Christine M Markham

• PhD
• Professor at The University of Texas Health Science Center at Houston

Existing adverse childhood experience (ACE) measures include a limited number of household dysfunction (HD) items and the use of adult-oriented language that is not always appropriate for middle schoolers. We developed an age-appropriate 10-item HD measure informed by previously validated ACE measures and tested its concurrent validity with dating...

Adverse childhood experiences, such as household dysfunction (HD), play a central role in how adolescents establish, experience, and navigate the challenges of relationship formation, maintenance, and dissolution. HD exposures have been independently associated with dating violence (DV) perpetration in both adolescents and adults. However, research...

Introduction The United States has the highest teen pregnancy rate and sexually transmitted infection rates among developed countries. One common approach that has been implemented to reduce these rates is abstinence‐only‐until‐marriage programs that advocate for delaying sexual intercourse until marriage. These programs focus on changing adolescen...

Purpose: While cross-sectional studies have shown that teen dating violence (TDV) victimization is linked to sexual risk behavior (SRB), the pathway between these variables is not well-understood. To address this knowledge gap, we explore the mediating role of self-efficacy to refuse sex in the longitudinal relationship between physical TDV victimi...

Purpose: The COVID-19 pandemic mandates that were imposed to curb the spread of disease may have triggered unhealthy dietary behaviors among university students. The current study aims at exploring university students' perception of their dietary behaviors through the course of the pandemic. Methods: The qualitative study is designed using a phe...

Background Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL. Methods Project HOMES is an ongoing longit...

Previous research has revealed a strong link between the experience of childhood sexual abuse (CSA) and diabetes in adulthood. Moreover, research has shown that sexual minorities (SM) are exposed to adverse childhood experiences (ACEs) (i.e. CSA) and experience depression at higher rates than their heterosexual counterparts. Thus, it is imperative...

Being a victim of sexual violence (SV) is generally believed to be associated with subsequent sexual risk behavior (SRB) during adolescence. While this assumption makes intuitive sense, it is based on methodologically limited research, including a reliance on cross-sectional data. To address this gap in research, we test whether experiencing SV vic...

Background: Intervention effectiveness in a randomized controlled trial is attributed to intervention fidelity. Measuring fidelity has increasing significance to intervention research and validity. The purpose of this article is to describe a systematic assessment of intervention fidelity for VITAL Start (Video intervention to Inspire Treatment Ad...

Background Despite CDC recommendations for breast and cervical cancer screening and HPV vaccination, cancer control behaviors are underutilized among low-income Latinas. Salud en Mis Manos (SEMM), adapted from Cultivando La Salud , is a community health worker- (CHW-) delivered evidence-based intervention (EBI), shown to increase breast and cervica...

Background American Indian and Alaska Native (AI/AN) youth experience serious disparities in sexual and reproductive health, including the highest teen birth rate among racial/ethnic groups, and disproportionate rates of sexually transmitted infections (STI), including HIV. A growing number of evidence-based programs (EBPs) that integrate the stren...

The relationships that youth experiencing homelessness (YEH) have with supportive family members (i.e. those who provide them with social support) may be protective against risk behaviours and buffer adverse health outcomes. However, little is known about the nature of YEH's supportive family relationships and the type of social support that these...

Mental illness in adolescence is associated with high-risk sexual behaviors including multiple sex partners, infrequent or inconsistent condom use, and nonuse of contraception. Inpatient psychiatric care represents a promising setting to provide sexual health education. This pilot study investigates the feasibility and acceptability of online sexua...

Introduction: US school systems underwent major upheaval, including closures, implementation of virtual and/or hybrid learning, and stringent infection mitigation protocols, during the initial phase of the COVID-19 pandemic. We aimed to examine the association between food insecurity and perceived health, perceived stress, and social determinants...

Me & You: Building Healthy Relationships (Me & You) is a multilevel, technology-enhanced adolescent dating violence (DV) prevention program that aimed to reduce DV among ethnic-minority, early adolescent, urban youth. A group-randomized control trial of Me & You, conducted with 10 middle schools from a large urban school district in Southeast Texas...

Background Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of...

Introduction Teaching is a stressful occupation due to high-stake job demands and limited resources, which were exacerbated during the initial phase of the COVID-19 pandemic. Our study assessed the prevalence of perceived stress and explored its predictors among elementary school teachers employed at schools serving predominantly low-income populat...

Purpose The purpose of this study was to develop and characterize the relevance and potential utility of an electronically delivered acceptance- and mindfulness-based approaches to physical activity promotion for insufficiently active breast cancer survivors. Methods The acceptance- and mindfulness-based physical activity intervention was delivere...

