Delay Discounting and Sexual Decision-Making: Understanding Condom Use Behavior Among U.S. College Students

Condoms provide protection against sexually transmitted diseases; however, condomless sex remains common among college students and intentions to use condoms do not consistently translate into condom use. This study tested which indicator of condom use intentions from a delay discounting paradigm of condom-protected sex best accounted for variance in condom use behavior. The sample consisted of 187 sexually active college students (51.9% female) who completed measures of condom use during vaginal and anal sex over the past three months and a decision-making paradigm regarding condom intentions with hypothetical sexual partners. In separate models, condom behavior was regressed on one of three indicators of condom intentions: initial intentions to use a condom, delay discounting of condom-protected sex, and overall area under the curve across all trials. Results showed that delay discounting of condom-protected sex best accounted for variance in absolute frequency of condomless sex, whereas initial intentions to use a condom best accounted for variance in relative proportion of condomless sex. Future research directions and implications for interventions are discussed.

Framed Messages to Increase Condom Use Frequency Among Individuals Taking Daily Antiretroviral Medication for Pre-exposure Prophylaxis

PrEP delivery and routine care provide a unique opportunity to promote sexually transmitted infection (STI) prevention by both increasing STI testing frequency and creating a space for affirmative and effective safer sex counseling. This study was a feasibility and acceptability pilot of an adapted framed message intervention to increase condom use frequency with PrEP. In the formative phase, two focus groups with PrEP users (N = 7) provided feedback on a provisional loss-framed message intervention and identified potential study barriers. In the pilot trial, the adapted loss-framed message intervention was compared to a gain-framed message intervention and enhanced skills condition in a sample of PrEP users (N = 29). In terms of intervention feasibility, 58% of approached PrEP users completed the eligibility screen; 79% of those eligible enrolled in the study and 66% of enrolled participants completed the three-month follow-up. In terms of intervention acceptability, participants found the informational messages, regardless of assignment, to be moderately interesting (M = 6.24, SD = 2.97) and useful (M = 7.07, SD = 3.00), and very easy to understand (M = 9.50, SD = 0.97) on Likert-type scales ranging from 1 to 10. In terms of intervention effects, there was a small effect of the gain-framed intervention (b = .58, SE = .93, CI = -1.33, 2.48, Cohen's d = .26) on HIV/STI risk transmission. There was a small-medium effect of both the loss- (b = 2.00, SE = .90, CI = .15, 3.85, Cohen's d = 1.46) and gain-framed (b = 2.24, SE = .93, CI = .34, 4.15, Cohen's d = 1.65) interventions on condom use motivation. Finally, there was a medium-large effect of both the loss- (b = .97, SE = 1.33, CI = -1.88, 3.82, Cohen's d = .54) and gain-framed intervention (b = 1.97, SE = 1.33, CI = -.88, 4.82, Cohen's d = .87) on condom use frequency. Further refinement and testing, in a larger -scale trial with higher ecological validity than this initial pilot intervention, is warranted.

Medication Beliefs, HIV-Related Stigmatization, and Adherence to Antiretroviral Therapy: An Examination of Alternative Models

HIV-related stigma and beliefs about medication necessity and concerns have separately demonstrated significant associations with antiretroviral adherence in people with HIV. However, no work has examined both of these associations in the same model. Based on the necessity-concerns framework, this study examined four alternative models of relationships among HIV-related stigma, medication beliefs, and adherence. Cross-sectional analyses were used to test the four alternative models to best depict associations among HIV-related stigma, medication beliefs, and medication adherence. Models tested included two indirect effects models, an interaction model, and a simple predictors model with no interaction or indirect effects. The outcome variable was HIV medication adherence, and model fit was determined by variance accounted for, Akaike information criterion (AIC), and Bayesian information criterion (BIC) values. An interaction model between internalized stigma and medication concerns accounted for the most variance in adherence. There was also a significant indirect effect of internalized stigma on adherence via medication concerns. Medication concerns are a promising target for interventions focusing on increasing adherence among people with HIV.

Does Initiating Vaginal Sexual Intercourse During a Safer Sex Media Campaign Influence Life Satisfaction Among African American Adolescents?

PURPOSE

Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, intervention impacts on life satisfaction are relatively unexplored. This study is a secondary analysis of data (N = 1,658) from a randomized, multisite, multilevel safer sex media campaign (Project iMPPACS) analyzing life satisfaction across baseline and follow-up data collected from 2006 to 2008 among participants (mean age 15.08 years) who reported never having had vaginal sex at baseline (n = 787).

METHODS

Participants were separated into groups based on whether they reported having vaginal sex (yes/no) at baseline. Then taking into account the nested study design and controlling for confounders, a mixed model repeated measures analysis of variance assessed whether differences in mean total life satisfaction (LS) were associated across time in the media and nonmedia study conditions separately by gender.

RESULTS

A significant interaction between time and media condition was detected (p = .039) where mean total LS increased +.065 units from baseline (M = 5.364) to last contact in media cities and decreased -.084 units from baseline (M = 5.557) to last contact in nonmedia cities when controlling for the effect of initiating vaginal sex. No significant differences in LS at baseline were observed between media and nonmedia intervention cities. Results by gender suggest most positive change in LS was observed for females with mixed findings for males.

CONCLUSIONS

Although Project iMPPACS was not designed with the intent on improving participants' life satisfaction, results advance the LS literature by demonstrating a temporal sequence for sexual risk taking and LS over time.

Pain self-efficacy, race, and motivation to quit smoking among persons living with HIV (PLWH)

Pain and cigarette smoking are commonly co-occurring and costly public health issues, and rates of both conditions are elevated among persons living with HIV (PLWH). Recent work has focused on elucidating the role of cognitive factors in pain-smoking interrelations, and PLWH have endorsed various beliefs regarding pain and smoking. There is reason to suspect that pain self-efficacy (i.e., belief in one's ability to cope with pain) may be associated with the maintenance of smoking. However, no previous research has examined relations between pain self-efficacy and motivation to quit. The goal of this study was to conduct the first test of cross-sectional associations between pain self-efficacy and motivation to quit smoking among PLWH. Race was tested as a moderator of the hypothesized associations. Participants (N = 76 daily smokers; 37% female; M_age = 50.6; M_CPD = 13.7) were recruited from an outpatient infectious disease clinic for a primary study examining the effects of a personalized feedback intervention for PLWH. Results indicated that pain self-efficacy was positively associated with perceived importance of quitting and intention to quit within the next six months across the entire sample (ps < 0.05), and positively associated with readiness to consider smoking cessation and confidence in quitting among Black/African American participants (but not among other participants; ps < 0.05). These data provide initial evidence that pain self-efficacy may be related to motivation and intention to quit smoking, particularly among Black/African American PLWH. Future research should test prospective associations between pain self-efficacy and the initiation/maintenance of smoking cessation.

