The impact of afterschool program attendance on academic outcomes of middle school students

This evaluation examined the effects of afterschool programs—supported by an afterschool system intermediary organization (ASIO)—on middle school students' academic performance and examined how those effects varied by student characteristics and program engagement. In this longitudinal, quasi-experimental matched comparison group evaluation, propensity score matching was used to create demographically balanced samples of ASIO-supported afterschool program participants and nonparticipants. Students enrolled in the afterschool programs did not differ from non-participants in growth over time on most academic outcomes. Students attending the afterschool programs showed less growth on certain state test scores compared to nonparticipants. Student demographic characteristics did not consistently influence participant outcomes. Among program participants only, students who were enrolled more than 1 year demonstrated a 7-percentile-point increase in state test scores per year of program engagement. There was no consistent evidence that ASIO-supported afterschool program participation was associated with improved student academic outcomes. However, study results support increased emphasis on afterschool program retention, given that longer duration of participation in the afterschool programs was associated with more growth on multiple academic outcomes.     

Consistency of initial antiretroviral therapy with HIV treatment guidelines in a US cohort of HIV-infected women

BACKGROUND: HIV treatment guidelines define optimal initial antiretroviral therapy (ART). OBJECTIVE: To characterize initial ART used by a cohort of HIV-infected women according to US HIV treatment guidelines and determine whether regimen characteristics predict short-term outcomes. METHODS: Initial ART self-reported by Women's Interagency HIV Study (WIHS) participants. Regimens were classified as guideline consistent (GC), guideline not recommended (GNR), or unlisted. Univariate and multivariate logistic regression was used to analyze factors associated with guideline category. RESULTS: Two hundred seventeen WIHS participants initiated ART during the study period. Fifty-three percent reported use ofGC ART, 17% reported GNR ART, and 30% reported ART unlisted in guidelines. Study site, higher pretreatment CD4 cell count, lower HIV RNA level, and initiation before 2001 were associated with use of GNR regimens. GC ART users had a higher rise in CD4 cell counts and more frequent undetectable HIV-1 RNA levels 2 years after initiation compared with those GNR (P = 0.0003) or unlisted initial ART. CONCLUSIONS: A higher than expected proportion of WIHS participants reported using initial ART not recommended by HIV treatment guidelines, although this decreased over time. Use of such regimens was associated with a higher incidence of switching and poorer short-term immunologic and virologic outcomes.     

Alcoholics anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.     

The life-enhancing alcohol-management program: Results from a 6-month nonrandomized controlled pilot study assessing a community based participatory research program in housing first

A 2-arm, 6-month, nonrandomized controlled pilot trial was conducted to test the initial effectiveness of the Life Enhancing Alcohol-management Program (LEAP) as an adjunct to Housing First (HF; e.g., permanent supportive housing) on alcohol and quality-of-life (QoL) outcomes. The LEAP entails resident-driven leadership opportunities, meaningful activities, and pathways to recovery aimed at reducing alcohol-related harm and improving QoL. Data analyses were conducted to test between- and within-subjects effects of the LEAP on self-reported alcohol and QoL outcomes among HF residents. At the 6-month follow up, between groups analysis revealed nonsignificant findings for alcohol quantity or alcohol-related harm (ps > 0.06); however, LEAP participants reported significantly more engagement in meaningful activities than control participants (p < .001), and within-subjects analyses indicated that high levels of LEAP programming engagement predicted significant reductions in alcohol quantity and alcohol-related harm (ps < 0.01). The LEAP was associated with increased engagement in meaningful activities, and greater involvement in the LEAP programming was associated with reduced alcohol use and alcohol-related harm. Planning is underway for a future, large-scale randomized controlled trial to establish the efficacy of this approach, its generalizability across HF programs, and potential mechanisms of action.     

