AIDS Prevention and Health Promotion among Women

Investigators: Stevan Hobfoll, Anita Jackson, Justin Lavin, & James Shepherd

AIDS Prevention and Health Promotion among Women is designed to assist participants between 16 and 29 years of age in developing and following a sound sexual health plan. Based on the concepts of empowerment, group social support and culturally sensitive skill building, this program comprises four 1 1/2- to 2-hour small (2-8 participant) group sessions conducted over the course of three months. Video segments promote group discussion, spark group role plays and engage participants in cognitive rehearsal and guided exercises designed to encourage healthy choices about one's body and sexuality. Specifically, this program encourages women to think about the physical and emotional consequences of unsafe sex. It helps them achieve a sense of mastery and positive expectations when discussing sexual history, HIV/AIDS testing, monogamy, spermicide and condom use, and other health-related concerns with their partners. In addition, the program teaches participants how to effectively negotiate safer sex with one's partner and maintain safer sex goals. This program was field tested with pregnant low-income African-American and white women who were using medical center obstetrics services in Akron, Ohio. Compared to control groups, participants showed significant and sustained increases in HIV/AIDS knowledge, safer sex goals, and safer-sex behaviors, including spermicide and condom purchases and use. Click here to view more detailed information on this program.

Area-Level Data on the Impact of Family Planning Program Activity, Assembled by Centers for Disease Control: Blacks, 1980

Investigators: John Anderson & Lisa Cope

Fertility rates in the U.S. declined during the 1970's, both for teenages, 15-19, and all women, 15-44. Since the enactment of the Family Planning Services and Population Research Act in 1970 there have been large increases in both the number of family planning clinics in the U.S. and the number of women who receive their services. The aim of the Act was to give lowincome women access to effective contraception so that they could control their fertility and avoid unplanned births. The purpose of this study was to provide some evidence of the effectiveness of family planning programs in the U.S. as well as examine factors which influence family planning program enrollments. The study used multivariate areal analysis to assess the independent effect of family planning program enrollment in 1978 on the fertility of these groups of women in 1980. Two models were used in the study to assess the relationship between program enrollment rates and fertility rates. The first was a cross-sectional model that examined the relationship in 1980 and addressed the question of whether areas with higher levels of enrollment had lower levels of fertility, other factors being equal. The second model, a lagged-dependent variable model, included the same variables as the cross-sectional model but also controlled for past fertility levels by including 1970 fertility rates as well as the effect of unmeasured factors related to fertility.

Baltimore Multigenerational Family Study: Family Processes of Adolescent and Young Adult Mothers, 1987-1988

Investigators: P. Lindsay Chase-Landsale, Jeanne Brooks-Gunn, and Jennifer L. Matjasko

The Baltimore Multigenerational Family Study: Family Processes of Adolescent and Young Adult Mothers, 1987-1988 is a partial follow-up of the Baltimore Study of Adolescent Mothers begun twenty years ago by Frank Furstenberg and now in its fourth generation. The present study examines 136 African-American teenage mothers, their mothers, and their children in order to understand how family relationships affect the life prospects of the children of teen mothers. Data for this study were gathered by videotape, in-person interview, and psychological assessment. A total of 136 cases were surveyed. Of the 136 total cases, 103 cases contain full interview data; 99 cases contain complete data on all child outcome measures. This data set is comprised of separate data and documentation files for grandmothers (Data Set #M8-M9) and mothers (Data Set #N1-N2). All child outcome measures are included in Data Set #N1-N2. The grandmother's data file contains 1,039 variables; the mother's data file contains 1,210 variables.

Brother to Brother

Investigators: John L. Peterson, Thomas J. Coates, Joseph Catania, Walter W. Hauck, Michael Acree, Dennis Daigle, Bobby Hillard, Lee Middleton, & Norman Hearst

Brother to Brother is a three-session behavioral intervention aimed at reducing HIV infection among African-American gay and bisexual men. Sessions are designed to foster positive identity development, educate participants about HIV/AIDS risk, teach assertiveness, and encourage the sharing of commitments and strategies for risk reduction among group members. Participants gain mastery through role-play, group discussion, and behavioral skills exercises. Click here to view more detailed information on this program.

