Introduction to Special Issue on Advancing Health Equity Among Black Communities.

The current paper serves as an introduction to this special issue, Advancing Health Equity among Black Communities, in which we provide an overview of the papers included. Specifically, we summarize the papers covered in the special issue and highlight some of the common themes. The impetus for this special issue originated from a culmination of the COVID-19 pandemic, continued murders of Black people by police officers, and an unsettling political climate (e.g., Galea & Abdalla, 2020). While the impact of individual racism has been studied extensively, the insidious and pervasive impact of structural racism is less understood. Structural racism is a system in which embedded values, practices and policies facilitate and perpetrate the continued differential treatment of people based on race and becomes an almost hidden influence on the way an institution functions. For this special issue, prevention scientists were invited to submit conceptual and empirical research reflecting their understandings of structural racism as it operates in U.S. systems (e.g., education, justice, housing, workforce) and contributes to health inequities in the lives of Black Americans. The submissions also demonstrate how prevention scientists can leverage translational science to impact policies, practices, and procedures to promote equitable and sustainable change for Black communities.

Religious Coping Styles Used by Young Black Women Who Experience DatingViolence.

Young Black women experience higher rates of dating violence victimization compared to their White peers. Religion is a cornerstone of African American culture, suggesting that Black women may use religious coping after experiencing trauma like dating violence. However, research has not explored the patterns of religious coping following dating violence experiences. The current study analyzed survey data from 481 young Black women aged 18-19 years on their religious coping behaviors, acceptance of violence beliefs, and dating violence victimization experiences. Results showed that victimization was positively associated with negative religious coping. Findings indicate that one way young Black women cope with dating violence victimization is through feelings of spiritual discontent, and they may see their victimization as a punishment from God.

Predictors of cervical cancer screening for refugee women attending an international family medicine clinic in the United States.

PURPOSE: Cervical cancer screening (CCS) rates are lower for foreign-born women in the United States (U.S.) compared with the overall population. This study aimed to determine the CCS rate and predictors among refugees who were identified as female attending a family medicine clinic. METHODS: A retrospective chart review included refugee individuals aged 21+, seen in the previous 3 years (3/23/2015-3/20/2018), without hysterectomy (n = 525). Lab results determined CCS rate. Chi-square and logistic regression models explored predictors of CCS. RESULTS: Overall, 60.0% were up-to-date (UTD) on CCS. Individuals aged 30-49, married, and with [Formula: see text] 1 child had higher odds of being UTD. Ten or more years living in the U.S. was a significant bivariate predictor of CCS, and approached significance in the multivariate model. CONCLUSION: This study begins to fill gaps in knowledge about cervical cancer control among individuals who resettled in the U.S. as refugees and, given that CCS rates are suboptimal, informs clinical practice improvements and directions for future research.

Dating Matters and the Future of Teen Dating Violence Prevention.

Despite increased focus and research on violence prevention, rates of teen dating violence (TDV) victimization have remained stable for the last two decades. In response to this major public health concern, the Centers for Disease Control and Prevention developed and evaluated a multicomponent school-based program, Dating Matters, with the goal of reducing teen dating violence perpetration and victimization. This commentary discusses themes from the results of Dating Matters studies included in this special section of Prevention Science. We review the challenges in implementing multicomponent violence prevention programs across the social ecology as well as the promise of success in communities with elevated rates of TDV. Finally, we summarize the implications of these findings for violence prevention research and offer emerging areas where more research is needed.

Improving the school environment: School staff perceptions of school climate data and reporting practices.

School climate surveys have become widely used in U.S. schools, but there is little information on whether school leaders engage teachers and other staff in the process of reviewing and making use of survey results. This mixed-methods study examined staff interest, viewing, and use of survey results in a state that administers a school climate survey. Semistructured interviews with 15 staff members were conducted to gain insight into quantitative results from 16,525 staff members in 318 high schools. Survey data showed that although 84% of school staff were interested in seeing the results of their school climate survey, fewer than one-third reported seeing the results or using them for school planning or improvement. Administrators were more likely than teachers and other staff to have seen and used survey results. Content coding of the qualitative data elaborated on staff interest in reviewing and using climate data. These findings highlight the need for school leaders to collaborate with school staff on interpreting and using survey results for school climate improvement efforts.