Can Childhood Behavioural Characteristics Predict Adolescent Boys' Health?: A Nine-year Longitudinal Study

Nine-year longitudinal data were used to group participants in terms of the stability of the boys' disruptiveness and/or anxiety. In addition to annual assessment, 625 boys were interviewed between the ages 14 and 16 years to measure healthy and risky behaviours, as well as health outcomes. A logistic regression showed significant group effects for risky health behaviours (e.g. unsafe sex, alcohol abuse). Boys with stable disruptive characteristics were most likely and boys with stable anxious characteristics were least likely to engage in risky behaviours. As for health outcomes, boys with stable disruptive characteristics used health services more often. The boys with anxious characteristics reported more chronic minor health problems and were hospitalized more for non-psychiatric problems during the past year.     

Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol

Food insecurity is associated with HIV treatment non-adherence and poor health outcomes for people living with HIV/AIDS. Given the poor nutritional status common to people who drink alcohol, food insecurity may be particularly problematic for HIV positive individuals who drink alcohol. To examine food insecurity among HIV positive men and women who drink alcohol and its association with antiretroviral therapy (ART) adherence, health outcomes and health service utilization. Adults living with HIV (N = 183) in Atlanta, Georgia who reported alcohol use in the previous week and were receiving ART participated in a 12-month cohort. Participants were recruited from infectious disease clinics and social services to complete computerized interviews, monthly-unannounced pill counts to monitor ART adherence, and daily cell-phone delivered interactive-text assessments for alcohol use. Forty-three percent of participants experienced food insecurity during at least one month of the study period. Food insecurity was independently associated with suboptimal ART adherence and less suppressed HIV viral load over. Individuals who experienced food insecurity also had histories of more medical and psychiatric hospitalizations, and greater mental health problems. Food insecurity is prevalent among alcohol using people receiving ART and food insecurity is associated with treatment non-adherence, poor health outcomes, and increased medical and psychiatric hospitalizations.     

Faculty development in teaching skills: an intensive longitudinal model.

Although reflection contributes to the personal growth of clinician-educators and is important for effective teaching, few teaching skills programs report its use. The Johns Hopkins Faculty Development Program in Teaching Skills, first implemented in 1987 as a theoretically grounded, longitudinal model for faculty development of clinician-educators, comprises a set of conditions intended to promote reflective learning. This paper describes the program and reports evaluation results for 98 participants and a comparison group of 112 nonparticipants between 1988 and 1996. Participants met with facilitators weekly for nine months for 3.5 hours, in stable groups of four to six individuals. Educational methods used across seven content areas emphasized relationships and collaboration, and included information provision, experiential learning with reflection, and personal awareness sessions. A pre-post evaluation design with comparison group measured changes in self-assessed teaching and professional skills, teaching enjoyment, and learning effectiveness. A post-only evaluation design appraised overall program quality, educational methods, facilitation, learning environment, and perceived impact of participation. Program participants had significantly greater pre-post-change scores than nonparticipants for all 14 outcomes (p <.05). Multiple regression modeling indicated that program participation was associated with pre-post improvement in all outcomes except administration skills, controlling for all participant and nonparticipant baseline characteristics (p <.05). All measured programmatic characteristics were highly rated by participants. Experiential methods with reflection were rated significantly higher than information-provision and personal awareness sessions (p <.001). Evaluation results demonstrate a positive impact of this alternative approach to faculty development on clinician-educator perceptions of their attitudes and behaviors towards learners and colleagues.     

A finite mixture model of growth trajectories of adolescent alcohol use: predictors and consequences

The current study sought to identify classes of growth trajectories of adolescent alcohol use and to examine the predictors and outcomes associated with the classes. Alcohol use was assessed from Grades 7 to 12 in a school-based sample. Latent growth mixture modeling was used, and results indicated 5 discrete longitudinal drinking patterns. The 2 most common drinking patterns included occasional very light drinking from Grades 7 to 12 and moderate escalation in both quantity and frequency of alcohol use. One group drank infrequently but at high levels throughout the study period. Another group exhibited rapid escalation in both quantity and frequency. The final group started at high levels of frequency and quantity in Grade 7 and showed rapid de-escalation in frequency. Emotional distress and risk taking distinguished the classes, and all classes, particularly rapid escalators, showed elevated levels of alcohol-related problems relative to occasional very light drinkers.     

