1
|
Sadzaglishvili S, Gotsiridze T, Lekishvili K, Flores R, Hereth J, Bouris A. "How can you kiss and touch this child and show affection towards her? What kind of woman are you?": Provider perspectives on stigma towards native and ethnic minority street-connected youth in the Republic of Georgia. PLoS One 2023; 18:e0286710. [PMID: 37267230 PMCID: PMC10237414 DOI: 10.1371/journal.pone.0286710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/20/2023] [Indexed: 06/04/2023] Open
Abstract
The Republic of Georgia has experienced a rapid growth in the number of youth working and/or living on the street (YWLS). Although research indicates that YWLS are highly stigmatized, few studies have examined perceptions of stigma among Georgian social service providers who serve YWLS. We conducted in-person in-depth interviews with key informants recruited from governmental institutions and social service organizations in Tbilisi and Rustavi, two large urban areas. A semi-structured interview guide was used to explore provider perspectives on the social contexts surrounding the delivery of services to YWLS. Trained coders conducted a thematic analysis of the data in Dedoose. Twenty-two providers (68% female; 32% male) were interviewed, representing diverse professional roles. Providers perceived that YWLS are subjected to strong public stigma and social exclusion at multiple social-ecological levels, with Roma and Kurdish-Azeri youth experiencing the strongest levels of social hostility, discrimination, and exclusion. Providers perceive that these dynamics prevent YWLS from developing trusting relationships with social service, health and educational institutions. Furthermore, we find that providers report encounters with courtesy stigma, i.e., stigma directed towards the people who serve or are associated with a stigmatized group, when working with YWLS, especially those from ethnic minority groups, which they characterize as a stressor. At the same time, we find that some providers reported negative stereotypes about ethnic minority YWLS. While campaigns have targeted public awareness on the plight of YWLS, study findings suggest that additional efforts are needed to address stigma directed towards YWLS, with a specific need to address stigma directed towards ethnic minority young people who work and/or live on the street.
Collapse
Affiliation(s)
| | | | | | - Rey Flores
- Chicago Center for HIV Elimination, University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Jane Hereth
- University of Wisconsin Helen Bader School of Social Welfare, Milwaukee, Wisconsin, United States of America
| | - Alida Bouris
- Chicago Center for HIV Elimination, University of Chicago Medicine, Chicago, Illinois, United States of America
- Crown Family School of Social Work, Policy and Practice, University of Chicago, Chicago, Illinois, United States of America
| |
Collapse
|
2
|
Kandula NR, Patel KM, Lancki N, Welch S, Bouris A, Marquez DX, Liem R, Rastogi M, Roy R, Bharucha H, Bever J, Kwon S. South Asians Active Together (SAATH): Protocol for a multilevel physical activity intervention trial for South Asian American mother and daughter dyads. Contemp Clin Trials 2022; 120:106892. [PMID: 36007709 DOI: 10.1016/j.cct.2022.106892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Abstract
South Asian (SA), including Asian Indian and Pakistani Americans, have a high burden of cardiometabolic risk factors and low levels of physical activity (PA). Increasing PA in the U.S. population is a national priority; however, SA American women and girls experience unique barriers to PA that are not addressed by current promotion efforts. To address this gap, our community-based participatory research partnership developed the South Asians Active Together (SAATH) intervention. This study is a two-arm randomized clinical trial to evaluate the effects, mediators, and implementation of the 18-week SAATH intervention. A total of 160 mother-daughter dyads will be randomized in a 1:1 ratio to the SAATH intervention and control groups. The intervention was designed for mother-daughter dyads and targets individual, interpersonal, and family levels through (1) group exercise classes, (2) mother-daughter discussions, and (3) peer group discussions. The intervention targets the environment level through community partner meetings aimed at creating environment changes to enhance PA opportunities for SA women and girls. The control group will receive PA education materials. We hypothesize that dyads who receive the intervention will have significantly greater increases in moderate- and vigorous-intensity PA (MVPA) from baseline to 4 months, compared to the control group. MVPA will be measured at 12 months in intervention participants to examine if changes are sustained. A process evaluation will use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. This study will fill knowledge gaps about the effectiveness and implementation of culturally adapted, community-based PA interventions for SA women and girls.
Collapse
Affiliation(s)
- Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States; Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Kajal M Patel
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Nicola Lancki
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Sarah Welch
- Feinberg School of Medicine, Buehler Center for Health Policy and Economics, Northwestern University, Chicago, IL, United States.
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, United States.
| | - David X Marquez
- Department of Kinesiology and Nutrition, Center for Research on Health and Aging, University of Illinois at Chicago, Chicago, IL, United States.
| | - Robert Liem
- Center for Cancer and Blood Disorders, Ann & Robert H. Lurie Children's Hospital of Chicago, Pediatrics, Chicago, IL, United States; Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, United States.
| | - Mudita Rastogi
- The Family Institute, Northwestern University, Chicago, IL, United States.
| | - Rency Roy
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Himali Bharucha
- Metropolitan Asian Family Services, Chicago, IL, United States.
| | | | - Soyang Kwon
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
| |
Collapse
|
3
|
Schneider JA, Bouris A. Ryan White programming that primarily supports clinical care falls short when core people needs are not met: further evidence from the medical monitoring project. AIDS 2022; 36:1453-1456. [PMID: 35876703 PMCID: PMC9521181 DOI: 10.1097/qad.0000000000003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- John A. Schneider
- Crown School of Social Work Practice and Policy, University of
Chicago
| | - Alida Bouris
- Crown School of Social Work Practice and Policy, University of
Chicago
| |
Collapse
|
4
|
Stump T, Ethier K, Hirschhorn L, Dakin A, Bouacha N, Freeman A, Bannon J, Gómez W, Moskowitz J, Bouris A. Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White-Funded Clinics in Chicago. J Acquir Immune Defic Syndr 2022; 90:S197-S205. [PMID: 35703772 PMCID: PMC9204837 DOI: 10.1097/qai.0000000000002980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To reduce the impact of depression on people living with HIV, we are implementing a clinic-based behavioral health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention. We used the Consolidated Framework for Implementation Research to identify contextual barriers and facilitators in advance of implementation. SETTING Sixteen Chicagoland area Ryan White Medical Case Management sites. METHODS We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing Consolidated Framework for Implementation Research domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis. RESULTS On average, survey respondents (n = 58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (mean = 3.80-3.87). Potential barriers included intervention complexity (mean = 3.47), needed human resources (mean = 2.71-3.33), and only slight agreement with relative advantage over existing screening/referral systems (mean = 3.09-3.71). Qualitative results (n = 15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation. CONCLUSIONS Ryan White Medical Case Management sites are a generally favorable context for the implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic- and individual-level outcomes, including electronic prompts (reduce complexity), training on Optimizing Resilience and Coping with HIV through Internet Delivery as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives).
Collapse
Affiliation(s)
- Tammy Stump
- Northwestern University Feinberg School of Medicine, University of Illinois – Chicago
| | - Kristen Ethier
- University of Chicago Crown Family School of Social Work, Policy and Practice, University of Illinois – Chicago
| | - Lisa Hirschhorn
- Northwestern University Feinberg School of Medicine, University of Illinois – Chicago
| | - Andrea Dakin
- AIDS Foundation Chicago, University of Illinois – Chicago
| | - Nora Bouacha
- AIDS Foundation Chicago, University of Illinois – Chicago
| | - Angela Freeman
- Northwestern University Feinberg School of Medicine, University of Illinois – Chicago
| | - Jacqueline Bannon
- Northwestern University Feinberg School of Medicine, University of Illinois – Chicago
| | - Walter Gómez
- Jane Addams College of Social Work, University of Illinois – Chicago
| | - Judith Moskowitz
- Northwestern University Feinberg School of Medicine, University of Illinois – Chicago
| | - Alida Bouris
- University of Chicago Crown Family School of Social Work, Policy and Practice, University of Illinois – Chicago
- Chicago Center for HIV Elimination
| |
Collapse
|
5
|
Pyra M, Motley D, Bouris A. Moving toward equity: fostering transdisciplinary research between the social and behavioral sciences and implementation science to end the HIV epidemic. Curr Opin HIV AIDS 2022; 17:89-99. [PMID: 35225249 DOI: 10.1097/coh.0000000000000726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Since the beginning of the HIV epidemic, social and behavioral scientists have developed interventions to stem the spread of the virus. The dissemination of these interventions has traditionally been a lengthy process; however, implementation science (IS) offers a route toward hastening delivery of effective interventions. A transdisciplinary approach, wherein IS informs and is informed by social and behavioral sciences (SBS) as well as community participation, offers a strategy for more efficiently moving toward health equity and ending the HIV epidemic. RECENT FINDINGS There has been considerable growth in HIV research utilizing IS theories, methods and frameworks. Many of these studies have been multi or interdisciplinary in nature, demonstrating the ways that IS and SBS can strengthen one another. We also find areas for continued progress toward transdisciplinarity. SUMMARY We review literature from 2020 to 2021, exploring the ways IS and SBS have been used in tandem to develop, evaluate and disseminate HIV interventions. We highlight the interplay between disciplines and make a case for moving toward transdisciplinarity, which would yield new, integrated frameworks that can improve prevention and treatment efforts, moving us closer to achieving health equity.
