Understanding forms of childhood adversities and associations with adult health outcomes: A regression tree analysis.

BACKGROUND: Empirical studies have demonstrated associations between ten original adverse childhood experiences (ACEs) and multiple health outcomes. Identifying expanded ACEs can capture the burden of other childhood adversities that may have important health implications. OBJECTIVE: We sought to identify childhood adversities that warrant consideration as expanded ACEs. We hypothesized that experiencing expanded and original ACEs would be associated with poorer adult health outcomes compared to experiencing original ACEs alone. PARTICIPANTS: The 11,545 respondents of the National Longitudinal Surveys (NLS) and Child and Young Adult Survey were 48.9 % female, 22.7 % Black, 15.8 % Hispanic, 36.1 % White, 1.7 % Asian/Native Hawaiian/Pacific Islander/Native American/Native Alaskan, and 7.5 % Other. METHODS: This study used regression trees and generalized linear models to identify if/which expanded ACEs interacted with original ACEs in association with six health outcomes. RESULTS: Four expanded ACEs-basic needs instability, lack of parental love and affection, community stressors, and mother's experience with physical abuse during childhood -significantly interacted with general health, depressive symptom severity, anxiety symptom severity, and violent crime victimization in adulthood (all p-values <0.005). Basic needs instability and/or lack of parental love and affection emerged as correlates across multiple outcomes. Experiencing lack of parental love and affection and original ACEs was associated with greater anxiety symptoms (p = 0.022). CONCLUSIONS: This is the first study to use supervised machine learning to investigate interaction effects among original ACEs and expanded ACEs. Two expanded ACEs emerged as predictors for three adult health outcomes and warrant further consideration in ACEs assessments.

A Literature Review of Digital Behavioral Parent Training Programs for Parents of Adolescents.

Parents of adolescents are faced with a variety of challenges related to their children's behavior and development. Behavioral parent training (BPT) programs may be effective strategies to mitigate adverse childhood experiences (ACEs) and other common behavioral problems in the adolescent period. Adolescence is the period following the onset of puberty and describes the transition from childhood to adulthood. Digital BPTs, including those delivered via the internet, downloaded digital content, text message, tablet, and video call, may present a unique opportunity to reach a broad audience of parents of adolescents by removing barriers to program accessibility (e.g., cost and transportation). We conducted a literature review to synthesize the existing evidence on digital BPTs for parents of adolescents. We described the digital BPTs, study designs, and evaluation and feasibility outcomes. A structured literature search identified studies meeting the following criteria for inclusion: (a) published between January 2000 and October 2022, (b) peer-reviewed, (c) available in English language, (d) study included a description of a digital BPT methodological approach, (e) study had to identify at least one parent or child behavioral outcome (e.g., parent-reported communication with their child) or feasibility outcome associated with the digital BPT, and (f) study included parents of adolescents aged 10-18 years. We extracted data on the characteristics of the study and demographic characteristics of participants, digital BPT, and evaluation and feasibility outcomes. Twenty-eight studies met inclusion criteria. Twenty-two unique digital BPTs were evaluated across the published studies. Thirteen digital BPTs (59.1%) were developed from or grounded by an identified theory. Six digital BPTs were freely accessible by the public, while the remaining 16 were available through study participation or purchase. One digital BPT was specifically tailored to parents of adolescents of a racial/ethnic minority group. Of the 16 studies that reported either parent or adolescent race/ethnicity, 10 consisted of more than 50% White parent or adolescent participants. Twenty-four (88.9%) studies provided evaluation data for the digital BPT. Fourteen studies (63.6%) employed a randomized control trial study design, and the remaining study designs included quasi-experimental (n = 2), mixed methods (n = 1), open trial (n = 3), case study (n = 1), pretest-posttest design (n = 1), and feasibility and acceptability trial (n = 2). All studies reported improvements in at least one parent-reported or adolescent-reported behavioral outcome or feasibility outcomes, with effect sizes (Cohen's d) ranging from small (e.g., 0.20-0.49) to very large (e.g., > 1.20). The findings of this review illustrate that technology may be a valuable way to deliver BPTs to parents of adolescents. However, few digital BPTs were developed for parents of adolescents from racial/ethnic minority groups, and many digital BPTs were not available without cost or participation in a research study. Considerations for future research are discussed.

