Dianne Morrison-Beedy

The HIV-Knowledge Questionnaire: Development and Evaluation of a Reliable, Valid, and Practical Self-Administered Questionnaire

We have developed and evaluated a self-administered questionnaire of knowledge about human immunodeficiency virus (HIV) infection for use in program evaluation. Formative work led to the development of the 62-item HIV-Knowledge Questionnaire (HIV-K-Q), which was administered to 409 women and 227 men. Item analyses resulted in the deletion of 17 items that were either too easy or did not correlate well with the total score. Factor analysis on the remaining 45 items resulted in a single factor labeled HIV Knowledge. The generalizability of this one-factor solution was confirmed with data from 285 women and 76 men. Reliability analyses revealed that the HIV-K-Q is internally consistent (alpha = .91) and stable over 1-week (r = .83), 2-week (r = .91), and 12-week (r = .90) intervals. Evidence for the validity of the HIV-K-Q was assembled using known groups and treatment outcome analyses. Additional evidence emerged from analyses that revealed associations between scores on the HIV-K-Q and two related knowledge measures, and between HIV-K-Q scores and level of educational attainment. Discriminant evidence was obtained through nonsignificant relationships between the HIV-K-Q and potentially biasing constructs, including social desirability. The HIV-K-Q requires a sixth-grade education, and 7 min to complete. The HIV-K-Q is a reliable, valid, and practical measure of HIV-related knowledge that can be used with low-literacy adults.

Accuracy of audio computer-assisted self-interviewing (ACASI) and self-administered questionnaires for the assessment of sexual behavior.

This study examined the accuracy of two retrospective methods and assessment intervals for recall of sexual behavior and assessed predictors of recall accuracy. Using a 2 [mode: audio-computer assisted self-interview (ACASI) vs. self-administered questionnaire (SAQ)] by 2 (frequency: monthly vs. quarterly) design, young women (N =102) were randomly assigned to one of four conditions. Participants completed baseline measures, monitored their behavior with a daily diary, and returned monthly (or quarterly) for assessments. A mixed pattern of accuracy between the four assessment methods was identified. Monthly assessments yielded more accurate recall for protected and unprotected vaginal sex but quarterly assessments yielded more accurate recall for unprotected oral sex. Mode differences were not strong, and hypothesized predictors of accuracy tended not to be associated with recall accuracy. Choice of assessment mode and frequency should be based upon the research question(s), population, resources, and context in which data collection will occur.

Reducing sexual risk behavior in adolescent girls: results from a randomized controlled trial.

PURPOSE Teenage girls in low-income urban settings are at an elevated risk for HIV, sexually transmitted infections, and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction (SRR) intervention, supplemented with postintervention booster sessions, targeting low-income, urban, sexually active teenage girls. METHOD Randomized controlled trial in which sexually active urban adolescent girls (n = 738) recruited in a midsize northeastern U.S. city were randomized to a theory-based SRR intervention or to a structurally equivalent health promotion control group. Assessments and behavioral data were collected using audio computer-assisted self-interview at baseline, then at 3, 6, and 12 months postintervention. Both interventions included four small-group sessions and two booster sessions. RESULTS Relative to girls in the control group, girls receiving the SRR intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all follow-ups, (b) number of unprotected vaginal sex acts at 3 and 12 months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n = 322) documented a 50% reduction in positive pregnancy tests at 12 months. CONCLUSIONS Theory-based behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of SRR interventions for girls is needed to ensure they are feasible, appealing, and effective.

Multi-System Influences on Adolescent Risky Sexual Behavior

We examined multi-system influences on risky sexual behavior measured by cumulative sexual risk index and number of nonromantic sexual partners among 4,465 single, sexually experienced adolescents. Hierarchical Poisson regression analyses were conducted with Wave I-II data from the National Longitudinal Study of Adolescent Health. Individual and family factors predicted both outcome measures. Neighborhood set predicted cumulative sexual risk index only, and peer factors predicted the number of nonromantic sexual partners only. School set did not predict either outcome. There were significant associations among risky sexual behavior, drug use, and delinquent behaviors. The results highlight the need for multifaceted prevention programs that address relevant factors related to family, peer and neighborhood influence as well as individual factors among sexually active adolescents.

