The Impact of Parental Suicide Stigma on Youth Suicide Stigma in Mexico.

Suicide negatively impacts societies worldwide. A particular area of concern is the prevalence of suicide among Latinx youth, as research indicates that suicide behaviors among Latinx in the United States and youth in Latin America have increased drastically over the last decade. Reducing suicide stigma is a key factor in promoting youth help-seeking behaviors regarding suicidality. Previous research suggests that a relationship with a trusted adult may influence the likelihood of an adolescent contacting a suicide crisis line. Our study seeks to further the research of how parents can influence youth perceptions of suicide by studying the relationship between parent and child suicide stigma. Data were collected from parent-child dyads throughout Mexico. The Stigma of Suicide Scale Short Form was used to measure suicide stigma among adult and youth participants independently. Results suggest that parent suicide stigma was a significant predictor of youth suicide stigma, that male youth in our sample had higher suicide stigma than female youth, and that access to healthcare services was associated with lower suicide stigma. Results are discussed considering unique cultural factors in Mexico such as familismo. If future research reinforces the findings of this study, suicide stigma programs might be more effective if targeted at the entire family unit rather than just adolescents.

Exploring the Association between Educational Aspirations and Intentions to Migrate among Youth in Central Mexico by Gender.

We assessed the association between educational aspirations and the intention to migrate among 1,446 adolescents aged 11-17 years, living in semi-urban/rural communities in Jalisco, Mexico. Analyses rely on survey data from the Family Migration and Early Life Outcomes study. The outcome variable was the intention to migrate, a three-category variable coded as no intention to migrate, intention to migrate within Mexico, and intention to migrate internationally. The main independent variable was the adolescents' educational aspirations, conceptualized as the intention to achieve higher education. Multinomial logistic regression models were used to examine associations. We found an association between educational aspirations and intentions to migrate, and it was moderated by gender. Girls with the highest educational aspirations intended to migrate internationally, while higher educational aspirations were not a driver for boys' migration intentions. The study findings have implications for education and migration policies and future research.

Reaching Vulnerable and Underserved Communities in the US Southwest Through a Successful COVID-19 Community-Academic Partnership.

This article describes a community-academic partnership designed and implemented to address disparities in accessing COVID-19 testing in Arizona, from November 2020 through March 2023. An equitable community-academic partnership, the involvement of local leaders, and the engagement of community health workers were critical for the success of the intervention. More than 5000 previously underserved patients were tested and received COVID-19 related services. A profile comparison with a matched group documents the success of the program in reaching the targeted population. (Am J Public Health. 2024;114(S5):S388-S391. https://doi.org/10.2105/AJPH.2024.307684).

Parent-child conflict and adolescent health literacy in Mexico: Results from a nationwide dyad study in Mexico.

Research suggests that health literacy (HL) is critical in preventing and managing health problems. However, over half of adults in Mexico report having inadequate health literacy. Research suggests the parent-child relationship can be a key predictor of developmental competencies; however, little research has examined how dyadic family interactions relate to HL. This study examined whether parent-child relationship conflict was associated with adolescent health literacy among families living in Mexico. Data from a parent-child dyads in Mexico were gathered using online surveys (N = 746, 373 parent-child dyads). Our findings suggested that child-reported family conflict-but not parent-reported family conflict - was associated with lower adolescent health literacy. Researchers and practitioners should consider how parent-child conflict may impact adolescent health outcomes, and prioritise child reports in data collection.

Introduction to the Special Issue: International Responses to Prevention Intervention Research During Human Ecosystem Disruptions.

For decades, human ecosystem disruptions (HEDs), including pandemics, natural disasters, and socio-economic crises, have shaped national and international responses affecting everyday life. These disruptions present challenges and opportunities for prevention science to address emerging behavioral and mental health research questions, intervention strategies, methodologies, analyses, and research collaboration. This paper introduces a special issue that aims to document examples of how prevention science research teams had (1) globally improved health and well-being through swift, scientifically based responses during HED events and (2) advanced our understanding of the conduct and outcomes of prevention intervention research during crises such as pandemics, natural disasters, and socio-economic crises. The issue presents six research studies conducted in over ten different countries (e.g., Australia, Mexico, China). This issue includes original empirical and descriptive work that addressed HED implications for preventive interventions at within-country and cross-national levels. The findings hold potential applications for responses during current and future pandemics and natural disasters. Participants reflected on methodological and contextual considerations during HEDs, such as navigating travel restrictions, adapting ongoing research efforts to accommodate scientific learning during disruptions, and assessing the impact of policies redistributing preventive resources during and after a HED.

Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022.

Importance: Xylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses. Objective: To gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports. Design, Setting, and Participants: This cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023. Exposure: State. Main Outcomes and Measures: Yearly xylazine-related overdose deaths per 100 000 residents; xylazine NFLIS drug reports, both per 100 000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories). Results: A total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100 000 residents) and Connecticut (9.8 per 100 000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine's representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states. Conclusions and Relevance: In this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine's reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine's geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.

Health Behavior and Attitudes During the COVID-19 Pandemic Among Vulnerable and Underserved Latinx in the Southwest USA.

The COVID-19 pandemic highlighted deep-rooted health disparities, particularly among Latinx immigrants living on the Mexico-US border. This article investigates differences between populations and adherence to COVID-19 preventive measures. This study investigated whether there are differences between Latinx recent immigrants, non-Latinx Whites, and English-speaking Latinx in their attitudes and adherence to COVID-19 preventive measures. Data came from 302 participants who received a free COVID-19 test at one of the project sites between March and July 2021. Participants lived in communities with poorer access to COVID-19 testing. Choosing to complete the baseline survey in Spanish was a proxy for being a recent immigrant. Survey measures included the PhenX Toolkit, COVID-19 mitigating behaviors, attitudes toward COVID-19 risk behaviors and mask wearing, and economic challenges during the COVID-19 pandemic. With multiple imputation, ordinary least squares (OLS) regression was used to analyze between-group differences in mitigating attitudes and behaviors toward COVID-19 risk. Adjusted OLS regression analyses showed that Latinx surveyed in Spanish perceived COVID-19 risk behaviors as more unsafe (b = 0.38, p = .001) and had stronger positive attitudes toward mask wearing (b = 0.58, p = .016), as compared to non-Latinx Whites. No significant differences emerged between Latinx surveyed in English and non-Latinx Whites (p > .05). Despite facing major structural, economic, and systemic disadvantages, recent Latinx immigrants showed more positive attitudes toward public health COVID-19 mitigating measures than other groups. The findings have implications for future prevention research about community resilience, practice, and policy.

The Impact of Major Earthquakes on Students' Emotional Distress and Internalizing Symptoms, Externalizing Behaviors, and Coping During the Implementation of keepin' it REAL-Mexico.

This article reports on effects of two earthquakes in Mexico on adolescents attending middle school. The earthquakes struck in close succession during the implementation of a school-based prevention program, providing an opportunity to assess emotional distress due to the earthquakes and whether the life skills taught in the program affected how students coped with the natural disaster. The objectives were to (1) evaluate the earthquakes' impact on students' distress; (2) assess if distress is associated with internalizing symptomology and externalizing behaviors; and (3) investigate if students receiving the original and adapted versions of the intervention coped better with the events. A Mexico-US research team culturally adapted keepin' it REAL to address connections between substance use among early adolescents in Mexico and exposure to violence. A random sample of public middle schools from three cities (Mexico City, Guadalajara, and Monterrey), stratified by whether they held morning or afternoon sessions, was selected. A total of 5522 7th grade students from 36 schools participated in the study. Students answered pretest and posttest questionnaires; the latter assessed earthquake-related distress and coping strategies. Earthquake-related distress was associated with all measures of undesired internalizing symptomology and externalizing behaviors. Compared to controls, students in the adapted intervention reported less aggressive and rule-breaking externalizing behavior and less violence perpetration. However, these intervention effects were not moderated by the level of earthquake-related distress, and they were not mediated by positive or negative coping. The findings have implications for prevention intervention research and policy as natural and human-made disasters occur more often.

Associations between parent-adolescent health-related conversations and mealtime media use among Hispanic families.

