Abstract: We examined the direct contribution of parent and peer risk and promotive factors on youth condom use trajectories, in addition to the indirect influence of these factors via youth's substance use over four years in a sample of urban, African American youth (N=679; 51% female; M=14.86 years; SD=0.65). Growth curve modeling was used to estimate changes in substance use and sexual risk across adolescence and test their association with parent and peer factors. Parent and peer risk factors were strongly associated with increasing substance use as youth aged. Substance use and condom use were interrelated. Parent and peer risk factors were indirectly associated with youth condom use; parent and peer promotive factors were directly associated with condom use, after accounting for substance use. Findings suggest the value of considering multiple influences on youth risk behavior.
Abstract: Previous research has linked higher levels of hopelessness about one's future to violent behavior during adolescence; however, little is known about this relationship over time for adolescents. Using growth curve modeling, we tested the association between future orientation and violent behavior across the high school years of adolescence in a sample of African American youth (n = 681). Variation based on demographic characteristics (i.e., sex, SES, previous violence) was explored. At baseline, differences in violent behavior varied by demographic characteristics. Overall, violent behavior decreased with age. Higher levels of future orientation were associated with greater decreases in violent behavior over time. Demographic characteristics were not associated with change in violent behavior overtime. Our findings suggest that future orientation can act as a promotive factor for at risk African American youth. Interventions that help support the development of future goals and aspirations could play a vital role in violence prevention efforts.
Abstract: Complex and dynamic societal factors continue to challenge the capacity of the social and behavioral sciences in preventive medicine and public health to overcome the most seemingly intractable health problems. This paper proposes a fundamental shift from a research approach that presumes to identify (from highly controlled trials) universally applicable interventions expected to be implemented "with fidelity" by practitioners, to an applied social and behavioral science approach similar to that of engineering. Such a shift would build on and complement the recent recommendations of the NIH Office of Behavioral and Social Science Research and require reformulation of the research-practice dichotomy. It would also require disciplines now engaged in preventive medicine and public health practice to develop a better understanding of systems thinking and the science of application that is sensitive to the complexity, interactivity, and unique elements of community and practice settings. Also needed is a modification of health-related education to ensure that those entering the disciplines develop instincts and capacities as applied scientists.
Abstract: Neighborhood context may influence youth sexual decision-making. We examined the association between neighborhood characteristics and condom use in a sample of African American youth followed across the high school years (N = 681; 51% female). Using a three-level hierarchical linear model, we modeled inconsistent condom use over time and then examined its association with youth's sexual risk trajectories (sexual intercourse frequency, number of partners, and pregnancy concerns) and individual-level characteristics (sex, age, SES, and household composition), and neighborhood disadvantage. While sexual intercourse frequency was associated with inconsistent condom use over time, youth reporting greater pregnancy concerns and number of partners reported more consistent condom use over time. Females were more likely to report more inconsistent condom use over time. Neighborhood disadvantage characteristics were associated with less baseline condom use, but did not have an association with changes in youth's condom use over the high school years. We discuss the implications for community-based HIV/AIDS prevention for youth.
Abstract: This article describes the development and evaluation of an after-school curriculum designed to prepare adolescents to prevent violence through community change. This curriculum, part of the Youth Empowerment Solutions for Peaceful Communities (YES) program, is guided by empowerment and ecological theories within a positive youth development context. YES is designed to enhance the capacity of adolescents and adults to work together to plan and implement community change projects. The youth curriculum is organized around six themed units: (a) Youth as Leaders, (b) Learning about Our Community, (c) Improving Our Community, (d) Building Intergenerational Partnerships, (e) Planning for Change, and (f) Action and Reflection. The curriculum was developed through an iterative process. Initially, program staff members documented their activities with youth. These outlines were formalized as curriculum sessions. Each session was reviewed by the program and research staff and revised based on underlying theory and practical application. The curriculum process evaluation includes staff and youth feedback. This theoretically based, field-tested curriculum is designed to be easily adapted and implemented in a diverse range of communities.
Abstract: Adolescents with a history of peer assault are known to report high rates of other risky behaviors. The characteristics of adolescents seeking care in the ED for acute assault-related injury are less well established. This knowledge deficit is particularly noticeable for adolescent female victims of peer assault. This study's objectives were: 1) to characterize the demographics and risk behaviors of youths presenting to the emergency department (ED) with acute assault-related injury and 2) to compare assaulted youths' demographic characteristics, past experiences with violence, and other risk behaviors by sex.
Abstract: The purpose of this study was to examine differences in interpersonal violence among individuals who reported a head injury compared with those who did not report a head injury.