The Association Between African American Parent-Child Sex Communication and Adolescent Condomless Sex

African American adolescents are at elevated risk for HIV and sexually transmitted infections. Risk reduction efforts have focused on parent-child communications, despite inconsistent findings regarding their association with adolescent sexual risk behaviors. The present study included sexually active African American adolescents and their parents/guardians (N = 125 dyads). All participants reported on frequency of sexual health conversations and adolescents reported recent occasions of protected and condomless sex. Analyses examined the congruence between parent-child communication reports and the association between this congruence and adolescent condomless sex. Parents and adolescents disagreed on the frequency of sexual health communication: 30% of parents reported such conversations as frequent, whereas only 2% of adolescents did. Parent-reported sex communication was negatively associated with adolescent condomless sex, while adolescent-reported communication was not. The moderation hypothesis was supported in that adolescent-reported sex communication was negatively associated with adolescent condomless sex only among parent-child dyads high in agreement on sexual health communication. Promoting parent-child conversations regarding sexual health, with attention to relational characteristics of the conversations, offers a promising approach to sexual health promotion and disease prevention for African American youth.

Neighborhood Stress and Life Satisfaction: Is there a Relationship for African American Adolescents?

This study identified associations between perceived neighborhood stress and adolescents' perceptions of life satisfaction. African American adolescents aged 13-18 (n=1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.

Can a Multilevel STI/HIV Prevention Strategy for High Risk African American Adolescents Improve Life Satisfaction?

Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and η 2 was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected (F = 5.19, p = .02, η 2 = .03), along with three interactions: between experimental condition and media intervention (F = 7.96, p = .005, η 2= .04); experimental condition, sex, and media intervention (F = 6.51, p = .01, η 2 = .04); and experimental condition, sex, assessment point, and media intervention (F = 3.23, p = .01, η 2 = .02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants' life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males.

Depressive symptoms as a longitudinal predictor of sexual risk behaviors among African-American adolescents

OBJECTIVE

Understanding individual level factors associated with sexual risk behaviors among African-American adolescents remains an important public health priority. The current secondary data analysis examined the longitudinal association between a baseline assessment of depressive symptoms and sexual risk behaviors reported 6 months later; the purpose was to determine whether the association of depressive symptoms to risky sex varies as a function of gender. A secondary aim was to examine self-efficacy for sex refusal and condom use assessed at a 3-month follow-up as mediators of the depressive symptoms-sexual risk relationship.

METHODS

The sample consisted of 782 sexually active African-American adolescents (Mage = 15.3 years, SD = 1.08; 54% female) recruited to participate in a sexual health intervention trial. Data analyses focused on vaginal sex, and outcomes included: (a) sexual activity with 2 or more partners in the previous 3 months; (b) the relative frequency of condom use in the previous 3 months; (c) noncondom use at last occasion of sex; and (d) positive sexually transmitted infection (STI) screening.

RESULTS

Depressive symptoms predicted sex with 2 more partners for female participants, but no other risk markers for the sample as a whole. However, there was a significant indirect effect of depressive symptoms on condomless sex via decreased condom use self-efficacy for both male and female adolescents.

CONCLUSIONS

These findings have important implications for HIV/STI prevention, in which behavioral interventions may benefit from modules that include a focus on the influence of mood on self-efficacy for safer sex practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Is the Brief Multidimensional Student's Life Satisfaction Scale Valid and Reliable for African American Adolescents?

BACKGROUND

Health promotion/education strive to promote healthful conditions that improve quality of life1 based on the perceptions of those whose lives are affected.2-4 Though health promotion/education might have instrumental value in reducing risks for premature morbidity and mortality, their ultimate value lies in contributions to quality of life.1 Life satisfaction (LS) has been defined as an individual's assessment of their quality of life based upon personal criteria5,6 and linked to adolescent health risk behaviors7,8 and developmental assets.9.

PURPOSE

We investigated the psychometrics of the Brief Multidimensional Students' Life Satisfaction Scale [BMSLSS] with an adolescent sample of African Americans (N=1,658) from four mid-sized cities in the United States (US). Reliability and validity of the BMSLSS has not been determined for samples of exclusively African American adolescents.

METHODS

Data analysis included calculating mean ratings, standard deviations and effect sizes (Cohen's d) and inspecting the scale's internal structure, reliability, and relationships to other variables.

RESULTS

Evidence of internal structure, internal consistency reliability, and hypothesized relationships to other variables for participants were determined.

TRANSLATION TO HEALTH EDUCATION PRACTICE

The BMSLSS is a useful indicator of LS for research and health education assessment purposes among African American adolescents where brevity of psychometric measures is imperative.

Necessity and concerns beliefs and HIV medication adherence: a systematic review

According to the Necessity-Concerns Framework, beliefs about medication necessity and concerns are two core themes from diverse patient medication beliefs across chronic illnesses that may directly influence adherence. Past work has supported associations of necessity and concerns to adherence in the chronic disease literature and in HIV research. However, there has not been a focused review of the literature on associations of necessity and concerns to HIV medication adherence, nor on what variables may influence these associations. This systematic review synthesized findings from 26 studies regarding associations of necessity and concerns to HIV medication adherence. Both beliefs showed small, clinically significant effects on adherence. A subset of studies identified perceptions of healthcare providers as determinants of necessity and concerns beliefs with indirect effects on adherence. Overall, necessity and concerns demonstrated clinically significant associations to adherence among people with HIV.

Problem Solving Reduces Sexual Risk Associated with Sensation Seeking, Substance Use, and Depressive Symptoms Among African-American Adolescents

OBJECTIVE

African-American adolescents experience higher rates of sexually transmitted infections (STIs) compared to same-age Caucasian peers. Substance use, sensation seeking, and depression have all been linked to risky sexual practices. Theory suggests that problem-solving skills may help to buffer against these risk factors.

METHOD

To test this hypothesis, we used data from African-American adolescents (N = 1018; M age = 16.7, SD = 1.1; 58% female) who participated in a prevention trial.

