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HIV continues to be serious issue in the U.S., especially for men who have sex with men (MSM). Pre–exposure prophylaxis (PrEP) is a highly effective means of preventing HIV, but its adoption has be...

In this manuscript, we present recent findings concerning concordance and discrepancy between biological measures and self-reports of these three outcomes of HIV programs: HIV status, adherence to antiretroviral medications (ARVs) and use of and adherence to pre-exposure prophylaxis medication (PrEP), and condom use/unprotected sex. Recent studies suggest that three successive rapid HIV tests (for those whose first test in positive) might be reasonably inexpensive and valid biological data to collect to combine with self-reports of HIV status, dried blood spots sufficiently affordable to combine with self-reports of adherence to ARVs and use of or adherence to PrEP, and that the discrepancy between self-reports of condom use and biomarkers of unprotected sex may be relatively small in high-income countries. Additional work on assessment of incorrect condom usage and breakage, standardized self-report measures of condom use, and more private data collection methodologies in low-income settings might reduce the recent observed discrepancies even further. Concordance between self-reports of HIV and biomarkers indicating HIV positive status has varied considerably, with much lower rates in low-income countries, where the stigma of HIV is still very high. Recommendation is for combining self-report data with the results of three successive rapid tests for those testing positive. For adherence, again agreement between self-reports and a variety of more objective and/or biological measures is only moderate. Dried blood spots (DBS) may be sufficiently inexpensive in low-resource settings that this may be the best biological method to combine with self-reports. In publications over the last 8 years, the discrepancy between self-reports of condom use and biomarkers for unprotected sex may be even lower than 20% after controlling for other features of the study, particularly in high-income countries. Our results suggest that more careful assessment of incorrect condom use and breakage as reasons other than intentional misreporting should be investigated more carefully and that more private data collection methods such as audio, computer-assisted self-interviewing (ACASI) might be employed more often in low-resource settings to reduce this discrepancy in those settings further. In addition, further analysis of the discrepancy between self-reports of condom use and biomarkers should be conducted of published studies using the correct calculation methods to be more certain of these findings.

This study evaluated The Grassroot Project, a middle school sexual health promotion program in Washington, DC that uses university-level athlete role models and sports-based games. Seven schools we...

Little attention has been paid to goal structures in health education, despite their well-established roles in motivation and learning. The primary goal of this study was to examine the longitudinal relations of classroom goal structures to high school students’ (N = 636) motivation and learning outcomes in health education. We incorporated two aspects of motivation: self-efficacy for negotiating condom use and task values for learning new information about HIV and pregnancy prevention. Results revealed that students’ perceptions of a mastery goal structure were positively related to their self-efficacy and task values, and also their knowledge and behavioral intentions one year after the health education curriculum had been delivered. In contrast, students’ perceptions of an extrinsic goal structure were not related to their motivation and learning outcomes. Our findings suggest that the implementation of instructional practices focusing on mastery may enhance the efficacy of HIV and pregnancy prevention programs. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Background Transgender women (“trans women”), particularly African-American and Latina trans women, have disproportionately high prevalence of HIV in the United States (U.S.). In order to decrease gender dysphoria and overcome discrimination, trans women affirm their gender through social and medical transition, often in contexts of economic hardship and sexual risk. This study qualitatively examined how gender-affirming behaviors enhance or diminish vulnerability to HIV in light of structural and economic barriers to gender transition. Methods We conducted individual interviews with 19 adult trans women in two U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of trans women were racial/ethnic minorities with mean age of 26.3 years. Gender-affirming behaviors varied with 58% of trans women having legally changed their name and gender marker; 79% having initiated hormone therapy; and 11% having not initiated any medical or legal changes. None had undertaken surgical changes. Findings suggested that the process of gender transitioning resulted in both increasing and decreasing HIV risk. The high need for gender affirmation by male sex partners contributed to trans women’s exposure to sexual objectification, sexual risk behaviors, and conflicting interests in HIV prevention messaging. Loss of housing and employment due to transition along with the high costs of transition products and medical visits increased reliance on sex work and created new obstacles in accessing HIV services. Trans women experienced lower HIV risk as they acquired legal and medical transition services, reshaped interactions with sex partners, and received gender-affirming support by others, including health providers, employers, peers, and housing professionals. Sexual abstinence was viewed as a negative consequence of incomplete transition, although characterized as a period of low HIV risk. Conclusions Structural and policy initiatives that promote safe gender transition and economic stability in trans women may play a critical role in reducing HIV in this population. Addressing the harmful pressures for U.S. trans women to conform to perceived feminine stereotypes may also serve an important role.

