Chisina Kapungu

Beyond the “Birds and the Bees”: Gender Differences in Sex‐Related Communication Among Urban African‐American Adolescents

The current study examined gender differences in communication about sex-related topics in a community sample of urban, African-American mothers and adolescents living in impoverished neighborhoods with high HIV rates. One hundred and sixty-two mother-adolescent dyads completed self-report measures of sex-related communication. Youth also reported on their sexual risk. We identified the range of sexual-based topics that adolescents discussed with their mothers, fathers, friends, and at school. The relationship between the frequency of sexual communication and sexual risk was examined. We also investigated congruency between adolescent and mother report about whether sexual-based discussions occurred. Consistent with prior research, girls talked to their mothers, fathers, friends, and at school about sex-related topics more than boys. Findings indicated that mothers not only communicated more frequently about sexual issues with their daughters than sons but that parental messages for girls were more protective. Greater sexual communication with mother was significantly associated with decreased HIV risk in the past 90 days and increased protection from HIV. Inconsistencies between mother and adolescent reports about sexual communication were marginally associated with decreased protection from HIV. Findings reveal the protective effect of sexual communication and the general lack of congruence between mother and adolescent reports of sexual communication.

Parental Monitoring as a Moderator of the Effect of Family Sexual Communication on Sexual Risk Behavior Among Adolescents in Psychiatric Care

Authors examined if parental monitoring moderated effects of family sexual communication on sexual risk behavior among adolescents in psychiatric care. Seven hundred and eighteen parents reported upon quality of family discussions about sex-related topics and degree to which they monitor teen behavior. Adolescents reported the frequency of their own safe sex practices. Parental monitoring moderated the family communication quality–sexual risk behavior relationship among African American families. African American parents who perceived themselves as capable of open family sexual communication and frequent monitoring had adolescents who reported decreased sexual risk behavior. The moderator model was not supported among Caucasian and Hispanic families and findings did not depend upon gender. For African Americans, findings support the influential role of family processes in development of teen sexual risk behavior and suggest, for parents of teens receiving mental health services, learning communication and monitoring skills may be critical to their adolescent’s sexual health.

Community‐based distribution of misoprostol to prevent postpartum haemorrhage at home births: results from operations research in rural Ghana

To report on a rigorous distribution and monitoring plan to track misoprostol for community‐based distribution to reduce postpartum haemorrhage (PPH) in rural Ghana.

Barriers to Intrauterine Device Uptake in a Rural Setting in Ghana

Long-acting reversible contraception is an underutilized method in low-resource areas. Our study aims to: (a) assess knowledge and attitudes around contraception; (b) identify barriers to intrauterine device (IUD) uptake; and (c) develop interventions to address this gap in contraceptive care. We conducted focus group discussions with pregnant, postpartum, and reproductive-aged women, males, and health care workers in rural Ghana. Lack of IUD-specific knowledge, provider discomfort with insertion, and incomplete contraceptive counseling contribute to lack of IUD use. Participant- and provider-related barriers contribute to poor uptake of IUDs within the community. Targeted interventions are necessary to improve IUD use.

Family-Based HIV-Prevention for Adolescents with Psychiatric Disorders

Family factors are influential in both HIV/AIDS-risk behavior and mental illness, and thus, families can be a critical resource in HIV/AIDS prevention efforts, especially for young people with psychiatric problems. Surprisingly few HIV-risk reduction programs capitalize on the strengths of families to prevent risk behavior while simultaneously addressing mental health. This chapter reviews current research on the association of mental health, HIV/AIDS-risk behavior, and behavioral interventions with special emphasis on the role of families in improving health outcomes for young people. Given the paucity of available empirically validated family-based interventions, we describe an innovative and highly promising program for teens with in mental health treatment based on the Social-Personal Framework of HIV/AIDS-risking mental health issues.