Collapse
Affiliation(s)
- Maria Pyra
- Chicago Center for HIV Elimination, Biological Sciences Division, University of Chicago
- Howard Brown Health Center
| | - Darnell Motley
- Chicago Center for HIV Elimination, Biological Sciences Division, University of Chicago
| | - Alida Bouris
- Chicago Center for HIV Elimination, Biological Sciences Division, University of Chicago
- Crown Family School of Social Work, Policy and Practice, University of Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Brodyn A, Lee SY, Futrell E, Bennett I, Bouris A, Jagoda P, Gilliam M. Body Mapping and Story Circles in Sexual Health Research With Youth of Color: Methodological Insights and Study Findings From Adolescent X, an Art-Based Research Project. Health Promot Pract 2021; 23:594-608. [PMID: 34553642 DOI: 10.1177/15248399211039796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the implementation and select findings from Adolescent X, an arts-based research project that used story circles and body mapping to elucidate how young people understand the relationship between their social contexts and their sexual and reproductive health, with a particular focus on youth's understandings of gender, sexuality, and the body as sites of possibility and power. A community-based sample of N = 24 youth of color was recruited from the South and West Sides of Chicago to participate in 3-day workshops. In addition to story circles and body mapping, data were collected via brief surveys with N = 24 youth, debriefing groups (n = 10 youth), and focus groups (n = 14 youth). Study data consisted of (1) body map visuals, that is, legends, mini-, and full-body maps; (2) written body map narratives; and (3) audio recordings of the story circles, body mapping activities, debriefing groups, and focus groups. All audio recordings were transcribed, deidentified, and uploaded in Dedoose for qualitative thematic analysis. Data analysis was conducted by a team of independent coders. Across all sources of data, three major themes were identified: (1) strong feelings of unsafety related to how young people's bodies are gendered, sexualized, and racialized in different social settings; (2) the extent to which adults and institutions foster youth safety; and (3) sources of young people's coping and resilience. Implications for public health research, practice, and policy are discussed.
Collapse
|
7
|
Teixeira da Silva D, Bouris A, Ramachandran A, Blocker O, Davis B, Harris J, Pyra M, Rusie LK, Brewer R, Pagkas-Bather J, Hotton A, Ridgway JP, McNulty M, Bhatia R, Schneider JA. Embedding a Linkage to Preexposure Prophylaxis Care Intervention in Social Network Strategy and Partner Notification Services: Results From a Pilot Randomized Controlled Trial. J Acquir Immune Defic Syndr 2021; 86:191-199. [PMID: 33109935 PMCID: PMC8103968 DOI: 10.1097/qai.0000000000002548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased preexposure prophylaxis (PrEP) uptake among black men who have sex with men and black transgender women (BMSM/TW) is needed to end the HIV epidemic. Embedding a brief intervention in network services that engage individuals in HIV transmission networks for HIV/ sexually transmitted infections testing may be an important strategy to accelerate PrEP uptake. SETTING Partner Services PrEP study is a pilot, randomized, control trial to improve linkage to PrEP care among BMSM/TW presenting for network services in Chicago, IL, from 2015 to 2017. METHODS BMSM/TW (N = 146) aged 18-40 years were recruited from network services (partners services and social network strategy services). Intervention participants developed an individualized linkage plan based on the information-motivation-behavioral skills model and received minibooster sessions. Control participants received treatment as usual. Sociodemographic, behavioral, and clinical factors were examined at baseline and 3- and 12-month postintervention. Intent-to-treat analyses examined linkage to PrEP care within 3-month postintervention (primary outcome). Secondary outcomes were PrEP initiation, time to linkage to PrEP care, and time to PrEP initiation. RESULTS Compared with control participants, a significantly greater proportion of the intervention participants were linked to PrEP care within 3 months (24% vs. 11%; P = 0.04) and initiated PrEP (24% vs. 11%; P = 0.05). Among those linked to PrEP care within the study period, intervention participants were linked significantly sooner than control participants [median (interquartile range) days, 26.5 (6.0-141.8) vs. 191.5 (21.5-297.0); P = 0.05]. CONCLUSION Study results support the preliminary efficacy of Partner Services PrEP to improve linkage to PrEP care and PrEP initiation among BMSM/TW.
Collapse
Affiliation(s)
- Daniel Teixeira da Silva
- Department of Combined Internal Medicine and Pediatrics, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | | | | | - Billy Davis
- Chicago Center for HIV Elimination, Chicago, IL
| | | | - Maria Pyra
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
| | | | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | - Jade Pagkas-Bather
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
| | - Anna Hotton
- Chicago Center for HIV Elimination, Chicago, IL
| | - Jessica P Ridgway
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | - Moira McNulty
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| |
Collapse
|
8
|
Keene LC, Heath RD, Bouris A. Disclosure of Sexual Identities Across Social-Relational Contexts: Findings from a National Sample of Black Sexual Minority Men. J Racial Ethn Health Disparities 2021; 9:201-214. [PMID: 33415706 DOI: 10.1007/s40615-020-00944-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
Black sexual minority men (BSMM) in the USA navigate a range of factors that may influence the extent to which they disclose or conceal their sexual identity in various social contexts. To date, few studies have investigated the correlates of sexual identity disclosure or concealment among BSMM across multiple life domains. Guided by a minority stress perspective and intersectionality, we analyzed data from N = 809 BSMM who participated in the Social Justice Sexuality Survey. We conducted ordinary least squares regression to examine the relative weight of perceptions of homophobia, religiosity, LGBT community connectedness, racial identity salience, and sexual identity salience on disclosure of sexual identity in six social-relational contexts: (1) family, (2) friends, (3) neighbors, (4) religious community, (5) work, and (6) online. Findings indicate that BSMM disclosed their sexual identity unevenly across social-relational contexts. Notably, LGBTQ community connectedness and sexual identity importance were consistent predictors of sexual identity disclosure across contexts. In contrast, perceptions of homophobia were not related to sexual identity disclosure, suggesting that other factors may be more salient for BSMM when deciding to disclose their sexual identity. Finally, bisexual men consistently reported lower levels of sexual identity disclosure relative to gay men in all six contexts. Study findings have important implications for future research on sexual identity disclosure with diverse samples of BSMM.
Collapse
Affiliation(s)
- Lance C Keene
- New York University Center for Latino Adolescent and Family Health, 15 Washington Pl, New York, NY, 10003, USA.
| | - Ryan D Heath
- Syracuse University School of Social Work, Syracuse, NY, USA
| | - Alida Bouris
- University of Chicago School of Social Service Administration, Chicago, IL, USA
| |
Collapse
|
9
|
Schneider JA, Young L, Ramachandran A, Michaels S, Cohen H, Robinson I, Alon L, Hill B, Nakasone S, Balenciaga M, Motley D, Bouris A, Khanna A, Ferreira M, Valente T, Schumm P. A Pragmatic Randomized Controlled Trial to Increase PrEP Uptake for HIV Prevention: 55-Week Results From PrEPChicago. J Acquir Immune Defic Syndr 2021; 86:31-37. [PMID: 33306562 PMCID: PMC7722461 DOI: 10.1097/qai.0000000000002518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We tested preliminary efficacy of a peer change agent type I network intervention to increase pre-exposure prophylaxis (PrEP) linkage to care among network members connected to young Black men who have sex with men. DESIGN Parent study is a pragmatic randomized controlled trial with 110 weeks of total follow-up. Interim midpoint analyses are performed here using participant data before crossover assignment at 55 weeks. METHODS We randomly assigned 423 participants in Chicago to receive the network intervention, an opinion leader workshop with telephonic booster sessions, versus a time-matched control from 2016 to 2018. The consolidated surrogate outcome was PrEP referral and linkage to clinical care among network members connected to study participants and was collected from independent administrative data. RESULTS Each study participant in the trial (n = 423) had on average 1822 network contacts who could be eligible for PrEP referral and linkage. During the 55-week observation period, PrEP referral was most likely to occur within 3 days of an intervention session compared to control [odds ratio (OR) 0.07 (0.02-0.013); P = 0.007] resulting in 1-2 referrals of network members per session. Network members with referral or linkage were more likely to be connected to study participants in the intervention arm than the control condition [aOR 1.50 (1.09-2.06); P = 0.012]. CONCLUSIONS A peer change agent type I network intervention is preliminarily effective at diffusing PrEP through a network of individuals highly susceptible to HIV over 55 weeks. This low-intensity intervention demonstrated network-level impact among populations that have experienced limited PrEP care engagement in the United States.
