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1.
J Am Coll Health ; : 1-8, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31995458

RESUMEN

Objective: To explore sexual sensation seeking (SSS) among an ethnically-diverse sample of first-year college students and their hookup behaviors.Participants: 1,480 first-year college students who hooked up in the last 30 days were recruited from four universities in 2016.Methods: Students completed an online survey before completing an online STI and alcohol prevention intervention.Results: Male and sexual minority students had significantly higher SSS scores compared to female and heterosexual students respectively. Students with higher SSS scores were less likely to report condom use at last vaginal and anal hookup, more likely to hookup under the influence of alcohol and participate in a wide range of sexual behaviors. There were no significant mean differences in SSS scores by level of intoxication during their last hookup.Conclusion: These findings highlight the role of SSS in predicting sexual risk behaviors of first-year college students and the overall low SSS scores among this sample.

2.
Cult Health Sex ; : 1-17, 2019 Dec 05.
Artículo en Inglés | MEDLINE | ID: mdl-31805826

RESUMEN

This study used a sexual scripting framework to analyse data from the Online College Social Life Survey to examine the role of individual, (e.g. gender, race and alcohol use), relational (partner type, condom use behaviours), and contextual factors (sex ratios and fraternity/sorority affiliation) influencing 4,292 first-year college students' hookup experiences. Results suggest that hookups are relatively "safe", with the the majority involving non-penetrative sexual behaviour, condom use, and familiar partners. However, alcohol use affected hookup behaviours and lower levels of condom use were associated with heavy alcohol use, even with less well known partners. Findings point to the importance of interventions that reinforce first-year students' positive behaviours and present them with protective behavioural strategies to use in the context of alcohol, and with repeat or well-known partners to reduce risk and have enjoyable, consensual sexual experiences.

3.
Psychol Addict Behav ; 33(6): 511-519, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31436446

RESUMEN

Although computer delivered brief interventions (CDBIs) have been effective in reducing alcohol use, few studies have examined which components of CDBIs are most associated with drinking reductions. The current factorial trial deconstructed a brief alcohol intervention into component parts to identify main and interaction effects on drinking outcomes. Participants (N = 352) were randomly assigned to 1 of 16 possible combinations of four dichotomous (present vs. absent) CDBI components for which theoretical and empirical support was available: empathic reflections, motivational strategies, a spoken voice, and an animated narrator. We measured main and interaction effects of these components on the primary outcome of self-reported mean drinks per day at 1- and 3-month follow-up, as well as on secondary outcomes, including binge drinking, intentions to reduce drinking, and alcohol consequences. Participants reduced drinking across all alcohol use indices over the 3-month assessment period. These effects were stronger for participants who were exposed to motivational strategies, F = 7.7, p < .001. Empathic reflections, use of a spoken voice, and use of an animated narrator were not associated with reductions in alcohol use, either as main effects or in interaction with other factors. Results suggest that CDBIs using motivational strategies are effective in reducing alcohol use. However, empathic reflections and lifelike characteristics (e.g., narrator, voice) may operate differently in CDBIs than they do in person-delivered interventions. More research is needed to better understand how these (or other factors) may influence efficacy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Alcoholismo/rehabilitación , Consejo/métodos , Empatía , Retroalimentación , Motivación , Terapia Asistida por Computador/métodos , Adulto , Consumo de Bebidas Alcohólicas/psicología , Alcoholismo/psicología , Estudios de Seguimiento , Humanos , Masculino , Adulto Joven
4.
J Adolesc Health ; 64(6): 732-736, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30850310

RESUMEN

PURPOSE: The objective of the study was to examine whether latent class analysis (LCA) could (1) identify distinct subgroups of youth characterized by multiple risk and protective factors for early sexual initiation and (2) allow for a more nuanced assessment of the effects of a middle school program to prevent teen pregnancy/HIV/sexually transmitted infection. METHODS: LCA was applied to data from the baseline (seventh grade) sample of 1,693 sexually inexperienced students participating in a randomized controlled trial of It's Your Game…Keep It Real in Harris County, Texas. Multilevel analysis was applied within subgroups defined by the latent classes to assess for potential differential program effects. RESULTS: LCA identified 3 distinct profiles of youth: family disruption, other language household, and frequent religious attendance. Multilevel analyses found differential effects of the program across these profiles with a significant and substantial reduction (30%) in initiation of vaginal sex by ninth grade for students in the family disruption profile only. CONCLUSIONS: Application of LCA may hold promise for conducting more nuanced evaluations and refinements of behavior change interventions for youth.