Abstract: Risk factors for adolescent alcohol use are typically conceptualized as individual and interpersonal level factors; however, these factors do not fully explain adolescent drinking behavior. We used a socioecological model to examine the contribution of neighborhood factors in a risk and promotive model of adolescent alcohol use among urban high school youth (N = 711; 52% female; 82% African American; M = 18 years old).
Abstract: Acute stroke treatments are underutilized primarily because of delayed hospital arrival. Using a community-based participatory research approach, we explored stroke self-efficacy, knowledge, and perceptions of stroke among a predominately African American population in Flint, Michigan.
Abstract: Psychological distress has been inconsistently associated with sexual risk behavior in youth, suggesting additional factors, such as substance use, may explain this relationship. The mediating or moderating role of substance use on the relationship between psychological distress and sexual risk behaviors was prospectively examined over the four high school years in a sample of urban youth (N = 850; 80% African American; 50% female). Growth curve modeling was used to estimate changes in sexual risk across adolescence and to test its association to psychological distress symptoms and frequency of substance use. Substance use was associated with psychological distress. Greater psychological distress was associated with increased sexual intercourse frequency, decreased condom use, and increased number of partners. Substance use fully mediated the relationship between psychological distress and intercourse frequency and condom use, and partially mediated the relationship between psychological distress and number of partners. We found no differences in mediation by sex or race/ethnicity and no evidence to support moderation of psychological distress and substance use on sexual risk. Findings suggest that psychological distress is associated with sexual risk because youth with greater psychological distress are also more likely to use substances. Practical implications for adolescent HIV/STI prevention are discussed.
Abstract: One of the biggest challenges facing racial health disparities research is identifying how and where to implement effective, sustainable interventions. Community-based organizations (CBOs) and community-academic partnerships are frequently utilized as vehicles to conduct community health promotion interventions without attending to the viability and sustainability of CBOs or capacity inequities among partners. Utilizing organizational empowerment theory, this paper describes an intervention designed to increase the capacity of CBOs and community-academic partnerships to implement strategies to improve community health. The Capacity Building project illustrates how capacity building interventions can help to identify community health needs, promote community empowerment, and reduce health disparities.
Abstract: Community-Based Participatory Research (CBPR) has the twin goals of generating data and shaping policy decisions, yet examples that combine these goals are scarce in the literature. We describe how a community-based survey was created and used to help develop a county health plan. The Genesee Health Plan (GHP), a community-initiated non-profit organization, provides primary care, prescription drugs, and specialty care to uninsured, low-income adults through a network of independent physicians, clinics, and hospital systems. As part of an advocacy effort, GHP supporters used results from the Speak to Your Health! Community Survey to gain financial and political support for GHP. Our study, which used CBPR principles, was created by the community, local health department, and university partners. As a result, Genesee County became one of the first counties in the United States to make basic health care available to nearly all of its uninsured, low-income adults.
Abstract: Partner age is associated with youth's sex risk behaviors and sexually transmitted infections. At present, however, it is not known whether the co-occurrence of other risk behaviors is associated with having older sex partners during adolescence and young adulthood. Using growth curve modeling, this study first describes the shape of the age difference between participants and their sex partners across adolescence and young adulthood in a sample of African American youth. Second, whether this model varied systematically by sex, mother's education, and high school dropout was tested. Third, whether age differences were associated with youth's self-acceptance, alcohol use, and employment trajectories over these two developmental periods was assessed. Finally, whether these associations had non-proportional effects over both periods was tested. This study modeled sex partners' age differences nonlinearly, with females being more likely to date older partners at baseline and over time. High school dropouts also reported older partners at baseline. Self-acceptance and the number of hours worked were associated with sex partners' age differences over time, with the effect decreasing over young adulthood years. Alcohol use frequency was also associated with having older partners over time. This study discusses the findings from a health perspective on youth's sexual development.
Abstract: Research suggests that increasing egalitarian relations between young people and adults is optimal for healthy development; however, the empirical assessment of shared control in youth-adult partnerships is emerging, and the field still requires careful observation, identification, categorization and labeling. Thus, our objective is to offer a conceptual typology that identifies degrees of youth-adult participation while considering the development potential within each type. We use an empowerment framework, rooted in evidence-based findings, to identify five types of youth participation: (1) Vessel, (2) Symbolic, (3) Pluralistic, (4) Independent and (5) Autonomous. The typology is constructed as a heuristic device to provide researchers, practitioners and policy-makers with a common language for articulating degrees of youth participation for optimal child and adolescent health promotion.