Collapse
Affiliation(s)
| | | | | | | | - Hildie Cohen
- NORC at the University of Chicago, Chicago, IL; and
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Teixeira da Silva D, Bouris A, Voisin D, Hotton A, Brewer R, Schneider J. Social Networks Moderate the Syndemic Effect of Psychosocial and Structural Factors on HIV Risk Among Young Black Transgender Women and Men who have Sex with Men. AIDS Behav 2020; 24:192-205. [PMID: 31289985 DOI: 10.1007/s10461-019-02575-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The interaction between the cumulative effect of psychosocial and structural factors (i.e. syndemic effect) and social networks among young Black transgender women and men who have sex with men (YBTM) remains understudied. A representative cohort of 16-29 year-old YBTM (n = 618) was assessed for syndemic factors [i.e. substance use; community violence; depression; poverty; justice system involvement (JSI)], social network characteristics, condomless anal sex (CAS), group sex (GS), and HIV-infection. The syndemic index significantly increased the odds of CAS, GS, and HIV-infection, and these effects were moderated by network characteristics. Network JSI buffered the effect on CAS, romantic network members buffered the effect on GS, and network age and proportion of family network members buffered the effect on HIV-infection. The proportion of friend network members augmented the effect on GS and HIV-infection. Future research to prevent HIV among YBTM should consider social network approaches that target both structural and psychosocial syndemic factors.
Collapse
Affiliation(s)
- Daniel Teixeira da Silva
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA.
- Department of Combined Internal Medicine and Pediatrics, University of Chicago, 5841 S Maryland Avenue MC 7082, Chicago, IL, 60637, USA.
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Dexter Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Anna Hotton
- Chicago Center for HIV Elimination, Chicago, IL, USA
| | | | - John Schneider
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| |
Collapse
|
11
|
Newcomb ME, LaSala MC, Bouris A, Mustanski B, Prado G, Schrager SM, Huebner DM. The Influence of Families on LGBTQ Youth Health: A Call to Action for Innovation in Research and Intervention Development. LGBT Health 2019; 6:139-145. [PMID: 30844341 DOI: 10.1089/lgbt.2018.0157] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lesbian, gay, bisexual, transgender, queer, questioning, and other sexual and gender minority youth (LGBTQ) experience myriad health inequities relative to their cisgender heterosexual peers. Families have a profound impact on adolescent health, but little is known about this influence on LGBTQ youth specifically. We draw on work presented at a public symposium that aimed to characterize existing scientific evidence, identify gaps in knowledge, and set priority areas for future research on the influence of family factors on LGBTQ youth health. We review the evidence in each identified priority area and propose promising avenues for future research and opportunities for innovation.
Collapse
Affiliation(s)
- Michael E Newcomb
- 1 Department of Medical Social Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Michael C LaSala
- 2 School of Social Work, Rutgers, the State University of New Jersey, New Brunswick, New Jersey
| | - Alida Bouris
- 3 School of Social Service Administration, University of Chicago, Chicago, Illinois
| | - Brian Mustanski
- 1 Department of Medical Social Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Guillermo Prado
- 4 Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Sheree M Schrager
- 5 Office of Research and Sponsored Programs, California State University, Northridge, Northridge, California
| | - David M Huebner
- 6 Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| |
Collapse
|
12
|
Hill BJ, Crosby R, Bouris A, Brown R, Bak T, Rosentel K, VandeVusse A, Silverman M, Salazar L. Exploring transgender legal name change as a potential structural intervention for mitigating social determinants of health among transgender women of color. Sex Res Social Policy 2018; 15:25-33. [PMID: 29520314 PMCID: PMC5837073 DOI: 10.1007/s13178-017-0289-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The purpose of this exploratory study was to examine the effects of legal name change on socioeconomic factors, general and transgender-related healthcare access and utilization, and transgender-related victimization in a sample of young transgender women (transwomen) of color. A cross-sectional group comparison approach was used to assess the potential effects of legal name change. A convenience sample of young transwomen enrolled in a no-cost legal name change clinic were recruited to complete a 30-minute interviewer-guided telephone survey including sociodemographic and socioeconomic factors, health and well-being, health care utilization, transgender transition-related health care, and transgender-related victimization. Sixty-five transgender women of color (37 = pre-name change group; 28 = post-name change group) completed the survey. Results indicated that the transwomen in the post-name change group were significantly older than the pre-name change group. In age-adjusted analyses, the post-name change group was significantly more likely to have a higher monthly income and stable housing than the pre-name change group. No significant differences were observed for general healthcare utilization; however, a significantly greater percentage of transwomen in the pre-name change group reported postponing medical care due to their gender identity. In addition, a significantly larger proportion of transwomen in the pre-name change group reported using non-prescribed hormones injected by friends and experiencing verbal harassment by family and friends compared to transwomen in the post-name change group. Findings suggest that legal name change may be an important structural intervention for low-income transwomen of color, providing increased socioeconomic stability and improved access to primary and transition-related health care.
Collapse
Affiliation(s)
- Brandon J Hill
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, 6030 S. Ellis Ave, Edelstone 266, Chicago, IL 60637, USA
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, 5841 S Maryland Ave., Chicago, IL 60637, USA
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, 1165 E. Third St., Morrison Hall 313, Bloomington, IN 47405, USA
| | - Richard Crosby
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, 1165 E. Third St., Morrison Hall 313, Bloomington, IN 47405, USA
- College of Public Health, University of Kentucky, 111 Washington Ave., Lexington, KY 40536, USA
| | - Alida Bouris
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, 6030 S. Ellis Ave, Edelstone 266, Chicago, IL 60637, USA
- School of Social Service Administration, University of Chicago, 969 E. 60 St., Chicago, IL 60637, USA
- Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave., Chicago, IL 60637, USA
| | - Rayna Brown
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, 6030 S. Ellis Ave, Edelstone 266, Chicago, IL 60637, USA
| | - Trevor Bak
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, 6030 S. Ellis Ave, Edelstone 266, Chicago, IL 60637, USA
| | - Kris Rosentel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, 6030 S. Ellis Ave, Edelstone 266, Chicago, IL 60637, USA
- School of Social Service Administration, University of Chicago, 969 E. 60 St., Chicago, IL 60637, USA
| | - Alicia VandeVusse
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, University of Chicago, 6030 S. Ellis Ave, Edelstone 266, Chicago, IL 60637, USA
| | - Michael Silverman
- Transgender Legal Defense & Education Fund, Inc., 20 West 20 St., Suite 705, New York, NY 10011, USA
| | - Laura Salazar
- School of Public Health, Georgia State University, 33 Gilmer St. SE, Atlanta, GA 30303, USA
| |
Collapse
|
13
|
Bouris A, Jaffe K, Eavou R, Liao C, Kuhns L, Voisin D, Schneider JA. Project nGage: Results of a Randomized Controlled Trial of a Dyadic Network Support Intervention to Retain Young Black Men Who Have Sex With Men in HIV Care. AIDS Behav 2017; 21:3618-3629. [PMID: 29079949 PMCID: PMC5705428 DOI: 10.1007/s10461-017-1954-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HIV-positive young black MSM (YBMSM) experience poor outcomes along the HIV care continuum, yet few interventions have been developed expressly for YBMSM retention in care. Project nGage was a randomized controlled trial conducted across five Chicago clinics with 98 HIV-positive YBMSM aged 16-29 between 2012 and 2015. The intervention used a social network elicitation approach with index YBMSM (n = 45) to identify and recruit a support confidant (SC) to the study. Each index-SC dyad met with a social worker to improve HIV-care knowledge, activate dyadic social support, and develop a retention in care plan. Each index and SC also received four mini-booster sessions. Control participants (n = 53) received treatment as usual. Surveys and medical records at baseline, 3-, and 12-months post-intervention assessed visit history (3 or more visits over 12 months; primary outcome), and sociodemographic, network, social-psychological, and behavioral factors. At baseline, there were no differences in age (M = 23.8 years), time since diagnosis (M ≤ 2 years), clinic visits in the previous 12 months (M = 4.1), and medication adherence (68.6 ≥ 90% adherence). In multivariate logistic regression analysis, intervention participants were 3.01 times more likely to have had at least 3 provider visits (95% CI 1.0-7.3) than were control participants over 12 months. Project nGage demonstrates preliminary efficacy in improving retention in care among YBMSM. Results suggest that engaging supportive network members may improve key HIV care continuum outcomes.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA.
