The path to intervention: community partnerships and development of a cognitive behavioral intervention for ethnic minority adolescent females

Reproductive health needs for ethnic minority adolescents are a national priority given the population growth of minority adolescents in the United States. United States census reports predict minority adolescents will comprise one-third of all young persons less than 20 years of age early in the twenty-first century. Developing culturally sensitive interventions for minority adolescents includes ecological assessments of cultural priorities, community resources, disease burden, and socioeconomic conditions. These assessments must be accomplished in partnership with the local community. Understanding reproductive health needs necessarily includes an evaluation of the absence of reproductive health, namely, the prevalence of sexually transmitted infection (STI), sexual or physical abuse, unplanned pregnancy, and the risk factors that contribute to such adverse outcomes. This article describes the methodological processes utilized to conduct an ecological assessment of a community including the health, economic, and psychosocial status of, and resources available to, a target population prior to the implementation of a community-based, cognitive behavioral intervention to reduce STI, abuse, and unplanned pregnancy.     

Safety-promoting behaviors of community-dwelling abused Chinese women after an advocacy intervention: a randomized controlled trial

ObjectiveTo examine the effect of an advocacy intervention on the use of safety-promoting behaviors in community-dwelling abused Chinese women as compared to a control condition of usual care.DesignThis efficacy trial used a randomized controlled, parallel group design.Participants and methodsA total of 200 Chinese women in a community setting who screened positive for intimate partner violence using the Chinese version of the Abuse Assessment Screen were randomized to receive either an advocacy intervention (intervention group, n = 100) or usual community care (control group, n = 100). The outcome measured was the change in the self-reported safety-promoting behaviors as measured by the Safety-promoting Behavior Checklist over three time-points (baseline, 3-month follow-up and 9-month follow-up). Participants and assessors were blinded to the study hypothesis. Assessors were further blinded to the group membership of the participants.ResultsThe Safety-promoting Behavior Checklist scores in the intervention group increased from the baseline on average by 5.65 (95% confidence interval [CI], 4.92–6.39) at 3-month and 6.65 (95% CI, 5.90–7.39) at 9-month follow-ups, while the scores in the control group also increased by 1.71 (95% CI, 1.06–2.37) at 3-month and 1.79 (95% CI, 1.15–2.43) at 9-month follow-ups. After adjusting for baseline differences, the between-group differences in scores were significant at 3-month and 9-month follow-ups (p = 0.04). The intervention group increased the scores by 3.61 (95% CI, 2.61–4.61, p < 0.001) more than the control group at 3-month and by 4.53 (95% CI, 3.53–5.53, p < 0.001) at 9-month follow-ups.ConclusionAn advocacy intervention is efficacious in increasing the use of safety-promoting behaviors as compared to usual community care in community-dwelling abused Chinese women.     

An intervention to increase safety behaviors of abused women: results of a randomized clinical trial

BACKGROUND: Although intimate partner violence is recognized as a major threat to women's health, few interventions have been developed or tested. OBJECTIVE: To test an intervention administered to abused women in order to increase safety-seeking behaviors. METHOD: A two-group clinical trial randomized 75 abused women to receive six telephone intervention sessions on safety behaviors. A control group of 75 women received standard care. Women in both groups were re-interviewed at 3 months and 6 months post-initial measurement. RESULTS: Using repeated measures analysis of variance (ANOVA), we found significantly [F (2,146) 5.11, =.007] more adopted safety behaviors reported by women in the intervention group than by women in the control group at both the 3-month [F (91,74) = 19.70, <.001] and 6-month [F (1,74) = 15.90, <.001] interviews. The effect size (ES) of the intervention was large at 3 months (ES = 1.5) and remained substantial at 6 months (ES = 0.56). DISCUSSION: These findings demonstrate that an intervention to increase safety behaviors of abused women is highly effective when offered following an abusive incident and remains effective for 6 months.     

Evaluation of a community-based organization's intervention to reduce the incidence of sexually transmitted diseases: a randomized,controlled trial

BACKGROUND: The study objectives were to determine whether a community-based organization's intensive counseling intervention would reduce sexually transmitted disease (STD) acquisition among high-risk STD clinic patients and to determine whether a low-cost trial could be conducted in a community-based setting with passive follow-up. METHODS: Participants were randomly assigned to routine counseling or intensive counseling consisting of three 1-hour sessions. We reviewed clinic records to determine 1-year cumulative incidence of STD. RESULTS: From September 1994 through December 1995, we enrolled 581 high-risk black men. Among the intervention group, 38% did not attend any intervention session; 38% attended all three. The 1-year cumulative incidence of STD did not differ significantly between the intervention (16%) and control groups (12%) (P = 0.20). CONCLUSION: Our results suggest that the intensive counseling did not reduce STD acquisition. We encountered problems in conducting this low-cost trial, making results difficult to interpret Future trials should schedule follow-up STD assessments and will likely need more staff.     

