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1.  Measuring Social Capital Investment: Scale Development and Examination of Links to Social Capital and Perceived Stress 
Social indicators research  2015;120(3):669-687.
Individuals with greater social capital have better health outcomes. Investment in social capital likely increases one’s own social capital, bearing great implications for disease prevention and health promotion. In this study, the authors developed and validated the Social Capital Investment Inventory (SCII). Direct effects of social capital investment on perceived stress, and indirect effects through social capital were examined. 397 Participants from Beijing and Wuhan, China completed surveys. Analyses demonstrated that the SCII has a single factor structure and strong internal consistency. Structural equation modeling showed that individuals who invested more in social capital had greater bonding social capital, and subsequently less perceived stress. Results suggest that disease prevention and health promotion programs should consider approaches to encourage social capital investment; individuals may be able to reduce stress by increasing their investment in social capital. Future research is needed to provide additional empirical support for the SCII and observed structural relationships.
doi:10.1007/s11205-014-0611-0
PMCID: PMC4310564  PMID: 25648725
Social capital investment; Social capital; Perceived stress; Structural equation modeling
2.  Application of the Protection Motivation Theory in Predicting Cigarette Smoking Among Adolescents in China 
Addictive behaviors  2013;39(1):181-188.
Reducing tobacco use among adolescents in China represents a significant challenge for global tobacco control. Existing behavioral theories developed in the West – such as the Protection Motivation Theory (PMT) – may be useful tools to help tackle this challenge. We examined the relationships between PMT factors and self-reported cigarette smoking behavior and intention among a random sample of vocational high school students (N = 553) in Wuhan, China. Tobacco-related perceptions were assessed using the PMT Scale for Adolescent Smoking. Among the total sample, 45% had initiated cigarette smoking, and 25% smoked in the past month. Among those who never smoked, 15% indicated being likely or very likely to smoke in a year. Multiple regression modeling analysis indicated the significance of the seven PMT constructs, the four PMT perceptions and the two PMT pathways in predicting intention to smoke and actual smoking behavior. Overall, perceived rewards of smoking, especially intrinsic rewards, were consistently positively related to smoking intentions and behavior, and self-efficacy to avoid smoking was negatively related to smoking. The current study suggests the utility of PMT for further research examining adolescent smoking. PMT-based smoking prevention and clinical smoking cessation intervention programs should focus more on adolescents’ perceived rewards from smoking and perceived efficacy of not smoking to reduce their intention to and actual use of tobacco.
doi:10.1016/j.addbeh.2013.09.027
PMCID: PMC3966196  PMID: 24157424
Protection Motivation Theory; Adolescents; Cigarette smoking; China
3.  Adolescent Age at Time of Receipt of One or More Sexual Risk Reduction Interventions 
Purpose
Age of the target audience at time of intervention is thought to be a critical variable influencing the effectiveness of adolescent sexual risk reduction interventions. Despite this postulated importance, to date studies have not been designed to enable a direct comparison of outcomes according to age at time of intervention delivery.
Methods
We examined outcomes of 598 youth who were sequentially involved in two randomized controlled trials of sexual risk prevention interventions, the first one delivered in grade 6 [Focus on Youth in the Caribbean (FOYC)] and the second one in grade ten [Bahamian Focus on Older Youth (BFOOY)]. Four groups were examined, including those who received: 1) both treatment conditions, FOYC and BFOOY; 2) FOYC in grade 6 and the control condition in grade 10; 3) the control condition in grade 6 and BFOOY in grade 10; and 4) both control conditions. Intentions, perceptions, condom-use skills as well as HIV-related knowledge were assessed over 60 months.
Results
Data showed that those who received both interventions had the greatest increase in condom-use skills. Youth who received FOYC in grade 6 had greater scores in knowledge and intention.
Conclusion
These results suggest that youth receive the most protection with early and repeated exposure to interventions. These findings suggest that educators should consider implementing HIV prevention and risk reduction programs as a fixed component of education curriculum beginning in the pre-adolescent years and if possible also during the adolescent years.
doi:10.1016/j.jadohealth.2014.01.016
PMCID: PMC4108619  PMID: 24656447
HIV Prevention Intervention; Adolescence; Condom-use skills; Randomized Controlled Trials; Risk Reduction Behavior
4.  Protection Motivation Theory in Predicting Intention to Engage in Protective Behaviors against Schistosomiasis among Middle School Students in Rural China 
Background
Among millions of people who suffer from schistosomiasis in China, adolescents are at increased risk to be infected. However, there is a lack of theory-guided behavioral prevention intervention programs to protect these adolescents. This study attempted to apply the Protection Motivation Theory (PMT) in predicting intentions to engage in protective behaviors against schistosomiasis infection.
