Looking Cool, Doing Tricks, Managing Stress, and Nicotine Addiction: Youth Perspectives on Nicotine Vaping and Implications for Prevention.

PURPOSE: To understand the contextual and psychosocial factors associated with youth vaping in Colorado, the state with the highest youth vaping rates in 2019, and to propose strategies for prevention interventions. DESIGN: Focus groups. SETTING: In-person. PARTICIPANTS: 24 youth aged 11-17, including youth who had vaped (n = 11) and who had never vaped (n = 13). METHOD: Qualitative responses using a semi-structured focus group guide were analyzed using a matrix approach with a mixed deductive/inductive content analysis. RESULTS: Analysis revealed the highly social nature of vaping initiation and use; the use of vaping to control negative emotions; and the acquisition of vaping products through retail outlets, friends, family, and other youth who sell a variety of substances and devices to youth. Youth provided insight into how vaping is concealed from parents and teachers, and their attitudes about the health risks and benefits of vaping. CONCLUSION: When considered with other studies, our findings suggest a universality in the youth vaping experience that is highly social. Interventions should include peer-to-peer messaging with an emphasis on changing social norms and highlighting undesirable outcomes of vaping such as negative reactions by friends and close adults, adverse effects on athletic success and future aspirations, expense, addiction, and punishment. Parent education is also recommended. Rigorous research is needed to test interventions to reverse the growing trend of youth vaping.

Centering culture in an mHealth adaptation of an alcohol-exposed pregnancy prevention program for American Indian Youth.

Native WYSE CHOICES adapted an Alcohol Exposed Pregnancy (AEP) prevention curriculum for mobile health delivery for young urban American Indian and Alaska Native (AIAN) women. This qualitative study explored the relevance of culture in adapting a health intervention with a national sample of urban AIAN youth. In total, the team conducted 29 interviews across three iterative rounds. Participants expressed interest in receiving culturally informed health interventions, were open to cultural elements from other AIAN tribes, and highlighted the importance of culture in their lives. The study underscores why community voices are central in tailoring health interventions for this population.

Grounding evidence-based prevention within cultural context: promising effects of substance use prevention adapted for American Indian families.

Background: Effective substance use prevention strategies are needed for American Indian (AI) youth, who face disproportionate risk for early substance use and consequently bear a disproportionate burden of health and developmental disparities related to early use. With few exceptions, significant advances in prevention science have largely excluded this population, leaving gaps in the evidence of effective practice. This paper builds on emerging efforts to address this gap, reporting first outcome findings from an evidence-based early substance use prevention program culturally adapted for young adolescents on a Northern Plains reservation. Methods: Using a community-based participatory approach, the Thiwáhe Gluwás'akapi Program (TG, sacred home in which family is made strong) was developed by embedding cultural kinship teachings within the Strengthening Families Program for Parents and Youth 10-14 and aligning other elements of program content with local culture and context. Results: Results of pre and post comparisons of proximal program outcomes showed that youth reported significant improvements in parental communication about substance use, substance use resistance skills, stress management, family cohesion, and overall well-being. Adults reported improvements in a wide array of parenting behaviors and indicators of family dynamics. Conclusions: These findings provide an initial glimpse into the potential effects of the TG program and suggest that it holds promise for helping AI families address risks for youth substance use through positive impacts on modifiable risk and protective factors documented to influence early substance use.

A virtual randomized controlled trial of an alcohol-exposed pregnancy prevention mobile app with urban American Indian and Alaska Native young women: Native WYSE CHOICES rationale, design, and methods.

BACKGROUND: Fetal Alcohol Spectrum Disorders (FASD) result in lifelong disability and are a leading cause of preventable birth defects in the US, including for American Indian and Alaska Natives (AIANs). Prevention of alcohol exposed pregnancies (AEPs), which can cause FASD, is typically aimed at adult women who are risky drinkers and have unprotected sex. Among AIANs, AEP prevention research has been primarily conducted in reservation communities, even though over 70% of AIANs live in urban areas. Culturally appropriate AEP prevention for urban AIAN young women, regardless of current drinking or sexual behaviors, may maximize the potential for primary prevention at the beginning of the reproductive years for this underserved population. METHODS: We developed a virtual randomized controlled trial (RCT) - fully implemented through technology - to evaluate Native WYSE CHOICES, a culturally tailored mobile app, with urban AIAN young women ages 16-20 nationally. While virtual RCTs are not new, this is the first engaging a solely urban AIAN population, historically excluded from research. Participants are recruited on a rolling basis through the project social media community, organizational partnerships, and in-person events. Eligible participants complete a baseline survey and are randomized to either the app's intervention or comparison arm - each of which provide about 3 h of content. Follow-up data are collected at 1-, 6-, and 12-months post-baseline. RESULTS: Our study offers a template for building trust and extending reach to this underserved population while also providing important lessons and insights on advances in virtual or hybrid research approaches.

