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Merzel C., N. VanDevanter, and M. Irvine. 2008. Adherence to antiretroviral therapy among older children and Adolescents with HIV: A qualitative study of psychosocial contexts. AIDS Patient Care & STDs. 22: 977-987.
Abstract Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10-16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest children. In other cases, caregivers developed a kind of partnership with their child for administering the medications. Disclosure to the child of his or her HIV status was used as a strategy to promote adherence but seemed to be effective only under certain circumstances. Social support appeared to have an indirect influence on adherence, primarily by providing caregivers with temporary help when needed. Health care professionals were an important source of disclosure and adherence support for parents. The study illustrates the interplay of maturational issues with other contextual psychosocial factors as influences on adherence among older children and adolescents.
Merzel C, J Moon-Howard, D Dickerson, D Ramjohn, and N VanDevanter. 2008. Making the connections: community capacity for tobacco control in an urban African American community. American Journal of Community Psychology. 41:74-88.
Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community's capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action.
Shelley, D., Cantrell, J., Moon Howard, J., Ramjohn, D.Q., and N. VanDevanter. 2007. The $5 man: the underground economic response to a large cigarette tax increase in New York City. American Journal of Public Health, 97:1483-1488.
We examined the mechanisms by which living in a disadvantaged minority community influences smoking and illegal cigarette sale and purchasing behaviors after a large cigarette tax increase.
Data were collected from 14 focus groups (n=104) that were conducted during the spring of 2003 among Blacks aged 18 years and older living in New York City.
A large tax increase led to what focus group participants described as a pervasive illegal cigarette market in a low-income minority community. Perceived pro-smoking community norms, a stressful social and economic environment, and the availability of illegal cigarettes worked together to reinforce smoking and undermine cessation.
Although interest in quitting was high, bootleggers created an environment in which reduced-price cigarettes were easier to access than cessation services. This activity continues to undermine the public health goals of the tax increase.
Van Devanter, N., Messeri, P., Middlestadt, S.E., Bleakley, A., Merzel, C., Hogben, M., Ledsky, R. & Malotte, C.K. 2005. A Community Based Intervention to Increase Preventive Health Care Seeking in Adolescents: The Gonorrhea Community Action Project. American Journal of Public Health 2005, 95(2):331-337.
Objectives. We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents.
Methods. Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression.
Results. Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes.
Conclusions. This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.
Hogben, M., Ledsky, R., Middlestadt, S.E., Van Devanter, N., Messeri, P., Merzel, C., Bleakley, A., Sionean, C.K. & St. Lawrence, J.S. 2005. Psychological mediating factors in an intervention to promote adolescent health care-seeking. Psychology, Health, & Medicine2005:10(1) 64-77.
Some of the highest rates of curable sexually transmitted diseases in the USA are found among adolescents. Routine, comprehensive health care that includes a sexual history may contribute to alleviating this problem. We designed and ran a three-session small-group workshop for adolescents, using local community organizations as intervention sites, with peers (typically 2-3 years older) helping facilitate the interactive sessions. Outcomes are summarized elsewhere: in this paper, we present an examination of theoretically based psychological mediating factors that we sought to influence during the intervention. Adolescents' health care-seeking beliefs, general attitudes to seeking care, and intentions to do so all changed such that they held more positive beliefs, evaluated health care more favorably, and developed stronger intentions to seek care. Furthermore, relationships among these constructs were strengthened according to theoretical precepts. Adolescents' self-efficacy and their perceptions of social norms pertaining to health care-seeking, however, were unaffected by the intervention. We explored gender differences in mediating factors, finding no interaction, although females did score higher on post-intervention attitude and intention measures.
Malotte, C.K., Ledsky, R., Hogben, M., Larro, M., Middlestadt, S.E., St. Lawrence, J.S., Olthoff, G., Settlage, R.H. & Van Devanter, N. 2004. GCAP Study Group. Comparison of methods to increase repeat testing in persons treated for gonorrhea or chlamydia at public sexually transmitted disease clinics. Sexually Transmitted Diseases 2004:31(11)637-642.
