Naomi Farber

Using culture-centered qualitative formative research to design broadcast messages for HIV prevention for African American adolescents

The need for formative research in designing mass media health-education messages is widely accepted; however, distinct methodologies for developing such messages are less well documented. This article describes a culture-centered approach for developing messages to promote sexual risk reduction in urban African American adolescents. The method uses qualitative formative research to identify “competing narratives” that support healthy behavior despite the dominance of messages that favor risk-taking behavior. The method is illustrated using qualitative analysis of semistructured interviews with 124 adolescents. Analysis focuses on two barriers to sexual risk reduction: (a) social pressure for early initiation of sexual intercourse and (b) perceptions that condoms reduce sexual pleasure. We demonstrate how competing narratives identified in the analysis can be featured in radio and television messages advocating healthy behavior by modeling risk-reducing negotiation skills.

Using Culturally Sensitive Media Messages to Reduce HIV-Associated Sexual Behavior in High-Risk African American Adolescents: Results From a Randomized Trial

PURPOSE To test the long-term effects of a mass media intervention that used culturally and developmentally appropriate messages to enhance human immunodeficiency virus (HIV)-preventive beliefs and behavior of high-risk African American adolescents. METHODS Television and radio messages were delivered for more than 3 years in two cities (Syracuse, NY; and Macon, GA) that were randomly selected within each of the two regionally matched city pairs, with the other cities (Providence, RI; and Columbia, SC) serving as controls. African American adolescents, aged 14-17 years (N = 1,710), recruited in the four cities over a 16-month period, completed audio computer-assisted self-interviews at recruitment and again at 3, 6, 12, and 18-months postrecruitment to assess the long-term effects of the media program. To identify the unique effects of the media intervention, youth who completed at least one follow-up and who did not test positive for any of the three sexually transmitted infections at recruitment or at 6-and 12-month follow-up were retained for analysis (N = 1,346). RESULTS The media intervention reached virtually all the adolescents in the trial and produced a range of effects including improved normative condom-use negotiation expectancies and increased sex refusal self-efficacy. Most importantly, older adolescents (aged 16-17 years) exposed to the media program showed a less risky age trajectory of unprotected sex than those in the nonmedia cities. CONCLUSION Culturally tailored mass media messages that are delivered consistently over time have the potential to reach a large audience of high-risk adolescents, to support changes in HIV-preventive beliefs, and to reduce HIV-associated risk behaviors among older youth.

Qualitative Comparison of Women's Perspectives on the Functions and Benefits of Group and Individual Prenatal Care.

INTRODUCTION Womens definitions and experiences of the functions and benefits of their routine prenatal care are largely absent from research and public discourse on prenatal care outcomes. This qualitative study aimed to develop a framework of womens prenatal care experiences by comparing the experiences of women in individual and group prenatal care. METHODS We conducted serial qualitative interviews with racially diverse low-income women receiving individual prenatal care (n = 14) or group prenatal care (n = 15) through pregnancy and the early postpartum period. We completed 42 second-trimester, 48 third-trimester, and 44 postpartum interviews. Using grounded theory, the semistructured interviews were coded for themes, and the themes were integrated into an explanatory framework of prenatal care functions and benefits. RESULTS Individual and group participants described similar benefits in 3 prenatal care functions: confirming health, preventing and monitoring medical complications, and building supportive provider relationships. For the fourth function, educating and preparing, group care participants experienced more benefits and different benefits. The benefits for group participants were enhanced by the supportive group environment. Group participants described greater positive influences on stress, confidence, knowledge, motivation, informed decision making, and health care engagement. DISCUSSION Whereas pregnant women want to maximize their probability of having a healthy newborn, other prenatal care outcomes are also important: reducing pregnancy-related stress; developing confidence and knowledge for improving health; preparing for labor, birth, and newborn care; and having supportive relationships. Group prenatal care may be more effective in attaining these outcomes. Achieving these outcomes is increasingly relevant in health care systems prioritizing woman-centered care and improved birth outcomes. How to achieve them should be part of policy development and research.

The effects of a mass media HIV-risk reduction strategy on HIV-related stigma and knowledge among African American adolescents

HIV-related stigma undermines HIV prevention, testing, and treatment. Multipronged risk-reduction strategies may reduce stigma among African American adolescents. To test the effectiveness of a risk-reduction strategy in addressing stigma, 1613 African American adolescents from four mid-sized cities participated in a randomized control trial. Participants received a sexual-risk reduction [Focus on Youth (FOY)] or general health curriculum [Promoting Health Among Teens (PHAT)]. Two cities received a culturally-tailored media intervention. Participants completed baseline, 3-, 6-, and 12-month surveys to measure HIV-related stigma and knowledge. Analysis of covariance tested for stigma and knowledge differences by media city status and curriculum/media city status (PHAT media vs. PHAT non-media, FOY media vs. FOY non-media; FOY media vs. PHAT media; FOY non-media vs. PHAT non-media) at each measurement. Hierarchical linear modeling (HLM) determined stigma and knowledge differences over time. Media participants demonstrated greater HIV-related knowledge (p<0.10) at 6 months and lower stigma at 3 months (p<0.10). FOY media participants had lower 3-month (p<0.05) and 12-month (p<0.10) stigma scores than non-media FOY participants. FOY media and non-media participants had greater knowledge than PHAT for all intervals after baseline. FOY media had lower stigma than PHAT media after baseline for all intervals after baseline. HLM indicated greater knowledge slopes for the media group (p<0.05). FOY media participants had greater knowledge slopes (p<0.05) relative to non-media FOY participants and media PHAT participants (p<0.01). A combination of a HIV risk-reduction curriculum and culturally-tailored media demonstrated some effectiveness in reducing stigma. Future use of media in HIV-prevention should include and evaluate effects on stigma.