Development of a Video-Delivered Serial Drama Designed to Reduce Community Homophobia and HIV Stigma, Decrease Sexual Risk Behavior, and Increase HIV Testing Among Black Youth.

This article describes the development of a video serial drama intervention that was designed to address factors that influence HIV in the United States among Black youth. These include HIV testing, sexual behaviors not protected by condoms, negative attitudes towards sexual minorities, and HIV stigma. Behavior-change principles (social learning theory and education-entertainment) and input from members of the priority audience formed the basis of this 27-episode (3 minutes each) drama for dissemination on multiple platforms, including in public spaces or privately online. The developmental process, specifically involving members of the population of interest and use of behavioral theory, enriched the narrative elements and likely ensured intervention acceptability, enhancing effectiveness. Public health practitioners and prevention programmers may want to consider using this intervention and/or the narrative communication approach when intervening to change behavior.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 2: Evaluation of a Pilot Intervention.

In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people.

Developing a Motion Comic for HIV/STD Prevention for Young People Ages 15-24, Part 1: Listening to Your Target Audience.

Young people (15-24 years) in the United States are disproportionately affected by infection with human immunodeficiency virus (HIV) and sexually transmitted diseases (STD). Shortfalls in HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI) likely contribute to this discrepancy. In this report we describe our experience developing a novel means of health communication combining entertainment-education theory and recent technological advances to create a HIV/STD-focused "motion comic." We also report the audience satisfaction and acceptance of the intervention. We used the Health Belief Model (HBM), entertainment-education (EE) principles, and the Sabido Method (SM) and conducted three rounds of focus groups to develop a 38-minute HIV/STD focused motion comic for young people between the ages 15 and 24 years. Participants indicated that motion comics were an acceptable method of delivering HIV/STD prevention messages. They also expressed satisfaction with motion comics plot, story settings, the tone of humor, and drama. Our results suggest that motion comics are a viable new method of delivering health communication messages about HIV/STD and other public health issues, and warrant further development and broader evaluation.

Efficacy of a Brief Intervention to Reduce Substance Use and Human Immunodeficiency Virus Infection Risk Among Latino Youth.

PURPOSE: Familias Unidas is an efficacious and effective family-based intervention for preventing and reducing substance use and unsafe sexual behaviors among Latino youth. To facilitate its dissemination, Familias Unidas was shortened from a 12-week intervention to a 6-week intervention and evaluated. We hypothesized that brief Familias Unidas would be efficacious in reducing substance use and unsafe sexual behaviors relative to a comparison condition. METHODS: We randomized 160 ninth-grade Latino adolescents and their families to brief Familias Unidas or a community practice control condition. Adolescents were surveyed at baseline and 6, 12, and 24 months after baseline. RESULTS: At 24 months, youth randomized to brief Familias Unidas had a significantly lower sexual initiation rate (34.0%) relative to control (55.0%), p = .02. Brief Familias Unidas also increased positive parenting. Moderation analyses revealed that brief Familias Unidas was significantly associated with decreased substance use initiation among girls (30.4% vs. 64.0%, respectively; p = .02), but not boys (28.0% vs. 26.7%, respectively; p = .91). Brief Familias Unidas was also significantly associated with reduced unsafe sex among adolescents aged 15 years or less (p < .001), but not among older adolescents (p = .37). Moderating effects were also found for family-level variables. CONCLUSIONS: Brief Familias Unidas was efficacious in reducing sex initiation and improving positive parenting. Moderation analyses suggested that brief Familias Unidas was efficacious in reducing substance use initiation and unsafe sex for certain Hispanic adolescent subgroups, highlighting the importance of conducting moderation analyses, and of targeting interventions for specific subgroups.

Evaluation of Pharmacy-Based HIV Testing in a High-Risk New York City Community.

