[Show abstract][Hide abstract] ABSTRACT: The primary aim of this study was to test an intervention to support antiretroviral medication adherence among primarily low-income men and women with HIV. The study was a randomized controlled trial (Get Busy Living) with participants assigned to treatment (Motivational Interviewing [MI]) and control groups. Participants were recruited from an HIV/AIDS clinic in Atlanta, Georgia, US. Of those referred to the study, 247 completed a baseline assessment and were enrolled with 125 randomized to the intervention group and 122 to the control group. Participants were patients beginning antiretroviral therapy or changing to a new drug regimen. The intervention consisted of five MI sessions delivered by registered nurses in individual counselling sessions. Participants were paid for each session attended. The intervention sought to build confidence, reduce ambivalence and increase motivation for ART medication-taking. Medication adherence was measured by the Medication Event Monitoring System (MEMS) from the time of screening until the final follow-up conducted approximately 12 months following the baseline assessment. Participants in the intervention condition showed a trend towards having a higher mean percent of prescribed doses taken and a greater percent of doses taken on schedule when compared to the control group during the months following the intervention period. This effect was noted beginning at about the eighth month of the study period and was maintained until the final study month. Although the finding was weaker for overall percent of prescribed doses taken, the results for the percent of doses taken on schedule suggests that the MI intervention may be a useful approach for addressing specific aspects of medication adherence, such as adherrence to a specified dosing schedule.
AIDS Care 04/2008; 20(3):273-83. DOI:10.1080/09540120701593489 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: SUMMARY The purpose of this study was to identify predictors of risk behaviors among college students and to determine how students differed in HIV risk practices. Participants were from six colleges and universities in a large southeastern metropolitan area. The present analysis was limited to participants who were 18 to 25 years of age; single; White, African American, or Asian; and reported initiation of sexual intercourse. The results demonstratedsignificant associations of gender and race with having sex within the past3 months, number of partners, condom use, length of time one knew one's sexual partner, substance use, and asking one's partner about sexualhistory. Using Chi-Square Automatic Interaction Detection (CHAID), the strongest predictor of condom use was noted to be gender, and the strongest predictor of number of partners was race.The findings of this study indicate that HIV risk factors vary dependingon a college student's ethnicity, gender, academic status, and substanceuse. Most importantly, African American men, particularly men who use drugs, and White and Asian men who use alcohol tend to report higher numbers of sexual partners. Females, particularly upperclass White females, and White men who do not use alcohol report infrequent condom use. These findings areuseful for health educators who have begun to recognize the importance ofconsidering the HIV risk factors of students and incorporating informationrelated to these factors into HIV prevention programs. From the results ofthis study, we have several suggestions that health educators and researchersmay want to consider when developing programs for college students:1. Although students may not need extensive information about basic HIVfacts, they may need reinforcement of the information. In particular, students need to be made aware that lambskin condoms do not offer protection against HIV transmission.2. Females need to be encouraged and taught the skills to negotiate theuse of and to actually use condoms. These skills need to be reinforced throughout college, particularly as women adopt other methods of birth control (i.e., the pill).3. The general acceptance of condom use among African Americans and Asians may be a useful tool for the health educator. Promoting and reinforcingthis norm and behavior, while addressing some of the other risk factors inthese groups, may be a particularly effective approach to HIV prevention.4. For White students whose condom use rates are lower, messages can include the use of condoms for STD and pregnancy protection. Messages for male students could include control over preventing pregnancy or sharing control for pregnancy prevention.5. Couples often abandon using condoms when they feel they know each other “well enough.” Some guidelines for when to give up condoms might also be given to provide couples with responsible and realistic directions for minimizing their risk when choosing to engage in unprotected sex. These guidelines would include HIV testing two times at least 6 months apart, no evidence of STDs in either partner, and a commitment of both partners to a monogamous relationship.6. When addressing the number of sexual partners as a risk factor, African American men and women may hold the greatest potential for change, given the greater likelihood of multiple partners in these groups.7. With respect to drug and alcohol use, health educators may want to include discussions about the influence of drugs (particularly for African American students) and alcohol (particularly for White and Asian students) on inhibiting logical decision-making as it relates to sexual intercourse.
Journal of Applied Biobehavioral Research 06/2007; 3(2):119 - 134. DOI:10.1111/j.1751-9861.1998.tb00049.x
[Show abstract][Hide abstract] ABSTRACT: To examine sexual possibility situations (SPS) and protective practices associated with involvement in intimate sexual behaviors and the initiation of sexual intercourse among young adolescents and to determine if protective factors moderate the relationship between SPS and sexual behaviors.