Reducing Youth Vaping: A Pilot Test of the Peer-Led "Youth Engaged Strategies for Changing Adolescent Norms!" (YES-CAN!) Program.

Effective prevention interventions are needed to stem the rising tide of nicotine vaping among adolescents. We conducted a quasi-experimental, non-equivalent comparison group pilot study of the effectiveness of the "Youth Engaged Strategies for Changing Adolescent Norms" (YES-CAN!) program for reducing risks for youth nicotine vaping. YES-CAN! is an innovative peer-led program that supports older adolescents in developing and delivering short narrative prevention videos and related prevention education to younger adolescents. High-school and middle-school program participants and non-program comparison group students completed pre and post surveys assessing vaping susceptibility, behavioral intentions, resistance, knowledge, attitudes, perceived harm, and normative beliefs. Vaping knowledge and the perceived number of friends and classmates who vape showed significantly greater pre- to post-program increases among high-school participants compared to non-participants, and positive vaping attitudes demonstrated significantly greater decreases. Among middle-school students, vaping knowledge increased significantly more among program participants compared to non-participants. The findings from this study indicate that the YES-CAN! program holds promise for reducing risks of nicotine vaping among adolescents. This contributes to a growing body of evidence regarding the utility of peer-led approaches to adolescent health promotion. Further evaluation of the YES-CAN! program in a large-scale randomized control trial is warranted to determine its effectiveness in curbing the escalation of youth nicotine vaping that has characterized the past decade. Future studies should monitor program effect on perceptions of vaping prevalence to ensure participation and/or exposure does not inadvertently promote vaping by increasing perceptions that others vape.

Design and Effectiveness of the Youth Engaged Strategies for Changing Adolescent Norms! (YES-CAN!) Program for Reducing Skin Cancer Risk.

Adolescence is a critical period for reducing skin cancer risks, yet the development of effective interventions for middle and high school youth has lagged behind those for younger children. We developed and implemented the "Youth Engaged Strategies for Changing Adolescent Norms!" (YESCAN!) program, a school-based peer leader program that uses a youth-researcher partnership approach and a project-based curriculum to support high school students in developing and delivering short narrative videos and related material about skin cancer prevention to middle school students. Participating middle and high school students completed pre- and post-program surveys assessing skin cancer attitudes, perceived norms, and behavioral intentions. Middle school students (N = 97) reported positive pre- to post-program changes in future intentions to engage in sun protection and reduce UV exposure behaviors and on numerous measures of normative beliefs and attitudes. High school students (N = 13) reported positive changes on a smaller set of behavioral intentions, normative beliefs, and attitudes. These findings add to a growing body of support for youth-participatory, peer-led approaches to adolescent risk reduction in general and to skin cancer risks specifically. The YESCAN! program fills a need for effective skin cancer prevention among adolescents, while at the same time addressing educational objectives to develop 21st Century Skills.

Measure of Socialization of American Indian Children (MOSAIC): Understanding the roots of ethnic-racial identity.

OBJECTIVES: The Measure of Socialization of American Indian Children (MOSAIC) was created as part of a larger study developing a family-based and culturally grounded substance use prevention program for young American Indian (AI) adolescents. The MOSAIC was designed to measure ethnic-racial socialization (ERS) for use with AI families to support better understanding of the roots of ethnic-racial identity among AI youth and their relationship to risk for substance use in early adolescence. METHOD: This study was conducted in partnership with a Lakota reservation community. Community partners and advisors provided guidance on the creation of an item pool, which also drew extensively from the existing literature on ERS in other populations. The MOSAIC was pilot tested with a small sample of parents (N = 19) and then tested with a development sample of participants (N = 197) taking part in the larger study. A series of factor analyses were conducted with data from this development sample to explore associations among items and alignment with proposed dimensions. RESULTS: Four dimensions emerged, related to socialization practices to support spirituality, language, pride, and preparation for bias. The original MOSIAC measure was refined based on these analyses and prepared for testing in an independent sample. CONCLUSIONS: Dimensions of ERS common to measures developed for other populations emerged as relevant for AI families, with adaptations to reflect the unique context of this population. Further work is needed to confirm the structure of the MOSAIC in both this AI community and with other diverse indigenous populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring the feasibility of validating early developmental screening tools for American Indian and Alaska Native children.