5.
Child Abuse Negl ; 87: 112-119, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29891176

RESUMEN

Children with substantiated child maltreatment (CM) experience adverse health outcomes. However, it is unclear whether substantiation vs. an investigation not resulting in substantiation has a greater impact on subsequent adolescent health. Propensity scores were used to examine the effect of investigated reports on the subsequent health of 503 adolescent females. CM was categorized into three levels: 1) investigated and substantiated, 2) investigated but unsubstantiated, and 3) no investigation. Models using inverse propensity score weights estimated the effect of an investigation on subsequent teen motherhood, HIV-risk behaviors, drug use, and depressive symptoms. Females with any investigation, regardless of substantiation status, were more likely to become teen mothers, engage in HIV-risk behaviors, and use drugs compared to females with no investigated report. Substantiated CM was associated with depressive symptoms. Findings underscore the importance of maintaining case records, regardless of substantiation, to better serve adolescents at risk for deleterious outcomes. Prospective methods and propensity scores bolster causal inference and highlight how interventions implemented following investigation are an important prevention opportunity.


Asunto(s)
Salud del Adolescente , Maltrato a los Niños/psicología , Servicios de Protección Infantil , Adolescente , Niño , Maltrato a los Niños/diagnóstico , Maltrato a los Niños/prevención & control , Femenino , Humanos , Embarazo , Embarazo en Adolescencia/estadística & datos numéricos , Puntaje de Propensión , Estudios Prospectivos , Factores de Riesgo , Trastornos Relacionados con Sustancias/etiología
6.
Trials ; 19(1): 255, 2018 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-29703237

RESUMEN

BACKGROUND: Rates of alcohol and illicit drug use (AIDU) are consistently similar across racial groups (Windsor and Negi, J Addict Dis 28:258-68, 2009; Keyes et al. Soc Sci Med 124:132-41, 2015). Yet AIDU has significantly higher consequences for residents in distressed communities with concentrations of African Americans (DCAA - i.e., localities with high rates of poverty and crime) who also have considerably less access to effective treatment of substance use disorders (SUD). This project is optimizing Community Wise, an innovative multi-level behavioral-health intervention created in partnership with service providers and residents of distressed communities with histories of SUD and incarceration, to reduce health inequalities related to AIDU. METHODS: Grounded in critical consciousness theory, community-based participatory research principles (CBPR), and the multiphase optimization strategy (MOST), this study employs a 2 × 2 × 2 × 2 factorial design to engineer the most efficient, effective, and scalable version of Community Wise that can be delivered for US$250 per person or less. This study is fully powered to detect change in AIDU in a sample of 528 men with a histories of SUD and incarceration, residing in Newark, NJ in the United States. A community collaborative board oversees recruitment using a variety of strategies including indigenous field worker sampling, facility-based sampling, community advertisement through fliers, and street outreach. Participants are randomly assigned to one of 16 conditions that include a combination of the following candidate intervention components: peer or licensed facilitator, group dialogue, personal goal development, and community organizing. All participants receive a core critical-thinking component. Data are collected at baseline plus five post-baseline monthly follow ups. Once the optimized Community Wise intervention is identified, it will be evaluated against an existing standard of care in a future randomized clinical trial. DISCUSSION: This paper describes the protocol of the first ever study using CBPR and MOST to optimize a substance use intervention targeting a marginalized population. Data from this study will culminate in an optimized Community Wise manual; enhanced methodological strategies to develop multi-component scalable interventions using MOST and CBPR; and a better understanding of the application of critical consciousness theory to the field of health inequalities related to AIDU. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02951455 . Registered on 1 November 2016.