Background Transgender women in the United States (U.S.) experience a disproportionate burden of HIV infection and challenges to engagement in HIV prevention and care. This excess burden is driven by structural and economic inequities. Microeconomic interventions may be effective strategies for reducing HIV inequities for this population. However, few studies have explored transgender women’s preferences for microeconomic interventions to address structural determinants of HIV vulnerability. Methods We conducted individual interviews with 19 adult transgender women in 2 U.S. cities (Richmond, VA and St. Louis, MO) who reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing, or food security. Interviews were recorded, transcribed, and analyzed using thematic content analysis. Results The majority (74%) of transgender women were racial/ethnic minorities with mean age of 26.3 years. 89% were currently economically vulnerable; and 23% were employed full-time. 37% reported living with HIV. Participants expressed strong support for unrestricted vouchers, with many expressing the need for funds to support gender-affirming interventions. Assistance with how to budget and save and support for job acquisition, career planning, and employment sustainment were also preferred, including access to non-stigmatizing employment. Visible transgender leadership, group empowerment, and small (rather than large) numbers of participants were considered important aspects of intervention design for transgender women, including outreach through existing transgender networks to facilitate inclusion. Incorporating HIV counseling and testing to reduce vulnerability to HIV was acceptable. However, transgender women enrolled in the study preferred that HIV not be the focus of an intervention. Conclusions Flexible microeconomic interventions that support gender affirming interventions, improve financial literacy, and provide living-wage non-stigmatizing employment are desired by economically vulnerable transgender women. While not focused on HIV, such interventions have the potential to reduce the structural drivers of HIV vulnerability among transgender women.

Background:A sense of competency and confidence in disaster management is linked to response willingness and efficacy. This study assessed current health-care student disaster competency curricula and resultant confidence.Methods:A survey was sent to students and administrators in nurse practitioner (NP), master of public health (MPH), and medical/osteopathic schools (MD/DO), assessing curriculum coverage of 15 disaster management competencies (1-4, total 15-60), and confidence in performing 15 related behaviors (1-7, total 15-105). One-way analysis of variance with Tukey’s post-hoc and Mann-Whitney U-tests were used to examine group differences.Results:A total of 729 students and 72 administrators completed the survey. Low coverage of all topics was reported by both students and administrators (mean 24.4; SD 9.6). Among students, NP students (21.66 ± 8.56) scored significantly lower than MD/DO (23.32 ± 8.19; P < 0.001) and MPH students (26.58 ± 9.06; P < 0.001) on curriculum coverage. Both administrators and students expressed low confidence in competence, with students significantly lower (P < 0.001). NP students scored higher (63.12 ± 20.69; P < 0.001) than both MPH (54.85 ± 17.82) and MD/DO (51.17 ± 19.71; P < 0.001) students.Conclusions:Health-care students report low coverage of topics considered to be necessary disaster response competencies, as well as their confidence to execute functions. This may negatively impact willingness and ability of these professionals to respond effectively in a disaster.

Pregnant women and children and individuals suffering from chronic illness are disproportionally impacted by public health emergencies. To meet the healthcare needs of these populations, the nursing workforce must be capable of responding in a timely and appropriate manner. The goal of this project was to create interactive and engaging evidence-based educational tool kits to advance healthcare provider readiness in the management of population health in response to the Zika and Flint Water crises. A multipronged, mixed-methods approach was used to identify essential education needs and required core competencies. Data were synthesized from discussion with key informants, review of relevant documents, and surveys of schools of nursing, public health, and medicine. The ADDIE model was used to integrate results into the development of the online learning tool kits using the ThingLink software program. An innovative online educational program to prepare healthcare providers to rapidly identify, mitigate, and manage the impact of the Zika and Flint Water crises upon pregnant women and children was implemented by the Society for the Advancement of Disaster Nursing. Innovative online learning tool kits can advance healthcare provider readiness by increasing knowledge and understanding of key components of specific public health emergencies.

This study examined how frequently men who have sex with men (MSM) used a selection of sources, including news media, social media, health organizations, and dating/hookup apps, for HIV information. Additionally, the study explored the extent to which MSM's efficacy beliefs about pre-exposure prophylaxis (PrEP) and perceptions of condom importance could be predicted by the sources they used. A sample of MSM (

HIV treatment optimism and the ways in which news of HIV biomedical advances in HIV is presented to the most at-risk communities interact in ways that affect risk behavior and the incidence of HIV. The goal of the current study was to understand the relationships among HIV treatment optimism, knowledge of HIV biomedical advances, and current and expected increased risk behavior as a result of reading hypothetical news stories of further advances. Most of an online-recruited sample of MSM were quite knowledgeable about current biomedical advances. After reading three hypothetical news stories, 15-24% of those not living with HIV and 26-52% of those living with HIV reported their condom use would decrease if the story they read were true. Results suggest the importance of more cautious reporting on HIV biomedical advances, and for targeting individuals with greater treatment optimism and those living with HIV via organizations where they are most likely to receive their information about HIV.

