OBJECTIVE Sleep plays a critical role in children's growth and development. This study examined the frequency and persistence of children's sleep problems following a natural disaster, risk factors for children's sleep problems, and the bidirectional relationship between children's sleep problems and posttraumatic stress symptoms (PTSS) over time. METHODS This study assessed 269 children (53% female, M = 8.70 years, SD = 0.95) exposed to Hurricane Ike at 8 months (Time 1) and 15 months (Time 2) post-disaster. Children completed measures of hurricane exposure and related stressors, stressful life events, sleep problems, and PTSS. RESULTS Children's sleep problems were significantly correlated from Time 1 to Time 2 (r = .28, p < .001). Risk factors for sleep problems at Time 2 were younger age, sleep problems at Time 1, and PTSS, not including sleep items, at Time 1. Examinations of the bidirectional relationship between sleep problems and PTSS indicated that PTSS significantly predicted later sleep problems, but sleep problems did not significantly predict later PTSS. CONCLUSIONS Findings demonstrate that PTSS may contribute to the development and course of children's sleep problems post-disaster.

In 2015, the CDC published its recommendations for use of the meningococcal B (MenB) vaccine among healthy adolescents age 16 through 23 years, preferably administered between 16 and 18 years of age. Administration of the vaccine ideally follows a discussion between the provider and the patient that assesses risk of disease and balances the pro and cons of vaccination. This recommendation is described as "shared clinical decision making." At this time, there is little guidance for providers on how to start such a conversation and what elements are ideally included in that conversation. The goal of this project was to develop clinically useful materials for providers to help them engage in productive, supportive discussions with parents and adolescents regarding MenB vaccination.

OBJECTIVE:The objective of this study is to identify factors influencing the vaccine intention-behaviour relationship.DESIGN:A total of 445 parents who received a brief intervention to promote HPV vaccination were categorized based on their intentions post-intervention (yes/unsure/eventually/never) and subsequent adolescents' vaccine status (yes/no). Fifty-one of these parents participated in qualitative interviews.MAIN OUTCOME MEASURES:Parents described their intentions, decision-making and planning processes towards vaccination. Framework analysis was used to analyse the data.RESULTS:Parents in the 'Yes/Yes' category were knowledgeable about HPV/vaccine, described strong, stable intentions, considered themselves the primary decision-makers about vaccination and said they vaccinated immediately. 'Yes/No' parents described strong intentions and thought their adolescent was vaccinated OR described hesitant intentions, seeking advice/agreement from others and noting barriers to vaccination without solutions. 'Unsure/Yes' parents described their intentions as strengthening with information from credible sources and identified strategies for overcoming barriers. 'Unsure/No' and 'Eventually/No' parents had misinformation/negative beliefs regarding vaccination, described being ambivalent or non-supportive of vaccination and cited barriers to vaccination. 'Never/No' parents held negative beliefs about vaccination, described strong, stable intentions to NOT vaccinate, deferring the decision to others, and reported no planning towards vaccination.CONCLUSIONS:Intention characteristics and planning processes could moderate the vaccine intention-behaviour relationship, potentially serving as targets for future vaccine strategies.

Human papillomavirus (HPV) is the necessary cause of virtually all cervical cancers and genital warts and many anal cancers. While effective vaccines are available and are routinely recommended, rates of HPV vaccine uptake have been much lower than expected. Traditional health behavior theories suggest that health beliefs influence intentions to vaccinate, which, in turn, directly influence vaccine initiation behavior. In these models, intentions are thought to be the proximal determinant of behavior. Yet, studies have consistently found that vaccine intentions are much higher than actual vaccine rates. Reasons for the vaccine intention-behavior gap are not known. To design effective interventions to promote HPV vaccination, a better understanding of the factors influencing the relationship between vaccine intentions and behavior is greatly needed. Therefore, using qualitative methods, we examined parents' descriptions of their intentions, decision-making behaviors, and planning processes toward vaccination.