Asunto(s)
Servicios Comunitarios de Salud Mental , Investigación Participativa Basada en la Comunidad , Prisioneros/psicología , Psicoterapia/métodos , Trastornos Relacionados con Sustancias/prevención & control , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Masculino , Salud Mental , New Jersey/epidemiología , Educación del Paciente como Asunto , Selección de Paciente , Influencia de los Compañeros , Proyectos Piloto , Pobreza/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Tamaño de la Muestra , Marginación Social , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/etnología , Trastornos Relacionados con Sustancias/psicología , Factores de Tiempo , Resultado del Tratamiento
7.
J Early Adolesc ; 37(5): 662-676, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28529400

RESUMEN

Although early sexual initiation has been linked to negative outcomes, it is unknown whether these effects are causal. In this study, we use propensity score methods to estimate the causal effect of early sexual initiation on young adult sexual risk behaviors and health outcomes using data from the National Longitudinal Study of Adolescent to Adult Health. We found that early sexual initiation predicted having 2 or more partners (for both males and females) and having a sexually transmitted infection in the past year (females only) but did not predict depressive symptoms in the past week (for either gender). These results underscore the importance of continued programmatic efforts to delay age of sexual initiation, particularly for females.

8.
Int J Behav Nutr Phys Act ; 14(1): 9, 2017 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-28125997

RESUMEN

BACKGROUND: Parents shape children's eating environments and act as powerful socialization agents, impacting young children's behavioral controls of food intake. Most feeding measures assess parents' use of control to manage children's intake of energy dense foods. The Structure and Control in Parent Feeding (SCPF) questionnaire was developed to assess more positive aspects of feeding practices with their young children -setting limits, providing routines-that promote self-regulation, as well as controlling feeding practices. METHODS: A mixed method approach was used to develop the SCPF. In 2013, cognitive interviews informed the modification, deletion and/or replacement of items. In 2014, the survey was distributed statewide to mothers of toddlers aged 12 to 36 months participating in the Women, Infants, and Children program. In 2016, exploratory factor analyses was conducted to test our theoretical parenting model and content validity and criterion validity were assessed (n = 334). RESULTS: Exploratory factor analysis (EFA) and second-order EFA revealed a 2-factor, 22-item Structure model and a 2-factor, 12-item Control model. Internal consistencies for all factors exceeded 0.70. As predicted, the Structure superfactor was positivity associated with responsiveness, whereas the Control superfactor was positively associated with demandingness on the Caregiver's Feeding Styles Questionnaire. The Structure subscales were also positively associated with mealtime behaviors and Control subscales were positively associated with control-oriented feeding measures from the Control in Parent Feeding Practices questionnaire. CONCLUSION: The SCPF questionnaire is a reliable tool that can be used to assess aspects of structure- and control-based feeding practices to better understand how parents feed their toddlers.


Asunto(s)
Conducta Infantil , Conducta Alimentaria , Madres , Responsabilidad Parental , Encuestas y Cuestionarios/normas , Adulto , Índice de Masa Corporal , Preescolar , Análisis Factorial , Femenino , Preferencias Alimentarias , Humanos , Lactante , Masculino , Obesidad , Reproducibilidad de los Resultados , Adulto Joven
9.
J Behav Med ; 40(1): 85-98, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28058516

RESUMEN

As more behavioral health interventions move from traditional to digital platforms, the application of evidence-based theories and techniques may be doubly advantageous. First, it can expedite digital health intervention development, improving efficacy, and increasing reach. Second, moving behavioral health interventions to digital platforms presents researchers with novel (potentially paradigm shifting) opportunities for advancing theories and techniques. In particular, the potential for technology to revolutionize theory refinement is made possible by leveraging the proliferation of "real-time" objective measurement and "big data" commonly generated and stored by digital platforms. Much more could be done to realize this potential. This paper offers proposals for better leveraging the potential advantages of digital health platforms, and reviews three of the cutting edge methods for doing so: optimization designs, dynamic systems modeling, and social network analysis.


