Dr. Halpern-Felsher is a developmental psychologist whose research has focused on cognitive and psychosocial factors involved in adolescents’ and young adults’ health-related decision-making, perceptions of risk and vulnerability, health communication, and risk behavior. Her research has focused on understanding and reducing health risk behaviors such as tobacco use, alcohol and marijuana use, risky driving, and risky sexual behavior. Her research has been instrumental in changing how providers discuss sexual risk with adolescents and has influenced national policies regulating adolescent and young adult tobacco use. Most recently, she was awarded over $1million by the NIH/NCI and FDA to conduct a large, longitudinal study examining adolescents’ and young adults’ perceptions regarding as well as initiation, continuation, and cessation of current and new tobacco products, including e-cigarettes and smokeless tobacco. Dr. Halpern-Felsher’s research and committee work have been instrumental in setting policy at the local, state, and national level. In California, Dr. Halpern-Felsher’s research was cited in support of school-based tobacco education initiatives within California’s Tobacco Education Research Oversight Committee’s 2012 Masterplan. This Masterplan sets funding priority areas for research, education and intervention for California. Dr. Halpern-Felsher is also collaborating with the California Department of Education to develop, implement and evaluate new school-based tobacco prevention and education materials. At the national level, Dr. Halpern-Felsher’s research was highlighted in the 2012 Surgeon General Report, ”Preventing Tobacco Use among Youth and Young Adults,” and Dr. Halpern-Felsher contributed to the chapter on Clinical interventions: The role of health care providers in the prevention of youth tobacco use. Dr. Halpern-Felsher has been a member of five Institute of Medicine, National Academies of Sciences committees focusing on adolescent and young adult health risk behavior. She has served on the Board of Directors of the Society for Adolescent Health and Medicine and currently serves on the Council for the Society for Pediatric Research (SPR), and Co-Chairs the SPR Mentoring Committee. In 2007, Dr. Halpern-Felsher became one of the Program Directors for the NIH/NIDDK-funded Short-Term Research Experience for Underrepresented Persons (STEP-UP), High School Program. She has received two NIH 5-year grants to coordinate this program thus far. For this Step-Up Program, Dr. Halpern-Felsher mentors and supervises 22-25 junior and senior high school students each year. These high students are recruited throughout the country, and conduct their 8-10 weeks of research in their hometown. In addition to mentoring high school students, Dr. Halpern-Felsher has been a mentor to over 75 graduate and medical students and postdoctoral fellows.

Academic Appointments

Administrative Appointments

  • Director of Research, Division of Adolescent Medicine (2014 - Present)
  • Associate Director, Adolescent Medicine Fellowship Program (2014 - Present)

Honors & Awards

  • Fellow, Society for Adolescent Health and Medicine (2012)
  • Elected Council Member, Society for Pediatric Research (2012)
  • Member (Elected), American Pediatric Society (2011)
  • Program Director, Society for Adolescent Health and Medicine Annual Meetings (2011-2013)
  • Elected Board Member, Society for Adolescent Health and Medicine (2008-2011)
  • Hellman Family Award for Early Career Faculty, UCSF (2001-2002)

Boards, Advisory Committees, Professional Organizations

  • Committee Member, Institute of Medicine Committee to Develop a Strategy to Prevent and Reduce Underage Drinking, Institute of Medicine (2002 - 2003)
  • Committee Member, Institute of Medicine Committee on Reducing Tobacco Use: Strategies, Barriers, and Consequences (2004 - 2007)
  • Committee Member, Institute of Medicine Committee on Contributions from the Behavioral and Social Sciences in Reducing and Preventing Teen Motor Crashes, Institute of Medicine and the Division of Behavioral and Social Sciences and Education (2005 - 2007)
  • Committee Member, IOM Committee on Scientific Standards for Studies on Reduced Risk Tobacco Products (2011 - 2012)
  • Committee Member, IOM Committee on the Health Implications of Raising the Minimum Age for Purchasing Tobacco Products (2013 - Present)
  • Elected Member, American Pediatric Society (2011 - Present)
  • Fellow, Society for Adolescent Health and Medicine (2012 - Present)
  • Elected Council Member, Society for Pediatric Research (2012 - Present)
  • Editorial Board Member, Journal of Adolescent Health (2006 - Present)
  • Associate Editor, Tobacco Regulatory Science Journal (2014 - Present)

Professional Education

  • PhD, University of California, Riverside, Developmental Psychology (1994)

Community and International Work

  • Tobacco Use Prevention Education, Los Angeles


    Evaluating School-Based Tobacco Education Programs

    Partnering Organization(s)

    Los Angeles Unified School District

    Populations Served

    At-risk youth



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

My research focuses on developmental, cognitive and psychosocial factors involved in adolescents’ and young adults’ health-related decision-making, perceptions of risk and vulnerability, health communication and risk behavior. My research has focused on understanding and reducing health risk behaviors such as tobacco use, alcohol and marijuana use, risky driving, and risky sexual behavior. An early study, funded by California’s Tobacco-Related Disease Research Program, involved a prospective cohort design in which 400 male and female adolescents of varying racial/ethnic background were followed from 9th grade through one-year post high school. The ultimate goal of this longitudinal study has been to determine the extent to which adolescents’ perceptions of smoking-related long- and short-term risks and benefits influence adolescents’ and young adults’ initiation, continuation and cessation of smoking. Another study, funded by the National Institute of Child Health and Human Development (NIH), used a prospective cohort design in which over 600 ethnically and socioeconomically diverse male and female adolescents were followed for five years, the aims of this study were to: (1) examine whether the onset of adolescent sexual activity, both with and without condom use, is associated with previous and/or subsequent changes in judgments concerning STD and HIV/AIDS risk; (2) examine whether adolescents’ personal experiences with negative outcomes related to sexual behavior (or lack of such experiences) influence subsequent risk judgments and sexual behavior; (3) determine the extent to which perceived benefits of sexual behavior are related to adolescent sexual behavior, over and above perceived risks; and (4) determine whether knowledge of peers’ experiences with sexual behaviors and related positive and negative outcomes play a role in adolescents’ risk judgments and subsequent sexual behavior. I received additional funding to continue following the sample into young adulthood. The results of this research provides valuable information concerning the relationship between risk judgments and behavior that is expected to be useful to researchers and health practitioners concerned with developing programs to reduce adolescents’ sexual risk. With funding from the William T. Grant Foundation, we conducted qualitative studies on adolescent decision-making, one focusing on sexual decision-making and the other on decisions to use tobacco. These qualitative studies provide for a larger, adolescent-driven perspective on decision-making not always captured by quantitative surveys. We have also completed interviews with 40 adolescents participating in the tobacco study, and are completing additional manuscript shortly. In 2012, I received funding from California’s Tobacco-Related Disease Research Program and the California Department of Education to translate my research findings to the development of novel school-based interventions to prevent tobacco use. Most recently, I received funding from the NIH/FDA (Center for Tobacco Products) to examine adolescent and young adults’ use of and perceptions related to current conventional and new tobacco products, including cigarettes, e-cigarettes, smokeless tobacco, hookahs, and so on. I have also expanded and extended my research to understanding risk behaviors in a larger context of adolescent development as well as within the emerging adult population, as this is a developmental period most often characterized by exploration including health-compromising behaviors. My research and committee work have been instrumental in setting policy at the local, state, and national level.


  • The Role of Risk and Benefit Perceptions in Tobacco Control and Product Usage, Stanford University

    Tobacco companies have developed and implemented advertising and marketing efforts to reduce perceptions of harm associated with tobacco use, increase perceptions that tobacco is socially acceptable, and ultimately encourage and sustain use of tobacco.1-5 These marketing strategies have particularly focused on changing perceptions and increasing tobacco use among adolescents and young adults. There are gaps in the science concerning: 1) how perceptions influence tobacco use among adolescents and young adults, including changes in patterns of tobacco use from initiation to regular use, cessation, relapse, product switching, or dual use; 2) the role of pro- and anti-tobacco messages on perceptions of new tobacco products such as e-cigarettes, small cigars (little cigars and cigarillos), smokeless tobacco, snus, dissolvables, compressed tobacco, and emerging products that come on the market during the course of this research; and 3) the specific mechanisms by which marketing messages change tobacco-related perceptions, perceived acceptability of the product, and tobacco use behaviors. Prospective, longitudinal studies using frequent assessments and comprehensive measures of tobacco use, perceptions, and marketing are needed in order to provide specific scientific evidence about how marketing shapes decisions to use and stop using different tobacco products. This information will inform FDA regulation of the marketing and promotion of conventional, new and emerging tobacco products. This study fills gap in the science base by developing and testing a novel, comprehensive model concerning the relationships among pro- and anti-tobacco marketing messages, perceptions of tobacco risks and benefits, perceived product acceptability, and patterns of tobacco use among adolescents and young adults. We will address these gaps, and develop and test our model by accomplishing three specific aims. Using a longitudinal cohort design with a sample of 1,000 ninth graders followed through high school and another sample of 1,000 young adults followed for five years: Aim 1: Determine adolescents’ and young adults’ perceptions of risk for disease, addiction, and death; acceptability; and benefits of using conventional, new, and emerging tobacco products that come on the market during the course of this research. Aim 2: Determine the predictive relationships among perceptions of tobacco-related risks, benefits, and acceptability of tobacco products, and the onset, continuation, cessation, relapse, switching, and dual use of tobacco products. Aim 3: Identify contextual factors (exposure to pro-tobacco media, anti-tobacco media, warning labels, and smoking images in the media and on the Internet) that influence perceptions of risks, benefits, acceptability, and subsequent tobacco use.



  • A Youth Development & Parent Toolkit for Tobacco Education, Stanford University

    School-based tobacco education efforts have had mixed results, with some showing short- and long-term success in reducing tobacco usage, and other programs yielding little or no positive outcomes. Few tobacco prevention programs are developed by first directly asking the stakeholders of these programs (educators, students, and parents) what is missing from school-based tobacco prevention programs, and then incorporating these missing aspects into new prevention messages and delivery strategies. Applying results from a previous Pilot SARA in which we identified missing health messages, the specific aims of our project are as follows: Aim 1: To develop, test, and implement a toolkit containing a set of youth development modules applied to school-based tobacco control and education efforts. Specifically, we are developing (a) a module for tobacco educators on the principles of youth development, (b) modules for implementing youth development strategies and best practices in the schools, including one on best practices to encourage youth involvement, using peers and near-peers, guiding youth to develop anti-tobacco messages, and guiding youth to create media an advocacy campaigns, and (c) a module that includes tobacco (nicotine) addiction messages to increase understanding and appreciation of nicotine addiction in order to reduce initiation and encourage cessation among youth who discount the addictive nature of tobacco. Aim 2: To develop, test and implement modules for parents, aimed at providing information about school tobacco policies, school tobacco control efforts and messages that parents can use to reinforce and append school messages.




