Search

This study aimed to evaluate the linguistic and cultural equivalency of two Chinese-version instruments measuring sexual knowledge, attitudes, and behaviors among 10 bilingual and 2 monolingual Chinese immigrant youth aged 13-19 years. We used a rigorous design to translate, back-translate, and pilot test the instruments. Kappa coefficient, percentage agreement, and qualitative feedback from participants were used to examine reliability and validity of the instruments. Telephone interviews revealed that answer discrepancies in different language versions were due to external factors rather than lack of linguistic and cultural equivalency. This study offers preliminary evidence supporting the cultural and linguistic equivalence of two Chinese-version sexual scales.Copyright © 2010 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

This study investigated attendance at an HIV-prevention randomized controlled trial for urban adolescent females. The intervention included four 2-hour sessions that were held at convenient community-based locations. Participants were recruited from reproductive and general health care clinics, as well as youth development programs. Of the 744 girls who consented to participate in the research study, 86% (n = 640) attended one or more of the risk reduction sessions, but 14% (n = 104) did not attend any sessions. Data analyses indicated that girls who attended were more likely to be younger, African American, and non-Hispanic. They also reported earlier sexual debut and more recent sexual partners. Results indicated that sexual risk reduction interventions are attractive to many at-risk female adolescents. Strategies to improve attendance are described for this vulnerable population subgroup. [ABSTRACT FROM AUTHOR]

We describe the sexual risk behaviors, psychological distress, and substance use of 102 late adolescent girls and identify predictors of protected and unprotected vaginal sex. Participants completed questionnaires assessing hypothesized predictors and then daily behavioral diaries for 12 weeks. Protected intercourse was predicted by baseline sexual behavior, greater knowledge, positive condom attitudes, lower perceived condom-use difficulty, greater condom-use intentions, more drinking days, less binge drinking, less Ecstasy use, and lower psychological distress. Unprotected intercourse was predicted by baseline sexual behavior, binge drinking, Ecstasy and opiate use, fewer drinking days, and fewer daily drinks. These findings suggest that psychological distress, substance use, and sexual risk behavior are interconnected and should be considered collectively in interventions for adolescent females. © 2008 Wiley Periodicals, Inc. Res Nurs Health 31:329-340, 2008 [ABSTRACT FROM AUTHOR]

INTRODUCTION: There has been a paucity of theory-based interventions to improve health outcomes in overweight adolescents. Therefore, two intervention studies were conducted to: (a) determine the feasibility of implementing the Creating Opportunities for Personal Empowerment (COPE) Healthy Lifestyles Thinking, Emotions, Exercise, and Nutrition (TEEN) program with overweight adolescents; (b) obtain feedback that could be used to refine the program; and (c) examine the preliminary efficacy of the COPE program on the adolescents' weight and body mass index (BMI). METHOD: Phase I and Phase II clinical trials were conducted with 23 overweight teens. The Phase 1 trial used a pre-experimental design with one group of 11 urban adolescents. The Phase 2 trial was conducted with 12 suburban teens using a randomized controlled pilot study. COPE teens received a 15-session cognitive-behavioral skills building program that included physical activity, while the control group received an attention control program. Weight change and BMI were the key outcomes. RESULTS: COPE teens experienced a significantly greater reduction in weight and BMI than did teens in the control group, who gained weight over time. Although the COPE program was well received by all of the teens, retention of subjects across time and parent involvement in the program were challenges in the urban high school. DISCUSSION: These studies provide preliminary data to indicate that the implementation of COPE is feasible and may lead to a reduction in weight and BMI in overweight teens. Implementing COPE within the context of the school day may be more successful in sustaining adolescent involvement in the program versus using an after-school format. [ABSTRACT FROM AUTHOR]

