Reducing HIV risk-associated sexual behavior among African American adolescents: testing the generality of intervention effects

Delinquency, Substance Use, and Risky Sexual Behaviors among Youth who are involved in the Justice System and Predominantly Reside in Rural Communities: Patterns and Associated Risk Factors

There is a significant gap in research examining the prevalence of problem behaviors among youth involved in the juvenile justice system in rural areas. The current study sought to address this gap by exploring the behavioral patterns of 210 youth who were on juvenile probation in predominantly rural counties and who were identified as having a substance use disorder. First, we examined the correlation among 7 problem behaviors representing different forms of substance use, delinquency, and sexual risk-taking and 8 risk factors related to recent service utilization, internalizing and externalizing difficulties, and social support networks. Then, we used latent class analysis (LCA) to identify distinct behavioral profiles based on the observed problem behaviors. LCA identified a 3-class model representing distinct groups labeled Experimenting (70%), Polysubstance Use + Delinquent Behaviors (24%), and Diverse Delinquent Behaviors (6%). Finally, we assessed differences (i.e., ANOVA, χ2) in each risk factor across the behavioral profiles. Important similarities and differences in the association among the problem behaviors, behavioral profiles, and the risk factors were revealed. These findings underscore the need for an interconnected behavioral health model within rural juvenile justice systems that is able to address youths' multidimensional needs including criminogenic, behavioral, and physical health needs.

Using the participatory education and research into lived experience (PEARLE) methodology to localize content and target specific populations

Technology-based behavioral health interventions offer potentially limitless opportunities to localize content and target specific populations. However, this ability to customize requires developers to make a wide range of decisions not only about who should appear on screen, but how each message should be refined to most effectively reach a particular group of intervention recipients. These issues become especially salient as interventions are scaled for delivery to multiple populations in different geographical locations or settings (e.g., a hospital emergency department versus the drop-in center of a community-based clinic), and in more than one language. To facilitate evidence-based development of customized, targeted intervention content, our team created a multi-step methodology over a series of NIH-funded research projects. The resulting Participatory Education and Research into Lived Experience (PEARLE) Methodology entails formative qualitative interviews to examine why members of a given population do not enact a specific health behavior such as HIV/HCV testing or vaccinating against COVID-19 (this step includes identifying potential gaps in related health literacy), followed by iterative evaluations of draft content designed to address these barriers, and extensive discussions with a Community Advisory Board. The final step is a clinical trial. PEARLE is designed to be highly flexible, adaptable to a variety of behavioral outcomes in clinical and community settings, and to create content in more than one language depending on the needs or preferences of a population. The current paper discusses how our team employed PEARLE to develop content in English and Spanish for our latest project, which is intended to increase COVID-19 vaccination uptake among people who inject drugs.

A Review of Recent HIV Prevention Interventions and Future Considerations for Nursing Science

ABSTRACT

As our knowledge of HIV evolved over the decades, so have the approaches taken to prevent its transmission. Public health scholars and practitioners have engaged in four key strategies for HIV prevention: behavioral-, technological-, biomedical-, and structural/community-level interventions. We reviewed recent literature in these areas to provide an overview of current advances in HIV prevention science in the United States. Building on classical approaches, current HIV prevention models leverage intimate partners, families, social media, emerging technologies, medication therapy, and policy modifications to effect change. Although much progress has been made, additional work is needed to achieve the national goal of ending the HIV epidemic by 2030. Nurses are in a prime position to advance HIV prevention science in partnership with transdisciplinary experts from other fields (e.g., psychology, informatics, and social work). Future considerations for nursing science include leveraging transdisciplinary collaborations and consider social and structural challenges for individual-level interventions.

Pre- and post-HIV test knowledge, attitude, behavior, and practice of people living with HIV and AIDS by questionnaire pattern

Context

In spite of intensive information, education, and communication (IEC) activities, the incidence of new HIV cases is also increasing. Its incidence for the past 3 years was 375, 385, and 457 at our tertiary care center.

Aims

The impact of IEC activities on the society was assessed in this study.

Settings and Design

This was a retrospective, epidemiological study conducted by a questionnaire pattern.

Subjects and Methods

The questionnaire pattern was issued to 100 newly diagnosed PLWHA, which evaluated the knowledge, attitude, behavior, and practice pre- and posttesting. Every month, follow-up was done for 3 months for further assessment.

Statistical Analysis Used

One-way ANOVA test was used for the statistical analysis.

Results

Out of the 100 patients, 37 were male, 60 were female, and 3 were transgender. Academic education had a significant association, while occupation had no association with the awareness. Nearly 80% of the new cases were identified by the government institutions. Around 33% of the study group were first identified on sexually transmitted infection screening and 20% by skin problems. Nearly 79% of the married couples revealed their status to their spouse. Out of 79% of single individuals willing to get married, 50% were willing to reveal their status to their future partner. Almost 94% of the participants were willing to undergo antiretroviral treatment. Acceptance by family and society was reflected by 87% and 68%, respectively.

Conclusions

Although this study reveals the success of IEC activities, the subtle population who are still undergoing high-risk behavior after knowing their status should be targeted for achieving zero new case identification. This study gives hope to reach that day in the near future.

Risk reduction through family therapy (RRFT): Protocol of a randomized controlled efficacy trial of an integrative treatment for co-occurring substance use problems and posttraumatic stress disorder symptoms in adolescents who have experienced interpersonal violence and other traumatic events

Decades of research demonstrate that childhood exposure to traumatic events, particularly interpersonal violence experiences (IPV; sexual abuse, physical abuse, witnessing violence), increases risk for negative behavioral and emotional outcomes, including substance use problems (SUP) and posttraumatic stress disorder (PTSD). Despite this well-established link-including empirical support for shared etiological and functional connections between SUP and PTSD -the field has been void of a gold standard treatment for adolescent populations. To address this gap, our team recently completed a large randomized controlled trial to evaluate the efficacy of Risk Reduction through Family Therapy (RRFT), an integrative and exposure-based risk-reduction and treatment approach for adolescents who have experienced IPV and other traumatic events. The purpose of this paper is to provide a detailed description of the design and methods of this RCT designed to reduce SUP, PTSD symptoms, and related risk behaviors, with outcomes measured from pre-treatment through 18 months post-entry. Specifically, the recruitment and sampling procedures, assessment measures and methods, description of the intervention, and planned statistical approaches to evaluating the full range of outcomes are detailed. Clinical and research implications of this work are also discussed.

