Question Details

(solution) Selecting statistical measures can be challenging because each

Selecting statistical measures can be challenging because each situation may be different. As you review your learning resources this week, you will become familiar with several statistical measures such as measures of central location, variability, standard deviation, box plots and much more.

For this Assignment, revisit the journal article below. 

Gilbert, L., et al. (2016). Efficacy of a Computerized Intervention on HIV and Intimate Partner Violence Among Substance-Using Women in Community Corrections: A Randomized Controlled Trial. AmJ Public Health, 106: 1278?1286. doi:10.2105/AJPH.2016.303119

The Assignment (1?2 pages)

  • Summarize the major results of the study
  • Describe the information presented in tables and/or graphs 
  • Briefly summarize the major conclusions of the study

AJPH RESEARCH Ef?cacy of a Computerized Intervention on HIV and


Intimate Partner Violence Among Substance-Using


Women in Community Corrections: A Randomized


Controlled Trial


Louisa Gilbert, PhD, Dawn Goddard-Eckrich, MS, Timothy Hunt, MS, Xin Ma, MS, Mingway Chang, PhD, Jessica Rowe, MDes, Tara McCrimmon,


MPH, Karen Johnson, PhD, Sharun Goodwin, BS, Maria Almonte, MSW, and Stacey A. Shaw, PhD


Objectives. To test the ef?cacy of a computerized, group-based HIV and intimate


partner violence (IPV) intervention on reducing IPV victimization among substance-using


women mandated to community corrections.


Methods. Between November 2009 and January 2012, we randomly allocated 306


women from community corrections in New York City to 3 study arms of a computerized


HIV and IPV prevention trial: (1) 4 group sessions intervention with computerized


self-paced IPV prevention modules (Computerized Women on the Road to Health


[WORTH]), (2) traditional HIV and IPV prevention intervention group covering the same


HIV and IPV content as Computerized WORTH without computers (Traditional WORTH),


and (3) a Wellness Promotion control group. Primary outcomes were physical, injurious,


and sexual IPV victimization in the previous 6 months at 12-month follow-up.


Results. Computerized WORTH participants reported signi?cantly lower risk of


physical IPV victimization, severe injurious IPV victimization, and severe sexual IPV victimization at 12-month follow-up when compared with control participants. No significant differences were seen between Traditional WORTH and control participants for any


IPV outcomes.


Conclusions. The ef?cacy of Computerized WORTH across multiple IPV outcomes


highlights the promise of integrating computerized, self-paced IPV prevention modules


in HIV prevention groups. (Am J Public Health. 2016;106:1278?1286. doi:10.2105/


AJPH.2016.303119) T he intersecting epidemics of intimate


partner violence (IPV) victimization and


HIV are heavily concentrated among women


who use drugs or alcohol (herein de?ned


as substance-using women) in community


corrections (i.e., probation, parole, drug


treatment courts, community courts, and


alternative-to-incarceration programs).1?4


Rates of experiencing physical or sexual IPV


in the past year range between 32% and 56%


for substance-using women on probation


and are 2 to 5 times higher than rates found


among nationally representative samples of


women.5 Additionally, HIV prevalence


rates among substance-using women mandated to community corrections in New


York City range from 13% to 17%, which are 1278 Research Peer Reviewed Gilbert et al. comparable to rates found among women in


sub-Saharan Africa.6,7 Despite the elevated


rates of IPV victimization, HIV, and other


sexually transmitted infections (STIs) among


this population of women, as well as accumulating research linking IPV victimization


to HIV and STIs,4,8 HIV prevention interventions that integrate IPV prevention among substance-using women remain scarce


in community corrections settings.