Synthetic and Other Drug Use among High School Students: The Role of Perceived Prevalence, Access, and Harms.

BACKGROUND: Synthetic and other drugs have become available to teens, yet little is known about risk factors of use. OBJECTIVE: To examine adolescent use of one class of synthetic drugs and its association with perceptions about its prevalence, access, and risk of substance use. METHODS: Adolescents from a convenience sample of 104 middle and high schools (N = 59,218) participated in an anonymous survey to assess school climate and substance use in 2013-2014. Multilevel logistic regression examined the association between risk for synthetic and other drug use, perceptions of substance use, and school-level characteristics. RESULTS: Results indicated that 2,407 (4.3%) students reported synthetic and other drug use in the past 30 days. A large proportion of youth perceived drugs to be problematic at school but underestimated the harms associated with drug use. Participants also perceived tobacco, alcohol, marijuana, and prescription drugs are easy to obtain. Risk factors for synthetic and other drug use included the perception that substance use was a large problem at school, ease of access to drugs, and limited harm associated with drug use. School enrollment and socio-economic status of students reduced odds of drug use. Similar trends were found regarding marijuana use. Conclusion/Importance: Synthetic and other drug use is an emerging public health concern. Many youth identified substances as problematic and easily accessible in their schools but underestimated their potential harms. Health and education professionals need to increase effective education around substance use, including common risk factors for synthetic drug use.

Responding to intimate partner violence: Healthcare providers' current practices and views on integrating a safety decision aid into primary care settings.

Supportive care for survivors of intimate partner violence (IPV) remains limited in primary care settings. Low-income and Spanish-speaking survivors of IPV are even more disadvantaged, given the dearth of linguistically and culturally appropriate interventions for IPV. We conducted semi-structured individual interviews with 17 healthcare workers, including physicians, nurses, and social workers, to describe how healthcare workers serving primarily low-income, Latina populations are currently screening and responding to IPV disclosure, and to explore the acceptability of integrating an interactive, personalized safety decision aid application-myPlan app-into the clinic setting. Despite recognition of IPV as a problem, none of the clinical sites had a protocol to guide screening and response to IPV disclosure. Screening practices varied across the sites, sometimes conducted by medical assistants prior to the provider visit and other times by the physician or nurse provider. When IPV was disclosed, it was often during assessment for a presenting problem such as poor sleep or anxiety. Most healthcare workers felt that clinical and community resources were limited for their patients experiencing IPV. The "warm hand-off" to a social worker was the most common response strategy when possible; otherwise, women were given information about available resources such as hotlines and safe houses. We discuss structural, family, and individual barriers to accessing safety resources for underserved women and review how an easily accessible safety decision app, such as myPlan, could be a resource for women to safely tailor an action plan for her situation.

A Cross-National Comparison of Risk Factors for Teen Dating Violence in Mexico and the United States.

Involvement in dating violence has been linked with negative health outcomes including depressive symptomology, substance use, and later expressions of aggressing and victimizing behaviors. Less is known about the prevalence and mental health correlates of teen dating violence in countries like Mexico where adult partner violence is high. Additional research on teen dating violence is also needed, as it may be an important precursor to adult partner violence and linked to other mental health problems. The current study used self-report ratings to assess the similarities and differences in risk factors associated with dating violence among middle school students in Mexico and the United States. The US sample (Nus = 15,099; Mus = 12.8; 49.5% female) included non-Hispanic Caucasian (24.9%), Hispanic American (20.3%), and African American (24.2%) adolescents. The Mexican sample (NMexico = 2211; MMexico = 13.67; 51% female) included 93.1% adolescents of Hispanic or Latin descent. Logistic regressions showed that dating violence victimization was reported at similar rates in the cross-national samples, though exposure to risk factors like deviant peers and substance use differed significantly by country. Our analyses indicated that, although the country of residence was not significantly associated with dating violence victimization, the strength of the association between some known risk factors and dating violence victimization varied as a function of nationality, such that there was a significant interaction between country of residence, Mexico or the US, and experiencing internalizing symptoms on experiencing physical dating violence victimization. This study contributes to the growing body of literature on dating violence, both inside and outside the US.

