Colleen M. Fisher

Adapting the Information–Motivation–Behavioral Skills Model: Predicting HIV-Related Sexual Risk Among Sexual Minority Youth

Young sexual minority males are among those at highest risk for HIV infection, yet we know relatively little about the impact of sexual identity development on HIV risk. This study used cross-sectional data to investigate factors associated with HIV-related sexual risk among a sample of sexual minority males (n = 156), ages 14 to 21 years, using an extended version of the information–motivation–behavioral skills (IMB) model tailored for this population. Path analysis results indicated that the extended model predicted a sizable amount of primary and secondary sexual risk (r2 = .35 and .42). In addition to increasing HIV prevention information and motivation and decreasing substance use, study findings suggest that interventions with young sexual minority males should focus on sexual identity development factors including youths’ attitudes toward LBGT people, sex-centered versus identity-centered development, and with specific emphasis on youth with non–male exclusive sexual orientations.

Are Information, Motivation, and Behavioral Skills Linked with HIV-Related Sexual Risk among Young Men Who Have Sex with Men?

Young men who have sex with men are disproportionately affected by HIV/AIDS, yet relatively little is known about the most effective theoretical frameworks for preventive interventions with this population. This study investigated the fit of the Information-Motivation-Behavioral Skills (IMB) model for predicting sexual risk among a sample of ethnically diverse young men who have sex with men aged 14 to 21. Path analysis results indicated that the IMB model predicted a moderate amount of variance in primary and secondary sexual risk for young men who have sex with men (r 2 = .26 and .21, respectively). Fit of this model was acceptable on most indicators of model fit for primary and secondary risk.

Providing effective medical and case management services to HIV-infected youth preparing to transition to adult care.

&NA; A key aspect of maintaining health for HIV‐infected adolescents is the transition from pediatric care to adult medical care. Because young people who were infected with HIV as children were initially not expected to survive until adulthood, relatively little attention has been given to issues associated with this transition to adult care. With improved life expectancies, health professionals are increasingly faced with the new challenge of working with these young people as they grapple with the unique experience of being an HIV‐infected adolescent transitioning into adulthood. This article discusses the unique developmental trajectories of young people infected with HIV as children, challenges for health care professionals who work with them, and strategies for practitioners to increase the competencies needed to develop effective partnerships with these youth as they transition into adult care.

Queering Data Collection: Using the Life History Calendar Method With Sexual-Minority Youth

ABSTRACT A challenge for research with sexual-minority youth is to capture their unique stories in a way that heightens understanding of lived experience and promotes the development of culturally relevant programs and policies tailored for this population. One data collection approach that may be particularly useful for research with sexual-minority youth is the life history calendar (LHC) method. The LHC provides a visual, calendar-based assessment of life events and behaviors anchored by contextual cues to enhance retrospective recall. The purpose of this article is to examine the utility of the LHC method with sexual-minority youth and its potential to address three methodological and conceptual challenges: developmental complexity, shifting and evolving identities, and timing. The LHC method is illustrated using three studies conducted by the author as case examples. Findings suggest that the LHC offers several potential benefits for research with sexual-minority youth including its adaptable and flexible structure, capacity to assess event timing and sequence, mixed-methods capability, and its ability to engage and empower youth to co-create the interview process. Strengths and limitations of the LHC method and implications for research and practice with sexual-minority youth in a range of social service settings are discussed.

Assessing Recent Adolescent Sexual Risk Using a Sexual Health History Calendar: Results From a Mixed Method Feasibility Study

