Presentation on theme: "PARENTS AS HIV EDUCATORS: DELAY OF FIRST INTERCOURSE FOR BOTH SONS AND DAUGHTERS Beatrice J. Krauss, Ph.D., and The Parent/Preadolescent Training for HIV."— Presentation transcript:
PARENTS AS HIV EDUCATORS: DELAY OF FIRST INTERCOURSE FOR BOTH SONS AND DAUGHTERS Beatrice J. Krauss, Ph.D., and The Parent/Preadolescent Training for HIV Prevention (PATH) Research Team 5/28/09 Hunter College Center for Community and Urban Health 1
Acknowledgements Cornell University/Cornell Cooperative Extension Insituto Mexicano de Investigacion de Familia y Poblacion University of Miami Albert Einstein College of Medicine Lutheran Medical Center WHEDCO 163 rd Street Improvement Association The families of the Lower East Side The PATH research team Our trainers Donald T. Campbell The work of Marilyn Brewer Kim Miller, CDC The National Institute of Mental Health, R01 MH The World AIDS Foundation 5/28/09 2 Hunter College Center for Community and Urban Health
Goals 5/28/09Hunter College Center for Community and Urban Health 3 Understand the importance of research designs that address selection biases Review the potential role of parents – mothers and fathers – in gender-fair HIV education Recognize the “common pathways” argument for responsible sexual and substance use behaviors Stress the importance of early intervention
Don Campbell: Design question and answer session 5/28/09Hunter College Center for Community and Urban Health 4 Who comes to HIV prevention interventions? Those who are interested? Are you then preaching to the choir? Those who are very needy? Have you then set yourself up to work with the most difficult clients? If so, what is your appropriate comparison group? You will only know the answers if you do true random sampling and use a random invitation to treatment design to appropriately assess effects. The densely populated Lower East Side (LES) of New York City allowed such a design.
The Parent/Preadolescent Training for HIV Prevention (PATH) evaluation design 5/28/09Hunter College Center for Community and Urban Health 5 Random dwelling unit sampling and, after baseline, a random invitation to enhanced treatment to evaluate the effects on children of an HIV prevention intervention aimed at parents 238 parents and their 238 children complete baselines | All parents receive health and communication brochures in English and Spanish / \ 161 (68%) randomly invited 77 (32%) not offered to group training group training (composed of / \ both potential decliners and accepters) 103 (43%) accept 58 (25%) decline | 238 parents and children measured at intervals post-baseline | All drop-outs tracked
Parents as HIV educators 5/28/09Hunter College Center for Community and Urban Health 6 In the best cases Available 24/7/365; communication can be Continuous Sequential Timely Responsive Communications can be adjusted to children’s Biographies Physical maturity Cognitive development Social circumstances Communication can begin early (“off-time” and “on-time”)
In practice … 5/28/09Hunter College Center for Community and Urban Health 7 Parents worry that if they talk about sex, drugs and HIV with their kids…Youth are concerned… My information is not accurate. I will give them the wrong information. They [parents] are not up to date. I will get too emotional. I will be embarrassed. They will get too emotional. I will find out something about my child that I don’t want to know. If I ask about it, they will accuse me of doing it. I will find out about all the risks there are out there now. They’ll start talking about what it was like when they were growing up. They won’t understand what I face. My parents can’t keep a secret. Everyone will know what we talked about. [For boys] I am already supposed to know.
Even in a community where 10% of adults are living with HIV … 5/28/09Hunter College Center for Community and Urban Health 8 Both children and adults have … Moderate levels of useful HIV knowledge, including knowledge of prevention practices High levels of unrealistic HIV worry Near-zero correlations between parent and child measures suggest little within-household sharing of Useful or practical HIV knowledge and skills Realistic or unrealistic HIV-related worry
Moderate scores on useful HIV prevention knowledge at baseline 5/28/09Hunter College Center for Community and Urban Health 9
The effects of absent or ineffective communication – High worry 5/28/09Hunter College Center for Community and Urban Health 10
But you can’t rely on schools to do it for you... 5/28/09Hunter College Center for Community and Urban Health 11 Percent of US elementary schools required to teach about how to prevent HIV (15.4%) how HIV is transmitted (14.8%) how HIV affects the body (12.2%) compassion for persons living with HIV (11.0%) signs and symptoms of HIV or AIDS (9.6%) how to find information about HIV services including testing (7.6%) how HIV is diagnosed or treated (6.4%) ( Kann, Telljohann & Wooley, 2007)
And it isn’t being done well … 5/28/09Hunter College Center for Community and Urban Health 12 I was talking to him about the AIDS view we were learning in school. You can’t get it by “friendly relations” [youth is quoting term]….I just wanted to speak to somebody who had experience with sex. (10-13 year old girl’s report of a conversation with the older brother who is raising her).
