Culturally adapted safer sex skills building: development and initial testing of an HIV prevention intervention for Black women using substances in the United States

Black women who use substances in the United States face unique human immunodeficiency virus (HIV) risk factors. However, interventions addressing cultural factors relevant for preventing HIV risk behaviors among Black women are limited. This project aimed to develop and initially test the effectiveness of a culturally adapted version of safer sex skills building (SSSB), an evidence-based HIV prevention intervention for reducing HIV risk among Black women who use substances. The cultural adaptation procedures involved (i) review of existing literature, (ii) use of Delphi process and theater testing to generate an adapted version, (iii) theater testing of the culturally adapted version and (iv) initial testing. Forty-eight Black women recruited from a substance use treatment clinic in the United States participated in three 2.5-h sessions of a culturally adapted or a generic version of the intervention. More (48%) women in the culturally adapted version self-reported condom use with casual partners compared to women in the generic (29%) version at a 6-week follow-up. The two groups did not differ on self-reported condom use with main partners. The culturally adapted SSSB offers a promising intervention for sexual risk reduction among Black women who use substances. Moreover, the findings advance the field by illustrating a concrete methodology for cultural adaptation.

Lessons learned and future directions: A scoping review of American Indian and Alaska Native participants in the National Drug Abuse Treatment Clinical Trials Network

INTRODUCTION

American Indian and Alaska Native (AI/AN) populations are disproportionately affected by substance use disorders (SUDs) and related health disparities in contrast to other ethnoracial groups in the United States. Over the past 20 years, substantial resources have been allocated to the National Institute on Drug Abuse Clinical Trials Network (CTN) to disseminate and implement effective SUD treatments in communities. However, we know little about how these resources have benefitted AI/AN peoples with SUD who arguably experience the greatest burden of SUDs. This review aims to determine lessons learned about AI/AN substance use and treatment outcomes in the CTN and the role of racism and Tribal identity.

METHOD

We conducted a scoping review informed by the Joanna Briggs framework and PRISMA Extension for Scoping Reviews checklist and explanation. The study team conducted the search strategy within the CTN Dissemination Library and nine additional databases for articles published between 2000 and 2021. The review included studies if they reported results for AI/AN participants. Two reviewers determined study eligibility.

RESULTS

A systematic search yielded 13 empirical articles and six conceptual articles. Themes from the 13 empirical articles included: (1) Tribal Identity: Race, Culture, and Discrimination; (2) Treatment Engagement: Access and Retention; (3) Comorbid Conditions; (4) HIV/Risky Sexual Behaviors; and (5) Dissemination. The most salient theme was Tribal Identity: Race, Culture, and Discrimination, which was present in all articles that included a primary AI/AN sample (k = 8). Themes assessed but not identified for AI/AN peoples were Harm Reduction, Measurement Equivalence, Pharmacotherapy, and Substance Use Outcomes. The conceptual contributions used AI/AN CTN studies as exemplars of community-based and Tribal participatory research (CBPR/TPR).

CONCLUSION

CTN studies conducted with AI/AN communities demonstrate culturally congruent methods, including CBPR/TPR strategies; consideration/assessment of cultural identity, racism, and discrimination; and CBPR/TPR informed dissemination plans. Although important efforts are underway to increase AI/AN participation in the CTN, future research would benefit from strategies to increase participation of this population. Such strategies include reporting AI/AN subgroup data; addressing issues of cultural identity and experiences of racism; and adopting an overall effort for research aimed at understanding barriers to treatment access, engagement, utilization, retention, and outcomes for both treatment and research disparities for AI/AN populations.

One size does not fit all: A NIDA CTN inspired model for community engaged cultural adaptation

The NIDA National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) is devoted to the development of effective interventions for people who use substances across a variety of populations. When positive outcomes of a particular intervention do not generalize to other groups, adaptation may improve effectiveness for a different target group. However, currently limited information is available for involving community participation in cultural adaptation. The current paper illustrates the evolution of our methodology for community engaged cultural adaptation by describing a series of sexual health and substance use interventions. We highlight the transition from minimal community involvement (the Delphi process), to moderate community involvement (theater testing), to full community engagement in cultural adaptation. Ultimately, the results of these three projects led to the development of Community Collaborative Cultural Adaptation, a novel and concrete approach to cultural adaptation. This approach emphasizes the advantage of establishing academic/community partnerships for cultural adaptation to increase the effectiveness and sustainability of interventions.

