Exploring the role of sex in the association of late chronotype on cardiorespiratory fitness.

Circadian rhythms differ between young adult males and females. For example, males tend to be later chronotypes, preferring later timing of sleep and activity, than females. Likewise, there are sex differences in body composition and cardiorespiratory fitness. Few studies have investigated the association between circadian rhythms, cardiorespiratory fitness, and body composition. We sought to determine whether chronotype and circadian phase were associated with cardiorespiratory fitness, body composition, and anthropometric measures in sedentary males and females. Fifty-nine adults participated in the study. Circadian phase and chronotype were measured using dim light melatonin onset (DLMO) and the Morningness-Eveningness Questionnaire (MEQ) score. We used peak oxygen uptake (VO2peak ) results from a maximal graded exercise test to assess cardiorespiratory fitness. Body composition, BMI, and circumferences were collected as markers of adiposity. We observed a sex difference in the association between DLMO and VO2peak . For males, a later DLMO was associated with a lower VO2peak . VO2peak did not vary based on DLMO in females. Later circadian phase was also associated with increased body fat percentage, fat mass index, and abdominal circumference in males, but not females. Collectively, these results suggest that males who are later chronotypes may be at risk of obesity and low cardiorespiratory fitness.

Effectiveness of a Bystander Intervention Program to Increase Bystander Behaviors Across Latent Risk Groups of High Schoolers.

Bystander intervention programs have established efficacy to increase bystander behaviors to prevent interpersonal violence (IPV). Little research has investigated intervention efficacy among latent risk classes among high school students. Data from a five-year randomized control trial were used to conduct multigroup path analyses to assess the association between type of training received and bystander outcomes moderated by risk groups identified via latent profile analysis (LPA). LPA was used to identify risk based on six indicators related to violence exposure, association with aggressive friends, and alcohol use. Bystander training received was the primary independent variable characterized as: no training, overview speech alone, or skills training. Outcomes included (a) observed bystander behaviors; (b) reactive bystander behaviors; or (c) proactive bystander behaviors. Three risk groups were identified via LPA: low risk, moderate risk witnesses of IPV, and highest risk victims and perpetrators. Of the bystander trainings received, overview speeches only increased reactive bystander behaviors among low risk students. The skills training was effective at increasing most bystander outcomes among all risk groups, with the largest effect sizes observed among the highest risk victims and perpetrators profile. Findings suggest that tailoring or modifying bystander training based on the risk profiles of youth may lead to greater potential to increase bystander behaviors to reduce risk of violence. Specifically, overview speech trainings should be targeted to low risk youth, while skills training primarily delivered to higher risk youth. These skills trainings could incorporate content related to trauma-informed care as well as associations with alcohol use, which may enhance their effectiveness further.

Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial.

BACKGROUND: Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. OBJECTIVE: The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF's success to facilitate future scale-up in campus settings. METHODS: This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. RESULTS: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. CONCLUSIONS: This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. TRIAL REGISTRATION: ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43986.

Bystander Program to Reduce Sexual Violence by Witnessing Parental Intimate Partner Violence Status.

INTRODUCTION: Youth who witness parental intimate partner violence are at increased risk for sexual violence. Existing data from a cluster RCT were used to determine the effectiveness of Green Dot bystander intervention to reduce sexual violence among high-school students who did and did not witness parental intimate partner violence. STUDY DESIGN: A secondary analysis was conducted in 2021 of extant data from a 5-year cluster RCT. SETTING/PARTICIPANTS: A total of 26 high schools in Kentucky were randomized to intervention or control condition in 2010. A total of 15,863 surveys were analyzed from baseline, 30,014 from partial intervention implementation (Years 1 and 2), and 25,907 from full implementation (Years 3 and 4). The sample was stratified to include students who witnessed or did not witness parental intimate partner violence. INTERVENTION: The bystander intervention program was delivered in 2 stages. During partial implementation, a persuasive speech describing rates, risk factors, and bystander-based approaches to violence prevention was provided to most students in schools randomized to the intervention. During full implementation, an in-depth 5-hour skill-based bystander training was provided to popular opinion leaders among the students in intervention schools (10%-15%). MAIN OUTCOME MEASURES: The primary outcome was sexual assault measured as perpetration and victimization. Secondary outcomes included sexual harassment and stalking, measured as victimization and perpetration. RESULTS: During full implementation, among students who witnessed parental intimate partner violence, the intervention was associated with significant reductions in sexual assault perpetration (ß= -0.21, p<0.01), sexual harassment perpetration (ß= -0.29, p<0.001), sexual assault victimization (ß= -0.25, p<0.01), and sexual harassment victimization (ß= -0.45, p<0.001). For students who did not witness parental intimate partner violence, the intervention was only associated with reductions in sexual harassment (ß= -0.19, p<0.001) and stalking (ß= -0.09, p<0.01) victimization. CONCLUSIONS: As implemented in the parent RCT, the bystander training was more effective at reducing violent outcomes among those who witnessed parental intimate partner violence than in those who did not witness parental intimate partner violence. TRIAL REGISTRATION: This study is registered at www. CLINICALTRIALS: gov, under identifier NCT01878097.