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
- Third Coast Center for AIDS Research, University of Chicago and Northwestern University, 969 E. 60th St, Chicago, IL, 60637, USA.
| | - Kaitlyn Jaffe
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Eavou
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Lisa Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dexter Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Third Coast Center for AIDS Research, University of Chicago and Northwestern University, 969 E. 60th St, Chicago, IL, 60637, USA
| | - John A Schneider
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Third Coast Center for AIDS Research, University of Chicago and Northwestern University, 969 E. 60th St, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| |
Collapse
|
14
|
Bouris A, Hill BJ. Out on Campus: Meeting the Mental Health Needs of Sexual and Gender Minority College Students. J Adolesc Health 2017; 61:271-272. [PMID: 28842064 DOI: 10.1016/j.jadohealth.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, Chicago Center for HIV Elimination, Third Coast Center for AIDS Research, University of Chicago, Chicago, Illinois
| | - Brandon J Hill
- Departments of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, Chicago, Illinois
| |
Collapse
|
15
|
Abstract
Research often analyzes gender minority youth and sexual minority youth as a single group, a practice that obscures differences in how gender identity and sexual orientation shape health. The present study uses intersectionality to explore similarities and differences in the relationships between minority stress theory variables in a sample of 28 gender minority and 135 sexual minority youth of color. We also explore the mother-adolescent relationship as a potential promotive resource for minority stress research with youth. Results find few differences in minority stressors, promotive resources, or health between sexual and gender minority youth. However, different patterns in the correlations between stressors, resources, and health were observed for each group, underscoring the need for researchers to consider sexual and gender minority youth as distinct groups. Furthermore, study findings suggest that the maternal relationship may be an important promotive resource for both sexual and gender minority youth.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, Chicago Center for HIV Elimination, and Third Coast Center for AIDS Research, University of Chicago, Chicago, IL
| | - Brandon J. Hill
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, Chicago, IL
| |
Collapse
|
16
|
Young LE, Schumm P, Alon L, Bouris A, Ferreira M, Hill B, Khanna AS, Valente TW, Schneider JA. PrEP Chicago: A randomized controlled peer change agent intervention to promote the adoption of pre-exposure prophylaxis for HIV prevention among young Black men who have sex with men. Clin Trials 2017; 15:44-52. [PMID: 28862483 DOI: 10.1177/1740774517730012] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS Advances in biomedical prevention strategies such as pre-exposure prophylaxis (PrEP) represent a new opportunity for reducing HIV incidence among young Black men who have sex with men, for whom the number of new HIV infections continues to rise. However, studies have documented low rates of PrEP uptake in this community. Research suggests that the peer networks of young Black men who have sex with men play important roles in their sexual health decisions. PrEP Chicago is a randomized controlled trial network intervention designed to increase PrEP uptake among young Black men who have sex with men living in Chicago. The aims of this study are twofold. Aim 1 is to estimate the effectiveness of a peer change agent intervention for (1) increasing the number of referrals made to a PrEP information line, (2) increasing the rate of PrEP adoption among non-participant peers, and (3) increasing PrEP knowledge, attitudes, and intentions among participants. Aim 2 is to determine the individual and network variables that explain peer change agent effectiveness. METHODS PrEP Chicago is a social network intervention that utilizes the influence of peer change agents to link young Black men who have sex with men in Chicago to PrEP. Young Black men who have sex with men were recruited using respondent-driven sampling. Once screened for eligibility, participants were randomly assigned to either one of two treatment sequences: (1) intervention treatment in Year 1 followed by a minimal contact attention control in Year 2 or (2) the minimal contact attention control in Year 1 followed by treatment in Year 2. The treatment consists of a PrEP/peer change agent training workshop followed by booster calls for 12 months. The attention control consists of a sex diary activity designed to help participants assess sexual risk. Psychosocial, sexual health, and network data are collected from all participants at baseline and at 12- and 24-month follow-ups. RESULTS In total, 423 participants aged 18-35 have been enrolled (more than 100% target enrollment) and have completed baseline data collection. A majority of participants in both intervention and control groups reported having heard of PrEP before enrolling in the study, yet also reported having had no current or prior experience taking PrEP. Statistical analyses await completion of Year 1 of the trial in March 2018. CONCLUSION PrEP Chicago addresses a gap in HIV prevention research and intervention design by utilizing the existing social networks among young Black men who have sex with men as mechanisms for information diffusion, behavioral influence, social support, and empowerment. Therefore, interventions that leverage peer influence processes to facilitate PrEP uptake are promising strategies to improve sexual health engagement and overcome disparities in outcomes among this at-risk population.
Collapse
Affiliation(s)
- Lindsay E Young
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Phil Schumm
- 3 Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Leigh Alon
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Alida Bouris
- 2 Chicago Center for HIV Elimination, Chicago, IL, USA.,4 School of Social Service Administration, The University of Chicago, Chicago, IL, USA
| | - Matthew Ferreira
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Brandon Hill
- 1 The University of Chicago Medicine, Chicago, IL, USA.,5 Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, The University of Chicago, Chicago, IL, USA
| | - Aditya S Khanna
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Thomas W Valente
- 6 Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - John A Schneider
- 1 The University of Chicago Medicine, Chicago, IL, USA.,2 Chicago Center for HIV Elimination, Chicago, IL, USA.,3 Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
17
|
Quinn K, Voisin DR, Bouris A, Jaffe K, Kuhns L, Eavou R, Schneider J. Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men. AIDS Behav 2017; 21:207-216. [PMID: 27233249 PMCID: PMC5124546 DOI: 10.1007/s10461-016-1439-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed (OR 0.96, 95 % CI 0.91-1.00 and OR 0.50, 95 % CI 0.25-1.02, respectively). Concerns about public attitudes toward HIV were positively related to medication adherence (OR 2.18, 95 % CI 1.20-3.94) and psychological distress (OR 5.02, 95 % CI 1.54-16.34). The various domains of HIV stigma differentially affected health and psychosocial outcomes, and our findings suggest that some forms of HIV stigma may significantly affect viral load and medication adherence among this population. Stigma-informed approaches to care and treatment are needed, along with incorporated psychological and social supports.
Collapse
Affiliation(s)
- Katherine Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Kate Jaffe
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lisa Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Eavou
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John Schneider
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| |
Collapse
|
18
|
Quinn K, Voisin DR, Bouris A, Schneider J. Psychological distress, drug use, sexual risks and medication adherence among young HIV-positive Black men who have sex with men: exposure to community violence matters. AIDS Care 2016; 28:866-72. [PMID: 26917328 PMCID: PMC4955550 DOI: 10.1080/09540121.2016.1153596] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the USA, Black males are disproportionately affected by community violence and HIV. The aim of this study was to assess whether exposures to community violence are related to psychological distress, drug use, sexual risk behaviors, and medication adherence among a sample of HIV-positive young Black men who had sex with men (YBMSM). Data are from 98 YBMSM ages 18-29 years recruited from Chicago who completed measures on demographics, exposures to community violence, psychological distress, drug use, condomless anal intercourse, and medication adherence. Rates of exposure to community violence were high and youth reported victimization and witnessing numerous types of violence in their lifetime. In adjusted logistic regression analyses, models indicate that YBMSM reporting higher levels of exposure to community violence had significantly higher rates of condomless anal intercourse in the previous 6 months (AOR: 5.33, 95%CI: 1.38-20.55). Additionally, exposure to community violence was positively associated with psychological distress, hard drug use, and use of marijuana as a sex drug. Adherence to HIV antiretroviral medication was negatively associated with community violence (AOR: 0.36, 95%CI: 0.13-0.97). Rates of exposure to community violence are especially high in urban communities. Overall findings suggest that treatment, intervention, and programmatic approaches that include initiatives to address exposure to community violence might correlate with better health-related outcomes for HIV-positive YBMSM.