A provider's strong recommendation to vaccinate has been shown to have a significant influence on parent acceptance of the HPV vaccine. Yet little is known about what a strong or weak recommendation entails and how parents respond to that recommendation.

Previous research has implied that while parents may be willing to have their adolescents receive some recommended vaccines via school-located vaccination program (SLVP), they were less likely to agree to the HPV vaccine being administered via SLVP. During an SLVP in a large urban area, 86% of those participating in the program received an HPV vaccine.

Adolescent immunization rates for human papillomavirus (HPV) are low and interventions within school-based health centers (SBHCs) may increase HPV uptake and series completion. We examined the effect of a parent health message intervention on HPV vaccination intent, first dose uptake and series completion among adolescents who received care at SBHCs. Via computer-assisted telephone interviews (CATI), 445 parents of young adolescents were randomly assigned to 2 two-level interventions using a 2 × 2 design (rhetorical question (RQ) or no-RQ and one-sided or two-sided message). The RQ intervention involved asking the parent a question they were likely to endorse (e.g., "Do you want to protect your daughter from cervical cancer?") with the expectation that they would then behave in a manner consistent with their endorsement (i.e., agree to vaccinate). For the one-sided message, parents were given information that emphasized the safety and effectiveness of HPV vaccine, whereas the two-sided message acknowledged that some parents might have concerns about the vaccine, followed by reassurance regarding the safety and effectiveness. At CATI conclusion, parents indicated intentions to have their adolescents vaccinated. Parents who endorsed any intent were sent a consent form to return and all adolescents with signed returned consents were vaccinated at SBHCs. Medical records were reviewed for uptake/completion. Parents were 87% female; adolescents were 66% male and racially/ethnically diverse. 42.5% of parents indicated some intention to immunize, 51.4% were unsure, and 6.1% were not interested. 34% (n = 151) of adolescents received their first dose with series completion rates of 67% (n = 101). The RQ component of the intervention increased intention to vaccinate (RR = 1.45; 95%CI 1.16,1.81), but not first dose uptake or series completion. The 1-sided and 2-sided messages had no effect. This brief, RQ health intervention enhanced intent, but did not impact vaccination rates, likely due to the time delay between the intervention and consent form receipt.

Immunization rates among adolescents are lower than rates among younger children, and 2012 HPV vaccination rates for >1 dose in Houston were approximately 60% for females and 38% for males. School-located immunization programs (SLIPs) represent a time-efficient strategy to vaccinate large numbers of adolescents. Little is known about whether parents are willing to have the HPV vaccine administered to their adolescents via SLIP.

PURPOSE:To determine variables associated with parental trust in a school-located immunization program (SLIP) and the effect of trust-building interventions on trust and participation in SLIPs.METHODS:Parents among eight schools randomized to a trust-building intervention or a control condition (four schools each) completed a five-item trust survey before SLIP implementation both in year 1 (fall 2012) and in year 2 (fall 2013). Mean trust scores were calculated. Associations between baseline demographic and experiential variables and mean trust scores were analyzed. Mean trust scores in intervention and control schools were compared before SLIP in years 1 and 2, and SLIP participation rates were noted.RESULTS:From year 1, 1,608 parent surveys were analyzed. Baseline mean trust score across schools was 3.59 of 5 (5 = highest trust). In a multiple linear regression model, annual household income, survey language version, participation in a previous SLIP, child's health insurance status, and perceived vaccine importance were significantly associated with parental trust in SLIPs (R(2)= .06, p < .001). There was no difference in mean trust scores between intervention and control schools (p = .8). In year 2, 844 surveys were analyzed, and a modest difference was observed between intervention and control schools (mean trust score = 3.66 and 3.57, respectively, p = .07). SLIP participation rates appeared higher in intervention (7.7%) versus control schools (4.3%) in year 1.CONCLUSIONS:Baseline trust in SLIPs among a low-income, largely Hispanic group of parents in Texas was moderately high. Factors associated with trust included demographic and experiential variables, and interventions aimed at increasing parents' perception of vaccine importance and participation in SLIPs may be effective in increasing parental trust in SLIPs.