HIV Testing Behaviors among Black Rural Women: The Moderating Role of Conspiracy Beliefs and Partner Status Disclosure

Objective

This study investigated whether HIV testing attitudes, HIV conspiracy beliefs, and reported sexual partner disclosure of HIV/STI status related to one-month self-report HIV testing outcomes following a brief intervention among Black women aged 18-25 years residing in rural Mississippi.

Participants

Black women (N=119; M age=19.90, SD=1.81) recruited in rural Mississippi completed an online assessment before a brief HIV prevention intervention and a one month follow-up assessment during January to November 2016.

Main Outcome Measures

Self-reported HIV testing 30-days following the intervention, partner HIV/STI status disclosure, beliefs in HIV conspiracy theory, and HIV testing attitudes in pre- and post-intervention assessments. Bivariate and multivariate analyses tested associations with HIV testing behaviors following the intervention.

Results

Moderated moderation was used to examine whether HIV conspiracy beliefs and partner disclosure status both moderated the relationship between pre-intervention attitudes toward HIV testing and HIV testing at 1-month follow-up. It was found that both HIV conspiracy beliefs and partner disclosure moderated the relationship between attitudes and HIV testing at one-month follow-up. When partner disclosure was low, women with more negative attitudes toward testing and higher conspiracy beliefs were less likely to get tested than those with negative attitudes and lower conspiracy beliefs; conspiracy beliefs did not relate to testing outcomes when testing attitudes were positive.

Conclusion

Findings suggest that interventions may benefit from accounting for conspiracy beliefs and the dyadic status disclosure when encouraging young rural women to test for HIV.

Computer-Based Substance Use Reporting and Acceptance of HIV Testing Among Emergency Department Patients

More than 10 years after the Centers for Disease Control and Prevention recommended routine HIV testing for patients in emergency departments (ED) and other clinical settings, as many as three out of four patients may not be offered testing, and those who are offered testing frequently decline. The current study examines how participant characteristics, including demographics and reported substance use, influence the efficacy of a video-based intervention designed to increase HIV testing among ED patients who initially declined tests offered by hospital staff. Data from three separate trials in a high volume New York City ED were merged to determine whether patients (N = 560) were more likely to test post-intervention if: (1) they resembled people who appeared onscreen in terms of gender or race; or (2) they reported problem substance use. Chi Square and logistic regression analyses indicated demographic concordance did not significantly increase likelihood of accepting an HIV test. However, participants who reported problem substance use (n = 231) were significantly more likely to test for HIV in comparison to participants who reported either no problem substance use (n = 190) or no substance use at all (n = 125) (x² = 6.830, p < 0.05). Specifically, 36.4% of patients who reported problem substance use tested for HIV post-intervention compared to 30.5% of patients who did not report problem substance use and 28.8% of participants who did not report substance use at all. This may be an important finding because substance use, including heavy alcohol or cannabis use, can lead to behaviors that increase HIV risk, such as sex with multiple partners or decreased condom use.

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

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

Effects of Church-Based Parent-Child Abstinence-Only Interventions on Adolescents' Sexual Behaviors

PURPOSE

The aim of the study was to evaluate the efficacy of faith-based and nonfaith-based parent-child abstinence-only interventions in reducing sexual risk behavior among young African American adolescents.

METHODS

Randomized controlled trial recruiting 613 African American parent-adolescent dyads from urban African American Baptist churches and randomizing them to one of three parent-child interventions: faith-based abstinence-only intervention emphasizing delaying or reducing sexual intercourse drawing on Biblical scriptures; nonfaith-based abstinence-only emphasizing intervention delaying or reducing sexual intercourse without referencing scriptures; or attention-matched control intervention targeting health issues unrelated to sexual behavior. Primary outcome was the self-reported frequency of condomless sexual intercourse in the past 3 months assessed periodically through 18 months postintervention. Secondary outcomes were frequency of sexual intercourse, number of sexual partners, consistent condom use and, among sexually inexperienced adolescents, sexual debut.

RESULTS

Generalized estimating equations analyses revealed that nonfaith-based abstinence-only intervention reduced the frequency of condomless sexual intercourse, frequency of sexual intercourse, and number of sexual partners compared with the attention-matched control intervention, whereas faith-based abstinence-only intervention did not. Neither intervention affected consistent condom use or sexual debut.

CONCLUSIONS

Parent-child abstinence-only interventions can reduce condomless sexual intercourse among young African American adolescents in church settings. Linking the abstinence message to Biblical scriptures may not be efficacious.

Reaching High-Need Youth Populations With Evidence-Based Sexual Health Education in California

OBJECTIVES

To explore the programmatic reach and experience of high-need adolescents who received sexual health education in 3 distinct implementation settings (targeted-prevention settings, traditional schools, and alternative schools) through a statewide sexual health education program.

METHODS

Data are from youth surveys collected between September 2013 and December 2014 in the California Personal Responsibility Education Program. A sample of high-need participants (n = 747) provided data to examine the impact of implementation setting on reach and program experience.

RESULTS

Implementation in targeted-prevention settings was equal to or more effective at providing a positive program experience for high-need participants. More than 5 times as many high-need participants were served in targeted-prevention settings compared with traditional schools. Reaching the same number of high-need participants served in targeted-prevention settings over 15 months would take nearly 7 years of programming in traditional schools.

CONCLUSIONS

To maximize the reach and experience of high-need youth populations receiving sexual health education, state and local agencies should consider the importance of implementation setting. Targeted resources and efforts should be directed toward high-need young people by expanding beyond traditional school settings.

Factors influencing adherence to continuous positive airway pressure devices in individuals with spinal cord injury and sleep apnea: Results of a qualitative study

BACKGROUND

In individuals with spinal cord injury (SCI) and sleep apnea (SA), adherence to continuous positive airway pressure (CPAP) therapy seems unsatisfactory despite technical and educational support implemented when starting treatment.

OBJECTIVE

We aimed to design comprehensive model of adherence to CPAP therapy in individuals with SCI and SA.

METHODS

This was a prospective qualitative study based on semi-directed interviews and using the grounded theory as an analytic method. The theoretical framework was the social cognitive theory of Bandura. Participants were recruited from an SCI referral centre. Individuals with SCI using or having used a CPAP device for SA were included. Data were collected by semi-directed interviews on the experience of individuals with SCI regarding SA and being fitted with a CPAP device and were coded and organized into categories of experience and category relationships.

