Michelle R. Broaddus

Randomized Trial of Group Interventions to Reduce HIV/STD Risk and Change Theoretical Mediators among Detained Adolescents.

Criminally involved adolescents engage in high levels of risky sexual behavior and alcohol use, and alcohol use may contribute to lack of condom use. Detained adolescents (n = 484) were randomized to (1) a theory-based sexual risk reduction intervention (GPI), (2) the GPI condition with a group-based alcohol risk reduction motivational enhancement therapy component (GPI + GMET), or (3) an information-only control (INFO). All interventions were presented in same-sex groups in single sessions lasting from 2 to 4 hr. Changes to putative theoretical mediators (attitudes, perceived norms, self-efficacy, and intentions) were measured immediately following intervention administration. The primary outcomes were risky sexual behavior and sexual behavior while drinking measured 3 months later (65.1% retention). The GPI + GMET intervention demonstrated superiority over both other conditions in influencing theoretical mediators and over the INFO control in reducing risky sexual behavior. Self-efficacy and intentions were significant mediators between condition and later risky sexual behavior. This study contributes to an understanding of harm reduction among high-risk adolescents and has implications for understanding circumstances in which the inclusion of GMET components may be effective.

Mediational analysis in HIV/AIDS research: estimating multivariate path analytic models in a structural equation modeling framework.

Mediational analyses have been recognized as useful in answering two broad questions that arise in HIV/AIDS research, those of theoretical model testing and of the effectiveness of multicomponent interventions. This article serves as a primer for those wishing to use mediation techniques in their own research, with a specific focus on mediation applied in the context of path analysis within a structural equation modeling (SEM) framework. Mediational analyses and the SEM framework are reviewed at a general level, followed by a discussion of the techniques as applied to complex research designs, such as models with multiple mediators, multilevel or longitudinal data, categorical outcomes, and problematic data (e.g., missing data, nonnormally distributed variables). Issues of statistical power and of testing the significance of the mediated effect are also discussed. Concrete examples that include computer syntax and output are provided to demonstrate the application of these techniques to testing a theoretical model and to the evaluation of a multicomponent intervention.

Condom Use Among South African Adolescents: Developing and Testing Theoretical Models of Intentions and Behavior

We developed and tested models of intentions and behavior among adolescents from Cape Town, South Africa. Data from 261 participants who completed an initial measure of attitudes, beliefs, and prior behavior were used to develop a model of intentions to use condoms based on the Theory of Planned Behavior (TPB) and additional constructs found to be important in previous research with adolescents. Of the initial sample, 227 (87%) completed a behavioral follow-up 4 months later, and approximately one-third of those (n=72; 44 boys and 30 girls) reported having had sex in the prior 4 months. Data from this smaller sample were used to develop a model of condom use behavior based on intentions (as per the TPB) and the additional sub-population relevant constructs. Analyses generally supported the validity of the TPB in this context for predicting intentions and behavior. HIV knowledge and positive outlook (self-esteem and future optimism) were significantly related to TPB predictors of intentions. Intentions, acceptance of sexuality, and gender were significant predictors of behavior. Implications for the status of the TPB and the design of interventions for South African adolescents are discussed.

HIV Risk Reduction Among Detained Adolescents: A Randomized, Controlled Trial

OBJECTIVES: Criminally involved adolescents engage in high levels of alcohol-related risky sex. A theory-based sexual and alcohol risk-reduction intervention was designed, implemented, and evaluated in juvenile detention facilities. Participants and Methods. In a randomized, controlled trial, 484 detained adolescents received 1 of 3 group-based interventions: combined sexual and alcohol risk reduction (group psychosocial intervention [GPI] + group motivational enhancement therapy [GMET]); sexual risk reduction only (GPI); or HIV/sexually transmitted disease prevention information only (group information-only intervention [GINFO]). Follow-up data were obtained 3, 6, 9, and 12 months after the intervention. Behavioral outcomes were condom-use behavior, frequency of intercourse while drinking, and alcohol-related problems. RESULTS: Condom-use behavior measured as frequency of condom use during sex (ranging from never to always) decreased over time, although the GPI and GPI + GMET interventions mitigated this tendency at the 3-, 6-, and 9-month follow-up assessments. Although both active interventions were significantly more successful than the GINFO condition and the pattern of effects favored the GPI + GMET, there were no statistically significant differences between the GPI and GPI + GMET interventions. CONCLUSIONS: Findings support the feasibility of integrating alcohol-specific sexual risk content into a theory-based sexual risk-reduction intervention and provide additional evidence that theory-based interventions are effective at reducing risky sex in this population. There was limited evidence of intervention effects on alcohol-use outcomes. Future research should focus on strengthening the GPI + GMET to most effectively target risky sexual behavior among at-risk adolescents.