2015-16 Courses

Graduate and Fellowship Programs

  • Adolescent Medicine (Fellowship Program)


All Publications

  • Longitudinal Study of Adolescents' Attempts to Promote and Deter Friends' Smoking Behavior JOURNAL OF ADOLESCENT HEALTH Brady, S. S., Morrell, H. E., Song, A. V., Halpern-Felsher, B. L. 2013; 53 (6): 772-777


    Little research has examined the extent to which adolescents directly attempt to influence friends' smoking. This study examines adolescents' reported actions to promote or deter friends' smoking, and whether actions vary by adolescents' smoking experience.Data were collected between 2001 and 2004 at four time points across the 9th and 10th grades from an ethnically diverse school-based sample (N = 395; 53% female).Deterrence of smoking was reported by a greater percentage of adolescents than was promotion of smoking, both among those who had ever smoked and never smoked. By the end of the study, over 45% of ever smokers and less than 5% of never smokers had promoted smoking among friends. In contrast, over 70% of ever smokers and roughly 40% of never smokers had deterred smoking. Among adolescents who had ever smoked, positive consequences of smoking by fall of 10th grade predicted attempts to promote smoking by the end of 10th grade (OR = 4.37, p < .05). To a lesser extent, negative consequences of smoking predicted attempts to deter smoking (OR = 2.60, p < .08). These effects were independent of the opposite type of smoking consequences, level of personal smoking experience, having close friends who smoked, prior attempts to influence friends' behavior, and smoker's gender.Models of peer influence should account for both positive and negative influence of adolescents on friends' health behavior. Adolescents who have engaged in risk-taking and experienced negative consequences may be a resource in designing and delivering interventions; future research should evaluate their ability to change friends' behavior.

    View details for DOI 10.1016/j.jadohealth.2013.06.022

    View details for Web of Science ID 000327481300016

    View details for PubMedID 23945053

  • "It was Pretty Scary": The Theme of Fear in Young Adult Women's Descriptions of a History of Adolescent Dating Abuse ISSUES IN MENTAL HEALTH NURSING Burton, C. W., Halpern-Felsher, B., Rehm, R. S., Rankin, S., Humphreys, J. C. 2013; 34 (11): 803-813


    The mental health impact of abusive adolescent dating relationships has not been well described, but fear related to abuse has been reported. We elaborate the theme of fear in women's descriptions of a history of adolescent dating abuse. A sample of community-based women, ages 19-34, who experienced an abusive dating relationship during adolescence (ages 11-20) was used. Data were analyzed via thematic analysis. Fear was a consistent and resonant theme. Three types of fear were identified: fear for self, fear for other relationships, and fearful expectation. These results offer important insights into the impact of abusive adolescent relationships on women's mental health.

    View details for DOI 10.3109/01612840.2013.827286

    View details for Web of Science ID 000209366900004

  • Identification and Characterization of Adolescents' Sexual Boundaries JOURNAL OF ADOLESCENT HEALTH Wolf, H. T., Morrell, H. E., Halpern-Felsher, B. L. 2013; 53 (1): 85-90


    Adolescents' decisions to have sex may be based on a priori boundaries placed on sex. This study addresses: (1) to what extent adolescents set vaginal sexual boundaries; (2) the types of sexual boundaries most and least likely to be endorsed; and (3) to what extent sexual boundaries vary by sex, race/ethnicity, and sexual experience.A cross-sectional study of 518 students attending 10th grade. Survey measures queried about demographics, ever having sex, and existence of sexual boundaries (e.g., being in love, having an attractive partner) that must be in place before having vaginal sex.The most frequently endorsed boundaries were maturity, commitment, trust, love, and marriage. These boundaries were more frequently endorsed than having a safer-sex method. Compared with females, males were more likely to choose boundaries based on partner attractiveness (p < .001) and avoiding trouble (p < .04). Compared with Asians and Pacific Islanders, whites were more likely to endorse wanting to be a certain age to have sex (p < .01 and p < .05, respectively); Asians and Pacific Islanders were more likely to choose sexual boundaries based on marriage (p's < .05). Adolescents who were sexually experienced were more likely than inexperienced adolescents to endorse boundaries related to relationship characteristics and partner attractiveness (OR = 2.5), and less likely to endorse boundaries related to feeling mature (OR = .34) and waiting until marriage (OR = .34).Identifying adolescents' sexual boundaries should help healthcare professionals better understand under what circumstances adolescents are more or less likely to have sex; and this information should ultimately inform the development of new interventions.

    View details for DOI 10.1016/j.jadohealth.2013.01.004

    View details for Web of Science ID 000320768200014

    View details for PubMedID 23481297

  • What Does It Take to Be a Smoker? Adolescents' Characterization of Different Smoker Types NICOTINE & TOBACCO RESEARCH Lee, J., Halpern-Felsher, B. L. 2011; 13 (11): 1106-1113


    Studies have demonstrated that clinical- and research-based definitions of who a smoker is and what constitutes smoking often differ from adolescent-derived definitions, which can be problematic for effective intervention and prevention efforts. We investigated how adolescents define different smoker types (nonsmoker, smoker, regular smoker, addicted smoker, heavy smoker, experimental smoker, casual smoker, and social smoker) using multiple indicators of smoking behaviors, including frequency, amount, place, and length of time cigarette smoking, and whether differences exist by smoking experience.Quantitative and qualitative methods were used to analyze data from a cohort of adolescents (N = 372) in northern California.We found differences in how adolescents characterized smoker types based on their own smoking experience. Ever-smokers tended to have a greater flexibility in determining what constituted nonsmoking and heavy smoking, while never-smokers had much narrower definitions. Results also indicated that adolescents may mistakenly associate nicotine addiction with a high frequency and amount of cigarette use as 74.3% characterized an addicted smoker as having smoked for a few years or more. In addition, there was a considerable amount of overlap in definitions between different smoker types, particularly among the smoker-regular smoker, addicted smoker-heavy smoker, and casual smoker-social smoker pairs.Health communication strategies for youth smoking prevention need to address the wide variability and overlap in how adolescents define different smoker types. Greater attention should be directed to understanding the nuances of how adolescents define smoking in order to maximize the effectiveness of youth-centered smoking prevention and cessation messages.

    View details for DOI 10.1093/ntr/ntr169

    View details for Web of Science ID 000296352300013

    View details for PubMedID 21849408

  • Earlier Age of Smoking Initiation May Not Predict Heavier Cigarette Consumption in Later Adolescence PREVENTION SCIENCE Morrell, H. E., Song, A. V., Halpern-Felsher, B. L. 2011; 12 (3): 247-254


    Previous studies suggest that earlier cigarette smoking initiation in adolescence predicts greater cigarette consumption later in adolescence or adulthood. Results from these studies have been used to inform interventions for adolescent smoking. However, previous studies suffer from several important methodological limitations. The objective of the present study was to address these limitations by longitudinally and prospectively examining whether and how age of initiation of smoking among adolescents predicts cigarette consumption by age 16 or 17. Participants completed an in-class survey every 6 months for 2-3 school years. Participants included 395 adolescents (Mean age=14 years at baseline; 53.2% female) from two public high schools in Northern California (Schools A and B) who completed self-report measures of smoking initiation, number of friends who smoke, and number of whole cigarettes smoked by the final survey time point. Adolescents who were older when they first smoked one whole cigarette were 5.3 to 14.6 times more likely in School A and 2.9 to 4.3 times more likely in School B to have smoked a greater number of cigarettes by age 16 or 17. Results suggested that earlier smoking initiation may not lead to heavier cigarette consumption later in time, as has been previously shown. There may be a period of heightened vulnerability in mid- or late adolescence where smoking experimentation is more likely to lead to greater cigarette consumption. Targeting prevention efforts to adolescents aged 14 to 17 years may further reduce smoking initiation among youth, thus limiting subsequent smoking-related morbidity and mortality in adulthood.

    View details for DOI 10.1007/s11121-011-0209-6

    View details for Web of Science ID 000293708700003

    View details for PubMedID 21384136

  • Predictive Relationship Between Adolescent Oral and Vaginal Sex Results From a Prospective, Longitudinal Study ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Song, A. V., Halpern-Felsher, B. L. 2011; 165 (3): 243-249


    To (1) identify the temporal order between oral and vaginal sex onset; (2) test whether oral sex or vaginal sex is a risk or protective factor for the other; and (3) determine whether the relationship between oral and vaginal sex varies across time.Prospective, longitudinal study with 6-month assessments conducted between 2002 and 2005.Self-administered surveys completed during class time.At baseline, 627 ninth grade high school students from 2 northern California schools were included in the study.Oral and vaginal sex onset.Among sexually active adolescents, most initiated vaginal sex after or within the same 6-month period of oral sex initiation. Adolescents who initiated oral sex at the end of ninth grade had a 50% chance of initiating vaginal sex by the end of 11th grade. In comparison, adolescents who delayed until the end of 11th grade had a 16% chance of initiating vaginal sex by the end of 11th grade.The first 2 years of high school may be a critical age period for adolescents' vulnerability to vaginal sex initiation via oral sex behaviors. Comprehensive evidenced-based interventions and provision of preventive services aimed toward reducing sexual risk should be expanded to include the role oral sex plays in adolescent sex behavior.

    View details for DOI 10.1001/archpediatrics.2010.214

    View details for Web of Science ID 000288087900010

    View details for PubMedID 21041589

  • Predicting Adolescent Perceptions of the Risks and Benefits of Cigarette Smoking: A Longitudinal Investigation HEALTH PSYCHOLOGY Morrell, H. E., Song, A. V., Halpern-Felsher, B. L. 2010; 29 (6): 610-617


    To evaluate developmental changes, personal smoking experiences, and vicarious smoking experiences as predictors of adolescents' perceptions of the risks and benefits of cigarette smoking over time, and to identify new and effective targets for youth smoking prevention programs.There were 395 adolescents surveyed every 6 months for two school years, from the beginning of 9th grade to the end of 10th grade.Time, participant smoking, friend smoking, parental smoking, and sex were evaluated as predictors of smoking-related short-term risk perceptions, long-term risk perceptions, and benefits perceptions using multilevel modeling techniques.Perceptions of benefits did not change over time. Perceptions of risk decreased with time, but not after sex and parental smoking were included in the model. Adolescents with personal smoking experience reported decreasing perceptions of risk and increasing perceptions of benefits over time. Adolescents with more than 6 friends who smoked also reported increasing perceptions of benefits over time.Changes in risk perceptions may not purely be the result of developmental processes, but may also be influenced by personal and vicarious experience with smoking. Findings highlight the importance of identifying and targeting modifiable factors that may influence perceptions.

    View details for DOI 10.1037/a0021237

    View details for Web of Science ID 000284794700007

    View details for PubMedID 20939640

  • Perceptions of Second-hand Smoke Risks Predict Future Adolescent Smoking Initiation JOURNAL OF ADOLESCENT HEALTH Song, A. V., Glantz, S. A., Halpern-Felsher, B. L. 2009; 45 (6): 618-625


    To directly test whether perceptions of second-hand smoke risks deter adolescent smoking initiation.A longitudinal survey design was utilized in this study. Baseline surveys measuring perceptions of tobacco-related risks and smoking behaviors were administered to 395 high school students, with three follow-up assessments every 6 months.Perceptions of personal second-hand smoke risks and parental second-hand smoke risks significantly deterred adolescent smoking initiation. Perceptions of personal second-hand smoke risks reduced the odds of smoking by a factor of 0.63 (95% confidence interval [CI]=0.42-0.94) for each quartile increase in perceptions of personal second-hand smoke risks. Adolescents who provided the highest estimates of risks for personal second-hand smoke were 0.25 as likely to smoke as adolescents who provided the lowest estimates of risk. Perceptions of parental second-hand smoke risks reduced the odds of smoking by a factor of 0.64 (95% CI=0.43-0.93) for each quartile increase. Adolescents who perceived the highest estimates of risks associated with parental second-hand smoke were 0.26 as likely to smoke in the future compared to adolescents who provided the lowest estimates of risk. These effects are over three times as large as a smoking peer's influence on a nonsmoking adolescents' risk for smoking initiation, odds ratio [OR]=1.18 (95% CI=1.02-1.35).Adolescent perceptions of risks of second-hand smoke are strongly associated with smoking initiation. Encouraging adolescents to express their objections to second-hand smoke, as well as encouraging parents to create smoke-free homes, may be powerful tobacco control strategies against adolescent smoking.

