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

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


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

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    • "To evaluate the effectiveness of HIV Prevention Project in reducing HIV high-risk sexual behavior of detained youth 196 youth detainees Participants demonstrated an increase in the ability to recognize risky behaviors However, the participants demonstrated no commitment to change their behaviors Schmiege et al. (2011) To examine the association between positive outlook and social cognitive constructs that are relevant to condom use "
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    ABSTRACT: Youth involved in the juvenile justice system report significantly higher rates of STI/HIV infections, compared to youth in the general population. A limited number of epidemiological studies document that social–ecological factors at the peer, family, school, and policy levels are significantly related to unsafe sexual behaviors among this population. However, no existing studies have evaluated the extent to which existing STI/HIV intervention approaches target the various social–ecological factors that are implicated in STI/HIV risk behaviors among this cohort. Applying the social–ecological framework, we review research on STI/HIV prevention and intervention programs, which targeted family, peers, and school contexts of children and adolescent involved in the juvenile justice system. Our findings suggest that these youth report significantly higher rates of STI than do those with no juvenile justice involvement. However, we also found that a bulk of the programs reviewed have targeted individual risk factors as the primary target for behavior change, even though contextual factors beyond the individual are implicated in sexual behaviors. We conclude with implications for research and practice based on this review.
    No preview · Article · Sep 2015 · Journal of Child and Family Studies
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    • "Low future outlook—perceived limited expectations for future advancement and prosperity in education, employment, and social status—has been associated with sexual risk in economically-deprived environments and often assessed via ethnographic research methods. In instances where quantitative approaches are employed, the focus has been on males (Kagan et al. 2012), incarcerated youth (Schmeige et al. 2011), youth in psychiatric institutions or demonstrating severe mental distress (Cotton and Rangle 1996; Kazdin et al. 1983; McLaughlin et al. 1996; Reifman and Windle 1995), a broad crosssection of socioeconomic conditions (Kashani et al. 1997), or violent consequences of low future outlook or hopelessness (Bolland et al. 2001; DuRant et al. 1994, 1995). One recent study by Sipsma and colleagues (Sipsma et al. 2013) addressed the limitation of previous research on the effects of future expectations on sexual risk behavior. "
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    ABSTRACT: African American women at increased risk of HIV/sexually transmitted infection (STI) may engage in risky sex as a coping mechanism for depressed economic conditions. This study examines the association between high-risk sexual behavior and structural determinants of sexual health among a sample of young African American women. 237 young African American women (16-19 years old) from economically disadvantaged neighborhoods in North Carolina were enrolled into a randomized trial testing the efficacy of an adapted HIV/STI prevention intervention. Logistic regression analyses predicted the likelihood that young women reporting lack of food at home, homelessness and low future prospects would also report sexual risk behaviors. Young women reporting a lack of food at home (22 %), homelessness (27 %), and low perceived education/employment prospects (19 %) had between 2.2 and 4.7 times the odds as those not reporting these risk factors of reporting multiple sex partners, risky sex partners including older men and partners involved in gangs, substance use prior to sex, and exchange sex. Self-reported structural determinants of sexual health were associated with myriad sexual risk behaviors. Diminished economic conditions among these young women may lead to sexual risk due to hopelessness, the need for survival or other factors.
    Full-text · Article · Aug 2014 · American Journal of Community Psychology
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    • "However, the participants demonstrated no commitment to change their behaviors Schmiege et al. (2011) To examine the association between positive outlook and social cognitive constructs that are relevant to condom use "

    Full-text · Article · Jan 2014 · Journal of Child and Family Studies
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