Friends in the 'hood: Should peer-based health promotion programs target nonschool friendship networks?

Tribal Reservation Adolescent Connections Study: A study protocol using mixed methods for examining social networks and associated outcomes among American Indian youth on a Northern Plains reservation

BACKGROUND

Rich cultural and traditional practices make interpersonal relationships vital for American Indian (AI) youth. Social relations and multigenerational networks (i.e., peer, family, kinship, and community) remain a salient fixture of AI culture, survival and thriving in reservation communities. Research in other populations has demonstrated how social networks impact youth risk and resilience, but data are lacking on AI adolescent networks. Intergenerational trauma from settler colonialism leads some AI youth to early initiation of substance use and subsequent substance misuse, along with disproportionately high risk for suicide and vulnerability to witnessing and experiencing violence. Using network data to develop prevention strategies among this population is a promising new avenue of research. In this study protocol paper, we describe the rationale and methodology of an exploratory study to be conducted with American Indian 9th and 10th graders at three schools on a Northern Plains reservation.

METHODS

This mixed methods study will collect quantitative social network surveys (N = 300) and qualitative interviews (n = 30). The study will examine the extent to which existing social network theories and data metrics adequately characterize AI youth networks or how they may need to be expanded for this population. Associations of network characteristics with risk and protective factors for substance use, exposure to violence, and suicide will also be examined.

DISCUSSION

This innovative methodological approach holds promise for informing the development of effective preventive approaches to address co-occurring risks for substance use, violence and suicide among AI adolescents. Understanding processes that impact social networks among AI adolescents can promote culturally resonant social relationships that may support better outcomes for youth.

Effects of a Sexual Risk-Reduction Intervention for Teenagers: A Cluster-Randomized Control Trial

This study evaluated the efficacy of the COMPAS program in the short term and 6 months after its application. For the initial sample, 2047 teenagers aged 14–19 years from 14 schools in 11 Colombian cities participated; eight schools were randomly assigned to the experimental condition and six to the control group. The participants completed self-report assessments that evaluated several variables theoretically associated with protective sexual behaviors. In the short term, the experimental group showed increased knowledge about HIV and other STIs, sexual assertiveness, self-efficacy, greater behavioral intention toward condom use, and more favorable attitudes toward HIV and condom use than the control group. After 6 months, most psychological and health variables also showed a significant positive change. In conclusion, the COMPAS program is the first school-based sexuality education program that has been shown to be effective in reducing mediating and behavioral variables associated with sexual risk reduction in Colombia.

Neighborhoods, Schools, and Adolescent Violence: Ecological Relative Deprivation, Disadvantage Saturation, or Cumulative Disadvantage?

Neighborhood and school socioeconomic "disadvantage" are consequential for youth violence perpetration. This study considers alternative ecological cumulative disadvantage, disadvantage saturation, and relative deprivation hypotheses regarding how the association between neighborhood disadvantage and violence varies by levels of socioeconomic disadvantage in schools. These hypotheses are tested with data from Wave I of Add Health (n = 15,581; 51% Female; Age mean = 15.67, SD = 1.74). Cross-classified multilevel Rasch models are used to estimate the interaction between neighborhood and school disadvantage in predicting adolescent violence. Consistent with the ecological relative deprivation hypothesis, results indicate that the association between neighborhood disadvantage and violence is most pronounced among youth attending low-disadvantage schools. Further, youth exposed to high-disadvantage neighborhoods and low-disadvantage schools tend to be at the greatest risk of perpetrating violence. These patterns are evident among both males and females, and particularly among older youth and those from low-parent education families. This study motivates future investigations considering how adolescents' experiences beyond the neighborhood shape how they engage with and experience the effects of their neighborhoods.

Neighborhood Effects on Children's Development in Experimental and Nonexperimental Research

Children's neighborhood contexts are defined by rising socioeconomic inequality and segregation. This article reviews several decades of research on how neighborhood socioeconomic conditions are associated with children's development. The nonexperimental literature suggests that the most salient neighborhood socioeconomic condition depends on the outcome—disadvantage for social, emotional, and behavioral outcomes and advantage for achievement-related outcomes. Moreover, children's cumulative exposure to neighborhood socioeconomic conditions over the first two decades of life, and possibly especially in childhood, may matter most for later development. These findings are partially supported by the few experimental studies available, and across study designs, neighborhood effects are typically modest. In order to improve our understanding of this topic, we recommend methodologically rigorous designs—experimental and nonexperimental—and comparative approaches, particularly ones addressing the complexities of development in neighborhood contexts. To guide this research, we provide an integrated framework that captures a broad and dynamic perspective including macro forces, neighborhood social processes and resources, physical features, spatial dynamics, and individual differences.