Methods
The participants were selected using the stratified cluster sampling method. Survey data were collected using anonymous self-reported questionnaire. The advanced structural equation modeling (SEM) method was utilized to assess the complex relationship among schistosomiasis knowledge, previous risk exposure and protective measures in predicting intentions to engage in protective behavior through the PMT constructs.
Principal Findings
Approximately 70% of participants reported they were always aware of schistosomiasis before exposure to water with endemic schistosomiasis, 6% of the participants reported frequency of weekly or monthly prior exposure to snail-conditioned water. 74% of participants reported having always engaged in protective behaviors in the past three months. Approximately 7% were unlikely or very unlikely to avoid contact with snail-conditioned water, and to use protective behaviors before exposure. Results from SEM analysis indicated that both schistosomiasis knowledge and prior exposure to schistosomiasis were indirectly related to behavior intentions through intrinsic rewards and self-efficacy; prior protective behaviors were indirectly related to behavior intentions through severity, intrinsic rewards and self-efficacy, while awareness had an indirect relationship with behavior intentions through self-efficacy. Among the seven PMT constructs, severity, intrinsic rewards and self-efficacy were significantly associated with behavior intentions.
Conclusions
The PMT can be used to predict the intention to engage in protective behaviors against schistosomiasis. Schistosomiasis intervention programs should focus on the severity, intrinsic rewards and self-efficacy of protection motivation, and also increase the awareness of infection, and enrich the contents of schistosomiasis education.
Author Summary
In China, millions of population suffer from schistosomiasis infection and adolescents tend to have higher infection rates than adults. The Knowledge-Attitude-Practice (KAP) Theory has traditionally been used as guidance to schistosomiasis prevention in China. However, despite increases in knowledge among residents in the epidemic areas due to KAP theory-based schistosomiasis health education, no significant reduction in water-contact behavior was evident. Therefore, it is of crucial importance to seek alternative health behavior change theories/models that are more effective than the KAP theory to promote purposeful behavioral change. The Protection Motivation Theory (PMT) as a social cognitive model may be an alternative to the KAP theory. In this study, we found that the PMT can be used to predict intention to engage in protective behaviors against schistosomiasis infection among middle school students in rural China. Based on the PMT, in addition to enhancing awareness of schistosomiasis infection, intervention programs should focus on the severity, intrinsic rewards and self-efficacy of protection motivation.
doi:10.1371/journal.pntd.0003246
PMCID: PMC4199519  PMID: 25329829
5.  Estimating Transitional Probabilities with Cross-Sectional Data to Assess Smoking Behavior Progression: A Validation Analysis 
Background and objective
New analytical tools are needed to advance tobacco research, tobacco control planning and tobacco use prevention practice. In this study, we validated a method to extract information from cross-sectional survey for quantifying population dynamics of adolescent smoking behavior progression.
Methods
With a 3-stage 7-path model, probabilities of smoking behavior progression were estimated employing the Probabilistic Discrete Event System (PDES) method and the cross-sectional data from 1997-2006 National Survey on Drug Use and Health (NSDUH). Validity of the PDES method was assessed using data from the National Longitudinal Survey of Youth 1997 and trends in smoking transition covering the period during which funding for tobacco control was cut substantively in 2003 in the United States.
Results
Probabilities for all seven smoking progression paths were successfully estimated with the PDES method and the NSDUH data. The absolute difference in the estimated probabilities between the two approaches varied from 0.002 to 0.076 (p>0.05 for all) and were highly correlated with each other (R2=0.998, p<0.01). Changes in the estimated transitional probabilities across the 1997-2006 reflected the 2003 funding cut for tobacco control.
Conclusions
The PDES method has validity in quantifying population dynamics of smoking behavior progression with cross-sectional survey data. The estimated transitional probabilities add new evidence supporting more advanced tobacco research, tobacco control planning and tobacco use prevention practice. This method can be easily extended to study other health risk behaviors.
doi:10.4172/2155-6180.S1-004
PMCID: PMC4178951  PMID: 25279247
PDES method; Validation; Adolescent smoking; Cross-sectional data
6.  Predictors of responsiveness among early adolescents to a school-based risk reduction intervention over 3 years 
AIDS and behavior  2013;17(3):1096-1104.
