Resilience to risk-taking behaviors in impoverished African American girls: the role of mother-daughter connectedness

Psychological Distress Symptoms and Resilience Assets in Adolescents in Residential Care

Most studies with institutionalised children and adolescents focus on evaluating the impact of negative life events on emotional development. However, few have investigated the relationship between resilience assets and the teenagers’ psychopathological problems. The purpose of the present study was to investigate differences in psychological distress symptoms and in resilience assets in institutionalised and non-institutionalised adolescents. A total of 266 adolescents aged between 12 and 19 years old took part in the study (60.5% female): 125 lived in residential care and 144 resided with their families. Results found a significant and inverse relation between psychopathology and the perception of individual resilience assets, specifically with self-efficacy and self-awareness in the community sample, and with empathy in the institutionalised sample. Overall, and regardless of the age group, adolescents in residential care tend to perceive themselves as significantly less resilient in perceived self-efficacy and empathy, and they report fewer goals and aspirations for the future. The importance of promoting mental health and resilience assets in adolescents, particularly in those in residential care, is discussed. This can be achieved through early interventions that may prevent emotional suffering and deviant life paths, with transgenerational repercussions.

Asian American Women's Recall of Conversations With Their Mothers About Sexual Health: A Secondary Analysis of Qualitative Data

ABSTRACT

Between 2010 and 2016, Asian Americans (AA) had a 35% increase in HIV diagnosis. Although mother-daughter sexual communication was found to be protective in minority populations, the opposite is true among AAs. The purpose of this study was to explore AA women's experiences of sexual communication with their mothers. Secondary qualitative analysis using analytic expansion with a phenomenological approach was used. Thematic analysis was used to search for common patterns and themes that emerged using qualitative description methodology. Twenty East and Southeast AA cisgender women, ages 18-33 years, were interviewed. The primary finding was an intergenerational gap with two themes: (a) mothers' attitudes about sexual communication and (b) content of sexual communication. Indirect sexual communication included cautionary messages consistent with previous studies. AA mothers' strong cultural beliefs created a barrier to communication. Future research should focus on the young women who want open sexual communication and could influence the next generation.

How Do Acculturation, Maternal Connectedness, and Mother-Daughter Sexual Communication Affect Asian American Daughters' Sexual Initiation?

Purpose: There was a growth of approximately ten million Asian American individuals in the United States between 2000 and 2015. Asian Americans have conservative values surrounding sexual health and sexual communication is a cultural taboo. Researchers have shown discrepancies on whether the level of acculturation influences Asian mother-daughter sexual communication. In other minority populations there is evidence that a connected mother-daughter relationship increases sexual communication and delays sexual initiation. The purpose of this study was to examine whether mother-daughter connectedness and level of acculturation predict sexual communication in turn affecting the age of female Asian emerging adult's sexual initiation. Methods: This was a longitudinal, secondary analysis of AddHealth examining whether mother-daughter connectedness and level of acculturation predict sexual communication. There were 243 Asian American mother-daughter dyads in Wave I with linked data in Wave III who were included in the study. Acculturation, connectedness, and sexual communication were all measured using interval level data. Results: Connectedness did not significantly contribute to the relationship between any of the concepts. Although it was predicted that sexual communication would delay initiation, the opposite was found. Also, communication mediated the relationship between acculturation and initiation. Conclusions: Further studies are needed to explore how connectedness is defined by Asian American mother-daughter dyads. In addition, more detailed operational definitions of acculturation and communication are needed, specifically the timing of sexual communication.

Culture and sexuality-related communication as sociocultural precursors of HPV vaccination among mother-daughter dyads of Mexican descent

U.S. Latinas are the second most affected ethnic group by cervical cancer morbidity and mortality. Cervical cancer is caused by high risk Human Papillomavirus (HPV) strains and HPV vaccines are an effective form of primary prevention. Parents are the primary decision makers of vaccination uptake as vaccination is recommended for children between the ages of 11–12. The purpose of our study is to investigate the influence of sociocultural factors particularly salient to U.S. Latinos and their role in facilitating or hindering communication about sexuality and vaccination uptake. We conducted a mixed methods sequential study with Latina mother-daughter dyads of Mexican descent (50% who had vaccinated). Our study was informed by the Information-Motivation-Behavioral Skills (IMB) model of preventive behavior. We assessed the influence of communication about sexuality on uptake and the influence of relationship factors such as familism, mother-daughter connectedness, and children’s autonomy and cultural factors such as acculturation and ethnic identity on sexuality-related communication. Our results indicated that mothers who engaged in conversations about birth control methods with their daughters had 5.69 times the odds of having vaccinated their daughters. Our qualitative data indicated that mothers who had vaccinated communicated about sexuality emphasizing that sexuality is a normal part of life, perceived that their child is likely to be sexually active one day, and viewed themselves as a primary source of sexuality-related information compared to mothers who had not vaccinated. Findings highlighted potential sociocultural approaches to motivate open communication about sexuality and adoption of sexual health preventative measures for children.

