Replication of It's Your Game…Keep It Real! in Southeast Texas

Despite the recent efforts of the Office of Adolescent Health to replicate programs with demonstrated efficacy, there are still few evidence-based HIV, sexually transmitted infection (STI), and teen pregnancy prevention programs that have been replicated in "real-world" settings. To test the effectiveness of It's Your Game…Keep It Real! (IYG), an evidence-based STI and pregnancy prevention program for middle schools, the curriculum was implemented by teachers in urban and suburban middle schools in Southeast Texas from 2012 to 2015. IYG was evaluated using a group-randomized wait-list controlled effectiveness trial design in which 20 middle schools in nine urban and suburban school districts in Southeast Texas were randomized equally, using a multi-attribute randomization protocol, to either the intervention condition (received IYG) (n = 10 schools comprising 1936 eligible seventh graders) or the comparison condition (received usual care) (n = 10 schools comprising 1825 eligible seventh graders). All students were blinded to condition prior to administering the baseline survey. The analytic sample comprised 1543 students (n = 804, intervention; n = 739, comparison) who were followed from baseline (seventh grade) to the 24-month follow-up (ninth grade). Multilevel regression analyses were conducted to assess behavioral and psychosocial outcomes at follow-up. There were no significant differences in initiation of vaginal or oral sex between study conditions at follow-up. However, at 12-month follow-up, compared with students in the comparison condition, students in the intervention condition reported increased knowledge, self-efficacy, and perceived favorable norms related to HIV/STIs, condoms, and/or abstinence; decreased intentions to have sex; and increased intentions to use birth control. Knowledge outcomes were statistically significant at 24-month follow-up. This IYG effectiveness trial did not replicate the behavioral effects of the original IYG efficacy trials. However, it adds to the growing literature on the replication of evidence-based programs, and underscores the need to better understand how variations in implementation, setting, and measurement affect the behavioral impact of such programs.Clinical trial registration clinicaltrials.gov (NCT03533192).

Dual Contraceptive Method Use Among Youth in Alternative Schools

Dual contraceptive method use, or using a highly effective contraceptive method plus a barrier method like condoms, is gaining attention as a strategy for preventing unplanned pregnancy and sexually transmitted diseases. We investigated rates of dual method use among a sample of youth in urban alternative schools, and explored the relationship between dual method use and sexual partner type. The study analyzed data from 765 students enrolled in 11 district-run continuation high schools in northern California. We explored the association between dual method use and sexual partner type (steady only, a mix of steady and non-steady, and non-steady only) using logistic regression. Differences in dual rates by partner type were statistically significant, with higher rates of dual methods use reported among young people reporting non-steady sexual partners only, as compared to those with steady partners only. The data illustrate that young people in alternative school settings could gain from further intervention on the benefits, skills, and challenges of using two methods of contraception as opposed to one with both steady and non-steady sexual partners.

Physical function and quality of well-being in fibromyalgia: the applicability of the goodness-of-fit hypothesis

Objective: The goodness-of-fit hypothesis suggests that the effectiveness of a coping strategy depends on the match between type of strategy (problem-focused, emotion-focused) and the level of perceived control. This hypothesis was examined as a predictor of physical functioning and quality of well-being (QWB) in a large sample of women with fibromyalgia. Methods: Participants were 478 women with diagnosed fibromyalgia (M_age = 54.31, SD = 11.2), who were part of a larger intervention in which no intervention effects were found. Hierarchical, mixed selection regressions were performed to determine whether the relationship between coping and control-predicted physical functioning and QWB. Results: Participants who reported having lower levels of perceived control over their fibromyalgia syndrome and who engaged in more self-controlling coping (emotion-focused strategy) experienced greater QWB and physical functioning than those who used less self-controlling coping. Various main effects for coping and perceived control were also found. Level of physical functioning was also related to escape-avoidance, distancing, and perceived control. The level of QWB was related to social-support seeking, accepting responsibility, distancing, problem-solving, and perceived control. Conclusions: This study provides a greater understanding of the relationships among coping, perceived control, physical functioning, and well-being for women with fibromyalgia. Implications and directions for future research are discussed.