Abstract: Disparities in HIV testing rates exist among socially disadvantaged communities. Using a longitudinal sample of urban African American youth followed from adolescence into young adulthood (n = 396; 51% female), we examined whether HIV testing was associated with individual (e.g., gender, socioeconomic status [SES], education, and history of sexually transmitted infections [STIs]) and area (i.e., neighborhood disadvantage and HIV prevalence) characteristics. In our multilevel regressions, we found females were more likely to have tested for HIV, with the magnitude of this association increasing if they lived in areas of greater disadvantage yet decreasing in higher HIV prevalence areas. Those without a high school degree, with a lower SES, or with a history of STIs in adolescence were less likely to test if they lived in greater disadvantage and HIV prevalence areas. We discuss the implications of these findings from an ecological perspective and propose recommendations for increasing testing among African American youth.
Abstract: This study focused on natural mentoring relationships between nonparental adults and African American adolescent mothers. Data were collected from 93 adolescent mothers over five time points, starting in the adolescent mothers' senior year of high school and ending five years post-high school. We found that having a natural mentor was related to fewer depressive symptoms and fewer anxiety symptoms over time. Natural mentor presence also modified the relationship between stress and mental health problems over time. Facilitating these natural mentoring relationships between adolescent mothers and nonparental adults may be a useful strategy for promoting healthy development within this population.
Abstract: Emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury.
Abstract: Violence is a leading cause of death for adolescents in inner-city settings. This article describes violent behaviors in relation to other risk behaviors (e.g., substance use) among adolescents screened in an urban emergency department (ED).
Abstract: The beneficial or deleterious effects of employment on youth and well-being have been highly contested. This study explores whether work influences youths' sexual risk correlates in a sample of African Americans (N = 562; 55% females; M = 14.5 years, SD = 0.6 years) followed longitudinally from adolescence to early adulthood. The study used growth curve modeling to test the association between number of hours worked and condom use, sex partners' age differences, and number of partners over time. Working a greater number of hours was associated with less condom use, with the effect varying by youths' grade point average. Working a greater number of hours was associated with older sex partners among female youth. No association was found between work and number of partners. The findings suggest that working during adolescence and early adulthood increased participants' sexual activity, thus lending some support for the work consequences perspective. The implications for future research and youth development programs are discussed.
Abstract: The objective was to describe rates of dating aggression and related high-risk behavior among teens presenting to the emergency department (ED) seeking gynecologic care, compared to those seeking care for other reasons.
Abstract: Alcohol use and violent behaviors are well documented among adolescents and have enormous effects on morbidity and mortality. The authors hypothesized that universal computer screening of teens in an inner-city emergency department (ED), followed by a brief intervention (BI), would be 1) feasible (as measured by participation and completion of BI during the ED visit) and well received by teens (as measured by posttest process measures of intervention acceptability) and 2) effective at changing known precursors to behavior change such as attitudes, self-efficacy, and readiness to change alcohol use and violence.
Abstract: This study illustrates the utility of process evaluation methods for improving a new violence prevention program, Youth Empowerment Solutions for Peaceful Communities (YES). The YES program empowered young adolescents to plan and complete community improvement projects with neighborhood adult advocates. The process evaluation methods included questionnaires and focus groups with students and interviews with neighborhood advocates. Process evaluation results guided program improvements for the second year. The process evaluation results after the second program year suggested that the program improvements were associated with higher student ratings of program staff and neighborhood advocates. The students and neighborhood advocates reported increased positive experiences after the second program year, but continued to note the challenges of working inter-generationally on community improvement projects.
Abstract: We examined developmental trajectories of alcohol use and violent behavior among urban African American youths and the longitudinal relationship between these behaviors from adolescence to emerging adulthood.
Abstract: We investigated whether role models (individuals adolescents look up to) contributed to the resilience of adolescents who were exposed to negative nonparental adult influences. Our sample included 659 African American, ninth-grade adolescents. We found that adolescents' exposure to negative adult behavior was associated with increased externalizing, internalizing, and substance using behaviors, as well as more negative school attitudes and behavior. We found that role models had protective effects on externalizing and internalizing behaviors and compensatory effects on school outcomes. Collectively, our findings indicate that role models can contribute to the resilience of African American adolescents who are exposed to negative nonparental adult behavior.
Abstract: Community mobilization efforts to address youth violence are often disconnected, uncoordinated, and lacking adequate resources. An organizational empowerment theory for community partnerships provides a useful framework for organizing and evaluating a coalition's community mobilization efforts and benefits for individual organizations, partnerships, and communities. Based on a qualitative analysis of steering committee interviews and other primary data, the results of a case study suggest that the intraorganizational infrastructure; interorganizational membership practices and networking; and extraorganizational research, training, and organizing activities facilitate the community mobilization efforts of the Youth Violence Prevention Center in Flint, Michigan. The organizational empowerment framework, and its focus on organizational structures and processes, illustrates the importance of recognizing and incorporating the organizational systems and structures that provide the foundation on which a community mobilization effort may build. This framework also highlights how organizational structures and processes are central components of multilevel strategies for organizing and mobilizing community efforts to address youth violence.
