Publications by authors named "Amy L Pennar"

8 Publications

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Tailored motivational interviewing (TMI): Translating basic science in skills acquisition into a behavioral intervention to improve community health worker motivational interviewing competence for youth living with HIV.

Health Psychol 2021 Jul 29. Epub 2021 Jul 29.

Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine.

Interventions to promote evidence-based practices are particularly needed for paraprofessional staff working with minority youth with HIV who have higher rates of HIV infection but lower rates of linkage and retention in care compared to older adults. Utilizing the ORBIT model for behavioral intervention development, we defined and refined a behavioral intervention for providers, Tailored Motivational Interviewing (TMI), to improve provider competence in previous studies (Phase 1a and 1b). The current study focuses on ORBIT Phase 2a-proof of concept. We hypothesized that TMI would be acceptable and feasible and would show a signal of efficacy of improving and maintaining community health worker (CHW) MI competence scores using an innovative statistical method for small N proof-of-concept studies. Longitudinal data were collected from 19 CHWs at 16 youth HIV agencies. CHWs from 8 sites were assigned to the TMI group per the cofunders request. The remaining 8 sites were randomly assigned to TMI or services as usual. MI competence was assessed at baseline and up to 15 times over 2 years. Random coefficient models were utilized to examine time trajectories of competence scores and the impact of the intervention on competence trajectories. Semistructured interviews were conducted to determine barriers and facilitators of TMI. Competence scores in the TMI group significantly increased while the scores of the control group significantly decreased. Further analysis of the intervention group demonstrated that scores significantly increased during the first 3 months after initial workshop and was sustained through the end of the study. Qualitative findings revealed insufficient time and competing priorities as perceived barriers whereas integrating MI into routine agency practices and ongoing training might facilitate implementation. Following a successful proof-of-concept, the next step is a fully randomized pilot study of TMI relative to a control condition in preparation for a stepped-wedge cluster randomized full scale trial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0001071DOI Listing
July 2021

Feasibility of Ethyl Glucuronide Nail Testing Biomarker for Alcohol Use Among Youth Living With HIV.

J Adolesc Health 2021 08 15;69(2):346-348. Epub 2021 Feb 15.

Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida.

Purpose: We assessed the feasibility of the ethyl glucuronide biomarker (EtG) through nail sampling to measure alcohol use among youth living with HIV in the United States (YLWH, N = 183); we also evaluated concordance between this EtG biomarker and self-reported measures of alcohol use, specifically, the Alcohol Timeline Followback (TFLB) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).

Methods: EtG, TFLB, and ASSIST were collected at 4 points over 1 year. At baseline and 52 weeks, 78.1% and 70.1%, respectively, provided a valid (full or partial) sample.

Results: At 16 weeks, EtG was associated with ASSIST (r = .25, p < .05). At 28 weeks and 52 weeks, TFLB and ASSIST were correlated with EtG (at 28 weeks r = .23, p < .05 and r = .41, p < .01, respectively; at 52 weeks r = .34, p < .01 and r = .25, p < .05, respectively).

Conclusions: We found that nail-based EtG biomarker was feasible to measure alcohol use among YLWH; we also found concordance between EtG, TLFB, and ASSIST, supporting ongoing use of self-reported alcohol use measures with YLWH.
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http://dx.doi.org/10.1016/j.jadohealth.2020.12.134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316253PMC
August 2021

Drug Use Among Adolescents and Young Adults with Unsuppressed HIV Who Use Alcohol: Identifying Patterns of Comorbid Drug Use and Associations with Mental Health.

AIDS Behav 2020 Oct;24(10):2975-2983

Center for Translational Behavioral Research, Florida State University College of Medicine, Tallahassee, FL, USA.