This study assesses potential predictive factors for unresponsiveness to the “Focus on Youth in the Caribbean (FOYC)” intervention using longitudinal data from 1360 Bahamian sixth-grade youth. Results from hierarchical logistic regression analyses indicate that the intervention had a greater impact on knowledge, skills, self-efficacy, and condom use intention among low and medium initial scorers. High initial scores in knowledge, skills, self-efficacy, and intention were predictive of relative unresponsiveness to the intervention. Advanced age and male sex were predictive of unresponsiveness to the intervention for HIV/AIDS knowledge. Female gender was predictive of unresponsiveness to the intervention for self-efficacy. High academic self-evaluation was predictive of unresponsiveness to the intervention for condom use intention. The greatest intervention impact was observed at the six-month post-intervention follow-up; these intervention-related gains were sustained over the subsequent follow-up periods. Youth with higher risk attributes (lower knowledge, skills and self-efficacy) were more likely to respond to a risk reduction intervention.
doi:10.1007/s10461-012-0144-y
PMCID: PMC4136491  PMID: 22311147
HIV/AIDS knowledge; condom use skills; self-efficacy; condom use intention; intervention; unresponsiveness
7.  INTENTION TO USE CONDOM, CUSP MODELING, AND EVALUATION OF AN HIV PREVENTION INTERVNETION TRIAL 
Adolescents are at particularly high risk to acquire HIV infection; increasing the likelihood of condom use is an effective measure to reduce the risk of such infections. Challenges in assessing actual condom use behavior among early adolescents render the precursor measure, intention to use condoms, an appealing alternative. While analyzing data from a randomized controlled trial to evaluate a theory-based intervention program to promote condom use among early adolescents, we observed a modest effect with regard to condom use intention when the linear analytical approach was used. If intention, as a measure of the readiness to perform a behavior, also contains a nonlinear discrete component, it would be more appropriately modeled using a non-linear approach. In this study, data from a randomized controlled trial (N=1360) were analyzed using the cusp catastrophe method with HIV knowledge and condom skills as the asymmetry variables and condom use self-efficacy as the bifurcation variables. Findings from concurrent and longitudinal modeling analyses indicated a much better fit of the cusp model (R2 = 0.85 and 4+ times smaller AIC and BIC) than the linear (R2 <=0.10 and 4+ times larger AIC and BIC) or the logistic model (R2<0.15, also 4+ times larger AIC and BIC). Receipt of the intervention as an asymmetry variable was significantly predicted condom use intention but did not as a bifurcation variable. In conclusion, adolescent intentions to use a condom contain both a continuous process and a discrete process and can better be modeled with cusp methods. A much greater program effect is likely from the same prevention intervention if additional measures are taken to foster sudden changes in condom intention.
PMCID: PMC4106698  PMID: 23735493
Behavioral Intention; Cusp modeling; HIV/AIDS; Bahamian Youth; Condom use
8.  Preparing for National Implementation of an Evidence-based, Effective HIV Prevention Program among Bahamian Sixth-Grade Students 
World health & population  2012;13(4):28-42.
Using data from the preparatory phase prior to national implementation of an effective HIV prevention program [Focus on Youth in the Caribbean (FOYC)] in all Bahamian government sixth-grade classes, we describe: 1) actual FOYC implementation; 2) factors which influenced implementation; and 3) the relationship of implementation with intervention outcome. Six elementary schools (with 17 grade six classrooms) were selected to participate in the preparatory phase. The 17 teachers were invited to: attend a training workshop; coordinate administration of questionnaires to the students; teach the 10 sessions of FOYC; and complete self-assessment checklists. 395 students submitted baseline and 311 students submitted year-end questionnaires. Thirteen teachers initiated FOYC; five completed all 10 sessions. Implementation of FOYC was not related to teacher FOYC workshop experience but did cluster by school. There were significant positive correlations between improved student knowledge of HIV/AIDS, protective health skills, perceived parental monitoring and reduced risk behaviors with the number of FOYC sessions delivered. Implementation was impeded by logistic impediments, structural issues with the measures, and comfort-level issues, most of which can be addressed for national implementation. Degree of FOYC implementation is correlated with positive student outcomes.
