Development and two-phased pilot RCT of a foster/kinship caregiver intervention to improve sexual health communication with youth.

PURPOSE: Foster youth have high rates of unintended teen pregnancies and other negative sexual health outcomes. Foster and kinship caregivers (FKC) are an untapped resource to reduce risks. We conducted a two-phase pilot study to evaluate feasibility, acceptability and assess preliminary efficacy of a training designed to improve caregiver communication, monitoring and conflict behaviors and improve sexual health outcomes for youth in foster care. Our study included a Randomized Controlled Trial (RCT) component. METHOD: Phase 1: We recruited 49 FKC and assessed feasibility quantitatively, and acceptability both qualitatively and quantitatively of our intervention (Heart to Heart). Phase 2: We conducted an RCT with 71 participants and evaluated caregiver communication, monitoring, and conflict behaviors as well as the psychological determinants thereof in intervention and control groups at 1, 3, and 6 months. RESULTS: Phase 1: Facilitators delivered all intervention content; >90% participants received the entire training. The intervention was highly acceptable (mean score 4.9/5 on two questions). Phase 2: 71 participants were eligible and completed baseline (68 completed at least one follow up survey). We found significant improvements in the intervention group in knowledge, communication expectations, and caregiver-youth conflict behaviors in one or more waves; the control group demonstrated no significant improvements. When groups were compared, we found significant differences in knowledge, communication frequency, and conflict behaviors at 6 months. CONCLUSIONS: Heart to Heart is feasible, acceptable, and preliminary outcomes data is promising. More research is needed to better establish evidence of efficacy for long-term behavior change in caregivers and youth. CLINICALTRIALSGOV IDENTIFER: NCT03331016.

Age at Sexual Initiation and Sexual and Health Risk Behaviors Among Jamaican Adolescents and Young Adults.

Current policies limit access to sexual and reproductive health services for adolescents younger than 16 years in Jamaica. Using data from a national survey, we explored the relationship between age at sexual initiation and subsequent sexual risk behaviors in a random sample of 837 Jamaican adolescents and young adults aged 15-24 years. In the sample overall, 21.0% had not yet had sex. Among the 661 sexually active participants, the mean age at first sex was 14.7 years. High percentages of sexually active youth reported engaging in risk behaviors such as inconsistent condom use (58.8%), multiple sex partners (44.5%), and transactional sex (43.0%). Age of sexual initiation for males was unrelated to subsequent sexual risk behaviors. However, earlier sexual debut for females was associated with their number of partners during the preceding year. Findings underscore the potential benefits of access to sexual and reproductive education and services at earlier ages than current policies allow. Interventions before and during the period of sexual debut may reduce sexual risk for Jamaican adolescents and young adults.

Mentoring the Mentors of Underrepresented Racial/Ethnic Minorities Who are Conducting HIV Research: Beyond Cultural Competency.

The majority of literature on mentoring focuses on mentee training needs, with significantly less guidance for the mentors. Moreover, many mentoring the mentor models assume generic (i.e. White) mentees with little attention to the concerns of underrepresented racial/ethnic minorities (UREM). This has led to calls for increased attention to diversity in research training programs, especially in the field of HIV where racial/ethnic disparities are striking. Diversity training tends to address the mentees' cultural competency in conducting research with diverse populations, and often neglects the training needs of mentors in working with diverse mentees. In this article, we critique the framing of diversity as the problem (rather than the lack of mentor consciousness and skills), highlight the need to extend mentor training beyond aspirations of cultural competency toward cultural humility and cultural safety, and consider challenges to effective mentoring of UREM, both for White and UREM mentors.

Remembering the Basics: African American Youth and HIV Knowledge - Brief Report.

