Relative Efficacy of a Pregnancy,Sexually Transmitted Infection,or Human Immunodeficiency Virus Prevention–Focused Intervention on Changing Sexual Risk Behavior Among Young Adults

Abstract

Objectives: Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior. Participants: Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008–2009. Methods: The authors compared the efficacy of 3 theory-based, sexual risk–reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up. Results: Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention. Conclusions: The focus of sexual risk–reduction interventions may lead to differential behavior change among young adults.     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

Replication of an Intensive Educational Intervention for Youth Pregnancy and STI Prevention: The GIG

The article reports the results of two years of program replication to determine the effectiveness of an innovative intervention which is one component of a program aimed at the prevention of pregnancy and sexually transmitted infection (STI). The GIG is a 6 h intervention which presents prevention information in an entertainment venue employing non-conventional and youth culture oriented educational activities. Statistically significant improvement in knowledge and attitudes with regard to pregnancy and STI was found in both replication samples, demonstrating consistency in the effectiveness of the intervention. Item by item analyses of measure items offer information regarding specific knowledge and attitudes. Implications for further implementation of the intervention and broader applications are offered. STI has replaced STD in medical parlance.     

Results of a Social Norm Intervention to Prevent Binge Drinking Among First-year Residential College Students

Abstract

The effects of a primary prevention social norm intervention on binge drinking among 1st-year residential college students were examined. Six hundred thirty-four students attending a medium-sized public university in the South were randomly assigned to receive a two-phase social norm intervention or the standard campus psychoeducational prevention program. At posttest, no differences were found between intervention and control group students on any of the alcohol use and alcohol-use risk factor measures. Significant subgroup differences were found by stage of initiating binge drinking behaviors, for frequency of alcohol use, F(3, 507) = 3.69, p = .01; quantity of alcohol use, F(3, 507) = 2.51, p = .05; and social norms, F(3, 505) = 2.53, p = .05. These findings suggest the need for tailoring social norm binge drinking interventions to students' stage of initiating heavy drinking and carefully monitoring for potential negative, as well as positive, effects of norm-based prevention messages.     

Preventing HIV/AIDS Among Trinidad and Tobago Teens Using a Family-Based Program

Summary

This paper describes a family-based HIV/AIDS prevention project currently underway in Trinidad and Tobago—an English speaking twin-island nation in the Caribbean. The project involves a partnership between U.S.-based researchers and a social service agency on the Islands. It describes the development and adaptation of the intervention and reports preliminary outcomes from a pilot intervention (n= 32). Findings indicate high participant retention; statistically significant pre to posttest changes in HIV/AIDS knowledge and awareness; parent/youth discussions at home; condom self-efficacy; and parental monitoring. Findings are discussed within the context of collaborative HIV/AIDS prevention research.     

Teaching Note—Keeping It Real: Program Evaluation Projects for an Undergraduate Research Class

ABSTRACT

This article describes a teaching innovation that focused on the redesign of an undergraduate social work research class. Students enrolled in the redesigned class had an opportunity to conduct program evaluation projects in community agencies. The projects included (a) pretest and posttest evaluation of reminiscence approach in improving the well-being of older adults in a long-term care facility, (b) evaluation of family support services at a Head Start center, and (c) pretest and posttest evaluation of an awareness program to promote community inclusion of individuals with an intellectual disability. Steps in course development, implementation, and evaluation as well as the positive student learning outcomes are discussed. The article concludes with limitations and potential areas for further improvement.     

Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older adolescents attending community college

Objective: To determine the feasibility of a mobile health (mHealth), media literacy education program, Media Aware, for improving sexual health outcomes in older adolescent community college students. Participants: 184 community college students (ages 18–19) participated in the study from April–December 2015. Methods: Eight community college campuses were randomly assigned to either the intervention or a wait-list control group. Student participants from each campus completed web-based pretest and posttest questionnaires. Intervention group students received Media Aware in between questionnaires. Results: Several intervention effects of the Media Aware program were significant, including reducing older adolescents' self-reported risky sexual behaviors; positively affecting knowledge, attitudes, normative beliefs, and intentions related to sexual health; and increasing media skepticism. Some gender differences in the findings were revealed. Conclusions: The results from this study suggest that Media Aware is a promising means of delivering comprehensive sexual health education to older adolescents attending community college.     

