Community-Based Support among African American Public Housing Residents

Recent shifts from federally owned public housing toward tenant-based housing assistance in the form of vouchers raise important questions about the health and wellbeing of rent-assisted households. In particular, little is known about how these shifts in housing policy will affect access to critical sources of community-based social support among those who receive rent assistance. Using the Survey of Income and Program Participation, we estimate the relationship between residence in a federally owned public housing project and the reported presence of social support among a nationally representative sample of blacks who receive rent assistance. We find that in comparison to other rent-assisted households, public housing residents are significantly more likely to report that people in their neighborhood count on each other, watch each other’s children, and have access to help from a family nearby. We also find that these measures of community-situated social support are associated with reduced odds of school expulsion among children and food insecurity among adults. In conclusion, we find evidence suggesting that public housing communities contain social resources that are important to the wellbeing of their residents and are less accessible to other rent-assisted households.     

Social Network Characteristics and HIV Sexual Risk Behavior among Urban African American Women

HIV/AIDS has emerged as a significant health threat for African American women with well-documented disparities. The purpose of this study was to assess the association between social network characteristics and high-risk sexual behaviors among a sample of urban African American women at risk of heterosexually acquired HIV/STIs. We performed a cross-sectional study of baseline data collected from the CHAT study, a randomized HIV-prevention trial targeting urban HIV-at-risk women in Baltimore, MD. Our primary outcomes were risky sexual behaviors defined as either (a) two or more sexual partners or (b) having a risky sex partner within the past 90 days. Bivariable and multivariable logistic regression examining the associations between individual and social network factors and our two outcomes of interest were conducted. The study population included 513 sexually active African American women with a mean age of 41.1 years. High levels of unemployment (89.5%), depressive symptoms (60.0%), and drug use (68.8%) were present among this high-risk urban cohort. Controlling for individual factors including participant drug use, age, and depression, having two or more sex partners within the past 90 days was associated with having a larger personal network (OR = 1.11; 95% CI, 1.06 and 1.17); more network members who pitched in to help (OR = 1.22; 95% CI, 1.04 and 1.44), provided financial support (OR = 1.33; 95% CI, 1.11 and 1.60), or used heroin or cocaine (OR = 1.26; 95% CI, 1.14 and 1.40). Having a risky sexual partner within the past 90 days was associated with having a larger social network (OR = 1.06; 95% CI, 1.00 and 1.12) and having more social networks who used heroin or cocaine (OR = 1.30; 95% CI, 1.14 and 1.49).In summary, social network characteristics are associated with HIV sexual risk behaviors among African American urban women. Social-network-based interventions that promote norms pertaining to HIV risk reduction and provide social support are needed for African American women at risk of heterosexually acquired HIV/STIs.     

Dissolution of Committed Partnerships during Incarceration and STI/HIV-Related Sexual Risk Behavior after Prison Release among African American Men

Incarceration is strongly associated with post-release STI/HIV risk. One pathway linking incarceration and STI/HIV risk may be incarceration-related dissolution of protective network ties. Among African American men released from prison who were in committed partnerships with women at the time of incarceration (N?=?207), we measured the association between committed partnership dissolution during incarceration and STI/HIV risk in the 4 weeks after release. Over one-quarter (28%) experienced incarceration-related partnership dissolution. In adjusted analyses, incarceration-related partnership dissolution was strongly associated with post-release binge drinking (adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI); 1.4–15.5). Those who experienced incarceration-related partnership dissolution were much more likely to engage in multiple/concurrent partnerships or sex trade defined as buying or selling sex (64%) than those who returned to the partner (12%; AOR 20.1, 95% CI 3.4–175.6). Policies that promote maintenance of relationships during incarceration may be important for protecting health.     

