Ronald J. Peters

Using Intervention Mapping to Adapt an Effective HIV, Sexually Transmitted Disease, and Pregnancy Prevention Program for High-Risk Minority Youth

Although many programs have been developed to reduce adolescent pregnancy and sexually transmitted diseases (STDs) (including HIV), with some showing promise in reducing sexual risk-taking behavior, little guidance has been given as to how to adapt existing interventions to new communities. When adapting a program, effective elements deemed necessary to change behaviors need to be preserved, while cultural competence and relevance for the new population must be considered in creating new elements. To address these needs, the authors describe the application of a systematic process, intervention mapping (IM), to adapt a theory-based, multicomponent HIV, STD, and pregnancy prevention program titled Safer Choices to a new target population, at-risk youth attending alternative schools and at risk of dropping out. IM is a detailed process that provides planners with a systematic method for decision making in each phase of developing or adapting an intervention to influence changes in behavior and environmental conditions.

Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students.

Few studies have examined the long-term efficacy of computer-based smoking prevention and cessation programs. We analyzed the long-term impact of A Smoking Prevention Interactive Experience (ASPIRE), a theoretically sound computer-based smoking prevention and cessation curriculum for high school students. Sixteen predominantly minority, inner-city high schools were randomly assigned to receive the ASPIRE curriculum or standard care (receipt of the National Cancer Institutes Clearing the Air self-help booklet). A total of 1160 students, 1098 of whom were nonsmokers and 62 smokers at baseline, were included. At 18-month follow-up, among baseline nonsmokers, smoking initiation rates were significantly lower in the ASPIRE condition (1.9% vs. 5.8%, p < .05). Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke. Differences between groups in self-efficacy and resistance skills were not significant. There was a nonsignificant trend toward improved smoking cessation with ASPIRE, but low recruitment of smokers precluded conclusions with respect to cessation. ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention. Further studies are required to determine ASPIREs effects on cessation.

Strategies to prevent HIV transmission among heterosexual African-American men

BackgroundAs part of qualitative research for developing a culturally sensitive and developmentally appropriate videotape-based HIV prevention intervention for heterosexual African- American men, six focus groups were conducted with thirty African-American men to determine their perceptions of AIDS as a threat to the African-American community, characteristics of past situations that have placed African Americans at risk for HIV infection, their personal high risk behaviors, and suggestions on how HIV intervention videotapes could be produced to achieve maximum levels of interest among African-American men in HIV training programs.MethodsThe groups took place at a low-income housing project in Houston, Texas, a major epicenter for HIV/AIDS. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis.ResultsThe results revealed that low-income African-American men perceive HIV/AIDS as a threat to their community and they have placed themselves at risk of HIV infection based on unsafe sex practices, substance abuse, and lack of knowledge. They also cite lack of income to purchase condoms as a barrier to safe sex practice. They believe that HIV training programs should address these risk factors and that videotapes developed for prevention should offer a sensationalized look at the effects of HIV/AIDS on affected persons. They further believe that programs should be held in African-American communities and should include condoms to facilitate reduction of risk behaviors.ConclusionsThe results indicate that the respondents taking part in this study believe that HIV and AIDS are continued threats to the African-American community because of sexual risk taking behavior, that is, failure to use condoms. Further, African-American men are having sex without condoms when having sex with women often when they are under the influence of alcohol or other mind-altering substances and they are having sex with men while incarcerated and become infected and once released resume unprotected sexual relations with women. According to the men, substance abuse is an important part of the problem of HIV in the African-American community. This is in keeping with research that shows that drug use, especially crack cocaine, is linked to sexual risk taking among African Americans and to increased likelihood of becoming infected with other sexually transmitted diseases (STDs) including HIV. Thus, interventions for men should address condom use, condom availability, skills for using condoms, eroticizing condoms and substance abuse prevention. Men in the present study also strongly recommended that HIV/AIDS videotaped messages should include footage of the sensational effects of the disease.

Beliefs and Perceived Norms Concerning Body Image among African-American and Latino Teenagers

Focus groups, utilizing the Theory of Planned Behavior, examined the beliefs and perceived norms regarding body image in a sample of urban African-American and Latino teenagers (N = 83, 18—19 years old) from Texas. Cultural eating (behavioral belief) explained the acceptance and tolerance of overweight. Popularity of hip-hop fashion and limited income explicated peer and familial normative beliefs, respectively. Thinness equated HIV infection in African-Americans (parental normative belief). Barriers to healthy eating and active living (control beliefs) included willpower, laziness, fast food, and excessive work. Findings can guide the development and implementation of culturally appropriate obesity interventions for African-American and Latino adolescents.

