[The role of spectral analysis of cough sounds in the diagnosis of COVID-19].

AIM: To evaluate the possibility of using spectral analysis of cough sounds in the diagnosis of a new coronavirus infection COVID-19. MATERIALS AND METHODS: Spectral toussophonobarography was performed in 218 patients with COVID-19 [48.56% men, 51.44% women, average age 40.2 (32.4; 51.0)], in 60 healthy individuals [50% men, 50% women, average age 41.7 (32.2; 53.0)] with induced cough (by inhalation of citric acid solution at a concentration of 20 g/l through a nebulizer). The recording was made using a contact microphone located on a special tripod at a distance of 15-20 cm from the face of the subject. The resulting recordings were processed in a computer program, after which spectral analysis of cough sounds was performed using Fourier transform algorithms. The following parameters of cough sounds were evaluated: the duration of the cough act (ms), the ratio of the energy of low frequencies (60-600 Hz) to the energy of high frequencies (600-6000 Hz), the frequency of the maximum energy of the cough sound (Hz). RESULTS: After statistical processing, it was found out that the parameters of the cough sound of COVID-19 patients differ from the cough of healthy individuals. The obtained data were substituted into the developed regression equation. Rounded to integers, the resulting number had the following interpretation: "0" - there is no COVID-19, "1" - there is COVID-19. CONCLUSION: The technique showed high levels of sensitivity and specificity. In addition, the method is characterized by sufficient ease of use and does not require expensive equipment, therefore it can be used in practice for timely diagnosis of COVID-19.

Psychosocial and environmental correlates of violence perpetration among African-American urban youth.

PURPOSE: To ascertain the proportion of youths involved in acts of violence; to examine individual, social, and environmental factors associated with perpetration; and to determine the relationship among victimization, witnessing, and perpetration of violence. METHODS: A cross-sectional survey was completed by 349 volunteer males and females, aged 9-15 years, 96% of whom were African-American. The youths were recruited from recreation centers associated with 10 public-housing communities in an eastern city. Survey instruments included the Child Health and Illness Profile, Survey of Children's Exposure to Community Violence, and other standardized questionnaires. Statistical analyses included Chi-square, correlation, regression, and test for linear trends. RESULTS: Half of the youths self-reported at least one act of violence perpetration, with similar distributions among males and females. One-third of the youths reported both personal victimization and the witnessing of violent events. Victim and witness status were moderately correlated. Individual risk behaviors and victimization made significant contributions to perpetration status. Further analysis demonstrated a linear relationship between acts of perpetration and number of victimization events. CONCLUSIONS: Participation in problem behaviors may place youths in circumstances in which they may be victim, witness, or aggressor. The chronic and high levels of community violence to which many youths are exposed are likely to contribute to an individual's participation in acts of violence.

Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents.

PURPOSE: To examine gender and age differences among urban, low-income, African-American children and adolescents in perceived monitoring by their parents, and the association of perceived parental monitoring with family characteristics, health risk behaviors, and risk perceptions. METHODS: Three cross-sectional surveys were conducted in 1992 (n = 455), 1994 (n = 355), and 1996 (n = 349). Respondents aged 9-17 years were recruited from low-income urban areas including public housing communities and associated recreation centers. Both multivariate analysis of variance and correlation analysis were performed. RESULTS: Low levels of perceived parental monitoring were associated with participation in several health risk behaviors, including sexual behavior, substance/drug use, drug trafficking, school truancy, and violent behaviors. Females perceived themselves to be more monitored than did males. In general, the perceived parental monitoring tended to decrease with advancing age of the youth. CONCLUSIONS: The strong inverse correlation between perceived parental monitoring and adolescent risk behavior suggests that parental monitoring initiatives may be an effective intervention tool. Longitudinal studies are needed to determine the long-term relationship between perceived parental monitoring and adolescent risk involvements.

Impact of perceived parental monitoring on adolescent risk behavior over 4 years.