    View details for DOI 10.1016/j.jadohealth.2009.04.022

    View details for Web of Science ID 000272460300013

    View details for PubMedID 19931835

  • Perceptions of Smoking-Related Risks and Benefits as Predictors of Adolescent Smoking Initiation AMERICAN JOURNAL OF PUBLIC HEALTH Song, A. V., Morrell, H. E., Cornell, J. L., Ramos, M. E., Biehl, M., Kropp, R. Y., Halpern-Felsher, B. L. 2009; 99 (3): 487-492


    The predictive value of perceptions of smoking-related risks and benefits with regard to adolescent smoking initiation has not been adequately established. We used prospective, longitudinal data to directly test whether smoking-related perceptions predict smoking initiation among adolescents.We administered surveys assessing perceptions of smoking-related risks and benefits to 395 high school students, beginning at the start of their ninth-grade year. We conducted follow-up assessments every 6 months until the end of 10th grade, obtaining 4 waves of data.Adolescents who held the lowest perceptions of long-term smoking-related risks were 3.64 times more likely to start smoking than were adolescents who held the highest perceptions of risk. Adolescents who held the lowest perceptions of short-term smoking-related risks were 2.68 times more likely to initiate. Adolescents who held the highest perceptions of smoking-related benefits were 3.31 times more likely to initiate.Findings from this study provide one of the first sets of empirical evidence to show that smoking initiation is directly related to smoking-related perceptions of risks and benefits. Thus, efforts to reduce adolescent smoking should continue to communicate the health risks of smoking and counteract perceptions of benefits associated with smoking.

    View details for DOI 10.2105/AJPH.2008.137679

    View details for Web of Science ID 000263808400021

    View details for PubMedID 19106420

  • Intertemporal Tradeoffs: Perceiving the Risk in the Benefits of Marijuana in a Prospective Study of Adolescents and Young Adults MEDICAL DECISION MAKING Goldberg, J. H., Millstein, S., Schwartz, A., Halpern-Felsher, B. 2009; 29 (2): 182-192


    Intertemporal tradeoffs characterize the decision to use drugs: pleasure now traded off against the possibility of pain later. Traditional approaches have examined whether individuals use drugs because they either seek immediate benefit or fail to appreciate long-term risk. We asked whether risk taking might also result from failing to appreciate benefits. We refer to this as risk in the benefits (RIBs), an understanding that one's first drug experience can be so good, that a person may not want (or be able) to stop, putting him/her on a path that leads directly to addiction.In total, 304 participants, 160 adolescents and 144 young adults, participated in a longitudinal study on marijuana use and other risky health behaviors.The failure to perceive the RIBs of marijuana use led to increased risk taking 1 year later within 3 different health behaviors: alcohol, tobacco, and sexual risk-taking. Greater appreciation of RIBs predicted significantly less future risk taking over-and-above all the traditional cognitive and behavioral predictors, and RIBs were the only significant cognitive predictor when all were included in 1 model. RIBs also partially mediated the relationship between past and future risk taking, over and above the strongest predictors of risk taking.Failing to appreciate the impact of short-term benefits within the context of long-term risk increased future risk taking. Interventions that enhance the salience of RIBs may represent a new approach to reducing the likelihood that individuals will take risks with their health.

    View details for DOI 10.1177/0272989X08323918

    View details for Web of Science ID 000265110000004

    View details for PubMedID 18836059

  • Oral sexual behavior: Harm reduction or gateway behavior? JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B. 2008; 43 (3): 207-208
  • Adolescents report both positive and negative consequences of experimentation with cigarette use PREVENTIVE MEDICINE Brady, S. S., Song, A. V., Halpern-Felsher, B. L. 2008; 46 (6): 585-590


    To examine the physiological and social consequences that 9th and 10th grade adolescents experience as a result of experimenting with cigarette use, and whether consequences vary by level of experimentation and gender.Data were collected between 2001 and 2004 from 395 adolescents attending two northern California public high schools. Analyses are limited to 155 adolescents who reported puffing on cigarettes or smoking whole cigarettes at any of four time points during the study.The percentage of adolescents reporting consequences of smoking was as follows: any positive consequence (56%), felt relaxed (46%), looked cool (31%), looked grown-up (27%), became popular (17%), any negative consequence (56%), friends were upset (35%), trouble catching breath (29%), bad cough (26%), and got into trouble (23%). Ten percent of adolescents reported only experiencing negative consequences, 11% reported only positive consequences, 45% reported both negative and positive consequences, and 34% reported no consequences. Greater levels of experimentation were associated with greater likelihood of reporting positive or negative consequences. Few gender differences emerged.Adolescents experience both positive and negative consequences of experimentation with cigarette use. Prevention and intervention efforts should acknowledge that positive consequences of smoking may occur and address how these consequences can be achieved through other behaviors.

    View details for DOI 10.1016/j.ypmed.2008.01.019

    View details for Web of Science ID 000257627000017

    View details for PubMedID 18336892

  • Social and emotional consequences of refraining from sexual activity among sexually experienced and inexperienced youths in California AMERICAN JOURNAL OF PUBLIC HEALTH Brady, S. S., Halpern-Felsher, B. L. 2008; 98 (1): 162-168


    We examined the social and emotional consequences among adolescents of refraining from sexual activity (oral or vaginal sex) and whether these consequences differed over time and by gender and sexual experience.Adolescents (N=612; 58% female) recruited from 2 schools were assessed at 4 time points separated by 6-month intervals, beginning in fall of ninth grade.The percentage of adolescents who reported only positive consequences (e.g., they felt responsible, friends were proud) dramatically decreased over time, whereas the percentage that reported negative consequences (e.g., they felt left out, partners became angry) steadily increased. Adolescent girls and sexually experienced adolescents were more likely to report both positive and negative consequences than were adolescent boys and sexually inexperienced adolescents. Adolescents who began the study with sexual experience were more likely to report positive consequences of refraining from sexual activity by the end of the study than those who initiated sexual activity later.Sexual education programs should address how adolescents can cope with or prevent negative consequences of refraining from sexual activity, so that decisions to abstain are rewarding and decisions to engage in sexual activity are motivated by maturity and readiness.

    View details for DOI 10.2105/AJPH.2006.097923

    View details for Web of Science ID 000252178200033

    View details for PubMedID 18048792

  • Adolescents' reported consequences of having oral sex versus vaginal sex PEDIATRICS Brady, S. S., Halpern-Felsher, B. L. 2007; 119 (2): 229-236


    The present study examined whether adolescents' initial consequences of sexual activity differ according to type of sexual activity and gender.Surveys were administered to 618 adolescents recruited from 2 public high schools in the autumn of ninth grade (2002) and at 6-month intervals until the spring of tenth grade (2004). Analyses were limited to the 275 adolescents (44%) who reported engaging in oral sex and/or vaginal sex at any assessment. Participants were 14 years of age at study entry, 56% female, and of diverse socioeconomic and ethnic backgrounds.In comparison with adolescents who engaged in oral sex and/or vaginal sex, adolescents who engaged only in oral sex were less likely to report experiencing a pregnancy or sexually transmitted infection, feeling guilty or used, having their relationship become worse, and getting into trouble with their parents as a result of sex. Adolescents who engaged only in oral sex were also less likely to report experiencing pleasure, feeling good about themselves, and having their relationship become better as a result of sex. Boys were more likely than girls to report feeling good about themselves, experiencing popularity, and experiencing a pregnancy or sexually transmitted infection as a result of sex, whereas girls were more likely than boys to report feeling bad about themselves and feeling used.Adolescents experience a range of social and emotional consequences after having sex. Our findings have implications for clinical practice and public health campaigns targeted toward youth.

    View details for DOI 10.1542/peds.2006-1727

    View details for Web of Science ID 000243942000001

    View details for PubMedID 17272611

  • Adolescents tell us why teens have oral sex JOURNAL OF ADOLESCENT HEALTH Cornell, J. L., Halpern-Felsher, B. L. 2006; 38 (3): 299-301


    Adolescents' perceived reasons why teens have oral sex ranged from physical pleasure, improving intimate relationships, reducing risks associated with vaginal sex, the influence of substances, and social factors such as reputation concerns and peer experiences.

    View details for DOI 10.1016/j.jadohealth.2005.04.015

    View details for Web of Science ID 000235817200020

    View details for PubMedID 16488832

  • Oral versus vaginal sex among adolescents: Perceptions, attitudes, and behavior PEDIATRICS Halpern-Felsher, B. L., Cornell, J. L., Kropp, R. Y., Tschann, J. M. 2005; 115 (4): 845-851


    Despite studies indicating that a significant proportion of adolescents are having oral sex, the focus of most empirical studies and intervention efforts concerning adolescent sexuality have focused on vaginal intercourse. This narrow focus has created a void in our understanding of adolescents' perceptions of oral sex. This study is the first to investigate adolescents' perceptions of the health, social, and emotional consequences associated with having oral sex as compared with vaginal sex, as well as whether adolescents view oral sex as more acceptable and more prevalent than vaginal sex.Participants were 580 ethnically diverse ninth-grade adolescents (mean age: 14.54; 58% female) who participated in a longitudinal study on the relationship between risk and benefit perceptions and sexual activity. Participants completed a self-administered questionnaire that inquired about their sexual experiences and percent chance of experiencing outcomes from, attitudes toward, and perceived prevalence of oral versus vaginal sex among adolescents.More study participants reported having had oral sex (19.6%) than vaginal sex (13.5%), and more participants intended to have oral sex in the next 6 months (31.5%) than vaginal sex (26.3%). Adolescents evaluated oral sex as significantly less risky than vaginal sex on health, social, and emotional consequences. Adolescents also believed that oral sex is more acceptable than vaginal sex for adolescents their own age in both dating and nondating situations, oral sex is less of a threat to their values and beliefs, and more of their peers will have oral sex than vaginal sex in the near future.Given that adolescents perceive oral sex as less risky, more prevalent, and more acceptable than vaginal sex, it stands to reason that adolescents are more likely to engage in oral sex. It is important that health care providers and others who work with youths recognize adolescents' views about oral sex and broaden their clinical preventive services to include screening, counseling, and education about oral sex.

