Faculty Bibliography

The need for formative research in designing mass media health-education messages is widely accepted; however, distinct methodologies for developing such messages are less well documented. This article describes a culture-centered approach for developing messages to promote sexual risk reduction in urban African American adolescents. The method uses qualitative formative research to identify "competing narratives" that support healthy behavior despite the dominance of messages that favor risk-taking behavior. The method is illustrated using qualitative analysis of semistructured interviews with 124 adolescents. Analysis focuses on two barriers to sexual risk reduction: (a) social pressure for early initiation of sexual intercourse and (b) perceptions that condoms reduce sexual pleasure. We demonstrate how competing narratives identified in the analysis can be featured in radio and television messages advocating healthy behavior by modeling risk-reducing negotiation skills.

OBJECTIVE:To test the hypothesis that individuals attending a sexually transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). METHODS:Recruitment (N = 360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manufactured by Biokit (Lexington, MA) and they completed a self-administered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). RESULTS:Of those completing follow-up, 43.4% (n = 111) tested positive for HSV-2 at enrollment. Significant differences between participants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex partners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P = 0.037) and nonsteady partners at follow-up (P = 0.017). However, repeated measures analyses yielded only 1 significant group x time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. CONCLUSIONS:Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against further acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serostatus may not be sufficient to motivate the adoption of safer sex behaviors among this population.

STUDY OBJECTIVE/OBJECTIVE:To identify young women's pros and cons (decisional balance) to seeking chlamydia (CT) and gonorrhea (NGC) screening. DESIGN/METHODS:Prospective, cross sectional study SETTING/METHODS:Community-based reproductive health clinic PARTICIPANTS/METHODS:192 young women (66% African American; mean age 18.9 years). MAIN OUTCOME MEASURES/METHODS:Content analysis of responses obtained during a decisional balance exercise (pros and cons) promoting CT and NGC screening was conducted. Thematic categories were developed through a coding process, and each response was assigned to one thematic category. The frequency of pros and cons responses for each category and the frequency of participants endorsing each category were calculated. RESULTS:Ten thematic categories in relation to pros and cons of seeking CT and NGC screening were: being healthy; awareness of the body; systemic factors around the clinic visit and testing procedures; benefits and aversions around treatment; partner trust issues; confidentiality; prevention of long term adverse effects, protection of the body; concern for others; fear of results/aversion to testing; and logistical barriers. The three most often cited pros were awareness of the body, being healthy and treatment issues; and the three most often cited cons were logistical barriers (time/transportation), fear/aversion to testing, and systemic factors. CONCLUSIONS:A variety of pros and cons to seeking CT and NGC screening were identified at a community-based clinic. Providers in clinical settings can utilize this information when encouraging patients to seek regular STI screening by elucidating and emphasizing those pros and cons that have the most influence on a young woman's decision-making to seek screening.

BACKGROUND:The co-occurrence of a behaviour (being intoxicated on alcohol/drugs during sex) with a disease outcome [laboratory-confirmed sexually transmissible infection (STI) prevalence] among young African American women and their male sex partners was studied. METHODS:A cross-sectional study was conducted. Recruitment and data collection occurred in three clinics located in a metropolitan city of the Southern USA. A total of 715 African American adolescent females (15-21 years old) were enrolled (82% participation rate). The primary outcome measure was the analysis of self-collected vaginal swabs using nucleic acid amplification assays for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. RESULTS:After controlling for age and self-efficacy to negotiate condom use, young women's alcohol/drug use while having sex was not significantly associated with STI prevalence [adjusted odds ratios (AOR) = 1.29, 95% confidence interval (CI) = 0.90-1.83]. However, using the same covariates, the association between male partners' alcohol/drug use and sexually transmitted disease prevalence was significant (AOR = 1.44, 95% CI = 1.03-2.02). Young women reporting that their sex partners had been drunk or high while having sex (at least once in the past 60 days) were approximately 1.4 times more likely to test positive for at least one of the three assessed STIs. CONCLUSION/CONCLUSIONS:Young African American women reporting a male sex partner had been intoxicated during sex were significantly more likely to have an STI. The nature of this phenomenon could be a consequence of women's selection of risky partners and lack of condom use possibly stemming from their intoxication or their partners' intoxication.

