It's Your Game: Keep It Real: delaying sexual behavior with an effective middle school program.

PURPOSE: This study tested the effects of a theory-based, middle-school human immunodeficiency virus, STI, and pregnancy prevention program, It's Your Game: Keep it Real (IYG), in delaying sexual behavior. We hypothesized that the IYG intervention would decrease the number of adolescents who initiated sexual activity by the ninth grade compared with those in the comparison schools. METHODS: The target population consisted of English-speaking middle school students from a large, urban, predominantly African-American and Hispanic school district in Southeast Texas. Ten middle schools were randomly assigned either to receive the intervention or to the comparison condition. Seventh-grade students were recruited and followed through ninth grade. The IYG intervention comprises 12 seventh-grade and 12 eighth-grade lessons that integrate group-based classroom activities with computer-based instruction and personal journaling. Ninth-grade follow-up surveys were completed by 907 students (92% of the defined cohort). The primary hypothesis tested was that the intervention would decrease the number of adolescents who initiated sexual activity by the ninth grade compared with those in the comparison schools. RESULTS: Almost one-third (29.9%, n=509) of the students in the comparison condition initiated sex by ninth grade compared with almost one-quarter (23.4%, n=308) of those in the intervention condition. After adjusting for covariates, students in the comparison condition were 1.29 times more likely to initiate sex by the ninth grade than those in the intervention condition. CONCLUSIONS: A theory-driven, multi-component, curriculum-based intervention can delay sexual initiation up to 24 months; can have impact on specific types of sexual behavior such as initiation of oral and anal sex; and may be especially effective with females. Future research must explore the generalizabilty of these results.

The relationship between future orientation and street substance use among Texas alternative school students.

Self-reported substance use data were collected from 963 alternative school students in grades 7-12 who were surveyed through the Safer Choices 2 study in Houston, Texas. Data were collected between October 2000 and March 2001. Logistic regression analyses indicated that lower levels of future orientation was significantly associated (OR = 0.88, 95% CI = 0.81-0.97) with thirty-day substance use after controlling for age and gender. In addition, lower levels of future orientation was found to have a significant association with students' lifetime substance use (OR = 0.93, 95% CI = 0.87-.99) after controlling for age, race, and gender. While the relationships tested in this study are exploratory, they provide evidence for an important connection between future orientation and substance use among adolescents attending alternative schools.

Impact of the media on adolescent sexual attitudes and behaviors.

BACKGROUND: Adolescents in the United States are engaging in sexual activity at early ages and with multiple partners. The mass media have been shown to affect a broad range of adolescent health-related attitudes and behaviors including violence, eating disorders, and tobacco and alcohol use. One largely unexplored factor that may contribute to adolescents' sexual activity is their exposure to mass media. OBJECTIVE: We sought to determine of what is and is not known on a scientific basis of the effects of mass media on adolescent sexual attitudes and behaviors. Method. We performed an extensive, systematic review of the relevant biomedical and social science literature and other sources on the sexual content of various mass media, the exposure of adolescents to that media, the effects of that exposure on the adolescents' sexual attitudes and behaviors, and ways to mitigate those effects. Inclusion criteria were: published in 1983-2004, inclusive; published in English; peer-reviewed (for effects) or otherwise authoritative (for content and exposure); and a study population of American adolescents 11 to 19 years old or comparable groups in other postindustrial English-speaking countries. Excluded from the study were populations drawn from college students. RESULTS: Although television is subject to ongoing tracking of its sexual content, other media are terra incognita. Data regarding adolescent exposure to various media are, for the most part, severely dated. Few studies have examined the effects of mass media on adolescent sexual attitudes and behaviors: only 12 of 2522 research-related documents (<1%) involving media and youth addressed effects, 10 of which were peer reviewed. None can serve as the grounding for evidence-based public policy. These studies are limited in their generalizability by their cross-sectional study designs, limited sampling designs, and small sample sizes. In addition, we do not know the long-term effectiveness of various social-cultural, technologic, and media approaches to minimizing that exposure (eg, V-Chips on television, Internet-filtering-software, parental supervision, rating systems) or minimizing the effects of that exposure (eg, media-literacy programs). CONCLUSIONS: Research needs to include development of well-specified and robust research measures and methodologies; ongoing national surveillance of the sexual content of media and the exposure of various demographic subgroups of adolescents to that content; and longitudinal studies of the effects of that exposure on the sexual decision-making, attitudes, and behaviors of those subgroups. Additional specific research foci involve the success of various types of controls in limiting exposure and the mitigative effects of, for example, parental influence and best-practice media-literacy programs.

