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Natural Mentors, Ethnic Identity, and Adolescent Mental Health


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NATURAL MENTORS, ETH N IC IDENTITY, AND ADOLESCENT MENTAL HEALTH By RAMONA GREIG A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2003

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Copyright 2003 by Ramona Greig

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To my mother for her unconditional love and for always being there. To my grandmother for teaching me the value of education and lifelong learning. And to the rest of my family and friends for all of their love and support that made this possible.

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iv ACKNOWLEDGMENTS I would like to acknowledge the contributions of my dissertation committee. I acknowledge my dissertation chairperson, Dr. Jennifer H. Elder, for supervising a project and a student that requi red expansion of her area of expertise. She has demonstrated the qualities of a true scientist who is also sincerely committed to the mental health care of children. I would also like to acknowledge Dr. Kathleen A. Long for serving on my committee. She helped me to find a passion for the topic of mentoring. She always considered my interests and dissertation project thoughtfully despite her demanding role as dean of the college of nursing. I would especially like to thank the final member of my committee from the college of nursing, Dr. Martha Jo Snider. She has been my mentor since I was an undergraduate nursing student. She introduced me to psychiatric mental-health nursing. I would like to thank her for her open-door policy and for the professional and personal support she provided during my doctoral studies. I would also like to acknowledge my dissertation committee members from outside the college of nursing: Dr. Jenni fer L. Woolard, from the Department of Developmental Psychology, and Dr. Lisa M. Brown, from the Department of Clinical Psychology. Dr. Woolard was instrumental in enabling me to work on her collaborative research project with middle school students that became my dissertation. She also demonstrated that a woman could have it all. She handled her roles as a professor and mother with grace. I would especially like to thank her for attending my qualifying exam while more than eight months pregnant. Lastly, I would like to thank Dr. Brown for her

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v passion for research and issues of race and ethnicity. She provided thoughtful and insightful analysis of the theoretical and empirical work we discussed. She also was a tremendous resource for me while I was completing my statistical analysis. She is a great role model as an educator and a social scientist. I would also like to acknowledge other groups and individuals who helped me to complete my doctoral studies. Dr. Myrna Courage and the University of Florida provided the Alumni Fellowship that allowed me to focus on my studies full-time. Also, Dr. Scott Miller provided the opportunity for me to work as a research assistant while completing my dissertation and allowed me to integrate my research questions into his survey development project. Dr. Eve Brank, from the department of statistics, taught me about data management and computer-assisted data analysis. Lastly I would like to thank Drs. Stephanie and Elias Sarkis for their encouragement and their crucial advice about when to finish.

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vi TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................................iv ABSTRACT..........................................................viii CHAPTER 1INTRODUCTION ....................................................1 Problem............................................................1 Purpose.............................................................2 Conceptual FrameworkNeuman Systems Model...........................2 Mental Health Functioning.............................................3 Middle-Range Theories................................................4 Conceptual and Operational Definitions...................................8 Research Aims and Hypotheses .........................................13 Summary..........................................................14 2REVIEW OF LITERATURE..........................................16 Relevance to Nursing-Adolescent Mental Health...........................16 Ethnic Identity ......................................................19 Mentoring..........................................................34 General Discussion..................................................46 3METHODOLOGY ..................................................47 Design............................................................47 Research Aims......................................................48 Research Hypotheses .................................................48 Procedures.........................................................48 Instrumentation.....................................................51 Data Analysis.......................................................56 Limitations.........................................................58 4RESULTS.........................................................59 Research Design....................................................59 Sampling Procedure..................................................59 Sample Characteristics................................................61 Mentors...........................................................63 Ethnic Identity ......................................................66

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vii 5DISCUSSION AND RECOMMENDATIONS .............................72 Adverse Mental Health Outcomes.......................................72 Mentoring..........................................................73 Ethnic Identity ......................................................75 Recommendations and Future Directions.................................78 Nursing Implications.................................................80 APPENDIX AMENTORING ITEMS................................................84 BPARENT INFORMED CONSENT......................................87 CVERBAL PARTICIPANT ASSENT.....................................91 REFERENCES........................................................93 BIOGRAPHICAL SKETCH.............................................102

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viii Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy NATURAL MENTORS, ETHNIC IDENTITY, AND ADOLESCENT MENTAL HEALTH By Ramona Corrin Greig August 2003 Chair: Jennifer H. Elder. Major Department: Nursing Adolescent mental health research has undergone a shift in emphasis from problem-focused to strength-based research. There has also been a shift toward more research that is inclusive of ethnic minority group members and the constructs that are particularly salient to them. This study explored individual and socio-cultural variables and their relationships to adolescent mental health from a nursing perspective. Ethnic identity development and the presence of natural mentors were examined in a sample of 566 multi-ethnic middle-school students. Adolescent mental health was assessed in the domains of mood-related symptoms (depressed/anxious mood, angry/irritable mood, somatic complaints due to anxiety) and substance use (alcohol/drug use). It was hypothesized that those adolescents with a natural mentor would have better mental health than those without a mentor. It was also hypothesized that there would be a relationship between ethnic identity achievement and mental health outcomes in the African American and Hispanic adolescents. Lastly, a moderation model was tested to

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ix examine the influence of an ethnically matched mentor on the relationship between ethnic identity and mental health. Multivariate analyses of variance, multiple linear regression, and logistic regression were used to test these hypotheses. The hypotheses were not supported, with one exception. Ethnic identity achievement was predictive of Alcohol/Drug Use for both minority and majority adolescents. Ethnic identity achievement was not predictive of mood-related symptoms possibly because of the early developmental age of the participants. The presence of a natural mentor was also not predictive of mental health in this sample, despite accounting for several aspects of relationship quality. Issues of measurement validity and statistical power were limitations that may have influenced these findings. Nonrandom sample selection, the use of a cross-sectional, correlational design, and self-report measures were also limitations of this study. This study has direct implications for nursing research, education, and practice. Psychiatric-mental health nurses could use th ese findings to develop screening protocols for mental health problems. Nursing education, practice, and research should emphasize adolescent socio-cultural and psychosocial strengths.

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1 CHAPTER 1 INTRODUCTION Ethnic minority groups are a substantial part of U.S. society. Currently, Hispanics and African Americans represent approxima tely 12% and 13% of the U.S population, respectively (U.S Census Bureau, 2000). This is equivalent to over 32 million people in each group. There is also little empirical knowledge about the mental health problems of nonwhite adolescents (Grisso & Barnum, 2000). Therefore, it is critical for nurses and other health professionals to include issues relevant to these groups in their research. In addition, adolescent mental health is a growing concern for all ethnic groups. More than half of early adolescents have had at least one physical fight in the last year (Fetro, Coyle, & Pham, 2001; DuRant, Smith, Kreiter, & Krowchuk, 1999). More than half of middle-school students have tried alcohol and more than 17% have tried marijuana (Fetro et al.; DuRant et al.). By the time adolescents reach high school, their rates of clinical depression reach adult levels with over 20% of adolescents being affected (Lewinsohn, Rohde, & Seeley, 1998). Problem Research is needed that examines the relationships between individual and social factors and mental health outcomes in adolescents. This area of research has typically neglected factors that are relevant to ethnic minorities. Discovering what attributes or strengths specifically may protect minority adolescents from emotional and behavioral problems is an understudied area of research. More research also is needed that focuses

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2 on positive factors that may be associated with better mental health outcomes for adolescents. Purpose The purpose of this study was to evaluate the relationships between ethnic identity, mentorship, and adolescent mental health from a nursing perspective. Multiple factors in various domains are related to mental health functioning. This study specifically addressed these individual and soci al factors and their relationship to mental health functioning in middle-school students. Conceptual FrameworkNeuman Systems Model The Neuman Systems Model provides a broad conceptual framework for research that focuses on issues from health promotion and disease prevention to acute illness. It is one of the most widely used nursing models. According to Neuman (1995), nursing can be defined broadly to include prevention as intervention (p. 33). Neuman defined the client as a system that could potentially be an individual, a family, a community, or even a social problem. The emphasis in the model is on system stability or health. For this research, the system under consideration is that of an individual adolescent; and system stability is defined as the absence of the signs and symptoms of mental disorder. The client system is made up of several levels of protection from the onset of illness (Neuman, 1995). The layers of protection are as follows: Flexible line of defense is an outer protective barrier to the client system that is called into action first in the face of environmental stressors. It protects the wellness or healthy state; and it can expand or contract based on changes in the system and the environment. In this study, the presence of a mentor or a high level of achieved ethnic identity may maintain mental health as evidenced by no adverse symptoms. Normal line of defense is the conceptual line that delineates and defines health. If the normal line of defense is penetrated, illness has occurred and adverse symptoms are present.

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3 Lines of resistance are activated after illness has occurred. Factors at this level move the client toward recovery and health again. For example, an adolescent may seek out social support from a mentor in response to depressive symptoms. The lines of resistance are activated after the onset of symptoms and include any coping mechanisms or responses that may lead toward recovery. Central core contains factors that are necessary for survival or are considered common to all individuals. In the case of an individual, factors include bodily organs, cognitive ability, genetic make-up and identity structure. Neuman (1995) described the ego structure as a core construct. Aspects of this may be inherent (e.g., temperament). Ones sense of identity also can be conceptualized as a core construct that continues to develop over time. A further extension of this model is to conceptualize ethnic identity as a core aspect of self that also develops over time. The closer adolescents get to an achieved sense of ethnic identity, the more protected they may be from the onset of adverse mental health outcomes. A primary goal of nursing research is to identify existing and potential protective and risk factors related to illness. Another goal is to develop theoretically based interventions (Neuman, 1995; Fawcett, 2000). This study lays the foundation for nursing interventions that could target individuals' strengths and assist them in resisting illness or in returning to health after the onset of illness. This conceptual model provides a guiding framework in this study of factors that are potentially protective against adverse mental health outcomes in adolescents. Mental Health Functioning Mental health functioning is the outcome of interest in this research study. This construct is extremely broad and complex. A detailed explanation of all of the factors involved in determining this construct is beyond the scope of this project. However, this construct fits easily into the systems model described above. Each level of the systems model includes interacting variables from the physiological, psychological, sociocultural, developmental and spiritual domains (Neuman, 1995). Mental health functioning is determined by a complex interplay among several domains and multiple factors within each domain. This study targets concepts that are specifically in the

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4 individual and socio-cultural domains and their relationship to mental health functioning in adolescents. Middle-Range Theories This section describes the theories that are specific to the variables under study. These theories provide the groundwork for this study and much of the literature described in Chapter 2. The social and developmental theories of ethnic identity are described, as well as the theories related to the mentorship of adolescents. Ethnic Identity Development Using the developmental theories of Erikson (1968), and Marcia (1980), as well as the social identity theory of Tajfel (1981), Phinney (1989; 1992) constructed a theory of ethnic identity development that occurs during adolescence and early adulthood According to Erikson (1968), identity development is the primary task of adolescence. During adolescence, the most logical framework for examining the construct of ethnic identity is a developmental perspective. Tajfel (1981) defined social identity as t hat part of an individuals self-concept which derives from his (or her) knowledge of his (or her) membership of a social group (or groups) together with the value and emotional significance attached to that membership (p. 255). Social identity, in this context, is the aspect of identity related to ethnic group membership. Ethnic group membership can enhance, have minimal effect on, or be detrimental to general self-concept (Tajfel, 1981). Ethnic identity is defined as a general phenomenon that applies to all ethnic groups (Phinney & Tarver, 1988; Roberts et al., 1999). It is, however, of particular importance to minority group members (Phinney, 1992). This probably occurs because, when in the ethnic minority, ethnic group membership becomes a more important aspect

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5 of identity. Phinney (1989; 1990; 1992) described three phases of ethnic identity development: unexamined, exploration, and achievement. This differs from other theories because it has been applied to many ethnic groups. The unexamined phase is typified by the irrelevance of ones membership in an ethnic group to their self-concept. The exploration phase is a period of increased participation in cultural activities, increased interest in the history of their ethnic group, and increasing relevance to personal identity. The achieved phase includes both a positive connection to ones group and continued participation in cultural activities and behaviors (Phinney, 1992). This study focuses on the level of overall ethnic identity achievement. Mentoring Theories The two main theories that have been used to define and understand mentoring are attachment theory (Bowlby, 1969; Ainsworth, 1989) and social learning theory (Bandura, 1977). The definition of a mentor includes aspects of both theories. Neither one independently allows for full understanding of mentoring. In combination, the definition of a mentoring relationship becomes clearer and the mechanisms of any benefits these relationships may provide to adolescents are better understood. Ainsworth (1989) extended attachment theory beyond parent-child relationships to friendships, pair bonds and other affectional bonds. Mentor-mentee relationships include an affectional component (Rhodes, Ebert, & Fischer, 1992). These relationships provide unique support that is not necessarily available within peer or parental relationships (Beam, Chen, & Greenberger, 2002). There are several ways in which this type of relationship may positively influence adolescents. It is possible that attachment relationships with key non-parental adults, simply provide more social support (Rhodes, Ebert, & Fischer, 1992; Scales & Gibbons, 1996). These relationships also may serve a

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6 therapeutic purpose. They may be corrective relationship experiences in instances when the parent-child relationships are insecure (Rhodes, Haight, & Ernestine, 1999). The affective aspect of the mentor-mentee relationship can be easily conceptualized based on attachment theory. The main concept from social learning theory that applies to mentoring is observational or vicarious learning (Bandura, 1977). Vicarious learning is the ability to learn from the behavior of others. One obs erves both the beneficial and detrimental outcomes that result from specific behaviors. Positive role models demonstrate prosocial behavior, and adolescents learn that this is a viable behavioral option. This defines one mechanism of the behavioral influence of role models. Role modeling is a key concept within the mentoring literature and in the development of mentoring programs (Cavell & Hughes, 2000; Blum & Jones, 1993). Social lear ning has also been the basis of traditional prevention efforts in the form of social skills training and other teacher-learner models of intervention (e.g., Andrews, Hops, & Duncan, 1997). Role modeling is, however, different fr om mentoring. Famous people or world leaders can serve as role models without the context of a relationship. Mentoring has the added component of a supportive, trusting relationship. In a review of youth program evaluations, independent of the type of program, adolescents improved more on behavioral outcomes if there were caring adults involved in program implementation (Roth, Brooks-Gunn, Murray, & Foster, 1998). Consistent and stable relationships had an impact on adolescent outcomes. This provides evidence that the ability of a mentor to serve as a role model stems partly from the quality of the relationship between the adolescent and the mentor.

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7 In summary, it is possible that some adolescent-mentor relationships have more of an attachment component, while others serve more of the role-modeling function. It is also likely that the two functions of mentors may be inextricably linked. In other words, for a mentor to have social influence on an adolescent, there must be an affectional bond present. In this study, these two functions of the mentor-mentee relationship are not differentiated. The presence of mentors in the lives of adolescents was assessed. In addition, the emotionally supportive aspects of these relationships and the amount of influence adolescents believe the mentor has over their life decisions and behaviors were measured. Ethnic Mentors An additional characteristic of the adolescent-mentor relationship that this study examined was the ethnic match of the mentor and the mentee. The theoretical frameworks described above have not specifically addressed this concept. However, social learning theory and social identity theory can be applied to the concept of an ethnic role model (Brown, 1998, p. 170) and/or an ethnic mentor (the latter term is used in this study). That is, the ethnic match of a mentor may facilitate vicarious learning and may provide a sense of commonality that allows for easier attachment. Mentoring programs for at-risk adolescents typically attempt to ethnically match mentors and mentees; however, this is not necessarily theoretically or empirically grounded. Ethnic matching has been studied in other areas. For example, research has demonstrated that ethnically matching adoptive parents and children can enhance ethnic identity for Hispanic adolescents (Andujo, 1988). However, the ethnic identity of adolescents matched with mentors that have the same ethnic background has not been extensively studied. An additional goal of this project was to assess the potentially

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8 moderating effect that this ethnic match had on the relationship between an adolescents ethnic identity and his or her mental health functioning. Conceptual and Operational Definitions Mental Health Functioning Mental Health Functioning is defined as the absence of adverse mental and behavioral symptoms. It is differentiated from the broad construct of general healthy psychological development. Healthy psyc hological development can broadly include emotional, cognitive, and biological factors. This study focuses on the presence or absence of adverse emotional or behavioral symptoms. The presence of these symptoms has also been called psychopathology in the literature (Lewis, 2000). The investigation of psychopathology over the course of adolescent development has been defined as the study and prediction of maladaptive behaviors and processes across time (Lewis, 2000, p. 3). The specific aspects of mental health functioning that were assessed in this study were mood symptoms (i.e., depressed, anxious, angry and irritable moods); somatic symptoms due to anxiety (e.g., elevated heart rate and stomachache); and substance use (alcohol and other drugs). Mental health can be conceptualized as the presence of positive symptoms (e.g., high self-esteem); however, utilizing the above definition for this study allows the results to have direct implications for the applied science of psychiatric and mental-health nursing. This construct was operationalized with The Massachusetts Youth Screening Instrument-Second Version (MAYSI-2; Griss o, Barnum, Famularo, & Kinscherff, 1998). Four types of adverse mental health outcomes were measured. These were each measured

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9 with a specific subscale of the MAYSI-2. The subscales included three mood-related measures and one measure related to substance use. These were the four subscales used: 1. Depressed-anxious mood (8 items)experiences of a mixture of depressed and anxious feelings. 2. Somatic complaints due to anxiety (6 items)experiences of bodily symptoms associated with anxiety. 3. Angry-irritable mood (9 items)experiences of frustration, anger, and irritability. 4. Alcohol and other drug use (8 items)patterns of use of alcohol or drugs (Grisso & Barnum, 2000). Ethnic Identity Ethnic identity can be viewed as a general phenomenon that is relevant to all ethnic groups. Different ethnic groups can have various belief systems, cultural practices, even languages. However, it is the group identity or the sense of identification with, or belonging to, ones own (ethnic) group th at applies to all groups (Phinney, 1992, p. 158). This construct includes exploration/s earch and affirmation/belonging (Roberts et al., 1999). The exploration factor is the developmental and cognitive component (J. S. Phinney, personal communication, November 13, 2001). It includes searching for information related to ones ethnicity and participation and involvement in ethnic and cultural activities (Roberts et al., 1999). The affirmation and belonging factors are the affective components, (J. S. Phinney, personal communication, November 13, 2001). This includes ethnic pride, a positive feeling about ones group, and a commitment to that group. It also includes a feeling of be longing and attachment to ones ethnic group (Roberts et al., 1999).

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10 The Multigroup Ethnic Identity Measure (MEIM) was used as a measure of ethnic identity (Phinney, 1992; Roberts et al., 1999; J. S. Phinney, personal communication, November 13, 2001). This likert scale consists of 12 items. Responses range from Strongly Disagree (1) to Strongly Agree (5). Higher scores indicate a more achieved sense of ethnic identity. Mentors A mentor is defined as a nonparental adult who has a trusting relationship with the adolescent (Rhodes & Davis, 1996). According to the Oxford dictionary, a mentor is defined as an experienced and trusted advisor (Pearsall, 1999, p. 890). Naturally occurring mentors can be relatives, teachers, community members, or other important adults. They provide both role-modeling and emotional support (Grossman & Rhodes, 2002). Additional defining aspects of a mentor include relational factors. Adolescents believe they can count on the adult, that the adult cares for them deeply, inspires them to do their best, and has influence over important decisions that adolescents make (Rhodes & Davis, 1996, p. 216). The presence of a natural mentor was operationalized with the following question previously used by Rhodes and colleagues (1992, p. 449; Appendix A): Other than your parents or whoever raises you, is there an adult in your life (a mentor, or positive role model) who you go to for support and guidance? Mentoring quality factors Beyond the perception of the presence of a natural mentor, descriptive factors can serve as a measure of quality of the mentoring relationship. Several factors have been shown to influence the association between the presence of a mentor and positive

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11 outcomes (Grossman & Rhodes, 2002; Grossman & Tierney, 1998). These factors have been examined more in the mentoring program evaluation research than in the research done on natural mentors. The duration of the relationship has been found to be important in mentor-mentee matched relationships (Grossman & Rhodes, 2002). Brief (less than 6 months duration) relationships can actually have detrimental effects (Grossman & Rhodes, 2002). Other factors have been less well studie d. The frequency and duration of typical contact may also be important to the quality and potential influence of the relationship. The most extensively studied mentoring program, Big Brothers Big Sisters, sets minimum levels of contact between their matched mentors and mentees (Grossman & Tierney, 1998). Mentors must spend a minimum of 3 to 4 hours with their mentees at least two to four times per month. This program has demonstrated significant positive mental health outcomes for its participants (Grossman & Tierney, 1998). The final quality factor that was addressed in this study is the amount of trust adolescents have in their mentors and how much they confide in their mentors. These aspects have been considered part of the definition of a mentoring relationship (Rhodes et al., 1992). This includes how much the adolescents tell their mentor about good and/or bad things that happen to them. It also addresses the adolescents perception of how much this individual influences their behavior. A series of items were developed to operationally define the quality mentoring relationship constructs (Woolard & Greig, 2001). These items included several ordinal response items that assessed the duration of the relationship and the frequency and duration of typical contact. Also, based on previous measures and definitions a Trust/Confiding likert scale was developed (Appe ndix A; Institute of Behavioral Science,

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12 1990 as cited in Centers for Disease Cont rol and Prevention, 2002; Nakkula et al., 1990; Rhodes et al. 1992). The Trust/Confiding scale included seven items with the following response options: (a) a little bit, (b) somewhat, and (c) very much. Questions included items such as How much do you feel you can count on this person to be there for you? A mean score was calculated to reflect the amount of trust or confidence an adolescent perceives in reference to his or her mentor. Responses from all of the items described were used to determine the quality of the existing mentoring relationship. Minimum levels were determined based on previous programmatic and empirical work. The following criteria were used as the minimum for a quality relationship: 1. Duration of the relationship : those that indicate the relationship has lasted longer then 6 months (Grossman & Rhodes, 2002). 2. Frequency of visits : those that indicate that they spend time with their mentor at least weekly (Grossman & Tierney, 1998). 3. Length of visits : those that indicate that they spend at least 1 hour per visit with their mentor (Grossman & Tierney, 1998). 4. Trust and confiding scale : those that scored at least a mean of 2.0 were categorized as having a quality mentor. Mentor characteristics Other aspects related to the characteristics of the mentor were also obtained. These aspects included the ethnic match of the mentor. An ethnically matched mentor (i.e., Ethnic Mentor) is a mentor that is of the same ethnic background as the adolescent. This person meets the above definition of a mentor with the added condition of being an ethnic match with the adolescent. The gender and mutual community membership of the mentors were also assessed. Also, the relationship that the mentor has to the adolescent (e.g., teacher,

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13 minister, relative, etc.) was assessed. These characteristics were measured using a series of categorical items developed by the principal investigator (Appendix A). Research Aims and Hypotheses Aim 1.Evaluate the relationship between the presence of a mentor and the mental health functioning of the mentee. This will provide information related to the existence of natural mentors (e.g., extended relatives, teachers, ministers) in the lives of adolescents. The mental health of those with and without quality mentoring relationships also was examined. This information is important because there have been very few surveys that have assessed the presence of natural mentors in school samples or defined the nature and quality of these relationships. The studies that have found a relationship between the presence of mentors and the mental health of adolescents have been conducted with non-normative samples (e.g., pregnant teens). Based on existing re search findings (Rhodes et al., 1992; Rhodes, Contreras, & Mangelsdorf, 1994; Zimmerman, Bingenheimer, & Notaro, 2002), Hypothesis 1 was reached. Hypothesis 1.Those adolescents that have a natural mentor have better mental health functioning than those that do not have a mentor. Aim 2.Examine the relationship between the ethnic identity of the adolescent and his or her mental health functioning. This will provide important new information about the association of ethnic identity and general aspects of mental health functioning (i.e., mood disturbance and substance use). Although some of these aspects of mental health have been studied, results have been mixed. Existing research has demonstrated that there are differences in the relationship of these variables between ethnic groups and that this construct is more salient to ethnic minority group members (e.g., Phinney, 1992; Roberts et al., 1999).

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14 Based on existing research findings (Robe rts et al., 1999; Brook, Balka, Brook, Win, & Gursen, 1998; Brook, Whiteman, Balka, Win, & Gursen, 1998; Scheier, Botvin, Diaz, & Ifill-Williams, 1997), Hypothesis 2 was reached. Hypothesis 2.There is a relationship between ethnic identity and mental health functioning in minority adolescents. Aim 3. Evaluate the potential moderating effect of an ethnic mentor on the relationship between the ethnic identity of the mentee and his or her mental health functioning. This will provide information that has not been specifically addressed in the existing literature. Although ethnicity is assumed to be a critical factor in matching mentors and mentees in youth development programs, this has not been extensively studied. There has been research supporting the idea that those who are ethnically matched in an adoption situation do have higher ethnic identity. Based on research from the adoption literature (e.g., Andujo, 1988), Hypothesis 3 was reached. Hypothesis 3:The presence of an ethnically matched mentor moderates the relationship between ethnic identity and mental health outcomes in minority adolescents. Summary This chapter has described the general background and main purpose of this study. The conceptual and theoretical underpinnings for this research were also described (see Figure 1-1 for Conceptual Model). Conceptual and operational definitions, specific research aims, and hypotheses were detailed. Lastly, a synopsis of the background evidence for the research hypotheses was provided along with each specific hypothesis.

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15 Figure 1-1. Conceptual model Neuman Systems Model Attachment Theory Social Learning Theory Identity Development Theory Social Identity Theory Mentoring Ethnic Identity Protective Against Adverse Mental Health Outcomes DepressedAnxious Somatic Complaints Angry-Irritable Alcohol/Drug Use Dependent Variables Mi d -R a n ge Th eo ri es Independent Variables

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16 CHAPTER 2 REVIEW OF LITERATURE This chapter is an integrative review of the relevant literature. Nursing relevance and related mental health research in adolescents is detailed first. Second, literature that examines various psychological and behavioral factors that have been associated with ethnic identity is described. Lastly, mentoring literature is reviewed; including program evaluation research and research focused on naturally occurring mentors. Relevance to Nursing-Adolescent Mental Health The discipline of nursing has a history of evaluating mental health issues across the lifespan. Nurse researchers have also been involved in assessing developmental needs of various groups and implementing prevention and intervention programs in response to those needs. This study is unique within the field of nursing because there has been no research examining the presence of natural mentors and ethnic identity in the period of early adolescence. However, this study does join a growing body of literature that addresses mental health functioning in minority adolescents (Doswell, Millor, Thompson, & Braxter, 1998; Gall, Pagano, Desmond, Perrin, & Murphy, 2000; Guthrie & Low, 2000; Guthrie, Young, Williams, Boyd, & Kintner, 2002; Long & Boik, 1993). Nurse researchers have investigated adolescent substance use in multi-ethnic samples (Long & Boik, 1993; Guthrie et al., 2002; Guthrie & Low, 2000;). Long and Boik surveyed 625 multi-ethnic elementary and middle school students about their alcohol use and various measures of beliefs and self-concept. The sample was followed

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17 longitudinally. There were no significant diffe rences in alcohol use between the Native American, Hispanic or European American participants. However, church attendance, prayer, academic achievement, and a stable adult in the home were all protective against alcohol use. In contrast, negative attitudes about school and a poor self-concept were associated with higher levels of alcohol use (Long & Boik,). Other nurse researchers have examined specifically African American adolescent females and have developed theoretical models to explain substance use and other aspects of mental health (Doswell et al., 1998; Guthrie et al., 2002; Guthrie & Low, 2000). Guthrie and Low developed a theoretical framework that proposes that multiple social factors (sexism, racism, ageism) influence adolescents self-efficacy, which mediates the use of substances. An aspect of this model was tested on a sample of 105 African American adolescent girls (Guthrie et al). The results indicated that experiences of discrimination were related to cigarette smoking. This relationship was partially mediated by daily hassles, a measure of stress (Guthrie, et al.). Other work with African American female adolescents has evaluated the relationships between family contextual factors, biological development and self-e steem. Specific findings included establishing the relationship between early onset of menarche and poor global self-image (Doswell et al.). Less nursing research has focused on the externalizing behavior of violence or the related mood symptoms (i.e., anger/irritability). An exception is a survey of 213 violent and nonviolent adolescent girls (Smith and Thomas, 2000). The two groups were compared on several measures. The violent girls had more generalized anger, while the nonviolent girls were more likely to report being angry after specific events. Feeling angry enough to hit someone was associated with higher levels of loneliness, somatic

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18 symptoms of anger, and peer rejection (Smith & Thomas). This study highlights the relevance of exploring the angry and irritable mood symptoms of adolescent girls. Lamb and Puskar (1991) conducted a school-based survey of 69 high school students in order to assess the base-line mental health needs of the school. Rates of suicidality and depression were 16% and 14%, respectively. Measures of anger expression and control were also given to the participants. Those who scored high on the depression and suicidality measures were more likely to report high anger expression and low anger control (Lamb & Puskar). Nursing research has also examined causal models of the depression and outcomes due to depression in early adolescents (Mahon & Yarcheski, 2001; Yarcheski & Mahon, 2000). Utilizing large multi-ethnic samples of middle school students, relationships between stress, state-anxiet y, well-being, conflict, social support, and depression were evaluated. Findings were th at state-anxiety had a direct effect on depression, while stress was found to have a direct and indirect effect on depression (Yarcheski & Mahon). Outcomes of depre ssion included direct effects on well-being, conflict, and perceived social support (Mahon & Yarcheski). Nurse researchers working in school-based settings have assessed general psychosocial functioning of adolescents (Gall et al., 2000). In a predominately Hispanic (62%) high school, 383 adolescents were screened for general psychosocial dysfunction. Fourteen percent scored above a cutoff criterion to indicate those that may require intervention. Females, teen-parents, and those with Medicaid insurance were more likely to be above the cutoff. There was no difference between the ethnic groups. Those with higher scores had higher rates of tardiness and absenteeism. The adolescents that were referred for mental health treatment had decreases in their rates of tardiness and

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19 absenteeism, while the other group did not (Gall et al.). This study demonstrates how screening within a school-based health center by nurses can improve some academic indicators for adolescents with adverse mental health symptoms. These studies demonstrate the value of a nursing developmental perspective in research evaluating mental health in minority adolescents. Nurse researchers have examined predictors of substance use, anger, and violence (Guthrie et al., 2002; Long & Boik, 1993; Smith & Thomas, 2000). They have also developed theoretical models to explain substance use and depression in adolescents (Guthrie & Low, 2000; Yarcheski & Mahon, 2000). School-based surveys and screening procedures have demonstrated the usefulness of these methods for identifying adolescents suffering from adverse mental health symptoms (Gall et al., 2000; Lamb & Puskar, 1991). These methods also provide assessments of the scope of the problem of adverse mental health symptoms in multiethnic adolescents. Together this work provides precedence for this type of research within the field of nursing. The following sections detail research primarily from the developmental psychological literature and lay the foundation for this study. Ethnic Identity Adolescents are beginning to explore and formulate identities in several domains of life. Choices adolescents make concerning their developing identities can have an impact on long-range outcomes. For example, an adolescent may choose to become someone who is sexually active, uses substances, or plays sports. Other aspects of identity are ascribed, for example ethnicity. During adolescence, the cognitive and affective aspects of ethnic identity are beginning to take shape. In the following sections, research is reviewed that has evaluated the role of ethnic identity during adolescence for adolescents from several ethnic groups. Special

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20 emphasis is made on studies that have examined the ethnic identity development of Hispanic and African American adolescents and how this construct relates to various measures of mental health. Qualitative and quantitative research that evaluated the developmental model of ethnic identity is presented. Research that relates ethnic identity to several positive aspects of psychological development is reviewed. Also, research that has conceptualized ethnic identity within a resiliency framework is described. Lastly, research that has compared levels of ethnic identity to various mental and behavioral problems is reviewed. Ethnic Identity Development The majority of the research on ethnic identity development has been done with adolescents and adults. The concept of ethnic identity development prior to adolescence has been discussed only as it relates to racial or ethnic socialization (e.g., Bowman & Howard, 1985; Caughy, OCampo, Randolph, & Ni ckerson, 2002; Rotheram & Phinney, 1987; Thornton, Chatters, Taylor, & Allen, 1990) Rotheram and Phinney (1987) defined ethnic socialization as the developmental processes by which children acquire the behaviors, perceptions, values, and attitudes of an ethnic group, and come to see themselves and others as members of such groups (p. 11). This definition clearly links ethnic socialization to the development of ethnic identity, the aspect of identity related to ethnic group membership. Ethnic socialization practices and their long-term effects on ethnic identity development, however, rarely have been studied. Research with African American families has focused on the many facets of racial socialization (Bowman & Howard, 1985; Ca ughy et al., 2002; Thornton et al., 1990). In general, the majority of African American parents do provide some level of racial or ethnic socialization. Developing racial or ethni c pride is only one part of this process.

