Wrenetha A. Julion

Firearm homicide is a leading cause of death among children and young men in the U.S. (ages 1–19), with young Black males in urban environments facing rates 18-to-24-fold higher than their non-Hispanic White peers in 2023. A key precursor to firearm violence victimization is weapon-carrying behavior (WCB), defined as carrying, concealing, or displaying firearms or other weapons in community or social contexts that elevate risk for injury, interpersonal threats, or law enforcement contact. Several structural, behavioral, and trauma-based risk factors fuel weapon-carrying. Yet these WCBs are rarely studied in tandem, leaving a critical gap in our understanding of these high-risk behaviors for youth. This cross-sectional study leveraged baseline data from a convenience sample of 226 violence-exposed urban young Black males, ages 15–24 (M_age = 18.3 years; SD = 3.1) enrolled in a trauma-informed digital firearm violence prevention pilot study. Eligibility required prior personal or witnessed experience of youth violence; reported prevalence therefore characterizes a high-risk subgroup rather than urban young Black males as a whole. Past-30-day weapon-carrying frequency was measured across five YRBS-aligned categories (0, 1, 2 to 3, 4 to 5, and 6+ days) and modeled as a categorical index under negative binomial regression. Associations with peer and community violence exposure, substance use, sociodemographic, and socioeconomic factors were estimated as incidence rate ratios (IRRs) with 95% CI. Past-30-day weapon carrying was reported by 42.5% of participants, with carrying frequency ranging from 1 day to 6 or more days. Participants reported high levels of direct victimization (64.8%), witnessing community violence (76.4%), and use of nonprescribed medications, including in instances preceding violence. In the fully adjusted model, indicators of violence exposure were the most consistent correlates of carrying. Direct victimization (IRR = 1.15, p < 0.05), general exposure to violence or aggression (IRR = 7.82, p < 0.01), and physical fighting (IRR = 1.11, p < 0.05) remained independently significant. Conversely, associations with substance use, dating aggression, and employment were attenuated, suggesting shared ecological vulnerability rather than independent causal pathways. Findings underscore the central role of chronic violence exposure and support the need for trauma-informed, multilevel prevention strategies in clinical and community settings.

Background: Black adolescent females are disproportionately affected by obesity and its associated adverse health outcomes. Though racial disparities in obesity and related health outcomes are often attributed to differences in socioeconomic status, growing evidence suggests that structural racism is a contributing factor. To prevent the numerous comorbidities associated with obesity in black females, interventionists must confront the tripartite impact of structural racism, racial discrimination, and intersectionality on physical activity and dietary behaviors. The purpose of this paper was to describe Public Health Critical Race Praxis (PHCRP) as a race-conscious approach to intervention development, refinement, and evaluation. Approach: PHCRP can be applied to behavioral intervention research to provide a lens to develop, refine, deliver, and/or evaluate culturally tailored interventions. We present a description of the 4 PHCRP foci for interventionists with examples of the 10 affiliated principles. PHCRP Application: The intervention team led with the overarching principle, race consciousness, to guide their refinement efforts, including acknowledgment of personal biases, identification of the mechanisms in which bias perpetuates racism, and development of counteractivities to combat these biases. The intervention team operationalized PHCRP by critically evaluating decisions through a race-conscious lens, ensuring that the 4 foci remained foundational throughout the refinement process. Discussion: Interventionists have unintentionally reinforced racism with complicit silence by not directly addressing the profound influence of racism on health behaviors. We urge interventionists to regard the inclusion of a race-conscious framework, such as PHCRP, as a necessary requirement for designing interventions with marginalized populations.

Black adolescent females and women are disproportionately burdened by obesity that is attributed to structural and interpersonal racism. Previous researchers described that three protective mechanisms (racial identity, racial socialization, and Africentric worldview) serve as forms of coping for Black adolescent females with obesity. The purpose of this scoping review was to summarize evidence on the relationships among racial identity, racial socialization, and Africentric worldview in the context of obesity (body mass index, physical activity, and diet) among Black adolescent females. Six literature databases were searched for peer-reviewed studies published in English and included a sample with 50% or more Black adolescent females (age 10-19 years). Studies that reported a sample of participants over 24 years of age and/or with less than 50% Black adolescent females or did not report the findings for Black female participants separately and did not discuss racial identity, racial socialization, andAfricentric worldview in the context of obesity were excluded. The last search was performed on July 8, 2025. Six studies met eligibility criteria. The foci of studies included racial identity (n = 5) and racial socialization (n = 4). None of the studies assessed Africentric worldview. Findings suggest protective mechanisms (racial identity and racial socialization) are linked with obesity; however, the nature and pathways of the association are unknown. These preliminary findings can inform the development of culturally tailored obesity prevention intervention strategies designed for Black adolescent females.

