College student engaging in cyberbullying victimization: cognitive appraisals, coping strategies, and psychological adjustments.

The study's purpose was to explore whether frequency of cyberbullying victimization, cognitive appraisals, and coping strategies were associated with psychological adjustments among college student cyberbullying victims. A convenience sample of 121 students completed questionnaires. Linear regression analyses found frequency of cyberbullying victimization, cognitive appraisals, and coping strategies respectively explained 30%, 30%, and 27% of the variance in depression, anxiety, and self-esteem. Frequency of cyberbullying victimization and approach and avoidance coping strategies were associated with psychological adjustments, with avoidance coping strategies being associated with all three psychological adjustments. Interventions should focus on teaching cyberbullying victims to not use avoidance coping strategies.

The Eastland Prostate Cancer Survey: instrument development and psychometric testing.

African-American (AA) women could be instrumental in communicating positive prostate screening behavior to the significant males in their lives. However, little is known about AA women's prostate cancer attitudes, perceived behavioral control, subjective norms, intentions, behaviors, and knowledge regarding prostate cancer screening. This study describes the development and psychometric testing of the Eastland Prostate Cancer Survey (EPCS). A nonexperimental, correlational study with 200 AA women was used to test the psychometric properties of the six-subscale EPCS with 66 items. Construct validity, internal consistency, and test-retest reliability for the EPCS were acceptable and resulted in an eight-subscale EPCS with 56 items. Cronbach's alphas for the subscales ranged from 0.69 to 0.92. The EPCS is a culturally sensitive, gender-relevant instrument that could be used by community health providers to develop community health programs aimed at engaging AA women in the promotion of prostate cancer screening for AA men.

Stressors, resources, and stress responses in pregnant African American women: a mixed-methods pilot study.

This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative and qualitative data revealed 2 types of stress responses: high stress responses (7 women) and low stress responses (4 women). Patterns of stress responses were seen in psychological stress and cervical remodeling (attenuation or cervical length). All women in the high stress responses group had high depression and/or low psychological well-being and abnormal cervical remodeling at one or both data collection times. All but 1 woman had at least 3 sources of stress (racial, neighborhood, financial, or network). In contrast, 3 of the 4 women in the low stress responses group had only 2 sources of stress (racial, neighborhood, financial, or network) and 1 had none; these women also reported higher perceived support. The findings demonstrate the importance of periodically assessing stress in African American women during pregnancy, particularly related to their support network as well as the positive supports they receive.

African American families' expectations and intentions for mental health services.

A cross-sectional qualitative descriptive design was used to examine the links among expectations about, experiences with, and intentions toward mental health services. Individual face-to-face interviews were conducted with a purposive sample of 32 African American youth/mothers dyads. Content analysis revealed that positive expectations were linked to positive experiences and intentions, that negative expectations were not consistently linked to negative experiences or intentions, nor were ambivalent expectations linked to ambivalent experiences or intentions. Youth were concerned about privacy breeches and mothers about the harmfulness of psychotropic medication. Addressing these concerns may promote African Americans' engagement in mental health services.

Parent-child relationships between Korean American adolescents and their parents.

This cross-sectional correlational study examined the association between Korean American adolescents' and their parents' reports of parent-child relationships. A total of 61 Korean American families completed a questionnaire assessing parental knowledge, parental/filial self-efficacy, parent-child communication, and parent-child conflicts. T tests, Pearson's correlations, a scatter diagram, and bivariate regression were used to analyze the data. Both Korean American adolescents and their parents reported that fathers were less knowledgeable about their child's school life and less likely to communicate with their children than were mothers. Fathers reported a significantly lower level of parental self-efficacy than mothers, and adolescents also reported a significantly higher level of filial self-efficacy in mother-child relationships than in father-child relationships. Positive correlations between parents' and adolescents' reports of parent-child relationships were observed. These findings indicated a need for parent education programs or counseling services for Korean American parents of adolescents, particularly fathers with inadequate parental skills and limited communication with their children.

Consistent condom use among Thai heterosexual adult males in Bangkok, Thailand.