OBJECTIVE:We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S. METHODS:We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes. RESULTS:Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median = 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms. CONCLUSIONS:Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.

Condom use at last sex is a widely used indicator in sexual behavior research; however, there is little empirical research validating this indicator. This study examined whether a single-event recall period (the last time coitus occurred) was consistent with longer recall periods (14 days and 60 days) for a sample of African American adolescent females (N = 566). The findings from this study demonstrate that condom use at last coitus is a valid proxy for condom use behaviors spanning longer time periods.

This study tested the research hypothesis that men's errors using condoms would be associated with having multiple sex partners. Specifically, men engaging in sex with three or more women were compared with those having sex with two or fewer women. Recruitment (N = 271) occurred in a publicly funded sexually transmitted disease (STD) clinic located in a metropolitan area of the Southern United States. All men were clinically diagnosed with an STD. They completed a self-reported questionnaire (using a 3-month recall period). Those reporting sex with men were excluded from the analysis. About one half of the men (48.5%) reported penetrative sex with three or more women. The authors found that among young African American men, newly diagnosed with an STD, reporting recent (past 3 months) sex with multiple partners may be emblematic of condom errors. These men may benefit from clinic-based, targeted counseling and education designed to foster improved quality of condom use.

PURPOSE: Among a sample of detained youth, to investigate pathways that link witnessing community violence, in the 12 months prior to being detained, to drug and sexual risk behaviors, in the two months preceding detainment. METHODS: Using A-CASI technology, data was collected from 559 detained adolescents on demographics, family factors, peer influences, religiosity, witnessing community violence, and drug and sexual risk behaviors. RESULTS: Controlling for demographics and family variables, findings indicated positive associations between witnessing community violence and drug and sexual risk behaviors. Witnessing community violence was directly linked to sexual risk behaviors, and indirectly associated with these risk behaviors, through gang membership and perceived risky peer norms. Additionally, witnessing community violence was indirectly linked to substance use through gang membership and perceived risky peer norms. CONCLUSIONS: Interventions targeting change in peer affiliations and perceived norms may be an effective strategy for reducing risky drug and sexual behaviors among detained youth.

Little research has examined the links between role status changes during the transition to adulthood and sexual behaviors that place African Americans at risk for sexually transmitted infections. Moreover, the mediating processes that explain these links, or protective factors that may buffer young adults from risky sexual behavior, are unknown. African American young adults who had either completed or dropped out of high school (ages 18 to 21, N = 186) provided information regarding their sexual behavior, role status, substance use, peer affiliations, religiosity, and receipt of protective family processes. Anticipated school attendance, part-time rather than full-time employment, and residence in a dorm or barracks rather than with peers or alone were negatively associated with risk behavior. Parenthood was positively associated with risk behavior; affiliation with peers who encourage risky sex partially accounted for this effect. Substance use fully accounted for the effect of part-time versus full-time employment on sexual risk behavior. Protective family processes and religiosity moderated the association of parenthood with sexual risk behavior. Prospective studies on these processes are warranted.

This study describes HIV risk and preventive behaviors and their correlates among Armenian female commercial sex workers (CSWs) as a prerequisite to developing gender and culturally appropriate interventions. Ninety-eight CSWs from three Armenian cities were interviewed using a structured questionnaire. Quantitative findings were further elaborated by focus group discussions (N = 25) and key informant interviews (N = 8). Inconsistent condom use with all types of sexual partners was reported, as were condom tear/slippage, alcohol and drug use, and sex with drug injecting clients. Prominent misconceptions regarding HIV transmission, prevention and disease manifestations were noted. Correlates of condom use intentions included history of substance use, attitudes regarding condom use, risk perception, and comfort negotiating condom use. Intentions to use condoms were strongly associated with recent frequency of condom use. Understanding the relationship between condom use and its determinants is critical in the design and implementation of effective prevention programs tailored for Armenian CSWs.