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The author reflects developments on the prevalence of cases of drug- and alcohol-use disorders in the U.S. as of mid-2016. Also cited are the study by L. J. Welty and colleagues on the cases of substance-use disorders (SUD) among justice-involved young individuals in the country, the need to develop strategies to reduce recidivism due to its adverse effects to the community, and the Project Services to Assist Youth (STAY) program to resolve the issue.

We describe and compare the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY. As part of the Boricua Youth Study – Health Assessment, (mean age 23 ± 0.1 years) objective anthropometric, blood pressure and blood samples were collected. Information on diet, physical activity and sleep were collected via surveys. Life's Essential 8 metrics were characterized as continuous with higher scores indicating more optimal CVH and categorically (80–100 scores for ideal CVH). Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion. The prevalence of cardiometabolic risk factors was high for obesity (35% in NY, 19% in PR) and diabetes (17% NY, 20% PR). In this ethnically homogenous population, we found low levels of ideal CVH that varied across study site, suggesting differences by sociocultural context. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease. [ABSTRACT FROM AUTHOR]

This observational study was conducted to evaluate patient preferences for standard, express, or telehealth visits in sexual health care. Active PrEP users preferred telehealth and express visits. Cisgender women preferred standard visits. This study, completed at an sexually transmitted infection (STI) clinic in 2019 to 2020, evaluated patient preferences for telemedicine, express, and standard visits. Active PrEP users preferred telemedicine and express visits, patients with prior STIs preferred express visits, and cisgender women preferred standard visits. Configuring STI clinic visit types requires shared decision making and individualization. [ABSTRACT FROM AUTHOR]

Background and Objectives: Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center.Methods: Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906). Chief complaints relevant to STIs were defined as genitourinary or sexual complaints. Odds ratios and χ analyses were used to assess association between STI testing, chief complaint, and sexual history.Results: Of the 10,983 visits, 10% (n = 1118) had a complaint relevant to STIs, and 5% (n = 505) had STI testing ordered. Of these tests, 4% were positive for syphilis (n = 11), 13% for chlamydia (n = 29), 6% for gonorrhea (n = 13), and 0.5% for human immunodeficiency virus (n = 1). Sexually transmitted infection testing was more likely to be ordered for STI-relevant chief complaints than unrelated complaints (odds ratio, 16.2, P < 0.01). Sexual history was documented for 8% of visits (n = 72) and was associated with STI testing (P <0.01).Discussion: Sexually transmitted infections are diagnosed in men seen at urgent care centers more often when clients present with relevant symptoms. However, given the low rates of sexual history taking and the asymptomatic nature of most STIs, concern is raised about missing opportunities to identify, treat, and lower community burden of disease. Urgent care visits may represent opportunities for increased testing and treatment of STIs. [ABSTRACT FROM AUTHOR]

Introduction: Opioid prevention and treatment programs tailored to young adults involved in the criminal legal system are rare. We examined profiles of polysubstance use among younger and older adults involved in the criminal legal system who use opioids, and explored their experiences and motivations related to substance use. Information gleaned can inform the adaptation of existing programs and the development of novel approaches for young adults in the criminal legal system.Methods: Using a sequential mixed methods design we 1) quantitatively identified typologies of polysubstance users among adults aged 18-24 (n = 92) and those age 25 and over (n = 27) involved in the criminal legal system who use opioids, using latent class analysis and 2) qualitatively explored differences in personal motivations, cultural influences, and psychosocial contexts of substance use by class.Results: Our quantitative results supported a three-class typology: the majority of participants were in Class I (73 %, n = 87) and reported using primarily alcohol and marijuana. Participants in Classes II (15 %, n = 18) and III (12 %, n = 14) endorsed distinct and complicated polysubstance use profiles. Further, participants in Classes I and III were significantly younger than those in Class II. Qualitative analysis allowed us to understand associations between patterns of use, motivations, and contexts among young and older adults, comparing across classes.Conclusions: Our results highlight the importance of attending to the needs of subpopulations based on age and use patterns to adapt and develop targeted treatment and prevention programs for high-risk adults involved in the criminal legal system. [ABSTRACT FROM AUTHOR]

