Photovoice: Assessing the Long-Term Impact of a Disaster on a Community's Quality of Life.

Photovoice is a qualitative method of inquiry whereby individuals can document their lived experiences, particularly individuals whose voices are not typically heard in regard to promoting social change and policy development. We used photovoice to elicit major themes regarding community members' perceptions of the long-term impact on their quality of life as a deadly technological disaster hit a small, rural town in South Carolina. Overall, participants photographed more negative images than positive. Overarching themes included residential and business vacancies, economic decline, the need for clean-up and modernization, attention to wellness or rehabilitation, and concerns for safety. Emergency response agencies should consider the themes elicited from these community residents to help identify where to focus disaster response efforts both in the immediate aftermath and during the long-term recovery period of technological disasters, particularly in underserved, rural communities.

Understanding internet sex-seeking behaviour and sexual risk among young men who have sex with men: evidences from a cross-sectional study.

OBJECTIVE: Internet sex-seeking is common among young men who have sex with men (MSM). However, research examining its association with risky sexual behaviour has produced mixed findings, possibly due to various operational definitions of internet sex-seeking which fail to account for its multi-dimensionality. This study purposed to: (1) examine if the way internet sex-seeking behaviour is operationalised influences its association with risky sexual behaviour (unprotected anal intercourse (UAI) and casual sex) and (2) determine the association of each operational definition with sexual risk. METHODS: We recruited 263 sexually-experienced young MSM (18-29 years) and operationalised internet sex-seeking behaviour in four ways: (i) ever used the internet to meet other men, (ii) currently own a profile on a website dedicated to meeting other men, (iii) ever physically met a man you initially met online and (iv) ever had sex with a man you met online. Using binomial regression, we examined the association of each operationalisation with UAI and casual sex. RESULTS: Only MSM who reported physically meeting a man they met online and those who ever had sex with a man they met online were more likely to report a history of UAI (p<0.05), while MSM who engaged in all forms of internet sex-seeking were more likely to engage in casual sex (p<0.05). However, the strength of these associations varied according to the mode of operationalisation. CONCLUSIONS: The way internet sex-seeking is operationalised in research is differentially associated with sexual risk. Against this backdrop, the utility of these operational definitions in future research and inferences drawn from such research must be interpreted with caution. Findings have important implications for sexual health research and methodology, survey development, sexual health prevention interventions, and evaluating sexual risk among young MSM.

Evaluating leadership training in African American HIV prevention organizations.

This article aimed to examine changes in the HIV prevention capacity of HIV prevention program managers who completed the Institute for HIV Prevention Leadership ("Institute") between 2002 and 2004, and who worked in community-based organizations that primarily served African Americans. Participants completed a survey at three points in time, in which they rated the frequency with which they conducted activities related to HIV prevention practice. Participants also rated their confidence in performing activities. Repeated measures ANOVA was conducted to detect differences at three time points (baseline, immediate posttest, and 6 months posttest). A significant overall positive trend was found in the frequency and confidence of participants to perform specific HIV prevention practices and an overall positive trend in the frequency of processes that support HIV prevention practice. Investment in long-term, intensive, capacity-building programs like the Institute is critical to address the increasing incidence of HIV in many African American communities.

Virtual worlds: taking health promotion to new levels.

Health promotion strategies continue to evolve, with interventions using e-mail, text messaging, and Web sites becoming commonplace. The use of online virtual worlds is a less familiar venue for health promotion but offers numerous possibilities for wired citizens with health issues. The authors discuss three examples of virtual worlds--the River City Project, Whyville, and Second Life--and how health promotion strategies can be implemented in virtual worlds. They also address several challenges associated with implementing health interventions in virtual worlds, including questions of ethics, diffusion of health knowledge and logistics of intervening outside of the real world.

Does education matter? Examining racial differences in the association between education and STI diagnosis among black and white young adult females in the U.S.

OBJECTIVES: Education has long been considered a protective factor against sexual risk behaviors and sexually transmitted infections (STIs) among adolescents; however, few have explored this association and determined differences across racial/ethnic groups of young adult females on a national scale. The purpose of this study was to (1) describe the association between education and STI diagnosis among a national sample of black and white young adult females and (2) examine racial differences in this association. METHODS: We used data from the National Longitudinal Study of Adolescent Health (Add Health) to assess the association between education and chlamydia, gonorrhea, and/or trichomoniasis (self-reported and assay-diagnosed) in 2001-2002 using logistic regression analysis. RESULTS: After adjustment for risk behaviors, education was inversely associated with any assay-diagnosed STI, but this association was nonsignificant among black women for self-reported STI. Additionally, black females enrolled in, or who graduated from, college had significantly higher predicted probabilities of having an STI (12.4% self-reported; 13.4% assay-diagnosed) compared with white females who had less than a high school diploma (6.4% self-reported; 2.3% assay-diagnosed). CONCLUSIONS: Educational status was not uniformly protective against STIs for black and white females in this sample. Particularly for young black women, other factors may play a more prominent role in determining STI risk. Social determinants, such as education, should be viewed as important factors associated with STI prevalence, but their differential impact on various racial/ethnic groups should also be considered when addressing the disproportionate rates of STIs in the U.S.

