Special considerations for the use of AI tools by PEERs as a learning and communication aid.

There is no doubt that navigating academia is a formidable challenge, particularly for those from underrepresented backgrounds who face additional barriers at every turn. In such an environment, efforts to create learning and training environments that are diverse, equitable, and inclusive can feel like an uphill battle. We believe that harnessing the power of artificial intelligence (AI) tools can help in leveling the playing field. While AI cannot supplant the need for supportive mentorship, it can serve as a vital supplement, offering guidance and assistance to those who may lack access to adequate avenues of support. Embracing AI in this context should not be stigmatized, as it may represent a vital lifeline for underrepresented individuals who often face systemic biases while forging their own paths in pursuit of success and belonging in academia. AI tools should not be gatekept from these individuals, particularly by those in positions of power and privilege within the scientific community. Instead, we argue, institutions should make a strong commitment to educating their community members on how to ethically harness these tools.

Neural Tracking of Perceived Parent, but Not Peer, Norms Is Associated with Longitudinal Changes in Adolescent Attitudes about Externalizing Behaviors.

Adolescents' perceptions of parent and peer norms about externalizing behaviors influence the extent to which they adopt similar attitudes, yet little is known about how the trajectories of perceived parent and peer norms are related to trajectories of personal attitudes across adolescence. Neural development of midline regions implicated in self-other processing may underlie developmental changes in parent and peer influence. Here, we examined whether neural processing of perceived parent and peer norms in midline regions during self-evaluations would be associated with trajectories of personal attitudes about externalizing behaviors. Trajectories of adolescents' perceived parent and peer norms were examined longitudinally with functional neuroimaging (n = 165; ages 11-16 years across three waves; 86 girls, 79 boys; 29.7% White, 21.8% Black, 35.8% Latinx, 12.7% other/multiracial). Behavioral results showed perceived parent norms were less permissive than adolescents' own attitudes about externalizing behaviors, whereas perceived peer norms were more permissive than adolescents' own attitudes, effects that increased from early to middle adolescence. Although younger adolescents reported less permissive attitudes when they spontaneously tracked perceived parent norms in the ventromedial and medial pFCs during self-evaluations, this effect weakened as they aged. No brain-behavior effects were found when tracking perceived peer norms. These findings elucidate how perceived parent and peer norms change in parallel with personal attitudes about externalizing behaviors from early to middle adolescence and underscore the importance of spontaneous neural tracking of perceived parent norms during self-evaluations for buffering permissive personal attitudes, particularly in early adolescence.

Peer support for people living with hepatitis B virus-A foundation for treatment expansion.

Chronic hepatitis B infection (CHB) affects 300 million people worldwide and is being targeted by the United Nations 2030 Sustainable Development Goals (SDGs) and the World Health Organisation (WHO), working towards elimination of hepatitis B virus (HBV) as a public health threat. In this piece, we explore the evidence and potential impact of peer support to enhance and promote interventions for people living with CHB. Peer support workers (PSWs) are those with lived experience of an infection, condition or situation who work to provide support for others, aiming to improve education, prevention, treatment and other clinical interventions and to reduce the physical, psychological and social impacts of disease. Peer support has been shown to be a valuable tool for improving health outcomes for people living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), but to date has not been widely available for communities affected by HBV. HBV disproportionately affects vulnerable and marginalised populations, who could benefit from PSWs to help them navigate complicated systems and provide advocacy, tackle stigma, improve education and representation, and optimise access to treatment and continuity of care. The scale up of peer support must provide structured and supportive career pathways for PSWs, account for social and cultural needs of different communities, adapt to differing healthcare systems and provide flexibility in approaches to care. Investment in peer support for people living with CHB could increase diagnosis, improve retention in care, and support design and roll out of interventions that can contribute to global elimination goals.

Assessing Direct and Spillover Effects of Intervention Packages in Network-randomized Studies.

