Linda Kaljee

Parental underestimates of adolescent Risk behavior : A randomized, controlled trial of a Parental monitoring intervention

OBJECTIVES To develop and evaluate an intervention (ImPACT) seeking to increase monitoring (supervision and communication) by parents and guardians of African-American youth regarding high risk and protective behaviors; and to develop an instrument to assess parental monitoring, the Parent-Adolescent Risk Behavior Concordance Scale. DESIGN/INTERVENTION This research was a randomized, controlled longitudinal study. Baseline (preintervention), and 2 and 6 months postintervention data were obtained via a talking MacIntosh computer regarding youth and parent perceptions of youth involvement in 10 risk behaviors, parental monitoring and youth-parent communication, and condom-use skills. Intervention parents and youth received the ImPACT program and a video emphasizing parental supervision and discussion, followed by a structured discussion and role-play emphasizing key points. Control parents and youth received an attention-control program on goal-setting, which also included an at-home video and discussion. PARTICIPANTS A total of 237 parents and one each of their youth (ages 12-16 years) recruited from eight public housing developments located in a city in the mid-Atlantic region. RESULTS Similarity of youth and parental reporting on the Parent-Adolescent Risk Behavior Concordance Scale was positively correlated with protective behaviors, perceived parental monitoring, and good parent-youth communication. At baseline, parents significantly underestimated their youths risk behaviors. However, 2 and 6 months postintervention, the ImPACT program increased similarity of reports by youth and their parents of youth involvement in risk and protective behaviors. In addition, at 6 months postintervention, intervention (compared to control) youths and parents also demonstrated higher levels of condom-use skills. CONCLUSION Parental monitoring interventions such as ImPACT should be given to parents in conjunction with more traditional youth-centered risk-reduction interventions.

Longitudinal Stability and Predictability of Sexual Perceptions, Intentions, and Behaviors Among Early Adolescent African-Americans

PURPOSE To assess the stability and predictability of perceptions, intentions, and behaviors regarding intended sexual intercourse and condom use. METHODS One hundred and nineteen African-American youth aged 9-15 years living in urban public housing provided information at baseline and 6 months later using a theory-based and culturally- and developmentally-tailored instrument assessing perceptions, intentions, and sexual behaviors. RESULTS Over the 6-month study interval, individual behaviors, intentions, and perceptions demonstrated considerable stability. Intentions regarding sexual intercourse in the next half-year were predictive of subsequent coitus among the entire cohort and among the subset who were virgins at baseline. Youth who thought it likely that they would be sexually-active in the next 6 months were at significantly elevated risk of doing so, compared to youth who were uncertain or thought coitus unlikely. However, intentions regarding future coitus among the subset of youth who were sexually-experienced at baseline were not predictive of future coital behavior. CONCLUSIONS These data suggest that social cognitive behavioral models that incorporate intentions and perceptions are appropriate as the theoretical basis for interventions targeting these young adolescents.

Patterns of initiation of sex and drug-related activities among urban low-income African-American adolescents.

PURPOSE To examine the pattern of adolescents involvement in drug-related behaviors and sexual initiation, and its relationship with: (a) age and gender, (b) sensation- seeking, (c) perceptions of peer and family risk involvement, and (d) involvement in high-risk sexual behavior. SUBJECTS Two hundred and sixty-one urban African-American youth, aged 9 to 15 years at baseline, who were sexually experienced by the end of the 4-year study interval. The longitudinal assessment (4 years) was focused on: (a) alcohol use, illicit drug use, and drug trafficking; (b) high-risk sex; (c) propensity to sensation seeking; and (d) perceived peer and family risk involvement. RESULTS Involvement increased over the 4-year study interval such that over half of the adolescents reported use of alcohol and/or use of marijuana in the final assessment period. For each of the three drug-related activities examined, the largest proportion of youth who engaged in sexual intercourse never engaged in drug-related activity, and the next largest proportion initiated sexual involvement before drug use. Sensation-seeking scores, which were relatively stable across time, were lower among girls, and also were lower among youth who remained uninvolved in drug-related behaviors. For all three drug-related behaviors, rates of high-risk sex were higher among youth who initiated both sex and drugs, and were lower among youth who reported engaging only in sex. Although youth who did eventually initiate drug use had higher perceived levels of family and peer drug use compared to those who remained uninvolved, these perceptions did not contribute directly to high-risk sexual behavior. CONCLUSIONS Youth who will become both sexually active and involved with drugs during adolescence are especially vulnerable to involvement in high-risk sexual behavior.

Perceptions of Sexual Behavior among Urban Early Adolescents Translating Theory through Focus Groups

Risk activities for acquisition of the human immunodeficiency virus (HIV) remain prevalent among urban adolescents. Early adolescents represent a particularly vulnerable group, exhibiting high rates of unprotected sexual activity. In spite of a growing recognition of the need to examine cultural, environmental, and developmental variables contributing to both risk and protective behaviors, little such research has been described to date. Guided by the constructs of a model of risk-protective behavior (Protection Motivation Theory) and employing ethnographic techniques, an exploration of the developmental, sociohistorical, and cultural constructs that might influence adolescent sexual behavior was conducted. Focus group and individual interviews were conducted among 64 inner-city youths, 10 to 14 years of age, and their parents. Findings relevant to perceptions of sexual behavior among young adolescents are presented. The methodology employed in this exploratory phase and the strengths and limitations of focus group discussions are discussed

Perceptions and Attitudes Regarding Sex and Condom Use Among Chinese College Students: A Qualitative Study

Perceptions regarding sex and condom use among Chinese college students were examined within a framework provided by protection motivation theory. Data from semistructured individual interviews indicate that Chinese students generally perceive a low level of vulnerability to HIV and sexually transmitted disease (STD) infection and a minimum exposure from family to drugs and risky sexual behaviors. While only a small proportion of students reported being sexually experienced, the majority of them expressed tolerance toward premarital sex and a high level of perceived intrinsic rewards from sexual experience. Students view condoms to be efficacious in preventing pregnancy or HIV/STD, but they also perceive a high level of response cost for use of condoms. The findings suggest that efforts to adapt HIV/STD prevention programs targeting Chinese adolescents and young adults need to consider cultural aspects of perceptions regarding sex and condoms among Chinese students and to address the conflict between traditional Chinese cultural values and modern influences.

