Improving Delivery and Use of HIV Pre-Exposure Prophylaxis in the US: A Systematic Review of Implementation Strategies and Adjunctive Interventions.

Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States. To date, the literature has focused on identifying determinants of PrEP use, with a lesser focus on developing and testing change methods to improve PrEP implementation. Moreover, the change methods available for improving the uptake and sustained use of PrEP have not been systematically categorized. To summarize the state of the literature, we conducted a systematic review of the implementation strategies used to improve PrEP implementation among delivery systems and providers, as well as the adjunctive interventions used to improve the uptake and persistent adherence to PrEP among patients. Between November 2020 and January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer reviewed articles. We identified 44 change methods (18 implementation strategies and 26 adjunctive interventions) across a variety of clinical and community-based service settings. We coded implementation strategies and adjunctive interventions in accordance with established taxonomies and reporting guidelines. Most studies focused on improving patient adherence to PrEP and most conducted pilot trials. Just over one-third of included studies demonstrated a positive effect on outcomes. In order to end the human immunodeficiency virus (HIV) epidemic in the U.S., future, large scale HIV prevention research is needed that develops and evaluates implementation strategies and adjunctive interventions for target populations disproportionately affected by HIV.

Landscape of HIV Implementation Research Funded by the National Institutes of Health: A Mapping Review of Project Abstracts.

In 2019, the requisite biomedical and behavioral interventions to eliminate new HIV infections exist. "Ending the HIV Epidemic" now becomes primarily a challenge of will and implementation. This review maps the extent to which implementation research (IR) has been integrated into HIV research by reviewing the recent funding portfolio of the NIH. We searched NIH RePORTER for HIV and IR-related research projects funded from January 2013 to March 2018. The 4629 unique studies identified were screened using machine learning and manual methods. 216 abstracts met the eligibility criteria of HIV and IR. Key study characteristics were then abstracted. NIH currently funds HIV studies that are either formally IR (n = 109) or preparatory for IR (n = 107). Few (13%) projects mentioned a guiding implementation model, theory, or framework, and only 56% of all studies explicitly mentioned measuring an implementation outcome. Considering the study aims along an IR continuum, 18 (8%) studies examined barriers and facilitators, 43 (20%) developed implementation strategies, 46 (21%) piloted strategies, 73 (34%) tested a single strategy, and 35 (16%) compared strategies. A higher proportion of formal IR projects involved established interventions (e.g., integrated services) compared to newer interventions (e.g., pre-exposure prophylaxis). Prioritizing HIV-related IR in NIH and other federal funding opportunity announcements and expanded training in implementation science could have a substantial impact on ending the HIV pandemic. This review serves as a baseline by which to compare funding patterns and the sophistication of IR in HIV research over time.

Dynamic Transition Patterns in Acculturation Among Hispanic Adolescents.

Acculturation consists of multiple domains (i.e., cultural practices, identifications, and values). However, less is known about how acculturation processes influence each other across multiple domains of acculturation. This study was designed to investigate transition patterns of acculturative processes within and across domains in a sample of 302 recent-immigrant Hispanic adolescents, Mage (SD) = 14.51 years (0.88) at baseline; male = 53%). Adolescents were assessed six times over a 3-year period. Latent profile analyses identified two profiles (high [or increasing] vs. low) for each domain at each timepoint. We found largely stable transition patterns in each domain over six timepoints. Importantly, sequential associations among profiles in acculturation domains were also detected. Implication for acculturation theory and research are discussed.

Pragmatic adaptation of implementation research measures for a novel context and multiple professional roles: a factor analysis study.