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21 Other aspects include spirituality, preparation for bias, promotion of cultural mistrust, potential racial barriers, egalitarian values, aspects of heritage, traditional practices, and general self-development (Bowman & Howard; Caughy et al.; Thornton et al.). Racial socialization practices by parents has been linked to fewer behavioral problems in preschool aged children (Caughy et al., 2002). Also, adolescents and young adults who had exposure to racial socialization practices by their parents had increased levels of personal efficacy and better academic achievement than those with no reported history of racial socialization (Bowman & Howard, 1985). Ethnic or racial socialization seems to be associated with positive outcomes. Caughy and colleagues held parental involvement constant and still found that racial socialization practices were associated with positive outcomes for children. These parenting practices are probably closely related to later levels of ethnic identity. However, other community, peer, and school influences become increasingly important as children enter adolescence. Adoles cents are faced with the task of exploring and defining their identity in several domains. Ethnic identity has been relatively understudied in comparison to other aspects of identity (e.g., academic, social, physical). These aspects of identity have been conceptualized as universal. According to Cross (1991), ethnic identity has been viewed as separate from the general aspects of identity, as well as separate from ones state of mental health. The current state of the research in adolescents, however, demonstrates the role ethnic identity plays in the lives of ethnic minorities. It is not only central to the identity of many adolescents, but has been associated with multiple measures of mental health functioning. Qualitative research with a multi-ethnic (African American, Latino/a, Native American, European American, and Asian) sample of middle and high school students

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22 created the basis for much of the current literature in this area. Interview techniques were used in a series of studies investigating the salience of this construct and the potential existence of developmental phases of ethnic identity formation (Phinney, 1989; Phinney & Chavira, 1992; Phinney & Tarver, 1988). A sample of 48 black and white 8th graders were interviewed in an urban junior high school and were asked open-ended ques tions about ethnic identity. Responses were categorized into searching or exploring behavior and commitment to or ethnic identity achievement (Phinney & Tarver, 1988). Over 30 of the participants were moderately high in searching, and 29% were moderately high in commitment. There was a trend for more searching in the African American female adolescents. The construct of ethnic identity was less salient for the white adolescents. They were less likely to discuss their own group membership and more likely to discuss relations with other groups (Phinney & Tarver). This study suggests the salience of ethnic identity for black adolescents, particularly girls. Additional qualitative research furthered the evidence for a developmental theory of ethnic identity (Phinney, 1989; Phinney & Chavira, 1992). Phinney (1989) utilized several existing developmental theories to code interview data from a sample of Asian, African American, Hispanic, and European Am erican 10th graders. Results indicated that an adaptation of existing theories was needed to explain ethnic identity. A three-phase theory was developed. Students were categorized into an unexamined, a moratorium (exploring without commitment), or an achieved group. The European American response could not be categorized (Phinney). This study provided some initial evidence for a developmental theory of ethnic identity for minority adolescents.

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23 Phinney and Chavira (1992) conducted a longitudinal study of 18 African American, Hispanic, and Asian American hi gh school students. These adolescents were interviewed to determine their phase of ethnic identity development and then followed into young adulthood. Most of those adolescents that were in the unexamined or moratorium phases of development at baseline progressed to a higher phase over time. Those that were in the achieved phase at baseline were also in the achieved phase at follow-up (all except one). These findings provide some preliminary evidence for the developmental progression of ethnic identity and a relatively stable end state of an achieved ethnic identity (Phinney & Chavira). Dubois, Swenson, Tevendale, and Hardesty (2002) found no significant difference in levels of ethnic identity between the African American and European children that were in 5th and 6th grade. However, participants in their study that were in 7th and 8th grade did differ. The African American students had significantly higher ethnic identity than their European American classmates (DuBois, Burk-Braxton, et al.). This suggests that ethnic identity may increase over time, particularly for ethnic minorities. Phinney, Ferguson, and Tate (1997) compared 547 8th and 11th graders and found higher levels of ethnic identity in high school students than middle school students. This work provides additional evidence for the theory of ethnic identity development across the span of adolescence. The following sections review literature on ethnic identity and various aspects of mental health functioning. The majority of the research in the following sections has assessed the overall level of ethnic identity. Exceptions are highlighted, as are the specific aspects of ethnic identity that were assessed in the various studies. Unless

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24 otherwise noted, the term ethnic identity refers to the overall level of ethnic identity achievement for the adolescent. Ethnic Identity and Positive Mental Health Functioning The majority of research that has measured ethnic identity in adolescents has compared this construct to positive aspects of mental health and psychological functioning. The most commonly studied construct has been self-esteem (See Phinney, 1991 for a review). Other research has compared ethnic identity levels to aspects of selfconcept, self-efficacy, and academic achievement (Beale Spencer, Noll, Stoltzfus, & Harpalani, 2001; Phinney, 1992; Phinney & Chavira, 1992; Smith, Walker, Fields, Brookins, & Seay, 1999;). Effective coping styles and culturally based coping have also been associated with ethnic identity (Constantine, Donnelly, & Myers, 2002; McMahon & Watts, 2002; Phinney & Chavira, 1995) Research connecting ethnic identity and self-esteem, has consistently found a positive relationship (Phinney, 1992; Phinney & Chavira, 1992). Ethnic identity was positively correlated with self-esteem in the mi nority participants of a sample of 417 high school and 136 college students. This was not found in the white students, with one exception. Ethnic identity was associated with self-esteem for the white students that were the minority within their school (Phinney, 1992). This demonstrates that self-esteem is related to ethnic identity for those with minority status and that the relevance of this status may be contextual. In other words, minority status in one setting may make ethnic identity salient in that context despite majority status in the larger social context. Ethnic identity was also positively related to self-esteem levels longitudinally in a sample of African American and Hispanic high school students that were followed into young adulthood (Phinney & Chavira, 1992). Those with an achieved ethnic identity had

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25 higher self-esteem at both baseline and follow-up. Interestingly, self-esteem was found to be relatively consistent over time (self-esteem at baseline and follow-up were highly correlated), while ethnic identity underwent developmental progression (phase of ethnic identity development at baseline was not related to phase at follow-up; Phinney & Chavira). In a sample of 5,423 Mexican American, African American, and European American early adolescents, ethnic identity was associated with increased levels of coping, general mastery, self-esteem, and optimism (Roberts et al., 1999). Aspects of this result were confirmed in a sample of 100 6th grade African American students (Smith et al., 1999). Ethnic identity was linked directly and indirectly self-concept and selfefficacy (Smith et al., 1999). Ethnic identity was directly related to general mastery, emotional well-being, as well as peer and familial aspects of self-concept. It was also positively correlated with perceived self-efficacy in the academic and career domains. Interestingly, ethnic identity had a direct negative effect on prosocial attitudes (i.e., use of legitimate methods for goal attainment). This finding was offset by the indirect effect ethnic identity had on prosocial attitudes via self-efficacy (Smith et al.). Some research that has supported the notion of differential effects over the course of ethnic identity development has been in the area of academic achievement (Beale Spencer et al., 2001). Academic achievement is a somewhat distal outcome variable in comparison to self-esteem. However, this is an important area of functioning during adolescence. Beale Spencer and colleagues (2001) evaluated a sample of 562 African American middle-school students, 80% to 90% of which were receiving free lunch. In this study, standardized test rankings were used to operationalize academic achievement.

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26 Four stages of racial identity were described: Eurocentric (unexamined acceptance of the majority culture), transitional reactive Afrocentrism (an early exploration of an Afrocentric identity, considered superficial identification by the author), and proactive Afrocentrism (the achieved, secure sense of racial identity; Beale Spencer et al., p. 26). Although these terms are specific to African Americans and differ from those described in the ethnic identity research, the findings are still relevant to the proposed research. The Eurocentric (unexamined) and the reactive Afrocentrism (exploration/searching) phases were associated with significantly lower levels of academic achievement. In contrast, the proactive Afrocentrism (achieved) phase of racial identity development was positively associated with academic achievement (Beale Spencer et al., 2001). These findings suggest that certain phases of ethnic identity development may be a vulnerable time for adolescents, but that an achieved ethnic identity is associated with adequate functioning within the academic domain. The relationship between ethnic identity and coping style within intergroup relationships was examined in a study of 60 multi-ethnic parent-adolescent dyads (Phinney & Chavira, 1995). Ethnic socialization, ethnic identity and coping styles in the face of prejudice and stereotypes were st udied. Findings were that those high school students with high levels of ethnic identity were more likely to have proactive coping styles. They were more likely to use discussion, self-affirmation, and attempts to disprove stereotypes than to utilize passive or aggressive coping styles (Phinney & Chavira). This suggests that ethnic identity has a positive effect on the ability to cope with the stress of prejudice. McMahon and Watts (2002) found that higher ethnic identity was associated with an active coping style in a predominately African American early adolescent sample.

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27 This coping style included direct problem-solving, seeking understanding, and positive cognitive restructuring (McMahon & Watts). Constantine and colleagues (2002) found that public self-esteem and the importance of collective self-esteem (defined similarity to ethnic identity) were associated with culturally specific coping behaviors or Africultural coping styles. In a sample of 106 African American adolescents, public self-esteem (or how one believes their group is viewed by others) was associated with more use of spiritually-centered coping. Greater importance of collective self-esteem was associated with more collective coping (Constantine et al.). These studies provide significant evidence for the positive nature of ethnic identity development. Its association with positive psychological constructs (e.g., selfesteem, effective coping styles, self-efficacy) places it in the realm of healthy or adaptive development for those with minority status. Ethnic identity can be viewed as an aspect of self-concept that develops in psychologically healthy individuals. That is not to say that each individual requires the same level of this factor. It is only to say that a secure sense of oneself as an ethnic group member is a positive aspect of self-concept. Resiliency Models of Ethnic Identity The broad conceptual framework of risk and resiliency has been utilized within the disciplines of developmental psychology, medicine and nursing (Mandleco & Peery, 2000; Resnick, 2000; Werner, 1986). This framework is simple in that there are two primary concepts, risk and resiliency. Risk factors are those factors (e.g., individual, familial or social) that increase a persons chances of becoming ill? Resiliency factors are those factors that increase a childs or adolescents chances to complete healthy development in the face of adversity or known risk factors (Garmezy, 1991; Werner, 1986). The finding that some individuals are ab le to avoid serious illness or behavioral

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28 problems in spite of serious risk has led to a shift in the focus of research to the identification of factors that promote resiliency. A growing area of research has examined ethnic identity within the risk and resiliency framework (Brook, Balka, et al., 1998; Brook, Whiteman, et al., 1998; Miller & MacIntosh, 1999; Scheier, Botvin, Diaz, & Ifill-Williams, 1997). These studies have evaluated how protective ethnic identity achievement is against adverse mental health outcomes. Brook, Balka, and colleagues (1998) utilized several measures of ethnic identity in a sample of 627 African American adolescents. African American awareness and church attendance had a main effect on drug involvement. Those participants that reported more African American awareness and that attended church regularly had lower levels of drug involvement. The authors assessed risk and protective factors in multiple domains (personality, family, peer, and ecological). Ethnic identity enhanced personality, familial and peer protective factors. It protected against drug use in the face of personality (i.e., depressive symptoms) and ecological risk factors, such as drug offering strangers (Brook, Balka, et al.). A similar study of 555 Puerto Rican adolescents found that ethnic identity ameliorated several known risk factors for substance abuse and enhanced other protective factors (Brook, Whiteman, et al., 1998). Spanish language preference and immigrant status (as measures of ethnic identity) were both associated with lower levels of substance abuse. In addition, several aspects of ethnic identity (e.g., affirmation and belonging; familism; Hispanic awareness) were found to enhance resiliency or to be protective against substance use (Brook, Whiteman, et al.).

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29 A longitudinal study followed 1,303 7th grader s into 8th grade (Scheier et al., 1997). Risk factors were grouped into several domains (e.g., social skills risk like lack of assertiveness). High ethnic identity was actually associated with high alcohol use in African American and Hispanic adolescents. This association was especially strong in the presence of cognitive-affective risk (e.g., knowledge and expectancies related to alcohol use). In contrast, ethnic identity was protective against alcohol use in the presence of social skills risk (e.g., assertiveness, communication, etc.). Ethnic identity was also protective against marijuana use in the presence of social skills ands social influence risk (e.g., perception of peer usage and availability of marijuana; Scheier et al.). These findings, together, paint a complex picture about the relationship between ethnic identity and substance use. Although some aspects of ethnic identity may be protective against certain substances in certain individuals, many questions are still unanswered. In some cases ethnic identity may even increase risk, specifically for alcohol use (Scheier et al., 1997. One study examined ethnic identity as a resiliency factor that potentially protects adolescents in the domain of academic achievement (Miller & MacIntosh, 1999). In a sample of 131 African American adolescents that were at risk for academic failure, ethnic identity was positively correlated with grade point average and inversely related to school absenteeism. Ethnic identity also had a buffering or protective effect on academic achievement in the presence of risk factors. Specifically, when the participants reported a high amount of daily hassles, ethnic identity protected their level of academic achievement (Miller & MacIntosh). Simmons and colleagues (2002) found that community-wide ethnic identity was protective against depressive symptoms in the face of criminal victimization personally

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30 or within the family. The association between criminal victimization and depressive symptoms was larger for those early adolescents living in communities with lower ethnic identity. This study did not specifically utilize a resiliency framework, but it was a multicommunity study that included 810 children and early adolescents (Simmons et al.) This body of research provides an interesting framework for studying the protective nature of ethnic identity in minority adolescents. However, due to the nature of the resiliency framework, it is best suited for studying adolescents at risk for certain problems (e.g., substance abuse or academic failure). The construct of ethnic identity development is relevant to ethnic minority adolescents despite their risk status. Ethnic Identity and Adverse Mental Health Outcomes There is a growing body of literature that has examined ethnic identity and its relationship to adverse mental health outcomes in school-based samples. Based on the consistent finding that ethnic identity is directly related to positive mental health functioning, researchers have begun to examine the question of its relationship to negative outcomes. Findings have demonstrated that ethnic identity achievement has both direct and indirect effects on adverse mental health outcomes depending on the methodology utilized and the sample. The various findings related to this topic are described here and contradictory results are discussed along with methodological issues. Several studies have examined ethnic identity and levels of depressive and anxious symptoms (Arroyo & Zigler, 1995; Caldwell, Zimmerman, Bernat, Sellers, & Notaro, 2002; Dubois, Burk-Braxton, et al., 2002; McMahon & Watts, 2002; Roberts et al., 1999; Rotheram-Borus, 1989; Simons et al., 2002). Research involving African American and Puerto Rican high school stude nts found differential relationships between phases of ethnic identity development and internalizing and externalizing symptomology

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31 (Rotheram-Borus). An achieved ethnic identity was associated with less self-destructive behavior, but still was related to elevated levels of inattentiveness and nervousness. Those adolescents in the moratorium phase of development (the period of exploration/searching without commitment) were more likely to have internalizing and externalizing symptoms (Rotheram-Borus). This study lends evidence to the idea that exploration of ethnic identity may be a vulnerable time of development for adolescents, while the achieved phase is protective against some adverse symptoms. Findings related to mood symptoms and other internalizing symptoms have differed among ethnic groups. Roberts and colleagues (1999) found that ethnic identity was inversely related to depression and loneliness in a large sample of middle-school students. However, this finding was only in African American middle-school students and the effect sizes were very small. Ther e was no significant relationship between ethnic identity and internalizing symptoms in the Mexican American adolescents (Roberts et al.). In a sample of 91 African American high school students, high levels of racelessness, (identification with mainstream European American culture at the expense of ethnic identification) was associated with more anxious and depressive symptoms (Arroyo & Zigler, 1995, p. 904). In addition to racelessness, the researchers also measured collective (ethnic) self-esteem. This construct was inversely related to racelessness and also was positively related to self-efficacy (Arroyo & Zigler, 1995). This research suggests that sacrificing ones ethnic identity is related to an increase in anxiety and depressive symptoms. McMahon and Watts (2002) found no relationship between ethnic identity and depressive or anxious symptoms in a samp le of 209 middle school students at high risk

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32 for aggression. Simons and colleagues (2002) also found no association at the individual level in a community sample of 810 African American early adolescents. However, when community level ethnic identity scores were calculated, ethnic identity was related to fewer depressive symptoms (Simmons et al.). Other research has found indirect relationships between ethnic identity and mental health outcomes (Caldwell et al., 2002; DuBois, Burk-Braxton, et al., 2002). Ethnic identity was indirectly related to both emotional and behavioral problems via global self-esteem in a sample of 350 black and white elementary and middle school students (DuBois, Burk-Braxton, et al.). Racial Identity had an indirect effect on anxious and depressive symptoms via perceived stre ss in a sample of 521 African American high school students (Caldwell et al.). This latter study utilized a different conceptual framework that assesses aspects of racial identity, mainly the private regard and centrality of race (Sellers, Rowley, Chavous, Shelton, & Smith, 1997). Interestingly, the private positive regard was inversely related to perceived stress, and the centrality of race within the adolescents self-concept was positively related to perceived stress. There have been even fewer studies evaluating externalizing symptoms and ethnic identity. No research has actually evaluated ethnic identity and angry/irritable mood in early adolescents. However, attitudes about fighting and ethnic identity were evaluated in a sample of 330 multi-ethnic middle-school students (Arbona, Jackson, McCoy, & Blakely, 1999). The researchers controlled for two well-known risk factors for aggression: lack of parental involvement and negative peer behaviors. Ethnic identity was significantly related to non-fighting attitudes, in African American adolescents, but not in Hispanics.

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33 McMahon and Watts (2002) found a more achieved ethnic identity to be associated with both less approval of aggressive behavior and less self-reported aggression. This finding was in a sample of 209 predominately African American middle school students from an urban, predominatel y low-income area. This finding contrasted the finding that higher global self-esteem was associated with more self-reported approval of aggressive behavior (McMahon & Watts). Other research has examined ethnic identity and the externalizing symptom of substance abuse. In a study of 127 11 to 20 year olds, there was a discussion about the association between ethnic identity and high levels of substance abuse. However, this actual statistical finding was not detailed in the article (James, Kim, & Armijo, 2000). There were also differential findings be tween ethnic groups. The African American adolescents had the highest level of ethnic identity, while there was no significant difference between the Hispanics and European American adolescents (James et al., 2000). The findings contradict the predicted di rection of the relationship between ethnic identity and substance abuse. They also demonstrate the need for research that examines ethnic group differences. Conclusions The concept of ethnic identity has only been studied systematically in adolescents over the last 10-15 years. It is clear from this research, that young people are examining the meaning of their membership in ethnic minority groups. Adolescence is the logical period of the lifespan to study aspects of identity formation (Erikson, 1968). Ethnic identity has been consistently associated with positive aspects of psychological functioning in adolescents. Research has demonstrated that ethnic identity can serve as a resiliency factor in certain at risk adolescents, protecting them from adverse outcomes.

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34 Research measuring adverse mental health outcomes utilizing normative samples has had the most mixed results and is the sparsest. More research is needed in this area, especially research including Hispanic participants. Mentoring Most of the research examining mentors as a positive factor in children and adolescents lives has been in the area of program evaluation research. This research has widely varying types of methodologies in part because programs also vary widely. There is a growing body of research that has begun to examine naturally occurring relationships between adolescents and mentors. The effect these relationships have on different mental and behavioral problems is an understudied ar ea. There have also been very few studies that have systematically assessed factors that pertain to the quality of these relationships. The exceptions are detailed in this review. Relevant program evaluation research is also described in the following section. The work that has been done in the area of natural or existing mentors is reviewed. A discussion of ethnic mentors and related research is also reviewed. Program Evaluations Prevention research has indicated that broad based nonspecific prevention programs are effective at providing basic developmental needs to at risk children and adolescents (Grossman & Tierney, 1998; Tierney, Grossman & Resch, 1995). Recent research has demonstrated that relationships with mentors are developmentally normative (Beam et al., 2002). Mentoring of youths by consistent caring adults provides a developmentally necessary stable relationship for young people. Mentoring is an intervention that has been gaining a lot of attention in recent history. Mentoring, as a youth violence prev ention strategy, was named one of four best

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35 practices by the Centers for Disease Control along with family-based, home-visiting, and social-cognitive strategies (CDC, 2000). The Search Institute (2002) named the presence of a caring relationship with an adult as one of the key developmental assets for adolescents. One of the most scientifically rigorous program evaluations was done in association with Big Brothers Big Sisters of America (Grossman & Tierney, 1998). Big Brothers Big Sisters (BBBS) is the oldest a nd largest organized mentoring program in the United States. The program is unique because of the extensive supervision of matched youths and mentors by case managers. Mentors are thoroughly screened and trained prior to any contact with the youths. Mentors are also required to have consistent, regular contact for an extended period of time with the mentee. A sample of 959 7 to 14 year olds was randomly assigned to community-based mentoring or a wait-list comparison group (Grossman & Tierney, 1998). Measures were taken at baseline and after 18 months of mentoring. Participants in the experimental group had increases in positive attitudes toward school and increased perceived trust in their familial relationships. Girls had improved academic performance. Those that had a mentor also had reductions in aggressive behavior, substance use initiation, and school truancy (Grossman & Tierney). Rhodes, Grossman, and Resch (2000) also examined a mediation model using the data from this longitudinal evaluation of BBBS. Mentoring was found to have significant indirect effects on valuing school and academic achievement via improvements in parental relationships. The authors theorized that the mentoring relationships might have been corrective relationships that influenced the adolescents working models about

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36 relationships. In general, the relationships seemed to alleviate tensions in the parent-child relationships, which was associated with school-related improvements (Rhodes et al.). Grossman and Rhodes (2002) examined the duration of these mentoring relationships. The participants were categorized into four groups based on the duration of their relationship with their mentor and were evaluated on several outcome variables. Those adolescents that had relationships that lasted longer than 12 months reported less substance abuse and reported higher perceived self-worth, value of school, social acceptance, and scholastic competence. They also reported better relationship quality with their parents than those without a matched mentor. In contrast, those adolescents that had relationships that lasted less than six months reported significantly more alcohol use than the control group that received no mentoring (Grossman and Rhodes). The implications for these findings are that long lasting mentor-mentee relationships can be a positive influence on adolescents, while short lasting relationships may be damaging. The duration of a matched mentoring relationship was also an important factor in a program evaluation of a work-based ment oring program for African American high school students (Linnehan, 2001). Out of 202 eligible students (GPA at least 2.0), 34 were matched with a mentor in the first part of the school year and 34 were matched in the second half of the year. Those students that were matched for more than half the year had better grades and attendance rates then those that did not participate at follow-up (Linnehan). Grossman and Rhodes (2002) also examined factors that might predict relationship duration. Those matches with mentors that had higher incomes lasted longer, but other mentor qualities did not consistently predict relationship duration. They found that adolescents who had suffered abuse or we re referred for psychological or educational

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37 services were more likely to have a shorter relationship (Grossman & Rhodes). This is a key point because mentoring programs are increasingly seen as a potential way to help the adolescents at greatest risk for emotional and behavioral problems. Therapeutic mentoring programs have been developed specifically to address this issue (Cavell & Hughes, 2000 Jackson, 2002). Undergraduate psychology students enrolled in a 15-hour per week practicum, served as mentors for junior high school students with significant academic and behavioral problems (Jackson, 2002). The mentees had declines in parent-reported internalizing (depressed/anxious mood) and externalizing (behavioral) problems. They did not show improvements in adaptive behaviors or teacher-reported problems. However, other school related data was promising (i.e., reduced number of infractions). This program is an innovative way to bridge mentoring and professional services. However, the evaluation has methodological issues that plague much of the other program evaluation research. Lack of controls within the field of program evaluation is often a necessary reality. The types of mentoring program implementation are as varied as the research methodologies. Mentoring may take place in the community, in the school, or both. Mentoring programs have been initiated for elementary school, middle school, and high school students. Programs often include mentor ing as one piece of a broader intervention. This makes it difficult to differentiate effect s of mentoring alone. However, researchers have evaluated outcomes from aggression (Cavell & Hughes, 2000) to school attitudes and classroom behavior (Dennison, 2000) to se lf-efficacy and future possible selves (Lee & Cramond, 1999).

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38 Cavell and Hughes (2000) found significant decreases in parent reported aggression in a sample of 62 2nd and 3rd graders with behavior problems who had school-based therapeutic mentors (p. 199). These mentors were not specifically psychology students, but were provided with training specific to handling aggressive children. The children with these mentors had better outcomes then those in the standard mentoring group (Cavell & Hughes, p. 203). The mentors in the latter group had no training or ongoing supervision. Other research has found no significant improvement in classroom behavioral functioning in 25 3rd and 4th graders evaluate d in a pre-test post-test design (Dennison, 2000). These participants did, however, show academic improvement. They received an in-school peer tutoring and mentoring program. It is difficult to tease out if the tutoring was the key ingredient, or the mentoring, or both. Other mentoring programs, that do not have a tutoring component, have also demonstrated an effect on academic achievement (Blum & Jones, 1993; Grossman & Tierney, 1998). Blum and Jones (1993) found declines in the number of poor grades (Ds and Fs) and increases in better grades (Bs and Cs) in a sample of 22 middle school students that received mentoring from school personnel and a weekly peer support group. The mentoring involved daily interaction between the mentor and mentee and occasional planned recreational activities over 8-10 weeks. Other programs that have yielded positive psychological outcomes have included increases in levels of future aspirations (Lee & Cramond, 1999). A sample of 130 (78% African American) elementary and middle school students that were mentored for more than one year were compared to a wait-list group. The mentored group had higher levels

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39 of future aspirations, but there were no diffe rences in self-efficacy or future possible selves. Many of these studies utilized small sample sizes, lacked a comparison group, or did not obtain baseline measurements on the dependent variables. This makes interpretation of the findings difficult. However, some general conclusions can be made. Mentors seem to help with aggressive behavior and substance use initiation (Cavell & Hughes, 2000; Grossman & Tierney, 1998). These relationships also seem to promote positive attitudes about school and academic achievement, a primary area of functioning for children and adolescents (Blum & Jones, 1993; Dennison, 2000; Grossman & Tierney, 1998). Longer mentoring relationships seem to be better then those of shorter duration (Grossman & Rhodes, 2002; Linnehan, 2001) and therapeutic mentoring seems to be effective for children and adolescents with behavioral problems (Cavell & Hughes, 2000; Jackson, 2002). A recent meta-analysis of mentoring program evaluations utilized strict inclusion and exclusion criteria (DuBois, Holloway, Valentine, & Cooper, 2002). Each study included had to have utilized a comparison group or a pretest posttest design. The average weighted effect size (d = .14) was interpreted to mean that, on average, those with mentors did 55% better than those without mentors or had a 55% improvement over baseline measurements. Outcomes included psychological, behavioral, academic, and employment variables. The authors also evaluated several moderating effects on outcomes. Effect sizes did not vary between mentoring only program s and those that included mentoring along with other interventions. Other factors that increased effect size included community settings, structured activities, ongoing training for mentors, parental involvement, and

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40 mentors with a background in a helping profession (e.g., teacher). The frequency of contact with the mentor and the duration of the relationship were not moderators of effect size. However, very few evaluations measured these variables. The type of outcome variable did not moderate effect size, but the risk status of the youth did. Those youth from economically disadvantaged backgrounds or that had other environmental risk factors had more improvements than those th at did not (DuBois, Holloway, et al., 2002). Program evaluation research is often difficult to conduct with scientific rigor. However, experimental designs and meta-analyses assist in truly evaluating which interventions are effective for promoting healthy adolescent development. This review details the existing research evaluating the effectiveness of mentoring programs. This research provides evidence for the effectiveness of mentoring programs to have an influence on several domains of functioning for children and adolescents. The following section describes the literature related to natural mentors in the lives of adolescents. Natural Mentors The study of natural mentors is a relatively new area of research and there are fewer studies than in the program evaluation literature. Interventionists are eager to supply mentors without the assessment of existing supports in the natural environment. The following literature addresses the existence of natural mentors in the lives of adolescents at risk for emotional behavioral problems, as well as in more normative samples of adolescents. Early research on natural mentors by Rhodes and colleagues focused on African American and Latino adolescent mothers (Rhodes et al., 1992, 1994). Only 35% of the Latino female adolescent mothers had natural mentors (Rhodes et al, 1994). However, of those that did, 95% had access to their mentors as often as weekly. The mentors tended to

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41 be female (84.2%) and almost half of the adolescents had known their mentor for at least 16 years (46.4%). Those participants with supportive mentors had significantly less anxiety and depression than those without mentors (Rhodes et al., 1994). A descriptive study of 162 predominatel y Mexican American 10th graders found that 78% had natural mentors (Sanchez & Reyes, 1999). The majority of these mentors provided emotional support to their mentees (78%). This finding of almost double the rate of the study with Latino teen mothers is striking. It could possibly demonstrate the lack of a normative resource for the teen mothers. Other findings were similar between the two samples. The school-based sample tended to have gender and ethnically matched mentors. Seventy-one percent of the mentors were familial and another 23% were informal (i.e., neighbor or friend). Almost ha lf saw their mentor daily and 37% saw them at least weekly. Natural mentors were also protective against depression in African American adolescent mothers (Rhodes et al., 1992). Of the sample of 129 14 to 22 year olds, those that had a natural mentor had lower levels of depression than those who did not. Interestingly, those young women with mentors also made better use of their social support networks and accessed other support more readily. In a sample of 770 high school freshmen, the existence of natural mentors and several emotional and behavioral outcomes were measured (Zimmerman et al., 2002). The sample was 79.6% African American and did not include those that were high achieving (over 3.0 GPA) or those that had been diagnosed with emotional disturbances. The findings were that 53.8% of the adolescents had a natural mentor. Those with a mentor were less likely to smoke marijuana, had lower levels of violent and nonviolent delinquency, and had more positive attitudes toward school.

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42 Research on the protective quality of natural mentors for adolescents experiencing stressful situations (i.e., pregnancy) has been expanded to examine the role of natural mentors in normal adolescent development (Beam et al., 2002). In a sample of 243 multi-ethnic 11th graders in California, 82% reported having a natural mentor. Approximately half were relatives and half were not. The researchers found that these relationships were low in conflict and highly supportive. The adolescents received support from their mentors as often as once or twice a week. These relationships served different functions than either peer or pare ntal relationships. The adolescents also tended to obtain more support from their mentor if their relationship with their parents was high in conflict. Many of these studies have been done with African American samples; however, the socioeconomic status (SES) of the pa rticipants is often confounded with ethnic background (Hirsch, Mickus, & Boerger, 2002). Hirsch and colleagues demonstrated that certain aspects of the adolescent mentor relationship are culturally specific and other aspects are not. A sample of 122 African Am erican and European American high school students was asked to describe their relationships with an important grandparent and/or a significant male adult (other than their father). African American adolescents were more likely to name a natural mentor, either their maternal grandmother or an adult male mentor. However, when SES was accounted for in the analysis, only the relationships with grandmothers remained significant. Therefore, the African-American adolescents were only more likely to name their grandmother as a natural mentor after SES was accounted for in the analysis. This study demonstrates how certain types of mentoring relationships are culturally defined, while others are related to economic factors.

