Josefina J. Card

Epidemiology of PTSD in a national cohort of Vietnam veterans

At age 36, Vietnam veterans in the high school class of 1963 reported significantly more problems related to nightmares, loss of control over behavior, emotional numbing, withdrawal from the external environment, hyperalertness, anxiety, and depression than did their classmates matched with them on 51 high school characteristics. These problems correspond closely to the disorder labeled post-traumatic stress disorder (PTSD) by the American Psychiatric Association. PTSD was associated with other family, mental health, and social interaction problems. Some environmental variables--e.g., the presence of a spouse or being a churchgoer--were associated with reduced levels of PTSD or with reductions in the degree of association between combat and PTSD. The direction of cause and effect in these associations cannot be ascertained from our data, but it seems plausible to postulate that support factors can and do help some Vietnam veterans with PTSD.

Combat-related post-traumatic stress disorder etiology: replicated findings in a national sample of Vietnam-era men.

To examine the generality of recent findings on PTSD etiology in help-seeking Vietnam combat veterans, replication was attempted with data from a national study of Vietnam-era men that included combat veterans. Use of a Guttman scaling technique for assessing combat exposure was found to be robust for use with a national nonclinical sample as well. In addition, multiple regression analysis was used to examine predictive relationships between premilitary adjustment, military adjustment, combat exposure, and post-traumatic stress disorder (PTSD). Results obtained from the national sample showed the same patterning as that reported from the smaller clinical sample. Combat exposure was related significantly to PTSD symptomatology, while premilitary adjustment was not. A previously identified discriminant function, composed of psychological symptoms not found in the DSM III criteria for PTSD, also was cross-validated.

Preventing adolescent pregnancy : model programs and evaluations

Adolescent Pregnancy Prevention Programs - Josefina J Card, James L Peterson and Catherine G Greeno Design, Monitoring, and Evaluation Small Group Sex Education at School - B Helen Thomas et al The McMaster Teen Program Enhancing Social and Cognitive Skills - Richard P Barth et al An Information and Skills Approach for Younger Teens - Marion Howard and Judith A McCabe Postponing Sexual Involvement Program A Comprehensive Age-Phased Approach - Heather Johnston Nicholson and Leticia T Postrado Girls Incorporated Life Options and Community Service - Susan Philliber and Joseph P Allen Teen Outreach Program School-Linked Reproductive Health Services - Laurie Schwab Zabin The Johns Hopkins Program School-Based Clinics - Douglas Kirby and Cindy Waszak A Health Beliefs Field Experiment - Marvin Eisen and Gail L Zellman Teen Talk Comparing Adolescent Pregnancy Prevention Programs - Brent C Miller and Roberta L Paikoff Methods and Results

How to Adapt Effective Programs for Use in New Contexts

A wide variety of underused effective HIV prevention programs exist. This article describes sources for obtaining such effective programs and issues to consider in selecting an existing effective program for use with one’s priority population. It also discusses seven steps involved in adapting an effective program to meet the needs of a new context while preserving core components (what made, or is believed to have made, the intervention effective in the first place) and best practices (characteristics common to effective programs). Although the examples presented are from the HIV prevention field, the seven-step framework is applicable to the adaptation of effective programs in other health promotion and disease prevention arenas.

The Program Archive on Sexuality, Health & Adolescence: Promising "Prevention Programs in a Box"

The Program Archive on Sexuality, Health & Adolescence (PASHA) identifies programs aimed at preventing pregnancies and sexually transmitted diseases among teenagers, and makes materials from interventions with demonstrated effectiveness available to practitioners around the country. With the assistance of a panel of experts, PASHA has identified an initial group of 15 pregnancy prevention and 15 sexually transmitted disease prevention programs for inclusion in its collection; to date, 24 programs have accepted PASHAs invitation to participate. Once a program agrees to participate, PASHA packages all materials required to replicate or adapt the intervention, along with a users guide, two evaluation instruments and a directory guiding users to sources of assistance. As additional effective programs are identified and agree to submit their materials for archiving and distribution, they will be added to the collection.

tRanslating an effectiVe gRoup- Based HiV pReVention pRogRam to a pRogRam deliVeRed pRimaRily By a computeR: metHods and outcomes

We describe development of SAHARA (SISTAS Accessing HIV/AIDS Resources At-a-click), an innovative HIV prevention program that uses a computer to deliver an updated version of SiSTA, a widely used, effective group-level HIV prevention intervention for African American women ages 18-29. Fidelity to SiSTAs core components was achieved using: (1) video clips featuring group discussions and modeling of appropriate sexual- and contraceptive-related behavior; and (2) interactive Flash modules facilitating cognitive rehearsal, providing learning experiences through games and quizzes, and providing opportunities for simulated role-play. A preliminary outcome study of SAHARA conducted at Planned Parenthood, Atlanta, found that SAHARA, when followed by a brief 20-minute wrap-up group session facilitated by a health educator, was effective in promoting consistent condom use for vaginal sex. We discuss the potential advantages and challenges of an intervention like SAHARA delivered by computer to an individual, versus one like SiSTA delivered by a health educator to a small group.

