Police Violence Experienced by Black Gay and Bisexual Men: The Effects on HIV Care Engagement and Medication Adherence.

Black men face high rates of police violence, including direct victimization and indirect exposure to or knowledge of harmful policing. This violence can result in death and physical harm, as well as in numerous poor mental health outcomes. There has been little research examining experiences of police violence experienced by Black gay and bisexual men or the effects of police brutality on HIV continuum of care outcomes. To address this important gap, in this exploratory study, we examined the effects of police brutality on engagement in HIV care and adherence to antiretroviral medications. Cross-sectional survey data were collected from 107 Black gay and bisexual men living with HIV. The path analysis showed that men with greater exposure to police violence had increased symptoms of post-traumatic stress disorder and were more likely to have missed HIV care appointments in the past year. Additionally, there was a significant indirect effect of exposure to police violence on missed medication doses via PTSD symptoms.

An exploratory study of community violence and HIV care engagement among Black gay and bisexual men.

This study examined the relationship between exposure to community violence and HIV care engagement among 107 Black gay or bisexual men living with HIV in Chicago. Measures assessed the importance of demographic covariates (age, annual income, health insurance status, and years living with HIV), community violence exposures, mental health, social support, in explaining variations in missed doses of antiretroviral therapy (ART) medication and missed HIV care appointments. Results showed that participants who reported higher rates of exposure to community violence were two times more likely to have missed ART doses and HIV care appointments. Participants who reported depression scores were two times more likely to have greater non-ART adherence. Finally, older participants were more likely to report fewer missed ART doses. More research is needed to clarify the mechanisms between age or depression and ART adherence given community violence exposure. Health care providers should screen for depression when attempting to promote better ART adherence and keeping HIV care appointments for Black gay and bisexual men living with HIV. Younger Black gay and bisexual men living with HIV may be more vulnerable than older men for missed ART doses and may require additional screening and follow-up.

The Inherent Violence of Anti-Black Racism and its Effects on HIV Care for Black Sexually Minoritized Men.

The goal of this study was to examine the effects of racial discrimination, depression, and Black LGBTQ community support on HIV care outcomes among a sample of Black sexually minoritized men living with HIV. We conducted a cross-sectional survey with 107 Black sexually minoritized men living with HIV in Chicago. A path model was used to test associations between racial discrimination, Black LGBTQ community support, depressive symptoms, and missed antiretroviral medication doses and HIV care appointments. Results of the path model showed that men who had experienced more racism had more depressive symptoms and subsequently, missed more doses of HIV antiretroviral medication and had missed more HIV care appointments. Greater Black LGBTQ community support was associated with fewer missed HIV care appointments in the past year. This research shows that anti-Black racism may be a pervasive and harmful determinant of HIV inequities and a critical driver of racial disparities in ART adherence and HIV care engagement experienced by Black SMM. Black LGBTQ community support may buffer against the effects of racial discrimination on HIV care outcomes by providing safe, inclusive, supportive spaces for Black SMM.

Pathways From Bullying Victimization to Suicidal Thoughts Among Urban African American Adolescents: Applying the General Strain Theory.

ABSTRACT: The present study explores the relationship between bullying victimization and suicidal thoughts among African American adolescents in urban neighborhoods. The study, which was guided by the general strain theory, proposed and tested potential pathways that link bullying victimization with suicidal thoughts through the mediators including emotional distress, low future orientation, hopelessness, and drug use. The study sample included 414 African American adolescents who were between ages 12 and 22 years and residing in low-income Chicago's South Side neighborhoods. Descriptive statistics, bivariate correlation, and path analyses were conducted. Bullying victimization was not significantly related to suicidal thoughts, although it was positively associated with emotional distress and drug use. The association between low future orientation and hopelessness was bidirectional. The study findings have implications for practice, which is important as resources to assist adolescents who are affected by violence tend to be limited.

Religiosity and Associations with Substance Use and Delinquency Among Urban African American Adolescents.

Adolescent delinquency and substance use are global problems. African American adolescents are especially susceptible to the life-changing consequences of these problem behaviors. Religiosity is a notable protective factor that has been shown to mitigate these behaviors. This study uses a person-centered approach to examine the extent to which religiosity is associated with lower rates of delinquency and substance use among urban African American adolescents in the United States. Latent Class Analysis was used to examine the heterogeneity in five religiosity items among a sample of adolescents ages 13-18. After identifying religiosity classes through a class enumeration process, we examined predictors of the classes using multinomial logistic regression. The classes were then used to predict several substance use and delinquency outcomes. Three religiosity classes were identified; "low religious beliefs and engagement," (15.19%, n = 94), "religious with low active engagement," (56.70%, n = 351), and "religious with high active engagement," (28.11%, n = 174). Protective effects of religiosity on substance use (e.g., alcohol) and delinquency were found (e.g., assault). Implications for research and practice are discussed.