RESULTS

Among the 17 individuals included; 9 had tetraplegia; the median age was 62 (Q1-Q3 47-66) years and median time since injury was 16 (Q1-Q3 1.75-21) years. Four categories of data were identified: 1) from symptoms to validation of SA diagnosis, 2) CPAP device fitting process, 3) representations of SA, and 4) level of adherence to the treatment. In addition to the factors already observed in the general population, the proposed model identified specific adherence factors in individuals with SCI, such as physical and relational dependence on a third party, increased daily care burden and increased presence of medical devices in the daily environment.

CONCLUSION

SA and its management present certain specificities in individuals with SCI that the physician must take into account to optimize therapeutic proposals, follow-up modalities and device adherence.

Organizational influences on the intimate partner violence and sexual violence screening practices of college health care providers

Experts and professional organizations in the U.S. have issued recommendations that health care providers (HCPs) should screen women for intimate partner violence (IPV) and sexual violence (SV). Despite the high rates of IPV and SV experienced by female college students, investigators have found that providers are not screening for IPV and SV in college health centers. In this study, a cross-sectional survey design was utilized to: (a) examine college HCPs' reports of IPV/SV screening behaviors and (b) identify the individual-level and organization-level structure and process characteristics that promote or inhibit IPV/SV screening. A total of 773 college HCPs (physicians, nurse practitioners, and registered nurses) were invited to participate in the study using two separate sampling frames. The final sample included 210 college HCPs. Providers reported low rates of IPV/SV screening (median = 20%). Screening rates varied by provider type with nurse practitioners reporting the highest screening rates. Urban location was associated with a three and one-half times greater likelihood of IPV/SV screening. Use of an electronic health record that included a prompt to screen was associated with a three-fold increase in the likelihood that HCPs would screen for IPV/SV. Further study is needed to better understand how organizational factors influence providers' screening behaviors in college health centers and how these influences are mediated. Future studies should include larger and more diverse samples of colleges and examine geographical variations in screening practices.

Pathways for African American Success: Results of Three-Arm Randomized Trial to Test the Effects of Technology-Based Delivery for Rural African American Families

OBJECTIVE

The objective of this study was to test the effectiveness of a technology-based program to avert risky behaviors among rural African American youth. We hypothesized that the technology-based and group-based formats of the Pathways for African Americans Success (PAAS) program would lead to improvements in primary outcomes, and that the technology condition would perform at least as well as the group condition.

METHODS

A three-arm Randomized Control Trial (RCT) ([N = 141] technology-based delivery, [N = 141] small group delivery, and [N = 136] literature control) was conducted with 421 sixth graders and their caregivers, Summer 2009-Fall 2012. Families were recruited from five rural counties in Tennessee and completed baseline, posttest [M = 14.5 (4.4) months after pretest] and long-term follow-up [M = 22.6 (3.7) months after posttest]. Structural Equation Modeling (SEM) was used to test intervention-induced changes in both parents and youths' primary outcomes (pretest to posttest) and on secondary targeted outcome, youth sexual risk, and substance use patterns (pretest to follow-up).

RESULTS

Parents in the technology condition reported significant increases in strategies to reduce risk. Youth in the technology condition experienced a significant decline in intent to engage in risk behaviors and reduction in substance use and sexual risk behavior. Youth in the group condition experienced a significant increase in affiliation with deviant peers.

CONCLUSIONS

This study provides evidence of the ability of eHealth to improve parenting and reduce adolescent engagement in substance use and sexual risk behavior. Suggestions for dissemination in schools and health-care systems are offered.

Validation of the AIDS Prevention Questionnaire: A Brief Self-Report Instrument to Assess Risk of HIV Infection and Guide Behavioral Change

This paper describes the process of building and validating the AIDS Prevention Questionnaire (CPS), a brief HIV risk assessment measure. An initial 64-items bank was filled out by 466 young people (192 men and 274 women), aged between 17 and 26 years (M = 20.62; SD = 2.15). The exploratory factor analysis revealed five components: Knowledge about HIV, Condom Attitudes, Intentions of Condom Use, Safe sexual behavior and Stigma and discrimination towards people living with HIV. This structure was confirmed by confirmatory factor analysis. The internal consistency for the different components ranged from .67 to .74. Moreover, CPS has a classification system that allows determining the level of risk. These results support the AIDS Prevention Questionnaire as a valid and reliable measure to detect earlier the risk for HIV infection and to design adjusted preventive interventions.

Association of Mental Health Symptoms and Peer Behaviors with Risk for Substance Use and Condomless Sex among Youth in Juvenile Drug Court

Juvenile drug courts are a growing response to adolescent substance use, but a better understanding of modifiable risk factors is needed to improve program outcomes. Youth's mental health symptoms and peers' activities may impede the effectiveness of these "therapeutic" courts. In a unique longitudinal sample of 105 adolescents involved in juvenile drug court, we find elevated internalizing symptoms and deviant behavior of peers were each associated with increased risk of alcohol and marijuana use. Similar effects were seen on risk for condomless sex. Mental health and peer behaviors should be intervention targets for evidence-based juvenile drug court programming.

Heightened activity in social reward networks is associated with adolescents' risky sexual behaviors

Adolescent sexual risk behavior can lead to serious health consequences, yet few investigations have addressed its neurodevelopmental mechanisms. Social neurocircuitry is postulated to underlie the development of risky sexual behavior, and response to social reward may be especially relevant. Typically developing adolescents (N=47; 18M, 29F; 16.3±1.4years; 42.5% sexual intercourse experience) completed a social reward fMRI task and reported their sexual risk behaviors (e.g., lifetime sexual partners) on the Youth Risk Behavior Survey (YRBS). Neural response and functional connectivity to social reward were compared for adolescents with higher- and lower-risk sexual behavior. Adolescents with higher-risk sexual behaviors demonstrated increased activation in the right precuneus and the right temporoparietal junction during receipt of social reward. Adolescents with higher-risk sexual behaviors also demonstrated greater functional connectivity between the precuneus and the temporoparietal junction bilaterally, dorsal medial prefrontal cortex, and left anterior insula/ventrolateral prefrontal cortex. The greater activation and functional connectivity in self-referential, social reward, and affective processing regions among higher sexual risk adolescents underscores the importance of social influence underlying sexual risk behaviors. Furthermore, results suggest an orientation towards and sensitivity to social rewards among youth engaging in higher-risk sexual behavior, perhaps as a consequence of or vulnerability to such behavior.

