Gery Ryan

RAND Corporation, Santa Monica, California, United States

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Publications (77)177.01 Total impact

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    ABSTRACT: Objectives. We sought to understand incarcerated youths' perspectives on the role of protective factors and risk factors for juvenile offending. Methods. We performed an in-depth qualitative analysis of interviews (conducted October-December 2013) with 20 incarcerated youths detained in the largest juvenile hall in Los Angeles. Results. The adolescent participants described their homes, schools, and neighborhoods as chaotic and unsafe. They expressed a need for love and attention, discipline and control, and role models and perspective. Youths perceived that when home or school failed to meet these needs, they spent more time on the streets, leading to incarceration. They contrasted the path through school with the path to jail, reporting that the path to jail felt easier. All of them expressed the insight that they had made bad decisions and that the more difficult path was not only better but also still potentially achievable. Conclusions. Breaking cycles of juvenile incarceration will require that the public health community partner with legislators, educators, community leaders, and youths to determine how to make success, rather than incarceration, the easier path for disadvantaged adolescents. (Am J Public Health. Published online ahead of print December 18, 2014: e1-e7. doi:10.2105/AJPH.2014.302228).
    American Journal of Public Health 12/2014; · 4.23 Impact Factor
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    ABSTRACT: This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision making among homeless youth. Event-level interviews that explore characteristics of the environment surrounding sexual events were conducted with 29 youth who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. Other nonevent factors that influenced condom use decision making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision making was influenced by multiple interacting factors, with different pathways operating for event and nonevent factors. Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population.
    The Journal of Sex Research 11/2014; · 2.53 Impact Factor
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    ABSTRACT: Public health agencies face difficult decisions when allocating scarce resources to control the spread of HIV/AIDS. Decisions are often made with few local empirical data. We demonstrated the use of the robust decision making approach in Los Angeles County, an approach that is data driven and allows decision makers to compare the performance of various intervention strategies across thousands of simulated future scenarios. We found that the prevailing strategy of emphasizing behavioral risk reduction interventions was unlikely to achieve the policy goals of the national HIV/AIDS strategy. Of the alternative strategies we examined, those that invested most heavily in interventions to initiate antiretroviral treatment and support treatment adherence were the most likely to achieve policy objectives. By employing similar methods, other public health agencies can identify robust strategies and invest in interventions more likely to achieve HIV/AIDS policy goals.
    Health Affairs 03/2014; 33(3):410-7. · 4.64 Impact Factor
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    ABSTRACT: Background: During El Salvador's civil war (1980-1992), hundreds of children were separated, often forcibly, from their biological families and turned over to orphanages or given up for adoption overseas. Years later, many of these children-now adolescents or young adults-were reunited with their biological families. Understanding the reunification experiences of these disappeared children helps shed light on the process of family separation and reunification as a result of war, natural disasters, immigration, and in some circumstances, international adoption. Methods: Ethnographic fieldwork was conducted in El Salvador from 2005-2009. Data consisted of field notes and semi-structured interviews with disappeared youth who had been reunited with their families (n = 26; ages 24 to 34 years) and their biological relatives (n = 14). Thematic content analysis of the interviews is ongoing; preliminary results are presented here. Results: Most disappeared children were separated from their families during infancy or early childhood and later reunited as adolescents. Living in orphanages or with adoptive families, once reunited, many youth attempted to shed their former identities and formulate new identities and family concepts. Some developed close long-term ties with their biological families and almost all described difficulties with the relationships. Nevertheless, youth unanimously reported that reunification had been beneficial. Conclusion: Family reunification was a challenging, long-term, and ultimately beneficial process, highlighting the extreme dislocation caused by family separation and the healing potential of reunification. Further research on reunification across settings is warranted to help design interventions and policies that prevent unnecessary separations and ease reunifications.