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1.  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
2.  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
3.  A Feasibility Study of Motivational Interviewing for Health Risk Behaviors Among Thai Youth Living with HIV 
doi:10.1016/j.jana.2012.02.008
PMCID: PMC3459291  PMID: 22683198
alcohol; HIV infection; motivational interviewing; sexual behavior; Thailand
4.  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
5.  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
6.  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
7.  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
8.  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
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
Human organization  2011;70(1):22-32.
In this study, we examine migrant stigma and its effect on social capital reconstruction among rural migrants who possess legal rural residence but live and work in urban China. After a review of the concepts of stigma and social capital, we report data collected through in-depth interviews with 40 rural migrant workers and 38 urban residents recruited from Beijing, China. Findings from this study indicate that social stigma against rural migrants is common in urban China and is reinforced through media, social institutions and their representatives, and day-to-day interactions. As an important part of discrimination, stigma against migrant workers creates inequality, undermines trust, and reduces opportunities for interpersonal interactions between migrants and urban residents. Through these social processes, social stigma interferes with the reconstruction of social capital (including bonding, bridging and linking social capital) for individual rural migrants as well as for their communities. The interaction between stigma and social capital reconstruction may present as a mechanism by which migration leads to negative health consequences. Results from this study underscore the need for taking measures against migrant stigma and alternatively work toward social capital reconstruction for health promotion and disease prevention among this population.
PMCID: PMC3080703  PMID: 21516266
Social capital; Stigma; Rural migrants; China
Information sciences  2010;180(3):432-440.
In order to find better strategies for tobacco control, it is often critical to know the transitional probabilities among various stages of tobacco use. Traditionally, such probabilities are estimated by analyzing data from longitudinal surveys that are often time-consuming and expensive to conduct. Since cross-sectional surveys are much easier to conduct, it will be much more practical and useful to estimate transitional probabilities from cross-sectional survey data if possible. However, no previous research has attempted to do this. In this paper, we propose a method to estimate transitional probabilities from cross-sectional survey data. The method is novel and is based on a discrete event system framework. In particular, we introduce state probabilities and transitional probabilities to conventional discrete event system models. We derive various equations that can be used to estimate the transitional probabilities. We test the method using cross-sectional data of the National Survey on Drug Use and Health. The estimated transitional probabilities can be used in predicting the future smoking behavior for decision-making, planning and evaluation of various tobacco control programs. The method also allows a sensitivity analysis that can be used to find the most effective way of tobacco control. Since there are much more cross-sectional survey data in existence than longitudinal ones, the impact of this new method is expected to be significant.
doi:10.1016/j.ins.2009.09.018
PMCID: PMC2789352  PMID: 20161437
Discrete event systems; tobacco control; smoking behavior; cross-sectional survey; transitional probability
Behavioral research and prevention intervention science efforts have largely been based on hypotheses of linear or rational behavior change. Additional advances in the field may result from the integration of quantum behavior change and catastrophe models. Longitudinal data from a randomized trial for 1241 pre-adolescents 9–12 years old who self-described as virgin were analyzed. Data for 469 virgins in the control group were included for linear and cusp catastrophe models to describe sexual initiation; data for the rest in the intervention group were added for program effect assessment. Self-reported likelihood to have sex was positively associated with actual initiation of sex (OR=1.72, 95% CI: 1.43–2.06, R2 = 0.13). Receipt of a behavioral prevention intervention based on a cognitive model prevented 15.6% (33.0% vs. 48.6%, OR = 0.52, 95% CI: 0.24–1.11) of the participants from initiating sex among only those who reported “very likely to have sex.” The beta coefficients for the cubic term of the cusp assessing three bifurcating variables (planning to have sex, intrinsic rewards from sex and self-efficacy for abstinence) were 0.0726, 0.1116 and 0.1069 respectively; R2 varied from 0.49 to 0.54 (p<0.001 for all). Although an intervention based on a model of continuous behavior change did produce a modest impact on sexual initiation, quantum change has contributed more than continuous change in describing sexual initiation among young adolescents, suggesting the need for quantum change and chaotic models to advance behavioral prevention of HIV/AIDS.
PMCID: PMC3013356  PMID: 20887691
quantum behavior change; cusp catastrophe model; sexual risk behavior; adolescents; HIV prevention
Pediatrics  2009;123(5):e917-e928.
