Adolescent Abstinence and Unprotected Sex in CyberSenga, an Internet-Based HIV Prevention Program: Randomized Clinical Trial of Efficacy

Context Cost-effective, scalable programs are urgently needed in countries deeply affected by HIV. Methods: This parallel-group RCT was conducted in four secondary schools in Mbarara, Uganda. Participants were 12 years and older, reported past-year computer or Internet use, and provided informed caregiver permission and youth assent. The intervention, CyberSenga, was a five-hour online healthy sexuality program. Half of the intervention group was further randomized to receive a booster at four-months post-intervention. The control arm received ‘treatment as usual’ (i.e., school-delivered sexuality programming). The main outcome measures were: 1) condom use and 2) abstinence in the past three months at six-months' post-intervention. Secondary outcomes were: 1) condom use and 2) abstinence at three-month's post-intervention; and 6-month outcomes by booster exposure. Analyses were intention to treat. Results: All 416 eligible youth were invited to participate, 88% (n = 366) of whom enrolled. Participants were randomized to the intervention (n = 183) or control (n = 183) arm; 91 intervention participants were further randomized to the booster. No statistically significant results were noted among the main outcomes. Among the secondary outcomes: At three-month follow-up, trends suggested that intervention participants (81%) were more likely to be abstinent than control participants (74%; p = 0.08), and this was particularly true among youth who were abstinent at baseline (88% vs. 77%; p = 0.02). At six-month follow-up, those in the booster group (80%) reported higher rates of abstinence than youth in the intervention, no booster (57%) and control (55%) groups (p = 0.15); they also reported lower rates of unprotected sex (5%) compared to youth in the intervention, no booster (24%) and control (21%) groups (p = 0.21) among youth sexually active at baseline. Conclusions: The CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and, with the booster, may also promote HIV preventive behavior among sexually active youth in the longer term. Trial Registration NCT00906178

Opportunities for technology-based HIV prevention programming among high school students in Cape Town, South Africa

One in three new cases of HIV in South Africa is among adolescents. Given that adolescents are particularly affected, scalable, and cost-effective prevention programs are urgently needed. This study aims to identify opportunities to integrate technology into youth HIV prevention efforts. In 2012, 1107 8th-11th graders completed a paper-and-pencil survey. Respondents were enrolled in one of three public high schools in Langa, a lower income community in Cape Town, South Africa. Eighty-nine percent of respondents have used text messaging (SMS) and 86% have gone online. If an HIV prevention program was offered online, 66% of youth would be somewhat or extremely likely to access it; slightly fewer (55%) felt the same about SMS-based programming. In comparison, 85% said they would be somewhat or extremely likely to access a school-based HIV prevention program. Interest in Internet- (60%) and SMS-based (54%) HIV prevention programming was similar for youth who had a self-appraised risk of HIV compared to youth who appraised their risk to be lower, as it was for youth who were tired of hearing messages about HIV prevention. Technology use is common - even among high school students who live in lower income communities. At the same time, these data reveal that it is not uncommon for youth to be tired of hearing messages about HIV prevention, and many of the typical topics key to HIV prevention have low interest levels among youth. HIV prevention researchers need to be mindful of the extent of existing programming that youth are exposed to. Technology-based programming may be especially amenable to meeting these requirements because of its novelty especially in developing countries, and because interactive functionality can be easily integrated into the program design. Given the preference for school and Internet-based programming, it seems that a hybrid approach is likely feasible and acceptable

Influence of moisture, nutrients, and distance from stream on early-stage mass loss of western red cedar leaf litter in headwater riparian forests

Western red cedar (Thuja plicata Donn ex D.Don) is a dominant species in forests of the Pacific Northwest in North America, but little is known about its decomposition in riparian habitat. We experimentally tested how early-stage mass loss of cedar leaf litter varied with distance from the stream (five distances from 1 to 40 m away) and responded to nutrient and water additions near four headwater streams in southwestern British Columbia. We ran three coarse-mesh litterbag trials in durations between five months to one year from January 2013 and January 2014. Litterbags were either untreated or given the following treatments: water additions during dry summer months, nitrogen and phosphorus additions, or additions of both. Control litterbags lost 21% initial mass over 12 months (January 2013 – January 2014), 20% over five months (January 2013 – June 2013), and 15% over eight months (June 2013 – January 2014). Rates of mass loss did not increase with water in any trial but did increase with nutrients in the 12-month trial. Litter located 40 m from the stream lost 7% more mass than that located 1 m away in this same trial. Our study indicates that cedar leaf litter mass loss responded primarily to nutrient additions.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Process evaluation of a mHealth program: Lessons learned from Stop My Smoking USA, a text messaging-based smoking cessation program for young adults

ObjectiveReport lessons learned in an RCT of Stop My Smoking (SMS) USA, a mHealth smoking cessation program for young adult smokers.Methods164 18-24-year-olds were recruited nationally, online in 2011. Program evaluation data were provided at 12-week post-Quit Day.Results(1) Inviting participants to complete a brief text messaging survey and then asking them to complete a longer online survey resulted in the highest response rate (89%). (2) The positive tone of program messages was the most commonly noted program strength. (3) Suggested improvements included more social connectivity and additional assistance overcoming stressful situations. (4) Half of intervention participants moved through the program linearly and half went through various paths that reflected multiple relapses. Suggestions to use pharmacotherapy resulted in 22% of heavy smokers to utilize it.ConclusionParticipant feedback provided concrete ways in which this and other young adult-focused interventions can improve messaging and program features to be even more salient.Practice implicationsFuture young adult mHealth interventions could: Integrate models that are flexible to different "paths" of behavior change; address stressful life events directly and comprehensively; integrate proactive messaging that promotes pharmacotherapy options; and use text messaging as a gateway to longer online surveys

Sexual behavior at three- and six-month follow-up based upon baseline behavior by arm assignment (n = 366).

<p>Sexual behavior at three- and six-month follow-up based upon baseline behavior by arm assignment (n = 366).</p

Participant characteristics across the four schools (n = 366).

*<p>Rates are shown of all youth to provide a population-based estimate of dating violence involvement. Data are confounded by the rate of youth who have ever had a boyfriend or girlfriend.</p><p>Samples sizes by school are not shown to protect the identity of each school.</p

Past three-month abstinence at follow-up among adolescents in the CyberSenga intervention (n = 366).

<p>aOR = adjusted odds ratio.</p><p>Intervention, nb = Intervention, no booster.</p><p>Intervetion +b = Intervention with booster.</p><p>Bold denotes statistically significant difference between the intervention and control arms at p≤.05.</p><p>Abstinent youth include youth who have never had sex, as well as those who have had sex, but not more recently than 2 years ago.</p><p>Italics denotes a suggestion of a difference between the intervention and control arms at p≥.05 but p≤.10.</p>*<p>Reference group.</p><p>Odds ratios adjusted for: youth age, history of a boyfriend or girlfriend, support from a special person, Attitudes towards HIV preventive acts, Subjective Norms Regarding HIV Preventive acts, and Behavioral Intentions for HIV Prevention. Models for All Youth also are adjusted for biological sex; analyses stratified by baseline sexual experience are not due to collinearity.</p

Participant sample characteristics by arm assignment (n = 366).

<p>Participant sample characteristics by arm assignment (n = 366).</p