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| In its 13 year history, the Center for Adolescent Health has been home to many applied research projects. Here, we provide details on some of our completed work. Adolescent Behavioral Repertoire and Marijuana Use in Early Adulthood
Child Maltreatment and Functioning in Adolescence and Early Adulthood
Multistate Lifetable Analysis: Promoting Interdisciplinary Public Health Research Using Demographic Methods with Stata Statistical Software
Overweight Status of Adolescents in Baltimore City School Based Health Programs
Physical Activity Self-Report Substudy
Reaching Adolescents through Food Stores: An Environmental Intervention Program to Improve Diet and Nutrition in East Baltimore
The Role of Adolescent Depressive Symptomatology in Internet Experiences
Pilot Project to Inform the Development of a New Type of HIV Prevention Program for High-Risk Adolescents
Trajectories for Aggressive and Violent Behavior: Predictors and Influences
Trends and Trajectories of Adolescent Depression Symptoms, and the Role of Social Support Systems
Understanding the Cultural Context of Family Strengths and Adolescent Childbearing
Barriers to Cardiac Rehabilitation in Women
Culturally Integrated Health Promotion in Urban Churches: Project Joy
Parent and Adolescent Perceptions of Adolescent Involvement in Clinical Care and Research
A Methodological Appraisal of Photovoice as a Participatory Community Needs/Assets Assessment Tool
Monitoring Adolescents in Risky Situations Project (MARS)
Neighborhood and Families: Influences on Adolescent Behaviors
Parenting Adolescents Investing in Real Success (PAIRS) (Research and Evaluation)
Pathways to Romantic Unions
The Southeast Baltimore Reaching Every Adolescent by Collaborating for Health (REACH) PALS After-School Program
The Southeast Baltimore REACH Partnership - Americorps Program
YO! Health Screening Tool
| Project Period: October 2003-September 2004 Principal Investigator: Chuan-Yu Chen, PhD Co-Investigators: Carla L. Storr, ScD Focus Area: Substance Use, Psychiatric Epidemiology, Maryland Metropolitan areas Project Goals: To expand the concept of adolescent behavioral repertoire in relation to the occurrence and the transition of marijuana experiences, in a context of multidimensional behavioral repertoire and individual developmental trajectory. General Information: Building upon the nature of prospective study and the multidimensional measures of adolescent behavioral repertoire, the main aims of this proposed research are (1) to assess the association between the adolescent behavioral repertoire and different stages of marijuana involvement in an US urban adolescent population; and (2) to examine the role of the adolescent behavioral repertoire in the transition of marijuana experiences. - Target population: Young adults of 21-25 year olds in Maryland’s metropolitan areas.
- Study design: The research is based upon the Prevention Intervention Research Center Intervention Trial Project and Transitions through Adulthood Project (the PRC project), a prospective study with randomized controlled intervention trial nested within the observational design.
- Sample: Participants were initially recruited as first graders entering primary schools in one of Maryland’s metropolitan areas during two successive school years in 1985-1986, and were followed during adolescence on an annual basis from 1989 to 1994 (ages 9-14), and during early adulthood in 2000 and 2001 (ages 21-22).
- Analysis: Longitudinal data analytic methods will be implemented in order to reflect the time-varying nature of other suspected determinants for the onset of marijuana experiences, such as alcohol and tobacco use.
Data source: Prevention intervention research center intervention trial project; Transitions through adulthood project. Funding: Center for Adolescent Health Development Award ($10,000) Back to Top
| Project Period: October 2000–September 2002 Partner: Johns Hopkins University School of Nursing Principal Investigator: Jerilyn Allen, RN, ScD Co-Investigators: Lisa Benz Scott, PhD; Kerry J. Stewart, EdD; Deborah R. Young, PhD Project Staff: Carol Curtis Focus Area: Health Care Project Goals: To systematically assess determinants of women's enrollment and participation in cardiac rehabilitation General Information: This project will examine factors of patients (i.e. depression, comorbidities, attitudes and beliefs about rehabilitation), physicians (i.e. knowledge, attitudes, and beliefs about cardiac rehabilitation and women), and cardiac rehabilitation services (i.e. types of services, patients perceived accessibility and availability) that may contribute to whether women are referred to and whether they enroll and complete outpatient cardiac rehabilitation programs - Target population: African American and white women over 45 years old with Coronary Heart Disease (CHD)
- Study design: This investigation is a longitudinal cohort study. Women will be interviewed by telephone survey within approximately four weeks following discharge from the hospital for a cardiac event and again six months later. In addition, the investigators will conduct a cross-sectional survey of physicians caring for the women in this study.
- Sample: 400 women (200 African American and 200 white) with CHD and their health care providers
Data source: Primary data collection Findings: The purpose of this study was to examine the predictors of referral to and enrollment in outpatient CR in eligible African American (AA) and white (W) females who experienced a cardiac event. Six months after discharge, only 19% of women had received a referral to CR and only 15% had enrolled in a program. Compared to W women, fewer AA women reported referral to, (24% vs. 12%, p=.03) and enrollment in CR (19% vs. 9%, p=.03). More than half (51%) of women reported no knowledge of CR; 61% had knowledge of their insurance coverage for CR; however, 80% of those with a referral actually enrolled. Logistic regression analysis, controlling for age, education, income, angina class, and comorbidities revealed that women with incomes less than $20,000 were 66% less likely to be referred to CR compared to women with incomes greater than $20,000 (p=.01) and AA women were 55% less likely to be referred compared to W women (p=59%). Similarly, women with incomes less than $20,000 were 60% less likely to enroll in CR compared to women with incomes greater than $20,000 (p=.05) and AA women were 58% less likely to enroll compared to W women (p=.059). After controlling for race, education, and angina class; poor physical functional status, younger age, greater comorbidity score and having responsibility for taking care of others were independent predictors of depression in women eligible for cardiac rehabilitation. A physician roundtable discussion to gather descriptive data from physicians and cardiac rehabilitation specialists to understand their perceptions regarding facilitators of and barriers to the referral of eligible women to Phase II cardiac rehabilitation was held. Data also were gathered regarding their view of how to improve the referral process to guide future intervention research. Five critical elements that may influence referral emerged from an analysis of the qualitative data collected from this research. The providers’ ability to determine that a patient is an appropriate candidate for CR. The importance of extrinsic motivators to promote referral. The need for providers to have a clearly defined role in the referral of eligible patients to CR and clear channels of communication between inpatient and outpatient providers, PCPs and cardiologists The need for providers to believe in their female patients’ interest in CR as a part of their cardiac care and the likelihood that women would make CR a priority. The importance of having systems in place that make referral an automatic part of inpatient or outpatient cardiac care.
Publications & Products: Allen, J.K. & Scott, L.B., (2003). Alternative Models in the delivery of primary and secondary prevention programs. Journal of Cardiovascular Nursing. 18(2), 150-156. Benz-Scott L., BenOr, K. & Allen, J.K. (2002) Why are women missing from outpatient cardiac rehabilitation programs? A review of multi-level factors affecting referral, enrollment, and completion. Journal of Women's Health and Gender Based Medicine, 11(9), 773-791. Allen, J.K., Scott, L.B. Curtis, C., Lavis, A. Disparities in Referral and Enrollment of Women in Cardiac Rehabilitation Programs. [Abstract]. Circulation, 2003. 108(17), IV-382.