Can Mother-Daughter Communication Buffer Adolescent Risk for Mental Health Problems Associated With Maternal Depressive Symptoms?

The current study sought to test whether higher quality mother-daughter communication would buffer associations between maternal depressive symptoms and girls' internalizing and externalizing psychopathology symptoms among urban African American girls across a 12-month period. One hundred ninety-four treatment-seeking urban African American adolescent girls, ages 12-16, and their mothers participated in the study. Every 6 months (for up to 3 assessments), daughters reported on their internalizing and externalizing symptoms, mothers reported on their depressive symptoms, and both mothers and daughters reported on the quality of their dyadic communication. Daughters additionally reported on the extent to which they felt accepted by their mothers at each assessment. Results of multilevel modeling revealed that quality of communication significantly interacted with maternal depressive symptoms to predict externalizing and internalizing symptoms in daughters, such that the risk associated with maternal depressive symptoms was fully buffered for daughters in high-quality communication dyads. Secondary analyses demonstrated that these patterns of results were not accounted for by higher levels of social status or maternal acceptance. Drawing on a vulnerable and understudied population of urban African American adolescent girls, this work suggests that family communication may contribute to important intergenerational psychopathology transmission processes, above and beyond more general features of the family environment.

Daughter-Initiated Cancer Screening Appeals to Mothers

Youth-initiated health interventions may provide a much needed avenue for intergenerational dissemination of health information among families who bear the greatest burden from unequal distribution of morbidity and mortality. The findings presented in this paper are from a pilot study of the feasibility and impact of female youth-initiated messages (mostly daughters) encouraging adult female relatives (mostly mothers) to obtain cancer screening within low-income African American families living in a Southern US state. Results are compared between an intervention and control group. Intervention group youth (n = 22) were exposed to a 60-min interactive workshop where they were assisted to prepare a factual and emotional appeal to their adult relative to obtain specific screening. The face-to-face workshops were guided by the Elaboration Likelihood Model (ELM) and the Theory of Planned Behavior (TPB). Control group girls (n = 18) were only provided with a pamphlet with information about cancer screening and specific steps about how to encourage their relative to obtain screening. Intervention youth (86 %) and adults (82 %) reported that the message was shared while 71 % in the control group reported sharing or receiving the message. Importantly, more women in the intervention group reported that they obtained a screen (e.g., mammogram, Pap smear) directly based on the youth's appeal. These findings can have major implications for youth-initiated health promotion efforts, especially among hard-to-reach populations.

Trajectories of parent-adolescent relationship quality among at-risk youth: parental depression and adolescent developmental outcomes

BACKGROUND

Although the parent-adolescent relationship has been studied intensely, predictors and consequences of changes in the quality of the relationship across time have not been examined.

OBJECTIVES

This study examined the role of parent depression on changes in the parent-adolescent relationship, defined as support and conflict, and subsequent effects of relationship change on adolescent psychosocial outcomes including risky behavior, substance use, depressive symptoms, and hopelessness.

METHOD

Using data from a large prevention study, the sample included 110 youth at risk for high school drop out from the control condition; the sample was 48.2% of female, with a mean age of 15.9years. The data, gathered from adolescents and their parents across a period of approximately 18months, were analyzed using growth mixture modeling.

RESULTS

Three distinct trajectories for parent-adolescent conflict (high-decreasing, low-increasing, low-stable trajectory) were identified as well as a single growth model for support, which revealed a slight decline in support across time. Parent depression was a significant predictor of perceived support, but not of membership in trajectories of conflict. Low parent-adolescent support was associated with adolescent depression and hopelessness measured 18months post-baseline. Adolescents in the low but increasing conflict trajectory and those having a parent with depression reported increased depression and hopelessness 18months later.

DISCUSSION

Parent-Adolescent support and conflict were associated with adolescent emotional outcomes, particularly depression and hopelessness. The findings provide evidence that will inform prevention strategies to facilitate parent-adolescent support, minimize the negative impact of relationship conflict, and thereby promote healthy psychosocial outcomes for at-risk adolescence.

Sexual communication intervention for African American mothers & daughters

BACKGROUND

African American girls ages 13-19 comprised nearly 3 out of 4 new cases of HIV in 2009. The goal of this study was to deliver a theoretically-driven intervention to test the feasibility for recruitment and retention of mother-daughter dyads.

METHODS

Twenty mother-daughter dyads were recruited from a community health center between February-April 2014. Comparisons were made between pre- and post-intervention scores using percent change.

RESULTS

Twelve dyads (60%) completed the intervention. There were no demographic differences between completers and noncompleters. Notable post-intervention percent increases in scores were observed in the domains: Sexual knowledge (15%), confidence to talk (23.2%); and openness of sexual communication (26.4%).

CONCLUSION

Our small-sized study showed promise in the intervention. Increasing sexual communication between African American mothers and daughters is likely to be sustainable over time and across relationships, and thus have a greater impact on HIV-prevention behaviors later in life.

Profiles of Connectedness: Processes of Resilience and Growth in Children With Cancer

OBJECTIVE

Identified patterns of connectedness in youth with cancer and demographically similar healthy peers.

METHOD

Participants included 153 youth with a history of cancer and 101 youth without a history of serious illness (8-19 years). Children completed measures of connectedness, posttraumatic stress symptoms (PTSS), and benefit-finding. Parents also reported on children's PTSS.

RESULTS

Latent profile analysis revealed four profiles: high connectedness (45%), low connectedness (6%), connectedness primarily to parents (40%), and connectedness primarily to peers (9%). These profiles did not differ by history of cancer. However, profiles differed on PTSS and benefit-finding. Children highly connected across domains displayed the lowest PTSS and highest benefit-finding, while those with the lowest connectedness had the highest PTSS, with moderate PTSS and benefit-finding for the parent and peer profiles.

CONCLUSION

Children with cancer demonstrate patterns of connectedness similar to their healthy peers. Findings support connectedness as a possible mechanism facilitating resilience and growth.

Exploration of Social, Environmental, and Familial Influences on the Sexual Health Practices of Urban African American Adolescents

Despite efforts to examine social influences and provide interventions that lead to safer sexual practices for African American (AA) adolescent girls, statistics have demonstrated this population continues to have the highest rates of teen pregnancy and sexually transmitted infections (STIs) including HIV when compared with adolescent girls of other races. Guided by the principles of Black Feminist Thought and Photovoice and focus group methodology, this descriptive study aimed to discover the social realities influencing a group of eight AA adolescent girls aged 15 to 19 years. Data from individual interviews and a focus group session were collected from November 11, 2012, to February 1, 2013. Analysis of selected photographs, interviews, and focus group conversations through a feminist lens suggests AA adolescents of low socioeconomic status continue to foster racial and mental inferiority stereotypes by using their sexuality as a bargaining tool for acceptance, value, and even love.

Avoiding adolescent pregnancy: a longitudinal analysis of African-American youth

PURPOSE

The timing and social context of pregnancy have significant implications for the well-being of African-American young people. Rarely, however, do studies focus on identifying the developmental processes associated with young people's avoidance of pregnancy until after adolescence.

METHODS

We tested hypotheses regarding the factors associated with delayed fertility (no experience of a pregnancy by age 19) among a sample of 889 African-American youth recruited at age 11 and assessed longitudinally through age 19. We hypothesized that, during preadolescence (age 11), health-promoting environmental processes would be linked to nurturant-responsive parenting, which in turn would be linked to youths' conventional future orientations and risky sexual behavior in midadolescence (age 16) and to pregnancy experience by late adolescence (age 19). Hypotheses were tested with logistic structural equation modeling.

RESULTS

Our conceptual model fit the data well. We identified a cascade process whereby protective environments were associated with nurturant-responsive parenting, which was associated with youths' conventional future orientations; conventional future orientations were associated with avoidance of sexual risk behaviors at age 16 and avoidance of pregnancy by age 19. We identified an additional direct effect between nurturant-responsive parenting and avoidance of risky sexual behavior.