HIV pre-exposure prophylaxis (PrEP) effectively reduces new HIV diagnoses. High rates of incident bacterial sexually transmitted infections (STIs) have been observed in patients eligible for and adherent to PrEP. Observational studies generally report low long-term retention in PrEP care. Limited data exist on the rates of bacterial STI diagnosis upon re-engagement with PrEP services. We conducted a retrospective chart review within the HIV prevention program of an urban academic medical center in New York City. Eligible patients started PrEP from 2015 to 2019, then resumed PrEP services after a gap in care of at least 180 days. Demographic, clinical, and laboratory data were used to characterize the patient population and rates of bacterial STI diagnosis at re-engagement. In total, 286 patients were identified, with 316 qualifying re-engagement visits. Twenty-nine percent of patients had continued PrEP during the care gap, and 30% reported discontinuing medication due to a perceived change in risk. A new STI was diagnosed at 19% of re-engagement visits. There was no statistically significant difference in rates of new STI between individuals returning on or off PrEP, nor between those with perceived lower risk and those without. Individuals who fall out of PrEP services and subsequently re-engage remain at high risk of bacterial STI during the gap in care, regardless of whether PrEP medication is continued or the patient perceives themselves to be at lower HIV acquisition risk. Providers should strongly encourage patients discontinuing PrEP to remain engaged in sexual health services. Alternatives to clinic-based PrEP care must still include regular bacterial STI screening. [ABSTRACT FROM AUTHOR]

Background: HIV preexposure prophylaxis (PrEP) remains underutilized despite its efficacy and potential population impact. Achieving PrEP's full potential depends on providers who are knowledgeable and comfortable prescribing it to individuals at risk of acquiring HIV. Previous educational interventions targeting provider-related uptake barriers have had limited success. We designed and tested an electronic medical record (EMR) interpretative comment to improve the delivery of PrEP.Methods: An EMR comment provided information on PrEP eligibility and referral resources to providers delivering positive chlamydia and gonorrhea results. Positive test results for bacterial sexually transmitted infections before intervention (January 1, 2019-August 23, 2019) and after intervention (August 24, 2019-December 31, 2019) were identified. A retrospective chart review was conducted to ascertain provider documentation of PrEP discussions or provision, HIV prevention discussions, and HIV screening. Pretest-posttest analysis was performed to compare the provision of PrEP and HIV prevention services.Results: We reviewed 856 preintervention encounters spanning 8 months and 461 postencounters spanning 4 months. Patient demographics were comparable. We observed an increase in provider documentation of safe sex and condom counseling (odds ratios [ORs], 1.2 [95% confidence interval {CI}, 1.07-1.18] and 1.11 [95% CI, 1.05-1.17], respectively), and the absence of any HIV prevention discussion decreased (OR, 0.85; 95% CI, 0.80-0.90), but not HIV screening or PrEP documentation.Conclusions: We demonstrated that an EMR laboratory comment had a modest effect on increasing risk reduction counseling, although not HIV screening or PrEP prescriptions. Future strategies to encourage provider delivery of sexual health services may benefit from more targeted strategies that combine behavioral and information technology approaches. [ABSTRACT FROM AUTHOR]

Collective sex venues such as sex clubs are strategic sites to promote sexual health among sexual and gender minority individuals. We present qualitative findings from a multiple-method study on the acceptability of sexual-health services at collective sex venues in New York City (NYC) among attendees who identified as men, transgender, or gender non-conforming. In a survey used for sample selection (n = 342), most respondents (82.7%) agreed that "having outreach workers at sex venues is a good thing." Interviewees (n = 30) appreciated how on-site services could promote sexual health in their community. They felt peer workers should be familiar with collective sex venues and share demographic characteristics with attendees. Some participants felt workers should keep some boundaries from attendees, while others felt they could be fully integrated in the environment, suggesting that either peer outreach or popular-opinion leader types of interventions could be feasible. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) prevents HIV, but low rates of retention in care limit its effectiveness. We conducted a prospective survey-based study to investigate reasons for PrEP disengagement among men who have sex with men attending a sexual health clinic at a large urban academic medical center in New York City who were lost to follow up; surveys asked about current PrEP status, reasons for disengagement, attitudes toward PrEP, substance use, sexual practices, and behavioral/social determinants of health. Outreach attempts were made to 634 patients; majority of eligible participants were unable to be contacted (59%). Among those who agreed to participate (n = 175), 21% asked to re-establish care. Among those who completed the questionnaire (n = 86), 36% were taking PrEP. The most common reasons for PrEP discontinuation were cost/lack of insurance coverage (31%), decreased HIV risk perception (29%), and side effects (16%). Among those with decreased perception of risk, 62% were less sexually active, 38% were no longer engaging in anal sex, and 31% were using condoms for prevention. Participants reported that free medication (60%), having a sexual partner recommend PrEP (13%), and being able to receive PrEP from a primary care provider (13%) would encourage restarting PrEP. Findings were limited by low response rate (12% of eligible subjects completed the survey) and lack of Spanish-language questionnaires. Understanding reasons for loss-to-PrEP follow-up is essential for HIV prevention. Many people lost to follow up still desired PrEP, underscoring the importance of outreach, benefits navigators, and expansion of PrEP into primary care settings. [ABSTRACT FROM AUTHOR]