A randomized controlled trial of azithromycin versus doxycycline/ciprofloxacin for the syndromic management of sexually transmitted infections in a resource-poor setting

A randomized controlled trial was carried out to assess the effectiveness of azithromycin versus a standard regimen with doxycycline/ciprofloxacin in the treatment of sexually transmitted infections in a resource-poor environment. Infection with Chlamydia trachomatis was cured in 23/24 (95.8%) of women in the azithromycin arm versus 19/21 (90.5%) in the doxycycline arm (P = 0.6), resulting in three treatment failures. Gonorrhoea was cured in 55/56 (98.2%) women, with one treatment failure in a patient with concomitant C. trachomatis infection. These results indicate that a single oral dose of azithromycin may prove to be a more effective and convenient treatment for sexually transmitted infections in women in a resource-poor environment     

The CONECSI trial: results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury

Many people with spinal cord injury (SCI) rate chronic neuropathic pain as one of the most difficult problems to manage. The aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI. The intervention consisted of educational, cognitive, and behavioral elements. A total of 61 people were randomized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers. Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire), and secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Measurements were performed at baseline, and at 3, and 6 months follow-up. The primary statistical technique was random coefficient analysis. The analyses showed significant changes over time on both primary (t1-t2), and 2 out of 4 secondary outcomes (both t1-t2 and t1-t3). Significant intervention effects (Time * Group interactions) were found for anxiety and participation in activities, but not for the primary outcomes. Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group: decrease of pain intensity, pain-related disability, anxiety, and increase of participation in activities. This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain.     

Goserelin acetate 10.8 mg plus iron versus iron monotherapy prior to surgery in premenopausal women with iron-deficiency anemia due to uterine leiomyomas: results from a Phase III, randomized, multicenter, double-blind, controlled trial

BACKGROUND: Women with symptomatic uterine leiomyomas (fibroids) may have iron-deficiency anemia (IDA); therefore, surgery places them at risk of blood-borne morbidity from perioperative transfusions. Such women might benefit from a preoperative treatment that restores hematologic normality and alleviates fibroid symptoms. OBJECTIVE: The purpose of this study was to examine the effects of a single preoperative depot injection of goserelin acetate plus iron treatment compared with iron monotherapy, in premenopausal women with IDA due to uterine leiomyomas. METHODS: This Phase III, randomized, multicenter, double-blind, controlled trial (12 weeks of treatment plus a 24-week follow-up period) was conducted from October 1997 to August 1999. Patients received an injection of goserelin acetate 10.8 mg (3-month formulation) or a sham, with both groups receiving PO iron (ferrous sulfate) 325-mg tablets TID during the 12-week treatment period. Surgery (hysterectomy or myomectomy) was planned for week 12. Hemoglobin (Hb) level, symptoms of uterine leiomyomas, requirement for blood transfusion throughout, ability to donate blood for autologous transfusion, and leiomyoma and uterine volume were assessed for efficacy. The tolerability assessment included bone mineral density measurements and subjective symptomatology (ie, menstrual bleeding [uterine hemorrhage], fatigue, pelvic pain, and pelvic pressure). RESULTS: A total of 110 women received treatment (n = 54, goserelin acetate 10.8 mg; n = 56, sham). The majority of patients (69.1%) were black and the mean age at study entry was 39.9 years, with a mean weight of 80.1 kg. At approximately 12 weeks, Hb levels were significantly higher in the goserelin group compared with the sham group (difference of least squares mean, 1.17 g/dL; 95% CI, 0.68-1.66; P < 0.001), and significantly more patients in the goserelin group had an increase in Hb concentration of >or=2 g/dL (odds ratio 6.36; 95% CI, 2.00-20.18; P < 0.001). A nonsignificant decrease in both uterine and leiomyoma volume was experienced by patients who administered goserelin compared with increases in the sham group. Uterine hemorrhage was also experienced numerically less often by goserelin-treated patients compared with those given the sham injection (9.3% vs 28.6%, respectively). One or more adverse events (AEs) were reported by 89% of patients in each treatment group. Goserelin acetate 10.8 mg was generally well tolerated by patients, with no serious drug-related AEs reported during this 36-week trial. CONCLUSION: A single, preoperative injection of goserelin acetate 10.8 mg in addition to PO iron 325 mg TID was associated with improved Hb levels in these premenopausal women with IDA due to uterine leiomyomas.