Jennifer L. Collins

Comparison of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: Results of a randomized controlled trial ☆

BACKGROUND Ethnic minority adolescent women with a history of sexual or physical abuse and sexually transmitted infections represent a vulnerable population at risk for HIV. Community-based interventions for behavior modification and subsequent risk reduction have not been effective among these women. OBJECTIVES To evaluate the effects of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention model versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection at 6 and 12 months follow-up. DESIGN Controlled randomized trial with longitudinal follow-up. SETTINGS Southwestern United States, Metropolitan community-based clinic. PARTICIPANTS Mexican-and-African American adolescent women aged 14-18 years with a history of abuse or sexually transmitted infection seeking sexual health care. METHODS Extensive preliminary study for intervention development was conducted including individual interviews, focus groups, secondary data analysis, pre-testing and feasibility testing for modification of an evidence-based intervention prior to testing in the randomized controlled trial. Following informed consents for participation in the trial, detailed interviews concerning demographics, abuse history, sexual risk behavior, sexual health and physical exams were obtained. Randomization into either control or intervention groups was conducted. Intervention participants received workshop, support group and individual counseling sessions. Control participants received abuse and enhanced clinical counseling. Follow-up including detailed interview and physical exam was conducted at 6 and 12 months following study entry to assess for infection. Intention to treat analysis was conducted to assess intervention effects using chi-square and multiple regression models. RESULTS 409 Mexican-(n=342) and African-(n=67) American adolescent women with abuse and sexually transmitted infection histories were enrolled; 90% intervention group attendance; longitudinal follow-up at 6 (93%) and 12 (94%) months. Intervention (n=199) versus control (n=210) group participants experienced fewer infections at 0-6 (0% versus 6.6%, p=.001), 6-12 (3.6% versus 7.8%, p=.005, CI 95% lower-upper .001-.386) and 0-12 (4.8% versus 13.2%, p=.002, CI 95% lower-upper, .002-.531) month intervals. CONCLUSIONS A cognitive behavioral intervention specifically designed for ethnic minority adolescent women with a history of abuse and sexually transmitted infection was effective for prevention of infection. These results provide evidence for development of evidence-based interventions for sexually transmitted infection/HIV. Implications include translation to community-clinic-based settings for prevention of adverse outcomes regarding sexual health of adolescent women.

Sexual risk behavior and STI health literacy among ethnic minority adolescent women.

Although information is available for prevention of sexually transmitted infection (STI/HIV), adolescents continue to engage in high risk sexual behavior particularly ethnic minority adolescent women with histories of STI or abuse. A description therefore of STI/HIV knowledge and sexual risk behavior among these women is indicated for modification of prevention efforts for sexual health promotion. African-American (n=94) and Mexican-American (n=465) adolescent women 14-18 years of age were included in the study. Assessments of sexual risk behavior and STI/HIV knowledge among these adolescent women described Mexican-American women as at higher risk of STI, pregnancy, substance use and abuse with lower levels of STI/HIV knowledge, previous HIV testing and perceptions of risk than African-American women. A focus on Mexican-American adolescent women with histories of STI and abuse is indicated for translation of community-based health promotion interventions for amelioration of potential adverse sexual health outcomes among ethnic minority adolescent women.

The Path to Intervention: Community Partnerships and Development of a Cognitive Behavioral Intervention for Ethnic Minority Adolescent Females

Reproductive health needs for ethnic minority adolescents are a national priority given the population growth of minority adolescents in the United States. United States census reports predict minority adolescents will comprise one-third of all young persons less than 20 years of age early in the twenty-first century. Developing culturally sensitive interventions for minority adolescents includes ecological assessments of cultural priorities, community resources, disease burden, and socioeconomic conditions. These assessments must be accomplished in partnership with the local community. Understanding reproductive health needs necessarily includes an evaluation of the absence of reproductive health, namely, the prevalence of sexually transmitted infection (STI), sexual or physical abuse, unplanned pregnancy, and the risk factors that contribute to such adverse outcomes. This article describes the methodological processes utilized to conduct an ecological assessment of a community including the health, economic, and psychosocial status of, and resources available to, a target population prior to the implementation of a community-based, cognitive behavioral intervention to reduce STI, abuse, and unplanned pregnancy.

An Exploration of Young Ethnic Minority Males’ Beliefs about Romantic Relationships

Ethnic minority males experience a disproportionate prevalence of sexually transmitted infections and HIV. Few studies have explored the beliefs that frame romantic relationships in which sexual behavior occurs. The purpose of this study was to explore the experience of romantic relationships for young ethnic minority men who partner with adolescent women with high-risk sexual histories and the beliefs about romantic relationships that underlie these relationship choices. A phenomenologic approach was used. Two semi-structured interviews were completed with six Mexican American and two African American young adult males 19 to 26 years of age. Participants struggled to balance a desire to maintain physical and psychological closeness with partners with a desire to distance from partners in the face of unmet psychological needs. Recognition of how males struggle to balance getting needs met in romantic relationships will be necessary for the provision of culturally relevant care for males and their partners.

Male adolescent sexual behavior: what they know and what they wish they had known.