PURPOSE: To determine the stability of perceived parental monitoring over time and its long-term effect on health risk behaviors among low-income, urban African-American children and adolescents. DESIGN: Prospective, longitudinal follow-up (4 years). SUBJECTS: A total of 383 African-American youth aged 9-15 years at baseline recruited from nine recreation centers serving three public housing communities in an Eastern city. OUTCOME MEASURES: A six-item measure assessing perceived parental monitoring and an 11-item self-reported measure assessing unprotected sex, drug use, and drug trafficking were administered at baseline and at regular intervals over the subsequent 4 years. ANALYSIS: Concordance was assessed by Pearson correlation coefficients at the level of scale and by kappa scores at the level of items. The association between the monitoring score and risk involvement was determined by stepwise multiple regression analysis including parental monitoring, age, gender, intervention status, and two-way interactions between parental monitoring and age, gender, intervention status as independent variables. RESULTS: The perception of being monitored demonstrated consistency over time. Parental monitoring was inversely correlated with all three targeted risk behaviors cross-sectionally and prospectively. CONCLUSION: These data provide evidence for an inverse relationship between perceived parental monitoring and risk involvement cross-sectionally and longitudinally. These data support the long-term effect of perceived parental monitoring on risk behaviors among urban, low-income African-American children and adolescents. Coupled with some evidence suggesting that directed interventions might be able to increase parental monitoring, this study provides a solid platform for reinforcing the importance of parental monitoring and directing intervention efforts at strengthening parental monitoring to reduce adolescent risk behaviors.

Parental underestimates of adolescent risk behavior: a randomized, controlled trial of a parental monitoring intervention.

OBJECTIVES: To develop and evaluate an intervention (ImPACT) seeking to increase monitoring (supervision and communication) by parents and guardians of African-American youth regarding high risk and protective behaviors; and to develop an instrument to assess parental monitoring, the Parent-Adolescent Risk Behavior Concordance Scale. DESIGN/INTERVENTION: This research was a randomized, controlled longitudinal study. Baseline (preintervention), and 2 and 6 months postintervention data were obtained via a talking MacIntosh computer regarding youth and parent perceptions of youth involvement in 10 risk behaviors, parental monitoring and youth-parent communication, and condom-use skills. Intervention parents and youth received the ImPACT program and a video emphasizing parental supervision and discussion, followed by a structured discussion and role-play emphasizing key points. Control parents and youth received an attention-control program on goal-setting, which also included an at-home video and discussion. PARTICIPANTS: A total of 237 parents and one each of their youth (ages 12-16 years) recruited from eight public housing developments located in a city in the mid-Atlantic region. RESULTS: Similarity of youth and parental reporting on the Parent-Adolescent Risk Behavior Concordance Scale was positively correlated with protective behaviors, perceived parental monitoring, and good parent-youth communication. At baseline, parents significantly underestimated their youth's risk behaviors. However, 2 and 6 months postintervention, the ImPACT program increased similarity of reports by youth and their parents of youth involvement in risk and protective behaviors. In addition, at 6 months postintervention, intervention (compared to control) youths and parents also demonstrated higher levels of condom-use skills. CONCLUSION: Parental monitoring interventions such as ImPACT should be given to parents in conjunction with more traditional youth-centered risk-reduction interventions.

Parental influence on adolescent sexual behavior in high-poverty settings.

BACKGROUND: African American adolescents living in high-poverty urban settings are at increased risk for early sexual initiation and sexually transmitted diseases. OBJECTIVE: To determine whether parental strategies to monitor their children's social behavior and to communicate with them about sexual risks help to reduce the initiation of risky sexual behavior and prevent the resulting adverse health outcomes. METHODS: To assess the viability of these strategies, we surveyed a stratified cross-section of African American children aged 9 to 17 years (N = 355) living in urban public housing. Talking computers were used to increase the confidentiality and comparability of the interviews across the wide age range. RESULTS: Children who reported high levels of parental monitoring were less likely to report initiating sex in pre-adolescence (aged < or = 10 years) and reported lower rates of sexual initiation as they aged. Children who reported receiving both greater monitoring and communication concerning sexual risks were also less likely to have engaged in anal sex. Communication was also positively related to the initiation of condom use and consistent condom use. The protective correlates of these parenting strategies were independent of the type of guardian (mother vs other family member). CONCLUSION: Interventions with parents and other guardians to increase monitoring and communication about sexual risks seem to be promising health-promotion strategies for adolescents in high-risk settings.

