HIV/AIDS Projects (2010-2012)


A Parenting Intervention for HIV+ Moms: The IMAGE Program

Debra A. Murphy, Ph.D., Principal Investigator (dmurphy@mednet.ucla.edu)
Diana Payne, Ph.D., Project Director

The purpose of this R01 pilot study is to develop and then test the feasibility of implementing a parenting intervention for HIV-infected mothers with well children age 6–14 years old. The intervention is designed to improve parenting skills and maternal self-care skills in order to improve child and maternal outcomes.  The basis for development of this intervention is work from two previous R01s (MH # 5R01MH057207) designed to longitudinally assess mothers living with HIV (MLHs) and their children.  Sixty-one MLHs and their children (total N = 122) have been enrolled (target enrollment, N = 120).  Of the 61 MLHs, 30 were randomly assigned to the theory-based, 4-session skills training intervention; 29 interventions have been completed.  The remaining 31 MLHs were randomized to the control condition.  The intervention (“Improving Mothers’ parenting Abilities, Growth, & Effectiveness”—the IMAGE program) is based on the Information – Motivation – Behavioral Skills (IMB) model of health behavior change, with specific skills selected based on our 10-year observational study of MLH and their children, an ongoing study at UCLA.  MLHs and their children are assessed at baseline and 3-, 6-, and 12-month follow-ups.  Three mother-child pairs have completed their final follow-up assessments.  Upon completion of their follow-up assessments, a random subset of 40% of the intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview to obtain detailed process information on their experiences in the intervention.

A Parenting Intervention for HIV+ Moms: The IMAGE Program was funded by the National Institute of Mental Health, grant 1 R01 MH086329, from April 2010 to December 2013.

Center for HIV Identification,
Prevention and Treatment Services

Mary Jane Rotheram-Borus, Ph.D., Principal Investigator (rotheram@ucla.edu)
Debra A. Murphy, Ph.D., Co-Investigator

This Center comprises an interdisciplinary group from UCLA, Drew University, RAND, and the Los Angeles County community (Department of Health and community-based agencies) with the aim of enhancing understanding of HIV and promoting early detection and effective prevention and treatment programs for HIV at the societal, community, and individual levels.

Center for HIV Identification, Prevention and Treatment Services is funded by the National Institute of Mental Health, grant 5 P30 MH58107, from September 1997 through January 2017.

Longitudinal Study of Maternal HIV on their
Late Adolescent/Early Adult Children

Debra A. Murphy, Ph.D., Principal Investigator
(dmurphy@mednet.ucla.edu)
Diane Herbeck, M.A., Project Coordinator

This study was designed to extend and expand a longitudinal study (R01-MH057207-10), “Parents And Children Coping Together” (PACT). The original study was designed to longitudinally assess mothers living with HIV (MLHs) and their young, well children 6 to 11 years old.  Five follow-up interviews were conducted at 6-month intervals in the PACT study.  A subsequent longitudinal study, “Parents and Adolescents Coping Together” (PACT II), followed up the majority of these families when the children were transitioning to early and middle adolescence; there were 6 follow-ups.  This study  (“PACT III”) continued to follow the MLHs and adolescents one last time, to investigate outcomes as the adolescents transition to late adolescence/young adulthood.  Both qualitative and quantitative interviews at 7 time-points were conducted.  This is the first cohort of children in the United States to be followed almost continuously as they grow up to adulthood while living with a mother with HIV/AIDS.  Further description of the study can be found in the following publications:

Murphy, D.A., Marelich, W.D., Herbeck, D.M. (2012). Impact of maternal HIV health:  A 12-year study in the Parents and Children Coping Together project. Journal of Adolescent Health, 51(4), 313-318. PMID: 22999830

Marelich, W.D., Murphy, D.A., Payne, D.L., Herbeck, D.M., & Schuster, M.A.  (2012).  Self-competence among early and middle adolescents affected by maternal HIV/AIDS.  International Journal of Adolescence and Youth, 17(1), 21-33. PMID: 22485061

Murphy, D.A., Roberts, K.J., & Herbeck, D.M. (2012). HIV-positive mothers’ communication about safer sex and STD prevention with their children. Journal of Family Issues, 33(2), 136-157. PMID: 22368316 

Murphy, D.A., Herbeck, D.M., Marelich, W.D., & Schuster, M.A. (2010). Predictors of sexual behavior among early and middle adolescents affected by maternal HIV. International Journal of Sexual Health, 22, 195-204. PMID: 21998620

