For psychologist Angela Heads, prevention is the best intervention. Her health disparities research focuses on how to prevent people from engaging in risky health behaviors in an attempt to mitigate health gaps between populations. Heads’ recent research on HIV risk on college campuses calls for a deeper examination of the interplay of ethnic identity and the risk of HIV contraction among college students.
Could you share a summary of your most recent research?
I was funded by Substance Abuse and Mental Health Services Administration to provide HIV prevention services and interventions at a historically black university (HBCU) in Texas. Our goal was to identify any factors that prevented HIV or STD contraction. Going in, we knew that the risk factors for HIV included substance use and unprotected sex, so we looked at binge drinking, marijuana use, and sex without a condom. Since we were looking for protective factors, we also gauged the students’ knowledge of the risks of contracting HIV.
Our findings indicate that students understand the risks of HIV—half of the students reported being worried that they could contract HIV. Sixty-one percent of students believed that they risked harming themselves by using marijuana once or twice a week and about 84% reported that they believed people risk harming themselves by having five or more drinks once or twice a week. Despite awareness of these risks, 41% of the sample reported engaging in unprotected sex, about 38% reported that they participated in binge drinking, and 37% reported they had used marijuana in the month prior to the survey.
We also gave them a quiz about HIV and more than half of them were able to answer 65% or more of the questions correctly. Even so, there were some concerning misconceptions about HIV risk. For example, most students thought that if they had sex one week and took a test for HIV the next week, they would know if they had been infected. Overall, they understood the risks involved with their behaviors, but this knowledge did not reduce their risk behaviors. So there is a disconnect between what students know and what they do.
Another group of colleagues and I conducted a similar study looking at African Americans at colleges across the U.S., focusing on ethnic identity as a protective factor against sexual risk behaviors and substance use. We measured ethnic identity using an instrument that defines ethnic identity as the degree to which an individual feels a sense of belonging and identity with an ethnic group, whether the individual is engaged with the customs and activities of the ethnic group, and the degree to which they hold members of their ethnic group in positive regard. We wanted to carefully choose an instrument that would accurately measure ethnic identity and look at all the dimensions of ethnic identity, rather than a unidimensional construct. We found that affirmation, belonging, and commitment to ethnic identity predicted lower alcohol and other substance use.
What motivates you to do the work that you do?
For me, it’s not enough to know that things happen, but I want to know why—I need to know why.
My research is broadly focused on health disparities. There’s a long history in research of studying the majority group. Historically that has been White men and, unfortunately, has resulted in a “one size fits all approach” to treatments in medicine and behavioral health. We now know that all treatments aren’t equally effective for everybody. So it is important to move towards an understanding of individual differences in an attempt to improve treatment engagement and outcomes. Each semester, I speak with interns, students, and clinical staff about adapting the ways we evaluate and treat—with a goal of being more culturally competent in our practices. I believe that if the people we work with think we don’t understand them, then they may be less likely to engage in treatment or follow through with their treatment. When I do research that examines racial and ethnic identity it provides information that helps us understand what works with all types of people.
For example, although new HIV infection rates have declined in recent years due to better information, increased use of condoms, and the availability of biomedical prevention like Pre-exposure prophylaxis (PrEP), new HIV infection rates are not declining in college age groups at the same rate as the overall population. African Americans still have eight times the new infection rate and Hispanic/Latinx Americans have three times the new infection rate for HIV when compared to White Americans. To me, this is evidence that certain groups do not have the same access to interventions, the interventions do not work the same way for all people, or for some other reason the opportunities to improve outcomes are not equally available or effective for all. This is what propels me to continue my research and clinical work—to decrease these disparities.
What do you intend to do with the research? To what uses do you aim for it to be applied?
I’m a psychologist, and I am involved in clinical practice. My hope is that these studies can inform the interventions we use with clients. I believe prevention is the best intervention, which is why I’m also interested in adolescent and young adult populations, who are the focus of my current project funded by RWJF. If we have the tools to prevent adolescents and young adults from engaging in these risky behaviors earlier, we can reduce health and social problems later in life.
My hope is that educators and clinicians will look at this research and think about ways that we can prevent future problems through prevention and early-intervention.
It’s important for fellow researchers to consider this type of work, too. We examined ethnic identity in substance use and risky sexual behavior studies but found different protective factors. There are similar conflicting findings in other research. This means researchers know there’s something about ethnic identity that can be protective, but more work needs to be done to understand this, so we can move forward with developing culturally adapted evidence-based interventions.