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

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

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

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

Background & Significance THE INTERSECTION BETWEEN HEALTH & FAITH

 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

 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

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

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

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

 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

 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 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

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

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

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

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

Recruitment & Retention Efforts STUDY IMPLEMENTATION

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

RECRUITMENT SOURCES

INELIGIBLE REASONS

ELIGIBLE, NOT PARTICIPATING (N=27)

RANDOMIZATION

3 MONTH RETENTION

6 MONTH RETENTION

RETENTION BY STUDY ARM

ALLOCATION TABLE

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

SOCIO-DEMOGRAPHICS VariableSISTA (n=69) Mean (SD) % (n) P4 (n=65) Mean (SD) % (n) P Value Age (18-34 years) (4.5)24.58 (3.7)0.96 Employed 62.3% (43)66.2% (43)0.64 Hours Worked (week) (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

DEMOGRAPHICS CONT.

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

SEXUAL BEHAVIORS

CONDOM USE BEHAVIORS

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

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

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

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

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

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

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

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

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

For African American Churches For African American Women CONTINUING THE RESEARCH: OTHER FAITH-BASED STUDIES

REFERENCES 1.CDC. HIV surveillance – United States, MMWR. 2011; 60: Pew Forum on Religion & Public Life. The Pew Report on U.S. Religious Landscape Survey. February Accessed on October 10, Taylor RJ, Chatters L., Levin J. Religion in the lives of African Americans: Social, psychological, and health perspectives. Thousand Oaks, CA: Sage; 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): DiClemente RJ, Wingood GM. A randomized controlled trial of an HIV sexual risk-reduction intervention for young African American women. JAMA. 1995:274(16): Campbell MK, Hudson MA, Resnicow K, et al. Church-based health promotion interventions: Evidence and lessons learned. Annual Review of Public Health. 2007; 28: