Interventions For African American Youth

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Interventions For African American Youth

  1. 1. Enhancing Evidence-based HIV Prevention Interventions for African-American Youth: Addressing Gaps through Review of the Literature Kari Gloppen, MPH Lisa Romero, DrPH Division of Adolescent and School Health Division of Adolescent and School Health August 24, 2009 August 24, 2009 Disclaimer: Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Centers for Disease Control and Prevention.
  2. 2. Overview  Study Rationale and Objectives  Literature Review  Unified Framework of Behavior-Change Constructs  Content Analysis of EBIs  Conclusions
  3. 3. Prevalence of “any STD” among Sexually Experienced U.S. Female Adolescents, 14-19 years old by Race/Ethnicity Race/ethnicity Prevalence of “any STD” (n= 587) Non-Hispanic White 20.3% Hispanic 19.7% Non-Hispanic Black 47.7% Source: 2008 National STD Prevention Conference Oral Presentation. Prevalence of Sexually Transmitted Infections and Bacterial Source: 2008 National STD Prevention Conference Oral Presentation. Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutritional Examination Survey Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutritional Examination Survey (NHANES) 2003-2004. (NHANES) 2003-2004.
  4. 4. Study Rationale and Objectives  Culturally relevant interventions are a promising approach  Efficacious behavioral interventions are tailored and preceded by formative research  To describe behavioral constructs most likely to influence African American adolescents’ HIV prevention behaviors  To identify the degree to which behavioral constructs are reflected in current EBIs
  5. 5. Three-Step Process 1. Review the HIV prevention literature to identify variables associated with sexual risk behaviors among African American adolescents 2. Map variables onto the unified framework of behavior- change constructs 3. Analyze the content of HIV-prevention EBIs developed for African-American youth using behavior-change constructs
  6. 6. Literature Review Methods  Literature search performed through • Databases • Manual search • Reference lists  Abstracts were identified (N=896)  Articles meeting inclusion criteria were coded (N= 54)
  7. 7. Research Literature Review Inclusion Criteria  Assess the association of a variable and at least one sexual behavior outcome  Be conducted in the United States  Be published in peer-reviewed journals from 1995 through 2007  Include multivariate analyses  Have sufficiently large sample sizes (at least 100 for significant results)  Have participants younger than 19 years  Have the majority of the sample (>50%) be African American
  8. 8. Sexual Risk Behavior Outcomes  Ever had sex  Age at first sex  Number of sexual partners  Unprotected sexual intercourse (did not use a condom)  History of STDs
  9. 9. Variables Most Frequently Correlated with Sexual Risk Behavior Outcomes  Sexual possibility situations  Parental connectedness  Parental involvement  Communication with parents about sex-related issues  Societal/cultural factors  Perceived peer sexual behavior  Perceived peer related risk behaviors
  10. 10. Constructs Identified in Unified Framework Theorists’ Workshop, 1991  Strong intentions  Environmental conditions  Skills  Positive attitude  Perceived norms  Consistency between standards or values and practicing the behavior  Positive emotional reaction  Self-efficacy
  11. 11. Construct Influence on Behavioral Outcomes Theorists’ Workshop  Environmental conditions, intentions, and skills, are necessary and sufficient for producing behavior change  The remaining five constructs, positive attitude, perceived norms, consistency, positive emotional reaction, and self- efficacy, are viewed as influencing the strength of intention Interventions should address all three of the necessary constructs Focus on the one or two constructs from the remaining five most likely to influence participants to engage in the desired behavior