Mediation of an efficacious HIV risk reduction intervention for adolescents: A cluster-randomised controlled trial

The 'Cuidate' programme for adolescents in Spain has proven to be effective for promoting healthy sexuality (N = 626), but the mechanisms underlying its effects are unknown. This study aimed to identify mediators of the intervention's effects compared to a control group. Participants were students from five areas of Spain, who completed baseline, immediate-posttest, 12-month and 24-month follow-up assessments. Mediation analyses revealed that 'Cuidate' positively affected consistent condom use indirectly through knowledge in serial with the intention to use condoms. The findings underscore the importance of targeting knowledge on HIV and sexually transmitted infections to promote condom use intention and consistent condom use.

Conducting rigorous research with subgroups of at-risk youth: lessons learned from a teen pregnancy prevention project in Alaska

In 2010, Alaska Department of Health and Social Services (DHSS) received federal funding to test an evidence-based teen pregnancy prevention program. The grant required a major modification to an existing program and a randomized control trial (RCT) to test its effectiveness. As the major modifications, Alaska used peer educators instead of adults to deliver the program to youth aged 14-19 instead of the original curriculum intended age range of 12-14. Cultural and approach adaptations were included as well. After 4 years of implementation and data collection, the sample was too small to provide statistically significant results. The lack of findings gave no information about the modification, nor any explanation of how the curriculum was received, or reasons for the small sample. This paper reports on a case study follow-up to the RCT to better understand outcome and implementation results. For this study, researchers reviewed project documents and interviewed peer educators, state and local staff, and evaluators. Three themes emerged from the data: (a) the professional growth of peer educators and development of peer education, (b) difficulties resulting from curriculum content, especially for subpopulations of sexually active youth, youth identified as lesbian, gay, bisexual, transgender, queer, intersex and/or asexual, pregnant, and parenting youth and (c) the appropriateness of an RCT with subpopulations of at-risk youth. Three recommendations emerged from the case study. First, including as many stakeholders as possible in the program and evaluation design phases is essential, and must be supported by appropriate funding streams and training. Second, there must be recognition of the multiple small subpopulations found in Alaska when adapting programs designed for a larger and more homogeneous population. Third, RCTs may not be appropriate for all population subgroups.

Family and Friend Influence on Urban-Dwelling American Indian Adolescent Girl's Sexual Risk Behavior

Previous research with American Indian (AI) adolescent sexual risk behavior primarily focused on reservation-dwelling youth despite 70% of AIs living off Native lands. Using grounded theory methodology, I sampled 20 adolescent AI girls via talking circles and interviews to explore the perceptions of AI adolescent girls living in an urban, Midwest area about the influence of family and friends on their sexual behavior. Similar to research with other racial groups, participants cited their family and friends as a major influence. Five unique themes emerged related to family and friend influence. Urban-dwelling AI girls rely on their female family members and peers for information related to sex and receive varying messages from their networks of family and friends, which often overlap. AI youth have unique family groups yet have some similarities to other ethnic groups with regard to family and friend relationships that may allow for enhanced intervention development.

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions.

Theory of Planned Behavior in School-Based Adolescent Problem Gambling Prevention: A Conceptual Framework

Given its serious implications for psychological and socio-emotional health, the prevention of problem gambling among adolescents is increasingly acknowledged as an area requiring attention. The theory of planned behavior (TPB) is a well-established model of behavior change that has been studied in the development and evaluation of primary preventive interventions aimed at modifying cognitions and behavior. However, the utility of the TPB has yet to be explored as a framework for the development of adolescent problem gambling prevention initiatives. This paper first examines the existing empirical literature addressing the effectiveness of school-based primary prevention programs for adolescent gambling. Given the limitations of existing programs, we then present a conceptual framework for the integration of the TPB in the development of effective problem gambling preventive interventions. The paper describes the TPB, demonstrates how the framework has been applied to gambling behavior, and reviews the strengths and limitations of the model for the design of primary prevention initiatives targeting adolescent risk and addictive behaviors, including adolescent gambling.

Welfare, Liberty, and Security for All? U.S. Sex Education Policy and the 1996 Title V Section 510 of the Social Security Act

When adolescents delay (meaning they wait until after middle school) engaging in sexual intercourse, they use condoms at higher rates and have fewer sexual partners than those who have sex earlier, thus resulting in a lower risk for unintended pregnancies and sexually transmitted infections. The 1996 Section 510 of Title V of the Social Security Act (often referred to as A-H) is a policy that promotes abstinence-only-until-marriage education (AOE) within public schools. Using Stone's (2012) policy analysis framework, this article explores how A-H limits welfare, liberty, and security among adolescents due to the poor empirical outcomes of AOE policy. We recommend incorporating theory-informed comprehensive sex education in addition to theory-informed abstinence education that utilizes Fishbein and Ajzen's (2010) reasoned action model within schools in order to begin to address adolescent welfare, liberty, and security.

Two-Year Follow-Up of a Sexual Health Promotion Program for Spanish Adolescents

The aim is to evaluate the effects of the Competencias para adolescentes con una sexualidad saludable (COMPAS) program and compare them with an evidence-based program ( ¡Cuídate!) and a control group (CG). Eighteen public high schools were randomly assigned to one of the three experimental conditions. Initially, 1,563 Spanish adolescents between 14 and 16 years of age participated, and 24 months after their implementation, 635 of them completed a survey. Self-report measures collected data on sexual behavior, knowledge, attitudes, intention, sexual risk perception, and perceived norm. Compared to the CG, COMPAS increased the level of knowledge about sexually transmitted infections and improved the attitudes toward people living with human immunodeficiency virus at the 2-year follow-up. Neither intervention had a long-term impact on behavioral variables. Results suggest that COMPAS has a comparable impact to the other intervention on the variables predicting consistent condom use. Reinforcing the messages and skills that have the greatest impact on condom use and adding booster sessions following program completion as strategies to maintain long-term effects are necessary.