"They were only joking": efforts to decrease LGBTQ bullying and harassment in seattle public schools

BACKGROUND

Seattle Public Schools has implemented policies and programs to increase safety, family involvement, and student achievement for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. This case study examines students' perceptions of bullying and harassment in the school environment, and teacher intervention when these problems arise in the presence of strong district policies and programs aimed at reducing LGBTQ bullying and harassment in schools.

METHODS

We surveyed students in Gay-Straight Alliance (GSA) groups at 13 secondary schools (N = 107). We also conducted focus groups with GSA students and students not involved in the GSAs in 7 of 13 schools (N = 16 groups, including 154 students).

RESULTS

GSA students who were lesbian, gay, bisexual, or questioning (LGBQ) were significantly more likely than straight students to experience several types of harassment. On the basis of student report, the 2 most common intervention strategies by teachers for verbal harassment included stopping the harassment and explaining why it is wrong; teachers intervened in physical harassment by trying to stop the harassment. Students provided input on how to strengthen teacher interventions, including the need for more consistency in responding and following up. Students also noted a need for more focus on educating those who harass, rather than just asking them to stop.

CONCLUSIONS

Seattle Public Schools has made great strides in creating safe and welcoming schools for LGBTQ students, but still have to work further toward reaching this goal. Data from students on how they experience their school environment can help identify areas for improvement.

Interventions to reduce sexual risk behaviors among youth in alternative schools: a randomized controlled trial

PURPOSE

This paper presents results from a randomized controlled trial that assessed the short- and longer-term impact of a skills-based HIV/STI/pregnancy prevention curriculum, service learning, and the combination.

METHODS

The study featured a four-arm experimental design involving 47 classrooms (765 youth) from continuation high schools. Classrooms were randomly assigned to one of four conditions: (1) HIV/STI/pregnancy prevention curriculum only; (2) service learning only; (3) HIV/STI/pregnancy prevention curriculum plus service learning; or (4) an attention control curriculum. Students completed 3 surveys over 18 months. Multi-level analysis was used to adjust for the correlation among students within the same classroom and school, and the correlation of repeated measurements.

RESULTS

Participants were 53% male (mean age: 16.2 years). The majority of youth reported being Hispanic/Latino or African-American (37.9% and 22.3%, respectively). Students in the HIV/STI/pregnancy prevention curriculum condition were less likely to have vaginal intercourse without a condom in the 3 months prior to the survey [odds ratio (OR) = .58, p = .04]; these effects diminished by final follow-up. The program also significantly reduced students' exposure to risky situations. These changes were not significant in the service learning only or combined intervention conditions relative to control.

CONCLUSION

This study is one of a few controlled studies of HIV/STI and pregnancy prevention programs in continuation settings, and suggests the curriculum was effective in changing selected risk behaviors in the short term.

Condom use: slippage, breakage, and steps for proper use among adolescents in alternative school settings

BACKGROUND

School-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI), and pregnancy prevention programs often focus on consistent and correct condom use. Research on adolescents' experience using condoms, including condom slippage/breakage, is limited. This exploratory study examines proper condom use and the occurrence of condom slippage/breakage among alternative school youth.

METHODS

Data are from an HIV/STI prevention trial for youth in continuation school settings (N = 776). Analyses included separate hierarchical logistic regression analyses to explore the relationship between potential correlates and each outcome variable.

RESULTS

Students' use of steps for proper condom use varied-73.8% put on the condom before sexual contact, 71.1% squeezed air from the tip, and 92.0% unrolled the condom fully. Notably, 28.5% reported condom slippage/breakage. Results from the regression analyses showed that 4 sets of variables (demographic, substance use, sexual risk behaviors, and condom psychosocial factors) were associated with putting on a condom before sexual contact; none of the variable sets were associated with the other 2 condom steps measured. For slippage/breakage, the demographic and sexual risk behaviors were significant correlates; steps for proper condom use approached statistical significance (p = .058).

