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Objective: This study aimed to describe the perceptions of Southern, rural, African American women regarding personal and environmental factors that affect their hypertension.Design: A purposive sample of 25 African American women aged 40-74 years, who lived in rural Alabama, participated in seven Talking Circles for 60 minutes.Results: Most felt that hypertension was a "common occurrence" and that it was "typical in the African American community." They associated hypertension with stroke and heart attacks and referred to hypertension as the "silent killer." Barriers to following the treatment plan were low income, high medical expenses, and lack of insurance. Barriers to medication were cost, dislike for taking medication, running out of medication, side effects, forgetting, and being tired; and barriers to exercise were being tired, busy schedule, and safety. Walking paths, fitness centers, or malls to walk around were not available in all communities, and not all sidewalks were well-lit, limiting their walking exercise opportunities after work hours. Healthcare facilities were accessible, but it was easier to get an appointment and receive respect from healthcare providers if the women had money or insurance. Blood pressure monitors were available in their homes, at grocery stores and at Wal-Mart. No church health programs were available, but some churches had nurses on duty who offered blood pressure and cholesterol screening; however, no medication was provided. Grocery stores were accessible, and they had a flea market with fresh fruits and vegetables. Social environment/support by families and friends for persons with hypertension was not always positive.Conclusion: The findings of this study indicate that personal and environmental factors play important roles in hypertensive status. The modified ecological framework used in this study may help us explore perspectives of family members and friends regarding their support for persons with hypertension. More serious efforts and resources need to be made available for preventive measures of hypertension in this population. [ABSTRACT FROM AUTHOR]

African American adolescent females continue to be at disproportionate high risk for HIV infection. A repeated measures quasi-experimental comparison group design compared an HIV risk-reduction intervention delivered by mothers with an HIV risk-reduction intervention delivered by health professionals and with a health promotion intervention delivered by mothers. The three interventions were randomly assigned to one of three geographical distinct sites. A convenience sample of 553 low-income African American adolescent girls with a baseline age of 11 to 14 years participated in the study. The results revealed that over a 6-month period, compared to girls in the health promotion intervention, the girls in the HIV risk-reduction interventions had significant higher scores on HIV transmission knowledge, condom attitudes, and self-efficacy to use condoms. The implication is mothers who receive appropriate training may be able to deliver HIV risk reduction to their daughters as well as health professionals. [ABSTRACT FROM AUTHOR]

African-American adolescent females are at high risk for HIV infection, acquired primarily as a result of heterosexual intercourse. Multiple regression analyses was used to describe the correlates of the outcome variable, ever having had sex, for low-income African-American adolescent females in a cross-sectional study of 322 (N = 322) mother/daughter pairs. The results revealed that while the daughters' age was positively associated with the outcome variable, the daughters' perceptions of strictness of curfew and maternal monitoring, and the daughters'self-efficacy to refuse sex and their intention to refuse sex were negatively associated with the outcome variable. Mothers tended to report significantly more maternal monitoring and stricter curfews than what their daughters perceived them to be. The daughters'intention to refuse sex mediated the effects of age and self-efficacy to refuse sex on the outcome variable. These results suggest that health-care providers should promote clearer communication between mothers and daughters in order to reduce divergent perceptions and to help mothers facilitate their daughters' self-efficacy and their intention to refuse sex. [ABSTRACT FROM AUTHOR]

Little is known about rural Malawian adolescents' perceptions of their sexual behavior and what would constitute an effective HIV risk-reduction program. This study explored the perceptions of Malawain adolescents using qualitative description research with focus groups. A purposive sample of 144 adolescents, ranging from 10 to 19 years of age was obtained. Subjects were then placed in focus groups separated by gender Qualitative content analysis revealed that adolescents were at risk for HIV based on the select behaviors These included early sexual debut, multiple partners, non-use of condoms and among girls older partners These adolescents acknowledged peer pressure and lack of parental supervision as factors that perpetuated these behaviors and identified two components of HIV prevention programs. For example, parental involvement and support for sexual abstinence were among the issues discussed. It is essential that HIV risk-reduction programs create ways of involving parents and of enhancing adolescents' HIV risk-reduction skills by helping them to change peer norms and to develop negotiation and assertiveness skills to in order to resist peer pressure. [ABSTRACT FROM AUTHOR]

