RELIGIOSITY, RACIAL IDENTITY, AND SEXUAL INITIATION AMONG BLACK AMERICAN ADOLESCENTS

There is a large and persistent racial disparity in the incidence of HIV and STD infection among adolescents. Despite advances in prevention and treatment, black adolescents experience the greatest burden of these diseases. Decreasing the number of adolescents who engage in sexual activity is one way to address this disparity. Researchers have identified several determinants associated with black adolescent sociocultural context which delay adolescent sexual initiation; one such determinant is religiosity. Grounded in concepts from social control theory, intersectionality, and models of socialization and religious development, this dissertation explored how black adolescent religiosity and racial identity influence sexual initiation. Data originated from the National Survey of American Life-Adolescent (n=1170), a nationally representative study of black adolescents. Factor analysis, structural equation modeling, latent profile analysis, and logistic regression were used to test study hypotheses. Aim one assessed the measurement properties of a multidimensional measure of black adolescent religiosity. The final model of black adolescent religiosity consisted of four constructs and was invariant across ethnic-gender subgroups. This measure of religiosity was used in subsequent aims. Aim two determined the nature of associations among religious socialization, religiosity, and sexual initiation. Results indicated that as adolescents received more messages about religious beliefs and practices, their religiosity increased. In turn, they were less likely to report sexual initiation. Tests for moderated-mediation showed that these relationships varied by gender and ethnicity (Caribbean black and African American). Aim three explored the joint effects of religiosity and racial identity on sexual initiation. Analyses yielded four distinct profiles of religiosity and racial identity. These profiles explained approximately 8% of the variability in sexual initiation. Additional analysis revealed sociodemographic differences for profile membership based on adolescent ethnicity, gender, and parent nativity. Findings from this dissertation contribute to evidence supporting re-conceptualizing black adolescent religiosity for research and practice. These results also provide insight into how examining intra-group variability among factors associated with black adolescent sociocultural context has implications for designing culturally and developmentally appropriate interventions. Additional research is needed to further clarify how these concepts, in addition to structural factors, contribute to HIV and STD infection among black adolescents.Doctor of Philosoph

AMP!: A Cross-site Analysis of the Effects of a Theater-based Intervention on Adolescent Awareness, Attitudes, and Knowledge about HIV

AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N = 159) and a suburban county in North Carolina (N = 317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46% male, 90% self-identified as heterosexual, 32% reported receiving free or reduced lunch, and 49% White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p = .05), HIV awareness (p = .01), and HIV attitudes (p = .05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p = .001), HIV awareness (p = .001), and HIV attitudes (p = .001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p = .01), HIV awareness (p = .01), and HIV attitudes (p = .05)). Thus, AMP!’s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings

‘I learned to be okay with talking about sex and safety’: assessing the efficacy of a theatre-based HIV prevention approach for adolescents in North Carolina

Adolescents are at increased risk of HIV and sexually transmitted infections (STIs) in the Southern states of the USA, where rates among youth are higher than in the rest of the nation. This paper reports on findings from a pilot study of an HIV prevention intervention that uses interactive theatre to educate young people about sexual health. The intervention was developed in Los Angeles and adapted for testing in the South of the USA, with its legacy of abstinence-based approaches to sexual health education. This study assessed intervention effects among a sample of young people in two public high schools in North Carolina. We used a pre-test, post-test quasi-experimental evaluation design to assess changes in 317 ninth grade participants’ knowledge and attitudes about HIV. At post-test, we found statistically significant increases in participants’ HIV knowledge (t= 60.14; p=.001), as well as changes in attitudes (X2=8.23; p=.042) and awareness (X2=4.94; p=.026). Focus group data corroborated increase in HIV knowledge and reduction in HIV stigma as successful outcomes of intervention participation. The findings make an important contribution to the literature on theatre-based interventions for sexual health education. Furthermore, they highlight the importance of considering socio-cultural and political context in implementing HIV prevention interventions in schools

Using Photovoice to Understand Barriers to and Facilitators of Cardiovascular Health Among African American Adults and Adolescents, North Carolina, 2011–2012

IntroductionCardiovascular disease is the leading cause of death in the United States, and mortality rates are higher among African Americans than among people of other races/ethnicities. We aimed to understand how African American adults and adolescents conceptualize cardiovascular health and perceive related barriers and facilitators.MethodsThis qualitative study was conducted as formative research for a larger study, Heart Healthy Lenoir, which aimed to reduce cardiovascular disease disparities among African Americans in eastern North Carolina, part of the widely-known “stroke belt” that runs through the southeastern United States. Using photovoice, a community-based participatory research method, we conducted eight 90-minute photovoice sessions with 6 adults and 9 adolescents in Lenoir County, North Carolina. Topics for each discussion were selected by participants and reflected themes related to cardiovascular health promotion. All sessions were transcribed and coded using a data-driven, inductive approach.ResultsParticipants conceptualized cardiovascular health to have mental, spiritual, and social health dimensions. Given these broad domains, participants acknowledged many ecological barriers to cardiovascular health; however, they also emphasized the importance of personal responsibility. Facilitators for cardiovascular health included using social health (eg, family/community relationships) and spiritual health dimensions (eg, understanding one’s body and purpose) to improve health behaviors.ConclusionThe perspectives of African American adults and adolescents elicited through this formative research provided a strong foundation for Heart Healthy Lenoir’s ongoing engagement of community members in Lenoir County and development and implementation of its intervention to prevent cardiovascular disease

