Joel and Barbara Alpert Award Application                                Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
                 The Joel and Barbara Alpert Endowment For The Children of the City

                                          GRANT APPLICATION

INVESTIGATOR:            Renée Boynton-Jarrett, MD, ScD

TITLE:          Assistant Professor of Pediatrics ____________________

DEPARTMENT: Boston Medical Center/Boston University School of Medicine Department of

MAILING ADDRESS: 88 East Concord Street, Vose Hall 310, Boston, MA 02118

TELEPHONE #:             (617) 414-7477


PROJECT TITLE:      A Trauma-Focused Cognitive Behavioral Therapy Intervention for Youth
Exposed to Community Violence __________________________________________________

MENTOR'S NAME: Howard Bauchner, MD

TOTAL PROJECT BUDGET:                     $13,380.00

APPLICANT'S SIGNATURE:                                                               DATE:

MENTOR'S SIGNATURE:                                                         DATE:

Abstract. Children who receive care at Boston Medical Center are at high risk for exposure to community

violence. While there is heightened awareness of the extent to which violence exposure impacts mental

health, behavior, and developmental trajectory, there are few evidence-based interventions to proactively

address the needs of this population of children who are at risk for traumatic stress and associated health

consequences and improve psychosocial functioning and maximize socio-emotional developmental potential.

Mounting evidence from cohort studies and randomized controlled trials have demonstrated that Trauma-

focused cognitive behavioral therapy (TF-CBT) is among the most effective interventions to treat symptoms

of traumatic stress in clinical population. The proposed translational study aims to evaluate the effectiveness

of a TF-CBT intervention on depressive and trauma symptomatology and psychosocial functioning in a

population of boys, ages 12-14, exposed to community violence. The novelty of this approach is that it may

inform the dissemination of an intervention validated in clinically symptomatic populations to youth at-risk

of poor mental health outcomes, but with sub-clinical symptoms.

Joel and Barbara Alpert Award Application                                 Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
A. Specific Aims. Exposure to community violence in early life may have an enduring impact on socio-

emotional development and health. While early intervention is important, there are few evidence-based

strategies to address the needs of youth post-violence exposure, particularly those who do not fit clinical

criteria for depression or PTSD. Trauma-focused cognitive behavioral therapy (TF-CBT) is a treatment

model that has demonstrated effectiveness among youth with clinical depression or PTSD. The utility of TF-

CBT for preventing symptoms post-violence exposure and enhancing resiliency and psychosocial

functioning among youth with sub-clinical trauma symptoms is unknown. The proposed IRB approved

study aims to:

    1. To evaluate the effectiveness of a TF-CBT intervention on change in post-traumatic stress, somatic,
        and depressive symptoms and maintenance of change over a 3 month period.

    2. To evaluate the impact of a TF-CBT intervention on externalizing behaviors.

    3. To evaluate the role of a TF-CBT intervention on changes in socio-emotional coping with
       community violence exposure and self-efficacy with respect to conflict avoidance.

    4. To evaluate the acceptability of TF-CBT intervention to participants and their parents, as measured
        by group attendance rates and semi-qualitative questions on intervention satisfaction.

B. Background and Significance. Exposure to violence is among youth’s earliest exposures,1-3 and

constitutes a significant national public health problem.4, 5 Empirical research consistently documents that

racial/ethnic minorities and youth residing in urban cities are at increased risk for witnessing violence, direct

victimization,4 and exposure to community violence.4, 6 The toxic level of violence exposure for youth is a

public health emergency 6, 7 and bespeaks the need to uncover the most efficacious strategies to reduce the

negative impact of these adverse exposures on health, cognitive, and developmental outcomes.

        The population of children served at Boston Medical Center is at high risk for exposure to

witnessing, experiencing, or hearing about violence in their communities. 1 in 10 children seen in the Boston

Medical Center ER have witnessed a knifing or shooting prior to age 6 years.8, 9 In the past year, the

homicide rate in Dorchester has risen 83%.10 For far too many children, community violence is the norm,

rather than the exception. Witnessing or being the direct victim of community violence events may cause a

traumatic stress response. While there is heightened awareness of the extent to which violence exposure

impacts mental health, behavior, school performance, and developmental trajectory, there is limited

Joel and Barbara Alpert Award Application                                Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
understanding of interventions to reduce the symptoms of post-traumatic stress disorder (PTSD) and improve

psychosocial functioning post-violence exposure. While the Child Witness to Violence Program (CWTV) is

highly efficacious, it is limited to children age 8 years and younger. There is a great need for disseminating

efficacious behavioral interventions to respond to the needs of early adolescent youth exposed to violence

and optimize their health, development, and life chances.

