Search

Research shows that exposure to adverse childhood experiences (ACEs) is common among adolescents and that exposure to ACEs is associated with an increased risk of depression in adolescents. Furthermore, it is unknown whether resilience and spirituality moderate the association between ACEs and depression in African-American adolescents. Thus, the present study examined the prevalence of ACEs and the association between ACEs and the risk for depression in African-American adolescents and examined whether this association is moderated by resilience and spirituality. Survey data were collected from African-American adolescents who attended youth-targeted events held by churches in Houston, TX. An expanded ACE tool was used to collect data and respondents were dichotomized into two groups based on their summed ACE scores, i.e., 0–3 ACEs versus 4–19 ACEs. Logistic regression was conducted to examine the association between ACEs and the likelihood of depression and to examine whether this association is moderated by resilience and spirituality. The results indicate that half of the sample had been exposed to four or more ACEs and that ACEs are negatively associated with depression: higher levels of resilience and spirituality suggest a lower likelihood of depression. These results suggest the need to explore the prevalence of cumulative ACEs among homogenous samples of African-American adolescents and the need to continue exploring and addressing the prevalence of individual ACEs among homogenous samples of African-American adolescents. No clinical trials were performed for this study.

Background Although schools often implement evidence-based sexual health education programs to address sexual and reproductive health disparities, multiple factors may influence program effectiveness. Methods Using student-reported perceived impact measures as a proxy for program effectiveness, we employed a socio-ecological approach to examine student, teacher, school, and district factors associated with greater perceived impact of It's Your Game (IYG), an evidence-based middle school sexual health education program. The student sample was 58.7% female, 51.8% Hispanic, mean age 13.2 years, from 73 middle schools. We assessed students' (N = 4531) perceived impact of IYG on healthy decision-making (α = 0.75) and sexual communication (α = 0.71); satisfaction with IYG activities and teacher; and demographics. We assessed teachers' (N = 56) self-efficacy to teach IYG, perceived administrative support, implementation barriers, and demographics. School and district data were abstracted from state records. We used multilevel logistic regression to estimate associations between independent variables and student-reported perceived impact. Results In final multivariate models, students' demographics (sex, β = 0.06, SE = 0.015), satisfaction with IYG (β = 0.21, SE = 0.012), and their IYG teacher (β = 0.18, SE = 0.013) (all p = .000) were significantly associated with perceived impact on healthy decision-making. Similar findings resulted for sexual communication. No other variables were significantly associated with perceived impact. Conclusions Helping schools select age-appropriate, culturally relevant programs, and facilitate supportive learning environments may enhance the perceived impact of sexual health education programs.

BackgroundEarly adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health.ObjectiveThis study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions.MethodsWe followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS.ResultsSSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings.ConclusionsThe SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health.

Objectives. To test the efficacy of Me & You, a multilevel technology-enhanced adolescent dating violence (DV) intervention, in reducing DV perpetration and victimization among ethnic-minority early adolescent youths. We assessed secondary impact for specific DV types and psychosocial outcomes. Methods. We conducted a group-randomized controlled trial of 10 middle schools from a large urban school district in Southeast Texas in 2014 to 2015. We used multilevel regression modeling; the final analytic sample comprised 709 sixth-grade students followed for 1 year. Results. Among the total sample, odds of DV perpetration were lower among intervention students than among control students (adjusted odds ratio = 0.46; 95% confidence interval = 0.28, 0.74). Odds of DV victimization were not significantly different. There were significant effects on some specific DV types. Conclusions. Me & You is effective in reducing DV perpetration and decreasing some forms of DV victimization in early middle-school ethnic-minority students.

Much is known about the prevalence and correlates of dating violence, especially the perpetration of physical dating violence, among older adolescents. However, relatively little is known about the prevalence and correlates of the perpetration of cyber dating abuse, particularly among early adolescents. In this study, using a predominantly ethnic-minority sample of sixth graders who reported ever having had a boyfriend/girlfriend (n = 424, 44.2 % female), almost 15 % reported perpetrating cyber dating abuse at least once during their lifetime. Furthermore, using a cross-sectional design, across multiple levels of the socio-ecological model, the individual-level factors of (a) norms for violence for boys against girls, (b) having a current boyfriend/girlfriend, and (c) participation in bullying perpetration were correlates of the perpetration of cyber dating abuse. Collectively, the findings suggest that dating violence interventions targeting these particular correlates in early adolescents are warranted. Future studies are needed to establish causation and to further investigate the relative importance of correlates of the perpetration of cyber dating abuse among early adolescents that have been reported among older adolescents.