BACKGROUND: Intervention packages may result in a greater public health impact than single interventions. Understanding the separate impact of each component on the overall package effectiveness can improve intervention delivery. METHODS: We adapted an approach to evaluate the effects of a time-varying intervention package in a network-randomized study. In some network-randomized studies, only a subset of participants in exposed networks receive the intervention themselves. The spillover effect contrasts average potential outcomes if a person was not exposed to themselves under intervention in the network versus no intervention in a control network. We estimated the effects of components of the intervention package in HIV Prevention Trials Network 037, a Phase III network-randomized HIV prevention trial among people who inject drugs and their risk networks using marginal structural models to adjust for time-varying confounding. The index participant in an intervention network received a peer education intervention initially at baseline, then boosters at 6 and 12 months. All participants were followed to ascertain HIV risk behaviors. RESULTS: There were 560 participants with at least one follow-up visit, 48% of whom were randomized to the intervention, and 1,598 participant visits were observed. The spillover effect of the boosters in the presence of initial peer education training was a 39% rate reduction (rate ratio = 0.61; 95% confidence interval = 0.43, 0.87). CONCLUSIONS: These methods will be useful for evaluating intervention packages in studies with network features.

Peer2Me - evaluation of a peer supported program for adolescent and young adult (AYA) cancer patients: study protocol of a randomised trial using a comprehensive cohort design.

BACKGROUND: Developing cancer in young adulthood is a non-normative life event and associated with adverse physical, social and psychological consequences. High psychological distress is common in AYA cancer patients including anxiety, depression or fear of recurrence. At the same time, it is well known that AYA often report unmet needs for support, particularly in terms of informational exchange and emotional support from peers in order to benefit from shared experiences and enhance self-efficacy. Especially in the AYA group, interactions with other same-aged cancer patients may represent an essential resource in terms of coping with the disease, as family members and friends are often overwhelmed and struggling with helplessness. Currently, there is a lack of professional support services using peer support (e.g. psycho-oncological support, aftercare consultations, social legal counselling) or evaluated peer support interventions in Germany. Our aim is to assess the effectiveness of the Peer2Me intervention for AYAs, in which acute patients (mentees) are accompanied by an AYA survivor (mentor) over a period of three months. METHODS: A prospective Comprehensive Cohort Design with repeated measures will be used to evaluate the effectiveness of Peer2Me for AYA. A sample of 180 patients in active cancer treatment aged 18 to 39 years will be enrolled and randomized to the intervention or control condition (a single AYA-specific consultation). Following mentor training, mentees and mentors are matched by diagnosis, age, and gender. The primary outcome is self-efficacy; secondary outcomes include measures of anxiety, depression, health literacy, life satisfaction and social support life. Outcomes will be measured at baseline before the intervention (t1), immediately after completion of the three-month intervention (t2) and three months after completion the intervention (t3). For the final analyses, we will use an intention-to-treat approach (ITT) and compare patients in the assigned treatment groups. DISCUSSION: Peer2Me might be an important addition to existing professional psychosocial support services for young cancer patients. At the end of the study, a psycho-oncological intervention for young cancer patients undergoing acute treatment should be available, from which both mentors and mentees could benefit. The long-term continuity of Peer2Me should be ensured through collaboration with different partners. TRIAL REGISTRATION: The study was retrospectively registered on February 4, 2022 at clinicaltrials.gov (NCT05336318).

Peer support for adults with type 2 diabetes starting continuous glucose monitoring-An exploratory randomised controlled trial.

AIMS: To explore the feasibility and potential benefits of a peer support programme for adults with insulin-treated type 2 diabetes (T2D) starting continuous glucose monitoring (CGM). METHODS: This part of the Steno2tech study is an exploratory, single-centre, open-labelled, prospective, randomised controlled trial (RCT). A total of 60 participants were randomised 2:1 to 12 months of CGM with or without peer support. All participants received a 3-h diabetes self-management education course including a CGM part on how to use the CGM and interpret the CGM-derived data. Peer support consisted of three 3-h peer support meetings over the first 6 months of the study period with groups of three to six people. The exploratory outcomes included the acceptability and feasibility of the peer support intervention, and the between-group difference in change in several glycaemic, metabolic and participant-reported outcomes measured at baseline, 6 and 12 months. RESULTS: The peer support intervention was found acceptable and feasible. Participants shared their experiences of using and interpreting CGM data and its association with health behaviour. While both groups had improvements in glycaemic, metabolic and participant-reported outcomes, there were no significant between-group differences. CONCLUSIONS: Although feasible, we found no measured additional benefits when adding a peer support programme after starting CGM in this exploratory RCT including adults with insulin-treated T2D. Understanding the perceived effect of and preferences for a peer support intervention from the participants' points of view, including why individuals declined to participate, would be of value for future research.

