Christopher D. Houck, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): Early adolescents are at risk for HIV due to risk behaviors (e.g., unprotected sex, substance abuse) initiated during this developmental period, and delaying initiation into this risk can have a significant impact on an adolescent's future health. Approximately 20% of adolescents have mental health problems that impair their functioning, and these teens are at even greater risk for HIV. In addition, emotional reactivity common among those with mental health problems appears to interfere with the use of cognitive skills learned in traditional health education or HIV prevention programs. Furthermore, abilities related to emotion are still developing in early adolescence. These findings suggest an important role for an intervention that can reach early adolescents with mental health problems to address emotional factors associated with risk situations, such as those involving sex, alcohol, and drugs, in order to reduce HIV risk behaviors. This project will be a unique collaboration between an experienced HIV prevention research team and a public school setting to develop an Affect Management intervention for use with early adolescents who have mental health problems. The project will be guided by the Social Personal Framework of HIV Risk Behavior and will begin with an intervention development phase including individual interviews, focus groups, expert panel reviews, scripting, pilot groups, and structured interviews. After the intervention has been developed, a preliminary randomized control trial of the Affect Management intervention in comparison to an attention-only control (general health promotion intervention) will be conducted with 120 seventh graders. An estimate of the efficacy of the Affect Management intervention in reducing sexual risk will be determined by less self-reported sexual behavior, improved emotion regulation skills, and differences in HIV- and abstinence-related attitudes. This study will partner with the Pawtucket School District in Rhode Island to produce a novel intervention that relates Affect Management to factors relevant to risk among early adolescents in order to inform the development of a larger research program of HIV prevention intervention that uses school settings to identify those most at risk. The information gained in this project will improve our understanding of how to prevent early teens from engaging in HIV risk behaviors. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Early Adolescents are at risk for HIV due to risk behaviors (e.g., unprotected sex, substance abuse) initiated during this developmental period, and delaying initiation into this risk can have a significant impact on an adolescent's future health. Many early adolescents are at high risk for contracting HIV due to emotional, behavioral, and substance use factors. Underlying all of these problems are difficulties with affect regulation. Emotional reactivity appears to interfere with the use of cognitive skills learned in traditional health education or HIV prevention programs, and recent evidence highlights the role of affect dysregulation in increasing the likelihood of sexual risk behaviors among adolescents. Also, early adolescence is a time when teens are developing their understanding of emotions and their ability to regulate affect. These findings suggest an important role for an intervention that can reach vulnerable early adolescents to address emotional factors associated with risk situations, such as those involving sex, alcohol, and drugs, in order to reduce HIV risk behaviors. This project, guided by the Social Personal Framework of HIV Risk Behavior, will target high-risk early adolescents (those who exhibit emotional, behavioral, or substance use risks) at urban junior high schools in Providence County, Rhode Island. This randomized, controlled trial will evaluate the efficacy of an Affect Management skills intervention in comparison to a control condition (General Health Promotion) for reducing risk behaviors with 432 high-risk seventh graders who will be followed for three years. The efficacy of the intervention in reducing sexual risk will be determined by less self-reported sexual behavior, improved emotion regulation skills, and differences in HIV- and abstinence-related attitudes among vulnerable early adolescents. The information gained in this project will improve our understanding of how to prevent early teens from engaging in HIV risk behaviors. This project represents an innovative progression in HIV prevention whose implementation in school settings has great potential for sustainability and relevance for early adolescents everywhere. PUBLIC HEALTH RELEVANCE: The information gained in this project will improve our understanding of how to prevent early teens from engaging in HIV risk behaviors.

