Karen Basen-Engquist

Attitudes, Norms, and Self-Efficacy: A Model of Adolescents' HIV-Related Sexual Risk Behavior

Using data from a cross-sectional, statewide survey of 1,720 Texas ninth graders in 13 school districts, a model of psychosocial predictors of human immunodeficiency virus (HIV)-related sexual risk behavior was tested. Predictor variables in the model, based on variables from the Theory of Reasoned Action and Social Learning Theory, were attitudes, norms, self-efficacy, and behavioral intentions. Attitudes, norms, and self-efficacy predicted 36.4% of the variance in the intention to limit the number of sexual partners and the same variables plus intention predicted 24.6% of the variance in number of sexual partners in the past year. Attitudes, norms, and self-efficacy regarding condom use predicted 17.0% of the variance in condom use intentions; these variables plus intentions predicted 19.0% of the variance in condom use frequency. Attitudes, norms, and intentions were directly related to the number of sexual partners, while self-efficacy ad condom use intentions were directly related to frequency of condom use.

Recruitment and retention of minority women in cancer screening, prevention, and treatment trials.

Researchers are giving greater attention to the recruitment and retention of minority women in clinical studies because of their historical underrepresentation, despite their greater morbidity and mortality for many conditions. Using findings from four studies, this article examines documented barriers to the recruitment and retention of minority women to clinical cancer research and discusses effective recruitment strategies. Among the major barriers to recruitment were lack of awareness, lack of transportation, interference with work/family responsibilities, financial costs, negative side effects, and burdensome procedures. Effective recruitment strategies focused on using culturally targeted mass mailings and media presentations based on acquiring an understanding of the minority community. Recommendations are made for further study and implementation.

Short-Term and Long-Term Psychosocial Adjustment and Quality of Life in Women Undergoing Different Surgical Procedures for Breast Cancer

BackgroundThe various surgical procedures for early-stage breast cancer are equivalent in terms of survival. Therefore, other factors, such as the procedures’ effect on psychosocial adjustment and quality of life (QOL), take on great importance. The aim of the current study was to prospectively examine the short- and long-term effects of mastectomy with reconstruction, mastectomy without reconstruction, and breast conservation therapy on aspects of psychosocial adjustment and QOL in a sample of 258 women with breast cancer.MethodsParticipants completed questionnaires before surgery and then again 1, 6, 12, and 24 months after surgery. Questionnaires assessed depressive symptoms, anxiety, body image, sexual functioning, and QOL.ResultsAdjustment patterns differed throughout the 2-year period after surgery. Some short-term changes in adjustment (less anxiety, less overall body satisfaction) were similar across surgery groups, whereas others (satisfaction with chest appearance, QOL in physical health domain) were higher for women who had breast conservation therapy. However, women who had mastectomy with reconstruction reported greater satisfaction with their abdominal area. During the long-term follow-up period (6 months to 2 years after surgery), women in all three groups experienced marked improvements in psychosocial adjustment (depressive symptoms, satisfaction with chest appearance, sexual functioning) and QOL in physical and mental health domains. In fact, the level for most variables returned to baseline levels or higher.ConclusionsOverall, the general patterns of psychosocial adjustment and QOL are similar among the three surgery groups.

The co-morbidity of violence-related behaviors with health-risk behaviors in a population of high school students

PURPOSE To describe the frequency of violence-related behaviors and their association with other health behaviors among high school students. METHODS The Youth Risk Behavior Survey was administered to all ninth and eleventh graders (n = 2075) of a school district in Texas. It provided information regarding violence-related behaviors and other health behaviors. Students were classified into four mutually exclusive, violence-related categories according to whether they were involved in a physical fight and/or carried a weapon. RESULTS Overall, 20% of the students were involved in a physical fight but had not carried a weapon, 10% carried a weapon but had not been involved in a physical fight, and 17% had been involved in a physical fight and had carried a weapon. Prevalence of weapon-carrying and fighting were higher among males than females, and among ninth graders than eleventh graders. Among males, 48% had carried a weapon the month prior to the survey. Students who both fought and carried a weapon were 19 times more likely to drink alcohol six or more days than students who did not fight nor carried a weapon. Logistic regression analyses showed that drinking alcohol, number of sexual partners, and being in ninth grade were predictors of fighting. These three variables plus having a low self-perception of academic performance and suicidal thoughts were predictors of fighting and carrying a weapon. CONCLUSIONS The data indicate that violence-related behaviors are frequent among high school students and that they are positively associated with certain health behaviors. Interventions designed to reduce violence should also address coexisting health-risk behaviors and target high-risk groups.

