Youth Response to Rape: Rape Myths and Social Support.

Adolescents and young adults face the highest incidence of sexual assault, yet only limited research focuses on the experience of adolescent survivors, adolescent rape myth acceptance, or the ways youth respond to rape. Survivors tend to disclose to at least one person, typically peers, and the response, whether positive or negative, can impact well-being and help-seeking behaviors. Focus groups across Oregon, a leader in state-level comprehensive sexuality education policy, solicited high school-student reactions to an alcohol-involved rape scenario. These rich-case participants had taken comprehensive sexuality education classes and were affiliated with health and sexuality organizations. These youth were anticipated to showcase best possible outcomes resulting from current sexuality education practices. After hearing a hypothetical scenario involving a friend's experience with alcohol-involved sexual assault, participants were asked how they would respond. Participants spontaneously discussed whether the actions described constituted rape, often relying on victim-blaming rape myths as evidence. Alcohol use was a critical factor in interpretations. Female use increased her perceived culpability and male use decreased his. After assessing blame and whether the incident constituted rape, youth described three types of support (informational, instrumental or practical, and emotional support) they would offer as well as barriers when responding to the victim and intentions to hold victims accountable. These responses paint a concerning portrait of the ways youth make sense of sexual violence and consider responding to a friend's disclosure. Sexuality education policy mandates and intervention programs must target the problematic links between alcohol, rape, and rape myths while reinforcing non-victim-blaming support.

Including older rural adults in research: Practical guidance for addressing the NIH Inclusion Across the Lifespan policy.

INTRODUCTION: The NIH Inclusion Across the Lifespan policy has implications for increasing older adult (OA) participation in research. This study aimed to understand influential factors and facilitators to rural OA research participation. METHODS: Thirty-seven rural adults aged ≥66 years participated in focus groups in community centers in four Oregon "non-metro" counties. Transcribed discussions were coded using open-axial coding by an interdisciplinary analytical team. RESULTS: Ages were 66-96 (mean 82.2) years. Majority were women (64%) and white (86%). Primary, interrelated discussion themes were Motivation and Facilitators, Perceptions of Research, and Barriers to Research Participation. Participants were motivated to engage in research because they believed research had implications for improved longevity and quality of life and potentially benefited future generations. Motivational factors influencing participation included self-benefit and improving others' lives, opportunities to socialize and learn about current research, research transparency (funding, time commitment, and requirements), and financial compensation. Perceptions influencing trustworthiness in research included funding source (industry/non-industry) and familiarity with the research institution. Barriers to research participation included transportation and concern about privacy and confidentiality. Suggestions for making research participation easier included researchers coming to rural communities and meeting participants in places where OAs gather and providing transportation and hotel accommodations. CONCLUSION: Lessons learned offer practical guidance for research teams as they address the new NIH Inclusion Across the Lifespan policy. Including OAs in research in ways that motivate and facilitate participation will be critical for a robust representation across the lifespan and in tailoring treatments to the specific needs of this population.

The First National Institutes of Health Institutional Training Program in Emergency Care Research: Productivity and Outcomes.

STUDY OBJECTIVE: We assess the productivity, outcomes, and experiences of participants in the National Institutes of Health/National Heart, Lung, and Blood Institute-funded K12 institutional research training programs in emergency care research. METHODS: We used a mixed-methods study design to evaluate the 6 K12 programs, including 2 surveys, participant interviews, scholar publications, grant submissions, and funded grants. The training program lasted from July 1, 2011, through June 30, 2017. We tracked scholars for a minimum of 3 years and up to 5 years, beginning with date of entry into the program. We interviewed program participants by telephone using open-ended prompts. RESULTS: There were 94 participants, including 43 faculty scholars, 13 principal investigators, 30 non-principal investigator primary mentors, and 8 program administrators. The survey had a 74% overall response rate, including 95% of scholars. On entry to the program, scholars were aged a median of 37 years (interquartile range [IQR] 34 to 40 years), with 16 women (37%), and represented 11 disciplines. Of the 43 scholars, 40 (93%) submitted a career development award or research project grant during or after the program; 26 (60%) have secured independent funding as of August 1, 2017. Starting with date of entry into the program, the median time to grant submission was 19 months (IQR 11 to 27 months) and time to funding was 33 months (IQR 27 to 39 months). Cumulative median publications per scholar increased from 7 (IQR 4 to 15.5) at program entry to 21 (IQR 11 to 33.5) in the first post-K12 year. We conducted 57 semistructured interviews and identified 7 primary themes. CONCLUSION: This training program produced 43 interdisciplinary investigators in emergency care research, with demonstrated productivity in grant funding and publications.

