Disparities in prenatal HIV testing: evidence for improving implementation of CDC screening guidelines.

OBJECTIVES: We investigated the within-group and between-group variation in prenatal HIV testing in a sample of low-income pregnant and recently postpartum women. METHODS: Multivariable linear regression was used to estimate proportional differences in prenatal HIV testing for the total sample and stratified by race. RESULTS: In bivariate analyses, race and site of care jointly affected the probability of being tested. Hispanic women had the highest probability of being tested in public practice settings but relative to white women, black women had a higher probability of being tested in public and private practice settings. Predictors of prenatal HIV testing differed by race. Receiving prenatal care in a community health center or hospital outpatient clinic increased the probability of testing for Hispanics. Being a recent victim of intimate partner violence was associated with less frequent testing for blacks. Positive beliefs about HIV screening, while significant for blacks and Hispanics, was the only factor associated with testing for whites. CONCLUSION: Our data suggest that racial biases may be influencing providers' approach to testing, rather than CDC's 2001 guidelines for HIV screening of pregnant women. Study findings are being used to modify social marketing campaigns and improve provider trainings regarding prenatal HIV testing.

Bridging data and decision making: development of techniques for improving the HIV prevention community planning process.

Assessments of community planning in Massachusetts and Texas were used to develop tools for increasing the use of data by HIV prevention community planning groups (CPGs) and prevention providers while also increasing participation of CPG members. Barriers to data use included organizational problems in CPGs (e.g., lack of clear procedures, distrust of peers and leadership) and technical assistance needs for CPG members and researchers who provide data. The absence of data relevant to local epidemics was another barrier. Specific linkages are provided between the assessments of these needs and the development of a technical assistance tools (e.g., websites, templates for data presentation, experiential involvement in data use) and strategies for organizational change in CPGs, as well as efforts to better use available data and create or identify new sources of local data.

HIV prevention community planning: enhancing data-informed decision-making.

The primary purpose of this study was to test the impact of the first year of a 3-year intervention designed to enhance the use of behavioral data in the Massachusetts HIV Prevention Community Planning Group (MPPG). A one-group, pretest-posttest, nonequivalent independent variables, quasi-experimental design was used to assess changes before and after the first year of implementing strategies to enhance the use of behavioral data in decision-making. Over 90% of the CPG members completed surveys at baseline and at the end of the first year of the intervention. Consistent with the focus of the MPPG intervention in Year One, significant improvements were found from baseline to follow-up in member perceptions of decision-making structure and leadership, satisfaction with prevention planning processes, and intervention prioritization decisions. Findings provide preliminary evidence for the impact on member satisfaction of changes in CPG organizational structures and processes, including redistribution of power and broader constituent representation.

Improving the use of data for HIV prevention decision making: lessons learned.

HIV prevention community planning was developed to promote identification of local prevention priorities through a process that was evidence-based and provided community input. There are a variety of barriers to effective use of data in community planning which include characteristics of data (availability, timeliness, relevance to planning tasks), characteristics of planning group members and providers of data (e.g., skills in understanding and applying data), and social-organizational aspects of community-planning groups (CPGs). Lessons learned from this project illustrate how to create locally relevant sources of data, build data use skills of CPG members and data providers, and address social-organizational aspects of planning, while also better integrating community planning with implementation of prevention plans. Adaptation of tools and methods is discussed along with future considerations for research and planning practice.

Creating a bridge between data collection and program planning: a technical assistance model to maximize the use of HIV/AIDS surveillance and service utilization data for planning purposes.

Over time, improvements in HIV/AIDS surveillance and service utilization data have increased their usefulness for planning programs, targeting resources, and otherwise informing HIV/AIDS policy. However, community planning groups, service providers, and health department staff often have difficulty in interpreting and applying the wide array of data now available. We describe the development of the Bridging Model, a technical assistance model for overcoming barriers to the use of data for program planning. Through the use of an iterative feedback loop in the model, HIV/AIDS data products constantly are evolving to better inform the decision-making tasks of their multiple users. Implementation of this model has led to improved data quality and data products and to a greater willingness and ability among stakeholders to use the data for planning purposes.

Smoking behaviours and attitudes among male restaurant workers in Boston's Chinatown: a pilot study.

OBJECTIVE: Asian American immigrants experience high rates of cigarette smoking. A community based survey was conducted to understand the smoking behaviours, knowledge, and attitudes of restaurant workers in Boston's Chinatown. DESIGN: Cross sectional survey in Chinese of a convenience sample of 54 restaurant workers recruited through extensive outreach activities. RESULTS: All 54 of the workers were male immigrants. 45 (83.3%) reported smoking cigarettes regularly, and the remaining nine were former smokers. 36 of the smokers (80.0%) started smoking before entering the USA. The workers were aware that cigarettes are addictive (98.1%), cause lung cancer (79.6%), and lead to heart disease (64.8%). However, a substantial number reported that smoking was relaxing (75.9%) and enhanced concentration (66.7%). Nearly half believed low tar and low nicotine cigarettes to be safer than standard brands. The vast majority of workers believed that smoking was not socially acceptable for women. Smokers reported they received information on quitting most commonly from friends (60%), newspapers (53.5%), and television (44.4%). The restaurant workers most often saw advertising against smoking in Chinese newspapers (63%). CONCLUSION: Despite high rates of smoking, Chinese American restaurant workers were generally aware of the health risks and were interested in quitting. Community based research can set the stage for targeted public health efforts to reduce smoking in immigrant communities.