The Moderating Role of Spirituality in the Association between Stress and Substance Use among Adolescents: Differences by Gender.

Adolescents are exposed to various stressors that may increase the risk for substance use. Due to the detrimental, and potentially long-lasting, effects related to substance use, it is necessary to explore more optimal coping strategies. This study explored the association between substance use and stress among male and female high school students in relation to spirituality as a moderator. To examine these relationships, the study used cross-sectional data collected from 27,874 high school students (Male = 50.7%, Female = 49.3%) across 58 high schools in Maryland that included an ethnically diverse sample (49% Caucasian, 30% African American) with an average age of 16 years old. Bivariate results showed differences in substance use, stress, and spirituality between male and female students. Higher rates of substance use were generally found among male students compared to female students; rates tended to be higher among female students for stress and spirituality compared to their male counterparts. Multilevel analyses indicated a positive association between stress and substance use among male and female students after adjusting for demographic and school-level factors. Both male and female students who reported turning to spiritual beliefs when experiencing problems were less likely to use substances. However, the interaction between stress and spirituality was significant for males only. These findings suggest that stress may increase the propensity for substance use and that spirituality might be a viable coping mechanism useful for helping high school students adapt to stressful circumstances and situations.

African American Girls' Ideal Dating Relationship Now and In the Future.

Adolescence is a particularly important and challenging time for developing long lasting romantic relationship patterns. However, limited empirical research has explored teen perceptions of ideal partner characteristics during adolescence or their significance to the quality of current and future relationships. Semi-structured in-depth interviews were conducted with 33 African American high school girls to shed light on the qualities desired in their dating relationships and relational factors that influence teen dating behaviors. Guided by the Social Ecological Framework, interviews were transcribed verbatim and entered into ATLAS.ti, for coding and analysis. Girls discussed the important influence of parents in choosing a partner and provided positive depictions of friendship and marriage with a suitable partner. More research is needed to understand how and why adolescents desire particular characteristics, how socialization shapes teen perceptions and how these preferences may be related to current and future adolescent dating choices, including violence perpetration and victimization.

The Role of Stress and Spirituality in Adolescent Substance Use.

BACKGROUND: Substance use can occur as a result of coping with stress. Within the school context, youth are exposed to stressors related to school achievement and peer-relationships. Protective factors, such as spirituality, may moderate adolescents' engagement in substance use. OBJECTIVE: The current study investigated the role of spirituality in the association between stress and substance use, in an effort to test the hypothesis that spirituality moderates the association between stress and substance use. METHODS: This study used data from youth in grades 6-8 attending 40 parochial private schools. A total of 5,217 students participated in the web-based survey administered in Spring 2013. Multilevel structural equation models were used to examine the association between stress, spirituality, and substance use, while accounting for the nested nature of the data (i.e., students within schools). RESULTS: Higher stress was significantly associated with increased alcohol, tobacco, and other drug use among youth (b =.306, p <.001). In addition, lower spiritual beliefs were associated with greater substance use (b =.349, p <.001). Spiritual beliefs did not moderate the relationship between stress and substance use. CONCLUSIONS/IMPORTANCE: Implications for increasing students' adaptive coping when confronted with school-related stressors and the role of school climate are discussed.

A systematic review of intervention studies to prevent hospitalizations of community-dwelling older adults with dementia.

OBJECTIVES: To conduct a systematic literature review to determine if there were any intervention strategies that had any measurable effect on acute-care hospitalizations among community-dwelling adults with dementia. DESIGN: Studies were identified by a professional research librarian and content experts. SETTING: Community dwelling. PARTICIPANTS: Participants were diagnosed with dementia, severity ranging from mild to severe, and were recruited from health care and community agencies. MEASUREMENTS: A study met the inclusion criteria if it: (a) was published in English; (b) included a control or comparison group; (c) published outcome data from the intervention under study; (d) reported hospitalization as one of the outcomes; (e) included community-dwelling older adults; and (f) enrolled participants with dementia. Ten studies met all inclusion criteria. RESULTS: Of the 10 studies included, most assessed health services use (ie, hospitalizations) as a secondary outcome. Participants were recruited from a range of health care and community agencies, and most were diagnosed with dementia with severity ratings ranging from mild to severe. Most intervention strategies consisted of face-to-face assessments of the persons living with dementia, their caregivers, and the development and implementation of a care plan. A significant reduction in hospital admissions was not found in any of the included studies, although 1 study did observe a reduction in hospital days. CONCLUSIONS: The majority of studies included hospitalizations as a secondary outcome. Only 1 intervention was found to have an effect on hospitalizations. Future work would benefit from strategies specifically designed to reduce and prevent acute hospitalizations in persons with dementia.