Background: Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended.
Goal: We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea.
Study: In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus $20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1, 5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder.
Results: Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6-2.5) and 2.6 (95% CI, 1.3-5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7-193.5) and 4.6 (95% CI, 0.4-58.0).
Conclusions: A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.
Merzel, C.R., Van Devanter, N., Middlestadt, S.E., Bleakley, A., Ledsky, R. & Messeri, P.A. 2004. Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits. Journal of Adolescent Health 2004:35(2)108-115.
The purpose was to examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits. A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression. Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing. Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues
This report presents data on computer access, Internet use, and factors associated with health information seeking on the Internet among a sample of youths aged 15 to 30 years in New York City. Findings from street intercept surveys indicate substantial computer access at home (62%) and frequent (everyday or a few times a week) Internet use (66%). Fifty-five percent of the sample reported seeking health information on the Internet, which was associated with positive beliefs about getting a health checkup and frequent Internet use.
Van Devanter, N., Shinn, B., Tannert-Naing, K, Bleakley, A., Perl, S. & Cohen, N. 2003. The Role of Social and Behavioral Science in Public Health Practice: A Study of the New York City Department of Health. Journal of Urban Health 2003;80(4)625-634.
Studies over the last decade have demonstrated the effectiveness of public health interventions based on social and behavioral science theory for many health problems. Little is known about the extent to which health departments are currently utilizing these theories. This study assesses the application of social and behavioral science to programs in the New York City Department of Health (NYCDOH). Structured open-ended interviews were conducted with executive and program management staff of the health department. Respondents were asked about the application of social and behavioral sciences within their programs, and about the benefits and barriers to increasing the use of such approaches. Themes related to the aims of the study were identified, a detailed coding manual developed, narrative data were coded independently by two investigators (kappa.85), and data analyzed. Interviews were conducted with 61 eligible individuals (response rate 88%). The most common applications of social and behavioral science were individual-level behavior change to prevent HIV transmission and community-level interventions utilizing community organizing models and/or media interventions for health promotion and disease prevention. There are generally positive attitudes about the benefits of utilizing these sciences; however, there are also reservations about expanded use because of resource constraints. While NYCDOH has successfully applied social and behavioral sciences in some areas of practice, many areas use them minimally or not at all. Increasing use will require additional resources. Partnerships with academic institutions can bring additional social and behavioral science resources to health departments and benefit researchers understanding of the health department environment.
Van Devanter, N., Hennessy, M., Howard, J.M., Bleakley, A., Peake, M., Cohall, A., Fullilove, R. & Weisfuse, I. 2002. Researcher-Community Collaboration for STD Prevention. The Gonorrhea Community Action Project in Harlem. Journal of Public Health Management and Practice 2002;8(6):62-68.
Community interventions are rare in the field of sexually transmitted disease (STD) control and prevention. The goals of the Gonorrhea Community Action Project are to design and implement interventions for the reduction of gonorrhea in high-prevalence areas and to increase the appropriateness and effectiveness of STD care in the participating communities. Key to conducting the formative research and developing the interventions was the creation of a community-academic-health department collaborative partnership. Using a staged model, this article presents a case study of collaboration development in the community of Harlem, New York.
Van Devanter, N., Gonzales, V., Merzel, C., Celentano, D. & Greenberg, J. 2002. Effectiveness of STD/HIV behavior change intervention on women's use of the female condom. American Journal of Public Health 2002; 92(1) 109-115.
This study assessed the effectiveness of a sexually transmitted disease (STD)/HIV behavior change intervention in increasing women's use of the female condom. Methods. A total of 604 women at high risk for STDs and HIV in New York City, Baltimore, Md, and Seattle, Wash, enrolled in a randomized controlled trial of a small-group, skills-training intervention that included information and skills training in the use of the female condom. Results. In a logistic regression, the strongest predictors of use were exposure to the intervention (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.8,10.7), intention to use the female condom in the future (OR = 4.5; 95% CI = 2.4, 8.5), having asked a partner to use a condom in the past 30 days (OR = 2.3; 95% CI = 1.3, 3.9), and confidence in asking a partner to use a condom (OR = 1.9; 95% CI = 1.1, 3.5). Conclusions. Clinicians counseling women in the use of the female condom need to provide information, demonstrate its correct use with their clients, and provide an opportunity for their clients to practice skills themselves.
