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Item Item 11. Changes in Adolescent and Young Adult (AYA) Relationship Status during COVID19: Data from a 30 Country Sexual and Reproductive Health Study(Elsevier, 2022) Hensel, Devon J.; Campbell, Linda; Erausquin, Jennifer T.; Mark, Kristin P.; I-SHARE Consortium; Pediatrics, School of MedicinePurpose: Important milestones - including romantic/sexual relationship development - were impacted by COVID19 mitigation measures. We examined self-reported change in relationship status before, during and after COVID among AYA who participated in a 30-country survey. Methods: Data were drawn from the International Sexual Health And REproductive Health Survey (I-SHARE-1), a multi-country, cross-sectional, online study conducted to assess the impact of the pandemic on adult sexual health across the globe. Participants were recruited through local, regional, and national networks (e.g. listservs of professional organizations and international health organizations, social media, etc.) of each country’s research team. We drew a subsample of AYA (N=7527 18-26 years; 32.3% of the total sample; 60.1% female, 86.1% cisgender, 77.1% heterosexual). We examined 5 categories of relationship status change: 1) unpartnered pre/post; 2) unpartnered pre, new partner post; 3) same partner pre/post; 4) partnered pre, broke up, unpartnered post; 5) partnered pre, broke up, new partner post. Random intercept mixed effects multinomial regression (gllamm; Stata 17.0; all p<.05) adjusted for country-level clustering was used to understand how demographic (age, gender identity, sexual identity, employment status during COVID, mental health, distancing or isolation during COVID) and country-level predictors (income group, Oxford Stringency Index [national response to COVID], Palma Ratio [country-income inequality) and Gender Inequality Index (country-gender inequality) were associated with relationship change. Results: 15% of AYA had no partner pre/post COVID, 5% were unpartnered pre-COVID with new partner post. 63.3% had the same partner pre/post, whereas 11.3% had a partner pre-COVID, but broke up and had no new partner post-COVID. Less than 5% had a new partner post-COVID after breaking up with their pre-COVID partner. Of those who broke up with their partner, the majority ended during (44.4%) or after (26.6%) COVID-lockdowns, and one-third thought social distancing precipitated the relationship’s end. Older (RRR=0.86-0.91), female (RRR=0.32-0.63) and transgender AYA (RRR=0.10-0.37) all had a lower risk, and sexual minority AYA had a higher risk (RRR=1.35-1.51), of being in all status categories compared to being in the same relationship before-and-after COVID. Higher mental health scores were linked to lower probability of being unpartnered pre/post as compared to being partnered pre/post (RRR=0.89-0.82). Social-distancing was associated with a lower risk for pre-COVID unpartnered individuals finding new post-COVID relationships (RRR=0.76) or of partnered individuals breaking up, while ever being in isolation was associated with higher risk of being unpartnered pre/post (RRR=1.20). Higher country income was associated with being unpartered pre-COVID (RRR=0.08-0.12) and higher risk of having a pre-COVID relationship break-up (RRR=1.32). Unpartnered individuals in countries with higher lockdown stringency had a greater probability of finding a new post-COVID relationship (RRR=1.13). Conclusions: COVID measures were associated with AYA relationships both initiating and ending. Strategies for relationship development/support should be included as part of preparation for future public health emergencies.Item 137. The Impact of Past Year Difficult Worries On Recency of Adolescent Mental Health Outcomes By Gender, Age, Sexual Orientation And Race/Ethnicity – Results From A Nationally Representative Probability Survey of U.S. Adolescents 14-17 Years(Elsevier, 2019-02-01) Hensel, Devon J.; Herbenick, Debby; Fu, Jane; Dodge, Brian; Beckmeyer, JonathonItem 148. Exploring the Impact of College Students' COVID-19- and Capitol Insurrection-Related Horizontal and Vertical Collectivism/Individualism on Emotional Reaction to Those Events(Elsevier, 2022) Sorge, Brandon H.; Fore, Grant; Williamson, Francesca; Angstmann, Julia; Hensel, Devon J.; Engineering Technology, School of Engineering and TechnologyPurpose: While many studies have explored individuals’ feelings related to