A measure of ethnic identity, the Multigroup Ethnic Identity Measure (MEIM), was examined in this study with a sample of 2,184 early adolescents who self-identified with a single race or ethnicity (monoracial, n = 1,812) or with two or more racial or ethnic groups (multiracial, n = 372). Principal components and multigroup confirmatory factor analysis were used to explore and confirm the factor structure of the MEIM items. Two factors were identified: (a) identification and (b) exploration. Identification was represented by items that reflect a sense of belonging and pride in an individual's ethnic group. Exploration was represented by items that characterize a search for ethnic group identity and participation in ethnic practices. Reliabilities were adequate for the two subscales ( = .84, identification; = .76, exploration). Also, the results indicated that most individuals from monoracial minority groups and multiracial subgroups scored similarly on overall ethnic identity.

Rates of chronic diseases are high among Black South Africans. Few studies have tested cognitive-behavioral health-promotion interventions to reduce chronic diseases in South Africa. We tested the efficacy of such an intervention among adolescents in a cluster-randomized controlled trial. We randomly selected 9 of 17 matched-pairs of schools and randomized one school in each pair to the cognitive-behavioral health-promotion intervention designed to encourage health-related behaviors and the other to a HIV/STD risk-reduction intervention that served as the control. Interventions were based on social cognitive theory, the theory of planned behavior, and qualitative data from the target population. Data collectors, blind to participants’ intervention, administered confidential assessments at baseline and 3, 6, and 12 months post-intervention. Primary outcomes were fruit and vegetable consumption and physical activity. Participants were 1,057 grade 6 learners (mean age = 12.4 years), with 96.7% retained at 12-month follow-up. Generalized estimating equations revealed that averaged over the follow-ups, a greater percentage of health-promotion intervention participants than HIV/STD control participants met 5-a-Day fruit and vegetable and physical activity guidelines. The intervention also increased health-promotion knowledge, attitude, and intention, but did not decrease substance use or substance-use attitude and intention. The findings suggest that theory-based, contextually appropriate interventions may increase health behaviors among young adolescents in sub-Saharan Africa.

To test the efficacy of a school-based human immunodeficiency virus/sexually transmitted disease (HIV/STD) risk-reduction intervention for South African adolescents.Design: A cluster-randomized, controlled design with assessments of self-reported sexual behavior collected before intervention and 3, 6, and 12 months after intervention.Setting: Primary schools in a large, black township and a neighboring rural settlement in Eastern Cape Province, South Africa.Participants: Nine of 17 matched pairs of schools were randomly selected. Sixth-grade students with parent or guardian consent were eligible.Interventions: Two 6-session interventions based on behavior-change theories and qualitative research. The HIV/STD risk-reduction intervention targeted sexual risk behaviors; the attention-matched health promotion control intervention targeted health issues unrelated to sexual behavior.Outcome Measures: The primary outcome was self report of unprotected vaginal intercourse in the previous 3 months averaged over the 3 follow-ups. Secondary outcomes were other sexual behaviors.Results: A total of 1057 (94.5%) of 1118 eligible students (mean age,12.4 years) participated, with 96.7% retained at the 12-month follow-up. Generalized estimating equation analyses adjusted for clustering from 18 schools revealed that, averaged over the 3 follow-ups, a significantly smaller percentage of HIV/STD risk-reduction intervention participants reported having unprotected vaginal intercourse (odds ratio [OR] ,0.51; 95% confidence interval [CI], 0.30-0.85), vaginal intercourse (OR,0.62; 95% CI, 0.42-0.94), and multiple sexual partners (OR,0.50; 95% CI, 0.28-0.89), when adjusted for baseline prevalences, compared with health-promotion control participants. Conclusion:This is the first large-scale, community-level, randomized intervention trial to show significant effects on the HIV/STD sexual risk behavior of South African adolescents in the earliest stages of entry into sexual activity.

Objective Little research has tested HIV/STI risk-reduction-interventions’ effects on early adolescents as they age into middle and late adolescence. This study tested whether intervention-induced reductions in unprotected intercourse during a 12-month period endured over a 54-month period and whether the intervention reduced sexually transmitted infections (STIs), which increase risk for HIV. Method Grade-6 learners (mean age = 12.4 years), participants in a 12-month trial in Eastern Cape Province, South Africa in which nine matched-pairs of schools were randomly selected and within pairs randomized to a theory-based HIV/STI risk-reduction intervention or an attention-control intervention, were eligible, provided parental consent, and completed 42- and 54-month postintervention measures of unprotected intercourse, the primary outcome, other sexual behaviors, theoretical constructs, and, at 42- and 54-month follow-up only, biologically confirmed curable STIs (chlamydial infection, gonorrhea, and trichomoniasis) and herpes-simplex virus 2. Results The HIV/STI risk-reduction intervention reduced unprotected intercourse averaged over the entire follow-up period, OR = 0.42, 95% CI [0.22, 0.84], an effect not significantly reduced at 42- and 54-month follow-up compared with 3, 6, and 12-month follow-ups. The intervention caused positive changes on theoretical constructs averaged over the five follow-ups, though most effects weakened at long-term follow-up. Although the intervention’s main effect on STI was nonsignificant, an Intervention-Condition x Time interaction revealed it significantly reduced curable STIs at 42-month follow-up in adolescents who reported sexual experience. Conclusion These results suggest that theory-based behavioral interventions with early adolescents can have long-lived effects in the context of a generalized severe HIV epidemic.

The present study sought to replicate effects of the number of syndemic psychosocial health conditions on sexual risk behavior and HIV infection among a sample of high-risk African American men who have sex with men (MSM) and to identify resilience factors that may buffer these effects. We used baseline data from an HIV risk-reduction trial to examine whether a higher number of syndemic conditions was associated with higher rates of self-reported sexual risk behavior and HIV infection. Using logistic regression models, we tested for interactions between number of syndemic conditions and several potential resilience factors to identify buffering effects. Replicating previous studies, we found significant associations between numbers of syndemic conditions and higher rates of sexual risk behavior and HIV infection. Surprisingly, we also replicated a previous finding (Stall et al., 2003) that the effects of syndemic burden on HIV status fell off at the highest levels of syndemic conditions. Among a variety of potential resilience factors, two--optimism and education--buffered the syndemic effect on HIV prevalence. This is, to our knowledge, the first paper to identify resilience factors buffering against syndemic effects among MSM. It also constitutes a significant contribution to the literature regarding prevention among black MSM. These results point to the need to identify HIV-positive black MSM and provide effective treatment for them and to develop interventions addressing both syndemic and resilience factors.