COVID-19, Retention in HIV Care, and Access to Ancillary Services for Young Black Men Living with HIV in Chicago.

This study conducted 28 semi-structured, in-depth interviews with Young Black Men who have Sex with Men in Chicago to investigate the impact of COVID-19 on their HIV care and ancillary service access. The qualitative analysis identified both negative and positive effects. The negative effects included: (l) mixed disruptions in linkage to and receipt of HIV care and ancillary services, and (2) heightened concerns about police and racial tensions in Chicago following the murder of George Floyd, contributing to possible disruption of retention in care. The positive effects included: (1) the ability to reflect and socially connect, contributing to heightened self-care and retention in care, and (2) some improvements in receipt of medical care. These findings suggest that while COVID-19 disruptions in care reduced in-person use of HIV care, the expansion of telemedicine allowed more administrative tasks to be handled online and focused in-person interactions on more substantive interactions.

Would Caring Teachers Buffer the Link Between Violence Victimization and Early Sexual Initiation? Comparing Heterosexual and Non-Heterosexual African American Youth.

This study investigated the relationship between youth violence exposures (i.e., peer and neighborhood) and early sexual initiation. It also explored whether caring relationships with teachers might moderate this relationship and whether results differed for heterosexual versus non-heterosexual African American youth. The study sample (N = 580) comprised 475 heterosexual and 105 non-heterosexual youths, 319 female and 261 male, ages 13 to 24 years (M age = 15.8). Students were assessed for peer and neighborhood violence, relationship with teachers, early sexual initiation, sexual orientation, and socioeconomic status. Major results indicated a positive relationship between exposure to peer and neighborhood violence and early sexual initiation for heterosexual youth but not those who identified as non-heterosexual. Further, identifying as female (vs. male) was significantly associated with later sexual initiation for both heterosexual and non-heterosexual youth. In addition, caring teachers moderated the relationship between exposure to peer violence and age of sexual initiation among non-heterosexual youth. Programs and interventions to curtail violence sequelae would need to consider the unique effects of various types of youth violence exposures and the significance of sexual orientation.

Examining the Relationship between Anti-Black Racism, Community and Police Violence, and COVID-19 Vaccination.

In 2020, the COVID-19 pandemic emerged against a backdrop of long-standing racial inequities that contributed to significant disparities in COVID-19 mortality, morbidity, and eventually, vaccination rates. COVID-19 also converged with two social crises: anti-Black racism and community and police violence. The goal of this study was to examine the associations between community violence, police violence, anti-Black racism, and COVID-19 vaccination. Survey data were collected from a sample of 538 Black residents of Chicago between September 2021 and March 2022. Structural equation modeling was used to test associations between neighborhood violence, police violence, racism, medical mistrust, trust in COVID-related information, depressive symptoms, and having received a COVID-19 vaccination. In line with predictions, neighborhood violence had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor. Additionally, racism had a significant indirect effect on vaccination via trust in COVID-related information from a personal doctor, as well as via medical mistrust and trust in COVID-related information from a personal doctor. These findings add to the growing body of literature demonstrating the importance of medical mistrust when examining COVID-19 vaccination disparities. Furthermore, this study highlights the importance of considering how social and structural factors such as violence and racism can influence medical mistrust.

Bullying Victimization, Future Orientation, and Suicidal Ideation of African American Youth in an Under-Resourced Community: A Moderated-Mediation Approach.

African American youth living in low-resourced communities are at high risk for bullying victimization which is positively associated with suicidal ideation. This study explored whether positive future orientation mediated the relationship between bullying victimization and suicidal ideation. This study engaged 627 African American adolescents and measured bullying victimization, internalizing problems, suicidal ideation, future orientation, and several covariates. Major findings indicated that controlling for gender, socioeconomic status, school motivation, and perceived teacher support, internalizing problems mediated the relationship between bullying victimization and suicidal ideation. Furthermore, both the effect of bullying victimization on suicidal ideation and the mediating effect of internalizing problems were moderated by future orientation. The effects were weakened when the level of future orientation increased. The implications for future research and supporting resiliency are discussed based on these findings.

The association between exposure to community violence and somatic symptoms through bullying victimization among African American adolescents in Chicago: A developmental trauma approach.