Low-income African American inner city adolescent females continue to be at disproportionately high risk for contracting HIV. Though it has been speculated that mothers' involvement in HIV risk reduction may be helpful in the fight against HIV, very few interventions involve mothers. The Mother/Daughter HIV Risk Reduction intervention (MDRR), an innovative community-based intervention, trains mothers to be their daughters' primary HIV educators. A split-plot repeated measures design was used to test the effectiveness of the MDRR in decreasing daughters' sexual activity over a 2-month period. The mediating variables were daughters' HIV transmission knowledge, self-efficacy and intention to refuse sex. The sample consisted of 262 daughters with a mean age of 12.4 years. The results revealed that mothers were effective in increasing the mediating variables and in reducing their daughters' level of sexual activity. Active involvement of mothers is cost-effective and should be integrated into HIV intervention programs. [ABSTRACT FROM AUTHOR]

African Americans and Latinos share higher rates of cardiovascular disease (CVD) and diabetes compared with Whites. These diseases have common risk factors that are amenable to primary and secondary prevention. The goal of the Chicago REACH 2010-Lawndale Health Promotion Project is to eliminate disparities related to CVD and diabetes experienced by African Americans and Latinos in two contiguous Chicago neighborhoods using a community-based prevention approach. This article shares findings from the Phase 1 participatory planning process and discusses the implications these findings and lessons learned may have for programs aiming to reduce health disparities in multiethnic communities. The triangulation of data sources from the planning phase enriched interpretation and led to more creative and feasible suggestions for programmatic interventions across the four levels of the ecological framework. Multisource data yielded useful information for program planning and a better understanding of the cultural differences and similarities between African Americans and Latinos. [ABSTRACT FROM AUTHOR]

AIDS-related stigma has impacted the lives of many individuals, including Haitians. Little, however, is known about the long-term effects AIDS-stigmatization has had on Haitian women living in the United States. A pilot study was conducted to explore HaitianAmerican women's perceptions of the impact of the AIDS epidemic on their lives. The long-term effects of AIDS-stigmatization fell into five categories: rejection by the dominant society, self-doubt, effect on self-esteem, effect on intimate relationships, and rejection by Haitians within their community. More extensive research is needed to explore the long-term effects of the AIDS epidemic on Haitian women. Additionally, to counter the negative effects of the AIDS epidemic, intervention strategies need to be developed and tested. [ABSTRACT FROM AUTHOR]

The effectiveness of an HIV prevention intervention for low-income African American women between the ages of 20 and 44 years was assessed. The hypothesis was that at 3, 6, and 9 months, treatment intervention women would have significantly greater increase from baseline on self-efficacy, condom use knowledge, protective sexual behavior, prevention community behavior, and perceived HIV vulnerability compared with the control intervention women. Using an interrupted time series design, one of two geographically distinct but demographically similar communities was randomly assigned to the treatment intervention. A total of 280 women participated. Hierarchical linear modeling revealed no differences at pretest for the treatment and control women. Compared with control women, treatment women significantly increased self-efficacy, protective sexual behavior, condom knowledge, and prevention community behavior. A slight decline in protective sexual behavior at 9 months may indicate that a linear pattern of change may not be appropriate to describe sexual behavioral change. [ABSTRACT FROM AUTHOR]

Coping strategies, such as working harder and negotiation, may have an effect on depression for employed Korean immigrant wives. Additionally, income and education have been associated with depression in previous research. A cross-sectional survey research design was used to explore which coping strategies and demographic variables were significantly related to depression for employed Korean immigrant wives, The results of multiple regression analysis revealed that coping strategies and demographic variables accounted for 24% of the variance in depression. Specifically, as wives worked harder cleaning the house, their depression increased, whereas when they negotiated with their husbands, they were less likely to be depressed. To enhance negotiation among Korean wives, mental health nurses need to work within the community to foster the development of cultural and traditional norms that sanction negotiation between husbands and wives. [ABSTRACT FROM AUTHOR]

