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A Randomized, Controlled Effectiveness Trial of an AIDS Prevention Program for Low-Income African-American Youths
Abstract
Some interventions to reduce the risk of the acquired immunodeficiency syndrome (AIDS) that target youths have resulted in short-term increases in self-reported condom use. However, long-term intervention effects have not been assessed.
Can a theoretically and culturally based, AIDS-risk reduction intervention delivered to naturally formed peer groups increase self-reported condom use among African-American early adolescents at 6 and 12 months of follow-up?
A randomized, controlled trial of a community-based intervention delivered in eight weekly sessions involved 76 naturally formed peer groups consisting of 383 (206 intervention and 177 control) African-American youths 9 to 15 years of age. A theory-based, culturally and developmentally tailored instrument that assessed perceptions, intentions, and self-reported sexual behaviors was administered to all subjects at baseline (preintervention) and 6 and 12 months later.
At baseline, 36% of youths were sexually experienced, and by 12 months of follow-up, 49% were sexually experienced. Self-reported condom use rates were significantly higher among intervention than control youths (85% vs 61%; P<.05) at the 6-month follow-up. However, by 12 months, rates were no longer significantly higher among intervention youths. The intervention impact at 6 months was especially strong among boys (85% vs 57%; P<.05) and among early teens (13 to 15 years old) (95% vs 60%; P<.01). Self-reported condom use intention was also increased among intervention youths at 6 months but not at 12 months. Some perceptions were positively affected at 6 months, but the change did not persist at 12 months.
High rates of sexual intercourse underscore the urgent need for effective AIDS-risk reduction interventions that target low-income urban, African-American preteens and early teens. A developmentally and culturally tailored intervention based on social-cognitive theory and delivered to naturally formed peer groups recruited from community settings can increase self-reported condom use. The strong short-term improvements in behaviors and intentions followed by some relapse over longer periods argue for a strengthened program and research focus on sustainability.
... To respond to the disparity in teen pregnancies and address the lack of Native-specific programming, the Johns Hopkins Center for American Indian health in partnership with a tribal community in the Southwestern United States developed the "Respecting the Circle of Life" (RCL) teen pregnancy prevention program Tingey et al., 2015). The RCL program was adapted from the evidence-based HIV risk reduction intervention, Focus on Youth (FOY) + ImPACT program (Stanton et al., 1996) rooted in the Protection Motivation Theory (PMT). The PMT posits that behavior is a product of balancing negative outcomes of a maladaptive behavior (e.g., unprotected sex) with the ability to complete a protective behavior (e.g., using a condom) (Rogers, 1983). ...
... In this trial, RCL frequency was high and duration was short but varied across cohorts (Tingey et al., 2017). In other iterations of FOY, frequency has been lower and duration longer (Chen et al., 2010;Stanton et al., 1995;Stanton et al., 1996). Thus, in this paper, we aim to explore if higher frequency and lower duration significantly impacted adherence as well as amount of intervention received. ...
... Each activity was then assigned one or more PMT construct(s) (e.g., activity 2, lesson 2 = vulnerability). These assignments were based on previous work conducted by the Focus on Youth + ImPACT program developer (Stanton et al., 1996). They were reviewed by the study leadership team to ensure agreement that the PMT construct was consistent with the activity. ...
In 2019, Native youth had the highest rate of teen pregnancy of all racial/ethnic groups. "Respecting the Circle of Life" (RCL) is one of the first evidence-based teen pregnancy prevention programs for Native teens and there is interest in replicating the program across tribal communities. To inform replication, it is important to consider process data including quality, fidelity, and dosage as these may all moderate impact of the program. Participants were Native youth aged 11-19 and a trusted adult. This study includes participants randomized to the RCL program only (N = 266). Data sources include independent observations, facilitator self-assessments, attendance logs, and self-report assessments completed by enrolled youth at baseline and 3 months post assessment. Data was compiled and summed by cohort. Dosage was number of minutes participating in activities separated by theoretical constructs. Linear regression models were utilized to assess moderation of the effects of the intervention dosage on outcomes of interest. Eighteen facilitators delivered RCL. One hundred eighteen independent observations and 320 facilitator self-assessments were collected and entered. Findings indicate RCL was implemented with high fidelity and quality (4.40 to 4.82 out of a 5-point Likert scale; 96.6% of planned activities completed). Dosage was high with an average completion of 7 out of 9 lessons. There was no association between theoretical construct dosage and outcomes of interest. Overall, this study indicates RCL was delivered with high fidelity, quality, and dosage in this trial. This paper informs future replication of RCL and provides support for hiring paraprofessionals from the local community as facilitators, delivering the RCL to peer groups of the same age and sex, delivering the RCL with short duration and high frequency, and encouraging youth to attend all RCL lessons, but continue to serve youth who have missed one or more lessons.
... To address aforementioned sexual health disparities, we evaluated a culturally adapted evidence-based intervention (EBI) for HIV-risk reduction called: "Respecting the Circle of Life: Mind, Body and Spirit" (RCL). The RCL intervention was adapted from Focus on Youth (FOY), which has been replicated and evaluated longitudinally in several countries and across diverse cultural contexts (Gong et al., 2009;Kaljee et al., 2005;Li, Stanton, Feigelman, & Galbraith, 2002;Lwin, Stanaland, & Chan, 2010;Stanton et al., 1996). FOY has been shown to increase youth's HIV knowledge, condom use self-efficacy, and condom use intention, and to decrease unprotected sex among sexually active youth (Chen et al., 2010;Deveaux et al., 2007;Stanton et al., 1996Stanton et al., , 1997. ...
... The RCL intervention was adapted from Focus on Youth (FOY), which has been replicated and evaluated longitudinally in several countries and across diverse cultural contexts (Gong et al., 2009;Kaljee et al., 2005;Li, Stanton, Feigelman, & Galbraith, 2002;Lwin, Stanaland, & Chan, 2010;Stanton et al., 1996). FOY has been shown to increase youth's HIV knowledge, condom use self-efficacy, and condom use intention, and to decrease unprotected sex among sexually active youth (Chen et al., 2010;Deveaux et al., 2007;Stanton et al., 1996Stanton et al., , 1997. RCL was adapted through a partnership between a reservation-based tribal community and an academic institution (Tingey et al., 2015a). ...
This analysis explored predictors of responsiveness to the Respecting the Circle of Life (RCL) intervention, a sexual and reproductive health program for American Indian (AI) youth. Data were collected over 12-month follow-up with 267 AI youth aged 13–19. We used mixed effects regression models to examine: (1) whether trajectory patterns of HIV/AIDS knowledge, condom beliefs, condom use self-efficacy, condom use intention and partner negotiation skills differed by baseline levels categorized into low, medium, and high scorers, and (2) the characteristics of youth who made no improvement over the post-intervention period. Results indicate the RCL intervention had greater longitudinal impact among subgroups with low and medium initial scores. High initial scores in knowledge, beliefs, efficacy, intention and skills predicted unresponsiveness to the RCL intervention. Youth differences in age, gender and school truancy (skipping/suspension) did not predict responsiveness to RCL. Results have important prevention science implications: (1) AI youth at greater risk (i.e., those with low initial levels of knowledge, beliefs, self-efficacy, intention and skills) are likely to respond to RCL and should be the target of replication and dissemination efforts. (2) Responsiveness analyses can guide adaptation of RCL and other sexual and reproductive health programs for AI youth to improve efficacy among unresponsive subgroups (i.e., high initial scorers). (3) RCL is equally likely to impact AI youth across different ages, genders and school status, thus validating population-wide implementation strategies.
