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Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): protocol for a feasibility randomized clinical trial.

ABSTRACT: BACKGROUND:Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention with integrated text messages ("nudges") that are informed by behavioral economic principles. The trial aims to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. METHODS/DESIGN:In total, 40 young adults who are African-American, aged 18-24, live in Baltimore City, have experienced at least one episode of homelessness in the last 12?months, are unemployed or underemployed (fewer than 10?h per week), are not enrolled in school, own a cell phone with text messaging, and report at least one episode of unprotected or unsafe sex in the prior 12?months will be recruited from two community-based organizations providing residential supportive services to urban youth. Participants will undergo a 3-week run-in period and thereafter be randomly assigned to one of two groups with active interventions for 20?weeks. The first group ("comparison") will receive text messages with information on job openings. The second group ("experimental") will receive text messages with information on job openings plus information on HIV prevention and business educational sessions, a mentored apprenticeship, and a start-up grant, and business and HIV prevention text messages based on principles from behavioral economics. The two primary outcomes relate to the feasibility of conducting a larger trial. Secondary outcomes relate to employment, sexual risk behaviors, and HIV preventive practices. All participants will be assessed using an in-person questionnaire at pre-intervention (prior to randomization) and at 3 weeks post-intervention. To obtain repeated, longitudinal measures, participants will be assessed weekly using text message surveys from pre-intervention up to 3 weeks post-intervention. DISCUSSION:This study will be one of the first U.S.-based feasibility randomized clinical trials of an HIV prevention microenterprise intervention for economically-vulnerable African-American young adults. The findings will inform whether and how to conduct a larger efficacy trial for HIV risk reduction in this population. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03766165 . Registered on 4 December 2018.

SUBMITTER: Mayo-Wilson LJ

PROVIDER: S-EPMC6637550 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): protocol for a feasibility randomized clinical trial.

Mayo-Wilson Larissa Jennings LJ Glass Nancy E NE Ssewamala Fred M FM Linnemayr Sebastian S Coleman Jessica J Timbo Fatmata F Johnson Matthew W MW Davoust Melissa M Labrique Alain A Yenokyan Gayane G Dodge Brian B Latkin Carl C

Trials 20190717 1

<h4>Background</h4>Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention w ...[more]

PMID: 31315685

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Project description:Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement.Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165.

Project description:Background: Acceptability is a critical requisite in establishing feasibility when planning a larger effectiveness trial. This study assessed the acceptability of conducting a feasibility randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults, aged 18 to 24, in Baltimore, Maryland. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors.Methods: Thirty-eight participants were randomized to experimental (n =?19) or comparison group (n?=?19). The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Qualitative and quantitative post-intervention, in-person interviews were used in addition to process documentation of study methods.Results: Our results found that the study design and interventions showed promise for being acceptable to economically-vulnerable African-American young adults. The largely positive endorsement suggested that factors contributing to acceptability included perceived economic potential, sexual health education, convenience, incentives, and encouraging, personalized feedback to participants. Barriers to acceptability for some participants included low cell phone connectivity, perceived payment delays, small cohort size, and disappointment with one's randomization assignment to comparison group. Use of peer referral, network, or wait-list designs, in addition to online options may enhance acceptability in a future definitive trial. Expanding administrative and mentoring support may improve overall experience.Conclusion: Microenterprise interventions are acceptable ways of providing young adults with important financial and sexual health content to address HIV risks associated with economic vulnerability.Trial registration: ClinicalTrials.gov. NCT03766165 . Registered 04 December 2018.