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: This study used a stage-based approach to understand condom use behavior in a representative sample of 309 sexually active homeless youth recruited from shelters, drop-in centers, and street sites in Los Angeles County. Focusing on the youth's most recent sexual event, the three stages of condom use examined were: (1) whether the partners decided prior to the event about using condoms; (2) whether a condom was available at the event; and (3) whether a condom was used at the event. Logistic regression analysis was used to identify attitudinal, relationship, and contextual correlates of each of these three stages. Deciding ahead of time about condom use was associated with being Hispanic, level of education, condom attitudes, and various relationship characteristics (e.g., partner type, monogamy, relationship abuse), with the nature of these associations varying depending on the type of decision (i.e., deciding to use, deciding to not use). Condom availability was more likely to be reported by males, if the event was described as being special in some way, or if the event lacked privacy. Condom use was more likely among youth with more positive condom attitudes and among youth who decide ahead of time to use a condom, but less likely among those in monogamous relationships or when hard drugs were used prior to sex. Whether sexual intercourse is protected or unprotected is the end result of a series of decisions and actions by sexual partners. Results from this study illustrate how condom use can be better understood by unpacking the stages and identifying influential factors at each stage. Each stage may, in and of itself, be an important target for intervention with homeless youth.
    AIDS Care 10/2013; 26(5). · 1.60 Impact Factor
  • Annals of internal medicine 03/2013; 158(5 Pt 2):365-8. · 16.10 Impact Factor
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    ABSTRACT: Depression is common among people living with HIV/AIDS in sub-Saharan Africa. Yet, little is known about how depression influences physical health and socioeconomic well-being in the context of antiretroviral therapy (ART). Semistructured interviews with 40 adult HIV clients receiving ART in Uganda were conducted to assess experiences prior to and after HIV diagnosis and initiation of ART. Content analysis revealed themes that were suggestive of the following patterns: (1) functioning decreased after patients were diagnosed with HIV, but improved following ART, (2) depression is associated with lower physical health functioning and work status levels after both HIV diagnosis and ART, and (3) antidepressant medication is associated with better functioning compared with patients with depression not receiving depression treatment. These findings suggest that depression plays a role in the deleterious effects of HIV on functioning, and that antidepressant treatment provided alongside ART may serve to help individuals regain functioning, particularly employment. These findings highlight the potential value of integrating depression treatment into HIV care.
    Journal of the International Association of Physicians in AIDS Care (JIAPAC) 02/2013;
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    Quality of Life Research 04/2012; · 2.86 Impact Factor
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    ABSTRACT: We conducted interviews with 27 health care personnel in Bogotá, Colombia, to examine provider barriers and facilitators to screening for intimate partner violence (IPV). We used systematic qualitative analysis to identify the range and consistency of beliefs. We found that respondents did not routinely screen for IPV. Providers listed numerous barriers to screening. Ways to improve screening included increased clinician training, installing systematic IPV screening, providing patient education, and implementing health care setting interventions. Improving the care for IPV survivors will involve translating health care personnel preferred solutions into more systematic IPV screening interventions.
    Health Care For Women International 03/2012; 33(3):250-61. · 0.63 Impact Factor
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    ABSTRACT: PURPOSE: There is no global definition of well-being. Cultural differences in the perception of well-being and the social and behavioral contexts further limit its measurement. Existing instruments are developed in Western societies that differ in their conceptualization of well-being from Asian populations. Moreover, very few instruments address the multidimensional construct of well-being. METHODS: Literature was reviewed to develop a priori conceptual framework of mental health and well-being. Concepts were identified based on specific criteria to guide the qualitative investigations. Finally, focus group discussions were conducted among adults belonging to the three major ethnicities in Singapore to identify salient domains of mental health and well-being. RESULTS: Mental well-being is a multidimensional construct constituting of positive affect, satisfaction, and psychological functioning. While well-being explains the functional and psychological components, positive mental health is a combination of these and the skills required to achieve them. Although there is an overlap between the concepts identified from the literature and those identified in Singapore, certain differences existed, particularly with the relevance attributed to family interactions and religiosity or spirituality. Similar findings were observed across the three ethnic groups. CONCLUSION: Domains identified can be used to develop a culturally relevant instrument in Singapore.