... There were 16 cohorts in Columbia, Macon and Syracuse, and 20 in Providence. Once recruited, participants were randomized into one of two conditions (a) a general health intervention ("Promoting Health Among Teens"; Jemmott et al. 1998), or (b) a sexual risk reduction intervention ("Focus on Youth"; Stanton et al. 1996) using a complete randomization scheme and computational random number tables. Identification numbers of possible participants were randomized into experimental or control conditions prior to workshop participation. ...
... "Focus on Youth" (FOY; Galbraith et al. 1996;Li et al. 2002;Stanton et al. 1996Stanton et al. , 1997) is a sexual risk reduction intervention developed and targeted specifically toward African American youth. Using Protection Motivation Theory (Rogers 1975), FOY focuses primarily on effective decision-making, communication, and negotiating skills and information regarding peer condom use in addition to an emphasis values clarification and goal setting. ...
Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and η² was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected (F = 5.19, p = .02, η² = .03), along with three interactions: between experimental condition and media intervention (F = 7.96, p = .005, η²= .04); experimental condition, sex, and media intervention (F = 6.51, p = .01, η² = .04); and experimental condition, sex, assessment point, and media intervention (F = 3.23, p = .01, η² = .02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants’ life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males.
... Research has found that European American teens are generally more influenced by their peers to engage in sexual activity (B illy & Udry, 1985a) and substance use (Pilgrim et al.. 1999: Urberg et al., 1997 than are African American adolescents, who appear to be more tolerant o f behavioral differences in friendships (Giordano et al., 1993). Yet, peer based interventions addressing sexual activity (Fang et al., 1998;Stanton et al., 1996) ...
... I f teens believe that a risk behavior's prevalence is low, non-using friend's attitudes and behaviors may be seen as more legitimate and therefore be more persuasive. A similar technique has 83 already proven successful with interventions to increase condom use and reduce violence among teens(Stanton et al., 1996;Stanton et al., 1997). ...
It is difficult to determine whether influence or selection drive the association between an adolescent's behavior and his or her friend's behavior. To understand what role influence plays on adolescent risk activities, this research analyzed the longitudinal network sample of the AddHealth data set to examine whether any random friend, a best friend, or a peer group shapes an adolescent's risk behavior. ^ The project conducted cross-behavior analyses of five activities—cigarette smoking, alcohol consumption, tobacco chewing, marijuana use, and sexual debut—among a sample of 1,969 adolescents aged 12–17 years at time one. The data contained real behavior measures for the adolescents and their nominated friends. The analyses used logistic regressions to predict the respondents' time two behaviors and to determine whether demographic variables, self-esteem, or parental factors modified peer influence. ^ The results from this project contain four important findings. First, there is a main effect for peer influence and it is equivalent across risk behaviors. On average adolescents were twice as likely to engage in a risk behavior if their friend participated in the activity at time one. Second, peer influence may be both harmful and protective. For cigarette and marijuana use, there was only influence to initiate a risk behavior. In comparison, for alcohol consumption there was equal influence to conform to friends who drank and friends who did not drink. In contrast, for chewing tobacco use there was significantly more influence to stop chewing than to begin. This suggests that friends offer teens protection from risk activities. Third, the group analysis found that a linear measure of peer influence, which accounts for each group member's behavior, provides significantly more detail about the peer influence process when compared to a dichotomous measure of group influence, which does not detail how many peers engage in a risk activity. Finally, results found that best friends are not more influential than other close peers, suggesting that adolescents have multiple friends who exert equal levels of influence. In summary, this project found that peer influence is a real phenomenon that takes on varying roles across adolescent risk behaviors.
... In the past several decades, extensive research has been devoted to developing and testing evidence-based prevention programs aimed at reducing HIV transmission among youth (Coyle et al., 2001;Coyle et al., 2006;Jemmott, Jemmott, & Fong, 1992;Jemmott, Jemmott, & Fong, 1998;Kirby, Barth, Leland & Fetro, 1991;Main et al., 1994;Stanton et al., 1996;St. Lawrence et al., 1995). ...
... As a result, many research-based programs that have been shown to be effective in decreasing adolescent sexual risk-taking behavior are now being disseminated (Coyle et al., 2001;Kirby et al., 1991;Jemmott et al., 1992;Jemmott et al., 1998;Main et al., 1994;St. Lawrence et al., 1995;Stanton et al., 1996). ...
The effectiveness of evidence-based programs can be compromised if the program is not implemented with fidelity. This article describes the evaluation of an online training to improve implementation fidelity to an evidence-based HIV prevention curriculum, Reducing the Risk, through online skills-based instruction and support. Educators were randomly assigned to either the online training or a self-preparation control group. The primary outcome was the proportion of lesson activities implemented completely. Measurement of the main outcome was obtained through self-report logs, which educators were asked to complete following each of the 16 lessons taught. Data were analyzed from 162 educators. The online training group reported significantly higher overall implementation fidelity compared to the standard control group with modest effect sizes (p =.04–.051 and Cohen's d = 0.31 – 0.33). Additionally, when fidelity scores were compared for just the core activities, implementation fidelity was significantly higher for the training group compared to the control group (p =.023; d = 0.36). The online training group also reported significant improvements in knowledge of the curriculum and perceptions of knowledge and skills in role-play improvement (p <.001–.013; d = 0.40–0.62). However, many of the other secondary outcomes analyzed were not significant. Online training with video demonstrations may be an effective way to enhance implementation fidelity in educators.
... While several interventions to reduce sexual risk behavior created for Black youth have been developed and found to be effective (Crosby et al., 2009(Crosby et al., , 2014Robillard et al., 2020;Stanton et al., 1996;Wu et al., 2003), the same is not true of interventions to reduce homophobia. In fact, we were unable to find a single randomized controlled trial of an intervention that reduced homophobia and obtained significant effects among young Black audiences/communities, other than the Chittamaru (2017) and Chittamaru and Jemmott (2018) study of the Reality Check intervention (which reduced both condomless sex and homophobia). ...
This article describes the development of a video serial drama intervention that was designed to address factors that influence HIV in the United States among Black youth. These include HIV testing, sexual behaviors not protected by condoms, negative attitudes towards sexual minorities, and HIV stigma. Behavior-change principles (social learning theory and education-entertainment) and input from members of the priority audience formed the basis of this 27-episode (3 minutes each) drama for dissemination on multiple platforms, including in public spaces or privately online. The developmental process, specifically involving members of the population of interest and use of behavioral theory, enriched the narrative elements and likely ensured intervention acceptability, enhancing effectiveness. Public health practitioners and prevention programmers may want to consider using this intervention and/or the narrative communication approach when intervening to change behavior.
... First, FOY + ImPACT is one of few interventions to report significant reductions in substance use and sexual risktaking among adolescents. Intervention participants were less likely than control participants to report sexual intercourse and unprotected sex at 6-month follow-up, cigarette smoking at 6-and 24-month follow-up, alcohol use at 6-and 12-month follow-up, marijuana use at the 12-month follow-up, and pregnancy/impregnation at 24-month follow-up [28][29][30]. Second, it was developed and tested with poor, high-need African American youth living in public housing developments in Baltimore which best aligns with our priority population. ...
Background
Children exposed to household challenges (i.e., parental substance use, incarceration, and mental illness) are among the groups most vulnerable to sexual risk-taking in adolescence. These behaviors have been associated with a range of negative outcomes later in life, including substance abuse, low educational attainment, and incarceration. Adapting an evidence-based intervention (EBI) to be suitable for this population is one strategy to address the needs of this group.
