Lydia O'Donnell

Education Development Center · Health

Increasing care engagement is essential to meet HIV prevention goals and achieve viral suppression. It is difficult, however, for agencies to establish the systems and practice improvements required to ensure coordinated care, especially for clients with complex health needs. We describe the theory-driven, field-informed transfer process used to tr...

Using data from a regional census survey of high school students, we compared substance use patterns between transgender and cisgender students, and students who did not know if they are transgender (DKT). Data from more than 23,000 youth from 26 high schools were used to compare alcohol-related behaviors, marijuana use, and non-medical use of pres...

This study explores connections between inward‐directed violence and outward‐directed violence using data from the Reach for Health sample, which was originally recruited in the 1990s from three middle schools in economically distressed, predominantly African American neighborhoods of New York City. Now in their thirties, participants (N = 595) com...

Background Persons with human immunodeficiency virus (HIV) who get and keep a suppressed viral load are unlikely to transmit HIV. Simple, practical interventions to help achieve HIV viral suppression that are easy and inexpensive to administer in clinical settings are needed. We evaluated whether a brief video containing HIV-related health messages...

Huntsville clinic communication. (PDF)

Taking Care of Me de-identified study data file. (ZIP)

Background: Teen pregnancy rates and related risks remain elevated among Latino teens. We tested the impact on youth sexual behaviors of a brief, culturally targeted, bilingual media intervention designed for parents of young adolescents. Methods: Salud y éxito (Health & Success) uses dramatic audio stories to model positive parenting practices....

We investigated soldiers' conceptions of the causes, consequences, and treatment of common mental disorders. A vignette approach used to explore public beliefs was adapted to the military context, where heightened concerns about disclosure may impede timely recognition and response to problems. At three posts, 1,590 participants responded to a rand...

This study examined sexual-orientation differences in reports of outside- and within-school adult support, and whether sexual orientation moderates the associations between adult support and suicidality (i.e., thoughts, plans, and attempts). At 26 high schools across MetroWest Boston, 22,834 students completed surveys assessing: sexual orientation...

Background Few studies have assessed patients’ sexual behaviours during the period immediately following a new diagnosis of a curable sexually transmitted infection (STI). Methods Data were analysed from a behavioural study nested within the Safe in the City trial, which evaluated a video-based STI/HIV prevention intervention in three urban STI cli...

Schools are increasingly being called upon to address cyberbullying and its consequences. This study compares cyberbullying and school bullying trends and examines help-seeking among cyberbullying victims. We analyzed self-report data over 4 surveys (2006-2012) from more than 16,000 students in 17 MetroWest Boston high schools. Using generalized es...

Raising the tobacco sales age to 21 has gained support as a promising strategy to reduce youth cigarette access, but there is little direct evidence of its impact on adolescent smoking. Using regional youth survey data, we compared youth smoking trends in Needham, Massachusetts-which raised the minimum purchase age in 2005-with those of 16 surround...

Objectives: Previous studies have found social cognitive theory (SCT)-framed interventions are successful for improving condom use and reducing sexually transmitted infections (STIs). We conducted a secondary analysis of behavioural data from the Safe in the City intervention trial (2003-2005) to investigate the influence of SCT constructs on stud...

Background: Lesbian and bisexual (LB) girls, compared to heterosexual girls, are more likely to report psychosocial health problems, multiple sexual partners, sexually transmitted infections (STIs), and teen pregnancies. Syndemics, or the co-occurrence and interaction of psychosocial problems that exacerbate outcomes, have explained sexual risk beh...

HIV testing behavior is important in understanding the high rates of undiagnosed infection among Hispanic/Latino men who have sex with men (MSM). Correlates of repeat/recent testing (within the past year and ≥5 tests during lifetime) and test avoidance (never or >5 years earlier) were examined among 608 sexually active Hispanic/Latino MSM (Miami-Da...

Latino men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS, but few behavioral interventions address their prevention needs. Adaptation of evidence-based interventions is a pragmatic strategy that builds upon lessons learned and has the potential to fill gaps in prevention programming. Yet there are few reports of how transf...

Background: Structural-level condom distribution interventions or programs are efficacious in increasing condom use, increasing condom acquisition, and reducing incident STIs. While many community based agency staff have experience distributing condoms as part of their program activities, many feel isolated in their work and lack the knowledge and...

Background: Teen pregnancy rates among Latinos remain substantially higher than the national average, putting them at risk for adverse health, academic, and social outcomes. Tailored and culturally appropriate teen pregnancy prevention interventions have shown to be effective in reducing early sexual risk and other risky behaviors among youth. This...

