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Xu MA, Choi J, Capasso A, DiClemente R. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. Healthcare (Basel) 2023; 11:1702. [PMID: 37372820 DOI: 10.3390/healthcare11121702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.
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Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Ralph DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
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Tan ZC, Ali S, Ansari S, Brar A, Mohammed Y, Merdjanoff A, Parekh N, Abdulle A, Jabari A, Ali R, DiClemente R. Deconstructing the Diet of Young South Asians Socialized Within the United Arab Emirates: A Mixed-Methods Study Using Social Network Analysis. Curr Dev Nutr 2022. [PMCID: PMC9193431 DOI: 10.1093/cdn/nzac060.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
South Asians comprise most of the United Arab Emirates (UAE) population and face a complex non-communicable disease (NCD) burden linked with dietary behaviors. While past research has focused on disease risk factors of first-generation migrant workers, little is known on the dietary behaviors of the South Asians born or socialized within the UAE, who similarly face a growing NCD burden yet a distinct set of social forces relevant to health.
Methods
18–25-year-old UAE-based South Asians who spent at least 10 years of their life in the country were recruited via social media to participate in a mixed methods study. Participants first completed a survey to identify and rank factors contributing to their diet, including the strength (from 1 to 10) of the connection between different factors in jointly influencing eating behaviors. Descriptive and social network analysis (SNA) methods were used to analyze the factor data; all participants with contact details were invited for interviews to disentangle and interpret quantitative findings (analyzed using rapid qualitative analysis).
Results
A total of 150 young UAE-based South Asians completed the survey (mean age 20.8, 78% female, 48% born in the UAE). Drivers with the highest overall and rank-adjusted saliency were family (130; 90.5), taste (120; 80.3), and cost (109; 65.8). Strong connections were made between ease of preparation and religion (10.0) as well as mood and culture (10.0) as diet-contributing factors. SNA revealed family to consistently be the most central factor (degree: 28, betweenness: 37.2, closeness: 0.03), followed by taste and cost. Of the 71 participants who provided contact details, 11 agreed to be interviewed. Participants interpreted the saliency of family in diet and health to reflect the disconnect experienced by the South Asian community with other facets of UAE society and noted school environment to be a particularly influential yet less prominent factor in the quantitative data.
Conclusions
Findings provide specific, actionable considerations in the development of nutritional interventions tailored to the underserved, understudied population of South Asians socialized within the UAE, and pathways for further research to better understand these interconnected contributors to diet.
Funding Sources
The NYU South Asian Health and Research Group (SAHARA).
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Kunz A, Moodley A, Colby DJ, Soltis M, Robb-McGrath W, Fairchok A, Faestel P, Jungels A, Bender AA, Kamau E, Wingood G, DiClemente R, Scott P. Feasibility, acceptability, and short-term impact of a brief sexually transmitted infection intervention targeting U.S. Military personnel and family members. BMC Public Health 2022; 22:640. [PMID: 35366848 PMCID: PMC8977033 DOI: 10.1186/s12889-022-13096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Over the past 10 years, incidence of sexually transmitted infections (STIs) has increased to record numbers in the United States, with the most significant increases observed among adolescents and young adults. The US military, where the majority of active duty personnel are 18–30 years old, has seen similar increases. However, the US military does not yet have a standardized, service-wide program for STI education and prevention. Methods The KISS intervention (Knocking out Infections through Safer-sex and Screening) was adapted from an evidence-based intervention endorsed by the US Centers for Disease Control and Prevention and consisted of a one-time, small group session. Content included STI/HIV knowledge and prevention, condom use skills, and interpersonal communication techniques. The intervention was pilot tested for feasibility and acceptability among a population of service members and medical beneficiaries at Joint Base Lewis-McChord in Washington state. Results A total of 79 participants aged 18–30 years were consented to participate in the pilot study and met entry criteria, 66/79 (82.5%) attended the intervention session, and 46/66 (69.7%) returned at 3 months for the final follow-up assessment. The intervention sessions included 31 male (47.0%) and 35 female (53.0%) participants. Almost all participants felt comfortable discussing sexual issues in the group sessions, reported that they intended to practice safer sex after the intervention, and would also recommend the intervention to friends. Knowledge about STI/HIV prevention significantly increased after the intervention, and intervention effects were maintained at 3 months. About one-fifth of participants tested positive for N. gonorrhea or C. trachomatis infection at enrollment, while none had recurrent STIs at the final visit. Use of both male and female condoms increased after the intervention. Conclusions The KISS intervention was feasible to implement in the military setting and was acceptable to the active duty service members and other medical beneficiaries who participated in the pilot project. Further studies are needed to determine if the KISS intervention, or others, effectively decrease STI incidence in active duty personnel and would be appropriate for more widespread implementation. Trial Registration Retrospectively registered as the pilot phase of clinicaltrials.gov NCT04547413, “Prospective Cohort Trial to Assess Acceptability and Efficacy of an Adapted STI/HIV Intervention Behavioral Intervention Program in a Population of US Army Personnel and Their Medical Beneficiaries—Execution Phase.” Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13096-x.
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Woods C, Yusuf H, Matson P, Marcell AV, DiClemente R, Fields E, Trent M. Social Media Versus Traditional Clinic-Based Recruitment for a Dyadic Sexually Transmitted Infection Prevention Trial: Results From the Sexperience Study. J Adolesc Health 2021; 69:668-671. [PMID: 33867231 PMCID: PMC8429059 DOI: 10.1016/j.jadohealth.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The enrollment of youth in clinical trials has generally been achieved through conventional in-person recruitment but is evolving with the surge in the use of social media and presents an alternative resource for research recruitment for sexually transmitted infection (STI) prevention trials. PURPOSE To compare the direct costs and performance of social media recruitment versus clinic-based recruitment method for a dyadic behavioral intervention for STI among heterosexual couples. METHODS In the clinic-based recruitment arm spanning 60 weeks, patients aged 16-25 years were recruited through an adolescent/young adult clinic. Social media adverts targeting college students within the city were also posted online over 23 weeks, using Facebook ad software. We compared the direct costs and performance of both recruitment methods to assess feasibility. RESULTS Three hundred eighty-one individuals were approached, of which 21 completed the dyadic intervention (11 from social media-based recruitment and 10 from clinic-based recruitment). Clinic-based recruitment accounted for 91.0% of total recruitment cost and 9.9% of the total cost was spent on social media recruitment via Facebook ad. CONCLUSIONS Recruitment of adolescents and young adults for a dyadic behavioral STI intervention trial using social media is feasible, has lower direct costs, and results in similar outcomes compared to clinic-based recruitment.
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Affiliation(s)
- Colin Woods
- Department of Global Public Health, New York University, New York, NY, USA
| | - Hasiya Yusuf
- Department of Global Public Health, New York University, New York, NY, USA
| | - Pamela Matson
- Department of Global Public Health, New York University, New York, NY, USA
| | - Arik V. Marcell
- Department of Global Public Health, New York University, New York, NY, USA
| | - Ralph DiClemente
- Department of Global Public Health, New York University, New York, New York
| | - Errol Fields
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Ali S, Parekh N, Capasso A, Tozan Y, Jones A, Foreman J, DiClemente R. Changes in Eating Behaviors During COVID-19 and Association With Food Insecurity: Results From a Nation-Wide Online Survey. Curr Dev Nutr 2021. [PMCID: PMC8181656 DOI: 10.1093/cdn/nzab029_003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives The COVID-19 pandemic has catalyzed both a health and economic crisis in the US, with growing concerns on how eating behaviors and food security (risk factors of non-communicable disease) have changed. This study examines changes in food insecurity and eating behaviors during the early months of the pandemic among US adults. Methods A nationwide survey of US adults was conducted in April 2020 through social-media advertisement-based recruitment to assess the impact of the COVID-19 pandemic. Food insecurity was measured using a six-item validated USDA Household Food Security instrument. Eating behaviors were assessed by asking participants how their eating has changed since the pandemic (“Much More” to “Much Less”). Sociodemographic differences in food behaviors were assessed with chi-square tests, and an adjusted logistic regression model evaluated the association between food insecurity and eating behaviors. Results Overall, 5256 participants had data on eating behaviors; 58.6% were female, 43.8% aged 40–59 years old, and 56.4% were employed. Eating remained unchanged for most participants (52.7%), while 34.6% noted eating more, and 12.7% noted eating less since the pandemic. 85.3% of participants displayed high/marginal food insecurity, while 14.7% displayed low/very-low food security. Compared to those eating more during the pandemic, those eating less were more likely to be younger (24.7% vs. 17.4% aged 18–39), male (42.0% vs. 33.4%), not working, or unemployed (17.1% vs. 13.7%), and make <$30,000 a year (20.7% vs. 12.6%). When adjusting for socio-demographic variables, compared to those whose eating behavior did not change, the adjusted odds of low/very-low food insecurity was higher among both those who were eating less (AOR:6.44, 95%CI:4.96–8.37) and eating more (AOR:1.67, 95%CI:1.33–2.09). Conclusions Our findings suggest that the COVID-19 pandemic has catalyzed significant food insecurity, with food insecurity being associated with bidirectional changes in food consumption. Public health professionals must critically examine the various contributors of eating behaviors during the pandemic and their link with food insecurity to develop targeted interventions. Funding Sources N/A
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Affiliation(s)
- Shahmir Ali
- New York University School of Global Public Health
| | - Niyati Parekh
- New York University School of Global Public Health, NYU Grossman School of Medicine
| | | | - Yesim Tozan
- New York University School of Global Public Health
| | - Abbey Jones
- New York University School of Global Public Health
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Ali S, Gupta S, Hanif C, Tariq M, Vasquez-Lopez X, Penikalapati R, Parekh N, Merdjanoff A, DiClemente R. Exploring the Drivers of Second-Generation South Asian American Eating Behaviors Using a Novel Qualitative Methodology: Virtual Free-Listing Informed Mind-Mapping. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab038_002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
South Asian Americans (SAAs) face a growing non-communicable disease burden, however the behavioral contributors to health disparities experienced by second-generation South Asians remain under-explored. The aim of this study was to identify major drivers of the foods typically eaten by second-generation SAAs.