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43 The existence of natural mentors has been associated with less depressive symptoms, less substance use, and lower rates of delinquency in adolescents (Rhodes et al.,1992, 1994; Zimmerman et al., 2002). There is evidence to suggest that relationships with natural mentors are a normative part of healthy adolescent development (Beam et al., 2002). However, rates tend to vary widely across samples. Additional research is needed to assess the existence and quality of these relationships. Clearly the relationships between adolescents and naturally occurring mentors are different than those initiated by intervention programs. Strengthening existing relationships with natural mentors may be an additional way to intervene and enhance the lives of adolescents. Ethnic Mentors Another interesting question that has been studied minimally brings the area of ethnic identity and mentoring together. The question of whether or not the ethnicity of a natural mentor has an effect on the ethnic identity of the mentee has not been evaluated extensively. This aspect of the research study will be somewhat exploratory. However, there is some evidence to suggest that contact with same ethnic adults can influence ethnic identification. The construct of ethnic identity development has been studied in the foster parent and adoption literature (Andujo, 1988; Friedl ander, 1999; Friedlander et al., 2000). Researchers have been interested in the development of ethnic identity in those children and adolescents that are parented by adults with the same ethnic background compared to those that are raised by parents with a different ethnic background. One study included 60 families, 30 European American couples, and 30 Mexican American couples that adopted Mexican American children (Andujo, 1988). Both groups of adolescents (mean age 14 years old) had comparable levels of self-esteem after

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44 approximately 5 years in the adoptive home. However, the ethnically matched families had adolescents who were more likely to identify themselves as Mexican Americans and had lower scores on a measure of acculturation. Also, the Mexican American parents were more likely to socialize their children biculturally than the European American parents. Other researchers have utilized qualitative methods to examine the ethnic identity of international adoptees (Friedlander, 1999). A study of 12 parents and 12 children and adolescents utilized interviews and family drawings (as a measure of family relationships and sense of belonging) to study ethnic identity development. Results indicated that all but one of the participants were in the unexamined phase of ethnic identity. The implications are that international cross-ethnic adoption may be related to a lack of exploration of ethnic identity by the adoptee. In a review of the research examining ethnic identity in internationally adopted children, Friedlander and colleagues (2000) found that many cross-ethnically adopted children are uncomfortable with their appearance and tend to have an Americanized identity rather than a bicultural or achieved ethnic identity. These conclusions were drawn from limited research and do not negate the findings that most of these children and adolescents are fairly well adjusted (Friedlander et al., 2000). This population (international adoptees) differs from ethnic minority group members born in the United States. However, these findings provide some evidence that contact with those from the same ethnic background can influence adolescents ethnic identity development. Rhodes and Reddy (2002) compared same-race to cross-race matches in the longitudinal evaluation of BBBS. The results indicated that there were differences between the groups. Mentees talked more about their problems with cross-race matches.

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45 Also, parents perceived these relationships to improve peer relationships more than the parents of those in same-race matches. However, girls in same-race matches had smaller declines in the amount of value placed on school and self-worth. Boys in same-race matches had smaller declines in school competence (Rhodes & Reddy, 2002). These mixed results do not clearly indicate whether an ethnically matched mentor is, in total, more beneficial for adolescents. The construct of ethnic identity was not evaluated in this study. Mentoring programs typically do attempt to ethnically match mentors and mentees. It is considered common sense that adolescents will be able to relate more easily to an adult from the same ethnic background and that that person will be better suited to serve as a role model and mentor. Natural mentors tend to be ethnically matched (Sanchez & Reyes, 1999). However, the possible effect an ethnic mentor may have on ethnic identity has not been studied. Research is needed to examine the potential mechanisms by which an ethnic mentor may be beneficial for adolescents and their mental health functioning. Conclusions Whether a caring adult is part of a program or is a family or community member, these relationships seem to have the potential to promote healthy psychological development. It may be that as adolescents mature, the support of a trusted adult, other than a parent, becomes important. Although mentors seem to be a part of normative development, descriptions of the quality of these relationships, the characteristics of the mentor (e.g., community member, ethnic match) are factors that have only been minimally studied. This clearly is an area that needs more research. Surveys can be

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46 useful in assessing the availability of natural mentors and the quality of these relationships for ethnic minority youth. General Discussion Adolescence is a time of growth, transition, and unfortunately risk for a variety of mental health problems. There has been a large body of research examining various risk factors for emotional and behavioral distur bance during adolescence. However, there has been significantly less research examining issues that are specific to ethnic minority group members. Ethnic identity and its relationship to mental health outcomes is one new area of research that needs to be expanded. The mentoring literature is also under the early stages of development. The existence of natural mentors and the roles they play in the lives of adolescents are important research topics. Lastly, the question of how ethnic mentors may influence ethnic identity and enhance mental health has yet to be answered.

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47 CHAPTER 3 METHODOLOGY Research is needed that examines the relationships between individual and social factors and mental health outcomes in adolescents. This area of research has typically neglected factors that have particular relevance to ethnic minorities. Discovering what attributes or strengths may protect adolescen ts from emotional and behavioral problems is also an understudied area of research. The purpose of this study was to evaluate the relationships between ethnic identity, mentorship, and adolescent mental health from a nursing perspective. The Neuman Systems Model provided the framework for this study (Neuman, 1995). This enables the findings to add to the body of knowledge within the applied field of nursing science. The specific aims included: evaluating the relationship between ethnic identity and adverse mental health outcomes, comparing the mental health of those that have a mentor and those that do not, and examining the moderating effect of an ethnic mentor on ethnic identity and adverse mental health outcomes. Design This study utilized a cross-sectional, multi-site survey design. It was part of a larger study that addressed several psychological constructs related to school violence. The larger research study was entitled National Middle-School Survey: School Violence and Beliefs About Self, Others, and the Future (Miller et al., 2001). The primary purpose of the larger study was to develop a survey instrument that measures

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48 psychological factors that have been or may be associated with aggressive and violent behavior in early adolescents. Research Aims Aims of this study were to Explore the presence of reported natural mentors in the lives of adolescents, define the quality of these relationships, and describe the general characteristics of these mentors. Evaluate the relationship between the presence of a mentor and the mental health functioning of the mentee. Evaluate the relationship between the presence of a quality mentoring relationship and the mental health functioning of the mentee. Examine the relationship between the ethnic identity of the adolescent and his or her mental health functioning. Evaluate the potential moderating effect of an ethnic mentor on the relationship between ethnic identity of the mentee and his or her mental health functioning. Research Hypotheses Related hypotheses include Those adolescents who have natural mentors will have better mental health functioning than those that do not have a mentor. There is a relationship between ethnic identity and mental health functioning in minority adolescents. The presence of ethnically matched mentor moderates the relationship between ethnic identity and mental health outcomes in minority adolescents. Procedures Setting The larger school violence study will, when concluded, include data from approximately 25 public middle schools in four states (Florida, Texas, California, and New Jersey). This study includes data from 14 schools in four counties, and two states

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49 (Florida and California). The public schools included mainstream schools only. Testing took place in classrooms, gymnasiums, cafeterias, libraries, and/or auditoriums as dictated by the school personnel and administration. The entire survey took participants between 45 minutes and 2 hours depending on the version of the survey administered and the school. Research assistants were available to answer questions throughout the survey procedures. Human Subjects Active parental consent, as required for Department of Education funded projects, was obtained for all minor participants (Appendix B). A research team member distributed permission slips to students after describing the research purpose and procedures. Parents were provided the option of consenting or refusing participation for their child. Failure to sign the informed consent form was considered a refusal. Research assistants returned to the schools a second time to administer the survey. The survey was given only to those students that returned a signed permission slip/informed consent form. The current ethical standard is to obtain assent from participants that are at least seven years of age (Vanderpool, 1996). A verbal assent form was read to potential participants that had already returned a signed parental consent form (Appendix C). Students were given the option to decline participation before the implementation of the instrument. They were also told that they could stop participation at any time or leave blank any questions they did not want to answer. The survey was anonymous. Participants were instructed not to put any identifying information on the survey. The participants names were on the parental informed consent forms. However, this information was kept confidential. All informed

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50 consent forms and completed surveys were kept in locked filing cabinets in the research lab at The University of Florida. There is no way to connect a specific survey to a specific consent form. Questions on the overall survey were related to a variety of sensitive issues from victimization, aggressive behavior, and relationships with parents to adverse mental health symptoms. For this reason, participants were told to contact the school counselor if they felt upset or uncomfortable. The name of the school specific counselor was provided in the verbal assent process. Because the research team cannot match individual responses to specific participants, individual interventions were not implemented. However, if a participant became visibly upset during the survey, he or she was referred directly to the school specific counselor. Sample The sample includes all of the middle school students that completed the measures specific to this study during their participation in the The National MiddleSchool Survey: School Violence and Beliefs About Self, Others, and the Future (Miller et al., 2001). Survey da ta were projected to be collected from 5000 middle-school students in four states (Florida, California, Texas and New Jersey). Only the data from Florida and California were completed at the time of this analysis. The measures of interest for this study were removed from future testing plans. Therefore, this study includes data from California and Florida only. A variety of geogr aphic locations (e.g., rural vs. urban) were surveyed. Nonprobability, purposive sampling procedures were used to obtain a sample that is overrepresentative of African American and Hispanic adolescents. Representative percentages vary based on which national statistics are utilized. According to the 1999-2000 public elementary and secondary school enrollment statistics

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51 released by the U.S. Department of E ducation (2002), 15.57% and 17.16% of students are Hispanic and African American, respectively. According to the United States Census Bureau (2000), 12.3% of the population are of Hispanic origin and 12.5% are black or African American. These percentages are diffe rent due to the fact that more African American and Hispanic families have children under the age of 18 years old (U.S. Census Bureau, 2000) and these ethnic groups are over-represented in the public school system. Instrumentation Demographics The following demographic data were included in the survey: age, sex, ethnicity, socioeconomic status (SES), and single-parent household status. The racial and/or ethnic background was assessed utilizing categories designed to accompany the Multigroup Ethnic Identity Measure (Phinney, 1992). Socioeconomic Status (SES) was assessed utilizing the Two Factor Index of Social Position, developed by Hollingshead (1965). This is a widely used measure of SES that asks the participants to report their parents level of education and occupation. These responses were categorized and weighted to calculate a score from 11-77. This score can be used as a continuous variable or converted into social class categories (Hollingshead, 1965). For this study the social class categories were used in the analyses. This measure has been widely validated. The two-factor index is preferable with adolescents, because they are usually unable to answer accurately the third factor, household income. Multigroup Ethnic Identity Measure The Multigroup Ethnic Identity Measure (MEIM) was used to measure ethnic identity. The MEIM was originally designed based on prior qualitative data (Phinney,

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52 1992). The current version has 12 items that are scored on a likert scale from (1) strongly disagree to (5) strongly agree. Higher scores indicated a more achieved ethnic identity (J. S. Phinney, personal communication, November 13, 2001). Results of an exploratory factor analysis with 200 middle school students indicated two primary factors: (a) affirmation, belonging and commitment, and (b) exploration and behaviors (Roberts et al., 1999). The correlations between these two factors ranged from 0.70-0.75. This provides ev idence that both factors are part of one overarching construct and that the questionnaire can be used as a single measure of ethnic identity. The factorial structure was weaker for the European American students. Roberts and colleagues (1999) conducted the most recent and relevant study that provided evidence of reliability and validity for early adolescents. They surveyed 5,423 middle-school students from several ethni c backgrounds. Cronbachs alpha was between 0.81-0.89 across ethnic groups for the 12-item survey. The MEIM was positively correlated with coping (r=.23, p<.001), general mastery (r=.19, p<.001), self-esteem (r=.20, p<.001), and optimism (r=.19, p<.001). It was inversely associated with loneliness (r=-.09, p<.001), and depression (r=-.09, p<.001). The strongest relationship that helped to provide validation for this measure was the relationship between the MEIM scores and the salience of ethnic identity (r=.48, p<.001). Although these correlations are low to moderate, they help to provide evidence for convergent and divergent validation of the MEIM. Mentoring Items The first question used to assess the presence of a mentor was Other than your parents or whoever raises you, is there an adult in your life (a mentor or positive rolemodel) who you go to for support and guidance? (Rhodes et al., 1992, p. 449). This

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53 question was developed based on the theoretical work of Levinson and colleagues (Levinson, Darrow, Klein, Levinson, & McKee, 1978, as cited in Rhodes et al., 1992). It has been used in previous research to assess the presence of a natural mentor (Rhodes et al. 1992; 1994). This question has a yes or no dichotomous response. If the participants answered, yes to this question, then they answered follow-up questions relating to mentoring relationship quality and mentor characteristics. These items were used to distinguish between the simple presence of someone perceived as a mentor and the presence of a quality mentoring relationship. Theorists and researchers alike have differing definitions of mentoring relationship quality. There is also not a consistent way to measure this construct. Previous researchers have asked individual items related to a mentor-mentee relationship, however, there is not an existing measure of relationship quality that has been tested for reliability and validity. For this reason, the Principal Investigator and other members of the research team used existing research and theoretical literature on mentoring, to develop a series of questions pertaining to mentoring relationship quality. These questions related to the duration of the relationship, the frequency of contact with mentor, and the length of time spent on a typical visit. These items were developed in order to assess the amount of time spent together, the consistency of contact, and the duration of the relationship. Previous theoretical, applied, and empirical literature were used to determine cutoff points for each aspect of relationship quality that was used to define a quality mentoring relationship (Chapter 1). These items have ordinal response options. Previous research has found that arranged mentoring relationships that last less then six months can have minimal beneficial and actually some detrimental effects on

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54 adolescents (Grossman & Rhodes, 2002). For this reason, those adolescents that reported at least a 6-month duration of relationship were categorized as having a quality mentor. The aspects of the frequency of contact and the amount of time spent at each visit have also not been specifically researched in reference to natural mentors. The baseline criteria used by Big Brothers Big Sisters (BBBS) was used as a guideline for these factors. Community-based mentors in BBBS are required to meet with their mentees at least 2-4 times per month and to spend approximately two to four hours at each visit (Grossman & Tierney, 1998). For this study, those participants that reported seeing their mentor at least once per week and that spent at least one hour per visit with their mentor were categorized as having a quality mentor. The last factor used to determine the quality of the existing mentoring relationship was the amount of trust the adolescent has in their mentor and the comfort they have with confiding in their mentor. A scale comprised of seven questions was developed based on previous definitions of me ntors and other measures of social support (Nakkula et al., 1990 & Institute of Behavioral Science, 1990, as cited in Centers for Disease Control and Prevention, 2002; Rhodes et al. 1992; ). The reliability of this subscale has not been previously tested. However, reliability coefficients are detailed for the current study in Chapter 4. This construct has been specifically used to define a mentoring relationship (Pearsall, 1999; Rhodes et al., 1992). The minimum level for this factor is also described in Chapter 1. Several specific characteristics of the mentors were assessed using categorical response items. The ethnic match of the mentor and their gender were assessed. Also, the relationship between the mentor and the mentee or who the mentor is in reference to the

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55 adolescent (e.g., relative, teacher, minister, etc.) was ascertained. Lastly whether or not they live in the adolescents community was determined. Mental Health Functioning The Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) assesses several aspects of psychological symptoms (Grisso et al., 1998). The instrument was originally developed to screen adolescents ages 12-17 who have entered the juvenile justice system. The instrument has several subscales that assess different domains of emotional and behavioral symptoms. As previously mentioned, four subscales (depressed/anxious mood, somatic complaints due to anxiety, angry/irritable mood, and alcohol/drug use) were utilized in this study. The items have true/false responses and one point is given for a yes response and zero points are given for a no response. The responses are summed and ranges of available scores are utilized to assess risk (Grisso & Barnum, 2000). The original development of this instrument involved 1,200 adolescents in the juvenile justice system in Massachusetts Additional studies have been conducted in California, Washington, and several other states. These data were utilized to establish its reliability and validity for this population. The established average alpha coefficient for the entire measure was 0.75. The average test-retest correlation coefficient was 0.74. Validity coefficients ranged from .40-.65 (depending on subscale) when subscales were correlated with other standardized assessments of psychopathology (Grisso & Barnum, 2000). Recent research with the MAYSI-2 has included community samples of adolescents (J. Woolard, personal communication, January 11,2001). This has provided evidence for the reliability and validity of this instrument in normative samples of adolescents.

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56 This measure of adverse mental health outcomes was chosen for two primary reasons. First, this measure assesses several domains of mental health functioning in relatively few questions. The use of a brief measure is necessary in order to fit the time constraints (a one class period survey) of the larger research project. Second, this instrument has been used as a screening tool in the juvenile justice system. A brief screening instrument may be useful in assessment of adverse mental health outcomes in a school setting as well. This study provides additional validity and reliability for use with a normative school sample. Data Analysis The statistical computer program SPSS was utilized for data analysis. Descriptive statistics (frequencies, means and standard deviations) were done as appropriate for all of the demographic variables. Univariate analyses were done to examine differences between groups on the variables of interest. Descriptive statistics were also used to analyze the specific characteristics of the natural mentors. The statistical tests used for the specific research hypotheses are described in Table 3-1. A secondary series of Factorial MANOVAs were done to examine the relationship between the presence of a mentor and adverse mental health outcomes and to test for interactions between mentoring and gender, ethnicity, socioec onomic status, and single-parent status. Power Analysis Power for the regression analyses was sufficient. At least 50 participants are required per independent variable to ensure adequate power in multiple linear and logistic regression (Tabachnik & Fidell, 1989; Wright, 1997). Previous research that has examined the variables under study has yielded small effect sizes (Roberts et al., 1999; Zimmerman et al., 2002). For example one study examined the presence or absence of a

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57 natural mentor and adverse mental health outcomes (i.e., marijuana use) and demonstrated that those adolescents that had a natural mentor had significantly lower use [ = (4.71-3.90)/4.34 = 0 .18] than those that did not have a mentor (Zimmerman et al., 2002). A difference of this size would be considered clinically relevant on the outcome measures for this study. Table 3-1. Statistical analyses Research AimsHypothesesAnalysis I.Evaluate the relationship between the presence of a mentor and mental health functioning of the mentee. I. Those adolescents who have natural mentors have better mental health functioning than those who do not have natural mentors. I. Multivariate Analysis of Variance (MANOVA) II.Examine the relationship between the ethnic identity of the adolescent and his or her mental health functioning. II.There is a relationship between ethnic identity and mental health functioning in minority adolescents. II.Multiple Linear Regression & Logistic Regression. III.Evaluate the potential moderating effect of an ethnic mentor on ethnic identity of the mentee and his or her mental health functioning. III.The presence of ethnically matched mentor moderates the relationship between ethnic identity and mental health outcomes in minority adolescents. III.Multiple Linear Regression was used to test for a significant interaction. A simple analysis for a dichotomous predictor variable (natural mentor, yes or no) and a continuous outcome variable (alcohol/drug use subscale) was utilized to estimate sample size. Assuming an alpha (two-tailed) = .05, and a beta of 0.20 (power = 0.80), how many participants are needed to demonstrate a 6.25% difference on the alcohol/drug use subscale, a small effect size? Utilizing an estimated standardized effect size of 0.20 SD, approximately 197 participants are needed per group to avoid a Type II error with

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58 80% power (Marks, 1999; Polit & Hungler, 1991). Observed power is provided in Chapter 4. Power was adequate for some of the research questions, but not others. This issue is discussed in Chapter 5. Limitations Despite careful research design, there are several study limitations that should be considered in reference to the interpretation of results. The limitations are as follows: The use of a nonrandomly selected sample can limit external validity of the research findings. However, for this study a purposeful sampling procedure was utilized to ensure a representative number of minority participants The use of active parental consent may introduce bias into sample selection and can also limit the generalizability of the research findings (Anderman et al., 1995). However, the Department of Education requires active parental consent for all of their funded research studies. The use of cross-sectional and correlational design limits the ability to determine cause and effect relationships. A longitudi nal or quasi-experimental design is beyond the scope and purpose of this study. The primary purpose of the larger study was to develop a survey. The use of adolescent self-report measures as the only data source may limit the accuracy of the findings. Peer nominations and parent or teacher reports can be utilized to address this problem. However, in order to maintain anonymity and to remain within the time and financial constraint of the study grant, self-report methods were utilized. Any effects that are due to the ethnic background of the research team and data collectors will not be accounted for in the research findings. Even though the research team is multi-ethnic, some students may have exposure to only European American, African American or Hispanic team members. This factor is not accounted for in the data analysis and is therefore a study limitation. Lastly, due to time and financial constraints this survey was only available in English. This may be a limitation because the English reading and writing skills of the participants were not assessed. It is possible that there were difficulties with comprehension in some of the Hispanic participants.

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59 CHAPTER 4 RESULTS This chapter describes the study design and sample as well as the larger research project. The sample is then described in terms of demographic characteristics and the other variables of interest. Lastly, the results related to the research aims and specific hypotheses are detailed. Research Design This cross-sectional survey was part of a larger study of school violence. The larger study was a pilot project for a national survey and had as one of its primary objectives the testing and design of a survey instrument. The procedures included adding, evaluating, and deleting instruments and specifi c items at different phases of the project based on empirical, theoretical, and logistical factors. For this reason the instruments specific to this study were utilized on a subset of the larger sample. In order to maximize statistical power, data from all available participants were utilized for each statistical analysis. Sampling Procedure Nonprobability, purposive sampling was used to obtain an overrepresentation of Hispanic and African American participants. The school violence survey obtained a total of 866 participants at the time of this analysis. Of those participants, 548 received the primary outcome measure (MAYSI-2) and the measure of ethnic identity (MEIM). The mentoring items and the MAYSI-2 were given to 429 participants. All of the participants

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60 received every demographic variable item with the exception of the single-parent status question. This item was given to a subset of 281 participants. Missing data rates varied from 2.5 to 8 % on demographic items and from 11.31 to 19% on the independent and dependent variables. One demographic measure did have a higher rate of missing data than those reported above. This was the measure of socioeconomic status. This measure required the respondent to report their parents type of job and their parents occupation. Many participants said they did not know this information or left it blank. Another subset responded to the occupation item with a response that was too vague to be accurately coded. Consequently, this variable was only included in the secondary analyses. For the primary research objectives, data were included in the analyses that reached a certain level of completeness. For the MAYSI-2 the guidelines outlined in the survey manual were used. These guidelines require that a minimum of approximately 70% of the items per subscale be complete (Grisso & Barnum, 2000). For the other subscales, those who completed at least 80% of the items were included in the analysis. This cutoff was used for the larger survey for those measures that did not prescribe any set procedure for handling missing data. Analyses for the primary research questions were done with and without an adjustment for missing data. The method utilized to account for missing data was replacement with group means for the MAYSI-2 subscales and the MEIM. The results were the same for both sets of analyses. Therefore, only the analyses utilizing the completed dataset are presented.

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61 Sample Characteristics Demographics are presented for the sub-sample of 548 participants. The geographic breakdown for this sample is presented in table 4.1. Table 4-1. Sample breakdown by geographic location Location (State, County) n%Description California Los Angeles18233.2Metropolitan Florida36666.8 Alachua 14326.1Urbanized Dade325.8Metropolitan Hamilton19134.9Rural Note : Census 2000; Definitions based on population density. The other characteristics of the sample are listed in Table 4-2. The majority of the sample was African American, European Am erican or Hispanic. The remaining ethnic groups (Asian, Native American, Multiracial and Other) were combined into one group entitled Other for analysis purposes. The sample ranged in age from 10 to 15 years of age with a mean age of 12.41 (SD = 0.96). The socioeconomic status of the participants who could be categorized (n = 132) had a mean of 3.72 (SD = 1.01) on a scale from 1 to 5 with lower numbers representing a higher social class. The top two groups were combined because of the few (n = 2) in the highest socioeconomic group. Another general descriptive factor related to economic status is the percentage eligible for free or reduced lunch. The schools that participated in this survey had rates of student eligibility for free and reduced lunch that ranged from 30% to 86%. The majority of the schools had rates of over 50% eligibility (California Department of Education, 2002; Flor ida Department of Education, 2002).

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62 Table 4-2. Sample breakdown by demographic characteristics Characteristics n % Ethnicity African American16329.7% Hispanic16029.2% European American12522.8% Other10018.2% Gender Male20340.3% Female30159.7% Grade 615328.1% 721038.5% 818233.4% The subscales of the MAYSI-2 were significantly inter-correlated. See Table 4-3 for exact figures. The overall Cronbachs Alpha was 0.86. The Cronbachs Alphas for each subscale are listed in Table 4-3. Reliability coefficients were acceptable and similar to those obtained in previous studies using this measure (Grisso & Barnum, 2000). Correlations and descriptive statistics were also similar to those reported in the scoring manual. The exception was the difference in the alcohol/drug use subscale. The youths from the juvenile justice system had a higher mean score on this measure as would be expected (Grisso & Barnum, 2000). Subgroups means were compared based on ethnicity, grade and gender using univariate analysis of variance tests with multiple comparisons. Differences were found only on the depressed/anxious mood subscale. Girls scored higher on this subscale than boys [F (1, 434) = 7.76; p = .006] and European Americans scored lower than the other three ethnic groups [F (3, 443) = 7.29; p < .004].

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63 Table 4-3. Measures of adverse mental health outcomes MAYSI-2 subscale MeanSDA/ID/AS/CA/D Angry/irritable (A/I).774.082.54.61*.49*.30* Depressed/anxious (D/A).722.842.20.45*.35* Somatic complaints (S/C).693.191.83.16* Alcohol/drug use (A/D).79.6241.35 *p<.001 Mentors Out of 362 respondents, 76.2% (n = 276) reported the presence of a mentor. Of the group with mentors, 75.3% (n = 204) reported an ethnic match with their mentor and 63.4% (n = 170) reported that they are both from the same community. Seventy-two percent of the mentors were female (n = 186) and 28.5% were male (n = 74). The mentors were a gender match for 75% (n = 180) of the total matches; 54.6% (n = 131) were female matches and 20.4% (n = 49) were male matches. Table 4-4 details who the mentors are in relationship to the mentee. Table 4-4. Description of mentors RelativeNeighborTeacherCoachMinisterOther n 15020187663 % 56.87.66.82.72.323.9 Mentoring Quality Factors The results thus far have pertained to the general perception of the presence of a mentor. More specific aspects of these relationships were also assessed. A series of items about the duration of the relationship, frequenc y of contact, typical length of visits, and the amount trust the mentee has in their mentor were used to categorize those who

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64 perceived the presence of a mentor and those who had a substantial and consistent or quality relationship. The majority of the mentoring relationships was stable and consistent. Eightythree percent knew their mentors for more than one year, 45% saw them everyday, and 50% spent over four hours at a typical visit. The average amount of trust and confiding the youths reported was also high (mean = 2.67; range 0 to 3). The following cutoffs were developed to define a quality mentoring relationship: Frequency of visits: At least weekly, Length of visits: At least one hour, Duration of the relationship: Six months or longer, Trust and confiding subscale: Those that scored at least a mean of 2.0. Descriptive information is provided in Table 4-5. These criteria allowed for the creation of two new groups, those with a quality mentoring relationship (n = 144) and those without (n = 163). Table 4-5. Descriptive statistics for quality mentoring items n (%) above cutoffn (%) under cutoff Frequency of contact 214 (81.7)48 (18.3) Duration of typical contact223 (85.4)38 (14.6) Duration of relationship213 (90.6)22 (9.4) Trust and confiding subscale ( = .83) 238 (92.2)20 (7.8) Natural Mentors and Adolescent Mental Health The research questions related to the presence of natural mentors, the presence of quality mentoring relationships, and adolescent mental health were answered using two Multivariate Analyses of Variance (MANOVAs). The statistical rationale for using MANOVA included the significant correlations between dependent measures and the desire to reduce the risk for Type I error by repeated univariate analyses (Weinfurt,

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65 1997). This test is appropriate only if the dependent variables can be combined theoretically which is the case in this study. Combing the four dependent variables creates a general construct of adverse mental health symptoms. The statistical assumptions for MANOVA include multivariate normality, homogeneity of covariance matrices, linearity, and independence of observations (Tabachnik & Fidell, 1989; Weinfurt, 1997). These assumptions were met with the exception of the distribution of the alcohol/drug use subscale, which had a positively skewed distribution. Several transformations were attempted without success. However, this subscale was retained in the model because MANOVA is robust to skewed distributions with sample sizes greater than 200 (Tabachnik & Fidell, 1989; Weinfurt, 1997). In addition, the central limit theorem is applicable to studies with at least 20 degrees of freedom in each cell. This theory states that the sampling distribution of means approach normality even if the sample data does not (Tabachnik & Fidell, 1989). Two MANOVAs were done; the results are in Table 4-6. The first test compared those who reported the presence of a mentor and those who did not. Those with a natural mentor had higher levels of adverse mental health outcomes than those without a mentor. The observed power was 0.78. The first hypothesis was not supported. Second, the participants who met all four of the quality factor cutoff points described in the previous section were categorized as having a quality mentoring relationship. The second MANOVA compared the adverse mental health outcomes of those with a quality mentor to the rest of the adolescents. These two groups were not different on the mental health outcomes. There was no significant difference between these two groups. However, this analysis had an observed power of only 0.20.

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66 Table 4-6. Results for presence of a mentor and quality mentor analyses Mentor groupingHotellings TFdf (b/w)p 2 Presence of a mentor.0362.884/324.023.034 Quality mentor.009.6174/281.651.009 Is the relationship between the presence of a mentor and adverse mental health outcomes different when gender, ethnicity, so cioeconomic status, and single-parent status are taken into account? These questions were addressed by the use of three Factorial MANOVAs. These analyses tested for interaction effects between the presence of mentors and various demographic variables. All of the demographic variables were not included in one model, because of the relatively smaller availability of data assessing the SES (n = 137) and single-parent (n = 281) statuses of the adolescents household. The following analyses were done: 2 (mentor) X 4 (ethnicity) X 2 (gender) MANOVA; 2 (mentor) X 2 (single-parent) MANOVA; 2 X 4 (SES) MANOVA. Results indicated that there were no significant interactions between the mentoring factor and the SES or single-parent status variables. There were also no two-way or three-way interactions between mentoring, gender, and ethnicity. Ethnic Identity The second major area of interest pertains to the construct of ethnic identity. The basic information about this measure is presented in Table 4-7. The European American participants scored significantly lower (p = .019) than the African Americans and those categorized as Other (p = .017), but not the Hispanic participants. There was no significant difference on this measure based on grade or gender.

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67 Ethnic Identity and Adverse Mood Related Symptoms Multiple regression and logistic regression were used to test the second hypothesis: There is a relationship between ethnic identity and mental health functioning in minority adolescents. The assumptions for linear regression include residual homoscedasticity (i.e., equal variance of the dependent variable at each level of the independent variable), normal distribution, and linearity. Also, all pertinent variables must be included, and all irrelevant variables are excluded. Lastly, measures must be reliable and observations must be independent (Licht, 1997). These assumptions were met with the exception of linearity. Transforma tion of the data and/or use of a non-linear model were not appropriate due to the large number of zero scores. However, multiple regression is robust to the effects of violations of the error assumptions (Licht, 1997). Table 4-7. Multigroup Ethnic Identity Measure by Ethnic GroupMeanSD African American.743.55.61 European American.75 3.33.53 Hispanic.833.47.59 Other.853.59.67 Three subscales of the MAYSI-2 (angry/irritable mood, depressed/anxious mood, and somatic complaints due to anxiety) were summed to create one dependent variable (= 0.86). This variable was normally distributed. This sub-divides the general construct of adverse mental health symptoms and creates two more specific constructs. The constructs are mood related adverse mental health symptoms and substance use. The alcohol/drug use measure was not normally distributed and this measure was analyzed separately using logistic regression. The rationale for this separation is detailed in the following section.

