Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents.

PURPOSE: To examine gender and age differences among urban, low-income, African-American children and adolescents in perceived monitoring by their parents, and the association of perceived parental monitoring with family characteristics, health risk behaviors, and risk perceptions. METHODS: Three cross-sectional surveys were conducted in 1992 (n = 455), 1994 (n = 355), and 1996 (n = 349). Respondents aged 9-17 years were recruited from low-income urban areas including public housing communities and associated recreation centers. Both multivariate analysis of variance and correlation analysis were performed. RESULTS: Low levels of perceived parental monitoring were associated with participation in several health risk behaviors, including sexual behavior, substance/drug use, drug trafficking, school truancy, and violent behaviors. Females perceived themselves to be more monitored than did males. In general, the perceived parental monitoring tended to decrease with advancing age of the youth. CONCLUSIONS: The strong inverse correlation between perceived parental monitoring and adolescent risk behavior suggests that parental monitoring initiatives may be an effective intervention tool. Longitudinal studies are needed to determine the long-term relationship between perceived parental monitoring and adolescent risk involvements.     

Episodic and persistent gun-carrying among urban African-American adolescents.

PURPOSE: To examine whether similar risk factors influenced episodic and persistent gun-carrying among urban African-American adolescents. METHODS: The sample consisted of 705 African-American youths (48.9% male; mean age at baseline = 14.56 years) who were interviewed annually throughout high school as part of a larger study on students who leave school before graduation. Episodic gun-carrying was defined as carrying a gun during one or two waves of the study. Persistent gun-carrying involved carrying a gun during three or four waves. Data were analyzed using multinomial logistic regression to test how risk factors assessed at ninth grade influenced the persistence of gun-carrying. RESULTS: Fifteen percent of students reported carrying a gun episodically, and 5% persistently. "Male gender" (OR = 3.61, 95% CI = 2.16-6.04), "adult weapon-carrying" (OR = 1.58, 95% CI = 1.20-2.09), "marijuana use" (OR = 1.03, 95% CI = 1.01-1.06), "selling drugs" (OR = 3.24, 95% CI = 1.52-6.92), and "fighting" (OR = 1.57, 95% CI = 1.14-2.15) distinguished noncarriers from episodic carriers. Frequency of fighting (OR = 1.60, 95% CI = 1.00-2.57) and selling drugs (OR = 3.29, 95% CI = 1.16-9.35) distinguished episodic gun-carriers from persistent gun-carriers. Variables associated with victimization did not uniquely differentiate among the patterns of gun-carrying. These results were similar for males and females. CONCLUSIONS: Similar risk factors characterize episodic and persistent gun-carrying. Specifically, selling drugs and fighting had a strong dose-response relationship with the persistence of gun-carrying. In this population, episodic gun-carrying should be viewed as very risky and not merely as youthful experimentation or a defensive behavior.     

Perceived risks and benefits of alcohol,cigarette, and drug use among urban low-income African-American early adolescents.

Perceptions about drugs and the social environment may be important influences on cigarette, alcohol and drug use, yet little is known regarding the perspective of early adolescent boys and girls, especially among minority urban youths. Among 351 African-American low-income urban youth, 9 through 15 years of age, completing a community-based computerized questionnaire, 25% acknowledged alcohol, cigarette, and/or illicit drug use in the past 6 months; 19% expected to use one of those substances in the next 6 months. Family exposure to drugs increased the likelihood that youths expected to use drugs by factors of 4.5 (boys) and 2.5 (girls). Other factors (feelings about drugs, community drug use, long-term expectations) distinguished users from nonusers or had different associations with use in boys and girls. Gender-specific perceptions about drugs may have the potential to be modified in drug and substance use prevention programs.     

Tracking of dietary intake patterns is associated with baseline characteristics of urban low-income African-American adolescents