Screening children from birth through age 5 is critical to early identification of challenges and referral to intervention to support optimal development. Screening of American Indian and Alaska Native (AIAN) children lags behind that of other children, partly due to the lack of screening tools validated for this population. This study tested the feasibility of an online data collection strategy for use in a future study of the validity of existing screening instruments for AIAN children. Parents of AIAN children in four communities were recruited to complete screeners, provide demographic information, and provide feedback on experiences with online data collection. Participants were given the option of receiving screening results from the local early childhood program through which they were recruited. 240 participants began the process, 183 were enrolled in a partner program and reported a birthdate for at least one AIAN child, 157 had an age-eligible child, 81 began the consent process, 62 consented, and 39 fully completed data collection. Most participants were female and AIAN, the majority reported that online data collection was easy. Collecting screener validation data on a large sample of AIAN children may be able to utilize online data collection tools, with in-person support to facilitate participation.

Un examen de detección en los niños a partir del nacimiento hasta la edad de 5 años es esencial para la temprana identificación de retos y la referencia a intervenciones como apoyo a un desarrollo óptimo. El examen de detección en el caso de niños del grupo Indio Americano y Nativo de Alaska (AIAN) está muy por debajo del de otros niños, en parte debido a la falta de herramientas de detección validadas para esta población. Este estudio puso a prueba la posibilidad de una estrategia electrónica de recolección de datos para uso en un estudio futuro acerca de la validez de los existentes instrumentos de detección para niños AIAN. Se reclutaron progenitores de niños AIAN en cuatro comunidades para completar los exámenes de detección, proveer información demográfica, así como proveer información sobre las experiencias con la recolección electrónica de datos. A los participantes se les dio la opción de recibir los resultados de la detección de parte del programa local para la temprana niñez a través del cual habían sido reclutados. 240 participantes comenzaron el proceso; 183 estaban matriculados en un programa paralelo y reportaron la fecha de nacimiento de por lo menos un niño AIAN; 157 tenían un niño elegible según la edad; 81 comenzaron el proceso de consentimiento; 62 consintieron; 39 completaron en su totalidad la recolección de datos. La mayoría de los participantes eran mujeres y AIAN; la mayoría reportó que la recolección electrónica de datos fue fácil. La recolección de información de validación de la detección en un grupo muestra grande de niños AIAN pudiera ser capaz de utilizar herramientas electrónicas de recolección de datos, con un apoyo presencial para facilitar la participación.

Le dépistage des enfants de la naissance à l'âge de 5 ans est critique pour l'identification précoce des défis et problèmes et l'orientation vers l'intervention afin de soutenir le développement optimal. Le dépistage des enfants d'amérindiens des Etats-Unis et des autochtones d'Alaska est en retard par rapport à celui des autres enfants, en partie du fait du manque d'outils de dépistage validés pour cette population. Cette étude a testé la fiabilité de la stratégie de collecte de données en ligne pour son utilisation pour une étude à venir sur la validité d'instruments de dépistage existants pour les enfants AIAN. Les parents d'enfants AIAN de quatre communautés ont été recrutés afin de remplir des dépistages, d'offrir des renseignements démographiques, et d'offrir des commentaires sur les expériences de collecte de données en ligne. Les participants ont reçu l'option de recevoir les résultats de dépistage d'un programme de petite enfance local au travers duquel ils avaient été recrutés. 240 participants ont commencé le processus. 183 ont été inscrits dans un programme partenaire et ont fait état de la date de naissance d'au moins un enfant AIAN. 157 avait un enfant admissible par l'âge. 81 ont commencé le processus de consentement. 62 ont consenti. 39 ont fini la collecte de données en ligne. La collecte de données de validation du filtre de recherche sur un grand échantillon d'enfants AIAN pourrait utiliser des outils de collecte de données en ligne avec un soutien en personne afin de faciliter la participation.

