1. APHA 2014 Session# 304318 Tuesday, November 18, 2014 LaShun Robinson, PhD Emory University I CAN DO ALL THINGS: POSITIVE RELIGIOUS COPING AND ITS EFFECTS ON RISK REDUCTION

2. LaShun R. Robinson, PhD Danielle Lambert, MPH, CHES Gina Wingood, ScD, MPH Rollins School of Public Health Department of Behavioral Sciences & Health Education Atlanta, GA AUTHORS

3. Nikia Braxton, MPH Anita Conner, MPH Deja Er, MPH Tiffiany Aholou, PhD; Tanisha Grimes, PhD; Ayesha McAdams-Mahmoud; Tiffany Pennick, MPH; Tiffaney Renfro, MSW & A host of Consultants/Students/Volunteers In conjunction with New Birth Missionary Baptist Church New Mercies Christian Church Atlanta, GA STAFF & PARTNERS

4. The Church Advisory Board (CAB) consisted of leaders from ministries that dealt with the topic of HIV and/or came in contact with women in the target age group. *Women’s Ministry *Health Ministry *Singles Ministry *College Ministry *Counseling Ministry *Pastoral Services CHURCH ADVISORY BOARD

5. Background & Significance THE INTERSECTION BETWEEN HEALTH & FAITH

6.  HIV is the leading cause of death among young adult African American women. 1  80% of African Americans consider religion very important in their lives, and nearly 60% of Black adults are affiliated with historically Black protestant churches. 2  The Black church is among the most visible, respected and credible agencies in the African American community. 3-4  60% of the congregation in historically Black churches is comprised of women. 2  As a result, they serve key positions in sustaining the churches’ social programs. BACKGROUND

7.  A review of existing literature shows that of all the health interventions conducted in a church setting, few focused on HIV sexual risk reduction. 5  A closer examination of the church’s role in HIV prevention efforts with this population should be explored. RATIONALE

8. The goal of this study was to assess the efficacy of adapting SISTA 6 for a faith- based setting in order to analyze the intervention’s effect on women’s HIV- associated sexual risk behaviors, specifically by enhancing religious coping and social capital. STUDY AIM

9. Methods & Measures P 4 FOR WOMEN STUDY DESIGN … Wisdom is the principal thing; therefore get wisdom: and in all your getting, get understanding. Proverbs 4:7

10. Purpose: To assess the efficacy of adapting and implementing a HIV sexual risk reduction intervention in a faith-based setting Recruitment Methods: Convenience sampling from 2 Black churches in the Greater Atlanta metro area Data Collection Methods: Audio Computer-Assisted Self- Interviewing (ACASI) surveys administered at baseline and at 3- & 6- months post-intervention Intervention Methods: a 2-arm comparative effectiveness trial, comparing the adapted faith-based HIV intervention (P4 for Women) with the original SISTA HIV intervention Data Analysis: Quantitative Analyzes including descriptive statistics, t-tests, X 2, & linear and logistic GEE regression models STUDY OVERVIEW

11.  P4 (Treatment Condition) – 3 sessions  SISTA (Comparison Condition) – 3 sessions  Assessments via ACASI at Baseline, 3 and 6 months Consent Screening Baseline Assessment Randomization (N=134) P4 for Women Faith-based Risk Reduction Condition N=65 SISTA Comparison Condition N=69 3-month Follow-Up 6-month Follow-Up 6-month Follow-Up 3-month Follow-Up

12.  Recruitment Process: Recruiters screened from a convenience sample at New Birth Missionary Baptist and New Mercies Christian Church. Both print and media advertising were utilized to increase visibility, as well as word-of-mouth referrals from participants.  Duration: January 2010-August 2011  Inclusion Criteria: African American woman 18-34 years of age Unmarried and not living with a partner Reported unprotected vaginal sex with a male partner in the past 180 days Not pregnant or planning pregnancy Attends church services at a predominantly Black church RECRUITMENT & TARGET POPULATION

13. INTERVENTION IMPLEMENTATION P4 for Women Number of Sessions3 Length & Format of Sessions3 hours, group setting Facilitation2 trained African American female health educators. Location of Intervention DeliveryOn-site at each partner church Theoretical FrameworkReligious Social Capital, Theory of Gender & Power, and Social Cognitive Theory

14. INTERVENTION IMPLEMENTATION SessionsSession Content Session 1:Ethnic & Gender Pride, Personal Values and HIV risk awareness Session 2:Healthy Relationships and Effective Communication Session 3:HIV/AIDS Information, Condom Use Skills & Negotiating Safer Sex Situations

15. Behavioral Outcomes No Condom Use Condom Use at Last Sex Proportion of Condom-Protected Vaginal Sex Acts Remaining Abstinent Psychosocial Constructs HIV Knowledge Barriers to Condom Use Condom Negotiation Self-Efficacy Condom Use Self- Efficacy OUTCOMES

16. Structural Social Capital Religious Values & Norms Linking Trust Religious Coping RELIGIOUS SOCIAL CAPITAL MEASURES

17. Recruitment & Retention Efforts STUDY IMPLEMENTATION

18. 517 African American Women Screened Randomized = 134 356 Not Eligible 27 Eligible, but not participating SUMMARY OF RECRUITMENT EFFORTS

