Examining Sexual Health Organizational Networks in Urban African American Communities Using Social Network Theory.

PURPOSE: Collaboration among organizations offering sexual health and youth development services has the potential to provide youth with effective sexual health support. However, formally structured efforts (eg, coalition formation) may be impractical or unsuitable for low-income communities where resources are often already limited. Social network theories provide an alternative approach for building collaborative organizational networks. APPROACH: Research aims to evaluate the barriers and facilitators to collaboration in sexual health organizational networks. SETTING: Organizations in low income, urban, communities in Chicago and San Francisco that serve African American adolescents. PARTICIPANTS: Providers (n = 22) from organizations that offer sexual health services and youth development services. METHODS: Focus groups (n = 4) were conducted and analyzed utilizing a combination of coding strategies. RESULTS: Barriers to collaboration included resource limitations and competition, differences in organizational roles and deliverables, and prejudice and stigma. Identifying common ground among organizations was found to be a facilitator to collaboration. Social network concepts in conjunction with study findings lead to the development of a practice model that hypothesizes a pathway for organizations to improve collaboration without formally structured efforts. CONCLUSION: Our findings offer ways to encourage collaboration among organizations that support youth sexual health in low-income, urban, African American communities without relying on formal structures. Such collaborations may be critical for improving the provision of comprehensive sexual health support.

Probiotic Supplementation for Promotion of Growth in Undernourished Children: A Systematic Review and Meta-Analysis.

OBJECTIVES: Probiotic supplementation has been proposed as a therapeutic intervention to improve growth outcomes in children with undernutrition. The objective of this review is to synthesize the current evidence on probiotic supplementation for promotion of growth in undernourished children. METHODS: We searched MEDLINE, Cochrane CENTRAL, CINAHL, Embase, LILACS, and Scopus for randomized controlled trials (RCTs) that administered probiotics or eligible comparators to undernourished children below 5 years of age. Our primary outcomes of interest were weight-for-age, height-for-age, and weight-for-height at the longest follow-up points reported. Random-effects meta-analysis was used to calculate standardized mean differences (SMD) for continuous outcomes and risk ratios for dichotomous outcomes. The Grading of Recommendations Assessment, Development and Evaluation criteria were used to assess certainty of the evidence. RESULTS: Nine RCTs with 5295 children in total were included. Durations of treatment ranged from 1 month to 1 year. Pooled analyses from 7 studies showed that probiotics may have little to no effect on weight-for-age (SMD 0.05 standard deviation [SD], 95% CI: -0.04 to 0.13, n = 2115 children; low-certainty evidence) and height-for-age (SMD -0.04 SD, 95% CI: -0.14 to 0.07, n = 1357 children; low-certainty evidence). The evidence was very uncertain about the effect on weight-for-height. CONCLUSIONS: Probiotics may have little to no effect on anthropometry in undernourished children, though there is considerable heterogeneity among the trials reviewed thus far. The interaction between gut microbiota and human nutrition is complex, and further research is needed to determine how the gut microbiome may contribute to undernutrition and how probiotics may affect growth in this vulnerable population.

The Effect of Consumption of Animal Milk Compared to Infant Formula for Non-Breastfed/Mixed-Fed Infants 6-11 Months of Age: A Systematic Review and Meta-Analysis.

Many infants do not receive breastmilk for the recommended 2-year duration. Instead, alternative milk beverages are often used, including infant formula and raw animal milk products. The purpose of this systematic review was to summarize the effect of animal milk consumption, compared to infant formula, on health outcomes in non-breastfed or mixed-fed infants aged 6-11 months. We searched multiple databases and followed Cochrane guidelines for conducting the review. The primary outcomes were anemia, gastrointestinal blood loss, weight-for-age, length-for-age, and weight-for-length. Nine studies were included: four randomized controlled trials (RCT) and five cohort studies. All studies, except one, were conducted in high income countries. There was a low certainty of evidence that cow's milk increased the risk of anemia compared to formula milk (Cohort studies RR: 2.26, 95% CI: 1.15, 4.43, RCTs: RR: 4.03, 95% CI: 1.68, 9.65) and gastrointestinal blood loss (Cohort study RR: 1.52, 95% CI: 0.73, 3.16, RCTs: RR: 3.14, 95% CI: 0.98, 10.04). Additionally, there was low certainty evidence that animal milk consumption may not have a differential effect on weight and length-for-age compared to formula milk. Overall, the evidence was of low certainty and no solid conclusions can be drawn from this data. Further studies are needed from low- and middle-income countries to assess optimal milk type in non-breastfed infants aged 6-11 months.