Community Committee Involvement: A focus group from the community advised investigators on study methods. An early draft of the telephone interview was reviewed for content, question format, and organization by a volunteer group of community advisors. The group included one African American and three white women who had a prior cardiac event and were eligible for rehabilitation, a cardiologist, a cardiac rehabilitation nurse, and a Medicare reimbursement specialist. Funding: Centers for Disease Control and Prevention Special Interest Project Other Resources: www.son.jhmi.edu/research/cardio/reach/reach.asp Back to Top
| Project Period: December 2003 – December 2004 Principal Investigator: Jonathan Ellen, MD Co-Investigators: Dr. Lori Leonard Project Coordinators: Chavonne Lenoir, Emma Tsui Focus Area: Sexual Health, HIV, STD, Baltimore Project Goals: The purpose of this study is to gather data that will help us to develop HIV and STD prevention programs for high-risk adolescents that move beyond the conventional models as well as the constraints imposed by the conceptualization of interventions in terms of ‘levels’ or of spatial or temporal distance from the point of disease transmission. General Information: An acknowledged problem is uncertainty on the part of public health professionals about how to go about incorporating broader social variables, factors, and experience into HIV and STD prevention programs for adolescents. Our purpose in conducting this ethnographic pilot study is to begin such a process. We are interested in starting with a limited number of constructs that have been shown, in clinical and epidemiological studies, to be linked to risk for HIV and STDs or other poor health outcomes and around which prevention messages have frequently been structured. Examples of these constructs include membership in a high risk social network, a lack of parental monitoring, and concurrency, or having more than one sex partner in a given period of time. This study will focus on how these ‘risks’, in particular sexual concurrency, function in context. Target population: The primary population we will be working with in this study is the population of adolescents who are at high risk for HIV or STDs, ages 15-19, living in East Baltimore. High risk will be defined as living within one of the census block groups of Historic East Baltimore in the top quartile for rates of gonorrhea. Adolescents seeking reproductive health services at the Johns Hopkins Adolescent Clinic will also be considered high risk for the purposes of this study. Study design: This study is ethnographic in character. We will conduct repeated interviews (2 to 3) with a maximum of 30 adolescents defined by the criteria listed above under “Target Population”. We will also interview parents, guardians, and caretakers of high risk adolescents, and social service providers, health care professionals, and church, school, or social work representatives who are well-placed to speak about the ways in which concepts, such as concurrency, function in the lives of high risk adolescents. Data collection will take place over a period of 4-6 months, beginning as soon as ethical approvals have been secured and informants have been recruited. Sample: Maximum of 30 adolescents who are at high risk for HIV or STDs, ages 15-19, living in East Baltimore and adolescents seeking reproductive health services at the Johns Hopkins Adolescent Clinic. Analysis: We initially envision looking closely at portions of these interviews that include narratives relevant to the constructs mentioned above. Part of our analysis will include querying these texts using different sets of questions. These questions might be derived from a particular theoretical or methodological tradition. Grounded theorists, for example, use axial coding (coding around an ‘axis’ or a theoretical concept such as concurrency) to ‘dimensionalize’ or flesh out this concept (Glaser and Strauss, 1967; Strauss, 1987). This process involves examining other segments of the text for material that relates to the following four dimensions of the concept: Causal conditions, Interactions between actors, Strategies and tactics, and Consequences. The querying of the text in this manner typically leads to a long list of additional questions that might be asked in a follow-up interview. These interviews could be conducted with the same and/or other informants who are selected, ideally, on the basis of their ability to contribute to the development of the emerging theory. Additional theoretical or methodological lenses would likely suggest additional sets of questions.
Data source: Interviews Funding: Center for Adolescent Health Development Award Back to Top
| Project Period: October 1995-September 2001 Partner: Center for Health Promotion, Johns Hopkins School of Medicine Principal Investigator: Diane M. Becker, RN, ScD, MPH Co-Investigators: Jerilyn Allen, ScD; Joel Gittelsohn, PhD; Taryn Moy, RD, MS; Lisa Yanek, MPH Contact Information: Lisa R. Yanek, MPH Focus Area: Cardiovascular Health, Health Promotion Project Goals: To promote the health of African American women through the reduction of cardiovascular health risks. General Information: 16 moderate size (>250 members) churches participated in this study. The churches were randomized into one of three interventions including: (1) a spiritually based behavior modification program with individual recommendations, weekly sessions with a health educator for four months and weekly sessions with lay leaders for eight months, (2) a non spiritually based behavior modification program with individual recommendations, weekly sessions with a health educator for four months and weekly sessions with lay leaders for eight months, or (3) a self-help behavior modification program with individual recommendations and no weekly sessions. - Target population: Socially heterogeneous, church-going, African American women aged 40 – 88 (mean age = 57)
- Study design: This multiple risk factor cohort study was designed to test a progressive and additive gradient of spiritually based lifestyle interventions to foster smoking cessation, weight optimization, physical activity, and good nutrition in African American women aged 40 years and older. The three arms of the study include (1) a self-help minimal intervention program with an informational approach distributed to women, (2) a standard group behavior modification program, and (3) a spiritual program including a religious component in the standard group behavior modification program.
- Sample: 529 socially heterogeneous, church-going, African American women aged 40 – 88 (mean age = 57)
- Analysis: Intention to treat, adjusted for within-church clustering effects
Data source: Baseline measurements were taken on cardiovascular disease risk factors, including blood pressure, fasting glucose and lipid profile, weight, dietary intake, and physical activity levels. Measurements were repeated at a one year follow-up. Qualitative research, including focus groups and in-depth interviews, is currently being conducted to identify the factors associated with the maintenance of healthy behavior change in nutrition and physical activity. Findings: African American Women respond well to group support of any kind. A significant number of women made sustained positive changes in eating patterns and body weight and fat, accompanied by positive changes in risk factors, blood pressure and blood lipids. Physical activity is a more difficult construct, largely because the women are seriously physically reconditioned, some are physically limited and have been exposed to years of uncontrolled hypertension and obesity. Physical activity, when it does improve, is not of sufficient magnitude to influence activities of daily living, body weight loss, or change in biological markers of risk including lipids, glucose, and blood pressure. The strongest predictors of improved eating habits and weight loss are the number of sessions attended and the magnitude of overweight at baseline, probable indicators of motivational issues. Publications & Products: Yanek LR, Moy TF, Raqueño JV, Becker DM. Comparison of a Telephone 24-Hour Dietary Recall with In-Person Methods. J Am Diet Assoc 2000;100:1172-1177. Becker, DM. "Public Health and Divinity: The Basis of Interventions in Urban African American Communities." In Integrating Behavioral and Social Sciences with Public Health, ed. N Schneiderman, MA Speers, JM Silva, H Tomes, JH Gentry. American Psychological Association, Washington, D.C., 2000. Yanek LR, Becker DM, Moy TF, Gittelsohn J, Matson-Koffman D. Project Joy: Faith-based cardiovascular health promotion for African American women. Public Health Rep 2001;116(Suppl 1):68-81. Yanek LR, Moy TF, Raqueño JV, Becker DM. Comparison of food frequency and dietary recall methods in African American women. J Am Diet Assoc 2001;101:1361-64. Patt MR, Lane AE, Finney CP, Yanek LR, Becker DM. Body image assessment: comparison of figure rating scales among urban Black women. Ethn Dis 2002;12:54-62. Patt MR, Yanek LR, Moy TF, Becker DM. Assessment of global coronary heart disease risk in overweight and obese African-American women. Obes Res 2003; 11(5):660-667. Bronner YC, Miller K, Young D, Teoh N, Griffin T, Garrett D, Becker D. Qualitative research methods used in formative evaluation: planning a church-based culturally integrated intervention. Ethn Dis 1997;7(1 suppl):S25. Presented at the 12th International Interdisciplinary Conference on Hypertension in Blacks, July 21-22, 1997, London, UK. Bronner YC, Miller KW, Becker DM. Integrating public health messages and interventions in to the culture of the church. APHA Abstracts of the 125th Annual Meeting, 1997. Presented as a round table discussion, November 12, 1997. Yanek LR, Raqueño JV, Moy TF, Becker DM. Predictors of hypertension control in urban African American women. Ethn Dis, 1999;9(2):300. Presented at the 14th International Interdisciplinary Conference on Hypertension in Blacks, July 12-13, 1999, Toronto, ON.