Sexual Violence Perpetration as a Risk Factor for Current Depression or Posttraumatic Symptoms in Adolescents.

Sexual violence perpetration (SVP), including coerced, physically forced, and alcohol- or drug-facilitated unwanted sex, occurs frequently in adolescence and may represent a risk factor for future perpetration. Sexual violence victimization (SVV) has been found to be a risk factor for increased rates of depression and posttraumatic stress disorder (PTSD); however, the associations of SVP with depression or posttraumatic stress symptoms (PTSS) have been less well described. This study examined associations between symptoms of depression and PTSS with SVP in the prior 12 months among high school students. In this cross-sectional analysis, a representative sample of public high school students (ninth-12th grades) completed self-reported surveys on peer SVP and SVV within the past year. Among 16,784 students completing surveys, 7.2% disclosed SVP against another high school student in the past 12 months; 64.4% of students disclosing SVP also experienced SVV. Both SVP and SVV, alone or in combination, were associated with a greater likelihood of symptoms of depression or PTSS. These associations were similar by sex and sexual minority status (e.g., lesbian, gay, bisexual, transgender, and queer [LGBTQ+]). These findings highlight the need for continued primary prevention efforts. Additional screening to recognize adolescent SVP can allow both early treatment of depression and PTSD and address the individual risks of SVP to reduce subsequent repeated sexual assaults.

How Does Green Dot Bystander Training in High School and Beyond Impact Attitudes Toward Violence and Sexism in a Prospective Cohort?

Bystander interventions are recognized as "promising" programming to reduce sexual violence. Gaps in current evaluations include limited follow-up post-training (beyond 24 months) and knowledge of additional bystander training during follow-up.In this prospective cohort study, nested in a cluster randomized controlled trial (RCT), three cohorts of high school (HS) seniors were recruited (Fall 2013-2015) and followed through Spring 2018 (n = 1,831). Training was based on their school cluster RCT assignment and receipt of additional Green Dot (GD) training after HS. Training was hypothesized to be associated with lower scores indicating less acceptance of violence or sexism.Sixty percent reported GD training after HS (68.7% of 986 in intervention and 50% of 845 in control conditions). No significant differences (p < .05) were observed by GD training for four of the five violence acceptance or sexism attitudinal measures at recruitment or final surveys. For "ambivalent sexism" alone was there a significant reduction in scale scores over time in the intervention versus control condition. Additional GD training after the RCT significantly reduced neither violence acceptance nor sexism scores over time.GD training does not appear to have a consistent longer-term impact on reducing violence acceptance and sexism.

A Methodology Report for the Life's Snapshot Cohort Study to Investigate the Long-Term Efficacy of a Violence Intervention.

Engaged bystander interventions are recognized as "promising" programming to reduce sexual violence (SV), yet little is known of the long-term (>12-month) impact of programming on SV and related forms of gender-based violence. Funded by NIH as a prospective cohort study, Life's Snapshot recruited and followed three waves of high school seniors who had participated in a large high-school cluster-randomized controlled trial to evaluate the effectiveness of the Green Dot bystander intervention. This report provides the study design, recruitment methodology, recruitment and retention rates, survey items, and psychometric properties of measures included in the initial and annual electronic surveys with 24-48 months follow-up.

Bystander Intervention Efficacy to Reduce Teen Dating Violence Among High School Youth Who Did and Did Not Witness Parental Partner Violence: A Path Analysis of A Cluster RCT.

