Latent Class Groups of Concurrent Substance Use Among Adolescents in an Urban Community: Correlates With Mental Health, Access to Drugs and Alcohol, and Risk Perception.

BACKGROUND: Concurrent substance use among adolescents has been associated with an increase in physical and mental health problems. These outcomes tend to be exacerbated among adolescents of color in underserved urban settings. The purpose of this study was to understand alcohol and concurrent drug use patterns among adolescents in an underserved urban community to provide targeted prevention and treatment recommendations. METHOD: This study examined data among adolescents in an underserved urban community (N = 1789; 56.90% female; 70.86% Hispanic/Latino/a; meanage = 15.96 ± 1.56). Using latent class analysis (LCA) and multinomial logistic regression modeling, analyses identified independent correlates of latent class membership. RESULTS: Five latent classes (LC) were identified including LC group 1: Predominant alcohol use and limited to no concurrent-drug use (n = 213; 11.9%); LC group 2: Concurrent drug and alcohol use including methamphetamine, marijuana and synthetic marijuana use, and alcohol use (n = 74; 4.2%); LC group 3: Concurrent drug and alcohol use, with no marijuana use (n = 204; 11.39%); LC group 4: High Concurrent drug use and alcohol use (n = 204; 11.40%); and LC group 5: Concurrent drug use without alcohol use (n = 1101; 61.52%). Significant between group differences were noted between latent class groups and sociodemographic characteristics. Multinomial logistic regression models identified the associations between sociodemographic characteristics and corollary clinical features of substance use on latent class groupings of alcohol and concurrent drug use. CONCLUSION: Understanding concurrent substance use LC groups among adolescents is essential to providing targeted interventions and treatment programs, as well as early intervention programs that may help reduce substance use during adolescence.

Aberrant DNA repair reveals a vulnerability in histone H3.3-mutant brain tumors.

Pediatric high-grade gliomas (pHGG) are devastating and incurable brain tumors with recurrent mutations in histone H3.3. These mutations promote oncogenesis by dysregulating gene expression through alterations of histone modifications. We identify aberrant DNA repair as an independent mechanism, which fosters genome instability in H3.3 mutant pHGG, and opens new therapeutic options. The two most frequent H3.3 mutations in pHGG, K27M and G34R, drive aberrant repair of replication-associated damage by non-homologous end joining (NHEJ). Aberrant NHEJ is mediated by the DNA repair enzyme polynucleotide kinase 3'-phosphatase (PNKP), which shows increased association with mutant H3.3 at damaged replication forks. PNKP sustains the proliferation of cells bearing H3.3 mutations, thus conferring a molecular vulnerability, specific to mutant cells, with potential for therapeutic targeting.

Shifting gears: Creating equity informed leaders for effective learning health systems.

Leadership is vital to a well-functioning and effective health system. This importance was underscored during the COVID-19 pandemic. As disparities in infection and mortality rates became pronounced, greater calls for equity-informed healthcare emerged. These calls led some leaders to use the Learning Health System (LHS) approach to quickly transform research into healthcare practice to mitigate inequities causing these rates. The LHS is a relatively new framework informed by many within and outside health systems, supported by decision-makers and financial arrangements and encouraged by a culture that fosters quick learning and improvements. Although studies indicate the LHS can enhance patients' health outcomes, scarce literature exists on health leaders' use and incorporation of equity into the LHS. This article begins addressing this gap by examining how equity can be incorporated into LHS activities and discussing ways leaders can ensure equity is considered and achieved in rapid learning cycles.

Fairness for Whom? Learning Health Systems' Approach to Equity in Healthcare.

Many healthcare systems use "equity" as a catch-all term to underscore their commitment to delivering care matching users' needs. Despite its ubiquity, it is often haphazardly used and applied to care and improvement efforts. As the learning health systems (LHSs) approach gains prominence, LHS researchers have sought to embed equity into their work while navigating systems with differing views of equity. We examine several components of equity, its definitions within LHSs and knowledge from LHSs' equity approach that could be implemented across systems. We conclude by suggesting various ways in which readers can embed equity into their respective LHSs.

