Robin Stevens

Examining the dimensions of cancer-related information seeking and scanning behavior.

Recent decades have witnessed a growing emphasis on patients as active consumers of health information. The literature about cancer-related information focuses on active and purposeful information seeking, but a great deal of exposure to cancer-relevant information may happen less purposively (termed information scanning). This article presents results from an in-depth interview study that examined information seeking and scanning behavior in the context of cancer prevention and screening decisions among a diverse sample of people living in a major metropolitan area. Results suggest that information scanning is quite common, particularly for information related to screening tests. Information seeking is rarer and occurs primarily among those who also are information scanners. Respondents report using a greater variety of sources for information scanning than for information seeking, but participants were much more likely to report that their decisions were influenced by information received through seeking than through scanning. These findings shed new light on how individuals navigate the media environment and suggest future research should examine predictors and effects of less purposeful efforts to obtain cancer-related information.

Optimism and Education Buffer the Effects of Syndemic Conditions on HIV Status Among African American Men Who Have Sex with Men

The present study sought to replicate effects of the number of syndemic psychosocial health conditions on sexual risk behavior and HIV infection among a sample of high-risk African American men who have sex with men (MSM) and to identify resilience factors that may buffer these effects. We used baseline data from an HIV risk-reduction trial to examine whether a higher number of syndemic conditions was associated with higher rates of self-reported sexual risk behavior and HIV infection. Using logistic regression models, we tested for interactions between number of syndemic conditions and several potential resilience factors to identify buffering effects. Replicating previous studies, we found significant associations between numbers of syndemic conditions and higher rates of sexual risk behavior and HIV infection. Surprisingly, we also replicated a previous finding (Stall et al., Am J Public Health, 93(6):939–942, 2003) that the effects of syndemic burden on HIV status fell off at the highest levels of syndemic conditions. Among a variety of potential resilience factors, two—optimism and education—buffered the syndemic effect on HIV prevalence. This is, to our knowledge, the first paper to identify resilience factors buffering against syndemic effects among MSM. It also constitutes a significant contribution to the literature regarding prevention among black MSM. These results point to the need to identify HIV-positive black MSM and provide effective treatment for them and to develop interventions addressing both syndemic and resilience factors.

How do cancer patients navigate the public information environment? Understanding patterns and motivations for movement among information sources.

Little is known about how patients move among information sources to fulfill unmet needs. We interviewed 43 breast, prostate, and colorectal cancer patients. Using a grounded theory approach, we identified patterns and motivations for movement among information sources. Overall, patients reported using one source (e.g., newspaper) followed by the use of another source (e.g., Internet), and five key motivations for such cross-source movement emerged. Patients’ social networks often played a central role in this movement. Understanding how patients navigate an increasingly complex information environment may help clinicians and educators to guide patients to appropriate, high-quality sources.

Social environment and sexual risk-taking among gay and transgender African American youth

More prevention effort is required as the HIV epidemic increases among gay and transgender African American youth. Using ecological systems theory and an integrative model of behaviour change, this study examines the sexual behaviour of gay and transgender African American young people as embedded within the unique social and structural environments affecting this population. Also examined is the important role played by mobile technology in the social and sexual lives of individuals. Seven focus groups were conducted with 54 African American young adults in a northeastern US city. The findings provide a rich examination of the social and sexual lives of gay and transgender African American youth, focusing on the social environment and the impact of the environment on sexual-risk behaviour.

The digital hood: Social media use among youth in disadvantaged neighborhoods

This study examines the role of social media in the lives of youth living in disadvantaged neighborhoods. Feminist Standpoint Theory, which privileges the voices of marginalized communities in understanding social phenomena, suggests that youth at the margins have specific knowledge that helps us understand social media more broadly. We conducted semi-structured interviews with 30 females and 30 males aged 13–24 years about their social worlds and neighborhoods, both online and offline. The findings reveal a dynamic and somewhat concerning interplay between the geographic neighborhood and the digital neighborhood, whereby negative social interactions in the geographic neighborhood are reproduced and amplified on social media.