Quality of life, overweight, and body fat distribution in middle-aged men

Measurements of obesity [body mass index (BMI)] and body fat distribution [waist-to-hip ratio (WHR)] were analyzed in 284 51-year-old men in relation to items about social, mental, and physical well-being from the G?teborg Quality of Life Instrument. Overweight participants (BMI > or = 25) reported a better home-family situation, appetite, and self-esteem, but decreased physical fitness and more pain in the legs compared with their leaner counterparts. Men with abdominal obesity (WHR > or = 1.0) experienced impaired health and physical fitness and lower self-esteem compared with those with WHR < 1.0. The abdominally obese participants were more often exhausted and experienced depressive symptoms. Abdominal pain was more frequent among those with WHR > or = 1.0. Overweight and abdominal obesity seem differently associated with social, mental, and physical well-being in men. Impaired quality of life may be causally related to the development of abdominal obesity; the mechanism involved might be increased cortisol secretion, which can redistribute body fat to central adipose tissue depots.     

Quality of Life,Overweight, and Body Fat Distribution in Middle-Aged Men

Abstract

Measurements of obesity [body mass index (BMI)] and body fat distribution [waist-to-hip ratio (WHR)] were analyzed in 284 51-year-old men in relation to items about social, mental, and physical well-being from the Göteborg Quality of Life Instrument. Overweight participants (BMI ≥ 25) reported a better home-family situation, appetite, and self-esteem, but decreased physical fitness and more pain in the legs compared with their leaner counterparts. Men with abdominal obesity (WHR ≥ 1.0) experienced impaired health and physical fitness and lower self-esteem compared with those with WHR < 1.0. The abdominally obese participants were more often exhausted and experienced depressive symptoms. Abdominal pain was more frequent among those with WHR ≥ 1.0. Overweight and abdominal obesity seem differently associated with social, mental, and physical well-being in men. Impaired quality of life may be causally related to the development of abdominal obesity; the mechanism involved might be increased cortisol secretion, which can redistribute body fat to central adipose tissue depots.     

Regular alcohol consumption is associated with increasing quality of life and mood in older men and women: The Rancho Bernardo Study

Objective

This study examines the sex-specific association between alcohol intake and health-related quality of life in middle class community-dwelling older adults.

Methods

Information on alcohol intake and measures of quality of life were obtained from 1594 participants (n = 633 men, n = 961 women) aged 50–97 years during a research clinic visit in 1992–1996, and from their responses to a phone interview and mailed questionnaires. Quality of life measures included the Medical Outcome Study Short Form 36 (SF-36), Quality of Well-Being (QWB) Scale, Life Satisfaction Index-Z (LSI-Z), and Satisfaction with Life Survey (SWLS). Depressed mood was assessed using the Beck Depression Inventory (BDI). Men and women were stratified into four groups of reported alcohol intake: non-drinker, occasional drinker (alcohol <3 times/week), light regular drinker (alcohol intake ≥3 times/week, but <170 g/week), and moderate regular drinker (alcohol intake ≥3 times/week and ≥170 g/week).

Results

Average age of both sexes was 72 ± 10 years. Only 11% of the men and 17% of the women were non-drinkers; 54% of men and 40% of women reported drinking alcohol ≥3 times per week; 18% of men and 7.5% of women were heavier regular drinkers. In multivariable regression analyses, increasing frequency of alcohol use was positively associated with better quality of life in men and in women. Associations were not explained by age, physical activity, smoking, depressed mood, or common chronic diseases including diabetes, hypertension and cardiovascular disease.

Conclusions

Regular alcohol consumption is associated with increased quality of life in older men and women.     