Exposure to drug trafficking among urban, low-income African American children and adolescents.

OBJECTIVE: To examine the association between exposure to drug trafficking (selling or delivering drugs) and exposure to other forms of community violence and risk behaviors among urban, low-income African American children and adolescents. DESIGN: Community-based, cross-sectional survey. SETTING: Ten public housing developments in a large eastern city in the United States. PARTICIPANTS: Three hundred forty-nine urban, low-income African American children and adolescents (198 boys and 151 girls), aged 9 to 15 years. MAIN OUTCOME MEASURES: Exposure to drug trafficking and other forms of community violence (as either a victim or a witness), risk behaviors/perceptions including risk-taking/delinquency, drug use, perpetration of violence or other crimes, threats to school achievement, and perceived peer involvement. ANALYSIS: Exploratory factor analysis was performed to examine whether exposure to drug trafficking is a risk factor that is distinct from other exposure to violence. Multivariate analysis of variance and chi2 tests were performed to assess the relationship between exposure to drug trafficking and other forms of community violence and risk behaviors/perceptions. RESULTS: Of 349 participants, 63 (18%) had been asked to traffic drugs and 134 (38%) had seen someone else being asked to traffic drugs. Factor analysis indicates that exposure to drug trafficking appears to be different from other forms of community violence. However, having been asked and having seen other people being asked to traffic drugs were both strongly associated with exposure to other forms of community violence. Compared with children and adolescents who had not been exposed to drug trafficking, those who were exposed to drug trafficking reported more risk-taking and delinquent behaviors, drug use, threats to achievement, and a perception of more peer involvement in these risk behaviors. CONCLUSION: Exposure to drug trafficking is a unique risk factor that is strongly associated with exposure to other forms of community violence and involvement in other risk behaviors.

Drug trafficking and drug use among urban African-American adolescents: a causal analysis.

OBJECTIVE: To test the hypothesis that involvement in drug trafficking leads to illicit drug use among urban African-American adolescents. METHODS: Self-reports of substance use, illicit drug use, and drug trafficking were obtained at baseline and every 6 months for 24 months from 383 African-American early adolescents. Transitions between involvement in drug trafficking and illicit drug use over time were examined. Path analysis was conducted to examine the causal relation between drug trafficking and drug use. RESULTS: Among the 35 youth who were initially involved only in drug trafficking, 22 (67%) subsequently used illicit drugs. Of the 53 youth who were initially involved only in illicit drug use, only 19 (42%) continued using drugs at later waves (p < 0.05). Path analysis revealed that baseline drug trafficking had a strong effect on subsequent drug trafficking and drug use, whereas baseline drug use did not have an effect on subsequent drug use or drug trafficking. CONCLUSIONS: Initiation of drug trafficking by adolescents appears to lead to sustained involvement in drug-related activities, including continued drug trafficking and drug use. By contrast, initiation of drug use does not necessarily lead to continued involvement in drug-related behaviors.

Similarities in sexual activity and condom use among friends within groups before and after a risk-reduction intervention.