How Do My Friends Matter? Examining Latino Adolescents' Friendships, School Belonging, and Academic Achievement

Are Latino adolescents' friendships an untapped resource for academic achievement or perhaps one of the reasons why these youth struggle academically? Using data from the National Longitudinal Study of Adolescent Health (N = 6782; 7th through 12th graders; 52.9 % female), we examined whether the process of Latino students' school belonging mediated the relationships between the context of friendships (i.e., friendship network indicators) and their academic outcomes (i.e., a context-process-outcomes model), and tested whether the process-context link varied by friends' characteristics (i.e., GPA and problem behavior; social capital). Moreover, we tested whether all relationships varied across the four largest Latino subgroups in the U.S. (i.e., Mexican, Central/South American, Puerto Rican, and Cuban). Our findings indicate that being nominated as a friend by peers and perceiving to have friends exerted both direct effects on school belonging in all but one of the Latino ethnic samples (i.e., Puerto Rican samples) and indirect effects on academic achievement in the full Latino, Mexican, and Central/South American samples. As such, school belonging was more likely to explain the links between academic achievement with nominations by peers as a friend and perceived friends than with having close-knit friendship groups. However, having a close-knit group of average or low-achieving friends predicted more school belonging for Mexican youth, but less school belonging for Cubans. Our findings suggest that friendships may be particularly beneficial for the school belonging process of highly marginalized groups in the U.S. (i.e., Mexican-origin).

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.

Nonprobability and probability-based sampling strategies in sexual science

With few exceptions, much of sexual science builds upon data from opportunistic nonprobability samples of limited generalizability. Although probability-based studies are considered the gold standard in terms of generalizability, they are costly to apply to many of the hard-to-reach populations of interest to sexologists. The present article discusses recent conclusions by sampling experts that have relevance to sexual science that advocates for nonprobability methods. In this regard, we provide an overview of Internet sampling as a useful, cost-efficient, nonprobability sampling method of value to sex researchers conducting modeling work or clinical trials. We also argue that probability-based sampling methods may be more readily applied in sex research with hard-to-reach populations than is typically thought. In this context, we provide three case studies that utilize qualitative and quantitative techniques directed at reducing limitations in applying probability-based sampling to hard-to-reach populations: indigenous Peruvians, African American youth, and urban men who have sex with men (MSM). Recommendations are made with regard to presampling studies, adaptive and disproportionate sampling methods, and strategies that may be utilized in evaluating nonprobability and probability-based sampling methods.

Exploration of Social, Environmental, and Familial Influences on the Sexual Health Practices of Urban African American Adolescents

Despite efforts to examine social influences and provide interventions that lead to safer sexual practices for African American (AA) adolescent girls, statistics have demonstrated this population continues to have the highest rates of teen pregnancy and sexually transmitted infections (STIs) including HIV when compared with adolescent girls of other races. Guided by the principles of Black Feminist Thought and Photovoice and focus group methodology, this descriptive study aimed to discover the social realities influencing a group of eight AA adolescent girls aged 15 to 19 years. Data from individual interviews and a focus group session were collected from November 11, 2012, to February 1, 2013. Analysis of selected photographs, interviews, and focus group conversations through a feminist lens suggests AA adolescents of low socioeconomic status continue to foster racial and mental inferiority stereotypes by using their sexuality as a bargaining tool for acceptance, value, and even love.

Members, isolates, and liaisons: meta-analysis of adolescents' network positions and their smoking behavior

Existing research finds that peer networks play an important role in adolescents' smoking behaviors. To evaluate this research, meta-analysis was utilized to investigate the relationship between social positions (e.g., group members vs. isolates vs. liaisons) in friendship networks and smoking behaviors. The results (N = 5,067, k = 8) showed that adolescents from multiple countries who are isolated in friendship networks are more likely to report smoking behaviors than those with friends (members or liaisons). The results also show that these differential odds of smoking based on network position has decreased over the past 15 years.