Blacks/Hispanics face limited access to HIV testing. We examined in-pharmacy HIV testing among customers in pharmacies participating in a nonprescription syringe program in New York City. Participants were recruited in two pharmacies to complete a survey and receive an optional HIV test. Bivariate and multivariable analyses were performed to examine associations of demographics and risk behaviors with receiving in-pharmacy HIV testing. Most participants were male (55%), black (80%), had used hard drugs (88%), and 39.5% received in-pharmacy HIV testing. Being female (AOR=2.24; 95%CI 1.24-4.05), having multiple sex partners (AOR=1.20; 95% CI 1.06-1.35), having an HIV test more than 12 months ago (AOS=4.06; CI 1.85-8.91), injecting drugs in last 3 months (AOR=2.73; 95% CI 1.31-5.69) and having continuous care (AOR=0.32; 95% CI 0.17-0.58) were associated with receiving in-pharmacy HIV test. These data provide evidence of in-pharmacy HIV testing reaching persons at risk of HIV. HIV testing in pharmacies may complement existing strategies.

Diagnoses of human immunodeficiency virus (HIV) infection among foreign-born persons living in the District of Columbia.

This study characterizes available surveillance data for HIV infected foreign-born residents in the District of Columbia (DC) to inform local HIV prevention and care efforts. HIV surveillance data were reviewed for adults and adolescents (ages ≥13 years) living with HIV in 2008. Variables analyzed included demographics, region of origin (for persons born outside of the U.S.), insurance coverage, linkage to and continuous HIV care. Of the 16,513 DC residents living with HIV diagnoses, 1,391 (8.4%) were foreign-born. Of foreign-born infected, 71.9% were male; 33.3% were from Africa and 20.8% from Central America; 80.6% were exposed through sex; 36.3% had health coverage at diagnosis. While 100% of foreign-born persons had documented linkage to HIV care, only 18.0% had documentation of continued HIV care. These data suggest that strengthening continuous HIV care support after successful care linkage is warranted for foreign-born persons living with HIV in DC.

A census tract-level examination of social determinants of health among black/African American men with diagnosed HIV infection, 2005-2009--17 US areas.

BACKGROUND: HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population. METHODS: Using data from the National HIV Surveillance System and the US Census Bureau's American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract-level social determinants of health variables for 21,948 black MSM and non-MSM aged ≥ 15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling. RESULTS: Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased. CONCLUSIONS: This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income.

Strengthening the network of mentored, underrepresented minority scientists and leaders to reduce HIV-related health disparities.

OBJECTIVES: We reviewed data for the Minority HIV/AIDS Research Initiative (MARI), which was established in 2003 to support underrepresented minority scientists performing HIV prevention research in highly affected communities. METHODS: MARI was established at the Centers for Disease Prevention and Control as a program of competitively awarded, mentored grants for early career researchers conducting HIV prevention research in highly affected racial/ethnic and sexual minority communities. We have described progress from 2003 to 2013. RESULTS: To date, MARI has mentored 27 scientist leaders using low-cost strategies to enhance the development of effective HIV prevention interventions. These scientists have (1) developed research programs in disproportionately affected communities of color, (2) produced first-authored peer-reviewed scientific and programmatic products (including articles and community-level interventions), and (3) obtained larger, subsequent funding awards for research and programmatic work related to HIV prevention and health disparities work. CONCLUSIONS: The MARI program demonstrates how to effectively engage minority scientists to conduct HIV prevention research and reduce racial/ethnic investigator disparities and serves as a model for programs to reduce disparities in other public health areas in which communities of color are disproportionately affected.

Efficacy of HIV/STI behavioral interventions for heterosexual African American men in the United States: a meta-analysis.

This meta-analysis estimates the overall efficacy of HIV prevention interventions to reduce HIV sexual risk behaviors and sexually transmitted infections (STIs) among heterosexual African American men. A comprehensive search of the literature published during 1988-2008 yielded 44 relevant studies. Interventions significantly reduced HIV sexual risk behaviors and STIs. The stratified analysis for HIV sexual risk behaviors indicated that interventions were efficacious for studies specifically targeting African American men and men with incarceration history. In addition, interventions that had provision/referral of medical services, male facilitators, shorter follow-up periods, or emphasized the importance of protecting family and significant others were associated with reductions in HIV sexual risk behaviors. Meta-regression analyses indicated that the most robust intervention component is the provision/referral of medical services. Findings indicate that HIV interventions for heterosexual African American men might be more efficacious if they incorporated a range of health care services rather than HIV/STI-related services alone.