Abstract: Adolescence and young adulthood (ages 18-25 years) are periods of development and change, which include experimentation with and adoption of new roles and behaviors. We investigated longitudinal trajectories of sexual risk behaviors across these time periods and how these trajectories may be different for varying demographic groups.
Abstract: We examined the association between neighborhood characteristics and cigarette use among adolescents and explored the protective effects of participation in prosocial activities to better understand strengths in adolescents' lives and help identify protective factors for the prevention of adolescent smoking.
Abstract: Resiliency theory provides a conceptual framework for studying why some youth exposed to risk factors do not develop the negative behaviors they predict. The purpose of this study was to test compensatory and protective models of resiliency in a longitudinal sample of urban adolescents (80% African American). The data were from Years 1 (9th grade) and 4 (12th grade). The study examined effects of cumulative risk and promotive factors on adolescent polydrug use including alcohol, tobacco and marijuana. Cumulative measures of risk/promotive factors represented individual characteristics, peer influence, and parental/familial influences. After controlling for demographics, results of multiple regression of polydrug use support the compensatory model of resiliency both cross-sectionally and longitudinally. Promotive factors were also found to have compensatory effects on change in adolescent polydrug use. The protective model of resiliency evidenced cross-sectionally was not supported in longitudinal analysis. The findings support resiliency theory and the use of cumulative risk/promotive measures in resiliency research. Implications focused on utilizing multiple assets and resources in prevention programming are discussed.
Abstract: The relationship between depressive symptoms and cigarette use was examined in a sample of 623 African Americans during adolescence and transition to adulthood by using hierarchical linear modeling. Participants in the study were interviewed across 6 occasions over 8 years. Results indicate that depressive symptoms tend to decrease over time, whereas cigarette use tends to increase for both female and male adolescents. The results also suggest that depressive symptoms predict later cigarette use. Male adolescents who reported more depressive symptoms were more likely than female adolescents to use cigarettes as a way to cope with their mood. These results suggest that depressive symptoms may be important to consider when developing smoking cessation interventions for African American youth.
Abstract: Adolescent resilience research differs from risk research by focusing on the assets and resources that enable some adolescents to overcome the negative effects of risk exposure. We discuss three models of resilience-the compensatory, protective, and challenge models-and describe how resilience differs from related concepts. We describe issues and limitations related to resilience and provide an overview of recent resilience research related to adolescent substance use, violent behavior, and sexual risk behavior. We then discuss implications that resilience research has for intervention and describe some resilience-based interventions.
Abstract: This paper provides a description of and rationale for components of a theoretically based conceptual model that guided the development and implementation of the Fathers and Sons Intervention Program. Using a community-based participatory research process, this intervention was designed to prevent risky health behaviors through strengthening father-son relationships among non-resident African-American fathers and their pre-adolescent sons. The implications of the conceptual model for future interventions with African-American fathers and sons are discussed.
Abstract: This study examined the influences of racial discrimination and different racial identity attitudes on engaging in violent behavior among 325 African American young adults. The contributions of racial discrimination and racial identity attitudes in explaining violent behavior during the transition into young adulthood while controlling for the influences of prior risk behaviors at ninth grade were examined separately for males and females. In addition, the buffering effects of racial identity attitudes on the relationship between racial discrimination and violent behavior were tested. Results indicated that experience with racial discrimination was a strong predictor of violent behavior, regardless of gender. The centrality of race for males and the meaning others attribute to being Black for both males and females were moderators of the influence of racial discrimination on violent behavior.
Abstract: The purpose of this study was to examine longitudinally the relationship between depressive symptoms and alcohol use in a sample of black youth.
Abstract: This study examines how religious activity is associated with risk behaviors, concurrently and developmentally among urban African American adolescents. Seven hundred and five African American youths were interviewed annually during high school. Retention rates for the study exceeded 90%. Frequency of religious activity, sexual intercourse, and alcohol, cigarette, and marijuana use were assessed at each wave. Growth curve analyses found negative concurrent associations between religious activity and each of the four risk behaviors. The developmental effects of religious activity varied by gender. Higher levels of religious activity in 9th grade predicted smaller increases in marijuana use among males and cigarette use among females. In addition, larger decreases in religious activity during high school were associated with greater increases in alcohol use among males and sexual intercourse among females. During high school, religious activity limits the development of certain types of risk behavior among African American youth, even after controlling for reciprocal effects.