OBJECTIVE:Although several eating disorder prevention programs reduce eating disorder risk factors and symptoms for female high school and college students, few efficacious prevention programs exist for female middle school students, despite the fact that body image and eating disturbances often emerge then. Two pilot trials evaluated a new dissonance-based eating disorder prevention program for middle school girls with body image concerns.METHOD:Female middle school students with body dissatisfaction from two sites [Study 1: N = 81, M age = 12.1, standard deviation (SD) = 0.9; Study 2: N = 52, M age = 12.5, SD = 0.8] were randomized to a dissonance intervention (MS Body Project) or educational brochure control; Study 2 included a 3-month follow-up.RESULTS:Intervention participants showed significant post-test reductions in only one of the six variables with both Studies 1 and 2 (i.e., pressure to be thin and negative affect, respectively), though post-test effect sizes suggested medium reductions in eating disorder risk factors and symptoms (Study 1: M d = .40; Study 2: M d = .65); reductions at 3-month follow-up in Study 2 were not evident (M d = .19).CONCLUSIONS:Results suggest that this new middle school version of the Body Project is producing medium magnitude reductions in eating disorder risk factors at post-test but that effects are showing limited persistence. Continued refinement and evaluation of this intervention appears warranted to develop more effective prevention programs for this age group.

School-located immunization programs (SLIP) remove barriers to care and have the potential of increasing vaccination rates among populations. Patient trust in SLIPs (the belief that a health care provider will provide the utmost care in addressing one's interests and needs during a time of vulnerability) could potentially influence the use of these programs. While there are a few published scales to assess patient trust in providers and health settings, no scales exist to specifically assess paitent trust in SLIPs. We assessed the reliability of a modified patient trust measure for use with a SLIP among parents of middle school students in a predominantly urban Hispanic population. Prior to initiating a service project to provide vaccines via a mobile SLIP to 8 urban middle schools, questionnaires were distributed to students either in school enrollment packets or within a month of the start of school. Questionnaire distribution pre-dated notification that a SLIP would be available at the school. Surveys were provided in both English and Spanish; each parent could complete the forms in his/her preferred language. Demographic items assessed age, race, ethnicity, language spoken at home, insurance status, whether the child had a medical home, and annual household income. A 5-item patient trust in provider scale previously used among English speaking adults was modified in English and Spanish for use pertaining SLIPs. The Spanish translation was reviewed/reverse-translated to assure accuracy. Item 1 in the tool was a reverse-worded item designed to prevent rote responses. Internal consistency of the measure was assessed using Cronbach's alpha; data were then stratified by demographic variables. 1913 questionnaires were included in the analysis. 68% of parents were primarily Spanish-speaking; 40% completed the Spanish version of the survey, and 84% identified as Hispanic. The Cronbach's alpha for the 5-item scale was 0.71. Cronbach alpha was different when stratifying for demographic variables; most notably higher for those using the Spanish vs English version (0.76 vs. 0.64), for those who spoke English vs Spanish at home (0.79 vs. 0.68), and for those with annual household incomes above vs. below $50,000 (0.81 vs. 0.71). The modified trust scale for SLIP(s) showed adequate internal consistency among a sample of predominately Hispanic parents of middle school students. However, internal consistency of this scale was lower among Spanish speakers than English speakers and those with higher incomes. In addition, among this primarily Hispanic population, the Spanish version of the survey demonstrated higher internal consistency. These data suggest a need to further evaluate and modify this scale for populations with significant variation in language variables and socioeconomic status.

