Adapting the VOICES HIV behavioral intervention for Latino men who have sex with men.

Latino men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS, but few behavioral interventions address their prevention needs. Adaptation of evidence-based interventions is a pragmatic strategy that builds upon lessons learned and has the potential to fill gaps in prevention programming. Yet there are few reports of how transfers are executed and whether effectiveness is achieved. This research reports on the adaptation of VOICES/VOICES, a single-session intervention designed for heterosexual adults, into No Excuses/Sin buscar excuses for Latino MSM. To test the adapted intervention, 370 at-risk Latino MSM were enrolled in a randomized trial. At a three-month follow-up, there was a sharper decrease in unprotected intercourse in the intervention group compared to controls (59 % vs. 39 %, ANOVA p < 0.05, F = 4.10). Intervention participants also reported more condom use at last intercourse (AOR = 1.69; 95 % CI 1.02-2.81, p < 02). Findings support use of adapted models for meeting prevention needs of high-priority populations.

Cyberbullying, school bullying, and psychological distress: a regional census of high school students.

OBJECTIVES: Using data from a regional census of high school students, we have documented the prevalence of cyberbullying and school bullying victimization and their associations with psychological distress. METHODS: In the fall of 2008, 20,406 ninth- through twelfth-grade students in MetroWest Massachusetts completed surveys assessing their bullying victimization and psychological distress, including depressive symptoms, self-injury, and suicidality. RESULTS: A total of 15.8% of students reported cyberbullying and 25.9% reported school bullying in the past 12 months. A majority (59.7%) of cyberbullying victims were also school bullying victims; 36.3% of school bullying victims were also cyberbullying victims. Victimization was higher among nonheterosexually identified youths. Victims report lower school performance and school attachment. Controlled analyses indicated that distress was highest among victims of both cyberbullying and school bullying (adjusted odds ratios [AORs] were from 4.38 for depressive symptoms to 5.35 for suicide attempts requiring medical treatment). Victims of either form of bullying alone also reported elevated levels of distress. CONCLUSIONS: Our findings confirm the need for prevention efforts that address both forms of bullying and their relation to school performance and mental health.

Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors.

Using cross-sectional data collected from 1081 Latino men who have sex with men (MSM) recruited with respondent-driven sampling (RDS) techniques from Los Angeles and New York, we examined the extent to which Latino MSM reported exposure to social discrimination (i.e., experienced both homophobia and racism, homophobia only, racism only, or neither homophobia nor racism). More than 40% of respondents experienced both homophobia and racism in the past 12 months. Los Angeles participants, those with lower income, and those who reported being HIV-positive were more likely to report experiencing both types of social discrimination. Adjusting for potential confounders, men exposed to both homophobia and racism were more likely than men exposed to neither form of discrimination to report unprotected receptive anal intercourse with a casual sex partner (AOR = 1.92, 95% CI, 1.18-3.24) and binge drinking (AOR = 1.42, 95% CI, 1.02-1.98). Our findings suggest the presence of a syndemic of adverse social experiences and call for more intervention research to address both homophobia and racism experienced among Latino MSM in the United States.

Having supportive social relationships is associated with reduced risk of unrecognized HIV infection among black and Latino men who have sex with men.

We examined the hypothesis that black and Latino men who have sex with men (MSM) who have supportive social relationships with other people are less likely to have unrecognized HIV infection compared with MSM of color who report lower levels of social support. We interviewed 1286 black and Latino MSM without known HIV infection in three metropolitan areas who were recruited using respondent driven sampling. Participants completed a computer-administered questionnaire and were tested for HIV. Unrecognized HIV infection was found in 118 men (9.2%). MSM who scored higher on the supportive relationship index had significantly lower odds of testing HIV-positive in the study. The mediation analysis identified two possible behavioral pathways that may partially explain this association: men who had strong supportive relationships were more likely to have had a test for HIV infection in the past 2 years and less likely to have recently engaged in high-risk sexual behavior. The findings illuminate the protective role of social relationships among MSM of color in our sample.

Mistaken assumptions and missed opportunities: correlates of undiagnosed HIV infection among black and Latino men who have sex with men.