INTRODUCTION: Whereas parents play an important role in shaping the home environment, it is unknown whether health-related parent-adolescent conversations may be associated with different health-promoting parenting practices, such as limiting adolescent mealtime media use in Hispanic families. METHOD: For this cross-sectional analysis, Hispanic parents (n = 344; 40.4 ± 6.6 years; 89.2% female) of sixth- to eighth-grade adolescents self-reported the frequency of having health- or weight-related conversations with their adolescent child, and the frequency of adolescent mealtime media device use. Spearman's rank correlations were used to assess whether parent-adolescent health-related conversations are associated with mealtime media device use by adolescents. RESULTS: Over 75% of parents reported having conversations about healthy eating and being physically active at least a few times per week. Fewer parents reported having frequent weight-related conversations. Frequency of mealtime media use was low, except for television/movie watching (only 30% of parents reported their child rarely/never watching television during family meals). Having conversations related to the adolescent weighing too much was correlated with the mealtime use of television (r = .207; p < .001), cellphones (r = .134; p = .018), and headphones for music listening (r = .145; p = .010). Conversations about exercising to lose weight were correlated with television/movie watching during mealtimes (r = .129; p = .035). DISCUSSION: Findings suggest the co-occurrence of less health-promoting parenting behaviors, such as focusing on weight-related conversations and allowing the use of media devices during mealtimes. Focusing on health- rather than weight-related parent-adolescent conversations and implementing mealtime media use rules may have the potential to shape a home food environment which ultimately could improve an adolescent's overall health outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Xylazine in Drug Seizure Reports and Overdose Deaths in the US, 2018-2022.

Xylazine is increasingly reported in street drugs and fatal overdoses in the United States (US), often in combination with synthetic opioids, yet state-level xylazine data are limited, hampering local public health responses. The present study analyzed 2018-2022 state-level data from the National Forensic Laboratory Information System (xylazine-positive reports of seized drugs analyzed by forensic laboratories), the Centers for Disease Control and Prevention (population estimates, synthetic opioid overdose mortality rates), and individual states' medical examiner/public health agency reports (numbers of xylazine-involved overdose deaths). An ordinary least squares regression model predicted state-level synthetic opioid overdose mortality rates by xylazine seizure report rates, adjusting for US Census Region. In 2018, relatively low rates of xylazine seizure reports were observed, with 21 states reporting zero xylazine seizures. In 2022, only three states reported zero xylazine seizures, and the highest xylazine seizure report rates (per 100,000 residents) were observed in New Jersey (30.4), Rhode Island (22.7), Maryland (18.9), Virginia (15.5), New Hampshire (13.0), and Ohio (10.9). Data on 2019-2022 xylazine-involved overdose deaths were available for 21 states/DC (60 state-years), with the highest 2022 xylazine-involved overdose death rates (per 100,000 residents) in Vermont (10.5) and Connecticut (9.8). Finally, in 2021, at the state level, each additional reported xylazine seizure per 100,000 residents was associated with a 2% higher synthetic opioid overdose mortality rate (b=0.02, robust standard error=0.01; p=0.049). Overall, study results emphasize xylazine's increasing involvement in US law enforcement drug seizure reports and overdose deaths, primarily in the East, yet also extending across the country.

Diet Outcomes from a Randomized Controlled Trial Assessing a Parenting Intervention Simultaneously Targeting Healthy Eating and Substance Use Prevention among Hispanic Middle-School Adolescents.

Parents play a significant role in adolescent health behaviors; however, few nutrition interventions for Hispanic adolescents involve parents. This study assessed the effects of a 10-week parenting intervention simultaneously targeting nutrition and substance use prevention. Hispanic parent/6th-8th-grade adolescent dyads (n = 239) were randomized to Families Preparing the New Generation Plus (FPNG+; nutrition/substance use prevention), FPNG (substance use prevention only), or Realizing the American Dream (RAD; academic success control). Surveys assessed diet, alcohol use, substance use intentions, and substance use norms at baseline (T1), immediately post-intervention (T2), and at 16 weeks post-intervention (T3). Latent change modeling assessed diet changes; adolescent substance use outcomes were assessed using effect sizes. Among adolescents, those in FPNG+ increased fruit (+0.32 cup equivalents, p = 0.022) and fiber intake (+1.06 g, p = 0.048) and did not change added sugars intake at T2; those in FPNG and RAD reduced their intake of fruit and fiber (p < 0.05 for both). FPNG+ parents marginally increased fruit/vegetable intake (+0.17 cup equivalents, p = 0.054) and increased whole grains intake (+0.25-ounce equivalents, p < 0.05), in contrast to the reduction among RAD and FPNG parents (p < 0.05). Reductions in added sugar intake at T2 were greater among FPNG and FPNG+ parents relative to RAD parents (p < 0.05). FPNG+ and FPNG had comparable substance use outcomes (i.e., both had lower alcohol use and intentions to use substances relative to RAD). Engaging parents in a nutrition and substance use prevention parenting intervention yielded positive changes in dietary intake and maintained substance use prevention outcomes among their adolescent children.