Methods
In this study, we describe the use of the Intervention Mapping for Adaption (IM-Adapt) framework to adapt an evidence-based, sexual health intervention (Focus on Youth with Informed Children and Parents). We describe the actions taken at each step of the IM-Adapt process which are to assess needs, search for EBIs, assess fit and plan adaptions, make adaptions, plan for implementation and plan for evaluation.
Results
Key changes of the adapted intervention include the incorporation of trauma-informed principles and gender inclusive language, standardization of the session length, and modernization of the content to be more appropriate for our priority population.
Conclusions
The adapted intervention shows promise toward meeting the behavioral health needs of Black youth exposed to household challenges. Our process and approach can serve as a model for researchers and practitioners aiming to extend the reach of EBIs.
... All other studies using the same data were excluded. 47,48 For studies with more than 1 intervention group, we selected the sexual health intervention that was most comprehensive. When studies included more than 1 indicator for an outcome (eg, multiple indicators of condom use), we used a random number generator to select 1 indicator to reduce possible bias associated with outcome selection. ...
Importance
Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge.
Objective
To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes.
Data Sources
For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial.
Study Selection
Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English.
Data Extraction and Synthesis
Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models.
Main Outcomes and Measures
Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy.
Results
Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose.
Conclusions and Relevance
The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.
... For example, to curb the growing HIV epidemic in the Bahamas, a multiyear randomized controlled trial was conducted to test the PMT-based behavioral intervention among middle school students. The program was adapted from Focus on Youth, a U.S.-tested intervention (Stanton et al., 1996). Even though the intervention showed an immediate and long-term effect on a number of outcome variables, including enhancement of HIV knowledge and intention to use condoms (X. ...
Advancing social work research on human behaviors for HIV prevention and control calls for new paradigms and analytical methods to characterize the nonlinear behavioral dynamics within complex systems. However, most HIV-related behaviors cannot be adequately investigated with commonly used methods because the dynamics of HIV-related behaviors are quantum, consisting of both continuous and discrete processes. Achievements in nonlinear and discrete modeling methods—particularly cusp catastrophe modeling—enable researchers to characterize the quantum nature of these behaviors. We describe the research and developments in analyzing social behavior with conventional and new paradigms and methods, and we review cognitive and behavioral theories that provide guidance to cusp catastrophe modeling, including the dual-system theory and the construal-level theory. The latter describes concrete and context-dependent cognitive processes at low construal levels for rapid and discrete changes vs. abstract and viewpoint-dependent cognitive processes at high construal levels for gradual and continuous changes. Achievements in HIV behavior research—including the paradigm of quantum behavior change, cusp catastrophe modeling methodology, and cognitive theories—can be used to study social behaviors to advance social work research and practice. © 2019 by the Society for Social Work and Research. All rights reserved.
... That extrinsic rewards, the perception that peers are participating in risky behaviors, predicted condom use intention across sex and sexual experience provides additional evidence that delivering programs to peer groups may be advantageous (15,48). Additionally, programs that work to change peer norms, discuss values, and include strategies to cope with peer pressure, such as Respecting the Circle of Life, may wield greater influence than those not targeting these extrinsic rewards (15,49). ...
Introduction: American Indian (AI) youth experience poor sexual health outcomes. Research indicates the Protection Motivation Theory (PMT) is a robust model for understanding how sexual risk and protective behaviors are associated with condom use intention (CUI). Studies indicate the constructs of the PMT which influence CUI vary by sex and sexual experience. This analysis explores associations between PMT constructs and CUI by sex and sexual experience among AI youth who participated in the Respecting the Circle of Life (RCL) trial, a sexual and reproductive health intervention.
Methods: We analyzed baseline data from the sample of 267 AIs, ages 13–19, who participated in the evaluation. We examined CUI and PMT construct scores by sex and sexual experience utilizing generalized estimated equations and multiple regression models to test which PMT constructs were associated with CUI across sex and sexual experience.
Results: Twenty-two percentage of participants were sexually experienced; 56.8% reported CUI at baseline. We found several differences in scores in PMT constructs by sex and sexual experience including self-efficacy, response efficacy, vulnerability, severity, and extrinsic rewards. We also found constructs varied that were associated with CUI varied across sex and sexual experience. No PMT constructs were associated with CUI among sexually experienced youth.
Conclusion: Results provide support for developing, selecting and delivering sexual health programs by sex and sexual experience in American Indian communities. Girls programs should focus on internal satisfaction and self-worth while boys should focus on negative impacts of not using condoms. Programs for youth who are not sexually active should focus on negative impacts of not using condoms. Programs for sexually inactive youth should work to change peer norms around condom use and improve knowledge about the efficacy of condom use.
... Several STI prevention interventions for African American youths have sought to engage peer groups to enhance protective behaviors, such as condom use (DiClemente et al., 2008;Harper, Dolcini, Benhorin, Watson, & Boyer, 2012;Jones, Salazar, & Crosby, 2017). Although peer-led initiatives, such as peer education and peer group interventions, have shown to be effective in influencing safer sexual behaviors (Fang, Stanton, Li, Feigelman, & Baldwin, 1998;Stanton et al., 1996), youths who are victimized are less likely to be a part of positive social networks or have supportive friendships (Card & Hodges, 2008). Consequently, for these youths, the role of peers may increase risk behaviors rather than promote protective ones. ...
African American youths, especially those in low resource communities are vulnerable to peer victimization, which can increase risk of sexually transmitted infections. However, few studies explored the relationship between these two health concerns and the pathways that may link them. The present study aimed to address this gap. We used descriptive statistics, correlation coefficients, and structural equation modeling to analyze data collected from 277 adolescents ages 13-24 in Chicago. Primary results indicated that peer victimization was not directly related to the acquisition of sexually transmitted infections. However, peer victimization was negatively associated with condom use, and condom use was negatively associated with sexually transmitted infections. Further, affiliation with sexually active peers was positively associated with substance use. These findings have implications for bullying and sexual risk prevention and intervention low-income youths. Attention to treatment approaches and interventions that are holistic and culturally feasible is recommended for practitioners working with urban youth.
... We selected the EBI for its theoretical underpinnings promoting protective factors, capacity for delivery by trained community members, non-school-based intervention setting, and history of productive cross-cultural replication (Tingey et al., 2015a). The intervention we selected for adaptation is rooted in Protection Motivation Theory (PMT), which has been has used successfully to develop efficacious sexual risk reduction interventions for adolescents in a variety of sociocultural contexts (Chen et al., 2010;Kaljee et al., 2005;Stanton et al., 1996). ...
Early sexual initiation is a catalyst for sexually transmitted infection and unintended pregnancy. American Indian/Alaska Native (AI/AN) youth initiate sex prior to age 13 more often than other U.S. youth, contributing to current inequalities in sexual health. Identifying what factors were associated with lifetime sexual experience among AI/AN youth can inform the development of primary prevention programming to delay sexual initiation, alleviate the costs of early sexual activity, and improve sexual health outcomes in this population. We analyzed cross-sectional data from 267 AI youth ages 13-19, recruited from a rural, reservation-based community. We used multivariate logistic regression models to estimate associations between independent variables and lifetime sexual experience (vaginal and/or anal sex) across the following categories: sociodemographic, knowledge, attitudes/perceptions, beliefs, intentions, skills, behaviors, and theoretical constructs. The sample was 56.2% female, mean age 15.1 years (SD = 1.7), and 22.5% were sexually experienced. In our final model, condom use self-efficacy (attitude/perception factor) and intentions to remain abstinent until marriage (intention factor) were associated with lower odds of lifetime sexual experience. Age (sociodemographic factor), intention to have sex (intention factor), use of any contraception (behavior factor), and higher response efficacy (theoretical construct) were associated with lifetime sexual experience. Of these, intention to have sex was the strongest indicator. These results both corroborate and contrast with other research conducted among rural, reservation-based AI/AN youth. Our findings show programs targeting intentions may have the greatest impact among reservation-based AI youth, and justify program delivery stratified by age group in this setting.