The Longitudinal Study of Maternal HIV on their Late Adolescent/Early Adult Children was funded by the National Institute of Mental Health, grant R01 MH57207-11, from 2008 to 2013

Trajectories of HIV Sexual Risks: Impacts of Drug Use,
Mental Health, and Criminality

David Huang, DrPH, Principal Investigator (yhuang@ucla.edu)
Debra A. Murphy, Ph.D., Co-Investigator
Yih-Ing Hser, Ph.D., Co-Investigator
H. Isabella Lanza, Ph.D., Project Director (hilanza@ucla.edu)

The purpose of this research was to conduct extensive analyses on a national representative sample of youth (NLSY97) to identify distinctive trajectories of HIV sexual risk behaviors and examine how the distinctive trajectories are influenced by drug use, mental health, delinquency, and other factors.  We focused on the following research questions: (1) Are there subgroups of individuals with distinctive patterns of sexual-risk trajectories, and how do women and men differ in these patterns? (2) What factors distinguish different sexual-risk trajectories? and (3) How are sexual-risk trajectories associated with alcohol use, marijuana use, and delinquency over time?

The study identified five distinctive sexual-risk trajectory patterns across adolescence and young adulthood (ages 15 to 23).  The High group had a risk trajectory that was high at age 15 and increased over the observed ages.  The Decreased group had a risk trajectory that accelerated before age 19, but decreased afterwards.  The risk trajectories of the Increased-Early and Increased-Late groups were low at age 15, but increased significantly starting at age 16 for the former group and at age 18 for the latter group.  Participants in the Low group remained at low risk over time.  The findings support the concept that sexual risk behavior is dynamic and that there are distinct developmental trajectories of such behavior among adolescents.  Heterogeneity of developmental trajectories of sexual risk behavior indicates a need for diverse prevention programs targeted to various subgroups.  Publications from this study are briefly summarized below:

Huang, D., Murphy, D.A., & Hser, Y.I. (2011).  Developmental trajectory of sexual risk behaviors from adolescence to young adulthood. Youth and Society, 44(4), 479-499. NIHMS: 290394.

This article reports on the investigation of pathways of sexual risk behavior from adolescence to young adulthood and examined the association of such behaviors with substance use and delinquency.  The article evaluated the following research questions: (1) Are there subgroups of individuals with distinctive patterns of sexual-risk trajectories, and, if so, what factors distinguish the sexual-risk trajectories? and (2) How are sexual-risk trajectories associated with trajectories of alcohol use, marijuana use, and delinquency?

Significant findings:

  1. Sexual risk behaviors are dynamic over time and developmental trajectories of such behaviors are distinctive among adolescents.
  2. The High sexual-risk trajectory is associated with adverse consequences, including increased risk of acquiring sexually transmitted infections, repeating a grade, relying on money from a government program, and exhibiting deviant behaviors.
  3. A deceleration of sexual risk behaviors exists among a subset of adolescents.
  4. Age 16 to 18 is an important window of opportunity for preventing the escalation of sexual risk.
  5. Parental support and peer influences are significantly associated with sexual risk trajectories.
  6. There are gender and ethnic differences among the five sexual risk trajectories.
  7. Sexual risk behaviors co-occur with substance use and/or delinquency over time. 

Implications: Heterogeneity of developmental trajectories of sexual risk behavior indicates a need for diverse prevention programs targeted to various subgroups of adolescents.

Huang, D., Murphy, D.A., & Hser, Y.I. (2011). Parental monitoring during early adolescence deters adolescent sexual initiation: Discrete-time survival mixture analysis. Journal of Child and Family Studies, 20(4), 511-520.  NIHMS: 234642.

The article examined whether continual parental monitoring during early adolescence impeded the onset of sexual intercourse, and determined whether this protective factor prevented adolescents from engaging in high-risk sexual behaviors as well as other problem behaviors.  The study assessed the following research questions: (1) What are the distinctive trajectory patterns of parental monitoring during early adolescence? (2) How do these trajectory patterns differ by gender and ethnicity? (3) Will different trajectories of parental monitoring result in a delay of youths’ sexual initiation? and (4) What is the long-term impact of parental monitoring on the development of risky sexual behaviors, substance use, and delinquency over time? 