And it isn’t being done early enough… 5/28/09Hunter College Center for Community and Urban Health 13 HIV-related health risks know no lower age boundary (e.g., a toddler can learn to non-verbally or verbally ask a parent or adult to pick up a sharp object or clean up blood; parents can be surveillant of toddlers, their activities and surroundings, Hagan, Shaw, & Duncan, 2008) Early age-appropriate conversations lay the groundwork for later discussions about issues related to sex and substance use that may require more detail and more depth; Data suggests that a substantial minority of US youth (7.1%) are sexually active before age 13, and 34.8% are by ninth grade, with rates varying by gender, geography and ethnicity (Eaton et al., 2008); Values and expectations about the appropriate timing for sexual and drug risk may already be in place by preadolescence
But we know what to do … Parent/child monitoring is one of the most robust predictors of safer sexual and substance use behaviors Effective communication Accurate and in-depth Two-way and clarifying Concrete skills for addressing problems Responsive and rooted in child’s life Shares or clarifies emotions
The community-based Parent/Preadolescent Training for HIV Prevention (PATH) curriculum 5/28/09Hunter College Center for Community and Urban Health 15 Four basic modules Useful and practical HIV knowledge and skills Child development and parent-child communication skill Recognizing, avoiding or negotiating risk Safe and sensitive socializing with PLwHIV, a destigmatization module Two advanced Transition to adolescence-1, internalized caring Transition to adolescence-2, lifelong learning Participants: Mothers or fathers of year old sons or daughters Activities described in Pequegnat et al., 2000
Risk outcome of PATH—Delay of first male sexual intercourse 5/28/09Hunter College Center for Community and Urban Health 16 Delay of intercourse for male youth sexually active by 40 months post- parent intervention
Risk outcome of PATH—Delay of first female sexual intercourse 5/28/09Hunter College Center for Community and Urban Health 17 Delay of intercourse for female youth sexually active by 40 months post- parent intervention
Delay for every sexually active youth to date demonstrates longer delays, particularly for young men 5/28/09Hunter College Center for Community and Urban Health 18
Multivariate predictors of delay for youth sexually active by 40 months post-intervention 5/28/09Hunter College Center for Community and Urban Health 19 Expected age of first intercourse at baseline, p=.017 Age at baseline, p=.029 Age of first sexual partner, p<.001 The offer of training, p=.047 At 40 months post-intervention, there was a mean 5.5 month longer delay for sexually active children of parents offered training Parent gender was not predictive Youth gender was not predictive
Why is gender-fair so important? Reviews of the literature indicate Daughters receive more communications about sex and drugs than sons More of these communications emphasize responsibility and limit-setting Daughters experience more parental monitoring Sons experience more coercive control (e.g., yelling) In PATH, there were no gender differences in reported content or style of communication by mothers or fathers.
Sexually active children of trained parents were more likely to say 5/28/09Hunter College Center for Community and Urban Health 21 It is “like me” to not be too embarrassed to buy condoms, Chi-squared (1)=5.0, p=.026 It is “like me” to think it’s not cold and uncaring to keep using condoms after first intercourse, Chi- squared (1)=5.1, p=.023
The importance of early intervention: Estimated age of first intercourse at ages is predictive of youth’s delay of intercourse 5/28/09Hunter College Center for Community and Urban Health 22 Sexually active male youth’s estimated age of first intercourse at baseline and months delay to first intercourse
Why is delay of early intercourse important? Early intercourse has… Differential health effects (Kaestle et al., 2005) Higher odds of STIs throughout adolescence for young men and women Differential predictors Alcohol use, delinquency, school problems for intercourse by age 15 with some predictors varying by gender and ethnicity (Zimmer-Gembeck & Helfand, 2007) Family composition, parenting practices, parent characteristics, parent attitudes for early and middle adolescents Youth’s ability to predict first intercourse one or more years in advance has been replicated by others (Forste & Haas, 2002; Miller et al., 1997; Whitaker, Miller, & Clark, 2000)
Replication of PATH in Miami Added PATH to an early parenting training Demonstrated a generalized protective effect
5/28/09Hunter College Center for Community and Urban Health 25 Familias Unidas + Path vs ESOL + PATH, ns Familias Unidas + Path vs ESOL+HEART p<.05 Outcome is continuous measure of frequency of drug use in past 90 days Results: Illicit Drug Use – Past 90 days
5/28/09Hunter College Center for Community and Urban Health 26 Familias Unidas + Path vs ESOL + PATH p<.002 Familias Unidas + Path vs ESOL+HEART p<.008 Results: Smoking – Past 90 days
What they walked away with… When asked to recall top of mind what influenced them regarding “personal changes because of HIV” since the date of PATH project entry, the majority of intervention-arm respondents, parents and their youth, mentioned PATH and were able to recall, 7 years post- intervention, specific exercises or homework assignments that influenced them. “She came home with the packet and she wanted me to show it to my friends. Made me think about if I wanted to live long or short. I had to choose my path. I chose the path to be clean.” (youth) In selecting three top-of-mind recollected influences, parents divided their choices among exercises designed to raise awareness, promote concrete skills (putting on a condom), and improve communication, while youth focused on open communication and concrete skills. “Teaching hands on, role playing.” (youth)
5/28/09Hunter College Center for Community and Urban Health 28 + Next steps Thank you