News & Announcements

Circle of Life HIV/AIDS Prevention Intervention for American Indian and Alaska Native Youth

Posted: August 03, 2012

This article describes the objectives, theoretical bases, development process, and evaluation efforts to-date for the Circle of Life curricula, HIV/AIDS prevention interventions designed for American Indian and Alaska Native youth. The curricula are based on Indigenous models of learning and behavior encompassing concepts of Western theories of health behavior change. The curricula underwent extensive national and community review. Subsequent advances include the development of a computer-based version of the intervention.

A review of the interventions aimed at HIV prevention for youth reveals a growing list showing success in sexual risk reduction. While these reviews have provided useful guidance for many youth-serving programs, absent from these lists is an intervention designed specifically for American Indian/Alaska Native (AI/AN) youth. Several factors contribute to this absence, including the challenges of generating sufficient scientific evidence to meet the standards required by such lists, the gaps created by inconsistent funding and shifting programmatic priorities, and the rapid change in technology and opportunities to use approaches to learning appropriate for AI/AN youth. In this brief article, the authors present the case of two curricula developed specifically for AI/AN youth: “Circle of Life: HIV/AIDS Curriculum for K-6” and “Circle of Life: HIV/AIDS and STD Prevention Curriculum for Middle School.” They outline the challenges and successes of development, implementation, and dissemination of these AI/AN youth-focused interventions. This history, coupled with strategic partnerships and escalating HIV prevention need in AI/AN communities, has propelled the two Circle of Life (COL) curricula forward, positioning them as meaningful and appropriate options for youth sexual risk prevention. The article begins by describing the development of COL, including the objectives of the curricula and their theoretical bases. It then describes the evaluations of the COL curricula, recent developments with respect to COL, and the promise of upcoming research efforts.

Read the abstract of the study. Read the full-text of the article (pdf).

Using Telepsychiatry for the Treatment of Depression in Underserved Hispanics

Posted: August 02, 2012

St. Elizabeth’s Health Center (St. Elizabeth’s) located in Tucson, Arizona, offers an array of medical, dental, counseling, and social services to its patient population. St. Elizabeth’s serves a highly underinsured and uninsured primarily Spanish speaking population. One respondent indicated at least 60% of the patient population identifies as Hispanic and approximately 97% of patients are uninsured or underinsured. The clinic also treats some undocumented immigrants who seek care.

Hispanics, the single largest and fastest growing minority group in the United Sates, face significant disparities in health and health care access. Research shows inadequate care for major depression among Hispanics. In April 2008, the University of Arizona College of Medicine, Department of Psychiatry (University of Arizona), in partnership with St. Elizabeth’s, received funding from the Robert Wood Johnson Foundation (RWJF) to conduct a project examining the acceptability and effectiveness of telepsychiatry depression treatment for low-income Hispanic adults provided by a psychiatrist through internet videoconferencing using a webcam. Prior to RWJF funding, the University of Arizona partnered with St. Elizabeth’s to conduct a telepyschiatry pilot project to determine the feasibility of using commercially available webcams to provide mental health services to patients in their primary care medical home.

As part of the RWJF project, which replicated the pilot on a larger scale, University of Arizona and St. Elizabeth’s staff screened approximately 160 patients into a study based on a diagnosis of major depressive disorder and other criteria. Researchers randomly assigned patients to one of two groups: an experimental group receiving the psychiatric webcam intervention, and the control group receiving “treatment as usual” care from their primary care provider and additional behavioral health services from a counselor if determined necessary. Researchers measured several depression outcome variables from physician and patient-rated perspectives, including quality of life, mental and physical functional abilities, and satisfaction with treatment, and assessed how acceptability and clinical response are impacted by levels of acculturation, severity of illness, age, and gender. 

Read the full report (pdf).

Black Teens in Public Housing Twice As Likely to Smoke

Posted: August 01, 2012

Black teens living in public housing communities are more than twice as likely to smoke as their peers in other U.S. communities, researchers have found. The findings, published in the August issue of Addictive Behaviors, suggest that early interventions are needed to prevent young people in these communities from lighting up. The study is titled Understanding tobacco use among urban African American adolescents living in public housing communities: A test of problem behavior theory.

"Compared to their same-aged peers, youth living in public housing were more likely to use tobacco and have positive attitudes about using tobacco," researcher Mansoo Yu, an assistant professor of social work and public health in the MU College of Human Environmental Sciences, said in a University of Missouri news release. "As previous research suggests, early use of tobacco increases individuals' chances of using more serious drugs later. In addition, early drug use is related to other serious problems, such as delinquent behaviors, and family and social problems," Yu added.

In conducting the study, Yu and colleagues from the University of Illinois at Chicago, Boston College and the University of South Carolina asked 518 black teenagers living in public housing in three large U.S. cities about their attitudes on tobacco use, symptoms of depression and delinquent behaviors. The study authors found that these teens were 2.3 times more likely to use tobacco than other black teens. The investigators pointed out that teens living in public housing may be more afraid, have poorer social relationships and more psychological strain, which could contribute to the higher rates of smoking.

"Smoking cessation programs for young African-Americans living in public housing communities should focus on reversing their positive attitudes toward tobacco use," Yu said in the news release. "In addition, programs should help address the youths' depressive symptoms and keep them from getting involved in delinquent behaviors." The researchers added that smoking prevention programs in public housing communities should target young children. "Early interventions are critical for these individuals since the likelihood of being exposed to risky behaviors dramatically increases as the children age," explained Yu. "In public housing communities, adolescents may have easier access to drugs and social activities where drugs are used."

Read more on Medline Plus website. Read the abstract of the study.

