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Comprehensive sexual health education is critical for the prevention of STIs and unintended pregnancy among young people. Yet, increasing barriers to comprehensive sexual health education in classroom settings underscore the importance of youth-friendly technologies to address sexual health among young people. "It's OK to Ask Someone" (IOTAS) uses a customised technology to expand Planned Parenthood of Western Pennsylvania's sexual health programming with a confidential sexual health textline designed to answer sexual health questions in a timely, user-friendly manner. This paper describes results from a process evaluation focused on assessing who uses IOTAS, how they use IOTAS and in what ways IOTAS is perceived to be helpful to texters. Results illustrate that a textline-approach is an acceptable and appropriate way to engage with young people. Findings demonstrate that young people are using the confidential textline to seek information about sexual health and report it as a helpful resource. Findings are relevant for sexual health educators and practitioners working with young people, including those interested in using a technology approach to expand health education opportunities. Additional research should continue to explore the potential of youth-friendly, technology-based approaches to support sexual health information seeking.

Introduction. Research suggests that awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) among adolescents is associated with increased harm perception of e-cigarettes. The depiction of EVALI on three primetime medical dramas offers an opportunity to examine the use of these storylines for tobacco prevention education. Methods. We conducted four focus groups with seventh- and eighth-grade students at an urban middle school. Participants viewed three clips of scenes followed by a facilitated discussion as to the influence of the clips on knowledge and perceptions of e-cigarettes and the use of clips for tobacco prevention education. Two research assistants double-coded notes from the focus groups using a qualitative content analysis approach. Results. Our final sample included 78 adolescents; we obtained self-reported demographic information for 75. The majority of participants were 13 to 14 years of age (82.7%) and identified as cisgender female (52.0%) and Black (52.0%). No participants had knowledge of EVALI prior to viewing the clips. Comments made both during and after watching suggest the clips may have reinforced knowledge and perceptions of harm; participants stated that the clips could be a useful intervention tool. Viewing the clips also generated unprompted discussion about flavored products, tobacco advertising, other television programs, and marijuana. Conclusions. Clips featuring the depiction of EVALI on medical dramas may be an effective tool for raising awareness of e-cigarette use-related harms. These results offer a promising first step for future collaborative research between public health, adolescents, and schools to develop tobacco prevention education utilizing these clips. [ABSTRACT FROM AUTHOR]

Youth mental health has been significantly impacted by COVID-19, with concerns of rising anxiety-related and depressive symptoms and reduced quality of life. This study provides a nuanced understanding of mental health stressors and supports in the lives of youth during the pandemic. Using Collaborative Filmmaking, an embodied, visual, and participatory research method, participants in Pittsburgh, Pennsylvania, were trained to create, analyze, and screen films about mental health. The films elucidated numerous stressors impacting youth mental health, including educational stressors (e.g., academic pressure and relationships with teachers), personal and social stressors (e.g., social and cultural expectations), and current events (e.g., the election and the political system). Supports included individual level supports (e.g., hobbies, self-care, spending time outdoors), and interpersonal level supports (e.g., family and socializing). Several themes were discussed as both stressors and supports, such as family, COVID-19, and social media. Overall, educational stressors are major contributors to adverse mental health symptoms among youth, which have been magnified by the COVID-19 pandemic. Youth discussions of the importance of self-care and engaging in healthy hobbies demonstrated strong awareness about maintaining mental health, though structural-level recommendations are still needed to improve youth mental health. Screening the Collaborative Films with the public illuminated several additional opportunities for action, including structural and social actions (e.g., changing policies and social norms around mental health). Given the structural nature of the stressors mentioned by participants, systemic changes as well as policy level action and programming are needed to address the intersectional nature of current mental health concerns among youth. [ABSTRACT FROM AUTHOR]

In this study, we examined how mental health inequities by gender and sexual identity changed from before the COVID-19 pandemic to during the early phase of the pandemic. Sexual and gender minority (SGM) adults and non-SGM adults were recruited through social media to complete online questionnaires. Results indicate a worsening change in depression from before the pandemic to during the early phase of the pandemic that was significantly greater for gender minorities compared to cisgender (cis) women. Anxiety and loneliness scores did not change differentially for gender minorities (vs cis women) or sexual minorities (vs heterosexuals). Overall, COVID-19 had a greater negative impact on depression for gender minorities compared with cis women. [ABSTRACT FROM AUTHOR]

