Adolescents' input on the development of an HIV risk reduction intervention

A "Triple Threat" to Research Protocols and Logistics: Adolescents, Sexual Health, and Poverty

The purpose of this article is to discuss lessons learned from conducting research with urban communities. A brief overview of the Health Improvement Project for Teens (HIPTeens) will be provided. It will be followed by several suggestions concerning recruitment and retention of participants, challenges related to working in impoverished environments, hiring and training of research teams, interacting with administration and community, and strategies for doing research in diverse settings.

A Qualitative Examination of Respondent-Driven Sampling (RDS) Peer Referral Challenges Among Young Transwomen in the San Francisco Bay Area

BACKGROUND

Efforts have focused on developing innovative recruitment strategies to engage the most marginalized of populations in public health research. Respondent-driven sampling (RDS) has been found to be an effective sampling strategy for hard-to-reach, hidden populations. Though studies have documented RDS peer referral as challenging, literature contextualizing these challenges is scant and rarely do they discuss the role of Internet technologies.

OBJECTIVE

The objective of the study was to explore reasons for peer referral challenges in a human immunodeficiency virus (HIV) risk and resilience study among a hidden population of youth, specifically, young transwomen. These findings amplify the unique opportunities Internet technologies bring to public health research and methodology.

METHODS

We conducted focused, semistructured, qualitative interviews with 16 young transwomen to investigate the reasons why youth did or did not refer peers to an RDS study for transwomen ages 16-24 in the San Francisco Bay Area. Qualitative interview data were coded and analyzed using grounded theory.

RESULTS

Participants discussed specific barriers and facilitators related to four factors that include study design, study implementation, community characteristics, and individual characteristics, which contributed to RDS peer referral challenges.

CONCLUSIONS

Our grounded theory analysis identifies important considerations for future RDS studies with hidden youth populations. Exploring research participants' experiences is integral in strengthening future epidemiologic research efforts that plan to use RDS to sample and estimate the hidden epidemics among at-risk youth and transgender women. Additionally, Internet technologies and Web-based adaptations offer solutions to traditional RDS peer referral challenges, having the potential to increase accessibility and use among hidden youth populations.

Black adolescent mothers' perspectives on sex and parenting in nonmarital relationships with the biological fathers of their children

OBJECTIVE

To understand single Black adolescent mothers' perspectives on the sexual and parenting-related aspects of their relationships with the biological fathers of their children.

METHODS

The study was a qualitative description of perspectives from a convenience sample of Black single (nonmarried) adolescent mothers. Data were generated through focus groups and interviews. Participants were recruited using self-referral and health provider referrals.

SETTING

The study was conducted in a county public health department sexually transmitted diseases clinic in Rochester, New York.

PARTICIPANTS

Single mothers (N = 31) ages 15 to 19 participated in the study. The mean age of participants was 17.5 years (SD = 1.4).

FINDINGS

Four themes were identified that reflected the major characteristics of the relationships between the mothers and the biological fathers of their children: (a) You will always care about your "baby daddy" because of your child, (b) Negative behavior is tolerated to keep the family together, (c) The "baby daddy" can get sex as long as we are not on bad terms, and (d) He will always be part of our lives.

CONCLUSION

Black adolescent mothers have complex relationships with the biological fathers of their children that may include ongoing sexual activity. The intersection of coparenting and sexual health needs among adolescent mothers highlights the importance of integrating sexually transmitted infections prevention with perinatal health programs. It is important to consider this unique coparenting relationship when providing risk-reduction counseling to young mothers.

Relative efficacy of a pregnancy, sexually transmitted infection, or human immunodeficiency virus prevention-focused intervention on changing sexual risk behavior among young adults

OBJECTIVES

Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior.

PARTICIPANTS

Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008-2009.

METHODS

The authors compared the efficacy of 3 theory-based, sexual risk-reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up.

RESULTS

Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention.

CONCLUSIONS

The focus of sexual risk-reduction interventions may lead to differential behavior change among young adults.

Always, never, or sometimes: examining variation in condom-use decision making among Black adolescent mothers

Our purpose in this study was to describe Black adolescent mothers' decisions regarding condom use and non-use with their male sex partners, including their children's fathers. Research on partner type and condom use has been insufficiently focused on understanding the specific influence that the biological father of the baby has on condom use among adolescent mothers. We conducted five focus groups and three interviews with 31 predominantly African-American mothers. We found that their decisions to use condoms always, never, or sometimes were based on partner type and on emotional and relationship factors. The "baby daddy" was the only partner with whom they never used condoms. HIV/STI prevention interventions for adolescent mothers must address risk taking with their children's biological fathers.

