent age and family structure were both independently associated with adherence and also moderated the association between adolescent-report parental monitoring and adherence to diabetes care, in particular, adolescent report of parental direct observation/presence during diabetes care. In the parent report models, income was moderated the association between parent-report youth disclosure and adherence. Research should focus on identifying additional modifiable factors that place families at risk for low levels of parental monitoring of diabetes care. Future clinical research is needed to help identify risk factors for low levels of parental monitoring and develop interventions to promote optimal parenting skills that can support youth diabetes care.
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- 2015
13. Computerized intervention to increase motivation for diabetes self-management in adolescents with type 1 diabetes
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Steven J. Ondersma, Dana K. May, Deborah A. Ellis, April Idalski Carcone, Sylvie Naar-King, Dixy Rajkumar, and Kathleen Moltz
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Type 1 diabetes ,Health (social science) ,business.industry ,Multimethodology ,Behavior change ,Motivational interviewing ,medicine.disease ,Article ,Behavioral Neuroscience ,Quality of life (healthcare) ,Diabetes management ,Intervention (counseling) ,Helpfulness ,Medicine ,business ,General Psychology ,Clinical psychology - Abstract
Purpose: The purpose of this study was to assess the feasibility of a three-session computer intervention to improve diabetes management among African-American youth with type 1 diabetes. Methods: The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills model of health behavior change and Motivational Interviewing approaches. Feasibility was assessed based on rates of intervention participation and intervention satisfaction using a mixed-methods approach. Participants included 23 youths aged 10–13. Results: Mean satisfaction rates from questionnaires were high across ratings for both general satisfaction and helpfulness of the intervention for improving diabetes care. Intervention participation rates were also high, with 87% completing all three sessions. Thematic analyses suggests that adolescents found the intervention helpful for changing their diabetes management behaviors, their thoughts about the importance of diabetes care, reminding them to com...
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- 2015
14. African American Emerging Adults’ Perspectives on Taking Asthma Controller Medication
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Phebe Lam, April Idalski Carcone, Karen MacDonell, Sylvie Naar-King, and Wanda Gibson-Scipio
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Gerontology ,education.field_of_study ,Sociology and Political Science ,Interview ,media_common.quotation_subject ,Population ,Psychological intervention ,Context (language use) ,Health equity ,Feeling ,Developmental and Educational Psychology ,Thematic analysis ,education ,Psychology ,media_common ,Clinical psychology ,Qualitative research - Abstract
This study included African Americans with asthma in emerging adulthood, a developmental period largely neglected in the research literature but known to be a time of great risk asthma morbidity and mortality. We conducted thematic analysis of semi-structured interviews ( N = 19) to explore barriers to adherence in the context of the transition into adulthood. Key themes for non-adherence emerged after careful follow-up prompting by the interviewer: forgetting to take medications, deciding not to take medications as prescribed, and systemic barriers. Clinicians and researchers interested in improving adherence should carefully assess barriers to adherence when working with this population. Effective adherence interventions should target both intentional and unintentional reasons for non-adherence behavior and take into account the unique developmental needs of emerging adults.
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- 2014
15. Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial
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April Idalski Carcone, Sylvie Naar-King, Gloria Palmisano, Deborah A. Ellis, Dixy Rajkumar, and Kathleen Moltz
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Blood Glucose ,Male ,medicine.medical_specialty ,Evidence-based practice ,Adolescent ,MEDLINE ,Pilot Projects ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Quality of life (healthcare) ,Randomized controlled trial ,Diabetes management ,law ,030225 pediatrics ,Intervention (counseling) ,Developmental and Educational Psychology ,medicine ,Diabetes Mellitus ,Humans ,Hypoglycemic Agents ,0501 psychology and cognitive sciences ,Poverty ,Glycated Hemoglobin ,Type 1 diabetes ,business.industry ,05 social sciences ,medicine.disease ,Patient Satisfaction ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Quality of Life ,Female ,business ,050104 developmental & child psychology ,Regular Articles - Abstract
Objective To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. Methods In a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n = 26) or standard care (SC) only (n = 24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data. Results Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low. Conclusions Results provide preliminary support for RFC's acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.
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- 2017
16. Multisystemic Therapy for high-risk African American adolescents with asthma: A randomized clinical trial
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Elizabeth Secord, Sylvie Naar-King, Jean-Marie Bruzzese, Thomas Templin, Deborah A. Ellis, Phillippe B. Cunningham, Pamela S. King, and Phebe Lam
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Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Family support ,Psychological intervention ,Article ,Medication Adherence ,law.invention ,Young Adult ,Randomized controlled trial ,law ,Health care ,Ethnicity ,medicine ,Humans ,Multisystemic therapy ,Asthma ,business.industry ,Emergency department ,medicine.disease ,Health equity ,respiratory tract diseases ,Black or African American ,Hospitalization ,Psychotherapy ,Psychiatry and Mental health ,Clinical Psychology ,Female ,business ,human activities - Abstract
Objective The primary purpose of the study was to determine whether Multisystemic Therapy adapted for health care settings (MST-HC) improved asthma management and health outcomes in high-risk African American adolescents with asthma. Method Eligibility included self-reported African American ethnicity, ages 12 to 16, moderate to severe asthma, and an inpatient hospitalization or at least 2 emergency department visits for asthma in the last 12 months. Adolescents and their families (N = 170) were randomized to MST-HC or in-home family support. Data were collected at baseline and posttreatment (7 months) based on an asthma management interview, medication adherence phone diary, and lung function biomarker (forced expiratory volume in 1 s [FEV1]). Analyses were conducted using linear mixed modeling for continuous outcomes and generalized linear mixed modeling for binary outcomes. Results In intent-to-treat analyses, adolescents randomized to MST-HC were more likely to improve on 2 of the measures of medication adherence and FEV1. Per-protocol analysis demonstrated that MST-HC had a medium effect on adherence measures and had a small to medium effect on lung function and the adolescent's response to asthma exacerbations. Conclusion There are few interventions that have been shown to successfully improve asthma management in minority youth at highest risk for poor morbidity and mortality. MST, a home-based psychotherapy originally developed to target behavior problems in youth, improved asthma management and lung function compared to a strong comparison condition. Further follow-up is necessary to determine whether MST-HC reduces health care utilization accounting for seasonal variability. A limitation to the study is that a greater number of participants in the control group came from single-parent families than in the MST group.
- Published
- 2014
17. Adherence to asthma medication regimens in urban African American adolescents: Application of self-determination theory
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Phebe Lam, Deborah A. Ellis, April Idalski Carcone, Jean-Marie Bruzzese, and Sylvie Naar-King
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Male ,Multivariate analysis ,Adolescent ,Urban Population ,Psychological intervention ,MEDLINE ,Medication Adherence ,law.invention ,Randomized controlled trial ,law ,Humans ,Medicine ,Anti-Asthmatic Agents ,Competence (human resources) ,Qualitative Research ,Applied Psychology ,Self-determination theory ,Asthma ,Motivation ,business.industry ,medicine.disease ,Black or African American ,Psychiatry and Mental health ,Adolescent Behavior ,Personal Autonomy ,Female ,Psychological Theory ,business ,Qualitative research ,Clinical psychology - Abstract
Objective: Asthma medication adherence is low, particularly among African American adolescents, a high-risk group with respect to asthma prevalence, morbidity, and mortality. This study tested the utility of self-determination theory (SDT), a theory of motivation, to explain adherence to asthma medication regimens in African American adolescents. Method: We used baseline data from 168 urban African American adolescents (Mage 13.94 years; 61% male) with poorly controlled asthma who were part of a trial testing the efficacy of interventions to improve adherence. Participants and their caregivers were interviewed using the Family Asthma Management System Scale; this study used the Asthma Medication Adherence subscale. Adolescents completed four asthma-specific scales representing the SDT constructs of autonomous motivation (one importance scale), competence (one confidence scale), and relatedness (two scales—family routines and parental support). Using multiple linear regression, we tested the hypothesis that SDT variables would predict adherence. Results: Adherence was significantly correlated with three SDT variables—importance, confidence, and family routines. In multivariate analysis, family routines was the only significant predictor of asthma adherence (p .001). Asthma management behaviors integrated into and shared among family members was associated with better adherence. Greater confidence was marginally associated with increased adherence (p .07). Conclusion: Though several variables representing SDT constructs were correlated with adherence, results demonstrate that family routines may be more relevant for African American adolescents’ adherence than other SDT constructs. Thus, helping families to share and better integrate asthma care into daily schedules may be an important intervention strategy to improve medication adherence among high-risk African American adolescents.
