Publications by authors named "Emily Ozer"

53 Publications

Youth Participatory Approaches and Health Equity: Conceptualization and Integrative Review.

Am J Community Psychol 2020 12 24;66(3-4):267-278. Epub 2020 Sep 24.

College of Public Health, Community and Behavioral Health Department, University of Iowa, Iowa City, IA, USA.

There is an array of youth participatory approaches relevant to health equity efforts in community psychology, adolescent health, youth development, and education. While they share some commonalities, they also reflect important distinctions regarding key processes and intended level of impact. Here, we consider the following: (a) youth-led participatory action research (YPAR), (b) youth organizing (YO), (c) youth-led planning, (d) human-centered design, (e) participatory arts, and (f) youth advisory boards. Informed by community psychology theories on empowerment and levels of change and social epidemiology frameworks that focus on the social determinants of health inequities, we aim to promote greater clarity in the conceptualization, implementation, and evaluation of youth participatory approaches; frame the "landscape" of youth participatory approaches and their similarities and differences; present an integrative review of the evidence regarding the impact of youth participatory approaches; and describe several illustrative cases so as to consider more deeply how some youth participatory approaches aim to influence the social determinants of health that lead to the physical embodiment of health inequities. We conclude by identifying areas of future policy- and practice-relevant research for advancing youth participation and health equity.
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http://dx.doi.org/10.1002/ajcp.12451DOI Listing
December 2020

Using Technology to Scale up Youth-Led Participatory Action Research: A Systematic Review.

J Adolesc Health 2020 08;67(2S):S14-S23

Berkeley School of Public Health, University of California, Berkeley, California.

Purpose: Rapid advances in technology create opportunities for adolescents to influence practice and policy in health and other domains. Technology can support the scaling of Youth-Led Participatory Action Research (YPAR), in which adolescents conduct research to improve issues that affect them. We present the first known published systematic review of the use of technology to scale YPAR.

Methods: A systematic review of the empirical literature was conducted from 2000 to 2018 using databases PsycARTICLES, PsycINFO, and PubMed. The review included peer-reviewed articles of YPAR studies involving adolescents (aged 10-19 years) using technology for scaling. Appraisal of papers included the role of technology and consistency with YPAR principles.

Results: Nine peer-reviewed YPAR publications focusing on a range of health issues with adolescents aged 11-19 years were identified. Technology included Facebook (most common), Twitter, Instagram, Skype, e-mail, blogs, and personalized mapping applications. Overall, technology was primarily used for adolescent participants to gather data. The appraisal revealed the complexities inherent in conducting YPAR using technology across multiple sites, with different adults in supportive roles and varying levels of opportunities for adolescent engagement.

Conclusions: This review provides insights at the intersection of youth-led research and technology, highlighting opportunities in a changing technological landscape and the challenges of YPAR at scale.
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http://dx.doi.org/10.1016/j.jadohealth.2019.10.019DOI Listing
August 2020

Use of Research Evidence Generated by Youth: Conceptualization and Applications in Diverse U.S. K-12 Educational Settings.

Am J Community Psychol 2020 09 4;66(1-2):81-93. Epub 2020 Jun 4.

University of California-Berkeley School of Public Health, Berkeley, CA, USA.

Youth-Led Participatory Action Research (YPAR) is a social justice-focused approach for promoting social change and positive youth development in which youth conduct systematic research and actions to improve their schools and communities. Although YPAR is oriented to generating research for action, with evidence-based recommendations often aimed at influencing adults with power over settings and systems that shape youths' lives, we have little understanding of how YPAR evidence influences the thinking and/or actions of adult policymakers or practitioners. In general, the participatory research field lacks a theoretically informed "use of research evidence" lens, while the use of evidence field lacks consideration of the special case and implications of participatory research. To start to address these gaps, this paper presents a conceptual linkage across these two fields and then provides six illustrative case examples across diverse geographic, policy, and programmatic contexts to demonstrate opportunities and challenges in the use of YPAR evidence for policy and practice. Our illustrative focus here is on U.S. K-12 educational contexts, the most-studied setting in the YPAR literature, but questions examined here are relevant to YPAR and other systems domestically and internationally, including health, educational, and legal systems. HIGHLIGHTS: The use of research evidence (URE) field identifies characteristics of research and conditions that strengthen URE. Youth-led Participatory Action Research is a special case for factors that influence research use. Six case examples across diverse K-12 contexts illustrate facilitators and barriers for YPAR use. We propose next steps for community psychology research and action to promote the study and use of YPAR evidence.
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http://dx.doi.org/10.1002/ajcp.12425DOI Listing
September 2020

Intersectional Discrimination Is Associated with Housing Instability among Trans Women Living in the San Francisco Bay Area.

Int J Environ Res Public Health 2019 11 15;16(22). Epub 2019 Nov 15.

San Francisco Department of Public Health, San Francisco, CA 94102 USA.