Funding: CDC Special Interest Project and NIH Office of Women’s Health Other Resources: www.choosetomove.org Back to Top
| Project Period: January 1997-September 2000 Partner: Maryland AIDS Administration, National Network for Youth, and Montgomery County Department of Health and Human Services Principal Investigators: Cheryl Alexander RN, PhD, and Robert W. Strack PhD, MBA Focus Area: Alcohol Use, Mental Health, Sexual and Reproductive Health, Substance Use, Maryland, Runaway and homeless experiences, Systems Youth, HIV/AIDS. Project Goals: The goals of the MARS Project are: 1) to evaluate the appropriateness and feasibility of using standard HIV risking behavior items (i.e. Youth Risk Behavior Survey) as a behavioral surveillance instrument for youth that are in "out-of-home" situations; 2) to develop and test items that specifically address the contexts in which high risk sexual and substance use behaviors occur, and the protective behaviors young people use to avoid exposure to HIV infection; 3) to administer the developed instrument to youth (n=328) in group homes and shelters throughout Maryland; and 4) analyze and provide information to project partners and agencies. General Information: The purpose of this study is to try to understand the behaviors and situations that place young people not currently living at home at risk for health problems. An "Out-of-Home" Youth Survey, designed for youth that receive services through youth group homes and shelters, was developed through the M.A.R.S. project. Information collected from the MARS survey is being used to inform policy and help organizations provide better programs and services for young people who are not living at home. Formative research utilizing focus groups, pilot instrument testing and cognitive interviews was conducted to develop the Out-of-Home Youth Survey (OHYS). The final OHYS contained 93 questions, some with multiple components, covering a variety of topics relevant to youth in out-of-home situations. Survey categories consisted of 1) demographics, 2) living situations and personal history, 3) relationships with parents and others, 4) suicidal ideation and attempt, 5) alcohol and other drug use, 6) sexual behavior, experiences and attitudes, and 7) HIV/AIDS testing and perception of risk. During August and September of 1999 the final OHYS was administered to 336 youth between 14 and 21 years of age from 48 group homes and shelters throughout the State of Maryland. Of the 336 surveys collected 8 (2.4%) were discarded due to highly inconsistent responses. This resulted in a total of 328 usable surveys. It is estimated that 80% of eligible youth in the group homes and shelters participated in the survey. Non-participants primarily consisted of youth that were either working, on home visits or had runaway. The refusal rate of the youth that were present at the group home or shelter when the data collector arrived was less than 4%. - Target Population: Adolescents ages 14-21 who receive services in group homes and shelters that serve abandoned, runaway, homeless, substance using and delinquent youth.
- Data source: Survey
Summary/Preliminary Findings: Results of the survey of revealed that 25% of the youth surveyed have been forced to have sex, have been or have gotten someone pregnant, and did not feel loved or safe at home. Over one third of the youth have been physically hurt at home and over half have run away in the previous year. Eighty percent of the youth surveyed have had vaginal intercourse and 25% have had anal intercourse. Results also revealed that over 40% of youth surveyed have spent at least one night in the past year without permission at a boy/girlfriends place and hanging out all night with friends. Additional finding are described in the linked executive summary. Publications & Products: - Report of the Monitoring Adolescents in Risky Situations (MARS) Project: Findings from the 1999 Out-of-Home Youth Survey, November 2000, Baltimore, MD.
- Strack, R; Anderson, K; Graham, CM; Tomoyasu, N; Weston, C; Alexander, CS. Race-Gender differences among Maryland youths living in out-of-home state funded group care. Presentation given at the 2003 Annual Meeting of the American Public Health Association in San Francisco, CA, November 18, 2003 (Abstract ID 58895).
- Anderson, K; Graham, CM; Tomoyasu, N; Strack, R. HIV Risk among out-of-home youth: An exploration of sexual identity and same-sex sexual behavior as possible demographic risk factors. Presentation given at the 2003 National HIV Prevention Conference in Atlanta, Georgia, July 27-30, 2003 (Abstract ID 833).
- Strack RW, Weston C. Assessing the HIV health risks of youth in group homes and shelters: Results of the ‘Out-of-Home Youth Risk Survey’. Presentation given at the American Public Health Association (APHA) 128th Annual Meeting, Boston, MA, November 15, 2000, (Abstract number 5039.0).
- Strack RW, Boyle A, Eldred L, Weston C. Developing appropriate language for surveys of youth with higher HIV infection risk. Oral presentation given at the American Public Health Association (APHA) 127th Annual Meeting, Chicago, IL, November 1999, (Abstract number 3997).
- Boyle A, Strack RW, Morreale M. Assessing health risks among “Out of Home” youth: A review of the literature. Oral presentation given at the American Public Health Association (APHA) 127th Annual Meeting, Chicago, IL, November 1999, (Abstract number 5728).
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| Project Period: October 1998-September 2001 Partner: Bureau of Maternal and Child Health, Health Resources Administration Principal Investigator: Cheryl S. Alexander, RN, PhD Co-Investigators: Nan Astone, PhD, Karen Bandeen-Roche, PhD, Margaret Ensminger, PhD, Debra Mekos, PhD, Kathleen Roche, MSW, PhD Project Coordinator: Shelly Trim, MPH Focus Area: Neighborhoods, Youth Violence, Sexual and Reproductive Health, Baltimore Project Goals: There are five goals of this study: 1) identify characteristics of urban neighborhoods associated with early sexual activity and delinquency and fighting; 2) investigate the direct and indirect influences of urban neighborhoods on adolescent behaviors; 3) explore variations in the availability, accessibility, and visibility of neighborhood social resources; 4) investigate the mechanisms that families use to obtain social resources; and 5) assess the extent to which families with and without adolescents who are involved in health compromising behaviors vary in their use of social resources, parenting practices, and cultural practices. General Information: This is a three year study involving secondary data analysis of The National Longitudinal Study of Adolescent Health (Add Health) and primary collection and analysis of qualitative and quantitative data from three neighborhoods in Baltimore City. - Target population: 7th and 8th graders
- Study design: Trained Interviewers conducted ethnographic interviews with youth, parents, and "knowledgeable" neighbors (n=75) and administered structured questionnaires to living in three Baltimore City neighborhoods stratified by level of juvenile crime and adolescent child bearing.
- Sample: nationally representative sample 2,544 urban 7th and 8th graders
- Analysis: Secondary multivariate analysis to examine neighborhood and parenting influences on the initiation of sexual intercourse and transitions in delinquent behavior.
Data source: National Longitudinal Study of Adolescent Health and Primary data collection Publications & Products: Alexander, C., Roche, K., Mekos, D., Astone, N., Bandeen-Roche, K., & Ensminger, M. (April 2002). Gender differences in the onset of sexual intercourse among early adolescents. Poster presented at the Biennial Meeting of the Society for Research on Adolescence, New Orleans, LA. Back to Top
| Project Period: August 1999 – January 2000 Partner: Southeast Youth Academy Principal Investigator: Robert Strack, MBA, PhD Project Coordinator: Cathleen Magill, MHS Candidate Focus Area: Community Based Participatory Research, Baltimore Project Goals: The Photovoice project was designed to give young people a voice by engaging them in the process of defining and discussing the issues that affect the health of youth in their community through photography. It also attempted to assess the degree to which the Photovoice process could be used as a tool for engaging youth as research partners in their own community. General Information: A core group of 14 participants attended 20 Photovoice sessions focusing on enabling youth as research partners. Photovoice Participant Surveys were administered to youth at three intervals during the project. The surveys were designed to provide a snapshot of participant attitudes toward taking pictures, discussing pictures, the logistics of the Photovoice process, the Photovoice project overall, and a desire to remain apart of the project at those three intervals. In addition to the structured surveys, qualitative interviews were conducted with participants at the conclusion of the project. Photovoice is an innovative method of engaging a community in a participatory research project by inviting people to identify, represent, and enhance their community through a shared photographic process. This process was evaluated through structured surveys and qualitative interviews with the youth participants. - Target Population: Southeast Youth Academy participants aged 11-17. The core group of 14 participants was evenly split between males and females; 50% were non-Hispanic black, 29% non-Hispanic white 7% Hispanic white and 14% identified themselves as mixed race.
- Data Source: Structured surveys and qualitative interviews
Summary/Preliminary Findings: In terms of attitudes toward the project, answers to the structured questions indicate that all the teens in the core group of 14 were glad to be a part of it. At all three points in time every youth agreed or strongly agreed with the statement: "I am glad that I am part of the Photovoice Project at the Southeast Youth Academy." The youths were equally adamant about their desire to remain in the project, as no teens expressed interest in dropping out at any of the three points in time. The data from the qualitative interviews confirm and enhance these survey data. When asked whether they would participate in the project if it were offered again, all nine youth interviewed said "yes." Some answered with an enthusiastic "definitely." Based on the investigator’s evaluations, comments made by S.E.Y.A. staff members and the participating youths’ suggestions, a revised timeline for the implementation of the Photovoice process was developed. The revised timeline and other lessons learned are available in the final report. Three exhibits showcased the work of Photovoice participants. Of the first two exhibits, held at the S.E.Y.A, one was limited to family and friends of the young people and the second was opened to the local community, councilmen, funders, and collaborating organizations of S.E.Y.A.. The third exhibit was held in conjunction with a presentation of the Photovoice project at Johns Hopkins University as part of the Community-Based Public Health Research Seminar Series. Publications & Products: - Strack RW, Magill C., McDonagh, K. (2004). Engaging youth through Photovoice. Health Promotion Practice. Volume 5(1): 49-58.