RESULTS

Nearly half of the sample (47%) reported lifetime marijuana use, while 13% reported drug use prior to most recent sexual encounter. Sexual sensation seeking was directly associated with drug use prior to sex (β = 1.13, b = 0.13,
SE = 0.02, p < .001) and lower problem-solving skills (β = -0.08, b = -0.06,
SE = 0.02, p = .01). Problem-solving skills were associated with drug use prior to sex (β = 0.92, b = -0.08, SE = 0.03, p = .004), such that those with greater problem-solving skills were less likely to report drug use prior to most recent sex. Lastly, problem solving skills mediated the association between sexual sensation seeking and drug use prior to sex, though the effect was small (β = 0.01, 95% CI: .001, .01).

CONCLUSIONS

Problem-solving skills can have a protective influence on risky behavior for adolescents. Future research might examine the utility of strengthening problem-solving skills in order to reduce STI/HIV risk among African American adolescents.

The Effect of Partner Serostatus and Relationship Duration on HIV Medication Adherence

High adherence rates to antiretroviral medications are necessary for people living with HIV/AIDS. The current study focuses on relationship-level predictors of HIV medication adherence by testing whether adherence rates differ by dyadic serostatus (seroconcordant vs. serodiscordant couples) among individuals with HIV in romantic relationships. Results showed a significant interaction between dyadic serostatus and relationship duration on adherence, such that individuals in long-term serodiscordant relationships reported better adherence than short-term serodiscordant relationships or seroconcordant partners in long-term relationships. Future research is needed to understand what relationship dynamics explain differences in adherence rates based on dyadic serostatus.

A Pilot Intervention Trial to Promote Sexual Health and Stress Management Among HIV-Infected Men Who Have Sex with Men

Men who have sex with men (MSM) experience HIV disparities. This study pilot-tested a two session, group-delivered intervention to promote sexual health and stress management skills for HIV-infected MSM. Participants (N = 80) were randomized to an immediate or delayed intervention condition. Analyses of covariance examined intervention efficacy. Compared to the delayed condition, intervention condition participants reported: greater HIV transmission knowledge (p < .001), higher HIV disclosure self-efficacy (p = .004), stronger intentions to refuse unprotected sex (p = .05), decreased frequency of unprotected anal or oral sex (p = .03), decreased perceived stress levels (p = .03), and higher coping self-efficacy (p = .003). Differences in the number of unprotected anal sex episodes, condom attitudes, and level of social support did not differ between conditions. Findings provide evidence of intervention acceptability and suggest the brief intervention may enhance stress management skills and modify sexual risk behavior antecedents for HIV-infected MSM.

African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional study

PURPOSE

To better understand sexual health disparities among African-American sexual minority adolescents.

METHODS

African-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history.

RESULTS

Compared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV.

CONCLUSIONS

African-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.

Associations between Pain-Related Anxiety, Gender, and Prescription Opioid Misuse among Tobacco Smokers Living with HIV/AIDS

BACKGROUND

People living with HIV/AIDS (PLWHA) who smoke cigarettes are vulnerable to greater pain and aberrant use of prescription pain medications. Prescription opioid misuse is highly prevalent among PLWHA and can lead to a variety of adverse outcomes. Pain-related anxiety, which has been implicated in the maintenance of both pain and tobacco dependence, may also play a role in prescription pain medication misuse.

OBJECTIVES

This study aimed to test associations between pain-related anxiety and prescription opioid misuse. We hypothesized that, among those prescribed opioid medication, pain-related anxiety would be positively associated with current opioid misuse, and stated intentions to misuse prescription opioids in the future. We further hypothesized that these relations would be more pronounced among males (vs. females).

METHODS

Participants included 61 PLWHA daily tobacco smokers with pain. Hierarchical regressions were used to test interactions between gender and pain-related anxiety on current and intended opioid misuse among those prescribed opioid medications.

RESULTS

There was a significant interactive effect of pain-related anxiety and gender on opioid misuse, such that pain-related anxiety was positively associated with current opioid misuse among male (but not female) participants who were prescribed opioid medications. Among both males and females, pain-related anxiety was positively associated with intention to misuse prescription pain medications in the future. Conclusions/Importance: Additional research into the role of pain-related anxiety in prescription opioid misuse is warranted. This type of work may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.

Computer-based personalized feedback intervention for cigarette smoking and prescription analgesic misuse among persons living with HIV (PLWH)

Pain, tobacco cigarette smoking, and prescription opioid misuse are all highly prevalent among persons living with HIV (PLWH). Smoking and pain medication misuse can lead to deleterious outcomes, including more severe pain and physical impairment. However, we are not aware of any interventions that have attempted to address these issues in an integrated manner. Participants (N = 68) were recruited from an outpatient infectious disease clinic and randomized to either a computer-based personalized feedback intervention (Integrated PFI) that aimed to increase motivation, confidence, and intention to quit smoking, and decrease intentions to misuse prescription analgesic medications, or a Control PFI. Results indicated that PLWH who received the Integrated PFI (vs. Control PFI) evinced greater post-treatment knowledge of interrelations between pain and tobacco smoking. Moreover, participants who received the Integrated PFI and smoked at least 10 cigarettes per day (but not < 10 CPD) reported greater confidence and readiness/intention to quit smoking. Effects of the Integrated PFI on knowledge of pain and opioid misuse, and attitudes/intentions regarding prescription pain medication misuse were not statistically-significant. Taken together, these results indicate that this novel intervention strategy may offer promise for addressing a critical public health need in a population that is generally underrepresented in clinical research.

Depressive Symptoms and Condomless Sex Among Men Who Have Sex with Men Living with HIV: A Curvilinear Association

Depressive symptoms are highly prevalent among HIV-positive men who have sex with men (MSM) and may contribute to risky health behaviors. However, research linking depressed mood to condomless sex in HIV-positive MSM has yielded mixed findings and has focused primarily on testing for a linear association. In the current study, we tested both linear and curvilinear models to assess the association of depressive symptoms to condomless anal sex for the most recent sexual episode in a sample of MSM living with HIV (N = 96, M age = 44, 57% Caucasian). Participants completed the Center for Epidemiological Studies-Depression Scale and self-reported on their sexual behaviors. Findings confirmed a curvilinear association of depressive symptoms with condomless anal sex for encounters involving non-primary partner: MSM with moderate levels of depressed mood were more likely to report non-condom use compared to those with low and high levels of depressive symptoms. Future research should test whether treatment for depression can serve to enhance the impact of sexual health promotion interventions for MSM.

Correction to: Association of Depressive Symptoms with Lapses in Antiretroviral Medication Adherence Among People Living with HIV: A Test of an Indirect Pathway

The original version of this article unfortunately contained a mistake in Fig. 1. The figure was incorrectly presented with the results of an additional path model for forgotten antiretroviral therapy (ART) doses that was dropped from the primary analyses.

