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Merrill KG, Atujuna M, Emerson E, Blachman-Demner D, Bray BC, Bekker LG, Donenberg GR. Preliminary effectiveness and implementation outcomes of the IMARA-South Africa sexual health intervention on adolescent girls and young women: A pilot randomized trial. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001092. [PMID: 36962830 PMCID: PMC10022073 DOI: 10.1371/journal.pgph.0001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023]
Abstract
Family-based interventions may help reduce the risk of HIV and other sexually transmitted infections (STI) among adolescent girls and young women (AGYW) in sub-Saharan Africa but few have been tested. We examined the preliminary effectiveness and implementation outcomes of Informed, Motivated, Aware, and Responsible Adolescents and Adults-South Africa (IMARA-SA), an evidence-based intervention for South African AGYW (15-19 years) and their female caregivers. We piloted IMARA-SA in the Western Cape using an individually randomized experimental design and average follow-up at 11 months. Primary outcomes were HIV Testing and Counselling (HTC) uptake, STI incidence (gonorrhea, chlamydia), and pre-exposure prophylaxis (PrEP) uptake. Secondary outcomes were self-reported sexual risk behavior (condom use at last sex, consistency of condom use, substance use during sex, and number of sexual partners) and PrEP adherence. We examined four implementation outcomes: reach, feasibility, acceptability, and fidelity. Data from 59 AGYW (mean = 17.2 years) were analyzed at baseline (n = 29 from IMARA-SA, 30 from a health promotion control group). At follow-up, 51 (86%) completed surveys and 39 (66%) presented for HTC, STI testing, and/or PrEP. Compared to controls, fewer IMARA-SA participants tested positive for an STI (22% versus 38%), more IMARA-SA participants took up PrEP (68% versus 45%), and four of five secondary outcomes favored the IMARA-SA group at follow-up. These differences did not reach statistical significance. HTC uptake at follow-up was 100% in both groups. All AGYW-FC dyads agreed to participate in the study (reach). In the IMARA-SA group, 76% of dyads completed the intervention (feasibility), and over 76% of acceptability ratings from AGYW and their FC had the highest Likert rating. Fidelity of intervention delivery was 95%. IMARA-SA is a promising strategy for reducing HIV/STI risk among South African AGYW. We found strong evidence of reach, feasibility, acceptability, and fidelity. A fully powered randomized controlled trial is warranted. Trial registration: Clinical trials.gov registration number: NCT05504954.
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Affiliation(s)
- Katherine G Merrill
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL United States of America
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Erin Emerson
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL United States of America
| | - Dara Blachman-Demner
- Office of Behavioural and Social Sciences, National Institutes of Health, Bethesda, MD, United States of America
| | - Bethany C Bray
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Geri R Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois Chicago, Chicago, IL United States of America
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Barker DH, Dahabreh IJ, Steingrimsson JA, Houck C, Donenberg G, DiClemente R, Brown LK. Causally Interpretable Meta-analysis: Application in Adolescent HIV Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:403-414. [PMID: 34241752 PMCID: PMC8742835 DOI: 10.1007/s11121-021-01270-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/30/2022]
Abstract
Endowing meta-analytic results with a causal interpretation is challenging when there are differences in the distribution of effect modifiers among the populations underlying the included trials and the target population where the results of the meta-analysis will be applied. Recent work on transportability methods has described identifiability conditions under which the collection of randomized trials in a meta-analysis can be used to draw causal inferences about the target population. When the conditions hold, the methods enable estimation of causal quantities such as the average treatment effect and conditional average treatment effect in target populations that differ from the populations underlying the trial samples. The methods also facilitate comparison of treatments not directly compared in a head-to-head trial and assessment of comparative effectiveness within subgroups of the target population. We briefly describe these methods and present a worked example using individual participant data from three HIV prevention trials among adolescents in mental health care. We describe practical challenges in defining the target population, obtaining individual participant data from included trials and a sample of the target population, and addressing systematic missing data across datasets. When fully realized, methods for causally interpretable meta-analysis can provide decision-makers valid estimates of how treatments will work in target populations of substantive interest as well as in subgroups of these populations.