- “Engaging Youth as Researchers Through Photovoice.” W.K. Kellogg Foundation’s community-based research First Monday Seminar Series, March 6, 2000, Johns Hopkins School of Public Health, Baltimore, Maryland.
- “Engaging youth as researcher partners in a community needs/assets assessment through the Photovoice process,” American Public Health Association’s Annual Meeting, November 13, 2000, Boston, Massachusetts.
- “Engaging Youth as Researchers Through Photovoice.” Society for Public Health Education Annual Meeting, November 11, 2000, Boston, Massachusetts.
Community Committee Involvement: Project REACH Advisory Committee Other resources: www.photovoice.com, www.jhsph.edu/hao/cah/youthphotovoice/home.html Partner Involvement: Southeast Youth Academy provided on site administration of program and partnered in evaluation and analysis of project. Partnered with principle investigator in preparation of manuscript. Funding: Center for Adolescent Health (Development Award): $10,000 Back to Top
| Project Period: October 2002-September 2003 Principal Investigator: Margaret M. Weden Focus Area: Methods Project Goals: The goals of this project include: 1) the development of a Stata Program for the Calculation of Multistate Life Tables, 2) the epidemiological Application of the program, and 3) the dissemination of program to audiences familiar with demographic methods and those unfamiliar with demographic methods (including application instructions). General Information: This project is designed to promote the application of demographic methods by making multistate life table analysis readily accessible to Stata Statistical Software users. Multistate life tables allow researchers to capture dynamic histories of individual experience over the life course and translate them into broader statements about population trends. Application of these methods enable a researcher to more fully explore the implications of life history and the transitions between various social, economic and environmental contexts. Despite their great relevance to public health research, multistate methods have not been well explored in the public health literature. The programs which are available for download at this site have been developed in order to encourage such interdisciplinary research. Detailed instructions and multiple examples have been provided to illustrate the range and the flexibility of the programs. - Target Population: Social science researchers
Data Source: National Longitudinal Survey of Youth, 1979-2000 (data for two examples used to describe application of program). Schoen, 1988 (published tabulations used in two additional examples) Products: webpage; three Stata ado-file programs; four examples (complete with applicable Stata do files, Stata datasets, and Stata log files) Funding: Center for Adolescent Health Development Award $10,000 Back to Top
| Project Period: October 2003- September 2004 Partner: Baltimore City Health Department Principal Investigator: Maria Trent, MD, MPH Co-Investigators: Alain Joffe, MD, Gerry Waterfield, CPNP, Helen Thomas, CPNP, Jacky Jennings, MPH, PhD, Focus Area: School Health, Baltimore, Neighborhoods, Nutrition, Primary Data Analysis Project Goals: 1) To determine the prevalence of obesity among adolescents participating in the Baltimore City School Based Health Program 2) To determine if adolescents from certain neighborhoods and/or census tracts in Baltimore disproportionately affected by obesity General Information: This project is a collaborative effort with the Baltimore City Health Department (BCHD) and Johns Hopkins University to estimate the prevalence of adolescent obesity in Baltimore City and to evaluate the need for additional programming related to overweight youth in the school based medical centers. We plan to evaluate the prevalence of at-risk and obese youth in our school based health clinics as compared to national estimates and identify neighborhoods most significantly affected by obesity using census tract identification and geographic information systems technology. This project is in accordance with the mission of the Center to help identify and prevent the development of chronic diseases such as obesity in children and to improve the quality of life and overall health of children in inner-city Baltimore. - Target population: Urban Adolescents, grades 9-12 in Baltimore City
- Study design: Prospective Chart Review
- Sample: Students in the Baltimore City School Based Health Program (High Schools)
- Analysis: This prevalence data will then be stratified by site, gender, race/ethnicity, and age group. Exploratory geographic analysis using MapInfo will be conducted to identify high obesity prevalence neighborhoods/census block groups.
Data source: Obesity prevalence estimates will be obtained from a sample of adolescents participating in the Baltimore City School based health program Partner Involvement: The BCHD will aid in estimating the prevalence of adolescent obesity in Baltimore City and to evaluate the need for additional programming related to overweight youth in the school based medical centers Funding: Center for Adolescent Health Development Award ($10,000) Back to Top
| Project Period: October 2003–September 2004 Partner: Center for Applied Research & Technical Assistance, Inc. Principal Investigator: Barbara Sugland, MPH, ScD Project Coordinator: Chandra Gavin, MS Focus Area: Sexual and reproductive health, Baltimore City, Families, Secondary data analysis Project Goals: To distinguish measures of family strengths most strongly correlated with age of first birth for White, African-American, and Latino youth, and to document perspectives from a diverse sample of families in Baltimore City about programmatic strategies most useful for building strong families among ethnic minority communities. General Information: This project address gaps in both existing research and youth development practice. Specifically, it broadens our understanding of family characteristics that may be important for adolescent fertility behavior of youth of color. In addition, it will gather insights directly from families about the factors that promote and hinder their ability to support their adolescent children. The project will translate findings into recommendations for additional research and for program strategies that can be used to guide local prevention efforts in Baltimore City. Target population: Phase I – Includes national sample of male and female 8th graders who have never given birth as of 1988. Phase II -- Ethnically diverse families in Baltimore City where the head of the household is at least 21 years of age, where there is at least one adolescent child in the household, and families show moderate to strong functioning. Study design: Phase I -- Includes a retrospective quantitative analysis of delayed sex and delayed childbearing among participants in the National Education Longitudinal Study of 1988 (NELS:88) up through age 24, with assessment of influence of various family strengths attributes net of individual attributes, community and demographic characteristics, including race/ethnicity. Phase II – Includes focus group discussions with ethnically diverse families across Baltimore City. Groups will be conducted separately by race/ethnicity, but will include both males and females. Participants will be recruited through local community-based organizations, with assistance from the CAB. Final selection will be based on responses to a screening questionnaire structured to determine eligibility. Participants will: a) brainstorm and discuss what they believe reflects behaviors and characteristics of strong families; b) identify 3 or 4 attributes most important for helping young people avoid risky behavior, like early sex and parenting; c) respond to key findings from Phase I, noting whether research findings accurately capture aspects of strong families given their racial/ethnic background; d) offer suggestions for community organizations to support and help strengthen local families. Sample: Phase I – approximately 11, 400 white, black and Hispanic 8th graders in the NELS:88. Phase II -- 32 to 40 ethnically diverse families in Baltimore City. Analysis: Phase I - descriptive analyses will be conducted for all measures. Bivariate analyses will be conducted to examine associations of family strengths with age at first sex and age at first birth (early, middle and late adolescence). Bivariate analyses will be generated for the full sample, and separately by gender and race/ethnicity, and by gender controlling for race/ethnicity. Logistic regression models will be generated predicting transition to first sex and first birth. Depending upon results of bivariate analyses, multivariate models may be generated separately by race/ethnicity and/or gender. Phase II - CARTA will prepare top line summaries – short bulleted description of key themes that emerged from the group discussions. Top line summaries will be used to prepare a short, but integrated summary across all group discussions. Recommendations for programs will be generated and shared with the CAB. Data source: National Education Longitudinal Study of 1988, focus group discussions with a diverse group of families from Baltimore City Publications & Products: Presentation to CAB on final project findings. Community Committee Involvement: The Community Advisory Board (CAB) will aid in determining community based agencies from which to recruit families for focus group discussions and that might serve as a host site where the group discussions will be located. Partner Involvement: CARTA staff will summarize and present findings to the Center for Adolescent Health and submit an abstract of this work for presentation at the fall 2004 meeting of the American Sociological Association in preparation for a submission to a peer-reviewed journal. Funding: Center for Adolescent Health Development Award ($32,400) Back to Top
