Positive outlook as a moderator of the effectiveness of an HIV/STI intervention with adolescents in detention

Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado--Denver, Aurora, CO 80045, USA.
Health Education Research (Impact Factor: 1.66). 10/2010; 26(3):432-42. DOI: 10.1093/her/cyq060
Source: PubMed


Justice-involved adolescents engage in high levels of risky sexual behavior, underscoring the need for targeted, effective, prevention interventions geared toward this population. In a randomized controlled trial, 484 detained adolescents received a theory-based intervention or an information-only control. We have previously demonstrated that the theory-based intervention was superior to the control condition in changing theoretical mediators and in producing longitudinal decreases in risky sexual behavior. In the present study, we examined differential response to the intervention based on the adolescents' level of positive outlook (composed of self-esteem, perceived control over the future and optimism toward the future). Changes to putative theoretical mediators (attitudes, perceived norms, self-efficacy and intentions) were measured immediately post-intervention, and behavioral data were obtained 3, 6, 9 and 12 months later. Positive outlook significantly moderated program effects both in the context of the mediational path model and in the context of the longitudinal growth model. Specifically, intervention effects were strongest for those scoring relatively lower on the positive outlook dimension, whereas adolescents high in positive outlook demonstrated greater attitudes and self-efficacy and decreased risky sexual behavior, regardless of condition. Findings are discussed in terms of targeting and tailoring of intervention content.

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    • "Low future outlook—perceived limited expectations for future advancement and prosperity in education, employment, and social status—has been associated with sexual risk in economically-deprived environments and often assessed via ethnographic research methods. In instances where quantitative approaches are employed, the focus has been on males (Kagan et al. 2012), incarcerated youth (Schmeige et al. 2011), youth in psychiatric institutions or demonstrating severe mental distress (Cotton and Rangle 1996; Kazdin et al. 1983; McLaughlin et al. 1996; Reifman and Windle 1995), a broad crosssection of socioeconomic conditions (Kashani et al. 1997), or violent consequences of low future outlook or hopelessness (Bolland et al. 2001; DuRant et al. 1994, 1995). One recent study by Sipsma and colleagues (Sipsma et al. 2013) addressed the limitation of previous research on the effects of future expectations on sexual risk behavior. "
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    ABSTRACT: African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.
    American Journal of Community Psychology 08/2014; 54(3-4). DOI:10.1007/s10464-014-9668-9 · 1.74 Impact Factor
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    • "However, the participants demonstrated no commitment to change their behaviors Schmiege et al. (2011) To examine the association between positive outlook and social cognitive constructs that are relevant to condom use "
    Journal of Child and Family Studies 01/2014; · 1.42 Impact Factor
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    • "Empirically, these questions have not been answered using a longitudinal design with a high-risk incarcerated population. However, in other populations, there is some evidence that perceived risk for HIV infection can motivate individuals to engage in HIV testing (Spielberg et al., 2003), and there is evidence that individual-level differences can moderate the benefits of HIV education and prevention interventions (Bryan et al., 2006; Schmiege et al., 2010); likewise these individual differences, like race and positive outlook may influence the extent to which perceived susceptibility to HIV affects future HIV risk by inflating, reducing, or reversing the association. Answering these questions as they relate to individuals who cycle in and out of the criminal justice system may provide areas for intervention to protect this high-need group as they re-enter the community and re-establish sexual and/or drug use practices. "
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    ABSTRACT: Theories of health behavior change suggest that perceived susceptibility to illness precedes health-protective behavior. We used a cross-lagged panel design to explore the relationship between perceived susceptibility to AIDS, and HIV risk behavior pre-incarceration and postrelease in a sample of 499 jail inmates, a group at high risk for HIV. We also explored moderators of this relationship. HIV risk was calculated with a Bernoulli mathematical process model. Controlling for pre-incarceration HIV risk, perceived susceptibility to AIDS predicted less post-release HIV risk; the reverse relationship was not supported. Consistent with health behavior change theories, perceived susceptibility seemed to partially guide behavior. However, this relationship was not true for everyone. African-Americans and individuals high in borderline personality features exhibited no relationship between perceived susceptibility and changes in HIV risk. This suggests that targeted interventions are needed to use information about risk level to prevent HIV contraction.
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Christian Hendershot