HIV-Related Sexual Risk among African American Men Preceding Incarceration: Associations with Support from Significant Others,Family, and Friends

We evaluated the association between social support received from significant others, family, and friends and HIV-related sexual risk behaviors among African American men involved in the criminal justice system. Project DISRUPT is a cohort study among African American men released from prison in North Carolina (N?=?189). During the baseline (in-prison) survey, we assessed the amount of support men perceived they had received from significant others, family, and friends. We measured associations between low support from each source (<median value) and participants’ sex risk in the 6 months before incarceration. Low levels of social support from significant others, family, or friends were associated with poverty and homelessness, mental disorders, and substance use. Adjusting for age, poverty, and other sources of support, perceiving low support from significant others was strongly associated with multiple partnerships (fully adjusted odds ratio (OR) 2.64, 95% confidence interval (CI) 1.29–5.42). Low significant other support also was strongly associated with sex trade involvement when adjusting for age and poverty status (adjusted OR 3.51, 95% CI 1.25–9.85) but further adjustment for low family and friend support weakened the association (fully adjusted OR 2.81, 95% CI 0.92–8.55). Significant other support was not associated with other sex risk outcomes including concurrent partnerships, anal sex, or sex with an STI/HIV-infected partner. Low family support was associated with multiple partnerships in analyses adjusting for age and poverty (adjusted OR 1.98, 95% CI 1.05–3.76) but the association weakened and was no longer significant after adjusting for other sources of support (fully adjusted OR 1.40, 95% CI 0.65–3.00); family support was not correlated with other risk behaviors. Friend support was not significantly associated with sex risk outcomes. Indicators of overall support from any source were not associated with sex risk outcomes. Helping inmates maintain ties may improve economic security and well-being during community re-entry, while supporting and strengthening relationships with a significant other in particular may help reduce sex risk. Studies should evaluate the protective effects of distinct support sources to avoid masking effects of support and to best understand the influence of social support on health.     

Correlates and Consequences of Early Initiation of Sexual Intercourse

ABSTRACT: This cross-sectional analysis of the 1991 CDC Youth Risk Behavior Survey explored factors associated with an early age at first sexual intercourse. Almost 18% of White males, 49% of Black males, 5% of White females and 12% of Black females were sexually active before age 13. Carrying a weapon to school, fighting, and early (< age 13) experimentation with cigarettes and alcohol were associated with early initiation of sexual activity for all four race and gender groupings. Those initiating sexual activity early had greater numbers of partners but were 50% less likely to use condoms regularly and were two-seven times more likely to have been pregnant or caused a pregnancy. Females who initiated sexual activity early were more likely to have had a sexually transmitted disease (STD). Interventions to postpone sexual activity need to be tailored to the ethnic and gender differences observed in these analyses. Interventions must begin before age 13 and should be comprehensive school-based efforts. (J Sch Health. 1994; 64(9): 372–377)     

Onset of natural menopause in African American women

OBJECTIVES: This study assessed predictors of the onset of natural menopause in African American women. METHODS: We used mailed questionnaires to collect data at baseline in 1995 and during follow-up from Black Women's Health Study participants. Cox proportional hazards regression was used to assess potential predictors-including experiences of racism-of the onset of natural menopause among 17 070 women aged 35 to 55 years and premenopausal in 1995. RESULTS: The hazard ratio (HR) was 1.43 for current smokers (95% confidence interval [CI] = 1.24, 1.66) and 1.21 (95% CI = 1.06, 1.38) for ex-smokers and significantly less for obese women and oral contraceptive users. Hazard ratios for most questions about racism were elevated by 10% to 30% but were not statistically significant. CONCLUSIONS:Earlier onset of natural menopause among African American women is strongly associated with smoking and inversely associated with body mass index and oral contraceptive use.     

Early adult characteristics and mortality among inner-city African American women

OBJECTIVES: This study examined predictors of longevity in a cohort of inner-city African American women. METHODS: Data were derived from a cohort study of inner-city African American mothers whose median age in 1966 was 31 years. Analyses involved single-decrement life tables and pooled logistic regression. RESULTS: Giving birth for the first time before age 25 and having at least a high school education predicted longevity in this sample. Effects of later age at first delivery in terms of mortality risk were stronger after 55 years and, especially, after 70 years. CONCLUSIONS: The findings offer support for Geronimus's weathering hypothesis. Predictors of longevity among African Americans may be distinct from predictors for the population as a whole.     