| Partner: Baltimore City Health Department Principal Investigator: Robert Strack, PhD Co-Investigators: Cynthia Mobley, MD, MPH; Pat Paluzzi, CNM, DrPH Project Staff: Anna Groskin, MHS candidate, Marilyn Akinfolarin, MHS, Chanza Baytop, DrPH candidate, Hibist Astatke, PhD-Post Doctoral Fellow Focus Area: second births, repeat births, adolescent pregnancy, Evaluation, Sexual and Reproductive Health, Baltimore Project Goals: The goal of PAIRS is to reduce the rate of repeat pregnancies and enhance the academic skills and aspirations of program participants. The Center for Adolescent Health has partnered with the Baltimore City Health Department in conducting a process and impact/outcome evaluation of the PAIRS project. The goals of the evaluation are to better understand: 1) the effects a case-management intervention on parenting adolescents for increasing responsible sexual knowledge, attitudes and behaviors and the subsequent occurrence of second births and pregnancies; 2) the effects of a case management intervention with parenting adolescents on increasing school and /or job motivation and completion/readiness, and 3) the key components of an effective case-management model with parenting adolescents. General Information: The Parenting Adolescents Investing in Real Success (PAIRS) project is a Baltimore City Health Department case-management program for addressing the family planning, academic and social needs of parenting female adolescents. PAIRS is founded on the positive preliminary results of the case-management portion of the Teen Incentive Project (TIPs) that was conducted from March 1997 to 2000 at the Healthy Teens and Young Adults clinic in West Baltimore. The case management model is designed to promote healthy adolescent development and behaviors by establishing a personal relationship between the caseworker and adolescent participant. The PAIRS study uses a case-management model with parenting female adolescents receiving services at the same Healthy Teens and Young Adults clinic in West Baltimore. The project uses a randomized longitudinal design with a self administered questionnaire being carried out at baseline and telephone interviews being conducted at 3, 6, 12, and 18 months following baseline measurement. Recruitment resulted in 128 parenting female adolescents enrolling in the study who were subsequently randomized into case or control groups. The surveys of participants will assess a range of issues that are targeted by the case-management model from academic achievement and career expectations, to sexual attitudes and behaviors, to questions on global esteem and self-image. A process evaluation of the case-management model will be carried out through a case-intervention tracking form, interviews with caseworkers and surveys of participants. - Target population: Parenting female adolescents currently receiving services at the Healthy Teens and Young Adults clinic who agree to be enrolled in a case-management program
- Data source: Surveys
Findings: A sample of 129 urban, parenting female adolescents were randomized to receive the PAIRS intervention or regular clinic services. Follow-up data collection utilized telephone interviews conducted at intervals of 3, 6, 12, and 18 months following baseline measurement. Chi-squares and paired t-tests were used to compare changes among 89 participants at the final follow-up. All of the youth were residents of Baltimore City and all but two youth were African American. The mean age for cases and controls was 16.7 and 17.0 respectively with a median age of 17. Eleven participants (5 cases, 6 controls) self-reported through a questionnaire that they had gotten pregnant during the program. Statistically significant differences were found between the groups on whether they had dropped out of school with no dropouts at follow-up among the cases engaged in the program (p-value>.10). The descriptions provided of the program’s process highlights some of these challenges. The PAIRS program attempted to balance these urban realities with the needs and issues faced by parenting adolescents. While it is clear from the final surveys with engaged cases that the program provided value to their lives, it is unclear as to the net impact on many of the variables assessed given equivalent changes in the unengaged case and control groups. Publications & Products: - Strack RW, Baytop C, Paluzzi P, Mobley C (2002) Evaluation Report of the Parenting Adolescents Investing in Real Success (PAIRS) Project, Submitted to the Baltimore City Health Department, Baltimore, MD; 98 pages.
- Strack RW, Baytop CM, Paluzzi P & Mobley C (Manuscripts in Process) Results, Realities, Rethinking: Evaluation of the Parenting Adolescents Investing in Real Success (PAIRS) Program.
Community Committee Involvement: CAB – provided advisory role. Partner Involvement: Baltimore City Health Department – a fully collaborative process with the Baltimore City Health Department from evaluation planning to analysis and reporting. Funding: Baltimore City Health Department Back to Top
| Principal Investigator: Freya L. Sonenstein, PhD Focus Area: Transitions to Adulthood, Youth Development, Sexual and Reproductive Health, Secondary Data Analysis Project Goals: To combine qualitative and quantitative methodologies iteratively to build an understanding of the sequencing of young men’s romantic relationships as they grow older. General Information: This project focuses on a new construct in life course development: relationship progression in late adolescence and early adulthood among young men. As young men mature, most move through a series of romantic relationships. This concept is implicit in the ways that many young adults discuss their relationships, but is absent from the current literature on adolescent transition to adulthood. Our project posits 1) that patterns of relationship progression exist in late adolescent and early adult development, 2) that these patterns are influenced by various factors, and 3) that these patterns have consequences in young adult development. How young men progress towards more durable romantic relationships is an important question because there is considerable concern among policy makers and others that young men today are only loosely attached to their romantic partners and their children. - Target population: Young males who are progressing towards late adolescence and early adulthood
- Study design: The qualitative component includes conducting interviews with the young men. The interviews will obtain their views of how their own relationships progressed and the factors that have led to their current union status. This information in combination with the wealth of earlier information available about these respondents will be examined to generate theory and hypotheses about young men's relationship progression. The quantitative component will examine the three rounds of existing NSAM information to develop descriptions of relationship progression patterns, to examine factors associated with the assumption of different patterns of progression and to examine whether particular progressions are associated with the achievement of different union statuses in 1995.
- Sample: Cohort from the National Survey of Adolescent Males (NSAM) and 54 young men from the original sample who are now living in one of the following metropolitan areas: Los Angeles, Chicago, or New York
- Analysis: The qualitative results will guide the quantitative analyses and the quantitative results will inform our interpretation of the information from the qualitative study respondents. This information and the results of a proposed tracing study of a 10 percent sample of the original cohort will be used to determine whether a 4th round of interview with the entire original cohort would be informative and feasible.
Data source: National Survey of Adolescent Males (NSAM), Interviews Funding: William T. Grant Foundation Back to Top
| Project Period: September 2001–October 2002 Principal Investigator: Deborah Young, PhD Co-Investigators: Margarita Treuth, PhD, Carolyn Voorhees, PhD Project Coordinator: Brit Saksvig, PhD Focus Area: Physical Activity, School Health Project Goals: To evaluate the feasibility, acceptability, retest reliability, and concurrent validity of two physical activity self-report instruments. - Target population: Adolescent boys attending middle schools.
- Study design: Boys wore the CSA monitors for 7 consecutive days and completed two different self-report physical activity instruments. Data were successfully downloaded from the CSAs.
- Sample: 29 adolescent boys attending middle school. Data were combined with data from 5 additional field sites.
- Analysis: The CSA data and questionnaires were sent to the Coordinating Center for analysis.
Data source: Original data collected for the study. Findings: The TB instrument took significantly longer to complete (TB= 31±10, AB= 28±8 min; p = 0.022). Test-retest correlations for MVPA were similar for the TB survey and the AB survey (r = 0.455-0.777), but the girls were more reliable on the AB survey than the boys (girls: r = 0.713; boys: r = 0.568). The overall 3-day correlations between MVPA determined by the surveys and Actigraph counts varied by gender (girls: AB = 0.265 vs. TB = 0.314; boys: AB = 0.340 vs. TB = 0.277). As the interval between completing the surveys and the days being recalled increased, reliability and validity was lower, especially for the boys. For both genders, either approach is acceptable for obtaining PA information on a single day; but the Time-Based approach appears to be somewhat more reliable for obtaining multiple days of MVPA or VPA self-report information from adolescents. A 3-day recall period appears to be too long for accurate recall of PA information. For both genders, the surveys over-estimated activity levels; thus, there appears to be a need to obtain both objective and self-report information. Publications & Products: R. G. McMurray, K.B. Ring, M.S. Treuth, G.J. Welk, R.R. Pate, M.K. Schmitz, J. L. Pickrel, V. Gonzalez, M.J.C.A. Almedia, D. Rohm Young, and J.F. Sallis (2004). Comparison of two approaches to structured physical activity surveys for adolescents. Medicine and Science in Sports and Exercise, 36(12):2135-43. Community Committee Involvement: None Partner Involvement: 1 middle school in Baltimore County Funding: Center for Adolescent Health, $8,904 Back to Top
| Project Period: July 2002 - December 2003 Principal Investigator: Eric Slade, PhD Project Staff: James Rice Focus Area: Mental Health Project Goals: The purpose of the proposed project is to estimate associations of past maltreatment with functional outcomes in late adolescence and early adulthood, and to allow these associations to differ depending on behavioral and emotional impairments during childhood and adolescence. The proposed project has two specific aims, namely: - To estimate the association of history of maltreatment to functioning in late adolescence and early adulthood, as measured by graduation from high school, adult criminal justice system conviction, participation by women in TANF/AFDC, and alcohol related impairment, and to compare these associations across socioeconomic and demographic subgroups; and
- To test whether social competence (i.e., success in forming at least one friendship with a peer and positive feelings about one’s social acceptance) as well as symptoms of mental illness and closeness of relationships with parents/parent-figures during adolescence mediate the association between previous maltreatment and later functioning.