Keepin' It REAL-Mantente REAL in Mexico: Longitudinal Examination of Youth Drug Resistance Strategies and Substance Use Among Early Adolescents.

PURPOSE: This study examined if culturally and linguistically adapted versions of a US-developed adolescent substance use prevention intervention, keepin' it REAL (kiREAL), for Mexico increases the use of drug resistance strategies and if increased use of resistance strategies subsequently leads to a reduction in the frequency of substance use (i.e., alcohol, cigarette, marijuana, and inhalants). METHODS: Students (N = 5,522, 49% female, age range = 11-17) in 36 middle schools across three cities in Mexico were randomized into three conditions: (1) Mantente REAL (MREAL), the culturally adapted version, (2) kiREAL-S, the linguistically adapted version, and (3) Control. Using survey data collected at four time points, random intercept cross-lagged path analyses tested the direct and indirect effects of MREAL and kiREAL-S compared to Control. RESULTS: At time 2, the number of drug resistance strategies used by students increased in both MREAL (ß = 0.103, p = .001) and kiREAL-S (ß = 0.064, p = .002) compared to Control. However, only MREAL lead to less frequent use of alcohol (ß = -0.001, p = .038), cigarettes (ß = -0.001, p = .019), marijuana (ß = -0.002, p = .030), and inhalants (ß = -0.001, p = .021) at time 4, mediated through increased use of drug resistance strategies. DISCUSSION: This study provides evidence that MREAL and kiREAL-S are successful in spurring use of the drug resistance strategies that are the core component of the intervention. Only MREAL achieved long-term effects on substance use behaviors, the ultimate objective of these interventions. These findings provide support for the value and importance of rigorous cultural adaptation of efficacious prevention programs as a necessary condition for enhancing prevention benefits for participating youth.

A Pilot Study of an Evidence-Based Prevention Intervention (keepin' it REAL) for Early Adolescents in Kenyan Schools.

CONCLUSIONS: Although larger trials with a more representative sample of schools are needed, the study suggests the potential for kiR as an effective approach for substance use prevention in Kenya. METHOD: A convenience sample of primary schools in metropolitan Nairobi was randomized into an intervention or control group. Teachers in intervention schools were trained to deliver the kiR curriculum with fidelity. Students in seventh and eighth grades in the intervention and control schools (N = 533) completed pretest and posttest questionnaires assessing substance use behaviors, attitudes, and drug resistance strategies. OBJECTIVE: Although many primary school students in Kenya report use of alcohol and other drugs, evidence-based prevention interventions for schools are generally unavailable. Globally, there are growing opportunities to conduct research that assesses whether efficacious interventions from elsewhere can be adopted for new settings and populations. This small pilot study implemented and evaluated a linguistically adapted version of the school-based keepin' it REAL (kiR) universal substance use prevention program from the United States in Kenyan primary schools to assess its effectiveness and estimate potential effect sizes. RESULTS: Relative to the control group, kiR students reported several desired changes in behaviors and attitudes: less recent alcohol use and heavy (binge) alcohol drinking, and continuing or increased adherence to certain anti-drug norms. There was partial evidence that kiR helped students rely less on conflictual drug resistance strategies, such as reacting to substance offers angrily or with violence. Effect sizes for these outcomes compare favorably to those obtained in other school-based prevention interventions.

Qualitative Research on the Perceptions of Factors Influencing Diet and Eating Behaviors Among Primarily Latinx Seventh-Grade Students.

