[Show abstract][Hide abstract] ABSTRACT: Background: Adults who experience abuse as children have a higher use of medical health services in adulthood compared to those not abused. However, among children, those who experience abuse have lower immunization rates and are less likely to have a primary care provider. We examined the relation between child abuse and health service use among Puerto Rican children.
Methods: Parents and children participating in the Boricua Youth Study, a longitudinal study of Puerto Rican youth residing in the Bronx, NY (N=1116) and San Juan, Puerto Rico (N=1339) completed reports of child physical, sexual and emotional abuse. Parents reported if the child had visited a doctor, hospital or clinic because the child was ill, was injured or for routine care.
Results: Mean age was 9 years and 51% were boys, 26% of children in NY reported abuse vs. 23% in PR. Models were stratified by site and adjusted for sociodemographic factors. In PR, children who experienced one type of abuse (OR 1.6 95% CI 1.1, 2.3) or two or more (OR 1.9 95%CI 1.1, 3.2) were more likely to report an injury visit. In the Bronx, children who experienced two or more types (OR 2.0 95%CI 1.1, 3.6) were more likely to report an illness visit. No relation between child abuse and routine service use was noted in either site.
Conclusion: Whether for illness or injury, children who experience abuse, frequently come in contact with health care providers, presenting opportunities for intervention and the prevention of further abuse.
[Show abstract][Hide abstract] ABSTRACT: The process of creating a geographically tailored health information website with ongoing feedback from community members is one of inquiry and discovery, frustration and triumph, and development and reevaluation. This article reviews the development and implementation of GetHealthyHarlem.org, a health literacy level-appropriate consumer health information website tailored to consumers in Harlem, New York City. From 2004 to 2009, the Harlem Health Promotion Center, one of 37 Prevention Research Centers in the United States, sought to determine the use and seeking of online health information in Harlem, New York City in order to further explore the possibility of providing online health information to this community. Specifically, this article details how we sought to identify gaps, concerns, and uses of online health information and health care seeking in this local, predominantly racial and ethnic minority population. We review how we identified and addressed the multitude of variables that play a role in determining the degree of success in finding and using online health information, and include discussions about the genesis of the website and our successes and challenges in the development and implementation stages.
Full-text · Article · Apr 2014 · Health Promotion Practice
[Show abstract][Hide abstract] ABSTRACT: Purpose:
This study sought to evaluate HIV testing locations in New York City in terms of staff communication of confidentiality policies for adolescent clients.
Using the New York State Directory of HIV Counseling and Testing Resources as a sampling frame, this study made telephone contact with 164 public HIV testing locations in New York City and used a semistructured interview to ask questions about confidentiality, parental permission, and parent access to test results.
At 48% of locations, either HIV testing was not offered or we were unable to reach a staff member to ask questions about testing options and confidentiality. At the remaining sites, information provided regarding confidentiality, parental consent, and privacy of test results was correct only 69% to 85% of the time. Additionally, 23% of sites successfully contacted offered testing exclusively between 9:00 a.m. and 3:00 p.m. weekdays, when most adolescents are in school.
Our findings point to a need for increased training and quality control at the clinical level to ensure that consumers in need of HIV testing are provided with accurate information and accessible services. Furthermore, these results highlight the need for more "patient-centric" sites with enhanced accessibility for potential clients, particularly youth.
No preview · Article · Aug 2013 · Health Promotion Practice
[Show abstract][Hide abstract] ABSTRACT: Background: The Internet has potential as a vehicle for health communication and support, although it is often difficult to gauge its impact on health outcomes. Researchers and community members created a community, health-focused website with social networking capabilities aimed at increasing health knowledge and participation in healthy behaviors, thus leading to decreased risk for chronic disease. Objective/purpose: Our objective was to assess the website's ability to reinforce user capacity to enhance personal health through improved knowledge and increased intent and ability to take action on health conditions related to nutrition and exercise. Methods: Researchers employed a pre-post survey design to measure use of the website and assess changes in knowledge, attitude and behavioral intent after exposure to the site. Adult volunteers enrolled through in-person community recruitment completed an initial baseline survey, received a virtual tour as an introduction to the site, and completed a follow up survey three to six months after the initial survey. Results: A total of 146 participants completed both initial and follow-up surveys. Of those who visited the site, 92% reported that it was very or somewhat easy to find health information. Further, 96% and 92% reported that they understood and trusted, respectively, all or some of the information they found, and 73% rated the website as excellent or very good. However, there was no significant change found in knowledge, attitudes or behavioral intent after exposure to the site. Discussion/conclusions: With social networking aspects combined with validated and trusted sources of health information, the community website has potential to exist as a dynamic environment capable of bridging the complex interplay between health and the multiple levels of the individual, community and society. However, further research is necessary to more fully describe the site's ability to affect short-term and longer-term outcomes.
