The birds and the bees: do Puerto Rican mothers and daughters talk about sex?

INTRODUCTION: Effective communication skills that foster responsible sexual decisions are known to have the potential to reduce the risky adolescent sexual behavior. It is well understood that maternal communication is a key element in modifying the adolescent sexual behavior. The objective of this qualitative study was to explore if Puerto Rican mothers of adolescent girls have conversations about sexuality with their daughters and the content of such conversations. METHODS: A total of 22 HIV-seropositive mothers and 22 HIV-seronegative mothers were enrolled. Six focus groups were conducted, sessions were transcribed ad-verbum and coded for specific topics. All qualitative analysis was incorporated into Atlas.ti. RESULTS: Participants in both groups had a similar average age (mean=41 years old); but, the HIV-seropositive mothers were more likely single, less educated and unemployed. Regarding having engaged in conversations about sexuality and the topics covered, however, there were no differences revealed among HIV-seropositive mothers and seronegative mothers. In both groups, mothers understood the importance of these conversations, but most said they were difficult and uncomfortable. CONCLUSION: These findings reinforce the importance of communication between mothers and daughters for the prevention of STIs, HIV/AIDS, and teenage pregnancy in minority populations.Interventions are needed for mother and daughter to improve communication skills, communication about sexuality, and addressing prevention.

Implementing a Randomized Controlled Trial through a Community-Academia Partnered Participatory Research: Arte con Salud Research-Informed Intervention.

OBJECTIVE: "Arte con Salud" is an HIV/AIDS prevention intervention tailored for Puerto Rican women who have sex with men. The intervention curriculum was refined through a community-academic collaboration between Taller Salud, the UPRCayey Campus, and the UCC-School of Medicine, subsided in 2012-13 by PRCTRC. The collaboration has been crucial to validate the impact of using art as a tool to facilitate sexual negotiation skills and safer sexual practices among adult women have sex with men participating in HIV prevention education. METHODS: This article describes the vision, valley, victory phases endured to establish a community-academia partnership based on the CPPR framework as an effective mean to implement a randomized controlled trial intervention (RCT). We also discuss the barriers, outcomes, and lessons learned from this partnership. RESULTS: Some of the identified solutions include: setting goals to secure funding, regular meetings, and the inclusion of undergraduate level students to assist in the implementation of the intervention. These solutions helped to build trust among the community and academic partners. As a result of this collaboration, a total of 86 participants were enrolled and 5 competitive research grants have been submitted. CONCLUSION: The community-academic collaboration was essential in order to build a solid research infrastructure that addresses the complexities of HIV prevention education among groups of Puerto Rican women.

Impact of ASUMA Intervention on HIV Risk Behaviors among Puerto Rican Adolescents.

The purpose of this manuscript is to assess and compare HIV risk behaviors among early adolescents after a three-year pilot study. A total of 135 public and private junior high schools students completed the intervention protocol. A self-administered questionnaire was given at baseline and at the end of the third year (fourth measure). Descriptive and inferential analyses were performed using SPSS 20.0. About 60% of the students were 14 years old at the fourth measure. The proportion of students that did not report at least one HIV risk behavior at baseline and those that reported any risk behavior at the fourth measure was lower in the intervention group (45.0%) than in the control group (54.5%). The proportion of students that reported at least one HIV risk behavior at baseline and those that did not report any HIV risk behavior at the fourth measure was higher in the intervention group than in the control group (33.3% vs. 8.3%). The proportion of students engaging in HIV risk behaviors was higher in the control group than in the intervention group at the fourth measure, suggesting that A Supportive Model for HIV Risk Reduction in Early Adolescence (ASUMA) intervention might be a promising initiative to reduce adolescents' engagement in HIV risk behaviors.

Changes in developmental factors and HIV risk behaviors among early adolescents in Puerto Rico.

INTRODUCTION: Teenagers are the fastest growing group of newly HIV-infected persons. Consequently, a support model for HIV risk reduction was designed and implemented for early adolescents in Puerto Rico. OBJECTIVE: The purpose of this article is to assess changes in developmental factors and HIV risk behaviors among early adolescents after three years of follow-up of an intervention and a non-intervention group. METHODS: This prospective cohort study followed 135 early adolescents who were enrolled in the ASUMA (A Supportive Model for HIV Risk Reduction in Early Adolescents) Project. The study was performed in two public and two private junior schools. Baseline and three follow-up self-administered questionnaires were given. We examined sociodemographic factors, HIV risk behavior and developmental factors. RESULTS: 48% were in the intervention group and 51.1% were controls. Most adolescents were aged 12 years; 47.4% were males; 75.6% reported not having risk behaviors and 24.4% reported having risk behaviors at anytime in their lifespan. A significant decrease in the HIV risk behaviors median was observed among the intervention group (P < .05), while a nonsignificant increase was found among adolescents in the control group. At the end of the implementation phase, positive improvement in the developmental factors were observed in the intervention group (P < .05). CONCLUSIONS: Our study suggests that the ASUMA project curriculum had a positive effect on developmental factors and HIV risk behaviors, as proposed in our conceptual framework. Also, this study illustrates the importance of the creation of culturally appropriate instruments and interventions to reach the goal of HIV/AIDS reduction.

Mothers of adolescent girls: comparing HIV positive and HIV negative women.