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68 Standard multiple regression was done with gender, ethnicity, ethnic identity, and an interaction term predicting the sum of the three mood related symptoms. The interaction term combined ethnic identity and ethnic minority status. The interaction term tested the idea that the significant relationship between ethnic identity and mood related symptoms existed for minority group members only. Gender and ethnicity were dummy coded and four dichotomous variables were cr eated (African American = 1, Hispanic = 1, European American = 1; Female = 1). The final model had six predictors. The model was not predictive of the outcome variable [F (6, 403) = 1.76; p = .106]. Ethnic identity achievement was not predictive in minorities for this dependent variable. The second hypothesis was not supported for mood related symptoms. Ethnic Identity and Alcohol/Drug Use The alcohol/drug use subscale was positively skewed with the majority of the respondents (73.5%) scoring zero on this subscale. Multiple transformations were unsuccessful in obtaining a normal distribution. Therefore, this measure was changed to a dichotomous outcome variable (0/1). A score of one indicated a positive response to any item. This subscale was then used as an outcome in a logistic regression analysis. In logistic regression it is assumed not only that the dependent variable is dichotomous, but also that the options are statistically independent, mutually exclusive, and collectively exhaustive (Wright, 1997). Also, the model must be adequately specified (includes all relevant predictors and excludes all irrelevant predictors), and the sample size must be adequate. Logistic regression requires at least 50 participants per independent variable (Wright, 1997). All of these assumptions were met in this case. Multiple logistic regression was done with the same predictor variables used in the multiple regression analysis. The results indicated that the overall model was

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69 predictive of alcohol/drug use category membership [X (6, 399) = 14.44; p = .025]. Group membership was accurately predicted for 98.1% of the participants based on the predictors in the model. Upon further analysis, the primary predictor of category membership was gender (B = .531, Walds X = 5.18, p = .023). Forty-five percent of the boys were categorized as having any problems due to alcohol/drug use and only 30% of the girls were. The rest of the predictor variables (including the interaction term) did not provide a significant contribution to the model. The second hypothesis was not supported for alcohol/drug use. A second multiple logistic regression was done without the interaction term included. The rationale for this test was to create a more parsimonious model to test the independent contribution of ethnic identity to the prediction of alcohol/drug use category for all ethnic groups. The overall model maintained its significance with no loss of accuracy in categorization [X (5, 400) = 14.07; p = .015]. The individual predictor statistics are presented in Table 4.8. This finding demonstrates that ethnic identity does predict alcohol/drug use for all of the study participants, not simply the minority adolescents. Those participants with higher ethnic identity scores were more likely to be in the non-use group than those with lower scores. The mean ethnic identity score for those in the nonuse group was 3.52. The mean for the use group was 3.33. Table 4-8. Variable contributions to the prediction of alcohol/drug use category VariableBSEWaldSig. African American-.290.350.689.407 Hispanic.025.355.005.943 European American.283.364.604.437 Gender.526.2335.09.024 MEIM Score*-.507.2026.32.012 *MEIM = Multigroup Ethnic Identity Measure

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70 Y 0X Ethnic Identity Nonmatch Adverse Mental Health Symptoms Ethnic Match Y 0X Ethnic Identity Nonmatch Adverse Mental Health Symptoms Ethnic MatchEthnic Mentors: Testing A Moderation Model A series of multiple linear and logistic regressions were done to test the moderation model. The predicted model is presented in Figure 4-1. Although no significant results were demonstrated for the minority adolescents alone, the moderation model was tested in this group and in the sample as a whole. Figure 4-1. Ethnic mentors and ethnic identity: Moderation model Two multiple linear regressions were done with gender, ethnicity, ethnic identity, presence of an ethnic mentor (Y/N), and an interaction term as predictors. The interaction term combined ethnic identity and the presence of an ethnic mentor. These results are in Table 4-9. Neither of these models was significantly predictive of mood related symptoms despite the addition of a new interaction variable. The interaction variables also were not independently predictive. Two multiple logistic regressions were done with the same predictor variables. These results are also detailed in Table 4-9. These two models were significantly predictive in both the minority adolescents and the sample as a whole. However, the interaction term was not independently predictive of alcohol/drug use categorization.

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71 In the entire sample gender was the only significantly predictive variable (B = .773; X = 5.87; p = .015). In the minority sub-sample gender (B = .791, X = 4.93; p = .026) and Ethnic Identity (B = -.708, X = 3.87; p = .049) were the variables that provided the significant contributions to the outcome variable. Hypothesis 3 was not supported based on these analyses. Table 4-9. Results of regressions testing the moderation model ModelSampleOutcomedfTest ValueSig. LinearMinorityMood Sym.6/188 F = .554.766 LinearMin/MajMood Sym7/237F = .984.443 LogisticMinorityAlc/Drug 6/173X = 16.12.013 LogisticMin/MajAlc/Drug7/177X = 19.68.006 Min = Minority Group Membership Maj = Majority Group Membership/European American Ethnicity Sym = Symptoms Alc = Alcohol

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72 CHAPTER 5 DISCUSSION AND RECOMMENDATIONS This study has explored individual and socio-cultural variables and their relationships to mental health functioning in early adolescents. These factors were conceptualized as strengths or aspects of healthy psychological development. They were examined for their relationship to adverse mental health symptoms. This chapter explores the results of the study. Findings related to the mental health functioning of the sample are presented and then the constructs of ethnic identity and mentoring are detailed separately. Recommendations are made and future directions for this area of study are listed. Lastly, the implications for nursing are described. Adverse Mental Health Outcomes The assessment of levels of adverse mental health outcomes in a multiethnic sample provides information that in and of itself contributes to the research literature. There were no significant differences between the ethnic groups with the exception of the depressed/anxious mood subscale. The European American adolescents scored significantly lower on this measure than the other three ethnic groups. There are many factors that may explain this finding. Diffe rences in levels of depressed/anxious symptoms may be due to socioeconomic factors (Conger, Ge, Elder, Lorenz, & Simons, 1994) or increased stress related to racism and/or discrimination (Guthrie et al., 2002). However, other studies using this measur e have found no significant differences between ethnic groups or different profiles (Grisso & Barnum, 2000).

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73 The MAYSI-2 was designed to identify those youths who are most seriously at risk of mental and emotional disturbances (Grisso and Barnum, 2000, p. 32). The authors of this instrument provided Caution and Warning cutoff levels for scores on each subscale. The caution level was defined as having possible clinical significance, while the warning level indicates those adolescents with the greatest need for clinical intervention (Grisso and Barnum, p. 27). The mean levels for this study did not reach even cautionary levels except for the somatic complaints due to anxiety subscale. Thirteen percent of this sample met the warning level criteria for somatic complaints due to anxiety. Fourteen percent and 11% respectively were in the warning range on the depression/anxiety and angry/irritable subscales respectively. Less than 1% met the warning level for alcohol/drug use. The results of the alcohol/drug use measure (over 50% with a score of zero) indicate that this measure may not be an appropriate measure of substance use for this age group in a school-based sample. This subscale measures frequent use of substances and the potential for serious difficulties with substances (e.g., dependence). A more appropriate measure for middle-school students might instead measure experimentation or infrequent use. However, reports of any presence of problems due to substance use in this age range may predict future difficulties in this domain. Longitudinal studies are necessary to determine the significance of these findings. Mentoring The majority of adolescents reported the presence of a natural mentor. This validates earlier findings that have found natural mentoring relationships to be a part of normative development (Beam et al., 2002). The majority of the mentoring relationships were stable and consistent. The adolescents also reported a fairly high level of trust in

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74 their mentors and were comfortable confiding in them as well. Over half of the mentors were relatives. This finding is consistent with prior research (Rhodes et al., 1992, 1994; Beam et al., 2002). Despite these general trends, when strict criteria were utilized to define quality mentoring relationships, the sample size became quite a bit smaller. Fifty-five more participant responses could not be used because of at least some missing data on the quality factor items. There was no significant difference between those with a quality mentoring relationship and the other adolescents. This finding has a high risk for a Type II error because of the low observed power. Future research could answer this question more confidently with a larger sample. Also, it is possible that the criteria were too strict and excluded mentoring relationships that were potentially beneficial in some way. Those adolescents who reported the presence of a natural mentor did not have better mental health functioning than those without a mentor. In contrast, they had higher levels of adverse mental health symptoms than those without the presence of a mentor. Although, the effect size was small and may be of little clinical significance, there are some possible explanations for this finding. It is possible that adolescents experiencing adverse mental health symptoms may seek out mentors to help them cope with these difficulties. The theory that mentors can make up or compensate for problems that adolescents are experiencing is part of the basis for mentoring programs and also for some of the research on natural mentors (Rhodes et al., 1992, 1994). Beam and colleagues (2002) found that the presence of natural mentors was normative and not indicative of problems. However, these adolescents did tend to seek out support from their mentors when their relationship with their parents was high in conflict.

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75 As previously mentioned, a large majority of participants in this study reported the presence of a natural mentor. This group had higher rates of adverse mental health symptoms. If having a natural mentor is normative, a logical follow-up question is Is it normative to have adverse mental health symptoms during early adolescence? Early theories of adolescent development stated that it was a period of turmoil, stress, transition, and mood lability (Muuss, 1996). However, despite the common stereotypes, modern theory and research have demonstrated that the majority of adolescents transition quite well through this period of the lifespan (Lewinsohn et al., 1998). It is unclear what the explanation is for this unexpected finding. Additional studies are needed to further evaluate this finding and examine its clinical significance Ethnic Identity Ethnic identity was not found to be predictive of mood related symptoms. This finding is in contrast to some previous re search (Arroyo & Zigler, 1995; Roberts et al., 1999; Rotheram-Borus, 1989). Other studies have also found no direct links between ethnic identity and adverse mood related symptoms (Caldwell et al., 2002; DuBois, BurkBraxton, et al., 2002). Some research has conf irmed models that demonstrate an indirect relationship between ethnic identity and mood related symptoms. Ethnic identity has been related to mood symptoms via perceived stress (Caldwell et al., 2002) and global self-worth (DuBois, Burk-Braxton, et al., 2002). These additional constructs were not measured in this study, so it is impossible to confirm if such mechanisms were at work in this sample. The developmental level of the participants in this study is also important to consider. Ethnic identity increases over time and it is possible that many of the participants in this study were still in a relatively early phase of this developmental

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76 progression. DuBois and colleagues (DuBois, Burk-Braxton, et al., 2002) found no significant differences between African American and European American children (5th and 6th grades), but in early adolescents (7th and 8th grades) African Americans had significantly higher ethnic identity. This change in only a matter of one to two years of development may also play a role in the influence of ethnic identity to mood related symptoms. Research with high school students has demonstrated many of the previous findings in this area (Arroyo & Zigler, 1995; Rotherman-Borus, 1989). It is possible that the influence of ethnic identity on mental health does not manifest until further along the developmental path. Previous research has demonstrated that early during the development of ethnic identity (i.e., exploration and increasing ethnic awareness), adolescents can actually have increases in anxiety and depression (Rotheram-Borus, 1989). Stages of development were not assessed in this study; rather a general measure of level of ethnic identity achievement was measured. It is possible that these differences, which were not detectable with the measurement technique used in this study, clouded the accuracy of the findings. Ethnic identity was negatively related to alcohol/drug use. This finding validates previous studies that have found ethnic identity to be protective against substance use in minority adolescents (Scheier et al., 1997; Brook, Balka, et al., 1998; Brook, Whiteman, et al., 1998). However, the results from these studies were varied based on the type of substance and the ethnic group. This study measured the overall influence of ethnic identity on any difficulties related to substance use and found it to be predictive. This finding was found for the

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77 sample as a whole. It was not found specifically for the minority adolescents. There are several possible reasons why this may have occurred. One possibility is the presence of white-ethnics, those who strongly identify w ith their European country of origin. Unfortunately, subgroups within the European American participants were not specifically identified, and it is therefore not possible to determine if this may have influenced the findings. Another factor, that was not directly assessed, was the possible minority status of the European American adolescents in some of the schools. Phinney (1992) found that ethnic identity was associated with self-esteem for white high school students when they were the minority in the school. A final reason that could explain why this construct predicted substance use for all of the adolescents could relate to selfesteem. A positive self-concept could be partially reflected by higher scores on the ethnic identity measure. This could be true since many of the items reflect positive attitudes toward ones ethnic group membership. The predicted moderation model including ethnic mentors and their influence on the relationship between ethnic identity and mental health outcomes was not supported. In reference to adverse mood symptoms, this was probably not supported due to the lack of a significant relationship between ethnic identity and this outcome. However, this model was also not supported when there was a significant relationship (i.e., prediction of substance use). It is possible that ethnic mentors do have an effect on adolescents in different domains (e.g., self-esteem). The practice of matching mentors and mentees based on ethnicity, gender, and interests is still considered standard. Although, this makes intuitive sense, more research is needed to explain the mechanism by which these relationships may influence adolescents and in what domains.

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78 Recommendations and Future Directions The first area of recommendations is related to methodology. Nonrandom sampling procedures limit the external validity of the findings. Future studies using probability-sampling techniques could greatly increase the generalizability of findings. The use of survey methods has several limitations, some of which are described in Chapter 3. Additional research in this area could be supplemented with additional informants (e.g., parents, teachers, mentors) to validate the reports of the adolescents. Another methodological issue was the length of the survey. The survey, at its longest, contained 338 items. It took participants between 45 minutes and 2 hours to complete. Fatigue and attention span are serious issues. Many were unable to complete the survey due to fatigue or, in some cases, time constraints set by the school. Instruments toward the end of the survey had higher rates of missing data than those at the beginning. Future surveys of this type could be improved by giving shorter versions to subgroups of participants. As previously mentioned, it might be beneficial to translate the questionnaire into Spanish or other languages for new immigrants whose English language skills may be less well developed than other participants. Other ethnic groups could be examined and specific items could be added to assess the specific Hispanic heritage of the participants. Also, specifically in reference to the mentoring items, interview techniques could be very useful. Many participants had difficulty following the directions that asked them to answer questions if they had a mentor and to leave blank if they did not. Difficulty with instructions may have interfered with the accuracy of the responses. A different measure of SES should be utilized in future studies due to the high rates of missing data and the somewhat dated occupational coding scheme used for the

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79 Hollingshead (1965). In addition, longitudinal research is the ideal way to study developmental issues. Longitudinal research could examine ethnic identity development across adolescence. Also, the formation of mentoring relationships, their quality and duration as well as any influence they have on the adolescents well-being could be studied over time. Continued research related to the presence of natural mentors is definitely needed. This area would benefit from qualitative research that explores the nature and quality of mentoring relationships. Qualitative research would also improve the construct validity of measures that could benefit from further development and validation. Also, a large portion of the adolescents categorized their mentors as other. In order to assess who these mentors are, open-ended interview or survey items are necessary. Philip and Hendry (2002) interviewed adolescents in Scotland and found intriguing results in response to questions about natural mentors. The adolescents indicated that individual peers (or best friends), peer groups, and adult-teen groups were all contexts in which they obtained mentoring support. More research of this type is needed. Alternative or supplemental measures of ethnic identity could be utilized in future studies. For example, the Hispanic participants did not score significantly differently from the European American participants. However, Spanish language usage and level of acculturation are aspects of ethnic identity that were not assessed. These specific issues are not part of the MEIM, which is a generic measure that can be utilized for all ethnic groups. More specific measures may be needed for certain subgroups. It is possible that these factors are related to mental health. Also population divisions may even have to be more specific (e.g., Cuban American) if the intent is to develop programs or to intervene with specific sub-populations.

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80 As described above, this study utilized a measure of alcohol/drug use that assessed problems due to drinking or drugs. A measure of substance use that assesses infrequent use or experimentation with substances may be more appropriate in future research with this age group. There are large-scale studies that address these sorts of substance use issues (e.g., Youth Risk Behavior Surveillance-Middle-School; CDC, 1998 as cited in Fetro et al., 2001) for this age group. However, these studies tend to focus only on the problem behaviors rather than examining strengths factors. Future studies could examine individual and socio-cultural strengths and their relationship to substance experimentation in middle-school students. Nursing Implications Several future directions for research are described in the previous section. This section addresses the direct implications to nursing practice, education, and research. One goal of an applied science such as psychiatric mental-health nursing is to provide the basis for interventions that promote mental health, prevent disease, and treat mental health problems when indicated. Psychiatric-mental health nurses are increasingly involved in school-based screenings for those in need of mental health services (Gall et al., 2000; Lamb & Puskar, 1991). The results of this study demonstrate that a brief screening instrument can identify adolescents who are suffering from mental health problems. The adolescents who scored in the warning range of the MAYSI-2 could be referred for intervention in school-based settings. In terms of the direct applications of this research study to the field of nursing, ethnic identity achievement was found to be negatively related to alcohol/drug use. Aspects of self-concept, including ethnic identity could be assessed when intervening with adolescents. Research focused on psychosocial strengths can provide nurses with the

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81 tools to develop theoretically based interventions with empirical support. Individual or group interventions could target issues related to ethnic identity development in young adolescents. Schools of nursing also have implemented holistic interventions that have included mentoring adolescents (Scheuring, Hanna, & DAquila-Lloyd, 2000). Nursing education typically includes learning about the development of nurse-client relationships. Nursing students could potentially serve as mentors as well as health care providers. In addition, school nurses can serve as collaborators with the increasing number of school-based mentoring programs. School nurses can play an integral role in helping to develop these programs and to ensure that factors such as consistency, adequate duration, and relationship building are considered within these programs. Nursing education must also integrate knowledge of factors that are pertinent to the well being of ethnic minorities. Culturally sensitive health care includes an acknowledgement of differences. These differences ideally should be viewed as strengths rather than liabilities. Nurses also should learn how to tap into resources beyond the walls of the health care setting. Adolescents can be encouraged to access the support provided by natural mentors in times of difficulty. Holistic health care must include assessment of multiple domains of functioning and attempts to develop or enhance existing resources. Nurse researchers have studied multiple individual and social factors that are associated with depressive and anxious symptoms (Mahon & Yarcheski, 2001; Yarcheski & Mahon, 2000) and substance use (Long & Boik, 1993). Additional mood symptoms were assessed in this study (i.e., angry/irritable mood and somatic complaints due to anxiety). This expanded the body of knowledge to include the wide array of mood related symptoms that can be experienced by early adolescents. This study adds to the existing

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82 nursing literature by examining factors relate to ethnic group membership and how this relates to adolescent mental health. An achieved ethnic identity was associated with less risk for alcohol/drug use. This study also describes the prevalence and characteristics of an important community resource: natural mentors.

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APPENDIX A MENTORING ITEMS

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84 YES NO 10. Other than your parents or whoever raises you, is there an adult in your life (a mentor, or positive role model) who you go to for support and guidance? 1 2 Relative Neighbor Teacher Coach Minister Other 11.Is this person a? 12 34 56 12. Is this person from the same YES NO ethnic group that you are? 1 2 Female Male 13. What is the persons gender? 1 2 14. Is this person from your community? YES NO (Ex. lives in your neighborhood, 1 2 attends your church) Less than 1 to 3 times 4 to 6 times Every once per week per week per week day 15.How many times each week do you see this person? 1234 Less than More than 1 hour 1 to 2 hours 3 to 4 hours 4 hours 16. How long do you spend together on a typical visit? 1 2 3 4 For the next question, please circle 1 for YES or 2 for NO to answer whether that question is true for you. If you answered YES to question number 10, please answer the following questions about this adult you go to for support or guidance. If you answered NO to last question, please go on to page 15.

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85 Thinking of the adult you go to for support or guidance, for the following items, choose the number (1) for A little bit, the number (2) for Some, and the number (3) for A lot that best describes your feelings about that adult. Circle the number you choose. A little bit Some A lot 17. How much do you feel you can count on this person to be there for you?123 18. If you needed some information or advice about something, how likely is it that you could talk with this person? 123 19. If you got an award or did something well, how likely is it that you would tell this person?123 20. If you were in trouble at home, how likely is it that you would tell this person?123 21. How much do you feel he or she believes in and cares deeply about you?123 22. How much do you feel that he or she inspires you to do your best?123 23. How much do you think that knowing him or her has really affected what you do and the choices you make?123 Less than Greater than 3 months 3-6 months 6-12 months 12 months 24. How long have you known this person?1234 (Centers for Disease Control and Prevention, 2002; Rhodes, Ebert, & Fischer, 1992; Woolard & Greig, 2001) Thinking of the adult you go to for support or guidance, for the next question, please indicate the length of time you have known the person by choosing the number (1) for Less than 3 months, the number (2) for 3 to 6 months, the number (3) for 6 to 12 months, and the number 4 for more than 12 months. Circle the number you choose.

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APPENDIX B PARENT INFORMED CONSENT

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87 National Middle-School Survey: School Viol ence and Beliefs About Self, Others, and the Future Scott A. Miller Parent Letter Dear Parent: A research team from the University of Florida is currently conducting a project at your childs school. The purpose of this letter is to explain the project and to ask your permission for us to include your child in the testing. The goal of our project is to develop and to test a survey for middle-school students. The survey is intended to identify some of the important thoughts and concerns and characteristics of the present generation of middle-school students. We believe that the results will provide some new and valuable information about this age group for the educators and policy makers who shape childrens school experiences. Your childs school is one of about 25 schools around the c ountry at which we are administering the survey. The survey will be given in the regular classroom setting [or whatever setting applies in the particular school], and it will take about an hour to complete [if pilot testing reveals a different session length this wording will be adjusted accordingly]. The questions will address a number of topics that are important in the lives of middle-school students. Some will ask students to reflect about themselveswhat they feel especially satisfied or dissatisfied about, what their expectations are for the future. Others will ask about the childs relations with the important people in his or her life. Still others will ask about experiences at school, including possi ble worries or fears about bullying and school violence. In each case, we have worked hard to make the questions as clear as possible for students this age, and to try to ensure that none will be upsetting to the child. An important point to note about the survey is that responses will be completely anonymous and confidential. Students will not put their names on the response forms, and there will be no information on the forms from which individual children could ever be identified. This means that no one will ever know how particular children respondedno one at your childs school, for example, and indeed none of us on the research team. Our interest is in general patterns of response and in possible variations across different groups (for example, boys compared with girls, or 6th graders compared with 8th graders). We have no need ever to know particular childrens names. The fact that responses are confidential is so mething that we will explain carefully to the children. We want the children to feel free to answer honestlyand we want to be sure that no child is ever concerned that someone might know how he or she responded. Please indicate on the attached form whether you are willing to have your child participate in the survey. The form should be returned to the childs school. Children who

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88 do not participate will be given an appropriate alternative activity by their teachers. There will be no negative consequences of any sort for children who do not participate. In addition to asking your permission we will be asking your childs permission. Prior to administering the survey, the researcher will provide a general description of the questions to be asked and will emphasize that children are free to decide not to take part either from the start or at any point after beginning the survey. Children will also be told that they do not have to answer any question that they do not wish to answer. Again, there will be no negative consequences for children who decide not to participate. Children who decide not to participate [here we will describe whatever alternative activity the teachers have decided is appropriate for nonparticipants]. Our work is supported by grant from the Department of Educations Fund for the Improvement of Education program. This project has been approved by the University of Floridas Committee for the Protection of Huma n Subjects. It has also been approved by the principal of your childs school. We hope that both you and your child will decide to help us with the project. We believe that the results of the survey can provide valuable information about the thoughts and concerns of todays middle-school students, information that may eventually help to make the school experience a more rewarding one for all children. The greater the number of students who participate, the more accurate and helpful the results will be. If you have any questions about the project, please call or e-mail Scott Miller at the number or address given below. [Note: When we test in states other than Florida we will attempt to provide a local contact number.] Questions or concerns about your childs rights as a research participant may be directed to the UFIRB office, University of Florida, Box 112250, Gainesville, FL 32611, (352) 392-0433. Scott A. Miller Professor Department of Psychology University of Florida Gainesville, FL 32611 352-392-0605, x 216 samiller@ufl.edu

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89 University of FloridaMiddle-School Survey Childs name_________________________________ Childs grade______________ I am willing to have my child participate in the project. _______________________________________ parent/guardian _______________________________________ 2nd parent/witness I do not wish to have my child participate in the project. _______________________________________ parent/guardian _______________________________________ 2nd parent/witness (Miller, 2001)

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APPENDIX C VERBAL PARTICIPANT ASSENT

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91 National Middle-School Survey: School Violence and Beliefs About Self, Others, and the Future Scott Miller Assent Script for Middle-School Participants Were from the University of Florida and were doing a project at your school. The project is for students in middle school, and your principal and teachers have given us permission to do it at _____School. Were hoping that youll decide to help us out. The way you can help us out is by answering some questions about yourselfwhat youre like, how you feel or th ink about different things. The questions are on this survey [tester holds up copy], and you answer them on your own without anyone seeing your answers. Well give out the survey here in a few minutes, and it should take about an hour to finish [if pilo t testing reveals a different session length this wording will be adjusted accordingly]. We cant tell you in advance about all the questions on the survey, but well try to give you some idea of what theyre like. Some of them are about things about yourself that youre happy or perhaps not so happy aboutfor example, what you feel youre good at and what you feel youre not so good at. Some of them are about your relations with other peoplefor example, how you feel about other kids, or about your teachers or parents. And some of them are about things that sometimes worry kids at schoolfor example, the problem of bullies or school violence. In each case, we just want to know what you honestly think. There are several things that are very important to understand before we start. One is that you dont have to do this. You can decide not to do it before we even start. Or if you start and decide you dont want to do it thats OK too. Nothing bad will happen to you if you decide not to do the surveyfor example, your teachers wont be mad or give you bad grades. If you decide not to do it [Here, we will describe whatever alternative activity the teachers have decided is appropriate for nonparticipants.] Another thing thats important is that you dont have to answer any question that you dont want to answer. If theres anything that you just dont want to think about or dont want to give an answer to you can leave it out. Now, if theres ever simply something that you dont understand you should raise your hand and ask us. We want you to skip a question only if you really dont want to answer it. One last thing is very important. All the answers you give on the survey will be confidential. This means that no one will ever know how you answered. Your teachers wont know, your parents wont know, and thos e of us doing the project wont know. We wont know because you wont put your name on the survey. Also, all the copies of the survey are the same, so no one can tell which one you got. Finally, when youre done you drop your survey in this box, and when we take them out later well have no way to know which one is yours. We set it up this way for a couple reasons. One is that what were

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92 interested in finding out is how kids your age in general thinkwe dont need to know how any one particular kid thinks. The other is that we want you to feel free to answer honestly, because you know that no one will ever know how you answered. One more thing, we hope that taking the survey will be an interesting experience. But theres a chance that some kids might find some of the questions upsetting to think about, or might have some things that they want to talk about afterwards. Your counselors know this, and theyll be ready to talk to anyone who wants to talk. [Here, we will provide more specifics if the school desirese.g., Mrs. Smith will be in her office from 3 to 4 every day this week.] We hope all this is clear! Does anyone have any questions before we start? Remember, if you have questions when youre taking the survey just raise your hand and well try to answer them. And if you have any questions after youre done well be here to talk to you. (Miller, 2001)

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99 Rhodes, J. E., & Davis, A. B. (1996). Supportive ties between nonparent adults and urban adolescent girls. In B. J. Ross Leadbeater & N. Way (Eds.), Urban girls revisiting stereotypes, creating identities (pp. 213-225). New York: New York University Press. Rhodes, J. E., Ebert, L., & Fischer, K. (1992). Natural mentors: An overlooked resource in the social networks of young, African American mothers. American Journal of Community Psychology, 20 (4), 445-461. Rhodes, J. E., Grossman, J. B., & Resch, N. L. (2000). Agents of change: Pathways through which mentoring relationships influence adolescents academic adjustment. Child Development, 71 (6), 1662-1671. Rhodes, J. E., Haight, W. L., & Ernestine, B. C. (1999). The influence of mentoring on peer relationships of foster youth in relative and nonrelative care. Journal of Research on Adolescence, 9 (2), 185-201. Rhodes, J. E., & Reddy, R. (2002). Volunteer mentoring relationships with minority youth:an analysis of same-versus cross-race matches Journal of Applied Social Psychology, 32 (10), 2114-2133. Roberts, R. E., Phinney, J. S., Masses, L. C., Chen, Y. R., Roberts, C. R., & Romero, A. (1999). The structure of ethnic identity of young adolescents from diverse ethnocultural groups. Journal of Early Adolescence, 19 (3), 301-322. Roth, J., Brooks-Gunn, J., Murray, L., & Foster, W. (1998). Promoting healthy adolescents: Synthesis of youth development program evaluations. Journal of Research on Adolescence, 8 (4), 423-459. Rotheram, M. J., & Phinney, J. S. (1987). Introduction: Definitions and perspectives in the study of childrens ethnic socialization. In J. S. Phinney & M. J. Rotheram (Eds.), Childrens ethnic socialization (pp. 10-28). Newbury Park, CA: Sage Publications. Rotheram-Borus, M. J. (1989). Ethnic differences in adolescents identity status and associated behavior problems. Journal of Adolescence, 12 361-374. Sanchez, B., & Reyes, O. (1999). Descriptive profile of the mentorship relationships ofLatino adolescents. Journal of Community Psychology, 27 (3), 299-302. Scales, P. C., & Gibbons, J. L. (1996). Extended family members and unrelated adults in the lives of young adolescents: A research agenda. Journal of Early Adolescence, 16( 4), 365-389.

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100 Scheier, L. M., Botvin, G. J., Diaz, T., & Ifill-Williams, M. (1997). Ethnic identity as a moderator of psychological risk and adolescent alcohol and marijuana use: Concurrent and longitudinal analyses. Journal of Child and Adolescent Substance Abuse, 6 (1), 21-47. Scheuring, S. E., Hanna, S., & DAquila-Ll oyd, E. (2000). Strengthening the safety net for adolescent health: Partners in creating realities out of opportunity. Family Community Health, 23 (2), 43-53. Search Institute. (2002). Developmental assets: An overview. Retrieved March 16, 2002, from http://www.search-institute.org/ Sellers, R. M., Rowley, S. J., Charous, T. M., Shelton, J. N., & Smith, M. A. (1997). Multidimensional inventory of black identity: A preliminary investigation of reliability and construct validity. Journal of Personality and Social Psychology, 73, 805-815. Simons, R. L., Murray, V., McLoyd, V., Lin, K. H., Cutrona, C., & Conger, R. D. (2002). Discrimination, crime, ethnic identity, and parenting as correlates of depressive symptoms among African American children: A multilevel analysis. Development and Psychopathology, 14 371-393. Smith, H., & Thomas, S. P. (2000). Violent and nonviolent girls: Contrasting perceptions of anger experiences, school, and relationships. Issues in Mental Health Nursing, 21 547-575. Smith, E. P., Walker, K., Fields, L., Brooki ns, C. C., & Seay, R. C. (1999). Ethnic identity and its relationship to self-esteem, perceived efficacy and prosocial attitudes in early adolescence. Journal of Adolescence, 22 867-880. Tabchnick, B. G., & Fidell, L. S. (1989). Using multivariate statistics (2nd ed.). New York: Harper & Row. Tajfel, H. (1981). Human groups and social categories. Cambridge: Cambridge University Press. Tierney, J. P., Grossman, J. B., & Resch, N. C. (1995). Making a difference. An impact study of Big Brothers Big Sisters. Philadelphia, PA: Public/Private Venture. Thornton, M. C., Chatters, L. M., Taylor, R. J., & Allen, W. R. (1990). Sociodemographic and environmental correlates of racial socialization. Child Development, 61 401-409. U.S. Census Bureau. (2000). State and county quick facts. Retrieved March 14, 2002, from http://www.census.gov/

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101 U.S. Department of Education, National Center for Education Statistics, Common Core of Data (CCD). (2002)., State Nonfiscal Survey of Public Elementary/Secondary Education, 1999-2000. Retrieved March 22, 2002, from http://www.ed.gov/ Vanderpool, H. Y. (1996). The ethics of research involving human subjects; facing the21st century. Fredrick, MD: University Publishing Group. Weinfurt, K. P. (1997). Multivariate analysis of variance. In L. G. Grimm & P. R. Yarnold (Eds.), Reading and understanding multivariate statistics Washington, DC: American Psychological Association. Werner, E. E. (1986). Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol, 47 (1), 34-40. Wright, R. E. (1997). Logistic regression. In L. G. Grimm & P. R. Yarnold (Eds.), Reading and understanding multivariate statistics Washington, DC: American Psychological Association. Woolard, J., & Greig, R. (2001). Mentoring items. Unpublished manuscript. Gainesville, Fl: University of Florida. Yarcheski, A., & Mahon, N. E. (2000). A causal model of depression in early adolescents. Western Journal of Nursing Research, 22 (8), 879-894. Zimmerman, M. A., Bingenheimer, J. B., & Notaro, P. C. (2002). Natural mentors and adolescent resiliency: A study with urban youth. American Journal of Community Psychology, 30(2), 221-243.