Implementation problems and adaptations among organizations delivering school-based dental sealant programs.

OBJECTIVES: Although research supports the effectiveness of school-based dental sealant programs (SBDSPs) in increasing access to dental care and reducing dental caries, there is limited information on the implementation processes that impact success at the population level. This study assessed SBDSP program implementation in terms of problems (and adaptations) encountered during school and client (students) recruitment, client attendance, and workforce capacity. These four factors are necessary for reaching eligible youth. METHODS: We interviewed program personnel (n = 18) at five organizations delivering SBDSPs in Oregon in 2018. Qualitative analysis employed a directed content approach. RESULTS: Specific implementation problems included the following: school recruitment: workforce limitations, school refusals, community objections; client recruitment: ineffective recruitment materials, poor parent/guardian engagement, consent form shortcomings, poor consent forms dissemination and return, low school cooperation; client attendance: poor school cooperation, physical barriers, scheduling conflicts; workforce capacity: insufficient size, high turnover. Participants reported that their respective organizations successfully adapted to resolve these implementation problems with some exceptions (e.g., insufficiencies in workforce capacity). CONCLUSION: Implementation problems related to school and client recruitment, client attendance, and workforce capacity may impact SBDSP reach. Adaptations to address these problems provide a basis for specific program recommendations. Larger systemic and translational problems were also observed, and recommendations were made regarding organizational communication and the need for additional pre-implementation planning and pilot testing.

National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey.

BACKGROUND: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. OBJECTIVE: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. METHODS: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). RESULTS: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. CONCLUSIONS: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.

Pre-Exposure Prophylaxis (PrEP) Dissemination: Adapting Diffusion Theory to Examine PrEP Adoption.

PrEP adoption among African-American men-who-have-sex-with-men (AAMSM) remains low. We applied Diffusion-of-Innovations (DOI) theory to understand PrEP adoption processes among young HIV-negative/status unknown AAMSM (AAYMSM; N = 181; 17-24 years). Quantitative and qualitative analyses were used to examine predictors of PrEP diffusion stages. Most AAYMSM were in the persuasion stage (PrEP-aware, hadn't adopted; 72.4%). Our results suggest that model antecedents are DOI stage-specific. PrEP awareness (knowledge stage) was associated with lower levels of social stigma (p < .03) and greater health literacy (p < .05), while sexual risk (p < .03) and education (p < .03) predicted PrEP adoption (12.2%). PrEP efficacy and side effects were primary innovation characteristics influencing adoption receptivity in the persuasion stage. Interventions to improve PrEP diffusion should be tailored to stage-specific antecedents depending on how a community is stratified across the DOI stages.

RESUMEN: La adopción de Pre-exposición Profilaxis (PrEP) entre hombres afroamericanos que tienen relaciones sexuales con otros hombres (HASH) sige baja. Aplicamos la teoría de la difusión de innovaciones para comprender los procesos de adopción de la PrEP entre los hombres jóvenes afroamericanos que tienen relaciones sexuales con otros hombres (HJASH) VIH negativos/estado desconocido (HJASH; N = 181; 17­24 años). Se utilizaron análisis cuantitativos y cualitativos para examinar los predictores de las etapas de difusión de PrEP. La mayoría de los HJASH se encontraban en la etapa de persuasión (conscientes de la PrEP, no la habían adoptado; 72.4%). Nuestros resultados sugieren que los antecedentes del modelo son específicos de la etapas de la difusión de innovaciones. La conciencia de la PrEP (etapa de conocimiento) se asoció con niveles más bajos de estigma social (p <.03) y una mayor alfabetización en salud (p <.05), mientras que el riesgo sexual (p <.03) y la educación (p < .03) predijeron la adopción de la PrEP (12.2%). La eficacia y los efectos secundarios de la PrEP fueron las principales características de la innovación que influyeron en la receptividad de la adopción en la etapa de persuasión. Las intervenciones para mejorar la difusión de la PrEP deben adaptarse a los antecedentes específicos de la etapa, dependiendo de cómo se estratifique una comunidad en las etapas del la difusión de innovaciones.

