Intervention In Year Research Articles

A Brief Intervention to Promote Conflict Reappraisal Preserves Marital Quality Over Time

Marital quality is a major contributor to happiness and health. Unfortunately, marital quality normatively declines over time. We tested whether a novel 21-min intervention designed to foster the reappraisal of marital conflicts could preserve marital quality in a sample of 120 couples enrolled in an intensive 2-year study. Half of the couples were randomly assigned to receive the reappraisal intervention in Year 2 (following no intervention in Year 1); half were not. Both groups exhibited declines in marital quality over Year 1. This decline continued in Year 2 among couples in the control condition, but it was eliminated among couples in the reappraisal condition. This effect of the reappraisal intervention on marital quality over time was mediated through reductions in conflict-related distress over time. This study illustrates the potential of brief, theory-based, social-psychological interventions to preserve the quality of intimate relationships over time.

Effect of women's groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trial

Women's groups and health education by peer counsellors can improve the health of mothers and children. We assessed their effects on mortality and breastfeeding rates in rural Malawi. We did a 2×2 factorial, cluster-randomised trial in 185,888 people in Mchinji district. 48 equal-sized clusters were randomly allocated to four groups with a computer-generated number sequence. 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems. 72 trained volunteer peer counsellors made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care. Primary outcomes for the women's group intervention were maternal, perinatal, neonatal, and infant mortality rates (MMR, PMR, NMR, and IMR, respectively); and for the peer counselling were IMR and exclusive breastfeeding (EBF) rates. Analysis was by intention to treat. The trial is registered as ISRCTN06477126. We monitored outcomes of 26,262 births between 2005 and 2009. In a factorial model adjusted only for clustering and the volunteer peer counselling intervention, in women's group areas, for years 2 and 3, we noted non-significant decreases in NMR (odds ratio 0.93, 0.64-1.35) and MMR (0.54, 0.28-1.04). After adjustment for parity, socioeconomic quintile, and baseline measures, effects were larger for NMR (0.85, 0.59-1.22) and MMR (0.48, 0.26-0.91). Because of the interaction between the two interventions, a stratified analysis was done. For women's groups, in adjusted analyses, MMR fell by 74% (0.26, 0.10-0.70), and NMR by 41% (0.59, 0.40-0.86) in areas with no peer counsellors, but there was no effect in areas with counsellors (1.09, 0.40-2.98, and 1.38, 0.75-2.54). Factorial analysis for the peer counselling intervention for years 1-3 showed a fall in IMR of 18% (0.82, 0.67-1.00) and an improvement in EBF rates (2.42, 1.48-3.96). The results of the stratified, adjusted analysis showed a 36% reduction in IMR (0.64, 0.48-0.85) but no effect on EBF (1.18, 0.63-2.25) in areas without women's groups, and in areas with women's groups there was no effect on IMR (1.05, 0.82-1.36) and an increase in EBF (5.02, 2.67-9.44). The cost of women's groups was US$114 per year of life lost (YLL) averted and that of peer counsellors was $33 per YLL averted, using stratified data from single intervention comparisons. Community mobilisation through women's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural populations in Africa. Saving Newborn Lives, UK Department for International Development, and Wellcome Trust.

Abstract A22: The Kin KeeperSM Intervention: Women move beyond psychological barriers to Pap screening

