The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; chi(2) = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation.

In general, U.S. college students have low perceived susceptibility of acquiring HIV infection while 15–25 percent of youth have had negative perceptions towards HIV positive individuals. Factors associated with HIV stigma among college students were examined in a convenience sample of 200 students. Descriptive and inferential statistics were utilized to summarize the data. Only four percent of participants responded correctly to HIV transmission knowledge items. HIV transmission knowledge scores were significantly higher for participants who were single with partner and those who resided outside university residential dorms (p < 0.05). There was a significant negative correlation between composite HIV knowledge scores and stigma scores r = −0.18 (p < 0.05). After adjusting for confounders, a marginal significant negative linear relationship emerged (β = −0.09, p = 0.06) between HIV knowledge and stigma. HIV prevention education among college students needs to be addressed with nuance to minimize HIV knowledge gaps, stigma and student risk perception that impacts HIV prevention and stigma against those living with HIV.

The purpose of this study was to examine the prevalence of symptoms of psychological distress experienced by African Americans upon self-enrollment in HIV-related mental health care and to compare the symptoms in this sample to the Brief Symptom Inventory (BSI) normative sample, the instrument used in this study to assess symptoms of psychological distress. Data were collected from 575 African Americans living with HIV who self-enrolled at an HIV-related mental health clinic located in a large city in the southeastern United States. Nearly 20% of the sample reported a t score Ն 63 for both somatization and paranoid ideation, a level indicative of a need for further psychological evaluation. Compared to the normative sample, this sample had significantly lower levels (p Ͻ 0.05) of anxiety, depression, phobic anxiety, interpersonal sensitivity, and global severity index than the normative sample and had significantly higher levels of paranoid ideation and somatization than the normative sample. These results indicate that, overall, African Americans presented for mental health services with lower levels of symptoms of psychological distress than the normative sample. To that end, it is possible that African Americans living with HIV may underreport symptoms of psychological distress or may experience symptoms of psychological distress differently than other individuals. As a result, it is important that HIV-related service providers recognize these patterns of psychological distress and provide appropriate referrals to HIV-related mental health providers. 413

Recent literature has documented growing concerns related to access to HIV care services for rural individuals living with both HIV and a dual diagnosis of substance abuse. Previous research has investigated issues from a client perspective, but limited research has investigated provider perspectives of rural issues surrounding HIV and substance abuse. The purpose of this qualitative study was to examine issues that impact the ability of care providers to create sustainable linkages to care for dual diagnosed individuals who live in rural areas. In-depth interviews were conducted in late 2005 with 39 HIV service providers at 11 agencies that provided HIV-related services to individuals in rural areas of a Midwestern state in the United States. Findings suggest multidimensional stigma in the medical referral network as the leading factor that presents challenges to service providers in rural areas. The service providers reported verbal stigma in the form of insults, a loss of role/respect, and a global loss of resources such as poorer quality health care or no health care provided. The stigma is conceptualized in four themes: (1) staff of medical referral sources stigmatizing against rural dual-diagnosis clients, (2) physicians stigmatizing against rural dual-diagnosis clients, (3) medical specialists stigmatizing against rural dual-diagnosis clients, and (4) client-perceived stigma. These themes were expressed equally among all of the providers, regardless of geographic location, type of HIV-related organization, or job title. 669

Since its discovery in 1947 in Uganda, ZIKV has spread to 61 countries with a total of 229,238 confirmed human cases worldwide. Specifically, Ecuador has recorded 3,058 confirmed cases and 7 confirmed cases of congenital syndrome associated with ZIKV. Using the Health Belief Model (HBM), this pilot study was conducted to assess Zika virus-related knowledge and attitudes among adults in Ecuador. The survey data were collected in public places in rural and urban areas of Ecuador in May 2016. Seven items measured ZIKV knowledge and 23 items measured attitudes toward ZIKV. A total of 181 Ecuadorians participated in this study. The average age of the sample was 33.4. With respect to ZIKV knowledge, the majority of the participants had heard of ZIKV (n = 162, 89.5%). More males reported first hearing of ZIKV on the internet (p = 0.02), more rural individuals reported knowing someone diagnosed with ZIKV (p = 0.02), more primary school educated individuals reported hearing about ZIKV first from their doctor/nurse (p = 0.03), and more high school graduates correctly identified that ZIKV could be transmitted from mother to child (p = 0.03). As for the HBM constructs, there was a statistically significant difference between gender and cues to action (p = 0.04), with males having a statistically significant lower mean on the cues to action items compared to females. There were also statistically significant differences between those categorized as having “adequate” knowledge compared to “low” knowledge on the benefits construct (p = 0.04) and the perceived severity construct (p = 0.03). There is a clear need for education about the transmission and prevention of ZIKV. High levels of self-efficacy for prevention behaviors for ZIKV combined with low perceived barriers in this community set the stage for effective educational interventions or health promotion campaigns that can ameliorate the knowledge deficits surrounding transmission and prevention.