        Exposure to Violence and Mental Health and Psychosocial Functioning. Exposure to

community violence through witnessing and/or direct victimization leads to traumatic stress.2, 5, 11 Exposure

to community violence during critical developmental periods may enhance vulnerability to negative impacts

on mental and physical health, cognition, and development.2, 5, 11, 12 Reducing adverse health outcomes related

to violence has been identified as a health promotion priority of Healthy People 2010. 13 Advancing our

understanding of efficacious and feasible treatment options for children exposed to community violence has

a number of public health benefits. Children who experience community violence are likely to suffer both

short- and long-term effects on their healthy development and functioning throughout the life course,12

yielding a high societal burden due to losses in productivity.14, 15

        Cognitive Behavioral Therapy and Traumatic Stress. Cognitive behavioral therapy has been

defined as one of the more effective treatments of psychotherapy to treat traumatic stress.16 Individual

cognitive-behavioral therapy has been demonstrated to be effective with at-risk populations.17-20 The majority

of research to date has focused on extremely high risk populations exposed to war, disaster, and sexual

abuse; little research has focus on group interventions for children exposed to community violence.20-28

        To date, a single randomized controlled-intervention (RCT) study has evaluated TF-CBT among

middle school aged children who had experienced community violence and had clinically symptomatic

levels of PTSD. This tertiary intervention, RCT study, had significant reductions in PTSD and depression

symptomology for 126 middle school children at 3 months post the intervention.26-28 No published report

has evaluated TF-CBT among a population with sub-clinical symptoms as a secondary prevention

strategy. Groups have potential to create a safe and supportive atmosphere for boys and support the mental

health of larger numbers of youth.

Joel and Barbara Alpert Award Application                                 Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
        Rationale for the proposal. Although we acknowledge that violence exposure is a prevalent

problem, there are few evidence-based approaches to proactively address the needs of youth post-

exposure. This work investigates the feasibility of implementing a novel therapeutic modality, TF-CBT,

with fidelity in a group setting among boys with sub-clinical symptoms. The public health impact of this

pilot work is significant, in that if we are able to demonstrate sustained improvements in a sub-clinical

population, this may become a more globally applied secondary prevention measure against future

violence exposure and the poor outcomes known to be associated with chronic community violence

exposure that are unaddressed. Moreover, the number of youth with sub-clinical trauma symptoms is far

greater than those with a clinical diagnosis of PTSD. Therefore, the potential population served is greater. In

order to accomplish the successful translation of this promising work, it is important to test the ability of

such an intervention to help buffer negative effects of violence exposure on at-risk youth who have had

violence exposure but have not yet developed clinical symptoms. Our proposed study has the potential to

provide evidence for the extension of the group-based TF-CBT model as a preventive therapeutic

intervention for a population of boys at risk for poor mental health outcomes due to exposure to community


        The Joel and Barbara Alpert Grant would enable us to study the components of this therapy that are

most efficacious, improve intervention delivery, and evaluate the long-term benefits of this therapy in

preparation for delivery of this intervention on a larger scale to school-children in the city of Boston. Over

the past 5-10 years the NIH has funded over180 R- mechanism research grants that incorporate the study,

implementation, or evaluation of CBT interventions. The support of the Joel and Barbara Alpert Award

would allow us to collect pilot data to refine the intervention and apply for future grant support from the

Office of Juvenile Justice and Delinquency Prevention (OJJDP), Centers for Disease Control (CDC), Robert

Wood Johnson Foundation (RWJ), and National Institutes of Health (NIH) to implement a larger study.

C. Research Design and Methods:

C.1. Study Participants. The inclusion criteria for adolescent boys is: (1) male participants; (2) age range

of 12-14; (3) fluent in English language; (4) history of exposure to community violence in the past 12

months; (5) have symptoms of distress associated with a community violence exposure (as measured by a

Joel and Barbara Alpert Award Application                                  Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
Child PTSD Symptom Scale score of 8 or above); (6) are not considered to be too disruptive to participate in

a group therapy intervention session as determined by the study psychologist, Dr. Joanna Cole; (7) have

access to individual therapy. Psychometric analysis of the Child PTSD Symptom Scale (CPSS) among 12

year olds indicates that a total score of > 11 is associated with greater severity of PTSD symptoms and a

score < 11 is associated with mild PTSD symptoms.29 This data has informed the selection of our inclusion

criteria. The inclusion criterion for parents/ legal guardians is fluency in English.

C.2. Design. This pilot study will employ a longitudinal behavioral intervention. This study will enroll up to

8 adolescent boys and 8 parents/legal guardians for Group 1 and then another 8 adolescent boys and 8

parents/legal guardians for Group 2. Recruitment for Group 2 takes place 4 weeks after the commencement

of the intervention for Group 1. For the purposes of this pilot, there will be no control group since it is not

feasible to recruit all 32 participants in a reasonably timely manner. Then, participants will be followed- up

with a post intervention, and 3 month follow-up. (see Figure 1). See attached documentation for IRB


Figure 1. Pilot Behavioral Intervention Study Timeline
  T-1        T-0       1      2     3      4      5               6        7       8        9       10       11     12

    Baseline           Group 1               Group 1:                   Group 1:
    Assessment         Intervention          Follow- up                 Follow- up
    And Recruitment                          Assessment 1                Assessment 2
    Group 1                                  (3 month post-baseline)    (6 month post-baseline)

                          Baseline            Group 2 Intervention      Group 2:                  Group 2:
                          Assessment and                                Follow-Up                 Follow-Up
                          Recruitment                                   Assessment 1              Assessment 2
                          Group 2                                       (3 month post-baseline)   (6 month post-baseline)

The Intervention: The intervention will take place weekly over a ten week period. Adolescent boy

participants will meet for 60 minutes in a group lead by a clinical psychologist, Dr. Joanna Cole, in the

Boston Medical Center Child Psychiatry Department. The group will follow an adapted version of the

Cognitive- Behavioral Intervention for Trauma in Schools (CBITS) group intervention curriculum

developed. This intervention curriculum will focus on the following cognitive-behavioral techniques: (a)

Joel and Barbara Alpert Award Application                                   Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
education about reactions to trauma, (b) relaxation training, (c) cognitive therapy, (d) real life exposure, (e)

stress or trauma exposure, and (f) social problem solving.

The Instruments: Adolescent boys will be screened using the following: (1)The Teen Conflict Scale

measures self-efficacy regarding conflict avoidance,30 (α =.85). 31 (2) The KidCope Scale32, 33 measures

resilient coping with violence exposure; reliability (r = .41 to .83). 32, 33 (3) The Provision of Social

Relations34 measures social support, (α =.88).34 (4) The Child Depression Inventory (CDI),35 (α =.80 to .

94).36 (5) The PTSD Symptom Scale, (α =.89). 29 (6) The Violence Exposure Screen37 measures witnessing,

experiencing, or hearing about a variety of types of violence, (r = 0.75-0.94). 37 (7) Information will be

collected in a series of open ended questions on coping with stress, group satisfaction, and current therapy.

The following instruments will be used to collect data from the parents/guardians: (1) The Vanderbilt Scale

of behavioral problems and activity, (α =.90-95).38 (2) The Pediatric Symptom Checklist39 measures somatic

complaints and social-emotional health, (α =.89).40 (3) The Berkman-Syme Social Support Index assesses

religiosity and emotional support.41 (4) Demographic questionnaire on psychosocial needs, material

hardships, school performance, violence exposure, and health history of the adolescent boy.

C3. Study Protocol. Participants will be recruited from the BMC Pediatric Adolescent Clinic and Child

and Adolescent Psychiatry Department by clinicians and social workers. If interested, a referral will be made

to the study team by clinic social worker and licensed psychologist, Dr. Joanne Cole will contact the family

to schedule an in-person baseline assessment. Clinic staff has been introduced to the study and referral

protocol. After consenting the parent and assenting the youth, all instruments will be administered orally by

the PI and RA to participants. During the TF-CBT intervention all participants will receive the current

standard of care, including individual therapy via behavioral health services at BMC. Participants will

receive post-intervention assessment within 1 week after completion of the 10 weeks program in-person or

via phone and another post-intervention assessment 3 months later in- person or via phone.

C4. Analysis Plan. Primary analyses will explore change in mental health symptoms, coping, self-efficacy,

and behavior between baseline and the end of the 10 week intervention. In order to assess the effectiveness

of the intervention we will use standard multivariate linear regression models to estimate the mean difference

in outcome scores (mental health symptoms, coping, self-efficacy and behavior) between baseline and the

Joel and Barbara Alpert Award Application                                 Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
end of the 10 week intervention. We will control for group placement in our analyses. All statistical

analyses will be conducted in SAS. Our secondary outcome of interest is maintenance of change from the

end of the intervention over a 3 month period post-intervention (approximately 6 months post-baseline);

therefore we will evaluate change in outcomes during this period. Our final outcome of interest is feasibility

of the intervention, as measured by drop-out rate, participation rate, and participant satisfaction with the

intervention. Drop-out rate will be assessed in terms of the number of participants who stop attending group

sessions during the 10 week therapeutic period. Finally, participation rate will be measured in terms of the

average number of sessions attended by each participant. We will also perform sub-analyses to evaluate

whether the degree of participation varied by sociodemographic factors including age and race/ethnicity, and

nature of community violence exposure, and length of time since exposure.

C5. Strengths and Limitations. The planned study has several strengths. First, while TF-CBT has been

demonstrated to be effective in high-risk populations, little is know about its impact on youth at-risk for poor

mental health outcomes due to violence exposure. This study will have the opportunity to directly address

these questions. Moreover, the study design will allow us to study several process measures including

change in self-efficacy, coping and allow us to learn more about how TF-CBT may lead to improved

outcomes and for whom. The potential to provide useful knowledge and service to a large number of

children is great. Although we are limited by the small sample size of the pilot study, the richness of the

quantitative and qualitative data to be gained will support future efforts to expand this work.

D. Conclusion. The need for services for adolescents with community violence exposure and trauma-related

behavioral and health problems is great. Our hope is that demonstration of effectiveness via this pilot will

support a larger study and expansion of preventive mental health services to more youth on a larger scale.

E. Candidate Career Development. The candidate aspires to be a leader in the field of research and

advocacy for children and youth exposed to adversities in early life. To date her work has primarily focused

on epidemiologic exploration on the impact of childhood adversities on neuroendocrine health outcomes.

This pilot intervention study is the candidate’s first entry into intervention study design, implementation, and

evaluation. Therefore the Alpert Award would support this new area of development for the candidate.

Joel and Barbara Alpert Award Application                           Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
F. Literature Cited.

1.     Finkelhor D, Hotaling G, Lewis IA, Smith C. Sexual abuse in a national survey of adult men and
       women: Prevalence, characteristics, and risk factors. Child abuse & neglect. 1990;14(1):19-28.
2.     Fitzpatrick KM, Boldizar JP. The prevalence and consequences of exposure to violence among
       African-American youth. Journal of the American Academy of Child and Adolescent Psychiatry.
3.     Repetti RL, Taylor SE, Seeman TE. Risky families: Family social environments and the mental and
       physical health of offspring. Psychological Bulletin. 2002;128(2):330-366.
4.     Buka SL, Stichick T, Birdthistle I, Earls FJ. Youth exposure to violence: Prevalence, risks, and
       consequences. American Journal of Orthopsychiatry. 2001;71(3):298-310.
5.     Margolin G, Gordis EB. The effects of family and community violence on children. Annual Review
       of Psychology. 2000;51(1):445-479.
6.     Richters JE, Martinez P. The NIMH community violence project: I. Children as victims of and
       witnesses to violence; 1993.
7.     U.S. Surgeon General. Youth violence: A report of the Surgeon General. Washington DC US
       Department of Health and Human Services; 2001.
8.     Groves BM, Zuckerman B, Marans S, Cohen DJ. Silent victims. Children who witness violence.
       Jama. 1993;269(2):262-264.
9.     Zuckerman B, Augustyn M, Groves BM, Parker S. Silent victims revisited: the special case of
       domestic violence. Pediatrics. 1995;96(3):511-513.
10.    Boston Police Department Office of Strategic Planning and Research. Part One Crime Reported by
       the Boston Police Department. In. Boston; 2008.
11.    Fowler PJ, Tompsett CJ, Braciszewski JM, Jacques-Tiura AJ, Baltes BB. Community violence: A
       meta-analysis on the effect of exposure and mental health outcomes of children and adolescents.
       Development and Psychopathology. 2009;21(1):227-259.
12.    Committee on Evaluation of Childrens Health: The National Research Council. Children's Health,
       the Nations's Wealth: Assessing and Improving Chid Health. Washington, D.C.: National Academy
       Press; 2004.
13.    Services US Department of Health and Hunam. Healthy People 2010: Understanding and Improving
       Health. Washington D.C.: US Government Printing Office; 2000. Report No.: 2nd Ed.
14.    Heckman JJ. Skill formation and the economics of investing in disadvantaged children. In: American
       Association for the Advancement of Science; 2006. p. 1900-1902.
15.    Cunha F, Heckman J. The technology of skill formation. American Economic Review.
16.    Foa EB. Effective treatments for PTSD: practice guidelines from the International Society for
       Traumatic Stress Studies: The Guilford Press; 2008.
17.    Links E. Cognitive behavioral therapy dffective for trauma symptoms in children. American Journal
       of Preventive Medicine. 2008;35:287-313.
18.    Jaycox L. Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Longmont, CO: Sopris
       West Educational Services. 2003.
19.    Meiser-Stedman R. Towards a cognitive–behavioral model of PTSD in children and adolescents.
       Clinical Child and Family Psychology Review. 2002;5(4):217-232.
20.    Wethington HR, Hahn RA, Fuqua-Whitley DS, Sipe TA, Crosby AE, Johnson RL, et al. The
       effectiveness of interventions to reduce psychological harm from traumatic events among children
       and adolescents. American Journal of Preventive Medicine. 2008;35(3):287-313.
21.    Cohen JA, Mannarino AP, Murray LK, Igelman R. Psychosocial interventions for maltreated and
       violence-exposed children. Journal of social issues. 2006;62(4):737-766.
22.    Kerig PK, Fedorowicz AE, Brown CA, Warren M. Assessment and intervention for PTSD in
       children exposed to violence. Journal of Aggression, Maltreatment & Trauma. 2000;3(1):161-184.
23.    Aisenberg E, Mennen FE. Children exposed to community violence: issues for assessment and
       treatment. Child and Adolescent Social Work Journal. 2000;17(5):341-360.