CONCLUSIONS

This study extends the limited research on how adolescents use condoms, and highlights important targets for prevention interventions.

Impact of victimization on risk of suicide among lesbian, gay, and bisexual high school students in San Francisco

PURPOSE

This study investigated the association between sexual orientation, victimization, and suicide risk-related outcomes among youth attending public high schools in San Francisco.

METHODS

Data from the 2009 Youth Risk Behavior Survey were analyzed using bivariate and logistic regression methods for complex samples to examine the relationship between sexual orientation, victimization, and three suicide risk-related outcomes (sadness/depression, suicide planning, and attempting suicide) while controlling for demographics and substance use.

RESULTS

Lesbian, gay, or bisexual (LGB) youth reported significantly higher rates of substance use, victimization, and suicide risk-related outcomes than heterosexual youth. However, in the controlled regression models, victimization was a significant predictor of sadness/depression and suicide attempts, regardless of sexual orientation. There was a significant interaction effect between sexual orientation and victimization on suicide planning, with heterosexual youth more affected than LGB youth.

CONCLUSIONS

Results underscore the deleterious effect of victimization on suicide risk-related outcomes, regardless of sexual orientation. As LGB youth continue to report higher rates of victimization, effective violence prevention approaches must focus on reducing violence among youth, specifically LGB youth. Additional research should focus on identification of other factors that may help further explain elevated suicide risk among LGB youth.

Appraisals and coping in people living with cancer: a meta-analysis

The present meta-analysis examined the relationship between primary appraisal dimensions and coping strategies in people with cancer. Primary appraisals were operationalized as appraisals of threat, challenge, and harm/loss. Coping was operationalized according to two coping taxonomies: the first based on coping efforts to manage the stressor itself and/or the distressful feelings associated with it (problem- or emotion-focused coping, respectively) and the second based on the general orientation of the coping efforts (approach or avoidance coping). Appraisals of threat were (counter-intuitively) related to use of problem-focused coping (r=0.20); appraisals of harm and/or loss were related to avoidance coping (r=0.23); and appraisals of challenge were related to both problem-focused (r=0.15) and approach coping (r=0.14). These findings suggest that individuals with cancer who appraise their illness as a threat are likely to use more problem-focused coping strategies. Individuals who appraise their cancer as a harm/loss, however, are likely to use more avoidance coping strategies. And finally, those who appraise their cancer as a challenge are likely to use approach coping strategies. Factors found to moderate the relationship between appraisals and coping included age of the participant, time since diagnosis, and type of cancer.

Interaction between ethanol and antihistamines: 3. mebhydrolin

We used 17 student volunteers in an experiment to investigate the effects of orally administered mebhydrolin (0.71 mg/kg), alone and in combination with ethanol (0.75 g/kg), on perceptual, cognitive and motor functions. Mebhydrolin did not significantly modify performance when given alone, but showed evidence of enhancing ethanol-induced performance deficits. Histamine challenge experiments indicated that the dose of mebhydrolin used exerted an antihistaminic effect over the period of the ethanol interaction study.

The interaction between ethanol and antihistamines: 2. Clemastine

Eighty paid student volunteers (35 male, 45 female) were used in an experiment to investigate the effects of a therapeutic dose of clemastine (1 mg) alone and in combination with a social dose of ethanol (0.54 g/kg) on perceptual, cognitive and motor functions. Both drugs were given orally. Clemastine did not significantly modify performance when given alone, and the performance decrements induced by ethanol were not enhanced by clemastine premedication.

The interaction between ethanol and antihistamines. 1: Dexchlorpheniramine

Thirteen paid student volunteers (9 male, 4 female) were used in a double-blind crossover experiment to investigate the effects of a therapeutic dose of dexchlorpheniramine alone, and in combination with a social dose of ethanol on perceptual, cognitive and motor functions. Both ethanol (0.75 g/kg) and dexchlorpheniramine (4 mg/70 kg) were given orally. Although a synergistic effect of dexchlorpheniramine with ethanol was only observed in some of the tests, a delayed recovery from the effects of the combination was noted. Subjective data indicated that the sedative effects of dexchlorpheniramine were more pronounced in the presence of ethanol.

