Tatiana Perrino

The Role of Families in Adolescent HIV Prevention: A Review

Recent research has highlighted the significant contribution families make in the prevention of HIV risk behaviors among adolescents. As the most proximal and fundamental social system influencing child development, families provide many of the factors that protect adolescents from engaging in sexual risk behaviors. Among these are positive family relations, effective communication about sexuality and safer sexual behaviors, enhancement and support of academic functioning, and monitoring of peer activities. HIV risk behaviors occur in a social context, and it is becoming clear that the earliest and most effective way to intervene is in the context where one initially learns about relationships and behavior—the family. Both the Centers for Disease Control and Prevention and the National Institute for Mental Health have taken steps to support and emphasize research that will further elucidate our understanding of the role of families in HIV prevention. This article uses Ecodevelopmental Theory to guide and organize the findings of this promising research area. Within this context, and with special attention to the comorbidity of adolescent problem behaviors, this article reviews empirical research on the role of families in HIV prevention, discusses current intervention efforts that involve families and ecosystems, and addresses prospects and implications for future research and interventions.

Initial Engagement in Parent-Centered Preventive Interventions: A Family Systems Perspective.

This article examines factors predicting participant engagement in a parent-centered, substance abuse preventive intervention. One hundred forty-three families assigned to the experimental condition were identified as either “initially engaged” (having attended at least one of the first three sessions) or “not initially engaged.” The groups were compared on demographics, family need for the intervention, barriers to participation, and family systems level variables. Results from hierarchical logistic regression analyses indicate that caregiver need for the intervention and family systems variables significantly predicted initial engagement in the intervention, while demographic variables, stressful life circumstances, and family stress failed to significantly influence engagement. Family systems variables were the strongest predictors of engagement within the full model. Furthermore, ethnic and racial background significantly moderated the effects of family systems variables on engagement in the intervention. For instance, African American families with low levels of family organization were less likely to be engaged than those with high levels of organization. This effect was not as strong for Hispanic caregivers. Implications for recruitment and engagement strategies are discussed.

High Rates of Club Drug Use and Risky Sexual Practices Among Hispanic Men Who Have Sex with Men in Miami, Florida

This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X2 = 7.4, p = 0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed.

The Internet as recruitment tool for HIV studies: viable strategy for reaching at-risk Hispanic MSM in Miami?

Although use of the Internet as a vehicle for HIV/STI research is increasing, its viability to recruit at-risk populations such as Hispanic men who have sex with men (HMSM) to participate in community-based HIV studies is in its infancy. We report on the first 171 participants enrolled in an ongoing study exploring use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in Miami-Dade County, Florida to participate in community-based studies. We report our initial success with chat-room recruitment and describe the sexual and drug use practices of the initial set of participants who were recruited through the Internet. In addition, we describe the formative work conducted to develop the Internet recruitment procedures we are testing. In two months, we spent 211 hours recruiting in chat-rooms and engaged 735 chatters. One hundred and seventy-six men came to our community sites; 172 (98%) were eligible and completed an audio computer-assisted self-interview. In the previous six months, 94.7% of participants had anal sex; 48.9% did not use condoms for anal sex or used them inconsistently; and 48.5% had used club drugs. Six-month use rates for individual drugs were: poppers (31.6%), cocaine (15.8%), ecstasy (14%) and crystal methamphetamines (11.7%). Use of club drugs was significantly associated with unprotected insertive and unprotected receptive anal sex. These initial findings point to the Internets potential as a tool for recruiting at-risk Hispanic MSM for community studies.

Surfing New Territory: Club-Drug Use and Risky Sex Among Hispanic Men Who Have Sex with Men Recruited on the Internet

The Internet presents unique and growing opportunities for conducting HIV/STD research. This article reports on the first 171 participants enrolled in an ongoing study examining use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in an AIDS epicenter to participate in community-based studies. First, it descibes initial success with chatroom recruitment. Second, it compares the demographic, psychosocial, and sexual risk practices among HMSM recruited through the Internet who had used club drugs in the last 6 months and those who had not. In 2 months, 211 hours were spent recruiting in chatrooms; 735 chatroom users were engaged. Researchers used a scripted dialogue to describe the study and to invite chatroom users to visit the study’s community sites for screening and enrollment. One bundred and seventy-six men came to the community sites; 172 (98%) were eligible and completed an audio-computer assisted self-interview. In the last 6 months, 48.5% of the sample had used club drugs [defined as cocaine, crystal methamphetamines (crystal), amyl nitrites (poppers), Ecstasy, gammahydroxybutyrate (GHB), ketamine (Special K), and Viagra]. The proportion of men reporting use of each drug was: cocaine (15.8%), crystal (11.7%), poppers (31.6%), Ecstasy (14%), GHB (3.5%), Special K (3.5%), and Viagra (19.3%). In multivariate analyses, having higher number of sex partners, having higher social isolation scores, and having engaged in unprotected receptive anal intercourse were significantly associated with club-drug use. These initial findings suggest that high-risk HMSM can be successfully recruited through chatroom dialogues to participate in community-based HIV studies. The alarmingly high rates of club-drug use and risky sexual practices among HMSM underscore the need for effective HIV preventive interventions for this population.