OBJECTIVE: To identify demographic, behavioral, and psychological variables associated with being HIV positive unaware among black and Latino men who have sex with men (MSM). METHODS: Participants recruited in 3 cities completed a computer-assisted interview and were tested for HIV infection (OraSure Technologies, Bethlehem, PA). HIV-positive unaware MSM were compared with MSM who tested HIV negative in bivariate and multivariate analyses. RESULTS: Of 1208 MSM (597 black and 611 Latino), 11% were HIV-positive unaware (18% black; 5% Latino). In multivariate analysis of the Latino MSM, being HIV-positive unaware was associated with nongay identity, high perceived risk of currently being HIV positive, and belief that sex with other Latino men reduces HIV transmission risk. Among black MSM, being HIV-positive unaware was associated with gay identity, moderately higher income, having health insurance, sexuality disclosure to a current health care provider, fewer than 3 lifetime HIV tests, high perceived risk of testing HIV positive, and belief that sex with other black men reduces HIV transmission risk. CONCLUSIONS: HIV prevention efforts should address misperceptions among those black and Latino MSM who believe that assortative (ie, intraracial) sexual mixing reduces risk of HIV infection. Our findings also revealed missed opportunities to diagnose black MSM with HIV infection who were already engaged in care and had disclosed their sexuality to their health care provider. Clinicians should offer HIV testing to all MSM, particularly black MSM, who disclose engaging in recent sex with other men to facilitate earlier diagnosis of HIV infection and reduce transmission risk to sexual partners.

Older partner selection, sexual risk behaviour and unrecognised HIV infection among black and Latino men who have sex with men.

OBJECTIVES: The authors examine whether young black and Latino men who have sex with men (MSM) who have older sex partners are more likely than those who do not have older sex partners to have unrecognised HIV infection. The authors examine whether the association stems from (1) increased sexual risk behaviour with male partners of any age, (2) heightened risk of being exposed to HIV infection by older partners or (3) a combination of these two factors. METHODS: The analytical sample consisted of 723 black and Latino MSM, aged 18-35 years, who were HIV negative or of unknown serostatus at study entry. Participants completed a self-administered questionnaire and were tested for HIV infection. Men who reported having a male sex partner who was at least 4 years older than themselves were compared with those who did not. Outcomes included unprotected receptive anal intercourse (URAI) with male partners of any age (past 3 months) and having unrecognised HIV infection. RESULTS: Men with older partners reported a higher prevalence of URAI (AOR = 1.50, 95% CI 1.02 to 2.21). A second model found that men with older partners had increased odds of having unrecognised HIV infection (AOR = 2.51, 95% CI 1.18 to 5.34) after controlling for the number of URAI partners of any age, which remained an independent predictor. CONCLUSIONS: Young black and Latino MSM who had older male sex partners were at increased risk of having unrecognised HIV infection. This heightened risk was associated with sexual risk behaviour with partners of any age as well as possible increased exposure to HIV infection from older partners.

The role of peer support on condom use among Black and Latino MSM in three urban areas.

This article examines the sociodemographic/behavioral variables associated with low peer support of condom use and the relation between low peer support of condom use and unprotected anal sex for Black and Latino MSM in cities heavily impacted by the HIV/AIDS epidemic. Our findings indicate that perceived low peer support of condom use is associated with increased odds of recent unprotected anal intercourse (UAI) among Black and Latino MSM, regardless of male partner type. Although many participants reported having high peer support of condom use, this analysis highlights a considerable subgroup of Black and Latino MSM, 21% and 30%, respectively, who report low peer support of condoms. Given the prevalence of low peer support of condom use and its association with UAI in these highly impacted MSM populations, we recommend future intervention work that draws upon Black and Latino MSM's peer and social network members to reduce HIV risk behaviors.

Especially for daughters: parent education to address alcohol and sex-related risk taking among urban young adolescent girls.

This study evaluates the Especially for Daughters intervention, which aims to provide urban Black and Latino parents with information and skills to support their daughters in delaying sexual initiation and alcohol use. In a randomized field trial, 268 families with sixth-graders were recruited from New York City public schools and assigned either to the intervention, a set of audio CDs mailed home; an attention-controlled condition (print materials); or controls. Girls completed classroom baseline and three follow-up surveys, and telephone surveys were conducted with parents. At follow-up, girls in the intervention reported fewer sexual risks (adjusted odds ratio [AOR] = 0.39, confidence interval [CI] = 0.17-0.88) and less drinking (AOR = 0.38, CI = 0.15-0.97, p < .05). Their parents reported greater self-efficacy to address alcohol and sex and more communication on these topics. This gender-specific parent education program was for communities with high rates of HIV, where early sexual onset is common and often fueled by alcohol.

Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men.

Self-reported HIV-negative black and Latino MSM who engaged in serosorting or strategic positioning were less likely to have unrecognized HIV infection than men who engaged in unprotected anal intercourse without using these risk-reduction strategies.

Parenting and violence toward self, partners, and others among inner-city young adults.

OBJECTIVES: We examined relationships between parenting status and multiple forms of violence perpetration among young adults in high-poverty environments. METHODS: We analyzed data obtained from a survey of 990 young adults in New York City. Respondents reported on violence they had perpetrated toward themselves, intimate partners, and others. Associations between parenting and violence were examined in logistic regressions, controlling for sociodemographics. RESULTS: Fewer young men (33.0%) than young women (48.6%) reported that they were raising children. Among young men, parenting was associated with violence toward themselves (odds ratio [OR]=1.8; 95% confidence interval [CI]=1.03, 3.16) but not with violence toward partners or others. Among young women, violence perpetration did not differ by parenting status. Correlations among forms of violence were higher among young women than among young men, especially among mothers. Community violence was associated with violence toward others for both genders. For young men, community violence was associated with violence toward partners. CONCLUSIONS: Parenting did not reduce inner-city young adults' perpetration of violence. Among fathers, parenting may be, along with unemployment, a risk for violence toward self. Understanding patterns of violence can inform interventions that support young adults, including those who are parenting, in creating nonviolent homes and communities.

Keep It Up: development of a community-based health screening and HIV prevention strategy for reaching young African American men.

This article addresses the challenge of developing HIV prevention interventions that not only prove to be efficacious but also are designed from the outset to overcome obstacles to reaching priority populations. We describe how community input has informed development of Keep It Up (KIU), a community health screening and behavioral prevention program for young Black men. KIU embeds HIV prevention in a broader health promotion campaign, with the goal of reducing stigma and reaching a population that bears a disproportionate burden of HIV/AIDS and other health problems-hypertension, high cholesterol, diabetes, asthma, and obesity. Information from community partners, expert advisers, and focus groups was collected at key junctures and incorporated into four core components: social marketing, a computerized behavioral learning module, biological testing for HIV and other conditions, and a personalized health profile and risk reduction plan. A pilot with 116 participants provided evidence that the KIU model of integrating HIV prevention with other health screening is acceptable and has the potential to reach Black men at risk for HIV as well as other chronic health conditions.

Intimate partner violence among economically disadvantaged young adult women: associations with adolescent risk-taking and pregnancy experiences.

CONTEXT: Intimate partner violence negatively impacts the health of substantial proportions of young women in economically disadvantaged communities, where sexual initiation, aggressive behaviors, unintended pregnancies and childbearing are common among adolescents. It is therefore important to assess how adolescent risk behaviors and pregnancy experiences are linked to such violence during young adulthood. METHODS: Data from 526 participants in the Reach for Health Longitudinal Study who were surveyed during middle school (in 1995-1996 and 1996-1997) and at ages 22-25 (in 2005-2007) provided information on adolescent risk behaviors and pregnancy experiences, as well as experiences of intimate partner violence during young adulthood. Bivariate and multivariate analyses were conducted to identify correlates of intimate partner violence involvement. RESULTS: As young adults, 29% of women reported having been victims of intimate partner violence in the past 12 months; 21% reported having perpetrated such violence. In multivariate analyses, victimization and perpetration in the last year are positively associated with aggressive behavior in middle school (odds ratios, 1.9 and 2.5, respectively), lifetime number of sex partners (1.3 for both) and having a history of unintended pregnancy or pregnancy problems (1.3 for both). Perpetration also is associated with early sexual initiation (0.5) and living with a partner (1.8). CONCLUSIONS: It is important to consider women's pregnancy histories in programs aimed at preventing the adverse outcomes of relationship violence and in screening for partner violence in sexual and reproductive health services. Early intervention may help women develop the skills needed for resolving conflicts with peers and partners.