Currently, about 1 million women are


on probation, parole, or other types of


community corrections nationwide, 70%


of whom have a history of drug use.9,10


Community corrections settings represent


an untapped venue to reach numerous


dif?cult-to-reach substance-using women


who are at risk for both IPV victimization


and HIV. Growing research has documented multiple ?entwined and mutually


enhancing? biological and behavioral


mechanisms linking substance abuse, violence, and AIDS (SAVA) that are fueled by


social and economic inequities, which has


been conceptualized as the SAVA


syndemic.4,11?13 Substance-using women


in community corrections have been disproportionately affected by the SAVA


syndemic, because they often live in


low-income urban communities that have


concentrated HIV epidemics and high rates


of violence and incarceration. Incarceration disrupts intimate relationships and


pushes households into poverty, increasing


the likelihood of women having multiple


sex partners and engaging in survival


sex.14,15 Substance-using women in


community corrections also are more


likely to experience sexual assault, further ABOUT THE AUTHORS


Louisa Gilbert, Dawn Goddard-Eckrich, Timothy Hunt, Xin Ma, Mingway Chang, Tara McCrimmon, Karen Johnson, and


Stacey A. Shaw are with Social Intervention Group, Columbia University, New York, NY. Jessica Rowe is with Columbia


Center for New Media Teaching and Learning, New York, NY. Sharun Goodwin is with The New York City Department


of Probation, New York, NY. Maria Almonte is with Bronx Community Solutions, Center for Court Innovation, Bronx, NY.


Correspondence should be sent to Louisa Gilbert, PhD, Social Intervention Group, Columbia University School of Social


Work, 1255 Amsterdam Ave, Room 832, New York, NY 10027 (e-mail: [email protected]). Reprints can be ordered at by clicking the ?Reprints? link.


This article was accepted February 4, 2016.


doi: 10.2105/AJPH.2016.303119 AJPH July 2016, Vol 106, No. 7 AJPH RESEARCH increasing their risk for HIV. 16 Despite the


large and growing population of women in


community corrections programs in the


United States affected by the SAVA syndemic, a recent systematic review identi?ed only 4 interventions that reduced HIV


risk behaviors for women in community


corrections and none that reduced physical


or sexual IPV. 16


A recent meta-analysis identi?ed sexual


IPV as an independent risk factor for HIV


infection among women.17 Biologically, the


risk of HIV acquisition increases during


forced sex with HIV-positive partners as


a result of vaginal and anal lacerations and an


altered stress response from the immune


system.18 Multiple structural, biological, and


behavioral syndemic mechanisms link IPV


victimization to substance misuse and a wide


range of HIV transmission risks.4,12 Strong


bidirectional associations have been


established between use of different drugs


and alcohol and all types of IPV victimization


among women, including sexual IPV.19,20


Among substance-using women, IPV victimization not only has been found to increase the likelihood of sharing injection


drug equipment,21 having multiple sexual


partners,8 exchanging sex for money or


drugs,15 acquiring STIs,8 and not using


condoms8 but also is associated with not


getting tested for HIV, not accessing HIV


care, not adhering to antiretroviral medication, and failing to achieve viral load


suppression.12,22 Taken together, this research underscores the need for integrated


behavioral HIV and IPV prevention interventions that can ef?ciently target the


unique syndemic risks among


substance-using women.


A small but growing body of research


indicates that integrated behavioral IPV and


HIV interventions are ef?cacious in reducing sexual HIV risks among women at risk


for experiencing IPV.4,23 Although the IPV


prevention content in these HIV interventions has ranged in type, intensity, and


modality, common components include


raising awareness of IPV, screening for IPV,


safety planning, identifying IPV service


needs and referrals, and increasing sexual


negotiation skills.4 A recent systematic review of 44 best-evidence US-based HIV


prevention interventions identi?ed by the


Centers for Disease Control and July 2016, Vol 106, No. 7 AJPH Prevention23 ascertained 5 HIV interventions that addressed IPV and reduced 1


or more HIV risks. To our knowledge,


however, only 2 integrated interventions


have been found to be ef?cacious in reducing


IPV among women.24,25 To date, no integrated interventions have emerged that


have shown ef?cacy in reducing the syndemic risk of sexual IPV (i.e., forced sex by


an intimate partner) among substance-using




Emerging literature suggests the promise


of brief computerized self-paced IPV prevention intervention tools that may be


integrated in HIV interventions for


substance-using women.4 Compared with


human-delivered interventions, computerized self-paced IPV prevention interventions have been found to be more


effective in identifying and addressing IPV


among women in health care settings.26


Integrating computerized self-paced IPV


prevention modules into group-based HIV


interventions may have several advantages


in addressing IPV among substance-using


women over the traditional group format,


including a greater likelihood of ensuring


that all group members will complete IPV


prevention activities, resulting in higher


?delity and precision of implementation. A


computerized self-paced module also may


ensure greater con?dentiality and privacy


among substance-using women who may


fear legal or social consequences from disclosing IPV in a group setting.26 To our


knowledge, however, no integrated HIV


and IPV prevention interventions have used


computerized self-paced IPV prevention


modules among substance-using women or


women in general.


