Risk Reduction Education Research Articles

Stroke Recovery and Prevention Barriers Among Young African-American Men: Potential Avenues to Reduce Health Disparities

Background: African Americans (AAs) who experience a first time stroke are younger and have double the stroke rate and more poststroke complications than other Americans. Objective: To assess perceived poststroke care barriers among younger AA men and their care partners (CPs) in order to inform the development of acceptable and effective improvements in poststroke care for this high-risk group. Methods: Ten community-dwelling AA stroke survivors and 7 of their CPs participated in focus groups and advisory board meetings. Survivors had stroke or transient ischemic attack within 1 year and a Barthel Index score >60. In focus groups, using a semi-structured interview guide, survivors and CPs identified self-perceived barriers and facilitators to poststroke care. Thematic analysis of session transcripts and the constant comparative method were used to generate themes. Results: Survivor age ranged from 34 to 64 years. Mean Barthel score was 95.5. CPs, all AA women, ranged in age from 49 to 61 years. Five CPs were wives, 1 was a fiancée, and 1 was a niece. Participants cited multiple personal, social, and societal stroke recovery challenges. Although hypertension and smoking risks were acknowledged, stress, depression, posttraumatic stress disorder, anger/frustration, personal identity change, and difficulty communicating unique needs as AA men were more frequently noted. Facilitators included family support, stress reduction, and dietary changes. Conclusions: Younger AA men and their CPs perceive multiple poststroke care barriers. Biological risk reduction education may not capture all salient aspects of health management for AA stroke survivors. Leveraging family and community strengths, addressing psychological health, and directly engaging patients with health care teams may improve care management.

Pedagogies of the Unknown: Unpacking ‘Culture’ in Disaster Risk Reduction Education

Disaster risk reduction policies make heavy use of education for spreading a ‘culture’ of resilience at community level. This paper reflects on the uncritical way the concept of culture is used in current pedagogies of resilience. It describes how a deterministic/normative vision of culture is gradually giving way to a generative/emergentist approach. Indeed, the notion of resilience has brought with it an idea of culture that emphasizes the flexible and dynamic character of learning. The paper also illuminates the unrecognized potential for disaster education, for it can be used as a tool to absolve public institutions from failure by shifting responsibility for safety to the population. Resilience, in other words, can become a shock absorber that compensates for institutional inefficiency.

HIV Tests And New Diagnoses Declined After California Budget Cuts, But Reallocating Funds Helped Reduce Impact

Historically, California supplemented federal funding of HIV prevention and testing so that Californians with HIV could become aware of their infection and obtain lifesaving treatment. However, budget deficits in 2009 led the state to eliminate its supplemental funding for HIV prevention. We analyzed the impact of California's HIV resource allocation change between state fiscal years 2009 and 2011. We found that the number of HIV tests declined 19 percent, from 66,629 to 53,760, in local health jurisdictions with high HIV burden. In low-burden jurisdictions, the number of HIV tests declined 90 percent, from 20,302 to 2,116. New diagnoses fell from 2,434 in 2009 to 2,235 in 2011 (calendar years) in high-burden jurisdictions and from 346 to 327 in low-burden ones. California's budget crunch prompted state and local programs to redirect remaining HIV funds from risk reduction education to testing activities. Thus, the impact of the budget cuts on HIV tests and new HIV diagnoses was smaller than might have been expected given the size of the cuts. As California's fiscal outlook improves, we recommend that the state restore supplemental funding for HIV prevention and testing.

Abstract T P319: Reducing Health Disparities for African-American Men: Under-Recognized Factors in Stroke Recovery

Introduction: African-Americans (AA) have double the stroke rate, are younger and have more post-stroke complications than other Americans. There is a need for approaches that improve outcomes for AA stroke survivors. Unfortunately, little is known about which approaches are acceptable and effective for this high risk group. Objectives: To identify salient and modifiable barriers to post-stroke care among young (<age 65) AA men and members of their immediate social support network. Results informed refinement of a stroke recovery intervention for AA men. Methods: Ten AA stroke survivors and their care partners (CPs) (n=7) participated in focus groups and advisory board meetings. Survivors had stroke or transient ischemic attack within the past year, were community-dwelling, and had a Barthel ADL Index >60. Focus groups conducted with a semi-structured interview guide identified self-perceived barriers and facilitators to care among AA men and their CPs. Group interviews were conducted until theoretical saturation occurred. Thematic analysis of audio-recorded and transcribed sessions and the constant comparative method were used to generate constructs (themes). Results: Survivor mean age was 53 (range=34-64 years). Mean Barthel was 95.5 (SD=7.6). CPs were all AA women, mean age of 54 (range=49-61). Five CPs were wives (n=5) while others were fiancée (n=1) and niece (n=1). Participants cited multiple personal, social, and societal challenges to stroke recovery. While hypertension and smoking risks were acknowledged, psychological factors (stress, depression, PTSD, anger/frustration, change in personal identity, and communicating their own unique needs as AA men), were the most frequently noted barriers. Facilitators included family support, stress reduction and moderation of dietary habits. Conclusions: Biological risk reduction education may not capture all salient aspects of health management for AA stroke survivors. Men in this study identified psychological self-management barriers as critical impediments to good health outcomes. Incorporation of these factors into stroke care may help reduce health disparities for minority men.