Data for these analyses were obtained from the baseline assessment for adolescents conducted as part of an HIV prevention study called "Keepin' it R.E.A.L.!" The study was conducted with a community-based organization (CBO) in an urban area serving a predominantly African-American population. In addition to items assessing SPS, intimate sexual behaviors, and initiation of sexual intercourse, adolescents provided information on the following protective factors: educational goals, self-concept, future time perspective, orientation to health, self-efficacy, outcome expectations, parenting, communication, values, and prosocial activities. Background personal information, including age and gender, was also collected. The analyses were conducted on data from 491 predominantly African-American adolescents, 61% of whom were boys. Variables were combined to form SPS and protective indices that were used in the first set of regression analyses. In a second set of analyses, the indices were unbundled and individual variables were entered into regression analyses.
Both SPS and protective indices explained significant portions of variance in intimate sexual behaviors, and the SPS index explained a significant portion of variance in the initiation of sexual intercourse. The regression analysis using the unbundled SPS and protective factors revealed the following statistically significant predictors for intimate sexual behaviors: age, gender, time alone with groups of peers, time alone with a member of the opposite sex, behavior self-concept, popularity self-concept, self-efficacy for abstinence, outcome expectations for abstinence, parental control, personal values, and parental values. A similar regression analysis revealed that age, time alone with a member of the opposite sex, and personal values were significant predictors of initiation of sexual intercourse.
These results provide evidence for the important role of protective factors in explaining early involvement in sexual behaviors and show that protective factors extend beyond personal characteristics to include both familial and peer factors.
Journal of Adolescent Health 01/2005; 35(6):528.e11-20. DOI:10.1016/j.jadohealth.2004.02.013 · 2.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder.
One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow-up interview approximately 4 weeks after the birth.
The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self-efficacy, internal locus of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth.
These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum.
[Show abstract][Hide abstract] ABSTRACT: This report describes a pilot study of a nursing intervention to increase adherence to combination therapy. The intervention was based on motivational interviewing (MI). Participants completed a baseline assessment using the computer-administered self-interview with audio (ACASI) data collection method and then were randomly assigned to the MI intervention or control condition. Nurse counselors met with participants in the MI intervention group for three adherence sessions. Two months following baseline, participants completed a follow-up assessment. Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group. Although there were no significant differences in the number of medications missed during the past 4 days, participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider. The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures. The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications.
Journal of the Association of Nurses in AIDS Care 03/2003; 14(2):52-62. DOI:10.1177/1055329002250996 · 1.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to identify HIV prevention goals of college students, to determine if there are differences in goal setting between males and females, and to determine if an association exists between goal setting and behavior. The data are from a study designed to identify HIV prevention practices of college students. The results of the study showed that 71.4% of the respondents indicated that they had a goal to reduce their risk of contracting HIV. The primary goals identified were condom use, limiting number of partners, abstinence, and monogamy. Females were more likely to select abstinence as their first goal, and men, condom use. Females were more likely than
[Show abstract][Hide abstract] ABSTRACT: Motivational interviewing (MI), initially developed for addiction counseling, has increasingly been applied in public health, medical, and health promotion settings. This article provides an overview of MI, outlining its philosophic orientation and essential strategies. Major outcome studies are reviewed, nuances associated with the use of MI in health promotion and chronic disease prevention are described, and future directions are offered.
Health Psychology 10/2002; 21(5):444-51. DOI:10.1037/0278-6188.8.131.524 · 3.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the role of self-efficacy, outcome expectancies, and perception of peer attitudes in the delay of onset of sexual activity among 13- through 15-year-old adolescents. We also explored the role of self-efficacy, outcome expectancies, and perception of friends' condom use behavior in explaining the use of condoms among sexually active adolescents.
This study was part of a larger cross-sectional study to evaluate personal characteristics and maternal factors associated with early initiation of sexual intercourse. Mothers and adolescents were recruited from a community-based organization that offered afterschool and summer programs for youth. Enrollment was limited to adolescents aged 13-15 years and their mothers. Mothers and adolescents completed separate interviews. For adolescents, the interviews included the assessment of the variables in the present study. Each interview lasted about 60 min and was conducted by a trained interviewer. Data were analyzed using descriptive statistics and regression analysis. The average age of the 405 adolescent participants was 13.86 years, and approximately 30% of them had engaged in sexual intercourse. Slightly more than half (56%) of participants were male, and 82% were African-American.
