Re-Evaluating the Costs of Teenage Childbearing, 1988-1991

Investigators: Saul D. Hoffman, E. Michael Foster, and Frank F. Furstenberg, Jr.

In 1991 two researchers, A. T. Geronimus and S. Korenman, startled many researchers and policymakers with findings that early childbearing was not as devastating to the socioeconomic lives of teen mothers as was long perceived. By using "fixed-effects methodology" and comparing socioeconomic outcomes for sisters who had first births at different ages (with data from the 1982 National Longitudinal Survey of Young Women), Geronimus and Korenman concluded that teenage childbearing has little socioeconomic consequences and that the negative effects of teenage childbearing primarily reflect unmeasured family background rather than the true consequences of teen birth. The purpose of this study was to attempt to replicate the above findings using data from the longitudinal survey: the Panel Study of Income Dynamics (PSID). The PSID is a national survey of American families conducted since 1968 by the Institute for Social Research. The 1968-1987 PSID family-individual files provide up to 20 years of annual demographic and socioeconomic information for all individuals in the original sample of approximately 5,000 households. The PSID oversampled poor families, but when weighted to reflect the initial sampling probabilities and subsequent attrition, the data are nationally representative. The statistical technique known as fixed-effects model can be employed to analyze parts of these data. Initially used for analyses of repeated observations over time, this technique accounts for individual-specific effects that are unobserved but fixed across repeated observations. The fixed-effects model frequently has been applied to the analysis of siblings but until recently was not used to analyze the socioeconomic consequences of teenage childbearing.

Reach for Health: A School-Sponsored Community Youth Service Intervention for Middle School Students

Investigators: Lydia O'Donnell, Alexi San Doval, Richard Duran, Deborah Haber, Rebecca Atnafou, Patricia Piessens, & Renee F. Wilson-Simmons, Ann Stueve, Joseph H. Pleck, Norma Johnson, Uda Grant, Helen Murray

The REACH FOR HEALTH COMMUNITY YOUTH SERVICES PROGRAM (RFH-CYS) targets African-American and Hispanic youth living in urban areas. REACH FOR HEALTH combines a classroom teaching component with community service work. The intervention, as implemented, provides opportunities for middle school students to participate in service activities within their communities while simultaneously reducing early and unprotected sexual activity. The intervention was initially delivered in 1994 to two large middle schools in Brooklyn, NY; one school was designated as the intervention school, the other as the control. A total of 68 classrooms participated in the initial implementation. In the control school, 33 classrooms (584 students) received the standard New York City health education program, which includes some mandated lessons on drugs and AIDS. Within the intervention school, 22 classrooms (222 students) were randomly assigned to receive core RFH curriculum (classroom component only). The remaining 13 intervention classrooms (255 students) received the enhanced RFH plus Community Youth Services program (RFH-CYS). Bi-lingual and special education classes were included from both school sites. At follow-up six months later, reports of sexual activity were higher across the sample. However, students in the control condition showed greater increases in risk behavior (ever had sex, recent sex, recent sex without condom, recent sex without birth control) than did their peers in the treatment conditions. In contrast, students in both intervention conditions showed increases in their use of STD protection and birth control. Also noteworthy are the findings that eighth graders and special education students showed the greatest improvement. Click here to view more detailed information on this program.

Reaching for Excellence in Adolescent Care and Health, 1996-2000

Investigators: Basic Science and Clinical Science Groups, Adolescent Medicine HIV/AIDS Research Network

The Reaching for Excellence in Adolescent Care and Health (REACH) Project was an observational study designed to better understand HIV disease progression and co-morbidity in adolescents, with the ultimate goal of improving the health care management of adolescents living with HIV. The study sample includes both HIV infected adolescents and high-risk HIV uninfected adolescents, between the ages of 12 through 18 years, who were recruited from clinics throughout the United States during the late 1990s. The study utilized five primary methods of data collection: 1) direct face-to-face interview, 2) Audio Computer-Assisted Self-Administered Interview (ACASI), 3) medical record abstraction, 4) physical examinations, and 5) laboratory examinations. REACH includes data on 578 adolescents who were observed for an average of one and a half years, providing unique opportunities to study extensive biomedical, behavioral and psychosocial outcomes. Examples of topics covered in this data set include: Antiretroviral and contraceptive drug adherence Health-related quality of life Sexual and drug-related behaviors HIV status disclosure Social support Health care utilization Alcohol and drug treatment Physical examinations Laboratory examinations (e.g., immunologic, virologic, hormonal, cervicography, STI testing) REACH participant data are available as standard and sensitive data files. Standard data files primarily include information collected via subject data collection forms, in addition to the majority of the laboratory results. Sensitive data files include confidential subject information such as urine drug screen results, the Health Behavior Questionnaire, the ACASI, and derived variables for such data. Separate ID numbers for the standard and sensitive data files were assigned and data from these files cannot be linked without access to the linkage file decoding data or the acquisition of the merged sensitive dataset files from Sociometrics. Additionally, biologic specimens collected by the study are available for analysis. Investigators who are interested in utilizing REACH sensitive data files and/or specimens are required to submit a research proposal and IRB correspondence to Sociometrics that approves the proposal with no concerns about identifiable information or conflicts with the data.

