Julie A. Cederbaum

Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention

The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth.Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F recruited online youth (OY) to participate in MySpace and Facebook communities where digital media was disseminated and discussed. The resulting social networks were assessed with respect to size, growth, density, relative centrality of positions and homophily of ties. Seven PL, 53 F2F and 103 OY created two large networks. After the first 50 F2F youth participated, online networks entered a rapid growth phase. OY were among the most central youth in these networks. Younger aged persons and females were disproportionately connected to like youth. The program appears highly acceptable to homeless youth. Social network analysis revealed which PL were the most critical to the program and which types of participants (younger youth and females) may require additional outreach efforts in the future.

Substance Use Among Military-Connected Youth The California Healthy Kids Survey

BACKGROUND Young people in military-connected families may be exposed to deleterious stressors, related to family member deployment, that have been associated with externalizing behaviors such as substance use. Substance use predisposes youth to myriad health and social problems across the life span. PURPOSE This study examined the prevalence and correlates of lifetime and recent substance use in a normative sample of youth who were either connected or not connected to the military. METHODS Data are from a subsample of the 2011 California Healthy Kids Survey (N=14,149). Items in the present analyses included present familial military affiliation (no one, parent, sibling); number of deployments (none, one, two or more); gender; grade; and race/ethnicity. Substance use items assessed whether the youth reported lifetime use of alcohol, tobacco, marijuana, other drugs, or prescription drugs; and recent (past 30 days) use of alcohol, tobacco, marijuana, and other drugs. RESULTS Multivariate analysis conducted in 2012 revealed that an increase in the number of deployments was associated with a higher likelihood of lifetime and recent use, with the exception of lifetime smoking. CONCLUSIONS These results indicate that experiences associated with deployment of a family member may increase the likelihood of substance use.

Well-being and suicidal ideation of secondary school students from military families.

BACKGROUND The mental health of children is a primary public health concern; adolescents of military personnel may be at increased risk of experiencing poorer well-being overall and depressive symptoms specifically. These adolescents experience individual and intrafamilial stressors of parental deployment and reintegration, which are directly and indirectly associated with internalizing behaviors. PURPOSE The present study sought to better understand the influence of parental military connectedness and parental deployment on adolescent mental health. METHODS Data from the 2011 California Healthy Kids Survey examined feeling sad or hopeless, suicidal ideation, well-being, and depressive symptoms by military connectedness in a subsample (n = 14,299) of seventh-, ninth-, and 11th-grade California adolescents. Cross-classification tables and multiple logistic regression analyses were used. RESULTS More than 13% of the sample had a parent or sibling in the military. Those with military connections were more likely to report depressive symptoms and suicidal ideation. Controlling for grade, gender, and race/ethnicity, reporting any familial deployment compared with no deployments was associated with increasing odds of experiencing sadness or hopelessness, depressive symptoms, and suicidal ideation. CONCLUSIONS Findings emphasize the increased risk of mental health issues among youth with parents (and siblings) in the military. Although deployment-related mental health stressors are less likely during peace, during times of war there is a need for increased screening in primary care and school settings. Systematic referral systems and collaboration with community-based mental health centers will bolster screening and services.

Talking to Daddy’s Little Girl About Sex: Daughters’ Reports of Sexual Communication and Support From Fathers

Although mothers are widely acknowledged as the primary in-home sexual educators of children, fathers also play an important role in sexual socialization. Paternal involvement is linked to positive social and psychological outcomes; an increased father—daughter communication can delay sexual debut and decrease frequency of engagement in intercourse. This study examined late-adolescent females’ reports of their fathers’ contributions to their sexual socialization. Four open-ended questions were included in a larger study examining family influences of adolescent sexual risk. Daughters described how their fathers prepared them for sexuality and dating and how they could have done better. A thematic content analysis was conducted. Most daughters reported receiving little sexual information from their fathers but identified unique contributions that their fathers made or could have made to their sexual socialization. Future interventions should assist fathers to increase their comfort with sexual communication, to identify barriers, and to provide skill-building practice to promote abstinence and safer sex behaviors among their daughters.

Prevalence and correlates of victimization and weapon carrying among military- and nonmilitary-connected youth in Southern California.

OBJECTIVES The present analysis sought to explore the normative rates and correlates of school victimization and weapon carrying among military-connected and nonmilitary-connected youth in public schools in Southern California. METHODS Data are from a sub-sample of the 2011 California Healthy Kids Survey (N=14,512). Items to assess victimization and weapon carrying were separated into three categories: physical acts (e.g., being pushed or shoved), nonphysical acts (e.g., having rumors spread about them) and weapon carrying. RESULTS The bivariate results indicate that youth with a military-connected parent had higher rates of physical victimization (56.8%), nonphysical victimization (68.1%), and weapon carrying (14.4%) compared to those with siblings serving (55.2%, 65.2%, and 11.4%, respectively) and nonmilitary-connected (50.3%, 61.6%, and 8.9%, respectively) youth. Having a parent in the military increased the odds of weapon carrying by 29% (Odds Ratio=1.29, 95% confidence interval=1.02-1.65). Changing schools and a larger number of family member deployments in the past 10years were associated with significant increases in the likelihood of victimization and weapon carrying. CONCLUSIONS The results of this analysis warrant a focus on school supports for youth experiencing parental military service, multiple relocations and deployments of a family member.

Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women

ObjectiveWe evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and human immunodeficiency virus (HIV) infection with cognition. We hypothesized that HIV-infected perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. MethodsThis cross-sectional study included 708 HIV-infected and 278 HIV-uninfected premenopausal, perimenopausal, or postmenopausal women (64% African American; median age, 44 y) from the Women’s Interagency HIV Study. Participants completed tests of verbal learning and memory, attention/processing speed, and executive function. We administered a menopausal symptom questionnaire that assessed anxiety, vasomotor, and sleep symptoms and obtained measures of depressive symptoms. ResultsIn multivariable regression analyses controlling for relevant covariates, HIV infection, but not menopausal stage, was associated with worse performance on all cognitive measures (P’s < 0.05). Depressive symptoms were associated with lower cognitive performance on measures of verbal learning and memory, attention, and executive function (P’s < 0.05); anxiety symptoms were associated with lower performance on measures of verbal learning and memory (P’s < 0.05). Vasomotor symptoms were associated with worse attention (P < 0.05). HIV and anxiety symptoms interacted to influence verbal learning (P’s < 0.05); elevated anxiety was associated with worse verbal learning in HIV-infected women only. ConclusionsVasomotor, depressive, and anxiety symptoms, but not menopausal stage, are associated with worse cognitive performance in both HIV-infected and HIV-uninfected women, although elevated anxiety symptoms are more associated with verbal learning deficits in HIV-infected women. Because cognitive problems can interfere with everyday functioning, including treatment adherence, it may be important to screen and treat anxiety in HIV-infected women.

The HIV Risk Reduction Needs of Homeless Women in Los Angeles

BACKGROUND Substance use, housing instability, and transactional sex all contribute to HIV risk engagement among homeless women. Because of the increased risk of HIV among homeless women, this study sought to understand the context of sexual behaviors and condom use among homeless women and elucidate modifiable factors that can be targeted by interventions. METHODS Homeless women (n = 45) participated in focus groups (n = 6) at shelters throughout Los Angeles County. Thematic analyses revealed that similar to other high-risk women, homeless women engage in sex with multiple types of partners (steady, casual, and transactional). FINDINGS Our findings indicate that, similar to use among other high-risk women, condom use by homeless women varied by type of partner. Substance use also contributed to condom non-use. In a departure from previous research, homeless women reported overarching feelings of hopelessness. Participants spoke of hopelessness contributing to risk engagement, specifically the number of ongoing stressors experienced because of homelessness contributing to despair. Without acknowledgement of this unique quality of homelessness, women felt their risk reduction needs would never truly be understood. CONCLUSIONS Interventions involving homeless women should include self-esteem building, acknowledgment and use of inherent resilience qualities gained during homelessness, respect for current knowledge and skills, and an exploration of when women choose to trust their partners and how they make safer sex choices.

A Population-Based Examination of Maltreatment History Among Adolescent Mothers in California

PURPOSE To document the abuse and neglect histories of adolescent mothers using official child protection records. METHODS Vital birth records were used to identify adolescents 12-19 years of age who were born in California and gave birth in 2009. These records were linked to statewide child protective service data to determine maternal history of alleged and substantiated maltreatment victimization, as well as placement in foster care. RESULTS A total of 35,098 adolescents gave birth in 2009. Before conception, 44.9% had been reported for maltreatment, 20.8% had been substantiated as victims, and 9.7% had spent time in foster care. CONCLUSIONS These population-based data indicate that many adolescent mothers have had contact with child protective services as alleged or substantiated victims of abuse or neglect. Understanding the impact of childhood and adolescent maternal maltreatment on both early childbearing risk and subsequent parenting capacity is critical to the development of responsive service interventions.

Barbershops as Venues to Assess and Intervene in HIV/STI Risk Among Young, Heterosexual African American Men

African Americans, particularly men, are disproportionately affected by the HIV epidemic. Inconsistent condom use and concurrent sexual partnerships are risk factors; there is limited investigation on how these factors influence HIV risk engagement in young, heterosexual, African American men. To identify contextual risk factors that place young men (18-24 years) at risk for HIV infection, one focus group was conducted with 13 men, and questionnaires were administered to 48 men. Participants were 18 to 24 years old and were recruited from local barbershops. The majority engaged in noncondom use (83%) and had multiple sexual partners (64%). Qualitative themes revealed noncondom use “when in the moment” and enhanced condom use with casual partners. This study provided an understanding of participants’ attitudes, intentions, and behaviors as they related to HIV risk and revealed the need for culturally relevant, theory-based HIV prevention programs to reduce HIV transmission among this population.

Adoption and utilization of sexually transmitted infections testing in outpatient substance abuse treatment facilities serving high risk populations in the U.S.

BACKGROUND Although adoption and utilization of sexually transmitted infection (STI) testing is a cost effective public health intervention, it is inconsistently offered or referred out for by outpatient substance abuse treatment (OSAT) programs where at-risk racial/ethnic and sexual minorities receive services. METHODS We explored the organizational adoption and client utilization of STI testing using a nationally representative sample of OSAT facilities in the U.S. in 2005 (N=566). Data missing at random was imputed and the resulting database was analysed using multivariate Tobit and logistic regressions. RESULTS The analyses suggest that private non-profit facilities, which are the largest providers of OSAT treatment are less likely than public facilities to offer STI testing or to report adequate client utilization rates. Higher utilization was instead associated with professionally accredited facilities, and with facilities whose majority of clients were Latino/a, reported a history of treatment, stayed in treatment longer, or received case management. CONCLUSION While OSAT facilities are poised to be primary intervention points for diagnosis and treatment of STIs, only a segment of these facilities provide this preventive practice or manage to refer clients out. As such, U.S. health care policy should ensure the adoption and comprehensive utilization, particularly among high risk clients, of this cost-effective prevention strategy in OSAT admission protocols.