Participants who were less likely to believe that their friends favored intercourse for adolescents and who held more favorable attitudes about the personal benefits of abstaining from sex were less likely to have initiated sexual intercourse. Among sexually active adolescents, those who expressed confidence in putting on a condom, and in being able to refuse sex with a sexual partner, and who expressed more favorable outcome expectancies associated with using a condom were more likely to use condoms consistently.
Human immunodeficiency virus and pregnancy prevention programs should emphasize peer influences in both the initiation of sexual intercourse and the use of safer sex practices among sexually active adolescents, as well as personal attitudes about consequences to self and confidence in negotiating safer sex practices with one's partner.
Journal of Adolescent Health 10/2001; 29(3):208-16. DOI:10.1016/S1054-139X(00)00200-7 · 2.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Correlates of safer sex communication among college students The purpose of this study was to examine factors that are thought to promote communication about safer sex and HIV among college students in the United States of America and to determine the extent to which communication about safer sex is important in the use of condoms. A better understanding of factors associated with safer sex communication can be helpful in developing HIV and STD prevention programmes for college students. Following approval from the institutional review boards of the six participating colleges and universities, researchers collected data from a random sample of students. The study included participant responses if participants were 18-25 years of age, single and sexually active. For the sample of 1349 participants, the mean age was 20.6 years. Sixty-three per cent of the sample was female, 50.5% white, 42.3% African-American, and the remainder of other ethnic groups. Over 50% of respondents reported frequent condom use, with 28% noting that they used a condom every time and 30.6% reporting condom use almost every time they had sex. Only 9.6% indicated that they never used a condom. The results of hierarchical multiple regression analysis revealed that the perception of quality of general communication with parents, the perception of a partner's attitude towards communication, communication self-efficacy, and communication outcome expectancies, were associated with safer sex communication. However, the association between safer sex communication and condom use was weak, suggesting that other factors excluded from this study are important in determining condom use for this sample of respondents. The findings provide some implications for HIV interventions. Interventions that enhance self-efficacy and positive outcome expectancies related to communication about safer sex are likely to foster discussion with a sexual partner. However, they might not lead to actual condom use.
[Show abstract][Hide abstract] ABSTRACT: Social cognitive theory has been used extensively to explain health behaviors. Although the influence of one construct in this model-self-efficacy-has been well established, the role of other social cognitive constructs has not received as much attention in human immunodeficiency virus (HIV) prevention research. More complete understanding of how social cognitive constructs operate together to explain condom use behaviors would be useful in developing HIV and sexually transmitted disease (STD) prevention programs for college students.
The primary aim of this study was to test a social cognitive-based model of condom use behaviors among college students.
Data were collected from a sample of college students attending six different colleges and universities. Participants were 18 to 25 years of age, single, and sexually active. For the sample of 1,380 participants, the mean age was 20.6 years (SD = 1.76). Most participants reported having had vaginal intercourse (95.8%) and oral sex (86.5%); 16% reported anal sex.
Self-efficacy was related directly to condom use behaviors and indirectly through its effect on outcome expectancies. As predicted, self-efficacy was related to anxiety, but anxiety was not related to condom use. Substance use during sexual encounters was related to outcome expectancies but not to condom use as predicted.
Overall, the findings lend support to a condom use model based on social cognitive theory and provide implications for HIV interventions. Interventions that focus on self-efficacy are more likely to reduce anxiety related to condom use, increase positive perceptions about condoms, and increase the likelihood of adopting condom use behaviors.
Nursing Research 08/2000; 49(4):208-14. DOI:10.1097/00006199-200007000-00004 · 1.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We describe a self-generated coding form used in a study of HIV prevention practices of college students and provide information on the success rate of matching questionnaires over a 3-year period using the form. The data for this study were from a longitudinal study of HIV risk-reduction practices of college students. In order to match questionnaires over the 3-year study period while maintaining anonymity, participants were asked to complete a self-generated identification form at each data collection point. In the second year of the project, we were able to successfully match 74.3% of the questionnaires to those returned during the first year using 6 to 8 of the code elements on the form, and in the third year, we were able to match 73% of questionnaires to those returned in the second year. Participants for whom questionnaires matched were more likely than participants with unmatched questionnaires to be white students enrolled as underclassmen.