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102 BIOGRAPHICAL SKETCH Ms. Ramona Greig obtained a Bachelor of Science degree in nursing from the University of Florida in 1995, with high honors. She worked briefly in intensive care, but then focused her career on psychiatric-ment al health nursing. She obtained a Master of Science in nursing with a specialization in psychiatric-mental health nursing from the University of South Florida in 1998. She received the Rose Horn Psychiatric Nursing Scholarship as recognition for her work during her master's program. She then began her practice as a certified clinical nurse specialist and licensed psychiatric nurse practitioner in a family psychiatric outpatient clinic. At this time, Ms. Greig began teaching courses at the University of Florida. She also worked as a study coordinator and sub-investigator conducting clinical pharmaceutical research in an outpatient setting. She entered the Ph.D. program in nursing science at the University of Florida in August of 2000 and received the Alumni Fellowship Award from the University of Florida for support of her doctoral education. During her tenure in doctoral studies, Ms. Greig helped to develop the Doctoral Student Council and began a doctoral student mentorship program for new students. She also served as the student representative on the College of Nursing Ph.D. Task Force at the University of Florida in 2002 and 2003. Ms. Greig's aspirations include further development of her career within the field of child and adolescent mental health. She plans to expand her experience as practitioner, educator and researcher. She would like to work as a member of an interdisciplinary team that creates, implements, and evaluates prevention and early intervention programs for

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103 adolescents at risk for emotional and behavioral problems. Ms. Greig's primary career goal is to promote adolescent mental health within a multicultural society and the larger global community.


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Title: Natural Mentors, Ethnic Identity, and Adolescent Mental Health
Physical Description: Mixed Material
Copyright Date: 2008

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Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
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NATURAL MENTORS, ETHNIC IDENTITY, AND
ADOLESCENT MENTAL HEALTH















By

RAMONA GREIG


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


2003































Copyright 2003

by

Ramona Greig















To my mother for her unconditional love and for always being there.
To my grandmother for teaching me the value of education and lifelong learning.
And to the rest of my family and friends for all of their love and support
that made this possible.















ACKNOWLEDGMENTS

I would like to acknowledge the contributions of my dissertation committee. I

acknowledge my dissertation chairperson, Dr. Jennifer H. Elder, for supervising a

project and a student that required expansion of her area of expertise. She has

demonstrated the qualities of a true scientist who is also sincerely committed to the

mental health care of children. I would also like to acknowledge Dr. Kathleen A. Long

for serving on my committee. She helped me to find a passion for the topic of mentoring.

She always considered my interests and dissertation project thoughtfully despite her

demanding role as dean of the college of nursing. I would especially like to thank the

final member of my committee from the college of nursing, Dr. Martha Jo Snider. She

has been my mentor since I was an undergraduate nursing student. She introduced me to

psychiatric mental-health nursing. I would like to thank her for her open-door policy and

for the professional and personal support she provided during my doctoral studies.

I would also like to acknowledge my dissertation committee members from

outside the college of nursing: Dr. Jennifer L. Woolard, from the Department of

Developmental Psychology, and Dr. Lisa M. Brown, from the Department of Clinical

Psychology. Dr. Woolard was instrumental in enabling me to work on her collaborative

research project with middle school students that became my dissertation. She also

demonstrated that a woman could have it all. She handled her roles as a professor and

mother with grace. I would especially like to thank her for attending my qualifying exam

while more than eight months pregnant. Lastly, I would like to thank Dr. Brown for her









passion for research and issues of race and ethnicity. She provided thoughtful and

insightful analysis of the theoretical and empirical work we discussed. She also was a

tremendous resource for me while I was completing my statistical analysis. She is a great

role model as an educator and a social scientist.

I would also like to acknowledge other groups and individuals who helped me to

complete my doctoral studies. Dr. Myrna Courage and the University of Florida provided

the Alumni Fellowship that allowed me to focus on my studies full-time. Also, Dr. Scott

Miller provided the opportunity for me to work as a research assistant while completing

my dissertation and allowed me to integrate my research questions into his survey

development project. Dr. Eve Brank, from the department of statistics, taught me about

data management and computer-assisted data analysis. Lastly I would like to thank Drs.

Stephanie and Elias Sarkis for their encouragement and their crucial advice about when

to finish.















TABLE OF CONTENTS
page

ACKNOW LEDGM ENTS ................................................ iv

ABSTRACT .......... ................................................ viii

CHAPTER

1 INTRODUCTION ........ ..........................................1

Problem .................. ................. ........... ........ 1
Purpose ............................ ..... .............. ..... .. 2
Conceptual Framework-Neuman Systems Model ......................... 2
M ental Health Functioning .... ............ ....................... 3
Middle-Range Theories ............................................ 4
Conceptual and Operational Definitions ............................... 8
Research Aims and Hypotheses ................ ...................... 13
Summary ....... ................................................ .14

2 REVIEW OF LITERATURE ................ ....................... 16

Relevance to Nursing-Adolescent Mental Health ........................... 16
Ethnic Identity ..................................... ................ 19
Mentoring ........ ................................................ 34
General Discussion .................................................. 46

3 METHODOLOGY .................................................. 47

Design ....... ..... .... .................................. 47
Research Aims ........ ............................................ 48
Research Hypotheses ................ ............................. 48
Procedures ........ .............................................. .48
Instrumentation ................. ............................ 51
Data Analysis ................ ................................ 56
Limitations ................ .................................. 58

4 RESULTS ................. .................................. 59

Research Design ................... .............................. 59
Sampling Procedure ................. ......................... 59
Sample Characteristics ................. ......................... 61
Mentors ................. ................. ............ ........ 63
Ethnic Identity ..................................................66










5 DISCUSSION AND RECOMMENDATIONS ............................ 72

Adverse Mental Health Outcomes ................ ................... 72
Mentoring ........ ............................................... .73
Ethnic Identity ...................................................75
Recommendations and Future Directions .............................. 78
Nursing Implications ............................................... 80

APPENDIX

A MENTORING ITEMS ....................................... ....... 84

B PARENT INFORMED CONSENT ................. ................. 87

C VERBAL PARTICIPANT ASSENT ................................... 91

REFERENCES .............. .................................. 93

BIOGRAPHICAL SKETCH ............................................ 102















Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

NATURAL MENTORS, ETHNIC IDENTITY, AND
ADOLESCENT MENTAL HEALTH

By

Ramona Corrin Greig

August 2003

Chair: Jennifer H. Elder.
Major Department: Nursing

Adolescent mental health research has undergone a shift in emphasis from

problem-focused to strength-based research. There has also been a shift toward more

research that is inclusive of ethnic minority group members and the constructs that are

particularly salient to them. This study explored individual and socio-cultural variables

and their relationships to adolescent mental health from a nursing perspective.

Ethnic identity development and the presence of natural mentors were examined

in a sample of 566 multi-ethnic middle-school students. Adolescent mental health was

assessed in the domains of mood-related symptoms (depressed/anxious mood,

angry/irritable mood, somatic complaints due to anxiety) and substance use (alcohol/drug

use). It was hypothesized that those adolescents with a natural mentor would have better

mental health than those without a mentor. It was also hypothesized that there would be a

relationship between ethnic identity achievement and mental health outcomes in the

African American and Hispanic adolescents. Lastly, a moderation model was tested to









examine the influence of an ethnically matched mentor on the relationship between

ethnic identity and mental health.

Multivariate analyses of variance, multiple linear regression, and logistic

regression were used to test these hypotheses. The hypotheses were not supported, with

one exception. Ethnic identity achievement was predictive of Alcohol/Drug Use for both

minority and majority adolescents. Ethnic identity achievement was not predictive of

mood-related symptoms possibly because of the early developmental age of the

participants. The presence of a natural mentor was also not predictive of mental health in

this sample, despite accounting for several aspects of relationship quality. Issues of

measurement validity and statistical power were limitations that may have influenced

these findings. Nonrandom sample selection, the use of a cross-sectional, correlational

design, and self-report measures were also limitations of this study.

This study has direct implications for nursing research, education, and practice.

Psychiatric-mental health nurses could use these findings to develop screening protocols

for mental health problems. Nursing education, practice, and research should emphasize

adolescent socio-cultural and psychosocial strengths.















CHAPTER 1
INTRODUCTION

Ethnic minority groups are a substantial part of U.S. society. Currently, Hispanics

and African Americans represent approximately 12% and 13% of the U.S population,

respectively (U.S Census Bureau, 2000). This is equivalent to over 32 million people in

each group. There is also little empirical knowledge about the mental health problems of

nonwhite adolescents (Grisso & Barnum, 2000). Therefore, it is critical for nurses and

other health professionals to include issues relevant to these groups in their research.

In addition, adolescent mental health is a growing concern for all ethnic groups.

More than half of early adolescents have had at least one physical fight in the last year

(Fetro, Coyle, & Pham, 2001; DuRant, Smith, Kreiter, & Krowchuk, 1999). More than

half of middle-school students have tried alcohol and more than 17% have tried

marijuana (Fetro et al.; DuRant et al.). By the time adolescents reach high school, their

rates of clinical depression reach adult levels with over 20% of adolescents being

affected (Lewinsohn, Rohde, & Seeley, 1998).

Problem

Research is needed that examines the relationships between individual and social

factors and mental health outcomes in adolescents. This area of research has typically

neglected factors that are relevant to ethnic minorities. Discovering what attributes or

strengths specifically may protect minority adolescents from emotional and behavioral

problems is an understudied area of research. More research also is needed that focuses







2

on positive factors that may be associated with better mental health outcomes for

adolescents.

Purpose

The purpose of this study was to evaluate the relationships between ethnic

identity, mentorship, and adolescent mental health from a nursing perspective. Multiple

factors in various domains are related to mental health functioning. This study

specifically addressed these individual and social factors and their relationship to mental

health functioning in middle-school students.

Conceptual Framework-Neuman Systems Model

The Neuman Systems Model provides a broad conceptual framework for research

that focuses on issues from health promotion and disease prevention to acute illness. It is

one of the most widely used nursing models. According to Neuman (1995), nursing can

be defined broadly to include "prevention as intervention" (p. 33). Neuman defined the

client as a system that could potentially be an individual, a family, a community, or even

a social problem. The emphasis in the model is on system stability or health. For this

research, the system under consideration is that of an individual adolescent; and system

stability is defined as the absence of the signs and symptoms of mental disorder.

The client system is made up of several levels of protection from the onset of

illness (Neuman, 1995). The layers of protection are as follows:

* Flexible line of defense is an outer protective barrier to the client system that is
called into action first in the face of environmental stressors. It protects the wellness
or healthy state; and it can expand or contract based on changes in the system and the
environment. In this study, the presence of a mentor or a high level of achieved ethnic
identity may maintain mental health as evidenced by no adverse symptoms.

* Normal line of defense is the conceptual line that delineates and defines health. If
the normal line of defense is penetrated, illness has occurred and adverse symptoms
are present.







3

* Lines of resistance are activated after illness has occurred. Factors at this level move
the client toward recovery and health again. For example, an adolescent may seek out
social support from a mentor in response to depressive symptoms. The lines of
resistance are activated after the onset of symptoms and include any coping
mechanisms or responses that may lead toward recovery.

* Central core contains factors that are necessary for survival or are considered
common to all individuals. In the case of an individual, factors include bodily organs,
cognitive ability, genetic make-up and identity structure. Neuman (1995) described
the ego structure as a core construct. Aspects of this may be inherent (e.g.,
temperament). One's sense of identity also can be conceptualized as a core construct
that continues to develop over time. A further extension of this model is to
conceptualize ethnic identity as a core aspect of self that also develops over time.
The closer adolescents get to an achieved sense of ethnic identity, the more protected
they may be from the onset of adverse mental health outcomes.

A primary goal of nursing research is to identify existing and potential protective

and risk factors related to illness. Another goal is to develop theoretically based

interventions (Neuman, 1995; Fawcett, 2000). This study lays the foundation for

nursing interventions that could target individuals' strengths and assist them in resisting

illness or in returning to health after the onset of illness. This conceptual model provides

a guiding framework in this study of factors that are potentially protective against

adverse mental health outcomes in adolescents.

Mental Health Functioning

Mental health functioning is the outcome of interest in this research study. This

construct is extremely broad and complex. A detailed explanation of all of the factors

involved in determining this construct is beyond the scope of this project. However, this

construct fits easily into the systems model described above. Each level of the systems

model includes interacting variables from the physiological, psychological, socio-

cultural, developmental and spiritual domains (Neuman, 1995). Mental health

functioning is determined by a complex interplay among several domains and multiple

factors within each domain. This study targets concepts that are specifically in the









individual and socio-cultural domains and their relationship to mental health functioning

in adolescents.

Middle-Range Theories

This section describes the theories that are specific to the variables under study.

These theories provide the groundwork for this study and much of the literature described

in Chapter 2. The social and developmental theories of ethnic identity are described, as

well as the theories related to the mentorship of adolescents.

Ethnic Identity Development

Using the developmental theories of Erikson (1968), and Marcia (1980), as well

as the social identity theory of Tajfel (1981), Phinney (1989; 1992) constructed a theory

of ethnic identity development that occurs during adolescence and early adulthood.

According to Erikson (1968), identity development is the primary task of adolescence.

During adolescence, the most logical framework for examining the construct of ethnic

identity is a developmental perspective.

Tajfel (1981) defined social identity as "that part of an individual's self-concept

which derives from his (or her) knowledge of his (or her) membership of a social group

(or groups) together with the value and emotional significance attached to that

membership" (p. 255). Social identity, in this context, is the aspect of identity related to

ethnic group membership. Ethnic group membership can enhance, have minimal effect

on, or be detrimental to general self-concept (Tajfel, 1981).

Ethnic identity is defined as a general phenomenon that applies to all ethnic

groups (Phinney & Tarver, 1988; Roberts et al., 1999). It is, however, of particular

importance to minority group members (Phinney, 1992). This probably occurs because,

when in the ethnic minority, ethnic group membership becomes a more important aspect









of identity. Phinney (1989; 1990; 1992) described three phases of ethnic identity

development: unexamined, exploration, and achievement. This differs from other

theories because it has been applied to many ethnic groups. The unexamined phase is

typified by the irrelevance of one's membership in an ethnic group to their self-concept.

The exploration phase is a period of increased participation in cultural activities,

increased interest in the history of their ethnic group, and increasing relevance to

personal identity. The achieved phase includes both a positive connection to one's group

and continued participation in cultural activities and behaviors (Phinney, 1992). This

study focuses on the level of overall ethnic identity achievement.

Mentoring Theories

The two main theories that have been used to define and understand mentoring

are attachment theory (Bowlby, 1969; Ainsworth, 1989) and social learning theory

(Bandura, 1977). The definition of a mentor includes aspects of both theories. Neither

one independently allows for full understanding of mentoring. In combination, the

definition of a mentoring relationship becomes clearer and the mechanisms of any

benefits these relationships may provide to adolescents are better understood.

Ainsworth (1989) extended attachment theory beyond parent-child relationships

to friendships, pair bonds and other affectional bonds. Mentor-mentee relationships

include an affectional component (Rhodes, Ebert, & Fischer, 1992). These relationships

provide unique support that is not necessarily available within peer or parental

relationships (Beam, Chen, & Greenberger, 2002). There are several ways in which this

type of relationship may positively influence adolescents. It is possible that attachment

relationships with key non-parental adults, simply provide more social support (Rhodes,

Ebert, & Fischer, 1992; Scales & Gibbons, 1996). These relationships also may serve a









therapeutic purpose. They may be corrective relationship experiences in instances when

the parent-child relationships are insecure (Rhodes, Haight, & Ernestine, 1999). The

affective aspect of the mentor-mentee relationship can be easily conceptualized based on

attachment theory.

The main concept from social learning theory that applies to mentoring is

observational or vicarious learning (Bandura, 1977). Vicarious learning is the ability to

learn from the behavior of others. One observes both the beneficial and detrimental

outcomes that result from specific behaviors. Positive role models demonstrate prosocial

behavior, and adolescents learn that this is a viable behavioral option. This defines one

mechanism of the behavioral influence of role models. Role modeling is a key concept

within the mentoring literature and in the development of mentoring programs (Cavell &

Hughes, 2000; Blum & Jones, 1993). Social learning has also been the basis of traditional

prevention efforts in the form of social skills training and other teacher-learner models of

intervention (e.g., Andrews, Hops, & Duncan, 1997).

Role modeling is, however, different from mentoring. Famous people or world

leaders can serve as role models without the context of a relationship. Mentoring has the

added component of a supportive, trusting relationship. In a review of youth program

evaluations, independent of the type of program, adolescents improved more on

behavioral outcomes if there were caring adults involved in program implementation

(Roth, Brooks-Gunn, Murray, & Foster, 1998). Consistent and stable relationships had an

impact on adolescent outcomes. This provides evidence that the ability of a mentor to

serve as a role model stems partly from the quality of the relationship between the

adolescent and the mentor.









In summary, it is possible that some adolescent-mentor relationships have more

of an attachment component, while others serve more of the role-modeling function. It is

also likely that the two functions of mentors may be inextricably linked. In other words,

for a mentor to have social influence on an adolescent, there must be an affectional bond

present. In this study, these two functions of the mentor-mentee relationship are not

differentiated. The presence of mentors in the lives of adolescents was assessed. In

addition, the emotionally supportive aspects of these relationships and the amount of

influence adolescents believe the mentor has over their life decisions and behaviors were

measured.

Ethnic Mentors

An additional characteristic of the adolescent-mentor relationship that this study

examined was the ethnic match of the mentor and the mentee. The theoretical

frameworks described above have not specifically addressed this concept. However,

social learning theory and social identity theory can be applied to the concept of an

"ethnic role model" (Brown, 1998, p. 170) and/or an ethnic mentor (the latter term is

used in this study). That is, the ethnic match of a mentor may facilitate vicarious learning

and may provide a sense of commonality that allows for easier attachment.

Mentoring programs for at-risk adolescents typically attempt to ethnically match

mentors and mentees; however, this is not necessarily theoretically or empirically

grounded. Ethnic matching has been studied in other areas. For example, research has

demonstrated that ethnically matching adoptive parents and children can enhance ethnic

identity for Hispanic adolescents (Andujo, 1988). However, the ethnic identity of

adolescents matched with mentors that have the same ethnic background has not been

extensively studied. An additional goal of this project was to assess the potentially









moderating effect that this ethnic match had on the relationship between an adolescent's

ethnic identity and his or her mental health functioning.

Conceptual and Operational Definitions

Mental Health Functioning

Mental Health Functioning is defined as the absence of adverse mental and

behavioral symptoms. It is differentiated from the broad construct of general healthy

psychological development. Healthy psychological development can broadly include

emotional, cognitive, and biological factors. This study focuses on the presence or

absence of adverse emotional or behavioral symptoms. The presence of these symptoms

has also been called psychopathology in the literature (Lewis, 2000). The investigation of

psychopathology over the course of adolescent development has been defined as "the

study and prediction of maladaptive behaviors and processes across time (Lewis, 2000,

p. 3).

The specific aspects of mental health functioning that were assessed in this study

were mood symptoms (i.e., depressed, anxious, angry and irritable moods); somatic

symptoms due to anxiety (e.g., elevated heart rate and stomachache); and substance use

(alcohol and other drugs). Mental health can be conceptualized as the presence of

positive symptoms (e.g., high self-esteem); however, utilizing the above definition for

this study allows the results to have direct implications for the applied science of

psychiatric and mental-health nursing.

This construct was operationalized with The Massachusetts Youth Screening

Instrument-Second Version (MAYSI-2; Grisso, Barnum, Famularo, & Kinscherff, 1998).

Four types of adverse mental health outcomes were measured. These were each measured









with a specific subscale of the MAYSI-2. The subscales included three mood-related

measures and one measure related to substance use. These were the four subscales used:

1. Depressed-anxious mood (8 items)-experiences of a mixture of depressed and
anxious feelings.

2. Somatic complaints due to anxiety (6 items)-experiences of bodily symptoms
associated with anxiety.

3. Angry-irritable mood (9 items)-experiences of frustration, anger, and
irritability.

4. Alcohol and other drug use (8 items)-patterns of use of alcohol or drugs
(Grisso & Barnum, 2000).

Ethnic Identity

Ethnic identity can be viewed as a "general phenomenon" that is relevant to all

ethnic groups. Different ethnic groups can have various belief systems, cultural practices,

even languages. However, it is the group identity or the "sense of identification with, or

belonging to, one's own (ethnic) group" that applies to all groups (Phinney, 1992, p.

158). This construct includes exploration/search and affirmation/belonging (Roberts et

al., 1999). The exploration factor is the "developmental and cognitive component" (J. S.

Phinney, personal communication, November 13, 2001). It includes searching for

information related to one's ethnicity and participation and involvement in ethnic and

cultural activities (Roberts et al., 1999). The affirmation and belonging factors are the

"affective components," (J. S. Phinney, personal communication, November 13, 2001).

This includes ethnic pride, a positive feeling about one's group, and a commitment to

that group. It also includes a feeling of belonging and attachment to one's ethnic group

(Roberts et al., 1999).







10

The Multigroup Ethnic Identity Measure (MEIM) was used as a measure of ethnic

identity (Phinney, 1992; Roberts et al., 1999; J. S. Phinney, personal communication,

November 13, 2001). This likert scale consists of 12 items. Responses range from

Strongly Disagree (1) to Strongly Agree (5). Higher scores indicate a more achieved

sense of ethnic identity.

Mentors

A mentor is defined as a nonparental adult who has a trusting relationship with

the adolescent (Rhodes & Davis, 1996). According to the Oxford dictionary, a mentor is

defined as "an experienced and trusted advisor" (Pearsall, 1999, p. 890). Naturally

occurring mentors can be relatives, teachers, community members, or other important

adults. They provide both role-modeling and emotional support (Grossman & Rhodes,

2002). Additional defining aspects of a mentor include relational factors. Adolescents

believe they can "count on" the adult, that the adult cares for them "deeply," inspires

them to do their best, and has influence over important decisions that adolescents make

(Rhodes & Davis, 1996, p. 216).

The presence of a natural mentor was operationalized with the following question

previously used by Rhodes and colleagues (1992, p. 449; Appendix A): "Other than your

parents or whoever raises you, is there an adult in your life (a mentor, or positive role

model) who you go to for support and guidance?"

Mentoring quality factors

Beyond the perception of the presence of a natural mentor, descriptive factors can

serve as a measure of quality of the mentoring relationship. Several factors have been

shown to influence the association between the presence of a mentor and positive







11

outcomes (Grossman & Rhodes, 2002; Grossman & Tierney, 1998). These factors have

been examined more in the mentoring program evaluation research than in the research

done on natural mentors. The duration of the relationship has been found to be important

in mentor-mentee matched relationships (Grossman & Rhodes, 2002). Brief (less than 6

months duration) relationships can actually have detrimental effects (Grossman &

Rhodes, 2002).

Other factors have been less well studied. The frequency and duration of typical

contact may also be important to the quality and potential influence of the relationship.

The most extensively studied mentoring program, Big Brothers Big Sisters, sets

minimum levels of contact between their matched mentors and mentees (Grossman &

Tiemey, 1998). Mentors must spend a minimum of 3 to 4 hours with their mentees at

least two to four times per month. This program has demonstrated significant positive

mental health outcomes for its participants (Grossman & Tiemey, 1998).

The final quality factor that was addressed in this study is the amount of trust

adolescents have in their mentors and how much they confide in their mentors. These

aspects have been considered part of the definition of a mentoring relationship (Rhodes

et al., 1992). This includes how much the adolescents tell their mentor about good and/or

bad things that happen to them. It also addresses the adolescent's perception of how

much this individual influences their behavior.

A series of items were developed to operationally define the quality mentoring

relationship constructs (Woolard & Greig, 2001). These items included several ordinal

response items that assessed the duration of the relationship and the frequency and

duration of typical contact. Also, based on previous measures and definitions a

Trust/Confiding likert scale was developed (Appendix A; Institute of Behavioral Science,







12

1990 as cited in Centers for Disease Control and Prevention, 2002; Nakkula et al., 1990;

Rhodes et al. 1992). The Trust/Confiding scale included seven items with the following

response options: (a) "a little bit," (b) "somewhat," and (c) "very much." Questions

included items such as "How much do you feel you can count on this person to be there

for you?" A mean score was calculated to reflect the amount of trust or confidence an

adolescent perceives in reference to his or her mentor.

Responses from all of the items described were used to determine the quality of

the existing mentoring relationship. Minimum levels were determined based on previous

programmatic and empirical work. The following criteria were used as the minimum for

a quality relationship:

1. Duration of the relationship: those that indicate the relationship has lasted
longer then 6 months (Grossman & Rhodes, 2002).

2. Frequency of visits: those that indicate that they spend time with their mentor at
least weekly (Grossman & Tierney, 1998).

3. Length of visits: those that indicate that they spend at least 1 hour per visit with
their mentor (Grossman & Tierney, 1998).

4. Trust and confiding scale: those that scored at least a mean of 2.0 were
categorized as having a quality mentor.

Mentor characteristics

Other aspects related to the characteristics of the mentor were also obtained.

These aspects included the ethnic match of the mentor. An ethnically matched mentor

(i.e., Ethnic Mentor) is a mentor that is of the same ethnic background as the adolescent.

This person meets the above definition of a mentor with the added condition of being an

ethnic match with the adolescent.

The gender and mutual community membership of the mentors were also

assessed. Also, the relationship that the mentor has to the adolescent (e.g., teacher,







13

minister, relative, etc.) was assessed. These characteristics were measured using a series

of categorical items developed by the principal investigator (Appendix A).

Research Aims and Hypotheses

Aim 1. Evaluate the relationship between the presence of a mentor and the mental health
functioning of the mentee.

This will provide information related to the existence of natural mentors (e.g.,

extended relatives, teachers, ministers) in the lives of adolescents. The mental health of

those with and without quality mentoring relationships also was examined. This

information is important because there have been very few surveys that have assessed the

presence of natural mentors in school samples or defined the nature and quality of these

relationships. The studies that have found a relationship between the presence of mentors

and the mental health of adolescents have been conducted with non-normative samples

(e.g., pregnant teens). Based on existing research findings (Rhodes et al., 1992; Rhodes,

Contreras, & Mangelsdorf, 1994; Zimmerman, Bingenheimer, & Notaro, 2002),

Hypothesis 1 was reached.

Hypothesis 1. Those adolescents that have a natural mentor have better mental health
functioning than those that do not have a mentor.

Aim 2. Examine the relationship between the ethnic identity of the adolescent and his
or her mental health functioning.

This will provide important new information about the association of ethnic

identity and general aspects of mental health functioning (i.e., mood disturbance and

substance use). Although some of these aspects of mental health have been studied,

results have been mixed. Existing research has demonstrated that there are differences in

the relationship of these variables between ethnic groups and that this construct is more

salient to ethnic minority group members (e.g., Phinney, 1992; Roberts et al., 1999).









Based on existing research findings (Roberts et al., 1999; Brook, Balka, Brook, Win, &

Gursen, 1998; Brook, Whiteman, Balka, Win, & Gursen, 1998; Scheier, Botvin, Diaz, &

Ifill-Williams, 1997), Hypothesis 2 was reached.

Hypothesis 2. There is a relationship between ethnic identity and mental health
functioning in minority adolescents.

Aim 3. Evaluate the potential moderating effect of an ethnic mentor on the relationship
between the ethnic identity of the mentee and his or her mental health
functioning.

This will provide information that has not been specifically addressed in the

existing literature. Although ethnicity is assumed to be a critical factor in matching

mentors and mentees in youth development programs, this has not been extensively

studied. There has been research supporting the idea that those who are ethnically

matched in an adoption situation do have higher ethnic identity. Based on research from

the adoption literature (e.g., Andujo, 1988), Hypothesis 3 was reached.

Hypothesis 3: The presence of an ethnically matched mentor moderates the relationship
between ethnic identity and mental health outcomes in minority
adolescents.
Summary

This chapter has described the general background and main purpose of this

study. The conceptual and theoretical underpinnings for this research were also described

(see Figure 1-1 for Conceptual Model). Conceptual and operational definitions, specific

research aims, and hypotheses were detailed. Lastly, a synopsis of the background

evidence for the research hypotheses was provided along with each specific hypothesis.





















Mid-Range Theories


Depressed- Somatic Angry-Irritable Alcohol/Drug Use
Anxious Complaints

Dependent Variables


Figure 1-1. Conceptual model


Neuman Systems
Model















CHAPTER 2
REVIEW OF LITERATURE

This chapter is an integrative review of the relevant literature. Nursing relevance

and related mental health research in adolescents is detailed first. Second, literature that

examines various psychological and behavioral factors that have been associated with

ethnic identity is described. Lastly, mentoring literature is reviewed; including program

evaluation research and research focused on naturally occurring mentors.

Relevance to Nursing-Adolescent Mental Health

The discipline of nursing has a history of evaluating mental health issues across

the lifespan. Nurse researchers have also been involved in assessing developmental needs

of various groups and implementing prevention and intervention programs in response to

those needs. This study is unique within the field of nursing because there has been no

research examining the presence of natural mentors and ethnic identity in the period of

early adolescence. However, this study does join a growing body of literature that

addresses mental health functioning in minority adolescents (Doswell, Millor,

Thompson, & Braxter, 1998; Gall, Pagano, Desmond, Perrin, & Murphy, 2000; Guthrie

& Low, 2000; Guthrie, Young, Williams, Boyd, & Kintner, 2002; Long & Boik, 1993).

Nurse researchers have investigated adolescent substance use in multi-ethnic

samples (Long & Boik, 1993; Guthrie et al., 2002; Guthrie & Low, 2000;). Long and

Boik surveyed 625 multi-ethnic elementary and middle school students about their

alcohol use and various measures of beliefs and self-concept. The sample was followed









longitudinally. There were no significant differences in alcohol use between the Native

American, Hispanic or European American participants. However, church attendance,

prayer, academic achievement, and a stable adult in the home were all protective against

alcohol use. In contrast, negative attitudes about school and a poor self-concept were

associated with higher levels of alcohol use (Long & Boik,).

Other nurse researchers have examined specifically African American adolescent

females and have developed theoretical models to explain substance use and other

aspects of mental health (Doswell et al., 1998; Guthrie et al., 2002; Guthrie & Low,

2000). Guthrie and Low developed a theoretical framework that proposes that multiple

social factors (sexism, racism, ageism) influence adolescent's self-efficacy, which

mediates the use of substances. An aspect of this model was tested on a sample of 105

African American adolescent girls (Guthrie et al). The results indicated that experiences

of discrimination were related to cigarette smoking. This relationship was partially

mediated by daily hassles, a measure of stress (Guthrie, et al.). Other work with African

American female adolescents has evaluated the relationships between family contextual

factors, biological development and self-esteem. Specific findings included establishing

the relationship between early onset of menarche and poor global self-image

(Doswell et al.).

Less nursing research has focused on the externalizing behavior of violence or the

related mood symptoms (i.e., anger/irritability). An exception is a survey of 213 violent

and nonviolent adolescent girls (Smith and Thomas, 2000). The two groups were

compared on several measures. The violent girls had more generalized anger, while the

nonviolent girls were more likely to report being angry after specific events. Feeling

angry enough to hit someone was associated with higher levels of loneliness, somatic









symptoms of anger, and peer rejection (Smith & Thomas). This study highlights the

relevance of exploring the angry and irritable mood symptoms of adolescent girls.

Lamb and Puskar (1991) conducted a school-based survey of 69 high school

students in order to assess the base-line mental health needs of the school. Rates of

suicidality and depression were 16% and 14%, respectively. Measures of anger

expression and control were also given to the participants. Those who scored high on the

depression and suicidality measures were more likely to report high anger expression and

low anger control (Lamb & Puskar).