Youth who witness parental intimate partner violence (IPV) are at increased risk of teen dating violence (DV). This analysis of secondary data investigated whether a bystander intervention program, Green Dot, was effective at reducing physical and psychological DV victimization and perpetration among youth who had and had not previously witnessed parental IPV. The parent RCT assigned 13 schools to control and 13 schools to the Green Dot intervention. Responses from 71,797 individual surveys that were completed by high school students were analyzed across three phases of a 5-year cluster randomized control trial. Multigroup path analyses revealed that students in intervention schools who witnessed parental IPV had a reduction in psychological (p < .001) and physical DV (p < .01) perpetration and psychological DV victimization (p < .01) in Phase 2 of the intervention, while those who did not witness parental IPV had a significant reduction in psychological DV victimization (p < .01). Individuals in the intervention received more training (p < .001), which was associated with lower levels of violence acceptance (p < .001). Violence acceptance was positively associated with DV victimization and perpetration (p < .001), especially for individuals who previously witnessed parental IPV. Green Dot is an effective program at reducing DV victimization and perpetration among the high-risk group of youth who previously witnessed parental IPV, largely operating through violence acceptance norms. This underscores the bystander intervention approach as both a targeted and universal prevention program.

Disinfectant use by K-12 school staff to combat SARS-CoV-2.

K-12 school staff from Indiana, Kentucky and Ohio were asked about their use of disinfectants to mitigate the spread of COVID-19 in schools. Survey participants (n = 1,555) reported frequent use of disinfectants, often using unknown products, and were provided little to no training on safe and effective use. Participant concerns included student involvement in disinfection, inadequate ventilation, surface contact time, and potential health effects.

Effect sizes and intra-cluster correlation coefficients measured from the Green Dot High School study for guiding sample size calculations when designing future violence prevention cluster randomized trials in school settings.

PURPOSE: Cluster randomized controlled trials (cRCTs) are popular in school-based research designs where schools are randomized to different trial arms. To help guide future study planning, we provide information on anticipated effect sizes and intra-cluster correlation coefficients (ICCs), as well as school sizes, for dating violence (DV) and interpersonal violence outcomes based on data from a cRCT which evaluated the bystander-based violence intervention 'Green Dot'. METHODS: We utilized data from 25 schools from the Green Dot High School study. Effect size and ICC values corresponding to dating and interpersonal violence outcomes are obtained from linear mixed effect models. We also calculated the required number of schools needed for future studies utilizing available methods that do and do not consider variation in school size. RESULTS: Observed effect sizes for DV outcomes range from 0.06 to 0.11. Observed ICC values for DV outcomes range from 0.0006 to 0.0032. The upper limit of 95% CIs for the true ICCs range from 0.0023 to 0.0070. CONCLUSION: School-based evaluations with violence outcomes are expected to have small effect sizes. Observed ICCs are less than 0.005 and upper limit of of 95% CIs for the true ICCs are less than 0.01. Designing school-based cRCTs should account for the ICC, even if its value is assumed to be negligible. Furthermore, variation in school sizes should also be accounted for to avoid having too few schools to achieve the desired power.

Kentucky Women's Justice Community Opioid Innovation Network (JCOIN): A type 1 effectiveness-implementation hybrid trial to increase utilization of medications for opioid use disorder among justice-involved women.

The opioid crisis has disproportionately affected women, but research on approaches to increase initiation of medications for opioid use disorder (MOUD) among women is limited. The Kentucky Justice Community Opioid Innovation Network (JCOIN) will implement a type 1 hybrid effectiveness and implementation trial to examine an innovative MOUD pretreatment model using telehealth (alone and in combination with peer navigators) for justice-involved women in transition from jail to the community. The overall goal of the project is to increase initiation and maintenance of MOUD among high-risk justice-involved women during community reentry to reduce opioid relapse and overdose. This project and other studies through the JCOIN network have the potential to significantly impact the OUD treatment field by contributing empirical evidence about the effectiveness and implementation of innovative technologies to increase initiation and maintenance of MOUD during a critical, high-risk time of community reentry among vulnerable, justice-involved individuals in both urban and nonurban communities.

Sexual Minority High School Boys' and Girls' Risk of Sexual Harassment, Sexual Violence, Stalking, and Bullying.