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Affiliation(s)
- David H Barker
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Issa J Dahabreh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Christopher Houck
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Geri Donenberg
- School of Public Health, University of Illinois At Chicago, Chicago, IL, USA
| | - Ralph DiClemente
- New York University College of Global Public Health, New York, NY, USA
| | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Brown E, Lo Monaco S, O’Donoghue B, Nolan H, Hughes E, Graham M, Simmons M, Gray R. Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179063. [PMID: 34501652 PMCID: PMC8430747 DOI: 10.3390/ijerph18179063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.
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Affiliation(s)
- Ellie Brown
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-3-9966-9100
| | - Samantha Lo Monaco
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Brian O’Donoghue
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Hayley Nolan
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Elizabeth Hughes
- School of Healthcare University of Leeds, Woodhouse, Leeds LS2 9JT, UK;
| | - Melissa Graham
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; (M.G.); (R.G.)
| | - Magenta Simmons
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Richard Gray
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; (M.G.); (R.G.)
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Collins PY, Velloza J, Concepcion T, Oseso L, Chwastiak L, Kemp CG, Simoni J, Wagenaar BH. Intervening for HIV prevention and mental health: a review of global literature. J Int AIDS Soc 2021; 24 Suppl 2:e25710. [PMID: 34164934 PMCID: PMC8222838 DOI: 10.1002/jia2.25710] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre-exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare. METHODS We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention. RESULTS AND DISCUSSION We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare. CONCLUSIONS Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.
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Affiliation(s)
- Pamela Y Collins
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | | | - Linda Oseso
- HIV Vaccine Trials Network, Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWAUSA
| | | | - Jane Simoni
- Department of PsychologyUniversity of WashingtonSeattleWAUSA
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Brawner BM, Jemmott LS, Hanlon AL, Lozano AJ, Abboud S, Ahmed C, Wingood G. Results from Project GOLD: A pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention for black youth. AIDS Care 2021; 33:767-785. [PMID: 33550841 PMCID: PMC8494072 DOI: 10.1080/09540121.2021.1874273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Black youth face significant disparities in HIV/sexually transmitted infection (STI) disease burden. Mental illness and emotion regulation are ontributors to HIV/STI risk, yet many HIV/STI prevention interventions do not address these factors. Project GOLD was a pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention designed to address the role of mental illness and emotion regulation in HIV/STI risk among heterosexually active Black youth aged 14-17 (N = 108). Participants were recruited from outpatient mental health treatment programs and general community settings via community partner referrals, face-to-face encounters, flyers and social media. Assessments were conducted pretest, immediate posttest, and at 3-, 6-, and 12-month follow-up. Although there were no statistically significant differences in behavior change from baseline, there were practically significant effect sizes among HIV condition participants when compared to the general health condition (e.g., fewer sexual partners at 6 months). An increase in theoretical mediators (e.g., condom use negotiation beliefs) was sustained at 12 months. HIV condition participants also reported lower depressive symptom severity, with statistical significance noted at immediate post and at 3 months. The findings highlight the importance and challenges of engaging Black youth in culturally and contextually relevant, developmentally and psychologically appropriate HIV/STI prevention interventions.