The relation of ethnic identification with cigarette smoking among US Urban African American and Latino Youth: A pilot study

Primarily African American and Latino seventh graders (N = 545) attending health and science classes at three urban Southern California junior high schools were administered a 13‐item ethnic identification assessment during one class period, to investigate the relationship between ethnic identification and tobacco use. For African Americans, the perception of looking different from other ethnic groups was found to be associated with avoidance of peer tobacco use. Among Latinos, the perception of being liked by other ethnic groups, and enjoying interaction with people outside of their ethnic group, were found to be associated with negating peer influence for tobacco use. Watching television shows with main characters of same ethnic group was associated with being able to make friends without using tobacco, for both ethnic groups. For Latinos, ever trying a cigarette was associated with the perception of being liked by other ethnic groups. These results suggest there may be elements inherent in ethnic identification protective against peer influence for smoking among ethnic minority youth. Also, acculturation of Latinos to the majority population may increase their risk for experimentation with tobacco products.     

Sexual and behavioral health disparities among African American sexual minority men and women

ABSTRACT

Introduction: Sexual and behavioral health disparities have been consistently demonstrated between African American and White adults and between sexual minority and heterosexual communities in the United States; however, few studies using nationally representative samples have examined disparities between sexual minority and heterosexual adults within African American populations. The purpose of this study was to examine the prevalence of sexual and behavioral health outcomes between sexual minority and heterosexual African American adults and to examine whether there were different patterns of disparities for African American sexual minority men and women, respectively.

Methods: We analyzed data from 4502 African American adults who participated in the 2001–2015 waves of the National Health and Nutrition Examination Survey. Using multivariable analyses, we examined differences in HIV, sexually transmitted infections, mental health, and substance use among African American sexual minority and heterosexual men and women.

Results: After adjusting for sociodemographic variables, African American sexual minority men had significantly higher odds of HIV, sexually transmitted infections, and poor mental health compared to their heterosexual male counterparts, whereas African American sexual minority women had significantly higher odds of Hepatitis C, poor mental health, and substance use compared to their heterosexual female counterparts.

Conclusions: These findings demonstrate notable sexual orientation disparities among African American adults. Disparities persisted beyond the role of sociodemographic factors, suggesting that further research utilizing an intersectional approach is warranted to understand the social determinants of adverse health outcomes among African American sexual minority men and women.     

Experiences of Racial Discrimination and Relation to Sexual Risk for HIV among a Sample of Urban Black and African American Men

This study aimed to examine racial discrimination and relation to sexual risk for HIV among a sample of urban Black and African American men. Participants of this cross-sectional study were Black and African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban clinical sites in the northeast. Multivariate logistic regression models were used to analyze the relation of reported racial discrimination to the following: (1) sex trade involvement, (2) recent unprotected sex, and (3) reporting a number of sex partners in the past 12 months greater than the sample average. The majority of the sample (96 %) reported racial discrimination. In adjusted analyses, men reporting high levels of discrimination were significantly more likely to report recent sex trade involvement (buying and/or selling) (adjusted odds ratio (AOR) range = 1.7–2.3), having recent unprotected vaginal sex with a female partner (AOR = 1.4, 95 % confidence interval (CI), 1.1–2.0), and reporting more than four sex partners in the past year (AOR = 1.4, 95 % CI, 1.1–1.9). Findings highlight the link between experiences of racial discrimination and men''s sexual risk for HIV.     

Development and Implementation of Mass Media Campaigns to Delay Sexual Initiation Among African American and White Youth

Reducing new HIV/STD infections among at-risk adolescents requires developing and evaluating evidence-based health communication approaches. Research overwhelmingly supports the conclusion that early sexual initiation is associated with STDs and other negative outcomes in later years (e.g., unintended pregnancy). The authors' research group secured funding from the National Institute of Mental Health to develop, implement, and rigorously evaluate televised mass media campaigns to delay initiation of sexual intercourse among African American and White adolescents in two cities in the Southeastern United States. The focus of the present study is on the development and implementation of the campaigns, including (a) rationale and theoretical underpinnings; (b) collection, screening, and assessment of existing public service announcements; (c) development of new public service announcements; (d) study design and campaign airing plan; and (e) message exposure achieved in the campaigns. Health communication campaigns hold much promise in reaching at-risk adolescent populations with targeted, timely, and relevant risk-reduction messages.     

Intergenerational Associations Between Parental Incarceration and Children's Sexual Risk Taking in Young Adulthood

Purpose

Research on parental incarceration and the health of offspring is relatively scarce despite studies linking childhood adverse experiences to a range of physical and mental health conditions. This study aimed to estimate the associations between parental incarceration and sexual risk outcomes (early sexual onset, inconsistent condom use, and sexually transmitted infections [STIs]) in young adulthood.