BACKGROUND: Although some advances have been made in recent years, the lack of measures remains a major challenge in the field of implementation research. This results in frequent adaptation of implementation measures for different contexts-including different types of respondents or professional roles-than those for which they were originally developed and validated. The psychometric properties of these adapted measures are often not rigorously evaluated or reported. In this study, we examined the internal consistency, factor structure, and structural invariance of four well-validated measures of inner setting factors across four groups of respondents. The items in these measures were adapted as part of an evaluation of a large-scale organizational change in a rehabilitation hospital, which involved transitioning to a new building and a new model of patient care, facilitated by a significant redesign of patient care and research spaces. METHODS: Items were tailored for the context and perspective of different respondent groups and shortened for pragmatism. Confirmatory factor analysis was then used to test study hypotheses related to fit, internal consistency, and invariance across groups. RESULTS: The survey was administered to approximately 1208 employees; 785 responded (65% response rate) across the roles of clinician, researcher, leader, support staff, or dual clinician and researcher. For each of the four scales, confirmatory factor analysis demonstrated adequate fit that largely replicated the original measure. However, a few items loaded poorly and were removed from the final models. Internal consistencies of the final scales were acceptable. For scales that were administered to multiple professional roles, factor structures were not statistically different across groups, indicating structural invariance. CONCLUSIONS: The four inner setting measures were robust for use in this new context and across the multiple stakeholder groups surveyed. Shortening these measures did not significantly impair their measurement properties; however, as this study was cross sectional, future studies are required to evaluate the predictive validity and test-retest reliability of these measures. The successful use of adapted measures across contexts, across and between respondent groups, and with fewer items is encouraging, given the current emphasis on designing pragmatic implementation measures.

Translating evidence-based parenting programs for primary care: Stakeholder recommendations for sustainable implementation.

AIMS: To translate evidence-based programs (EBP) for a new setting, attention must be given to the characteristics of the intervention and the local setting, as well as evidence that is compelling to decision-makers. This paper describes the history of a partnership and stakeholder recommendations to inform the adaptation of an EBP for primary care. METHODS: We established a community advisory board (CAB) consisting of stakeholders with expertize in primary care delivery. A thematic analysis was conducted with fieldnotes and transcriptions from CAB meetings and regular meetings with participating clinics. RESULTS: We found that (a) parenting programs with a focus on behavioral and physical health are appropriate for this setting, (b) variability in the structure of primary care means implementation must be tailorable, and (c) financial and organizational outcomes are compelling for decision-makers. CONCLUSION: Factors related to the content and structure of evidence-based programs are uniquely related to distinct implementation outcomes of interest to key stakeholders.

Longitudinal Trajectories of Family Functioning Among Recent Immigrant Adolescents and Parents: Links With Adolescent and Parent Cultural Stress, Emotional Well-Being, and Behavioral Health.

This study examined longitudinal effects of adolescent and parent cultural stress on adolescent and parent emotional well-being and health behaviors via trajectories of adolescent and parent family functioning. Recent immigrant Latino adolescents (Mage  = 14.51) and parents (Mage  = 41.09; N = 302) completed measures of these constructs. Latent growth modeling indicated that adolescent and parent family functioning remained stable over time. Early levels of family functioning predicted adolescent and parent outcomes. Baseline adolescent cultural stress predicted lower positive adolescent and parent family functioning. Latent class growth analyses produced a two-class solution for family functioning. Adolescents and parents in the low family functioning class reported low family functioning over time. Adolescents and parents in the high family functioning class experienced increases in family functioning.

The use of cultural identity in predicting health lifestyle behaviors in Latinx immigrant adolescents.

OBJECTIVES: This study explored whether cultural identity predicts health lifestyle behaviors. METHOD: Participants included 302 recently immigrated (<5 years in the U.S.) Latinx adolescents (53% boys; mean age 14.51 years at baseline) from Miami and Los Angeles. Participants completed cultural identity measures at baseline and 1-year post baseline. A path analysis was used to estimate associations between cultural identities (ethnic, national, and bicultural) and health lifestyle behaviors (physical activity, diet, and sleep hygiene). RESULTS: Ethnic identity positively predicted diet. Results also indicated a significant interaction between ethnic and national identity on sleep hygiene. Specifically, when national identity was high (+1 SD), ethnic identity positively predicted sleep hygiene. CONCLUSION: This study focuses on health lifestyle behaviors such as physical activity, diet, and sleep hygiene in this population. Results highlight the need to explore the protective nature of cultural identity retention in relation to health lifestyle behaviors in Latinx adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parent-Centered Prevention of Risky Behaviors Among Hispanic Youths in Florida.