PMCID: PMC4063301  PMID: 23089726
Bahamas; implementation; HIV prevention; AIDS knowledge; intention; risk behavior; preadolescents
9.  A Cluster Randomized Controlled Trial of an Adolescent HIV Prevention Program among Bahamian Youth: Effect at 12 Months Post-Intervention 
AIDS and behavior  2008;13(3):499-508.
Background
Behavioral interventions based on the Protection Motivation Theory (PMT) have been demonstrated to reduce HIV risk behavior among mid- and older adolescents in different settings across the globe but have not been evaluated among Caribbean nations and have received limited evaluation among pre-adolescents.
Objective
To determine 1) the effectiveness among pre-adolescents in The Bahamas of a PMT-based HIV prevention program “Focus on Youth in the Caribbean” (FOYC) and 2) the role of the targeted PMT constructs in intervention effect.
Methods
1,360 sixth grade youth (10-11 years of age) from 15 urban schools in New Providence, The Bahamas were randomized by school to receive either FOYC or a control condition. Data collected at baseline, six and 12 months post intervention were analyzed. A five-step scheme was used to assess sexual behavior progression, ranging from “1” = “a virgin without intention to have sex” to” 5″ = “having sex without a condom”. Group-based trajectory analysis was utilized in assessing the program effect.
Results
Two sexual behavior progression patterns were detected: slow progressors and quick progressors. Receiving FOYC reduced the likelihood for adolescents to become quick progressors (adjusted OR = 0.77, 95% CI: 0.64-1.00). The observed effectiveness was especially impacted by a subset of the targeted PMT constructs.
Conclusion
FOYC effectively delays sexual risk among Bahamian pre-adolescents. The group-based trajectory analysis provides an analytical approach for assessing interventions among adolescents with low rates and diverse progression patterns of sexual activity.
doi:10.1007/s10461-008-9511-0
PMCID: PMC4026176  PMID: 19116781
Behavioral Intervention; FOK; HIV/AIDS; Adolescent risk behavior; The Bahamas
10.  Acculturative Stress and Influential Factors among International Students in China: A Structural Dynamic Perspective 
PLoS ONE  2014;9(4):e96322.
Stress represents a prominent aspect of modern life and is associated with numerous negative health consequences. International students are a key force in shaping globalization. However, these students often experience acculturative stress, influencing their health and well-being. The growing number of international students in China emerges as a new global health challenge and presents an opportunity to advance our understanding of acculturative stress. This study aims to investigate the acculturative stress of international students in China, and verify the mechanism and influential factors of acculturative stress. We analyzed survey data from 567 international students attending universities in Wuhan, China. We used a network-based analytical approach to assess the structure of the Acculturative Stress Scale for International Students and used regression analysis to assess the relationships between acculturative stress and theoretically related factors. We found that higher levels of acculturative stress were reported by students from Asia and Africa than from other regions (Europe/America/Oceania). Lower acculturative stress was reported by unmarried students than others and by students well prepared than not well prepared. We verified seven acculturative stress subconstructs: rejection, identity threat, opportunity deprivation, self-confidence, value conflict, cultural competence, and homesickness; and discovered a three-dimensional network structure of these subconstructs. Our results suggest that acculturative stress was more common among international students in China than in developed countries. Acculturative stress was also more common among international students who did not well prepared, married, and belonged to an organized religion. African and Asian students' stress was higher than that for students from other regions. Acculturative stress prevention programs should seek to improve preparedness of the international students for studying abroad and pay extra attention to the high risk subgroups.
doi:10.1371/journal.pone.0096322
PMCID: PMC4005751  PMID: 24788357
12.  Brief Sensation Seeking Scale for Chinese - Cultural Adaptation and Psychometric Assessment 
International behavioral research requires instruments that are not culturally-biased to assess sensation seeking. In this study we described a culturally adapted version of the Brief Sensation Seeking Scale for Chinese (BSSS-C) and its psychometric characteristics. The adapted scale was assessed using an adult sample (n=238) with diverse educational and residential backgrounds. The BSSS-C (Cronbach alpha=0.90) was correlated with the original Brief Sensation Seeking Scale (r = 0.85, p<0.01) and fitted the four-factor model well (CFI=0.98, SRMR=0.03). The scale scores significantly predicted intention to and actual engagement in a number of health risk behaviors, including alcohol consumption, cigarette smoking, and sexual risk behaviors. In conclusion, the BSSS-C has adequate reliability and validity, supporting its utility in China and potential in other developing countries.