Significant findings:

  1. Risk of sexual initiation across age differs by gender and ethnicity.
  2. Level of parental monitoring during early- and mid- adolescence (ages 14 to 16) are distinctive among adolescents. Using discrete-time survival mixture modeling on parental monitoring from ages 14 to 16, four parental monitoring groups were identified.
  3. Trajectories of parental monitoring are associated with incidence of sexual debut.
  4. Parental monitoring during early adolescence has a long-term mitigating impact on adolescent problem behaviors.
  5. Gender and ethnic differences on parental monitoring consistently correspond to gender and ethnic differences on early sexual initiation. 
  6. Levels of parental monitoring are associated with school experience, future expectation, personal values, peer influences, and neighborhood safety.

Implications:

  1. High parental monitoring, in contrast to Low parental monitoring, results in an average of 1.5 years of postponement of adolescent sexual initiation. 
  2. The correspondence between level of parental monitoring and risk of problem behavior engagement during adolescence implies that implementation of parental monitoring, even in late adolescence, may protect against future risky sexual behaviors. 
  3. The findings of the study suggest the possible superiority of family-based interventions, as opposed to interventions that focus only on adolescents. 
  4. The interrelationships of parental monitoring with school experiences, future expectation, peer influence, and perceived environment reflect the complexity of possible mechanisms by which adolescent sexual behaviors emerge and indicate a need for an integrated intervention program with a combined efforts from family, school, and community.  Development of tight family connectedness, reduction of the chance of exposure to negative peer influences, and improvement in the safety of the community could lead to reductions in early sexual onset and problem behaviors among adolescents. 

Huang, D., Lanza, H.I., Murphy, D.A., & Hser, Y.I. (2012). Parallel development of risk behaviors in adolescence: Potential pathways to co-occurrence. International Journal of Behavioral Development, 36(4), 247-257.

This study aimed to gain a better understanding of potential pathways of co-occurrence of risk behaviors (alcohol use, marijuana use, sexual risks, and delinquency) across adolescence.  The study applied group-based dual-trajectory modeling (Jones & Nagin, 2007) to identify trajectories of risk behaviors in adolescence in order to: (1) evaluate the magnitude of associations between specific risk behaviors across adolescence; (2) determine which risk behavior trajectories are more likely to predict engagement in other risk behavior trajectories; and (3) assess whether higher engagement in specific risk behaviors across adolescence is associated with depressive symptoms in adolescence.

Significant findings:

  1. Each risk behavior was best identified by a 4-class trajectory model.
  2. Group-based dual trajectory modeling not only revealed strong interrelationships among developmental trajectories of the four risk behaviors, but also showed pathways to co-occurrence of these risk behaviors.
    1. Adolescents in the Moderate and High-Increasing alcohol trajectories are more likely to belong to the Early-Increasing sexual risk trajectory.
    2. Adolescents engaging in marijuana use are more likely to belong to the Early-Increasing sexual trajectory.
    3. Adolescents in the High-Increasing alcohol trajectory are more likely to belong to the High and Moderate delinquency trajectories.
    4. Adolescents’ marijuana risk trajectory corresponds directly to their delinquency trajectory.
    5. Early-Increasing sexual-risk trajectory was associated with the High delinquency trajectory
    6. An increase of alcohol use was associated with an increase of marijuana, and vice versa
  3. Level of risk behavior was related to level of depressive symptoms in adolescence. Adolescents reporting lower levels of alcohol use across adolescence also exhibited.

Implications:

  1. Group-based dual trajectory modeling, examining trajectories of two outcomes over time, revealed strong interrelationships among developmental trajectories of the four risk behaviors, and indicated potential pathways to co-occurring risk behaviors.  Adolescents with higher levels of alcohol use or marijuana use were more likely to engage in higher levels of early sexual risk-taking and delinquency. Moreover, adolescents involved in higher levels of delinquency were at higher risk for engaging in early sexual risk-taking.
  2. Evaluation of longitudinal, bidirectional relationships across four types of risk behaviors trajectories indicates that special attention should be paid to high-risk alcohol use and marijuana use, as these behaviors are strongly related to earlier sexual-risk behavior and delinquency in adolescence.
  3. Engaging in risk behaviors across adolescence does not just pose a threat to physical health or long-standing problems with the justice system, but is also related to increased risk of experiencing depressive symptoms. Prevention efforts aimed at decreasing depressive symptoms in adolescence may seek to identify those adolescents engaging in higher and co-occurring risk behaviors as a primary target group.  Also, future work on the relationship between risk behaviors and depression may find that prevention efforts aimed at mitigating risk behaviors may indirectly decrease depressive symptoms in a significant proportion of adolescents.