- Published
- 2014
18. Motivational Interviewing Targeting Risky Sex in HIV-Positive Young Thai Men Who Have Sex with Men
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Apirudee Panthong, Torsak Bunupuradah, Chokechai Rongkavilit, Praphan Phanuphak, Bo Wang, Jeffrey T. Parsons, Pichai Saengcharnchai, Juline A. Koken, and Sylvie Naar-King
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sexual Behavior ,Motivational interviewing ,HIV Infections ,Motivational Interviewing ,Article ,law.invention ,Men who have sex with men ,Developmental psychology ,Young Adult ,Risk-Taking ,Arts and Humanities (miscellaneous) ,Randomized controlled trial ,law ,Intervention (counseling) ,HIV Seropositivity ,medicine ,Humans ,Homosexuality, Male ,Young adult ,General Psychology ,Public health ,Thailand ,Mental health ,Sexual Partners ,Sexual orientation ,Psychology ,Risk Reduction Behavior ,Clinical psychology - Abstract
Motivational interviewing (MI) has been shown to reduce sexual risks among HIV-positive men who have sex with men (HMSM) in the U.S. We conducted a randomized trial of Healthy Choices, a 4-session MI intervention, targeting sexual risks among 110 HIV-positive youth ages 16–25 years in Thailand. Risk assessments were conducted at baseline, 1 month, and 6 months post-intervention. This report presents the analysis of 74 HMSM in the study. There were 37 HMSM in the Intervention group and 37 in the control group. The proportions of participants having anal sex and having sex with either HIV-uninfected or unknown partners in past 30 days were significantly lower in Intervention group than in control group at 6 months post-intervention (38% vs. 65%, p = .04; and 27% vs. 62%, p < .01, respectively). There were no significant differences in general mental health scores and HIV stigma scores between the two groups at any study visit. Thirty-five (95%) HMSM in the Intervention group vs. 31 (84%) in control group attended ≥3 sessions. Loss to follow-up was 8% and 30%, respectively (p = .04). Healthy Choices for young Thai HMSM was associated with sexual risk reduction. Improvements in mental health and HIV stigma were noted in Intervention group. Healthy Choices is a promising behavioral intervention and should be further developed to serve the needs of young HMSM in resource-limited countries.
- Published
- 2014
19. A Feasibility Study of Motivational Interviewing for Health Risk Behaviors Among Thai Youth Living With HIV
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Chokechai Rongkavilit, Sylvie Naar-King, Torsak Bunupuradah, Pichai Saengcharnchai, Juline A. Koken, Apirudee Panthong, Jeffrey T. Parsons, and Xinguang Chen
- Subjects
Male ,Adolescent ,Anti-HIV Agents ,Substance-Related Disorders ,media_common.quotation_subject ,Health Behavior ,Population ,Motivational interviewing ,Developing country ,HIV Infections ,Motivational Interviewing ,Article ,Medication Adherence ,Condoms ,Young Adult ,Risk-Taking ,Acquired immunodeficiency syndrome (AIDS) ,Intervention (counseling) ,medicine ,Humans ,Young adult ,education ,media_common ,Advanced and Specialized Nursing ,education.field_of_study ,Cultural Characteristics ,Unsafe Sex ,Behavior change ,Focus Groups ,Thailand ,medicine.disease ,Self Efficacy ,Feasibility Studies ,Female ,Psychology ,Risk Reduction Behavior ,Autonomy ,Program Evaluation ,Clinical psychology - Abstract
hailandisamongthefewless-developedcountrieswith successful HIV prevention among segments ofthe population (National AIDS Prevention andAlleviation Committee, 2010). However, the successof HIV prevention among Thai adolescents andyoung adults has been questionable. The highestpercentage of Thai persons with AIDS remain inthe age group of 25–34 years, indicating that thetime of greatest HIV acquisition has occurred inadolescence and young adulthood (Thai WorkingGroup on HIV/AIDS, 2010). Most Thai youth livingwith HIV (TYLH) acquire HIV through sexualcontact (National AIDS Prevention and AlleviationCommittee, 2010). In a study of TYLH, only half re-ported consistent condom use in the previous 30 days(Rongkavilit et al., 2007); therefore, secondaryprevention targeting sexual risk behaviors in TYLHare needed.Behavioral intervention research targeting youthwith HIV in less-developed countries remains non-existent. An intervention that is brief, culturallyacceptable, and can increase young people’s intrinsicmotivation to reduce risk behaviors and maintainthese changes over time is critically neededfor this setting. Motivational interviewing (MI),an empirically supported behavioral counselingapproach, targets an individual’s intrinsic motivationfor change by exploring and resolving ambivalenceabout behavior change while supporting theindividual’s self-efficacy and autonomy for makingchanges. The MI approach can impact the informa-tion, motivation, and behavioral skills necessary toachieve a behavior change according to theInformation-Motivation-Behavioral Skills model(Fisher & Fisher, 1992). MI has been successfully
- Published
- 2014
20. New Directions in Behavioral Intervention Development for Pediatric Obesity, An Issue of Pediatric Clinics of North America
- Author
-
Sylvie Naar-King and Sylvie Naar-King
- Abstract
Almost one out of every three US children is overweight or obese, with minority youth at highest risk. There are limited efficacious pediatric obesity interventions available for clinicians, and successful weight loss trials for minority youth are rare. Even fewer interventions have been shown to significantly improve clinical health outcomes such as adiposity, blood pressure, and cholesterol level, and maintenance of behavior change over the long-term remains a challenge Translation I research in which'bench'findings are applied to the'bedside'is uncommon in the behavioral arena. Thus, advances in our understanding of fundamental human processes such as motivation, emotion, cognition, self-regulation, decision-making, stress, and social networks are not being optimally applied to our most pressing behavioral health problems. This issue of Pediatric Clinics will focus on promising behavioral treatments'in the pipeline'that have been translated from basic behavioral science and are the process of refinement and proof of concept testing.
- Published
- 2016
21. The initial feasibility of a computer-based motivational intervention for adherence for youth newly recommended to start antiretroviral treatment
- Author
-
Marvin Belzer, Anna Aagenes, Jeffrey T. Parsons, Aids Interventions, Lisa J. Merlo, Mary Tanney, Sylvie Naar-King, and Angulique Y. Outlaw
- Subjects
Male ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Social Psychology ,Exit interview ,Psychological intervention ,MEDLINE ,Motivational interviewing ,HIV Infections ,Pilot Projects ,Motivational Interviewing ,Article ,Medication Adherence ,law.invention ,Young Adult ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Intervention (counseling) ,Humans ,Medicine ,Program Development ,Young adult ,Goal setting ,Motivation ,Computers ,business.industry ,Public Health, Environmental and Occupational Health ,Tennessee ,Treatment Outcome ,Anti-Retroviral Agents ,Florida ,Physical therapy ,Feasibility Studies ,Female ,business - Abstract
Young people represent the largest number of new HIV infections, thus youth living with HIV (YLH) are likely to be the largest group to initiate antiretroviral treatment (ART). Adherence patterns for behaviorally infected YLH are not adequate to effectively manage the disease; therefore, novel interventions are needed to improve medication adherence. The purpose of the current study, which will precede a randomized controlled trial, was to assess the initial feasibility of an individually tailored computer-based two-session interactive motivational interviewing (MI) intervention for YLH newly recommended to start ART. Intervention development occurred in collaboration with three youth advisory groups. Ten youth (ages 18–24) were recruited to participate in this study. Participants completed the intervention online. Intervention components focused on medication adherence (rating perceived importance and confidence, and goal setting). Retention was 100% for both intervention sessions. All participants (n = 10) felt medication adherence was important, but 80% felt confident they could manage their adherence to HIV medications. Ninety percent of participants set the goal of taking their HIV medications exactly as prescribed and reported success achieving this goal at follow-up. Additionally, participants were satisfied with the quality of the sessions and the amount of assistance they received for managing their adherence to HIV medications (90% participants for Session 1; 89% for Session 2). Per exit interview responses, participants felt that the intervention made them think more about their health and was a motivator for them to take better care of their health. In conclusion, the intervention was feasible for YLH enrolled in the study.
- Published
- 2013
22. Asthma Medication Device Skills in High-Risk African American Adolescents
- Author
-
Elizabeth Secord, Sylvie Naar-King, Jean-Marie Bruzzese, Phebe Lam, and Deborah A. Ellis
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,education ,Specialty ,Humans ,Immunology and Allergy ,Medicine ,Anti-Asthmatic Agents ,Child ,Asthma ,African american ,business.industry ,Nebulizers and Vaporizers ,Inhaler ,Attendance ,Emergency department ,Asthma medication ,medicine.disease ,Checklist ,respiratory tract diseases ,Black or African American ,Family medicine ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Female ,business - Abstract
To describe the asthma medication device skills of high-risk African American adolescents and associations between skills and other components of illness management,170 African American adolescents, with at least one hospitalization or two emergency department visits in the last year, demonstrated how they use their asthma quick-relief and controller medication devices. Observations were scored using an in vivo observation asthma skills checklist. To assess other areas of asthma management, adolescents and their primary caregiver were interviewed using the Family Asthma Management System Scales,Only 5% of adolescents correctly demonstrated all controller skills, and none of the adolescents correctly showed all quick-relief inhaler skills (5% showed between 90 and 95% of skills). Several components of asthma management predicting controller medication skills were attendance at an asthma specialty clinic, collaboration with provider, medication adherence, and quick-relief medication skills. These variables accounted for a total of 24% of the variance in controller medication skills,Results indicate the need for interventions directly targeting observed asthma management skills and the importance of relationship with providers.