Young peoples' dietary habits may persist over time. However, few studies have examined the dynamic patterns in urban low-income African-American adolescents' intakes. This study examined these dynamic patterns and their predictors and explored the association between the patterns and BMI over time. Dietary data were collected from 181 low-income African-American adolescents using a 152-item FFQ at baseline and 1-y follow-up. High intakes and high BMI were defined as the top quartile and high-fat intake as >35% of energy from fat. Multinomial logistic regression models were fit to study the association between study variables. Correlation coefficients (0.4 < r < 0.6; P < 0.05) between participants' intakes at baseline and at 1-y follow-up suggested tracking, particularly intakes of energy, fat, fiber, calcium, vegetables and fruits, fried food, and snack food. However, the tracking of percentage of energy from fat and sugar-sweetened beverages was weak (0.2 < or = r < 0.3; P < 0.01). Proportion of agreement (>30%) and k-values (>0.2) also indicated tracking. Adjustment for tracking of energy changed little the observed tracking for other micronutrients and food groups. Factor analysis showed moderate tracking in a Western diet pattern (r = 0.47; P < 0.001) but was weaker in 2 healthier diet patterns (r = 0.31-0.36; P < 0.001). Age, gender, physical activity, and BMI predicted dietary changes (P < 0.05). Adolescents who tracked high intakes of energy, fiber, fried food, and snacks were less likely to track high BMI. Decreased energy and snack intakes were negatively related to tracking of high BMI. Overall, urban low-income African-American adolescents tracked their dietary patterns over time. The tracking was affected by baseline characteristics.     

Cultural tailoring for mammography and fruit and vegetable intake among low-income African-American women in urban public health centers

BACKGROUND: It is widely accepted that disease prevention efforts should consider cultural factors when addressing the needs of diverse populations, yet there is surprisingly little evidence that doing so enhances effectiveness. The Institute of Medicine has called for randomized studies directly comparing approaches that do and do not consider culture. METHODS: In a randomized trial, 1227 lower-income African-American women from 10 urban public health centers were assigned to either a usual care control group, or to receive a series of six women's health magazines with content tailored to each individual. By random assignment, these magazines were generated from either behavioral construct tailoring (BCT), culturally relevant tailoring (CRT) or both (BCT + CRT). The CRT magazines were based on four cultural constructs: religiosity, collectivism, racial pride, and time orientation. All tailored magazines sent to women ages 40-65 promoted use of mammography; magazines sent to women ages 18-39 promoted fruit and vegetable (FV) intake. Analyses examined changes from baseline to 18-month follow-up in use of mammography and servings of FV consumed daily. RESULTS: Women receiving BCT + CRT magazines were more likely than those in the BCT, CRT, and control groups to report getting a mammogram (76% vs. 65% vs. 64% vs. 55%, respectively), and had greater increases in FV servings consumed daily (+0.96 vs. + 0.43 vs. + 0.25 vs. + 0.59). CONCLUSIONS: Systematically integrating culture into tailored cancer prevention and control interventions may enhance their effectiveness in diverse populations.     

Exploring unstructured parent–child communication about sex among African-American adolescents with HIV-positive mothers

Few studies have focused on the sexual health of HIV-affected adolescents despite their exposure to the same community-level factors that contributed to their parent’s status. Guided by an interpretative phenomenological analysis (IPA) approach, this study explored HIV-affected adolescents’ perceptions on the unstructured sexual health education received from their HIV-positive mothers and its influence on their decision-making and sexual health via six in-depth individual interviews with HIV-affected adolescents ages 15–17 years and a contextual focus group with eight HIV peer educators ages 13–18 years. Findings from this study (1) describe non-positive, HIV-affected adolescents’ perceptions of sexual health influenced by parent–child communication about sex and (2) identify deficiencies in sexual health education models available for the unique needs of HIV-affected families.     

Low awareness of cardiovascular disease risk among low-income African-American women

Focus groups were conducted with low-income African-American women in six different community settings in Northern California to assess their awareness of and concern for cardiovascular disease (CVD). These women had low awareness of the prevalence of CVD, attributed CVD to stress and low socioeconomic status, saw the media as an important source of health-related knowledge, and saw a need for more community awareness on CVD among African-American people.     

The intention of adolescents to carry a knife or a gun: a study of low-income African-American adolescents.

PURPOSE: To examine whether African-American inner-city adolescents are independently motivated by a fear of victimization or by delinquency to carry a knife or gun. METHODS: A household sample of 130 female and 93 male African-American adolescents, aged 13-19 years old, were queried about their fear of victimization, history of delinquency, and intention to carry a knife or a gun in the next 3 months. RESULTS: A high intention to carry a knife was reported by 27% of the males and 35% of the females. A high intention to carry a gun was reported by 25% of the males and 9% of the females. The intention to carry a knife was independently associated with a history of delinquency in females (odds ratio [OR] = 3.0; 95% confidence interval [CI] = 1.4-6.2) and males (OR = 4.7; 95% CI = 1.7-13.3). It was not associated with a fear of victimization. The intention to carry a gun was independently associated with fear of victimization in females (OR = 4.5; 95% CI = 1.1-17.7) and males (OR = 3.3; 95% CI = 1.1-9.9). It was also independently associated with a history of delinquency in females (OR = 4.1; 95% CI = 1.1-16.3) and males (OR = 11.7; 95% CI = 3.1-44.7). CONCLUSIONS: Delinquency may play a role in motivating inner-city African-American adolescents to carry a knife, whereas both delinquency and fear of victimization may influence adolescents' motivation to carry a gun.     