General Information: The proposed project will explore the relationship of past maltreatment to functioning among 18 to 25 year old young adults in the U.S. Data from Waves I to III of the Longitudinal Study of Adolescent Health (Add Health) will be used in the analyses. Both bivariate (i.e., descriptive) and multivariate analyses of the Wave III Add Health data will be conducted. Multivariate analyses will use logistic regression for each of four impairment outcomes, high school graduation, adult criminal conviction, welfare receipt, and alcohol related impairment, and will also include multiple explanatory variables. Target Population: 18 to 25 year old young adults Data Sources: Waves I to III of the National Longitudinal Study of Adolescent Health (Add Health) Findings: Preliminary findings suggest an important role of adolescent mental health problems in mediating the effects of child maltreatment on academic performance as well as other outcomes (e.g., adult criminal activity and substance use). Maltreatment, particularly in the form of neglect and sexual contact, was significantly associated with lowered school performance based on several measures (GPA, homework completion, getting along with teachers and peers, paying attention in school, and school days missed). However, these relationships were relatively weak in terms of statistical significance. Also, controlling for adolescent mental health status (depressive symptoms, delinquent behaviors, and attention problems) substantially reduced the association of maltreatment with school performance. Also, mental health problems were, but maltreatment was not, significantly associated with school performance in fixed-effects models, which controlled for unobservable factors common to sibling pairs. Partner Involvement: Lawrence Wissow, M.D., Assoc. Prof., Department of Health Policy and Management contributed to this research. Back to Top
| Project Period: January-December 2004 Partners: Center for a Livable Future, Baltimore City Health Department-Child and Adult Care Food Program, Housing Authority of Baltimore City-Division of Family Support Services, The Men’s Center, Middle East Community Development Corporation, Historic East Baltimore Community Action Coalition, Baltimore’s Safe and Sound Campaign, St. Francis Academy, Super A Farms, Stop, Shop & Save, and Baltimore Public Markets Corporation Principal Investigator: Joel Gittelsohn, PhD, MSc Co-Investigators: Benjamin Caballero, Kevin D. Frick, Jean Anliker, and Sangita Sharma Project Coordinator: Sharla Jennings Project Team members: Chrisa Arcan, Tae H. Chong, and Justine E. Dang Focus Area: Nutrition, Neighborhoods, Baltimore Project Goals: The goal of the Baltimore Healthy Stores program is to increase the availability of healthy foods, and provide targeted and culturally appropriate nutrition education at the point of purchase to improve consumer knowledge and skills to make better food choices and improve dietary quality. In addition, the aim of the program is also to develop intervention components for the Baltimore Healthy Stores program that will focus on adolescents, and that will be feasible (acceptable, operational, sustainable) to corner store owners/managers. General Information: The program, which will be based on our formative research coupled with the recommendations from Nutrition and Your Health: Dietary Guidelines for Americans (USDA, 2002) and the Food Guide Pyramid will function on multiple levels. At the individual and behavioral levels, consumers will be provided with the opportunity to acquire specific skills and knowledge that will support healthful changes in food selection, preparation and consumption. At the environmental level, intervention stores will be asked to stock and actively promote selected foods and preparation methods. Training will be held for the owners, managers, and staff of the intervention stores, and will introduce the goals of the project, intervention activities, and the role of the store staff in promoting and maintaining the intervention. The program will be conducted over one year in the intervention stores, divided into 6 two-month phases, with each phase emphasizing a different set of activities and foods. Following the final evaluation of the program, intervention materials and training will be provided to comparison stores. The intervention will take four main approaches: 1) Improving the availability of healthy choices; 2) Promoting healthy food choices; 3) Promoting healthy cooking methods; and 4) Promoting healthy food distribution networks to inner city stores. Each of the strategies will include elements to encourage healthy foods acquisition in persons on a food assistance program. Stores will be encouraged to stock and promote healthy alternatives to commonly consumed foods consistent with U.S. Dietary Guidelines. General components of the intervention strategy will include key messages/themes, character motif, and a logo. In-store components of the intervention will include shelf labels, flyers, cooking demonstrations, taste tests, prepackaged meals, and recipe cards. Mass media campaigns will include posters and fliers. Furthermore, based on the formative work, we will also evaluate additional approaches that will increase the appeal of the program to adolescents. The potential ideas include targeting popular hangout sports that have food (in addition to a food store), “healthy stores” club memberships, and rap songs with a health theme. Target population: Adolescents (age range: 12-17 years old) from East and West Baltimore. Study design: This study has a quasi-experimental design where one area will receive the store intervention program (East Baltimore), and another community serves as a comparison (West Baltimore). The program will be implemented in eight food sources in the intervention community (2 large supermarkets and 6 corner/convenience stores), and compared with a similar set of stores in the comparison community. The primary goal is to assess the feasibility of the intervention program and evaluation measures to support the development of a city-wide trial. However, trends in program impacts and outcomes will be examined. We will conduct in-depth interviews with adolescents (n=20) and the parents of adolescents (n=20). Store owners and managers will be sampled from the participating stores in the feasibility study. Adolescents and their parents will be sampled from participating community organizations that work with adolescents. All participating store manager/owners will be interviewed for the feasibility study (n=16), both at post intervention and at follow-up. Store customers for the feasibility study will be selected from two main types of locales: 1) the clients of three District Human Services Centers which service East (n=48) and West (n=48) Baltimore (districts 2, 4, 5), which represent low income residents of the community; and 2) at each of the participating stores (both intervention and comparison community), we will randomly sample (e.g., every tenth customer) approximately 6 respondents for the consumer feasibility and impact questionnaires, yielding a total sample of 96, half from the intervention and half from the comparison area. The sample population for the adult feasibility will be main food preparer/shopper of the household age greater than 21 years old, total sample =192. We will follow this cohort of individuals and plan conservatively for a loss-to-follow up of 20%. In addition, in order to pilot the adolescent feasibility and impact instruments, we will sample 60 adolescents (age range: 12-17 years old) respondents from the community organizations and middle schools, stratified by gender, age group and economic status. - Sample: The sampling design for this study is based on achieving three goals: 1) additional formative research with parents and adolescents to help plan the adolescent intervention components and evaluation instruments to assess adolescent participation and impact; 2) an assessment of the feasibility of the overall program; and 3) to estimate of the variability in key program outcomes (e.g., Consumer diet) in order to make accurate sample size estimations for a city-wide intervention trial.
- Analysis: Quantitative data will be entered in MS Access files and analyzed in SAS® (Cary, NC).
- Scale Development: Scales will be developed for feasibility constructs (acceptability, operationality and sustainability), food knowledge (fat, sugar, label reading), food intentions and self-efficacy. Principal components analysis will be conducted with the questions to identify and weight items belonging to each scale. The eigenvalue-one criterion (Hatcher, 1994) will be used to retain and interpret a component. Individual scale items will be identified as having loaded at 0.40 or higher. The final variables will be summed together to create each scale. Coefficient alpha reliability estimates (Cronbach, 1951) will be computed for each scale to measure internal consistency. Items that do not scale will be eliminated from the final instrument. In addition, we will develop scores for dietary quality based on the food frequency instrument.
- Adolescent Feasibility Instrument Analyses: Analysis of the feasibility instrument data will be primarily qualitative and descriptive. We will evaluate the acceptability of various intervention components to adolescents, looking for key themes, consensus opinions and contrasting viewpoints in relation to each of the intervention components and materials.
