"Speak from a place of love": The family dynamics surrounding Black father-daughter sexual health communication.

INTRODUCTION: Parent-child sexual health communication reduces sexual risk behaviors among youth, which in turn lowers the transmission rate of HIV and sexually transmitted infections. Despite being a known protective factor, gender differences persist with mothers being more likely to discuss sexual health with their children than fathers. Although individual characteristics, interpersonal familial factors and societal norms (e.g., communication self-efficacy, parent-child closeness, and cultural and gender norms) are associated with Black parents' likelihood to communicate about sex with their children, the current study seeks to explore which of these factors found among Black mother-child or father-son dyads extend to Black father-daughter dyads and how this phenomenon (i.e., Black father-daughter sexual health communication) relates to family structure. METHODS: Seven father-daughter dyads (N = 7) and an additional five daughters (n = 5) in the United States completed individual in-depth semi-structured interviews. Daughters (Mage = 20.3) and fathers (Mage = 56.7) were biologically related, majority heterosexual, close, and lived together. Data were transcribed verbatim and analyzed using thematic analysis. RESULTS: Analysis revealed three themes centering around the role of authoritative parenting, the tactics and skills facilitating sexual health communication, and family structure. CONCLUSIONS: Black father-daughter sexual health communication is facilitated by close father-daughter relationships, non-authoritative parenting styles, and open, supportive, and non-judgmental communication. Fathers can be better supported in knowing how and when best to communicate sexual health messages, and to mitigate the possibly negative impacts on communication of divorce or having multiple children.

Familial sources of encouragement and breast-feeding practices among women participating in the US Special Supplemental Nutrition Programme for Women, Infants and Children.

OBJECTIVE: To explore how sources of familial encouragement are associated with breast-feeding initiation and duration among a national sample participating in the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: This study uses the 2013-2015 WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS-2) data. Breast-feeding initiation was measured at the first month, while duration was derived from a composite of the first 13 months. The analysis used logistic and linear regression to explore the association between encouragement sources and breast-feeding outcomes. SETTING: A nationally representative sample of WIC participants in the USA. PARTICIPANTS: WIC participants who completed the 13-month interview of the WIC ITFPS-2 (n 2807). RESULTS: Encouragement was significantly associated with both initiation and duration. Each source of encouragement was associated with a 3·2 (95 % CI 2·8, 3·8) increase in odds of initiating breast-feeding in the unadjusted model and 3·0 (95 % CI 2·5, 3·6) increased odds, controlling for age, education, nativity, poverty status, race and ethnicity (<0·0001). When predicting log duration, each percent increase in source of encouragement was associated with an increasing duration on average by 0·003 d (95 % CI 0·2, 0·3, <0·0001). When controls were added, it was associated with an increase of an average of 0·002 d (95 % CI 0·2, 0·3) per percent increase in encouragement source (<0·0001). CONCLUSIONS: Women who receive encouragement appear to be more likely to breastfeed. Additional work is needed to explore sources of encouragement and how to include them in intervention work.

'I told him I'm gonna get it': intimate partner birth control communication among homeless young women.

Homeless youth have disproportionately high rates of unintended pregnancy and STIs. Enhancing communication between sexual partners can improve sexual health outcomes, yet little is known about this topic among homeless youth; therefore, this study aimed to examine how homeless youth communicate with their partners about birth control. In-depth semi-structured interviews regarding intimate partner birth control communication were conducted with 10 homeless young women aged 14-22 years following their completion of a comprehensive sexual health program (Wahine Talk). We transcribed the interviews verbatim and used a structured, inductive analytic approach to identify themes. Analysis identified three themes: Getting the Conversation Started, Conversation Content, and Impact of Conversation. Birth control conversations were prompted by programme participation, birth control side effects, and family members' interest in homeless youth becoming pregnant. Barriers to communication included fear and mistimed conversations (e.g. during the initiation of sex). Homeless young people shared simultaneous desires to delay pregnancy and concerns about side effects of birth control use. Discussions about birth control with their partners may demonstrably improve homeless youth's intimate relationships and family planning efforts. Providers can support homeless young women by helping them plan conversation timing and addressing fear, including the risk of violence.

