Projects

The following is an overview of various projects led by Center staff, members, and community partners.

Access and Utilization Study, funded by WellPoint/Blue Cross of California. Mark Schuster (PI). The purpose of this project is to collect qualitative information (through focus groups with adolescents and parents of adolescents) to help understand and clarify the reasons why adolescents do or don't go to the doctor for well-adolescent visits, to collect information on the type of health information adolescents would like to receive during their well-adolescent visits, and to examine the best way to provide health information to adolescents. In addition, the project will describe potential structural changes or incentives that could be implemented to facilitate and/or increase well-adolescent visits. The findings from this project will help WellPoint/Blue Cross of California to develop programs or to modify delivery of services to make it easier to access services and to encourage visits to the doctor for well adolescent visits.

Alcohol Advertising and Adolescents, funded by a Pfizer Scholars' Grant. Paul Chung (PI). Alcohol is the most commonly abused drug in adolescence and is associated with many of the leading causes of morbidity and mortality among teens. Alcohol advertising generates mass exposure to explicit and potentially powerful pro-drinking messages, and mounting evidence suggests that alcohol advertising encourages adolescents to drink. Alcohol trade organizations, however, contend that they do not target underage audiences, and that exposure of teens to their advertising is both incidental and modest. This argument has successfully persuaded the Federal Trade Commission not to pursue regulatory oversight of alcohol advertising; nevertheless, the accuracy of the industry's assertions remains unclear. We are using quantitative analyses of commercially available data to reconstruct indirectly advertising decisions made by the alcohol industry with respect to television, the medium that attracts the majority of alcohol advertising dollars. We have created a unique dataset that links industry-standard measures of ad placements with measures of television viewers. We are using this dataset to determine whether alcohol advertising decisions are sensitive to differences in the numbers or proportions of underage viewers controlling for relevant factors such as numbers or proportions of adult viewers, and viewer race, gender, and household income. This research may have substantial policy and public health implications.

Away from Home and Out of School, funded by NHLBI. Deb Cohen (PI). The proposed study will build on information collected in our previous study, "Community Characteristics and Physical Activity Among Adolescent Girls", which was an ancillary study to TAAG, Trial of Activity of Adolescent Girls.  We will follow the same girls from the Minneapolis and San Diego TAAG sites and identify where they go when they are not in school or home by using portable global positioning system (GPS) units, unobtrusive devices worn on the wrist or hip that record the latitude and longitude of locations at user-specified time intervals.  GPS will be combined with accelerometry and self-reports of food purchases and consumption so that we will be able to determine the context in which physical activity and eating occurs in neighborhoods.   In the baseline study we found associations between neighborhood characteristics such as parks and playgrounds and physical activity, but could not determine if girls were active in these settings or whether increased levels of physical activity were due to community norms.   Our specific aims are:

1. To identify the specific environmental exposures to food sources and activity venues based upon actual travel patterns of older adolescent girls;
2. To study the trajectory of physical activity in older adolescent girls, how physical activity patterns change when girls and their peers become more autonomous, and to identify the environments in which girls are physically active and the characteristics of those environments;
3. To study the trajectory of BMI among adolescent girls as they grow into adulthood and determine if eating away from home is associated with neighborhood food environments, BMI, and with changes in BMI.

  We will obtain both dietary and physical activity data from 300 girls at two timepoints; half will be in 10th grade at the first measurement and the other half in 11th grade.  The second measurement will be in the 11th and 12th grades in order to understand how diet and physical activity change as girls become more autonomous, obtain driving licenses and spend more time in cars alone or with peers. We will analyze the data using propensity scoring and longitudinal growth models to identify how local environments may play a role in physical activity, diet and BMI. The findings will be useful to inform future community and population level interventions to promote healthy eating, active living, and obesity control.

Children with HIV-Infected Parents, funded by the National Institute of Child Health and Human Development (NICHD). Mark Schuster (PI). The population of children with HIV-positive parents is growing because of demographic shifts in the HIV/AIDS epidemic and increases in life expectancy of HIV-positive people. Parents living with HIV often have limited financial, social, and emotional resources and may intermittently be too ill to take care of children. Prior studies have provided valuable data on some topics related to these children, but none have been based on a national probability sample. We are studying this population to gain a better understanding of important issues in the lives of HIV-positive parents and their children (e.g., custody; guardianship planning; parent disclosure of their HIV status to their children; parents' ability to care for children; HIV prevention messages within these families; the effects of HIV on parenting issues, sibling relationships, and child adjustment; and the role of other caregivers-spouse, live-in partner, grandparent-in family adaptation to HIV. We are conducting a two-phase study to address these aims. In Phase I, we analyzed data from the HIV Cost and Services Utilization Study (HCSUS), a study of a nationally representative sample of people receiving care for HIV in the U.S. In Phase II, we are using qualitative interviews to obtain detailed narrative information about the parent-child relationship and family adjustment to parental HIV and to test hypotheses generated from the secondary data analysis.