Asunto(s)
Terapia Conductista/organización & administración , Investigación Conductal/organización & administración , Conductas Relacionadas con la Salud , Promoción de la Salud/organización & administración , Servicios de Salud , Humanos
10.
J Behav Med ; 40(1): 203-213, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27481103

RESUMEN

The dissemination and implementation of evidence-based behavioral medicine interventions into real world practice has been limited. The purpose of this paper is to discuss specific limitations of current behavioral medicine research within the context of the RE-AIM framework, and potential opportunities to increase public health impact by applying novel intervention designs and data collection approaches. The MOST framework has recently emerged as an alternative approach to development and evaluation that aims to optimize multicomponent behavioral and bio-behavioral interventions. SMART designs, imbedded within the MOST framework, are an approach to optimize adaptive interventions. In addition to innovative design strategies, novel data collection approaches that have the potential to improve the public-health dissemination include mHealth approaches and considering environment as a potential data source. Finally, becoming involved in advocacy via policy related work may help to improve the impact of evidence-based behavioral interventions. Innovative methods, if increasingly implemented, may have the ability to increase the public health impact of evidence-based behavioral interventions to prevent disease.


Asunto(s)
Terapia Conductista/tendencias , Medicina de la Conducta/tendencias , Investigación Biomédica/tendencias , Medicina Basada en la Evidencia/estadística & datos numéricos , Promoción de la Salud/tendencias , Predicción , Investigación sobre Servicios de Salud/tendencias , Humanos , Salud Pública
11.
BMC Public Health ; 16(1): 1181, 2016 11 22.
Artículo en Inglés | MEDLINE | ID: mdl-27876027

RESUMEN

BACKGROUND: Emerging approaches to building more efficient and effective behavioral interventions are becoming more widely available. The current paper provides an empirical example of the use of the engineering-inspired multiphase optimization strategy (MOST) to build a remotely delivered responsive parenting intervention to prevent obesity among children of low-income mothers with and without depressive symptoms. METHODS: Participants were 107 mothers with (n = 45) and without (n = 62) depressive symptoms who had a child aged 12 to 42 months participating in the Women, Infants and Children program. Participants were randomized to one of sixteen experimental conditions using a factorial design that included a combination of the following eight remotely delivered intervention components: responsive feeding curriculum (given to all participants), parenting curriculum, portion size guidance, obesogenic risk assessment, personalized feedback on mealtime routines, feeding curriculum counseling, goal setting, mobile messaging, and social support. This design enabled efficient identification of components with low feasibility and acceptability. RESULTS: Completion rates were high (85%) and did not statistically differ by depressive symptoms. However, mothers with depressive symptoms who received obesogenic risk assessment and personalized feedback on mealtime routines components had lower completion rates than mothers without depressive symptoms. All intervention components were feasible to implement except the social support component. Regardless of experimental condition, most participants reported that the program increased their awareness of what, when, and how to feed their children. CONCLUSIONS: MOST provided an efficient way to assess the feasibility of components prior to testing them with a fully powered experiment. This framework helped identify potentially challenging combinations of remotely delivered intervention components. Consideration of how these results can inform future studies focused on the optimization phase of MOST is discussed.


Asunto(s)
Madres/psicología , Obesidad Pediátrica/prevención & control , Adulto , Terapia Conductista/métodos , Preescolar , Consejo , Femenino , Humanos , Lactante , Responsabilidad Parental/psicología , Proyectos Piloto , Pobreza , Apoyo Social , Resultado del Tratamiento
12.
J Adolesc Health ; 59(3): 291-297, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27265422

