Papers by John B. Jemmott III
Journal of Adolescent Health, 2020
PLOS ONE, Mar 13, 2019
African American men are disproportionately affected by, not only HIV/AIDS, but also chronic non-... more African American men are disproportionately affected by, not only HIV/AIDS, but also chronic non-communicable diseases. Despite the known benefits of physical activity for reducing chronic non-communicable diseases, scant research has identified factors that may influence physical activity in this population. A growing literature centers on the syndemic theory, the notion that multiple adverse conditions interact synergistically, contributing to excess morbidity. This secondary data analysis examined two primary questions: whether syndemic conditions prospectively predicted physical activity, and whether, consistent with the syndemic theory, syndemic conditions interacted to predict physical activity. Participants were 595 African American men who have sex with men (MSM), a population underrepresented in health research, enrolled in a health-promotion intervention trial from 2008-2011. We used generalized-estimating-equations models to test the associations of syndemic conditions and resilience factors measured pre-intervention to self-reported physical activity 6 and 12 months post-intervention. As hypothesized, reporting more syndemic conditions pre-intervention predicted reporting less physical activity 6 and 12 months postintervention, adjusting for the intervention. However, contrary to the syndemic theory, we did not find evidence for the interaction effects of syndemic conditions in predicting physical activity. Receiving high school education and having greater social network diversity predicted more physical activity whereas older age predicted less physical activity. To our knowledge, this is the first study to examine the syndemic theory in relation to physical activity. Although reporting a greater number of syndemic conditions was related to reduced physical activity, there was no evidence for synergy among syndemic conditions.
Archives of Sexual Behavior, Jun 20, 2018
Studies show that having sex with multiple partners increases the risk of acquiring and transmitt... more Studies show that having sex with multiple partners increases the risk of acquiring and transmitting sexually transmitted diseases, including HIV. The present article reports prospective predictors of having multiple sexual partners among 505 African American men in Philadelphia who have sex with men (MSM) who participated in an intervention trial and attended a 6-month follow-up. Participants completed audio computer-assisted surveys of demographics, sexual behavior, and Reasoned Action Approach and Social Cognitive Theory mediators concerning multiple partners. We analyzed the incidence of selfreported multiple partners at the 6-month follow-up, controlling for treatment condition and baseline levels of the theoretical variables. The odds of having multiple partners decreased with increasing age (p < .03). Participants who said they were HIV positive had lower odds of having multiple partners (p < .009). The more pride participants reported in their identities as black or African American men, the lower the odds that they reported having multiple partners (p < .02). Adverse outcome expectancies accruing to multiple partners fully mediated the effect of black pride and partially mediated the effects of age on the odds of having multiple partners. Modifiable factors such as perceived negative outcome expectancies regarding having multiple sex partners should be addressed in designing interventions and prevention programs with the goal of decreasing the number of sexual partners among African American MSM.
Journal of Adolescent Health, Jul 1, 2019
Scant research has investigated whether health promotion interventions have sustained effects in ... more Scant research has investigated whether health promotion interventions have sustained effects in increasing physical activity and healthful diet among adolescents in sub-Saharan Africa, which is experiencing an epidemiological transition from infectious diseases to noncommunicable diseases as leading causes of mortality. We examined whether an intervention increased adherence to 5-a-day diet and physical activity guidelines during a 54-month postintervention period among South African adolescents and whether its effects weakened at long-term (42 and 54 months postintervention) compared with short-term (3, 6, and 12 months postintervention) follow-up. Methods: We randomized 18 randomly selected schools serving grade 6 learners (mean age ¼ 12.6) in a township and a semirural area in Eastern Cape Province, South Africa, to one of the two 12-hour interventions: health promotion, targeting healthful diet and physical activity; attentionmatched control, targeting sexual risk behaviors. We tested the intervention's effects on adherence to 5-a-day diet and physical activity guidelines using generalized estimating equations logistic regression models adjusting for baseline behavior and clustering within schools. Results: Health promotion intervention participants had higher odds of meeting 5-a-day diet and physical activity guidelines than control participants. The effect on 5-a-day diet did not weaken at long-term compared with short-term follow-up, but the effect on physical activity guidelines was weaker at long-term follow-up, mainly because of a reduced effect on muscle-strengthening physical activity. The intervention also increased health promotion attitude and intention and health knowledge and reduced binge drinking compared with the control group.