In response to the opioid crisis in New York State (NYS), the Unified Court System developed a new treatment court model-the opioid intervention court-designed around 10 Essential Elements of practice to address the flaws of existing drug courts in handling those with opioid addiction via broader inclusion criteria, rapid screening, and linkage to medications to treat opioid use disorder (MOUD). The new court model is now being rolled out statewide yet, given the innovation of the opioid court, the exact barriers to implementation in different counties with a range of resources are largely unknown. We describe a study protocol for the development and efficacy-test of a new implementation intervention (Opioid Court REACH; Research on Evidence-Based Approaches to Court Health) that will allow the opioid court, as framed by the 10 Essential Elements, to be scaled-up across 10 counties in NYS. Using a cluster-randomized stepped-wedge type-2 hybrid effectiveness-implementation design, we will test: (a) the implementation impact of Opioid Court REACH in improving implementation outcomes along the opioid cascade of care (screening, referral, treatment enrollment, MOUD initiation), and (b) the clinical and cost effectiveness of Opioid Court REACH in improving public health (treatment retention/court graduation) and public safety (recidivism) outcomes. Opioid Court REACH has the potential to improve management of individuals with opioid addiction in the court system via widespread scale-up of the opioid court model across the U.S., should this study find it to be effective. [ABSTRACT FROM AUTHOR]

Abstract: Graduate medical training is an opportune time to improve provider delivery of sexually transmitted infection (STI) screening. A survey of trainees found that the majority feel STI screening is their job but identified barriers to successful screening. Training that intentionally address service-specific barriers will be valuable in ending the STI epidemic. [ABSTRACT FROM AUTHOR]

Multiplex polymerase chain reaction testing for gastrointestinal pathogens was performed on a longitudinal cohort of 110 men who have sex with men taking human immunodeficiency virus preexposure prophylaxis. At least 1 pathogen was detected among 50 (45%) participants, with some participants testing positive for the same pathogen on multiple consecutive visits over a period of months. [ABSTRACT FROM AUTHOR]

New York City is the metropolitan area in the United States with the highest number of new HIV diagnoses nationwide. The End-The-Epidemic (EtE) initiative calls for identifying persons with HIV who remain undiagnosed, linking and retaining persons living with HIV to maximize viral suppression, and facilitate access to pre-exposure prophylaxis (PrEP) for patients at increased risk of HIV. HIV screening represents the first step to both the primary and secondary HIV prevention cascades. We conducted an online, anonymous, cross-sectional survey of residents at all stages of training within four residency programs at one institution in Northern Manhattan between August 2017 and August 2018. All internal medicine, emergency medicine, obstetrics and gynecology trainees, and pediatrics were invited to complete the survey via email. Of 298 eligible trainees, 142 (48%) completed the survey. Most trainees were aware of the HIV testing law and agreed that HIV testing was their responsibility, but few successfully screened most of their patients. Most trainees were not knowledgeable about non-occupational post-exposure prophylaxis (nPEP) or PrEP, but felt that it was important to provide these services across settings. Barriers to HIV, nPEP, and PrEP varied across specialties. Ending the HIV epidemic will require efforts across clinical specialties. In this survey from an EtE jurisdiction, most trainees felt that it is important to provide HIV prevention services in most settings; however, their knowledge and comfort with HIV prevention services other than testing were low. Barriers varied across specialties, and developing specialty-specific materials for trainees may be beneficial. [ABSTRACT FROM AUTHOR]