An assessment of the feasibility and acceptability of a friendship-based social network recruitment strategy to screen at-risk African American and Hispanic/Latina young women for HIV infection

OBJECTIVES To examine the feasibility and acceptability of a friendship-based network recruitment strategy for identifying undiagnosed human immunodeficiency virus (HIV) infection within young women's same-sex friendship networks and to determine factors that facilitated and hindered index recruiters (IRs) in recruiting female friendship network members (FNMs) as well as factors that facilitated and hindered FNMs in undergoing HIV screening. DESIGN A cross-sectional study design that incorporated dual incentives for IRs and their female FNMs. SETTING The IRs were recruited through 3 Adolescent Trials Network for HIV/AIDS Interventions sites within their Adolescent Medicine Trials Units. Data were collected from January 1, 2009, through June 30, 2010. PARTICIPANTS The IRs self-identifying as HIV positive, negative, or status unknown were enrolled to recruit FNMs to undergo HIV screening. MAIN OUTCOME MEASURES Self-reports of HIV risk and facilitators and barriers to network recruitment and HIV screening were assessed using an audio-computer-assisted self-interview. Participants were identified as HIV negative or positive on the basis of an OraQuick HIV test with confirmatory enzyme-linked immunosorbent assay and/or Western blot tests. RESULTS Nearly all (156 [98.1%]) eligible IRs agreed to participate and most (78.4%) recruited 1 or more FNMs. Of the 381 FNMs, most (342 [89.8%]) agreed to HIV screening. Although a high acceptance of HIV screening was achieved, the HIV prevalence was low (0.26%). CONCLUSION Our findings provide compelling evidence to suggest that use of a female friendship network approach is a feasible and acceptable means for engaging at-risk young women in HIV screening, as shown by their high rates of agreement to undergo HIV screening.

Psychosocial Outcomes of Sexual Risk Reduction in a Brief Intervention for Urban African American Female Adolescents

This article describes psychosocial outcomes of a group randomized controlled trial of a friendship-based HIV/STI prevention intervention grounded in the AIDS Risk Reduction Model (ARRM). A total of 264 African American adolescent females were randomized to a single-session Project ÒRÉ HIV/STI prevention intervention or a nutrition/exercise health promotion intervention with their friendship group. At posttest, Project ÒRÉ participants scored higher on knowledge of HIV/STI prevention and protection (p < .01), knowledge of living with HIV/STI (p < .01), perceived HIV risk (p < .05), perceived STI risk (p < .01), and intentions to use condoms for vaginal sex (p < .05). Findings suggest that a brief friendship-based HIV/STI prevention intervention for youth can impact ARRM factors that increase the ability to recognize and label risky sexual behaviors as problematic and promote commitment to changing high-risk behaviors.

Norms governing urban African American adolescents' sexual and substance-using behavior

Using a probability-based neighborhood sample of urban African American youth and a sample of their close friends (N = 202), we conducted a one-year longitudinal study to examine key questions regarding sexual and drug using norms. The results provide validation of social norms governing sexual behavior, condom use, and substance use among friendship groups. These norms had strong to moderate homogeneity; and both normative strength and homogeneity were relatively stable over a one-year period independent of changes in group membership. The data further suggest that sex and substance using norms may operate as a normative set. Similar to studies of adults, we identified three distinct "norm-based" social strata in our sample. Together, our findings suggest that the norms investigated are valid targets for health promotion efforts, and such efforts may benefit from tailoring programs to the normative sets that make up the different social strata in a given adolescent community.

Perceived peer safer sex norms and sexual risk behaviors among substance-using Latino adolescents

We investigated the association between perceived peer norms and safer sexual behaviors among substance using Latino youth. Between 2005 and 2006, cross-sectional data were collected from 92 Latino adolescents recruited from clinic- and community-based settings in two U.S. cities. Separate multivariate logistic regression models were used to assess the relationship between perceived peer norms around safer sex and two different outcomes: consistent condom use and multiple sexual partnerships. Among these participants, perceived peer norms encouraging safer sex were associated with consistent condom use even after controlling for individual- and partner-related factors. Perceived peer norms supporting safer sex were inversely associated with recently having two or more sexual partners after controlling for demographic characteristics. Perceived peer norms around safer sexual behavior contribute to a lower likelihood of engaging in two HIV/STI risk behaviors: inconsistent condom use and multiple partnering. These findings suggest that further development of peer-based interventions for Latino youth is warranted.