Community perspectives on developmental screening of American Indian and Alaska Native children.

Children are highly regarded and treasured as the future of American Indian and Alaska Native (AIAN) communities. Developmental disorders, however, are more frequently undiagnosed and untreated in AIAN children compared to others in the United States. Developmental screening can help communities ensure that their children reach their full potential, but lack of culturally sensitive and valid screening measures complicates screening among AIAN children. This can, in turn, delay access to early intervention and undermine the ability of AIAN communities to support children's optimal development. This study explored families' and professionals' perceptions of screening systems and processes in AIAN communities and to identify gaps and opportunities. A total of 53 interviews and 23 focus groups were conducted with 157 parents and early childcare professionals in four AIAN communities. A conceptual framework to describe systems of screening for young children was developed by AIAN early childhood program partners and early childhood researchers working together on a Tribal Early Childhood Research Center Community of Learning; this framework guided study design and interview guides. Transcripts were coded for themes in alignment with the conceptual framework; 13 key themes and 81 subthemes were identified. Findings are discussed in terms of implications for enhancing screening efforts in Tribal communities.

Los niños son altamente considerados y apreciados como el futuro de las comunidades de Indios Americanos y Nativos de Alaska (AIAN). Los trastornos en el desarrollo, sin embargo, no son diagnosticados ni tratados a una frecuencia más alta que en el caso de otros en los Estados Unidos. La detección en cuanto al desarrollo puede ayudar a las comunidades a asegurar que sus niños logran su completo potencial, pero la falta de sensibilidad cultural y de válidas medidas de detección complica el proceso de detección entre niños AIAN. Esto puede, a la vez, retrasar el acceso a la temprana intervención y quebrantar la habilidad de las comunidades AIAN de apoyar el óptimo desarrollo de los niños. Este estudio exploró las percepciones que las familias y los profesionales tienen de los sistemas y procesos de detección en comunidades AIAN para identificar vacíos y oportunidades. 53 entrevistas y 23 grupos de enfoque se llevaron a cabo con 157 progenitores y profesionales del temprano cuidado infantil en cuatro comunidades AIAN. Se desarrolló un marco de trabajo conceptual para describir los sistemas de detección para niños pequeños por parte de los asociados de un programa AIAN de temprana niñez e investigadores de la temprana niñez que trabajaban en conjunto en un Centro Tribal Investigativo de la Temprana Niñez y Comunidad de Aprendizaje; este marco de trabajo marcó las pautas para el diseño del estudio y las guías de entrevista. Se codificaron las transcripciones por temas en alineamiento con el marco de trabajo conceptual; se identificaron 13 temas claves y 81 subtemas. Los resultados se discuten en términos de las implicaciones para mejorar los esfuerzos de detección en comunidades tribales.

Les enfants sont tenus en haute estime et précieux puisqu'ils sont l'avenir des communautés d'amérindiens des Etats-Unis et des autochtones d'Alaska (abrégé en anglaise AIAN). Cependant les troubles de comportement restent plus fréquemment non diagnostiqués et non traités chez les enfants AIAN que chez les autres enfants aux Etats-Unis. Le dépistage comportemental peut aider les communautés à s'assurer que leurs enfants atteignent leur plein potentiel mais le manque de mesures de dépistage culturellement adaptées et valides complique le dépistage chez les enfants AIAN. En retour cela peut retarder l'accès à une intervention précoce et compromettre la capacité des communautés AIAM à soutenir le développement optimal des enfants. Cette étude a exploré les perceptions des familles et des professionnels des systèmes de dépistage et des processus dans les communautés AIAN dans le but d'identifier les écarts et les opportunités. 53 entretiens et 23 groupes de discussion ont été organisés avec 157 parents et professionnels de garderies d'enfants dans quatre communautés AIAN. Un cadre conceptuel pour décrire les systèmes de dépistage pour les jeunes enfants a été développé par les partenaires de programmes de la petite enfance et des chercheurs sur la petite enfance travaillant ensemble dans le cadre d'une communauté d'apprentissage du Centre de Recherche sur la Petite Enfance Tribale. Ce cadre a guidé le plan d'étude et les guides de l'entretien. Les transcriptions ont été codées pour des thèmes se conformant au cadre conceptuel et 13 thèmes clés ainsi que 81 sous-thèmes ont été identifiés. Les résultats sont discutés dans le contexte des implications pour l'amélioration des efforts de dépistages dans les communautés tribales.