doi:10.1016/j.paid.2012.11.007
PMCID: PMC3539791  PMID: 23316097
Sensation Seeking scale; Cross-cultural adaptation; Health Behavior; China
13.  A Protection Motivation Theory-Based Scale for Tobacco Research among Chinese Youth 
Rates of tobacco use among adolescents in China and other lower and middle-income countries remain high despite notable prevention and intervention programs. One reason for this may be the lack of theory-based research in tobacco use prevention in these countries. In the current study, a culturally appropriate 21-item measurement scale for cigarette smoking was developed based on the core constructs of Protection Motivation Theory (PMT). The scale was assessed among a sample of 553 Chinese vocational high school students. Results from correlational and measurement modeling analysis indicated adequate measurement reliability for the proposed PMT scale structure. The two PMT Pathways and the seven PMT constructs were significantly correlated with adolescent intention to smoke and actual smoking behavior. This study is the first to evaluate a PMT scale for cigarette smoking among Chinese adolescents. The scale provides a potential tool for assessing social cognitive processes underlying tobacco use. This is essential for understanding smoking behavior among Chinese youth and to support more effective tobacco use prevention efforts. Additional studies are needed to assess its utility for use with Chinese youth in other settings.
doi:10.4172/2155-6105.1000154
PMCID: PMC3903136  PMID: 24478933
Protection Motivation Theory (PMT); Adolescents; Cigarette smoking
14.  Multisystemic Therapy Compared to Telephone Support for Youth with Poorly Controlled Diabetes: Findings From A Randomized Controlled Trial 
Background
Few interventions have effectively improved health outcomes among youth with diabetes in chronic poor metabolic control.
Purpose
To determine whether Multisystemic Therapy (MST), an intensive, home-based, tailored family treatment, was superior to weekly telephone support for improving regimen adherence and metabolic control among adolescents with chronic poor metabolic control.
Methods
A randomized controlled trial was conducted with 146 adolescents with type 1 or 2 diabetes. Data were collected at baseline, seven months (treatment termination) and twelve months (six month follow-up).
Results
Adolescents receiving MST had significantly improved metabolic control at seven (1.01% decrease) and twelve months (0.74% decrease) compared to adolescents in telephone support. Parents of adolescents receiving MST reported significant improvements in adolescent adherence. However, adolescent-reported adherence was unchanged.
Conclusions
MST improved health outcomes among adolescents with chronic poor metabolic control when compared to telephone support. Home-based approaches may provide a viable means to improve access to behavioral interventions for such youth.
doi:10.1007/s12160-012-9378-1
PMCID: PMC3443313  PMID: 22644587
Adherence; Youth; Diabetes; Family Treatment
15.  Exposure to School and Community Based Prevention Programs and Reductions in Cigarette Smoking among Adolescents in the United States, 2000–08 
Evaluation and Program Planning  2011;35(3):321-328.
Smoking remains prevalent among U.S. youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control.
A national representative sample of youth 12–17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth.
More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose-response relation. Reduction in smoking was related to increased quitting in 2000–02, to increased quitting and declined initiation in 2003–05, and to initiation, quitting and relapse in 2005–08.
Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.
doi:10.1016/j.evalprogplan.2011.12.001
PMCID: PMC3305912  PMID: 22410164
Adolescents; Community; Probabilistic Discrete Event System; Tobacco use prevention; United States
16.  Prevalence and Factors of Addictive Internet Use among Adolescents in Wuhan, China: Interactions of Parental Relationship with Age and Hyperactivity-Impulsivity 
PLoS ONE  2013;8(4):e61782.
Purposes
This study examined the prevalence of addictive Internet use and analyzed the role of parental relationship in affecting this behavior among a random sample of adolescents in Wuhan, China.
Methods
Students (n = 1,101) were randomly selected from four schools, including 638 boys and 463 girls with a mean age of 13.8 (standard deviation = 1.2) years. Addictive Internet use, parental relationship, hyperactivity-impulsivity were measured by validated instruments. Prevalence rate, ANOVA and multiple linear regression method were used to analyze the level of Internet addiction and its association with parental relationship, hyperactivity-impulsivity, as well as the interaction of parental relationship with chronological age and hyperactivity-impulsivity.
