Do Parents Still Matter? The Impact of Parents and Peers on Adolescent Electronic Cigarette Use

PurposeVaping among adolescents has reached epidemic levels. Identifying factors associated with electronic cigarette (e-cigarette) use initiation could inform prevention programming. This study examined whether parental attitudes toward e-cigarettes impacted adolescent e-cigarette use intentions, positive expectancies of use, and actual use when accounting for adolescent attitudes and peer norms. Parents' negative attitudes toward e-cigarettes were expected to reduce teen e-cigarette use intentions. Low e-cigarette use intentions were expected to mediate the association between parental attitudes and teen e-cigarette use. Peer norms were expected to be associated with positive expectancies. Positive expectancies were expected to mediate the association between peer norms and teen e-cigarette use.MethodsA sample of e-cigarette naïve adolescents (n = 176, aged 14–17 years, 52% female, 82% Latinx/Hispanic) and their parents were assessed. Parents and adolescents rated harm associated with e-cigarette use. Adolescents reported their perceptions of peer e-cigarette norms, intentions, positive expectancies, and e-cigarette use. Cross-sectional models were estimated for e-cigarette use intentions and positive expectancies. Prospective mediation models (n = 142) characterized pathways to e-cigarette use.ResultsParents' attitudes toward e-cigarettes were associated with weaker intentions. Intentions mediated the association between parental attitudes and e-cigarette use. Adolescents reporting favorable e-cigarette peer norms endorsed more positive expectancies. Positive expectancies did not mediate the association between peer norms and e-cigarette use.ConclusionsParents actively shape adolescent e-cigarette use even when accounting for peer norms and adolescent attitudes. Involving parents in prevention programming may help reduce vaping among teens. These associations should be examined with a larger and more diverse sample.     

Gender and the Effects of an Economic Empowerment Program on Attitudes Toward Sexual Risk-Taking Among AIDS-Orphaned Adolescent Youth in Uganda

PurposeThis article examines gender differences in attitudes toward sexual risk–taking behaviors of acquired immune deficiency syndrome (AIDS)–orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda.MethodsAdolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n = 135) or a control condition (n = 142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education.ResultsFindings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk–taking behavior, in a different way and to a lesser extent than boys.ConclusionsFuture research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.     

“When You Get Old Like This … You Don't Run Those Risks Anymore”: Influence of Age on Sexual Risk Behaviors and Condom Use Attitudes Among Methamphetamine-Using Heterosexual Women with a History of Partner Violence

BackgroundDrug use and partner violence affect older women, yet few studies highlight age-specific HIV risks and prevention strategies. This study compares sexual risk behaviors, condom use attitudes, and HIV knowledge between midlife/older women (ages 45+) and younger women (ages 18–44) reporting methamphetamine use and partner violence in San Diego, California.MethodsOur mixed methods study used themes from a qualitative substudy (n = 18) to inform logistic regression analysis of baseline data from an HIV behavioral intervention trial (n = 154).FindingsAge-related qualitative themes included physiologic determinants, HIV knowledge, and “dodging the bullet,” referring to a lifetime of uncertainty surrounding HIV serostatus after engaging in unsafe drug and sex practices. Midlife/older age was associated with never being married (24.2% vs. 51.2; p = .03), having less than a high school education/GED (12.1% vs. 34.7%; p = .04), lower condom use self-efficacy (2.87 vs. 3.19; p = .03), lower positive outcome expectancies (1.9 vs. 2.1; p = .04), and lower HIV knowledge (85.3% vs. 89.7%; p = .04); however, sexual risk behaviors were not associated with age group. In the multivariate analysis, midlife/older age remained independently associated with lower condom use self-efficacy (adjusted odds ratio, 0.49; 95% CI, 0.27–0.87) and lower HIV knowledge (adjusted odds ratio, 0.96; 95% CI, 0.93–0.99).ConclusionsMidlife/older methamphetamine-using women with experiences of partner violence present similar sexual risk profiles, but possess different HIV-related knowledge and attitudes toward prevention methods compared with their younger counterparts. Clinicians and public health practitioners can have a positive impact on this overlooked population by assessing HIV risks during routine screenings, encouraging HIV testing, and providing age-appropriate HIV prevention education.     

