Scott Clair

Toward Dissemination of Evidence-Based Family Interventions: Maintenance of Community-Based Partnership Recruitment Results and Associated Factors

A major challenge in the dissemination of evidence-based family interventions (EBFIs) designed to reduce youth substance use and other problem behaviors is effective and sustainable community-based recruitment. This understudied topic is addressed by a preliminary study of 14 community-university partnership teams randomly assigned to an intervention condition in which teams attempted sustained implementation of EBFIs with two cohorts of middle school families. This report describes attendance rates of recruited families maintained over time and across both cohorts, along with exploratory analyses of factors associated with those rates. When compared with community-based recruitment rates in the literature, particularly for multisession interventions, relatively high rates were observed; they averaged 17% across cohorts. Community team functioning (e.g., production of quality team promotional materials) and technical assistance (TA) variables (e.g., effective collaboration with TA, frequency of TA requests) were associated with higher recruitment rates, even after controlling for community and school district contextual influences. Results support the community-university partnership model for recruitment that was implemented in the study.

Preventing Substance Misuse Through Community-University Partnerships Randomized Controlled Trial Outcomes 4½ Years Past Baseline

BACKGROUND Substance misuse by adolescents and related health issues constitute a major public health problem. Community-based partnership models designed for sustained, quality implementation of proven preventive interventions have been recommended to address this problem. There is very limited longitudinal study of such models. PURPOSE To examine the long-term findings from an RCT of a community-university partnership model designed to prevent substance misuse and related problems. DESIGN/SETTING/PARTICIPANTS A cohort sequential design included 28 public school districts in rural towns and small cities in Iowa and Pennsylvania that were randomly assigned to community-university partnership or usual-programming conditions. At baseline, 11,960 students participated, across two consecutive cohorts. Data were collected from 2002 to 2008. INTERVENTION Partnerships supported community teams that implemented universal, evidence-based interventions selected from a menu. The selected family-focused intervention was implemented with 6th-grade students and their families; school-based interventions were implemented during the 7th grade. Observations demonstrated intervention implementation fidelity. MAIN OUTCOME MEASURES Outcome measures were lifetime, past-month, and past-year use of a range of substances, as well as indices of gateway and illicit substance use; they were administered at baseline and follow-ups, extending to 4.5 years later. RESULTS Intent-to-treat, multilevel ANCOVAs of point-in-time use at 4.5 years past baseline were conducted, with supplemental analyses of growth in use. Data were analyzed in 2009. Results showed significantly lower substance use in the intervention group for 12 of 15 point-in-time outcomes, with relative reductions of up to 51.8%. Growth trajectory analyses showed significantly slower growth in the intervention group for 14 of 15 outcomes. CONCLUSIONS Partnership-based implementation of brief universal interventions has potential for public health impact by reducing growth in substance use among youth; a multistate network of partnerships is being developed. Notably, the tested model is suitable for other types of preventive interventions.

High Risk Drug Use Sites, Meaning and Practice: Implications for AidS Prevention

A study of drug use locations in Hartford, CT, Is designed to understand the environmental and social conditions within “high risk sites” where drug users inject drugs or smoke crack, In order to develop AIDS prevention models that build upon the physical and social organization of these locations. The study assesses high-risk sites characterized on the basis of type of location or structure, presence and strength of gatekeepers, and presence and strength of HIV prevention opportunities and pressures. A combination of ethnographic, epidemiological, and social network methods are used to document the characteristics, social organization, natural history, and dynamics of these sites, the network relations of site users, and the various opportunities for, or barriers to, on-site social-level HIV prevention intervention. This paper provides an overview of the study and presents preliminary findings, Including the degree to which drug injectors and crack smokers use specific types of sites in Hartford. The paper also discusses the ways these findings Inform development of on-site, type-specific and peer-led or structural HIV-prevention Interventions.

The Risk Avoidance Partnership: Training Active Drug Users as Peer Health Advocates:

Efforts have expanded to create AIDS prevention programs for drug users that consider the social context and interpersonal relationships within which risky practices take place. The Risk Avoidance Partnership (RAP) project is designed to train active drug users as peer/public health advocates (PHAs) to bring a structured, peer-led intervention into the sites where they and their drug-using social networks use illicit drugs. The RAP peer health advocacy training curriculum and peer-led intervention promote harm reduction among drug users and support drug-user organization to reduce infectious disease and other harm in the context of injection drug use, crack cocaine use, and sexual activity. Initial findings suggest that RAP PHAs perceive a significant positive role change in themselves while conducting health advocacy work and willingly and successfully carry the peer-led intervention into locations of high-risk drug activity to deliver it to their peers even in the absence of project staff support.

