Emil Coman

Youth Action Research for Prevention: a multi-level intervention designed to increase efficacy and empowerment among urban youth.

Youth Action Research for Prevention (YARP), a federally funded research and demonstration intervention, utilizes youth empowerment as the cornerstone of a multi-level intervention designed to reduce and/or delay onset of drug and sex risk, while increasing individual and collective efficacy and educational expectations. The intervention, located in Hartford Connecticut, served 114 African-Caribbean and Latino high school youth in a community education setting and a matched comparison group of 202 youth from 2001 to 2004. The strategy used in YARP begins with individuals, forges group identity and cohesion, trains youth as a group to use research to understand their community better (formative community ethnography), and then engages them in using the research for social action at multiple levels in community settings (policy, school-based, parental etc.) Engagement in community activism has, in turn, an effect on individual and collective efficacy and individual behavioral change. This approach is unique insofar as it differs from multilevel interventions that create approaches to attack multiple levels simultaneously. We describe the YARP intervention and employ qualitative and quantitative data from the quasi-experimental evaluation study design to assess the way in which the YARP approach empowered individual youth and groups of youth (youth networks) to engage in social action in their schools, communities and at the policy level, which in turn affected their attitudes and behaviors.

Multilevel Social Influences on Female Condom Use and Adoption Among Women in the Urban United States

Heterosexually transmitted HIV remains of critical concern in the United States and around the world, especially among vulnerable and disadvantaged women, complicated by socioeconomic circumstances, gender power, addiction, and experiences of abuse, among other conditions. Effective woman-initiated HIV prevention options, such as the female condom (FC), are needed that women can use in different sexual relationship contexts. We conducted a behavioral and attitudinal survey with 461 primarily African American and Latina (especially Puerto Rican) women in Hartford, Connecticut, to measure factors on the individual, partner relationship, peer, and community levels influencing their initial and continued use of FC (using the prototype FC1) for disease prevention. We used multivariate analyses and structural equation modeling to assess effects of multiple level factors on FC use and unprotected sex with primary, casual, and paying partners. Initial, recent, and continued FC use was associated with factors on the individual level (education, marital status, drug use, child abuse experiences, HIV status), partner level (number of sex partners, paying sex partner, relationship power), and peer level (more or influential peers saying positive things about FC). Community level factors of availability and support were consistently poor across all sectors, which limited overall FC use. Patterns differed between African American and Latina women in stages and contexts of FC use and unprotected sex. FC can make a valuable contribution to reducing heterosexually transmitted HIV among women in many circumstances. The greatest barrier to increased FC use is the lack of a supportive community environment for its promotion and use.

Multi-Level Intervention to Prevent Influenza Infections in Older Low Income and Minority Adults

In this paper we describe a successful multi-level participatory intervention grounded in principles of individual and group empowerment, and guided by social construction theory. The intervention addressed known and persistent inequities in influenza vaccination among African American and Latino older adults, and associated infections, hospitalizations and mortality. It was designed to increase resident ability to make informed decisions about vaccination, and to build internal and external infrastructure to support sustainability over time. The intervention brought a group of social scientists, vaccine researchers, geriatricians, public health nurses, elder services providers and advocates together with senior housing management and activist African American and Latino residents living in public senior housing in a small east coast city. Two buildings of equal size and similar ethnic composition were randomized as intervention and control buildings. Pre and post intervention surveys were conducted in both buildings, measuring knowledge, attitudes and peer norms. Processes and outcomes were documented at four levels: Influenza Strategic Alliance (macro and exo levels), building management (meso level), building resident committee (meso level) and individual residents. The Influenza Strategic Alliance (I.S.A.) provided ongoing resources, information and vaccine; the building management provided economic and other in-kind resources and supported residents to continue flu clinics in the building. The V.I.P. Resident Committee conducted flu campaigns with flu clinics in English and Spanish. The vaccination rate in the intervention building at post test exceeded the study goal of 70% and showed a significant improvement over the control building. The intervention achieved desired outcomes at all four levels and resulted in a significant increase in influenza vaccination, and improvements in pro-vaccination knowledge, beliefs, and understanding of health consequences.

Mental health in senior housing: racial/ethnic patterns and correlates of major depressive disorder

Objectives: Mental health problems are associated with disability, overuse of medical care, higher rates of mortality and suicide as well as personal suffering for older adults. Residents of urban, low-income senior housing may face increased risk of a variety of mental health problems, including depression. This study identified the prevalence of multiple mental health problems in older residents of low-income senior housing and explored correlates of major depressive disorder for the two largest ethnic groups: black and Latino. Method: In-person diagnostic interviews identified rates of mental illness in a sample of 635 residents of 13 low-income senior housing buildings in a medium-sized northeastern city. Applying Georges Social Antecedent Model of Depression, logistic regression analyses identified shared and unique correlates of depression for Latino and black participants. Results: This population had high rates of major depressive disorder (26%), generalized anxiety disorder (12%) and other mental health problems that varied significantly by ethnic and racial group. Separate multivariate models for Latino and black people showed that younger age, more chronic conditions and social distress were related to major depressive disorder for both ethnic groups. Perceived environmental stress, shorter tenure in the building, poorer perceived health, higher life stress and fewer leisure activities were associated with depression for Latinos only. Conclusion: Mental health screening and treatment services are needed in senior housing to address these high rates of mental illness. Unique constellations of correlates of depression for different ethnic groups underscore a need for culturally competent approaches to identification and treatment.

