Prevention is a privilege: Implementing drug-free community coalitions in Black communities

Community-based interventions for youth substance use prevention require high levels of capacity to organize and coordinate community resources to support youth development and create opportunities to prevent youth substance use. This project aimed to better understand what Black prevention practitioners perceive as the requirements for a successful drug-free community coalition. Black prevention practitioners, who were engaged in drug-free community funded coalitions, had discussions about coalitions as a strategy for youth substance use prevention in Black communities. These facilitated discussions resulted in consensus over a set of nine core principles regarding successful youth substance use prevention coalition building in these communities.

Black Sexual Minority Adults' Avoidance of Professional Mental Health Care

OBJECTIVE

The authors sought to determine whether Black sexual minority individuals were more likely than White sexual minority individuals to postpone or avoid professional mental health care (PMHC) and, if so, to identify the reasons for postponing or avoiding care.

METHODS

Analyses were conducted with a subsample of cisgender Black (N=78) and White (N=398) sexual minority individuals from a larger survey of U.S. adults administered via MTurk in 2020 (N=1,012). Logistic regression models were used to identify racial differences in overall postponement or avoidance of care as well as differences in the prevalence of each of nine reasons for postponing or avoiding care.

RESULTS

Black sexual minority individuals were more likely than their White counterparts to report ever postponing or avoiding PMHC (average marginal effect [AME]=13.7 percentage points, 95% CI=5.4-21.9). Black sexual minority people also were more likely than their White counterparts to cite beliefs that they should work out their problems on their own (AME=13.1 percentage points, 95% CI=1.2-24.9) or with family and friends (AME=17.5 percentage points, 95% CI=6.0-29.1) and to cite providers' refusal to treat them (AME=17.4 percentage points, 95% CI=7.6-27.1) as reasons for postponing or avoiding care.

CONCLUSIONS

Black sexual minority individuals were more likely than their White counterparts to report delaying or avoiding PMHC. Personal beliefs about managing mental health and providers' refusal to offer treatment influenced Black sexual minority individuals' willingness or ability to seek PMHC.

Profiles of psychosocial stressors and buffers among Latinx immigrant youth: Associations with suicidal ideation

This study aimed to examine the associations of latent profile group membership based on post-migration psychosocial stressors (proximal immigrant minority stress) and buffers (family, peer, and school support, and ethnic identity importance), and distal stressors (pre- to post-migration victimization and forced immigration-related family separation) with suicidal ideation among immigrant youth from the Northern Triangle (NT). Surveys were administered in a public high school-based Latinx immigrant youth support program between Spring 2019 and Spring 2022 (N = 172). A three latent profile model was previously identified, characterized by moderate stress/low buffer (weak resources), moderate stress/moderate buffer (average resources), and low stress/high buffer (strong resources) levels of psychosocial stressors and buffers. Associations of profile membership and the previously mentioned distal stressors with suicidal ideation were examined using multivariable logistic regression. Findings revealed that youth in the strong resources group experienced significant protection from suicidal ideation compared to youth in both the average and weak resources groups. Distal stressors were not significantly associated with suicidal ideation in multivariable analysis. Immigrant youth from the NT may require substantial buffering resources (i.e., ethnic identity importance, and school, family, and peer support) and minimization of proximal immigrant minority stress during post-migration to experience protection from suicidal ideation.

Monkeypox-Related Stigma and Vaccine Challenges as a Barrier to HIV Pre-Exposure Prophylaxis among Black Sexual Minority Men

BACKGROUND

The U.S. monkeypox (mpox) outbreak of 2022 was a unique emergent public health crisis disproportionately affecting Black sexual minority men (BSMM). Similar to other stigmas, mpox-related stigma may have adverse effects on BSMM, including deterring HIV prevention such as PrEP.

METHODS

Our study investigated the experiences and perceptions of BSMM related to mpox, including mpox-associated stigma, and PrEP engagement among BSMM. We conducted qualitative interviews of 24 BSMM attending HIV prevention-related events in the greater D.C. Metropolitan area. In-depth interviews were conducted via phone, and responses to questions specific to the mpox outbreak were analyzed using thematic analysis.

RESULTS

We identified three key themes from the analysis: Mpox-related stigma, Mpox vaccine availability concerns, and Mpox vaccine hesitancy. Participants also described relationships between each of these three themes and PrEP use. Mpox stigma was particularly relevant as it is related to sexual stigma and is a deterrent to PrEP use. A sense of health system neglect of BSMM, especially related to low mpox vaccine availability, was also described.

CONCLUSIONS

We identified mpox stigma and challenges related to mpox vaccination as key themes among BSMM, with implications for PrEP use. Future research exploring medical mistrust among BSMM, particularly related to HIV prevention, is recommended.

Assessing the Implementation of an LGBTQ+ Mental Health Services Training Program to Determine Feasibility and Acceptability During the COVID-19 Pandemic

Despite significant social and legal progress, LGBTQ+ (lesbian, gay, bisexual, transgender, and other sexual and gender minority) populations continue to experience higher rates of mental health and substance use disorders than their heterosexual and cisgender counterparts. Effective LGBTQ+ affirmative mental health care is essential for addressing these disparities but is often limited and difficult to access. The shortage of LGBTQ+ affirmative mental health care providers results from the absence of required and accessible LGBTQ+-focused training and technical assistance opportunities for mental health care professionals. This study evaluates the implementation of our COVID-19 adapted, completely virtual, organization- and therapist-focused training program to improve the mental health workforce's cultural competence in working with the LGBTQ+ community: the Sexual and Gender Diversity Learning Community (SGDLC). Guided by an expanded RE-AIM model, we used administrator and therapist feedback to assess SGDLC implementation factors to understand how it may be best translated for scaled-up promotion and widespread adoption. Assessment of the initial reach, adoption, and implementation of the SGDLC indicated that it had strong feasibility; reports on satisfaction and relevance support the SGDLC's acceptability. Maintenance could not be fully assessed from the short study follow-up period. Still, administrators and therapists expressed an intent to continue their newfound practices, a desire for continued training and technical assistance in this area, but also concerns about finding additional opportunities for this education.