Background: Pediatric and adolescent firearm injuries and fatalities in the United States have surged to levels not seen since the mid-1990s, marking a critical public health inflection point. Young Black males (ages 15‐24) experience firearm-related fatality rates 24 times higher than their White peers. Despite this disproportionate risk, they are less likely to participate in traditional firearm violence prevention programs. This disparity highlights the urgent need for innovative, culturally responsive approaches that address the emotional, behavioral, and social determinants of violence. Objective: This pilot study aims to evaluate the preliminary effects of BrotherlyACT, a culturally responsive, trauma-informed, multicomponent mobile and web-based intervention designed to support young Black males (ages 15‐24) in navigating and preventing community violence, substance use, and mental health challenges. The intervention aims to increase access to precrisis support and mental health resources for youth living in low-resource, high-violence settings. Methods: Seventy young Black males with Serious Fighting, Friend Weapon Carrying, Community Environment, and Firearm Threats (SaFETy) scores between 1 and 5 (indicating low-to-moderate firearm violence risk) were enrolled in this prospective pretest-posttest study. Participants completed a psychoeducational component of the BrotherlyACT intervention, consisting of 7 video-based modules. Surveys were administered at baseline and again 4 weeks later to assess changes in attitudes toward guns and violence (Attitudes Toward Guns and Violence Questionnaire), reactive and proactive aggression (Reactive-Proactive Aggression Questionnaire), psychological distress (Kessler Psychological Distress Scale), and depressive symptoms (8-item Patient Health Questionnaire). Paired t tests were conducted to analyze pre-post differences. Results: A total of 70 young Black males (mean age 20.97 years, SD 2.44 years) participated in the study. Nearly half reported recent physical fights (48/70, 69%), gun threats (39/70, 56%), or hearing gunshots in their neighborhood (63/70, 90%). More than 50% (39/70, 56%) reported illicit drug use, and 32 out of 70 (46%) reported substance-related violence. SaFETy scores revealed heterogeneous but elevated exposure to firearm risk factors, particularly in community violence and firearm threats. Postintervention, participants demonstrated a statistically significant reduction in attitudes toward guns and violence (Attitudes Toward Guns and Violence Questionnaire; mean 29.8-26.1, P<.001, d=0.53), with the largest shift observed in “Aggressive Response to Shame” (28% reduction). Reactive aggression significantly declined (mean 10.48-8.67, P=.008, d=0.37), whereas proactive aggression remained stable. Psychological distress and depressive symptoms remained stable. Nearly all participants (68/70, 97%) completed all modules in a single session, with 47 out of 70 (67%) finishing within an hour, suggesting high feasibility and user engagement. Conclusions: Preliminary findings indicate that BrotherlyACT may reduce proviolence attitudes and reactive aggression among young Black males. These results underscore the feasibility and potential impact of culturally responsive digital interventions as a strategy to prevent firearm violence among underserved youth populations.

Black Americans have higher rates of antihypertensive medication nonadherence, leading to increased morbidity and mortality. The impact of system-level experiences on medication adherence (MA) has so far been understudied. We sought to understand patients' perceptions of system-level experiences influencing antihypertensive MA. Using a qualitative descriptive design, we conducted semi-structured interviews via Zoom. Transcripts were reviewed and coded, with spot checking of themes and coding by a second team member. A community advisory group performed member checking as a credibility audit. Fifteen participants were enrolled. We identified four main themes: social and economic barriers, social and economic facilitators, health system-level barriers, and health system-level facilitators. Subthemes highlighted logistical challenges and the complexities of system-level impacts on antihypertensive MA. Social and economic and health system-level facilitators should be considered when designing future interventions to promote antihypertensive MA and when augmenting existing policy and healthcare delivery structures.