recent national events, none have explored the relationship of individualism and collectivist leanings caused by these events on the individuals emotions related to those events. For this research we specifically focus on the COVID-19 Pandemic and the January 6 Capitol Insurrection. Methods: Data were collected from college students at a small, private midwestern private university over a 10-day period at the end of January and the beginning of February 2021. A Qualtrics survey was sent to 1,041 students who had completed a similar survey 5 months earlier related to their feelings about the COVID-19 pandemic. We used a subsample (N=314 students; 74.2% female; 83.4% White; 0.6% freshman, 24.5% sophomores, 34.7% juniors and 29.3% seniors) who provided complete data. Measures included horizontal (“We are the same, high freedom, equality”) and vertical (“I am different, Authority ranking, high freedom”) individualism as well as horizontal (“We are the same, share, less freedom”) and vertical (“I am different, sharing, authority ranking”) collectivism. Participants also provided data on the positive and negative affective responses to COVID-19 and to the January 6 Capitol Insurrection. Structural equation modeling was used to investigate the direct effects between individual and collectivism and the affective responses to each event (all standardized; Stata v. 17.0). Global fit was evaluated using the chi-square test and the root mean square error of approximation (RMSEA). Local fit was addressed using the Comparative Fit Index (CFI) and the Tucker Louis Index (TLI). We also investigated group differences by gender (male/female) and race (minority/white) where significant overall direct effects were observed. Results: Fit indices (Chi-sq[df]: 60.99[31], p<.001; RMSEA[90% CI]: 0.046[0.035-0.076); CFI: 0.972; TLI: 0.905) suggested the specified model provided a good fit to the data. Higher COVID VI was associated with higher positive (B=0.12) and negative (B=0.15) affective reactions to COVID (B=0.12). Higher Capitol HI and HC were both associated with higher positive (both: B=0.21) and higher negative (B=0.12-0.23) affective reaction to the capitol riots. Higher COVID VI was associated with lower negative affective response (B=-0.16) to COVID. We observed no gender or race/ethnicity differences in these significant effects. Conclusions: Students who felt more strongly that people were the same (horizontal individualism and horizontal collectivism) were more likely to have both strong positive and negative emotions to the Janury 6th insurrection. For COVID-19 negative feelings, students whose feelings towards COVID were more individualistic had mixed results. Those who believed people are different (vertical individualism) were more likely to have lower negative feelings towards COVID-19 while those who believed people are the same (horizontal individualism) had greater negative feelings. These data have implications for scaffolding young adult support in advance of future socio-political emergencies.Item 156. Daily Association of Drug Use Cravings and Physical and Emotional Well-Being among Students Attending a Recovery High School during COVID-19: Results from an EMA Study(Elsevier, 2023) Hensel, Devon J.; Wilburn, Victoria Garcia; Pediatrics, School of MedicinePurpose: Ongoing COVID-19 restrictions are now well-known to increase youth substance use. Little research has addressed this vulnerability among adolescents in substance use recovery (AIR), who may be at heightened risk for relapse within ongoing pandemic management. We used ecological momentary assessment-focused (EMA) to characterize daily shifts in recovery management among adolescents attending a recovery high school. We engage the first wave of these EMA-data collected during third wave of the pandemic (January-February 2022) to: 1) document day-to-day changes in drug craving context (e.g., frequency, temporality, duration, and intensity) and; 2) examine its association with daily shifts in physical and emotional well-being. Methods: Data were from an EMA-study (ongoing through 2022-2023 school-year) intended to understand the social/emotional context of drug use cravings among a cohort of AIR attending a recovery high school in Indianapolis, IN. Our analytic-sample includes six-students (N=40 total) who were enrolled during the second pandemic wave (57.3% female, 42.5% heterosexual, 71.0% White, 52.3% 12th-grade, 57.4% had