Efficacy of structural-level condom distribution interventions: a meta-analysis of U.S. and international studies, 1998-2007.

This systematic review examines the overall efficacy of U.S. and international-based structural-level condom distribution interventions (SLCDIs) on HIV risk behaviors and STIs and identifies factors associated with intervention efficacy. A comprehensive literature search of studies published from January 1988 through September 2007 yielded 21 relevant studies. Significant intervention effects were found for the following outcomes: condom use, condom acquisition/condom carrying, delayed sexual initiation among youth, and reduced incident STIs. The stratified analyses for condom use indicated that interventions were efficacious for various groups (e.g., youth, adults, males, commercial sex workers, clinic populations, and populations in areas with high STI incidence). Interventions increasing the availability of or accessibility to condoms or including additional individual, small-group or community-level components along with condom distribution were shown to be efficacious in increasing condom use behaviors. This review suggests that SLCDIs provide an efficacious means of HIV/STI prevention.

Attitudes of young african american fathers toward early childbearing.

OBJECTIVE: To qualitatively examine the perceptions of young fathers toward issues related to early childbearing. METHODS: Focus groups were held with male partners of adolescent females who had become pregnant while participating in an HIV-prevention trial. RESULTS: Primary domains that emerged included young male's desire for pregnancy, their attitudes toward father/child involvement, and their perceived social support as young fathers. CONCLUSIONS: Findings may help in developing gender-appropriate interventions to delay early childbearing and prevent HIV/STD transmission.

Uncovering the mystery: factors of African American suicide.

Traditionally, African Americans have registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African Americans. To date, the research conducted regarding this phenomenon has been limited for a variety of reasons and previous research has been inconclusive in determining risk factors of African American suicide. The purpose of this paper is to identify risk and protective factors specific to African American suicide. To determine the factors, the 1993 National Mortality Follow-back Survey was analyzed. The risk factors identified include being under age 35, southern and northeastern residence, cocaine use, firearm presence in home, and threatening others with violence. Some of the protective factors associated with African American suicide include rural residence and educational attainment. These results provide valuable information about completed African American suicides in relation to Whites. Several of these factors are unique to African Americans.

Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide.

African-Americans have typically registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African-Americans between the ages of 15 and 19 (National Center for Injury Prevention and Control, Mortality Statistics, 1998, Atlanta, GA). Today, young African-American males are as likely to commit suicide as their White counterparts. To date, the research conducted regarding this phenomenon has been inconclusive and existing suicide interventions appear to have no effect on reducing this behavior among young African-Americans. This paper synthesizes classical (Durkheim, Suicide, 1979, Free Press, New York) and postmodern (Beck, Risk Society: Towards a New Modernity, 1992, Sage, London; Bauman, Modernity and Ambivalence, Cornell University Press, Ithaca, 1991) social theories in order to provide a more complete theoretical explanation for the increase in the suicide rate among adolescent African-American males. Postmodern society is typified by: (1) institutional deconstruction; (2) decreased collectivism; (3) increased normlessness and helplessness; and (4) exacerbated personal risk for stress. It is therefore possible to hypothesize that postmodernity characteristically loosens the bonds between the individual and society, thereby increasing vulnerability to depression, related pathologies (such as substance abuse), and suicide. African-Americans tend to be more affected/vulnerable because they are concentrated in resource-poor, low income areas, and institutions that provided social support (family, religious, community) and protected individuals from societal risk factors, have gradually been dissolving in postmodern societies. We argue that young African-American males of today are more exposed to stressors which increase psychological distress thus increasing depression and related pathological behaviors such as suicide. The main reason behind this increase is found in the inability of institutions to offer protection from psychological distress. Overall, this paper presents a postmodern, macro-level framework to explain the increase in suicide among African-American male adolescents.