This study addressed a critical gap in


HIV and IPV prevention research by testing


the ef?cacy of a group-based computerized


HIV and IPV prevention intervention


(WORTH?Women on the Road to


Health) in reducing the risk of IPV victimization among substance-using women in


community corrections. A recent publication


from this randomized controlled trial


found that WORTH, whether delivered in


a format with computerized self-paced and


interactive group modules (Computerized


WORTH) or in a traditional group format


(Traditional WORTH), was ef?cacious in


decreasing the number of unprotected sexual acts over the 12-month follow-up period,


which was the primary outcome of this


randomized controlled trial, compared with


a Wellness Promotion attentional control


group among 306 substance-using women in


community corrections.7 The primary aim of


this study was to examine whether Computerized WORTH was more ef?cacious in


reducing the risk of different types of IPV


victimization at the 12-month follow-up,


which was a secondary outcome of this


randomized controlled trial, when compared


with the Wellness Promotion control condition. We also examined whether Traditional WORTH was more ef?cacious


than Wellness Promotion in reducing risk


of IPV victimization at the 12-month


follow-up. METHODS


This randomized controlled trial was


conducted in New York City between


November 2009 and January 2012. We


have described detailed methods, sample


characteristics, and sample power


calculations elsewhere7 and included


the CONSORT study ?ow diagram


in Figure A (available as a supplement


to the online version of this article at Recruitment and Eligibility


Research assistants actively recruited and


screened 1104 women from multiple community corrections sites by handing out


?yers and inviting women to be screened.


Of the 1104 women, 306 were eligible


and were enrolled in the study. Eligible


women reported




d d d d being aged 18 years or older;


being mandated to community corrections


(i.e., probation, parole, community court,


drug treatment court, or an alternative-toincarceration program) in the past 90 days;


using illicit drugs, binge drinking, or attending a substance abuse treatment program in the past 90 days;


engaging in unprotected vaginal or anal


intercourse within the past 90 days; and


having at least 1 other HIV risk factor. Gilbert et al. Peer Reviewed Research 1279 AJPH RESEARCH We conducted repeated assessments at 3-,


6-, and 12-month postintervention followups at a centrally located community research


of?ce, but IPV outcomes were assessed only at


6- and 12-month follow-ups. Participants


were reimbursed for completing assessments


and intervention sessions up to a maximum of


$265. More details on participant recruitment


and retention are described in a previous


publication.7 Randomization and Masking


A study investigator randomly assigned


groups of 4 to 9 women to 1 of 3 study


conditions; a computer-generated randomization algorithm was designed to balance


the number of women per study arm via


an adaptive, biased-coin procedure.27 A


total of 103 participants were assigned


to Computerized WORTH, 101 to Traditional WORTH, and 102 to Wellness




Investigators were masked to treatment


assignment until the ?nal 12-month followup assessment was completed in April 2013.


Data were locked in September 2013, after


which study arms were unmasked. Intervention and Control




Traditional WORTH, consisting of


a 4-session group HIV and IPV prevention


intervention, is an evidence-based HIV intervention that was originally tested with


women in jail28 and in drug treatment.29 For


this study, we made minor modi?cations to


WORTH to make it more contextually


relevant for substance-using women in


community corrections, such as addressing


criminal justice?related triggers for unsafe sex


and IPV (e.g., resisting drug use with a partner


being released from prison).28,29 The intervention was informed by social cognitive


learning theory, which focuses on observation, modeling, and skill rehearsal through