The number of adolescent girls becoming infected with HIV has dramatically escalated to the point where they now represent one of the groups most at risk for this infection. As a component of addressing this pandemic, there is a need for psychometrically sound, tailored measures to assess an adolescent girl's level of knowledge regarding transmission and prevention of HIV. The purpose of this research was to modify an existing HIV knowledge measure used in the general adult population (brief HIV Knowledge Questionnaire [HIV-KQ]) and increase its utility by making it developmentally- and gender-specific for adolescent girls. The revised version with additional items underwent item and scale analysis to confirm psychometric properties with a sample of 62 adolescent girls. HIV-related knowledge is assessed extensively in clinical practice and educational settings and is an important component for monitoring change in successful HIV risk-reduction interventions. The final HIV-KQ for adolescent girls is a practical, specific, and appropriate instrument for use with adolescent girls in these settings. [ABSTRACT FROM AUTHOR]

Background and Purpose: Adolescent girls now represent one of the fastest growing groups of persons infected with HIV. A systematic review was undertaken to identify and critique the most scientifically rigorous HIV prevention interventions identified in the literature that focused on adolescent girls. Due to the limited number of randomized controlled trials (RCTs) in adolescent girls, the search was extended to identify any NIH-funded studies underway to provide an additional dimension to our understanding of the state of the science in this area.Method: An extensive search of the Cochrane database of systematic reviews, PubMed, Medline, PsycInfo, CINAHL, and CRISP was undertaken. Ultimately, six completed RCTs targeted at adolescent girls and measuring behavioral outcomes were critiqued and summarized. Key strengths and limitations were identified. Four additional studies were also summarized but were not critically reviewed because of their ongoing nature.Findings: Most intervention studies targeted at adolescent girls have been shown to affect change in HIV risk-related behaviors to varying degrees. Most intervention studies have been conducted using predominantly racial minority samples in the United States. Clinically relevant components of successful interventions include the combination of providing information and behavioral skills training, as well as enhancing motivation to reduce risk within these interventions. Considerable diversity in study methods (e.g., intervention, measures, outcomes assessed) was noted, thus limited research evidence has been amassed to guide practice implications.Conclusions and Implications: The state of the science for evidence-based practice is severely restricted in the area of gender-specific HIV prevention interventions for adolescent girls despite worldwide epidemiological trends that identify them as a high-risk group. The critical need for full-scale longitudinal interventions provided to both groups and individuals is evident. Studies that target various subpopulations of adolescent girls as well as those that address diverse cultures throughout the world are needed. Research in progress will provide further evidence of the efficacy of individual versus group-based interventions. [ABSTRACT FROM AUTHOR]

Focus groups were conducted with 45 young, single, low-income women regarding the human immunodeficiency virus (HIV). Risk in this sample was substantial, as 53% had multiple sexual partners, and 55% reported a recent sexually transmitted disease. Qualitative analysis of transcribed focus groups identified six themes that emerged across groups: (a) misinformation about vertical transmission and treatment of HIV-related illnesses; (b) risk perception linked to emotive factors rather than objective data; (c) uncertainty regarding the risk-reducing value of monogamy; (d) fatalism linked with ambivalence about HIV-antibody testing and treatment; (e) recognition of the importance of discussing HIV-related topics with children, but concern that such discussion with other women might be inappropriate; and (f) inconsistent communication regarding HIV transmission and prevention with partners, partly the result of concerns about violating trust in intimate relationships. These themes warrant attention in the development of HIV risk-reduction programs. [ABSTRACT FROM AUTHOR]

We have developed and evaluated a self-administered questionnaire of knowledge about human immunodeficiency virus HIV infection for use in program evaluation. Formative work led to the development of the 62-item HIV-Knowledge Questionnaire (HIV-K-Q), which was administered to 409 women and 227 men. Item analyses resulted in the deletion of 17 items that were either too easy or did not correlate well with the total score. Factor analysis on the remaining 45 items resulted in a single factor labeled HIV Knowledge. The generalizability of this one-factor solution was confirmed with data from 285 women and 76 men. Reliability analyses revealed that the HIV-K-Q is internally consistent (alpha = .91) and stable over 1-week (r = .83), 2-week (r = .91), and 12-week (r = .90) intervals. Evidence for the validity of the HIV-K-Q was assembled using known groups and treatment outcome analyses. Additional evidence emerged from analyses that revealed associations between scores on the HIV-K-Q and two related knowledge measures, and between H1V-K-Q scores and level of educational attainment. Discriminant evidence was obtained through nonsignificant relationships between the HIV-K-Q and potentially biasing constructs, including social desirability. The HIV-K-Q requires a sixth-grade education, and 7 min to complete. The HIV-K-Q is a reliable, valid, and practical measure of HIV-related knowledge that can be used with low-literacy adults. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare no conflicts of interest.