ACKNOWLEDGEMENTS: This research was supported by a grant from the Royalty Research Fund at the University of Washington. We thank all the youth, families, and community organizations for their participation. OBJECTIVE: The current work examined three HIV knowledge areas (i.e.,general knowledge, HIV-safe behaviors, HlV-risk behaviors) among African American youth living in two urban areas. METHODS: In a cross sectional sample of 142 African American youth ages11-17 years living in Chicago and Seattle, youth's HIV knowledge wasassessed using a 16-item survey adapted from the Youth AIDS Prevention Project and the Aban Aya Project. RESULTS: Multiple linear regression analyses examined the association among youth HIV knowledge and key demographic variables (i.e., age, gender, parent education, household income, and city). Overall HIV knowledge was low among all youth. Youth were most informed about general knowledge, followed by knowledge of HlV-risk behaviors. Youth were considerably misinformed about HIV-safe behaviors. Generally, older youth and those living in Seattle were more informed about HIV than younger adolescents and youth living in Chicago. Household income and youth gender were unrelated to youth's HIV knowledge. However, parental education was related to youth's HIV-safe knowledge, with youth of more educated parents having less knowledge than youth with less educated parents. CONCLUSIONS: Findings from this study underscore the importance of continued attention to HIV knowledge as an important component of HIVprevention among African American youth. Accurate information about HIV is critical for prevention efforts. Prevention efforts should ensure that new generations of youth continue to be provided with knowledge about HIV risk and transmission. PUBLICATION INDEX: PubMed.

Sexual Health and Communication Between Foster Youth and Their Caregivers.

PURPOSE: Foster youth are at increased risk for negative sexual health outcomes and rarely receive the information or social/familial support needed to reduce risks. Foster and kinship caregivers report lacking the information and skills needed to effectively talk to youth in their care about sexual health. In a sample of caregivers from 2 large urban jurisdictions, our goals were to: 1) describe caregiver sexual health variables including communication and monitoring characteristics; and 2) assess associations between self-reported emotion regulation and caregiver-youth conflict and these variables. METHODS: We administered surveys to foster and kinship caregivers in New York, New York and Los Angeles, California. Surveys assessed caregiver emotion regulation, caregiver-youth conflict, sexual/reproductive health knowledge, communication expectations and behaviors, and caregiver monitoring/youth disclosure. We generated descriptive statistics for all variables (aim 1) then performed multivariate regression analyses for aim 2. RESULTS: Our sample included 127 foster and kinship caregivers who were primarily female (92%) and African American (55%). Most reported having >4 years of caregiving experience with foster youth (66%). On average, caregivers answered sexual health knowledge questions correctly 68% of the time. Caregiver-youth conflict was the only variable significantly associated with assessed sexual health variables; it was inversely associated with percent correct on the knowledge scale, outcomes expectations, number of topics discussed, and monitoring/disclosure. CONCLUSION: Our study suggests that caregiver-youth conflict behaviors are related to sexual health knowledge, communication, and monitoring variables. Further prospective and longitudinal investigation is warranted to better characterize the complex relationship between these variables.

The impact of mental health problems and religiosity on African-American girls' HIV-risk.

We investigated the relationship between religiosity, mental health problems, and two sexual risk behaviors-condom use and number of partners. Participants were 80 sexually active African American girls in psychiatric care and their caregivers. Results indicated differential relationships, depending on parent versus youth report. Mother's religiosity was positively related to girls' condom use and not to girls' number of partners. Controlling for other predictors in the models, mother's religiosity explained as much as 15% of the variance in girls' condom use. Whereas parent and adolescent reports of girls' depression/anxiety and rule-breaking were positively associated with number of partners, reports of aggression were associated with having fewer partners. Neither parent nor youth reports of girls' mental health problems were associated with condom use. Controlling for other predictors in the models, girls' mental health problems accounted for as much as 31% of the variance in number of partners. Findings underscore the importance of adopting an ecological framework to understand both the risk and promotive factors for sexual risk taking among troubled girls. The roles of specific aspects of psychopathology and religiosity in relation to sexual risk behavior among African American girls in psychiatric care are discussed.

The relationship between early sexual debut and psychosocial outcomes: a longitudinal study of Dutch adolescents.