CONCLUSIONS

The results suggest processes that may be targeted to facilitate delayed fertility among African-American youth.

Maternal models of risk: links between substance use and risky sexual behavior in African American female caregivers and daughters

African American (AA) adolescent girls are at heightened risk for HIV and sexually transmitted infections (STIs), and thus knowledge of factors related to risky sexual behavior in this population is crucial. Using Social Learning Theory (Bandura, 1977), this paper examines pathways from female caregivers' risky sexual behavior and substance use to adolescent girls' risky sexual behavior and substance use in a sample of 214 low-income, urban AA female caregivers and daughters recruited from outpatient mental health clinics in Chicago. Structural equation modeling (SEM) revealed that sexual risk reported by female caregivers was associated with adolescent sexual risk, and illicit drug use reported by female caregivers was related to adolescent-reported substance use, which was in turn associated with adolescent-reported sexual risk behavior. These findings suggest that female caregivers' sexual behavior and substance use both relate to girls' sexual risk. Thus, results emphasize the role of female caregivers in transmitting risk.

The Experience of Sexual Risk Communication in African American Families Living With HIV

Mother-daughter communication plays an influential role in adolescent development. The impact of maternal HIV infection on family communication is not clear. This study explores how living with HIV impacts sexual risk communication between mothers and daughters and whether maternal HIV status influences adolescent choices about engagement in HIV risk behaviors. Data were collected from 12 African American women and 10 of their adolescent daughters through focus groups. Both mothers and daughters shared information about issues that promoted and inhibited communication and engagement in risk behaviors. Findings show that HIV status served as a mechanism for behavioral change related to communication and risk engagement behaviors. Therefore, HIV-infected mothers should be supported in communicating values and expectations to their daughters.

HIV prevention among African American youth: how well have evidence-based interventions addressed key theoretical constructs?

Certain constructs are demonstrated in the research literature to be related to HIV risk behaviors among African American adolescents. This study examines how well these constructs are addressed in evidence-based interventions (EBIs) developed for this population. A literature review on variables for sexual risk behaviors among African American adolescents was undertaken. Simultaneously, a review was conducted of the contents of HIV-prevention EBIs. To facilitate comparison, findings from both were organized into constructs from prominent behavior change theories. Analysis showed that environmental conditions and perceived norms were frequently associated with sexual risk behaviors in the literature, while EBIs devoted considerable time to knowledge, skills, and self-efficacy. Findings imply that (a) EBIs might be complemented with activities that focus on important constructs identified in the literature and (b) researchers should better assess the relationship between skill development and HIV risk behaviors. Implications for practice and research are discussed.

Health promotion and cervical cancer in South Africa: why adolescent daughters can teach their mothers about early detection

The notion that adolescent daughters can provide their mothers with health information that could actually impact the mothers' behavior is a novel area of health promotion research. The goal of this study is to explore the reasons why adolescent daughters would give their mothers cervical cancer information, and why mothers would have the intent to listen to advice to obtain a Pap smear. We randomly selected and interviewed 157 mother and daughter dyads in Cape Town, South Africa. Almost one-fourth of mothers (22%) indicated never having had a Pap smear, while 92% of their daughters said their mother has never talked to them about cervical cancer or a Pap smear. Willingness of daughters to ask their mothers to obtain a Pap smear was high (80%). Motivations included the important health benefit and the sense of responsibility to share life saving information. Most mothers said they would definitely obtain a Pap smear when advised by their daughter (74%), while 25% said they would have to think about it and 1% said they would not listen. Mothers' main motivations included the direct health benefit and a strong sense of duty and responsibility to listen to her daughter. This study provides important information about the reasons why an upward (child to parent) health intervention may be feasible. The values of duty and responsibility, especially as it manifests within the family, hold promise for informing health promotion interventions directed at multiple generations.

Maternal navigational strategies: examining mother-daughter dyads in adolescent families of color

Mother-daughter relationships are critical to the health and well-being of adolescent girls. Understanding mothers' and daughters' perspectives on the relationship can inform health promotion strategies that may benefit both. In-depth semistructured interviews were conducted with mothers (N = 12) and their adolescent daughters (N = 16). Narrative profiles were constructed to identify participants' perceptions of each other and the relationship. Profiles were condensed into analytic poems that were compared and contrasted across roles and within and across dyads. Maternal navigational strategies of protection and preparation, and subthemes of maternal self-protection and daughter reverse protection emerged. The fabric of maternal strategies changed by girls' developmental stage, with mothers of older daughters describing an interweaving of protection and preparation. Suggestions for future family nursing and health promotion research and campaigns are provided.