PubMed, Dec 1, 1998
A 10-hour small-group informational and skill-building intervention was tested among patients (N ... more A 10-hour small-group informational and skill-building intervention was tested among patients (N = 472) attending publicly funded sexually transmitted disease clinics in Maryland, Georgia, and New Jersey. After completing a 90-minute interview concerning HIV risk behaviors, condom use self-efficacy and condom outcome expectancies, participants were randomized to either an intervention or a control condition. Participants in both conditions displayed significant reductions in unprotected encounters and number of partners and increases in condom use. No differences between treatment conditions were observed, indicating that the motivational effects of the interview may have been stronger than the effects of the intervention in this population.
Journal of Obstetric, Gynecologic, & Neonatal Nursing, Mar 1, 2008
African American women, particularly those who live in inner-city areas, experience disproportion... more African American women, particularly those who live in inner-city areas, experience disproportionately high rates of sexually transmitted infections including HIV. As there are currently no preventive vaccines for HIV and most sexually transmitted infections, prevention efforts must focus on behavioral risk reduction. Thus, culturally tailored interventions for African American women are needed to reduce their incidence of sexually transmitted infections including HIV. One place to intervene with inner-city African American women is in primary care settings. Primary care settings have the potential to reach a wide range of women, including those who may not proactively seek sexually transmitted infection/HIV prevention services. However, in order to be feasible for use in clinical settings, sexually transmitted infection/HIV risk reduction interventions must be brief and easily adapted for use with diverse clients in varied practice environments. To date, few brief sexually transmitted infection/HIV prevention interventions have been designed for use with African American women in primary care settings. Only one of these, the " Sister to Sister: Respect Yourself! Protect Yourself! Because You Are Worth It! " intervention, has demonstrated effectiveness in reducing sexual risk behaviors and sexually transmitted infection incidence. This article describes this 20-minute, one-on-one nurse-led intervention for African American women and discusses considerations for its implementation in primary care and other clinical settings.
American Journal of Public Health, Jun 1, 2007
Objectives. We tested the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction... more Objectives. We tested the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction interventions for African American women in primary care settings.Methods. In a randomized controlled trial, 564 African American women recruited at a Newark, NJ, inner-city women’s health clinic were assigned to a 20-minute one-on-one HIV/STD behavioral skill-building intervention, 200-minute group HIV/STD behavioral skill-building intervention, 20-minute one-on-one HIV/STD information intervention, 200-minute group HIV/STD information intervention, or 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence.Results. At 12-month follow-up, participants in the skill-building interventions reported less unprotected sexual intercourse than did participants in the information interventions (Cohen’s d [d]=0.23, P=.02), reported a greater proportion of protected sexual intercourse than did information intervention participants (d=0.21, P=.05) and control participants (d=0.24, P=.03), and were less likely to test positive for an STD than were control participants (d=0.20, P=.03).Conclusions. This study suggests that brief single-session, one-on-one or group skill-building interventions may reduce HIV/STD risk behaviors and STD morbidity among inner-city African American women in primary care settings.