19. RECRUITMENT SOURCES

20. INELIGIBLE REASONS

21. ELIGIBLE, NOT PARTICIPATING (N=27)

22. RANDOMIZATION

23. 3 MONTH RETENTION

24. 6 MONTH RETENTION

25. RETENTION BY STUDY ARM

26. ALLOCATION TABLE

27. Analysis & Results DETERMINING THE EFFECTIVENESS OF A FAITH-BASED HIV PREVENTION INTERVENTION

28. SOCIO-DEMOGRAPHICS VariableSISTA (n=69) Mean (SD) % (n) P4 (n=65) Mean (SD) % (n) P Value Age (18-34 years) 24.55 (4.5)24.58 (3.7)0.96 Employed 62.3% (43)66.2% (43)0.64 Hours Worked (week) 32.28 (11.1)32.35 (12.7)0.98 Hourly Wage 12.6 (5.9)13.16 (8.6)0.56 Recipient of Public Assistance 52.2% (36)46.2% (30)0.49

29. DEMOGRAPHICS CONT.

30. 73% Baptist 77.6% Paid Tithes 84% Church Members 41% Involved in Church Ministries RELIGIOUS DEMOGRAPHICS

31. SEXUAL BEHAVIORS

33. CONDOM USE BEHAVIORS

34. VariablesMean DifferenceP Value Condom Use Barriers -1.67<0.001 Condom Negotiation Self-Efficacy 2.36<0.001 Condom Responsibility 0.430.006 Condom Use Self- Efficacy 3.87<0.001 STD Testing Barriers 0.720.022 STD Knowledge 0.48<0.001 HIV PSYCHOSOCIAL MEDIATORS Adjusted GEE Models Baseline – 6 Months, 95% CI

35. VariablesMean DifferenceP Value Frequency of Participation in: women’s ministry 0.180.018 health ministry 0.230.004 counseling ministry 0.160.007 singles’ ministry 0.190.006 WOW group 0.160.010 STRUCTURAL SOCIAL CAPITAL Adjusted GEE Models Baseline – 6 Months, 95% CI

36. VariablesMean DifferenceP Value Overall Ministries Participation 1.060.001 Level of Activity in Church 0.310.002 STRUCTURAL SOCIAL CAPITAL CONT. Adjusted GEE Models Baseline – 6 Months, 95% CI

37. VariablesMean DifferenceP Value Church Influence on Sex Avoidance 0.100.095 Influence of Faith on Condom Use 0.200.040 Frequency of Fasting 0.190.012 RELIGIOUS VALUES & NORMS Adjusted GEE Models Baseline – 6 Months, 95% CI

38. VariablesMean DifferenceP Value Frequency – wondering whether: Abandoned by God -0.290.013 Punished by God -0.230.029 Did something to be punished by God -0.300.007 Loved by God -0.150.106 Devil made this happen -0.060.506 RELIGIOUS COPING Adjusted GEE Models Baseline – 6 Months, 95% CI

39. VariablesMean DifferenceP Value Positive Religious Coping -0.060.509 Negative Religious Coping -1.130.021 RELIGIOUS COPING CONT. Adjusted GEE Models Baseline – 6 Months, 95% CI

40. VariablesMean DifferenceP Value Frequency of Communication with Religious Leader 0.220.006 LINKING TRUST Adjusted GEE Models Baseline – 6 Months, 95% CI

41. After participating in P4, women were:  More likely to confide in a religious leader at the church  More likely to report an increase in religious participation  More likely to be able to discuss using condoms with their sexual partners  Had greater confidence in their ability to use condoms PROGRAM EFFECTS

42. P4 for Women also had a significant effect on all measures of religious social capital, impacting:  Structural social capital through ministry participation  Religious values and norms  Collaboration and trust  Religious coping IMPACT ON RELIGIOUS SOCIAL CAPITAL

43. For African American Churches For African American Women 35-60 CONTINUING THE RESEARCH: OTHER FAITH-BASED STUDIES

44. REFERENCES 1.CDC. HIV surveillance – United States, 1981-2008. MMWR. 2011; 60:689-693. 2.Pew Forum on Religion & Public Life. The Pew Report on U.S. Religious Landscape Survey. February 2008. Accessed on October 10, 2012. 3.Taylor RJ, Chatters L., Levin J. Religion in the lives of African Americans: Social, psychological, and health perspectives. Thousand Oaks, CA: Sage; 2004. 4.Corbie-Smith G, Ammerman AS, Katz ML, et al. Trust, benefit, satisfaction, and burden: a randomized controlled trial to reduce cancer risk through African-American churches. J Gen Intern Med. 2003; 18(7):531-541. 5.DiClemente RJ, Wingood GM. A randomized controlled trial of an HIV sexual risk-reduction intervention for young African American women. JAMA. 1995:274(16):1271-1276. 6.Campbell MK, Hudson MA, Resnicow K, et al. Church-based health promotion interventions: Evidence and lessons learned. Annual Review of Public Health. 2007; 28: 213-234.