A Community-Academic Partnership to Improve Long-Term Follow-Up Care for Childhood Cancer Survivors, funded by The Robert Wood Johnson Foundation. Jackie Casillas (PI) The pediatric cancer survivor population is at-risk for a myriad of late effects which often occur several years to decades after their previous cancer treatment. Thus, there is a post-treatment transition period that occurs as adolescent and young adult (AYA) childhood cancer survivors age because they require long-term follow-up care by both a subspecialist who is familiar with the late effects associated with the treatment of childhood cancer (typically a pediatric oncologist) and a primary care physician for the care of adult diseases. Given the lack of an established model for the post-treatment transition process for AYA childhood cancer survivors, it is important to define factors that facilitate or impede the transition process. The specific aims of the study are therefore: (1) to determine the health beliefs of AYA survivors between 17-21 years of age regarding the post-treatment transition to comprehensive long-term follow-up care, including their general motivation to seek adult preventive/routine health care, late effects subspecialty care, perceived susceptibility to late effects, and perceived seriousness of late effects; (2) to determine the characteristics, location, and timing of the transition to adult-centered health care provided to and reported by childhood cancer survivors 17-21 years of age. The proposed study will utilize both qualitative and quantitative research methodologies to accomplish the specific aims. The study design will be observational, cross-sectional in which a convenience sample of AYA survivors will be obtained from the greater Los Angeles area utilizing three hospital sites. Semi-structured interviews and focus groups will be conducted from which verbatim transcriptions will be made. Each transcript will be coded for major themes using the grounded theory approach from which formal theories will be developed. Quantitative data will be collected through the use of a questionnaire from which descriptive statistics will be completed.

Drug Use, Social Context, and HIV Risk in Homeless Youth, funded by the National Institute on Drug Abuse (NIDA). Joan Tucker (PI). Homeless youth are estimated to be 6-12 times more likely to become infected with HIV than home-based youth. Homeless youth have high rates of drug use and are embedded in social networks that include regular drug users. Risky sexual behavior, the primary route of infection in this population, is common. Understanding the social context of drug use and risky sex among homeless youth is critical to intervention efforts aimed at reducing the spread of HIV in this growing population. Using data from a probability sample of homeless youth in Los Angeles County, this study takes an innovative and multifaceted approach to understanding the personal networks of homeless youth, and how the composition and structure of these networks may influence substance use and sexual behavior in this vulnerable population.

Employment and Leave Among Parents of Newborn Infants with Special Health Care Needs, funded by NIH. Paul Chung (PI). As 2-parent families have become increasingly 2-income, and as single-parent families have become more common, resolving conflicts between work and family has become critical for child health. Family leave policies allow parents to bond with a newborn infant or to care for an ill child. In July 2004, California implemented the Paid Family Leave Insurance (PFLI) program - the first major new family leave policy in the U.S. in over a decade - becoming the first state to guarantee paid family leave to most employees. What effects PFLI will have remain unclear, because how parents weigh the costs and benefits of employment and leave against the needs of their children has not been characterized. The goals in this application are to elucidate the work-family decision-making processes of parents of newborn infants and children with special health care needs (CSHCN). The specific aims are to examine: (1) what factors influence decisions about leave-taking and employment among parents of newborn infants or of CSHCN; (2) how taking leave (or seeking, changing, reducing, or quitting work) affects child's health and health care, parents' emotional wellbeing, and family's financial health; and (3) whether an intervention among physicians, nurses, and social workers can affect parents' knowledge and use of leave options, help parents address work-family conflicts, and improve child's health and health care, parents' emotional wellbeing, and family's financial health. Phase I will include parent focus groups, Phase II will be interviews and longitudinal follow-ups of parents with newborn or hospitalized children, and Phase III will be a hospital-based randomized controlled intervention for parents.