- Published
- 2013
23. Social Ecological Predictors of Longitudinal HIV Treatment Adherence in Youth With Perinatally Acquired HIV
- Author
-
Sylvie, Naar-King, Grace, Montepiedra, Patricia, Garvie, Betsy, Kammerer, Kathleen, Malee, Patricia A, Sirois, Lisa, Aaron, Sharon L, Nichols, and M, Lavoie
- Subjects
Male ,Special Issue Articles ,Multivariate analysis ,Adolescent ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,Psychological intervention ,Ethnic group ,HIV Infections ,medicine.disease_cause ,Medication Adherence ,Social support ,Surveys and Questionnaires ,HIV Seropositivity ,Developmental and Educational Psychology ,medicine ,Humans ,Longitudinal Studies ,Child ,African american ,business.industry ,Cognitive test ,Caregivers ,Pediatrics, Perinatology and Child Health ,Female ,business ,Psychosocial ,Clinical psychology - Abstract
Objective To apply a social ecological model to explore the psychosocial factors prospectively associated with longitudinal adherence to antiretroviral treatment in youth perinatally infected with HIV. Methods Randomly selected youth, age 8 to
- Published
- 2013
24. Toward a Universal Maintenance Intervention: Integrating Cognitive-Behavioral Treatment With Motivational Interviewing for Maintenance of Behavior Change
- Author
-
Paul Earnshaw, Sylvie Naar-King, and Jeff Breckon
- Subjects
Psychotherapist ,media_common.quotation_subject ,Behavior change ,Psychological intervention ,Motivational interviewing ,Fidelity ,Experimental and Cognitive Psychology ,Cognition ,Relapse prevention ,Psychiatry and Mental health ,Clinical Psychology ,Intervention (counseling) ,Psychology ,Goal setting ,media_common - Abstract
Improvements in behavior following active interventions diminish over time across a broad spectrum of behaviors. Motivational interviewing (MI) has been found to increase intrinsic motivation forinitialbehavior change, but there has been little discussion on how to integrate MI and the cognitive-behavioral treatments (CBTs) commonly used tomaintainchange. A prominent CBT approach to relapse prevention that has been tested in multiple behavioral domains includes the following maintenance strategies: managing the goal violation effect, flexible goal setting, identifying triggers and developing coping skills, and increasing self-efficacy and social support. Using a model of integration where MI is the foundation for CBT delivery, the integration of specific relational and technical components of MI and CBT strategies for maintenance of change are described. A universal maintenance intervention that uses MI as an integrative framework to deliver CBT may address maintenance of behavior change across multiple behavioral domains. Further research is necessary to confirm whether delivering MI with fidelity adds to the effectiveness of CBT maintenance interventions.
- Published
- 2013
25. Calendaring and Alarms Can Improve Naturalistic Time-based Prospective Memory for Youth Infected with HIV
- Author
-
Marika P. Faytell, Sylvie Naar-King, Katie L. Doyle, Steven Paul Woods, Angulique Y. Outlaw, Sharon Nichols, and Elizabeth W. Twamley
- Subjects
Male ,050103 clinical psychology ,Time Factors ,Statistics as Topic ,Human immunodeficiency virus (HIV) ,HIV Infections ,Neuropsychological Tests ,medicine.disease_cause ,Medical and Health Sciences ,Developmental psychology ,Task (project management) ,AIDS dementia complex ,Time-Based Prospective Memory ,cue salience ,Prospective memory ,Activities of Daily Living ,Young adult ,Episodic memory ,Applied Psychology ,Pediatric ,Infectious disease ,Mental Disorders ,05 social sciences ,Rehabilitation ,Neurological Rehabilitation ,episodic memory ,Neuropsychology and Physiological Psychology ,neuropsychological rehabilitation ,HIV/AIDS ,Female ,Psychology ,Episodic ,Infection ,Hiv disease ,medicine.medical_specialty ,Memory, Episodic ,Clinical Trials and Supportive Activities ,050105 experimental psychology ,Article ,ALARM ,Young Adult ,Physical medicine and rehabilitation ,Arts and Humanities (miscellaneous) ,Memory ,Clinical Research ,Behavioral and Social Science ,medicine ,Humans ,0501 psychology and cognitive sciences ,Psychiatric Status Rating Scales ,Memory Disorders ,Psychology and Cognitive Sciences - Abstract
Individuals with HIV disease often evidence deficits in prospective memory (PM), which interfere with daily functioning and increase the risk of suboptimal health behaviours. This study examined the benefits of simple encoding and cueing supports on naturalistic time-based PM in 47 HIV-positive young adults. All participants completed a naturalistic time-based PM task in which they were instructed to text the examiner once per day for seven days at a specified time. Participants were randomised into (1) a Calendaring condition in which they created a calendar event in their mobile telephone for the specified texting time; (2) an Alarm condition in which they programmed an alarm into their mobile telephone for the specified texting time; (3) a Combined calendaring and alarm condition; and (4) a Control condition. Participants in the Combined condition demonstrated significantly better naturalistic PM performance than participants in the Control and Calendaring conditions. Findings indicate that HIV-positive young people may benefit from a combined calendaring and alarm supportive strategy for successful execution of future intentions in daily life.
- Published
- 2016
26. Multisystemic therapy for poorly adherent youth with HIV: Results from a pilot randomized controlled trial
- Author
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Deborah A. Ellis, Elizabeth J. Letourneau, Jason E. Chapman, Sylvie Naar-King, Sandra L. Fowler, and Phillippe B. Cunningham
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Health (social science) ,Adolescent ,Social Psychology ,Anti-HIV Agents ,Motivational interviewing ,Human immunodeficiency virus (HIV) ,Medication adherence ,Home Care Services, Hospital-Based ,Pilot Projects ,Context (language use) ,medicine.disease_cause ,Article ,Medication Adherence ,law.invention ,Randomized controlled trial ,Risk Factors ,law ,Intervention (counseling) ,Internal medicine ,HIV Seropositivity ,Humans ,Medicine ,Community Health Services ,Child ,Multisystemic therapy ,business.industry ,Public Health, Environmental and Occupational Health ,Viral Load ,United States ,CD4 Lymphocyte Count ,Self Care ,Adolescent Behavior ,Physical therapy ,Female ,business ,Viral load - Abstract
Adherence to antiretroviral medication for the treatment of HIV is a significant predictor of virologic suppression and is associated with dramatic reductions in mortality and morbidity and other improved clinical outcomes for pediatric patient populations. Effective strategies for addressing adherence problems in youth infected with HIV are needed and require significant attention to the complex interplay of multiple, interacting causal risk factors that lead to poor self-care. Within the context of a pilot randomized trial, we evaluated the feasibility and initial efficacy of a multisystemic therapy (MST) intervention adapted to address HIV medication adherence problems against a usual care condition that was bolstered with a single session of motivational interviewing (MI). For 34 participating youth, health outcomes (viral load [VL] and CD4 count) were obtained from approximately 10 months pre-baseline through approximately 6 months post-baseline and self-reported medication adherence outcomes were obtained quarterly from baseline through 9 months post-baseline. Using mixed-effects regression models we examined within- and between-groups differences in the slopes of these outcomes. Feasibility was supported, with a 77% recruitment rate and near-maximal treatment and research retention and completion rates. Initial efficacy also was supported, with the MST condition but not the MI condition demonstrating statistically and clinically significant VL reductions following the start of treatment. There was also some support for improved CD4 count and self-reported medication adherence for the MST but not the MI condition. MST was successfully adapted to improve the health outcomes of youth poorly adherent to antiretroviral medications. Replication trials and studies designed to identify the mechanisms of action are important next steps.
- Published
- 2012
27. Multisystemic Therapy Compared to Telephone Support for Youth with Poorly Controlled Diabetes: Findings from a Randomized Controlled Trial
- Author
-
Sylvie Naar-King, Kathleen Moltz, Deborah A. Ellis, April Idalski-Carcone, Xinguang Chen, and Phillippe B. Cunningham
- Subjects
Blood Glucose ,Male ,Family therapy ,medicine.medical_specialty ,Adolescent ,Psychological intervention ,MEDLINE ,Article ,law.invention ,Randomized controlled trial ,Behavior Therapy ,law ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Child ,Multisystemic therapy ,General Psychology ,Glycated Hemoglobin ,business.industry ,Remote Consultation ,medicine.disease ,Telephone ,Psychiatry and Mental health ,Health psychology ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Metabolic control analysis ,Physical therapy ,Patient Compliance ,Family Therapy ,Female ,business - Abstract
Few interventions have effectively improved health outcomes among youth with diabetes in chronic poor metabolic control.This study aims to determine whether multisystemic therapy (MST), an intensive, home-based, tailored family treatment, was superior to weekly telephone support for improving regimen adherence and metabolic control among adolescents with chronic poor metabolic control.A randomized controlled trial was conducted with 146 adolescents with types 1 or 2 diabetes. Data were collected at baseline, 7 months (treatment termination), and 12 months (6 months follow-up).Adolescents receiving MST had significantly improved metabolic control at 7 (1.01 % decrease) and 12 months (0.74 % decrease) compared to adolescents in telephone support. Parents of adolescents receiving MST reported significant improvements in adolescent adherence. However, adolescent-reported adherence was unchanged.MST improved health outcomes among adolescents with chronic poor metabolic control when compared to telephone support. Home-based approaches may provide a viable means to improve access to behavioral interventions for such youth.