Integrating Women's Human Rights into Global Health Research: An Action Framework

This article uses Scale of Change theory as a framework to guide global health researchers to synergistically target womens health outcomes in the context of improving their right to freedom, equity, and equality of opportunities. We hypothesize that health researchers can do so through six action strategies. These strategies include (1) becoming fully informed of womens human rights directives to integrate them into research, (2) mainstreaming gender in the research, (3) using the expertise of grass roots womens organizations in the setting, (4) showcasing womens equity and equality in the organizational infrastructure, (5) disseminating research findings to policymakers in the study locale to influence health priorities, and (6) publicizing the social conditions that are linked to womens diseases. We explore conceptual and logistical dilemmas in transforming a study using these principles and also provide a case study of obstetric fistula reduction in Nigeria to illustrate how these strategies can be operationalized. Our intent is to offer a feasible approach to health researchers who, conceptually, may link womens health to social and cultural conditions but are looking for practical implementation strategies to examine a womens health issue through the lens of their human rights.

Increasing Parent Involvement in Youth HIV Prevention: A Randomized Caribbean Study.

This article presents preliminary findings of a randomized HIV prevention study in Trinidad and Tobago in the Caribbean. The study centers on a family HIV workshop aimed at strengthening parenting skills that are empirically linked to reducing adolescent HIV exposure and other sexual risks. These skills include parental monitoring; educating youth about HIV, sex, and other sexually transmitted infections (STIs); and discussing cultural and interpersonal pressures to have sex. Participants include 180 primary caregivers and their 12-14-year-old adolescents randomized to either the Trinidad and Tobago family HIV Workshop (N = 92) or a general workshop (N = 88). Intervention and control group participants completed pretest and posttest measures on parenting and HIV risk outcomes. Compared to controls, intervention parents reported improvements in HIV knowledge (d = .79); attitudes toward AIDS (d = .42); general communication with adolescents (d = .94); conversations with adolescents about sex (d = .95); conversations about sexual risks and values (d = .43); monitoring of adolescents (d = .34); conflicts with adolescents (d = .30); and intensity of daily parenting hassles (d = .35). Intervention and control parents did not differ in behavioral control, use of positive parenting techniques, and expansion of support networks. Implications for addressing rising HIV risks among young people in Trinidad and Tobago and the Caribbean are discussed.

A community-based continuum of care model for the prevention of postpartum hemorrhage in rural Ghana

To report on Phase 1 of an operations research study designed to reduce postpartum hemorrhage (PPH)‐related morbidity and mortality in rural Ghana.

Navigating the Challenges of Global Reproductive Health Research

Reproductive health research in low-resource settings poses unique and complex challenges that must be addressed to ensure that global research is conducted with strict adherence to ethical principles, offers direct benefit to the research subjects, and has the potential for adoption of positive findings to the target population. This article addresses challenges to conducting reproductive health research in low-resource settings in the following areas: (1) establishment and maintenance of global collaboration, (2) community partnerships, (3) ethical issues, including informed consent and the role of incentives, (4) staff training and development, (5) data collection and management, and (6) infrastructure and logistics. Particular attention to these challenges is important to ensure that research is culturally appropriate and methodologically sound and enhances the adoption of health-promoting behaviors. Rigorous evaluation of interventions in low-resource settings may be a cost-effective and time-efficient way to identify interventions for large-scale program replication to improve womens health.

Recommendations for scale-up of community-based misoprostol distribution programs.

Community‐based distribution of misoprostol for prevention of postpartum hemorrhage (PPH) in resource‐poor settings has been shown to be safe and effective. However, global recommendations for prenatal distribution and monitoring within a community setting are not yet available. In order to successfully translate misoprostol and PPH research into policy and practice, several critical points must be considered. A focus on engaging the community, emphasizing the safe nature of community‐based misoprostol distribution, supply chain management, effective distribution, coverage, and monitoring plans are essential elements to community‐based misoprostol program introduction, expansion, or scale‐up.