OBJECTIVES: To evaluate the effectiveness of an evidence-based, parent-centered intervention, Familias Unidas, delivered by nonresearch personnel, in preventing substance use (alcohol, illicit drugs) and sex without a condom among Hispanic adolescents. METHODS: A randomized controlled trial (n = 746) evaluated the effectiveness of Familias Unidas among Hispanic eighth graders (age range = 12-16 years), relative to prevention as usual, within a public school system. School personnel, including social workers and mental health counselors, were trained to deliver the evidence-based intervention. Participant recruitment, intervention delivery, and follow-up ran from September 2010 through June 2014 in Miami-Dade County, Florida. RESULTS: Familias Unidas was effective in preventing drug use from increasing and prevented greater increases in sex without a condom 30 months after baseline, relative to prevention as usual. Familias Unidas also had a positive impact on family functioning and parental monitoring of peers at 6 months after baseline. CONCLUSIONS: This study demonstrated the effectiveness of a parent-centered preventive intervention program in preventing risky behaviors among Hispanic youths. Findings highlight the feasibility of training nonresearch personnel on effectively delivering a manualized intervention in a real-world setting.

Personal and cultural identity development in recently immigrated Hispanic adolescents: Links with psychosocial functioning.

OBJECTIVES: This study examined directionality between personal (i.e., coherence and confusion) and cultural identity (i.e., ethnic and U.S.) as well as their additive effects on psychosocial functioning in a sample of recently immigrated Hispanic adolescents. METHOD: The sample consisted of 302 recent (<5 years) immigrant Hispanic adolescents (53% boys; Mage = 14.51 years at baseline; SD = .88 years) from Miami and Los Angeles who participated in a longitudinal study. RESULTS: Results indicated a bidirectional relationship between personal identity coherence and both ethnic and U.S. identity. Ethnic and U.S. affirmation/commitment (A/C) positively and indirectly predicted optimism and negatively predicted rule breaking and aggression through coherence. However, confusion predicted lower self-esteem and optimism and higher depressive symptoms, rule breaking, unprotected sex, and cigarette use. Results further indicated significant site differences. In Los Angeles (but not Miami), ethnic A/C also negatively predicted confusion. CONCLUSION: Given the direct effects of coherence and confusion on nearly every outcome, it may be beneficial for interventions to target personal identity. However, in contexts such as Los Angeles, which has at least some ambivalence toward recently immigrated Hispanic adolescents, it may be more beneficial for interventions to also target cultural identity to reduce confusion and thus promote positive development. (PsycINFO Database Record

Longitudinal Effects of Latino Parent Cultural Stress, Depressive Symptoms, and Family Functioning on Youth Emotional Well-Being and Health Risk Behaviors.

U.S. Latino parents can face cultural stressors in the form of acculturative stress, perceived discrimination, and a negative context of reception. It stands to reason that these cultural stressors may negatively impact Latino youth's emotional well-being and health risk behaviors by increasing parents' depressive symptoms and compromising the overall functioning of the family. To test this possibility, we analyzed data from a six-wave longitudinal study with 302 recently immigrated (<5 years in the United States) Latino parents (74% mothers, Mage  = 41.09 years) and their adolescent children (47% female, Mage  = 14.51 years). Results of a cross-lagged analysis indicated that parent cultural stress predicted greater parent depressive symptoms (and not vice versa). Both parent cultural stress and depressive symptoms, in turn, predicted lower parent-reported family functioning, which mediated the links from parent cultural stress and depressive symptoms to youth alcohol and cigarette use. Parent cultural stress also predicted lower youth-reported family functioning, which mediated the link from parent cultural stress to youth self-esteem. Finally, mediation analyses indicated that parent cultural stress predicted youth alcohol use by a way of parent depressive symptoms and parent-reported family functioning. Our findings point to parent depressive symptoms and family functioning as key mediators in the links from parent cultural stress to youth emotional well-being and health risk behaviors. We discuss implications for research and preventive interventions.