Youth living with HIV (YLWH; aged 16-24) are at elevated risk of alcohol and drug use. Studies in older populations have identified patterns or profiles of multiple substance use differentially associated with mental health and anti-retroviral therapy (ART) adherence. No studies of YLWH have yet examined such patterns. A sample of 179 YLWH, reporting ART non-adherence and alcohol use, were recruited at five Adolescent Trials Network clinics in urban areas of the US between November 2014 and August 2017. Participants completed the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) to assess substance use involvement scores, and the Brief Symptom Inventory. Latent Profile Analysis identified three substance use patterns: minimal illicit drug use (15.1%), cannabis only (56.4%), and global polysubstance use (28.5%). Global polysubstance users experienced more mental health problems compared to the minimal illicit drug use group. The co-occurrence of drug use with alcohol was common among these YLWH-all of whom reported ART adherence problems-indicating the importance of interventions capable of addressing multiple substance use rather than alcohol alone.
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http://dx.doi.org/10.1007/s10461-020-02848-8DOI Listing
October 2020

Cascade Monitoring in Multidisciplinary Adolescent HIV Care Settings: Protocol for Utilizing Electronic Health Records.

JMIR Res Protoc 2019 May 30;8(5):e11185. Epub 2019 May 30.

College of Medicine, Florida State University, Tallahassee, FL, United States.

Background: Past research shows that youth living with HIV (YLH) are not as engaged in the HIV treatment cascade as other HIV-positive populations. To achieve the health benefits of rapid and widespread testing and advanced pharmacologic treatment, YLH must be fully engaged in every stage of the treatment cascade. Cascade monitoring provides an opportunity to assess the youth care cascade, including engagement in care and when youth commonly drop out of care, across 10 clinical sites in the United States. Collecting electronic health record (EHR) data for prevention and care across participant recruitment venues within the Adolescent Medicine Trials Network (ATN) allows for monitoring of the prevention and care cascades within the ATN, for comparing the ATN population to large-scale surveillance, for future integration of technology-based interventions into EHRs, and for informing ATN strategic planning.

Objective: The aim of this protocol study is to examine the trends in treatment cascade, including whether patients are receiving antiretroviral therapy, adhering to regimens, attending care appointments, and maintaining suppressed viral loads, to guide new protocol development and to facilitate community engagement. This protocol is part of the ATN Scale It Up (SIU) program described in this issue.

Methods: Deidentified EHR data of YLH, aged 15 to 24 years, will be collected annually (2017 to 2022) from 10 ATN clinical sites, resulting in patient data from 2016 to 2021. These data will be transferred and stored using Dropbox Business, a Health Insurance Portability and Accountability Act-compliant site and then analyzed by the SIU analytic core.

Results: This study was launched in December 2017 in 10 clinical sites, with 2016's EHR data due on January 31, 2017. All 10 sites electronically uploaded their EHR data. The mandatory variables requested to monitor cascade of care include date of visit, age, gender, height, weight, race, ethnicity, viral load, and International Classification of Diseases codes for other diagnosis. In total, 70% of the sites provided data for all mandatory variables. The remaining mandatory variables were manually extracted.

Conclusions: This study will provide a platform to determine how YLH across the nation progress through or drop out of the HIV treatment cascade. It will also provide a foundation for assessing impact of SIU projects on treatment cascade outcomes.

International Registered Report Identifier (irrid): DERR1-10.2196/11185.
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http://dx.doi.org/10.2196/11185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658287PMC
May 2019

Adolescent HIV Healthcare Providers' Competencies in Motivational Interviewing Using a Standard Patient Model of Fidelity Monitoring.

AIDS Behav 2019 Oct;23(10):2837-2839

Center for Translational Behavioral Medicine, Florida State University, Tallahassee, FL, USA.

The goal of this project is to describe adolescent HIV care providers' competence in Motivational Interviewing (MI) using a standard patient interaction model of fidelity assessment. Providers (N = 151) at 11 clinics completed monthly MI role plays. The MI Coach Rating Scale was utilized to assess MI skill. Despite mean differences in baseline MI ability by provider type (medical providers, psychologists/social workers, other), when examined together, only clinic had a significant main effect. Aspects of the clinic environment may have a greater impact on providers' baseline MI ability than their job type. Future research should continue to explore these clinic factors.
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http://dx.doi.org/10.1007/s10461-019-02445-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732046PMC
October 2019

Comprehensive Community-Based Intervention and Asthma Outcomes in African American Adolescents.