Results
The prevalence rate of Internet addiction was 13.5% (16.5% for boys and 9.5% for girls, p<0.01). Compared to non-addictive users, addictive Internet users were scored significantly lower on parental relationships and significantly higher on hyperactivity-impulsivity. Interaction analysis indicated that better parental relationship was associated with more reductions in risk of addictive Internet use for younger students than for older students, and with more risk of Internet addiction among higher than among lower hyperactivity-impulsivity students.
Conclusions
Findings of this study indicate that adolescent addictive Internet use is a significant public health threat in China. Prevention interventions targeting parental relationship must consider adolescent’s age and hyperactivity-impulsivity tendency.
doi:10.1371/journal.pone.0061782
PMCID: PMC3626596  PMID: 23596525
17.  Effect of a grade 6 HIV risk reduction intervention four years later among students who were and were not enrolled in the study trial 
The Journal of Adolescent Health  2011;50(3):243-249.
Purpose
To assess the long-term impact of HIV-prevention interventions delivered to youth before sexual initiation and the effects of interventions delivered in non-study settings.
Methods
A five-group comparison of HIV knowledge, and condom-use skills, self-efficacy, intentions and practice among 1997 grade 10 youth attending one of the eight government high schools in Nassau, The Bahamas. Group 1 received an HIV-prevention intervention, Focus on youth in the Caribbean (FOYC), in Grade 6 as part of a randomized trial; Group 2 received FOYC as part of the regular school curriculum but outside of the trial; Group 3 received the control condition as part of the trial; Group 4 received the control condition as part of the school curriculum but outside of the trial; and, Group 5 (Naïve Controls) were not enrolled in a school receiving FOYC or the control and did not participate in the trial.
Results
FOYC youth compared to control youth and Naive Controls had higher HIV knowledge, condom-use skills and self-efficacy four years later. By subgroups, Group 1 demonstrated higher HIV/AIDS knowledge than all groups except Group 2, higher condom skills than all groups, and higher condom self-efficacy than Naïve Controls. Youth in Group 2 demonstrated higher HIV knowledge than youth in Groups 3 to 5. Behavioral effects were not found.
Conclusions
FOYC delivered to grade 6 students continued to have protective effects four years later. Positive effects are present among youth who received FOYC as part of the school curriculum but were not enrolled in the trial.
doi:10.1016/j.jadohealth.2011.06.012
PMCID: PMC3279702  PMID: 22325129
HIV Prevention; pre-adolescents; long-term follow-up; testing effect
18.  Alcohol and Marijuana Use Outcomes in the Healthy Choices Motivational Interviewing Intervention for HIV-Positive Youth 
AIDS Patient Care and STDs  2012;26(2):95-100.
Abstract
Healthy Choices is a motivational interviewing intervention targeting multiple risk behaviors among HIV-positive youth. This study investigated the effects of this intervention program specifically on alcohol and marijuana use. Youth living with HIV (n=143, mean age=20.7, 51.5% male) were recruited from four sites in the United States, and randomly assigned to intervention or control conditions. The four-session intervention focused on two of three possible problem behaviors based on entry screening; this study focused on 143 HIV-positive youth who received the intervention for substance use. At 15-month follow-up past-week alcohol use was significantly lower for intervention youth than control youth (39.7% versus 53.6%, χ2=2.81, 0.05
doi:10.1089/apc.2011.0157
PMCID: PMC3266518  PMID: 22191456
Social capital and health research has emerged as a focus of contemporary behavioral epidemiology, while intervention research is seeking more effective measures to increase health protective behaviors and decrease health-risk behaviors. In this review we explored current literature on social capital and health outcomes at the micro-, mesa-, and macro-levels with a particular emphasis on research that incorporates a social capital framework, and adolescent and young adult engagement in risk behaviors. These data indicate that across a broad range of socio-cultural and economic contexts, social capital can affect individuals' risk for negative health outcomes and their engagement in risk behaviors. Further research is needed which should focus on differentiating and measuring positive and negative social capital within both mainstream and alternative social networks, assessing how social constructions of gender, ethnicity, and race – within specific cultural contexts – mediate the relationship between social capital and risk and/or protective behaviors. This new research should integrate the existing research within historical socioeconomic and political conditions. In addition, social capital scales need to be developed to be both culturally and developmentally appropriate for use with adolescents living in a diversity of settings. Despite the proliferation of social capital research, the concept remains underutilized in both assessment and intervention development for adolescents' and young adults' engagement in risk behaviors and their associated short- and long-term poor health outcomes.