The effect of the national demonstration project Healthy Respect on teenage sexual health behaviour

BACKGROUND: As part of the independent evaluation of Healthy Respect (a national demonstration project to improve teenage sexual health in Scotland) this study examined the effect of the school-based sexual health education intervention comprising multiprofessional classroom delivery and alongside drop-in clinics on teenage sexual behaviour outcomes. METHODS: Before-and-after cross-sectional surveys of secondary school pupils (average age 14 years and 6 months) were used in 10 Healthy Respect intervention schools in Lothian region and 5 comparison schools without intervention in Grampian region (2001 and 2003). RESULTS: By 2003, the proportion of pupils in Lothian feeling confident about getting condoms and using condoms properly significantly increased, more Lothian pupils (particularly boys) showed improved knowledge about condoms being protective against sexually transmitted infections. No further evidence of improved knowledge, attitudes, or intentions was evident after the intervention. Pupils in Lothian remained more likely to think using a condom would be embarrassing (especially girls), would reduce sexual enjoyment (especially boys), and intentions about condom use (as closer predictors of actual behaviour change) showed no significant improvement. More Lothian ( approximately 24%) than Grampian ( approximately 19%) pupils report having had sexual intercourse at age <16 years, both before and after the intervention, with no evidence of a significant reduction in Lothian by 2003. Overall differences in attitudes to condom use by gender were noted. Findings remain consistent in both unadjusted and adjusted comparisons. CONCLUSION: These findings demonstrate limited impact on sexual health behaviour outcomes, and raise questions about the likely and achievable sexual health gains for teenagers from school-based interventions.     

The impact of an educational forum intervention on East African mothers’ HPV vaccine-related knowledge,attitudes, and intentions to vaccinate their adolescent children

ObjectiveHPV vaccine uptake in U.S. East African adolescents is low. We developed and evaluated a culturally-targeted interactive educational intervention for East African immigrant mothers to increase HPV-vaccine-related knowledge, attitudes, and intentions to vaccinate adolescent children.MethodsEligible mothers had ≥ 1 11–17-year-old child and reported all children’s HPV vaccination status as unvaccinated or unknown. The intervention was delivered via 10 dinners in the Seattle metropolitan area (8 with the Somali community, 2 with the Ethiopian community). Educational presentations and pre/post-tests on knowledge, attitudes, and intentions were conducted in the participants’ native language by a co-ethnic physician. Pre/post differences in responses were evaluated with McNemar’s tests and GEE models. HPV vaccination uptake 6-months post-intervention was evaluated using state immunization registry data.ResultsOf 115 participating mothers, most (84%) were Somali and < 40 years of age (60%). Median years of formal education was 8 (range 0–16), and 61% reported a household income <$25,000. Knowledge of HPV/HPV-vaccines was low pre-intervention, with correct responses ranging from 4% to 39% (61%-91% of responses were “not sure”); correct post-intervention responses ranged from 29% to 97%. Pre-intervention, only 12% of mothers thought they had enough information to make a decision about vaccination, compared to 90% post-intervention. Pre-intervention, only 16% of mothers reported that they were somewhat or very likely to vaccinate their child, compared to 83% post-intervention. All pre/post comparisons were statistically significantly different (p < 0.0001). Although mothers were more likely to report correct HPV-related knowledge and positive vaccine attitudes and intentions post-intervention, only two mothers’ children initiated HPV vaccination within 6 months after the intervention.ConclusionsResults illustrate that a culturally targeted educational intervention effectively increased East African mothers’ HPV vaccine-related knowledge, attitudes, and intentions to vaccinate their adolescent children. Future research should identify additional intervention components that can bridge the gap between intention and behavior to facilitate HPV vaccine uptake.     