    View details for DOI 10.1542/peds.2004-2108

    View details for Web of Science ID 000228107900022

    View details for PubMedID 15805354

  • Adolescents' beliefs about the risks involved in smoking "light" cigarettes PEDIATRICS Kropp, R. Y., Halpern-Felsher, B. L. 2004; 114 (4): E445-E451


    Light cigarettes have been marketed by the tobacco industry as being a healthier smoking choice, a safe alternative to cessation, and a first step toward quitting smoking altogether. Research, however, has failed to show a reduction in smoking-related health risks, an increase in rates of smoking cessation, a decrease in the amount of carbon monoxide or tar released, or a reduction in the rates of cardiovascular disease or lung cancer associated with light cigarette use, compared with regular cigarette use. Nevertheless, more than one-half of adolescent smokers in the United States smoke light cigarettes. This study is the first to investigate adolescents' perception of the risks associated with smoking light cigarettes, as well as adolescents' attitudes and knowledge about the delivery of tar and nicotine, health risks, social effects, addiction potential, and ease of cessation with light cigarettes, compared with regular cigarettes.Participants were 267 adolescents (mean age: 14.0 years) who completed a self-administered questionnaire during class time. After reading scenarios in which they imagined that they smoked regular or light cigarettes, participants estimated the chances that they would personally experience 7 smoking-related health risks and 3 addiction risks. Participants also responded to 14 items concerning their attitudes and knowledge about light cigarettes versus regular cigarettes.Participants thought that they would be significantly less likely to get lung cancer, have a heart attack, die from a smoking-related disease, get a bad cough, have trouble breathing, and get wrinkles when smoking light cigarettes, compared with regular cigarettes, for the rest of their lives. Furthermore, when participants were asked how long it would take to become addicted to the 2 cigarette types, they thought it would take significantly longer to become addicted to light versus regular cigarettes. Adolescents also thought that their chances of being able to quit smoking were higher with light versus regular cigarettes. Similarly, when participants were asked how easy it would be to quit smoking the 2 cigarette types, they thought it would be significantly easier for them to quit smoking light cigarettes than regular cigarettes. Adolescents agreed or strongly agreed that regular cigarettes deliver more tar than light cigarettes and that light cigarettes deliver less nicotine than regular cigarettes.Overall, the results of this study show that adolescents hold misperceptions in both their personal risk estimates and their general attitudes about the health risks, addictive properties, and ease of cessation associated with light cigarettes. With a variety of light and ultralight cigarettes on the market, adolescents are led to think that there is a progression of safety levels to choose from when deciding which cigarettes to smoke. This illusion of control over health outcomes contributes to an underestimation of risks associated with smoking light cigarettes and supports these misperceptions. These results are of concern, given evidence suggesting that, if adolescents think they are less vulnerable to smoking-related health risks (ie, lung cancer), then they are more likely to initiate smoking. Furthermore, there is evidence that adolescents are not fully aware of the addictive nature of cigarettes and therefore think that they can experiment with smoking during adolescence without becoming addicted or experiencing any health consequences. The data presented here support concerns regarding smoking addiction; adolescents might be even more inclined to smoke light cigarettes to delay addiction. Without correct information about light cigarettes, adolescents are unable to make informed decisions about their smoking behaviors. The findings presented here strongly suggest that health care practitioners need to talk to their adolescent clients not only about the overall risks of smoking but also about the specific risks associated with smoking light cigarettes and other tobacco varieties, including the potential for addiction and long-term health consequences. Information shared with adolescents about light cigarettes, both individually by health care practitioners and at the population level via counter-advertising campaigns, may be successful in changing current misperceptions, and ultimately light cigarette smoking patterns, among youth.

    View details for DOI 10.1542/peds.2004-0893

    View details for Web of Science ID 000224242200008

    View details for PubMedID 15466070

  • Perceived risks and benefits of smoking: differences among adolescents with different smoking experiences and intentions PREVENTIVE MEDICINE Halpern-Felsher, B. L., Biehl, M., Kropp, R. Y., Rubinstein, M. L. 2004; 39 (3): 559-567


    Explanations of adolescent smoking often make reference to adolescents' beliefs that they are invulnerable to harm. However, empirical examination of whether adolescents do acknowledge risks. Further, few studies have considered perceived benefits in adolescents' behavioral decisions. This study examined perceived smoking-related physical and social risks and benefits between adolescents who have vs. have not smoked and do vs. do not intend to smoke.Three hundred and ninety-five students (mean age = 14.0) completed a survey concerning their smoking experiences, intentions, and perceived risks and benefits of smoking.Adolescent smokers and those who intend to smoke estimated their chance of experiencing a smoking-related negative outcome as less likely than did nonsmokers and non-intenders. Smokers and intenders also reported the chance of addiction as less likely than did others. In contrast, adolescent smokers and intenders perceived the chance of experiencing a smoking-related benefit as more likely than did nonsmokers and non-intenders.The data suggest that rather than solely focusing on health risks as a way to deter adolescent smoking, the role of perceived social risks and benefits in adolescents' smoking may be an additional critical focus for intervention. In addition, efforts should be made to increase adolescents' awareness of the addictive nature of cigarettes.

    View details for DOI 10.1016/j.ypmed.2004.02.017

    View details for Web of Science ID 000223760000016

    View details for PubMedID 15313096

  • The role of behavioral experience in judging risks HEALTH PSYCHOLOGY Halpern-Felsher, B. L., MILLSTEIN, S. G., Ellen, J. M., Adler, N. E., Tschann, J. M., Biehl, M. 2001; 20 (2): 120-126


    This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

    View details for Web of Science ID 000170976500004

    View details for PubMedID 11315729

  • Costs and benefits of a decision - Decision-making competence in adolescents and adults JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY Halpern-Felsher, B. L., Cauffman, E. 2001; 22 (3): 257-273
  • Preventive services in a health maintenance organization - How well do pediatricians screen and educate adolescent patients? ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Halpern-Felsher, B. L., Ozer, E. M., MILLSTEIN, S. G., Wibbelsman, C. J., Fuster, C. D., Elster, A. B., IRWIN, C. E. 2000; 154 (2): 173-179


    To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services.Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior.The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services.Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.

    View details for Web of Science ID 000085193100010

    View details for PubMedID 10665605

  • Neighborhood Characteristics and ADHD: Results of a National Study JOURNAL OF ATTENTION DISORDERS Razani, N., Hilton, J. F., Halpern-Felsher, B. L., Okumura, M. J., Morrell, H. E., Yen, I. H. 2015; 19 (9): 731-740


    We examined the association of neighborhood social and physical characteristics with ADHD, accounting for individual and family factors.The 2007 National Survey of Child Health, a nationally representative data set, was used (N = 64,076). Three neighborhood scales were generated: social support, amenities, and disorder. Logistic and ordinal logistic regressions were conducted to examine the association of these scales with ADHD diagnosis and severity while adjusting for individual and family characteristics.Eight percent had a child with ADHD: 47% described as mild, 40% moderate, and 13% severe. In adjusted models, lower neighborhood support was associated with increased ADHD diagnosis (odds ratio [OR] = 1.66 [1.05, 2.63]) and severity (OR = 3.74 [1.71, 8.15]); neighborhood amenities or disorder were not significantly associated. Poor parental mental health was associated with ADHD prevalence and severity.Neighborhood social support is a potential area of intervention for children with ADHD and their caregivers. Research challenges and opportunities are discussed.

    View details for DOI 10.1177/1087054714542002

    View details for Web of Science ID 000359153500001

    View details for PubMedID 25028386

  • "It is all about the fear of being discriminated [against] ... the person suffering from HIV will not be accepted": a qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya BMC PUBLIC HEALTH Wolf, H. T., Halpern-Felsher, B. L., Bukusi, E. A., Agot, K. E., Cohen, C. R., Auerswald, C. L. 2014; 14


    Youth represent 40% of all new HIV infections in the world, 80% of which live in sub-Saharan Africa. Youth living with HIV (YLWH) are more likely to become lost to follow-up (LTFU) from care compared to all other age groups. This study explored the reasons for LTFU among YLWH in Kenya.Data was collected from: (1) Focus group Discussions (n = 18) with community health workers who work with LTFU youth. (2) Semi-structured interviews (n = 27) with HIV + youth (15-21 years old) that had not received HIV care for at least four months. (3) Semi-structured interviews (n = 10) with educators selected from schools attended by LTFU interview participants. Transcripts were coded and analyzed employing grounded theory.HIV-related stigma was the overarching factor that led to LTFU among HIV + youth. Stigma operated on multiple levels to influence LTFU, including in the home/family, at school, and at the clinic. In all three settings, participants' fear of stigma due to disclosure of their HIV status contributed to LTFU. Likewise, in the three settings, the dependent relationships between youth and the key adult figures in their lives were also adversely impacted by stigma and resultant lack of disclosure. Thus, at all three settings stigma influenced fear of disclosure, which in turn impacted negatively on dependent relationships with adults on whom they rely (i.e. parents, teachers and clinicians) leading to LTFU.Interventions focusing on reduction of stigma, increasing safe disclosure of HIV status, and improved dependent relationships may improve retention in care of YLWH.

    View details for DOI 10.1186/1471-2458-14-1154

    View details for Web of Science ID 000345145000001

    View details for PubMedID 25377362

  • Experiences of community and parental violence among HIV-positive young racial/ethnic minority men who have sex with men AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV Phillips, G., Hightow-Weidman, L. B., Fields, S. D., Giordano, T. P., Outlaw, A. Y., Halpern-Felsher, B., Wohl, A. R. 2014; 26 (7): 827-834


    Adolescents and young adults (ages 13-24) in the USA are frequently exposed to violence in their community and home. While studies have examined the prevalence and impact of violence exposure among adolescents, there is a lack of data focusing specifically on adolescent men of color who have sex with men. Eight demonstration sites funded through a Special Projects of National Significance (SPNS) Initiative recruited 363 HIV-positive racial/ethnic minority young men who have sex with men (YMSM) for a longitudinal study between 2006 and 2009. Over two-thirds of participants (83.8%) had witnessed community violence, 55.1% in the prior three months. Witnessing violence committed with a deadly weapon was significantly associated with being African-American, having ever used drugs, and drinking alcohol in the prior two weeks. Fear of violence in the community was significantly associated with depressive symptomatology, having less than a high school degree, not possessing health insurance, and site of enrollment. Having been emotionally or physically abused by a parent or caretaker was significantly associated with depressive symptomatology, attempting suicide, site of enrollment, and increased age. Witnessing violence with a deadly weapon was significantly associated with alcohol and drug use but not with high-risk sexual behaviors. As this was one of the first studies on the prevalence and correlates of violence exposure among racial/ethnic minority YMSM living with HIV, the findings can be used to inform the development of culturally appropriate resilience-focused interventions to address the aftereffects of violence exposures and help develop social support systems outside of the family.

    View details for DOI 10.1080/09540121.2013.861571

    View details for Web of Science ID 000335118600006

    View details for PubMedID 24274141

  • Rejoinder-response to: Human linear growth trajectory defined. American journal of human biology Mon, A., Meyerhoff, D., Cabana, M., Halpern-Felsher, B. 2014; 26 (1): 109-110

    View details for DOI 10.1002/ajhb.22484

    View details for PubMedID 24254459

  • Human linear growth trajectory defined AMERICAN JOURNAL OF HUMAN BIOLOGY Mon, A., Cabana, M., Halpern-Felsher, B., Meyerhoff, D. J. 2013; 25 (5): 666-672


    The purpose of this study was to assess the applicability of a simple mathematical formula for prediction of individual child linear growth. The formula describes a square root dependence of height on age with only two constants, k and C.Retrospective serial height measurements of 137 healthy children (61 female), who attended clinic in the Pediatrics Department at the University of California, San Francisco were used. For each child, two of the initial measurements and their corresponding measurement times were used to determine the values of k and C. By substituting the determined values of k and C into the formula, the formula was then used to predict the trajectory of the child's growth.The 137 children were comprised of 20% Hispanic, 23% African-American, 27% Caucasian and 30% Asian. The formula predicted growth trajectories of 136 out of the 137 children with minimal discrepancies between the measured data and the corresponding predicted data. The mean of the discrepancies was 0.8 cm.Our proposed formula is very easy to use and predicts individual child growth with high precision irrespective of gender or ethnicity. The formula will be a valuable tool for studying human growth and possibly growths of other animals.