Gerzoff, R.B. & Van Devanter, N. 2000. Recent Data Are Needed to Support Public Health Training and Workforce Initiatives. American Journal of Public Health, May 2000, Vol. 90 Issue 5, p809-809, 3/8p.
A letter to the editor and a response to the letter by Nancy L. Van Devanter about the shortage of public health professionals and the need to support efforts to enhance public health training are presented.
Van Devanter, N., Parikh, N., Cohall, R., Faber, N., Litwak, E., Messeri, P., Gonzales, V., Kruger, S. & Greenberg, J. 2000. Factors influencing participation in weekly support groups among women completing an HIV/STD Intervention program. Women and Health 2000; 30(1): 15-35.
Over the past three decades, the influence and importance of social support has been well documented and the findings have suggested a beneficial effect on stress-related situations, mental and physical health, and social functioning. More recently, small group/skills training behavioral interventions have demonstrated success in changing behaviors which affect the transmission of sexually transmitted diseases, including HIV among populations at risk for these diseases. Studies of support groups to date have been conducted exclusively in research settings where women are offered financial incentives for participation. Little is known about the willingness of women to participate in ongoing support groups after successfully completing a skills training intervention. The present study examines the factors that may influence participation among women in a weekly support group after completing a structured, six session HIV/STD intervention. Both quantitative and qualitative data are collected from 265 women in the intervention arm of a multi-site randomized controlled behavioral intervention trial. Results reveal that less than a quarter (22%) of women participated in at least one support group. Participation varied significantly by site, ranging from 34% to 15% (p = .008). Participation was also strongly linked to recent use of domestic violence services. Qualitative data indicated that although monetary incentives play some role in the woman's decision to participate, other factors are also important. These include program outreach, support group size, salience of the group content, consistency of group leadership from the intervention to the support group, and use of peer leaders along with professional facilitators. Implications for design of post-intervention support groups programs are discussed.
Greenberg, J., Hennessy, M., Celentano, D., Gonzales, V. & Van Devanter, N. 2000. The WINGS Project: Modeling intervention effectiveness for high-risk women. Evaluation & the Health Professions, Vol. 23, No. 2, 123-148.
This study evaluates the effectiveness of two strategiesï¿½communication and condom skills trainingï¿½for increasing condom-protected sex in a sample of 510 high-risk women ages 17 to 61. Baseline and 3- and 6-month postintervention interview data were gathered in three cities participating in a randomized trial of a six-session, group skill-building intervention. This analysis was conducted for the entire sample and for six subgroups categorized by age, single or multiple partners, and history of childhood sexual abuse. The dependent variable was the odds ratio of protected sex acts at each follow-up. Structural equation modeling was used to estimate effects for two intervention pathways. The pathway through condom skills increased the odds of protected sex for the intervention group (2 difference = 35, df = 2, p < .05) as well as for all subgroups. The pathways through communication were significant for the intervention group (2 difference = 23, df =3, p < .05) but fully effective only for participants under 30 and participants who reported childhood sexual abuse. The effectiveness of both pathways diminished at 6 months. WINGS demonstrates that condom skills training can increase protected sex for a heterogeneous group of women. Further research needs to examine how such skill training translates into use of condoms by male partners. To increase the duration of intervention effects, booster sessions may need to be incorporated.
Van Devanter, N., Cicatelli, B., Weisfuse, I., Halpern, O., Levinson, M., Deli, K. & Dunn, A. 1999. Transfer of behavioral intervention technology to an STD Clinic setting. Journal of Public Health Management and Practice 1999; 5(5): 40-51.