Pediatrics 2018 10 5;142(4). Epub 2018 Sep 5.

School of Nursing, Columbia University, New York, New York.

: media-1vid110.1542/5804911922001PEDS-VA_2017-3737 BACKGROUND: African American adolescents appear to be the most at risk for asthma morbidity and mortality even compared with other minority groups, yet there are few successful interventions for this population that are used to target poorly controlled asthma.

Methods: African American adolescents (age 12-16 years) with moderate-to-severe persistent asthma and ≥1 inpatient hospitalization or ≥2 emergency department visits in 12 months were randomly assigned to Multisystemic Therapy-Health Care or an attention control group ( = 167). Multisystemic Therapy-Health Care is a 6-month home- and community-based treatment that has been shown to improve illness management and health outcomes in high-risk adolescents by addressing the unique barriers for each individual family with cognitive behavioral interventions. The attention control condition was weekly family supportive counseling, which was also provided for 6 months in the home. The primary outcome was lung function (forced expiratory volume in 1 second [FEV]) measured over 12 months of follow-up.

Results: Linear mixed-effects models revealed that compared with adolescents in the comparison group, adolescents in the treatment group had significantly greater improvements in FEV secondary outcomes of adherence to controller medication, and the frequency of asthma symptoms. Adolescents in the treatment group had greater reductions in hospitalizations, but there were no differences in reductions in emergency department visits.

Conclusions: A comprehensive family- and community-based treatment significantly improved FEV, medication adherence, asthma symptom frequency, and inpatient hospitalizations in African American adolescents with poorly controlled asthma. Further evaluation in effectiveness and implementation trials is warranted.
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http://dx.doi.org/10.1542/peds.2017-3737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317763PMC
October 2018

An SEM Assessment of the Internal Structure and Predictive Validity of the Abbreviated Early Adolescent HOME Inventory.

Assessment 2020 09 11;27(6):1285-1299. Epub 2018 May 11.

Arizona State University, Tempe, AZ, USA.

The Home Observation for Measurement of the Environment (HOME) Inventory is designed to assess the quality and quantity of support, stimulation, and structure provided to children in the home environment. HOME has been widely used for research and applied purposes. We focused on an abbreviated version of the Early Adolescent HOME (EA-HOME-A) that was administered to 15-year-old adolescents and their parents ( = 958) as part of the NICHD (National Institute of Child Health and Human Development) Study of Early Child Care and Youth Development. Our study had two objectives. First, we hypothesized and tested a bifactor model that specified a general factor in support of the use of the HOME total score and group factors for subsets of items in support of the content domain scores. Second, we applied structural equation modeling to relate the EA-HOME-A factors to outcome factors assessing maladaptive behaviors, autonomy, self-control, and cognitive-academic performance. The results supported the construct validity of the EA-HOME-A with respect to its internal structure as well as its correlates.
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http://dx.doi.org/10.1177/1073191118775214DOI Listing
September 2020

Who are the fathers in Healthy Families Arizona? An examination of father data in at-risk families.

Am J Orthopsychiatry 2011 Jul;81(3):327-36

School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287, USA.

Despite substantial research documenting the importance of father-child relations, little is known about fathers in families considered at risk for child abuse, and this lack of information makes adequate targeting of fathers in interventions challenging. This research aims to provide information that will aid interventions in targeting fathers and addressing father-related family issues through: (a) providing descriptive information regarding fathers in families at risk for child abuse, and (b) examining aspects of family well-being relative to father involvement. Analyses were conducted on mother-report data in families eligible for the Healthy Families Arizona prevention program (N = 197). Results indicated that although only 15% of parents in the sample were married, 47% of families had resident fathers, and 77% of fathers had some contact with their new babies. Families with greater father involvement had better prenatal care, higher incomes, less maternal involvement in Child Protective Services, less physical domestic violence (DV), and greater maternal mental health reflected through less loneliness. These findings have implications for targeting nonresident as well as resident fathers in families at risk for child abuse and for exploring DV issues in families with noninvolved fathers.
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http://dx.doi.org/10.1111/j.1939-0025.2011.01101.xDOI Listing
July 2011
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