Barriers and Facilitators to the Online Delivery of a School-Based Intervention to Reduce Racial Trauma.

Students of color face disproportionate rates of adverse childhood experiences, including racial discrimination in school settings. Effective interventions strategies are needed to address school-based racial trauma. Link for Equity was designed to be a culturally-responsive trauma-informed intervention that includes universal cultural humility training for teachers. As a result of the COVID-19 pandemic, the in-person trauma-informed cultural humility training was adapted for online delivery. The purpose of this study was to assess barriers and facilitators that impacted online delivery of the training. We conducted semi-structured interviews with 25 high school teachers from three public school districts in the Midwestern United States who participated in the online training. Interview transcripts were coded by two team members, and thematic analysis was utilized. Barriers and facilitators to online delivery were identified across five domains: receptivity, logistics, engagement, comfort, and application. The implications of these barriers and facilitators are discussed and tailored recommendations for the virtual delivery of culturally-responsive trauma-informed interventions to reduce racial discrimination in schools are provided.

Anti-Racist Violence Prevention: Partnering With Black Youth to Identify Intervention Priorities.

In this study, academic researchers partnered with Black youth to engage in critical analysis of the intersection between racism and community violence to promote anti-racist social action that advances health equity. Through youth participatory action research, we examined perspectives and experiences of Black youth to develop a shared understanding of how to approach community violence prevention with an anti-racist lens. Thirteen youth from Kansas City and Atlanta who identified as Black or African American participated in a photovoice project to explore the intersection of racism and community violence. Youth generated photo assignments, took photos that reflected the assignment, shared their photos as a group, and chose one photo to explore in depth each week using a structured method to guide photo-discussion. Qualitative analysis of youth photo-discussions identified themes related to Black youth's experiences of racism at multiple levels and identified suggestions for anti-racist interventions, including promoting Black history knowledge and nurturing Black mentoring relationships. Grounded in these findings, we propose an anti-racist approach to community violence prevention among Black youth that engages Black youth as equitable partners to build from their expertise and strengths in developing comprehensive solutions.

Youth Empowered Advocating for Health (YEAH): Facilitating Partnerships Between Prevention Scientists and Black Youth to Promote Health Equity.

Structural racism inflicts a disproportionate burden of stress and trauma within Black communities, resulting in physical and mental health inequities that impact Black youth. Yet few multilevel interventions exist to address these deeply rooted inequities from a preventive standpoint, and even fewer are informed by the participatory input of the impacted communities. To bridge these gaps, we developed a community-based prevention strategy that promotes agency and active resistance to structural racism, Youth Empowered Advocating for Health (YEAH), and implemented it across various settings. We outline the development, implementation, and expansion of YEAH as a tool for promoting optimal health among Black communities. Lastly, we discuss lessons learned and offer a framework outlining key principles for prevention scientists to partner with Black youth and engage them in translational science to address structural racism. This framework is aimed at driving policies, practices, and procedures that promote equitable and sustainable change for and with Black communities.

Horizons and Group Motivational Enhancement Therapy: HIV Prevention for Alcohol-Using Young Black Women, a Randomized Experiment.

INTRODUCTION: Black women are at disproportionately greater risk for HIV and sexually transmitted infections than women of other ethnic/racial backgrounds. Alcohol use may further elevate the risk of HIV/sexually transmitted infection acquisition and transmission. STUDY DESIGN: A random-assignment parallel-group comparative treatment efficacy trial was conducted with random assignment to 1 of 3 conditions. SETTING/PARTICIPANTS: The sample comprised 560 Black or African American women aged 18-24 years who reported recent unprotected vaginal or anal sex and recent alcohol use. Participants were recruited from community settings in Atlanta, Georgia, from January 2012 to February 2014. INTERVENTION: A Group Motivational Enhancement Therapy module was designed to complement a Centers for Disease Control and Prevention-designated evidence-based intervention (Horizons) to reduce sexual risk behaviors, alcohol use, and sexually transmitted infections, with 3 comparison groups: (1) Horizons + Group Motivational Enhancement Therapy intervention, (2) Horizons + General Health Promotion intervention, and (3) enhanced standard of care. MAIN OUTCOME MEASURES: Outcome measures included safe sex (abstinence or 100% condom use); condom nonuse; proportion of condom use during sexual episodes; incident chlamydia, gonorrhea, and trichomonas infections; and problematic alcohol use measured by Alcohol Use Disorders Identification Test score. Treatment effects were estimated using an intention-to-treat protocol‒generalized estimating equations with logistic regression for binomial outcomes and Poisson regression for count outcomes. Analyses were conducted between October 2018 and October 2019. RESULTS: Participants assigned to Horizons + Group Motivational Enhancement Therapy had greater odds of safe sex (AOR=1.45, 95% CI=1.04, 2.02, p=0.03), greater proportion of condom use (AOR=1.68, 95% CI=1.18, 2.41, p=0.004), and lower odds of condom nonuse (AOR=0.57, 95% CI=0.38, 0.83, p=0.004). Both interventions had lower odds of problematic alcohol use (Horizons: AOR=0.57, 95% CI=0.39, 0.85, p=0.006; Horizons + Group Motivational Enhancement Therapy: AOR=0.61, 95% CI=0.41, 0.90, p=0.01). CONCLUSIONS: Complementing an evidence-based HIV prevention intervention with Group Motivational Enhancement Therapy may increase safer sexual behaviors and concomitantly reduce alcohol use among young Black women who consume alcohol. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01553682.

