Faculty Bibliography

We conducted an observational study of a collection of interactive processes known as "demand-withdraw" in relation to adolescent dating aggression. Couples (N = 209) aged 14-18 years participated in a challenging observational laboratory assessment to measure demands (i.e., pressures for a change), as well as demand → partner withdraw and demand → partner avoid sequences. Actor and partner effects were disentangled via dyadic data analyses. The results indicated a fairly consistent pattern in which demand → withdraw and demand → avoid sequences led by either partner were positively associated with both partners' physical and psychological aggression (measured via a dual informant questionnaire method). Further, higher quality demands (i.e., pressures for change that were specific and encouraged both members of the dyad to increase a given behavior) were inversely associated with aggression. Yet, all of the above associations were attenuated to the point of statistical nonsignificance after controlling for hostility. These results suggest two primary possibilities. The associations of demand → withdraw and demand → avoid sequences with dating aggression may be spurious, with the sequences merely markers for hostility, a known correlate of dating aggression. Alternatively, hostility may mediate the relations of demand → withdraw and demand → avoid sequences with dating aggression. Further research is required to test these competing explanations. Implications for preventive intervention are discussed.

In a study of conflict recovery and adolescent dating aggression, 14- to 18-year-old couples (N = 209 dyads) participated in a 1-hr observational assessment. Negative behavior was observed during conflict-evoking "hot" tasks and in a "cooldown" task. Physical and psychological dating aggression were assessed via questionnaires. Negative behavior measured in the cooldown task was not associated with dating aggression after controlling for carryover effects of negativity from the hot to cooldown tasks. Moreover, cooldown negativity moderated the associations of hot task negativity and dating aggression. Actor and partner effects were disentangled via dyadic data analyses. Given the paucity of observational studies of dating aggression, our findings are an important contribution to the literature and in need of replication and extension.

African American emerging adults (age 18-29 years) tend to have poor asthma outcomes, possibly due to poor adherence to medication. Few studies have explored barriers to controller adherence in this population. This study utilized electronic daily diaries to assess barriers to adherence and asthma symptoms among 141 African American emerging adults with uncontrolled persistent asthma and poor adherence. Participants reported symptoms M = 3.43 days (of 7 days). They reported unintentional (e.g., forgetting) and intentional (e.g., choosing not to take) barriers to adherence, but forgetting, being too busy, and sleeping through a dose were the most common. Significant correlations were found between symptoms and barriers, as well as asthma control and medication adherence in the expected directions. Asthma symptoms and number of barriers were significant predictors of asthma control. Existing intervention strategies such as text-messaging may prove effective to address these barriers, but measuring and addressing adherence remains complex.

OBJECTIVE:Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma. MATERIALS AND METHODS/METHODS:CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air. RESULTS:CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees. CONCLUSION/CONCLUSIONS:CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma. PRACTICE IMPLICATIONS/CONCLUSIONS:A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved.

BACKGROUND:Mind-body integrative health (MBIH) interventions to improve adolescent sleep are lacking. The study characterized sleep quality and bedtime-related psychosocial stressors among urban minority adolescents, explored associations between demographics factors, stressors and sleep quality, and gauged interest in a MBIH sleep intervention. MATERIALS AND METHODS/METHODS:167 school-based health center (SBHC) patients (mean age = 16.3; 64% female; 68% Latino) participated in a needs assessment as part of a quality improvement project. They reported bedtime-related psychosocial stressors using items from the Adolescent Sleep Hygiene Scale (ASHS), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and interest in a MBIH-based sleep intervention. Chi-square and logistic regression examined associations between demographics, stressors, sleep quality, and interest in the intervention. RESULTS:67% had poor sleep quality. Females, compared to males, had 2.23 higher odds (95% Confidence Interval [CI]: 1.12, 4.42) of having poor sleep quality. Nearly 80% experienced bedtime-related stressors (25% experienced one stressor, 17% two stressors and 37% three or more stressors); relative to those reporting no stressors, those reporting 3+ stressors had 3.15 higher odds (95% CI: 1.27, 7.84) of having poor sleep quality. Most (77%) reported they would participate in an SBHC-based intervention that utilized MBIH modalities preferring both one-on-one and group sessions. CONCLUSIONS:Urban, predominantly Hispanic and Black, SBHC adolescent patients have poor sleep quality and report bedtime-related psychosocial stressors. Their interest in MBIH interventions to address sleep problems represents a unique opportunity for practitioners and complementary therapists to offer MBIH interventions to a population at high-risk for poor sleep quality.

