Uptake of and Engagement With an Online Sexual Health Intervention (HOPE eIntervention) Among African American Young Adults: Mixed Methods Study.

BACKGROUND: Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities. OBJECTIVE: We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O'Brien and Toms' model of engagement. METHODS: This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a "HOPE party." Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. A generalized linear mixed-effects model identified predictors of eIntervention uptake, server logs were summarized to describe use over time, and interview transcripts were coded and thematically analyzed to identify factors affecting uptake and engagement. RESULTS: Participants' initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement. CONCLUSIONS: To encourage uptake, CHI interventions for African American young adults can better leverage users' desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions to promote uptake and engagement. To guide future analyses, we present an expanded uptake and engagement model for CHI interventions targeting African American young adults based on our empirical results.

Community-Engaged Neighborhood Revitalization and Empowerment: Busy Streets Theory in Action.

Busy streets theory predicts that engaging residents in physical revitalization of neighborhoods will facilitate community empowerment through the development of sense of community, social cohesion, collective efficacy, social capital, and behavioral action. Establishing safe environments fosters positive street activity, which reinforces neighborhood social relationships. A community-engaged approach to crime prevention through environmental design (CE-CPTED) is one promising approach to creating busy streets because it engages residents in collaborative interactions to promote safer environments. Yet, few researchers have studied how CE-CPTED may be associated with busy streets. We interviewed 18 residents and stakeholders implementing CE-CPTED in Flint, Michigan. We studied three neighborhoods with different levels of resident control over CE-CPTED. Participants described how CE-CPTED implementation affected their neighborhood. Participants from all three neighborhoods reported that CE-CPTED was associated with positive street activity, sense of community, and collective efficacy. Participants from neighborhoods with higher resident control of CE-CPTED reported more social capital and behavioral action than those from neighborhoods with less resident control. Our findings support busy streets theory: Community engagement in neighborhood improvement enhanced community empowerment. CE-CPTED that combines physical revitalization with resident engagement and control creates a potent synergy for promoting safe and healthy neighborhoods.

Busy Streets Theory: The Effects of Community-engaged Greening on Violence.

Lack of maintenance on vacant neighborhood lots is associated with higher levels of depression, anxiety, and stress for nearby residents. Overgrown grasses and dense brush provide hiding spots for criminals and space to conduct illicit activities. This study builds upon previous research by investigating greening programs that engage community members to conduct routine maintenance on vacant lots within their neighborhoods. The Clean & Green program is a community-based solution that facilitates resident-driven routine maintenance of vacant lots in a midsized, Midwestern city. We use mixed effects regression to compare assault and violent crime counts on streets where vacant lot(s) are maintained by community members (N = 216) versus streets where vacant lots were left alone (N = 446) over a 5-year timeframe (2009-2013). Street segments with vacant lots maintained through the Clean & Green program had nearly 40% fewer assaults and violent crimes than street segments with vacant, abandoned lots, which held across 4 years with a large sample and efforts to test counterfactual explanations. Community-engaged greening programs may not only provide a solution to vacant lot maintenance, but also work as a crime prevention or reduction strategy. Engaging the community to maintain vacant lots in their neighborhood reduces costs and may increase the sustainability of the program.

The Role of Present Time Perspective in Predicting Early Adolescent Violence.

This study investigated the role of present and future time perspectives, and their relationships with subjective norms and beliefs regarding violence, in predicting violent behaviors among urban middle school students in the Midwestern United States. Although present time perspective covaried with subjective norms and beliefs, each made a unique prediction of self-reported violent behaviors. Future time perspective was not a significant predictor when accounting for these relationships. In addition, present orientation moderated the relationship between subjective norms and beliefs and rates of violent behaviors; those with higher present orientations exhibited stronger associations. We replicated this pattern of results in data from new participants in a subsequent wave of the study. Interventions that explicitly address issues related to time perspective may be effective in reducing early adolescent violence.

Youth Empowerment Solutions: Evaluation of an After-School Program to Engage Middle School Students in Community Change.

