The Development and Implementation of a Cognitive-Based Intervention Aimed at Culturally Diverse Women at Risk for HIV/AIDS

The development and implementation of a culturally and gender sensitive, cognitive behavioral-intervention program aimed at preventing high-risk sexual and drug-use behaviors among culturally diverse women at risk for HIV/AIDS is described. The intervention stressed education, cultural/social barriers to change, and assertiveness/negotiation skill building. Methodological problems and their solutions are presented. The article stresses ways to recruit poor at-risk women, how to reduce attrition using incentives such as providing transportation, having food and child care at the intervention sessions, financial rewards, and a tracking system that includes many friends and family members of the participant. Preliminary findings indicated that the intervention was successful in promoting knowledge about HIV/AIDS. At the end of the six-week intervention protocol, the intervention group compared to the control group showed significant improvements in HIV/AIDS knowledge items dealing with clinical aspects of the disease, transmission knowledge, and partner risk knowledge. Knowledge, along with motivation to reduce risk and negotiation skills are essential in changing behaviors that put one at risk.

HIV transmission risks of females and males in paired partner relationships

As the HIV/AIDS epidemic has evolved, heterosexual behaviors have come to be an increasingly important mode of transmission and rates of infection have increased faster among women generally and minority women in particular. Most of what we known about heterosexual risk taking is based on survey data collected from either women or men. These data have been useful for helping to understand different levels and types of risk taking by women and men. However, they provide little information about the levels of risk taking that exist for paired partners in main partner relationships, the types of risks each partner brings to the relationship and how the contribution of partner risks varies. Using data from the pretest of a pilot project designed to test a behavioral intervention to reduce HIV/AIDS transmission among main sex partners, the authors developed four subscales of sexual risk taking for each partner. The association between subscales within and between genders are examined and the subscales are combined to obtain measures of couple risks. Particular attention is given to the gender contribution of partners to couple risk and the differential contribution of types of risk to total risk. The data suggest that, even though men bring relatively higher risks to their main partner relationship than women, this varies inversely with the level of couple risk.

The Florida "truth" anti-tobacco media evaluation: design, first year results, and implications for planning future state media evaluations

OBJECTIVES

To outline the design and present selected findings from the evaluation of a state counter-advertising, anti-tobacco media campaign. The appropriateness of the design for states developing media evaluations is discussed.

DESIGN

Four cross sectional, telephone surveys of the 12--17 year old population were used to track and monitor advertising and campaign awareness, confirmed awareness, and receptivity. The Florida baseline and one year surveys were used with two parallel national surveys in a quasi-experimental design to assess attitude and smoking related behaviour change attributable to the campaign.

MEASURES

Awareness was measured by self report, confirmed awareness by unaided description, and receptivity by self reports of how well advertisements were liked, talked to friends about, and made one think about whether or not to smoke. Eleven attitude and three smoking behaviour items for Florida (treatment) and a national (control) population were compared at baseline and after 12 months.

RESULTS

Significant increases in ad specific awareness, confirmed, receptivity, and campaign awareness, and confirmed awareness were reached by the sixth week. They continued to rise through the first year. No attitude and only minor behaviour differences were noted between the treatment and comparison populations at baseline. By the end of the first year, Florida youth had stronger anti-tobacco attitudes and better behaviour patterns than the comparison population.

CONCLUSIONS

The industry manipulation strategy used in the Florida campaign resulted in high rates of recall, significant changes in attitudes/beliefs, and reduced rates of smoking behaviour among youth.

Influence of a counteradvertising media campaign on initiation of smoking: the Florida "truth" campaign

OBJECTIVES

The purpose of this study was to assess the short-term effects of television advertisements from the Florida "truth" campaign on rates of smoking initiation.

METHODS

A follow-up survey of young people aged 12 to 17 years (n = 1820) interviewed during the first 6 months of the advertising campaign was conducted. Logistic regression analyses were used to estimate the independent effects of the campaign on smoking initiation while other factors were controlled for.

RESULTS

Youths scoring at intermediate and high levels on a media effect index were less likely to initiate smoking than youths who could not confirm awareness of television advertisements. Adjusted odds ratios between the media index and measures of initiation were similar within categories of age, sex, susceptibility, and whether a parent smoked.

CONCLUSIONS

Exposure to the "truth" media campaign lowered the risk of youth smoking initiation. However, the analysis did not demonstrate that all such media programs will be effective.