BACKGROUND Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of...

Abstract Background Parents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV) vaccination. Nurses are on the frontlines of healthcare and play a critical role in promoting HPV vaccination and parent-child sexual health communication. We enhanced the Families Talking Together (FTT) parent-based sexual health curriculum t...

We identified factors associated with student nurses’ Human Papillomavirus Vaccine (HPV) vaccination status and their intention to counsel parents on HPV vaccination. Undergraduate student nurses (N = 153) from a large university in the south participated. Descriptive statistics, chi-squared tests, and independent t-tests (p ≤ 0.05) were used to ch...

VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of d...

Using data from a cross-sectional sample of seventh to twelfth graders who attended northeastern schools between 2011 and 2012, we examined the associations between psycho-emotional dating violence and cyber, physical, and sexual violence Overall, we found that respondents experienced more than one type of dating violence simultaneously, indicating...

The shift in the technology landscape has altered the technology ecosystem of adolescents and emerging adults in the 21st century. Yet, with greater use of digital gadgets comes greater mental health risks that technological advancement brings. This study provides a narrative review of contemporary cyber risks faced by adolescents and emerging adul...

Background: Parents play a pivotal role in adolescent sexual health and HPV vaccination. Nurses are on the frontlines of healthcare and play a critical role in promoting HPV vaccination and parent-child sexual health communication. We enhanced the Families Talking Together (FTT) parent-based sexual health curriculum to include adolescent vaccinatio...

Background: Parents play a pivotal role in adolescent sexual health and Human Papillomavirus (HPV) vaccination. Nurses are on the frontlines of healthcare and play a critical role in promoting HPV vaccination and parent-child sexual health communication. We enhanced the Families Talking Together (FTT) parent-based sexual health curriculum to includ...

Using data from a nationally representative sample of school-aged teens ( n = 795), this study examined covariates associated with three subtypes of dating violence victimization (physical violence, emotional abuse, and imposed isolation). We asked the research questions: What were the family factors, dating attitudes, and risky behaviors associate...

BACKGROUND Early adolescent sexual behavior is a significant public health problem in the United States. Parental influence can help to delay sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to youth while engaging parents an...

Background Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related...

BACKGROUND Although schools often implement evidence‐based sexual health education programs to address sexual and reproductive health disparities, multiple factors may influence program effectiveness. METHODS Using student‐reported perceived impact measures as a proxy for program effectiveness, we employed a socio‐ecological approach to examine st...

Little is known about human papillomavirus (HPV) vaccination uptake among youth experiencing homelessness (YEH), who may be at higher risk for HPV than their housed counterparts. We examined the prevalence and associations of HPV vaccination initiation and completion among YEH. Guided by the Behavioral Model for Vulnerable Populations, we analyzed...

Access to healthcare services is critical for youth experiencing homelessness (YEH) given their high risk of experiencing adverse physical and mental health outcomes. Previous studies have identified factors that impact YEH’s access to healthcare services from the perspective of YEH, but less is known from the perspective of providers. The purpose...

Background Food preparation interventions are an increasingly popular target for hands-on nutrition education for adults, children, and families, but assessment tools are lacking. Objective data on home cooking practices, and how they are interpreted through different data collection methods, are needed. Objective The goal of this study was to exp...

Purpose Increased cardiovascular disease and second cancer risks among childhood cancer survivors (CCS) makes them and their families important audiences for nutrition intervention. Family meals and home cooking practices have been associated with improved diet and health, but there is a gap in the literature on understanding these behaviors and th...

Background: Improving maternal antiretroviral therapy (ART) retention and adherence is a critical challenge facing prevention of mother-to-child transmission (PMTCT) of HIV programs. There is an urgent need for evidence-based, cost-effective, and scalable interventions to improve maternal adherence and retention that can be feasibly implemented in...

Objective Survival rates for paediatric cancers have increased dramatically since the 1970s, but childhood cancer survivors (CCS) are at increased risk for several chronic diseases throughout life. Nutrition interventions promoting healthy family meals may support wellness for survivors, but little research has explored CCS family food preparation...

This paper has two main aims: (1) to describe the design, implementation, and testing of a protocol to assess longitudinal changes in F&V plate waste conducted as part of a quasi-experimental study, (2) to provide baseline descriptive data on school demographics and study participants. This paper describes the protocol development and implementatio...

Objective: To determine the preliminary impact of the Brighter Bites nutrition intervention on decreasing fruit and vegetable (F&V) waste at school lunches among fourth- and fifth-grade children. Method: This was a nonrandomized pre-post-controlled study in Houston and Dallas, TX. Two schools received the Brighter Bites intervention (n = 76), an...