BACKGROUND: The developmental trauma theory suggests that traumatic events impede the ability of individuals to form interpersonal relationships, impair cognition, affect, and increase the vulnerability of adolescents to develop psychopathology. However, few studies have examined the applicability of this theory among African American adolescents who were exposed to community violence and adverse outcomes, including bullying victimization and somatic symptoms. AIMS: Therefore, the purpose of the present study is to first test the association between exposure to community violence and somatic symptoms. Then, we explored whether bullying victimization mediated the relationship between exposure to community violence and somatic symptoms while controlling for gender differences and substance use (n = 622). RESULTS: Results suggest that exposure to community violence is positively associated with somatic symptoms. Moreover, the association between exposure to community violence and somatic symptoms was mediated by bullying victimization. DISCUSSION AND CONCLUSION: These results were consistent with the developmental trauma theory, such that trauma could increase the vulnerability for future victimization, thus, leading to somatic symptoms. Implications for research and practice are discussed.

Teasing and alcohol drinking among African American adolescents in Chicago's Southside: Implications for nursing practice.

OBJECTIVE: Guided by the routine activity theory, the current study proposes and tests pathways by which an absence of a capable guardian can contribute to interactions with motivated offenders and suitable targets, increasing the likelihood of teasing others and using alcohol. SAMPLE: The study participants consisted of 612 African American adolescents in four low-income neighborhoods in Chicago's Southside. MEASURES: Measures include alcohol use, absence of a capable guardian, the presence of a motivated offender, target suitability, and teasing. Covariates include age, biological sex, and government assistance. Analyses included descriptive statistics, correlation analysis, and structural equation modeling. RESULTS: The absence of a capable guardian variable positively correlated with the presence of a motivated offender. The presence of a motivated offender variable was positively associated with target suitability, which was positively related to teasing and alcohol use. The presence of a motivated offender and target suitability variables were positively associated with teasing and alcohol use. CONCLUSION: Findings highlight the importance of capable guardians and potentially have implications for nursing practice.

Demographic and Regional Factors Associated With Reporting Homicides of Transgender People in the United States.

INTRODUCTION: The American Medical Association recently declared homicides of transgender individuals an epidemic. However, transgender homicide victims are often classified as nontransgender. Our objective was to describe existing data and coding of trans (i.e., transgender) victims and to examine the risk factors for homicides of trans people relative to nontrans people across the United States. METHODS: A retrospective review of the Centers for Disease Control and Prevention's National Violent Death Reporting System for the years 2003-2018 identified victims defined as transgender either through the "transgender" variable or narrative reports. Fisher's exact tests and logistic regression models were run to compare the demographics of trans victims to those not identified as trans. RESULTS: Of the 147 transgender victims identified, 14.4% were incorrectly coded as nontrans despite clear indication of trans status in the narrative description, and 6% were coded as hate crimes. Relative to nontrans victims, trans victims were more frequently Black (54.4% versus 40.7%, P = 0.001), had a mental health condition (26.5% versus 11.3%, P < 0.001), or reported being a sex worker (9.5% versus 0.2%, P < 0.001). There were disproportionately few homicides of transgender people in the South (13.6% of trans victims versus 29.1% of nontrans victims, P < 0.001). Conversely, the West and Midwest accounted for a higher-than-expected proportion of trans victims relative to nontrans victims (23.1% of trans victims versus 16.2% of nontrans victims, P = 0.03; 24.5% of trans victims versus 16.8% of nontrans victims, P = 0.02, respectively). CONCLUSIONS: Though the murder of transgender individuals is a known public health crisis, inconsistencies still exist in the assessment and reporting of transgender status. Further, these individuals were more likely to have multiple distinct vulnerabilities. These findings provide important information for injury and violence prevention researchers to improve reporting of transgender status in the medical record and local trauma registries.

Sex Differences in the Pathways from Exposure to Parental Fighting to Risky Sexual Activities Among Adolescents in Urban Neighborhoods.

OBJECTIVES: Adolescents' exposure to violence between parents acts as a precursor to risky behaviors; however, empirical studies that examined the potential pathways from exposure to violence between parents to risky behaviors are rare. Consequently, the prevention and intervention strategies for risky sexual activities are limited without the identification of malleable mediators. METHODS: Mediators on the association between adolescent exposure to parental fighting and risky sexual activities are examined, which include internalizing behaviors, running away from home, and affiliation with risky peers. Relationships between these variables are examined for males and females separately. The sample consists of 673 adolescents in a neighborhood located in Chicago's Southside who completed a survey. RESULTS: Exposure to parental fighting was not directly associated with risky sexual activities for either males or females. However, among females, exposure to parental fighting was significantly and positively related to internalizing behaviors and running away from home, and internalizing behaviors were also positively associated with running away from home. For males, however, only the association between internalizing behaviors and running away from home was found to be significant. Further, the relationship between exposure to parental fighting and risky sexual activities was mediated by running away from home. CONCLUSIONS: Targeted strategies for prevention are critical for improving sexual health outcomes among adolescents in low-resourced urban neighborhoods.