Opportunities and Challenges to Linkage to Housing in the Context of a Sexual and Reproductive Health Program for Youth Experiencing Homelessness.

Youth homelessness remains a major public health issue in the USA, and youth experiencing homelessness (YEH) are still one of the more understudied and underserved groups. Comprehensive sexual and reproductive health (SRH) programs for YEH are rare. Yet, such programs are potentially effective settings through which to link YEH with housing services. Wahine ("woman") Talk is one such comprehensive program for YEH, and is a multilevel intervention delivered out of a youth drop-in center in Honolulu, Hawai 'i. One of Wahine Talk's core components is addressing basic needs, including providing linkages to housing services. Little research exists on SRH programs' opportunities and challenges to providing linkage to housing for YEH. The current study is an exploratory study asking, "What are opportunities and challenges to linking young women experiencing homelessness to housing services through a comprehensive sexual and reproductive health program?" The study team collected in-depth qualitative data through seven focus groups and 25 individual interviews with Wahine Talk staff and youth participants aged 14-22 years. Multiple team members analyzed the data using template analysis. The analysis revealed that while comprehensive SRH programs may have some opportunities and challenges to linking YEH to housing services that are consistent with traditional housing assistance programs, there are also factors specific to SRH programs. In particular, opportunities would be SRH programs employing a housing staff person and bolstering staff-youth meetings and communication. A challenge specific to SRH programs would be prioritizing youth's reproductive justice (i.e., choice) in lieu of solely prioritizing pregnancy reductions and delays; thus, it is recommended to train staff to prioritize youth's reproductive justice. The findings highlight the importance of SRH programs having staff focused on housing, sufficient opportunities for youth and staff to communicate with each other, and staff trained to prioritize youth's reproductive justice.

Assessing the Implementation of an LGBTQ+ Mental Health Services Training Program to Determine Feasibility and Acceptability During the COVID-19 Pandemic.

Despite significant social and legal progress, LGBTQ+ (lesbian, gay, bisexual, transgender, and other sexual and gender minority) populations continue to experience higher rates of mental health and substance use disorders than their heterosexual and cisgender counterparts. Effective LGBTQ+ affirmative mental health care is essential for addressing these disparities but is often limited and difficult to access. The shortage of LGBTQ+ affirmative mental health care providers results from the absence of required and accessible LGBTQ+-focused training and technical assistance opportunities for mental health care professionals. This study evaluates the implementation of our COVID-19 adapted, completely virtual, organization- and therapist-focused training program to improve the mental health workforce's cultural competence in working with the LGBTQ+ community: the Sexual and Gender Diversity Learning Community (SGDLC). Guided by an expanded RE-AIM model, we used administrator and therapist feedback to assess SGDLC implementation factors to understand how it may be best translated for scaled-up promotion and widespread adoption. Assessment of the initial reach, adoption, and implementation of the SGDLC indicated that it had strong feasibility; reports on satisfaction and relevance support the SGDLC's acceptability. Maintenance could not be fully assessed from the short study follow-up period. Still, administrators and therapists expressed an intent to continue their newfound practices, a desire for continued training and technical assistance in this area, but also concerns about finding additional opportunities for this education.

"I Need to Get My Culture Back": Youth and Provider Perspectives on Integrating Culturally Based Approaches into Sexual and Reproductive Health Programs for Native Hawaiian and Pacific Islander Youth Experiencing Homelessness.