Real Men Are Safe (REMAS)

Investigators: Donald A. Calsyn, PhD, Mary Hatch-Maillette, PhD, Susan Tross, PhD, Suzanne R. Doyle, PhD, Yong S. Song, PhD, Judy M. Harrer, PhD, Genise Lalos, MA, Sara B. Berns, PhD

REMAS is a group-level, clinic-based behavioral intervention designed to reduce HIV/STI risk among male substance abuse treatment center attendees. More specifically, the program aims to reduce the number of times that men engage in unprotected vaginal and anal sexual intercourse, or have sex while under the influence of drugs or alcohol. Two trained male health counselors teach participants information, help participants develop risk-reduction skills, and motivate behavior change through group discussion, role-play, and condom use skill training. REMAS is comprised of five 90-minute sessions where participants learn about HIV risky-behaviors, HIV prevention planning, and methods for communicating about safer sex and discussing sex without drugs. Click here to view more detailed information on this program.

Rehabilitation Services Administration-Social Security Administration Data Link, 1988

Investigators: Rehabilitation Services Administration, Social Security Administration

The State-Federal Program of Vocational Rehabilitation provides individualized vocational rehabilitation services to persons with disabilities to help them attain, maintain, or regain employment. In the course of providing these services, State Rehabilitation Agencies maintain case records on all of the individuals requesting services under the Rehabilitation Act of 1973 as amended. In an effort to improve program evaluation through the exchange of statistical information, the Department of Education's Rehabilitation Services Administration (RSA) and the Social Security Administration (SSA) have established a Data Link. The continuing exchange of RSA-SSA Data was established in law with Section 141 of the Rehabilitation Act Amendments of 1992. The merging of records of these two agencies has advanced the understanding of the rehabilitation experience of disabled persons by providing their employment, earnings, and beneficiary history following the receipt of services through the State-Federal Program of Vocational Rehabilitation. The RSA-SSA Data Link allows researchers to examine key issues regarding rehabilitation, including whether or not rehabilitated persons remain employed and for how long; the earnings of rehabilitated persons in the years following case closure; how earnings of rehabilitated persons compare to those of persons who could not be rehabilitated or who were not accepted for rehabilitation services; how well severely disabled individuals responded to their rehabilitation experience compared to their non-severely disabled counterparts; how frequently rehabilitated persons become publicly supported; whether or not rehabilitated persons are less likely to require public support than individuals who could not be rehabilitated or were not accepted for rehabilitation services; and the work histories of disabled persons in the years prior to their rehabilitative experience.

Reproductive Health Counseling for Young Men

Investigators: Ross Danielson, Anne Plunkett, Shirley Marcy, William Wiest, & Merwin Greenlick

Originally developed for boys between 15 and 18 years of age, this is a one-hour, single-session, clinic-based intervention. The program is designed to meet the needs of sexually active and inactive teens, and to promote abstinence as well as contraception. The session begins with a video presentation that is viewed privately by each teen. The materials address reproductive anatomy, fertility, hernia, testicular self-examination, STDs (including HIV/AIDS), contraception (including abstinence), communication skills, and access to health services. A half-hour private consultation with a health care practitioner follows the presentation. Guided by the young men's interests, the consultation may include such topics as sexuality, fertility goals, and reproductive health risks, along with rehearsal and modeling of sexual communication. A field study of the intervention was conducted with 1,195 high school-aged males visiting health maintenance organizations in two Northwestern cities. Compared to a control group of their peers, sexually active program participants were significantly more likely to use effective contraception at the one-year follow-up assessment, especially if they were not yet sexually active at the time of the intervention. Sexually active female partners of program participants were also more likely to use effective contraception at the follow-up. Click here to view more detailed information on this program.

