Ronan Van Rossem

Reductions in HIV Risk Among Runaway Youth

Runaway youth are 6–12 times more likely to become infected with HIV than other youth. Using a quasi-experimental design, the efficacy of an HIV prevention program was evaluated over 2 years among 2 groups of runaways: (1) those at 2 shelters who received Street Smart, an intensive HIV intervention program, and (2) youth at 2 control shelters. Street Smart provided youth with access to health care and condoms and delivered a 10-session skill-focused prevention program based on social learning theory to youth. Prior to analysis of the interventions outcomes, propensity scores were used to identify comparable subgroups of youth in the intervention (n = 101) and control conditions (n = 86). Compared to females in the control condition, females in the intervention condition significantly reduced their unprotected sexual acts at 2 years and alcohol use, marijuana use, and the number of drugs used over 12 months. Male adolescents in the intervention condition showed significant reductions in marijuana use over 6 months compared to control youth. Adolescent HIV prevention programs must proactively identify mechanisms for maintaining behavior change over the long-term, and innovative research designs are needed to allow examination of agency-level interventions.

Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials

Objective:Systematically assess the effectiveness of HIV-prevention interventions in changing sexual behaviour of young people (10–25 years) in sub-Saharan Africa. Methods:Three online databases were searched using prespecified terms. Additional articles were identified on websites of international organizations and by searching bibliographies. Randomized and nonrandomized trials of interventions aiming to reduce risk behaviour were included as well as single-arm studies reporting effects of differential exposure to an intervention. Data were extracted independently in duplicate using predefined data fields. Results:Thirty-one studies on 28 interventions met the inclusion criteria, including 11 randomized trials. Difficulties with implementing planned activities were reportedly common and differential exposure to intervention was high. Two hundred and seventeen outcome measures were extracted: 88 early (within 1 year of intervention) and 129 late outcomes (more than 1 year after the end of the intervention). Sex education and condom promotion among youth did not increase sexual behaviour as well as risky sexual behaviour. No positive effects on sexual behaviour were detected either and condom use at last sex only increased among males [relative risk = 1.46; 95% confidence interval = 1.31–1.64]. One study reported a reduction of herpes simplex virus-2, but not HIV incidence. Conclusion:There remains a stark mismatch between the HIV burden in youth and the number of attempts to design and test prevention interventions – only two trials report biological outcomes. More effective interventions targeting youth are needed. Attention should go to studying implementation difficulties, sex differences in responses to interventions, determinants of exposure to interventions and perhaps inclusion of other factors apart from HIV/AIDS which influence sexual behaviour.

Relation of cranial ultrasound abnormalities in low-birthweight infants to motor or cognitive performance at ages 2, 6, and 9 years.

This study sought to determine whether neonatal cranial ultrasound abnormalities are related to motor and cognitive outcomes in low‐birthweight (LBW, <2000g) children without major motor or cognitive disability. The relation of neonatal cranial ultrasound abnormalities to motor performance and general cognitive ability at ages 2, 6, and 9 years was examined in a prospectively followed regional cohort of LBW children, excluding those with major disability, and controlling for other risk factors. Compared with children without ultrasound abnormalities, children with abnormalities indicative of ischemic white‐matter injury had poorer motor performance at all three ages and, at age 2, lower general cognitive ability. The latter finding was not seen when motor performance was also controlled for. It was concluded that in LBW children without major motor or cognitive disability, ischemic white‐matter injury indicated by neonatal cranial ultrasound abnormalities adversely affected motor performance at ages 2, 6, and 9 years, but not general cognitive ability.

Effects of Acculturation and Psychopathology on Sexual Behavior and Substance Use of Suicidal Hispanic Adolescents

Two theoretical constructs of acculturation (high vs. low and biculturalism) were compared across adolescent risk behaviors among a seldom-studied group of Hispanic adolescents, 70% of whom were from the Dominican Republic. The sample consisted of 116 consecutively referred suicidal adolescentfemales who were assessed on diagnostic, acculturative, and risk behavior instruments. Hierarchical regressions were carried out separately for sexual behavior and substance use. Biculturalism (OR = 1.18, p < .01) and substance use (OR = 1.47, p <.01) were uniquely associated with sexual intercourse. High acculturation (R2 = .37, p <.001) and psychopathology as a block (R2 = .12, p <.01) were associated with greater use of substances (cigarettes, alcohol, and marijuana). Results suggest that acculturative status is an important indicator of high-risk activity and may vary across behavioral contexts. This is the first known report of an association between biculturalism and sexual behavior in Hispanic adolescent girls.