Use of Online Communities among People with Type 2 Diabetes: A Scoping Review.

PURPOSE OF REVIEW: People with diabetes require continuous self-monitoring and face numerous decisions in their day-to-day lives. Therefore, on many occasions, they need more support than that provided by health professionals. In this context, peer support in online diabetes communities could be a useful tool. The purpose of the review is to describe, analyze and synthesize the available evidence on the use and health out-comes of online communities for people with type 2 diabetes mellitus. A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines. Searches were performed PubMed, Web of Science, CINHAL, Scopus and Cochrane databases. RECENT FINDINGS: From 1821 identified documents, 6 articles were included. These studies explored the characteristics of diabetes online communities and the population features. Besides, the results were classified according to whether they were clinical, psychosocial, or addressed people's experiences with the online community. The analysis underscores their value in facilitating communication, improving diabetes management, and enhancing psychosocial well-being. Future investigations should prioritize longitudinal assessments to elucidate the sustained impact of community engagement and optimize user participation for enhanced patient outcomes. The growing relevance of new technologies has led to a significant number of individuals with chronic illnesses seeking peer support. Online health communities have emerged as virtual spaces where individuals with shared health interests interact and form relationships. Within these digital spaces, individuals can engage in peer interaction, observe behaviors, and mutually benefit, potentially leading to improved attitudes toward the disease.

Reduced prosocial motivation and effort in adolescents with conduct problems and callous-unemotional traits.

BACKGROUND: Prosocial behaviours - acts that benefit others - are of crucial importance for many species including humans. However, adolescents with conduct problems (CP), unlike their typically developing (TD) peers, demonstrate markedly reduced engagement in prosocial behaviours. This pattern is particularly pronounced in adolescents with CP and high levels of callous-unemotional traits (CP/HCU) who are at increased risk of developing psychopathy in adulthood. While a substantial amount of research has investigated the cognitive-affective mechanisms thought to underlie antisocial behaviour, much less is known about the mechanisms that could explain reduced prosocial behaviours in adolescents with CP. METHODS: Here we examined the willingness to exert effort to benefit oneself (self) and another person (other, prosocial condition) in children with CP/HCU, CP and lower levels of CU traits (CP/LCU) and their TD peers. The task captured both prosocial choices, and actual effort exerted following prosocial choices, in adolescent boys aged 11-16 (27 CP/HCU; 34 CP/LCU; 33 TD). We used computational modelling to reveal the mechanistic processes involved when choosing prosocial acts. RESULTS: We found that both CP/HCU and CP/LCU groups were more averse to initiating effortful prosocial acts than TD adolescents - both at a cognitive and at a behavioural level. Strikingly, even if they chose to initiate a prosocial act, the CP/HCU group exerted less effort following this prosocial choice than other groups. CONCLUSIONS: Our findings indicate that reduced exertion of effort to benefit others may be an important factor that differentiates adolescents with CP/HCU from their peers with CP/LCU. They offer new insights into what might drive low prosocial behaviour in adolescents with CP, including vulnerabilities that may particularly characterise those with high levels of CU traits.

Healthy Outcomes through Peer Educators: Feasibility of a peer support diabetes prevention programme for African-American grandmother caregivers.

AIM: To assess the protocol feasibility and intervention acceptability of a community-based, peer support diabetes prevention programme (DPP) for African-American (AA) grandmother caregivers at risk for diabetes. MATERIALS AND METHODS: Grandmother caregivers were randomized in a 2:1 ratio to DPP (active comparator) or DPP plus HOPE (Healthy Outcomes through Peer Educators; intervention). DPP + HOPE incorporated support from a peer educator who met with participants in person or by telephone every week during the 1-year intervention. Outcomes included: (1) recruitment rates, outcome assessment, and participation adherence rates assessed quantitatively; and (2) acceptability of the programme assessed through end-of-programme focus groups. RESULTS: We successfully consented and enrolled 78% (n = 35) of the 45 AA grandmothers screened for eligibility. Eighty percent of participants (aged 64.4 ± 5.7 years) were retained up to Week 48 (74% for DPP [n = 17] and 92% for DPP + HOPE [n = 11]). All grandmothers identified social support, neighbourhood safety, and access to grocery stores as influences on their health behaviours. At Month 12, the active comparator (DPP) group and the intervention group (DPP + HOPE) had a mean change in body weight from baseline of -3.5 ± 5.5 (-0.68, -6.29) kg and - 4.4 ± 5.7 (-0.59, -8.2) kg, respectively. CONCLUSIONS: This viable study met the aim of educating and equipping AA grandmothers with the practical and sustained support needed to work toward better health for themselves and their grandchildren, who may be at risk for diabetes. The intervention was both feasible and acceptable to participating grandmothers and their organizations.