Background: Teens with socially complex needs—those who face multiple and potentially overlapping adversities—are disproportionately affected by several barriers to mental health screening and treatment. Pediatric primary care (PPC) is a typically low-stigmatized setting for teens that is visited at least annually. As such, implementing digital mental health tools (DMH), as low-intensity treatments in PPCs may increase the reach of such tools for teens with socially complex needs. Objective: This study aimed to evaluate the Teen Assess, Check, and Heal (TeACH) System in comparison to a control condition while integrated into PPCs at 2 Medical Centers serving teen patients in Chicago, Illinois. Through collaboration with key players throughout the design and implementation planning phases, the TeACH System is hypothesized to increase teen patient self-reported engagement with DMH and address specific individual-level barriers to mental health care, compared with a digital psychoeducation control condition. Methods: Eligible participants will be recruited through PPC clinics housed within the University of Illinois Chicago (UIC) and Rush University Medical Center (RUSH). Recruitment involves invitations from research staff members and primary care clinicians and staff members, as well as posting flyers with QR codes at the specified clinics. All participants complete a brief demographic survey, baseline survey, and Kiddie-Computerized Adaptive Tests Anxiety Module. Participants are randomized to receive either the control condition (digital evidence-based workbook) or the intervention (TeACH System Feedback and Resources). All randomized participants will then be invited to complete an immediate and 1-week follow-up survey. The primary outcomes assess changes in engagement with DMH (ie, likelihood to use DMH for anxiety and actual DMH use) and individual-level barriers to mental health care (ie, symptom understanding and confidence to act). Descriptive analyses will be conducted to characterize the sample and usability ratings of the TeACH System. Linear or generalized linear mixed effects regression models will examine differences in primary outcomes over time. Results: Recruitment began in July 2024 and data collection is expected to be completed by August 2025. To date, 122 teens have assented to complete study activities, 80 have been randomized (an additional 24 teens have had subthreshold anxiety symptoms and were therefore not randomized), and 42 teens have completed the 1-week follow-up assessment. Conclusions: This study will provide preliminary feasibility data that may inform how the TeACH System and other DMH low-intensity treatments might better engage and support teens with socially complex needs. Trial Registration: ClinicalTrials.gov NCT05466929; https://clinicaltrials.gov/study/NCT05466929 International Registered Report Identifier (IRRID): DERR1-10.2196/65245

BACKGROUND Pediatric and adolescent firearm injuries and fatalities have reached levels not seen since the mid-1990s, indicating a critical juncture in US public health. Young Black males, ages 15-24, represent the worst affected demographic, exhibiting a 24-fold higher probability of firearm-related fatalities compared to their White peers. This crisis is compounded by low engagement in firearm violence intervention programs among young Black males, emphasizing the urgent need for timely, culturally appropriate, and innovative interventions addressing the socioemotional, relational, and behavioral factors driving violence in this demographic. OBJECTIVE This pilot study aims to evaluate the efficacy of a novel app-based intervention (BrotherlyACT)—a nurse-led, culturally tailored, multicomponent smartphone application—to reduce the risk and effects of firearm injuries and homicides and to improve access to pre-crisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. METHODS Seventy young Black males with a SaFETy score between 1 and 5 (indicating low to moderate firearm violence risk) were enrolled in this prospective pretest/posttest study. The study assessed a psychoeducational intervention (seven video-based modules) via the BrotherlyACT app. Following consent, participants completed a 63-item survey battery pre- and post-intervention, evaluating Attitudes Towards Guns and Violence (AGVQTM), aggression (Reactive-Proactive Aggression Questionnaire), Psychological Distress (Kessler Psychological Distress Scale [K10]), and depression (Patient Health Questionnaire [PHQ-8]). Surveys were re-administered 4 weeks after the pretest. Outcome measures were reported as total and subscale scores. Paired-sample t-tests analyzed pre-post outcome changes. RESULTS 70 YBM enrolled (Mage = 21.21 ± 3.16 years, 10% Hispanic); 26.3% had some high school education. Nearly half (48.6%) worked part-time, with 66.4% reporting an annual household income of US $40,000-$59,999. Almost all participants (96.9%) finished the video modules in one session, and 67.7% did so within an hour. Statistically significant reductions in attitudes towards guns and violence were observed from pretest (M = 29.8) to posttest (M = 26.1), with a mean difference of 3.69 (p < .0001, Cohen’s d = 0.53). The ‘Aggressive Response to Shame’ subscale showed the highest reduction (↓28%), followed by ‘Excitement Towards Guns and Violence’ (↓14.8%). Reactive aggression scores significantly decreased from 10.48 to 8.67 (p = 0.003), while proactive aggression scores showed no significant reduction (p = 0.305). No significant changes were observed in depression, anxiety, or overall psychological distress. CONCLUSIONS BrotherlyACT demonstrated efficacy in reducing negative attitudes towards firearms and violence, and reactive aggression among young Black males. These findings indicate that this digital intervention has the potential to address both attitudinal and behavioral factors in a medium to high-risk population, presenting a unique opportunity for the primary prevention of firearm violence and associated risk factors for youth violence. CLINICALTRIAL Title Registration: ClinicalTrials.gov NCT06359990. IRRID: RR2-10.2196/43842 INTERNATIONAL REGISTERED REPORT RR2-10.2196/43842

