Evaluating the role of engagement in a web-based intervention to improve parenting risk and protective factors for adolescent depression and anxiety disorders (Preprint)

2020 ◽  
Author(s):  
Claire C Nicolas ◽  
Anthony F Jorm ◽  
Katherine A Lawrence ◽  
Marie BH Yap
Keyword(s):  
Protective Factors ◽  
Adolescent Depression ◽  
Large Body ◽  
Parenting Programs ◽  
Depression And Anxiety ◽  
Post Intervention ◽  
Web Based ◽  
Multiple Measures

BACKGROUND A large body of evidence highlights the important role of parental behavior in reducing the risk of, and increasing the protective factors for, adolescent internalizing disorders. The possible benefits offered by preventive parenting programs may be undermined by low rates of engagement by parents. Online interventions have the potential to mitigate the common barriers to participation and engagement in face-to-face preventive parenting programs. However, there is a surprising lack of studies that report on the relationship between intervention engagement and improvement in target outcomes. OBJECTIVE This study evaluated the predictive power of several measures of engagement in a Web-based intervention aimed at increasing parental protective factors and reducing risk factors for adolescent depression and anxiety. We aimed to ascertain which measures of program engagement best predict 3-month post-intervention and 12-month follow-up scores on preventive parenting, parental self-efficacy (PSE), and adolescent depressive and anxiety symptoms. METHODS Our sample comprised 176 parents who received the Partners in Parenting (‘PiP’) intervention and their adolescents. Engagement was measured through multiple measures derived from server logs on a web database. Potential predictors included total modules completed, percentage of intended modules completed, percentage of quiz questions answered correctly, and percentage of goals completed. RESULTS Hierarchical multiple regressions indicated that the total modules completed predicted parent rated preventive parenting at post-intervention, and a combination of the total modules completed, percentage of intended modules completed, and percentage of quiz questions answered predicted PSE scores at post-intervention. At 12-month follow up, a combination of engagement measures predicted preventive parenting scores, and the percentage of intended modules completed predicted PSE scores. The percentage of intended modules completed predicted parent report of adolescent depressive symptoms at 12-month follow-up. None of the engagement measures predicted adolescent report of preventive parenting or their own symptoms. CONCLUSIONS Our findings suggest that future programs will benefit from including multiple measures of engagement and reinforce the importance of examining the longer-term effects of engagement. Our study provides evidence for the benefits of including goal-setting exercises as a persuasive feature and ensuring quiz questions are challenging. The implications of these findings for future program development, as well as our understanding of improvement in behavior and symptoms through intervention, are discussed.

scholarly journals Medium-Term Effects of a Tailored Web-Based Parenting Intervention to Reduce Adolescent Risk of Depression and Anxiety: 12-Month Findings From a Randomized Controlled Trial

10.2196/13628 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e13628 ◽  
Author(s):  
Marie Bee Hui Yap ◽  
Mairead C Cardamone-Breen ◽  
Ronald M Rapee ◽  
Katherine A Lawrence ◽  
Andrew J Mackinnon ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Protective Factors ◽  
Adolescent Depression ◽  
Controlled Trial ◽  
Intervention Group ◽  
Risk And Protective Factors ◽  
Depression And Anxiety ◽  
Web Based ◽  
Randomized Controlled