We report the prevalence and number of violent events of sexual violence, sexual harassment, stalking, and bullying experienced among sexual minority girls, sexual minority boys, heterosexual girls, and heterosexual boys. We conducted covariate-adjusted analyses of variance on 16,243 high school youth from 13 schools in Kentucky. Sexual minority boys and girls and heterosexual girls had higher rates of all forms of violence compared with heterosexual boys, but rates of violence between sexual minority girls and boys were statistically equivalent. Prevention and intervention programs must incorporate elements of minority stress theory to disrupt heterosexist norms that contribute to violence.

Do Violence Acceptance and Bystander Actions Explain the Effects of Green Dot on Reducing Violence Perpetration in High Schools?

This study extends prior analyses from a 5-year multisite cluster-randomized controlled trial to examine how the previously reported effects of the Green Dot bystander-based prevention program worked to reduce violence perpetration. Bystander-based interventions are hypothesized to prevent violence by reducing violence acceptance and increasing trained participants' willingness and ability to actively engage others in violence prevention using safe and effective bystander actions to diffuse or avoid potentially violent situations. We tested this hypothesis by examining whether Green Dot worked to reduce violence through two mediators measured over time: reducing violence acceptance and increasing bystander actions. When accounting for changes in these mediators over time, the effect of this intervention on violence perpetration was hypothesized to be attenuated or explained. At baseline (spring 2010) and annually (2011-2014), all students in recruited high schools (13 intervention, 13 control) completed an anonymous survey (response rate = 83.9%). Student responses were aggregated as school-level counts for the analysis. Path analyses estimated direct and indirect effects at specific points in the implementation of the intervention. Longitudinal models were used to determine if changes in violence acceptance and bystander actions could explain or attenuate the effect of the intervention. Time-framed path model analyses indicated that the intervention worked as expected to increase bystander behaviors and reduce violence acceptance; both potential mediators were significantly associated with sexual violence perpetration. In addition, after adjusting intent-to-treat models for the hypothesized mediators, the intervention was no longer associated with violence perpetration. In conclusion, these findings indicate that this bystander intervention worked as hypothesized to reduce sexual violence perpetration by creating theory-based changes in students' violence acceptance and bystander actions.

A Campus Climate/Violence Survey's Psychometrics and Findings.

Data from a campus climate/violence survey (CCS) include psychometric information for survey items/scales plus findings from a large state university to promote its usefulness for assessment of interpersonal violence/harassment. This CCS can thus be evaluated for its measurement and documented findings, allowing for benchmarking purposes. An innovative measurement strategy is introduced to comprehensively capture incidence of victimization types through streamlined questioning. Tables provide detailed data for 6,995 undergraduate and graduate/professional students over a 1-year period. Adding to published literature on existing CCSs, this article provides the range of information needed for universities to determine the potential usefulness of a CCS.

Implementation and sustainment of a statewide telemedicine diabetic retinopathy screening network for federally designated safety-net clinics.

CONTEXT: Diabetic retinopathy (DR) is the leading cause of incident blindness among working-age adults in the United States. Federally designated safety-net clinics (FDSC) often serve as point-of-contact for patients least likely to receive recommended DR screenings, creating opportunity for targeted interventions to increase screening access and compliance. STUDY DESIGN AND METHODS: With such a goal, we implemented and assessed the longitudinal performance of an FDSC-based telemedicine DR screening (TDRS) network of 22 clinical sites providing nonmydriatic fundus photography with remote interpretation and reporting. Retrospective analysis of patient encounters between February 2014 and January 2019 was performed to assess rates of pathology and referral. A generalized estimating equation logistic regression model was used for subset analysis from audits of pre- and post-implementation screening rates. Finally, patient surveys were conducted and assessed as a measure of intervention acceptability. RESULTS: Of the 13,923 individual telescreening encounters (4327 female, 4220 male, and 5376 unspecified; mean [SD] age, 54.9 [12.5] years) studied, 10,540 were of adequate quality to identify 3532 (33.5%) patients with ocular pathology: 2319 (22.0%) patients had some level of DR with 1604 (15.2%) requiring specialist referral, and 808 (7.7%) patients required referral for other ocular pathologies. The mean screening rate for audited clinics in the year prior to program implementation was 29.9% (641/2147), which increased to 47.7% (1012/2124) in the program's first year, doubling patients' odds of being screened (OR 2.2; 95% CI: 1.3-3.7; P = .003). These gains were sustained over four years following implementation (OR 1.9; 95% CI: 1.1-3.1; P = .018) despite varied clinic screening performance (4-year averaged range, 22.9-55.1%). Odds of early detection likewise doubled for patients with consecutive screenings (OR 2.2, 95% CI: 2.0-2.4; P < .001). Finally, surveyed patients preferred TDRS to specialist exams (82.5%; 776/941) and would recommend the service to friends (92.7%; 868/936). CONCLUSION AND RELEVANCE: A statewide, FDSC-centered TDRS network was successfully established and sustained in a medically underserved region of the United States. Our results suggest that large TDRS networks in FDSCs can increase screening access and compliance for otherwise unscreened populations, but outcomes can vary greatly among clinics. Further work to optimize program implementation is needed to maximize this model's impact.

