Those Who Disappear and Those Who Say Goodbye: Patterns of Attrition in Long-Term Home Visiting.

Most evidence-based home visiting models are designed to support families from pregnancy through a child's second birthday, though programs often struggle to retain families for this long. Previous research on client and program factors that predict attrition has produced mixed results, which may be partly because attrition is typically conceptualized as a homogeneous phenomenon. The current study sampled 991 women who received home visiting services from one of 26 agencies in a statewide network of evidence-based programs. Participants who remained in services were compared to three types of early leavers: those who communicated their intent to leave (active attrition), those whose cases closed due to non-participation (passive attrition), and those who moved from the service area. Within a year of enrollment, 42% of women exited services. Cox regression results suggested no differences in the timing of service exit among the three attrition types. Multinomial analyses revealed that, when compared to participants who remained in services, active leavers were more likely to be married or cohabitating, while passive leavers were more likely to be younger, African American, unemployed, and to have a home visitor with low job satisfaction. Participants who moved were less likely to be Latina and employed. An early pattern of inconsistent attendance was the strongest predictor of active and passive withdrawal. Rates of attrition varied by home visiting model, though inconsistent attendance was a robust predictor of passive attrition across models. This study underscores the need to scrutinize service duration as a metric of success in home visiting.

Neighborhood Predictors of Intimate Partner Violence: A Theory-Informed Analysis Using Hierarchical Linear Modeling.

Due to high prevalence rates and deleterious effects on individuals, families, and communities, intimate partner violence (IPV) is a significant public health problem. Because IPV occurs in the context of communities and neighborhoods, research must examine the broader environment in addition to individual-level factors to successfully facilitate behavior change. Drawing from the Social Determinants of Health framework and Social Disorganization Theory, neighborhood predictors of IPV were tested using hierarchical linear modeling. Results indicated that concentrated disadvantage and female-to-male partner violence were robust predictors of women's IPV victimization. Implications for theory, practice, and policy, and future research are discussed.

An Auditory Sonic Sleep Treatment for Individuals Living With Dementia in a Memory Care Setting: A Quality Improvement Program Evaluation.

BACKGROUND: The absence of a cure for dementia, combined with the increased longevity of the baby boom generation, is resulting in a dramatic increase in the number of people living with dementia. Aging-related changes coupled with dementia-related behavioral symptoms pose unique challenges for those living with dementia as well as those who provide care. There is evidence that improved sleep can improve health and well-being. Research also supports using auditory interventions as a form of nonpharmacological therapy. OBJECTIVE: This study evaluated the effects of a customized auditory (sonic) treatment during sleep on the mood, behavior, quality of life, functional ability, and health condition of individuals living with the symptoms of dementia. Workforce outcomes were evaluated as a secondary outcome. METHODS: A controlled before-after design with a mixed-method approach was used to evaluate the impact of the sonic sleep treatment during baseline, intervention, and discontinuation time frames. RESULTS: Statistically significant improvements were observed in participants' cooperation with care (p = .0249) and daytime drowsiness (p = .0104). Other nonstatistically significant improvements included bed mobility, appetite, bathing self-performance, toilet use, incidence of falls, following requests and instructions, and nighttime insomnia. While workforce outcomes remained unchanged, staff were supportive of resuming the sonic sleep treatment after the discontinuation time frame. CONCLUSIONS: The sonic sleep treatment demonstrated improved outcomes for individuals living with dementia. This supports using an appropriate auditory stimulus as a fundamental component of care for individuals living in memory care settings.

A comparison of contextual and biomedical models of stigma reduction for depression with a nonclinical undergraduate sample.

Stigma reduction programs are dominated by a biomedical model that presents depression as a medical illness. Alternately, a contextual model emphasizes that one should not be blamed for environmental influences. This study compared biomedical, contextual, and control stigma reduction programs to each other and to a no-program control. The main hypotheses were that the contextual program would have the greatest impact and that a match between participants' beliefs about depression and the model presented would moderate this effect. Seventy-four participants were randomized to the 3 programs and 12 participants served as a no-program control. The contextual and control programs reduced stigma significantly compared with the no-program control, whereas the biomedical program did not. Beliefs about depression moderated this effect only for the biomedical condition. Contextual and control programs seem to be effective but a biomedical model may be risky for those who disagree with the model. Theoretical implications are discussed.