    View details for DOI 10.1002/ajhb.22428

    View details for Web of Science ID 000323479700013

    View details for PubMedID 23934960

  • Understanding How Latino Parents Choose Beverages to Serve to Infants and Toddlers. Maternal and child health journal Beck, A. L., Takayama, J. I., Halpern-Felsher, B., Badiner, N., C Barker, J. 2013


    To determine Latino parents' beliefs on the health effects of beverages on infants and toddlers, their sources of information on beverages and perceived barriers to following guidelines for healthy beverage consumption by children. We conducted 29 interviews with parents of Latino children ages 6-36 months. Parents were recruited in three community health centers in Northern California. The interviews were recorded, transcribed and analyzed using standard qualitative methods. The following dominant themes emerged. Parents believed that water and milk were healthy beverages for children and that sugar-sweetened beverages (SSBs) were unhealthy. Views on 100 % fruit juice were mixed. Parents distinguished between homemade beverages such as "agua fresca" which they considered healthy, despite containing added sugar, and beverages from stores which were viewed as unhealthy. Participants' main source of information on beverages was the federal nutrition program for Women, Infants, and Children (WIC). Parents were confused, however, as to why WIC provides juice yet counseled parents to avoid giving their children juice. Parents preferred to receive information on beverages from experts. Differing practices among family members regarding which beverages they provide to children was the most important barrier to following beverage guidelines. Our study suggests that Latino parents are receptive to counseling on beverages from expert sources. Such counseling should address both store-bought and homemade beverages. The WIC program is a key source of information on beverages for Latino parents; thus counseling offered by WIC should be evidence-based and avoid mixed messages.

    View details for DOI 10.1007/s10995-013-1364-0

    View details for PubMedID 24077961

  • HIV Testing Behaviors of a Cohort of HIV-Positive Racial/Ethnic Minority YMSM AIDS AND BEHAVIOR Phillips, G., Hightow-Weidman, L. B., Arya, M., Fields, S. D., Halpern-Felsher, B., Outlaw, A. Y., Wohl, A. R., Hidalgo, J. 2012; 16 (7): 1917-1925


    The HIV epidemic in the United States has disproportionately affected young racial/ethnic minority men who have sex with men (YMSM). However, HIV testing rates among young men of color remain low. Within this sample of racial/ethnic minority YMSM (n = 363), the first HIV test was a median of 2 years after men who have sex with men sexual debut. Individuals with less than 1 year between their first negative and first positive HIV test were significantly more likely to identify the reason for their first negative test as being sick (OR = 2.99; 95 % CI 1.23-7.27). This may suggest that these YMSM may have experienced symptoms of acute HIV infection. Of major concern is that many YMSM in our study tested positive for HIV on their first HIV test. Given recommendations for at least annual HIV testing, our findings reveal that medical providers YMSM need to know the importance of regular testing.

    View details for DOI 10.1007/s10461-012-0193-2

    View details for Web of Science ID 000309223000024

    View details for PubMedID 22555382

  • Age of MSM Sexual Debut and Risk Factors: Results from a Multisite Study of Racial/Ethnic Minority YMSM Living with HIV AIDS PATIENT CARE AND STDS Outlaw, A. Y., Phillips, G., Hightow-Weidman, L. B., Fields, S. D., Hidalgo, J., Halpern-Felsher, B., Green-Jones, M. 2011; 25: S23-S29


    The average reported age of sexual debut for youth in the United States is 14.4 years, with approximately 7% reporting their sexual debut prior to age 13. While the research literature on sexual debut for youth addresses gender and ethnic differences (with males and African-American youth experiencing earlier sexual debut), there is limited data regarding factors associated with sexual debut for young men who have sex with men (YMSM). Early sexual debut poses potential health risks, such as contracting HIV with an increased risk of unprotected intercourse. Given current high HIV infection rates for racial/ethnic minority YMSM, learning more about their sexual debuts and associated risk factors of this population is of great importance. This study investigated risk behaviors and emotional distress, and their association with MSM sexual debut for a multisite cohort of racial/ethnic minority YMSM living with HIV. We hypothesized that a MSM sexual debut younger than age 16 would be associated with engagement in more high-risk sexual behaviors (unprotected sex and exchange sex), substance use, and emotional distress than a MSM sexual debut at age 16 or older. Results indicated that participants having a MSM sexual debut before the age of 16 reported more exchange sex; drug use (specifically marijuana); emotional/psychological problems related to substance use; and a history of suicide attempts, compared to participants with later MSM sexual debuts. Comprehensive interventions that are racially/ethnically sensitive, inquire about initial sexual experiences, and focus on sexual health and healthy relationships are needed to improve health outcomes for this population.

    View details for DOI 10.1089/apc.2011.9879

    View details for Web of Science ID 000293886700005

    View details for PubMedID 21711140

  • Relationships and betrayal among young women: theoretical perspectives on adolescent dating abuse JOURNAL OF ADVANCED NURSING Burton, C. W., Halpern-Felsher, B., Rankin, S. H., Rehm, R. S., Humphreys, J. C. 2011; 67 (6): 1393-1405


    Adolescent dating abuse is not specifically described by any current nursing theory, and this article presents discussion of some existing theories that could inform a nursing theory of adolescent dating abuse. To account for the effects of gender, this discussion is limited to young women.Adolescent dating abuse is an important and understudied international issue for nursing. Theoretical frameworks can support development of nursing scholarship for such issues. No single theory yet exists in nursing to explain the experiences and health ramifications of dating abuse among young women.A summary table of theories is provided. Literature was gathered via database search and bibliographic snowballing from reference lists of relevant articles. Included literature dates from 1982 through 2010.Theories of relationship formation and function are discussed, including attachment, investment, feminist and gender role conflict theories. Betrayal trauma theory is considered as a mechanism of injury following an abusive dating experience.Gender, relationship and adolescence combine in a complex developmental moment for young women. To improve nursing care for those at risk for or in the throes of abusive relationships, it is critical to develop specific nursing approaches to understanding these relationships.Existing theories related to relationship and traumatic experiences can be combined in the development of a nursing theory of adolescent dating abuse among young women.

    View details for DOI 10.1111/j.1365-2648.2010.05565.x

    View details for Web of Science ID 000290398300022

    View details for PubMedID 21261691

  • Transmitted HIV-1 Drug Resistance Among Young Men of Color Who Have Sex With Men: A Multicenter Cohort Analysis JOURNAL OF ADOLESCENT HEALTH Hightow-Weidman, L. B., Hurt, C. B., Phillips, G., Jones, K., Magnus, M., Giordano, T. P., Outlaw, A., Ramos, D., Enriquez-Bruce, E., Cobbs, W., Wohl, A., Tinsle, M. 2011; 48 (1): 94-99


    Given the elevated potential for primary or transmitted drug resistance (TDR) among newly HIV-infected individuals, there is a need for a deeper understanding of the baseline resistance patterns present in young men of color who have sex with men.Genotypic data were collected for participants aged 13-24 who were enrolled from seven sites. Univariate and bivariate methods were used to describe the prevalence of TDR and characteristics associated with TDR.Of the 296 individuals participating in the substudy, 145 (49%) had baseline genotypes. The majority of the individuals were African American (65%) and gay-identified (70%). There was significant variation in genotype availability by site (p < .001). Major surveillance drug resistance mutations were present in 28 subjects (19.3%); the majority were non-nucleoside reverse transcriptase inhibitor mutations (12.4%). Subjects with TDR were less likely to have used alcohol on 1 or more days in the prior 2 weeks. Location was not associated with acquisition of TDR.There was a high rate of TDR in a geographically and racially diverse sample of HIV-infected young men of color who have sex with men. This represents a serious public health concern given the young age of this sample and the potential need for long-term antiretroviral therapy. These findings underscore the critical roles of both early case identification and secondary prevention.

    View details for DOI 10.1016/j.jadohealth.2010.05.011

    View details for Web of Science ID 000285629200016

    View details for PubMedID 21185530

  • Unpredicted Trajectories: The Relationship Between Race/Ethnicity, Pregnancy During Adolescence, and Young Women's Outcomes JOURNAL OF ADOLESCENT HEALTH Casares, W. N., Lahiff, M., Eskenazi, B., Halpern-Felsher, B. L. 2010; 47 (2): 143-150


    Adolescents who become pregnant in the United States are at higher risk for a myriad of health concerns. One would predict even more adverse health outcomes among pregnant adolescents who are from disadvantaged racial/ethnic groups; however, previous studies indirectly suggest the opposite. This study examines whether adolescents from racial/ethnic minority groups are less affected by adolescent pregnancy compared to white adolescents.We used data from 1,867 adolescents participating in the National Longitudinal Study of Adolescent Health (1995-2001). Our predictor variable was self-reported race/ethnicity. Self-perception of health, educational attainment, and public assistance use in young adulthood were outcome measures. We conducted weighted multivariate logistic regressions and analyzed how adolescent pregnancy modified the relationship between our predictor and outcome variables.Black and American Indian young women had significantly higher odds than white young women of receiving public assistance (OR, 2.6 and 2.7, respectively; p <.01) and even higher odds if ever pregnant in adolescence (OR, 4.2 and 19.0, respectively; p = .03). White young women had significantly lower odds of high educational attainment if they had a live birth in adolescence as compared to those who had not (OR, 0.1; CI = 0.1-0.4).These findings support studies that found adolescent pregnancy increases the risk of public assistance use and low educational attainment. The study shows that, for educational attainment, black young women who become pregnant may not be as disadvantaged as their peers, whereas white young women who become pregnant are more disadvantaged.

    View details for DOI 10.1016/j.jadohealth.2010.01.013

    View details for Web of Science ID 000280063400005

    View details for PubMedID 20638006

  • Adolescents and Driving: A Position Paper of the Society for Adolescent Health and Medicine JOURNAL OF ADOLESCENT HEALTH D'Angelo, L. J., Halpern-Felsher, B. L., Abraham, A. 2010; 47 (2): 212-214


    Motor vehicle crashes continue to be the leading cause of mortality and severe morbidity among adolescents and young adults. All states have changed their drivers' licensure laws to make the process of obtaining a license more protracted and focused on the development of safe driving skills. Health care providers who counsel children and adolescents should actively address safe driving with them, and also involve their parents in this discussion. Additionally, they should also advocate for strict and uniform graduated licensure laws.