Abstract: To examine the trajectories of depressive symptoms among African-American youth and the psychosocial factors associated with these trajectories.
Abstract: This study examined racial identity and parental support as predictors of alcohol use in a sample of 488 African American adolescents. Two dimensions of racial identity were investigated: (1) racial centrality (i.e., the significance that one places on race in defining oneself) and (2) private regard (i.e., the extent to which one feels positively about Black people). In addition, perceived support from mothers and fathers was examined. Multivariate results showed that private regard and father support were associated with less self-reported alcohol use after partialling out the effects of age and gender. An interaction between the two racial identity dimensions was also found such that private regard was associated with less alcohol use for adolescents who reported that race was a more central part of their identity.
Abstract: In this study, the relationships between racial identity and academic outcomes for African American adolescents were explored. In examining race beliefs, the study differentiated among (a) importance of race (centrality), (b) group affect (private regard), and (c) perceptions of societal beliefs (public regard) among 606 African American 17-year-old adolescents. Using cluster analysis, profiles of racial identity variables were created, and these profile groups were related to educational beliefs, performance, and later attainment (high school completion and college attendance). Results indicated cluster differences across study outcomes. Also, the relationships between academic attitudes and academic attainment differed across groups. Finally, the paper includes a discussion on the need to consider variation in how minority youth think about group membership in better understanding their academic development.
Abstract: This study examines the direct and indirect relationships among racial identity, racial discrimination, perceived stress, and psychological distress in a sample of 555 African American young adults. A prospective study design was used to assess the influence of two dimensions of racial identity attitudes (i.e., centrality and public regard) on other study variables to investigate the relationship between racial identity attitudes and psychological distress. The results show some evidence of a direct relationship between racial centrality and psychological distress, as well as evidence of indirect relationships for both centrality and public regard through the impact of racial discrimination and perceived stress. In addition, racial centrality was both a risk factor for experiencing discrimination and a protective factor in buffering the negative impact of discrimination on psychological distress. Results are discussed within the context of identifying multiple pathways to psychological well-being for African American young adults within the context of racial discrimination.
Abstract: Cortisol levels have consistently been related to socioeconomic status (SES). Possible moderators for this relationship are coping styles that are known to moderate relationships between cardiovascular factors and SES. The authors examined whether coping style moderated a relationship between resting cortisol levels and various measures of SES in a sample of urban, African American young adults. Those scoring low on coping style had high cortisol levels if they were currently students or unemployed. This effect, however, differed for men and women. The authors suggest that coping style may play an adaptive role regarding salivary cortisol measures in young adults when they are students or unemployed. Active coping may help protect against stress among young African American adults.
Abstract: Natural mentors may play an important role in the lives of adolescents. We interviewed 770 adolescents from a large Midwestern city. Fifty-two percent reported having a natural mentor. Those with natural mentors were less likely to smoke marijuana or be involved in nonviolent delinquency, and had more positive attitudes toward school. Natural mentors had no apparent effect on anxiety or depression. Using the resiliency theory framework, natural mentors were found to have compensatory but not protective effects on problem behaviors, and both compensatory and protective effects on school attitudes. Direct and indirect (mediated) effects of natural mentors are explored for problem behaviors and school attitudes. The potential importance of natural mentors is supported, and implications for future research are considered.
Abstract: This study investigated the role of racial identity and maternal support in reducing psychological distress among African American adolescents. Both direct and indirect influences of multiple dimensions of racial identity (i.e., centrality, private regard) and maternal support on perceived stress, depressive symptoms, and anxiety were examined among 521 African American twelfth graders. Findings indicated that maternal support was positively related to both centrality and private regard. Results provided little support for a direct association between racial identity or maternal support and depressive symptoms and anxiety within a multivariate context. Rather, the influences of racial identity attitudes and maternal support on these mental health outcomes were mediated by perceived stress. Further, the two racial identity attitudes were associated with perceived stress in different ways. Study findings suggest that the significance and meaning that African American adolescents attribute to being Black may be critical to their psychological well-being, and that maternal support and perceived stress are important considerations.
Abstract: This is a study of psychosocial outcomes of adolescents born to teenage mothers. Adolescents'problem behaviors, psychological well-being, social support, school variables, and sexual behaviors are compared across three groups- those born to mothers 17 or younger, mothers 18-19 years old, and mothers 20 or older. Analyses from two samples of African American adolescents from Maryland (n = 205) and Michigan (n = 570) are reported. The results from both samples indicate that mother's age at birth is unrelated to adolescents' psychosocial outcomes. These two studies add to the limited number of analyses that examine adolescent outcomes for children of teen mothers. The results suggest that efforts to understand social structural determinants of healthy and problematic adolescent development may be more informative than examining the effects of mother's age. They also suggest that teen pregnancy prevention programs may be more effective if they are part of a larger prevention strategy that incorporates social structural change efforts and not only a focus on individual level change.
