Meeting the needs of adolescents living with HIV through home based care: Lessons learned from Tanzania

PurposeHome based care is central to HIV care and support throughout Africa. Most programs have not addressed the unique needs of adolescents living with HIV, who display lower retention in HIV care and treatment adherence. This study examined the experiences of adolescents living with HIV in Tanzania in order to identify ways to improve home based care to better meet their needs.MethodsWe conducted a qualitative study in Dar es Salaam and Tanga Region consisting of in-depth interviews with 14 adolescents living with HIV, 10 primary caregivers, and 12 providers assigned to their households. Interviews examined adolescents' experiences of growing up with HIV, perceptions of current home based care, and challenges in increasing acceptability of services.ResultsWe found the program did not align well with adolescents' expectations. Adolescents felt home based care to be more relevant to their caregivers and did not form independent relationships with providers. They expressed anxiety that participation might lead to inadvertent disclosure of their status and consequent discrimination. Both adolescents and their caregivers felt disappointment that no material or financial support was available despite widespread poverty, although they appreciated receiving psychosocial support and practical referrals. Providers demonstrated motivation to work with adolescents but acknowledged lacking requisite skills such as ways to communicate with young people and key messages to deliver.ConclusionsDespite challenges, we identified feasible adaptations to make home based care more adolescent-centered. These include actively engaging adolescents in program design, improving provider training in communication with adolescents, and proactively addressing unrealistic expectations. Finally, increasing referral links to a wider range of services could improve program effectiveness by integrating it into a broader development approach.     

Schools,Peers, and Prejudice in Adolescence

Adolescents' perceptions of the prejudice in their social environments can factor into their developmental outcomes. The degree to which others in the environment perceive such prejudice—regardless of adolescents' own perceptions—also matters by shedding light on the contextual climate in which adolescents spend their daily lives. Drawing on the National Longitudinal Study of Adolescent Health, this study revealed that school‐wide perceptions of peer prejudice, which tap into the interpersonal climate of schools, appeared to be particularly risky for adolescents' academic achievement. In contrast, adolescents' own perceptions of peer prejudice at schools were associated with their feelings of alienation in school. Importantly, these patterns did not vary substantially by several markers of vulnerability to social stigmatization.     

Social Exclusion and Parental Incarceration Impacts on Adolescents' Networks and School Engagement

Although prior research links parental incarceration to deleterious outcomes for children during the life course, few studies have examined whether such incarceration affects the social exclusion of children during adolescence. Drawing on several lines of scholarship, the authors examined whether adolescents with incarcerated parents have fewer or lower quality relationships, participate in more antisocial peer networks, and feel less integrated or engaged in school. The study applies propensity score matching to survey and network data from a national sample of youth. Analyses indicated that children with incarcerated parents have more antisocial peers; the authors found limited evidence that parental incarceration adversely impacts peer networks and school integration domains. The results suggest that the impacts of parental incarceration on adolescents' social lives have less to do with isolation than with the types of peers adolescents befriend. Findings provide support for the idea that parental incarceration may adversely affect children's social exclusion.     

Beyond Exposure: A Person‐Oriented Approach to Adolescent Media Diets

Research on adolescents' use of sexual media has been dominated by a variable‐oriented perspective, focusing on incremental effects of media exposure on sexual behavior. The present investigation examines the ways in which adolescents select and organize their television viewing. This study used cluster analysis to identify, validate, and describe distinct profiles of adolescent television use. Eight discrete clusters emerged, each with a unique profile of primetime viewing. To validate the cluster solution, participants' television viewing profiles were compared with their music preferences. The study then examined the sexual content consumed by adolescents in different viewing clusters. Content analysis of the most popular programs revealed that participants in all clusters were watching programs that were high in sexual content alongside programs that were low in sexual content. None of the clusters demonstrated an exclusive preference for sexual content.     

Association of Demanding Kin Relations With Psychological Distress and School Achievement Among Low‐Income,African American Mothers and Adolescents: Moderating Effects of Family Routine

Association of demanding kin relations and family routine with adolescents' psychological distress and school achievement was assessed among 200 low‐income, African American mothers and adolescents. Demanding kin relations were significantly associated with adolescents' psychological distress. Family routine was significantly related to adolescents' school achievement. Demanding kin relations were negatively associated with school achievement for adolescents from families low in routine, but unrelated to achievement for adolescents in families high in routine. Additional research is needed on poor families and their social networks.     