MINDSET, a bilingual (Eng./Span.) decision support tool was found feasible for facilitating goal-based epilepsy self-management (ESM) in the clinic.To evaluate the efficacy of MINDSET to increase ESM adherence among Hispanic patients.A RCT was conducted from August 2017 through January 2019. Spanish and English speaking Hispanic adult patients (n=94) with epilepsy in Arizona (n=53) and Texas (n=41) were randomly assigned within 6 neurology clinics to treatment (MINDSET plus Usual Care, hereafter referred to as MINDSET; n=46) and comparison (Usual Care Only; n=48) conditions. Self-reported self-management behavior (assessed through the Epilepsy Self-management scale) were categorized as adherent if performed 'usually' or 'always.' The proportion of adherence was compared between study conditions for 36 individual ESM behaviors and 5 ESM domains using Fischer's exact test.The average time between visit 1 through 3 was 350+/-79 days with retention at 96.8%. Participants in the treatment condition had more college education and less unemployment. Self-management adherence improved across visits for all self-management behaviors irrespective of study condition. Compared to usual care MINDSET use led to greater ESM adherence for 86.1% behaviors (5 with statistical significance; p0.05) and to significant improvement in the ESM domain of 'information management' (p0.05).Implementation of MINDSET within regular neurology visits may assist Hispanic adults with epilepsy to increase their adherence to ESM behaviors and maintain this adherence longitudinally. Replication with a broader demographic population of people with epilepsy is indicated.

This paper describes the expanded English/Spanish version of the Management Information and Decision Support Epilepsy Tool (MINDSET) as well as the methods and findings from a feasibility study conducted from July 2016 through February 2017 with 43 Spanish and English-speaking Hispanic people living with epilepsy (PWE) in Arizona (n = 23) and Texas (n = 20) over two consecutive regular clinic visits. The expansion of MINDSET added goal setting and strategy selection to improve self-management (S-M) in PWE. The previous study tested the feasibility of English MINDSET, which was designed to facilitate the identification and discussion of S-M issues between the patient and healthcare provider (HCP) during a regular clinic visit. Results indicate MINDSET feasibility for use in the following: 1) identifying S-M issues across several domains; 2) selecting and assessing confidence in tailored S-M goals/strategies for improvement; 3) discussing S-M issues/goals/strategies/confidence with a HCP; and 4) creating an action plan (AP) and tracking achievement during regular clinic visits. Across two visits, 80–90% of patients agreed that the revised version of MINDSET was helpful, understandable, trustworthy, promoted careful thinking about management, was of appropriate duration, and would be helpful in future management and communication with HCP. Participating HCPs agreed that MINDSET improved the ease, thoroughness, and accuracy in identifying patient S-M issues and establishing a plan for improvement.

Purpose American Indian and Alaska Native (AI/AN) youth experience disparities associated with sexual and reproductive health, including early age of sexual initiation. Identifying factors that are most proximally related to early sexual intercourse and that are modifiable through health promotion interventions may help to reduce these disparities. Using a multisystem approach, we assessed individual (biological, psychological, and behavioral), familial, and extrafamilial (peer behavioral) factors associated with lifetime sexual experience among AI/AN early adolescents living in three geographically dispersed U.S. regions. Methods We analyzed cross-sectional data from 537 AI/AN youth aged 12–14 years, recruited from 27 study sites in Alaska, Arizona, and the Pacific Northwest. We used multilevel logistic regression models to estimate associations between independent variables and lifetime sexual intercourse (oral and/or vaginal sex) individually, within discrete systems, and across systems. Results The analytical sample was 55.1% female, with a mean age of 13.2 years (standard deviation = 1.06 years); 6.5% were sexually experienced. In the final model, we found that lower next-year intentions to have oral or vaginal sex (psychological factors), avoidance of risky situations, and nonuse of alcohol (behavioral factors) were associated with lower odds of lifetime sexual intercourse (all p ≤ .01). No other variables were significantly associated with lifetime sexual intercourse. Conclusions Interventions that reduce sexual intentions, exposure to risky situations, and alcohol use may help to delay sexual initiation among AI/AN early adolescents.

Purpose Few computer-based HIV, sexually transmitted infection (STI), and pregnancy prevention programs are available, and even fewer target early adolescents. In this study, we tested the efficacy of It's Your Game (IYG)-Tech , a completely computer-based, middle school sexual health education program. The primary hypothesis was that students who received IYG-Tech would significantly delay sexual initiation by ninth grade. Methods We evaluated IYG-Tech using a randomized, two-arm nested design among 19 schools in a large, urban school district in southeast Texas (20 schools were originally randomized). The target population was English-speaking eighth-grade students who were followed into the ninth grade. The final analytic sample included 1,374 students. Multilevel logistic regression models were used to test for differences in sexual initiation between intervention and control students, while adjusting for age, gender, ethnicity, time between measures, and family structure. Results There was no significant difference in the delay of sexual activity or in any other sexual behavior between intervention and control students. However, there were significant positive between-group differences for psychosocial variables related to STI and condom knowledge, attitudes about abstinence, condom use self-efficacy, and perceived norms about sex. Post hoc analyses conducted among intervention students revealed some significant associations: "full exposure" (completion of all 13 lessons) and "mid-exposure" (5–8 lessons) students were less likely than "low exposure" (1–4 lessons) students to initiate sex. Conclusions Collectively, our findings indicate that IYG-Tech impacts some determinants of sexual behavior, and that additional efficacy evaluation with full intervention exposure may be warranted.