Methods
Between October-November 2020, second-generation SAAs aged 18–29 years old were recruited to conduct virtual video-conferencing-based interviews using a novel qualitative methodology which integrated free-listing and ranking, mind-mapping, and discussion-based exercises. Ranked free-lists were quantitatively analyzed to identify salient drivers of eating behaviors, while the USDA socio-ecological model was used to inform a semi-inductive thematic analysis of interview transcripts. A network analysis was conducted by quantifying connections made across participant mind-maps.
Results
Overall, 32 participants (53% female, 22.4 mean age) were interviewed in the study. Thirty-five distinct eating behavior drivers were identified in the free-listing data; those with the highest saliency scores (unadjusted for ranking) were 1) family, 2) friends, 3) taste, and 4) health; when adjusted for participant rankings, the most impactful drivers were 1) taste, 2) family, 3) health, and 4) friends. In applying the USDA socio-ecological model, individual-level drivers included personal capacity to cook, convenience in accessing certain foods, cost, emotional state, and preferences regarding taste or novelty of non-South Asian foods. Setting-level drivers included specific daily activities (e.g., socializing, working), people (e.g., family, roommates), and places (e.g., workplaces, religious institutions). Notably less sector-level drivers were identified but included interacting with the healthcare sector or social media. Norm-level drivers included South Asian cultural background, religious background, and priorities regarding health and vegetarianism informed by values outside of religion.
Conclusions
Complex, interconnected, and multi-level drivers were identified motivating second-generation SAAs eating behaviors. Findings highlight the need to distinguish these drivers from first generation SAAs to better design interventions to improve health of second-generation SAAs.
Funding Sources
N/A.
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Affiliation(s)
- Shahmir Ali
- New York University School of Global Public Health
| | | | | | - Maham Tariq
- New York University School of Global Public Health
| | | | | | - Niyati Parekh
- New York University School of Global Public Health, NYU Grossman School of Medicine
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Trent M, Yusuf HE, Rowell J, Toppins J, Woods C, Huettner S, Robinson C, Fields EL, Marcell AV, DiClemente R, Matson P. Dyadic Intervention for Sexually Transmitted Infection Prevention in Urban Adolescents and Young Adults (The SEXPERIENCE Study): Protocol for a Randomized Controlled Trial (Preprint). JMIR Res Protoc 2021; 11:e29389. [PMID: 35612881 PMCID: PMC9178458 DOI: 10.2196/29389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Adolescents and young adults (AYA) aged younger than 25 years have the highest rates of sexually transmitted infections (STIs) in the United States. Current STI prevention strategies for AYA rely primarily on individual approaches, leaving sexual partners with significant unmet sexual and reproductive health care and health education needs. Dyadic interventions may hold promise for harnessing the power of communal coping within relationship dynamics to enhance sexual decision making, communication, and behavior changes that reduce the future risk of STIs. Objective This paper describes the protocol and research methods of a dyad-based behavioral intervention that augments individual evidence-based interventions with joint health education counseling for heterosexual AYA dyads within a primary care setting. The trial aims to improve partner communication and collaborative sexual decision making and promote the adoption of sexual behaviors such as consistent condom use. The primary objective of this study is to assess the feasibility, acceptability, and effectiveness of a dyadic intervention targeted at preventing STIs in heterosexual couples in an urban setting. Methods A total of 100 AYA (50 dyads) aged 16 to 25 years, engaged in heterosexual intercourse, who reside in the city and are willing to recruit their main sexual partner for the study will be recruited and randomized into 2 groups, an intervention arm and a control arm. Participants will be recruited from an AYA medicine clinic and by using social media (Facebook and Instagram). The index participant and partner will complete a single individual session separately (Sister to Sister or Focus on the Future) with a gender-matched health educator. Dyads will then be randomized to receive an additional joint debriefing session together to discuss relationship dynamics, condom negotiation, etc. Participants will separately complete a telephone interview 6 weeks postintervention to determine the feasibility, acceptability, and impact of the intervention on mutual sexual negotiation, consistency of condom use, and communal coping skills, etc. Results So far, 25.4% (44/173) of eligible participants have been enrolled and randomized. Participants are mostly female (20/22, 91%), with at least a high school diploma (19/22, 86%), and 9 average lifetime sexual partners. Acceptability is high, with 98% (43/44) of participants expressing satisfaction with their study experience; 100% of dyads recruited were still together at 6-week follow-up. Conclusions Findings from this study will add to the current literature on the approaches to STI prevention, and its success will inform its application in risk reduction counseling for youth who are most at risk. Trial Registration Clinical Trials.gov NCT03275168; https://www.clinicaltrials.gov/ct2/history/NCT03275168 International Registered Report Identifier (IRRID) DERR1-10.2196/29389
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Affiliation(s)
- Maria Trent
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hasiya Eihuri Yusuf
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julia Rowell
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jacquelin Toppins
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Colin Woods
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Steven Huettner
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Camille Robinson
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Errol L Fields
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arik V Marcell
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ralph DiClemente
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States
| | - Pamela Matson
- Department of Pediatrics, Division of Adolescent/Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Waller B, Quinn CR, Boyd D, DiClemente R, Voisin DR. Correlates of depression among Black girls exposed to violence. J Racial Ethn Health Disparities 2021; 9:146-155. [PMID: 33403651 DOI: 10.1007/s40615-020-00937-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
Depression rates for youth remanded to juvenile detention is double that of the general population and Black girls are especially vulnerable. A dearth of literature analyzes the factors that are correlated with depression among system-involved Black girls, ages 12-17 years old. We utilized personal agency to examine the relationship between risk factors (i.e., abuse history, and fear of condom negotiation) and protective factors (i.e., condom self-efficacy, and perceived social support) that might correlate with depression among Black girls exposed to violence. Findings indicate that fear of condom negotiation, abuse history and low condom self-efficacy are correlated with depressive symptomology while self-esteem and perceived social support are protective factors that may serve as a buffer against girls' feelings of helplessness and hopelessness. The findings of this study suggest several implications for prevention and intervention efforts to reduce the depression-related risks among justice-involved Black females, including strategies that promote healing within their social support networks.
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Affiliation(s)
- Bernadine Waller
- School of Social Work, Adelphi University, Garden City, NY, USA.
| | - Camille R Quinn
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Donte Boyd
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Ralph DiClemente
- School of Global Public Health, New York University, New York, NY, USA
| | - Dexter R Voisin
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Owen-Smith A, Black H, Emerson D, Cotner M, Smith H, Jackson D, Ford JD, DeBar L, DiClemente R, Hayat MJ. A Pilot Study to Adapt a Trauma-Informed, Mindfulness-Based Yoga Intervention for Justice-Involved Youth. Int J Yoga Therap 2021; 31:Article_18. [PMID: 34875056 PMCID: PMC10775923 DOI: 10.17761/2021-d-21-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of the present study was to adapt and pilot a trauma-informed, mindfulness-based yoga (TIMBY) intervention focused on enhancing self-regulation among youth in the Georgia Department of Juvenile Justice system. In this article we (1) describe the process by which we systematically adapted an evidence-based protocol specifically for this population, (2) describe the nature of and rationale for those adaptations, (3) present some preliminary qualitative findings based on interviews with youth participants, and (4) briefly summarize how the adapted protocol will be evaluated in the subsequent feasibility trial. The iterative drafting and revision process involved modifications to a well-established, protocolized Trauma-Informed Yoga program and was identified by the project advisory board and t h rough formal interviews with intervention staff. Qualitative interviews were conducted with youth participants concerning intervention impact, credibility, and satisfaction. Several needed modifications were identified so that the intervention would be contextually appropriate for justice-involved youth. Thirty youth were enrolled in the pilot study: 77% we re Non - Hispanic Black/African-American, 18% were Non-Hispanic White, and 5% were Hispanic White. The average age was 16.45 years (range 14-20). The youth consistently reported satisfaction with the sessions and positive beliefs about how the sessions were helping them with a range of physical and psychological/ emotional challenges. Adaptations to the protocol in the present study highlight how mindfulness-based interventions for justice-involved youth need to consider what is both developmentally suitable for youth and appropriate in a justice setting. A feasibility study using this revised TIMBY protocol is underway at four Georgia Department of Juvenile Justice facilities to formally identify the barriers and facilitators to implementation for the present study and a future, larger-scale trial.