doi:10.2147/AHMT.S26560
PMCID: PMC3521560  PMID: 23243387
social capital; global health; risk behaviors
Aims: To systematically review the literature on the Chinese translations of the Alcohol Use Disorders Identification Test (AUDIT) and their cross-cultural applicability in Chinese language populations. Methods: We identified peer-reviewed articles published in English (n = 10) and in Chinese (n = 11) from 1980 to September 2009, with key words China, Chinese and AUDIT among PubMed, EBSCO, PsycInfo, FirstSearch electronic databases and two Chinese databases. Results: Five teams from Beijing, Tibet, Taiwan and Hong Kong reported their region-specific translation procedures, cultural adaptations, validity (0.93–0.95 in two versions) and reliability (0.63–0.99). These Chinese translations and short versions demonstrated relatively high sensitivity (0.880–0.997) and moderate specificity (0.709–0.934) for hazardous/harmful drinking and alcohol dependence, but low specificity for alcohol dependence among Min-Nan Taiwanese (0.58). The AUDIT and its adaptations were most utilized in workplace- and hospital-settings for screening and brief intervention. However, they were under-utilized in population-based surveys, primary care settings, and among women, adolescents, rural-to-urban migrants, the elderly and minorities. Among 12 studies from mainland China, four included both women and men, and only one in Tibet was published in English. Conclusion: There is a growing amount of psychometric, epidemiologic and treatment research using Chinese translations of the AUDIT, much of it still unavailable in the English-language literature. Given the increase in burden of disease and injury attributable to alcohol use in the Western Pacific region, the use of an internationally comparable instrument (such as the AUDIT) in research with Chinese populations presents a unique opportunity to expand clinical and epidemiologic knowledge about alcohol problem epidemics.
doi:10.1093/alcalc/agr012
PMCID: PMC3119458  PMID: 21467046
AIDS Research and Treatment  2012;2012:806384.
The present study randomly assigned 15 Bahamian elementary schools to one of three intervention conditions. To assess the adequacy of cluster randomization, we examined two concerns identified by the local research team: inequality of gender distribution and environmental risk among groups. Baseline significant differences in risk and protective behaviors were minimal. There were significantly more males in the intervention group. Males had higher rates of risk behavior at all assessments. Poor school performance was also higher among the intervention condition and was significantly associated with increased rates of many but not all risk behaviors. Prior to adjusting for gender and school performance, several risk behaviors appeared to be higher after intervention among intervention youth. Adjusting for gender and school performance eradicated the group differences in risk behavior rates. Results demonstrate the importance of adequate randomization where outcomes of interest are rare events at baseline or differ by gender and there is an unequal gender distribution and the importance of the local research team's knowledge of potential inequalities in environmental risk (i.e., school performance). Not considering such individual differences could impact the integrity of trial outcomes.
doi:10.1155/2012/806384
PMCID: PMC3356864  PMID: 22645667
Objective
To detect subgroups with different risks at different ages to develop overweight and obese during the adolescence–young adulthood period.
Design
Accelerated longitudinal design and developmental trajectory analysis were used. The likelihoods to become overweight (body mass index [BMI] >25 kg/m2) and obese (BMI >30 kg/m2) were assessed across the life course from the ages of 12 to 28 years.
Subjects
Adolescent participants aged 12–17 years (n = 4119) identified in the National Longitudinal Survey of Youth 1997 at baseline were followed up to 2008.
Results
Seven overweight risk groups (WG) were detected for male and female samples respectively, of which five were closely related to each of the following five periods: (a) middle-school ages (19.7% and 12.6% for male and female, respectively), (b) high-school ages (11.4% and 13.6%, respectively), (c) college ages (12.6% and 9.1%, respectively), (d) post-college ages (11.8% and 10.0%, respectively), and (e) work–family-formation ages (11.0% and 12.9%, respectively); two were nonperiod-specific groups: a permanent low-risk group for both sexes (27.3% for male, 36.4% for female), a growing-risk group for males (6.2%), and a self-limiting risk group for females (5.4%, with the likelihood increasing with age, which peaked at the age of 21 years, and then declined). Likewise, six obesity risk groups (OG) were detected, of which four corresponded to the first four high-risk WG groups. The risk groups were relatively independent of race and educational attainment.
