Reducing Concurrent Sexual Partnerships Among Blacks in the Rural Southeastern United States: Development of Narrative Messages for a Radio Campaign

Improving African Americans' Intentions to Enroll in a Health Registry: Message Development and Evaluation

African Americans' enrollment in health registries is low, negatively affecting their representation in clinical research. Young African Americans are particularly underrepresented. Because medical discoveries are typically based on findings from research that lacks minority representation, new treatments may not be equally effective with members of the African American community. This may further exacerbate health disparities. In this two-phase study, we first collected data from five focus groups to (a) investigate young African Americans' knowledge about and attitudes toward health registries and (b) explore their perceptions about current messages used to recruit participants into health registries. The findings from the first phase of our research showed that participants had limited awareness and understanding of health registries' functions and held negative attitudes toward research participation. In Phase 2, we conducted an experiment to compare the effects of a current message, a new message designed based on the findings from our Phase 1 study, and a control. Results showed mixed findings on the impact of the new targeted message. Based on the findings from both phases of this study, we present and discuss future strategies.

Tecnologias educativas para prevenção do HIV em negros: revisão de escopo

RESUMO Objetivo: Mapear as tecnologias educativas implementadas para prevenção do HIV em negros. Método: Revisão de escopo, realizada conforme as recomendações do The Joanna Briggs Institute, nas bases de dados Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane e PsycINFO, utilizando-se do instrumento Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Resultados: Encontraram-se 14 estudos publicados entre 1999 e 2020. Os principais impactos para saúde dos negros envolveram a redução das taxas de relações sexuais desprotegidas, o maior uso de preservativos, a diminuição de comportamentos de risco, a minimização do número de parceiros, a maior solicitação de testagens para HIV e o aumento do uso de Profilaxia Pré-exposição (PrEP). Conclusão: As tecnologias educativas mapeadas foram: workshops, cursos, mensagens, dramatização, vídeos, aplicativo, panfleto, campanhas de mídia e de rádio, grupos de Facebook, site, programas de computadores e softwares multimídia.

Educational technologies for HIV prevention in black people: scope review

OBJECTIVE

To map the educational technologies implemented for HIV prevention in black people.

METHOD

Scope review, performed according to the recommendations of The Joanna Briggs Institute, in Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane and PsycINFO databases, using the Preferred Reporting Items for Systematic reviews and Meta- Analyses extension for Scoping Reviews (PRISMA-ScR).

RESULTS

There were 14 studies published between 1999 and 2020. The main health impacts for black people involved a reduction in rates of unprotected sex, greater use of condoms, a decrease in risky behaviors, a minimization of the number of partners, a greater request for HIV testing and an increase in the use of Pre-exposure prophylaxis (PrEP).

CONCLUSION

The educational technologies mapped were: workshops, courses, messages, dramatization, videos, application, pamphlet, media and radio campaigns, Facebook groups, website, computer programs and multimedia software.

Black College Women's Interpersonal Communication in Response to a Sexual Health Intervention: A Mixed Methods Study

We investigated interpersonal communication generated from a successful sexual health intervention for Black college women attending a Historically Black College/University (HBCU). Guided by the integrative model of behavioral prediction and the theory of gender and power, the intervention combined point-of-access health messages with condom distribution via condom dispensers. Using a mixed-methods approach, we examined communication partners, content, mode, valence, and perceived impact. Data were gathered from surveys (N = 105) and interviews (n = 10) with young adult women at an HBCU campus, conducted three months after the intervention. The findings revealed that 43% of women engaged in interpersonal communication and 21% engaged in online interactions about the dispensers. Friends were the most common conversation partners, and the conversations were mainly about condoms and the dispensers themselves. In general, the discussions were positive, showing support for the dispensers. Regression analyses revealed positive, significant associations between interpersonal communication and two key outcomes: condom acceptability and condom intentions. Overall, this study adds to research linking health communication interventions to interpersonal communication and subsequent attitudes and beliefs. Health communication interventions should actively encourage young Black women to share health-promoting information within their social networks to extend both the reach and impact of those interventions.

