Kathy Goggin - US grants

Drinking among adolescents is prevalent. By the age of 14, over half all secondary school students drink at least occasionally. Further, adolescents are one of the major at-risk populations for alcohol abuse, with an estimated 30% of adolescent boys and 15% of adolescent girls meeting the criteria for heavy drinking (consuming greater than or equal to 5 drinks at a time) by the age of 18. The initiation of drinking is associated with a variety of negative outcomes for teens including higher risk of alcohol dependence, serious health problems including suicide and alcohol-related traffic accidents. While rates of heavy drinking among other adolescents have declined, rates among African-American youth have stayed consistently high (15% for boys and 5% for girls) over a 10-year period. Frequent heavy drinking places African-American youth at high risk for the development of problems related to their alcohol use. In fact, African- American adolescents who drink experience disproportionately more negative consequences as a result of alcohol use even though their levels of use are comparable or even lower than youth of other ethnic groups. Due to the severity of the problems associated with adolescent alcohol misuse, researchers have begun to explore protective factors that may inoculate at-risk adolescents from developing problem drinking patterns. Several of those inquiries have examined the potential protective role that religiosity and spirituality might play. Higher ratings of global religiosity and spirituality do indeed appear to be protective factors against problem drinking in adolescents. However, in adults recent evidence suggests that the extent of an individual's belief that God directly controls his or her alcohol use may have particular importance as a protective factor against problem drinking. This new evidence suggests a need for research on the protective role of alcohol- related God/Higher Power control beliefs in adolescents, however no published studies exist. The dearth of studies in this area is due at least in part to the paucity of available measures of domain-specific God/Higher Power control beliefs for use with African-American youth, 2) to explore the protective role of alcohol-related God/Higher Power control beliefs in the development of problem drinking among African-American youth.

Drinking among adolescents is prevalent. By the age of 14, over half all secondary school students drink at least occasionally. Further, adolescents are one of the major at-risk populations for alcohol abuse, with an estimated 30% of adolescent boys and 15% of adolescent girls meeting the criteria for heavy drinking (consuming greater than or equal to 5 drinks at a time) by the age of 18. The initiation of drinking is associated with a variety of negative outcomes for teens including higher risk of alcohol dependence, serious health problems including suicide and alcohol-related traffic accidents. While rates of heavy drinking among other adolescents have declined, rates among African-American youth have stayed consistently high (15% for boys and 5% for girls) over a 10-year period. Frequent heavy drinking places African-American youth at high risk for the development of problems related to their alcohol use. In fact, African- American adolescents who drink experience disproportionately more negative consequences as a result of alcohol use even though their levels of use are comparable or even lower than youth of other ethnic groups. Due to the severity of the problems associated with adolescent alcohol misuse, researchers have begun to explore protective factors that may inoculate at-risk adolescents from developing problem drinking patterns. Several of those inquiries have examined the potential protective role that religiosity and spirituality might play. Higher ratings of global religiosity and spirituality do indeed appear to be protective factors against problem drinking in adolescents. However, in adults recent evidence suggests that the extent of an individual's belief that God directly controls his or her alcohol use may have particular importance as a protective factor against problem drinking. This new evidence suggests a need for research on the protective role of alcohol- related God/Higher Power control beliefs in adolescents, however no published studies exist. The dearth of studies in this area is due at least in part to the paucity of available measures of domain-specific God/Higher Power control beliefs for use with African-American youth, 2) to explore the protective role of alcohol-related God/Higher Power control beliefs in the development of problem drinking among African-American youth.

