DigitalCommons@The Texas Medical Center

    Predicting adolescent posttraumatic stress in the aftermath of war: differential effects of coping strategies across trauma reminder, loss reminder, and family conflict domains.

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    BACKGROUND AND OBJECTIVES: The vast majority of youth who lived through the Bosnian war were exposed to multiple traumatic events, including interpersonal violence, community destruction, and the loss of a loved one. This study examined factors that predict post-war psychological adjustment, specifically posttraumatic stress, in Bosnian adolescents. DESIGN: Regression analyses evaluated theorized differential relations between three types of post-war stressors - exposure to trauma reminders, loss reminders, and intrafamilial conflict - specific coping strategies, and posttraumatic stress symptom dimensions. METHODS: We examined 555 Bosnian adolescents, aged 15-19 years, to predict their long-term posttraumatic stress reactions in the aftermath of war. RESULTS: Findings indicated that post-war exposure to trauma reminders, loss reminders, and family conflict, as well as engagement and disengagement coping strategies, predicted posttraumatic stress symptoms. Secondary control engagement coping responses to all three types of post-war stressors were inversely associated with posttraumatic stress symptoms, whereas primary control engagement coping responses to family conflict were inversely associated with hyperarousal symptoms. Disengagement responses to trauma reminders and family conflict were positively associated with re-experiencing symptoms. CONCLUSIONS: These findings shed light on ways in which trauma reminders, loss reminders, and family conflict may intersect with coping responses to influence adolescent postwar adjustment

    Reducing Sexual Risk among Racial/ethnic-minority Ninth Grade Students: Using Intervention Mapping to Modify an Evidenced-based Curriculum

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    Background: Racial/ethnic-minority 9th graders are at increased risk for teen pregnancy, HIV, and STIs compared to their White peers. Yet, few effective sexual health education programs exist for this population. Purpose: To apply IM Adapt—a systematic theory- and evidence-based approach to program adaptation—to modify an effective middle school sexual health education curriculum, It’s Your Game…Keep It Real! (IYG), for racial/ethnic-minority 9th graders. Methods: Following the six steps of IM Adapt, we conducted a needs assessment to describe the health problems and risk behaviors of the new population; reviewed existing evidence-based programs; assessed the fit of IYG for the new population regarding behavioral outcomes, determinants, change methods, delivery, and implementation; modified materials and activities; planned for implementation and evaluation. Results: Needs assessment findings indicated that IYG targeted relevant health and risk behaviors for racial/ethnic-minority 9th graders but required additional focus on contraceptive use, dating violence prevention, active consent, and access to healthcare services. Behavioral outcomes and matrices of change objectives for IYG were modified accordingly. Theoretical methods and practical applications were identified to address these behavioral outcomes, and new activities developed. Youth provided input on activity modifications. School personnel guided modifications to IYG’s scope and sequence, and delivery. The adapted program, Your Game, Your Life, comprised fifteen 30-minute lessons targeting determinants of sexual behavior and healthy dating relationships. Pilot-test data from 9th graders in two urban high schools indicate promising results. Conclusion: IM Adapt provides a systematic theory- and evidence-based approach for adapting existing evidence-based sexual health education curricula for a new population whilst retaining essential elements that made the original program effective. Youth and school personnel input ensured that the adapted program was age-appropriate, culturally sensitive, and responsive to the needs of the new population. IM Adapt contributes to the limited literature on systematic approaches to program adaptation

    The Association Between Inhibitory Control and Dating Violence Outcomes Among Adolescents

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    Executive function (EF) is commonly known as a set of cognitive skills which aid in thought processing and decision-making. Though an association between overall (EF) and risky behavior is speculated, this dissertation includes two of the first studies to assess the association between inhibitory control- one component of EF - and psychological teen dating violence (TDV) perpetration. In the first paper, we conducted a narrative review of prior studies that examined the association between EF and multiple adolescent risky behaviors among neurotypical developing teen populations. Study results from Paper 1 reveal that there is strong evidence for the association between “hot” (i.e. .inhibitory control, impulsivity processing speed and emotional control) components of EF (Zelazo, Carlson, 2012; Chan, Shum, Toulopoulou, Chen, 2008) and risky behavior. There is less evidence, however, that supports the association between “cold” EF (i.e. planning, working memory, attention verbal fluency and cognitive flexibility) components and risky behavior (Zimmerman, Ownsworth, Donovan, et al, 2016). Findings from Paper 1 show that associations are dependent on how EF is assessed and identified. Thus, future studies should continue to examine the association between risky behavior and overall EF to fill these gaps. In the second paper, we conducted a cross-sectional analysis assessing the association between psychological TDV perpetration and inhibitory control. Study participants were members of the control group as part of a large randomized study of an effective teen pregnancy prevention program, It’s Your Game…Keep it Real (Tortolero, Markham, Peskin, Shegog, Addy, 2010; Peskin, Coyle, Anderson, et al. 2017). Study results revealed that male and female youth who had poorer EF were more likely to be perpetrators of psychological TDV after controlling for multiple covariates. Results from Paper 2 suggest the need for psychological TDV interventions to assist teens with emotional and self-control management as many are already involved in dating relationships
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