PIP: Adolescent risk behavior is determined, in large part, by the perceived or actual social behavior of one's close friends. Thus, an intervention delivered to youth along with his or her friends could be a powerful vehicle for proactive behavior change. This possibility was assessed in 382 low-income African-American adolescent friends 9-15 years of age who were recruited from public housing developments for a longitudinal HIV risk-reduction program. These young people formed 76 friendship groups. The intervention, based on protection motivation theory, was delivered through weekly meetings of 38 of the friendship groups; the remaining 38 groups met weekly, but there were no social-cognitive interventions. Both groups received general education on HIV/AIDS and free condoms. In the intervention group, the percentage of groups in which all sexually active members used condoms increased from 33% at baseline to 69% after 6 months, 50% at 12 months (an expectable decline, indicating the need for a "booster" intervention), and 72% at 18 months. Among control friendship groups, however, homogeneous condom use within a group remained relatively stable: 17% at baseline, 18% at 6 months, 38% at 12 months, and 29% at 18 months. The intervention's impact was strongest among groups of youth with a low baseline prevalence of risk behaviors. These findings confirm the potential of use of group process as a vehicle for behavior change among adolescents.^ieng

Evolution of risk behaviors over 2 years among a cohort of urban African American adolescents.

OBJECTIVE: To examine the evolution of risk behaviors over 2 years among a community-based cohort of low-income African American preadolescents and young adolescents enrolled in a randomized trial of an acquired immunodeficiency syndrome risk reduction intervention. DESIGN: Longitudinal, community-based cohort. SETTING: Nine recreation centers serving 3 public housing developments. SUBJECTS: Three hundred eighty-three African American youths aged 9 through 15 years at baseline. INTERVENTIONS: Frequency distributions, chi 2 analyses, and regression analyses regarding 10 risk behaviors were conducted. To assess whether a specific risk behavior or its protective (nonrisk) behavioral analogue, composing a risk-nonrisk behavioral complex (eg, was sexually active and was sexually abstinent or used drugs and refrained from drugs), was stable over time, kappa values were determined for the 10 risk-nonrisk behavioral complexes. MAIN OUTCOME MEASURES: Instrument assessing risk/ behaviors administered at baseline and every 6 months aurally and visually via talking computer. RESULTS: The prevalence of sexual intercourse, cigarette smoking, alcohol consumption, and drug use increased notably over time. Drug use increased from a 6-month cumulative prevalence of 7% at baseline to 27% at the 24-month follow-up (P < .001). Cumulatively over the 2-year study interval, 81% of youths had engaged in fighting, 58% had engaged in sexual intercourse, and from 33% to 40% had engaged in truancy, knife or bat carrying or both, alcohol consumption, drug use, and cigarette smoking. All of the risk-nonrisk behavioral complexes except weapon carrying were stable during the semiannual assessment intervals. Fighting (kappa = 0.22, P < .01), sexual intercourse (kappa = 0.33, P < .001), alcohol consumption (kappa = 0.21, P < .001), and unprotected sexual intercourse (kappa = 0.34, P < .05) were stable for 2 years. Six risk-nonrisk behavioral complexes were stable for the 2-year interval among youths aged 13 through 15 years at baseline, while only 2 risk-nonrisk behavioral complexes were stable among younger youths. The intervention seemed to affect the stability of 4 risk behaviors: truancy, drug use, unprotected sexual intercourse, and, possibly, fighting. For unprotected sexual intercourse, this intervention effect seemed to be due to stabilization of nonparticipation in risky behavior. Intervention youths were less likely to adopt a risk behavior (ie, engage in it for > or = 2 risk assessment periods) than control youths, but they were not less likely to experiment with a risk behavior. CONCLUSIONS: There is evidence that although the prevalence of risk behaviors does change with age, most risk-nonrisk behavioral complexes seem to be relatively stable over time and stability may increase with time. Risk reduction interventions seem to decrease risk adoption, stabilize nonrisk behaviors, and possibly destabilize risk behavior.

The rate and pattern of alcohol consumption among Chinese adolescents.