Objectives. To test the efficacy of Me & You, a multilevel technology-enhanced adolescent dating violence (DV) intervention, in reducing DV perpetration and victimization among ethnic-minority early adolescent youths. We assessed secondary impact for specific DV types and psychosocial outcomes.Methods. We conducted a group-randomized controlled tri...

Evidence-informed health intervention planning that incorporates theoretical and empirical evidence and engages key stakeholders and community members or patients in the planning process results in interventions that are more effective. Nevertheless, exactly how and when to use evidence, theory, and community-based participation during planning rep...

This study examines the role of poverty in the acquisition of and the adherence to antiretroviral therapy (ART) and prescribed clinical follow-up regimens among HIV-positive women. We conducted in-depth interviews with 40 women living with HIV (WLHIV) in Ghana and 15 stakeholders with a history of work in HIV-focused programs. Our findings indicate...

Background: The ultimate impact of a health innovation depends not only on its effectiveness but also on its reach in the population and the extent to which it is implemented with high levels of completeness and fidelity. Implementation science has emerged as the potential solution to the failure to translate evidence from research into effective p...

Despite the recent efforts of the Office of Adolescent Health to replicate programs with demonstrated efficacy, there are still few evidence-based HIV, sexually transmitted infection (STI), and teen pregnancy prevention programs that have been replicated in “real-world” settings. To test the effectiveness of It’s Your Game…Keep It Real! (IYG), an e...

Purpose The objective of the study was to examine whether latent class analysis (LCA) could (1) identify distinct subgroups of youth characterized by multiple risk and protective factors for early sexual initiation and (2) allow for a more nuanced assessment of the effects of a middle school program to prevent teen pregnancy/HIV/sexually transmitte...

Tribal health educators across the United States have found it challenging to locate engaging, culturally-relevant sexual health curricula for American Indian and Alaska Native (AI/AN) youth. Healthy Native Youth is a new online resource that provides a “one-stop-shop” for tribal health advocates to access age-appropriate curricula. The site was de...

Objectives Intravaginal practices (IVPs) include washing, wiping, or inserting something inside the vagina. This study investigates the associations between IVPs and genital human papillomavirus (HPV) infection. Methods We conducted a cross‐sectional study of 200 female sex workers aged 18–35 years in Phnom Penh, Cambodia from August–September 201...

Introduction: HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation. Methods: The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of a...

Background Admission into an intensive care unit (ICU) may result in long-term physical, cognitive, and emotional consequences for patients and their relatives. The care of the critically ill patient does not end upon ICU discharge; therefore, integrated and ongoing care during and after transition to the follow-up ward is pivotal. This study descr...

Purpose: Successful implementation of sexual health curricula in school settings is often compromised by competing academic priorities. This study explores the association between exposure to sexual health lessons (time-on-task in hours and lesson content topics) and delayed sexual initiation of middle school students at long term follow-up. Method...

Background- Due to the lack of interventions on sexual and reproductive health for older teen males of color engagement with the target population is critical for intervention development. Be Legendary (BL) was developed using intervention mapping, design thinking strategies and participatory methods alongside African-American male high school stud...

Background: In emerging adulthood, youth often become involved in more serious romantic relationships. However, many lack the skills to avoid an unplanned pregnancy or sexually transmitted infection (STI), and to ensure a healthy dating relationship. Community college students serve nearly half of all undergraduate students in the United States; ye...

Background: Racial/ethnic-minority 9th graders are at increased risk for teen pregnancy, HIV, and STIs compared to their White peers. Yet, few effective sexual health education programs exist for this population. Purpose: To apply IM Adapt—a systematic theory- and evidence-based approach to program adaptation—to modify an effective middle school se...

Background: Much of the research literature on sexual consent and sexual consent education has been focused on college students, providing a significant gap in our understanding of high school students, especially ethnic minority youth, who are at greatest risk for unwanted sexual contact and sexual activity. Furthermore, recent research suggests t...

Background: Few HIV/STI and pregnancy prevention programs for youth in American Indian and Alaska Native (AI/AN) communities have been rigorously evaluated despite sexual health disparities in this population. This study reports the evaluation of a culturally adapted Internet-based HIV/STI and pregnancy prevention program for AI/AN youth, Native It...

A food waste problem coexists with food insecurity and obesity. Brighter Bites, a school-based food cooperative program, successfully channels primarily donated produce to low-income communities and provides nutrition education, creating an increased demand for and intake of fruits and vegetables. We present the framework used in Brighter Bites and...