Diffusion of sexual health evidence-based programs (EBPs) in schools is a complex and challenging process. iCHAMPSS ( CHoosing And Maintaining effective Programs for Sex education in Schools) is an innovative theory- and Web-based decision support system that may help facilitate this process. The purpose of this study was to pilot-test iCHAMPSS for usability and short-term psychosocial impact.School district stakeholders from across Texas were recruited ( N = 16) and given access to iCHAMPSS for 3 weeks in fall 2014. Pre- and posttests were administered to measure usability parameters and short-term psychosocial outcomes. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test.Most participants reported that iCHAMPSS was easy to use, credible, helpful, and of sufficient motivational appeal. iCHAMPSS significantly increased participants' self-efficacy to obtain approval from their board of trustees to implement a sexual health EBP. Positive, though nonsignificant, trends included increased knowledge to locate EBPs, skills to prioritize sexual health education at the district level, and ability to choose an EBP that best meets district needs.iCHAMPSS is an innovative decision support system that could accelerate uptake of EBPs by facilitating diffusion and advance the field of dissemination and implementation science for the promotion of sexual health EBPs.

Purpose An earlier randomized controlled trial found that two middle school sexual education programs—a risk avoidance (RA) program and a risk reduction (RR) program—delayed initiation of sexual intercourse (oral, vaginal, or anal sex) and reduced other sexual risk behaviors in ninth grade. We examined whether these effects extended into 10th grade. Methods Fifteen middle schools were randomly assigned to RA, RR, or control conditions. Follow-up surveys were conducted with participating students in 10th grade (n = 1,187; 29.2% attrition). Results Participants were 60% female, 50% Hispanic, and 39% black; seventh grade mean age was 12.6 years. In 10th grade, compared with the control condition, both programs significantly delayed anal sex initiation in the total sample (RA: adjusted odds ratio [AOR], .64, 95% confidence interval [CI], .42–.99; RR: AOR, .65, 95% CI, .50–.84) and among Hispanics (RA: AOR, .53, 95% CI, .31–.91; RR: AOR, .82, 95% CI, .74–.93). Risk avoidance students were less likely to report unprotected vaginal sex, either by using a condom or by abstaining from sex (AOR: .61, 95% CI, .45–.85); RR students were less likely to report recent unprotected anal sex (AOR: .34, 95% CI, .20–.56). Both programs sustained positive impact on some psychosocial outcomes. Conclusions Although both programs delayed anal sex initiation into 10th grade, effects on the delayed initiation of oral and vaginal sex were not sustained. Additional high school sexual education may help to further delay sexual initiation and reduce other sexual risk behaviors in later high school years.

Although sexting among U.S. youth has received much popular media attention, there are only limited data on its prevalence among ethnic minority youth. This study, therefore, specifically examined the prevalence and patterns of sexting (sending and/or receiving a nude or semi-nude picture/video or a sexual text-only message) among a sample of black and Hispanic youth. Data from 1,034 tenth graders from a large, urban school district in southeast Texas were used to calculate the prevalence of sexting by gender-race/ethnicity. Overlap among sexting behaviors was also examined. Electronic surveys were administered via an audio-computer-assisted self-interview on laptop computers. Prevalence estimates were obtained, and chi-square analyses were conducted to compare the distribution of sexting behaviors by gender-race/ethnicity subgroups. More than 20% of students reported sending either a nude or semi-nude picture/video or a sexual text-only message (jointly referred to as a "sext"), and more than 30% reported receiving a sext. Sexts were also frequently shared with unintended recipients. Black males and females reported similar prevalence estimates for sexting behaviors. However, they were more likely than Hispanic males to participate in some sexting behaviors. Hispanic females reported the lowest estimates for sexting behaviors for all gender-race/ethnicity subgroups. Many youth who sent or received a nude or semi-nude picture/video were also likely to have sent or received sexual text-only messages. The results of this study indicate that sexting is prevalent among ethnic minority youth. However, more research is needed to understand the specific context and circumstances around which sexting occurs in this population.

