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Objective:Scant research addresses how technology use impacts job satisfaction for medical case managers. The E-VOLUTION program is a novel client-to-medical case manager direct text messaging intervention to improve health outcomes for youths with HIV. This study examines how E-VOLUTION affected medical case managers’ job satisfaction and the care they provided to clients. Method:We recruited medical case managers and their clients (ages 18–29) from three clinics in St. Louis, MO, for in-depth, semistructured interviews. We interviewed eight medical case managers and 19 clients and used directed content analysis to analyze interview transcripts and the 17,286 text messages sent between clients and their case managers. Results:Direct texting improved medical case managers’ job satisfaction and feelings of efficiency by streamlining rote responsibilities and allowing them to provide better client care. Medical case managers reported that direct texting enabled clients to achieve better health and well-being. Conclusion:Use of text messaging programs in medical case management may reduce worker turnover and improve quality of care, and ultimately health outcomes, for young people with HIV.

Objective:A syndemic of violence exposure, substance misuse, and mental health problems (i.e., depression, anxiety, posttraumatic stress disorder) is associated with increased unprotected anal sex and number of sexual partners in young men who have sex with men (YMSM). However, few studies have examined multiple forms of violence—including childhood abuse, intimate partner violence, and community violence—and identified which factors are significant predictors of HIV risk for YMSM when controlling for all other factors. Accordingly, this study examined the additive and independent influence of different forms of violence, substance misuse, and mental health problems associated with sexual risk behaviors in YMSM who used HIV prevention services. Method:A convenience sample of 168 (97 Black or multiethnic Black, 71 white) YMSM ages 18–34 completed computer-assisted personal interviews assessing syndemic factors and HIV risk behaviors. We conducted Spearman correlations and negative binomial regressions to describe syndemic relationships and identify the significant independent predictors of HIV risk. Results:A syndemic of violence exposure, substance use, and mental health problems was observed in the sample. Also, participants with depression, drug abuse in the clinical range, and polydrug use reported significantly higher frequencies of sexual risk behaviors. Violence exposure did not uniquely predict sexual risk. Conclusions:Depression, drug abuse, and polydrug use should be targets for HIV prevention among YMSM using HIV prevention services.

Background: Substance use in adolescence is associated with multiple negative outcomes. Lesbian, gay, or bisexual or transgender or nonbinary (TNB) youth, and those who question their sexual orientation or gender, are more likely to engage in substance use than straight or cisgender youth. However, the extant literature largely considers sexual orientation and gender identity independently. Accordingly, this study examines the associations between the intersectional identities of sexual orientation and gender and substance use to identify those with the greatest need for prevention interventions.Methods: Data were from 36 504 high school students aged 14 to 18 years (mean = 15.7, SD = 1.18) enrolled in the 2019 Healthy Kids Colorado Survey using a statewide stratified random sampling design. Logistic regression models examined the associations between intersectional sexual orientation and gender on marijuana use, prescription drug misuse, and polysubstance use, as well as depression and violence victimization (eg, forced sex, partner violence).Results: Adjusted odds of substance use for sexual and gender minority youth varied by intersectional identity and substance. The largest effect sizes were seen for prescription drug misuse, especially among those questioning their gender and sexual orientation and heterosexuals either questioning their gender or who identified as TNB. Effect sizes for marijuana use and polysubstance use were highest for TNB and heterosexual participants. Depression and violence victimization were significantly associated with each substance use outcome.Conclusions: Interventions to reduce substance use in these populations may benefit from targeted interventions for youth with different intersectional identities, and a focus on violence prevention and depression screening and treatment.