- Published
- 2012
28. Factors Associated with Weight Resilience in Obesogenic Environments in Female African-American Adolescents
- Author
-
Deborah A. Ellis, K.-L. Catherine Jen, Sylvie Naar-King, Sharon Marshall, Kathryn Brogan, and April Idalski Carcone
- Subjects
Gerontology ,Michigan ,Multivariate analysis ,Adolescent ,Cross-sectional study ,Health Behavior ,Models, Psychological ,Motor Activity ,Logistic regression ,Article ,Body Mass Index ,Risk Factors ,medicine ,Humans ,Obesity ,Child ,Family Characteristics ,Nutrition and Dietetics ,Parenting ,business.industry ,Body Weight ,General Medicine ,Odds ratio ,medicine.disease ,Confidence interval ,Diet ,Black or African American ,Cross-Sectional Studies ,Caregivers ,Socioeconomic Factors ,Adolescent Behavior ,Female ,business ,Body mass index ,Psychosocial ,Food Science ,Demography - Abstract
This study used a descriptive, cross-sectional analysis to examine a social ecological model of obesity among African-American female adolescents residing in obesogenic environments. The goal was to identify factors that promote weight resilience, defined as maintaining a healthy body weight despite living in an environment that encourages inactivity and undermines healthy weight behaviors. During 2005 to 2008, weight-resilient (n=32) and obese (n=35) African-American female adolescents (12 to 17 years) living in Detroit, MI, and their caregivers completed measures of individual, family, and extrafamilial weight-resilience factors. Variables related to weight resilience in bivariate analyses were subjected to multivariate analysis using logistic regression to test the hypothesis that these factors independently predicted adolescent membership into the weight-resilient or obese group. As hypothesized, the odds of an adolescent being weight resilient were predicted by lower caregiver body mass index (calculated as kg/m 2 ) (odds ratio [OR]=0.790; 95% confidence interval [CI]: 0.642 to 0.973), lower caregiver distress (OR=0.796; 95% CI: 0.635 to 0.998), higher caregiver monitoring and supervision of exercise (OR=5.746; 95% CI: 1.435 to 23.004), more frequent full-service grocery store shopping (OR=5.147; 95% CI: 1.137 to 23.298), and more peer support for eating (OR=0.656; 95% CI: 0.445 to 0.969). Contrary to prediction, lower eating self-efficacy (OR=0.597; 95% CI: 0.369 to 0.965) also predicted weight resilience. The model correctly classified 92.5% of all cases. Findings suggest that increasing psychosocial weight-resilience factors across multiple systems might be an important intervention strategy for obese African-American female adolescents residing in obesogenic environments.
- Published
- 2012
29. Psychometric Properties of the Revised Parental Monitoring of Diabetes Care Questionnaire in Adolescents With Type 1 Diabetes
- Author
-
Thomas Templin, Sylvie Naar-King, Bassem Dekelbab, Kathleen Moltz, Deborah A. Ellis, and April Idalski Carcone
- Subjects
Male ,Parents ,Parental monitoring ,medicine.medical_specialty ,Adolescent ,Psychometrics ,MEDLINE ,Article ,Parental supervision ,Surveys and Questionnaires ,Diabetes mellitus ,Internal consistency ,medicine ,Humans ,Child ,Parental knowledge ,Psychiatry ,Type 1 diabetes ,business.industry ,Public Health, Environmental and Occupational Health ,medicine.disease ,Self Care ,Psychiatry and Mental health ,Diabetes Mellitus, Type 1 ,Pediatrics, Perinatology and Child Health ,Female ,business ,Clinical psychology - Abstract
We evaluated the psychometric properties of a revised version of the Parental Monitoring of Diabetes Care questionnaire (PMDC-R) designed to evaluate parental supervision and monitoring of adolescent diabetes care behaviors. The revised measure was intended to capture a broad range of ways used by parents to gather information about youth adherence to diabetes care.Two hundred sixty-seven caregivers of 12-18-year-old adolescents with type 1 diabetes completed the PMDC-R. Measures of parental knowledge of youth illness management, illness management behavior, and metabolic control were also obtained.The PMDC-R demonstrated good internal consistency (alpha coefficient = .91) and test-retest reliability (r = .79, p.001). Supporting the instrument's construct validity, a bifactor model with one primary factor and three secondary factors had an acceptable fit to the data (comparative fit index = .92, root mean square error of approximation = .06). Concurrent validity was also supported. In structural equation models, parental monitoring, as assessed by the PMDC-R, had a significant direct effect on parental knowledge of adolescent diabetes management and, through knowledge, an indirect effect on adolescent diabetes management and metabolic control.The PMDC-R displayed strong psychometric properties and represents an important next step in refining the measurement of parental monitoring for youth with chronic illnesses.
- Published
- 2012
30. A Cross-Cultural Three-Step Process Model for Assessing Motivational Interviewing Treatment Fidelity in Thailand
- Author
-
Sanya Umasa, Sylvie Naar-King, Chokechai Rongkavilit, Praphan Phanuphak, Jeffrey T. Parsons, Juline A. Koken, and Pichai Saengcharnchai
- Subjects
Cross-Cultural Comparison ,Quality Assurance, Health Care ,media_common.quotation_subject ,Population ,Motivational interviewing ,Psychological intervention ,Fidelity ,HIV Infections ,Context (language use) ,Motivational Interviewing ,Article ,Medication Adherence ,Arts and Humanities (miscellaneous) ,Nursing ,Humans ,Medicine ,Cross-cultural ,Cooperative Behavior ,education ,Language ,media_common ,Medical education ,education.field_of_study ,Cultural Characteristics ,business.industry ,Public Health, Environmental and Occupational Health ,Thailand ,Feasibility Studies ,Health education ,business ,Cultural competence - Abstract
The provision of culturally relevant yet evidence-based interventions has become crucial to global HIV prevention and treatment efforts. In Thailand, where treatment for HIV has become widely available, medication adherence and risk behaviors remain an issue for Thai youth living with HIV. Previous research on motivational interviewing (MI) has proven effective in promoting medication adherence and HIV risk reduction in the United States. However, to test the efficacy of MI in the Thai context a feasible method for monitoring treatment fidelity must be implemented. This article describes a collaborative three-step process model for implementing the MI Treatment Integrity (MITI) across cultures while identifying linguistic issues that the English-originated MITI was not designed to detect as part of a larger intervention for Thai youth living with HIV. Step 1 describes the training of the Thai MITI coder, Step 2 describes identifying cultural and linguistic issues unique to the Thai context, and Step 3 describes an MITI booster training and incorporation of the MITI feedback into supervision and team discussion. Throughout the process the research team collaborated to implement the MITI while creating additional ways to evaluate in-session processes that the MITI is not designed to detect. The feasibility of using the MITI as a measure of treatment fidelity for MI delivered in the Thai linguistic and cultural context is discussed.
- Published
- 2012
31. Visualisation of future task performance improves naturalistic prospective memory for some younger adults living with HIV disease
- Author
-
Katie L. Doyle, Steven Paul Woods, Kaitlin B. Casaletto, Angulique Y. Outlaw, Sharon Nichols, Sylvie Naar-King, and Marika P. Faytell
- Subjects
Male ,medicine.medical_specialty ,Memory, Episodic ,HIV Infections ,Neuropsychological Tests ,050105 experimental psychology ,Article ,Cohort Studies ,03 medical and health sciences ,Random Allocation ,Young Adult ,0302 clinical medicine ,Physical medicine and rehabilitation ,Arts and Humanities (miscellaneous) ,Prospective memory ,medicine ,Humans ,Learning ,0501 psychology and cognitive sciences ,Neuropsychological assessment ,Young adult ,Psychiatry ,Episodic memory ,Applied Psychology ,Memory Disorders ,medicine.diagnostic_test ,05 social sciences ,Rehabilitation ,Neuropsychology ,Neurological Rehabilitation ,Cognition ,Neuropsychology and Physiological Psychology ,Logistic Models ,Treatment Outcome ,Imagination ,Female ,Psychology ,Neurocognitive ,030217 neurology & neurosurgery ,Cohort study - Abstract
Human immunodeficiency virus (HIV) disease is commonly associated with deficits in prospective memory (PM), which increase the risk of suboptimal health behaviours, like medication non-adherence. This study examined the potential benefits of a brief future visualisation exercise during the encoding stage of a naturalistic PM task in 60 young adults (aged 19-24 years) with HIV disease. Participants were administered a brief clinical neuropsychological assessment, which included a standardised performance-based measure of time- and event-based PM. All participants were also given a naturalistic PM task in which they were asked to complete a mock medication management task when the examiner showed them the Grooved Pegboard Test during their neuropsychological evaluation. Participants were randomised into: (1) a visualisation condition in which they spent 30 sec imagining successfully completing the naturalistic PM task; or (2) a control condition in which they repeated the task instructions. Logistic regression analyses revealed significant interactions between clinical neurocognitive functions and visualisation. HIV positive (HIV+) participants with intact retrospective learning and/or low time-based PM demonstrated observable gains from the visualisation technique, while HIV+ participants with impaired learning and/or intact time-based PM did not evidence gains. Findings indicate that individual differences in neurocognitive ability moderate the response to visualisation in HIV+ young adults. The extent to which such cognitive supports improve health-related PM outcomes (e.g., medication adherence) remains to be determined.