AIMS/OBJECTIVE:To assess the intervention effects of BREATHE (BRief intervention to Evaluate Asthma THErapy), a novel brief shared decision-making intervention and evaluate feasibility and acceptability of intervention procedures. DESIGN/METHODS:Group-randomized longitudinal pilot study. METHODS:In total, 80 adults with uncontrolled persistent asthma participated in a trial comparing BREATHE (N = 40) to a dose-matched attention control intervention (N = 40). BREATHE is a one-time shared decision-making intervention delivered by clinicians during routine office visits. Ten clinicians were randomized and trained on BREATHE or the control condition. Participants were followed monthly for 3 months post-intervention. Data were collected from December 2017 - May 2019 and included surveys, lung function tests, and interviews. RESULTS:Participants were Black/multiracial (100%) mostly female (83%) adults (mean age 45). BREATHE clinicians delivered BREATHE to all 40 participants with fidelity based on expert review of audiorecordings. While the control group reported improvements in asthma control at 1-month and 3-month follow-up, only BREATHE participants had better asthma control at each timepoint (β = 0.77; standard error (SE)[0.17]; p ≤ 0.0001; β = 0.71; SE[0.16]; p ≤ 0.0001; β = 0.54; SE[0.15]; p = .0004), exceeding the minimally important difference. BREATHE participants also perceived greater shared decision-making occurred during the intervention visit (β = 7.39; SE[3.51]; p = .03) and fewer symptoms at follow-up (e.g., fewer nights woken, less shortness of breath and less severity of symptoms) than the controls. Both groups reported improved adherence and fewer erroneous medication beliefs. CONCLUSION/CONCLUSIONS:BREATHE is a promising brief tailored intervention that can be integrated into office visits using clinicians as interventionists. Thus, BREATHE offers a pragmatic approach to improving asthma outcomes and shared decision-making in a health disparity population. IMPACT/CONCLUSIONS:The study addressed the important problem of uncontrolled asthma in a high-risk vulnerable population. Compared with the dose-matched attention control condition, participants receiving the novel brief tailored shared decision-making intervention had significant improvements in asthma outcomes and greater perceived engagement in shared decision-making. Brief interventions integrated into office visits and delivered by clinicians may offer a pragmatic approach to narrowing health disparity gaps. Future studies where other team members (e.g., office nurses, social workers) are trained in shared decision-making may address important implementation science challenges as it relates to adoption, maintenance, and dissemination. TRAIL REGISTRATION: clinicaltrials.gov # NCT03300752.

BACKGROUND:Developmental assets provide a framework for optimizing development among adolescents but have not been studied in adolescents with chronic illness and comorbid depression, which is a group at risk for poor health outcomes. YouTube postings provide valuable insights to understand this understudied population. OBJECTIVE:This study aims to explore asset development from the perspectives of adolescents and young adults (AYAs) with chronic illness and comorbid depression. METHODS:YouTube was searched using 12 chronic illnesses (eg, diabetes) coupled with "depression" as keywords. Videos were included if they were uploaded by AYAs aged between 11 and 29 years and discussed living with chronic illness and depression during adolescence. Video transcripts were coded deductively for 40 internal and external assets that constitute the Developmental Assets Framework. Categories not captured by deductive coding were identified using conventional content analysis. Categories and their respective assets were labeled as being discussed either negatively or positively. RESULTS:In total, 31 videos from 16 AYAs met the inclusion criteria. A total of 7 asset categories, support, constructive use of time, boundaries and expectations (external assets), identity, commitment to learning, positive values, and social competence (internal assets), reflecting 25 (13 internal; 12 external) assets, were discussed. Internal assets, particularly relating to identity, were commonly discussed by AYAs either in a negative way or fluctuated between positive and negative perspectives. CONCLUSIONS:In this sample of AYAs with chronic illness and comorbid depression, internal assets were commonly discussed in a negative way. Future research is needed to better understand how assets develop and if the Developmental Assets Framework adequately represents the experiences of this population.