role play and feedback from group members.30 Empowerment theory also guided


a strengths-based approach of WORTH to


build collective ef?cacy of women to negotiate safe relationships and counter stigma


that they face as women in community




Interventions were conducted at a community research site. A detailed description 1280 Research Peer Reviewed Gilbert et al. of IPV prevention content in Traditional


and Computerized WORTH is provided in


the box on the next page.7 IPV-related


components included risk reduction


problem-solving and negotiation skills,


awareness-raising of IPV, IPV triggers for


unsafe sex and drug use, IPV screening and


feedback, safety planning, social support to


increase safety, identi?cation of service needs


and linkage to services, and IPV prevention


goal setting.32 For Traditional WORTH, all


components, including IPV prevention activities, were conducted in a group setting.


Two facilitators led group activities face-toface once per week, with sessions lasting


from 90 to 120 minutes.


Computerized WORTH also consisted of


4 weekly group sessions lasting 90 to


120 minutes, led by 2 facilitators. Computerized


WORTH covered the same core components as Traditional WORTH, while


employing group and individual interactive


computerized games, video enhancements,


and visual tools.32 During each session, participants used individual laptops to independently view video vignettes of 4


?ctional role models to promote identi?cation and emotional engagement. Computerized self-paced modules covered the same


IPV screening, prevention, and service referral activities that were conducted in the


Traditional WORTH arm. Some activities


(e.g., safety plan and IPV service referrals)


were recorded in an electronic log that was


printed for participants.


The Wellness Promotion control arm also


consisted of 4 weekly group sessions lasting


between 90 and 120 minutes, designed to


control for modality and dosage. Core


components of this psychoeducational intervention were adapted from an evidencebased wellness promotion intervention33 and


included maintaining a healthy diet, promoting ?tness in daily routines, addressing


tobacco use, learning stress-reduction exercises including guided meditation, and setting


and achieving personal health goals.33


None of the Wellness Promotion activities


focused on IPV prevention. Measures


IPV victimization outcomes. The primary


outcomes for this study focused on different


types of IPV victimization in the past 6 months. These outcomes were assessed at


baseline, 6-month follow-up, and 12-month


follow-up with a shortened 8-item version of


the Revised Con?ict Tactics Scale,34 which


includes 3 subscales measuring any sexual,


physical, and injurious IPV within the past


6 months (responses were dichotomized as


yes or no). These subscales contained items


that assessed minor or severe IPV by type of


IPV. Internal consistency of the Revised


Con?ict Tactics Scale subscales ranges between 0.79 and 0.95.35


Sociodemographic variables. Participants


self-reported sociodemographic characteristics including gender, age, ethnicity, marital


status, years of education, employment,


monthly income, homelessness, the types of


community corrections settings where they


had enrolled in the past 90 days, and the


number of times they had been arrested or


incarcerated in jail or prison.


Current and past substance use. We used the


Risk Behavior Assessment36 to assess use


of illicit drugs ever and within the past


90 days. To assess binge drinking, we asked


whether participants consumed 4 or more


alcoholic drinks within a 6-hour period.37 Analysis Plan


Consistent with the intent-to-treat approach, we estimated intervention effects


by analyzing participant responses based on


their experimental assignment. Because


some missing data were the result of loss to


follow-up at postintervention assessments, we


used all available data at any follow-up visit


in the statistical models. The 87% or higher


retention rate at each follow-up did not


differ signi?cantly by condition. Attrition


analyses, which compared sociodemographic


characteristics of those who completed all


follow-up assessments (completers) with


those who missed 1 or more follow-up assessments (noncompleters), identi?ed that


completers on average were older (42 vs


39 years) and less likely to report homelessness


(8% vs 18%). We estimated that with a sample


of 112 women per arm, the study would


have 80% statistical power, assuming an a


level of .05, 2-sided hypothesis testing, no


covariance adjustment, and intraclass correlations of 0.05 for the primary study outcomes






Aim of WORTH Activity Traditional WORTH Activity Enhance sexually transmitted infection (STI) Facilitator uses myth or fact statements Computerized WORTH Activity


Participants play interactive game, and HIV knowledge and perceived risk and reading of case studies to transfer watch culturally tailored videos, and respond and identify attitudes toward safer knowledge and correct misperceptions. to questions on a computer screen. sex and condom use.