Short-Term Mediating Factors of a School-Based Intervention to Prevent Youth Substance Use in Europe

PurposeTo investigate factors mediating the effects of a European school-based intervention (Unplugged) based on a social influence approach to youths' substance use.MethodsSchools in seven European countries (n = 143, including 7,079 pupils) were randomly assigned to an experimental condition (Unplugged curriculum) or a control condition (usual health education). Data were collected before (pretest) and 3 months after the end of the program (posttest). Multilevel multiple mediation models were applied to the study of effect mediation separately for tobacco, alcohol, and cannabis use. Analyses were conducted on the whole sample, and separately on baseline users and nonusers of each substance.ResultsCompared with the control group, participants in the program endorsed less positive attitudes toward drugs; positive beliefs about cigarettes, alcohol, and cannabis; and the normative perception of peers using tobacco and cannabis. They also increased in knowledge about all substances and refusal skills toward tobacco. Decreased positive attitudes toward drugs, increase in refusal skills, and reappraisal of norms about peer using tobacco and cannabis appeared to mediate the effects of the program on the use of substances. However, mediating effects were generally weak and some of them were only marginally significant.ConclusionsThis study lends some support to the notion that school-based programs based on a social influence model may prevent juvenile substance use through the modification of attitudes, refusal skills, and normative perceptions.     

Crush: A Randomized Trial to Evaluate the Impact of a Mobile Health App on Adolescent Sexual Health

PurposeMobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents.MethodsWe recruited 1,210 women aged 14–18 years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app. At 3 and 6 months post randomization, we compared changes from baseline in behaviors, attitudes, self-efficacy, perceived social norms, birth control knowledge, perceived control and use intentions, and SRH service utilization. Odds ratios were estimated with multivariable logistic regression and adjusted for baseline outcome, age, race/ethnicity, mother's education, and sexual experience.ResultsThere was no difference in accessing SRH services according to study group. Three months post baseline, Crush users had higher odds (p < .05) than control participants of reporting confidence in accessing SRH services (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1–2.3) and of believing that it is a good thing to use birth control consistently (aOR = 2.3, 95% CI: 1.4–3.8). Six months after baseline, Crush users had higher odds than control participants of reporting they can control whether birth control is used every time they have sex (aOR = 1.8, 95% CI: 1.2–2.6) and perceiving they would get pregnant if they did not use birth control (aOR: 1.5, 95% CI: 1.1–2.2). Impacts on other behavioral constructs were also found.DiscussionCrush was associated with improvements in knowledge, attitudes, and self-efficacy related to key SRH behaviors and may be a strategy to deliver SRH education to adolescent women. Studies including larger numbers of sexually active adolescents are needed to demonstrate behavioral impacts.     

Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua,Nicaragua: a quasi-experimental intervention study

BackgroundThe objective of this study was to evaluate a competitive voucher program intended to make sexual and reproductive health care (SRHC) accessible to adolescents from disadvantaged areas of Managua.MethodsA quasi-experimental intervention study was performed in which 28,711 vouchers that gave free access to SRHC in 20 health centers, were distributed to adolescents. To evaluate the impact, community sampling took place in markets, neighborhoods, and outside schools where self-administered questionnaires were distributed. The study comprised a random sample of 3,009 female adolescents, ages 12 to 20 years old, 904 voucher receivers and 2,105 nonreceivers. Their use of SRHC, and knowledge and use of contraceptives and condoms were measured.ResultsVoucher receivers had a significantly higher use of SRHC compared with nonreceivers, 34% versus 19% (adjusted odds ratio, 3.1; 95% confidence interval, 2.5–3.8). The highest influence was seen among respondents at schools, where use was 24% relative to 6% in nonreceivers (adjusted odds ratio, 5.9; 95% confidence interval, 3.7–9.5). Voucher receivers answered significantly more questions correctly that were related to knowledge of contraceptives and sexually transmitted infections than nonreceivers. At schools, sexually active voucher receivers had a significantly higher use of modern contraceptives than nonreceivers, 48% versus 33% (adjusted odds ratio, 2.3; 95% confidence interval, 1.2–4.4); and in neighborhoods, condom use during last sexual contact was significantly greater among voucher receivers than nonreceivers (adjusted odds ratio, 2.5; 95% confidence interval, 1.4–4.5).ConclusionThe voucher program succeeded in increasing access to SRHC for poor and underserved girls. The needs of adolescents were met with a relatively simple intervention through existing health facilities. Many adolescents appeared willing to protect themselves against the risks of sexual intercourse. This suggest that access to SRHC can play an important role in changing youth behavior and increase the use of contraceptives and condoms.     

