On the Efficacy and Mediation of a One-on-One HIV Risk-Reduction Intervention for African American Men Who Have Sex With Men: A Randomized Controlled Trial

We examined the efficacy and mediation of Being Responsible for Ourselves (BRO), an HIV/STI risk reduction intervention for African American men who have sex with men (MSM), the population with the highest HIV diagnosis rate in the US. We randomized African American MSM to one of two interventions: BRO HIV/STI risk reduction, targeting condom use; or attention-matched control, targeting physical activity and healthy diet. The interventions were based on social cognitive theory, the reasoned-action approach, and qualitative research. Men reporting anal intercourse with other men in the past 90 days were eligible and completed pre-intervention

Mediation and Moderation of an Efficacious Theory-Based Abstinence-Only Intervention for African American Adolescents

ObjectiveThis secondary data analysis sought to determine what mediated reductions in self-reported sexual initiation over the 24-month postintervention period in early adolescents who received "Promoting Health among Teens," a theory-based, abstinence-only intervention (Jemmott, Jemmott, & Fong, 2010).MethodAfrican American Grade 6 and 7 students at inner-city public middle schools were randomized to 1 of 5 interventions grounded in social-cognitive theory and the theory of reasoned action: 8-hr abstinence-only targeting reduced sexual intercourse; 8-hr safer-sex-only targeting increased condom use; 8-hr and 12-hr comprehensive interventions targeting sexual intercourse and condom use; 8-hr control intervention targeting physical activity and diet. Primary outcome was self-report of vaginal intercourse by 24 months postintervention. Potential mediators, assessed immediately postintervention, were theory-of-reasoned-action variables, including behavioral beliefs about positive consequences of abstinence and negative consequences of sex, intention to have sex, normative beliefs about sex, and HIV and sexually transmitted infection (STI) knowledge. We tested single and serial mediation models using the product-of-coefficients approach.ResultsOf 509 students reporting never having vaginal intercourse at baseline (324 girls and 185 boys; mean age = 11.8 years, SD = 0.8), 500 or 98.2% were included in serial mediation analyses. Consistent with the theory of reasoned action, the abstinence-only intervention increased positive behavioral beliefs about abstinence, which reduced intention to have sex, which in turn reduced sexual initiation. Negative behavioral beliefs about sex, normative beliefs about sex, and HIV/STI knowledge were not mediators.ConclusionsAbstinence-only interventions should stress the gains to be realized from abstinence rather than the deleterious consequences of sexual involvement

Reducing Hiv Sexual Risk Among African American Women Who Use Drugs: Hearing Their Voices

A pilot study was conducted to understand women\u27s realities, perspectives, and perceived needs regarding the interaction between substance use, types of sexual relationships, and the challenges and barriers they pose to practicing safer sex. An additional purpose was to examine this population\u27s willingness to participate in the program and receptiveness to the components of proposed interventions. Data were collected in this descriptive, exploratory study by the use of one focus group. Twelve African American women between 20 and 55 years of age who had previous drug detoxification experience participated in a 3-hour focus group. All participants were sexually active as well as current users of illicit substances, and all but one had traded sex for money, drugs, or alcohol. The focus group interview was guided by a semistructured questionnaire. Participants were recruited by counselors in detoxification units. Each unit counselor was asked to randomly select a third of their residents, explain and read the purpose of the focus group, and get the residents\u27 verbal consent to participate. The women discussed their sexual behaviors and drug use that increased their risk for acquiring HIV. They provided insight about the effects of different drugs on one\u27s sexual behavior, motivation for sex, and reasons for unsafe sex and made recommendations for HIV prevention intervention. Participants agreed that safer sex and healthy living intervention would be most beneficial if placed within the context of a detoxification program. The juxtaposition of increased sexual risk behavior and the potential to acquire and transmit HIV infection suggests the urgency of intervening with African American women who are substance abusers

Hiv Prevention: Among People With Developmental Disabilities

This investigation sought to determine the effect of HIV/AIDS on people with developmental disabilities. Inquiries about contributing factors and HIV preventions needs also were made. In this qualitative descriptive study, two focus groups were conducted with individuals from the target population, as well as service providers. Each focus group was held in a conference room of a community-based organization located in Philadelphia on a weekly evening. Sixteen adults participated in the focus groups. Seven were members of the target population, and 9 were service providers. Focused topics were developed to guide the group discussion. Participants identified several contributing factors and barriers associated with risk behavior and HIV risk in this population. Recommendations for HIV prevention needs and strategies also were generated. The results of this formative inquiry indicated there is a need for development of specific HIV intervention strategies for this vulnerable and ofter overlooked population. Clinical and research implications are proposed

African American Grandmothers\u27 Perceptions Of Caregiver Concerns Associated With Rearing Adolescent Grandchildren

In 1996, grandparents were the sole providers of care for 269,000 grandchildren. Research findings indicate that grandmothers are usually the primary caretakers of grandchildren. Previous issues associated with raising grandchildren vary, but usually relate to the grandparents\u27 health, financial concerns, or lack of social support. This qualitative descriptive study was designed to describe African American grandmothers\u27 perceptions about the burdens of raising adolescent grandchildren. Using this approach, the researchers were able to study the richness and diversity of the grandmothers\u27 perceptions. Data were collected from 35 grandmothers through a focus group (n = 7) and during a 4-day intervention research study (n = 28) entitled Grandmother-Grandchild Health Promotion Program. Numerous concerns were voiced by both groups, but those stated most frequently were associated with the well-being of grandchildren (grandchildren\u27s sexual behavior, potential drug use, and potential risk of encountering violence) and relational conflicts with adult children. Unexpected findings were the absence of stated concerns associated with the grandmothers\u27 financial situation or health. Recommendations for intervention, clinical practice, and research are discussed. Copyright © 2000 by W.B. Saunders Company

Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

BackgroundFew trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM).PurposeWe examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM.MethodAfrican American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys.ResultsOf the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period.ConclusionsInterventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM's physical activity.Clinical trial registrationThe trial was registered with the ClinicalTrials.gov Identifier NCT02561286

Mediation of effects of a theory-based behavioral intervention on self-reported physical activity in South African men

Objective. Increasing physical activity is an important public-health goal worldwide, but there are few published mediation analyses of physical-activity interventions in low-to-middle-income countries like South Africa undergoing a health transition involving markedly increased mortality from non-communicable diseases. This article reports secondary analyses on the mediation of a theory-of-planned-behavior-based behavioral intervention that increased self-reported physical activity in a trial with 1181 men in Eastern Cape Province, South Africa. Method. Twenty-two matched-pairs of neighborhoods were randomly selected. Within pairs, neighborhoods were randomized to a health-promotion intervention or an attention-matched control intervention with baseline, immediate-post, and 6- and 12-month post-intervention assessments. Theory-of-planned-behavior constructs measured immediately post-intervention were tested as potential mediators of the primary outcome, self-reported physical activity averaged over the 6- and 12-month post-intervention assessments, using a product-of-coefficients approach in a generalized-estimating-equations framework. Data were collected in 2007-2010. Results. Attitude, subjective norm, self-efficacy, and intention were significant mediators of intervention-induced increases in self-reported physical activity. The descriptive norm, not affected by the intervention, was not a mediator, but predicted increased self-reported physical activity. Conclusion. The results suggest that interventions targeting theory-of-planned-behavior constructs may contribute to efforts to increase physical activity to reduce the burden of non-communicable diseases among South African men. (C) 2015 Elsevier Inc. All rights reserved