Discrimination and victimization are very common experiences of transgender women. Social marginalization is often linked to poor mental health, substance use, and risky sexual behaviors. HIV prevalence in transgender women in the USA may be as high as 27.7%, and has been estimated at nearly 50 times that of the overall adult population globally. It is in this context that we test structural equation models for the relationships among perceived gender-identity discrimination, internalized anxiety about being transgender (transphobia), mental health problems, illicit substance and alcohol use, and HIV risk behaviors. We tested two mediational models: one that proposes mental health, alcohol, and other substance use as key mediators of sexual risk behaviors, and the other that posits the exchange of sex for money or goods as a key mediator linking mental health and substance use with other risky sexual behaviors. Our results suggest that perceived gender-identity discrimination and internalized transphobia ...

In this study, we explored the role of reciprocal filial values in protecting the wellbeing of Chinese adult-child caregivers in the US. Using survey data obtained from 137 Chinese adult-child caregivers living in seven US cities, we tested a latent variable model using structural equation modeling. In this model, informed by role theory, social exchange theory and stress-coping theory, reciprocal filial values affect caregiver wellbeing in the face of caregiver role strain, both directly and indirectly through protective effects of role rewards and coping. In the final model, reciprocal filial values had both direct and indirect protective effects on caregivers' wellbeing, offering evidence to address culturally sensitive issues in family caregivers with similar filial values.

This research compared the ability of the theory of planned behavior (TPB) and the altruism framework (AM) to predict paper-recycling behavior. It was comprised of formative research and a major survey. Data collected from 628 undergraduate students in Thailand were analyzed using structural equation modeling. Results showed that TPB was superior to AM in predicting paper recycling. Perceived behavioral control was the only significant determinant from the TPB; personal norms alone significantly predicted behavior in AM. A communication approach is proposed to reinforce change in sociopsychological factors that could lead to a long-term paper-recycling commitment.

Background The “Undetectable = Untransmittable” (“U=U”) campaign is gaining traction, but prior studies from 2012–2017 have shown that the proportion of gay and bisexual men who have sex with men (GBMSM) who are aware of or have perceived accuracy of U=U is low. We report findings from a survey administered to GBMSM in 2018 to understand whether the landscape is changing with respect to U=U message dissemination. Methods GBMSM were recruited on gay dating apps to complete a 96 question survey. Survey data were collected in April-August of 2018. Collected data elements included demographic information, HIV status, ART and PrEP use, and beliefs and opinions regarding HIV transmission. Results 969 GBMSM completed the survey; of whom, 678 had analyzable data (241 had never had anal sex with a man and 54 were missing ≥1 of the variables used in the analysis). Average age was 43 years, 65% were white, 15% black, 15% white, and 15% were HIV-infected (of whom 92% were on anti-retrovirals). Of the 85% who were HIV-uninfected, 39% were on PrEP. In response to the statement that a person with an undetectable viral load cannot transmit HIV to an HIV-uninfected person, 24% strongly agreed. Among HIV-negative GBMSM, 33% of those on PrEP agreed and 12% of those not on PrEP agreed. Among those living with HIV, 42% agreed. A multivariable logistic regression was run to explain correlates of strong agreement with U=U, using the following variables: age, education, being Black, being Hispanic, relationship status, number of lifetime male sexual partners, condom use with most recent anal sex, HIV status, PrEP use, and attitudes about living with HIV. Variables associated with strong agreement with U=U were living with HIV (AOR = 1.63, P < 0.001), taking PrEP (AOR = 2.85, P < 0.001), most recent encounter’s condom use (AOR = 2.22, P = 0.003), and having positive attitudes about living with HIV (AOR= 1.93, P < 0.001). Table 1 shows percentages for each of these variables (bivariate relationships) strongly agreeing with U=U. Conclusion Now that U=U has been scientifically proven, the challenge is public awareness. U=U awareness seems to be improving among GBMSM, with HIV-negative GBMSM making the greatest strides. Education around U=U and PrEP efficacy may help reduce guilt around HIV transmission and alleviate HIV stigma. Disclosures All authors: No reported disclosures.