There is growing interest in decolonizing sexual and reproductive health (SRH) and embedding cultural practices into social and medical services in Hawai'i. Wahine ("woman") Talk is a multilevel, comprehensive SRH program for female youth experiencing homelessness (YEH) led by community health, social work, and medical providers. This study examines youth and program provider perspectives of culturally based approaches that may strengthen SRH programs. The study team conducted three focus groups and ten in-depth interviews with participating youth and program providers after the program's conclusion. Youth participants were aged 14 to 22 years (M = 18.1) and of Native Hawaiian or Pacific Islander ancestry. Interview transcripts were analyzed using structured thematic analysis. The youth described feeling estranged from their ancestral cultures and suggested incorporating multiple cultural practices to enhance their connection to community, body, and land into SRH programming for YEH. They identified several 'aina ("land")-based approaches, hands-on learning, hula, and language as possible practices to weave into the program. While youth felt estranged from their ancestral cultures, they discussed Native Hawaiian and Pacific Islander health perspectives where 'aina and relationships are considered life-sustaining. Youth and program staff stressed incorporating culture respectfully, caring for the whole person, and providing trauma-informed care. Future policy, practice, and research should consider protecting and integrating Native Hawaiian conceptions of health into SRH policy and practice and include youths' cultural identities in SRH intervention development.

Practical Guidance for the Development of Rosie, a Health Education Question-and-Answer Chatbot for New Mothers.

Communities of color experience higher maternal and infant mortality, as well as a host of other adverse outcomes, during pregnancy and postpartum. To address this, our team is developing a free, user-friendly, question-answering chatbot called Rosie. Chatbots have gained significant popularity due to their scalability and success in individualizing resources. In recent years, scientific communities and researchers have started recognizing this technology's potential to inform communities, promote health outcomes, and address health disparities. The development of Rosie is an interdisciplinary project, with teams focused on the technical build of the application (app), the development of machine learning models, and community outreach, making Rosie a chatbot built with the input from the communities it aims to serve. From June to October 2022, more than 20 demonstration sessions were conducted in Washington, District of Columbia, Maryland, and Virginia, where a total of 109 pregnant women and new mothers of color could interact with Rosie. Results from the live demonstrations showed that 75% of mothers searched for maternity and baby-related information at least once a week and more than 90% of participants expressed the likelihood to use the app. Most of the participants inquired about their baby's development, nutrition for babies, and identifying and addressing the causes of certain symptoms and conditions, accounting for about 80% of the total questions asked. Mother-related questions in the community demonstrations were mainly about pregnancy. The high level of interest in the chatbot is a clear indication of the need for more resources. Rosie aims to help close the racial gap in maternal and infant health disparities by providing new mothers with easy access to reliable health information.

LGBTQ+ cultural-competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial.

Lesbian, gay, bisexual, transgender, queer/questioning and other sexual and gender diverse (LGBTQ+) persons frequently lack access to mental health service organizations (MHOs) and therapists who are competent with LGBTQ+ clients. Existing continuing education programmes to better equip therapists to work with LGBTQ+ clients are often not widely accessible or skills focused, evaluated for effectiveness and inclusive of MHO administrators who can address the organizational climate needed for therapist effectiveness. A virtual, face-to-face, multi-level (administrators and therapists) and multi-strategy (technical assistance, workshop and clinical consultations) LGBTQ+ cultural competence training-the Sexual and Gender Diversity Learning Community (SGDLC)-was tested in a pilot randomized controlled trial. Ten organizations were randomly assigned to the intervention (SGDLC plus free online videos) or control (free online videos only) group. Pretest/posttest Organization LGBTQ+ Climate Surveys (n = 10 MHOs) and pretest/posttest Therapist LGBTQ+ Competence Self-Assessments (n = 48 therapists) were administered. Results showed that at pretest, average ratings across organization LGBTQ+ climate survey items were low; twice as many items improved on average in the intervention (10/18 items) than control (5/18 items) group organizations. At pretest, therapist average scores (range 0-1) were highest for knowledge (0.88), followed by affirmative attitudes (0.81), practice self-efficacy (0.81), affirmative practices (0.75) and commitment to continued learning (0.69). Pretest/posttest change scores were higher for the intervention relative to the control group regarding therapist self-reported affirmative attitudes (cumulative ordinal ratio [OR] = 3.29; 95% confidence interval [CI] = 1.73, 6.26), practice self-efficacy (OR = 5.28, 95% CI = 2.00, 13.93) and affirmative practices (OR = 3.12, 95% CI = 1.18, 8.25). Average therapist and administrator satisfaction scores were high for the SGDLC. These findings suggest the SGDLC training can affect organizational- and therapist-level changes that may benefit LGBTQ+ clients.