Shop Talk: A Qualitative Study to Understand Peer Health-related Communication Among Black Men at the Barbershop.

BACKGROUND: While successful health promotion efforts among Black men have been implemented at barbershops, the focus has largely been on outcomes as opposed to the processes by which outcomes are produced. An understanding of processes can be leveraged in the design and implementation of future efforts to improve the health of Black men. PURPOSE: The objectives of the present study were to: (i) understand peer-derived sources of health-related support at the barbershop and (ii) understand the role of the barbershop in promoting health among Black men. METHODS: Seven focus groups were conducted at barbershops used predominately by Black men. Each focus group lasted between 45 and 60 min. Using a thematic approach, each focus group was independently coded by two coders using a codebook derived from an inductive and deductive approach. The results were confirmed with members of the community advisory board. RESULTS: Three themes emerged: (i) dynamic and candid exchange of health-related support at the barbershop; (ii) tailored forms of health-related and judgment-free communication that provide encouragement and increase motivation; and (iii) characteristics of a supportive environment at the barbershop that facilitate health-related communication. CONCLUSIONS: The findings of the present study offer a potential pathway for public health efforts seeking to improve health among Black men. Those interested in designing and implementing these efforts can create tailored programs for Black men by recognizing and leveraging the unique dynamics of health-related conversations at the barbershop.

For many Black men, barbershops are more than just a place for a haircut. Barbershops are community hubs that have transformed into safe places for difficult conversations about health. The goal of our study was to understand how Black men communicate about health at the barbershop. To address this goal, we conducted focus groups among the true experts­Black men. We asked them: (i) how do Black men communicate about health at the barbershop? (ii) what do Black men communicate about health at the barbershop? and (iii) what about the barbershop facilitates these conversations? These men indicated that barbershops are a place where Black men can openly and dynamically provide health support to one another through role modeling, passing of wisdom, and passive testimonials. They said their conversations about health are often judgment-free and tailored to provide encouragement and motivation. Finally, they said that the supportive atmosphere of the barbershop facilitates these types of conversations. Although barbershops have been sources of health-related support for Black men for generations, the findings from this study can be used by those developing health promotion programs (in partnership with barbershops) to promote health among Black men.

Using formative process evaluation to improve program implementation and accessibility of competitive group-based physical activity in the TEAM-PA trial.

BACKGROUND: This study demonstrates how formative process evaluation was used to assess implementation and improve dose and fidelity in the Together Everyone Achieves More Physical Activity (TEAM-PA) randomized controlled trial. TEAM-PA uses a randomized group cohort design to evaluate the efficacy of a group-based intervention for increasing physical activity among African American women. METHODS: Intervention groups met for 10 weeks and were co-led by female African American facilitators, with intervention sessions consisting of group feedback, a health curriculum, group-based physical activity games, and group-based goal-setting. Drawing from a multi-theoretical framework, the intervention targeted social affiliation using collaborative and competitive group strategies, including essential elements focused on group-based behavioral skills, peer-to-peer positive communication, collectivism, optimal challenge, social facilitation, and peer to peer challenges. Formative process evaluation was used to monitor reach, dose, and fidelity, and implement feedback and solutions. RESULTS: Across two cohorts, four groups (n = 54) were randomized to the TEAM-PA intervention. On average 84.8% of participants attended each week, which exceeded the a priori criteria. Results from the systematic observations indicated that on average 93% of the dose items were completed in each session and adequate levels of fidelity were achieved at both the facilitator and group-levels. Participants were compliant with wearing the FitBits (6.73 ± 0.42 days/week) and most participants successfully contributed to meeting the group-based goals. The use of open-ended items also revealed the need for additional modifications to the group-based PA games, including allowing for individuals to take breaks, incorporating a broader range of exercises, minimizing activities that required bending/reaching down without assistance, and providing facilitators with additional training for implementing the games. Initial evidence suggests that these changes were successful in increasing participants' comprehension of the games from Cohort 1 (M = 1.83, SD = 0.71) to Cohort 2 (M = 3.33, SD = 0.69). CONCLUSION: Findings from this study demonstrated high levels of reach, dose, and fidelity, while also highlighting strategies for implementing competitive group-based PA games that are accessible across physical fitness levels. Formative process evaluation, including open-ended items and collaborative brainstorming, holds tremendous potential for improving future interventions. TRIAL REGISTRATION: This study was registered on Clinicaltrials.gov (# NCT05519696) on August 22, 2022 prior to the enrollment of the first participant on September 12, 2022 ( https://clinicaltrials.gov/study/NCT05519696?term=NCT05519696&rank=1 ).