Vulnerability to drug abuse is related to both reward seeking and impulsivity, two constructs thought to have a biological basis in the prefrontal cortex (PFC). This review addresses similarities and differences in neuroanatomy, neurochemistry and behavior associated with PFC function in rodents and primates. Emphasis is placed on monoamine and amino acid neurotransmitter systems located in anatomically distinct subregions: medial prefrontal cortex (mPFC); lateral prefrontal cortex (lPFC); anterior cingulate cortex (ACC); and orbitofrontal cortex (OFC). While there are complex interconnections and overlapping functions among these regions, each is thought to be involved in various functions related to health-related risk behaviors and drug abuse vulnerability. Among the various functions implicated, evidence suggests that mPFC is involved in reward processing, attention and drug reinstatement; lPFC is involved in decision-making, behavioral inhibition and attentional gating; ACC is involved in attention, emotional processing and self-monitoring; and OFC is involved in behavioral inhibition, signaling of expected outcomes and reward/punishment sensitivity. Individual differences factors (e.g., age and sex) influence functioning of these regions, which, in turn, impacts drug abuse vulnerability. Implications for the development of drug abuse prevention and treatment strategies aimed at engaging PFC inhibitory processes that may reduce risk-related behaviors are discussed, including the design of effective public service announcements, cognitive exercises, physical activity, direct current stimulation, feedback control training and pharmacotherapies. A major challenge in drug abuse prevention and treatment rests with improving intervention strategies aimed at strengthening PFC inhibitory systems among at-risk individuals.

Adolescents remain the most critical group to target for reducing human immunodeficiency virus (HIV) infection, as most infections occur during this period. However, given that the rates of HIV infection continue to rise, South African youth would appear to be unable to protect themselves as well as they should. Gender role attitudes have been implicated in adolescent boys having multiple partners and inconsistent condom use. We examined gender role attitudes among schoolgoing adolescents in a South African township. While partial correlations showed that male gender role attitudes were related to positive condom attitudes, positive attitudes to waiting for sex, peer pressure to have sex, condom self efficacy and intention to use condoms, the effect of this mediational variable was indirect rather than direct. Logistic regression revealed mediating effects of traditional gender roles attitudes for girls in relation to last condom use but not for condom attitudes, condom self-efficacy or negotiati...

Although a number of interventions are effective at reducing risky adolescent sexual behavior it may be possible to make them even more effective by addressing adolescents approaches to risk-taking. Schools were assigned to teach one of three curricula in a quasi-experimental intervention study: the schools standard pregnancy and HIV prevention curriculum; the Reducing the Risk curriculum; or a modified Reducing the Risk curriculum adapted for high sensation seekers and impulsive decision makers. A sample of 1944 students from 17 schools was surveyed at three time points between 1995 and 1997. Mixed models regression and logistic regression were used to examine the difference in impact among curricula. Differences in the impact of the original and modified Reducing the Risk interventions were not significant for the total sample or for high sensation seekers and impulsive decision makers separately. Students from both intervention groups demonstrated short-term improvements in knowledge; students who received their schools standard curriculum were significantly more likely than those assigned to either intervention to have initiated sexual intercourse by the third time point (odds ratio 2.4). More work is necessary to understand the best ways to design classroom messages that will be effective in reducing the risk behaviors of high sensation seekers and impulsive decision makers. (authors)

A computer- and Internet-based intervention was designed to influence several variables related to the prevention of pregnancy, STDs, and HIV in rural adolescents. Three-hundred and thirty-eight tenth-graders enrolled in two rural public high schools participated in this field experiment. Results indicate that students in the experimental school had greater knowledge, greater condom negotiation efficacy, greater situational efficacy, and more favorable attitudes toward waiting to have sex than students in the control school. In tandem, the results suggest that computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy, STDs, and HIV.

A comprehensive multiple domain model (MDM) to understand condom use in adolescents was proposed and tested using structural equation modeling of data at three time points. The proposed model integrates social psychological theory, demographic and personality factors, social environment, and situational/contextual variables. Adolescents who were sexually active at time 2 (6 months after baseline) and time 3 (1 year after time 2) and completed surveys at all three time points were included in the analyses (N = 511). An iterative process of model testing resulted in a structural equation model that provided a good fit to the data (CFI = .92, RMSEA = .04). Models comparing gender and race as moderators also were calculated and supported the generalizability of the model. Results provide support for an MDM that goes beyond traditional social psychological models for a broader understanding of condom use in adolescents. Implications for further theory testing and safer sexual interventions are discussed.

This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month high-audience-saturation campaign took place in Lexington, KY, with Knoxville, TN, as a comparison city. Messages were especially designed and selected for the target audience (those above the median on a composite sensation-seeking/impulsive-decision-making scale). Data indicate high campaign exposure among the target audience, with 85%-96% reporting viewing one or more PSAs. Analyses indicate significant 5-month increases in condom use, condom-use self-efficacy, and behavioral intentions among the target group in the campaign city with no changes in the comparison city. The results suggest that a carefully targeted, intensive mass media campaign using televised PSAs can change safer sexual behaviors.