Background: American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. Objective: We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet’s potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. Methods: This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths’ perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. Results: Sites had sufficient computer access and Internet connectivity to implement the 6 programs with adequate fidelity; however, variable bandwidth (ranging from 0.24 to 93.5 megabits per second; mean 25.6) and technical issues led some sites to access programs via back-up modalities (eg, uploading the programs from a Universal Serial Bus drive). The number of youth providing engagement ratings varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN). Across programs, youth rated the programs as easy to use (68-91%), trustworthy (61-89%), likeable (59-87%), and impactful (63-91%). Most youth understood the words in the programs (60-83%), although some needed hints to complete the programs (16-49%). Overall, 37-66% of the participants would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons. Conclusions: Findings demonstrate the potential of the Internet to enhance the reach and implementation of evidence-based health promotion programs, and to engage AI/AN youth. Provision of back-up modalities is recommended to address possible connectivity or technical issues. The dissemination of Internet-based health promotion programs may be a promising strategy to address health disparities for this underserved population. Trial Registration: Clinicaltrials.gov NCT01303575; https://clinicaltrials.gov/ct2/show/NCT01303575 (Archived by WebCite at http://www.webcitation.org/6m7DO4g7c) [JMIR Res Protoc 2016;5(4):e225]

“Lack of effort” attributions for failure (behavioral self-blame) have been associated with a greater sense of control over illness outcomes because the failure is attributed to internal (ie, subject to personal factors), unstable (ie, amenable to different outcomes on future occasions), and controllable (ie, subject to personal intent) causes. This study examines the causal attributions (locus, stability, control) used by children and their parents to explain success and failure in 3 asthma self-management domains: symptom monitoring, medication adherence, and environmental trigger avoidance. Participants included 65 children (9-13 years) diagnosed with asthma and their primary caregivers, recruited from urban specialty and community clinics and schools. Responses to a structured interview presenting 18 scenarios of self-management success and failure were coded along causal dimensions and causal labels using the Coding Scheme of Perceived Causality. Children attributed self-management success and failure of themselves and other children mainly to internal (84.6% to 98.1%), unstable (50.8% to 79.4%), and controllable (73% to 98.4%) causes. Compared to other children, respondents regarded their own failure in monitoring symptoms as more unstable. Parents attributed their child’s management mainly to internal (66.7% to 90.5%), unstable (52.4% to 84.1%), and controllable (54.0% to 85.5%) causes. Personal effort and intrinsic motivation were the primary causal labels provided. Understanding a child’s causal attributions for asthma self-management could help asthma educators intervene on beliefs that may be undermining management success. Further research of causal attributions for asthma self-management is required to understand the potential of this theory to inform education and treatment strategies.

Although adolescent pregnancy rates have declined steadily in the United States over the past decade, adolescent births and sexually transmitted infections (STIs) remain serious public health issues. In 2006, births to mothers aged 15-19 years increased for the first time since the early 1990s.1 In 2000, youth between the ages of 15 and 24 accounted for 9.1 million (48%) of all new STI cases.2 Minority youth are disproportionately affected. Birth rates among Hispanic and black teens remain higher than other racial/ethnic groups, including rates among those aged 10-14 years.1 Although black teens represent only 17% of US teenagers, they account for 70% of HIV/AIDS cases reported among teens.3 Early sexual initiation has been associated with an increased risk of pregnancy and STI.4-6 Youth who initiate vaginal intercourse at age 14 or younger are more likely to have multiple lifetime sexual partners, engage in greater frequency of sex, use alcohol or drugs before sex, and have sex without a condom compared to youth who initiate sex at an older age.5-8 Some adolescents engage in oral or anal intercourse as perceived less risky alternatives to vaginal sex;9-13 however, both have been implicated in the transmission of nonviral and viral STIs.13-15 In order to develop effective pregnancy and STI prevention efforts for early adolescents (aged 11-14 years), it is important to understand the prevalence of vaginal, oral, and anal intercourse in this age-group and the characteristics of early initiators. It is also helpful to understand the sequence of initiation of these different types of sexual behavior to ensure that interventions are relevant to youth’s needs. However, public sensitivity regarding sexual behavior surveys among early adolescents, particularly in public school settings, has impeded this research. Active parental consent is typically required, and parents and school administrators may be reluctant to expose students to explicit questions regarding sexual behavior, particularly those regarding oral and anal sex. In the 2003 Middle School Youth Risk Behavior Surveillance Survey (MSYRBS) (grades 6-8 and roughly ages 11-13), 6 of 8 states administered items on sexual behavior. Across states, the percentage of seventh graders who reported ever having “sexual intercourse” (implicitly vaginal sex) ranged from 6.6% to 31.2%, with a median of 15.6%. Of those students, between 3.2% and 13.2% (median 8.5%) reported having 3 or more sexual partners.16 Other studies have examined sexual behavior among middle school students;5,6,17-21 however, few have included examination of oral and anal intercourse, and none have examined the sequence of initiation of types of sexual behavior among early adolescents. Previous studies among older adolescents report contrasting findings regarding the sequence of sexual initiation. Several studies among 9th- and 10th-grade students indicate earlier initiation of oral sex compared to vaginal sex.11,22 In contrast, data from the 2002 National Survey of Family Growth (NSFG) among 15- to 19-year-olds indicate greater likelihood of initiating vaginal sex prior to other types of sex. The NSFG data also indicate significant differences in sexual behavior by racial/ethnic group and by socioeconomic status with white and higher socioeconomic status teen more likely to engage in oral and anal sex than their peers.23 However, it is unclear whether patterns of sexual activity and initiation among older adolescents accurately reflect patterns among younger teens, who become sexually active. Given this lack of detailed information, further epidemiological studies examining sexual behavior among middle school youth are needed to help prioritize effective sexual health education efforts. The goals of the present study were to (1) examine the prevalence of vaginal, oral, and anal intercourse among a population of urban, public middle school seventh-grade students; (2) to examine the demographic characteristics of those youth who engaged in each type of sexual intercourse, and (3) to examine the sequence of initiation of the 3 types of sexual intercourse. This information may help to prioritize needs for middle school sexual health education to prevent or mitigate the consequences of early sexual initiation among potentially high-risk youth populations.