Nursing research has also examined causal models of the depression and

outcomes due to depression in early adolescents (Mahon & Yarcheski, 2001; Yarcheski

& Mahon, 2000). Utilizing large multi-ethnic samples of middle school students,

relationships between stress, state-anxiety, well-being, conflict, social support, and

depression were evaluated. Findings were that state-anxiety had a direct effect on

depression, while stress was found to have a direct and indirect effect on depression

(Yarcheski & Mahon). Outcomes of depression included direct effects on well-being,

conflict, and perceived social support (Mahon & Yarcheski).

Nurse researchers working in school-based settings have assessed general

psychosocial functioning of adolescents (Gall et al., 2000). In a predominately Hispanic

(62%) high school, 383 adolescents were screened for general psychosocial dysfunction.

Fourteen percent scored above a cutoff criterion to indicate those that may require

intervention. Females, teen-parents, and those with Medicaid insurance were more likely

to be above the cutoff. There was no difference between the ethnic groups. Those with

higher scores had higher rates of tardiness and absenteeism. The adolescents that were

referred for mental health treatment had decreases in their rates of tardiness and









absenteeism, while the other group did not (Gall et al.). This study demonstrates how

screening within a school-based health center by nurses can improve some academic

indicators for adolescents with adverse mental health symptoms.

These studies demonstrate the value of a nursing developmental perspective in

research evaluating mental health in minority adolescents. Nurse researchers have

examined predictors of substance use, anger, and violence (Guthrie et al., 2002; Long &

Boik, 1993; Smith & Thomas, 2000). They have also developed theoretical models to

explain substance use and depression in adolescents (Guthrie & Low, 2000; Yarcheski &

Mahon, 2000). School-based surveys and screening procedures have demonstrated the

usefulness of these methods for identifying adolescents suffering from adverse mental

health symptoms (Gall et al., 2000; Lamb & Puskar, 1991). These methods also provide

assessments of the scope of the problem of adverse mental health symptoms in multi-

ethnic adolescents. Together this work provides precedence for this type of research

within the field of nursing. The following sections detail research primarily from the

developmental psychological literature and lay the foundation for this study.

Ethnic Identity

Adolescents are beginning to explore and formulate identities in several domains

of life. Choices adolescents make concerning their developing identities can have an

impact on long-range outcomes. For example, an adolescent may choose to become

someone who is sexually active, uses substances, or plays sports. Other aspects of

identity are ascribed, for example ethnicity. During adolescence, the cognitive and

affective aspects of ethnic identity are beginning to take shape.

In the following sections, research is reviewed that has evaluated the role of

ethnic identity during adolescence for adolescents from several ethnic groups. Special









emphasis is made on studies that have examined the ethnic identity development of

Hispanic and African American adolescents and how this construct relates to various

measures of mental health. Qualitative and quantitative research that evaluated the

developmental model of ethnic identity is presented. Research that relates ethnic identity

to several positive aspects of psychological development is reviewed. Also, research that

has conceptualized ethnic identity within a resiliency framework is described. Lastly,

research that has compared levels of ethnic identity to various mental and behavioral

problems is reviewed.

Ethnic Identity Development

The majority of the research on ethnic identity development has been done with

adolescents and adults. The concept of ethnic identity development prior to adolescence

has been discussed only as it relates to racial or ethnic socialization (e.g., Bowman &

Howard, 1985; Caughy, O'Campo, Randolph, & Nickerson, 2002; Rotheram & Phinney,

1987; Thornton, Chatters, Taylor, & Allen, 1990). Rotheram and Phinney (1987) defined

ethnic socialization as "the developmental processes by which children acquire the

behaviors, perceptions, values, and attitudes of an ethnic group, and come to see

themselves and others as members of such groups" (p. 11). This definition clearly links

ethnic socialization to the development of ethnic identity, the aspect of identity related to

ethnic group membership. Ethnic socialization practices and their long-term effects on

ethnic identity development, however, rarely have been studied.

Research with African American families has focused on the many facets of racial

socialization (Bowman & Howard, 1985; Caughy et al., 2002; Thornton et al., 1990). In

general, the majority of African American parents do provide some level of racial or

ethnic socialization. Developing racial or ethnic pride is only one part of this process.









Other aspects include spirituality, preparation for bias, promotion of cultural mistrust,

potential racial barriers, egalitarian values, aspects of heritage, traditional practices, and

general self-development (Bowman & Howard; Caughy et al.; Thornton et al.).

Racial socialization practices by parents has been linked to fewer behavioral

problems in preschool aged children (Caughy et al., 2002). Also, adolescents and young

adults who had exposure to racial socialization practices by their parents had increased

levels of personal efficacy and better academic achievement than those with no reported

history of racial socialization (Bowman & Howard, 1985). Ethnic or racial socialization

seems to be associated with positive outcomes. Caughy and colleagues held parental

involvement constant and still found that racial socialization practices were associated

with positive outcomes for children.

These parenting practices are probably closely related to later levels of ethnic

identity. However, other community, peer, and school influences become increasingly

important as children enter adolescence. Adolescents are faced with the task of exploring

and defining their identity in several domains. Ethnic identity has been relatively

understudied in comparison to other aspects of identity (e.g., academic, social, physical).

These aspects of identity have been conceptualized as universal. According to Cross

(1991), ethnic identity has been viewed as separate from the general aspects of identity,

as well as separate from one's state of mental health. The current state of the research in

adolescents, however, demonstrates the role ethnic identity plays in the lives of ethnic

minorities. It is not only central to the identity of many adolescents, but has been

associated with multiple measures of mental health functioning.

Qualitative research with a multi-ethnic (African American, Latino/a, Native

American, European American, and Asian) sample of middle and high school students







22

created the basis for much of the current literature in this area. Interview techniques were

used in a series of studies investigating the salience of this construct and the potential

existence of developmental phases of ethnic identity formation (Phinney, 1989; Phinney

& Chavira, 1992; Phinney & Tarver, 1988).

A sample of 48 black and white 8th graders were interviewed in an urban junior

high school and were asked open-ended questions about ethnic identity. Responses were

categorized into searching or exploring behavior and commitment to or ethnic identity

achievement (Phinney & Tarver, 1988). Over 30 of the participants were moderately high

in searching, and 29% were moderately high in commitment. There was a trend for more

searching in the African American female adolescents. The construct of ethnic identity

was less salient for the white adolescents. They were less likely to discuss their own

group membership and more likely to discuss relations with other groups (Phinney &

Tarver). This study suggests the salience of ethnic identity for black adolescents,

particularly girls.

Additional qualitative research furthered the evidence for a developmental theory

of ethnic identity (Phinney, 1989; Phinney & Chavira, 1992). Phinney (1989) utilized

several existing developmental theories to code interview data from a sample of Asian,

African American, Hispanic, and European American 10th graders. Results indicated that

an adaptation of existing theories was needed to explain ethnic identity. A three-phase

theory was developed. Students were categorized into an unexamined, a moratorium

(exploring without commitment), or an achieved group. The European American

response could not be categorized (Phinney). This study provided some initial evidence

for a developmental theory of ethnic identity for minority adolescents.









Phinney and Chavira (1992) conducted a longitudinal study of 18 African

American, Hispanic, and Asian American high school students. These adolescents were

interviewed to determine their phase of ethnic identity development and then followed

into young adulthood. Most of those adolescents that were in the unexamined or

moratorium phases of development at baseline progressed to a higher phase over time.

Those that were in the achieved phase at baseline were also in the achieved phase at

follow-up (all except one). These findings provide some preliminary evidence for the

developmental progression of ethnic identity and a relatively stable end state of an

achieved ethnic identity (Phinney & Chavira).

Dubois, Swenson, Tevendale, and Hardesty (2002) found no significant

difference in levels of ethnic identity between the African American and European

children that were in 5th and 6th grade. However, participants in their study that were in

7th and 8th grade did differ. The African American students had significantly higher

ethnic identity than their European American classmates (DuBois, Burk-Braxton, et al.).

This suggests that ethnic identity may increase over time, particularly for ethnic

minorities. Phinney, Ferguson, and Tate (1997) compared 547 8th and 11th graders and

found higher levels of ethnic identity in high school students than middle school students.

This work provides additional evidence for the theory of ethnic identity development

across the span of adolescence.

The following sections review literature on ethnic identity and various aspects of

mental health functioning. The majority of the research in the following sections has

assessed the overall level of ethnic identity. Exceptions are highlighted, as are the

specific aspects of ethnic identity that were assessed in the various studies. Unless









otherwise noted, the term ethnic identity refers to the overall level of ethnic identity

achievement for the adolescent.

Ethnic Identity and Positive Mental Health Functioning

The majority of research that has measured ethnic identity in adolescents has

compared this construct to positive aspects of mental health and psychological

functioning. The most commonly studied construct has been self-esteem (See Phinney,

1991 for a review). Other research has compared ethnic identity levels to aspects of self-

concept, self-efficacy, and academic achievement (Beale Spencer, Noll, Stoltzfus, &

Harpalani, 2001; Phinney, 1992; Phinney & Chavira, 1992; Smith, Walker, Fields,

Brookins, & Seay, 1999;). Effective coping styles and culturally based coping have also

been associated with ethnic identity (Constantine, Donnelly, & Myers, 2002; McMahon

& Watts, 2002; Phinney & Chavira, 1995)

Research connecting ethnic identity and self-esteem, has consistently found a

positive relationship (Phinney, 1992; Phinney & Chavira, 1992). Ethnic identity was

positively correlated with self-esteem in the minority participants of a sample of 417 high

school and 136 college students. This was not found in the white students, with one

exception. Ethnic identity was associated with self-esteem for the white students that

were the minority within their school (Phinney, 1992). This demonstrates that self-esteem

is related to ethnic identity for those with minority status and that the relevance of this

status may be contextual. In other words, minority status in one setting may make ethnic

identity salient in that context despite majority status in the larger social context.

Ethnic identity was also positively related to self-esteem levels longitudinally in a

sample of African American and Hispanic high school students that were followed into

young adulthood (Phinney & Chavira, 1992). Those with an achieved ethnic identity had







25

higher self-esteem at both baseline and follow-up. Interestingly, self-esteem was found to

be relatively consistent over time (self-esteem at baseline and follow-up were highly

correlated), while ethnic identity underwent developmental progression (phase of ethnic

identity development at baseline was not related to phase at follow-up; Phinney &

Chavira).

In a sample of 5,423 Mexican American, African American, and European

American early adolescents, ethnic identity was associated with increased levels of

coping, general mastery, self-esteem, and optimism (Roberts et al., 1999). Aspects of this

result were confirmed in a sample of 100 6th grade African American students (Smith et

al., 1999). Ethnic identity was linked directly and indirectly self-concept and self-

efficacy (Smith et al., 1999). Ethnic identity was directly related to general mastery,

emotional well-being, as well as peer and familial aspects of self-concept. It was also

positively correlated with perceived self-efficacy in the academic and career domains.

Interestingly, ethnic identity had a direct negative effect on prosocial attitudes (i.e., use of

legitimate methods for goal attainment). This finding was offset by the indirect effect

ethnic identity had on prosocial attitudes via self-efficacy (Smith et al.).

Some research that has supported the notion of differential effects over the course

of ethnic identity development has been in the area of academic achievement (Beale

Spencer et al., 2001). Academic achievement is a somewhat distal outcome variable in

comparison to self-esteem. However, this is an important area of functioning during

adolescence.

Beale Spencer and colleagues (2001) evaluated a sample of 562 African

American middle-school students, 80% to 90% of which were receiving free lunch. In

this study, standardized test rankings were used to operationalize academic achievement.







26

Four stages of racial identity were described: Eurocentric (unexamined acceptance of the

majority culture), transitional, reactive Afrocentrism (an early exploration of an

Afrocentric identity, considered "superficial" identification by the author), and proactive

Afrocentrism (the achieved, secure sense of racial identity; Beale Spencer et al., p. 26).

Although these terms are specific to African Americans and differ from those described

in the ethnic identity research, the findings are still relevant to the proposed research.

The Eurocentric (unexamined) and the reactive Afrocentrism

(exploration/searching) phases were associated with significantly lower levels of

academic achievement. In contrast, the proactive Afrocentrism (achieved) phase of racial

identity development was positively associated with academic achievement (Beale

Spencer et al., 2001). These findings suggest that certain phases of ethnic identity

development may be a vulnerable time for adolescents, but that an achieved ethnic

identity is associated with adequate functioning within the academic domain.

The relationship between ethnic identity and coping style within intergroup

relationships was examined in a study of 60 multi-ethnic parent-adolescent dyads

(Phinney & Chavira, 1995). Ethnic socialization, ethnic identity and coping styles in the

face of prejudice and stereotypes were studied. Findings were that those high school

students with high levels of ethnic identity were more likely to have proactive coping

styles. They were more likely to use discussion, self-affirmation, and attempts to

disprove stereotypes than to utilize passive or aggressive coping styles (Phinney &

Chavira). This suggests that ethnic identity has a positive effect on the ability to cope

with the stress of prejudice.

McMahon and Watts (2002) found that higher ethnic identity was associated with

an active coping style in a predominately African American early adolescent sample.









This coping style included direct problem-solving, seeking understanding, and positive

cognitive restructuring (McMahon & Watts). Constantine and colleagues (2002) found

that public self-esteem and the importance of collective self-esteem (defined similarity to

ethnic identity) were associated with culturally specific coping behaviors or Africultural

coping styles. In a sample of 106 African American adolescents, public self-esteem (or

how one believes their group is viewed by others) was associated with more use of

spiritually-centered coping. Greater importance of collective self-esteem was associated

with more collective coping (Constantine et al.).

These studies provide significant evidence for the positive nature of ethnic

identity development. Its association with positive psychological constructs (e.g., self-

esteem, effective coping styles, self-efficacy) places it in the realm of healthy or adaptive

development for those with minority status. Ethnic identity can be viewed as an aspect of

self-concept that develops in psychologically healthy individuals. That is not to say that

each individual requires the same level of this factor. It is only to say that a secure sense

of oneself as an ethnic group member is a positive aspect of self-concept.

Resiliency Models of Ethnic Identity

The broad conceptual framework of risk and resiliency has been utilized within

the disciplines of developmental psychology, medicine and nursing (Mandleco & Peery,

2000; Resnick, 2000; Werner, 1986). This framework is simple in that there are two

primary concepts, risk and resiliency. Risk factors are those factors (e.g., individual,

familial or social) that increase a person's chances of becoming ill? Resiliency factors are

those factors that increase a child's or adolescent's chances to complete healthy

development in the face of adversity or known risk factors (Garmezy, 1991; Werner,

1986). The finding that some individuals are able to avoid serious illness or behavioral









problems in spite of serious risk has led to a shift in the focus of research to the

identification of factors that promote resiliency.

A growing area of research has examined ethnic identity within the risk and

resiliency framework (Brook, Balka, et al., 1998; Brook, Whiteman, et al., 1998; Miller

& Macintosh, 1999; Scheier, Botvin, Diaz, & Ifill-Williams, 1997). These studies have

evaluated how protective ethnic identity achievement is against adverse mental health

outcomes.

Brook, Balka, and colleagues (1998) utilized several measures of ethnic identity

in a sample of 627 African American adolescents. African American awareness and

church attendance had a main effect on drug involvement. Those participants that

reported more African American awareness and that attended church regularly had lower

levels of drug involvement. The authors assessed risk and protective factors in multiple

domains (personality, family, peer, and ecological). Ethnic identity enhanced personality,

familial and peer protective factors. It protected against drug use in the face of

personality (i.e., depressive symptoms) and ecological risk factors, such as drug offering

strangers (Brook, Balka, et al.).

A similar study of 555 Puerto Rican adolescents found that ethnic identity

ameliorated several known risk factors for substance abuse and enhanced other protective

factors (Brook, Whiteman, et al., 1998). Spanish language preference and immigrant

status (as measures of ethnic identity) were both associated with lower levels of

substance abuse. In addition, several aspects of ethnic identity (e.g., affirmation and

belonging; familism; Hispanic awareness) were found to enhance resiliency or to be

protective against substance use (Brook, Whiteman, et al.).









A longitudinal study followed 1,303 7th graders into 8th grade (Scheier et al.,

1997). Risk factors were grouped into several domains (e.g., social skills risk like lack of

assertiveness). High ethnic identity was actually associated with high alcohol use in

African American and Hispanic adolescents. This association was especially strong in the

presence of cognitive-affective risk (e.g., knowledge and expectancies related to alcohol

use). In contrast, ethnic identity was protective against alcohol use in the presence of

social skills risk (e.g., assertiveness, communication, etc.). Ethnic identity was also

protective against marijuana use in the presence of social skills ands social influence risk

(e.g., perception of peer usage and availability of marijuana; Scheier et al.).

These findings, together, paint a complex picture about the relationship between

ethnic identity and substance use. Although some aspects of ethnic identity may be

protective against certain substances in certain individuals, many questions are still

unanswered. In some cases ethnic identity may even increase risk, specifically for

alcohol use (Scheier et al., 1997.

One study examined ethnic identity as a resiliency factor that potentially protects

adolescents in the domain of academic achievement (Miller & Macintosh, 1999). In a

sample of 131 African American adolescents that were at risk for academic failure,

ethnic identity was positively correlated with grade point average and inversely related to

school absenteeism. Ethnic identity also had a buffering or protective effect on academic

achievement in the presence of risk factors. Specifically, when the participants reported a

high amount of daily hassles, ethnic identity protected their level of academic

achievement (Miller & Macintosh).

Simmons and colleagues (2002) found that community-wide ethnic identity was

protective against depressive symptoms in the face of criminal victimization personally









or within the family. The association between criminal victimization and depressive

symptoms was larger for those early adolescents living in communities with lower ethnic

identity. This study did not specifically utilize a resiliency framework, but it was a multi-

community study that included 810 children and early adolescents (Simmons et al.)

This body of research provides an interesting framework for studying the

protective nature of ethnic identity in minority adolescents. However, due to the nature of

the resiliency framework, it is best suited for studying adolescents at risk for certain

problems (e.g., substance abuse or academic failure). The construct of ethnic identity

development is relevant to ethnic minority adolescents despite their risk status.

Ethnic Identity and Adverse Mental Health Outcomes

There is a growing body of literature that has examined ethnic identity and its

relationship to adverse mental health outcomes in school-based samples. Based on the

consistent finding that ethnic identity is directly related to positive mental health

functioning, researchers have begun to examine the question of its relationship to

negative outcomes. Findings have demonstrated that ethnic identity achievement has both

direct and indirect effects on adverse mental health outcomes depending on the

methodology utilized and the sample. The various findings related to this topic are

described here and contradictory results are discussed along with methodological issues.

Several studies have examined ethnic identity and levels of depressive and

anxious symptoms (Arroyo & Zigler, 1995; Caldwell, Zimmerman, Bernat, Sellers, &

Notaro, 2002; Dubois, Burk-Braxton, et al., 2002; McMahon & Watts, 2002; Roberts et

al., 1999; Rotheram-Borus, 1989; Simons et al., 2002). Research involving African

American and Puerto Rican high school students found differential relationships between

phases of ethnic identity development and internalizing and externalizing symptomology







31

(Rotheram-Borus). An achieved ethnic identity was associated with less self-destructive

behavior, but still was related to elevated levels of inattentiveness and nervousness.

Those adolescents in the moratorium phase of development (the period of

exploration/searching without commitment) were more likely to have internalizing and

externalizing symptoms (Rotheram-Borus). This study lends evidence to the idea that

exploration of ethnic identity may be a vulnerable time of development for adolescents,

while the achieved phase is protective against some adverse symptoms.

Findings related to mood symptoms and other internalizing symptoms have

differed among ethnic groups. Roberts and colleagues (1999) found that ethnic identity

was inversely related to depression and loneliness in a large sample of middle-school

students. However, this finding was only in African American middle-school students

and the effect sizes were very small. There was no significant relationship between ethnic

identity and internalizing symptoms in the Mexican American adolescents (Roberts et

al.).

In a sample of 91 African American high school students, high levels of

"racelessness," (identification with mainstream European American culture at the

expense of ethnic identification) was associated with more anxious and depressive

symptoms (Arroyo & Zigler, 1995, p. 904). In addition to racelessness, the researchers

also measured collective (ethnic) self-esteem. This construct was inversely related to

racelessness and also was positively related to self-efficacy (Arroyo & Zigler, 1995).

This research suggests that sacrificing one's ethnic identity is related to an increase in

anxiety and depressive symptoms.

McMahon and Watts (2002) found no relationship between ethnic identity and

depressive or anxious symptoms in a sample of 209 middle school students at high risk







32

for aggression. Simons and colleagues (2002) also found no association at the individual

level in a community sample of 810 African American early adolescents. However, when

community level ethnic identity scores were calculated, ethnic identity was related to

fewer depressive symptoms (Simmons et al.).

Other research has found indirect relationships between ethnic identity and

mental health outcomes (Caldwell et al., 2002; DuBois, Burk-Braxton, et al., 2002).

Ethnic identity was indirectly related to both emotional and behavioral problems via

global self-esteem in a sample of 350 black and white elementary and middle school

students (DuBois, Burk-Braxton, et al.). Racial Identity had an indirect effect on anxious

and depressive symptoms via perceived stress in a sample of 521 African American high

school students (Caldwell et al.). This latter study utilized a different conceptual

framework that assesses aspects of racial identity, mainly the private regard and

centrality of race (Sellers, Rowley, Chavous, Shelton, & Smith, 1997). Interestingly, the

private positive regard was inversely related to perceived stress, and the centrality of race

within the adolescents' self-concept was positively related to perceived stress.

There have been even fewer studies evaluating externalizing symptoms and ethnic

identity. No research has actually evaluated ethnic identity and angry/irritable mood in

early adolescents. However, attitudes about fighting and ethnic identity were evaluated in

a sample of 330 multi-ethnic middle-school students (Arbona, Jackson, McCoy, &

Blakely, 1999). The researchers controlled for two well-known risk factors for

aggression: lack of parental involvement and negative peer behaviors. Ethnic identity

was significantly related to non-fighting attitudes, in African American adolescents, but

not in Hispanics.









McMahon and Watts (2002) found a more achieved ethnic identity to be

associated with both less approval of aggressive behavior and less self-reported

aggression. This finding was in a sample of 209 predominately African American middle

school students from an urban, predominately low-income area. This finding contrasted

the finding that higher global self-esteem was associated with more self-reported

approval of aggressive behavior (McMahon & Watts).

Other research has examined ethnic identity and the externalizing symptom of

substance abuse. In a study of 127 11 to 20 year olds, there was a discussion about the

association between ethnic identity and high levels of substance abuse. However, this

actual statistical finding was not detailed in the article (James, Kim, & Armijo, 2000).

There were also differential findings between ethnic groups. The African American

adolescents had the highest level of ethnic identity, while there was no significant

difference between the Hispanics and European American adolescents (James et al.,

2000). The findings contradict the predicted direction of the relationship between ethnic

identity and substance abuse. They also demonstrate the need for research that examines

ethnic group differences.

Conclusions

The concept of ethnic identity has only been studied systematically in adolescents

over the last 10-15 years. It is clear from this research, that young people are examining

the meaning of their membership in ethnic minority groups. Adolescence is the logical

period of the lifespan to study aspects of identity formation (Erikson, 1968). Ethnic

identity has been consistently associated with positive aspects of psychological

functioning in adolescents. Research has demonstrated that ethnic identity can serve as a

resiliency factor in certain 'at risk' adolescents, protecting them from adverse outcomes.







34

Research measuring adverse mental health outcomes utilizing normative samples has had

the most mixed results and is the sparsest. More research is needed in this area, especially

research including Hispanic participants.

Mentoring

Most of the research examining mentors as a positive factor in children and

adolescent's lives has been in the area of program evaluation research. This research has

widely varying types of methodologies in part because programs also vary widely. There

is a growing body of research that has begun to examine naturally occurring relationships

between adolescents and mentors. The effect these relationships have on different mental

and behavioral problems is an understudied area. There have also been very few studies

that have systematically assessed factors that pertain to the quality of these relationships.

The exceptions are detailed in this review. Relevant program evaluation research is also

described in the following section. The work that has been done in the area of natural or

existing mentors is reviewed. A discussion of ethnic mentors and related research is also

reviewed.

Program Evaluations

Prevention research has indicated that broad based nonspecific prevention

programs are effective at providing basic developmental needs to at risk children and

adolescents (Grossman & Tierney, 1998; Tiemey, Grossman & Resch, 1995). Recent

research has demonstrated that relationships with mentors are developmentally normative

(Beam et al., 2002). Mentoring of youths by consistent caring adults provides a

developmentally necessary stable relationship for young people.

Mentoring is an intervention that has been gaining a lot of attention in recent

history. Mentoring, as a youth violence prevention strategy, was named one of four best







35

practices by the Centers for Disease Control along with family-based, home-visiting, and

social-cognitive strategies (CDC, 2000). The Search Institute (2002) named the presence

of a caring relationship with an adult as one of the key developmental assets for

adolescents.

One of the most scientifically rigorous program evaluations was done in

association with Big Brothers Big Sisters of America (Grossman & Tierney, 1998). Big

Brothers Big Sisters (BBBS) is the oldest and largest organized mentoring program in the

United States. The program is unique because of the extensive supervision of matched

youths and mentors by case managers. Mentors are thoroughly screened and trained prior

to any contact with the youths. Mentors are also required to have consistent, regular

contact for an extended period of time with the mentee.

A sample of 959 7 to 14 year olds was randomly assigned to community-based

mentoring or a wait-list comparison group (Grossman & Tiemey, 1998). Measures were

taken at baseline and after 18 months of mentoring. Participants in the experimental

group had increases in positive attitudes toward school and increased perceived trust in

their familial relationships. Girls had improved academic performance. Those that had a

mentor also had reductions in aggressive behavior, substance use initiation, and school

truancy (Grossman & Tiemey).

Rhodes, Grossman, and Resch (2000) also examined a mediation model using the

data from this longitudinal evaluation of BBBS. Mentoring was found to have significant

indirect effects on valuing school and academic achievement via improvements in

parental relationships. The authors theorized that the mentoring relationships might have

been corrective relationships that influenced the adolescents' working models about







36

relationships. In general, the relationships seemed to alleviate tensions in the parent-child

relationships, which was associated with school-related improvements (Rhodes et al.).

Grossman and Rhodes (2002) examined the duration of these mentoring

relationships. The participants were categorized into four groups based on the duration of

their relationship with their mentor and were evaluated on several outcome variables.

Those adolescents that had relationships that lasted longer than 12 months reported less

substance abuse and reported higher perceived self-worth, value of school, social

acceptance, and scholastic competence. They also reported better relationship quality

with their parents than those without a matched mentor. In contrast, those adolescents

that had relationships that lasted less than six months reported significantly more alcohol

use than the control group that received no mentoring (Grossman and Rhodes). The

implications for these findings are that long lasting mentor-mentee relationships can be a

positive influence on adolescents, while short lasting relationships may be damaging.

The duration of a matched mentoring relationship was also an important factor in

a program evaluation of a work-based mentoring program for African American high

school students (Linnehan, 2001). Out of 202 eligible students (GPA at least 2.0), 34

were matched with a mentor in the first part of the school year and 34 were matched in

the second half of the year. Those students that were matched for more than half the year

had better grades and attendance rates then those that did not participate at follow-up

(Linnehan).

Grossman and Rhodes (2002) also examined factors that might predict

relationship duration. Those matches with mentors that had higher incomes lasted longer,

but other mentor qualities did not consistently predict relationship duration. They found

that adolescents who had suffered abuse or were referred for psychological or educational







37

services were more likely to have a shorter relationship (Grossman & Rhodes). This is a

key point because mentoring programs are increasingly seen as a potential way to help

the adolescents at greatest risk for emotional and behavioral problems. Therapeutic

mentoring programs have been developed specifically to address this issue (Cavell &

Hughes, 2000 Jackson, 2002).

Undergraduate psychology students enrolled in a 15-hour per week practicum,

served as mentors for junior high school students with significant academic and

behavioral problems (Jackson, 2002). The mentees had declines in parent-reported

internalizing (depressed/anxious mood) and externalizing (behavioral) problems. They

did not show improvements in adaptive behaviors or teacher-reported problems.

However, other school related data was promising (i.e., reduced number of infractions).

This program is an innovative way to bridge mentoring and professional services.

However, the evaluation has methodological issues that plague much of the other

program evaluation research. Lack of controls within the field of program evaluation is

often a necessary reality.

The types of mentoring program implementation are as varied as the research

methodologies. Mentoring may take place in the community, in the school, or both.

Mentoring programs have been initiated for elementary school, middle school, and high

school students. Programs often include mentoring as one piece of a broader intervention.

This makes it difficult to differentiate effects of mentoring alone. However, researchers

have evaluated outcomes from aggression (Cavell & Hughes, 2000) to school attitudes

and classroom behavior (Dennison, 2000) to self-efficacy and future possible selves (Lee

& Cramond, 1999).









Cavell and Hughes (2000) found significant decreases in parent reported

aggression in a sample of 62 2nd and 3rd graders with behavior problems who had

school-based "therapeutic mentors" (p. 199). These mentors were not specifically

psychology students, but were provided with training specific to handling aggressive

children. The children with these mentors had better outcomes then those in the

"standard mentoring" group (Cavell & Hughes, p. 203). The mentors in the latter group

had no training or ongoing supervision.

Other research has found no significant improvement in classroom behavioral

functioning in 25 3rd and 4th graders evaluated in a pre-test post-test design (Dennison,

2000). These participants did, however, show academic improvement. They received an

in-school peer tutoring and mentoring program. It is difficult to tease out if the tutoring

was the key ingredient, or the mentoring, or both. Other mentoring programs, that do not

have a tutoring component, have also demonstrated an effect on academic achievement

(Blum & Jones, 1993; Grossman & Tiemey, 1998).

Blum and Jones (1993) found declines in the number of poor grades (Ds and Fs)

and increases in better grades (Bs and Cs) in a sample of 22 middle school students that

received mentoring from school personnel and a weekly peer support group. The

mentoring involved daily interaction between the mentor and mentee and occasional

planned recreational activities over 8-10 weeks.

Other programs that have yielded positive psychological outcomes have included

increases in levels of future aspirations (Lee & Cramond, 1999). A sample of 130 (78%

African American) elementary and middle school students that were mentored for more

than one year were compared to a wait-list group. The mentored group had higher levels









of future aspirations, but there were no differences in self-efficacy or future possible

selves.

Many of these studies utilized small sample sizes, lacked a comparison group, or

did not obtain baseline measurements on the dependent variables. This makes

interpretation of the findings difficult. However, some general conclusions can be made.

Mentors seem to help with aggressive behavior and substance use initiation (Cavell &

Hughes, 2000; Grossman & Tiemey, 1998). These relationships also seem to promote

positive attitudes about school and academic achievement, a primary area of functioning

for children and adolescents (Blum & Jones, 1993; Dennison, 2000; Grossman &

Tiemey, 1998). Longer mentoring relationships seem to be better then those of shorter

duration (Grossman & Rhodes, 2002; Linnehan, 2001) and therapeutic mentoring seems

to be effective for children and adolescents with behavioral problems (Cavell & Hughes,

2000; Jackson, 2002).

A recent meta-analysis of mentoring program evaluations utilized strict inclusion

and exclusion criteria (DuBois, Holloway, Valentine, & Cooper, 2002). Each study

included had to have utilized a comparison group or a pretest posttest design. The

average weighted effect size (d = .14) was interpreted to mean that, on average, those

with mentors did 55% better than those without mentors or had a 55% improvement over

baseline measurements. Outcomes included psychological, behavioral, academic, and

employment variables.

The authors also evaluated several moderating effects on outcomes. Effect sizes

did not vary between mentoring only programs and those that included mentoring along

with other interventions. Other factors that increased effect size included community

settings, structured activities, ongoing training for mentors, parental involvement, and









mentors with a background in a helping profession (e.g., teacher). The frequency of

contact with the mentor and the duration of the relationship were not moderators of effect

size. However, very few evaluations measured these variables. The type of outcome

variable did not moderate effect size, but the risk status of the youth did. Those youth

from economically disadvantaged backgrounds or that had other environmental risk

factors had more improvements than those that did not (DuBois, Holloway, et al., 2002).

Program evaluation research is often difficult to conduct with scientific rigor.