RESUMEN

PURPOSE: To examine how age of onset of sexual intercourse is associated with past-year and lifetime sexually transmitted infections (STIs) and depression in young adulthood. METHODS: We examined how occurrence of a lifetime and past-year STI, lifetime diagnosis of depression, and past-week depressive symptoms differed as a function of age of onset of sexual intercourse using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 8,938 individuals). Time-varying effect models were used to examine how age of onset, measured as continuous age, was associated with these outcomes in young adulthood, with all analyses stratified to examine gender differences. RESULTS: Individuals who engaged in first intercourse before age 16 reported higher than average rates of all outcomes studied; for example, an estimated 35% of women and 12% of men who initiated at age 14 years reported a lifetime STI, compared with about 5% of those who initiated at age 24 years. Timing of first intercourse past the mid-twenties was associated with lower than average rates of STIs and lifetime depression diagnoses but was associated with a somewhat higher level of past-year depressive symptoms. Patterns were similar by gender, although there was little difference in men's depression diagnoses by age of onset. CONCLUSIONS: Results suggest that sexual intercourse before age 16 years may be associated with higher rates of STIs and depression. Findings provide support for comprehensive programs that both promote delay of first intercourse and provide safe sex and psychological support for those who initiate early.


Asunto(s)
Factores de Edad , Coito/psicología , Depresión/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Conducta del Adolescente/psicología , Adulto , Edad de Inicio , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Distribución por Sexo , Factores Sexuales , Adulto Joven
13.
AIDS Behav ; 20 Suppl 1: S197-214, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26238037

RESUMEN

To move society toward an AIDS-free generation, behavioral interventions for prevention and treatment of HIV/AIDS must be not only effective, but also cost-effective, efficient, and readily scalable. The purpose of this article is to introduce to the HIV/AIDS research community the multiphase optimization strategy (MOST), a new methodological framework inspired by engineering principles and designed to develop behavioral interventions that have these important characteristics. Many behavioral interventions comprise multiple components. In MOST, randomized experimentation is conducted to assess the individual performance of each intervention component, and whether its presence/absence/setting has an impact on the performance of other components. This information is used to engineer an intervention that meets a specific optimization criterion, defined a priori in terms of effectiveness, cost, cost-effectiveness, and/or scalability. MOST will enable intervention science to develop a coherent knowledge base about what works and does not work. Ultimately this will improve behavioral interventions systematically and incrementally.


Asunto(s)
Terapia Conductista/métodos , Ingeniería/métodos , Infecciones por VIH/terapia , Desarrollo de Programa/métodos , Análisis Costo-Beneficio , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Humanos , Modelos Teóricos , Evaluación de Programas y Proyectos de Salud/métodos , Conducta de Reducción del Riesgo
14.
J Sex Res ; 53(7): 742-53, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-26445133

RESUMEN

Adolescents' sexual and romantic relationship experiences are multidimensional but often studied as single constructs. Thus, it is not clear how different patterns of sexual and relationship experience may interact to differentially predict later outcomes. In this study we used latent class analysis to model patterns (latent classes) of adolescent sexual and romantic experiences, and then examined how these classes were associated with young adult sexual health and relationship outcomes in data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We identified six adolescent relationship classes: No Relationship (33%), Waiting (22%), Intimate (38%), Private (3%), Low Involvement (3%), and Physical (2%). Adolescents in the Waiting and Intimate classes were more likely to have married by young adulthood than those in other classes, and those in the Physical class had a greater number of sexual partners and higher rates of sexually transmitted infections (STIs). Some gender differences were found; for example, women in the Low-Involvement and Physical classes in adolescence had average or high odds of marriage, whereas men in these classes had relatively low odds of marriage. Our findings identify more and less normative patterns of romantic and sexual experiences in late adolescence and elucidate associations between adolescent experiences and adult outcomes.