Identify and avoid unsafe sex


and drug-related risks. In group format, participants discuss triggers,


including fear of IPV and substance use; Participants review potential triggers for


unsafe sex, which include fear of IPV and share experiences; and read a case example substance misuse, and identify own triggers to apply problem solving to reduce risks for unsafe sex or risky drug use on their for unsafe sex. computer (self-paced activity). Using a video


model, the group applies a problem-solving


model to avoid triggers and reduce risks. Practice sexual negotiation, sexual safety


planning, and problem-solving skills. Facilitator discusses steps of negotiating Video scenarios model sexual negotiation condom use, reads a case example, skills and sexual safety planning to and facilitates role play. avoid risky sexual encounters. Group


identi?es steps in negotiation and engages


in role-play practice. Improve linkage to services and promote


HIV testing and care. Reduce IPV and enhance supportive network. Facilitator reviews HIV testing options, Computerized demonstration of HIV testing provides resource manual, encourages and exposure window assessment assists participants to identify psychosocial needs, in prioritizing psychosocial needs and links and uses manual to contact organizations to to Web-based information to access community address HIV, IPV, and other services, facilitating services (self-paced activity). Facilitators can group discussion about barriers to service access. access logs and assist in addressing barriers to


accessing services for HIV, IPV, and other issues. Facilitator raises awareness about different Participants use a video and audio tool to learn types of IPV and supports the completion about different types of IPV, con?dentially of individual IPV assessment and safety planning identify IPV risks, provide feedback on IPV to reduce IPV risks. Participants are asked to risks, and develop a safety plan to reduce identify sources of social support and service IPV risks (self-paced activity). Computerized, referrals that may reduce their IPV risks. interactive tool helps women to identify


sources of social support and IPV services that


may help them reduce their IPV risks


(self-paced activity). We used logistic regression models with


random effects to evaluate the effects of the


intervention arms on IPV victimization in


the past 6 months at each follow-up. All


random-effects regression models included


the dummy codes for intervention and


modality effects and the baseline measure


of the outcome of interest to estimate the


effects for the follow-up period; we added


the follow-up assessment time (in months)


and interaction terms between time and


dummy codes to yield the effects for each


follow-up assessment. We grouped


membership and repeated measures of


a participant at each time point. We used July 2016, Vol 106, No. 7 AJPH a bootstrapping strategy that calculates


estimates? SEs and P values to compensate


for multiple comparisons. 38 The data were


resampled 2000 times for each regression


model. We used SAS version 9.3 (SAS


Institute, Cary, NC) for all analyses. We


reported odds ratios (ORs) and 95% con?dence intervals (CIs) for these effects. RESULTS


Sociodemographic, substance use,


HIV, and lifetime IPV victimization characteristics of participants are reported in Table 1. The mean age of participants


was 41.5 (SD = 10.5). A total of 208 participants (68%) identi?ed as Black or


African American, and 47 (15.4%) identi?ed


as Latina. Two thirds (n = 202; 66.0%)


were single and never married. Only 25


women (8.2%) were employed, and 278


(90.8%) had ever been in prison or jail. Of


the women, 194 (63.4%) reported using


illicit drugs in the past 90 days. About one


quarter (n = 81; 26.5%) tested positive for an


STI, and 43 (14.1%) tested positive for HIV.


We did not ?nd signi?cant differences in


any of the characteristics by study condition


(Table 1). Gilbert et al. Peer Reviewed Research 1281 AJPH RESEARCH TABLE 1?Background Characteristics and Intimate Partner Violence (IPV) Prevalence, by Study Arm: New York City, 2009?2012