[unreadable] DESCRIPTION (provided by applicant): The benefits of antiretroviral therapy (ART) are clear, however its effectiveness is dependent on strict adherence, which is difficult and not often accomplished by patients. The success of directly observed therapy (DOT) strategies for increasing treatment adherence in tuberculosis has led to calls for research exploring its potential efficacy for ART. However, DOT for ART is complicated by the need to continue medication for life, the current lack of truly once-a-day regimes where all doses can be observed, and the high cost. An alternative to observing every dose, called observed therapy (OT), has been offered as a potential solution and has some demonstrated efficacy. Great effort is currently focused on developing additional once daily ART medications with the goal of creating truly once-a-day regimes. As these regimes become available, it will be increasingly important to understand the relative merits and feasibility of OT in diverse community samples. Psycho educational interventions to increase adherence to therapy, especially those that increase motivation, have been shown to be effective in a number of contexts, including adherences to ART. Among the interventions that have been developed to increase motivation for change is a counseling approach known as Motivational Interviewing (MI). A number of controlled treatment outcomes studies have demonstrated the efficacy of MI counseling approaches for several health behaviors including adherence to ART. Because of its neutral and supportive stance, MI may be particularly effective in fostering enhancing motivation to adhere to ART. We propose a 5 year randomized controlled trial of patients starting a new ART regime assigned to enhanced counseling with observed therapy, enhanced counseling alone, or standard care with assessments conducted at baseline, 3, 6, and 12 months, and the primary test of adherence and secondary outcome of viral load assessed at 1 year. The specific aims of this study are as follows: 1) To determine whether enhanced counseling combined with observed therapy is more effective than enhanced counseling alone or standard care in increasing adherence to ART. 2) To determine whether enhanced counseling combined with observed therapy is more effective than enhanced counseling alone or standard care in decreasing viral load.; and 3) To evaluate the role of potential mediators and moderators on adherence and HIV RNA levels. [unreadable] [unreadable]

DESCRIPTION (provided by applicant): African Americans continue to experience striking health disparities, including shorter life expectancy and higher rates of cancer, heart disease, stroke, HIV/AIDS, diabetes, asthma, influenza and pneumonia, and infant mortality and low birth weights. To more effectively address these disparities, there is a pressing need for health research that includes African Americans -- and the community organizations that serve them - in the research process. One potential partner for reaching African Americans is the African American church community. African American churches have significant influence and reach with over 50% of the African American population attending church on a weekly basis. We propose to build on our more than 11-year track record of extramurally-funded (e.g., NIH, CDC, SAMSHA, local foundations) health science research with African American churches and community-based organizations (CBOs) to create a new formal partnership, the Heartland Health Network (HHN) based at the University of Missouri-Kansas City. The HHN will support collaborative research between an academic health center, an African American faith-based community, and a community-based health service organization. The HHN will focus on overcoming the barriers that each partner faces in order to facilitate health research and dissemination. To achieve this goal we will: 1) formalize our existing network of health researchers, African American faith-based organizations, and a community-based health service organization;2) increase the infrastructure capacity of our partners to efficiently develop and disseminate health science research by enhancing communication and partner relationships, technology support, organizational capacity, and health research and dissemination expertise;3) broaden our network to become a regional entity inclusive of additional churches and other community sectors (e.g., schools, media) to address health disparities affecting African Americans;and 4) achieve sustainability by expanding university institutional support, collaborative submission of grants by HHN partners, and securing foundation support. To assist in facilitating these goals, we have identified a Community Research Associate (CRA) who has extensive experience in developing and implementing health programming in African American churches. The CRA will ensure that representatives of the African American church community are actively involved in all aspects of this application. She will advocate for their interests and ensure that the HHN strives to meet their infrastructure needs. Achievement of these goals will result in several innovations, including more African American church-based health research and dissemination, more culturally competent researchers and health service staff, enhanced understanding of the research process by all partners, enhanced ability to adapt/develop culturally-appropriate health interventions, and an increased number of health disparities addressed with at-risk African Americans. PUBLIC HEALTH RELEVANCE: African Americans continue to experience striking health disparities, and are underrepresented in academic health research. This project addresses the need to fully engage African Americans in research, as well as expand the skills and experience of faith and community-based organizations and researchers to develop strategic community partnerships that facilitate research. The potential public health impact is substantial because it will enhance the capacity of the community to implement evidence-based interventions among African Americans.