Aim: The aim of this study was to describe the experience of Norwegian nursing students with internationalization through participation in a Collaborative Online International Learning (COIL) course., Background: Educators in Norway and the United States collaborated to incorporate internationalization and population health concepts into virtual courses during the pandemic. Literature gaps exist in post-implementation assessment data that ascertain internationalization through the COIL experience., Design: This was a qualitative study with a descriptive design. Data were collected from focus group interviews and analyzed conventional content-analysis approaches., Methods: Fifteen Norwegian undergraduate nursing students who participated in the COIL opportunity completed focus group interviews., Findings: The themes identified included, "virtual conversation builds collaborations and enhances learning," and "this opened my eyes.", Conclusions: Norwegian students acknowledged they had learned transferable lessons from their global partners that could be applied to patient care of the marginalized population in Norway., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Nausea, vomiting and diarrhea are frequent co-occurring symptoms that can mask or mimic commonly occurring conditions, or rarely, more serious concerns. The Ending the HIV Epidemic's focus on increased widespread use of PrEP, a biomedical HIV prevention strategy, highlights the importance of discussing common clinical management scenarios. The use of oral PrEP formulations has demonstrated a "startup syndrome" which involves GI upset. This case challenge of a 32year old client admitted to the ED with GI symptoms highlights key PrEP considerations including a sexual health history. Clinicians should understand common complaints associated with oral PrEP start to improve differential diagnosis and appropriate intervention.

Refugee girls may be unprepared for the sexual risk challenges facing teens in the US. We sought to understand refugee girls' general experience, discussions with parents and motivations related to participation in an evidence-based sexual risk reduction program. Through semi-structured interviews with twelve girls ages 15-17 years from nine countries, we acquired insight into the girls' reactions to the program, if they had discussed their experiences, and reflections on their decision to participate. Qualitative analysis of verbatim transcriptions identified three themes: (1) my cultural norm is not to ask; (2) groups were a safe way for me to learn and share; and (3) I learned to use my voice. As the numbers of adolescent refugees grow, we cannot ignore their need for tailored sexual health research and programming. This first-of-its-kind study provides insight into acceptability, motivation for participation, and impact of a sexual health promotion program., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: With a focus on building global citizens, a U.S. and Norwegian academic collaborative partnership fostered clinical learning experiences addressing cultural and health care comparisons. High-impact educational practices integrated into international clinical experiences, combined with virtual global learning classrooms, highlighted the Sustainable Development Goals., Problem: Given nursing education's requirements, devising innovative strategies expanded global learning in brief but transformative experiences while integrating nontraveling students, especially relevant considering current pandemic-related travel restrictions., Approach: We developed an educational experience pairing U.S. students (17 in person; 64 through web conference) and Norwegian students (50 in person; 3 for web conference) in population health experiences, providing required clinical hours and a shared cultural exchange. Integration of nontraveling students in joint virtual global experiences broadened the global learning opportunity for all., Conclusion: This work offers insight into how faculty used a virtual global learning experience as a synergistic tool with traditional study abroad.

This study examined perceptions toward mental health and seeking psychological care among Bhutanese refugees in a large Midwestern U.S. city. Bhutanese adults ( n  = 201) completed a community health needs assessment. Survey questions addressed beliefs toward mental health and seeking psychological care. Perceptions toward mental illness and receiving psychological help were generally negative among participants. Over 71% believed others would look unfavorably on a person who sought out a counselor. Participants who had less than a high school education, were 35 years and older, and lived in refugee camps for more than 20 years had significantly greater negative beliefs toward mental illness. Over one-third (34.8%) of participants reported access to counseling services as being somewhat of a problem or a serious problem. These findings may inform future research and interventions aimed at improving mental health among Bhutanese refugees.

Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.

Sexually transmitted infections, HIV, and unplanned pregnancy challenge the health of Scottish teens. We conducted focus groups with teens (ages 16-19 years) recruited from an urban youth cafe in Edinburgh and assessed sexual risk-taking and protective behaviors. A trained facilitator, using a semi-structured interview guide, led the groups. We taped and transcribed data verbatim for coding and theming. The teens revealed similar concerns despite differences in gender and/or sexual histories. Despite school-based sex education, sex was rarely discussed with peers or adults outside classrooms; the ability to practice communication and negotiation skills was minimal. Much risky behavior occurred in public spaces and was often linked to drug or alcohol intake. There was a glaring lack of teen planning for, or contemplating, future adult lives. Findings highlight the challenges these teens faced in practicing safer sex and limited opportunities to tailor intervention strategies to address the cultural realities of their lives.

A disproportionate number of new HIV infections in the United States occur in Black women. We pilot-tested feasibility and acceptability of a manualized HIV prevention intervention developed with and for Black college women. We used a prospective, randomized 2-group design, with 3 data collection times. Participants included 18- to 24-year-old Black women (N = 65), who were enrolled at 2 southern universities; 46 completed pre- and post-assessments. We found that participants in the intervention arm had positive changes in HIV knowledge (p < .0001) and behavioral intentions (p = .039) outcomes. There were, however, no significant differences between intervention and control groups when considering motivational factors and behavioral skills that promoted HIV prevention: social norms, condom use self-efficacy, and assertive sexual communication. We found preliminary evidence of efficacy for an HIV prevention intervention tailored to Black college women. Researchers should partner with Black college women to develop and implement HIV prevention interventions.

Background: The #MeToo social media campaign in the United States has highlighted what is a pervasive problem in many cultures-the sexual intimidation and victimization of women by men, especially those in roles of authority., Methods: In a study of 735 girls, ages 15-19 years, enrolled in a sexual risk reduction randomized controlled trial, we captured baseline data using audio-computer assisted self-interviews to increase validity and reliability of responses to questions regarding such behaviors., Results: Despite their age, one-half of these girls reported being coerced into sex acts (excluding intercourse) with 1 in 5 reporting such victimization by a man who used his position of authority. Alarmingly, 12-28% of girls reported being forced into penetrative sex acts against their will. Far too many girls reported they had had multiple episodes of such violence., Linking Evidence to Action: It is clear that this study captures a common, but minimally documented, threat faced by adolescent girls ranging from men pressuring them to engage in sex activities through the use of victimization, intimidation, or provision of substances to underage girls to gain compliance. Using such evidence to enhance and tailor sexual risk reduction, health, safety, and communication interventions for both males and females is essential. Identifying triggers to at-risk situations, providing skill building in communication, negotiation and refusal skills, as well as clearly discussing consent issues among both genders are important components in evidence-based interventions if we are to impact positively the next generation to curtail sexual pressure, coercion, and violence., (© 2018 Sigma Theta Tau International.)

Identifying why girls participate in safe and risky sexual behaviors is key to developing successful intervention strategies. This study identified motivations for sex in 738 girls enrolled in the Health Improvement Project for Teens (HIPTeens) randomized controlled trial and analyzed differences in sex motives among at-risk subgroups. Sexually active girls, ages 15-19 years, were recruited from urban community-based settings. Baseline data were collected via audio computer-assisted self-interview surveys including a modified Sex Motives Scale based on six domains (intimacy, enhancement, self-affirmation, coping, peer pressure, and partner approval), assessing drivers of both protective and risk-promoting motivations. Statistically significant motive differences across domains were identified among subgroups with different risk profiles, including mental health issues (depression, drug and alcohol use) as well as demographic group characteristics (race, age, and parental status). Understanding why girls have sex provides an opportunity to address motivation-focused strategies that may augment intervention efficacy., (Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