Background: Ending the HIV epidemic requires linkage of at-risk individuals from diverse health care settings to comprehensive HIV prevention services. Sexually transmitted infections (STIs) are significant biomarkers of HIV risk and should trigger preexposure prophylaxis (PrEP) discussion. We reviewed STI testing practices outside of sexual health clinics to identify opportunities for improvement in the provision of HIV prevention services.Methods: An electronic sexual health dashboard was used to identify patient encounters with a positive gonorrhea, chlamydia, and/or rapid plasma reagin test result between January 1, 2019, and August 23, 2019, at a large urban academic medical center. A retrospective chart review was performed to assess HIV testing, completeness of STI screening, and HIV prevention discussion; inadequate screening was defined as no HIV test in 12 months before STI diagnosis.Results: A total of 815 patients with 856 patient encounters were included. Patients were predominantly female (64.4%); median age was 24 years (range, 18-85 years). The most common test and most common positive test result was the genitourinary gonorrhea/chlamydia nucleic acid amplification test. Multisite testing was rare (7.5% of patient encounters) and performed more frequently in men than in women (20.3% vs. 0.36%). Women were also more likely to be inadequately screened for HIV (15.1% vs. 25.8%).Documentation of PrEP discussion was rare (4.7% of patient encounters) compared with safe sex (44.6%) and condoms (49.8%). Preexposure prophylaxis was discussed almost exclusively with men compared with women (17% vs. 1.1%).Conclusions: In patients diagnosed with bacterial STI outside of sexual health clinics, gaps in HIV prevention exist. HIV screening, multisite STI screening, and discussion of PrEP were particularly infrequent among women. [ABSTRACT FROM AUTHOR]

Infections with hepatitis C virus (HCV) are increasing among adolescents and adults born after 1965. Screening strategies may need to be adapted for this changing population. We surveyed trainees in different specialties about attitudes and practices related to HCV screening and identified specific barriers to screening across various healthcare settings. Constraints related to health system resources and the provider's role were among the most common barriers cited across specialties, but paediatrics residents also cited barriers specific to their population, which can likely be addressed with targeted education. [ABSTRACT FROM AUTHOR]

Rates of syphilis are increasing in the United States especially among men who have sex with men (MSM). The purpose of this project was to implement an educational intervention based on the 2015 CDC Sexually Transmitted Diseases (STD) Treatment Guidelines for urgent care providers with an emphasis on identifying MSM sexual behavior and appropriate screening for syphilis. An urgent care center was identified as a location where men seek care and where STD testing was occurring. After a baseline provider focus group to identify barriers to STD testing, a patient survey was created and given to clients to increase identification of MSM behaviors and to prompt providers to order syphilis testing. In addition, an educational intervention was implemented to improve provider and staff screening for syphilis. The intervention occurred between September 2015–December 2015. A total of 1341 males were seen with 1067 surveys collected. The mean age was 35.6 and 57.4% were Hispanic. Overall, 72 (5.4%) males identified as MSM. Approximately 50% of all MSM identified had RPRs (n = 37) sent and of these 13.5% (n = 5) tested positive for syphilis. The focus group among urgent care providers and staff identified barriers to syphilis testing. Targeted screening of males using a self-administered questionnaire is acceptable to urgent care populations and may assist in identifying MSM which in turn may help to facilitate syphilis screening and other relevant STI testing pertinent to this population. [ABSTRACT FROM AUTHOR]

Background: HIV pre-exposure prophylaxis (PrEP) reduces incident HIV infections, but efficacy depends on adherence and retention, among other factors. Substance use disorders, unmet mental health needs, and demographic factors are associated with nonadherence in HIV-infected patients; we studied whether these affect PrEP retention in care. Methods: To investigate potential risk factors disengagement in a comprehensive HIV prevention program, we conducted a retrospective cohort analysis of individuals starting tenofovir–emtricitabine between January 1, 2015, and November 30, 2017. The primary outcome was adherence to the initial 3-visit schedule after PrEP initiation. Results: The cohort was predominantly African American (23%) and Hispanic (46%). Race, ethnicity, substance use, patient health questionnaire 9 score, insurance, and housing status were not associated with retention at the third follow-up visit. Age <30, PrEP initiation in 2017, PrEP initiation in the sexual health clinic, and PrEP same-day start were associated with lower retention; male gender at birth, transition from post‐exposure prophylaxis (PEP) to PrEP, feeling that they could benefit from, or participating in mental health services were associated with increased retention. Overall, retention in HIV preventative care at the first follow-up visit (68%) and third follow-up visit (35%) after PrEP initiation was low. Conclusion: Clinic services and ancillary services (such as mental health) may facilitate retention in care. In this study, select social and behavioral determinants of health were not found to be linked to retention. Focused investigation of reasons for dropout may elucidate the challenges to maintaining individuals in PrEP care and direct resource allocation to those in greatest need. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic causes upheaval in New York City (NYC), 1 consequence is the accessibility of sexual health services. The NYC STD Prevention Training Center at Columbia University administered an online provider survey to understand how the COVID-19 pandemic is affecting the availability of sexual health care services regionally. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted infections are a significant, and growing, public health problem in this country - particularly among youth. Innovative strategies are needed to reduce the community burden of infection. Preliminary studies indicate that individuals involved in the criminal legal system have high rates of infection. While gaps exist in providing screening for incarcerated individuals, there are minimal efforts that have been initiated to screen individuals diverted from incarceration. In this study, we examined the STI risk profile and feasibility of screening for sexually transmitted infections for youth who were attending an alternative sentencing program after arrest for a minor offense. Youth were screened for chlamydia and gonorrhea using urine-based nucleic acid amplification tests., Results: Of the 307 participants engaged in a program providing supportive services for criminal legal system involved youth at the Brooklyn Court House in New York City, 186 agreed to screening for sexually transmitted infections, and 8% were positive for chlamydia, gonorrhea, or both., Conclusions: Screening programs within carceral settings have proven effective in identifying individuals with STIs. However, with policy changes diverting more young people away from incarceration and into community-based programs, innovative programs are needed to identify STIs among youth in these settings. Our findings indicate that it is feasible to conduct venue-based screening in these settings, and, doing so may identify youth in need of treatment and further evaluation., (© 2024. The Author(s).)