Trans women face numerous structural barriers to health due to discrimination. Housing instability is an important structural determinant of poor health outcomes among trans women. The purpose of this study was to determine if experiences of intersectional anti-trans and racial discrimination are associated with poor housing outcomes among trans women in the San Francisco Bay Area. A secondary analysis of baseline data from the Trans *National study ( = 629) at the San Francisco Department of Public Health (2016-2018) was conducted. Multivariable logistic regression was used to analyze the association between discrimination as an ordered categorical variable (zero, one to two, or three or more experiences) and housing status adjusting for age, years lived in the Bay Area, and gender identity. We found that the odds of housing instability increased by 1.25 for every categorical unit increase (1-2, or 3+) in reported experiences of intersectional (both anti-trans and racial) discrimination for trans women (95% CI = 1.01-1.54, -value < 0.05). Intersectional anti-trans and racial discrimination is associated with increased housing instability among trans women, giving some insight that policies and programs are needed to identify and address racism and anti-trans stigma towards trans women. Efforts to address intersectional discrimination may positively impact housing stability, with potential for ancillary effects on increasing the health and wellness of trans women who face multiple disparities.
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http://dx.doi.org/10.3390/ijerph16224521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888394PMC
November 2019

Emotion Reactivity and Regulation in Maltreated Children: A Meta-Analysis.

Child Dev 2019 09 7;90(5):1503-1524. Epub 2019 Jul 7.

Stanford University.

The many adverse effects of child maltreatment make the scientific investigation of this phenomenon a matter of vital importance. Although the relationship between maltreatment and problematic emotion reactivity and regulation has been studied, the strength and specificity of these associations are not yet clear. We examine the magnitude of the maltreatment-child-emotion reactivity/regulation link. Studies with substantiated maltreatment involving children aged up to 18 were included, along with a smaller number of longitudinal studies (58 papers reviewed, encompassing more than 11,900 children). In comparison to nonmaltreated children, maltreated children experience more negative emotions, behave in a manner indicative of more negative emotion, and display emotion dysregulation. We outline several theoretical implications of our results.
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http://dx.doi.org/10.1111/cdev.13272DOI Listing
September 2019

"The hook-up": How youth-serving organizations facilitate network-based social capital for urban youth of color.

J Community Psychol 2019 09 24;47(7):1614-1628. Epub 2019 Jun 24.

Division of Community Health Sciences, University of California Berkeley, School of Public Health, Berkeley, California.

Young people of color residing in distressed urban contexts face challenges in accessing social capital that supports positive development and the transition to educational and employment opportunities. Youth-serving organizations play potentially important roles for youth participants to access and leverage networks. This ethnographic study draws on qualitative interviews, conducted with adolescents at a youth-serving organization based in East Oakland, California, to examine how network-based social capital is activated and sustained for and by urban Black and Latinx youth. We found that relationships with supportive adult staff at the organization put youth in contact with caring, trusted adults of color outside of their families who serve as role models for them. These adults provide loving accountability to young people, serving as critical forces in distressed and stigmatized communities. We also found that adult staff activate social leverage to garner various current and future educational and professional opportunities for the youth there. These unique opportunities serve to boost young people's current self-esteem and also to prime them to envision positive futures for themselves. Overall, these findings point to the importance of interpersonal pathways embedded within neighborhood institutions in the activation of network-based social capital.
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http://dx.doi.org/10.1002/jcop.22216DOI Listing
September 2019

Tobacco use in the sexual borderlands: The smoking contexts and practices of bisexual young adults.

Health Place 2019 07 11;58:102069. Epub 2019 Jan 11.

Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA 94143, United States. Electronic address:

Little is known about why bisexual people use tobacco at higher rates than any other sexual identity group. Non-binary sexualities, such as bisexuality, exist within the socially constructed borderland between homosexuality and heterosexuality. Exploration of the everyday smoking contexts and practices of bisexual individuals may reveal unique mechanisms driving tobacco use. We employed a novel mixed method, integrating real-time, smartphone-administered surveys of (non)smoking situations, location tracking, spatial visualization of participant data, and subsequent map-led interviews. Participants (n = 17; ages 18-26, California) identified as bisexual, pansexual, and/or queer. Most were cisgender women. Survey smoking patterns and situational predictors were similar to other young adults'. However, interviews revealed unique roles of tobacco use in participants' navigation of differently sexualized spaces in everyday life: 1) stepping away from uncomfortable situations related to bisexual identity; 2) facilitating belonging to LGBTQ+ community; and 3) recovering from bisexual identity perception management. Similar studies can examine the place-embedded practices and spatio-temporal patterns of other substance use and other stigmatized identity experiences.
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http://dx.doi.org/10.1016/j.healthplace.2018.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620170PMC
July 2019

Broken bonds: A meta-analysis of emotion reactivity and regulation in emotionally maltreating parents.

Child Abuse Negl 2019 02 20;88:376-388. Epub 2018 Dec 20.

Stanford University, United States.

Background: Emotional maltreatment is the most pervasive but least studied form of abuse.