Ethanol and delta9-tetrahydrocannabinol interactive effects on human perceptual, cognitive and motor functions. II

Fifteen paid student volunteers (10 male, five female) were used in a double-blind crossover experiment to further investigated the effects of delta9-tetrahydrocannabinol (THC), alone and in combination with ethanol, on perceptual, cognitive and motor functions. Both ethanol (0-54 g/kg) and THC (15 MG/70 KG) WERE GIVEN ORALLY. Ethanol was not very effective in in+uencing performance but this dose of THC produced marked decrements, predominantly in the latter part of the experiment. When they were given together, an early additive effect was apparent, but later, there was a suggestion of antagonism in that subjects who received the drug combination performed better than those who were given THC along. The interaction between THC and ethanol was considered to be complex.

The interaction of fructose, dextrose and ethanol on human performance

1. The effects of orally administered fructose (1.2 g.kg-1) and dextrose (1.2 g.kg-1) on the performance decrement induced by ethanol (1.0 g.kg-1) in a series of perceptual, cognitive and motor tests were studied in twelve healthy, paid University student volunteers using a double-blind cross-over design. Ethanol was consumed at a constant rate over 20 min and the hexoses or placebo were given approximately 40 min later. 2. The peak blood ethanol concentration was attained earlier when the subjects also received either hexose than after placebo but although its rate of fall was unaffected, significantly lower ethanol concentrations were encountered in the hexose-treated groups in the latter part of the experiment. 3. In general, the subjects were impaired to a slightly lesser degree when they received a combination of hexose and ethanol than after ethanol alone. There were no differences between the effects of fructose and dextrose. 4. The results do not support contentions that fructose is able to accelerate a return to sobriety and observed differences between hexose and placebo-treated groups were attributed to an effect on the absorption of ethanol rather than its metabolism.

The interaction of ethanol and delta9-tetrahydrocannabinol in man: effects on perceptual, cognitive and motor functions

Twelve paid student volunteers (8 male, 4 female) were used in a double-blind crossover experiment to investigate the effects of delta9-tetrahydrocannabinol (THC) alone, and in combination with ethanol, on human perceptual, cognitive and motor functions. Both THC (10 mg/70 kg) and ethanol (0-5 g/kg) had little effect when administered alone. The combination of drugs, however, induced a significnat decrement in performance in some of the tests and this interaction was considered to be at least additive. The peak blood ethanol concentration was higher (P = 0-05) when subjects received both ethanol and THC than when they received ethanol alone.

The effect of disodium cromoglycate on human performance, alone and in combination with ethanol

Seventeen paid volunteer subjects were used in a double-blind crossover experiment to investigate the effects of disodium cromoglycate (DSCG), alone and in combination with ethanol, on human perceptual, cognitive and motor performance. DSCG (40 mg) had little effect when given alone. When administered with ethanol (0-75 g/kg), DSCG did not significantly modify the ethanol-induced decrement in performance except in the complex reaction time test.

The relationship between alcohol dosage and performance decrement in humans

The effects of alcohol on human perceptual, cognitive and motor performance was assessed in a battery of tests, and the dose-response relationships for alcohol, important for the study of drug-alcohol interactions, established.

The effect of caffeine on human performance, alone and in combination with ethanol

The effect of caffeine (300 mg/70 kg) on cognitive, perceptual and motor functions was investigated both alone and in combination with ethanol (0.75 g/kg) in 68 healthy student volunteers of both sexes. A test battery consisting of standing steadiness, simple and complex reaction time, manual dexterity, numerical reasoning, perceptual speed and verbal fluency was used. Placebos for both drugs were included. Caffeine was administered in decaffeinated coffee immediately after finishing drinking the alcoholic beverage. A peak plasma ethanol concentration of 92 +/- 4 mg/100 ml occurred at 40 min which was not modified by caffeine. Caffeine did not antagonise the ethanol-induced decrement in performance except in the reaction time tests. Caffeine alone caused a significant increase in body sway at 40 min.