School-located immunization programs (SLIPs) provide a convenient avenue of access for adolescents to receive their vaccines, and trust in SLIPs is an important factor in parents' decisions to participate. The extent to which parents trust SLIPs is unknown. The aim of this study was to examine baseline trust in SLIPs of a low-income, largely Hispanic population of middle school students' parents prior to the implementation of a SLIP in their school. Middle schools with high percentages of students in the free lunch program were invited to participate in a multi-visit SLIP in Fall, 2012. Eight schools participated and received surveys in Spanish and English for parents to complete. Surveys assessed demographic items (race, ethnicity, level of education, primary language spoken at home, annual household income, type of child's health insurance, child's participation in a medical home), history of participation in SLIPs, and degree of agreement with the importance of vaccines. Parental trust in SLIPs was assessed using a five-item scale; mean trust score (range: 1-5, 5 = maximum trust) was calculated based on parents' responses to the scale items. Associations between demographic items and trust score were examined using two-sample t-tests, one-way ANOVA, and multiple regression analysis. 1608 of 1913 surveys contained completed 5-item scales and were included in the analysis. The majority of respondents were Hispanic (85%), spoke Spanish at home (67%), had a medical home for the child (82%), had never participated in a SLIP (86%) and felt that vaccines were important (93%). One-third of parents reported an annual income =$10,000, and fewer than 5% of respondents had an annual income over $50,000. Medicaid/CHIP (68%) was the primary form of insurance for children. Mean trust score among all respondents was 3.59; 25% had a trust score corresponding to 3.0 or below. Correlation between reported assessment of vaccines' importance and trust in SLIPs was 0.20 (P<0.001). Statistically higher mean trust scores were noted among parents who: had an annual income < $50,000 (3.60) vs. higher income (3.32); completed Spanish surveys (3.68) vs. English (3.53); had previously participated in a SLIP (3.76 vs. 3.57); identified as Hispanic (3.61 vs. 3.51); had not graduated from high school (3.63 vs. 3.56); were Medicaid or self-pay (3.59, 3.70) vs. those with private insurance (3.44); and those who spoke Spanish (3.62) vs. those who spoke primarily English (3.53) at home. In the multiple regression analysis, survey version, annual income, perceived vaccine importance, Medicaid versus private insurance, and previous SLIP participation were significant independent variables in the model describing trust; however, all betas were less than 0.16, implying questionable practical importance. These analyses indicate that parental trust in SLIPS among a primarily lower SES, Hispanic population in a large, urban area was high. Future research should examine whether greater trust in SLIPS is associated with greater likelihood to participate in school-located immunization programs.

Background Disasters are destructive, potentially traumatic events that affect millions of youth each year. Objective The purpose of this paper was to review the literature on depressive symptoms among youth after disasters. Specifically, we examined the prevalence of depression, risk factors associated with depressive symptoms, and theories utilized in this research area. Methods We searched MEDLINE, PsycInfo, and PubMed electronic databases for English language articles published up to May 1, 2013. Reference lists from included studies were reviewed to capture additional studies. Only quantitative, peer reviewed studies, conducted with youth under the age of 18 years, that examined postdisaster depressive symptoms were included. Seventy-two studies met inclusion criteria. Prevalence of depressive symptoms, disaster type, correlates of depressive symptoms, and theories of depressive symptoms were reviewed. Results Only 27 studies (38 %) reported on prevalence rates among youth in their sample. Prevalence rates of depression among youth postdisaster ranged from 2 to 69 %. Potential risk factors were identified (e.g., female gender, exposure stressors, posttraumatic stress symptoms). Theories were examined in less than one-third of studies ( k = 21). Conclusions Given the variability in prevalence rates, difficulty identifying a single profile of youth at risk for developing depressive symptoms, and lack of a unifying theory emerging from the studies, recommendations for future research are discussed. Use of established batteries of assessments could enable comparisons across studies. Merging existing theories from children’s postdisaster and depression literatures could aid in the identification of risk factors and causal pathways.