Methods for Synthesizing Findings on Moderation Effects Across Multiple Randomized Trials

This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

Advancing Science Through Collaborative Data Sharing and Synthesis

The demand for researchers to share their data has increased dramatically in recent years. There is a need to replicate and confirm scientific findings to bolster confidence in many research areas. Data sharing also serves the critical function of allowing synthesis of findings across trials. As innovative statistical methods have helped resolve barriers to synthesis analyses, data sharing and synthesis can help answer research questions that cannot be answered by individual trials alone. However, the sharing of data among researchers remains challenging and infrequent. This article aims to (a) increase support for data sharing and synthesis collaborations among researchers to advance scientific knowledge and (b) provide a model for establishing these collaborations using the example of the ongoing National Institute of Mental Health’s Collaborative Data Synthesis on Adolescent Depression Trials. This study brings together datasets from existing prevention and treatment trials in adolescent depression, as well as researchers and stakeholders, to answer questions about “for whom interventions work” and “by what pathways interventions have their effects.” This is critical to improving interventions, including increasing knowledge about intervention efficacy among minority populations, or what we call “scientific equity.” The collaborative model described is relevant to fields with research questions that can only be addressed by synthesizing individual-level data.

Preventing Internalizing Symptoms Among Hispanic Adolescents: A Synthesis Across Familias Unidas Trials

Studies document that there are efficacious interventions to prevent adolescent depression and internalizing symptoms, including several family-focused interventions. Questions remain about for whom interventions work (moderation) and by what mechanisms they work (mediation) to prevent internalizing symptoms. Unfortunately, single trials are often underpowered to address moderation and mediation, an issue addressed in this paper. This synthesis study combined individual-level, longitudinal data from 721 adolescents across 3 randomized clinical trials of Familias Unidas, a family-focused prevention intervention for Hispanic youth. Using integrative data analysis (IDA) methods applied to trials, the study examined intervention moderation and mediation effects on internalizing symptoms. Baseline internalizing symptoms were a significant moderator of the intervention’s effects on internalizing symptoms, while baseline externalizing symptoms did not moderate intervention effects. Baseline parent–adolescent communication, a modifiable risk factor and hypothesized mechanism by which the intervention works, significantly moderated the intervention’s effects. Specifically, the intervention was more efficacious in its impact on internalizing symptoms for youth with lower initial levels of parent–adolescent communication compared to those with higher communication levels. Moderated mediation analyses showed that parent–adolescent communication changes mediated the intervention’s effects on internalizing symptoms, with stronger effects for those with poorer baseline communication. Results suggest a potential benefit of identifying youth risks prior to interventions, and targeting specific modifiable mediators that lead to reductions of internalizing problems of adolescents. Findings also highlight advantages of utilizing data from combined trials and IDA for examining intervention moderators and mediators.

Built environment and physical functioning in Hispanic elders: the role of "eyes on the street".

Background Research on neighborhood effects increasingly includes the influences of the built environment on health and social well-being. Objectives In this population-based study in a low-socioeconomic-status (SES), Hispanic neighborhood, we examined whether architectural features of the built environment theorized to promote direct observations and interactions (e.g., porches, stoops) predicted Hispanic elders’ social support and psychological and physical functioning. Methods We coded built-environment features for all 3,857 lots in the 403-block area of an urban Miami, Florida, community. We then conducted three annual assessments of social support, psychological distress, and physical functioning in a population-based sample of 273 low-SES Hispanic elders (70–100 years of age). We used structural equation modeling analytic techniques to examine hypothesized relationships between the built environment and elders’ social support, psychological distress, and physical functioning over a 3-year period. Results After controlling for age, sex, and income, architectural features of the built environment theorized to facilitate visual and social contact had a significant direct relationship with elders’ physical functioning as measured 3 years later, and an indirect relationship through social support and psychological distress. Further binomial regression analyses suggested that elders living on blocks marked by low levels of positive front entrance features were 2.7 times as likely to have subsequent poor levels of physical functioning, compared with elders living on blocks with a greater number of positive front entrance features [b = 0.99; χ2 (1 df) = 3.71; p = 0.05; 95% confidence interval, 1.0–7.3]. Conclusions Architectural features that facilitate visual and social contacts may be a protective factor for elders’ physical functioning.

Promoting HIV Testing Among Never-Tested Hispanic Men: A Doctor's Recommendation May Suffice

This study examined factors associated with HIV testing intentions among a community sample of 255 never-tested Hispanic men. It compared (1) men who intended to test in the next 6 months with those who did not and (2) men who intended to test only on the day of the interview with those who intended to test in the next 6 months. Eighty-four percent of men had never been offered testing. Yet, 86% would accept testing if recommended by their doctor. The strongest multivariate predictor of testing intention was willingness to accept a physician-endorsed test. Almost 49% of men who intended to test in the next 6 months would only do so if the test were offered on the interview day. These findings highlight the importance of encouraging physicians, particularly in high-prevalence areas, to routinely recommend testing. They also suggest that for some men, there is a window of opportunity for testing that does not endure.