Predicting sexual risk behaviors among adolescent and young women using a prospective diary method

We describe the sexual risk behaviors, psychological distress, and substance use of 102 late adolescent girls and identify predictors of protected and unprotected vaginal sex. Participants completed questionnaires assessing hypothesized predictors and then daily behavioral diaries for 12 weeks. Protected intercourse was predicted by baseline sexual behavior, greater knowledge, positive condom attitudes, lower perceived condom-use difficulty, greater condom-use intentions, more drinking days, less binge drinking, less Ecstasy use, and lower psychological distress. Unprotected intercourse was predicted by baseline sexual behavior, binge drinking, Ecstasy and opiate use, fewer drinking days, and fewer daily drinks. These findings suggest that psychological distress, substance use, and sexual risk behavior are interconnected and should be considered collectively in interventions for adolescent females.

What’s Age Got to Do With It? Partner Age Difference, Power, Intimate Partner Violence, and Sexual Risk in Urban Adolescents:

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc’s framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors’ effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (−.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Psychosocial Correlates of HIV Risk Behavior in Adolescent Girls

OBJECTIVE To present the preintervention data collected for a pilot HIV-prevention randomized controlled trial specifically developed for single, sexually active adolescent girls. DESIGN Comparative, descriptive design using confidential self-administered questionnaires. SETTING An urban family planning clinic that provided gynecologic services to adolescents. PARTICIPANTS One hundred twenty-nine single, sexually active adolescent girls 15 to 19 years of age (44% minority, 34% economically disadvantaged). MAIN OUTCOME MEASURES In addition to demographics and risk behaviors, the following were assessed: HIV-related information (i.e., knowledge) and motivation to reduce risk (i.e., perceived vulnerability, readiness to change HIV risk behaviors, behavioral intentions, pros and cons of condom use, and confidence in condom use). RESULTS Assessments revealed limited HIV-related knowledge, ambivalence regarding risk reduction, and considerable risk behaviors. Compared with girls at lower risk for HIV infection (i.e., consistent condom users), those at higher risk (i.e., inconsistent or noncondom-users) were more likely to be White and older and to have better HIV-related knowledge but less motivation to reduce risk (i.e., behavioral intentions to use condoms, condom-use confidence) than girls at lower risk. CONCLUSION These data document (a) the need for HIV prevention interventions targeted to all sexually active adolescent girls and (b) the importance of including a motivational component in the intervention.

Low-Income Women and HIV Risk Reduction: Elaborations from Qualitative Research.

Focus groups were conducted with 45 young, single, low-income women regarding the human immunodeficiency virus (HIV). Risk in this sample was substantial, as 53% had multiple sexual partners, and 55% reported a recent sexually transmitted disease. Qualitative analysis of transcribed focus groups identified six themes that emerged across groups: (a) misinformation about vertical transmission and treatment of HIV-related illnesses; (b) risk perception linked to emotive factors rather than objective data; (c) uncertainty regarding the risk-reducing value of monogamy; (d) fatalism linked with ambivalence about HIV-antibody testing and treatment; (e) recognition of the importance of discussing HIV-related topics with children, but concern that such discussion with other women might be inappropriate; and (f) inconsistent communication regarding HIV transmission and prevention with partners, partly the result of concerns about violating trust in intimate relationships. These themes warrant attention in the development of HIV risk-reduction programs.

Risk Behaviors Among Adolescent Girls in an HIV Prevention Trial

Adolescent girls remain vulnerable to HIV and other sexually transmitted infections. Understanding their sexual and substance use behaviors is essential to designing effective interventions to reduce their risk. In this study, baseline data were analyzed from 738 adolescent girls ages 15 to 19 years in Rochester, New York. Data on sexual behavior and substance use (lifetime, past 3 months, and most recent sexual experience) were collected. Nearly one half of recent vaginal (42%) and anal (45%) sex acts were not condom protected; 39% had a prior sexually transmitted infection (STI) and 12% were currently infected with an STI. Approximately one third (31%) of girls had more than one sex partner in the past 3 months. Girls with multiple partners reported that their recent sexual experiences were more likely to involve drug and alcohol use by themselves and partners. Adolescent girls, particularly those with multiple sexual partners, continue to report high-risk sexual behaviors and need focused risk-reduction interventions.

Adolescents input on the development of an HIV risk reduction intervention.

Adolescence is a developmental period often associated with sexual debut as well as risk taking. Given these considerations, HIV prevention interventions need to become an important component of adolescent health care. This article describes the use of formative research to guide intervention refinement. To refine an HIV risk reduction intervention that has been used successfully with adults, the authors conducted focus groups with 30 adolescent females. These participants identified misconceptions regarding HIV-related information and factors that influence motivation to participate in risky behaviors. They also suggested strategies for recruitment and retention in a longitudinal study. Formative research such as this can be used to develop interventions that are gender specific and developmentally and culturally appropriate for adolescents.