Asthma education for school staff in Riyadh city: effectiveness of pamphlets as an educational tool

Teachers and support staff are often called upon to manage asthma at school but may have little knowledge and understanding of the condition. The objectives of this study were to develop educational package (pamphlets) about asthma, and assess its effectiveness as an educational tool for schools' staff through evaluation of its impact on the staff's asthma-related knowledge, attitudes and management practices on their pupils. A pre-post experimental research design was used in Riyadh city with distribution of self-administered questionnaires and asthma package to 4 randomly selected girls schools compounds. Participants were school staff (n = 297) of primary, intermediate and secondary schools. Results showed that only 5.7% of the staff had received previous training in asthma education. Lack of knowledge and misconceptions about asthma medication were evident among a considerable proportion of the staff specifically for use of antibiotics, steroids, side effect of ventolin, and addicting effect of inhalers. At pretest, only 35% and 40.1% of the staff had good level of knowledge and management practices. At posttest, the corresponding percentages increased significantly to be 83.9% and 68.6% respectively. The mean total score of staff's asthma related-attitudes became more favorable towards asthma education after intervention, it increased significantly from 53.5 to be 55.0. Total posttest knowledge score was the only predictor of both staff attitudes and management practices constituting 9.1% and 10.2% of their variance. The great majority cited lack of training (92%), unavailability school policy (86.8%), and shortage of educational resources (88.3%) as barriers against asthma education and management in their schools. Conclusions: Most of school staff had poor to fair level of asthma knowledge and management practices. Such simple educational intervention using pamphlets and demonstration of inhaler use and peaked flow meter was significantly successful in enhancing staff's asthma-related knowledge, attitudes and management practices among their pupils. It is very important that training is directed to all staff as pre-service and in-service programs.     

Decision-making about HPV vaccination in parents of boys and girls: A population-based survey in England and Wales

BackgroundSchool-based HPV vaccination in the UK will soon be extended to boys. Based on other countries’ experience, uptake may initially be lower in boys than girls. We assessed HPV vaccine attitudes and decision-making in parents of boys and girls, to explore sex differences and inform public health messages.MethodsWe carried out a cross-sectional population-based survey using home-based interviews in spring 2019. Participants were adults in England and Wales, with a child in school years 5–7 (aged 9–12 and eligible for HPV vaccination within 3 years). Measures included awareness of HPV and the vaccine, demographic factors, previous vaccine refusal and (after exposure to brief information) whether participants would allow their child to have the HPV vaccine (decided to vaccinate; decided not to vaccinate; undecided). We also assessed vaccine attitudes. Data were weighted to adjust for non-response. Multinomial logistic regression was used to explore predictors of deciding to (or not to) vaccinate compared with being undecided.ResultsAmong 1049 parents (weighted n = 1156), 55% were aware of HPV and the girls’ vaccination programme, but only 23% had heard of plans to vaccinate boys. After information exposure, 62% said they would vaccinate their child, 10% would not, and 28% were undecided. Parents of girls were more willing to vaccinate than parents of boys (adjusted odds ratio: 1.80 (1.32–2.45)). Positive attitudes and HPV/vaccine awareness were significantly independently associated with deciding to vaccinate. Previous vaccine refusal for a child was the strongest predictor of not wanting the HPV vaccine.ConclusionsOur findings suggest a need for public health campaigns to raise awareness of plans to extend HPV vaccination to boys. Reassuringly only 10% of all parents were unwilling to vaccinate and our data suggest further information, including about safety and efficacy, may be important in supporting undecided parents to make the decision to vaccinate.     

Contraceptive Method at First Sexual Intercourse and Subsequent Pregnancy Risk: Findings from a Secondary Analysis of 16-Year-Old Girls from the RIPPLE and SHARE Studies

PurposeExisting failure rate studies indicate that typical use of oral contraception (OC) results in fewer unplanned pregnancies than condom use, even among teenagers. However, comparative data on pregnancy risk associated with different contraceptive methods are lacking for younger teenagers starting their first sexual relationship. This study examined associations between contraceptive method at first intercourse and subsequent pregnancy in 16-year-old girls.MethodsSix thousand three hundred forty-eight female pupils from 51 secondary schools completed a questionnaire at mean age 16 years; 2,501 girls reported sexual intercourse. Logistic regression (N = 1952) was used to model the association of contraceptive method at first intercourse with pregnancy.ResultsAt first intercourse (median age 15 years) 54% reported using condoms only, 11% dual OC and condoms, 4% OC only, 4% emergency contraception, and 21% no effective method. Method used was associated with a similar method at a most recent intercourse. One in 10 girls reported a pregnancy. When compared to use of condoms only, greater pregnancy risk was found with no effective method (odds ratio [OR] 2.97, 95% confidence interval [CI] 2.12–4.15) or OC only (OR 2.44, 95% CI 1.29–4.60). Pregnancy risk for dual use and emergency contraception did not differ from that for condoms only. Both significant effects were partially attenuated by adjusting for user characteristics and sexual activity.ConclusionsYoung teenagers may use OC less efficiently than condoms for pregnancy prevention. The characteristics of those using OC-only confirm vulnerability to unintended pregnancy, and suggest that alternative contraceptive strategies should be considered for these young women.     