HIV-Related Stigmatization and Medication Adherence: Indirect Effects of Disclosure Concerns and Depression

Background

Stigmatization due to HIV status may interfere with disease management among persons living with HIV (PLWHA) by heightening serostatus disclosure concerns and vulnerability to depressive symptoms.

Purpose

In this cross-sectional study, indirect effects of disclosure concerns and depressive symptoms were examined for the association of stigma to treatment adherence (medication and clinic appointment adherence) in an outpatient sample of PLWHA.

Method

Participants (N = 179; 47% White, 41% African-American; 35% MSM) completed measures of stigma-related experiences, concerns about disclosing HIV status, depression, and medication adherence; clinic appointment attendance was obtained from chart data.

Results

Stigma had an indirect effect on medication adherence (but not clinic attendance) via disclosure concerns. Stigma had indirect effects on both medication adherence and clinic attendance via depressive symptoms. In path analyses including both disclosure concerns and depressive symptoms, combined indirect effects emerged for both medication adherence and clinic attendance. There was a significant indirect pathway from stigma to disclosure concerns to depression to clinic attendance, whereas the positioning of the mediators was swapped for the significant indirect pathway from stigma to medication adherence.

Conclusions

These analyses provide evidence that stigmatizing experiences negatively affect treatment adherence through the indirect effects of disclosure concerns and depressive symptoms. Disclosure concerns and depressive symptoms are two mechanisms worthy of further research to enhance understanding of the association between stigma and treatment adherence difficulties.

Gender Moderates the Association of Depressive Symptoms to Sexual Risk Behavior Among HIV-Positive African-American Outpatients

Previous research has reported an association between depressive symptoms and sexual risk behavior. The purpose of this study was to explore whether gender moderates this association in a sample of HIV-positive African-Americans. Participants (N = 93) self-reported depressive symptoms (Center for Epidemiological Studies-Depression Scale; CES-D), and sexual risk behavior for the past 4 months. Analyses revealed that the depressive symptoms-by-gender interaction was associated with condomless sex and substance use proximal to sex. When analyses were stratified by gender, depressive symptoms were associated with condomless sex and frequency of substance use only for women. We conclude that depressive symptoms may be a more powerful sexual risk factor among women relative to men.

Associations Between Health Literacy and Health Behaviors Among Urban High School Students

BACKGROUND

Health literacy is crucial to develop health-related knowledge, adopt healthy lifestyles, and benefit from health care services. However, research on the association between health literacy and adolescent health outcomes, particularly on their prospective associations, is rare. We assessed health literacy using 3 validated measures, and examined cross-sectional and prospective associations between health literacy and adolescent health behaviors and outcomes.

METHODS

We conducted a short-term prospective study of 250 adolescents (mean age = 14 years; 57% female; 48% African American) who were entering or in the ninth grade in an urban school district. Health literacy was assessed by individual interviews at baseline, and health-related behaviors and outcomes were assessed by a paper-and-pencil survey at baseline and at a 6-month follow-up.

RESULTS

Nearly half of the sample was reading at least 2 grades below expected levels. Lower baseline health literacy was associated with a lower self-rating of general health, unhealthier diet, heavier weight, and greater engagement in problem behaviors and sexual behaviors at baseline. Lower baseline health literacy also was associated with a greater increase in substance use over time.

CONCLUSIONS

Results point to the pressing need to improve health literacy in urban high school students.

Partner Support, Willingness to Sacrifice, and HIV Medication Self-Efficacy

When taken as prescribed, highly active anti-retroviral medications allow individuals with HIV to live long, healthy lives. Nevertheless, poor adherence is common. In the current study, we examined why some people fail to feel efficacious to adhere, focusing on their interpersonal relationships. Given past findings that some individuals with primary partners adhere better than those without, whereas others adhere worse, we examined whether relationship dynamics influence the association between support from a primary partner and adherence self-efficacy. Specifically, we hypothesized and found that relationship partners' support regarding medication adherence undermines self-efficacy when the partner is perceived as unwilling to sacrifice for the relationship. We discuss the implications of these results for intervention construction and for understanding the power of the relationship context on HIV medication adherence.

Using actor-partner interdependence modeling to understand HPV vaccine acceptance

A wealth of scientific literature has been devoted to understanding what factors influence parents and their adolescent children to obtain the HPV vaccine. This literature is relatively uniform in its methodological approach of sampling individuals (i.e., either parents or adolescents) and examining the predictors of uptake for that individual. To improve understanding of HPV vaccination uptake, we sampled low-income, African American parent-child dyads with either a female (n = 93) or a male (n = 116) adolescent who had not been vaccinated. Both parents and children completed self-report measures that tapped intent to receive the vaccine and hypothesized predictors of intent (i.e., self-efficacy, beliefs about the vaccine, beliefs about HPV, knowledge of HPV). Using a dyadic analytic approach (i.e., the Actor-Partner Interdependence Model or APIM) [1], we found that parents and their adolescents have different structures of beliefs regarding HPV vaccination (i.e., they are empirically distinguishable). Consistent with prior research, the majority of predictors of an individual's own intention to vaccinate were individual-level variables; uniquely though, some predictors endorsed by one member of the dyad influenced the intentions held by the other member. Specifically, parents' reports of HPV severity and their self-efficacy were both associated with adolescents' intent to obtain the vaccine. Further, adolescents' beliefs that the vaccine will lead to greater promiscuity or be stigmatizing were associated with parents holding an increased intent to vaccinate. Use APIM improves understanding of HPV vaccination uptake and can be used to guide intervention efforts.

Gender Differences in Relations among Perceived Family Characteristics and Risky Health Behaviors in Urban Adolescents

BACKGROUND

Research regarding the role of gender in relations between family characteristics and health risk behaviors has been limited.

PURPOSE

This study aims to investigate gender differences in associations between family processes and risk-taking in adolescents.

METHODS

Adolescents (N = 249; mean age = 14.5 years) starting their first year at an urban high school in the northeastern USA completed self-report measures that assessed family characteristics (i.e., parental monitoring, family social support, family conflict) and health behaviors (i.e., tobacco use, alcohol use, marijuana use, sex initiation) as part of a prospective, community-based study. Multivariate logistic regression models were used to investigate gender differences in associations between the family characteristics and health behaviors.

RESULTS

Among males, higher levels of perceived parental monitoring were associated with lower odds of using tobacco and having ever engaged in sex. Among females, higher levels of perceived parental monitoring were associated with lower odds of marijuana use, alcohol use, and having ever engaged in sex. However, in contrast to males, among females (a) higher levels of perceived family social support were associated with lower odds of alcohol use and having ever engaged in sex and (b) higher levels of perceived family conflict were associated with higher odds of marijuana use and having ever engaged in sex.