Objectives: Nationally, community colleges provide academic instruction to 5.6 million students annually. However, sexual health services, are often lacking. This pilot study was developed to assess the feasibility of implementing screening for sexually transmitted infections in community college settings in New York City where approximately 86,075 students attend classes. Methods: We recruited and trained an interdisciplinary group of graduate students (public health, nursing, and post-baccalaureate/pre-med) to provide sexual health risk assessments, screening for sexually transmitted infections, and linkages to care at three community college campuses in New York City. Results: Over a three-year period (2017-2019), 545 students were screened for STIs and 7.2% were positive for Chlamydia. Conclusions: Community college students are at high risk for sexually transmitted infections yet have limited access to sexual health services. Coordinated partnerships between state and local departments of health, public health schools, and an academic medical center demonstrate an important model which can fill identified gaps for this vulnerable population.

Sexual and gender minority individuals who attend collective sex venues (CSVs; establishments where people can have sex in groups or the presence of others) are at elevated risk for HIV and STIs. On-site sexual health interventions have been attempted at CSVs, but attendees' interest in receiving such services is under-investigated. This paper presents results from a 2020 online cross-sectional survey completed by 342 sexual and gender minority individuals who attended CSVs in New York City. Interest in services such as on-site testing for STIs, testing vans near CSVs, and informational referrals was overall high, particularly among younger participants. Among participants who reported being HIV negative, those of younger age and those who were not using PrEP reported being more likely to take an HIV test if it would be offered at CSVs. In open-text survey responses, participants expressed interest in CSVs providing free prevention services such as HIV/STI testing, PEP, PrEP, and STI medications or vaccination, as well as in ways to improve norms surrounding condom use and consent at these venues. Some participants expressed barriers to on-site services such as privacy concerns, preexisting access to health services, an emphasis on personal responsibility, and negative reactions to the presence of service providers. However, some participants also felt that these services could be delivered in a positive, acceptable, and non-judgmental way, especially by involving CSV organizers and attendees in their implementation. Findings from this study can inform future initiatives to develop sexual health interventions at CSVs., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults., Method: Justice-involved young adults (18-24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness., Results: More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated., Conclusions: This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Introduction: Youth aged 13-29 years represent 23% of the population but account for 40% of new HIV diagnoses, with risk peaking at ages 22-23 years. We assessed sexual behaviors, PrEP knowledge and attitudes among patients of 6 School-Based-Health-Centers (SBHCs) located in Northern Manhattan and the Bronx., Method: 667 patients, aged 13-19 years, completed a survey in the SBHCs waiting rooms between 10/2018 - 4/2019 RESULTS: Of the survey respondents attending SBHCs, 32% reported ever having heard of PrEP and, upon learning of PrEP, 67% stated that would be very likely (35%) or somewhat likely (32%) to take PrEP if it was offered to them free of charge., Discussion: Youth of color are disproportionately infected by HIV throughout the US. Efforts are needed to educate adolescents on the benefits of PrEP, SBHCs are well situated to reduce barriers in providing PrEP directly to those who would benefit from its protection.., (Copyright © 2021 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Study Objectives: In a randomized controlled trial, we compared the effect of the Tailored Approach to Sleep Health Education (TASHE) on obstructive sleep apnea (OSA) self-efficacy among community-dwelling blacks in New York City., Methods: Study participants were 194 blacks at high risk for OSA based on the Apnea Risk Evaluation System. TASHE intervention was delivered via a Wi-Fi-enabled tablet, programmed to provide online access to culturally and linguistically tailored information designed to address unique barriers to OSA care among blacks. Blacks in the attention-controlled arm received standard sleep information via the National Sleep Foundation website. Blacks in both arms accessed online sleep information for 2 months. Outcomes (OSA health literacy, self-efficacy, knowledge and beliefs, and sleep hygiene) were assessed at baseline, at 2 months, and at 6 months., Results: We compared outcomes in both arms based on intention-to-treat analysis using adjusted Generalized Linear Mixed Modeling. TASHE exposure significantly increased OSA self-efficacy (OSA outcome expectation [β = .5; 95% CI: .1-.9] and OSA treatment efficacy [β = 0.4; 95% CI: .0-.8]) at 2 months but not at 6 months. Additionally, TASHE exposure improved sleep hygiene at 6 months (β = 6.7; 95% CI: 2.2-11.3) but not at 2 months., Conclusions: Community-dwelling blacks exposed to TASHE materials reported increased OSA self-efficacy compared with standard sleep health education. Stakeholder-engaged, theory-based approaches, as demonstrated in the TASHE intervention, can be used successfully to deliver effective sleep health messages., Clinical Trial Registration: Registry: ClinicalTrials.gov; URL: https://clinicaltrials.gov/ct2/show/NCT02507089; Identifier: NCT02507089., (© 2020 American Academy of Sleep Medicine.)

