A Mental Health Intervention for Schoolchildren Exposed to Violence: A Randomized Controlled Trial
Bradley D. Stein, Lisa H. Jaycox, Sheryl H. Kataoka, Marleen Wong, Wenli Tu, Marc N. Elliott, Arlene Fink
JAMA. 2003;290:603-611.
CONTEXT: No randomized controlled studies have been conducted to date on the effectiveness of psychological interventions for children with symptoms of posttraumatic stress disorder (PTSD) that has resulted from personally witnessing or being personally exposed to violence. OBJECTIVE: To evaluate the effectiveness of a collaboratively designed school-based intervention for reducing children's symptoms of PTSD and depression that has resulted from exposure to violence. DESIGN: A randomized controlled trial conducted during the 2001-2002 academic year. SETTING AND PARTICIPANTS: Sixth-grade students at 2 large middle schools in Los Angeles who reported exposure to violence and had clinical levels of symptoms of PTSD. INTERVENTION: Students were randomly assigned to a 10-session standardized cognitive-behavioral therapy (the Cognitive-Behavioral Intervention for Trauma in Schools) early intervention group (n = 61) or to a wait-list delayed intervention comparison group (n = 65) conducted by trained school mental health clinicians. MAIN OUTCOME MEASURES: Students were assessed before the intervention and 3 months after the intervention on measures assessing child-reported symptoms of PTSD (Child PTSD Symptom Scale; range, 0-51 points) and depression (Child Depression Inventory; range, 0-52 points), parent-reported psychosocial dysfunction (Pediatric Symptom Checklist; range, 0-70 points), and teacher-reported classroom problems using the Teacher-Child Rating Scale (acting out, shyness/anxiousness, and learning problems; range of subscales, 6-30 points). RESULTS: Compared with the wait-list delayed intervention group (no intervention), after 3 months of intervention students who were randomly assigned to the early intervention group had significantly lower scores on symptoms of PTSD (8.9 vs 15.5, adjusted mean difference, - 7.0; 95% confidence interval [CI], - 10.8 to - 3.2), depression (9.4 vs 12.7, adjusted mean difference, - 3.4; 95% CI, - 6.5 to - 0.4), and psychosocial dysfunction (12.5 vs 16.5, adjusted mean difference, - 6.4; 95% CI, -10.4 to -2.3). Adjusted mean differences between the 2 groups at 3 months did not show significant differences for teacher-reported classroom problems in acting out (-1.0; 95% CI, -2.5 to 0.5), shyness/anxiousness (0.1; 95% CI, -1.5 to 1.7), and learning (-1.1, 95% CI, -2.9 to 0.8). At 6 months, after both groups had received the intervention, the differences between the 2 groups were not significantly different for symptoms of PTSD and depression; showed similar ratings for psychosocial function; and teachers did not report significant differences in classroom behaviors. CONCLUSION: A standardized 10-session cognitive-behavioral group intervention can significantly decrease symptoms of PTSD and depression in students who are exposed to violence and can be effectively delivered on school campuses by trained school-based mental health clinicians.

Communicating Health Information Through The Entertainment Media
A study of the television drama ER lends support to the notion that Americans pick up information while being entertained.
Mollyann Brodie, Ursula Foehr, Vicky Rideout, Neal Baer, Carolyn Miller, Rebecca Flournoy, Drew Altman
Health Affairs. 2001;20(1):192.
CONTEXT: The American public receives health information from a wide variety of sources. Entertainment media is increasingly cited as a source for health information. OBJECTIVE: To assess what health and health policy information presented on television is acquired, how long it is retained, can it alter viewer’s knowledge about health topics, whether health-related story lines can maintain viewer’s interest, and whether these programs can have an impact on audiences’ actions. METHOD: Ten separate national random-sample telephone surveys of regular viewers of at least three out of four episodes during the 1997 and 2000 regular season of the television drama, ER. Cross-sectional preshow, postshow, and follow-up surveys were conducted. OUTCOME MEASURES: Viewers were evaluated on (1) knowledge gain and retention of health information, and (2) interest in health-related story lines and any actions taken based on these storylines. The health issues were emergency contraception and human papilloma virus (HPV). Surveys were subject to sampling errors (±5 - ± 6 percentage points for these ten surveys). RESULTS: Regarding emergency contraception, among regular viewers who know there are options for preventing pregnancy after unprotected sex for preshow, postshow, and follow-up survey: 50%, 67%, and 50% knew of these options respectively. Among regular viewers who mentioned taking birth control pills as something women can do to prevent pregnancy after unprotected sex for preshow, postshow, and follow-up survey: 10%, 33%, and 10% respectively. With regards to HPV, among regular viewers who have heard of HPV for preshow, postshow, and follow-up survey: 24%, 47%, and 38% reported hearing about HPV respectively. Those who could give correct description of HPV for preshow, postshow, and follow-up survey: 9%, 28% and 16% were able to respectively. Overall viewers’ interest in ER story lines is greater for health related story lines compared to romance ones. Viewers’ reported actions taken as a result of watching ER: 51% said they talked with family and friends about the health issues addressed on ER, 32% said they got information from ER that help them make health care choices, and 23% said that they have gone to other sources to find additional information about health issues. CONCLUSION: Viewers are interested in health related story lines, and some learn about health topics and were motivated to seek additional health information. Repetition of messages is important to comprehension and long term retention of health related topics among audiences.