Background Prevention of depression and anxiety disorders early in life is a global health priority. Evidence on risk and protective factors for youth internalizing disorders indicates that the family represents a strategic setting to target preventive efforts. Despite this evidence base, there is a lack of accessible, cost-effective preventive programs for parents of adolescents. To address this gap, we recently developed the Partners in Parenting (PiP) program—an individually tailored Web-based parenting program targeting evidence-based parenting risk and protective factors for adolescent depression and anxiety disorders. We previously reported the postintervention outcomes of a single-blinded parallel-group superiority randomized controlled trial (RCT) in which PiP was found to significantly improve self-reported parenting compared with an active-control condition (educational factsheets). Objective This study aimed to evaluate the effects of the PiP program on parenting risk and protective factors and symptoms of adolescent depression and anxiety using data from the final assessment time point (12-month follow-up) of this RCT. Methods Parents (n=359) and adolescents (n=332) were recruited primarily from secondary schools and completed Web-based assessments of parenting and adolescent depression and anxiety symptoms at baseline, postintervention (3 months later), and 12-month follow-up (317 parents, 287 adolescents). Parents in the PiP intervention condition received personalized feedback about their parenting and were recommended a series of up to 9 interactive modules. Control group parents received access to 5 educational factsheets about adolescent development and mental health. Both groups received a weekly 5-min phone call to encourage progress through their program. Results Intervention group parents completed an average of 73.7% of their intended program. For the primary outcome of parent-reported parenting, the intervention group showed significantly greater improvement from baseline to 12-month follow-up compared with controls, with a medium effect size (Cohen d=0.51; 95% CI 0.30 to 0.72). When transformed data were used, greater reduction in parent-reported adolescent depressive symptoms was observed in the intervention group (Cohen d=−0.21; 95% CI −0.42 to −0.01). Mediation analyses revealed that these effects were mediated by improvements in parenting (indirect effect b=−0.08; 95% CI −0.16 to −0.01). No other significant intervention effects were found for adolescent-reported parenting or adolescent depression or anxiety symptoms. Both groups showed significant reductions in anxiety (both reporters) and depressive (parent reported) symptoms. Conclusions PiP improved self-reported parenting for up to 9 months postintervention, but its effects on adolescent symptoms were less conclusive, and parent-reported changes were not perceived by adolescents. Nonetheless, given its scalability, PiP may be a useful low-cost, sustainable program to empower parents of adolescents. Trial Registration Australian Clinical Trials Registration Number (ACTRN): 12615000328572; http://www.anzctr.org.au/ACTRN12615000328572.aspx (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj).

scholarly journals Medium-Term Effects of a Tailored Web-Based Parenting Intervention to Reduce Adolescent Risk of Depression and Anxiety: 12-Month Findings From a Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Marie Bee Hui Yap ◽  
Mairead C Cardamone-Breen ◽  
Ronald M Rapee ◽  
Katherine A Lawrence ◽  
Andrew J Mackinnon ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Protective Factors ◽  
Adolescent Depression ◽  
Controlled Trial ◽  
Intervention Group ◽  
Risk And Protective Factors ◽  
Depression And Anxiety ◽  
Web Based ◽  
Randomized Controlled

BACKGROUND Prevention of depression and anxiety disorders early in life is a global health priority. Evidence on risk and protective factors for youth internalizing disorders indicates that the family represents a strategic setting to target preventive efforts. Despite this evidence base, there is a lack of accessible, cost-effective preventive programs for parents of adolescents. To address this gap, we recently developed the Partners in Parenting (PiP) program—an individually tailored Web-based parenting program targeting evidence-based parenting risk and protective factors for adolescent depression and anxiety disorders. We previously reported the postintervention outcomes of a single-blinded parallel-group superiority randomized controlled trial (RCT) in which PiP was found to significantly improve self-reported parenting compared with an active-control condition (educational factsheets). OBJECTIVE This study aimed to evaluate the effects of the PiP program on parenting risk and protective factors and symptoms of adolescent depression and anxiety using data from the final assessment time point (12-month follow-up) of this RCT. METHODS Parents (n=359) and adolescents (n=332) were recruited primarily from secondary schools and completed Web-based assessments of parenting and adolescent depression and anxiety symptoms at baseline, postintervention (3 months later), and 12-month follow-up (317 parents, 287 adolescents). Parents in the PiP intervention condition received personalized feedback about their parenting and were recommended a series of up to 9 interactive modules. Control group parents received access to 5 educational factsheets about adolescent development and mental health. Both groups received a weekly 5-min phone call to encourage progress through their program. RESULTS Intervention group parents completed an average of 73.7% of their intended program. For the primary outcome of parent-reported parenting, the intervention group showed significantly greater improvement from baseline to 12-month follow-up compared with controls, with a medium effect size (Cohen d=0.51; 95% CI 0.30 to 0.72). When transformed data were used, greater reduction in parent-reported adolescent depressive symptoms was observed in the intervention group (Cohen d=−0.21; 95% CI −0.42 to −0.01). Mediation analyses revealed that these effects were mediated by improvements in parenting (indirect effect b=−0.08; 95% CI −0.16 to −0.01). No other significant intervention effects were found for adolescent-reported parenting or adolescent depression or anxiety symptoms. Both groups showed significant reductions in anxiety (both reporters) and depressive (parent reported) symptoms. CONCLUSIONS PiP improved self-reported parenting for up to 9 months postintervention, but its effects on adolescent symptoms were less conclusive, and parent-reported changes were not perceived by adolescents. Nonetheless, given its scalability, PiP may be a useful low-cost, sustainable program to empower parents of adolescents. CLINICALTRIAL Australian Clinical Trials Registration Number (ACTRN): 12615000328572; http://www.anzctr.org.au/ACTRN12615000328572.aspx (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj).