“You See It Everywhere. It’s Just Natural.”: Contextualizing the Role of Peers, Family, and Neighborhood in Initial Substance Use

The current study utilizes in-depth interviews with inner city African-American and Latino adolescents to understand how they negotiate initial substance use. We applied the social norms approach to explore the role of peers, family, and neighborhood on adolescents’ initial substance use. Utilizing data from 36 interview participants, our analysis revealed that extended family members were pivotal in providing adolescents with their initial alcohol; however, female adolescents were more likely than male adolescents to acquire marijuana from their male peers, for free. Understanding situational contexts underlying initial substance use is imperative for future interventions with this population.

Socioecological Factors in Sexual Decision Making among Urban Girls and Young Women

OBJECTIVES To examine how girls and young women living in disadvantaged urban neighborhoods make decisions relating to sexual debut and HIV prevention. DESIGN Thirty semistructured in-depth interviews. We used a socioecological approach to investigate the role of neighborhood and social context on sexual decision making. SETTING Community-based organizations and on-campus interview sites. PARTICIPANTS African American and Latina girls and young women age 13 to 24 living in disadvantaged neighborhoods. METHODS We examine their attitudes and beliefs about sex, first opportunities for sexual intercourse, prevention behaviors, and neighborhood environments. RESULTS Lack of neighborhood safety and safe socialization places led youth to spend significant amounts of time indoors, often without adult supervision. CONCLUSION The findings provide insight into the socioecological context in which girls are situated as they navigate sexual decision making. Unsupervised, cloistered time coupled with peer norms to engage in sexual behavior may contribute to increased risky sexual behavior among some youth. Prevention efforts should consider neighborhood context and incorporate structural and community-level interventions to create social environments that support healthy sexual decision making.

Social Media Use and Sexual Risk Reduction Behavior Among Minority Youth: Seeking Safe Sex Information

Background Sexual health is an important area of study—particularly for minority youth and youth living in disadvantaged neighborhoods. Objectives The purpose of the research was to examine the sources of sexual health information associated with youth adopting sexual risk reduction behaviors. Methods Data collection took place in a small city in the Northeastern United States using cross-sectional behavioral surveys and modified venue-based sampling. Participants included 249 African American and Latino youth aged 13–24. Participants reported their sources of information about contraception and human immunodeficiency virus/sexually transmitted disease, such as TV/movies, parents, social media; their intentions to have sex; and condom and contraception use during their last sexual activity. Social media use, past pregnancy experience, past sexual history, age, and gender were also measured. Standard tests of bivariate association (chi-square and F tests) were used to examine initial associations between sexual risk reduction behavior and exposure to sexual risk reduction information on social media. Logistic regression models were used to test multivariate relationships between information sources and sexual risk reduction behavior. Results Youth who were exposed to sexual health messages on social media were 2.69 times (p < .05) and 2.49 times (p < .08) more likely to have used contraception or a condom at last intercourse, respectively. Parents, schools, or traditional media as information sources were not significantly associated with contractive use or condom use at last intercourse. Discussion Youth sexual behavior is increasingly informed by social media messages. Health practitioners should utilize social media as an important health promotion tool.

AIDS in black & white : the influence of news coverage of HIV/AIDS on HIV/AIDS testing among African Americans and White Americans, 1993--2007

This study examined the effect of newspaper coverage of HIV/AIDS on HIV testing behavior in a U.S. population. HIV testing data were taken from the Center for Disease Control and Preventions National Behavioral Risk Factor Surveillance System from 1993 to 2007 (N = 265,557). The authors content-analyzed news stories from 24 daily newspapers and 1 wire service during the same time period. The authors used distributed lagged regression models to estimate how well HIV/AIDS newspaper coverage predicted later HIV testing behavior. Increases in HIV/AIDS newspaper coverage were associated with declines in population-level HIV testing. Each additional 100 HIV/AIDS-related newspaper stories published each month was associated with a 1.7% decline in HIV testing levels in the subsequent month. This effect differed by race, with African Americans exhibiting greater declines in HIV testing subsequent to increased news coverage than did Whites. These results suggest that mainstream newspaper coverage of HIV/AIDS may have a particularly deleterious effect on African Americans, one of the groups most affected by the disease. The mechanisms driving the negative effect deserve further investigation to improve reporting on HIV/AIDS in the media.

Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

BackgroundFew trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM).PurposeWe examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM.MethodAfrican American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys.ResultsOf the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period.ConclusionsInterventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM’s physical activity.Clinical trial registrationThe trial was registered with the ClinicalTrials.gov Identifier NCT02561286.