Joel and Barbara Alpert Award Application                             Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
24.    Salloum A. Group Therapy for Children After Homicide and Violence: A Pilot Study. Research on
       Social Work Practice. 2008;18(3):198.
25.    Salloum A, Overstreet S. Evaluation of individual and group grief and trauma interventions for
       children post disaster. Journal of Clinical Child & Adolescent Psychology. 2008;37(3):495-507.
26.    Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN, et al. A mental health intervention
       for schoolchildren exposed to violence: a randomized controlled trial. JAMA. 2003;290(5):603-611.
27.    Stein BD, Jaycox LH, Kataoka S, Rhodes HJ, Vestal KD. Prevalence of child and adolescent
       exposure to community violence. Clinical Child and Family Psychology Review. 2003;6(4):247-264.
28.    Stein BD, Kataoka S, Jaycox LH, Wong M, Fink A, Escudero P, et al. Theoretical basis and program
       design of a school-based mental health intervention for traumatized immigrant children: a
       collaborative research partnership. The Journal of Behavioral Health Services and Research.
29.    Foa EB, Johnson KM, Feeny NC, Treadwell KRH. The Child PTSD Symptom Scale: a preliminary
       examination of its psychometric properties. Journal of Clinical Child & Adolescent Psychology.
30.    Dahlberg Linda L, Toal Susan B, Swah Monica, Behrens Christopher B. Measuring Violence-
       Related Attitudes, Behaviors, and Influences Among Youths: A Compendium of Assessment Tools
       2nd ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury
       Prevention and Control; 2005.
31.    Bosworth K, Espelage D. Teen conflict survey. In. Bloomington, Indiana: Center for Adolescent
       Studies, Indiana University.(Unpublished); 1995.
32.    Blount RL, Simons LE, Devine KA, Jaaniste T, Cohen LL, Chambers CT, et al. Evidence-based
       assessment of coping and stress in pediatric psychology. Journal of Pediatric Psychology.
33.    Spirito A, Stark LJ, Williams C. Development of a brief coping checklist for use with pediatric
       populations. Journal of Pediatric Psychology. 1988;13(4):555-574.
34.    Turner RJ, Frankel BG, Levin DM. Provision of Social Relations Scale. Measures for Clinical
       Practice: A Sourcebook. 1987:143–146.
35.    Kovacs M. Child depression inventory. Psychopharmacological Bulletin. 1985;21:995-998.
36.    Saylor CF, Finch AJ, Spirito A, Bennett B. The Children’s Depression Inventory: A systematic
       evaluation of psychometric properties. Journal of Consulting and Clinical Psychology.
37.    Selner-O'Hagan MB, Kindlon DJ, Buka SL, Raudenbush SW, Earls FJ. Assessing exposure to
       violence in urban youth. The Journal of Child Psychology and Psychiatry and Allied Disciplines.
38.    Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric
       properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of
       Pediatric Psychology. 2003;28(8):559-568.
39.    Jellinek MS, Murphy JM, Robinson J, Feins A, Lamb S, Fenton T. Pediatric Symptom Checklist:
       screening school-age children for psychosocial dysfunction. The Journal of pediatrics.
40.    Reijneveld SA, Vogels AGC, Hoekstra F, Crone MR. Use of the Pediatric Symptom Checklist for
       the detection of psychosocial problems in preventive child healthcare. BMC Public Health.
41.    Berkman LF. The relationship of social networks and social support to morbidity and mortality.
       Social support and health. 1985:241-262.