Everybody's talking about equity, but is anyone really listening?: The case for better data-driven learning in health systems.

Data collection, analysis, and data driven action cycles have been viewed as vital components of healthcare for decades. Throughout the COVID-19 pandemic, case incidence and mortality data have consistently been used by various levels of governments and health institutions to inform pandemic strategies and service distribution. However, these responses are often inequitable, underscoring pre-existing healthcare disparities faced by marginalized populations. This has prompted governments to finally face these disparities and find ways to quickly deliver more equitable pandemic support. These rapid data informed supports proved that learning health systems (LHS) could be quickly mobilized and effectively used to develop healthcare actions that delivered healthcare interventions that matched diverse populations' needs in equitable and affordable ways. Within LHS, data are viewed as a starting point researchers can use to inform practice and subsequent research. Despite this innovative approach, the quality and depth of data collection and robust analyses varies throughout healthcare, with data lacking across the quadruple aims. Often, large data gaps pertaining to community socio-demographics, patient perceptions of healthcare quality and the social determinants of health exist. This prevents a robust understanding of the healthcare landscape, leaving marginalized populations uncounted and at the sidelines of improvement efforts. These gaps are often viewed by researchers as indication that more data is needed rather than an opportunity to critically analyze and iteratively learn from multiple sources of pre-existing data. This continued cycle of data collection and analysis leaves one to wonder if healthcare has a data problem or a learning problem. In this commentary, we discuss ways healthcare data are often used and how LHS disrupts this cycle, turning data into learning opportunities that inform healthcare practice and future research in real time. We conclude by proposing several ways to make learning from data just as important as the data itself.

Positioning patients to partner: exploring ways to better integrate patient involvement in the learning health systems.

Globally, health systems are increasingly striving to deliver evidence based care that improves patients', caregivers' and communities' health outcomes. To deliver this care, more systems are engaging these groups to help inform healthcare service design and delivery. Their lived experiences-experiences accessing and/or supporting someone who accesses healthcare services-are now viewed by many systems as expertise and an important part of understanding and improving care quality. Patients', caregivers' and communities' participation in health systems can range from healthcare organizational design to being members of research teams. Unfortunately, this involvement greatly varies and these groups are often sidelined to the start of research projects, with little to no role in later project stages. Additionally, some systems may forgo direct engagement, focusing solely on patient data collection and analysis. Given the benefits of active patient, caregiver and community participation in health systems on patient health outcomes, systems have begun identifying different approaches to studying and applying findings of patient, caregiver and community informed care initiatives in a rapid and consistent fashion. The learning health system (LHS) is one approach that can foster deeper and continuous engagement of these groups in health systems change. This approach embeds research into health systems, continuously learning from data and translating findings into healthcare practices in real time. Here, ongoing patient, caregiver and community involvement is considered vital for a well functioning LHS. Despite their importance, great variability exists as to what their involvement means in practice. This commentary examines the current state of patient, caregiver and community participation in the LHS. In particular, gaps in and need for resources to support their knowledge of the LHS are discussed. We conclude by recommending several factors health systems must consider in order to increase participation in their LHS. Systems must: (1) assess patients', caregivers and community understanding of how their feedback are used in the LHS and how collected data are used to inform patient care; (2) review the level and extent of these groups' participation in health system improvement activities; and (3) examine whether health systems have the workforce, capacity and infrastructure to nurture continuous and impactful engagement.