Diversifying the academic public health workforce: strategies to extend the discourse about limited racial and ethnic diversity in the public health academy.

While public health has gained increased attention and placement on the national health agenda, little progress has been made in achieving a critical mass of underrepresented minority (URM) academicians in the public health workforce. In 2008, a telephone-based qualitative assessment was conducted with URM faculty of schools of public health to discuss this issue. As a result, we present successful strategies that institutional leaders can employ to extend the discourse about addressing limited diversity in the public health academy.

Vaginal douching and intimate partner violence: is there an association?

OBJECTIVE: This study tests the hypothesis that vaginal douching among women of reproductive age is associated with exposure to intimate partner violence (IPV). METHODS: The data source is a cross-sectional population-based sample of 2,002 women ages 18-45 in the Central Pennsylvania Women's Health Study. The survey included measures of IPV, douching behavior, and relevant sociodemographic and health-related covariates. FINDINGS: Six percent of the sample reported experiencing any type of IPV in the past year, and 23% reported douching in the past year. IPV is significantly associated with douching after controlling for sociodemographic and health-related covariates. This finding holds for women with and without current reproductive capacity. CONCLUSIONS: This is the first study to identify an association between vaginal douching and IPV. Because vaginal douching is a risk factor for sexually transmitted infections, bacterial vaginosis, and adverse pregnancy outcomes, the findings could have important implications for prevention. Further research is needed to identify the reasons why women who have been exposed to IPV are more likely to douche.

Prevalence of impaired driving behaviors in a diverse, rural, southern middle school.

Little research has been reported on the risky behaviors of pre-driving adolescents revolving around alcohol use, in particular impaired driving behaviors, which in general have been shown to be higher in rural areas. This study investigated the prevalence of drinking while driving and riding with a drinking driver among 290 middle school students in a Mississippi Delta area middle school. Just under half (45.3%) responded that at least once in the past 30 days they had ridden with a drinking driver and 17% indicated they had driven an automobile after drinking alcohol. The prevalence of underage drinking, driving under the influence of alcohol, and riding with a drinking driver among our sample of middle school students is alarming. This study shows alcohol-related driving behaviors are not solely performed by those who are legally licensed to drive, but simply by those who have access to vehicles. The authors recommend that prevention programs focusing on reducing the incidence of impaired driving should start in early adolescence.

Racial disparities in tobacco use and social influences in a rural southern middle school.

This study investigated racial differences of tobacco use and social exposure to tobacco products in a sample of middle school students. Questionnaires were administered in January 2005 to 290 students in a Mississippi Delta-area middle school. The participants were 51.0% female and 56.6% African American. Unadjusted odds ratios revealed that Caucasian students were statistically more likely than were African American students to (1) have ever tried smoking, (2) have ever been a daily smoker, (3) have smoked in the past 30 days, (4) live with someone who smokes, (5) have seen a parent or guardian smoke, and (6) have friends who smoke. In contrast, African Americans were more likely to report "no one is allowed to smoke" in their home. Caucasian females had the highest rates of smoking, as well as the highest exposure to social smoking behaviors. This study not only showed that Caucasians were indeed smoking more but also that African American adolescents do not have the same exposure to social smoking, particularly African American females. Of particular interest was why the differences eventually dissipate and smoking rates are virtually the same in adulthood. A greater understanding of the impact of exposure to tobacco use on an adolescent's own tobacco use is vital to prevention efforts, especially in regard to racial differences. Future research on youth tobacco prevention and cessation programs should focus on sociocultural and racial differences in the development of tobacco use in adolescents.

Prevalence of condom use errors among STD clinic patients.

OBJECTIVE: To evaluate potential associations among condom errors and gonorrhea and chlamydial infection among a population of sexually transmitted disease clinic patients. METHODS: Audio computer-assisted self-interviewing was used to conduct a cross-sectional survey with 1124 participants. Biological specimens were collected during the evaluation visit. RESULTS: A substantial proportion of participants reported condom-use errors with condom breakage statistically associated with gonorrhea infection among males at enrollment (AOR = 1.91; 95% CI: 123-2.96; P = .004). CONCLUSION: Behavioral interventions that promote consistent condom use must provide the necessary skills associated with proper condom use.

Evaluation of an intervention for hospitalized African American smokers.