- Published
- 2015
32. Motivational Interviewing in Adolescent Treatment
- Author
-
Sylvie Naar-King
- Subjects
education.field_of_study ,Psychotherapist ,Population ,MEDLINE ,Motivational interviewing ,Psychological intervention ,Physical health ,Cognition ,law.invention ,Psychiatry and Mental health ,Randomized controlled trial ,law ,Substance use ,Psychology ,education ,Clinical psychology - Abstract
This paper briefly reviews the research literature on motivational interviewing (MI) and behaviour change in adolescents and then discusses the implications of adolescent cognitive and social–emotional developmental processes for the relational and technical components of MI. Research suggests that MI is efficacious in improving substance use in adolescents. Research has been slower to emerge in other behaviours, but available randomized controlled trials suggest that MI has great promise for improving mental and physical health outcomes in this developmental period. The relational and technical components of MI are highly relevant for the adolescent developmental period, and studies have shown that these components are related to outcomes in this population. There are several ways to include MI in clinical interventions for adolescents, ranging from MI in brief settings to using MI as a platform from which all other treatments are offered. Future research is necessary to test the effects of MI in adolescent group settings and the full integration of MI into other adolescent treatment approaches.
- Published
- 2011
33. Social Support for Diabetes Illness Management: Supporting Adolescents and Caregivers
- Author
-
April Idalski Carcone, Sylvie Naar-King, Arlene Weisz, and Deborah A. Ellis
- Subjects
Adult ,Blood Glucose ,Male ,Adolescent ,Health care provider ,Friends ,Social Environment ,Article ,Structural equation modeling ,Social support ,Illness management ,Diabetes management ,Surveys and Questionnaires ,Intervention (counseling) ,Diabetes mellitus ,Diabetes Mellitus ,Developmental and Educational Psychology ,Humans ,Hypoglycemic Agents ,Insulin ,Medicine ,Family ,Glycated Hemoglobin ,business.industry ,Disease Management ,Social Support ,medicine.disease ,Test (assessment) ,Psychiatry and Mental health ,Treatment Outcome ,Caregivers ,Pediatrics, Perinatology and Child Health ,Female ,business ,Clinical psychology - Abstract
The aim of this research study was to examine the relationship between 4 sources of social support (support for the adolescent from family, support for the adolescent from friends, support for the caregiver from another adult, and support to the family from the health care provider) and adolescents' diabetes outcomes (illness management behavior and health status) using a diverse sample of urban adolescents.One hundred forty-one adolescents with insulin-managed diabetes and their primary caregivers completed questionnaires assessing social support and illness management behavior. Glucose meters were downloaded and hemoglobin A1c assays were obtained. Structural equation modeling was used to test a model social support informed by social ecological theory.The results of the structural equation modeling indicated that support for the caregiver from another adult was directly and positively related to support for the adolescent from family and indirectly related to better illness management. Support for the adolescent from family was directly related to better diabetes management and, through better management, to better diabetes health. Support to the family from the health care provider was not related to support for the adolescent and support to the adolescent from friends was not related to illness management, as hypothesized.This study identifies a novel target for social support intervention to improve adolescents' illness management behavior-the caregivers of adolescents with diabetes. By enhancing the social support caregivers receive from other adults in their lives, caregivers' ability to support their adolescent children with diabetes might also be improved which, in turn, improves adolescents' illness outcomes.
- Published
- 2011
34. Adolescent and Parent Motivation for Change Affects Psychotherapy Outcomes Among Youth With Poorly Controlled Diabetes
- Author
-
April Idalski Carcone, Heidi Berio, Deborah A. Ellis, and Sylvie Naar-King
- Subjects
Adult ,Male ,Parents ,Family therapy ,Psychotherapist ,Adolescent ,media_common.quotation_subject ,Fidelity ,Structural equation modeling ,Developmental psychology ,law.invention ,Randomized controlled trial ,Behavior Therapy ,law ,Diabetes mellitus ,Diabetes Mellitus ,Developmental and Educational Psychology ,medicine ,Humans ,media_common ,Motivation ,Middle Aged ,medicine.disease ,Test (assessment) ,Treatment Outcome ,Alliance ,Metabolic control analysis ,Pediatrics, Perinatology and Child Health ,Special Section: Intervention ,Family Therapy ,Female ,Psychology ,Clinical psychology - Abstract
Objectives Investigate effect of baseline motivation for change on treatment fidelity, therapeutic alliance, treatment dose, and treatment outcome in a randomized controlled trial of family therapy for youth with poorly controlled diabetes. Methods Seventy-four adolescents and caregivers completed measures of motivation for change. Measures of fidelity, alliance, dose, and youth health status were collected. Structural equation modeling was used to test the direct and indirect effects of motivation on treatment outcomes. Results Parent motivation was significantly related to alliance and fidelity. Only alliance was significantly related to posttreatment metabolic control. In adolescent models, only motivation was significantly related to alliance. In both models, motivation had a significant indirect effect on metabolic control through alliance. Conclusions Findings demonstrate the importance of parent and youth initial motivational status and treatment alliance to treatment outcome among youth with poorly controlled diabetes. Additional research on treatment techniques that promote motivation for change is needed.
- Published
- 2011
35. A Clinic-based Motivational Intervention Improves Condom Use Among Subgroups of Youth Living With HIV
- Author
-
Xinguang Chen, Jeffrey T. Parsons, Sylvie Naar-King, and Debra A. Murphy
- Subjects
education.field_of_study ,Harm reduction ,business.industry ,Population ,Public Health, Environmental and Occupational Health ,Motivational interviewing ,Psychological intervention ,medicine.disease ,Developmental psychology ,law.invention ,Psychiatry and Mental health ,Condom ,Randomized controlled trial ,Acquired immunodeficiency syndrome (AIDS) ,law ,Pediatrics, Perinatology and Child Health ,Medicine ,Young adult ,education ,business ,Clinical psychology - Abstract
Purpose More than 50% of youth living with HIV (YLH) have unprotected sex. In previous studies, we reported effects of a motivational interviewing-based multirisk reduction intervention, "Healthy Choices" in improving motivation, depression, and viral load in YLH. In this study, we report the effect of the intervention on increasing condom use. Methods Six waves of longitudinal data (n = 142) across a period from baseline through 15 months postintervention were analyzed. The developmental trajectory modeling method was used for program effect evaluation. Results The three groups detected with distinct sexual risks were: Persistent low sexual risk (PLSR), delayed high sexual risk, and high and growing sexual risk with regard to levels and time trajectories of condom use throughout the trial. Receiving Healthy Choices increased the likelihood to be in the PLSR group (63% vs. 32%, p p β = −.325, p β = −.364, p Conclusion The motivational interviewing-based program Healthy Choices, when delivered in clinic settings, can prevent unprotected sex in subgroups of YLH, although more intensive interventions may be needed to change risk trajectories among those at highest risk of transmitting the AIDS virus. Developmental trajectory analysis provides an alternative approach to evaluate program effects for study samples that contain distinct subgroups.
- Published
- 2011
36. Treatment Engagement in a Weight Loss Intervention for African American Adolescents and Their Families
- Author
-
Phillippe B. Cunningham, Karen E. MacDonell, Linda Kaljee, Sylvie Naar-King, Deborah A. Ellis, and April Idalski Carcone
- Subjects
African american ,business.industry ,Psychological intervention ,medicine.disease ,Obesity ,Treatment engagement ,Clinical Psychology ,Weight loss ,Pediatrics, Perinatology and Child Health ,Developmental and Educational Psychology ,medicine ,medicine.symptom ,business ,Multisystemic therapy ,Clinical psychology - Abstract
African American adolescents are disproportionately affected by obesity. Few interventions target this group, produce sustainable results, and retain participants. Phenomenology was used to compare the treatment experiences of African American families in multisystemic therapy for weight loss. Families that discontinued treatment described life problems and negative experiences with interventions as barriers. Therapeutic time was spent building confidence and motivation for treatment. Although successful families struggled with intrafamilial relationships, they were more engaged in treatment and experienced greater weight loss. Instilling hope is one strategy proposed to increase treatment engagement in families dealing with serious life problems.