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Affiliation(s)
| | | | - David Emerson
- Trauma Center Trauma Sensitive Yoga Facilitator, Center for Trauma and Embodiment, Justice Resource Institute, Needham, Mass
| | | | - Herschel Smith
- School of Public Health, Georgia State University, Atlanta
| | | | - Julian D Ford
- School of Medicine, University of Connecticut, Farmington
| | - Lynn DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Wash
| | - Ralph DiClemente
- New York University School of Global Public Health, New York, N.Y
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Elkington KS, Spaulding A, Gardner S, Knight D, Belenko S, Becan JE, Robertson AA, Oser C, DiClemente R. A System-Level Intervention to Encourage Collaboration Between Juvenile Justice and Public Health Agencies to Promote HIV/STI Testing. AIDS Educ Prev 2020; 32:337-355. [PMID: 32897134 PMCID: PMC9426765 DOI: 10.1521/aeap.2020.32.4.337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Justice-involved youth are at high risk for HIV and STIs, and justice agencies are uniquely poised to offer HIV/STI testing. However, testing in these settings is not routine and represents a missed opportunity. This study describes a system-level implementation intervention designed to increase access to HIV/STI testing through juvenile justice (JJ) and public health agency collaboration across six counties in six states in the United States. Local change teams, active facilitation, and training were utilized to facilitate agency partnerships and development of HIV/STI practice change protocols. Five counties established health and JJ partnerships and four counties successfully implemented their protocols. Sites with HIV/STI education and testing protocols behaviorally screened 98.5% of youth and tested 41.2% of those youth; 0% were HIV+ and 43.2% had an STI. The intervention provides a feasible, scalable solution, through promoting partnerships between JJ and health agencies, to link youth to testing and treatment services.
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Affiliation(s)
- Katherine S. Elkington
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY
| | - Anne Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sheena Gardner
- Social Science Research Center, Mississippi State University, Starkville, MS
| | - Danica Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA
| | - Jennifer E. Becan
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX
| | - Angela A. Robertson
- Social Science Research Center, Mississippi State University, Starkville, MS
| | - Carrie Oser
- Department of Sociology, University of Kentucky, Lexington, KY
| | - Ralph DiClemente
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Social and Behavioral Sciences, New York University (NYU) College of Global Public Health, New York, NY
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Abstract
The recent conference Turning the Tide: A New Generation of Public Health Interventions highlighted the need to utilize innovative and emergent methodologies to confront increasingly complex public health challenges. In this commentary, we discuss three dominant themes from the conference: addressing multiple levels of causality in reducing health problems; technology-based methodologies to enhance health promotion; and improving translation and sustainment of effective health promotion programs. The subsequent articles, included in this supplement issue of AJPH, provide compelling examples and arguments supporting these progressive approaches to public health promotion. We recommend that public health researchers draw inspiration from these examples and embrace interdisciplinary, innovative methods within their future work.
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Affiliation(s)
- Ralph DiClemente
- Ralph DiClemente is with the Department of Social and Behavioral Sciences, New York University College of Global Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are with the Lerner Center for Public Health Promotion and the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are also Guest Editors for this supplement issue
| | - Azure Nowara
- Ralph DiClemente is with the Department of Social and Behavioral Sciences, New York University College of Global Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are with the Lerner Center for Public Health Promotion and the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are also Guest Editors for this supplement issue
| | - Rachel Shelton
- Ralph DiClemente is with the Department of Social and Behavioral Sciences, New York University College of Global Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are with the Lerner Center for Public Health Promotion and the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are also Guest Editors for this supplement issue
| | - Gina Wingood
- Ralph DiClemente is with the Department of Social and Behavioral Sciences, New York University College of Global Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are with the Lerner Center for Public Health Promotion and the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY. Azure Nowara, Rachel Shelton, and Gina Wingood are also Guest Editors for this supplement issue
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Elkington KS, Robertson AA, Knight DK, Gardner SK, Funk RR, Dennis ML, Oser C, DiClemente R. HIV/STI Service Delivery Within Juvenile Community Supervision Agencies: A National Survey of Practices and Approaches to Moving High-Risk Youth Through the HIV Care Cascade. AIDS Patient Care STDS 2020; 34:72-80. [PMID: 32049557 PMCID: PMC7044763 DOI: 10.1089/apc.2019.0157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Justice-involved youth (JIY) are at considerable risk for human immunodeficiency virus (HIV), but are disconnected from treatment and prevention. Juvenile justice agencies providing community supervision (CS) are well positioned to provide HIV prevention, testing, and prompt referral to treatment for JIY. However, we lack an understanding of juvenile CS agency responses to HIV/sexually transmitted infection (STI) needs among JIY. We conducted a nationwide systematic assessment of how juvenile CS agencies identify, refer, and move youth through the HIV care cascade using a nationally representative sample of 195 juvenile CS agencies across 20 states. Two-thirds of CS agencies did not offer any HIV-/STI-related services, and 82% reported no collaboration with health agencies. Screening or referral for HIV risk behaviors was reported by 32% of the CS agencies and 12% for any intervention or prevention for HIV/STI risk behaviors. Between 21% and 30% of agencies were unaware of the location of local HIV/STI services. HIV/STI prevention training was not a priority for directors and was ranked second to last out of 16 training topics. Agencies where staff expressed need for HIV risk training and where specific court programming was available were more likely to provide or refer for HIV/STI screening and/or testing. Agencies were more likely to provide or refer for services if they provided pre-trial/pre-adjudication supervision, parole, or court programming. Considering the low provision of HIV/STI-related services and limited collaboration between health and justice agencies, interventions that promote cross-system collaboration designed to minimize barriers and facilitate identification, referral, and linkage to HIV services for JIY are necessary.
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Affiliation(s)
- Katherine S. Elkington
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Angela A. Robertson
- Social Science Research Center, Mississippi State University, Starkville, Mississippi
| | - Danica K. Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas
| | - Sheena K. Gardner
- Social Science Research Center, Mississippi State University, Starkville, Mississippi
| | | | | | - Carrie Oser
- Department of Sociology and Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, Kentucky
- Department of Behavioral Science, Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Ralph DiClemente
- Department of Social and Behavioral Sciences, New York University, New York, New York
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Kim BKE, Quinn CR, Logan-Greene P, DiClemente R, Voisin D. A longitudinal examination of African American adolescent females detained for status offense. Child Youth Serv Rev 2020; 108:104648. [PMID: 32565590 PMCID: PMC7304544 DOI: 10.1016/j.childyouth.2019.104648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Behaviors like truancy, running away, curfew violation, and alcohol possession fall under the status offense category and can have serious consequences for adolescents. The Juvenile Justice and Delinquency and Prevention Act prohibited detaining status offenders. We explored the degree to which African American adolescent girls were being detained for status offenses and the connections to their behavioral health risks and re-confinement. METHODS 188 African American girls (aged 13-17), recruited from detention facilities, were surveyed at baseline and 3-month follow-ups. Logistic regression models estimated the likelihood of longitudinal re-confinement, controlling for sexual and behavioral health risk factors. RESULTS One third of the overall sample was detained for a status offense. Status offenders were exposed to higher peer risk profiles. At follow-up, nearly 39% of status offenders reported re-confinement. Compared to youth with other offenses, those who violated a court order (type of status offense) were 3 times more likely to be re-confined. Controlling for sexual and behavioral health risk factors, the odds of re-confinement was not statistically significant. CONCLUSION Overall findings suggest that courts and detention facilities must devote specialized resources to addressing the socio-behavioral needs of African American girls with status offenses so as not to use detention as an intervention.
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Affiliation(s)
- Bo-Kyung Elizabeth Kim
- USC Suzanne Dworak-Peck School of Social Work, University
of Southern California, 669 W 34 Street, SWC 218, Los Angeles, CA
90089, United States
| | - Camille R. Quinn
- College of Social Work, The Ohio State University, 325U
Stillman Hall, 1947 College Road, Columbus, OH 43210, United States
| | - Patricia Logan-Greene
- School of Social Work, University at Buffalo, 685 Baldy
Hall, Buffalo, NY 14260, United States
| | - Ralph DiClemente
- College of Global Public Health, New York University,
715-719 Broadway Avenue, New York, NY 10003, United States
| | - Dexter Voisin
- School of Social Work, University of Toronto, 246 Bloor
Street West, Toronto, ON M5S 1V4, Canada
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Kitzman H, Olds DL, Knudtson MD, Cole R, Anson E, Smith JA, Fishbein D, DiClemente R, Wingood G, Caliendo AM, Hopfer C, Miller T, Conti G. Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial. Pediatrics 2019; 144:e20183876. [PMID: 31748254 PMCID: PMC6889968 DOI: 10.1542/peds.2018-3876] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. METHODS We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership). RESULTS Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors. CONCLUSIONS The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.