Adolescents and parental caregivers as lay health advisers in a community-based risk reduction intervention for youth: baseline data from Teach One, Reach One

The purpose of the current study is to describe the demographic, behavioral, and psychosocial characteristics of adolescent and caregiver lay health advisers (LHAs) participating in an intervention designed to reduce risk behaviors among rural African-American adolescents. Teach One, Reach One integrates constructs from the Theory of Planned Behavior and Social Cognitive Theory. It acknowledges that changing the sexual behaviors of African-American adolescents requires changing one's knowledge, attitudes, normative beliefs about the behavior of peers, and self-efficacy regarding adolescent sexual behavior, parent-teen communication about sex, and healthy dating relations among adolescents. Study participants completed baseline questionnaires assessing demographics and psychosocial determinants (knowledge, attitudes, perceived social norms, and self-efficacy) of sexual behaviors. Sixty-two adolescent and caregiver dyads participated. Caregivers included biological parents, legal guardians, or other parental figures. Strengths and areas in need of improvement were determined using median splits. Few adolescents had initiated sex. Their strengths included high levels of open parent-teen communication; positive attitudes and normative beliefs regarding both sex communication and healthy dating relationships; and high knowledge and self-efficacy for healthy dating behaviors. Areas needing improvement included low knowledge, unfavorable attitudes, poor normative beliefs, and low self-efficacy regarding condom use. Caregiver strengths included positive attitudes, normative beliefs, and self-efficacy for sex communication; positive attitudes and self-efficacy for condom use; and low acceptance of couple violence. Areas needing improvement included low levels of actual communication about sex and low knowledge about effective communication strategies and condom use. The current study highlights the value of assessing baseline characteristics of LHAs prior to intervention implementation, as it enables a better understanding of the key characteristics necessary for planning and implementing interventions, as well as engaging in targeted training activities.

Mediation of an efficacious HIV risk reduction intervention for South African men

"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.

Group Interventions for Patients with Cancer and HIV Disease: Part III. Moderating Variables and Mechanisms of Action

Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.

Group Interventions for Patients with Cancer and HIV Disease: Part I: Effects on Psychosocial and Functional Outcomes at Different Phases of Illness

Group interventions for individuals facing cancer or HIV disease have drawn considerable attention among researchers and clinicians over the past 20 years. There is growing evidence that group services may be helpful, but which interventions are most effective for participants at which phases in the trajectory of disease has been less clear. Moreover, professionals working in different intervention settings (e.g., primary prevention vs. clinical care) and different disease sites (cancer vs. HIV disease) often have little awareness of relevant advances in other fields. Efforts to integrate findings in the literature may accelerate research and advance the standard of clinical care. The current article, the first in a series of four special reports, critically evaluates the efficacy of group interventions led by professional or trained facilitators for individuals confronted by cancer or HIV, across the spectrum of illness from elevated risk through advanced disease. We examine psychosocial and functional outcomes for different interventions directed toward different patient subgroups, trace common themes, highlight limitations, and offer recommendations for further research.

Mediation and moderation of an efficacious theory-based abstinence-only intervention for African American adolescents

OBJECTIVE

This secondary data analysis sought to determine what mediated reductions in self-reported sexual initiation over the 24-month postintervention period in early adolescents who received "Promoting Health among Teens," a theory-based, abstinence-only intervention (Jemmott, Jemmott, & Fong, 2010).

METHOD

African American Grade 6 and 7 students at inner-city public middle schools were randomized to 1 of 5 interventions grounded in social-cognitive theory and the theory of reasoned action: 8-hr abstinence-only targeting reduced sexual intercourse; 8-hr safer-sex-only targeting increased condom use; 8-hr and 12-hr comprehensive interventions targeting sexual intercourse and condom use; 8-hr control intervention targeting physical activity and diet. Primary outcome was self-report of vaginal intercourse by 24 months postintervention. Potential mediators, assessed immediately postintervention, were theory-of-reasoned-action variables, including behavioral beliefs about positive consequences of abstinence and negative consequences of sex, intention to have sex, normative beliefs about sex, and HIV and sexually transmitted infection (STI) knowledge. We tested single and serial mediation models using the product-of-coefficients approach.

RESULTS

Of 509 students reporting never having vaginal intercourse at baseline (324 girls and 185 boys; mean age = 11.8 years, SD = 0.8), 500 or 98.2% were included in serial mediation analyses. Consistent with the theory of reasoned action, the abstinence-only intervention increased positive behavioral beliefs about abstinence, which reduced intention to have sex, which in turn reduced sexual initiation. Negative behavioral beliefs about sex, normative beliefs about sex, and HIV/STI knowledge were not mediators.

CONCLUSIONS

Abstinence-only interventions should stress the gains to be realized from abstinence rather than the deleterious consequences of sexual involvement.

On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk-reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV-diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk-reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention, immediately post-intervention, and 6 and 12 months post-intervention surveys. Of 595 participants, 503 (85 %) completed the 12-month follow-up. Generalized-estimating-equations analysis indicated that, compared with the attention-matched control intervention, the BRO intervention did not increase consistent condom use averaged over the 6- and 12-month follow-ups, which was the primary outcome. Although BRO did not affect the proportion of condom-protected intercourse acts, unprotected sexual intercourse, multiple partners, or insertive anal intercourse, it did reduce receptive anal intercourse compared with the control, a behavior linked to incident HIV infection. Mediation analysis using the product-of-coefficients approach revealed that although BRO increased seven of nine theoretical constructs it was designed to affect, it increased only one of three theoretical constructs that predicted consistent condom use: condom-use impulse-control self-efficacy. Thus, BRO indirectly increased consistent condom use through condom-use impulse-control self-efficacy. In conclusion, although BRO increased several theoretical constructs, most of those constructs did not predict consistent condom use; hence, the intervention did not increase it. Theoretical constructs that interventions should target to increase African American MSM’s condom use are discussed.

A 1-year follow-up evaluation of a sexual-health education program for Spanish adolescents compared with a well-established program

BACKGROUND

Competencies for adolescents with a healthy sexuality (COMPAS) is the only school-based sexual health promotion program in Spain that has been found to be as effective as an evidence-based intervention (¡Cuídate!) in the short term. This study's aim was to compare data from a 12-month follow-up evaluation on the effects of COMPAS on adolescents' sexual risks (knowledge, attitudes, perceived norms, sexual risk perception and intentions) and sexual behaviours (age of the first sex, consistent condom use and multiple partners) with an evidence-based intervention (¡Cuídate!) and a control group.