Experiences of the COVID-19 pandemic among young parents with foster care backgrounds: A participatory action PhotoVoice study.

The COVID-19 pandemic has had a disproportionate impact on many vulnerable populations, including youth in foster care and parents of young children. In this study, we worked with nine parenting current and former foster youth to share their experiences of the COVID-19 pandemic through photography. Data were collected between January and March 2021 during a series of three virtual PhotoVoice sessions, then transcripts of PhotoVoice sessions and participant-selected captioned photographs were analyzed using thematic analysis. Themes in participants' photographs included 1) Pandemic Parenting and 2) Making the Best of It. Findings indicate the need to expand mental health services, protect essential workers, and ensure young parents receive support navigating medical and social welfare systems and the process of receiving pandemic relief-related benefits.

"Having a Baby Can Wait": Experiences of a Sexual and Reproductive Health Promotion Program in the Context of Homelessness among Asian American, Native Hawaiian, and Other Pacific Islander Youth Captured Through PhotoVoice.

Nearly half of female youth experiencing homelessness (YEH) become pregnant due to myriad individual, family, community, and structural factors. In response, our team developed and tested Wahine ("woman") Talk, a multilevel, trauma-informed sexual and reproductive health intervention created with and for female YEH aged 14 to 22. After Wahine Talk, youth were invited to participate in a participatory action PhotoVoice project regarding experiences of the program, waiting to start or expand their families, and homelessness. Photographs were taken and captioned by youth, and then further examined through Thematic Analysis. Final project themes include (a) Youth-Driven Birth Timing Decisions; (b) A Sense of Place: Finding Safe Spaces; and (c) Glimpsing Hope. Because YEH live under society's radar, it is critical to understand their experiences from their own perspectives to improve interventions at multiple levels. Implications for meeting the needs of YEH in the areas of reproductive justice, financial stability, and affordable housing are discussed.

Birth Control Access and Selection among Youths Experiencing Homelessness in the United States: A Review.

Youths experiencing homelessness (YEH) become pregnant at five times the general population rate. Education, social, and health care systems struggle to adequately address this young community's sexual and reproductive health needs, yet social workers are well positioned across sectors to address their sexual and reproductive health and well-being. A growing body of literature exists on the factors affecting YEH's access and selection of birth control, prompting the present review that aimed to understand this process and inform better attuned sexual and reproductive health approaches. Using a systematic search and analytic approach, we retrieved 203 articles, of which 23 met inclusion criteria. Key findings emerged across socioecological levels, including barriers and facilitators to condom use; the differential impact on YEH of hormonal birth control side effects; and the devastating effects of economic insecurity leading to sexual exploitation, survival sex, and exposure to violence. Implications include the need for multilevel intervention that addresses youths' knowledge, attitudes, and behavior as well the need to improve social norms and system design to provide better attuned care for YEH.

"Even if you think you can trust them, don't trust them": An exploratory analysis of the lived experiences of sexual health among sexual minority girls in foster care.

Girls in foster care are at heightened risk for poor sexual health outcomes compared to their general population counterparts. Sexual minority girls are also at greater risk for poor sexual health compared to their heterosexual counterparts. Yet, little is known about the sexual health of sexual minority girls in foster care. This study aims to provide a preliminary understanding of how sexual minority girls in foster care experience the phenomenon of sexual health. Using a single-case interpretative phenomenological analysis (IPA) design, we interviewed five sexual minority girls in foster care using a single in-depth focus group discussion and analyzed the data using a series of IPA steps. Analysis revealed three major themes about the lived experiences of sexual health among sexual minority girls in foster care: fear of being victimized and distrust within sexual relationships, self-protection from sexual relationship harm, and sexual health communication. Further research is warranted to investigate the sexual health experiences and needs of sexual minority girls in foster care, with particular sensitivity to the potential impact of past sexual victimization and abuse on their sexual health and wellbeing.