‘Just getting by’: a cross-sectional study of male sex workers as a key population for HIV/STIs among men who have sex with men in Peru

ObjectivesTo describe the sociodemographic and sex work characteristics, recent sexual practices, HIV risk perception and testing history, and HIV and syphilis prevalence of Cercado (downtown) and non-Cercado (close urban) male...

HIV/AIDS trends in China

HIV/AIDS trends in China

Promoting sustainable living in the borderless world through blended learning platforms

Student-centred learning approaches like collaborative learning are needed to facilitate meaningful learning among self-motivated lifelong learners within educational institutions through interorganizational Open and Distant Learning (ODL) approaches. The purpose of this study is to develop blended learning platforms to promote sustainable living, building on an e-hub with sub-portals in SEARCH to facilitate activities such as “Education for Sustainable Development” (ESD), webinars, authentic learning, and the role of m-/e-learning. Survey questionnaires and mixed-research approach with mixed-mode of data analysis were used including some survey findings of in-service teachers’ understanding and attitudes towards ESD and three essential skills for sustainable living. Case studies were reported in telecollaborative project on “Disaster Risk Reduction Education” (DR RED) in Malaysia, Germany and Philippines. These activities were organized internationally to facilitate communication through e-platforms among participants across national borders using digital tools to build relationships, promote students’ Higher Order Thinking (HOT) skills and innate ability to learn independently.

Effectiveness of Disaster-Based School Program on Students’ Earthquake-Preparedness

Given the importance of public disaster education, efforts have been made to integrate disaster risk reduction in the school system. Studies focusing on the effects of school disaster programs on actual preparedness and factors influencing preparedness behaviour, however, have been limited. The present study assesses the effectiveness of disaster risk education (DRR) in schools by comparing students in two junior high schools regarding action taken in earthquake preparedness and major factors of disaster preparedness such as risk knowledge, risk perception, critical awareness and attitude. Data on earthquake preparedness and other variables were collected from two junior high schools in Yogyakarta, Indonesia. Participants were 124 students froma school adopting disaster risk reduction education and 115 students from a school not adopting it. Multivariate Analysis of Variance (MANOVA) revealed that there was a significant difference in investigated variables among students although their level of actual preparedness was quite low. This study provided evidence that having a school adopting disaster risk reduction issues effectively enhanced knowledge, risk perception, critical awareness and attitude but limited in preparedness behaviour. Efforts should be taken by policy makers, teachers, and other stakeholders to develop public education in schools focusing on changes in preparedness behaviour.

Increasing hepatitis C prevalence and associated risk behaviors among incarcerated young adults.

This study sought to assess the rate of hepatitis C virus (HCV) infection and associated risk factors in young adults 18-28 years of age who were incarcerated in the Rhode Island Department of Corrections. The majority of participants reported injection drug use and engaged in high-risk behaviors such as needle sharing. Despite having these risk factors and believing themselves to be at risk, the majority of youths reported no prior HCV testing. Correctional facilities present a unique opportunity to detect HCV infection and provide risk reduction education to young adults, the population with the highest rates of new infections in the US. Seventy-two incarcerated individuals with a history of drug use were approached to participate in the study; 68 completed the screening and interview. The rate of HCV infection among adults <30 years of age and incarcerated at the Rhode Island Department of Corrections in 2011 was high (24%). In 1998, the rate of HCV among inmates <30 years of age at the same facility was only 11.4%. These data follow the same increase in HCV infection rates among young adults observed in non-incarcerated young adults across the nation. HCV is the leading cause of liver failure and hepatocellular carcinoma in the US. Despite a decline and leveling in HCV incidence nationwide, alarming increases in HCV rates among adolescents and young adults have been reported during the period between the years 1992 and 2005. This disquieting epidemic is attributable to injection drug use amongst young adults.