Maternal depression and mother-child interaction patterns: association with toddler problems and continuity of effects to late childhood.

OBJECTIVE: Increased behavior problems have been reported in offspring of mothers with depression. In-home observations link maternal depressive symptoms (MDS) and mother-child interaction patterns with toddler behavior problems and examine their persistence into late childhood. METHOD: Maternal characteristics (N = 153) and behaviors of two-year-old offspring (N = 215) were assessed in families from a randomly selected population cohort. Maternal self-reported depressive symptoms and observed maternal-toddler interaction patterns were evaluated as risks for toddler problem behaviors. Follow-up CBCL assessments about a decade later assessed persistence of effects identified in the toddler data. RESULTS: Maternal negativity toward her toddler was related to toddler problems, regardless of maternal depressive symptoms. MDS in combination with positive mother-toddler interaction showed only marginal ill effects on toddler offspring and no long-term effects. Depressive symptoms of less responsive/emotion teaching dyads were related to offspring tantrums and to mother and observer rated fearfulness, independent of family contextual risks. Analyses of Child Behavior Checklist (CBCL) problem scales obtained on these children in late childhood showed persistent effects similar to those shown at the younger age. CONCLUSIONS: In sum, these findings suggest that for mothers with high levels of depressive symptoms, demonstrations of affection and responsiveness to toddler offspring may mitigate both current and long-term consequences on offspring behavior.

Understanding differences in HIV sexual transmission among Latino and black men who have sex with men: The Brothers y Hermanos Study.

HIV sexual transmission risk behaviors were examined among 1,065 Latino and 1,140 black men who have sex with men (MSM). Participants completed a computer-administered questionnaire and were tested for HIV infection. Of men who reported that their last HIV test was negative or that they had never been tested or did not get the result of their last test, 17% of black and 5% of Latino MSM tested HIV-positive in our study. In both ethnic groups, the three-month prevalence of unprotected anal intercourse (UAI) with HIV-negative or unknown serostatus partners was twice as high among men unaware of their HIV infection than men who knew they were HIV seropositive at the time of enrollment. UAI exclusively with HIV-positive partners was more prevalent among HIV-positive/aware than HIV-positive/unaware men. The findings advance understanding of the high incidence of HIV infection among black MSM in the U.S.

Parenting practices, parents' underestimation of daughters' risks, and alcohol and sexual behaviors of urban girls.

PURPOSE: In urban economically distressed communities, high rates of early sexual initiation combined with alcohol use place adolescent girls at risk for myriad negative health consequences. This article reports on the extent to which parents of young teens underestimate both the risks their daughters are exposed to and the considerable influence that they have over their children's decisions and behaviors. METHODS: Surveys were conducted with more than 700 sixth-grade girls and their parents, recruited from seven New York City schools serving low-income families. Bivariate and multivariate analyses examined relationships among parents' practices and perceptions of daughters' risks, girls' reports of parenting, and outcomes of girls' alcohol use, media and peer conduct, and heterosexual romantic and social behaviors that typically precede sexual intercourse. RESULTS: Although only four parents thought that their daughters had used alcohol, 22% of the daughters reported drinking in the past year. Approximately 5% of parents thought that daughters had hugged and kissed a boy for a long time or had "hung out" with older boys, whereas 38% of girls reported these behaviors. Parents' underestimation of risk was correlated with lower reports of positive parenting practices by daughters. In multivariate analyses, girls' reports of parental oversight, rules, and disapproval of risk are associated with all three behavioral outcomes. Adult reports of parenting practices are associated with girls' conduct and heterosexual behaviors, but not with their alcohol use. CONCLUSION: Creating greater awareness of the early onset of risk behaviors among urban adolescent girls is important for fostering positive parenting practices, which in turn may help parents to support their daughters' healthier choices.

Urban young women's experiences of discrimination and community violence and intimate partner violence.

This paper examines the interrelationships between urban young adult women's experiences of discrimination and community violence and their reports of involvement in intimate partner violence (IPV). We explore whether such experiences are independent risk factors for IPV victimization and perpetration, even when accounting for aggressive behaviors and related risk taking, including drinking and sexual initiation, during early adolescence. We use data from the Reach for Health study, in which a sample of 550 urban African American and Latina women was followed from recruitment in economically distressed middle schools into young adulthood, over approximately 7 years. At the last wave, respondents were 19-20 years old; 28% were raising children. More than 40% reported experiencing at least one form of racial/ethnic discrimination sometimes or often over the past year. About 75% heard guns being shot, saw someone being arrested, or witnessed drug deals within this time period; 66% had seen someone beaten up, 26% had seen someone get killed, and 40% knew someone who was killed. Concurrent reports of lifetime IPV were also high: about a third reported being a victim of physical violence; a similar proportion reported perpetration. Results of multivariate regression analyses indicate that discrimination is significantly associated with physical and emotional IPV victimization and perpetration, controlling for socio-demographic characteristics, including ethnic identity formation, and early adolescent risk behaviors. Community violence is correlated with victimization, but the relationship remains significant only for emotional IPV victimization once early behaviors are controlled. Implications for violence prevention are discussed, including the importance of addressing community health, as well as individual patterns of behavior, associated with multiple forms of violence victimization and perpetration.

Circumcision status and HIV infection among Black and Latino men who have sex with men in 3 US cities.

OBJECTIVE: To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection. METHODS: Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. A 45-minute computer-assisted interview and a rapid oral fluid HIV antibody test (OraSure Technologies, Bethlehem, PA) were administered to participants. RESULTS: Circumcision prevalence was higher among black MSM than among Latino MSM (74% vs. 33%; P < 0.0001). Circumcised MSM in both racial/ethnic groups were more likely than uncircumcised MSM to be born in the United States or to have a US-born parent. Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex. CONCLUSIONS: In these cross-sectional data, there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM.

Continued smoking and smoking cessation among urban young adult women: findings from the Reach for Health longitudinal study.

We examined smoking and smoking cessation among 538 young inner-city women who had been followed from early adolescence to young adulthood. Results showed that 14.3% of these young women had smoked in middle school, 26.4% had smoked in high school, and 21.9% had smoked at age 19 or 20 years, when many were rearing children, pregnant, or considering pregnancy. Young women who were raising children were more likely than those who were not to currently smoke or to have smoked in the past. Partner violence victimization was an independent risk factor for continued smoking. If improvements in smoking cessation rates are to be achieved, public health efforts must address factors underlying early and continued smoking.

New York City young adults' psychological reactions to 9/11: findings from the Reach for Health longitudinal study.

This research examines psychological distress among 955 economically disadvantaged New York City residents surveyed during high school and again after the September 11th terrorist attacks (9/11), when they were young adults. As part of the longitudinal Reach for Health study, young adult surveys were conducted from 6-19 months post-9/11 (average 8 months), providing opportunity to assess types of exposures and psychological distress, including symptoms of post-traumatic stress disorder (PTSD), depression, hopelessness, and anger. Regressions of psychological distress on 9/11 exposure were performed, controlling for high school distress, prior exposure to violence victimization, and socio-demographic characteristics. Exposure to 9/11 was positively associated with anger, hopelessness, and PTSD symptoms and a measure of global distress. The relationship was greater among women for PTSD symptoms. Although those who reported high school distress also reported more distress in young adulthood, prior psychological distress did not moderate the relationship between exposure and psychological outcomes. Greater exposure is related to distress among those who, during high school, reported lower distress, as well as among those who reported prior greater distress.

Rethinking the bystander role in school violence prevention.

Public concerns about school shootings and safety draw attention to the role bystanders can play in preventing school violence. Although school violence prevention plans are often required, there is little guidance about whether these should address the roles of bystanders and what actions bystanders should take in different circumstances, from more common instances of bullying and fighting to rare, but potentially lethal, threats and use of weapons. Literature pertaining to bystanders is reviewed and applied to the school setting. The definition of bystander is expanded, including parents, teachers, and other school staff as well as youths and those who have information about potential violence as well as those who witness its occurrence. Barriers preventing bystanders from taking positive actions are discussed. The authors call on health promotion researchers and practitioners to work with school communities to identify norms, attitudes, and outcome expectancies that shape bystander behaviors to inform prevention efforts.