Background and Objectives: African-American family caregivers may have insufficient knowledge to make informed end-of-life (EOL) decisions for relatives with dementias. Advance Care Treatment Plan (ACT-Plan) is a community-based education intervention to enhance knowledge of dementia and associated EOL medical treatments, self-efficacy, intentions, and behavior (written EOL care plan). This study evaluated efficacy of the intervention compared to attention control., Research Design and Methods: In a theoretically based, 2-group, cluster randomized controlled trial, 4 similar Midwestern urban megachurches were randomized to experimental or control conditions. Each church recruited African-American caregivers, enrolling concurrent waves of 5 to 9 participants in 4 weekly 1-hour sessions (358 total: ACT-Plan n = 173, control n = 185). Dementia, cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and tube feeding (TF) treatments were discussed in ACT-Plan classes. Participants completed assessments before the initial class, after the final class (week 4), and at week 20. Repeated measures models were used to test the intervention effect on changes in outcomes across time, adjusting for covariates as needed., Results: Knowledge of CPR, MV, TF, and self-efficacy to make EOL treatment decisions increased significantly more in the ACT-Plan group at weeks 4 and 20. Knowledge of dementia also increased more in the ACT-Plan group at both points, reaching statistical significance only at week 20. Intentions to make EOL treatment decisions and actually an advance care plan were similar between treatment arms., Discussion and Implications: Findings demonstrate promise for ACT-Plan to increase informed EOL treatment decisions for African American caregivers of individuals with dementias.

Using an ecological model, we describe substance use and sexual risk behaviors of young male laborers at a roadside market in Malawi. Data included observations and interviews with 18 key market leaders and 15 laborers (ages 18-25 years). Alcohol, marijuana, and commercial sex workers (CSWs) were widely available. We identified three patterns of substance use: 6 young men currently used, 6 formerly used, and 3 never used. Substance use was linked to risky sex, including sex with CSWs. The market supported risky behaviors through availability of resources; supportive norms, including beliefs that substance use enhanced strength; and lack of restraints. Community-level poverty, cultural support for alcohol, interpersonal family/peer influences, early substance use, and school dropout also contributed to risky behaviors. Parental guidance was protective but not often reported. Local programs addressing substance use and risky sex simultaneously and better national substance use policies and mental health services are needed., (Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

Background: For interventions to be implemented effectively, fidelity must be documented. We evaluated fidelity delivery, receipt, and enactment of the 48-week Women's Lifestyle Physical Activity Program conducted to increase physical activity and maintain weight in African American women., Methods: Three study conditions all received 6 group meetings; 1 also received 11 motivational interviewing personal calls (PCs), 1 received11 automated motivational message calls (ACs), and 1 received no calls. Group meeting delivery was assessed for adherence and competence. PC delivery was assessed with the Motivational Interviewing Treatment Integrity Code. Receipt was defined as group meeting attendance, completion of PCs, and listening to ACs. Enactment was number of weeks an accelerometer was worn., Results: For group meeting delivery, mean adherence was 80.8% and mean competence 2.9 of 3.0. Delivery of PCs did not reach criterion for competence. Receipt of more than one-half the dose was achieved for 84.9% of women for group meetings, 85.5% for PCs, and 42.1% for ACs. Higher group meeting attendance was associated with higher accelerometer steps at 24 weeks and lower BMI at 24 and 48 weeks., Conclusions: Fidelity measurement and examination of intervention delivery, receipt, and enactment are important to explicate conditions in which interventions are successful.

Purpose: To compare the effects of a physical activity (PA) intervention of group meetings versus group meetings supplemented by personal calls or automated calls on the adoption and maintenance of PA and on weight stability among African-American women., Design: Randomized clinical trial with three conditions randomly assigned across six sites., Setting: Health settings in predominately African-American communities., Subjects: There were 288 women, aged 40 to 65, without major signs/symptoms of pulmonary/cardiovascular disease., Intervention: Six group meetings delivered over 48 weeks with either 11 personal motivational calls, 11 automated motivational messages, or no calls between meetings., Measures: Measures included PA (questionnaires, accelerometer, aerobic fitness), weight, and body composition at baseline, 24 weeks, and 48 weeks., Analysis: Analysis of variance and mixed models., Results: Retention was 90% at 48 weeks. Adherence to PA increased significantly (p < .001) for questionnaire (d = .56, 128 min/wk), accelerometer (d = .37, 830 steps/d), and aerobic fitness (d = .41, 7 steps/2 min) at 24 weeks and was maintained at 48 weeks (p < .001), with no differences across conditions. Weight and body composition showed no significant changes over the course of the study., Conclusion: Group meetings are a powerful intervention for increasing PA and preventing weight gain and may not need to be supplemented with telephone calls, which add costs and complexity., (© The Author(s) 2016.)