Entertainment Television as a Healthy Sex Educator: The Impact of Condom-Efficacy Information in an Episode of Friends
Rebecca L. Collins, Marc N. Elliott, Sandra H. Berry, David E. Kanouse, Sarah B. Hunter
Pediatrics. 2003;112(5):1115-1121.
CONTEXT: Television is often decried as a negative influence on the sexual attitudes and behavior of America's adolescents. However, television occasionally includes messages about the risks of having sex that may have a positive effect on youth. OBJECTIVE: To assess the impact of condom-efficacy messages in an episode of Friends on teens. Design, Setting, and Participants. A national sample of 506 adolescents 12 to 17 years old who had been regular viewers of Friends the previous year were surveyed by telephone shortly after the episode aired. OUTCOME MEASURES: Viewership of the Friends episode, recall of the condom-efficacy message, beliefs about condoms, self-reported change in condom knowledge, and discussions of condom efficacy with parents. RESULTS: At least 27% of the sample saw the episode, and 65% of these viewers recalled its depiction of condom failure resulting in pregnancy. Forty percent of the viewers watched with an adult. Ten percent of viewers talked to an adult about condom efficacy as a result of the show. Compared with other viewers, youth who talked with an adult were more likely to report learning about condoms from the episode and appeared less likely to reduce their perceptions of condom efficacy after the episode. CONCLUSIONS: Entertainment television can serve as a healthy sex educator and can work in conjunction with parents to improve adolescent sexual knowledge.

Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status
Sheryl H. Kataoka, Lily Zhang, Kenneth B. Wells
Am J Psychiatry. 2002;159:1548-1555.
OBJECTIVE: Policy discussions regarding the mental health needs of children and adolescents emphasize a lack of use of mental health services among youth, but few national estimates are available. The authors use three national data sets and examine ethnic disparities in unmet need (defined as having a need for mental health evaluation but not using any services in a 1-year period) to provide such estimates. METHOD: The authors conducted secondary data analyses in three nationally representative household surveys fielded in 1996-1998: the National Health Interview Survey, the National Survey of American Families, and the Community Tracking Survey. They determined rates of mental health service use by children and adolescents 3-17 years of age and differences by ethnicity and insurance status. Among the children defined as in need of mental health services, defined by an estimator of mental health problems (selected items from the Child Behavior Checklist), they examined the association of unmet need with ethnicity and insurance status. RESULTS: In a 12-month period, 2%-3% of children 3-5 years old and 6%-9% of children and adolescents 6-17 years old used mental health services. Of children and adolescents 6-17 years old who were defined as needing mental health services, nearly 80% did not receive mental health care. Controlling for other factors, the authors determined that the rate of unmet need was greater among Latino than white children and among uninsured than publicly insured children. CONCLUSIONS: These findings reveal that most children who need a mental health evaluation do not receive services and that Latinos and the uninsured have especially high rates of unmet need relative to other children. Rates of use of mental health services are extremely low among preschool children. Research clarifying the reasons for high rates of unmet need in specific groups can help inform policy and clinical programs.

Beating Depression: The Journey to Hope
Maga Jackson-Triche, Kenneth B. Wells, Katherine Minnium
McGraw-Hill. 2002.
SYNOPSIS: Approximately 10 million Americans suffer from symptoms of depression. Beating Depression can help them take the first steps to ending the pain and making a lasting recovery. Nationally recognized practitioners/researchers at UCLA and RAND, Maga Jackson-Triche, Kenneth B. Wells, and Katherine Minnium equip readers with the knowledge and tools to help them return to feeling like themselves again. Based on findings from the landmark RAND “Partner in Care” study—which identified ways to improve care for depression—this books guide people through steps needed to get good quality care and find the right mental health professional. In addition, it shows people what pharmacology and therapy approaches are available and what skills to use each day to overcome depression. There are also self-assessment tolls to help gauge the level of depression and many inspiring stories from people who have faced the challenges or identifying their own depression and found the care they needed.