The GirlStars Program: Challenges to Recruitment and Retention in a Physical Activity and Health Education Program for Adolescent Girls Living in Public Housing

BACKGROUND. Although physical inactivity is a concern for all adolescents, physical activity levels are especially low among minority adolescents and minimal among girls from low-income families. After-school programs can reduce high-risk behaviors and strengthen schools, families, and communities. CONTEXT. We conducted an operational research project that provided free access to a program of regular, organized physical activity combined with health education sessions for adolescent girls in 2 public housing developments in Boston, Massachusetts. METHODS. From July 2002 through October 2005, at each of 2 public housing sites, the GirlStars program participants met each week for two 2-hour sessions, 1 dedicated to physical activity and 1 dedicated to health education. Sessions were led by the project coordinator and a resident assistant at each development. OUTCOME. Participants in the GirlStars program increased their health knowledge, self-confidence, and decision-making skills, but rates of participation were low. Factors that affected participation included safety concerns, lack of community support for the program, interpersonal conflicts, attrition in staff, and conflicts with other activities. INTERPRETATION. Programs in public housing developments that address these barriers to recruitment and retention may be more successful and reach more girls

Adolescents' perceptions of risk for HIV infection: Implications for future research

Few studies have investigated adolescents' perceptions of their risk for HIV infection. Findings from two studies of adolescents in Massachusetts indicate that there are differences in the knowledge, beliefs, behaviors, and perceptions of risk among adolescents and suggest the need for understanding the differences among adolescents from different racial or ethnic backgrounds. In both studies, white students were the most knowledgeable about casual, sexual, and drug use transmission of HIV followed by black, Hispanic, and Asian students. In both studies more black adolescents than other racial or ethnic groups were sexually active, and black and Hispanic adolescents began having sexual intercourse at an earlier age than white or Asian adolescents. Asian and Hispanic adolescents were most worried about getting AIDS. Although more Hispanics than other groups reported changing their behavior because of AIDS, fewer of them who had changed their sexual or contraceptive behavior were using effective methods. Despite clear differences in the perceived risk of getting AIDS among these adolescents, the underlying reasons remain to be explicated, using, among other data collection methods, ethnographic techniques to probe adolescents' risk perceptions, their understandings of sickness, and their explanatory models of AIDS. Life events affect risk taking behaviors and also shape perceptions of risk. To understand what it is that adolescents consider 'risky' requires seeing their life options as they do in the larger context of their aspirations and worries about how 'to fit in'.adolescents perceptions risk HIV infection

Family consequences of chronic back pain

This paper considers occupational back injuries as they are described by injured workers, including the impact on their abilities to function in family and social roles. In this study, we interviewed people with work-related back injuries in Florida and Wisconsin. The sample was chosen from among workers who either lost more than 28 days from work or who received workers' compensation permanent partial disability benefits. Respondents indicated a wide range of limitations on family and social roles, including physical impacts that hampered respondents' ability to do household chores, to take part in raising children, and to engage in leisure activities with their spouses. Spouses and children took over family responsibilities once carried on by injured workers. The impacts of limitations resulted in a restructuring of family and social roles, relationships, and self-identities. In addition, these impacts led to depression and anger among the injured workers and to stress and strain in family relationships. Unlike the effects on work, many of these outcomes are not valued in the marketplace and, as a consequence, are less visible. They are nonetheless important and suggest that priorities based only on economic outcomes may understate the importance of preventive activities. Moreover, they suggest that attention should be focused on social structural factors such as the provision of medical services and social support to reduce the impact of chronic back pain on family members.Injured workers Back pain impacts Effects on family Qualitative methods Gender differences Social structural factors USA

Evaluating the impact of prevention of mother-to-child transmission of HIV in Malawi through immunization clinic-based surveillance.

BACKGROUND: Prevention of mother-to-child transmission of HIV (PMTCT) programs can greatly reduce the vertical transmission rate (VTR) of HIV, and Malawi is expanding PMTCT access by offering HIV-infected pregnant women life-long antiretroviral therapy (Option B+). There is currently no empirical data on the effectiveness of Malawian PMTCT programs. This study describes a surveillance approach to obtain population-based estimates of the VTR of infants <3 months of age in Malawi immediately after the adoption of Option B+. METHODS AND FINDINGS: A sample of caregivers and infants <3 months from 53 randomly chosen immunization clinics in 4 districts were enrolled. Infant dried blood spot (DBS) samples were tested for HIV exposure with an antibody test to determine maternal seropositivity. Positive samples were further tested using DNA PCR to determine infant infection status and VTR. Caregivers were surveyed about maternal receipt of PMTCT services. Of the 5,068 DBS samples, 764 were ELISA positive indicating 15.1% (14.1-16.1%) of mothers were HIV-infected and passed antibodies to their infant. Sixty-five of the ELISA-positive samples tested positive by DNA PCR, indicating a vertical transmission rate of 8.5% (6.6-10.7%). Survey data indicates 64.8% of HIV-infected mothers and 46.9% of HIV-exposed infants received some form of antiretroviral prophylaxis. Results do not include the entire breastfeeding period which extends to almost 2 years in Malawi. CONCLUSIONS: The observed VTR was lower than expected given earlier modeled estimates, suggesting that Malawi's PMTCT program has been successful at averting perinatal HIV transmission. Challenges to full implementation of PMTCT remain, particularly around low reported antiretroviral prophylaxis. This approach is a useful surveillance tool to assess changes in PMTCT effectiveness as Option B+ is scaled-up, and can be expanded to track programming effectiveness for young infants over time in Malawi and elsewhere