We report on an effectiveness evaluation of the Youth Empowerment Solutions (YES) program. YES applies empowerment theory to an after-school program for middle school students. YES is an active learning curriculum designed to help youth gain confidence in themselves, think critically about their community, and work with adults to create positive community change. We employed a modified randomized control group design to test the hypothesis that the curriculum would enhance youth empowerment, increase positive developmental outcomes, and decrease problem behaviors. Our sample included 367 youth from 13 urban and suburban middle schools. Controlling for demographic characteristics and pretest outcome measures, we found that youth who received more components of the curriculum reported more psychological empowerment and prosocial outcomes and less antisocial outcomes than youth who received fewer of the intervention components. The results support both empowerment theory and program effectiveness.

Psychological Empowerment Among Urban Youth: Measurement Model and Associations with Youth Outcomes.

Empowerment-based strategies have become widely used method to address health inequities and promote social change. Few researchers, however, have tested theoretical models of empowerment, including multidimensional, higher-order models. We test empirically a multidimensional, higher-order model of psychological empowerment (PE), guided by Zimmerman's conceptual framework including three components of PE: intrapersonal, interactional, and behavioral. We also investigate if PE is associated with positive and negative outcomes among youth. The sample included 367 middle school youth aged 11-16 (M = 12.71; SD = 0.91); 60% female, 32% (n = 117) white youth, 46% (n = 170) African-American youth, and 22% (n = 80) identifying as mixed race, Asian-American, Latino, Native American, or other ethnic/racial group; schools reported 61-75% free/reduced lunch students. Our results indicated that each of the latent factors for the three PE components demonstrate a good fit with the data. Our results also indicated that these components loaded on to a higher-order PE factor (X2  = 32.68; df: 22; p = .07; RMSEA: 0.04; 95% CI: .00, .06; CFI: 0.99). We found that the second-order PE factor was negatively associated with aggressive behavior and positively associated with prosocial engagement. Our results suggest that empowerment-focused programs would benefit from incorporating components addressing how youth think about themselves in relation to their social contexts (intrapersonal), understanding social and material resources needed to achieve specific goals (interactional), and actions taken to influence outcomes (behavioral). Our results also suggest that integrating the three components and promoting PE may help increase likelihood of positive behaviors (e.g., prosocial involvement); we did not find an association between PE and aggressive behavior. Implications and future directions for empowerment research are discussed.

A Comprehensive Prevention Approach to Reducing Assault Offenses and Assault Injuries among Youth.

Since 2011, the CDC-funded Michigan Youth Violence Prevention Center (MI-YVPC), working with community partners, has implemented a comprehensive prevention approach to reducing youth violence in Flint, MI, based on public health principles. MI-YVPC employed an intervention strategy that capitalizes on existing community resources and application of evidence-based programs using a social-ecological approach to change. We evaluated the combined effect of six programs in reducing assaults and injury among 10-24 year olds in the intervention area relative to a matched comparison community. We used generalized linear mixed models to examine change in the intervention area counts of reported assault offenses and assault injury presentation relative to the comparison area over a period 6 years prior- and 30 months post-intervention. Results indicated that youth victimization and assault injuries fell in the intervention area subsequent to the initiation of the interventions and that these reductions were sustained over time. Our evaluation demonstrated that a comprehensive multi-level approach can be effective for reducing youth violence and injury.

Relationships Among Disease, Social Support, and Perceived Health: A Lifespan Approach.

We examined the relationship between the cumulative presence of major disease (cancer, stroke, diabetes, heart disease, and hypertension), social support, and self-reported general and emotional well-being in a community representative sample of predominantly White and African American respondents (N = 1349). Across all ages, greater presence of disease predicted poorer reported general health, and predicted lower emotional well-being for respondents 40 and above. In contrast, social support predicted better-reported general and emotional well-being.We predicted that different types of social support (blood relatives, children, friends, community members) would be relatively more important for health in different age groups based on a lifespan or life stage model. This hypothesis was supported; across all ages, social support was related to better reported general and emotional health, but sources of support differed by age. Broadly, those in younger age groups tended to list familial members as their strongest sources of support, whereas older group members listed their friends and community members. As a whole, social support mediated the effect of disease on reported wellbeing,however, moderated mediation by type of support was not significant. The results are consistent with a lifespan approach to changing social ties throughout the life course.

