Lifetime HIV testing among three samples of adults with histories of incarceration in Southern California.

ABSTRACTJustice-impacted persons may inconsistently access HIV testing. This cross-sectional secondary analysis investigates lifetime HIV testing prevalence among adults with prior histories of incarceration in Southern California, United States, participating in health-focused programming (n = 3 studies). Self-reported demographic and lifetime HIV testing data were collected between 2017-2023; descriptive analyses were conducted. Across the three samples, at least 74% of participants were male; Latino and African American individuals accounted for nearly two-thirds of participants. Lifetime HIV testing ranged from 72.8% to 84.2%. Males were significantly more likely than females to report never being tested in two samples and accounted for >95% of those never tested. No statistically significant differences in testing were observed by race/ethnicity. Single young adults (ages 18-26) were less likely than their partnered peers to report testing. HIV testing is critical for ensuring that individuals access prevention and treatment. HIV testing among justice-impacted adults in this study was higher than in the general population, potentially due to opt-out testing in correctional settings. Nevertheless, these findings underscore the importance of implementing targeted interventions to reduce structural (e.g., health insurance, access to self-testing kits) and social barriers (e.g., HIV stigma) to increase HIV testing among justice-impacted males and single young adults.

Building trust: Leadership reflections on community empowerment and engagement in a large urban initiative.

BACKGROUND: Trust is essential for healthy, reciprocal relationships; creating safe environments; engaging in transparent interactions; successfully negotiating power differentials; supporting equity and putting trauma informed approaches into practice. Less is known, however, about the ways that trust-building may be at the forefront of consideration during community capacity building efforts, what trust-building elements are perceived as essential for optimally engaging communities, and what practices might support these efforts. METHODS: The present study examines an evolving understanding of trust-building over the course of 3 years, from qualitative data derived during interviews with nine agency leads from a large and diverse urban community, who are spearheading community-based partnerships to create more trauma-informed communities and foster resiliency. RESULTS: Data reflected fourteen trust-building elements, captured by three themes: 1) Building relationships and engagement (e.g., behavioral practices such as meeting people "where they are at" and creating safe spaces), 2) Embodying core values of trustworthiness (e.g., traits such as being transparent and embodying benevolence), and 3) Sharing decision-making, championing autonomy, and addressing barriers to trust (e.g., collaborative practices such as creating a shared vision and goals and addressing systemic inequities). These trust-building elements are presented in the Community Circle of Trust-Building, which provides an accessible, visual format that can facilitate capacity building efforts within organizations and with the broader community; guide the selection of training opportunities that support healthy interpersonal relationships; and aid in the identification of relevant, supporting frameworks (e.g., health equity, trauma-informed practices, inclusive leadership models). CONCLUSIONS: Community engagement and trust are essential for overall health and well-being, increasing equitable access to resources, and supporting an effective and connected citizenry. These data shed light on opportunities for trust-building and thoughtful engagement among agencies working directly with community members in large urban areas.

A randomized clinical trial testing a health literacy intervention to reduce disparities in access to care among Justice-Impacted Adults (JIA).

BACKGROUND: Low health literacy is costly and observed among justice-impacted adults (JIA), a group that often faces numerous barriers in accessing healthcare and a disproportionate burden of illness. Health literacy interventions for JIA are critically needed to improve healthcare access and related outcomes. METHODS: This manuscript describes the protocol for a longitudinal mixed-methods randomized clinical trial that assesses the effectiveness of a coach-guided health literacy intervention on JIA's healthcare access. The intervention was previously piloted with justice impacted adults. We will recruit 300 JIA ages 18 + in San Diego, California. Participants will be randomized 1:1 to the Treatment Group (i.e., coach-guided intervention providing 12 sessions of individualized health coaching and service navigation over 6 months) or the Control Group (i.e., self-study of the health coaching program, and brief service navigation support). We will quantitatively assess JIA's healthcare access defined as: use of healthcare, health insurance status, and regular source of care at 6-months as the primary outcomes. Participants will also be surveyed at 12-months. Statistical analyses will incorporate the intent-to-treat (ITT) principle and we will estimate mixed-effects logistic regression for the primary outcomes. We will also conduct qualitative interviews at 6 and 12-months with 40 purposively sampled participants, stratified by study arm, who reported healthcare access barriers at baseline. Interviews will explore participants' satisfaction with the intervention, healthcare attitudes, self-efficacy for and barriers to healthcare access over time, perceived contribution of the intervention to health and well-being, and diffusion of intervention-related information within participants' social networks. We will conduct deductive thematic analyses of qualitative data. DISCUSSION: Low health literacy among JIA is a foundational challenge requiring tailored intervention strategies. Findings from this trial may inform policies and the structure of service delivery models to build health literacy among JIA in institutional and community settings throughout the United States and elsewhere. TRIAL REGISTRATION: This study is registered with the United States' ClinicalTrials.gov registry under protocol # 161,903.