RATIONALE/BACKGROUND:Minority sexual identity appears to confer asthma risks. Although associations between inhaled substances and asthma are established, these have not been examined among sexual minority youths. Given sexual minority adolescents' disproportionately high rates of substance use, research is needed to fill this important gap. OBJECTIVES/OBJECTIVE:Using a representative sample of adolescents from the United States, we: 1) examined associations among asthma, sexual identity, and inhaled substance use; and tested 2a) whether sexual identity moderates relationships between asthma and inhaled substance use; and 2b) whether inhaled substance use mediates associations between sexual identity and asthma. METHODS:Data are from the 2015 and 2017 Youth Risk Behavior Surveillance Survey. Adolescents (n=30,113) reported if they were ever diagnosed with asthma, current use of cigarettes, cigars/cigarillos, marijuana and electronic vapor products, and if they ever used inhalants or synthetic marijuana. We used logistic regression to examine associations between asthma, sexual identity, and inhaled substance use controlling for age, race/ethnicity, and BMI percentile, stratified by sex/gender. RESULTS:Lesbian, gay, and bisexual respondents had higher relative risks for asthma than heterosexual youth. Sexual minority female youths had significantly higher relative risks than heterosexual female youths for use of every inhaled substance. There were few sexual identity differences in inhaled substance use among male youths. Inhaled substance use was significantly associated with higher risks for asthma. In general, associations between each individual inhaled substance and asthma did not differ between sexual minority and heterosexual youths. However, when all inhaled substances were added into the models concurrently, inhaled substance use appeared to mediate associations with asthma among lesbian and bisexual female youths, and partially mediated these associations among sexual minority male youths. CONCLUSIONS:Sexual identity and inhaled substance use appear to play important roles in asthma risk. However, these variables do not fully explain the risk suggesting other unmeasured variables (e.g., stress and victimization), may be implicated in risks for both inhaled substance use and asthma. It is important that clinicians providing care to adolescents ask about sexual identity and inhaled substance use. Effective approaches to reducing inhaled substance use among adolescents, especially sexual minorities, are needed.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents are more likely to report suicidality and worse mental health than their heterosexual peers. We conducted a systematic review to examine the relationship between positive school climate and suicidality and mental health among LGBTQ adolescents. We searched the literature using PubMed, PsycINFO, and CINAHL. Six studies met inclusion criteria, and all had low to moderate risks of bias. Results indicate that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Being at the forefront of health in schools, school nurses have the opportunity to advocate for changes in school environments that promote positive mental health for all youth, including LGBTQ adolescents.

INTRODUCTION/BACKGROUND:Depression is prevalent among adolescents with chronic illness. However, little is known about how depression affects chronic illness over time. This review aimed to synthesize longitudinal relationships between depression and disease control, self-management behaviors, illness-related morbidity, and quality of life. METHOD/METHODS:Four databases were searched, including PubMed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and EMBASE. Inclusion criteria were cohort studies examining depression among adolescents aged 10-21 years with a chronic illness and studies published in English. Study quality was appraised using the Newcastle-Ottawa scale and data was synthesized by the outcome. RESULTS:Of the 3,463 articles identified, 11 were included in the review. For adolescents with diabetes, increased depressive symptoms predicted decreased metabolic control and monitoring, medication adherence, quality of life, and increased hospitalization. Studies on cystic fibrosis, congenital heart disease, sickle cell disease, and juvenile idiopathic arthritis were limited but demonstrated that depressive symptoms affected the quality of life, disability, pain, and hospitalization rates/costs. DISCUSSION/CONCLUSIONS:Evidence supports the need for mental health care strategies suitable for adolescents with chronic illness. Future research is needed to examine the effects of depressive symptoms across diversified chronic illness populations.