Positive youth involvement with any adult—not just parents—may be protective against adolescent participation in risk behaviors. This cross-sectional study examines the association between adult involvement and weapon carrying among predominantly low-income African American and Hispanic urban high school students. Adult involvement was measured using a 6-item scale that assessed frequency of student participation in activities with an adult; weapon carrying was measured using questions from the Youth Risk Behavior Survey. Almost 20% of high school students reported carrying a weapon at least once during the past month. In the adjusted model, adult involvement was protective against student participation in weapon carrying. School absenteeism caused by safety concerns, threats at school, and substance use were also associated with weapon carrying. Interventions that aim to increase the amount of time youth spend with adults may be beneficial for the prevention of weapon carrying behaviors. Future longitudinal studies are needed to confirm the temporal association between variables.

The aim of this study was to examine factors related to frequent douching among a predominantly black and Hispanic alternative school population. It was observed that although Hispanic females were more likely to douche weekly compared with black females (30% vs. 13%), monthly douching was associated with black ethnicity, beliefs related to the therapeutic value of douching, perceived partner expectations, having female relatives who douched, and pregnancy history.

The purpose of this study was to examine bullying/victimization and internalizing symptoms among low-income racial/ethnic-minority adolescents. In the total sample and for females only, victims and bully-victims were more likely to report symptomology. Middle and high school victims, but only middle school bully-victims, were more likely to experience internalizing symptoms. Internalizing symptomology was not significantly increased for bullies in any analysis. These study findings expand the association between bully/victim status and internalizing symptoms to a less-studied population that may be limited in their ability to use and obtain mental health assistance.

Adolescent sexually transmitted infection (STI) and birth rates indicate a need for effective middle school HIV/STI, and pregnancy prevention curricula to delay, or mitigate consequences of, early sexual activity. Individual and organizational barriers to adoption, implementation, and maintenance, however, can hamper dissemination of evidence-based sexual health curricula, adversely impacting fidelity and reach. Internet-based approaches may help mitigate these barriers. This paper describes the development and feasibility testing of It’s Your Game (IYG)-Tech, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing effective sexual health curriculum—It’s Your Game… Keep it Real (IYG). IYG-Tech development adaptation steps were to: 1) Select a suitable effective program and gather the original program materials; 2) Develop “proof of concept” lessons and test usability and impact; 3) Develop the program design document describing the core content, scope, and methods and strategies; and 4) produce the new program. Lab- and school-based tests with middle school students demonstrated high ratings on usability parameters and immediate impact on selected psychosocial factors related to sexual behavior—perceptions of friends’ beliefs, reasons for not having sex, condom use self-efficacy, abstinence intentions, negotiating with others to protect personal rules, and improved knowledge about what constitutes healthy relationships (all p IYG-Tech is favorably compared to other learning channels (>76.2% agreement) and rated the lessons as helpful in making healthy choices, selecting personal rules, detecting challenges to those rules, and protecting personal rules through negotiation and refusal skills (89.5% - 100%). Further efficacy testing is indicated for IYG-Tech as a potential strategy to deliver effective HIV/STI, and pregnancy prevention to middle school youth.

Self-reported substance use data were collected from 963 alternative school students in grades 7-12 who were surveyed through the Safer Choices 2 study in Houston, Texas. Data were collected between October 2000 and March 2001. Logistic regression analyses indicated that lower levels of future orientation was significantly associated (OR = 0.88, 95% CI = 0.81-0.97) with thirty-day substance use after controlling for age and gender. In addition, lower levels of future orientation was found to have a significant association with students' lifetime substance use (OR = 0.93, 95% CI = 0.87-.99) after controlling for age, race, and gender. While the relationships tested in this study are exploratory, they provide evidence for an important connection between future orientation and substance use among adolescents attending alternative schools.