Mentoring Multi-College Bystander Efficacy Evaluation - an Approach to Growing the Next Generation of Gender-Based Interpersonal Violence Intervention and Prevention (VIP) Researchers.

The Centers for Disease Control and Prevention provided funding (U01 CE002668) to evaluate bystander program efficacy to reduce gender-based violence on college campuses (Aim 1) and to create a mentoring network (Aim 2) for young campus-based researchers interested in violence intervention or prevention (VIP). While an evaluation of this mentoring program is ongoing, our purpose here was to document the strategies used to create, implement, and begin evaluation of this national multi-college mentoring network. As each public college was recruited into this evaluation named multi-college Bystander Efficacy Evaluation (mcBEE), each college was invited to nominate a researcher interested in receiving mentorship as a mcBEE fellow. Senior faculty with active VIP research careers were recruited as mentors. Mentorship occurred through annual meetings over time (2015-2019), weekly to bimonthly calls or video conferencing with 2-3 other fellows, and a mentor forming a group with 3-4 mentees, termed a hive. The initial focus of hive meetings was 1) creating and maintaining an active daily writing practice and 2) developing productivity plans, to include research, personal, and professional goals. Manuscript and grant writing feedback was provided throughout the network electronically or 'live' workshops. Annual surveys were implemented to investigate program efficacy. Our mcBEE team was able to successfully assemble a national network of VIP fellows and provide small group and individualized mentoring. Our ultimate goal was that of supporting our fellows' own trajectories in gender-based VIP research, teaching, administration, or service. Evaluation of our fellow and mentor cohort is ongoing (2015-2019).

Sex Differences in Problem Alcohol Use in High School as a Function of Recent Sexual Violence Victimization or Perpetration.

To investigate sex differences in associations between sexual violence victimization (SVV), sexual violence perpetration (SVP), and binge drinking and/or alcohol problems among high school students. While SVV has been linked to problem alcohol use among young women, little research has addressed the unique associations of SVV and SVP on alcohol use/problems within both sexes. A cross-sectional analysis of 16,992 high school students' self-reports of past-year SVP and SVV was used where SVV/SVP was defined by three tactics (sexual coercion, drug/alcohol-facilitated or incapacitated sex, and physically forced sex). Alcohol measures included past-month binge drinking and past-year alcohol problems. Rates of SVV were twice as high in females (21.2% vs. 13.3%), and SVP rates were twice as high in males (10.9% vs. 5.2%). SVV and SVP were each associated with an increased rate of current binge drinking and problem alcohol use for both sexes, across increasing numbers of SV tactics and within each of three tactics. After controlling for demographic and other risk factors including SVP, drug/alcohol-facilitated or incapacitated SVV was more strongly linked to binge drinking and alcohol problems among females. SVP was more strongly linked to binge drinking and alcohol problems among males (adjusting for SVV and other covariates). No sex differences emerged in associations between coerced or physically forced SVV/SVP and alcohol-related outcomes. Both SVV and SVP are associated with an increased likelihood of binge drinking and alcohol problems for males and females. Important sex differences emerged when SV tactics are considered.

Signal of increased opioid overdose during COVID-19 from emergency medical services data.