... After obtaining written youth assent and parental/legal guardian informed consent, eligible participants were assigned to play PlayForward or attention/control games in a 1:1 ratio using a computerized single randomization scheme. Randomization was stratified by gender and age group (11-12 years and 13-14 years), both predictors of the outcomes of interest [28,29]. Notably, gender differences have been identified as being important not only in terms of the trajectory of sexual behaviors in boys and girls during adolescence but also in terms of their response to interventions targeting sexual risk [29]. ...
Background
Human immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed.
Objective
We hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents.
Methods
Participants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age.
Results
A total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56).
Conclusions
An interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months.
Trial Registration
Clinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).
... For example, researchers successfully adapted two evidence-based interventions for African American women [48,49] and youth [52] (SISTA and Focus on Youth, respectively) by using individual churches as implementation sites. These adaptations are noteworthy because the original efficacy studies for these interventions did not include religion or spirituality as components [59,60]. However, d-up: Defend Yourself! ...
HIV affects African American gay and bisexual men (AAGBM) more disproportionately than any other group in the USA. The Black Church, which has been a historic mainstay for African American empowerment and well-being, has the potential to be a public health partner for HIV prevention with AAGBM. Public health partnerships with the Black Church can strengthen HIV prevention efforts with AAGBM by [1] adapting church-based prevention strategies developed for other African American subgroups [2], providing prevention and referral services [3], considering how scripture supports prevention efforts, and [4] emphasizing the tenets of liberation theology. Public health should consider how thoughtful engagement, research, and interventions can support these approaches. Developing partnerships with the Black Church and African American clergy can promote effective HIV prevention efforts for AAGBM.
... "Respecting the Circle of Life: Mind, Body and Spirit" was adapted in 2010 by the tribal-academic partners from an evidence-based intervention (EBI) for the prevention of HIV/AIDS called "Focus on Youth (FOY) + Informed Parents and Children Together (ImPACT)." FOY consists of eight lessons delivered weekly by pairs of adult interventionists from the community to selfselected same-sex peer-groups in community centers [12]. ImPACT is a separate, one-time lesson delivered to the teen and parent together by an adult interventionist after the initial eight lessons; it is comprised of a DVD and workbook. ...
Background
American Indian adolescents have one of the highest rates of teen pregnancy and repeat teen births in the US. Substance use is a significant risk factor for unprotected sex, and American Indian adolescents have the highest substance use-related morbidity and mortality of any US racial group. Despite these disparities, there are no existing, evidence-based programs for pregnancy prevention that have been rigorously evaluated among American Indian teens. Methods
The proposed study is a randomized controlled trial to test the efficacy of a comprehensive sexual and reproductive health program developed in partnership with an American Indian community. Participants will be American Indians ages 11–19 and their parent or trusted adult, randomized to receive the control condition or intervention called Respecting the Circle of Life: Mind, Body and Spirit. The intervention includes eight lessons delivered to self-selected peer groups during a summer basketball camp and one lesson delivered to the youth and parent/trusted adult together within 3 months after camp. All lessons are administered by trained community health workers from the participating American Indian community. Youth and parent/trusted adult participants will complete assessments at baseline, 3, 9, 12, 24 and 36 months post-intervention completion. The primary outcome variables are sexual/reproductive health knowledge, sexual initiation, condom use self-efficacy and intent to use a condom at next sex as changed from baseline to post-intervention between intervention and control participants. Selected primary outcomes are applicable to all study participants. DiscussionCurrently there are no sexual and reproductive health programs designed specifically for American Indian youth that have been rigorously evaluated and found to have an evidence base. Respecting the Circle of Life is highly innovative by incorporating lesson delivery into a summer basketball camp and involving parents or other trusted adults in curriculum administration. If found successful, it will be the first evidence-based program for teen pregnancy prevention for American Indian youth and adolescents. Trial RegistrationClinicaltrials.gov, NCT02904629. Retrospectively registered on 23 September 2016.
... 6,7 Despite the risks that unprotected intercourse pose to all African American young adults, research has focused primarily on high-risk groups (e.g., drug users and men who have sex with men), college students, and young adult women. [8][9][10][11][12][13][14] Neither high-risk samples nor those comprising college students generalize to many African American young adults, and studies that include only women preclude adequate investigations of gender differences in risk and protective processes. ...
Objectives
Despite increasing risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), few data are available concerning the factors associated with risky sexual behavior among African American young adults who do not attend college. Additionally, the possibility that different risk mechanisms affect men and women remains understudied. This article reports on the risk and protective factors associated with unprotected intercourse and gender differences in these factors' influence among this group. Predictors were derived from ecological and self-regulatory theories of risk behavior.
Methods
African Americans aged 18–21 years were recruited via respondent-driven sampling (RDS) from seven contiguous rural counties. Risk and protective factors for unprotected intercourse were analyzed for 214 of 292 participants who reported sexual intercourse during the past three months.
Results
Among sexually active participants, 62.6% used condoms inconsistently. The influence of leaving the parental home, perceived discrimination, risk-taking peers, family relationships, risk-taking propensity, and binge drinking on unprotected intercourse were moderated by gender. Positive attitudes toward condom use were associated with less unprotected intercourse controlling for the influence of risk variables for both men and women.
Conclusions
Men and women have unique STI prevention needs. Additional research addressing these needs is necessary, particularly for rural African American men.
... There is very good precedent with other chronic and communicable diseases to believe that interventions to change risk behaviours will be effective with HIV-seropositive persons. Where it is not feasible to have patients receive intensive behavioural interventions in the provider's clinic, there is strong evidence from RCTs for the effectiveness of HIV prevention interventions delivered by health departments and community-based organizations to HIV-seronegative persons [116][117][118][119][120][121][122][123]. Efficacy studies of agency-delivered interventions far HIV-seropositive persons presently are limited to a few RCTs [124][125][126] and to other studies, most of which did not assess behavioural outcomes [81,[127][128][129][130][131][132]. ...
Healthcare providers caring for HIV-seropositive men and women have a unique opportunity to help their patients engage in healthy behaviours that improve quality of life and reduce risks of transmitting HIV to others. This chapter describes brief behavioural intervention strategies and referral mechanisms they can use. The clinical care setting is ideal for addressing behavioural issues because healthcare providers can sensitively integrate behavioural prevention with routine medical care and assess and address behaviour change across time. The chapter begins with discussion of psychological, social, cultural, and structural issues that may lead to risky sexual and drug-use practices by HIV-seropositive patients. Characteristics of healthcare providers that may facilitate or detract from prevention efforts are also discussed. The chapter continues with suggestions for eliciting risk information and integrating it into prevention messages regarding the importance of protecting patients' own and their partner's health if they are sexually active or if they use drugs. Suggestions for reinforcing these messages within the clinical care setting, screening patients for behavioural risk, and providing appropriate intervention strategies tailored to those risks are presented. The referral of patients with behavioural and psychosocial issues to community-based agencies is also discussed.
... This DVD and workbook are based on a previously developed face-toface intervention (STYLE; R01MH63008) [39] targeting teens in mental health treatment and their caregivers. The STYLE family based intervention demonstrated initial efficacy in reducing sexual risk behavior among a sample of teens in mental health treatment and their caregivers and compares favorably to other successful intervention programs that are currently being disseminated in a faceto-face format [40].The Social-Personal Framework for HIV-Risk Behavior, which is consistent with Social Learning Theory, informed the development of the STYLE family-based intervention and emphasizes the relationship between cognitive, emotional and social factors [41,42]. The interactive DVD and workbook targeting African American adolescents aimed to address all essential constructs and skills of the in-person intervention, but deemphasized the role of mental health treatment. ...