The study's purpose was to explore whether frequency of cyberbullying victimization, cognitive appraisals, and coping strategies were associated with psychological adjustments among college student cyberbullying victims. A convenience sample of 121 students completed questionnaires. Linear regression analyses found frequency of cyberbullying victimization, cognitive appraisals, and coping strategies respectively explained 30%, 30%, and 27% of the variance in depression, anxiety, and self-esteem. Frequency of cyberbullying victimization and approach and avoidance coping strategies were associated with psychological adjustments, with avoidance coping strategies being associated with all three psychological adjustments. Interventions should focus on teaching cyberbullying victims to not use avoidance coping strategies., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women., Methods: Pregnant African-American women (n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15 and 25 weeks and between 25 and 37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems., Findings: Perceived neighborhood environment, social support, avoidance coping, and depressive symptoms were correlated significantly in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time 1 (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time 1 and depressive symptoms at time 2 (29 ± 2.7 weeks). An increase in avoidance coping between times 1 and 2 also mediated the effects of perceived neighborhood environment at time 1 on depressive symptoms at time 2., Conclusion: Pregnant African-American women's negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health., (Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Malawian adolescents are at risk for HIV infection. Using a quasi-experimental two group research design, we determined the efficacy of Mzake ndi Mzake Kuunikira Achinyamata (MMKA) in enhancing 13-19 year old Malawian males' and females' HIV knowledge, attitude about HIV, self-efficacy for condom use and for safer sex, and HIV risk reduction behaviors. The regression analyses revealed that compared to their cohorts in the control community, the adolescents in the MMKA community had significantly better scores on the outcome variables. The intervention had significant benefits for male and 16-19 year old adolescents, but not for 13-15 year old female adolescents. Tailored interventions are needed for these females.

A cross-sectional qualitative descriptive design was used to examine the links among expectations about, experiences with, and intentions toward mental health services. Individual face-to-face interviews were conducted with a purposive sample of 32 African American youth/mothers dyads. Content analysis revealed that positive expectations were linked to positive experiences and intentions, that negative expectations were not consistently linked to negative experiences or intentions, nor were ambivalent expectations linked to ambivalent experiences or intentions. Youth were concerned about privacy breeches and mothers about the harmfulness of psychotropic medication. Addressing these concerns may promote African Americans' engagement in mental health services.

This qualitative description study was designed to describe Korean American parents' perceptions of challenges and difficulties they encounter while raising their children in the USA. A convenience sampling of 21 parents of adolescents aged 11-14 years recruited from the Midwest Korean American community participated in the study. Data were collected using in-depth, face-to-face interviews, which took place in agreed-upon, convenient locations. All interviews were audiotaped and transcribed in Korean and the transcripts were translated into English. Qualitative content analysis revealed that the main stresses that parents encountered while raising their children in the USA were inability to advocate for children, feeling uneasy and insecure about incompatible American culture, ambivalence towards children's ethnic identities, and feeling alienated. In relation to these stresses, parents often felt inadequate, ashamed, guilty, regretful and powerless. The findings demonstrated the importance of understanding parents' feelings that are deeply embedded in the conflicted parent-child relationships and their perceptions of being parents in the USA. The present study highlights the need for and importance of providing intervention programmes for parents, particularly programmes that would empower parents, strengthen parent-child relationships and address ways to integrate two very different cultures while upholding ethnic identity and pride., (© 2012 John Wiley & Sons Ltd.)

Purpose: To explore pregnant African American women's views of factors that may impact preterm birth., Study Design and Methods: Qualitative descriptive exploratory cross-sectional design. A convenience sample of 22 low-risk pregnant African American women participated in focus group interviews. Women were asked questions regarding their belief about why women have preterm birth and factors impacting preterm birth. Data were analyzed using content analysis., Results: Pregnant African American women encounter multiple physical, psychological, and social stressors. The four themes included knowledge of preterm birth, risk factors for preterm birth, protective factors for preterm birth, and preterm birth inevitability. The risk factors for preterm birth were health-related conditions, stressors, and unhealthy behaviors. Stressors included lack of social and financial support, interpersonal conflicts, judging, dangerous neighborhoods, racism, and pregnancy- and mothering-related worries. Protective factors for preterm birth included social support and positive coping/self-care., Clinical Implications: Clinicians may use the results of this study to better understand women's perceptions of factors that affect preterm birth, to educate women about risk factors for preterm birth, and to develop programs and advocate for policies that have the potential to decrease health disparities in preterm birth.