Dysmenorrhea,the Menstrual Cycle,and Sleep

This study examined the relationship between dysmenorrhea and insomnia, as well as variability in sleep across the menstrual cycle. Participants were 89 women, ages 18 to 24 (M = 18.63, SD = 0.93), who completed daily surveys for five weeks. On the second day of menses, they completed a questionnaire regarding dysmenorrhea. Participants having insomnia rated their dysmenorrhea as being more severe and causing more interference with daily activities than did participants without insomnia. Insomnia severity was directly associated with dysmenorrhea severity and interference. Sleep onset latency was longer and sleep efficiency was lower in participants with severe dysmenorrhea than in those with mild dysmenorrhea. Further, participants with mild dysmenorrhea reported significantly better sleep quality than did those having moderate or severe dysmenorrhea. Additionally, wake time after sleep onset was shortest and number of awakenings was lowest around the time of ovulation. Future research should examine whether treating dysmenorrhea or insomnia alone results in improvements in the other condition.     

Cigarette Smoking among HIV+ Men and Women: Examining Health,Substance Use,and Psychosocial Correlates across the Smoking Spectrum

The prevalence of cigarette smoking among HIV+ individuals is greater than that found in the general population. However, factors related to smoking within this population are not well understood. This study examined the associations between smoking and demographic, medical, substance use, and psychosocial factors in a clinic-based sample of HIV+ men and women. Two hundred twelve participants completed self-report measures of tobacco use, HIV-related symptoms, viral load, CD4, alcohol and illicit drug use, depression, and social support. Multinomial logistic regression (MLR) analyses modeled the independent associations of the cross-sectional set of predictors with smoking status. Results indicated that 74% of the sample smoked at least one cigarette per day; using standard definitions, 23% of the sample were light smokers, 22% were moderate smokers, and 29% smoked heavily. Smoking was associated with more HIV-related symptoms, greater alcohol and marijuana use, and less social support. Light smoking was related to minority race/ethnicity and less income; moderate smoking was associated with less education; and heavy smoking was related to less education and younger age. Viral load, CD4 count, and depression were not associated with smoking status. Psychosocial interventions targeting this population should consider the relationships between biopsychosocial factors and smoking behavior.     

Demographic and psychosocial risk factors for adolescent pregnancies among sexually active girls in the slums of Kampala,Uganda

Background/IntroductionAdolescent pregnancy is a global public health issue and often linked to adverse health outcomes for both the mother and child. Youth and adolescents living in the slums of Kampala, Uganda face many environmental and psychosocial adversities, and are at a high risk of experiencing adolescent pregnancy. The goal of this study was to determine the correlates of adolescent pregnancy among sexually active girls living in the slums of Kampala.MethodsThis study is based on a cross-sectional survey conducted in 2014 on youth and adolescents living in the slums of Kampala, Uganda (n=1,134) who were attending Uganda Youth Development Link drop-in centers. IRB approvals were granted.ResultsIn this study, 30.4% of girls reported a pregnancy. Girls who reported a pregnancy were more likely to have less than a primary education, to have lived on the streets, live in a house with more than two rooms, to drink alcohol, to have an STI, and have been raped and use condoms inconsistently, than girls who did not report a pregnancy.ConclusionsThese findings may inform pregnancy prevention interventions among adolescent girls living in Kampala. Interventions may benefit from incorporating alcohol use prevention strategies, particularly for alcohol use during sex.Key Messages

• Approximately 30% of sexually active girls (ages 12–18) living in the slums of Kampala, Uganda reported a previous pregnancy.
• In the multivariable analysis, consuming alcohol during sex was the only statistically significant correlate with pregnancy.
• Intervention programs are urgently warranted to delay pregnancy and address correlates of pregnancy, such as alcohol use, for this population, as these youth and adolescents face dire environmental and psychosocial adversities.

     

Alcohol consumption in Mozambique: Results from a national survey including primary and surrogate respondents

Background: Data on the correspondence between information on alcohol consumption obtained from household members directly interviewed and those evaluated through surrogate respondents are scarce in developing countries.