Shifting Coronavirus Disease 2019 Testing Policy and Research to Include the Full Translation Pipeline.

The current severe acute respiratory syndrome coronavirus 2 testing policy and practice limits testing as a prevention tool. Radical shifts are required to increase the scale of rapid testing strategies and improve dissemination and implementation of venue-based and self-testing approaches. Attention to the full translation pipeline is required to reach high-risk segments of the population.

Effect of consumption of animal milk compared to infant formula for non-breastfed/mixed-fed infants 6-11 months of age: a systematic review (protocol).

INTRODUCTION: Prevalence rates of breastfeeding remain low even though the World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breast feeding for the first 6 months of life in combination with appropriate complementary feeding beyond six 6 months of age. There have been several studies that address the implication of drinking animal milk and/or infant formula on children's health and development when breast feeding is not offered during the first year of life. Vast improvements have been made in infant formula design, which may increase its benefits compared with animal's milk. The objective of this review is therefore to synthesise the most recent evidence on the effects of the consumption of animal milk compared with infant formula in non-breastfed or mixed breastfed infants aged 6-11 months. METHODS AND ANALYSIS: We will conduct a systematic review and meta-analysis of studies that assessed the effect of animal milk compared with formula or mixed-fed (breastmilk and formula) on infants aged 6-11 months. The primary outcomes of interest include anaemia, gastrointestinal blood loss, weight for age, height for age and weight for height. We will include randomised and non-randomised studies with a control group. We will use the Cochrane risk of bias tools to assess the risk of bias. We will use meta-analysis to pool findings if the identified studies are conceptually homogenous and data are available from more than one study. We will assess the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. ETHICS AND DISSEMINATION: This is a systematic review, so no patients will be directly involved in the design or development of this study. The findings from this systematic review will be disseminated to relevant patient populations and caregivers and will guide the WHO's recommendations on formula consumption versus animal milk in infants aged 6-11 months. TRIAL REGISTRATION NUMBER: CRD42020210925.

Use of effective training and quality assurance strategies is associated with high-fidelity EBI implementation in practice settings: a case analysis.

High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.

Overcoming cultural barriers to implementing oral HIV self-testing with high fidelity among Tanzanian youth.

Tanzanian youth have high levels of HIV risk and poor access to HIV-testing. Oral self-implemented testing (Oral-SIT) provides an alternative that reduces barriers to HIV-testing. We examined adaptations to Oral-SIT training components in a randomized experiment to evaluate a "train-the-trainer" strategy for improving comprehension of graphic training materials. Participants (N = 257, age = 14-19 years) were randomly assigned to one of two self-training conditions: graphic instruction book (GIB) or Video-GIB. Outcomes included behavioral performance fidelity, self-reported comprehension, and intentions to seek treatment. Video-GIB participants, relative to GIB-only participants, had higher performance fidelity scores, made fewer performance errors, had better instruction comprehension, and were more likely to intend to seek treatment. Oral-SIT timing errors were significantly more common among GIB-only participants. Graphic training materials in conjunction with a "train-the-trainer" video has significant potential for increasing Oral-SIT's reach by overcoming technological and literacy barriers.

Probiotic Supplementation for Promotion of Growth in Children: A Systematic Review and Meta-Analysis.