A computer-based intervention was designed to change perceived threat, perceived efficacy, attitudes, and knowledge regarding pregnancy, STD, and HIV prevention in rural adolescents. The intervention, which was guided largely by the extended parallel process model (Witte, 1992), was implemented and evaluated in nine rural high schools using an institutional cycle pretest-posttest control-group design (Campbell & Stanley, 1963; Cook & Campbell, 1979). Eight-hundred eighty-seven ninth-graders completed the survey at both points in time. Process evaluation results indicated that the intervention was implemented as intended, and that over 91% of students in the treatment group completed at least one of the six computer-based activities (M = 3.46, SD = 1.44 for those doing at least one activity). Two-way mixed-model repeated-measures analysis of variance revealed that students in the treatment group outperformed students in the control group on knowledge, condom self-efficacy, attitude toward waiting to have sex, and perceived susceptibility to HIV. These results suggest that computer-based programs may be a cost-effective and easily replicable means of providing teens with basic information and skills necessary to prevent pregnancy, STDs, and HIV.

Fear appeals are a polarizing issue, with proponents confident in their efficacy and opponents confident that they backfire. We present the results of a comprehensive meta-analysis investigating fear appeals' effectiveness for influencing attitudes, intentions, and behaviors. We tested predictions from a large number of theories, the majority of which have never been tested meta-analytically until now. Studies were included if they contained a treatment group exposed to a fear appeal, a valid comparison group, a manipulation of depicted fear, a measure of attitudes, intentions, or behaviors concerning the targeted risk or recommended solution, and adequate statistics to calculate effect sizes. The meta-analysis included 127 articles (9% unpublished) yielding 248 independent samples (NTotal = 27,372) collected from diverse populations. Results showed a positive effect of fear appeals on attitudes, intentions, and behaviors, with the average effect on a composite index being random-effects d = 0.29. Moderation analyses based on prominent fear appeal theories showed that the effectiveness of fear appeals increased when the message included efficacy statements, depicted high susceptibility and severity, recommended one-time only (vs. repeated) behaviors, and targeted audiences that included a larger percentage of female message recipients. Overall, we conclude that (a) fear appeals are effective at positively influencing attitude, intentions, and behaviors; (b) there are very few circumstances under which they are not effective; and (c) there are no identified circumstances under which they backfire and lead to undesirable outcomes.

Male-to-female transgender women (TGW) experience high rates of substance use and HIV. A recent substance use trend is the use of prescription medication without a doctor’s consent. No research to date has examined the associations between this non-medical use of prescription drugs and HIV risk behaviour in TGW. In the present study, TGW recruited from community venues (N = 104) in the Mid-Atlantic region of the United States completed surveys assessing demographic information, non-medical use of prescription drugs, other substance use, injection practices and sexual risk behaviour. Twenty-four per cent of the sample reported lifetime non-medical use of prescription drugs across the following categories: analgesics (21.2%), anxiolytics (14.4%), stimulants (12.5%) and sedatives (8.7%). Participants reporting non-medical use of prescription drugs were more likely to report other substance use, needle use to inject drugs, injecting silicone and sharing needles. In multivariable analyses, non-medical use of prescription drugs was associated with unprotected sex, sex after engaging in substance use, and commercial sex work, after controlling for demographic factors. Self-esteem and social support from family served as protective factors for non-medical use of prescription drugs. HIV-prevention programmes focused on TGW in the United States may wish to expand their assessment of substance use to include the use of prescription medications without a physician’s consent.

The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

The purpose of this cross-sectional study is to examine how personality traits such as sensation- seeking and impulsive decision-making affect Taiwanese college students' intentions to seek online information about sexually transmitted diseases (STDs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Five hundred thirty-five (n = 535) junior and senior college students in Taiwan were recruited and completed self-report questionnaires. This study found high sensation-seekers were more likely to seek information about STDs and HIV/AIDS on the Internet than low sensation-seekers. Impulsive decision-makers were less likely than rational decision-makers to seek information about STDs and HIV/AIDS on the Internet. These findings suggest that personality needs to be considered as an exploratory factor which potentially influences intentions to seek STD and HIV/AIDS information on the Internet among Taiwanese college students.

The primary purpose of this study was to develop a perceived message cognition value (PMCV) scale and provide preliminary evidence concerning its reliability and validity. The manuscript presents PMCV as a theoretical construct consisting of three distinct dimensions: cognitive challenge, credibility, and clarity. Exploratory factor analysis revealed a significant three-factor solution, and SEM confirmed a significant second-order model that accounted for variations in the three dimensions. Composite scale and subscale reliabilities are presented, and composite scale/subscale stability across psychographic and message variables is demonstrated. The manuscript concludes with an argument that a reliable and valid PMCV scale can aid persuasion researchers in designing more effective health behavior change messages.