Objective: In the present study, we examined the role of emotion reactivity and emotion regulation in emotional child maltreatment.

Methods: We identified nine studies that compared levels of parental emotion reactivity and regulation in emotionally maltreating families with levels in non-maltreating families.

Results: Our meta-analytic findings revealed that, in comparison to non-maltreating parents, parents who are emotionally maltreating their children report higher levels of negative affect, depression, verbal aggression, and anger. We also found that in comparison to non-maltreating parents, emotionally maltreating parents report lower levels of emotional control, emotion regulation, and coping strategies.

Conclusions: We outline the theoretical and practical implications of these results, and emphasize how research into the etiology of child maltreatment may provide the basis for more effective prevention, screening, and treatment practices designed to eradicate emotional maltreatment.
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http://dx.doi.org/10.1016/j.chiabu.2018.11.016DOI Listing
February 2019

Youth Engagement and Participation: Field-Building Across Research and Practice.

J Adolesc Health 2018 12;63(6):671-672

UC-Berkeley School of Public Health and Innovations for Youth (I4Y), Berkeley, California; University of Iowa College of Public Health, Iowa City, Iowa; Centre for Health Equity, Melbourne School of Population and Global Health, Melbourne, Australia.

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http://dx.doi.org/10.1016/j.jadohealth.2018.09.011DOI Listing
December 2018

Adolescent Sleep Barriers: Profiles within a Diverse Sample of Urban Youth.

J Youth Adolesc 2018 Oct 2;47(10):2169-2180. Epub 2018 Mar 2.

School of Public Health, University of California, Berkeley, CA, USA.

Most adolescents face numerous obstacles to good sleep, which may undermine healthy development. In this study, we used latent class analysis and identified four categories of sleep barriers in a diverse sample of 553 urban youth (57% female). The majority profile, School/Screens Barriers, reported the most homework and extracurricular barriers, along with high screen time. The Home/Screens Barriers class (i.e., high environmental noise, light, screen use) and the High/Social Barriers class (i.e., high barriers across domains, particularly social) reported the poorest sleep quality and highest depressive/anxiety symptoms. The Minimal Barriers class-predominately male, with low depressive/anxiety symptoms-reported more sleep per night. We discuss implications of our findings for targeting interventions to address poor adolescent sleep among specific clusters of students.
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http://dx.doi.org/10.1007/s10964-018-0829-2DOI Listing
October 2018

Stimulating Parenting Practices in Indigenous and Non-Indigenous Mexican Communities.

Int J Environ Res Public Health 2017 12 25;15(1). Epub 2017 Dec 25.

School of Public Health, University of California, Berkeley, CA 94720, USA.

Parenting may be influenced by ethnicity; marginalization; education; and poverty. A critical but unexamined question is how these factors may interact to compromise or support parenting practices in ethnic minority communities. This analysis examined associations between mothers' stimulating parenting practices and a range of child-level (age; sex; and cognitive and socio-emotional development); household-level (indigenous ethnicity; poverty; and parental education); and community-level (economic marginalization and majority indigenous population) variables among 1893 children ages 4-18 months in poor; rural communities in Mexico. We also explored modifiers of associations between living in an indigenous community and parenting. Key findings were that stimulating parenting was negatively associated with living in an indigenous community or family self-identification as indigenous (β = -4.25; SE (Standard Error) = 0.98; β = -1.58; SE = 0.83 respectively). However; living in an indigenous community was associated with significantly more stimulating parenting among indigenous families than living in a non-indigenous community (β = 2.96; SE = 1.25). Maternal education was positively associated with stimulating parenting only in indigenous communities; and household crowding was negatively associated with stimulating parenting only in non-indigenous communities. Mothers' parenting practices were not associated with child sex; father's residential status; education; or community marginalization. Our findings demonstrate that despite greater community marginalization; living in an indigenous community is protective for stimulating parenting practices of indigenous mothers.
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http://dx.doi.org/10.3390/ijerph15010029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800129PMC
December 2017

Maternal Depressive Symptoms and Child Behavior among Mexican Women and Their Children.

Int J Environ Res Public Health 2017 12 18;14(12). Epub 2017 Dec 18.

Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.

Over 50% of mothers in rural Mexico have high depressive symptoms, and their children's health and development are likely to be negatively affected. A critical question is whether children vary in their vulnerability to the effects of high maternal depressive symptoms according to their indigenous ethnicity, maternal education, or household wealth. Our sample included 4442 mothers and 5503 children from an evaluation of Mexico's social welfare program. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale, and child behavior was measured using an adapted version of the Behavior Problems Index (BPI). Multiple linear regression models were used to explore the associations between maternal depressive symptoms and child behavior problems, and the heterogeneity of associations by indigenous ethnicity, maternal education, and household assets. We found that having greater maternal depressive symptoms was significantly associated with having a child with more behavior problems ( = 0.114, < 0.0001, [95% CI 0.101, 0.127]), in adjusted models. In tests of heterogeneity, the association between maternal depressive symptoms and child behavior problems was strongest in households with indigenous ethnicity, low maternal education, or in households with fewer assets. These results strengthen the case for effective mental health interventions in low- and middle-income countries, particularly among the most vulnerable families where mothers and children appear to be at the greatest risk.
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http://dx.doi.org/10.3390/ijerph14121566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750984PMC
December 2017

Obstacles to preventing obesity in children aged 2 to 5 years: Latino mothers' and fathers' experiences and perceptions of their urban environments.