Abstract: Community-based research has emerged as a vital strategy for developing effective, culturally relevant health interventions. This article describes the strengths and challenges of building a collaborative research partnership based on equality between academic researchers, public health practitioners, and representatives from community-based organizations. The model of collaboration adopted for the Fathers and Sons Project is described and examples of model applications are discussed. Lessons learned in the form of strengths/benefits and potential pitfalls in developing a community-based intervention designed to enhance the health behaviors of African American nonresidential fathers and their sons are provided.
Abstract: Alcohol and other drug (AOD) use during sexual encounters, sexual partner's age, perceived HIV risk and perceived condom effectiveness were studied among 388 sexually active African American youth. Cluster analysis of condom use, number of partners, and frequency of sexual intercourse identified four groups: low risk, monogamy strategy, condom strategy, and high risk. Low-risk youth used condoms consistently and had few partners. High-risk youth used condoms inconsistently with many partners. Monogamy strategy youth used condoms inconsistently but had few partners. Condom strategy youth used condoms consistently with a moderate number of partners. The high-risk group included more males and the monogamy group included more females. High-risk males reported more AOD use during sexual activity than all females, and low-risk or condom strategy males. Females had older partners, rated condoms as less effective and perceived lower HIV/AIDS risk than males. Results suggest differential HIV risk mechanisms by gender. Implications for gender-specific HIV prevention are discussed.
Abstract: Resilience refers to the notion that some people succeed in the face of adversity. In a risk-protective model of resilience, a protective factor interacts with a risk factor to mitigate the occurrence of a negative outcome. This study tested longitudinally the protective effects of sociopolitical control on the link between helplessness and mental health. The study included 172 urban, male, African American adolescents, who were interviewed twice, 6 months apart. Sociopolitical control was defined as the beliefs about one's capabilities and efficacy in social and political systems. Two mental health outcomes were examined--psychological symptoms and self-esteem. Regression analysis to predict psychological symptoms and self-esteem over time were conducted. High levels of sociopolitical control were found to limit the negative consequences of helplessness on mental health. The results suggest that sociopolitical control may help to protect youths from the negative consequences of feelings of helplessness. Implications for prevention strategies are discussed.
Abstract: Sexual activity among high-school-aged youths has steadily increased since the 1970s, emerging as a significant public health concern. Yet, patterns of youth sexual risk behavior are shaped by social class, race, and gender. Based on sociological theories of financial deprivation and collective socialization, we develop and test a model of the relationships among neighborhood poverty; family structure and social class position; parental involvement; prosocial activities; race; and gender as they predict youth sexual risk behavior. We employ structural equation modeling to test this model on a cross-sectional sample of 370 sexually active high-school students from a midwestern city; 57 percent (n = 209) are males and 86 percent are African American. We find that family structure indirectly predicts sexual risk behavior through neighborhood poverty, parental involvement, and prosocial activities. In addition, family class position indirectly predicts sexual risk behavior through neighborhood poverty and prosocial activities. We address implications for theory and health promotion.
Abstract: Adolescence is a period of sexual experimentation. We examined psychosocial predictors of high-risk sexual behavior and condom use. The sample included 824 ninth-graders, most of whom are African American. We conducted separate analyses for whites and African Americans. Predictors included alcohol and substance use, delinquency, prosocial behaviors, and family and peer influences. We found that problem behaviors predicted high-risk sexual behavior, but the effects were stronger for white youth. We also found that friends' behaviors were more predictive than family influences, except for family conflict. In general, the models explained more variance for white youths than for African-American youths. The results suggest that problem behavior theory and social interactions theory may be most relevant for white youth and that other models may be necessary to explain high-risk sexual behavior among African-American youths.
Abstract: In this intervention, participants design and implement an HIV/AIDS prevention project for Mexican homosexual men. The intervention is consistent with, and contributes to, empowerment theory because it enhances collective action, provides opportunities to develop knowledge and skills, creates needed resources, and includes shared control with professional and among participants. The intervention described provides an illustration of an empowering process and distinguishes itself from empowerment outcomes. An evaluation of the project is also described, but the outcomes were HIV/AIDS-related behaviors rather than psychological empowerment of the participants. The results suggest that the participants' HIV/AIDS knowledge and preventive behavior improved when compared to individuals who did not participate in the intervention. In addition, the intervention generated community change initiated by participants. Implications for designing interventions using an empowerment approach are discussed.