The reach and impact of social marketing and reproductive health communication campaigns in Zambia

Beginning in 2004 the Implementing AIDS Preventions and Care (IMPACT) Project provided the Bolivian government with invaluable assistance in its efforts to prevent the spread of HIV/AIDS. Managed by Family Health International (FHI) IMPACT strengthened the capacity of the Bolivian government and nongovernmental organizations (NGOs) to develop policies systems and practices aimed at preventing the spread of the epidemic. Early achievements of the IMPACT/Bolivia project include the successful development and production of a wide range of HIV/AIDS-related policies manuals and materials. The most far-reaching of these was the national HIV/AIDS strategic plan. Technical assistance from the IMPACT project enabled the Ministry of Health (MOH) to develop and finalize the plan. Technical assistance (TA) was also provided to the MOH to develop information education and communication (IEC) materials. Later achievements of the IMPACT/Bolivia project improved upon the countrys voluntary counseling and testing (VCT) services. Technical assistance provided by IMPACT/Bolivia was instrumental in the production of a VCT counselors manual that was widely disseminated in Bolivia and has been used in conjunction with VCT services since 2005. IMPACT/Bolivia staff also developed and translated tools for conducting a rapid situation assessment of VCT in the country the results of which were used to determine opportunities for improvement in VCT service provision. In response to the assessment IMPACT/Bolivia staff facilitated HIV/AIDS counseling technique courses that improved counselor-patient communication and strengthened attendees technical skills. Responding to a request by USAID IMPACT conducted additional workshops that identified and standardized the requirements for VCT centers and focused on providing a support network for HIV/AIDS counselors. (excerpt)BackgroundLike many sub-Saharan African countries, Zambia is dealing with major health issues, including HIV/AIDS, family planning, and reproductive health. To address reproductive health problems and the HIV/AIDS epidemic in Zambia, several social marketing and health communication programs focusing on reproductive and HIV/AIDS prevention programs are being implemented. This paper describes the reach of these programs and assesses their impact on condom use.MethodsThis paper assesses the reach of selected radio and television programs about family planning and HIV/AIDS and of communications about the socially marketed Maximum condoms in Zambia, as well as their impact on condom use, using data from the 2001–2002 Zambia Demographic and Health Survey. To control for self-selection and endogeneity, we use a two-stage regression model to estimate the effect of program exposure on the behavioural outcomes.ResultsThose who were exposed to radio and television programs about family planning and HIV/AIDS were more likely to have ever used a condom (OR = 1.16 for men and 1.06 for women). Men highly exposed to Maximum condoms social marketing communication were more likely than those with low exposure to the program to have ever used a condom (OR = 1.48), and to have used a condom at their last sexual intercourse (OR = 1.23).ConclusionFindings suggest that the reproductive health and social marketing campaigns in Zambia reached a large portion of the population and had a significant impact on condom use. The results suggest that future reproductive health communication campaigns that invest in radio programming may be more effective than those investing in television programming, and that future campaigns should seek to increase their impact among women, perhaps by focusing on the specific constrains that prevent females from using condoms.

Economic hardship and depression across the life course: the impact of welfare state regimes.

Previous research in the United States suggests that depression related to economic hardship decreases with age. We test whether this pattern can be generalized to other developed nations. Based on data from 23 countries in the European Social Survey (2006–2007), multilevel analyses show that the moderating role of age depends on the socio-political context. While the hardship–depression link is not significantly different across the life course in Nordic and Bismarckian regimes, the hardship–depression link increases with age in Southern and Eastern European countries and decreases with age in strength in Anglo-Saxon welfare states. Our findings suggest that welfare state regimes play a significant role in attenuating, boosting, or even reversing the health effects of social experiences such as economic hardship on aging. Health knowledge gained through research that ignores the socio-political context may be limited in terms of generalization.