OBJECTIVES
The purpose of this work was to report the intervention effects of Focus on Youth in the Caribbean (youth HIV intervention), an HIV prevention intervention based on protection motivation theory, through 24 months of follow-up on sexual risk and protection knowledge, perceptions, intentions, and behavior among Bahamian sixth-grade youth.
METHODS
We randomly assigned 1360 sixth-grade youth (and their parents) attending 15 government elementary schools in the Bahamas to 1 of 3 conditions: (1) youth HIV intervention plus a parental monitoring/communication/HIV education intervention; (2) youth HIV intervention plus a parental goal-setting intervention; or (3) an environmental protection intervention plus the parental goal-setting intervention. Baseline and 4 follow-up surveys at 6-month intervals were conducted. Intervention effects were assessed using the mixed model for continuous outcome variables and the generalized linear mixed model for dichotomous outcome variables.
RESULTS
Through 24 months of follow-up, youth HIV intervention, in combination with the parent interventions, significantly increased youths’ HIV/AIDS knowledge, perceptions of their ability to use condoms, perception of the effectiveness of condoms and abstinence, and condom use intention and significantly lowered perceived costs to remaining abstinent. There was a trend for higher condom use among youth in the Focus on Youth in the Caribbean groups at each follow-up interval.
CONCLUSIONS
Focus on Youth in the Caribbean, in combination with 1 of 2 parent interventions administered to preadolescents and their parents in the Bahamas, resulted in and sustained protective changes on HIV/AIDS knowledge, sexual perceptions, and condom use intention. Although rates of sexual experience remained low, the consistent trend at all of the follow-up periods for higher condom use among youth who received youth intervention reached marginal significance at 24 months. Additional follow-up is necessary to determine whether the apparent protective effect is statistically significant as more youth initiate sex and whether it endures over time.
doi:10.1542/peds.2008-2363
PMCID: PMC3008808  PMID: 19380429
protection motivation theory; preadolescent; intervention; HIV/AIDS; condom use; sexual behavior
Objective
To determine if Healthy Choices, a motivational interviewing intervention targeting multiple risk behaviors, improved human immunodeficiency virus (HIV) viral load.
Design
A randomized, 2-group repeated measures design with analysis of data from baseline and 6- and 9-month follow-up collected from 2005 to 2007.
Setting
Five US adolescent medicine HIV clinics.
Participants
A convenience sample with at least 1 of 3 risk behaviors (nonadherence to HIV medications, substance abuse, and unprotected sex) was enrolled. The sample was aged 16 to 24 years and primarily African American. Of the 205 enrolled, 19 did not complete baseline data collections, for a final sample size of 186. Young people living with HIV were randomized to the intervention plus specialty care (n = 94) or specialty care alone (n = 92). The 3- and 6-month follow-up rates, respectively, were 86% and 82% for the intervention group and 81% and 73% for controls.
Intervention
Healthy Choices was a 4-session individual clinic-based motivational interviewing intervention delivered during a 10-week period. Motivational interviewing is a method of communication designed to elicit and reinforce intrinsic motivation for change.
Outcome Measure
Plasma viral load.
Results
Youth randomized to Healthy Choices showed a significant decline in viral load at 6 months postintervention compared with youth in the control condition (β = −0.36, t = −2.15, P = .03), with those prescribed antiretroviral medications showing the lowest viral loads. Differences were no longer significant at 9 months.
Conclusion
A motivational interviewing intervention targeting multiple risk behaviors resulted in short-term improvements in viral load for youth living with HIV.
doi:10.1001/archpediatrics.2009.212
PMCID: PMC2843389  PMID: 19996045
A probabilistic discrete event system (PDES) is a nondeterministic discrete event system where the probabilities of nondeterministic transitions are specified. State estimation problems of PDES are more difficult than those of non-probabilistic discrete event systems. In our previous papers, we investigated state estimation problems for non-probabilistic discrete event systems. We defined four types of detectabilities and derived necessary and sufficient conditions for checking these detectabilities. In this paper, we extend our study to state estimation problems for PDES by considering the probabilities. The first step in our approach is to convert a given PDES into a nondeterministic discrete event system and find sufficient conditions for checking probabilistic detectabilities. Next, to find necessary and sufficient conditions for checking probabilistic detectabilities, we investigate the “convergence” of event sequences in PDES. An event sequence is convergent if along this sequence, it is more and more certain that the system is in a particular state. We derive conditions for convergence and hence for detectabilities. We focus on systems with complete event observation and no state observation. For better presentation, the theoretical development is illustrated by a simplified example of nephritis diagnosis.
doi:10.1016/j.automatica.2008.05.025
PMCID: PMC2717802  PMID: 19956775
Probabilistic discrete event systems; state estimation; detectability; observability
Objective
To study the toxicity of inhaled PGE1 (IPGE1) in healthy ventilated piglets.