CONCLUSION

Family processes were more strongly related to health behaviors among adolescent females than adolescent males. Interventions that increase parental monitoring and family social support as well as decrease family conflict may help to protect against adolescent risk taking, especially for females.

The interaction between the dopamine receptor D4 (DRD4) variable number tandem repeat polymorphism and perceived peer drinking norms in adolescent alcohol use and misuse

Peer drinking norms are arguably one of the strongest correlates of adolescent drinking. Prospective studies indicate that adolescents tend to select peers based on drinking (peer selection) and their peers' drinking is associated with changes in adolescent drinking over time (peer socialization). The present study investigated whether the peer selection and socialization processes in adolescent drinking differed as a function of the dopamine receptor D4 (DRD4) variable number tandem repeat genotype in two independent prospective data sets. The first sample was 174 high school students drawn from a two-wave 6-month prospective study. The second sample was 237 college students drawn from a three-wave annual prospective study. Multigroup cross-lagged panel analyses of the high school student sample indicated stronger socialization via peer drinking norms among carriers, whereas analyses of the college student sample indicated stronger drinking-based peer selection in the junior year among carriers, compared to noncarriers. Although replication and meta-analytic synthesis are needed, these findings suggest that in part genetically determined peer selection (carriers of the DRD4 seven-repeat allele tend to associate with peers who have more favorable attitudes toward drinking and greater alcohol use) and peer socialization (carriers' subsequent drinking behaviors are more strongly associated with their peer drinking norms) may differ across adolescent developmental stages.

The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables.

Depressive Symptoms Mediate the Effect of HIV-Related Stigmatization on Medication Adherence Among HIV-Infected Men Who Have Sex with Men

This study tested the hypothesis that depressive symptoms would mediate the association of HIV-related stigma to medication adherence. We recruited HIV-infected men who have sex with men (MSM; N = 66; 66 % White, 23 % African-American) from an outpatient infectious disease clinic, and asked them to complete self-report measures. Mediational analyses showed that depressive symptoms fully mediated the association between HIV-related stigma and adherence. That is, stigma-related experiences were positively associated with depressive symptoms and negatively associated with adherence, and, in the final model, depressive symptoms remained a significant correlate of adherence while stigma did not. A test of the indirect effect of stigma on adherence through depressive symptoms was also significant (unstandardized b = -0.19; bootstrap 95 % CI -0.45 to -0.01). These results highlight the importance of treating depressive symptoms in interventions aiming to improve medication adherence among HIV-infected MSM.

Evaluating a Brief, Video-Based Sexual Risk Reduction Intervention and Assessment Reactivity with STI Clinic Patients: Results from a Randomized Controlled Trial

We report results from a randomized controlled trial designed to evaluate the efficacy of a video-based sexual risk reduction intervention and to measure assessment reactivity. Patients (N = 1010; 56 % male; 69 % African American) receiving care at a sexually transmitted infection (STI) clinic were assigned to one of four conditions formed by crossing assessment condition (i.e., sexual health vs. general health) with intervention condition (i.e., sexual risk reduction intervention vs. general health promotion). After completing their assigned baseline assessment, participants received their assigned intervention, and subsequently returned for follow-up assessments at 3, 6, 9, and 12 months. Participants in all conditions reduced their self-reported sexual risk behavior, and the incidence of new STIs declined from baseline through the follow-ups; however, there was no effect of intervention or assessment condition. We conclude that further risk reduction will require more intensive interventions, especially in STI clinics that already provide excellent clinical care.

Perceived Difficulty of Performing Selected HIV/AIDS Preventive Behaviors and Life Satisfaction: Is there a Relationship for African American Adolescents?

Research on the relationship between adolescent health risk behaviors, sexual risk behaviors in particular, and perceived life satisfaction is emerging. Some researchers suggest that life satisfaction has been a neglected component of adolescent health research. African American adolescents aged 13-18 (n = 1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire via Audio Computer Assisted Self-Interview. Analyses were conducted to examine relationships between perceived difficulty in performing HIV/AIDS preventive behavior and perceived life satisfaction, while controlling for socioeconomic status. Results suggest that perceived life satisfaction is related to perceived difficulty in performing HIV/AIDS preventive behaviors, for both males and females, with variability in the magnitude of associations by gender. Further research is necessary to identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived difficulty in performing HIV/AIDS preventive behavior to develop gender-appropriate and culturally-sensitive quality of life/health promotion programs.

Identifying HIV-Infected Women's Psychosocial Stressors: Findings from a Qualitative Study

To inform future psychosocial interventions for HIV-infected women, five focus groups were conducted with 29 HIV-infected women (72% African-American). Sessions were audio-recorded, transcribed, and coded by two raters. HIV-specific stressors included difficulties with serostatus disclosure, HIV medication adherence, and HIV-related discrimination. Stressors not directly linked to HIV were described as more concerning and included mental health or substance use problems, relationship challenges, caretaking for children or grandchildren, and financial difficulties. Participants suggested that interventions provide social support from other HIV-infected women, consistent case management and social work services, and forums to acquire additional information about HIV and treatment options.

The effects of a mass media HIV-risk reduction strategy on HIV-related stigma and knowledge among African American adolescents

HIV-related stigma undermines HIV prevention, testing, and treatment. Multipronged risk-reduction strategies may reduce stigma among African American adolescents. To test the effectiveness of a risk-reduction strategy in addressing stigma, 1613 African American adolescents from four mid-sized cities participated in a randomized control trial. Participants received a sexual-risk reduction [Focus on Youth (FOY)] or general health curriculum [Promoting Health Among Teens (PHAT)]. Two cities received a culturally-tailored media intervention. Participants completed baseline, 3-, 6-, and 12-month surveys to measure HIV-related stigma and knowledge. Analysis of covariance tested for stigma and knowledge differences by media city status and curriculum/media city status (PHAT media vs. PHAT non-media, FOY media vs. FOY non-media; FOY media vs. PHAT media; FOY non-media vs. PHAT non-media) at each measurement. Hierarchical linear modeling (HLM) determined stigma and knowledge differences over time. Media participants demonstrated greater HIV-related knowledge (p<0.10) at 6 months and lower stigma at 3 months (p<0.10). FOY media participants had lower 3-month (p<0.05) and 12-month (p<0.10) stigma scores than non-media FOY participants. FOY media and non-media participants had greater knowledge than PHAT for all intervals after baseline. FOY media had lower stigma than PHAT media after baseline for all intervals after baseline. HLM indicated greater knowledge slopes for the media group (p<0.05). FOY media participants had greater knowledge slopes (p<0.05) relative to non-media FOY participants and media PHAT participants (p<0.01). A combination of a HIV risk-reduction curriculum and culturally-tailored media demonstrated some effectiveness in reducing stigma. Future use of media in HIV-prevention should include and evaluate effects on stigma.