Emotion regulation in adolescence is associated with health risk behaviors, including sex and substance use, and early onset of these behaviors represents a risk factor for negative health outcomes throughout life. Thus, interventions appropriate for early adolescence, when these behaviors commonly begin, are critical for prevention efforts. Our research team has developed and tested a novel, engaging, and efficacious intervention that addresses emotion regulation, a theoretically important and under-researched factor associated with risk. Our efficacy trial of this intervention, Project TRAC, showed that an intervention strategy using emotion regulation was significantly more successful than an active comparison condition on the primary target, delaying onset of sexual activity over a two and a half year follow-up, as well as on other risk behaviors, such as condom use, fighting, and partner violence. While efficacious, the current face-to-face, small group format of the program is a difficult model to sustain and implement on a larger scale. With a long-term goal toward dissemination, this two-year project will translate the emotion regulation components of this successful program for tablet-based delivery to enable it to reach a large audience in a format that can be related to a variety of health behavior education topics (e.g., sexual health, violence, substance use). For the proposed project, the Rhode Island Hospital/ Brown University research team will collaborate with Klein Buendel, a health communications technology company, to translate the emotion regulation content of Project TRAC for tablet computers. This translation, using well-established theoretical frameworks, will be approached in consultation with members of the target population (early adolescents) and experts in the field. After the intervention has been translated to a tablet form, ten adolescents will test the program to assess acceptability and usability. Finally, a small pilot study (n=100) will assess feasibility of the translated intervention and compare it to a waitlist control group. The project is novel in its focus on emotion regulation to address early adolescent risk and in teaching emotion regulation through tablet-based gaming that could be modified and enhanced through educational material targeting specific risk behaviors. It represents a continued collaboration between an experienced research team, an experienced health communications firm, and local urban school districts. Information gained in this project will improve our understanding of strategies for teaching emotion regulation and, if successful, lead to the next steps of translating the health education components and testing the full digital TRAC intervention?s efficacy. By addressing emotion regulation through a mechanism that can be widely used (an intervention program for tablets), this project aims to take an important step toward translating this efficacious intervention strategy. This project represents an innovative progression in adolescent risk prevention; its implementation in school settings has great potential for sustainability and relevance for early adolescents everywhere.

Project STRONG: A web-based dating violence prevention program for parents and middle school boys Dating violence first emerges in early adolescence and is associated with negative impacts including declines in academic performance, mental health, and psychosocial functioning. Despite broad calls for primary prevention, few programs with demonstrated efficacy exist. Further, the vast majority of existing programs are designed to be delivered in small mixed-gender groups and do not capitalize on the importance of parents in modeling and influencing the choices their child makes in their future romantic relationships. Further, there is a dearth of programs designed specifically for males despite growing research that has identified gender differences in risk factors for DV. To address these gaps, STRONG was developed as a web-based intervention for early adolescent males and their parent/guardian to complete together. The curriculum is grounded in Developmental Assets Theory which asserts that family support, knowledge, values development, and social skills are necessary for healthy development and offset the emergence of risk behavior. The curriculum is also informed by the DV literature which suggests that emotion regulation and communication skills are key mechanisms involved in DV behaviors. STRONG has been previously piloted with parent-son dyads (7th and 8th grade males) and demonstrates promising impact on key outcomes and target mechanisms. The proposed project builds on these initial findings by testing the efficacy of STRONG with a sample of 340 parent-son dyads on the primary outcome of adolescent self-reported dating violence. We will also evaluate the impact on other violence-related measures (e.g., attitudes, aggression, discipline problems, other risk behaviors) as well as on the proposed mediators of these effects, emotion regulation and parent-adolescent communication. We will implement a Hybrid 1 design that expands upon our efficacy trial by exploring critical factors involved in future dissemination of the program, such as challenges to implementation and cost considerations. By testing the efficacy of STRONG in tandem with future dissemination questions, we are able to shorten the time-lag often observed in bringing evidence-based interventions to the community.

Respiratory sinus arrhythmia as a predictor of substance use among early adolescents Risk behaviors that cause negative health outcomes, such as substance use or sexual risk behaviors, typically begin in adolescence. Identifying those most at risk in early adolescence is critical for prevention interventions. Emotion regulation plays an important role in reducing adolescent risk but detecting those who are vulnerable because of deficits in emotion regulation during early adolescence is challenging due to poor adolescent insight into these still-developing emotional processes. Respiratory sinus arrhythmia (RSA), an index of heart rate variability that is influenced by the parasympathetic nervous system, is an established marker of emotion regulation processes. RSA does not rely on self-report and may be useful for early identification of risk. Our team has developed a novel virtual reality party task with which to assess emotion regulation patterns in adolescents. Pilot data in our laboratory using this task suggest that adolescents with a history of substance use exhibit slower return to baseline RSA (measured at rest) after exposure to a challenging situation (referred to as recovery RSA) compared to non-using peers. This may suggest that recovery RSA is a relevant index of emotion regulation related to risk behaviors, as emotional triggers often occur in rapid succession in real-world risk situations. The proposed study will prospectively examine RSA's utility in predicting adolescent risk behaviors (substance use and sexual risk) among a sample of 280 early adolescents (ages 12.0-12.5 years) for a period of 24 months. We will also evaluate whether emotion regulation in the context of a substance use and sexual risk-taking situation (the virtual reality party) is more useful in predicting risk behavior than a computer risk-taking task (the Balloon Analogue Risk Task). We also will examine strategies for defining recovery RSA, given inconsistencies in the current literature. The current proposal advances the field by combining virtual reality and RSA collection to assess emotion regulation with the aim of identifying markers of those most vulnerable to engaging in risk behaviors at an early age, thus innovating the science of prevention.