IMPLEMENTING AN ATTACHMENT-BASED PARENTING INTERVENTION WITHIN HOME-BASED EARLY HEAD START: HOME-VISITORS' PERCEPTIONS AND EXPERIENCES.

Implementation of evidence-based interventions in "real-world" settings is enhanced when front-line staff view the intervention as acceptable, appropriate, and feasible. This qualitative study addresses Early Head Start (EHS) home visitors' perceptions and experiences of an evidence-based parenting intervention, the Attachment and Biobehavioral Catch-up program (M. Dozier, O. Lindhiem, & J. Ackerman, 2005), when added to EHS services as usual within the context of a research-practice partnership. Thematic analysis of in-depth, qualitative interviews indicates that home visitors experienced the intervention as positive and helpful for EHS families. Some challenges included scheduling and uncertainty regarding the goals of the intervention. Concerns over participation in the research centered on information exchange, confidentiality, and time limitations.

FIRST-GENERATION LATINA MOTHERS' EXPERIENCES OF SUPPLEMENTING HOME-BASED EARLY HEAD START WITH THE ATTACHMENT AND BIOBEHAVIORAL CATCH-UP PROGRAM.

This qualitative pilot study examined first-generation Latina mothers' experiences of supplementing home-based Early Head Start (EHS) services with the evidence-based Attachment and Biobehavioral Catch-up (ABC; M. Dozier, O. Lindheim, & J. Ackerman, 2005) program. Ten low-income, first-generation Latina mothers with infants and toddlers enrolled in home-based EHS were provided 10 ABC home visits by a supplemental parent coach. Following delivery of ABC, mothers participated in in-depth, semistructured, qualitative interviews about their experiences. Interview themes included positive experiences of both EHS and the ABC, a high value placed on receiving both programs, and cultural relevance of the ABC program for Latino families. Participants offered several suggestions for improved program delivery. Study findings suggest that a model of EHS supplemented by ABC delivered to the Latino community is feasible, valuable to participants, and culturally relevant. Considerations for sustainability of this supplemental model are discussed.

Resilient Infant Feeding Among Young Women With Histories of Maltreatment and Poor Support.

OBJECTIVE: To explore how young women with histories of maltreatment describe their experiences and decisions around infant feeding. DESIGN: Secondary qualitative analysis using supplementary analysis. SETTING: Washington, DC; Baltimore, MD; and their respective suburbs. PARTICIPANTS: Young women with histories of being abused or neglected as children or adolescents and who gave birth to one child before age 19 years (N = 9). METHODS: We collected data through in-depth semistructured interviews and analyzed them using reflexive thematic analysis. RESULTS: The analysis resulted in three themes: Infant Feeding Intention, Identifying Challenges and Persistence, and Pivoting to What Is Feasible. Participants felt that breastfeeding was valuable and wanted to be able to breastfeed their children. They continued to provide human milk through painful latches and a lack of support and guidance, but formula became the only viable option for many of them. CONCLUSION: Despite wanting to breastfeed and continuing through barriers, many participants could not continue to breastfeed as long as they wanted because of a systemic lack of support. These findings indicate a need to support young women with histories of maltreatment through increased and consistent access to lactation support providers and trauma-informed care. Nurses and other clinicians are uniquely positioned to support young women with histories of maltreatment to overcome barriers related to breastfeeding.

Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study.

BACKGROUND: Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. OBJECTIVE: In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. METHODS: Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ≥14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52% received the Rosie app) or control group (14/29, 48% received a children's book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie's knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial's sample size calculations. RESULTS: Of 41 individuals who were screened and eligible, 31 (76%) enrolled and 29 (71%) were retained in the study. More than 87% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33%) or weekly (8/15, 53%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93%) and provided responses quickly (13/15, 87%). The remaining issues identified included crashing of the app (8/15, 53%), and users were not satisfied with some of Rosie's answers (12/15, 80%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9%) compared with control group members (3/13, 23%). Nonetheless, no between-group differences reached statistical significance at P<.05. CONCLUSIONS: Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot's ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. TRIAL REGISTRATION: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515.