Examining HIV Diagnosis and Linkage to PrEP Prescription Among Members at An Integrated Health System in the Southeast United States

Pre-Exposure Prophylaxis (PrEP) is a priority method for preventing HIV infection. This study's aims were threefold: (1) identify characteristics of members of a large health maintenance organization, Kaiser Permanente Georgia (KPGA), associated with HIV infection, (2) identify which member characteristics associated with HIV were also associated with PrEP prescription, and (3) identify which HIV-associated characteristics were associated with under- or over-prescribing of PrEP. Analysis of variables from the electronic medical record revealed that age, race, gender, mental health diagnosis, STI diagnosis, and sexual orientation were independently associated with HIV diagnosis. The same characteristics were independently associated with PrEP prescription except for race. Persons identifying as Black or unknown race, women, and/or heterosexual; and who had an STI diagnosis and/or illicit drug use had lower odds of being prescribed PrEP than of having an HIV diagnosis. The implications of these findings for improving physician identification of candidates for PrEP prescription are discussed.

Professional Expectations of Provider LGBTQ Competence: Where We Are and Where We Need to Go

Introduction

Mental and behavioral health professional organizations use their governing documents to set expectations of provider competence in working with LGBTQ+ clients.

Method

The codes of ethics and training program accreditation guidelines of nine mental and behavioral health disciplines (n=16) were analyzed using template analysis.

Results

Coding resulted in fives themes: mission and values, direct practice, clinician education, culturally competent professional development, and advocacy. Expectations for provider competency vary greatly across disciplines.

Conclusion

Having a mental and behavioral health workforce that is uniformly competent in meeting the unique needs of LGBTQ populations is key for supporting the mental and behavioral health of LGBTQ persons.

What motivates community mental and behavioral health organizations to participate in LGBTQ+ cultural competency trainings?

The constantly evolving language, understanding, and cultural context regarding the mental health of lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse individuals (LGBTQ+) require mental health providers to obtain LGBTQ+ cultural competency training to be affirmative and effective with this population. Unfortunately, many providers are not obtaining this ongoing training and mental health disparities continue to plague LGBTQ+ populations. Guided by the Consolidation Framework for Implementation Research (CFIR), we conducted eight focus groups with community mental and behavioral health organization (MBHO) administrators (e.g., directors, clinical supervisors) and therapists to explore what factors facilitated or inhibited their adoption and implementation of a multicomponent LGBTQ+ cultural competency training program that required administrator and therapist participation in multiple learning sessions over several months (i.e., workshop, clinical consultation, and organizational technical assistance). Results from template analysis supported CFIR-aligned themes, including characteristics of individuals, inner setting, outer setting, and process, and two additional codes-marketing and other/previous training opportunities-emerged from the focus group data. Findings suggest that therapists are motivated to engage in such a program because they want to feel more efficacious, and administrators see the benefits of LGBTQ+ training programs for their clientele and marketing. Barriers to adoption and implementation include cost and personnel resistance, although participants believed these barriers were surmountable. Emphasizing therapist efficacy, clientele need, and benefits for marketing mental and behavioral health services could motivate MBHOs' and therapists' adoption and implementation of LGBTQ+ cultural competency training. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Discomfort in LGBT Community and Psychological Wellbeing for LGBT Asian Americans: The Moderating Role of Racial/Ethnic Identity Importance

While past research has examined the deleterious effects of racism on Asian Americans, fewer studies have investigated lesbian, gay, bisexual, and transgender (LGBT) Asian Americans' unique experiences of oppression and unbelonging within the broader LGBT community. Guided by intersectionality and minority stress theoretical frameworks, the present study examined the effect of discomfort due to one's race/ethnicity within the LBGT community on psychological wellbeing in a national sample of 480 LGBT Asian Americans from the Social Justice Sexuality Project. The moderating role of how important one considered their race/ethnicity to their identity was also examined. Regression analyses revealed that greater discomfort due to one's race/ethnicity within the LGBT community was associated with reduced psychological wellbeing for LGBT Asian Americans who viewed their racial/ethnic identity as moderately or highly important, whereas this association was not significant for LGBT Asian Americans who considered their racial/ethnic identity as less important. These findings highlight the necessity of examining the role of racial/ethnic discomfort in relation to LGBT Asian Americans' psychological wellbeing, as well as the extent to which LGBT Asian Americans consider their race/ethnicity as important.

LGBTQ Identity-Related Victimization During COVID-19 Is Associated with Moderate to Severe Psychological Distress Among Young Adults

Purpose: Existing evidence indicates significant threats against the mental health of sexual and gender minority (SGM) young adults as a result of the COVID-19 pandemic, including elevated rates of substance use, anxiety, depression, and traumatic stress. Therefore, it is imperative to understand the mechanistic identity-related factors that may influence the mental health needs of SGM young adults in the time of COVID-19. This study aims to examine the impact of increases in lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) identity-related victimization since the start of COVID-19 on psychological distress among SGM college students. Methods: A nonprobability, cross-sectional online survey was conducted between May and August 2020 to explore the psychological impacts of COVID-19 on U.S. SGM college students (N = 565). Previously validated scales were used to measure LGBTQ identity-related victimization and psychological distress. Chi-square tests of independence, independent samples T-tests, and adjusted logistic regression were used to examine the study aim. Results: Adjusted logistic regression findings revealed that reporting past year+more frequent LGBTQ identity-related victimization since the start of COVID-19 (compared to no report) was associated with over four times greater odds of experiencing moderate to severe psychological distress. Conclusion: Findings highlight the importance of research, practice, and policy stakeholders toward addressing the unique identity-related mental health needs and victimization experiences of SGM college students. Mental health, social service, and higher education practitioners have an important opportunity and responsibility toward identifying and intervening on SGM college students and young adults facing identity-related victimization amid the ongoing COVID-19 pandemic.

Trends in Health Care Access/Experiences: Differential Gains across Sexuality and Sex Intersections before and after Marriage Equality

Background: Sexual minority adults experience several health care access inequities compared to their heterosexual peers; such inequities may be affected by LGBTQ+ legislation, such as the 2015 national marriage equality ruling. Methods: Using population-based data (n = 28,463) from the Association of American Medical Colleges biannual Consumer Survey of Health Care Access, we calculated trend ratios (TR) for indicators of health care access (e.g., insurance coverage, delaying or forgoing care due to cost) and satisfaction (e.g., general satisfaction, being mistreated due to sexual orientation) from 2013 to 2018 across sexuality and sex. We also tested for changes in trends related to the 2015 marriage equality ruling using interrupted time series trend interactions (TRInt). Results: The largest increases in access were observed in gay men (TR = 2.42, 95% CI 1.28, 4.57). Bisexual men had decreases in access over this period (TR = 0.47, 95% CI 0.22, 0.99). Only gay men had a significant increase in the health care access trend after U.S. national marriage equality (TRInt = 5.59, 95% CI 2.00, 9.18), while other sexual minority groups did not. Conclusions: We found that trends in health care access and satisfaction varied significantly across sexualities and sex. Our findings highlight important disparities in how federal marriage equality has benefited sexual minority groups.

