Quality of Research
Review Date: December 2010
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Meade, C. S., Drabkin, A. S., Hansen, N. B., Wilson, P. A., Kochman, A., & Sikkema, K. J. (2010). Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories. Addiction, 105(11), 1942-1951. 
Sikkema, K. J., Hansen, N. B., Kochman, A., Tarakeshwar, N., Neufeld, S., Meade, C. S., et al. (2007). Outcomes from a group intervention for coping with HIV/AIDS and childhood sexual abuse: Reductions in traumatic stress. AIDS and Behavior, 11(1), 49-60.
Sikkema, K. J., Wilson, P. A., Hansen, N. B., Kochman, A., Neufeld, S., Ghebremichael, M. S., et al. (2008). Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. Journal of Acquired Immune Deficiency Syndromes, 47(4), 506-513.
Sikkema, K. J., Wilson, P. A., Hansen, N. B., Kochman, A., Neufeld, S., Ghebremichael, M. S., et al. (2010). Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse: Erratum. Journal of Acquired Immune Deficiency Syndromes, 55(2), 286.
Supplementary Materials Gribble, J. N., Miller, H. G., Rogers, S. M., & Turner, C. F. (1999). Interview mode and measurement of sexual behaviors: Methodological issues. Journal of Sex Research, 36(1), 16-24.
Hansen, N., Kershaw, T., Kochman, A., & Sikkema, K. (2007). A classification and regression trees analysis predicting treatment outcome following a group intervention randomized controlled trial for HIV-positive adult survivors of childhood sexual abuse. Psychotherapy Research, 17(4), 404-415.
Harrison, L. D., Martin, S. S., Enev, T., & Harrington, D. (2007). Highlights. In Comparing drug testing and self-report of drug use among youths and young adults in the general population (pp. 1-4, DHHS Publication No. SMA 07-4249, Methodology Series M-7). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.
Schrimshaw, E. W., Rosario, M., Meyer-Bahlburg, H. F. L., & Scharf-Matlick, A. A. (2006). Test-retest reliability of self-reported sexual behavior, sexual orientation, and psychosexual milestones among gay, lesbian, and bisexual youths. Archives of Sexual Behavior, 35(2), 225-234.
Sikkema, K. J., Hansen, N. B., Meade, C. S., Kochman, A., & Fox, A. M. (2009). Psychosocial predictors of sexual HIV transmission risk behavior among HIV-positive adults with a sexual abuse history in childhood. Archives of Sexual Behavior, 38(1), 121-134.
Sundin, E. C., & Horowitz, M. J. (2002). Impact of Event Scale: Psychometric properties. British Journal of Psychiatry, 180, 205-209.
Outcomes
| Outcome 1: Traumatic stress symptoms |
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Description of Measures
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Traumatic stress symptoms were assessed using the Impact of Event Scale (IES), a 15-item self-report scale that measures the frequency and severity of distress associated with a specific life event. The IES measures both the intrusion and avoidance of certain ideas, feelings, and situations associated with the trauma. Each item presents a symptom that is measured for the prior 7-day period on a 4-point scale (0, 1, 3, and 5) that ranges from "not at all" to "often." The Intrusion subscale includes items such as "I thought about it when I didn't mean to" and "I had waves of strong feelings about it." The Avoidance subscale includes items such as "I stayed away from reminders of it" and "I tried not to think about it." Participants rated symptoms with reference to their traumatic childhood sexual experiences. The instrument was administered using a computer-assisted personal interview.
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Key Findings
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In a randomized clinical trial, HIV-positive clients with a history of childhood sexual abuse were assigned to one of three conditions: LIFT, 15 weekly 90-minute sessions of an HIV support group, or a wait-list control. Traumatic stress symptoms were assessed at pretest and within 2 weeks posttreatment (posttest). Findings included the following:
- From pre- to posttest, LIFT participants had a decrease in the frequency and severity of intrusion symptoms compared with control group participants (p = .007). This difference was associated with a small effect size (Cohen's d = 0.49). Change in intrusion symptoms from pre- to posttest did not differ between HIV support group and control group participants.
- From pre- to posttest, both LIFT and HIV support group participants had a decrease in the frequency and severity of intrusion symptoms (p = .001 for each group) and avoidance symptoms (p = .004 for each group). However, the improvement in avoidance symptoms was larger for LIFT than HIV support group participants (p = .026).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 2: HIV sexual risk behaviors |
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Description of Measures
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HIV sexual risk behaviors were evaluated using an adapted version of the Sexual Risk Behavior Assessment Schedule, which measures the number of self-reported unprotected sex acts--with all partners and with partners whose HIV serostatus was negative or unknown to the participant--during a prior time period (past 4 months was used at all assessments in this study). An unprotected sex act was defined as any act of insertive or receptive anal or vaginal intercourse in which neither party used a condom. The instrument was administered using a computer-assisted personal interview.