Background: Justice-involved young adults (JIYA) aged 18-24 are at significant risk for HIV and problematic substance use (SU) but are unlikely to know their HIV status or be linked to HIV or SU treatment and care. Intensive efforts to increase screening and improve linkage to HIV and SU services for JIYA are needed that address youth as well as justice and health/behavioral health system-level barriers., Methods: MoveUp is a four-session intervention that integrates evidence-based protocols to promote HIV and STI testing, HIV and SU behavioral risk reduction and engagement in treatment for JIYA. MoveUp is delivered onsite at an alternative sentencing program (ASP) by HIV testing outreach workers from a youth-focused medical and HIV treatment program. N = 450 youth are randomized following baseline assessment into two groups: MoveUp or standard of care. Youth are followed for 12 months following the intervention; unprotected sexual behavior, substance use, HIV and STI testing as well as treatment linkage will be assessed at 3, 6, 9 and 12-months., Discussion: This study is one of the first to systematically test an integrated screen/testing, prevention intervention and linkage-to-care services program (MoveUp), using evidence-based approaches to address the overlapping HIV/STI and substance use epidemics in JIYA by providing on-site services to identify HIV/STI and SU risk and treatment need within justice-settings as well as linkage to services in the community. This approach, capitalizing on health and justice partnerships, represents an innovation that can capitalize on missed opportunities for engaging JIYA in health care.

The incidence of Hepatitis A virus (HAV) among the general population in the United States has decreased by over 95% since the introduction of HAV vaccination in 1995. However, 10% of all new HAV infections occur among men who have sex with men (MSM). However routine HAV is not part of standard of care for provision of PrEP services. Retrospective cohort analysis of MSM assessed for HIV prevention services between 1/1/2016 and 6/30/2017 to evaluate the rates of screening for anti-HAV seroprevalence and subsequent vaccination. HAV IgG was drawn on 96% (96/100) of the patients with 58% (56/96) of patients demonstrating serologic immunity. Of the 40 patients without evidence of immunity, 77% (29/40) returned for a subsequent visit, 48% (14/29) were provided HAV vaccination, and 29% (4/14) received at least two doses. Only 35% (14/40) of patients without documented immunity received HAV vaccination. Visits for PrEP initiation and monitoring in MSM patients are potential opportunities for ensuring HAV vaccination among this high-risk patient population. Public health agencies could optimize HAV vaccination of the high risk MSM by incorporating HAV screening into national PrEP guidelines.