OBJECTIVE: To evaluate the effectiveness of a smoking cessation intervention based on the transtheoretical model of change with a sample of low-income African American smokers admitted to an indigent-care hospital. METHODS: The intervention incorporated components shown to be effective in increasing cessation in other populations, tailored to a bedside counseling format with follow-up contact postdischarge. RESULTS: Intervention patients were significantly more likely to advance in stage than were control patients. CONCLUSION: A hospital-offered bedside intervention offers promise in reaching underserved smokers with effective, though limited, cessation assistance.

Engaging a chemical disaster community: lessons from Graniteville.

Community engagement remains a primary objective of public health practice. While this approach has been adopted with success in response to many community health issues, it is rarely adopted in chemical disaster response. Empirical research suggests that management of chemical disasters focuses on the emergency response with almost no community engagement for long-term recovery. Graniteville, an unincorporated and medically underserved community in South Carolina was the site of one of the largest chlorine exposures by a general US population. Following the immediate response, we sought community participation and partnered with community stakeholders and representatives in order to address community-identified health and environmental concerns. Subsequently, we engaged the community through regular town hall meetings, harnessing community capacity, forming coalitions with existing local assets like churches, schools, health centers, and businesses, and hosting community-wide events like health picnics and screenings. Information obtained from these events through discussions, interviews, and surveys facilitated focused public health service which eventually transitioned to community-driven public health research. Specific outcomes of the community engagement efforts and steps taken to ensure sustainability of these efforts and outcomes will be discussed.

Effects of Promoting Health Among Teens on Dietary, Physical Activity and Substance Use Knowledge and Behaviors for African American Adolescents.

BACKGROUND: African Americans are disproportionately affected by cardiovascular disease and cancer. Health promotion interventions hold promise for reducing health disparities. PURPOSE: Promoting Health Among Teens (PHAT) is a brief, culturally tailored health education intervention to decrease cardiovascular disease and cancer risk for African Americans. This study evaluated the effects of PHAT for African American adolescents ages 14 to 17 in four eastern cities in the USA. METHODS: A randomized controlled design (N = 1,654) was used to determine differences in health knowledge, diet, physical activity, and substance use behaviors between PHAT participants and a sexual health promotion control group. Data were collected at baseline, three, six, and twelve months post intervention. Growth curve modeling was used to detect differences in health knowledge, dietary behaviors, physical activity, and substance use between PHAT and control group participants. RESULTS: PHAT participants had significantly greater knowledge gains but modest behavior changes compared to control group participants. DISCUSSION: PHAT is a promising intervention to increase knowledge and address selected health behaviors in African American youth. TRANSLATION TO HEALTH EDUCATION PRACTICE: Future attempts to execute PHAT should continue its emphasis on knowledge building while increasing intervention dosage and modifying length of time for intervention sessions.

Development of a framework for HIV/AIDS prevention programs in African American churches.

Churches and other faith-based organizations (FBOs) are a vital resource for HIV prevention and education efforts in African American communities. Few models describe how churches and FBOs have implemented such efforts within their congregations or communities, the challenges they faced, or the changes that resulted from such efforts. This article presents a framework for implementing HIV/AIDS prevention programs in African American churches based upon a qualitative investigation of Project FAITH (Fostering AIDS Initiatives that Heal), an HIV education and stigma reduction demonstration project conducted in South Carolina. Between 2007-2008 in-depth interviews were conducted with 8 pastors, 4 technical assistance providers, and 2 project champions; 22 care team members also participated in focus groups to identify domains associated with project implementation. Data analysis was conducted using a grounded theory approach and inputs, enablers, inhibitors, mediators, and outputs associated with HIV/AIDS prevention programs conducted as part of Project FAITH were identified. Furthermore, the framework includes the influences of public policy and stigma on the faith-based HIV/AIDS prevention programs in this study. The framework calls for the identification of individuals (members of the congregation and church leadership) who are passionate about and devoted to addressing HIV/AIDS, and provides specific mechanisms (i.e., health ministries) through which these individuals can organize, strategies for HIV/AIDS implementation, and areas of technical assistance and capacity building to maximize effectiveness of such efforts.

Do health beliefs, health care system distrust, and racial pride influence HPV vaccine acceptability among African American college females?

The promise of human papillomavirus (HPV) vaccines rests with the ability to promote widespread uptake especially among populations at high risk of cervical cancer and other associated disease outcomes. The purpose of this study was to examine health beliefs and culturally specific influences of HPV vaccine acceptability among African American college females. Approximately 76 percent of participants reported HPV vaccine acceptability. Predictors of acceptability included: higher perceived benefit and lower racial pride. Findings can be used to inform development of campus-based HPV educational approaches to promote widespread HPV vaccine acceptability and safer sex practices among African American college females.