Patients, caregivers and communities have started taking more hands on roles in health systems, partnering with healthcare providers and researchers to impact the ways healthcare services are made and delivered. Their input has been shown to improve patient health. While many systems are working to include patients, caregivers and communities in helping improve healthcare, this work often focuses on collecting and analyzing patient data without using it in a timely way. Also, the level of their input can vary and is often limited to the start of a research project. As more health systems recognize the importance of their input in creating better healthcare, some are using different approaches to make this feedback a constant part of their systems. The learning health system (LHS) is one approach that can support deeper and ongoing patient, caregiver and community involvement in health system change. In the LHS, projects are frequently reviewed and feedback used to help health systems make changes as they go. While their involvement is critical to a well functioning LHS, it is unclear what this involvement looks like. This commentary reviews the current state of this involvement. We offer readers a way forward and suggestions to help them determine if they are actively including patients, caregivers and communities in their LHS. Suggestions include reviewing: (1) the ways data are collected and used; (2) how patients, caregivers and communities are involved in health system improvement efforts; and (3) whether or not systems have the tools needed to frequently partner with these groups.

Gathering speed and countering tensions in the rapid learning health system.

The vision of the learning health system (LHS), conceptualized 15 years ago, is for the rapid generation, use, and spread of high-quality evidence that yields better health experiences, outcomes, efficiencies, and equity in everyday practice settings across communities. However, despite the emergence of many useful LHS frameworks and examples to guide adoption, large gaps remain in the speed and consistency with which evidence is generated and used across the range of settings from the bedside to the policy table. Gaps in progress are not surprising, however, given the tensions that predictably arise when key stakeholders-researchers, health systems, and funders-comingle in these efforts. This commentary examines eight core tensions that naturally arise and offers practical actions that stakeholders can take to address these tensions and speed LHS adoption. The urgency for attenuating these tensions and accelerating health system improvements has never been higher. Timeliness, rigor, and prioritization can be aligned across stakeholders, but only if all partners are intentional about the operational and cultural challenges that exist.

Psychological sense of community, community civic participation, and ethnic identity on social justice orientation and psychological empowerment between LGBQ and Non-LGBQ youth of color.

For lesbian, gay, bisexual, and questioning (LGBQ) youth of color, the intersection of identifying as both LGBQ and a person of color results in not only managing racial stereotypes, but also heterosexism and genderism. Developing a critical understanding of oppressive social conditions and ways to engage in social action is a form of resistance for these youth. Research is needed among LGBQ youth of color that examines the range of predictors and outcomes related to civic engagement, development, and empowerment. Drawing on data derived from a sample of urban youth of color (N = 383; 53.1% Female; 75% Hispanic; Age range = 14 to 18 years; 15% identify as LGBQ), this study will: (1) examine the relationship between community-based perceptions (e.g., psychological sense of community), ethnic identity, behaviors (e.g., community civic participation) and awareness of social justice concerns with dimensions of psychological empowerment; and (2) assess differences that these relationships have between LGBQ and non-LGBQ youth of color. Findings indicate that main predictors have a positive impact on intrapersonal and cognitive dimensions of psychological empowerment through social justice orientation, with noted variations between LGBQ and non-LGBQ youth of color.

An Integrated Care Model to Support Adolescents With Diabetes-related Quality-of-life Concerns: An Intervention Study.

BACKGROUND: Our aim in this study was to determine whether participating in an integrated stepped care model for adolescents with type 1 diabetes (T1D) would lead to improvements in overall quality of life (QoL), diabetes-related quality of life (DRQoL) and glycated hemoglobin (A1C) levels compared with usual care. METHODS: A nonrandomized, 2-group, pre/post, delayed-intervention design was used for this study. The Mind Youth Questionnaire (MY-Q) was used to assess QoL and DRQoL. Adolescents attending the diabetes clinic using the stepped care model formed the intervention group (n=77). These adolescents completed the MY-Q, and the identified concerns were discussed and addressed with them by their care team as part of the care model. Adolescents attending a pediatric diabetes clinic on another site completed the MY-Q as a comparison group (n=39), results were not shared with their care team, and they received the standard care. RESULTS: There were 116 adolescents between 13 to 17 years of age, who completed the MY-Q on 2 occasions. Baseline data were obtained on the first occasion, and, on the second occasion, an average of 12 months later, there was a follow-up assessment. At follow-up, adolescents in the intervention group had a significantly higher overall QoL and reported significantly fewer concerns on DRQoL domains than those in the comparison group. Participation in the intervention group, however, did not lead to improvements in A1C. CONCLUSION: This study shows that implementing an integrated stepped care model within an interprofessional pediatric diabetes clinic can lead to the improvement of adolescents' overall QoL and DRQoL.