Interaction effects between the 5-hydroxy tryptamine transporter-linked polymorphic region (5-HTTLPR) genotype and family conflict on adolescent alcohol use and misuse

AIMS

To investigate whether the effects of family conflict on adolescent drinking differed as a function of 5-hydroxy tryptamine transporter-linked polymorphic region (5-HTTLPR) genotype cross-sectionally and prospectively in two independent samples of adolescents.

DESIGN

Path analysis and multi-group analysis of two prospective datasets were conducted.

SETTINGS

United States and United Kingdom.

PARTICIPANTS

Sample 1 was 175 adolescents in the United States (mean age = 15 at times 1 and 2 with a 6-month interval); Sample 2 was 4916 adolescents in the United Kingdon (mean age = 12 at time 1 and 15 at time 2).

MEASUREMENTS

In both samples, demographics, tri-allelic 5-HTTLPR genotype and perceived family conflict were assessed at time 1. Alcohol use (frequency of drinking) and alcohol misuse (frequency of intoxication, frequency of drinking three or more drinks, maximum number of drinks) were assessed at times 1 and 2.

FINDINGS

A significant gene-environment interaction on alcohol misuse at time 1 was found in both sample 1 (β = 0.57, P = 0.001) and sample 2 (β = 0.19, P = 0.01), indicating that the 5-HTTLPR low-activity allele carriers exposed to higher levels of family conflict were more likely to engage in alcohol misuse than non-carriers. A significant gene-environment interaction effect on change in alcohol misuse over time was found only in sample 1 (β = 0.48, P = 0.04) but not in sample 2.

CONCLUSIONS

Compared with non-carriers, adolescents carrying the 5-HTTLPR low-activity allele are more susceptible to the effects of family conflict on alcohol misuse.

HIV-related stigma among African-American youth in the Northeast and Southeast US

HIV-related stigma inhibits optimal HIV prevention and treatment among African-Americans. Regional differences in HIV/AIDS prevalence may be related to stigma among young African-Americans. Baseline data (N = 1,606) from an HIV prevention intervention were used to investigate regional differences in HIV-related stigma and knowledge among African-American adolescents in four midsized cities in the Northeastern and Southeastern US. Analyses indicated greater HIV-related stigma among adolescents from the Southeast relative to adolescents from the Northeast (F = 22.23; p < 0.0001). Linear regression indicated a negative relationship between HIV stigma and HIV knowledge (b = -0.65; p < 0.0001). Addressing HIV/AIDS in high prevalence locales should include efforts to reduce HIV-related stigma.

The relationship between CAM use and adherence to antiretroviral therapies among persons living with HIV

OBJECTIVE

The use of complementary and alternative medicine (CAM) among people living with HIV and AIDS (PLWHA) may undermine other adaptive illness management behaviors, such as treatment adherence. The present study tests the hypothesis that CAM use is associated with intentional lapses in adherence (e.g., "medication vacations"), perhaps due to negative beliefs about antiretroviral therapy (ART).

METHOD

Cross-sectional interviews with 116 PLWHA were completed using a computerized assessment of self-reported CAM use and ART adherence.

RESULTS

Almost half of participants used CAM to treat or manage HIV-related health concerns in the past month, and 78% had used CAM since being diagnosed with HIV. Seventy-one percent of participants endorsed at least one domain of intentional nonadherence since starting HIV treatment. As hypothesized, CAM users did not differ from nonusers on overall ART adherence. Contrary to hypotheses, CAM users were less likely to report taking medication vacations or having stopped taking HIV medications without their doctor's approval compared with nonusers. CAM intensity was also related to intentional nonadherence, such that patients who engaged in more CAM tended to report fewer skipped doses and fewer nonprescribed adjustments to their medication regimen in the past month.

CONCLUSIONS

Findings suggest that PLWHA use CAM as an adjunct to ART and that CAM use does not undermine ART adherence. Needed now is longitudinal research to determine how a proactive, holistic approach to HIV care interacts with conventional HIV treatment over time, and whether CAM use impacts long-term quality of life and health outcomes.

Optimizing the scientific yield from a randomized controlled trial (RCT): evaluating two behavioral interventions and assessment reactivity with a single trial

Randomized controlled trials (RCTs) remain the gold standard for evaluating intervention efficacy but are often costly. To optimize their scientific yield, RCTs can be designed to investigate multiple research questions. This paper describes an RCT that used a modified Solomon four-group design to simultaneously evaluate two, theoretically-guided, health promotion interventions as well as assessment reactivity. Recruited participants (N = 1010; 56% male; 69% African American) were randomly assigned to one of four conditions formed by crossing two intervention conditions (i.e., general health promotion vs. sexual risk reduction intervention) with two assessment conditions (i.e., general health vs. sexual health survey). After completing their assigned baseline assessment, participants received the assigned intervention, and returned for follow-ups at 3, 6, 9, and 12 months. In this report, we summarize baseline data, which show high levels of sexual risk behavior; alcohol, marijuana, and tobacco use; and fast food consumption. Sexual risk behaviors and substance use were correlated. Participants reported high satisfaction with both interventions but ratings for the sexual risk reduction intervention were higher. Planned follow-up sessions, and subsequent analyses, will assess changes in health behaviors including sexual risk behaviors. This study design demonstrates one way to optimize the scientific yield of an RCT.

