1. Pihlquist, Emily
  2. Kennedy, Maureen Shawn MA, RN, news director

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HIV Prevention in Hispanic Youths

Success with a culturally specific intervention.

Despite the increases seen in HIV infection rates among Hispanic youths, few prevention strategies have targeted them. Associate professor at the University of Michigan School of Nursing, Antonia M. Villarruel, PhD, RN, FAAN, and colleagues set out to determine the effectiveness of culturally tailored interventions for reducing HIV transmission among young, inner-city Hispanics.


Participants in the two-day program, called Cuidate (Spanish for "take care of yourself"), were inner-city teens attending Philadelphia public schools. Their average age was 14.9 years; the group included both Spanish speakers (85%) and English speakers who were randomly assigned to one of two instructional groups. The control group was counseled on general health issues, such as drug and alcohol use, tobacco cessation, exercise, and nutrition. The intervention group learned about safer sex through a curriculum adjusted to cultural beliefs and gender roles; investigators presented information on condom use in English and Spanish.


At the three-, six-, and 12-month follow-up improvements in behavior were seen in the intervention group, who reported lower frequency of intercourse, less unprotected intercourse, fewer partners, and more consistent condom use than those in the control group.

FIGURE. The Kenyan g... - Click to enlarge in new windowFIGURE. The Kenyan grandmothers, ages 35 to 70 years, had to be HIV negative, not pregnant or hypertensive, and without "wasting" disease.

Villarruel encourages additional study of high-risk youths. -EP


Breastfeeding by Grandmothers to Prevent HIV Transmission

Researchers find older Kenyan women can resume lactation.

With a staggering number of HIV-positive women in sub-Saharan Africa, transmission of HIV through breast milk is a major concern. It accounts for 15% to 30% of pediatric AIDS cases, according to Chandice Y. Covington, PhD, RN, CPNP, of the University of California, Los Angeles. This nurse researcher may have found a way to interrupt the cycle of mother-to-child HIV transmission, using a process that dates back to pre-history: breastfeeding by non-puerperal women (women who haven't recently given birth).


In a small trial, Covington examined whether grandmothers, all of whom had breastfed during their own childbearing years, could act as surrogates to breastfeed their grandchildren. The six-week intervention trial was conducted in small villages in coastal Kenya. The ages of the 25 grandmothers ranged from 35 to 70 years; they were all HIV negative, not pregnant, and not hypertensive. They had breastfed for at least six months in the past but had not done so in the preceding six months. They pumped their breasts for 10 minutes four to six times daily, using a small, foot-powered pump.


Of the 25 women, 21 could produce breast milk, which was analyzed and compared with that of 20 younger lactating women. The preliminary findings indicated that the breast milk of the two groups was nutritionally similar. Covington pointed out that female humans live much longer after their childbearing years than do females of other species. This makes it possible for them to have a larger part in raising successive generations. She believes that these "aging African women may serve a significant role in circumventing" the tragedy of AIDS in that part of the world. -MSK


Cooking Lessons

A culturally sensitive intervention to prevent cardiovascular disease.

Nurses and colleagues from West Virginia University in Morgantown have developed, implemented, and evaluated a program to decrease cardiovascular disease (CVD) risk among low-income Appalachian women. The nurse team used an innovative cooking-show format in which local cooks made traditional regional recipes with more healthful ingredients.


According to Susan H. McCrone, PhD, RN, the planning of a health intervention to prevent CVD began with focus groups in the community. The participants in the four focus groups, a total of 48 women, were white and between the ages of 40 and 65. They were given a meal and a $20 incentive.


The focus groups revealed that the women associated heart disease with death. Most knew that women exhibited different symptoms of CVD than men, and most were aware of the role of diet in preventing it. However, the women said that they were more often motivated to change their diet for the purpose of losing weight. They wanted to make meals that required less than 30 minutes to prepare. Money was a major concern, and many of the women bought food in bulk and on sale. An overriding theme, McCrone said, was stress. The women talked a lot about changing roles and the stress brought on by working outside of the home. They admitted that they often put themselves last. As one participant noted, she was "raised to think that if I thought of myself first, I was selfish." It also became apparent that cultural heritage and upbringing were major influences on the women's confidence that they could change.


With insights from the focus groups, the researchers developed a plan to adapt traditional recipes to low-fat, portion-controlled meals that were easy to prepare. Sheila L. Rye, MS, CHES, described development of an interactive intervention, a cooking show called "Cookin' Up Health." The show could be watched while women were waiting to see health care professionals at clinics or at health department screening programs. A computer with a touch screen allowed a viewer to navigate the program, adapting it to her own family's situation.


The cooking program used traditional bluegrass music, regional recipes and ingredients, and local cooks. In addition to doing step-by-step meal preparation, the local cooks also provided information on nutrition and the importance of reducing dietary fat and reading nutrition labels.


According to Rye, the 13 recipes they created were healthful variations of regional favorites, like oven-fried chicken and chicken and dumplings. Ingredients were substituted to make the dishes more in keeping with CVD prevention guidelines. Particular points of emphasis included portion control and the use of more vegetables and grains. Researchers used "the new American plate," a portion template based on the American flag, as a model.


Other presenters in the symposium discussed recruitment of participants for the intervention, as well as evaluation of the interactive nutrition program. -MSK