Project description:BackgroundThe first three years of life are the critical and sensitive periods for the formation of individual abilities. However, existing data indicates that early childhood development (ECD) in economically vulnerable areas of China is lagging, which is closely related to the lack of parenting knowledge and poor parenting practices.MethodsWe conducted a non-masked cluster-randomized controlled trial in a former nationally designated poverty county of China. All 6-36-month-old children and their caregivers living in 18 communities/clusters (10 towns and 8 districts of the county seat) were enrolled in a 9-month parenting training program. In the treatment-group communities, ECD centers were installed where community workers provided parenting training sessions. If caregivers were unable to visit the center, home-based parenting training was offered. No intervention was provided to the control group. Furthermore, we assigned half of the treatment group to receive monthly developmental feedback in addition to the parenting training. Based on the baseline and follow-up data, we investigated the treatment effects on parenting knowledge, attitudes, and practices through Intention-to-Treat (ITT) and Treatment-on-the-Treated (TOT) analyses.ResultsWe found no effects on the parenting knowledge and attitudes of the caregivers but significant effects on the parenting practices. The effects were heterogeneous among families with different characteristics. Specifically, on average, the program had the largest effect on internally oriented caregivers, mothers with higher education, and mothers who are primary caregivers. We want to emphasize that, although the ITT effect on parenting practices (the average treatment effect) were stronger for mothers with higher education, the TOT effect on parenting practices (the local average treatment effect, LATE) were stronger for mothers with less education. That is, even though on average the program helped mothers with higher education, but among complier families, the program benefited mothers with less education.ConclusionThe findings indicate that, at least in the short run, the program can directly change caregivers' parenting practices without changing their knowledge and attitudes. Future studies are needed to investigate whether parenting knowledge and attitudes can change in the long run.

Project description:ImportanceAlthough suicide is the second leading cause of death among Asian American adolescents, there is a dearth of studies examining overall and possible sex and sexual orientation disparities in the trends in suicidal behaviors among Asian American adolescents. Such information is crucial to inform targeted efforts of suicide prevention among Asian American adolescents.ObjectiveTo examine temporal trends and sex and sexual orientation disparities in trends of nonfatal suicidal behaviors in Asian American adolescents from 1991 through 2019.Design, setting, and participantsThis cross-sectional study used data from the national Youth Risk Behavior Survey from 1991 through 2019, analyzing a representative sample of US adolescents in grades 9 through 12 using a 3-stage cluster-sampling design. Data were analyzed from October through November 2020.ExposuresCalendar year, sex, sexual identity, sex of sexual contact, and interaction terms of these factors.Main outcomes and measuresCrude prevalence and annual percentage changes (APCs) in self-reported suicidal ideation, suicide plan, suicide attempts, and injury by suicide attempt for the overall sample and by sex, sexual identity, and sex of sexual contacts were calculated. Sexual minorities were defined as individuals whose sexual identity was gay or lesbian, bisexual, or not sure.ResultsAmong 7619 Asian Americans who participated in the Youth Risk Behavior Survey from 1991 to 2019 (mean [SD] age, 16.09 [1.29] years; 3760 [47.1%] female adolescents), 1576 individuals completed the sexual identity and behaviors questions after 2015 (mean [SD] age, 15.97 [1.28] years; 810 [49.2%] female adolescents). From 2009 through 2019, there was a 1.3-fold (95% CI, -0.8 to 3.3; P = .22) increase in suicide attempts and a 1.7-fold (95% CI, -2.6 to 5.9; P = .45) increase in injury by suicide attempt among Asian American female adolescents, although these increases were not statistically significant. Among 39 Asian American adolescents who identified as gay, lesbian, or bisexual or who were attracted to and had sexual contact with partners of the same sex or both sexes, compared with 1556 Asian American adolescents who were heterosexual, prevalence was greater for suicidal ideation (24 individuals [68.2%] vs 223 individuals [15.0%]; P < .001), suicide plan (15 individuals [57.7%] vs 179 individuals [11.9%]; P < .001), suicide attempts (14 individuals [41.0%] vs 74 individuals [5.5%]; P < .001), and injury by suicide attempt (5 individuals [17.6%] vs 23 individuals [1.7%]; P < .001) between 2015 and 2019. These sexual minorities identified by sexual identity and sexual contact also had an increasing rate over this period in suicide plan (APC, 10.5%; 95% CI, 4.4% to 16.9%; P < .001).Conclusions and relevanceThis study found significant increases in rates of suicide plan among Asian American adolescents who were sexual minorities identified by sexual identity and sexual contact together. These findings suggest that suicide screening needs to inquire about sexual minority status in terms of sexual identity and sex of sexual contact when identifying Asian American adolescents who are at risk for suicidal behaviors. Culturally relevant suicide-prevention programs addressing unique risk and protective factors, racial discrimination, and sexual orientation-related stigma may be needed for Asian American adolescents.