Research in Nursing & Health 05/2000; 23(2):167-74. · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To aid development of programs to prevent HIV transmission in women, differences in sexual attitudes and behavior were examined among women who described themselves as dominant in their relationship with a male partner, sharing dominance equally with a male partner, or being dominated by a male partner. Ethnic differences were also examined among these three groups. Results indicated that perceived dominance was a significant predictor of women's personal empowerment (self-efficacy and outcome expectancies) with regard to sexual decisionmaking in their current relationship and safer sex behaviors. Ethnic differences were found between African American and White women in personal empowerment and safer sex behavior. Perceived dominance did not appear to affect African American and White women differently.
Psychology of Women Quarterly 01/2000; 23(4):707-23. DOI:10.1111/j.1471-6402.1999.tb00393.x · 2.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the past several years, the greatest proportionate increase in AIDS diagnoses has occurred among women. Yet, while the risk of HIV infection increases, female college students continue to report inconsistent HIV prevention behaviors. Past research on condom use among college women has focused on intrapersonal aspects of the behavior, and little is known about the influence of interpersonal factors on women's condom use. In this study we examined the relative salience of both intra and interpersonal factors on African American and white women's use of condoms. We found that interpersonal variables were particularly salient predictors of condom use. There were no ethnic differences in the effects of interpersonal variables; however, there were differences in the effects of self-efficacy on condom use.
Women & Health 02/1998; 27(4):19-32. DOI:10.1300/J013v27n04_02 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The telephone is being widely used by the private sector as a communication medium for understanding and influencing consumer behavior. Coinciding with the growth of telephone use in the private sector is the expansion of telephone use in health care to include complex health promotion and disease prevention interventions aimed at initiating and maintaining health-related behavioral changes. While several studies have evaluated the impact of telephone interventions on a wide range of health behaviors, no published reports synthesizing current knowledge about using the telephone as a communication medium for health education were identified. In this article, the authors therefore (1) examine recent applications of telephone use in health education by describing three example interventions, (2) outline key features and alternatives in conceptualizing and designing health education using the telephone, (3) review advantages and disadvantages of using the telephone for health education, and (4) discuss implications for health education practice and research.
[Show abstract][Hide abstract] ABSTRACT: While Asian Americans remain one of the ethnic groups least affected by AIDS, recent data suggests that this may be changing. The incidence of AIDS in the Asian community is increasing. The purpose of this study was to explore the knowledge, attitudes, and sexual practices of a sample of Asian college students. Data were collected from students enrolled at six colleges and universities in a southeastern metropolitan area (n = 2,044). For this analysis, respondents who reported that they were of Asian background and unmarried were included (n = 128). Twenty percent of the subsample (n = 26) indicated they had grown up outside the United States. Descriptive analyses were done by gender and country of early development (U.S. vs. foreign-reared). Results indicated that males were more sexually active, more likely to use condoms and had less positive attitudes toward abstinence than females. U.S.-reared students initiated intercourse at a younger age and had higher knowledge scores than foreign-reared students. Compared to students of other ethnic groups, Asian students initiated intercourse at a older age, had more positive attitudes toward abstinence, and more negative attitudes towardcondoms and discussion of safer sex. Implications for health education research and practice are discussed.
Journal of health education / Association for the Advancement of Health Education 12/1997; 28(sup1):S-22-S-30. DOI:10.1080/10556699.1997.10608629
[Show abstract][Hide abstract] ABSTRACT: This article compares the sexual practices and risk-taking behaviors of African-American male and female college students (n = 649) attending 4-year institutions in a major southeastern metropolitan area. It is a descriptive study of the kinds of practices that put African-American college students at a high risk of contracting the human immunodeficiency virus (HIV). Overall, the reported practices indicate that the college students studied are exposed to risk by certain sexual behaviors, with males reporting significantly higher frequency of risk behaviors than females. The percentages of male students reporting they engage in an array of risky sexual practices (including sex without condoms and anal intercourse) suggest the invulnerability to HIV apparently perceived by this group. Although the students overall adhere to some HIV-preventive behaviors, they also violate important HIV prevention practices. The findings illuminate the need for designing and conveying messages for African-American college students, and particularly for males, that impress the realities of acquired immunodeficiency syndrome (AIDS) as an indiscriminant disease on this group.
Journal of the National Medical Association 07/1997; 89(6):397-403. · 0.91 Impact Factor