- Published
- 2011
37. Applying the Information-Motivation-Behavioral Skills Model in Medication Adherence Among Thai Youth Living with HIV: A Qualitative Study
- Author
-
Juline A. Koken, Sylvie Naar-King, Linda Kaljee, Apirudee Panthong, Jeffrey T. Parsons, Chokechai Rongkavilit, and Torsak Bunupuradah
- Subjects
Male ,Adolescent ,Anti-HIV Agents ,Population ,Psychological intervention ,Motivational interviewing ,Developing country ,HIV Infections ,Qualitative property ,Models, Psychological ,Article ,Medication Adherence ,Young Adult ,Acquired immunodeficiency syndrome (AIDS) ,Behavior Therapy ,medicine ,Humans ,education ,Qualitative Research ,Motivation ,education.field_of_study ,Individualistic culture ,business.industry ,Public Health, Environmental and Occupational Health ,Thailand ,medicine.disease ,Infectious Diseases ,Patient Compliance ,Female ,business ,Clinical psychology ,Qualitative research - Abstract
With disproportionately higher rates of HIV/AIDS among youth and increasing access to antiretroviral therapy (ART) in Thailand, there is a growing urgency in understanding the challenges to medication adherence confronting this population and in developing theory-based interventions to address these challenges. One potentially relevant model, the information-motivation-behavioral skills (IMB) model of adherence, was developed in Western settings characterized by a more individualistic culture in contrast to the more collectivistic culture of Thailand. We explored the application and adaptability of IMB on ART adherence among HIV-positive Thai youth through the analysis of qualitative data from a pilot motivational interviewing study. Twenty-two interview sessions from 10 HIV-positive Thai youth (17–24 years) were analyzed; 6 youth were on ART. Data support the utility of IMB as a potential framework for understanding ART adherence in this population. However, data indicate a consideration to expand the motivation construct of IMB to incorporate youths' perceived familial and social responsibilities and the need to adhere to medications for short- and long-term well-being of self, family, and society in a context of Buddhist values. These modifications to IMB could be relevant in other cultural settings with more collectivistic worldviews.
- Published
- 2010
38. The Effects of Multisystemic Therapy on Family Support for Weight Loss Among Obese African-American Adolescents: Findings From a Randomized Controlled Trial
- Author
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Karen Kolmodin, Deborah A. Ellis, Sharon Marshall, Heather C. Janisse, Phillippe B. Cunningham, Sylvie Naar-King, and K-L Catherine Jen
- Subjects
Male ,Family therapy ,medicine.medical_specialty ,Adolescent ,Diet, Reducing ,Family support ,Systems Theory ,Overweight ,Body Mass Index ,law.invention ,Randomized controlled trial ,Weight loss ,law ,Weight Loss ,Developmental and Educational Psychology ,medicine ,Body Fat Distribution ,Humans ,Child ,Exercise ,Multisystemic therapy ,Social Support ,medicine.disease ,Obesity ,Obesity, Morbid ,Black or African American ,Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,Body Composition ,Physical therapy ,Family Therapy ,Female ,medicine.symptom ,Psychology ,Body mass index - Abstract
Objective To determine whether multisystemic therapy, an intensive, home- and community-based intervention, could increase family support for healthy eating and exercise in obese African-American adolescents. Relationships between changes in family support, weight status, and body fat composition at the end of the trial were also evaluated. Method A pilot randomized clinical trial was conducted with 49 obese adolescents (body mass index > or = 95th %ile). Participants were randomized to receive multisystemic therapy or Shapedown, a group weight loss intervention. Participants received treatment for 6 months. Data were collected at baseline and 7-month posttest (i.e., treatment termination). Changes in family support for healthy eating and exercise were assessed by self-report questionnaire. Bivariate analyses were used to assess the relationship between change in family support during the trial and youth body mass index, percent overweight, and body fat composition at follow-up. Results Participation in multisystemic therapy was associated with significantly greater improvements in family encouragement for healthy eating and family participation in exercise and greater decreases in discouraging behavior from family members than Shapedown participation. Increases in family participation in exercise were significantly related to lower youth body mass index, percent overweight, and body fat composition at follow-up. Conclusions Intensive, home- and community-based treatment increased family support for health behavior changes among obese minority adolescents, and these changes were directly related to weight status. Such health improvements are important for the well-being of a subset of youth who are at high risk for future health complications.
- Published
- 2010
39. Health literacy and antiretroviral adherence among HIV-infected adolescents
- Author
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Larry R. Muenz, D. Robert Harris, Sylvie Naar-King, Debra A. Murphy, Jeffrey T. Parsons, and Phebe Lam
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Adolescent ,Human immunodeficiency virus (HIV) ,Medication adherence ,HIV Infections ,Health literacy ,medicine.disease_cause ,Antiviral Agents ,Article ,Medication Adherence ,Young Adult ,Surveys and Questionnaires ,Hiv infected ,mental disorders ,Confidence Intervals ,medicine ,Humans ,Young adult ,Child ,Psychiatry ,business.industry ,Communication ,virus diseases ,General Medicine ,Patient Acceptance of Health Care ,United States ,CD4 Lymphocyte Count ,Health Literacy ,Logistic Models ,Adolescent Behavior ,Family medicine ,Linear Models ,Female ,business ,Risk Reduction Behavior ,psychological phenomena and processes - Abstract
This study investigates HIV positive adolescents' health literacy and whether factors associated with health literacy in HIV-positive adults are associated with health literacy among HIV-positive adolescents.Adolescents in this study were behaviorally and perinatally HIV-infected youth (n=186) from five U.S. cities. Participants had a mean age of 20.5, and 49.5% were male.Contrary to findings for adult HIV-positive patients, among adolescents health literacy was not significantly associated with: medication adherence adjusting for age and education level; viral load; or self-efficacy to adhere to medication regimens. The only significant association was of health literacy with medical care received.Practice implications are discussed.
- Published
- 2010
40. Using Motivational Interviewing in HIV Field Outreach With Young African American Men Who Have Sex With Men: A Randomized Clinical Trial
- Author
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Elizabeth Secord, Sylvie Naar-King, Angulique Y. Outlaw, Monique Green-Jones, Heather C. Janisse, and Jeffrey T. Parsons
- Subjects
Counseling ,Male ,Program evaluation ,Gerontology ,Michigan ,medicine.medical_specialty ,Adolescent ,Research and Practice ,education ,Motivational interviewing ,Men who have sex with men ,law.invention ,Interviews as Topic ,Young Adult ,Randomized controlled trial ,Acquired immunodeficiency syndrome (AIDS) ,law ,HIV Seropositivity ,Humans ,Mass Screening ,Medicine ,Homosexuality, Male ,Young adult ,health care economics and organizations ,Motivation ,business.industry ,Public Health, Environmental and Occupational Health ,medicine.disease ,Community-Institutional Relations ,Black or African American ,Outreach ,Family medicine ,Health education ,business ,Program Evaluation - Abstract
Objectives. We sought to determine whether field outreach with motivational interviewing, as compared with traditional field outreach, leads to increases in HIV counseling and testing and rates of return for test results among young African American men who have sex with men (MSM). Methods. In a randomized, 2-group, repeated-measures design, 96 young African American MSM completed a motivational interviewing—based field outreach session and 92 young African American MSM completed a traditional field outreach session. The percentages of participants agreeing to traditional HIV counseling and testing (an oral swab of the cheek) and returning for test results were the primary outcome measures. Results. More of the participants in the motivational interviewing condition than the control condition received HIV counseling and testing (49% versus 20%; χ21 = 17.94; P = .000) and returned for test results (98% versus 72%; χ21 = 10.22; P = .001). Conclusions. The addition of motivational interviewing to field outreach is effective in encouraging high-risk young African American MSM to learn their HIV status. Also, peer outreach workers can be effectively trained to reduce health disparities by providing evidence-based brief counseling approaches targeting high-risk minority populations.
- Published
- 2010
41. Multiple Risk Behaviors Among Youth Living with Human Immunodeficiency Virus in Five U.S. Cities
- Author
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Mary R, Tanney, Sylvie, Naar-King, Debra A, Murphy, Jeffrey T, Parsons, Heather, Janisse, and V, Conners
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Urban Population ,Substance-Related Disorders ,Psychological intervention ,HIV Infections ,Article ,HIV Long-Term Survivors ,Young Adult ,Risk-Taking ,Acquired immunodeficiency syndrome (AIDS) ,Surveys and Questionnaires ,medicine ,Humans ,Psychiatry ,Sida ,Unsafe Sex ,biology ,business.industry ,Public Health, Environmental and Occupational Health ,Social environment ,medicine.disease ,biology.organism_classification ,United States ,Substance abuse ,Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,Lentivirus ,Patient Compliance ,Female ,Viral disease ,business ,Viral load - Abstract
Purpose To describe multiple risk behaviors (substance use, sexual risk, and medication adherence) in a multi-site sample of youth living with human immunodeficiency virus (HIV) in five U.S. cites. Methods Youth (N=352) were recruited from four Adolescent Trials Network (ATN) sites (Philadelphia, Fort Lauderdale, Baltimore, and Los Angeles) and one non-ATN site in Detroit and screened for multiple problem behaviors for an intervention study. A substance abuse problem was determined with the CRAFFT, a six-item adolescent screener. Single items were used to screen for current sexual risk and for an HIV medication adherence problem. Of the youth, 239 (68%) had at least one of the three risk behavior problems based on the screener. A total of 186 (52.8%) completed longer, in-depth questionnaires for each problem behavior. Results Of the 352 youth screened, 60% had problem level substance use and 42% had a sexual risk problem. Of the 165 (47%) who were prescribed medications, 91 (55%) reported an adherence problem. A total of 112 (32%) reported no problem behavior, 123 (35%) reported 1 problem behavior, 95 (27%) reported 2 problem behaviors, and 20 (6%) reported 3 problem behaviors. Males were more likely to have a substance use problem. Younger youth living with HIV and those perinatally infected were more likely to have an adherence problem. Among the 186 (52.8%) completing longer measures, those with a substance abuse problem had higher substance use on a timeline follow-back procedure than those without. Participants who screened positive for a sexual risk problem reported more unprotected sex on an in-depth interview than those without. Those who screened positive for an adherence problem had higher viral loads than those without an adherence problem. Conclusions Results suggest high rates of problem behaviors among youth living with HIV, particularly in older youth. Younger and perinatally infected youth may require specialized adherence interventions. Associations between the screener and more in-depth assessment measures suggest potential clinical utility of screening youth for high-risk behaviors.