The purpose of the current study was to test an interactive DVD and workbook specifically designed for African-American parents and adolescents (ages 13-18), based on an efficacious face-to-face intervention, to address key factors associated with risk. A total of 170 parent-adolescent dyads were enrolled and randomly assigned to receive either the "Work It Out Together" DVD or a General Health Promotion DVD (HP). Parents and adolescents completed measures of HIV knowledge, self-efficacy, and parenting behaviors. Immediately after receiving the Work It Out Together intervention, parents and adolescents demonstrated higher HIV knowledge and greater HIV prevention self-efficacy. Three months after receiving the Work It Out Together intervention, parents and adolescents reported higher levels of parental monitoring and sexually active adolescents reported higher levels of condom use self-efficacy and a lower rate of recent sex. These outcomes provide preliminary evidence that the "Work It Out Together" DVD impacted individual attitudes and protective parenting behaviors.
... Analysis did not adjust for clustering within school districts. (Li et al., 2002 andStanton et al, 1996) ...
... Both variables have been found to be important predictors of outcomes of interest. 14,15 After reviewing the adolescent's eligibility, the study personnel accessed the TrialDB system to enter the participant's data, initiate randomization, and retrieve the assignment. We will perform an intent-to-treat analysis. ...
Background:
To address the need for risk behavior reduction and human immunodeficiency virus prevention interventions that capture adolescents "where they live," we created a tablet-based videogame to teach skills and knowledge and influence psychosocial antecedents for decreasing risk and preventing human immunodeficiency virus infection in minority youth in schools, after-school programs, and summer camps.
Methods:
We developed PlayForward: Elm City Stories over a 2-year period, working with researchers, commercial game designers, and staff and teens from community programs. The videogame PlayForward provides an interactive world where players, using an avatar, "travel" through time, facing challenges such as peer pressure to drink alcohol or engage in risky sexual behaviors. Players experience how their choices affect their future and then are able to go back in time and change their choices, creating different outcomes. A randomized controlled trial was designed to evaluate the efficacy of PlayForward. Participants were randomly assigned to play PlayForward or a set of attention/time control games on a tablet at their community-based program. Assessment data were collected during face-to-face study visits and entered into a web-based platform and unique real-time "in-game" PlayForward data were collected as players engaged in the game. The innovative methods of this randomized controlled trial are described. We highlight the logistical issues of conducting a large-scale trial using mobile technology such as the iPad(®), and collecting, transferring, and storing large amounts of in-game data. We outline the methods used to analyze the in-game data alone and in conjunction with standardized assessment data to establish correlations between behaviors during gameplay and those reported in real life. We also describe the use of the in-game data as a measure of fidelity to the intervention.
Results:
In total, 333 boys and girls, aged 11-14 years, were randomized over a 14-month period: 166 were assigned to play PlayForward and 167 to play the control games. To date (as of 1 March 2016), 18 have withdrawn from the study; the following have completed the protocol-defined assessments: 6 weeks: 271 (83%), 3 months: 269 (84%), 6 months: 254 (79%), 12 months: 259 (82%), and 24 months: is ongoing with 152 having completed out of the 199 participants (76%) who were eligible to date (assessment windows were still open).
Conclusion:
Videogames can be developed to address complex behaviors and can be subject to empiric testing using community-based randomized controlled trials. Although mobile technologies pose challenges in their use as interventions and in the collection and storage of data they produce, they provide unique opportunities as new sources of potentially valid data and novel methods to measure the fidelity of digitally delivered behavioral interventions.
... Many patients have underlying issues that impede adoption of safer behaviors, and achieving behavioral change is often dependent on addressing such issues. Clinicians will usually not have time or resources to fully address these issues, many of which can best be addressed through referrals for services such as intensive HIV prevention interventions (e.g., multisession risk-reduction counseling) [109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126], medical services (e.g., family planning and contraceptive counseling, substance abuse treatment), mental health services (e.g., treatment for sexual compulsivity), and social services (e.g., housing, protection from domestic violence) (table 10). Patients who have difficulty initiating or sustaining behaviors that reduce or Direct fluorescent antibody test performed on rectal or pharyngeal swab specimen c NOTE. ...
The estimated number of annual new human immunodeficiency virus ( HIV) infections in the United States has remained at 40,000 for 110 years. Reducing the rate of transmission will require new strategies, including emphasis on prevention of transmission by HIV- infected persons. Medical care providers can affect HIV transmission by screening HIV- infected patients for risk behaviors, communicating prevention messages, discussing sexual and drug- use behaviors, reinforcing changes to safer behavior, referring patients for services such as substance abuse treatment, facilitating partner counseling and referral, and identifying and treating other sexually transmitted diseases. The Centers for Disease Control and Prevention ( CDC), the Health Resources and Services Administration ( HRSA), the National Institutes of Health ( NIH), and the HIV Medicine Association ( HIVMA) of the Infectious Diseases Society of America ( IDSA) have recently collaborated to develop evidence-based recommendations for incorporating HIV prevention into the medical care of persons living with HIV. This article summarizes key aspects of the recommendations.
... For example, treatment for reduction of HIV risk based on SCT, tailored for African-American pre-adolescents and young adolescents, affected condom use six months after the intervention. However, the rate of condom use decreased at 12-month follow up, and the differences became non-significant (see Stanton et al. 1996). ...
... While in many ways distinct, one behavior that highly co-occurs with sexual risk is alcohol use. A number of theory-based interventions to increase adolescent safer sexual behavior focus on improving intentions to use condoms both in non-drinking, as well as drinking situations [33][34][35]. Interestingly, even when young people report high intentions to engage in protected sex (e.g. ...
Human adolescents engage in very high rates of unprotected sex. This behavior has a high potential for unintended, serious, and sustained health consequences including HIV/AIDS. Despite these serious health consequences, we know little about the neural and cognitive factors that influence adolescents' decision-making around sex, and their potential overlap with behaviorally co-occurring risk behaviors, including alcohol use. Thus, in this review, we evaluate the developmental neuroscience of sexual risk and alcohol use for human adolescents with an eye to relevant prevention and intervention implications.
The present study examined the association between safety perceptions and communication with a trusted adult about sex and drugs among Black adolescents exposed to adverse childhood experiences (ACEs) and the role of gender as a potential moderator in this association. Data were drawn from a small, randomized control pilot test of an adapted evidence‐based intervention conducted from 2022 to 2023 in Baltimore, Maryland. The sample included 57 Black adolescents who had been exposed to ACEs ( M age = 15.14 years, SD = 0.81l; 47.4% female, 52.6% male). Information about safety perceptions, health communication, health behaviors, and demographic characteristics was measured using an electronic survey at baseline. Group differences by gender emerged among ACEs and substance use behaviors. Safety perceptions were significantly associated with communication with a trusted adult, B = 0.31, SE = 0.24, p = .039. As youth felt more unsafe, their communication with a trusted adult about sex and drugs increased; this association did not differ by gender. Health communication was also associated with ACEs. Black adolescents living with a parent with mental health challenges reported increased communication, B = 0.60, SE = 0.20, p = .005, whereas youth experiencing homelessness had reduced health communication, B = ‐0.63, SE = 0.24, p = .012. A lack of perceived safety significantly impacts health communication; however, having trusted adults outside of the home, school, and neighborhood can serve as a protective factor in reducing substance use and sexual risk‐taking among this population.