Gender,Contraceptive Attitudes,and Condom Use in Adolescent Romantic Relationships: A Dyadic Approach

Although sexual risk behavior occurs in a dyadic context, most studies of adolescent sexual behavior focus on individuals. This study uses couple data (N = 488 couples) from the National Longitudinal Study of Adolescent Health to examine how partners' contraceptive attitudes correlate over time and whether male or female partners' attitudes are better predictors of condom use. Net of their own prior attitudes, partners' prior attitudes predicted both male and female adolescents' Wave 2 attitudes. This association was stronger for female than for male adolescents, suggesting that female attitudes were influenced more by males' prior attitudes than vice versa. When entered together, only male adolescents' attitudes predicted dyadic condom use. Findings suggest that male partners may have greater influence on adolescent contraceptive decisions and that prevention programs should emphasize the relational context of sexual behavior.     

Mexican American and European American Adolescents' Dating Experiences across the Ecosystem: Implications for Healthy Relationships within an Ecodevelopmental Framework

Dating health interventions that target the complex, multi-systemic spheres in which adolescents experience their first romantic relationships are required. This study utilizes an ecodevelopmental approach to better understand Mexican American and European American youths' perceptions of how peers, parents, school, and the media act both independently and collectively to affect their dating lives, also elucidating how such systems are at times in conflict. Seventy-five middle adolescents participated in focus groups divided by gender and ethnicity to uncover differences and similarities within and across groups. Findings underscore the importance and widespread effects of romantic relationships for adolescents' social development and the need for intervention programs that target multiple points of intervention while attending to mesosystemic conflicts across systems.     

Divorce Disclosures and Adolescents' Physical and Mental Health and Parental Relationship Quality

Two studies were constructed to examine the associations between custodial parents' negative disclosures about the other parent after a divorce and parent–adolescent relational quality (closeness and satisfaction) and adolescents' physical and mental health. In general, the results suggested that even though negative disclosures about the other parent might be associated with more cohesive relationships between custodial parents and adolescents, it does not mean that adolescents are immune to the physical and psychological effects of such disclosures. In Study 2, negative disclosures about the other parent were associated with adolescents' increased reports of physical and mental health symptoms. The results revealed a similar effect for general divorce information and adolescents' mental health. However, there was no association for catharsis and adolescents' physical and mental health. The results from both studies also revealed that adolescents perceived that their custodial parents disclosed more negative information about the other parent than the parents perceived that they disclosed.     

Identity status differences among Italian adolescents: Associations with time perspective

Based on Marcia's identity status model, this cross-sectional study examined adolescents' identity formation analyzing its association with time perspective. A sample of 1300 Italian adolescents filled in self-report measures assessing two major developmental processes: identity resolution and time perspective. Adolescents who achieved an integrated identity status seemed to primarily adopt a future time perspective and to have a positive view of the past. By contrast, Diffused adolescents reported negative experiences in the past, a lower future orientation and a greater inclination to fatalism compared to others.     

What family dimensions are important for health-related quality of life in adolescence?

Adolescence is a relevant life stage in which to study a global well-being measure, health-related quality of life, in order to analyse the impact of important determinants in adolescents' health-related quality of life (e.g., the quality of family relationships). This study aimed to examine the impact of several family dimensions (parental affection, parental promotion of autonomy, family activities, adolescent disclosure, parental solicitation and parental knowledge) on adolescents' health-related quality of life. Additionally, this study investigated whether demographic variables (adolescents' gender and age) influenced health-related quality of life and moderated the relationship between family dimensions and health-related quality of life. The sample was composed of 14,825 adolescents, aged 13–14, 15–16, and 17–18, from the 2006 edition of Spain's Health Behaviour in School-aged Children study. The results showed that parental promotion of autonomy, family activities and especially parental affection were the most important dimensions influencing health-related quality of life. Boys reported higher health-related quality of life than girls, and younger adolescents reported higher health-related quality of life than older adolescents. The discussion explains how the aforementioned family dimensions encourage better health-related quality of life in adolescents.     