Joel and Barbara Alpert Award Application                                 Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09

BUDGET CATEGORIES                                         Start: 01/01/2010; End: 12/31/2010
Research Assistant/Data Analyst                                                                                   8,000
   RA Fringe Benefits                                                                                             2,080
Other Direct Costs
Participant reimbursement                                                                                          960
Participant travel expenses                                                                                        640
Refreshments for group sessions                                                                                    400
Program materials/Office supplies                                                                                  300
Laptop computer                                                                                                   1,000

TOTAL AMOUNT REQUESTED                                                                                           13,380

                                             BUDGET JUSTIFICATION

PERSONNEL : Michelle Schlesinger; Research Assistant/Database Manager: For the proposed work the

candidate is supporting a research assistant to help with data collection (survey administration), data

cleaning, coding, database creation, and maintaining an updated literature review. Salary support is

requested at 25% effort.

FRINGE BENEFITS: The fringe benefit rate of 26% is for all Boston Medical Center personnel and is used for

federal and non-federal grants and contracts. This is the rate that is used in the calculation of the Research

Assistant’s salary.

PROGRAM MATERIALS/OFFICE SUPPLIES: During the first year $300 is dedicated to the purchase of books,

curriculum, materials, and miscellaneous office supplies, including mail envelopes for storing survey

instruments. In order to provider refreshments at each group session a total of $400 is requested.

PARTICIPANT INCENTIVES & TRAVEL REIMBURSEMENT: Each youth participant and guardian/parent will receive a

$10 gift card for each survey completed. For the 3 surveys this will be a total of $60 for each participating

family. For the 16 youth-parent dyads the total will be $960. Travel expenses for transport to the group

sessions will be reimbursed with a $2 Charlie card for transportation each way.

LAPTOP COMPUTER: A laptop computer will be useful for collection of questionnaire data, use during group

sessions, and for confidential storage of the database.

Joel and Barbara Alpert Award Application                               Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09

                          EXPOSURE TO COMMUNITY VIOLENCE
 Protocol Number:         H-28346
 RE:                      New Protocol
 Review Type:             Full Board
 Action:                  Approved
 Date of Action:          8/27/2009
 Date of Expiration:      8/26/2010
 Funding Source:          Not Funded


 The Institutional Review Board (IRB) has reviewed the above referenced protocol and
 has determined that it meets the requirements set forth by the IRB and is hereby
 approved. This protocol is valid through the date indicated above.

 This study involves greater than minimal risk, but presents the prospect of direct benefit
 to the subjects. In accordance with 45 CFR 46.405, the board has determined that one
 parent consent is required.

 The board determined that written assent of the children enrolled in this study is

 The approved HIPAA Prep is externally attached.

 Revisions have been reviewed and approved as of this date 9/9/09.

 The study may not continue after the approval period without additional IRB review and
 approval for continuation. You will receive an email renewal reminder notice prior to
 study expiration; however, it is your responsibility to assure that this study is not
 conducted beyond the expiration date.

 Please be aware that only IRB-approved informed consent forms may be used when
 informed consent is required. Only consent forms validated with current approval dates
 (either generated by the INSPIR system or by a manual stamp by the IRB office) may
 be used. Manually stamped consent forms may be found under External Attachments in

 Any changes to the protocol or informed consent must be reviewed and approved prior
 to implementation unless the change is necessary for the safety of subjects. In addition,
 you must report to the IRB unanticipated problems involving risk to subjects or others
 according to the process posted on the IRB website. The IRB must be informed of any
 new or significant information that might impact a research participant's safety or

Joel and Barbara Alpert Award Application                                   Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
  willingness to continue in your study.

 Investigators are required to ensure that all HIPAA requirements have been met prior to
 initiating this study. Once approved, validated HIPAA forms may be found within
 INSPIR as External Attachments.