Abstract: The purpose of this study was to identify the factors that contributed to intervention effectiveness in acquired immunodeficiency syndrome (AIDS) prevention projects targeting youth.
Abstract: In 1988, the Robert Wood Johnson Foundation awarded grants to 54 AIDS prevention and service projects. This article presents the results from a survey of the 37 projects that contained a substantial prevention effort and embellishes these findings with qualitative data from in-depth site visits to 12 projects. Survey respondents reported conducting a mean of 19 different intervention activities. Small-group discussion, outreach to populations engaged in high-risk behaviors, and training peers and volunteers were the intervention activities rated most effective by project staff. Qualitative analysis identified eight factors facilitating intervention effectiveness. Three site-visited projects were chosen to exemplify the ways in which these facilitating factors contributed to the perceived effectiveness of small-group discussions, outreach, and the training of peer educators. Recommendations to guide the development and delivery of future community-based AIDS prevention projects are presented.
Abstract: Enculturation is the process by which individuals learn about and identify with their ethnic minority culture. It is distinguished from acculturation which refers to the process by which an ethnic minority individual is assimilated into the majority culture. Three studies with Native American youths are reported that describe the development of a measure of enculturation for Native American youths. Development of a measure of enculturation provides a foundation upon which to build a body of literature that focuses on strengths in a youth's life rather than on deficits. Results of the first study (n = 120), a confirmatory factor analysis, indicated that cultural affinity, native American identity, and family involvement in traditional activities adequately represent the construct of ecnulturation. The study also provides some convergent validity for this interpretation. The second study examines factor invariance for enculturation among youths with data from over 2 years (n = 69). The factor structure was similar across time. The third study replicates the factor structure and validity analyses with a new sample (n = 42). Usefulness of the measure for assessing protective factors and stressing ethnicity over simple assessment of race categories is discussed.
Abstract: Recently there has been an increase in the different types of strategies used in health education interventions, including an emphasis on broadening programs focused on individual behavior change to include larger units of practice. There has also been an increasing critique of the traditional physical science paradigm for evaluating the multiple dimensions inherent in many interventions. Additionally, there is a growing recognition of the importance of involving multiple stakeholders in designing, implementing, and evaluating interventions. Each of these factors carries specific evaluation challenges. With the overall aim of strengthening the evaluation of health education programs, this article aims to (a) present conceptual and technical design issues and options, (b) describe different approaches to evaluation, (c) highlight evaluation approaches that have been effective, (d) critique the limitations of traditional evaluation approaches, (e) examine promising approaches and implications for future evaluations, and (f) provide recommendations for evaluation designs, data collection methods, roles, responsibilities, and principles for evaluating interventions.
Abstract: On Day 2 of the joint CDC/SOPHE conference on Creating Capacity: Establishing a Research Agenda for Health Education, the participants were asked to identify research needs or special issues in working with children and adolescents, the elderly, women, men, and underserved groups. This article presents the priority research areas across subgroups identified by the participants. The cross-group priorities are followed by research recommendations for each subgroup.
Abstract: Substance use and delinquency, psychological well-being, and social support were compared across 5 family constellations among 254 urban African-American adolescent males. Single-mother, stepparent, both parents, mother with extended family, and extended family only households were studied. The only differences found were that youth living in single-mother households reported more parental support than other youth. Relationships with father and male role models were also studied and related to several psychosocial outcomes. The results challenge the assumptions that single African-American mothers are alone in providing support to their sons and that fathers' absence results in no significant relationship.
Abstract: Discussed several issues related to psychological empowerment. The thesis of this paper is that the development of a universal and global measure of psychological empowerment may not be a feasible or appropriate goal. I begin by distinguishing between empowerment processes and outcomes. Underlying assumptions are discussed including the notion that empowerment differs across people, contexts, and times. A nomological network that includes intrapersonal, interactional, and behavioral components is also presented. Two examples of psychological empowerment for voluntary service organization members and members of a mutual help organization are described to help illustrate differences in the specific variables that may be used to measure psychological empowerment in different populations and settings.
Abstract: This introduction to the special issue briefly reviews the meaning and significance of the empowerment concept and problems associated with the proliferation of interest in empowerment. We identify some of the topics not included in this issue and relate those to the many broad and diverse areas of psychological empowerment theory and community-based research and intervention that are covered. We present synopses of each article along with some of the themes and lessons cutting across the frameworks, studies, and applications. These include a wide diversity of settings, fairly representative of empowerment interventions, and, at the same time, improved clarity (if not unanimity) of definitions and measurement, which has been a problem in much empowerment research and intervention.