This Campbell systematic review examines the effectiveness of teenage pregnancy prevention programs in promoting abstinence, encouraging the use of contraception and reducing the likelihood of pregnancy among teens.
A thorough literature search was conducted up to April 2006. The review summarises findings from 31 studies which included 37,000 youth conducted in the US or in developed countries with higher than average rates of unplanned teen pregnancy, such as Canada, England, New Zealand, and Australia.
This review finds no consistent evidence that the types of pregnancy prevention programs evaluated rigorously to date will alter in intended ways the sexual activity or pregnancy risks of youth. However, this overall pooling of studies mixes results of different program types serving different populations of adolescents.
This review highlights the relative dearth of evidence to judge the overall effectiveness of particular intervention strategies. For this reason, further research and evaluation is necessary, including studying programs that have not yet been evaluated rigorously and programs that have been replicated and are serving new populations of adolescents in different communities.
The purpose of this study was to conduct a youth participatory action research project to address the disparities in sexually transmitted infection (STI) and HIV rates among homeless youth. Four youth served as co-investigators and cultural informants for the project. The team conducted focus groups (N = 22; ages 16–22) and in-depth interviews (N = 20; ages 18–24) with homeless youth to explore decisions about condomless sex, knowledge of STIs and HIV, health-care access for STI-related services, and perceptions about STI testing. Findings revealed that homeless youth have good general knowledge about STIs, are receptive to STI testing for themselves and their sexual partners, and have heightened concerns about being HIV positive and peers knowing their STI status. Results from the current study could contribute to the development of youth-informed tailored interventions to increase protective sexual behavior, reduce health disparities, and improve access to and the quality of health-care services for homeless youth.
Service learning has been identified as a promising approach to reduce sexual risk behavior, among other outcomes. This study used qualitative data analysis to offer suggestions for optimally integrating service learning into a program to reduce sexual risks among alternative school students. Data were collected from student participants in the All4You! Project using classroom materials, focus groups, and individual interviews. Project educators and project staff also provided data through summary forms and field notes. Qualitative data analysis revealed 5 strategies for creating positive service experiences for alternative school students: (1) find appropriate service-learning sites, (2) create staff support, (3) maintain appropriate student participation and behavior, (4) enhance student reflection on service-learning experiences, and (5) address students' self-images.
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The scope of this study was to know how principals and teachers of technical schools evaluate the AIDS prevention programs developed in their teaching institute environment. 72 principals and 103 teachers of technical schools from the state of São Paulo took part in this research. According to the principals' point of view, some aspects stand out: increase in prevention activities from 53 % to 85%, from 1996 to 1999; predominance of an oral exposition method (68,4%); absence of a theoretical reference; health professional participation (48 %) and philanthropic groups (38%). Themes were about the STDs / AIDS (62,3%), sex and reproduction (21%), drugs (11,3%) and psychosocial (5,4%). Less than half of the activities were included in the School's Plans. According to the teachers, the most used method was oral exposition (34,1%); the professionals involved were health professionals (46,8%) followed by the psychologists (24,6%) and philanthropic groups (23%). There were no changes (66,7%). It's concluded that the activities and/or prevention programs which are developed do not aim at evaluations of changes in the student's behavior.
Background:
The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, many educational interventions addressing contraception have no explicit theoretical base.
Objectives:
To review randomized controlled trials (RCTs) that tested a theoretical approach to inform contraceptive choice and encourage or improve contraceptive use.
Search methods:
To 1 November 2016, we searched for trials that tested a theory-based intervention for improving contraceptive use in PubMed, CENTRAL, POPLINE, Web of Science, ClinicalTrials.gov, and ICTRP. For the initial review, we wrote to investigators to find other trials.
Selection criteria:
Included trials tested a theory-based intervention for improving contraceptive use. Interventions addressed the use of one or more methods for contraception. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy and contraceptive choice or use.
Data collection and analysis:
We assessed titles and abstracts identified during the searches. One author extracted and entered the data into Review Manager; a second author verified accuracy. We examined studies for methodological quality.For unadjusted dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). Cluster randomized trials used various methods of accounting for the clustering, such as multilevel modeling. Most reports did not provide information to calculate the effective sample size. Therefore, we presented the results as reported by the investigators. We did not conduct meta-analysis due to varied interventions and outcome measures.
Main results:
We included 10 new trials for a total of 25. Five were conducted outside the USA. Fifteen randomly assigned individuals and 10 randomized clusters. This section focuses on nine trials with high or moderate quality evidence and an intervention effect. Five based on social cognitive theory addressed preventing adolescent pregnancy and were one to two years long. The comparison was usual care or education. Adolescent mothers with a home-based curriculum had fewer second births in two years (OR 0.41, 95% CI 0.17 to 1.00). Twelve months after a school-based curriculum, the intervention group was more likely to report using an effective contraceptive method (adjusted OR 1.76 ± standard error (SE) 0.29) and using condoms during last intercourse (adjusted OR 1.68 ± SE 0.25). In alternative schools, after five months the intervention group reported more condom use during last intercourse (reported adjusted OR 2.12, 95% CI 1.24 to 3.56). After a school-based risk-reduction program, at three months the intervention group was less likely to report no condom use at last intercourse (adjusted OR 0.67, 95% CI 0.47 to 0.96). The risk avoidance group (abstinence-focused) was less likely to do so at 15 months (OR 0.61, 95% CI 0.45 to 0.85). At 24 months after a case management and peer-leadership program, the intervention group reported more consistent use of hormonal contraceptives (adjusted relative risk (RR) 1.30, 95% CI 1.06 to 1.58), condoms (RR 1.57, 95% CI 1.28 to 1.94), and dual methods (RR 1.36, 95% CI 1.01 to 1.85).Four of the nine trials used motivational interviewing (MI). In three studies, the comparison group received handouts. The MI group more often reported effective contraception use at nine months (OR 2.04, 95% CI 1.47 to 2.83). In two studies, the MI group was less likely to report using ineffective contraception at three months (OR 0.31, 95% CI 0.12 to 0.77) and four months (OR 0.56, 95% CI 0.31 to 0.98), respectively. In the fourth trial, the MI group was more likely than a group with non-standard counseling to initiate long-acting reversible contraception (LARC) by one month (OR 3.99, 95% CI 1.36 to 11.68) and to report using LARC at three months (OR 3.38, 95% CI 1.06 to 10.71).
Authors' conclusions:
The overall quality of evidence was moderate. Trials based on social cognitive theory focused on adolescents and provided multiple sessions. Those using motivational interviewing had a wider age range but specific populations. Sites with low resources need effective interventions adapted for their settings and their typical clients. Reports could be clearer about how the theory was used to design and implement the intervention.
Introduction and DefinitionsThis entry reviews research and knowledge relating to the development and implementation of HIV/AIDS prevention programs for school-aged children (see definitions in Cornman, Sileo, and Johnson, (2013) in this encyclopedia). This entry reviews the scope of the problem and outlines the current recommendations for effective HIV/AIDS prevention programs for school-aged children between the ages of 6 and 12. ScopeUNAIDS, the Joint United Nations Program on HIV/AIDS, and the Global Fund’s goal of virtually eliminating mother-to-child transmission of HIV by 2015 is within reach. From 2001 to 2009 mother-to-child HIV infection rates declined by 26 % (United Nations AIDS, 2010). However, there is still much more to be done to prevent the HIV/AIDS pandemic from affecting the world’s children. United Nations AIDS estimates that over 370,000 children were infected with HIV in 2009 and 2.5 million children are currently living with HIV or ...
Objective:
Sexual activity often begins in early adolescence, and adolescents with mental health symptoms are at greater risk for sexual activity and other health risks. This study aimed to evaluate a developmentally targeted intervention designed to enhance early adolescents' emotion regulation competencies as a strategy for reducing health risk behaviors, including sexual initiation.