A Spatial Analysis of Heterogeneity in the Link Between Alcohol Outlets and Assault Victimization: Differences Across Victim Subpopulations.

The positive association between alcohol outlet density and assault rates is well established, but little is known about how this association differs across victim subpopulations. We use spatial point process models on police data from Flint, Michigan, to test how the link between alcohol outlet density and assault rates changes as a function of three victim characteristics: age, gender, and race. We found that, although both on-premises and package outlet densities consistently emerge as risk factors for victimization, their relative effects are markedly larger in Whites than in African Americans. No analogous age- or gender-based differences were found. These results suggest the racial effects arise more from relative differences in the atmosphere in and around alcohol outlets than differences in drinking behavior alone.

EXAMINING LONG-TERM EFFECTS OF AN INFANT MENTAL HEALTH HOME-BASED EARLY HEAD START PROGRAM ON FAMILY STRENGTHS AND RESILIENCE.

Infant Mental Health based interventions aim to promote the healthy development of infants and toddlers through promoting healthy family functioning to foster supportive relationships between the young child and his or her important caregivers. This study examined impacts of an Infant Mental Health home-based Early Head Start (IMH-HB EHS) program on family functioning. The sample includes 152 low-income families in the Midwestern United States, expectant or parenting a child younger than 1 year of age, who were randomly assigned to receive IMH-HB EHS services (n = 75) or to a comparison condition (n = 77). Mothers who received IMH-HB EHS services reported healthier psychological and family functioning, outcomes that are consistent with the IMH focus, when their children were between the ages of 3 and 7 years of age. Specifically, mothers in the IMH-HB EHS group reported healthier family functioning and relationships, better coping skills needed to advocate for their families, and less stress in the parenting role versus those in the comparison condition. The study also examined support seeking coping, some of which changed differently over time based on program group assignment. Overall, findings suggest that the gains families achieve from participating in IMH-HB EHS services are maintained after services cease.

Changes in body mass index associated with head start participation.

OBJECTIVES: The goal of this study was to determine if Head Start participation is associated with healthy changes in BMI. METHODS: The sample included children participating in Head Start between 2005 and 2013 and children from 2 comparison groups drawn from a Michigan primary care health system: 5405 receiving Medicaid and 19,320 not receiving Medicaid. Change in BMI z score from the beginning to the end of each of 2 academic years and the intervening summer was compared between groups by using piecewise linear mixed models adjusted for age, gender, and race/ethnicity. RESULTS: The total sample included 43,748 children providing 83,239 anthropometric measures. The Head Start sample was 64.9% white, 10.8% black, and 14.4% Hispanic; 16.8% of the children were obese and 16.6% were overweight at the initial observation. Children who entered Head Start as obese exhibited a greater decline in the BMI z score during the first academic year versus the comparison groups (ß = -0.70 [SE: 0.05] vs -0.07 [0.08] in the Medicaid group [P < .001] and -0.15 [SE: 0.05] in the Not Medicaid group [P < .001]); patterns were similar for overweight children. Head Start participants were less obese, less overweight, and less underweight at follow-up than children in the comparison groups. CONCLUSIONS: Preschool-aged children with an unhealthy weight status who participated in Head Start had a significantly healthier BMI by kindergarten entry age than comparison children in a primary care health system (both those receiving and those not receiving Medicaid).

From broken windows to busy streets: a community empowerment perspective.

In the present article, we introduce a community empowerment perspective to understanding neighborhoods. A preponderance of literature exists on neighborhood risk factors for crime. Yet less is known about positive factors that make neighborhoods safe and desirable. We propose community empowerment as a conceptual foundation for understanding neighborhood factors that promote social processes, and ultimately, lead to an improvement in structural factors. We suggest that neighborhoods are empowered because they include processes and structures for positive social interactions to emerge and develop. We present busy streets as a mechanism that creates a positive social context, in which social cohesion and social capital thrive. Thus, empowered communities are characterized by climates that promote busy streets. Our article underscores the need to examine both the broader, structural context and social processes operating within this context. Such an integrative perspective is necessary to fully understand how to empower neighborhoods, particularly in the face of structural challenges.