OBJECTIVE: To assess the prevalence and pattern of alcohol consumption and its relation to participation in other social activities and problem behaviors among adolescents residing in the People's Republic of China. METHODS: Data were collected from a sample of 1,040 students in 6th, 8th, and 10th grades from five public schools in Beijing, China by using a self-administered questionnaire. Chi-square statistics and two-way ANOVA were used to assess the gender and grade difference in lifetime alcohol use of various alcoholic beverages. The age-adjusted and grade-adjusted odds ratio was used to assess the association between alcohol use and selected social activities and problem behaviors. RESULTS: Approximately 70% of the study sample reported prior alcohol consumption. The rate of drinking among males was significantly higher than among females (78% vs. 61%, p < .00001), and the rates among both genders increased with advancing grade (54%, 72%, and 84%, respectively, p < .001). Beer was the most commonly consumed alcoholic beverage. The results also suggested a progression from beer to wine and/or liquor. Drinking behavior was positively associated with participation in unstructured social activities and other problem behaviors. CONCLUSIONS: Alcohol use was prevalent among adolescents residing in China. The findings underscore the need for and importance of intervention efforts targeting alcohol consumption among early adolescents in China.

Challenges and rewards of involving community in research: an overview of the "Focus on Kids" HIV Risk Reduction Program.

Acquired immunodeficiency syndrome (AIDS) continues to be a significant concern for adolescents, especially in minority populations. There is a scarcity of knowledge of the cultural context of sexual behavior in this age group and the influences that lead to early initiation of sex and unsafe sex. Few efforts targeting young adolescents have been community based, although there has been an increased awareness of the need for such research and intervention programs. Four key processes have been defined in gaining community participation in health education programs: (a) defining the community and reaching the community; (b) recognizing tensions among service, research, and community participation; (c) involving community residents; and (d) considering cultural differences in a community. These processes are used to describe the "Focus on Kids" project, a human immunodeficiency virus (HIV) risk reduction intervention that resulted in significant increases in condom use demonstrated by a randomized controlled trial.

A randomized, controlled effectiveness trial of an AIDS prevention program for low-income African-American youths.

BACKGROUND: Some interventions to reduce the risk of the acquired immunodeficiency syndrome (AIDS) that target youths have resulted in short-term increases in self-reported condom use. However, long-term intervention effects have not been assessed. STUDY QUESTION: Can a theoretically and culturally based, AIDS-risk reduction intervention delivered to naturally formed peer groups increase self-reported condom use among African-American early adolescents at 6 and 12 months of follow-up? METHOD: A randomized, controlled trial of a community-based intervention delivered in eight weekly sessions involved 76 naturally formed peer groups consisting of 383 (206 intervention and 177 control) African-American youths 9 to 15 years of age. A theory-based, culturally and developmentally tailored instrument that assessed perceptions, intentions, and self-reported sexual behaviors was administered to all subjects at baseline (preintervention) and 6 and 12 months later. RESULTS: At baseline, 36% of youths were sexually experienced, and by 12 months of follow-up, 49% were sexually experienced. Self-reported condom use rates were significantly higher among intervention than control youths (85% vs 61%; P<.05) at the 6-month follow-up. However, by 12 months, rates were no longer significantly higher among intervention youths. The intervention impact at 6 months was especially strong among boys (85% vs 57%; P<.05) and among early teens (13 to 15 years old) (95% vs 60%; P<.01). Self-reported condom use intention was also increased among intervention youths at 6 months but not at 12 months. Some perceptions were positively affected at 6 months, but the change did not persist at 12 months. CONCLUSIONS: High rates of sexual intercourse underscore the urgent need for effective AIDS-risk reduction interventions that target low-income urban, African-American preteens and early teens. A developmentally and culturally tailored intervention based on social-cognitive theory and delivered to naturally formed peer groups recruited from community settings can increase self-reported condom use. The strong short-term improvements in behaviors and intentions followed by some relapse over longer periods argue for a strengthened program and research focus on sustainability.

Sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention. Combined contraceptive practices among urban African-American early adolescents.