  12. 12. Constructs Influencing Behavior Change Theorists’ Workshop, 1991 Constructs Identified by Leading Theorists Examples of Variables Mapped Under Each Strong intentions to perform a behavior Intentions to have sex Environmental conditions--that foster feasible social, Parent connectedness, family ecological, and structural influences to perform a behavior structure, societal factors Having the skills necessary to perform the behavior Condom use, refusal A positive attitude towards the behavior Towards buying condoms Perceived norms about the behavior that are more positive Peer sexual norms, family than negative norms Consistency between an individual’s personal standards or Self concept, future values and practicing the behavior aspirations, beliefs/values Positive emotional reaction towards performing the Positive feelings about behavior condoms Self-efficacy, the individual’s belief that he or she can Self-efficacy to communicate, complete the behavior use condoms
  13. 13. Constructs Influencing Behavior Change Added From Literature Review and Content Analysis Constructs Identified by Leading Theorists Examples of Variables Mapped Under Each Strong intentions to perform a behavior Intentions to have sex Environmental conditions--that foster feasible social, ecological, and Parent connectedness, family structural influences to perform a behavior structure, societal factors Having the skills necessary to perform the behavior Condom use, refusal A positive attitude towards the behavior Towards buying condoms Perceived norms about the behavior that are more positive than negative Peer sexual norms, family norms Consistency between an individual’s personal standards or values and Self concept, future aspirations, practicing the behavior beliefs/values Positive emotional reaction towards performing the behavior Positive feelings about condoms Self-efficacy, the individual’s belief that he or she can complete the Self-efficacy to communicate, use behavior condoms Knowledge-- factual information about HIV transmission Awareness of where to and prevention purchase condoms Other related risky behaviors Substance use, lower school performance
  14. 14. Relationship Between Constructs and Sexual Risk Behavioral Outcomes  Environmental conditions and perceived norms were frequently associated with sexual risk behaviors among African American adolescents  Knowledge was not measured in the reviewed studies • Knowledge is a necessary, but insufficient, construct in changing behavior  Skills were infrequently measured in the reviewed studies
  15. 15. Evidence-Based Interventions Theoretical Number of sessions Curriculum/intervention framework (dose per session) Be Proud Be Responsible (Be Social Cognitive Theory 6 (50-min) Proud!) Theory of Reasoned Action Theory of Planned Behavior Becoming a Responsible Teen Information Motivation 8 (90–120 min) (BART) Behavior Model Social Learning Theory Focus on Youth with ImPACT Protection Motivation Theory 8 (100–125-min) for youth and (formerly Focus on Kids) 1 (90 min) for parent Making a Difference Social Cognitive Theory 8 (50-min) Theory of Reasoned Action Theory of Planned Behavior Making Proud Choices Social Cognitive Theory 8 ( 50-min) Theory of Reasoned Action Theory of Planned Behavior Sistas, Informing, Healing, Social Cognitive Theory 4 (125-188-min) Living and Empowering Theory of Gender and Power (SiHLE) Street Smart Social Learning Theory 10 (100 min) and 1 (100 min) individual session
  16. 16. Content Analysis Methods  Coded activities to correspond with behavior-change constructs  Coded dosage (i.e. minutes spent on each type of activity)  2 people analyzed the content of each EBI • Standardized coding • Resolved coding discrepancies
  17. 17. Key Results from the EBI Content Analysis  All 7 EBIs addressed the 10 identified theoretical constructs  EBIs devoted considerable time (higher dose) to knowledge, skills, and self-efficacy  EBIs devoted measurably less time (lower dose) to environmental conditions, perceived norms, and intentions
  18. 18. Programmatic Conclusions To increase program impact on African American adolescents, activities should  Correct perceptions about peer sexual norms, and promote healthy sexual norms and behaviors  Promote environmental conditions that facilitate healthy sexual behavior • For example, parent education programs, family strengthening programs, service learning, career planning, and increasing access to STD and HIV testing, care, and treatment  Consider how much knowledge dosage is necessary
  19. 19. Overall Conclusions  Programs and science should match whenever possible  Promote what works (environmental conditions and perceived norms)  Research and practice improve each other
  20. 20. Thank You! Lisa Romero, DrPH Jennifer Galbraith, PhD Lyndsey Wilson-Williams, MPH Kari Gloppen, MPH

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