Probiotics are commonly prescribed to promote a healthy gut microbiome in children. Our objective was to investigate the effects of probiotic supplementation on growth outcomes in children 0-59 months of age. We conducted a systematic review and meta-analysis which included randomized controlled trials (RCTs) that administered probiotics to children aged 0-59 months, with growth outcomes as a result. We completed a random-effects meta-analysis and calculated a pooled standardized mean difference (SMD) or relative risk (RR) and reported with a 95% confidence interval (CI). We included 79 RCTs, 54 from high-income countries (HIC), and 25 from low- and middle-income countries (LMIC). LMIC data showed that probiotics may have a small effect on weight (SMD: 0.26, 95% CI: 0.11-0.42, grade-certainty = low) and height (SMD 0.16, 95% CI: 0.06-0.25, grade-certainty = moderate). HIC data did not show any clinically meaningful effect on weight (SMD: 0.01, 95% CI: -0.04-0.05, grade-certainty = moderate), or height (SMD: -0.01, 95% CI: -0.06-0.04, grade-certainty = moderate). There was no evidence that probiotics affected the risk of adverse events. We conclude that in otherwise healthy children aged 0-59 months, probiotics may have a small but heterogenous effect on weight and height in LMIC but not in children from HIC.

Oral HIV Self-Implemented Testing: Performance Fidelity Among African American MSM.

Oral-Self Implemented HIV Testing (Oral-SIT) offers a low-cost way to extend the reach of HIV testing systems. It is unclear, however, if high risk populations are able to perform the test with high fidelity. Using a simulation-based research design, we administered desensitized Oral-SIT kits to African American MSM (AAMSM; 17-24 years, N = 178). Participants were HIV negative or never tested, and had never self-administered an Oral-SIT kit. We assessed performance fidelity, and hypothesized antecedents. High levels of social stigma were associated with lower levels of training knowledge (Range = No Errors: 51.9%, 4 Errors: 0.6%) and performance fidelity (Range = No Errors: 39.9%, 3 Errors: 1.7%). Training knowledge and prior testing history were positively associated with performance fidelity. The present work extends research on HIV-related social stigma and suggests that social stigma inhibits knowledge acquisition and task performance. The Oral-SIT training materials were understood by individuals with a wide-range of educational backgrounds. Interventions are needed, however, to further improve Oral-SIT performance fidelity.

"You've Gotta be Careful": Familial Messages Regarding Sexual Behavior and Sexual Relationships among African American Adolescents.

BACKGROUND: Research on the sexual behaviors of African American youth has primarily focused on associated risks, with a dearth of studies examining a fuller representation of African American adolescents' sexual lives. This study explored the range of messages African American adolescents receive from family members regarding sexual behavior and sexual relationships. METHODS: Participants were 52 sexually experienced African American youth (male = 32, female = 20) between the ages of 15 and 17 recruited from community-based organizations in the United States. Youth participated in individual in-depth qualitative interviews, and data were analyzed using a phenomenological framework. RESULTS: Participants received a variety of messages about sexual behavior and sexual relationships from a range of family members including parents, siblings, grandmothers, aunts/uncles, and cousins. Types of messages clustered into three domains: sexual decision-making, quantity and quality of sexual activity, and sexual health promotion; with themes and sub-themes emerging within each area. CONCLUSION: Gender differences in the types of messages received are explored, and applications of the findings to the development of family-involved community interventions that promote sexual and reproductive health are discussed.

Immunology beliefs as a factor in vaccine opposition among complementary and alternative medical providers.

OBJECTIVES: Parental pediatric vaccine decisions are influenced by parents' health provider networks. Complementary and alternative medical providers may be key influences in the networks of those parents who do not vaccinate their children. METHODS: From March to July 2013, we conducted semi-structured interviews of Oregon complementary and alternative medical providers (N = 36) in five disciplines likely to treat parents or children, or both, and whose practitioners are known to express opinions about vaccines and vaccination. We interviewed them concerning their immunology beliefs, vaccine positions, and what these providers recommend to their patients concerning vaccines. We conducted face-to-face interviews and analyzed the interview data using thematic analysis methodology. RESULTS: This article identifies the range and type of immunological beliefs of complementary and alternative medical providers concerning pediatric vaccine recommendations. From repeated readings of the data, we identified three areas of alternative immunological beliefs among complementary and alternative medical providers (i.e. "natural is best," "innate intelligence," and "the fragile immune system"). In addition, complementary and alternative medical providers who embraced mainstream medicine were likely to be vaccine accepters and to mention vaccines as a positive health measure to their patients-these themes were "vaccines prevent illness" and "herd immunity." CONCLUSION: Complementary and alternative medical providers influence their patients' vaccination decisions, particularly urging caution or complete vaccine avoidance, and may be a major influence in states like Oregon with high non-medical exemption rates. Complementary and alternative medical providers come to their anti-vaccine positions largely through post-graduation continuing education courses and seminars. In Oregon, such courses are unregulated and not vetted.