OBJECTIVE: To evaluate the success of efforts to educate youth not only to use prescription contraceptives to avoid pregnancy, but also to use condoms to avoid sexually transmitted diseases, including infection with the human immunodeficiency virus. METHODS: Longitudinal study of 383 African-American youth aged 9 to 15 years enrolled in a randomized, controlled trial of an acquired immunodeficiency syndrome (AIDS) risk reduction intervention. Data about contraceptive practices were obtained at baseline and 6, 12, and 18 months later using a culturally and developmentally appropriate risk assessment tool administered with "talking" computers (Macintosh, Apple Computer Inc, Cupertino, Calif). RESULTS: Approximately three fourths of sexually active youth used some form of contraception in each 6-month round, with almost half of the youth using combinations of contraceptives. Among all youth at baseline and among control youth throughout the study, more than half used condoms and more than two thirds who used oral contraceptives also used condoms. Receipt of an AIDS education intervention was associated with use of more effective contraceptive practices (eg, condoms and another prescription or nonprescription method of birth control). After receiving the intervention, more than 80% of the youth who used oral contraceptives also used condoms. Contraceptive practices showed considerable stability. Knowledge about AIDS was positively associated with use of more effective contraceptive methods. CONCLUSIONS: Many youth are using condoms and prescription birth control simultaneously, and these use rates can be increased through AIDS education interventions.

Longitudinal stability and predictability of sexual perceptions, intentions, and behaviors among early adolescent African-Americans.

PURPOSE: To assess the stability and predictability of perceptions, intentions, and behaviors regarding intended sexual intercourse and condom use. METHODS: One hundred and nineteen African-American youth aged 9-15 years living in urban public housing provided information at baseline and 6 months later using a theory-based and culturally- and developmentally-tailored instrument assessing perceptions, intentions, and sexual behaviors. RESULTS: Over the 6-month study interval, individual behaviors, intentions, and perceptions demonstrated considerable stability. Intentions regarding sexual intercourse in the next half-year were predictive of subsequent coitus among the entire cohort and among the subset who were virgins at baseline. Youth who thought it likely that they would be sexually-active in the next 6 months were at significantly elevated risk of doing so, compared to youth who were uncertain or thought coitus unlikely. However, intentions regarding future coitus among the subset of youth who were sexually-experienced at baseline were not predictive of future coital behavior. CONCLUSIONS: These data suggest that social cognitive behavioral models that incorporate intentions and perceptions are appropriate as the theoretical basis for interventions targeting these young adolescents.

PIP: A longitudinal study conducted among low-income African-American early adolescents identified the salience of intentions and perceptions regarding sexual intercourse to subsequent behavior. The 119 boys and girls 9-15 years of age were recruited from public housing project recreation centers in Baltimore, Maryland, in 1993. Each youth completed the Youth Health Risk Behavioral Inventory; the instrument was re-administered 6 months later. At baseline, 71 respondents (60%) were virgins; 6 (9%) became sexually active during the 6-month study period. 27 (56%) of the 48 subjects who were sexually experienced at baseline engaged in intercourse during the ensuing 6 months. Overall, the predictiveness of intention to have sex in the next 6 months and actual behavior was very strong, especially among younger youth; nearly half of young people who thought it likely they would have sex did so, while only one-fifth of those who were uncertain and one-seventh of those who considered it unlikely had sex. Condom intention, on the other hand, was not predictive of subsequent use. Youth who engaged in sexual intercourse during the study period had more perceived peer support and internal rewards for sexual activity and perceived the sequelae of intercourse as less severe than their abstinent counterparts. Overall, these findings suggest that social cognitive behavioral models that incorporate intentions and perceptions should form the theoretical basis for interventions aimed at young adolescents.

Similarity of risk and protective behaviors among African-American pre- and early adolescent members of naturally occurring friendship groups.