Drug stock-outs are an unfortunate yet common reality for patients living in low and middle income countries, particularly in sub-Saharan Africa where trouble with consistent stock of antiretroviral medications (ARVs) continues. Our study takes a snapshot of this problem in Ghana. Although the country launched its antiretroviral therapy (ART) progr...

Hispanic families are at elevated risk for certain diet related illnesses including obesity and diabetes. Brighter Bites is a 16-week school-based program that delivers produce and nutrition education to high-need areas. The purpose of this study was to explore the adoption of Brighter Bites healthy eating strategies in low-income Spanish-speaking...

Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN...

Background: Food co-op models have gained popularity as a mechanism for offering affordable, quality produce. We describe the challenges, successes, and lessons learned from implementation of a school-based program using a food co-op model combined with nutrition education to improve access to and intake of fresh fruits and vegetables among low-in...

Despite the sizable population of military-dependent youth (MDY) in the United States and the military stressors they experience (e.g., relocations, parental deployment), little is known about MDY’s sexual behavior, especially about the perceived role that military stressors play in their sexual decisions, such as the decision to initiate sex. We c...

Much is known about the prevalence and correlates of dating violence, especially the perpetration of physical dating violence, among older adolescents. However, relatively little is known about the prevalence and correlates of the perpetration of cyber dating abuse, particularly among early adolescents. In this study, using a predominantly ethnic-m...

Introduction: Diffusion of sexual health evidence-based programs (EBPs) in schools is a complex and challenging process. iCHAMPSS ( CHoosing And Maintaining effective Programs for Sex education in Schools) is an innovative theory- and Web-based decision support system that may help facilitate this process. The purpose of this study was to pilot-te...

Background American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isola...

Although disclosure of positive HIV status has recognized benefits, enacted and perceived stigma is a continuing problem in Ghana, especially affecting women living with HIV (WLHIV). This qualitative study investigates how WLHIV make these decisions. We interviewed 40 WLHIV, analysing their transcripts using thematic content analysis. Four themes e...

Borrowing insights from concepts that have been shown to predict deviant or criminal outcomes (i.e., social bonding, personal control, and strain), this study examined dating violence from the perpetrators’ and gender-relevance perspective among young college students (18–25 years old). This study raised 2 research questions: Were social bonding, p...

Background: The conceptualization and measurement of gender-based relations and equity are still challenging to researchers worldwide. Given a growing number of health studies which want to take into account the roles of gender relations, there is a need for quantitative measures of this determinant. Objectives: Based on the theory of gender and po...

Using data from the Relationship Dynamics and Social Life Study, this study examined the association of peer, family, attitudinal, aspirational, and attainment factors relevant to 820 young women's (aged 18-19) number of sexual partners. Overall, this study found that perceived peer norms and early onset of sexual initiation had a positive and stat...

The purpose of this study was to evaluate the effectiveness of a new school-based food co-op program, Brighter Bites (BB), to increase fruit and vegetable intake, and home nutrition environment among low-income 1st graders and their parents. This was a non-randomized controlled comparative effectiveness trial (2013-2015). Six schools received BB (n...

Intravaginal practices (IVPs) are associated with several adverse health outcomes, including HIV infection. However, few studies have examined this topic in Asian cultures, particularly in female sex workers (FSWs). This theory-based qualitative study aimed to describe the IVPs and to identify salient determinants of these practices in FSWs in Phno...

Objectives: The objective of this study was to examine the association between obesity and all-cause mortality, length of stay and hospital cost among patients with sepsis 20 years of age or older. Materials and methods: It was a retrospective cohort study. The dataset was the Nationwide Inpatient Sample 2011, the largest publicly available all-...

Purpose: Adolescent and young adult (AYA)-aged central nervous system (CNS) tumor survivors are an understudied population that is at risk of developing adverse health outcomes, such as obesity. Long-term follow-up guidelines recommend monitoring those at risk of obesity, thus motivating the need for an eating behavior questionnaire. An abbreviate...

Objectives: While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts. Design and sample: Employing a m...

Using data from the International Dating Violence Study, this study examined the roles of early socialization, family social structure, and relationship dynamics factors on physical aggression in dating among U.S. college students in emerging adulthood. The interaction effects between these three domains of interest (early socialization, family soc...

Purpose: Research shows that rap music use is associated with risky sexual behavior in ethnic minority youth; however, it is unknown whether rap music use impacts sexual initiation specifically and, if so, which factors mediate this impact. Thus, we investigated the longitudinal relationship between hours spent listening to rap music in seventh gr...