 It is the responsibility of the PI to ensure that all required institutional approvals have
 been obtained prior to initiating any research activities.

 Please note that the IRB is no longer stamping attachments, subject letters, recruitment
 materials, etc. These documents are each associated with this approved version of the
 protocol. They can be found by going to Letters/Protocol History in INSPIR and clicking
 on the highlighted (linked) word "Approved" and then clicking on the paperclip icon in
 the upper left corner. *This does NOT apply to consent forms, which must be validated.

 Sincerely yours,

 IRB Chair

     Joel and Barbara Alpert Award Application                                                 Investigator: Boynton-Jarrett, Renée
     Date Submitted: 11/1/09

                                             BIOGRAPHICAL SKETCH
                            Provide the following information for the key personnel and other significant contributors.
                                     Follow this format for each person. DO NOT EXCEED FOUR PAGES.

NAME                                                                        POSITION TITLE
Renée Danielle Boynton-Jarrett                                              Assistant Professor of Pediatrics, Boston University
eRA COMMONS USER NAME                                                       School of Medicine
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)
                 INSTITUTION AND LOCATION                                                       YEAR(s)                   FIELD OF STUDY
                                                                        (if applicable)
Princeton University                                                         B.A.                 1997           Anthropology
Yale University School of Medicine                                           M.D.                 2004           Medicine
Harvard University School of Public Health                                   M.S.                 2002           Social Epidemiology
Harvard University School of Public Health                                   Sc.D.                2004           Social Epidemiology

            A.           Positions and Honors.

       Positions and Employment
       2004 – 2005 Internship, Pediatrics, Johns Hopkins Hospital, Baltimore, MD
       2005 - 2007   Residency, Pediatrics, Johns Hopkins Hospital, Baltimore, MD
       2007 -        Assistant Professor of Pediatrics, Boston University School of Medicine, Boston
       2007 -        Assistant Professor of Pediatrics, Boston Medical Center, Boston, MA

       Other Experience and Professional Memberships:
            Alpha Omega Alpha National Honor Society
            American Academy of Pediatrics
            Ambulatory Pediatrics Association
            American Public Health Association

               Peer Reviewer:
               American Journal of Epidemiology
               Archives of Pediatric and Adolescent Medicine
               Journal of Adolescent Health
               Social Science and Medicine
               Journal of Women’s Health
               American Journal of Obstetrics and Gynecology

         2007            Kamsler Awards, Johns Hopkins Hospital Department of Pediatrics
         2005            Ambulatory Pediatric Society New Century Scholar
         2005            Outstanding Achievement Award, Englewood Health Department
         2004            The Parker Prize, Yale School of Medicine
         2004            American Medical Women’s Association Glasgow-Rubin Achievement Award
         1999            Bristol-Myers Squibb Fellowship in Academic Medicine for Minority Students
         1999            W. K. Kellogg Community-Based Training Fellowship for Minority Medical
         1998            Wilbur J. Down’s International Health Fellowship for Summer Research

Joel and Barbara Alpert Award Application                         Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
  1997         Ruth Simmons Senior Thesis Prize in African American Studies

 B. Selected peer-reviewed publications (in chronological order).

 Boynton-Jarrett R, Thomas T, Peterson K, Weicha J, Sobol A, Gortmaker S. “The Impact of
 Television Viewing Patterns on Fruits and Vegetable Consumption among Adolescents,”
 Pediatrics, 2003; 112: 1321-1326
 Boynton-Jarrett R, Rich-Edwards J, Malspeis S, Missmer SA, Wright R. “A Prospective Study
 of Hypertension and Risk of Uterine Leiomyomata,” American Journal of Epidemiology, 2005;
 Jun HJ, Rich-Edwards JW, Boynton-Jarrett R, and Wright RJ. “Women’s Experience with
 Battering and Cigarette Smoking: Added Risk Related to co-occurrence with other forms of
 Intimate Partner Violence.” American Journal of Public Health 2008; 98(3): 527-35.
 Jun HJ, Rich-Edwards JW, Boynton-Jarrett R, and Wright RJ. “Child Abuse and Smoking
 among Young Women: The Importance of Severity, Accumulation, and Timing of Abuse,’
 Journal of Adolescent Health, 2008; 43(1): 55-63.
 Boynton-Jarrett R, Ryan L, Berkman L, Wright RJ, “Cumulative Exposure to Violence and Self-
 Rated Health: A Longitudinal Study of Adolescents in the United States,” Pediatrics, 2008;
 122(5): 961-970.
 Boynton-Jarrett R, Rich-Edwards JW, Jun HJ, Wright RJ. “Self-Reported Abuse in Childhood
 and Risk of Uterine Leiomyomata: The Role of Emotional Support in Biological Resiliency” (under
 review, Epidemiology).