HIV prevention interventions can help college students engage in safe sexual behaviors. We used the Information, Motivation, Behavioral Skills model to frame four focus group discussions with Black women (n = 32) attending a historically Black college/university or a traditional university to understand their HIV prevention needs. Participants wanted clear information about sexually transmitted infections/HIV and access to contraception. Motivators for practicing safe sex were related to cultural and religious expectations, desire to avoid pregnancy, and conscious efforts to defy racial stereotypes. Barriers to practicing safe sex included issues of accountability, stigma associated with accessing HIV testing/prevention services, and media influences. We found general consensus about the need to develop skill-building HIV prevention interventions focused on communication skills, condom negotiation, access to services, and empowerment. We offer insight into culture- and age-appropriate HIV prevention for Black college women to guide the development of future interventions., (Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

The preparation of future baccalaureate-prepared nurses will require undergraduate students to have both cultural awareness and global or international health competencies in order to meet the increasingly complex health care needs of a diverse community. Additionally, the nursing accrediting bodies have identified global healthcare as an area of core knowledge for clinical nurses. In order to meet the workforce needs, and provide global education of the undergraduate student body, we designed an international clinical experience within the undergraduate Community/Population Health course. The purpose of this article is to provide a guide for faculty in the planning, infrastructure needs, and implementation of a global clinical experience for undergraduate nursing students, in the context of the United States with addressing university concerns for student safety and security while abroad., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The purpose of this article is to discuss lessons learned from conducting research with urban communities. A brief overview of the Health Improvement Project for Teens (HIPTeens) will be provided. It will be followed by several suggestions concerning recruitment and retention of participants, challenges related to working in impoverished environments, hiring and training of research teams, interacting with administration and community, and strategies for doing research in diverse settings., (© The Author(s) 2015.)

Background: To address the unique needs of our returning military and veterans, the White House initiated the Joining Forces campaign and has encouraged colleges of nursing throughout the nation to support this mission., Methods: At the University of South Florida College of Nursing, we have implemented a multifaceted approach that addresses education, research, and employment. These military-related programs have been unified under our RESTORE LIVES (Research and Education to Rehabilitate and Restore the Lives of Veterans, Services Members and their Families) initiative., Results: To accomplish this mission, we enhanced our curriculum to include veteran health care issues, developed research that addresses veteran wellness, launched an accelerated program to enable veterans and military personnel with medical experience to obtain their baccalaureate in nursing, and encouraged a culture within the college that is supportive of military-based health care and employment needs., Conclusions: We have shared our experiences through webinars and presentations and by hosting a national conference., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Gestational weight gain (GWG) is a modifiable risk factor for obesity in women. Black women have the greatest prevalence of high body mass, which predisposes them to excessive GWG. Increased understanding of genetic influences on GWG has implications for the health of women. The purpose of this study was to explore the associations of GNB3 and FTO risk alleles in pregnant women with prepregnancy body mass index (BMI), GWG, and postpartum and infant birth weights., Research Design and Methods: This was an observational, prospective candidate gene association study. Pregnant, low-income Black women (N = 97) were enrolled in early pregnancy and followed until 6 months postpartum., Results: GWG differed depending on number of FTO risk alleles. The mean 6-month postpartum BMI differed, although not significantly, by 4 kg/m(2) between homozygous women. There was an interaction between the FTO risk allele and prepregnancy BMI (p = .022), with obese homozygote AA women having significantly higher mean GWG than obese TT women. When controlling for age and smoking, the FTO gene and physical activity predicted GWG (p = .032). Although not statistically significant, women who carried the GNB3 T risk allele gained 6 pounds more than noncarriers, and mean 6-month postpartum BMI differed by 2.2 kg/m(2) between homozygous women. Neither the GNB3 nor FTO gene predicted prepregnancy BMI, infant birth weight, or postpartum weight., Conclusion: Obese women homozygous for the FTO risk allele were at greater risk of excessive GWG compared to nonrisk allele homozygous obese women or nonobese women. This study provides evidence of the FTO gene's effect on GWG in Black women., (© The Author(s) 2014.)