Disparities in Mental Health Care Access Among Persons Differing in Sexual Identity: Nationally Representative Findings

OBJECTIVE

The authors sought to describe disparities in three outcomes: self-reported mental health, need for mental health care, and barriers to care at the intersection of sexual identity and sex.

METHODS

Data from the 2015 Association of American Medical Colleges Consumer Survey of Health Care Access (N=5,932) were analyzed in regression analyses to estimate relationships among sex, sexual identity, and all three outcomes.

RESULTS

Compared with heterosexual men, bisexual women reported the poorest mental health (adjusted prevalence ratio [APR]=0.42, 95% confidence interval [CI]=0.35-0.51) and the greatest number of barriers to care (APR=2.29, 95% CI=1.77-2.97), whereas gay-lesbian women reported the most frequent need for care (APR=1.67, 95% CI=1.28-2.18).

CONCLUSIONS

The findings support existing knowledge on health inequities among sexual minority groups and situate these disparities in the context of unequal access to behavioral and mental health care. As such, addressing barriers to care is paramount in efforts to address sexual orientation-related disparities in behavioral and mental health.

Differences in Health Care Access and Satisfaction Across Intersections of Race/Ethnicity and Sexual Identity

PURPOSE

Racial/ethnic and sexual minorities experience numerous health disparities compared with their White and heterosexual counterparts, which may be exacerbated when these social identities intersect. The authors tested for differences in health care access and satisfaction across intersections of sexual identity and race/ethnicity.

METHOD

A cross-sectional secondary data analysis of the 2012-2018 waves of the Association of American Medical Colleges biannual online Consumer Survey of Health Care Access was conducted. This survey captures a national sample of U.S. adults who reported needing health care in the past 12 months. The analytic sample included 29,628 participants. Sixteen possible combinations of sexual identity and race/ethnicity were examined. Health care access and satisfaction were measured with 10 items and an index created from these items. Cumulative prevalence ratios (PRs) for the index and PRs across sexual identity, both individually and in combination with race/ethnicity, for each health care access and satisfaction item were generated.

RESULTS

Compared with White heterosexuals, all other groups had significantly more barriers to care before adjustment. The greatest barriers were observed among non-Hispanic Asian/Pacific Islander/Hawaiian gay/lesbian (unadjusted PR = 3.08; 95% confidence interval [CI]: 2.45, 3.88; adjusted PR = 2.01; 95% CI: 1.59, 2.53), non-Hispanic Black bisexual (unadjusted PR = 2.73; 95% CI: 2.28, 3.27; adjusted PR = 1.83; 95% CI: 1.52, 2.20), non-Hispanic Black other sexual identity (unadjusted PR = 2.27; 95% CI: 1.69, 3.06; adjusted PR = 2.07; 95% CI: 1.53, 2.78), and Hispanic/Latino other sexual identity (unadjusted PR = 2.06; 95% CI: 1.60, 2.65; adjusted PR = 1.39; 95% CI: 1.08, 1.79) participants.

CONCLUSIONS

Persons of both racial/ethnic and sexual minority status generally had less health care access and satisfaction than White heterosexuals. An intersectional perspective is critical to achieving equity in quality health care access.

Sexual Identity Differences in Access to and Satisfaction With Health Care: Findings From Nationally Representative Data

Identification of barriers to adequate health care for sexual minority populations remains elusive given that they are complex and variable across sexual orientation subgroups (e.g., gay, lesbian, bisexual). To address these complexities, we used data from a US nationally representative sample of health-care consumers to assess sexual identity differences in health-care access and satisfaction. We conducted a secondary data analysis of 12 waves (2012-2018) of the biannual Consumer Survey of Health Care Access (n = 30,548) to assess sexual identity differences in 6 health-care access and 3 health-care satisfaction indicators. Despite parity in health insurance coverage, sexual minorities-with some variation across sexual minority subgroups and sex-reported more chronic health conditions alongside restricted health-care access and unmet health-care needs. Gay/lesbian women had the lowest prevalence of health-care utilization and higher prevalence rates of delaying needed health care and medical tests relative to heterosexual women. Gay/lesbian women and bisexual men were less likely than their heterosexual counterparts to be able to pay for needed health-care services. Sexual minorities also reported less satisfactory experiences with medical providers. Examining barriers to health care among sexual minorities is critical to eliminating health disparities that disproportionately burden this population.

Disparities in Health Care Access and Utilization at the Intersections of Urbanicity and Sexual Identity in California

Purpose: The aim was to examine differences in health care access at the intersections of urbanicity and sexual identity in California. Methods: We used the 2014-2017 Adult California Health Interview Survey paired with the sexual orientation special use research file to create dummy groups representing each dimension of urbanicity and sexual identity to compare access to health care outcomes. We calculated unadjusted proportions and estimated adjusted odds ratios of each dimension relative to urban heterosexual people using logistic regressions. Results: Relative to urban heterosexual people, urban gay/lesbian people had 1.651 odds of using the emergency room (ER). Urban bisexual people had 1.429 odds of being uninsured, 1.575 odds of delaying prescriptions, and 1.907 odds of using the ER. Rural bisexual people experienced similar access barriers having 1.904 odds of uninsurance and 2.571 odds of using the ER. Conclusions: Our study findings demonstrated disparate access to health care across sexual orientation and rurality. The findings are consistent with literature that suggests urban and rural sexual minority people experience health care differently and demonstrate that bisexual people experience health care differently than gay/lesbian people. These findings warrant further study to examine how social identities, such as race/ethnicity, interact with sexual orientation to determine health care access. Furthermore, these findings demonstrate the need to emphasize the health care access needs of sexual minority people in both rural and urban areas to eliminate health care access disparities.

"Even if you think you can trust them, don't trust them": An exploratory analysis of the lived experiences of sexual health among sexual minority girls in foster care

Girls in foster care are at heightened risk for poor sexual health outcomes compared to their general population counterparts. Sexual minority girls are also at greater risk for poor sexual health compared to their heterosexual counterparts. Yet, little is known about the sexual health of sexual minority girls in foster care. This study aims to provide a preliminary understanding of how sexual minority girls in foster care experience the phenomenon of sexual health. Using a single-case interpretative phenomenological analysis (IPA) design, we interviewed five sexual minority girls in foster care using a single in-depth focus group discussion and analyzed the data using a series of IPA steps. Analysis revealed three major themes about the lived experiences of sexual health among sexual minority girls in foster care: fear of being victimized and distrust within sexual relationships, self-protection from sexual relationship harm, and sexual health communication. Further research is warranted to investigate the sexual health experiences and needs of sexual minority girls in foster care, with particular sensitivity to the potential impact of past sexual victimization and abuse on their sexual health and wellbeing.

