John B. Jemmott

Increasing condom-use intentions among sexually active black adolescent women.

Whether a social cognitive theory AIDS prevention intervention would increase intentions to use condoms among 109 sexually active inner-city black female adolescents was tested. Analyses revealed that the women scored higher in intentions to use condoms, AIDS knowledge, outcome expectancies regarding condom use, and self-efficacy to use condoms after the intervention than before the intervention. Although increased self-efficacy and more favorable outcome expectancies regarding the effects of condoms on sexual enjoyment and sexual partners support for condom use were significantly related to increased condom-use intentions, increases in general AIDS knowledge and specific prevention-related beliefs were not.

Reducing HIV risk-associated sexual behavior among African American adolescents: Testing the generality of intervention effects.

This randomized controlled trial tested the effects of a theory-based culture-sensitive HIV risk-reduction intervention among 496 inner-city African American adolescents (mean age = 13 years) and examined the generality of its effects as a function of the facilitators race and gender and the gender composition of the intervention group. Adolescents who received the HIV risk-reduction intervention expressed more favorable behavioral beliefs about condoms, greater self-efficacy, and stronger condom-use intentions postintervention than did those who received a control intervention on other health issues. Six-month follow-up data collected on 93% of the adolescents revealed that those who received the HIV risk-reduction intervention reported less HIV risk-associated sexual behavior, including unprotected coitus, than did their counterparts in the control condition. Self-reported sexual behavior and changes in self-reported behavior were unrelated to scores on a standard measure of social desirability response bias. There was strong evidence for the generality of intervention effects. Moderator analyses testing eight specific interaction hypotheses and correlational analyses indicated that the effects of the HIV risk-reduction intervention did not vary as a function of the facilitators race or gender, participants gender, or the gender composition of the intervention group.

Academic stress, social support, and secretory immunoglobulin A.

We examined the relation of academic stress and social support to salivary concentrations of secretory immunoglobulin A (S-IgA), an antibody class that plays an important role in mucosal defense against acute upper respiratory tract infections. We assayed whole, unstimulated saliva samples collected from 15 healthy undergraduates 5 days before their final exam period, during their exam period, and 14 days after their last final exam for S-IgA concentrations by single radial immunodiffusion. The students rated the universitys general psychological climate as being more stressful during the exam period compared with the two other periods. Paralleling this, their salivary concentrations of S-IgA were lower during the exam period. Students who reported more adequate social support at the preexam period had consistently higher S-IgA levels than did their peers reporting less adequate social support. This latter finding is consonant with the social support direct effects hypothesis, which states that social support enhances health outcomes irrespective of whether the individual is exposed to stressful experiences.

Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings.

OBJECTIVES We tested the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction interventions for African American women in primary care settings. METHODS In a randomized controlled trial, 564 African American women recruited at a Newark, NJ, inner-city womens health clinic were assigned to a 20-minute one-on-one HIV/STD behavioral skill-building intervention, 200-minute group HIV/STD behavioral skill-building intervention, 20-minute one-on-one HIV/STD information intervention, 200-minute group HIV/STD information intervention, or 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence. RESULTS At 12-month follow-up, participants in the skill-building interventions reported less unprotected sexual intercourse than did participants in the information interventions (Cohens d [d]=0.23, P=.02), reported a greater proportion of protected sexual intercourse than did information intervention participants (d=0.21, P=.05) and control participants (d=0.24, P=.03), and were less likely to test positive for an STD than were control participants (d=0.20, P=.03). CONCLUSIONS This study suggests that brief single-session, one-on-one or group skill-building interventions may reduce HIV/STD risk behaviors and STD morbidity among inner-city African American women in primary care settings.

Predictors of sexual intercourse and condom use intentions among Spanish-dominant Latino youth: a test of the planned behavior theory.