The Social Norms and Beliefs of Teenage Male Electronic Cigarette Use

Electronic cigarettes (e-cigarettes) are novel, battery-operated inhalation devices that provide warm, vaporized nicotine, and often propylene glycol, to users without the inclusion of tobacco smoke. Because men, in general, are more likely to use cigarettes and illicit drugs than women, a qualitative study was undertaken to investigate the beliefs and perceived social norms regarding this issue among 47 teenage boys who self-identified themselves as current e-cigarette smokers. The majority of respondents reported that they used e-cigarettes because of expeditious consumption and concealment. Furthermore, the most common places respondents self-reported using e-cigarettes were everywhere, in school bathrooms, at home, and in school staircases. Interestingly, respondents stated that e-cigarettes are popular because they are accessible, healthier than tobacco cigarettes, and more aesthetically pleasing. Because of the growing popularity and uncertainty regarding the social and physical consequences of e-cigarettes, this study shows a need for additional research discovery.

Use of interactive health communication to affect smoking intentions in middle school students: a pilot test of the "Headbutt" risk assessment program.

Purpose. Developing and disseminating innovative and effective approaches for smoking prevention among middle school children remains a public health priority. This pilot study evaluates the use of a Web-based tobacco prevention program, Headbutt, to change intentions of middle school children to smoke tobacco. Methods. Headbutt was implemented with the use of a single-group pretest-posttest study design in sixth grade classes of nine middle schools in Texas (student n = 2227). The program assesses cognitive determinants of smoking and provides intervention feedback tailored to the childs responses. Results. Headbutt significantly affected smoking intentions, prosmoking attitudes, self-efficacy expectations, and knowledge of negative consequences (all p ≤ .001) measured with scales adopted from the Texas Tobacco Initiative Survey. Change in prosmoking attitudes had the greatest predictive effect on smoking intentions (p < .001). These results were moderated by ethnicity and age of students. Conclusion. Findings need to be interpreted in the light of study design limitations. However, strong associations between the Headbutt program and intention change suggests that a more rigorous effectiveness trial is indicated.

Gender Differences in the Class of 1989 Study: The School Component of the Minnesota Heart Health Program

Abstract The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP). Beginning in sixth grade (1983), seven annual waves of measurements were taken from students in one of the MHHP intervention communities and its matched pair (baseline n = 2,376). Self-reported data were collected at each time period describing a variety of health-related behaviors, including smoking, physical activity, and food preferences. With regard to the intervention hypotheses, significant positive differences between genders were observed on the physical activity and food preference variables. Significant gender by treatment interactions were observed on five of six follow-up periods for food preferences. The effects of the intervention on smoking by gender were less apparent. The results from the tracking analysis indicate there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behaviors, but these results did not differ greatly by gender. These data suggest that...

Beliefs and social norms about codeine and promethazine hydrochloride cough syrup (CPHCS) onset and perceived addiction among urban houstonian adolescents: An addiction trend in the City of Lean

In the current study, we used a qualitative approach to investigate relevant beliefs and norms associated with codeine and promethazine hydrochloride cough syrup (CPHCS) consumption, initiation, and perceived addiction among 48 alternative school students who identified themselves as current CPHCS users. In general, both boys and girls believed that CPHCS addiction started during an individuals initial consumption. A majority of both groups reported that their second CPHCS event was initiated during the same or next day after their first event. Our findings suggest that friends and an innovative form of hip-hop music called “screw” are strong reinforcers of CPHCS use.

Beliefs and social norms about codeine and promethazine hydrochloride cough syrup (CPHCS) use and addiction among multi-ethnic college students.

Abstract In this study a qualitative approach is used to investigate relevant beliefs and nonns concerning the consumption, initiation, and perceived addiction of codeine and promethazine hydrochloride cough syrup (CPHCS) among 61 college-age students who identified themselves as current CPHCS users. In general, a majority of students stated that doctors and phannacists were the greatest facilitators of CPHCS acquisition. A majority of students believed that their friends felt codeine promethazine use was “normal” and “cool” among college students their age, and that reinforcing factors, such as peer pressure and curiosity, contributed to initial CPHCS use.

Potential markers of female condom use among inner city African-American women.

Abstract Despite the availability of the female condoms and theoretically based interventions to promote its use, studies have indicated a low level of acceptability of their use among women in most populations. We aimed to determine female condom use prevalence and the potential markers among African-American women. In an intervention trial to test the efficacy of the Information-Motivation-Behavioral Skills model in increasing condom use, we utilized the baseline data of 280 subjects and examined the potential predictors of female condom use. Chi square statistic and unconditional logistic regression were used to test for group independence among users and non-users of the female condom and to assess the potential markers of female condom use respectively. After adjustment for relevant covariates associated independently with female condom use, the significant potential markers for female condom use were age, multiple sexual relationships, knowledge of female condom, and educational status. Women having multiple sexual relationships compared with a monogamous relationship were five times more likely to use the female condom, while women with high school education were three times more likely to use the female condom; prevalence odds ratio, POR=5.32, 95% CI=1.79–15.83 and POR=3.01, 95% CI=1.01–8.93. Women who were not knowledgeable of the female condom, compared to those who were, were 81% less likely to use the female condom, POR=0.19, 95% CI=0.08–0.45. Among African-American women in this sample, knowledge of female condom use, age, educational status, and multiple sexual relationships were significant markers of female condom use. This study is therefore suggestive of the need to educate African-American women on female condom use, given the obstacles in male condom negotiation, especially among the socio-economically challenged.