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Affiliation(s)
- Bridgette M. Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America; Twitter: @DrBMBrawnerhttps://twitter.com/DrBMBrawner; Facebook: Dr. Bridgette M. Brawner https://www.facebook.com/DrBMBrawner/; LinkedIn: Bridgette M. Brawner, PhD, MDiv, APRN https://www.linkedin.com/in/bridgette-m-brawner-phd-mdiv-aprn-754a24109/
| | - Loretta Sweet Jemmott
- Department of Nursing, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, United States of America; Twitter: https://twitter.com/Dr_SweetJ
| | - Alexandra L. Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, College of Science, Virginia Tech, Roanoke, Virginia, United States of America; Twitter: @al_hanlonhttps://twitter.com/al_hanlon
| | - Alicia J. Lozano
- Center for Biostatistics and Health Data Science, Department of Statistics, College of Science, Virginia Tech, Roanoke, Virginia, United States of America; Twitter: @aliciajlozanohttps://twitter.com/aliciajlozano
| | - Sarah Abboud
- Department of Women, Children, and Family Health Science, University of Illinois at Chicago, College of Nursing, Chicago, Illinois, United States of America; Twitter: @SarahAbboud78https://twitter.com/sarahabboud78
| | - Charisse Ahmed
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America; LinkedIn: https://www.linkedin.com/in/charisse-ahmed-2b341866/
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis. Harv Rev Psychiatry 2021; 29:196-215. [PMID: 33979106 DOI: 10.1097/hrp.0000000000000294] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention). METHODS We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges' g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number. RESULTS 295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features. CONCLUSION Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.
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Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry 2021; 12:628252. [PMID: 34759846 PMCID: PMC8573252 DOI: 10.3389/fpsyt.2021.628252] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.
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Affiliation(s)
- Frank W Paulus
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, Regional Psychiatric Hospital, Mauer, Austria
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Donenberg GR, Kendall AD, Emerson E, Fletcher FE, Bray BC, McCabe K. IMARA: A mother-daughter group randomized controlled trial to reduce sexually transmitted infections in Black/African-American adolescents. PLoS One 2020; 15:e0239650. [PMID: 33137103 PMCID: PMC7605636 DOI: 10.1371/journal.pone.0239650] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/09/2020] [Indexed: 11/23/2022] Open
Abstract
Black/African-American girls are infected with sexually transmitted infections (STIs) at higher rates than their White counterparts. This study tested the efficacy of IMARA, a mother-daughter psychosocial STI/HIV prevention program, on adolescent Black/African-American girls’ incident STIs at 12 months in a 2-arm group randomized controlled trial. Black/African-American girls 14–18 years old and their primary female caregiver were eligible for the study. Girls provided urine samples to test for N. gonorrhoeae, C. trachomatis, and T. vaginalis infection at baseline and 12-months. Mother-daughter dyads were randomly assigned to IMARA (n = 118) or a time-matched health promotion control program (n = 81). Retention at 12-months was 86% with no difference across arms. Both interventions were delivered over two consecutive Saturdays totaling 12 hours. Girls who received IMARA were 43% less likely to contract a new STI in the 12-month post-intervention period compared with those in the health promotion control program (p = .011). A secondary follow-up intent-to-treat analysis provided additional support for the protective effect of IMARA, albeit with a similar magnitude of 37% (p = .014). Findings provide early evidence for IMARA’s efficacy, such that IMARA protected against STIs at 12-months among adolescent Black/African-American girls. Future research should examine the mechanisms associated with reduced STIs.