HIV-disclosure, social support, and depression among HIV-infected African American women living in the rural southeastern United States.

This cross-sectional study examined the relationships between social support, HIV disclosure, and depression among 340 rural African American women with HIV disease living in the southeastern United States. Three aspects of social support (perceived availability of support, sources of available support, and satisfaction with available support) were measured along with HIV disclosure and depression. Perceived availability of support (p < .0001), sources of support (p = .03), satisfaction with support (p = .003), and HIV disclosure (total and to children; p = .05 and .04, respectively) were significantly and inversely correlated with depression. Perceived availability of support and satisfaction with support mediated the relationship between HIV disclosure and depression. If confirmed in longitudinal studies, these findings have implications for designing and implementing interventions supporting African American women with HIV disease in disclosing their HIV status appropriately, particularly to their children. In long run, appropriate self-disclosure may help decrease depression and improve quality of life among HIV infected African American women living in limited resource settings.

Using nominal technique to inform a sexual health program for black youth.

OBJECTIVES: To describe how nominal group technique (NGT) was used to inform the development of a sexual health education program for black high school youth in the South. METHODS: NGT was used with a community advisory board (CAB) to obtain information regarding the key components of a sexual health program for youth in their community. RESULTS: The CAB identified 5 priorities to include in the program: sex education, "keeping it real," responsibility/consequences, self-esteem, and female aggressiveness. CONCLUSIONS: Findings can be useful in modeling the successful use of NGT as a formative step toward developing health education programs for minority youth.

Knowledge, beliefs, and behaviors: examining human papillomavirus-related gender differences among African American college students.

OBJECTIVE: Given recent approval for administration of a human papillomavirus (HPV) vaccine to men, it is important to assess the HPV-related perspectives of men and women. The purpose of this study was to examine gender differences in HPV knowledge, beliefs, and vaccine acceptance among college students attending 3 historically black colleges/universities in the Southeast. PARTICIPANTS AND METHODS: A nonprobability sample of 575 students completed a self-report questionnaire. RESULTS: Males were significantly less likely to have heard of HPV, scored lower in HPV knowledge, were less likely to perceive HPV health outcomes as severe and that there was a benefit to vaccinate, reported fewer cues for vaccine acceptance, and perceived more barriers to vaccination compared to females (all p < .05). CONCLUSIONS: The gender disparities demonstrated in this study highlight the need to increase HPV-related communication/education to include men and to extend HPV research to a broader segment of the college population.

HIV testing among midlife women in the deep south: an analysis of the 2008 Behavioral Risk Factor Surveillance System survey data.

OBJECTIVE AND BACKGROUND: Our objective was to examine HIV testing uptake among postmenopausal women. Many women are routinely tested for HIV during pregnancy. Disproportionate numbers of women beyond reproductive age are diagnosed HIV-positive late in the disease course. Some older women and healthcare providers have dismissed early AIDS symptoms as signs of aging. This has resulted in missed opportunities for early initiation of effective antiretroviral therapy. METHODS: Behavioral Risk Factor Surveillance System (BRFSS) 2008 data were analyzed for non-Hispanic white and non-Hispanic black women (50-64 years) from six deep south states. Logistic regression models examined associations between uptake of HIV testing and population/behavioral characteristics. RESULTS: More than half of our sample (1091 of 2027) had an HIV test during their postreproductive years (>45 years old). Women 50-54 years old were about 40% as likely to have been tested for HIV during their postreproductive years as those 60-64 years old (adjusted odds ratio [AOR] 0.62, 95% confidence interval [CI] 0.45-0.84). Population characteristics, such as race/ethnicity, family poverty status, and urbanization, as well as HIV exposure risk, were all potential confounders of this relationship. CONCLUSIONS: Routine HIV testing is underused among women during their postreproductive years. HIV prevention messages that target midlife women are needed to reduce the prevalence of HIV/AIDS and disproportionate burden of late diagnosed HIV infection in this population.

Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States.

This cross-sectional study examined relationships between HIV-related stigma, social support, and depression in a sample of 340 HIV-infected African American women living in rural areas of the Southeastern United States. Three aspects of social support (availability of different types of support, sources of support, and satisfaction with support) and two aspects of HIV-related stigma (perceived stigma and internalized stigma) were measured. Perceived availability of support (p < .0001), sources of support (p = .03), satisfaction with support (p = .003), perceived stigma (p < .0001), and internalized stigma (p < .0001) were all significantly correlated with depression. Social support variables were negatively correlated and stigma variables were positively correlated with depression. HIV-related perceived stigma and internalized stigma were found to mediate the effect of sources of available support on depression. Study findings have implications for designing and implementing interventions to increase social support and decrease HIV-related stigma in order to decrease depression among African American women with HIV disease.