Perceptions of the benefits and costs associated with condom use and unprotected sex among late adolescent college students

To assess the differential effects of the perceived benefits and costs associated with both condom use and unprotected sex on sexual risk behaviors, data were collected from 704 ethnically diverse male and female sexually experienced late adolescent college students (aged 17-25). Perceived benefits and costs for condom use and perceived benefits and costs for unprotected sex were measured separately through an anonymous self-report survey. In addition, participants completed measures of self-efficacy for practicing safer sex and temptation for unsafe sex in various situations, and three measures of sexual risk-taking (stage of change for condom use, consistency of condom use during the past month, and whether or not a condom was used for the last act of intercourse). Univariate analyses indicated that benefits and costs of condom use, benefits of unprotected sex, self-efficacy and situational temptation were all related to sexual risk-taking. Gender differences were identified, with females reporting more benefits of condom use and costs of unprotected sex, fewer benefits of unprotected sex and costs of condom use, greater self-efficacy for practicing safer sex, and less situational temptation for unsafe sex. Multivariate analyses indicated that sexual risk behaviors were most related to situational temptation, self-efficacy for safer sex, and perceived benefits of unprotected sex. The results suggest that, among late adolescents, perceived benefits of the unhealthy behavior (unprotected sex) were better determinants of sexual risk-taking than were perceived benefits (or costs) associated with the healthy behavior (condom use). Perceived costs associated with unprotected sex were unrelated to sexual behaviors. These findings support previous work identifying adolescents as more driven by their perceptions of the positive benefits associated with risky behaviors, rather than knowledge of the costs or dangers involved in risk-taking.     

Guide to health: Nutrition and physical activity outcomes of a group-randomized trial of an internet-based intervention in churches

Background: Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight.Purpose: The aim was to assess nutrition; physical activity; and, secondarily, body weight in the tailored, social cognitive Guide to Health (GTH) Internet intervention delivered in churches.Methods: Participants (N=1,071; 33% male, 23% African American, 57% with body mass index ≥25, 60% sedentary, Mdn age=53 years) within 14 Baptist or United Methodist churches were randomized to the GTH intervention only (GTH-Only; 5 churches), with church-based supports (GTH-Plus; 5 churches), or to a waitlist (control; 4 churches). Verified pedometer step counts, measured body weight, fat, fiber, and fruit and vegetable (F&V) servings from food frequency and supermarket receipts were collected at pretest, posttest (7 months after pretest), and follow-up (16 months after pretest).Results: Participants in GTH-Only increased F&V at post (∼1.50 servings) compared to control (∼0.50 servings; p=.005) and at follow-up (∼1.20 vs. ∼0.50 servings; p=.038) and increased fiber at post (∼3.00 g) compared to control (∼1.5 g; p=.006) and follow-up (∼3.00 g vs. ∼2.00 g; p=.040). GTH-Plus participants compared to control increased steps at post (∼1,500 steps/day vs. ∼400 steps/day; p=.050) and follow-up (∼1,000 steps/day vs. ∼−50 steps/day; p=.010), increased F&V at post (∼1.5 servings; p=.007) and follow-up (∼1.3 servings; p=.014), increased fiber at post (∼3.00 g; p=.013), and follow-up (∼3.00; p=.050) and decreased weight at post (∼−0.30 kg vs. ∼+0.60 kg; p=.030).Conclusions: Compared to control, both GTH treatments improved nutrition at posttest, but church supports improved physical activity and nutrition at posttest and follow-up, suggesting environmental supports may improve Internet-based interventions. This project was supported by a grant from the National Cancer Institute (RO1CA79469) to Virginia Tech. The trial is registered in the National Cancer Institute’s PDQ trial registry (VPISU-05-209).     