scholarly journals A Single-Session, Web-Based Parenting Intervention to Prevent Adolescent Depression and Anxiety Disorders: Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Mairead C Cardamone-Breen ◽  
Anthony F Jorm ◽  
Katherine A Lawrence ◽  
Ronald M Rapee ◽  
Andrew J Mackinnon ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Parenting Practices ◽  
Adolescent Depression ◽  
Controlled Trial ◽  
Depression And Anxiety ◽  
Single Session ◽  
Self Assessment ◽  
Web Based ◽  
Symptoms Of Depression

BACKGROUND Depression and anxiety disorders are significant contributors to burden of disease in young people, highlighting the need to focus preventive efforts early in life. Despite substantial evidence for the role of parents in the prevention of adolescent depression and anxiety disorders, there remains a need for translation of this evidence into preventive parenting interventions. To address this gap, we developed a single-session, Web-based, tailored psychoeducation intervention that aims to improve parenting practices known to influence the development of adolescent depression and anxiety disorders. OBJECTIVE The aim of this study was to evaluate the short-term effects of the intervention on parenting risk and protective factors and symptoms of depression and anxiety in adolescent participants. METHODS We conducted a single-blind, parallel group, superiority randomized controlled trial comparing the intervention with a 3-month waitlist control. The intervention is fully automated and consists of two components: (1) completion of an online self-assessment of current parenting practices against evidence-based parenting recommendations for the prevention of adolescent depression and anxiety disorders and (2) an individually tailored feedback report highlighting each parent’s strengths and areas for improvement based on responses to the self-assessment. A community sample of 349 parents, together with 327 adolescents (aged 12-15 years), were randomized to either the intervention or waitlist control condition. Parents and adolescents completed online self-reported assessments of parenting and adolescent symptoms of depression and anxiety at baseline, 1-month (parent-report of parenting only), and 3-month follow-up. RESULTS Compared with controls, intervention group parents showed significantly greater improvement in parenting risk and protective factors from baseline to 1-month and 3-month follow-up (F2,331.22=16.36, P<.001), with a small to medium effect size at 3-month follow-up (d=0.33). There were no significant effects of the intervention on adolescent-report of parenting or symptoms of depression or anxiety in the adolescents (all P>.05). CONCLUSIONS Findings suggest that a single-session, individually tailored, Web-based parenting intervention can improve parenting factors that are known to influence the development of depression and anxiety in adolescents. However, our results do not support the effectiveness of the intervention in improving adolescent depression or anxiety symptoms in the short-term. Long-term studies are required to adequately assess the relationship between improving parenting factors and adolescent depression and anxiety outcomes. Nonetheless, this is a promising avenue for the translation of research into a low-cost, sustainable, universal prevention approach. CLINICALTRIAL Australian New Zealand Clinical Trials Registry: ACTRN12615000247572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000247572 (Archived by WebCite at http://www.webcitation.org/6v1ha19XG)

scholarly journals A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Marie Bee Hui Yap ◽  
Shireen Mahtani ◽  
Ronald M Rapee ◽  
Claire Nicolas ◽  
Katherine A Lawrence ◽  
...  
Keyword(s):  
Protective Factors ◽  
Adolescent Depression ◽  
Controlled Trial ◽  
Risk And Protective Factors ◽  
Secondary Outcome ◽  
Depression And Anxiety ◽  
Web Based ◽  
Child Report ◽  
Adolescent Report ◽  
Intervention Condition

BACKGROUND Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. OBJECTIVE This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms. METHODS A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms). RESULTS Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions. CONCLUSIONS The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health. CLINICALTRIAL Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj)

scholarly journals The Genesis 12–19 (G1219) Study: A Twin and Sibling Study of Gene–Environment Interplay and Adolescent Development in the UK

2012 ◽  
Vol 16 (1) ◽  
pp. 134-143 ◽  
Author(s):  
Tom A. McAdams ◽  
Alice M. Gregory ◽  
Richard Rowe ◽  
Helena M. S. Zavos ◽  
Nicola L. Barclay ◽  
...  
Keyword(s):  
Data Collection ◽  
Adolescent Depression ◽  
Depression And Anxiety ◽  
Antisocial Behaviors ◽  
Sibling Pairs ◽  
Multiple Phenotypes ◽  
Gene Environment ◽  
Sample Data ◽  
The Uk