Perceived cancer risk and risk attributions among African-American residents of a low-income,predominantly African-American neighborhood

Objective. In some national surveys, African-Americans have had lower scores on perceived cancer risk items than whites. Our goals were to confirm low perceptions of cancer risk in an African-American community sample and explore participants' attributions for their perceived cancer risk.

Design. Data were from three cross-sectional surveys. We report levels of perceived absolute and comparative cancer risk in a community sample of African-Americans (N = 88), and African-Americans (Ns = 655, 428) and whites (Ns = 5262, 1679) from two nationally representative Health Information National Trends Surveys (HINTS). We analyzed the content of spontaneously-provided explanations for perceived risk from the community sample.

Results. Perceived absolute and comparative cancer risk were lower in the community and national samples of African-Americans than in the national sample of whites. Participants' spontaneous attributions for low or lower than average risk included not having family history or behavioral risk factors, classes of attributions noted elsewhere in the literature. However, participants also explained that they wanted to avoid wishing cancer on themselves (positive affirmations) and hoped their risk was low (wishful thinking), responses rarely reported for majority-white samples.

Conclusions. Results provide further evidence that cancer risk perceptions are lower among African-Americans than whites. Some participant explanations for low perceived risk (wishful thinking, affirmations) are inconsistent with behavioral scientists' assumptions about perceived risk questions. Results reveal a need to expand cancer risk attribution typologies to increase applicability to diverse populations, and may indicate that perceived cancer risk questions have lower validity in African-American populations.     

Prevalence of self-reported human immunodeficiency virus testing among a population-based sample of urban African-American adolescents

We explored the prevalence of gender differences in human immunodeficiency virus (HIV) testing among a household sample of sexually active African-American adolescents. Females disproportionately self-report being tested for HIV more than males. This difference was not explained by age or receipt of services for sexually transmitted infection but was partially attributable to history of pregnancy.     

Psychosocial and environmental correlates of violence perpetration among African-American urban youth.

PURPOSE: To ascertain the proportion of youths involved in acts of violence; to examine individual, social, and environmental factors associated with perpetration; and to determine the relationship among victimization, witnessing, and perpetration of violence. METHODS: A cross-sectional survey was completed by 349 volunteer males and females, aged 9-15 years, 96% of whom were African-American. The youths were recruited from recreation centers associated with 10 public-housing communities in an eastern city. Survey instruments included the Child Health and Illness Profile, Survey of Children's Exposure to Community Violence, and other standardized questionnaires. Statistical analyses included Chi-square, correlation, regression, and test for linear trends. RESULTS: Half of the youths self-reported at least one act of violence perpetration, with similar distributions among males and females. One-third of the youths reported both personal victimization and the witnessing of violent events. Victim and witness status were moderately correlated. Individual risk behaviors and victimization made significant contributions to perpetration status. Further analysis demonstrated a linear relationship between acts of perpetration and number of victimization events. CONCLUSIONS: Participation in problem behaviors may place youths in circumstances in which they may be victim, witness, or aggressor. The chronic and high levels of community violence to which many youths are exposed are likely to contribute to an individual's participation in acts of violence.     

Psychosocial and behavioral correlates of refusing unwanted sex among African-American adolescent females.

PURPOSE: To identify psychosocial and behavioral correlates of refusing unwanted sex among African-American female adolescents. We hypothesized that greater power in relationships, less concern about negative emotional consequences, supportive family and peers, positive self-perceptions, greater perceived risk, and fewer sexual risk behaviors would be associated with increased odds of refusing unwanted sex. METHODS: Data regarding demographics, sexual behaviors, communication with parents, and psychosocial factors relevant to romantic and sexual partnerships were collected both via self-administered questionnaire and structured interview from a clinic- and school-based sample of 522 African-American adolescent females ages 14-18 years in Birmingham, Alabama. Adjusted odds ratios were calculated using logistic regression. RESULTS: Of those who had experienced pressure for unwanted sex (n = 366), 69% consistently refused to engage in unwanted sex. Adolescents with high safer sex self-efficacy and low perceived partner-related barriers (i.e., concerns about partners' negative emotional reactions) to condom negotiation were over 2.5 times more likely to consistently refuse unwanted sex than were those reporting low safer sex self-efficacy and high partner-related barriers. Adolescents who spoke more frequently with their parents about sexual issues were nearly twice as likely to consistently refuse unwanted sex than were those who spoke less frequently with their parents. CONCLUSIONS: Sexual-risk reduction efforts directed toward adolescent females should seek to build self-efficacy to negotiate safer sex and provide training in social competency skills that may help to reduce or eliminate partner barriers to condom use. Further, sexual risk-reduction programs may be more effective if they include parents as advocates of safer sexual behaviors.     

