Lydia O'Donnell

Early sexual initiation and subsequent sex-related risks among urban minority youth: the reach for health study.

CONTEXT Since the 1980s, the age at which U.S. teenagers, especially minority youth, begin having sex has decreased. There is limited information on the relationship between early sexual initiation and subsequent risky sexual behaviors. METHODS A sample of 1,287 urban minority adolescents completed three surveys in seventh and eighth grade, and 970 completed a follow-up in 10th grade. Logistic regression was used to test the effects of timing of initiation on 10th-grade sexual behaviors and risks, adjusting for gender, ethnicity and age. RESULTS At baseline, 31% of males and 8% of females reported sexual initiation; by the 10th grade, these figures were 66% and 52%, respectively. Recent intercourse among males increased from 20% at baseline to 39% in eighth grade; 54% reported recent sex and 6% had made a partner pregnant by 10th grade. Among females, recent intercourse tripled from baseline to eighth grade (5% to 15%); 42% reported recent sex and 12% had been pregnant by grade 10. Early initiators had an increased likelihood of having had multiple sex partners, been involved in a pregnancy, forced a partner to have sex, had frequent intercourse and had sex while drunk or high. There were significant gender differences for all outcomes except frequency of intercourse and being drunk or high during sex. CONCLUSIONS Minority adolescents who initiate sexual activity early engage in behaviors that place them at high risk for negative health outcomes. It is important to involve parents and schools in prevention efforts that address sexual initiation in early adolescence and that target youth who continue to place themselves and their partners at risk.

The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.

OBJECTIVES This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.

Video-based sexually transmitted disease patient education: its impact on condom acquisition.

OBJECTIVES This study assessed the impact of video-based educational interventions on condom acquisition among men and women seeking services at a large sexually transmitted disease clinic in the South Bronx, New York. METHODS During 1992, 3348 African American and Hispanic patients were enrolled in a clinical trial of video-based interventions designed to promote safer sex behaviors, including increased condom use. Patients were assigned to one of three groups: control, video, or video plus interactive group discussion. Subjects were given a coupon to redeem for free condoms at a pharmacy several blocks from the clinic. Rates of condom acquisition were assessed by level of intervention. RESULTS In comparison with a control group, subjects who viewed videos were significantly more likely to redeem coupons for condoms (21.2% redemption rate vs 27.6%). However, participation in interactive sessions after video viewing augmented the positive effects of video viewing alone (27.6% redemption rate vs 36.9%). Gender and ethnicity were significantly associated with outcomes. CONCLUSIONS The condom acquisition are almost doubled with the use of culturally appropriate, video-based interventions. Designed to present minimal disruption to clinical services, these interventions can be implemented in clinics servicing at-risk men and women.

Sexual Behaviors and Risks Among Bisexually- and Gay-Identified Young Latino Men

This research compares patterns of sexual behavior and sexual risk of bisexually- and gay-identified Latino young men who have sex with men (YMSM). Four hundred forty-one Latino YMSM were surveyed at community venues in New York City. Twenty-two percent of the sample identified as bisexual, and 78% identified as gay. Bisexually-identified men were more likely to report having had multiple male sex partners in the last 3 months and less likely to report being exclusively involved with a main male partner. They were also approximately 31/2; times more likely to report unprotected insertive anal intercourse at last sexual contact with a nonmain male partner and more likely to report being high at last contact with both main and nonmain male partners. Findings suggest that prevention programs need to address the particular sexual risk patterns of bisexually-identified Latino YMSM that place them at risk of both HIV infection and transmission.

Obtaining written parent permission for school-based health surveys of urban young adolescents.