Collapse
Affiliation(s)
- Katherine Quinn
- a Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Dexter R Voisin
- b School of Social Service Administration , University of Chicago , Chicago , IL , USA
- c STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA
| | - Alida Bouris
- b School of Social Service Administration , University of Chicago , Chicago , IL , USA
- c STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA
| | - John Schneider
- c STI/HIV Intervention Network , University of Chicago , Chicago , IL , USA
- d Department of Medicine , University of Chicago , Chicago , IL , USA
- e Department of Public Health Sciences , University of Chicago , Chicago , IL , USA
| |
Collapse
|
19
|
Kuhns LM, Hotton AL, Garofalo R, Muldoon AL, Jaffe K, Bouris A, Voisin D, Schneider J. An Index of Multiple Psychosocial, Syndemic Conditions Is Associated with Antiretroviral Medication Adherence Among HIV-Positive Youth. AIDS Patient Care STDS 2016; 30:185-92. [PMID: 27028184 DOI: 10.1089/apc.2015.0328] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medication adherence among HIV-infected individuals is critical to limit disease progression and onward transmission. Evidence indicates that among youth living with HIV (YLH), adherence is suboptimal and related to co-morbid psychosocial conditions. Cross-sectional data from 212 YLH, ages 16-29, collected between 2011-2014 in Chicago were analyzed to assess the relationship of multiple psychosocial conditions (e.g., depressive symptoms, anxiety symptoms, moderate/heavy marijuana use, moderate/heavy alcohol use, HIV-related stigma) to ART adherence (i.e., a "syndemic.") Adherence was regressed on an index of increasing numbers of psychosocial conditions, controlling for demographic and treatment factors as well as enrollment site. The mean age of participants was 24, 89% were male, 87% black, and 91% behaviorally infected. Psychosocial conditions were prevalent, including 38% and 34% with high depressive and anxiety symptoms, respectively, 54% and 25% with a moderate/high level of marijuana and alcohol use, respectively, and 46% reporting high HIV-related stigma. In regression analysis, the likelihood of ART adherence decreased with the number of syndemic conditions (linear dose response, p = 0.02) as did the odds of viral load suppression (p = 0.008). Interventions to address these conditions in concert with biomedical treatment as prevention for YLH are needed.
Collapse
Affiliation(s)
- Lisa M. Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Anna L. Hotton
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois
| | - Rob Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Abigail L. Muldoon
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kaitlyn Jaffe
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Alida Bouris
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
- School of Social Service Administration, University of Chicago, Chicago, Illinois
- STI/HIV Intervention Network, University of Chicago, Chicago, Illinois
| | - Dexter Voisin
- School of Social Service Administration, University of Chicago, Chicago, Illinois
- STI/HIV Intervention Network, University of Chicago, Chicago, Illinois
| | - John Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
- Department of Medicine, University of Chicago, Chicago, Illinois
- STI/HIV Intervention Network, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| |
Collapse
|
20
|
Bouris A, Everett BG, Heath RD, Elsaesser CE, Neilands TB. Effects of Victimization and Violence on Suicidal Ideation and Behaviors Among Sexual Minority and Heterosexual Adolescents. LGBT Health 2016; 3:153-61. [PMID: 26789401 PMCID: PMC4841901 DOI: 10.1089/lgbt.2015.0037] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Sexual minority youth (SMY) are at higher risk for victimization and suicide than are heterosexual youth (HY). Relatively little research has examined which types of victimization are most closely linked to suicide, which is necessary to develop targeted prevention interventions. The present study was conducted to address this deficit. METHODS The data come from the 2011 Chicago Youth Risk Behavior Survey (n = 1,907). Structural equation modeling (SEM) in Mplus evaluated the direct, indirect, and total effects of sexual orientation on a latent indicator of suicidal ideation and behaviors via seven types of victimization. Four indicators of victimization were school-specific (e.g., harassment due to sexual orientation or gender identity (SO/GID), bullying, threatened or injured with a weapon, and skipping school due to safety concerns), and three indicators assessed other types of victimization (e.g., electronic bullying, intimate partner violence, and sexual abuse). RESULTS Thirteen percent of youth were classified as SMY. Significantly more SMY than HY reported suicidal ideation (27.95% vs. 13.64%), a suicide plan (22.78% vs. 12.36%), and at least one suicide attempt (29.92% vs. 12.43%) in the past year (all P < .001). A greater percentage of SMY reported SO/GID-related harassment, skipping school, electronic bullying, and sexual abuse. Sexual orientation was not directly related to suicidal ideation and behaviors in SEM. Rather, SMY's elevated risk of suicidality functioned indirectly through two forms of school-based victimization: being threatened or injured with a weapon (B = .19, SE = .09, P ≤ .05) and experiencing SO/GID-specific harassment (B = .40, SE = .15, P ≤ .01). There also was a trend for SMY to skip school as a strategy to reduce suicide risk. CONCLUSION Although SMY experience higher rates of victimization than do HY, school-based victimization that involves weapons or is due to one's SO/GID appear to be the most deleterious. That SMY may skip school to reduce their risk of suicidal ideation and behaviors is problematic, and schools should be encouraged to enact and enforce policies that explicitly protect SMY from victimization.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, Illinois
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
| | - Bethany G. Everett
- Department of Sociology, College of Social and Behavioral Science, The University of Utah, Salt Lake City, Utah
| | - Ryan D. Heath
- School of Social Service Administration, University of Chicago, Chicago, Illinois
| | | | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California
| |
Collapse
|
21
|
Hill BJ, Bouris A, Barnett JT, Walker D. Fit to Serve? Exploring Mental and Physical Health and Well-Being Among Transgender Active-Duty Service Members and Veterans in the U.S. Military. Transgend Health 2016; 1:4-11. [PMID: 29159293 PMCID: PMC5685248 DOI: 10.1089/trgh.2015.0002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Although transgender people are currently excluded from enlistment and discharged from service based on medical and psychological fitness policies, the current mental and physical health of transgender active-duty U.S. military personnel and veterans is poorly understood. The purpose of the current study was to investigate the military histories, lifetime mental and physical health diagnoses, and transgender transition-related health of transgender active-duty service members (ADSM) and veterans. Methods: Participants were recruited through private LGBT military and veteran organizational listservs, snowball sampling, and in-person recruitment to complete an anonymous and confidential self-administered online questionnaire. Results: A total of 106 transgender ADSM (n=55) and veterans (n=51) completed the questionnaire. Transgender veterans were significantly older (44 mean years vs. 29.5 mean years, t=-6.23, p<0.001). A greater percentage of veterans than ADSM reported depression (64.6% vs. 30.9%, χ2=11.68, p=0.001) and anxiety (41.3% vs. 18.2%, χ2=6.54, p=0.011). In addition, 15.9% of veterans versus 1.8% of ADSM (χ2=6.53, p=0.011) had been diagnosed with a substance abuse disorder. There were no significant differences in lifetime physical health conditions; however, veterans reported a higher body-mass index than ADSM (28.4 vs. 24.9, t=-3.85, p<0.001). For both groups, mental and physical health problems were positively correlated with age and years of military service (r=0.37-0.84, p<0.01). There were no significant differences between groups in transgender transition-related health. Conclusion: Our data represent the first descriptive statistics of lifetime mental and physical health issues among transgender ADSM and veterans. Data indicate that transgender ADSM report fewer lifetime mental and physical health problems than transgender veterans. Taken together, our findings suggest that more research, specifically among transgender ADSM, is needed to challenge the exclusion of transgender persons from U.S. military service based on the presumption of poor mental or physical health.
