Kirk von Sternberg

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents

Adolescence is a time for exploration and risk-taking; in todays urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff. University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.

Reducing Sexual Risk Behaviors and Alcohol Use Among HIV-Positive Men Who Have Sex With Men: A Randomized Clinical Trial

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical models stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior.

Screening, Brief Intervention, and Referral for Alcohol Use in Adolescents: A Systematic Review

BACKGROUND AND OBJECTIVE: Alcohol use by adolescents is widespread and is connected to a number of negative health and social outcomes. Adolescents receiving emergent care for injuries are often linked with risky use of alcohol. The trauma system has widely adopted the use of screening, brief intervention, and referral to treatment (SBIRT) for preventing alcohol-related injury recidivism and other negative outcomes. The purpose of this article is to review the evidence around SBIRT with adolescent patients in acute care settings. METHODS: This article reviews 7 randomized controlled trials evaluating risky drinking interventions among adolescent patients in acute care settings. All studies took place in the emergency departments of level I trauma centers. RESULTS: Four of the 7 studies reviewed demonstrated a significant intervention effect; however, no one intervention reduced both alcohol consumption and alcohol-related consequences. Two of these 4 studies only included patients ages 18 and older. Subgroup analyses with adolescents engaged in risky alcohol-related behaviors, conducted in 2 of the studies, showed significant intervention effects. Five studies showed positive consumption and/or consequences for all study participants regardless of condition, suggesting that an emergent injury and/or the screening process may have a protective effect. CONCLUSIONS: Based on existing evidence, it is not clear whether SBIRT is an effective approach to risky alcohol use among adolescent patients in acute care. Additional research is needed around interventions and implementation.

Young Women's Perspective of the Pros and Cons to Seeking Screening for Chlamydia and Gonorrhea: An Exploratory Study

STUDY OBJECTIVE To identify young womens pros and cons (decisional balance) to seeking chlamydia (CT) and gonorrhea (NGC) screening. DESIGN Prospective, cross sectional study SETTING Community-based reproductive health clinic PARTICIPANTS 192 young women (66% African American; mean age 18.9 years). MAIN OUTCOME MEASURES Content analysis of responses obtained during a decisional balance exercise (pros and cons) promoting CT and NGC screening was conducted. Thematic categories were developed through a coding process, and each response was assigned to one thematic category. The frequency of pros and cons responses for each category and the frequency of participants endorsing each category were calculated. RESULTS Ten thematic categories in relation to pros and cons of seeking CT and NGC screening were: being healthy; awareness of the body; systemic factors around the clinic visit and testing procedures; benefits and aversions around treatment; partner trust issues; confidentiality; prevention of long term adverse effects, protection of the body; concern for others; fear of results/aversion to testing; and logistical barriers. The three most often cited pros were awareness of the body, being healthy and treatment issues; and the three most often cited cons were logistical barriers (time/transportation), fear/aversion to testing, and systemic factors. CONCLUSIONS A variety of pros and cons to seeking CT and NGC screening were identified at a community-based clinic. Providers in clinical settings can utilize this information when encouraging patients to seek regular STI screening by elucidating and emphasizing those pros and cons that have the most influence on a young womans decision-making to seek screening.

Efficacy of a Motivational Behavioral Intervention to Promote Chlamydia and Gonorrhea Screening in Young Women: A Randomized Controlled Trial

BACKGROUND Seeking screening and treatment for chlamydia (CT) and gonorrhea (GC) by young women is critical to reduction of asymptomatic cervicitis and its complications. OBJECTIVES To evaluate the efficacy of a client-centered motivational behavioral intervention (MBI), to promote seeking of sexually tranmitted infection (STI) checkups by young women. METHODS Three hundred seventy-six of 770 eligible sexually active, nonpregnant, English-speaking women (mean age 18.5 years) were recruited from an urban reproductive health clinic and randomized to two groups: intervention plus standard care (MBI) or standard care alone (SC). MBI (two sessions plus booster) was based on the Transtheoretical Model of Change and employed motivational interviewing. Outcome measures monitored for 12 months included: client-initiated clinic visits for STI checkups in response to seven high-risk sexual behaviors by self-report (primary), consistent condom use, number of CT and GC episodes, and movement along the stages of change obtained at baseline and 6- and 12-month follow-up assessments (secondary). Analyses included chi-square, logistic regression, and generalized estimating equations. RESULTS At baseline, more than 70% endorsed the action stage of change for seeking STI checkups for three of seven high-risk sexual behaviors. No significant differences were noted between the two groups for the primary or secondary outcomes. Across groups, having multiple partners and being pregnant or thinking one might be pregnant were associated with STI checkups. CONCLUSIONS This is the first known client-centered clinical trial to promote STI screening. Risk-taking and health-seeking behaviors are complex and interrelated with STI and pregnancy concerns. The intervention may have an effect if it is targeted to women in a less medically connected community-based sample.

