Use of Web-Based Parent-Adolescent Health Promotion Program Among Puerto Ricans.

BACKGROUND: Despite positive attitudes of Latinos using the Internet and the increased availability of health information resources, few studies have been conducted that examine actual use and barriers to web-based health information. OBJECTIVE: The aim of this study was to examine whether select sociodemographic factors and technology factors (e.g., computer and Internet access) predicted use of a web-based, parent-adolescent sexual communication program or a physical activity program, entitled Cuídalos, among Puerto Rican parents. METHODS: This study uses data from a randomized controlled trial designed to examine the long-term effectiveness of Cuídalos. Parents were recruited from community-based and school sites throughout Puerto Rico and randomly assigned to a web-based, parent-adolescent sexual communication (n = 245) or a physical activity (n = 247) program. Parents were instructed to complete the two-session program within 1 week and had access to the program for a period of 3 months. Outcomes in this secondary analysis were the number of log-ins and self-reported access during the 3-month period. Reasons for not accessing the program after the 3-month period were assessed. RESULTS: Self-reported access after completion of the Cuídalos program and the actual number of log-ins over the intervention period were low. There were no statistically significant differences in the number of log-ins between parents who accessed Cuídalos during the 3-month time frame and those who did not (p = .28). Logistic regression analyses demonstrated that the odds of accessing Cuídalos during the 3-month period was 72% higher (OR = 1.72, 95% CI [1.08, 2.75]) among parents with a high school education or less, as compared to parents with a college education (p = .02). Similarly, Poisson regression model results indicated that, with every year increase in age, the expected number of log-ins increased by 1% (RR = 1.01, 95% CI [1.00, 1.02]); compared to those who accessed the program at home, the expected number of log-ins ranged from 10% to 27% lower for parents accessing elsewhere. Reasons for not accessing the program during the 3-month period included not having easy access to a computer (n = 134, 48.6%), or they did not know how to access the program again (n = 56, 20.3%). DISCUSSION: Despite the availability of web-based and e-health resources, further research is needed to identify how to facilitate greater access and actual use of digital health resources by Latinos. This is an important effort in order to prevent a widening health equity gap caused by a lack of access and use of digital health resources.

[ATTITUDES TOWARDS SEXUAL COMMUNICATION BETWEEN PARENTS AND ADOLESCENTS IN PUERTO RICO]. / ACTITUDES HACIA LA COMUNICACIÓN SEXUAL ENTRE PADRES/MADRES Y ADOLESCENTES EN PUERTO RICO.

Communication between parents and adolescents about sexuality faces challenges due in part to sociocultural factors. This study aimed to document the attitudes of parents and adolescents about communication regarding sexuality. The results emanate from the baseline measurement of the Cuídalos Project. The presented data is part of a larger study that aimed to evaluate a web-based module to foster communications between parents and adolescents (13-17 years of age) on health-related issues. In this article, we present the baseline data in which participants answered questions on their comfort when talking about sexual health issues. The sample was composed of 458 parent/adolescent dyads (n=916). We carried out a frequency and central tendency analysis of the gathered data. The average age for adolescents was 15 years of age, and 15% were sexually active. Adolescents reported better attitudes towards sexual communication than parents. Still, parents understood that they shared sufficient information on sexuality related topics. Parents and adolescents reported some level of difficulty and lack of comfort when talking about specific prevention methods. Results highlight the need to incorporate parents into interventions geared for adolescents and their sexual health. In Puerto Rico, it is necessary to develop programs that aim to reduce high-risk sexual activity among adolescents.

[ACCESS TO AN ONLINE EDUCATIONAL MODULE ON SEXUAL HEALTH FOR LATINO/A ADOLESCENTS]. / ACCESIBILIDAD DE UN MÓDULO EDUCATIVO EN LÍNEA SOBRE SALUD SEXUAL PARA ADOLESCENTES LATINOS/AS.

Project Cuídalos aimed to test the efficacy of a web-based intervention aiming to increase communication on sexual health topics between parents and adolescents in the Puerto Rican population. To achieve this goal, we implemented a longitudinal experimental design which examined whether the intervention would impact communication about sexuality between the participants (N=1,320). Parents completed a web-based interactive module in recruitment centers throughout Puerto Rico. Afterwards, parents could revisit the web-based workshop on their own. The process of accessing the workshop proved to be challenging. To explore why, we expanded our design and incorporated a qualitative component that included semi-structured telephone interviews to 23 randomly selected participants. After transcribing the interviews, we conducted a content analysis from which six thematic categories emerged: 1) perceived impact of the module in the parent-adolescent relationship, 2) communication between research team and parents, 3) platform to access the module, 4) assistance to complete the module, 5) remote access to the module, and 6) changes to the module for future implementations. Our findings will allow us to refine our intervention and offer recommendations to similar efforts using the Internet to increase their impact.