Sociopolitical control as a mediator between ethnic identity and social support on 30-day drug use among black girls.

While Black girls have lower rates of drug use, they face worse health and wellbeing consequences associated with drug use. Understanding which strengths-based factors serve as buffers to limit adverse outcomes related to drug use among Black girls is essential for prevention. This study investigated the mediating role of sociopolitical control on drug use among Black girls (n = 340). Using path analysis, models were tested to include the variables of interest. Sociopolitical control (e.g. leadership competency and policy control) significantly mediated the relationship between ethnic identity and social support on drug use. Implications from this study may consider bolstering empowerment-based strategies in drug use prevention for Black girls.

What happens when we ask? A phenomenological focus group on HIV prevention and sexual health education among emancipated foster care youth.

Youth of color who have recently been emancipated from foster care are among the most vulnerable group at risk for having poor sexual health outcomes. It is essential for researchers to understand how emancipated foster care youth receive messages about safe sex and HIV/STI prevention in order to tailor health promotion activities for this group. This study presents a strengths-based view of emancipated foster care youth of color who developed an empowering, arts-based campaign to prevent HIV in their community using Youth Participatory Action Research (Y-PAR) methods. The project was led by 10 emancipated foster care youth who participated in two focus groups that centered on understanding their knowledge of HIV. Five major themes emerged from the focus group. Implications for researchers include incorporating safe spaces for youth to develop ideas that can result in empowering activities relating to prevention.

Measuring Intrapersonal Psychological Empowerment and Ethnic Identity: Highlighting Strengths of Urban Black Girls.

Limited research has examined intrapersonal psychological empowerment (PE) among Black girls solely. This study aims to fill a gap in empowerment literature by examining the factor structure of the Sociopolitical Control Scale for Youth (SPCS-Y) among Black girls (N = 377) between the ages of 14-17 years old. We also examine the association with ethnic identity as a conceptually related variable. Structural equation modeling (SEM) was used to examine the factorial validity of the abbreviated, eight-item SPCS-Y among Black girls. Results support the two-dimensional factor structure of the abbreviated SPCS-Y among Black girls, as well as the association intrapersonal PE has with ethnic identity. Findings provide preliminary support for the empirical and theoretical relationship between intrapersonal PE and ethnic identity among Black girls.

Ethnic Identity, Empowerment, Social Support and Sexual Risk Behaviors Among Black Adolescent Girls: Examining Drug Use as a Mediator.

Substance abuse and sexual health research tends to overlook the resiliency skills that Black adolescent girls possess. Using a strengths-based lens, this study examines the role of protective factors: (e.g. ethnic identity, social support, and psychological empowerment) on sexual risk behaviors testing drug use as a mediator among a sample of Black adolescent girls. The study uses a sample (N = 340) female adolescents (13-17 years old) who identified as being Black only and reside in a northeastern urban community in New Jersey. Structural equation modeling was employed to test the hypothesized model of the mediating role of drug use on sexual risk behaviors among this sample. Findings revealed that drug use significantly mediated the relationship between social support, ethnic identity, and psychological empowerment on sexual risk behaviors, with high ethnic identity scores having the strongest relationship on low sexual risk behaviors and low levels of drug use. Given the rise of sexually transmitted infections (STIs) in the United States among Black adolescent girls, findings from this study can contribute to development of culturally appropriate and innovative strategies to reduce risky behaviors by promoting social and cultural strengths among Black girls living in urban communities.