BACKGROUND: Individuals with opioid use disorder may be at heightened risk of opioid overdose during the COVID-19 period of social isolation, economic distress, and disrupted treatment services delivery. This study evaluated changes in daily number of Kentucky emergency medical services (EMS) runs for opioid overdose between January 14, 2020 and April 26, 2020. METHODS: We evaluated the statistical significance of the changes in the average daily EMS opioid overdose runs in the 52 days before and after the COVID-19 state of emergency declaration, March 6, 2020. RESULTS: Kentucky EMS opioid overdose daily runs increased after the COVID-19 state emergency declaration. In contrast, EMS daily runs for other conditions leveled or declined. There was a 17% increase in the number of EMS opioid overdose runs with transportation to an emergency department (ED), a 71% increase in runs with refused transportation, and a 50% increase in runs for suspected opioid overdoses with deaths at the scene. The average daily EMS opioid overdose runs with refused transportation increased significantly, doubled to an average of 8 opioid overdose patients refusing transportation every day during the COVID-19-related study period. CONCLUSIONS: This Kentucky-specific study provides empirical evidence for concerns that opioid overdoses are rising during the COVID-19 pandemic and calls for sharing of observations and analyses from different regions and surveillance systems with timely data collection (e.g., EMS data, syndromic surveillance data for ED visits) to improve our understanding of the situation, inform proactive response, and prevent another big wave of opioid overdoses in our communities.

Circadian rhythm phase shifts caused by timed exercise vary with chronotype.

BACKGROUNDThe circadian system entrains behavioral and physiological rhythms to environmental cycles, and modern lifestyles disrupt this entrainment. We investigated a timed exercise intervention to phase shift the internal circadian rhythm.METHODSIn 52 young, sedentary adults, dim light melatonin onset (DLMO) was measured before and after 5 days of morning (10 hours after DLMO; n = 26) or evening (20 hours after DLMO; n = 26) exercise. Phase shifts were calculated as the difference in DLMO before and after exercise.RESULTSMorning exercise induced phase advance shifts (0.62 ± 0.18 hours) that were significantly greater than phase shifts from evening exercise (-0.02 ± 0.18 hours; P = 0.01). Chronotype also influenced the effect of timed exercise. For later chronotypes, both morning and evening exercise induced phase advances (0.54 ± 0.29 hours and 0.46 ±0.25 hours, respectively). In contrast, earlier chronotypes had phase advances from morning exercise (0.49 ± 0.25 hours) but had phase delays from evening exercise (-0.41 ± 0.29 hours).CONCLUSIONLate chronotypes - those who experience the most severe circadian misalignment - may benefit from phase advances induced by exercise in the morning or evening, but evening exercise may exacerbate circadian misalignment in early chronotypes. Thus, personalized exercise timing prescription, based on chronotype, could alleviate circadian misalignment in young adults.TRIAL REGISTRATIONTrial registration can be found at www.clinicaltrials.gov (NCT04097886).FUNDINGFunding was supplied by NIH grants UL1TR001998 and TL1TR001997, the Barnstable Brown Diabetes and Obesity Center, the Pediatric Exercise Physiology Laboratory Endowment, the Arvle and Ellen Turner Thacker Research Fund, and the University of Kentucky.

Bystander Program Effectiveness to Reduce Violence and Violence Acceptance Within Sexual Minority Male and Female High School Students Using a Cluster RCT.

Bystander interventions have been highlighted as promising strategies to reduce sexual violence and sexual harassment, yet their effectiveness for sexual minority youth remains largely unexamined in high schools' populations. This rigorous cluster randomized control trial addresses this gap by evaluating intervention effectiveness among sexual majority and minority students known be to at increased risk of sexual violence. Kentucky high schools were randomized to intervention or control conditions. In intervention schools, educators provided school-wide Green Dot presentations (phase 1) and intensive bystander training to student popular opinion leaders (phase 2). Each spring from 2010 to 2014, students attending 26 high schools completed anonymous surveys about violence acceptance and violent events. An analytic sample of 74,836 surveys with no missing data over the 5 years was available. Sexual violence acceptance scores declined significantly over time in intervention versus control schools among all but sexual minority males. This intervention was also associated with reductions in both perpetration and victimization of sexual violence, sexual harassment, and physical dating violence among sexual majority yet not sexual minority youth. Both sexual minority and majority youth experienced reductions in stalking victimization and perpetration associated with the intervention. In this large cluster randomized controlled trial, the bystander intervention appears to work best to reduce violence for sexual majority youth. Bystander programs may benefit from explicitly engaging sexual minority youth in intervention efforts or adapting intervention programs to include attitudes that shape the experience of sexual minority high school youth (e.g., homophobic teasing, homonegativity).