METHODS

Eighteen schools from five provinces of Spain were randomly assigned to one of three conditions: COMPAS, ¡Cuídate! and a control group. The adolescents (N = 1563; 34% attrition) were evaluated 1 week before and after the program, and 1 year post-program implementation.

RESULTS

We found that the COMPAS program was as effective as ¡Cuídate!, the evidence-based program, in increasing the adolescents' knowledge about sexually transmitted infections and in fostering favourable attitudes about condom use and people living with HIV/AIDS. COMPAS was more effective than ¡Cuídate! in increasing the adolescents' perceptions of their peer's consistent condom use and the age delay of their first vaginal intercourse. However, it was less effective in maintaining the adolescents' intentions to use condoms and in delaying the age of their first oral sex experience.

CONCLUSION

COMPAS was as effective as ¡Cuídate! in reducing sexual risk among adolescents.

Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence

BACKGROUND

US adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health.

MATERIALS AND METHODS

This review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants - sexual activity, number of sexual partners, condom use, and other contraceptive use - among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent-youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use.

RESULTS

Our review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent-youth relationship programs and clinic-based program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use).

CONCLUSION

Future efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use.

Clusters of Factors Identify A High Prevalence of Pregnancy Involvement Among US Adolescent Males

The study purpose was to use recursive partitioning analysis (RPA) to identify factors that, when clustered, are associated with a high prevalence of pregnancy involvement among US adolescent males. The National Survey of Family Growth is a nationally representative survey of individuals 15-44 years old. RPA was done for the 2002 and 2006-2010 cycles to identify factors which, when combined, identify adolescent males with the highest prevalence of pregnancy involvement. Pregnancy-involvement prevalence among adolescent males was 6 %. Two clusters of adolescent males have the highest pregnancy-involvement prevalence, at 84-87 %. In RPA, the highest pregnancy-involvement prevalence (87 %) was seen in adolescent males who ever HIV tested, had >4 lifetime sexual partners, reported less than an almost certain chance of feeling less physical pleasure with condom use, had an educational attainment of <11th grade, and had ≤2 sexual partners in the past 12 months. Adolescent males who ever HIV tested, had >4 lifetime sexual partners, reported less than an almost certain chance of feeling less physical pleasure with condom use, had an educational attainment ≥11th grade, were >17 years old, and had their first contraceptive education ≥10th grade, had a pregnancy-involvement prevalence of 84 %. Pregnancy-prevention efforts among adolescent males who have been involved in a pregnancy may need to target risk factors identified in clusters with the highest pregnancy prevalence to prevent subsequent pregnancies in these adolescent males and improve their future outcomes.

Short-term evaluation of a skill-development sexual education program for Spanish adolescents compared with a well-established program

PURPOSE

The Centers for Disease Control and Prevention highlights the importance of evaluating interventions rigorously and recommends evaluating new interventions against interventions with established efficacy. Competencias para adolescentes con una sexualidad saludable (COMPAS) is a school-based HIV prevention program that has been shown to be effective in reducing sexual risk behaviors among adolescents in Spain. This study evaluates the efficacy of COMPAS program compared with a Spanish-culture adapted version of ¡Cuídate! (Take Care of Yourself), an evidence-based HIV prevention curriculum designed for Latino adolescents in the US.

METHODS

This cluster randomized controlled trial involved 1,563 adolescents attending 18 public high schools located in 5 provinces of Spain. The schools invited to participate were enrolled and randomly assigned to the three experimental conditions: COMPAS, ¡Cuídate!, and control group (CG; no intervention).

RESULTS

Generalized estimating equation analyses revealed that both interventions improved attitudes toward people living with human immunodeficiency syndrome (HIV)/AIDS and the HIV test and increased HIV/sexually transmitted infection knowledge and intention to engage in safer sex behaviors compared with the CG. Although only COMPAS increased participants' sexual risk perception and attitude toward condom use compared with the CG, the two interventions did not significantly differ on any outcome.

CONCLUSIONS

When compared with an established program, COMPAS was at least as effective at increasing the intention to engage in safer sex behaviors as the evidence-based intervention.

Using process data to understand outcomes in sexual health promotion: an example from a review of school-based programmes to prevent sexually transmitted infections

This article discusses how process indicators can complement outcomes as part of a comprehensive explanatory evaluation framework, using the example of skills-based behavioural interventions to prevent sexually transmitted infections and promote sexual health among young people in schools. A systematic review was conducted, yielding 12 eligible outcome evaluations, 9 of which included a process evaluation. There were few statistically significant effects in terms of changes in sexual behaviour outcomes, but statistically significant effects were more common for knowledge and self-efficacy. Synthesis of the findings of the process evaluations identified a range of factors that might explain outcomes, and these were organized into two overarching categories: the implementation of interventions, and student engagement and intervention acceptability. Factors which supported implementation and engagement and acceptability included good quality teacher training, involvement and motivation of key school stakeholders and relevance and appeal to young people. Factors which had a negative impact included teachers' failure to comprehend the theoretical basis for behaviour change, school logistical problems and omission of topics that young people considered important. It is recommended that process indicators such as these be assessed in future evaluations of school-based sexual health behavioural interventions, as part of a logic model.

Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: a systematic review

PURPOSE

This systematic review provides a comprehensive, updated assessment of programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections (STIs), or associated sexual risk behaviors.

METHODS

The review was conducted in four steps. First, multiple literature search strategies were used to identify relevant studies released from 1989 through January 2011. Second, identified studies were screened against prespecified eligibility criteria. Third, studies were assessed by teams of two trained reviewers for the quality and execution of their research designs. Fourth, for studies that passed the quality assessment, the review team extracted and analyzed information on the research design, study sample, evaluation setting, and program impacts.

RESULTS

A total of 88 studies met the review criteria for study quality and were included in the data extraction and analysis. The studies examined a range of programs delivered in diverse settings. Most studies had mixed-gender and predominately African-American research samples (70% and 51%, respectively). Randomized controlled trials accounted for the large majority (87%) of included studies. Most studies (76%) included multiple follow-ups, with sample sizes ranging from 62 to 5,244. Analysis of the study impact findings identified 31 programs with evidence of effectiveness.

CONCLUSIONS

Research conducted since the late 1980s has identified more than two dozen teen pregnancy and STI prevention programs with evidence of effectiveness. Key strengths of this research are the large number of randomized controlled trials, the common use of multiple follow-up periods, and attention to a broad range of programs delivered in diverse settings. Two main gaps are a lack of replication studies and the need for more research on Latino youth and other high-risk populations. In addressing these gaps, researchers must overcome common limitations in study design, analysis, and reporting that have negatively affected prior research.