Thai heterosexual males between 20 and 39 years old are at increased risk for HIV infection. Consistent condom use is effective against HIV transmission, but little is known about determinants of consistent condom use for these males. The purpose of this study is to explore determinants of consistent condom use for this population. The determinants of interest are age, educational level, marital status, income, and concepts from the theory of planned behavior: attitude toward condom use, subjective norm about consistent condom use, perceived behavioral control (PBC) of consistent condom use, and intention to use condoms consistently. We used a cross-sectional descriptive research design with a convenience sample of 400 heterosexual Thai males between 20 and 39 years. Our sample had a mean age of 28.71 years (SD = 6.33). During the last three months, 39.5% reported using condoms consistently, 23% reported using condoms inconsistently, and 37.5% reported never using condoms. The results from the regression analyses revealed that marital status, income, subjective norm about consistent condom use, PBC of consistent condom use, and intention to use condoms consistently were determinants of consistent condom use. Also the effect of subjective norm about consistent condom use and PBC of consistent condom use on consistent condom use was mediated by intention to use condoms consistently. These results suggest that interventions to increase consistent condom use should focus on enhancing intention to use condoms consistently by promoting subjective norm about consistent condom use and PBC of consistent condom use.

The experience of mental health service use for African American mothers and youth.

Little is known about African American families' experiences with mental health services. A purposive sample of 40 dyads of African American youth (aged 13 to 19) and their mothers participated in a cross-sectional qualitative research design using semi-structured interviews that elicited information about their past experiences and satisfaction with mental health services. Though rarely received, group and family therapy were perceived favorably. However, both mothers and youth reported dissatisfaction centered on medication and lack of professionalism, confidentiality, and concern by providers. The failure of mental health services providers to meet basic standards of quality and professionalism may explain the low rate of service use by African Americans.

Advance Care Planning for African American Caregivers of Relatives With Dementias: Cluster Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: African-American family caregivers may have insufficient knowledge to make informed end-of-life (EOL) decisions for relatives with dementias. Advance Care Treatment Plan (ACT-Plan) is a community-based education intervention to enhance knowledge of dementia and associated EOL medical treatments, self-efficacy, intentions, and behavior (written EOL care plan). This study evaluated efficacy of the intervention compared to attention control. RESEARCH DESIGN AND METHODS: In a theoretically based, 2-group, cluster randomized controlled trial, 4 similar Midwestern urban megachurches were randomized to experimental or control conditions. Each church recruited African-American caregivers, enrolling concurrent waves of 5 to 9 participants in 4 weekly 1-hour sessions (358 total: ACT-Plan n = 173, control n = 185). Dementia, cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and tube feeding (TF) treatments were discussed in ACT-Plan classes. Participants completed assessments before the initial class, after the final class (week 4), and at week 20. Repeated measures models were used to test the intervention effect on changes in outcomes across time, adjusting for covariates as needed. RESULTS: Knowledge of CPR, MV, TF, and self-efficacy to make EOL treatment decisions increased significantly more in the ACT-Plan group at weeks 4 and 20. Knowledge of dementia also increased more in the ACT-Plan group at both points, reaching statistical significance only at week 20. Intentions to make EOL treatment decisions and actually an advance care plan were similar between treatment arms. DISCUSSION AND IMPLICATIONS: Findings demonstrate promise for ACT-Plan to increase informed EOL treatment decisions for African American caregivers of individuals with dementias.

Perceptions of hypertension and contributing personal and environmental factors among rural Southern African American women.

OBJECTIVE: This study aimed to describe the perceptions of Southern, rural, African American women regarding personal and environmental factors that affect their hypertension. DESIGN: A purposive sample of 25 African American women aged 40-74 years, who lived in rural Alabama, participated in seven Talking Circles for 60 minutes. RESULTS: Most felt that hypertension was a "common occurrence" and that it was "typical in the African American community." They associated hypertension with stroke and heart attacks and referred to hypertension as the "silent killer." Barriers to following the treatment plan were low income, high medical expenses, and lack of insurance. Barriers to medication were cost, dislike for taking medication, running out of medication, side effects, forgetting, and being tired; and barriers to exercise were being tired, busy schedule, and safety. Walking paths, fitness centers, or malls to walk around were not available in all communities, and not all sidewalks were well-lit, limiting their walking exercise opportunities after work hours. Healthcare facilities were accessible, but it was easier to get an appointment and receive respect from healthcare providers if the women had money or insurance. Blood pressure monitors were available in their homes, at grocery stores and at Wal-Mart. No church health programs were available, but some churches had nurses on duty who offered blood pressure and cholesterol screening; however, no medication was provided. Grocery stores were accessible, and they had a flea market with fresh fruits and vegetables. Social environment/support by families and friends for persons with hypertension was not always positive. CONCLUSION: The findings of this study indicate that personal and environmental factors play important roles in hypertensive status. The modified ecological framework used in this study may help us explore perspectives of family members and friends regarding their support for persons with hypertension. More serious efforts and resources need to be made available for preventive measures of hypertension in this population.