Methods
Mechanically ventilated anesthetized piglets received either high dose IPGE1 (IPGE1 group) or nebulized saline (control group) continuously for 24 hours. Cardio-respiratory parameters, complete blood counts and serum electrolytes were monitored. Lung histology was evaluated by a masked pathologist for the severity (minimal, moderate, and severe) and extent (focal, multifocal, and diffuse) of histologic injury.
Results
Ten neonatal pigs were instrumented. Four received nebulized saline and six received high dose IPGE1. There was no evidence of adverse cardio-respiratory effects, bronchial irritation or hypernatremia related to IPGE1. Diffuse/multifocal alveolar edema and focal polymorphonuclear infiltration was observed in both the control and IPGE1 groups suggesting that alveolar alterations may be secondary to effects of mechanical ventilation. The most distinct histomorphological abnormalities observed in the IPGE1 animals were focal ulceration, flattening of the bronchial epithelium and loss of cilia of moderate to severe degree in the trachea and bronchi.
Conclusion
In healthy piglets, inhalation of high dose IPGE1 was not associated with adverse cardiorespiratory effects, bronchial irritation, or hypernatremia and produced minimal signs of pulmonary toxicity even after 24 hours. Prolonged inhalation of high dose PGE1 therefore appears safe in newborn piglets.
doi:10.1016/j.pupt.2008.01.011
PMCID: PMC2443360  PMID: 18343700
Pulmonary toxicity; inhaled; PGE1/Alprostadil; neonatal; piglet/animal; histomorphology; nebulizer; aerosol
Background
Although young age is considered a risk factor for adverse events related to procedural sedation and analgesia (PSA), data in very young children (<2 years of age) are lacking.
Aims
The main objective of our study is to describe PSA in children <2 years of age in an inner city tertiary care pediatric emergency department (PED).
Methods
We conducted a retrospective chart review from January 2005 to June 2007 of children <2 years of age who received PSA in our PED. We collected demographic variables, indication for and medications used for PSA, adverse events (AE) related to PSA, and interventions performed to treat them.
Results
Of the children who received PSA, 14.5% (180/1,235) were <2 years of age of whom 173 were included for the analysis; 73% (126/173) of the study subjects were between 1 and 2 years of age, 54.3% (94/173) were male, and 96.5% (167/173) belonged to American Society of Anesthesiologists class 1. Incision and drainage (45.0%, 78/173) and laceration repair (32.4%, 56/173) were the two most common indications for PSA. Ketamine and midazolam was the most common combination medication used for PSA (62.4%, 108/173). Sedation was deemed ineffective in 5.8% (10/173) of the children. There were only two failed sedations; 5.8% (10/173) of the children experienced AE with most being minor [oxygen desaturations 1.7% (3/173), emesis 2.3% (4/173), and others 1.2% (2/173)]. One child experienced serious AE in the form of apnea and bradycardia requiring intubation.
Conclusions
Our data suggest that children under 2 years of age can be sedated effectively without increased risk of AE in a PED.
doi:10.1007/s12245-008-0047-x
PMCID: PMC2657272  PMID: 19384511
Pediatric; Procedural sedation; Conscious sedation; Analgesia; Adverse events
World health & population  2006;8(2):5-21.
The process of rural-to-urban migration in China is accelerating with increased modernization and industrialization. To address the issues of health outcomes and geographic mobility among this population, data from 4,208 rural-to-urban migrants in two major metropolitans of China were analyzed. Results indicate that average duration of migration was 4.3 years, with younger migrants being more mobile than their older counterparts. After controlling for possible confounders, increases in mobility were associated with unstable living arrangements, substandard employment conditions, suboptimal health status, inferior health-seeking behavior, elevated level of substance use, depressive symptoms, and expression of dissatisfaction with life and work. The findings in the present study underscore the need for improved living and employment conditions and increased health care services available to rural-to-urban migratory population.
PMCID: PMC2249565  PMID: 18277098
China; general health; health-seeking; migration; mobility

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