    Quality of Life Research 01/2012; · 2.86 Impact Factor
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    ABSTRACT: Childhood abuse has been linked to negative sequelae for women later in life including drug and alcohol use and violence as victim or perpetrator and may also affect the development of women's social networks. Childhood abuse is prevalent among at-risk populations of women (such as the homeless) and thus may have a stronger impact on their social networks. We conducted a study to: (a) develop a typology of sheltered homeless women's social networks; (b) determine whether childhood abuse was associated with the social networks of sheltered homeless women; and (c) determine whether those associations remained after accounting for past-year substance abuse and recent intimate partner abuse. A probability sample of 428 homeless women from temporary shelter settings in Los Angeles County completed a personal network survey that provided respondent information as well as information about their network members' demographics and level of interaction with each other. Cluster analyses identified groups of women who shared specific social network characteristics. Multinomial logistic regressions revealed variables associated with group membership. We identified three groups of women with differing social network characteristics: low-risk networks, densely connected risky networks (dense, risky), and sparsely connected risky networks (sparse, risky). Multinomial logistic regressions indicated that membership in the sparse, risky network group, when compared to the low-risk group, was associated with history of childhood physical abuse (but not sexual or emotional abuse). Recent drug abuse was associated with membership in both risky network groups; however, the association of childhood physical abuse with sparse, risky network group membership remained. Although these findings support theories proposing that the experience of childhood abuse can shape women's social networks, they suggest that it may be childhood physical abuse that has the most impact among homeless women. The effects of childhood physical abuse should be more actively investigated in clinical settings, especially those frequented by homeless women, particularly with respect to the formation of social networks in social contexts that may expose these women to greater risks.
    Child abuse & neglect 01/2012; 36(1):21-31. · 2.34 Impact Factor
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    ABSTRACT: To explore how people living with HIV (PLHIV) and in care encourage others to adopt HIV-protective behaviours, we conducted in-depth interviews with a purposive sample of 40 HIV clinic patients in Kampala, Uganda. Content analysis was used to examine the message content, trigger events, and outcomes of HIV-prevention advocacy events initiated by the HIV clients with members of their social networks. The content themes included encouraging specific behaviours, such as HIV testing and treatment, condom use and non-promiscuity, as well as more general cautionary messages about protecting oneself from HIV infection. Common triggers for bringing up HIV-prevention advocacy information in a discussion or conversation included: wanting to prevent the targeted person from 'falling into the same problems,' wanting to benefit oneself with regard to avoiding re-infection, out of concern that the target would engage in higher-risk behaviour, due to observed changes in the target's health, and to convey information after receiving treatment at the clinic. The participants mostly reported positive or neutral responses to these advocacy events; negative responses were rare. Interventions to empower PLHIV to be agents of change could represent a new frontier for HIV prevention.
    African Journal of AIDS Research 12/2011; 10(4):427-433. · 0.61 Impact Factor
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    ABSTRACT: Background: In order to generalize to the homeless youth population a probability sample is essential, yet few studies have attempted to obtain probability samples of homeless youth from a diverse array of settings in terms of types of sites and/or geographic areas. Methods: For a study on the relationship between the social context and risky behaviors in homeless youth, we designed and obtained a probability sample of 419 homeless youth from 15 shelters, 7 drop-in centers and 19 street hangouts located in four regions of Los Angeles County with the highest concentrations of homeless youth. Results: We describe a two-stages time-location sampling methodology, as well as key fielding strategies, that were adopted to obtain a large and representative probability sample of homeless youth. We also discuss how the study results would have differed if we had sampled the homeless youth from only a specific type of sites (e.g. only from shelters or only from street hangouts) or from only a narrower geographic area within Los Angeles County (e.g. only from Hollywood). Conclusions: Homeless youth that can be found in shelters differ considerably from youth that do not use shelters both in terms of demographic characteristics and rates of risky behaviors. Similarly, we found differences in the characteristics and behaviors of homeless youth across geographic regions. Our findings demonstrate how limiting the type of sites or geographic areas from which youth are sampled can considerably bias study results.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