Crisis-Resilient and Antiracist Approaches to Community-Based Participatory Research During COVID-19 and Beyond.

Social and health inequities among communities of color are deeply embedded in the United States and were exacerbated by the COVID-19 pandemic. Community-based participatory research (CBPR) is a powerful approach to advance health equity. However, emergencies both as global as a pandemic or as local as a forest fire have the power to interrupt research programs and weaken community relationships. Drawing from Public Health Critical Race Praxis (PHCRP), as well as our research experience during the pandemic, this article proposes an expansion of prior CBPR principles with an emphasis on advocacy and storytelling, community investment, and flexibility. The article summarizes key principles of CBPR and PHCRP, contextualizes their relevance in COVID-19, and outlines a practical vision for crisis-resilient research through deeper engagement with antiracism scholarship. Structural barriers remain an issue, so policy changes to funding and research institutions are recommended, as well, to truly advance health equity.

Community-Led Health Promotion Groups in a Bhutanese-Nepali Refugee Community.

This practice note reports on the work of the Namaste Community Health Partnership, an academic-community partnership established to address health disparities in a metro-area Bhutanese-Nepali refugee community in the western United States. Partners worked together to develop, implement, and evaluate a culturally-tailored health promotion program where Bhutanese-Nepali individuals led weekly walking groups and shared health promotion information and behavior change tools with community participants. The program was implemented with approximately 70 community members across two metro-area neighborhoods and two adult day care centers serving elders. Evaluation strategies included documenting walk attendance, tracking engagement with health promotion goals, and focus group discussions with program participants. Once enrolled, most participants consistently attended walks and achieved weekly goals-some even increased walking frequency beyond program requirements. Participants provided positive feedback about having a community leader and reported learning new information and enjoying participating with other community members. Challenges and lessons learned included difficulties engaging younger adults from the community, concerns about signing research consent forms, cultural norms discouraging the distribution of individual research participation incentives, variability across groups in preferences for program activities, and barriers to administering survey-based evaluation instruments. This academic-community partnership built capacity in the local Bhutanese-Nepali community, produced culturally relevant health programming, and trained and employed community members as health educators and physical activity leaders. The program resulting from this work has the potential to improve health knowledge and chronic disease prevention practices and ultimately reduce health disparities in an underserved refugee community.

Making it stick: use of active learning strategies in continuing medical education.

BACKGROUND: Despite the known benefits of active learning (AL), the predominate educational format in higher education is the lecture. The reasons for slow adaptation of AL in medical education are not well understood. The purpose of this survey was to determine knowledge, usage, attitudes, and barriers to AL use in academic Continuing Medical Education (CME). METHOD: A 20-item questionnaire was developed and sent with a link to an online questionnaire to the Society of Academic Continuing Medical Education (SACME) listserv of ~ 350 professionals representing academic medical centers, teaching hospitals, and medical specialty societies in the United States (U.S.) and Canada. Responses were collected with SurveyMonkey® from October-November, 2019. Data were analyzed using SPSS®. RESULTS: Responses from 146 SACME members in 91 CME units yielded a ~ 42% survey response rate. Many respondents reported their self-perceived knowledge of AL as high. Advanced training (e.g., certificate, Master of Education degree) was positively correlated with AL knowledge. AL methods were reportedly used in half of the CME activities in the majority (80%) of institutions. Higher levels of self-perceived knowledge were correlated with an increased percentage of AL-related CME activities. Commonly perceived barriers to use of AL were presenters' lack of familiarity and a need for more time-consuming preparation. CONCLUSIONS: More efforts are needed to increase innovation and incorporate evidence-based AL strategies in medical education, especially to foster learner engagement, critical thinking, and problem-solving ability.

Health outcomes in a national sample of American Indian and Alaska Native adults: Differences between multiple-race and single-race subgroups.