Int J Behav Nutr Phys Act 2017 11 2;14(1):148. Epub 2017 Nov 2.

School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA, 94720-7360, USA.

Background: The prevalence of obesity among Latino children is alarmingly high, when compared to non-Latino White children. Low-income Latino parents living in urban areas, even if they are well-educated, face obstacles that shape familial health behaviors. This study used qualitative methods to explore parents' experiences in providing meals and opportunities to play to their children aged 2 to 5 years. In contrast to most prior studies, this study examined perceptions of familial behaviors among both mothers and fathers.

Methods: An ecological framework for exploring the associations of parental feeding behaviors and children's weight informed this study. An interview guide was developed to explore parents' experiences and perceptions about children's eating and physical activity and administered to six focus groups in a community-based organization in the Mission District of San Francisco. Transcripts were coded and analyzed. Twenty seven mothers and 22 fathers of Latino children ages 2 to 5 participated.

Results: Mothers, fathers, and couples reported that employment, day care, neighborhood environments and community relationships were experienced, and perceived as obstacles to promoting health behavior among their children, including drinking water instead of soda and participating in organized playtime with other preschool-age children.

Conclusions: Results from this study suggest that the parents' demographic, social and community characteristics influence what and how they feed their children, as well as how often and the types of opportunities they provide for physical activity, providing further evidence that an ecological framework is useful for guiding research with both mothers and fathers. Mothers and fathers identified numerous community and society-level constraints in their urban environments. The results point to the importance of standardized work hours, resources for day care providers, clean and safe streets and parks, strong community relationships, and reduced access to sugar-sweetened beverages in preventing the development of obesity in preschool-age Latino children.
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http://dx.doi.org/10.1186/s12966-017-0605-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667480PMC
November 2017

Fathers' feeding practices and children's weight status in Mexican American families.

Appetite 2017 10 17;117:109-116. Epub 2017 Jun 17.

School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA, 94720-7360, USA. Electronic address:

Mothers' feeding practices are associated with their children's weight status, but little is known about the associations between fathers' feeding practices and children's weight status. Moreover, there is a dearth of research on Latino fathers' feeding practices and children's weight status, even though Latino children suffer some of the highest obesity rates in the U.S. We examined the associations between fathers' feeding practices and child weight status, conditional on mothers' feeding practices, within 174 Mexican American families with children aged 8-10 years. Parents completed the Parental Feeding Practices Questionnaire, which consists of four subscales: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. To assess child weight status, body mass index (BMI) was calculated and converted to age- and gender-specific percentile scores (BMI z-score). We fit four sets of regression models, one set for each of the four parental feeding practices subscales, with child BMI z-score as the outcome variable. Fathers' pressure to eat (b = -0.20, p = 0.04; 95% CI: -0.39, -0.01) and use of food to control behavior (b = -0.36, p = 0.02; 95% CI: -0.65, -0.07) were associated with lower child BMI z-score, and restriction of amount of food (b = 0.56, p < 0.001; 95% CI: 0.27, 0.84) was associated with higher child BMI z-score, after accounting for mothers' feeding practices. Fathers' positive involvement in child eating was not associated with child BMI z-score. These findings provide empirical evidence that fathers' feeding practices are independently associated with children's weight status, even when mothers' feeding practices are taken into account, and suggest that fathers' feeding practices also matter in regard to children's weight status.
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http://dx.doi.org/10.1016/j.appet.2017.06.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675558PMC
October 2017

Intertrial interval duration affects error monitoring.

Psychophysiology 2017 Aug 17;54(8):1151-1162. Epub 2017 Apr 17.

Department of Psychology, Haverford College, Haverford, Pennsylvania.

The purpose of this study was to investigate the effect of varying intertrial interval (ITI) durations on neural signals of error monitoring, given the importance of the ITI as a time window for engaging in self-evaluation and cognitive control. In a between-subjects design, 35 participants were assigned to one of three ITI durations (short: 768 ms; medium: 1,280 ms; long: 1,792 ms) in a standard Stroop task while EEG was recorded. Participants in the short-ITI group demonstrated lower performance accuracy, a reduced error-related negativity (even when correcting for frequency of errors), lower error-related alpha suppression during the ITI, and increased post-error slowing. Results indicate that fast-paced trial timing can be disruptive to self-monitoring, perhaps due to capacity limitations or bottlenecks in processing.
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http://dx.doi.org/10.1111/psyp.12877DOI Listing
August 2017

Female sex workers use power over their day-to-day lives to meet the condition of a conditional cash transfer intervention to incentivize safe sex.