The industry manipulation attitudes of smokers and nonsmokers

A cross-sectional random sample was obtained of Florida youth between the ages of 12-17. Data were collected through a telephone survey after obtaining parent and child consent. Industry manipulation attitudes of three groups (self-identified nonsmokers who did not use cigarettes in the past 30 days, self-identified nonsmokers who used cigarettes in the past 30 days, and self-identified smokers who used cigarettes in the past 30 days) were compared. Constraints resulting from the method of data collection resulted in a conservative estimate of the strength of the association between industry manipulation attitudes and smoking behavior.

Florida's "truth" campaign: a counter-marketing, anti-tobacco media campaign

The "truth" campaign was created to change youth attitudes about tobacco and to reduce teen tobacco use throughout Florida by using youth-driven advertising, public relations, and advocacy. Results of the campaign include a 92 percent brand awareness rate among teens, a 15 percent rise in teens who agree with key attitudinal statements about smoking, a 19.4 percent decline in smoking among middle school students, and a 8.0 percent decline among high school students. States committed to results-oriented youth anti-tobacco campaigns should look to Florida's "truth" campaign as a model that effectively places youth at the helm of anti-tobacco efforts.

Relationship dynamics, ethnicity and condom use among low-income women

CONTEXT

Women's protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use.

METHODS

Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms.

RESULTS

Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently.

CONCLUSIONS

HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.

Dual-method use among an ethnically diverse group of women at risk of HIV infection

CONTEXT

Few U.S. women protect themselves against both pregnancy and sexually transmitted diseases (STDs) by using an efficient contraceptive method and a condom. Understanding the factors that influence dual-method use could help improve interventions aimed at encouraging protective behaviors.

METHODS

Interviews were conducted with 552 low-income women at risk of HIV who attended public health or economic assistance facilities in Miami in 1994 and 1995. Multinomial logit analyses were used to determine the influence of women's background characteristics, perceived vulnerability to pregnancy and AIDS, and relationship characteristics on the odds of dual-method use.

RESULTS

Overall, 20% of the women used dual methods. Women who were not married, who worried about both pregnancy and AIDS, who had ever had an STD, who were confident they could refuse a sexual encounter in the absence of a condom and who made family planning decisions jointly with their partner were the most likely to use dual methods rather than a single method (odds ratios, 2.0-3.5); those who considered the condom only somewhat effective in preventing AIDS or who shared economic decision-making with their partner were the least likely to use dual methods rather than a single method (0.5-0.6). The results were generally similar in analyses examining the odds of dual-method use involving an efficient contraceptive, except that black and Hispanic women were significantly more likely than whites to use condoms in conjunction with efficient contraceptives (3.3-7.1).

CONCLUSIONS

Both women's individual characteristics and the context of their sexual relationships influence whether they simultaneously protect themselves from pregnancy and HIV. The involvement of male partners in family planning decision-making and women's control over economic decision-making ensure greater protection against HIV infection.

Ethnic differences in sexual decisions and sexual behavior

Previous investigators have reported ethnic differences in the expression of sexual decision making and sexual behaviors in women. In a sample of women of low socioeconomic status between ages 18 and 45, we examined the influence of ethnicity and other variables (age, education, marital status, and comfort in discussing sex) on (i) who makes decisions on the timing and type of sex, (ii) whether a woman engages in vaginal, oral, and anal sex, (iii) the frequencies of each type of sex, and (iv) whether or not a woman has multiple partners. Multivariate analyses showed that, independent of other independent variables, ethnicity had little direct effect on most variables. The notable exception was that ethnicity influenced joint decision making regarding the timing and type of sexual activities for Hispanic but not for African American women. We conclude that ethnicity contributes to differences in sexual behaviors but that other variables are equally important.

Magic Johnson and children's conceptions of AIDS

Longitudinal data for a heterogeneous sample of 609 elementary school children are used to assess the long-term effects of Magic Johnson's announcement on children's HIV and AIDS conceptions. Four hypotheses are tested concerning these relationships, and background variables measured prior to Johnson's announcement are controlled. Findings suggest that Johnson's announcement increased children's HIV and AIDS knowledge and reduced their prejudice toward a hypothetical child with AIDS. No relationship is evident between the announcement and perceived vulnerability to HIV and AIDS. Males are more likely to be aware of Johnson's announcement, but its effects are more pronounced among blacks. Findings from the present research affirm the potential for celebrities like Johnson in HIV and AIDS education campaigns directed toward children.