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Key Findings
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In a randomized clinical trial, HIV-positive clients with a history of childhood sexual abuse were assigned to one of three conditions: LIFT, 15 weekly 90-minute sessions of an HIV support group, or a wait-list control (which was randomly assigned to LIFT or the HIV support group after 4 months). Assessments occurred at pretest, within 2 weeks posttreatment (posttest), and at 4-month intervals thereafter through 12 months posttreatment (follow-ups). Findings included the following:
- Across the posttest and follow-up assessments, both LIFT and HIV support group participants had a decrease in the frequency of unprotected sex with all partners (p = .02 for each group) and with partners who were HIV-negative or of unknown serostatus (p < .001 for each group).
- LIFT participants had a greater decrease in the frequency of unprotected sex with all partners compared with HIV support group participants at the 4-, 8-, and 12-month follow-ups (p < .001). These group differences were associated with small effect sizes (Cohen's d = 0.43, 0.41, and 0.48, respectively).
- LIFT participants also had a greater decrease in the frequency of unprotected sex with partners who were HIV-negative or of unknown serostatus compared with HIV support group participants at the 4-, 8-, and 12-month follow-ups (p < .001). These group differences were associated with small effect sizes at the 4- and 8-month follow-ups (Cohen's d = 0.48 and 0.39, respectively) and a very small effect size at the 12-month follow-up (Cohen's d = 0.04).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.2
(0.0-4.0 scale)
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| Outcome 3: Substance use |
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Description of Measures
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Substance use was measured using items from the 2000 National Survey on Drug Use and Health. The frequency of past-month use of alcohol, cocaine (powder or crack), and marijuana was reported using the following rating scale: 0 = none, 1 = 1-2 days, 2 = 3-5 days, 3 = 6-10 days, 4 = 11-20 days, 5 = 21-28 days, and 6 = every day. For cocaine and marijuana, a dichotomous variable for any use (1) versus no use (0) was created. For alcohol, the number of drinks typically consumed on drinking days was reported using the following rating scale: 0 = none, 1 = one or fewer, 2 = two to three, 3 = four to five, and 4 = six or more. An estimate of past-month drinking quantity (i.e., number of drinks consumed in the month) was calculated by multiplying drinking frequency by number of drinks per drinking day. The instrument was administered using a computer-assisted personal interview.
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Key Findings
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In a randomized clinical trial, HIV-positive clients with a history of childhood sexual abuse were assigned to one of three conditions: LIFT, 15 weekly 90-minute sessions of an HIV support group, or a wait-list control (which was randomly assigned to LIFT or the HIV support group after 4 months). Assessments occurred at pretest, within 2 weeks posttreatment (posttest), and at 4-month intervals thereafter through 12 months posttreatment (follow-ups). Findings included the following:
- From pretest to the 12-month follow-up, both LIFT and HIV support group participants had a decrease in past-month drinking quantity (p = .03 for each group), with LIFT participants having greater improvement (a decrease of 5.1 vs. 1.6 drinks per month for LIFT and HIV support group participants, respectively; p = .029).
- Across the posttest and follow-up assessments, both LIFT and HIV support group participants had decreases in any cocaine use (p = .001 for each group) and the frequency of cocaine use (p = .006 for each group). LIFT participants had greater improvement than HIV support group participants in any cocaine use over time (p = .044), such that fewer LIFT than support group participants reported any cocaine use at posttest (14% vs. 27%) and at the 12-month follow-up (11% vs. 24%).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.2
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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26-55 (Adult)
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52.6% Female
47.4% Male
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68% Black or African American
17% Hispanic or Latino
10% White
5% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Traumatic stress symptoms
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3.5
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3.5
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3.5
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3.0
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3.0
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3.5
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3.3
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2: HIV sexual risk behaviors
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3.0
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3.0
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3.5
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3.0
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3.0
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3.5
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3.2
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3: Substance use
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3.0
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3.5
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3.5
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3.0
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2.5
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3.5
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3.2
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Study Strengths Self-report instruments with strong psychometric properties served as the basis for the outcome measures. Prior research has documented the reliability of computer-assisted interviews for reporting behaviors of a sensitive nature. Implementation fidelity was strong overall in this study; systematic training was conducted using an intervention manual, and an adherence instrument was used to document that intervention delivery followed the manual. The study design included random assignment to conditions. Data analysis involved an intent-to-treat statistical approach with sophisticated data modeling that used all data collected from each participant and controlled for the correlation of repeated assessments over time on the same individual.
Study Weaknesses Sample reliability and validity data for the HIV sexual risk behavior measure were not provided despite an adaptation of the original instrument. Exposure to the intervention was variable, and no fidelity instrument with established reliability and validity was identified. Attrition of intervention participants steadily increased across follow-ups, with the attrition rate being moderate (35%) at the 12-month follow-up. Statistical modeling of potential confounding variables was limited because of the diversity in the recruited sample relative to sample size and a severe skew in the percentage of participants (49%) reporting at pretest that they had not used substances in the previous 4 months.
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