Targeting Families to Reduce Adolescent Risk?

1. Targeting Families to Reduce Adolescent Risk? Geri R. Donenberg, PhD Associate Dean for Research Professor of Psychology in Psychiatry Director, Healthy Youths Program & Community Outreach Intervention Projects

3. HIV/AIDS Risk Among Youth in the US • Young people 15–24 years represent 25% of the sexually experienced population, yet acquire nearly half of 50% of all new STIs annually (CDC, 2009) • Most teens acquire HIV through risky sexual behavior (CDC, 2009) • Health disparities are prominent • Men who have sex with men • African Americans • African American females • African American women represent 63% of all women with AIDS in the US; • Nearly 80% of all women with AIDS in Chicago are AA • 44% of AA girls have an STI (Forhan et al., 2009)

5. HIV/AIDS Risk Among Youth in the US • Young people 15–24 years represent 25% of the sexually experienced population, yet acquire nearly half of 50% of all new STIs annually (CDC, 2009) • Most teens acquire HIV through risky sexual behavior (CDC, 2009) • Health disparities are prominent • Men who have sex with men • African Americans • African American females • African American women represent 66% of all new HIV infections among women in the US; • Nearly 80% of all women with AIDS in Chicago are AA • New data indicate rates among AA women rival South Africa (1 out of every 32 black women will be infected with HIV during her lifetime) • 44% of AA girls have an STI (Forhan et al., 2009)

6. New Technologies • Facebook • Sexting • YouTube • Hook-up websites • Formspring • Photobucket

7. A Girl’s Nude Photo and Altered Lives (New York Times, March 26, 2011) Kathy, 17, Queens: “There’s a positive side to sexting. You can’t get pregnant from it, and you can’t transmit S.T.D.’s. It’s a kind of safe sex.”

8. Can families influence mitigate adolescent HIV risk?

9. Social Personal Theoretical Model (Donenberg & Pao, 2005)

10. Study Samples • (N=346): 12-19 years old (M=16); 55% female; 40% Caucasian; Outpatient mental health clinics; B, 6- and 12-months • (N=266): 12-16 years old (M =14.5); 100% female and African Americans; Outpatient mental health clinics; B, 6-, 12-, 18-, 24-months • (N=721): 13-18 years old (M=14.8); 57% female; 63% Black; Inpatient and outpatient mental health settings; 3-site, 3-arm RCT; B, 6-, 12-, 24-, 30-, 36-months

11. Family Context and HIV Risk Family Context Affective Characteristics Parent-Teen Communication Instrumental Characteristics

12. Donenberg et al. (2002) AIDS Education and Prevention

13. Hadley et al. (2011) J of Family Psychology

14. Donenberg et al. (2011) JCCP • African American girls who reported ever having vaginal/anal sex were more likely to report: • More permissive parenting • Less parental monitoring

15. Family Context and HIV Risk Family Context Affective Characteristics Parent-Teen Communication Instrumental Characteristics

16. Peer Attachment -.06 .41*** Risky Sexual Behavior Mother-Daughter Attachment -.14 -.03 Peer Norms -.27*** .57*** Emerson et al. (in press) J of Family Psychology ***p < .001

17. Donenberg et al. (2003) JAACAP

18. Family Context and HIV Risk Family Context Affective Characteristics Parent-Teen Communication Instrumental Characteristics

19. Donenberg et al. (2011) JCCP • African American girls who reported ever having vaginal/anal sex were more likely to report: • Less open mother-daughter communication about sex • More frequent mother-daughter communication about sex

20. Communication Content Hadley et al. (2009) AIDS and Behavior

21. Communication Frequency Hadley et al. (2009) AIDS and Behavior • Parents reported more open communication than teens • Teenagers’ report of having a condom discussion with their parents was related to more open communication • Youth who reported a condom discussion with their parents reported 64% of their sexual acts protected compared to 47% for teens who had not discussed condoms with their parents

22. Evaluating Interactions Among Family Characteristics

23. Nappi et al. (2009) AIDS and Behavior

24. Donenberg et al., 2012

25. African American 14-18 year-old girls and primary female caregiver • Receiving mental health services • 2 full-day workshops • 2-arm randomized controlled trial • IMARA (SISTA, SiHLE, project STYLE) • FUEL • Assessments at Baseline, 6-, and 12-months • Surveys, interviews, STIs

26. Ethnic and gender pride • Strengthen mother-daughter relationships and communication • Knowledge, attitudes and beliefs about HIV prevention • Skills building (assertive communication, condom use) • Parental monitoring • Healthy relationships

27. MOTTO IMARA is Mothers and Daughters IMARA is Staying Safe IMARA is Healthy Living We Are IMARA!!

28. Saying it Assertively • Speech: • Tell the other person what you want and how you feel • Use honest, direct words • Talking: • Be firm, clear and confident • Be loud enough to be heard but not too loud • Eyes: • Use eye contact but do not glare • Body: • Face the other person • Stand up straight • Relax • Don’t crowd the other person

29. Future Directions: Reducing Adolescent Risk • Families in HIV prevention to sustain outcomes (Donenberg et al., 2006) J Ped Psych. • Maternal needs and adolescent needs (Hadley et al., 2011) • Monitoring, communication,and attachment • W. Pequegnat & C. Bell (2012) • Structural interventions • Schools, clinics, hospitals, juvenile justice • Mental health • Cultural values and beliefs pertinent to individual’s risk (Wyatt et al., 2011) Prev. Med. • Seek, Test, Treat, and Retain • Target specific groups – MSM, juvenile offenders, African American girls and women • HIV treatment as prevention

30. Acknowledgements • Healthy Youths Program Staff • Community Collaborators • Families and Youth • National Institute of Mental Health • National Institute of Minority Health Disparities

31. Healthy Youths Program Funded by the National Institutes of Health (NIMH, NICHD, NIMHD)

32. Thank You