Using focus groups to understand mother-child communication about sex

The purpose of this descriptive focus group study was to examine communication themes regarding sex and sexual risk behavior in low-income mothers of adolescent children. Focus group questions were guided by Jaccard's communication constructs. Data analysis provided three overriding themes in all five construct areas: mothers are often uncomfortable discussing sex with their male children, mothers feel strongly that their own values and beliefs must guide discussion, and mothers believe their children need developmentally appropriate information. This information may be useful in assisting pediatric nurses in discussing adolescent sex and sexual risk behavior with families.

An integrative model of adolescent health risk behavior

Nursing research in adolescent health risk behavior is lacking because there are few comprehensive nursing models to guide it. Nurses need to understand what influences adolescents to engage in health risk behavior or to refrain from it. The Integrative Model of Adolescent Health Risk Behavior was developed to guide adolescent nursing research using existing theoretical and empirical data. Components include protective/escalatory factors, risk stimulus, maturity of judgment (as a meditational influence), and the risk decision (dichotomized into risk avoidance and taking). The model will facilitate development of nursing interventions to increase health protection by discouraging adolescents from making unhealthy choices.

Preliminary efficacy of a comprehensive HIV prevention intervention for abstinent adolescent girls: pilot study findings

We developed and pilot-tested a comprehensive HIV prevention/sexual risk reduction intervention with 54 sexually abstinent girls and estimated the effect of the intervention on three antecedents of sexual risk behavior: information, motivation, and behavioral skills. Girls ages 14-18 were randomized into either (a) an AbsPlus intervention or (b) a structurally equivalent control group. Assessments were obtained at baseline and 3 months follow-up using audio computer assisted self-interview. The intervention resulted in a large effect for information (d = 1.11); small to large effects for the motivational measures (d = .34-.88), and a moderate effect for a measure of behavioral skills (d = .67). The results indicate that antecedents of sexual risk behavior change were improved by a gender-specific theoretically guided intervention.

An Expansion and Modification of the Information, Motivation, and Behavioral Skills Model: Implications from a Study with African American Girls and Their Mothers

African American females make up a disproportionate number of adolescent HIV cases. Focus groups were conducted to investigate sexual communication between 11- to 14-year-old girls and their mothers. Twenty-eight African American mother-daughter dyads from inner-city community centers participated. Implementing an intervention for families with children requires the use of a framework that is amenable to the development of intervention strategies as well as taking a family approach. The focus of the study was to adapt a leading theory used in interventions for HIV risk reduction at the individual level to be employed with a dyadic relationship between mother and daughter. Following qualitative analysis, data were reexamined according to an expanded and modified version of the Information, Motivation, and Behavioral Skills (IMB) Model. Each of the constructs was represented in the data, and insights for intervention strategies were obtained. However, the IMB model restricted an understanding of the dynamic relationship and the mother-daughter interactions with the community.

Leadership, education, achievement, and development: a nursing intervention for prevention of youthful offending behavior

PURPOSE

This 3-year study examines a theoretically designed community-based program aimed to reduce the risk of first-time involvement by minority youth with the juvenile justice system.

METHODS

A quasi-experimental design with a nonrandomized sample of 146 African American youth test an expressive art curriculum with an after school control group. Outcome measures include protective factors, behavioral self-control, self-esteem, and resilience.

FINDINGS

Ninety males and 56 females participated over the 3 years. All four of the outcomes were statistically significant or the LEAD group over the control group. Youth evaluate the LEAD program higher.

CONCLUSION

LEAD can be viewed as a promising prevention program. Plans for replication, with larger samples and a longitudinal design are needed to examine the effects of the development of African American youth along with other variables that relate to later acquisition of offending behaviors. J Am Psychiatr Nurses Assoc, 2009; 14(6), 429-441.