Correlates of physical activity among individuals with multiple sclerosis

Background: There is accumulating evidence that individuals with multiple sclerosis (MS) are less physically active than nondiseased populations. One method for increasing the level of participation in physical activity among MS patients involves the identification of factors that correlate with physical activity and that are modifiable by a well-designed intervention.Purpose: This study adopts a social cognitive perspective and examines self-efficacy, enjoyment, social support, and disability as correlates of participation in physical activity among individuals with MS.Methods: We recruited 196 individuals with a diagnosis of MS from the Midwest region of the United States. The participants completed a battery of questionnaires and then wore a belt with an accelerometer for a 7-day period. The data were analyzed using covariance modeling.Results: Enjoyment (γ = .38, p > .001), social support (γ = .15, p > .05), and disability (γ =.18, p > .01) had statistically significant direct relations with self-efficacy, and self-efficacy (β = .29, p > .001) and enjoyment (γ = .28, p > .001) had statistically significant direct relations with physical activity.Conclusions: Future researchers should consider examining self-efficacy and enjoyment as possible components of an intervention that is designed to increase physical activity participation in MS patients.     

Memory training for adults with probable mild cognitive impairment: a pilot study

Abstract

Background & Objectives: This pilot study aimed to evaluate the efficacy of memory training and health training intervention over a 24-month period in people with probable mild cognitive impairment (MCI).

Research Design & Methods: Based on the accepted criteria, and the neuropsychiatric measures used in the trial, MCI was defined as a subjective change in cognition, impairment in episodic memory, preservation of independence of functional abilities, and no dementia. Without a neurological assessment, laboratory tests, and psychometric evaluation combined, some of our participants may have had dementia that we were unable to detect through neuropsychological testing. Of the 263 total participants, 39 met criteria for a diagnosis of MCI. There were 19 adults in the memory and 20 in health training conditions. Both groups received twenty hours of classroom content that included eight hours of booster sessions at three months post intervention. Hierarchical linear models (HLM) and standardized regression-based (SBR) analyses were used to test the efficacy of the intervention on immediate recall, delayed recall, subjective memory complaints, and memory self-efficacy. Age, education, depression, racial group, ethnic group, MMSE score, and baseline performance were included as covariates.

Results: Over 24 months, the MCI group in the memory training condition showed better objective and subjective memory outcomes compared with the MCI group in the health training condition.

Conclusions: Senior WISE Memory training delivered to individuals with MCI was able to forestall the participants’ declining cognitive ability and sustain the benefit over two years in both subjective and objective memory function.     

Psychosocial and behavioral correlates of seeking sex partners on the internet among hiv-positive men

Background: The Internet is revolutionizing how people access and use information; for some people, the Internet is also redefining interpersonal relationships, including sexual relationships.Purpose: The objective of this study was to extend the understanding of HIV-positive men who use the Internet to meet sex partners.Methods: This study examined the use of the Internet for meeting sex partners among 141 sexually active HIV-positive men who completed anonymous surveys.Results: Results showed that 37% of sexually active HIV-positive men who were using the Internet had gone online to seek potential sex partners in the previous 3 months. Seeking sex partners online was associated with greater likelihood of having HIV-negative sex partners and engaging in unprotected intercourse with HIV-negative or unknown HIV status partners. Multivariate analyses showed that seeking sex partners online was associated with greater education, higher CD4 cell counts, using the Internet for sexual entertainment, and higher Sexual Compulsivity scale scores over and above demographic, health, Internet use, sexual behavior, and other psychosocial characteristics including optimism and depression.Conclusions: Results suggest a continued need for interventions targeting HIV transmission risk reduction among HIV-positive men who use the Internet to meet potential sex partners. We thank the AIDS Survival Project of Atlanta for their assistance with data collection. National Institute of Mental Health (NIMH) Grant We thank the AIDS Survival Project of Atlanta for their assistance with data collection. National Institute of Mental Health (NIMH) Grant     

Sex and substance use behaviors among children of teen mothers: A systematic review