Community-based Directly Observed Therapy (C-DOT) Program

Investigators: Maribel Muñoz, RN, Karen Finnegan, MPH, Jhon Zeladita, RN, Adolfo Caldas, MSW, Eduardo Sanchez, MD, Miriam Callacna, RN, Christian Rojas, MD, Jorge Arevalo, MD, Jose Luis Sebastian, MD, Cesar Bonilla, MD, Jaime Bayona, MPH, MD, & Sonya Shin, MPH, MD

The C-DOT Program aims to increase adherence of individuals living with HIV beginning highly active antiretroviral therapy (HAART). The program includes 4-day training for DOT workers. After training, DOT workers provide support to participants for a total of 11 months. For eight months DOT workers monitor all HAART doses (and doses of other medications for indications other than HIV) in participants' homes while providing social, emotional, and informational support to participants and their families and reporting missed doses, adverse events, and psychosocial crises to nurses. During the last three months DOT workers visit participants less frequently to prepare the participant for self-administration. Supervisors act as an intermediary between participants and the medical organization, coordinating other aspects of participants. medical care. Nurses supervise C-DOT Program staff and monitor follow-up care of participants. The C-DOT Program was shown to increase adherence, suppress viral load, and be associated with better tuberculosis outcomes. Additionally, the program has been shown to improve stigma, social support, self-efficacy, and health service acquisition. The C-DOT Program was originally implemented throughout the community as DOT workers conducted home visits to participants and monitored medication doses in homes or other community locations. This program may also be applicable to clinic settings and feasible to implement in clinics or hospitals serving individuals living with HIV. Click here to view more detailed information on this program.

Consequences of Prenatal Exposure to Methadone: Chicago, 1978-1984

Investigators: Sydney L. Hans

This longitudinal study assessed the effects of prenatal methadone exposure on a cohort of children who were followed from birth to two years of age. The purpose of the study was to examine teratogenic effects of methadone as well as to determine how other non-teratogenic risk factors might be related to the behavior of drug-exposed children. The study was designed to replicate prior research and clinical observations which identified a variety of behaviors and medical conditions that might appear soon after birth for methadone-exposed infants. These included tremulousness, hypertonicity, irritability, incessant high-pitched crying, sleep disturbances, hyperactive reflexes, frantic but weak sucking, regurgitation, yawning, sneezing, nasal congestion, sweating, fever, and convulsions. These behaviors, termed neonatal narcotics abstinence syndrome, bore a close resemblance to withdrawal symptoms observed in adult narcotics addicts, and their presence during the neonatal period had usually been attributed to generalized hyperirritability of the central nervous system caused by withdrawal from opioid drugs following in utero exposure. However, methadone exposure often co-occurred with other factors such as perinatal complications, which might be affecting the neonatal behaviors assumed to be caused by withdrawal from opioids. The study comprised 42 infants delivered by 36 pregnant opioid-using women between the ages of 18 and 35 who were recruited at prenatal clinics at Chicago Lying-In Hospital between 1978 and 1982. All of the women were involved in low-dose methadone-maintenance programs for the treatment of chronic heroin addiction, and the majority occasionally used other drugs, most commonly alcohol, marijuana, heroin, cocaine, Valium, or Talwin. All of the women were black, came from low-income inner-city neighborhoods, and received good quality prenatal care. Infants' behavior was assessed at one day and at four weeks of age using the Neonatal Behavioral Assessment Scale with Kansas Supplements (NBAS-K). The children were assessed again at 4, 8, 12, 18 and 24 months of age using the Bayley Scales of Infant Development. Children's heights, weights, and head circumferences were measured at each of the assessments. The study assessed a total of 436 variables across 79 cases.

Doing Something Different: Group Counseling at STD Clinics to Promote Condom Use

Investigators: Deborah A. Cohen

Doing Something Different, a single-session, one-hour intervention, was designed for use in an inner-city public health clinic, but is appropriate for use in any community setting that provides education or services to at-risk populations. The intervention is led by a health educator, who presents a video on the social acceptability of condom use, demonstrates proper condom-use techniques, and directs a role-playing session in which participants practice negotiating condom use with sexual partners. Click here to view more detailed information on this program.