Realities of replication: implementation of evidence-based interventions for HIV prevention in real-world settings

BackgroundTo have public health impact, evidence-based interventions (EBIs) must be implemented appropriately at meaningful scale. The Center for Disease Control and Prevention’s Replicating Effective Programs and Diffusion of Effective Behavioral Interventions programs disseminate select EBIs by providing program materials and training health providers on their appropriate use and implementation. Sociometrics’ HIV/AIDS Prevention Program Archive (HAPPA) and Program Archive for Sexuality, Health, and Adolescents (PASHA) are likewise the largest EBI collections targeting sexual risk behaviors in the private sector. This study examined the extent to which organizations that obtain EBIs from HAPPA and PASHA implement, adapt and evaluate them and factors associated with program implementation.MethodsSurvey data were collected from 123 organizations that acquired, and had been in possession for a minimum of six months, at least one EBI from HAPPA or PASHA between January 2009 and June 2011. Data regarding program characteristics and date of acquisition were obtained from Sociometrics’ sales and marketing databases. Logistic regression was used to assess barriers to program implementation.ResultsAmong organizations that obtained an EBI from Sociometrics intending to implement it, 53% had implemented the program at least once or were in the process of implementing the program for the first time; another 22% were preparing for implementation. Over the three-year time period assessed, over 11,381 individuals participated in these interventions. Almost two-thirds (65%) of implementers made changes to the original program. Common adaptations included: editing content to be more current and of local relevance (81%); adding, deleting or modifying incentives for participation (50%); changing the location in which the program takes place (44%); and/or changing the number, length and/or frequency of program sessions (42%). In total, 80% of implementers monitored program delivery. Participant outcomes were tracked by 78%; 28% of which used evaluation designs that included a control or comparison group. Lack of adequate resources was significantly associated with decreased likelihood of program implementation (odds ratio = 0.180, p <0.05).ConclusionsFindings provide greater understanding of implementation processes, barriers and facilitators that may be used to develop strategies to increase the appropriate use of EBIs.

Handbook of adolescent sexuality and pregnancy : research and evaluation instruments

Items and Scales Measuring Adolescent Pregnancy and its Antecedents and Consequences - James L Peterson and Josefina J Card A Minimum Data Set for Evaluating Programs Aimed at Caring for Adolescent Mothers and their Children - Dennis McBride A Minimum Data Set for Evaluating Programs Aimed at Preventing Adolescent Pregnancy - Claire Brindis and Marvin Eisen Instruments in the Data Archive on Adolescent Pregnancy and Pregnancy Prevention - Bonnie Sherman-Williams et al

The Prevention Minimum Evaluation Data Set (PMEDS). A tool for evaluating teen pregnancy and STD/HIV/AIDS prevention programs.

This article presents the Prevention Minimum Evaluation Data Set (PMEDS), a ready-to-use questionnaire or tool for evaluating teen pregnancy prevention and teen STD/HIV/AIDS prevention programs. Recognizing the diversity of approaches taken by these programs, PMEDS has two parts. Part I contains a primary questionnaire applicable to all programs. Part 2 consists of 15 additional supplementary modules for optional use by programs with a more specific target population or intervention approach that matches the modules content. It is hoped that PMEDS will facilitate the conducting of high-quality evaluations, first by highlighting important aspects of a program model that should be included in an evaluation, such as the demographic profile of the target population, the specific aspects of the intervention or treatment received by each participant, and the short-term outcomes and long-term goals that the program is trying to affect; second, by presenting measuresfor these evaluation constructs that have been extensively pretested and used in large-scale national studies and .for which national comparison norms and data exist.

Evaluating teenage pregnancy prevention and other social programs: ten stages of program assessment.

A full impact evaluation of a program designed to address social problems such as teenage pregnancy should be considered the end of an ordered series of 10 successive stages which together constitute program assessment. The first of 3 levels of stages is that of planning and model building (what social problem is being addressed and how should it be tackled). The levels in this stage are 1) stating the problem, 2) setting goals and objectives, 3) defining the intervention, and 4) drafting the program model. Data collection is the next level and incorporates the stages of 5) client accounting, 6) measuring the intervention, and 7) monitoring participation. The third and final level is providing a comparison against a standard. This is accomplished by 8) doing a process evaluation, 9) doing an outcome evaluation, and 10) doing a full impact evaluation. While these 10 stages are not the only way to conceptualize program assessment, they provide an ordered technique for building an evaluation design into overall planning of an intervention. Each stage advances on the previous stage and has attendant benefits and costs (which are described in this article). This process allows evaluators and program administrators to 1) do a less ambitious program well instead of doing a grand design poorly, 2) use the detailed series of steps to make improvements consistent with available resources, 3) understand that not every program need be evaluated at its highest level, and 4) realize that nearly every program should be able to achieve stage 4 without incurring high costs.