Development of a culturally relevant consumer health information website for Harlem, New York.

The process of creating a geographically tailored health information website with ongoing feedback from community members is one of inquiry and discovery, frustration and triumph, and development and reevaluation. This article reviews the development and implementation of GetHealthyHarlem.org, a health literacy level-appropriate consumer health information website tailored to consumers in Harlem, New York City. From 2004 to 2009, the Harlem Health Promotion Center, one of 37 Prevention Research Centers in the United States, sought to determine the use and seeking of online health information in Harlem, New York City in order to further explore the possibility of providing online health information to this community. Specifically, this article details how we sought to identify gaps, concerns, and uses of online health information and health care seeking in this local, predominantly racial and ethnic minority population. We review how we identified and addressed the multitude of variables that play a role in determining the degree of success in finding and using online health information, and include discussions about the genesis of the website and our successes and challenges in the development and implementation stages.

HIV testing preferences among young men of color who have sex with men.

OBJECTIVES: We assessed awareness of and preferences for rapid HIV testing among young, urban men of color who have sex with men and are engaged in high-risk behaviors for HIV. METHODS: A cross-sectional survey was conducted in New York City among 177 young men who have sex with men (MSM). RESULTS: Among the 85% of the participants who had previously undergone HIV testing, 43% reported rapid testing at their most recent test. In terms of future tests, 64% would seek rapid testing, as compared with 36% who preferred traditional testing. Those who preferred rapid testing were significantly more likely to have attended at least some college, to have discussed HIV testing with a sexual partner, to be aware of rapid testing, and to have had a previous HIV test. CONCLUSIONS: In general, young MSM of color seem aware of rapid testing. However, our results indicate the need to carefully consider the unique needs of those who are particularly disenfranchised or engaged in high-risk behaviors and who may need concerted efforts around HIV counseling and testing. Likewise, our findings point to a need for more effective education and social marketing strategies.

Feasibility of using computer-assisted interviewing to enhance HIV test counseling in community settings.

OBJECTIVES: Significant advances in the treatment of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) place a premium on early detection and linkage to care. Recognizing the need to efficiently yet comprehensively provide HIV counseling, we assessed the feasibility of using audio computer-assisted self-inventory (A-CASI) in a community-based HIV counseling and testing facility. METHODS: A convenience sample of 50 adults presenting for HIV testing was recruited to complete an 85-item computerized HIV Assessment of Risk Inventory (HARI) containing domains of demographics, sexual behaviors, alcohol and substance use, emotional well-being, past experiences with HIV testing, and attitudes about taking HARI. RESULTS: Client acceptance rate was limited by the completion time outlined during the intake process. However, the majority of respondents who completed HARI felt that it took only a short to moderate time to complete and was easy to understand. A majority also reported a preference for using a computerized format in the future. Further, HARI identified a number of risk-taking behaviors, including unprotected anal sex and substance use prior to past sexual encounters. Additionally, more than half of the sample reported moderate to severe depressive symptoms. CONCLUSIONS: Those respondents who had time to complete the survey accepted the A-CASI interview, and it was successful at identifying a substantial level of risk-taking behaviors. A-CASI has the potential to guide HIV counselors in providing risk-reduction counseling and referral activities. However, results suggested the need to shorten the instrument, and further studies are needed to determine applicability in other HIV testing sites.

The New York City Community Outreach Study: biomedical and mental health status among a community sample of urban Hispanics.

OBJECTIVE: This report provides a snapshot of health behavior and risk in one low-income, urban, Latino community. As part of a community health and education program, 200 adult residents were asked about their health status and behavior and screened for conditions known to constitute significant health risk. DESIGN: A random sample of 10 buildings around a large community-based organization (CBO) service area was selected to receive personal invitation and/or door-to-door flyers announcing several days of free health screening and education at the CBO. All individuals age > or = 18 years were eligible. Those who received screening were mailed lay descriptions of their results along with recommendations and locations for follow-up, if appropriate. SETTING AND PARTICIPANTS: Participants were adult residents of an economically and medically under-served district in New York City, where Latinos make up approximately 75% of the population. Free screening for high blood pressure, diabetes, high cholesterol, obesity, and depression was provided. MAIN OUTCOME MEASURES: The clinical outcomes of the aforementioned tests constitute the main outcomes of this report. RESULTS: Compared to national estimates for Hispanics, health risk was quite high in this sample, particularly with regard to diabetes and cholesterol. Moreover, participants were much less likely to have insurance or to have a regular source of health care than reported in national studies of Hispanics. CONCLUSIONS: Though site specific, these data provide critical information to local CBOs and can be used as a tool for comparison with national data and Healthy People 2010 goals.