IntroductionAdolescent birth is a known correlate of many challenging behavioral health consequences for offspring. This systematic review seeks to understanding the sex and substance use behaviors of children born to teen mothers extending the body of literature on the long-term outcomes of being born to a teen mother.MethodsA systematic approach, in accordance with PRISMA guidelines, was used to review and identify eligible studies in the following electronic databases: Web of Science, ProQuest, PubMed, and Ovid MEDLINE. Study inclusion: (a) maternal age (>20) was the key predictor or group variable and (b) children's risky sexual or substance use behaviors were outcome variables. All articles meeting inclusion criteria were next screened using the quality assessment tool created by the Effective Public Health Practice Project.ResultsSeventeen articles reporting on risky sexual behaviors and 12 articles on substance use behaviors met inclusion criteria. We found a consistent association between being born to a teen mother and risky sexual behaviors, including early sexual debut and transitioning into motherhood during adolescence/young adulthood. The link between being born to a teen mother and substance use behaviors was inconsistent and only found in large population-based studies.ConclusionTeen mothers and their children have unique individual, family, and structural needs. Evidence highlights that while there is no clear need to adapt substance use prevention interventions for these children, investing in targeted adaptations of abstinence and safer sex interventions to meet the unique experiences of children of teen mothers and their children is warranted.     

Developmentally appropriate sexual risk reduction interventions for adolescents: Rationale,review of interventions,and recommendations for research and practice

Background: Despite awareness of the need to design developmentally appropriate sexual risk reduction interventions for adolescents, limited information exists to identify the aspects of intervention design or content that make an intervention developmentally appropriate.Purpose: (a) To clarify the rationale for designing developmentally appropriate interventions, (b) to review randomized controlled trials (RCTs) of adolescent sexual risk reduction interventions, (c) to identify developmentally appropriate strategies, (d) to examine the relationship between developmental appropriateness and sexual risk outcomes, and (e) to provide recommendations for research.Methods: The authors examined studies (n = 24) published before 2003 that evaluated a risk reduction intervention, sampled adolescents, used an RCT study design, and evaluated sexual behavior outcomes.Results: Content analysis indicated that the interventions tested were often tailored to the cognitive level of adolescents, as indicated by the use of exercises on decision making, goal setting and planning, and concrete explanation of abstract concepts. Interventions also addressed the social influences of risky sex such as peer norms and provided communication skills training. Overall, the interventions tested in RCTs were more effective in delaying the onset of sexual activity than in promoting abstinence among sexually active youth. Interventions with booster sessions were effective in reducing sexual risk behavior. The use of process measures, linked with developmental constructs, was rare. However, improvements in sexual communication skills and perceived norms for safer sex were associated with reductions in sexual risk outcomes.Conclusions: Developmental transitions during adolescence influence sexual behavior and should be considered when developing and evaluating risk reduction interventions for youth. Future research should assess process measures of key developmental constructs as well as risk behavior and biological outcomes. This review was supported in part by grants from the National Institute of Mental Health to both authors (F31-MH12740) and to Dr. Carey (K02-MH015 82). C. Teal Pedlow is now at Brown University, Providence, RI. We thank the reviewers for their helpful suggestions on earlier versions of the article.     

Modeling and rehabilitation following anterior cruciate ligament reconstruction

Background/Purpose: This study sought to examine the effectiveness of a modeling video to reduce preoperative perceptions of anxiety and pain, as well as to increase postoperative self-efficacy and functional outcomes after anterior cruciate ligament reconstruction.Methods: Following baseline assessment of state anxiety, perceptions of expected pain, injury severity, and knee function (International Knee Documentation Committee [IKDC] system), patients scheduled for surgical reconstruction of the anterior cruciate ligament were randomly assigned to either a modeling intervention or a control group. Psychological assessments were repeated preoperatively for expected pain and anxiety. Actual pain was assessed preoperatively, prior to discharge, and at 2 weeks postoperatively. Rehabilitation self-efficacy was assessed prior to discharge and at 2 and 6 weeks postoperatively. IKDC functional assessments were repeated at 6 weeks postoperatively, whereas range of motion was assessed at 2 and 6 weeks postsurgery.Results: Compared with the participants in the control condition, participants assigned to the modeling intervention reported significantly lower perceptions of expected pain preoperatively and significantly greater self-efficacy at predischarge to perform rehabilitation tasks. Those who received the modeling intervention also experienced significantly better IKDC objective functional outcome scores compared with their control counterparts. No psychological variables mediated relations between the intervention and functional outcomes.Conclusions: The data suggest that watching a modeling video may be an effective prophylactic treatment to decrease perceptions of expected pain, increase rehabilitation self-efficacy, and provide an early stimulus with respect to early function.     