Suicide Prevention in the Dot Com Era: Technological Aspects of a University Suicide Prevention Program

Abstract

Western Michigan University's Suicide Prevention Program utilizes multiple technological components, including an online training course, a Web site, and 2 social networking Web site profiles, as integral aspects of a comprehensive program. This article discusses the development, maintenance, use, and impact of the technological aspects of this program, which complement other program activities in meeting program goals. The Web site and use of social networking Web sites have been very well received by members of the university and wider community. Although initial outcomes of each component are positive, low participation in the online training course has limited the usefulness of pretest–posttest comparisons. It is thought that other campus suicide prevention programs may benefit from using technology as a primary method in their suicide prevention programming efforts.     

Creating New Patterns of Social and Economic Activity Through Planned Housing Environments

Abstract

HOPE VI programs have transformed distressed public housing areas into “planned neighborhoods.” This research highlights key results from an evaluation request by the Tampa Housing Authority to assess the social and economic impact of the local HOPE VI community. Findings suggest that the majority of residents enjoy the new neighborhood. Questions remain regarding the social cohesion among the mixed-income community residents and the potential for economic revitalization of the surrounding area. Implications for social workers are addressed.     

Impact of Social and Structural Influence Interventions on Condom Use and Sexually Transmitted Infections Among Establishment-Based Female Bar Workers in the Philippines

Abstract

This quasi-experimental study evaluated the influence of structural intervention components (e.g., changing organizational and social influence factors) in reducing biological sexually transmitted infections (STIs) and reports of unprotected sex among female bar workers (FBWs) in the Philippines (N = 369 at baseline). Recruited from four large southern Philippines cities, FBWs were exposed to a standard care, a manager influence, a peer influence, or a combined manager/peer influence condition. After the two-year intervention period, FBWs in the combined peer and manager intervention condition showed greater reductions in STIs and unprotected sex relative to those in the standard care condition. FBWs in the combined and the manager only conditions also showed a decrease in STIs compared to those in the standard care condition. Managers in the standard care condition reported lower positive condom attitudes and lower attendance at HIV/AIDS related training sessions compared to those in the combined condition. The combined effect of managers and peers had a positive, synergistic effect on condom use behavior and STI reduction compared to the standard care. This research provides empirical evidence that structural changes such as rules, regulations, and increased accessibility of condoms must be in combination with normative changes (individuals' attitudes, beliefs and normative expectancies) in order to achieve the greatest benefit in condom use behavior and STI reduction/prevention.     

University efforts to address confidentiality issues for STI services

Abstract

Objective: This study assessed university policies for addressing confidentiality issues for students seeking STI services. Participants: Universities with sponsored health insurance plans (SHIP) and/or wellness centers were selected from a university health services survey in 2017. Methods: STI service coverage and polices for addressing confidentiality issues related to explanation of benefit (EOB) forms were stratified by institution type (4-year versus 2-year) and minority serving institution (MSI) status. Rao-Scott chi-square tests were used to assess for differences in STI service coverage and polices. Results: More non-MSIs (61.6%) had SHIPs compared to MSIs (40.0%, p?<?.001). Only 40.8% of health centers had a policy for addressing EOB-related confidently issues. Of those, the most reported policy was that students could pay out-of-pocket to avoid generating an EOB (36.2%). Conclusions: Reducing confidentiality barriers are important for STI prevention in students. Universities may consider establishing policies for addressing EOB-related confidentiality concerns.     

Preventing violence in disadvantaged communities: Strategies for building collective efficacy and improving community health

ABSTRACT

Violence is a critical health issue that compromises the strength of communities and permanently damages the lives of individuals and families. The impact of violence on health and well-being is particularly devastating in disadvantaged and minority communities, leading to negative health outcomes, including premature death. However, research suggests that communities can prevent violence and negative health outcomes by developing collective efficacy, which happens when neighbors share norms and values, trust one another, and are willing to intervene to address problems. Despite the importance of collective efficacy in preventing violence and improving health, almost no research has investigated actionable strategies to build collective efficacy in disadvantaged neighborhoods. This article describes a theoretical and conceptual model that illustrates how collective efficacy impacts community violence and related health outcomes. We begin by reviewing other approaches to community violence prevention, including criminal justice and developmental approaches. We then discuss how collective efficacy works and why it matters, including theoretical and empirical research explaining collective efficacy and its impact on community violence and health. We then discuss a research-based intervention that social workers can use to facilitate collective efficacy, including our conceptual model and the key components of the intervention. Finally, we discuss implications for social workers who are working with communities to address violence and related health issues.     

