M. Margaret Dolcini

Research suggests that the impact of childhood sexual trauma (CST) on adult well-being varies in relation to characteristics of CST experiences (e.g., age of onset and duration/frequency) that influence the degree of trauma severity. Yet there remains a need for a CST severity measure that consistently delineates survivors with an elevated risk of adverse adult outcomes (AAOs) and accounts for correlations between severity characteristics. We compared two theory-based, categorical proxy measures of CST severity (duration and developmental timing) in their relationship with three AAOs, among a national probability sample of U.S. adult CST survivors (N = 568). We found a strong relationship between CST duration and developmental timing (p < 0.001), and redundancy in their impact on AAOs (i.e., no meaningful difference in how well they predicted AAOs). Participants with more chronic CST (≥4 years duration or occurring across childhood and adolescence) were twice as likely to report AAOs as other participants. Findings support the importance of assessing trauma chronicity in research and practice, to focus prevention and intervention strategies on CST survivors with the greatest long-term health risk. A categorical CST duration measure offers a theory-based assessment strategy that accounts for both the temporal and developmental effects of trauma severity on health outcomes.

Background: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.

BACKGROUND Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. OBJECTIVE The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. METHODS Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). RESULTS Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. CONCLUSIONS Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.

High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.

Background: Research on the sexual behaviors of African American youth has primarily focused on associated risks, with a dearth of studies examining a fuller representation of African American adolescents’ sexual lives. This study explored the range of messages African American adolescents receive from family members regarding sexual behavior and sexual relationships. Methods: Participants were 52 sexually experienced African American youth (male = 32, female = 20) between the ages of 15 and 17 recruited from community-based organizations in the United States. Youth participated in individual in-depth qualitative interviews, and data were analyzed using a phenomenological framework. Results: Participants received a variety of messages about sexual behavior and sexual relationships from a range of family members including parents, siblings, grandmothers, aunts/uncles, and cousins. Types of messages clustered into three domains: sexual decision-making, quantity and quality of sexual activity, and sexual health promotion; with themes and sub-themes emerging within each area. Conclusion: Gender differences in the types of messages received are explored, and applications of the findings to the development of family-involved community interventions that promote sexual and reproductive health are discussed.

Sustaining evidence-based interventions (EBIs) is an ongoing challenge for dissemination and implementation science in public health and social services. Characterizing the relationship among human resource capacity within an agency and subsequent population outcomes is an important step to improving our understanding of how EBIs are sustained. Although human resource capacity and population outcomes are theoretically related, examining them over time within real-world experiments is difficult. Simulation approaches, especially agent-based models, offer advantages that complement existing methods. We used an agent-based model to examine the relationships among human resources, EBI delivery, and population outcomes by simulating provision of an EBI through a hypothetical agency and its staff. We used data from existing studies examining a widely implemented HIV prevention intervention to inform simulation design, calibration, and validity. Once we developed a baseline model, we used the model as a simulated laboratory by systematically varying three human resource variables: the number of staff positions, the staff turnover rate, and timing in training. We tracked the subsequent influence on EBI delivery and the level of population risk over time to describe the overall and dynamic relationships among these variables. Higher overall levels of human resource capacity at an agency (more positions) led to more extensive EBI delivery over time and lowered population risk earlier in time. In simulations representing the typical human resource investments, substantial influences on population risk were visible after approximately 2 years and peaked around 4 years. Human resources, especially staff positions, have an important impact on EBI sustainability and ultimately population health. A minimum level of human resources based on the context (e.g., size of the initial population and characteristics of the EBI) is likely needed for an EBI to have a meaningful impact on population outcomes. Furthermore, this model demonstrates how ABMs may be leveraged to inform research design and assess the impact of EBI sustainability in practice.

Dissemination of HIV behavioral prevention programs has increased the reach of evidence-based interventions, but there is a paucity of data on implementation and diffusion. The present mixed methods study focused on RESPECT, a brief counseling and testing intervention, examining compliance fidelity and the extent to which Centers for Disease Control and Prevention (CDC) policies and training have diffused to practice settings. Using client exit surveys (N = 830) and counselor interviews (N = 64), we examined implementation in 26 community-based agencies (CBOs) and public health departments (DPHs) in the USA. Multivariate analyses showed that at-risk clients, ethnic minority clients, and those who were primarily seeking services other than HIV/STI testing, were more likely to receive the program with fidelity. Counselor data suggested that multiple factors (e.g., client characteristics, agency structure) impact program adaptations. RESPECT is being delivered with good fidelity and reaching at-risk clients. The data provide support for CDC diffusion efforts. Future studies should continue to examine compliance fidelity and program sustainability.

The authors describe psychosocial outcomes of a group randomized controlled trial of a friendship-based HIV/sexually transmitted infection (STI) prevention intervention grounded in the AIDS Risk Reduction Model (ARRM). A total of 264 African American adolescent girls were randomized to a single-session Project ÒRÉ HIV/STI prevention intervention or a nutrition/exercise health promotion intervention with their friendship group. At posttest, Project ÒRÉ participants scored higher on knowledge of HIV/STI prevention and protection (p < .01), knowledge of living with HIV/STI (p < .01), perceived HIV risk (p < .05), perceived STI risk (p < .01), and intentions to use condoms for vaginal sex (p < .05). Findings suggest that a brief friendship-based HIV/STI prevention intervention for youth can impact ARRM factors that increase the ability to recognize and label risky sexual behaviors as problematic and promote commitment to changing high-risk behaviors.