Race-based health disparities for racially and ethnically diverse people with orthopedic-related conditions are well documented and their experiences when seeking care deserve more attention. The purpose of this study was to understand the lived experiences of racial microaggressions occurring when racially and ethnically diverse people seek health care services for orthopedic-related conditions. We used transcendental phenomenology to understand their lived experiences of racial microaggressions while receiving orthopedic-related health care services. All participants self-identified as Black, none as Hispanic. Nineteen final codes were organized into five patterns and then into five themes—two background and three figural themes. Background themes: discrimination can occur across a lifetime, and poor treatment of poor people fuels health inequity. Figural themes: racial discrimination can come at any time and in various forms; resistance is necessary in the face of racial discrimination; and despite discriminatory encounters, health care goals are achievable. Participants shared their lived experiences of racial microaggressions while seeking care for their orthopedic-related conditions (figural) through a lens shaped by their other past experiences with varied discrimination (background). Black individuals have a longstanding relationship with racial discrimination that has a negative impact on many aspects of their lives, including their health. The results highlight ways to promote equity by capitalizing on Black individuls’ goals to actively pursue health.

BACKGROUND Teens with socially complex needs—those who face multiple and potentially overlapping adversities—are disproportionately affected by several barriers to mental health screening and treatment. Pediatric primary care (PPC) is a typically low-stigmatized setting for teens that is visited at least annually. As such, implementing digital mental health tools (DMH), as low-intensity treatments in PPCs may increase the reach of such tools for teens with socially complex needs. OBJECTIVE This study aimed to evaluate the Teen Assess, Check, and Heal (TeACH) System in comparison to a control condition while integrated into PPCs at 2 Medical Centers serving teen patients in Chicago, Illinois. Through collaboration with key players throughout the design and implementation planning phases, the TeACH System is hypothesized to increase teen patient self-reported engagement with DMH and address specific individual-level barriers to mental health care, compared with a digital psychoeducation control condition. METHODS Eligible participants will be recruited through PPC clinics housed within the University of Illinois Chicago (UIC) and Rush University Medical Center (RUSH). Recruitment involves invitations from research staff members and primary care clinicians and staff members, as well as posting flyers with QR codes at the specified clinics. All participants complete a brief demographic survey, baseline survey, and Kiddie-Computerized Adaptive Tests Anxiety Module. Participants are randomized to receive either the control condition (digital evidence-based workbook) or the intervention (TeACH System Feedback and Resources). All randomized participants will then be invited to complete an immediate and 1-week follow-up survey. The primary outcomes assess changes in engagement with DMH (ie, likelihood to use DMH for anxiety and actual DMH use) and individual-level barriers to mental health care (ie, symptom understanding and confidence to act). Descriptive analyses will be conducted to characterize the sample and usability ratings of the TeACH System. Linear or generalized linear mixed effects regression models will examine differences in primary outcomes over time. RESULTS Recruitment began in July 2024 and data collection is expected to be completed by August 2025. To date, 122 teens have assented to complete study activities, 80 have been randomized (an additional 24 teens have had subthreshold anxiety symptoms and were therefore not randomized), and 42 teens have completed the 1-week follow-up assessment. CONCLUSIONS This study will provide preliminary feasibility data that may inform how the TeACH System and other DMH low-intensity treatments might better engage and support teens with socially complex needs. CLINICALTRIAL ClinicalTrials.gov NCT05466929; https://clinicaltrials.gov/study/NCT05466929 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/65245