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Affiliation(s)
- Harriet Kitzman
- School of Nursing, University of Rochester, Rochester, New York
| | | | | | - Robert Cole
- School of Nursing, University of Rochester, Rochester, New York
| | - Elizabeth Anson
- School of Nursing, University of Rochester, Rochester, New York
| | - Joyce A Smith
- School of Nursing, University of Rochester, Rochester, New York
| | - Diana Fishbein
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, State College, Pennsylvania
| | - Ralph DiClemente
- College of Global Public Health, New York University, New York, New York
| | - Gina Wingood
- Mailman School of Public Health, Columbia University, New York, New York
| | - Angela M Caliendo
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christian Hopfer
- Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ted Miller
- Pacific Institute for Research and Evaluation and School of Public Health, Curtin University, Beltsville, Maryland; and
| | - Gabriella Conti
- Departments of Economics and Social Science, University College London, London, United Kingdom
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15
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Kim B, Callander D, DiClemente R, Trinh-Shevrin C, Thorpe LE, Duncan DT. Location of Pre-exposure Prophylaxis Services Across New York City Neighborhoods: Do Neighborhood Socio-demographic Characteristics and HIV Incidence Matter? AIDS Behav 2019; 23:2795-2802. [PMID: 31321639 DOI: 10.1007/s10461-019-02609-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Despite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.
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Affiliation(s)
- Byoungjun Kim
- Department of Population Health, School of Medicine, New York University, 180 Madison Ave, 3rd Floor, New York, NY, 10016, USA.
| | - Denton Callander
- Department of Population Health, School of Medicine, New York University, 180 Madison Ave, 3rd Floor, New York, NY, 10016, USA
| | - Ralph DiClemente
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, School of Medicine, New York University, 180 Madison Ave, 3rd Floor, New York, NY, 10016, USA
| | - Lorna E Thorpe
- Department of Population Health, School of Medicine, New York University, 180 Madison Ave, 3rd Floor, New York, NY, 10016, USA
| | - Dustin T Duncan
- Department of Population Health, School of Medicine, New York University, 180 Madison Ave, 3rd Floor, New York, NY, 10016, USA
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16
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Dennis ML, Smith CN, Belenko S, Knight D, McReynolds L, Rowan G, Dembo R, DiClemente R, Robertson A, Wiley T. Operationalizing a Behavioral Health Services Cascade of Care Model: Lessons Learned from a 33-Site Implementation in Juvenile Justice Community Supervision. Fed Probat 2019; 83:52-64. [PMID: 34366438 PMCID: PMC8341285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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17
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Becan JE, Bartkowski JP, Knight DK, Wiley TRA, DiClemente R, Ducharme L, Welsh WN, Bowser D, McCollister K, Hiller M, Spaulding AC, Flynn PM, Swartzendruber A, Dickson MF, Fisher JH, Aarons GA. A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study. Health Justice 2018; 6:9. [PMID: 29654518 PMCID: PMC5899075 DOI: 10.1186/s40352-018-0068-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/02/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. METHODS The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. DISCUSSION The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. TRIAL REGISTRATION NCT02672150 . Retrospectively registered on 22 January 2016.
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Affiliation(s)
- Jennifer E Becan
- Institute of Behavioral Research, Texas Christian University, Box 298740, Fort Worth, TX, 76129, USA.
| | - John P Bartkowski
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Danica K Knight
- Institute of Behavioral Research, Texas Christian University, Box 298740, Fort Worth, TX, 76129, USA
| | | | - Ralph DiClemente
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lori Ducharme
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Wayne N Welsh
- Department of Criminal Justice, Temple University, Philadelphia, PA, USA
| | - Diana Bowser
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - Matthew Hiller
- Department of Criminal Justice, Temple University, Philadelphia, PA, USA
| | - Anne C Spaulding
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Patrick M Flynn
- Institute of Behavioral Research, Texas Christian University, Box 298740, Fort Worth, TX, 76129, USA
| | - Andrea Swartzendruber
- College of Public Health, Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Megan F Dickson
- Behavioral Science, University of Kentucky, Lexington, KY, USA
| | | | - Gregory A Aarons
- Department of Psychiatry, and Child and Adolescent Services Research Center, University of California, San Diego, CA, USA
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18
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Davis TL, DiClemente R, Prietula M. Taking mHealth Forward: Examining the Core Characteristics. JMIR Mhealth Uhealth 2016; 4:e97. [PMID: 27511612 PMCID: PMC4997001 DOI: 10.2196/mhealth.5659] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/02/2016] [Accepted: 07/20/2016] [Indexed: 01/21/2023] Open
Abstract
The emergence of mobile health (mHealth) offers unique and varied opportunities to address some of the most difficult problems of health. Some of the most promising and active efforts of mHealth involve the engagement of mobile phone technology. As this technology has spread and as this technology is still evolving, we begin a conversation about the core characteristics of mHealth relevant to any mobile phone platform. We assert that the relevance of these characteristics to mHealth will endure as the technology advances, so an understanding of these characteristics is essential to the design, implementation, and adoption of mHealth-based solutions. The core characteristics we discuss are (1) the penetration or adoption into populations, (2) the availability and form of apps, (3) the availability and form of wireless broadband access to the Internet, and (4) the tethering of the device to individuals. These collectively act to both enable and constrain the provision of population health in general, as well as personalized and precision individual health in particular.
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19
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Rosenbaum JE, Zenilman J, Rose E, Wingood G, DiClemente R. Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power. J Urban Health 2016; 93:493-510. [PMID: 27188460 PMCID: PMC4899331 DOI: 10.1007/s11524-016-0047-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15-21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.
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Affiliation(s)
- Janet E Rosenbaum
- Department of Epidemiology, School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Jonathan Zenilman
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Eve Rose
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gina Wingood
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ralph DiClemente
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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20
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Knight DK, Belenko S, Wiley T, Robertson AA, Arrigona N, Dennis M, Bartkowski JP, McReynolds LS, Becan JE, Knudsen HK, Wasserman GA, Rose E, DiClemente R, Leukefeld C. Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS): a cluster randomized trial targeting system-wide improvement in substance use services. Implement Sci 2016; 11:57. [PMID: 27130175 PMCID: PMC4850663 DOI: 10.1186/s13012-016-0423-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/20/2016] [Indexed: 01/11/2024] Open
Abstract
Background The purpose of this paper is to describe the Juvenile Justice—Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, a cooperative implementation science initiative involving the National Institute on Drug Abuse, six research centers, a coordinating center, and Juvenile Justice Partners representing seven US states. While the pooling of resources across centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, co-producing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented with fidelity across the cooperative can be challenging. This paper describes (a) the study background and rationale, including the juvenile justice context and best practices for substance use disorders, (b) the selection and use of an implementation science framework to guide study design and inform selection of implementation components, and (c) the specific study design elements, including research questions, implementation interventions, measurement, and analytic plan. Methods/design The JJ-TRIALS primary study uses a head-to-head cluster randomized trial with a phased rollout to evaluate the differential effectiveness of two conditions (Core and Enhanced) in 36 sites located in seven states. A Core strategy for promoting change is compared to an Enhanced strategy that incorporates all core strategies plus active facilitation. Target outcomes include improvements in evidence-based screening, assessment, and linkage to substance use treatment. Discussion Contributions to implementation science are discussed as well as challenges associated with designing and deploying a complex, collaborative project. Trial registration NCT02672150.
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Affiliation(s)
- Danica K Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA.
| | - Steven Belenko
- Department of Criminal Justice, Temple University, Philadelphia, PA, USA
| | - Tisha Wiley
- National Institute on Drug Abuse, Bethseda, MD, USA
| | - Angela A Robertson
- Social Science Research Center, Mississippi State University, Starkville, MS, USA
| | - Nancy Arrigona
- Council of State Governments Justice Center, Austin, TX, USA
| | | | - John P Bartkowski
- Department of Sociology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Larkin S McReynolds
- Center for the Promotion of Mental Health in Juvenile Justice, Columbia University/NYSPI, New York, NY, USA
| | - Jennifer E Becan
- Institute of Behavioral Research, Texas Christian University, Fort Worth, TX, USA
| | | | - Gail A Wasserman
- Center for the Promotion of Mental Health in Juvenile Justice, Columbia University/NYSPI, New York, NY, USA
| | - Eve Rose
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ralph DiClemente
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carl Leukefeld
- Behavioral Science, University of Kentucky, Lexington, KY, USA
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Rosen BL, DiClemente R, Shepard AL, Wilson KL, Fehr SK. Factors associated with school nurses’ HPV vaccine attitudes for school-aged youth. PSYCHOL HEALTH MED 2016; 22:535-545. [DOI: 10.1080/13548506.2016.1173710] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Davis TL, DiClemente R. Human Immunodeficiency Virus Prevention. Child Adolesc Psychiatr Clin N Am 2016; 25:283-95. [PMID: 26980130 DOI: 10.1016/j.chc.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Human immunodeficiency virus (HIV) is the virus that causes AIDS. Surveillance data from 2012 indicate an estimated 1.2 million people aged 13 years and older were living with HIV infection in the United States, and 12.8% do not know their status. There are approximately 50,000 new HIV infections annually. With no available cure for HIV, primary prevention to reduce incident cases of HIV is essential. Strategies to prevent HIV transmission include reducing sexual risk behavior and needle sharing. The Centers for Disease Control and Prevention has multiple resources available for primary and secondary prevention to reduce disease transmission and severity.