Collapse
Affiliation(s)
- Brandon J. Hill
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
| | - Alida Bouris
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
- School of Social Service Administration (SSA), The University of Chicago, Chicago, Illinois
| | | | - Dayna Walker
- Transgender American Veterans Association (TAVA), Tampa, Florida
| |
Collapse
|
22
|
Bouris A, Hill BJ, Fisher K, Erickson G, Schneider JA. Mother-Son Communication About Sex and Routine Human Immunodeficiency Virus Testing Among Younger Men of Color Who Have Sex With Men. J Adolesc Health 2015; 57:515-22. [PMID: 26321527 PMCID: PMC4624009 DOI: 10.1016/j.jadohealth.2015.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/17/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purposes of this study were to document the HIV testing behaviors and serostatus of younger men of color who have sex with men (YMSM) and to explore sociodemographic, behavioral, and maternal correlates of HIV testing in the past 6 months. METHODS A total of 135 YMSM aged 16-19 years completed a close-ended survey on HIV testing and risk behaviors, mother-son communication, and sociodemographic characteristics. Youth were offered point-of-care HIV testing, with results provided at survey end. Multivariate logistic regression analyzed the sociodemographic, behavioral, and maternal factors associated with routine HIV testing. RESULTS A total of 90.3% of YMSM had previously tested for HIV, and 70.9% had tested in the past 6 months. In total, 11.7% of youth reported being HIV positive, and 3.3% reported unknown serostatus. When offered an HIV test, 97.8% accepted. Of these, 14.7% had a positive oral test result, and 31.58% of HIV-positive YMSM (n = 6) were seropositive unaware. Logistic regression results indicated that maternal communication about sex with males was positively associated with routine testing (odds ratio = 2.36; 95% confidence interval = 1.13-4.94). Conversely, communication about puberty and general human sexuality was negatively associated (odds ratio = .45; 95% confidence interval = .24-.86). Condomless anal intercourse and positive sexually transmitted infection history were negatively associated with routine testing; however, frequency of alcohol use was positively associated. CONCLUSIONS Despite high rates of testing, we found high rates of HIV infection, with 31.58% of HIV-positive YMSM being seropositive unaware. Mother-son communication about sex needs to address same-sex behavior as this appears to be more important than other topics. YMSM with known risk factors for HIV are not testing at the recommended time intervals.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, Illinois; The Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois.
| | - Brandon J. Hill
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, 1225 E. 60th Street, Chicago, IL, 60637, United States of America.
| | - Kimberly Fisher
- The Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave., Chicago, IL, 60637, United States of America.
| | - Greg Erickson
- School of Social Service Administration, University of Chicago, 969 E. 60th St., Chicago, IL 60637, United States of America.
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, and Director, The Chicago Center for HIV Elimination, University of Chicago, 5837 S. Maryland Ave., Chicago, IL, 60637, United States of America.
| |
Collapse
|
23
|
Bouris A, Voisin D, Pilloton M, Flatt N, Eavou R, Hampton K, Kuhns LM, Eder M, Schneider JA. Project nGage: Network Supported HIV Care Engagement for Younger Black Men Who Have Sex with Men and Transgender Persons. ACTA ACUST UNITED AC 2013; 4. [PMID: 24404408 PMCID: PMC3881415 DOI: 10.4172/2155-6113.1000236] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Young Black men who have sex with men and transgender persons (YBMSMT) aged 13–29 carry the nation’s highest burden of new HIV infections. Studies indicate that YBMSMT have poor retention in care, which is associated with reduced medication adherence and increased virologic failure. Objective Project nGage is a randomized controlled (RCT) trial evaluating the feasibility and preliminary efficacy of a brief, dyadic intervention designed to promote adherence to HIV primary care in safety-net clinics. Network visualization is used to identify and engage a support confidant (SC) from participants’ social networks. A social work interventionist then meets with the SC and SC-participant dyad to activate and maintain HIV-specific social support. Methods Project nGage is operating in two phases. In Phase I, the Team refined study protocols based on pilot testing. In Phase II, 94 HIV infected YBMSMT ages 16–29 will be recruited, enrolled and randomly assigned to receive Project nGage or treatment as usual (TAU). The primary outcome is appointment attendance; the secondary outcomes are medication adherence and viral load. Results Implementation challenges include coordinating sites, managing dyadic intervention logistics, and recruiting non-adherent patients or those who have fallen out of care. The team continues to address implementation issues as the study progresses. Conclusions Project nGage is addressing a gap in HIV care-related research by focusing on supportive relationships as a mechanism through which to promote retention in care. Pending study results, a larger RCT would compare the relative effectiveness of the Project nGage intervention versus TAU over 18 to 24 months.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA ; STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Dexter Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA ; STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | - Molly Pilloton
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Natasha Flatt
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Rebecca Eavou
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Lisa M Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Milton Eder
- Access Community Health Network, Chicago, IL, USA
| | - John A Schneider
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA ; Department of Medicine, University of Chicago, Chicago, IL, USA ; Department of Health Studies, University of Chicago, Chicago, IL, USA
| |
Collapse
|
24
|
Guilamo-Ramos V, Bouris A, Lee J, McCarthy K, Michael SL, Pitt-Barnes S, Dittus P. Paternal influences on adolescent sexual risk behaviors: a structured literature review. Pediatrics 2012; 130:e1313-25. [PMID: 23071205 PMCID: PMC5527663 DOI: 10.1542/peds.2011-2066] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To date, most parent-based research has neglected the role of fathers in shaping adolescent sexual behavior and has focused on mothers. The objective of this study was to conduct a structured review to assess the role of paternal influence on adolescent sexual behavior and to assess the methodological quality of the paternal influence literature related to adolescent sexual behavior. METHODS We searched electronic databases: PubMed, PsychINFO, Social Services Abstracts, Family Studies Abstracts, Sociological Abstracts, and the Cumulative Index to Nursing and Allied Health Literature. Studies published between 1980 and 2011 that targeted adolescents 11 to 18 years and focused on paternal parenting processes were included. Methodological quality was assessed by using an 11-item scoring system. RESULTS Thirteen articles were identified and reviewed. Findings suggest paternal factors are independently associated with adolescent sexual behavior relative to maternal factors. The most commonly studied paternal influence was emotional qualities of the father-adolescent relationship. Paternal communication about sex was most consistently associated with adolescent sexual behavior, whereas paternal attitudes about sex was least associated. Methodological limitations include a tendency to rely on cross-sectional design, nonprobability sampling methods, and focus on sexual debut versus broader sexual behavior. CONCLUSIONS Existing research preliminarily suggests fathers influence the sexual behavior of their adolescent children; however, more rigorous research examining diverse facets of paternal influence on adolescent sexual behavior is needed. We provide recommendations for primary care providers and public health practitioners to better incorporate fathers into interventions designed to reduce adolescent sexual risk behavior.
Collapse
Affiliation(s)
- Vincent Guilamo-Ramos
- Silver School of Social Work, New York University, New York, New York 10003-6654, USA.