The Genesis 12–19 (G1219) Study is an ongoing longitudinal study of a sample of UK twin pairs, non-twin sibling pairs, and their parents. G1219 was initially designed to examine the role of gene–environment interplay in adolescent depression. However, since then data have continued to be collected from both parents and their offspring into young adulthood. This has allowed for longitudinal analyses of depression and has enabled researchers to investigate multiple phenotypes and to ask questions about intermediate mechanisms. The study has primarily focused on emotional development, particularly depression and anxiety, which have been assessed at multiple levels of analysis (symptoms, cognitions, and relevant environmental experiences). G1219 has also included assessment of a broader range of psychological phenotypes ranging from antisocial behaviors and substance use to sleep difficulties, in addition to multiple aspects of the environment. DNA has also been collected. The first wave of data collection began in the year 1999 and the fifth wave of data collection will be complete before the end of 2012. In this article, we describe the sample, data collection, and measures used. We also summarize some of the key findings to date.

scholarly journals Short-term serial assessment of electronic patient-reported outcome for depression and anxiety in breast Cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jeeyeon Lee ◽  
Jin Hyang Jung ◽  
Wan Wook Kim ◽  
Byeongju Kang ◽  
Jungmin Woo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Period ◽  
Depression Scale ◽  
Patient Reported Outcome ◽  
Depression And Anxiety ◽  
Short Term ◽  
Web Based ◽  
Patient Reported ◽  
Patient Health

Abstract Purpose The incidence of depression and anxiety is higher in patients with breast cancer than in the general population. We evaluated the degree of depression and anxiety and investigated the changes in patients with breast cancer during the treatment period and short-term follow-up period. Methods Overall, 137 patients with breast cancer were evaluated using the Patient Health Questionnaire 9-item depression scale (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7). The scales were developed as a web-based electronic patient-reported outcome measure, and serial results were assessed before the operation, after the operation, in the post-treatment period, and in the 6-month follow-up period after surgery. Results The degree of depression and anxiety increased during treatment and decreased at 6-month follow-up, even if there were no statistical differences among the four periods (PHQ-9: p = 0.128; GAD-7: p = 0.786). However, daily fatigue (PHQ-9 Q4) and insomnia (PHQ-9 Q3) were the most serious problems encountered during treatment and at 6-month follow-up, respectively. In the GAD-7, worrying too much (Q3) consistently showed the highest scores during the treatment and follow-up periods. Of the patients, 7 (5.11%) and 11 (8.03%) patients had a worsened state of depression and anxiety, respectively, after treatment compared with before treatment. Conclusion Most factors associated with depression and anxiety improved after treatment. However, factors such as insomnia and worrying too much still disturbed patients with breast cancer, even at 6-month follow-up. Therefore, serial assessment of depression and anxiety is necessary for such patients.

scholarly journals PENGARUH PROGRAM PARENTING DALAM MENGURANGI STRES ORANG TUA DENGAN ANAK AUTIS

2019 ◽  
Vol 1 (2) ◽  
pp. 43
Author(s):  
Andikawati Fitriasari ◽  
Ah Yusuf ◽  
Nurilla Kholidah
Keyword(s):  
Systematic Review ◽  
Average Duration ◽  
Parent Stress ◽  
Parenting Program ◽  
Parenting Programs ◽  
Autistic Children ◽  
Post Intervention ◽  
Parenting Support ◽  
Reducing Stress