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Affiliation(s)
- Teaniese Latham Davis
- Public Health Sciences Institute, Morehouse College, 830 Westview Drive Southwest, Atlanta, GA 30314, USA.
| | - Ralph DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road Northeast, Atlanta, GA 30322, USA
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23
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Kottke M, Whiteman MK, Kraft JM, Goedken P, Wiener J, Kourtis AP, DiClemente R. Use of Dual Methods for Protection from Unintended Pregnancy and Sexually Transmitted Diseases in Adolescent African American Women. J Pediatr Adolesc Gynecol 2015; 28:543-8. [PMID: 26152648 PMCID: PMC4618263 DOI: 10.1016/j.jpag.2015.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/19/2015] [Accepted: 04/14/2015] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To characterize factors associated with dual method contraceptive use in a sample of adolescent women. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a cross-sectional survey of sexually active African American women aged 14-19 years who attended an urban Title X clinic in Georgia in 2012 (N = 350). Participants completed a computerized survey to assess contraceptive and condom use during the past 2 sexual encounters with their most recent partner. Dual method use was defined as use of a hormonal contraceptive or intrauterine device and a condom. We applied multinomial logistic regression, using generalized estimating equations, to examine the adjusted association between dual method use (vs use of no methods or less effective methods alone; eg, withdrawal) and select characteristics. RESULTS Dual methods were used by 20.6% of participants at last sexual intercourse and 23.6% at next to last sexual intercourse. Having a previous sexually transmitted disease (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.26-4.18), negative attitude toward pregnancy (aOR, 2.25; 95% CI, 1.19-4.28), and a mother who gave birth as a teen (aOR, 2.34; 95% CI, 1.21-4.52) were associated with higher odds of dual method use. Having no health insurance (aOR, 0.39; 95% CI, 0.18-0.82), 4 or more lifetime sexual partners (aOR, 0.42; 95% CI, 0.22-0.78), sex at least weekly (aOR, 0.54; 95% CI, 0.29-0.99), and agreeing to monogamy with the most recent partner (aOR, 0.40; 95% CI, 0.16-0.96) were associated with decreased odds of dual method use. CONCLUSION Dual method use was uncommon in our sample. Efforts to increase use of dual methods should address individual and relationship factors.
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Affiliation(s)
- Melissa Kottke
- Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia.
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joan Marie Kraft
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia
| | - Jeffrey Wiener
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Athena P Kourtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ralph DiClemente
- Department of Behavioral Science and Health Education, Emory University, Rollins School of Public Health, Atlanta, Georgia
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Wiley T, Belenko S, Danica K, Bartkowski J, Robertson A, Aarons G, Wasserman G, Leukefeld C, DiClemente R, Jones D. Juvenile Justice-Translating Research Interventions for Adolescents in the Legal System (JJ-TRIALS): a multi-site, cooperative implementation science cooperative. Implement Sci 2015. [PMCID: PMC4551773 DOI: 10.1186/1748-5908-10-s1-a43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leukefeld C, Knight D, Belenko S, Robertson A, Wiley T, Wasserman G, DiClemente R, Brody G, Knudsen H. Community involvement in a juvenile partner justice behavioral health. Addict Sci Clin Pract 2015. [PMCID: PMC4347513 DOI: 10.1186/1940-0640-10-s1-a34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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26
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Davis TL, Boyce LS, Rose E, Swartzendruber A, DiClemente R, Gelaude D, Fasula AM, Carry M. Lessons Learned From Delivering Imara, an HIV/STI Risk Reduction Intervention for African American Girls in Juvenile Detention. Health Promot Pract 2015; 17:31-9. [PMID: 26452768 DOI: 10.1177/1524839915606395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A critical need exists for efficacious interventions to reduce sexual risk and sexually transmitted infections (STIs) among African American girls in juvenile detention. Adapting evidence-based interventions is one strategy for developing interventions that might protect detained African American girls from adverse sexual health outcomes. To support development and implementation of evidence-based HIV/STI prevention interventions for this population, this qualitative study describes lessons learned from delivering Imara, an adapted HIV/STI prevention intervention for detained African American girls. Program implementation includes one-on-one sessions in the detention facility that offer logistical advantages; provide intervention contact inside the facility, soon after release, and frequently thereafter; address STI treatment for girls and their sexual partners; tailor intervention content based on individual risk and learning needs; and identify and acknowledge girls' competing priorities. These lessons are discussed in the context of challenges encountered and solutions for addressing the challenges, and in terms of the structure and content of the intervention. The lessons learned from delivering Imara exemplify the continuous process of adapting an existing intervention for a new population and setting.
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Affiliation(s)
- Teaniese L Davis
- Emory University, Atlanta, GA, USA Center for AIDS Research, Emory University, Atlanta, GA Morehouse College, Atlanta, GA, USA
| | | | - Eve Rose
- Emory University, Atlanta, GA, USA
| | - Andrea Swartzendruber
- Emory University, Atlanta, GA, USA Center for AIDS Research, Emory University, Atlanta, GA
| | - Ralph DiClemente
- Emory University, Atlanta, GA, USA Center for AIDS Research, Emory University, Atlanta, GA
| | - Deborah Gelaude
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy M Fasula
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monique Carry
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Sales JM, Brown JL, Swartzendruber AL, Smearman EL, Brody GH, DiClemente R. Genetic sensitivity to emotional cues, racial discrimination and depressive symptoms among African-American adolescent females. Front Psychol 2015; 6:854. [PMID: 26157407 PMCID: PMC4476200 DOI: 10.3389/fpsyg.2015.00854] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/09/2015] [Indexed: 01/28/2023] Open
Abstract
Psychosocial stress, including stress resulting from racial discrimination (RD), has been associated with elevated depressive symptoms. However, individuals vary in their reactivity to stress, with some variability resulting from genetic differences. Specifically, genetic variation within the linked promoter region of the serotonin transporter gene (5-HTTLPR) is related to heightened reactivity to emotional environmental cues. Likewise, variations within this region may interact with stressful life events (e.g., discrimination) to influence depressive symptoms, but this has not been empirically examined in prior studies. The objective of this study was to examine whether variation in the 5-HTTLPR gene interacts with RD to predict depressive symptoms among a sample of African-American adolescent females. Participants were 304 African-American adolescent females enrolled in a sexually transmitted disease prevention trial. Participants completed a baseline survey assessing psychosocial factors including RD (low vs. high) and depressive symptomatology (low vs. high) and provided a saliva sample for genotyping the risk polymorphism 5-HTTLPR (s allele present vs. not present). In a logistic regression model adjusting for psychosocial correlates of depressive symptoms, an interaction between RD and 5-HTTLPR group was significantly associated with depressive symptomatology (AOR = 3.79, 95% CI: 1.20-11.98, p = 0.02). Follow-up tests found that high RD was significantly associated with greater odds of high depressive symptoms only for participants with the s allele. RD and 5-HTTLPR status interact to differentially impact depressive symptoms among African-American adolescent females. Efforts to decrease depression among minority youth should include interventions which address RD and strengthen factors (e.g., coping, emotion regulation, building support systems) which protect youth from the psychological costs of discrimination.
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Affiliation(s)
- Jessica M. Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory UniversityAtlanta, GA, USA
| | - Jennifer L. Brown
- Department of Psychological Sciences, Texas Tech UniversityLubbock, TX, USA
| | - Andrea L. Swartzendruber
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory UniversityAtlanta, GA, USA
| | - Erica L. Smearman
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory UniversityAtlanta, GA, USA
| | - Gene H. Brody
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory UniversityAtlanta, GA, USA
| | - Ralph DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory UniversityAtlanta, GA, USA
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Gargano LM, Herbert N, Painter JE, Sales JM, Morfaw C, Rask K, Murray D, DiClemente R, Hughes J. Clarification of "Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines". Hum Vaccin Immunother 2014; 10:2631. [PMID: 25483502 DOI: 10.4161/21645515.2014.972897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lisa M Gargano
- a Department of Medicine ; Emory University ; Atlanta , GA USA
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Leader A, Weddington P, DiClemente R, Wingood G, Jackson A, Juzang I. Abstract A26: Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention. Cancer Epidemiol Biomarkers Prev 2014. [DOI: 10.1158/1538-7755.disp13-a26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
While traditional settings such as physician offices and community health agencies have had measurable success in delivering behavioral health interventions, they are less successful in recruiting underserved African American participants. Inner-city African American women, faced with multiple risk factors contributing to persistent health disparities, require a source of reliable health information in a setting that is easily accessible and credible to them. Salon-based health education programs are becoming increasingly popular for reaching African American females because they engage trusted members of the community (salon owners and hair stylists) in a location that represents care and reflects the tradition of sharing information through oral communication. We partnered with neighborhood hair salons to promote messages about persistent cervical cancer disparities and low rates of human papillomavirus (HPV) vaccination in the African American community. Study goals were to: (1) recruit eight beauty salons in low-income Philadelphia neighborhoods to serve as health education sites; (2) train hair stylist to be able to discuss cervical cancer disparities and HPV infection with their customers, and (3) increase knowledge and awareness about HPV, as well as intentions to vaccinate, among customers at each salon. Study inclusion criteria for customers consisted of being a young woman ages 18 to 26 or the caregiver of a young female ages 9 to 17.