Methamphetamine and Poly-Substance Use Among Gym-Attending Men Who Have Sex with Men in New York City

Background Methamphetamine and other drug use has been documented among men who have sex with men (MSM). Patterns of use may be influenced by point of recruitment into these studies. Purpose The aim of this study is to describe patterns of methamphetamine and other drug use and to delineate psychosocial and demographic factors which accompany these patterns of use in a sample of MSM attending gyms in New York City. Methods Active recruitment strategies were implemented to ascertain a sample of 311 MSM. Participants completed a one-time survey regarding both health risks and health promotion. Results Methamphetamine use in the last 6 months was reported by 23.8% of men. Inhalation and smoking were the most common modes of administration, and 84% of men reported more than one mode of use. Study participants also indicated a variety of other substances used, including but not limited to alcohol, inhalant nitrates, and 3,4 methylenedioxymethamphetamine (MDMA). Compared to nonusers, methamphetamine users were more likely to report being black or Latino, depressed, HIV-positive, perceiving more benefits of unprotected sex, and understanding masculinity in sexual terms. Conclusions These data suggest that health-risk behaviors are common among MSM who are regularly using a gym and are indicative of the complexities of health issues for this segment of the population. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Center for Disease Control and Prevention.     

Psychiatric and legal features of 113 men convicted of sexual offenses

BACKGROUND: To increase understanding of the relationships among sexual violence, paraphilias, and mental illness, the authors assessed the legal and psychiatric features of 113 men convicted of sexual offenses. METHOD: 113 consecutive male sex offenders referred from prison, jail, or probation to a residential treatment facility received structured clinical interviews for DSM-IV Axis I and II disorders, including sexual disorders. Participants' legal, sexual and physical abuse, and family psychiatric histories were also evaluated. We compared offenders with and without paraphilias. RESULTS: Participants displayed high rates of lifetime Axis I and Axis II disorders: 96 (85%) had a substance use disorder; 84 (74%), a paraphilia; 66 (58%), a mood disorder (40 [35%], a bipolar disorder and 27 [24%], a depressive disorder); 43 (38%), an impulse control disorder; 26 (23%), an anxiety disorder; 10 (9%), an eating disorder; and 63 (56%), antisocial personality disorder. Presence of a paraphilia correlated positively with the presence of any mood disorder (p <.001), major depression (p =.007), bipolar I disorder (p =.034), any anxiety disorder (p=.034), any impulse control disorder (p =.006), and avoidant personality disorder (p =.013). Although offenders without paraphilias spent more time in prison than those with paraphilias (p =.019), paraphilic offenders reported more victims (p =.014), started offending at a younger age (p =.015), and were more likely to perpetrate incest (p =.005). Paraphilic offenders were also more likely to be convicted of (p =.001) or admit to (p <.001) gross sexual imposition of a minor. Nonparaphilic offenders were more likely to have adult victims exclusively (p =.002), a prior conviction for theft (p <.001), and a history of juvenile offenses (p =.058). CONCLUSIONS: Sex offenders in the study population displayed high rates of mental illness, substance abuse, paraphilias, personality disorders, and comorbidity among these conditions. Sex offenders with paraphilias had significantly higher rates of certain types of mental illness and avoidant personality disorder. Moreover, paraphilic offenders spent less time in prison but started offending at a younger age and reported more victims and more non-rape sexual offenses against minors than offenders without paraphilias. On the basis of our findings, we assert that sex offenders should be carefully evaluated for the presence of mental illness and that sex offender management programs should have a capacity for psychiatric treatment.     

Explaining physical activity levels from a self-efficacy perspective: the physical activity counseling trial