Soc Sci Med 2017 05 14;181:148-157. Epub 2017 Mar 14.

School of Public Health, 50 University Hall, #7360, University of California Berkeley, Berkeley, CA, 94720-7360, USA. Electronic address:

Female Sex Workers are a core population in the HIV epidemic, and interventions such as conditional cash transfers (CCTs), effective in other health domains, are a promising new approach to reduce the spread of HIV. Here we investigate how a population of Tanzanian female sex workers, though constrained in many ways, experience and use their power in the context of a CCT intervention that incentivizes safe sex. We analyzed 20 qualitative in-depth interviews with female sex workers enrolled in a randomized-controlled CCT program, the RESPECT II pilot, and found that while such women have limited choices, they do have substantial power over their work logistics that they leveraged to meet the conditions of the CCT and receive the cash award. It was through these decisions over work logistics, such as reducing the number of workdays and clients, that the CCT intervention had its greatest impact on modifying female sex workers' behavior.
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http://dx.doi.org/10.1016/j.socscimed.2017.03.018DOI Listing
May 2017

Dream Teens: Adolescents-Led Participatory Project in Portugal in the Context of the Economic Recession.

Health Promot Pract 2018 01 27;19(1):51-59. Epub 2016 Jul 27.

1 University of Lisbon, Lisbon, Portugal.

This article describes the implementation process of a nationwide project to enhance young people's participation and active citizenship in the context of Portugal's economic recession. This project used an innovative Positive Youth Development approach that engaged Portuguese youth (aged 11-18 years) through social media tools to facilitate their civic engagement and development. Participants from all over the country were empowered (1) to design and conduct research activities on topics of their choice and about their life contexts and (2) to create ways to improve youth civic participation in their communities, while developing supportive interactions with adults and peers. Overall, youth were engaged in their activities, felt their voices were heard, and felt that they were viewed as experts of their own well-being and living contexts. Youth research actions and preliminary findings were then compiled in a set of recommendations that was formally received by a high commissioner of the Ministry of Health. The article concludes with a discussion of the next steps for the project and its limitations so far.
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http://dx.doi.org/10.1177/1524839916660679DOI Listing
January 2018

Scaling-Up Youth-Led Social Justice Efforts through an Online School-Based Social Network.

Am J Community Psychol 2016 06 26;57(3-4):266-79. Epub 2016 Apr 26.

School of Public Health, University of California, Berkeley, Berkeley, CA, USA.

The exploration of social networking sites (SNS) in promoting social change efforts offers great potential within the field of community psychology. Online communities on SNS provide opportunities for bridging across groups, thus fostering the exchange of novel ideas and practices. Currently, there have only been limited efforts to examine SNS within the context of youth-led efforts. To explore the potential of SNS to facilitate the diffusion of social justice efforts between distinct youth groups, we linked three school-based youth-led participatory action research projects involving 54 high school students through a SNS. This study offers an innovative methodological approach and framework, utilizing social network analysis and strategic sampling of key student informants to investigate what individual behaviors and online network features predict student adoption of social change efforts. Findings highlight prospective facilitators and barriers to diffusion processes within a youth-led online network, as well as key constructs that may inform future research. We conclude by providing suggestions for scholars and practitioners interested in examining how SNS can be used to enhance the diffusion of social justice strategies, youth-led engagement efforts, and large-scale civic organizing.
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http://dx.doi.org/10.1002/ajcp.12042DOI Listing
June 2016

Youth-Led Participatory Action Research: Developmental and Equity Perspectives.

Authors:
Emily J Ozer

Adv Child Dev Behav 2016 25;50:189-207. Epub 2016 Jan 25.

University of California-Berkeley School of Public Health, Berkeley, CA, United States. Electronic address:

Youth-led participatory action research (YPAR) is an approach to scientific inquiry and social change grounded in principles of equity that engages young people in identifying problems relevant to their own lives, conducting research to understand the problems, and advocating for changes based on research evidence. This chapter provides an introduction to YPAR followed by consideration of the (a) developmental relevance of YPAR for marginalized youth, (b) implications of YPAR for developmental science research on inequities experienced by youth, and (c) potential opportunities and impact of YPAR for improving key developmental settings such as schools and youth-serving organizations. Resources for conducting YPAR projects are discussed, as well as the need for potential integration of YPAR and other participatory approaches to engaging youth and their expertise-at a significant enough scale to have a meaningful impact on policies and practices that affect youth development.
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http://dx.doi.org/10.1016/bs.acdb.2015.11.006DOI Listing
July 2016

The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection.

PLoS One 2015 1;10(7):e0128599. Epub 2015 Jul 1.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States of America; Center for Health Care Evaluation, Department of Veterans Affairs Medical Center, Menlo Park, California, United States of America.

Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans' transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a "family" that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents-those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems-were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be developed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0128599PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489090PMC
April 2016

Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family, School, and Community Moderators.