Drug User Intervention Trial (DUIT)

Investigators: Richard S. Garfein, PhD, MPH, Steffanie Strathdee, Ph.D, Lawrence Ouellet, PhD, Sharon Hudson, PhD, Mary Latka, PhD, Holly Hagan, PhD, Hanne Thiede, DVM, MPH, Elizabeth Golub, PhD, Marie Bailey-Kloch, Karen Yen-Hobelman, PhD, Susan Bailey, PhD, Joyce Fitzgerald, Peter Kerndt, MD, MPH, Karla Wagner, PhD, David Vlahov, PhD, Farzana Kapadia, PhD, Nadine Snyder, BA, Jennifer V. Campbell, MPH, David Purcell, PhD, JD, Ian Williams, PhD, Paige Ingram, RN, Andrea Swartzendruber, MPH

DUIT is a small-group, clinic-based, behavioral intervention that aims to reduce risky injection and sexual behaviors among injection drug users who are HIV and HCV negative. During six 2-hour sessions, two trained health advisors promote group cohesion and peer education within the DUIT group. The health advisors also encourage behavior change by teaching peer-education tactics, risk-reduction strategies, and safer sex and injection negotiation skills. Ultimately, the DUIT program increases participants. perceived risk of HIV/HCV, their motivation to practice safer injection and sexual behaviors, their knowledge of risky behaviors, and key risk-reduction strategies. Click here to view more detailed information on this program.

FOCUS: Preventing Sexually Transmitted Infections and Unwanted Pregnancies among Young Women

Investigators: Cherrie Boyer, Mary-Ann Shafer, Lance Pollack, Kelli Betsinger, Y. Jason Yang, Julius Schachter, Richard Shaffer, Stephanie Brodine, Heidi Kraft

The FOCUS program, a four-session cognitive-behavioral group intervention addressing prevention of sexually transmitted infections (STIs) and unintended pregnancies, was originally delivered to young women US Marine Corps recruits. Following a baseline survey, 2,157 women were randomized into either the experimental group (n=1,062) or the control group (n=1,095). Both groups received interventions of four two-hour sessions. Follow-up surveys were conducted with both groups at approximately four months post-baseline and approximately 14 months post-baseline. The evaluation results revealed that a higher proportion of the control group had a post-intervention STI or unintended pregnancy than the intervention group (Odds Ratio = 1.41, 95% Confidence Interval = 1.01-1.98). Among study participants who had no pre-intervention history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was significantly more likely to acquire a post-intervention STI than the intervention group (OR = 2.05, CI = 1.74-4.08). Among study participants who reported not being sexually experienced at baseline, control group participants were significantly more likely to have had multiple sexual partners post-intervention than intervention group participants (OR = 1.87, CI = 1.01-3.47). FOCUS 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 been proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

Focus on the Future

Investigators: Richard Crosby, PhD, Ralph J. DiClemente, PhD, Richard Charnigo, PhD, Gregory Snow, Adewale Troutman, MD

FOCUS ON THE FUTURE, a one-to-one, single session intervention, administered by a lay health advisor, is culturally appropriate for use among young (aged 18-29 years) heterosexual African American men newly diagnosed with a sexually transmitted infection (STI). Based on the behavioral skills model, this one hour long program consists of a personalized discussion, presentation of basic STI/HIV/AIDS and safer sex information, and condom use skills practice. For each individual participant, the FOCUS ON THE FUTURE health facilitator initiates a discussion about the disproportionate HIV/AIDS burden experienced by African American men (illustrated using large posters); condom negotiation skills; and any questions, problems, and concerns the men may have regarding safer sex with their partners. The health facilitator also conducts a demonstration of available condom and lubricant varieties and correct condom and lubrication use. Throughout the session, the advisor encourages the individual to feel good about using condoms, to experience condoms as being compatible with sexual pleasure, to equate condom use with an investment in his future, and to actively protect himself from obtaining a future STI. Men are encouraged to use condoms that they feel fit them well and provide them with a sense of security. Participants receive pocketsize vials of water-based lubricants as well as 12 or more condoms of their choice from a broad selection of brands and sizes. Click here to view more detailed information on this program.