    View details for DOI 10.1016/j.jadohealth.2010.05.016

    View details for Web of Science ID 000280063400016

    View details for PubMedID 20638018

  • Is adolescence-onset antisocial behavior developmentally normative? DEVELOPMENT AND PSYCHOPATHOLOGY Roisman, G. I., Monahan, K. C., Campbell, S. B., Steinberg, L., Cauffman, E. 2010; 22 (2): 295-311


    Largely because of the influence of Moffitt's useful distinction between adolescence-limited and life-course persistent antisocial behavior, it has become increasingly common to view problem behavior that makes its first appearance in adolescence as developmentally normative. This study prospectively examined the lives of individuals in the NICHD Study of Early Child Care and Youth Development whose patterns of antisocial behavior varied with respect to age of onset and stability from kindergarten through age 15. Consistent with past research, early-onset, persistently deviant youth experienced more contextual adversity and evinced higher levels of intraindividual disadvantages than their peers from infancy through midadolescence. However, relative to youth who never showed significantly elevated antisocial behavior through age 15, children who showed antisocial behavior primarily in adolescence also were more disadvantaged from infancy forward, as were youth who only demonstrated significant externalizing problems in childhood. Findings generally replicated across sex and did not vary as a function of whether antisocial behavior groups were defined using T-scores normed within sex or identified using an empirically driven grouping method applied to raw data.

    View details for DOI 10.1017/S0954579410000076

    View details for Web of Science ID 000277598000007

    View details for PubMedID 20423543

  • Adolescents' Perceived Risk of Dying JOURNAL OF ADOLESCENT HEALTH Fischhoff, B., de Bruin, W. B., Parker, A. M., Millstein, S. G., Halpern-Felsher, B. L. 2010; 46 (3): 265-269


    Although adolescents' expectations are accurate or moderately optimistic for many significant life events, they greatly overestimate their chances of dying soon. We examine here whether adolescents' mortality judgments are correlated with their perceptions of direct threats to their survival. Such sensitivity would indicate the importance of ensuring that adolescents have accurate information about those threats, as well as the psychological support needed to deal with them.Data from two separate studies were used: a national sample of 3,436 14-18-year-old adolescents and a regional sample of 124 seventh graders and 132 ninth graders, 12-16 years old. Participants were asked about their chance of dying in the next year and before age 20, and about the extent of various threats to their physical well-being.Adolescents in both samples greatly overestimated their chance of dying. Those mortality estimates were higher for adolescents who reported direct threats (e.g., an unsafe neighborhood). Thus, adolescents were sensitive to the relative size of threats to their survival, but not to the implications for absolute risk levels.Contrary to the folk wisdom that adolescents have a unique sense of invulnerability, the individuals studied here reported an exaggerated sense of mortality, which was highest among those reporting greater threats in their lives. Such fears could affect adolescents' short-term well-being and future planning.

    View details for DOI 10.1016/j.jadohealth.2009.06.026

    View details for Web of Science ID 000274572400011

  • Predictors and sequelae of trajectories of physical aggression in school-age boys and girls DEVELOPMENT AND PSYCHOPATHOLOGY Campbell, S. B., Spieker, S., Vandergrift, N., Belsky, J., Burchinal, M. 2010; 22 (1): 133-150


    Teacher-rated trajectories of physical aggression in boys and girls from first through sixth grade were examined using data from the NICHD Study of Early Child Care and Youth Development. In separate analyses, four trajectories were identified in boys and three in girls. Higher levels of aggression in both boys and girls were related to greater sociodemographic risk and higher maternal harshness in the preschool years; lower levels of observed maternal sensitivity during early childhood also predicted higher trajectories of aggression among girls. Trajectory groups also differed on a range of social and academic adjustment outcomes in sixth grade, with the most aggressive children and even moderately aggressive children evidencing some difficulties in adjustment. Patterns and levels of aggression in boys and girls are discussed as are their predictors and consequences.

    View details for DOI 10.1017/S0954579409990319

    View details for Web of Science ID 000274470800010

    View details for PubMedID 20102652

  • Longitudinal Development of Secondary Sexual Characteristics in Girls and Boys Between Ages 9 1/2 and 15 1/2 Years ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Susman, E. J., Houts, R. M., Steinberg, L., Belsky, J., Cauffman, E., DeHart, G., Friedman, S. L., Roisman, G. I., Halpern-Felsher, B. L. 2010; 164 (2): 166-173


    To identify ages when adolescents were in sexual maturity stages 2 through 5; to explain the relations between breast (girls), genital (boys), and pubic hair (girls and boys) development between ages 9(1/2) and 15(1/2) years; and to evaluate synchrony of pubertal development across characteristics.Annual pubertal assessments.Ten locations in the United States.A total of 859 adolescents (427 boys [49.7%] and 432 girls [50.3%]; 737 white [85.8%] and 122 black [14.2%]).Changes in the 5 stages of breast, genital, and pubic hair development.Girls were in breast maturity stages 2 and 3 earlier than comparable pubic hair stages. Although breast development in girls started earlier than pubic hair development, girls completed breast and pubic hair development at approximately the same age. Black girls were in all stages of breast and pubic hair development earlier than white girls. Boys were in stages 2, 3, 4, and 5 of genital development before the comparable pubic hair stage. In boys, genital development started earlier than pubic hair development, but pubic hair development was completed in less time. Black boys were in genital and pubic hair development about 7 months earlier than white boys. Black and white boys completed genital development in approximately 4(1/2) years, but black boys took approximately 6 months longer than white boys to complete pubic hair development. At stage 2, for 66.2% of girls, breast development preceded their pubic hair development; for 91.1% of boys, genital development preceded their pubic hair development.The results of this study are useful in understanding normative variation in the timing and change in the development of secondary sexual characteristics at puberty. They will help identify adolescents with atypical changes in sexual maturation and unusual progression of sexual maturation and growth disorders.

    View details for Web of Science ID 000274139500008

    View details for PubMedID 20124146

  • The Development of Reproductive Strategy in Females: Early Maternal Harshness -> Earlier Menarche -> Increased Sexual Risk Taking DEVELOPMENTAL PSYCHOLOGY Belsky, J., Steinberg, L., Houts, R. M., Halpern-Felsher, B. L. 2010; 46 (1): 120-128


    To test a proposition central to J. Belsky, L. Steinberg, and P. Draper's (1991) evolutionary theory of socialization-that pubertal maturation plays a role in linking early rearing experience with adolescent sexual risk taking (i.e., frequency of sexual behavior) and, perhaps, other risk taking (e.g., alcohol, drugs, delinquency)-the authors subjected longitudinal data on 433 White, 62 Black, and 31 Hispanic females to path analysis. Results showed (a) that greater maternal harshness at 54 months predicted earlier age of menarche; (b) that earlier age of menarche predicted greater sexual (but not other) risk taking; and (c) that maternal harshness exerted a significant indirect effect, via earlier menarche, on sexual risk taking (i.e., greater harshness --> earlier menarche --> greater sexual risk taking) but only a direct effect on other risk taking. Results are discussed in terms of evolutionary perspectives on human development and reproductive strategy, and future directions for research are outlined.

    View details for DOI 10.1037/a0015549

    View details for Web of Science ID 000273503400010

    View details for PubMedID 20053011

  • The Developmental Significance of Adolescent Romantic Relationships: Parent and Peer Predictors of Engagement and Quality at Age 15 JOURNAL OF YOUTH AND ADOLESCENCE Roisman, G. I., Booth-LaForce, C., Cauffman, E., Spieker, S. 2009; 38 (10): 1294-1303


    From a longitudinal sample (n = 957; 49.9% male; 77.3% White/non-Hispanic) of participants studied from infancy through age 15, adolescents' depth of engagement in, and quality of romantic relationships were predicted from early and contemporaneous parent-child interactive quality and peer social competence. High quality maternal parenting and peer experiences prior to and during adolescence tended to be negatively associated with the depth of engagement in this domain for the full sample, yet positively associated with the quality of adolescents' romantic relationships for the sub-set of individuals currently dating at age 15. Results reconcile contrasting views of the origins of romantic relationship engagement and quality and the positive versus negative developmental salience of romantic relationships in adolescence.

    View details for DOI 10.1007/s10964-008-9378-4

    View details for Web of Science ID 000270180200003

    View details for PubMedID 19779806

  • Early Family and Child-Care Antecedents of Awakening Cortisol Levels in Adolescence CHILD DEVELOPMENT Roisman, G. I., Susman, E., Barnett-Walker, K., Booth-LaForce, C., Owen, M. T., Belsky, J., Bradley, R. H., Houts, R., Steinberg, L. 2009; 80 (3): 907-920


    This study examined early observed parenting and child-care experiences in relation to functioning of the hypothalamic-pituitary-adrenocortical axis over the long term. Consistent with the attenuation hypothesis, individuals (n = 863) who experienced: (a) higher levels of maternal insensitivity and (b) more time in child-care centers in the first 3 years of life had lower awakening cortisol levels at age 15. Associations were small in magnitude. Nonetheless, results were (a) additive in that both higher levels of maternal insensitivity and more experience with center-based care uniquely (but not interactively) predicted lower awakening cortisol, (b) not accounted for by later caregiving experiences measured concurrently with awakening cortisol at age 15 or by early demographic variables, and (c) not moderated by sex or by difficult temperament.

    View details for DOI 10.1111/j.1467-8624.2009.01305.x

    View details for Web of Science ID 000266110400020

    View details for PubMedID 19489911

  • Adolescent drivers - A developmental perspective on risk, proficiency, and safety AMERICAN JOURNAL OF PREVENTIVE MEDICINE Keating, D. P., Halpern-Felsher, B. L. 2008; 35 (3): S272-S277


    Despite considerable improvement in the rates of crashes, injuries, and fatalities among adolescent drivers, attributable in part to effective interventions such as graduated driver licensing, these rates and their associated health risks remain unacceptably high. To understand the sources of risky driving among teens, as well as to identify potential avenues for further advances in prevention, this article presents a review of the relevant features of contemporary research on adolescent development. Current research offers significant advances in the understanding of the sources of safe driving, proficient driving, and risky driving among adolescents. This multifaceted perspective--as opposed to simple categorization of good versus bad driving--provides new opportunities for using insights on adolescent development to enhance prevention. Drawing on recent work on adolescent physical, neural, and cognitive development, we argue for approaches to prevention that recognize both the strengths and the limitations of adolescent drivers, with particular attention to the acquisition of expertise, regulatory competence, and self-regulation in the context of perceived risk. This understanding of adolescent development spotlights the provision of appropriate and effective scaffolding, utilizing the contexts of importance to adolescents--parents, peers, and the broader culture of driving--to support safe driving and to manage the inherent risks in learning to do so.

    View details for DOI 10.1016/j.amepre.2008.06.026

    View details for Web of Science ID 000258740000004

    View details for PubMedID 18702981

  • From the exam room to behind the wheel - Can healthcare providers affect automobile morbidity and mortality in teens? AMERICAN JOURNAL OF PREVENTIVE MEDICINE D'Angelo, L. J., Halpern-Felsher, B. L. 2008; 35 (3): S304-S309


    Despite clear evidence that motor-vehicle crashes are the leading cause of mortality and severe morbidity among adolescents and young adults, healthcare providers have not been fully engaged in efforts to reduce these rates. A new national awareness and effort to reduce motor-vehicle crashes provides an opportunity to engage healthcare providers and encourage them to play an active role in curbing crash rates. Indeed, research supports the notion that, when provided with adequate knowledge, training, and charting tools or electronic prompts, healthcare providers can increase their rates of screening, educating, and counseling youth and their parents about safe driving and that these efforts can be effective at increasing safety and reducing risk. Healthcare providers' efforts to advocate for safer driving laws and regulations are also important efforts in reducing youth driving risk.