J Clin Child Adolesc Psychol 2017 May-Jun;46(3):353-378. Epub 2015 Jun 26.

b Prevention Research Center.

This review provides a comprehensive investigation of the pattern and strength of findings in the literature regarding the environmental moderators of the relationship between exposure to community violence and mental health among children and adolescents. Twenty-nine studies met criteria for inclusion in our analysis of family, school, and community variables as moderators. Dependent variables included internalizing (e.g., anxiety, depression, posttraumatic stress disorder) and externalizing symptoms (e.g., aggression, substance use). Effect sizes for the interactions of exposure to violence and potential moderators were summarized by their patterns of protective processes. The majority of studies in the literature examined family characteristics as moderators of the exposure to violence-symptom relationship, rather than school- or community-level factors. Our results indicated more consistent patterns for (a) close family relationships and social support for internalizing symptoms and (b) close family relationships for externalizing symptoms. Overall, the most common type of protective pattern was protective-stabilizing, in which youth with higher levels of the environmental attribute demonstrate relative stability in mental health despite exposure to violence. We found no consistent evidence that parental monitoring-a dimension inversely associated with exposure to violence in prior studies-moderated the relationship between exposure to violence and symptoms. The study emphasizes the importance of strengthening family support for young people's exposure to community violence; more research is needed to provide a solid evidence base for the role of school and community-level protective factors for youth exposed to violence.
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http://dx.doi.org/10.1080/15374416.2015.1046178DOI Listing
June 2017

Mental health and social networks in early adolescence: a dynamic study of objectively-measured social interaction behaviors.

Soc Sci Med 2015 Jan 15;125:40-50. Epub 2014 Apr 15.

Data Science Laboratory, ISI Foundation, Torino, Italy.

How are social interaction dynamics associated with mental health during early stages of adolescence? The goal of this study is to objectively measure social interactions and evaluate the roles that multiple aspects of the social environment--such as physical activity and food choice--may jointly play in shaping the structure of children's relationships and their mental health. The data in this study are drawn from a longitudinal network-behavior study conducted in 2012 at a private K-8 school in an urban setting in California. We recruited a highly complete network sample of sixth-graders (n = 40, 91% of grade, mean age = 12.3), and examined how two measures of distressed mental health (self-esteem and depressive symptoms) are positionally distributed in an early adolescent interaction network. We ascertained how distressed mental health shapes the structure of relationships over a three-month period, adjusting for relevant dimensions of the social environment. Cross-sectional analyses of interaction networks revealed that self-esteem and depressive symptoms are differentially stratified by gender. Specifically, girls with more depressive symptoms have interactions consistent with social inhibition, while boys' interactions suggest robustness to depressive symptoms. Girls higher in self-esteem tended towards greater sociability. Longitudinal network behavior models indicate that gender similarity and perceived popularity are influential in the formation of social ties. Greater school connectedness predicts the development of self-esteem, though social ties contribute to more self-esteem improvement among students who identify as European-American. Cross-sectional evidence shows associations between distressed mental health and students' network peers. However, there is no evidence that connected students' mental health status becomes more similar in their over time because of their network interactions. These findings suggest that mental health during early adolescence may be less subject to mechanisms of social influence than network research in even slightly older adolescents currently indicates.
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http://dx.doi.org/10.1016/j.socscimed.2014.04.015DOI Listing
January 2015

A rights-based approach to sexuality education: conceptualization, clarification and challenges.

Perspect Sex Reprod Health 2014 Jun 1;46(2):63-72. Epub 2014 May 1.

Center for Research on Adolescent Health and Development, Public Health Institute, Oakland.

Context: Although a rights-based approach to sexuality education has been increasingly discussed in the past decade, documented consensus regarding the goals, concepts and underlying assumptions of this approach is lacking. Differences in the assumed meaning of a rights-based approach can limit discussions of its implementation and evaluation, and impede opportunities to explore and critique a new model for sexuality education.

Methods: In-depth interviews were conducted in 2012 with 21 U.S. and international sexuality education experts. Data were thematically coded and analyzed using an iterative approach. Responses were compared according to respondents' professional discipline and geographic focus.

Results: A rights-based approach can be defined as the intersection of four elements: an underlying principle that youth have sexual rights; an expansion of programmatic goals beyond reducing unintended pregnancy and STDs; a broadening of curricula content to include such issues as gender norms, sexual orientation, sexual expression and pleasure, violence, and individual rights and responsibilities in relationships; and a participatory teaching strategy that engages youth in critical thinking about their sexuality and sexual choices. These elements were consistently identified by respondents across professional disciplines and geographic foci. In addition, all respondents raised questions about the feasibility of implementing a rights-based approach, particularly in the United States.

Conclusions: While questions remain to be answered regarding the implementation and impact of rights-based sexuality education, the proposed conceptual definition suggests multiple avenues for advocates, researchers, program developers and funders to enhance adolescent sexual health.
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http://dx.doi.org/10.1363/46e1114DOI Listing
June 2014

A case study of middle school food policy and persisting barriers to healthful eating.