Improving Substance Use Services for Juvenile Justice-Involved Youth: Complexity of Process Improvement Plans in a Large Scale Multi-site Study.

Despite the high prevalence of substance use disorders among juvenile offenders, most do not receive services. System-level process improvement plans to address unmet service needs can be optimized by combining data-driven decisions and facilitated meetings with behavioral health stakeholders. This paper operationalizes and analyzes the level of specified complexity among process improvement plans evident within 36 juvenile probation and drug courts across 7 states. To inform more effective implementation strategies, this analysis identifies and prioritizes promising courses of agency enhancement toward addressing unmet substance use needs.

Mitigating Negative Consequences Of Community Violence Exposure: Perspectives From African American Youth.

The burden of community violence on young African Americans includes disproportionate rates of physical and mental health consequences. To develop appropriate and sustainable interventions that mitigate the negative consequences after violence exposure, it is critical to incorporate the lived experiences and perspectives of African American youth. We conducted five focus groups that collectively included thirty-nine African American youth living in income-disadvantaged urban neighborhoods in Kansas City, Missouri, to examine their experiences and perceptions of community violence and identify priorities to reduce the negative consequences of community violence. Youth-identified priorities included increasing proactive responses from multiple community sectors; reducing racial discrimination; and creating safe environments, including access to mental health care and other supportive services. Incorporating these findings into current policy and cross-sector initiatives offers a promising opportunity to improve the health and well-being of African American youth exposed to community violence.

Comparative effectiveness of a faith-based HIV intervention for African American women: importance of enhancing religious social capital.

OBJECTIVES: We assessed the effectiveness of P4 for Women, a faith-based HIV intervention. METHODS: We used a 2-arm comparative effectiveness trial involving 134 African American women aged 18 to 34 years to compare the effectiveness of the Centers for Disease Control and Prevention-defined evidence-based Sisters Informing Sisters about Topics on AIDS (SISTA) HIV intervention with P4 for Women, an adapted faith-based version of SISTA. Participants were recruited from a large black church in Atlanta, Georgia, and completed assessments at baseline and follow-up. RESULTS: Both SISTA and P4 for Women had statistically significant effects on this study's primary outcome-consistent condom use in the past 90 days-as well as other sexual behaviors. However, P4 for Women also had statistically significant effects on the number of weeks women were abstinent, on all psychosocial mediators, and most noteworthy, on all measures of religious social capital. Results were achieved by enhancing structural social capital through ministry participation, religious values and norms, linking trust and by reducing negative religious coping. High intervention attendance may indicate the feasibility of conducting faith-based HIV prevention research for African American women. CONCLUSIONS: P4 for Women enhanced abstinence and safer sex practices as well as religious social capital, and was more acceptable than SISTA. Such efforts may assist faith leaders in responding to the HIV epidemic in African American women.

Employing a teen advisory board to adapt an evidence-based HIV/STD intervention for incarcerated African-American adolescent women.

This manuscript assesses priorities and challenges of adolescent females by conducting a meeting with teen advisory board (TAB) members to collect information regarding their lives and experiences pre-, during and post-incarceration in a juvenile detention facility. Multiple themes emerged regarding the impact of incarceration on young African-American females, including experiencing a loss of personal liberties, the importance of making money upon release, unfaithfulness by partners on the 'outside', substance use and lack of control over their environment upon release, including parents, peers and male sexual partners. Based on feedback from TAB members, unique barriers and challenges were identified that suggested areas where adaptations to an evidenced-based HIV/sexually transmitted disease (STD) intervention would be justified to more adequately meet the needs of this particular subgroup of young African-American women. Adaptations to the evidence-based interventions included enhancing activities related to goal setting, emotion regulation skills, decision-making, recognizing and utilizing support networks and addressing the relationship between substance use and risky sexual behavior. Future health education efforts focusing on either the creation of new HIV/STD interventions or adaptations to existing interventions should consider utilizing advisory boards with members of the priority population at the earliest stages of intervention planning.

Application of ADAPT-ITT: adapting an evidence-based HIV prevention intervention for incarcerated African American adolescent females.

African American adolescent females are disproportionately affected by the HIV epidemic. Recent findings suggest that gender- and culturally appropriate HIV prevention interventions can significantly reduce HIV-associated sexual risk behaviors among this vulnerable population. Currently, there are no evidence-based interventions (EBIs) for this vulnerable subgroup. Thus, interventions specifically tailored for this subgroup are urgently needed. Effective interventions that reduce HIV risk behaviors remain one of the most powerful tools in curbing the HIV epidemic. The selected intervention (Horizons) was adapted using a coordinated and systematically guided adaptation process based on the ADAPT-ITT framework. This article serves as a starting point to support using the ADAPT-ITT model, which was beneficial when using an EBI in an alternative setting than originally created. Using this prescriptive method for adapting Horizons for incarcerated young girls proved to be a time- and cost-effective method.