Depression self-stigma: a new measure and preliminary findings.

It is widely recognized that stigmatization of mental disorders leads stigmatized individuals to avoid treatment altogether or discontinue treatment prematurely. Literature suggests that the impact of stigma may differ by diagnosis; however, previous attempts to measure self-stigma have not been disorder specific. This study sought to develop the Depression Self-Stigma Scale (DSSS) and identify distinct constructs associated with depression self-stigma. Items for the initial administration of the DSSS were developed through careful review of existing measures and the literature on stigma and depression. Items were administered to undergraduates and community members with self-reported depression (N = 391). Results indicated 5 factors (general self-stigma, secrecy, public stigma, treatment stigma, and stigmatizing experiences) with good factor structure, internal consistency, and evidence for construct validity.

Condom use negotiation in heterosexual African American adults: responses to types of social power-based strategies.

This study examined gender differences and preferences in the use of and response to six different styles of condom use negotiation with a hypothetical sexual partner of the opposite gender. Participants were 51 heterosexually active African American adults attending an inner-city community center. Participants completed a semistructured qualitative interview in which they were presented with six negotiation strategies based on Raven's 1992 Power/Interaction Model of Interpersonal Influence. Results showed that female participants responded best to referent, reward, and legitimate strategies, and worst to informational tactics. Male participants responded best to reward strategies, and worst to coercion to use condoms. Further, responses given by a subset of participants indicated that use of negotiation tactics involving coercion to use condoms may result in negative or angry reactions. Response to strategies may vary with the value of the relationship as viewed by the target of negotiation. Implications for HIV prevention efforts are discussed.

The revised safe at home instrument for assessing readiness to change intimate partner violence.

This article describes the development and factor structure of the Revised Safe At Home instrument, a 35-item self-report measure designed to assess individuals' readiness to change their intimate partner violence behaviors. Seven new items have been added, representing content specific to the Maintenance stage, and other items have been revised to strengthen the assessment of earlier stages and address gender concerns. Confirmatory factor analysis using multisite data (two sites, a total of 281 men at intake) supported the conclusion that a four-factor model (Precontemplation, Contemplation, Preparation/Action, and Maintenance stages) was consistent with the observed covariances. A high degree of correlation between the Preparation/Action and Maintenance scales was observed, but subsequent testing indicated a need to treat the two as distinct factors in the model. It is recommended that scoring include only 31 items that perform well.

Outcomes of a randomized, controlled community-level HIV prevention intervention for adolescents in low-income housing developments.

OBJECTIVES: Youth are increasingly at risk for contracting HIV infection, and community-level interventions are needed to reduce behavioral risk. DESIGN: A randomized, controlled, multi-site community-level intervention trial was undertaken with adolescents living in 15 low-income housing developments in five US cities. METHODS: Baseline (n = 1172), short-term follow-up (n = 865), and long-term follow-up (n = 763) risk assessments were conducted among adolescents, ages 12-17, in all 15 housing developments. The developments were randomly assigned in equal numbers to each of three conditions: experimental community-level intervention (five developments); "state-of-the-science" skills training workshops (five developments); and, education-only delayed control intervention (five developments). RESULTS: At long-term follow-up, adolescents living in the housing developments receiving the community-level intervention were more likely to delay onset of first intercourse (85%) than those in the control developments (76%), while those in the workshop developments (78%) did not differ from control condition adolescents. Adolescents in both the community-level intervention (77%) and workshop (76%) developments were more likely to use a condom at last intercourse than those in control (62%) developments. CONCLUSIONS: Community-level interventions that include skills training and engage adolescents in neighborhood-based HIV prevention activities can produce and maintain reductions in sexual risk behavior, including delaying sexual debut and increasing condom use.

Reductions in transmission risk behaviors in HIV-positive clients receiving prevention case management services: findings from a community demonstration project.

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV transmission. More than 350 HIV-positive clients participated in PCM in Wisconsin between 2000 and 2003, and 109 completed both baseline and follow-up risk assessments. The percentage of clients reporting risk transmission behaviors, specifically unprotected vaginal intercourse, insertive anal intercourse, or needle sharing with partners of negative or unknown HIV status, declined from 41.3% at baseline to 29.4% at follow-up (p = 0.04). Furthermore, clients showed progression (p < or =.05) through stages of change using Prochaska and DiClemente's transtheoretical model on seven domains related to HIV transmission risk, including personalizing risk of HIV transmission and sexual risk behavior.