PURPOSE To document the process and implications of obtaining written parental consent for school-based health surveys of young adolescents. METHODS As part of the evaluation of the Reach for Health prevention program, written parental permission was obtained for student participation in school-based health surveys conducted for three cohorts of seventh graders (N = 3253) enrolled in three urban schools serving predominately economically disadvantaged minority adolescents. Students in general, bilingual, and special education classes were eligible to participate. Rates were recorded for the number of forms returned by parents, parental consents and refusals, student consents and refusals, and surveys completed. Procedures for achieving acceptable rates of written parental permission and survey completion included daily communication between research and school staff during the consent form collection period, student and teacher incentives, provision of alternate activities for students without consent, and scheduling of multiple makeup surveys for absentee students. RESULTS Survey completion rates met or exceeded preset goals and ranged from a low of 70% for Cohort A to a high of 83% for Cohort C. At least 89% of the parents in each cohort returned forms. Of forms returned, parent refusals ranged from a high of 18% (Cohort A) to a low of 12% (Cohort C). CONCLUSIONS Obtaining written permission from parents for young adolescents to participate in school-based health surveys is possible in urban settings and has potential benefits in terms of community awareness and involvement in research and evaluation studies. It does, however, require a substantial commitment of program resources as well as significant planning and data collection prior to actual survey administration.

Intimate partner violence among economically disadvantaged young adult women: Associations with adolescent risk-taking and pregnancy experiences

CONTEXT Intimate partner violence negatively impacts the health of substantial proportions of young women in economically disadvantaged communities, where sexual initiation, aggressive behaviors, unintended pregnancies and childbearing are common among adolescents. It is therefore important to assess how adolescent risk behaviors and pregnancy experiences are linked to such violence during young adulthood. METHODS Data from 526 participants in the Reach for Health Longitudinal Study who were surveyed during middle school (in 1995-1996 and 1996-1997) and at ages 22-25 (in 2005-2007) provided information on adolescent risk behaviors and pregnancy experiences, as well as experiences of intimate partner violence during young adulthood. Bivariate and multivariate analyses were conducted to identify correlates of intimate partner violence involvement. RESULTS As young adults, 29% of women reported having been victims of intimate partner violence in the past 12 months; 21% reported having perpetrated such violence. In multivariate analyses, victimization and perpetration in the last year are positively associated with aggressive behavior in middle school (odds ratios, 1.9 and 2.5, respectively), lifetime number of sex partners (1.3 for both) and having a history of unintended pregnancy or pregnancy problems (1.3 for both). Perpetration also is associated with early sexual initiation (0.5) and living with a partner (1.8). CONCLUSIONS It is important to consider womens pregnancy histories in programs aimed at preventing the adverse outcomes of relationship violence and in screening for partner violence in sexual and reproductive health services. Early intervention may help women develop the skills needed for resolving conflicts with peers and partners.

Cost-effectiveness of a brief video-based HIV intervention for African American and Latino sexually transmitted disease clinic clients.

Background and objectivesDecisions about the dissemination of HIV interventions need to be informed by evidence of their cost-effectiveness in reducing negative health outcomes. Having previously shown the effectiveness of a single-session video-based group intervention (VOICES/VOCES) in reducing incidence of sexually transmitted diseases (STD) among male African American and Latino clients attending an urban STD clinic, this study estimates its cost-effectiveness in terms of disease averted. MethodsCost-effectiveness was calculated using data on effectiveness from a randomized clinical trial of the VOICES/VOCES intervention along with updated data on the costs of intervention from four replication sites. STD incidence and self-reported behavioral data were used to make estimates of reduction in HIV incidence among study participants. ResultsThe average annual cost to provide the intervention to 10 000 STD clinic clients was estimated to be US

Adolescent suicidality and adult support: the reach for health study of urban youth

447 005, with a cost per client of US

Especially for Daughters: Parent Education to Address Alcohol and Sex-Related Risk Taking Among Urban Young Adolescent Girls

43.30. This expenditure would result in an average of 27.69 HIV infections averted, with an average savings from averted medical costs of US

Barriers to condom use in primary and nonprimary relationships among Hispanic STD clinic patients.

5 544 408. The number of quality adjusted life years saved averaged 387.61, with a cost per HIV infection averted of US