Personal Identity Development in Hispanic Immigrant Adolescents: Links with Positive Psychosocial Functioning, Depressive Symptoms, and Externalizing Problems.

The present study was designed to examine trajectories of personal identity coherence and confusion among Hispanic recent-immigrant adolescents, as well as the effects of these trajectories on psychosocial and risk-taking outcomes. Personal identity is extremely important in anchoring young immigrants during a time of acute cultural change. A sample of 302 recently immigrated (5 years or less in the United States at baseline) Hispanic adolescents (Mage = 14.51 years at baseline; SD = 0.88 years, range 14-17) from Miami and Los Angeles (47 % girls) completed measures of personal identity coherence and confusion at the first five waves of a six-wave longitudinal study; and reported on positive psychosocial functioning, depressive symptoms, and externalizing problems at baseline and at Time 6. Results indicated that identity coherence increased linearly across time, but that there were no significant changes in confusion over time and no individual differences in confusion trajectories. Higher baseline levels of, and improvements in, coherence predicted higher levels of self-esteem, optimism, and prosocial behavior at the final study timepoint. Higher baseline levels of confusion predicted lower self-esteem, greater depressive symptoms, more aggressive behavior, and more rule breaking at the final study timepoint. These results are discussed in terms of the importance of personal identity for Hispanic immigrant adolescents, and in terms of implications for intervention.

Alcohol use among recent immigrant Latino/a youth: acculturation, gender, and the Theory of Reasoned Action.

OBJECTIVE: Latino/a youth are at risk for alcohol use. This risk seems to rise with increasing US cultural orientation and decreasing Latino cultural orientation, especially among girls. To ascertain how acculturation may influence Latino/a youth alcohol use, we integrated an expanded multi-domain model of acculturation with the Theory of Reasoned Action. DESIGN: Participants were 302 recent Latino/a immigrant youth (141 girls, 160 boys; 152 from Miami, 150 from Los Angeles) who completed surveys at 4 time points. Youth completed measures of acculturation, attitudes toward drinking, perceived subjective norms regarding alcohol use, intention to drink, and alcohol use. RESULTS: Structural equation modeling indicated that collectivistic values predicted more perceived disapproval of drinking, which negatively predicted intention to drink. Intention to drink predicted elevated alcohol use. CONCLUSION: Although the association between collectivistic values and social disapproval of drinking was relatively small (ß = .19, p < .05), findings suggest that collectivistic values may help protect Latino/a immigrant youth from alcohol use by influencing their perceived social disapproval of drinking, leading to lower intention to drink. Educational preventive interventions aimed at reducing or preventing alcohol use in recent Latino/a immigrant youth could promote collectivistic values and disseminate messages about the negative consequences of drinking.

Human Subjects Protection and Technology in Prevention Science: Selected Opportunities and Challenges.

Internet-connected devices are changing the way people live, work, and relate to one another. For prevention scientists, technological advances create opportunities to promote the welfare of human subjects and society. The challenge is to obtain the benefits while minimizing risks. In this article, we use the guiding principles for ethical human subjects research and proposed changes to the Common Rule regulations, as a basis for discussing selected opportunities and challenges that new technologies present for prevention science. The benefits of conducting research with new populations, and at new levels of integration into participants' daily lives, are presented along with five challenges along with technological and other solutions to strengthen the protections that we provide: (1) achieving adequate informed consent with procedures that are acceptable to participants in a digital age; (2) balancing opportunities for rapid development and broad reach, with gaining adequate understanding of population needs; (3) integrating data collection and intervention into participants' lives while minimizing intrusiveness and fatigue; (4) setting appropriate expectations for responding to safety and suicide concerns; and (5) safeguarding newly available streams of sensitive data. Our goal is to promote collaboration between prevention scientists, institutional review boards, and community members to safely and ethically harness advancing technologies to strengthen impact of prevention science.