BACKGROUND: Little is known about bystander behaviors in situations involving cyberbullying. In the digital world, where cyberbullying can be witnessed by hundreds of youth, how often do youth intervene and seek help from trusted adults? METHODS: 24,459 students completed the 2012 MetroWest Adolescent Health Survey, a regional census conducted in 2...

Increases in youth screen time have occurred across the socioeconomic spectrum as new digital media and mobile communication devices have become widely available. Because media use frequently involves sedentary activity, this trend has important health implications, particularly in poor communities where obesity rates are higher and access to safe...

Background: African American youth living in high poverty settings have higher rates of early sexual initiation and related behavioral risks associated with negative health and social outcomes into adulthood. Healthy Futures is a brief, low demand intervention for parents of young adolescents; it provides culturally tailored audio stories that mode...

BACKGROUND: Legislators are increasingly requiring schools to take action to reduce cyberbullying, even though it most often occurs outside of school. Our study aimed to understand efforts to address cyberbullying in the school environment in response to recent legislation, and their implications for social media approaches to encourage positive us...

BACKGROUND: New state legislation decriminalizing marijuana has brought attention to the issue of driving under the influence of marijuana. We compared how adolescents' perceptions and behaviors differ regarding driving under the influence of marijuana versus alcohol. METHODS: 24,459 students completed the 2012 MetroWest Adolescent Health Survey, a...

Introduction: Latino youth in the US have higher rates of earlier sexual initiation compared to white peers, placing them at increased risk for negative health, academic, and social outcomes. Ensuring that youth receive accurate information about sex is critical for promoting healthy decision making. This study documents the relationships between s...

Background Condom use consistency is influenced by factors including participant and partnership characteristics, sex acts and cognitive mediators. We aimed to: (1) assess condom use consistency among urban U.S. STD clinic users; (2) examine condom use patterns for anal and vaginal sex within partnerships; and (3) identify characteristics and cogni...

Background Online communities of practise have the potential to address multiple barriers to the broader dissemination and maintenance of evidence-based HIV/STI interventions. Addressing these barriers is critical to narrowing the gap between what researchers have identified as best practises and what gets delivered in communities to curb the sprea...

Background/Purpose: This study examines the relationship between sexting and physical dating violence victimization in teen heterosexual dating relationships. Methods: In Fall 2010, 23,187 students completed surveys in 24 high schools in MetroWest Boston. These analyses included youth who identified as heterosexual (90.7%) and who had dated in th...

Background/Purpose: In 2010, the MetroWest Adolescent Health Survey was completed by 23,187 high school students, including 1,681 who did not self-identify as heterosexual. This large sample provides data on relationships between known risks, like bullying victimization and psychological distress, and potential protective factors, like perceptions...

Introduction: This study examines the relationship between parenting practices and the obesity-related exercise and eating behaviors of young minority adolescents at increased risk of obesity. Methods: In 2009 and 2010, surveys were conducted with 852 seventh grade youth and their parents as part of the Healthy Futures study. Parent/youth dyads wer...

Introduction: This study documents the cyberbullying involvements of urban adolescents living in economically constrained settings where risks of other forms of youth violence are elevated and access to technologies is limited. It also examines the association of parenting practices on youths' reports of cyberbullying victimization and perpetration...

Background/Purpose: This study examines patterns of sexting behavior and its association with physical partner violence among heterosexually and nonheterosexually identified youth (NHY). Methods: In Fall 2010, 23,187 students were surveyed in 24 high schools in MetroWest Boston. Analyses included youth who dated in the past 12 months (76.9%). To...

Background/Purpose: We examined reports of alcohol and marijuana use and related driving behaviors among high school youth in Boston's MetroWest region. Significance: Understanding patterns in risky driving behaviors related to substance use among youth is important in informing education and prevention efforts of school-based health educators an...

The public health literature documents the efficacy-effectiveness gap between research and practice resulting from the research priority of demonstrating efficacy at the expense of testing for effectiveness. The Safe in the City video-based HIV/sexually transmitted infection (STI) prevention intervention designed for sexually transmitted disease (S...

Our research aims were to: (1) assess the prevalence of two condom use problems: breakage or slippage and partial use (delayed application or early removal) among men who have sex with men (MSM) seeking services in urban US STD clinics; and (2) examine the association between these condom use problems and participant, partner and partnership charac...