A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network

Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Age Differences in Knowledge about HIV Transmission among African-American Men and Women

To test whether knowledge about HIV transmission may be one contributing factor to the disproportionately high rates of HIV and AIDS cases among older African Americans, this study examined data from 448 African-American men and women, who completed the AIDS Knowledge and Awareness Scale. Overall the findings supported the hypothesis that older African Americans were not as knowledgeable as their younger counterparts. However, the analyses also indicated older (age 61+) African-American women were significantly less knowledgeable about HIV transmission than the younger women. However, the difference between older and younger men was not significant. One implication is that older African Americans, especially women, should be targets of educational efforts.

The Experiences of Black Females in Traditional and Nontraditional Professions

This study is an investigation of differences in the backgrounds, attitudes, and career-related expectations of black college females pursuing traditional (e.g. teaching, social work, and nursing) and nontraditional (e.g. sciences, engineering, pre-law, business) careers for women. The subjects were 147 black female undergraduates attending a large urban university in the midwest who completed a questionnaire. The results showed that mothers of nontraditionals were likely to be better educated than mothers of traditionals. Also, the mothers of nontraditionals were more likely to have worked in nontraditional fields themselves. Nontraditionals were more likely to have had an early work experience, were more confident in their own ability to complete nontraditional educational programs, and had less traditional views about appropriate roles for women than traditionals. However, nontraditionals were less confident than traditionals that they and other women could actually achieve the careers they themselves were pursuing. Finally, nontraditionals did not think they were any less likely than traditionals to marry because of their career choices. However, nontraditionals did expect that they would have fewer female but more male friends because of their careers.

Does treatment readiness enhance the response of African American substance users to Motivational Enhancement Therapy?

The development of effective treatments for African Americans and other ethnic minorities is essential for reducing health disparities in substance use. Despite research suggesting that Motivational Enhancement Therapy (MET) may reduce substance use among African Americans, the findings have been inconsistent. This research examined the extent to which readiness-to-change (RTC) affects response to MET among African American substance users. The study was a secondary analysis of the 194 African American substance users participating in a multisite randomized clinical trial evaluating MET originally conducted within the National Drug Abuse Treatment Clinical Trials Network. The participants were randomly assigned to receive either three sessions of MET or Counseling-As-Usual (CAU) followed by the ordinary treatment and other services offered at the five participating outpatient programs. Participants were categorized as either high or lower on RTC based on their scores on the University of Rhode Island Change Assessment. The participants reported their substance use at baseline and throughout the 16 weeks after randomization. Among the high RTC participants, those in MET tended to report fewer days of substance use per week over time than participants in CAU. However, among the lower RTC participants, the CAU group tended to report fewer days of substance use over time than MET participants. In contrast to previous thinking, the findings suggest that MET may be more effective for high than lower RTC African American participants.

Motivational enhancement therapy for African American substance users: a randomized clinical trial

Limited empirical evidence concerning the efficacy of substance abuse treatments among African Americans reduces opportunities to evaluate and improve program efficacy. The current study, conducted as a secondary analysis of a randomized clinical trial conducted by the Clinical Trials Network of the National Institute of Drug Abuse, addressed this knowledge gap by examining the efficacy of motivational enhancement therapy (MET) compared with counseling as usual (CAU) among 194 African American adults seeking outpatient substance abuse treatment at 5 participating sites. The findings revealed higher retention rates among women in MET than in CAU during the initial 12 weeks of the 16-week study. Men in MET and CAU did not differ in retention. However, MET participants self-reported more drug-using days per week than participants in CAU. Implications for future substance abuse treatment research with African Americans are discussed.

Measurement and data analysis in research addressing health disparities in substance abuse

This article describes concrete strategies for conducting substance abuse research with ethnic minorities. Two issues associated with valid analysis, measurement and data analysis, are included. Both empirical (e.g., confirmatory factor analysis, item response theory, and regression) and nonempirical (e.g., focus groups, expert panels, pilot studies, and translation equivalence) approaches to improve measures are described. A discussion of the use of norms and cutoff scores derived from a different ethnic group along with the effects of the ethnicity of the interviewer or coder on measurement is included. The section on data analysis describes why the use of race-comparison designs may lead to misleading conclusions. Alternatives to race-comparison analysis including within-group and between-group analyses are described. The shortcomings of combining ethnic groups for analyses are discussed. The article ends with a list of recommendations for research with ethnic minorities.

