Sarah J. Schmiege

Social Media-Delivered Sexual Health Intervention A Cluster Randomized Controlled Trial

BACKGROUND Youth are using social media regularly and represent a group facing substantial risk for sexually transmitted infection (STI). Although there is evidence that the Internet can be used effectively in supporting healthy sexual behavior, this has not yet extended to social networking sites. PURPOSE To determine whether STI prevention messages delivered via Facebook are efficacious in preventing increases in sexual risk behavior at 2 and 6 months. DESIGN Cluster RCT, October 2010-May 2011. SETTING/PARTICIPANTS Individuals (seeds) recruited in multiple settings (online, via newspaper ads and face-to-face) were asked to recruit three friends, who in turn recruited additional friends, extending three waves from the seed. Seeds and waves of friends were considered networks and exposed to either the intervention or control condition. INTERVENTION Exposure to Just/Us, a Facebook page developed with youth input, or to control content on 18-24 News, a Facebook page with current events for 2 months. MAIN OUTCOME MEASURES Condom use at last sex and proportion of sex acts protected by condoms. Repeated measures of nested data were used to model main effects of exposure to Just/Us and time by treatment interaction. RESULTS A total of 1578 participants enrolled, with 14% Latino and 35% African-American; 75% of participants completed at least one study follow-up. Time by treatment effects were observed at 2 months for condom use (intervention 68% vs control 56%, p=0.04) and proportion of sex acts protected by condoms (intervention 63% vs control 57%, p=0.03) where intervention participation reduced the tendency for condom use to decrease over time. No effects were seen at 6 months. CONCLUSIONS Social networking sites may be venues for efficacious health education interventions. More work is needed to understand what elements of social media are compelling, how network membership influences effects, and whether linking social media to clinical and social services can be beneficial. TRIAL REGISTRATION This study is registered at www.clinicaltrials.govNCT00725959.

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.

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.

Marijuana use and risky sexual behavior among high-risk adolescents: trajectories, risk factors, and event-level relationships

Adolescents involved with the juvenile justice system have a high incidence of risky sexual behaviors resulting in unintended pregnancy and sexually transmitted infections. Substance use may be particularly important as a risk factor for unsafe sexual behavior for this group, and recent evidence suggests a possible association between marijuana use and risky sexual behavior. Adolescents (n = 728; 33% female) on probation were followed for 2 years, at intervals of 6 months, to explore the association of marijuana use and condom use longitudinally and at a specific intercourse occasion. Latent growth curve modeling indicated that greater marijuana use at baseline was associated with a steeper decline in condom use over the 2-year period of the study. In-depth analysis of the most recent intercourse occasion suggested that condom use was less likely if marijuana was being used by the participant or his/her partner and that this association was more pronounced if intercourse occurred with someone the participant had just met. Implications for the prevention of risky sexual behavior in this population are discussed.

Adherence to Cognitive Behavioral Therapy for Insomnia (CBTI) Among Women Following Primary Breast Cancer Treatment: A Pilot Study

Cognitive behavioral therapy for insomnia (CBTI) has proven efficacy, yet 32%–89% of patients fail to consistently follow recommendations. This pilot study examines adherence to CBTI in breast cancer survivors with insomnia. There was a significant decline in adherence to prescribed rise time, and total time in bed, but no change in adherence to prescribed bedtime during six weekly sessions. Factors associated with higher adherence included lower fatigue and higher baseline motivation. Higher adherence was associated with worse subjective sleep quality at the beginning of CBTI and fewer nocturnal awakenings at the end of treatment. Results provide preliminary evidence supporting the impact of adherence on sleep outcomes such as fewer nocturnal awakenings. Attention to adherence as part of CBTI may yield greater sleep improvements.

Breast cancer and symptom clusters during radiotherapy.

