Six Pathways to Enduring Results: Lessons from Spend-Down Foundations

Fifty years ago, only 5 percent of the total assets of America's largest 50 foundations were held by spend-downs, compared to 24 percent in 2010. Spend-downs are even more influential when measured as a percent of giving, since they disburse money at a higher annual rate than foundations that aim to last forever. In 2010, 31 percent of giving from the largest foundations came from spend-downs (a figure that reflects the outsized effect of Bill and Melinda Gates and Warren Buffett)

Thematic Analysis of Mainstream Rap Music - Considerations for Culturally Responsive Sexual Consent Education in High School

Background: Much of the research literature on sexual consent and sexual consent education has been focused on college students, providing a significant gap in our understanding of high school students, especially ethnic minority youth, who are at greatest risk for unwanted sexual contact and sexual activity. Furthermore, recent research suggests that music with sexually suggestive and misogynistic themes influence sexual communication and consenting behaviors. An analysis of rap music produced after the year 2000 is necessary to identify themes that may influence sexual communication among youth. Methods: A thematic analysis was conducted to examine the lyrics of mainstream rap music songs. Songs from the Billboard Hot Rap Singles Year-End Charts for the years 2001 through 2011 served as the data corpus for thematic analysis. Results: Each year, an average of 18 songs in the top 25 rap music hits included some level of sexual content. Overall, approximately 74% of the 244 songs made references to sex, sexual expectations and/or relationships. Three major themes emerged from the analysis: (1) It’s Really About Sex or Nothing At All, (2) Substances as the Precursor/Enhancer, and (3) Performance, Parts & Brand. Conclusion: The major themes found here highlight the prevalence of norms that perpetuate non-consensual sex and non-verbal sexual communication in a dominant musical genre. Each theme presented in this study represents rules and expectations related to sexual interactions that could influence an adolescent’s view of sexual communication and consent. Findings here should be further examined to identify how adolescents may perceive them and resonate with their meanings

The relationship between rumination, gender, age, and posttraumatic stress

The purpose of the present study was to assess the relationship between rumination and posttraumatic stress, and to determine the effects of gender and age on that relationship. Responses on brooding and reflective subscales of a rumination measure were compared across adult age groups, and evaluated in relationship to an individual\u27s gender and emotional response to trauma. Women demonstrated higher levels of rumination than men, and younger adults demonstrated higher levels of rumination than older adults. In a college sample, total rumination score was a positive indicator of whether an individual was emotionally bothered by a traumatic experience. In a community sample, age was a negative indicator of whether an individual was emotionally bothered by trauma

Sexual health education for behavior change: How much is enough?

Purpose: Successful implementation of sexual health curricula in school settings is often compromised by competing academic priorities. This study explores the association between exposure to sexual health lessons (time-on-task in hours and lesson content topics) and delayed sexual initiation of middle school students at long term follow-up. Methods: Post hoc data analysis was conducted from a RCT (n=15 middle schools) in the south-central U.S. in which grade 7 students demonstrated delayed sexual initiation (adjusted odds ratio [AOR]: 1.54, 95% CI: 1.20 to 1.99) by grade 9 follow-up after using It’s Your Game (IYG), a 24 lesson sexual health curriculum. Logistic regression was conducted on a sub-sample of 314 grade 7 and 8 students who received IYG and who were sexually inexperienced at baseline, adjusting for covariates of age, gender, and race/ethnicity to address the impact of lesson exposure variables (time-on-task in hours and type of sexual health content) on initiation of any sex by grade 9. Results: The greatest impact of exposure on delayed sexual initiation was a duration of 13 or more lesson hours (OR = 8.40; p\u3c0.05) and exposure to lesson content on HIV/STI and pregnancy consequences (OR = 4.93; p\u3c0.05). Conclusions: Results support previous exposure studies and provide guidance on how effective sexual health curricula can meet the challenges of delivery in a reduced and competitive academic environment

Reducing Sexual Risk among Racial/ethnic-minority Ninth Grade Students: Using Intervention Mapping to Modify an Evidenced-based Curriculum