Abstract Cancer health disparities are underlined by structural and conceptual barriers, such as: Adequate cancer awareness and education, functional cancer literacy, appropriate and timely access to cancer screening and follow-up care, and psychological aspects of the decision to undergo cancer screening. Cervical cancer health disparities can be impacted by early detection and screening with the Papanicolaou (Pap) test. The Kin KeeperSM Cancer Prevention Intervention is a culturally and linguistically tailored breast and cervical cancer educational intervention designed to improve functional cancer literacy. The Health Belief Model (HBM) was used as a framework to explore potential associations between responses to a cervical Cancer Literacy Assessment Tool (C-CLAT) item assessing a psychological barrier to Pap screening and a woman's screening accomplishments. Methods: The Kin KeeperSM model has three levels of participants: community health worker (CHW), CHW's female clients (“kin keepers”), and female family members of female clients. Trained CHWs recruited 543 Black, Latina, and Arab women from Detroit and Dearborn, MI to participate in the two-year study. Analysis included only women with two years of data, thus the final number of participants was 446 (117 Black, 157 Latina, 172 Arab). Kin keepers recruited female family members in year one and delivered the cervical cancer educational intervention in year two. After recruitment, CHWs from three local agencies administered the C-CLAT to all participants in English, Spanish, or Arabic before administering an educational intervention (pre-C-CLAT) and after the educational intervention (post-C-CLAT 1); and provided women with Personal Action Plans (PAPs) to identify screening goals based on three statements: Find a health care provider to do first-ever Pap; schedule first-ever Pap; and continue getting yearly Pap. The outcome of interest was indication of these goals as accomplishments in year two. After kin keepers delivered the educational intervention in year two, CHWs administered a post-C-CLAT 2 and an accomplishment-oriented PAP to all participants. Using multivariable logistic regression, we observed the potential effect of responses to a C-CLAT item and sociodemographic covariates on PAP accomplishments. The C-CLAT item “Getting a Pap test is very painful,” suggests a psychological barrier to screening, thus it is relevant to a classic HBM construct, perceived barriers. Post-C-CLAT 1 responses to this item were scored with an answer key and SPSS (PASW Statistics 18) was used for statistical analyses. Results: In year one, the most significant covariates affecting the goals women selected were race, relationship to the kin keeper, and health insurance status. Response to the C-CLAT item “Getting a Pap test is very painful” was not significant to the goal to continue annual Pap tests, yet race and possibly relationship to the kin keeper were significant (with an alpha of .105, p-values were .038 and .104, respectively). Analysis of women's PAP accomplishments 12 months later indicates the majority of women found a health care provider for a first-ever Pap test, scheduled a Pap in the past 12 months, and had a Pap in the past 12 months. Relationship to the kin keeper was the only statistically significant covariate (p = .035) in analysis of having had a Pap test in the last 12 months. Conclusions: Future interventions designed to impact cervical cancer health disparities should support women's intentions to pursue screening despite potential psychological barriers. Such studies should explore dynamics between female family members and how these relationships might modify screening decisions and accomplishments. This research was funded by National Institutes of Health (NIH), National Institute for Nursing Research (NINR), 1R01NR011323. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A22.

HIV Prevention Interventions in Chennai, India: Are Men Who Have Sex with Men Being Reached?

India has the greatest number of HIV infections in Asia and the third highest total number of infected persons globally. Men who have sex with men (MSM) are considered by the Government of India's National AIDS Control Organization (NACO) a "core risk group" for HIV in need of HIV prevention efforts. However there is a dearth of information on the frequency of participation in HIV prevention interventions and subsequent HIV risk and other correlates among MSM in India. Recruited through peer outreach workers, word of mouth and snowball sampling techniques, 210 MSM in Chennai completed an interviewer-administered assessment, including questions about participating in any HIV prevention interventions in the past year, sexual risk taking, demographics, MSM identities, and other psychosocial variables. Bivariate and multivariable logistic regression procedures were used to examine behavioral and demographic correlates with HIV prevention intervention participation. More than a quarter (26%) of the sample reported participating in an HIV prevention intervention in the year prior to study participation. Participants who reported engaging in unprotected anal sex (UAS; odds ratio [OR] = 0.28; p = 0.01) in the 3 months prior to study enrollment were less likely to have participated in an HIV prevention program in the past year. MSM who were older (OR = 1.04; p = 0.05), kothis (feminine acting/appearing and predominantly receptive partners in anal sex) compared to panthis (masculine appearing, predominantly insertive partners; OR = 5.52, p = 0.0004), those with higher educational attainment (OR = 1.48, p = 0.01), being "out" about having sex with other men (OR = 4.03, p = 0.0001), and MSM who reported ever having been paid in exchange for sex (OR = 2.92, p = 0.001) were more likely to have reported participation in an HIV prevention intervention in the preceding year. In a multivariable model, MSM reporting UAS in the prior 3 months were less likely to have participated in an HIV prevention intervention (AOR = 0.34, p = 0.04). MSM who were older (AOR = 1.05, p = 0.05), those with higher educational attainment (AOR = 1.92, p = 0.0009), and MSM who were "out" about having sex with other men (AOR = 2.71, p = 0.04) were more likely to have reported participating in an HIV prevention program. Findings suggest that exposure to HIV prevention interventions may be protective against engaging in UAS for some MSM in India. Understanding predictors of participation in an HIV prevention intervention is helpful for identifying Indian MSM who might have had no exposure to HIV prevention information and skills building, hence allowing researchers and prevention workers to focus efforts on individuals at greatest need.