 Boynton-Jarrett R, Fargnoli J, Suglia SF, Zuckerman B, Wright RJ. "The Impact of Maternal
 Intimate Partner Violence on Incidence of Obesity in Preschool Children: Findings from the
 Fragile Families and Child Wellbeing Study," (under review, Archives of Pediatric and Adolescent
 Medicine, September 2009)
 Harville EW, Boynton-Jarrett R, Hypponen E, Power C. “Effects of Childhood Hardships on
 Pregnancy Outcomes,” (under review, Archives of Pediatric and Adolescent Medicine,
 September 2009)

 Boynton-Jarrett R, Rich-Edwards JW, Fredman L, Hibert E, Michaels K, Forman MR, Wright
 RJ. "Gestational Weight Gain and Daughter's Age at Menarche," (under review, Journal of
 Epidemiology and Community Health, October 2009)

 Jun HJ, Corliss HL, Boynton-Jarrett R, Speiglman D, Austin SB, Rich-Edwards J, Wright RW.
 "Growing Up in a Domestic Violence Environment: Relationship with Developmental Trajectories
 of BMI in Adolescence into Young Adulthood," (submitted, Archives of Pediatric and Adolescent
 Medicine, October 2009)

 C. Research Support.
 Ongoing Research Support
 W.T. Grant Foundation Scholar                                             Boynton-Jarrett (PI)
 07/01/08 - 06/30/13
 Social Ecology of Adolescent Obesity: Defining the Role of Adverse Social Settings & Social
 Mentors: Steve Gortmaker, PhD, and Howard Bauchner, MD
 The main goals of this project are to investigate the role of neighborhood and familial violence in
 explaining the social inequalities in obesity risk during adolescence; and design anintervention

Joel and Barbara Alpert Award Application                        Investigator: Boynton-Jarrett, Renée
Date Submitted: 11/1/09
 study whether youth exposed to neighborhood violence with higher levels of physical activity
 have improved mental and physical health outcomes and higher school achievement.
 Role: PI

 Academic Pediatrics Association Young Investigator Award                 Boynton-Jarrett (PI)
 07/01/08 - 06/30/09
 The Social Ecology of Adolescent Obesity
 Mentor: Howard Bauchner, MD
 The proposed study will use longitudinal cohort data to investigate the impact of neighborhood
 crime on physical activity, sedentary behaviors, and obesity risk among adolescents.
 Role: PI

 K12-HD43444                                                                      Freund (PI)
 04/01/08 - 03/31/10
 Building Interdisciplinary Research Careers in Women’s Health
 Mentors: Howard Bauchner, MD and Lisa Fredman, PhD
 To promote interdisciplinary research in women’s health, by funding junior faculty as Faculty
 Scholars, and mentoring towards independent funding.
 Role: Fellow

 NIH Pediatric Research Loan Repayment Program                            Boynton-Jarrett (PI)
 Early life Exposure to Violence and Health: Neuroendocrine Pathways between Social
 Adversities & Reproductive Health
 Mentors: Rosalind Wright, MD, MPH and Howard Bauchner, MD
 Using a prospective, national cohort, this study investigates the relation between maltreatment
 in childhood and reproductive health among adult women.
 Role: PI

 Completed Research Support
 Boston University School of Medicine faculty support grant              Boynton-Jarrett (PI)
 07/01/07 - 6/30/08
 Defining the Role of Early Life Social Adversities and Social Stress
 Mentors: Howard Bauchner, MD and Barry Zuckerman, MD
 Role: PI (completed)

 1 F31 MH67538-01                                                         Boynton-Jarrett (PI)
 07/01/02 - 06/10/04
 NIH National Research Service Award, NIMH
 Social Stress and Mental and Physical Health
 Principal Investigator: Renée Boynton-Jarrett, MD, ScD
 Role: Pre-Doctoral Dissertation Fellowship (completed)

 2 R25GM055353-09                                                                   Ryan (PI)
 09/01/00 - 06/30/02
 NIH MRNS IMSD Program at Harvard School of Public Health
 Role: Fellow/Trainee (completed)


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