Using intervention mapping to adapt an effective HIV, sexually transmitted disease, and pregnancy prevention program for high-risk minority youth.

Although many programs have been developed to reduce adolescent pregnancy and sexually transmitted diseases (STDs) (including HIV), with some showing promise in reducing sexual risk-taking behavior, little guidance has been given as to how to adapt existing interventions to new communities. When adapting a program, effective elements deemed necessary to change behaviors need to be preserved, while cultural competence and relevance for the new population must be considered in creating new elements. To address these needs, the authors describe the application of a systematic process, intervention mapping (IM), to adapt a theory-based, multicomponent HIV, STD, and pregnancy prevention program titled Safer Choices to a new target population, at-risk youth attending alternative schools and at risk of dropping out. IM is a detailed process that provides planners with a systematic method for decision making in each phase of developing or adapting an intervention to influence changes in behavior and environmental conditions.

Family connectedness and sexual risk-taking among urban youth attending alternative high schools.

CONTEXT: Youth in alternative high schools engage in risky sexual behavior at higher rates than do their peers in regular schools, placing themselves at an increased risk of sexually transmitted disease and unintended pregnancy. Family connectedness is associated with reduced adolescent sexual risk-taking, although this association has not been tested among alternative school youth. METHODS: A sample of 976 urban, predominantly minority alternative high school students in Houston, Texas, were surveyed in 2000-2002. Survey data were analyzed using logistic regression to determine whether family connectedness is related to sexual risk-taking. RESULTS: Overall, 68% of students reported ever having had sex. Of sexually experienced students, 74% reported having had sex in the past three months and 29% reported ever having been involved in a pregnancy. The higher students scored on a scale of perceived family connectedness, the less likely they were to report ever having had sex, recently having had unprotected sex and having been involved in a pregnancy (odds ratio, 0.97 per unit increase for each outcome). Among females, higher perceived family connectedness was associated with reduced odds of ever having had sex or having initiated sex prior to age 13 (0.96 for each); males who perceived higher family connectedness had reduced odds of having been involved in a pregnancy (0.93). CONCLUSIONS: Family connectedness may be a protective factor related to sexual risk-taking, even among high-risk youth. Including activities that acknowledge the influence of family relationships and facilitate positive parent-child relationships may increase the efficacy of programs for reducing sexual risk-taking among alternative school youth.

The relationship between sexual abuse and drug use: findings from Houston's Safer Choices 2 program.

Self-report drug use data were collected from 282 female alternative school students surveyed through the Safer Choices 2 study in Houston, Texas. Data collection took place between October 2000 and March 2001 via audio-enabled laptop computers equipped with headphones. Logistic regression analyses indicated that sexual abuse history was significantly associated with lifetime use (OR = 1.9, p < or = 0.05). While the relationships tested in this study are exploratory, they provide evidence for an important connection between sexual abuse and substance use among female alternative school students.

La relación entre los juegos de videos violentos, la aculturación y la agresión entre adolescentes latinos / The relationship between violent video games, acculturation, and aggression among Latino adolescents

Multiple factors are involved in the occurrence of aggressive behavior. The purpose of this study was to evaluate the hypotheses that Latino middle school children exposed to higher levels of video game playing will exhibit a higher level of aggression and fighting compared to children exposed to lower levels and that the more acculturated middle school Latino children will play more video games and will prefer more violent video games compared to less acculturated middle school Latino children. This study involved 5,831 students attending eight public schools in Texas. A linear relationship was observed between the time spent playing video games and aggression scores. Higher aggression scores were significantly associated with heavier video playing for boys and girls (p0.0001). The more students played video games, the more they fought at school (p0.0001). As Latino middle school students were more acculturated, their preference for violent video game playing increased, as well as the amount of time they played video games. Students who reported speaking more Spanish at home and with their friends were less likely to spend large amounts of time playing video games and less likely to prefer violent video games (p0.05).