Influence of Interpersonal Violence and Community Chaos on Stress Reactions in Children

This study evaluated the separate and additive contributions of direct violent victimization, witnessed violence, and community chaos to childrens posttraumatic stress reactions and behavior problems. Participants were 181 African American youths residing in low-income urban communities. Regression analyses revealed direct victimization to be most predictive of behavior problems and community chaos most predictive of posttraumatic stress reactions in children. Path models established community chaos as a mediator of the relation between witnessed violence and posttraumatic stress reactions and the relation between witnessed violence and behavior problems. Community chaos did not mediate the relation between direct victimization and posttraumatic stress reactions or behavior problems; however, a significant direct contribution of violent victimization to behavior problems was established. Findings support the emphasis placed on community chaos and instability in exacerbating stress reactions in the presence of interpersonal violence. Findings are discussed in terms of risk minimization and distress management.

A Social Network Approach to Demonstrate the Diffusion and Change Process of Intervention From Peer Health Advocates to the Drug Using Community

Project RAP (Risk Avoidance Partnership) trained 112 active drug users to become peer health advocates (PHAs). Six months after baseline survey (Nbl = 522), 91.6% of PHAs and 56.6% of community drug users adopted the RAP innovation of giving peer intervention, and 59.5% of all participants (N6m = 367) were exposed to RAP innovation. Sociometric network analysis shows that adoption of and exposure to RAP innovation was associated with proximity to a PHA or a highly active interventionist (HAI), being directly linked to multiple PHAs/HAIs, and being located in a network sector where multiple PHAs/HAIs were clustered. RAP innovation has diffused into the Hartford drug-using community.

Unintended consequences of using an oral HIV test on HIV knowledge

This study assessed the effects of oral HIV testing on the belief that HIV can be transmitted in saliva and on overall AIDS knowledge. A sample of current or former street drug users (N=155) was recruited to complete a survey of HIV risk behaviour at two points in time. The survey included three items that assessed beliefs in the possible transmission of HIV through saliva. Among the 80 participants who received oral HIV testing at baseline, accuracy on the three saliva items decreased at follow-up and, among the 75 participants who did not receive oral HIV testing, accuracy on these items increased at follow-up. This pattern of change was statistically significant. Oral HIV testing has been a significant advance. However, unintended effects may include increased belief in the transmission of HIV through saliva. This problematic outcome suggests the importance of enhanced HIV counselling among participants in oral HIV testing.

Dust in the Wind: The Growing Use of Embalming Fluid Among Youth in Hartford, CT

This study suggests that use of embalming fluid as a mind-altering drug has been underreported. Based on a social network recruitment strategy, findings from a study in 2000 of 401 outreach worker-recruited polydrug-involved youth (ages 16–24 years) from the inner city of Hartford, CT indicate widespread (over 80% of study participants had used the drug at least once) and regular use of embalming fluid mixed with either marijuana or mint. This paper reports findings on frequency and distribution of use, experience, and consequences of use, access to the drug, and characteristics of embalming fluid users. Given the toxic substances that comprise embalming fluid, and the tendency, affirmed in the present study, of the drug to be associated with violent behavior, there is a need to recognize embalming fluid as a drug of concern among youth.

Doubts Remain, Risks Persist: HIV Prevention Knowledge and HIV Testing Among Drug Users in Rio de Janeiro, Brazil

Brazil has been recognized for being the first developing country to provide universal AIDS treatment. Brazil also implemented a comprehensive prevention initiative. These efforts have been successful, with about half the number of HIV/AIDS cases forecast in 1992 developing by 2000. However, HIV/AIDS continues to spread, including among not-in-treatment drug users. Questions have been raised about gaps in existing prevention efforts. Based on qualitative research in 2006–2008 with street drug users in Rio de Janeiro (focus groups, N = 24; a pile sort, N = 108; open-ended interviews, N = 34), this paper examines enduring gaps in HIV knowledge and prevailing risk patterns and proposes strategies for strengthening prevention.