1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Active program participation and HIV risk reduction among urban youth: Findings from the Complementary Strengths Research Partnership Jennifer Sarah Tiffany, John Eckenrode, Deinera Exner- Cortens, Sara Birnel-Henderson July 25, 2012 - Session WEAE04: Young People, HIV and Sexual and Reproductive Health Services

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org This project was supported in part by award #R21NR009764 from the NIH/National Institute of Nursing Research and by USDA grant #NYC-323442- 0219950. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research, the National Institutes of Health, or the USDA. We have no conflicts of interest to disclose.

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Overview of today’s talk Complementary Strengths Research Partnership  Background and history  Methods  Results  Implications  Limitations  Next steps

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org Background and history  We started with a question: Does active participation boost HIV risk reduction among youth?  Partnership included Cornell University, New York State Department of Health, community programs, and New York City Department of Youth and Community Development  Steering committee launched pilot study (98 youth in 2006) and exploratory observational study (329 youth ages 13 to 18 in 2008-2009)  Aim: To develop measures, assess links between youth participation and sexual health promotion

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Pilot project 2005-2006 Exploratory study 2007-2010 Developed new measures for participation and HIV risk reduction Interviews : What helps/hinders participation? Intervention to boost the quality of youth engagement in ASH EBPs Designing Now

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Methods  Mixed-method Community-Based Participatory Research project; mostly statistical analyses  Youth and program staff worked with university to develop and refine surveys, sustain participation  329 ethnically diverse participants from 18 after- school programs in New York City; 62% female, 37% male, 1% transgender; 74% heterosexual, 26% LGBTQ; 91% retention at waves 2 and 3  Youth-Adult “data dialogues” to translate results

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Results Overview  Exploratory and confirmatory factor analysis validated our 20 item youth program participation scale (the “TEPPS”)  Candidate measure for sexual health/risk reduction  Significant positive associations: program participation, social connectedness, and HIV risk reduction scores  Youth in programs with participation scores that were average or high were more likely to sustain risk reduction practices (setting impact on individuals)  Longer program involvement increased the impact of participation on risk reduction practices

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Result #1  Validated 20 item youth program participation scale  5-point scale (1=not at all true for me, 5=very true for me)  Scores are created by summing across the 20 items; higher scores indicate greater program participation  Cronbach’s alpha at baseline was 0.87  Example items include “I help decide things like program activities or rules” and “I think that participating in the program will help me to get a job.”  4 subscales: Personal Development, Voice/Influence, Safety/Support, Community Engagement

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org Result #2

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Significant relationships among program participation, risk reduction & social connectedness Result #3 Risk Reduction ParticipationFamily Connectedness School Connectedness AgeEthnic Identity (MEIM) Hours per week Duration of involvement Risk reduction 1.00 Program Participation.257**1.00 Family connectedness.140*.294**1.00 School connectedness.171**.163**.335**1.00 Age.020.061-.172**-.0361.00 Ethnic Identity.232**.349**.231**.149**.0441.00 Hours per week.020.198**.004-.046-.089.0601.00 Duration of involvement.104^.047-.003-.047.127*.121*.149*1.00 **p<.01 *p<.05 ^p<.10 Two tailed significance tests. Effective sample size ranged from 302 to 329

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Youth in programs with participation scores that were average or high were more likely to sustain risk reduction practices (setting impact on individuals) Result #4 b=-0.32, p=.005

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Longer program involvement increased the impact of participation on risk reduction practices Result #5

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org Implications  Consider contexts as well as individual behaviors  Setting-level factors influence risk reduction among adolescents  Highly engaged program participation may help sustain adolescent risk reduction practices over time  Quality of youth program participation experiences can be reliably and easily measured using new 20-item scale  Design and test interventions that increase program-level engagement (intervene with settings, not just individuals)  After-school/out of school time programs one key setting

15. Washington D.C., USA, 22-27 July 2012www.aids2012.org Limitations  Observational study  Only 3 waves of survey data  Program variability and few sites (18) Next Steps  Intervention study with larger number of sites and more data waves  Setting-level intervention

16. Washington D.C., USA, 22-27 July 2012www.aids2012.org Thanks to Complementary Strengths research partners and participants:  Hetrick Martin Institute  Lutheran Family Health Care/Project Reach Youth  Citizens Advice Bureau/BronxWorks  Bronx AIDS Services  Mosholu Montefiore Community Center  The Educational Alliance/Edgies  The Children’s Aid Society/Frederick Douglass Community Center  Legal Outreach Inc.  NYS Department of Health AIDS Institute Adolescent HIV Prevention Services Unit  NYC Department of Youth and Community Development

17. Washington D.C., USA, 22-27 July 2012www.aids2012.org For more information: Jennifer Tiffany jst5@cornell.edu Bronfenbrenner Center for Translational Research www.bctr.cornell.edu Tiffany, J., Exner, D., and Eckenrode, J. (2012). A new measure for youth program participation. Journal of Community Psychology. 40(3), pp. 277- 291. doi: 10.1002/jcop20508

18. Washington D.C., USA, 22-27 July 2012www.aids2012.org