Addressing issues of asthma in inner-city children

For children living in the inner city, asthma tends to be more frequent and severe. Although the causes for this heightened severity of asthma are not clearly established, environmental allergens likely play a major role. To characterize, understand, and treat children with asthma living in the inner city better, the National Institutes of Allergy and Infectious Diseases of the National Institutes of Health established an Inner City Asthma Program in 1991. Over the past 15 years, 3 separate inner-city asthma research networks have been formed and funded by this institute. The work from these programs has led to important observations including evidence that environmental allergens, particularly cockroach, are important for sensitization and severity of asthma of the affected children. Furthermore, reductions in the allergen load can lead to improved asthma control. The most recent program, the Inner City Asthma Consortium, was formed in 2002 with a goal to develop immune-based therapy for children with asthma in the inner city and to determine mechanisms of these therapies as well as immunopathogenesis of asthma in these high-risk children. This article reviews these programs and how they have begun the effort to understand and treat children with asthma who live in inner cities better and what their findings mean in relationship to unique features of asthma in inner city children.

Motivating mothers to prevent caries: Confirming the beneficial effect of counseling

The purpose of this study was to compare the effect of a motivational interviewing (MI) counseling visit with traditional health education for mothers of young children at high risk of developing dental caries. The authors enrolled 240 infants aged 6 to 18 months and their mothers in the study and randomly assigned them to MI or traditional health education (control) groups. Mothers in the control group received a pamphlet and watched a videotape. Those in the MI group received the pamphlet and watched the videotape, as well as received an MI counseling session and six follow-up telephone calls during the first year. There were no interventions in year 2. After two years, children in the MI group exhibited significantly less new caries (decayed or filled surfaces) than those in the control group (that is, a protective effect of MI) (odds ratio = 0.35, 95 percent confidence interval = 0.15 to 0.83). MI is a promising approach that warrants further attention in a variety of dental contexts. The results of this study show that MI has a protective effect with regard to the development of early childhood caries. One reason for this clinical effect is greater compliance with recommended fluoride varnish treatment regimens in families who received MI counseling compared with families who received traditional education.

HIV Prevention Community Planning: Enhancing Data-Informed Decision-Making

The primary purpose of this study was to test the impact of the first year of a 3-year intervention designed to enhance the use of behavioral data in the Massachusetts HIV Prevention Community Planning Group (MPPG). A one-group, pretest-posttest, nonequivalent independent variables, quasi-experimental design was used to assess changes before and after the first year of implementing strategies to enhance the use of behavioral data in decision-making. Over 90% of the CPG members completed surveys at baseline and at the end of the first year of the intervention. Consistent with the focus of the MPPG intervention in Year One, significant improvements were found from baseline to follow-up in member perceptions of decision-making structure and leadership, satisfaction with prevention planning processes, and intervention prioritization decisions. Findings provide preliminary evidence for the impact on member satisfaction of changes in CPG organizational structures and processes, including redistribution of power and broader constituent representation.

Crisis intervention with adults

Abstract“Oh, I've been doing crisis intervention for years,” is not an unusual remark; such comments are often made, however, by persons with little knowledge or understanding of the specific techniques utilized in a definitive crisis intervention approach.