Explaining inconsistencies between data on condom use and condom sales

BackgroundSeveral HIV prevention programs use data on condom sales and survey-based data on condom prevalence to monitor progress. However, such indicators are not always consistent. This paper aims to explain these inconsistencies and to assess whether the number of sex acts and the number of condoms used can be estimated from survey data. This would be useful for program managers, as it would enable estimation of the number of condoms needed for different target groups.MethodsWe use data from six Demographic and Health Surveys to estimate the total annual number of sex acts and number of condoms used. Estimates of the number of sex acts are based on self-reported coital frequency, the proportion reporting intercourse the previous day, and survival methods. Estimates of the number of condoms used are based on self-reported frequency of use, the proportion reporting condom use the previous day and in last intercourse. The estimated number of condoms used is then compared with reported data on condom sales and distribution.ResultsAnalysis of data on the annual number of condoms sold and distributed to the trade reveals very erratic patterns, which reflect stock-ups at various levels in the distribution chain. Consequently, condom sales data are a very poor indicator of the level of condom use. Estimates of both the number of sexual acts and the number of condoms used vary enormously based on the estimation method used. For several surveys, the highest estimate of the annual number of condoms used is tenfold that of the lowest estimate.ConclusionsCondom sales to the trade are a poor indicator of levels of condom use, and are therefore insufficient to monitor HIV prevention programs. While survey data on condom prevalence allow more detailed monitoring, converting such data to an estimated number of sex acts and condoms used is not straightforward. The estimation methods yield widely different results, and it is impossible to determine which method is most accurate. Until the reliability of these various estimation methods can be established, estimating the annual number of condoms used from survey data will not be feasible. Collecting survey data on the number of sex acts and the number of condoms used in a fixed time period may enable the calculation of more reliable estimates of the number of sex acts and condoms used.

Depression in Europe: does migrant integration have mental health payoffs? A cross-national comparison of 20 European countries

Objectives. Depression is a leading cause of ill health and disability. As migrants form an increasing group in Europe, already making up about 8.7% of the population in 2010, knowledge on migrant-related inequalities in depression is of main public health interest. In this study, we first assess whether migrants in Europe are at higher risk for depression compared to the native population. Second, we assess whether the association between migration and depression is dependent on different forms of migrant integration. Migrant integration is looked at both from the individual and from the national level. Design. Hierarchical linear regression analyses based on data for 20 countries in the European Social Survey 2006/2007 (N = 37,076 individuals aged 15 or more). Depression is measured using the center for Epidemiologic Depression Scale. We consider migrant integration over time (first- and second-generation migrants, differentiated according to European Union (EU) or non-EU origin), barriers to integration (low educational level, financial difficulties, being out of the labor market, ethnic minority status, discrimination), and the host country environment (national migrant integration policy). Controls are gender, age, partner relationship, social support, and welfare state regime. Results. Natives and second-generation migrants do not differ significantly in their risk profile for depression. First-generation migrants show higher levels of depression, with those born outside of Europe to be the worst off. This higher risk for depression is not attributable to ethnic minority status but is mainly due to experienced barriers to socioeconomic integration and processes of discrimination. A countrys national policy on migrant integration shows not to soften the depressing effect of being a first-generation migrant nor does it have indirect beneficial health effects by reducing barriers to integration. Conclusion. In Europe, first-generation EU and non-EU migrants experience higher levels of depression. Second-generation migrants and natives show similar risk profiles.

Differences in First Graders' School Adjustment: the Role of Classroom Characteristics and Social Structure of the Group

Abstract We examined differences among classes in academic and psychosocial aspects of school adjustment. The sample consisted of 1241 6–7-year-olds in 71 classes from 49 schools. Multilevel analyses showed that 83.5% of the variance was at the child level, 10.3% at the class level, and 6.2% at the school level. Thus, for the part of the variance that was not at the child level, differences among classes were more important than differences among schools. To identify relevant class factors, we focused on classroom characteristics and aspects of the social structure in the class such as integration and openness. Classroom and teacher variables were relatively unimportant compared to social structure indices that yielded significant correlation indicators of social interaction and intellectual competence and explained part of their variance at the class level. This suggested that the structure of the social relations contributed to differences among classes in several aspects of school adjustment.

Doing worse but knowing better: An exploration of the relationship between HIV/AIDS knowledge and sexual behavior among adolescents in Flemish secondary schools

Most studies on sexual behavior have approached the relationship between AIDS knowledge and sexual behavior unidirectionally. This paper sets out to examine a reciprocal relationship between AIDS knowledge and sexual behavior, in which it is possible that adolescents who enter into sexuality may start to actively seek out information on sex. Additionally, the effects of various sources for AIDS-related information and condom use are analyzed. Data from the Flemish Educational Assessment project, which surveyed a sample of adolescents from the 3rd and 5th years of secondary school, were used. Results indicate that the relationship between AIDS knowledge and sexual behavior is quite complex. On one hand, we find that better knowledge leads to a later onset of sexuality and more consistent condom use; on the other hand, we find that adolescents who start sex earlier and use condoms inconsistently tend to be more knowledgeable about AIDS.