A quasi-experimental evaluation of a community-based HIV prevention intervention for Mexican American female adolescents: the SHERO's program

This article describes a quasi-experimental evaluation of a community-based, culturally and ecologically tailored HIV prevention intervention for Mexican American female adolescents grounded in the AIDS risk reduction model. A total of 378 Mexican American female adolescents (mean age = 15.2) participated in either the nine-session SHERO's (a female-gendered version of the word hero) intervention or a single session information-only HIV prevention intervention. Assessment data were collected at pretest, posttest, and 2-month follow up. Significant improvements across all time points were revealed on measures of self-esteem, condom attitudes, beliefs regarding a woman's control of her sexuality, beliefs regarding sexual assault, perceived peer norms, and HIV/AIDS and STI knowledge. At posttest SHERO's participants were more likely to carry condoms and to report abstaining from vaginal sex in the previous 2 months; and at 2-month follow up they reported using condoms more often in the preceding 2 months and planned on using them more frequently in the coming 2 months. Findings support the development of community-based adolescent HIV prevention interventions that address culturally specific ecological factors.

Project ORE: A friendship-based intervention to prevent HIV/STI in urban African American adolescent females

There is an urgent need for continued innovation in the design of HIV/STI prevention interventions for African American females, a group at high risk for STIs and HIV. In particular, attention to social development and to culture is needed. The present study reports on a group randomized controlled trial of a friendship-based HIV/STI prevention intervention delivered at community-based centers in four San Francisco neighborhoods (n = 2, experimental; n = 2, control). This brief program focuses on youth and their friendship group (N = 264). Program outcomes vary by age at 3-month follow-up, evidencing decreases in risky sex in the oldest group (p < or = .05), decreases in multiple partners in the middle age group (p < or = .05), and increases in HIV testing in the youngest group (p = .05). Findings extend recent work on the efficacy of interventions to reduce sexual risk for racial and ethnic minority youth.

Supportive friendships moderate the association between stressful life events and sexual risk taking among African American adolescents

OBJECTIVE

This study examined whether uncontrollable stressful life events were associated with sexual risk taking among adolescents across a 1-year period, and whether supportive friendships modified associations.

DESIGN

Participants were 159 sexually active African American adolescents (57% male; mean age [SD] = 17.0 [1.5] years at baseline). Participants were recruited for in-person interviews through random digit dialing in one inner-city neighborhood characterized by high rates of poverty and crime relative to the surrounding city.

MAIN OUTCOME MEASURES

Dependent variables included substance use before sexual activity and inconsistent condom use.

RESULTS

Among adolescents who reported low levels of supportive friendships, uncontrollable stressors were associated with greater levels of sexual risk taking over time. In contrast, uncontrollable stressors were not associated with sexual risk taking among adolescents who reported high social support from friends; risk taking was typically moderate to high among these adolescents.

CONCLUSION

Different processes may explain sexual risk taking among adolescents with varying levels of social support from friends. Adolescents with low support may be prone to engagement in health risk behavior as a stress response, while adolescents with high support may engage in risk behavior primarily due to peer socialization of risk.

Preliminary findings on a brief friendship-based HIV/STI intervention for urban African American youth: project ORE

This study presents preliminary findings of a brief friendship-based HIV/STI prevention intervention for urban African American youth. Using a no-control design, we found that the program is feasible, acceptable, and demonstrates promise with regard to changes in HIV/STI-related knowledge, beliefs, social norms, and behavior.

Influence of gang membership on negative affect, substance use, and antisocial behavior among homeless African American male youth

The current study examined differences between gang-involved and non-gang-involved homeless African American male youth with regard to negative affect, substance use, and antisocial/violent behavior. A total of 69 homeless African American young men were recruited from community agencies and completed structured face-to-face interviews. Overall, gang members reported higher rates of negative mental and physical health outcomes than did non-gang members, with current gang members reporting higher levels of depression and anxiety, greater levels of antisocial and violent behavior, and higher levels of lifetime alcohol and marijuana use. Multiple linear regression analyses revealed that greater levels of gang involvement were associated with more frequent lifetime use of alcohol and marijuana and higher levels of participation in violent behaviors. Implications of these findings for interventions with homeless African American male youth and future research directions are discussed.