To Understand Mental Health Disparities Look to Race, Immigration, Culture & Ethnicity

Posted: August 01, 2012

Accounting for racial disparities in mental health and mental illness involves more than race. “Race matters even if we don’t know what race is,” said James Jackson, Ph.D., a professor of psychology and director of the Institute for Social Research at the University of Michigan, speaking at APA’s 2012 annual meeting in Philadelphia in May. In brief, the issue is not only about “race,” but R.I.C.E.—Race, Immigration, Culture, and Ethnicity, explained Jackson, who received APA’s Solomon Carter Fuller Award at the meeting.

One way to sort out the observed health disparities among racial and ethnic groups is to uncouple race, ethnicity, and immigration status, he said. Afro-Caribbeans make up a useful population for that task, because they share ancestry but not ethnicity with African Americans. Surveys in both the United States and Great Britain indicate that ancestry, gender, timing of immigration, and age at immigration are all factors in rates of mood disorders. For instance, drawing on data from the National Survey of American Life in 2004, Jackson and colleagues found that 19.9 percent of white people recorded a lifetime mood disorder, compared with 12.5 percent of African Americans and 13.7 percent of Afro-Caribbeans.

However, those overall figures masked several complexities. The rate for Afro-Caribbean respondents whose parents had been born in the United States was 24.3 percent, while among respondents who had come to this country 11 to 12 years before was just 6.3 percent. Similar variations dependent on immigration status and timing were observed for any lifetime psychiatric disorders among Afro-Caribbeans over age 55. Age of onset of major depression appeared to be younger for Afro-Caribbean males, who also faced a higher risk for major depressive disorder and a greater chance of its persistence compared with other ethnic-gender subgroups.

Jackson also noted that his research has found that among imprisoned populations, Afro-Caribbean males who met criteria for substance abuse were five times more likely than African-American males who met criteria for substance abuse to also have major depression, which suggests there is something going on with the behaviors of these men who are migrating to the United States. It could be the difficulty of finding work or making an adjustment to life in this country, he suggested.

Finally, important differences appear within nominally similar ethnic groups. Patterns differ among Cubans, Puerto Ricans, and Mexicans, who can’t be lumped together uncritically as “Hispanics.” “There’s no simple story,” Jackson emphasized. “First-generation health protection may not be an adequate explanation, and differences in psychopathology are not reducible in any simplistic way to differences in social and economic statuses among groups.”

Read more on the Psychiatric News website.

Read a related article about Dr. Jackson’s research on the relationship between physical and mental health disparities among minority populations also on Psychiatric News.

Read the full-text of the journal article Race and Unhealthy Behaviors: Chronic Stress, the HPA Axis, and Physical and Mental Health Disparities Over the Life Course.

Rising HIV Infection Rates, Stigma and Discrimination among Gay Men and Transgender People

Posted: July 31, 2012

Men who have sex with men (MSM) remain at substantial risk for HIV infection in almost every nation across the globe. The situation is even more glaring in high–income nations such as the United States, France, the United Kingdom and Canada—where overall HIV trends are declining except among Black MSM. And in many nations, discrimination, stigma, and criminalization laws present significant barriers to creating an AIDS-free generation. These were just a few of the themes at Stigma to Strength: Strategies for MSM, Transgender People and Allies in a Shifting AIDS Landscape, the day-long pre-conference to the 19th International AIDS Conference sponsored by the The Global Forum on MSM & HIV. 

The forum opened with a plenary speech by Congresswoman Barbara Lee, the California Democrat and fierce advocate for HIV/AIDS funding. Lee recently introduced landmark anti-HIV criminalization legislation. Perhaps the most compelling research was announced by Kevin Fenton, M.D., Ph.D., director of the Centers for Disease Control and Prevention’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Dr. Fenton reminded the audience that there has been a soaring number of seroconversions among Black American men who have sex with men—and new data show that “globally Black men who have sex with men are 15 times more likely to be HIV-positive.”

The new data was published in the special July 2012 “HIV in Men Who Have Sex with Men” issue of The Lancet. The lead author: White House Office of National AIDS Policy’s Gregorio Millett. Other contributors include Dr. Fenton, Emory University’s David Malebranche, M.D., MPH, and Columbia University’s Patrick A. Wilson, Ph.D. “We see the tremendous variation from Africa to Canada, the Caribbean and elsewhere,” said Dr. Fenton. “The most glaring disparity is in the United States.”

That trend is particularly “alarming” among Black MSM aged 13 to 19, according to CDC. New seroconversions have increased by 48 percent between 2006 and 2009. But the "tide is turning" against the epidemic and there is finally potential that “we can have an AIDS-free generation”—even among Black gay and bisexual men—Dr. Fenton said after the preconference. “That means we have a range of highly effective tools in which we can bring this epidemic to an end. Now the real work begins of implementation, scaling up and targeting different tools to those communities at most risk.”

The MSMGF event also featured more than 20 breakout sessions. One that expanded on Fenton’s plenary was “Strengthening the Response to HIV/AIDS among Ethnic Minority MSM and Transgender People in the Global North.” Dr. Wilson moderated and panelists included Andrea Lamour-Harrington, a transgender black women who represented U.S. Positive Women's Network. Lamour-Harrington was a public face to the "extreme” socioeconomic disparities faced by Black trans women, who are more than likely to be killed, suffer violence or sexual abuse, HIV/AIDS and discrimination.

“There are so many laws on the books that allow police to harass us,” said Lamour-Harrington. “In Philadelphia there is a law called ‘Obstruction of Highway.’ Police can search me or ask for identification if I’m standing on the street. Most of those arrested are Black and Latino trans women. And the only way we can change these laws are through conferences such as these.”

Read more on the Black AIDS Institute website. Access the July issue of The Lancet on HIV in Men Who Have Sex with Men.

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