American Journal of Men's Health, Nov 1, 2022
People living with HIV on antiretroviral therapy have an increased risk of developing metabolic d... more People living with HIV on antiretroviral therapy have an increased risk of developing metabolic disturbances and central adiposity. Adequate engagement in physical activity (PA) could reduce the risk of chronic diseases associated with central adiposity. We conducted a secondary analysis of data from a randomized controlled trial of a PA intervention with 302 African American men aged 40 or older (53.9±7.2 years) living with HIV to assess whether the intervention reduced the waist-to-hip ratio (WHR). Generalized estimating equation analyses tested whether the PA intervention reduced WHR compared with the control group and whether age moderated its effect, adjusting for follow-up assessment time (3, 6, and 12 months postintervention) and baseline WHR and age. The analysis revealed that the intervention’s effect on WHR was not significant ( B = −0.008, p = .097). However, a significant interaction between age and the intervention ( B = 0.001, p = .046) indicated that the intervention’s effect in reducing WHR waned with increasing age. For instance, when dividing participants into three age subgroups, the intervention reduced WHR for men ages 40 to 50 ( B = −0.020, p = .013) and ages 50 and 60 ( B = −0.007, p = .315) but increased it among those older than 60 ( B = 0.013, p = .252). The intervention’s effects on WHR differed by participants’ age, suggesting that different PA strategies may be needed based on age to improve the metabolic profile and reduce chronic disease risk in African American men living with HIV.
Journal of Adolescent Health, Nov 1, 2019
The aim of the article was to test the efficacy of an HIV risk reduction intervention for African... more The aim of the article was to test the efficacy of an HIV risk reduction intervention for African American mothers in reducing condomless vaginal intercourse among mothers and their adolescent sons. Methods: In a randomized controlled trial design, mothereson dyads residing in public housing developments in Philadelphia, PA, were allocated to one of two four-session interventions: HIV risk reduction targeting sexual risk behaviors or attention-matched control targeting other health behaviors. Only mothers received the interventions; mothers and sons completed self-report measures preintervention, immediately postintervention, and 3, 6, 12, 18, and 24 months postintervention. The primary outcome was frequency of condomless vaginal intercourse in the past 3 months. Results: A total of 525 mothereson dyads participated, with 523 included in primary outcome analyses. Generalized estimating equations analyses revealed that condomless sex was reduced in the HIV risk reduction intervention compared with the attention control group, adjusting for baseline self-reports and time of postintervention assessment. The intervention's efficacy did not differ between mothers and sons or among the postintervention periods. Conclusions: Mothereson interventions are an effective strategy to reduce sexual risks among African American mothers and their adolescent sons residing in public housing.
Sexually Transmitted Diseases, Mar 1, 2015
Background-Adolescents living in South Africa are at high risk for HIV and other sexually transmi... more Background-Adolescents living in South Africa are at high risk for HIV and other sexually transmitted disease (STD). The present study sought to identify correlates of curable STD incidence among a cohort of adolescents in Eastern Cape Province, South Africa. Methods-Data were collected in conjunction with an HIV/STD prevention intervention randomized controlled trial 1. At 54 months post-intervention, curable STD incidence (gonorrhea, chlamydial infection and trichomoniasis) was assayed and self-report measures of potential correlates of STD incidence were collected. Results-Participants were adolescents reporting at least one sexual partner in the past 3 months (N = 659). As expected, univariate analyses revealed that girls were more likely than boys to have
Journal of the Association of Nurses in AIDS Care, May 1, 2019
African American men who have sex with men (MSM) have high rates of HIV, but interventions are ne... more African American men who have sex with men (MSM) have high rates of HIV, but interventions are needed to address their low rates of engagement in the HIV care continuum. To identify modifiable factors potentially affecting such engagement, we conducted qualitative interviews guided by the Theory of Planned Behavior with 27 African American MSM who had participated in an HIV riskreduction intervention trial. Qualitative analyses resulted in four overarching themes: stigma, concerns with health care providers (HCPs), social support, and logistical issues. Facilitators of care continuum engagement included reassurance about health, feeling and looking better, receiving treatment, avoiding infecting others, good relations with HCP, and social support. Barriers included HIV stigma, concerns about confidentiality, negative perceptions of HCP, convenience and availability of testing/treatment facilities, cost, and lack of social support. Efforts to improve African American MSM HIV care continuum engagement should focus on individual and health care system changes.