One of the greatest obstacles to conducting school-based HIV/STD/pregnancy prevention research with adolescents is the reluctance of administrators or site-based decision-making councils to commit their teachers and students to participation in a project designed and managed by an outside group of researchers. A major concern is that researchers may not understand or agree with community sensitivities about such personal topics. By first establishing a collaborative relationship with health district educators currently working in Appalachian schools and residing in those communities, one finds a distinct advantage in terms of gaining admittance to area schools. The presence of local health educators at formative meetings also allays many concerns of community members, as they view these local participants as monitors of outsider research efforts, thereby protecting the community culture from undue outside influence. During the course of the current study, health educators found they also learned more about their communities and about HIV prevention.

The high prevalence of HIV among young people in African countries underscores a pressing need for effective prevention interventions. Adapting school-based prevention programs developed in the United States for use in African schools may present an alternative to the time-consuming process of developing home-grown programs. The researchers report the results of a pretest-posttest field trial of an alcohol/HIV prevention curriculum adapted from an American model and delivered to ninth-grade students in five South African township schools. The revised intervention was based primarily on the Project Northland alcohol prevention and Reducing the Risk safer sex programs. The researchers found significant differences in change from baseline to follow-up between students in intervention and comparison groups on intentions to use a condom; drinking before or during sex; and, among females, sex refusal self-efficacy. The results of the field trial suggest that behavioral interventions developed in Western countries may be rapidly adapted to work in other cultural contexts.

Structural equation modeling (SEM) is a multivariate technique suited for testing proposed relations between variables. In this article, the authors discuss the potential for SEM as a tool to advance health communication research both statistically and conceptually. Specifically, the authors discuss the advantages that latent variable modeling in SEM affords researchers by extracting measurement error. In addition, they argue that SEM is useful in understanding communication as a complex set of relations between variables. Moreover, the authors articulate the possibility for examining communication as an agent, mediator, and an outcome. Finally, they review the application of SEM to recursive models, interactions, and confirmatory factor analysis.

The principal objective of this article is to offer an extended theoretical framework for further development of persuasive message design for media-based health campaigns. Drawing upon considerable convergent evidence that attention to and processing of persuasive messages is a function of both cognitive and biologically based processes, we consider implications for attention and processing from an extension of the activation model of information exposure through the addition of a cognitive variable associated with the elaboration likelihood model, need for cognition. The overall goal is to determine how target audiences are optimally influenced with persuasive health information that attracts and holds attention, triggers information processing, and eventually brings about behavior change.

The purpose of this study was to propose and conduct tests of a multivariate model of condom use utilizing data from 2 independent samples of young adults (City 1, N=746; City 2, N=743). The model examined the relations between personality characteristics, including sexual sensation seeking and sexual impulsive decision making; psychosocial variables, including condom attitudes, norms, and self-efficacy; and condom use behaviors, including carrying, communicating about, and using condoms. Structural equation modeling analyses indicated a good fit for both models (Confirmatory Fit Index=.93; Average Absolute Standardized Residuals=.05 for both), with each explaining 25% of the variance ( R (2)=.25) in condom use behaviors. Results support the fusion of personality and psychosocial approaches to gain a broader theoretical understanding of condom use in young adults. In addition, those developing and implementing health communication campaigns may find sexual sensation seeking and sexual impulsive decision making to be fruitful variables on which to target messages aimed at increasing safer sexual behavior.

Though HIV preventive and other health interventions in educational settings have often been grounded in health behavior theory, such interventions have rarely taken into account achievement motivation theory. The purpose of this article is to discuss how and why theories of both health behavior and achievement motivation have the potential to play an important part in the design and delivery of HIV preventive interventions in school settings. First, we briefly discuss health behavior theories, with a primary focus on their commonalties. Next, we discuss theories of achievement motivation and what is known about motivating students to learn and excel in the classroom, specifically applying these theories to safer sexual education. The complementary aspects of these theoretical perspectives are then considered. Finally, implications for improving the design of HIV preventive and other health interventions in school settings are discussed. Such interventions may be vastly improved if they pay great...

The Implicit Association Test (Greenwald, McGhee, & Schwartz, 1998) has become a popular tool for measuring implicit attitudes toward 2 contrasting concepts. In this study, we suggest including a neutral category (trees) to capture implicit evaluations of a single target attitude object. Using such a technique to measure implicit attitudes toward condoms, we predicted and found that explicit attitudes were related to intended condom use in situations that allow for controlled and deliberative processing, but implicit attitudes were related to intended condom use when automatic processing presides. Implications for such implicit and explicit attitude-behavior relations are discussed in the context of sexual risk-taking.