BackgroundSpanish-dominant Latino youth represent a growing yet underserved segment of the U.S. population, especially in terms of protection from sexually transmitted HIV infection. There is evidence to suggest that this subgroup engages in both risk and protective behaviors that may be different from the behaviors of English-dominant Latino youth. ObjectiveTo examine theoretical predictors (attitude, subjective norm, behavioral beliefs, normative beliefs, control beliefs) of sexual intercourse and condom use with a sample of Spanish-dominant Latino youth. MethodsParticipants in this study were part of a larger randomized controlled intervention designed to reduce the risk of sexually transmitted HIV among Latino youth. This article is based on preintervention data from 141 Spanish-speaking Latino adolescents (77 girls and 64 boys) who completed a Spanish version of the questionnaire. ResultsMultiple regression analyses showed significant effects of attitudes, perceived partner approval, self-pride, and parental pride on intentions to engage in sexual intercourse. Attitudes, intentions to engage in sex in the next 3 months, self-pride, parental pride, goals, and partner approval predicted sexual intercourse in the preceding 3 months. Attitudes, subjective norms, self-efficacy, partner and parental approval, and impulse control beliefs were significant predictors of intentions to use condoms. ConclusionsThis study represents initial efforts to address the needs of Spanish-dominant Latino youth. The identification of salient beliefs that may predict sexual risk and protective behavior are relevant to the design of culturally and linguistically effective interventions.

Secretory IgA as a Measure of Resistance to Infectious Disease: Comments on Stone, Cox, Valdimarsdottir, and Neale

We examined recent assertions of Stone, Cox, Valdimarsdottir, and Neale regarding the use of S-IgA concentrations in whole saliva as a measure of mucosal immune competence. Our conclusions are markedly different from theirs. In this article, we report the results of a meta-analysis that reveals a significant relation between psychosocial variables and salivary S-IgA concentrations. Second, we note that an inverse relation between salivary flow and S-IgA would not preclude studying salivary S-IgA concentration. Third, we present a different perspective on the assertion of Stone et al that IgA proteases in whole saliva potentially lead to erroneous results from the radial immunodiffusion assay. Fourth, we report a meta-analysis suggesting a statistically significant relation between S-IgA salivary concentrations and the incidence of acute upper respiratory illnesses. We conclude that there is no empirical or logical reason to prefer the measurement of another aspect of immunity to total S-IgA concentration in whole saliva.

National Institute of Mental Health Multisite Eban HIV/STD Prevention Intervention for African American HIV Serodiscordant Couples: A Cluster Randomized Trial

BACKGROUND Human immunodeficiency virus (HIV) has disproportionately affected African Americans. Couple-level interventions may be a promising intervention strategy. METHODS To determine if a behavioral intervention can reduce HIV/sexually transmitted disease (STD) risk behaviors among African American HIV serodiscordant couples, a cluster randomized controlled trial (Eban) was conducted in Atlanta, Georgia; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania; with African American HIV serodiscordant heterosexual couples who were eligible if both partners were at least 18 years old and reported unprotected intercourse in the previous 90 days and awareness of each others serostatus. One thousand seventy participants were enrolled (mean age, 43 years; 40% of male participants were HIV positive). Couples were randomized to 1 of 2 interventions: couple-focused Eban HIV/STD risk-reduction intervention or attention-matched individual-focused health promotion comparison. The primary outcomes were the proportion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea, or trichomonas). Data were collected preintervention and postintervention, and at 6- and 12-month follow-ups. RESULTS Data were analyzed for 535 randomized couples: 260 in the intervention group and 275 in the comparison group; 81.9% were retained at the 12-month follow-up. Generalized estimating equation analyses revealed that the proportion of condom-protected intercourse acts was larger among couples in the intervention group (0.77) than in the comparison group (0.47; risk ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41; P = .006) when adjusted for the baseline criterion measure. The adjusted percentage of couples using condoms consistently was higher in the intervention group (63%) than in the comparison group (48%; risk ratio, 1.45; 95% CI, 1.24 to 1.70; P < .001). The adjusted mean number of (log)unprotected intercourse acts was lower in the intervention group than in the comparison group (mean difference, -1.52; 95% CI, -2.07 to -0.98; P < .001). The cumulative STD incidence over the 12-month follow-up did not differ between couples in the intervention and comparison groups. The overall HIV seroconversion at the 12-month follow-up was 5 (2 in the intervention group, 3 in the comparison group) of 535 individuals, which translates to 935 per 100,000 population. CONCLUSION To our knowledge, this is the first randomized controlled intervention trial to report significant reductions in HIV/STD risk behaviors among African American HIV serodiscordant couples. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00644163.