African-American (AA) women could be instrumental in communicating positive prostate screening behavior to the significant males in their lives. However, little is known about AA women's prostate cancer attitudes, perceived behavioral control, subjective norms, intentions, behaviors, and knowledge regarding prostate cancer screening. This study describes the development and psychometric testing of the Eastland Prostate Cancer Survey (EPCS). A nonexperimental, correlational study with 200 AA women was used to test the psychometric properties of the six-subscale EPCS with 66 items. Construct validity, internal consistency, and test-retest reliability for the EPCS were acceptable and resulted in an eight-subscale EPCS with 56 items. Cronbach's alphas for the subscales ranged from 0.69 to 0.92. The EPCS is a culturally sensitive, gender-relevant instrument that could be used by community health providers to develop community health programs aimed at engaging AA women in the promotion of prostate cancer screening for AA men.

This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative and qualitative data revealed 2 types of stress responses: high stress responses (7 women) and low stress responses (4 women). Patterns of stress responses were seen in psychological stress and cervical remodeling (attenuation or cervical length). All women in the high stress responses group had high depression and/or low psychological well-being and abnormal cervical remodeling at one or both data collection times. All but 1 woman had at least 3 sources of stress (racial, neighborhood, financial, or network). In contrast, 3 of the 4 women in the low stress responses group had only 2 sources of stress (racial, neighborhood, financial, or network) and 1 had none; these women also reported higher perceived support. The findings demonstrate the importance of periodically assessing stress in African American women during pregnancy, particularly related to their support network as well as the positive supports they receive.

Objectives: To (a) examine the relationships among objective and perceived indicators of neighborhood environment, racial discrimination, psychological distress, and gestational age at birth; (b) determine if neighborhood environment and racial discrimination predicted psychological distress; (c) determine if neighborhood environment, racial discrimination, and psychological distress predicted preterm birth; and (d) determine if psychological distress mediated the effects of neighborhood environment and racial discrimination on preterm birth., Design: Descriptive correlational comparative., Setting: Postpartum unit of a medical center in Chicago., Participants: African American women (n(1)  = 33 with preterm birth; n(2)  = 39 with full-term birth)., Methods: Women completed the instruments 24 to 72 hours after birth. Objective measures of the neighborhood were derived using geographic information systems (GIS)., Results: Women who reported higher levels of perceived social and physical disorder and perceived crime also reported higher levels of psychological distress. Women who reported more experiences of racial discrimination also had higher levels of psychological distress. Objective social disorder and perceived crime predicted psychological distress. Objective physical disorder and psychological distress predicted preterm birth. Psychological distress mediated the effect of objective social disorder and perceived crime on preterm birth., Conclusion: Women's neighborhood environments and racial discrimination were related to psychological distress, and these factors may increase the risk for preterm birth., (© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

This cross-sectional correlational study examined the association between Korean American adolescents' and their parents' reports of parent-child relationships. A total of 61 Korean American families completed a questionnaire assessing parental knowledge, parental/filial self-efficacy, parent-child communication, and parent-child conflicts. T tests, Pearson's correlations, a scatter diagram, and bivariate regression were used to analyze the data. Both Korean American adolescents and their parents reported that fathers were less knowledgeable about their child's school life and less likely to communicate with their children than were mothers. Fathers reported a significantly lower level of parental self-efficacy than mothers, and adolescents also reported a significantly higher level of filial self-efficacy in mother-child relationships than in father-child relationships. Positive correlations between parents' and adolescents' reports of parent-child relationships were observed. These findings indicated a need for parent education programs or counseling services for Korean American parents of adolescents, particularly fathers with inadequate parental skills and limited communication with their children., (Copyright 2012, SLACK Incorporated.)

Having an HIV ministry within a church depends on the religious culture of that church. However, little is known about how a church's religious culture influences an HIV ministry. This study's purpose was to examine how an African American church's religious culture supported the development, implementation, and maintenance of an HIV ministry within the church. An ethnographic case study research design was used. Data were collected through interviews, nonparticipant and participant observations, review of pertinent documents, and survey of congregants. Results revealed the following as important for an HIV ministry: (a) a belief in helping others and treating everyone with respect and dignity, (b) feelings of compassion toward individuals infected with HIV, and (c) HIV education. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries., (Copyright © 2012 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention. Using multiple regressions controlling for six demographic factors, intervention district adults had significantly more favorable outcomes at 6- and 18-month evaluations for condom attitudes, self-efficacy for community prevention, self-efficacy for practicing safer sex, partner communication, using condoms ever in the past 2 months, and community prevention activities. Knowledge and hope for controlling the epidemic were significantly higher in the intervention district only at the 6-month evaluation; having a recent HIV test was significantly higher only at 18 months. Levels of stigma and the number of risky sex practices did not decrease when demographic factors were controlled. Expanding peer group intervention for HIV prevention would benefit rural adults.

Thai heterosexual males between 20 and 39 years old are at increased risk for HIV infection. Consistent condom use is effective against HIV transmission, but little is known about determinants of consistent condom use for these males. The purpose of this study is to explore determinants of consistent condom use for this population. The determinants of interest are age, educational level, marital status, income, and concepts from the theory of planned behavior: attitude toward condom use, subjective norm about consistent condom use, perceived behavioral control (PBC) of consistent condom use, and intention to use condoms consistently. We used a cross-sectional descriptive research design with a convenience sample of 400 heterosexual Thai males between 20 and 39 years. Our sample had a mean age of 28.71 years (SD = 6.33). During the last three months, 39.5% reported using condoms consistently, 23% reported using condoms inconsistently, and 37.5% reported never using condoms. The results from the regression analyses revealed that marital status, income, subjective norm about consistent condom use, PBC of consistent condom use, and intention to use condoms consistently were determinants of consistent condom use. Also the effect of subjective norm about consistent condom use and PBC of consistent condom use on consistent condom use was mediated by intention to use condoms consistently. These results suggest that interventions to increase consistent condom use should focus on enhancing intention to use condoms consistently by promoting subjective norm about consistent condom use and PBC of consistent condom use.

Little is known about African American families' experiences with mental health services. A purposive sample of 40 dyads of African American youth (aged 13 to 19) and their mothers participated in a cross-sectional qualitative research design using semi-structured interviews that elicited information about their past experiences and satisfaction with mental health services. Though rarely received, group and family therapy were perceived favorably. However, both mothers and youth reported dissatisfaction centered on medication and lack of professionalism, confidentiality, and concern by providers. The failure of mental health services providers to meet basic standards of quality and professionalism may explain the low rate of service use by African Americans.

Purpose: African-American adolescent females tend to initiate participation in sexual activity at an earlier age than Caucasian adolescent females. Early initial participation in sexual activity is associated with increased risk of HIV infection. However, limited prospective data are available on the rate at which African-American adolescent females delay their initial participation in sexual activity. The purpose is to determine low-income, inner-city, African-American adolescent females' survival or continued nonparticipation in sexual activity over a 20-month period and to determine predictors associated with survival., Methods: A longitudinal, quasi-experimental research design with multiple data collection points was used. The convenience sample consisted of 396 African-American females with a mean age of 12.4 years (SD = 1.1 years) and their mothers. The adolescents completed questionnaires assessing perceptions of maternal monitoring, HIV transmission knowledge, self-efficacy to refuse sex, intention to refuse sex, and age. Their mothers completed questionnaires assessing perception of maternal monitoring, safer sex self-efficacy, marital status, and educational level. At baseline, the adolescents reported nonparticipation in sexual activity. Survival analysis was conducted to determine the timing and predictors of sexual activity initiation for these adolescents., Findings: Of the 396 adolescents, 28.5% did not survive; they participated in sexual activity within the 20-month period. Predictors of non-survival were the adolescents' age, perception of maternal monitoring, and intention to refuse sex., Conclusion: Findings suggest interventions that increase maternal monitoring and adolescents' intentions to refuse sex could be beneficial in delaying sexual activity., (Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Problem: The purpose of this study was to describe Korean American adolescents' (KAAs') and their parents' perceptions of KAAs' experiences with acculturative stress and to examine the congruity between their perceptions., Method: This study used the qualitative descriptive method. Twenty KAAs aged 11-14 years and their 21 parents participated in in-depth, face-to-face interviews., Findings: Qualitative content analysis revealed that KAAs and their parents reported similar views regarding acculturative stress experienced by KAAs: peer relationships, being treated differently or unfairly, pressure to excel academically and be successful, and strained parent-child relationships., Conclusion: Culturally and developmentally relevant interventions focusing on strengthening peer relationships and parent-child relationships are needed for this population.

Purpose: As compared with minimal treatment (MT), to determine the effectiveness of a home-based walking intervention enhanced by behavioral strategies targeted and tailored to African-American women (enhanced treatment [ET]) on adherence, physical activity, fitness, and body composition at 24 and 48 weeks., Design: Using a quasi-experimental design, treatments were randomly assigned to one of two community health centers., Setting: The centers were in predominately African-American communities., Participants: Sedentary women (156 ET, 125 MT) 40 to 65 years were recruited within a 3-mile radius of each center., Intervention: Both treatments had the same orientation. The ET group had four targeted workshops followed by weekly tailored telephone calls over 24 weeks., Methods: Generalized linear mixed models were used to test effects of treatments on adherence, physical activity, aerobic fitness, and body composition., Results: Adherence was significantly higher in the ET than the MT group and was related to the number of workshops attended (r = .58) and tailored calls (r = .25) received. On-treatment analysis showed significant postintervention improvement in waist circumference and fitness in the ET group; however, these improvements were not statistically different between the two groups. Intent to treat analysis showed a significant increase in fitness, decrease in waist circumference, and no change in body mass index in both treatments., Conclusion: Findings suggest the potential impact of workshop group support on adherence in African-American women.

HIV prevention for adolescents is urgently needed in Africa, but interventions have been slow to develop because of controversies about sex education. In this report the authors describe a four-step process used to develop a culturally and developmentally appropriate adolescent HIV prevention program for communities in rural Malawi. This is the final component of a 2-year ongoing adult HIV prevention program in Malawi. First the authors identified the risky behaviors of rural adolescents as well as cultural, developmental, and contextual factors. Next they consulted the community regarding how to use this information effectively and acceptably. Then an existing intervention was adapted based on this information. Finally, the authors piloted the intervention and made modifications based on lessons learned. This process provides a systematic way to consult with the community, thereby jointly enriching understanding, engaging the issues, and promoting support for an intervention program.

Because little is known about elderly Thai immigrants' conceptualization of depression, a qualitative descriptive research study was conducted to explore their perception of depression. Semi-structured individual face-to-face interviews were performed with a purposeful sampling of ten men and ten women aged 60 years and older at participants' homes or Thai Buddhist temples. The results revealed that depression was defined as feeling disappointment and pressure in the mind and included symptoms of isolation, heart pounding, and dissatisfaction. Coping strategies comprised practicing Buddhism and acceptance. Gender differences existed and reflected cultural expectations for men and women. These findings provide a foundation for developing culturally sensitive health care.

This study examined changes in service delivery patterns of health and mental health service providers one year after a training on the fundamentals of HIV/AIDS and mental health. Paired t-tests for 424 training recipients showed significant increases in delivery of HIV-related services, and these remained significant while controlling for additional training, job changes, region (urban, rural, suburban), and provider discipline. Multiple logistic regression analysis revealed a significantly greater likelihood of providing direct services to HIV+ individuals among male providers, those with more years of HIV experience, those in counseling disciplines, and those working in a new job since the training.

The purpose was to investigate whether an HIV-prevention curriculum and a health maintenance curriculum produced different rates of change in reported consistent condom use and to explore what mediating variables predicted reported consistent condom use over time. A longitudinal crossover research design with extended posttest observations was used with a sample of 279 African American women. After pretesting, women received the designated curriculum and were posttested at completion, 3, 6, and 9 months. After the 9-month posttest, the curriculum was switched, and the above procedure was repeated. Using SAS macro GLIMMIX, the data revealed that the HIV curriculum yielded higher consistent condom use than did the health maintenance curriculum and that the mediating variables that predicted consistent condom use over time were self-efficacy for low-risk HIV behavior, HIV-related community behavior, and social norms. Enhancing consistent condom use over time may require the promotion and reinforcement of these mediating variables.

The elimination of health disparities for African Americans requires culturally relevant, empirical knowledge, which in turn requires including African Americans in research studies. However, power-difference barriers and conceptual barriers continue to inhibit the recruitment of African Americans. The purpose of this article is to define and discuss certain barriers to the recruitment of African Americans into research studies and to present culturally and contextually sensitive strategies to overcoming these barriers. Power-difference barriers reflect unequal authority and often generate mistrust. Conceptual barriers reflect researchers' need for better understanding about African Americans. Effective strategies include collaboration with the community through a community advisory board and conducting community-based participatory action research. Also, integrating alternative conceptual frameworks with mainstream frameworks may reduce researchers' ideological assumptions about African Americans. To promote optimal recruitment of African Americans, researchers must be aware of power-difference barriers and conceptual barriers and move toward active collaboration with African American communities.

Background and Significance: Alarming numbers of Latino teens continue to engage in behaviors that place them at risk for pregnancy and sexually transmitted infections including HIV., Design: This study includes data from six focus groups with 38 Latinas. The primary purpose of the focus groups was to elicit antecedents to unsafe sex to guide the development of an HIV-prevention intervention for adult Latinas. The data were reanalyzed using the rich content that had been elicited about community teens., Findings: Six major themes were identified surrounding teen issues and concerns. These are (a) the culture of risky behaviors; (b) romance: illusion and reality; (c) parental involvement: a protective factor; (d) HIV: knowledge versus ignorance; (e) HIV among youth: fear, stigma, and anger; and (f) saving our youth., Implications: A multimodal approach is required to help teens adopt healthy life styles, remain in school, and have a positive relationship with their parents.

Alarming numbers of teens engage in behaviors that place them at risk for pregnancy and sexually transmitted infections (STIs) including AIDS. Intervention studies targeted toward reducing risky sexual behavior and improving school retention and literature about variables that affect risky sexual behavior and school performance were reviewed to develop the Social-Cognitive Model for Sexual Behavior During Adolescence. Interventions that target change in the family and school environments in addition to building the personal capacities of each teen have the potential to be effective. Many environmental factors cannot be altered, but the intervention can help reframe the situation and provide the knowledge, specific skills, role models, and rehearsal that promote change. The 13-week school-based intervention assists students identify how personal strengths and family, school, and neighborhood environmental factors can reinforce health behaviors and choices.

Field theory and empowerment were used as guiding conceptual frameworks to address empowerment issues in two low-income inner city African-Americans communities. Field theory and empowerment provided a conceptualization of these communities in terms of the possible impact of the physical environment of these communities on their residents and the health care professionals who worked with these residents. The most likely response is learned helplessness and depression that are antithetical to empowerment. These frameworks also were helpful in generating strategies to foster empowerment among these community residents. These strategies include helping residents to redefine their behavior as ways of coping with a hostile environment that confronts them with poverty and racism and to reconnect with natural supports in the community for the purpose of enhancing community coalitions and alliances.

Background: Because an increasing number of chronically mentally ill individuals are HIV-positive, continuing education must include AIDS content to ensure psychiatric nurses provide competent care. The Fundamentals of Mental Health and HIV/AIDS Program was tested to determine its effectiveness in augmenting the AIDS knowledge of mental health professionals., Method: Two hundred forty RNs attended the Fundamental of Mental Health and HIV/AIDS Program. They completed pretest and posttest measures., Results: The program significantly increased AIDS knowledge. The increase in AIDS knowledge was more dramatic for psychiatric nurses than for non-psychiatric nurses., Conclusion: This study reinforces the need for AIDS continuing education.

While AIDS continues to escalate in Botswana, no systematic investigation has been done of the contextual (behavioral and situational) variables important to the tailoring of AIDS educational prevention program for adolescents. A cross-sectional descriptive study identified the specific behaviors and situations placing adolescents at risk for AIDS as perceived by a convenience sample of 48 adolescents. Adolescents attended gender-specific focus groups and completed a demographic questionnaire. Content analysis revealed that gender and age could categorize the adolescents' perceptions of contextual variables. For younger adolescents AIDS-related behaviors involved sex and intravenous drug use; for older adolescents AIDS-related behaviors involved multiple sexual partners and sexual relationships between older men and adolescent girls. Though a consensus existed regarding the situational variables, gender and age influenced the situation that was most challenging to these adolescents. The data support that AIDS educational prevention programs must be tailored to the adolescents' gender and age.

While a plethora of data describes homeless women's demographic characteristics and health status, a paucity of data exists on homeless women's perceptions of their housing situation. This exploratory-descriptive study of 70 shelter-residing women expands knowledge of homeless women. Content analysis of focus groups revealed that homelessness meant loss of autonomy-marginal control over their lives and uncertainly about their own and their children's future. Loss of autonomy was manifested as mental strain: feeling depressed, worried, and scared. They were especially concerned about the impact of shelter-living on their children. Shelter-living was not viewed as child-friendly.

Because designing programs based on an understanding of the target population's perceptions, expectations, and experiences is not only beneficial but feasible, a convenience sample of 17 African American men who have sex with men attended one of four focus groups to identify the needs of AIDS clients and what constitutes an ideal AIDS program. These men articulated what they needed and expected from the health care system. These needs and expectations should be incorporated into program planning to promote a more productive relationship between provider and providee and, thus, more efficacious programs. Their needs are competent comprehensive health care, adequate funds, and emotional support to enhance inner strength to cope with dying and death, dependency, and uncertainty. The ideal AIDS program would be holistic, providing health care needs as well as financial, social, emotional, and familial needs by means of both traditional and alternative treatments.