In the Know: A Cluster Randomized Trial of an In-person Sexual Health Education Program Integrating Digital Technologies for Adolescents.

PURPOSE: Integrating digital technologies into sexual health education can offer advantages for connecting with adolescents, particularly populations who may be underserved through common school-based approaches. This study assessed the effectiveness of In the Know, an in-person, group-based sexual health education program integrating digital technologies, codesigned with adolescents. METHODS: The study design was a cluster randomized trial with 1,263 adolescents aged 13-19 in 95 cohorts, implemented in community-based organizations and schools throughout Fresno County, California. Participants completed a baseline survey and a follow-up survey 3 months later. Two-level mixed-effects regression models with random intercepts for cohort were used to estimate the intervention's impact on unprotected sex, use of clinical health services, knowledge of local sexual health services, technology use to find or schedule services, and sexual health knowledge at the 3-month follow-up. RESULTS: The average age of participants was 15.7 years, and the majority identified as Hispanic (71%). In adjusted analyses, intervention group participants were more likely to use clinical services (42.7% vs. 33.2%, p = .009) and reported greater sexual health knowledge at 3 months (57.6% of items answered correctly vs. 50.7%, p = .001). No significant differences were observed in the other outcomes by study group. DISCUSSION: In the Know participants demonstrated greater use of clinical health services and sexual health knowledge at 3 months. The study findings show the potential for incorporating user-centered design and technology into sexual health education to better support adolescents who may have limited access to this important information.

Implementation of a Booster Sexual Health Education Curriculum for Older Adolescents in Rural Communities.

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A "booster" round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

Maternal Adverse Childhood Experiences and Young Adult Latino Children's Mental Health.

INTRODUCTION: Maternal adverse childhood experiences have been linked to a variety of negative health outcomes in young children; however, young adults and, specifically, young adult Latinos have been vastly understudied. This study investigates the intergenerational pathway between maternal adverse childhood experiences and behavioral health outcomes of their young adult children, as mediated through young adults' own adverse childhood experiences and maternal depression. METHODS: Structural equation modeling was used to analyze data (in 2023) from mothers and their young adult children (n=398 dyads) enrolled in the Center for the Health Assessment of Mothers and Children of Salinas cohort, a primarily Latino agricultural sample. Maternal and young adult adverse childhood experiences were self-reported retrospectively during a visit at the age of 18 years (2018-2020). Young adult- and maternal-reported internalizing and maternal-reported externalizing behaviors were assessed at the age of 18 years with the Behavior Assessment for Children, second edition. Maternal depression was assessed during a visit at the age of 9 years (2010-2012) using the Center for Epidemiologic Studies Depression Scale. RESULTS: Maternal and young adult adverse childhood experiences were weakly but statistically significantly correlated (r=0.22). Maternal adverse childhood experiences were statistically significantly associated with maternal-reported youth internalizing symptoms (ß=0.29; 95% CI=0.19, 0.38; p<0.001) and externalizing symptoms (ß=0.24; 95% CI=0.14, 0.33; p<0.001) and marginally associated with youth-reported internalizing symptoms (ß=0.08; 95% CI= -0.02, 0.18; p=0.13). Youth adverse childhood experiences and maternal depressive symptomatology mediated the associations between maternal adverse childhood experiences and young adult outcomes. CONCLUSIONS: Findings demonstrate the potential impacts of adversity across generations in Latino immigrant families, an understudied population. Understanding the mechanisms and factors associated with these pathways may lead to strategies that prevent poor mental health outcomes in young adults.

Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study.

BACKGROUND: Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative. METHODS: This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains. RESULTS: Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals. CONCLUSIONS: This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.

Youth perceptions and concerns about sexually transmissible infections versus pregnancy: a qualitative comparative study in California.

BACKGROUND: Although rates of adolescent pregnancy have been declining for decades, rates of sexually transmissible infections (STIs) continue to increase among youth. Little is known about youth's comparative concern regarding pregnancy and STIs, particularly among marginalised populations. Therefore, this study compares concerns toward unplanned pregnancy and STIs and identifies underlying reasons for these differing concerns in youth populations with elevated rates of STIs. METHODS: Fourteen focus groups were held with 92 youth in two counties in California, USA. Youth were purposefully selected from community-based organisations and schools to represent a variety of backgrounds and populations with elevated rates of pregnancy and STIs. Qualitative coding and analysis were conducted using ATLAS.ti. 7.0. RESULTS: Almost all participants were youth of colour (86%), 27% identified as gay, lesbian or bisexual, and 21% had ever experienced homelessness. Although most youth were generally concerned about the consequences of contracting an STI, including the possible stigma associated with it, both males and females were more worried about an unplanned pregnancy. Emergent themes included varying concerns about the lasting consequences of unplanned pregnancies and STIs; greater visibility of pregnancy compared to infection; stigma; and limited STI prevention efforts compared to teen pregnancy prevention. CONCLUSIONS: By addressing the underlying concerns and varying perceptions that different groups of youth have toward STIs and pregnancy, prevention approaches and messages can be tailored, including by age, gender, sexual orientation, and for those exposed to vulnerable living situations. Additional efforts are needed to address increasing rates of STIs among young people.

Young people's romantic relationships and sexual activity before and during the COVID-19 pandemic.

BACKGROUND: Social distancing measures to reduce the spread of COVID-19 may profoundly impact young people's relationships. This study compared adolescent and young adults' romantic relationships and sexual activity before and after social distancing policies were enacted. METHODS: In June 2020, 351 youth participating in an ongoing intervention study in Fresno County, California completed an online survey about their experiences related to COVID-19. The survey included open and closed-ended questions about their romantic relationships, sexual activity, and online romantic or sexual interactions before and during social distancing restrictions. We used the chi-square test of independence to compare adolescent (ages 13-17) and young adults' (ages 18-21) responses. Results were also compared to responses in the intervention study's baseline survey. RESULTS: One-third (37%) of youth were dating or in a romantic relationship and 28% spent time in person with a partner early in the COVID-19 pandemic. Among those dating or in a relationship, 34% physically distanced from their partner due to parental restrictions related to COVID-19. Youth also spent less time in person with their partners during the pandemic than before. Although most youth (69%) were not sexually active before or during the pandemic, 22% had sex during the social distancing period. Young adults were more likely to spend time with their partners and have sex during the restrictions than adolescents. Most youth were not involved in sexting or online dating, before or during the pandemic. CONCLUSIONS: Adolescents and young adults have continued to engage in sexual and romantic relationships during the COVID-19 pandemic, although many reported physical distancing from their partners. Results suggest that youth continue to need access to sexual health education and services during emergencies such as the COVID-19 pandemic.