'Let Us Protect Our Future' a culturally congruent evidenced-based HIV/STD risk-reduction intervention for young South African adolescents

One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15-24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the 'Let Us Protect Our Future!' HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed.

Expectations and self-efficacy of African American parents who discuss sexuality with their adolescent sons: an intervention study

OBJECTIVE

Despite research that suggests parental communication may help deter high-risk sexual behavior among adolescents, parents report a lack of confidence in their ability to answer sexually related questions. The purpose of this study was to test the effect of a multimedia intervention on outcome expectations and perceived self-efficacy for the sex educator role for parents of African American adolescent males.

DESIGN AND SAMPLE

A pilot study using mixed methods was conducted. A nonprobability sample (N = 61) was obtained from a large urban community using a combination of convenience and snowball recruitment methods.

MEASURES

Self-efficacy and outcome expectations were measured using self-reported questionnaires.

INTERVENTION

A multimedia intervention for use at home and incorporating an audio CD and associated activities was implemented over a 3-week time period.

RESULTS

Outcome expectations and self-efficacy both significantly improved after the intervention (p < .001).

CONCLUSIONS

Findings indicate that using a multimedia approach may be effective in improving parents' outcome expectancy and self-efficacy for talking about sex with adolescent sons.

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

BACKGROUND

Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program.

METHODS

This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points.

RESULTS

We found no significant differences between AGTO and control group's prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement.

CONCLUSIONS

This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design. CLINICALTRIALS.GOV IDENTIFIER: NCT00780338.

Intervening with practitioners to improve the quality of prevention: one-year findings from a randomized trial of assets-getting to outcomes

There continues to be a gap in prevention outcomes achieved in research trials versus those achieved in "real-world" practice. This article reports interim findings from a randomized controlled trial evaluating Assets-Getting To Outcomes (AGTO), a two-year intervention designed to build prevention practitioners' capacity to implement positive youth development-oriented practices in 12 community coalitions in Maine. A survey of coalition members was used to assess change on individual practitioners' prevention capacity between baseline and one year later. Structured interviews with 32 program directors (16 in the intervention group and 16 in the control group) were used to assess changes in programs' prevention practices during the same time period. Change in prevention capacity over time did not differ significantly between the intervention and control groups. However, in secondary analyses of only those assigned to the AGTO intervention, users showed greater improvement in their self-efficacy to conduct Assets-based programming and increases in the frequency with which they engaged in AGTO behaviors, whereas among non-users, self-efficacy to conduct Assets-based programming declined. Interview ratings showed improvement in several key areas of performance among intervention programs. Improvement was associated with the number of technical assistance hours received. These results suggest that, after one year, AGTO is beginning to improve the capacity of community practitioners who make use of it.

Application of the information, motivation and behavioural skills model for targeting HIV risk behaviour amongst adolescent learners in South Africa

This paper discusses the application of an information, motivation and behavioural skills (IMB) model in a school-based programme for the reduction of HIV risk behaviour among 259 Grade 11 learners in two high schools in Alexandra township, Johannesburg. School 1 was the Experimental group, while School 2 was the Control group. After a baseline study (Time 1) at both schools, a 3-week intervention programme was conducted at School 1. A post-test (Time 2) was conducted at both schools. The intervention was repeated at School 2, followed by another post-test (Time 3) at both schools. A final test (Time 4) was conducted at both schools. While there were positive changes in the levels of HIV&AIDS IMB in learner participants, these changes may not be entirely attributed to the intervention. If an IMB model-based intervention is to be maximally effective in reducing HIV-risk behaviour among adolescents, it must focus on the behavioural, structural and socio-cultural contexts in which adolescents live.

Cultural adaptations of behavioral health interventions: a progress report

OBJECTIVE

To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research.

METHOD

Influential literature from the past decade was examined to identify points of consensus.

RESULTS

There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions.

CONCLUSIONS

Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.

Mixing it Up: Integrating Men and Women Living with HIV/AIDS in Prevention Groups

AIMS

The current study was conducted to examine the impact of mixing genders in HIV prevention intervention groups targeted toward HIV positive men and women.

METHODS

Men (N=310) and women (N=126) participated in a randomized clinical trial testing a behavioral risk reduction/ medication adherence intervention versus a general health control condition administered to small mixed gender groups. Gender composition of groups was examined in relation to participant group attendance and group satisfaction measures through correlations and logistic regression.

RESULTS

Significant regression models were found for men in the risk reduction condition and for women in the general health condition, however, regression models were not significant for women in the risk reduction condition and men in the general health condition.

DISCUSSION

The findings indicate that mixing genders in risk reduction interventions for men and women living with HIV/AIDS has no negative impact on women's group satisfaction and may positively impact men's group satisfaction. This calls into question the assumption that gender sensitive material will always make individuals uncomfortable within mixed gender groups.

IMPLICATIONS FOR PRACTICE AND POLICY

In practice, mixed gender intervention groups can be a helpful option for delivering programs to diverse populations especially when resources are limited within community-based services providers and AIDS service organizations.

CONCLUSION

Although more thorough investigation is needed about the consequences and possible benefits of mixing genders within HIV prevention intervention groups, this study supports the idea that mixing genders may be a viable option, in practice, without sacrificing the integrity of the intervention.