Asunto(s)
Conducta del Adolescente , Matrimonio/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Factores Sexuales , Estados Unidos/epidemiología , Adulto Joven
15.
Arch Sex Behav ; 44(3): 705-15, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24449152

RESUMEN

Adolescent sexual behavior is multidimensional, yet most studies of the topic use variable-oriented methods that reduce behaviors to a single dimension. In this study, we used a person-oriented approach to model adolescent sexual behavior comprehensively, using data from the National Longitudinal Study of Adolescent Health. We identified five latent classes of adolescent sexual behavior: Abstinent (39%), Oral Sex (10%), Low-Risk (25%), Multi-Partner Normative (12%), and Multi-Partner Early (13%). Membership in riskier classes of sexual behavior was predicted by substance use and depressive symptoms. Class membership was also associated with young adult STI outcomes although these associations differed by gender. Male adolescents' STI rates increased with membership in classes with more risky behaviors whereas females' rates were consistent among all sexually active classes. These findings demonstrate the advantages of examining adolescent sexuality in a way that emphasizes its complexity.


Asunto(s)
Conducta del Adolescente , Conducta Sexual , Parejas Sexuales , Enfermedades de Transmisión Sexual/prevención & control , Adolescente , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Asunción de Riesgos , Distribución por Sexo , Enfermedades de Transmisión Sexual/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto Joven
16.
Transl Behav Med ; 4(3): 238-51, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25264464

RESUMEN

The multiphase optimization strategy (MOST) is a framework for not only evaluating but also optimizing behavioral interventions. A tool critical for MOST is the screening experiment, which enables efficient gathering of information for deciding which components to include in an optimized intervention. This article outlines a procedure for making decisions based on data from a factorial screening experiment. The decision making procedure is illustrated with artificial data generated to resemble empirical data. The illustration suggests that this approach is useful for selecting intervention components and settings based on the results of a factorial screening experiment. It is important to develop methods for making decisions based on factorial screening experiments. The approach demonstrated here is potentially useful, but has limited generalizability. Future research should develop additional decision making procedures for a variety of situations.

17.
Am J Prev Med ; 47(4): 498-504, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25092122

RESUMEN

BACKGROUND: An understanding of the individual and combined effects of a set of intervention components is important for moving the science of preventive medicine interventions forward. This understanding can often be achieved in an efficient and economical way via a factorial experiment, in which two or more independent variables are manipulated. The factorial experiment is a complement to the RCT; the two designs address different research questions. PURPOSE: To offer an introduction to factorial experiments aimed at investigators trained primarily in the RCT. METHODS: The factorial experiment is compared and contrasted with other experimental designs used commonly in intervention science to highlight where each is most efficient and appropriate. RESULTS: Several points are made: factorial experiments make very efficient use of experimental subjects when the data are properly analyzed; a factorial experiment can have excellent statistical power even if it has relatively few subjects per experimental condition; and when conducting research to select components for inclusion in a multicomponent intervention, interactions should be studied rather than avoided. CONCLUSIONS: Investigators in preventive medicine and related areas should begin considering factorial experiments alongside other approaches. Experimental designs should be chosen from a resource management perspective, which states that the best experimental design is the one that provides the greatest scientific benefit without exceeding available resources.


Asunto(s)
Servicios Preventivos de Salud/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Proyectos de Investigación , Humanos , Medicina Preventiva/métodos
18.
Nurs Res ; 61(3): 224-30, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22551997

RESUMEN

BACKGROUND: Assessing mediation is important because most interventions are designed to affect an intermediate variable or mediator; this mediator, in turn, is hypothesized to affect outcome behaviors. Although there may be randomization to the intervention, randomization to levels of the mediator is not generally possible. Therefore, drawing causal inferences about the effect of the mediator on the outcome is not straightforward. OBJECTIVES: The aim of this study was to introduce an approach to causal mediation analysis using the potential outcomes framework for causal inference and then discuss this approach in terms of the scientific questions addressed and the assumptions needed for identifying and estimating the effects. METHODS: The approach is illustrated using data from the Criminal Justice Drug Abuse Treatment Studies: Reducing Risky Relationships-HIV intervention implemented with 243 incarcerated women re-entering the community. The intervention was designed to affect various mediators at 30 days postintervention, including risky relationship thoughts, beliefs, and attitudes, which were then hypothesized to affect engagement in risky sexual behaviors, such as unprotected sex, at 90 days postintervention. RESULTS: Using propensity score weighting, we found the intervention resulted in a significant decrease in risky relationship thoughts (-0.529, p = .03) and risky relationship thoughts resulted in an increase in unprotected sex (0.447, p < .001). However, the direct effect of the intervention on unprotected sex was not significant (0.388, p = .479). DISCUSSION: By reducing bias, propensity score models improve the accuracy of statistical analysis of interventions with mediators and allow researchers to determine not only whether their intervention works but also how it works.