Social-cognitive correlates of antiretroviral therapy adherence among HIV-infected individuals receiving infectious disease care in a medium-sized northeastern US city

High levels of antiretroviral therapy (ART) adherence are required to achieve optimal viral suppression. To better understand mechanisms associated with ART adherence, this study characterized demographic and social-cognitive correlates of ART adherence among HIV-infected individuals from a medium-sized northeastern US city (n=116; 42% female; 43% African-American). Participants completed an audio computer-assisted self-interviewing survey assessing demographics, social-cognitive constructs, and ART adherence, and the participants' most recent viral load was obtained from their medical charts. Suboptimal ART adherence (taking less than 95% of prescribed medications during the past month) was reported by 39% of participants and was associated with being female, being a minority, and having a detectable viral load. In a hierarchical logistic regression analysis, greater than 95% ART adherence was associated with higher levels of adherence self-efficacy (AOR =1.1; p=0.015), higher perceived normative beliefs about the importance of ART adherence (AOR=1.3; p=0.03), and lower concern about missing ART doses (AOR=0.63; p=0.002). Adherence did not differ based on ART outcome expectancies, ART attitudes, or the perceived necessity of ART. In fact, most participants endorsed positive attitudes and expectancies regarding the need for and effectiveness of ART. Taken together, results indicate that suboptimal adherence remains high among HIV-infected minority women, a subpopulation that experiences particularly high rates of chronic stress due to both illness-specific stressors and broader environmental stressors. Consistent with social-cognitive theory, adherence problems in our sample were linked with deficits in self-efficacy as well as perceived norms and behavioral intentions that do not support a goal of 100% adherence. We suggest that interventions to improve adherence informed by social-cognitive theory (1) target patients who are at risk for adherence problems, (2) provide a supportive environment that promotes high rates of adherence, and (3) address inaccurate beliefs regarding optimal adherence levels.

Effects of Promoting Health Among Teens on Dietary, Physical Activity and Substance Use Knowledge and Behaviors for African American Adolescents

BACKGROUND

African Americans are disproportionately affected by cardiovascular disease and cancer. Health promotion interventions hold promise for reducing health disparities.

PURPOSE

Promoting Health Among Teens (PHAT) is a brief, culturally tailored health education intervention to decrease cardiovascular disease and cancer risk for African Americans. This study evaluated the effects of PHAT for African American adolescents ages 14 to 17 in four eastern cities in the USA.

METHODS

A randomized controlled design (N = 1,654) was used to determine differences in health knowledge, diet, physical activity, and substance use behaviors between PHAT participants and a sexual health promotion control group. Data were collected at baseline, three, six, and twelve months post intervention. Growth curve modeling was used to detect differences in health knowledge, dietary behaviors, physical activity, and substance use between PHAT and control group participants.

RESULTS

PHAT participants had significantly greater knowledge gains but modest behavior changes compared to control group participants.

DISCUSSION

PHAT is a promising intervention to increase knowledge and address selected health behaviors in African American youth.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Future attempts to execute PHAT should continue its emphasis on knowledge building while increasing intervention dosage and modifying length of time for intervention sessions.

Predicting discordance between self-reports of sexual behavior and incident sexually transmitted infections with African American female adolescents: results from a 4-city study

This study examined correlates of the discordance between sexual behavior self-reports and Incident Sexually Transmitted Infections. African American adolescent females (N = 964) from four U.S. cities were recruited for an HIV/STI prevention trial. Self-reported sexual behaviors, demographics, and hypothesized psychosocial antecedents of sexual risk behavior were collected at baseline, 6-, 12-, and 18-month follow-up assessments. Urine specimens were collected and tested for three prevalent STIs (chlamydia, gonorrhea, trichomonas) at each assessment. Seventeen percent of participants with a laboratory-confirmed STI reported either lifetime abstinence or recent abstinence from vaginal sex (discordant self-report). Lower STI knowledge, belief that fewer peers were engaging in sex, and belief that more peers will wait until marriage to have sex were associated with discordant reports. Discordance between self-reported abstinence and incident STIs was marked among African American female adolescents. Lack of STI knowledge and sexual behavior peer norms may result in underreporting of sexual behaviors.

Using growth mixture modeling to identify heterosexual men who reduce their frequency of unprotected sex following a behavioral intervention

Using growth mixture modeling, two 12-month trajectories of unprotected sex were identified in 210 heterosexual men (76 % African American, M(age) = 33.2 years) attending a sexual risk reduction intervention. Risk Reducers (46 %) reported fewer acts of unprotected sex following intervention, whereas Risk Maintainers (54 %) reported continuously high levels of unprotected sex. These groups did not differ with respect to demographic characteristics or intervention type. However, Risk Maintainers were more likely than Risk Reducers to report lifetime sex work, forced sex in the past year, and alcohol use before sex at baseline. They had higher levels of peak alcohol use, poorer condom skills, and scored lower on stage of change for condom use at baseline. Risk Maintainers were also more likely to have steady partners at baseline and less likely to change partner status following intervention. Understanding factors distinguishing these groups can contribute to the development of targeted Risk Reduction interventions.

The effects of alcohol and sexual arousal on determinants of sexual risk in men who have sex with men

Primary prevention efforts aimed at sexual risk behaviors are critical. This experiment was designed to investigate the effects of alcohol intoxication and sexual arousal, as well as person variables of alcohol sex expectancies and attitudes toward condom use, on hypothesized determinants of sexual risk behaviors among men who have sex with men (MSM). The participants were 117 MSM aged 21-50 years who were randomly assigned to one of six separate experimental conditions created by the combination of beverage administration (water control, placebo or alcohol designed to raise blood alcohol level to .07%) and sexual arousal (low or high, manipulated by participants' viewing non-erotic or mildly erotic film clips). Participants attended two experimental sessions. The first session included completing questionnaires about beliefs about alcohol's effects on sex and attitudes toward condoms' effect on sexual pleasure. The second session involved the beverage condition and arousal manipulations. Following these, participants viewed and responded to two interactive videos depicting high sexual risk scenarios. Participants also completed the CARE, a measure of risk perceptions. The dependent variables were behavioral skills, intentions to have unsafe sex, and "risk exposure," derived from responses to the videos. The results of both planned and exploratory analyses showed general support for the hypothesized enhancement of alcohol's effects on sexual risk by both sexual arousal and expectancies. Also as predicted, condom attitudes showed direct relationships to risk exposure and intentions. Implications of the findings for models of alcohol's effects on sexual risk and for the development of HIV prevention interventions were discussed.

African American adolescents meeting sex partners online: closing the digital research divide in STI/HIV prevention

Minority adolescents are affected disproportionately by HIV and STIs, and the Internet is a popular venue to meet sex partners. Little is known about the risks of this behavior for minority adolescents. The majority of studies that have examined sexual risk behavior online or STI/HIV prevention programs online have been among adult MSM. In this study, data from 1,045 African American youth found that 6% met sex partners online and in chat rooms. Odds ratios, adjusting for gender, found this behavior was associated with alcohol (AOR = 2.33, 95% CI [1.1, 4.7]) and drug use (AOR = 3.45, 95% CI [1.9, 6.1]), unprotected vaginal (AOR = 4.71, 95% CI [1.9, 8.4]) and anal sex (AOR = 4.77, 95% CI [1.3,17.1]) in the last 90 days, more lifetime vaginal (AOR = 3.65, 95% CI [2.0, 6.8]) and anal sex (AOR = 2.74, 95% CI [1.5, 4.8]), greater sexual sensation seeking (AOR = 2.92, 95% CI [1.5, 5.7]) and greater depression (AOR = 2.06, 95% CI [1.2, 3.6]. A final multiple logistic regression analyses found that male gender (AOR = 3.13, 95% CI [1.7, 5.8]), drug use at last sex (AOR = 2.41, 95% CI [1.3, 4.5]), lifetime history of vaginal (AOR = 2.90, 95% CI [1.5, 5.5]) and anal sex (AOR = 2.09, 95% CI [1.2, 3.6]), and cocaine use (AOR = 8.53, 95% CI [2.7, 27.3]) were independently associated with having sex with a partner met online. Meeting sex partners online is associated with a variety of risks among African American youth; however, the Internet may be an opportunity for intervention.