There is a need to involve sexual partners when addressing sexual behavior of high-risk adolescent women. This study explored men’s perceptions of their role in sexual relationships with adolescent women with a history of sexually transmitted infection (STI) and abuse. The AIDS risk reduction model was used to assess sexual risk behaviors of these men for development of cognitive behavioral risk reduction interventions for themselves and partner. Qualitative interviews were conducted with African and Mexican American men (n = 14; ages 18 to 21 years), recruited via adolescent women enrolled in a control-randomized trial of behavioral interventions for reduction of unintended pregnancy, abuse, substance use, and STI. Participants varied in their perceptions of personal susceptibility to STI or HIV, access to informational resources regarding sexual behavior, and level of adult support for safer sexual behavior. These men shared perceptions of inadequate sexual health preparation, including education concerning risk, ultimately contributing to adverse outcomes of sexual behavior.

Conceptualization of Sexual Partner Relationship Steadiness Among Ethnic Minority Adolescent Women: Implications for Evidence-Based Behavioral Sexual Risk Reduction Interventions

&NA; Cognitive behavioral interventions for sexual risk reduction have been less successful among ethnic minority adolescent women with histories of abuse and sexually transmitted infections (STI) than among other adolescent populations. African American and Mexican American adolescent women (ages 14–18 years, n = 548) self‐reported sexual partner relationship steadiness and sexual risk behaviors via semi‐structured interviews at study entry. Descriptive and bivariate analyses compared sexual risk behaviors by sexual partner relationship steadiness. Steady and unsteady relationships were conceptualized differently. Steady relationships included emotional or financial support, sexual communication, greater relationship importance, unintended pregnancy, and perceived monogamy during break‐ups. Unsteady relationships were unpredictable, including sex with ex‐steady partners and friends with benefits, lack of mutual respect, and poor sexual communication. Modification of sexual risk reduction interventions including conceptualizations of risk by context of sexual partner relationship status is recommended to enhance efficacy among minority adolescent women with STI or history of abuse.

Integrative Review: Delivery of Healthcare Services to Adolescents and Young Adults During and After Foster Care

The purpose of this integrative review is to summarize evidence describing delivery of healthcare services to adolescents while in foster care and to young adults after they exit foster care. The long-term, deleterious effect of abuse and/or neglect by caregivers among youth who have been placed in foster care is grounded in empirical evidence demonstrating the relationship between long-term health needs and exposure to trauma in childhood. Evidence is needed to provide culturally-specific care and also to identify knowledge gaps in the care of adolescents and young adults who have been in the foster care system. Peer-reviewed research studies published between 2004 and 2014 that include samples of youth 12 to 30 years of age are included in the review. Eighteen studies met inclusion criteria for the review. Physical and behavioral healthcare needs among youth with foster care experience are significant. The ability to adequately meet health needs are inextricable from the ability to negotiate resources and to successfully interact with adults. Challenges that youth with foster care histories experience when transitioning into young adulthood are comparable to other populations of vulnerable youth not in foster care. Nurses must use each healthcare encounter to assess how the social determinants of health facilitate or impede optimal health among youth with foster care experience. The development of integrated intervention strategies to inform best practice models is a priority for current and former foster care youth as they transition into young adulthood.

Assessment of Mobile Device and SMS Use for Diet and Exercise Information Among Rural Mexican-American Adolescents

This is a pilot study regarding the use of mobile technology and short message service (SMS) for diet and exercise among rural Mexican American adolescents (RMAA). Authors used convenience sampling to recruit RMAA seeking care at a rural healthcare clinic and conducted three focus groups (n=12). Content analysis was used to identify categories and subcategories. Participants applied diet and exercise information in their lives based on an interaction with community and through the use of use mobile devices. Culturally sensitive use of mobile devices and SMS may be a tool to provide rural adolescent populations with resources.

Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services

Purpose: To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican‐American adolescents. Data sources: Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%–80% of overweight/obese had limited follow‐up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%–75.6% without interventions. Conclusions: Obesity is a healthcare problem among rural Mexican‐American adolescents accessing care at the rural health clinic. Obesity intervention and follow‐up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access. Implications: Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence‐based interventions for rural Mexican‐American adolescents at rural health clinics is implicated.

The influence of social determinants of health among young adults after they have left foster care in the US

AIMS AND OBJECTIVES To describe the influence of the social determinants of health on health care seeking among young adults after they left foster care. BACKGROUND Extensive research suggests that stakeholders in foster care systems throughout the world struggle to consistently and effectively manage the health and well-being of youth. These struggles extend beyond time in foster care as indicated by poor health and social outcomes throughout the life course. Evidence that describes how young adults address health and related social needs after leaving foster care is missing. DESIGN A phenomenological design, Phenomenology of Practice, was used to collect data. Content analysis was used to analyse the data, using constructs from the Healthy People 2020 SDOH Model to organise the data. METHODS Thirteen young adults who left foster care in the southwestern US were recruited using convenience sampling. Data were collected via individual interviews. RESULTS Young adults formerly in foster care reported using and lacking social support networks to navigate SDOH. The interrelatedness of SDOH on health outcomes after foster care is evident. CONCLUSIONS Social support networks can help explain how young adults are both able and unable to navigate systems to address health issues. Evaluating social networks used to access care is an important aspect of assessment and intervention for these vulnerable young adults. RELEVANCE TO CLINICAL PRACTICE Healthcare providers facilitate healthcare access for young adults who have been in foster care through evaluation of social determinants. Assessment and care planning based on social determinants for those who have been in foster care are critical to ensure the efficacy of interventions designed to address health outcomes. Social support systems are key factors for young adults formerly in foster care to access resources, substantiating the need for ongoing assessment and development of these support systems.