In a longitudinal dataset of 470 Dutch adolescents, the current study examined the ways in which early sexual initiation was related to subsequent attachment, self-perception, internalizing problems, and externalizing problems. For male adolescents, analyses revealed general attachment to mother and externalizing problems at Wave 1 to predict to early transition at Wave 2. However, there was no differential change in these psychosocial factors over time for early initiators of sexual intercourse and their non-initiating peers. For female adolescents, the model including psychosocial factors at Wave 1 did not predict to sexual initiation at Wave 2. However, univariate repeated measures analyses revealed early initiators to have significantly larger increases in self-concept and externalizing problems than their non-initiating female peers. While the difference between female early initiators and non-initiators were statistically significant, the mean levels of problem behaviors were very low. The findings suggest that, contrary to previous research, early sexual initiation does not seem to be clustered with problem behaviors for this sample of Dutch adolescents.

A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse.

Young adults, including college students, engage in high levels of unprotected sexual activity despite relatively high rates of HIV/STI and pregnancy-related knowledge. Little is known about the cognitive strategies that young people use to explain this inconsistency. The current study examined young people's explanations for engaging in unprotected sexual activity in their committed relationships. A total of 63 young adults (32 women and 31 men) completed daily diaries over a 3-week period, providing a total of 1,284 daily reports tracking their condom use and non-use during intercourse. Diary collection was followed by in-depth interviews designed to explore participants' decision-making regarding their participation in sexual intercourse unprotected against infection or unwanted pregnancy. Less than a quarter of the sample used condoms or oral contraceptives consistently. Participants primarily viewed condoms as a means of preventing pregnancy; few described disease prevention as a main motivation for their use. Analysis of the cognitions underlying explanations for condom and contraception non-use were classified as (1) general biased risk evaluation, (2) biased evidence evaluation, (3) endorsement of poor alternatives, (4) focus on spurious justifications, (5) dismissing risk, and (6) ignoring risk. Prevention interventions should incorporate methods to challenge young people to acknowledge personal risk and commit themselves to taking steps to reduce this risk.

Does Parental Monitoring Moderate the Impact of Community Violence Exposure on Probation Youth's Substance Use and Sexual Risk Behavior?

The present study examined whether parental monitoring buffers the negative effects of communtity violence exposure on probation youth's substance use and sexual risk behaviors. Among a sample of 347 Chicago youth on probation, ages 13-17 years, parental monitoring did not moderate the relationship between community violence exposure and probation youth's sexual risk and substance use. However, parental monitoring was independently associated with less engagement in sexual risk and substance use, and community violence exposure was independently associated with more risk behavior among probation youth. The present study contributes to the growing literature on the impact of community violence exposure and parenting on adjudicated youth risk.

Young urban adults' heterosexual risk encounters and perceived risk and safety: a structured diary study.

Using diary methods, the current study explored characteristics of young adults' sexual risk interactions over a two-week period and the associations between perceived risk and safety with regard to these sexual risk behaviors. We screened all participants to ensure a moderate to high scores on an HIV knowledge measure. Men (n = 44) and women ( n = 48) enrolled at an inner-city college collected diary data, generating reports of 440 sexual occasions over a 2-week period (1,278 person-days). Despite participation in sexual risk activities, including highly inconsistent condom use during intercourse, participants uniformly reported high safety and little to no risk. Only women's perceptions of safety (not risk) were associated with condom use, men's perceptions of both safety and risk were unrelated. Ratings of safety and risk appeared to operate independently for the most part. Sex with new partners and new sexual activity were associated with both judgments of greater risk and lower safety were associated for men only. These results add to the growing evidence that young people fail to integrate fully their general knowledge regarding HIV risk into their personal interactions. This study has implications for the development of cognitive models around sexual decision-making for young adults at risk for HIV and may provide insight into the contextual features of sexual interactions associated with young people's perceptions of risk and safety.

HIV-Risk Reduction with Juvenile Offenders on Probation.