Outcomes of a home-based walking program for African-American women.

PURPOSE: As compared with minimal treatment (MT), to determine the effectiveness of a home-based walking intervention enhanced by behavioral strategies targeted and tailored to African-American women (enhanced treatment [ET]) on adherence, physical activity, fitness, and body composition at 24 and 48 weeks. DESIGN: Using a quasi-experimental design, treatments were randomly assigned to one of two community health centers. SETTING: The centers were in predominately African-American communities. PARTICIPANTS: Sedentary women (156 ET, 125 MT) 40 to 65 years were recruited within a 3-mile radius of each center. INTERVENTION: Both treatments had the same orientation. The ET group had four targeted workshops followed by weekly tailored telephone calls over 24 weeks. METHODS: Generalized linear mixed models were used to test effects of treatments on adherence, physical activity, aerobic fitness, and body composition. RESULTS: Adherence was significantly higher in the ET than the MT group and was related to the number of workshops attended (r = .58) and tailored calls (r = .25) received. On-treatment analysis showed significant postintervention improvement in waist circumference and fitness in the ET group; however, these improvements were not statistically different between the two groups. Intent to treat analysis showed a significant increase in fitness, decrease in waist circumference, and no change in body mass index in both treatments. CONCLUSION: Findings suggest the potential impact of workshop group support on adherence in African-American women.

Research brief: community consultation to develop an acceptable and effective adolescent HIV prevention intervention.

HIV prevention for adolescents is urgently needed in Africa, but interventions have been slow to develop because of controversies about sex education. In this report the authors describe a four-step process used to develop a culturally and developmentally appropriate adolescent HIV prevention program for communities in rural Malawi. This is the final component of a 2-year ongoing adult HIV prevention program in Malawi. First the authors identified the risky behaviors of rural adolescents as well as cultural, developmental, and contextual factors. Next they consulted the community regarding how to use this information effectively and acceptably. Then an existing intervention was adapted based on this information. Finally, the authors piloted the intervention and made modifications based on lessons learned. This process provides a systematic way to consult with the community, thereby jointly enriching understanding, engaging the issues, and promoting support for an intervention program.

Substance Use and Risky Sexual Behaviors Among Young Men Working at a Rural Roadside Market in Malawi.

Using an ecological model, we describe substance use and sexual risk behaviors of young male laborers at a roadside market in Malawi. Data included observations and interviews with 18 key market leaders and 15 laborers (ages 18-25 years). Alcohol, marijuana, and commercial sex workers (CSWs) were widely available. We identified three patterns of substance use: 6 young men currently used, 6 formerly used, and 3 never used. Substance use was linked to risky sex, including sex with CSWs. The market supported risky behaviors through availability of resources; supportive norms, including beliefs that substance use enhanced strength; and lack of restraints. Community-level poverty, cultural support for alcohol, interpersonal family/peer influences, early substance use, and school dropout also contributed to risky behaviors. Parental guidance was protective but not often reported. Local programs addressing substance use and risky sex simultaneously and better national substance use policies and mental health services are needed.

Mothers' effectiveness as HIV risk reduction educators for adolescent daughters.

Low-income African American inner city adolescent females continue to be at disproportionately high risk for contracting HIV. Though it has been speculated that mothers' involvement in HIV risk reduction may be helpful in the fight against HIV, very few interventions involve mothers. The Mother/Daughter HIV Risk Reduction intervention (MDRR), an innovative community-based intervention, trains mothers to be their daughters' primary HIV educators. A split-plot repeated measures design was used to test the effectiveness of the MDRR in decreasing daughters' sexual activity over a 2-month period. The mediating variables were daughters' HIV transmission knowledge, self-efficacy and intention to refuse sex. The sample consisted of 262 daughters with a mean age of 12.4 years. The results revealed that mothers were effective in increasing the mediating variables and in reducing their daughters' level of sexual activity. Active involvement of mothers is cost-effective and should be integrated into HIV intervention programs.