A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different.

Integrated behavioral health and primary care is a patient-centered approach designed to address a person's physical, emotional, and social healthcare needs. Increasingly, practices are integrating care to help achieve the Quadruple Aim, yet no studies have examined, using qualitative methods, patients' experiences of care in integrated settings. The purpose of this study was to examine patients' experiences of care in community-based settings integrating behavioral health and primary care. This is a qualitative study of 24 patients receiving care across five practices participating in Advancing Care Together (ACT). ACT was a 4-year demonstration project (2010-2014) of primary care and community mental health centers (CMHCs) integrating care. We conducted in-depth interviews in 2014 and a multidisciplinary team analyzed data using an inductive qualitative descriptive approach. Nineteen patients described receiving integrated care. Both primary care and CMHC patients felt cared for when the full spectrum of their needs, including physical, emotional, and social circumstances, were addressed. Patients perceived personal, interpersonal, and organizational benefits from integrated care. Interactions with integrated team members helped patients develop and/or improve coping skills; patients shared lessons learned with family and friends. Service proximity, provider continuity and trust, and a number of free initial behavioral health appointments supported patient access to, and engagement with, integrated care. In contrast, patients' prior experience, provider "mismatch," clinician turnover, and restrictive insurance coverage presented barriers in accessing and sustaining care. Patients in both primary care and CMHCs perceived similar benefits from integrated care related to personal growth, improved quality, and access to care. Policy makers and practice leadership should attend to proximity, continuity, trust, and cost/coverage as factors that can impede or facilitate engagement with integrated care.

Lesbian, gay, bisexual, transgender, queer, and questioning youths' perspectives of inclusive school-based sexuality education.

Sexuality education is perceived as one way to prevent unhealthy sexual behaviors. However, current sexuality education materials are not tailored to fit the needs of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth, and many have been critiqued for disenfranchising these populations. This study solicited the perspectives of LGBTQ youth on their experiences with school-based sexuality education in order to create a framework of LGBTQ-inclusive sexuality education. Five semistructured focus groups (N = 30 LGBTQ participants) were conducted to investigate the sexuality education experiences of LGBTQ youth and to solicit youth suggestions for improving the inclusiveness of sexuality education curricula. Results indicate that LGBTQ youth perceive current sexuality education as primarily "exclusive," although examples of "inclusive" sexuality education were provided. In addition, participants provided suggestions for creating a more inclusive experience, such as directly discussing LGBTQ issues, emphasizing sexually transmitted infection (STI) prevention over pregnancy prevention, and addressing healthy relationships. Educators and policymakers can use these ideas to help improve the quality of sexuality education-not only to make it more inclusive for LGBTQ youth but to make sexuality education more inclusive for all young people.

Trauma exposure and PTSD among older adolescents in foster care.

PURPOSE: Youth in foster care represent a highly traumatized population. However, trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the DSM-IV. The current study aims to fill this gap by reporting the prevalence of exposure to specific types of traumatic events for a large sample of youth with foster care experience. The study also reports the likelihood of lifetime PTSD diagnoses associated with each specific type of trauma. METHOD: Data are from a longitudinal panel study of 732 adolescents aged 17 and 18 who were in foster care. Lifetime trauma exposure and PTSD diagnosis were assessed using the Composite International Diagnostic Interview. Statistical comparisons were made using logistic regressions. RESULTS: The majority of respondents had experienced at least one trauma in their lifetime. While overall trauma prevalence did not differ by gender, males were more likely to experience interpersonal violence and environmental trauma, while females were more likely to experience sexual trauma. Caucasian participants reported higher rates of trauma exposure than African-American participants did. The types of trauma associated with the highest probability of a lifetime PTSD diagnosis were rape, being tortured or a victim of terrorists, and molestation. CONCLUSIONS: Youth in foster care are a highly traumatized population and meet diagnostic criteria for PTSD at higher rates than general youth populations. The ongoing impact of trauma may be particularly problematic for these young people given their abrupt transition to independence.