Rikers Health Advocacy Program (RHAP)

Investigators: Stephen Magura, Janet Shapiro, & Sung-Yeon Kang

This program, originally developed for use with incarcerated male adolescent drug users between 16 and 18 years of age, consists of four one hour small group sessions focusing on health education issues, particularly HIV/AIDS. Adapting techniques of Problem Solving Therapy, the facilitator guides eight-person groups in discussing the following topics: general health, HIV and AIDS, drug abuse and its consequences, sexual behavior, health and AIDS-risk behaviors, and strategies for seeking health and social services. Active learning is emphasized, with opportunities for youths to define high-risk attitudes and behaviors, suggest alternative actions, and engage in role play and rehearsal activities. A field study of the curriculum compared the attitudes and behaviors of RHAP participants with those of a control group of teens, selected from a waiting list for the program. Both samples were predominantly African-American and Hispanic. Following the intervention, program participants were more likely to use condoms during intercourse, compared to the comparison group of teens. RHAP is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

SMART Couples

Investigators: Robert Remien, PhD, Michael Stirratt, PhD, Joanna Dognin, PsyD, Emily May, MA, Curtis Dolezal, PhD, Alex Carballo-Dieguez, PhD, Nabila El Bassel, DSW, Tiffany Jung, NP, Patricia Warne, PhD, & Glenn Wagner, PhD

SMART COUPLES is a four-session intervention delivered by a nurse practitioner to serodiscordant (mixed HIV status) couples. The program aims to increase antiretroviral therapy (ART) adherence in the partner living with HIV/AIDS by increasing knowledge about the importance of medical care adherence, increasing adherence motivation and self-monitoring, increasing problem solving skills to overcome adherence issues, increasing self-efficacy, and optimizing partner support. In addition, the program was designed to foster active support between partners and help couples address issues of sex, intimacy, and transmission risk behaviors. During four 45- to 60-minute sessions, the couples engage in structured discussion and instruction, as well as specific problem-solving and couple-communication exercises. The nurse practitioner helps participants learn the different components of medical care adherence, and how a partner can help prompt adherence. Participants are also given an opportunity to discuss barriers to adherence, and how to communicate with their partners about different health care concerns including sexual risk taking. Finally, couples determine what their .triggers. are for poor medication adherence, and how to avoid these triggers in the future. Click here to view more detailed information on this program.

Safer Sex Efficacy Workshop

Investigators: Karen Basen-Engquist

This single session, three-hour workshop is designed to increase college students' self-efficacy, or belief in their own ability to act successfully to prevent HIV/AIDS and other sexually transmitted diseases. Drawing upon social learning theory, the program includes numerous role-play and skill-building exercises, and is led by peer educators who are trained to serve as persuasive models. To give students the knowledge necessary to practice preventive behaviors, the leaders begin by facilitating a group discussion about HIV/AIDS and STDs, including transmission and prevention. During the next section, participants discuss personal experiences of and feelings about AIDS and other STDs. Finally, the students role play safe-sex discussions and learn about correct condom use, gaining confidence in their abilities in the process. A field study of the workshop was conducted with 209 undergraduate students enrolled in a health education class at the University of Texas. Compared to comparison groups of their peers, program participants showed significant increases in self-efficacy at the two month follow-up assessment. Sexually active students also showed an increase in their frequency of condom use. Click here to view more detailed information on this program.

Safety Counts: A Cognitive-Behavioral Intervention to Reduce HIV/Hepatitis Risks among Drug Users Who Are Not in Drug Treatment

Investigators: Michele Wood, Jonny Andía, Gricel Arredondo, Nan Corby, Jason Farrell, Camilla Harshbarger, Gary MacDonald, Sharon Novey, Kevin O’Connor, Fen Rhodes, Paul Simons, James Testaverde, & the Centers for Disease Control and Prevention (CDC)

The Safety Counts program is a proven intervention for out-of-treatment drug-using persons that will enable them to reduce their risk of becoming infected with or transmitting the human immunodeficiency virus (HIV) and hepatitis viruses such as hepatitis C. The Safety Counts intervention is appropriate for HIV-positive as well as HIV-negative drug users. Safety Counts is based on research that found this intervention to be effective in reducing high-risk sex and drug-use behaviors among both injection and noninjection drug users. As such, it is recommended for implementation by community-based organizations (CBOs) serving drug users. Through structured group and individual activities, the intervention assists clients in setting personal risk reduction goals and developing specific steps for achieving them. In partnership with behavioral counselors and outreach workers, clients design and manage their personalized goals for reducing their risks of acquiring or transmitting HIV and viral hepatitis. Ongoing support for achieving risk reduction goals is provided through sustained contact with program staff, interactions with peers who are enrolled in the program, and exposure to the personal stories of other drug users in the local community who have been successful in reducing their own risks. Clients participate in the intervention for a period of 4 months. This client-centered intervention benefits the client and the community. The research showed that the intervention reduced HIV risks by reducing drug use, increasing condom use, and increasing self-reported entry into drug treatment. Clients benefit from the strong outreach component of Safety Counts and from referrals to medical and social services. For HIV-positive clients, Safety Counts may allow them to deal with issues beyond substance use and HIV, such as addressing risk behaviors that can lead to contracting hepatitis and other infections. All clients learn how to make positive changes in their lives through setting specific goals and developing action steps to achieve their goals. These skills empower clients to take charge of their own risk behaviors, thereby benefiting themselves, their partners, their families, and their communities.