Parents' Involvement in Adolescents' Peer Relationships: A Comparison of Mothers' and Fathers' Roles

The goals of this study were to compare mothers' and fathers' direct involvement in adolescent girls' versus boys' peer relationships and to examine the links between parents' involvement and the qualities of adolescents' friendship and peer experiences. Participants were mothers, fathers, and firstborn adolescents (mean age = 15 years) in 187 working‐ and middle‐class families. Data were collected during home visits and a series of seven nightly telephone interviews. Parents' direct involvement was measured by parents' reports of their peer‐oriented activities, parents' knowledge about adolescents' peer experiences, and parents' time spent with adolescents and their peers. Findings revealed that mothers were more knowledgeable about adolescents' peer relationships than were fathers, that mothers with daughters reported the most peer‐oriented activities, and that both mothers and fathers spent more time with same‐sex adolescents and their peers. Parents' direct involvement was differentially related to girls' versus boys' peer experiences. Discussion highlights the role of parents' and adolescents' gender in shaping this dimension of family life in adolescence.     

Caregiver–Adolescent Dyadic Disagreement and Problem Behaviors of Adolescents in the Child Welfare System

Parents and adolescents often provide different ratings of youths' behavior problems, yet few studies have examined such disagreement and its effect on later adjustment, especially among at‐risk adolescents. The purpose of this study was to investigate, among a sample of adolescents in foster care, whether the degree of caregiver–adolescent disagreement on adolescents' internalizing problems would be associated with adolescent externalizing problem behaviors over time. Two measures of adolescent caregiver agreement, the Pearson's r and intraclass correlations, were used with data drawn from a nationally representative study of children on foster care. Growth curve analyses of 180 adolescents revealed that the higher adolescent and caregiver agreement on adolescents' internalizing problems at Wave I, the slower the increase in externalizing problems over time.     

Family Time Activities and Adolescents' Emotional Well‐being

The literature is divided on the issue of what matters for adolescents' well‐being, with one approach focusing on quality and the other on routine family time. Using the experience sampling method, a unique form of time diary, and survey data drawn from the 500 Family Study (N = 237 adolescents with 8,122 observations), this study examined the association between family time and adolescents' emotional well‐being as a function of the type of activities family members engaged in during their time together. Hierarchical linear model analyses revealed that eating meals together was beneficial to adolescents' emotional well‐being, especially when fathers were present. Family leisure was also beneficial to teens' well‐being. By contrast, productive family time (e.g., homework) was associated with lower emotional well‐being, as was maintenance family time (e.g., household chores), but only when adolescents engaged in it with both parents.     

Adolescents' Characteristics and Parents' Beliefs as Predictors of Parentsapos; Peer Management Behaviors

This study examined parents' reported use of peer management behaviors (i.e., communicating preferences, communicating disapproval, supporting friendships, and information seeking) and linked these behaviors to (a) adolescentsapos; self‐reported psychosocial adjustment and friendships and (b) parents' beliefs about adolescents' peer relationships (i.e., perceived efficacy in managing adolescents' friendships and concerns about adolescents' friendships). The participants were 269 parents (161 mothers, 108 fathers) and their predominantly White adolescents in Grades 6 and 9 (N=177). Results suggest that parents may be more apt to use some behaviors (e.g., communicating disapproval and information seeking) when there are indications that their adolescents are engaged in problem behaviors and have friends who are deviant. In addition, parents' concerns about their adolescents' friends mediate the relationship between adolescent problem behaviors and parents' communications of disapproval. Parents' peer management is promising as a route to understand further the nature of parent–peer linkages.     

Harmonizing freedom and protection: Adolescents' voices on automatic monitoring of social networking sites

Automatic monitoring of user-generated content on social networking sites (SNSs) aims at detecting potential harm for adolescents by means of text and image mining techniques and subsequent actions by the providers (e.g. blocking users, legal action). Evidently, current research is primarily focused on its technological development. However, involving adolescents' voices regarding the desirability of this monitoring is important; particularly because automatic monitoring might invade adolescents' privacy and freedom, and consequently evoke reactance. In this study, fourteen focus groups were conducted with adolescents (N = 66) between 12 and 18 years old. The goal was to obtain insights into adolescents' opinions on desirability and priorities for automatically detecting harmful content on SNSs. Opinions reflect the contention between a need for protection online versus the preservation of freedom. Most adolescents in this study are in favour of automatic monitoring for situations they perceive as uncontrollable or that they cannot solve themselves. Clear priorities for detection must be set in order to ensure the privacy and autonomy of adolescents. Moreover, monitoring actions aiming at the prevention of harm are required.     