Impact of Human Resources on Implementing an Evidence-Based HIV Prevention Intervention.

Evidence-based interventions (EBIs) often require competent staff, or human resources (HR), for implementation. The empirical evidence characterizing the influence of HR fluctuations on EBI delivery is limited and conflicting. Using the Interactive Systems Framework, we explored staff fluctuation and the subsequent influence on RESPECT, an HIV prevention EBI. We conducted interviews with staff in two waves (n = 53, Wave I; n = 37, Wave II) in a national sample of organizations delivering RESPECT (N = 29). We analyzed interviews qualitatively to describe changes among RESPECT staff and explore the subsequent influences on RESPECT implementation. Organizations reported downsizing, turnover, and expansion of staff positions. Staff changes had multiple influences on RESPECT implementation including clients reached, fidelity to specific RESPECT protocols, and overall sustainability of RESPECT over time. HR fluctuations are common, and our analyses provide an initial characterization of the relationship between HR fluctuation and EBI implementation. Given the prominent influence of HR on EBI implementation, the Interactive Systems Framework is a useful guiding tool for future examinations.

HIV Self-Testing: a Review of Current Implementation and Fidelity.

Oral HIV self-testing is an innovative and potentially high-impact means to increase HIV-case identification globally. As a screening test, oral HIV self-testing offers the potential for increased adoption through greater convenience and privacy, and the potential to increase the proportion of the population who test regularly. Research on how best to translate the innovation of oral self-testing to high-risk populations is underway. Currently only one oral HIV self-test kit is FDA-approved (OraQuick In-Home HIV Test) and available for retail sale. In the present report we review recent studies on the dissemination, adoption, and implementation of oral HIV testing. Prior work has focused primarily on adoption, but recent studies have begun to identify methods for improving dissemination and problems associated with self-implementation. At present a major barrier to wider adoption is the relatively high retail cost of the oral HIV test kit. Significant but minor barriers are represented by overly complex instructional materials for some population segments, and dissemination programs of unknown efficacy. Theoretical and practical suggestions for conducting research on dissemination, adoption, and implementation of oral HIV testing are discussed.

Self-implemented HIV testing: perspectives on improving dissemination among urban African American youths.

We examined the potential for increasing the reach of HIV testing to African American youths through the dissemination of oral-HIV testing. From 2012 through 2013 we examined the perceptions of alternatives to pharmacy dissemination of SITs in African American youths (5 focus groups) and service providers (4 focus groups), and conducted an ethnographic study of pharmacies (n = 10). Participants perceived significant advantages to delivering SITs through community health and services for adolescents (e.g., increased confidentiality, reduced stigma) over pharmacy dissemination. Given proper attention to fit, SIT dissemination could be facilitated through distribution by health and social service sites, and by improving elements of pharmacy dissemination.

Nonprobability and probability-based sampling strategies in sexual science.

With few exceptions, much of sexual science builds upon data from opportunistic nonprobability samples of limited generalizability. Although probability-based studies are considered the gold standard in terms of generalizability, they are costly to apply to many of the hard-to-reach populations of interest to sexologists. The present article discusses recent conclusions by sampling experts that have relevance to sexual science that advocates for nonprobability methods. In this regard, we provide an overview of Internet sampling as a useful, cost-efficient, nonprobability sampling method of value to sex researchers conducting modeling work or clinical trials. We also argue that probability-based sampling methods may be more readily applied in sex research with hard-to-reach populations than is typically thought. In this context, we provide three case studies that utilize qualitative and quantitative techniques directed at reducing limitations in applying probability-based sampling to hard-to-reach populations: indigenous Peruvians, African American youth, and urban men who have sex with men (MSM). Recommendations are made with regard to presampling studies, adaptive and disproportionate sampling methods, and strategies that may be utilized in evaluating nonprobability and probability-based sampling methods.