Impact of the CARD (Comfort Ask Relax Distract) system on school-based vaccinations: A cluster randomized trial

BackgroundThe CARD (Comfort Ask Relax Distract) system is a vaccine delivery framework that integrates evidence-based interventions to reduce stress-related responses and improve the vaccination experience for children undergoing vaccinations at school. In preliminary studies, CARD was acceptable and effective. The objective was to evaluate CARD in a large, pragmatic trial to confirm its effectiveness in real-world settings.MethodsHybrid effectiveness-implementation cluster randomized trial in schools receiving vaccination services from Wellington-Dufferin-Guelph Public Health. Forty schools with grade 7 students (12 years old) were randomized to CARD and control (n = 20/group). Nurses in CARD schools planned clinics with principals and educated students about CARD ahead of time. Principals disseminated information to staff and parents and sent reminders. Vaccination day processes minimized fear and facilitated student self-selected coping strategies. Nurses in control schools followed usual practices, which excluded principal meetings, education, reminders, and systematic integration of fear-reducing or child-selected coping strategies. Outcomes included stress-related symptoms (fear – primary outcome, pain, dizziness, fainting, post-vaccination reactions), use of coping interventions, vaccination uptake, attitudes and implementation outcomes (acceptability, appropriateness, feasibility, fidelity).ResultsAltogether, 1919 students were included. Fear and pain were lower in CARD schools: OR 0.65 (95% CI 0.47–0.90) and OR 0.62 (95% CI 0.50–0.77), respectively. No students fainted in CARD schools compared to 0.8% in control (p = 0.02). Dizziness and post-vaccination reactions did not differ. Student-led coping interventions were used more frequently in CARD schools. Vaccination uptake was 76.1% in CARD schools and 72.5% in control schools (OR 1.13 (95% CI 0.85–1.50)). Staff and students had positive attitudes about CARD and implementation outcomes; however, recommendations were made to improve fidelity.DiscussionCARD reduced stress-related responses in students undergoing vaccinations at school and was positively received by students and public health staff. CARD is recommended to improve the quality of vaccination delivery services.Trial registration: NCT03966300.     

Applying the Transtheoretical Model to evaluate the effect of a call–recall program in enhancing Pap smear practice: A cluster randomized trial

ObjectiveThe objective of this study was to evaluate the effect of a call–recall approach in enhancing Pap smear practice by changes of motivation stage among non-compliant women.MethodsA cluster randomized controlled trial with parallel and un-blinded design was conducted between January and November 2010 in 40 public secondary schools in Malaysia among 403 female teachers who never or infrequently attended for a Pap test. A cluster randomization was applied in assigning schools to both groups. An intervention group received an invitation and reminder (call–recall program) for a Pap test (20 schools with 201 participants), while the control group received usual care from the existing cervical screening program (20 schools with 202 participants). Multivariate logistic regression was performed to determine the effect of the intervention program on the action stage (Pap smear uptake) at 24 weeks.ResultsIn both groups, pre-contemplation stage was found as the highest proportion of changes in stages. At 24 weeks, an intervention group showed two times more in the action stage than control group (adjusted odds ratio 2.44, 95% CI 1.29–4.62).ConclusionThe positive effect of a call–recall approach in motivating women to change the behavior of screening practice should be appreciated by policy makers and health care providers in developing countries as an intervention to enhance Pap smear uptake.     