Method:
Adolescents 12 to 14 years old (N = 420; 53% male) with mental health symptoms participated in either an emotion regulation (ER) or health promotion (HP) intervention consisting of 12 after-school sessions. Participants completed questionnaires on laptop computers at baseline, 2-, 6-, and 12-month follow-ups.
Results:
Time to event analyses were used to compare intervention conditions on rate of initiation to vaginal sex. Results showed that participants in the ER condition were less likely to transition into vaginal sexual activity by 1-year follow-up than were those in the HP condition (adjusted hazard ratio = 0.58, 95% confidence interval [0.36, 0.94], p = .01). However, those who were sexually active did not report differences in sexual risk behaviors (e.g., condomless sex). Participants in the ER condition were significantly less likely to report violence behaviors and showed improvement on a behavioral measure of emotion identification; however, they did not differ from HP participants on self-reports of emotional competence.
Conclusions:
Emotion regulation strategies can be used to delay sexual initiation among early adolescents with mental health symptoms and may have an important role in health education. (PsycINFO Database Record
Adolescence has traditionally been conceptualized as a period of transition between childhood and adulthood. While adolescence is less studied and less understood than other developmental periods, activities that youth begin to experience during this transition have been described as risky behavior predisposing adolescents to injury and illness. Thus, the development of interventions to promote the adoption and maintenance of healthy behaviors requires a careful consideration of the developmental characteristics of adolescence.
The human immunodeficiency virus (HIV) epidemic is a biomedical phenomenon given the viral etiology of the acquired immunodeficiency syndrome (AIDS). However, the HIV epidemic is equally, if not more so, a psychosocial and cultural phenomenon. It is not only the virus per se, but an individual’s behavior, more specifically, the lack of appropriate health-promoting behavior that propels the epidemic (DiClemente & Peterson, 1994a). Moreover, much of the behavior associated with HIV exposure is of an interpersonal nature resulting from intimate sexual interaction; and, precisely because HIV infection links sexuality with disease, it is inextricably a psychosocial and cultural phenomenon.
This entry reviews research and knowledge relating to the development and implementation of HIV/AIDS prevention programs for school-aged children. The entry reviews the scope of the problem and outlines the current recommendations for effective HIV/AIDS prevention programs for school-aged children, those between the ages of 6 and 12.
This paper examines decision-making around sexual behavior among reservation-based American Indian youth. Focus group discussions were conducted with youth ages 13-19 years old. Through these discussions, we explored youth's knowledge, attitudes and behaviors related to sexual risk taking through the lens of the protection motivation theory to inform the adaptation of an evidence-based HIV prevention intervention. Findings suggest that condom use self-efficacy and HIV prevention knowledge is low, vulnerability to sexually transmitted infections is lacking and alcohol plays a significant role in sexual risk taking in this population. In addition, parental monitoring and peer influence may contribute to or protect against sexual risk taking. Results suggest that future HIV prevention interventions should be delivered to gender-specific peer groups, include a parental component, teach sexual health education and communication skills, integrate substance-use prevention, and work to remove stigma around obtaining and using condoms.
Objective
To determine the associations between the frequency of unprotected vaginal sex (UVS) and female adolescents' perceptions, particularly their perceptions of relationship dynamics.Design
Cross-sectional study of 522 African American female adolescents enrolled in a sexually transmitted disease (STD) and human immunodeficiency virus prevention intervention trial.Setting and Participants
A volunteer sample of adolescents recruited from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and STDs; 28% tested positive for STDs as assessed by DNA amplification or culture.Main Outcome Measure
Frequency of UVS assessed by interview using a 6-month recall period.Results
Among adolescents having steady relationships, those spending more time with their boyfriends and having longer relationships reported a significantly greater frequency of UVS. Other significant correlates included perception of more girlfriends using condoms, no history of STDs, stronger normative beliefs favoring male decision making in relationships, greater pregnancy worry, and greater perceived invulnerability to STDs. For adolescents reporting casual relationships, personal barriers to condom use, no history of STDs, and reporting that their boyfriends typically decide when to have sex were associated with more frequent UVS.Conclusions
Adolescents' perceptions, particularly their perceptions of relationship dynamics, played an integral role in explaining female adolescents' frequency of UVS with both steady and casual partners. Female adolescents in steady relationships differ from those in casual relationships relative to their prevention needs. These findings have implications for clinic- or community-based STD and human immunodeficiency virus prevention programs.
The burden of HIV and sexually transmitted infections (STIs) is disproportionate for the African-American community. The Project GRACE (Growing, Reaching, Advocating for Change and Empowerment) Consortium is an ongoing community–academic partnership based in eastern North Carolina that was established to address the disproportionately high rates of HIV among the African-American/black population in two eastern North Carolina counties. In this chapter, we explore the impact that the HIV and STI epidemics have had on African-American communities in the southeastern USA in general and within rural communities in North Carolina specifically. We highlight the unique ways in which community members were engaged in the formation of the Project GRACE Consortium; the development, implementation, and evaluation of the multigenerational HIV-prevention intervention known as Teach One Reach One (TORO) that was born out of this community–academic partnership; the lessons learned throughout the community engagement process; and recommendations for future research. We also describe research needs and priorities in terms of prevention and community engagement.
Fanon’s plea for mankind has gone largely unaddressed in the fields of both medicine and public health. The tool of allopathic medicine has possessed the public health care system and fostered the continuing negation of the well being of millions. Practitioners of modern medicine are skilled at dealing with individuals and their acute conditions such as infections, viruses, and the breakdown of specific organs, but are inadequate in the face of chronic illnesses and their associated problems. According to one estimate (Rothman and Rice, 1998) chronic ailments cost $470 billion a year in direct health costs; indirectly, they cost an additional $234 billion in lost productivity from those who are disabled or die prematurely. Yet Americans continue to spend the major portion of their health care dollars on acute care, despite the overwhelming evidence that the major causes of premature death and disease are persistent chronic illnesses.
Although in the United States the largest number of reported cases of acquired immunodeficiency syndrome (AIDS) have involved white men who engaged in same-gender sexual activities, a confluence of evidence suggests that inner-city African-American adolescents are at risk for infection with human immunodeficiency virus (HIV). It may be possible to reduce the risk of AIDS among inner-city African-American adolescents by identifying the key HIV risk-associated behaviors in this population, the intervention-sensitive conceptual variables that determine those behaviors, and the most effective behavior-change intervention strategies. In this chapter, we will summarize and review critically the literature on interventions to reduce the risk of HIV infection among adolescents in community settings.
Adolescents and STDs: The Risk is RealSTD/HIV Risk-Reduction Interventions for Adolescents: The Need is RealThe Current Study: The Sistas Informing, Healing, Living, and Empowering InterventionEffects of the HIV InterventionConclusions
To address global questions regarding the timing of HIV-prevention efforts targeting youth and the possible additional benefits of parental participation, researchers from the USA and The Bahamas conducted two sequential longitudinal, randomized trials of an evidence-based intervention spanning the adolescent years. The first trial involved 1360 grade-6 students and their parents with three years of follow-up and the second 2564 grade-10 students and their parents with two years of follow-up. Through grade-12, involvement in the combined child and parent-child HIV-risk reduction interventions resulted in increased consistent condom-use, abstinence/protected sex, condom-use skills and parent-child communication about sex. Receipt of the grade-6 HIV-prevention intervention conferred lasting benefits regarding condom-use skills and self-efficacy. Youth who had not received the grade-six intervention experienced significantly greater improvement over baseline as a result of the grade-10 intervention. The HIV-risk reduction intervention delivered in either or both grade-6 and grade-10 conferred sustained benefits; receipt of both interventions appears to confer additional benefits.