The (mal) adaptive value of mid-adolescent dating relationship labels.

The aim of this study was to explore adolescent dating relationships through the prism of high school girls' narratives. We probed the contexts and meanings associated with different forms of dating to better understand the developmental significance of romantic relationships during adolescence. Cross-sectional, in-depth semi-structured interviews were conducted with 20 high school females. The analytic approach was phenomenological and grounded in the narratives rather than based on an a priori theoretical framework. Interviews were digitally recorded, transcribed verbatim by research staff and entered into ATLAS.ti 6, a qualitative data-management software package, prior to analysis. Teen relationships were found to vary along a Dis-Continuum from casual hookups to "official" boyfriend/girlfriend. There was a lack of consensus, and much ambiguity, as to the substantive meaning of different relationships. Labeling dating relationships seem to facilitate acquisition of important developmental needs such as identity, affiliation, and status, while attempting to manage cognitive dissonance and emotional disappointments. Findings underscore the confusion and complexity surrounding contemporary adolescent dating. Adolescent girls are using language and social media to assist them in meeting developmental goals. Sometimes their dating labels are adaptive, other times they are a cause of stress, or concealment of unmet needs and thwarted desires. Programs focused on positive youth development need to resonate with the realities of teens' lives and more fully acknowledge the complicated dynamics of teen dating relationships and how they are formalized, publicized and negotiated.

Positive self-perceptions as a mediator of religious involvement and health behaviors in a national sample of African Americans.

Self-esteem and self-efficacy are theorized to serve as mediators of the relationship between religious involvement and health outcomes. Studies confirming these relationships have produced mixed evidence. This study examined whether self-esteem and self-efficacy mediate the relationship between religious involvement (beliefs, behaviors) and a set of modifiable health behaviors in a national probability sample of African Americans. African Americans, in general, are relatively high in religious involvement and have higher than average rates of chronic disease. Participants were interviewed by telephone, and a Religion-Health Mediational Model was tested using structural equation modeling. Results suggest that self-esteem and self-efficacy at least in part mediate the relationship between religious beliefs (e.g., relationship with God) and greater fruit and vegetable consumption, and lower alcohol consumption. Religious behaviors (e.g., service attendance) were found to have direct, unmediated effects on health behaviors. Findings have implications for church-based health promotion in African American communities such as education or support groups.

"If you don't have honesty in a relationship, then there is no relationship": African American girls' characterization of healthy dating relationships, a qualitative study.

The quality of dating relationships in adolescence can have long lasting effects on identity development, self-esteem, and interpersonal skills, and can shape values and behaviors related to future intimate relationships. The aims of this study were to: (1) investigate how African American adolescent girls characterize healthy relationships; and (2) describe the meanings of these characteristics in the context of the Centers for Disease Control and Prevention's (CDC) 12 healthy dating relationship qualities. We conducted semi-structured one-on-one in-depth interviews with 33 African American high school girls in the mid-Atlantic region. Trained staff transcribed interviews verbatim and entered the data into ATLAS.ti for coding and analysis. Participants' specified and vividly described eight healthy relationship characteristics: good communication, honesty, trust, respect, compromise, understanding, individuality, and self-confidence. Of these characteristics, three (good communication, compromise, and respect) were described in ways discordant with CDC's definitions. Findings highlight a need to better understand how girls develop values and ascribe characteristics of healthy relationships in order to reduce their risk for teen dating violence.

Factors associated with anxiety in colorectal cancer survivors: a scoping review.