Predictors of screening for AIDS clinical trials among African-Americans and Latino/Hispanics enrolled in an efficacious peer-driven intervention: uncovering socio-demographic, health, and substance use-related factors that promote or impede screening

African-American and Latino/Hispanic persons living with HIV/AIDS are underrepresented in AIDS clinical trials (ACTs). The aim of this paper was to uncover factors, either unmodifiable or not directly targeted for change, that predicted screening for ACTs during an efficacious peer-driven intervention (N = 540 total; N = 351 in an intervention arm, N = 189 control). This paper focused on participants assigned to an intervention arm, 56 % of whom were screened for ACTs. We found a decreased odds of screening was associated with closer proximity to the screening site, gay/lesbian orientation, lower mental health symptoms, current injection drug use, more recent HIV diagnosis, lack of prior screening experience, and failure to attend all intervention sessions, but there were no gender or racial/ethnic differences. Efforts to reduce racial/ethnic disparities in ACTs can be enhanced by attending to these specific factors, which may interfere with programmatic efforts to increase African-American and Latino/Hispanic representation in ACTs.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

DISCUSSION

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

TRANSLATION TO HEALTH EDUCATION PRACTICE

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

Attitudes and beliefs regarding depression, HIV/AIDS, and HIV risk-related sexual behaviors among clinically depressed African American adolescent females

Individuals' attitudes and beliefs toward behaviors are key indicators of behavioral performance. The purposes of this study were to elucidate attitudes and beliefs about depression, HIV/AIDS, and HIV risk-related sexual behaviors among clinically depressed African American adolescent females and to develop an understanding of their context for HIV risk. For this descriptive qualitative inquiry, semistructured interviews and surveys were employed (N = 24). The narratives reveal that behavioral sequelae of depression (i.e., loneliness) can produce risk for HIV. These findings may guide psychiatric nurse educators, scientists, and practitioners to modify HIV risk among clinically depressed African American adolescent females.

Behavioural interventions for the prevention of sexually transmitted infections in young people aged 13-19 years: a systematic review

We systematically reviewed school-based skills building behavioural interventions for the prevention of sexually transmitted infections. References were sought from 15 electronic resources, bibliographies of systematic reviews/included studies and experts. Two authors independently extracted data and quality-assessed studies. Fifteen randomized controlled trials (RCTs), conducted in the United States, Africa or Europe, met the inclusion criteria. They were heterogeneous in terms of intervention length, content, intensity and providers. Data from 12 RCTs passed quality assessment criteria and provided evidence of positive changes in non-behavioural outcomes (e.g. knowledge and self-efficacy). Intervention effects on behavioural outcomes, such as condom use, were generally limited and did not demonstrate a negative impact (e.g. earlier sexual initiation). Beneficial effect on at least one, but never all behavioural outcomes assessed was reported by about half the studies, but this was sometimes limited to a participant subgroup. Sexual health education for young people is important as it increases knowledge upon which to make decisions about sexual behaviour. However, a number of factors may limit intervention impact on behavioural outcomes. Further research could draw on one of the more effective studies reviewed and could explore the effectiveness of 'booster' sessions as young people move from adolescence to young adulthood.

Effectiveness of a condom use educational program developed on the basis of the Information-Motivation-Behavioral Skills model

AIM

To assess a condom use educational program developed using the Information-Motivation-Behavioral Skills (IMB) model to enable Japanese young people to use condoms.

METHODS

The program was implemented in two sessions of approximately 90 min each over a 2 day period. The participants underwent the program in small same-sex groups. The study participants were divided into the intervention group (n=94) and the control group (n=186). Knowledge relating to HIV/sexually-transmitted diseases (STDs), attitudes towards contraception and sex, the risk perceptions of pregnancy and HIV/STD infection, anticipated reaction to proposed condom use, self-efficacy of condom use, and sexual behaviors were assessed. Data were obtained at baseline, immediately after the program, and 1 and 3 months after the program or baseline survey.

RESULTS

Intervention group participants with experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs, self-efficacy of condom use, and relief/confusion associated with condom use than the control group (n=13) at the 1 and 3 month surveys. Intervention group participants with no experience of sexual intercourse (n=14) had significantly higher scores for knowledge relating to HIV/STDs and self-efficacy of condom use, and significantly lower scores for condom avoidance, than the control group (n=116). Condom use behavior was not changed in either group.

CONCLUSION

The program used in this study did not promote condom use, but it increased knowledge relating to HIV/STDs and self-efficacy of condom use and reduced resistance to condom use.

The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services

CONTEXT

Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group.

EVIDENCE ACQUISITION

Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews.

EVIDENCE SYNTHESIS

Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates.

CONCLUSIONS

Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education.

Substance use among African American adolescents in the Midwest

The purpose of this article is to examine the attitudes and substance use behaviors of African American adolescents living in the Midwest. A baseline survey was administered to 463 African American teens between the ages of 11-19. The article examines the relationship between attitudes toward drugs and drug-using behavior in this African American sample. Drug use will be compared to national drug use norms established by the Youth Risk Behavior Surveillance Survey. Overall participants had fairly negative attitudes toward drugs. Sixty percent of the sample reported that they were committed to a drug-free life, 74% had made a decision to stay away from marijuana, 79% reported making a decision not to smoke cigarettes, and 71% reported they would not get drunk in the next year. Females were more likely to stay away from marijuana than males. In this current study there is cause for alarm; participants reported higher percentages of ever smoking cigarettes and marijuana than the Youth Risk Behavior Surveillance Survey. This study shows there is a need to provide substance abuse prevention programs for African American adolescents. Limitations and future directions are also discussed.

Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: unmasking the numbers

Clinically depressed and nondepressed African-American adolescent females aged 13-19 years (N=131) were interviewed and surveyed to determine the relationship between depression and HIV risk-related sexual behaviors. Narratives indicate that the psychopathology of depression may create situations where the target population could become exposed to HIV. Specifically, depressed participants described feelings of loneliness, isolation, and wanting somebody to "comfort them" as aspects of depression that affect the decisions they make about sex and relationships. In essence, sex was viewed as a stress reliever, an anti-depressant and a way to increase self-esteem. They shared that even if they did not feel like having sex, they might just "git it over wit" so their partners would stop asking. Some also discussed financial and emotional stability offered by older, more sexually experienced partners. These age-discordant relationships often translated into trusting that their partners knew what was best for their sexual relationships (i.e., having unprotected sex). Sixty-nine percent (n=88) of the sample reported engaging in sexual activity. Given their mean age (16 ± 1.9 years) participants had been sexually active for 2 ± 1.8 years. The adolescents reported an average of 2 ± 1.8 sexual partners within the past three months. Depressed participants reported a higher frequency of having ever had sex (78% vs. 59%, χ(2)=5.236, p=0.022), and had a higher mean number of sexual partners (2 vs. 1, t=-2.023, p= 0.048) and sexual encounters under the influence of drugs and alcohol (8 vs. 2, t=-3.078, p=0.005) in the past three months. The results of this study can guide the modification and/or development of tailored HIV/sexually transmitted infection (STI) prevention programs. The findings provide explicit, psychologically and culturally relevant information regarding the interaction between depression, self-medicating behaviors and risk for HIV/STIs among clinically depressed African-American adolescent females.