Emily J. Ozer - US grants

There is currently great concern regarding high rates of violence among American's adolescents, particularly those living in urban, low-income areas. Besides the risks of death and physical injury, many adolescents exposed to violence are likely to suffer from symptoms of Post-Traumatic Stress Disorder (PTSD), depression, and other behavioral problems. The majority of trauma research, however, has been conducted with adults and only a few studies have studied adolescents' reactions to traumatic stress; of these, none has studies a school-based, normal population of urban adolescents. This study seeks to contribute to the study of developmental psychopathology and community violence by (a) identifying the individual and family demographic correlates of community violence exposure; (b) assessing the relation ship between symptoms of PTSD, depression, and behavioral problems in adolescents exposed to community violence; (c) specifying and differentiating the impact of dimensions of violence exposure on adolescent symptoms; and (d) investigating the relationship between social support (in family, peer, and school domains) and symptoms among adolescents exposed to violence. In addition, this research will also examine adolescents' attributions, regarding the causes of violent events and how others frame these experiences for adolescents in order to understand more about the psychological processes that may mediate the impact of violence exposure on adolescents' psychological functioning. Self-report and teacher- report data will be provided for a sample of 400 seventh grade students (aged 12-13) attending 2 public middle schools in urban settings where community violence is prevalent.

DESCRIPTION (provided by applicant): Adolescent substance use is prevalent and associated with a broad range of adverse outcomes such as poorer academic performance, risky sexual behavior, mental health problems and increased risk of developing a substance use disorder. The aim of the proposed research is to pilot test a universal intervention to prevent substance use in youth by improving sleep. This indirect approach to substance use prevention is predicated on several lines of evidence: a) few programs directly targeting prevention of substance use in high school populations have been found to be effective, b) multiple cross-sectional and prospective studies have reported that insufficient sleep in youth predates and predicts substance use, c) multiple modifiable factors contribute to the current epidemic of insufficient sleep among youth (e.g., use of technology late into the night, irregular sleep-wake schedules from weekdays to weekends) and d) previous sleep interventions for youth have yielded promising results for improving sleep. We will pilot the 'Sleep Fitness' (SF) intervention. SF is an 8 session, scale-able, school-based prevention program for urban adolescents attending 9th grade (ages 14 to 16; n=300). The SF intervention draws on empirically- supported interventions for sleep problems, adapted to be effective in promoting healthful sleep patterns. The study uses a cluster-randomized experimental design (randomized at classroom level) in schools to test our hypotheses that the SF intervention will be more effective than a Psycho-education (PE) control condition in achieving improvements in sleep, substance use, and selected mental health outcomes (anxiety, depression). Outcome measures will be assessed at baseline, post-intervention, and 6 and 12 months later. We will further examine if reductions in substance use are mediated by improvements in sleep and mental health. All outcome analyses will control for perceived stress. The research conducted as part of this R34 application is intended to inform future large-scale testing of the intervention via: a) Establishig the feasibility of the intervention, study design, and measures in diverse high school settings; b) Generating initial effect size estimates for outcomes and potential moderators; and c) Further adaptation of the intervention for maximal effectiveness, including involvement of students at each school to clarify motivational levers for behavior change. The proposed program of research is the first to test a universal intervention to promote sleep as a means of reducing substance initiation and use. If positive, the findings will have major public health implications or adolescent health promotion as well as for the interactive relationships among sleep, substance use, and mental health among urban teenagers.

DESCRIPTION (provided by applicant): There is a mismatch between the static categories used as proxies for culture in health research and the fluidity of identities and practices identifed by cultural research. This mismatch is especially salient in adolescence, when identities and behavioral scripts are in flux. To achieve our long-term goal of advancing the basic science of culture and health, we have recruited an exceptionally strong network of scholars in sociology, anthropology, psychology, and public health who bring deep theoretical and methodological expertise in culture, health, and adolescence. The objective in this application is to conduct empirical examination of the implicit and explicit processes that link cultural identity and attitudes to health attitudes, behaviors and outcomes for adolescents. Psychologists have developed measures to tap implicit attitudes related to identity in many domains. Research with adults provides evidence that a) implicit attitudes help explain health behavior above the effect of self-reported explicit attitudes; and b) implicit attitudes can be trained to reduce risky behavior. Implicit attitude measures show great promise for advancing basic research, culture and health as they assess aspects of cultural scripts and attitudes relevant for health that are outside of conscious awareness or control. These methods are important for research on culture and health among adolescents as they can be assessed prior to engagement in risky habits. Major gaps must be addressed in order to realize this promise: a) Research focused on early and mid-adolescence, developmental windows critical for the internalization of cultural scripts relevant for health sexual health is absent; and b) substantive analysis of how effectively implici methods operationalize key aspects of culture is lacking. To address these gaps, our first specific aim is to create a sustained infrastructure for trans- disciplinary research to advance culturally-informed methods for assessing implicit attitudes. Our pilot project brings together experts in culture, implicit attitudes, and adolescent health to develop and pilot measures to assess implicit cultural attitudes related to health domains for Mexican American adolescents, a rapidly growing population with heightened health risks. In the pilot study, we address two specific aims: 1) Develop measures to assess adolescents' implicit associations linking cultural identity to (a) sexual health and (b) violence; and 2) Identify relationships among implicit and explicit attitudes regarding cultural identity and (a) sexual health and (b) violence. Our exploratory aim is to: Develop a protocol for assessing the effects of counter-stereotypical narratives on implicit and explicit attitudes regarding (a) sexual health and (b) violence.