EVALUATION OF ALL BABIES CRY, A SECOND GENERATION UNIVERSAL ABUSIVE HEAD TRAUMA PREVENTION PROGRAM.

Child maltreatment results in significant individual, family, and societal costs. This study assessed the efficacy of All Babies Cry (ABC), a media-based infant maltreatment prevention program, using a mixed-method, quasi-experimental staged evaluation design. ABC's messaging, designed and tested through a series of focus groups, provides strategies for reducing parental stress and soothing infants. Participants (n = 423) were first-time parents, 70% fathers, recruited at two hospitals. The first 211 were controls; the next 212 received ABC. Participants were interviewed 3 times: at baseline in hospital, and by telephone 5 weeks (n = 359; 85%) and 17 weeks (n = 326; 77%) later. Researchers measured parents' perceptions, intentions, and use of strategies to calm crying and manage caregiver stress. Outcomes were based on the Strengthening Families Model and the Theory of Planned Behavior. The intervention was well received, appears effective in improving mediators of behavior, and may change parental behavior.

Sexual risk factors for HIV and violence among Puerto Rican women in New York City.

The authors examined sexual factors for HIV risk in 1,003 women of Puerto Rican heritage who attended a community-based NewYork City hospital clinic. Participants' ages ranged from 18 to 73 years. Half were born in the continental United States, and half were born in the Commonwealth of Puerto Rico. All were sexually active within the past 90 days with a male partner.The authors compared sociodemographic characteristics, experience of intimate partner violence (IPV), and HIV sexual risk factors (number of partners, history of sexually transmitted infections [STIs],condom use, and so on).Multiple regression analyses considering sociodemographic characteristics were a predictor for IPV and sexual risk behaviors. The authors found differences in sexual risk behaviors by place of birth (continental United States versus Commonwealth of Puerto Rico) and language chosen for the interview (Spanish or English).Puerto Rican women reported fewer sexual partners and STIs. Mainland-born and English-preference women reported more IPV, risky partners, and condom use. Birth in the continental United States and preference for English appear to be indicators of greater risk for IPV, risky sexual practices, and risky partners. HIV prevention intervention strategies for Puerto Rican women must address differences in heterosexual risk according to language and place of birth.

Longitudinal observation of an HIV prevention community planning group (CPG).

HIV prevention community planning groups were formed to increase stakeholder participation and develop evidence-based comprehensive HIV prevention plans. To date, it is not well understood what factors affect group behavior as the planning group prepares for data-informed decision making. In this observational case study, the authors videotaped 18 meetings of a community planning group (CPG) to observe how a group's behavior changes over time in response to modifications in its structure and function. Discussions on authority and conflict were common, particularly during presentations on prioritized populations and interventions. Changes in the frequency of data-informed discussions were not statistically significant. Observed group conflict may have been an unintended consequence of efforts to improve equity. The authors suggest that formal and informal mechanisms to manage conflict and agreed-on procedures for decision making should be incorporated into the technical assistance offered to CPGs. Future studies should address whether data-informed decisions increase once contentious issues are resolved.

Heterosexual women of color and HIV risk: sexual risk factors for HIV among Latina and African American women.

This paper examines sexual risk for HIV among 2,318 Latina (60%) and African American (40%) women with a steady male partner who were attending an urban outpatient clinic. We compared ethnic groups on demographic characteristics (including being born in the U.S.) and sexual HIV risk factors (number of partners, history of sexually transmitted infection, condom use, and reported knowledge and perception of partner risk) while controlling for other demographic characteristics. African American women were about 1.5 times more likely than Latinas to report five or more sexual partners in their lifetime, to report two or more partners in the past year, and to perceive their partners as being risky. African American women were about 2.5 times more likely than Latinas to have had a history of sexually transmitted infections (STIs). They were also nearly twice as likely as Latinas to report having used condoms with their main partner in the past 90 days. Intervention strategies for HIV prevention must address ethnic/racial differences in sexual risk factors for HIV among Latina and African American women.

Interpersonal issues surrounding HIV counseling and testing, and the phenomenon of "testing by proxy".

This multimethod study explored challenges faced by women in close heterosexual relationships who decided to test for HIV, and their experiences with instituting safer sexual practices and partner testing. Eighty-one women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in one of four focus groups (women only, men only, or couples). Findings identified difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing. We also identified a pervasive phenomenon of "testing by proxy"--the belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. This dangerous practice must be addressed in public health prevention efforts. Programs aiming to reduce heterosexual HIV risk for women must include their male partners and incorporate effective interpersonal communication skills.

Child custody and visitation decisions when the father has perpetrated violence against the mother.