Aims and Objectives: To investigate differences in sexual risk factors between adolescent girls reporting similar-aged or older sex partners., Background: Adolescent girls are at significant risk of heterosexual-acquired HIV infection and other long-term reproductive health issues. Sexual partner age discordance in teen girls has been correlated with STIs, lack of protection, multiple partners and earlier age of sexual transition., Design: A descriptive study comparing girls currently involved with age-discordant partners to those with similar-aged partners. Two-sample t-test for continuous variables and chi-squared test or Fisher's exact test for categorical variables were used to compare groups., Methods: Baseline data from 738 sexually active, urban, adolescent girls aged 15-19 were analysed to determine which behaviours were more likely to occur in girls with older partners. Data were collected as part of a gender-specific HIV-prevention intervention in a randomised controlled trial (RCT) tailored to adolescent girls., Results: Multiple reported sexual risk behaviours were found to significantly differ between the two groups at baseline. Overall, girls with older partners had more episodes of sexual instances (vaginal, anal and oral). Specific sexual risk behaviours were found to be statistically significant between the two groups. Girls with older partners started having sex at earlier ages, had more lifetime sexual partners, higher incidents of STIs and were reluctant to discuss using condoms with their partners. Girls with similar-aged partners were less willing to engage in risky sexual behaviours., Conclusions: Findings from this investigation support data from other studies. Relationships with older male partners place adolescent girls at increased risk of HIV/STIs and unintended pregnancy., Relevance to Clinical Practice: Adolescent girls in age-discordant relationships are at risk of immediate and long-term sexual health morbidities. Identifying girls who are at increased risk by asking tailored questions will enable nurses to recommend appropriate diagnostics for this population and provide age-specific counselling., (© 2013 John Wiley & Sons Ltd.)

One quarter of HIV cases occur in women ages 15-44 years. We investigated preferential HIV prevention message mediums among college women (18-21 years of age) and their association with parent and partner communication. A nonexperimental cross-sectional survey assessed factors associated with parent and partner communication among 626 single female students who were sexually active in the previous 6 months and attending a 4-year public university in Florida. Women who perceived themselves to be at elevated risk of acquiring HIV were more likely to communicate with their parents (p < .05), but not their partners. In multivariable analysis, students were more likely to communicate about sexual risk behavior with their parents when mothers were younger and when less influenced by their peers. Reading items on the Internet about intravenous drug use and HIV were independently associated with higher parent and partner communication, respectively. Findings can guide future HIV prevention communication interventions., (Published by Elsevier Inc.)

Unlabelled: Adolescent girls throughout the globe are particularly vulnerable to HIV infection. In the U.S., sexually-active, adolescent girls in urban settings are at elevated risk for HIV. The purpose of this study was to describe a theoreticallydriven, HIV prevention intervention tailored for adolescent girls and evaluate its effectiveness in reducing sexually-risky behaviors. Sexually-active urban adolescent girls (n=738) recruited in a mid-size, northeastern U.S. city were recruited for a randomized controlled trial and participated in a theory-based, sexual risk reduction intervention or a structurallyequivalent health promotion control group. Preferred sexual risk-reduction strategies were collected using ACASI at baseline, then at 3, 6 and 12-months post-intervention. The manualized interventions included four small group sessions and two booster sessions all of which included information, motivational and behavioral skill constructs. Facilitators were trained in motivational interviewing and incorporated this technique throughout the sessions. Relative to girls in the control group, girls receiving the sexual risk-reduction intervention were more likely to increase the number of sexual-risk reduction strategies at post-intervention; however, girls in the control group also increased the number of strategies used though not at the same rate. Theory-based, HIV interventions tailored to adolescent girls can help increase sexual riskreduction behaviors and provide girls with a menu of options to employ. Due to the manualized structure of this randomized controlled trial, the intervention could be modified to meet the needs of adolescent girls throughout the world., Trial Registration: This study is registered at ClinicalTrials.gov (NCT 00161343).