Healthy Living: A Community-Academic Partnership to Address Disparities in Obesity Among Youth, funded by NCMHD. Mark Schuster, (PI). This three-year community-based participatory research (CBPR) planning grant aims to:

1. Build a strong community-academic partnership and assess community needs and priorities for healthy eating and physical activity programs among adolescents through effective collaboration among researchers from the UCLA/RAND Center for Adolescent Health Promotion, Los Angeles School District (LAUSD) staff, and key community stakeholders;
2. Jointly design an intervention to reduce/prevent obesity among adolescents of diverse racial/ethnic backgrounds by increasing physical activity and healthy eating behaviors; and
3. Pilot test the feasibility and effects of the pilot intervention among adolescents of diverse racial/ethnic backgrounds.

To accomplish these goals, we conducted extensive community-based formative work, including middle school site visits and qualitative interviews with key community stakeholders and parent and teen focus groups in middle schools, to assess local needs, priorities, and capacity with respect to nutrition and physical activity among youth of diverse race/ethnicity. Based on our formative research, we developed an intervention for middle school students, Students for Nutrition and Exercise (SNaX). The main goal of SNaX is to empower LAUSD 7th graders to make better food choices and engage in physical activity, both inside and outside of school, by bringing LAUSD obesity-related policy into practice within middle schools. SNaX aims to promote healthy eating with environmental school cafeteria changes (provision of sliced fruit and free chilled filtered water, posting of point-of-sale food nutrition signage), student-led advocacy and education about nutrition and physical activity, and school-wide activities to promote awareness of SNaX and its messages (e.g., lunchtime informational activities led by student peer leaders; school-wide assembly about nutrition and school cafeteria changes). In an after-school club, SNaX peer leaders learn how to advocate about healthy eating and physical activity to their peers and family members; peer leaders are asked to approach other students during pre-planned lunchtime activities, as well as to discuss SNaX messages at home and with their friends. We are now planning a randomized controlled trial of the intervention's effectiveness at promoting healthy eating and physical activity among LAUSD youth.

Healthy Passages: A Community-Based Longitudinal Study of Adolescent Health, funded by the CDC. Mark Schuster (PI). This community-based longitudinal study of child and adolescent health is designed to help families, health care providers, schools, communities, and the government, develop effective policies and programs to keep children and adolescents healthy. The two main study goals are: 1) to characterize trends over time and the relative contribution of important, multi-level factors that influence health behaviors and outcomes over time; and 2) to understand the factors that cause disparities in health outcomes by race/ethnicity and gender.

With funding from the CDC, we are collaborating with two other Prevention Research Centers (PRCs) in Birmingham and Houston to study a cohort of 5,147 fifth graders and their parents biennially though age 20 years. Biennial assessments identify the family, peer, school, and community influences on health behaviors, health outcomes, and educational and social outcomes across diverse racial and ethnic populations in three geographic areas (Birmingham, Houston, and Los Angeles). In addition, as children are in the fifth grade at the start of data collection, this study will assess the effects of major transitional periods (e.g., elementary school to middle school, puberty, high school to college or work) on health and educational outcomes. The study has completed enrollment and assessment of the baseline cohort of fifth grade children. A total of 5,147 fifth grade children and their parents were assessed between fall 2004 and summer 2006. Wave II data collection began fall 2006 with the cohort in seventh grade and will be completed by summer 2008.

Baseline data collection included in-home interviews with parents and adolescents, anthropometric measurements, neighborhood observations, teacher surveys and teacher ratings of students' behaviors, school surveys, and school record abstraction. This study assesses a broad array of health issues in adolescents including school performance, physical activity, nutrition, tobacco use, alcohol use, drug use, injuries and violence, romantic interests and sexual behaviors, and physical and mental health. The data we obtain will support the design of new interventions and programs to promote healthy youth development.

Paid Family Leave Insurance Program, funded by NICHD. Mark Schuster (PI). We are studying the impact of California's new Paid Family Leave Insurance (PFLI) Program, which took effect in July 2004. The law is the first in the country to go beyond the 1993 federal Family Medical Leave Act (FMLA) by guaranteeing partial salary during leave for family illness, including chronic illness in children. In our baseline study we surveyed parents of chronically ill children in the UCLA (California) and Northwestern (Illinois) medical systems, prior to July 2004. We explored parents' need for and use of leave, as well as perceived effects of leave and other issues. We are collecting follow-up data to assess whether PFLI has changed the use of or effects of leave in California compared to Illinois. Directly assessing the impact of a first in the nation state health policy law should aid in determining the value of and barriers to replication in other states.