Consistent Condom Use Among Juvenile Detainees: The Role of Individual Differences, Social Bonding, and Health Beliefs

This study takes the perspective that condom use may be a non-continuous variable, and that the endpoint of consistent condom use is an important focus of study both in terms of public health considerations and theoretically. As consistent condom use is the ultimate goal for prevention of the spread of HIV and STDs among those who are sexually active, special attention needs to be paid to those who have accomplished that goal, especially among high-risk populations. Guided by theories of resiliency, and using consistent condom use as a marker of the broader sexual health resiliency construct, condom promotive factors are used to predict consistent condom use among detained adolescents. Consistent condom users appear to be a distinct sub-population. Likely to be male, they are also likely to have higher self-esteem, higher optimism, and lower sensation seeking and impulsive decision making. They are likely to be in school and to live with both biological parents. Finally, they are likely to have positive attitudes towards condoms and report having friends and peers who feel the same way.

CORRELATES OF INTERNALIZED HOMONEGATIVITY AMONG BLACK MEN WHO HAVE SEX WITH MEN

Black men who have sex with men (MSM) carry a disproportionate burden of HIV in the United States. Such disparities cannot be attributed to individual behavioral risk factors alone, prompting the exploration of social and contextual factors experienced by minority MSM. Societal homonegativity and the internalization of those attitudes by Black MSM may play an important role in understanding racial and ethnic disparities in HIV incidence and prevalence. This study explores the correlates of internalized homonegativity in a large multi-site sample of Black MSM. Findings reveal a number of significant contextual and psychosocial factors related to internalized homonegativity including religiosity, resilience, and gay community acculturation, which have important implications for HIV risk, HIV testing, and social and psychological wellbeing for Black MSM.

An Expanded Model of the Temporal Stability of Condom Use Intentions: Gender-Specific Predictors among High-Risk Adolescents.

BackgroundAdolescents involved with the criminal justice system are at particularly high-risk for the Human Immunodeficiency Virus and sexually transmitted infections.PurposeThe purpose of this study was to longitudinally examine gender-specific models of condom use, incorporating temporal stability of intentions.MethodsAdolescents on probation (N = 728) were recruited to complete longitudinal surveys including measures of Theory of Planned Behavior and gender-specific constructs, relationship length, and condom use.ResultsGender-specific models of condom use behavior suggested by previous research were mostly replicated. For young women, the effect of baseline intentions on subsequent condom use behavior was stronger when intentions were either stable or increasing. For young men, more stable, increasing intentions were directly associated with more condom use. There was preliminary evidence to suggest an association between temporal stability of intentions and decreasing condom use in stable relationships.ConclusionsIntervention efforts should be tailored by gender and aim to forestall decreasing intentions and condom use over time by addressing difficulties in maintaining condom use.

Text Messaging for Sexual Communication and Safety Among African American Young Adults

African American young adults are at high risk of HIV infection during their lifetimes, and the male condom remains the best method of prevention. Efforts to increase condom use should address the barrier of condom negotiation. We conducted a thematic analysis of qualitative, semistructured interviews with African American young adults to examine their use of text messaging for requesting human immunodeficiency virus (HIV) or sexually transmitted infection (STI) testing and condom use within the larger context of general sexual communication using text messages. Text messaging gave participants a level of comfort and disinhibition to discuss sexual topics and negotiate sexual safety. Benefits of text messages included ease of communication, privacy, and increased ability to express condom desires. Difficulties reflected the potential relationship implications of suggesting HIV/STI testing and condom use. Condom negotiation strategies using text messages also mirrored those found to be used in face-to-face communication.

Risks and Benefits of Text-Message-Delivered and Small-Group-Delivered Sexual Health Interventions Among African American Women in the Midwestern United States

Interventions to decrease acquisition and transmission of sexually transmitted diseases among African American women using text messages versus small-group delivery modalities pose distinct research risks and benefits. Determining the relative risk–benefit ratio of studies using these different modalities has relied on the expertise of investigators and their institutional review boards. In this study, African American women participated in focus groups and surveys to elicit and compare risks and benefits inherent in these two intervention delivery modalities, focusing on issues such as convenience, privacy, and stigma of participation. Some risk/benefit variables were implicated in willingness to participate the two intervention modalities.

Acceptability of HIV Prevention Information Delivered Through Established Geosocial Networking Mobile Applications to Men Who Have Sex With Men

Geosocial networking (GSN) applications could disseminate HIV prevention information to thousands of men who have sex with men (MSM); however, acceptability of the type of information, methods, and frequency of information delivery are unknown. Acceptability of these constructs were assessed through a survey of 224 MSM at the Milwaukee Pridefest. All types of information were found acceptable. A sexual health section and self-seeking information were the most acceptable method and frequency of delivery. Demographics and differences in app usage did not correlate to acceptability. Continued research focusing on the feasibility of incorporating HIV prevention information into GSN applications is needed.