weekly urges use). Drug use context measures: any drug-use urge (no/yes), urge frequency (5-point item: once-6+ times), urge temporality/duration (6-point item: AM, aft or PM only, more than half the day, all day) and urge intensity (single item: 0-10). Physical and emotional variables: emotional pain (5-point single item: not at all-extremely), self-perceived health (5-point single item: poor to excellent), positive and negative mood (PANAS) and somatic symptoms (summed 12-point: all no/yes). Descriptive statistics and intraclass correlation coefficients (ICC) examined the prevalence and day-to-day variability of each outcome; random intercept mixed effects binary or ordinal regression assessed the impact of physical and emotional predictors on each outcome (Stata v. 18). Results: Participants contributed 81.2% (147/180) of expected EMAs, one-third of which were associated with an urge to use drugs. 6% of urge days also involved a report of drug-use (4/48; ns sample size for additional-analysis). Median within-day urge frequency was 3-5x/day (35.3% of all urge events). We observed significant day-to-day variability in reports of drug urges and the intensity of urges (ICC: 0.209-0.601), but not in temporality and duration of urges. Greater daily emotional pain nearly quadrupled the odds of reporting having drug urges (OR=3.75) and was associated with three-fold higher within-day urge frequency (OR=2.42) and urge intensity (OR=2.92). Higher positive mood was positively associated with urge to use (OR=1.36), urge frequency (OR=1.17) and urge intensity (OR=1.18). More somatic symptoms were associated with greater odds of having drug urges (OR=1.26) and urge frequency during the day (OR=1.10). Conclusions: Our research demonstrates that daily emotional valence and greater somatic symptoms are associated with daily drug urge occurrence, daily urge frequency and daily drug urge intensity among AIR. These EMA data have important clinical implications for “just in time” mental and behavioral health interventions that could focus on mood stability and physical wellness as scaffolds in adolescent recovery management.Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicinePurpose: Global research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic. Methods: Data were the 2020 National Survey of Sexual and Reproductive Health during COVID-19 (Ipsos Research: Menlo Park, CA, USA), an online, nationally representative survey of COVID-19 experiences and knowledge among noninstitutionalized adults in the United States (all 50 states and District of Columbia). Of all individuals recruited (N=1632; 18-94 years), 1010 (62%) completed the survey. We retained a subsample of participants 18-25 years of age (N=106; 10.1% of the larger study) for our current analytic sample. Participants rated the next 12-week occurrence likelihood of eight COVID consequences (all dichotomized for analsis: no chance + low chance – 25% vs. medium chance – 25% to 75% + high chance - >75%). Illness consequences were: being exposed to COVID-19, getting an infection from COVID-19, being hospitalized from COVID-19, knowing someone with COVID-19, knowing someone who has died from COVID-19. Social/economic consequences were: losing job, partner/spouse losing job, not having enough to eat, parent(s) losing their job, missing important healthcare appointments/treatments. Structural variables were: gender (male/female), age (18-21/22-25), sexual identity (heterosexual/sexual minority [SM]) and race/ethnicity (White/BIPOC). We evaluated the prevalence heterogeneity across structural variables using nonparametric McNemar tests. All estimates were adjusted using Ipsos provided weights to account for sampling differences and/or nonresponse. Results: The majority of AYA in the United States (85%) believed they were vulnerable to 2+ health or social/economic consequences. Significantly more SM (36.4%-57.5%) than heterosexual (23.2%-37.0%; p<.001 both) AYA perceived vulnerability to being exposed to and/or getting an infection from COVID-19. A significantly greater number of BIPOC (16.2%-38.7%) than White (11.4%-18.8%; p<.001 both) believed they were vulnerable to COVID19-associated hospitalization or job loss. More SM (26.4%) than heterosexual (22.4%; p<.001) AYA estimated a medium-to high likelihood they would know someone who died of COVID-19. Significantly more BIPOC than White AYA felt high vulnerability to personal job loss (38.7% vs. 