Gender Attitudes and Health Risk Behaviors in Urban African American and Latino Early Adolescents

Objectives: This study examines the association of beliefs about gender differences (frequently termed gender attitudes or attitudes about women in other research) and of beliefs specifically about masculinity to health risk behaviors in minority, urban, early adolescents, in light of the gender conventionality hypothesis. Methods: Data from a self-administered questionnaire assessing gender attitudes and violence-related, substance use, and heterosexual health risk behaviors administered to 587 African American and Latino early adolescents are analyzed. Results: With sociodemographic and family variables controlled, in males violence-related behaviors and substance use are associated with traditional beliefs about masculinity, and heterosexual activity is associated with traditional beliefs about gender differences. In females, being sexually active is positively associated with traditional beliefs about masculinity. Conclusions: Interventions to reduce health risk behaviors in minority, urban, early adolescents may be more effective if they include greater attention to ways in which gender-related attitudes may play a role in health risk taking.     

Decreasing Substance use Risk among African American Youth: Parent-based Mechanisms of Change

African American couples (N?=?139; 67.7 % married; with children between the ages of 9 and 14) were randomly assigned to (a) a culturally sensitive, couple- and parenting-focused program designed to prevent stress-spillover (n?=?70) or (b) an information-only control condition in which couples received self-help materials (n?=?69). Eight months after baseline, youth whose parents participated in the program, compared with control youth, reported increased parental monitoring, positive racial socialization, and positive self-concept, as well as decreased conduct problems and self-reported substance use. Changes in youth-reported parenting behavior partially mediated the effect of the intervention on conduct problems and fully mediated its impact on positive self-concept, but did not mediate effects on lifetime substance use initiation. Results suggest the potential for a culturally sensitive family-based intervention targeting adults’ couple and parenting processes to enhance multiple parenting behaviors as well as decrease youths’ substance use onset and vulnerability.     

History of Sexual Abuse and Development of Sexual Risk Behavior in Low-Income,Urban African American Girls Seeking Mental Health Treatment

Objective: This study examined relationships between sexual abuse and patterns of sexual risk-taking among low-income, urban African American adolescent girls seeking mental health treatment. Method: Participants (N = 158) were 12- to 16-year-old African American girls recruited from outpatient mental health clinics serving urban, mostly low-socioeconomic status communities in Chicago, Illinois and followed for two years between 2003 and 2010. This study included self-reports of sexual abuse and four waves (T2–T5) of self-reported data on sexual experience and sexual risk-taking (number of partners, inconsistent condom use, and sex with a risky partner). Latent curve modeling was used to examine patterns of sexual behavior over the four time points with sexual abuse and mental health symptoms as covariates. Results: Sexual abuse was significantly associated with T2 sexual experience, T2–T4 number of partners, T3 inconsistent condom use, and T2–T3 having a risky partner. These relationships decreased when mental health symptoms were controlled. Conclusions: This longitudinal study revealed a complex relationship between sexual abuse and sexual risk that would be missed if sexual risk were assessed at a single time point. Findings supported early intervention to delay onset of sexual risk behavior among low-income African American girls with mental health concerns and histories of sexual abuse.     

A Randomized Community Trial to Increase Mammography Utilization among Low-Income Women Living in Public Housing

Background.A randomized trial was conducted to evaluate the impact of a community-based intervention on mammography use among low-income women living in public housing.Methods.All 41 public housing high-rise buildings were randomized to treatment and delayed treatment (control) conditions. After a cross-sectional baseline survey, an intervention called Friend to Friend was conducted in the treatment buildings by American Cancer Society and building resident volunteers. The intervention consisted of a health professional talk, small group discussions, and an opportunity to request assistance in obtaining a mammogram or mammogram reminder. A second cross-sectional survey was conducted to measure differences in screening rates between the study groups.Results.Participation in the intervention averaged 27%. The study groups were equivalent at baseline. At follow-up, the proportion of women age 50–79 years who reported mammography screening in the previous 15 months was significantly higher in the treatment group (64%) than in the control group (52%). Breast cancer knowledge, attitudes, and beliefs did not differ between groups.Conclusions.These findings suggest that a multidimensional intervention which reaches women within their social environment and uses community volunteers can increase mammography utilization among women in public housing.     