The Transtheoretical Model as a Framework for Developing Substance Abuse Interventions

&NA; The Transtheoretical Model (TTM; Prochaska & DiClemente, 1984) suggests that one of the major challenges in substance abuse treatment is to creatively adapt to the complexities of change, (e.g., shifting motivation and ambivalence) using an array of change processes dependent upon treatment readiness. The TTM offers a solid theoretical foundation upon which innovative substance abuse treatments can be developed and the major dimensions of this model (stages of change, processes of change, decisional balance, and self‐efficacy) have proven to be important constructs in understanding and facilitating the process of intentional behavior change. We describe several recently developed substance abuse treatment programs based on the TTM constructs and describe the measures used to assess change in the various studies. We also highlight how counseling strategies, such as motivational interviewing, can be incorporated into TTM‐based treatments.

Skills-Based Residency Training in Alcohol Screening and Brief Intervention: Results from the Georgia-Texas "Improving Brief Intervention" Project.

ABSTRACT Alcohol screening and brief intervention (SBI) is recommended for all primary care patients but is underutilized. This project trained 111 residents and faculty in 8 family medicine residencies to conduct SBI and implement SBI protocols in residency clinics, then assessed changes in self-reported importance and confidence in performing SBI and brief intervention (BI) rates. Clinicians reported significant increases in role security, confidence, and ability to help drinkers reduce drinking and decreased importance of factors that might dissuade them from performing SBI. Stage of change measures indicated 37% of clinicians progressed toward action or maintenance in performing SBI; however, numbers of reported BIs did not increase. At all time points, 33% to 36% of clinicians reported BIs with ≥10% of the last 50 patients. Future studies should focus on increasing intervention rates using more patient-centered BI approaches, quality improvement approaches, and systems changes that could increase opportunities for performing BIs.

Jails as important but constrained venues for addressing women's health.

Women in US jails have many social and health risks that merit attention from public health agencies. This article: (1) reviews national and local data on this population for indicators of social disadvantage and of several health risks/conditions (substance abuse, risky sex, and mental illness), (2) describes the impact of federal mandatory sentencing for drug violations and recent developments in states on the numbers of incarcerated women, (3) outlines the similarities and differences between jails and prisons, focusing on characteristics of jails that facilitate and constrain intervention and evaluation activities, and (4) adds lessons learned in six years of experience in county and state jails in Texas.

CHOICES: an integrated behavioral intervention to prevent alcohol-exposed pregnancies among high-risk women in community settings.

CHOICES is an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. The intervention uses motivational interviewing and cognitive-behavioral strategies, and targets adoption of effective contraception and reduction of alcohol use. The CHOICES intervention includes four manual-guided counseling sessions delivered by behavioral health counselors and one contraceptive session with a family planning clinician. CHOICESs efficacy has been established through a series of randomized controlled trials in settings including primary care, university hospital–based obstetrical/gynecology practices, urban jails, substance abuse treatment settings, and a media-recruited sample in three large cities. This article describes the CHOICES line of research including the epidemiology, feasibility, and efficacy studies. It also details the CHOICES intervention and the components of each session. In addition, the authors describe current studies testing modifications of the CHOICES intervention, the dissemination efforts to date, and implications for social work practice.

Correlates of consistent condom use with main-new and main-old sexual partners.

An exploratory study identified correlates of consistent condom use for young women reporting Main-new or Main-old partners in the past 3 months: frequency of vaginal sex (across partner types); perceived likelihood of getting a STI (Main-new); age and STI history (Main-old). To enhance programmatic efficacy in community clinics, these key correlates of condom use for main partner types should be incorporated in STI risk reduction counseling.