Van Devanter, N. 1999. Prevention of Sexually Transmitted Diseases: The Need for Social and Behavioral Science Expertise in Public Health Departments (Editorial). American Journal of Public Health; 1999 89(6) 815-818.
This article reflects on a need for social and behavioral science expertise in public health departments in the U.S. for the prevention of sexually transmitted diseases (STD). In the developed world, the U.S. has the highest rates of STD, higher than for some developing countries. As a result of sexual behaviors, which are shaped by social and environmental factors in communities, individuals are at risk for STD. A landmark report by the Institute of Medicine in 1997 concluded that the outbreak of STD is influenced by the lack of awareness among the general public, lack of skills and training among health professionals and the absence of an effective national system for the prevention of STD.
Van Devanter, N., Thacker, A.S., Bass, G. & Arnold, M. 1999. Heterosexual couples confronting the challenges of HIV infection. AIDS Care 1999; 11(2): 181-193.
Couples confronted with HIV infection face significant challenges. Little is known about the impact of HIV on heterosexual couples who account for the vast majority of cases worldwide and an increasing proportion of cases in the USA, especially among women. In this study, analysis of data collected on HIV-discordant couples participating in a ten-week support group revealed four major groups of issues: (1) dealing with the emotional and sexual impact on the relationship; (2) confronting reproductive decisions; (3) planning for the future of children and the surviving partner; and (4) disclosure of the HIV infection to friends and family. These findings have implications for the design of interventions to enhance adaptation to HIV for discordant couples.
Coggins, C., Elias, C.J., Atisook, R., Bassett, M.T., Ettiegne-Traore, V., Ghys, P.D., Jenkins-Woelk, L., Thongkrajai, E. & Van Devanter, N. 1999. Safety of three formulations of nonoxynol-9 containing vaginal spermicides. International Journal of Gynecology and Obstetrics 1999; 58: 267-268.
Coggins, C., Elias, C.J., Ronachai, A., Bassett, M.T., Ettiegne-Traore, V., Ghys, P.D., Jenkins-Woelk, L., Thongkrajai, E. & Van Devanter, N. 1998. A study of women’s preferences regarding the formulation of over-the-counter vaginal spermicides. AIDS 1998; 12(11): 1389-1403.
Greenberg, J., J. Lifshay, Van Devanter, N., Gonzales, V. & Celentano, D. 1998. Preventing HIV Infection: The effects of community linkages, time, and money on recruiting and retaining women in intervention groups. Journal of Women’s Health 1998; 7: 587-596.
Few studies have addressed recruitment and retention of participants in preventive interventions directed at human immunodeficiency virus (HIV), and these generally have not focused on women. In this study, part of the Women in Group Support (WINGS) project, we examine the experience of three sites in recruiting 444 high-risk women for a small group intervention to reduce risky sexual behavior. The intervention included six structured sessions, followed by a continuing series of client-focused, drop-in sessions. Incentives for participants included child care, food, and transportation tokens. Attendees at each structured session also received a cash incentive of $10-$20. Forty-six percent of the women were recruited from community sources, 35% from clinics, and 19% from drug programs. Across all recruitment sources, almost a third of the women reported having had a sexually transmitted disease (STD) in the past year, 88%-94% reported a risky male partner (who, they believed, had sex with other partners or with sex workers, was an injecting drug user, or was HIV positive), and 10%-36% reported trading sex for money or drugs. During 18 months of recruitment, each site averaged 34 screening interviews monthly to secure 8 eligible women a month who completed baseline interviews and reported for randomization. The average number of paid sessions attended by participants was five of six (83%). Average attendance at unpaid sessions was 1 of 12 (8%). Key facilitators to recruitment and retention included linkages with community agencies and monetary incentives. Our findings suggest that researchers and community service providers need to explore alternative strategies to paying women for attending group sessions (e.g., incorporating group interventions into existing program requirements) and balance these against the costs and recruitment effectiveness.
Van Devanter, N., Cleary, P.D., Moore, J., Thacker, A.S. & O'Brien, T. 1998. Reproductive Behaviors among HIV discordant heterosexual couples. Implications for counseling. AIDS Patient Care and STDs 1998; 12(1): 43-49.