Background: The Physical Activity Counseling (PAC) trial compared the effects of a 13-week primary care physical activity (PA) intervention that incorporated a PA counselor into a health care practice compared to a control condition on PA over a 25-week period and showed group differences in PA were present at 6 and 13 weeks.Purpose: The main purpose was to examine the mediating effect of 6-week task and barrier self-efficacy on the intervention versus control group/13-week PA relationships. A secondary purpose was to determine whether task and barrier self-efficacy were significantly related to PA throughout the trial for both groups.Method: Participants were primarily sedentary individuals who received a 2- to 4-min PA intervention from their primary care provider, after which they were randomly assigned to the intervention (n=61) or control condition (n=59). Self-reported PA and task (barrier) self-efficacy measures were obtained during (i.e., baseline, 6 and 13 weeks) and after (i.e., 19 and 25 weeks) the intervention in both groups.Results: Six-week task and barrier self-efficacy had a small mediating effect. Furthermore, barrier self-efficacy had a significant relationship with PA throughout the trial, whereas the relationship between task self-efficacy and PA became significantly weaker as the trial progressed.Conclusions: PAC interventions among primarily sedentary individuals should be partly based on barrier and task self-efficacy. However, the stability of the task self-efficacy/PA relationship needs further examination. This study was supported by the Ontario Ministry of Health and Long — Term Care awarded to Dr. Michelle Fortier and Dr. William Hogg. Chris M. Blanchard is supported by the Canada Research Chairs Program.     

Examining the feasibility and effectiveness of a culturally adapted participation-focused stroke self-management program in a day-rehabilitation setting: A randomized pilot study

ABSTRACT

Background: Stroke survivors find it difficult to participate in daily activities, despite their improvement throughout the rehabilitation process. Thus, it has been questioned whether day-rehabilitation services provide adequate preparation for participation and reintegration into the community. Self-management programs can improve survivors’ self-efficacy to manage their condition and participation. Improving Participation After Stroke Self-Management program (IPASS) is an occupational therapy-based group intervention developed in the United States, which has been effective in improving participation outcomes.

Objective: To evaluate the feasibility and effectiveness of the IPASS adapted for an Israeli population of individuals admitted to a day-rehabilitation center after stroke.

Methods: A single-center, randomized, assessor-blind study was conducted. Eligible participants were randomized to receive the IPASS (intervention group), in addition to standard individual therapy or standard care only (control group). Feasibility was based on attendance rate and a feedback questionnaire. Effectiveness was evaluated with the Functional Independence Measure (FIM), the Reintegration to Normal Living Index (RNLI) and self-efficacy questionnaires.

Results: Sixty participants were included, of which 39 completed baseline and post-intervention evaluations. The intervention group improved significantly in the FIM scores (p < .01), as compared to the control group (p > .05). Moderate effect sizes (≥0.35) were found for the FIM and RNLI, and large effect sizes (≥0.65) for two subcategories in the participation self-efficacy questionnaire.

Conclusions: The results support the feasibility of the adapted IPASS, and show a trend for positive effects in improving participation and self-efficacy in managing participation in home and community activities, for an Israeli post-stroke population.     

Moving the prevention timeline: A scoping review of the literature on precursors to sexual risk in early adolescence among youth of color

IntroductionSexual health disparities are leading causes of morbidity among youth of color in the United States. We conducted a scoping review of the literature on precursors to sexual risk-taking among young adolescents of color (ages 10–14) to assess precedents of sexual experience and their utility as measurable proximal constructs and behaviors gauging sexual risk and sexual risk prevention efforts.MethodsThis study was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. We searched for quantitative studies that assessed the relationships between precursors and subsequent sexual behaviors, incorporated youth of color, and specified young adolescents as the study sample. All articles were in English, however we explored both U.S. and International databases.ResultsThe database search yielded 11 studies published between 2000 and 2017. Most literature focused on youth in urban settings, and on Black and Latinx youth, while only two addressed the special circumstances of American Indian and Alaska Native youth. Sex expectancies outcomes for youth of color were likely to predict sexual risk taking and self-efficacy about sex was related to abstinence.ConclusionsEtiologic studies that seek to understand precursors to sexual risk taking among youth of color are limited and this paucity truncates the ability to develop sexual risk prevention programs for the age group in which prevention is most needed.     