Project description:BackgroundThe family is an important social context where children learn and adopt eating behaviors. Specifically, parents play the role of health promoters, role models, and educators in the lives of children, influencing their food cognitions and choices. This study attempts to systematically review empirical studies examining the influence of parents on child food consumption behavior in two contexts: one promotive in nature (e.g., healthy food), and the other preventive in nature (e.g., unhealthy food).MethodsFrom a total of 6,448 titles extracted from Web of Science, ERIC, PsycINFO and PubMED, seventy eight studies met the inclusion criteria for a systematic review, while thirty seven articles contained requisite statistical information for meta-analysis. The parental variables extracted include active guidance/education, restrictive guidance/rule-making, availability, accessibility, modeling, pressure to eat, rewarding food consumption, rewarding with verbal praise, and using food as reward. The food consumption behaviors examined include fruits and vegetables consumption, sugar-sweetened beverages, and snack consumption.ResultsResults indicate that availability (Healthy: r = .24, p < .001; Unhealthy: r = .34, p < .001) and parental modeling effects (Healthy: r = .32, p < .001; Unhealthy: r = .35, p < .001) show the strongest associations with both healthy and unhealthy food consumption. In addition, the efficacy of some parenting practices might be dependent on the food consumption context and the age of the child. For healthy foods, active guidance/education might be more effective (r = .15, p < .001). For unhealthy foods, restrictive guidance/rule-making might be more effective (r = -.11, p < .01). For children 7 and older, restrictive guidance/rule-making could be more effective in preventing unhealthy eating (r = - .20, p < .05). For children 6 and younger, rewarding with verbal praise can be more effective in promoting healthy eating (r = .26, p < .001) and in preventing unhealthy eating (r = - .08, p < .01).ConclusionsThis study illustrates that a number of parental behaviors are strong correlates of child food consumption behavior. More importantly, this study highlights 3 main areas in parental influence of child food consumption that are understudied: (1) active guidance/education, (2) psychosocial mediators, and (3) moderating influence of general parenting styles.

Project description:BackgroundSub-Saharan Africa (SSA) has the highest number of people living with HIV/AIDS, with Nigeria, South Africa, and Uganda accounting for 48% of new infections. A systematic review of the HIV burden among women engaged in sex work (WESW) in 50 low- and middle-income countries found that they had increased odds of HIV infection relative to the general female population. Social structural factors, such as the sex work environment, violence, stigma, cultural issues, and criminalization of sex work are critical in shaping sexually transmitted infection (STI)/HIV risks among WESW and their clients in Uganda. Poverty is the most commonly cited reason for involvement in sex work in SSA. Against this backdrop, this study protocol describes a randomized controlled trial (RCT) that tests the impact of adding economic empowerment to traditional HIV risk reduction (HIVRR) to reduce new incidence of STIs and HIV among WESW in Rakai and the greater Masaka regions in Uganda.MethodsThis three-arm RCT will evaluate the efficacy of adding savings, financial literacy and vocational training/mentorship to traditional HIVRR on reducing new incidence of STI infections among 990 WESW across 33 hotspots. The three arms (n = 330 each) are: 1) Control group: only HIVRR versus 2) Treatment group 1: HIVRR plus Savings plus Financial Literacy (HIVRR + S + FL); and 3) Treatment group 2: HIVRR plus S plus FL plus Vocational Skills Training and Mentorship (V) (HIVRR + S + FL + V). Data will be collected at baseline (pre-test), 6, 12, 18 and 24-months post-intervention initiation. This study will use an embedded experimental mixed methods design where qualitative data will be collected post-intervention across all conditions to explore participant experiences.DiscussionWhen WESW have access to more capital and/or alternative forms of employment and start earning formal income outside of sex work, they may be better able to improve their skills and employability for professional advancement, thereby reducing their STI/HIV risk. The study findings may advance our understanding of how best to implement gender-specific HIV prevention globally, engaging women across the HIV treatment cascade. Further, results will provide evidence for the intervention's efficacy to reduce STIs and inform implementation sustainability, including costs and cost-effectiveness.Trial registrationClinicalTrials.gov , ID: NCT03583541 .

Dataset Information

Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): protocol for a feasibility randomized clinical trial.

Publications

Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): protocol for a feasibility randomized clinical trial.

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