Data from a sample (n = 154) of young men who have sex with men (YMSM), aged 13-21, residing in five mid-sized cities in the midwestern United States were used to test the hypothesis that personality variables (impulsive decision making, sensation seeking, anxiety/depression, internalized homophobia) contribute uniquely to the prediction of unprotected anal sex beyond what is accounted for by other high-risk behaviors (i.e., substance use and number of sex partners) and partner status (having a dating partner). Results of hierarchical regression analyses indicated that number of reported anal sex partners and partner status were positively associated with self-reported frequency of unprotected anal sex. Beyond these factors, impulsive decision making significantly contributed to the predictive model. These findings indicate that designing effective prevention programming for YMSM should take into consideration relationship status and the impulsiveness of sexual decision making among members of the target group.

The physical, emotional, and financial consequences of engaging in risky sexual behavior can be extremely high. This paper explores the relations between the Five Factor Model (FFM) of personality and a variety of risky sexual behaviors using a community sample of 481 individuals who are part of an ongoing longitudinal study. More specifically, we examined the relations between the five major personality domains, as well as the 30 specific facets, and six risky sexual behaviors including number of partners, the use of drugs or alcohol before or during sex, number of sexual acts without using a condom, giving birth at an early age, sex outside one's primary relationship, and early sexual initiation. The results suggest that personality can make a valuable contribution to our understanding of several risky sexual behaviors. In particular, the domains of low Agreeableness, low Openness to Experience, and high Extraversion were significantly related to multiple high risk sexual behaviors. In addition, several specific personality traits made significant contributions (e.g., high gregariousness, high excitement seeking, low openness to fantasy, low trust, and low straightforwardness).

Although many HIV/AIDS prevention programs for adolescents have used peer educators to deliver risk reduction information, fewresearchers have evaluated the effects of participation in educational activities on the peer educators themselves. The present study compares several outcomes experienced by peer educators involved in a school-based HIV prevention program with those of their classmates to determine areas in which involvement in the curriculum had an effect on peer educators. Analyses revealed few differences between peer educators that could be attributed to the implementation of the intervention. The findings are discussed in terms of their implications for prevention programs targeting adolescent populations, and suggestions are made concerning the importance of future research on the selection, training, and integration of peer educators into school-based programs.

Recent data show that the number of deaths from HIV has declined but the disease continues to spread. An emerging line of research suggests that the apparent increase may be due to complacency, whereby faith in medicine encourages risk-taking behavior. This study examines the hypothesis that certain approaches in the news media could disproportionately influence perceptions of treatment success even when paired with statistics. College students and gay men, recruited in the community, were exposed to a fictional news story in which the ratio of four cases of people taking antiretroviral (ARV) medications was varied in two conditions. The story was either consistent with or inconsistent with the success-rate data presented by an alleged medical expert in the story. Participants' perceptions of ARV success were estimated following exposure to the story. As expected, the personal news stories influenced estimation of ARV success more than the presence of statistical success rate data. Consistent with previous exemplification research, the size of the effect suggests that the stories influenced judgments of the true success rate by roughly 10 to 20%. The effect was moderated by sexual orientation, but not by gender. Exemplification as a journalistic tendency may be one factor that contributes to unrealistic faith in medical advancements. These data suggest that future research should explore in detail the extent and context of HIV/AIDS reporting using exemplification theory with considerations for how reporting might be modified to have less of an effect on increased sexual risk-taking.

Over the last 30 years, expectations for the quality, validity, and objectivity of the outcome measures used to assess the impact of behavior change interventions related to HIV have steadily increased. At this point (mid-2014 at this writing), biological evidence or biomarkers of the incidence of HIV and other sexually transmitted infections [STI] in a target population is clearly preferable to self-reports of behavior. This kind of evidence is, however, much more expensive to collect than participants’ reports of behavior change (e.g., increased condom use, reduced substance use or abstinence from substance use, and high levels of medication adherence). In addition, while potentially less subject to reporting bias, biomarkers and biological outcomes have their own flaws. In this paper we review the literature on the validity of self-reports of outcomes most relevant to HIV behavior change interventions, sexual behavior (ever having had sex and condom use), substance use, and medication adherence. We note the extent to which they may be adequate outcome measures without biological data, and the conditions under which they may be most likely to be sufficient. We also argue, like many others, that where possible, both self-report and biological measures should be collected.

A laboratory experiment, funded by the U.S. National Institutes of Health, involved 243 U.S. undergraduate students and employed a 2 (gain-framed vs. loss-framed) × 2 (high vs. low threat) plus control group pretest-posttest experimental design to assess the combined effects of frame (gain vs. loss) and level of threat of public service announcements (PSAs) about marijuana on attitudes, beliefs, and intentions related to marijuana, as well as the relationship of message condition to ratings of PSAs. Results suggest that loss-framed messages may lead to greater perceived threat, as well as reactance, and gain-framed messages may lead to a greater reduction in positive attitudes toward marijuana than loss-framed messages. Finally, frame and threat may interact in a complex way. Further research is suggested to replicate these findings. A substantial body of carefully crafted and systematic research studies examining both content and features of messages increasingly informs mass media prevention efforts, including the development of public service announcements (PSAs). Although the significance of messages on commercial broadcast stations may be diminishing with the increasing role and impact of new media, many of the basic questions addressed by this research are likely to apply across media channels. Nonetheless, important questions about what makes a message effective in changing an individual's attitudes or behavior remain to be answered. In this paper, the authors focus on two theoretically derived strategies that offer possibilities for developing persuasive messages: framing and threat.

Reducing new HIV/STD infections among at-risk adolescents requires developing and evaluating evidence-based health communication approaches. Research over-whelmingly supports the conclusion that early sexual initiation is associated with STDs and other negative outcomes in later years (e.g., unintended pregnancy). The authors’ research group secured funding from the National Institute of Mental Health to develop, implement, and rigorously evaluate televised mass media campaigns to delay initiation of sexual intercourse among African American and White adolescents in two cities in the Southeastern United States. The focus of the present study is on the development and implementation of the campaigns, including (a) rationale and theoretical underpinnings; (b) collection, screening, and assessment of existing public service announcements; (c) development of new public service announcements; (d) study design and campaign airing plan; and (e) message exposure achieved in the campaigns. Health communication campaigns hold much promise in reaching at-risk adolescent populations with targeted, timely, and relevant risk-reduction messages.

The purpose of this study was to assess the perceptions of the adult population in a largely rural, southeastern state without a state-mandated AIDS education curriculum, regarding the appropriateness of teaching various AIDS-related topics to sixth and ninth grade students. A random telephone poll of 654 respondents answered questions pertaining to the appropriateness of teaching delaying sexual activity, how to say “no” to sexual advances, the correct way to use a condom, the risk of AIDS, how to discuss condom use with a sexual partner, and the importance of not having premarital sex. Results indicate widespread support for teaching AIDS and sex education at the ninth grade level and, with the exception of teaching about correct condom use, at the sixth grade level. Males, older and married individuals, and people who strongly identified with their religion were less supportive of providing instruction about these topics at school. Implications for school policy makers are discussed.

In this study, we explored the role of reciprocal filial values in protecting the wellbeing of Chinese adult-child caregivers in the US. Using survey data obtained from 137 Chinese adult-child caregivers living in seven US cities, we tested a latent variable model using structural equation modeling. In this model, informed by role theory, social exchange theory and stress-coping theory, reciprocal filial values affect caregiver wellbeing in the face of caregiver role strain, both directly and indirectly through protective effects of role rewards and coping. In the final model, reciprocal filial values had both direct and indirect protective effects on caregivers' wellbeing, offering evidence to address culturally sensitive issues in family caregivers with similar filial values.

In an HIV prevention study, 2949 ninth-grade students in 17 high schools in two Midwestern U.S. cities were administered scales measuring sensation seeking and impulsive decision-making and their separate and combined relationships to a number of indicators of sexual risk-taking. Measures of sexual risk-taking included intentions to have sex, ever had sex, number of lifetime sexual partners, been pregnant or caused a pregnancy, used a condom, used marijuana, had unwanted sex when drunk, had unwanted sex under pressure, said no to sex, used alcohol or partner used alcohol before sex. Strong associations were observed between each of the measures and sexual risk-taking for most of the indicators. Strongest associations were found among sexually active students high on both sensation seeking and impulsive decision-making and weakest associations among students low on both measures. Implications for design of interventions in health campaigns are discussed.

Shedler and Block offered the provocative proposal that individuals who experiment with drugs are psychologically healthier than either those who abstain completely or those who are frequent users. Not all studies have come to such conclusions, however. In an effort to specify under what conditions Shedler and Block's conclusions might hold, the present study examined three groups of drug users (abstainers, experimenters, frequent users) classified according to three different criteria: (a) marijuana use at age 20; (b) alcohol use during 10th grade; and (c) alcohol use at age 20. The three groups were compared at age 20 in terms of personality, deviant behavior, and psychopathology. The results revealed that abstainers were never more psychologically impaired, and were occasionally healthier, than experimenters. Frequent users of marijuana were consistently more imparied than both the abstainers and experimenters, in terms of both internalizing and externalizing disorders. Classification according to marijuana use appeared to be more related to psychopathology than did classification according to alcohol use.