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Affiliation(s)
- Geri R. Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Community Outreach Intervention Projects, School of Public Health, Chicago, Illinois, United States of America
- * E-mail:
| | - Ashley D. Kendall
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Erin Emerson
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Community Outreach Intervention Projects, School of Public Health, Chicago, Illinois, United States of America
| | - Faith E. Fletcher
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Bethany C. Bray
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Kelly McCabe
- Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Healthy Youths Program, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Narushima M, Wong JPH, Li ATW, Bhagat D, Bisignano A, Fung KPL, Poon MKL. Youth perspectives on sexual health education: Voices from the YEP study in Toronto. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2020. [DOI: 10.3138/cjhs.2019-0049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Youth Engagement Project (YEP) is a community-based pilot study in Toronto, Canada that we developed to better understand perspectives about and experiences of sexual health education among socioeconomically marginalized, racialized, and LGBTQ youth. We investigated: 1) what sex-related messages these young people received as they grew up, 2) how those messages affected their perspectives and sexual behaviour, and 3) their recommendations for sexual health education that meets their needs. Engaging youth whose voices are often overlooked due to their low socioeconomic status and their racial, sexual, and religious identities, and using a place-based method, we recruited a total of 47 young people, aged 16–24, and divided them into six groups based on gender and residential neighbourhood. The data was collected through a demographic and sexual practice survey, followed by a series of two focus groups. We conducted thematic analysis, guided by a socio-ecological approach and paying particular attention to participants’ intrapersonal, interpersonal and environmental factors. Our results indicate that participants received inadequate and contradictory sexuality related information from multiple sources. These mixed messages contributed to confusion, misconceptions, distress, and sexual vulnerabilities. Youth expressed their need for more inclusive and relevant sexual health education starting from an early age, more support for parents and teachers to help them talk with children and youth about sexuality, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centred sexual health education at home, in school and in the community.
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Affiliation(s)
- Miya Narushima
- Department of Health Sciences, Brock University, Saint Catherines, ON
| | | | - Alan Tai-Wai Li
- Primary Health Care, Regent Park Community Health Centre, Toronto, ON
| | - Dimple Bhagat
- Health Services, Children’s Aid Society of Toronto, Toronto, ON
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Pathways from witnessing community violence to mental health problems among South African adolescents. S Afr Med J 2020; 110:145-153. [PMID: 32657687 PMCID: PMC9327528 DOI: 10.7196/samj.2020.v110i2.13929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The intersection of violence exposure and mental health problems is a public health crisis for South African (SA) adolescents. Understanding the impact of community violence on adolescent mental health can inform future interventions. OBJECTIVES To assess pathways between community violence exposure and internalising and externalising problems in SA adolescents receiving mental healthcare, and the roles of parent and peer relationships in these associations. METHODS Participants (N=120 parent-adolescent pairs) were recruited from four mental health clinics in Western Cape Province to participate in a pilot test of a family-based HIV prevention study. Adolescents reported on their exposure to community violence, parental attachment, peer support of risk behaviour, and mental health. Parents reported on adolescents' internalising and externalising mental health problems. Participants received transport money (ZAR30 = USD3) and a shopping voucher or cash (ZAR50 = USD5) for their time. RESULTS Adolescents were 12 - 18 years old (mean (standard deviation) 14.39 (1.82) years), 53% were male, and 67% and 33% reported black African and mixed-race ethnicity, respectively. Parents were 94% female and reported an average monthly income of ZAR3 973 (USD397). Boys reported significantly higher rates of witnessing community violence than girls. Among boys, significant paths emerged from community violence and low parent attachment to externalising symptoms and from community violence to peer support of risky behaviour. For girls, the only significant path was from low parent attachment to peer support of risky behaviour. CONCLUSIONS This cross-sectional study sheds new light on the possible pathways from witnessing community violence to mental health problems among SA adolescents. Identifying factors that drive and mitigate psychological distress in the context of persistent community violence is critical to SA's future and can inform the selection and delivery of appropriate and targeted evidence-based interventions.