Using data from a regional census of high school students, we have documented the prevalence of cyberbullying and school bullying victimization and their associations with psychological distress. In the fall of 2008, 20,406 ninth- through twelfth-grade students in MetroWest Massachusetts completed surveys assessing their bullying victimization and...

Background/Purpose: The MetroWest Adolescent Health Survey is a multi-year regional initiative to provide communities with timely data on youth risk behaviors. To respond to local concerns, the survey includes questions on emerging issues, including sexting. Methods: In Fall 2010, a census of students was conducted in 24 of 26 high schools in the...

Background/Purpose: The MetroWest Adolescent Health Survey is a regional census that provides data on cyberbullying, school bullying, and associated help-seeking behaviors to inform the development of school-based, anti-bullying prevention programs and strategies. Methods: In Fall 2010, a census was conducted in 21 of 23 middle schools in the Met...

Background Condom use problems including breakage, slippage, or partial use (delayed application or early removal) jeopardise condom effectiveness. Our research aims were to: 1) assess the prevalence of condom use problems among urban US STD clinic users; 2) identify participant and partner characteristics and Behaviours associated with condom use...

Prevention providers wonder whether benefits achieved in the original, researcher-led, efficacy trials of interventions are replicated when the intervention is delivered in real-world settings by their agency's staff. A replication study was conducted at 2 public sexually transmitted disease (STD) clinics (New York City and San Juan, PR). Using a c...

Background/Purpose: The MetroWest Adolescent Health Survey is a multi-year regional initiative to provide communities with timely, local data on youth health and risk behaviors. Methods: MetroWest is a cluster of working- to upper-middle income cities and towns lying within a 25-mile radius west of Boston. In 2008, a census of students was conducte...

While positive parenting practices are associated with reduced adolescent risk taking for both males and females, there are marked differences in how parents monitor, communicate, and set rules with their sons and daughters. Working with community advisors and focus groups of youth and parents in inner-city schools serving low-income families in co...

Logic models can guide researchers and practitioners in the development, delivery, and evaluation of behavioral interventions. Despite their potential to provide a theory of action for guiding dissemination efforts, there are few models that depict the linkages between the initial uptake of an EBI and its subsequent diffusion to populations that mi...

This study evaluates the Especially for Daughters intervention, which aims to provide urban Black and Latino parents with information and skills to support their daughters in delaying sexual initiation and alcohol use. In a randomized field trial, 268 families with sixth-graders were recruited from New York City public schools and assigned either t...

We examined relationships between parenting status and multiple forms of violence perpetration among young adults in high-poverty environments. We analyzed data obtained from a survey of 990 young adults in New York City. Respondents reported on violence they had perpetrated toward themselves, intimate partners, and others. Associations between par...

This article addresses the challenge of developing HIV prevention interventions that not only prove to be efficacious but also are designed from the outset to overcome obstacles to reaching priority populations. We describe how community input has informed development of Keep It Up (KIU), a community health screening and behavioral prevention progr...

Intimate partner violence negatively impacts the health of substantial proportions of young women in economically disadvantaged communities, where sexual initiation, aggressive behaviors, unintended pregnancies and childbearing are common among adolescents. It is therefore important to assess how adolescent risk behaviors and pregnancy experiences...

This report summarizes efforts to develop and pilot test a protocol for collecting information about parent involvement policies, practices, and programs being implemented at the middle and high school levels. The protocol can be used to expand documentation of strategies selected, adapted, and sustained in future years. The study reviewed the lite...

Sexually transmitted disease (STD) prevention remains a public health priority. Simple, practical interventions to reduce STD incidence that can be easily and inexpensively administered in high-volume clinical settings are needed. We evaluated whether a brief video, which contained STD prevention messages targeted to all patients in the waiting roo...

There is a strong need for inexpensive, easily administered HIV and STD prevention interventions that are highly replicable and appealing to diverse clinic audiences. This article describes the four-step iterative and collaborative process used by the Safe City Study Group to design and develop a brief video-based intervention: Safe in the City. St...

Study Protocol (133 KB DOC)

CONSORT Checklist (49 KB DOC)

Description of the Safe in the City Video Intervention (43 KB DOC)

In urban economically distressed communities, high rates of early sexual initiation combined with alcohol use place adolescent girls at risk for myriad negative health consequences. This article reports on the extent to which parents of young teens underestimate both the risks their daughters are exposed to and the considerable influence that they...

This paper examines the interrelationships between urban young adult women's experiences of discrimination and community violence and their reports of involvement in intimate partner violence (IPV). We explore whether such experiences are independent risk factors for IPV victimization and perpetration, even when accounting for aggressive behaviors...