HIV remains a significant health issue for women, and multiple overlapping factors shape women's HIV-related risk. Pre-exposure prophylaxis (PrEP) offers critical advantages over other existing options, yet it remains significantly underused among women in the USA where limited work has explored women's opinions on barriers to potential PrEP use. Using open-ended text responses from a sample of women seeking care at a US urban family planning health centre, this study aimed to understand perceptions of factors affecting potential PrEP use. Three themes concerning key factors impacting potential PrEP use emerged: HIV risk assessment, relationship dynamics, and anticipated stigma. Women's assessment of HIV risk suggests that identifying women in clinical settings as having low self-perceived risk may overlook the complexity of how women determine HIV-related risk and prevention needs. Women frequently referenced relationship dynamics when considering PrEP and discussed anticipated partner reactions about use contributing to non-use. Fear or worry of stigma were expressed as motivations to not use PrEP. Study results highlight the importance of public health and health care professionals normalising PrEP as a strategy in women's HIV prevention and sexual health decision-making. Woman-centred PrEP education, screening and communication strategies reflective of their unique HIV-related risk context are needed. [ABSTRACT FROM AUTHOR]

The early phases of the coronavirus 19 disease (COVID-19) pandemic were associated with changes in psychological well-being and alcohol use. However, it is unclear whether these changes are artifacts of psychological well-being and alcohol use prior to the pandemic across different sociodemographic groups. We received surveys from 247 adult residents of Allegheny County, Pennsylvania (United States), with an oversampling of sexual- and gender-minority individuals. Responses included measures of psychological well-being, substance use, and sociodemographic characteristics. Unadjusted mean depression scores, anxiety scores, and number of drinking days increased for all age and income groups during COVID-19, while average number of drinks per drinking day and days intoxicated differentially increased or decreased by age and income groups. Using Bayesian seemingly unrelated regression, we assessed depression and anxiety symptoms and alcohol use during the early stages of the pandemic and one month before COVID-19 was first identified in Allegheny County concurrently. Those in the youngest (18–24) group drank on more days during (but not before) the pandemic than those in the 25–44 age group. Compared to cisgender women, gender-minority adults had higher depression scores during the early stages of the pandemic. Employed adults had lower anxiety scores during (but not before) the pandemic than adults who were unemployed. Those with past-year annual incomes above $80,000 had fewer drinks on average drinking occasions than those in the $40,000 or below group before (but not during) the pandemic. Patterns of psychological distress and alcohol use associated with the COVID-19 pandemic differ by subgroup compared to patterns prior to the pandemic. Interventions addressing worsening mental health outcomes and shifting alcohol use patterns must be sensitive to the needs of vulnerable groups, such as younger adults and those experiencing poverty or unemployment. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic, a public health crisis, significantly impacted millions of people around the world. "Creating Community During COVID-19" is a community-engaged virtual art gallery that explores resilience, social cohesion, and creativity during the onset of the pandemic in the United States. It aimed to address social isolation and encourage inclusion at a large public university in the early days of the pandemic. The community was invited to submit artworks that reflected how they are staying connected during the pandemic. The artworks were then qualitatively analyzed and highlighted three key themes: (1) reflecting (turning inward), (2) advocating (turning outward), and (3) engaging (coming together). This arts-based project demonstrates promise as a creative approach for promoting social cohesion and positive health and well-being, especially in times of uncertainty. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) and child maltreatment outcomes are markedly associated with substance abuse disorders. However, few studies have explored these serious family violence outcomes in connection to the opioid epidemic or population-level geographic connections between these variables. This study assesses associations of ZIP code-level IPV and child maltreatment hospitalization outcomes with opioid- and alcohol-related diagnoses as well as economic and demographic neighborhood characteristics. We used 11 years (2004–2014) of ZIP code-level Pennsylvania hospital discharge data and U.S. Census neighborhood characteristics data. As nearby ZIP codes are more likely to be similar than those that are distant, we incorporated spatial autocorrelation using conditionally autoregressive Bayesian hierarchical space–time models. There was a positive relationship between ZIP code-level opioid-related diagnoses and both IPV (relative risk 1.061; 95% credible interval [1.015, 1.106]) and child maltreatment (relative risk 1.055; 95% credible interval [1.035, 1.070]) hospitalizations. There was a positive relationship between alcohol-related diagnoses and IPV but not child maltreatment. Higher median household incomes were associated with lower counts of both IPV and child maltreatment hospitalizations. To illustrate geographic heterogeneity of model estimates, posterior distributions were used to compare variability of effects across ZIP codes. Our findings emphasize the secondary implications of the opioid epidemic in the form of family violence within communities. [ABSTRACT FROM AUTHOR]

