Cheryl S. Alexander

Determinants of condom use to prevent HIV infection among youth in Ghana

PURPOSE To identify the psychosocial and behavioral factors that influence condom use to reduce the risk of human immunodeficiency virus (HIV) infection among young men in Ghana. METHODS This study used a cross-sectional design in which data on a community-based sample of 601 young men, 15-24 years of age, were collected by a household survey instrument. For a conceptual framework, the study used constructs from the Health Belief Model (HBM) and Social Learning Theory (SLT) in the Ghanaian context. RESULTS While 65% of the sexually active male respondents had used condoms at least once, only 25% had used condoms at last intercourse. Findings from multiple logistic regression analysis indicate that perceived susceptibility to HIV infection, perceived self-efficacy to use condoms, perceived barriers to condom use, and perceived social support were significant predictors of condom use. The most important finding, however, is that perceived barriers significantly interacted with perceived susceptibility and self-efficacy. Subjects who perceived a high level of susceptibility to HIV infection and a low level of barriers to condom use were almost six times as likely to have used condoms at last intercourse, compared to others. Similarly, young men who perceived a high level of self-efficacy to use condoms and a low level of barriers to condom use were nearly three times more likely to have used condoms at last intercourse when compared to others. CONCLUSION These results suggest that HIV prevention programs for youth should emphasize personal vulnerability to acquired immunodeficiency syndrome, instill in youth the self-belief that they can use condoms any time, and address how to overcome barriers to condom use.

Explanations of ethnic and gender differences in youth smoking: A multi-site, qualitative investigation

Two of the most powerful predictors of adolescent smoking are ethnicity and gender, but little research has focused on understanding how these factors play a role in adolescent smoking. This paper reports results from a qualitative, multi-site investigation of explanations for ethnic and gender differences in cigarette smoking with five ethnic groups: whites, African-Americans, Hispanics, Native Americans, and Asian-American/Pacific Islanders. Across 11 states, we conducted 178 focus groups with a total of 1175 adolescents. The groups explored such major research themes as reasons for smoking and not smoking; images of smoking and smokers; messages youth receive about smoking and not smoking; and the social context of smoking. We synthesized data from the focus groups through multiple cross-site collaborations and discussions, with an emphasis on identifying consistent themes across a majority of groups and sites. Striking differences emerged across ethnic and gender sub-groups in reasons for not smoking. African-American females in particular viewed not smoking as a positive identity marker. Asian-American/Pacific Islander females similarly reported strong mandates not to smoke. Youths perceptions of family messages about smoking also varied by ethnicity and gender, with African-American, Hispanic, and Asian-American/Pacific Islander youth consistently reporting strong, clear anti-smoking messages from family. These findings, notable in their consistency across geographic regions, may shed light on the discrepant prevalence of smoking across ethnic and gender groups.

Parenting Influences on Early Sex Initiation Among Adolescents How Neighborhood Matters

Building on social ecological research, this study considers whether neighborhood socioeconomic advantage modifies the relationship between parenting practices and sex initiation among young adolescents. Using data on a national sample of 2,559 middle school students, the authors examined two-way interactions between neighborhood socioeconomic status and parental involvement, decision making, and communication about sex. The parental decision-making measure was developed using latent class analysis. Greater parental involvement was related to a lower likelihood of sex initiation only when youth lived in socioeconomically advantaged neighborhoods. Parental decision making centered on the child’s activities within (e.g., television watching) and outside (e.g., hanging with peers) of the home was associated with a lower likelihood of sex initiation for adolescents in disadvantaged neighborhoods but to a greater likelihood of sex initiation for youth in advantaged neighborhoods. Results suggest that the neighborhood context must be considered in preventive interventions aimed at discouraging adolescent involvement in sexual intercourse.

Determinants of Hospital Staff Nurse Turnover

Organizational and nonorganizational determinants of staff nurse turnover are investigated in a panel study of 1,259 nurses employed in two university-affiliated hospitals. Findings are consistent with a causal chain in which perceived autonomy, job satisfaction, intent to leave the hospital and turnover are a sequence of outcomes reflecting the successive stages of a nurses decision to resign. Both personal characteristics and job-related attributes are predictive at various stages of the process, although family status variables have no significant effects. Implications for hospital management of turnover are discussed.

A measure of risk taking for young adolescents: Reliability and validity assessments

Researchers often define adolescent risk taking in terms of individual behaviors such as alcohol and drug use, early sexual activity, and reckless driving. It is not clear whether these behaviors defined by adults as “risky” have the same meaning for adolescents. This paper describes the development and preliminary testing of an instrument to assess risk taking among young adolescents. The six item scale was constructed by asking small groups of eighth grade boys and girls to describe “things that teenagers your age do for excitement or thrills.” The measure was then used in a longitudinal study of 758 young adolescents from three rural counties in Maryland. The scale shows good reliability, as indicated by coefficient alpha and factor analyses. Eighth-grade scores on the scale are associated with the initiation of sexual activity and substance use in ninth grade among virgins and nonusers of alcohol, marijuana, cocaine and pills in eighth grade.