Ecol Food Nutr 2014 ;53(3):333-46

a Loma Linda University School of Public Health , Loma Linda , California , USA.

Decreasing access to competitive foods in schools has produced only modest effects on adolescents' eating patterns. This qualitative case study investigated persistent barriers to healthful eating among students attending an ethnically diverse middle school in a working-class urban neighborhood that had banned on campus competitive food sales. Participant observations, semi-structured interviews and document reviews were conducted. Unappealing school lunches and easily accessible unhealthful foods, combined with peer and family influences, increased the appeal of unhealthy foods. Areas for further inquiry into strategies to improve urban middle school students' school and neighborhood food environments are discussed.
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http://dx.doi.org/10.1080/03670244.2014.872906DOI Listing
December 2014

Developmental trends in sleep duration in adolescence and young adulthood: evidence from a national United States sample.

J Adolesc Health 2014 Jun 18;54(6):691-7. Epub 2013 Dec 18.

Division of Community Health and Human Development, School of Public Health, University of California-Berkeley, Berkeley, California.

Purpose: To present normative values of mean sleep duration from adolescence through young adulthood (ages 13-32 years), prevalence of short (<6 hours) and long (>10 hours) sleep durations, and differences in each by sex and race/ethnicity.

Methods: Mean sleep duration and prevalence of extremely short and long sleep were estimated using data from the United States National Longitudinal Study of Adolescent Health, Waves 1-4 (N = 15,701).

Results: Sleep duration showed age-related trends, with decreases across the adolescent period from 8.5 hours per night at age 13 years to 7.3 hours at age 18 years, an increase through the emerging adulthood period to 8.5 hours at age 22, and a gradual decline across early adulthood to 7.7 hours at age 32 years. Prevalence of extremely long and short sleep followed similar developmental trends. Adolescent girls reported lower mean sleep duration than did boys, but women reported longer average sleep duration than did men from age 19 years onward. Short sleep duration was most common among African-Americans at all ages. Long sleep was most common among African-Americans in adolescence and emerging adulthood and among Hispanics in early adulthood.

Conclusions: Sleep duration is developmentally patterned from adolescence through early adulthood. Mean and extreme sleep durations vary systematically by sex and race/ethnicity as well as age. These normative data on sleep duration will inform studies of the role of sleep in the etiology of a wide range of health conditions affecting adolescents and young adults.
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http://dx.doi.org/10.1016/j.jadohealth.2013.10.201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401462PMC
June 2014

Latino youths' sexual values and condom negotiation strategies.

Perspect Sex Reprod Health 2013 Dec 28;45(4):182-90. Epub 2013 Oct 28.

Julianna Deardorff is assistant professor, and Emily J. Ozer is associate professor, Division of Community Health and Human Behavior, School of Public Health, University of California, Berkeley.

Context: Young Latinos in the United States are at high risk for STDs and are less likely than other youth to use condoms. To our knowledge, no studies have examined the relationship between sexual values and condom negotiation strategies among young Latinos.

Methods: Cross-sectional data collected in 2003-2006 from 571 Latino women and men aged 16-22 in the San Francisco Bay Area were used to examine associations between sexual values (e.g., considering sexual talk disrespectful or female virginity important) and use of strategies to engender or avoid condom use. Linear regression analyses were used to identify such associations while adjusting for potential covariates and gender interactions.

Results: Among women, sexual comfort and comfort with sexual communication were positively associated with frequency of direct communication to foster condom use; the importance of female premarital virginity and levels of sexual self-acceptance were positively associated with expressing dislike of condoms to avoid using them; and levels of sexual self-acceptance were negatively associated with expressing dislike of condoms to avoid using them. Moreover, the degrees to which women considered sexual talk disrespectful and female virginity important were positively associated with the frequency with which they shared risk information as a condom use strategy. Among both sexes, the importance that respondents placed on premarital female virginity was negatively associated with use of direct communication strategies.

Conclusion: Researchers designing interventions to influence Latino youths' sexual decision making and behaviors should consider including program components that address sexual values.
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http://dx.doi.org/10.1363/4518213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124077PMC
December 2013

"Bounded" empowerment: analyzing tensions in the practice of youth-led participatory research in urban public schools.

Am J Community Psychol 2013 Sep;52(1-2):13-26

UC-Berkeley School of Public Health, 50 University Hall #7360, Berkeley, CA 94720-7360, USA.