Parental Perspectives on Transitioning, funded by Stein Oppenheimer Endowment Award. Jackie Casillas (PI). Long-term follow-up (LTFU) care is essential for childhood cancer survivors since the use of cancer therapy at an early age can lead to life-threatening, physical and psychosocial late years after completion of therapy. Most survivors are not receiving appropriate LTFU care and are not aware of the importance. Current data suggest the examination of social factors, such as the family's role in the doctor-patient interaction, may expand our understanding of factors that facilitate a successful transition to receiving LTFU care when adolescent and young adult (AYA) survivors reach adulthood. This mixed methods cross-sectional study, using qualitative (in-depth interviews and focus groups) and quantitative research methods (survey), proposes to elucidate the role parental health beliefs and knowledge have on an AYA survivor's health-seeking behavior. This data will be used to develop an educational intervention that will ensure a smooth transition to LTFU care when survivors of childhood cancer reach adulthood.

Parents' Views on the Redesign of Well-Child Care for Young Children, funded by UCLA/DREW Project EXPORT, NCMHD. Tumaini Coker (PI). Well-child care (WCC) is the cornerstone of pediatric primary care. It provides preventive health services to infants and children. Well-child visits during the first three years of life are critical because they may be the only opportunity before a child reaches preschool to identify and address important social, developmental, behavioral, and health issues that could have negative consequences at present or later in their life. These visits are also a key opportunity to equip parents with the tools they need to help their child reach their full potential. In our current system of WCC this opportunity is often missed – many parents leave their visits with unaddressed psychosocial, developmental, and behavioral concerns, many children don't receive recommended screening for developmental delay, and many pediatricians don't have the time, training, or financial incentives to provide the wide range of preventive services recommended in health supervision guidelines. We are partnering with the South Bay Family Healthcare Center to examine the perspectives of low-income African-American and Latino parents on new models for the structure and delivery of preventive health care services to their young children, ages 0-3 years. We will be conducting focus groups to examine parents' views on non-traditional ways of receiving WCC services, including delivery by non-physician providers, in locations such as retail stores or daycare centers, and via non face-to-face formats including phone or email. Data from this proposed study will be combined with the perspectives of pediatricians and payors (commercial and Medicaid health plans) to develop a new model for the delivery of WCC for low-income, minority children that is effective, efficient, and economically feasible.

Project CHOICE: A Brief Voluntary Alcohol and Drug Intervention for Middle School Youth, funded by National Institute on Alcoholism and Alcohol Abuse (NIAAA). Elizabeth D’Amico (PI) and Joan Tucker (Co-PI). The middle school years are peak years for initiation and escalation of alcohol, tobacco, and marijuana use. Most youth who use harmful substances are unlikely to voluntarily make use of formal prevention services and research suggests that youth may benefit from less formal programs that are brief, voluntary, and easily accessible. However, few intervention programs of this type have been developed; thus, while this approach shows promise, the impact of intervention programs that younger teens may choose to attend has not been extensively examined. The goal of this study is to evaluate Project CHOICE (PC), developed by Dr. Elizabeth D’Amico at RAND, the only voluntary intervention tested for middle school youth. This evaluation involves a total of 16 middle schools located in 3 school districts in Los Angeles County. In addition to evaluating the impact of PC on substance use, secondary objectives are to better understand who participates in PC and how participants and changes in the school environment may influence the attitudes and behaviors of non-participants.

Social Context of Smoking in Adolescence and Young Adulthood, funded by the Tobacco-Related Disease Research Program. Joan Tucker (PI). Despite the large literature on peer relationships and smoking, much remains to be learned about the factors contributing to peer similarities in smoking, the diversity of peer influences relevant to smoking, and the conditions under which youth are susceptible versus resilient to smoking-related peer influences. Further, methodological limitations preclude drawing strong conclusions from most of these studies about the role of peer relationships as a contributing factor to youth smoking. Thus, the most fundamental question underlying research on peers and smoking has not been fully investigated: to what extent do friendship networks actually influence adolescent smoking behavior? Using longitudinal friendship network data from the National Survey of Adolescent Health (Add Health), this project is addressing the following specific aims: 1) To determine the extent to which friendship networks influence smoking (influence effects) and smoking influences friendship selection (selection effects), and whether these associations differ across key demographic groups; 2) To investigate how different levels of peer influence are concurrently and prospectively associated with youth smoking behavior, and to explore whether these associations are moderated by key network structure characteristics; and 3) To identify adolescents who are more resilient versus vulnerable to different levels of pro-smoking peer influences, focusing on characteristics from four domains: personal factors; school factors; family factors; and neighborhood factors.