Aggression and fighting behavior among African-American adolescents: individual and family factors.

OBJECTIVES. This study examined the extent to which individual and family factors are associated with aggression and fighting behavior among African-American middle school adolescents. METHODS. Four hundred thirty-six African-American boys and girls from two middle schools in a predominantly low-income North Carolina school system were surveyed and their school records examined. Information was collected concerning students' aggression levels, school fighting behavior, school suspensions for fighting, attitudes toward violence, perceptions of their families' attitudes toward violence, weapon-carrying behavior, and sociodemographics. Multivariate analyses were employed to predict the students' aggression levels, fighting behavior, and school suspensions. RESULTS. Factors related to the individual adolescents, such as gender, age, weapon-carrying behavior, and attitudes toward violence, were associated with students' reports of aggression and fighting behavior. Factors related to family and school were associated with school suspension for fighting. CONCLUSIONS. This study suggests that violence prevention programs set in our elementary and middle schools may reduce aggression and fighting among our youth. School teachers and public health practitioners are encouraged to work together in understanding and preventing adolescent violence.     

Casual sex among Norwegian adolescents

The issue of casual sex and amount of sexual experience was studied using data from a representative sample of 2997 Norwegians, 17–19 years old. Data were collected by anonymous self-administered questionnaires, and the response rate was 62.8%. Results showed that among adolescents, experience of casual sex to a large extent was a function of the time the individual had been coitally active. The amount of sexual experience was poorly related to social background and strongly related to life-style factors such as smoking and drinking of alcohol. A small minority of adolescents was found to have a sexual behavior deviating from that of the majority, and thus containing elements of potentially high risk for contracting HIV or other STDs. This minority of adolescents had the identifying characteristic of low self-reported intimacy with their first coital partner.The study was financed by the Norwegian Directorate of Health.     

Beliefs about contraceptive sterilization among low-income urban women

Among a group of low-income clinic patients planning to be sterilized, the vast majority--95 percent--reported believing that sterilization is the surest way to avoid getting pregnant and that it is safer than other contraceptive methods. Among a comparison group who also wanted no more children but did not plan to be sterilized, the majority also held these beliefs, but the proportion was lower (76-80 percent). In both groups, however, only between 64 and 70 percent knew that sterilization makes it impossible to have children in the future. Between 63 and 68 percent of the women in the sterilization group believed that having the operation would improve their family relationships, emotional state and other aspects of their lives, but only 35-58 percent of the comparison group held these beliefs. On the other hand, women in the comparison group were more likely than those in the sterilization group to believe that sterilization has negative health and psychological effects--for example, changes in menses (more bleeding or cramping) or defeminization. The beliefs held by both groups suggest that it is a conviction regarding the advantages of sterilization, rather than a relative unawareness of the disadvantages, that distinguishes women who plan to be sterilized from those who, although they want no more children, do not have similar plans. The study results have implications for family planning professionals: Counselors need to be aware that some women seeking sterilization may not understand its permanency or may have an unrealistic appraisal of its potential effect on their lives.(ABSTRACT TRUNCATED AT 250 WORDS)     

Patterns of drug use among Cuban-American, African-American, and white non-Hispanic boys.

This study examined initiation into drug use during grade school years in a sample of Cuban-American, Black, and White non-Hispanic students in the greater Miami, Fla, area. Findings indicate that first use of alcohol occurs in fifth grade and cigarettes in sixth grade for all subgroups except White non-Hispanics, who peak in the fifth grade. White non-Hispanics had the highest life-time levels of alcohol and cigarette use. Foreign-born Cuban Americans had a lower lifetime prevalence of alcohol and cigarette use than US-born Cuban Americans. Higher acculturation level was related to first use of alcohol. One important implication of this study is that alcohol interventions should begin no later than third grade and smoking interventions no later than fourth grade.