Alcohol Use as a Potential Mediator of Forced Sexual Intercourse and Suicidality Among African American, Caucasian, and Hispanic High School Girls

Purpose

Sexual assault on adolescent females is a major public health concern. The purposes of this study were to examine: (1) whether alcohol use mediates the relationship between forced sexual intercourse and suicidality in high-school girls, and (2) whether this mediation differs by ethnicity.

Methods

Using cross-sectional data from the 2009 Youth Risk Behavior Survey (n = 6,294), we used logistic regression and simple mediation using the Sobel test for indirect effect for our analyses.

Results

Overall rates for forced sexual intercourse, alcohol use, and suicidality were 10.9%, 56.6%, and 18%, respectively. Current alcohol use significantly mediated the relationship between forced sexual intercourse and suicidality in African American, Caucasian, and Hispanic high-school girls. Overall, 13% of variance in participants' suicidality can be accounted for by the indirect effect of forced sexual intercourse on suicidality through alcohol use. The amount of variance accounted for by alcohol use varied significantly by ethnicity, with the largest amount of variance (21%) accounted for suicidality in Hispanic girls.

Conclusion

In addition to its acute affects, alcohol use may serve as a general risk factor for suicidality in girls who have experienced forced sexual intercourse. Intervention programs targeting female adolescent sexual assault victims should include an alcohol use component.     

Patterns of Vaginal, Oral, and Anal Sexual Intercourse in an Urban Seventh-Grade Population

Background:  This study examines the prevalence of vaginal, oral, and anal intercourse among a population of urban, public middle school students, the characteristics of early sexual initiators, and the sequence of sexual initiation. Such data are limited for early adolescents.
Methods:  A total of 1279 seventh-grade students (57.3% female, 43.6% black, and 41.8% Hispanic), mean age 12.5 years (SD = 0.63) from 10 middle schools in a large southeastern US public school district completed a cross-sectional survey using audio computer-assisted self-interviews. Main outcomes included lifetime and past 3-months' experience of vaginal, oral, and anal sex; condom use; age of initiation; and number of lifetime partners.
Results:  Overall, 12.0% of students had engaged in vaginal sex, 7.9% in oral sex, and 6.5% in anal sex. Among students who had initiated intercourse, approximately two thirds were currently sexually active and one quarter reported ≥4 lifetime partners. Six percent had engaged in 1 type of intercourse, 4% in 2 types of intercourse, and 4% in all 3 types of intercourse; vaginal sex was typically initiated at an earlier or at the same age as other types of intercourse. Only 2% had engaged in oral sex without engaging in vaginal sex. Although black students were significantly more likely to have initiated sex compared to other racial/ethnic groups, Hispanic students who had initiated each type of intercourse were more likely to be currently sexually active and to have engaged in recent unprotected sex.
Conclusions:  A small percentage of early adolescents are engaging in multiple sexual behaviors. These findings have implications for early adolescent school-based sexual health education.     

Characteristics of Youth Who Report Early Sexual Experiences in Sweden

Archives of Sexual Behavior - Early timing of first sex is a common risk factor for adverse sexual and reproductive health (SRH) outcomes. This study explored characteristics and circumstances...     

Moderating Effects of Parental Feeding Practices and Emotional Eating on Dietary Intake among Overweight African American Adolescents

This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child’s weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit and vegetables (F&Vs), energy intake, sweetened beverage, total fat, and saturated fat) were assessed using random 24-h dietary recalls. Validated surveys were used to assess adolescent-reported EE and parental feeding practices. Results demonstrated a significant interaction between EE and parental monitoring (adjusted analyses; B = 0.524, SE = 0.176, p = 0.004), restriction (B = −0.331, SE = 0.162, p = 0.043), and concern (B = −0.602, SE = 0.171, p = 0.001) on F&V intake; under high monitoring, low restriction, and low concern, EE was positively associated with F&V intake. There were no significant effects for the other dietary outcomes. These findings indicate that parental feeding practices and EE may be important factors to consider for dietary interventions, specifically for F&V intake, among overweight African American adolescents.