Intrapersonal psychological empowerment profiles on ethnic identity, social support, and lifetime drug use among Hispanic adolescent girls.

The abbreviated Sociopolitical Control Scale for Youth (SPCS-Y) factor structure, used to measure intrapersonal psychological empowerment, was tested among a sample of Hispanic adolescent girls (N = 490). Confirmatory factor analysis and latent class analyses were conducted, and five distinct cluster groups emerged. Multivariate analysis of covariance was used to examine conceptually related variables and support the two-factor structure and validity of the scale. Participants with higher levels of intrapersonal psychological empowerment also had high social support, ethnic identity, and lower levels of alcohol and drug use. Findings support the use of the scale on Hispanic adolescent girls and contribute to alcohol and drug use prevention research.

Looking Back on Philanthropy in a Pandemic Foundation Colleagues Share Common Perspectives from Across the Pond.

Over the past year, the pandemic caused havoc globally touching the lives of most people. This included emerging challenges for nonprofits on the front lines of escalating need while at the same time limiting fundraising. Scaling up to meet needs in an extreme resource constrained environment pushed many nonprofits to the brink of insolvency. Many foundations have responded effectively to this circumstance by increasing grant making, reducing red tape, and extending greater flexibility for nonprofits. In doing so, foundations have exercised unusual humility in how they positioned themselves relative to nonprofits in protecting capacity to serve intended beneficiaries. This op-ed explores the relaxing of traditional tensions between foundations and grant seekers in ways that enabled more adequate and timely responses to pressing human needs in the face of the pandemic.

Ethnic Identity as a Moderator Between HIV Knowledge, Viral Hepatitis Knowledge, and Psychological Antecedents Among Racial-Ethnic Minority Youth Living in an Urban Community.

Racial-ethnic minority youth between the ages of 13 and 24 in the USA are disproportionately impacted by HIV. Low HIV knowledge and psychological antecedents such as low perception of risk and low sexual negotiation skills have all been associated with HIV risk behaviors; however, the role of ethnic identity on these factors is unclear in the literature. Ethnic identity, which is a critical part of identity development among racial-ethnic minority youth, has been found to be a protective factor in risk-taking behaviors. However, limited research is available on the role of ethnic identity in HIV prevention research among youth. For this study, data were collected as part of a larger HIV prevention education program using a sample of 564 students of color (Meanage = 16.30, standard deviation [SD] = 1.26; 67.4% Hispanic, 29.5% Black) from an underserved northeastern US urban community. We examined whether ethnic identity moderated the relationship between psychological antecedents (e.g., perception of risk and sexual negotiation skills), gender, and viral hepatitis knowledge on HIV knowledge. Findings revealed that ethnic identity significantly moderated the relationship between psychological antecedent variables and HIV knowledge by strengthening these associations as ethnic identity increased. Female adolescents were also more likely to have higher levels of HIV knowledge than males. Findings provide support for cultural and gender-specific prevention programs for racial-ethnic minority youth that seek to reduce HIV risk behaviors by increasing ethnic identity, particularly in under-resourced communities.

The brief sense of community scale: Testing dimensionality and measurement invariance by gender among Hispanic/Latinx youth.

Psychological sense of community is defined as feelings of belongingness and a shared belief that community members will meet one another's needs. Psychological sense of community has four dimensions: membership, influence, needs fulfillment, and emotional connection. In this study, multigroup confirmatory factor analysis was used to examine the first and second-order factor structure of the brief sense of community scale (BSCS) between male and female Hispanic/Latinx adolescents from an urban community (N = 947). To help validate the BSCS model, the second-order factor model was tested with regression to predict the measures of intrapersonal psychological empowerment and ethnic identity, as constructs conceptually related to psychological sense of community. Findings support that: (1) psychological sense of community can be measured through the BSCS and as a four-factor model among Hispanic/Latinx youth, supporting McMillan and Chavis's (1986) original theoretical discussions; (2) while no differences between genders were present at the model-level, there was path-specific variation; and (3) intrapersonal psychological empowerment and ethnic identity were associated with psychological sense of community.