A Path Analysis of Latino Parental, Teenager and Cultural Variables in Teenagers' Sexual Attitudes, Norms, Self-Efficacy, and Sexual Intentions.

OBJECTIVE: to test a theoretical model based on the Parent-Based Expansion of the Theory of Planned Behavior examining relation between selected parental, teenager and cultural variables and Latino teenagers' intentions to engage in sexual behavior. METHOD: a cross-sectional correlational design based on a secondary data analysis of 130 Latino parent and teenager dyads. RESULTS: regression and path analysis procedures were used to test seven hypotheses and the results demonstrated partial support for the model. Parent familism and knowledge about sex were significantly associated with parents' attitudes toward sexual communication with their teenagers. Parent Latino acculturation was negatively associated with parents' self-efficacy toward sexual communication with their teenagers and positevely associated with parents' subjective norms toward sexual communication with their teenagers. Teenager knowledge about sex was significantly associated with higher levels of teenagers' attitudes and subjective norms about sexual communication with parents. Only the predictor of teenagers' attitudes toward having sex in the next 3 months was significantly associated with teenagers' intentions to have sex in the next 3 months. CONCLUSION: the results of this study provide important information to guide future research that can inform development of interventions to prevent risky teenager sexual behavior among Latinos.

A Path Analysis of Latino Parental, Teenager and Cultural Variables in Teenagers' Sexual Attitudes, Norms, Self-Efficacy, and Sexual Intentions / Análise da trajetória dos pais latinos, variáveis culturais nas atitudes sexuais dos adolescentes, normas, auto-eficácia, e intenções sexuais / Análisis de ruta de padres latinos, adolescente y variables culturales en actitudes sexuales de los adolescentes, normas, autoeficacia e intenciones sexuales

to test a theoretical model based on the Parent-Based Expansion of the Theory of Planned Behavior examining relation between selected parental, teenager and cultural variables and Latino teenagers' intentions to engage in sexual behavior.

testar um modelo teórico com base na Expansão Parental da Teoria do Comportamento Planejado, examinando a relação entre pais selecionados, adolescentes e variáveis culturais e as intenções dos jovens latinos ao se envolverem com comportamento sexual.

poner a prueba un modelo teórico basado en " Parent-Based Expansion " y con base en la teoría del comportamiento planificado para examinar la relación entre los padres seleccionados, adolescente y variables culturales, como también en las intenciones de los adolescentes latinos a participar en el comportamiento sexual.

Predictors of condom use among Mexican adolescents.

Mexican adolescents continue to be at increased risk for HIV infection due to inconsistent condom use. The purpose of this study was to identify predictors of condom use intentions and condom use among Mexican adolescents who participated in a randomized control trial designed to test a sexual-risk reduction intervention. Data from sexually active adolescents 17 to 21 years (n = 157) of age who were assigned to the control group were analyzed 48 months post intervention. Regression analysis showed that positive attitudes toward condoms, subjective norms, and control beliefs significantly explained intention to use condoms (R2 = .75, p < .001). Attitudes toward condoms (beta = .67, p <.001), technical skills (beta = .13, p = .01), and condom use self-efficacy (beta = .24, p < .001) were significant predictors of condom use intention. Compared to those who inconsistently used condoms, adolescents who used condoms consistently had greater intention to use condoms and greater impulse control. Findings suggest that attitudes and control beliefs should be further explored with Mexican adolescents in order to support consistent condom use.

Examining long-term effects of Cuídate-a sexual risk reduction program in Mexican youth.