Pendahuluan: Pola asuh orang tua sangat berpengaruh terhadap pertumbuhan dan perkembangan anak, apalagi jika pada anak  mengalami autis. Umumnya orang tua yang memiliki anak autis mengalami stres, oleh karena itu bagaimana program pemberian parenting sangat penting dikaji agar orang tua dapat memperlakukan anak autis dalam mencapai perkembangan optimalnya. Systematic review ini bertujuan untuk menjelaskan pengaruh program parenting dalam mengurangi stres orang tua dengan anak autis.Metode: Pencarian jurnal dilakukan pada database Scopus dan Sience Direct, pembatasan jurnal pada 10 tahun terakhir mulai 2008-2017, area jurnal Nursing, Psychologi, Disabilitas, Child, dan Psychiatri dengan kata kunci Parenting, Parent Stress and Autism. Prosedur seleksi dan ekstraksi data menggunakan pendekatan PICOT.Hasil: Total keseluruhan partisipan dari seluruh penelitian yang diriview adalah 2107 dengan orangtua yang mengalami kecemasan atau stress akibat memiliki anak autis. Intervensi yang digunakan dalam semua penelitian adalah intervensi program parenting dan support parenting. Rerata durasi interfensi selama 3 minggu dengan rerata follow up 12 bulan. Efek signifikan ditemukan secara statistik dari program parenting atau support parenting untuk hasil pasca pemberian intervensi hingga follow up. Hasil yang signifikan ditemukan pada pemberian program parenting melalui media konseling peneliti di dampingi oleh terapis yang bersertifikat.Kesimpulan: Parenting memiliki pengaruh yang signifikan dalam menurunkan stres pada orang tua yang memiliki anak autis. ABSTRACTIntroduction: Parenting is very influential in the growth and development of children, especially if the child has autism. Generally, parents who have autistic children experience stress, therefore how the parenting program is very important to be studied so that parents can treat autistic children in achieving optimal development. This Systematic review aims to explain the effect of parenting programs in reducing the stress of parents with autistic children.Method: The journal search was conducted on the Scopus and Science Direct databases, journal restrictions in the last ten years starting 2008-2017, the journal areas of Nursing, Psychology, Disability, Child, and Psychiatry with the keywords Parenting, Parent Stress and Autism. Data selection and extraction procedures use the PICOT approach.Results: The total number of participants from all studies reviewed was 2107, with parents experiencing anxiety or stress due to having an autistic child. The interventions used in all research were parenting program interventions and parenting support. The average duration of intervention was three weeks with a mean follow-up of 12 months. Significant effects were found statistically from parenting programs or parenting support for outcomes post-intervention until follow-up. Significant results were found in parenting programs through researchers' counseling media accompanied by certified therapists.Conclusion: Parenting has a significant effect on reducing stress in parents who have autistic children.

scholarly journals Developmental approaches to substance use and abuse

1999 ◽  
Vol 11 (4) ◽  
pp. 655-656 ◽  
Author(s):  
DANTE CICCHETTI ◽  
SUNIYA S. LUTHAR
Keyword(s):  
Drug Use ◽  
Protective Factors ◽  
Developmental Psychopathology ◽  
Developmental Stages ◽  
Risk And Protective Factors ◽  
Institute Of Medicine ◽  
Drug Use Disorders ◽  
Adolescents And Adults

In 1996 the Institute of Medicine (IOM, 1996) issued a report on pathways to addiction. Although focused on the use of illegal drugs, the recommendations of the committee are equally applicable to more socially condoned, but still addictive, substances such as alcohol. The IOM (1996) report articulated the types of research that would be needed to expand the understanding of the etiology of drug use disorders, including the following: (a) multidisciplinary research to investigate the combined effects of biological, psychosocial, and contextual factors as they relate to the development of drug use, abuse, and dependence; (b) studies of sufficient duration to enable follow-up of participants in determining the role of risk and protective factors related to the transition from drug use to abuse to dependence; (c) research investigating the role of family factors in the etiology of drug use and abuse; (d) examination of psychopathology as a precursor to drug use and abuse in adolescents and adults; (e) studies of risk and protective factors related to drug use and abuse, especially during discrete developmental stages; and (f) investigation of childhood risk and protective factors that are associated with drug abuse and dependence. In reflecting on these comprehensive goals, striking similarities emerge with respect to these research foci and the field of developmental psychopathology (Cicchetti & Cohen, 1995; Cicchetti & Toth, 1991). Specifically, the principles that guide inquiries conceptualized within a developmental psychopathology framework can be applied toward the conduct of studies designed to address the agenda generated by the IOM (1996) report on substance abuse.

scholarly journals Risk and protective factors associated with BV chronicity among women in Rakai, Uganda

2019 ◽  
Vol 96 (5) ◽  
pp. 380-386
Author(s):  
Marie E Thoma ◽  
Rebecca M Brotman ◽  
Ronald H Gray ◽  
Nelson K Sewankambo ◽  
Maria J Wawer
Keyword(s):  
Protective Factors ◽  
Risk And Protective Factors ◽  
Consistent Condom ◽  
Nugent Score ◽  
Factors Associated ◽  
Vaginal Swabs ◽  
Adjustment Factors ◽  
Microbial Agents

ObjectivesTo assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria.MethodsA longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations.ResultsAverage BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3).ConclusionsFactors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.

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