This research evaluated the effectiveness of statutes mandating a presumption against custody to a perpetrator of domestic violence (DV) and judicial education about DV. Across six states, the authors examined 393 custody and/or visitation orders where the father perpetrated DV against the mother and surveyed 60 judges who entered those orders. With the presumption, more orders gave legal and physical custody to the mother and imposed a structured schedule and restrictive conditions on fathers' visits, except where there was also a "friendly parent" provision and a presumption for joint custody. The presumption is effective only as part of a consistent statutory scheme. Although 86% of judges had received DV education, they scored no better in knowledge or attitudes. More of their orders gave mothers sole physical custody, and knowledge was associated with maternal custody, yet fewer structured or restricted fathers' visitation. Quality of DV education is more important than statutory mandate.

Bridging data and decision making: development of techniques for improving the HIV prevention community planning process.

Assessments of community planning in Massachusetts and Texas were used to develop tools for increasing the use of data by HIV prevention community planning groups (CPGs) and prevention providers while also increasing participation of CPG members. Barriers to data use included organizational problems in CPGs (e.g., lack of clear procedures, distrust of peers and leadership) and technical assistance needs for CPG members and researchers who provide data. The absence of data relevant to local epidemics was another barrier. Specific linkages are provided between the assessments of these needs and the development of a technical assistance tools (e.g., websites, templates for data presentation, experiential involvement in data use) and strategies for organizational change in CPGs, as well as efforts to better use available data and create or identify new sources of local data.

HIV prevention community planning: enhancing data-informed decision-making.

The primary purpose of this study was to test the impact of the first year of a 3-year intervention designed to enhance the use of behavioral data in the Massachusetts HIV Prevention Community Planning Group (MPPG). A one-group, pretest-posttest, nonequivalent independent variables, quasi-experimental design was used to assess changes before and after the first year of implementing strategies to enhance the use of behavioral data in decision-making. Over 90% of the CPG members completed surveys at baseline and at the end of the first year of the intervention. Consistent with the focus of the MPPG intervention in Year One, significant improvements were found from baseline to follow-up in member perceptions of decision-making structure and leadership, satisfaction with prevention planning processes, and intervention prioritization decisions. Findings provide preliminary evidence for the impact on member satisfaction of changes in CPG organizational structures and processes, including redistribution of power and broader constituent representation.

Improving the use of data for HIV prevention decision making: lessons learned.

HIV prevention community planning was developed to promote identification of local prevention priorities through a process that was evidence-based and provided community input. There are a variety of barriers to effective use of data in community planning which include characteristics of data (availability, timeliness, relevance to planning tasks), characteristics of planning group members and providers of data (e.g., skills in understanding and applying data), and social-organizational aspects of community-planning groups (CPGs). Lessons learned from this project illustrate how to create locally relevant sources of data, build data use skills of CPG members and data providers, and address social-organizational aspects of planning, while also better integrating community planning with implementation of prevention plans. Adaptation of tools and methods is discussed along with future considerations for research and planning practice.

HIV prevention community planning: challenges and opportunities for data-informed decision-making.

The use of data in decision-making by the Massachusetts Prevention Planning Group (MPPG) was assessed using multiple methods: in-depth interviews, member surveys, directed observations, and archival review. Three factors known to influence group decision-making were of interest: (1) member characteristics, (2) group structure, and (3) data inputs. Membership characteristics were not related to reliance on data. However, group structure factors and data inputs were directly related to reliance on data. Most members accepted an advisory role and felt participation was worthwhile. About half were dissatisfied with decision-making processes, citing member conflicts and distrust. Incompleteness of data, inadequate presentation quality, and lengthy intervals between presentations and actual decision-making were identified as deficits. Although most members reported skills with HIV- and intervention-related data, most also reported deficiencies in interpreting evaluation and cost-effectiveness studies. Member trust and use of data in decision-making could be improved by clarifying decision-making structures and processes, assuring high-quality data presentations, and supporting or training members to better interpret and use data.

Heterosexual behavioral maintenance and change following HIV counseling and testing.

This study investigated heterosexual HIV risk behaviors, changes in stage of change for safer sex and factors associated with such changes, among a diverse sample of 560 heterosexually active individuals presenting at publicly funded HIV C&T sites. Questionnaires were administrated before HIV C&T, and three months afterwards. Positive serostatus was the most significant predictor of safer behavior after C&T. Many seronegative participants stopped sex with non-main partners. Behaviors with main partners were particularly resistant to change. Predictors of change varied by stage at pre-test. C&T services should tailor approaches and referrals based on stage of change and other client characteristics.

The obesity epidemic in the United States.

We describe the epidemic of obesity in the United States: escalating rates of obesity in both adults and children, and why these qualify as an epidemic; disparities in overweight and obesity by race/ethnicity and sex, and the staggering health and economic consequences of obesity. Physical activity contributes to the epidemic as explained by new patterns of physical activity in adults and children. Changing patterns of food consumption, such as rising carbohydrate intake--particularly in the form of soda and other foods containing high fructose corn syrup--also contribute to obesity. We present as a central concept, the food environment--the contexts within which food choices are made--and its contribution to food consumption: the abundance and ubiquity of certain types of foods over others; limited food choices available in certain settings, such as schools; the market economy of the United States that exposes individuals to many marketing/advertising strategies. Advertising tailored to children plays an important role.