The Use of Typhoid Vaccines in Asia: The DOMI Experience

BACKGROUND Two currently licensed typhoid vaccines have been evaluated in Asia, yet few Asian countries have considered including typhoid vaccines in their vaccination programs. The Diseases of the Most Impoverished (DOMI) Program was initiated to provide evidence to decide on the introduction of typhoid vaccines in Asian countries. METHODS The centerpiece of the program is a multidisciplinary demonstration project with Vi vaccine in 5 Asian countries. The project includes epidemiologic, economic, sociobehavioral, and policy studies. RESULTS Policy makers want evidence on which to base their vaccine-related decisions. The DOMI Program has provided updated information on the typhoid fever burden at several Asian sites. Cost-of-illness studies found high costs to governments and individuals. Sociobehavioral studies indicated a positive attitude toward typhoid vaccines. The results of the demonstration projects indicate that mass-immunization campaigns are feasible and acceptable. CONCLUSIONS The DOMI Program has begun to provide momentum for the evidence-based, rational introduction of typhoid vaccines into the public health programs of several Asian countries.

Psychosocial consequences for children experiencing parental loss due to HIV/AIDS in central China.

Abstract Individual in-depth interviews were conducted with 47 children (ages 8–17 years) experiencing the loss of one or both parents due to HIV/AIDS in two rural counties of central China. Findings in this study reveal that the families of the children orphaned by AIDS had experienced financial burdens because of treatment costs for sick parents and loss of labor in the household. The majority of the participants reported some level of stigmatization because of their parents’ HIV status. The participants described feelings of sadness, fear, anxiety, anger, loneliness, low self-esteem, social withdrawal, and sleep problems. Implications for intervention programs include the need for psychological support and special counseling services, more public education with accurate knowledge about HIV/AIDS to decrease stigma and discrimination, and financial programs to decrease economic and caregiving burdens for these children.

AIDS orphanages in China: reality and challenges.

With the increasing number of AIDS orphans in China, the government has been building AIDS orphanages since 2004 to accommodate some of those children who have lost both parents to AIDS. However, no data are available regarding the quality of this model of institutional care of AIDS orphans in China. This study, based on qualitative data from children and workers in AIDS orphanages, examines the daily lives, needs, and feelings of orphans and explores the advantages and disadvantages of institutionalized care of AIDS orphans in China. The current study was conducted in 2006-2007 in two rural counties of central China. Data in the current study included individual in-depth interviews with 23 children who lost both of their parents to HIV/AIDS (ages 8 to 17 years) living in AIDS orphanages and 5 AIDS orphanage workers. Findings in this study reveal that children living in orphanages mostly felt that the living conditions were better than the families they lived with after the death of their parents. However, according to the children and orphanage workers, the institutional care has some disadvantages, such as administrative restraints, limited psychological guidance, stigma, lack of education on AIDS, and financial burdens of the operation. Implications for intervention programs include continuing support from the government and nongovernmental organizations, improvements in administrative styles, and the need of incorporating psychological support within the institutions.

Trial participation and vaccine desirability for Vi polysaccharide typhoid fever vaccine in Hue City, Viet Nam

Objectives  To identify demand for Vi typhoid fever vaccine for school‐age children; obstacles and enabling factors for vaccine delivery; and socio‐behavioural factors associated with trial participation and possible predictors of future vaccine acceptance, in Hue City, Viet Nam.

Malaria elimination in Haiti by the year 2020: an achievable goal?

Haiti and the Dominican Republic, which share the island of Hispaniola, are the last locations in the Caribbean where malaria still persists. Malaria is an important public health concern in Haiti with 17,094 reported cases in 2014. Further, on January 12, 2010, a record earthquake devastated densely populated areas in Haiti including many healthcare and laboratory facilities. Weakened infrastructure provided fertile reservoirs for uncontrolled transmission of infectious pathogens. This situation results in unique challenges for malaria epidemiology and elimination efforts. To help Haiti achieve its malaria elimination goals by year 2020, the Laboratoire National de Santé Publique and Henry Ford Health System, in close collaboration with the Direction d’Épidémiologie, de Laboratoire et de Recherches and the Programme National de Contrôle de la Malaria, hosted a scientific meeting on “Elimination Strategies for Malaria in Haiti” on January 29-30, 2015 at the National Laboratory in Port-au-Prince, Haiti. The meeting brought together laboratory personnel, researchers, clinicians, academics, public health professionals, and other stakeholders to discuss main stakes and perspectives on malaria elimination. Several themes and recommendations emerged during discussions at this meeting. First, more information and research on malaria transmission in Haiti are needed including information from active surveillance of cases and vectors. Second, many healthcare personnel need additional training and critical resources on how to properly identify malaria cases so as to improve accurate and timely case reporting. Third, it is necessary to continue studies genotyping strains of Plasmodium falciparum in different sites with active transmission to evaluate for drug resistance and impacts on health. Fourth, elimination strategies outlined in this report will continue to incorporate use of primaquine in addition to chloroquine and active surveillance of cases. Elimination of malaria in Haiti will require collaborative multidisciplinary approaches, sound strategic planning, and strong ownership of strategies by the Haiti Ministère de la Santé Publique et de la Population.