- Published
- 2010
42. Treating Pediatric Obesity Using an Empirically Supported Treatment: A Case Report
- Author
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Phillippe B. Cunningham, Deborah A. Ellis, and Sylvie Naar-King
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Health Behavior ,Health Promotion ,Overweight ,Social Environment ,Multiple risk factors ,Body Mass Index ,Behavior Therapy ,Intervention (counseling) ,Developmental and Educational Psychology ,medicine ,Humans ,Effective treatment ,Community Health Services ,Obesity ,Psychiatry ,Exercise ,Multisystemic therapy ,Caloric Restriction ,African american ,Parenting ,business.industry ,medicine.disease ,Black or African American ,Substance abuse ,Clinical Psychology ,Family medicine ,medicine.symptom ,business ,human activities - Abstract
Overweight and obesity are increasing dramatically in the United States of America, especially among children. Effective treatment of the multiple risk factors that promote youth obesity requires treatment approaches that are flexible and comprehensive enough to address each of these factors. One such treatment approach is Multisystemic Therapy (MST), an empirically supported, intensive home-based treatment approach that has been proven effective with other childhood chronic illnesses and which has recently been adapted to treat youth with obesity. This case report describes the use of MST to treat an obese 15-year-old African American boy during the course of a pilot study designed to determine the feasibility of MST for African American youth.
- Published
- 2009
43. Case Study: Multisystemic Therapy for Adolescents Who Engage in HIV Transmission Risk Behaviors
- Author
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Phillippe B. Cunningham, Sandra L. Fowler, Sylvie Naar-King, Elizabeth J. Letourneau, and Deborah A. Ellis
- Subjects
Adolescent ,Substance-Related Disorders ,Sexual Behavior ,Systems Theory ,HIV Infections ,Medication Adherence ,Risk-Taking ,Acquired immunodeficiency syndrome (AIDS) ,Developmental and Educational Psychology ,medicine ,Humans ,Sida ,Multisystemic therapy ,biology ,business.industry ,Articles ,Viral Load ,biology.organism_classification ,medicine.disease ,Clinical trial ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Lentivirus ,Immunology ,Family Therapy ,Female ,Viral disease ,business ,human activities ,Viral load ,Clinical psychology ,Blood drawing - Abstract
Objective To present a case study using multisystemic therapy (MST), an intensive family focused psychotherapy. For the clinical trial from which this case was drawn, MST was adapted to address multiple human immunodeficiency virus (HIV) transmission risk behaviors in HIV-infected youth. Targeted behaviors included medication nonadherence, risky sexual behaviors, and substance use. Method One young woman's transmission risk behaviors are described, followed by a description of the MST procedures used to identify and treat the primary drivers of these risk behaviors. Outcome measures were self-report, urine screens, and blood draws. Results At discharge, the young woman showed significant improvements in medication adherence and related health status (e.g., reduced HIV viral load), healthier sexual behaviors, and reduced substance use. Importantly, neither her boyfriend nor her newborn tested positive for HIV. Conclusions Findings from this case study suggest that MST has the potential to reduce transmission risk behaviors among teens with HIV.
- Published
- 2009
44. Does Self-Report Data on HIV Primary Care Utilization Agree with Medical Record Data for Socially Marginalized Populations in the United States?
- Author
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Nancy L. Sohler, Sharon M. Coleman, Chinazo O. Cunningham, Carol Tobias, Howard Cabral, and Sylvie Naar-King
- Subjects
Adult ,Male ,Gerontology ,Self Disclosure ,Multivariate analysis ,Ethnic group ,HIV Infections ,Article ,Medical Records ,Self-report study ,Health care ,Odds Ratio ,Humans ,Medicine ,Minority Groups ,Medical Audit ,Primary Health Care ,business.industry ,Medical record ,Public Health, Environmental and Occupational Health ,Odds ratio ,United States ,Test (assessment) ,Infectious Diseases ,Multivariate Analysis ,Self-disclosure ,Regression Analysis ,Female ,business ,Demography - Abstract
To test whether self-report data agree with medical record data in marginalized, HIV-infected populations, we collected information about HIV primary care visits over a 6-month period from both sources. Patients were drawn from a large study of engagement and retention in care conducted between 2003 and 2005. Self-report data were collected in face-to-face interviews and medical records were extracted using a rigorous, standardized protocol with multiple quality checks. We found poor overall agreement (weighted kappa = 0.36, 95% confidence interval = 0.28, 0.43). Factors associated with disagreement included younger age (adjusted odds ratio for 20 versus 40 years = 1.25, 95% confidence interval = 0.98, 1.60), non-Hispanic black race/ethnicity (adjusted odds ratio for non-Hispanic blacks versus non-Hispanic whites = 1.48, 95% confidence interval = 1.03, 2.13), lower education (adjusted odds ratio for high school education, GED, or less versus some college or college graduate = 1.43, 95% confidence interval = 0.96, 2.13), and substance use (adjusted odds ratio for any illicit drug/heavy alcohol use in the past 6 months versus no use = 1.39, 95% confidence interval = 1.02, 1.90). These findings do not support a conclusion that unconfirmed self-report data of HIV primary care visits are a sufficient substitute for rigorously collected medical record data in studies focusing on marginalized populations. Use of other data sources (e.g., administrative data), use of other self-reported outcome measures that have better concordance with medical records/administrative data (e.g., CD4 counts), or incorporation of rigorous measures to increase reliability of self-report data may be needed. Limitations of this study include the lack of a true gold standard with which to compare self-report data.
- Published
- 2009
45. Predictors of Medication Adherence in High Risk Youth of Color Living with HIV
- Author
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Sylvie Naar-King, Karen E. MacDonell, Jeffrey T. Parsons, Gary W. Harper, and Debra A. Murphy
- Subjects
Male ,Adolescent ,Population ,Psychological intervention ,Ethnic group ,HIV Infections ,Series on Health Care Disparities ,Medication Adherence ,Developmental psychology ,Young Adult ,Social support ,Acquired immunodeficiency syndrome (AIDS) ,Surveys and Questionnaires ,HIV Seropositivity ,Developmental and Educational Psychology ,Humans ,Medicine ,Young adult ,education ,Motivation ,education.field_of_study ,Chi-Square Distribution ,business.industry ,Social Support ,Viral Load ,medicine.disease ,Black or African American ,Clinical trial ,Anti-Retroviral Agents ,Pediatrics, Perinatology and Child Health ,Female ,business ,Social cognitive theory ,Clinical psychology - Abstract
Objective To test predictors of medication adherence in high-risk racial or ethnic minority youth living with HIV (YLH) using a conceptual model of social cognitive predictors including a continuous measure of motivational readiness. Methods Youth were participants in a multi-site clinical trial examining the efficacy of a motivational intervention. Racial-minority YLH (primarily African American) who were prescribed antiretroviral medication were included (N = 104). Data were collected using computer-assisted personal interviewing method via an Internet-based application and questionnaires. Results Using path analysis with bootstrapping, most youth reported suboptimal adherence, which predicted higher viral load. Higher motivational readiness predicted optimal adherence, and higher social support predicted readiness. Decisional balance was indirectly related to adherence. Conclusions The model provided a plausible framework for understanding adherence in this population. Culturally competent interventions focused on readiness and social support may be helpful for improving adherence in YLH.