HIV and other sexually transmitted infections (STIs) represent a significant ongoing public health challenge in the United States. Adolescents account for nearly one third of all new HIV infections (Centers for Disease Control and Prevention [CDC], 2011) and half of all other STIs (Weinstock, Berman, & Cates, 2004). STIs can pose serious long-term health consequences for young people and increase HIV risk (CDC, 2009). Teen public health clinics may provide a key opportunity for prevention efforts that can reach youth who are at greatest risk for STI/HIV, including young people who are transient, underor uninsured, and youth of color. Accurate assessment of patient risk behaviors is critical in these settings and a key component of risk-reduction planning. Typical standardized risk assessment surveys, long utilized for their quick and easy administration, persist in health care settings despite well-documented limitations. In addition to concerns surrounding retrospective recall (Belli, 1998; Ostrow, Kessler, Stover, & Pequegnat, 1993), the closed-ended question format does not facilitate the active formation of insight into patient patterns of risk or enhance patient–provider interactions. Longer, more in-depth interviews are often not feasible in clinic settings due to the time required to administer them. The Sexual Health History Calendar (SHHC) was developed to address several of these challenges. In collaboration with staff and administrators at a public

Comparison of Adolescents' Reports of Sexual Behavior on a Survey and Sexual Health History Calendar

Assessing sexual risk is critical for human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevention with adolescents. This article compares sexual risk reports from two self-administered instruments, a standard survey and a sexual health history calendar (SHHC), among racially diverse youth (n = 232) ages 14 to 21 seeking services at a public health clinic. Agreement between methods was assessed using Lins concordance correlation coefficients (CCC) and Bland-Altman plots. Lins CCC showed poor to moderate agreement between instruments on reports of sexual partners in the past 3 (0.47), 6 (0.55), and 12 (0.49) months. While individual sexual partner questions were refused a total of 179 times on the survey, youth reported having sexual partners during the same time period on the SHHC in most (77.1%) of these instances. Poor agreement was also found for condom use frequency (CCC = 0.17), with youths frequency of condom use on the SHHC differing from that reported on the survey for more than half (55.6%) of the months they were sexually active. While lack of objective sexual behavior measures limits conclusions about the accuracy of reports, the ways in which youths responses varied across instruments may offer insight into the complexity of adolescent sexual risk taking as well as have important implications for development of HIV/STI preventive interventions.

Sexual Orientation, Gender, and Gender Identity Microaggressions: Toward an Intersectional Framework for Social Work Research

ABSTRACT Professional ethics compel social workers to address all forms of discrimination and oppression. Microaggressions can contribute to health disparities for marginalized groups; yet, little is known about the frequency, mechanisms, and impact of microaggressions on sexual minorities, cisgender women, and gender minorities—particularly for those with intersecting marginalized identities. This article extends microaggression literature by exploring interrelated constructs of sexual orientation, gender, and gender identity microaggressions, and offering recommendations for future research using an intersectional lens to foster an integrated and complex understanding of microaggressions. Implications of an intersectional microaggression framework for social work education and practice are discussed.

Opportunities for Integrating Physical Health Within Assertive Community Treatment Teams: Results from Practitioner Focus Groups

This qualitative study assessed the experiences of assertive community treatment (ACT) team members regarding the integration of physical and mental health self-management for persons with serious mental illness. Three focus groups elicited information from participants concerning barriers, strategies, and recommendations. Findings from inductive analyses revealed six overarching themes: (1) collaboration with primary care, (2) improvements in engagement, (3) team-focused roles, (4) education and training, (5) recommendations for system level barriers, and (6) systems collaboration. Participant recommendations suggest that ACT teams are well positioned to integrate mental and physical health treatment, but further research is needed to support integrated care.

Using Mixed-Method Assessment to Advance Adolescent HIV Prevention

This two-phase, community-based pilot study examined the impact of an innovative calendar-based assessment on HIV risk perception and risk reduction planning with racially diverse youth aged 14 to 21 at a public health clinic. Participants (N = 232) completed a Sexual Health History Calendar (SHHC) assessing behaviors over the previous 12 months, risk self-appraisals, and future behavioral intentions. Youths’ narratives included negative self-appraisals (36%), named a risk-related critical incident (13%) or regret (9%), or expressed increased risk awareness (9%) and need for behavior change (18%). A minority were positive (28%) or reflected improvement (7%). All Phase 2 participants (n = 122) identified at least one specific risky behavior they intended to change. These data and the SHHC’s visual cues facilitated risk-reduction intervention tailored to the unique circumstances in which each youth’s risk taking occurred. For nurses and other providers in clinical settings, the SHHC can offer a critical link between assessment and intervention.