Talking Parents, Healthy Teens, funded by the National Institute of Mental Health (NIMH) and CDC. Mark Schuster (PI). Research shows that parents can play a significant role in promoting healthy sexual development and risk reduction among adolescents. Parenting approaches such as engaging in open and responsive communication, providing appropriate levels of supervision, and keeping involved in children's lives are associated with better adolescent outcomes. However, many parents are uncertain about how to talk with their adolescents about sex, and although they may express a need for help with parenting issues, they are often too busy to attend ongoing programs in the community. To reach out to working parents, we developed a parenting program for parents of adolescents (grades 6-10) using a worksite-based teaching approach. Once a week for eight consecutive weeks, the program brings together groups of about 12-15 parents during the lunch hour. The main goals of the 8-session program, Talking Parents, Healthy Teens, are to improve parent-adolescent communication, promote healthy adolescent sexual development, and reduce adolescent sexual risk behavior. The program aims to help parents understand adolescent development and the changes in adolescents' thoughts and feelings about sexual issues and other risk behaviors. It helps parents develop skills for discussing sensitive but important topics with their adolescents, and for teaching their adolescents decision-making and problem-solving skills. The program also emphasizes the importance of parents knowing what is going on in their adolescents' lives (often called parental monitoring). We are evaluating the program's efficacy via randomized controlled trial. Parents who express interest in the program are randomized into an intervention group that takes the parenting program and a control group that does not. Intervention and control parents complete confidential surveys pre-intervention and at 0, 3, 9, 15, 21, 27, 33, 39, and 45 months post-intervention. We also ask participants' adolescents (who are not in the parenting program) to fill out mailed surveys. If the program proves successful, we will make it available to communities and employers. We are also adapting the program for other settings and to incorporate additional topics.

Transitioning Adolescent and Young Adult Childhood Cancer Survivors to Adult Health Care, funded by American Society of Clinical Oncology. Jackie Casillas (PI). In this project we propose to develop a targeted educational intervention for Latino Adolescent and Young Adult (AYA) survivors, delivered by peer navigators, on 5 selected late effects topics which will improve their knowledge of their future health risks due to a previous history of childhood cancer and increase their intent to seek long-term follow-up care. We hypothesize that it will be possible to modify existing health educational materials using parental views/beliefs and expert opinion to develop an educational intervention that will be culturally relevant and family centered. We hypothesize that the educational intervention will be more effective than usual care as measured by an increase in knowledge for late effects and increase in intent to seek long-term follow-up care.

Understanding Motivators and Barriers for Changing Sugar Sweetened Beverage Intake,funded by CDC. Laura Bogart, (PI). Using the principles of community-based participatory research (CBPR), we are conducting formative qualitative semi-structured interviews with 60 overweight and at-risk for overweight youth and their caregivers to examine sugar-sweetened beverage (SSB) purchasing, home availability, and intake. The specific aims are:

1. To explore patterns of purchasing, availability, and consumption of SSBs in the home;
2. To examine the social-cognitive influences on caregivers and youth for keeping SSBs in the home, including cultural and social norms, definitions and attitudes toward SSBs, and self-efficacy for refraining from SSB consumption and increasing healthy beverage consumption;
3. To investigate environmental motivators for reducing SSB intake in the home, including factors that lead to decreased purchasing and storage patterns of SSBs in the home; and
4. To describe how race/ethnicity and immigrant status moderate patterns of purchasing, availability, and consumption of SSBs in the home.

We are building upon an ongoing community partnership between the UCLA/RAND Center for Adolescent Health Promotion and the Los Angeles Unified School District (LAUSD). Our formative work will provide much-needed information to develop sustainable, effective, and culturally-sensitive interventions that help to reduce SSB intake and ultimately improve health outcomes among youth.

Understanding Sex Education Programming in Schools, funded by Planned Parenthood. Elizabeth D'Amico (PI).This project plans to understand and clarify the most effective prevention approaches for reducing pregnancy and intentions to have sexual intercourse and increasing condom use and perceptions of safe-sex self-efficacy by conducting focus groups at three schools in LAUSD to understand the needs of the community and their perceptions of effective sex education prevention programming.