A Longitudinal Test of the Parent-Adolescent Family Functioning Discrepancy Hypothesis: A Trend toward Increased HIV Risk Behaviors Among Immigrant Hispanic Adolescents.

Parent-adolescent discrepancies in family functioning play an important role in HIV risk behaviors among adolescents, yet longitudinal research with recent immigrant Hispanic families remains limited. This study tested the effects of trajectories of parent-adolescent family functioning discrepancies on HIV risk behaviors among recent-immigrant Hispanic adolescents. Additionally, we examined whether and to what extent trajectories of parent-adolescent family functioning discrepancies vary as a function of gender. We assessed family functioning of 302 Hispanic adolescents (47 % female) and their parent (70 % female) at six time points over a three-year period and computed latent discrepancy scores between parent and adolescent reports at each timepoint. Additionally, adolescents completed measures of sexual risk behaviors and alcohol use. We conducted a confirmatory factor analysis to determine the feasibility of collapsing parent and adolescent reported family functioning indicators onto a single latent discrepancy variable, tested model invariance over time, and conducted growth mixture modeling (GMM). GMM yielded a three-class solution for discrepancies: High-Increasing, High-Stable, and Low-Stable. Relative to the Low-Stable class, parent-adolescent dyads in the High-Increasing and High-Stable classes were at greater risk for adolescents reporting sexual debut at time 6. Additionally, the High-Stable class was at greater risk, relative to the Low-Stable class, in terms of adolescent lifetime alcohol use at 30 months post-baseline. Multiple group GMM indicated that trajectories of parent-adolescent family functioning trajectories did not vary by gender. Implications for future research and practice are discussed.

Individual and culture-level components of survey response styles: A multi-level analysis using cultural models of selfhood.

Variations in acquiescence and extremity pose substantial threats to the validity of cross-cultural research that relies on survey methods. Individual and cultural correlates of response styles when using 2 contrasting types of response mode were investigated, drawing on data from 55 cultural groups across 33 nations. Using 7 dimensions of self-other relatedness that have often been confounded within the broader distinction between independence and interdependence, our analysis yields more specific understandings of both individual- and culture-level variations in response style. When using a Likert-scale response format, acquiescence is strongest among individuals seeing themselves as similar to others, and where cultural models of selfhood favour harmony, similarity with others and receptiveness to influence. However, when using Schwartz's (2007) portrait-comparison response procedure, acquiescence is strongest among individuals seeing themselves as self-reliant but also connected to others, and where cultural models of selfhood favour self-reliance and self-consistency. Extreme responding varies less between the two types of response modes, and is most prevalent among individuals seeing themselves as self-reliant, and in cultures favouring self-reliance. As both types of response mode elicit distinctive styles of response, it remains important to estimate and control for style effects to ensure valid comparisons.

A process-oriented analysis of parent acculturation, parent socio-cultural stress, family processes, and Latina/o youth smoking and depressive symptoms.