18.8%; p=.015), parent job loss (19.0% vs. 16.3%; p<.001) and not having enough to eat (16.3% vs. 10.0%; p<.001). Conclusions: Nationally, many AYA – particularly sexual minority and BIOPC youth – believe they are highly vulnerability to COVID-19 associated consequences. Professionals who work with youth may consider including screening for COVID-19 worries during clinical/educational interactions as a means of both understanding and normalizing AYA’s experiences, as well as helping them devise support or coping mechanisms, during this unprecedented time. These “check-ins” may be particularly where long-term worry about COVID-19 could exacerbate existing disparities in mental and physical health among marginalized AYA.Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicineGlobal research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic.Item Adolescent Sexual Behavior Research: Perspectives of Investigators, IRB Members, and IRB Staff about Risk Categorization and IRB Approval(The Hastings Center, 2017) McGregor, Kyle A.; Hensel, Devon J.; Waltz, Amy C.; Molnar, Elizabeth; Ott, Mary A.; Pediatrics, School of MedicineItem Adolescent women's daily academic behaviors, sexual behaviors, and sexually related emotions(Elsevier, 2014-12) Hensel, Devon J.; Sorge, Brandon H.; Department of Pediatrics, IU School of MedicinePURPOSE: Emerging literature suggests that the emotional and behavioral experience in young women's romantic/sexual relationships may link to their academic success. However, existing studies' reliance on retrospective and/or global measures prevents detailed understanding of how and when specific academic experiences link to specific relationship experiences and whether these associations could vary over different school days. METHODS: Adolescent women (N = 387; 14-17 years at enrollment) were recruited from primary care adolescent clinics for a longitudinal cohort study of sexual relationships and sexual behavior. Participants provided daily diary information on academic behaviors, sexual emotions, and sexual behaviors. Chi-square and generalized estimating equation ordinal logistic or linear regression, respectively, assessed prevalence of sexual behaviors or differences in sexual emotions when academic behaviors did and did not occur. RESULTS: Young women's weekday reports of skipping school or failing a test were significantly linked to more frequent vaginal sex, less frequent condom use, and different levels of sexual emotions, on that same day. CONCLUSIONS: Our findings provide evidence that the emotional and behavioral experiences in young women's romantic/sexual relationships may impact young women's reaction to academic events.Item Adolescent Worry about School Gun Violence: Data from a Nationally Representative Study of 14 – 17 Year Olds in the United States(2024-09) Kirkland, Danielle Renee; Hensel, Devon J.; Mintus, Kenzie L.; Shasanmi, Amy C.Using a nationally representative sample from the 2022 National Survey of Sexual Health and Behavior (N = 1,004), this research examined the prevalence of school gun violence worry (SGVW) among U.S. adolescents aged 14 – 17 in the United States and its impact on anxiety and depression. This research draws upon Minority Stress Theory, which states that stigmatized individuals face unique stressors contributing to health disparities. The impact of minority status including racial, sexual, and gender identity on SGVW and its relationship to mental health were also explored. Results revealed that almost three out of four adolescents (73.3%) experience some degree of SGVW. The youngest and oldest respondents reported being more worried compared to the remaining age groups. Higher levels of SGVW were associated with increased anxiety (OR = 1.396, 95% CI: 1.196 – 1.629, p<0.001), but not depression. In separate models, racial minorities (OR = 2.012, 95% CI: 1.455 – 2.784, p<0.001) and gender minorities (OR = 1.948, 95% CI: 0.989 – 3.838, p < 0.05) had higher odds of SGVW than White adolescents and cisgender females, while cisgender males had lower odds (OR = 0.698, 95% CI: 0.501 – 0.974, p<0.01) than cisgender females. The impact of SGVW on anxiety was significant for both heterosexual (OR = 1.350, 95% CI: 1.137 – 1.603, p<0.001) and sexual minority adolescents (OR = 1.763, 95% CI: 1.119 – 2.777, p<0.1). These findings suggest that SGVW is prevalent among adolescents in the U.S. and is associated with increased anxiety.