Stylists were trained by members of the research team to be able to briefly discuss cervical cancer and HPV with their customers during regular salon hours. Additionally, professional health educators were trained more substantially on the health topics and were placed in the salons to supplement the work of the stylists and provide a more in-depth educational experience for the customers. Survey data related to knowledge and attitudes about HPV and HPV vaccination were collected from customers immediately before and after the health education, and approximately one month later. Salon stylists and owners were interviewed post-intervention to assess their experiences with participating in the intervention.
Two hundred and forty women from 10 salons were enrolled in the study. Roughly 60% of participants were caregivers while 40% were young women. Knowledge about cervical cancer and HPV infection increased significantly in both groups from baseline to endpoint and remained high at the one-month follow-up assessment. At follow-up, 68% of participants said that they had had a discussion with a friend or family member about what they learned, and 57% planned to talk to their doctor or their daughter's doctor about HPV vaccination. Sixty-two percent of caregivers reported that it was important that their daughter be vaccinated against HPV in the future. There were no significant differences between the caregivers and the young women on outcome measures of knowledge, attitudes, or intentions to vaccinate. During the post-intervention interviews with the stylists, many indicated that they enjoyed having discussions about health in the salon and that salons should continue to serve as venues of education for women in the African American community. The majority of stylists indicated that neither they, nor their customers, were aware of the magnitude of cervical cancer disparities among African American women nor the availability of the HPV vaccine as a method of protection for young women. Results of the study indicate that such community-based interventions are both feasible and effective in reaching populations not traditionally included in health education interventions.
Citation Format: Amy Leader, Pamela Weddington, Ralph DiClemente, Gina Wingood, Alicia Jackson, Ivan Juzang. Tackling cervical cancer disparities through African American beauty salons: A community-based health education intervention. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A26. doi:10.1158/1538-7755.DISP13-A26
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Affiliation(s)
- Amy Leader
- 1Thomas Jefferson University, Philadelphia, PA,
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Joppa MC, Rizzo CJ, Brown LK, Hadley W, Dattadeen JA, Donenberg G, DiClemente R. Internalizing Symptoms and Safe Sex Intentions among Adolescents in Mental Health Treatment: Personal Factors as Mediators. Child Youth Serv Rev 2014; 46:177-185. [PMID: 25284921 PMCID: PMC4180408 DOI: 10.1016/j.childyouth.2014.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.
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Affiliation(s)
- Meredith C. Joppa
- Department of Psychology, Rowan University. 201 Mullica Hill Road, Glassboro, NJ 08028
| | - Christie J. Rizzo
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Larry K. Brown
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Wendy Hadley
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Jodi-Ann Dattadeen
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Geri Donenberg
- Department of Psychiatry, University of Illinois at Chicago. Institute for Juvenile Research, Chicago, IL
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Herbert N, Painter JE, Sales JM, Morfaw C, Rask K, Murray D, DiClemente R, Hughes J, Gargano LM. Clarification of “Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines”. Hum Vaccin Immunother 2014. [DOI: 10.4161/hv.28625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Thomas TL, DiClemente R, Snell S. Overcoming the triad of rural health disparities: How local culture, lack of economic opportunity, and geographic location instigate health disparities. Health Educ J 2014; 73:285-294. [PMID: 25242822 PMCID: PMC4166513 DOI: 10.1177/0017896912471049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. METHODS We critically profile each component of the deterministic triad in shaping current health-related disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice. RESULTS The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants. CONCLUSION The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.
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Hadley W, Barker DH, Lescano CM, Stewart AJ, Affleck K, Donenberg G, DiClemente R, Brown LK. Associations Between Psychiatric Impairment and Sexual Risk Behavior Among Teens in Mental Health Treatment. J HIV AIDS Soc Serv 2014; 13:198-213. [PMID: 26023302 PMCID: PMC4443474 DOI: 10.1080/15381501.2013.789416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIMS To assess the associations of sexual risk behavior with psychiatric impairment and individual, peer, and partner attitudes among adolescents receiving mental health treatment. METHODS Adolescents (N=893, 56% female, 67% African American) completed assessments of psychiatric impairment, rejection sensitivity, peer norms, HIV knowledge, perceived vulnerability, self-efficacy and condom use intentions. Two structural equation models were used to test the study hypotheses; one for sexually active youth and one for non-active youth. RESULTS For non-active youth, psychiatric impairment influenced self-efficacy and condom use intentions via peer norms, rejection sensitivity, and perceived vulnerability. Among the sexually active youth, sexual risk was related to impairment and previous condom use. DISCUSSION These results suggest that individual, peer, and partner factors are related to impairment and to sexual risk attitudes, but depend on previous sexual experience.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | - David H. Barker
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Angela J. Stewart
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | - Katelyn Affleck
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | - Larry K. Brown
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
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Rosenbaum JE, Zenilman J, Melendez J, Rose E, Wingood G, DiClemente R. Telling truth from Ys: an evaluation of whether the accuracy of self-reported semen exposure assessed by a semen Y-chromosome biomarker predicts pregnancy in a longitudinal cohort study of pregnancy. Sex Transm Infect 2014; 90:479-84. [PMID: 24627289 DOI: 10.1136/sextrans-2013-051315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Adolescents may use condoms inconsistently or incorrectly, or may over-report condom use. This study used a semen exposure biomarker to evaluate the accuracy of female adolescents' reports of condom use and predict subsequent pregnancy. METHODS The sample comprised 715 sexually active African-American female adolescents, ages 15-21 years. At baseline, 6 months and 12 months, participants completed a 40-min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted pregnancy from semen exposure under-report using multivariate regression controlling for oral contraception, reported condom use and coital frequency. RESULTS At the 3 surveys, 30%, 20% and 15% of adolescents who reported always using condoms tested positive for semen exposure. At 6 month follow-up, 20.4% and 16.2% of the adolescents who under-reported semen exposure reported pregnancy, a higher pregnancy rate than accurate reporters of semen exposure, even accurate reporters who reported never using condoms (14.2% and 11.8%). Under-reporters of semen exposure were 3.23 (95% CI (1.61, 6.45)) times as likely to become pregnant at 6-month follow-up and 2.21 (0.94, 5.20) times as likely to become pregnant at 12-month follow-up as accurate reporters who reported not using contraception, adjusting for self-reported coital frequency. CONCLUSIONS Adolescents who under-report semen exposure may be at uniquely high risk for unplanned pregnancy and STIs, and may also under-report coital frequency. Condom efficacy trials that rely on self-report may yield inaccurate results. Adapted to a clinical setting, the Y-chromosome PCR could alert women to incorrect or inconsistent condom use.
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Affiliation(s)
- Janet E Rosenbaum
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jonathan Zenilman
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Johan Melendez
- Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Eve Rose
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gina Wingood
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ralph DiClemente
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Sullivan PS, Peterson J, Rosenberg ES, Kelley CF, Cooper H, Vaughan A, Salazar LF, Frew P, Wingood G, DiClemente R, del Rio C, Mulligan M, Sanchez TH. Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PLoS One 2014; 9:e90514. [PMID: 24608176 PMCID: PMC3946498 DOI: 10.1371/journal.pone.0090514] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 02/01/2014] [Indexed: 11/25/2022] Open
Abstract
Background The reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework. Methods and Findings From July 2010-Decemeber 2012, 803 men (454 black, 349 white) were recruited through venue-based and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.5–4.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/µL) than white (577 cells/µL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates. Conclusions Among black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively.
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Affiliation(s)
- Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - John Peterson
- Department of Psychology, Georgia State University, Atlanta, Georgia, United States of America
| | - Eli S. Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Colleen F. Kelley
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hannah Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Adam Vaughan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Laura F. Salazar
- Institute of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Paula Frew
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Gina Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Ralph DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Carlos del Rio
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Mark Mulligan
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Travis H. Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Rosenbaum J, Zenilman J, Rose E, Wingood G, DiClemente R. Do Jobs Work? Risk and Protective Behaviors Associated with Employment Among Disadvantaged Female Teens in Urban Atlanta. J Women Polit Policy 2014; 35:155-173. [PMID: 25221451 PMCID: PMC4159192 DOI: 10.1080/1554477x.2014.890836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Adolescent employment predicts lower educational engagement and achievement and greater engagement with risk behaviors. Most research has studied middle class rather than disadvantaged adolescents. We identified risk and protective behaviors associated with employment using data from a 3-wave, 12-month study of 715 low-socio-economic status female African American adolescents who were ages 15-21 at baseline. Adolescents who were employed at wave 2 (n=214) were matched with adolescents who were not employed at wave 2 (n=422) using nearest-neighbor matching on baseline factors within propensity score calipers on factors including marijuana use, sex while high, pregnancy risk, and socioeconomic status. We compared employed and non-employed teens on risk behaviors including marijuana use, sex while high or drunk, and a biomarker for semen exposure in the past 14 days. Employed teens were 44% as likely to say that their boyfriend is their primary spending money source and 43% as likely to be emotionally abused, but these benefits did not persist after employment ended. Six months after employment, employed respondents reported using marijuana 57% more often and had sex while drunk or high 2.7 times as frequently. Women who were employed at both waves 2 and 3 were 17% as likely to have their boyfriend as a primary source of spending money and 13% more likely to graduate high school, but they used marijuana twice as often, alcohol 1.6 times as often, had 1.6 times as many sexual partners, and had sex while high or drunk 2.3 times as often. Female teens who work may avoid potentially coercive romantic relationships, but they may buy drugs or alcohol with their earnings.