[Show abstract][Hide abstract] ABSTRACT: Background
Multiple studies have been done on adult men who have sex with men (MSM), but no studies have shown the rates of extragenital site sexually transmitted infections (STIs) among HIV positive young men who have sex with men (YMSM). The objective of this study was to document the rates of extragenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection among HIV positive YMSM while conducting a validity study for the use of nucleic acid amplified tests (NAATs), to detect extragenital GC and CT.Methods
Behaviorally infected HIV positive YMSM were enrolled in this study from one urban adolescent HIV clinic, and were screened for urine and extragenital site GC and CT over a 2 year period. Samples from these sites (pharyngeal and rectal) were tested for GC and CT using both traditional culture media and NAAT technology. Urine was tested using only NAAT.ResultsOf 67 screenings, 36% (n = 24) yielded at least one positive, and 69% of participants (18/26) had at least one positive GC or CT test result during the study period. Of those with at least one positive result, 89% (16/18) had at least one extragenital site infection. Urine testing was positive in 11% (2/18) of those with a corresponding extragenital site infection. None of the extragenital CT infections detected by NAATs were detected by culture, and only 38% (5/13) of the extragenital GC infections detected by NAATs were detected by culture.Conclusions
Use of NAATs for extragenital STI screening yielded more confirmed positive results than did traditional cultures. By use of NAATs, the majority of routinely screened HIV positive YMSM in this sample was found to have an STI at an extragenital site.
No preview · Article · Jun 2012 · American journal of men's health
[Show abstract][Hide abstract] ABSTRACT: Over the past decade, new technology and media have changed the way we communicate, access information, and share content with one another. Most 12- to 17-year-olds now own cell phones, and most adolescents and young adults spend several hours per day on computers and cell phones. The American Academy of Pediatrics now encourages all pediatricians to increase their knowledge of new media and technology. This article details technology access among adolescents and young adults, highlights several current and potential innovative applications for new technology and social networking in health promotion, and discusses issues to consider as practitioners move toward integrating new media into clinical and health education settings.
Full-text · Article · Dec 2011 · Adolescent medicine: state of the art reviews
[Show abstract][Hide abstract] ABSTRACT: Adolescent and young adult males, especially those who are economically and socially marginalized, need greater access to "male-friendly" health services. Engaging young males in health education and clinical services is challenging but feasible and is of vital importance not only for young men, but also their families, their communities, and the nation. Health and social service providers can play vital roles in promoting the health and well-being of young men by developing mutually respectful collaborations that break down the silos separating medical, educational, juvenile justice, social service, and other systems. We present the interdisciplinary clinic- and community-based initiatives developed by Columbia University Mailman School of Public Health and New York-Presbyterian Hospital that connect young males to clinical and health education services and empower them to choose behaviors that promote their health. We describe our "empowerment approach" to working with young men that recognizes the powerful influence of gender on utilization of health services, emphasizes the importance of a strengths-based perspective, and reframes the context of help seeking from passive participation to active engagement.
No preview · Article · Dec 2011 · Adolescent medicine: state of the art reviews
[Show abstract][Hide abstract] ABSTRACT: Computer use, Internet access, and online searching for health information were assessed toward enhancing Internet use for health promotion.
Cross-sectional random digit dial landline phone survey.
Eight zip codes that comprised Central Harlem/Hamilton Heights and East Harlem in New York City.
Adults 18 years and older (N=646).
Demographic characteristics, computer use, Internet access, and online searching for health information.
Frequencies for categorical variables and means and standard deviations for continuous variables were calculated and compared with analogous findings reported in national surveys from similar time periods.
Among Harlem adults, ever computer use and current Internet use were 77% and 52%, respectively. High-speed home Internet connections were somewhat lower for Harlem adults than for U.S. adults overall (43% vs. 68%). Current Internet users in Harlem were more likely to be younger, white vs. black or Hispanic, better educated, and in better self-reported health than non-current users (p<.01). Of those who reported searching online for health information, 74% sought information on medical problems and thought that information found on the Internet affected the way they eat (47%) or exercise (44%).