Despite evidence that some dropout prevention programs have positive effects, whether districts in the region are using such evidence-based programs has not been documented. To generate and share knowledge on dropout programs and policies, this report details a project to create a searchable database with information on target audiences, prevention...

What are the interrelationships between childhood and adolescent exposures to multiple forms of violence and subsequent young adult involvement in intimate partner violence (IPV) victimization and perpetration? This study uses longitudinal data from the Reach for Health study, in which a sample of 508 urban African American and Latina females was f...

As part of the Voices Against Violence middle-school prevention program, four hypothetical vignettes were developed to promote discussion about the roles of bystanders in preventing violence. Students were asked what actions they would take as a bystander if they witnessed violence or had information about potential violence. They were also asked w...

Background: In urban economically distressed communities, alcohol use combined with early sexual initiation place young females at risk of myriad negative health consequences. These risks are elevated for girls who reside in communities with high levels of HIV and other sexually-transmitted diseases. Although parental involvement is important throu...

Background: Especially for Daughters is an audio-CD parent education intervention that aims to provide urban parents with information and skills that will help their young adolescent daughters make healthy choices and, specifically, choose not to drink alcohol or engage in early sexual risk taking. Unlike adolescents in communities where alcohol in...

We examined smoking and smoking cessation among 538 young inner-city women who had been followed from early adolescence to young adulthood. Results showed that 14.3% of these young women had smoked in middle school, 26.4% had smoked in high school, and 21.9% had smoked at age 19 or 20 years, when many were rearing children, pregnant, or considering...

Young adolescents in communities with high rates of early sexual initiation are at risk of multiple negative health outcomes. Although sex education programs for this age group are often controversial, surveys document that many mothers and fathers would appreciate guidance about how to discuss sexuality with their children. This paper presents an...

This research examines psychological distress among 955 economically disadvantaged New York City residents surveyed during high school and again after the September 11th terrorist attacks (9/11), when they were young adults. As part of the longitudinal Reach for Health study, young adult surveys were conducted from 6-19 months post-9/11 (average 8...

Communities nationwide are under increasing pressure to adopt evidence-based interventions to address a range of public health problems, including intentional and unintentional injuries. This pressure is the result of a remarkable shift over the last decade in the number and stringency of requirements that practitioners are expected to meet when se...

This study examined the relationship between middle-school aggressive behaviors and young adults’ experiences as victims and perpetrators of intimate partner physical violence. As part of the Reach for Health longitudinal study, surveys were conducted with 977 8th graders who were resurveyed as young adults, when lifetime partner violence was asses...

Incidents of school violence have prompted calls for school communities to create environments that encourage student by-standers to act responsibly and proactively when they confront a range of violent incidents, from bullying and fights to weapon carrying and other serious threats to school safety. It is not always clear, however, what bystanders...

Urban 6th graders (n = 294) participate in a survey assessing early heterosexual risk behaviors as part of the Reach for Health Middle Childhood Study. About half the boys (47%) and 20% of girls report having a girlfriend or boyfriend; 42% of boys and 10% of girls report kissing and hugging for a long time. Stepwise regressions model the relationsh...

Public concerns about school shootings and safety draw attention to the role bystanders can play in preventing school violence. Although school violence prevention plans are often required, there is little guidance about whether these should address the roles of bystanders and what actions bystanders should take in different circumstances, from mor...

Initiation of sexual intercourse prior to high school is prevalent among inner-city black and Hispanic youths, and has multiple negative health and social consequences. A promising strategy for addressing early adolescent sexual activity is parent education that addresses normal pubertal changes and the challenges of becoming a teenager. A 2003-200...

To examine the association of aggressive behaviors during early adolescence with subsequent suicidality among inner-city males and females. Seven hundred sixty nine African-American and Latino males and females were surveyed about their involvement in aggressive behaviors in 8th grade and again during 11th grade, when suicidality was assessed. Logi...

CONTEXT: Initiation of sexual intercourse prior to high school is prevalent among inner-city black and Hispanic youths, and has multiple negative health and social consequences. A promising strategy for addressing early adolescent sexual activity is parent education that addresses normal pubertal changes and the challenges of becoming a teenager.ME...

As part of an HIV prevention study, 15-25 year-old young men who have sex with men (YMSM) were surveyed in community settings annually from 1999 to 2002. Data are presented from six comparison communities in the study; these communities recruited Latinos (Jackson Heights, NYC; San Gabriel Valley, CA), African Americans (Atlanta, GA); Asians/Pacific...