Background: Symptom clusters assessment shifts the clinical focus from a specific symptom to the patient’s experience as a whole. Few studies have examined breast cancer symptom clusters during treatment, and fewer studies have addressed symptom clusters during radiation therapy (RT). The theoretical underpinning of this study is the Symptoms Experience Model. Research is needed to identify antecedents and consequences of cancer-related symptom clusters. Objective: The present study was intended to determine the clustering of symptoms during RT in women with breast cancer and significant correlations among the symptoms, individual characteristics, and mood. Methods: A secondary data analysis from a descriptive correlational study of 93 women at weeks 3 to 7 of RT from centers in the mid-Atlantic region of the United States, Symptom Distress Scale, the subscales of the Positive and Negative Affect Scale, Life Orientation Test, and Self-transcendence Scale were completed. Results: Confirmatory factor analysis revealed symptoms grouped into 3 distinct clusters: pain-insomnia-fatigue, cognitive disturbance-outlook, and gastrointestinal. The pain-insomnia-fatigue and cognitive disturbance-outlook clusters were associated with individual characteristics, optimism, self-transcendence, and positive and negative mood. The gastrointestinal cluster correlated significantly only with positive mood. Conclusions: This study provides insight into symptoms that group together and the relationship of symptom clusters to antecedents and mood. Implications for Practice: These findings underscore the need to define and standardize the measurement of symptom clusters and understand variability in concurrent symptoms. Attention to symptom clusters shifts the clinical focus from a specific symptom to the patient’s experience as a whole and helps identify the most effective interventions.

Actual versus perceived peer sexual risk behavior in online youth social networks

ABSTRACTPerception of peer behaviors is an important predictor of actual risk behaviors among youth. However, we lack understanding of peer influence through social media and of actual and perceived peer behavior concordance. The purpose of this research is to document the relationship between individual perception of and actual peer sexual risk behavior using online social networks. The data are a result of a secondary analysis of baseline self-reported and peer-reported sexual risk behavior from a cluster randomized trial including 1,029 persons from 162 virtual networks. Individuals (seeds) recruited up to three friends who then recruited additional friends, extending three waves from the seed. ANOVA models compared network means of actual participant behavior across categories of perceived behavior. Concordance varied between reported and perceived behavior, with higher concordance between perceived and reported condom use, multiple partners, concurrent partners, sexual pressure, and drug and alcohol use during sex. Individuals significantly over-reported risk and under-reported protective peer behaviors related to sex.

Chronic Starvation Secondary to Anorexia Nervosa Is Associated With an Adaptive Suppression of Resting Energy Expenditure

BACKGROUND Chronic starvation is accompanied by a reduction in resting energy expenditure (REE). It is not clear whether this is due mainly to a reduction in body mass or also involves a significant reduction in the cellular metabolic rate of the fat-free mass (FFM). OBJECTIVES The main goal was to compare measured REE (REEm) with REE predicted by dual-energy X-ray absorptiometry modeling of organ-tissue mass (REEp) in malnourished patients with severe anorexia nervosa (AN) and in healthy lean control subjects. REE adjusted for FFM and fat mass was also compared between the groups. DESIGN This was a cross-sectional study of 30 patients with AN and 25 lean control subjects. REE was measured by indirect calorimetry. Body composition was modeled using dual-energy X-ray absorptiometry, and REE was predicted for each group based on organ-tissue mass. RESULTS REEm was significantly lower than REEp in subjects with AN (854 ± 41 vs 1080 ± 25 kcal/d, P < .001), but not in control subjects. In addition, REE adjusted for both FFM and fat mass was significantly lower in the subjects with AN (1031 ± 37 vs 1178 ± 32 kcal/d, P < .01). Finally, compared with the lean control subjects, both organ and skeletal muscle mass were approximately 20% smaller in subjects with AN. CONCLUSIONS Chronic starvation is accompanied by a significant reduction in the metabolic rate of the FFM. The organs and/or tissues accounting for this are unknown. In addition, this study suggests that protein is mobilized proportionately from organs and skeletal muscle during starvation. This too may be an adaptive response to chronic starvation.

Recruitment and retention of youth for research using social media: Experiences from the Just/Us study

Youth, particularly youth of color, continue to face disparities with regard to sexually transmitted infections (STIs), including HIV. Yet, comprehensive education about sex and sexual risk for STIs is not universal for youth in the United States. While Internet research on HIV prevention has demonstrated that the medium can be as effective as face-to-face education and prevention approaches, Internet-based research has faced challenges in recruitment of diverse samples, has not consistently been able to retain adequate samples, and do so for long-term follow-up. Additionally, we have few examples of research on social networking sites, which are particularly popular with youth and represent locations where they spend the majority of their time online. In this work, we describe efforts to recruit and retain youth on My Space and Facebook for a randomized controlled trial testing the efficacy of using social media for HIV prevention. Findings demonstrate no success in using My Space to recruit for our STI prevention intervention, but success in recruitment of a diverse sample and short-term retention of this sample using Facebook. We recruited 1578 diverse youth aged 16–24 years for the study and retained 69% of them for a two-month follow-up; follow-up dropped to 50% at six months, demonstrating challenges with longer-term retention. This work represents innovation in recruitment and retention of individuals and networks using social media.