Cleary, P.D., Van Devanter, N., A. Stuart, M. Steilen, Shipton-Levy, R., W. McMullen, T. Rogers, E. Singer, Avorn, J. & J. Pindyck. 1995. A randomized trial of an education and support program for HIV infected individuals.. AIDS 1995, vol. 9, no11, pp. 1271-1278 (37 ref.).
Objectives : To assess the effectiveness of an intervention for providing information and support to HIV-positive donors on changes in their sexual behavior, and to assess which donor characteristics are predictive of behavior change. Design : Subjects were randomly assigned to a structured intervention or community referral group. Follow-up assessments were conducted every 6 months. Setting : New York City, New York, USA. Participants : A cohort of 271 HIV-infected persons who donated blood to the New York Blood Center. Intervention : Donors randomized to the structured intervention program met individually with a nurse for counseling and were offered a six-session support group. The program was designed to provide information, encourage safer sexual behavior and provide support. Main outcome measures : Sexual behavior, psychological distress and psychological help seeking, and immune function. Results : In both groups there was a large decrease over time in reports of unsafe sexual activity. However, more than 30% of participants in both groups reported unsafe sexual activity at the 1-year follow-up visit. Donors randomized to the structured intervention program did not report significantly more behavior change at the 1-year follow-up. Conclusions : Better programs to promote behavior change in seropositive individuals are needed.
Cleary, P.D., Van Devanter, N., Rogers, T.F., Singer, E., Shipton-Levy, R., Steilen, M., Stuart, A., Avorn, J. & Pindyck, J. 1993. Depressive Symptoms in Blood Donors Notified of HIV Infection. American Journal of Public Health April, Vol. 83 Issue 4, p534-539, 6p.
Understanding more about the psychological state of persons notified of human immunodeficiency virus (HIV) infection is critical for designing notification and counseling programs that will have the most positive effect. Methods. The subjects were blood donors who had been notified of HIV infection by the New York Blood Center. A nurse elicited a medical history, performed a limited medical examination, and asked the subjects to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. The subjects completed another questionnaire approximately 2 weeks later. Results. The average depressive symptom scores for both men and women were substantially higher than scores typically found in representative population samples. More than a quarter of the men and more than a third of the women reported seeking psychological or psychiatric services in the first few weeks following notification. Conclusions. Anticipating and meeting individuals' psychological needs may be necessary if HIV screening programs are to address effectively the needs of persons infected with HIV.
Cleary, P.D., Van Devanter, N., Rogers, T.F., Singer, E., Shipton-Levy, R., Steilen, M., Stuart, A., Avorn, J. & Pindyck, J. 1991. Behavior Changes After Notification of HIV Infection. American Journal of Public Health, Dec 1991, Vol. 81 Issue 12, p1586-1586, 5p.
To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. Methods. Blood donors who were notified at the New York Blood Center that they were HTV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. Results. Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. Conclusions. To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HTV infection, we need to learn more about how to help people change their high-risk behaviors.
Cleary, P.D., Singer, E., Rogers, T., Avorn, J., Van Devanter, N., Soumerai, S., Perry, S. & Pindyck, J. 1988. Sociodemographic and Behavioral Characteristics of HIV Antibody-Positive Blood Donors. American Journal of Public Health, Aug 1988, Vol. 78 Issue 8, p953-957, 5p.
This paper describes the sociodemographic and behavioral characteristics of 173 blood donors who were confirmed by Western blot tests to have antibodies to human immunodeficiency virus (HIV), the etiologic agent for acquired immunodeficiency syndrome (AIDS). Seropositive donors were predominately young, unmarried, and male, and major risk factors could be identified for almost all donors. However, more than 20 per ¢ of the study participants were women, and many participants were not aware that they were at risk of infection. The heterogeneity of the study population, the lack of awareness among many subjects of risk factors and self-exclusion procedures, and the high level of distress among many subjects after notification, emphasize the need for intensive, well-designed education and support programs.