Mitigating intimate partner violence among South African women testing HIV positive during mobile counseling and testing.

South African women continue to suffer disproportionately from the interlinked epidemics of HIV and intimate partner violence (IPV). Effective strategies are needed to mitigate HIV-related IPV, which often creates barriers to successful engagement along the HIV continuum of care. More information is needed on how IPV impacts women's safety following mobile HCT diagnosis, and the HIV IPV Risk Assessment & Safety-planning (HIRS) protocol was developed to address several related gaps in knowledge. The sample included 255 black South African women experiencing IPV and testing HIV+ during mobile HCT in Gauteng province. Outcomes were compared between a standard of care (SOC) group and an Experimental group with two dosage levels (D1, D2). Of the total sample and in the last year, 99.2% had experienced non-violent control, 40.7% physical abuse, 44.8% sexual abuse, and 67.3% physical or sexual abuse. There were no significant differences in pre/post safety scores, or for satisfaction or acceptability items. The overall linkage rate was 45.8% (M = 12.97 days), and the Experimental group had more links to care in certain age groups-the highest in those aged ≤23 years in D1 (70%). The lowest linkage rate was for those aged 33-43 years in the SOC (22.2%). Almost two thirds of participants reported using the safety plan (61.9%), with 80% reporting it was helpful, and 80% using ≥1 safety strategy. The Experimental group reported significantly less violence upon partner notification of serostatus, but all groups felt significantly less safe getting to medical appointments by post-test. Overall, the study indicates the HIRS protocol is safe and helpful, brief to administer, and may mitigate violence during partner notification of serostatus, but further investigation is needed before implementing it as a standard of care.

Identifying Unbiased Items for Screening Preschoolers for Disruptive Behavior Problems.

Objective: Efficient identification and referral to behavioral services are crucial in addressing early-onset disruptive behavior problems. Existing screening instruments for preschoolers are not ideal for pediatric primary care settings serving diverse populations. Eighteen candidate items for a new brief screening instrument were examined to identify those exhibiting measurement bias (i.e., differential item functioning, DIF) by child characteristics. Method: Parents/guardians of preschool-aged children ( N = 900) from four primary care settings completed two full-length behavioral rating scales. Items measuring disruptive behavior problems were tested for DIF by child race, sex, and socioeconomic status using two approaches: item response theory-based likelihood ratio tests and ordinal logistic regression. Results: Of 18 items, eight were identified with statistically significant DIF by at least one method. Conclusions: The bias observed in 8 of 18 items made them undesirable for screening diverse populations of children. These items were excluded from the new brief screening tool.

Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control Trial.

OBJECTIVES: To test the efficacy of Reducing the Risk (RTR) and Love Notes (LN) on reducing risky sexual behavior among youths yet to experience or cause a pregnancy. METHODS: The four dependent variables were ever had sex, condom use, birth control use, and number of sexual partners at 3- and 6-month follow-up in a 3-arm cluster randomized controlled trial of 1448 impoverished youths, aged 14 to 19 years, in 23 community-based organizations in Louisville, Kentucky, from September 2011 through March 2014. RESULTS: At 3 and 6 months, compared with the control condition, youths in RTR reported fewer sexual partners and greater use of birth control. At 6 months, LN participants reported greater use of birth control and condoms, fewer sexual partners, and were less likely to have ever had sex compared with the control condition. CONCLUSIONS: We provided additional evidence for the continued efficacy of RTR and the first rigorous study of LN, which embeds sex education into a larger curriculum on healthy relationships and violence prevention.

Precision across race, age and gender of a HIV risk screen for adolescents and young adults.

Identification of adolescents and young adults at high risk for HIV infection in South Africa is a key component of current and future prevention efforts. A 5-item measure was developed in the current study with acceptable levels of reliability and validity, and all items discriminating sufficiently between respondents at different levels of risk. However, both uniform and non-uniform differential item functioning (DIF) were revealed as problems: items performed differently by age, race, and gender groups. Consequently age-, race-, and gender-specific percentile-based norms were developed. Implications for policy and practice are discussed.

Exploring attitudes regarding smokeless tobacco products for risk reduction.

Utilizing qualitative data analysis, this study focused on the attitudes, knowledge, and beliefs relating to smokeless tobacco (ST) as a reduced-risk cigarette substitute for smokers among focus groups from the general public and from the health profession. It revealed that there is a lack of awareness and understanding of ST products, which has a significant impact on overall perception of these products as acceptable substitutes. Regulatory actions regarding tobacco by the U.S. Food and Drug Administration should enhance consumers' access to accurate information about nicotine addiction and tobacco use.

Identification of developmentally appropriate screening items for disruptive behavior problems in preschoolers.

Screening preschool-aged children for disruptive behavior disorders is a key step in early intervention. The study goal was to identify screening items with excellent measurement properties at sub-clinical to clinical levels of disruptive behavior problems within the developmental context of preschool-aged children. Parents/caregivers of preschool-aged children (N = 900) were recruited from four pediatric primary care settings. Participants (mean age = 31, SD = 8) were predominantly female (87 %), either white (55 %) or African-American (42 %), and biological parents (88 %) of the target children. In this cross-sectional survey, participants completed a sociodemographic questionnaire and two parent-report behavioral rating scales: the PSC-17 and the BPI. Item response theory analyses provided item parameter estimates and information functions for 18 externalizing subscale items, revealing their quality of measurement along the continuum of disruptive behaviors in preschool-aged children. Of 18 investigated items, 5 items measured only low levels of disruptive behaviors among preschool-aged children. The remaining 13 items measured sub-clinical to clinical levels of disruptive behavior problems (i.e., >1.5 SD); however, 5 of these items offered less information, suggesting unreliable measurement. The remaining 8 items had high discrimination and difficulty parameters, offering considerable measurement information at sub-clinical to clinical levels of disruptive behavior problems. Behaviors measured by the 8 selected parent-report items were consistent with those identified in recent efforts to distinguish developmentally typical misbehaviors from clinically concerning behaviors among preschool-aged children. These items may have clinical utility in screening young children for disruptive behavior disorders.

The impact of the Solution Based Casework (SBC) practice model on federal outcomes in public child welfare.

OBJECTIVE: To test the effects of the Solution-Based Casework practice model on federal outcomes of safety, permanency and well-being. The Solution-Based Casework model combines family development theory, solution-focused skills and relapse prevention for the casework process in child protection. METHOD: 4,559 public child welfare cases were reviewed through a CQI case review process. RESULTS: This study found that cases with high levels of fidelity to the model demonstrated significantly better outcomes in the areas of child safety, permanency and well-being and exceeded federal standards, while cases with low fidelity to the model failed to meet federal standards. CONCLUSION: Components of the Solution-Based Casework were significant predictors of these federal outcomes and accounted for variance in these outcomes better than any other casework process factors.