Changes in service delivery following HIV/AIDS education of medical and mental health service providers: results of a one-year follow-up.

This study examined changes in service delivery patterns of health and mental health service providers one year after a training on the fundamentals of HIV/AIDS and mental health. Paired t-tests for 424 training recipients showed significant increases in delivery of HIV-related services, and these remained significant while controlling for additional training, job changes, region (urban, rural, suburban), and provider discipline. Multiple logistic regression analysis revealed a significantly greater likelihood of providing direct services to HIV+ individuals among male providers, those with more years of HIV experience, those in counseling disciplines, and those working in a new job since the training.

African-American adolescent females' predictors of having sex.

African-American adolescent females are at high risk for HIV infection, acquired primarily as a result of heterosexual intercourse. Multiple regression analyses was used to describe the correlates of the outcome variable, ever having had sex, for low-income African-American adolescent females in a cross-sectional study of 322 (N = 322) mother/daughter pairs. The results revealed that while the daughters' age was positively associated with the outcome variable, the daughters' perceptions of strictness of curfew and maternal monitoring, and the daughters'self-efficacy to refuse sex and their intention to refuse sex were negatively associated with the outcome variable. Mothers tended to report significantly more maternal monitoring and stricter curfews than what their daughters perceived them to be. The daughters'intention to refuse sex mediated the effects of age and self-efficacy to refuse sex on the outcome variable. These results suggest that health-care providers should promote clearer communication between mothers and daughters in order to reduce divergent perceptions and to help mothers facilitate their daughters' self-efficacy and their intention to refuse sex.

Risky sexual behaviors of adolescents in rural Malawi: evidence from focus groups.

Little is known about rural Malawian adolescents' perceptions of their sexual behavior and what would constitute an effective HIV risk-reduction program. This study explored the perceptions of Malawain adolescents using qualitative description research with focus groups. A purposive sample of 144 adolescents, ranging from 10 to 19 years of age was obtained. Subjects were then placed in focus groups separated by gender Qualitative content analysis revealed that adolescents were at risk for HIV based on the select behaviors These included early sexual debut, multiple partners, non-use of condoms and among girls older partners These adolescents acknowledged peer pressure and lack of parental supervision as factors that perpetuated these behaviors and identified two components of HIV prevention programs. For example, parental involvement and support for sexual abstinence were among the issues discussed. It is essential that HIV risk-reduction programs create ways of involving parents and of enhancing adolescents' HIV risk-reduction skills by helping them to change peer norms and to develop negotiation and assertiveness skills to in order to resist peer pressure.

Women's Lifestyle Physical Activity Program for African American Women: Fidelity Plan and Outcomes.

BACKGROUND: For interventions to be implemented effectively, fidelity must be documented. We evaluated fidelity delivery, receipt, and enactment of the 48-week Women's Lifestyle Physical Activity Program conducted to increase physical activity and maintain weight in African American women. METHODS: Three study conditions all received 6 group meetings; 1 also received 11 motivational interviewing personal calls (PCs), 1 received11 automated motivational message calls (ACs), and 1 received no calls. Group meeting delivery was assessed for adherence and competence. PC delivery was assessed with the Motivational Interviewing Treatment Integrity Code. Receipt was defined as group meeting attendance, completion of PCs, and listening to ACs. Enactment was number of weeks an accelerometer was worn. RESULTS: For group meeting delivery, mean adherence was 80.8% and mean competence 2.9 of 3.0. Delivery of PCs did not reach criterion for competence. Receipt of more than one-half the dose was achieved for 84.9% of women for group meetings, 85.5% for PCs, and 42.1% for ACs. Higher group meeting attendance was associated with higher accelerometer steps at 24 weeks and lower BMI at 24 and 48 weeks. CONCLUSIONS: Fidelity measurement and examination of intervention delivery, receipt, and enactment are important to explicate conditions in which interventions are successful.