Aim: To estimate alcohol consumption in Mozambique and to compare the information self-reported by subjects directly interviewed with data provided by surrogate respondents referring to household members that were absent during interview.

Subjects and methods: A representative sample of 20 033 Mozambicans aged 25–64 years was evaluated in 2003 as part of a national household survey. Face-to-face interviews were conducted using a structured questionnaire assessing socio-demographic and behavioural factors (12 902 participants were directly interviewed and for 7238 data were provided by surrogate respondents).

Results: Nearly a quarter of women and half the men were current drinkers, of which about 60% drank 1–2 days/week and more than 75% reported traditional beverages as the most frequently consumed. No meaningful differences were observed between the estimates obtained using only data reported directly by the participants and when surrogate reports were also considered.

Conclusion: Alcohol consumption was frequent in Mozambique, especially consumption of traditional beverages. Proxy respondents provided valid information on alcohol intake, which may be used to improve the efficiency of household surveys in this setting.     

Novelty seeking: interaction between parental alcohol use and dopamine D4 receptor gene exon III polymorphism over 17 years

Recent meta-analyses have questioned the association between the dopamine receptor D4 (DRD4) gene polymorphism and the temperament trait of novelty seeking, and proposed an interaction between the polymorphism and other factors. We wanted to test whether parental alcohol use during childhood moderated the effect of an offspring dopamine receptor gene (DRD4) polymorphism on the temperament trait of novelty seeking in adulthood. A population-based sample of children and adolescents (n=2149) and their parents was examined in 1980 and 1983 on parental alcohol use and rearing practices. In 1997, study participants completed the Temperament and Character Inventory for the novelty-seeking temperament trait, and a subsample (n=150) was genotyped for the DRD4 exon III polymorphism. For the participants with the father, but not the mother, reporting more frequent alcohol consumption or drunkenness in examinations 17 and/or 14 years before the novelty-seeking assessment, an association between the short (two- or five-repeat) alleles of the DRD4 gene and extremely high novelty-seeking scores was observed. When the father reported less frequent alcohol consumption or drunkenness, the genotype was not associated with novelty seeking. The association remained after controlling for sex, age, and maternal child-rearing. These results provide preliminary information on gene-environment interaction on the temperament trait of novelty seeking and may partly explain the heterogeneity of findings concerning the association between DRD4 polymorphisms and novelty seeking.     

Targets and dimensions of social comparison among people with spinal cord injury and other health problems

The present research examined comparison targets and comparison dimensions among two Spanish samples of individuals facing serious illnesses and diseases. In Study 1, 90 older patients (mean age 66.36) with various age‐related diseases, particularly cardiovascular diseases and diabetes, indicated that they compared themselves most often with others with the same disease, next with others with another disease and least with people without health problems. They compared themselves more often on their mental state, symptoms and physical activities than on their social activities. Social comparison orientation (SCO) as an individual difference characteristic was associated with more frequent comparisons with particularly similar targets, and with more frequent comparisons of one's symptoms and physical activities. Neuroticism was correlated only with more comparisons of one's symptoms. Study 2 was conducted in a sample of 70 relatively young patients (mean age 43.97) with spinal cord injury (SCI). Overall, they compared themselves more often with others than the participants in Study 1, and they compared themselves to a similar extent with people with SCI as with people with another disease and with people without health problems. While they felt on average better off than people with other diseases and other people with SCI, people with SCI felt on average worse off than people without health problems. They compared themselves more often on physical activities than on any other dimension. Higher levels of stress and uncertainty were associated with more frequent comparisons with people without SCI, and with more frequent comparisons of one's mental state, one's symptoms and one's future perspectives. The discussion focuses on the theoretical relevance of the results for social comparison theory, and on the practical relevance of the findings for interventions.     