Youth Empowerment Solutions for Peaceful Communities: combining theory and practice in a community-level violence prevention curriculum.

This article describes the development and evaluation of an after-school curriculum designed to prepare adolescents to prevent violence through community change. This curriculum, part of the Youth Empowerment Solutions for Peaceful Communities (YES) program, is guided by empowerment and ecological theories within a positive youth development context. YES is designed to enhance the capacity of adolescents and adults to work together to plan and implement community change projects. The youth curriculum is organized around six themed units: (a) Youth as Leaders, (b) Learning about Our Community, (c) Improving Our Community, (d) Building Intergenerational Partnerships, (e) Planning for Change, and (f) Action and Reflection. The curriculum was developed through an iterative process. Initially, program staff members documented their activities with youth. These outlines were formalized as curriculum sessions. Each session was reviewed by the program and research staff and revised based on underlying theory and practical application. The curriculum process evaluation includes staff and youth feedback. This theoretically based, field-tested curriculum is designed to be easily adapted and implemented in a diverse range of communities.

Youth empowerment solutions for violence prevention.

The limited success of youth violence prevention interventions suggests that effective prevention needs to address causes at multiple levels of analysis and empower youth in developing and implementing prevention programs. In this article, we review published studies of youth violence prevention efforts that engage youth in developing or implementing violence prevention activities. The reviewed studies suggest the promise of youth empowerment strategies and the need for systematic outcome studies of empowerment programs. After reviewing empowerment theory applied to youth violence prevention programs, we present a case study of the Youth Empowerment Solutions (YES) for Peaceful Communities program. YES engages middle-school youth in an after-school and summer program that includes a culturally tailored character development curriculum and empowers the youth to plan and implement community improvement projects with assistance from adult neighborhood advocates. The case study focuses on outcome evaluation results and presents evidence of the YES program effects on community-level outcomes (eg, property improvements, violent crime incidents) and on individual-level outcomes (eg, conflict avoidance, victimization). The literature review and the case study suggest the promise of engaging and empowering youth to plan and implement youth violence prevention programs.

Enhancing parenting skills among nonresident African American fathers as a strategy for preventing youth risky behaviors.

This study evaluated the effectiveness of a theoretically based, culturally specific family intervention designed to prevent youth risky behaviors by influencing the parenting attitudes and behaviors of nonresident African American fathers and the parent-child interactions, intentions to avoid violence, and aggressive behaviors of their preadolescent sons. A sample of 158 intervention and 129 comparison group families participated. ANCOVA results indicated that the intervention was promising for enhancing parental monitoring, communication about sex, intentions to communicate, race-related socialization practices, and parenting skills satisfaction among fathers. The intervention was also beneficial for sons who reported more monitoring by their fathers, improved communication about sex, and increased intentions to avoid violence. The intervention was not effective in reducing aggressive behaviors among sons. Findings are discussed from a family support perspective, including the need to involve nonresident African American fathers in youth risky behavior prevention efforts.

Using process evaluation to strengthen intergenerational partnerships in the Youth Empowerment Solutions program.

This study illustrates the utility of process evaluation methods for improving a new violence prevention program, Youth Empowerment Solutions for Peaceful Communities (YES). The YES program empowered young adolescents to plan and complete community improvement projects with neighborhood adult advocates. The process evaluation methods included questionnaires and focus groups with students and interviews with neighborhood advocates. Process evaluation results guided program improvements for the second year. The process evaluation results after the second program year suggested that the program improvements were associated with higher student ratings of program staff and neighborhood advocates. The students and neighborhood advocates reported increased positive experiences after the second program year, but continued to note the challenges of working inter-generationally on community improvement projects.

Assessing emergency response training needs of local environmental health professionals.