This study examined control of environmental tobacco smoke (ETS) exposure in the home by new mothers and identified factors related to the establishment of home smoking control rules. Pregnant women who, at 28 weeks gestation, reported they had not smoked in the past 28 days were enrolled in a randomized smoking cessation study. Telephone interviews were conducted at 6 weeks, 3 months, 6 months, and 12 months postpartum. A Home Smoking Control Index, composed of four items (whether the mother smokes in the home, the partner smokes in the home, other household smokers are asked to smoke outside, and visitors who smoke are asked to smoke outside), was used to classify homes as having a home smoking policy in effect, no policy or an incomplete policy, or no policy needed. Sociodemographic variables and maternal self-efficacy were examined in relation to the index data among 325 women who had need to exercise control of smoking in the home: 63% had a home smoking policy in effect at 3 months, 60% at 6 months, and 64% at 12 months postpartum. Predictors of policy at 6 and 12 months included (a) having a policy in effect at the previous assessment, (b) confidence in limiting infant ETS exposure in the home, and (c) perceived difficulty in preventing exposure. Early establishment of a policy appears to be important for ensuring sustained infant ETS avoidance over time. The index measures key actions that influence infant exposure and warrants further testing for use in intervention trials.

Self-report drug use data were collected from 282 female alternative school students surveyed through the Safer Choices 2 study in Houston, Texas. Data collection took place between October 2000 and March 2001 via audio-enabled laptop computers equipped with headphones. Logistic regression analyses indicated that sexual abuse history was significantly associated with lifetime use (OR = 1.9, p ≤ 0.05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among female alternative school students.

Objectives. We examined whether It’s Your Game . . . Keep It Real (IYG) reduced dating violence among ethnic-minority middle school youths, a population at high risk for dating violence. Methods. We analyzed data from 766 predominantly ethnic-minority students from 10 middle schools in southeast Texas in 2004 for a group randomized trial of IYG. We estimated logistic regression models, and the primary outcome was emotional and physical dating violence perpetration and victimization by ninth grade. Results. Control students had significantly higher odds of physical dating violence victimization (adjusted odds ratio [AOR] = 1.52; 95% confidence interval [CI] = 1.20, 1.92), emotional dating violence victimization (AOR = 1.74; 95% CI = 1.36, 2.24), and emotional dating violence perpetration (AOR = 1.58; 95% CI = 1.11, 2.26) than did intervention students. The odds of physical dating violence perpetration were not significantly different between the 2 groups. Program effects varied by gender and race/ethnicity. Conclusions. IYG significantly reduced 3 of 4 dating violence outcomes among ethnic-minority middle school youths. Although further study is warranted to determine if IYG should be widely disseminated to prevent dating violence, it is one of only a handful of school-based programs that are effective in reducing adolescent dating violence behavior.

Project MATCH is a national, randomized clinical trial of alcoholism treatment matching. The generalizability of Project MATCH has been questioned, as well as efficacy trials in general. This study investigates at one site whether there were differences between clients who participated in MATCH and others not entered into the study. Significant differences were found on three inclusion/exclusion related variables: plans to move, available transportation, and locator provision. Significant but rather small differences were also found on age and education. There were no significant differences on a large number of demographic and problem severity measures. In addition, the Alcohol Use Disorders Identification Test scores suggest that those included in the MATCH sample actually had more serious alcohol involvement than those who were ineligible or declined participation. Overall, the differences found do not appear to threaten the generalizability of the study.

A set of mediation analyses were carried out in this study using data from It’s Your Game. . .Keep It Real (IYG), a successful HIV/STI/pregnancy prevention program. The IYG study evaluated a skill and normbased. HIV/STI/pregnancy prevention program that was implemented from 2004 to 2007 among 907 urban low-income middle school youth in Houston, TX, USA. Analyses were carried out to investigate the degree to which a set of proposed psychosocial measures of behavioral knowledge, perceived self-efficacy, behavioral, and normative beliefs, and perceived risky situations, all targeted by the intervention, mediated the intervention’s effectiveness in reducing initiation of sex. The mediation process was assessed by examining the significance and size of the estimated effects from the mediating pathways. The findings from this study provide evidence that the majority of the psychosocial mediators targeted by the IYG intervention are indeed related to the desired behavior and provide evidence that the conceptual theory underlying the targeted psychosocial mediators in the intervention is appropriate. Two of the psychosocial mediators significantly mediated the intervention effect, knowledge of STI signs and symptoms and refusal self-efficacy. This study suggests that the underlying causal mechanisms of action of these interventions are complex and warrant further analyses.