OBJECTIVE: To examine the effectiveness of a safer sex program (Cuídate) on sexual behavior, use of condoms, and use of other contraceptives among Mexican youth 48 months after the intervention. METHODS: A total of 708 or 85% of those who participated in the original randomized control study (n = 829) were assessed in the 48-month follow-up. Each participant completed a questionnaire on sexual behavior. RESULTS: Findings indicated that adolescents who participated in the Cuídate program were more likely to be older at first sex (odds ratio [OR], 1.27; 95% confidence interval [CI], 0.41-2.12; P < 0.05) and to use condoms at first sex (OR, 1.75; 95% CI, 1.14-2.69; P < 0.05) or some other type of contraception at first sex (OR, 1.53; 95% CI, 1.00-2.33; P < 0.05) than those in the control group. Effects of the intervention on consistent condom use, condom use at last sex, and number of sexual partners were not significant. Gender did not moderate any intervention effects. Social desirability moderated the effect of the intervention on age at first sex. CONCLUSIONS: Results demonstrate the efficacy of Cuídate among Mexican adolescents. Future research, policy, and practice efforts should be directed at sustaining safe sex practices across adolescents' developmental and relationship trajectory.

Examining long-term effects of Cuídate-a sexual risk reduction program in Mexican youth / Examen de los efectos a largo plazo de Cuídate, un programa de reducción del riesgo sexual en jóvenes mexicanos

OBJECTIVE: To examine the effectiveness of a safer sex program (Cuídate) on sexual behavior, use of condoms, and use of other contraceptives among Mexican youth 48 months after the intervention. METHODS: A total of 708 or 85 percent of those who participated in the original randomized control study (n = 829) were assessed in the 48-month follow-up. Each participant completed a questionnaire on sexual behavior. RESULTS: Findings indicated that adolescents who participated in the Cuídate program were more likely to be older at first sex (odds ratio [OR], 1.27; 95 percent confidence interval [CI], 0.41-2.12; P < 0.05) and to use condoms at first sex (OR, 1.75; 95 percent CI, 1.14-2.69; P < 0.05) or some other type of contraception at first sex (OR, 1.53; 95 percent CI, 1.00-2.33; P < 0.05) than those in the control group. Effects of the intervention on consistent condom use, condom use at last sex, and number of sexual partners were not significant. Gender did not moderate any intervention effects. Social desirability moderated the effect of the intervention on age at first sex. CONCLUSIONS: Results demonstrate the efficacy of Cuídate among Mexican adolescents. Future research, policy, and practice efforts should be directed at sustaining safe sex practices across adolescents' developmental and relationship trajectory.

OBJETIVOS: Examinar la eficacia de un programa de promoción de actividad sexual de menor riesgo (Cuídate) en cuanto al comportamiento sexual, el uso de condones y el uso de otros anticonceptivos en jóvenes mexicanos, 48 meses después de la intervención. MÉTODOS: En el seguimiento después de 48 meses, se evaluó un total de 708 (85 por ciento) de los que participaron en el estudio de control aleatorizado original (n = 829). Cada participante respondió a un cuestionario sobre su comportamiento sexual. RESULTADOS: Los resultados indicaron que los adolescentes que participaron en el programa "Cuídate" tenían una probabilidad más alta de tener una edad mayor en la primera relación sexual (razón de posibilidades [OR]: 1,27; intervalo de confianza [IC]: de 95 por ciento, 0,41-2,12; p < 0,05) y de usar condones (OR: 1,75; IC 95 por ciento: 1,14-2,69; P < 0,05) o algún otro tipo de medida anticonceptiva en la primera relación sexual (OR: 1,53; IC 95 por ciento: 1,00-2,33; P < 0,05) en comparación con los del grupo de referencia. Los efectos de la intervención sobre el uso constante de condones, el uso de condones en la última relación sexual y el número de compañeros sexuales no fueron considerables. El género no moderó los efectos de la intervención. La conveniencia social moderó el efecto de la intervención sobre la edad en la primera relación sexual. CONCLUSIONES: Los resultados demuestran la eficacia del programa "Cuídate" en los adolescentes mexicanos. En el futuro, la investigación, las políticas y la práctica deberán diri-girse a promover actividades sexuales de menor riesgo en el desarrollo y las relaciones de los adolescentes.

Mexican adolescents' alcohol use, family intimacy, and parent-adolescent communication.

Despite widespread adolescent alcohol use, research on individual and contextual factors among Mexican adolescents is limited. This study describes the relationship between adolescent risk/protective factors, parent-adolescent communication, and their effects on alcohol use of 14- to 17-year-old adolescents living in Mexico (N = 829; 458 girls, 371 boys). In this study, adolescents reported that 55% ever used alcohol, 24% used alcohol in the past 30 days, and 10% reported binge drinking. Adolescents with high family intimacy were less likely to report ever using alcohol and binge drinking. Regression analysis revealed that parent-adolescent communication mediated the effect of family intimacy on overall and binge drinking. Alcohol use prevention with Mexican adolescents should focus on family intimacy and parent-adolescent communication.