Predictors of Sexual Functioning in Ovarian Cancer Patients

PURPOSE To characterize sexual functioning of ovarian cancer patients and identify factors predicting sexual activity, functioning or satisfaction, discomfort, and habit or frequency. PATIENTS AND METHODS Data were collected on 232 women with epithelial ovarian cancer, 47% of whom were receiving treatment. RESULTS Fifty percent of the patients had engaged in sexual activity in the past month. Of those who were sexually active, 47% reported no or little desire, 80% reported problems with vaginal dryness, and 62% reported pain or discomfort during penetration. Of those who were sexually inactive, reasons included no partner (44.1%), lack of interest (38.7%), physical problems making sex difficult (23.4%), and fatigue (10.8%). Partner factors also were identified, including physical problems (16.2%), lack of interest (15.3%), and fatigue (5.4%). A multivariate model was used to predict sexual activity and included demographic, medical, and psychosocial factors as predictors. Women who were married (P <.001), were younger than 56 years (P <.001), were not receiving active treatment (P <.01), had a longer time since original diagnosis (P =.104), and liked the appearance of their bodies (P =.004) were more likely to be sexually active. Univariate analyses indicated that demographic, medical, and psychosocial factors are significantly associated with sexual functioning or satisfaction, sexual discomfort, and sexual frequency or habit. CONCLUSION Sexual rehabilitation for ovarian cancer patients should address management of physical and psychologic symptoms and include the patients partner when appropriate.

Safer choices: reducing teen pregnancy, HIV, and STDs.

Objectives. This study evaluated the long-term effectiveness of Safer Choices, a theory-based, multi-component educational program designed to reduce sexual risk behaviors and increase protective behaviors in preventing HIV, other STDs, and pregnancy among high school students. Methods. The study used a randomized controlled trial involving 20 high schools in California and Texas. A cohort of 3869 ninth-grade students was tracked for 31 months from fall semester 1993 (baseline) to spring semester 1996 (31-month follow-up). Data were collected using self-report surveys administered by trained data collectors. Response rate at 31-month follow-up was 79%. Results. Safer Choices had its greatest effect on measures involving condom use. The program reduced the frequency of intercourse without a condom during the three months prior to the survey, reduced the number of sexual partners with whom students had intercourse without a condom, and increased use of condoms and other protection against pregnancy at last intercourse. Safer Choices also improved 7 of 13 psychosocial variables, many related to condom use, but did not have a significant effect upon rates of sexual initiation. Conclusions. The Safer Choices program was effective in reducing important risk behaviors for HIV, other STDs, and pregnancy and in enhancing most psychosocial determinants of such behavior.

Gender differences in chronic disease risk behaviors through the transition out of high school.

BACKGROUND Major life transitions (e.g., graduation from high school) are times when many changes occur in a persons social and physical environment. Men and women likely experience aspects of these changes differently. As a result, health-related behaviors likely change at these times with possible differences in these changes by gender. METHODS Gender differences in the performance of chronic disease risk-related behaviors (fruit, juice, and vegetable intake; physical activity; tobacco and alcohol use; and sexual practices) through the transition out of high school (HS) were assessed in a secondary analysis of a nationally representative sample from the 1992 National Health Interview Survey-Youth Risk Behavior Survey. The survey was completed by 5881 young people aged 14 to 21 years. Regression discontinuity analysis with piecewise regression was performed. RESULTS Statistically significant gender by transition effects were obtained for exercise/physical activity (decreases at the transition point for males), snuff use (decrease for females in HS), binge drinking and number of days drinking alcohol (increases for males at the transition point), and use of alcohol or drugs before sexual intercourse (decrease for females post HS). Fruit intake decreased for males and females and daily and heavy cigarette smoking increased during the HS years. Effect sizes were small but promising, given that the data set was not designed to test this hypothesis. CONCLUSION These data offer evidence of differences by gender in chronic disease risk behaviors through the HS transition. Longitudinal studies are needed to assess the true nature of these differences, the tracking of these risk behaviors and their personal, social, and environmental determinants, including gender-specific determinants, that may explain these changes and inform future intervention development.