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, Illinois; and
| | - Jane Lee
- Center for Latino Adolescent and Family Health, New York University, New York, New York
| | - Katharine McCarthy
- Center for Latino Adolescent and Family Health, New York University, New York, New York
| | | | | | - Patricia Dittus
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
25
|
Bouris A, Guilamo-Ramos V, Cherry K, Dittus P, Michael S, Gloppen K. Preventing rapid repeat births among latina adolescents: the role of parents. Am J Public Health 2012; 102:1842-7. [PMID: 22897524 PMCID: PMC3490667 DOI: 10.2105/ajph.2011.300578] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 11/04/2022]
Abstract
Latina adolescent parents are at increased risk for rapid repeat births (second birth ≤ 24 months after the first), sexually transmitted infections, and negative educational and social outcomes. Although several effective parent-based interventions have been developed to prevent Latino youths' sexual risk taking, little research has explored the development of interventions to prevent repeat births that involve the parents of these adolescents. Existing preventative interventions involving parents suffer from important methodological limitations. Additional research is needed to advance theories of behavior, identify the causal pathways of parental influence, and specify appropriate behavioral targets. Future parent-based interventions to prevent repeat births should target pregnancy intentions, age of partners, contraceptive use, integrated prevention of pregnancies and sexually transmitted infections, educational attainment, and future orientations.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, IL 60637, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Bouris A, Guilamo-Ramos V, Jaccard J, Ballan M, Lesesne CA, Gonzalez B. Early adolescent romantic relationships and maternal approval among inner city Latino families. AIDS Behav 2012; 16:1570-83. [PMID: 21901487 DOI: 10.1007/s10461-011-0034-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Latino youth are at high risk for acquiring HIV during adolescence. The present study documented the nature of adolescent romantic relationships among 702 Latino eighth grade students and their mothers in the Bronx, NY. The study examined adolescent romantic relationships, the association between participation in such relationships and intentions to engage in sexual risk behavior, and maternal influences on adolescent's involvement in intimate behaviors in romantic relationships. Almost 50% of youth had been in a romantic relationship, which typically lasted 3-3.5 months. Mothers tended to approve of intimate behaviors and sexual activity in romantic relationships more so for males than females. Latino youth tended to underestimate maternal disapproval of a range of intimate behaviors, and the correlations between perceived and actual maternal approval were generally low in magnitude. Finally, maternal orientations towards their adolescent engaging in romantic relationships were associated with their child's intentions to have sexual intercourse in the future.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, IL 60637, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Guilamo-Ramos V, Jaccard J, Dittus P, Bouris A, Gonzalez B, Casillas E, Banspach S. A comparative study of interventions for delaying the initiation of sexual intercourse among Latino and black youth. Perspect Sex Reprod Health 2011; 43:247-254. [PMID: 22151512 DOI: 10.1363/4324711] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Latino and black adolescents are disproportionately affected by STDs, including HIV, and unintended pregnancies. Few parent-based interventions have targeted these youth, focused on early adolescence and had high participation rates. METHODS Between 2003 and 2009, a randomized clinical trial was conducted with 2,016 Latino and black mother-adolescent dyads in New York City. Adolescents were eligible if they were in grade 6 or 7. Dyads were assigned to one of three conditions: a parent-based intervention, Families Talking Together (FTT); an adolescent-only intervention, Making a Difference! (MAD); or a combined FTT+MAD intervention. Respondents completed questionnaires at baseline and 12 months later. Single-degree-of-freedom contrasts and logistic regression analysis were used to evaluate differences in outcomes by intervention. RESULTS The proportion of youth who reported ever having engaged in vaginal intercourse increased over the study period by eight percentage points among those in the MAD group, five points in the FTT group and three points in the combined group; the differences among these increases were not statistically significant. Adolescents in the two FTT groups were significantly more likely than those in the MAD group to indicate that their mother had talked to them about not having intercourse (79% vs. 68%). They also scored higher than youth in the MAD group on measures of communication and perceived maternal attributes, and lower on activities that might lead to risky behaviors. CONCLUSIONS The proportions of adolescents who initiated intercourse during the study period were not significantly different across groups, implying that the interventions were comparable. Findings suggest that FTT may have led to improved parenting behaviors.
Collapse
Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Guilamo-Ramos V, Bouris A, Jaccard J, Gonzalez B, McCoy W, Aranda D. A parent-based intervention to reduce sexual risk behavior in early adolescence: building alliances between physicians, social workers, and parents. J Adolesc Health 2011; 48:159-63. [PMID: 21257114 PMCID: PMC3118646 DOI: 10.1016/j.jadohealth.2010.06.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 06/10/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the efficacy of a parent-based intervention to prevent sexual risk behavior among Latino and African American young adults. This was delivered to mothers while waiting for their adolescent child to complete an annual physical examination. METHODS A randomized clinical trial was conducted with 264 mother-adolescent dyads in New York City. Adolescents were eligible for the study only if they were African American or Latino and aged 11-14 years, inclusive. Dyads completed a brief baseline survey and were then randomly assigned to one of the following two conditions: (1) a parent-based intervention (n = 133), or (2) a "standard care" control condition (n = 131). Parents and adolescents completed a follow-up survey nine months later. The primary outcomes included whether the adolescent had ever engaged in vaginal sexual intercourse, the frequency of sexual intercourse, and the frequency of oral sex. RESULTS Relative to the control group, statistically significant reduced rates of transitioning to sexual activity and frequency of sexual intercourse were observed, with oral sex reductions nearly reaching statistical significance (p < .054). Specifically, sexual activity increased from 6% to 22% for young adults in the "standard of care" control condition, although it remained at 6% among young adults in the intervention condition at the 9-month follow-up. CONCLUSIONS A parent-based intervention delivered to mothers in a pediatric clinic as they waited for their child to complete a physical examination may be an effective way to reduce sexual risk behaviors among Latino and African American middle-school young adults.
Collapse
Affiliation(s)
- Vincent Guilamo-Ramos
- Silver School of Social Work, New York University, Washington Square North, New York, NY 10003, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Guilamo-Ramos V, Jaccard J, Dittus P, Gonzalez B, Bouris A, Banspach S. The Linking Lives health education program: a randomized clinical trial of a parent-based tobacco use prevention program for african american and latino youths. Am J Public Health 2010; 100:1641-7. [PMID: 20634469 DOI: 10.2105/ajph.2009.171637] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effectiveness of a parent-based add-on component to a school-based intervention to prevent cigarette smoking among African American and Latino middle school youths. METHODS Mother-adolescent dyads (n=1386) were randomly assigned to 2 groups: (1) a school-based smoking-prevention intervention or (2) the same intervention with a parent-based add-on component called Raising Smoke-Free Kids. Mothers in the experimental condition received the parent add-on component. Mothers in the control condition received information on selecting a high school. All adolescents received a version of Project Towards No Tobacco Use (TNT). The primary outcome was a reduction in adolescent cigarette smoking. Follow-up data were obtained from 1096 mother-adolescent dyads at 15 months postintervention. RESULTS At follow-up, the odds of smoking cigarettes were reduced by 42% for adolescents in the parent add-on condition versus the TNT-only condition. Mothers in the parent add-on condition were more likely than were mothers in the TNT-only condition to set rules about risk-sensitive social activities and to be perceived as trustworthy by their child. Group differences also were found in the frequency and quality of mother-adolescent communication. CONCLUSIONS Including parent add-on components in school-based smoking prevention programs can reduce smoking behavior on the part of inner-city middle school youths.
Collapse
Affiliation(s)
- Vincent Guilamo-Ramos
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY 10027, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Jaccard J, Guilamo-Ramos V, Johansson M, Bouris A. Multiple Regression Analyses in Clinical Child and Adolescent Psychology. Journal of Clinical Child & Adolescent Psychology 2010; 35:456-79. [PMID: 16836483 DOI: 10.1207/s15374424jccp3503_11] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A major form of data analysis in clinical child and adolescent psychology is multiple regression. This article reviews issues in the application of such methods in light of the research designs typical of this field. Issues addressed include controlling covariates, evaluation of predictor relevance, comparing predictors, analysis of moderation, analysis of mediation, assumption violations, outliers, limited dependent variables, and directed regression and its relation to structural equation modeling. Analytic guidelines are provided within each domain.
Collapse
Affiliation(s)
- James Jaccard
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA.
| | | | | | | |
Collapse
|
31
|
Bouris A, Guilamo-Ramos V, Jaccard J, McCoy W, Aranda D, Pickard A, Boyer CB. The feasibility of a clinic-based parent intervention to prevent HIV, sexually transmitted infections, and unintended pregnancies among Latino and African American adolescents. AIDS Patient Care STDS 2010; 24:381-7. [PMID: 20565322 PMCID: PMC3131827 DOI: 10.1089/apc.2009.0308] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of the present study was to examine the feasibility of conducting a parent-based intervention in a pediatric health clinic to prevent HIV, sexually transmitted infections (STIs), and unintended pregnancies among urban African American and Latino youth. Eight focus groups were conducted with health care providers, adolescent patients and the mothers of adolescent patients (n = 41) from December 2007 to February 2008. All participants were recruited from a community-based pediatric health clinic in the Bronx, New York. Content analysis of focus group transcripts identified results in three primary areas: (1) the role of parents and providers in preventing HIV, STDs and unintended pregnancies among adolescents, (2) feasibility of the intervention in the clinic setting; and (3) optimal recruitment, retention and intervention delivery strategies. Study results suggest that a parent-based intervention delivered in a community-based pediatric health clinic setting is feasible. Focused recommendations for intervention recruitment, delivery, and retention are provided.