Sexual Health of Adolescents in Quebec Residential Youth Protection Centres

To document risk behaviours and prevalence of chlamydia and gonorrhoea infections among adolescents aged 14 to 17 years entering care in Quebec Youth Protection Centres (YPC). From July 2008 to May 2009, adolescents residing in six YPCs completed a questionnaire during a face-to-face interview. Questions covered sexual and substance use behaviours prior to admission, as well as other health issues affecting respondents' mental and physical health. Urine samples were tested for Chlamydia trachomatis genital infection (CTGI) and Neisseria gonorrhoea genital infection (NGGI). Among 578 participants aged 14 to 17 years, 89% had had consensual sexual relations. Sexual risk behaviours included early sexual initiation (66% at <14 years); multiple partners (median lifetime number: girls 5, boys 8); 50% or more of sexual relations under the influence of drugs or alcohol (girls 43%, boys 48%); group sex (girls 38%, boys 43%); and sex in exchange for money or other goods (girls 27%, boys 8%). Only a quarter of boys and girls used double protection (condom and a contraceptive method) during the most recent vaginal relation. A history of pregnancy was reported by 28% of girls. Prevalence of CTGI was 9.3% (CI: 5.5-14.5) among girls and 1.9% (CI: 0.6-4.4) among boys. Prevalence of NGGI gonorrhoea was 1.7% (CI: 0.3-4.8) among girls and 0% (CI: 0.0-1.4) among boys.In multivariate analyses, factors significantly associated with chlamydia infection among sexually active girls were: hospitalization for alcohol intoxication; and a history of suicidal ideation with plan. Sexual risk behaviours are common among adolescents entering YPCs, resulting in high levels of chlamydia infection. Mental health issues such as substance misuse and serious depressive symptoms are associated with these high rates. A youth's stay in these facilities is an opportune time to screen not only for sexual risk behaviours but also for mental health problems; appropriate risk reduction education and referrals can then be provided as needed.

Rationale and design of the Primary pREvention strategies at the community level to Promote Adherence of treatments to pREvent cardiovascular diseases trial number (CTRI/2012/09/002981)

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality in low-income countries including India. There is a need for effective, low-cost methods to prevent CVDs in rural India. One strategy is to identify and implement interventions at high-risk individuals using community health workers (CHWs). There is a paucity of CHW-based CVD intervention trials from low-income countries. We designed a multicenter, household-level, cluster-randomized trial with 1:1 allocation to intervention and control arms. The CHWs undertook a door-to-door survey and screened 5,699 households in 28 villages from 3 rural regions in India to identify at-risk households. The households were defined as those with ≥1 individual aged ≥35 years and at moderate or high risk for CVD based on the non-laboratory-based National Health and Nutrition Examination Survey score. All at-risk individuals were invited to attend a physician-led village clinic that provided a CVD risk reduction prescription and education about target risk factor levels for CVD control. All households in which at least 1 member at moderate to high risk for CVD had received a risk reduction prescription were eligible for randomization. Households randomized to the CHW-based intervention will receive 1 household visit by a CHW every 2 months, for 12 months. During these visits, CHWs will measure blood pressure, ascertain and reinforce adherence to prescribed therapies, and modify therapy to meet targets. Households randomized to the control arm do not receive CHW visits. At 12 months after randomization, we will evaluate 2 primary outcomes of systolic blood pressure and adherence to antihypertensive drugs and secondary outcomes of INTERHEART risk score, body mass index, and waist-to-hip ratios. At 18 to 24 months after randomization and 6 to 12 months after the last intervention, we will record these outcomes to evaluate sustainability of intervention. Community health workers screened a total of 5,033 households that included 9,248 individuals and identified 2,571 households with 3,784 at-risk individuals. We randomized 2,438 households (1,219 to intervention and 1,219 to control groups). Our large trial of CHWs in rural India will provide important information regarding a promising approach to primary prevention of CVDs.

HIV Risk Assessment and Risk Reduction Education

HIV Risk Assessment and Risk Reduction Education

Insurance, A Risk Transfer Mechanism: An Examination Of The Nigerian Banking Industry

The study examines insurance as a suitable risk transfer mechanism for managing risks associated with the Nigerian banking industry. It explores risk and insurance; examines risks and features of insurable risks; outlines banking risks; highlights benefits of insurance to banks; and identifies banking risks and types of insurance banks purchase in Nigeria. The study adopts quantitative approach using the literature, and survey of 20 commercial banks in Nigeria selected through random probability sampling. Structured questionnaires were administered to 200 participants, 10 each from the 20 banks, selected through purposive sampling. The study concludes that banks purchase insurance to manage risks in the Nigerian banking industry; insurance is beneficial to banks and the economy; and insurance enhances banks' operations in the Nigerian banking industry. Implications for practice suggest that: insurance, if adequately arranged, serves as security and stimulus to banks; insurance facilitates spread of risk and stimulates banks' operations; and insurance reduces loss through risk prevention and reduction education. Thus, the study highlights the suitability of insurance for managing risks associated with banks' operations in Nigeria.

Smartphone Delivery of Mobile HIV Risk Reduction Education

We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability “as is” in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (all P < 0.05). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings.

Sexual Behaviors of Middle School Students: 2009 Youth Risk Behavior Survey Results From 16 Locations

The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey-Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t-tests were calculated for these 5 items by gender, age, and race for each location. Data show that 5-20% of sixth graders and 14-42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.

Smartphone-delivered mobile HIV Risk Reduction Education in Opioid Dependent Individuals

Smartphone-delivered mobile HIV Risk Reduction Education in Opioid Dependent Individuals

Ready for the Storm: Education for Disaster Risk Reduction and Climate Change Adaptation and Mitigation1

Incidences of disaster and climate change impacts are rising globally. Disaster risk reduction and climate change education are two educational responses to present and anticipated increases in the severity and frequency of hazards. They share significant complementarities and potential synergies, the latter as yet largely unexploited. Three dimensions of climate change education—understanding and attentiveness, mitigation and adaptation— are identified and explored as corresponding to key elements in disaster risk reduction education. While international bodies advocate the alignment of the two focuses, we are still only on the threshold of their alignment in practice within curriculum. Both focuses also align in their embrace of an interactive, experiential and participatory pedagogy. An educational contribution to a sustainable future must necessarily address disaster risk reduction and climate change.

HIV risk perceptions among adolescents attending family planning clinics: An integrated perspective

The current study assessed the impact of individual, interpersonal, and contextual factors on HIV risk perception. A total of 426 female adolescents attending family planning clinics took part in this study. The majority, 60.1% were African-American and 39.9% were Hispanic. The results indicated that the majority of participants perceived themselves to be at no or low risk for contracting HIV. Individual, interpersonal as well as contextual factors correlated with HIV risk perception in the study. Adolescents who perceived themselves to be at no or low risk were more likely to be Hispanic, be married and had children. They also felt that they can control situations where they have to refuse sex or insist on condom use, had more frequent communication with sexual partners about condom use and held perceptions that peer norms support condom use. The findings in this study have important implications for risk reduction education for female adolescents. Risk reduction education should strengthen adolescents' personal skills to help them avoid HIV risk despite the various pressures they experience in their life.

Climate disaster resilience of the education sector in Thua Thien Hue Province, Central Vietnam

Recognizing the importance of building disaster resilience for education sector, this study aims to develop a methodology to measure the level of educational resilience to cope with natural disasters and is then applied in Central Vietnam. The assessment tool in this paper is developed through a combination of climate disaster resilience indexes and the 16 tasks of Hyogo framework for action designed for education sector. It looks at five dimensions namely physical conditions, human resources, institutional issues, external relationships, and natural conditions, with each dimension characterized by three parameters and five variables. Findings from this study provide important insights into enhancing resilience of the education system in Thua Thien Hue at the provincial, local, and school levels. By giving the overall resilience situation, it can help policy-makers and practitioners in developing an effective plan to increase the level of educational resilience. In addition, it provides the School Management Board with a means to assess the school’s resilience level and set out priorities that need to be focused on with regard to the improvement of school safety and disaster risk reduction education.

Methods for Conducting Community Guide Systematic Reviews of Evidence on Effectiveness and Economic Efficiency of Group-Based Behavioral Interventions to Prevent Adolescent Pregnancy, Human Immunodeficiency Virus, and Other Sexually Transmitted Infections: Comprehensive Risk Reduction and Abstinence Education

This paper describes methods used to conduct systematic reviews and meta-analyses and economic reviews of group-based behavioral interventions for adolescents to prevent pregnancy, HIV, and other sexually transmitted infections. The steps described include developing a conceptual approach, defining the interventions, identifying outcome and moderator variables, searching the literature, abstracting the data, and analyzing the results. In addition, identification of potential harms and benefits, applicability of results, barriers to implementation, and research gaps are described.