Many Harlem adults currently use the Internet to search for health information. High-speed connections and culturally relevant materials may facilitate health information searching for underserved groups.
Full-text · Article · May 2011 · American journal of health promotion: AJHP
[Show abstract][Hide abstract] ABSTRACT: Understanding the sexual risk behaviors of youths living with HIV/AIDS is critical to secondary prevention of HIV. As part of a larger qualitative study of youths living with HIV, in-depth interviews were conducted with 27 African American and Latino, HIV-infected young men who have sex with men, aged 16-24 years, living in New York City. The study explored the role of substance use, the social-sexual-environmental, and psychological contexts in which sexual risk behaviors occurred. Since learning of their HIV infection, the majority of participants had reduced their risky sexual behaviors; however, a subset (26%) of participants continued to have unprotected sex, in most cases with multiple partners. Substance use, the social environmental context of the sexual encounter, the psychological impact of HIV on sexual behavior, and partner characteristics were associated with high-risk sexual behaviors in this group. Among high-risk participants, factors associated with risky sexual behaviors clustered, with 57% reporting two or more factors. More intensive interventions are needed for this subset of youths living with HIV, including assessment and treatment for substance use and mental health issues, strategies for stress reduction, and partner interventions.
Full-text · Article · Feb 2011 · AIDS patient care and STDs
[Show abstract][Hide abstract] ABSTRACT: Background: The Internet is an increasingly important source of health information for diverse populations. Nonetheless, disparities in access to online health information persist, such that younger, more affluent, more highly educated Whites tend to be better connected than older, poorer, less well-educated members of racial and ethnic minorities. This study focused on Harlem adults aged 45 years and older to understand more about online opportunities for health promotion and disease management by age group. Methods: Demographic characteristics, health status, computer use, Internet access, and online health information seeking of adults in Harlem, New York City were assessed via a random digit dial landline telephone survey and examined for three age groups: 45-54 years, 55-64 years, and 65 years and older. Online health seeking activities for health promotion and disease management were documented. Trends were examined by age group. Results: Important trends were evident by age group, such that adults aged 45-54 years were more likely than adults aged 55-64 years, who in turn were more likely than adults aged 65 years and older to use a computer (81.4%, 72.2%, and 34.0%, p<0.01) and the Internet (65.7%, 48.6%, 20.0%, p<0.01). More adults were using the Internet for health promotion than for disease management purposes. Conclusions: As the US population ages, the Internet presents an opportunity to engage directly with adults around health promotion to prevent disease, even in disadvantaged communities. Engaging communities in developing, implementing, and evaluating website health interventions may yield trusted and culturally relevant health information with broad reach.
[Show abstract][Hide abstract] ABSTRACT: Background: Community-academic partnerships have historically been challenging for researchers and community participants alike because of differing languages, objectives, and cultures. The defining of interventions as multilevel, community-based, and culturally situated emphasizes the importance of understanding community context as prelude to community intervention. This approach was used to develop, implement, and evaluate a locally-focused health information and social networking website in Harlem, New York City. Methods: Focus groups, key informant interviews, and a telephone survey were used to elicit consumer ideas and feedback for the website. Community partnerships and a community advisory group were formed to provide ongoing direction and support. The development process was an iterative progression by which key processes and decisions were discussed among the advisory group members and researchers until consensus was reached. Results: Based upon partner feedback, the GetHealthyHarlem.org website was created and implemented with educational content capable of being rated by users and social networking capacity for blogging, joining discussion groups, and posting events. Partnerships were critical for ensuring the website would benefit from and be utilized by a wide range of users. A growing social justice movement in Harlem around health issues, especially food, was evident as site users created and voted on content and communicated online. Conclusions: Engaging community in the creation of a website intervention allowed for both consumer and professional feedback to be well integrated into its content and functionality. The community relationships formed better ensured a central role of community context and culture in conceptualizing, implementing, and evaluating the intervention.
[Show abstract][Hide abstract] ABSTRACT: We assessed awareness of and preferences for rapid HIV testing among young, urban men of color who have sex with men and are engaged in high-risk behaviors for HIV.
A cross-sectional survey was conducted in New York City among 177 young men who have sex with men (MSM).
Among the 85% of the participants who had previously undergone HIV testing, 43% reported rapid testing at their most recent test. In terms of future tests, 64% would seek rapid testing, as compared with 36% who preferred traditional testing. Those who preferred rapid testing were significantly more likely to have attended at least some college, to have discussed HIV testing with a sexual partner, to be aware of rapid testing, and to have had a previous HIV test.