Schoolwide Effects of a Multicomponent HIV, STD, and Pregnancy Prevention Program for High School Students

Few studies have tested schoolwide interventions to reduce sexual risk behavior, and none have demonstrated significant schoolwide effects. This study evaluates the schoolwide effects of Safer Choices, a multicomponent, behavioral theory–based HIV, STD, and pregnancy prevention program, on risk behavior, school climate, and psychosocial variables. Twenty urban high schools were randomized, and cross-sectional samples of classes were surveyed at baseline, the end of intervention (19 months after baseline), and 31 months after baseline. At 19 months, the program had a positive effect on the frequency of sex without a condom. At 31 months, students in Safer Choices schools reported having sexual intercourse without a condom with fewer partners. The program positively affected psychosocial variables and school climate for HIV/STD and pregnancy prevention. The program did not influence the prevalence of recent sexual intercourse. Schoolwide changes in condom use demonstrated that a school-based program can reduce the sexual risk behavior of adolescents.

Predictors of Breast and Cervical Screening in Vietnamese Women in Harris County, Houston, Texas

The Vietnamese are a quickly growing, important part of the Texas population. Breast cancer is known to have different biologic characteristics in Vietnamese women. In order to develop appropriate intervention and screening strategies, we conducted a study of barriers to cervical and breast screening in Vietnamese women in Harris County, Tex. Our objective was to characterize the demographic factors, beliefs, and barriers to cervical and breast cancer screening in our study population and test the effect of these on Papanicolaou test, breast self-examination (BSE), medical breast examination (MBE), and mammography use. The Health Belief Model Scales for Measuring Beliefs Related to Breast Cancer (Champion VL, Nursing Research 1993;42:139–143) was the framework used to assess attitudes regarding risk of breast cancer and to design a component assessing risk of cervical cancer. The questionnaire addressed susceptibility, seriousness, benefits, barriers, and health about screening for breast and cervical cancer. It was translated into Vietnamese and back-translated into English prior to use. The questionnaire was mailed to Harris County residents. Those returned were entered into a database. The data were analyzed for validity using Chronbachs alpha. Simple descriptive analyses and nominal logistic regression identified predictors of Papanicolaou test, BSE, MBE, and mammography use. Twelve hundred surveys were mailed out to Vietnamese women using the telephone directory and the church directories in Harris County; 209 were returned and entered into the database. Of the respondents, 67% had ever received a Papanicolaou test; of these, 89% had received a Papanicolaou test within the past year; 55% of respondents had performed a BSE, 45% of patients received an MBE, and 45% of respondents had ever received a mammogram (15% of respondents had a mammogram during the previous year). The most significant predictors of Papanicolaou test, BSE, MBE, and mammography use were marital status (being married), high educational level, lack of barriers, a family history of the cancer, older age, and increased perception of seriousness. Compared to other studies of Vietnamese women, the women in Texas are among the highest users of the Papanicolaou test, BSE, MBE, and mammography. Barriers and incentives to breast and cervical screening were similar to those in other studies.

Using Intervention Mapping to Adapt an Effective HIV, Sexually Transmitted Disease, and Pregnancy Prevention Program for High-Risk Minority Youth

Although many programs have been developed to reduce adolescent pregnancy and sexually transmitted diseases (STDs) (including HIV), with some showing promise in reducing sexual risk-taking behavior, little guidance has been given as to how to adapt existing interventions to new communities. When adapting a program, effective elements deemed necessary to change behaviors need to be preserved, while cultural competence and relevance for the new population must be considered in creating new elements. To address these needs, the authors describe the application of a systematic process, intervention mapping (IM), to adapt a theory-based, multicomponent HIV, STD, and pregnancy prevention program titled Safer Choices to a new target population, at-risk youth attending alternative schools and at risk of dropping out. IM is a detailed process that provides planners with a systematic method for decision making in each phase of developing or adapting an intervention to influence changes in behavior and environmental conditions.