Conducting a Hispanic Health Needs Assessment in rural Kansas: Building the foundation for community action

Healthy People 2020 states ethnic health disparities are a priority for the US. Although considerable national statistics document ethnic-related health disparities, information specific to rural areas is scarce and does not provide direction for implementing chronic disease prevention programming. Therefore, the purpose of our project was to use the Hispanic Health Needs Assessment (HHNA), a tool designed by the National Alliance for Hispanic Health (NAHH), in culturally diverse, rural Southwest Kansas. Our focus areas included: access to healthcare, heart disease, diabetes, overweight, nutrition, and physical activity.MethodsThe assessment followed six steps: (1) developing the assessment team, (2) data gathering using community member surveys, existing statistics and community leader interviews, (3) assembling the findings, (4) formulating recommendations for action at individual, institutional, community and policy levels, (5) sharing findings and program planning, and (6) sharing findings with NAHH. We identified several challenges collecting health related data in rural communities, but overall, the HHNA was a comprehensive and useful tool for guiding a community level health assessment.ConclusionThis process has provided our community partners with locally relevant statistics regarding the current status of health, health behaviors, and perceived community needs to inform resource allocation, program planning and applications for new funding initiatives.     

Gender attitudes,sexual violence,and HIV/AIDS risks among men and women in Cape Town,South Africa

This study examined gender attitudes and sexual violence‐supportive beliefs (rape myths) in a sample of South African men and women at risk for HIV transmission. Over 40% of women and 16% of men had been sexually assaulted, and more than one in five men openly admitted to having perpetrated sexual assault. Traditional attitudes toward women's social and gender roles, as well as rape myths, were endorsed by a significant minority of both men and women. Multivariate analyses showed that for men, sexual assault history and rape myth acceptance, along with alcohol and other drug use history, were significantly related to cumulative risks for HIV infection. In contrast, although we found that women were at substantial risk for sexually transmitted infection (STI), including HIV, women's risks were only related to lower levels of education and alcohol use history. We speculate that women's risks for STI/HIV are the product of partner characteristics and male‐dominated relationships, suggesting the critical importance of intervening with men to reduce women's risks for sexual assault and STI/HIV.     

The Influence of Trauma History and Relationship Power on Latinas’ Sexual Risk for HIV/STIs

ABSTRACT

A community sample of Latinas completed surveys that included measures of sexual abuse and intimate partner violence history, relationship power, negotiating power regarding condom use, perceived HIV/sexually transmitted infection (STI) risk for sexual partner, and sexual behavior. More than half of the women reported a history of intimate partner violence in the past year and/or sexual abuse in their lifetime. Intimate partner violence was correlated with lower overall sexual relationship power scores, while sexual abuse was correlated with lower condom-use negotiating power. More extensive intimate partner violence had the strongest association with higher HIV/STI risk, while controlling for relationship status, sexual abuse, and relationship power.     

Qualitative evaluation of historical and relational factors influencing pregnancy and sexually transmitted infection risks in foster youth

PurposeTo explore how attitudes, norms, behaviors, responses to early life experiences, and protective factors influence pregnancy and sexually transmitted infection risks from the perspectives of current and former foster youth to inform the development of prevention strategies.MethodsWe conducted semi-structured individual qualitative interviews with a diverse sample of 22 current/former foster youth aged 15–21 years (63% female; average age = 18.6 years). We then used Theoretical Thematic Analysis to systematically analyze the data for key themes related to sexual health in four categories: 1) norms and attitudes, 2) responses to early life experiences, 3) protective factors, and 4) youth-driven intervention ideas.ResultsParticipants reported a range of sexual experience levels, varied sexual orientations, and also reported varied life experiences prior to and during foster care. We detected several norms and attitudes that likely contribute to risks of early pregnancies and sexually transmitted infections. These included that one can tell by looking whether a partner is trustworthy or has a sexually transmitted infection, that condoms aren't necessary with long-term or infrequent partners or if birth control is used, and that teen pregnancy is an inevitable event. With respect to responses to early life experiences, youth frequently described difficulties dealing with strong emotions in the context of romantic and/or sexual relationships; many attributed these difficulties to early experiences with biological family members or in foster care. Participants linked emotion regulation difficulties with struggles in trust appraisal, effective communication, and impulsive behaviors. Youth also described a variety of protective factors that they felt helped them prevent sexual risk behaviors or improved their lives in other respects. Finally, participants endorsed factors likely to improve intervention acceptability and efficacy, including an open, non-judgmental group-based environment, involvement of peer mentors, and inclusion of caregiver and caseworker training components.ConclusionsTrauma-informed, tailored intervention strategies which address key norms and attitudes and provide broad-based assertiveness and emotion regulation skills are likely to be the most effective strategies to reduce risks of teen pregnancies and sexually transmitted infections among teens in foster care. Group-based interventions that involve peer mentors and caregiver and caseworker components may be especially acceptable and effective for teens in foster and/or kinship care.     

