Tamera Coyne-Beasley

BACKGROUND HIV disproportionately impacts specific United States (US) populations, including Black adolescents and young adults (AYA) living in the US South. Multiple platforms for HIV pre-exposure prophylaxis (PrEP) are available but use by Black AYA remains low. Studies have shown that some AYA desire to receive help from adults in the form of tangible support (e.g. money for medicines or transportation), informational support (e.g. discussing options, side effects), and emotional support (e.g. encouragement). mHealth apps have improved certain components of sexual health behavior but have not been trialed explicitly with this population to increase types of support. OBJECTIVE The objective of this study is to explore if the combination of support persons and a mHealth app, HealthMPowerment (HMP), adapted to this population can facilitate Black AYA sexual health and HIV prevention communication with adult support persons. METHODS We will partner with an AYA community advisory board (CAB) and an adult support person CAB to guide this study. We will interview Black AYAs 14-21 years old who reside in the US South (n=25) and adult support persons aged 22 years and older who reside in the US South (n=25). Interviews will focus on attitudes towards and willingness to a) communicate with each other about HIV prevention and PrEP, and b) communicate using an app, exploring desirable app features. Then with the aid of the CAB and informed by the interview findings, we will administer a discrete choice experiment (DCE) to AYA (n=250) and adult support persons (n=250) in Alabama and metropolitan Atlanta, two high priority HIV jurisdictions. The DCE will focus on identifying preferred app features and app feature combinations. We will then work with the CAB to adapt the HMP app. We will pilot the refined HMP app with 10 AYA paired with a support person. RESULTS The primary outcomes will be app acceptability and feasibility using in-depth interviews. Secondary outcomes will be app paradata, e.g, engagement metrics including frequency of app use and time spent using specific features. Additionally, this study will provide valuable insights into how AYA may wish to partner with adult support persons, to optimize sexual health, which mHealth app features are most desirable for sexual health communication, and if partnering with adult support persons via an app can increase HIV prevention behaviors and PrEP use. CONCLUSIONS The development, piloting, and results from this digital health-enabled behavioral health intervention aim to strengthen HIV prevention strategies, including PrEP uptake. By leveraging digital tools to facilitate engagement, this intervention may improve sexual health in settings such as the US South, where structural barriers create significant impediments to accessing care and making healthy sexual choices. CLINICALTRIAL NCT06876324, NCT07535346

Purpose of Review: We highlight the disparate effects of climate change and unhealthy environments on children and youth and suggest pragmatic steps for pediatricians to address the harms both inside and outside the clinic space. Recent Findings: Environment and climate can inflict long-term, multi-faceted harms on children. As trusted resources by families and policy makers, pediatricians have a unique role in addressing these harms. Summary: Environmental toxins and climate change pose significant threats to the health and well-being of children and adolescents. There are inequities in how these threats are distributed in communities, resulting in many disparities. Pediatricians must prioritize addressing climate and environmental threats out of duty to their patients and as a matter of environmental justice. This can be done through research, advocacy, working with policymakers, and supporting youth in their advocacy and preparedness efforts, as well as through patient screening and clinical care.

Aims: This paper explores Black women's perspectives on bladder health using a social‐ecological conceptual framework and life course perspective.Methods: We conducted a directed content analysis of data from the Study of Habits, Attitudes, Realities, and Experiences (SHARE), a focus group study by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Analysis was conducted on data from five focus groups and a member‐checking session where all participants self‐identified as Black or African American.Results: Forty‐two participants aged 11–14 or 45+ years reported life course experiences with their bladder. The intersection of race and gender was the lens through which participants viewed bladder health. Participants' accounts of their perspectives on bladder health explicitly and implicitly revealed structural racism as an explanatory overarching theme. Participants described (a) historically‐rooted and still pervasive practices of discrimination and segregation, engendering inequitable access to quality medical care and public facilities, (b) institutional barriers to toileting autonomy in educational and occupational settings, promoting unhealthy voiding habits, (c) internalized expectations of Black women's stereotyped role as family caregiver, compromising caregiver health, (d) lack of reliable information on bladder health, leading to unhealthy bladder behaviors, and (e) potentially stress‐related comorbid chronic conditions and associated medication use, causing or exacerbating bladder problems.Conclusions: Bladder health promotion interventions should address social‐ecological and life course factors shaping Black women's bladder health, including social and structural barriers to accessing equitable health information and medical care.

Community engagement has been named a research priority by the National Institutes of Health, and scholars are calling for community engagement as an approach to address racism and equity in science. Robust community-engaged research can improve research quality, increase inclusion of traditionally marginalized populations, broaden the impact of findings on real-life situations, and is particularly valuable for underexplored research topics. The goal of this paper is to describe lessons learned and best practices that emerged from community engagement in a multi-institution population health research consortium. We describe how a foundation was laid to enable community-engaged research activities in the consortium, using a staged and stepped process to build and embed multi-level community-engaged research approaches. We staged our development to facilitate (a) awareness of community engagement among consortium members, (b) the building of solidarity and alliances, and (c) the initiation of long-term engagement to allow for meaningful research translation. Our stepped process involved strategic planning; building momentum; institutionalizing engagement into the consortium infrastructure; and developing, implementing, and evaluating a plan. We moved from informal, one-time community interactions to systematic, formalized, capacity-building reciprocal engagement. We share our speed bumps and troubleshooting that inform our recommendations for other large research consortia—including investing the time it takes to build up community engagement capacity, acknowledging and drawing on strengths of the communities of interest, assuring a strong infrastructure of accountability for community engagement, and grounding the work in anti-racist principles.

Racism is woven within the fabric of the United States culture, structures, and systems, including its healthcare system. There is extensive research on adults demonstrating racial discrimination’s physical and mental health impacts, and the evidence showing similar disproportionate effects for adolescents of color continues to grow. Furthermore, the devastation of the coronavirus pandemic has paralleled the resurgence of white nationalism movements and adverse outcomes associated with the over-policing of Black and Brown communities. Scientific evidence continues to illustrate how sociopolitical determinants of health and experiencing vicarious racism amplify overt racism and implicit bias actions individually and within health care structures. Therefore, evidence-based strategic interventions are desperately needed to ensure the health and well-being of adolescents and young adults.

Immunization is one the greatest prevention tools in the skillset of the general pe-diatrician. Ensuring that all patients, particularly adolescents and young adults, have the opportunity and access to age-appropriate vaccines should be an integral part of pediat-ric practice. Equitable immunization access and allocation should be afforded to adoles-cents and young adults to foster the health and well-being of America's next generation. This article will focus on select inequities that create health disparities disproportionately affecting adolescents and young adults of color. We seek to highlight inequities in ado-lescents and young adult vaccination and explore strategies for improving equity among this unique group. [Pediatr Ann. 2023;52(3):e102-e105.]

The HPV vaccine is approved for children as young as age nine and recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices routinely for ages 11–12. However, many U.S. adolescents do not complete the vaccine series until middle to late adolescence, if at all, leaving them vulnerable to future HPV infection and attributable cancers. Health disparities exist for both vaccination coverage and most HPV-associated cancers. A strategy for improving vaccination rates for all populations and reducing disparate gaps in protection and health disparities from HPV-associated cancers is to shift the routine recommendation to an earlier age, that is, to start the vaccine series at age nine instead of ages 11–12. Challenges, opportunities, and suggestions for communicating this recommendation are outlined alongside considerations of social determinants of health.