Vulnerable Children and Youth Studies最新文献

Previous research shows that educational attainment is a protective factor for substance use and sexual risk among adolescents and young adults. Evidence also shows that this relationship may differ by race/ethnicity and gender. This study aimed to elucidate the relationship between educational attainment, substance use and sexual risk among African American women in emerging adulthood. This study uses cross-sectional data from 646 African American women (aged 18 to 25) enrolled in a randomized trial of a behavioral HIV risk-reduction intervention. At enrollment, participants completed a risk behavior assessment via audio-computer assisted self-interview and provided a urine sample for drug screening. Bivariate logistic regression analyses were conducted to examine substance use and sexual risk factors associated with educational attainment: completing some college or more vs. completing high school or less). Participants who completed some college or more (52%) were more likely to report heavy alcohol use (four or more drinks in one day) in the past 30 days (OR=1.48; p=0.014) and more likely to report alcohol or other drug use just before or during last sex (OR=1.43; p=0.026) compared with participants who completed high school or less. Completing some college or more was protective for having a positive urine screen for cocaine (OR=0.43; p=0.018) and reporting condomless sex at last sex (OR=0.71; p=0.041). Differences in positive marijuana screens, reporting a previous STI, or reporting their partner used alcohol or other drugs at last sex were not statistically significant. The findings reveal notable differences in the magnitude and direction of associations between educational attainment and substance use and sexual risk. Although educational attainment is subject to change because of the frequent pursuit of education during emerging adulthood, the findings may have important implications for tailoring HIV risk-reduction interventions to key populations, such as African American women.

Disclosure to children has been identified as one of the main challenges for parents living with HIV (PLH). The aim of this study was to qualitatively explore motivators, barriers, and the process of parental disclosure in a Zimbabwean community with high HIV prevalence. A total of 28 PLH participated in three focus groups comprising PLH who had disclosed their HIV status to their children (n = 11), PLH who had not disclosed to their children (n = 7), and the third group contained PLH who both had and had not disclosed their status (n = 10). Full, partial and indirect disclosure approaches were used by parents. Barriers to disclosing included the children being "too young" and lacking understanding of HIV as well as inability to maintain confidentiality around parents' status, 2) causing the child to worry, 3) being embarrassed, and 4) fearing that disclosure would prompt a child to treat a parent with disrespect. Motivators included 1) support of various kinds from their children, 2) educating their children around HIV risk, and 3) facilitating discussions about parental illness and death. Our findings suggest that understanding the barriers to disclosure is likely insufficient for supporting and promoting parental disclosure. The motivation for disclosure, support for the disclosure process, and culturally relevant interventions are needed to promote and support parental disclosure.

Given the high rates of mental health problems and poor service access among youth in war-affected countries throughout Sub-Saharan Africa, incorporating evidence-based mental health interventions into alternative delivery platforms could improve service access in these settings. We conducted a randomized controlled pilot study with high-risk Sierra Leonean youth to investigate the feasibility of implementing the Youth Readiness Intervention (YRI), a cognitive behavioral and interpersonal therapy-based group intervention, within an employment promotion program (EPP) and preliminary effects of the YRI on mental health outcomes. Participants were 175 youth (females=62%) ages 18-30 recruited via flyers and radio announcements. Participants were assigned to geographic clusters stratified by gender; clusters were randomized into YRI+EPP (n=58) or EPP-only (n=57). Statistically matched controls were recruited from comparable chiefdoms (n=60). The 12-session YRI was delivered bi-weekly, following EPP completion. Qualitative findings indicated that the YRI was highly feasible and acceptable as integrated into the EPP. Mixed linear effects models showed promising trends. Compared with controls, both YRI+EPP and EPP-only males reported significantly reduced post-traumatic stress symptoms, and YRI+EPP reported marginally significantly reduced emotional regulation difficulties. EPP-only females reported significantly reduced functional impairment compared to controls. Findings suggest that the YRI can be feasibly implemented within an EPP. Integrating the YRI into existing delivery platforms may help increase access to mental health care in Sierra Leone and provide a leverage point for scaling up evidence-based mental health interventions in other low-resource settings globally. [Clinicaltrials.gov; NCT0360361; 5/18/18].

Social support is a key element to the health wellbeing of individuals, especially those experiencing major life transitions and crises. Prior evidence has demonstrated that orphaned adolescents are socially isolated with limited supportive networks. This study focused on how orphaned adolescents define social support, the nature of relationships with non-kin ties, barriers and challenges to seeking support. In-depth interviews from 38 orphaned adolescents (14-19 years) were analyzed using thematic analysis. Findings demonstrated that 1) orphaned adolescents define support in terms of "giving and receiving material and non-material assistance", and "helping individuals overcome problems", 2) relationships are initiated by family members, 3) economic hardships, stigma, and lack of trust deter adolescents from seeking support outside of the family unit. Study findings point to the need to integrate social support strengthening components within programming for orphaned adolescents living in HIV impacted communities.