BACKGROUND: Latinx youth are a population of concern, at elevated risk for chronic diseases and with poor adherence to dietary recommendations. OBJECTIVES: To examine Latinx seventh-grade students' perceptions of the factors that influence their diet and eating behaviors. DESIGN: This qualitative research used focus groups and an inductive content analysis approach. PARTICIPANTS/SETTING: Five sex-stratified focus groups (three groups with females) with 35 primarily Latinx seventh-grade students were conducted at two local Title 1 public middle schools in a large metropolitan area of the Southwestern United States. MAIN OUTCOME MEASURES: The discussion protocol included questions about participants' food choices, the role of their parents in their diet, and healthy body-related concerns among their peers. ANALYSES: Verbatim transcripts were coded in NVivo 12 on the basis of specificity, extensiveness, and frequency. Themes emerged from group dialogue, detailed conversations, and predominant topics of discussion, and aligned with ecological systems theory. RESULTS: Participants referred to factors influencing Latinx seventh-grade students' eating behaviors at the individual, family, household, and school levels. At the individual level, participants described their eating as unhealthy and perceived it as determined by taste, convenience, ease of preparation, and home availability. Participants expressed concerns about diabetes because of their body weight and family history, and identified those concerns as reasons for acceptance of healthy foods and the desire for parents to model healthy eating behaviors. Family-level factors perceived as influencing dietary behaviors included the role of parents as providers of food and models of unhealthy eating, budget constraints, and availability (or lack thereof) of healthy foods at home. Similarly, the identified school-level factors aligned with availability and quality of foods in that environment. CONCLUSIONS: Family- and household-related factors emerged as important influences on seventh-grade students' dietary behaviors. Future diet interventions should incorporate strategies targeting these multiple-level factors that influence dietary intake for Latinx youth and that address the concerns related to disease risk.

Evolution of COVID-19 Health Disparities in Arizona.

COVID-19 burdens are disproportionally high in underserved and vulnerable communities in Arizona. As the pandemic progressed, it is unclear if the initial associated health disparities have changed. This study aims to elicit the dynamic landscape of COVID-19 disparities at the community level and identify newly emerging vulnerable subpopulations. Findings from this study can inform interventions to increase health equity among minoritized communities in the Southwest, other regions of the US, and globally. We compiled biweekly COVID-19 case counts of 274 zip code tabulation areas (ZCTAs) in Arizona from October 21, 2020, to November 25, 2021, a time spanning multiple waves of COVID-19 case growth. Within each biweekly period, we tested the associations between the growth rate of COVID-19 cases and the population composition in a ZCTA including race/ethnicity, income, employment, and age using multiple regression analysis. We then compared the associations across time periods to discover temporal patterns of health disparities. The association between the percentage of Latinx population and the COVID-19 growth rate was positive before April 2021 but gradually converted to negative afterwards. The percentage of Black population was not associated with the COVID-19 growth rate at the beginning of the study but became positive after January 2021 which persisted till the end of the study period. Young median age and high unemployment rate emerged as new risk factors around mid-August 2021. Based on these findings, we identified 37 ZCTAs that were highly vulnerable to future fast escalation of COVID-19 cases. As the pandemic progresses, vulnerabilities associated with Latinx ethnicity improved gradually, possibly bolstered by culturally responsive programs in Arizona to support Latinx. Still communities with disadvantaged social determinants of health continued to struggle. Our findings inform the need to adjust current resource allocations to support the design and implementation of new interventions addressing the emerging vulnerabilities at the community level.

Adaptation process of a culturally congruent parenting intervention for parents of Hispanic adolescents to an online synchronous format.

Adaptations to interventions for specific settings or communities are critical for facilitating successful implementation. The Dynamic Adaptation Process model was applied to systematically assess the adaptation process made to an in-person parenting intervention (FPNG+) prior to its implementation online. This qualitative case study design included meeting notes and interviews completed with project team members. Meeting notes were analyzed using content analysis. Semi-structured interviews regarding project team members' roles on FPNG+ and processes and activities they identified as critical for the adaptation of FPNG+ to an online intervention were analyzed using a deductive-inductive approach. In the formative phase, three primary processes were identified: information gathering to determine if the environment existed for the implementation of an online program; considerations to support the facilitation process of FPNG+ to an online environment, and decision-making to support modifications to FPNG+. The pre-implementation phase consisted of three processes: information shared by the instructional designer to facilitate the delivery of the FPNG+ content online; modifications made to the format of the intervention to meet the cultural needs of Hispanic families and address contextual issues; and iterative efforts to tailor the intervention by the project team. This study used implementation science to distinguish the dynamic processes that occurred across different systems and multiple levels in the project team's effort to modify FPNG+ to an online intervention. The contribution of this study underscores the importance of identifying the processes that facilitate the modifications made to an intervention and the capacity to implement the modified intervention with Hispanic families.