OBJECTIVES: To determine differences among multi-race (MR) American Indian and Alaska Natives (AIAN), single race (SR) AIANs, and SR-Whites on multiple health outcomes. We tested the following hypotheses: MR-AIANs will have worse health outcomes than SR-AIANs; SR-AIANs will have worse health outcomes than SR-Whites; MR-AIANs will have worse health outcomes than SR-Whites. METHODS: Behavioral Risk Factor Surveillance System data were used to examine general health, risk behaviors, access to health care, and diagnosed chronic health conditions. Those identifying as SR-White, SR-AIAN, and MR-AIAN were included in multinomial logistic regression models. RESULTS: Compared to SR-AIANs, MR-AIANs had more activity limitations, a greater likelihood of experiencing cost as a barrier to health care and were more likely to be at increased risk and diagnosed with more chronic health conditions. Both SR and MR-AIANs have worse health than SR-Whites; MR-AIANs appear to be at increased risk for poor health. CONCLUSIONS: The current study examined access to health care and nine chronic health conditions, neither of which have been considered in prior work. MR AIANs are at increased risk compared to SR groups. These observations beg for further inquire into the mechanisms underlying these differences including stress related to identify, access to care, and discrimination. Findings support the continued need to address health disparities among AIANs regardless of SR or MR identification.

Moving the prevention timeline: A scoping review of the literature on precursors to sexual risk in early adolescence among youth of color.

INTRODUCTION: Sexual health disparities are leading causes of morbidity among youth of color in the United States. We conducted a scoping review of the literature on precursors to sexual risk-taking among young adolescents of color (ages 10-14) to assess precedents of sexual experience and their utility as measurable proximal constructs and behaviors gauging sexual risk and sexual risk prevention efforts. METHODS: This study was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. We searched for quantitative studies that assessed the relationships between precursors and subsequent sexual behaviors, incorporated youth of color, and specified young adolescents as the study sample. All articles were in English, however we explored both U.S. and International databases. RESULTS: The database search yielded 11 studies published between 2000 and 2017. Most literature focused on youth in urban settings, and on Black and Latinx youth, while only two addressed the special circumstances of American Indian and Alaska Native youth. Sex expectancies outcomes for youth of color were likely to predict sexual risk taking and self-efficacy about sex was related to abstinence. CONCLUSIONS: Etiologic studies that seek to understand precursors to sexual risk taking among youth of color are limited and this paucity truncates the ability to develop sexual risk prevention programs for the age group in which prevention is most needed.

Rural and Urban American Indian and Alaska Native Veteran Health Disparities: a Population-Based Study.

The health service ecology varies considerably across urban-rural divides for American Indian and Alaska Native (AIAN) veterans, which may place rural AIAN veterans at high risk for poor health outcomes. Using the Behavioral Risk Factor Surveillance System 2011 and 2012 data for its detailed race information, we employed adjusted multinomial logistical regression analyses to estimate differences in health outcomes among rural AIAN veterans (n = 1500) and urban AIAN veterans (n = 1567). We used rural White (n = 32,316) and urban White (n = 59,849) veteran samples as comparators. No statistically significant differences between urban and rural AIAN veterans' health outcomes were found. Urban AIAN veterans were 72% more likely to report financial barriers to care compared with urban White veterans (P = .002); no other healthcare access differences were found. Compared with their White veteran counterparts, both urban and rural AIAN veterans were significantly more likely to report poorer physical and mental health across an array of outcomes. Overall, rural and urban AIAN veterans' health outcomes were similar, but both groups suffered compromised health compared with that of both rural and urban White veterans. The findings identified key areas for improving and innovating care for both rural and urban AIAN veterans.

Patterns of use and perceptions of an institution-specific antibiotic stewardship application among emergency department and urgent care clinicians.

We surveyed emergency department and urgent care clinicians to assess patterns of use and perceived usefulness of a local antibiotic stewardship application to deliver institution-specific prescribing guidance. Among 114 eligible respondents, the application was widely utilized, and it was perceived to be a useful clinical resource that improved prescribing.

Integrating Community-Engagement and a Multiphase Optimization Strategy Framework: Adapting Substance Use Prevention for American Indian Families.

Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwás'akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact.

The high costs of cheap tanning: pricing and promotional practices of indoor tanning facilities in six cities in the United States.

Few studies have investigated pricing and promotional practices used by the indoor tanning industry, despite their potential to promote indoor UV tanning-a well-established risk factor for melanoma skin cancer. Posing as potential customers, we telephoned 94 indoor tanning businesses in six United States (U.S.) cities and requested pricing information. The price of a single tanning session ranged from $0 to $23, and was lower at facilities that offered indoor tanning as a secondary service (mean $4.82 and free in 35%) than at tanning salons (mean $16.45). Session prices in salons could be as low as $1.50 with daily use of an unlimited monthly plan. Free indoor tanning, monthly packages, and memberships encourage increased use. Policies that limit free indoor tanning or that restrict pricing and advertising for indoor tanning exist in several places in the U.S. and Europe. Future research should evaluate whether those policies are effective in reducing indoor tanning.

