JaNelle M. Ricks

Enhancing Condom Use Among Black Male Youths: A Randomized Controlled Trial

OBJECTIVES We tested the efficacy of a brief intervention to promote correct and consistent use of condoms among Black male youths attending sexually transmitted infection (STI) clinics in 3 southern US cities. METHODS In 2010 to 2012, we screened (n = 1102) and enrolled (n = 702) youths aged 15 to 23 years who identified as Black and reported recent (past 2 months) sexual activity and randomized them to a private, brief, interactive intervention (n = 349) or an attention-equivalent control condition (n = 353). Assessments occurred at baseline and 2 and 6 months after the intervention. RESULTS At 6 months, with adjustment for age and pretest nonequivalence of the outcome variable, an estimated odds ratio (EOR) of 1.63 (95% confidence interval [CI] = 1.07, 2.49; P = .02) indicated efficacy for correct condom use. An adjusted generalized estimating equations model with both 2- and 6-month condom use variables produced an EOR of 1.49 (95% CI = 1.06, 2.08; P = .02). We did not observe significant effects on chlamydia and gonorrhea incidence. CONCLUSIONS This brief intervention, delivered as part of STI clinical care, could help alleviate the disproportionate STI-HIV burden among young Black men.

Condom migration resulting from circumcision, microbicides and vaccines: brief review and methodological considerations.

OBJECTIVE To provide an updated review of condom migration as a means of highlighting methodological issues for future studies of this behavioural issue. METHODS Electronic searches of PubMed, MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were carried out in October 2010 and updated in January 2011 for English-language articles published from 1994 onward. RESULTS Evidence addressing condom migration from microbicides and vaccines is vastly underdeveloped, simply because these products are still experimental. In contrast, the more advanced evidence regarding male circumcision is hopeful because it suggests that migration may not be an overwhelming issue. Nonetheless, the entire body of empirical evidence on this question could be substantially expanded and improved. CONCLUSION Until stronger evidence suggests that condom migration is unlikely, it is important to be mindful of the potential for condom migration to occur in response to biomedical interventions (circumcision, microbicides and vaccines).

Elevated Sexual Risk Behaviors Among Postincarcerated Young African American Males in the South

The dramatic racial disparities in the rates of HIV/STIs(sexually transmitted infections) among African Americans make understanding broader structural factors that increase the risk for HIV/STIs crucial. The current study of young 564 African American men attending STI clinics investigated whether those who had ever been incarcerated reported recent sexual behaviors relatively more risky than their counterparts who had never been incarcerated. Participants were recruited from clinics treating STIs in three southern U.S. cities. Males 15 to 23 years of age who identified as Black/African American and reported recent (past 2 months) sexual activity were eligible. Linear mixed-effects models and generalized estimating equation models were used to assess associations between baseline incarceration history and sexual risk behavior over a 6-month follow-up period. Mean age was 19.6 years (SD = 1.87). At baseline, 240 (42.6%) men reported history of incarceration. Incarceration history predicted several risk behaviors over a 6-month follow-up period. Compared with those with no incarceration history, men previously incarcerated reported a desire to conceive a pregnancy (β = .40, p = .02), were less likely to have used a condom at last sex act (odds ratio = .91, p = .02) and were more likely to have used drugs and alcohol before sex in the past 2 months (β = .69, p < .001; β = .41, p < .001). A history of incarceration may influence the sexual risk behavior of young African American males. Prevention programs and interventions should intensify support for postincarceration African American males to help mitigate this behavior.

African-American men’s exposure to music videos and their sexual attitudes and risk behaviour

BACKGROUND Media is a social determinant of HIV and sexually transmissible infection (STI) risk. However, limited empirical data have examined mens media exposure and their sexual attitudes and behaviour towards women. METHODS Eighty heterosexual African-American men were assessed on their exposure to music videos, sexual attitudes and behaviour. They also were tested for STIs. RESULTS Findings indicated that men influenced by music videos reported more sexual adventurism, more condom barriers, more lifetime sexual partners, more condom request refusals, substance abuse and a history of incarceration. CONCLUSIONS Further longitudinal research is needed to better understand this relationship and to address the role of media in HIV and STI prevention interventions.

Adolescent Sex Offenders

In the United States, law enforcement and judicial systems and mental health professionals continue to struggle to deal with the rise in the number of juvenile sex offenders. The consequences of sex offending are substantial for victims, society, perpetrators, and their families, involving significant human (emotional and physical suffering) and financial costs. Adolescent sexual offending is a complex phenomenon that cannot be easily explained. Many theories have been proposed to explain why some children and teens sexually abuse others. However, to date there is no empirically derived and tested model to explain what motivates adolescents to perpetrate sexual crimes. This chapter provides an overview of biological, individual, familial, social, and behavioral characteristics of adolescents who have sexually offended. This chapter also reviews common approaches to treating and preventing recurrent sexually aggressive behavior in juveniles.