Adaptations to interventions for specific settings or communities are critical for facilitating successful implementation. The Dynamic Adaptation Process model was used to systematically assess the adaptation process made to an in-person parenting intervention (FPNG+) prior to its implementation online. Using a qualitative case study design, meeting notes were analyzed using content analysis; and semi-structured interviews were analyzed using a deductive-inductive approach. In the formative phase, three processes were identified: information gathering to determine if the environment existed for the implementation of an online program; considerations to support the facilitation process of FPNG+ to an online environment, and decision-making to support modifications to FPNG+. The pre-implementation phase consisted of three processes: information shared by the instructional designer to facilitate the delivery of the FPNG+ content online; modifications made to the format of the intervention to meet the cultural needs of Hispanic families and address contextual issues; and iterative efforts to tailor the intervention by the project team. The contribution of this study underscores the importance of identifying the processes that facilitate the changes made to an intervention and the capacity to implement the modified intervention with Hispanic families.

Migration Intentions and Alcohol Use Among Adolescents in West-Central Mexico.

This study explores the association between migration intentions and alcohol use among west-central Mexico adolescents living in high migration communities. This study used the baseline data from the Family Migration and Early Life Outcomes (FAMELO) project (N = 1286), collected in 2018. We used multiple imputations to address missingness and propensity score matching to reduce the selection bias. We also conducted subgroup analyses to compare gender difference (i.e., boys vs. girls) on the relationship between migration intention and alcohol use. The findings show that for the whole sample, youth with migration intentions had significant higher odds (OR = 1.78; p = .010) of having a lifetime drinking experience when compared to youth who reported no interest in living abroad, but this association remained significant only for boys (OR = 2.14; p = .010). This study makes an important contribution to our understanding of the etiology of migration intentions and alcohol use for adolescents living in sending migration communities. The findings have specific alcohol prevention, policy, and future research implications in Mexico and the U.S.

Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S.

This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.

Urban Violence, Migration and Alcohol, Tobacco, and Marijuana Use among Transnational Students in Northern Mexico.

This article reports on the findings of a study of the relationship between transnational experiences in the United States (US) and the use of alcohol, tobacco, and marijuana among 7th grade students (n = 1418). The study was guided by a cross-national framework for research on immigrant health and assessed the accumulation of risk factors for transnational adolescents. Data came from a survey conducted in 2017 in Nogales, Mexico. In this study, the last 30-day prevalence of use of alcohol, tobacco, and marijuana among students was 21.7%, 8.3%, and 2.4%, respectively. Most students were born in Nogales (69.6%), while 10.5% were born in the US, 7.5% attended school in the US, and 3.6% engaged in health-related risk behaviors while living in or visiting the US. Students with transnational experiences, such as attending school in the US, reported the highest 30-day prevalence of tobacco (13.3%) and marijuana (9.5%) use. After adjusting for family, school, access to substances and neighborhood violence variables, students who engaged in health-related risk behavior in the US had significantly increased odds of alcohol and marijuana use while later attending school in Mexico. The article discusses the findings from a prevention science perspective and provides implications for policy, practice, and future research on the Mexico-US border region.

Use of Violence as a Strategy of Early Adolescents for Rejecting Drug Offers in Mexican Cities.

Drug use and violence are two interconnected problems in violent urban contexts, leading to coercive drug offers. In this study, relationships between drug use, use of violence as a strategy for rejecting drug offers, and exposure to neighborhood violence were analyzed in Mexican students. Data were obtained through a self-report survey and focus groups with lower secondary students in three Mexican metropolitan areas. Both quantitative and qualitative results indicated that students who had used or would use violence as a strategy for rejecting drug offers presented a more problematic psychosocial profile, with exposure to neighborhood violence as the main predictor. These results suggest that Mexican students in violent cities may resort to violence as a strategy for rejecting drug offers.

El consumo de drogas y la violencia son dos problemas interconectados en contextos urbanos violentos y generan ofrecimientos de drogas coercitivos. En este estudio se analizaron las relaciones entre el consumo de drogas, el uso de violencia como una estrategia para resistir ofrecimientos de drogas y la exposición a violencia en el barrio entre estudiantes mexicanos. Se obtuvieron los datos mediante una encuesta de autoinforme y grupos de discusión centrada con estudiantes de educación secundaria en tres áreas metropolitanas de México. Tanto los resultados cuantitativos como los cualitativos indicaron que aquellos estudiantes que habían usado o usarían violencia como una estrategia para resistir ofrecimientos de drogas presentaban un perfil psicosocial más problemático, con la exposición a violencia en el barrio como el principal predictor. Estos resultados sugieren que los estudiantes mexicanos en ciudades violentas pueden recurrir a la violencia como una estrategia para resistir ofrecimientos de drogas.