Blocking the benefit of group-based HIV-prevention efforts during adolescence: the problem of HIV-related stigma

HIV-related stigma has been shown to impede HIV-antibody testing and safer sexual practices in adults. Less is known about its effects on prevention programs among at-risk youth. This study examined the longitudinal relationships between HIV-stigma and HIV-knowledge following completion of a validated group-based intervention. Data were provided by 1,654 African-American adolescents who participated in a large multi-city prevention trial (Project iMPACCS). Participants were randomly assigned to an empirically-validated skill-based intervention or a general health promotion control group. Both stigma and knowledge were assessed at baseline and post-intervention. Results suggested that adolescents participating in the intervention showed improvements in knowledge and decreases in stigma when compared to controls. Improvements in stigma appeared to be partly driven by improvements in knowledge. Higher baseline stigma was shown to reduce gains in knowledge in both the treatment and control groups. Results suggest that HIV-stigma can interfere with how youth identify with and internalize messages from group-based prevention trials.

What HIV-positive MSM want from sexual risk reduction interventions: findings from a qualitative study

To facilitate the development of a tailored intervention that meets the needs of HIV-positive men who have sex with men (HIV-positive MSM), we conducted formative research with 52 HIV-positive MSM. We sought to (a) identify major barriers to consistent condom use, (b) characterize their interest in sexual risk reduction interventions, and (c) elicit feedback regarding optimal intervention format. Men identified several key barriers to consistent condom use, including treatment optimism, lessened support for safer sex in the broader gay community, challenges communicating with partners, and concerns about stigmatization following serostatus disclosure. Many men expressed an interest in health promotion programming, but did not want to participate in an intervention focusing exclusively on safer sex. Instead, they preferred a supportive group intervention that addresses other coping challenges as well as sexual risk reduction. Study results reveal important considerations for the development of appealing and efficacious risk reduction interventions for HIV-positive MSM.

A global perspective on complementary and alternative medicine use among people living with HIV/AIDS in the era of antiretroviral treatment

Complementary and alternative medicine (CAM) is a popular adjunct to conventional medicine across medical populations, and is particularly relevant in the global HIV epidemic. Use of antiretroviral therapy (ART) to treat HIV is ubiquitous in high-resource areas and efforts to increase coverage in low-resource areas are underway. To better understand the role of CAM in HIV treatment and the implications of CAM use for ART uptake and adherence, we review international research published between 2007 and 2011. Findings confirm that CAM is commonly used as an adjunct to ART; however, in countries where ART is less accessible, many HIV-positive individuals take a pluralistic approach to health care, incorporating both traditional and, when available, conventional medicine. The reviewed studies provide no consensus on whether the use of CAM interferes with ART uptake or adherence; instead, research suggests that illness-related behaviors are driven by multiple factors and determined, at least in part, by the availability and accessibility of ART.

Long term effects of community-based STI screening and mass media HIV prevention messages on sexual risk behaviors of African American adolescents

We examined the long-term effects of two interventions designed to reduce sexual risk behavior among African American adolescents. African American adolescents (N = 1383, ages 14-17) were recruited from community-based organizations over a period of 16 months in two northeastern and two southeastern mid-sized U.S. cities with high rates of sexually transmitted infection (STI). Participants were screened for three STIs (gonorrhea, chlamydia, and trichomoniasis) and completed an audio computer-assisted attitude, intention, and behavior self-interview. Youth who tested positive for an STI (8.3%) received treatment and risk reduction counseling. In addition, television and radio HIV-prevention messages were delivered during the recruitment period and 18 months of follow-up in one randomly selected city in each region. Analyses determined effects of the media program for those receiving a positive versus negative STI test result on number of sexual partners and occurrence of unprotected sex. Adolescents who tested STI-positive reduced their number of vaginal sex partners and the probability of unprotected sex over the first 6 months. However, in the absence of the mass media program, adolescents returned to their previously high levels of sexual risk behavior after 6 months. Adolescents who tested STI-positive and received the mass media program showed more stable reductions in unprotected sex. Community-based STI treatment and counseling can achieve significant, but short-lived reductions in sexual risk behavior among STI-positive youth. A culturally sensitive mass media program has the potential to achieve more stable reductions in sexual risk behavior and can help to optimize the effects of community-based STI screening.

Using culturally sensitive media messages to reduce HIV-associated sexual behavior in high-risk African American adolescents: results from a randomized trial

PURPOSE

To test the long-term effects of a mass media intervention that used culturally and developmentally appropriate messages to enhance human immunodeficiency virus (HIV)-preventive beliefs and behavior of high-risk African American adolescents.

METHODS

Television and radio messages were delivered for more than 3 years in two cities (Syracuse, NY; and Macon, GA) that were randomly selected within each of the two regionally matched city pairs, with the other cities (Providence, RI; and Columbia, SC) serving as controls. African American adolescents, aged 14-17 years (N = 1,710), recruited in the four cities over a 16-month period, completed audio computer-assisted self-interviews at recruitment and again at 3, 6, 12, and 18-months postrecruitment to assess the long-term effects of the media program. To identify the unique effects of the media intervention, youth who completed at least one follow-up and who did not test positive for any of the three sexually transmitted infections at recruitment or at 6-and 12-month follow-up were retained for analysis (N = 1,346).

RESULTS

The media intervention reached virtually all the adolescents in the trial and produced a range of effects including improved normative condom-use negotiation expectancies and increased sex refusal self-efficacy. Most importantly, older adolescents (aged 16-17 years) exposed to the media program showed a less risky age trajectory of unprotected sex than those in the nonmedia cities.

CONCLUSION

Culturally tailored mass media messages that are delivered consistently over time have the potential to reach a large audience of high-risk adolescents, to support changes in HIV-preventive beliefs, and to reduce HIV-associated risk behaviors among older youth.