Acceptance of and experiences utilising expedited partner therapy among African-American juvenile girls

UNLABELLED Background The aim of this study was to describe acceptance of and experiences utilising expedited partner therapy (EPT) among African-American girls recruited from short-term juvenile detention centres. METHODS Ninety-five detained African-American girls (aged 13-17 years) completed audio computer-assisted self-interviews (ACASI) and self-collected vaginal swab specimens assayed for chlamydia and gonorrhoea. EPT was offered to sexually transmissible infection (STI)-positive participants (n=51); follow-up phone interviews assessed medication delivery to partners. Summary statistics described EPT acceptance frequency. Generalised estimating equations assessed correlates of acceptance. Nine semi-structured interviews elicited EPT experiences. RESULTS EPT was offered 69 times, accepted by 70% (n=37) girls and provided to 68% (n=36) of girls. Acceptance was significantly associated with sexual risk behaviours such as infrequent partner STI prevention discussion (OR=3.2, 95% CI: 1.0,-10.1, P=0.048) and≥4 lifetime sex partners (OR=3.3, 95% CI: 1.0-11.0, P=0.048). Discontinued relationships were the most common barrier to EPT acceptance. Emergent interview themes included sense of responsibility, which appeared to motivate acceptance and help overcome identified discomfort with partner disclosure conversations. CONCLUSIONS Future research is needed to determine EPT efficacy among African-American juvenile populations and feasibility of its use outside of research settings.

Creating Effective Media Messaging for Rural Smoke‐free Policy

OBJECTIVES Objectives were to (1) explore perceived effectiveness of existing smoke-free print advertisements in rural communities and (2) generate message content, characteristics, and media delivery channels that resonate with residents. DESIGN AND SAMPLE Qualitative methods design. Thirty-nine rural adults recruited by community partners. MEASURES Content analysis of findings from individuals in four focus groups who participated in general discussion and reviewed eight print ads related to secondhand smoke (SHS) and smoke-free policy. RESULTS Six content themes were identified: smoking/SHS dangers, worker health, analogies, economic impact, rights, and nostalgia. Seven message characteristics were recognized: short/to the point, large enough to read, graphic images, poignant stories, statistics/charts/graphs, message sender, and messages targeting different groups. Four media delivery channels were considered most effective: local media, technology, billboard messages, and print materials. CONCLUSIONS Seeking input from key informants is essential to reaching rural residents. Use of analogies in media messaging is a distinct contribution to the literature on effective smoke-free campaigns. Other findings support previous studies of effective messaging and delivery channels. Further research is needed to examine effectiveness of themes related to message content in smoke-free ads and delivery strategies. Effective media messaging can lead to policy change in rural communities to reduce exposure to SHS.

Concurrent partnering and condom use among rural heterosexual African-American men

UNLABELLED Background Limited research has targeted HIV risk among heterosexual African-American men in the rural south-eastern United States. METHODS A cross-sectional survey was administered to 538 men to assess HIV knowledge, attitudes towards HIV testing and sexual risk behaviour. RESULTS Fifty-one percent reported consistent condom use in the past 3 months. Monogamous men reported more consistent condom use (t=3.47, d.f.=536, P<0.001). In concurrent partnerships, condom use was inversely related to age (adjusted odds ratio (AOR)=0.98, 95% confidence interval (CI)=0.95-0.998, P=0.03) and increased with the number of female partners (AOR=1.49, 95% CI=1.26-1.76, P<0.001). CONCLUSIONS African-American HIV prevention outreach should include focus on concurrent partnering in rural settings.

It's just a way of fitting in: Tobacco use and the lived experience of lesbian, gay, and bisexual appalachians.

Lesbian, gay, and bisexual (LGB) people are affected by multiple health disparities and risk factors, including tobacco use. Few studies to date have examined tobacco use specifically in rural LGB populations, and none has investigated the intersections of identity, rural LGB culture, and tobacco. The purpose of this study was to explore the perspective of Appalachian LGB people regarding tobacco use. Methods. Nineteen LGB-identified Appalachian residents participated in audiotaped, semi-structured interviews. Two authors analyzed and coded transcripts through constant comparison, and determined themes through consensus. Results. Five themes emerged: the convergence of Appalachian and LGB identities, tacit awareness of LGB identity by others, culture and tobacco use, perceived associations with tobacco use, and health beliefs and health care. Conclusions. LGB Appalachians connect stress and culture to tobacco, but seem less aware that partial concealment of their identity might be a source of the stress that could influence their smoking.

Relational, Pleasure, and Fear-Associated Aspects of Condom Use for Disease Prevention: A Qualitative Study of High-Risk African American Men

This study explores beliefs held by young African American men newly diagnosed with a sexually transmitted infection (STI), regarding condom use. Recruited from a publicly funded STI clinic, participants were African American men (18–29 years of age) who reported using a condom in the past 3 months for penile–vaginal intercourse. Through face-to-face qualitative interviews, 20 men shared their perceptions of condom use with female partners. Findings suggest that condom use among high-risk African American men may best be understood as part of the complex relational dynamics associated with having multiple partnerships. Given the high seroprevalence of STIs in their communities and sexual networks, men also describe the tensions related to sexual pleasure and the fear associated with non-condom use.