Barriers to adolescents' participation in HIV biomedical prevention research

OBJECTIVES

The inclusion of adolescents in HIV prevention clinical research has the potential to improve the current understanding of the safety and efficacy of biomedical prevention technologies in younger populations that are at increasing risk of HIV infection. However, there are significant individual, operational, and community-level barriers to engaging adolescents in clinical prevention trials.

METHODS

This paper identifies and addresses individual, operational, and community-level barriers to adolescents' participation in HIV biomedical prevention research.

RESULTS

Barriers identified and addressed in this paper include: (1) insufficient understanding of clinic prevention research, (2) self-presentation bias, (3) issues surrounding parental consent, (4) access to clinical trials, (5) mistrust of research, and (6) stigma associated with participation in clinical trials. Examples of programs where adolescents have been successfully engaged in prevention research are highlighted and the lessons learned from these programs indicate that establishing collaborations with key stakeholders in the community are essential for conducting biomedical research with vulnerable populations, including adolescents.

CONCLUSIONS

Given the importance of understanding adolescents' reactions, acceptability, and utilization of new biomedical prevention technologies it is imperative that researchers acknowledge and address these barriers to enhance adolescents' participation and retention in HIV biomedical prevention research.

In their own voices: rural African American youth speak out about community-based HIV prevention interventions

BACKGROUND

The HIV epidemic is a major public health problem in the United States, particularly among rural African American adolescents and young adults.

OBJECTIVES

We sought to explore young, rural African American's perspectives about key programmatic components to consider when designing youth-targeted, community- based HIV prevention interventions.

METHODS

We report data from four focus groups with adolescents and young adults aged 16 to 24 (n = 38) conducted as part of a community-based participatory research (CBPR) project designed to develop multilevel HIV risk reduction interventions in two rural North Carolina communities with high HIV rates. Analysis was performed by academic and community partners using a modified grounded theory approach to content analysis.

RESULTS

Interventions should target preadolescents and early adolescents rather than older adolescents and young adults in an effort to "catch them while they're young." Intervention developers should obtain input from local young people regarding critical programmatic components, such as whom to employ as study recruiters and intervention leaders; intervention format and delivery options, acceptable recruitment and intervention locations, and incentive structures. Participants believe selecting community collaborators representing varied community sectors is critical. Important barriers to address included limited transportation, discomfort communicating about sexual issues, lack of community interest in HIV prevention, and unwillingness to acknowledge and address sexual activity among adolescents.

CONCLUSION

When designing HIV/AIDS prevention interventions, targeting young people, it is important to form academic-community partnerships that ensure young people's perspectives are integral to the intervention development process.

Understanding sexual abstinence in urban adolescent girls

OBJECTIVES

To gain insight into the context of sexual abstinence and identify potential determinants of abstinence in this population.

DESIGN

Four focus groups.

PARTICIPANTS AND SETTING

Twenty-four, predominantly African American (88%) girls aged 14 to 19 years were recruited from urban health centers and youth development programs in Rochester, New York, between September and December 2006.

DATA ANALYSIS

Content analysis was used to analyze the four verbatim transcripts. Using analytic induction, groups were compared and contrasted at the micro (within-group) and macro (between-group) levels to identify themes.

RESULTS

Four themes were identified that provided insight into how and why these girls remain abstinent despite being in sexually active social climates. They focused on the following: self-respect (I'm worth it), impact of mothers (Mama says ... think before you let it go), influence of boys and other peers (Boys will be boys), and potential negative consequences of sex (Hold on, there's a catch).

CONCLUSIONS

Developing interventions to maintain abstinence, delay onset of sexual activity, and promote protected first and subsequent sexual contact in abstinent girls are key to decreasing future sexual risk. These findings suggest opportunities to develop HIV prevention strategies tailored to the needs of abstinent girls.

Physical and sexual abuse and unstable housing among adolescents with HIV

Stable housing is a necessary component of treatment of adolescents with HIV. This study examines the housing status at two points in time of a sample of 224 adolescents with HIV seen at an adolescent medicine clinic in New York City. It addresses whether unstable housing is associated with several forms of abuse, and what factors predict continued instability. 38.6% (n = 86) had a prior history of unstable housing, reduced to 12.9% at the time of program entry. Multivariate logistic regression models predicting current and prior unstable housing revealed two variables related to both outcomes: physical abuse and referral from youth/social services entities. Continued unstable housing was associated with all abuse variables and adolescent history of arrest. When adolescents in abusive situations come to the attention of programs for youth, they have a positive impact on transitioning most adolescents to safer households, potentially improving adolescents' accessing of health care services.

AIDS-related stigma and attitudes towards AIDS-infected people among adolescents

This research examined the co-occurrence of accurate and inaccurate knowledge about HIV transmission among adolescents. Analyses were also conducted to examine the way in which variables related to demographic factors, personal characteristics, parent and peer relationships, and school involvement are associated with attitudes towards HIV/AIDS-infected people. Social and psychological processes that contribute to AIDS-related stigma are also described.