Comprehensive sexual health education is critical for the prevention of STIs and unintended pregnancy among young people. Yet, increasing barriers to comprehensive sexual health education in classroom settings underscore the importance of youth-friendly technologies to address sexual health among young people. It's OK to Ask Someone (IOTAS) uses a customised technology to expand Planned Parenthood of Western Pennsylvania's sexual health programming with a confidential sexual health textline designed to answer sexual health questions in a timely, user-friendly manner. This paper describes results from a process evaluation focused on assessing who uses IOTAS, how they use IOTAS and in what ways IOTAS is perceived to be helpful to texters. Results illustrate that a textline-approach is an acceptable and appropriate way to engage with young people. Findings demonstrate that young people are using the confidential textline to seek information about sexual health and report it as a helpful resource. Findings are relevant for sexual health educators and practitioners working with young people, including those interested in using a technology approach to expand health education opportunities. Additional research should continue to explore the potential of youth-friendly, technology-based approaches to support sexual health information seeking. [ABSTRACT FROM AUTHOR]

This article examines the prevalence of recent and lifetime intimate partner violence (IPV) and association with pre-exposure prophylaxis (PrEP) acceptability among women seeking care at an urban family planning clinic (N = 145). We found high prevalence of recent (40%) and lifetime IPV (71%). Almost a third of participants reported being worried about HIV risk, 70% were willing to take PrEP, and 71% of women who disclosed recent IPV were willing to take PrEP. Findings provide direction for research, practice, and policy attention needed around the context of IPV to focus development of a woman-centered PrEP intervention. [ABSTRACT FROM AUTHOR]

AbstractIn Nepal, menstrual practices, and particularly chhaupadi, impose restrictive norms affecting women’s daily lives. Chhaupadi is a tradition that involves isolating women and girls during menstruation and after childbirth, along with following other restrictions, which have physical and mental health implications. To date, interventions have yet to fully and sustainably address harms associated with chhaupadi across the country. This two-phase study conducted in Dailekh, Nepal facilitated the development of community-created solutions to mitigate chhaupadi’s adverse impacts on women’s health. Using Human Centred Design and a community-engaged approach, the discovery phase identified key stakeholders and contextualised chhaupadi, while the subsequent design phase facilitated the development of five community-created interventions. These included leveraging female community health volunteers (FCHVs) for counselling and awareness, targeting mothers to drive behavioural change, engaging the wider community in behaviour change efforts, empowering fathers to catalyse change at home, and training youth for advocacy. The FCHV intervention concept was selected as the most promising intervention by the women co-design team, warranting broader exploration and testing. Additionally, while it is imperative for interventions to prioritise tackling deleterious aspects of chhaupadi, interventions must also acknowledge its deep-rooted cultural significance and history and recognise the positive aspects that some women may wish to preserve. [ABSTRACT FROM AUTHOR]

Objective: Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women's health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. Data Source: We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women's health in Appalachia. Study Inclusion and Exclusion Criteria: Included articles were: (1) on women's health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. Data Extraction: Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. Data Synthesis: Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. Results: A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. Conclusions: Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development., Purpose: The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi ., Research Design and Study Sample: A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights., Data Collection: In the study's initial "discovery" phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second "design" phase, the Community Design Team crafted interventions to address harms associated with chhaupadi ., Results: Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants' literacy levels and engagement preferences, whether through group or individual activities., Conclusions: Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.