Journal of Primary Prevention最新文献

Suicidal behaviors are increasingly prevalent among college students. Although emotion dysregulation is theorized to increase suicide risk, research supporting this relationship is mixed. Engagement in self-damaging behaviors may play a role in the relationship between emotion dysregulation and suicide risk, theoretically by increasing one's capability of engaging in suicidal behaviors. Such behaviors may interact with emotion dysregulation to predict suicide risk. Alternatively, engaging in self-damaging behaviors may mediate the emotion dysregulation-suicide risk relationship. We examined the potential moderating and mediating roles of engagement in multiple self-damaging behaviors in the relationship between emotion dysregulation and suicide risk among college students. Participants were 181 undergraduate students who reported a history of self-damaging behaviors (i.e., non-suicidal self-injury, alcohol misuse, drug misuse, disordered eating), overall emotion dysregulation, and suicide risk. Findings revealed an interactive effect of emotion dysregulation and self-damaging behaviors on suicide risk, with engagement in more forms of self-damaging behaviors conferring higher risk for suicide, particularly in the context of greater emotion dysregulation. The model testing self-damaging behaviors as a mediator was also significant, such that greater emotion dysregulation had an indirect effect on elevated suicide risk via number of self-damaging behaviors. These findings help clarify associations among emotion dysregulation, self-damaging behaviors, and suicide risk, and have implications for specific targets of intervention and for the prevention of suicide by college students.

Diabetes is a potentially life-threatening metabolic condition that disproportionately affects US adults with a disability. Diabetes screening is key to early disease detection and prompt treatment, but it is not known whether US adults with a disability receive similar levels of diabetes screening as individuals without a disability. We compared diabetes screening levels in US adults with a disability to those without one. Using national 2017 Behavioral Risk Factor Surveillance System surveys, we determined the prevalence of diabetes screening by disability status in US adults who fall under the American Diabetes Association's recommended screening guidelines: those younger than 45 years old with a body mass index (BMI) ≥ 25 kg/m² and those aged 45 years and older. We used logistic regression modelling to examine the impact of disability status on diabetes screening while adjusting for diabetes associated sociodemographic and clinical factors. In people with a disability, around 50% of those younger than 45 years old with a BMI ≥ 25 kg/m² and 33% of those 45 years or older did not receive screening. In the under 45 years with a BMI ≥ 25 kg/m² screening group, individuals with a disability had a slightly higher but non-significant prevalence, but a lower adjusted odds of diabetes screening compared to those without a disability. People with a disability under age 45 had a slightly lower but again non-significant prevalence but a higher adjusted odds of diabetes screening than did those without a disability who were age 45 or older. Additional interventions are needed to improve diabetes screening levels among US adults with a disability at high risk of developing diabetes as screening is a critical initial step in the diabetes management process.

Latina and Vietnamese women are disproportionately burdened by human papillomavirus (HPV)-associated cervical cancer and underutilize the HPV vaccine, which is an effective cancer prevention measure. To inform the adaptation of a National Cancer Institute's evidence-based cancer control program, HPV Vaccine Decision Narratives, and because of the rapidly changing information concerning consumption patterns of young adults, we elicited preferences and characteristics associated with women's interest in various health information sources, specifically for HPV vaccination. We conducted 50 interviews with young Latina and Vietnamese women at two Planned Parenthood health centers in Southern California. Interview questions were guided by the Channel Complementarity Theory and focused on understanding the multiple communication channels women turn to for health, and the characteristics that motivate their use. Our results showed that Latina and Vietnamese women turn to many sources, from online and social media to school health classes, mothers, and doctors. Specific characteristics that motivate women's online use of health information included immediacy and access, convenience and credibility. When receiving HPV vaccine information, privacy, avoiding information overload, interpersonal engagement, and receiving health information from trusted sources was important. Our study advances the prevention literature by elevating the role of platform delivery considerations and emphasizing preferences to effectively reach Latina and Vietnamese women, who are disproportionately burdened by HPV cancers and are less aware of HPV vaccine prevention. These results can be used to further inform the dissemination of this cancer control program. Adaptation of the program should include changes to its delivery, such that trusted sources are used, and dissemination is coordinated to send a consistent message across multiple communication methods.

Understanding the behaviors that lead to sunburn is an important objective toward developing intervention strategies to reduce risk for skin cancers. Our cross-sectional study surveyed 400 college students aged 18 and older at a public state university in the northeastern US in 2018 to assess tanning behaviors, outdoor activities, sun protection, and sunburn over the past year. Sunburn was exceedingly common; over half reported one or more sunburns in the past 12 months. Outdoor intentional and unintentional tanning were also common. Male sex, White race, sun sensitive skin type, and outdoor intentional and unintentional tanning were independently associated with increased odds of sunburn. Water and non-water sports, sunbathing, and vacations were also associated with sunburn. These results indicate that tanning and outdoor activities such as sports are important behaviors on which to focus for sunburn prevention among college students. Understanding the behaviors that are associated with sunburn provides useful opportunities to prevent skin cancer among young people.

Hispanic/Latinx youth in the U.S. are disproportionately affected by HIV, and are in need of culturally, linguistically, and developmentally tailored HIV prevention programs focused on expanding routine screening and environmental prevention efforts. With SAMHSA support, we implemented an HIV prevention campaign targeting 18- to 24-year-old Hispanic/Latinx college students. Based on formative feedback, both traditional communication and social media channels were employed to motivate students to seek free-of-charge on-campus HIV testing. Participants' attitudes regarding the benefits of and confidence in condom use were also examined. From 2015 to 2018, 1406 Hispanic 18-24 year olds received an on-campus HIV test; for nearly half, this was their first HIV test ever. Among first time testers, the reasons for not getting tested sooner included that over 70% thought they were unlikely to have an HIV infection, over 20% said they did not know where to get tested, and 10% reported being afraid to find out their status. Moreover, participants reported a variety of cues to seeking testing: just under half reported printed flyers, on-campus lawn signs, and word-of-mouth, and almost 15% reported social media. Repeat testers (n = 717) were significantly more likely than first time testers to report hearing about HIV testing through social media. There were significant gains from baseline to the 1-month follow-up in both perceived advantages of condom use and confidence in condom use. Our study showed that messages conveyed through traditional communication channels remain important and serve as cues to seek HIV testing for Hispanic/Latinx college students, especially those who have never before been tested.

