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Objectives: African-American women are affected by disproportionately high rates of violence and sexually transmitted infections (STI)/human immunodeficiency virus (HIV) infection. It is imperative to address the intersection of these two urgent public health issues, particularly as these affect African-American adolescent girls. This study assessed the prevalence of rape victimization (RV) among a sample of African-American adolescent females and examined the extent to which participants with a history of RV engage in STI/HIV associated risk behaviors over a 12-month time period.Methods: Three hundred sixty-seven African-American adolescent females ages 15-21, seeking sexual health services at three local teenager-oriented community health agencies in an urban area of the Southeastern United States, participated in this study. Participants were asked to complete an audio computer-assisted self-interview (ACASI) at baseline, six- and 12-month follow-up. We assessed sociodemographics, history of RV and sexual practices. At baseline, participants indicating they had experienced forced sex were classified as having a history of RV.Results: Twenty-five percent of participants reported a history of RV at baseline. At six- and 12-months, victims of RV had significantly lower proportions of condom-protected sex (p=.008), higher frequency of sex while intoxicated (p=.005), more inconsistent condom use (p=.008), less condom use at last sex (p=.017), and more sex partners (p=.0001) than non-RV victims. Over the 12-month follow-up period, of those who did not report RV at baseline, 9.5% reported that they too had experienced RV at some point during the 12-month time frame.Conclusion: African-American adolescent females who experience RV are engaging in more risky sexual behaviors over time than non-RV girls, thereby placing themselves at higher risk for contracting STIs. In light of the results from this unique longitudinal study, we discuss considerations for policies and guidelines targeting healthcare, law enforcement and educational and community settings. The complexities of RV screening in healthcare settings are examined as is the need for tighter collaboration between healthcare providers and law enforcement. Finally, we consider the role of prevention and intervention programs in increasing awareness about RV as well as serving as an additional safe environment for screening and referral. [West J Emerg Med. 2011;12(3):333-342.]

In schools and programs of public health, active learning and restructured feedback strategies may improve student learning and course performance compared to traditional lecture-based formats and grading systems. To promote student engagement and active learning, we implemented the team-based learning (TBL) model and a restructured grading approach based on principles of "ungrading" in the required behavioral research methods course of a master's level public health curriculum. We conducted a quasi-experimental, mixed-methods evaluation of the implementation of restructured grading approach (two sections, n = 46) compared to the traditional grading approach (two sections, n = 34). For the restructured grading sections, numeric grades were removed for weekly team quizzes and team assignments. We administered and analyzed pre- and post-course surveys to compare perceived mastery of course learning objectives, intrinsic motivation, and perceptions of grading and instructor feedback by grading approach. Additionally, we compared course grades and final paper grades by grading approach and conducted two focus groups (one for each approach). The results indicate that students' learning, satisfaction, and perceptions of the course were mainly equivalent across grading approaches. Students in the restructured grading sections demonstrated a few modestly improved outcomes compared to their peers in the traditional grading courses. Students in the restructured grading sections had slightly higher mean course grades, reported greater increase in confidence to critically evaluate research designs, and found team quizzes to be more helpful. Removing grades for team quizzes and assignments supported student learning and reduced student stress. [ABSTRACT FROM AUTHOR]

Health sciences education is increasingly focusing on building students' skills to work collaboratively. Therefore, instructors must intentionally incorporate team-based skill building into their courses, using teaching strategies like team-based learning (TBL). An assumption of TBL is that team dynamics facilitate learning; however, limited research has examined this connection. The primary purposes of this mixed-methods evaluation were: (a) to describe the characteristics of team dynamics in a graduate-level research methods course that employs a modified TBL approach, and (b) to examine the association between team dynamics and student grades. Given the importance of preparing health professional students to work collaboratively in their careers, a secondary aim was to examine how team skills developed through a team-based learning approach could be transferred to other courses and to future jobs. We conducted surveys on team dynamics at mid-semester (n = 64) and the end of the semester (n = 66), collected students' grades for the final paper and overall course, and conducted 4 focus groups with Master of Public Health students (n = 25). Paired t tests were used to examine change in team dynamics and correlations were conducted to assess the relationship between team dynamics and grades. Thematic analysis was used to identify themes related to team dynamics from the focus group data. Overall, students reported experiencing positive and beneficial team dynamics. The findings support two main underlying categories of team dynamics, interpersonal team processes and task orientation, and the linkages between the categories that allow teams to function. Team dynamics scores were not associated with student grades. However, students recognized the value of practicing team skills in preparation for future group work and jobs. These findings suggest that active learning approaches, such as TBL, can help to facilitate the acquisition of collaborative skills.