A parent-adolescent intervention to increase sexual risk communication: results of a randomized controlled trial.

This article reports results of a randomized controlled trial designed to test an intervention to increase parent-adolescent sexual risk communication among Mexican parents. Data were analyzed from parents (n = 791) randomly assigned to an HIV risk reduction or health promotion intervention. Measures were administered at pretest, posttest, and 6- and 12-month follow-ups. Generalized estimation equation (GEE) analysis indicates parents in the HIV risk reduction intervention reported significantly more general communication (p < .005), more sexual risk communication (p < .001) and more comfort with communication (p < .001) than parents in the control intervention. Behavioral, normative, and control beliefs significantly mediated the effect of the intervention on all communication outcomes. This study demonstrates the efficacy of an intervention to increase the quality and quantity of parent-adolescent communication related to general and sex-specific communication.

Fidelidad de una intervención educativa / Fidelity of an educational proces

Objetivo: evaluar las estrategias de aseguramientode fidelidad utilizadas en un estudio de intervencióncontrolada y aleatorizada, tales como protocolizacióny estandarización de la intervención, seleccióny entrenamiento de los facilitadores, establecimientode criterios de evaluación de apego y monitoreo delmismo. Métodología: análisis de las estrategias através de las evaluaciones pre y post entrenamiento,los reportes de monitoreo, evaluaciones de final dedía y comentarios de participantes de investigación.Resultados: el análisis muestra que la selección yentrenamiento aseguró que los facilitadores contarancon el conocimiento suficiente para la entregadel currículo pero también que se sintieran autoeficacesen el proceso y confiaran en la eficienciade resultado. La protocolización del currículo, y elmonitoreo aseguraron el apego a la intervención.Las evaluaciones de final de día de los facilitadoresy los comentarios de los participantes reflejan unaactuación dinámica, asertiva y apegada a currículode los facilitadores. Conclusiones: el cuidado delos elementos que definen tanto el apego como laentrega competente en una intervención controladay aleatorizada permite garantizar la integridad de laintervención y con ello disminuir la posibilidad desesgo por esta fuente.

[Intervention to reduce adolescents sexual risk behaviors: a randomized controlled trial]. / Intervención para reducir riesgo en conductas sexuales de adolescentes: un ensayo aleatorizado y controlado.

OBJECTIVE: To test the efficacy of a behavioral intervention designed to decrease risk sexual behaviors for HIV/AIDS and unplanned pregnancies in Mexican adolescents. MATERIAL AND METHODS: Randomized controlled trial with four follow ups; 832 adolescents recruited from high schools, age 14-17, were randomly assigned to the experimental or control group. The six hour intervention used active learning strategies, and was delivered in two sessions on two consecutive Saturdays. The study was carried out in Monterrey, Mexico, 2002-2005. RESULTS: GEE analysis indicated no differences in sexual relationships intentions between the two conditions, however, the experimental group had higher intentions to use condoms and contraceptives (mean differences 0.15 and 0.16, CI 95%) in the next three months, as compared with the control group. Theoretical variables, such as control beliefs, were significant mediators of the intervention. CONCLUSIONS: The behavioral intervention represents an important effort in promoting safe sexual behaviors among Mexican adolescents.

Intervención para reducir riesgo en conductas sexuales de adolescentes: un ensayo aleatorizado y controlado / Intervention to reduce adolescents’ sexual risk behaviors: a randomized controlled trial

OBJETIVO: Determinar la eficacia de una intervención conductual-educativa diseñada para disminuir las conductas sexuales de riesgo de VIH/SIDA y embarazos no planeados de adolescentes mexicanos. MATERIAL Y MÉTODOS: Ensayo controlado aleatorizado con cuatro seguimientos en un año; 832 adolescentes reclutados de escuelas preparatorias, entre 14 y 17 años, se asignaron aleatoriamente al grupo experimental o al control. La intervención, de seis hrs. de duración, aplicó estrategias de aprendizaje activo. El estudio se realizó en Monterrey, México, de 2002 a 2005. RESULTADOS: De acuerdo al análisis GEE, no hubo diferencia en las intenciones de tener relaciones sexuales, pero sí mayor nivel de intenciones de usar condón y anticonceptivos (diferencia de medias 0.15 y 0.16, IC 95 por ciento) en el grupo experimental comparado con el control. Variables teoréticas como creencias sobre control fueron mediadoras de la intervención. CONCLUSIONES: La intervención conductual representa un importante esfuerzo en la promoción de conductas sexuales seguras en adolescentes mexicanos.