However, experimental designs and meta-analyses assist in truly evaluating which

interventions are effective for promoting healthy adolescent development. This review

details the existing research evaluating the effectiveness of mentoring programs. This

research provides evidence for the effectiveness of mentoring programs to have an

influence on several domains of functioning for children and adolescents. The following

section describes the literature related to natural mentors in the lives of adolescents.

Natural Mentors

The study of natural mentors is a relatively new area of research and there are

fewer studies than in the program evaluation literature. Interventionists are eager to

supply mentors without the assessment of existing supports in the natural environment.

The following literature addresses the existence of natural mentors in the lives of

adolescents at risk for emotional behavioral problems, as well as in more normative

samples of adolescents.

Early research on natural mentors by Rhodes and colleagues focused on African

American and Latino adolescent mothers (Rhodes et al., 1992, 1994). Only 35% of the

Latino female adolescent mothers had natural mentors (Rhodes et al, 1994). However, of

those that did, 95% had access to their mentors as often as weekly. The mentors tended to







41

be female (84.2%) and almost half of the adolescents had known their mentor for at least

16 years (46.4%). Those participants with supportive mentors had significantly less

anxiety and depression than those without mentors (Rhodes et al., 1994).

A descriptive study of 162 predominately Mexican American 10th graders found

that 78% had natural mentors (Sanchez & Reyes, 1999). The majority of these mentors

provided emotional support to their mentees (78%). This finding of almost double the

rate of the study with Latino teen mothers is striking. It could possibly demonstrate the

lack of a normative resource for the teen mothers. Other findings were similar between

the two samples. The school-based sample tended to have gender and ethnically matched

mentors. Seventy-one percent of the mentors were familial and another 23% were

informal (i.e., neighbor or friend). Almost half saw their mentor daily and 37% saw them

at least weekly.

Natural mentors were also protective against depression in African American

adolescent mothers (Rhodes et al., 1992). Of the sample of 129 14 to 22 year olds, those

that had a natural mentor had lower levels of depression than those who did not.

Interestingly, those young women with mentors also made better use of their social

support networks and accessed other support more readily.

In a sample of 770 high school freshmen, the existence of natural mentors and

several emotional and behavioral outcomes were measured (Zimmerman et al., 2002).

The sample was 79.6% African American and did not include those that were high

achieving (over 3.0 GPA) or those that had been diagnosed with emotional disturbances.

The findings were that 53.8% of the adolescents had a natural mentor. Those with a

mentor were less likely to smoke marijuana, had lower levels of violent and nonviolent

delinquency, and had more positive attitudes toward school.









Research on the protective quality of natural mentors for adolescents

experiencing stressful situations (i.e., pregnancy) has been expanded to examine the role

of natural mentors in normal adolescent development (Beam et al., 2002). In a sample of

243 multi-ethnic 11th graders in California, 82% reported having a natural mentor.

Approximately half were relatives and half were not. The researchers found that these

relationships were low in conflict and highly supportive. The adolescents received

support from their mentors as often as once or twice a week. These relationships served

different functions than either peer or parental relationships. The adolescents also tended

to obtain more support from their mentor if their relationship with their parents was high

in conflict.

Many of these studies have been done with African American samples; however,

the socioeconomic status (SES) of the participants is often confounded with ethnic

background (Hirsch, Mickus, & Boerger, 2002). Hirsch and colleagues demonstrated that

certain aspects of the adolescent mentor relationship are culturally specific and other

aspects are not. A sample of 122 African American and European American high school

students was asked to describe their relationships with an important grandparent and/or a

significant male adult (other than their father). African American adolescents were more

likely to name a natural mentor, either their maternal grandmother or an adult male

mentor. However, when SES was accounted for in the analysis, only the relationships

with grandmothers remained significant. Therefore, the African-American adolescents

were only more likely to name their grandmother as a natural mentor after SES was

accounted for in the analysis. This study demonstrates how certain types of mentoring

relationships are culturally defined, while others are related to economic factors.









The existence of natural mentors has been associated with less depressive

symptoms, less substance use, and lower rates of delinquency in adolescents (Rhodes et

al.,1992, 1994; Zimmerman et al., 2002). There is evidence to suggest that relationships

with natural mentors are a normative part of healthy adolescent development (Beam et

al., 2002). However, rates tend to vary widely across samples. Additional research is

needed to assess the existence and quality of these relationships. Clearly the relationships

between adolescents and naturally occurring mentors are different than those initiated by

intervention programs. Strengthening existing relationships with natural mentors may be

an additional way to intervene and enhance the lives of adolescents.

Ethnic Mentors

Another interesting question that has been studied minimally brings the area of

ethnic identity and mentoring together. The question of whether or not the ethnicity of a

natural mentor has an effect on the ethnic identity of the mentee has not been evaluated

extensively. This aspect of the research study will be somewhat exploratory. However,

there is some evidence to suggest that contact with same ethnic adults can influence

ethnic identification.

The construct of ethnic identity development has been studied in the foster parent

and adoption literature (Andujo, 1988; Friedlander, 1999; Friedlander et al., 2000).

Researchers have been interested in the development of ethnic identity in those children

and adolescents that are parented by adults with the same ethnic background compared to

those that are raised by parents with a different ethnic background.

One study included 60 families, 30 European American couples, and 30 Mexican

American couples that adopted Mexican American children (Andujo, 1988). Both groups

of adolescents (mean age 14 years old) had comparable levels of self-esteem after









approximately 5 years in the adoptive home. However, the ethnically matched families

had adolescents who were more likely to identify themselves as Mexican Americans and

had lower scores on a measure of acculturation. Also, the Mexican American parents

were more likely to socialize their children biculturally than the European American

parents.

Other researchers have utilized qualitative methods to examine the ethnic identity

of international adoptees (Friedlander, 1999). A study of 12 parents and 12 children and

adolescents utilized interviews and family drawings (as a measure of family relationships

and sense of belonging) to study ethnic identity development. Results indicated that all

but one of the participants were in the unexamined phase of ethnic identity. The

implications are that international cross-ethnic adoption may be related to a lack of

exploration of ethnic identity by the adoptee.

In a review of the research examining ethnic identity in internationally adopted

children, Friedlander and colleagues (2000) found that many cross-ethnically adopted

children are uncomfortable with their appearance and tend to have an Americanized

identity rather than a bicultural or achieved ethnic identity. These conclusions were

drawn from limited research and do not negate the findings that most of these children

and adolescents are fairly well adjusted (Friedlander et al., 2000). This population

(international adoptees) differs from ethnic minority group members born in the United

States. However, these findings provide some evidence that contact with those from the

same ethnic background can influence adolescent's ethnic identity development.

Rhodes and Reddy (2002) compared same-race to cross-race matches in the

longitudinal evaluation of BBBS. The results indicated that there were differences

between the groups. Mentees talked more about their problems with cross-race matches.









Also, parents perceived these relationships to improve peer relationships more than the

parents of those in same-race matches. However, girls in same-race matches had smaller

declines in the amount of value placed on school and self-worth. Boys in same-race

matches had smaller declines in school competence (Rhodes & Reddy, 2002). These

mixed results do not clearly indicate whether an ethnically matched mentor is, in total,

more beneficial for adolescents. The construct of ethnic identity was not evaluated in this

study.

Mentoring programs typically do attempt to ethnically match mentors and

mentees. It is considered common sense that adolescents will be able to relate more

easily to an adult from the same ethnic background and that that person will be better

suited to serve as a role model and mentor. Natural mentors tend to be ethnically matched

(Sanchez & Reyes, 1999). However, the possible effect an ethnic mentor may have on

ethnic identity has not been studied. Research is needed to examine the potential

mechanisms by which an ethnic mentor may be beneficial for adolescents and their

mental health functioning.

Conclusions

Whether a caring adult is part of a program or is a family or community member,

these relationships seem to have the potential to promote healthy psychological

development. It may be that as adolescents mature, the support of a trusted adult, other

than a parent, becomes important. Although mentors seem to be a part of normative

development, descriptions of the quality of these relationships, the characteristics of the

mentor (e.g., community member, ethnic match) are factors that have only been

minimally studied. This clearly is an area that needs more research. Surveys can be









useful in assessing the availability of natural mentors and the quality of these

relationships for ethnic minority youth.

General Discussion

Adolescence is a time of growth, transition, and unfortunately risk for a variety of

mental health problems. There has been a large body of research examining various risk

factors for emotional and behavioral disturbance during adolescence. However, there has

been significantly less research examining issues that are specific to ethnic minority

group members. Ethnic identity and its relationship to mental health outcomes is one new

area of research that needs to be expanded. The mentoring literature is also under the

early stages of development. The existence of natural mentors and the roles they play in

the lives of adolescents are important research topics. Lastly, the question of how ethnic

mentors may influence ethnic identity and enhance mental health has yet to be answered.















CHAPTER 3
METHODOLOGY

Research is needed that examines the relationships between individual and social

factors and mental health outcomes in adolescents. This area of research has typically

neglected factors that have particular relevance to ethnic minorities. Discovering what

attributes or strengths may protect adolescents from emotional and behavioral problems

is also an understudied area of research.

The purpose of this study was to evaluate the relationships between ethnic

identity, mentorship, and adolescent mental health from a nursing perspective. The

Neuman Systems Model provided the framework for this study (Neuman, 1995). This

enables the findings to add to the body of knowledge within the applied field of nursing

science. The specific aims included: evaluating the relationship between ethnic identity

and adverse mental health outcomes, comparing the mental health of those that have a

mentor and those that do not, and examining the moderating effect of an ethnic mentor

on ethnic identity and adverse mental health outcomes.

Design

This study utilized a cross-sectional, multi-site survey design. It was part of a

larger study that addressed several psychological constructs related to school violence.

The larger research study was entitled "National Middle-School Survey: School Violence

and Beliefs About Self, Others, and the Future" (Miller et al., 2001). The primary

purpose of the larger study was to develop a survey instrument that measures









psychological factors that have been or may be associated with aggressive and violent

behavior in early adolescents.

Research Aims

Aims of this study were to

S Explore the presence of reported natural mentors in the lives of adolescents,
define the quality of these relationships, and describe the general characteristics
of these mentors.

S Evaluate the relationship between the presence of a mentor and the mental health
functioning of the mentee.

* Evaluate the relationship between the presence of a quality mentoring relationship
and the mental health functioning of the mentee.

* Examine the relationship between the ethnic identity of the adolescent and his or
her mental health functioning.

S Evaluate the potential moderating effect of an ethnic mentor on the relationship
between ethnic identity of the mentee and his or her mental health functioning.

Research Hypotheses

Related hypotheses include

Those adolescents who have natural mentors will have better mental health
functioning than those that do not have a mentor.

There is a relationship between ethnic identity and mental health functioning in
minority adolescents.

The presence of ethnically matched mentor moderates the relationship between
ethnic identity and mental health outcomes in minority adolescents.

Procedures

Setting

The larger school violence study will, when concluded, include data from

approximately 25 public middle schools in four states (Florida, Texas, California, and

New Jersey). This study includes data from 14 schools in four counties, and two states







49

(Florida and California). The public schools included mainstream schools only. Testing

took place in classrooms, gymnasiums, cafeterias, libraries, and/or auditoriums as

dictated by the school personnel and administration. The entire survey took participants

between 45 minutes and 2 hours depending on the version of the survey administered and

the school. Research assistants were available to answer questions throughout the survey

procedures.

Human Subjects

Active parental consent, as required for Department of Education funded projects,

was obtained for all minor participants (Appendix B). A research team member

distributed permission slips to students after describing the research purpose and

procedures. Parents were provided the option of consenting or refusing participation for

their child. Failure to sign the informed consent form was considered a refusal. Research

assistants returned to the schools a second time to administer the survey. The survey was

given only to those students that returned a signed permission slip/informed consent

form.

The current ethical standard is to obtain assent from participants that are at least

seven years of age (Vanderpool, 1996). A verbal assent form was read to potential

participants that had already returned a signed parental consent form (Appendix C).

Students were given the option to decline participation before the implementation of the

instrument. They were also told that they could stop participation at any time or leave

blank any questions they did not want to answer.

The survey was anonymous. Participants were instructed not to put any

identifying information on the survey. The participant's names were on the parental

informed consent forms. However, this information was kept confidential. All informed







50

consent forms and completed surveys were kept in locked filing cabinets in the research

lab at The University of Florida. There is no way to connect a specific survey to a

specific consent form.

Questions on the overall survey were related to a variety of sensitive issues from

victimization, aggressive behavior, and relationships with parents to adverse mental

health symptoms. For this reason, participants were told to contact the school counselor if

they felt upset or uncomfortable. The name of the school specific counselor was provided

in the verbal assent process. Because the research team cannot match individual

responses to specific participants, individual interventions were not implemented.

However, if a participant became visibly upset during the survey, he or she was referred

directly to the school specific counselor.

Sample

The sample includes all of the middle school students that completed the

measures specific to this study during their participation in the "The National Middle-

School Survey: School Violence and Beliefs About Self, Others, and the Future" (Miller

et al., 2001). Survey data were projected to be collected from 5000 middle-school students

in four states (Florida, California, Texas and New Jersey). Only the data from Florida and

California were completed at the time of this analysis. The measures of interest for this

study were removed from future testing plans. Therefore, this study includes data from

California and Florida only. A variety of geographic locations (e.g., rural vs. urban) were

surveyed. Nonprobability, purposive sampling procedures were used to obtain a sample

that is overrepresentative of African American and Hispanic adolescents.

Representative percentages vary based on which national statistics are utilized.

According to the 1999-2000 public elementary and secondary school enrollment statistics









released by the U.S. Department of Education (2002), 15.57% and 17.16% of students

are Hispanic and African American, respectively. According to the United States Census

Bureau (2000), 12.3% of the population are of Hispanic origin and 12.5% are black or

African American. These percentages are different due to the fact that more African

American and Hispanic families have children under the age of 18 years old (U.S. Census

Bureau, 2000) and these ethnic groups are over-represented in the public school system.

Instrumentation

Demographics

The following demographic data were included in the survey: age, sex, ethnicity,

socioeconomic status (SES), and single-parent household status. The racial and/or ethnic

background was assessed utilizing categories designed to accompany the Multigroup

Ethnic Identity Measure (Phinney, 1992).

Socioeconomic Status (SES) was assessed utilizing the Two Factor Index of

Social Position, developed by Hollingshead (1965). This is a widely used measure of

SES that asks the participants to report their parent's level of education and occupation.

These responses were categorized and weighted to calculate a score from 11-77. This

score can be used as a continuous variable or converted into social class categories

(Hollingshead, 1965). For this study the social class categories were used in the analyses.

This measure has been widely validated. The two-factor index is preferable with

adolescents, because they are usually unable to answer accurately the third factor,

household income.

Multigroup Ethnic Identity Measure

The Multigroup Ethnic Identity Measure (MEIM) was used to measure ethnic

identity. The MEIM was originally designed based on prior qualitative data (Phinney,







52

1992). The current version has 12 items that are scored on a likert scale from (1) strongly

disagree to (5) strongly agree. Higher scores indicated a more achieved ethnic identity

(J. S. Phinney, personal communication, November 13, 2001).

Results of an exploratory factor analysis with 200 middle school students

indicated two primary factors: (a) affirmation, belonging and commitment, and

(b) exploration and behaviors (Roberts et al., 1999). The correlations between these two

factors ranged from 0.70-0.75. This provides evidence that both factors are part of one

overarching construct and that the questionnaire can be used as a single measure of

ethnic identity. The factorial structure was weaker for the European American students.

Roberts and colleagues (1999) conducted the most recent and relevant study that

provided evidence of reliability and validity for early adolescents. They surveyed 5,423

middle-school students from several ethnic backgrounds. Cronbach's alpha was between

0.81-0.89 across ethnic groups for the 12-item survey. The MEIM was positively

correlated with coping (r=.23, p<.001), general mastery (r=. 19, p<.001), self-esteem

(r=.20, p<.001), and optimism (r=. 19, p<.001). It was inversely associated with

loneliness (r=-.09, p<.001), and depression (r=-.09, p<.001). The strongest relationship

that helped to provide validation for this measure was the relationship between the

MEIM scores and the salience of ethnic identity (r=.48, p<.001). Although these

correlations are low to moderate, they help to provide evidence for convergent and

divergent validation of the MEIM.

Mentoring Items

The first question used to assess the presence of a mentor was "Other than your

parents or whoever raises you, is there an adult in your life (a mentor or positive role-

model) who you go to for support and guidance?" (Rhodes et al., 1992, p. 449). This









question was developed based on the theoretical work of Levinson and colleagues

(Levinson, Darrow, Klein, Levinson, & McKee, 1978, as cited in Rhodes et al., 1992). It

has been used in previous research to assess the presence of a natural mentor (Rhodes et

al. 1992; 1994). This question has a "yes" or "no" dichotomous response. If the

participants answered, "yes" to this question, then they answered follow-up questions

relating to mentoring relationship quality and mentor characteristics. These items were

used to distinguish between the simple presence of someone perceived as a mentor and

the presence of a "quality" mentoring relationship.

Theorists and researchers alike have differing definitions of mentoring

relationship quality. There is also not a consistent way to measure this construct.

Previous researchers have asked individual items related to a mentor-mentee relationship,

however, there is not an existing measure of relationship quality that has been tested for

reliability and validity. For this reason, the Principal Investigator and other members of

the research team used existing research and theoretical literature on mentoring, to

develop a series of questions pertaining to mentoring relationship quality.

These questions related to the duration of the relationship, the frequency of

contact with mentor, and the length of time spent on a typical visit. These items were

developed in order to assess the amount of time spent together, the consistency of

contact, and the duration of the relationship. Previous theoretical, applied, and empirical

literature were used to determine cutoff points for each aspect of relationship quality that

was used to define a quality mentoring relationship (Chapter 1). These items have ordinal

response options.

Previous research has found that arranged mentoring relationships that last less

then six months can have minimal beneficial and actually some detrimental effects on







54

adolescents (Grossman & Rhodes, 2002). For this reason, those adolescents that reported

at least a 6-month duration of relationship were categorized as having a quality mentor.

The aspects of the frequency of contact and the amount of time spent at each visit have

also not been specifically researched in reference to natural mentors. The baseline criteria

used by Big Brothers Big Sisters (BBBS) was used as a guideline for these factors.

Community-based mentors in BBBS are required to meet with their mentees at least 2-4

times per month and to spend approximately two to four hours at each visit (Grossman &

Tiemey, 1998). For this study, those participants that reported seeing their mentor at least

once per week and that spent at least one hour per visit with their mentor were

categorized as having a quality mentor.

The last factor used to determine the quality of the existing mentoring

relationship was the amount of trust the adolescent has in their mentor and the comfort

they have with confiding in their mentor. A scale comprised of seven questions was

developed based on previous definitions of mentors and other measures of social support

(Nakkula et al., 1990 & Institute of Behavioral Science, 1990, as cited in Centers for

Disease Control and Prevention, 2002; Rhodes et al. 1992; ). The reliability of this

subscale has not been previously tested. However, reliability coefficients are detailed for

the current study in Chapter 4. This construct has been specifically used to define a

mentoring relationship (Pearsall, 1999; Rhodes et al., 1992). The minimum level for this

factor is also described in Chapter 1.

Several specific characteristics of the mentors were assessed using categorical

response items. The ethnic match of the mentor and their gender were assessed. Also, the

relationship between the mentor and the mentee or who the mentor is in reference to the









adolescent (e.g., relative, teacher, minister, etc.) was ascertained. Lastly whether or not

they live in the adolescent's community was determined.

Mental Health Functioning

The Massachusetts Youth Screening Instrument-Second Version (MAYSI-2)

assesses several aspects of psychological symptoms (Grisso et al., 1998). The instrument

was originally developed to screen adolescents ages 12-17 who have entered the juvenile

justice system. The instrument has several subscales that assess different domains of

emotional and behavioral symptoms. As previously mentioned, four subscales

(depressed/anxious mood, somatic complaints due to anxiety, angry/irritable mood, and

alcohol/drug use) were utilized in this study. The items have true/false responses and one

point is given for a yes response and zero points are given for a no response. The

responses are summed and ranges of available scores are utilized to assess risk (Grisso &

Barnum, 2000).

The original development of this instrument involved 1,200 adolescents in the

juvenile justice system in Massachusetts. Additional studies have been conducted in

California, Washington, and several other states. These data were utilized to establish its

reliability and validity for this population. The established average alpha coefficient for

the entire measure was 0.75. The average test-retest correlation coefficient was 0.74.

Validity coefficients ranged from .40-.65 (depending on subscale) when subscales were

correlated with other standardized assessments of psychopathology (Grisso & Barnum,

2000). Recent research with the MAYSI-2 has included community samples of

adolescents (J. Woolard, personal communication, January 11,2001). This has provided

evidence for the reliability and validity of this instrument in normative samples of

adolescents.









This measure of adverse mental health outcomes was chosen for two primary

reasons. First, this measure assesses several domains of mental health functioning in

relatively few questions. The use of a brief measure is necessary in order to fit the time

constraints (a one class period survey) of the larger research project. Second, this

instrument has been used as a screening tool in the juvenile justice system. A brief

screening instrument may be useful in assessment of adverse mental health outcomes in a

school setting as well. This study provides additional validity and reliability for use with

a normative school sample.

Data Analysis

The statistical computer program SPSS was utilized for data analysis. Descriptive

statistics (frequencies, means and standard deviations) were done as appropriate for all of

the demographic variables. Univariate analyses were done to examine differences

between groups on the variables of interest. Descriptive statistics were also used to

analyze the specific characteristics of the natural mentors. The statistical tests used for

the specific research hypotheses are described in Table 3-1. A secondary series of

Factorial MANOVAs were done to examine the relationship between the presence of a

mentor and adverse mental health outcomes and to test for interactions between

mentoring and gender, ethnicity, socioeconomic status, and single-parent status.

Power Analysis

Power for the regression analyses was sufficient. At least 50 participants are

required per independent variable to ensure adequate power in multiple linear and

logistic regression (Tabachnik & Fidell, 1989; Wright, 1997). Previous research that has

examined the variables under study has yielded small effect sizes (Roberts et al., 1999;

Zimmerman et al., 2002). For example one study examined the presence or absence of a









natural mentor and adverse mental health outcomes (i.e., marijuana use) and

demonstrated that those adolescents that had a natural mentor had significantly lower use

[y = (4.71-3.90)/4.34 = 0.18] than those that did not have a mentor (Zimmerman et al.,

2002). A difference of this size would be considered clinically relevant on the outcome

measures for this study.

Table 3-1. Statistical analyses

Research Aims Hypotheses Analysis

I. Evaluate the I. Those adolescents who I. Multivariate Analysis of
relationship between have natural mentors Variance (MANOVA)
the presence of a have better mental
mentor and mental health functioning than
health functioning of those who do not have
the mentee. natural mentors.
II. Examine the II. There is a relationship II. Multiple Linear
relationship between between ethnic identity Regression & Logistic
the ethnic identity of and mental health Regression.
the adolescent and functioning in minority
his or her mental adolescents.
health functioning.
III. Evaluate the III. The presence of III. Multiple Linear
potential moderating ethnically matched Regression was used to
effect of an ethnic mentor moderates the test for a significant
mentor on ethnic relationship between interaction.
identity of the ethnic identity and
mentee and his or mental health
her mental health outcomes in minority
functioning. adolescents.

A simple analysis for a dichotomous predictor variable (natural mentor, yes or no)

and a continuous outcome variable (alcohol/drug use subscale) was utilized to estimate

sample size. Assuming an alpha (two-tailed) = .05, and a beta of 0.20 (power = 0.80),

how many participants are needed to demonstrate a 6.25% difference on the alcohol/drug

use subscale, a small effect size? Utilizing an estimated standardized effect size of 0.20

SD, approximately 197 participants are needed per group to avoid a Type II error with









80% power (Marks, 1999; Polit & Hungler, 1991). Observed power is provided in

Chapter 4. Power was adequate for some of the research questions, but not others. This

issue is discussed in Chapter 5.

Limitations

Despite careful research design, there are several study limitations that should be

considered in reference to the interpretation of results. The limitations are as follows:

* The use of a nonrandomly selected sample can limit external validity of the research
findings. However, for this study a purposeful sampling procedure was utilized to
ensure a representative number of minority participants

* The use of active parental consent may introduce bias into sample selection and can
also limit the generalizability of the research findings (Anderman et al., 1995).
However, the Department of Education requires active parental consent for all of
their funded research studies.

* The use of cross-sectional and correlational design limits the ability to determine
cause and effect relationships. A longitudinal or quasi-experimental design is beyond
the scope and purpose of this study. The primary purpose of the larger study was to
develop a survey.

* The use of adolescent self-report measures as the only data source may limit the
accuracy of the findings. Peer nominations and parent or teacher reports can be
utilized to address this problem. However, in order to maintain anonymity and to
remain within the time and financial constraint of the study grant, self-report
methods were utilized.

* Any effects that are due to the ethnic background of the research team and data
collectors will not be accounted for in the research findings. Even though the
research team is multi-ethnic, some students may have exposure to only European
American, African American or Hispanic team members. This factor is not
accounted for in the data analysis and is therefore a study limitation.

* Lastly, due to time and financial constraints this survey was only available in
English. This may be a limitation because the English reading and writing skills of
the participants were not assessed. It is possible that there were difficulties with
comprehension in some of the Hispanic participants.















CHAPTER 4
RESULTS


This chapter describes the study design and sample as well as the larger research

project. The sample is then described in terms of demographic characteristics and the

other variables of interest. Lastly, the results related to the research aims and specific

hypotheses are detailed.

Research Design

This cross-sectional survey was part of a larger study of school violence. The

larger study was a pilot project for a national survey and had as one of its primary

objectives the testing and design of a survey instrument. The procedures included adding,

evaluating, and deleting instruments and specific items at different phases of the project

based on empirical, theoretical, and logistical factors. For this reason the instruments

specific to this study were utilized on a subset of the larger sample. In order to maximize

statistical power, data from all available participants were utilized for each statistical

analysis.

Sampling Procedure

Nonprobability, purposive sampling was used to obtain an overrepresentation of

Hispanic and African American participants. The school violence survey obtained a total

of 866 participants at the time of this analysis. Of those participants, 548 received the

primary outcome measure (MAYSI-2) and the measure of ethnic identity (MEIM). The

mentoring items and the MAYSI-2 were given to 429 participants. All of the participants









received every demographic variable item with the exception of the single-parent status

question. This item was given to a subset of 281 participants. Missing data rates varied

from 2.5 to 8 % on demographic items and from 11.31 to 19% on the independent and

dependent variables.

One demographic measure did have a higher rate of missing data than those

reported above. This was the measure of socioeconomic status. This measure required the

respondent to report their parents' type of job and their parents' occupation. Many

participants said they did not know this information or left it blank. Another subset

responded to the occupation item with a response that was too vague to be accurately

coded. Consequently, this variable was only included in the secondary analyses.

For the primary research objectives, data were included in the analyses that

reached a certain level of completeness. For the MAYSI-2 the guidelines outlined in the

survey manual were used. These guidelines require that a minimum of approximately

70% of the items per subscale be complete (Grisso & Barnum, 2000). For the other

subscales, those who completed at least 80% of the items were included in the analysis.

This cutoff was used for the larger survey for those measures that did not prescribe any

set procedure for handling missing data.

Analyses for the primary research questions were done with and without an

adjustment for missing data. The method utilized to account for missing data was

replacement with group means for the MAYSI-2 subscales and the MEIM. The results

were the same for both sets of analyses. Therefore, only the analyses utilizing the

completed dataset are presented.









Sample Characteristics

Demographics are presented for the sub-sample of 548 participants. The

geographic breakdown for this sample is presented in table 4.1.

Table 4-1. Sample breakdown by geographic location
Location (State, County) n % Description

California
Los Angeles 182 33.2 Metropolitan
Florida 366 66.8
Alachua 143 26.1 Urbanized
Dade 32 5.8 Metropolitan
Hamilton 191 34.9 Rural
Note: Census 2000; Definitions based on population density.

The other characteristics of the sample are listed in Table 4-2. The majority of the

sample was African American, European American or Hispanic. The remaining ethnic

groups (Asian, Native American, Multiracial and Other) were combined into one group

entitled "Other" for analysis purposes. The sample ranged in age from 10 to 15 years of

age with a mean age of 12.41 (SD = 0.96).

The socioeconomic status of the participants who could be categorized (n = 132)

had a mean of 3.72 (SD = 1.01) on a scale from 1 to 5 with lower numbers representing a

higher social class. The top two groups were combined because of the few (n = 2) in the

highest socioeconomic group. Another general descriptive factor related to economic

status is the percentage eligible for free or reduced lunch. The schools that participated in

this survey had rates of student eligibility for free and reduced lunch that ranged from

30% to 86%. The majority of the schools had rates of over 50% eligibility (California

Department of Education, 2002; Florida Department of Education, 2002).









Table 4-2. Sample breakdown by demographic characteristics
Characteristics n %
Ethnicity
African American 163 29.7%
Hispanic 160 29.2%
European American 125 22.8%
Other 100 18.2%
Gender
Male 203 40.3%
Female 301 59.7%
Grade
6 153 28.1%
7 210 38.5%
8 182 33.4%


The subscales of the MAYSI-2 were significantly inter-correlated. See Table 4-3

for exact figures. The overall Cronbach's Alpha was 0.86. The Cronbach's Alphas for

each subscale are listed in Table 4-3. Reliability coefficients were acceptable and similar

to those obtained in previous studies using this measure (Grisso & Barnum, 2000).

Correlations and descriptive statistics were also similar to those reported in the scoring

manual. The exception was the difference in the alcohol/drug use subscale. The youths

from the juvenile justice system had a higher mean score on this measure as would be

expected (Grisso & Barnum, 2000).

Subgroups means were compared based on ethnicity, grade and gender using

univariate analysis of variance tests with multiple comparisons. Differences were found

only on the depressed/anxious mood subscale. Girls scored higher on this subscale than

boys [F (1, 434) = 7.76; p = .006] and European Americans scored lower than the other

three ethnic groups [F (3, 443) = 7.29; p < .004].









Table 4-3. Measures of adverse mental health outcomes
MAYSI-2 subscale ac Mean SD A/I D/A S/C A/D

Angry/irritable (A/I) .77 4.08 2.54 .61* .49* .30*

Depressed/anxious (D/A) .72 2.84 2.20 .45* .35*

Somatic complaints (S/C) .69 3.19 1.83 .16*

Alcohol/drug use (A/D) .79 .624 1.35
*p<.001

Mentors

Out of 362 respondents, 76.2% (n = 276) reported the presence of a mentor. Of

the group with mentors, 75.3% (n = 204) reported an ethnic match with their mentor and

63.4% (n = 170) reported that they are both from the same community. Seventy-two

percent of the mentors were female (n = 186) and 28.5% were male (n = 74). The

mentors were a gender match for 75% (n = 180) of the total matches; 54.6% (n = 131)

were female matches and 20.4% (n = 49) were male matches. Table 4-4 details who the

mentors are in relationship to the mentee.

Table 4-4. Description of mentors
Relative Neighbor Teacher Coach Minister Other

n 150 20 18 7 6 63

% 56.8 7.6 6.8 2.7 2.3 23.9

Mentoring Quality Factors

The results thus far have pertained to the general perception of the presence of a

mentor. More specific aspects of these relationships were also assessed. A series of items

about the duration of the relationship, frequency of contact, typical length of visits, and

the amount trust the mentee has in their mentor were used to categorize those who









perceived the presence of a mentor and those who had a substantial and consistent or

"quality" relationship.

The majority of the mentoring relationships was stable and consistent. Eighty-

three percent knew their mentors for more than one year, 45% saw them everyday, and

50% spent over four hours at a typical visit. The average amount of trust and confiding

the youths reported was also high (mean = 2.67; range 0 to 3).

The following cutoffs were developed to define a quality mentoring relationship:

* Frequency of visits: At least weekly,
* Length of visits: At least one hour,
* Duration of the relationship: Six months or longer,
* Trust and confiding subscale: Those that scored at least a mean of 2.0.