    View details for DOI 10.1016/j.amepre.2008.06.014

    View details for Web of Science ID 000258740000009

    View details for PubMedID 18702986

  • Adolescents' beliefs about preferred resources for help vary depending on the health issue JOURNAL OF ADOLESCENT HEALTH Marcell, A. V., Halpern-Felsher, B. L. 2007; 41 (1): 61-68


    Adolescents' health care use is less than ideal, especially for more sensitive services. We know little about adolescents' preferred resources for help for health-related issues, and whether these resources vary by problem type. This study examined whether adolescents' preferred resources for help differed depending on the health issue studied.Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the importance of getting help in general, how important it was to get help from specific resources (friends/siblings; significant adults; health care professionals; and mental health professionals), and highest rankings of specific resources.Most adolescents believed it somewhat or very important to get help in general for all scenarios (94% pneumonia; 81% cigarette; 88% depression) except the sex scenario (27%). Repeated measures analysis of variance revealed significant differences in participants' beliefs in the importance of getting help from each specific resource across the four scenarios (all p < .001). Participants' top ranked resources included a doctor (55%) and parents (40%) for the pneumonia scenario; a friend (31%), parents (20%), and doctor (20%) for the cigarette scenario; a partner (38%) and friend (35%) for the sex scenario; and a partner (33%), psychologist (23%), and friend (20%) for the depression scenario. Beliefs in the importance of getting help from specific resources also varied by age, gender, and beliefs in importance of getting help in general.Adolescents' preferred resources for help differ depending on the health issue in question, with adolescents preferring informal resources (friends and partners) and significant adults (parents) to go to for help for nonphysical health-related issues and physicians for physical health-related issues. Future preventive service efforts and research should also consider the importance of age and gender when examining adolescents' preferred resources for help.

    View details for DOI 10.1016/j.jadohealth.2007.02.006

    View details for Web of Science ID 000247616200009

    View details for PubMedID 17577535

  • Family rearing antecedents of pubertal timing CHILD DEVELOPMENT Belsky, J., Steinberg, L. D., Houts, R. M., Friedman, S. L., DeHart, G., Cauffman, E., Roisman, G. I., Halpern-Felsher, B. L., Susman, E. 2007; 78 (4): 1302-1321


    Two general evolutionary hypotheses were tested on 756 White children (397 girls) studied longitudinally: (1) rearing experiences would predict pubertal timing; and (2) children would prove differentially susceptible to rearing. Analysis of pubertal measurements, including some based on repeated physical assessments, showed that mothering and fathering, earlier and later in childhood, predicted pubertal development, but only for girls, with negative parenting appearing most influential; maternal harsh control predicted earlier menarche. Rearing effects varied by infant negative emotionality, proving stronger (and opposite) for girls who in infancy were lower rather than higher in negativity. Maternal menarche, controlled in all analyses, was a stronger predictor than rearing. Findings are discussed in terms of theory development, genetic and nutritional influences, and sample restrictions.

    View details for Web of Science ID 000248524600017

    View details for PubMedID 17650140

  • Clinician practices for the management of amenorrhea in the adolescent and young adult athlete JOURNAL OF ADOLESCENT HEALTH Carlson, J. L., Curtis, M., Halpern-Felsher, B. 2007; 40 (4): 362-365


    This study sought to describe clinician practices for the management of amenorrhea in the adolescent and young adult athlete. Clinicians adhered to certain guidelines but did not have a uniform "standard of care" for amenorrheic athletes. Almost 80% of clinicians reported insufficient guidelines for the management of this population.

    View details for DOI 10.1016/j.jadohealth.2006.10.017

    View details for Web of Science ID 000245567900011

    View details for PubMedID 17367734

  • Having sex and condom use: Potential risks and benefits reported by young, sexually inexperienced adolescents JOURNAL OF ADOLESCENT HEALTH Widdice, L. E., Cornell, J. L., Liang, W., Halpern-Felsher, B. L. 2006; 39 (4): 588-595


    This study determines what young adolescents themselves identify as the potential positive and negative outcomes of having sex, using a condom and not using a condom.Using written surveys, 418 ethnically diverse ninth graders, 86% of whom had never had sex, responded to a scenario describing two adolescents who had sex. One randomly selected group read a scenario in which a condom was used; the other group read a scenario in which no condom was used. All participants were asked to list the risks and benefits of having sex. Depending on the scenario read, participants were asked to list the risks and benefits of either using or not using a condom. Responses were coded thematically. Percentages of responses were compared with chi-square analysis in total and by gender.Participants spontaneously identified a broad range of health and psychosocial risks and benefits of having sex, using a condom and not using a condom. A strong aversion to pregnancy was evident, and the risks of sexually transmitted disease/human immunodeficiency virus (STD/HIV) and condom malfunction were commonly mentioned. Benefits of using a condom included pregnancy and STD prevention. Benefits of both having sex and of not using a condom included improving the relationship, fun, and pleasure. Gender differences emerged across questions.Communication with adolescents regarding safe sexual activity could benefit from widening the communication from a focus on health risks to include discussion of the psychosocial risks and benefits that adolescents themselves think about with respect to sex and condom use.

    View details for DOI 10.1016/j.jadohealth.2006.03.016

    View details for Web of Science ID 000240966400019

    View details for PubMedID 16982395

  • Greater expectations: Adolescents' positive motivations for sex PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH Ott, M. A., Millstein, S. G., Ofner, S., Halpern-Felsher, B. L. 2006; 38 (2): 84-89


    Effective STD and pregnancy prevention efforts should benefit from knowledge of what motivates adolescents to have sex. Positive motivations, and how they differ by gender and sexual experience, are poorly understood.A sample of 637 ninth graders were asked about their relationship goals, expectations of the degree to which sex would satisfy these goals and sexual experience. Three scales measured adolescents' goals for intimacy, sexual pleasure and social status within a romantic relationship. Another three scales measured expectations that sex would lead to these goals. Data were examined in analyses of variance and mixed models.Participants valued intimacy the most, then social status and, finally, sexual pleasure. These relationship goals differed significantly by gender and sexual experience. Females valued intimacy significantly more and sexual pleasure less than males. Sexually experienced adolescents valued both intimacy and pleasure more than sexually inexperienced adolescents. Among females, but not males, sexually experienced adolescents valued the goal of social status less than those with no sexual experience did. Adolescents expected that sex would most likely lead to sexual pleasure, then intimacy and, finally, social status. Females and sexually inexperienced adolescents reported lower expectations that sex would meet goals than did males and sexually experienced participants.Adolescents view intimacy, sexual pleasure and social status as important goals in a relationship. Many have strong positive expectations that sex would satisfy these goals. Prevention programs and providers should address the risks of sex in the context of expected benefits.

    View details for Web of Science ID 000238005900004

    View details for PubMedID 16772189

  • Preventing underage alcohol use: Where do we go from here? JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B. L., Cornell, J. L. 2005; 37 (1): 1-3
  • Clear the air: adolescents' perceptions of the risks associated with secondhand smoke PREVENTIVE MEDICINE Halpern-Felsher, B. L., Rubinstein, M. L. 2005; 41 (1): 16-22


    Despite numerous studies on adolescents' recognition of the medical risks of primary smoke, there have been surprisingly few investigations of how adolescents perceive the risks associated with exposure to secondhand smoke. This study examined whether adolescents' risk estimates when exposed to secondhand smoke differed by: (1) actual smoking experience and (2) adolescents' intentions to smoke in the near future. We also explored whether adolescents perceive different risk depending on who is producing the secondhand smoke.Three hundred and ninety-five 9th graders (mean age = 14.0) completed a survey concerning their perceptions of secondhand smoke, smoking experiences, and intentions.On average, adolescents were aware of the serious risks posed by exposure to secondhand smoke. However, adolescents who smoke or intend to smoke were more likely to perceive the risks from exposure to secondhand smoke as lower than did adolescents who had never smoked or had no intentions to smoke.The findings from this study suggest that education regarding the risks of secondhand smoke might serve as an additional deterrent against smoking and smoking intentions. Further study using longitudinal data is still needed to fully understand the relationship between such perceptions and smoking behavior.

    View details for DOI 10.1016/j.ypmed.2004.11.002

    View details for Web of Science ID 000229651800003

    View details for PubMedID 15916988

  • Adolescents' health beliefs are critical in their intentions to seek physician care PREVENTIVE MEDICINE Marcell, A. V., Halpern-Felsher, B. L. 2005; 41 (1): 118-125


    The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems.Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care.Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001).Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.

    View details for DOI 10.1016/j.ypmed.2004.10.016

    View details for Web of Science ID 000229651800017

    View details for PubMedID 15917002

  • Initiating sexual experiences: How do young adolescents make decisions regarding early sexual activity? JOURNAL OF RESEARCH ON ADOLESCENCE Michels, T. M., Kropp, R. Y., Eyre, S. L., Halpern-Felsher, B. L. 2005; 15 (4): 583-607
  • Adolescents' self-efficacy to communicate about sex: Its role in condom attitudes, commitment, and use ADOLESCENCE Halpern-Felsher, B. L., Kropp, R. Y., Boyer, C. B., Tschann, J. M., Ellen, J. M. 2004; 39 (155): 443-456


    This study examined whether and how self-efficacy to communicate with parents and peers about sex relate to sexually experienced adolescent males' and females' (N= 144, 112) condom attitudes, intentions, and use. Results showed that males who reported greater self-efficacy to communicate with parents used condoms more frequently; and both males and females who can communicate with peers used condoms more frequently. Self-efficacy to communicate with peers was related to more positive condom attitudes, which in turn were associated with greater condom commitment and use. Greater ability to communicate with parents was also related to greater condom commitment and use among males. These results suggest the importance of designing interventions that give adolescents the skills they need to feel efficacious in their ability to communicate about sex and contraception.

    View details for Web of Science ID 000225951000003

    View details for PubMedID 15673222

  • An evaluation of the use of the transdermal contraceptive patch in adolescents JOURNAL OF ADOLESCENT HEALTH Rubinstein, M. L., Halpern-Felsher, B. L., IRWIN, C. E. 2004; 34 (5): 395-401


    To evaluate the acceptability and feasibility of using the new transdermal contraceptive patch in adolescents.A 3-month longitudinal trial using the Ortho Evra transdermal contraceptive patch in 50 adolescent girls. All healthy girls aged 15-18 years were invited to participate from two San Francisco Bay Area teen clinics. Participants were followed after 1 month and 3 months of treatment. Data were collected on patch detachments, perceived advantages and disadvantages, side effects, and compliance. Data were analyzed using Student's t-test (SPSS).Forty participants (80%) completed 1 month of treatment and 31 (62%) completed all 3 months of the study. There were no pregnancies during treatment. At the 3-month follow-up, 87.1% of participants reported perfect compliance. Ease of use, the fact that it does not require daily attention, and the ease of concealment were among the main reported advantages. Roughly 77% of participants who completed the study were planning to continue using the patch. The 35.5% rate of complete or partial detachment of at least one patch was considerably higher than reported in previous studies of adults. As in adults, the most commonly reported complaints were application site reactions and breast discomfort.This evaluation found an overall positive impression of the new transdermal contraceptive patch, with good rates of short-term compliance and few side effects among adolescents. However, the high degree of detachment unique to this sample of adolescents is concerning and requires further evaluation.