A conceptual review of family resilience factors

Family resilience is the successful coping of family members under adversity that enables them to flourish with warmth, support, and cohesion. An increasingly important realm of family nursing practice is to identify, enhance, and promote family resiliency. Based on a review of family research and conceptual literature, prominent factors of resilient families include: positive outlook, spirituality, family member accord, flexibility, family communication, financial management, family time, shared recreation, routines and rituals, and support networks. A family resilience orientation, based on the conviction that all families have inherent strengths and the potential for growth, provides the family nurse with an opportunity to facilitate family protective and recovery factors and to secure extrafamilial resources to help foster resilience.

Maternal demandingness and responsiveness as predictors of adolescent abstinence

This retrospective study examined two distinct parenting dimensions, demandingness and responsiveness, as independent predictors of adolescent sexual risk behavior. The data used to test study hypotheses were from Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health). In this sample of 2,030 adolescents and their mothers, maternal demandingness [odds ratio (OR)=0.77] and maternal responsiveness (OR=0.89) independently predicted adolescent abstinence from sex. Findings substantiate the use of a dimensional approach to measuring parenting in examining adolescent sexual behavior.

Children at risk for special health care needs

OBJECTIVE

Despite the widespread use of the Maternal and Child Health Bureau definition of children with special health care needs, no published studies have considered the "at-risk" component of the definition. The purpose of this article is to present a conceptual model of risk for special health care needs.

METHODOLOGY

The conceptual model presented here was developed based on a comprehensive review of the literature on the determinants of population health and the etiologic literature for selected representative childhood chronic conditions.

RESULTS

Our conceptual model is built on 5 key pillars derived from the literature. First, determinants of health have been demonstrated to include genetic endowment, the physical and social environment, health-related behaviors, and the health care system. Second, the model recognizes that the relative importance of each of these domains in contributing to the presence of a special health care need is likely to vary across the major chronic conditions experienced by children. Third, these domains can be conceptualized as acting at the child, family, community, or societal level. Fourth, the model recognizes the presence of a complex interplay of causal factors influencing the development of chronic conditions and associated special health care needs. Fifth, the model incorporates a temporal aspect to the development of special health care needs.

CONCLUSIONS

The conceptual model presented here represents a starting point for thinking about the risk factors that influence the occurrence and severity of a special health care need. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach to considering risk. Nevertheless, we recognize that the conceptual model represents an oversimplification of reality. The study of risk factors for special health care needs remains largely in its infancy and is ripe for additional development.

Adolescent resilience: an evolutionary concept analysis

Resilience is a concept that has enormous utility in nursing, although there is a need for concept clarity as it relates to adolescence. The purpose of this article is to describe the concept and apply the Evolutionary Model of Concept Analysis to resilience in adolescents. A literature search and an analysis of 22 articles specific to the adolescent population were completed. The literature review revealed adolescent resilience to be a composite of attributes that include the characteristics of the adolescent, sources of social support, and available resources. Implications for nursing and a proposed model of adolescent resilience are presented.

Risk and protective factors for substance use among African American high school dropouts

Risk and protective factors that predict substance use were investigated with 318 African American high school dropout youths who completed the 1992 follow-up of the National Educational Longitudinal Study of 1988. A conceptual model linking positive family relationships and religious involvement to youths' substance use and conventional peer affiliations through a positive life orientation was examined with structural equation modeling. Positive life orientation, which included optimism and conventional goals for the future, fully mediated the influence of family relationships on conventional peer affiliations. Religious involvement directly predicted conventional peer affiliations and positive life orientation. Conventional peer affiliations mediated the other variables' influence on substance use.

The role of "envisioning the future" in the development of resilience among at-risk youth

The objective was to explore the process by which adolescents develop resilience and change their risk behaviors despite multiple stressors in their environment. The design was exploratory using grounded theory to understand the process from the teens' perspectives. Semistructured interviews were conducted with 32 individuals-28 adolescents (age range 16-21 years) and 4 adults (age range 32 and 72)-on two occasions. The participants used the basic social process "envisioning the future" to become resilient and stop engaging in risk behaviors. Envisioning the future included two processes "feeling competent" and "elevating expectations" that were facilitated within the context of a relationship with a reliable, caring, and competent adult. Participants in this study became resilient despite environmental stressors by setting higher expectations for themselves and feeling self-confident. The findings of this study provide information regarding the specific behaviors that promote positive outcomes in at-risk youth and suggest ways in which public health nurses can facilitate these behaviors in both the youth and their mentors.