Racial and Ethnic Disparities, Referral Source and Attrition From Outpatient Substance Use Disorder Treatment Among Adolescents in the United States.

The following study examined the association between race, ethnicity, referral source, and reasons for attrition from substance use treatment in a sample of 72,643 discharges of adolescent youth in the United States from 2014 to 2016. Black and Hispanic adolescents were more likely to be discharged due to incarceration and termination by the facility compared to White adolescents. Adolescents referred by probation, diversion, other juvenile justice organizations, health care providers, community agencies, and individual referrals were significantly more likely to be discharged due to incarceration and terminated by the treatment facility compared to youth who were referred by schools. Findings suggest that enhancing linkage to treatment from systems in the social environment may play a role in attenuating racial and ethnic disparities in rates of attrition from substance abuse treatment among adolescent youth in the United States.

Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States.

The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.

Posttraumatic Stress, Academic Performance, and Future Orientation as Pathways to Community Violence Exposure and Sexual Risk among African American Youth in Chicago's Southside.

Posttraumatic stress, low academic performance, and future orientation as pathways from community violence exposure to sexual risk-taking behavior were examined among 753 African American youth in a large urban school district, ranging from ages of 13 to 24 years. Youth completed a self-report instrument. Youth completed a self-report instrument of Exposure to Violence Probe, University of California at Los Angeles' PTSD Reaction Index Adolescent Version, and Coopersmith's Self-Esteem Scale. Structural equation modeling was performed to examine relationships among the major study variables. Results indicated that community violence exposure was not directly associated with sexual risk behavior. However, community violence exposure had a significantly positive impact on posttraumatic stress, which was associated with low future orientation and sexual risk behavior. Findings suggest that targeted interventions need to consider variables that mediate the association between violence exposure and sexual risk behavior, which can reduce poor sexual health outcomes among urban youth who are exposed to violence in their community.

What Types of Delinquent Activities are Bullies, Victims, and Bully/Victims in Urban Neighborhoods Most Likely Involved in?

PURPOSE: The current study explores which types of delinquent activities bullies, victims, and bully/victims are most at risk of from a sample of urban African American adolescents. DESIGN AND METHODS: The research design was cross-sectional, which includes a sample of low-income African American adolescents in Chicago's Southside. The study participants included 523 adolescents. Descriptive statistics, latent class analysis, and logistic regression analysis were conducted. RESULTS: Bullies, victims, and bully/victims are all at a heightened risk of theft, threatening behavior, and assaultive behavior. Irrespective of bullying status, delinquency is a serious problem for urban adolescents who are bullies, victims, or bully/victims. CONCLUSIONS: Investigating the types of delinquent activities bullies, victims, and bully/victims are most likely to be involved in is important. IMPLICATIONS FOR PRACTICE: Evidence-based treatment plans require assessment tools that are tailored for urban African American adolescents. Nurses are advised to consider interventions that promote resilience.

Bullying victimization, psychosocial functioning, and protective factors: Comparing African American heterosexual and sexual minority adolescents in Chicago's Southside.

African American heterosexual and sexual minority (SM) adolescents report widespread bullying victimization (BV), which is associated with poorer psychosocial functioning. However, studies examining potential protective factors that moderate this association are limited. Using data from a cross-sectional study conducted in Chicago, we examined the association between BV and psychosocial functioning among a sample of heterosexual (n = 475) and SM (n = 105) African American adolescents and examined whether four empirically-supported protective factors moderated these associations. Among SM adolescents, having close parents was protective against psychosomatic symptoms for those who reported high BV and having caring teachers was protective against substance use for those who reported both high and low BV. Among heterosexual adolescents, having close parents was protective against substance use for those who reported high BV but having high neighborhood support exacerbated the risk of developing psychosomatic symptoms for those who reported high BV. Implications for school and parental-based interventions are discussed.

Pathways From Witnessing Parental Intimate Partner Violence to Involvement in Bullying: Empirically Testing a Proposed Conceptual Framework.

We tested a proposed conceptual framework in which we hypothesized that witnessing parental intimate partner violence (witnessing parental IPV) is linked to children's bullying and peer victimization. We also hypothesized that the relationship between witnessing parental IPV and bullying and peer victimization in childhood would be mediated by increased psychological problem behavior, school absences, and problematic peer interactions. We utilized data from the National Survey of Children's Health. We found that witnessing parental IPV was positively related to children's bullying and peer victimization not only directly, but also indirectly through the mediating role of psychological problem behavior, school absences, and problematic peer interactions. Our findings highlight the importance of exploring the mechanisms by which bullying and peer victimization increase in those who have witnessed parental IPV.

ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities.

PURPOSE OF REVIEW: In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA. RECENT FINDINGS: Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.