Peer-to-Peer Chain Recruitment for Enrolling Young South African Women into an HIV Pre-exposure Prophylaxis (PrEP) Intervention Study: How Did It Perform?

Peer-to-peer chain recruitment has been used for descriptive studies, but few intervention studies have employed it. We used this method to enroll sexually active women ages 18 to 25 into an online Pre-Exposure Prophylaxis (PrEP) information and motivation intervention pilot in eThekwini (Durban), South Africa. Seeds (N = 16) were recruited by study staff and randomized to Masibambane, Ladies Chat, a Gender-Enhanced group-based WhatsApp Workshop (GE), or Individual-Access (IA), a control condition that provided participants with online information/motivation materials only. Each seed could recruit up to three women to participate in the same study condition, with an incentive for each enrolled woman; participants in subsequent waves could choose to recruit or not. We evaluated if peer-to-peer recruitment was self-sustaining and resulted in enrolling women who, in subsequent waves, had less contact with the health care system and less knowledge about PrEP than the initial seeds. Over three recruitment waves beyond the seeds, 84 women were recruited. Almost 90% of women became recruiters, with each recruiting on average 1.90 women and 1.26 eligible enrolled women. The approach was successful at reaching women with less education but not women with less health system contact and PrEP knowledge across waves. IA participants had a slightly higher, though non-significantly different, percentage of individuals who became Peer Health Advocates (PHAs) than GE participants and, on average, they recruited slightly more women who enrolled. Our findings demonstrated that peer-to-peer recruitment is a feasible and self-sustaining way to recruit SA young women into a PrEP intervention study.

Characteristics of Received HIV Prevention Advocacy from Persons Living with HIV in Uganda, and Associations with HIV Testing and Condom Use Among Social Network Members.

Receiving peer advocacy has been shown to result in increased HIV protective behaviors, but little research has gone beyond assessment of the mere presence of advocacy to examine aspects of advocacy driving these effects. With baseline data from a controlled trial of an advocacy training intervention, we studied characteristics of HIV prevention advocacy received among 599 social network members of persons living with HIV in Uganda and the association of these characteristics with the social network members' recent HIV testing (past six months) and consistent condom use, as well as perceived influence of advocacy on these behaviors. Participants reported on receipt of advocacy specific to HIV testing and condom use, as well as on measures of advocacy content, tone of delivery, support for autonomous regulation, and perceived influence on behavior. Receiving HIV testing advocacy and condom use advocacy were associated with recent HIV testing [65.2% vs. 51.4%; OR (95% CI) = 1.77 (1.11-2.84)], and consistent condom use with main sex partner [19.3% vs. 10.0%; OR (95% CI) = 2.16 (1.12-4.13)], respectively, compared to not receiving advocacy. Among those who received condom advocacy, perceived influence of the advocacy was positively correlated with consistent condom use, regardless of type of sex partner; support of autonomous regulation was a correlate of consistent condom use with casual sex partners, while judgmental advocacy was a correlate of consistent condom use with serodiscordant main partners. Among those who received testing advocacy, HIV testing in the past 6 months was positively correlated with receipt of direct support for getting tested. In multiple regression analysis, perceived influence of both HIV testing and condom use advocacy were positively correlated with advocacy that included access information and support of autonomous regulation; confrontational advocacy and judgmental advocacy were independent positive correlates of perceived influence of testing and condom use advocacy, respectively. These findings support associations that suggest potential benefits of peer advocacy from PLWH on HIV testing and condom use among their social network members, and indicate that advocacy content, tone of delivery, and support of autonomous regulation advocacy may play an important role in the success of advocacy.