The Role of Intrinsic Motivation in the Pursuit of Health Science-Related Careers among Youth from Underrepresented Low Socioeconomic Populations

A more diverse health science-related workforce including more underrepresented race/ethnic minorities, especially from low socioeconomic backgrounds, is needed to address health disparities in the USA. To increase such diversity, programs must facilitate youth interest in pursuing a health science-related career (HSRC). Minority youth from low socioeconomic families may focus on the secondary gains of careers, such as high income and status, given their low socioeconomic backgrounds. On the other hand, self-determination theory suggests that it is the intrinsic characteristics of careers which are most likely to sustain pursuit of an HSRC and lead to job satisfaction. Intrinsic and extrinsic motivation for pursuing an HSRC (defined in this study as health professional, health scientist, and medical doctor) was examined in a cohort of youth from the 10th to 12th grade from 2011 to 2013. The sample was from low-income area high schools, had a B- or above grade point average at baseline, and was predominantly: African American (65.7 %) or Hispanic (22.9 %), female (70.1 %), and children of foreign-born parents (64.7 %). In longitudinal general estimating equations, intrinsic motivation (but not extrinsic motivation) consistently predicted intention to pursue an HSRC. This finding provides guidance as to which youth and which qualities of HSRCs might deserve particular attention in efforts to increase diversity in the health science-related workforce.

Comparison of Student Self-Reported and Administrative Data Regarding Intercession into Alcohol Misuse among College Freshmen Dormitory Residents

Intercession into collegiate alcohol misuse by the Department of Resident Live (DRL) in freshmen dormitories at one large, Mid-Atlantic, diverse, public university was examined. Freshmen dormitory resident drinkers (n=357), 71% of whom reported alcohol misuse, were surveyed. Student self-report and DRL documentation, respectively, revealed that 6.4% and 7.8% (Kappa=.77) of drinkers were documented with an alcohol violation, 4.2% and 3.4% (Kappa=.81) lost housing priority points, 1.4% and .6% (Kappa=.28) were referred for alcohol counseling, and 1.4% and .3% (Kappa = .33) were taken to the emergency room. DRL infrequently interceded into alcohol misuse, perhaps because most misuse occurred off-campus.

DRINKING TO GET DRUNK AMONG INCOMING FRESHMEN COLLEGE STUDENTS

This study examined college freshmen who intentionally drink alcohol to get drunk (DTGD). Survey data from 307 incoming freshmen college students living in freshmen residence halls who reported drinking alcohol in the last 30 days were analyzed. The majority (76.9%) of these self-reported drinkers reported DTGD. Relative to other freshmen drinkers, those who reported DTGD were significantly more likely to have consumed alcohol before going out to a party or bar, participated in a drinking game, drank heavily on a non-school night but not on a school night, used liquor, used beer, combined alcohol and drugs, experienced a hangover, vomited, passed out, and/or blacked out. The associations support DTGD as a measure of pre-meditated, controlled, and intentional consumption of alcohol to reach a state of inebriation. Common intentional drunkenness as observed in this study population may have implications for college alcohol risk reduction programs.

Predictors of intent to pursue a college health science education among high achieving minority 10th graders

Minority populations are underrepresented in fields of science, perhaps limiting scientific perspectives. Informed by recent studies using Social Cognitive Career Theory, this study examined whether three conceptual constructs: self-efficacy, perceived adult support, and perceptions of barriers, as well as several discrete and immutable variables, were associated with intent to pursue college science education in a sample (N = 134) of minority youth (70.1% female and 67.2% African American). A paper-and-pencil survey about pursuit of college science was administered to 10th graders with a B- or better grade point average from six high schools in an underserved community. Results indicated that the three conceptual constructs were bivariate correlates of intent to pursue college science education. Only perceived adult support and knowing whether a parent received college education were significant predictors in multivariate modeling. These results build on previous research and provide further insight into youth decision-making regarding pursuit of college science.

Relationship of personal health experiences with interest in health careers among youth from an underserved area

Only 10% of health professionals are from racial/ethnic minority groups, and much research has been focused on encouraging minorities to enter a health career. The lack of health workforce diversity has many implications for the effective delivery of care to an increasingly diverse US population. The goal of this analysis is to examine the influence of personal health experiences on interest in a health career. "Personal Health Experiences" is a newly created scaled variable that assesses the influence of direct and indirect health experiences of respondents. In a sample of 134 predominantly minority 10th graders from underprivileged neighborhoods, the scale had adequate psychometric properties (range 1-7; mean 4.44, SD 1.46, median 4.60, Cronbach's alpha 0.72), and multivariate regression modeling revealed that it predicted increased "Interest in Health Careers" (B=0.46, SE 0.10, p<0.01). Future research is needed to determine the role that personal health experiences play in career choices and one's success in health career decisions. Such information could, for example, help to refine health profession recruitment strategies.

Clinical approaches to improving alcohol education and counseling in adolescents and young adults

Clinical prevention trials (approaches to educating and counseling) of adolescents (teens and young adults aged 12 to 25) about risks related to alcohol use indicate that reduction in adolescent alcohol use is possible with nonphysicians as interventionists and physicians as interventionists supported by patient counseling guides and resources. Opportunities for personalized, interactive adolescent education with goal setting appears key to intervention success. Physicians might also be more effective if they are aware of emerging alcohol problems among youth, systems-level resources for counseling adolescents about prevention, and appropriate guidance for parents. Recommendations and resources for clinicians working with adolescents regarding alcohol misuse are provided.

Dimensionality and psychometric analysis of an alcohol protective behavioral strategies scale

OBJECTIVE

The current study examined the dimensionality of a protective behavioral strategies (PBS) measure among undergraduate, predominantly freshmen (92.5%) college students reporting recent alcohol use (n = 320).

METHOD

Participants completed a web-based survey assessing 22 PBS items. Factor analyses determined the underlying factor structure of the items. Congruence of the factor structure among gender and racial sub-groups was examined by rotating the sub-groups' matrices via the Procrustes rotation method. Reliability analyses determined internal consistency.

RESULTS

A 2-factor solution was retained utilizing 17 of the original items. Both PBS sub-scales (Limits and Avoidance) had acceptable internal consistency across all samples.

CONCLUSIONS

This PBS Scale was determined to be bi-dimensional and reliable. The dimensions suggest two underlying foci: ways to limit alcohol intake and ways to avoid alcohol intake while socializing. Practical implications of these findings are discussed.