Changes in drinking habits in middle-aged British men

The drinking behaviour of 7735 middle-aged men drawn from general practices in 24 British towns was determined in 1978-80 and five years later in 1983-85. Those with heavier initial drinking were more likely to have reduced consumption after five years. At every level of consumption manual workers showed a greater tendency to decrease drinking than non-manual workers. Of those who became non-drinkers over the five years, 12% had been moderate or heavy drinkers. Men who were told by a doctor that they had developed ischaemic heart disease during the five years were more likely to reduce their alcohol consumption than men who remained free of ischaemic heart disease. Similarly, men who were put on regular medical treatment of any kind or who acquired two or more diagnoses of illness (including ischaemic heart disease) were more likely to become occasional or non-drinkers. Nondrinkers at both reviews had higher rates of diagnosed illness than drinkers. In particular, the ex-drinkers, who comprised 70% of non-drinkers at follow up, had higher rates of ischaemic heart disease and cardiovascular-related problems, such as high blood pressure and diabetes, than drinkers.

It is essential to be aware of the tendency for moderate or heavy drinkers to reduce or stop drinking over time, particularly if illness has been diagnosed. Non-drinkers and exdrinkers should not be used as a baseline in studies relating alcohol to disease.

     

Partner-specific sexual behavioral differences between phase 3 HIV vaccine efficacy trial participants and controls: Project VISION

OBJECTIVE: To assess and compare sexual behaviors using partner-specific data between HIV-negative men who have sex with men (MSM) recruited for an HIV vaccine efficacy trial and a control group. METHODS: HIV-negative MSM from an HIV vaccine trial (n = 525) and controls (n = 732) were recruited by similar strategies and interviewed about behaviors with the 3 most recent partners in the past 6 months, obtained by audio computer-assisted self-interview (A-CASI). RESULTS: Vaccine trial participants were more likely than controls to report an HIV-positive partner (24.7% and 14.1%, respectively) or an HIV-positive primary partner (16.1% and 6.8%, respectively) and were less likely to report occasional or single-time partners of unknown HIV status (51.6% and 63.2%, respectively; P < 0.05 for each comparison). Vaccine trial participants more often reported receptive unprotected anal intercourse (UAI) during their last sexual encounter with an HIV-positive partner (adjusted odds ratio [OR] = 2.7, 95% confidence interval [CI]: 1.0 to 7.9). Most believed their HIV-positive partners were receiving antiretroviral treatment (ART), however, and after adjustment for perceived ART use, the association between vaccine study participation and receptive UAI with an HIV-positive partner was not significant. CONCLUSIONS: High-risk sexual behavior was reported by many VAX004 participants and controls. Differences between vaccine trial and control participants in the highest risk per contact behavior, receptive UAI with HIV-positive partners, was partly accounted for by perceived ART use. Partner level data are useful in refining risk assessment, which is important in the evaluation of HIV vaccine and other prevention trials.     

Characteristics of women with hysterectomy

Socio-demographic and health information, including history of hysterectomy/oophorectomy, was obtained in a telephone survey of 2137 women aged 40–52. Subjects were randomly selected from a list of all women with a driver's license in Pittsburgh, Pennsylvania. Results showed that 27.3% of women surveyed reported having had a hysterectomy. Women who had undergone hysterectomy were more often black, less educated, older and heavier; and reported less frequent alcohol consumption, younger age at birth of first child and earlier menarche than women who did not report hysterectomy. Forty-seven precent of blacks reported hysterectomy compared with 24% of whites (P < 0.01) and blacks were significantly younger at surgery than whites (mean age 38.5 vs. 39.6 yr, P < 0.05). Results of multivariate analyses showed age, black race, less than a college education, menarche before age 12 and having no children to be associated with an increased risk of hysterectomy (P < 0.01). Additional multivariate analyses conducted separately for blacks and whites showed that, for whites but not blacks, the higher a woman's educational attainment the less likely she was to report having had a hysterectomy (P < 0.01). Black women with no children more often reported hysterectomy than those wit. children (P < 0.01), but this relationship was not found among whites. These findings show the distribution of hysterectomy in the population to vary by race, education and parity.