OBJECTIVE: To test the efficacy of a behavioral intervention designed to decrease risk sexual behaviors for HIV/AIDS and unplanned pregnancies in Mexican adolescents. MATERIAL AND METHODS: Randomized controlled trial with four follow ups; 832 adolescents recruited from high schools, age 14-17, were randomly assigned to the experimental or control group. The six hour intervention used active learning strategies, and was delivered in two sessions on two consecutive Saturdays. The study was carried out in Monterrey, Mexico, 2002-2005. RESULTS: GEE analysis indicated no differences in sexual relationships’ intentions between the two conditions, however, the experimental group had higher intentions to use condoms and contraceptives (mean differences 0.15 and 0.16, CI 95 percent) in the next three months, as compared with the control group. Theoretical variables, such as control beliefs, were significant mediators of the intervention. CONCLUSIONS: The behavioral intervention represents an important effort in promoting safe sexual behaviors among Mexican adolescents.

Research brief: sexual communication and knowledge among Mexican parents and their adolescent children.

This study describes the sexual knowledge and communication of Mexican parents and adolescents. Preintervention data were analyzed from 829 high school students (ages 14-17) and one of the parents of each. Differences were found between parents and adolescents in sexual knowledge (M = 16.16 vs. M = 14.92; t = 7.20, p < .001); specifically, parents had higher knowledge related to sexually transmitted diseases, HIV/AIDS, and condom use. Parents perceived more general communication (t [787] = 6.33, p < .001), and less discomfort talking about sex (t [785] = 4.69, p < .001) than adolescents. Parents with higher education levels scored higher in HIV knowledge and general communication. Fathers had higher total sexual knowledge, whereas mothers perceived higher sexual communication than fathers. There were no differences in knowledge and communication by parental socioeconomic level. Results suggest health care providers need to assist parents in developing specific knowledge and skills to support their adolescents' sexual decision-making.

A randomized controlled trial testing an HIV prevention intervention for Latino youth.

OBJECTIVE: To test the efficacy of a prevention intervention to reduce sexual risk behavior among Latino adolescents. DESIGN: Randomized controlled trial from April 2000 through March 2003, with data collection before and after intervention and at 3, 6, and 12 months. SETTING: Northeast Philadelphia schools. PARTICIPANTS: Latinos aged 13 through 18 years (249 males and 304 females); 81.6% retained at 12-month follow-up. INTERVENTIONS: The HIV and health-promotion control interventions consisted of six 50-minute modules delivered by adult facilitators to small, mixed-gender groups in English or Spanish. Main Outcome Measure Self-reported sexual behavior. RESULTS: Analyses using generalized estimation equations over the follow-up period revealed that adolescents in the HIV intervention were less likely to report sexual intercourse (odds ratio, 0.66; 95% confidence interval [CI], 0.46-0.96), multiple partners (odds ratio, 0.53; 95% CI, 0.31-0.90), and days of unprotected intercourse (relative risk, 0.47; 95% CI, 0.26-0.84) and more likely to report using condoms consistently (odds ratio, 1.91; 95% CI, 1.24-2.93). Baseline sexual experience and language use moderated intervention efficacy. Adolescents assigned to the HIV intervention who were sexually inexperienced at baseline reported fewer days of unprotected sex (relative risk, 0.22; 95% CI, 0.08-0.63); Spanish speakers were more likely to have used a condom at last intercourse (odds ratio, 4.73; 95% CI, 1.72-12.97) and had a greater proportion of protected sex (mean difference, 0.35; P<.01) compared with similar adolescents in the health-promotion intervention. CONCLUSION: Results provide evidence for the efficacy of HIV intervention in decreasing sexual activity and increasing condom use among Latino adolescents.

La uniendo de fronteras: collaboration to develop HIV prevention strategies for Mexican and Latino youth.

AIDS is a global epidemic. Regardless of the present incidence of AIDS, all countries must confront the threat of this devastating disease. The shared border and continued migration between Mexico and the United States as well as shared concerns about HIV/AIDS are compelling reasons to promote AIDS prevention as an important public health endeavor for both countries. This article describes collaborative efforts between nurse researchers in the United States and Mexico to decrease the risk of sexually transmitted HIV infection among adolescents. The significance of this effort to both countries and the processes and preliminary work that led to the development of a study funded by the National Institute of Nursing Research are discussed.