A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS

Background: By 2015, the Centers for Disease Control and Prevention predicts that 50% of all cases of HIV/AIDS in the United States will be in persons 50 years of age or older.Purpose: This pilot research tested whether a 12-session, coping improvement group intervention delivered via teleconference technology could improve life quality in 90 middle-age and older adults living with HIV/AIDS.Method: This research used a lagged-treatment control group design. Forty-four HIV-infected persons 50-plus years of age participated in a coping improvement group intervention immediately after study enrollment, whereas 46 individuals received the intervention after their time-matched immediate treatment participants completed the intervention. Participants completed self-administered surveys that assessed depressive and psychological symptoms, life-stressor burden, ways of coping, coping self-efficacy, and loneliness.Results: Outcome analyses indicated that, compared to their delayed treatment counterparts, immediate treatment participants reported fewer psychological symptoms, lower levels of life-stressor burden, increased coping self-efficacy, and less frequent use of avoidance coping. After receiving the intervention, delayed treatment participants reported greater coping self-efficacy and less psychological symptomatology, lifestressor burden, and loneliness. However, the intervention demonstrated little ability to reduce depressive symptoms in this sample of HIV-infected older adults diagnosed with depression.Conclusions: Although findings from this research suggest that telephone-delivered, coping improvement group interventions have potential to facilitate the adjustment efforts of HIV-infected older adults, more rigorous evaluations of this intervention modality for this group are needed. This research was supported by a grant from the National Institute on Aging (R21 AG20334).     

The Development of the Improving Participation after Stroke Self-Management Program (IPASS): An Exploratory Randomized Clinical Study

Introduction: There is a heavy emphasis in rehabilitation on restoration of function post-stroke at the expense of addressing how to manage the impact of stroke and the environment long term. Management of chronic health conditions is often and effectively addressed using self-management education; however, self-management is mostly focused on managing symptoms and health behaviors, not additional participation and community reintegration issues experienced following stroke. This study evaluated the Improving Participation after Stroke Self-Management Program (IPASS) to improve self-efficacy and participation in everyday life activities for individuals living with the long-term consequences of stroke.

Methods: A multisite, single-blind, exploratory randomized clinical study was conducted with participants with mild-to-moderate chronic stroke (n = 185). Participants were randomized either to receive the IPASS intervention immediately or to a wait list control group. The assessment was completed pre- and post-intervention and at 6–9 months post-intervention follow-up. The primary outcome assessments included measures of self-efficacy to manage chronic health conditions and to participate in everyday life activities.

Results: The results show that there was significant short-term increase in health-related self-efficacy both within-group and between-groups in managing chronic conditions which were retained at follow-up; the average effect size was 0.46, indicating moderate effect overall. Further, a significant short-term increase was found in participation self-efficacy, with an overall moderate effect size of 0.55.

Conclusions: These results provide early support for the use of IPASS to help improve self-efficacy to manage health behaviors and to improve participation post-stroke. Further investigation is warranted to confirm these findings with an active control group and a more sensitive outcome measure to capture participation changes.     

A classification and regression trees analysis predicting treatment outcome following a group intervention randomized controlled trial for HIV-positive adult survivors of childhood sexual abuse

Abstract

This study demonstrates the utility of classification and regression trees (C&RTs) in predicting treatment outcome. A total of 177 HIV-positive survivors of childhood sexual abuse were randomly assigned to either a 15-session coping group condition or a 15-session support group condition. Six predictive categories were identified using C&RT, three predicting clinically significant improvement and three predicting no change. Variables predicting outcome differed by intervention type; depressive symptoms and active coping strategies predicted outcome for the coping group condition, and shame about sexual abuse and dissociative symptoms predicted outcome for the support group condition. Methodological issues and implications for clinical decision making are discussed.     

Adolescents’ perceptions of sexual health education programs: An integrative review

IntroductionAdolescents are key stakeholders in sexual health education, yet they are rarely consulted when developing sexual health programs. Their voices are integral to improving the delivery of relevant and appropriate school-based sexual health education to promote safer adolescent sexual behaviors.MethodsAn integrative review was conducted utilizing three databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, PubMed, and Education Resources Information Center (ERIC). The PRISMA and matrix method were used to search the literature and synthesize the findings from 16 articles regarding adolescent perceptions of school-based sexual health education.ResultsThe main themes that emerged from this review included: (a) factors influencing adolescent perceptions of sexual health education programs, (b) characteristics of good sexual health education programs, and (c) areas of improvement in sexual health education programs.ConclusionAdolescents overwhelmingly requested honest, comprehensive content delivered by nonjudgmental, well-educated health professionals in a comfortable environment.     