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    ABSTRACT: This study used an event-based approach to understand condom use in a probability sample of 309 homeless youth recruited from service and street sites in Los Angeles County. Condom use was significantly less likely when hard drug use preceded sex, the relationship was serious, the partners talked about "pulling out", or sex occurred in a non-private place (and marginally less likely when heavier drinking preceded sex, or the partnership was monogamous or abusive). Condom use was significantly more likely when the youth held positive condom attitudes or were concerned about pregnancy, the partners talked about condom use, and the partners met up by chance. This study extends previous work by simultaneously examining a broad range of individual, relationship, and contexual factors that may play a role in condom use. Results identify a number of actionable targets for programs aimed at reducing HIV/STI transmission and pregnancy risk among homeless youth.
    AIDS and Behavior 08/2011; 16(6):1699-707. · 3.49 Impact Factor
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    ABSTRACT: Homeless men in the U.S. represent a large and growing population, and have elevated rates of HIV/AIDS and sexual risk behaviors, including unprotected sex with women. We conducted qualitative interviews (n = 30) with homeless men using shelters and meal lines in downtown Los Angeles (Skid Row) to better understand how such men view the risks of sexual encounters with female partners. Men living on Skid Row perceived multiple risks, including HIV and unwanted pregnancy as well as emotional trauma, loss of resources, exacerbation of drug addiction, and physical attack. Respondents described using visual and behavioral cues, social reputation, geographical location, feelings of trust, perceived relationship seriousness, and medically inaccurate "folk" beliefs to judge whether partners were risky and/or condom use was warranted. Medically inaccurate beliefs suggest the potential utility of evidence-based interventions to change such beliefs. We also consider implications for relationships on the street and housing interventions.
    AIDS and Behavior 06/2011; 16(3):774-84. · 3.49 Impact Factor
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    ABSTRACT: Previous research suggests that routinization of medication-taking behavior promotes antiretroviral therapy (ART) adherence. The current study explored the nature of medication-taking routines in the home environment, where medication is most often taken, to identify home-based cues for taking ART. Qualitative interviews were conducted in the homes of 31 HIV-positive adult males in the United States with varying levels of adherence problems. Interviews were audiotaped and transcribed. Content analysis was performed to elicit themes from the text and further categorize responses. Patients with more routinized medication-taking behavior reported fewer adherence problems. Home-based medication-taking triggers that were especially common among patients who reported fewer adherence problems included meals, pillboxes, time of day, and visual cues. Findings characterize the nature of home-based medication-taking routines and suggest the potential utility of the home environment as a setting for adherence interventions.
    Journal of the International Association of Physicians in AIDS Care (JIAPAC) 05/2011; 10(3):176-82.
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    ABSTRACT: Despite a decade's worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the findings and recommendations of this group, which include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions. Using these criteria and measuring and reporting contexts will improve the science of patient safety.
    Annals of internal medicine 05/2011; 154(10):693-6. · 16.10 Impact Factor

Publication Stats

853 Citations
177.01 Total Impact Points

Institutions

  • 2005–2013
    • RAND Corporation
      Santa Monica, California, United States
  • 2010
    • University of Pittsburgh
      • Division of General Internal Medicine
      Pittsburgh, Pennsylvania, United States
    • Makerere University
      • School of Women and Gender Studies
      Kampala, Kampala District, Uganda
  • 2008–2009
    • University of California, Los Angeles
      • • Department of Pediatrics
      • • Department of Medicine
      Los Angeles, CA, United States
    • Virginia Commonwealth University
      • Department of Psychology
      Richmond, Virginia, United States
    • Mount Sinai Hospital
      New York City, New York, United States