Abstract: Little knowledge exists about AIDS and Human Immunodeficiency Virus (HIV) infection among Latin American gay males. In Latin America, sexual transmission from man to man is the leading cause of HIV infection. In Mexico, which ranks third in number of AIDS cases in the Americas, more than three-quarters of the cases are due to sexual transmission; among these cases, 35% and 23.7% are due to homosexual and bisexual male practices, respectively. A sample of 200 individuals from Juarez, Mexico, a city on the U.S. border, was interviewed. Information about their AIDS knowledge, sexual behavior, and condom use was obtained. Factory workers and individuals who meet sexual partners in the streets reported more sexual partners than workers in service or professional occupations and those who meet their partners in bars and discos. Number of sexual partners and respondents' age were inversely associated with condom use. Implications for HIV prevention are discussed.
Abstract: This study investigated patient and physician perceptions of their relationship and examined how their perceptions related to patient satisfaction. Data are based on 134 patient-physician interactions. Study participants included 12 physicians (five women and seven men) and 134 male patients with a diagnosis of diabetes mellitus being seen on an outpatient basis. Information on patient and physician demographics, patient's metabolic control and functional status and time spent in the interaction were also collected. Results revealed that patients with lower levels of education were most satisfied and that physicians who viewed the relationship as a patient-physician partnership had more satisfied patients than those who viewed the relationship as physician controlled. Findings also indicated that physicians' gender and number of years in practice were not related to patient satisfaction. Practical implications include: (1) increasing attention to physician's perceptions of his or her relationship with individual patients and (2) exposing newly trained physicians to partnership types of relationships, if future research confirms these findings in chronic disease management.
Abstract: Cluster analyzed four variables: school attendance, employment, church attendance, and delinquency, to develop life-style profiles. Data from 218 African-American urban adolescents were used in the study. Five meaningful clusters were retained and subjected to criterion validity analyses using measures of spirituality, participation in a voluntary organization, self-esteem, and friend's substance use. The five clusters were then compared on cigarette, alcohol, marijuana, and hard drug use. The results suggest that a life-style that includes an adaptive compensatory behavior component may be more adaptive than a life-style that does not include compensatory behavior. For example, youths who left high school before graduation but were involved in church reported less alcohol and substance use than youths who left school and were not involved in any meaningful instrumental activity. Implications for intervention and future research on high-risk behaviors are discussed.
Abstract: This review and policy analysis examines the connection between physical and mental health. The review includes an analysis of individual diagnoses of physical and mental illness and training issues for both health and mental health professionals. A summary of earlier efforts to link health and mental health services includes a brief history of federal involvement and evaluation of linkage efforts. Linkage examples from a rural context are described briefly. Barriers to successful linkages are discussed with some suggestions for overcoming these obstacles. Policy recommendations for encouraging and establishing health and mental health linkages are presented.
Abstract: Described a study of the expansion strategies of a successful self- and mutual help organization for persons with mental illness. Resource mobilization and behavior-setting theories were used as conceptual frameworks to guide the investigation. Collaborative methods and a grounded theory approach were used. Archives, reports of contacts outside of the organization, and naturalistic observations were data sources. Of particular interest are the processes used by the organization to mobilize internal and external resources and to start new mutual help groups. Results suggest that the organization mobilizes resources from a variety of sources, displays flexibility in securing resources and defining organizational roles, and creates underpopulated settings to encourage individual involvement. The strategies appear to avoid overtaxing resource pools, reduce role ambiguity, and encourage pluralistic participation. Discussion includes several potential explanations for the successful growth of the organization.
Abstract: The role of consumers in rural health care is explored in this review of the literature. A brief history of public, private, and grassroots efforts to involve consumers in health care is presented. A more in-depth analysis of two primary areas where consumers can be useful resources for addressing rural health care problems--personnel shortages and improving community acceptance of health care innovations--is discussed. Emergency medical services, care for medically disabled persons, and prenatal care are specifically addressed. Barriers to effective citizen participation and policy recommendations are also presented.
Abstract: The research integrates the citizen participation literature with research on perceived control in an effort to further our understanding of psychological empowerment. Eleven indices of empowerment representing personality, cognitive, and motivational measures were identified to represent the construct. Three studies examined the relationship between empowerment and participation. The first study examined differences among groups identified by a laboratory manipulation as willing to participate in personally relevant or community relevant situations. Study II examined differences for groups defined by actual involvement in community activities and organizations. Study III replicated Study II with a different population. In each study, individuals reporting a greater amount of participation scored higher on indices of empowerment. Psychological empowerment could be described as the connection between a sense of personal competence, a desire for, and a willingness to take action in the public domain. Discriminant function analyses resulted in one significant dimension, identified as pyschological empowerment, that was positively correlated with leadership and negatively correlated with alienation.