Drinking motivations and experiences of unwanted sexual advances among undergraduate students

This study examined the relationship between drinking motivations and college students' experiences with unwanted sexual advances. Undergraduates, from a public university in the mid-Atlantic region, who reported recent (30 day) alcohol use ( n = 289) completed an online survey midway through the spring 2007 academic semester. Experiencing an unwanted sexual advance was the outcome of interest for the present study. The independent variables included sociodemographics and a three-factor (social ease, social image or reputation, emotional distress) drinking motivation measure. Prevalence estimates as well as unadjusted and adjusted odds ratios (OR) were produced. A strong relationship was found between having an unwanted sexual advance and recent binge drinking as well as drinking to remove emotional distress (OR = 3.40 and 2.73, respectively, for the total sample; OR = 7.27 and 2.82 for females). Findings suggest that experiencing an unwanted sexual advance is associated with specific drinking motivations and more likely to occur among females. Further research is needed to fully understand pathways and implications.

Perceptions about residence hall wingmates and alcohol-related secondhand effects among college freshmen

OBJECTIVE

The authors examined the secondhand effects among college freshmen of others' alcohol use and related student characteristics, and perceptions about residence hallmates.

PARTICIPANTS

The authors surveyed 509 incoming freshmen residing in predominantly freshman residence halls.

METHODS

The authors administered a Web-based survey 2 months into the 2006 fall academic semester.

RESULTS

Most (80%) students experienced at least 1 secondhand effect. Participants' perceptions of wingmates' acceptance and expectation of alcohol use and participants' perceived inability to protect themselves against alcohol problems were related to experiencing secondhand effects, as were being a female and a drinker.

CONCLUSIONS

Incoming college freshmen frequently experienced secondhand effects of alcohol use. Involving residence halls in norms-based interventions aimed at reducing secondhand effects warrants evaluation. Further research is also needed to examine skill building among college students to avoid and intervene into others' drinking and to examine resident advisor roles as both engenderers of trust and cooperation as well as enforcers of alcohol rules.

The association between parent communication and college freshmen's alcohol use

Using a cross-sectional survey, data were collected from 265 first-year college students to determine if parent-student alcohol communication is associated with college drinking or drinking consequences and if this relationship is mediated by students' parental subjective norms, attitudes toward drinking, and perceived risk. Structural equation modeling was used to test hypotheses. Students whose parents talked with them more about the negative effects of alcohol reported more extensive college drinking (beta = 0.12, p < 0.05). Favorable alcohol attitudes were significantly related to both more extensive college drinking (beta = 0.49, p < 0.05) and more drinking consequences (beta = 0.39, p < 0.05). Lower reported perceived risk was significantly related to more drinking consequences (beta = -0.24,p <0.05). Findings indicate that parental communication regarding the negative effects of alcohol may be ineffective at reducing college drinking or drinking consequences.

Impact of the "peers as family" dormitory wing-based intervention on college student alcohol use and its secondhand effects

An intervention to reduce college alcohol use and secondhand effects was tested. Freshmen dormitory wings at a large Mid-Atlantic public university were assigned to single-gender (SG) or mixed-gender (MG) Information-Motivation-Behavior (IMB) workshops implemented during the first weeks of school, or a control condition. Students were surveyed before school began and at 2- and 6-month follow-up. Analyses indicated that, among males, the adjusted mean weekly alcohol use was lower in the SG than the control condition (1.89 vs. 2.72, p = .041). Among females, the adjusted mean weekly alcohol use was lower in the MG than the SG (1.60 vs. 2.44, p = .021) and control condition (1.60 vs. 2.27, p = .056). Further research should identify underlying mechanisms for effective alcohol behavior change among male and female wing-mates.

Prevalence and psychosocial correlates of alcohol-related sexual assault among university students

This study examined the psychosocial correlates of alcohol-related sexual assault. Undergraduate students (N = 551) were recruited to complete a web-based survey. The outcome was a composite of 2 items: "experienced an unwanted sexual advance" or "was the victim of sexual assault or date rape" as a result of another's alcohol use. The predictors were substance use, other alcohol-related interpersonal violence victimization, and alcohol-related protective behaviors. Multivariate logistic regression analyses were conducted. Females reported higher prevalence of alcohol-related sexual assault than did males (20.4% vs. 6.6%). Females who reported binge drinking (OR = 7.74) and other alcohol-related interpersonal violence (OR = 5.03) were more likely to report alcohol-related sexual assault whereas only other alcohol-related interpersonal violence was associated with alcohol-related sexual assault (OR = 43.75) among males. The findings suggest that alcohol-related sexual assault is associated with other risk factors that deserve further attention through longitudinal research and intervention efforts.

Review of Clinical Trials Testing the Effectiveness of Physician Intervention Approaches to Prevention Alcohol-Related Problems in Adolescent Outpatients

OBJECTIVE

Conduct a review of clinical trials to identify effective approaches for improving physician provision of alcohol education and counseling services among outpatient adolescents.

METHODS

Reviewed all peer-reviewed, published clinical trials identified through computerized searches evaluating alcohol education and counseling services to outpatient adolescents by physicians.

RESULTS

Three trials were identified examining changes in physician provision of alcohol education and counseling services. One of the trials resulted in increased adolescent self-reported refusal skills, while another trial resulted in reduction of adolescent self-reported alcohol use and binge drinking. Seven trials were identified that compared physician with non-physician provision of alcohol education and counseling services. Four of the trials showed some reduction in adolescent self-reported alcohol use.

CONCLUSION

Trials indicate that further reduction in adolescent alcohol use is possible with non-physicians as interventionists and perhaps physicians as interventionists, if physicians are supported by patient counseling guides and resources. Opportunities for personalized, interactive adolescent education with goal setting appears key to intervention success. The physician role that is tested in most trials is confined to a single brief encounter with little attention to: development of physician skills, systems-level resources, the parental role, or the impact of incorporating prevention into an ongoing adolescent-physician relationship.

Perceived parental approval of drinking and its impact on problem drinking behaviors among first-year college students

There is a paucity of research investigating the impact that parents may have on college drinking. In this study, the authors investigated the relationship between students' perceptions of parent approval of drinking and problem drinking occurrence. They conducted a Web-based survey of 265 first-year students living on campus during their second semester. The authors used logistic regression to examine the relationship between students' perceptions of their mothers' and fathers' attitudes toward their drinking, their mothers' and fathers' drinking habits, and problem drinking since they had begun college. Sixty-nine percent of respondents reported experiencing at least 1 drinking problem. Over one third of students perceived that their parents would approve of them drinking occasionally. Students perceiving more parental approval for their drinking were more likely to report at least 1 drinking problem. Student perceptions of parental approval of drinking warrant further investigation as a potentially mutable correlate of problem drinking.