This study sought to explore the impact of condom negotiation self-efficacy, interpersonal factors, and sensational factors on condom use behavior among a population of college-educated women with different patterns and types of sexual partner. We administered an online questionnaire capturing sexual behavior, partnership patterns, perceived benefits of and barriers to condom use, and condom use negotiation self-efficacy. A total of 433 women completed the online survey. Perceived sensual, erotic, and interpersonal benefits and barriers to condom use, along with negotiation self-efficacy, were found to be significantly associated with consistent condom use. When compared to respondents reporting only main partners, respondents reporting only casual partners were more likely to use condoms while respondents reporting both main and casual partners were least likely to use condoms. Previous negative experiences with condoms were significantly associated with decreased condom use, while history of sexually transmitted infection diagnosis was not consistently associated with condom use. This study supports the importance of negotiation self-efficacy in promoting condom use; however, building women's self-efficacy is not enough for effective condom use promotion among women. The impact of interpersonal, sensual and erotic factors, as well as the context of different partnership patterns, must be considered in future interventions.

Many controversies surround sex education in the United States. One particular issue of contention is whether comprehensive sexuality education increases frequency of sexual intercourse among program participants. The current investigation examined frequency of vaginal sexual intercourse in a sample of 522 sexually experienced African-American adolescent females between the ages of 14 and 18 (mean = 16.0 years, standard deviation = 1.22). Participants were a part of a randomized, controlled trial evaluating the efficacy of a comprehensive sexuality education intervention. Data collection occurred at baseline and at 6-month and 12-month follow-up. Participants were recruited from four community health agencies in the Birmingham, Alabama area. Results indicate no significant differences in the frequency of sex between the HIV intervention group and the general health-promotion comparison group at any time point: baseline to 6-month assessment, 6-month to 12-month assessment, or over the entire 12-month follow-up period. These findings reiterate the value of hierarchical messages in sex education curricula that inform adolescents that abstinence is the most effective way to prevent sexually transmitted disease infection, while encouraging adolescents who choose to have sex to use condoms correctly and consistently, and teaching them the skills to do so. (Contains 1 table.)

Historically, spirituality has been an instrumental component to the survival of Black women. In an era when the HIV epidemic disproportionately compromises their health, it is imperative to explore spirituality's role in sustaining the psychological health of Black women living with HIV. This study examined the relationship between spirituality and self-reported depression among Black women living with HIV. A sample of 308 HIV-positive Black women were recruited from HIV/ AIDS clinics in the Southeastern United States. Participants completed an interview assessing demographics, quality of life, depression, coping, and spirituality. A hierarchical multiple regression was used to determine the association between spirituality and depression. The results suggest that in our sample, spirituality accounted for a small, yet significant proportion of variance in reducing depressive symptoms, above and beyond variance accounted for by demographic variables and other theoretically important psychosocial factors. In light of these findings, future studies with HIV-positive Black women should assess spirituality as a salient factor affecting psychological health. Developing interventions that address spirituality may serve to enhance women's psychological adjustment, to living with HIV. doi:10.1300/J013v46n02_08 KEYWORDS. Spirituality, Black women, HIV positive, depression