Conclusions
Findings of this study imply that five risk groups for weight gain like five consecutive “tests” exist from middle-school period to work-and-family formation. Failure to pass any of these tests in the life course could lead to overweight or obese status. Further research needs to study life-course-specific factors and mechanisms for more effective weight control.
doi:10.2147/AHMT.S30178
PMCID: PMC3915891  PMID: 24600285
developmental trajectory; overweight; obesity; adolescents and young adults; life course; United States
Purpose
Parent-child communication is associated with positive outcomes for youths’ engagement in sexual behaviors. Limited data are available regarding parent-child communication in transitional countries. We present data from Vietnamese parent-youth dyads on parent reproductive health knowledge, comfort of communication, frequency of talk, and discordancy between youths’ reported and parents’ perceptions for engagement in relationships and sexually intimate behaviors.
Methods
185 randomly selected parent-youth dyads in four communes in Ha Noi and Khanh Hoa Province. Descriptive and comparative analysis included chi-square tests, independent samples t-tests, and ANOVA. Linear regression analysis was utilized to assess relationships between parental knowledge, level of comfort, frequency of talk, and discordancy.
Results
Seventy-six percent of parents and 44% of youth were female. Youth mean age was 17.2 years. For parental “reproductive health knowledge” mean score was 24.74 (SD 3.84: range 15–34). Lower parental reproductive health knowledge was positively associated with lower levels of education [F=2.983, df 184: p=0.014]. Data indicate a linear model in which knowledge is related to “comfort” (β =0.17; p=0.048) and “comfort” to frequency of “talk” (β =0.6; p<0.0001). Frequency of “talk” is not related to parents’ discordant perceptions regarding their child’s reported involvement in relationships (β =0.002; p=0.79) or sexual touching (β =0.57; p=0.60).
Conclusions
Parent and youth in Viet Nam are engaged in limited communication about reproductive health. There is need for more data to assess the impact of these communication patterns on youths’ engagement in sexual behaviors and for development of family-centered interventions to increase parental knowledge and skills for positive communication.
doi:10.1016/j.jadohealth.2010.06.021
PMCID: PMC3058229  PMID: 21338898
The Journal of Adolescent Health  2011;49(2):193-198.
Purpose
More than 50% of youth living with HIV (YLH) have unprotected sex. In previous studies, we reported effects of a motivational interviewing (MI)-based multi-risk reduction intervention, “Healthy Choices,” in improving motivation, depression and viral load in YLH. In this study we report the effect of the intervention on increasing condom use.
Methods
Six waves of longitudinal data (n = 142) across a period from baseline through 15 months post intervention were analyzed. The developmental trajectory modeling method was used for program effect evaluation.
Results
Three groups detected with distinct sexual risks were: Persistent low sexual risk (PLSR), delayed high sexual risk (DHSR), and high and growing sexual risk (HGSR) with regard to levels and time trajectories of condom use throughout the trial. Receiving Healthy Choices increased the likelihood to be in the PLSR group (63% vs. 32%, p < 0.01) and reduced the likelihood to be in the DHSR group (16% vs. 50%, p < 0.05). Receiving the intervention was also associated with progressive reductions in no-condom sex for PLSR youth (adjusted β = −0.325, p < 0.01) and HGSR youth (adjusted β = −0.364, p < 0.01).
Conclusion
The MI-based program Healthy Choices, when delivered in clinic settings, can prevent unprotected sex in subgroups of YLH, although more intensive interventions may be needed to change risk trajectories among those at highest risk of transmitting the AIDS virus. Developmental trajectory analysis provides an alternative approach to evaluate program effects for study samples that contain distinct subgroups.
doi:10.1016/j.jadohealth.2010.11.252
PMCID: PMC3282587  PMID: 21783053
Healthy Choice; HIV positive youth; Sexual risk; Condom use; Randomized controlled trial; Trajectory analysis
Objective
To investigate the association of age, period and cohort with the changing pattern of cigarette smoking among youth and young adults for better planning tobacco control in the United States.
Methods
Age-period-cohort analysis of the 1990-2005 National Survey on Drug Use and Health data.
Results
Rates of lifetime and 30-day smoking for adolescents fluctuated between 1990-96 before they declined; the same rates for young adults progressively increased until 2002 before declining. There were significant cohort effects on changes in the prevalence rates of cigarette smoking.
Conclusions
The cohort effects on smoking underscore the need for sustained tobacco control policies.
PMCID: PMC3262964  PMID: 22040588
tobacco control; adolescent smoking; APC Modeling; United States

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