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc's framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors' effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (-.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Introduction: The purpose of this study was to invite girls who participated in a gender-specific sexual risk-reduction intervention to describe their experiences and identify program characteristics most or least beneficial to their involvement., Methods: Semistructured interviews were completed with 26 African American, low-income girls aged 15 to 19 years who had participated in a sexual risk-reduction intervention as part of a randomized controlled trial. The girls were interviewed after completing a 12-month postintervention survey. Interviews were recorded, transcribed, and analyzed for categories., Results: Analyses of the interview data identified 6 categories: 1) reasons for participating, 2) strategies for maintaining behavior changes, 3) interacting with others, 4) communicating with mothers, 5) disseminating information to friends and family, and 6) disseminating information to the males in the community., Discussion: Many of the girls participating in the theory-based behavior change intervention reported selecting from a menu of strategies learned through the intervention to reduce their sexual risk. Having the opportunity to discuss sexual health with peers and trained facilitators, particularly in an all-female environment, was cited as a positive benefit. Community health organizations and clinicians who care for adolescent girls can adapt many aspects of this intervention to help reduce their sexual risk., (© 2013 by the American College of Nurse-Midwives.)

Introduction: This research was conducted to gain insight into how low-income, pregnant, African American women viewed physical activity and approached nutrition during pregnancy., Methods: Three focus groups with a total of 26 women were conducted utilizing open-ended questions related to physical activity and diet during pregnancy. Content analysis was used to analyze the verbatim transcripts. Groups were compared and contrasted at the within-group and between-group levels to identify themes., Results: Two themes that related to physical activity during pregnancy were identified: 1) fatigue and low energy dictate activity and 2) motivation to exercise is not there. Three themes were identified that related to diet: 1) despite best intentions, appetite, taste, and cravings drive eating behavior; 2) I'll decide for myself what to eat; and 3) eating out is a way of life., Discussion: Women reported that being physically active and improving their diets was not easy. Women indicated that their levels of physical activity had decreased since becoming pregnant. Attempts at improving their diets were undermined by frequenting fast food restaurants and cravings for highly dense, palatable foods. Women ceded to the physical aspects of pregnancy, often choosing to ignore the advice of others. A combination of low levels of physical activity and calorie-dense diets increased the risk of excessive gestational weight gain in this sample of women, consequently increasing the risk for weight retention after pregnancy. Health care providers can promote healthy eating and physical activity by building on women's being "in tune with and listening to" their bodies. They can query women about their beliefs regarding physical activity and diet and offer information to ensure understanding of what contributes to healthy pregnancy outcomes. Intervention can focus on factors such as cravings and what tastes good, suggesting ways to manage pregnancy effects within a healthy diet., (© 2013 by the American College of Nurse-Midwives.)

Purpose: Teenage girls in low-income urban settings are at an elevated risk for HIV, sexually transmitted infections, and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction (SRR) intervention, supplemented with postintervention booster sessions, targeting low-income, urban, sexually active teenage girls., Method: Randomized controlled trial in which sexually active urban adolescent girls (n = 738) recruited in a midsize northeastern U.S. city were randomized to a theory-based SRR intervention or to a structurally equivalent health promotion control group. Assessments and behavioral data were collected using audio computer-assisted self-interview at baseline, then at 3, 6, and 12 months postintervention. Both interventions included four small-group sessions and two booster sessions., Results: Relative to girls in the control group, girls receiving the SRR intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all follow-ups, (b) number of unprotected vaginal sex acts at 3 and 12 months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n = 322) documented a 50% reduction in positive pregnancy tests at 12 months., Conclusions: Theory-based behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of SRR interventions for girls is needed to ensure they are feasible, appealing, and effective., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)