The Prevalence, Frequency and Social Ecology of Sexual Concurrency Among Young Adult Women

CONTEXT

Sexual concurrency among women is associated with increased risks of STD transmission, unintended pregnancy and sexual health disparities. Understanding the prevalence of concurrency-overlapping sexual partnerships-is imperative to reducing these disparities.

METHODS

Weekly, population-representative panel data from 757 women aged 18-22, collected from 2008 to 2012 in Michigan, were drawn from the Relationship Dynamics and Social Life study. Univariate analyses assessed the prevalence of two forms of sexual concurrency. Multivariate logistic regression models investigated associations between women's social-ecological characteristics and concurrency.

RESULTS

Twenty percent of women had vaginal intercourse with two partners in one week; 14% had intercourse with a second partner during an ongoing relationship. In both cases, the majority of individuals had intercourse with the second partner in one to three weeks in total. The likelihood of both types of concurrency was elevated among women who believed they should have sex with men after seeing them for a while (log-odds, 0.27 and 0.23, respectively) and among those who were Black (0.58 and 1.02, respectively); the likelihood was reduced among women who were more willing to refuse unwanted sex (-0.10 and -0.13, respectively) and who were in exclusive, cohabiting, or married or engaged relationships (-1.82 to -2.64). Having intercourse with multiple partners in one week was also associated with receiving sex education from parents, the degree that parents and friends approved of sex, and having had early intercourse without contraception.

CONCLUSIONS

Sexual concurrency among young women is prevalent but intermittent, and interventions that address individuals' social-ecological contexts are needed to reduce negative health outcomes.

Open Relationships, Nonconsensual Nonmonogamy, and Monogamy Among U.S. Adults: Findings from the 2012 National Survey of Sexual Health and Behavior

People in open and other consensually nonmonogamous partnerships have been historically underserved by researchers and providers. Many studies group such partnerships together with nonconsensual nonmonogamy (NCNM) under the banner of "concurrent sexual partnerships." Discrimination from service providers poses a substantial barrier to care. Responding to such concerns, this investigation explored sociodemographic correlates with open relationships and associations between relationship structure and sexual risk, HIV/STI testing, and relationship satisfaction in a nationally representative probability sample. Data were drawn from the 2012 National Survey of Sexual Health and Behavior (n = 2270). We used multinomial logistic regression to identify correlates with relationship structure, and linear and logistic regression to investigate associations between relationship structure and testing, condom use, and relationship satisfaction. Eighty-nine percent of participants reported monogamy, 4% reported open relationships, and 8% reported NCNM. Males, gay/lesbian individuals, bisexual individuals, and those who identified as "Other, Non-Hispanic" were more likely to report open relationships. Bisexual individuals and Black, Non-Hispanic participants were more likely to report NCNM; older participants were less likely to do so. Participants in open relationships reported more frequent condom use for anal intercourse and lower relationship satisfaction than monogamous participants. NCNM participants reported more HIV testing and lower satisfaction. Identities, experiences, and behaviors within open and other consensually nonmonogamous populations should be regarded as unique and diverse, rather than conflated with those common to other relationship structures. There is a need for greater awareness of diverse relationship structures among researchers and providers, and incorporation of related content into educational programming.

Protective behaviours among young African American women with non-monogamous sexual partners

In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women's increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18-24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms.