Appraising the threat of illness: a mental representational approach.

This article (a) describes a mental model underlying initial evaluations of illness signs and (b) reports an experiment demonstrating the models utility by showing how the model represents evidence of defensiveness among people who test positively for a sign of illness. The model consists of a set of cognitive elements that people consider to evaluate the threat represented by a sign of possible illness. Seventy-two undergraduates were led to believe that they tested positively or negatively on a saliva test for a fictitious risk factor for a disease. In addition, half the participants were told about the existence of a simple preventive treatment for the disease, whereas the others were not. Subsequently the participants answered questions about elements of the threat-appraisal model. Analysis of their responses reveals evidence of defensiveness on several elements of the model. Those testing positively for the risk factor, especially those uninformed about its treatment, minimized threat by (a) increasing their estimates of the false-positive rate of the test, (b) decreasing their estimates of the seriousness of the risk factor, and (c) decreasing their estimates of the extent to which the disease itself is life-threatening. Applications of the model to actual illness threats and the relation between threat-related judgments and health-related behavior are discussed.

Mediation Analysis of an Effective Sexual Risk-Reduction Intervention for Women : The Importance of Self-Efficacy

OBJECTIVE Sister-to-Sister: The Black Womens Health Project is a skill-building HIV/STD risk-reduction intervention for African American women that had significant effects in reducing self-reported sexual risk behavior and biologically confirmed sexually transmitted disease (STD) incidence. The present analyses were conducted to identify which theory-based factors that were addressed in the intervention accounted for its success. DESIGN The data were collected in the context of a randomized, 5-group intervention trial with assessments at baseline and at 3, 6, and 12 months following the intervention. A mediation analysis was conducted with condom use at last sex, self-reported 12 months after the intervention, as the outcome variable. Mediators were also measured at the 12-month follow-up. MAIN OUTCOME MEASURES Mediators were derived from social cognitive theory: condom use knowledge, hedonistic beliefs regarding effects of condom use, expected sex partner reactions to condom requests, sex partner approval of condom use, self-efficacy for impulse control, self-efficacy for carrying condoms, and self-efficacy to achieve consistent condom use with partner. RESULTS The intervention significantly improved all potential mediators except condom use knowledge (p = .15), hedonistic beliefs (p = .08), and self-efficacy for impulse control (p = .20). Analyses testing each mediator separately revealed that expected partner reaction, partner approval of condom use, self-efficacy for condom carrying, and self-efficacy for condom use were significant mediators. When they were entered into a multivariate mediation analysis, however, only self-efficacy for condom use was significant (p = .001). CONCLUSION These results highlight the importance of self-efficacy in explaining the effects of skill-building sexual risk-reduction interventions on womens use of condoms. Self-efficacy was more important than characteristics of male partners.

HIV Behavioral Interventions for Adolescents in Community Settings

Adolescence is a period of the life cycle characterized by biological, psychological, and social changes and transitions. There is growing concern that for many young people it is also a time of risks associated with sexual involvement. Adolescent pregnancy is a national concern, and far too many adolescents contract sexually transmitted infections, including infection with the human immunodeficiency virus (HIV)—the cause of acquired immunodeficiency syndrome (AIDS). In this chapter, we review research aimed at identifying effective interventions to reduce the risk of sexually transmitted HIV infections among adolescents in community settings.