Frequent residential mobility among American Indians and early indications of sexual risk among young adolescents.

American Indian and Alaska Native (AI/AN) youth are more likely to ever have had sex, and to have engaged in sexual activity prior to age 13 compared to all other race groups. It is essential to understand the development of skills to refuse sexual experience in early adolescence in order to reduce disparities associated with early sexual debut among AI/AN youth. Familial, social, and individual factors can act as protective influences on adolescent sexual experience; however, in other settings, research has shown that frequent residential mobility disrupts these protective influences and may increase the likelihood of adolescent sexual activity. AI/AN youth are highly mobile, and, as a result, may be especially vulnerable to increased sexual risk. To date, no prior study has considered the impact of residential mobility on AI/AN youth sexual experience, nor the influence on precursors that reduce initiation of sex. We used data from a longitudinal study of AI/AN youth attending all middle schools from a Northern Plains reservation from 2006-2009 to estimate a structural equation model based on a cultural and age adapted theoretical framework. The tested model included frequent residential mobility as the independent variable and sex refusal self-efficacy as the dependent variable. Mediating variables included factors related to individual risks, psychological well-being, and social supports. Results indicate a direct association between residential mobility and sex refusal self-efficacy (-.29, p = 0.05) and an indirect association mediated by deviant peers (-.08, p = .05). Other mediating variables did not provide insight on the mechanism by which residential mobility influences skills to refuse sexual intercourse among AI/AN youth in early adolescence. Findings provide evidence for an association between residential mobility and precursors to sexual experience suggesting augmenting sexual health interventions for highly mobile youth.

Trajectories of Nevus Development From Age 3 to 16 Years in the Colorado Kids Sun Care Program Cohort.

Importance: Nevi are a risk factor for melanoma and other forms of skin cancer, and many of the same factors confer risk for both. Understanding childhood nevus development may provide clues to possible causes and prevention of melanoma. Objectives: To describe nevus acquisition from the ages of 3 to 16 years among white youths and evaluate variation by sex, Hispanic ethnicity, and body sites that are chronically vs intermittently exposed to the sun. Design, Setting, and Participants: This annual longitudinal observational cohort study of nevus development was conducted between June 1, 2001, and October 31, 2014, among 1085 Colorado youths. Data analysis was conducted between February 1, 2015, and August 31, 2017. Main Outcomes and Measures: Total nevus counts on all body sites and on sites chronically and intermittently exposed to the sun separately. Results: A total of 557 girls and 528 boys (150 [13.8%] Hispanic participants) born in 1998 were included in this study. Median total body nevus counts increased linearly among non-Hispanic white boys and girls between the age of 3 years (boys, 6.31; 95% CI, 5.66-7.03; and girls, 6.61; 95% CI, 5.96-7.33) and the age of 16 years (boys, 81.30; 95% CI, 75.95-87.03; and girls, 77.58; 95% CI, 72.68-82.81). Median total body nevus counts were lower among Hispanic white children (boys aged 16 years, 51.45; 95% CI, 44.01-60.15; and girls aged 16 years, 53.75; 95% CI, 45.40-63.62) compared with non-Hispanic white children, but they followed a largely linear trend that varied by sex. Nevus counts on body sites chronically exposed to the sun increased over time but leveled off by the age of 16 years. Nevus counts on sites intermittently exposed to the sun followed a strong linear pattern through the age of 16 years. Hispanic white boys and girls had similar nevus counts on sites intermittently exposed to the sun through the age of 10 years, but increases thereafter were steeper for girls, with nevus counts surpassing those of boys aged 11 to 16 years. Conclusions and Relevance: Youths are at risk for nevus development beginning in early childhood and continuing through midadolescence. Patterns of nevus acquisition differ between boys and girls, Hispanic and non-Hispanic white youths, and body sites that are chronically exposed to the sun and body sites that are intermittently exposed to the sun. Exposure to UV light during this period should be reduced, particularly on body sites intermittently exposed to the sun, where nevi accumulate through midadolescence in all children. Increased attention to sun protection appears to be merited for boys, in general, because they accumulated more nevi overall, and for girls, specifically, during the adolescent years.