In general, young MSM of color seem aware of rapid testing. However, our results indicate the need to carefully consider the unique needs of those who are particularly disenfranchised or engaged in high-risk behaviors and who may need concerted efforts around HIV counseling and testing. Likewise, our findings point to a need for more effective education and social marketing strategies.
Full-text · Article · Oct 2010 · American Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: It can prove challenging to create social marketing materials aimed at a specific subsection of the population, especially when the topic is relatively new and possibly misunderstood. Therefore, the objective of this study was to assess adolescent knowledge of and attitudes towards emergency contraception (EC), with the goal of creating a locally relevant social marketing campaign and intervention.
This qualitative study consisted of 18 in-depth interviews and four focus groups (n=29) with adolescents and young adults ages 15 to 21 years, conducted in New York City between August and December 2006.
While respondents seemed generally aware of EC's existence, most were unclear about circumstances warranting its use and its mechanism of action. The FDA change to behind-the-counter availability appeared to increase knowledge and access to EC, although substantial barriers to EC access and use remain, including price.
Further work remains in educating those in need of EC, especially adolescents under the age of 18 years. Results from this study initiated a social marketing campaign and intervention aimed at increasing adolescent knowledge of and access to EC.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND
Among people living with HIV/AIDS (PLWHA), sexually transmitted infections ( STIs) represent significant risk as decreased immune function can increase severity of STIs and facilitate acquisition of new STIs. HIV/STI comorbidity also increases likelihood of transmitting HIV. In NYC, 13-24 year olds have the highest STI rate of any PLWHA, yet evidence from the CDC's Ask, Screen, Intervene (ASI) curriculum of risk assessment, STI/pregnancy screening, and harm reduction demonstrates that clinicians don't screen for STIs among PLWHA.
Project S.T.A.Y. (Services To Assist Youth) provides comprehensive services to adolescent PLWHA in NYC and routinely Asks, Screens and Intervenes. Through a retrospective chart review the proposed study will describe patients' self-reported sexual behavior, including number of partners, condom use, and HIV status disclosure. Screening results for gonorrhea/Chlamydia, syphilis, trichomoniasis, herpes, HPV, and cervical/anal pap and biopsies will be reported.
A preliminary analysis found 82% of S.T.A.Y. clientele were sexually active and among those, 40% were diagnosed with at least one new STI. Additionally, the majority of new STIs were asymptomatic, diagnosed through aggressive screening, underscoring the importance ASI in this high-risk group.
This presentation will describe sexual risk behaviors and STI rates of adolescent PLWHA, identify whether STIs are primarily discovered through routine screening or symptomatic diagnosis, and evaluate what variables predict condom use, HIV status disclosure, and STIs. Preliminary findings support the efficacy of the ASI approach to providing needed services to HIV positive adolescents, however additional attention is needed to reduce risk-taking behaviors in this population.
[Show abstract][Hide abstract] ABSTRACT: GetHealthyHarlem.org is a community website developed on an open-source platform to facilitate collaborative development of health content through participatory action research (PAR) principles. The website was developed to enable the Harlem community to create a shared health and wellness knowledgebase, to enable discourse about local and culturally relevant health information, and to foster social connections between community members and health promotion organizations. The site is gaining active use with more than 9,500 unique site visits in the six months since going live in November, 2008. In ongoing research studies, we are using the website to explore how the PAR model can be applied to the development of a community health website.
[Show abstract][Hide abstract] ABSTRACT: Significant advances in the treatment of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) place a premium on early detection and linkage to care. Recognizing the need to efficiently yet comprehensively provide HIV counseling, we assessed the feasibility of using audio computer-assisted self-inventory (A-CASI) in a community-based HIV counseling and testing facility.
A convenience sample of 50 adults presenting for HIV testing was recruited to complete an 85-item computerized HIV Assessment of Risk Inventory (HARI) containing domains of demographics, sexual behaviors, alcohol and substance use, emotional well-being, past experiences with HIV testing, and attitudes about taking HARI.
Client acceptance rate was limited by the completion time outlined during the intake process. However, the majority of respondents who completed HARI felt that it took only a short to moderate time to complete and was easy to understand. A majority also reported a preference for using a computerized format in the future. Further, HARI identified a number of risk-taking behaviors, including unprotected anal sex and substance use prior to past sexual encounters. Additionally, more than half of the sample reported moderate to severe depressive symptoms.
