A Hybrid Evaluation-Optimization Trial to Evaluate an Intervention Targeting the Intersection of Alcohol and Sex in College Students and Simultaneously Test an Additional Component Aimed at Preventing Sexual Violence.

BACKGROUND: Using the multiphase optimization strategy (MOST), we previously developed and optimized an online behavioral intervention, itMatters, aimed at reducing the risk of sexually transmitted infections (STI) among first-year college students by targeting the intersection of alcohol use and sexual behaviors. PURPOSE: We had two goals: (a) to evaluate the optimized itMatters intervention and (b) to determine whether the candidate sexual violence prevention (SVP) component (included at the request of participating universities) had a detectable effect and therefore should be added to create a new version of itMatters. We also describe the hybrid evaluation-optimization trial we conducted to accomplish these two goals in a single experiment. METHODS: First year college students (N = 3,098) at four universities in the USA were individually randomized in a hybrid evaluation-optimization 2 × 2 factorial trial. Data were analyzed using regression models, with pre-test outcome variables included as covariates in the models. Analyses were conducted separately with (a) immediate post-test scores and (b) 60-day follow-up scores as outcome variables. RESULTS: Experimental results indicated a significant effect of itMatters on targeted proximal outcomes (norms) and on one distal behavioral outcome (binge drinking). There were no significant effects on other behavioral outcomes, including the intersection of alcohol and sexual behaviors. In addition, there were mixed results (positive short-term effect; no effect at 60-day follow-up) of the SVP component on targeted proximal outcomes (students' self-efficacy to reduce/prevent sexual violence and perceived effectiveness of protective behavioral strategies). CONCLUSIONS: The hybrid evaluation-optimization trial enabled us to evaluate the individual and combined effectiveness of the optimized itMatters intervention and the SVP component in a single experiment, conserving resources and providing greatly improved efficiency. TRIAL REGISTRATION: NCT04095065.

The Healthy Young Men's Cohort: Health, Stress, and Risk Profile of Black and Latino Young Men Who Have Sex with Men (YMSM).

Young men who have sex with men (YMSM), especially YMSM of color, are at increased risk for a wide range of threats to their health and well-being. In this study, we recruited and surveyed an urban sample of 448 young African American/Black (Black), Hispanic/Latino (Latino), and multi-racial/ethnic YMSM, ages 16-24 years (mean = 22.3 years), about stressful life events, their health and mental health, their access to and utilization of care, and their involvement in risk-related behaviors. We found that the majority reported experiences of racism (87%) and homophobia (76%). A high percentage reported food insecurity/hunger (36%), residential instability (15%), financial hardship (63%), and conflict with family/friends (62%). The prevalence of risk behaviors was also high, including recent use of tobacco (46%), alcohol (88%), and marijuana (72%), and 41% tested positive for 1+ drugs. Furthermore, 26% tested positive for 1+ sexually transmitted infections (STIs). Over half (56%) reported being worried about their health, 33% reported having a chronic health condition and 31% a mental health condition, and 45% had wanted/needed mental health services during the past year. Further, 17% reported suicidal ideation/had planned a suicide attempt and 26% had ever engaged in self-injurious behaviors. Significant differences by race/ethnicity and HIV status included residential status/food insecurity, type of racism/homophobia, drug use, and STIs. These findings demonstrate how vulnerable this population is with respect to a wide range of structural and social determinants of health that may be important drivers of behavioral, health, mental health outcomes, and potentially long-term health disparities.

Health and Well-Being Among College Students in the United States During the COVID-19 Pandemic: Daily Diary Study.

BACKGROUND: There is evidence that anxiety and stress increased among college students during the COVID-19 pandemic. However, less is known about daily experiences of affect, worry, substance use behaviors, experiences of pleasure, concern over food security, experiences of bias or discrimination, feelings of belongingness, and other indicators of well-being and how they vary across days in this population. OBJECTIVE: This study surveyed a wide range of indicators of health and well-being in daily life over 21 days with a sample of college students in a large university system in the United States during the pandemic. The overall variance in each daily measure was partitioned to reflect the proportion due to (1) between-person differences versus (2) within-person, day-to-day variability. This is important because measures that vary primarily due to between-person differences may be more amenable to interventions that target particular students, whereas measures that vary more due to day-to-day variability may be more amenable to interventions that target day-level contextual factors. METHODS: A sample of 2068 young adult college students (aged 18-24, mean 19.8, SD 1.3 years; 66.6% women) completed a baseline survey; 97.3% (n=2012) then completed up to 21 consecutive daily surveys that assessed a comprehensive set of daily markers of health, behavior, and well-being. The daily diary study produced a total of 33,722 person-days. RESULTS: Among all person-days, a minority were substance use days (eg, 14.5% of days involved alcohol use, 5.6% vaping, and 5.5% cannabis). Experiences of pleasure were reported on most (73.5%) days. Between-person differences explained more than 50% of the variance in numerous indicators of health and well-being, including daily vaping, cannabis use, other illicit substance use, experiences of bias or discrimination, positive affect, negative affect, worry, food insecurity, and feelings of belonging at the university. In contrast, within-person differences explained more than 50% of the variance in daily alcohol use, cigarette use, stress, experiences of pleasure, where the student slept last night, and physical activity. CONCLUSIONS: College student health and well-being are multifaceted, with some aspects likely driven by person-level characteristics and experiences and other aspects by more dynamic, contextual risk factors that occur in daily life. These findings implicate services and interventions that should target individual students versus those that should target days on which students are at high risk for poor experiences or behaviors.

Valuing Human Impact of Natural Disasters: A Review of Methods.

This paper provides a comprehensive set of methodologies that have been used in the literature to give a monetary value to the human impact in a natural disaster setting. Four databases were searched for relevant published and gray literature documents with a set of inclusion and exclusion criteria. Twenty-seven studies that quantified the value of a statistical life in a disaster setting or discussed methodologies of estimating value of life were included. Analysis highlighted the complexity and variability of methods and estimations of values of statistical life. No single method to estimate the value of a statistical life is universally agreed upon, although stated preference methods seem to be the preferred approach. The value of one life varies significantly ranging from USD 143,000 to 15 million. While an overwhelming majority of studies concern high-income countries, most disaster casualties are observed in low- and middle-income countries. Data on the human impact of disasters are usually available in disasters databases. However, lost lives are not traditionally translated into monetary terms. Therefore, the full financial cost of disasters has rarely been evaluated. More research is needed to utilize the value of life estimates in order to guide policymakers in preparedness and mitigation policies.

itMatters: Optimization of an online intervention to prevent sexually transmitted infections in college students.

ObjectiveTo describe an iterative approach to developing an online intervention targeting the intersection of alcohol use and sexual behaviors among first year college students. Methods and Participants: Using the multiphase optimization strategy (MOST), we conducted two iterative optimization trials to: (1) identify candidate intervention components (i.e., descriptive norms, injunctive norms, outcome expectancies, perceived benefits of protective behavioral strategies, and self-efficacy to use strategies); (2) revise components; and (3) identify the optimized intervention. Participants were first year college students at six geographically diverse universities (optimization trial 1 N = 5,880; optimization trial 2 N = 3,551) Results: For both optimization trials, the results indicated that only descriptive and injunctive norms produced a significant effect (p<.05). Conclusions: The iterative process of MOST allowed us to develop an optimized intervention which is an essential tool to maximize intervention effectiveness and efficiency to improve uptake, sustainability, and public health impact.