Technology acceptance and trust: Overlooked considerations in young people's use of digital mental health interventions

ObjectivesDigital mental health interventions (DMHIs) have potential to provide support at scale for young people, yet uptake is low. The present study investigated whether attitudes towards technology solutions in relation to perceived usefulness, perceived ease of use, and trust of DMHIs influenced young people's intentions to use DMHIs.MethodsYoung people aged 17–25 (N = 248) were recruited online via advertising (e.g., Facebook, Twitter) to a survey assessing attitudes of technology acceptance and intentions to use DMHIs, previous use of DMHIs, demographics, and mental health need.ResultsParticipants reported relatively neutral attitudes towards DMHIs. Outcomes from linear regression indicated that greater perceived usefulness (β = .24) and trust of DMHIs (β = .28) have significant small to moderate positive associations with higher intentions to use DMHIs. Perceived ease of use (β = .07) was not associated with intentions to use DMHIs. Gender, age, previous use of DMHIs, and mental health need did not moderate unique associations between intentions to use DMHIs and perceived usefulness, perceived ease of use, and trust of DMHIs.ConclusionsModerate levels of technology acceptance for mental health, particularly in domains of perceived usefulness and trust of DMHIs, may represent a barrier to DMHI adoption among young people. Developers and service providers are recommended to provide information about the usefulness, effectiveness, and trustworthiness of DMHIs to improve uptake among young people.     

Effects of a School-Based Prevention Program on European Adolescents' Patterns of Alcohol Use

PurposeSchool-based substance abuse prevention programs are widespread but are rarely evaluated in Europe. We aimed to evaluate the effect of a new school-based prevention program against substance use on the frequency of alcohol consumption and alcohol-related problem behaviors among European students.MethodsDuring the school year 2004–2005, a total of 7,079 students aged 12–14 years from 143 schools in seven European countries participated in this cluster randomized controlled trial. Schools were randomly assigned to either control (65 schools, 3,532 students) or to a 12-session standardized program based on the comprehensive social influence model (78 schools, 3,547 students). Alcohol use and frequency of alcohol-related problem behaviors were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. The association between intervention and changes in alcohol-related outcomes was expressed as odds ratio (OR), estimated by multilevel regression model.ResultsThe preventive program was associated with a decreased risk of reporting alcohol-related problems (OR = .78, 95% confidence intervals [CI] = .63–.98), although this reduction was not statistically significant in the subgroup of 743 current drinkers at baseline. The risk for alcohol consumption was not modified by exposure to the program (OR = .93, 95% CI = .79–1.09). In the intervention group, nondrinkers and occasional drinkers at baseline progressed toward frequent drinking less often than in the control group.ConclusionsSchool curricula based on the comprehensive social-influence model can delay progression to frequent drinking and reduce occurrence of alcohol-related behavioral problems in European students. These results, albeit moderate, have potentially useful implications at the population level.     

Differences in Adolescent Relationship Abuse Perpetration and Gender-Inequitable Attitudes by Sport Among Male High School Athletes

PurposeSchool-based athletic programs remain an important context for violence prevention efforts although a better understanding of how gender attitudes and abuse perpetration differ among athletes is needed.MethodsWe analyzed baseline survey data from the “Coaching Boys into Men” study—a school-based cluster-randomized trial in 16 high schools in Northern California. We describe relationships among gender-inequitable attitudes, sport type, and recent adolescent relationship abuse perpetration among a sample of male athletes (n = 1,648).ResultsGender-inequitable attitudes (adjusted odds ratio (AOR), 3.26; 95% confidence interval (CI), 2.56, 4.15), participation in both high school football and basketball (AOR, 2.08; 95% CI, 1.37, 3.18), and participation in football only (AOR, 1.50; 95% CI, 1.02, 2.22) emerged as independently associated with recent ARA perpetration.ConclusionsFindings warrant targeted violence prevention efforts among male high school athletes that incorporate discussions of gender attitudes and healthy relationships, especially among sports teams at greater risk of adolescent relationship abuse perpetration.     

