Evaluation of the Be the Exception Sixth-Grade Program in Rural Communities to Delay the Onset of Sexual Behavior.

OBJECTIVES: To investigate the impact of Be the Exception, a newly developed program to delay onset of sexual behaviors, in a White, rural population. METHODS: A cluster randomized controlled trial in northwestern Indiana (14 schools, 1776 students, 2011-2015) compared an intervention (5 group sessions and multimedia assembly) with a no-intervention group; both continued usual standard health education. Multilevel mixed-effects logistic regressions with 1455 students measured long-term outcomes 12 months after baseline questionnaire. RESULTS: Intervention group students reported ever having had sexual intercourse and sexual intercourse in past 3 months significantly less often than did the comparison group (1.91% vs 6.29% and 1.09% vs 4.26%, respectively). No statistical differences were observed for reported sexual intercourse in past 3 months with risky behavior (1.23% vs 2.24%), without condom use (1.04% vs 1.73%), or without birth control (1.00% vs 1.53%). Cumulatively, intervention group students significantly more often reported no activity, holding hands, hugging and kissing and less often reported touching above and below the waist, other sex, or sexual intercourse. CONCLUSIONS: Be the Exception is effective in delaying the onset of sexual behavior among rural middle school students.

Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population.

Prior research has established associations between pregnancy outcomes and specific neighborhood characteristics, including economic disadvantage, violent crime, and racial/ethnic segregation. Recently, associations have also been found between various health outcomes and group density, the degree to which an individual is a racial or ethnic majority in his or her local community. The objective of this study was to determine the extent to which census tract economic disadvantage, violent crime rate, and group density are associated with pregnancy outcomes among White, Black, and Hispanic infants in a large metropolitan setting. This cross-sectional study utilized 1990 census data, 1991 crime data, and 1991 birth certificate information for singleton live births in Chicago, Illinois. Results show substantial racial segregation in Chicago, with 35% of census tracts having more than 90% Black residents and 45% of census tracts having fewer than 10% Black residents. After stratifying by maternal race/ethnicity, we used multilevel analyses to model pregnancy outcomes as a function of individual and census tract characteristics. Among all racial/ethnic groups, violent crime rate accounted for most of the negative association between tract economic disadvantage and birth weight. Group density was also associated with birth weight but this association was stronger among Whites and Hispanics than among Blacks. Further analysis revealed that group density was more strongly associated with preterm birth while violent crime rate was more strongly associated with small for gestational age. These results suggest that group density and violent crime may impact birth weight via different mechanisms.

Under-use of emergency contraception for victims of sexual assault.

BACKGROUND: Approximately 700,000 women in the reproductive age group are victims of sexual assault in the United States per year. Between 1% and 5% of sexual assaults result in pregnancy, for a total of 32,000 pregnancies per year. Of these, 14,000 are aborted because of incest or rape. OBJECTIVE: To determine the percent of emergency departments in the state of Pennsylvania offering routine counseling and provision of emergency contraception to victims of sexual assault. Secondary objectives were to compare provision practices for Catholic versus non-Catholic hospitals, and to compare these practices with other services, such as sexually transmitted disease prophylaxis and sexual assault counseling. METHODS: A 15-item survey instrument was designed to determine the volume of sexual assault patients seen per year, routinely offered services, and emergency contraception protocols. Three telephone callers administered surveys, using a pre-designed script for each call. RESULTS: Of the 165 eligible hospitals, 125 (76%) replied. Less than half (42%) of all hospitals routinely offer emergency contraception counseling, and 16% of the hospitals did not offer any counseling regarding emergency contraception. CONCLUSION: Provision of emergency contraception to victims of sexual assault is inconsistent and insufficient. It is important that sexual assault patients not be further victimized by a system that fails to meet their needs.

Internet access and empowerment: a community-based health initiative.

OBJECTIVE: To determine whether access to health information via in-home Internet technology can positively influence empowerment among residents of a low-income urban community. DESIGN: In-home Internet access and training were provided to volunteers, who, along with a comparison group, were interviewed prior to and 1 year after initiation of the program. Community-based participatory research methods were used to design and implement the intervention. SETTING: A 57-block area on the West Side of Chicago. PATIENTS/PARTICIPANTS: Twenty-five community residents completed all phases of the technology intervention. Thirty-five randomly selected neighbors of these residents served as the comparison group. INTERVENTIONS: Members of the intervention group received Internet access via WebTV, training, technical support, and access to a community specific health-oriented web page during the course of the study. MEASUREMENTS AND MAIN RESULTS: Intervention group members were similar to comparison group members in terms of empowerment at baseline. After receiving Internet access and training, empowerment related to health decision-making improved significantly in the intervention group. Similar changes did not occur in the comparison group. Affinity for and appreciation of information technology also increased in the intervention group but not in the comparison group. As a result, differences in attitudes toward technology increased between the 2 groups over time. CONCLUSIONS: Using community-based participatory research methods, we found that Internet access to community-specific and general health information can lead to increased empowerment and appreciation of information technology. These benefits accrued among the intervention group but not among a random group of their neighbors.