Journal of Child and Family Studies, Feb 4, 2023
Health Education & Behavior, May 12, 2021
Epidemiological evidence of the protective role of fruits and vegetables for a host of chronic he... more Epidemiological evidence of the protective role of fruits and vegetables for a host of chronic health conditions is well-documented. However, there is a dearth of studies examining predictors of fruit and vegetable intake among African American men living with HIV. We report secondary analyses—multiple regression and logistic regression models fitted to examine the strength of the relationships between the reasoned action approach constructs; namely, attitudes, subjective norms, descriptive norms, self-efficacy and intention to consume fruits and vegetables, and self-reported adherence to 5-A-DAY guidelines. We used baseline data from a randomized controlled trial of a physical activity intervention trial with 302 African American men aged 40 years or older ( M = 53.9; SD = 7.2) living with HIV. Attitudes, subjective norms, descriptive norms, and self-efficacy were positively associated with intention to meet 5-A-DAY guidelines. More positive attitudes toward 5-A-DAY guidelines were associated with higher odds of meeting 5-A-DAY guidelines. More positive attitudes and self-efficacy were also positively associated with meeting the guidelines for intake of vegetable servings and fruit-and-vegetable servings combined. To increase fruit and vegetable intake among African American men living with HIV, interventions should be tailored to address the perceived benefits of consumption.
Psychology of Men and Masculinity, Oct 1, 2021
Journal of Racial and Ethnic Health Disparities, 2022
Little is known about the predictors of blood pressure (BP) among African American men living wit... more Little is known about the predictors of blood pressure (BP) among African American men living with HIV. We examined whether age and body mass index (BMI) are associated with higher blood pressure (BP) and whether being married and muscular endurance are associated with lower BP among African American men living with HIV. Second, we examined whether being married moderated the effects of the other predictors on BP. Finally, we examined whether BMI mediated the relationship between muscular endurance and BP. This article is a prospective secondary analysis of data from a randomized controlled trial of a health-promotion intervention for African American men living with HIV. We measured the participants’ BP pre-intervention and three, six, and 12 months post-intervention. Generalized estimating equations linear regression analyses examined whether marital status, age, BMI, and muscular endurance predicted BP post-intervention, adjusting for pre-intervention BP and the intervention. Older age, higher BMI, and lower muscular endurance predicted higher BP post-intervention, adjusting for the intervention and baseline BP. Although marital status did not predict post-intervention BP, it moderated the negative effect of higher BMI. The positive relation of BMI to BP was weaker among married men than unmarried men. Muscular endurance had an indirect impact on BP mediated through BMI. Public health efforts targeting older African American men with HIV should focus on increasing muscular endurance in this population to lower BMI as a strategy to reduce cardiovascular disease risk in this population.
AIDS Patient Care and STDs, 2021
HIV and its treatment with antiretroviral therapy increase the risk of noncommunicable diseases (... more HIV and its treatment with antiretroviral therapy increase the risk of noncommunicable diseases (NCDs) tied to physical inactivity. Older African American men are also at high risk for NCDs. We tested the efficacy of a theory-based intervention to increase adherence to federal aerobic and muscle-strengthening physical activity (PA) guidelines among African American men aged 40 years and older living with HIV. We randomized African American men aged 40 years and older living with HIV to a three-session social cognitive theory-informed health promotion intervention targeting PA or a one-session health awareness control condition. The primary outcome was PA guideline adherence assessed (self-reported) preintervention, immediate postintervention, and 3, 6, and 12 months postintervention. Secondary outcomes were the number of days on which participants reported moderate-intensity aerobic PA, vigorous-intensity aerobic PA, and muscle-strengthening PA in the past 7 days. Of 302 participants, 255 completed the 12-month postintervention measures. Generalized estimated equation logistic regression indicated that the health promotion intervention participants had higher odds of meeting PA guidelines than health awareness control participants, adjusting for baseline adherence (p = 0.011). Health promotion intervention participants also reported more muscle-strengthening PA (p = 0.001), vigorous-intensity aerobic PA (p = 0.049), and moderate-intensity aerobic PA (p = 0.010) than control participants. The rise in selfreported adherence to PA guidelines and improvements in muscle-strengthening and aerobic PA considered separately suggest that a relatively brief behavioral intervention can increase PA among African American men aged 40 years and older living with HIV and potentially curb their risk of NCDs that PA can prevent.