- Published
- 2009
46. Lifetime Incidences of Traumatic Events and Mental Health Among Children Affected by HIV/AIDS in Rural China
- Author
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Xiuyun Lin, Xiaoyi Fang, Sylvie Naar-King, Douglas Barnett, Bonita Stanton, Yan Hong, Liying Zhang, Junfeng Zhao, Xiaoming Li, and Guoxiang Zhao
- Subjects
Male ,Rural Population ,China ,medicine.medical_specialty ,Coping (psychology) ,Adolescent ,Cross-sectional study ,media_common.quotation_subject ,HIV Infections ,Social Environment ,Life Change Events ,Acquired immunodeficiency syndrome (AIDS) ,Adaptation, Psychological ,Developmental and Educational Psychology ,medicine ,Humans ,Child ,Psychiatry ,media_common ,Depression ,Incidence ,Self-esteem ,Social environment ,medicine.disease ,Mental health ,Self Concept ,Clinical Psychology ,Cross-Sectional Studies ,Mental Health ,Female ,Rural area ,Child, Orphaned ,Psychology ,Social Adjustment ,Psychosocial ,Stress, Psychological - Abstract
Cross-sectional data were gathered from 1,625 children (M age = 12.85, SD = 2.21) which included 755 AIDS orphans, 466 vulnerable children, and 404 comparison children. Participants completed self-report measures of exposure to traumatic events, and psychosocial adjustment including behavior problems, depression, self-esteem, and future orientation. AIDS orphans and vulnerable children reported experiencing a higher total occurrence, density, duration, initial impact and lasting impact of traumatic events compared to comparison children. Scores reflecting adjustment were lower among orphans and vulnerable children than among comparison children. Both orphan status and traumatic events contributed unique variance in the expected direction to the prediction of psychosocial adjustment. The data in the current study suggested that children affected by HIV/AIDS in China are exposed to more trauma and suffer more adjustment problems than children who do not experience HIV/AIDS in their families.
- Published
- 2009
47. Motivational interviewing by peer outreach workers: a pilot randomized clinical trial to retain adolescents and young adults in HIV care
- Author
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Sylvie Naar-King, Angulique Y. Outlaw, Jeffrey T. Parsons, Kathryn Wright, and Monique Green-Jones
- Subjects
Adult ,Gerontology ,Inservice Training ,Health (social science) ,Adolescent ,Social Psychology ,Motivational interviewing ,HIV Infections ,Pilot Projects ,chemical and pharmacologic phenomena ,law.invention ,Young Adult ,Randomized controlled trial ,Acquired immunodeficiency syndrome (AIDS) ,law ,Interview, Psychological ,Outcome Assessment, Health Care ,Humans ,Medicine ,Community Health Workers ,Analysis of Variance ,Primary Health Care ,business.industry ,Medical record ,Behavior change ,Public Health, Environmental and Occupational Health ,Social environment ,Professional-Patient Relations ,Patient Acceptance of Health Care ,medicine.disease ,Home Care Services ,Mental health ,Outreach ,Female ,Clinical Competence ,business - Abstract
Youth living with HIV (YLH) are at particularly high risk for poor retention in HIV primary care. This study utilized Motivational Interviewing (MI) to improve youth retention in primary care and compared the fidelity and outcomes of peer outreach workers (POW) to masters level staff (MLS). Eighty-seven YLH were randomized to receive two MI sessions from POW or MLS. YLH were aged 16-29 and 92% were African American. Thirty-seven audiotaped sessions were coded with the Motivational Interviewing Treatment Integrity (MITI) coding system. Retention in care was assessed by review of medical records. POW had higher fidelity on two MITI scales, and did not differ from MLS on remaining three scales. While both groups improved the regularity of primary care appointments, the effect size for POW on retention in care and intervention dose was larger than that of MLS. The results suggest that POW can provide MI with quality comparable to MLS with adequate training and supervision. MI provided by POW to improve retention in health care services may increase the cost-effectiveness of evidence-based practices in urban settings.
- Published
- 2009
48. Feasibility of Adapting Multisystemic Therapy to Improve Illness Management Behaviors and Reduce Asthma Morbidity in High Risk African American Youth: A Case Series
- Author
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Sylvie Naar-King, Phillippe B. Cunningham, Elizabeth Secord, Karen Kolmodin, and Deborah A. Ellis
- Subjects
African american ,medicine.medical_specialty ,business.industry ,medicine.disease ,Asthma management ,Mental health ,respiratory tract diseases ,Illness management ,Intervention (counseling) ,Developmental and Educational Psychology ,Medicine ,Behavioral interventions ,Life-span and Life-course Studies ,business ,Psychiatry ,Multisystemic therapy ,Asthma - Abstract
African-American adolescents have the highest rates of asthma morbidity and mortality, yet there are few successful behavioral interventions to improve illness management for this group. Mental health providers have an opportunity to expand their services and impact by targeting adolescents with poor asthma management. We describe the adaptation of Multisystemic Therapy (MST), an intensive, home and community-based treatment originally used with antisocial youth, for improving asthma management. We present a case study to illustrate the treatment model. Feasibility was demonstrated with eight African American adolescents with chronic, persistent asthma, suggesting that further evaluation of MST for youth with asthma and poor illness management is warranted.
- Published
- 2009
49. Assessment of Adherence to Antiretroviral Therapy in Perinatally HIV-Infected Children and Youth Using Self-Report Measures and Pill Count
- Author
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John J, Farley, Grace, Montepiedra, Deborah, Storm, Patricia A, Sirois, Kathleen, Malee, Patricia, Garvie, Betsy, Kammerer, Sylvie, Naar-King, Sharon, Nichols, and M, Lavoie
- Subjects
Male ,Parents ,Pediatrics ,medicine.medical_specialty ,Adolescent ,HIV Infections ,Article ,Interviews as Topic ,Young Adult ,Pharmacotherapy ,Acquired immunodeficiency syndrome (AIDS) ,Surveys and Questionnaires ,Developmental and Educational Psychology ,medicine ,Humans ,Longitudinal Studies ,Young adult ,Child ,Sida ,biology ,business.industry ,Reproducibility of Results ,Viral Load ,medicine.disease ,biology.organism_classification ,Psychiatry and Mental health ,Anti-Retroviral Agents ,Caregivers ,Pill ,Multivariate Analysis ,Pediatrics, Perinatology and Child Health ,Lentivirus ,Patient Compliance ,Female ,Viral disease ,business ,Viral load - Abstract
BACKGROUND: Parent/caregiver or child/youth self-report and pill counts are commonly used methods for assessing adherence to antiretroviral therapy (ART) among children and youth with HIV. The purpose of this study was to compare these different methods with one another and with viral load. METHODS: Randomly selected parent/caregiver and child/youth dyads were interviewed using several adherence self-report measures and an announced pill count was performed. Adherence assessment methods were compared with one another and their relative validity was assessed by comparison with the child’s viral load close to the time of the interview or pill count, adjusting for primary caregiver, child age, and child disclosure of the diagnosis. RESULTS: There were 151 evaluable participants. Adherence rate by pill count was ≥ 90% in 52% of participants, was significantly associated with log(RNA) viral load (p=0.032), and had significant agreement with viral load < 400 copies/mL. However, pill count data were incomplete for 26% of participants. With similar proportions considered adherent, a variety of self-report adherence assessment methods also were associated with log(RNA) viral load including: “no dose missed within the past one month” (p=0.054 child/youth interview, p=0.004 parent/caregiver interview), and no barrier to adherence identified (p=0.085 child/youth interview, p=0.015 parent/caregiver interview). Within-rater and inter-rater agreement was high among self-report methods. Three day recall of missed doses was not associated with viral load. CONCLUSION: Findings demonstrate the validity of adherence assessment strategies that allow the parent/caregiver or child/youth to report on adherence over a longer period of time and to identify adherence barriers. Adherence assessed by announced pill count was robustly associated with viral load, but there was incomplete data for many participants.
- Published
- 2008
50. Toward Conceptual Clarity in a Critical Parenting Construct: Parental Monitoring in Youth with Chronic Illness
- Author
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Thomas Templin, Deborah A. Ellis, Sylvie Naar-King, and Maureen A. Frey
- Subjects
Self Disclosure ,Activities of daily living ,Adolescent ,Social Environment ,Developmental psychology ,Individuation ,Risk-Taking ,Activities of Daily Living ,Developmental and Educational Psychology ,medicine ,Humans ,Parent-Child Relations ,Set (psychology) ,Operationalization ,Parenting ,Sick role ,Sick Role ,Social environment ,Social Control, Informal ,medicine.disease ,Substance abuse ,Diabetes Mellitus, Type 1 ,Series on Methodology ,Chronic Disease ,Pediatrics, Perinatology and Child Health ,Self-disclosure ,Construct (philosophy) ,Psychology - Abstract
Parental monitoring has been defined as “a set of correlated parenting behaviors involving attention to and tracking of the child's whereabouts, activities, and adaptations.” This construct is of significant interest due to its relatedness to a broad range of youth risk behaviors, including risky sexual behavior, substance abuse, and poor adherence. However, to date, measures of parental monitoring are largely absent from the chronic illness literature. The present article focuses upon two key problems in the operationalization of the monitoring construct to date: (a) poor conceptual specificity in parenting constructs such as monitoring, overprotection, and over-involvement when used to date among youth with chronic conditions and (b) the confounding of existing measures of parental monitoring with items evaluating parental knowledge of youth activities, which has resulted in a lack of data regarding the mechanisms by which parents obtain their information. Recommendations for the future development of monitoring measures are discussed.
- Published
- 2008
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