Development of the Motivational Interviewing Supervision and Training Scale.

The movement to use empirically supported treatments has increased the need for researchers and supervisors to evaluate therapists' adherence to and the quality with which they implement those interventions. Few empirically supported approaches exist for providing these types of evaluations. This is also true for motivational interviewing, an empirically supported intervention important in the addictions field. This study describes the development and psychometric evaluation of the Motivational Interviewing Supervision and Training Scale (MISTS), a measure intended for use in training and supervising therapists implementing motivational interviewing. Satisfactory interrater reliability was found (generalizability coefficient p(2) = .79), and evidence was found supporting the convergent and discriminant validity of the MISTS. Recommendations for refinement of the measure and future research are discussed.

Beyond treatment effects: predicting emerging adult alcohol and marijuana use among substance-abusing delinquents.

Secondary analyses of a randomized clinical trial examined the effects of 4 putative risk factors and 2 protective factors in predicting drug use among 80 emerging adults treated 5 years earlier for delinquency and alcohol and/or marijuana use disorders. Frequency of marijuana use and the number of comorbid psychiatric disorders in adolescence predicted cannabis use in emerging adulthood. Increasing academic competence at high levels of social competence predicted less marijuana use. At emerging adulthood, greater use of alcohol and marijuana were associated with both criminality and psychopathology.

Changes in Physical Activity and Psychological Variables Following a Web-Based Motivational Interviewing Intervention: Pilot Study.

BACKGROUND: Web-based interventions for enhancing physical activity participation are in demand for application in health care settings. Recent research suggests Web-based interventions that are based on motivational interviewing are effective to increase physical activity. It is unclear whether motivational interviewing can influence targeted psychological variables such as perceived readiness, willingness, and ability to participate in physical activity. OBJECTIVE: The aims of this study were to determine whether there were changes in physical activity and psychological variables associated with readiness, willingness, and perceived ability to participate in physical activity following completion of a novel Web-based intervention. The goal of the motivational interviewing-based intervention was to increase physical activity. METHODS: Twenty-three underactive or inactive urban dwelling adults were recruited at a medical office for participation in a 4-session Web-based intervention lasting approximately 15 minutes per week. Sessions were based on principles of motivational interviewing. Assessment of physical activity was conducted using pedometers immediately prior to intervention participation (pre) and immediately post intervention (post1). Self-report assessments of physical activity and psychological variables were conducted using online surveys at pre, post1, and again at one month following intervention participation (post2). RESULTS: Comparisons of pre and post1 pedometer recordings revealed significant increases in steps per day (t22=2.09, P=.049). There were also significant changes in total physical activity energy expenditure per week (χ(2) 2=8.4, P=.02) and in moderate intensity physical activity energy expenditure per week (χ(2) 2=13.9, P<.001) over time following participation in the Web-based intervention. Significant changes in psychological variables following participation in the Web-based intervention included: (1) change in stage classification over time (χ(2) 2=21.5, P<.001), where the percentage of participants classified in the action or maintenance stages of change in physical activity increased over time (pre=25% [6/24], post1=71% [17/24], post2=68% [15/22]); (2) decreases in self-reported decisional balance cons (F2,42=12.76, P<.001); (3) increases in self-reported decisional balance pros (F2,42=16.19, P<.001); (4) increases in physical activity enjoyment (F2,20=3.85, P=.04); and (5) increases in self-efficacy (F2,42=3.30, P=.047). CONCLUSIONS: The Web-based intervention piloted in this study shows preliminary promise as a tool to promote physical activity in health care settings. Additional research is needed to test the effectiveness of motivational interviewing compared to a control condition and to refine content by considering mediation by psychological variables in a larger sample.

The Efficacy of a Walking Intervention Using Social Media to Increase Physical Activity: A Randomized Trial.