On May 15, 2018, the Federal Drug Administration amended the approval of preexposure prophylaxis (PrEP) to include minors (>35 kgs). Adolescent providers are now in need of access to a comprehensive education curriculum on the administration of PrEP to adolescents. This paper outlines such a curriculum with the goal of reaching adolescent providers unfamiliar with PrEP assessment, administration, and monitoring. A comprehensive adolescent PrEP curriculum was designed using a literature review. An expert panel of seven reviewed the curriculum for content validity. A pilot implementation of the curriculum was conducted with staff from eight school-based health clinics located in Upper Manhattan and the Bronx. A formal content-validated curriculum was established providing adolescent health care providers with the tools needed to administer PrEP in their clinical setting. Clinical providers can access our curriculum to aid in their administration of PrEP to an adolescent population., (Copyright © 2018 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Over the past decade, new technology and media have changed the way we communicate, access information, and share content with one another. Most 12- to 17-year-olds now own cell phones, and most adolescents and young adults spend several hours per day on computers and cell phones. The American Academy of Pediatrics now encourages all pediatricians to increase their knowledge of new media and technology. This article details technology access among adolescents and young adults, highlights several current and potential innovative applications for new technology and social networking in health promotion, and discusses issues to consider as practitioners move toward integrating new media into clinical and health education settings.

Adolescent and young adult males, especially those who are economically and socially marginalized, need greater access to "male-friendly" health services. Engaging young males in health education and clinical services is challenging but feasible and is of vital importance not only for young men, but also their families, their communities, and the nation. Health and social service providers can play vital roles in promoting the health and well-being of young men by developing mutually respectful collaborations that break down the silos separating medical, educational, juvenile justice, social service, and other systems. We present the interdisciplinary clinic- and community-based initiatives developed by Columbia University Mailman School of Public Health and New York-Presbyterian Hospital that connect young males to clinical and health education services and empower them to choose behaviors that promote their health. We describe our "empowerment approach" to working with young men that recognizes the powerful influence of gender on utilization of health services, emphasizes the importance of a strengths-based perspective, and reframes the context of help seeking from passive participation to active engagement.

GetHealthyHarlem.org is a community website developed on an open-source platform to facilitate collaborative development of health content through participatory action research (PAR) principles. The website was developed to enable the Harlem community to create a shared health and wellness knowledgebase, to enable discourse about local and culturally relevant health information, and to foster social connections between community members and health promotion organizations. The site is gaining active use with more than 9,500 unique site visits in the six months since going live in November, 2008. In ongoing research studies, we are using the website to explore how the PAR model can be applied to the development of a community health website.

Cardiovascular disease (CVD) remains the leading cause of death in the US. Therapeutic lifestyle change (TLC) is an effective intervention to reduce the risk of CVD. In developing a patient-centric electronic health record (PC-EHR), our project aims to build an evidence-based support system to facilitate patient-provider interaction, foster cooperative chronic disease management, and promote adherence to TLC guidelines by both providers and patients. In this paper we report on the findings of a modified Delphi method (MDM) study to determine the behavioral and psychosocial elements needed to extend the clinical data model and support the TLC decision support algorithm. An eight-member expert advisory committee reviewed a list of 83 proposed data elements including those from the National Cholesterol Education Program Adult Treatment Panel III guidelines and finalized a set of 30 data elements for inclusion. The MDM proved to be an effective approach for prioritizing data elements.

WEB 2.0 or the "social web" has created a new paradigm of collaborative information creation, organization and consumption. Among these, the social process of "tagging" has emerged as a bottom-up user-driven method to index content. We describe the use of tags as a way to connect users to resources in an online community that we are developing which utilizes social content creation and collaboration to promote health. Such connections are the basis of a recommendation engine that will suggest users a) other users who have similar health profiles, b) relevant information resources such as articles or blogs on health promotion and c) community resources such as local health facilities.

Consumer health informatics has emerged as a strategy to inform and empower patients for self management of their health. The emergence of and explosion in use of user-generated online media (e.g.,blogs) has created new opportunities to inform and educate people about healthy living. Under a prevention research project, we are developing a website that utilizes social content collaboration mediums in conjunction with open-source technologies to create a community-driven resource that provides users with tailored health information.

We describe the steps taken by the Harlem Health Promotion Center to develop a community-specific health web portal aimed at promoting health and well-being in Harlem. Methods and results that begin with data collection and move onto elucidating requirements for the web portal are discussed. Sentiments of distrust in medical institutions, and the desire for community specific content and resources were among the needs emanating from our data analysis. These findings guided our decision to customize social software designed to foster connections, collaborations, flexibility, and interactivity; an "architecture of participation". While, we maintain that the leveraging of social software may indeed be the way to build healthy communities and support learning and engagement in underserved communities, our conclusion calls for careful thinking, testing and evaluation research to establish best practice models for leveraging these emerging technologies to support health improvements in the community.