Drug Abuse in African American and Hispanic Adolescents: Culture, Development, and Behavior

An understanding of African American and Hispanic adolescent drug abuse occurs at the intersection of context, development, and behavior. The focus of this review is on the impact of racial/ethnic culture as one of the important contexts that influence adolescent development toward or away from prosocial behaviors. Because family plays a major role in both African American and Hispanic cultures, it is also a centerpiece of any discussion of adolescent development in these groups. This review on the state of the science in drug abuse for African American and Hispanic adolescents focuses on epidemiology, culturally specific risk and protective processes, and prevention and treatment research. From the perspective of a broad lens, specific minority groups such as African Americans and Hispanics would appear to have more in common than not. However, each of these groups encompasses considerable genetic, historical, social, and cultural heterogeneity. Investigation across such diversity will yield a more complete picture of the human condition.

Empirically derived guidelines for assessing the psychosocial needs of children and adolescents with sickle cell

This paper introduces an empirically derived psychosocial assessment form that may facilitate the incorporation of the growing body of research on sickle cell into the psychosocial assessment process. The psychosocial assessment form was guided by two theoretical models that explain the variability in adjustment among children and adolescents with sickle cell--the Disability-Stress-Coping Model (Wallender, Varni, Babani, Banis, & Wilcox, 1989) and the Transactional Stress and Coping Model (Thompson, Gustafson, George Spock, 1994). The Psychosocial Assessment Form consists of two sections. The first section includes primary indicators of adjustment such as internalizing disorders, externalizing disorders, school performance, and difficulties in social relationships. The second section lists secondary indicators of adjustment including intrapersonal factors, stress processing factors, and social ecological factors. The literature that guided this form is also reviewed.

Academic performance among children with sickle cell disease: setting minimum standards for comparison groups

The conclusions from previous research on childhood adjustment to sickle cell disease (SCD) have been inconsistent. One possible explanation for this inconsistency is that such children sometimes have been compared to children with different demographic characteristics. This study examined whether 42 African-American children with sickle cell disease differ in academic performance from a comparison group of 26 with similar demographic characteristics. The two groups were similar by sex, age, race, and socioeconomic status. School data were collected for both groups. The differences between the two groups on academic performance were not significant. One implication of the findings is the importance of setting minimum standards for comparison groups in studies of children with sickle cell disease.

The impact of a child with sickle cell disease on family dynamics

This paper has reviewed research and other papers that have furthered our understanding of the impact of the presence of a child with sickle cell disease on the family. The research suggests that the primary parent in such a family experiences additional emotional strain much like primary parents of children with other chronic illnesses have been found to exhibit. The research also suggests that the ill child's presence influences interpersonal relationships within the family. Specifically, there is some evidence that the relationship between the parents and the relationship between the parent and other offspring may be affected adversely. The only evidence for an adverse impact on the relationship between the parent and the chronically ill child was in our research when considering only single-parent families. The research also suggests that the family environment is affected. In particular, the research suggests that the level of conflict and organization within the family was less favorable than within the control families. Moreover, the research suggests that the child's presence reduces the ability of the primary parent to participate in social activities outside of the family. Secondary parents, on the other hand, report less satisfaction with the extent to which their own individual needs are being met within the family. The available research also suggests that other factors mediate the impact of the child's illness on the family. In particular, parents with more knowledge about the illness and more social support available appear to cope more favorably with the illness. Moreover, the available research also suggests that the family also impacts on how the patient responds to the illness. Specifically, the more psychosocial stressors within the family, the less effectively the patient copes with the illness. In addition, the more social support available to the patient from the family and other significant others, the more likely the patient is to comply with the treatment regimen. Finally, two methodological issues have been discussed. First, a tendency is evident for parents to deny any impact on the family when asked directly but to demonstrate the impact when the responses of these parents are compared to the responses of a comparison group. This suggests a need for more studies that involve a comparison group in the design. Second, the small sample sizes in many of the studies reflect the lack of adequate sample in individual geographic locales. This suggests a need for more collaborative research projects such as the CSSCD project to increase sample size.