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Affiliation(s)
| | | | - Eve Rose
- Emory University, Atlanta, Georgia
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37
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Sullivan PS, Wall KM, O’Hara B, Jones J, Barnes J, DiClemente R, Hoff C, Scales L, Salazar LF, Sanchez T, White D, Wingood G, Allen S, Stephenson R. The prevalence of undiagnosed HIV serodiscordance among male couples presenting for HIV testing. Arch Sex Behav 2014; 43:173-180. [PMID: 24233391 PMCID: PMC3945405 DOI: 10.1007/s10508-013-0214-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the United States, a substantial proportion of HIV transmissions among men who have sex with men (MSM) arise from main sex partners. Couples voluntary HIV testing and counseling (CHTC) is used in many parts of the world with male-female couples, but CHTC has historically not been available in the U.S. and few data exist about the extent of HIV serodiscordance among U.S. male couples. We tested partners in 95 Atlanta male couples (190 men) for HIV. Eligible men were in a relationship for ≥3 months and were not known to be HIV-positive. We calculated the prevalence of couples that were seroconcordant HIV-negative, seroconcordant HIV-positive, or HIV serodiscordant. We evaluated differences in the prevalence of HIV serodiscordance by several dyadic characteristics (e.g., duration of relationship, sexual agreements, and history of anal intercourse in the relationship). Overall, among 190 men tested for HIV, 11 % (n = 20) were newly identified as HIV-positive. Among the 95 couples, 81 % (n = 77) were concordant HIV-negative, 17 % (n = 16) were HIV serodiscordant, and 2 % (n = 2) were concordant HIV-positive. Serodiscordance was not significantly associated with any evaluated dyadic characteristic. The prevalence of undiagnosed HIV serodiscordance among male couples in Atlanta is high. Offering testing to male couples may attract men with a high HIV seropositivity rate to utilize testing services. Based on the global evidence base for CHTC with heterosexual couples and the current evidence of substantial undiagnosed HIV serodiscordance among U.S. MSM, we recommend scale-up of CHTC services for MSM, with ongoing evaluation of acceptability and couples' serostatus outcomes.
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Affiliation(s)
- Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, 4th Floor GCR, Atlanta, GA 30322, USA
| | - Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, 4th Floor GCR, Atlanta, GA 30322, USA
| | - Brandon O’Hara
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, 4th Floor GCR, Atlanta, GA 30322, USA
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, 4th Floor GCR, Atlanta, GA 30322, USA
| | - Jasper Barnes
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, 4th Floor GCR, Atlanta, GA 30322, USA
| | - Ralph DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colleen Hoff
- Center for Research on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | | | - Laura F. Salazar
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, 4th Floor GCR, Atlanta, GA 30322, USA
| | - Darcy White
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Gina Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Susan Allen
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Voisin DR, Hotton A, Tan K, DiClemente R. A Longitudinal Examination of Risk and Protective Factors Associated with Drug Use and Unsafe Sex among Young African American Females. Child Youth Serv Rev 2013; 35:1440-1446. [PMID: 23935234 PMCID: PMC3735175 DOI: 10.1016/j.childyouth.2013.05.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This study prospectively examined associations among multiple theoretically informed risk (e.g., depression, sexual sensation seeking, and risky peers norms) and protective factors (e.g., social support, STI knowledge, and refusal to have sex self efficacy) on unsafe sex among 715 African American adolescent females aged 15-21 who participated in an STI/HIV prevention intervention. Generalized estimating equation models were used to assess associations between baseline characteristics and sexual risk over a 12-month follow up period. Overall risk in this population was high: at baseline, nearly a third of women reported sex under the influence of alcohol or substances; ≥ 2 partners for vaginal sex, and casual sex partners in the 60 days prior to baseline, and nearly 75% of those reporting vaginal sex used condoms inconsistently. In multivariable analysis, when risk and protective factors were simultaneously considered, higher levels of sexual sensation seeking were associated with having multiple sex partners and inconsistent condom use. Greater perception of risky peer norms was associated with a higher risk of having sex under the influence of alcohol or drugs. In addition, higher sex refusal self-efficacy was protective against having multiple; casual; and concurrent sex partners. Incorporating these salient factors into prevention programs may be critical to the development of targeted interventions for this population.
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Affiliation(s)
- Dexter R. Voisin
- University of Chicago, School of Social Service Administration
- STI/HIV Intervention Network
| | - Anna Hotton
- John H. Stroger Hospital Department of Infectious Diseases
| | - Kevin Tan
- University of Chicago, School of Social Service Administration
| | - Ralph DiClemente
- STI/HIV Intervention Network
- Emory University, Rollins School of Public Health
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Kottke M, Whiteman M, Kraft J, Goedken P, DiClemente R. Dual method use in young African American women. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Sullivan PS, White D, Rosenberg ES, Barnes J, Jones J, Dasgupta S, O'Hara B, Scales L, Salazar LF, Wingood G, DiClemente R, Wall KM, Hoff C, Gratzer B, Allen S, Stephenson R. Safety and acceptability of couples HIV testing and counseling for US men who have sex with men: a randomized prevention study. J Int Assoc Provid AIDS Care 2013; 13:135-44. [PMID: 23995295 DOI: 10.1177/2325957413500534] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We tested a couples HIV testing and counseling (CHTC) intervention with male couples in Atlanta by randomizing eligible couples to receive either CHTC or separate individual voluntary HIV counseling and testing (iVCT). To evaluate the acceptability and safety of CHTC, main outcomes were satisfaction with the intervention and the proportions of couples reporting intimate partner violence (IPV) and relationship dissolution after the service. The results indicated that the service was very acceptable to men (median 7-item index of satisfaction was 34 for CHTC and 35 for iVCT, P = .4). There was no difference in either incident IPV (22% versus 17% for CHTC and iVCT, respectively, P = .6) or relationship dissolution (42% versus 51% for CHTC and iVCT, respectively, P = .5). Based on the preliminary data, CHTC is safe for male couples, and it is equally acceptable to iVCT for men who have main partners.
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Thomas TL, Strickland OL, DiClemente R, Higgins M, Williams B, Hickey K. Parental Human Papillomavirus Vaccine Survey (PHPVS): nurse-led instrument development and psychometric testing for use in research and primary care screening. J Nurs Meas 2013; 21:96-109. [PMID: 23786137 DOI: 10.1891/1061-3749.21.1.96] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Human papillomavirus (HPV) vaccine was approved for girls aged 9-24 years in 2006 to prevent HPV infection and cervical cancer. The Parental Human Papillomavirus Survey (PHPVS) was framed on theoretical constructs of the health belief model (HBM) and developed to survey parents regarding their HPV knowledge, attitudes, and intent to vaccinate. METHODS We evaluated the psychometric properties of the PHPVS using classical item analysis and exploratory factor analysis (EFA) among a sample of 200 parents/caregivers. RESULTS The EFA yielded a 4-factor unidimensional model that explained between 62% and 68% of the total variance depending on the extraction method used. The estimated Cronbach's alpha for the PHPVS was .96. CONCLUSIONS The PHPVS is a reliable measure of HPV knowledge, attitudes, and intent to vaccinate.
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Affiliation(s)
- Tami Lynn Thomas
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30032, USA.
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42
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Pettifor A, Bekker LG, Hosek S, DiClemente R, Rosenberg M, Bull SS, Allison S, Delany-Moretlwe S, Kapogiannis BG, Cowan F. Preventing HIV among young people: research priorities for the future. J Acquir Immune Defic Syndr 2013; 63 Suppl 2:S155-60. [PMID: 23764629 PMCID: PMC3746811 DOI: 10.1097/qai.0b013e31829871fb] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the current state of knowledge on the prevention of sexual transmission of HIV in adolescents and to highlight the existing gaps and priority areas for future research. BACKGROUND A disproportionate burden of HIV infections falls on adolescents, a developmental stage marked by unique neural, biological, and social transition. Successful interventions are critical to prevent the spread of HIV in this vulnerable population. METHODS We summarized the current state of research on HIV prevention in adolescents by providing examples of successful interventions and best practices, and highlighting current research gaps. RESULTS Adolescent interventions fall into 3 main categories: biomedical, behavioral, and structural. The majority of current research has focused on individual behavior change, whereas promising biomedical and structural interventions have been largely understudied in adolescents. Combination prevention interventions may be particularly valuable to this group. CONCLUSIONS Adolescents have unique needs with respect to HIV prevention, and, thus, interventions should be designed to most effectively reach out to this population with information and services that will be relevant to them.
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Affiliation(s)
- Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
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43
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Hadley W, Stewart A, Hunter HL, Affleck K, Donenberg G, DiClemente R, Brown LK. Reliability and Validity of the Dyadic Observed Communication Scale (DOCS). J Child Fam Stud 2013; 22:279-287. [PMID: 23645977 PMCID: PMC3639442 DOI: 10.1007/s10826-012-9577-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.