Background: Racial/ethnic-minority 9th graders are at increased risk for teen pregnancy, HIV, and STIs compared to their White peers. Yet, few effective sexual health education programs exist for this population. Purpose: To apply IM Adapt—a systematic theory- and evidence-based approach to program adaptation—to modify an effective middle school sexual health education curriculum, It’s Your Game…Keep It Real! (IYG), for racial/ethnic-minority 9th graders. Methods: Following the six steps of IM Adapt, we conducted a needs assessment to describe the health problems and risk behaviors of the new population; reviewed existing evidence-based programs; assessed the fit of IYG for the new population regarding behavioral outcomes, determinants, change methods, delivery, and implementation; modified materials and activities; planned for implementation and evaluation. Results: Needs assessment findings indicated that IYG targeted relevant health and risk behaviors for racial/ethnic-minority 9th graders but required additional focus on contraceptive use, dating violence prevention, active consent, and access to healthcare services. Behavioral outcomes and matrices of change objectives for IYG were modified accordingly. Theoretical methods and practical applications were identified to address these behavioral outcomes, and new activities developed. Youth provided input on activity modifications. School personnel guided modifications to IYG’s scope and sequence, and delivery. The adapted program, Your Game, Your Life, comprised fifteen 30-minute lessons targeting determinants of sexual behavior and healthy dating relationships. Pilot-test data from 9th graders in two urban high schools indicate promising results. Conclusion: IM Adapt provides a systematic theory- and evidence-based approach for adapting existing evidence-based sexual health education curricula for a new population whilst retaining essential elements that made the original program effective. Youth and school personnel input ensured that the adapted program was age-appropriate, culturally sensitive, and responsive to the needs of the new population. IM Adapt contributes to the limited literature on systematic approaches to program adaptation

Community clinic-based lifestyle change for prevention of metabolic syndrome: Rationale, design and methods of the ‘Vida Sana/healthy life’ program

Purpose and Objectives: The risk of diseases associated with Metabolic Syndrome (MetS) is higher for Hispanics living in the northeastern United States than for other racial and ethnic groups. Higher risk of diabetes, high blood lipids, obesity and limited access to continuity of care are all factors that also contribute to disproportionately poorer chronic disease outcomes for Hispanics. Intervention approach: This article describes the planning and implementation of, and evaluation plans for the Vida Sana Program (VSP), a community-based group intervention created to address the identified MetS risks by encouraging healthier diet and physical activity behaviors among a low-income, largely Spanish speaking, and literacy limited uninsured population. Developed in response to recent calls for culturally-tailored interventions, VSP is conducted by trained bicultural/bilingual Navegantes, who deliver a culturally sensitive, fun and engaging eight-week, in-person educational series through group meetings. The intervention also includes a 40-page colorful, picture and graphic enhanced booklet to be used in the group setting and at home. The intervention focused on screening for MetS-associated disease risk factors, understanding chronic disease management, encouraging medication adherence, increasing physical activity, and healthful dietary changes such as limiting alcohol, sodium, unhealthy fats and excess carbohydrate intake, while emphasizing portion control, whole grains and healthy fats. Conclusions: This creative, community-based approach fills an important gap in the community and in the public health literature, is well liked by health literacy limited patients, and will provide an important model of successfully engaging the Hispanic community on these important health issues

Prevalence and Patterns of Sexting among Ethnic Minority Urban High School Students

Although sexting among U.S. youth has received much popular media attention, there are only limited data on its prevalence among ethnic minority youth. This study, therefore, specifically examined the prevalence and patterns of sexting (sending and/or receiving a nude or semi-nude picture/video or a sexual text-only message) among a sample of black and Hispanic youth. Data from 1,034 tenth graders from a large, urban school district in southeast Texas were used to calculate the prevalence of sexting by gender-race/ethnicity. Overlap among sexting behaviors was also examined. Electronic surveys were administered via an audio-computer-assisted self-interview on laptop computers. Prevalence estimates were obtained, and chi-square analyses were conducted to compare the distribution of sexting behaviors by gender-race/ethnicity subgroups. More than 20% of students reported sending either a nude or semi-nude picture/video or a sexual text-only message (jointly referred to as a sext ), and more than 30% reported receiving a sext. Sexts were also frequently shared with unintended recipients. Black males and females reported similar prevalence estimates for sexting behaviors. However, they were more likely than Hispanic males to participate in some sexting behaviors. Hispanic females reported the lowest estimates for sexting behaviors for all gender-race/ethnicity subgroups. Many youth who sent or received a nude or semi-nude picture/video were also likely to have sent or received sexual text-only messages. The results of this study indicate that sexting is prevalent among ethnic minority youth. However, more research is needed to understand the specific context and circumstances around which sexting occurs in this population

Usability and Psychosocial Impact of Decision Support to Increase Sexual Health Education in American Indian and Alaska Native Communities