The Mediating Role of Ethnic Identity and Social Justice Orientation Between Community Civic Participation, Psychological Sense of Community, and Dimensions of Psychological Empowerment Among Adolescents of Color.

There is an emerging interest in studying social action and civic engagement as a part of the developmental process. Studies among youth of color indicate that empowerment has been associated with well-being, a critical perspective, and in combating social oppression. These studies also show that civic involvement and awareness of social justice issues are associated with positive developmental outcomes including empowerment. The range of predictors and outcomes related to empowerment have been insufficiently explored. This study used structural equation modeling path analysis techniques to examine the association community civic participation and psychological sense of community have with intrapersonal and cognitive psychological empowerment, through both ethnic identity and social justice orientation among urban youth of color (N =383; 53.1% Female; 75% Hispanic; 50.6% were 13 and 15 years of age). Findings illustrate that greater community civic participation and psychological sense of community are associated with both intrapersonal and cognitive psychological empowerment, through both ethnic identity and a social justice orientation; however, with some noted variations. Ethnic identity and social justice orientation mediated community civic participation and psychological sense of community and both intrapersonal and cognitive psychological empowerment. Implications put forward for community youth-workers and community programming.

A Spatial Analysis of Alcohol Outlet Density Type, Abandoned Properties, and Police Calls on Aggravated Assault Rates in a Northeastern U.S. City.

Background: Community-based research and prevention scholarship has shown a growing interest in examining the impact of the ecological structure of neighborhoods on community violence. Ecological structures such as higher numbers of alcohol outlets and abandoned/vacant properties in geographically dense, poor, and socially isolated communities are critically important to consider. Further, disadvantaged urban communities are burdened by greater police presence with limited or no abatement in crime or violence. Purpose: Using Geographic Information Systems (GIS) mapping, spatial analysis techniques, and a negative binomial regression analyses, this study investigated the relationships between alcohol outlet density consisting of license C (i.e., combined on and off premises establishments) and license D (i.e., off premises establishments such as liquor stores), abandoned properties, and police calls to service on aggravated assault rates in a Northeastern United States urban city. Results: Negative binomial regression analysis results showed that license C alcohol outlet density count (IRR = 1.36, 95% CI = 1.08, 2.11), license D alcohol outlet density count (IRR = 1.13, 95% CI = 1.01, 1.30), abandoned property count (IRR = 1.28, 95% CI = 1.01, 2.01), and police call to service counts (IRR = 1.24, 95% CI = 1.01, 1.50) were positively associated with aggravated assault rates. Analyses controlled for census data characteristics. Conclusions: The link between alcohol outlet density and violent crime has been established in public health research. However, this study represents an important contribution in recognizing the unique relationships between license C and license D alcohol outlet density, abandoned properties, and police calls to service with aggravated assaults in an urban neighborhood. Conclusions are drawn for policy and practice.

Testing the Factor Structure of the Brief Sense of Community Scale among Black Girls and the Relationship with Ethnic Identity, Empowerment and Social Support.

Research on Psychological Sense of Community (SOC) among Black girls are limited due to lack of validated measures for this group. Using confirmatory factor analysis (CFA), the first and second-order factor structure of the Brief Sense of Community Scale (BSCS) used to measure Psychological SOC was examined using a sample of Black girls from an urban community (N = 340). Using a regression-based approach, the second-order five-factor model of the BSCS was also examined with intrapersonal psychological empowerment (PE), social support, and ethnic identity as conceptually related variables. Findings support that: (1) psychological SOC can be conceptualized and measured through four dimensions among Black girls; and (2) intrapersonal PE, social support, and ethnic identity were significantly associated with SOC.