Latina/o youth in the U.S. are often characterized by elevated rates of cigarette smoking and depressive symptoms, and these rates appear to vary by youth acculturation and socio-cultural stress. Scholars suggest that parents' cultural experiences may be important determinants of youth smoking and depressive symptoms. However, few studies have examined the influence of parent acculturation and related stressors on Latina/o youth smoking and depressive symptoms. To address this gap in the literature, in the current study we investigated how parent-reported acculturation, perceived discrimination, and negative context of reception affect youth smoking and depressive symptoms through parent reports of familism values and parenting. The longitudinal (4 waves) sample consisted of 302 Latina/o parent-adolescent dyads from Los Angeles (N = 150) and Miami (N = 152). Forty-seven percent of the adolescent sample was female (M age = 14.5 years), and 70% of the parents were mothers (M age = 41.10 years). Parents completed measures of acculturation, perceived discrimination, negative context of reception, familism values, and parenting. Youth completed measures regarding their smoking and symptoms of depression. Structural equation modeling suggested that parents' collectivistic values (Time 1) and perceived discrimination (Time 1) predicted higher parental familism (Time 2), which in turn, predicted higher levels of positive/involved parenting (Time 3). Positive/involved parenting (Time 3), in turn, inversely predicted youth smoking (Time 4). These findings indicate that parents' cultural experiences play important roles in their parenting, which in turn appears to influence Latino/a youth smoking. This study highlights the need for preventive interventions to attend to parents' cultural experiences in the family (collectivistic values, familism values, and parenting) and the community (perceived discrimination).

Developmental trajectories of acculturation: links with family functioning and mental health in recent-immigrant Hispanic adolescents.

The present study was designed to examine acculturative changes, and their effects on mental health and family functioning, in recent-immigrant Hispanic adolescents. A sample of 302 Hispanic adolescents was assessed five times over a 2½-year period. Participants completed measures of Hispanic and U.S. practices, collectivist and individualist values, and ethnic and U.S. identity at each time point. Baseline and Time 5 levels of mental health and family functioning were also assessed. Latent class growth analyses produced two-class solutions for practices, values, and identifications. Adolescents who increased over time in practices and values reported the most adaptive mental health and family functioning. Adolescents who did not change in any acculturation domain reported the least favorable mental health and family functioning.

Depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents: Examining longitudinal effects of cultural stress.

This study examined longitudinal effects of cultural stress (a latent factor comprised of bicultural stress, ethnic discrimination, and negative context of reception) on depressive symptoms and a range of externalizing behaviors among recently (≤5 years in the U.S. at baseline) immigrated Hispanic adolescents. A sample of 302 adolescents (53% boys; mean age 14.51 years) completed baseline measures of perceived ethnic discrimination, bicultural stress, and perceived negative context of reception; and outcome measures of depressive symptoms, cigarette smoking, alcohol use, aggressive behavior, and rule-breaking behavior six months post-baseline. A path analysis indicated that higher cultural stress scores predicted higher levels of all outcomes. These effects were consistent across genders, but varied by study site. Specifically, higher cultural stress scores increased depressive symptoms among participants in Miami, but not in Los Angeles. Findings suggest that cultural stress is a clinically relevant predictor of depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents.

Longitudinal trajectories of bicultural identity integration in recently immigrated Hispanic adolescents: Links with mental health and family functioning.

This study examined, in a sample of recently immigrated Hispanic adolescents in Miami and Los Angeles, the extent to which bicultural identity integration (BII; involving the ability to synthesise one's heritage and receiving cultural streams and to identify as a member of both cultures) is best understood as a developmental construct that changes over time or as an individual-difference construct that is largely stable over time. We were also interested in the extent to which these trajectories predicted mental health and family functioning. Recent-immigrant 9th graders (N = 302) were assessed 6 times from 9th to 12th grade. Latent class growth analyses using the first 5 timepoints identified 2 trajectory classes-one with lower BII scores over time and another with higher BII scores over time. Higher heritage and US identity at baseline predicted membership in the higher BII class. At the 6th study timepoint, lower BII adolescents reported significantly poorer self-esteem, optimism, prosocial behaviour and family relationships compared with their higher BII counterparts. These findings are discussed in terms of further research on the over-time trajectory of biculturalism, and on the need to develop interventions to promote BII as a way of facilitating well-being and positive family functioning.