The Effects of Previous Experiences of Healthcare Discrimination on HIV Intervention Outcomes.

Although several healthcare interventions have been developed to address HIV among young Black/African American men who have sex with men (YBMSM), the HIV epidemic in the United States continues to disproportionately burden this population. The current study examines previous healthcare discrimination and how it affects HIV intervention delivery. One hundred seventy-two YBMSM participated in the Peer Promotion of Wellness and Enhanced Linkage to Resources (PPOWER) project, which used a short, multi-faceted, community-level intervention based on Community Peers Reaching Out and Modeling Intervention Strategies (Community PROMISE). Data were collected at baseline, a 45-day follow up, and a 90-day follow up. Generalized Estimating Equations (GEE) were used to examine the effects of previous healthcare discrimination on outcomes related to HIV testing, alcohol and drug use, and sexual behaviors. Previous healthcare discrimination was found to moderate the relationship between time and intentions to test for HIV, perceptions of sexual risk, problem marijuana use, and problem other drug use, such that those who had experienced more healthcare discrimination showed greater improvements over time compared to those who had experienced less healthcare discrimination. The results of the current study suggest that a community-level peer intervention, in combination with a component to promote cultural competency and address prior experiences of discrimination in healthcare settings, may be highly effective for people who have experienced a barrier in their continuum of care as a result of racial discrimination.

A Scripted, PrEP-Using Peer Change Agent Improves Perceived Risk for HIV and Willingness to Accept Referrals Quickly Among Black Sexual Minority Men: Preliminary Findings from POSSIBLE.

PrEP use remains suboptimal among Black sexual minority men (SMM) partly due to low perceived risk for HIV (PRH). This study describes baseline results of POSSIBLE, a multicomponent pilot intervention including a peer change agent (PCA) to increase PRH among Black SMM. POSSIBLE was a theoretically guided two-session, single-group feasibility intervention in Baltimore, MD conducted between 2019 and 2021 (N = 69). Baseline study visits involved a 20-minute session with a PrEP-using PCA who used a motivational interview-based script to discuss participants' lifestyles, goals, and values, HIV risk behaviors, and PRH and tailor communication to encourage PrEP use. Bivariate analyses were conducted to assess differences in PRH before and after baseline sessions along with the correlates of PrEP referral willingness. A total of 75% of participants identified as gay; 73% were employed; 84% reported having insurance; 78% were single; 51% reported ever being diagnosed with an STI. Baseline results showed a statistically significant improvement in PRH after the first session (t=-3.09; p < .01). Additionally, 64% were willing to be referred to PrEP care after baseline; 45% of whom made a PrEP appointment. PRH was not associated with referral willingness. However, receptive anal intercourse in the previous 6 months was statistically significantly associated with referral willingness. Findings suggests that a scripted PCA could independently improve PRH among Black SMM quickly. The person-centered nature of the scripted PCA could be key to improving PrEP use among a highly marginalized and elusive community.

User-informed tailoring of electronic and in-person peer navigation strategies to improve retention in HIV care for adolescents and young adults: a qualitative inquiry.

Poor adherence and retention in HIV care remain a major challenge among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA). Strategies are urgently required to support AYA to remain in care for better health outcomes. We explored AYA preferences regarding the format and delivery of electronic and in-person peer navigation to improve HIV care outcomes. This formative qualitative study was conducted among AYA enrolled in HIV care at three clinics in western Kenya. We conducted two focus group discussions (FGDs) each with 8-9 participants (n = 17) purposively selected based on age, gender and clinic where they received care. The characteristics desired of a navigator are a person of the same age group and HIV status who has a good memory and is friendly and able to maintain confidentiality. AYA want the content of their interaction with the navigator to center on sharing motivational messages and also educating them on matters of HIV care, sexual and reproductive health and mental health. The preferred navigation formats for electronic communication are platforms considered confidential. AYA preferred interventions delivered through secure communication platforms by navigators with whom they have commonalities. The navigation interventions that prioritize confidentiality and holistic content will likely be most highly valued by AYA. Furthermore, electronic mechanisms can help support the relationship building that is at the core of our navigation approach and a fundamental aspect of social work in general.