PARENTS' PERCEPTIONS OF THEIR ADOLESCENT CHILDREN,PARENTAL RESOURCES,AND PARENTS' SATISFACTION WITH THE PARENT-CHILD RELATIONSHIP

Building on Belsky's process model of the determinants of parenting and using a nationally representative dataset of U.S. adolescents, this article examines the relationship between parental satisfaction and parents' perceptions of their adolescents and their own personal and social resources. As such, it provides a coherent framework for understanding parental well-being during a critical stage of the family life course. The results suggest that parental satisfaction is negatively related to parents' perceptions that their adolescents are involved in problem behaviors or experiencing challenges in other domains of their lives; however, the relationship between parental satisfaction and adolescents' problem behaviors is mediated by parents' perceptions of their adolescents' characters, including whether or not they have a bad temper and their levels of trustworthiness. With respect to personal and social resources, parents' educational achievement and marital status are positively related to parental satisfaction, and the level of conflict in the spousal relationship is negatively related to parental satisfaction.     

The influence of adolescent physical abuse on school adjustment in South Korea: The mediating effects of perceived parenting types

The present study examined whether adolescents' perceptions of parenting behavior mediated the link between physical abuse and school adjustment in South Korea. Additionally, we investigated adolescents' perceptions of their parents' acceptance as a potential protective factor of the relation between physical abuse and school adjustment. Participants included 1354 South Korean adolescents from 26 schools in a metropolitan area of Seoul. Structural equation modeling and hierarchical regression analyses were conducted. Our results suggested that the perceived acceptance fully mediated the association between physical abuse and school adjustment. Moreover, the negative association between physical abuse and school adjustment is likely to be less strong for adolescents with high perceived acceptance than those with low perceived acceptance. These findings highlight the importance of adolescents' perceptions of parenting in understanding how and when physical abuse affects their school adjustment in South Korea.     

Socio‐Emotional Context and Adolescents' Decision Making: The Experience of Regret and Relief After Social Comparison

Many studies indicate that adolescents are hypersensitive to rewards in salient socio‐emotional contexts. However, little is known about adolescents' sensitivity to complex negative emotions. To study the development of the ability to experience regret and relief, children, adolescents, and young adults performed a gambling task in a socio‐emotional context of competition, in which they were informed that their outcome would be compared with that of a competitor. The context of competition impacted the feelings of regret and relief in adolescents. When adolescents experienced an initial negative outcome, their feeling of relief was reinforced. However, they did not seem to experience regret in the social context of competition. These results provide a possible explanation for adolescents' enhanced risk seeking.     

Maternal Affective Expression and Adolescents' Subjective Experience of Positive Affect in Natural Settings

This study investigated the association between maternal affective expression during laboratory‐based interaction tasks and adolescents' experience of positive affect (PA) in natural settings. Participants were 80 healthy adolescents and their mothers. Durations of maternal positive (PA) and negative affective (NA) expressions were observed during a conflict resolution task and a positive event planning interaction task. Ecological momentary assessment (EMA) procedures were employed to assess adolescents' momentary and peak experience of PA in daily life. Results indicated that maternal NA, but not maternal PA, was related to adolescents' EMA‐reported PA. Adolescents whose mothers expressed more NA experienced less PA in daily environments. Results suggest that adolescents' exposure to maternal negative affective behavior is associated with adolescents' subjective daily well‐being.     

Cyberbullying perpetration and victimization among adolescents in Hong Kong

Cyberbullying is a growing concern worldwide. Using a sample of 1917 secondary adolescents from seven schools, five psychometric measures (self-efficacy, empathy level, feelings regarding a harmonious school, sense of belonging to the school, and psychosocial wellbeing) and five scales regarding bullying experiences (cyber- and traditional bullying perpetration and victimization; reactions to cyberbullying victimization) were administered to explore the prevalence of cyberbullying in Hong Kong. Findings indicated that male adolescents were more likely than female adolescents to cyberbully others and to be cyber-victimized. Cyberbullying perpetration and victimization were found to be negatively associated with the adolescents' psychosocial health and sense of belonging to school. Cyber- and traditional bullying were positively correlated. Multivariate analyses indicated that being male, having a low sense of belonging to school, involvement in traditional bullying perpetration, and experiencing cyber-victimization were associated with an increased propensity to cyberbully others.