Lanza, H.I., Huang, D., Murphy, D.A., & Hser, Y.I. (in press). A latent class analysis of maternal responsiveness and autonomy-granting in early adolescence: Prediction to later adolescent sexual risk-taking.  Journal of Early Adolescence. 

This study sought to identify classes representing varying levels of maternal responsiveness and autonomy-granting in early adolescence, evaluate whether particular classes predict lower or higher risk of sexual risk-taking behavior in later adolescence, and assess whether ethnic and/or gender differences in maternal responsiveness and autonomy-granting inform ethnic and gender disparities in adolescent sexual risk-taking. Using latent class analysis, the study addressed the following research questions: (1) What are the underlying patterns of mother responsiveness and autonomy-granting in early adolescence? (2) Which classes characterized by varying levels of maternal responsiveness and autonomy-granting in early adolescence predict lower or higher sexual risk-taking in mid- and late-adolescence? and (3) Are there ethnic and gender differences in endorsement of maternal responsiveness and autonomy-granting, and if so, may this inform previously reported disparities in adolescent sexual risk-taking?

Significant findings:

  1. The identified 4-class model indicates a more autonomous style, alongside high levels of responsiveness, is favored by mothers in early adolescence.
  2. The high responsiveness/moderate autonomy-granting class predicted lower risk of sexual risk-taking.
  3. The class characterized by low responsiveness and high autonomy-granting predicted higher risk of sexual risk-taking.
  4. Ethnic differences were found among adolescent endorsement of responsiveness and autonomy-granting, but differences in sexual-risk taking were unfounded.
  5. Gender differences were found among adolescent endorsement of responsiveness and autonomy-granting, as well as sexual risk-taking.

Implications:

  1. Mothers exhibiting high responsiveness along with moderate autonomy-granting appear to be demonstrating a parenting style that may be protective against sexual risk-taking in adolescence, suggesting an adoption of greater autonomy-granting may be more developmentally appropriate as children transition into adolescence. Interventions aimed at increasing responsiveness and autonomy-granting to developmentally appropriate levels are likely to help parents interact with their youth in ways that promote adolescents adaptive goals of seeking autonomy and responsibility but with needed guidance, support, and supervision by parents. Moderate levels of autonomy-granting may provide adolescents with necessary limits and restrictions to mitigate negative developmental outcomes (e.g., delinquency, antisocial behavior), but are not extreme enough to restrict adolescents’ desire to be more self-reliant and responsible in their behavior. Furthermore, continuing to provide high levels of responsiveness may thwart adolescents from meeting needs for emotional support from romantic partners, which may encourage riskier sexual behavior earlier in adolescence.
  2. Low responsiveness/high autonomy granting by mothers in early adolescence seems particularly problematic as it predicts an earlier risk of sexual-risk taking. Adolescents receiving lower levels of responsiveness from mothers may seek out other sources of emotional support, such as romantic partners and are more able to involve themselves in sexually risky behavior with romantic partners as a result of high autonomy-granting. Caregivers of adolescents identified in the low responsiveness/high autonomy-granting class represents a small, but significant proportion of adolescents (12%) who should be targeted for high-risk prevention and intervention efforts to mitigating sexual risk-taking in adolescence.
  3. Although ethnic minority adolescents in the sample were more likely to report low maternal responsiveness and high autonomy-granting pattern compared to other patterns, which predicted greater sexual risk-taking, sexual risk-taking did not differ by ethnicity. Thus, the implications of ethnic differences in maternal responsiveness and autonomy-granting for explaining disparities in sexual risk-taking should be taken with caution. Future studies may find that ethnic disparities in sexual risk-taking are partially explained by the increased likelihood of ethnic-minority mothers to engage in less responsive forms of parenting.
  4. Males’ greater sexual risk-taking in late adolescence may be at partially explained by the tendency for mothers to give higher autonomy for males compared to females. Mothers may be less concerned about sons’ exposure to risky situations than daughters, which may encourage males to seek out these experiences at a higher rate. Increased awareness of sons’ risk-taking consequences may increase mothers’ responsiveness and autonomy-granting during the earlier stages of adolescence when males seem more vulnerable to increased sexual risk-taking.
Trajectories of HIV Sexual Risks: Impacts of Drug Use, Mental Health, and Criminality was funded by the National Institute of Mental Health, grant 1 R03 MH084434, from June 2009 to May 2011.

Last Updated:  12/06/2012

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