Descriptive information is provided in Table 4-5. These criteria allowed for the creation

of two new groups, those with a quality mentoring relationship (n = 144) and those

without (n = 163).

Table 4-5. Descriptive statistics for quality mentoring items
n (%) above cutoff n (%) under cutoff
Frequency of contact 214 (81.7) 48 (18.3)

Duration of typical contact 223 (85.4) 38 (14.6)

Duration of relationship 213 (90.6) 22 (9.4)

Trust and confiding subscale (c = .83) 238 (92.2) 20 (7.8)

Natural Mentors and Adolescent Mental Health

The research questions related to the presence of natural mentors, the presence of

quality mentoring relationships, and adolescent mental health were answered using two

Multivariate Analyses of Variance (MANOVAs). The statistical rationale for using

MANOVA included the significant correlations between dependent measures and the

desire to reduce the risk for Type I error by repeated univariate analyses (Weinfurt,









1997). This test is appropriate only if the dependent variables can be combined

theoretically which is the case in this study. Combing the four dependent variables

creates a general construct of adverse mental health symptoms.

The statistical assumptions for MANOVA include multivariate normality,

homogeneity of covariance matrices, linearity, and independence of observations

(Tabachnik & Fidell, 1989; Weinfurt, 1997). These assumptions were met with the

exception of the distribution of the alcohol/drug use subscale, which had a positively

skewed distribution. Several transformations were attempted without success. However,

this subscale was retained in the model because MANOVA is robust to skewed

distributions with sample sizes greater than 200 (Tabachnik & Fidell, 1989; Weinfurt,

1997). In addition, the central limit theorem is applicable to studies with at least 20

degrees of freedom in each cell. This theory states that the sampling distribution of

means approach normality even if the sample data does not (Tabachnik & Fidell, 1989).

Two MANOVAs were done; the results are in Table 4-6. The first test compared

those who reported the presence of a mentor and those who did not. Those with a natural

mentor had higher levels of adverse mental health outcomes than those without a mentor.

The observed power was 0.78. The first hypothesis was not supported.

Second, the participants who met all four of the quality factor cutoff points

described in the previous section were categorized as having a quality mentoring

relationship. The second MANOVA compared the adverse mental health outcomes of

those with a quality mentor to the rest of the adolescents. These two groups were not

different on the mental health outcomes. There was no significant difference between

these two groups. However, this analysis had an observed power of only 0.20.









Table 4-6. Results for presence of a mentor and quality mentor analyses
Mentor grouping Hotelling's T F df (b/w) p r2
Presence of a mentor .036 2.88 4/324 .023 .034
Quality mentor .009 .617 4/281 .651 .009


Is the relationship between the presence of a mentor and adverse mental health

outcomes different when gender, ethnicity, socioeconomic status, and single-parent status

are taken into account? These questions were addressed by the use of three Factorial

MANOVAs. These analyses tested for interaction effects between the presence of

mentors and various demographic variables. All of the demographic variables were not

included in one model, because of the relatively smaller availability of data assessing the

SES (n = 137) and single-parent (n = 281) statuses of the adolescent's household. The

following analyses were done: 2 (mentor) X 4 (ethnicity) X 2 (gender) MANOVA; 2

(mentor) X 2 (single-parent) MANOVA; 2 X 4 (SES) MANOVA. Results indicated that

there were no significant interactions between the mentoring factor and the SES or

single-parent status variables. There were also no two-way or three-way interactions

between mentoring, gender, and ethnicity.

Ethnic Identity

The second major area of interest pertains to the construct of ethnic identity. The

basic information about this measure is presented in Table 4-7. The European American

participants scored significantly lower (p = .019) than the African Americans and those

categorized as Other (p = .017), but not the Hispanic participants. There was no

significant difference on this measure based on grade or gender.









Ethnic Identity and Adverse Mood Related Symptoms

Multiple regression and logistic regression were used to test the second

hypothesis: There is a relationship between ethnic identity and mental health functioning

in minority adolescents. The assumptions for linear regression include residual

homoscedasticity (i.e., equal variance of the dependent variable at each level of the

independent variable), normal distribution, and linearity. Also, all pertinent variables

must be included, and all irrelevant variables are excluded. Lastly, measures must be

reliable and observations must be independent (Licht, 1997). These assumptions were

met with the exception of linearity. Transformation of the data and/or use of a non-linear

model were not appropriate due to the large number of zero scores. However, multiple

regression is robust to the effects of violations of the error assumptions (Licht, 1997).

Table 4-7. Multigroup Ethnic Identity Measure by Ethnic Group
a Mean SD
African American .74 3.55 .61
European American .75 3.33 .53
Hispanic .83 3.47 .59
Other .85 3.59 .67

Three subscales of the MAYSI-2 (angry/irritable mood, depressed/anxious mood,

and somatic complaints due to anxiety) were summed to create one dependent variable (a

= 0.86). This variable was normally distributed. This sub-divides the general construct of

adverse mental health symptoms and creates two more specific constructs. The constructs

are mood related adverse mental health symptoms and substance use. The alcohol/drug

use measure was not normally distributed and this measure was analyzed separately

using logistic regression. The rationale for this separation is detailed in the following

section.







68

Standard multiple regression was done with gender, ethnicity, ethnic identity, and

an interaction term predicting the sum of the three mood related symptoms. The

interaction term combined ethnic identity and ethnic minority status. The interaction term

tested the idea that the significant relationship between ethnic identity and mood related

symptoms existed for minority group members only. Gender and ethnicity were dummy

coded and four dichotomous variables were created (African American = 1, Hispanic = 1,

European American = 1; Female = 1). The final model had six predictors. The model was

not predictive of the outcome variable [F (6, 403) = 1.76; p = .106]. Ethnic identity

achievement was not predictive in minorities for this dependent variable. The second

hypothesis was not supported for mood related symptoms.

Ethnic Identity and Alcohol/Drug Use

The alcohol/drug use subscale was positively skewed with the majority of the

respondents (73.5%) scoring zero on this subscale. Multiple transformations were

unsuccessful in obtaining a normal distribution. Therefore, this measure was changed to a

dichotomous outcome variable (0/1). A score of one indicated a positive response to any

item. This subscale was then used as an outcome in a logistic regression analysis.

In logistic regression it is assumed not only that the dependent variable is

dichotomous, but also that the options are statistically independent, mutually exclusive,

and collectively exhaustive (Wright, 1997). Also, the model must be adequately specified

(includes all relevant predictors and excludes all irrelevant predictors), and the sample

size must be adequate. Logistic regression requires at least 50 participants per

independent variable (Wright, 1997). All of these assumptions were met in this case.

Multiple logistic regression was done with the same predictor variables used in

the multiple regression analysis. The results indicated that the overall model was









predictive of alcohol/drug use category membership [X2 (6, 399) = 14.44; p = .025].

Group membership was accurately predicted for 98.1% of the participants based on the

predictors in the model.

Upon further analysis, the primary predictor of category membership was gender

(B = .531, Wald's X2 = 5.18, p = .023). Forty-five percent of the boys were categorized

as having any problems due to alcohol/drug use and only 30% of the girls were. The rest

of the predictor variables (including the interaction term) did not provide a significant

contribution to the model. The second hypothesis was not supported for alcohol/drug use.

A second multiple logistic regression was done without the interaction term

included. The rationale for this test was to create a more parsimonious model to test the

independent contribution of ethnic identity to the prediction of alcohol/drug use category

for all ethnic groups. The overall model maintained its significance with no loss of

accuracy in categorization [X2 (5, 400) = 14.07; p = .015]. The individual predictor

statistics are presented in Table 4.8. This finding demonstrates that ethnic identity does

predict alcohol/drug use for all of the study participants, not simply the minority

adolescents. Those participants with higher ethnic identity scores were more likely to be

in the non-use group than those with lower scores. The mean ethnic identity score for

those in the nonuse group was 3.52. The mean for the use group was 3.33.

Table 4-8. Variable contributions to the prediction of alcohol/drug use category
Variable B SE Wald Sig.
African American -.290 .350 .689 .407
Hispanic .025 .355 .005 .943
European American .283 .364 .604 .437
Gender .526 .233 5.09 .024
MEIM Score* -.507 .202 6.32 .012
*MEIM = Multigroup Ethnic Identity Measure









Ethnic Mentors: Testing A Moderation Model

A series of multiple linear and logistic regressions were done to test the

moderation model. The predicted model is presented in Figure 4-1. Although no

significant results were demonstrated for the minority adolescents alone, the moderation

model was tested in this group and in the sample as a whole.

Y
Nonmatch


Adverse
Mental Health
Symptoms

Ethnic Match


0 X

Ethnic Identity

Figure 4-1. Ethnic mentors and ethnic identity: Moderation model

Two multiple linear regressions were done with gender, ethnicity, ethnic identity,

presence of an ethnic mentor (Y/N), and an interaction term as predictors. The interaction

term combined ethnic identity and the presence of an ethnic mentor. These results are in

Table 4-9. Neither of these models was significantly predictive of mood related

symptoms despite the addition of a new interaction variable. The interaction variables

also were not independently predictive.

Two multiple logistic regressions were done with the same predictor variables.

These results are also detailed in Table 4-9. These two models were significantly

predictive in both the minority adolescents and the sample as a whole. However, the

interaction term was not independently predictive of alcohol/drug use categorization.









In the entire sample gender was the only significantly predictive variable

(B = .773; X2 = 5.87; p = .015). In the minority sub-sample gender (B = .791, X2 = 4.93;

p = .026) and Ethnic Identity (B = -.708, X2 = 3.87; p = .049) were the variables that

provided the significant contributions to the outcome variable. Hypothesis 3 was not

supported based on these analyses.

Table 4-9. Results of regressions testing the moderation model
Model Sample Outcome df Test Value Sig.

Linear Minority Mood Sym. 6/188 F = .554 .766

Linear Min/Maj Mood Sym 7/237 F = .984 .443

Logistic Minority Alc/Drug 6/173 X2 = 16.12 .013

Logistic Min/Maj Alc/Drug 7/177 X2 = 19.68 .006
Min = Minority Group Membership
Maj = Majority Group Membership/European American Ethnicity
Sym = Symptoms
Alc = Alcohol















CHAPTER 5
DISCUSSION AND RECOMMENDATIONS

This study has explored individual and socio-cultural variables and their

relationships to mental health functioning in early adolescents. These factors were

conceptualized as strengths or aspects of healthy psychological development. They were

examined for their relationship to adverse mental health symptoms. This chapter explores

the results of the study. Findings related to the mental health functioning of the sample

are presented and then the constructs of ethnic identity and mentoring are detailed

separately. Recommendations are made and future directions for this area of study are

listed. Lastly, the implications for nursing are described.

Adverse Mental Health Outcomes

The assessment of levels of adverse mental health outcomes in a multiethnic

sample provides information that in and of itself contributes to the research literature.

There were no significant differences between the ethnic groups with the exception of the

depressed/anxious mood subscale. The European American adolescents scored

significantly lower on this measure than the other three ethnic groups. There are many

factors that may explain this finding. Differences in levels of depressed/anxious

symptoms may be due to socioeconomic factors (Conger, Ge, Elder, Lorenz, & Simons,

1994) or increased stress related to racism and/or discrimination (Guthrie et al., 2002).

However, other studies using this measure have found no significant differences between

ethnic groups or different profiles (Grisso & Barnum, 2000).









The MAYSI-2 was designed "to identify those youths who are most seriously at

risk of mental and emotional disturbances" (Grisso and Barnum, 2000, p. 32). The

authors of this instrument provided "Caution" and "Warning" cutoff levels for scores on

each subscale. The caution level was defined as having "possible clinical significance,"

while the warning level indicates those adolescents with the greatest need for clinical

intervention (Grisso and Barnum, p. 27).

The mean levels for this study did not reach even cautionary levels except for the

somatic complaints due to anxiety subscale. Thirteen percent of this sample met the

warning level criteria for somatic complaints due to anxiety. Fourteen percent and 11%

respectively were in the warning range on the depression/anxiety and angry/irritable

subscales respectively. Less than 1% met the warning level for alcohol/drug use.

The results of the alcohol/drug use measure (over 50% with a score of zero)

indicate that this measure may not be an appropriate measure of substance use for this

age group in a school-based sample. This subscale measures frequent use of substances

and the potential for serious difficulties with substances (e.g., dependence). A more

appropriate measure for middle-school students might instead measure experimentation

or infrequent use. However, reports of any presence of problems due to substance use in

this age range may predict future difficulties in this domain. Longitudinal studies are

necessary to determine the significance of these findings.

Mentoring

The majority of adolescents reported the presence of a natural mentor. This

validates earlier findings that have found natural mentoring relationships to be a part of

normative development (Beam et al., 2002). The majority of the mentoring relationships

were stable and consistent. The adolescents also reported a fairly high level of trust in







74

their mentors and were comfortable confiding in them as well. Over half of the mentors

were relatives. This finding is consistent with prior research (Rhodes et al., 1992, 1994;

Beam et al., 2002).

Despite these general trends, when strict criteria were utilized to define quality

mentoring relationships, the sample size became quite a bit smaller. Fifty-five more

participant responses could not be used because of at least some missing data on the

quality factor items. There was no significant difference between those with a quality

mentoring relationship and the other adolescents. This finding has a high risk for a Type

II error because of the low observed power. Future research could answer this question

more confidently with a larger sample. Also, it is possible that the criteria were too strict

and excluded mentoring relationships that were potentially beneficial in some way.

Those adolescents who reported the presence of a natural mentor did not have

better mental health functioning than those without a mentor. In contrast, they had higher

levels of adverse mental health symptoms than those without the presence of a mentor.

Although, the effect size was small and may be of little clinical significance, there are

some possible explanations for this finding.

It is possible that adolescents experiencing adverse mental health symptoms may

seek out mentors to help them cope with these difficulties. The theory that mentors can

make up or compensate for problems that adolescents are experiencing is part of the basis

for mentoring programs and also for some of the research on natural mentors (Rhodes et

al., 1992, 1994). Beam and colleagues (2002) found that the presence of natural mentors

was normative and not indicative of problems. However, these adolescents did tend to

seek out support from their mentors when their relationship with their parents was high in

conflict.









As previously mentioned, a large majority of participants in this study reported

the presence of a natural mentor. This group had higher rates of adverse mental health

symptoms. If having a natural mentor is normative, a logical follow-up question is "Is it

normative to have adverse mental health symptoms during early adolescence?" Early

theories of adolescent development stated that it was a period of turmoil, stress,

transition, and mood liability (Muuss, 1996). However, despite the common stereotypes,

modern theory and research have demonstrated that the majority of adolescents transition

quite well through this period of the lifespan (Lewinsohn et al., 1998). It is unclear what

the explanation is for this unexpected finding. Additional studies are needed to further

evaluate this finding and examine its clinical significance

Ethnic Identity

Ethnic identity was not found to be predictive of mood related symptoms. This

finding is in contrast to some previous research (Arroyo & Zigler, 1995; Roberts et al.,

1999; Rotheram-Borus, 1989). Other studies have also found no direct links between

ethnic identity and adverse mood related symptoms (Caldwell et al., 2002; DuBois, Burk-

Braxton, et al., 2002). Some research has confirmed models that demonstrate an indirect

relationship between ethnic identity and mood related symptoms. Ethnic identity has

been related to mood symptoms via perceived stress (Caldwell et al., 2002) and global

self-worth (DuBois, Burk-Braxton, et al., 2002). These additional constructs were not

measured in this study, so it is impossible to confirm if such mechanisms were at work in

this sample.

The developmental level of the participants in this study is also important to

consider. Ethnic identity increases over time and it is possible that many of the

participants in this study were still in a relatively early phase of this developmental









progression. DuBois and colleagues (DuBois, Burk-Braxton, et al., 2002) found no

significant differences between African American and European American children (5th

and 6th grades), but in early adolescents (7th and 8th grades) African Americans had

significantly higher ethnic identity. This change in only a matter of one to two years of

development may also play a role in the influence of ethnic identity to mood related

symptoms.

Research with high school students has demonstrated many of the previous

findings in this area (Arroyo & Zigler, 1995; Rotherman-Borus, 1989). It is possible that

the influence of ethnic identity on mental health does not manifest until further along the

developmental path. Previous research has demonstrated that early during the

development of ethnic identity (i.e., exploration and increasing ethnic awareness),

adolescents can actually have increases in anxiety and depression (Rotheram-Borus,

1989). Stages of development were not assessed in this study; rather a general measure of

level of ethnic identity achievement was measured. It is possible that these differences,

which were not detectable with the measurement technique used in this study, clouded

the accuracy of the findings.

Ethnic identity was negatively related to alcohol/drug use. This finding validates

previous studies that have found ethnic identity to be protective against substance use in

minority adolescents (Scheier et al., 1997; Brook, Balka, et al., 1998; Brook, Whiteman,

et al., 1998). However, the results from these studies were varied based on the type of

substance and the ethnic group.

This study measured the overall influence of ethnic identity on any difficulties

related to substance use and found it to be predictive. This finding was found for the









sample as a whole. It was not found specifically for the minority adolescents. There are

several possible reasons why this may have occurred. One possibility is the presence of

white-ethnics, those who strongly identify with their European country of origin.

Unfortunately, subgroups within the European American participants were not

specifically identified, and it is therefore not possible to determine if this may have

influenced the findings. Another factor, that was not directly assessed, was the possible

minority status of the European American adolescents in some of the schools. Phinney

(1992) found that ethnic identity was associated with self-esteem for white high school

students when they were the minority in the school. A final reason that could explain why

this construct predicted substance use for all of the adolescents could relate to self-

esteem. A positive self-concept could be partially reflected by higher scores on the ethnic

identity measure. This could be true since many of the items reflect positive attitudes

toward one's ethnic group membership.

The predicted moderation model including ethnic mentors and their influence on

the relationship between ethnic identity and mental health outcomes was not supported.

In reference to adverse mood symptoms, this was probably not supported due to the lack

of a significant relationship between ethnic identity and this outcome. However, this

model was also not supported when there was a significant relationship (i.e., prediction

of substance use). It is possible that ethnic mentors do have an effect on adolescents in

different domains (e.g., self-esteem). The practice of matching mentors and mentees

based on ethnicity, gender, and interests is still considered standard. Although, this

makes intuitive sense, more research is needed to explain the mechanism by which these

relationships may influence adolescents and in what domains.









Recommendations and Future Directions

The first area of recommendations is related to methodology. Nonrandom

sampling procedures limit the external validity of the findings. Future studies using

probability-sampling techniques could greatly increase the generalizability of findings.

The use of survey methods has several limitations, some of which are described in

Chapter 3. Additional research in this area could be supplemented with additional

informants (e.g., parents, teachers, mentors) to validate the reports of the adolescents.

Another methodological issue was the length of the survey. The survey, at its

longest, contained 338 items. It took participants between 45 minutes and 2 hours to

complete. Fatigue and attention span are serious issues. Many were unable to complete

the survey due to fatigue or, in some cases, time constraints set by the school.

Instruments toward the end of the survey had higher rates of missing data than those at

the beginning. Future surveys of this type could be improved by giving shorter versions

to subgroups of participants.

As previously mentioned, it might be beneficial to translate the questionnaire into

Spanish or other languages for new immigrants whose English language skills may be

less well developed than other participants. Other ethnic groups could be examined and

specific items could be added to assess the specific Hispanic heritage of the participants.

Also, specifically in reference to the mentoring items, interview techniques could be very

useful. Many participants had difficulty following the directions that asked them to

answer questions if they had a mentor and to leave blank if they did not. Difficulty with

instructions may have interfered with the accuracy of the responses.

A different measure of SES should be utilized in future studies due to the high

rates of missing data and the somewhat dated occupational coding scheme used for the









Hollingshead (1965). In addition, longitudinal research is the ideal way to study

developmental issues. Longitudinal research could examine ethnic identity development

across adolescence. Also, the formation of mentoring relationships, their quality and

duration as well as any influence they have on the adolescent's well-being could be

studied over time.

Continued research related to the presence of natural mentors is definitely needed.

This area would benefit from qualitative research that explores the nature and quality of

mentoring relationships. Qualitative research would also improve the construct validity

of measures that could benefit from further development and validation. Also, a large

portion of the adolescents categorized their mentors as "other." In order to assess who

these mentors are, open-ended interview or survey items are necessary. Philip and

Hendry (2002) interviewed adolescents in Scotland and found intriguing results in

response to questions about natural mentors. The adolescents indicated that individual

peers (or best friends), peer groups, and adult-teen groups were all contexts in which they

obtained mentoring support. More research of this type is needed.

Alternative or supplemental measures of ethnic identity could be utilized in future

studies. For example, the Hispanic participants did not score significantly differently

from the European American participants. However, Spanish language usage and level of

acculturation are aspects of ethnic identity that were not assessed. These specific issues

are not part of the MEIM, which is a generic measure that can be utilized for all ethnic

groups. More specific measures may be needed for certain subgroups. It is possible that

these factors are related to mental health. Also population divisions may even have to be

more specific (e.g., Cuban American) if the intent is to develop programs or to intervene

with specific sub-populations.









As described above, this study utilized a measure of alcohol/drug use that

assessed problems due to drinking or drugs. A measure of substance use that assesses

infrequent use or experimentation with substances may be more appropriate in future

research with this age group. There are large-scale studies that address these sorts of

substance use issues (e.g., Youth Risk Behavior Surveillance-Middle-School; CDC, 1998

as cited in Fetro et al., 2001) for this age group. However, these studies tend to focus

only on the problem behaviors rather than examining strengths factors. Future studies

could examine individual and socio-cultural strengths and their relationship to substance

experimentation in middle-school students.

Nursing Implications

Several future directions for research are described in the previous section. This

section addresses the direct implications to nursing practice, education, and research. One

goal of an applied science such as psychiatric mental-health nursing is to provide the

basis for interventions that promote mental health, prevent disease, and treat mental

health problems when indicated. Psychiatric-mental health nurses are increasingly

involved in school-based screenings for those in need of mental health services (Gall et

al., 2000; Lamb & Puskar, 1991). The results of this study demonstrate that a brief

screening instrument can identify adolescents who are suffering from mental health

problems. The adolescents who scored in the warning range of the MAYSI-2 could be

referred for intervention in school-based settings.

In terms of the direct applications of this research study to the field of nursing,

ethnic identity achievement was found to be negatively related to alcohol/drug use.

Aspects of self-concept, including ethnic identity could be assessed when intervening

with adolescents. Research focused on psychosocial strengths can provide nurses with the









tools to develop theoretically based interventions with empirical support. Individual or

group interventions could target issues related to ethnic identity development in young

adolescents.

Schools of nursing also have implemented holistic interventions that have

included mentoring adolescents (Scheuring, Hanna, & D'Aquila-Lloyd, 2000). Nursing

education typically includes learning about the development of nurse-client relationships.

Nursing students could potentially serve as mentors as well as health care providers. In

addition, school nurses can serve as collaborators with the increasing number of

school-based mentoring programs. School nurses can play an integral role in helping to

develop these programs and to ensure that factors such as consistency, adequate duration,

and relationship building are considered within these programs. Nursing education must

also integrate knowledge of factors that are pertinent to the well being of ethnic

minorities. Culturally sensitive health care includes an acknowledgement of differences.

These differences ideally should be viewed as strengths rather than liabilities. Nurses also

should learn how to tap into resources beyond the walls of the health care setting.

Adolescents can be encouraged to access the support provided by natural mentors in

times of difficulty. Holistic health care must include assessment of multiple domains of

functioning and attempts to develop or enhance existing resources.

Nurse researchers have studied multiple individual and social factors that are

associated with depressive and anxious symptoms (Mahon & Yarcheski, 2001; Yarcheski

& Mahon, 2000) and substance use (Long & Boik, 1993). Additional mood symptoms

were assessed in this study (i.e., angry/irritable mood and somatic complaints due to

anxiety). This expanded the body of knowledge to include the wide array of mood related

symptoms that can be experienced by early adolescents. This study adds to the existing







82

nursing literature by examining factors relate to ethnic group membership and how this

relates to adolescent mental health. An achieved ethnic identity was associated with less

risk for alcohol/drug use. This study also describes the prevalence and characteristics of

an important community resource: natural mentors.















APPENDIX A
MENTORING ITEMS










For the next question, please circle 1 for YES or 2 for NO to answer whether that
question is true for you.


YES NO
10. Other than your parents or whoever raises you,
is there an adult in your life (a mentor, or positive role model)
who you go to for support and guidance? 1 2


If you answered YES to question number 10, please answer the following questions
about this adult you go to for support or guidance.

If you answered NO to last question, please go on to page 15.


Relative Neighbor


Teacher Coach Minister Other


11. Is this person a?


12. Is this person from the same
ethnic group that you are?


13. What is the person's gender?


14. Is this person from your community?
(Ex. lives in your neighborhood,
attends your church)


Less than
once per week


1 to 3 times
per week


4 to 6 times
per week


15. How many times each week
do you see this person?


Less than
1 hour 1 to 2 hours 3 to 4 hours


16. How long do you spend
together on a typical visit?


YES


Female
1


NO
2

Male
2


NO
2


YES
1


Every
day


More than
4 hours










Thinking of the adult you go to for support or guidance, for the following items,
choose the number (1) for A little bit, the number (2) for Some, and the number (3) for
A lot that best describes your feelings about that adult. Circle the number you choose.


A little bit


17. How much do you feel you can count
on this person to be there for you?

18. If you needed some information or advice
about something, how likely is it that
you could talk with this person?

19. If you got an award or did something well,
how likely is it that you would tell this person?

20. If you were in trouble at home,
how likely is it that you would tell this person?

21. How much do you feel he or she believes
in and cares deeply about you?

22. How much do you feel that he or she
inspires you to do your best?

23. How much do you think that knowing him
or her has really affected what you do and
the choices you make?


Some A lot

2 3



2 3


2 3


2 3


2 3



2 3


24. How long have you
known this person?


Less than
3 months

1


3-6 months


6-12 months


Greater than
12 months


(Centers for Disease Control and Prevention, 2002; Rhodes, Ebert, & Fischer, 1992;
Woolard & Greig, 2001)


Thinking of the adult you go to for support or guidance, for the next question, please
indicate the length of time you have known the person by choosing the number (1) for
Less than 3 months, the number (2) for 3 to 6 months, the number (3) for 6 to 12
months, and the number 4 for more than 12 months. Circle the number you choose.















APPENDIX B
PARENT INFORMED CONSENT









National Middle-School Survey: School Violence and Beliefs About Self, Others,
and the Future

Scott A. Miller
Parent Letter
Dear Parent:

A research team from the University of Florida is currently conducting a project
at your child's school. The purpose of this letter is to explain the project and to ask your
permission for us to include your child in the testing.

The goal of our project is to develop and to test a survey for middle-school
students. The survey is intended to identify some of the important thoughts and concerns
and characteristics of the present generation of middle-school students. We believe that
the results will provide some new and valuable information about this age group for the
educators and policy makers who shape children's school experiences. Your child's
school is one of about 25 schools around the country at which we are administering the
survey.

The survey will be given in the regular classroom setting [or whatever setting
applies in the particular school], and it will take about an hour to complete [if pilot
testing reveals a different session length this wording will be adjusted accordingly]. The
questions will address a number of topics that are important in the lives of middle-school
students. Some will ask students to reflect about themselves-what they feel especially
satisfied or dissatisfied about, what their expectations are for the future. Others will ask
about the child's relations with the important people in his or her life. Still others will ask
about experiences at school, including possible worries or fears about bullying and
school violence. In each case, we have worked hard to make the questions as clear as
possible for students this age, and to try to ensure that none will be upsetting to the child.

An important point to note about the survey is that responses will be completely
anonymous and confidential. Students will not put their names on the response forms,
and there will be no information on the forms from which individual children could ever
be identified. This means that no one will ever know how particular children
responded-no one at your child's school, for example, and indeed none of us on the
research team. Our interest is in general patterns of response and in possible variations
across different groups (for example, boys compared with girls, or 6th graders compared
with 8th graders). We have no need ever to know particular children's names.

The fact that responses are confidential is something that we will explain carefully to the
children. We want the children to feel free to answer honestly-and we want to be sure
that no child is ever concerned that someone might know how he or she responded.

Please indicate on the attached form whether you are willing to have your child
participate in the survey. The form should be returned to the child's school. Children who









do not participate will be given an appropriate alternative activity by their teachers. There
will be no negative consequences of any sort for children who do not participate.

In addition to asking your permission we will be asking your child's permission.
Prior to administering the survey, the researcher will provide a general description of the
questions to be asked and will emphasize that children are free to decide not to take part
-either from the start or at any point after beginning the survey. Children will also be
told that they do not have to answer any question that they do not wish to answer. Again,
there will be no negative consequences for children who decide not to participate.
Children who decide not to participate [here we will describe whatever alternative
activity the teachers have decided is appropriate for nonparticipants].

Our work is supported by grant from the Department of Education's Fund for the
Improvement of Education program. This project has been approved by the University of
Florida's Committee for the Protection of Human Subjects. It has also been approved by
the principal of your child's school.

We hope that both you and your child will decide to help us with the project. We
believe that the results of the survey can provide valuable information about the thoughts
and concerns of today's middle-school students, information that may eventually help to
make the school experience a more rewarding one for all children. The greater the
number of students who participate, the more accurate and helpful the results will be.

If you have any questions about the project, please call or e-mail Scott Miller at
the number or address given below. [Note: When we test in states other than Florida we
will attempt to provide a local contact number.] Questions or concerns about your child's
rights as a research participant may be directed to the UFIRB office, University of
Florida, Box 112250, Gainesville, FL 32611, (352) 392-0433.

Scott A. Miller
Professor
Department of Psychology
University of Florida
Gainesville, FL 32611
352-392-0605, x 216 samiller@ufl.edu









University of Florida-Middle-School Survey


Child's name

Child's grade

I am willing to have my child participate in the project.



parent/guardian



2nd parent/witness


I do not wish to have my child participate in the project.



parent/guardian



2nd parent/witness

(Miller, 2001)















APPENDIX C
VERBAL PARTICIPANT ASSENT









National Middle-School Survey: School Violence and Beliefs About Self, Others, and the
Future

Scott Miller
Assent Script for Middle-School Participants

We're from the University of Florida and we're doing a project at your school.
The project is for students in middle school, and your principal and teachers have given
us permission to do it at School. We're hoping that you'll decide to help us out.

The way you can help us out is by answering some questions about
yourself-what you're like, how you feel or think about different things. The questions
are on this survey [tester holds up copy], and you answer them on your own without
anyone seeing your answers. We'll give out the survey here in a few minutes, and it
should take about an hour to finish [if pilot testing reveals a different session length this
wording will be adjusted accordingly].

We can't tell you in advance about all the questions on the survey, but we'll try to
give you some idea of what they're like. Some of them are about things about yourself
that you're happy or perhaps not so happy about-for example, what you feel you're
good at and what you feel you're not so good at. Some of them are about your relations
with other people-for example, how you feel about other kids, or about your teachers or
parents. And some of them are about things that sometimes worry kids at school-for
example, the problem of bullies or school violence. In each case, we just want to know
what you honestly think.

There are several things that are very important to understand before we start.
One is that you don't have to do this. You can decide not to do it before we even start. Or
if you start and decide you don't want to do it that's OK too. Nothing bad will happen to
you if you decide not to do the survey-for example, your teachers won't be mad or give
you bad grades. If you decide not to do it [Here, we will describe whatever alternative
activity the teachers have decided is appropriate for nonparticipants.]

Another thing that's important is that you don't have to answer any question that
you don't want to answer. If there's anything that you just don't want to think about or
don't want to give an answer to you can leave it out. Now, if there's ever simply
something that you don't understand you should raise your hand and ask us. We want
you to skip a question only if you really don't want to answer it.

One last thing is very important. All the answers you give on the survey will be
confidential. This means that no one will ever know how you answered. Your teachers
won't know, your parents won't know, and those of us doing the project won't know. We
won't know because you won't put your name on the survey. Also, all the copies of the
survey are the same, so no one can tell which one you got. Finally, when you're done you
drop your survey in this box, and when we take them out later we'll have no way to know
which one is yours. We set it up this way for a couple reasons. One is that what we're