PURPOSE: Anxiety is one of the most common psychological issues among colorectal cancer (CRC) survivors. It can interact with physical symptoms, impacting cancer progression, survival, and quality of life. This scoping review aims to explore the factors associated with anxiety in patients with CRC and the instruments used to measure anxiety. METHODS: Using Arksey and O'Malley's (2005) framework for the scoping review, studies investigating anxiety in CRC patients published in CINAHL, PubMed, PsycINFO, and Scopus between 2013 and 2024 were included. RESULTS: We analyzed fifty-one studies for this review. The review identified several risk factors and consequences of anxiety in CRC patients. The risk factors were classified into six domains using Niedzwiedz et al.'s (2019) framework: individual characteristics, social/ contextual factors, prior psychological factors, psychological responses to diagnosis and treatment, characteristics of cancer, and treatment. The consequences of anxiety were classified into three categories: global health status/quality of life, functions, and symptoms/problems. The most frequently used tool was the Hospital Anxiety and Depression Scale, with International Classification of Diseases codes being the second most used. CONCLUSIONS: This scoping review highlighted the intricate interaction between biological and psychosocial aspects in the lives of CRC survivors. It also identified unique factors associated with anxiety among these individuals. However, the review found some inconsistencies in the results related to anxiety-related factors, potentially due to differences in study populations, designs, measurement tools, and analysis methods. IMPLICATIONS FOR CANCER SURVIVORS: This review underscores the potential for interventions targeting modifiable factors to prevent or reduce anxiety and enhance the quality of life for CRC survivors.

Centering students' voices in the exploration of in-classroom culturally responsive practices.

Scholars have developed culturally responsive frameworks and interventions to support educators as they aim to create inclusive and equitable classroom environments. Despite the number of frameworks on the topic, research on culturally responsive practices (CRPs) is limited by the lack of clear definitions or evidence on the effectiveness of in-classroom culturally responsive interventions. With the aim to understand which characteristics are important for in-classroom CRPs, this qualitative study explored students' perceptions of practices teachers use to respond to students' learning and cultural identities. We conducted 23 focus groups with 103 Black, Latine, and White students in middle and high school from two midwestern schools. After analyzing the data, we identified four overarching themes: (a) inclusive classroom instruction, (b) emotional safety in the classroom, (c) relational quality with the teachers, and (d) racism and other "isms" in the classroom. Students consistently commented on the importance of teacher support for students' emotional and academic well-being while also describing teachers that demeaned them or their peers, in turn, obstructing their learning. The findings hold promise to clarify and strengthen professional development CRP interventions as students offer insight about teacher cultural responsiveness and non-responsiveness.

A Research-Practice Partnership to Develop the R-CITY Multi-Component, Equity-Focused Social-Emotional Learning Intervention.

There is growing interest in the integration of social-emotional learning (SEL) and equity approaches in schools, yet systematic research on how to blend these two frameworks is limited. In this article, we describe the process by which a research-practice partnership (RPP) collaborated to iteratively co-create a multi-component equity-focused SEL preventive intervention in the context of a politically charged landscape related to the 'dual pandemics' of racial injustice and COVID-19 in the early 2020s. We conducted a document review of informal data sources (e.g., meeting minutes, correspondence) and analyses of formal data sources (i.e., teacher interviews, student focus groups) to describe how we overcame challenges to form an RPP, to demonstrate our collaborative intervention development efforts, and to assess feedback on the contextual appropriateness of the intervention. We discuss lessons learned from our partnership efforts and reflect on future directions for RPP-driven work to advance equity-focused SEL in K-12 public schools.

Relationship between religious social support and general social support with health behaviors in a national sample of African Americans.

Chronic diseases are the leading cause of death and disability in the United States and have significant behavioral origins. African Americans suffer a disproportionate burden of chronic disease relative to other US racial/ethnic groups. Previous research supports an association between both general and religious social support and health behaviors that impact the risk of chronic disease. The present study examined the relative contributions of these constructs to a variety of health behaviors in a national probability sample of African American men and women (N = 2,370). A telephone interview assessing fruit and vegetable consumption, physical activity, alcohol consumption, and current cigarette use was completed by participants. Results showed that several dimensions of religious social support predicted fruit and vegetable consumption, moderate physical activity, and alcohol use over and above the role of general social support. Findings highlight the unique role of religious support in this population in the context of health behaviors. Implications for health promotion interventions are discussed.