Objectives. We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. Methods. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Results. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Conclusions. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence. doi:10.2105/AJPH.2004.053595)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.beth.2005.04.004 Byline: Barbara Olasov Rothbaum (a), Page Anderson (b), Elana Zimand (c), Larry Hodges (d), Delia Lang (e), Jeff Wilson (f) Abstract: This controlled clinical trial tested virtual reality exposure (VRE) therapy for the fear of flying (FOF), a relatively new and innovative way to do exposure therapy, and compared it to standard (in vivo) exposure therapy (SE) and a wait list (WL) control with a 6- and 12-month follow-up. Eighty-three participants with FOF were randomly assigned to VRE, SE, or WL. Seventy-five participants, 25 per group, completed the study. Twenty-three WL participants completed randomly assigned treatment following the waiting period. Treatment consisted of 4 sessions of anxiety management training followed either by exposure to a virtual airplane (VRE) or an actual airplane at the airport (SE) conducted over 6 weeks. Results indicate that VRE was superior to WL on all measures, including willingness to fly on the posttreatment flight (76% for VRE and SE; 20% for WL). VRE and SE were essentially equivalent on standardized questionnaires, willingness to fly, anxiety ratings during the flight, self-ratings of improvement, and patient satisfaction with treatment. Follow-up assessments at 6 and 12 months indicated that treatment gains were maintained, with more than 70% of respondents from both groups reporting continued flying at follow-up. Based on these findings, the use of VRE in the treatment of FOF was supported in this controlled study, suggesting that experiences in the virtual world can change experiences in the real world. Author Affiliation: (a) Emory University School of Medicine, USA (b) Georgia State University, USA (c) Virtually Better, Inc., USA (d) University of North Carolina-Charlotte, USA (e) Emory University, USA (f) Georgia Institute of Technology, USA Article History: Received 29 September 2004; Accepted 1 April 2005

One of the most consistent findings in the adolescent literature is the higher prevalence of depression among girls compared with boys. (1-5) Moreover, this gender difference in prevalence rates continues [...], Objective. The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents. Methods. Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14-18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior. Results. Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors. Conclusions. The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population. Pediatrics 2005;116:78-81; adolescent depression, adolescent health, adolescent sexual behavior, adverse outcomes, black. ABBREVIATIONS. CES-D, Center for Epidemiological Studies Depression Scale; GEE, generalized estimating equations.

The study evaluates the efficacy of an intervention to reduce HIV transmission risk behaviors and sexually transmitted diseases (STDs) and enhances HIV-preventive psychosocial and structural factors among women living with HIV.

Adolescent girls in general and African-American girls in particular are high-risk targets for contracting human immunodeficiency virus (HIV) despite specifically designed interventions for this community. A test was conducted to study the efficacy of intervention to reduce sexually transmitted diseases and it was found that tailored interventions can enhance HIV preventive behavior and may reduce pregnancy.

The goals of this study were to test the relationship between dating violence victimization (i.e., verbal, emotional, and physical abuse) and psychological well-being (i.e., depressive symptomatology, self-esteem, and body image) among 522 African American girls, and to determine whether social support acted as a buffer of negative effects (moderator) or as an intervening factor (mediator) in the relationship between dating violence victimization and psychological well-being. Results from structural equation modeling indicated that dating violence victimization was associated with negative psychological outcomes. Although social support did not moderate this relationship, it served as a mediator of the relationship between dating violence victimization and psychological well-being. Dating violence programs for African American girls should consider how to incorporate family, church, and other networks in the community to foster support, and allow adolescent girls to discuss their abusive experiences in a nonblaming environment. If programs are able to buoy girls who experience dating violence, then they may be able to ameliorate the associated negative psychological sequelae.

Problem-based learning (PBL) is a pedagogical framework that centers on a problem of interest and structures classroom tasks around teams formulating practical, evidence-based solutions. This approach is particularly well-suited for public health curricula, as it prepares students for a dynamic, interdisciplinary, professional environment. This study explores the piloting of a PBL approach with three student cohorts in a graduate-level public mental health course. Biweekly, interdisciplinary student teams were presented with a public mental health case provided by an expert in the field and asked to develop and present evidence-based solutions through a process grounded in knowledge acquisition, critical thinking, and faculty guidance. A mixed-methods evaluation was completed to examine student perceptions of PBL components and the benefits of PBL and to gather recommendations to enhance this approach. Among 37 students who completed self-administered surveys, more than 70% found case analysis, reviewing additional literature to support case solutions, and discussions with an expert to be the components "Most Helpful" to their learning. Four focus groups with 21 students were conducted to further examine perceived course benefits and suggested changes. Participants appreciated real-world simulations of public health issues and interdisciplinary teams and offered recommendations for future improvements, such as adding a culminating project. Findings support the benefits of a PBL approach in equipping graduate students with the knowledge and skills to successfully pursue professional public health work. Recommendations inform future efforts to implement this approach in other public health curricula as well as for other courses and settings. [ABSTRACT FROM AUTHOR]