BACKGROUND: Whereas dating violence among high school students has been linked with sexual risk-taking and substance use, this association has been understudied among early adolescents. We estimated the prevalence of physical and nonphysical dating violence in a sample of middle school students and examined associations between dating violence, sexual, and substance use behaviors. METHODS: Logistic regression models for clustered data from 7th grade students attending 10 Texas urban middle schools were used to examine cross-sectional associations between dating violence victimization and risk behaviors. RESULTS: The sample (N = 950) was 48.5% African American, 36.0% Hispanic, 55.7% female, mean age 13.1 years (SD 0.64). About 1 in 5 reported physical dating violence victimization, 48.1% reported nonphysical victimization, and 52.6% reported any victimization. Adjusted logistic regression analyses indicated that physical, nonphysical, and any victimization was associated with ever having sex, ever using alcohol, and ever using drugs. CONCLUSIONS: Over 50% of sampled middle school students had experienced dating violence, which may be associated with early sexual initiation and substance use. Middle school interventions that prevent dating violence are needed. Language: en

Human Papillomavirus (HPV) is the most common STI among youth in the U.S. As alternative school students are at higher risk of acquiring STIs compared to regular high school students, this study examined HPV knowledge and risk perception among Latino youth attending 9 alternative high schools in Houston, Texas. HPV knowledge measures assessed prevalence, health consequences, symptoms, transmission, and risk reduction strategies. Three measures assessed perceived risk. The sample included 414 youth (58.4% female) with a mean age of 16.6 years (SD = 1.86); 63.8% were sexually experienced. Most (76.0%) were U.S.-born to parents from Mexico, Central or South America (70.8% of mothers and 77.8% of fathers, respectively); 61.7% had parents with less than a high school education. Results indicate that youth answered 1 out of 5 HPV knowledge items correctly (mean = 1.3, SD = 1.45); 35.8% identified skin-to-skin contact during sex as the most common mode of HPV transmission, and 72.5% selected condoms as an effective HPV risk reduction strategy followed by avoiding multiple partners (55.8%), abstinence (47.5%), monogamous relationships (26.8%) and HPV vaccination (22.3%). Only twenty-seven youth (6.5%) perceived themselves to be at high risk for contracting HPV. Regression analyses examining the association between demographic variables, sexual behavior, HPV knowledge, and HPV risk perception, showed significant associations for mothers’ place of birth only – youth whose mothers were born outside of the U.S. had significantly lower HPV knowledge than those with American-born mothers (p < 0.007). Findings indicate the need for enhanced educational efforts among Latino alternative school youth regarding the prevalence of HPV and effective risk reduction strategies.

Purpose To evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation. Methods Three-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes. Results Participants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54–.77), among females (AOR: .43, 95% CI: .31–.60), and among African Americans (AOR: .38, 95% CI: .18–.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47–.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33–.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36–.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19–.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52–.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01–2.82). Both programs positively affected psychosocial outcomes. Conclusions The RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.

Media consumption may contribute to childhood obesity. This study developed and evaluated a theory-based, parent-focused intervention to reduce television and other media consumption to prevent and reduce childhood obesity. Families (n = 202) with children ages 6-9 were recruited from a large, urban multiethnic population into a randomized controlled trial (101 families into the intervention group and 101 into the control group), and were followed for 6 months. The intervention consisted of a 2-hour workshop and six bimonthly newsletters. Behavioral objectives included: (i) reduce TV watching; (ii) turn off TV when nobody is watching; (iii) no TV with meals; (iv) no TV in the child's bedroom; and (v) engage in fun non-media related activities. Parents were 89% female, 44% white, 28% African American, 17% Latino, and 11% Asian, mean age 40 years (s.d. = 7.5); 72% were married. Children were 49% female, mean age 8 years (s.d. = 0.95). Sixty-five percent of households had three or more TVs and video game players; 37% had at least one handheld video game, and 53% had three or more computers. Average children's weekday media exposure was 6.1 hours. At 6 months follow-up, the intervention group was less likely to report the TV being on when nobody was watching (adjusted odds ratio (AOR) = 0.23, P < 0.05), less likely to report eating snacks while watching TV (AOR = 0.47, P < 0.05), and less likely to have a TV in the child's bedroom (AOR = 0.23, P < 0.01). There was a trend toward reducing actual media consumption but these outcomes did not reach statistical significance. Effective strategies to reduce children's TV viewing were identified.