Little is known about adolescent males and their parents with respect to intent and first dose uptake of the human papillomavirus (HPV) vaccine outside of primay care settings. The purpose of this study was to evaluate potential predictors of parental intent to vaccinate (study was conducted in November 2010-December 2012) and of first dose uptake of HPV vaccine among a sample of young adolescent males, 11-15 years of age, who received care at a school-based health center (SBHC). We also examined intent as a potential mediator of the relationships between predictors (health beliefs and perceived spousal agreement) and vaccination. Slightly more than half (n = 135 of 249) of parents reported an intention to vaccinate and 28% (n= 69) of males received their first dose of the HPV vaccine. Two of three health beliefs were significantly associated with both intention and uptake as was perceived spousal agreement. We found intention to vaccinate was a partial mediatator between the perceived benefits of HPV vaccine and first dose acceptance. We also determined that intent was a strong mediator between both general immunization benefits and perceived spousal agreement and first dose uptake. While vaccine uptake was lower than expected, particularly considering that many barriers to vaccine initiation were eliminated because of the SBHC setting, this rate is higher than in traditional settings. After controlling for intent, only perceived benefits of the HPV vaccine remained a significant predictor of first dose acceptance. (C) 2014 Elsevier Ltd. All rights reserved.

Prevention of sexually transmitted infections (STIs) requires a multi-pronged approach. This includes understanding the risks associated with infection (e.g. anatomy, biology, puberty, cognitive development, parenting, history of sexual abuse, other risk behaviors, and sexual partnerships/networks), so that one can identify populations at greater risk and develop prevention and intervention strategies likely to be effective. There are several strategies to prevention of STIs, including biomedical approaches, comprehensive sexual education, access to care and routine screening, and partner notification/treatment. Finally, although efforts should be focused on preventing the initial infection, there is a psychosocial impact of acquiring infections which needs to be considered and addressed to prevent further sequelae.

Parental intentions to have adolescents receive the human papilloma virus (HPV) vaccine have been noted to be higher than actual initiation rates. Among parents with intentions to vaccinate their young adolescent, we sought to identify factors that predicted first dose acceptance.

Study Objective: Genital herpes, which can be spread through oral sex, is an important target for microbicides. We examined episode-specific predictors of young women's receptive oral sex and of microbicide surrogate use.Design: Longitudinal study.Setting: Participants were recruited to participate in a microbicide acceptability study from adolescent clinics and local colleges and through snowballing.Participants: Young women (ages 14 to 21 y) who reported sexual contact on at least 1 weekly phone interview (n = 181) were included from the larger sample of 208 young women.Main Outcome Measures: On weekly diary phone interviews, participants reported whether or not their last sexual contact included receptive oral sex and whether or not their last sexual contact included use of a microbicide surrogate.Results and Conclusions: Participants reported a total of 1042 episodes of sexual contact of which 311 included receptive oral sex and 354 included microbicide surrogate use. Being older, having sex for the first time with a partner, and having given oral sex were associated with having received oral sex during a sexual episode. Being older, being African American, and having discussed the microbicide surrogate with their partner were associated with having used the microbicide surrogate use during a sexual episode. These results indicate that oral sex should be considered in the design of clinical trials. Future studies need to evaluate ways to promote consistent microbicide use in the context of receiving oral sex as well as those factors (eg, taste, pleasure) which may serve as a barrier.

During adolescence, individuals develop increased ability to have emotionally and physically intimate relationships. The type of intimate relationship will make a difference as to whether the adolescent engages in protective behaviors or avoids risky behaviors. However, in reviewing the literature on the association of relationship type and sexual risk and protective behaviors, four methodological challenges were noted. These challenges limit our understanding of the impact of relationship type. These four challenges are: (a) inconsistent definitional frameworks; (b) lack of adolescent voices; (c) lack of consideration of gender; and (d) poor differentiation between individual and relationship risk. These issues direct the course of future work in this area and are necessary to advance the field of adolescent sexual health, particularly with regard to the development and testing of appropriate interventions designed to reduce untoward outcomes of adolescent sexuality.