BACKGROUND: Facebook may be a useful tool to provide a social support group to encourage increases in physical activity. This study examines the efficacy of a Facebook social support group to increase steps/day in young women. METHODS: Female college freshmen (N = 63) were randomized to one of two 8-week interventions: a Facebook Social Support Group (n = 32) or a Standard Walking Intervention (n = 31). Participants in both groups received weekly step goals and tracked steps/day with a pedometer. Women in the Facebook Social Support Group were also enrolled in a Facebook group and asked to post information about their steps/day and provide feedback to one another. RESULTS: Women in both intervention arms significantly increased steps/day pre- to postintervention (F(8,425) = 94.43, P < .001). However, women in the Facebook Social Support Group increased steps/day significantly more (F(1,138) = 11.34, P < .001) than women in the Standard Walking Intervention, going from 5295 to 12,472 steps/day. CONCLUSIONS: These results demonstrate the potential effectiveness of using Facebook to offer a social support group to increase physical activity in young women. Women in the Facebook Social Support Group increased walking by approximately 1.5 miles/day more than women in the Standard Walking Intervention which, if maintained, could have a profound impact on their future health.

Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders.

OBJECTIVE: Although several treatments for adolescent substance abuse have been identified as promising by reviewers and federal agencies, treatment effects extending beyond 12 months have not been demonstrated in randomized clinical trials. The primary purpose of this report was to examine the 4-year outcomes of an evidence-based treatment of substance-abusing juvenile offenders. METHOD: Eighty of 118 substance-abusing juvenile offenders participated in a follow-up 4 years after taking part in a randomized clinical trial comparing multisystemic therapy (MST) with usual community services. A multimethod (self-report, biological, and archival measures) assessment battery was used to measure the criminal behavior, illicit drug use, and psychiatric symptoms of the participating young adults. RESULTS: Analyses demonstrated significant long-term treatment effects for aggressive criminal activity (0.15 versus 0.57 convictions per year) but not for property crimes. Findings for illicit drug use were mixed, with biological measures indicating significantly higher rates of marijuana abstinence for MST participants (55% versus 28% of young adults). Long-term treatment effects were not observed for psychiatric symptoms. CONCLUSIONS: Findings provide some support for the long-term effectiveness of an evidenced-based family-oriented treatment of substance-abusing juvenile offenders. The clinical, research, and policy implications of these findings are noted.

HIV risk behavior among ethnically diverse adolescents living in low-income housing developments.

PURPOSE: To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. METHODS: Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of "no risk," "lower risk," and "higher risk" group classification. RESULTS: Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. CONCLUSIONS: HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.

Sex-related alcohol expectancies predict sexual risk behavior among severely and persistently mentally ill adults.

Three hundred three adults (57% male, average age 42 years) with severe and persistent mental illness receiving treatment at community mental health clinics completed a survey, which included B. C. Leigh's (1990) sex-related alcohol expectancy scale and measures of alcohol use and sexual risk behavior. Hierarchical logistic regression analyses, controlling for drinking behavior, revealed that participants with stronger expectancies that drinking would lead to enhanced sexual experience were more likely to have drank prior to intercourse and that, among participants who drank prior to intercourse, those with stronger expectancies that alcohol would lead to riskier sexual behavior were more likely to have engaged in sexual risk behavior. Implications for preventing HIV infection among people with severe mental illness are discussed.

Readability of 3 heart disease health-related quality of life questionnaires.

PURPOSE: To compare the readability of the English language versions of 3 heart disease health-related quality of life questionnaires, the Minnesota Living with Heart Failure (MLHF) Questionnaire, the Seattle Angina Questionnaire (SAQ), and the MacNew Heart Disease Health-Related Quality of Life (MacNew) Questionnaire. METHODS: The readability of the MLHF, the SAQ, and the MacNew was calculated using 6 different readability formulas; the FOG Index, the Fry Readability Formula for Short Passages, the Harris-Jacobson, the Flesch, the New Dale-Chall, and the SMOG. RESULTS: The reading grade level of the MacNew averaged between the fifth and sixth grades. Readability of the MLHF and the SAQ averaged between the seventh and eighth grade levels. CONCLUSIONS: These findings suggest that care should be taken to select heart disease health-related quality of life instruments that match closely the reading level of the target population as the ease of reading these 3 heart disease health-related quality of life instruments varies.

Reactions of heterosexual African American men to women's condom negotiation strategies.

This study describes responses of 172 single heterosexual African American men, ages 18 to 35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven's (1992) influence model. The purpose was (a) to identify strategies influencing participant acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a "steady partner." After each segment, participants completed measures of request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men's ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that, although the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, sexually transmitted disease history, and experience with sexual coercion. Also, the "least willing to use" subgroup was highest in anger-rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.

HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States.

Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.