- Adolescent Impact Instrument Analyses: Using scales described above and other data from this instrument, we will conduct two main types of analyses of the impact data. First, we will use the data from the 60 surveys to estimate variance in our key intermediate and impact variables. Second, we will descriptively analyze the data in order to describe purchasing and consumption patterns in Baltimore City adolescents, to permit us to better focus the BHS program on key behaviors and foods
Data source: In-depth interviews, focus groups, workshops, questionnaires Community Committee Involvement: To date, Baltimore Healthy Stores does not have a formal community advisory board that regularly meets to help plan BHS activities. Many partners have been involved through the formative research and workshop process (described below). Following the pilot intervention experience (Mar-May 2004) we plan to form an advisory committee in support of the Baltimore Healthy Stores work. Partner Involvement: Partners in the Baltimore Healthy Stores program include Maryland Cooperative Extension, Maryland State Department of Education, Child and Adult Care Food Program, Baltimore City Health Department (BCHD)Child Adult Care Food Program, Baltimore Housing Authority, Baltimore City 4th District Human Services Center, St. Frances Academy Community Center, BCHD, Environmental Health, The Men’s Center, Cultural Eye Productions, Julie Community Center, BCHD Food Stamps Program, Maryland Food Bank and some others. Representatives of most of these organizations have been interviewed as part of the formative research conducted last year. The aforementioned organizations have sent representatives to attend one or both of the workshops we have held for the development of the intervention approach and materials. In addition, the Stop Shop and Save supermarket chain and Super A Markets are food store partners in the program and will be the locales for the pilot and feasibility studies upcoming. We meet with them individually to show they materials and understand how best to collaborate with these institutions. Funding: Center for Adolescent Health Development Award ($29,951) Other Resources: www.healthystores.org Back to Top
| Project Period: December 2003-June 2005 Principal Investigator: Ryan H. Pasternak, MD Co-Investigators: Tina L. Cheng, MD, MPH; Gail Geller, ScD; Catherine Parrish, MD Focus Area: Risk behavior research, Evaluation Project Goals: The goals of this study are t 1. Assess parental and adolescent perceptions of the need for parental consent, confidentiality, and expectations for disclosure of information regarding risk behavior in clinical care and risk behavior research. 2. Assess parental and adolescent perceptions of the need for risk behavior research. 3. Assess parental and adolescent knowledge of local statutes regarding confidentiality and disclosure in adolescent clinical care. We believe the results of this study will provide important information critical to the development of improved research practices and guidelines for adolescent involvement in research, superior informed consent practices, and improved understanding between healthcare professionals and the communities they serve. Without this knowledge, we risk alienating parents in both clinical and research settings. The eventual goal of this work is to provide a reference for the development of such guidelines and to define targetable areas of education for parents, adolescents, review boards and researchers regarding confidentiality, consent, and disclosure practices in adolescent healthcare and risk behavior research. It is my goal to develop these educational programs with parents, adolescents, and clinicians. These goals coincide with The Center for Adolescent Health’s goals: to “advance prevention science in the area of adolescent health, increase the capacity of public health professionals to conduct prevention research, and utilize research findings on adolescent health to affect public health practice and policy.” - Target population: Adolescents (12-19 years old) presenting with a parent or guardian, these adolescents’ parent/guardian, and adolescents (14-19 years old) presenting alone to several Johns Hopkins clinical sites.
- Study design: Cross-sectional, audio survey with written response, involving adolescents and their parents. The study will involve a cross-sectional audio questionnaire administered to 260 parent-adolescent pairs and 260 solo adolescents presenting to several medical clinics in the Greater Baltimore area. After reviewing pre-testing information gathered through adolescent discussion groups and extensive pilot testing, a questionnaire will be developed using both yes-no and Likert-scaled questions. Questions will examine participants’ perceptions regarding confidentiality, consent, and disclosure in the provision of clinical care and research concerning adolescent risk behaviors; and measure their research participation experience. It will also examine parent and adolescent understanding of local statutes related to confidentiality and consent in the provision of healthcare for specific adolescent issues. The survey will be anonymous, without identifying information. The answer sheets will be linked by a number/letter code to allow comparison of views between parents and their adolescents. Point estimates, independent chi square, and McNemar’s test will be used to demonstrate and compare proportions of parent and adolescent responses.
- Sample: Adolescents (12-19 years old) presenting with a parent or guardian, and adolescents (14-19 years old) presenting alone to several Johns Hopkins clinical sites will be recruited for participation. These sites include: the Harriet Lane Pediatric and Adolescent Medicine Clinics, the Johns Hopkins Bayview Pediatric Clinic, and the Johns Hopkins Community Physicians Pediatric Clinics (pending approval). Participants must be English-speaking. A sample size of 200 adolescent/parent pairs is expected. For solo adolescents, 200 participants are expected.
- Analysis: We plan to hold several in-depth discussion groups and pre-testing interviews with parents and adolescents to further develop our survey instrument. Discussion groups have been held with The Center for Adolescent Health at Johns Hopkins and with adolescents in their Youth Advisory Committee.
The predictor variables for this study are divided into parental/guardian and adolescent predictors. Parental predictors are: education, age, gender, race/ethnicity, parentally perceived number of adolescent risk behaviors, prior discussion of confidentiality with a medical provider, prior exposure to health care research and legal knowledge of confidentiality/consent laws. Adolescent factors are: education, age, gender, race/ethnicity, prior discussion of confidentiality with a medical provider, prior exposure to health care research, and legal knowledge of confidentiality/consent laws. The Likert-scaled responses to questions regarding confidentiality, disclosure, and consent will be dichotomized to permit binomial responses, and frequencies of response will be tabulated for all questions. To test our hypotheses that 1) a majority of adolescents and parents perceive a need for confidentiality in provision of healthcare for adolescent risk behaviors, 2) perceive a need for risk behavior research in adolescents, and 3) do not perceive a need for parental consent for risk behavior research, point estimates will be made of the parent and adolescent group responses. Similar point estimates will be used to evaluate parent and adolescent understanding of local statutes regarding confidentiality and consent. Independent chi-square analysis will be used to compare the responses of adolescents presenting with a parent/guardian and of those presenting solo. McNemar’s test for matched pairs will be used to summarize differences in responses among the adolescents and their parent/guardian. This method will test our hypotheses that adolescents have a greater perceived need for confidentiality, and a lower perceived need for parental consent than do their parents/guardians. Additionally, we plan to use multivariable techniques relating the hypothesized predictors and outcomes described in the conceptual framework. First we will complete bivariate analyses to assess the overall assumptions of hypothetical predictors and outcomes. Depending on the associations found, we will conduct multivariable analysis to assess the independent and combined influences of predictor variables. Data source: Audio surveys with written responses, questionnaires Publications & Products: - “Research in Progress” Presentation 4-23-03
- Parent and Adolescent Perceptions of Adolescent Involvement in Clinical Care and Research. Accepted at Southern Society for Pediatric Research Annual Conference.
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| Partners: Girl Scouts of Central Maryland, Julie Community Center, and Southeast Youth Academy Principal Investigator: Cheryl Alexander, RN, PhD Co-Investigators: Dominque Charlot-Swilley, Barbara English, Joan Kub, Kara McDonagh, Debra Mekos, Carol Lynn Pucciarrella, Robert Strack Project staff: Chanza Baytop, Azikiwe DeVeaux, Shelly Trim, Kelly Briscoe, and Mick Young Focus Area: Community Based Participatory Research, Youth, Adolescents, After-School Programming, Neighborhood, Baltimore Project Goals: The goals of the community resource mapping project are to determine the array of available programs and services for youth in Southeast Baltimore, identify gaps in programs and services, determine the degree of collaboration among youth-serving organizations, and produce a community resource directory to be distributed to youth in Southeast. General Information: Sixteen community youth and adults conducted surveys with 17 youth organizations, 3 middle and high schools, and 3 health care providers in Southeast Baltimore. The survey included questions on location and hours of operation, populations served, programs and services offered, staffing and staff training, collaboration with other organizations, organizational needs, and major health concerns of adolescents in Southeast. - Target population: Youth-serving organizations, including schools, health care providers, and youth development programs, in Southeast Baltimore
- Data source: Surveys
Schools: The total student population attending public schools in Southeast Baltimore is 3,154. Fifty-five percent are African-American, 32.5% are White, and the remainder are of Native American, Latino, or Asian descent. Area public schools offer a variety of programs for students, including sports programs, extracurricular activities, tutoring, mental health counseling, and family planning services. Health Care Providers: The health care providers surveyed (including school- and community-based) annually serve an average of 1,430 children, youth, and young adults, with the largest group being 12-19 year olds (58.6%). The services provided include treatment of illnesses and injuries, dental exams, STD testing and treatment, family planning services. Youth Development Programs: The size and scope of youth development programs in Southeast Baltimore ranges from 10 to 5,543 registered youth per program, but the number of youth who regularly attend at least twice per week is much lower, ranging from 10 – 275 per program. In addition, only 7 of the 17 programs serve youth ages 18-21 and only 17.4% of their youth on average fall into this age group. In general, youth organizations were most likely to offer health-related activities such as substance use counseling and HIV education, followed by youth development activities such as tutoring and life skills. Youth organizations also tend to rely more on volunteers than paid staff , and staff training focuses primarily on youth development activities. Across Organizations: Considering all 23 organizations together, the three most common organizational needs cited were insufficient funding, staffing, and space. The four most commonly mentioned health issues affecting Southeast Baltimore youth were teen and family substance use, poor nutrition, teen pregnancy, and sexually transmitted diseases. Publications & Products: - Mekos D., McDonagh K., Strack R, Sheng P, Baytop C, Kuorkumoji K, Devaux A, Astake H, Ndi. Americorp Program Evaluation Final Report. May 2003. 80 pages.