Adolescence often begins with the onset of puberty. It is a critical developmental period during which children achieve reproductive capability. For more than 1 billion adolescents worldwide, these years set the template for adult sexuality. During this time, adolescents need to learn those behaviors, which are healthy and those which are not. The World Health Organization defines sexual health as “the integration of the physical, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching, and that enhance personality, communication and love” (http://www.siecus.org/pubs/cnct/cnct0001.html). In early adolescence the following decisions about sexual behavior are made: (1) When to become sexually active; (2) How to express one’s sexuality; (3) Whether and how one should control one’s reproductive abilities; (4) Who are the people with whom one expresses one’s sexuality; and (5) How one uses sex in relationships (Wyatt, 1997).
Health psychologists have played a pivotal role in the prevention and care of HIV disease. Biopsychosocial and behavioral interventions in HIV/AIDS have generally focused on reducing the incidence of HIV (primary prevention) and, to a lesser extent, reducing the prevalence and severity of HIV (secondary prevention). In this chapter, we review the primary and secondary prevention efforts that have led to reductions in the rates of HIV transmission. We focus our review on research conducted in the United States but include illustrative findings from international trials. We conclude the chapter by identifying important research needs and outlining our expectations regarding future developments.
Background
Community engagement has been advanced as a promising way of improving health and reducing health inequalities; however, the approach is not yet supported by a strong evidence base.
Objectives
To undertake a multimethod systematic review which builds on the evidence that underpins the current UK guidance on community engagement; to identify theoretical models underpinning community engagement; to explore mechanisms and contexts through which communities are engaged; to identify community engagement approaches that are effective in reducing health inequalities, under what circumstances and for whom; and to determine the processes and costs associated with their implementation.
Data sources
Databases including the Cochrane Database of Systematic Reviews (CDSR), The Campbell Library, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) database, the NHS Economic Evaluation Database (NHS EED) and EPPI-Centre’s Trials Register of Promoting Health Interventions (TRoPHI) and Database of Promoting Health Effectiveness Reviews (DoPHER) were searched from 1990 to August 2011 for systematic reviews and primary studies. Trials evaluating community engagement interventions reporting health outcomes were included.
Review methods
Study eligibility criteria: published after 1990; outcome, economic, or process evaluation; intervention relevant to community engagement; written in English; measured and reported health or community outcomes, or presents cost, resource, or implementation data characterises study populations or reports differential impacts in terms of social determinants of health; conducted in an Organisation for Economic Co-operation and Development (OECD) country. Study appraisal: risk of bias for outcome evaluations; assessment of validity and relevance for process evaluations; comparison against an economic evaluation checklist for economic evaluations. Synthesis methods: four synthesis approaches were adopted for the different evidence types: theoretical, quantitative, process, and economic evidence.
Results
The theoretical synthesis identified key models of community engagement that are underpinned by different theories of changes. Results from 131 studies included in a meta-analysis indicate that there is solid evidence that community engagement interventions have a positive impact on health behaviours, health consequences, self-efficacy and perceived social support outcomes, across various conditions. There is insufficient evidence – particularly for long-term outcomes and indirect beneficiaries – to determine whether one particular model of community engagement is likely to be more effective than any other. There are also insufficient data to test the effects on health inequalities, although there is some evidence to suggest that interventions that improve social inequalities (as measured by social support) also improve health behaviours. There is weak evidence from the effectiveness and process evaluations that certain implementation factors may affect intervention success. From the economic analysis, there is weak but inconsistent evidence that community engagement interventions are cost-effective. By combining findings across the syntheses, we produced a new conceptual framework.
Limitations
Differences in the populations, intervention approaches and health outcomes made it difficult to pinpoint specific strategies for intervention effectiveness. The syntheses of process and economic evidence were limited by the small (generally not rigorous) evidence base.
Conclusions
Community engagement interventions are effective across a wide range of contexts and using a variety of mechanisms. Public health initiatives should incorporate community engagement into intervention design. Evaluations should place greater emphasis on long-term outcomes, outcomes for indirect beneficiaries, process evaluation, and reporting costs and resources data. The theories of change identified and the newly developed conceptual framework are useful tools for researchers and practitioners. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation.
Funding
The National Institute for Health Research Public Health Research programme.
It has been asserted that (I) tests of expectancy-value models require within-persons analyses and that (2) within-persons analyses yield better predictions of behavioral tendencies than do across-persons analyses. The first assertion is correct; the second is not. Justification for within-persons tests of expectancy-value models must be made on theoretical rather than empirical grounds.
This study examines the knowledge, beliefs, and sources of information of junior and senior high school students concerning AIDS. The students were found to have a very limited knowledge of AIDS. Males were more knowledgeable about AIDS than were females, but the majority of students were not personally worried about contracting AIDS. The primary sources of AIDS information were TV, newspapers, magazines, and radio. Schools were one of the least often mentioned sources of information.
The acquisition and subsequent use of condoms are two important behaviors that sexually active adolescents must adopt to reduce the transmission of human immunodeficiency virus (HIV). The aims of this study were: first, to evaluate whether combining prescriptions for free condoms with anticipatory guidance would increase the number of adolescents actually using the prescription-redemption plan; and second, to see if education about acquired immunodeficiency syndrome (AIDS) might make adolescents more willing to obtain an HIV blood test. Adolescents were randomly assigned to one of three groups, but only those who were sexually active were included in the data analyses. Each participant was given a prescription to be redeemed for free condoms at the hospital pharmacy, and each was privately offered a confidential, free HIV blood test. Education about AIDS did not increase the likelihood that adolescents would take the blood test, since only seven subjects did so. Our logistic regression model showed the most significant variables influencing a teenager to obtain condoms were gender, socioeconomic status, lifetime number of partners, and experimental condition. Anticipatory guidance concerning HIV promoted the use of the prescription-redemption plan especially among more sexually active males who come from middle-class families.
Prevention, through school-based education campaigns, has been suggested as a response to the AIDS crisis although the impact of such education is unproven. The seventh and tenth grade classes (n = 313) in one Rhode Island school district were surveyed regarding AIDS knowledge, attitudes, and coping skills before and after a two-session educational program. Following instruction, students reported more knowledge, greater tolerance of AIDS patients, and more hesitancy toward high-risk behaviors, but the changes were modest. Using residual change scores to control for baseline levels, two subgroups (seventh grade boys and tenth grade girls) changed the most in tolerance, and the correlations between variables were the strongest. In the general sample, change in knowledge was independent of change in tolerance, attitudes regarding high-risk behaviors, or coping strategies. These data lend support to the potential usefulness of school-based education programs, especially if behavior and coping skills are emphasized in the education. Evaluation of such programs should include assessment of change in subgroups to determine components of programs that can be tailored for more effective education.
In the spring of 1987, 20 medical students from the Eastern Virginia Medical School of the Medical College of Hampton Roads were involved in a pilot program to teach about the acquired immune deficiency syndrome (AIDS) to high school senior students in Norfolk, Virginia. The medical students received instruction about AIDS from basic science and clinical faculty members at the medical school in preparation for the project. All participating high school seniors completed a 15-item knowledge test about AIDS prior to the intervention and an equivalent posttest one week after the program was completed. T-test analysis revealed a significant increase in knowledge by students at all five high schools. Responses to 10 subjective posttest questions indicated that the high school students were interested in learning about AIDS and having medical students as their teachers. This program provides an example of how medical institutions can develop a collaborative community education project that contributes to the education of medical students.