Asunto(s)
Infecciones por VIH/prevención & control , Investigación en Enfermería/estadística & datos numéricos , Prisioneros/psicología , Conducta de Reducción del Riesgo , Sexo Seguro , Adulto , Causalidad , Femenino , Humanos , Puntaje de Propensión , Estados Unidos
19.
Acad Pediatr ; 12(3): 205-13, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22424698

RESUMEN

OBJECTIVE: To identify factors distinguishing adolescents across 3 groups: no self-harm, nonsuicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). METHODS: Data were from the 2007 Minnesota Student Survey. The sample included 61,330 students in grades 9 and 12. Logistic regression analysis determined factors that best distinguished adolescents who reported NSSI from those who reported no self-harm, and adolescents who reported NSSI + SA. Final models were developed over 3 stages of analysis that tested the importance of variables within risk factor, protective factor, and co-occurring health-risk behavior domains. RESULTS: For male and female subjects, factors that consistently distinguished youth who reported NSSI from those who reported no self-harm included depressive symptoms, hopelessness, physical abuse, less parent connectedness, running away from home, and maladaptive dieting behavior. Factors that distinguished the NSSI + SA group from the NSSI only group for both sexes were a mental health problem, depressive symptoms, hopelessness, physical abuse, and running away from home. Other factors, such as sexual abuse, were significant in models for males or females only. Hopelessness constituted the leading factor to increase the likelihood that youth who self-injured also attempted suicide. CONCLUSIONS: Youth engaging in NSSI experience diverse psychosocial stressors and significant distress. Clinicians and school personnel are well-positioned to offer support to these youth. Furthermore, they can help address NSSI among youth by identifying those who self-injure early, assessing for hopelessness and suicidality, facilitating connections to prosocial adults, addressing maladaptive dieting behavior, and supporting runaway youth.


Asunto(s)
Depresión , Conducta Autodestructiva/psicología , Intento de Suicidio/psicología , Adolescente , Maltrato a los Niños , Femenino , Humanos , Modelos Logísticos , Masculino , Minnesota/epidemiología , Factores de Riesgo , Asunción de Riesgos , Conducta Autodestructiva/epidemiología , Conducta Sexual , Medio Social , Estudiantes , Intento de Suicidio/estadística & datos numéricos , Encuestas y Cuestionarios
20.
Open Fam Stud J ; 4(Suppl 1-M9): 81-88, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-23125880

RESUMEN

Understanding the multiple factors that place individuals at risk for sexual risk behavior is critical for developing effective intervention programs. Regression-based methods are commonly used to estimate the average effects of risk factors, however such results can be difficult to translate to prevention implications at the individual level. Although differential effects can be examined to some extent by including interaction terms, as risk factors and moderators are added to the model interpretation can become difficult. The current study presents finite mixture regression as an alternative approach, where population subgroups are identified based on the pattern of associations between multiple risk factors and sexual risk behavior. Data from participants in the National Longitudinal Study on Adolescent Health were used to explore the effects of five adolescent risk factors (early sexual debut, heavy episodic drinking, school connectedness, positive consequences of having sex, and negative consequences of having sex) on the total number of sexual partners in adulthood. Four latent classes were identified on the basis of the Poisson regression parameter estimates. Gender, race, and grade were included as predictors of latent class membership. Results suggest that prevention programs focused on mediating these particular risk factors may be most effective for adolescents who are at lower risk for later engaging in risky sexual behaviour; however, for the subgroup of adolescents who go on to have the most sexual partners, the evidence is less conclusive and warrants further study.

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