Electronic health records have been recognized as essential for improving clinical documentation, coordination, and management of health care in addition to lowering costs and improving patient safety. In recent years, there has been a significant impetus for promoting the adoption of electronic health records, as evidenced by the numerous public and private initiatives across the United States. However, currently available electronic health records have not focused on the unique clinical, psychosocial, and health educational needs and requirements of the adolescent age group. In this chapter we discuss briefly the history, development, and adoption of electronic health records and provide examples of how electronic health records can be extended to focus on the needs of adolescents and those who care for them.

Youth development programs have the potential to positively impact psychosocial growth and maturation in young adults. Several youth development programs are capitalizing on youths' natural gravitation toward technology as well. Research has shown that youth view technology and technologic literacy as positive and empowering, and that youth who master technology have increased self-esteem and better socioeconomic prospects than their counterparts. Technology-centered youth development programs offer a unique opportunity to engage youth, thereby extending their social networks, enhancing their access to information, building their self-esteem, and improving their self-efficacy. This article provides an overview of the intersection between youth development and technology and illustrates the ways technology can be used as a cutting-edge tool for youth development.

Although e-mail has become a popular means of communication among consumers, particularly youth, available evidence suggests that current use of this modality to facilitate communication between consumers and their health providers is relatively modest. Historically, structural and legal issues have provided substantial impediments; however, new developments in providing secure and protected mechanisms for transmitting and delivering e-mail messages may pave the way to enhance use and improve communication.

The purpose of this study is twofold: to evaluate the extent of knowledge possessed by young people residing in an urban sexually transmitted disease (STD) and AIDS epicenter about STDs, including AIDS; and to determine whether knowledge levels varied by age, gender, race/ ethnicity, and/or previous health instruction. A total of 867 adolescents (472 females and 395 males) attending a large public high school in New York City completed a self-administered survey. Levels of knowledge about AIDS transmission and prevention were high (mean percentage correct = 91.8%). Nonetheless, adolescent respondents locked awareness about the prevalence of common STDs, had limited understanding of the ways in which these diseases can be transmitted and prevented, and were unaware of potentially serious sequelae resulting from exposure to infectious agents (e.g., infertility from chlamydial infections). Young people who had taken a health education course in which STDs were discussed did slightly better on the knowledge survey than did their peers. While the prevention of HIV infection is, and should be, a national priority, more concerted efforts are needed to better educate young people about other STDs in the overall context of sexual health.

Estimates of the prevalence of dating violence among adolescents range from 9% to 60%. Teens in all ethnic groups, socioeconomic strata, and geographic regions report involvement. The spectrum of abuse includes verbal, physical, and sexual violence. Young men and women are involved as both victims and perpetrators. Female teens inflict more minor physical injuries than male teens, but are also likely to receive more significant physical injuries and are more likely to be sexually victimized. Contextual (aggressive personalities, acceptance of dating violence, exposure to familial violence) and situational factors (relationship problems, alcohol and drug use, jealousy) contribute to aggressive behavior. Effective prevention, early detection, and treatment strategies require coordinated school, community, legal, and health care provider interventions.

The important roles that culture, race, and poverty play in contributing to health beliefs and health behaviors are reviewed in this chapter. It also outlines strategies for working with young people, their parents, and their communities in order to deliver "culturally effective" health care services, with an emphasis on prevention, health promotion, and risk reduction.

Objectives: To assess the awareness of emergency contraception (EC) among inner-city adolescents attending a general primary health care clinic., Method: 197 patients filled out an anonymous 28-item survey on sexual activity, experience with contraceptives, attitude toward pregnancy, experience with pregnancy, awareness of and intent to use EC., Results: 71% of the sample was sexually experienced; 90% had been active within six months of the clinic visit. While 81% of the sexually experienced segment of the sample had ever used contraceptives, 53% reported having had sex at least once during the past six months without using contraception. Fifty-seven percent "worried" following unprotected intercourse about a potential pregnancy; 32% of the sample had been involved in a pregnancy. Only 30% of the sexually experienced had heard of EC, but more than 87% stated they would use it if the need arose in the future., Conclusions: Urban adolescents are at high risk for unintended pregnancy due to inconsistent contraceptive use and/or method failure. Level of awareness of EC was low in our sample, particularly as compared to adult women in the United States, and to women of all ages (including teenagers) in European countries. Intent to use EC was high, however, indicating a strong desire to avoid unintended pregnancy. Attention should be focused on increasing both adolescent awareness of and access to EC.