- Southeast Baltimore Youth Book 2000, which contains key facts on all youth programs in Southeast, as well as study tips, youth poetry, a school calendar, and blank pages for names and phone numbers.
- Southeast Community Fair, a community event held Sept. 27, 2000 in conjunction with the Virginia Baker Recreation Center Open House.
- Levy, S., Baldyga, W., Rodriguez-Sanchez, M., Odeh, C., Mekos, D., Wearins, F., & Strack, R. (February 2000). Building university-community partnerships in Chicago and Baltimore. Paper presented at the 10th Annual Prevention Research Centers Conference, Atlanta, GA.
- Strack, R. W., Mekos, D., Kub, J. , & McDonagh, K. (November 1999). Lessons learned in establishing university-community partnerships. Paper presented at the annual meetings of the Society for Public Health Education, Chicago, IL.
Community Committee Involvement: Community Advisory Board provided oversight to goals and objectives of project. Partner Involvement: - Girl Scouts of Central Maryland, Julie Community Center - Provided oversight to goals and objectives of project.
- Southeast Youth Academy – Provided onsite program administration. Partnered in the development and execution of evaluation plan.
Funding: Centers for Disease Control and Prevention Back to Top
| Project Period: April 2002 – September 2004 Partner: Baltimore City Police Athletic League Principal Investigator: Amita N. Vyas, PhD Co-Investigators: Cheryl Alexander, PhD, and Debra Mekos, PhD Project Coordinators: Anita Chandra, MPH, Nital Subhas, MPH Focus Area: Youth Development, Health Risk Behaviors Project Goals: There is both qualitative and quantitative component to the PAL evaluation. The qualitative study seeks to 1) assess variability among PAL centers, 2) examine program characteristics and activities, 3) examine program staff and police officer characteristics, roles, and responsibilities, and 4) describe community perceptions of the youth centers. The quantitative evaluation aims to answer the following questions: 1) is there a measurable difference in juvenile crime and victimization rates between neighborhoods with PAL centers compared with similar neighborhoods without PAL centers, 2) is there a measurable difference in school attendance and dropout rates between young people who attend PAL centers compared with young people who do not attend PAL centers, 3) what is the effect of a PAL after-school program on young people’s perceptions of safety, health risk behaviors, and aggressive behavior, 4) is there a significant difference in characteristics between young people who participate in the PAL program compared with young people who do not participate in PAL or those who participate in other after-school programs, and 5) to what extent do the individual characteristics of a young person participating in PAL predict how he/she will respond to the program? General Information: The PAL programs overall objectives are to reduce crime and violence through character development, academic enrichment, arts and cultural activities, and sports. - Target population: Boys and girls between the ages of 12 and 17 who are enrolled in PAL Centers.
- Study design: The qualitative phase utilizes several methods including: 1) naturalistic observations of youth and staff at PAL sites, 2) formal interviews with center staff, including program coordinators, police officers, adult volunteers, etc. conducted during site visits, and 3) formal and informal ‘canvassing’ interviews with at least 8-10 community members at each site. The quantitative study employs a quasi-experimental study design with a non-equivalent control group simultaneously enrolled form middle and high schools.
- Sample: The intervention group will include 270 young people participating in programs at sample of nine PAL Centers. The control group will be selected from four schools in close proximity to PAL centers: 2 middle schools and 2 high schools and matched on age and gender.
- Analysis: Both qualitative analysis using Atlas it and descriptive quantitative analysis using SPSS
- Data source: Data will include: a self-report instrument administered to the youth participants; qualitative interviews and naturalistic observation with police and volunteer staff; record reviews of administrative school data, and community level indicators (from the Baltimore Neighborhood Data Collaborative).
Findings: Researchers found a variety of program components offered in all programs, with the three core elements of homework help, open play/recreation, and organized sports. The PAL Center environments also are fairly similar in that many of the sites have large open rooms for homework and recreation, with an indoor gym area for sports. The lack of quality furniture and materials is an issue in most of the Centers. The communities that surround the PAL Center differ to some degree. In many cases, staff report concerns about safety including issues of drug abuse and drug trafficking that occurs place within close proximity to the Center. Interviews revealed that staff are challenged by the lack of resources and parental involvement and concerned about the high level of academic and behavioral needs of the children. While staff suggests their training opportunities are adequate, they do feel that the program has a need for expert resources in child behavior and academics. Interviews and surveys indicated that PAL Centers seem to be somewhat more successful at interacting with the community in general, including engagement with other social, educational, and health programs. However, the lack of strong and consistent volunteers is an issue across a majority of PAL Centers. Potential areas for program improvement included program structure, staff support, community ownership and involvement, and family involvement. Publications & Products: Lynch, Chandra (2003). Baltimore City Police Athletic League Qualitative Case Study Report. Partner Involvement: The Baltimore PAL cooperated with facilitating interviews and on-site observations. Funding: Centers for Disease Control and Prevention Back to Top
| Project Period: November 2000 – November 2002 Partner: Southeast Youth Academy Principal Investigator: Kara McDonagh, MSW (affiliated with the Southeast Youth Academy) Co-Investigators: Debra Mekos, PhD; Robert Strack, PhD, MBA Project Coordinators: Azikiwe DeVeaux, Kalonji Walker Project Staff: Hibist Astake, ‘Kuor Kumoji, Chanza Baytop Focus Area: Youth Development, Transition to Adulthood, Baltimore, Evaluation, School Health, Sexual and Reproductive Health Project Goals: The goals of the AmeriCorps program are to reduce school failure and promote healthy development among middle school youth in Southeast Baltimore. General Information: The AmeriCorps program is a 2-year intervention, involving two cohorts of AmeriCorps members as mentors for middle and high school youth attending the Southeast Youth Academy (SEYA). The program provides tutoring and homework assistance, recreational activities, creative and dramatic arts, computer classes, HIV education, field trips, and teen support groups. GED classes are also offered for community adults. - Target population: Youth ages 11 – 19 in Southeast Baltimore
- Study design: Longitudinal design, with assessment of youth outcomes over a two-year period and assessment of AmeriCorps member outcomes over a one-year period. Youth outcomes include school performance, social competence, and involvement in health risk behaviors. AmeriCorps member outcomes include skills in working with youth and commitment to community service.
- Sample: 51 youth ages 11 – 19 in Southeast Baltimore; 14 AmeriCorps members
- Analysis: Paired samples t-tests and chi-square analyses; content analyses of in-depth interviews.
- Data source: Audio-CASI surveys with youth, in-depth interviews with AmeriCorps members and SEYA staff, direct observations of adult-youth interaction at SEYA
Findings: A total of 45 youth completed the first or second survey, with 20 youth completing both surveys. The youth range in age from 12 – 19, with a mean age of 14.75. Sixty-five percent are boys and 34% are girls. Fifty-three percent of the youth are African-American, 12.5% are Latino, 9.4% are White, 3.1% are Native American, and 21.9% describe themselves as multiracial. Key results of the cross-sectional analyses and analyses of change are reported below. Descriptive Results: First Survey (N=32) (Second Survey (N=33)) School status and performance: - 72% (79%) currently enrolled in school and attending regularly
- 9.4% (9.4%) dropped out of school
- 59.4% (75%) receive mostly As and/or Bs in school, 40.6% (25%) receive mostly Cs and/or Ds
- 84.4% (81.2%) have been suspended from school at least once
- 68.7% (75%) spend less than an hour per day on homework
Perceptions of SEYA:< |
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