A Group Randomized Trial Evaluating High School FLASH,a Comprehensive Sexual Health Curriculum

PurposeTo evaluate the effectiveness of a school-based comprehensive sexual health curriculum (FLASH) on high-school students’ sexual behavior and related outcomes.MethodsA cohort of 1,597 9th and 10th grade students representing 20 schools from two regions in the U.S. (Midwest and South) were enrolled and completed the baseline survey. Following baseline, the 20 schools were randomly assigned to receive FLASH (n = 10 schools, five per region) or a knowledge-based sexual health curriculum (n = 10 schools, five per region). Follow-up surveys were administered at 3 months and 12 months after the instruction period.ResultsThere were no statistically significant differences between conditions for the overall sample on rates of vaginal sex in the past 3 months or the rates of vaginal sex without a condom or other birth control. In supplementary subgroup analyses of students who were not sexually experienced at baseline, FLASH showed a statistically significant protective impact at the 3-month follow-up on vaginal sex without a condom or birth control (p = .04). FLASH also showed statistically significant gains in psychosocial outcomes, such as refusal and condom use self-efficacy, attitudes toward birth control and condoms, and perceived norms.ConclusionsFLASH demonstrated consistent short-term and long-term impacts on key behavioral determinants. It also showed a significant impact on vaginal sex without a condom or other birth control for the subgroup of students who were not sexually experienced at baseline. Behavioral impacts were not evident for the entire study population.     

Schoolteachers’ Nutrition Knowledge,Beliefs, and Attitudes Before and After an E-Learning Program

ObjectiveΤο explore teachers’ nutrition knowledge, beliefs, and attitudes and to examine the effectiveness of an electronic learning (e-learning) program in teachers’ nutrition knowledge.DesignCross-sectional and experimental design.SettingThe study took place in Greece, while schoolteachers were invited by e-mail.ParticipantsTeachers of primary and secondary education, with no exclusion criteria, were enrolled in the study between March, 2015 and 2016.Main Outcome MeasuresSchoolteachers' nutrition knowledge, beliefs, and attitudes.InterventionTeachers completed a 36-item nutrition questionnaire and then a subgroup participated in an e-learning program. After the intervention, teachers completed the same questionnaire.AnalysisPrincipal component analysis and multivariate logistic regression were used for data analysis.ResultsA total of 1,094 teachers completed the questionnaire; 619 participated in the e-learning program. Teachers showed moderate nutrition knowledge scores (ie, 65% correct answers) before the intervention, whereas their attitudes regarding acting as role models and their belief in the importance of the role of nutrition were associated with 74% (odds ratio, 1.28; 95% confidence interval, 1.13–1.45) and 79% (odds ratio, 1.21; 95% confidence interval, 1.07–1.37) increased possibility of having good nutrition knowledge, respectively. The e-learning program was effective in strengthening teachers’ nutrition knowledge (P < .001) and improving their beliefs and attitudes (P < .05).Conclusions and ImplicationsFuture research is needed to validate the current results, which can be used to design and implement similar educational programs to teachers as a means of creating health-promoting schools.     

Effect of a Simple Exercise Program on Hospitalization-Associated Disability in Older Patients: A Randomized Controlled Trial

ObjectiveHospitalization-associated disability [HAD, ie, the loss of ability to perform ≥1 basic activities of daily living (ADLs) independently at discharge] is a frequent condition among older patients. The present study assessed whether a simple inpatient exercise program decreases HAD incidence in acutely hospitalized very old patients.DesignIn this randomized controlled trial (Activity in Geriatric Acute Care) participants were assigned to a control or intervention group and were assessed at baseline, admission, discharge, and 3 months thereafter.Setting and ParticipantsIn total, 268 patients (mean age 88 years, range 75–102) admitted to an acute care for older patients unit of a public hospital were randomized to a control (n = 125) or intervention (exercise) group (n = 143).MethodsBoth groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total duration of ∼20 minutes/day). We measured ADL function (Katz index) and incident HAD at discharge and after 3 months (primary outcome) and Short Physical Performance Battery, ambulatory capacity, number of falls, rehospitalization, and death during a 3-month follow-up (secondary outcomes).ResultsMedian duration of hospitalization was 7 days (interquartile range 4 days). The intervention group had a lower risk of HAD with reference to both baseline [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17–0.76, P = .007] and admission (OR 0.29; 95% CI 0.10–0.89, P = .030). A trend toward an improved ADL function at discharge vs admission was found in the intervention group compared with controls (OR 0.32; 95% CI ‒0.04 to 0.68; P = .083). No between-group differences were noted for the other endpoints (all P > .05).Conclusion and ImplicationsA simple inpatient exercise program decreases risk of HAD in acutely hospitalized, very old patients.