Randomized Clinical Trial of the Women's Lifestyle Physical Activity Program for African-American Women: 24- and 48-Week Outcomes.

PURPOSE: To compare the effects of a physical activity (PA) intervention of group meetings versus group meetings supplemented by personal calls or automated calls on the adoption and maintenance of PA and on weight stability among African-American women. DESIGN: Randomized clinical trial with three conditions randomly assigned across six sites. SETTING: Health settings in predominately African-American communities. SUBJECTS: There were 288 women, aged 40 to 65, without major signs/symptoms of pulmonary/cardiovascular disease. INTERVENTION: Six group meetings delivered over 48 weeks with either 11 personal motivational calls, 11 automated motivational messages, or no calls between meetings. MEASURES: Measures included PA (questionnaires, accelerometer, aerobic fitness), weight, and body composition at baseline, 24 weeks, and 48 weeks. ANALYSIS: Analysis of variance and mixed models. RESULTS: Retention was 90% at 48 weeks. Adherence to PA increased significantly (p < .001) for questionnaire (d = .56, 128 min/wk), accelerometer (d = .37, 830 steps/d), and aerobic fitness (d = .41, 7 steps/2 min) at 24 weeks and was maintained at 48 weeks (p < .001), with no differences across conditions. Weight and body composition showed no significant changes over the course of the study. CONCLUSION: Group meetings are a powerful intervention for increasing PA and preventing weight gain and may not need to be supplemented with telephone calls, which add costs and complexity.

Condom use predictors for low-income African American women.

The purpose was to investigate whether an HIV-prevention curriculum and a health maintenance curriculum produced different rates of change in reported consistent condom use and to explore what mediating variables predicted reported consistent condom use over time. A longitudinal crossover research design with extended posttest observations was used with a sample of 279 African American women. After pretesting, women received the designated curriculum and were posttested at completion, 3, 6, and 9 months. After the 9-month posttest, the curriculum was switched, and the above procedure was repeated. Using SAS macro GLIMMIX, the data revealed that the HIV curriculum yielded higher consistent condom use than did the health maintenance curriculum and that the mediating variables that predicted consistent condom use over time were self-efficacy for low-risk HIV behavior, HIV-related community behavior, and social norms. Enhancing consistent condom use over time may require the promotion and reinforcement of these mediating variables.

The Impact of Neighborhood Environment, Social Support, and Avoidance Coping on Depressive Symptoms of Pregnant African-American Women.

BACKGROUND: Although depressive symptoms during pregnancy have been related to negative maternal and child health outcomes such as preterm birth, low birth weight infants, postpartum depression, and maladaptive mother-infant interactions, studies on the impact of neighborhood environment on depressive symptoms in pregnant women are limited. Pregnant women residing in disadvantaged neighborhoods reported higher levels of depressive symptoms and lower levels of social support. No researchers have examined the relationship between neighborhood environment and avoidance coping in pregnant women. Guided by the Ecological model and Lazarus and Folkman's transactional model of stress and coping, we examined whether social support and avoidance coping mediated associations between the neighborhood environment and depressive symptoms in pregnant African-American women. METHODS: Pregnant African-American women (n = 95) from a medical center in Chicago completed the instruments twice during pregnancy between 15 and 25 weeks and between 25 and 37 weeks. The self-administered instruments measured perceived neighborhood environment, social support, avoidance coping, and depressive symptoms using items from existing scales. Objective measures of the neighborhood environment were derived using geographic information systems. FINDINGS: Perceived neighborhood environment, social support, avoidance coping, and depressive symptoms were correlated significantly in the expected directions. Objective physical disorder and crime were negatively related to social support. Social support at time 1 (20 ± 2.6 weeks) mediated associations between the perceived neighborhood environment at time 1 and depressive symptoms at time 2 (29 ± 2.7 weeks). An increase in avoidance coping between times 1 and 2 also mediated the effects of perceived neighborhood environment at time 1 on depressive symptoms at time 2. CONCLUSION: Pregnant African-American women's negative perceptions of their neighborhoods in the second trimester were related to higher levels of depressive symptoms in the third trimester. If these results are replicable in prospective studies with larger sample sizes, intervention strategies could be implemented at the individual level to support pregnant women in their ability to cope with adverse neighborhood conditions and ultimately improve their mental health.