Receiving aphasia intervention in a virtual environment: the participants’ perspective

Background: Digital technology is making an increasing contribution to aphasia therapy. However, applications of virtual reality are rare. EVA Park is a virtual island developed with and for people with aphasia. It is a multi-user environment, which enables people with aphasia to interact with support workers, therapists and each other. The first study to use EVA Park in aphasia rehabilitation demonstrated significant gains in functional communication. This article augments the findings of that study, by reporting results from qualitative interviews conducted with the 20 study participants.

Aims: This study aimed to determine the views of participants about the intervention that they received in EVA Park, and the impacts of that intervention. Long-term retrospective views were also explored.

Methods & Procedures: Participants took part in 1:1, semi-structured interviews two weeks before (entry) and two weeks after (exit) the intervention. Questions focussed on activities undertaken by participants, communication, changes since the stroke and uses of technology. Exit interviews additionally explored participants’ views and experiences of EVA Park and any perceived impacts of the intervention. A subset of five participants was interviewed at least one year later, to explore long-term recollections of the EVA Park intervention and any perceived long-term impacts. Interview data were transcribed and subject to framework analysis.

Outcomes & Results: The thematic framework comprised 10 parent themes and 33 sub-themes. Following “affect”, the largest single theme related to EVA Park, with 636 coded references. Comments were overwhelmingly positive. EVA Park intervention was strongly associated with fun and enjoyment. Participants particularly valued their relationship with the support workers who delivered the intervention. The virtual locations and activities in EVA Park were also appreciated, together with the contact with other participants. Perceived impacts related to communication, activity, computer use and confidence. Most (4) participants in the long-term interviews described maintained impacts.

Conclusions: These interview results indicate that the first intervention delivered in EVA Park was highly acceptable to participants and perceived as beneficial. They augment the findings of our experimental study and suggest that EVA Park could be a valuable addition to the resources available to practising clinicians.     

Sexual attraction and experiences in the primary care setting: Examining disparities in satisfaction with provider and health self-efficacy

IntroductionTo test whether sexual minority males and females report lower satisfaction with primary care providers and lower health self-efficacy relative to heterosexual males and females.MethodsData from 535 adolescents who participated in one of two randomized clinical trials conducted in a primary care setting were analyzed. Multiple linear regressions controlling for demographic characteristics and treatment condition were used to examine sexual attraction differences in indicators of satisfaction with provider and health self-efficacy.ResultsSexual minority and heterosexual youth both endorsed high satisfaction with providers. Relative to heterosexual males, sexual minority males reported lower self-efficacy in reaching their health goals. Relative to heterosexual females, sexual minority females reported lower confidence in positively impacting their own health, and lower self-efficacy in setting goals and working actively to improve their health.ConclusionsSexual minority youth may benefit from additional support from health care providers to enhance their health self-efficacy and reach their health goals.     

Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers

Introduction: Behavioral and psychological symptoms in dementia (BPSD) are the principal sources of stress in caregivers. The aim of the present work is to analyze the moderating effect of self-efficacy for managing BPSD on the distress these problems generate in family caregivers.

Method: The participants were 231 family caregivers of people with dementia. We assessed the frequency and caregiver distress associated with three dimensions of BPSD (depressive, disruptive and memory problems). In addition, we assessed the moderating effect of self-efficacy for dealing with BPSD in the relationship between the dementia patient's frequency of BPSD and caregiver distress through hierarchical regression analyses, one for each of the dimensions of BPSD.

Results: We found a moderating effect of self-efficacy on the relation between the frequency of BPSD and the distress in caregivers for the dimensions of depressive and disruptive behaviors. Caregivers having to deal with a high frequency of behavior problems but with high levels of self-efficacy presented significantly lower levels of distress associated with depressive and disruptive behavior problems compared to those caregivers with low levels of self-efficacy. No differences in the effects of self-efficacy were found for distress levels of caregivers who dealt with low frequency of BPSD. Also, we did not find a moderating effect of self-efficacy on the relation between the frequency of memory problems and caregivers’ distress.

Conclusions: The results suggest that self-efficacy for managing BPSD attenuates the relation between the frequency of behavior problems – both disruptive and depressive – and the distress they cause in caregivers.