In this study, we describe the relative contributions of and interactions between individual risk factors associated with ineffective pregnancy prevention among female adolescents in Portugal. Our sample consisted of 856 sexually experienced female adolescents (10-19 years) who did not intend to become pregnant. Of these, 379 were pregnant, and the residual (477) had never been pregnant. We used classification tree analysis to describe the interplay among a set of established sociodemographic, familial, reproductive, and relationship factors as predictors of ineffective pregnancy prevention. The tree model showed good predictive properties. Seven profiles predicted one-half to all the cases of ineffective pregnancy prevention. Ineffective pregnancy prevention was predicted by adolescents' grade level and different combinations of variables, specifically female age, age at the time of first sexual intercourse, religious beliefs, place of residence, maternal pregnancy before age 20, household structure in childhood, and partner's age difference. According to our findings, limiting assessments to the cumulative presence of risk factors may be insufficient to accurately identify adolescents at elevated risk of unwanted pregnancy, as the impact of any given risk factor may vary according to other factors. Our findings may contribute to the development of a risk assessment tool that may support healthcare providers' efforts to provide individualized risk assessment for adolescent patients and, thus, to better support pregnancy prevention.

Multiple methodological approaches have been used to explore adolescent alcohol use and related sexual behaviors, ranging from surveys to assessments of alcohol outlet density. Although surveys can capture the extent of alcohol use, they do not allow for a contextualized understanding of young people's voiced experiences with alcohol, including sociocultural, gendered and environmental pressures to consume, and related engagement in sex. The mapping of alcohol outlets provides physical density information, but infrequently from youths' perspectives. Traditional qualitative methods like in-depth interviews and focus group discussions do allow for a more nuanced understanding of adolescents' experiences, but they can be limited by the use of semi-structured guides that may negatively impact the fluidity of discussion. We seek to contribute to the methodological approaches utilized with adolescents by demonstrating how contextualized data were captured from Tanzanian adolescents' experiences of alcohol and sex, which are sensitive topics in many African countries. We collected data in secondary schools and youth centers across four sites in Dar es Salaam, the largest and most diverse city in Tanzania. As a complement to in-depth interviews, archival reviews, and a systematic mapping of alcohol availability, participatory methodologies such as photovoice, story writing, and drawing allowed Tanzanian youth to offer more honest, descriptions of lived experiences with their physical and social environment in relation to alcohol use and related sexual behavior patterns. Through participatory methods, study participants were able to discuss behaviors that are viewed as social transgressions, sensitive topics like violence in relation to sex, and views around their own self-agency. The use of a methodological toolkit including participatory methodologies enabled youth to trust the researchers and share sensitive information in a relatively short period of time, overcoming some of the challenges of traditional qualitative methods.

Compared to other key populations, adolescents living in sub-Saharan Africa experience a high HIV disease burden. To address this, organizations have implemented a variety of youth-oriented HIV prevention strategies, including the HIV SEERs Project. SEERs is an innovative, community-based program designed with and for youth in Kenya to reduce HIV stigma (a known barrier to HIV testing), and increase treatment and retention in care. While preliminary research has demonstrated SEERs efficacy for increasing HIV knowledge and decreasing stigma, information about its efficacy as a means to increase HIV testing has been limited to assessing behavioral intentions. To address this limitation, SEERs facilitators partnered with 20 local HIV agencies in 2018 to offer on-site HIV testing during SEERs programming. The purpose of this article is to examine the impact, as well as the benefits and challenges of SEERs programming on HIV testing and linkage to care. SEERs facilitators collected and reported the following data monthly over the course of the year: number of locations for SEERs programming, number and age range of SEERs attendees, number of attendees who screened for HIV and, among those, the number who tested positive and were linked to care. Facilitators also provided written descriptions of the benefits and challenges of implementing the SEERs programming. We analyzed HIV testing data using descriptive statistics and used qualitative data to describe facilitators' perceptions of the benefits and challenges of implementing the SEERs program. We discuss the contributions of these findings to the existing literature and explore future directions.

Adolescent pregnancy is considered a priority public health issue because of its implications in the lives of young mothers, their children, and the well-being of the general population. In this paper, we describe an intervention targeting adolescents (aged 11-19 years old) in a rural context and estimate its impact on key outcomes relevant to early pregnancy prevention: knowledge and self-efficacy concerning sexual and reproductive health, knowledge of sexual and reproductive rights, and attitudes toward gender roles. Our study used a quasi-experimental design comprising 747 adolescents. Three difference-in-differences models (raw, adjusted, and by exposure level) with fixed effects estimated the changes in all outcome measures. Our results showed that the intervention community had a significant improvement in all outcomes, and this improvement was larger in those who received the highest-exposure level of intervention compared to a control community. Our study provides evidence that a community-based intervention, founded on comprehensive sexual education, is a promising approach to improve key outcomes related to early pregnancy in rural contexts. Further research should be undertaken to test how similar strategies focusing on multi-layer early pregnancy determinants work on other sub-groups of vulnerable adolescents, such as school dropouts or those living in disadvantaged circumstances.