Strategic social decision making undergoes significant changes in typically developing and autistic early adolescents.

Information sampling about others' trustworthiness prior to cooperation allows humans to minimize the risk of exploitation. Here, we examined whether early adolescence or preadolescence, a stage defined as in between childhood and adolescence, is a significant developmental period for strategic social decisions. We also sought to characterize differences between autistic children and their typically developing (TD) peers. TD (N = 48) and autistic (N = 56) 8- to 12-year-olds played an online information sampling trust game. While both groups adapted their information sampling and cooperation to the various trustworthiness levels of the trustees, groups differed in how age and social skills modulated task behavior. In the TD group social skills were a stronger overall predictor of task behavior. In the autistic group, age was a stronger predictor and interacted with social skills. Computational modeling revealed that both groups used the same heuristic information sampling strategy-albeit older TD children were more efficient as reflected by decreasing decision noise with age. Autistic children had lower prior beliefs about the trustee's trustworthiness compared to TD children. These lower priors indicate that children believed the trustees to be less trustworthy. Lower priors scaled with lower social skills across groups. Notably, groups did not differ in prior uncertainty, meaning that the priors of TD and autistic children were equally strong. Taken together, we found significant development in information sampling and cooperation in early adolescence and nuanced differences between TD and autistic children. Our study highlights the importance of deep phenotyping of children including clinical measures, behavioral experiments and computational modeling. RESEARCH HIGHLIGHTS: We specified how early adolescents with and without an autism diagnosis sampled information about their interaction partners and made cooperation decisions in a strategic game. Early adolescence is a significant developmental period for strategic decision making, marked by significant changes in information sampling efficiency and adaptivity to the partner's behavior. Autistic and non-autistic groups differed in how age and social skills modulated task behavior; in non-autistic children behavior was more indicative of overall social skills. Computational modeling revealed differences between autistic and non-autistic groups in their initial beliefs about cooperation partners; autistic children expected their partners to be less trustworthy.

Act generously when others do so: Majority influence on young children's sharing behavior.

Children's sharing behavior is profoundly shaped by social norms within their society, and they can learn these norms by directly observing how most others share in their immediate environment. Here we systematically investigated the impact of majority influence on the sharing behavior of young Chinese children through three studies (N = 336, 168 girls). Four- and 6-year-olds were allowed to choose 10 favorite stickers and had an opportunity to engage in anonymous sharing. Before making the sharing decision, children were assigned to one of two conditions: watching a video in which three peers all shared 8 out of 10 stickers (i.e., the majority sharing condition) or making their decisions without watching the video (i.e., the control condition). Results showed that both the 4- and 6-year-old children shared more stickers in the majority sharing condition than in the control condition (Studies 1 & 2). Moreover, the influence of the majority had a stronger effect compared to the influence of a single role model. Children shared more stickers after observing three peers sharing, compared to watching one peer sharing three times (Study 2). Furthermore, children were less likely to copy the majority's non-sharing behavior when it came to giving away stickers without prosocial outcomes, which was particularly evident among 4-year-olds (Study 3). The results reveal that majority influence uniquely shapes children's sharing behavior and that children selectively follow the majority based on whether the behavior exhibits prosocial attributes. A video abstract of this article can be viewed at https://youtu.be/8qNNhf9754I?si=7YfpaFpcD_IjlXjJ RESEARCH HIGHLIGHTS: Observing a majority of three peers' unanimous generous sharing promoted sharing behavior in both 4- and 6-year-olds. The influence of three peers on children's sharing was stronger than that of one peer sharing three times. Four-year-olds, but not 6-year-olds, did not copy the non-sharing behavior of the majority as it did not lead to prosocial outcomes.

Body map stories from Colombia: experiences of people affected by leprosy and the influence of peers during diagnosis and treatment.

INTRODUCTION: Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. METHODS: A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2-3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. RESULTS: The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. CONCLUSION: People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability.