Arjan E.R. Bos

Effective methods to change sex-risk among drug users: a review of psychosocial interventions.

This review examines the current state of knowledge on the effectiveness of HIV prevention interventions with respect to sexual behavior among the population of drug users. The review focuses specifically on the relation between intervention methods found to be effective and the underlying theory. Electronic searches were conducted and supplemented by publications gathered through other channels. The studies were reviewed for (1) study design, (2) evident use of theory in intervention development, (3) clear targeting of determinants, (4) description of the study or studies, and (5) evaluation of the behavioral goals and targeted determinants. For each study, a description is given of: (1) the size and nature of the sample; (2) the retention rate; (3) the study design; (4) the nature of the intervention programs, including theoretical methods, practical strategies and theoretical background; (4) the measures of variability. The results show that a limited number of interventions were effective in changing sexual risk behavior among drug users. More successful programs featured several of the following elements: use of multiple theories and methods, inclusion of peers and rehearsal of skills. Moreover, the community-level interventions showed the importance of sustainability. The most successful intervention methods were modeling, skill building and social support enhancement. These methods are generally derived from the Social-Cognitive Theory or the Diffusion of Innovations Theory. Future HIV/AIDS interventions should build on the strengths discussed. Evaluations of interventions should be designed to facilitate comparison, using standardized and specific behavioral outcomes as well as standardized and preferably long-term follow-up levels, and should also evaluate the impact of programs at a psychosocial level to examine whether or not the theoretical methods on which a program was based were actually effective in changing the psychosocial factors targeted and why.

Mental illness stigma and disclosure: consequences of coming out of the closet.

The present study investigated disclosure patterns among mental health consumers (N = 500) and examined the relationships among disclosure, perceived stigmatization, perceived social support, and self-esteem. Results suggest that selective disclosure optimizes social support and limits stigmatization. Perceived stigmatization has a detrimental impact on self-esteem, especially for those who are relatively open about their mental disorder.

A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder

The present study examined a hierarchical model for the relationships between general and specific vulnerability factors and symptom manifestations of generalized anxiety disorder (GAD). A clinical sample of patients with GAD (N=137) completed a set of self-report questionnaires for measuring neuroticism, extraversion, intolerance of uncertainty, metacognitive beliefs, and symptoms of generalized anxiety (i.e., worry) and depression. A bootstrapping analysis yielded support for a model in which the relation between the general vulnerability factor of neuroticism and symptoms of GAD were mediated by the specific vulnerability factors of intolerance of uncertainty and negative metacognitions. Implications for the classification and treatment of GAD are discussed.

The World Starts With Me: A multilevel evaluation of a comprehensive sex education programme targeting adolescents in Uganda

BackgroundThis paper evaluates the effect of the World Starts With Me (WSWM), a comprehensive sex education programme in secondary schools in Uganda. The aim of the present study was to assess the effects of WSWM on socio-cognitive determinants of safe sex behaviour (delay; condom use and non-coercive sex).MethodsA survey was conducted both before and immediately after the intervention among students in intervention (N = 853) and comparison (N = 1011) groups. A mixed model repeated measures analysis was performed to assess the effectiveness of the WSWM programme on the main socio-cognitive determinants of safe sex behaviour at post-test. A similar post-hoc comparison was made between schools based on completeness and fidelity of implementation of WSWM.ResultsSignificant positive effects of WSMW were found on beliefs regarding what could or could not prevent pregnancy, the perceived social norm towards delaying sexual intercourse, and the intention to delay sexual intercourse. Furthermore, significant positive effects of WSWM were found on attitudes, self-efficacy and intention towards condom use and on self-efficacy in dealing with sexual violence (pressure and force for unwanted sex). A reversed effect of intervention was found on knowledge scores relating to non-causes of HIV (petting, fondling and deep kissing). A follow-up comparison between intervention schools based on completeness of the programme implementation revealed that almost all significant positive effects disappeared for those schools that only implemented up to 7 out of 14 lessons. Another follow-up analysis on the basis of implementation fidelity showed that schools with a partial fidelity score yielded more significant positive effects than schools with a full fidelity of implementation score.ConclusionsThe study showed an intervention effect on a number of socio-cognitive determinants. However, the effectiveness of WSWM could be improved by giving more systematic attention to the context in which such a programme is to be implemented. Implications for the systematic development and implementation of school-based safe sex interventions in Uganda will be discussed.

Evaluation of the Dutch AIDS information helpline: an investigation of information needs and satisfaction of callers

AIDS telephone hotlines have an important function in AIDS education, HIV prevention and counselling. In this study, consults of the Dutch AIDS information helpline were evaluated to determine the AIDS information needs of the callers and callers satisfaction with the telephone-delivered information and consultation. Immediately after their telephone consult, callers (N = 309) were redirected to co-workers of an independent telephone survey. They participated in an interview on content and evaluation of the telephone consult. This study shows that most telephone calls concerned questions about personal risk of HIV transmission, HIV transmission in general and HIV testing. Callers were very satisfied with the services of the helpline. Furthermore, helpline employees counselling and conversation skills were evaluated very positively. These results are discussed within the scope of the professional organization of the Dutch AIDS information helpline.

Individual and group level responses to threat experienced by Dutch shopkeepers in East-Amsterdam

The present study investigates how native shopkeepers in Amsterdam respond to the threat experienced by the emergence of immigrant stores. A survey among 101 native shopkeepers confirmed that psychological, rather than instrumental, considerations play an important role. First, perceptions of fraternal deprivation were relatively independent of the amount of egoistical deprivation people perceived. Instead, the experience of fraternal deprivation was related to people’s identification as native shopkeepers. Second, egoistical deprivation resulted in negative perceptions of all other entrepreneurs, regardless of their ethnic origin. Third, regardless of perceived egoistical deprivation, native shopkeepers were more likely to discredit immigrant entrepreneurs, as they thought they were more fraternally deprived.

Psychopathology symptoms in a sample of female cosmetic surgery patients

OBJECTIVEnDuring the past decades, cosmetic surgery has become increasingly popular. People with certain psychopathology disorders, for example, body dysmorphic disorder (BDD), are dissatisfied with their physical appearance, and a significant number try to receive cosmetic medical treatment for their complaints. It seems relatively easy for them to receive this type of surgery, despite the fact that it has no or even adverse effects on the symptoms. The present study aimed to investigate the psychological condition and especially the presence of psychopathological symptoms such as BDD in cosmetic surgery patients.nnnMETHODSnQuestionnaires about body image dissatisfaction, symptoms of BDD and psychopathology in general and satisfaction about surgery were sent to patients who had been treated in a large cosmetic surgery clinic.nnnRESULTSnOf the patients who replied, 86% were pleased with the outcome of the cosmetic procedure. Further, 21-59% of these former patients scored higher on questionnaires of body image dissatisfaction and psychopathological symptoms than a norm group from the general population. When differentiating the group on the basis of BDD symptomatology, it appeared that the high BDD symptomatic group displayed significantly worse outcome on all measurements. That is, high BDD symptomatic patients were more dissatisfied about the result of surgery, exhibited higher levels of psychopathology, and had lower self-esteem than the low symptomatic BDD patients.nnnCONCLUSIONnThese findings clearly suggest that the evaluation of the psychological condition and motivation of the candidate patient might be a valuable addition to the standard procedure in cosmetic medical treatment settings.

View the label before you view the movie: A field experiment into the impact of Portion size and Guideline Daily Amounts labelling on soft drinks in cinemas

BackgroundLarge soft drink sizes increase consumption, and thereby contribute to obesity. Portion size labelling may help consumers to select more appropriate food portions. This study aimed to assess the effectiveness of portion size and caloric Guidelines for Daily Amounts (GDA) labelling on consumers portion size choices and consumption of regular soft drinks.MethodsA field experiment that took place on two subsequent evenings in a Dutch cinema. Participants (n = 101) were asked to select one of five different portion sizes of a soft drink. Consumers were provided with either portion size and caloric GDA labelling (experimental condition) or with millilitre information (control condition).ResultsLabelling neither stimulated participants to choose small portion sizes (OR = .75, p = .61, CI: .25 - 2.25), nor did labelling dissuade participants to choose large portion sizes (OR = .51, p = .36, CI: .12 - 2.15).ConclusionsPortion size and caloric GDA labelling were found to have no effect on soft drink intake. Further research among a larger group of participants combined with pricing strategies is required. The results of this study are relevant for the current public health debate on food labelling.

Psychosocial determinants of suicide attempts among black south african adolescents: a qualitative analysis

In South Africa, one in five adolescents attempt suicide. Suicide attempts continue to rise. We aimed to identify psychosocial target points for future educational interventions. One-to-one semi-structured interviews were conducted to explore psychosocial factors associated with past suicide attempts among suicide survivors in Limpopo province, South Africa. A total of 14 adolescents (eight girls and six boys) who recently attempted suicide were interviewed. Lack of knowledge of available counsellors, conflicts in interpersonal relationships, perceived accusations of negative behaviour, inadequate social support, past family and peer suicide attempts and poor living circumstances were factors found to be related with suicide attempts. This study suggests that availability and access to counselling is essential in the prevention of suicide among young people, at both the individual level and family level.

Portion size labeling and intended soft drink consumption: the impact of labeling format and size portfolio.

OBJECTIVEnTo assess what portion size labeling format is most promising in helping consumers selecting appropriate soft drink sizes, and whether labeling impact depends on the size portfolio.nnnMETHODSnAn experimental study was conducted in fast-food restaurants in which 2 labeling formats (ie, reference portion size and small/medium/large labels) were compared to a control condition, and 2 size ranges were assessed. The main outcome variable was participants intended soft drink size choice. Stimulus material was presented through photographs.nnnRESULTSnThere was a statistical trend for reference portion size labeling increasing the likelihood to choose small sizes (n=158, odds ratio=2.55, P=.06, confidence interval: 0.84-7.70).nnnCONCLUSIONS AND IMPLICATIONSnReference portion size labeling is potentially most promising in reducing large portion size preferences. More research assessing the effectiveness of reference portion size labeling (combined with pricing strategies) on actual choices and consumption behavior in a realistic setting is recommended.