Review of Clinical Trials Testing the Effectiveness of Clinician Intervention Approaches to Prevent Sexually Transmitted Diseases in Adolescent Outpatients

OBJECTIVE

Identify approaches for improving clinician provision of sexually transmitted diseases (STDs) prevention services among outpatient adolescents.

METHODS

Reviewed all peer-reviewed, published clinical trials identified through computerized searches (MEDLINE, PsychINFO) evaluating STD prevention services to outpatient adolescents by clinicians.

RESULTS

Five trials were identified examining changes in clinician provision of STD prevention services. Two of these trials resulted in adolescent self-reported risk reduction but neither of these trials effectively demonstrated reductions in objectively measured STD incidence. Nine clinical trials were identified that compared clinician with non-clinician provision of STD prevention services. Four of these trials resulted in adolescent self-reported risk reduction, and one of these trials demonstrated a reduction in objectively measured STD incidence.

CONCLUSIONS

Trials indicate that improvement in outpatient adolescent STD incidence is possible with non-clinicians as interventionists, and perhaps clinicians as interventionists if clinicians are supported by other educational resources. Opportunities for personalized, interactive adolescent education appears key to intervention success. The clinician role that is tested in most trials is confined to a single brief encounter with little attention to: development of clinician skills, quality of psychosexual risk assessment and tailoring to meet individual adolescent need, systems-level resources and supports, the parental role, or the impact of incorporating prevention into an ongoing adolescent-clinician relationship.

Randomized trial of brief office-based interventions to reduce adolescent alcohol use

OBJECTIVE

To determine whether office-based interventions change adolescents' alcohol beliefs and alcohol use.

DESIGN

Randomized, controlled trial.

SETTING

Five managed care group practices in Washington, DC.

PARTICIPANTS

Consecutive 12- to 17-year-olds (N = 409) seeing primary care providers (N = 26) for general check-ups. Most of the adolescents (79%) were African American, 44% were male, and 16% currently drank.

INTERVENTIONS

Usual care (Group I), adolescent priming with alcohol self-assessment just prior to check-up (Group II), adolescent priming and provider prompting with adolescent self-assessment and brochure (Group III).

MAIN OUTCOME MEASURES

Adolescent alcohol beliefs at exit interview and self-reported behaviors at 6- and 12-month follow-up.

RESULTS

At exit interview, Groups II and III reported that less alcohol was needed for impaired thinking and a greater intent to drink alcohol in the next 3 months than Group I. At 6 months, Group III reported more resistance to peer pressure to drink, and Groups II and III reported more bingeing than Group I. At 1-year follow-up, controlling for baseline levels, Groups II (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.44-6.24) and III (OR, 2.86; CI, 1.13-7.26) reported more bingeing in the last 3 months than Group I. Group II reported more drinking in the last 30 days (OR, 2.31; CI, 1.31-4.07) and in the last 3 months (OR, 1.76; CI, 1.12-2.77) than Group I.

CONCLUSION

Brief office-based interventions were ineffective in reducing adolescent alcohol use but may increase adolescent reporting of alcohol use.

Parental monitoring and adolescent drinking: results of a 12-month follow-up

OBJECTIVE

To examine the relationship between parental monitoring and adolescent drinking over time.

METHODS

Adolescents completed a baseline survey regarding their involvement with alcohol and parental monitoring. They were interviewed 12 months later, to obtain follow-up measures of drinking and involvement in alcohol-risk situations.

RESULTS

Highly monitored adolescents were less likely to report that they were drinking 12 months later. This relationship remained when controlling for age, gender, drinking at baseline, and being in various high-risk situations.

CONCLUSIONS

The longer term protective relationship between parental monitoring and alcohol involvement was demonstrated. The need to establish frequent parental monitoring is indicated.

Using the case-study methodology to teach ethics to public health students

This article uses the case-study methodology as a strategy to facilitate examination of ethical principles that underlie developmental risk research carried out among adolescents. Description of the ethical dilemmas that arose during the implementation of a longitudinal randomized controlled trial is presented along with discussion guidelines. As youth were being enrolled and the trial was being conducted, it was noted that a small but significant number had responded "yes" to a question on suicidal ideation. After review by the Institutional Review Boards overseeing the trial, it was decided that confidentiality had to be breached. A revised protocol was implemented explicitly stating that confidentiality would be broken if a youth reported suicidal ideation. The number of youth reporting suicidal ideation after the consent form was amended decreased significantly. Presentation of this research by use of the case study method sensitizes students to issues that arise at the intersection of disease prevention and health promotion intervention research.

Truth and consequences: ethics, confidentiality, and disclosure in adolescent longitudinal prevention research

PURPOSE

To examine data from a natural experiment resulting from a change made in the confidentiality agreement midway through a randomized, longitudinal, controlled trial to prevent or delay adolescent alcohol use. The investigators explored the impact of the change on adolescents' rates of participation and affirmative responses to a question on suicidal thoughts.

METHODS

Adolescents 12-17 years old were administered a question on suicidal thoughts as part of a confidential exit interview after a general health examination with their primary care provider. After administration to 263 adolescents, the exit interview was made conditionally confidential with the remaining 181 adolescents. The revised consent form and protocol stipulated that researchers would reveal to appropriate professionals and parents any adolescent indicating suicidal thoughts. Prevalence estimates for the suicidal thoughts question and study participation rates were computed for conditions both before and after the change.

RESULTS

Fewer adolescents responded affirmatively to the suicidal thoughts question when they were recruited using the revised (1%) than the original (8%) consent form and protocol (p=.001). The revised confidentiality agreement did not affect participation rates.

CONCLUSIONS

Adolescents who assent to participate in research studies may be less likely to disclose personal information regarding suicidal thoughts if they know that their disclosure may result in a break in confidentiality. Specific guidelines are needed for conditional and unconditional confidentiality agreements to study mental health in adolescent longitudinal prevention research.

Effect of patient priming and primary care provider prompting on adolescent-provider communication about alcohol

OBJECTIVE

To determine whether priming adolescent patients to discuss alcohol with their primary care providers and prompting providers to discuss alcohol increases adolescent-provider communication about alcohol.

DESIGN

Randomized controlled trial.

SETTING

Five managed care group practices in Washington, DC.

PARTICIPANTS

Consecutive patients aged 12 to 17 years who were seeing primary care providers (n = 26) for health checkups. Of 892 eligible adolescents, 444 (50%) were randomized and completed data collection. Most adolescents (80%) were African American, 55% were male, and 17% currently drank alcohol.

INTERVENTION

Usual care (group 1) vs adolescent priming with alcohol self-assessment and education just before their health checkups (group 2) vs adolescent priming and provider prompting with the adolescent's self-assessment and a patient education brochure (group 3).

MAIN OUTCOME MEASURES

This exploratory substudy of a longitudinal study on adolescent alcohol behaviors examined adolescent-provider communication by adolescent exit survey, researcher observation, and audiotapes of a subsample of visits.

RESULTS

More adolescents in group 3 (96%) than group 1 (87%) reported that their provider talked about alcohol (adjusted odds ratio [OR], 1.10; 95% confidence interval [CI], 1.04-1.17). More adolescents in group 3 (18%) than group 1 (10%) reported asking about alcohol (adjusted OR, 1.08; 95% CI, 1.00-1.16). The mean +/- SD number of minutes adolescents were with their providers without parents being present was greater for group 3 (10.8 +/- 7.6) than group 1 (8.8 +/- 8.0). Adolescents in group 2 spent more time with their provider and reported initiating more discussion not specific to alcohol than did group 1 adolescents.

CONCLUSION

Adolescent priming and provider prompting increases adolescent-provider communication about alcohol.

Parental monitoring and adolescent alcohol risk in a clinic population

OBJECTIVES

To assess the association between parental monitoring and adolescent alcohol risk.

METHODS

Adolescent managed-care patients completed a survey of their involvement with alcohol and their perceptions of monitoring and other forms of parental influence.

RESULTS

Frequent monitoring was associated with less likelihood that adolescents had engaged in a variety of alcohol-risk behaviors or had been in a variety of risk situations. Choosing to share alcohol-related concerns with other adults and placing importance on parents' opinions were not as consistently related to alcohol risk.

CONCLUSIONS

The need to enhance parental monitoring as a proactive protective parental response is indicated.

Provider perceptions of key barriers to providing state-of-the-art clinical care for HIV-infected African-American patients

U.S. AIDS rates have declined among same population groups; however, African-Americans and other ethnic minorities have experienced the least amount of decline. As a result medical and public health authorities are tasked with developing strategies to help eliminate the disparity in HIV/AIDS incidence rate and clinical outcomes. Thus, in 1999, the National Minority AIDS Education and Training Center (NMAETC) was developed to facilitate training, clinical consultation and technical assistance to clinicians that provide care to HIV-infected minority patients. Its initial activities were designed solely to increase providers' clinical capacity to use state-of-art anti-retroviral therapies to treat and manage the disease. However, through focused discussions with target providers and a survey of medical care service sites, the NMAETC confirms that provider' training and assistance needs extend into non-medical domains.

Provider willingness to screen all sexually active adolescents for chlamydia

OBJECTIVES

To assess differences in provider willingness to screen all sexually active male and female adolescents for chlamydia and to determine whether concerns about cost effectiveness of screening are related to provider willingness to screen for chlamydia.

METHODS

All primary care providers in a managed care organisation self administered a survey about screening all sexually active adolescents for chlamydia.

RESULTS

Respondents were 217 physicians (MDs) and 121 nurse practitioners (NPs) or physician assistants (PAs). Excluding obstetrician/gynaecologists, more providers were willing to routinely screen adolescent females than males for chlamydia (67% v 49% respectively; p<0.001). Independent predictors of provider willingness to screen both males and females included belief that routine screening is cost effective and being a NP/PA v an MD. Belief that chlamydia screening is easier in females than males independently predicted less willingness to screen males.

CONCLUSION

Information that reduces provider concern about the cost effectiveness of screening may increase provider willingness to screen adolescents for chlamydia. Availability of urine based tests may reduce provider beliefs that females are easier to screen than males and increase chlamydia screening in males.

Oral sexual experience among young adolescents receiving general health examinations

OBJECTIVE

To examine whether oral sex occurs among young adolescents receiving general health examinations and warrants inclusion in sexual risk assessments.

METHODS

Confidential, interviewer-assisted questionnaires completed by 12 to 15-year-olds (n=335).

RESULTS

Overall, 18% of adolescents reported having oral sex. Among adolescents who had oral sex, 25% reported no vaginal sex. Few adolescents reported using barrier protection during oral sex. Most adolescents thought that penile-vaginal sex (96%) and penile-anal sex (81%) can transmit HIV, but 68% thought that penile-mouth sex can transmit HIV.

CONCLUSION

Unprotected oral sex among young adolescents warrants attention in research and clinical sexual assessment.

Adolescent chlamydia testing practices and diagnosed infections in a large managed care organization

GOAL

To determine chlamydia screening practices and the resulting positive test results for adolescents enrolled in a large nonprofit managed care organization.

STUDY DESIGN

The electronic medical records of all 12- to 19-year-olds enrolled in a large nonprofit managed care organization serving a demographically diverse patient population from January 1998 through December 1999 were reviewed retrospectively.

RESULTS

Among the 43,205 female and 44,133 male managed care organization members, ages 12 to 19 years in 1998-1999, 7575 adolescents (8.7%) (6914 females [16%] and 661 males [1.5%]) were tested for chlamydia. Among the members tested, chlamydia was diagnosed in 1109 adolescents (14.6%) (983 females [14.2] and 126 males [19.1%]); 761 (68.6%) adolescents were retested for chlamydia; and 182 (16.4%) had repeat positive test results. The median time to diagnosis of a repeat infection was 6 months.

CONCLUSIONS

Chlamydia imposes a large disease burden in the private, organized healthcare sector. Managed care organizations can use operational data to enhance chlamydia prevention services by defining testing practices and local disease prevalence.

A STD/HIV prevention trial among adolescents in managed care

OBJECTIVE

To determine if sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, risk assessment, and education tools provided as part of office-based primary care reduce adolescent risky sexual behaviors.

DESIGN

A randomized intervention trial with 3- and 9-month follow-up.

SETTING

Five staff-model managed care sites in Washington, DC (n = 19 pediatricians).

PATIENTS

Consecutive 12- to 15-year-olds receiving a general health examination; 81% minority. Participation rate = 215/432 (50%). Nine-month follow-up rate = 197/215 (92%).

INTERVENTION

Audiotaped STD risk assessment and education about staying safe (safer = condoms, safest = abstinence).

MAIN OUTCOME MEASURES

Adolescent-reported sexual intercourse and condom use.