    View details for DOI 10.1016/j.jadohealth.2003.08.017

    View details for Web of Science ID 000227099100007

    View details for PubMedID 15093794

  • Adolescents discriminate between types of smokers and related risks: Evidence from nonsmokers JOURNAL OF ADOLESCENT RESEARCH Rubinstein, M. L., Halpern-Felsher, B. L., Thompson, P. J., MILLSTEIN, S. G. 2003; 18 (6): 651-663
  • Differences in altruistic roles and HIV risk perception among staff, peer educators, and students in an adolescent peer education program AIDS EDUCATION AND PREVENTION Ott, M. A., Evans, N. L., Halpern-Felsher, B. L., Eyre, S. L. 2003; 15 (2): 159-171


    This qualitative study examines how adolescent peer educators understand and communicate HIV prevention messages. Semistructured ethnographic interviews were conducted with 21 program participants, including staff, peer educators, and students. Interviews were transcribed and analyzed using concept analysis, a method for identifying shared concepts among interview subjects. We found (a) similar beliefs about HIV transmission and risk reduction across groups; (b) different, but strong, altruistic roles among staff and peer educators; and (c) differences in HIV risk perception across the three groups. Altruistic roles took two forms. Staff acted as life skills mentors, whereas peer educators acted as HIV educators. Students were more passive, receiving counseling but not passing it on to others. Staff contextualized HIV risk, whereas peer educators and students emphasized risk. Although similar HIV knowledge across groups suggests program efficacy, stronger altruistic roles or contextualization of HIV risk may affect how prevention messages are delivered.

    View details for Web of Science ID 000182524000005

    View details for PubMedID 12739792

  • Work group II: Healthy adolescent psychosocial development JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B. L., MILLSTEIN, S. G., IRWIN, C. E. 2002; 31 (6): 201-207

    View details for Web of Science ID 000179724900010

    View details for PubMedID 12470916

  • Beyond invulnerability: The importance of benefits in adolescents' decision to drink alcohol HEALTH PSYCHOLOGY Goldberg, J. H., Halpern-Felsher, B. L., MILLSTEIN, S. G. 2002; 21 (5): 477-484


    Some investigators propose that adolescents engage in risky behaviors mainly because they perceive themselves to be invulnerable to risk. However, studies have typically not included perceived benefits. In the current study, 5th, 7th, and 9th graders were surveyed about their perceptions of and experience with alcohol and tobacco. Results indicated that perceptions of the benefits were significantly related to drinking and smoking 6 months later, over and above perceptions of the risks, age of the respondent, and experience level. Further, the importance of benefits was replicated across 3 separate analyses. Experience with alcohol alone, especially positive experience, was also related to perception and behavior. These findings are discussed in terms of how to improve messages and influence adolescents' decisions regarding risk-taking behaviors.

    View details for DOI 10.1037//0278-6133.21.5.477

    View details for Web of Science ID 000177618900009

    View details for PubMedID 12211515

  • Perceptions of risk and vulnerability JOURNAL OF ADOLESCENT HEALTH MILLSTEIN, S. G., Halpern-Felsher, B. L. 2002; 31 (1): 10-27

    View details for Web of Science ID 000176699500003

    View details for PubMedID 12093608

  • The effects of terrorism on teens' perceptions of dying: The new world is riskier than ever JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B. L., MILLSTEIN, S. G. 2002; 30 (5): 308-311


    Adolescents assessed after the September 11, 2001 terrorist attacks perceived the risk of dying from general causes, a tornado, and an earthquake as dramatically higher than did adolescents assessed years before the attacks. Adolescents' heightened perceptions of vulnerability to death extended beyond the terrorist acts, and generalized to unrelated risks.

    View details for Web of Science ID 000175406700004

    View details for PubMedID 11996779

  • Physicians' attitudes and beliefs concerning alcohol abuse prevention in adolescents AMERICAN JOURNAL OF PREVENTIVE MEDICINE Marcell, A. V., Halpern-Felsher, B., Coriell, M., MILLSTEIN, S. G. 2002; 22 (1): 49-55


    Primary alcohol abuse-prevention services delivered to adolescents are inadequate, despite the fact that alcohol abuse is a major health problem. Physicians' attitudes and beliefs regarding primary prevention of adolescent alcohol abuse and appropriate onset ages of alcohol use may be useful in understanding why delivery of prevention services is inadequate, but as yet has not been investigated.To examine (1) physicians' attitudes and beliefs regarding alcohol abuse prevention and practice, and (2) correlates of these attitudes and beliefs, including the delivery of primary alcohol abuse-prevention services to adolescents.A national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Association's Masterfile Registry. Inclusion criteria included active medical practice and seeing at least one adolescent per week. The response rate was 63%, resulting in a final sample of 1842 physicians. Participants were queried about their practice, alcohol use, attitudes and beliefs, and delivery of alcohol-related screening and education to adolescents.On average, physicians reported providing alcohol-related screening to 40.3% (standard error [SE]=0.6) and education to 52.0% (SE=0.8) of their adolescent patients. Participants had positive attitudes toward adolescents, believed that prevention was important, and approved of alcohol screening early in adolescence, but did not feel very comfortable about their adolescent alcohol-management skills. Except for ceremonial use, most physicians did not believe in underage drinking. Attitudes and beliefs were significantly related to the delivery of alcohol screening (R(2)=0.34, p < 0.001) and education (R(2)=0.18, p < 0.001). Participants who delivered more screening and education had more positive beliefs in the importance of prevention (beta=0.14 and beta=0.13, respectively; p < 0.001); approved of early alcohol screening (beta=0.29 and beta=0.09, respectively; p < 0.001); and were more comfortable with their alcohol management skills (beta=0.31 and beta=0.28, respectively; p < 0.001). A profile of physicians with positive attitudes and beliefs is presented.Physician attitudes and beliefs are associated with variations in alcohol screening and education services delivered to adolescents. A better understanding of physicians' attitudes and beliefs can be useful in providing physician education and training aimed at improving primary alcohol-abuse prevention.

    View details for Web of Science ID 000174222500008

    View details for PubMedID 11777679

  • Judgments about risk and perceived invulnerability in adolescents and young adults JOURNAL OF RESEARCH ON ADOLESCENCE Millstein, S. G., Halpern-Felsher, B. L. 2002; 12 (4): 399-422
  • Adolescents' and adults' understanding of probability expressions JOURNAL OF ADOLESCENT HEALTH Biehl, M., Halpern-Felsher, B. L. 2001; 28 (1): 30-35


    To examine whether there are differences between adolescents and adults in their interpretation of probability terms.Participants were 20 fifth graders, 54 seventh graders, 45 ninth graders, and 34 young adults (mean adult age = 26.24 years, standard deviation = 2.09) from the San Francisco Bay area. They completed a self-administered survey asking them to assign percentage estimates (0% to 100%) to 30 randomly ordered probability terms.Significant age differences in the mean percentage estimates for 8 of the 30 terms were shown. Moreover, we found large variation in the interpretation of most probability terms studied, with larger variation among the adolescents than adults. Finally, all age groups had some difficulty correctly differentiating between "possibly" and "probably".Owing to wide variation in the interpretation of probability terms, both within and across age groups, we suggest health practitioners use percentages rather than probability terms to convey risk to both adolescents and adults.

    View details for Web of Science ID 000166152200006

    View details for PubMedID 11137903

  • Verbal and numerical expressions of probability: "It's a fifty-fifty chance" ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES de Bruin, W. B., Fischhoff, B., MILLSTEIN, S. G., Halpern-Felsher, B. L. 2000; 81 (1): 115-131


    When estimating risks, people may use "50" as an expression of the verbal phrase "fifty-fifty chance," without intending the associated number of 50%. The result is an excess of 50s in the response distribution. The present study examined factors determining the magnitude of such a "50 blip," using a large sample of adolescents and adults. We found that phrasing probability questions in a distributional format (asking about risks as a percentage in a population) rather than in a singular format (asking about risks to an individual) reduced the use of "50." Less numerate respondents, children, and less educated adults were more likely to say "50." Finally, events that evoked feelings of less perceived control led to more 50s. The results are discussed in terms of what they reveal about how people express epistemic uncertainty. Copyright 2000 Academic Press.

    View details for Web of Science ID 000084791400006

  • Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care - A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Ford, C. A., MILLSTEIN, S. G., HALPERNFELSHER, B. L., IRWIN, C. E. 1997; 278 (12): 1029-1034


    Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians.To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care.Randomized controlled trial.Three suburban public high schools in California.The 562 participating adolescents represented 92% of students in mandatory classes.After random assignment to 1 of 3 groups, the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality, a physician who assured conditional confidentiality, or a physician who did not mention confidentiality.Adolescents' willingness to disclose general information, willingness to disclose information about sensitive topics, intended honesty, and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire.Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) (beta=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (beta=.17, P<.001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) (beta=.14, P=.001).Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality. Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future health care for routine and nonreportable sensitive health concerns.

    View details for Web of Science ID A1997XX01200040

    View details for PubMedID 9307357

  • Relationship of alcohol use and risky sexual behavior: A review and analysis of findings JOURNAL OF ADOLESCENT HEALTH HALPERNFELSHER, B. L., MILLSTEIN, S. G., Ellen, J. M. 1996; 19 (5): 331-336


    In this review article, three methodologic approaches that have been used to examine the association between adolescents' alcohol use and their involvement in risky sex are discussed: global correlation studies, situational covariation studies, and event analyses. The strengths and limitations of each of these research methods are discussed. An extensive review of the most rigorous studies, which used event analysis to examine the alcohol-risky sex link, reveals positive results for first-time sexual events but equivocal findings for other types of sexual relationships. It is argued that differences in the types of sexual relationships studied have been confounded, limiting our ability to evaluate the extent to which alcohol has a causal influence on adolescents' condom use. It is suggested that future investigations consider the nature of the sexual relationship, and go beyond studying the length or status of the relationship to explore how variation in relationship dimensions such as trust and intimacy affect adolescents' sexual behavior.

    View details for Web of Science ID A1996VU57800004

    View details for PubMedID 8934293



    This observational study examined the development and use of communication in a pair of deaf and hearing monozygotic twins from 13 months of age until 36 months of age. One twin contracted meningitis at 7 months, leaving her profoundly deaf but without other measurable sequelae. The other twin is normal in all respects. The prelingual twins were enrolled in a total communication preschool program where, with their parents, they participated in activities designed to enhance the language skills of deaf children. The twins were videotaped monthly, first at their preschool program and later at home. All forms of communication were recorded, including signs, vocalizations, and hand and body gestures. Additionally, eye gaze direction and body positions during communication were noted. Comparisons between the deaf and hearing twins showed that although both children were able to learn language and communicate successfully, the hearing twin preferred a vocal form of language, whereas the deaf twin used mostly sign language. Moreover, the hearing twin's communication was usually responsive, while the deaf twin's communication was comprised mostly of imitative signs and gestures. Methods of teaching a profoundly deaf child to communicate are discussed.

    View details for Web of Science ID A1995QV27800012

    View details for PubMedID 7778519