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Affiliation(s)
- Wendy Hadley
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | - Angela Stewart
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | - Heather L. Hunter
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | - Katelyn Affleck
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
| | | | | | - Larry K. Brown
- Bradley/Hasbro Children’s Research Center/Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI 02903.
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Hennessy M, Romer D, Valois RF, Vanable P, Carey MP, Stanton B, Brown L, DiClemente R, Salazar LF. Safer sex media messages and adolescent sexual behavior: 3-year follow-up results from project iMPPACS. Am J Public Health 2012; 103:134-40. [PMID: 23153149 DOI: 10.2105/ajph.2012.300856] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We estimated the long-term (36-month) effects of Project iMPPACS, a multisite randomized controlled trial of mass media and small-group intervention for African American adolescents. METHODS We collected 6 waves of longitudinal data on program participants aged 14 to 17 years (n = 1139) in Providence, Rhode Island; Syracuse, New York; Columbia, South Carolina; and Macon, Georgia, 36 months (December 2009-December 2010) after the intervention began (August 2006-January 2008). Seemingly unrelated regressions at each wave estimated the effects of 3 types of mass media messages (the thematic mediators: selection, pleasure, and negotiation) on condom use intention and self-reported unprotected vaginal sex events. RESULTS All 3 mediators of behavior change that were introduced during the media intervention were sustained at the follow-up assessments at least 18 months after the intervention ended, with intention having the largest correlation. Unprotected vaginal sex increased with each wave of the study, although cities receiving media exposure had smaller increases. CONCLUSIONS Project iMPPACS demonstrates that mass media influence delivered over an extended period, when adolescents were beginning to learn patterns of behavior associated with sex, persisted after the media program ended.
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Affiliation(s)
- Michael Hennessy
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
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45
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Thomas TL, Strickland OL, DiClemente R, Higgins M, Haber M. Rural African American parents' knowledge and decisions about human papillomavirus vaccination. J Nurs Scholarsh 2012; 44:358-67. [PMID: 23126428 DOI: 10.1111/j.1547-5069.2012.01479.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify predictors of human papillomavirus (HPV) vaccination among rural African American families. DESIGN Cross-sectional descriptive study in schools in three rural counties in southeastern United States. The sample consisted of African American parents or caregivers with children 9 to 13 years of age who attended elementary or middle school in 2010-2011. METHODS Using an anonymous, 26-item survey, we collected descriptive data during parent-teacher events from African American parents with children in elementary or middle school. The main outcome was measured as a response of "yes" to the statement "I have or will vaccinate my child with the HPV vaccine." In addition, composite scores of knowledge and positive attitudes and beliefs were compared. No interventions were conducted. FINDINGS We identified predictors of HPV vaccination and found that religious affiliation had a correlation with vaccinating or planning to vaccinate a child. CONCLUSIONS Results indicate a need for further research on the role of local culture, including religion and faith, in rural African Americans' decisions about giving their children the HPV vaccination. CLINICAL RELEVANCE This study emphasizes the importance of understanding rural African American parents' knowledge, attitudes, and spiritual beliefs when designing health education programs and public health interventions to increase HPV vaccination uptake among African American boys and girls living in rural areas.
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Affiliation(s)
- Tami Lynn Thomas
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA 30322, USA.
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46
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Rosenbaum J, Zenilman J, Rose E, Wingood G, DiClemente R. Cash, cars, and condoms: economic factors in disadvantaged adolescent women's condom use. J Adolesc Health 2012; 51:233-41. [PMID: 22921133 PMCID: PMC3428592 DOI: 10.1016/j.jadohealth.2011.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Evaluate whether adolescent women who received economic benefits from their boyfriends were more likely never to use condoms. METHODS Data are obtained from a longitudinal HIV prevention intervention study with 715 African American adolescent women in urban Atlanta surveyed at baseline, 6 months, and 12 months. The primary outcome was never using condoms in the past 14 and 60 days at 6 and 12 months. The primary predictor was having a boyfriend as primary spending money source at baseline. Analysis minimized confounding using propensity weighting to balance respondents on 81 variables. RESULTS A boyfriend was the primary spending money source for 24% of respondents, who did not differ in neighborhood or family context but had lower education, more abuse history, riskier sex, and more sexually transmitted infections. After propensity score weighting, no statistically significant differences for 81 evaluated covariates remained, including age distributions. Women whose boyfriend was their primary spending money source were 50% more likely never to use condoms at 6 and 12 months and less likely to respond to the intervention at 12 months. Women whose boyfriend had been their primary spending money source but found another spending money source were more likely to start using condoms than women who continued. Women whose boyfriends owned cars were more likely never to use condoms. CONCLUSIONS Receiving spending money from a boyfriend is common among adolescent women in populations targeted by pregnancy and sexually transmitted infection prevention interventions, and may undermine interventions' effectiveness. Clinicians and reproductive health interventions need to address females' economic circumstances.
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Affiliation(s)
- Janet Rosenbaum
- Maryland Population Research Center, College of Behavioral and Social Science, University of Maryland, College Park, 20742, USA.
| | - Jonathan Zenilman
- Sexually Transmitted Disease Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Department of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Eve Rose
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Ralph DiClemente
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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47
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Whiteley LB, Brown LK, Swenson RR, Valois RF, Vanable PA, Carey MP, DiClemente R, Salazar LF, Romer D. African American adolescents meeting sex partners online: closing the digital research divide in STI/HIV prevention. J Prim Prev 2012; 33:13-8. [PMID: 22293979 DOI: 10.1007/s10935-012-0262-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Laura B Whiteley
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, Coro West Building, One Hoppin Street, Providence, RI 02903, USA.
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Stewart AJ, Theodore-Oklota C, Hadley W, Brown LK, Donenberg G, DiClemente R. Mania symptoms and HIV-risk behavior among adolescents in mental health treatment. J Clin Child Adolesc Psychol 2012; 41:803-10. [PMID: 22540428 DOI: 10.1080/15374416.2012.675569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, M age = 14.9 years) who received mental health treatment completed private, computer-based assessments of psychiatric disorders and of sexual and substance use behaviors and provided urine to screen for sexually transmitted infections (STI). Eighty-seven percent met criteria for a psychiatric disorder, and among these youth 21% were considered ESM+. Compared to those with other psychiatric disorders, ESM+ were more likely to be sexually active (61.6% vs. 53.6%), have multiple sexual partners (58.6% vs. 37.5%), have unprotected sex (38.4% vs. 28.0%), exchange sex for money (4.7% vs. 1.2%), and test positive for an STI (14.0% vs. 6.3%). Among ESM+ youth, sexual risk behaviors were primarily associated with individual factors (e.g., self-efficacy, impulsivity, and substance use) and varied depending on the type of sexual behavior (e.g., onset of sex, number of partners, and condom use). Adolescents with ESM should be regularly screened for sexual risk behaviors and receive HIV prevention skills. Efforts to increase self-efficacy for safer sex, reduce impulsivity, and decrease substance use may be effective targets for sexual risk reduction among adolescents with ESM.
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Owen-Smith A, DePadilla L, DiClemente R. The assessment of complementary and alternative medicine use among individuals with HIV: a systematic review and recommendations for future research. J Altern Complement Med 2012; 17:789-96. [PMID: 21875350 DOI: 10.1089/acm.2010.0669] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The use of complementary and alternative medicine (CAM), a group of health care practices and products that are not considered part of conventional medicine, has increased in recent years, particularly among individuals with human immune deficiency virus (HIV). Assessing the prevalence and predictors of CAM use among HIV-positive populations is important because some CAM therapies may adversely affect the efficacy of conventional HIV medications. Unfortunately, CAM use is not comprehensively or systematically assessed among HIV-positive populations. Therefore, the aim of the present study was to evaluate the quality of the instruments employed in observational studies assessing CAM use among HIV-positive populations by examining the degree to which these studies (1) evaluated the psychometric properties of their CAM instruments and (2) assessed the multidimensional nature of CAM use. DESIGN A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. Specifically, articles were included that were published in English and in a peer-reviewed journal between 1997 and 2007, recruited HIV-positive study participants, and assessed CAM use. Thirty-two (32) studies met these inclusion criteria. RESULTS Results suggest that CAM assessment among HIV-positive populations continues to be problematic. For example, approximately 20% of the studies assessed the reliability and 3% assessed the validity of the CAM instrument employed. CONCLUSIONS CAM assessment--regardless of the specific study population--is a complex and challenging task. However, CAM instruments will not become more refined over time in the absence of rigorous psychometric evaluation. Future research must assess reliability and validity and report these data in a clear and nuanced manner.
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Affiliation(s)
- Ashli Owen-Smith
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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50
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Sznitman S, Stanton BF, Vanable PA, Carey MP, Valois RF, Brown LK, DiClemente R, Hennessy M, Salazar LF, Romer D. Long term effects of community-based STI screening and mass media HIV prevention messages on sexual risk behaviors of African American adolescents. AIDS Behav 2011; 15:1755-63. [PMID: 21484280 DOI: 10.1007/s10461-011-9946-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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