Peer modeling influences girls' snack intake.

Previous studies indicate that the presence of peers influences children's food consumption. It is assumed that one factor producing this effect in children is child modeling of food intake. The present study assesses the effect of a video model on the food intake of overweight (n=22) and nonoverweight (n=22) preadolescent girls. A 2 (weight status)x2 (small vs large serving size) factorial design was used to test the hypothesis that youth model others' food intake. Serving sizes were manipulated by showing a video model selecting and consuming either a small or a large serving of cookies. Results indicate a main effect of serving size condition, F(1,40)=5.1, P<0.05 (d=0.65; 95% confidence interval: 0.35 to 0.65), and a main effect of weight status, F(1,40)=4.9, P<0.05 (d=0.63; 95% confidence interval: 0.35 to 0.65). Participants exposed to the large serving-size condition consumed more cookies than participants exposed to the small serving-size condition and overweight participants consumed considerably more cookies than nonoverweight participants. The interaction of weight status by serving-size condition did not reach statistical significance (P=0.2). These results suggest that peer-modeling influences overweight and nonoverweight preadolescent girls' snack consumption.

Effect of peers and friends on youth physical activity and motivation to be physically active.

OBJECTIVE: To test whether the presence of a peer or a friend increases the motivation to be physically active in overweight and non-overweight youth in a laboratory setting. METHODS: Youth motivation to be physically active as a function of the social context was measured using a computerized relative reinforcing value task to earn points exchangeable for physical and/or sedentary activities. RESULTS: The presence of a friend (p<.001) increased youth's; motivation to be physically active. The presence of a peer increased overweight youth's; motivation to be physically active, whereas this was not the case for lean youth (p=.47). Participants biked a greater distance in the presence of a friend than when alone (p<.001). Overweight youth biked a greater distance in the presence of a peer than when alone, while this was not the case for lean youth (p=.23). CONCLUSIONS: Friendships may increase youth's motivation to engage in physical activity and promote greater physical activity in non-overweight and overweight youth.

Peer influence on children's physical activity: an experience sampling study.

OBJECTIVE: The primary objective was to examine the associations between social context (the presence of peers, friends, and family members) and physical activity intensity for overweight and lean girls and boys. METHODS: Participants for this study included 10 boys (M = 13.4 years; SD = .8) and 10 girls (M = 13.8 years; SD =. 8). Twelve participants were between the 15th and the 85th BMI percentile (eight girls, four boys) and eight youth were at or above the 85th BMI percentile (six boys, two girls). Participants reported on their activity intensity and whether the activity was solitary or with others for seven consecutive days. RESULTS: Children were more likely to report more intense physical activity when in the company of peers or close friends. Overweight children reported greater physical activity when in the presence of peers than did lean children; however, overweight children also reported more time spent alone. CONCLUSIONS: Taken together, findings highlight the importance of considering peer relationships in studies of physical activity and childhood "obesity".

Peer influence on pre-adolescent girls' snack intake: effects of weight status.

Although most eating occurs in a social context, the effects of peer influence on child eating have not been the object of systematic experimental study. The present study assesses the effects of peer influence on lean and overweight pre-adolescent girls' snack intake as a function of the co-eaters' weight status. The weight status of the participants was varied by studying weight discordant dyads (i.e., one lean and one overweight participant) and weight concordant dyads (i.e., both members of the dyads were either lean or overweight). Results from the random regression model indicate that overweight girls eating with an overweight peer consumed more kilocalories than overweight participants eating with a normal-weight peer. Normal-weight participants eating with overweight peers ate similar amounts as those eating with lean eating companions. The regression model improved when the partners' food intake was entered in the model, indicating that the peers' intake was a significant predictor of participants' snack consumption. This study underscores differences in responses to the social environment between overweight and non-overweight youths.