Faculty Bibliography

Adolescent employment predicts lower educational engagement and achievement and greater engagement with risk behaviors. Most research has studied middle class rather than disadvantaged adolescents. We identified risk and protective behaviors associated with employment using data from a 3-wave, 12-month study of 715 low-socio-economic status female African American adolescents who were ages 15-21 at baseline. Adolescents who were employed at wave 2 (n=214) were matched with adolescents who were not employed at wave 2 (n=422) using nearest-neighbor matching on baseline factors within propensity score calipers on factors including marijuana use, sex while high, pregnancy risk, and socioeconomic status. We compared employed and non-employed teens on risk behaviors including marijuana use, sex while high or drunk, and a biomarker for semen exposure in the past 14 days. Employed teens were 44% as likely to say that their boyfriend is their primary spending money source and 43% as likely to be emotionally abused, but these benefits did not persist after employment ended. Six months after employment, employed respondents reported using marijuana 57% more often and had sex while drunk or high 2.7 times as frequently. Women who were employed at both waves 2 and 3 were 17% as likely to have their boyfriend as a primary source of spending money and 13% more likely to graduate high school, but they used marijuana twice as often, alcohol 1.6 times as often, had 1.6 times as many sexual partners, and had sex while high or drunk 2.3 times as often. Female teens who work may avoid potentially coercive romantic relationships, but they may buy drugs or alcohol with their earnings.

[This corrects the article DOI: 10.1186/2193-1801-3-249.].

The current study examined and compared the willingness of young Black men who have sex with men (YBMSM) to accept pre-exposure prophylaxis (PrEP), adult male circumcision, and condoms for reducing their risk of HIV acquisition. The majority (67%) reported unprotected receptive anal sex in the last six months. About three-quarters (71%) would accept using PrEP if it was 100% effective. Cost influenced PrEP acceptance with 19% indicating acceptance at $100 per month co-pay. Of those not circumcised, 50% indicated willingness if circumcision was 100% effective. Acceptance of circumcision decreased markedly to 17% with co-pays of $100. About 73% of men were willing to use condoms if they were 100% effective and 50% indicated a willingness at the cost of $10 per month. The findings suggest that condom use promotion strategies should remain at the forefront of public health efforts to control HIV incidence among YBMSM.

OBJECTIVE:To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. METHODS:We critically profile each component of the deterministic triad in shaping current health-related disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice. RESULTS:The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants. CONCLUSION/CONCLUSIONS:The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.

Background/UNASSIGNED:Prior studies have assessed relationships between gang membership and health-related factors. However, the existing literature has largely failed to consider how individual and broader social contextual factors might be related to such gang involvement among African American females. Thus, the aim of the present study was to identify empirically driven correlates of gang involvement and then better understand the relationship between gang membership and health-related behaviors for African American females, after controlling for covariates of gang involvement. Methods/UNASSIGNED:= 188). After obtaining written informed assent and parental permission, participants answered survey questions using A-CASI procedures that assessed socio-contextual factors and health-related behaviors. Results/UNASSIGNED:Multiple logistic regression models controlling for age and SES documented that low self-esteem, emotional dysregulation, trauma history, deviant peers, low parental monitoring, infrequent parental communication, housing instability and poor neighborhood quality were correlates of gang involvement. In addition, multiple linear and logistic regression models, controlling for these constructs, revealed that gang involvement was independently associated with lower STD prevention knowledge, a higher likelihood of having a gang-involved boyfriend, a greater risk of having current casual sexual partnerships, higher rates of substance abuse, higher incidences of condom misuse and a lower likelihood of ever having been tested for HIV. Conclusions/UNASSIGNED:These results provide information that can help service providers target certain profiles of African American females who may be at risk for joining gangs and address the health risk behaviors that may be associated with such memberships.

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.

For decades the HIV epidemic has exacted an enormous toll worldwide. However, trend analyses have discerned significant declines in the overall prevalence of HIV over the last two decades. More recently, advances in biomedical, behavioural, and structural interventions offer considerable promise in the battle against generalised epidemics. Despite advances in the prevention of transmission and new infections, morbidity and mortality of HIV among young people remains a considerable concern for individuals, couples, families, communities, practitioners, and policy makers around the globe. To accelerate the end of the global HIV epidemic among young people, we must merge existing efficacious interventions with more novel, cost-effective implementation strategies to develop integrated, multilevel combination interventions. The benefits of conceptualising the HIV epidemic more broadly and adopting ecological frameworks for the development of HIV prevention programmes are critical.

Among 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population.

IMPORTANCE/OBJECTIVE:Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy. OBJECTIVE:To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up. DESIGN, SETTING, AND PARTICIPANTS/METHODS:In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment. INTERVENTIONS/METHODS:Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health. MAIN OUTCOMES AND MEASURES/METHODS:The primary outcomes were percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments. RESULTS:During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95% CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95% CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95% CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95% CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95% CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95% CI, -0.98 to -0.24; P < .001). CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling. TRIAL REGISTRATION/BACKGROUND:clinicaltrials.gov Identifier: NCT00279799.