RESULTS

More intervention adolescents reported pediatrician discussion on 11/13 sexual topics. Although more vaginal intercourse (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.04-5.84) was reported in the intervention group at 3 months, this was not true of overall sexual intercourse (OR = 1.55, 95% CI =.73-3.32). More sexually active adolescents reported condom use in the intervention group at 3 months (OR = 18.05, 95% CI = 1.27-256.03). At 9 months, there were no group differences in sexual behaviors; however, more signs of STD were reported by the control (7/103) than the intervention group (0/94).

CONCLUSIONS

STD risk assessment and education tools administered in a single office visit facilitated STD/HIV prevention education. Any impact on sexual activity and condom use was short-lived. Further research is needed to develop brief, office-based sexual risk reduction for young adolescents.

Ability to measure sensitive adolescent behaviors via telephone

INTRODUCTION

Difficulty in measuring sensitive behaviors in 12-15-year-old adolescents is a barrier to research. This study determined whether early adolescents reported substance use and sexual activity similarly in assisted paper-and-pencil versus touch-tone telephone responses.

METHODS

Adolescents 12-15 years old completed confidential, interviewer-assisted questionnaires first in a physician office by paper-and-pencil and then at home by touch-tone approximately 3 months later. Adolescents were from a high-risk urban area, 71% were minority, and all had parent consent to participate.

RESULTS

The follow-up participation rate was 94% (follow-up n = 207). Test-retest stability was generally poor for low-frequency behaviors such as injection drug use, anal intercourse, and sexual behaviors in 12-13-year-olds. Test-retest stability was fair to good for common substance use items. Test-retest stability was generally good among females and 14-15-year-old adolescents, and poor to fair among males and 12-13-year-olds, for common sexual experiences in the last 3 months. Test-retest stability was generally good to excellent for all lifetime sexual experiences except among 12-13-year-olds in which it was generally poor. Internal consistency of the self-esteem scale was high using both response technologies. Both response technologies reproduced correlations between substance use and lifetime sexual experience.

CONCLUSION

A high participation rate and reliable data capture were achieved when assessing sensitive behaviors of 14-15-year-olds using touch-tone telephone response. Sexual behaviors were more reliably captured using a "lifetime" versus "last 3-month" reference period. Low prevalence contributed to poor reliability in 12-13-year-olds.

Young adolescents' comfort with discussion about sexual problems with their physician

OBJECTIVE

To identify factors associated with young adolescents' sense of comfort about discussing sexual problems with their physician.

DESIGN

Confidential, assisted self-report questionnaires on physician-adolescent communication developed by the investigators and completed by participants at visits for general health examinations.

SETTING

Five primary care pediatric practices at health maintenance organizations in Washington, DC.

PATIENTS

A consecutive sample of all adolescents 12 to 15 years old who received a general health examination. Of 412 eligible patients, 221 received parental consent and participated.

MAIN OUTCOME MEASURE

Adolescents' sense of comfort about talking to their physician about a sexually transmitted disease or some other sexual problem. This outcome was chosen for a substudy of a larger longitudinal prevention trial.

RESULTS

Most adolescents valued their physicians' opinions about sex (89%) and said it was easy to talk to the physician during their visit (99%), but about half said they would be uncomfortable talking to the physician if they had a sexually transmitted disease or some other sexual problem (43%) [corrected]. Adolescents' sense of comfort was greater when physicians discussed sexual issues in the general health examination, adolescents perceived their personal risk of sexually transmitted disease to be high, adolescents had high self-esteem, and physicians were adolescents' usual physicians.

CONCLUSIONS

This study emphasizes the need for physicians to discuss sexual risks with young adolescents and suggests ways physicians can help young adolescents feel more comfortable talking with them about sexual concerns.

Improving office-based physician's prevention practices for sexually transmitted diseases

OBJECTIVE

To determine whether office-based interventions increase primary care physicians' risk assessment of and counseling practices for patients regarding sexually transmitted diseases and the human immunodeficiency virus (HIV).

DESIGN

Randomized controlled clinical trial.

SETTING

Washington, D.C., Metropolitan Statistical Area.

STUDY PARTICIPANTS

Office-based primary care physicians (family or general practice, internal medicine, and obstetrics-gynecology).

INTERVENTION

Mailed educational materials alone or coupled with a simulated patient instructor office visit.

MEASUREMENTS

Self-reported and observed frequency of assessing and counseling patients regarding their risk factors for sexually transmitted diseases and HIV infection. Participants were interviewed by telephone before and after the intervention (n = 757). A subset of participants (n = 194) was also observed after the intervention by simulated patient evaluators in blinded office visits.

RESULTS

89% of physicians who received both educational materials and a simulated patient instructor visit reported that they reviewed the educational materials compared with 53% of those who only received the educational materials (P < or = 0.001). Physicians in the combined intervention group had higher self-reported and observed rates for several risk assessment questions and counseling recommendations than did physicians in the control group or the group that only received educational materials. Seventy-three percent of physicians of the combined intervention group reported an increase in counseling patients about reducing risky sexual behavior compared with 53% of the group receiving only educational materials and 42% of the control group (P < or = 0.001).

CONCLUSIONS

Mailed educational materials combined with an office visit by a simulated patient instructor for role-play and feedback on clinical performance increased the frequency of office-based physicians' risk assessment and risk reduction counseling of patients for sexually transmitted diseases and HIV infection.

Self-reports of HIV risk factors by patients at a sexually transmitted disease clinic: audio vs written questionnaires

OBJECTIVES

The purpose of this study was to determine how the method of assessment affects patient report of human immunodeficiency virus (HIV) risks.

METHODS

Patients at a sexually transmitted disease clinic randomly received either a written self-administered questionnaire or an audio self-administered questionnaire delivered by cassette player and headset. These questionnaires were followed by face-to-face interviews.

RESULTS

Audio questionnaires had fewer missing responses than written questionnaires. Audio questionnaires also identified more unprotected vaginal intercourse and sexual partners suspected or known to have HIV infection or acquired immunodeficiency syndrome than did written questionnaires. Although both the audio and written questionnaires identified more risks than the face-to-face interviews, the difference in the mean number of reported risks between the audio questionnaires and the face-to-face interviews was greater than that between the written questionnaires and the face-to-face interviews.

CONCLUSIONS

Audio questionnaires may obtain more complete data and identify more HIV risk than written questionnaires. Research is warranted about whether audio questionnaires overcome barriers to the completion and accuracy of HIV risk surveys. This study emphasizes the need to elucidate the relative strengths and weaknesses of written questionnaires, audio questionnaires, and face-to-face interviews for HIV risk assessment.