Despite sexual and reproductive health disparities, few evidence-based sexual health education programs exist for American Indian/Alaska Native (AI/AN) youth, with even fewer tools available to assist AI/AN communities in adopting, implementing, and maintaining such programs. iCHAMPSS (Choosing And Maintaining effective Programs for Sex education in Schools) is a theory- and web-based decision-support-system designed to address dissemination barriers and increase the reach and fidelity of evidence-based programs (EBPs), specifically sexual health education programs. To investigate the potential of iCHAMPSS in AI/AN communities, we pilot-tested iCHAMPSS with adult stakeholders (N = 36) from agencies across the country that serve AI/AN communities. Stakeholders were recruited to review selected iCHAMPSS tools over two weeks in spring 2016. Pre- and post-surveys were administered to assess usability constructs, short-term psychosocial outcomes, and perceived feasibility. Data were analyzed using descriptive and non-parametric statistics. iCHAMPSS was perceived as acceptable, easy to use, credible, appealing, more helpful than current resources, and impactful of EBP adoption, implementation, and maintenance. Conversely, using iCHAMPSS significantly increased participants’ perceived barriers to adopting an EBP (p = 0.01). Overall, AI/AN stakeholders responded positively to iCHAMPSS, indicating the potential for adaptation to support the dissemination and implementation of evidence-based sexual health education in AI/AN communities

Latino Teen Pregnancy in Texas: Prevalence, Prevention, and Policy

Texas is home to over one million Latino teens who are at risk for negative reproductive health outcomes, such as teen pregnancy and STIs. Teen pregnancy disproportionately impacts the health of Latino teens in Texas and places them at risk of continued high rates of poverty, school dropout, and unemployment unless Texas makes a concerted effort to reduce its teen pregnancy rate. The birth rate among Latina girls is astonishing: 98 per 1000 Latinas (aged 15-19) are giving birth. This translates to over 32,000 births each year among Latina teens, costing almost $98 million in direct medical expenditures and well over$638 million if other costs are included. Most teens become sexually experienced while they are of school age, which translates to an estimated 414,583 sexually experienced Latino students attending Texas public schools. Of these Latino youth, 237,466 report being currently sexually active, and 89,000 report having had four or more sexual partners in their lifetime. While causes of teen pregnancy are complex, the solutions to teen pregnancy are known. Texas needs an effective, comprehensive approach to address the sexual health needs of Texas Latino youth that includes: statewide implementation and monitoring of evidence-based sex education for middle school and high school students, access to reproductive health services for students who are already sexually experienced, and widespread training on adolescent sexual health for teachers, service providers, and parents. By tackling teen pregnancy, we can positively impact the future and well-being of not only Latinos, but of all Texans, and subsequently can contribute to the social and economic success of Texas

Overdose prevention for injection drug users: Lessons learned from naloxone training and distribution programs in New York City

BACKGROUND: Fatal heroin overdose is a significant cause of mortality for injection drug users (IDUs). Many of these deaths are preventable because opiate overdoses can be quickly and safely reversed through the injection of Naloxone [brand name Narcan], a prescription drug used to revive persons who have overdosed on heroin or other opioids. Currently, in several cities in the United States, drug users are being trained in naloxone administration and given naloxone for immediate and successful reversals of opiate overdoses. There has been very little formal description of the challenges faced in the development and implementation of large-scale IDU naloxone administration training and distribution programs and the lessons learned during this process. METHODS: During a one year period, over 1,000 participants were trained in SKOOP (Skills and Knowledge on Opiate Prevention) and received a prescription for naloxone by a medical doctor on site at a syringe exchange program (SEP) in New York City. Participants in SKOOP were over the age of 18, current participants of SEPs, and current or former drug users. We present details about program design and lessons learned during the development and implementation of SKOOP. Lessons learned described in the manuscript are collectively articulated by the evaluators and implementers of the project. RESULTS: There were six primary challenges and lessons learned in developing, implementing, and evaluating SKOOP. These include a) political climate surrounding naloxone distribution; b) extant prescription drug laws; c) initial low levels of recruitment into the program; d) development of participant appropriate training methodology; e) challenges in the design of a suitable formal evaluation; and f) evolution of program response to naloxone. CONCLUSION: Other naloxone distribution programs may anticipate similar challenges to SKOOP and we identify mechanisms to address them. Strategies include being flexible in program planning and implementation, developing evaluation instruments for feasibility and simplicity, and responding to and incorporating feedback from participants