Causes for loss-to-follow-up, including early refusals of and stopping antiretroviral therapy (ART), in Malawi's Option B+ program are poorly understood. This study examines the main barriers and facilitators to uptake and adherence to ART under Option B+. In depth interviews were conducted with HIV-infected women who were pregnant or postpartum in...

Background Effective control of sexually transmitted infections (STIs) depends on affected patients notifying their sexual partners, and partners following through with screening and treatment. Our study assessed high-risk-STI women’s confidence in STI-diagnosis-related communications with their primary male partners in Ho Chi Minh City, Vietnam, a...

Concurrent infection with multiple types of Human Papillomavirus (HPV) is associated with an increased risk of cervical cancer; yet, little is known about risk factors for concurrent HPV infection in Vietnam. This study investigated the prevalence of and risk factors for high-risk-type HPV and multi-type HPV infections among women in Ho Chi Minh Ci...

American Indian and Alaska Native (AI/AN) youth experience disparities associated with sexual and reproductive health, including early age of sexual initiation. Identifying factors that are most proximally related to early sexual intercourse and that are modifiable through health promotion interventions may help to reduce these disparities. Using a...

Although sexual behaviors have been extensively studied among youth in general, they have been relatively understudied among military-dependent youth (MDY). Furthermore, the impact of unique military stressors, such as parental deployment and multiple relocations, on the sexual behaviors of MDY has not been assessed. In this pilot study, we estimat...

Background: Cigarette smoking is increasingly recognized as a predictor for inferior adherence to antiretroviral therapy (ART) among HIV-positive patients. Given the limited body of work on this issue, this study aimed to explore the impact of cigarette smoking and nicotine dependence on ART adherence in Vietnam. Methods: A cross-sectional study of...

In this paper, we introduce the IM taxonomy of behavior change methods and its potential to be developed into a coding taxonomy. That is, although IM and its taxonomy of behavior change methods are not in fact new, because IM was originally developed as a tool for intervention development, this potential was not immediately apparent. Second, in exp...

Objectives-This study aimed to examine the relationship between self-reported oral health, oral hygiene practices, and oral human papillomavirus (HPV) infection among women at risk for sexually transmitted infections in Ho Chi Minh City, Vietnam. Study design-Convenience and referral sampling methods were used in a clinic-based setting to recruit 1...

Intake of fruits and vegetables (F&V) continues to be low in children in the United States. The purpose of this study was to conduct a pilot feasibility evaluation of Brighter Bites, a school-based food co-op to provide access to fresh F&V and nutrition education to low-income children and their families. Brighter Bites is a 16-week school-based fo...

Background Evidence regarding whether male partners’ characteristics can influence women’s likelihood of getting sexually transmissible infections (STIs) is insufficient and inconsistent. Our study examined associations between women’s perception of primary male partners’ demographic and behavioural characteristics and women’s history of bacterial...

Background: Smoking cessation is emerging as an important component in current HIV care to reduce smoking-related adverse health outcomes. This study aimed to examine motivation to quit and its associated factors in a sample of 409 HIV-positive smokers in Vietnam. Methods: A cross-sectional survey was conducted from January to September 2013 in H...

Objectives: Sexual health discussions between parents and their preadolescent youth can delay sexual debut and increase condom and contraceptive use. However, parents frequently report being uncomfortable talking with their youth about sex, often reporting a lack of self-efficacy and skills to inform and motivate responsible decision making by yout...

This study aimed to examine the relationships among self-reported oral health, oral hygiene practices, and oral human papillomavirus (HPV) infection in women at risk for sexually transmitted infections (STIs) in Ho Chi Minh City, Vietnam. Convenience and referral sampling methods were used in a clinic-based setting to recruit 126 women aged 18-45 y...

Few computer-based HIV, sexually transmitted infection (STI), and pregnancy prevention programs are available, and even fewer target early adolescents. In this study, we tested the efficacy of It's Your Game (IYG)-Tech, a completely computer-based, middle school sexual health education program. The primary hypothesis was that students who received...

Cigarette smoking presents a salient risk for HIV-positive populations. This study is among the first to examine smoking prevalence, nicotine dependence, and associated factors in a large sample of HIV-positive patients receiving antiretroviral therapy (ART) in Vietnam. A cross-sectional study of 1133 HIV-positive people was conducted from January...

CONTEXTParent-based adolescent sexual health interventions aim to reduce sexual risk behaviors by bolstering parental protective behaviors. Few studies of theory use, methods, applications, delivery and outcomes of parent-based interventions have been conducted.METHODSA systematic search of databases for the period 1998–2013 identified 28 published...