We examined relations between early alcohol use and subsequent alcohol and sexual risk behaviors among urban adolescents. A total of 1034 African American and Hispanic youths completed surveys assessing alcohol and sexual behaviors at 7th and 10th grade. After we controlled for early sexual initiation, we examined relations between early drinking a...

This research compares patterns of sexual behavior and sexual risk of bisexually- and gay-identified Latino young men who have sex with men (YMSM). Four hundred forty-one Latino YMSM were surveyed at community venues in New York City. Twenty-two percent of the sample identified as bisexual, and 78% identified as gay. Bisexually-identified men were...

For decades, suicide rates among minority African American and Latino young people have been stable and, when compared with Whites, relatively low. This is no longer the case, underscoring the need for documenting and understanding the problem of suicidality in this population. We report on the prevalence and predictors of suicidality among 879 urb...

For decades, suicide rates among minority African American and Latino young people have been stable and, when compared with Whites, relatively low. This is no longer the case, underscoring the need for documenting and understanding the problem of suicidality in this population. We report on the prevalence and predictors of suicidality among 879 urb...

We describe a community-based pilot study to boost HIV testing in a minority community through social network recruitment and a noninvasive HIV testing methodology. Over an 11-month period, the number of test takers at the intervention site increased by 71.7%, and the proportions of test takers with risk factors similar to those of peer recruiters...

To examine suicidality among urban youth and its relationship to patterns of adult support. Study surveyed 879 adolescents. Suicide ideation and attempts, perceived adult support, family and formal network availability, and network activation were assessed. Only half of those reporting a suicide attempt had spoken with an adult about their distress...

This study assessed whether sexual norms and attitudes expressed during early adolescence by minority youth from economically disadvantaged urban areas produce a sustained influence on the timing of sexual initiation. African American and Latino youth attending three middle schools were enrolled in the Reach for Health study in seventh grade and fo...

Culturally relevant prevention programs are required to reduce HIV risk exposure of Latino young men who have sex with men (YMSM). As part of Hermanos Jóvenes, 465 Latino YMSM were surveyed at community venues of New York City outside the gay-identified area of lower Manhattan. We examined factors that influence ethnic and gay community attachments...

Adolescent and young adult males who have sex with men (MSM) remain at high risk of HIV infection. Many sexual risk factors have been identified, yet the role of substance use remains controversial. We assess the extent to which urban young MSM report being "high" on drugs or alcohol during sex and the association between being "high" and unprotect...

To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade. During the fall of seventh grade and again in eighth grade, students were randomly assigned by classroom to participate eithe...

Since the 1980s, the age at which U.S. teenagers, especially minority youth, begin having sex has decreased. There is limited information on the relationship between early sexual initiation and subsequent risky sexual behaviors. A sample of 1,287 urban minority adolescents completed three surveys in seventh and eighth grade, and 970 completed a fol...

This study addressed methodological issues influencing the feasibility of time-space sampling in HIV prevention studies targeting hard-to-reach populations of minority young men who have sex with men (MSM). We conducted interviews with 400 men in 32 venues where young Latino MSM congregate in New York City. Response rates and demographic and sexual...

Decisions about the dissemination of HIV interventions need to be informed by evidence of their cost-effectiveness in reducing negative health outcomes. Having previously shown the effectiveness of a single-session video-based group intervention (VOICES/VOCES) in reducing incidence of sexually transmitted diseases (STD) among male African American...

This study examined the relationships between recency of immigration, substance use, and sexual behavior. Surveys were conducted with 2635 Massachusetts 8th and 10th graders that allowed comparisons of health behaviors and risk and protective factors among students living in the United States "always," more than 6 years, or 6 years or less. Compare...

This study assessed whether immigrant adolescents receive health education and services in schools at levels comparable to native-born peers. Surveys from 2,635 8th and 10th graders allowed comparisons between students living in the United States "always" (n = 2,080), "more than six years" (n = 299), and "six years or less" (n = 191). Immigrant stu...

: This study assessed whether immigrant adolescents receive health education and services in schools at levels comparable to native-born peers. Surveys from 2,635 8th and 10th graders allowed comparisons between students living in the United States “always” (n = 2,080), “more than six years” (n = 299), and “sixyears or less” (n = 191). Immigrant st...

Objectives: This study examines the association of beliefs about gender differences (frequently termed gender attitudes or attitudes about women in other research) and of beliefs specifically about masculinity to health risk behaviors in minority, urban, early adolescents, in light of the "gender conventionality" hypothesis. Methods: Data from a...