Collapse
Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, Illinois
| | | | | | - Wanda McCoy
- Morris Heights Health Center, Bronx, NY, Assistant Clinical Professor of Pediatrics at Montefiore Medical Center/Albert Einstein College of Medicine, Sophie Davis School of Biomedical Education, Bronx, New York
| | | | - Angela Pickard
- Centers for Disease Control and Prevention ORISE Fellow, Columbia University School of Social Work, New York, New York
| | - Cherrie B. Boyer
- Division of Adolescent Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
32
|
Abstract
The Caribbean has the highest HIV rates outside of sub-Saharan Africa. In recent decades, tourism has become the most important Caribbean industry. Studies suggest that tourism areas are epicenters of demographic and social changes linked to HIV risk, such as transactional sex, elevated alcohol and substance use, and internal migration. Despite this, no formative HIV-prevention studies have examined tourism areas as ecologies that heighten HIV vulnerability. HIV/AIDS research needs to place emphasis on the ecological context of sexual vulnerability in tourism areas and develop multilevel interventions that are sensitive to this context. From our review and integration of a broad literature across the social and health sciences, we argue for an ecological approach to sexual health in Caribbean tourism areas, point to gaps in knowledge, and provide direction for future research.
Collapse
Affiliation(s)
- Mark B Padilla
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 109 Observatory St, Room 3830, Ann Arbor, MI 48108, USA.
| | | | | | | |
Collapse
|
33
|
Soletti AB, Guilamo-Ramos V, Burnette D, Sharma S, Bouris A. India-US collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV-prevention intervention for rural Indian youth. J Int AIDS Soc 2009; 12:35. [PMID: 19925680 PMCID: PMC2788348 DOI: 10.1186/1758-2652-12-35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 11/19/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the centrality of family in Indian society, relatively little is known about family-based communication concerning sexual behaviour and HIV/AIDS in rural Indian families. To date, very few family-based adolescent HIV-prevention interventions have been developed for rural Indian youth. This study conducted formative research with youth aged 14 to18 years and their parents in order to assess the feasibility of conducting a family-based HIV-prevention intervention for rural Indian adolescents. METHODS Eight focus groups were conducted (n = 46) with mothers, fathers, adolescent females and adolescent males (two focus groups were held for each of the four groups). All focus groups consisted of same-gender participants. Adolescents aged 14 to18 years old and their parents were recruited from a tribal community in rural Maharashtra, India. Focus group transcripts were content analyzed to identify themes related to family perceptions about HIV/AIDS and participation in a family-based intervention to reduce adolescent vulnerability to HIV infection. RESULTS Six primary thematic areas were identified: (1) family knowledge about HIV/AIDS; (2) family perceptions about adolescent vulnerability to HIV infection; (3) feasibility of a family-based programme to prevent adolescent HIV infection; (4) barriers to participation; (5) recruitment and retention strategies; and (6) preferred content for an adolescent HIV prevention intervention. CONCLUSION Despite suggestions that family-based approaches to preventing adolescent HIV infection may be culturally inappropriate, our results suggest that a family-based intervention to prevent adolescent HIV infection is feasible if it: (1) provides families with comprehensive HIV prevention strategies and knowledge; (2) addresses barriers to participation; (3) is adolescent friendly, flexible and convenient; and (4) is developmentally and culturally appropriate for rural Indian families.
Collapse
Affiliation(s)
- Asha Banu Soletti
- School of Social Work, Tata Institute of Social Sciences, Mumbai, India
| | | | - Denise Burnette
- Columbia University School of Social Work, New York, NY, USA
| | - Shilpi Sharma
- School of Social Work, Tata Institute of Social Sciences, Mumbai, India
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, USA
| |
Collapse
|
34
|
Guilamo-Ramos V, Bouris A, Jaccard J, Lesesne C, Ballan M. Familial and cultural influences on sexual risk behaviors among Mexican, Puerto Rican, and Dominican youth. AIDS Educ Prev 2009; 21:61-79. [PMID: 19824835 DOI: 10.1521/aeap.2009.21.5_supp.61] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present study examined the relationship among acculturation, familismo, and HIV-related adolescent sexual risk behavior. Data were collected from Latino mother-adolescent dyads to permit parent and adolescent analyses of familismo for predicting oral, vaginal, and anal sexual behaviors. A random sample of 702 Latino eighth-grade students and their mothers was recruited from New York City. The sample included Mexicans (n = 203), Puerto Ricans (n = 239), and Dominicans (n = 260). Acculturation was unrelated to sexual behavior, but adolescent familismo was related to girls' but not boys' sexual behavior. The most important facet of familismo was subjugation to the family, which was negatively associated with girls' sexual behavior. The implications for HIV prevention programs for Latino youth are discussed.
Collapse
|
35
|
Banu Soletti A, Guilamo-Ramos V, Burnette D, Sharma S, Bouris A. India-U.S. collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV prevention intervention for rural Indian youth. J Int AIDS Soc 2009. [DOI: 10.1186/1758-2652-2-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
36
|
Guilamo-Ramos V, Jaccard J, Dittus P, Bouris A, Holloway I, Casillas E. Adolescent expectancies, parent-adolescent communication and intentions to have sexual intercourse among inner-city, middle school youth. Ann Behav Med 2008; 34:56-66. [PMID: 17688397 DOI: 10.1007/bf02879921] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The incidence and prevalence of pregnancy and sexually transmitted infections among American adolescents remain unacceptably high. PURPOSE This research examines adolescent intentions to have sexual intercourse, their expectancies about having sexual intercourse, and maternal communication about the expectancies of engaging in sexual intercourse. METHODS Six hundred sixty-eight randomly selected inner-city middle school students and their mothers completed self-administered questionnaires. Adolescents reported their intentions to have sexual intercourse and the perceived positive and negative expectancies of doing so. Both mothers and adolescents reported on the frequency of communication about these expectancies. RESULTS Boys reported higher intentions, more positive expectancies, and lower levels of maternal communication than did girls. Expectancies statistically significantly associated with intentions focused on the positive physical, social, and emotional advantages of having sex rather than on concerns about pregnancy and HIV/AIDS. With some exceptions, maternal communication was associated with adolescents expectancies about engaging in sexual intercourse. However, only modest correlations between maternal and adolescent reports of communication were observed. CONCLUSIONS Results indicate that intervention programs should address the positive expectancies youth have about having sex, not just the threat of pregnancy and HIV/AIDS, and should address potential gender differences in expectancies between boys and girls.
Collapse
|
37
|
Guilamo-Ramos V, Jaccard J, Dittus P, Bouris A, Holloway I, Casillas E. Adolescent expectancies, parent-adolescent communication and intentions to have sexual intercourse among inner-city, middle school youth. Ann Behav Med 2007. [PMID: 17688397 DOI: 10.1080/08836610701495664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The incidence and prevalence of pregnancy and sexually transmitted infections among American adolescents remain unacceptably high. PURPOSE This research examines adolescent intentions to have sexual intercourse, their expectancies about having sexual intercourse, and maternal communication about the expectancies of engaging in sexual intercourse. METHODS Six hundred sixty-eight randomly selected inner-city middle school students and their mothers completed self-administered questionnaires. Adolescents reported their intentions to have sexual intercourse and the perceived positive and negative expectancies of doing so. Both mothers and adolescents reported on the frequency of communication about these expectancies. RESULTS Boys reported higher intentions, more positive expectancies, and lower levels of maternal communication than did girls. Expectancies statistically significantly associated with intentions focused on the positive physical, social, and emotional advantages of having sex rather than on concerns about pregnancy and HIV/AIDS. With some exceptions, maternal communication was associated with adolescents expectancies about engaging in sexual intercourse. However, only modest correlations between maternal and adolescent reports of communication were observed. CONCLUSIONS Results indicate that intervention programs should address the positive expectancies youth have about having sex, not just the threat of pregnancy and HIV/AIDS, and should address potential gender differences in expectancies between boys and girls.
Collapse
|
38
|
Abstract
This study presents descriptive qualitative data about Latino parenting practices in an urban context. Focus groups were conducted with Dominican and Puerto Rican mother-adolescent pairs in the Bronx borough of NewYork City. When parenting style typologies are integrated with the Latino cultural components familismo, respeto, personalismo, and simpatía, Latino parenting practices and their underlying styles are better understood. Content analysis of parents' focus groups revealed five essential Latino parenting practices: (1) ensuring close monitoring of adolescents; (2) maintaining warm and supportive relationships characterized by high levels of parent-adolescent interaction and sharing; (3) explaining parental decisions and actions; (4) making an effort to build and improve relationships; and (5) differential parenting practices based on adolescents' gender. Mothers reported concerns related to the risks associated with living in an urban area, exposure to different cultural values, and opportunities for engaging in risky behaviors. Adolescents' recommendations for effective parenting strategies were similar to the practices reported by their mothers. The study has important applied implications for culturally competent social work practice with Latino adolescents and their families.
Collapse
|