Factors associated with use of the female condom

Black, Hispanic and white women recruited for an HIV prevention intervention were instructed in the use of the female condom and encouraged to try the device. Of the 231 women who completed the intervention, 29% tried the condom over the course of a month; 30% of those who tried it used it during at least half of their sexual encounters. Both ethnicity and age were associated with trying the device: Nearly 40% of black women and 30% of Hispanic women did so, compared with 18% of white women; 37% of those aged 25-34 tried the female condom, compared with 22% of women younger than 25. Trying the device was more likely among women living with a partner, those with a history of sexually transmitted disease infection, women who had had an HIV test, those who did not believe that the method afforded them a greater degree of overall control than did the male condom and those who had no prior knowledge of the device. Among women who used the device during at least half of their sexual encounters, 27% were black and 44% were Hispanic: 38% were younger than 25, and 43% were single. More regular users were about half as likely as less regular users to experience difficulty with insertion and one-eighth as likely to report the device slipping during use; they were more likely than less regular users to report that sex was more pleasurable with the female condom than with the male condom.

The association between substance use, condom use and sexual risk among low-income women

Substance use is frequently assumed to be associated with higher levels of sexual risk-taking and lower levels of condom use. An analysis of 668 black, Hispanic and white low-income women at public health and public assistance facilities in Miami show that 19% engaged in risky sexual behavior over the preceding six months, 24% in substance use and 31% in condom use. Overall, substance users are nearly four and one-half times more likely to take sexual risks than nonusers, but are about half as likely to have relied on condoms. When the probability of condom use is considered in the context of both substance use and sexual risk, substance users who take sexual risks appear just as likely to rely on condoms as are nonusers who take sexual risks and those who do not (odds of 0.43-0.49). However, substance users who do not take sexual risks are much less likely to use condoms (odds of 0.15). This pattern holds among black, Hispanic and white women, and suggests that perceptions of risk and the risks that partners bring to sexual encounters may be more important determinants of condom use than substance use per se.

Early childhood differentials in mother-child AIDS-information interaction

To date there have been no systematic inquiries into 1) the extent of parent-child AIDS interaction; or 2) the factors that influence whether young children and their parents talk about AIDS. In our sample, from a medium-sized Southern metropolitan area, 70 percent of mothers of children in the first, third, and fifth grades said they had talked to their child about AIDS, but only 41 percent of the mothers said their child had asked them questions about AIDS. Fourteen hypotheses about factors which might influence mother-child AIDS interaction are derived from the health/sex socialization literature. In the process of testing these bivariate hypotheses it is shown that, although sons and daughters are equally likely to ask their mother questions about AIDS, mothers are more likely to talk to their daughters than their sons about AIDS. This pattern maintains even after controls are introduced. It is suggested that discussing AIDS with young children as a health issue rather than waiting until adolescence and discussing it as a sex issue may be a more effective socialization route. Mothers may be able to do this with young daughters in the context of women's health, but because most AIDS education for adults generally is sex- rather than health-oriented they may lack the knowledge and framework to do this with their sons.

Proximate determinants of child mortality in Liberia

The study looks at the effects of maternal sociodemographic characteristics and the quality of the environment on child survival through two intervening variables, breast-feeding and prenatal care. A linear structural equation modelling approach was used to examine infant and child survival based on a weighted sample of 5180 Liberian children aged 0-5 years. The findings confirm previous studies, but also reveal complex relationships of the role of education, maternal age and breast-feeding in enhancing child survival.

The component structure of elderly population growth in the Netherlands: 1950–1980

"While there is no doubt about the magnitude of the growth of older age groups in industrialized nations, its structural components are less well understood. This paper examines the roles played by cohort succession and mortality in the process for the Netherlands during the period 1950 to 1980. While the size of the population aged 65 and over has increased for both males and females, increases in the size of succeeding cohorts explain all of the growth in the older male population. Reductions in mortality at the older old ages play a much greater role than do reductions at younger old ages; the latter reductions occur among females only." (SUMMARY IN FRE)

The impact of children on the components of parental savings: the case of rural Syria

"This study is based on a survey conducted by the two authors in 1980 on family income and costs in the rural areas of [Syria. It] examines the indirect impact of children on family savings...with the hypothesis that the number of children has a positive effect on parents' income and a negative effect on their costs.... The conclusions point out that children play a major role in affecting the types of parents' income and expenditure and that increasing the number of children leads to increasing the time during which the parents undertake productive economic activities...."