This multi-method study examines tensions in the practice of youth-led participatory research (YPAR) in urban high schools among 15 semester-cohorts. Student participants in the present study were 77 ethnically diverse youth from four high schools in a major metropolitan school district. Data were gathered using systematic classroom observations, interviews with teachers and students involved in the projects, and participant observation. The two most commonly-constrained phases of the YPAR project were issue selection and action steps. A central tension in the issue selection phase for projects enacted across multiple semester cohorts was the tension between original inquiry and "traction:" Sticking with the same topic enabled sustained building of strategic alliances and expertise for making change, but limited the incoming cohort's power to define the problem to be addressed. In further analyses, we identified processes that promoted student power despite continuity-related constraints-teachers' framing and buy-in strategies, "micro-power" compensation, and alignment of students' interests with the prior cohort-as well as constraints in other phases of the projects. This study's findings regarding the promotion of youth power in the face of constraints advance the integration of theory and practice in youth-led research and have implications for participatory research more broadly.
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http://dx.doi.org/10.1007/s10464-013-9573-7DOI Listing
September 2013

The impact of participatory research on urban teens: an experimental evaluation.

Am J Community Psychol 2013 Mar;51(1-2):66-75

School of Public Health, University of California at Berkeley, Berkeley, CA, USA.

Although there is much practice of community-based participatory research in economically-developing countries and increasingly in North America, there has been little systematic assessment of empowerment effects. Youth-led participatory research holds particular promise for fostering positive development and civic participation among economically disadvantaged urban youth. The present investigation uses a clustered-randomized, within-school experimental design to test the effects of youth-led participatory research on the psychological empowerment of 401 students attending urban public schools. We find that attending a participatory research elective class during the school day was associated with increases in sociopolitical skills, motivation to influence their schools and communities, and participatory behavior. We found no significant effects for perceived control at school. The implications for participatory research and related youth development interventions are discussed.
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http://dx.doi.org/10.1007/s10464-012-9546-2DOI Listing
March 2013

Sexual abuse in childhood and adolescence and the risk of early pregnancy among women ages 18-22.

J Adolesc Health 2011 Sep 17;49(3):287-93. Epub 2011 Feb 17.

Community Health and Human Development Division, School of Public Health, University of California, Berkeley, California 94720-7360, USA.

Purpose: This clinic- and community-based study of young women investigated the relationship between previous sexual abuse and early pregnancy, examining the effect of the developmental period in which sexual abuse occurred and type of sexual abuse, while also providing methodological advances in the assessment of distinctive sexual abuse and its sequelae.

Methods: Secondary data analysis using Cox proportional hazards models was conducted to determine the association between sexual abuse in childhood, in adolescence, or both, and risk of early pregnancy among 1,790 young women. In addition, this study examined the type of sexual abuse that occurred during each period.

Results: As compared with women with no history of sexual abuse, women who experienced sexual abuse only in childhood had a 20% greater hazard of pregnancy; women who experienced sexual abuse only in adolescence had a 30% greater hazard of pregnancy; and women who experienced sexual abuse in both childhood and adolescence had an 80% greater hazard of pregnancy. Across these periods, attempted rape and rape were associated with an increased hazard of pregnancy. The association between sexual abuse and pregnancy was mediated by age at first intercourse and moderated by a woman's education level.

Conclusion: This study provides evidence that both the developmental timing and the type of sexual abuse contributes to an increased risk for early pregnancy. The study findings indicate that sexual abuse leads to an earlier age of first sexual intercourse, which in turn increases the likelihood of an early pregnancy. Women with higher educational attainment are less likely to experience early pregnancy as a result of abuse.
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http://dx.doi.org/10.1016/j.jadohealth.2010.12.019DOI Listing
September 2011

Does alleviating poverty affect mothers' depressive symptoms? A quasi-experimental investigation of Mexico's Oportunidades programme.

Int J Epidemiol 2011 Dec 7;40(6):1565-76. Epub 2011 Jul 7.

Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.

Background: Depression is a major cause of disability, particularly among women; poverty heightens the risk for depression. Beyond its direct effects, maternal depression can harm children's health and development. This study aimed to assess the effects of a large-scale anti-poverty programme in Mexico (Oportunidades) on maternal depressive symptoms.

Methods: In 2003, 5050 women living in rural communities who had participated in Oportunidades since its inception were assessed and compared with a group of 1293 women from matched communities, whose families had received no exposure to Oportunidades at the time of assessment but were later enrolled. Self-reported depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Ordinary least squares regressions were used to evaluate the treatment effect of programme participation on depression while adjusting for covariates and clustering at the community level.

Results: Women in the treatment group had lower depressive symptoms than those in the comparison group (unadjusted mean CES-D scores: 16.9 ± 9.8 vs 18.6 ± 10.2). In multivariable analyses, programme participation was associated with lower depression whilst controlling for maternal age, education and household demographic, ethnicity and socio-economic variables [β= -1.7 points, 95% confidence interval (95% CI) -2.46 to -0.96, P < 0.001]. Reductions in perceived stress and increases in perceived control were mediators of programme effects on women.

Conclusions: Although Oportunidades did not target maternal mental health directly, we found modest but clinically meaningful effects on depressive symptoms. Our design permits stronger causal inference than observational studies that have linked poverty and depressive symptoms. Our results emphasize that the well-being of individuals is responsive to macro-level economic policies and programmes.
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http://dx.doi.org/10.1093/ije/dyr103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235019PMC
December 2011