BACKGROUND: HIV+ mothers of adolescent girls can serve as agents of change, particularly when it comes to preventing patterns of behaviors that are inherently dangerous. In order to do so these women need to be able to communicate with their daughters and educate them about risk behaviors, especially those associated with HIV acquisition. The objective is to describe the sociodemographic and risk profile in a sample of mothers of adolescent girls who are HIV+ or HIV negative and analyze differences between them. METHODS: A convenience sample was recruited from three sites, the Universidad Central del Caribe School of Medicine, the UPR School of Medicine, and the Ponce School of Medicine. Six focus groups, two in each institution, were conducted following Krueger's methodology with the objective of developing an educational intervention for mothers of adolescent girls. All participants completed two self-administered questionnaires prior to the focus group. A data analysis was performed--descriptive statistics for the sociodemographic measures included frequencies, percents, mean and SD. We used t test and the Fisher's exact test to analyze differences between groups. RESULTS: A total of 44 participants were enrolled, with 50% being HIV positive mothers and 50% being HIV negative mothers. The mean age for both groups was similar (41 years). Statistically significant differences (P < .05) were observed among HIV diagnosis and for the following variables: education, working status, income, marital status, age at first intercourse, and illicit drug use. CONCLUSIONS: It is possible that the sociodemographic characteristics of HIV+ women affect their parenting and communication skills. The same factors that may have led to these women being infected by HIV in the first place might in addition be compromising their roles as effective parents.

Recruitment of HIV positive and negative women in Puerto Rico: the experiences of a research team.

BACKGROUND: Women with HIV positive status are considered a hard to reach population by many. We discuss the experiences of a research team while conducting the recruiting process with both Hispanic Puerto Rican HIV positive and HIV negative populations. OBJECTIVE: To provide strategies and recommendations for conducting research interventions with HIV+ and HIV- women. METHODS: This study explored the communication skills between HIV+ and HIV-mothers and their adolescent daughters regarding disclosure of their status, and the discussion, or lack of, on topics related to sexuality and prevention of HIV/AIDS. This study explored the recruitment, retention and intervention processes of a qualitative research study that used focus groups to understand the communication skills between HIV+ and HIV-mothers and their adolecent daughters regarding disclosure of their status, and the discussion, or lack of, on topics related to sexuality and prevention of HIV/AIDS. The goal of this team was to describe the diverse factors and dynamics that influence the process of recruitment and retention when conducting research. RESULTS: The process of recruitment entails not only the action but the planning of the interventions with both the community and the participants. Minority women and the HIV positive population have many difficulties complying with study procedures such as attendance and transportation, among other issues. We describe the importance of constant communication with the centers' coordinators and prospective participants about the process of planning and recruiting. CONCLUSIONS: The significance of flexibility within the research team and recognizing the particular characteristics of conducting research with minorities and women with and without HIV+ status should be emphasized. Researchers should recognize that many of the HIV+ women have been exposed to previous studies. In addition, the general population should be informed about the importance of participating in research studies.

Gender differences in social and developmental factors affecting Puerto Rican adolescents during the early stage.

BACKGROUND: Adolescence is associated with risky behaviors related with social and developmental factors. Objectives were to describe social and developmental factors affecting Puerto Rican early adolescent by gender and type of school at study entry. METHODS: Cross-sectional study design. The study group was composed by 168 seventh grade adolescents from private and public schools. Descriptive and non-parametric comparisons were performed. RESULTS: Significance differences among proportions for gender by type of school were found in the following variables: self-esteem and HIV/AIDS attitudes in public school and peer pressure and sensation seeking in private school. DISCUSSION: Our study revealed that public school adolescents are characterized by males with higher self-esteem and less attitude for HIV/AIDS, while in private school the males has more peer pressure and seeking sensation than females. Future studies could analyze factors related with changes in developmental factors, this step is important to evaluate the effectiveness of ASUMA interventions.

Do parents know about the adverse effects of passive smoking and the relationship with respiratory illness on their children?

UNLABELLED: Recent studies still show parental smoke as the number one environmental exposure agent causing asthma in pediatric population. OBJECTIVE: The purpose of this study is to determine the knowledge of parents about the adverse effects of passive smoking and the prevalence of passive smoking in children. DESIGN: Cross sectional study, participants were caregivers of students from first to sixth grade (three private and two public schools) who answered a self-administered survey. Data was analyzed using SPSS. RESULTS: Surveys were collected by availability. Total of caregivers was 594, (47% from private and 53% from public school). The total of estimated children in the survey was 1318, and 48.3% in general had recurrent respiratory illness. Among caregivers, 12.1% (72) reported to be smokers. There were 127 participants who revealed at least 1-3 smokers in their home; these smokers are affecting 167 children who are exposed to secondhand smoke. Among smokers, 16.9% smoked inside the house, 15.5% in their cars and 12.3% smoked in the presence of their children. Participants with higher education had a higher average score on knowledge about adverse effects of smoking (p<.001). Over half of the participants (52%) reported seen anti-smoking promotion on T.V. during previous days. Non-smokers revealed they have seen such promotion recently (p=0.00), but 31% of all participants reported not seen any anti-smoking promotion at all. CONCLUSIONS: The prevalence of smokers in our study was 12.1%. We estimated there was more than one smoker in those households where smoking was allowed. There was a higher prevalence of smokers among parents from public schools. There was no significant difference between passive smoker households and non-smoker households for respiratory illness in their children. Pediatricians are giving information to caregivers about active and passive smoking but still, 34% of smokers reported not receiving any information. We need to reinforce the counseling given to caregivers about the adverse effects of smoking has on environmental pollution, and as a cause of other cancers besides lung cancer, recurrent infections and SIDS.