Recruiting and retaining minority women: findings from the Women on the Move study.

OBJECTIVES: To describe the recruitment, enrollment, and retention of women participating in the Women on the Move study, a physical activity validation study targeting urban minority women aged 40 to 70 years. DESIGN: The intensive 15-day validation protocol included ingestion of doubly labeled water (2H2 18O), collection of 9 urine samples, completion of multiple physical activity surveys, including selected questions from the BRFSS and NHANES III, wearing an accelerometer, and completing a detailed diary of physical activity for 7 days. The follow-up interview included completion of more questionnaires, followed by measurement of resting metabolic rate. In planning for recruitment, enrollment, and retention of participants, investigators consulted with a community advisory board and conducted focus groups with members of the target communities and with key community leaders. METHODS: Recruitment methods included print, television, and radio advertisements and presentations at community health fairs, churches, and health clinics. RESULTS: Of the 656 women who expressed interest in the study, 386 (59%) met eligibility criteria, and 260 were enrolled (130 Latina, 130 African-American). To retain participants in the study, investigators had intensive telephone contact with the participants, scheduled meetings at times and locations convenient for the participants, used bilingual and bicultural staff, and offered participants staged monetary payments. Of the women enrolled, the retention for the meetings that could happen at more convenient locations was 98.8% and for the required meeting at a central location it was 85.4%. CONCLUSION: Experience from the Women on the Move study suggests that by working with community members, Latina and African-American women can be successfully recruited and, through extensive contact, retained, even in research studies with demanding protocols.

The relationship between violent video games, acculturation, and aggression among Latino adolescents.

Multiple factors are involved in the occurrence of aggressive behavior. The purpose of this study was to evaluate the hypotheses that Latino middle school children exposed to higher levels of video game playing will exhibit a higher level of aggression and fighting compared to children exposed to lower levels and that the more acculturated middle school Latino children will play more video games and will prefer more violent video games compared to less acculturated middle school Latino children. This study involved 5,831 students attending eight public schools in Texas. A linear relationship was observed between the time spent playing video games and aggression scores. Higher aggression scores were significantly associated with heavier video playing for boys and girls (p < 0.0001). The more students played video games, the more they fought at school (p < 0.0001). As Latino middle school students were more acculturated, their preference for violent video game playing increased, as well as the amount of time they played video games. Students who reported speaking more Spanish at home and with their friends were less likely to spend large amounts of time playing video games and less likely to prefer violent video games (p < 0.05).

Violent behavior among urban youth attending alternative schools.

This study described violent behavior and aggression among youth attending alternative schools, and examined sociodemographic factors associated with such violence. The study involved 494 students attending 10 alternative schools in Houston, Texas. Data were collected between November 2000 and February 2001 by audio-enabled laptop computers equipped with headphones. Students self-reported an average of 11.8 aggressive acts during the week prior to the survey. Students reported a 30-day weapon carrying prevalence of 22.7%; 30-day gun carrying prevalence of 11.1%; 30-day knife or club prevalence of 17.2%; 12-month fighting prevalence of 50.6%; and 12-month prevalence of injuries due to fighting of 6.5%. Association between demographic variables, self-reported aggressive behavior, and other forms of aggression was examined using multivariate logistic regression. Students were divided into four mutually exclusive violence-related categories: no fighting and no weapon (referent), fighting only, carrying weapon only, fighting and weapon carrying. Student aggression was significantly associated with fighting and weapon carrying, with incremental increases at each level (OR 1.1 per unit of increase, 95% CI 1.1-1.2) and in presence of the covariates. Among Houston's alternative school students, the prevalence of violent behavior (weapon carrying, gun carrying, knife or club carrying, fighting, and treatment by a doctor or nurse for injuries) is higher compared to regular high school students. Aggression related strongly to weapon carrying and fighting in the sample. Data indicate alternative school youth urgently need prevention and treatment programs to help them live in safer environments.