Purpose This study tested the effects of a theory-based, middle-school human immunodeficiency virus, STI, and pregnancy prevention program, It's Your Game: Keep it Real ( IYG ), in delaying sexual behavior. We hypothesized that the IYG intervention would decrease the number of adolescents who initiated sexual activity by the ninth grade compared with those in the comparison schools. Methods The target population consisted of English-speaking middle school students from a large, urban, predominantly African-American and Hispanic school district in Southeast Texas. Ten middle schools were randomly assigned either to receive the intervention or to the comparison condition. Seventh-grade students were recruited and followed through ninth grade. The IYG intervention comprises 12 seventh-grade and 12 eighth-grade lessons that integrate group-based classroom activities with computer-based instruction and personal journaling. Ninth-grade follow-up surveys were completed by 907 students (92% of the defined cohort). The primary hypothesis tested was that the intervention would decrease the number of adolescents who initiated sexual activity by the ninth grade compared with those in the comparison schools. Results Almost one-third (29.9%, n=509) of the students in the comparison condition initiated sex by ninth grade compared with almost one-quarter (23.4%, n=308) of those in the intervention condition. After adjusting for covariates, students in the comparison condition were 1.29 times more likely to initiate sex by the ninth grade than those in the intervention condition. Conclusions A theory-driven, multi-component, curriculum-based intervention can delay sexual initiation up to 24 months; can have impact on specific types of sexual behavior such as initiation of oral and anal sex; and may be especially effective with females. Future research must explore the generalizabilty of these results.

Students attending 'alternative' high schools form relatively small, highly mobile high-risk populations, presenting challenges for the design and implementation of HIV-, other STI-, and pregnancy-prevention interventions. This paper describes the rationale, study design, and baseline results for the Safer Choices 2 program.Modified group-randomized intervention trial with cross-over of schools but not of students. The study cohort was defined a priori as those who completed the baseline measures and were still enrolled at the time of first follow-up. DESIGN RESULTS: Of 940 students initially enrolled in the study, 711 (76%) formed the study cohort. There were significant demographic differences between those included and those excluded from the study cohort in sex, age, sexual experience, experience with pregnancy, drug use, and some psychosocial measures. There were no significant differences between the intervention and control groups within the study cohort. The only significant difference between those students excluded from the intervention group and those excluded from the control group was reported age at first intercourse. BASELINE DATA RESULTS: Students (n=940) enrolled were predominately African-American (29.7%) and Hispanic (61.3%); 57.3% were female; 66% had ever had sex; and reported drug use in the previous 30 days ran from 4.3% (cocaine) to 26.9% (marijuana). Of the 627 sexually experienced, 41.8% reported their age at first intercourse as 13 years or younger; 28.5% reported ever being or having gotten someone pregnant; 74% reported sex in the past 3 months. Of the 464 sexually active in the last 3 months, 55.4% reported unprotected intercourse and 31.3% reported using drugs beforehand.The cross-over design will provide a rigorous test of the intervention; however, loss to follow-up of this population can result in some selection bias. Students attending dropout prevention and recovery schools are at high risk for HIV, STIs, and pregnancy, and are in need of interventions.

The goal of this study was to explore whether a history of sexual abuse is associated with high-risk sexual behaviors among female adolescents attending alternative schools in a large urban city in the southwestern United States, and to examine the role of depression and substance abuse in explaining this association. One hundred eighty-four sexually active female adolescents constituted the sample for this analysis. Forty-nine (26.6%) reported that they were forced to have sex. Having a history of sexual abuse substantially increased sexual risk behaviors. Adolescents reporting a history of sexual abuse, compared to those who did not report such a history, were significantly more likely to have initiated sexual activity (intercourse) before age 14, to have had three or more sexual partners in the last 3 months, and to have had a history of sexually transmitted diseases. These associations remained significant after controlling for age, ethnicity, and family income. Depression and substance abuse did not explain the association between sexual abuse and high-risk sexual behaviors. It seems reasonable to conclude that adolescents with a history of sexual abuse have greater difficulty practicing safe sexual behaviors than do those who have not been sexually abused. Given the prevalence of child sexual abuse and the extent of its impact, it is critical that intervention strategies for adolescent females address the issue of abuse and help them adopt self-protective sexual behaviors. The findings also highlight the importance of targeting adolescents who attend alternative schools.

Self-report drug use data were collected from 494 alternative school students, grades seven through 12, surveyed through the Safer Choices 2 study in Houston, Texas. Data were collected between October 2000 and March 2001 via audio-enabled laptop computers equipped with headphones. Twenty-eight percent of the sample reported past-month marijuana use, and 10% reported past-month opiate/codeine use. Males were almost twice as likely as females to have used cocaine during the past month, and over four times as likely to have used opiates/codeine during the past month. Students 16 years and older and were twice as likely to have ever used cocaine and opiates/codeine than students under 16 years. Latinos were 10 times more likely than Blacks to have ever used cocaine; Blacks were twice as likely as Latinos to have used opiates/codeine during the past month. Males were twice as likely as females to have tried "fry," a new street drug made of tobacco or marijuana mixed with embalming fluid and PCP. These new drug trends are startling because they indicate a potential for long-term treatment services for abusers.