Computer use, internet access, and online health searching among Harlem adults.

PURPOSE: Computer use, Internet access, and online searching for health information were assessed toward enhancing Internet use for health promotion. DESIGN: Cross-sectional random digit dial landline phone survey. SETTING: Eight zip codes that comprised Central Harlem/Hamilton Heights and East Harlem in New York City. SUBJECTS: Adults 18 years and older (N=646). MEASURES: Demographic characteristics, computer use, Internet access, and online searching for health information. ANALYSIS: Frequencies for categorical variables and means and standard deviations for continuous variables were calculated and compared with analogous findings reported in national surveys from similar time periods. RESULTS: Among Harlem adults, ever computer use and current Internet use were 77% and 52%, respectively. High-speed home Internet connections were somewhat lower for Harlem adults than for U.S. adults overall (43% vs. 68%). Current Internet users in Harlem were more likely to be younger, white vs. black or Hispanic, better educated, and in better self-reported health than non-current users (p<.01). Of those who reported searching online for health information, 74% sought information on medical problems and thought that information found on the Internet affected the way they eat (47%) or exercise (44%). CONCLUSIONS: Many Harlem adults currently use the Internet to search for health information. High-speed connections and culturally relevant materials may facilitate health information searching for underserved groups.

There's always Plan B: adolescent knowledge, attitudes and intention to use emergency contraception.

BACKGROUND: It can prove challenging to create social marketing materials aimed at a specific subsection of the population, especially when the topic is relatively new and possibly misunderstood. Therefore, the objective of this study was to assess adolescent knowledge of and attitudes towards emergency contraception (EC), with the goal of creating a locally relevant social marketing campaign and intervention. METHODS: This qualitative study consisted of 18 in-depth interviews and four focus groups (n=29) with adolescents and young adults ages 15 to 21 years, conducted in New York City between August and December 2006. RESULTS: While respondents seemed generally aware of EC's existence, most were unclear about circumstances warranting its use and its mechanism of action. The FDA change to behind-the-counter availability appeared to increase knowledge and access to EC, although substantial barriers to EC access and use remain, including price. CONCLUSIONS: Further work remains in educating those in need of EC, especially adolescents under the age of 18 years. Results from this study initiated a social marketing campaign and intervention aimed at increasing adolescent knowledge of and access to EC.

Secure e-mail applications: strengthening connections between adolescents, parents, and health providers.

Although e-mail has become a popular means of communication among consumers, particularly youth, available evidence suggests that current use of this modality to facilitate communication between consumers and their health providers is relatively modest. Historically, structural and legal issues have provided substantial impediments; however, new developments in providing secure and protected mechanisms for transmitting and delivering e-mail messages may pave the way to enhance use and improve communication.

One chip at a time: using technology to enhance youth development.

Youth development programs have the potential to positively impact psychosocial growth and maturation in young adults. Several youth development programs are capitalizing on youths' natural gravitation toward technology as well. Research has shown that youth view technology and technologic literacy as positive and empowering, and that youth who master technology have increased self-esteem and better socioeconomic prospects than their counterparts. Technology-centered youth development programs offer a unique opportunity to engage youth, thereby extending their social networks, enhancing their access to information, building their self-esteem, and improving their self-efficacy. This article provides an overview of the intersection between youth development and technology and illustrates the ways technology can be used as a cutting-edge tool for youth development.

An online audio computer-assisted self-interview for pre-screening prior to rapid HIV testing in a vulnerable population.

ACASI (Audio Computer-Assisted Self-Interview) has been demonstrated to be more effective than face to face interviews in eliciting truthful responses on sensitive subjects such as substance abuse and sexual behavior (1, 2). Thus, ACASI has the potential to streamline and standardize HIV counseling and testing by providing a comprehensive overview of each patients behavior while highlighting areas that may merit further exploration.