Those respondents who had time to complete the survey accepted the A-CASI interview, and it was successful at identifying a substantial level of risk-taking behaviors. A-CASI has the potential to guide HIV counselors in providing risk-reduction counseling and referral activities. However, results suggested the need to shorten the instrument, and further studies are needed to determine applicability in other HIV testing sites.
Full-text · Article · Nov 2008 · Public Health Reports
[Show abstract][Hide abstract] ABSTRACT: Food logs are important tools for assessing eating habits. Traditionally, people handwrite what, when, and how much they eat, after which nutritionists use the results for developing revised eating plans. Personal web-based food logs have recently become popular; however, for both methods, barriers exist including cost, length of completion time, and lack of customization and cultural, economic considerations.
We sought to understand barriers to food logs for an urban population beset by high rates of diabetes and obesity, in order to create a novel, effective health promotion tool as part of a community-specific health website.
Through focus groups conducted in Harlem, NYC, we determined the need for a web-based food log that is user-friendly, solutions-based, customizable, and culturally-relevant. Based on the expressed needs of the community, we found that members want a food log that is visual, interactive and personalized to individual trouble zones (e.g. portion size, night-time eating). Further, we found that solutions must consider contextual factors such as economics, family, and lifestyle. Through this community-based research, we have also identified critical barriers to health such as mindless eating, impact of social relationships, and myths around snacking and fast food.
Our unique and systematic approach to the development of this interactive health promotion tool indicates the importance of community involvement at each stage of the process. By understanding the social, economic and cultural factors that hinder or promote the use of web-based tools, we are creating an interactive platform that provides useful and customizable advice around healthy behaviors.
[Show abstract][Hide abstract] ABSTRACT: The Internet holds potential to reduce inequities in access to health information; however, barriers exist to its use as vehicle for health promotion. In order to understand and address barriers and create more effective Internet health messaging tools, we sought to assess Internet use and online health information seeking in a lower-income, urban population. A total of 646 respondents completed a random digit dial landline phone survey in Harlem, New York City. The majority of respondents had used a computer (77%) and the Internet (65%), and about half (52%) were categorized as current Internet users. Similar to results from national studies, findings indicated that younger, better educated, more affluent individuals were more likely to use the Internet. In regard to health information, 43% of respondents reported searching for information on health or medical issues online; of those, 84% agreed that the Internet improved their understanding of symptoms, conditions, or treatments, and 47% agreed that it affected the way they eat or exercise. However, of the total sample, 31% reported having difficulty understanding the health information they read, and 36% said it was hard to find good answers to health questions and concerns. Although digital connectivity continues to exist along a spectrum influenced by education and income, evidence suggests that people of color residing in low-income communities are going online and have interest in using the Internet for health information seeking. Further research is needed to determine how best to utilize this medium to convey literacy-level appropriate health messages.
[Show abstract][Hide abstract] ABSTRACT: Background:
The Region II STD/HIV Prevention Training Center (PTC) is part of the National Network of STD/HIV Prevention Training Centers and has the mission to address the STD/HIV educational needs of clinicians. Providers have requested the PTC provide training regarding adolescent sexual health. In 2004, the PTC collaborated with Columbia University to expand its clinical STD/HIV training to address adolescent-specific issues, including: effective communication; risk assessment screening and prevention strategies. This two day course includes a mock clinic where peer educators act as patients for participants to role-play.
To determine whether the Region II PTC adolescent-specific course addresses a provider-identified educational gap regarding adolescent sexual health issues.
The following were collected and analyzed: registration data for persons attending adolescent courses January 2004 January 2007 to examine the professional background of course attendees; and student evaluation course data regarding organization, didactic and skills-building presentations.
On a scale of 1 (poor) to 5 (excellent), the mean rating for didactic presentations was 4.75 (range, 3-5; n=98); course organization, 4.95 (range, 4-5; n=85), and skills-building presentations, 4.86 (range, 2-5; n=94). The number of course participants increased from 19 to 35/course from January 2004 to January 2007. Comparing courses held in the first two years to those in the latter two years, the proportion of course participants who were nurse practitioners (NPs) increased by 10%
High ratings and an increased attendance rate suggest both interest and high provider satisfaction. Increased clinical provider attendance suggests that providers consider the content and format to be of value. However, improved marketing is an alternative explanation for our findings.
As the Region II PTC is the only PTC to offer such a course, there is likely a need for adolescent-focused training in other regions.