Violence in the Lives of Rural, Southern, and Poor White Women:

Poor White single mothers and their children in non-urban communities in the American South experience high levels of domestic violence. We report selected findings from a life history study among White, low-income, unmarried mothers in South Carolina. Here, we examine how domestic violence in both childhood and adulthood may inhibit asset development by diminishing low-income single mothers’ accumulation of human and social capital, thus compromising their well-being as adults and parents.

Effects of Promoting Health Among Teens on Dietary, Physical Activity and Substance Use Knowledge and Behaviors for African American Adolescents

Background African Americans are disproportionately affected by cardiovascular disease and cancer. Health promotion interventions hold promise for reducing health disparities. Purpose Promoting Health Among Teens (PHAT) is a brief, culturally tailored health education intervention to decrease cardiovascular disease and cancer risk for African Americans. This study evaluated the effects of PHAT for African American adolescents ages 14 to 17 in 4 eastern cities in the United States. Methods A randomized controlled design (N = 1654) was used to determine differences in health knowledge, diet, physical activity, and substance use behaviors between PHAT participants and a sexual health promotion control group. Data were collected at baseline and at 3, 6, and 12 months postintervention. Growth curve modeling was used to detect differences in health knowledge, dietary behaviors, physical activity, and substance use between PHAT and control group participants. Results PHAT participants had significantly greater knowledge gains but modest behavior changes compared to control group participants. Discussion PHAT is a promising intervention to increase knowledge and address selected health behaviors in African American youth. Translation to Health Education Practice Future attempts to execute PHAT should continue its emphasis on knowledge building while increasing intervention dosage and modifying length of time for intervention sessions.

Chicks Aren’t Chickens Women, Poverty, and Marriage in an Orthodoxy of Conservatism

This article describes the marital and domestic violence experiences of poor women in South Carolina in the context of an orthodoxy of conservatism. Drawing on Bourdieu’s scholarship, the authors present a conceptual framework that is based on the concepts of habitus, orthodoxy, and heterodoxy. The interpretation of the qualitative and quantitative data connects the observed behavioral phenomena with the structural, cultural, and political factors that sustain them. The article ends with a discussion of the implications of the findings and the debate on marriage promotion

Prevalence and Factors Associated with Teen Pregnancy in Vietnam: Results from Two National Surveys

This study asked two broad questions: (1) what is the prevalence of teen pregnancy in contemporary Vietnam; and (2) what selected social, family, and individual factors are associated with teen pregnancy in Vietnam? The study utilized Vietnam Survey Assessment of Vietnamese Youth surveys conducted in 2003 and 2008 to answer the two research questions within the context of fast political, economic, and social change in Vietnam in the last two decades. Results of this study show that the prevalence of pregnancy among Vietnamese teenagers in the surveys was stable at 4%, or 40 pregnancies per 1000 adolescent girls aged 14 to 19. Age, experience of domestic violence, and early sexual debut were positively correlated with higher odds of teenage pregnancy for both survey cohorts; however, being an ethnic minority, educational attainment, sexual education at school, Internet use, and depressive symptoms were significantly related to teenage pregnancy only in the 2008 cohort.

Marital quality and self-efficacy: influence on disease management among individuals with rheumatoid arthritis.

Individuals with rheumatoid arthritis (RA) struggle to maintain improved functional ability and reduced pain levels. Health education emphasizing self-efficacy helps individuals to adjust with the disease outcome and progression. As a basis to develop comprehensive evidence-based patient education programs, the aim of the study was to examine the role of marriage as a predictor of pain and functional self-efficacy among individuals with RA. Review of the regression analysis did not provide support for the relationships between marital quality and self-efficacy. Relationships were not observed between marital quality, length of marriage, and self-efficacy as predicted by the first hypothesis. Additional regression analysis examination found that marital quality, length of marriage, pain, and health assessment together reported significant variance in self-efficacy. However, only health assessment significantly predicted self-efficacy. Other nonexamined variables could have influenced the independent marital quality effects. Future longitudinal studies with larger sample sizes can further validate the current findings.

“First Train Out”: Marriage and Cohabitation in the Context of Poverty, Deprivation, and Trauma

There has been a steep rise in the proportion of children born to and living with unmarried parents. Unmarried parents are increasingly likely to cohabitate, especially low-income couples, placing their children at elevated psychosocial risk. This life history study of poor, White single mothers suggests that the current focus on differences between married and cohabiting poor women may overstate underlying similarities in factors associated with their partner formation and dissolution and that poor womens decisions about marriage and cohabitation must be understood in a developmental context that reflects the stacking, over time, of multiple forms of vulnerability to unstable partnerships, single motherhood, and continuing poverty into adulthood.