To determine whether self-reported risk and protective behaviors, expectations, and attitudes are more similar among African-American early adolescents within a community-based friendship group than across groups, a cross-sectional study was conducted among 382 African-American youth 9 through 15 years of age forming 76 community-based groups of 3 through 10 same-gender friends. Each member of the friendship group reported his/her own past involvement in nine risk behaviors (sexual intercourse, substance abuse, drug-trafficking, and other delinquent activities) and two protective behaviors (high academic performance and regular church attendance) and their expectations and feelings regarding several of these behaviors. Intraclass correlation coefficients were calculated overall and by gender and age. Members were generally more similar within friendship groups than across groups with regard to several risk behaviors and expectations including sexual intercourse and drug-trafficking. Particularly striking was the similarity among members of "junior" friendship groups (e.g., median age of youth < 11 years) of both risk and protective behaviors and expectations. The finding of enhanced similarity of risk behaviors and expectations among members within groups suggests that intervention delivery through community-based friendship groups may be a useful approach for risk prevention efforts targeting pre-adolescent African-American youth living in low-income settings.

Sources of health care and health needs among children in kinship care.

OBJECTIVES: To determine the characteristics of children in kinship care and their caregivers who have access to health care (a single source of health care or a single provider), and to determine the relation between indicators of access and health needs. DESIGN: Cross-sectional. SETTING: A large eastern city. SUBJECTS: Two hundred ten children selected from households with children in kinship care in April 1989. METHODS: Data were obtained from medical records, access and demographic questionnaires, and a medical and psychologic evaluation. RESULTS: A single facility for health care was reported by 93% of the sample; two thirds of those identified one health care provider. One source of care or one provider was associated with variables such as young age at placement and medical assistance insurance. Children who did not have a single source of care were more likely to have unmet health needs (87% vs 61%, P < .05), especially unmet mental health needs (60% vs 31%, P < .05). CONCLUSIONS: Children in kinship care had good access to health care, but the level of unmet health needs was high. Children who did not have a single source of health care were more likely to have unmet health needs, especially unmet mental health needs. These findings have implications for future health care planning for children in out-of-home care.

Development of a culturally, theoretically and developmentally based survey instrument for assessing risk behaviors among African-American early adolescents living in urban low-income neighborhoods.

The creation of developmentally and culturally appropriate data-gathering instruments is necessary as health researchers and interventionists expand their investigations to community-based minority adolescent populations. The creation of such instruments is a complex process, requiring the integration of multiple data-gathering and analytic approaches. Recent efforts have delineated several issues to be considered in survey design for minority populations: community collaboration; problem conceptualization; application of the presumed model of behavioral change; and dialect and format of delivery. This paper describes the process of creating a culturally and developmentally appropriate, theoretically grounded instrument for use in monitoring the impact of an AIDS educational intervention on the behavior and health outcomes of urban African-American pre-adolescents and early adolescents. Three phases of research were involved: preliminary (and ongoing) ethnographic research including extensive participant observation, as well as, focus group and individual interviews with 65 youths; construction and testing of the preliminary instrument involving two waves of pilot testing (N1 = 57; N2 = 45); and, finalization of the instrument including reliability testing and assessment of tool constructs and selection of the mode of delivery (involving 2 additional waves of pilot testing (N3 = 91; N4 = 351). The essential role played by the community in all phases of instrument development is underscored.

Perceived risks and benefits of alcohol, cigarette, and drug use among urban low-income African-American early adolescents.

Perceptions about drugs and the social environment may be important influences on cigarette, alcohol and drug use, yet little is known regarding the perspective of early adolescent boys and girls, especially among minority urban youths. Among 351 African-American low-income urban youth, 9 through 15 years of age, completing a community-based computerized questionnaire, 25% acknowledged alcohol, cigarette, and/or illicit drug use in the past 6 months; 19% expected to use one of those substances in the next 6 months. Family exposure to drugs increased the likelihood that youths expected to use drugs by factors of 4.5 (boys) and 2.5 (girls). Other factors (feelings about drugs, community drug use, long-term expectations) distinguished users from nonusers or had different associations with use in boys and girls. Gender-specific perceptions about drugs may have the potential to be modified in drug and substance use prevention programs.