Changing Attitudes About Concurrency Among Young African Americans: Results of a Radio Campaign

We created and evaluated an 8-month campaign of provocative radio ads to change attitudes about concurrent (overlapping) sexual partnerships among young African Americans. We created a concurrency attitude scale and compared its score distributions in independent samples of African Americans, ages 18-34 years, interviewed by telephone before (n = 678) and after (n = 479) the campaign. Pre- and post-campaign samples reflected similar response rates (pre: 32.6%; post: 31.8%) and distributions of personal characteristics. Reported exposure to concurrency messages was greater after the campaign (pre: 6.3%, post: 30.9%), and mean scores indicated less acceptance of concurrency (pre: 3.40 [95% CI 3.23, 3.57]; post: 2.62 [2.46, 2.78]). Score differences were not a function of differences in composition of the samples (adjusted means: pre: 3.37 [3.21, 3.53]; post: 2.62 [2.47, 2.76]). Findings demonstrate that a carefully targeted, intensive mass media campaign can change attitudes about concurrency, which should facilitate behavior change.

Using the Theory of Planned Behavior to Guide Focus Group Development of Messages Aimed at Increasing Compliance With a Tobacco-Free Policy

Purpose:

This study details the persuasive message development for a theory-based campaign designed to increase compliance with a university’s tobacco-free policy.

Approach:

The theory of planned behavior (TPB) guided message design and evaluation for focus group–tested messages that were adapted to the context of complying with a tobacco-free policy.

Setting:

The study was conducted at a university located in the tobacco belt.

Participants:

Undergraduate focus group participants (n = 65) were mostly male (69%), white (82%), and freshman (62%) who smoked at least 1 cigarette in the last 30 days; on-campus smoking percentages were never/rare (60%), occasionally (23%), and often/frequently (16%).

Method:

Data analysis used a theoretical thematic approach to identify how the TPB constructs related to perceptions of message effectiveness.

Results:

Participants responded favorably to attitudinal strategies about health, respect, and university figures; they rejected approaches they considered juvenile and offensive. They also discussed the impact of noncompliance and avoiding overgeneralized statements for addressing subjective norms, suggesting shortening text, adjusting picture location, and emphasizing the importance of compliance to increase perceptions of behavioral control.

Conclusion:

Applying theory to preexisting messages is challenging. The design approach in this study is an evidence-based strategy that can be used as a universal process for message adaptation. Results offer health promotion suggestions for designing messages aimed at improving undergraduate smokers’ willingness to comply with tobacco-free campus policies.

Measuring Concurrency Attitudes: Development and Validation of a Vignette-Based Scale

Background

Concurrent sexual partnerships (partnerships that overlap in time) may contribute to higher rates of HIV transmission in African Americans. Attitudes toward a behavior constitute an important component of most models of health-related behavior and behavioral change. We have developed a scale, employing realistic vignettes that appear to reliably measure attitudes about concurrency in young African American adults.

Methods

Vignette-based items to assess attitudes about concurrency were developed following focus groups and cognitive testing of items adapted from existing scales assessing psychosocial constructs surrounding related sexual behaviors. The new items were included in a telephone survey of African American adults (18–34 years old) in Eastern North Carolina immediately before and after a radio campaign designed to discourage concurrency. We performed an exploratory factor analysis on each sample (pre- and post-campaign) to cross-validate results. We retained factors with a primary loading of ≥0.50 and no secondary loading >0.30. Cronbach’s coefficient alpha was used to evaluate internal reliability. Associations in the predicted direction between the mean responses to items on the final factor and known correlates of concurrency validated the scale.

Results

Factor analysis in a random pre-campaign subsample yielded a one-factor 6-item scale with acceptable internal consistency (Cronbach’s α = 0.79). As expected, the attitude factor was positively associated with participation in concurrent partnerships, whether assessed by self-report (r = 0.298, p<0.0001) or deduced from dates of recent sexual partnerships (r = 0.298, p<0.0001). The factor was also positively associated with alcohol (r = 0.216, p<0.0001) and drug use (r = 0.225, p<0.0001) and negatively associated with increasing age (r = -0.088, p- = 0.02) and female gender (r = -0.232, p<0.0001). Factor analyses repeated in the second random pre-campaign subsample and post-campaign sample confirmed these results.

Conclusion

A vignette-based scale may be an effective measure of key attitudes related to concurrency and potentially a useful tool to evaluate interventions addressing this network pattern.