Where is the Faith? Using a CBPR Approach to Propose Adaptations to an Evidence-Based HIV Prevention Intervention for Adolescents in African American Faith Settings

African American adolescents are at increased risk for HIV/AIDS. Using a community-based participatory research approach, we engaged three black churches in adapting an evidence-based HIV prevention intervention, Focus on Youth (FOY)+ImPACT, for faith settings. To identify potential adaptations to increase FOY's relevance, utility, and efficacy for faith settings, we conducted eight focus groups pre- and post-intervention. Recommendations for maintaining FOY's core elements and enhancing its cultural authenticity include the following: incorporating faith tools, building pastor capacity, strengthening parent-child communication skills, and expanding social support for parents and youth. Engaging faith communities in adapting and implementing evidence-based HIV prevention programs could reduce HIV/AIDS disparities

Implementation of Client-Centered Care Coordination for HIV Prevention with Black Men Who Have Sex with Men: Activities, Personnel Costs, and Outcomes—HPTN 073

Background: Black men who have sex with men (MSM) experience disproportionate rates of HIV infection in the USA, despite being no more likely to engage in sexual risk behaviors than other MSM racial/ethnic groups. HIV pre-exposure prophylaxis (PrEP) has been shown to reduce risk of HIV acquisition; however, rates of PrEP use among Black MSM remain low. Clinical, psychosocial, and structural factors have been shown to impact PrEP use and adherence among Black MSM. Care coordination of HIV prevention services has the potential to improve PrEP use and adherence for Black MSM, as it has been shown to improve HIV-related care outcomes among people living with HIV. Methods: Client-centered care coordination (C4) is a multi-level intervention designed to address clinical, psychosocial, and structural barriers to HIV prevention services for Black MSM within HPTN 073, a PrEP demonstration project among Black MSM in three cities in the USA. The current study examined the implementation process of C4, specifically investigating the activities, cost, time, and outcomes associated with the C4 intervention. Results: On average, participants engaged in five care coordination encounters. The vast majority of care coordination activities were conducted by counselors, averaging 30 min per encounter. The cost of care coordination was relatively low with a mean cost of $8.70 per client encounter. Conclusion: Although client-centered care coordination was initially implemented in well-resourced communities with robust HIV research and service infrastructure, our findings suggest that C4 can be successfully implemented in resource constrained communities

Context and Considerations for the Development of Community-Informed Health Communication Messaging to Support Equitable Uptake of COVID-19 Vaccines Among Communities of Color in Washington, DC.

BACKGROUND: Communities of color have been disproportionately impacted by COVID-19. We explored barriers and facilitators to COVID-19 vaccine uptake among African American, Latinx, and African immigrant communities in Washington, DC. METHODS: A total of 76 individuals participated in qualitative interviews and focus groups, and 208 individuals from communities of color participated in an online crowdsourcing contest. RESULTS: Findings documented a lack of sufficient, accurate information about COVID-19 vaccines and questions about the science. African American and African immigrant participants spoke about the deeply rooted historical underpinnings to their community\u27s vaccine hesitancy, citing the prior and ongoing mistreatment of people of color by the medical community. Latinx and African immigrant participants highlighted how limited accessibility played an important role in the slow uptake of COVID-19 vaccines in their communities. Connectedness and solidarity found were found to be key assets that can be drawn upon through community-driven responses to address social-structural challenges to COVID-19 related vaccine uptake. CONCLUSIONS: The historic and ongoing socio-economic context and realities of communities of color must be understood and respected to inform community-based health communication messaging to support vaccine equity for COVID-19 and other infectious diseases

Social Media & PrEP: A Systematic Review of Social Media Campaigns to Increase PrEP Awareness & Uptake Among Young Black and Latinx MSM and Women.

Pre-exposure prophylaxis (PrEP) has been shown to be highly effective at reducing the risk of HIV. Despite efforts to employ various social marketing strategies to promote PrEP among young people at greater risk for HIV, PrEP awareness and uptake remain low. We conducted a comprehensive review of current literature that presents or evaluates the use of social media and/or specific communication campaigns to increase PrEP awareness among young Black and Latinx men who have sex with men (MSM) and women. Eight articles met the inclusion criteria for the final analysis. The most used platforms included Facebook, Instagram, and custom mobile applications. Social media is a dynamic and promising tool that may be used to increase PrEP awareness, uptake, and adherence among young Black and Latinx MSM and women