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Brawner BM, Jemmott LS, Wingood G, Lozano AJ, Hanlon AL. Project GOLD: A pilot randomized controlled trial of a novel psychoeducational HIV/STI prevention intervention for heterosexually-active black youth. Res Nurs Health 2019; 42:8-28. [PMID: 30730043 PMCID: PMC6913528 DOI: 10.1002/nur.21930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/24/2018] [Indexed: 11/08/2022]
Abstract
Black youth account for the largest number of new HIV infections among heterosexual youth. Mental illness and difficulties in emotion regulation contribute to increased reports of HIV/sexually transmitted infection (STI) risk-related sexual behaviors in this group. Yet limited interventions exist to address this affective component of the sexual decision-making process. The purpose of this paper was to describe the trial design, research challenges, and baseline characteristics from a study designed to fill this gap. Project GOLD was a pilot randomized controlled trial of a psychoeducational HIV/STI prevention intervention designed to address the role of mental illness and emotion regulation in HIV/STI risk among heterosexually-active Black youth aged 14 to 17 (N = 108). Challenges encountered in the research process warrant further attention in future research (e.g., disagreement among the regulatory bodies on parental permission requirements). The most common mental health diagnoses were Recurrent Major Depressive Disorder (15.7%) and current substance abuse (7.4%). Participants reported higher levels of emotional suppression, and adaptive methods of emotion management, than culturally inappropriate expressions of anger or sadness. They also reported a mean age of 13.6 at first vaginal sex, used condoms 66% of the time for vaginal sex, and had an average of three sexual partners in the past 6 months. More than one-quarter (26.9%) had sex with more than one person in the same day. These findings indicate intervention is crucial for this population. The forthcoming trial evaluation will indicate the promise of such interventions in reducing HIV/STI infections in this key population.
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Affiliation(s)
- Bridgette M. Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Loretta Sweet Jemmott
- Department of Nursing, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Alicia J. Lozano
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Alexandra L. Hanlon
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
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Brawner BM, Abboud S, Reason J, Wingood G, Jemmott LS. The development of an innovative, theory-driven, psychoeducational HIV/STI prevention intervention for heterosexually active black adolescents with mental illnesses. VULNERABLE CHILDREN AND YOUTH STUDIES 2019; 14:151-165. [PMID: 31687041 PMCID: PMC6826258 DOI: 10.1080/17450128.2019.1567962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), continue to disproportionately affect Black adolescents. Those experiencing the psychological sequelae of mental illnesses are at increased risk. Here, we outline the development of an HIV/STI prevention intervention for heterosexually-active Black adolescents with mental illnesses. This research was guided by a psychosocial expansion of the Theory of Planned Behavior, nested within a broader social determinants of health framework. A youth community advisory board provided study oversight. Heterosexually-active Black adolescents aged 14 to 17 were recruited from community-based outpatient mental health providers for focus groups, surveys and two "dress rehearsals" of the intervention protocol (N = 68). The qualitative and quantitative findings indicated that knowledge, attitudes and skills related to consistent condom use, reduced number of sexual partners, routine HIV/STI testing, abstinence and emotion regulation were important areas to target. These elicitation data provided insight on the context of HIV/STI risk for the study population, and were used to develop the intervention content. "Project GOLD: We are Kings and Queens" was designed to be delivered over two days (three hours per day), with eight, 45-minute modules. The activities address behaviors, as well as cognitive, emotional, psychological and social processes associated with HIV/STI risk. Alongside evidence-based HIV/STI prevention strategies (e.g., sexual partner communication skills), the intervention activities are rooted in principles of Cognitive Behavioral Therapy. Dress rehearsal participants were in favor of the intervention and provided feedback on activity length, gender and cultural relevance, and strategies to sustain attention; this information was used to finalize the curriculum. In partnership with the community, we developed a theoretically-driven, gender and culturally relevant, developmentally and psychologically appropriate HIV/STI prevention program. Our ultimate goal is to standardize sexual health assessment and intervention in outpatient mental health treatment settings to meet sexual health needs in this underserved population.
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Affiliation(s)
- Bridgette M. Brawner
- Department of Family and Community Health, University of
Pennsylvania School of Nursing, 418 Curie Blvd., 4th Floor, Room 419, Philadelphia,
PA 19104-4217, USA; Twitter: @DrBMBrawner; 215-898-0715 (office), 215-746-3374
| | - Sarah Abboud
- Department of Women, Children and Family Health Science,
College of Nursing, University of Illinois at Chicago, Chicago, IL, USA, Twitter:
@SarahAbboud78
| | - Janaiya Reason
- Department of Family and Community Health, University of
Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Gina Wingood
- Mailman School of Public Health, Columbia University, New
York, NY, USA
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