Youth involved in the juvenile justice system are at elevated risk for HIV as a result of high rates of sexual risk taking, substance use, mental health problems and sexually transmitted infections. Yet few HIV prevention programs exist for young offenders. This pilot study examined change in juvenile offenders' sexual activity, drug/alcohol use, HIV testing and counseling, and theoretical mediators of risk taking following participation in PHAT Life, an HIV-prevention program for teens on probation. Participants (N=54) were 13-17 year-old arrested males and females remanded to a detention alternative setting. Youth participated in a uniquely tailored HIV prevention intervention and completed a baseline and 3-month follow up assessment of their HIV and substance use knowledge, attitudes, beliefs, and behaviors. At 3-month follow up, teens reported less alcohol use, more positive attitudes toward peers with HIV, greater ability to resist temptation to use substances, and for males, improved HIV prevention self-efficacy and peer norms supporting prevention. Teens were also more likely to seek HIV counseling and males were more likely to get tested for HIV. Effect sizes revealed moderate change in sexual behavior. Findings support PHAT Life as a promising intervention to reduce HIV-risk among youth in juvenile justice.

Nurse-delivered counselling intervention for parental HIV disclosure: results from a pilot randomized controlled trial in China.

OBJECTIVE: The objective of this study was to design and conduct a preliminary evaluation of an intervention to assist parents in decision-making about disclosure of their HIV diagnosis to their children. DESIGN: This was a pilot randomized controlled trial (RCT) with blinded assessment. Participants were randomized to intervention or treatment-as-usual (TAU) arms. SETTING: The study occurred at an outpatient HIV primary care centre in Shanghai, China. PARTICIPANTS: Participants were 20 HIV-positive outpatients with at least one child (13-25 years old) who was unaware of the parent's HIV diagnosis. INTERVENTION: The nurse-delivered intervention involved three, hour-long, individual sessions over 4 weeks. Intervention content comprised family assessment, discussion of advantages and disadvantages of disclosure, psycho-education about cognitive, social and emotional abilities of children at different developmental stages, and disclosure planning and practicing via role-plays. MAIN OUTCOME MEASURE(S): Primary study outcomes for intervention versus TAU arms were self-reported disclosure distress, self-efficacy, and behaviours along a continuum from no disclosure to full disclosure and open communication about HIV. RESULTS: In all cross-sectional (Wald tests) and longitudinal (general estimating equations) analyses, at both postintervention (4 weeks) and follow-up (13 weeks), effects were in the hypothesized directions. Despite the small sample size, most of these between-arm comparisons were statistically significant, with at least one result for each outcome indicating a 'large' effect size. CONCLUSION: Our results suggest that nurses are able to deliver a counselling intervention in a clinic setting with the potential to alleviate parental distress around HIV disclosure to their children. Findings warrant future trials powered for efficacy.

Parents matter in HIV-risk among probation youth.

We investigated the relationship between parenting practices (i.e., parental monitoring, parent permissiveness, and parent-teen communication), and probation youth's HIV-related sexual risk behavior (i.e., ever having sex, condom use, alcohol and marijuana use before sex). Participants were 61 male and female juvenile offenders, ages 13-17, on probation and awaiting sentencing. Results indicated different relationships between parenting and HIV-related sexual risk behavior for probation boys and girls. Parental monitoring, parenting permissiveness, and parent-teen communication were collectively related to whether girls' ever had sex and with boys' use of alcohol and marijuana use before last sex. Findings underscore the important role of parenting on probation teens' HIV risk behaviors.

The development of argument skills.

This work sought to obtain experimental evidence to corroborate cross-sectional patterns of development in argument skills and to evaluate the effectiveness of an intervention designed to foster development of these skills in academically at-risk 13- to 14-year-olds. Students participated in 16 sessions of a collaborative, goal-based activity providing dense exercise of argumentive thinking. One condition included peer dialogues; another did not. The former was the more effective, although both groups progressed. Participants showed increased frequency of usage of powerful argumentive discourse strategies, such as counterargument, and decreased frequency of less effective strategies. Quality of individual arguments (for or against a claim) also improved, supporting the existence of a close relation between these two kinds of argument skills.