An Exploration of Family Environment,Adolescent Perceptions,and Home-Based Intervention

ABSTRACT

Home-based family intervention has become a successful approach to treatment in the field of social work and family therapy. Studies in this area have usually focused on the outcome of nonplacement as the measure of success; few studies have reported specifically on changes in family environment and adolescent perceptions following home-based intervention. Using the family life cycle as a theoretical framework, this study assessed changes in family environment and adolescent perceptions from pretest to post-test in families receiving home-based family intervention. Findings indicate that the family environment improved in cohesion, conflict, and independence; and adolescents improved in self-concept and peer security from pretest to posttest. Suggestions for aftercare are presented.     

Predicting disclosure of MSM status to providers in a primarily socially conservative state

ABSTRACT

Purpose: This study aimed to determine what predicts a man who identifies as MSM living in a conservative state to inform his provider of his sexual behaviors and/or his sexual orientation. Methods: We administered an anonymous online survey to 148 men who reported seeing a general medical provider in the last 12 months. All participants resided in Oklahoma. Results: When controlling for HIV status, previous STI diagnosis, and age, logistic regression modeling yielded significant results (x²(9) = 31.22, p <.001) predicting 70.3% of cases. Age and overall disclosure of sexual orientation and/or sexual behaviors were significant predictors. Conclusion: Individuals who did not disclose their sexual orientation or same-sex behaviors to friends and family members were less likely to inform their providers of their sexual orientation. Disclosure of MSM status provides additional opportunities to enhance primary and secondary prevention strategies in rural and conservative areas that are necessary to optimize health, including but not limited to HIV screening and discussion of pre-exposure prophylaxis that their counterparts in urban settings more readily receive.     

Latino youth participation in community-based participatory research to reduce teen pregnancy disparities

BackgroundCommunity-based participatory research can provide a framework to build community capacity to do health equity research, particularly from community members who may not typically participate in research design and intervention.PurposeThe purpose of this paper is to describe a community-based coalition's partnership and engagement with Latino youth throughout the research process addressing health disparities in unintended teen pregnancy rates in a local community. Israel and colleagues' components of CBPR provide a framework to develop youth participation throughout the research process.MethodHigh school and college Latino youth participated in health equity research from community assessments to design an intervention and dissemination of results.ResultsWorking with youth can improve the integrity and validity of the research process and can also provide benefits to the community and individual youth members, resulting in increased community capacity for health equity research.DiscussionLessons learned about the direct and indirect benefits and challenges are presented. Community-based partnerships working with youth should consider documenting the individual and collective impact of community engagement on the youth from the onset of participation.     

Brief Report: Same-Sex Male Couples’ Characteristics and Attitudes Toward Different HIV Prevention Services,by Dyad HIV Serostatus,in Lima,Peru

Abstract

Few HIV/STI prevention studies have been conducted with same-sex male couples in Lima, Peru. This brief report describes quantitative findings of 42 same-sex male couples’ characteristics and attitudes towards using various HIV prevention services. Couples’ communal coping and preferences for sexual health outcomes varied by their serostatus. Many partners were willing to use pre-exposure prophylaxis, couples HIV testing and counseling, and other couples-based prevention services, if and when they would become available. Partners’ likelihood of using HIV prevention services differed by their dyadic serostatus. These findings lend support for providing couples-based HIV/STI prevention interventions for this population in Lima.