METHODS

Data were collected from the Portuguese sample of the 'Health Behaviour in School-Aged Children - 2002 - a collaborative WHO study'. The study provided data representative of 6137 Portuguese adolescents at national level. Based on these results, we conducted 14 focus groups discussions.

RESULTS

Adolescents presented high levels of knowledge about HIV transmission. However, the proportion of young people who hold misperceptions is also high. A multiple regression analysis identified several associations with attitudes towards HIV-infected persons. The focus groups showed that adolescents believe that people with AIDS experienced discrimination and social exclusion. Adolescents' opinions for HIV-infected persons were mostly positive and tolerant, although some adolescents showed an ambivalent attitude and undefined fears.

CONCLUSION

These findings have significant implications to implement and design comprehensive interventions with impact in adolescents' attitudes towards people with HIV/AIDS.

Heterosocial behaviors in early adolescent African American girls: the role of mother-daughter relationships

Recent epidemiological trends in HIV/AIDS have helped draw attention to minority adolescents as especially high risk for HIV acquisition. Research shows the importance of maternal-child closeness and sexual communication in decreasing adolescent risk behaviors. The information, motivation, behavioral skills model (IMB) formed the framework for this pilot study whose purpose was to examine the informational and motivational antecedents of heterosocial risks in African American middle-school-aged girls and the maternal influence on these risks. Thirty-nine mother-daughter dyads participated, of whom 54% were impoverished. The girls' intent to stay safe, perceived social norms, and closeness to mother were negatively correlated with reported participation in potentially risky situations. Early interventions may enhance mother-daughter bonding, increasing sexual communication, and decreasing girls' participation in risky behaviors. This pilot study provides direction regarding testing of the IMB model in studies focused on early adolescent behaviors and mother-daughter interactions.

Group-based HIV risk reduction intervention for adolescent girls: evidence of feasibility and efficacy

The purposes of this pilot study were (a) to assess the feasibility of a community-based, small group HIV risk reduction intervention with adolescent girls, and (b) to obtain preliminary evidence of the efficacy of this theoretically-guided intervention using a controlled design. The feasibility of the intervention was demonstrated by successfully implementing it with 33 sexually-active, single girls. Preliminary evidence of the efficacy of the intervention was obtained using a randomized trial with 62 sexually-active, single girls. Data obtained at a 3-month follow-up assessment showed that girls who received the HIV-related intervention improved their HIV-related knowledge and enhanced their motivation for risk reduction compared to girls who received a control (health promotion) intervention. Effect sizes suggest that the HIV intervention also reduced several risk behaviors (e.g., vaginal sex without a condom, giving oral sex, and alcohol and drug use before sex). Challenges to implementation and suggestions for intervention enhancement are discussed.

Psychosocial correlates of HIV risk behavior in adolescent girls

OBJECTIVE

To present the preintervention data collected for a pilot HIV-prevention randomized controlled trial specifically developed for single, sexually active adolescent girls.

DESIGN

Comparative, descriptive design using confidential self-administered questionnaires.

SETTING

An urban family planning clinic that provided gynecologic services to adolescents.

PARTICIPANTS

One hundred twenty-nine single, sexually active adolescent girls 15 to 19 years of age (44% minority, 34% economically disadvantaged).

MAIN OUTCOME MEASURES

In addition to demographics and risk behaviors, the following were assessed: HIV-related information (i.e., knowledge) and motivation to reduce risk (i.e., perceived vulnerability, readiness to change HIV risk behaviors, behavioral intentions, pros and cons of condom use, and confidence in condom use).

RESULTS

Assessments revealed limited HIV-related knowledge, ambivalence regarding risk reduction, and considerable risk behaviors. Compared with girls at lower risk for HIV infection (i.e., consistent condom users), those at higher risk (i.e., inconsistent or noncondom-users) were more likely to be White and older and to have better HIV-related knowledge but less motivation to reduce risk (i.e., behavioral intentions to use condoms, condom-use confidence) than girls at lower risk.

CONCLUSION

These data document (a) the need for HIV prevention interventions targeted to all sexually active adolescent girls and (b) the importance of including a motivational component in the intervention.

Mentoring students and junior faculty in faculty research: a win-win scenario

The concept of mentoring in nursing has focused primarily on moving novice nurses to a more advanced level of expertise in the clinical setting. With the growing emphasis on expanding evidence-based practice in nursing, however, mentoring within the context of research is becoming increasingly important. This article describes the many reciprocal benefits of research mentoring for students, junior faculty, and senior faculty researchers as well as for colleges of nursing and nursing science. Suggestions for implementing processes that facilitate successful mentoring within a research setting also are offered.