Consistency of adolescents' self-report of sexual behavior in a longitudinal study

This study examines three issues relevant to adolescent self-reported sexual behavior: the extent to which adolescents rescind reports of sexual intercourse, changes in reporting of lifetime sexual intercourse, and changes in reported age at first sexual intercourse. Data come from a three-year longitudinal study of health-compromising behaviors among a cohort a 758 rural adolescents. Students completed a self-administered questionnaire on health behaviors annually in eighth, ninth, and tenth grades. Findings show that 88.8% of students in eighth grade and 94.3% in ninth grade who reported having had sexual intercourse gave the same answer in a subsequent year. Approximately 15% of students reported fewer numbers of lifetime sexual intercourse experiences in tenth grade than they did in ninth grade. Age at first sexual intercourse was reported inconsistently by 67% of the students. Inconsistency rates differed by racial-gender groups, question sensitivity, and prior sexual experience.

Taking a first puff: cigarette smoking experiences among ethnically diverse adolescents.

OBJECTIVES To study the social contexts and physiological consequences of an initial cigarette smoking experience among adolescents from four ethnic groups (African American, European American, Hispanic, Native American) who vary by gender and locale (e.g. urban vs rural). METHOD A qualitative study using individual interviews and focus groups. RESULTS Results both amplify and reinforce conclusions about peer and family influences on adolescent smoking initiation reported in quantitative studies of teen smoking. Within the broader themes of peers and family, several important sub-themes emerged. The study findings suggest that peer influence can be characterized as social conformity or social acceptance. Males were more likely than females to describe experiences involving peers exerting strong messages to conform to smoking behaviors. Roles played by family members in the initiation process were complex and included those of initiator, prompter, accomplice, and inadvertent source of cigarettes. European American and Hispanic girls provided descriptions of parents/family members as instigators of their first smoking experience. Hispanic adolescents descripted instances in which family members prompted cigarette use at a young age by encouraging the young person to light the adults cigarette. Finally, ethnic differences in the physiological responses to initial smoking suggest the need to further explore the role of brand preference and variations in inhaling among ethnically diverse adolescents. CONCLUSION In order to design effective cigarette smoking prevention programs for adolescents, it is important to understand the meaning of smoking behaviors for adolescents from different ethnic and social backgrounds.

Early sexual activity among adolescents in small towns and rural areas: race and gender patterns.

A 1987 survey of 758 eighth-grade students from three rural counties in Maryland revealed that 61 percent of males and 47 percent of females have engaged in sexual intercourse, and that 77 percent of black students and 40 percent of whites have ever had intercourse. A logistic regression analyzing the effects of race and gender shows that the odds that young black teenagers would have had intercourse are over five times those for whites, and that the odds for males are about twice those for females. The introduction of developmental, individual, academic and behavioral factors into the regression model has little effect on these odds ratios. Separate logistic analyses of four subgroups--white males, white females, black males and black females--reveal no consistent associations between sexual activity and the factors examined. For example, such types of problem behavior as cigarette smoking and use of alcohol or certain other drugs are associated with the likelihood of sexual activity, but the specific type of behavior involved differs by subgroup: Cigarette smoking is related to an increased likelihood of sexual activity just among white females, while alcohol consumption is associated with sexual experience among black females and white males only. Use of drugs other than marijuana or alcohol is linked to a 5-9 times greater risk of sexual activity among whites, but not to any significantly increased risk among blacks, whereas living in a town (rather than in the country) is significantly associated with the likelihood of sexual intercourse among both white and black males, but not among females of either race.(ABSTRACT TRUNCATED AT 250 WORDS)

Social and psychological influences on HIV preventive behaviors of youth in Haiti

PURPOSE To examine HIV/AIDS prevention-related sexual behaviors and identify potential predictors of those behaviors among youth living in Haiti. METHODS Data were gathered from a cross-sectional survey conducted with 845 youth, aged 15-19 years, attending 12 primary and/or secondary schools. A subsample of the 491 students who were sexually active comprised the study sample. Data were collected using a theory-based, self-administered questionnaire. Data were analyzed by multiple logistic regression using SPSS for Windows. RESULTS Only 18% of sexually active adolescents reported always or sometimes using condoms and 27% reported having used a condom the last time they had sex. Over 40% (43%) had had three or more lifetime sex partners. Findings from the multivariate logistic regression analyses indicate that consistent condom use, condom use at last sexual intercourse, and fewer lifetime sexual partners were significantly associated with high levels of self-efficacy to communicate about HIV/AIDS or use a condom. Significant negative associations were found among consistent condom use, condom use at last sex, and high barriers to condom use. Fewer lifetime sexual partners was significantly associated with high peer preventive norms and low traditional gender norms. CONCLUSION These findings emphasize the importance of providing HIV prevention programs for young people in the study communities which enhance effective sexual communication and negotiation skills, target prevention-oriented social norms, and address how to overcome barriers to condom use.

Outcomes of Emergency Room Treatment of Children with Asthma

Duration of symptoms, medication use and follow-up medical care were examined over an 8-week period in children following emergency room treatment for an acute asthma episode. Two groups of children were compared: Short-course (N = 90) and Continuous Medication Users (N = 46). Over a third of Short-Course Users continued to report symptoms up to 6 weeks following the index episode with 31% reporting medication use at 8 weeks. Relapse, resulting in an emergency room visit, occurred in 26% of all study children. Factors associated with relapse included maternal smoking, female gender, prior hospitalization for asthma, cough, and medication use during the follow-up period.