The Michigan Center for Public Health Preparedness collaborated with environmental health (EH) professionals at the local, state, and national levels to develop and conduct a state-wide study to identify the preparedness-training needs of local EH professionals in Michigan. The specific aims of the study were first, to determine the self-rated level of confidence among Michigan's EH professionals regarding relevant emergency planning and response competencies; second, to determine the specific preparedness training topic preferences of Michigan's EH professionals; and third, to establish baseline needs assessment data to be used to track progress toward higher levels of readiness after implementation of planning, training, and other preparedness activities. The study recruited 400 EH professionals to complete the survey (61% of all EH professionals in 45 local health departments in Michigan). The top training topic preferences were "environmental health role in emergencies" followed by "water security" and "food security." The EH professionals rated their confidence in demonstrating relevant emergency planning and response competencies. Most of the average ratings (on a 5-point scale) were close to the scale's middle point (rating = 3), suggesting that EH professionals rate themselves as "somewhat confident" in performing important tasks in preparedness and response. Variations in specific ratings helped identify training needs. The discussion of these results focused on the implications of this study for the development of emergency response training for environmental health professionals.

The effect of professional partnership on the development of a mutual-help organization.

The effects of partnership between Schizophrenics Anonymous (SA, a mutual-help organization) and the Mental Health Association in Michigan (MHAM, a professionally staffed advocacy organization) on SA's growth and development were explored. Following the initiation of a formal partnership, SA groups were more available throughout the state, more likely to be associated with formal mental health settings, and less likely to have leaders who had been participants in other SA groups. Groups with consumer leaders had significantly greater longevity than groups with professional leaders. Changes in the organizational structure and process of SA were also identified. SA leaders reported that SA moved from a collective to a more bureaucratic structure. As a result, there was greater consistency, administrative capacity, and response capacity. This enhanced capacity came with costs reported by SA leaders. The leadership role of SA members became less defined. SA members expressed concerns about the more hierarchical structure of SA's organization, decreased consumer control, increased professional involvement in SA, and an excessive focus on group development as opposed to group maintenance. Mental Health Association in Michigan staff reported that MHAM was also impacted by the partnership, both with regard to internal functioning and external perception. Implications for effective partnerships between mutual-help and professional organizations are discussed.

Organizational empowerment in community mobilization to address youth violence.

Community mobilization efforts to address youth violence are often disconnected, uncoordinated, and lacking adequate resources. An organizational empowerment theory for community partnerships provides a useful framework for organizing and evaluating a coalition's community mobilization efforts and benefits for individual organizations, partnerships, and communities. Based on a qualitative analysis of steering committee interviews and other primary data, the results of a case study suggest that the intraorganizational infrastructure; interorganizational membership practices and networking; and extraorganizational research, training, and organizing activities facilitate the community mobilization efforts of the Youth Violence Prevention Center in Flint, Michigan. The organizational empowerment framework, and its focus on organizational structures and processes, illustrates the importance of recognizing and incorporating the organizational systems and structures that provide the foundation on which a community mobilization effort may build. This framework also highlights how organizational structures and processes are central components of multilevel strategies for organizing and mobilizing community efforts to address youth violence.

Neighborhood social conditions mediate the association between physical deterioration and mental health.

This study investigates how neighborhood deterioration is associated with stress and depressive symptoms and the mediating effects of perceived neighborhood social conditions. Data come from a community survey of 801 respondents geocoded and linked to a systematic on-site assessment of the physical characteristics of nearly all residential and commercial structures around respondents' homes. Structural equation models controlling for demographic effects indicate that the association between neighborhood deterioration and well-being appear to be mediated through social contact, social capital, and perceptions of crime, but not through neighborhood satisfaction. Specifically, residential deterioration was mediated by social contact, then, social capital and fear of crime. Commercial deterioration, on the other hand, was mediated only through fear of crime. Additionally, data indicate that the functional definition of a "neighborhood" depends on the characteristics measured. These findings suggest that upstream interventions designed to improve neighborhood conditions as well as proximal interventions focused on social relationships, may promote well-being.