Anxious depression among Puerto Rican and African-American older adults

Objectives: To determine racial/ethnic differences in the prevalence and impact of anxious depression (i.e. major depressive disorder, MDD, occurring concomitant with generalized anxiety symptoms) among older adults. Method: Interviews were conducted with 218 Puerto Rican and 206 African American older (age ≥60) urban senior housing residents. Data were collected on diagnostic status, depression severity and psychosocial functioning. Results: Results indicated a higher prevalence of MDD and anxious depression among Puerto Rican participants. Anxious depression was associated with more severe ratings of distress and suicidality compared with MDD alone, and the impact of depression and anxiety was most pronounced for the Puerto Rican participants. Puerto Rican participants also reported poorer subjective health and more substantial disability; however, these effects were independent of depression or anxiety status. Conclusions: Anxious depression is common among older ethnic minority adults and the impact of these symptoms differs by race/ethnicity. These results highlight the importance of conducting culturally sensitive assessments of depression and anxiety among older adults.

Initial and sustained female condom use among low-income urban U.S. women.

OBJECTIVES The female condom (FC), an effective barrier method for HIV/sexually transmitted infection (STI) prevention, continues to be absent from most community settings, including reproductive health and treatment clinics. Reducing or eliminating basic barriers, including lack of awareness, knowledge of proper use, and access to free samples, may significantly increase use among those who want or need them. METHODS A prospective cohort of 461 women in Hartford, Connecticut (2005-2008), was interviewed at baseline, 1 month, and 10 months about FC use and other personal, partner, peer, and community factors. All participants received brief demonstration of FC use and four free FC1 at baseline. Pairwise longitudinal tests and structural equation modeling were used to test predictors of initial (1 month) and sustained (10 month) FC use. RESULTS Although only 29% of the sample reported ever having used FC at baseline, 73% of never users (51% of the returned 1-month sample) had initiated FC use by 1 month after receiving the brief intervention. Additionally, 24% of the returned 10-month sample (30% of 10-month FC users) reported sustained use, measured as having used FC at baseline or 1 month and also in the prior 30 days. General latent variable modeling indicated that FC knowledge and attitudes predicted initiating FC use; male condom use, FC knowledge and attitudes, and network exposure to FC information predicted sustained use. CONCLUSIONS Findings indicated that many women will potentially initiate and continue using FC when basic barriers are removed. Brief FC education with free trial samples should be built into standard clinical practice and public health programs.

The paired t-test as a simple latent change score model.

The t-test is a common statistical test of differences in means. Despite the fact that its extension, the paired t-test (t-testP), appears in most introductory statistics textbooks, it is less known that for repeated variables the t-testP is in fact a model of change that can be replicated within the Structural Equation Modeling (SEM) framework. We show how to perform the t-testP with latent change scores (LCS) models, which allow for direct testing of significance of mean changes, and moreover can explain inter-individual (and group) differences in changes over time.

Comparisons of CES-D depression scoring methods in two older adults ethnic groups. The emergence of an ethnic-specific brief three-item CES-D scale.

To compare the reliabilities and convergent validities of five CES‐D (Center for Epidemiologic Studies Depression) composite scores in two ethnic/racial groups of community‐dwelling older adults.

Active8! Technology-Based Intervention to Promote Physical Activity in Hospital Employees

Purpose. Increase physical activity in health care employees using health messaging, and compare e-mail with mobile phone short-message service (SMS) as delivery channels. Design. Randomized controlled trial Setting. U.K. hospital workplace. Subjects. Two hundred ninety-six employees (19–67 years, 53% of study Web site visitors). Intervention. Twelve-week messaging intervention designed to increase physical activity and delivered via SMS (n =147) or e-mail (n =149); content tailored using theory of planned behavior (TPB) and limited to 160 characters. Measures. Baseline and 6, 12, and 16 weeks. Online measures included TPB constructs, physical activity behavior on the Global Physical Activity Questionnaire, and health-related quality of life on the Short-Form 12. Analysis. General linear models for repeated measures. Results. Increase in duration (mean h/d) of moderate work-related activity and moderate recreational activity from baseline to 16 weeks. Short-lived increase in frequency (d/wk) of vigorous recreational activity from baseline to 6 weeks. Increase in duration and frequency of active travel from baseline to 16 weeks. E-mails generated greater changes than SMS in active travel and moderate activity (work and recreational). Conclusion. Minimal physical activity promotion delivered by SMS or e-mail can increase frequency and duration of active travel and duration of moderate intensity physical activity at work and for leisure, which is maintained up to 1 month after messaging ends. Both channels were useful platforms for health communication; e-mails were particularly beneficial with hospital employees.

Stress Mediates the Relationship Between Past Drug Addiction and Current Risky Sexual Behaviour Among Low‐income Women

This study examined the role of stress as a mediator of the relationship between prior drug addiction and current high-risk sexual behaviour. Eight hundred twenty women aged 18 to 30 years, who received care at community-based family planning clinics, were interviewed using the Composite International Diagnostic Interview and the Sexual Risk Behavior Assessment Schedule. They also completed the brief version of the Self-Control Scale as a measure of problem-solving strategies and measures of recent stressful events, daily hassles and ongoing chronic stress. Regardless of addiction history, stress exposure during the previous 12 months was associated with risky sexual behaviour during the previous 12 months. Structural equation modelling revealed that 12-month stress levels mediated the relationship between past drug addiction and 12-month high-risk sexual behaviours, as well as the negative relationship between problem-solving strategies and high-risk sexual behaviours. Problem-solving strategies did not moderate the relationship between drug addiction and high-risk sexual behaviours. These findings suggest that stress management training may help reduce risky behaviour among young, low-income women.