Journal of the Association of Nurses in AIDS Care, 2020
Physical activity (PA) is associated with a reduced incidence of chronic diseases. However, littl... more Physical activity (PA) is associated with a reduced incidence of chronic diseases. However, little is known about the predictors of PA among African American men living with HIV. We report secondary analyses examining the strength of the relationships between the reasoned action approach constructs, attitude, subjective norm, descriptive norm, and self-efficacy and intention to exercise and self-reported adherence to Department of Health and Human Services PA guidelines using baseline data from a trial of a PA intervention with 302 African American men, between 40 and 88 years of age (M = 53.9; SD = 7.2) living with HIV. Multiple regression revealed that attitude, subjective norm, and self-efficacy were positively associated with intention. Logistic regression revealed higher odds of meeting PA guidelines as self-efficacy increased. Self-efficacy and descriptive norm predicted meeting the aerobic guideline. Self-efficacy predicted meeting the muscle-strengthening guideline. Interventions targeting reasoned action approach variables may contribute to efforts to improve PA among African American men living with HIV.
Archives of Sexual Behavior, 2018
Studies show that having sex with multiple partners increases the risk of acquiring and transmitt... more Studies show that having sex with multiple partners increases the risk of acquiring and transmitting sexually transmitted diseases, including HIV. The present article reports prospective predictors of having multiple sexual partners among 505 African American men in Philadelphia who have sex with men (MSM) who participated in an intervention trial and attended a 6-month follow-up. Participants completed audio computer-assisted surveys of demographics, sexual behavior, and Reasoned Action Approach and Social Cognitive Theory mediators concerning multiple partners. We analyzed the incidence of selfreported multiple partners at the 6-month follow-up, controlling for treatment condition and baseline levels of the theoretical variables. The odds of having multiple partners decreased with increasing age (p < .03). Participants who said they were HIV positive had lower odds of having multiple partners (p < .009). The more pride participants reported in their identities as black or African American men, the lower the odds that they reported having multiple partners (p < .02). Adverse outcome expectancies accruing to multiple partners fully mediated the effect of black pride and partially mediated the effects of age on the odds of having multiple partners. Modifiable factors such as perceived negative outcome expectancies regarding having multiple sex partners should be addressed in designing interventions and prevention programs with the goal of decreasing the number of sexual partners among African American MSM.
Journal of Homosexuality, 2018
The goal of this study is to examine the relations between histories of three types of sexual ori... more The goal of this study is to examine the relations between histories of three types of sexual orientation victimization (childhood, personal, and institutional) and HIV sexual risk behavior among Black South African men who have sex with men (MSM). Secondarily, this study examines whether marijuana use and problem drinking mediate the relations. Participants were 125 Black MSM recruited from neighborhoods in Eastern Cape Province, South Africa. Questionnaires administered through audio computerized self-interviewing assessed sexual orientation victimizations, problem drinking and marijuana use, and unprotected anal sex with casual partners. Data were analyzed using multiple regression and multiple mediation modeling. Personal and institutional sexual victimizations were associated with condomless anal sex. Childhood sexual orientation victimization was positively associated with problem drinking. Neither problem drinking nor marijuana use mediated the relations between sexual orientation victimizations and having condomless anal sex with casual partners.
AIDS and Behavior
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Papers by John B. Jemmott III