Total (n = 306),


Mean 6SD or No. (%) Wellness (n = 102),


Mean 6SD or No. (%) Traditional (n = 101),


Mean 6SD or No. (%) Computerized (n = 103),


Mean 6SD or No. (%) 41.5 610.5 42.1 69.7 41.9 610.8 40.5 610.9 Black 208 (68.0) 68 (66.7) 67 (66.3) 73 (70.9) Latina 47 (15.4) 15 (14.7) 17 (16.8) 15 (14.6) Other 51 (16.7) 19 (18.6) 17 (16.8) 15 (14.6) 176 (57.5) 55 (53.9) 66 (65.3) 55 (53.4) 202 (66.0) 66 (64.7) 70 (69.3) 66 (64.1) 49 (16.0)


55 (18.0) 18 (17.6)


18 (17.6) 12 (11.9)


19 (18.8) 19 (18.4)


18 (17.5) 25 (8.2) 9 (8.8) 7 (6.9) 9 (8.7) Age, y


Race/ethnicity High school or general equivalency diploma


Marital status










Homeless, past 90 d 29 (9.5) 9 (8.8) 8 (7.9) 12 (11.7) In inpatient drug treatment facility, past 90 d 63 (20.6) 23 (22.5) 15 (14.9) 25 (24.3) Hospitalized for mental health or health reasons, past 90 d 40 (13.1) 13 (12.7) 9 (8.9) 18 (17.5) Incarcerated in jail or prison, past 90 d 73 (23.9) 22 (21.6) 24 (23.8) 27 (26.2) 278 (90.8) 92 (90.2) 95 (94.1) 91 (88.3) Ever in jail or prison


Community court, past 90 d 70 (22.9) 28 (27.5) 21 (20.8) 21 (20.4) 107 (35.0) 33 (32.4) 34 (33.7) 40 (38.8) On parole, past 90 d 40 (13.1) 19 (18.6) 12 (11.9) 9 (8.7) Drug court, past 90 d 47 (15.4) 13 (12.7) 16 (15.8) 18 (17.5) Alternative-to-incarceration program, past 90 d 23 (7.5) 9 (8.8) 6 (5.9) 8 (7.8) On probation, past 90 d Ever used heroin 65 (21.2) 32 (31.4) 17 (16.8) 16 (15.5) Used heroin, past 90 d 30 (9.8) 18 (17.6) 6 (5.9) 6 (5.8) Ever used crack/cocaine 246 (80.4) 84 (82.4) 81 (80.2) 81 (78.6) Used crack/cocaine, past 90 d 118 (38.6) 46 (45.1) 40 (39.6) 32 (31.1) Ever used marijuana 267 (87.3) 85 (83.3) 90 (89.1) 92 (89.3) Used marijuana, past 90 d 117 (38.2) 36 (35.3) 42 (41.6) 39 (37.9) 69 (22.5) 32 (31.4) 19 (18.8) 18 (17.5) Injected drugs, past 90 d 22 (7.2) 11 (10.8) 5 (5.0) 6 (5.8) Ever used any illicit drug 300 (98.0) 99 (97.1) 99 (98.0) 102 (99.0) Used any illicit drug, past 90 d 194 (63.4) 67 (65.7) 63 (62.4) 64 (62.1) Ever engaged in binge drinking 174 (56.9) 54 (52.9) 64 (63.4) 56 (54.4) 93 (30.4) 25 (24.5) 36 (35.6) 32 (31.1) Ever injected drugs Engaged in binge drinking, past 90 d


HIV positive 43 (14.1) 13 (12.7) 12 (11.9) 18 (17.5) Any sexually transmitted infection 81 (26.5) 29 (28.4) 23 (22.8) 29 (28.2) Ever experienced


Any physical IPV 185 (60.5) 58 (56.9) 66 (65.3) 61 (59.2) Any injurious IPV 177 (57.8) 51 (50.0) 67 (66.3) 59 (57.3) Any sexual IPV 166 (54.2) 54 (52.9) 62 (61.4) 50 (48.5) Severe physical IPV 170 (55.6) 53 (52.0) 62 (61.4) 55 (53.4) Severe injurious IPV 151 (49.3) 44 (43.1) 54 (53.5) 53 (51.5) Severe sexual IPV 117 (38.2) 40 (39.2) 37 (36.6) 40 (38.8) 1282 Research Peer Reviewed Gilbert et al. AJPH July 2016, Vol 106, No. 7 AJPH RESEARCH TABLE...


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